Schizophrenia: symptoms, causes, and treatment approaches

Schizophrenia: The Key

Schizophrenia. Perhaps one of the most often-associated images with this word is Russell Crowe's character in A Beautiful Mind; perhaps it is not necessarily the image that is associated with the word, but the feeling, the feeling of realizing that Crowe's character's friends were not real. In other movies that draw similar crowds the audience is often forced to face the realization that a character is not alive, such as the case in The Others, when the audience finds out the protagonists they have come to love are ghosts. But there is nothing that comes close to that feeling of despair when Crowe's character realizes his life is imaginary. It is worse than death because it never was.

This, in a nutshell, is schizophrenia, and because of these overwhelming feelings associated with the disease, it has been historically difficult to define. Gottesman, Shields, and Hanson (1982) call on the World Organization Classification of Mental Disorders for a definition: "schizophrenia involves a fundamental but not pathognomic disturbance of personality, a more or less characteristic disordering of the process of thought, a frequent sense of being controlled by outside forces, bizarre perceptions and delusions, and inappropriate emotions" (pg. 5). But with its clinical terminology, this definition does not do justice to the difficulty that psychologists have had in attempting to understand the disorder over the years, nor does it underline the potential significance that an understanding of schizophrenia may have for many neurological and physical fields. Even the original definition of the disorder, coined by Bleuler in 1911, fails to capture the essence of what schizophrenia really is. Bleuler used four A's -- Affect, Associations, Ambivalence, and Autism -- to describe the disease or its significance. Walters (n.d.) calls the disorder an "enigma," and suggests that understanding the disorder is not only of the utmost significance to those affected, but also that schizophrenia is the key to making sense of "the mechanisms by which the brain filters, prioritizes and processes the relentless current of information available from the richness of its internal, social and natural environments" (para. 1). But, unfortunately, much of what causes schizophrenia, what it is really like to be afflicted with schizophrenia, and methods of treatment are largely unknown. In addition, there are many types of schizophrenics, including paranoid, disorganized, catatonic, undifferentiated, and residual (Walters, n.d.). Schizophrenics must live with many stereotypes that have been applied to them because of a popular misunderstanding of the condition. They are not sufferers of multiple personality disorder, nor is there a "dissociation of personality" among schizophrenics. Still, some assume that they are prone to violent behavior, which they are not, and schizophrenics are discriminated against when it comes to many aspects of social living, such as employment or housing (Walters, n.d.). For this reason, delving into cures for schizophrenic is of the utmost importance. Through an exploration of the symptoms of schizophrenia, possible causes, and treatments, a better understanding of the disorder's massive impact on society can be gleaned.

I. Symptoms

Schizophrenia can be a difficult disease to diagnose not only because symptoms differ so greatly, but also because there are many other disorders that can result in symptoms that appear similar. The different types of schizophrenia yield very different symptoms. For instance, Sitnikova, Goff, and Kuperberg (2009) focus on the disorganized type of schizophrenia when they write that sufferers display "deficits in adaptive goal-directed behavior," in addition to "context-inappropriate commission errors that may appear bizarre and out of place" (pg. 256). This symptom can be one of the most difficult to deal with for family members and friends of schizophrenics. Indeed, Kymalainen and Mamani (2008) discuss the effects of both expressed emotion and communication deviance, suggesting that in harmony, these two problems can predict schizophrenia itself. Expressed emotion (EE) is the degree to which a person associated with a physically or mentally ill patient has a "critical, hostile, or emotionally overinvolved" attitude toward the patient (pg. 85). The authors contend that many people with high levels of EE have difficulty communicating this effectively, so it is quickly associated with communication deviance (CD) or the "degree to which a relative's communication lacks clarity and causes disruptions in the focus of attention" (Kymalainen and Mamani, 2008, pg. 86). Taken together, these issues can predict schizophrenic behavior in others, suggesting that they may have something to do with its cause. Thus, the circumstance regarding schizophrenia may be a circular one, with symptoms of schizophrenia causing EE and CD, and EE and CD associated with schizophrenia.

Another symptom of schizophrenia that may be difficult for the average person to understand is one of the A's that Bleuler identified -- Autism (Walters, n.d.). Indeed Wout et al. (2007) point out that the emotional deficit among schizophrenics is nothing new or unidentified. Schizophrenics traditionally have a difficult time recognizing emotions and processing those emotions. One of the most important and debilitating symptoms associated with this feature of schizophrenia is the inability to recognize emotional clues in facial expressions. Indeed Wout et al. (2007) discuss the fact that this can lead to difficulty functioning in society. Certainly this can lead to both EE and CD, and a misunderstanding of the schizophrenic individual. Further, this circumstance becomes even more complicated when Wout et al.'s (2007) complete findings are shared. The researchers determined that certain types of schizophrenics and certain sexes are more or less likely to identify different kinds of expressions on faces. Thus, understanding just how the schizophrenic processes emotion or the expression of emotion in others can be difficult.

All of these symptoms can be blanketed under one umbrella -- impaired social functioning. Indeed, Shur et al. (2007) suggest that the degree to which schizophrenic sufferers are impaired socially has been known for quite some time. They do not understand how to think and reason in social situations, and have difficulty reading clues from others. Another central problem in schizophrenic's ability to function in society is the lack of empathy they feel toward others. In their 2007 study, Shur et al. found that schizophrenics exhibit a profoundly lower degree of empathy than healthy individuals when both emotional and cognitive empathy is considered. The authors define emotional empathy as the ability to understand and share another person's emotions. Cognitive empathy, on the other hand, is simply the ability to understand another's circumstances. In both areas, schizophrenics were found deficient. This means that schizophrenics, through no fault of their own, simply cannot understand where others are coming from, thus, they cannot sympathize with them and are often seen as cold, unfeeling, and inappropriate in society. Thus, for schizophrenics, daily functioning in society becomes a task unmatched with many that a healthy, functioning individual can understand. The symptoms make schizophrenics prime candidates for ridicule, stereotyping, discrimination, and alienation. For this reason, understanding the causes of schizophrenia, which will lead to its treatment, is of the utmost importance.

II. Treatments

Directly related to its causes, the treatment of schizophrenia is a mixture of chemical and therapeutic treatment. Grohol (2006) lists psychotherapy, medications, and self-help as treatments for the afflicted schizophrenic. He contends that the method for causing a schizophrenic to be able to function in society is a lifelong, regimented, treatment of support, therapy, and medications. The medications are needed to control the psychotic episodes that are most likely the result of improper brain functioning, while therapy, support, and self-help are needed in order to teach the schizophrenic to function appropriately in social situations, such as school or work (para. 2). The PhD warns that if a person should stop medication and discontinue other forms of treatment, relapse is almost inevitable. However, with a steady course of treatment, Grohol (2006) writes that a schizophrenic can "lead a happy and successful life" (para. 2)" with treatment.

That treatment, however, can have drastic side effects. Most remember the effects of the medication on Crowe's life, and how he stopped taking it just because he felt like it was making it difficult for him to be himself. Grohol (2006) writes that this is a common occurrence. Because schizophrenia is treated with a combination of antidepressant drugs, antipsychotic medication, and antianxiety prescriptions, people often stop taking the medication after about a year because they dislike the side effects. Some may feel as if they have been cured, when it is a continual commitment to the medication that achieves these results. "Intolerable side effects" is one major reason that schizophrenics discontinue this medication, according to Grohol (2006, para. 9). The cocktail of drugs recommended for the schizophrenic is a result of the drugs' different functions. For instance, antipsychotic medications are needed to keep hallucinations to a minimum (Grohol, 2006). It is these drugs that have the worst side effects, which range in severity from dry mouth to muscle spasms (Grohol, 2006). Because these drugs are some of the most important, when patients stop taking them, it can be disastrous. Despite the side effects and the difficulty convincing patients to take the drugs, they are, indeed, affective. Kryzhanovskaya et al. (2008) found that Olanzapine was more effective in decreasing the psychosis in adolescents. However this drug, like others, has side effects, including weight increase, which might be problematic in schizophrenic teens tending toward depressing.

In addition to these drugs, another method of treatment for schizophrenics is psychotherapy. Although psychotherapy does not offer a cure of symptoms, like medication, it does offer help to a patient who is trying to live a normal life. Through therapy, schizophrenics can learn the importance of staying on medication, in addition to how to function in a society that may be alien to them. However, just as there are downsides to drugs, there are also downsides to therapy. Smith (2009) points out that therapy is a rather subjective process that does not always fit with the person who is receiving it. Because therapy deals with the subjective question of what is a good life, it often reflects what the therapist thinks is a good life, not necessarily what the schizophrenic or patient receiving treatment considers positive. In this way, it is easy for therapists to influence their patients, in addition to frustrating them, just because of a difference in viewpoints.

Thus, regardless of whether drugs or therapy is used, there is a downside to the treatment of schizophrenia. While treatment can help mask the symptoms of the disorder and help the sufferer live a "normal" life in society, or at least appear normal to others, the question can be asked -- Does it make the schizophrenic happy? Because happiness is, again, relative, the exact nature of this cannot be known. However, what can be gleaned from an understanding of this treatment process is the difficulty that schizophrenia poses for the individual, the person treating that individual, and the society.

I. Conclusions

Understanding the nature of schizophrenia can be either a downcast or hopeful experience. Delving into the minds and plights of schizophrenics can certainly make one downcast, as their situation is quite difficult, and one can certainly sympathize with feeling out of place. Schizophrenics must feel out of place nearly all of the time. However, a journey into the nature, causes, and treatment of schizophrenia can also be a hopeful experience based on the degree of scientific and social evidence that has been applied to the disorder. Although schizophrenics still receive a great deal of criticism and discrimination, a better understanding of schizophrenia has allowed scientists to develop treatments for the symptoms of the disease, and continued scholarship promises not only a better understanding of the disorder and relief for its sufferers, but also a deeper understanding of brain function, the relationship between nature and nurture (or biology and society), and a greater comprehension of the human element in humanity, of what makes humanity human. Thus, further research must be done on the subject of schizophrenia, but science's current achievements are to be lauded.