Schizophrenia as a Mental Illness

What is schizophrenia? The often-misjudged mental illness known as schizophrenia is defined as a long-term mental disorder involving the breakdown in the relation between thought, emotion and behavior leading to faulty perception, inappropriate actions, withdrawal from reality into delusions and hallucinations and a sense of mental fragmentation. The word schizophrenia originates from the Greek word schizo meaning to split, to describe disjointed thinking and behavior. A common misunderstanding from the public is believed to associate this definition with the idea of a split personality disorder, or as medical terminology classifies it, dissociative identity disorder. Since the definition of schizophrenia has continuedly changed over time, scientists and psychologists have now tried to more accurately define the different types of mental illness.

In Greek and Roman mythology, mental illness was thought of as a punishment bestowed from the gods. In the middles ages however, religion and medieval asylums and even some monasteries renovated themselves into treatment centers for the mentally ill. Early in the Renaissance period, burning of people suffering from mental illness occurred based on the belief that a demonic possession was among them. During the mid 1600’s and late 1700’s in Europe is where we see a more humane approach to mental illness. John Locke and Denis Diderot disputed prior beliefs and argued that reason and emotions are caused only by sensations. A breakthrough in psychology by a physician named Phillipe Pinel, began viewing mental illness as the leading effect of social and psychological stressors. Shortly after, the first institution for humane care with those suffering from mental illness was established in England.

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In 1911, a Swiss psychiatrist named Eugen Bleuler coined the term schizophrenia, meaning split mind, replacing the years of prior stigma. His schizophrenia involved the understanding of a group of illnesses rather than a state of dementia that was associated with this disease years before. Bleuler created his four A’s, as he believed schizophrenia had four main symptoms: blunted Affect- a flat emotional response and personality, loosening in Associations and disorganized thoughts, Ambivalence, or having trouble making decisions, and Autism, meaning loss of awareness to external events and anxiety within one’s individual thoughts.

Examples of treatments of what in today’s society would be documented as mental illness go back thousands of years. People used to drill holes in the skulls of those mentally ill, along with exorcisms to allow “evil spirits” to exit the body. The Greeks and Romans believed that mental illness was a sign of an imbalance in the blood causing madness. Treatment included a change of lifestyle, purging, and even draining of the blood through incisions.

As many years passed, different approaches were taken to treat the mentally ill. In the early 1900’s, shock therapy was sought to be a big breakthrough. However, shock therapy often put people into comas, risking these people of further impairment. Developed in the 1930’s were popular treatments of schizophrenics known as lobotomies. This procedure involved drilling into the skull and injecting into the frontal lobe. This was thought to almost “rewire” the brain. Again, these procedures often led to further harm of these people, causing comas and impairments of social and cognitive function. Starting in the 1950’s, antipsychotic drugs were used to treat schizophrenia. Antipsychotics often lead people to have functional lives, however, they have their downsides. Common side-effects often include tiredness, significant weight loss or gain, low blood pressure and lowered sex drive. These drugs are not a cure by any means, but many patients live functional lives while on them consistently.

The media teaches us about people whom we do not regularly interact with. This constant stream of information often gives a misperception of the nature of other groups of people. Media depiction of those with mental illness often scare us away because of the stigmatization they bring upon them. T.V., film, and social media have all been criticized for bringing upon negative stereotypes of those with mental health problems. It is true that some people with mental illness commit violent actions and crimes, however, so do people without mental illnesses. It is of high important that as a society, we need to give timely aid to these people. It is also important that the negative stereotypes placed on those with mental illness, especially schizophrenia, needs to be heavily reduced.

There are many illustrations of schizophrenia in film. A depiction that is somewhat accurate in film, is the 2001 movie, “A Beautiful Mind”. I urge anyone who is interested in learning more about schizophrenia to watch this film as it made myself extremely curious to find out more about this form mental illness. The movie is based on the life of an incredible mathematician and college professor named John Nash, who dealt with schizophrenia throughout his life. The movie creates a timeline of his life that begins when he studied mathematics at Princeton University. This is where the early symptoms of schizophrenia develop. It continues into the later parts of his life when he becomes a professor and even wins a Nobel Prize while dealing with his illness. As the movie progresses, so does his disability which worsens by his “so-called” involvement with the military working as an undercover spy.

The first time the audience is introduced to his developing schizophrenia is when he begins graduate school. While doing his work in his one-person dorm room, he looks behind him and meets his roommate, Charles. Although the movie may not be entirely accurate since schizophrenics normally have auditory hallucinations rather than visually, like portrayed in the movie, it does help paint an accurate illustration of schizophrenia. The movie follows valid symptoms of schizophrenia including disorganized speech, a flat affect and delusions. Although the scenes may not always appropriately portray what specifically happens to John Nash, they still depict facts about schizophrenia. The movie even incorporates the correct science that was recognized in the mid 1900’s that further helps the audience to understand what was known about this long-lived disorder.

According the National Institute of Mental Health, schizophrenia affects nearly .5 percent of the world. It is more common in men, specifically Caucasian men. It typically starts around the early 20’s and as late as the early 30’s in women. Symptoms include disorganized speech, hallucinations, delusions, catatonic behavior, and a flat affect.

Examined closely was a small study about the misdiagnosis and overdiagnosis of this disorder. In a small study, researchers found that about half of the referred Johns Hopkins Early Psychosis Intervention Clinic, didn’t actually have the disorder. The specialized clinic was designed to give second opinions to reduce the risk of misdiagnosis and ensure proper treatment. “It’s a problem for those who are not schizophrenia specialists because symptoms can be complex and misleading”, says Krista Baker, manager of adult outpatient schizophrenia services at Johns Hopkins Medicine. “Diagnostic errors can be devastating for people, particularly the wrong diagnosis of a mental disorder,” she adds.

The study came to be after health providers in Baker’s specialty clinic began to see a good number of people who were misdiagnosed. It was said that these people often had anxiety disorders and depression. To see if there was a trend, the researchers looked at 78 cases of patient data. Patients were around the ages of 20 and almost 70 percent were men. Seventy-four percent were white, 12 percent were African American, and 14 percent were another ethnicity. Each consultation was around three to four hours long and involved patient interviews, parent interviews, physical exams, questionnaires, and looks at previous medical history.

Of the people referred to the clinic, 54 people went into it with a pre-diagnosis of schizophrenia. Following the consultation, of that 54, only 26 received confirmation of their schizophrenic disorder. Over fifty percent of the entire patients at the clinic who were given a prior diagnosis of schizophrenia were diagnosed with either an anxiety or mood disorder. One of the more common symptoms that the researchers believed was the notion of hearing voices. At times when someone is “hearing voices”, it may be a general statement of distress rather than the literal case. The point is that “hearing voices” doesn’t necessarily mean you have schizophrenia.

“The big take-home message from our study is that careful consultative services by experts are important and likely underutilized in psychiatry,” says Russell Margolis, clinical director of the Johns Hopkins Schizophrenia Center at the Johns Hopkins School of Medicine. “Just as a primary care clinician would refer a patient with possible cancer to an oncologist or a patient with possible heart disease to a cardiologist, it’s important for general mental health practitioners to get a second opinion from a specialty clinic like ours. This may minimalize the possibility that a symptom will be missed or overinterpreted.” Even though this was only one study, it would agree with Johns Hopkins’ prior belief that this may be a national ongoing issue.