Abstract
Over the past two years, I have been given the opportunity to be of service to three young men in our community between the ages of 35 and 45 diagnosed with schizophrenia. A significant part of my assistance is filling out their confidential paperwork, scheduling their appointments with their doctor, psychiatrist, social security office, landlords and any other resources accessible to their recovery process. There is a stigma surrounding people who live with schizophrenia. They are deemed to be crazy because they hear voices, seeing things that are not actually apparent, have thoughts of others wanting to hurt them, their conversation jumps from one thing to another, and their feeling lines up with the way they look (sad, distant, confused). I have gained a passion for working with the mental health population while working with these men. Two of the men have died due to their inability to accept their personal responsibility of continually living with schizophrenia (refusing to take medicine, drug abuse, and prison); however, I get great delight in my continuous endeavors working with Mr. Doe. My paper will give you an overview of the disorder, importance of the assessment process, across systems impact, evidence-based practices for interventions, conclusion, and recommendations.
Overview of Schizophrenia
Schizophrenia is one of the most frightening of mental illnesses. It is a mental condition that often causes the individual to find they are incapable of handling the social world in any reasonable manner. They rarely hold down jobs for any length of time and their personal relationships suffer a great deal as well. In addition, they frighten the “normal” people in society because they are different and more often than not misunderstood. The following paper examines the condition known as schizophrenia. The sections presented are symptoms, causes or links to the disease, treatment, and family. The last section, family, examines how schizophrenia affects family members of someone diagnosed with schizophrenia.
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Symptoms
“Its symptoms include hallucinations, delusions, apathy, and distorted emotional expression. Symptoms usually first appear in adolescence and young adulthood,” though there are apparently forms which have a tendency to hit people in their 20s-30s and sometimes can be short-lived (Bower 164). Most schizophrenics possess a personality which “is seriously disorganized, but not split as is often thought, and contact with reality is usually impaired” (Drury NA). Drury makes note of the film most people are familiar with, “A Beautiful Mind,” which portrays a schizophrenic man who was able to “handle his constant hallucinations and delusions to win a Nobel Prize in physics” (NA). This story, though true, is not necessarily representative of all that schizophrenia is: “While the severity of the illness varies greatly in individuals, most people diagnosed with schizophrenia will usually suffer from one or more of its symptoms. The symptoms that require hospitalization occur during the acute stage and they are delusions, a false belief that cannot be corrected by reason; hallucinations, usually in the form of nonexistent voices; disorganized speech, with frequent derailments or incoherence; and grossly disorganized or catatonic behavior” (Drury NA).
In general “People living with schizophrenia are often robbed of the pleasures in life, and they have less ability to experience feelings. Long-term impairments for people living with schizophrenia include low levels of interest, motivation, emotional arousal, mental activity, social drive and speech” (Drury NA). The social skills they might have possessed prior to schizophrenia begin to dissolve and they find themselves without social skills, losing their jobs, or being expelled from school. “They can be extremely aggressive, or unreasonably silent. But the most common type is intense paranoia” (Drury NA). As such, because they do not necessarily live in the same world of perceptions as most people, from a social perspective, we note that “Schizophrenic patients are prone to saying things that do not always make sense and their intellectual capacity also shows a tendency to decline. The disorder, however, is very individualistic, as no two cases of schizophrenia are exactly the same” and as such the symptoms are not always the same, though paranoia, ridiculous or completely unfounded and unrealistic paranoia, seem to be the most common symptom (Drury NA). As one individual notes, in presenting a picture of such schizophrenic behavior, “The world is against you and the man sitting next to you on the bus just scratched his head, signaling authorities. It is a conspiracy and even the people you once loved are part of it” (Whyte NA). And, while “This may sound like the plot of a movie...for some people living with schizophrenia this is reality” (Whyte NA).
Causes or Links to the Disease
There has been more and more scientific information of late that points to several possibilities in relation to the cause of schizophrenia. For example, recently there has been a great deal of discussion about stress and high blood pressure during a woman’s last trimester of pregnancy. It is believed that certain conditions can raise the chances of a child having schizophrenia by the time they are middle-aged adults. For example, “Pregnant women who take diuretic medication for high blood pressure during the third trimester substantially raise the chances that their unborn children will develop schizophrenia by age 35, according to a new study” (Bower 164).
It is believed that this study, and others like it, give us more information about fetal brain development and thus provide information regarding possible problems later in life. Bower indicates, “Still, the findings provide an intriguing clue in the search for factors that affect fetal-brain development and contribute to schizophrenia (SN: 7/1/00, p. 6), Sorensen's group contends. Other researchers have found that diuretic use after the first trimester of pregnancy lowers a woman's blood volume. If that effect occurs in the fetus as well, it could disrupt brain growth enough to lay the groundwork for schizophrenia, Sorensen, and his coworkers theorize” (164).
In addition, it has been noted for quite some time that schizophrenia runs in the genetics of a family. “Schizophrenia is highly heritable, but the genes have remained elusive. Identifying the genes is essential if the pathogenesis and pathophysiology of schizophrenia are finally to be understood and to give the prospect of more effective treatment” (Harrison; Owen 417) The authors note the following in regards to the discoveries being made relating to genes and schizophrenia: “recent papers describe six additional susceptibility genes. Replications are already being reported for some of them. The genes are biologically plausible and may have convergent effects on glutamatergic and other synapses...Given earlier failures to replicate apparent breakthroughs, the results should be viewed with caution. Unequivocal replications remain the top priority. The respective contributions of each gene, epistatic effects, and functional interactions between the gene products, all need investigation. Confirmation that any of the genes is a true susceptibility gene for schizophrenia could trigger the same rapid therapeutic progress as has occurred recently in Alzheimer's disease.” (Harrison; Owen 417)
There are other rare conditions which can sometimes lead to schizophrenia. For example, one woman suffering from Cushing’s disease became schizophrenic: “35-80 % of patients with Cushing's syndrome develop mental symptoms which they tend to conceal. It is unusual for such patients to present with schizophrenia-like symptoms: only five cases have been reported” (Zielasek et al. 1392). And, it is also noted that “Chronic schizophrenia-like symptoms may dominate the clinical presentation of Cushing's syndrome. Even when longstanding, severe, and unresponsive to neuroleptic treatment, they may improve rapidly after the excess cortisol is reduced,” which indicates that particular forms of medication may increase the likelihood of schizophrenia (Zielasek et al. 1392). In fact, in recent years there have been links to marijuana use and schizophrenia.
Treatment
For the most part, since all cases of schizophrenia are different, there is no one form of treatment. Some people receive psychiatric help and others receive medication. But, in all honesty, most treatments do little to truly help the person who suffers from schizophrenia. And, perhaps most interesting, when speaking of the treatment of the condition, it is a family knowledge that seems to make the biggest difference: “Family psychoeducation interventions have repeatedly demonstrated reductions in illness relapse, negative symptoms, and inpatient service utilization...As a result, a family psychoeducation and support interventions are considered a best practice in the treatment of schizophrenia” (McDonell et al. 91).
Family
As noted in the previous section, a family is an incredibly important element within the life of the individual diagnosed with schizophrenia. But, at the same time being related to an individual with schizophrenia can be an incredibly difficult position. One author notes that “Schizophrenia is the most personally destructive and least understood of the entire major mental illnesses. Its principal hallmark is extremely disordered thinking--the kind that robs many of its victims of the ability to keep a job, maintain a relationship or even holds a coherent conversation” (Gorman; Cole 90). As a result “schizophrenia affects far more than one person at a time. For a look at its extended impact, I visited one family to see how schizophrenia touched its members across four generations and how the family coped with the disease” (Gorman; Cole 90). In many “ways, particularly in their struggle to deal with the stigma and isolation of a mental illness, the Beales of Howard, Ohio, are all too typical” (Gorman; Cole 90).
The man under examination is Ed Beale. He is 65 and “never knew his mother, Emma, a vivacious former schoolteacher with a knack for picking up foreign languages. When she was 30 and Ed was just 7 months old, she was committed to a psychiatric institution with what the family later recognized as schizophrenia” (Gorman; Cole 90). Unfortunately, when Ed was three years old his father informed him that his mother had died shortly after giving birth to Ed. “Although she actually lived until 1973--when Ed was 36--he never met her, heard her voice or kissed her cheek” (Gorman; Cole 90).
Ed’s aunt Virginia said that “His father wanted it to be a secret” (Gorman; Cole 90). His aunt was the one who eventually told him everything about his mother. “For a while, Ed blamed himself for his mother's condition. He wondered if his birth had made her snap, but mostly he tried to banish her from his mind and go on with his life. He joined the Air Force and married his wife Velma” and “they had three children” (Gorman; Cole 90). However, with the fact that schizophrenia can run in families, Ed and his wife’s third child, Peter eventually became a victim of schizophrenia: “A happy, precocious youngster who learned to read in kindergarten, Peter focused less and less on school as he got older. It wasn't until after he joined the Air Force in 1985, however, that his life truly began to deteriorate. Peter remembers sitting next to another student in a training class and telling him about what seemed to him to be a wondrous, novel idea. ‘But then he just looked at me funny,’ Peter recalls. ‘He says to me, ‘You aren't saying anything. You're just making noises’’” (Gorman; Cole 90).
He then started having delusions which clearly interfered with his military duties. “Finally, the Air Force court-martialed him for dereliction of duty, and he was given a less than honorable discharge. Still, neither he nor his parents were ready to accept the idea that he had a mental illness although by then his grandmother's history was no longer a secret” (Gorman; Cole 90).
Over the next few years, things became more and more confusing and stressful. Peter was involved in numerous college courses and several part-time jobs “from which Peter was invariably fired for erratic performance. He moved constantly, and his parents paid his overdue rent more than once to spare him from being evicted” (Gorman; Cole 90). It was in 1990 that another sibling, Peter’s brother James, “confronted his parents and strongly suggested that Peter get a psychiatric evaluation. They were, James recalls, initially indignant--no doubt remembering the horrific treatment Emma Beale had suffered” (Gorman; Cole 90). They finally agreed and he was admitted to a hospital where he was diagnosed as “paranoid schizophrenia with depression” and was given antipsychotic drugs (Gorman; Cole 90).
When he was released he moved back in with his parents and their “vision of a blissful retirement quickly evaporated. They focused all their energy on their son, who enrolled in a day treatment center that provided him with a social outlet as well as some coping skills” (Gorman; Cole 90). Ed also worked on improving Peter’s military discharge so that “he would be eligible for veterans' health benefits and monthly disability payments....After a while, things started looking up. Ed and Velma began to see that Peter's prospects were not as bleak as they had feared” and “They learned to recognize the cyclical nature of schizophrenia; they noticed that Peter would have good days and bad days, and that his ups and downs were not necessarily related to how much medication he was taking” (Gorman; Cole 90).
They became more and more educated about schizophrenia, involving themselves in organizations and mental-health groups. “Today Ed and Velma lead courses teaching other families how to cope when a loved one is found to have a mental illness” (Gorman; Cole 90). Interestingly enough, however, that is not the end of their story and their commitment to Peter. “Peter went on to earn a two-year degree in computer programming. He made friends, started dating, and in May 2000 his son, Dana, was born” (Gorman; Cole 90). However, it became apparent very quickly that “neither Peter nor Dana's mother was able to take care of a child, and Velma and Ed once again stepped in and agreed to raise the boy. ‘One never knows when the next blessing will appear, does one?’ Ed wrote in a Christmas letter that year to his friends and family.” (Gorman; Cole 90)
Because they have chosen not to put their son in an institution and because they have chosen to raise their grandson, they have made a difference in the life of their son and grandson. “Dana is thriving, and though he is at greater risk of developing schizophrenia at some point than a child without an afflicted parent, there is a better than 80% chance that he will not. The Beales have also learned to cast aside the feelings of shame and stigma that are still too often attached to schizophrenia,” a very common problem for those who have a family member with schizophrenia (Gorman; Cole 90). Velma says, “My mother had cancer...I'm not ashamed to talk about that. Why should I be afraid to tell people about mental illness?” (Gorman; Cole 90) Peter’s siblings are also very open about the disease. And for his part, Peter says he has come to terms with the fact that schizophrenia will always be a part of his life. He knows that others can easily take advantage of him and has learned to ask family members for a ‘reality check’ every now and then when he's not sure what an appropriate response might be” (Gorman; Cole 90). He states, “I used to think my goal was to become like I was before the illness...Then I realized that I was older, that I had experienced and learned a lot, even from my illness, and my goal became to discover who I am now and make the best future for myself that I can,” something he could likely not have done without the support of his family (Gorman; Cole 90).
REFERENCE
- The Association of the British Pharmaceutical Industry. “Target Schizophrenia: Psychiatric Approaches.” Retrieved Nov 27, 2017 from http://www.abpi.org.uk/publications/publication_details/targetSchizophrenia/section3.asp
- Bower, B.. “Schizophrenia linked to fetal diuretic exposure (Pressurized Pregnancies). Science News, March 2003, v163 i11, pp. 164(2).
- Drury, Barbara. “Schizophrenia, not a beautiful experience.” The America's Intelligence Wire, December 2002, pp. NA.
- Gorman, Christine; Cole, Wendy. “One Family's Burden: First Ed Beale's mother, then his son developed schizophrenia. How tragedy gave way to love. (Mind & Body).” Time, January 2003, v161 i3, pp. 90+.
- Harrison, Paul J.; Owen, Michael J.. “Genes for schizophrenia? Recent findings and their pathophysiological implications. (Rapid review).” The Lancet, February 2003, v361 i9355, pp. 417.
- McDonell, Michael G.; Short, Robert A.; Berry, Christopher M.; Dyck, Dennis G.. “Burden in schizophrenia caregivers: impact of family psychoeducation and awareness of patient suicidality. (Families and Couple Research).” Family Process, Spring 2003, v42 i1, pp. 91(13).
- Mental Help Net. “Schizophrenia.” Retrieved November 27, 2017 from http://mentalhelp.net/poc/center_index.php?id=7
- “What Will Confirm a Diagnosis of Schizophrenia: Symptoms Suggesting a Diagnosis.” Retrieved November 27, 2017 from:
- http://www.ucdmc.ucdavis.edu/ucdhs/health/a-z/47Schizophrenia/doc47diagnosis.html
- Whyte, Julia. “Fighting the myths about living with schizophrenia.” Asia Africa Intelligence Wire, May 24, 2003, pp. NA.
- Zielasek, Jurgen; Bender, Gwendolyn; Schlesinger, Stefan; Friedl, Peter; Kenn, Werner; Allolio, Bruno; Lauer, Martin. “A woman who gained weight and became schizophrenic. (Case Report).” The Lancet, November 2002 v360 i9343, pp. 1392.
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