Introduction: Schizophrenia and Its Complexities
Schizophrenia is a disorder that causes the patient to experience psychosis, which is a loss of contact with reality. The amount of people who suffer from schizophrenia is estimate to be around 21 million in the world, with 3.6 million being from the US (Comer, 2018. para. 422). It is important to note that a big portion of people with schizophrenia attempt suicide and have higher risks of experiencing fatal illnesses. This leads to a decrease in the life expectancy for people with schizophrenia by ten to twenty years (Comer, 2018. para. 422). For someone to be diagnosed with schizophrenia, he or she needs to show two or more symptoms continuously for one month. The symptoms for this disorder include: hallucinations, disorganized speech, delusions, negative symptoms and bizarre behavior. The symptoms mentioned are called positive symptoms given that they are added to the behavior of the patient. Negative symptoms are defined as the absence of normal behavior such as social withdrawal, poverty of speech and avolition. After the first month of exhibiting the symptoms, the individual must show functional impairment for an additional five months, meaning that the symptoms must be present for at least six months. The DSM 5 states that two one of these symptoms need to be present, but one of those symptoms need to be either hallucinations, disorganized speech or delusions.
Etiological Perspectives: Biological, Psychological, and Sociocultural Views
There are a different number of etiologies that try to explain schizophrenia. The biological perspective argues that schizophrenia can be caused due to genetic factor such as family links. Schizophrenia is more common among family members, where “some people inherit a biological predisposition to schizophrenia and develop this disorder later when they face extreme stress, usually during late adolescence or early adulthood” (Comer, 2018. para. 432). Researchers also found that the average age of onset for schizophrenia is around twenty three for males and twenty eight for women. The biology view also supports the Dopamine Hypothesis. The Dopamine Hypothesis states that there are neurons in the brain that fire dopamine too often, causing the symptoms of schizophrenia. The biological perspective has been the view with the most research support. On the other hand, the psychological perspective argues that family plays a role in schizophrenia. Parents who do not pay the attention necessary to their kids or give them confusing or contradictory messages can lead to schizophrenia. These types of parents are called schizophrenogenic (schizophrenia-causing) parents. This was later found to be a myth since “the majority of people with schizophrenia do not appear to have mothers who fit the schizophrenogenic description” (Comer, 2018. para. 438). Another psychological etiology is the cognitive behavioral perspective. Cognitive-behavioral theorists believe that schizophrenia can be caused due to operant condition in which the individual is rewarded with attention or other type of reinforcement for responding to irrelevant cues instead of socially accepted cues, causing them to have bizarre responses. Additionally, individuals with schizophrenia tend to feel unreal sensations and when the individual asks about these types of sensations, most people will deny them since they never occurred. This causes the individual to believe that everyone else is lying, giving rise to a “ rational path of madness” in which they start to develop their own theories of what is happening. Lastly, the sociocultural view argues that schizophrenia can be caused due to multicultural factors, social labelling and family dysfunction. Multicultural factors takes in consideration the socioeconomic status, genetic and environmental differences. For social labeling, self-fulfilling prophecy can be taken into account. For family dysfunction, hostile treatment and criticism by family members can lead to schizophrenia.
Treatment Approaches: Medication and Therapy
Each perspective has their own treatment to deal with schizophrenia. For the biological perspective, the treatment they use are second-generation antipsychotic drugs. These antipsychotic drugs can be divided into typical and atypical antipsychotics. Typical antipsychotics will block D-2 dopamine receptors. The blocking of these receptors can lead to side effects on other regions of the brain such as involuntary movements and muscle tremors. For the atypical antipsychotics, the treatment is very similar but it decreases the amount of dopamine receptors and increase serotonin and norepinephrine receptors. Atypical antipsychotics helps in decreasing the side effects that typical antipsychotics cause. On the other hand, the psychological perspective tends to ignore these different cues and focuses on normal cues to reinforce normal behavior. Therapists also help patients in change the way they react to their hallucinations. For the sociocultural perspective, treatment can be family therapy in which the therapy addresses issues in the family, provides education about schizophrenia and creates realistic expectation about the patient. Another treatment that can be used is social therapy, which address social and personal conflicts of the patient.
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"Shutter Island": A Cinematic Exploration of Schizophrenia
The movie “Shutter Island” directed by Martin Scorsese, portrays a young man called Andrew Laeddis (Leonardo DiCaprio), a white male around thirty six years old from Hull, Massachusetts, who suffers from schizophrenia. He is a middle-class man, who’s occupation is a US marshal. He married a woman who suffers with bipolar disorder and had three children with her. Andrew served in the army during World War II, which ended up being a traumatic experience for him. One day, his wife decides to drown their three children in a lake near the house and Andrew eventually ends up killing his wife as a result. Due to the death of his wife and kids, Andrew starts hallucinating and believes someone else killed his family. He is later sent to an asylum for the mentally insane.
As mentioned, one of the symptoms of schizophrenia is hallucinations. This is portrayed accurately in the movie since Andrew would experience these hallucinations and no one else would experience these sensations. Andrew believes that everyone else is lying and starts developing this conspiracy in which he is being drugged by the staff of the hospital. Moreover, the age of onset for patients with schizophrenia is around twenty three for men. This is somewhat accurate for the portrayal of Andrew given that he is around thirty years old and has been in the mental institution for around two years. The movie also had accurate portrayals on how his family situation can influence his behavior. One of the etiologies for the sociocultural perspective is family stress, in which conflict and communication difficulties can create a disturbance in the family. These factors can range from unemployment to even death in the family. Andrew experienced this sort of stress since he had to deal with the death of his wife and kids. Another accurate portrayal from the movie is that Andrew may have been experiencing social labelling since he was referred to as the “most dangerous patient in the hospital” leading to a self-fulfilling prophecy. Andrew was given so much attention by the doctors and guards, that they even decided to follow Andrew’s conspiracy as method for treating his mental illness, which could lead to operant conditioning and causing Andrew to experience his schizophrenia even more.
Fact vs. Fiction: Analyzing the Accuracy of "Shutter Island"
Even though Shutter Island made accurate portrayals of schizophrenia, the movie also offered inaccurate representations of such mental illness. First of all, at the end of the movie they psychiatrist explains that the last resort for treating Andrew’s illness is a lobotomy. A lobotomy is a psychosurgery that involves cutting down different connections in the prefrontal lobe by using an ice pick and insert it through the eye with a hammer; the ice pick divides the frontal lobe and the thalamus. Since the movie takes place in 1951, the lobotomy was one of the treatments for mental illnesses. However, the movie makes it seem as if the lobotomy’s function is to erase the patient’s memory. This can be derived by Andrew’s quote “Which would be worse: to live as a monster or to die as a good man?”. This quote means that if Andrew accepts the lobotomy, he will forget what he did and be a “good man” but if he refuses the lobotomy, he will live with the knowledge his wife and kids’ deaths and therefore, live as a “monster”. Even though the use of a lobotomy is somewhat accurate in the film, the side effects are much different “While a small percentage of people supposedly got better or stayed the same, for many people, lobotomy had negative effects on a patient's personality, initiative, inhibitions, empathy and ability to function on their own. The main long-term side effect was mental dullness. People could no longer live independently and lost their personalities” (Lewis, T. 2014). Another inaccurate representation in the film is that the movie did not focus on the other symptoms of schizophrenia. Andrew did show delusions and hallucinations but other symptoms such as social withdrawal, poverty of speech and abnormal motor activity were not present in the film. This stands as a misrepresentation of schizophrenia which makes it seems as if the only symptoms are delusions and hallucinations, but it is far more than that. Another inaccurate representation in the movie is that schizophrenic patients need to be in an asylum for the mentally insane. Throughout the movie, we see different patients interacting with Andrew and they’re all portrayed as if they can’t live a normal functional life. Also, the fact that this mental institution is located on an island, appears to be as if people with mental disorders need to be separated from society and have no contact with the real world. This is proven to be false given that people with this mental disorder are able to live a productive and normal life.
Conclusion: The Multifaceted Nature of Schizophrenia
The movie “Shutter Island” portrayed the disorder authentically in some aspects, but it was also inaccurate with others. The movie depicted very well how people with schizophrenia can’t distinguish the real sensations from those that are not. Contrarily, the movie portrayed very poorly the effects of a lobotomy, considering information given is from a patient’s quote. I think a person with this disorder could relate with the character but it is obvious that the movie shows the incorrect stigma that people with schizophrenia had traumatic experiences. The movie also omitted other symptoms from schizophrenia, leading to misinformation about the mental illness to the viewer. Furthermore, I believe the movie did a good job in portraying how a schizophrenic patient experiences these delusions and hallucinations that even the viewer can’t tell what is real and what’s not until the end of the movie. I would give “Shutter Island” a B when it comes to portraying schizophrenia.
References
- Comer, R. & Comer, J. (2018). Abnormal Psychology (10th Ed). New York: Worth Publishers.
- Lewis, T. (2014, August 29). Lobotomy: Definition, Procedure & History. Retrieved from https://www.livescience.com/42199-lobotomy-definition.html
- The New DSM-5: Schizophrenia Spectrum and Other Psychotic Disorders. (n.d.). Retrieved from https://www.mentalhelp.net/schizophrenia/the-new-dsm-5/
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