Schizophrenia
The word schizophrenia conjures images of a nightmare world where strange and twisted realities exist. Schizophrenia is a brain disorder that can be so devastating, and has such a dark history, that its very name can be frightening. But the past several decades have brought increasing hope to patients and their families. Research on schizophrenia is beginning to uncover its causes, and treatments now bring stability to some patients’ lives. Though some people with schizophrenia struggle with the disease throughout their lives, many can manage their condition with treatment and support, and their lives can be relatively independent and productive.
What is Schizophrenia
Schizophrenia, a complex and often disabling mental illness, is among the most serious of brain diseases. Because the term schizophrenia literally means “split mind,” it is often confused with a “split,” or multiple, personality. Schizophrenia, however, is a psychotic disorder that causes severe mental disturbances that disrupt thoughts, speech, and behavior. Despite its devastating effect on people who suffer from it, schizophrenia is difficult to diagnose. There is a broad range of symptoms that a schizophrenic might display, but no unique characteristic symptom. In general, a person with schizophrenia has disordered thinking and may attract attention with his behavior.
For example, someone with schizophrenia might mumble to themselves or dress in a way that is inappropriate for the season, such as wearing a heavy coat in summer. Some schizophrenics show symptoms such as withdrawal, apathy, hallucinations, or delusions. Certain symptoms tend to occur in clusters within a patient. Psychiatrists consider schizophrenia to be a group of related illnesses or a complex illness with subtypes, each characterized by a particular cluster of symptoms. The subtypes include Paranoid, Disorganized, Catatonic, and Residual.
schizophrenics show symptoms such as withdrawal, apathy, hallucinations, or delusions. Certain symptoms tend to occur in clusters within a patient. Psychiatrists consider schizophrenia to be a group of related illnesses or a complex illness with subtypes, each characterized by a particular cluster of symptoms. The subtypes include Paranoid, Disorganized, Catatonic, and Residual.
In addition, some patients are diagnosed with “undifferentiated schizophrenia” because their symptoms do not fall into one of the more common clusters that characterize the other major subtypes. There are no biological tests, such as blood tests, that can diagnose schizophrenia. A patient must be thoroughly evaluated by a psychiatrist, and even then misdiagnoses are common. Several other illnesses, such as bipolar disorder and schizoaffective disorder, have some of the same symptoms as schizophrenia and are sometimes confused with it.
History of schizophrenia
We know that people through the centuries have suffered from schizophrenia. Archaeologists have found writings describing schizophrenic-like behaviors and symptoms from as far back as ancient Egyptian civilization. The earliest account of a mental illness that clearly refers to schizophrenia was written in 1656.
In the late nineteenth century, Emil Kraepelin, a German psychiatrist, first characterized schizophrenia, describing its symptoms and claiming that damage to the brain was its cause. He called it “dementia praecox,” or premature dementia, because he believed that patients suffered a continuous, irreversible mental deterioration starting early in life. Kraepelin’s contemporary Eugen Bleuler disagreed. He felt that patients could show improvement with treatment. He called the disease “schizophrenia,” derived from the Greek words schizo, or “split,” and phrenia, or “mind,” because he believed it was characterized by a split, or mismatch, between different “psychic functions” such as thought and emotion.
Emil Kraepelin, a German psychiatrist, provided the first characterization of schizophrenia, in the late nineteenth century. He believed that the disorder was caused by irreversible physical damage to the brain. National Library of Medicine
He described “the four A’s,” features that he felt defined the illness: lack of affect, or emotion; irrational or disorganized associations; ambivalence in attitudes and feelings; and autism, or retreat into an internal world. Bleuler believed that schizophrenia was not caused by physical damage to the brain but by a psychosocial disturbance.
Kraepelin and Bleuler’s studies of patients with schizophrenia were the first steps toward our current understanding of the disease, but their conclusions led to some misunderstandings more harmful than helpful. Followers of Kraepelin who believed that schizophrenia was progressive and irreversible felt that treatment was fruitless and advocated permanent institutionalization of patients.
Followers of Bleuler’s views, on the other hand, believed that the condition was caused by psychological trauma during the patient’s childhood. Out of this view came the concept of the “schizophrenogenic mother,” or a mother who caused schizophrenia in her child through her style of parenting. By the 1960s and ‘70s, research had shown that neither of these was really true. Contrary to Kraepelin’s claims, schizophrenia does not lead to an inevitable decline but follows a course that includes one or multiple psychotic episodes with periods of relative stability in between.
In fact, symptoms might lessen or even disappear as the patient grows older. Although stress and emotion in the life of a schizophrenic may worsen the severity of symptoms, they are not the underlying cause of the disease, as Bleuler’s followers claimed.
Beginning in the 1970s and continuing through to the present, we have made important advances in our understanding of schizophrenia. Old notions of its causes have been discredited and old treatments have been discarded. One of the earliest “treatments” for schizophrenia in Western medicine was institutionalization.
Eugen Bleuler, a contemporary of Emil Kraepelin, believed that schizophrenia was caused by psychological trauma sustained early in life. National Library of Medicine.
Starting in the late 1600s, the mentally ill were kept in hospitals, not to cure them, but to remove them from society. Often, patients were little more than prisoners in the institutions, and were very poorly treated. In fact, many of the mentally ill were simply thrown in jails. Through the 1700s and 1800s, attitudes did change, along with conditions in the hospitals. The hospitalized mentally ill were cared for much more humanely, and counseling was offered as treatment.
In the 1900s, psychiatrists began to look for ways to alter the functioning of the brain to treat mental illness.
Treatments were developed that were used in hospitals to calm schizophrenics and other patients and reduce the delusions and hallucinations that agitated them. Three commonly practiced methods were insulin shock or insulin coma therapy, electroconvulsive therapy, and lobotomy. Insulin coma therapy involved administering high enough levels of insulin to induce a coma. A shot of glucose would bring patients out of the coma, and, when they awoke, they were left slow and lethargic. In electroconvulsive therapy, the patient’s brain is given repeated sessions of Electrical shock in order to alter brain activity. The altered electrical activity in the brain can change the patient’s emotional state.
Lobotomy surgically disrupts connections between the frontal lobes—parts of the brain critical to thought and emotion. The surgery left patients calmer but could also alter memory, intelligence, and personality. Although these methods sound more like torture than treatment today, there were few alternatives at the time. Despite terrible side effects associated with the treatments—including possible death from insulin coma therapy—these were considered effective ways of helping patients.
In fact, electroconvulsive therapy is still used today and has been found to be effective in treating the most severe forms of major depression.
In the 1950s, psychiatrists began to use drugs to treat schizophrenia. Initially, tranquilizers were used simply to calm and subdue patients. The first medication that actually treated the symptoms of schizophrenia was the antipsychotic drug chlorpromazine, or Thorazine. Thorazine was a revolutionary treatment because patients on the drug could leave the hospital.
—
John Forbes Nash Jr.
Not all we know about schizophrenia is dark and fearful. Even
in the past, when effective treatments were not yet available,
many schizophrenics could live many years of their lives rela-
tively free from the devastating symptoms. As Bleuler pointed
out almost 100 years ago, the course of the disease is not a
one-way downward slide. The story of one of the most famous
people who has suffered from schizophrenia makes that clear
and gives many people hope.
John Forbes Nash Jr. is a brilliant mathematician who won
a Nobel Prize in Economics. You might recognize his name
from the popularity of a movie loosely based on his biogra-
phy, A Beautiful Mind, by Sylvia Nasar. Nash completed his
education, started a career as a professor, and married before
he developed schizophrenia. In 1958, at the age of 30, Nash
developed paranoid delusions that the government was plotting
against him. Against his will, he was committed to McLean hos-
pital in Massachusetts. While in the hospital, Nash was given
antipsychotic medication. After leaving the hospital, he soon
quit taking the medication because of the side effects, and the
paranoid delusions returned. Over the next 12 years, Nash was
in and out of mental hospitals where he was treated with drugs
and insulin coma therapy. He showed temporary improvement
after each hospitalization but always deteriorated again to a
delusional state. During this time, he lost his job, his marriage,
and his home.
In 1974, Nash’s wife took him into her home, near Princeton
University. Because of his reputation and the friendships he had
made before his illness, Nash was allowed to spend his days
wandering around the university, where people left him alone
or ignored his odd behaviors. He lived in his own world within
Princeton, refusing medication but avoiding hospitalization, for
almost two decades.
John Nash pictured at Princeton University. After his
schizophrenia went into remission, he was able to accept his Nobel
Prize and return to work. © Najilah Feanny/Corbis SABA
Then, in the 1990s, Nash began to escape from his halluci-
nations and delusional thinking and his schizophrenia went into
remission. By 1994, he was well enough to travel to Sweden
to accept the Nobel Prize that was awarded for his early work.
In 2001, he remarried his ex-wife and began to make contact
with long-lost family. He took up his work again and restarted
his brilliant career, making new and important contributions to
the field of mathematics.
What accounts for John Nash’s stunning recovery? Nash
himself believes that he reasoned himself out of his illness,
that he overcame his hallucinations and delusions through intellect.
In an interview for a public television program, he
said: “I began arguing with the concept of the voices. And ulti-
mately I began rejecting them and deciding not to listen.” In
his autobiography for the Nobel Prize, he wrote: “[G]radually
I began to intellectually reject some of the delusionally influ-
enced lines of thinking which had been characteristic of my
orientation.” His biographer, Nasar, believes that it was the
support of his family and friends and the tolerance and protec-
tion of the Princeton community that allowed Nash to recover.
She wrote of his time wandering the halls of Princeton, “To
have his delusions seen not just as bizarre and unintelligible,
but as having intrinsic value, was surely one aspect of these
‘lost years’ that paved the way for an eventual remission.”
And interviewed for the same public television program, she
said, “The fact that people did not abandon him, that there
were people who treated him like a human being, made it pos-
sible for him to re-emerge.”
Although it is certainly true that family and community sup-
port can help people with schizophrenia deal better with the
illness, support networks cannot cure the disease. Remission
from schizophrenia is not something that only Nash’s unusual
circumstances at Princeton—or his extraordinary intellectcould
bring about. E. Fuller Torrey, a psychiatrist and renowned
expert on schizophrenia has said, “We know as a general rule,
with exceptions, that as people with schizophrenia age, they
have fewer symptoms, such as delusions and hallucinations.
. . . So that when Nash hits his late forties and fifties, and his
life gets better, it’s not shocking at all. Anyone who follows the
literature would never characterize it as a miracle.” Nash’s
recovery was not yet another astonishing accomplishment of a
remarkable man, but the normal course of his disease, and an
outcome for which all sufferers of schizophrenia may hope.
——
Thorazine does not cure patients, but it does allow them to lead a more normal life that is not controlled by psychotic symptoms. Although it has serious side effects, it was safer and far more helpful than any treatment that had been used before it.
Since the introduction of Thorazine, even more effective drugs have been developed, but still no cure. The best medications improve many symptoms but also have unpleasant side effects. The goal of modern pharmaceutical science is to design drugs that target atypical brain functions and leave all others unaffected. Finding the best treatments for schizophrenia will require a better understanding of its causes.
Heather Barnett Veague, Ph.D.
Heather Barnett Veague attended the University of California, Los Angeles,
and received her Ph.D. in psychology from Harvard University in 2004. She
is the author of several journal articles investigating information processing
and the self in borderline personality disorder. Currently, she is the Director
of Clinical Research for the Laboratory of Adolescent Sciences at Vassar
College. Dr. Veague lives in Stockbridge, Massachusetts, with her husband
and children.
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