“There are things that tend to moderate with age. Schizophrenia is somewhat like that. “- John Nash
Schizophrenia is a disorder that is often pointed out in the realm of psychology as one that is extremely complex. Today, we’d like to discuss the disorder in depth to simplify the skewed perception it often garners. Most people tend to think that individuals having schizophrenia frequently display violent behavior. We’d like to say that very often, this isn’t the case. Those suffering from this disorder tend to withdraw into a world of their own, owing to the sensory distortions caused by it. People also tend to generalize by saying that most individuals suffering from the disorder live in hospitals. This is not the case. Most victims of this crippling condition require nourishment and care just like all of us, and may live with family, or in group homes. John Nash, a mathematician who is know to have suffered from the disease, claimed that the disorder mellows with age with respect to the displayed symptoms. In cases like these, an individual could even be fully capable of leading an independent life!
A chronic disorder, Schizophrenia affects about one percent of the population. Its causality is linked mainly to genetic factors. However, extreme cases of viral infection are also linked to an onset of the disease. Men and women are equally susceptible to the disorder, but research has shown that the disease tends to have an earlier onset in males. In very rare cases, it may be observed in young children and adolescents. Earlier on, schizophrenia was considered as a single disorder which was divided into subtypes. However, that system was changed recently to involve a spectrum. Schizophrenia is the highest point on this spectrum, and is diagnosed according to the characteristics present in the subtypes. The other disorders on the spectrum (Schizophreniform and Schizoaffective disorder) have extremely similar symptoms, but the duration for which these are experienced is far different.
The Positive Symptoms for Schizophrenia include hallucinations (auditory and visual), hearing voices, delusions (feeling that people are out to get you), and exaggerated beliefs. This distortion of sensory perception and belief systems leads to a flat affect, and a decline in social competency. These symptoms may be accompanied by repetitive speech, trouble with logical thinking, and in some cases, odd movements of the limbs. The disorder also has an effect on cognition and may impair concentration and memory to some extent. At least 2 of these symptoms shown over a period of 6 months go to show the presence of a concrete diagnosis for Schizophrenia.
Depending on the intensity and nature of the symptoms, Schizophrenia is divided into five main subtypes:
- Paranoid Schizophrenia: This is the most common subtype. The notion of ‘paranoia’ and thoughts about persecution are common in this subtype. Auditory hallucinations may be frequent. For example, one might think that people sitting in a restaurant are plotting to kill them. The delusions generally revolve around a fixed theme.
- Disorganized Schizophrenia: This subtype is characterized by a severe disorganization of thought processes and cognition. Emotional stability may be hampered, leading the individual to be unable to respond appropriately in social settings, or conduct activities of daily living. Hallucinations are pronounced, and speech can become virtually incomprehensible.
- Catatonic Schizophrenia: This subtype is characterized by disorganization in movement. ‘Waxy flexibility’ is something that is often displayed. This is when the individual may resist moving their orientation from a certain position or pose, and may remain still for extended periods of time. This subtype may also be characterized by contorted facial expressions and movement of the limbs.
- Undifferentiated Schizophrenia: This subtype is assigned to a diagnosis when the symptoms fluctuate between those of varied types of schizophrenia, leaving insufficient evidence to classify it into any one of them.
- Residual Schizophrenia: This subtype is assigned to a diagnosis when there are no significant instances of the symptoms of the disorder. In this case, the severity of symptoms would be considerably reduced, possibly allowing the individual to slowly integrate themselves into the daily grind. This could probably be analogous to the ‘mellowing’ effect that Nash spoke of.
High-functioning schizophrenia is another observed phenomenon that some individuals experience. The auditory and visual hallucinations persist, sometimes accompanied by delusions. However, when experienced in controlled amounts or when alleviated by medication, individuals are often able to do things like go to university and handle a course load, or simple things like grocery shopping. This doesn’t mean, however, that they never feel compromised. There may be transient periods in which symptoms are felt at a heightened rate, causing them to feel an inability to interact socially or go to work.
Treatment for those on the spectrum is fueled by positivity and hope, which often form the pillars of recovery. The rehabilitation plans prescribed often revolve around integration into daily activities. Psychosocial Rehabilitation programs involve in depth guidance to help re-familiarize individuals with activities of daily life such as cooking, cleaning, grocery shopping and socializing. Self-help groups that are guided by individuals suffering from similar conditions inspire those struggling to cope to put their best foot forward. Talk therapy in a family setting may help raise awareness and sensitivity about the effects of the disorder itself. Assisted employment programs are another common facet of rehabilitation, and help familiarize individuals with the tenets of professional behavior. These implements may even involve assistance to complete educational and vocational training to achieve one’s goals!
It was earlier believed that talk therapies were counterproductive to improving the symptoms of psychosis. However, studies in recent times by scholars such as Jolley and Morrison have proven that Beck’s Cognitive Behavioral Therapy for Psychosis, which focuses on the behaviors that lead to the maintenance of symptoms, and the beliefs that lead to delusions, can be effective in dealing with schizophrenia. The physical and motor symptoms or catatonia associated with Schizophrenia is often alleviated using Electroconvulsive Therapy. This method is regarded as one of the quickest ways to relieve the catatonic symptoms.
While schizophrenia doesn’t have a sure-shot cure, there are several ways to balance the symptoms faced by an individual to help them normalize their experience. Determination and a strong sense of hope often help these individuals break through and re-integrate themselves into the daily grind!
An undergraduate in Psychology, Shantanu is an aspiring Educational Psychologist who will be pursuing his Master’s in 2018 at the Ohio State University. He is adept with psychometric and statistical research, and has honed his grasp over psychology through a 4 year undergraduate course in Liberal Education at FLAME University, Pune.