Before going further with reading this article, I want the readers to do a small activity. Look around you, observe the people around you. Various objects that are around you, their colour, their shape, the noises around you etc. Once you have done that, I want the readers to close their eyes and recollect everything that you have observed. Now open your eyes. What if I now tell you that all of this is an illusion. None of this exists, even this article is just an imagination. None of this exists. You would be shocked, right? Have you ever observed while you were out and about, a man walking aimlessly on the road, talking very animatedly to someone but there is no one around him? Have you watched a woman sitting on the steps of a closed, old shop just staring at something almost looking numb? She suddenly starts walking and her walk almost looks robotic. She stumbles and when you try to help her she shrugs you away and says that she’s running away from someone. Both of these individuals may have schizophrenia.
Schizophrenia is a chronic psychotic mental illness characterized by a broad spectrum of cognitive and emotional symptoms including delusions, hallucinations, disorganized speech and behaviour and inappropriate emotions. Movies like 15 Park Avenue by Aparna Sen, Black, Karthik Calling Karthik; Hollywood Movies like A Beautiful Mind, Shutter Island, Black Swan and many more beautifully depict this disorder and its symptoms.
This disorder is a complex syndrome that disrupts a person’s perception, thoughts, thoughts, speech, movement and almost every functioning of daily life. It is characterised by psychosis i.e distortion of reality. Treatment is available and effective for individuals suffering from schizophrenia but a complete recovery is rare.
Psychiatrists: Hello, Jay, do you know why you are here?
Jay: No I don’t. My wife said that I need to go to meet this appointment for the marriage to work
Psychiatrist: and why is that
Jay: She says that she couldn’t see Alisha when she came home the other day. So I asked my mom to tell her that she’s going crazy but even my mom couldn’t see Alisha. I was so pissed at them that day. My wife then said that I need to take my medication. But I know what they are trying to do. There’s no way I will take that poison!
Psychiatrist: And what is it that your wife is trying to do?
Jay: She wants my money and she wants to take our baby, Jenny, away from me. That day I was giving a bath to Jenny but I got so lost in talking to Alisha that I completely forgot about taking her out of the bathtub. You know, we were talking about helping poor people and how it is important we joined together and we even made a plan you know!
Psychiatrist: Did your wife know that you were bathing Jenny?
Jay: Yeah. She knew it. She came into the bathroom yelling at me. It’s been so long, she will fall sick, what are you doing...blah blah blah....she was just screaming. I mean it’s just water. I mean fish live in it! You know me and Uncle would go fishing. He’s dead now (laughs). But it was fun!
Jay is a patient with schizophrenia. He exhibits some of the main symptoms of schizophrenia. Symptoms of schizophrenia are divided into 3 umbrella categories: positive symptoms (symptoms around distorted reality i.e hallucinations and delusions), negative symptoms (deficits in normal behaviour like speech, lack of emotional reactivity, etc) and disorganized symptoms (22esrambling speech, erratic behaviour and inappropriate affect).
1. Positive Symptoms: These are the most obvious signs of psychosis. They include hallucinations and delusions. About 70% of individuals with schizophrenia experience these symptoms.
Hallucinations: The experience of sensory events without any inputs from the environment is called hallucination. This means, hearing, seeing, feeling, smelling or tasting that are not there. Auditory and visual hallucinations are most commonly experienced.
Delusions: Disorder of thought content is known as delusion. These are rigidly held beliefs that are not based on reality or facts. There are multiple types of delusions. Some individuals can have rigid false beliefs that someone is trying to get/kill them, that they are exceptional or famous, someone is trying to broadcast or telecast some information about you etc. when all of these are opposite of the reality.
2. Negative Symptoms: These indicate a lack or absence of some abilities to function normally. Approximately 25% of individuals with schizophrenia experience these symptoms. Some of them include:
Avolition/Apathy: It is the inability to initiate and persist in activities i.e showing little to no interest in daily activities including those like hygiene.
Alogia: This is a relative absence of speech. A person with alogia may respond to questions with singular or very little words and appear disinterested in the conversation.
Anhedonia: It is the presumed lack of pleasure, even in the activities that may be typically considered pleasurable.
Affective flattening: This refers to little to no facial/emotional expressions. This can be looked at as someone wearing a mask.
3. Disorganized Symptoms: These are a variety of erratic behaviours that affect speech, motor behaviour and emotional reactions. Some of these can include disorganized speech where they may jump from topic to topic or are even illogical in their speech. They may show inappropriate affect and disorganized behaviour. They may laugh or cry in inappropriate situations. Sometimes they may even show bizarre behaviours like hoarding or behave inappropriately in public places.
Like most other mental illnesses, one single cause for schizophrenia cannot be identified. Some of the contributing factors for the onset of the disorder can be genetics. Genetics may make an individual vulnerable to schizophrenia but that is not the only factor responsible. Researchers have also identified that some aspects of the environment may play a role in the onset of schizophrenia. Poverty, abuse, loss of a beloved can be some of the environmental factors. Some scientists have also identified some structural problems in the brain that may lead to the onset of schizophrenia. Changes in the levels of dopamine or serotonin may also be one of the factors. Some other causes include complications while pregnancy and birth, stress, drug abuse.
Treatment of the disorder can include the integration of multiple treatment options. Depending upon the severity of the disorder medication may be prescribed and sometimes even hospitalization may be required to manage the symptoms. Antipsychotic drugs are prescribed by a qualified professional to help and reduce the intensity and frequency of psychotic symptoms. These medications tend to have several side effects some of which may subside over time but some may persist. Hence, medical professionals advise psychosocial interventions too. These can be in the form of individual therapy, social skills training, vocational rehabilitation, etc.
Conclusion:
Schizophrenia doesn’t just affect the individual but also takes a toll on the family, emotionally and economically. Despite advancements in science and medicines, although symptoms might be managed, complete recovery is quite rare. Hence, there is a chance of psychosis that may require hospitalization in some cases which may be extremely expensive. Moreover, society also tends to stigmatize individuals with schizophrenia. They can be ostracised by their families and society as a whole. People devalue them by calling them “crazy” or “psychos”. About 3 out of 1000 people in India tend to have schizophrenia and globally more than 20 million people are affected by it. It is also more prevalent in men than in women. Although prevention of the disorder is not possible entirely, those children with higher risk can be identified and treated. Besides this, several organizations are working for the treatment and rehabilitation of schizophrenia at a global and national level. With talks around mental illness increasing and even appropriate depiction in popular media, awareness about the disorder is increasing. We have a long way to go as a society for us to help those suffering from the disorder, we can certainly benefit from individual readings and research. Compassion, awareness and empathy are always beneficial. Early intervention by family members of an individual who may be showing signs and symptoms of the disorder can be extremely essential to the health of the person.
References:
Barlow, D. H., Durand, V. M., Lalumiere, M. L., & Hofmann, S. G. (2021). Abnormal psychology: an integrative approach. Nelson Education Ltd.
Mayo Foundation for Medical Education and Research. (2020, January 7). Schizophrenia. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/schizophrenia/diagnosis-treatment/drc-20354449.
U.S. Department of Health and Human Services. Schizophrenia. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml#part_145430.
Loganathan, S., & Murthy, R. S. (2011, November). Living with schizophrenia in India: gender perspectives. Transcultural psychiatry. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3233233/#:~:text=In%20India%2C%20where%20about%201.1,women%20when%20they%20develop%20schizophrenia.
World Health Organization. Schizophrenia. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/schizophrenia.
This article on 'Schizophrenia' has been contributed by Smruti Pusalkar, who is a graduate Psychology student from Fergusson College. She is part of the Global Internship Research Program (GIRP), which is under the leadership and guidance of Anil Thomas. GIRP is an Umang Foundation Trust initiative to encourage young adults across our globe to showcase their research skills in psychology and to present it in creative content expression.
Smruti wishes to develop herself to be a more patient listener and a sharp observer to understand the happenings of the world and grow increasingly empathetic. She is passionate about mental health and well being and plans to pursue a career in this field. She is extremely curious about psychology and wants to spread awareness about mental health problems to help those in need.
Anil is an internationally certified NLP Master Practitioner and Gestalt Therapist. He has conducted NLP Training in Mumbai, and across 6 other countries. The NLP practitioner course is conducted twice every year. To get your NLP certification