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Fighting the Imaginary

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Imagine a world where you couldn’t distinguish between fantasy and reality. The person sitting in the chair beside you, whom you thought everyone could see, didn’t really exist. The voice you hear calling your name isn’t heard by anyone else. Schizophrenics live with this frightening uncertainty and in their world and mind, these imaginary objects and people, really do exist. Dr. Carol Anderson, a physician at the University of Pittsburgh Western Psychiatric Institute and Clinic states, “Schizophrenia is this country’s [United States] and, in many ways, the world’s most serious and abiding, yet enigmatic, mental health problem.”

Schizophrenia is a psychological disorder that is characterized by differences in the frontal and temporal lobes of patients with the disorder. The frontal lobes, which are responsible for decision-making, planning, and reasoning, are not as active. The temporal lobes, amygdala, and hippocampus are thought to contribute to schizophrenia’s positive symptoms, which are discussed later. Schizophrenics usually have enlarged brain ventricles and a shortage of brain tissue. This triggers differences in critical thinking (Bernstein, 12). Every day 600,000 people are undergoing treatment for schizophrenia and 100,000 Americans are diagnosed with the disorder each year (Taylor, 115).
Researchers divide symptoms of schizophrenia into positive and negative categories. This does not mean that these symptoms are good or bad, but instead describe symptoms that are added or symptoms that take away previously held personality characteristics. For example, positive symptoms include hallucinations and delusions because they are added to the person’s environment. Before being diagnosed, they hadn’t had these symptoms. A decrease in social abilities is considered a negative symptom because their personality changed. Before, they might have been social and outgoing, but the disorder took away these characteristics. (Bernstein, 112) Withdrawal from one’s family and friends is usually one of the first symptoms to appear and is considered negative. This is followed by a decrease in work and school performance, and eventually the ability to care for oneself (E.B., 1).

Historians believe that the first written documentation of schizophrenia dates back to 12th century B.C., where a recovered Indian text, known as Carka Samita, describes people with symptoms very similar to schizophrenia. Schizophrenia was once referred to as “demence”, which was named by Pinel, a French physician, in 1801. During the same year, an English physician by the name of Haslam described the disorder as “insanity without furious or depressing passion.” In 1845, Griesinger, a German psychiatrist, began to hypothesize that a single disease of the brain accounted for extremely abnormal human behavior. This idea was challenged by Morel and Falret, who stated that a separate disease accounted for a disorder characterized by early onset, decrease in self-care and social withdraw, and a loss of intellectual ability. In 1896, another German psychiatrist, Kraepelin, changed the French name “demence” to “dementia praecox”, which is the current Latin equivalent for schizophrenia. He is most famous for creating a distinction between schizophrenia and “manic-depressive insanity”, which is more commonly known as bi-polar disorder. It wasn’t until 1911 that the term “schizophrenia” would actually be used, which was coined by Swiss psychiatrist Eugen Bleuler (Anderson, Reiss, and Hogarty, 80-81).

Treatment has drastically evolved over the centuries. During the Middle Ages, exorcism was the most common form of treatment. Some exorcisms required the patients to listen to certain types of music, while others involved drilling holes into the patient’s head to release the evil spirits. It is important to remember that all psychological illnesses were viewed and treated as one disorder until the late 19th century. At that time, people with mental illnesses were forced into insane asylums, with harsh conditions and very little chance of recovery. They were often referred to as human zoos and wealthy individuals could even tour the premises for a small fee (Anderson, Reiss, and Hogarty, vii).
In the 1930s, Egus Moniz developed a procedure, known as the lobotomy, which cut the nerve fibers that connected the frontal lobe to the interior of the brain. Emotions are created in this area and this procedure was supposed to reduce agitated and aggressive behavior. This procedure seemed to be effective and hospital patients were often released after the surgery. However, an American neurologist known as John Freeman created his own form of the lobotomy procedure, which would become known as one of the “darkest moments in the history of schizophrenia.” His procedure involved placing an ice pick above the eyeball and hammering the device about an inch into the brain. With this form of lobotomy, patients often died due to epilepsy, surgical infections, and brain damage. Over 40,000 Americans were given lobotomies between 1940 and 1960. As lobotomies were sweeping the nation, a new form of treatment was developing, known as shock therapy. Early shock therapy was very harsh, with high electricity levels and the absence of anesthetic (Harman, 86-88).

Today’s treatments are more humane and produce more positive results. Medications, known as antipsychotic drugs, can be prescribed to reduce symptoms, but they do not cure the patient. A few common antipsychotic drugs used to treat schizophrenics are Thorazine, Risperdal, and Clozaril. Psychotherapy is another widely-used form of treatment, but it used in conjunction with antipsychotic drugs. The goal of this type of therapy is to restore the patient’s social skills, motivate the patient to set goals and become involved in the community, and teach the patient skills needed for everyday life. The patient is constantly reassured, advised, and comforted throughout this entire process. Even after successful therapy, schizophrenics often experience relapses. Studies have shown that family therapy can reduce these outbreaks by educating the family members about the disorder and teaching them to be more understanding and forgiving towards the patient. This creates a healthier environment. These approaches to treatment are far more effective than those in the past, but new antipsychotic drugs and therapy techniques are constantly being developed (Falloon, Boyd, McGill, 12-15).

One of the main questions people ask is what causes schizophrenia? There are a number of theories, such as environmental factors and heredity. The current prevailing theory is that schizophrenia is caused by a mixture of genetics and environmental factors. In psychology, this is known as the nature-nurture concept. Psychiatrist Fuller Torrey believes that schizophrenia is caused by a virus that is present in every individual. Torrey states that, “If you look at the blood of people with schizophrenia, there are too many odd-looking lymphocytes” (Douglas, 58). CAT scans show that schizophrenics also have less brain tissue and larger ventricles. “These convinced me that this is a brain disease, not a psychological problem” (Fox, 58).

Schizophrenia is usually diagnosed for people between the ages of 15 and 25, although symptoms usually become apparent in early childhood. The Elmore twins provide a perfect example. Steven and David are considered identical twins, but they showed differences from the beginning. After birth, Steven had to stay in ICU for a month because of a viral infection. Even after recovering from this infection, he still displayed noticeable differences. He hardly ever cried and he seemed to look at people with blank stares. When learning how to walk, Steven constantly lost balance and fell over objects, unlike his brother. By the time the twins started school, they seemed to have equalized and acted almost exactly the same. However, at age seventeen, differences would again arise, as Steven began hearing voices. These voices teased him, tried to persuade him to go certain places, and yelled at him. Steven would soon be diagnosed with schizophrenia after landing in a psychiatric hospital (Douglas, 58). What causes these tremendous differences? These twins grew up in the same environment and received the same care from family and friends. Torrey believes that Steven’s schizophrenia was caused by the virus he contracted soon after he was born. His idea is gradually changing researchers’, such as those at Johns-Hopkins University, opinions on the causes of schizophrenia.

However, if schizophrenia is only caused from a virus, how can we explain situations where people develop symptoms of schizophrenia after spending large amounts of time around schizophrenics? Mildred Smiley was diagnosed with schizophrenia in 1985 and her condition would influence her daughters’ lives in unbelievable ways. Tina and Susan, Mildred’s daughters, both approached their mother’s condition differently. At age twelve, Susan left home to live with her father and stepmother in order to escape from her mother’s illness. Tina always had a closer relationship to her mother and decided to remain at home. Susan recalls, “I was sure when I left [Tina would} be all right. I was wrong.” (Diedrich, 103) At age 14, Tina attempted suicide by overdosing on her mother’s schizophrenic medication. At Old Orchard hospital, a social worker on staff diagnosed her with a “psychotic condition” due to her fragmented speech and loss of reality. She had displayed no symptoms as a child and didn’t suffer from a virus when she was born. Doctors at the hospital believed that her condition was caused by the environment created by extended amounts of time spent with her mother.

John Nash, a talented mathematician and a Nobel Prize winner, is a well-known schizophrenic, particularly due to the success of his biographical film, A Beautiful Mind. When Nash was about thirty years old, he developed symptoms of schizophrenia. He began to hear voices and underwent a change in emotion and behavior (Harman, xviii). Shortly after the release of A Beautiful Mind, John Nash, his wife, Alicia, and his son, John Charles Nash, were interviewed by Mike Wallace from CBS 60 minutes. The interview was mainly concentrated on the life of John Nash Sr., but near its conclusion, it became focused on Nash’s son. John Nash Jr. also became a mathematician, but this was not the only characteristic that he and his father shared. In 1976, he was diagnosed with paranoid schizophrenia. Research has shown that children whose parent is schizophrenic, have a ten percent chance of also developing the disorder. This example supports the theory that schizophrenia is caused by a genetic defect, with the defected gene being passed down from father to son (Harman, xix).

Are schizophrenics aware of their condition and what is their perception of the disease? In one study, researchers sought to find the answer to this question by interviewing schizophrenics. They were asked questions about their experiences with schizophrenia and their overall understanding of their illness. When asked about the voices she was hearing, one participant stated, “They do silly things and torment me, we argue as well and things like that… they just won’t go and I scream get out get out go away my mind get out go away I throw things and I slam the door things like that.” Many of the participants complained of tormenting voices that they could not escape, but most of them recognized that the voice was in their mind. However, they usually linked the voice to an unknown stranger or someone they had known in real life (Cookson and Dickson, 382).

When asked about their diagnosis, most of the participants never referred to their condition as schizophrenia; instead, they gave their illness terms such as “learning disability” and “intellectual difficulty”. Participants were also asked how schizophrenia had impacted their lives. “My family became scared of me…they did though they came scared of me,” was one response. Another stated, “Well, I feel distressed…I thought I’m never going to get rid of it. If I’ve got that, it’s never going to go away.” (Cookson and Dickson, 385).

Schizophrenia is a life-altering condition. The illness can cause tension and separation from family members and friends, lead to extreme depression and even suicide, and can keep its victims from advancing in their lives and careers. The hallucinations and voices that they see and hear may try to persuade them to harm themselves or others. In their minds, there is a constant battle between reality and a nightmare world of their minds and, most of the time, the imaginary world wins.

Works Cited
Anderson, Carol M., Douglas J. Reiss, and Gerard E. Hogarty. Schizophrenia and the family: a practitioner's guide to psychoeducation and management. New York: Guilford Press, 1986. Print.
Barnes, Arnold. "Race and Hospital Diagnoses of Schizophrenia and Mood Disorders." Social Work 53.1 (2008): 77-83. Academic Search Premier. EBSCO. Web. 23 Sept. 2011
Bernstein, L 2008, 'The Puzzle of Schizophrenia', Current Health 2, 34, 7, p. 12, MasterFILE Premier, EBSCOhost, viewed 23 September 2011.
Cookson, Alex, and Joanne M. Dickson. "The Subjective Experiences of People with an Intellectual Disability and Diagnosis of Schizophrenia Who are Detained in a Medium Secure Unit." Journal of Applied Research in Intellectual Disabilities 23.4 (2010): 379-389. Academic Search Premier. EBSCO. Web. 23 Sept. 2011.
Diedrich, Lisa. "Being the Shadow: Witnessing Schizophrenia." Journal of Medical Humanities 31.2 (2010): 91-109. Academic Search Premier. EBSCO. Web. 23 Sept. 2011.
E.B. "The puzzle of schizophrenia." Medical Update 19.12 (1996): 1. Academic Search Premier. EBSCO. Web. 23 Sept. 2011.
Falloon, Ian R. H., Jeffrey L. Boyd, and Christine W. McGill. Family care of schizophrenia: a problem-solving approach to the treatment of mental illness. New York: Guilford Press, 1984. Print.
Fox, Douglas. "the insanity Virus." Discover 31.5 (2010): 58-64. Academic Search Premier. EBSCO. Web. 23 Sept. 2011
Gale, David. "A Beautiful Mind: A Biography (Book)/ A Beautiful Mind (Motion Picture)/ The Essential John Nash (Book)." Mathematical Intelligencer 24.3 (2002): 75. MasterFILE Premier. EBSCO. Web. 23 Sept. 2011.
Harman, Charles E.The diagnosis and stigma of schizophrenia. Brookings: Old Court Press, 2003. Print.
Taylor, Edward H. "The Biological Basis of Schizophrenia." Social Work 32.2 (1987): 115. MasterFILE Premier. EBSCO. Web. 23 Sept. 2011

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