One of the most disabling mental disorders has the unfortunate circumstance of being one of the least understood. Schizophrenia is a mental illness defined by its symptoms, as genetic or environmental causes have not yet been conclusively found. For this reason, there is a maddening debate over a literally maddening disease: what causes schizophrenia?
Symptoms mirroring those seen in schizophrenics have been documented in literature as far back as 2000 BC, but no definite description of the disease was made until 1893. German psychiatrist Emil Kraepelin made the first step by highlighting the difference between what he called early dementia and manic depression. He believed these early dementias to be diseases of the brain, in contrast to dementias that strike later in life, such as Alzheimer’s.
It wasn’t until 1908 that the term schizophrenia was coined by Eugen Bleuler. He noticed that some patients suffering from the disorder could improve, rather than declining steadily as the case of most dementias. He decided to name the disease after the apparent separation in thinking, personality, memory, and perception. The name comes from Greek roots meaning “split” and “mind,” and has been the source of some confusion.
Schizophrenia is often confused for dissociative identity disorder, better known among the public as split or multiple personalities. A wide range of symptoms and its unpredictable course do not help public recognition and understanding of the disease. Symptoms include auditory hallucinations, disorganized thinking, delusions, catatonic states, and an atypical lack of emotional response to events and people. When asked what schizophrenics might suffer from, a typical response from most people would involve hallucinations or hearing voices telling them to perform certain actions. Frustratingly, not all patients experience these symptoms, and pigeonholing schizophrenia into strict symptomatic categories reflects a poor understanding. How, then, can we describe schizophrenia? Doctor David Braff offered a succinct definition during an interview on the television show, Health Matters:
“Schizophrenia is a fragmentation of consciousness and the inability to navigate effectively in the world and relate to others,” said Braff.
Schizophrenia can be particularly devastating considering that it strikes during adolescence or early adulthood. Patients may not be aware that the symptoms they are experiencing are due to a mental disorder, as one of the hallmarks of the disease, disordered thinking, makes it difficult to function properly. “If you believe there is nothing wrong with you and it’s the outside world, why would you take medication?” Observations from friends or family members regarding strange behaviours, and self-reported symptoms from sufferers often make up the diagnosis. Researchers have not yet found a biological cause for schizophrenia, so tests are run to discount other potential sources of the experienced symptoms before a diagnosis is made.
Having a concrete cause for this debilitating mental disorder would enable researchers to develop targeted treatments. So far, the evidence points towards both genetics and environment as causative agents. This frustrating complication is common with many diseases. Studies between identical twins—useful for determining differences between nature and nurture—have found that a twin has a 50 per cent chance of acquiring schizophrenia if the other twin suffers from it. This perfect middle value suggests that more than just genetics is involved.
A well-known sufferer of the disease—due to the Hollywood movie A Beautiful Mind—is Nobel Prize winning mathematician John Nash. His story is a vivid depiction of how the disorder can derail one’s life:
“What you saw was the erosion of his reality. Nash is unusual in that he seems to have made some recovery without medications, but that was after a very long and devastating period of his life,” said Braff. “The fundamentals of his deterioration are quite accurate for what happens to many schizophrenia patients.”
Other noteworthy sufferers come from all walks of life. Syd Barrett, one of the founding members of Pink Floyd, was a fascinating and, at the same time, depressing case. Early on in the band’s career, he would at times become completely catatonic as the band was performing, simply standing and staring off into space as the rest of the band played. Bandmate Nick Mason described his bizarre behaviour in a past interview:
“Syd went mad on that first American tour in the autumn of 1967. He didn’t know where he was most of the time. I remember he detuned his guitar onstage in Venice, LA, and he just stood there rattling the strings, which was a bit weird, even for us.”
Eventually, his behaviour became so erratic that he had to split from the band, only releasing a few solo albums before becoming a recluse. Other notable schizophrenics include Jack Kerouac, Superbowl-winning football player Lionel Aldridge, and Peter Green, guitarist for Fleetwood Mac.
Politicians and policy makers like to speak in dollar amounts with regard to health problems and their effect on society. Schizophrenia is not a very widespread disorder, affecting about one per cent of people worldwide—so the costs associated with it seem unusually high.
“The total cost to society is probably close to $100 billion. There’s a huge cascading effect on families and other systems. It ranks up there with many cardiovascular diseases or any other serious medical illness,” said Braff.
This bleak portrait is not without hope. Treating schizophrenics with anti-psychotic medications has had moderate success, although prolonged use of these medications can lead to involuntary tics or difficulty with movement, termed dyskinesia. Medications, coupled with cognitive behavioural therapy or psychotherapy, are the recommended course of action for most patients, but there is no magic pill that can stop schizophrenia, and there may never be. Now the focus is on looking at the genetic level for clues on what makes an individual pre-disposed to acquiring the disorder.
“Now we are looking for the genes that are abnormal in schizophrenia and we have found probably between eight and ten major genes and some minor genes that interact to create vulnerability [to schizophrenia],” said Braff.
All things considered, there is still a long way to go. Famous British psychiatrist R.D. Laing can perhaps give us the best understanding of this mysterious and crippling mental disorder:
“Schizophrenia cannot be understood without understanding despair.”
