Riverview Psychiatric Center

Psychology Articles by Dr. Arthur Dingley - Living With Schizophrenia

Dr. Art Dingley

Let me begin by pointing out that schizophrenia has nothing whatsoever to do with having a “split personality”, whatever that is. Schizophrenia is a psychotic disorder in which thoughts, speech, behavior, and perception may become disorganized.

A person with schizophrenia may use words incorrectly, invent words, or put words together in ways others can’t understand. Behavior may become disorganized as well. A person with schizophrenia may dress in layers of heavy wool clothing in summer, or go barefoot in winter. He may avoid all human contact, hoard useless items, become agitated or even violent. A person with schizophrenia may have ideas which are plainly incorrect, yet remain unable to change these ideas when he sees evidence to the contrary. These fixed ideas are called delusions. Examples include ideas that one is being filmed with cameras everywhere she goes, that people are entering her home or apartment and removing things or leaving evil items, that her blood is contaminated, that “transceivers” have been implanted in her brain, or that all her internal organs have been removed. Schizophrenia may distort the senses. These experiences are called hallucinations. People with schizophrenia often hear sounds, particularly voices, that others around them do not hear. They may see things that others do not, or they may report that things “don’t look right”.

In addition to these more dramatic disturbances of thought and behavior, schizophrenia may leave the person lethargic and unmotivated. Thoughts and speech may slow down to a snail’s pace. Observable emotion (affect) may “flatten” until the person’s face becomes expressionless. The person may appear depressed but deny feeling sad. Schizophrenia is distinguished from other psychotic illnesses, in part, by its duration. The symptoms must persist for six months to warrant a diagnosis. Although the disease may remit after six months, it is usually life-long.

Schizophrenia is a very serous illness because it leaves a person vulnerable to all sorts of difficulties such as unemployment, homelessness, social isolation, chronic medical illness, and substance abuse. The rates of suicide, alcoholism, and tobacco addiction in people with schizophrenia are many times higher than in the general population. Rates of serious medical conditions, such as heart disease and diabetes, are higher in folks with schizophrenia.

Although we have much to learn, a good deal is known about this disease. It most often strikes in the second and third decades of life, the teen and young adult years. Often the onset is gradual and easily confused with the more harmless oppositional and idiosyncratic features of adolescence. Healthy teens may lack motivation, clam up, dress in weird clothes, or appear fascinated with the supernatural, the spiritual, or the occult. However, kids who are evolving a major mental illness become isolated from friends and groups. They are not joining a spiritual movement or dressing like other people they admire – they are simply odd.

Only about one percent of the population has schizophrenia. Men and women are affected equally often, but women may have later onset and tend to have a more benign form of the disease. There is a clear genetic component, but schizophrenia is not simply “inherited”. Identical twins have the same genetic makeup, yet, if one twin has schizophrenia, the other twin has less than a fifty-percent chance of developing the illness.

There are some things which make schizophrenia worse. Many people with schizophrenia refuse medicine, whether for their mental illness or other conditions. This makes the disease hugely worse. People with schizophrenia may abuse alcohol or drugs. This increases their confusion and may result in anxiety and depression, while contributing to homelessness and unemployment. Rejection, or loss, of “natural supports” like family, friends, work, and church result in a much greater degree of disability.

What is the treatment for schizophrenia? Individuals affected by this illness need many kinds of assistance. Adequate housing is crucial. The homeless mentally ill are often victimized. Well-trained social workers, who meet with their clients weekly, provide invaluable assistance navigating the maze of services. A person with schizophrenia may be too confused or frightened or lethargic to locate available help on her own. Supportive family members are the strongest source of help for people with mental illness. Severely mentally ill people without close family ties are at a big disadvantage. Regular paid employment is extremely important on the road to recovery from severe mental illness. Work has an organizing and uplifting power that is the equal of any other treatment we have. Medicines for schizophrenia work to reduce hallucinations and disorganized thinking by blocking a chemical in the nervous system called dopamine. There are many such medicines available. Beyond the fact that each of them blocks dopamine, their characteristics vary widely. As in the treatment of any disease, the goal is to select a particular medicine which will address a particular patient’s symptoms, not interact with other medicines, and not aggravate other illnesses. These medicines are very effective for many of the symptoms of schizophrenia, but the medicines must be taken consistently. This is difficult for people with severe mental illness. It is uncommon for people with schizophrenia to take medicine consistently for more than a year. When the medicine is discontinued, the illness flares up and disorganization increases. Sometimes, the person needs hospital care to get back on medicine and re-oriented to reality. There has been a lot of blather in the “news” about the side effects of some medicines for schizophrenia. This has generated a lot of heat and smoke, but not much light. The mortality from schizophrenia, particularly suicide, far exceeds mortality from many infections and many cancers, yet we aren’t bombarded by “news” stories on the potential side effects of antibiotics and anticancer drugs.

Even though schizophrenia is a serious persistent illness, there is an excellent chance for recovery by taking medicine consistently, securing safe affordable housing, staying away from drugs and alcohol, paying attention to diet and exercise, looking to family and friends for support, avoiding stress, and locating at least part-time employment. In fact, people with schizophrenia, using this approach to managing their illness, have been able to use their unique thoughts and perceptions to produce great works of art, music, and literature.

Dr. Art Dingley is a psychiatrist at Evergreen Behavioral Services in Farmington. He may be contacted at adingley@fchn.org

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Psychology Articles by Dr. Arthur Dingley - Living With Schizophrenia

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