Bonnie Lane: What is schizophrenia?
One of the most misunderstood and misrepresented mental illnesses is schizophrenia. As this is a thought disorder that usually emerges between the ages of 18 and 25, it’s important for families to have a basic understanding.
People with schizophrenia are often portrayed in the media as violence-prone. More often than not, the criminals in the media are struggling with anti-social behavior or a personality disorder.
Sociopaths and psychopaths are not struggling with schizophrenia, and the misidentification in the media increases stigma and prevents those suffering from accessing help and support. The reality is that people with mental illness are more often the victims than the perpetrators of violence.
Visual and auditory hallucinations are two common symptoms of schizophrenia, but there are several more, classified as “positive” and “negative.”
Positive symptoms can be described as active brain symptoms. In addition to hallucinations, some of them are:
• Disorganized, racing, intrusive thoughts or rumination
• Paranoia, intense feelings of distrust and suspicion
• Delusions, a fixed belief that feels real to the person but is not based in reality
• Grandiosity, a sense of invincibility or excellence in a specific area that isn’t grounded in reality
Negative symptoms represent a lack of behaviors. They include:
• Catatonia, the lack of movement and communication, characterized as waxy- flexibility
• Social anxiety and a lack of social skills
• Flat affect, a reduction or complete absence of emotional expression
• Anhedonia, an inability to feel pleasure
A person with schizophrenia may feel they have a direct connection to God, or that they are a deity. They may hear command hallucinations, telling them to do something that may be destructive to themselves, property or others. They may believe that people walking down the street are talking about them.
I usually advise families to seek a consultation with their primary care physician when they see signs of an emotional, mood or thought disorder, but, in these cases, the affected person should see a psychiatrist immediately or be taken to the emergency room.
Families can also call 911 and request an officer who is trained in mental health de-escalation. Major hospitals, such as Northwestern, offer “first episode” psychosis programs, because when a person gets treated sooner and more quickly, the more stability they can attain.
Where does schizophrenia come from? We know it runs in families, but it doesn’t emerge in everyone who inherits the genetic predisposition. Likely triggers include stress, clinical depression, bipolar disorder and other disorders. There’s evidence that recreational drugs, especially THC, are involved in triggering psychosis, which, left untreated, can evolve into a permanent state like schizophrenia. This makes it even more important to seek early treatment.
You may hear the term “paranoid schizophrenia,” but that is no longer an accepted diagnosis, although most schizophrenic individuals deal with paranoia at some point. Schizophrenia in all of its forms impacts a person’s life completely. Untreated, it leaves someone unable to live a typical life, with a job and social interactions with family, friends and peers. It increases the odds of being unhoused and without community.
Another form is schizoaffective disorder, a mental health condition that combines symptoms of schizophrenia, such as hallucinations and delusions, with mood disorder symptoms like depression or mania.
Many generations of medications are available to treat schizophrenia and schizoaffective disorder, and new drugs are always being developed. That said, everyone metabolizes medications differently, and some of the side effects can be as serious as excessive weight gain, drooling, gastrointestinal problems and flat affect. More meds are then needed to manage the side effects, which often leads to noncompliance.
The most common reaction in adolescents and young adults is that “there’s nothing wrong with me and everyone else has a problem.” The medical term for that is anosognosia, where a person is unaware of their own illness or cognitive decline.
The family may need to get their child help without their cooperation, meaning an involuntary hospitalization for assessment and referral to a long-term treatment team, including a psychiatrist and therapist. There are also many levels of care, from residential to day treatment, to give the individual insight and skills once they are stabilized.
Symptoms of schizophrenia can be noticed in younger children, but it’s never clinically diagnosed until the age of 18. Just because it can’t be diagnosed, however, doesn’t mean it doesn’t exist. Children can also exhibit anger, agitation and delusions and talk about things they see or hear that don’t exist.
Stigma is still the most common reason for families and those suffering to deny care, but education about this illness is helping to slowly change this. We can all do better by sharing the truth about this illness, because only through knowledge can we end stigma and save lives.
There’s no cure for schizophrenia. Proper medication and therapy, however, may allow a young person to finish school, hold a job, have relationships with families and friends, and live the life they deserve.
• Bonnie Lane, M.S., is principal consultant with Family Support Services in Northbrook, specializing in supporting families whose loved ones suffer from severe mental illness or substance addiction. Daily Herald readers can contact her at (847) 651-1554 or bonnielane@thefamilysupportservices.com.