Mental health articles

OF mental health care and mentally ill

The nature of schizophrenia

The exact nature of schizophrenia remains hotly disputed. However, the consensus view is that it comprises a number of related disorders characterized by fundamental distortions of thinking and perception. Disturbances in thought processes are usually the most obvious symptom of schizophrenia. Conversations may lack coherence, jumping from topic to topic and idea to idea in an apparently incoherent manner. People with schizophrenia may use neologisms or make bizarre associations between words. They may feel that someone is putting thoughts into their mind and lose track of their conversation or thoughts, perhaps not completing sentences. They may have deluded and sometimes bizarre beliefs about themselves or others. These may include delusions of control (being able to control others or being controlled by others), delusions of grandeur (believing they are rich, famous, talented) and delusions of reference (believing the behaviour of others is directly related to them: glances, looks, laughter, are all seen as being directed at the individual). People with schizophrenia may also experience hallucinations, the most frequent of which are auditory. Their content may vary from benign to persecutory. The emotions that such people experience are often described as fl attened. That is, they experience a general lack of emotional responsiveness, although they may be prone to apparently inappropriate mood states such as anger or depression as a consequence of internal thoughts or hallucinations.

Personal experiences

The experiences of people with schizophrenia vary markedly, as does the degree to which any experiences interfere with their life. Many people experience delusions over long periods without any significant impact on their life; for others, the experience may be much more problematic. Two examples of this may be found in the experiences of Michael and David. Michael was a middle-aged man diagnosed with schizophrenia some years ago who was living a relatively normal life in a small fl at inCardiff. One of his delusional beliefs was that he is being attacked by lasers from an unknown, probably extraterrestrial, source:

The lasers attack me. They aim for my head. I know when they are fi ring because I have pains when they hit me. They don’t fi re at me all the time. They come and go. I don’t know what I have done to have them do this to me. But it’s been going on for years. They usually hit me in the head, so I wear protection against it when they fi re. I wrap metal foil over my head so it refl ects the lasers away  .  .  .  that way they can’t get to me  .  .  .  I think they are aliens that do this  .  .  .  The last time they f i red at me was Sunday morning. They woke me up – the lasers – with my head really hurting. I couldn’t get out of bed because of the pain. I had to wear protection and take my time to get going because of the pain  .  .  .  That was bad. Usually I can stop the lasers with the metal, but it can get through sometimes.

[It is perhaps not coincidental that Michael had spent much of Saturday night drinking beer in a local pub.

A more acute and devastating set of delusional beliefs resulted in David being admitted to hospital as he was running naked down the middle of a city road proclaiming that he was the son of God come to save us from our sins. At the time he was brought into casualty he was proclaiming: I am the messiah! I am David, David, the saviour  .  .  .  I will save you from the sins you have committed that commit you to the heat of the hell not heaven of the Lord my God. You cannot hold me  .  .  .  God is angry with you, the world, the whole round  .  .  .  the devil will take you for your sins of holding me here  .  .  .  the nine that follow will kill you for holding the son of God in your hall  .  .  . I have come to save the world  .  .  .  you cannot hold me  .  .  .  By the writings of Methuselah and the prophets and God and Jesus I am here. God speaks to me! Not you! And he is angry at the wickedness of the world and the work of the people and the things they have done  .  .  .  the sins, things  .  .  .  wings of angels will come for me to take me away from this hall.

About 1 per cent of adults are diagnosed as having some form of schizophrenia (APA 2000). Prevalence rates appear stable across countries, cultures and over time, with onset typically occurring between the ages of 20 and 35 years. On average, women develop the condition three to four years later than men and show a second peak of onset around the menopause. It is an episodic condition with a poor prognosis. Of those people that have one episode, approximately half will experience a signifi cant reduction in symptoms over the next fi ve years. However, only a quarter are likely to maintain good social and vocational functioning, and only an eighth will meet the criteria for full recovery for two years or more (Robinson et al. 2004). Factors associated with a good prognosis include receiving appropriate treatment, an acute onset and short duration of the fi rst episode, the presence of an identifi able stress trigger, a predominance of positive symptoms (see p. 160), good social support, no family history of schizophrenia, and having a job.

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