In This Chapter
Differentiating between what schizophrenia is and isn’t
Understanding the nature of people with schizophrenia
Exploding the myths and misperceptions about the disorder and its treatment
Schizophrenia is one of the most feared, misunderstood, and stigmatized disorders because myths and misperceptions abound about the diagnosis, its symptoms, and its treatment. Although there still is no cure, schizophrenia is an eminently treatable and manageable, no-fault disorder of the brain.
In this chapter, we dispel some of the myths that get in the way of effective treatment and that impede public acceptance and understanding of people with the disorder.
Myth 1: Schizophrenia Isn’t a Brain Disorder
Many people think that someone with schizophrenia is simply “acting crazy” and could behave normally if she wanted to. Nothing could be further from the truth.
Experts generally agree that schizophrenia is a no-fault neurobiological illness involving chemical imbalances in the brain and/or brain abnormalities that affect people in different ways. Symptoms of the disorder can include changes in feelings, perceptions, thinking, and behavior that are rooted in biology. Want proof? The growing body of evidence includes
Measures of brain electrophysiology (as measured by EEG-type equipment) showing differences in people with schizophrenia
MRIs of the brain structure showing enlarged ventricles and white matter damage in people with schizophrenia
Functional MRIs showing malfunction in the frontal lobes as well as certain other areas of the brain in people with schizophrenia
What’s still missing at this time is the ability to identify the specific chemical imbalance or brain abnormality that occurs in any individual diagnosed with schizophrenia. (This would be the equivalent of a lab test like the one that confirms a diagnosis of strep throat.)
It’s quite possible that symptoms of schizophrenia are manifest in different ways for different people — just like one person can suffer a heart attack and experience chest pain, and another person suffering a heart attack may have pain in his arm or jaw, but not in his chest. In fact, scientists may eventually find that, like cancer or diabetes, there’s more than one type of schizophrenia.
Myth 2: A Person with Schizophrenia Has a “Split Personality”
Schizophrenia is not a split personality.
Because the word schizophrenia is derived from the combined Greek terms schizein (meaning “to split”) and phren (referring to the mind), people have long come to the erroneous conclusion that schizophrenia means “split personality.”
For more than a century, stories about people with split or multiple personalities appeared in different forms throughout popular culture, capturing the imagination not only of authors and screenwriters but also of their audiences:
Most students have read Robert Louis Stevenson’s tale of The Strange Case of Dr. Jekyll and Mr. Hyde, in which both good and evil personalities are embodied in a single man.
Supposedly based on a true story, The Three Faces of Eve was an Academy Award-winning movie portrayal of the life of Chris Costner-Sizemore, who was diagnosed with multiple personalities by her psychiatrists in the 1950s after witnessing two deaths and a terrible accident as a child. (Later, the psychiatrists involved in the case are said to have recanted the diagnosis.)
Although these stories and others like them are fascinating and entertaining, they’ve only increased the public’s confusion when it comes to schizophrenia. In fact, almost two-thirds of people surveyed by the Harris Organization in the late 1990s still believed that schizophrenia was associated with a split personality. In a more recent online survey examining the mental-health literacy of university students, nearly two-thirds of them thought that a “split personality” was one of the main symptoms of schizophrenia.
The closest Diagnostic and Statistical Manual (DSM) of Mental Disorders diagnosis resembling the stereotypic split or multiple personality is dissociative identity disorder, a relatively rare and controversial diagnosis, the symptoms of which are distinct from those of schizophrenia. Making the diagnosis requires that at least two personalities routinely take control of the individual’s behavior with memory loss that goes beyond normal forgetfulness. (This cannot be due to substance abuse or medical causes.)
People with schizophrenia have only one personality, but they have problems distinguishing what is real from what is not. So, if there is any split associated with schizophrenia, it is the disconnect between (a) an individual’s thoughts, behaviors, and emotions, and (b) what we call reality.
Myth 3: Schizophrenia Is Caused by Bad Parenting
Schizophrenia is a biological disease of the brain, with genetic underpinnings, and its causation has nothing to do with parenting styles.
For many years, even mental-health professionals were trained to believe that bad parenting, particularly by mothers, was the root cause of schizophrenia — so that became the conventional wisdom.
Imagine how it felt to be on the frontline with a family member you love suffering from schizophrenia, only to be told that you’re the cause of your relative’s illness — either because you were too cold, too rejecting, or too permissive, or because you gave mixed messages! The guilt, shame, and sense of remorse that resulted created enormous gulfs between doctors and families, and between patients and their families.
With advances in research and new imaging techniques that have opened virtual windows into the living brain, doctors have learned that schizophrenia is caused by an underlying neurobiological susceptibility (probably predetermined by multiple genes) that is exacerbated by certain prenatal, environmental, or social triggers.
Now most professionals view family members as partners in care as opposed to seeing them as part of the problem. Therapies focus on the patient rather than the “pathology” of the family. Family interventions are aimed at educating families about the disorder, its symptoms, and treatment; helping them learn necessary communication and coping skills; and providing them with support for their demanding and complex roles as caregivers.
Schizophrenia does run in families: Having a family history of schizophrenia places offspring at a greater risk for the disorder (see Chapter 2). But this association is genetic and has nothing do to with parenting styles. If you encounter a dinosaur doctor who still clings to the idea that families cause schizophrenia, run the other way!
Myth 4: Schizophrenia Is Untreatable
Although schizophrenia can’t be cured, it can be treated and managed.
Less than 50 years ago, receiving a diagnosis of schizophrenia was akin to being diagnosed with a terminal illness. Families would resign themselves to the fact that their loved ones would live out their lives in state institutions, far removed from their family members, friends, neighbors, and communities, with little hope for improvement. People with mental illness were shackled for their own safety and protection, and locked behind bars for the protection of society.
With the advent of antipsychotic medications in the 1950s, it became clear that most people with schizophrenia could be successfully treated in the community and would be able to live in less-restrictive settings. Now when someone is acutely ill, she’s typically hospitalized for a relatively short time (a number of weeks) until her acute symptoms are stabilized. Alternatively, treatment of an acute episode can sometimes take place on an outpatient basis.
Although scientists still haven’t found a “cure” for schizophrenia, psychotropic medications and psychosocial supports are highly effective in addressing positive symptoms (see Chapter 3 for more on the positive symptoms of schizophrenia). The vast majority of people diagnosed with schizophrenia improve significantly with currently available treatments, and research holds the promise that people whose illnesses are now deemed “treatment-resistant” will be able to be helped in the future. Scientists are also working on recognizing the earliest signs of schizophrenia among those at high-risk, to prevent the disorder and to intervene early to minimize its disabling effects.
Significant gaps still exist in the availability of evidence-based treatments to reduce the negative symptoms of schizophrenia (see Chapter 3) and to get rid of the cognitive deficits associated with the disorder, but ongoing research is targeted in these directions. Most experts believe that, with proper treatment, at least one-quarter of those diagnosed with schizophrenia totally recover, another quarter improve considerably, and another quarter show some modest improvement.
Myth 5: All People with Schizophrenia Are Violent
Unfortunately, the media often sensationalizes stories about people with mental illness who are involved in acts of violence because it makes for catchy headlines, feeding into people’s fears and misunderstandings about the disorder.
Although people with schizophrenia can be unpredictable, they’re more often victims of violent crime than perpetrators of it. This is because they often appear to be frightened and confused, making them look like easy prey for criminals.
When individuals with schizophrenia do commit crimes, they’re usually petty misdemeanors that are an outgrowth of their poverty and despair. For example, a homeless person with schizophrenia might urinate on someone’s lawn because he has no access to a public restroom or may be charged with petty theft for stealing food when he has no money and is hungry.
When serious crimes do occur that involve people with schizophrenia, it’s because their illness is untreated or is aggravated by drug or alcohol abuse. Acutely psychotic patients may have outbursts of aggression: Untreated psychosis — as well as the presence of substance abuse — increases the chances of an individual becoming violent or aggressive in response to voices they hear, feelings of being persecuted or followed by enemies, or feelings of loss of control over impulses. Psychotropic medications reduce the risk of violence as does substance-abuse treatment.
Myth 6: People with Schizophrenia Are Just Lazy
People with schizophrenia aren’t lazy per se. However, they may appear that way due to symptoms of the illness, as well as the side effects of medications used to treat it.
People with schizophrenia often seem to lack motivation, energy, or “get up and go.” They find it difficult to adhere to a regular schedule; instead, they sleep too much, sleep too little, or keep irregular hours. They may show no interest in getting a job or spending their time productively — preferring to stay in bed or watch TV for endless hours. These behaviors may convey the impression that they are just lazy and unwilling to do anything for themselves.
Understandably, people get very frustrated when they see a loved one taking it easy while they struggle to make ends meet. When they try to motivate the person, they may be met with a flat “I don’t care” attitude. In addition, people with schizophrenia may show little interest or concern for other people, even those they love, and have difficulty making or keeping friends, or sustaining relationships with relatives.
For a long time, these “negative” symptoms were seen as side effects of psychotropic medication. This is true to some extent — but a constellation of negative symptoms is associated with the illness, including low energy, lack of interest in other people and things, and the inability to form social relationships and/or a lack of caring about social relationships.
When you understand that these symptoms are due to changes in brain chemistry and functioning, you realize how pointless it is to harangue your loved one with schizophrenia. It isn’t a matter of a flawed character or a lack of will — nor is it something she can just “snap out of” on her own. However, with proper medication and other supports, negative symptoms are often manageable (although they are more resistant to treatment than positive symptoms like delusions and hallucinations).
Myth 7: People with Schizophrenia Are Loners Who Don’t Want to Have Friends
Although people with schizophrenia typically have limited, narrow social networks, most of them would love to have friends and families of their own.
In many ways, schizophrenia is an alienating illness. When people are ill, they may have peculiar mannerisms, poor hygiene, and odd behaviors, all of which may make them unattractive or frightening to other people. They may be suspicious, fearing that others are talking about them, don’t like them, or are out to hurt them. Additionally, they lack the social skills necessary to establish new friendships and maintain old ones — they may be less apt to understand social cues one on one, or to respond appropriately in larger social settings.
Schizophrenia is often associated with high rates of poverty and unemployment, too, both of which further undermine a person’s sense of self-esteem and confidence. After all, one of the first things someone asks you when you meet is, “What do you do?” Many people with schizophrenia only see themselves functioning in the role of a patient, idling away their time and passively accepting care from treatment providers and support from family members. After paying their bills, they may have no money available for social or leisure pursuits. Stigma and discrimination make it all the more difficult for them to candidly explain their illness and its impact on their lives.
Yet, when asked, patients with schizophrenia often express a profound sense of loneliness and alienation and yearn for companionship. It’s only human to want to feel loved and needed. Struck by the illness in the prime of their lives, they may have lost contact with their close friends from high school or college who moved on socially, vocationally, or geographically without them.
Even after recovery, they may be skeptical about renewing relationships with people who knew them then, feeling embarrassed to explain the time they lost due to illness and/or disability. For reasons that are obvious, they may be ambivalent about relationships with other people who have mental illnesses or with those without them. They feel like they simply don’t fit in.
As a result of these losses, people with schizophrenia tend to over-rely on family to fill the void in their lives. It’s not uncommon for adults with schizophrenia to remain in their parents’ homes or depend on them for most of their social interactions. They may even be hesitant to participate in gatherings outside the nuclear family, such as holiday family get-togethers, because of the fear of being uncomfortable and misunderstood.
Peer support groups, therapy groups, clubhouse programs, volunteer jobs, social clubs, drop-in centers, and supported employment and rehabilitation programs can enable people with schizophrenia to gradually develop ties that make them feel more connected and better understood.
Myth 8: People with Schizophrenia Are Stupid
There’s no association between schizophrenia and diminished intelligence. People diagnosed with schizophrenia have the same wide range of abilities as the “normal” population does. Yet there are reasons why people may assume otherwise.
Years ago, people with schizophrenia and those with developmental disabilities (once called “mental retardation”) were often kept together in the same asylums, so it’s easy to see how this misperception evolved.
Because the average age of onset of schizophrenia typically overlaps with the time when young people are pursuing their education and careers, a person who is “doing nothing” — not attending school, not working — may be assumed to be of low intelligence, not smart enough to work or go to school.
Plus, the symptoms of schizophrenia and the medications used to control them can lead to specific cognitive deficits such as impaired memory, inability to respond quickly, difficulty paying attention, and problems organizing and sequencing information. Many of these functional deficits can be minimized through cognitive remediation programs.
Myth 9: When People with Schizophrenia Start to Feel Better, They Can Stop Taking Medication
They’re probably feeling better because they’re taking medication, and stopping it on their own will increase the risk of relapse.
Schizophrenia is a chronic and relapsing illness that requires medication to be taken for the long-term. Just as someone with diabetes shouldn’t stop taking insulin or someone with high blood pressure shouldn’t stop taking blood-pressure medication, a person with schizophrenia shouldn’t stop taking her antipsychotic medication unless she’s advised to do so by her doctor and is carefully monitored.
Studies show that when people stop taking their medication, they’re likely to have a relapse within the first year. The major reason people stop their medication often has to do with adverse side effects that feel unpleasant or uncomfortable. These can often be addressed by changing the dosage, adjusting how the medication is taken, switching to another drug, or adding another medication.
When someone is prescribed medication for a chronic illness, he may worry that he’ll need to take it for the rest of his life. In the case of schizophrenia, this isn’t always the case, but going off meds should only be done under medical supervision.
Myth 10: You Should Never Tell Anyone That Your Loved One Has Schizophrenia
With increased public understanding of mental disorders, families need to carefully weigh the pros and cons of disclosure.
For many years, people were terribly ashamed of loved ones who were diagnosed with schizophrenia. They never spoke about “eccentric” Uncle Joe who stayed upstairs in his room talking to himself or about Grandma Ethel who was sent away to a state hospital for most of her adult life. To have schizophrenia in your family was stigmatizing and reflected badly on other relatives. It was something that was only discussed behind closed doors.
Now that schizophrenia is accepted as a no-fault neurobiological illness, affected individuals and their families are more apt to be honest in telling friends, neighbors, and potential employers about the illness. That said, you still need to be aware of the potential risks because stigma still exists!
Peer and family support groups give people the chance to learn from each other how to better cope; they also provide some comfort — it helps to know that you’re not alone. And legislation such as the Americans with Disabilities Act has afforded protection to people who need accommodations in the workplace.
This doesn’t mean that you should indiscriminately tell everyone you know about your loved one’s illness. Determine for yourself how much to tell and when (see Chapter 11), recognizing that mental-health literacy and a spirit of openness goes a long way toward enhancing public awareness and minimizing stigma and misunderstanding. When the people around you know and understand your loved one’s disorder, they can provide you with compassion, support, and understanding when you need it most.
