Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states
Schizophrenia is an acute mental illness characterized by the inability to remain in contact with the real world. Instead, patients live in a world of hallucinations and paranoid delusions. Hallucinations mean that a person hears and sees things that do not exist. This not the result of an active imagination. Instead, they truly hear and see things that others do not. In addition, delusions are ways of thinking that are totally untrue. For example, a patient may think that the FBI is following them in order to execute them. The patient may even believe that their own thoughts have the power to kill people and that they have killed millions of others. Patients are tortured by these terrible symptoms. It is like living in a nightmare from which the individual cannot wake up. It is thought that this is a brain disease caused by problems with the way the brain works.
Those diagnosed with the brain disease, schizophrenia, face many challenges. One of the greatest of them all is accepting that they are truly suffering that mental disease. In one sense, this is not so unusual. Whether its diabetes, cancer or many other diseases, patients often react with disbelief and shock. However, none of these illnesses carry with them the powerful stigma associated with a mental illness. That stigma causes patients who have schizophrenia to be secretive about the illness. They fear rejection and judgment from other people that they are “crazy.”
A good case in point is the autobiography of Elyn Saks in her book, “The Center Cannot Hold.” It was only her closest and deeply trusted friends to whom she could share the nightmare she was living with schizophrenia. As she describes it, part of the fear the misunderstanding that people have about mental illness is that patients are dangerous and violent. Despite the fact the she knew this was not true, she lived in terror that, if people knew she had schizophrenia, they would think of her as an irrational and violent person.
Along with the attempts to keep the disease secret from others there is the other need to keep it secret from one’s own self. In other words, patients find it difficult to admit to themselves that they have schizophrenia. Who would want to admit to having a totally debilitating illness that has no hope of being cured? In fact, one percent of those people diagnosed with this illness commit suicide because they feel utterly hopeless about their lives and future.
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Today medical science has learned more than ever about schizophrenia, what causes it and how best to treat it. Now, psychiatrists are armed with powerful neuroleptic medications that relieve the psychotic symptoms of delusions and hallucinations. Yet, people suffering from this psychotic illness stop taking their medication and suffer terrible relapses back into their mental illness. Why? As Elyn Saks describes it, the medications truly do work and allow patients to live fairly normal lives so long as they control their stress levels and do not abuse drugs and alcohol. At the very same time, taking the medication is a reminder to the patient that they have this sickness that they do not want. More than any other disease, the stigma attached to it is so interwoven into an individual’s identity that it feels traumatizing to be forced to admit to having it and to have to take medication.
Along with the need to have to take medications to control this sickness there is the fact that the medications have terrible side effects. When taking the neuroleptics people feel tired and sluggishness, gain weight and run the risk of developing disorder called Tardive Dyskinesia. TD is characterized by the fact that the individual experiences involuntary twitching and drooling around the mouth and other parts of the body. It is not known why some people suffer these symptoms while others do not. It is possible that patients have to be tried on other, newer types of neuroleptics and at lower doses in order to prevent it’s onset. Regardless, the danger of getting TD is another reason why people stop taking their medications. If schizophrenia were not stigmatizing enough, having TD is extremely embarrassing.
Saks points out that one of her greatest battles with this disease has been to not allow it to define who she is. She points to how we use language in relation to the mental illnesses. It is well known that people with this sickness are called schizophrenic. Even with depression, people are called “depressives.” On the other hand, we do not call those with the flu, “fluists.” She asserts that she has the sickness called schizophrenia but that she is not “a schizophrenic.”
Just a few clarify remarks before closing this blog:
1. One percent of the world population suffers from schizophrenia.
2. One percent of those with schizophrenia attempt suicide.
3. That rate of violent and non violent crimes is among the schizophrenic population is no larger than among the normal population.
4. With medication and psychotherapy most people with this disease can live and work in the community.
Your comments and questions about this issue are encouraged.
Allan N. Schwartz, PhD
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