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This paper addresses the causes of schizophrenia and the myths surrounding this complicated ailment, the affect of untreated or misunderstood aspects of schizophrenia has on society and important crisis intervention strategies for those in close contact to victims of schizophrenia. The definition of schizophrenia is a group of psychotic disorders characterized by disturbances in thought, perception, affect, behavior and communication that endures longer than six months. Psychotic symptoms could include delusions (beliefs that are false in light of direct evidence of truth), hallucinations, incoherence (confused logic), catatonic behavior (bizarre physical movement) or flat affect (showing no emotion). (Lehman 15) Three types of schizophrenia exist; these are catatonic, paranoid, and disorganized. The catatonic schizophrenic is often negative, easily excitable, usually cannot take care of personal needs, little sensitivity to painful stimulus. The paranoid type has delusional thoughts that are frightening (usually of persecution), anxiety, anger, violent tendencies, and argumentative. The disorganized type is incoherent, displays flat affect, delusional, hallucinates, laughs at inappropriate times and lives life as a hermit. (Lehman 15) The causes of schizophrenia remain unknown, but several theories exist explaining possible causes of the debilitating disease. Genetics may play a significant role because close relatives of a person with schizophrenia are more likely to develop the disorder. The risk is even greater for those relatives who are genetically similar to the schizophrenic. This theory poses important debates however. If schizophrenia is caused by simple genetics, identical twins should both be affected by schizophrenia if one twin has been diagnosed. It is rare to find a majority of identical twins affected. Studies have found there to be a weak genetic link to schizophrenia. A recent study of high-risk children found there to be little proof of a genetic link. The contrast between offspring of ill parents and offspring of normal parents was significant only for gross motor skills, but the direct affect of an ill parent on development of schizophrenia-related psychoses was not significant, which indicated a weak genetic model. (Erlenmeyer-Kimling, 28) Erlenmeyer-Kimling also noted that environment and early developmental damage could play a role in the onset on schizophrenia. This disease may have a series of triggers that could bring on the onset of the disease. These triggers could include complications during pregnancy and/or labor, prenatal exposure to a virus (especially in the fifth month when brain development occurs), and stress throughout the stages of life. (Dincin 103) Because of the complexity of the disease, many myths surround schizophrenia. One of these myths is poor parenting causes schizophrenia. Sigmund Freud and psychiatrists since him have regarded the family as the key in the development of personality. Traits of dysfunctional families are labeled "contradictory expectations" and "covert rejection". The problem with solely blaming the family for the onset of schizophrenia is these studies often lack controls. Until the late 1970s, mothers were still blamed for the onset of schizophrenia in their child. "No good evidence supports the theory that family environment causes schizophrenia and very strong evidence supports biological factors as the cause" ( Dincin 105 ). Some people believe that schizophrenics are mentally retarded, but the two conditions are entirely different. Schizophrenia does cause some cognitive problems, but does not affect overall intelligence. Schizophrenia occurs in people of all levels of intelligence and talent. Another myth is that schizophrenia is the same as a "split personality". Since the word schizophrenia comes from two Greek words meaning "split mind", confusion arose about the differences between schizophrenia and split personality. The Greek terminology refers to the breakdown of an individual's thinking and feeling processes, not a split personality, (Swanson 25). Other ridiculous myths exist, including schizophrenia is caused by a curse, God's punishment, a lack of faith in God, a demonic possession, result of a broken heart, and even reading to many books. (McGlashan 329) How do doctors diagnose the disease? Many doctors look the patient's developmental background (motor skills, memory deficiencies), genetic and family history, current stress factors, level of functioning before becoming ill, responses to therapy, and a CT scan of the head to reveal any enlarged ventricles. (Lehman 15) The CT scans below show the enlarged ventricles of a schizophrenic and the normal sized ventricles of a person without any mental illness. Scientists look at the region of the brain known as the "limbic region". It contains the complex system of nerve pathways and networks. This area is responsible for human functions such as fear, rage, pleasure and memory patterns. The difference in the limbic systems of schizophrenics and healthy patients are visible to the naked eye. (Dincin 102). A schizophrenic brain is like a radio tuned into several stations at once. Dincin explains: Research into the operation of the brain has shown that people with schizophrenia have problems with certain types of brain cells called inhibitory interneurons. These damp down the action of other nerve cells. Thus they prevent the brain from being overwhelmed by too much sensory information from the environment. (Dincin 102) Schizophrenia can be a devastating disease if not treated or ignored. Many times if a mentally ill person has intentions of becoming violent, red flags exist to alert those around them of any danger. According to Torrey, three primary predictors exist. The most important being a history of violence. In trying to predict future violence, the person's history is the single most important piece of information. The second predictor is drug and/or alcohol abuse. A growing number of studies indicate a significant link between schizophrenia, substance abuse, and violence. The third predictor is the failure to take medication. According to Torrey, those who do not take their prescribed medication are more likely to commit violent acts. Torrey says that the strongest predictors of violence in the mentally ill are the feelings that others are out to harm them and feeling that their mind “is dominated by forces beyond their control or that thoughts are being put into their head”. (Torrey 250-252) Several accounts of run-ins with violent schizophrenics have happened in the United States and around the world over the years. In September of 1997, a father who was a paranoid schizophrenic murdered his six-year-old daughter and mother in a Toronto suburb. He believed he was the Messiah and believed his daughter was Satan. He’d sworn off medication and was, according to his doctor, “almost functioning on auto-pilot”. The schizophrenic man did not really believe his daughter and mother were dead. (Stanford 1) Another man killed two US Capitol police officers in 1998, because he believed he was cloned at birth, had invented a machine to turn back time, that the CIA had been spying on him with satellites, and that President Clinton had planned the Kennedy assassination out of jealousy for Marilyn Monroe. (Mohandie 9) In Portland, another woman bludgeoned her mother to death with a 23-pound rock after she was convinced her mother was Satan. (Hedges 1) Not only can schizophrenics harm others, but they can harm themselves as well. According to Clin, patients with panic disorder are reportedly at higher risk of suicidal behavior. Major depression was diagnosed in 59% of the seventeen suicide victims studied and substance abuse was reported in 47% of the cases. (Clin 276) A myth surrounding schizophrenia is that one can never recover from it. The truth is some people recover completely from the illness (all psychotic symptoms disappear). Others continue to have some symptoms, but can lead satisfying and productive lives. One-third of patients do not recover and may have to be institutionalized. (Duncan 1135)) Schizophrenia suffers a reputation worse than that of a criminal. According to one US survey, an ex-mental patient was rated less acceptable than an ex-convict. (Monohan 512) How then should a health care provider or family member handle the first episode of schizophrenia? The first episode of schizophrenia typically occurs in the late teens or early twenties. The goal of treatment is to bring about a rapid end to the first episode with the most effective and best tolerated drugs. After clinical treatment, however, most schizophrenics find it difficult to achieve in school, employment, and relationships. According to Frangou, the family must work with the patient and increase their knowledge of the condition. They must nurture relationships and communication. Frangou stresses that treating a schizophrenia patient must be done rapidly, with “swift initiation of treatment in a setting that does not have a stigma attached to it with psychological interventions and support”. This support of those with schizophrenia includes society as well. This includes law enforcement officers, who often deal with schizophrenia at its worst. According to Mohandie, some paranoid schizophrenics are homeless, dress in shabby clothing and have poor personal hygiene, but are usually harmless. If an officer is confronted with a violent schizophrenic, he/she should not focus on the criminal aspects of the case, but how they can relate to the person to deescalate the situation. Prior to any violent acts, some patients will write letters, make phone calls, or communicate in other ways to law enforcement and the community. Community member should bring these threats to the attention to the police, no matter how bizarre they may seem. Police and other community advocates should judge a potentially violent mentally ill patient with five principles. The first is whether the individual is organized and coherent or if he/she is not. The second is whether the patient stays fixed on one or several themes (or explanations) for their problems. The third is whether the individual focuses on a specific person for the problem. The fourth is whether they believe the only way to solve the problem is to take it into their own hands. The last is whether the patient exerts urgency about solving his/her problems. Community members should not base their opinions about someone being violent on threats alone. “Researchers have noted that some who make threats do not pose threats, and some who pose threats do make threats”. (Mohandie 11) Some verbal and nonverbal strategies can be taken to ensure the safety of those involved in the crisis situation. Those who are first to respond to a schizophrenic episode should first and foremost, show respect and interest in the patient and their concerns, no matter how difficult. The first contact a person makes with the patient can set the tone for the rest of the situation. Those dealing with the patient should always speak nonconfrontationally. Bell says to speak in an even tone with a sense of respect and dignity. (Bell 2238) After setting some groundwork, responders should take an “unemotional, logical, and factual” approach to understand what the patient is saying. For instance, an officer may speak to a delusional person by saying, “I understand what you are saying, but I do not hear those voices. Can you tell me more about them?” Schizophrenics rarely trust anyone and cannot understand why others cannot hear what they hear. Direct attempts by family, officers or doctors to force trust only confirms the schizophrenic’s delusions. To gain trust a responder may say, “ It makes sense that you would feel that way; maybe later you might decide that I am worthy of some of your trust.” Schizophrenics are sensitive about personal space as well. They can easily perceive direct eye contact, body space, and mannerisms as threatening. Schizophrenics require more distance to feel safe. Too much eye contact evokes fear of aggression or fear of mind control in patients. Since many things can be perceived as threatening, responders should always tell the patient what they are going to do before they do it without insulting their intelligence. Responders should continue to show respect, interest and thoughtfulness in their interactions with subjects. In addition, they should share information to hospitals, law enforcement, doctors, and family members to expedite social support and assistance. (Mohandie 14) Family continues to have a central role in recovery of schizophrenia. According to Hall, recovery involves the “development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.” (Hall 430) Hall warns, however, that family caretakers of those with schizophrenia can become overprotective of their loved one. Hall notes that family members must balance the role of caregiver and “nurturer of independence”. (Hall 432) As many as 75 percent of individuals discharged from psychiatric hospitals return to live with their families. Over ninety percent of mentally ill patients keep in regular contact with their families. In conclusion, schizophrenia is not a common disease, but its effects affect our society. From homeless persons on the street to your well-to-do neighbor, schizophrenia does not discriminate. Law enforcement officers, educators, family members, care-takers, doctors, ministers and anyone who is an advocate for the community should understand the direct effects of this sometimes tragic disease. Everyday in America, someone is admitted into a psychiatric hospital desperate for help, or worse murders a family member or stranger, because no one took the time to understand his/her symptoms and how to react to them. Mental illness cannot be prevented. Therefore, we as a community must know the signals people give when something is not right. We should know to react in a kind and non-threatening manner and get professional help to the person who needs it. Adding a stigma to schizophrenia does no one any good. It only manifests the myths and discrimination felt by so many already. Bibliography: Works Cited Bell,H., “ A Potenitally Violent Patient?”, American Family Physician, 61(7):2237-2238, 2000. Clin, J., “Panic Disorder in Completed Suicide”, Psychiatry Spring 57:275-281, 1996. Dincin, J., “Current Challenges”, New Directions in Mental Health Services, Winter 68:95-105, 1995. Duncan, J.C., “Medication Compliance in Patients with Chronic Schizophrenia”, Journal of Forensic Science 43: 1133-1137, 1998. Erlenmeyer-Kimling, “Attention, Memory, and Motor Skills as childhood predictors of schizophrenia-related psychoses”, The American Journal of Psychiatry, 157(9): 1416-1422, 2000. Frangou, S., “How to Manage the First Episode of Schizophrenia”, British Medical Journal, London, September 2000: 522-523. Hall, L., “Recovery and Serious Brain Disorders: The Central Role of Families in Nurturing Roots and Wings”, Community Health Journal, 36(4):427-441, 2000. Hedges, Mimi., “Woman Kills Mother”, Portland Press Herald, July 11, 1997. Lehman, A., “Patterns of Usual Care for Schizophrenia”, Schizophrenia Bulletin 24(1): 11-20, 1998. McGlashan, T., “Early Detection and Intervention in Schizophrenia”, Schizophrenia Bulletin, 22(2): 327-345, 1996. Monahan, J., “Mental Disorder and Violent Behavior. Perceptions and Evidence,” American Psychologist 47: 511-521, 1992. Monhandie, K., “Understanding Subjects with Paranoid Schizophrenia”, FBI Law Enforcement Bulletin; 68: 8-16, 1999. Stanford, Duane., “To Dad, Girl was Satan”, Toronto Sun, Sept. 17, 1997, Final Edition. Swanson, J., “Violence and Severe Medical Disorder in Clinical and Community Populations”, Psyhiatry, Spring 60(1): 1-22, 1997. Torrey, E. Fuller., “Out of the Shadows-Confronting America’s Mental Ilness Crisis”, New York: Random House, 1998.220-258 Works Cited Bell,H., “ A Potenitally Violent Patient?”, American Family Physician, 61(7):2237-2238, 2000. Clin, J., “Panic Disorder in Completed Suicide”, Psychiatry Spring 57:275-281, 1996. Dincin, J., “Current Challenges”, New Directions in Mental Health Services, Winter 68:95-105, 1995. Duncan, J.C., “Medication Compliance in Patients with Chronic Schizophrenia”, Journal of Forensic Science 43: 1133-1137, 1998. Erlenmeyer-Kimling, “Attention, Memory, and Motor Skills as childhood predictors of schizophrenia-related psychoses”, The American Journal of Psychiatry, 157(9): 1416-1422, 2000. Frangou, S., “How to Manage the First Episode of Schizophrenia”, British Medical Journal, London, September 2000: 522-523. Hall, L., “Recovery and Serious Brain Disorders: The Central Role of Families in Nurturing Roots and Wings”, Community Health Journal, 36(4):427-441, 2000. Hedges, Mimi., “Woman Kills Mother”, Portland Press Herald, July 11, 1997. Lehman, A., “Patterns of Usual Care for Schizophrenia”, Schizophrenia Bulletin 24(1): 11-20, 1998. McGlashan, T., “Early Detection and Intervention in Schizophrenia”, Schizophrenia Bulletin, 22(2): 327-345, 1996. Monahan, J., “Mental Disorder and Violent Behavior. Perceptions and Evidence,” American Psychologist 47: 511-521, 1992. Monhandie, K., “Understanding Subjects with Paranoid Schizophrenia”, FBI Law Enforcement Bulletin; 68: 8-16, 1999. Stanford, Duane., “To Dad, Girl was Satan”, Toronto Sun, Sept. 17, 1997, Final Edition. Swanson, J., “Violence and Severe Medical Disorder in Clinical and Community Populations”, Psyhiatry, Spring 60(1): 1-22, 1997. Torrey, E. Fuller., “Out of the Shadows-Confronting America’s Mental Ilness Crisis”, New York: Random House, 1998.220-258 Word Count: 2277
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