Psychology 101: The 101 Ideas, Concepts and Theories that Have Shaped Our World - Adrian Furnham 2021

Schizophrenia: A Seriously Misunderstood Problem

Schizophrenia cannot be understood without understanding despair. (R.D. Liang, The Divided Self, 1959)

Sanity is madness put to good uses: waking life is a dream controlled. (George Santayana, Interpretations of Poetry and Religion, 1900)

Schizophrenia is a psychotic illness characterized by a disorder of thoughts and perceptions, behaviours and moods. Psychoses all show much more serious and disturbing symptoms. These include hallucinations, delusions, powerful disturbance of mood, obvious disturbances of thought, as well as acute and chronic relationship problems leading to isolation and social withdrawal. Whereas most neurotics have insight into their condition, psychotics don’t.

The diagnostic term schizophrenia is a major cause of dispute and debate among psychiatrists, patient groups and the laypublic. The most common objection is that it is an unhelpful ’umbrella’ term that covers a range of different disorders with different symptoms and different causes. Diagnosis is therefore unreliable. Some advocate the idea of schizotypy which refers to a continuum of personality characteristics and experiences related to psychoses, particularly schizophrenia. This is different from the categorical view that you either have or do not have the problem.

It is assumed that schizophrenia affects 1 in a 100 people and is the most serious of mental disorders. It has been suggested that prognosis for the problem is this: a third of people require long- term institutionalization; a third show remission and could be considered cured; while a third have periods of symptoms followed by ’normality’. They are different because of the symptoms that they do have (positive) and don’t have (negative) compared to normal people. They tend to have various manifestations of thought disorders (disorganized, irrational thinking), delusions and hallucinations. However, they tend to lack energy, initiative and social contacts. They are emotionally very flat, have few pleasures and are withdrawn.

There are several common misconceptions about schizophrenia:

The first is that schizophrenics are dangerous, uncontrollable and unpredictable while most are rather shy, withdrawn and concerned with their problems.

The second is that they have a split Jekyll and Hyde personality, whereas what is split is the emotional (affective) and cognitive (thought) aspect of people with schizophrenia.

Third, many people believe they do not, and cannot, recover and that once a schizophrenic always a schizophrenic.

The classification of schizophrenia remains complex because of the range of diversity of symptoms. These include delusion (odd, false beliefs); hallucinations (false sensory perceptions of sound, sight, smell); disorganized speech (incoherence, loose association, use of neologisms); disorganized behaviour (dress, body posture, personal hygiene); negative flat emotions (lack of energy, libido) as well as poor insight into their problems and depression.

Because of complications with the diagnosis, various subtypes have been named. There is paranoid, catatonic and disorganized schizophrenia. Catatonics (from the Greek ’to stretch or draw tight’) often adopt odd, stationary poses for long periods of time. Paranoid schizophrenics have delusions of control, grandeur and persecution and are consistently suspicious of all around them. Disorganized schizophrenics manifest bizarre thoughts and language with sudden inappropriate emotional outbursts. Some mention simple or undifferentiated schizophrenia. Others have distinguished between acute (sudden onset and severe) vs. chronic (prolonged gradual). Another distinction is between Type I (mostly positive symptoms) and Type II (mostly negative symptoms).

It has been recognized that researchers and medical and laypeople tend to believe in, or follow, different approaches that describe the cause and cure of schizophrenia. Essentially these split into biological models stressing genetic, biochemical or brain structure causes vs. the socio-psychological which focus on problems of communication and punishment in early life. Certainly development in behaviour genetics and brain science has led to more interest in the biological approach to cause and cure.

A. The medical model: Schizophrenic persons are in most cases called ’patients’, reside in ’hospitals’, and are ’diagnosed’, given a ’prognosis’, and then ’treated’. The medical model regards mental malfunction such as that found in the schizophrenic patient primarily as a consequence of physical and chemical changes, primarily in the brain. Treatment consists of medical and sometimes surgical procedures, but mainly the use of neuroleptic drugs.

B. The moral-behavioural model: Schizophrenics are seen as suffering for their ’sinful’ or problematic behaviour in the past. Much schizophrenic behaviour contravenes moral or legal principles, and this is the key to both understanding and curing the disorder. Whether behaviour is seen as sinful, irresponsible, simply maladjusted or socially deviant, the crucial thing is to change it so to make it socially acceptable.

C. The psychoanalytic model: The psychoanalytic model of schizophrenia differs from the others in that it is interpretative, treating the patient as an agent capable of meaningful action. Rather than seeing persons with schizophrenia as ’acted on’ by various forces (both biological and environmental) which cause them to behave in certain ways, the psychoanalytic conception of schizophrenia is concerned with patients’ intentions, motives and reasons. The behaviour of the person with schizophrenia is to be interpreted symbolically; it is the therapist’s task to decode it.

D. The social model: All social models in psychiatry have the fundamental premise that the wider influence of social forces are more important than other influences as causes or precipitants of mental disorder. Mental illness is seen partly as a symptom of a ’sick’ society, others being a high divorce rate, work pressures, juvenile delinquency, increased drug addiction, and so on. People with schizophrenia are seen to be driven to their form of madness by the social, economic and familial pressures.

E. The conspiratorial model: The conspiratorial theory is perhaps the most radical conceptual model of schizophrenia in that it denies the existence of mental illness (as a physical disorder) and stands in direct opposition to the medical model. The behaviour of the person with schizophrenia is a direct consequence of the way the person has been treated by others. The conspiratorial model denies any ’treatment’ or ’cure’ in the normal sense.

REFERENCES

Furnham, A. & Baguma, P. (1999). Cross-cultural differences in explanations for health and illness: a British and Ugandan comparison. Mental Health, Religion and Culture, 2, 121—34.

Furnham, A. & Bower, P. (1992). A comparison of academic and lay theories of schizophrenia. British Journal of Psychiatry, 161, 201—10.

Furnham, A. & Chan, E. (2004). Lay theories of schizophrenia: a cross-cultural comparison of British and Hong Kong Chinese attitudes, attributions and beliefs. Social Psychiatry and Psychiatric Epidemiology, 39, 543—52.