The Mystery of Schizophrenia

Of all the psychiatric illnesses, the schizophrenias are the hardest to understand. They are mysterious because they seem to be the furthest from reality. Despite that, in some ways, the research about them is the most promising.
Common schizophrenia is rare, affecting 0.5% to 1 % of the population. If Cape May County is reflective of that incidence, then a minimum of approximately 500 of its citizens are so affected. Symptoms include hallucinations, delusions and thought disorders, all of which are called the ‘positive symptoms’ or active ones. The ‘negative symptoms’ are the ones that make the illness so disabling: disorganized thinking, social withdrawal, poor hygiene, and lack of connection with reality.
The hallucinations are typically heard (‘auditory hallucinations’). These are not one’s internal voice, such as one’s conscience, but rather a voice heard outside the head, even though the speaker is not to be found. (Visual hallucinations are not likely.) The voices of schizophrenia may be heard talking about the person. Some of the voices, which may be male or female or both, may be making positive, and others negative, commentary. One voice may say, “He’s a good boy,” while another may say, “she’s a witch, you can’t trust her.”
Sometimes voices speak directly to the person even to the point of giving commands. Commands may be innocuous such as “Brush your hair!” or “Go to your room.” In rare cases the voice may say, “The children are possessed by the devil. Send them to heaven!” Those unfortunates sometimes are led to commit violence. The newspaper accounts of these cases add to the stigma and fears surrounding schizophrenia.
Delusions and thought disorders can be quite bizarre. Some think that men inside the television are photographing them. Others might think that they can broadcast their thoughts to Brazil or receive messages from Jupiter. In cases of paranoid schizophrenia, the fear might be that the FBI or the CIA is monitoring one’s thoughts or that their body is controlled by technology.
What makes these delusions is that they are firm, fixed beliefs from which the person cannot be dissuaded and which bear no relation to reality as we know it. People with delusions may be frightened by them or they may just take them up as a simple matter of fact. People who say they believe in ghosts, especially in Cape May County, do not suffer from delusions. They usually do not have schizophrenia. Rather they suffer from the folk lore of the area, which includes a belief in haunted churches and houses.
The negative symptoms affect how a person lives and what they can do in life. They are pervasive whereas the above positive symptoms can often be compartmentalized. If a person has disorganized thinking, they find it hard to manage their day-to-day affairs. If they can’t keep themselves focused, they may not bathe or eat well and may suffer more illnesses. They may be so wrapped up in their internal world that they don’t relate well to others and they may be socially isolated.
Many sufferers of schizophrenia are protected by their families who shelter them in their homes. Some portion of the affected population gets psychiatric help for their illness. Modern medicines do a much better job of reducing the positive (active) symptoms and an even better job of relieving the negative symptoms. There are day programs and psychosocial programs available to help patients re-integrate into society.
The research on schizophrenia is extensive and there is a promising and exciting new trend in the research that a combination of multiple gene defects account for the illness. Depending on which set of genes go wrong, a person will have one or another group of symptoms. In the years ahead, I think we can expect some major breakthroughs in this area.
-Dr. William Hankin, MD is Board Certified in general psychiatry and is a Fellow of the American Psychiatric Association. For more information about this or other issues, contact Dr. Hankin at his Atlantic County office in Linwood 609-653-1400 or his Cape May County office in Cape May Court House at 609-465-4424. Or visit www.WHHMD.com.