Causes of Schizophrenia
Please click on the following links:
What causes schizophrenia? - Remedy Health Communities
Definition of Paranoia
Speaking as a physicist, rather than a physician, the traditional definition of paranoia and the circumstances of the diagnosis are of no great use, in fact the exact opposite, to the person diagnosed with it. I discussed this with some patients. Instead we defined paranoia as "the inability or reduced ability to accurately identify the source of danger". Many patients have no difficulty with this to the extent they learn to identify the psychiatrist as the source of danger. Why might they be right? Because the moment he goes away and tells their family members the diagnosis the psychiatrist shortens their life by 17 years on average in the UK. Yet with Open Dialogue in West Lapland with the same number of people presenting, that is 1/100, they progress to only 2/100,000 cases of paranoid schizophrenia being diagnosed instead of 1/100. In most first presentation cases of course the immediate situation is not the fault of the psychiatrist but also in most cases there is no scientific proof of what exactly happened to put the patient and the psychiatrist in that position but evidence of a scientific nature can be obtained from the statistic that if your identical twin develops so called paranoid schizophrenia the chance of you getting it too is only 49%. This tells us 2 things: firstly you have an elevated genetic disposition to developing the condition and if you don't develop it something must have happened to your twin which did not happen to you. It seems appropriate at this point to include this video of someone being made to feel insecure in a related circumstance anyone not keen on taking "their" medication being able to gain confidence from the 3 times Olympic champion and his compatriots' Open Dialogue.
Definitions of Schizophrenia
Schizophrenia is just a label and no individual has exactly the same experience of the illness as anyone else therefore no definition is necessarily the "right" one. One person's illness does not define the condition. People don't often fit exactly into boxes. For example whilst my diagnosis has always been said to be paranoid schizophrenia a psychiatrist once asked me if I would like to try some lithium, a drug normally given to persons with manic depression (another label). There is a continuum of mental health conditions all overlapping at some point. There is even one mental health condition which is actually called autistic spectrum disorder condition. Having said this I thought I'd collect a few definitions for you, below, even where they are quite out of date in this case commenting at the bottom. But one definition is that it is a mental health condition whose symptoms are delusions and hallucinations. A delusion is when you believe something to be the case that isn't. With hallucinations most people know about visual and auditory hallucinations, that is seeing and hearing things that aren't really there, at least in your location, but what is less well known is that you can taste, smell and feel things that aren't really there. I have had all those types of hallucination. But you see a large part of the condition is simply the way you get treated once you have the diagnosis. The condition is created by abuse and conflict with power structures, one might surmise, and then the diagnosis makes this many times worse (many times and then times 3 again for young black males). This is an easy matter to prove, and I know it has been over the decades eg in America with undercover so called paranoid schizophrenics with fake medical records who find they receive automated abuse from the so called health apparatus having to be rescued in the end I think I read. The weakness of all the following definitions is they were written by doctors for doctors the doctors themselves being part of the condition as well as what led to the patient coming into contact with them.
Schizophrenia: A mental disease marked by a breakdown in the relation between thoughts, feelings and actions, frequently accompanied by delusions and retreat from social life - Concise Oxford Dictionary.
Schizophrenia: Mental disease marked by disconnection between thoughts, feelings and actions - The Readers Digest Great Encyclopaedic Dictionary.
Schizophrenia: Psychosis. A severe illness, usually starting in early adult life; relapses are common, and the disease may be progressive. Hallucinations are also common. It is sometimes inaccurately called split personality - The Readers Digest Great Encyclopaedic Dictionary.
Schizophrenia: A serious mental disorder marked by irrational thinking, disturbed emotions and a breakdown in communications with others. Schizophrenia is the most common type of psychosis, accounting for about half the serious mental illness in Britain. The cause is not known, but it may be related to a hereditary disorder in metabolism - The Readers Digest Illustrated Family Medical Encyclopaedia.
Schizophrenia: Schizophrenia is an emotive word. Thanks to old films like The Three Faces of Eve, many mistakenly take it to mean having a multiple personality. The condition was originally called dementia praecox (early madness), but in 1911 a Swiss psychiatrist, Eugene Bleuler, renamed it schizophrenia, which comes from the Greek, meaning 'splitting of mind'. Because the symptoms of schizophrenia are still not clearly recognised, families may simply not understand the increasingly strange behaviour of a member. These symptoms fall into four main categories. There is "simple schizophrenia", which includes a general deterioration in personality, illogical thoughts, the wrong kind of emotion for a certain situation, or no emotion at all. These symptoms usually start during or after adolescence. The "hebephrenic type" will hear hallucinatory voices and have delusions - like believing that announcements on TV or radio have a personal message. The "catatonic type" is characterised by alternate cycles of unpredictable excitement and stupor. Movement is affected: sufferers may become almost immobile or take up rigid positions. The main feature of the "paranoid type" is delusions of persecution. Sufferers are convinced they are being watched, followed, plotted against and persecuted. They think people are whispering about them, laughing at them, or out to get them. Stress may help to bring on symptoms of schizophrenia but there are serious arguments between psychiatrists as to the possible causes of the condition, its various diagnoses - and even as to its actual existence. The psychiatrist RD Laing, for example, provoked great controversy with his belief that people developed schizophrenia as a way of coping with intolerable family circumstances. "Insight" is a term routinely applied to signify good mental health or the recovery of patients, when they are able to see they have been suffering delusions. Up to this point they maintain they are normal and in good health. Psychotherapy is rarely used to treat schizophrenics, as they have no insight*. But over the last 25 years drugs have proved a very effective treatment - controlling hallucinatory voices, calming excitement and reducing delusions. With their help, schizophrenics can become less anti-social and they can re-enter the ordinary world - The Sunday Times A-Z of Preventative Medicine.
Schizophrenia: This is the commonest major psychiatric disorder and affects about 1% of the population of the Western World. It usually shows itself between the ages of sixteen and twenty-five and lasts for life. About half the patients in psychiatric hospitals are schizophrenics, as are many of the homeless who inhabit city streets. Schizophrenia is not a disease in the normal sense of the word and has no fixed characteristics. Definitions vary wildly and the condition is being officially re-defined. At one time it was called "premature dementia" (dementia praecox), but it is in no sense a dementia and the intellectual powers are not affected. There is no laboratory test for schizophrenia and no observable change in the nervous system**. The diagnosis is based entirely on the behaviour of the person under consideration - Royal Society of Medicine Encyclopaedia of Family Health.
Schizophrenia: Schizophrenia is the commonest psychiatric illness, accounting for some 80% of patients under the age of 65 who have been in hospital for 2 years or more. The term schizophrenia was introduced by Bleuler in 1908 replacing an older name dementia praecox in order to describe the apparent splitting of mind which is characteristic of the condition, part remaining in touch with reality and part not. The manifestations are protean, the commonest being withdrawal, regression, infantilism, asocial or antisocial behaviour, aberrant ideas, delusions, and hallucinations. Several clinical types are recognised: simple, paranoid, hebephrenic and mixed. The onset is usually in adolescence or early adult life and the course is chronic, sometimes with remissions. Despite intensive research over many years, the aetiology and pathogenesis of schizophrenia are still not understood. It is certain however, that there is a strong genetic component - Oxford Companion to Medicine.
Schizophrenia: a mental disorder, a psychosis of unknown origin, which can lead to profound changes in personality and behaviour including paranoia and hallucinations. Contrary to popular beilef, it does not involve a split personality. Modern treatment approaches include drugs, family therapy, stress reduction and rehabilitation. Schizophrenia implies a severe divorce from reality in the patient's thinking. Although the causes are poorly understood, it is now recognised as an organic disease, associated with structural anomalies in the brain. In 1995 Canadian researchers identified a protein in the brain, PSA-NCAM, that plays a part in filtering sensory information. The protein is significantly reduced in the brains of schizophrenics, supporting the idea that schizophrenia occurs when the brain is overwhelmed by sensory information. There is some evidence that early trauma, either in the womb or during delivery, may play a part in causation. There is also a genetic contribution - Hutchinson Encyclopaedia
Further Comments on the Above
*The Sunday Times A-Z of Preventative Medicine says above "Psychotherapy is rarely used to treat schizophrenics, as they have no insight". These days I think psychotherapy is recommended at all stages
**The Royal Society of Medicine Encyclopaedia of Family Health says above the condition last for life. This is an unfortunate statement as Open Dialogue proves. In addition Brent Nokes who painted my book cover and had a number of years with schizophrenia recovered completely and not only that has stayed well without medication since the 1970s. They also say it produces no observable change in the nervous system so this must have been written before PET scans (see Useful Links section). I haven't got a PET scan of my brain to hand so here's a picture of my cat Miss Pingu Tobaski.
Recovery from Schizophrenia
What, in the absence of Open Dialogue, is/was the prognosis for patients who develop paranoid schizophrenia?
Total Medical Recovery from paranoid schizophrenia: "Over a time scale of decades between 1/3 and 1/2 of persons suffering severe schizophrenia recover to the point of not requiring medication".*
This statistic represents a synthesis of the results of several studies, the most important being the 27 year follow-up of people discharged from the Vermont State hospital in the 1950s. The Vermont study was published by Courtney Harding and colleagues in American Journal of Psychiatry (The Vermont longitudinal study of persons with severe mental illness, II: Long-term outcome of subjects who retrospectively met DSM-III criteria for schizophrenia. Am J Psychiatry. 144:727-35, 1987 ).
Courtney Harding has published a good review article that examine the various different longitudinal studies performed over the past 100 years (Chronicity in Schizophrenia: fact, partial fact, or artifact? Hosp Community Psychiatry. 1987, 38(5):477-86.
Two well-known studies, one by the University of Bonn and the one at the University of Vermont, showed a remarkable similarity in outlook for those suffering this debilitating illness. The teams in the studies did a long-term follow-up of patients with schizophrenia admitted to psychiatric hospitals in the late 1940s and early 1950s. There were 500 patients in each study. They located the patients or their families and, through interviews with the patients and people who knew them, created detailed portraits of what had happened to them. About a quarter had died, mostly by suicide. Many of them might have survived if the traditional medical model accepted schizophrenia as rooted in experience rather than mere biology. Most of those who committed suicide did so in the first ten years of their illness. Some, a small percentage, were still institutionalised, apparently unresponsive to drugs or to electroshock therapy. Another group was living with their families but still had symptoms, especially the negative ones of lethargy, lack of drive and interest or pleasure in life, these symptoms being those caused by the less modern drugs for schizophrenia then available- as well as some of the newer ones. But a surprisingly large proportion, about a quarter, seemed to be symptom-free, living independently, with a circle of friends and jobs in the professions for which they had been trained or had before they become ill. Most of these had not been under the care of a physician for years. (Taken from A Beautiful Mind by Sylvia Nasar).
*Professor Thomas Barnes (see picture) complements the above "1/3 to a 1/2" statistic by saying the patients are not all "prospectively identifiable" which I think means not all of the patients who went into the system have been covered in the statistic of who came out. He instead cites Jobe & Harrow (2005): “between 21% and 57% show good outcome”. Both statistics give hope to those new to the diagnosis of paranoid schizophrenia.