Mental Health Conditions
The term schizophrenia is widely used in the mental health system. Doctors may describe it as a psychosis. They mean that, in their view, a person can't distinguish their own intense thoughts, ideas, perceptions and imaginings from reality.
Others adopt a holistic view of schizophrenia, and suggest that these symptoms are logical or natural reactions to adverse life events. In other words, an extreme form of distress. They emphasise the need to think about individual experience, and the importance of understanding what the experiences mean to the individual. Hearing voices, for instance, holds a different significance within different cultures and spiritual belief systems.
How is a diagnosis of schizophrenia reached?
When someone becomes unwell, they are likely to show drastic changes in their behaviour. They may be upset, anxious, confused and suspicious of other people, particularly anyone who doesn't agree with their perceptions. They may be reluctant to believe they need help. Doctors will want to rule out other physical or mental health problems. They will look for various 'positive' symptoms (strange thinking, hallucinations and delusions) and 'negative' symptoms (apathy, emotional flatness, inability to concentrate, wanting to avoid people or to be protected).
Strange thinking – a person may be unable to follow a logical sequence of thought; their ideas may seem jumbled and make little sense to others. Conversation may be very difficult and this may contribute to a sense of loneliness and isolation.
Hallucinations – some people hear voices that others around them don't hear. (Some people hear other sounds). The voices may be familiar, friendly or critical. They might discuss the hearer's thoughts or behaviour, or they might issue orders. Research indicates that up to four percent of the population hear voices, and for most, they present no problem. But people who are diagnosed with schizophrenia seem to hear mostly critical or unfriendly voices. They may have heard voices all their lives, but a stressful life event might have made the voices harsher and more difficult to deal with.
Delusions – are beliefs or experiences that others don't share. For instance, someone might believe secret agents are following them or that outside forces are controlling them or putting thoughts into their mind.
Negative symptoms – other symptoms, such as being withdrawn, apathetic, and unable to concentrate, are described as 'negative' rather than 'positive', because they are less clear-cut. It can be very difficult to tell whether they are part of the schizophrenia, or whether the person is reacting to other symptoms they find frightening and distressing. For instance, depending on what kind of experience they are having, someone might be quiet and immobile for hours, or move about constantly. Such symptoms could also be a response to other people's behaviour towards them. It's all too often the case that someone with a mental health problem is discriminated against or ignored, causing them to feel isolated and depressed.
Because of differences of opinion about schizophrenia, it's not easy to identify what might cause it, but there are various different ideas.
Inheritance – researchers have looked for a particular 'schizophrenia gene' without success. It's now thought that combinations of certain genes might make some people more vulnerable, but this doesn't mean they will necessarily develop the symptoms.
Dopamine – biochemical research has been centred on dopamine, which is one of the chemicals that carry messages between brain cells. The theory is that an excess of dopamine may be involved, but it's still not clear whether it has a role in the development of schizophrenia. However, neuroleptic drugs are designed to work on the dopamine system.
Family experiences and personality – parents of people with schizophrenia sometimes blame themselves, unnecessarily. Early experiences may affect the development of personality, but the idea that a particular type of family contributes to the development of schizophrenia is generally dismissed.
Stressful life events – studies and personal accounts suggest that very stressful or life-changing events may trigger schizophrenia. Being homeless, living in poverty, having no job, losing someone close to you, or being physically, emotionally, sexually or racially abused or harassed may be factors. According to one study, over half the people who heard negative voices said that sexual or physical abuse was a cause of their problem. Nearly a quarter of them thought that guilt at their own actions had triggered the negative voices.
Drug abuse – some people may develop symptoms of schizophrenia as a result of using cannabis or other street drugs. It has already been established that using cannabis, cocaine and amphetamines makes the problem worse.
Other causes – injury to, or physical differences in the brain may be linked to schizophrenia. But this could be either a cause or an effect. Research into other possible causes including viruses, hormonal activity (particularly in women), diet, allergic reaction or infection is either contradictory, inconclusive or applicable only in a few cases.
It's generally agreed that schizophrenia is probably caused by a combination of factors; someone's genetic make-up could make them more vulnerable, but stressful events or life experiences could trigger the onset of symptoms. However, there's no complete answer to why some people develop the symptoms, when other people do not.