What is Schizophrenia

Schizophrenia is one of the most complex and difficult mental diseases ever known; it is difficult to diagnosis and even more difficult to know its causes. Theorists and scientists have mentioned different reasons and causes behind this disease and these hypotheses have been dramatically changed throughout the history. What is schizophrenia and what causes this disease? Is there a reason or a range of reasons behind it? Is the causes are genetic, biochemical, behavioural, or environmental? In order to find a reliable or at least an acceptable answer to this question, this short essay tries to analyse different theories and hypotheses about schizophrenia.

Schizophrenia is a severe disease of brain; it is common to a degree as it affects 1% of population with similar numbers of males and females. It affects poor more than rich people. It is not a split personality as it was thought, but it is a split from reality. It is a chronic disease and even hard to treat, however it is controllable with medications nowadays. As there is not a special known cause for schizophrenia, many suggestions and hypotheses have been made throughout the history, starting with myth and magic and continuing with the latest technology of the 21st century.

Although there are still mysteries surrounding schizophrenia, it is not a new illness. Symptoms relating to schizophrenia have been noted since the age of antiquity. A popular belief was that strange behaviour was a result of possession by the devil or assaults from the gods for immoral behaviour. [History of schizophrenia, online]

Patients of schizophrenia are diagnosed with positive and negative symptoms: positive symptoms are hallucinations, delusions and thought disturbances, and negative symptoms are loss of energy, lack of expressed emotions and prevention from talking, especially in the sever stages. However it is not easy to diagnose a patient for schizophrenia at the first place because:

It usually comes on very slowly and so the personality of the person developing it changes very slowly. Often the patient is quite normal. It is therefore difficult to detect disease at such times. Sometimes when the disease is quite advanced and the true personality of the patient quite overlaid by the ill personality, the ill personality may be mistaken by doctors as the true personality. [Schizophrenia Association of Great Britain, online]

Some scientists argue that the cause of schizophrenia is genetic. They have carried out researches on twins and collected useful data. The US Surgeon General’s Report on Schizophrenia found out that there are great possibilities for identical twins more than fraternal twins and coming down to lower possibilities to end in 1% in general population. [See Appendix 1]

The same report gave further details to emphasis the genetic cause of schizophrenia by saying:

Family, twin, and adoption studies support the role of genetic influences in schizophrenia. Immediate biological relatives of people with schizophrenia have about 10 times greater risk than that of the general population. Given prevalence estimates, this translates into a 5 to 10 percent lifetime risk for first-degree relatives (including children and siblings) and suggests a substantial genetic component to schizophrenia [US Surgeon General's Report on Schizophrenia (2002) online]

However the available data cannot suggest that the cause of schizophrenia is wholly genetic, if it was so the rate should be 100% in identical twins, as they have the same genes. Holding a gene may put somebody in danger but it is not the only cause, as Turner said:

The diathesis stress model of mental illness suggests that inheritance can put people at risk; however, stress may also play a part. [Turner, 2003: 73]

The US Surgeon General’s Report on Schizophrenia also mentioned other causes together with genetic causes for schizophrenia, however the main cause or the basic one is still genetic, as they argue:

Current research proposes that schizophrenia is caused by a genetic vulnerability coupled with environmental and psychosocial stressors, the so-called diathesis-stress model. Family studies suggest that people have varying levels of inherited genetic vulnerability, from very low to very high, to schizophrenia. Whether or not the person develops schizophrenia is partly determined by this vulnerability. [US Surgeon General's Report on Schizophrenia (2002) online]

However, the research in this field continues and still it is not clear either a single gene or a group of genes are responsible for this illness.

The chemical balance of the body suggests another hypothesis for the cause of schizophrenia. Biochemical theorists argue that a high rate of neurotransmitter dopamine is the cause of this disease. This argument comes after they have treated patients with Parkinson’s disease by dopamine. They noticed that:

Drug treatments to increase dopamine levels in Parkinson’s patients can have side effects similar to the symptoms of schizophrenia. [Turner, 2003: 73]

They have also noticed that the antipsychotic drugs which reduce the levels of dopamine can be used to reduce the symptoms of schizophrenia. They based their arguments on post-mortems which suggest that “schizophrenic patients have high levels of dopamine in their brains. Drug users who take amphetamines and cocaine have symptoms similar to schizophrenia, and these drugs are known to increase dopamine levels. [Turner, 2003: 73-74]

However these findings cannot solve the problem of schizophrenia, because it cannot be established either excess to dopamine causes the disease nor does the disease itself affects the levels of dopamine? As the US Surgeon General”s Report said:

Excessive levels of the neurotransmitter dopamine have long been implicated in schizophrenia, although it is unclear whether the excess is a primary cause of schizophrenia or a result of a more fundamental dysfunction. More recent evidence implicates much greater complexity in the deregulation of dopamine and other neurotransmitter systems. [US Surgeon General's Report on Schizophrenia (2002) online]

It can be argued that the abnormality of the brain may cause from some difficulties during birth, as it is possible for the baby’s head to be hurt during birth. Smith, et al., said:

These abnormalities in brain structure and neurochemical functioning could be due to genetics, but they also could be the result of insults to the brain of a fetus or young child. [Smith, et al., 2003:553]

There are further explanations for the causes of schizophrenia, all these studies are emphasising on the circumstances when the fetus’ brain has formulated or during the birth, as Jablnesky (2000) said:

Studies have found that people who have schizophrenia are more likely to have a history of birth complications, prenatal brain damage, infections in the central nervous system (such as meningitis) in infancy, and maternal pregnancy complications or influenza in pregnancy (Jablensky, 2000 Cited in Smith, et.al, 2003:553-555)

The psychodynamic approach’s view to schizophrenia is similar to their views to other psychological disorders. Freud believed that schizophrenia is a result of the conflict between the ego, id and superego; the ego is besieged by either id or superego. The ego returns back to childhood and the person acts as a baby, by trying to emphasis his/her self-importance. In this conflict fantasies become confused with reality.

Freud’s ideas on schizophrenia are not supported by scientific evidence, as Turner said:

Unfortunately there is no scientific evidence to support Freud’s ideas on schizophrenia. Stirling and Hellewell (1999) point out that schizophrenic behaviour is not similar to infantile behaviour. Research has not found a correlation between early childhood experiences and a subsequent diagnosis. [Turner, 2003: 74]

The behaviourists explain schizophrenia as a learned response. They believe that schizophrenia is reinforced in those patients who show the symptoms as any other behaviour. As Turner said:

The disorder develops through a process of operant conditioning. Bizarre behaviour gains attention from other people so may be reinforced more than normal behaviour. Through a process of social learning, patients in hospitals may also observe and imitate the behaviour of other schizophrenics. [Turner, 2003: 75]

This approach cannot explain how schizophrenic symptoms have come into view at the first place. It can be argued that they cannot give a good reason why different patients show different symptoms not the same learned symptoms, as they argue.

Schizophrenia is mainly accompanied by language, thought, attention and awareness disturbances. This leads the cognitive psychologists to argue that it causes from problems in the information process of the individual. The brain of the schizophrenic patients cannot tolerate all the mass information that surrounds them from everywhere. As a result of this, the patient withdraws from the reality, as they argue, and becomes catatonic:

Pickering (1981) proposed that catatonic schizophrenia may be caused by a breakdown in auditory selective attention, making social interaction increasingly difficult, as the individual is overloaded with auditory information. Pickering believes that withdrawal from the world is the only way for catatonic schizophrenics to keep sensory stimulation at a manageable level. [Turner, 2003: 76]

Cognitive psychologists can give a good description of the schizophrenic language and information process, however they cannot explain why these cognitive changes are happening and what are the real causes of these cognitive changes. The schizophrenic symptoms are not only limited to adults, they appear in children also, in this context, it can be argued that they are not successful in their explanation. The report of the Surgeon General said:

These cognitive problems vary from person to person and can change over time. In some situations it is unclear whether such deficits are due to the illness or to the side effects of certain neuroleptic medications (Zalewski et al., 1998). As research on brain functioning grows more sophisticated, some models posit dysfunction of fundamental cognitive processes at the centre of schizophrenia, rather than as one of numerous symptoms (Andreasen, 1997a, 1997b; Andreasen et al., 1996). [Mental health: A report of the Surgeon General-Chapter 4(online)]

There are sociocultural theories about schizophrenia, Szasz (1962) claims that there is no any disease called schizophrenia. He believes that the behaviour of those people is strange and out of control, so they classify them as mentally ill, and labelling them in that way. [Turner, 2003]

Scheff (1966) also argued that as individuals are diagnosed with mental illness, they grow the symptoms, he believed that people do and act according to the expectations from them; calling them mentally ill creates a stigma and isolates them socially. [Turner, 2003]

Labelling theory contributes in diagnosing the schizophrenic patients; however they cannot give a clear understanding for this serious mental disease. It can be argued that labelling may influence people’s behaviour in one way or the other, but for a brain disease such as schizophrenia it is not sufficient.

Schizophrenia is more observed in poor people and those who live in miserable conditions. This leads some psychologists to argue that environmental stressors are the causes of the disease. US Surgeon General’s Report on Schizophrenia confirms the role of behaviour and life experiences in affecting the mind, by saying:

Not only does brain biology influence behaviour and experience, but behaviour and experience mould brain biology as well. {US Surgeon General’s Report on Schizophrenia (2002) [online]}

There is no scientific basis to confirm that stressful and difficult life conditions are direct causes of schizophrenia, however patients with schizophrenia can be affected by these situations and they may boost their illness. As Smith et al., said:

Although it is clear that stressful events cannot cause a person to develop the full syndrome of schizophrenia, psychological factors may play an important role in determining the eventual severity of the disorder in people with a biological predisposition, as well as in triggering new episodes of psychosis. [Smith et al., 2003: 555]

In this context, environmental conditions may make the situation worse for people with schizophrenic grounds such as holding genes. From this point of view improving life conditions may help individuals with most possibilities of being affected by the diseases, as US Surgeon General’s Report on Schizophrenia said:

Since life stresses can exacerbate the course of the illness, access to good quality services and social supports, as well as attention to relapse prevention interventions, can have beneficial effects on longer-term outcome. {US Surgeon General’s Report on Schizophrenia (2002) [online]}

However, it can be argued that the rich people catch the disease in the same scale as the poor people, but the rich people are hiding their weak sides and they are in control of the means to do so.

Schizophrenia is a disease of mind; it may have different causes and may need different factors to be combined together in an individual in order to show the symptoms. Researchers are on the way but still there is not a special known cause for it. However there are good improvements in treating or controlling the disease.

As promising as these theories are, the causes and mechanisms of schizophrenia remain unknown. Nonetheless, research has uncovered several of treatments for schizophrenia that are effective in reducing symptoms and functional impairments. {US Surgeon General’s Report on Schizophrenia (2002) [online]}

It can be argued that schizophrenia is a result of holding a gene and being subject to environmental stresses and social deprivations. There may be other reasons for the disease and researchers are studying this serious and chronic mental disease in many parts of the world. The US Surgeon General’s Report on Schizophrenia combines the causes of the disease as:

Current research proposes that schizophrenia is caused by a genetic vulnerability coupled with environmental and psychosocial stressors, the so-called diathesis-stress model. Family studies suggest that people have varying levels of inherited genetic vulnerability, from very low to very high, to schizophrenia. Whether or not the person develops schizophrenia is partly determined by this vulnerability. At the same time, the development of schizophrenia also depends on the amount and types of stresses the person experiences over time. {US Surgeon General’s Report on Schizophrenia (2002) [online]}