Can a Mind be Sick? A Discussion of Schizophrenia
In a recent essay, Imprisoning the Mentally Ill, I wrote about the fact that some patients suffering with Schizophrenia refuse their medications and, without adequate community mental health facilities nationwide, they end up in prison after they relapse. One reader wrote in that he was one of those people who refuse medication and ended his comment with a significant question: "Can a mind be sick?"
In a book entitled The Myth of Mental Illness, psychiatrist Thomas Szasz wrote that there is no such thing as a mental illness. Later, psychologist David Rosenhan conducted a now famous experiment in which graduate students in his class voluntarily signed themselves into mental institutions complaining of symptoms typical of schizophrneia. Once admitted, they behaved in ways that were perfectly normal. None of the staff noticed that anything was wrong. In other words, staff continued to view the new admissions as mentally ill. This study actually resulted in much greater care being used in hospital admissions with a much more clearly defined set of criteria being used before diagnoses are made. The name of this famous article is "On Being Sane in Insane Places."
Presently, there are web sites and blogs that argue that anti psychotic medications are misused and not necessary. In fact, one psychologist insists that he has been able to cure schizophrenia with psychoanalysis and that schizophrenic symtpoms are a metaphor for issues that the patient is unable to directly discuss.
Schizophrenia: Can a mind be sick?
Unfortunately, the answer is yes. The mind is a construct that has its roots in the human brain. We know that the brain is extremely complex, made up of two billion neurons or nerve cells. Each neuron has dendrites, or wiggly little fibers that stretch into a space called a synapse. There are trillions of these dendrites and they help carry messages along the neurons to the processing centers of the brain. These processing centers interpret information coming in from all parts of the body. Some of the information originates in the body and lets us know that we are hungry, tired, etc. Other information originates outside of the body and is carried inside from places like our eyes, hands, noses, mouths and ears: sight, touch, smell, taste and hearing. All of the information, whether it originates from outside or inside the body, is carried to the brain through the intricate network of neurons that run throughout the body and the brain. In the brain, the information is processed, and interpreted or given meaning. For example, we hear many sounds and are aware of them. However, the brain helps us distinguish between those sounds that are noise, others speech and others music. The process becomes very complex because what one person hears as wonderful music, let us say a teenager, another person may interpret as being noise. In this way, we interpret or give meaning to the stimuli we are receiving.The same process goes on for each of the five senses. We know when we are hearing music as opposed to a loud and unpleasant noise. Of course, to some of us, that which is music is noise to others.
The brain is an organ of the body. As the Gestalt psychologists have said, "the whole is greater than the sum of its parts." Therefore, out of the organ called the brain springs something we refer to as the mind of each human being. If the brain is not working properly then the mind cannot work properly. In the complicated process described above, we depend upon our sensory organs, bodies and our brains to make sense of the world. If the parts of the brain that are designed to carry information to its processing centers are damaged or malfunctioning, we become unable to make real sense of what is happening. In addition, if the parts of the brain governing the processing and interpretation of information are damaged then we cannot think accurately.
Medical science has shown that the brains of people suffering from schizophrenia have neurons and dendrites that have been damaged. The location in the brain where the damage occurs determines which types of hallucinations and delusions a person experiences. If the neurons in the parts of the brain that handle sound and verbal communication are damaged, the patient may experience auditory halllucinations or voices telling them a story or ordering them to do certain acts. To the patient, these auditory hallucinations are just as real as when the rest of us hear our friends talking to us.
What I have learned during my many years working in mental health is that those individuals who developed schizophrenia when they were in their late teens or during their twenties are keenly aware that what they are hearing are hallucinations. They do not have to be convinced and many feel frightened by the voices. However, those individuals who developled childhood schizophrenia and who never knew that there was a different way to experience life, truly believe their voices and are never convinced that the hallucinations spring from their brain. In a way, they learn through life experience, to just say "yes" to their psychiatrists and therapists while firmly believing their psychotic experiences.
What strikes me as most significant about all of this is that the illness we refer to as schizophrenia completely distorts an individual's view of the real world into something that does not exist, except in their mind. This can lead to dangerous consequences and I am not referring to violence against other people. In fact the incidence of violence stemming from those with schizophrenia is no higher than in the normal population. Actually, what is troubling is that this illness, which causes such complete misjudgement of reality, can, and sometimes does, lead to self harm.
I will never forget an incident that occurred very early in my career. A young man who was a patient at the day hospital and responded well to his medications, left treatment, stopped his medications and was not heard from again despite the best efforts of the staff to find him. Then, one day, months later, there was a news report about a man whose arm was bitten off by a lion at the zoo. It seemed that this man climbed into the lion exhibit, called the African Plains, and sat down to have a discussion with a lion. Let me emphasize that there was nothing humorous about this. He was attacked and it was a miracle that he was not killed. It seems that he was responding to auditory hallucinations that his deceased father came back into life in the form of the lion. The voices commanded him to talk to his father (the lion) directly.
Is Schizophrenia Curable?
I believe it is a mistake to make generalizations and dire conclusions about what can happen to any human being. I am old enough to have experienced friends, relatives and patients being told their deaths were imminent, only to have them live for many years afterward.
First, I am not alone in believing that one day there will be a more complex diagnostic set of criteria for many more types of schizophrenia than we are now aware of. The reason I believe this is that all the studies show that there are a myriad of different ways the brain is affected that bring about the symptoms of this disease. Also, there is a wide variety in the intensity of this disease and in my experience, there are those who suffer greatly while others are affected to a much lesser degree. Finally, I have seen a few who are able to improve on medication to such a degree that they really can return to work, family and functioning with a minimum of interference from symptoms. So, to answer the question about whether or not this illness is curable, I would say, sometimes, depending multiple factors.
More important to the question of a cure is a related question: is it possible for patients to become well enough to resume a somewhat normal life. Here, my answer would be yes but, again, it would depend on having family, friends and mental health centers that are supportive.
One of the most supportive of centers for those suffering from this illness is called Fountain House. This organization is located in New York City but their are "Club Houses" throughtout the nation that are designed to help people with schizophrenia adjust to life in the community. What is nice about them is that a person need not have an MD's prescription to attend. Anyone with a psychotic illness can attend. For the family and loved one's of people with these illnesses, there is a national organization that provides support called FAMI and that refers to "Families of the Mentally Ill." There is also a related organization called NAMI or the "National Alliance for Mental Illness." These and many more resources can be found on the Internet where you can find local meetings in your community.
It is also important to know that schizophrenia is a chronic disease marked by the fact that it does not go away. Having made this statement it is important to add that there are those people who experience a brief psychotic experience complete with halllucinations, without ever having a repeat episode. However, these individuals do not have schizophrenia.
What Causes Schizophrenia?
Many theories and ideas abound about the causes of this and other psychotic illnesses. However, it remains unclear what really causes this debilitating sickness. Increasingly, articles are appearing suggesting that some type of virus affects the brain of the fetus in utero and leads to schizophrenia.
There is always the question of genetics and there are some indications that this illness runs in families and is, therefore, inherited.
The old argument comes to mind about what most affects our mental health, nurture or nature. Nurture refers to environmental factors, such as a virus or child abuse, versus nature, which refers to genetics or the genes we inherit from our parents and grandparents. Of course, there could be a combination of both factors. When the discovery or discoveries are made about the causes of this dread illness we might be able to cure and certainly be able to prevent this psychosis from occurring again.
In the meantime, medications, supportive psychotherapy, supportive and involved families, and centers such as Fountain House or Clubs, FAMI and NAMI are available.
Your comments and opinions are encouraged.