Schizophrenia is an accursed debilitating illness that continues to defy a “cure”. The term schizophrenia was coined by Eugen Bleuler a Swiss psychiatrist a century ago. Bleuler constructed the term from the Greek words Schizen and phren meaning split and mind respectively. Perhaps it’s this origin of the word that perpetuates the enduring myth that schizophrenia equals split personality.
And yet you don’t have to look far to get the facts on schizophrenia. Even Wikipedia makes a reasonable attempt at defining schizophrenia. A more reputable source is the psychiatrists’ bible: the Diagnostic and Statistical Manual of Mental Disorders, in short, the DSM-IV.
Whilst we shouldn’t generalize about schizophrenia, there is sufficient accord among the professors that the condition is typically characterized by what’s termed a fundamental disturbance in personality. A disturbance, not a split in one’s personality. First onset often occurs (though not always) in late adolescence or early adulthood. People experiencing schizophrenia typically have positive or negative symptoms. Positive symptoms are hallucinations, false beliefs and thought disorder or negative symptoms are loss of motivation, social withdrawal and poverty of thought. We’ve all seen someone acting in a bizarre way on the tram or train or shopping mall, perhaps muttering to himself or laughing for no apparent reason. Such people may be disheveled and malodorous or often they may not. Seldom do they pose a threat to anyone.
Even academics, writers, poets and other wordsmiths who should know better, deliberately or inadvertently trivialize schizophrenia whenever they declare they have a “schizophrenic” attitude towards some issue. That is, they entertain an ambiguity about reaching a conclusion or making a decision. If only it was so simple. Unfortunately the reality that is the lived world of schizophrenia and psychosis is much more complex.
When I was a student psychiatric nurse back in the 1980s, Carlos, a psychotic twenty-two year-old, already institutionalized, and who had a diagnosis of schizophrenia confronted me one morning, screaming that I give him back his nose. There was nothing was wrong with his nose and nothing ambivalent either about Carlos’s perception of his problem.
Three decades on, myths and misunderstandings of schizophrenia persist. It is perhaps one of the last taboos in our society. Despite a better understanding and acceptance of conditions like anxiety, depression and bipolar affective disorder, schizophrenia stubbornly remains misunderstood and feared.
Could it be that Robert Louis Stevenson’s novella Dr Jekyll and Mr. Hyde, originally published in 1886, which sold an astonishing 250,000 copies in the US alone, has given rise to the persisting enduring fallacy that is the split personality? This good and evil dichotomy. It seems extraordinary that this should be so.
There is no ongoing confusion about medical conditions such as diabetes or cancer. Nor should there be. These illnesses attract and generate, quite rightly, research funding and resources. What will it take to demystify mental illness and to move it up a few more notches in realm of public perception and acceptance? That answer, I’m afraid probably doesn’t reside in the laboratory or in more research dollars.
We can take some consolation that we have moved on from the practice in previous generations of denying the existence of relatives who were institutionalized for the remainder of their days. And over the past decade the pharmaceutical industry has been particularly busy. Psychiatric medication is big business. For there is no shortage of hopeful consumers and hopeful carers. We had a new generation of antipsychotic medication, arguably with less severe side effects, but with significant side effects (in some cases irreversible) all the same. Medication alleviates the symptoms but medication does not cure the underlying illness.
Where can we go from here? Schizophrenia isn’t going away. Approximately one out of one hundred people will be diagnosed with schizophrenia during their lives. There are stories of family heart ache, loved ones with lost potential and twilight existences. Substance abuse, licit and illicit, generally complicates the picture. People with schizophrenia are also prone to having relapses. The vast majority will need to take antipsychotic medication for the rest of their lives.
Sobering stuff I know. But to sugarcoat the reality of schizophrenia is, I believe, disingenuous and dishonest. Those among us who live with schizophrenia will go on managing as best they can. They have no choice. The least we can do is to afford them the courtesy to pay more than lip service and ditch those millennium old clichés about schizophrenia. It’s not much, is it? But perhaps it’s a modest start.