What is Schizophrenia?

What is schizophrenia? The short answer is that no one knows. The effects are well documented even though they are not necessarily unique to schizophrenia. Since the term was first used by Eugen Bleuler in 1911, intense research has so far failed to identify the condition’s causes though it is thought to be a combination, in varying degrees, of genetic, environmental and neurological factors. This debilitating mental disorder is believed to affect about 1% of the World’s population and is generally first diagnosed in late teenage and early adulthood. For reasons not yet established more males than females are affected.

Not only is schizophrenia difficult to define but is without any confirmed pathological, molecular or genetic origin – it has no confirmed biological basis. Diagnosis is made from observed behaviours meeting the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-IV Axis 1) criteria. These criteria relate principally to the determination of an afflicted individual’s mental state, from their speech patterns and perceptions which may indicate possible hallucinations and/or delusions. This is supported by observed unusual behaviour which may affect the afflicted person’s ability to function effectively in the broader community. Therefore any diagnosis cannot be objectively “scientifically” proven, it is subjective - someone’s opinion and interpretation of behaviour. Furthermore it is not an illness which prescription medication can cure. It is certainly an unfortunate and debilitating condition but it is not an illness – and to call it such is misleading and wrong.

There appear to be many factors involved in the causes of schizophrenia. Obstetric complications, such as foetal hypoxia (foetus deprived of oxygen); viral infections the mother may have experienced during pregnancy; even the season of the year when giving birth, (winter being statistically the least favourable); the patient’s social status; even where the patient resides - in an urban or rural locality (urban being the least favourable), all appear to have a bearing on the incidence of this condition.

While not one single factor has been identified as common to all patients with the condition researchers are working on some evidence that schizophrenia may be a polygenic disorder (influenced by many genes) which is further influenced by environmental factors and a person’s emotional vulnerability while developing in teenage years. Stress appears also to be a factor in the development of schizophrenia as it is recognised in playing a significant role in many medical conditions. It is now thought, with some individuals, that certain levels of stress experienced may exceed their adaptive capacity and thus compound the vulnerabilities of the person concerned. Comments critical of the patient’s demeanour and behaviour together with the alternative of an over-protective relationship have a significant bearing on the course of schizophrenia – this is called a high level of Expressed Emotion. Some patient’s may suffer a relapse from a relatively stable condition which allowed for their discharge from a treatment centre. There is, however, no agreement on the meaning of relapse.

It is now known that people suffering schizophrenia are more likely to recover and less likely to suffer a relapse if they live in a calm, non-critical, non-overprotective environment – a low level of Expressed Emotion. It is well documented that early intervention programmes are of vital importance in determining a favourable outcome for schizophrenia patients but there appears to be no agreement on what recovery actually means. Recovery varies considerably in effect from individual to individual – is it a “clinical” objective recovery (decided by using DSM IV criteria) or an individual’s subjective assessment of their quality of life? It was believed that, once diagnosed with schizophrenia, there was no chance of recovery. There is now, however, a body of evidence suggesting that the situation, for many sufferers, may not be quite so dire, particularly with those individuals not using street drugs and not drinking to excess. With a correct balance between antipsychotic drug treatments and other psychosocial and psychological interventions it is now known that between 20% to 30% recover sufficiently to lead relatively normal lives, with a further 20% to 30% manifesting continuing moderate symptoms. Other reports show that the recovery rate is actually quite high though generally under-reported and is actually somewhere between 50% and 60%. All this shows that the “experts” still don’t really know.

Given the astonishing lack of knowledge about what causes schizophrenia, expressed emotion, relapse and recovery together with the limited understanding of how they relate to one another, how scientists can claim statistical “evidence” and validity proves anything is really surprising. Research is consistent in reporting that high levels of expressed emotion are likely lead to a relapse by patients with schizophrenia. Why this should be, however, is not fully understood. The many factors involved may possibly be partly genetic but certainly involve subjective elements which are difficult to define and measure. No one knows what it really means to recover or relapse nor is it understood from “what” a recovery or relapse is occurring! Also no one knows why high levels of expressed emotion (an “un-calm” environment) may be a predictor of a patient’s relapse.

A mental condition as complex as schizophrenia cannot be artificially restricted to fit the requirements of the DSM-IV. Nature will not be governed by man-made conditions which attempt to force it to answer questions required for statistical analysis to satisfy the ideals of “scientific research”. Statistics are unable to adequately assess the nuances and subtleties of words, gestures, feelings, imaginings, desires and beliefs that, in varying degrees, are so tied to and characteristic of each individual and which are known to have an effect on the outcome of schizophrenia and any relapse or recovery.

To force a patient suffering from schizophrenia to take medication – without knowing what the medication actually does or how it works (and with significant side effects) – is ethically questionable and quite wrong in my opinion. The better way is to look at the physical and emotional environment and conditions which spawned the patient’s affliction. It is necessary to find out what all this means to the patient – their interpretation of the events and how it has affected his or her thinking.

Schizophrenia is as much a mysterious condition as it was 100 years ago, certainly the "experts" have no idea what it really is or how to "cure" the condition.

Why is suicide considered a bad thing?

Amended September 11, 2018:

I know this is quite an old post but I strongly believe it is as relevant as ever. Some people do commit suicide and this has surely happened since humans first walked the earth.

This is not a treatise on the causes or possible reasons for suicide but the complexities behind the act have puzzled me for many years. In particularly our seeming abhorrence and our obvious dismay, regret and great sadness that anyone should even contemplate the need to end their life, by whatever means has taxed my understanding and the meaning of my life.

What follows below is my considered opinion:-

I ask the question – why is suicide considered such a bad thing? Now I am not advocating that anyone should commit suicide. I am just trying to pick apart the emotional clutter that accompanies this very personal and private act. The only answers I get are that it is a waste of a (usually) young person’s life; that they were loved; that they had unlimited potential, now never to be realised; that they had a future to live for – etc., etc.

This is partially correct but is not a real answer. The person concerned – the person now deceased – obviously had a different view of life. Their view, which I am not discussing (I have no idea what that was); I am discussing our view; that of the outsider; the ones left behind.

Why do we “outsiders” (I deliberately use this word because we are “outside’ that person’s inner world) consider suicide to be such a bad thing? Are we affronted because someone considers living – in their current situation – to be so bad, so threatening, so limiting as to be not worthwhile continuing? Are we discomforted because this rejection, this dismissal of all we has striven for (in “our” world), may reflect poorly on us, those left behind, regarding the way we have organised the world? Are we disturbed by the confronting prospect of having to admit that we make mistakes and that the way in which the economy, our legal, welfare and education systems are set up may actually cause distress, that we are not always fair or just in our dealings? Do we feel guilty that we have developed a financial system that promotes the massive imbalance between the very wealthy and the very poor and the disadvantaged?

We have to recognise that we are all, all, party to the ills of the world. We created them. If we look with even a modicum of insight we should see in ourselves the cause of these short comings and see ourselves reflected in the eyes of the distressed. And we should be dismayed.

Is this why we consider suicide a “bad thing” and are so shocked when it occurs?

It is needful to remember that we, each one of us, have our own experiences of life. These are our own. No one can see the world through our eyes with the same imagery and emotional response. No one can see the world through our eyes with our life experiences and our interpretations of those experiences – these are our own.

So I ask the question again – why is suicide considered such a bad thing? Obviously for the person concerned the prospect of death is more alluring than continuing living as currently experienced. What is “wrong” with that? It is their choice.

Then for some to say that only God can decide when or where a person dies is surely a gross over assumption - how do they know? What special insight do they possess? Is it not possible, because (I assume) God gave us free will that God may have already decided to allow a person who wants to die, to die?

Furthermore to declare (as some authority figures do) that most people who commit suicide suffer from a mental "illness" or disorder is surely wrong. It is also highly presumptuous on the part of the person making such a declaration – how do they ACTUALLY know! This is categorising a person, who now has no recourse or ability to refute the presumption. This is putting a label on someone. And then what about those “outsiders” left behind to live with the event – the family and friends? Are they to be made to suffer further pain with the stigma provided by so called experts who provide the “knowledge” that their son, daughter, friend, brother, sister “must have been mentally deranged” to have committed such an act. This implies that no “normal” person would ever do such a thing! What about self-sacrifice when there is loss of life? Isn’t this an act of suicide? But if it saves the life of others it is considered “noble”!! ("There is no greater love than this, that a man should lay down his life for his friends" - English King James Bible: John 15:13).

Research on completed suicides is notoriously difficult. It is always referring to an historic act – something that has already happened. Police, coronial, autopsy, psychiatric and psychological and counselling reports are analysed and carefully combed to try and establish some reason or motive for the suicide. This is fraught as it is impossible to know what was actually going through the person’s mind at the precise moment in time when they took their own life. At that moment they made a choice. Why? We can never know.

Shall we now look at what suicide actually is? Someone taking their own life – right? It seems that the “act” is only considered suicide if it results in the quick death of the person concerned. But what about those who commit suicide in the “long term”? Those who drink or drug themselves to death over a number of years, what about them? They may suffer from abuse, or from unbearable pressures associated with their domestic arrangements or at work. They may determine that the easiest and most “socially acceptable” way of easing this pressure or pain, is to get drunk or to get “stoned” on a regular basis. It may take some time but in possibly five or ten years they will be dead.   The emotional (and economic) “cost” of this (“long term suicide”) far exceeds that of any number of “quick” suicides.

To get back to the “mental illness or disorder” accusation. Disordered from what? What are these people supposed to be disordered from? From “normal”? As far as I can discover there is no accepted definition of “normal”. Possibly those considered “disordered” react to life’s trials and tribulations differently from those around them. Are they wrong? Or are we “outsiders” just being intolerant and lacking in understanding or compassion? Maybe these people are just eccentric – God knows there are enough odd ball people in the community!! Some behaviour may be considered mal-adaptive or possibly anti-social by “outsiders” but not by the people concerned – otherwise they wouldn’t act the way they do!

Similarly, why should anyone "live" according to another's expectations?  

There is an essay, “Suicide”, by the Scottish philosopher David Hume (1711 – 1776) wherein he wrote, “I believe that no man ever threw away Life while it was worth keeping.”

What follows below is a warning relating to anti-depressant drugs:-

USA Federal Drug Administration Product Information Warning

Patients with major depressive disorder, both adult and pediatric, may experience worsening of their

depression and/or the emergence of suicidal ideation and behavior (suicidality), whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs. Although there has been a long-standing concern that antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients, a causal role for antidepressants in inducing such behaviors has not been established. Nevertheless, patients being treated with antidepressants should be observed closely for clinical worsening and suicidality, especially at the beginning of a course of drug therapy, or at the time of dose changes, either increases or decreases.

Consideration should be given to changing the therapeutic regimen, including possibly discontinuing the medication, in patients whose depression is persistently worse or whose emergent suicidality is severe, abrupt in onset, or was not part of the patient’s presenting symptoms.

From the above it is apparent that psycho-pharmceutical medications are not always the answer!

Finally I will repeat a quote, from the Indian sage Jiddu Krishnamurti (1895-1986), who said, "It is no measure of health to be well adjusted to a profoundly sick society"

There we have it - in a nutshell!