comerfund8e

Chapter 12 Introduction

384

CHAPTER 12

385

TOPIC OVERVIEW

The Clinical Picture of Schizophrenia

What Are the Symptoms of Schizophrenia?

What Is the Course of Schizophrenia?

How Do Theorists Explain Schizophrenia?

Biological Views

Psychological Views

Sociocultural Views

How Are Schizophrenia and Other Severe Mental Disorders Treated?

Institutional Care in the Past

Institutional Care Takes a Turn for the Better

Antipsychotic Drugs

Psychotherapy

The Community Approach

Putting It Together: An Important Lesson

Schizophrenia

Laura, 40 years old: Laura’s desire was to become independent and leave home ….s soon as possible…. She became a professional dancer at the age of 20 ….nd was booked for ….heaters in many European countries….

It was during one of her tours in Germany that Laura met her husband…. They were married and went to live in a small ….own in France where the husband’s business was…. She spent a year in that town and was very unhappy…. [Finally] Laura and her husband decided to emigrate to the United States….

They had no children, and Laura ….howed interest in pets. She had a dog to whom she was very devoted. The dog became sick and partially paralyzed, and veterinarians felt that there was no hope of recovery…. Finally [her husband] broached the problem to his wife, asking her “Should the dog be destroyed or not?” From that time on Laura became restless, agitated, and depressed….

Later Laura started to complain about the neighbors. A woman who lived on the floor beneath them was knocking on the wall to irritate her. According to the husband, this woman had really knocked on the wall a few times; he had heard the noises. However, Laura became more and more concerned about it. She would wake up in the middle of the night under the impression that she was hearing noises from the apartment downstairs. She would become upset and angry at the neighbors…. Later she became more disturbed. She started to feel that the neighbors were now recording everything she said; maybe they had hidden wires in the apartment. She started to feel “funny” sensations. There were many strange things happening, which she did not know how to explain; people were looking at her in a funny way in the street…. She felt that people were planning to harm either her or her husband…. In the evening when she looked at television, it became obvious to her that the programs referred to her life. Often the people on the programs were just repeating what she had thought. They were stealing her ideas. She wanted to go to the police and report them.

(Arieti, 1974, pp. 165–168)

Richard, 23 years old: In high school, Richard was an average student. After graduation from high school, he [entered] the army…. Richard remembered [the] period ….fter his discharge from the army ….s one of the worst in his life…. Any, even remote, anticipation of disappointment was able to provoke attacks of anxiety in him….

Approximately two years after his return to civilian life, Richard left his job because he became overwhelmed by these feelings of lack of confidence in himself, and he refused to go look for another one. He stayed home most of the day. His mother would nag him that he was too lazy and unwilling to do anything. He became slower and slower in dressing and undressing and taking care of himself. When he went out of the house, he felt compelled “to give interpretations” to everything he looked at. He did not know what to do outside the house, where to go, where to turn. If he saw a red light at a crossing, he would interpret it as a message that he should not go in that direction. If he saw an arrow, he would follow the arrow interpreting it as a sign sent by God that he should go in that direction. Feeling lost and horrified, he would go home and stay there, afraid to go out because going out meant making decisions or choices that he felt unable to make. He reached the point where he stayed home most of the time. But even at home, he was tortured by his symptoms. He could not act; any motion that he felt like making seemed to him an insurmountable obstacle, because he did not know whether he should make it or not. He was increasingly afraid of doing the wrong thing. Such fears prevented him from dressing, undressing, eating, and so forth. He felt paralyzed and lay motionless in bed. He gradually became worse, was completely motionless, and had to be hospitalized….

Being undecided, he felt blocked, and often would remain mute and motionless, like a statue, even for days.

(Arieti, 1974, pp. 153–155)

386

schizophrenia A psychotic disorder in which personal, social, and occupational functioning deteriorate as a result of unusual perceptions, odd thoughts, disturbed emotions, and motor abnormalities.

psychosis A state in which a person loses contact with reality in key ways.

Eventually, Laura and Richard each received a diagnosis of schizophrenia (APA, 2013). People with schizophrenia, though they previously functioned well or at least acceptably, deteriorate into an isolated wilderness of unusual perceptions, odd thoughts, disturbed emotions, and motor abnormalities. Like Laura and Richard, people with schizophrenia experience psychosis, a loss of contact with reality. Their ability to perceive and respond to the environment becomes so disturbed that they may not be able to function at home, with friends, in school, or at work (Harvey, 2014). They may have hallucinations (false sensory perceptions) or delusions (false beliefs), or they may withdraw into a private world. DSM-5 calls for a diagnosis of schizophrenia only after the symptoms of psychosis continue for six months or more (see Table 12.1).

As you saw in Chapter 10, taking LSD or abusing amphetamines or cocaine may produce psychosis. So may injuries or diseases of the brain. And so may other severe psychological disorders, such as major depressive disorder or bipolar disorder (Pearlson & Ford, 2014). Most commonly, however, psychosis appears in the form of schizophrenia.

Actually, there are a number of schizophrenia-like disorders listed in DSM-5, each distinguished by particular durations and sets of symptoms (see Table 12.2). Because these psychotic disorders all bear a similarity to schizophrenia, they—along with schizophrenia itself—are collectively called schizophrenia spectrum disorders (APA, 2013). Schizophrenia is the most prevalent of these disorders. Most of the explanations and treatments offered for schizophrenia are applicable to the other disorders as well (Potkin et al., 2014).

Approximately 1 of every 100 people in the world suffers from schizophrenia during his or her lifetime (Long et al., 2014). An estimated 26 million people worldwide are afflicted with it, including 3 million in the United States (MHF, 2015; NIMH, 2010). Its financial cost is enormous, and the emotional cost is even greater (Kennedy et al., 2014). In addition, people with schizophrenia have an increased risk of suicide and of physical—often fatal—illness (Dickerson et al., 2014). On average, they live 20 fewer years than other people (Laursen et al., 2014).

387

Although schizophrenia appears in all socioeconomic groups, it is found more frequently at the lower economic levels (Burns, Tomita, & Kapadia, 2014; Sareen et al., 2011) (see Figure 12.1). This has led some theorists to believe that the stress of poverty is itself a cause of the disorder. However, it could be that schizophrenia causes its sufferers to fall from a higher to a lower socioeconomic level or to remain poor because they are unable to function effectively. This is sometimes called the downward drift theory.

Figure 12.1: figure 12.1 Socioeconomic class and schizophrenia Poor people in the United States are more likely than wealthy people to experience schizophrenia. (Information from: Sareen et al., 2011.)

Equal numbers of men and women are diagnosed with schizophrenia. The average age of onset for men is 23 years, compared with 28 years for women (Lindenmayer & Khan, 2012). Almost 3 percent of all those who are divorced or separated suffer from schizophrenia sometime during their lives, compared with 1 percent of married people and 2 percent of people who remain single. Again, however, it is not clear whether marital problems are a cause or a result (Solter et al., 2004).

People have long shown great interest in schizophrenia, flocking to plays and movies that explore or exploit our fascination with the disorder. Yet, as you will read, all too many people with schizophrenia are neglected in our country, their needs almost entirely ignored. Although effective interventions have been developed, those sufferers live without adequate treatment and may never fully fulfill their potential as human beings.