Schizophrenia is one of the most challenging mental disorders. This paper begins by discussing the mental disorder, using the criteria outlined in the DSM-V classification. The history of the disorder is explored in terms of symptoms, prevention and treatment. Further, the paper delves into modern approaches to prevention and treatment of schizophrenia. An analysis of the cross-cultural context shows that schizophrenia equally affects all ethnic groups, though perception of the causes of the disorder varies across cultures. The exhibition of the symptoms is also shown to depend on the cultural values of the respective societies. Lastly, the biblical view on schizophrenia is analysed, where the disorder is perceived as a result of sin and a manifestation of the evil spirit. The Bible prescribes living a sinless life and seeking divine intervention to exorcise evil spirits as the cure for schizophrenia. Since no holistic medical treatment approach has been developed, future research should focus on how genetic variation can help to improve treatment.
Keywords: schizophrenia, mental disorder, delusion, neurotransmitters
Schizophrenia is a mental disorder that involves a breakdown in the connection between emotional and cognitive processes and behaviour with the subsequent false perception, feelings, inappropriate actions and collapse in personal relationships. Schizophrenia is diagnosed according to five criteria established by the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). The first criterion in this classification deals with the characteristic symptoms. Thus, an individual is diagnosed with the disorder if two or more of the following five symptoms are persist for at least one month. The first characteristic symptom is delusions. The individual displaying this symptom strongly holds false beliefs in spite of invalidating evidence. The individual might be excessively paranoid or have a false belief that he/she has a special power and abilities. The individual also exhibits hallucinations, disorganised speech, catatonic behaviour or negative behaviour, such as low energy.
The second criterion refers to social and occupational dysfunction. The individual suffering from schizophrenia displays a lower level of social and occupational activity as compared to the period before the onset of the condition. The individual might exhibit less interest in interpersonal relations or low energy at work. The third criterion is the duration of the characteristic symptoms listed in the first criterion for at least 6 months. The fourth criterion is the existence of a general medical disturbance that does not arise from the direct physiological effects of a substance such as medication or drug abuse.
Historical Context of Schizophrenia
The history of schizophrenia dates back to ancient times, though the disorder was first named schizophrenia only in 1911 (Osbv, 2012). Before that time, the disorder was described only by symptoms. People believed that it was caused by possession of an evil spirit or involvement with the devil.
The early treatment of schizophrenia was quite barbaric due to the initial bad perception of the disorder. People perceived to have the disease were starved, exorcised or burned. In some cases, holes were made in their skulls to exorcise the evil spirits. Some societies believed that the illness was as a result of excess blood, so they treated mentally ill individuals by cutting them and letting the excess blood flow (so-called bloodletting method). Such barbaric treatment approaches resulted in the death of many people with schizophrenia.
The 19th century saw the beginning of scientific intervention into the disease. Doctors and scientists began to gain a better understanding of the disease. Ewald Hecker initially coined the term “hebephrenia” to refer to people who had symptoms of silliness and disorganisation. Later, Emil Kraepelin coined the term “dementia praecox,” which referred to symptoms of schizophrenia that appeared in between 16-24 years (Osbv, 2012). He later regarded the condition as a brain disorder. Though progress was made in detecting the symptoms of the disorder, there were no significant improvements in its treatment. Schizophrenics were still subjected to being tied and confined to dark, filthy and dehumanising insane asylums.
The condition was first named a complex disorder by Dr. Bleuler in the 20th century (Reavley & Jorm, 2014). The psychiatrist noticed that many patients have a different perception of reality and used the term schizophrenia to refer to the split mind of schizophrenics. Although mental institutions continued to make improvements in the study of the disorder, an effective treatment has not been developed even by the mid-twentieth century. Schizophrenia was treated by electroshock therapy, which involved surgical removal of a part of the brain.
The treatment approach shifted to the use of antipsychotic medication in the last quarter of the 20th century (Tsai, Chen, & Huang, 2014). Antipsychotic medication has improved, which has allowed schizophrenics to live a productive life at the present time. Despite significant progress in the medical field, there is no instant cure for schizophrenia. As psychiatrists acquire a more profound understanding of the disorder, they will advance treatment options, and ultimately a cure or effective preventive measures for the disorder will be discovered.
Causes of the Illness
Despite decades of research into schizophrenia, the causes of the disorder are not clear. However, the research indicates that a combination of genetic, physical, environmental and psychological factors increase the risk of developing the condition.
Though no specific gene is considered to be responsible for the mental disorder, it has a high chance of developing in more than one member of a family. There is a high probability that a certain combination of gene exposes people to the risk of developing the condition. A study of twins indicates that the disorder is inheritable. If one of the identical twins develops schizophrenia, the other one has a 65% likelihood of being diagnosed with the disorder, even when they are raised separately (Reavley & Jorm, 2014). The case of non-identical twins is different. If one twin is diagnosed with schizophrenia, the other one has a 12% chance of developing the disorder (Reavley & Jorm, 2014). This scenario indicates that genetics is significant risk factor contributing to the disorder.
Schizophrenia has a close connection with chemicals that transmit nerve impulses to brain cells. Drugs that change the level of these transmitters have been proved to relieve certain symptoms of schizophrenia. Therefore, a logical inference can be drawn that a change in the level of serotonin and dopamine neurotransmitters may cause the disorder (Jacka & Berk, 2014). An alteration of the body’s sensitivity to the two neurotransmitters is also a likely cause of the disorder.
Stress and Drug Abuse
Stress triggers schizophrenia in an individual who is already at the risk of developing the disorder. However, it is not a direct cause of the disorder. Stressful life events may include the loss of a job, divorce, and emotional abuse.
Drug abuse also increases the risk of developing the disorder. Drugs such as cocaine and cannabis trigger schizophrenic symptoms in individuals who are already at the risk of developing the disorder. Research indicates that people who use cannabis regularly stand four times greater probability of developing schizophrenia.
Treatment of schizophrenia requires a mix of physiological, medical and psychosocial approaches. The bigger proportion of care is received in outpatient settings. This calls for a multidisciplinary team that includes counsellors, psychopharmacologists, nurses and social workers. The patient’s family members are also critical in the recovery process. The major approaches to schizophrenia treatment are explained below.
Antipsychotic medication, also referred to as neuroleptic medication, eliminates the positive symptoms of the disorder. The benefit of this approach is that it prevents about 80% of the patient’s relapses in a one year (Jacka & Berk, 2014). However, great caution should be observed while undertaking the medication.
As mentioned above, schizophrenia causes occupational and social dysfunction. Psychotherapy is a team-based approach that helps patients to learn social skills and perform their occupational activities. The activities conducted in this treatment approach include education, reassurance, limit setting, modelling and reality testing. People with the disorder have a problem performing ordinary duties, such as cooking (DeVylder, 2014). Psychotherapy helps patients regain their confidence and improve their living. The benefit of this approach is that it improves patients’ social skills and facilitates their integration into the society.
Prevention of Schizophrenia
Research indicates that schizophrenia is caused by genetic disposition and exposure to environmental stressors during the early stages of child development. These disturbances cause alterations in the brain that predispose an individual to schizophrenia. Additional stressors during adolescence and young adulthood damage the already vulnerable brain. However, there are some measures likely to reduce the risk of schizophrenia.
Avoiding the Use of Street Drugs and Excessive Alcohol
Street drugs contain chemicals that have a potential to harm the brain. Excessive alcohol consumption also causes brain damage and exposes an individual to schizophrenia. A combination of drugs and alcohol further increases the risk of schizophrenia for people with a family history of mental illnesses (DeVylder, 2014). Avoidance of street drugs and moderating alcohol intake can potentially mitigate the risk of developing schizophrenia.
Developing Social Skills
Shy and unsociable people have a greater exposure to mental illnesses. Even if an individual is overly shy, he/she should try to maintain a few close friends with whom to freely discuss issues. Additionally, parents should teach and improve social skills of their children. Young adults should also learn and practice to improve their social skills. Avoiding isolation is also an important behavioural factor in mitigating the risk of schizophrenia. Therefore, an individual should spend time socializing with friends whereas too much isolation can expose him/her to mental illnesses.
Learning To Deal With Stress and Anxiety
High levels and frequent feelings of sadness, depression, anxiety, fear and worry expose an individual to mental illnesses. However, many children grow in families where they are unable to talk freely with their parents. In such cases, children should address adults that they can trust and share their experiences. These may be relatives, school counsellors or teachers. Individuals should learn to develop a positive attitude to life and engage in activities that relieve stress, such as sport or drawing. People who have difficulties in dealing with worry, anxiety and stress and those with a family history of the mental disorder should seek the help of qualified psychiatrists to undergo effective therapies.
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Research conducted on this disorder found similar rates of schizophrenia across different cultures. The pattern of the disorder development is also consistent across all cultures. The onset of the disorder commonly coincides with the transitioning into adulthood. Schizophrenia has more cross-cultural similarities than differences, with the cultural factors affecting the course and pattern of symptoms.
Culture plays a very significant role in the development of schizophrenia both in developed and developing countries. Different cultures show differences in the symptoms of the illnesses, its prognosis and treatment. The course of schizophrenia is usually more severe in industrialised countries as compared to developing countries. The reason for this trend lies in the belief of the people from developing countries in the supernatural nature of the disorder. In addition, in developing countries, people are organised into traditional extended families which provide support and facilitate the recovery of the patient and his/her subsequent integration into the society. Apart from that, non-industrialized countries lack specialised jobs and high competitive expectations, which enables recovered schizophrenics to reintegrate into the society after psychotic episodes (Tsai et al., 2014).
Western countries exhibit a great difference from developing countries in terms of the support systems offered to schizophrenics. These societies are characterised by a high level of competition of technological advancement, which impedes the recovery process of schizophrenics. Thus, the stress of living in the fast-paced environent causes disruptions in the thought process and hinder patients’ recovery.
Cultural differences are also reflected in the symptoms of the mental disorder. For example, delusions reflect the predominant themes of an individual’s culture. In countries with a strong emphasis on religious values such as Ireland, schizophrenics will most often exhibit delusions of sainthood. In highly industrialised nations such as America, schizophrenics exhibit delusions of sinister use of technology, such as the paranoid fear of being spied. In Nigeria, where mental illnesses are believed to be caused by evil spirits, schizophrenics mostly develop delusions of ancestral ghosts and witches (Osbv, 2012).
The treatment for the disorder also differs in the cultural dimension. Thus, Western countries depend more on medical therapy as a treatment approach to schizophrenia. In India, active family involvement and high dependency on family responsibility are preferred treatment approaches to the mental disorder. Many African countries depend on religion and spirituality as a key cure for schizophrenia and other mental disorders.
Biblical View on Schizophrenia
The Bible does not refer to schizophrenia explicitly but links the confusion of the human mind to sinful life. In Deuteronomy 28:29, God punishes mankind for sin with madness and confusion of heart. In this case, madness can be related to delusion, which is a symptom of schizophrenia. Confusion of the heart can be linked to the condition when schizophrenic patients lose touch with reality as a result of delusions (Knight & Knight, 2011). The soul and heart from the Biblical perspective are used to mean the mind.
A Biblical example of a schizophrenic is the king Nebuchadnezzar. The king totally neglected his hygiene and isolated himself from the society. Shortly before the king developed the disorder, a prophet warned him against doing evil and advised him to observe religious practices if he wanted lasting prosperity (Daniel 4:27). However, Nebuchadnezzar displayed pride and developed madness. From a psychological perspective, pride is an emotional problem that resulted from the king’s paranoia (Knight & Knight, 2011).
From Biblical perspective, schizophrenia and other mental illnesses are self-imposed results of sin (Deuteronomy 28:15-29). The New Testament portrays mental illnesses as a manifestation of demonic power that dwells in sinners. The treatment approach prescribed by the Bible is confession of sin, cessation of sinful life and a divine intervention. Jesus and his disciples healed people with mental challenges by exorcising evil spirits (Luke 4:31-36). The victims were instantly restored to sanity and regained their normal communication abilities (Mark 5:15).
Conclusion and Areas for Future Research
The diagnosis of schizophrenia is based on exhibition of such symptoms as delusion, hallucinations, disorganised speech, negative behaviour, emotional and occupational dysfunction and the existence of a general medical disturbance. Although the diagnosis of schizophrenia has improved over time, the cure for the disorder has not been discovered. The main triggers of schizophrenia include genetic predisposition, decreased level of neurotransmitters, stress and drug abuse. Schizophrenic patients can be treated through antipsychotic medication and psychotherapy. The disorder can also be prevented by avoiding the use of street drugs, developing social skills and learning to deal with stress.
Though the exact cure of the disorder has not yet been discovered, future research should focus on developing ways to improve the life of schizophrenics. One of the areas that should be explored is how drug therapies can be used to improve cognitive processes such as information processing and verbal memory. Research should also focus on how genes can identify individuals at risk of developing the disorder and work out strategies that can facilitate prevention and treatment of schizophrenia. Treating people on the basis of genetic variation might enhance the discovery of effective medication for schizophrenia.