Ever see “One Flew Over the Cuckoo’s Nest?” The movie paints a picture of despair, in which characters suffering from schizophrenia are confined to a grim, violent, and hopeless life in an institution presided over by the sadistic Nurse Ratched.
That’s Hollywood. In real life, it looks more like “A Beautiful Mind” and treating schizophrenia is a lot different. “If it’s addressed early, treatments can be very effective. People can finish college and hold down jobs and lead full, successful, satisfying lives,” says Anil Malhotra, M.D., director of psychiatry research at Zucker Hillside Hospital, a behavioral health center in Glen Oaks, New York.
According to the National Alliance on Mental Illness, about 1.5 million Americans struggle with this serious chronic condition, which is marked by hallucinations and delusions.
Schizophrenia begins as a young person’s condition, and that’s part of what makes it so challenging. This condition appears in men by the late teens or early twenties, whereas in women, symptoms tend to appear a little later—usually by around the age of 30.
“The symptoms occur at such a critical point in development,” says Dr. Malhotra, “just as young people are launching their adult lives. It can be devastating if proper evaluation and treatment are not initiated early in the course of illness.” Luckily, says Dr. Malhotra, there are ways to do just that.
Understanding the Myths Versus the Realities of Schizophrenia
Thanks in part to films like “Cuckoo’s Nest,” schizophrenia is surrounded by antiquated myths and misunderstandings. Knowing the difference between truth and fiction can show you what to look out for, and may even help you reach out and help a friend in need. Here’s a look at the realities of schizophrenia.
Reality #1: Schizophrenia has nothing to do with multiple personalities.
“There is a condition that used to be called multiple personality disorder, and is now called dissociative identity disorder,” Dr. Malhotra says, “but that’s totally unrelated.”
Why the confusion? It may have to do with the fact that the word schizophrenia comes from the Greek root words schizen, which means splitting, and phren, which means mind. In the case of schizophrenia, the split happens between emotions and reality—not with personality.
Still, a National Alliance on Mental Illness survey showed that almost two-thirds of Americans believe that people with schizophrenia have two distinct—and often conflicting—personalities occupying their one brain. This misperception makes schizophrenia seem a lot scarier than it actually is.
Reality #2: Hallucinations and delusions are signs of schizophrenia, but not the only ones.
Sure, the most recognizable signs of schizophrenia are the ones that show a break with reality. People with schizophrenia often experience delusions—false beliefs about themselves or others. For example, someone might think she’s being chased by the CIA or that he has superpowers.
The other major sign of schizophrenia is hallucinations. That’s when people see or hear things that don’t actually exist—to them, those experiences feel completely real. If someone is hearing voices that nobody else around them is hearing, it’s time to be concerned.
Those aren’t the only signs of schizophrenia, though. Other symptoms include:
- Disordered thinking. This shows up in disorganized speech. Someone may, for instance, string a bunch of meaningless words together, or respond to questions with completely unrelated answers.
- Abnormal motor behavior. Someone might act silly or giddy, resist instructions, or even move around excessively.
- You might notice this when a person can’t seem to function normally—he or she might neglect personal cleanliness, fail to make eye contact during a conversation, or lose interest in everyday activities.
- Cognitive problems. Sometimes people with schizophrenia have trouble paying attention or experience problems with their memory.
Reality #3: People with schizophrenia are NOT dangerous.
“The data is clear,” Dr. Malhotra says. “Most violent acts are not performed by people with schizophrenia. As a matter of fact, they’re more likely to have violence committed against them. The vast majority of people with schizophrenia are not dangerous.”
More often than not, people with schizophrenia simply want to be left alone—withdrawal from friends and family can be one of the symptoms of the condition. So the perception that they’re dangerous has serious consequences, increasing the stigma of mental illness and piling more stress on top of an already difficult situation.
Reality #4: Treatments for schizophrenia are varied and effective.
No longer are people with schizophrenia warehoused for life in mental institutions or subjected to archaic treatments like frontal lobotomies. Today there are treatment options that are “remarkably effective,” says Dr. Malhotra.
“Medication is the most effective, and there are also some excellent psychotherapeutic interventions, including cognitive behavioral therapy (CBT) and some forms of group therapy. And we can use electroconvulsive therapy (ECT) when patients don’t respond to medication.”
For best results, seek treatment quickly—as soon as possible after symptoms first begin to appear. Unfortunately, there’s usually a giant delay in getting help—the average is 8.5 years. That’s why it’s so important to be aware of the signs of schizophrenia. You can’t diagnose it yourself, but if you’re concerned about a friend, advises Dr. Malhotra, “encourage them to seek treatment with a psychiatrist. What you’re seeing may or may not be schizophrenia, but it’s a good idea to have them evaluated.”
Reality #5: The exact cause of schizophrenia remains unknown.
Researchers are examining everything from brain chemistry to exposure to certain viruses as possible causes of schizophrenia. There are even studies looking into a link between vitamin D deficiencies and schizophrenia.
Even genetics cannot draw a direct line to whether someone will suffer from schizophrenia. Research published in Schizophrenia Bulletin have found that even if your parent has a collection of disorders that include bipolar disease, major depressive disorder, and schizophrenia, the chances that you will get schizophrenia is approximately 32%.
But while your genes cannot determine cause, let alone a diagnosis, they can unlock the ability to find treatments that might be more effective for you. Primary scientific findings published in Current Opinion of Psychiatry conclude that pharmacogenetics—an assessment of your specific genes to determine how you’ll likely respond to specific medications—may help better understand the side effects associated with the antipsychotics that are typically prescribed for schizophrenia. This is why genetic testing can help inform your physician as to the treatment that will be effective for you.
Even though Hollywood has painted schizophrenia as a violent existence, the reality is that quick action when schizophrenia first presents itself can make this fictional depiction just that—fiction. Living with schizophrenia can be normal, fulfilling, and productive when you or your loved one gets the care needed—especially if it’s sooner rather than later.