An Introduction to Schizophrenia

What do you understand ‘Schizophrenia’ to be ?

Do you think of a hypnotic spinning wheel ? A mind-bending pattern of colourful zig-zags ? Whispers in the wind ? Hallucinations of demons ? An inexplicable murderous urge ?

Those can be correct, yet the mental condition in reality is often more subtle.

In media it is often portrayed as an other-wordly experience, affecting our thinking, emotions, and actions. Hence, it is known by experts as a psychotic disorder.

“The schizophrenic mind is not so much split as shattered. I like to say schizophrenia is like a waking nightmare.”

Elyn Saks

The onscreen portrayals of schizophrenia have been greatly exaggerated. Stories often showcase the afflicted individuals as murderous, psychopathic lunatics, which is far from the truth.

The ‘real’ schizophrenics live in a mind shrouded by delusions and hallucinations. This impairs the sufferer’s speech, and their behaviour is almost always catatonic, meaning that they are unable to respond properly to their environments. 

As such, it becomes increasingly difficult for people with schizophrenia to develop an emotional bond with others. They may appear ‘cold’ and distant towards people, showing little to no visible responses of affection or intimacy.

Schizophrenia And Virtual Reality Testing

Yeah, you read that right. It is entirely possible to assess schizophrenic symptoms through the use of VR technology. In fact, virtual reality plays an important role in modern psychology, and it has successfully been used to treat social phobias.

Of course, there are standard procedures to follow before setting up the patient’s entry into the virtual world. Prior to starting VR therapy, the study by Freeman et al. (2008) profiled their patients’ levels of paranoid thinking, cognitive traits, and emotional distress.

When first assessing symptoms, the patient is immersed in the simulation, and they are then directed to answer a series of questions in the form of a self-report. The scores of the individual will determine the level of severity of their schizophrenia.

From the research conducted in Freeman et al.’s study, it was found that those who scored higher were more likely to experience intense persecutory ideation. This means that they believed that the “people” within the artificial simulation were thinking and speaking negatively about them.

Interestingly, Freeman also noted that people who heard auditory hallucinations in real life also experienced them during their time in the virtual world.

Are Genetics To Be Blamed?

The most common symptom for schizophrenia is psychosis. Psychoses are obvious abnormalities in one’s functioning. People with schizophrenia often show sensory dysfunction and find particular difficulty in recalling memory.

A study conducted by Gottesman and Shields (1972) suggested that the aforementioned schizophrenic symptoms have identifiable genetic markers which may be inherited.

Gottesman and Shields investigated. They then came to realise that approximately 50% of identical twins shared schizophrenic traits. In the case of identical twins, one twin would be very likely to show schizophrenic symptoms, should the other be found in a critical schizophrenic condition.

The case of identical twins is significant, since they are each genetically identical. Since they share identical genes, the study relates that schizophrenia may have a genetic basis.

The Dopamine Hypothesis

According to Lindström et al. (1999), dopamine is produced in much larger quantities in the brain of a person who suffers from schizophrenia. Dopamine has been dubbed as ‘the happy hormone’, because it functions to induce feelings of pleasure.

The evidence of this claim is somewhat unusual, as people who take ‘stimulant’ drugs, like amphetamines and cocaine, report experiencing hallucinations and delusions while under the influence. Drugs like amphetamines and cocaine induce a strong sense of euphoria, which explains their addictive nature.

The Influence Of Cognitive Errors

Biological factors aren’t entirely responsible for schizophrenic symptoms. Sometimes, the way we think and incorrectly process information can bring about the same result.

The truth behind schizophrenic hallucinations is that they are a manifestation of our occasional self-talk. Frith (1992) suggested that schizophrenic patients hear their inner voices as if they were being said by another person.

An explanation for this phenomenon may be explained by schizophrenics’ particular difficulties in recalling memory and their impaired attention, which are crucial for self-monitoring. Hence, they process their thoughts as external influences, rather than internal assessments.

Another factor Frith investigates is the occurrence of delusional thinking, stemming from false perceptions. This further intensifies a patient’s symptoms, as they often attempt to apply rational reasonings for their hallucinations.

Thinking rationally, they conclude that the “voices” must have come from somewhere, or maybe from someone. They will associate those thoughts as belonging to another source when in reality it is simply something they conceived themselves.

All in all, Frith’s theory further justifies why people with schizophrenia often behave indifferently towards those around them. The schizophrenic may not be intentionally trying to push others away, nor are they explicitly wanting to be left alone. To Frith, their ailment is being unable to respond properly to everything around them, including other people. They are stuck in-between knowing what is real, and what is not.

Treatment And Management:

Cognitive Behavioural Therapy (Sensky et al., 2000)

To simplify, Cognitive Behavioural Therapy (CBT) is a form of ‘talking therapy’. It is a one-on-one session between the patient and their therapist. As with most other psychological therapies, the therapist is sworn to secrecy.

CBT looks to directly change the way patients behave, and aims to correct their faulty thought processes.

CBT has been described as the best alternative to prescribing antipsychotic medications, as not every patient has the same level of tolerance for them.

1. Engaging With The Therapist

First, the patient is formally introduced to their therapist, and vice-versa. 

The therapist then makes the objectives of their sessions clear, and states that the client’s willingness to participate is crucial to the therapy’s success, and that all cooperation will be fully reciprocated. 

Talking therapies, like CBT, rely critically on the patient’s involvement, else there can be no changes to the patient’s condition. Two-way communication is the key to success. Therefore, therapists need to gain a better understanding of their patients before they can move forward with treatment.

The therapist also lays out the fundamental principle of doctor-patient confidentiality; whatever is said in the counselling room, stays in the counselling room. So, that means that the therapist is not at liberty to disclose any of their client’s sensitive information and identity, regardless of who is receiving the information. The therapist can’t tell their colleagues, husband or wife, children or anyone. Period.

2. Identifying The Root Of The Problem

Once the introduction is completed, the therapist then attempts to find out the origins of their patients’ schizophrenic symptoms. The details of how, what, and when help the therapist to gain a deeper understanding of their patient and the symptoms that they show.

However, schizophrenic patients often have difficulty recalling their memory, and by extension, memory is also reconstructive in and of itself. By this I mean that the schizophrenic morphs, changes and reimagines their memories.

The therapist overcomes this by challenging the logic behind their patient’s reasoning for their delusions and hallucinations.

By knowing the triggers of schizophrenic symptoms and how the patient reacts to them, the therapist can further understand the true extent of their patient’s schizophrenic state.

3. Thought And Behavioural Monitoring

In the final step of the CBT process, the patient is assigned a task. Their task is to keep a personal audio recorder on them at all times. Their duty is simple: record what they hear or see whenever they hallucinate.

During the sessions, the therapist discusses what has been recorded with the patient. The two will then devise specific, targeted coping strategies that would be most suitable for the patient in question. It also helps greatly if they can identify any patterns in their hallucinations.

The frequency of the hallucinations, and what the patient hears and sees during those moments can hint at what is unresolved in the patient’s mind. Commonly, it is that the patient is unable to process an event or a concept correctly. If he or she cannot process them at all, the thoughts and hallucinations are felt strongly.

Any errors in thinking or behaviour are identified and the therapist tries to change to the way the patient thinks and acts. Once the patient’s symptoms are reduced and managed, the patient gradually reduces contact with their therapist.

After this, the patient applies the coping strategies that work most effectively on them in real life situations. If, in the eyes of the therapist, the patient has recovered, the therapist marks the end of their sessions.


References

[1] Freeman, D. (2008). Studying and treating schizophrenia using virtual reality: A new paradigm. Schizophrenia Bulletin, 34(4), 605–610. 

[2] Gottesman, I. I., & Shields, J. (1972). Schizophrenia and genetics: A twin study vantage point. Academic Press.

[3] Lindström et al (1999). Dopamine hypothesis.

[4] Frith, C. D. (1992). Essays in cognitive psychology.The cognitive neuropsychology of schizophrenia. Lawrence Erlbaum Associates, Inc.

[5] Sensky, T. (2004). Cognitive-behavior therapy for patients with physical illnesses. In J. H. Wright (Ed.), Review of psychiatry, Vol. 23 no. 3. Cognitive-behavior therapy (p. 83–121). American Psychiatric Publishing, Inc.


An Intro to Schizo


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