Schizophrenia is a severe, episodic illness caused by a chemical imbalance in the brain. It frequently has a far-reaching negative impact on many aspects of an individual's life, as well as that of his or her family. It often has its onset when a person is young. About half of males and one-fourth of females who develop this illness do so before they turn 19.
Schizophrenia clearly has a biological basis; numerous studies have shown changes in brain structure and function. Neurotransmitters substances that allow communication between brain cells are thought to be involved in the development of the disorder. Persons with a close relative who has this condition are at the greatest risk of acquiring it. One in ten persons Who have a parent with the disease will eventually develop: it. The disorder carries a high risk of suicide. One in ten individuals with the illness end his or her life in suicide, especially in the first six years after the initial psychotic episode.1
The disorder carries several disturbing symptoms, such as impairment of a variety of basic psychological functions including perception (hallucinations), reality testing {delusions), thought processes (loose associations), feeling (flat or inappropriate affect), behavior (disorganization), concentration, motivation, and judgment. Thus the condition usually affects occupational, educational, and social activities.
Primary treatment
Antipsychotic medications are not a cure, but they offer the best treatment available for persons suffering from this severe mental illness. After going onto such medications, most people show substantial improvement within a few weeks. The medications are especially helpful in reducing delusions, hallucinations, agitation, confusion, and distortions. Antipsychotic medications also reduce by half the risk of future episodes.
As is frequently the case, however, antipsychotic medications may have side effects, including stiffness, tremors, restlessness, drowsiness, dry mouth, and, occasionally, a chronic irreversible movement disorder. Newer antipsychotic medications appear to cause fewer side effects.
One of the greatest challenges in treating persons with schizophrenia through medication is that they stop taking their medication. Short-term hospitalization in a well-staffed facility can offer a person and his or her family needed stress,.relief in,a protective environment while the person is adjusting to medications.
About 20-30 percent of those with schizophrenia recover to lead a normal life. Another 20-30 percent continue to suffer from moderate symptoms, while 40-60 percent continue to be seriously impaired from the disease. Approximately one-half of all mental hospital beds in the United States are occupied by patients with some form of this illness.2
Long-term care
Since schizophrenia is usually a long-term illness, continuing medical care and medications will be needed. It is important to find a psychiatrist who, is well-qualified, interested in the illness, and empathetic with the sufferer.
Individual psychotherapy can also be helpful. Such therapy involves scheduled conversations between the client and a mental health specialist. These sessions focus on current and past problems, thoughts, feelings, or relationships. By sharing life experiences in this way, the person may gradually come to a better understanding of himself or herself, learning to more effectively sort the real from the unreal and distorted.
A supportive, reality-oriented approach is generally of more benefit than probing insight-oriented psychotherapy. Offering accurate, simple information about schizophrenia and the medications will be an important part of the process of healing. Self-help groups have become increasingly common and are often used by mental health professionals in addition to therapy and medication. These groups, usually led by ex-patients or family members of people with schizophrenia, provide patients with mutual support as well as comfort in the awareness that they are not alone.
Self-help groups also seek to promote accurate information about mental illness in order to dispel the stigma and to empower those affected by it.
The role of the faith community
The church can be of great value as a continuing source of contact and support for persons suffering from schizophrenia. It can also be of significant value to the families of persons suffering from the illness.
The church can offer acceptance and care that is often not found else where. Families dealing with any chronic illness undergo considerable strain, and this is no less true for mental illness. Since schizophrenia is a disease of the brain, it is important that pastors encourage blame-free acceptance of the person and his or her family.
In a recent study, researchers dis covered that three in four psychiatric patients identified religion to be an important source of comfort and sup port. However, the same study found that psychiatric inpatients were less likely to talk to a pastor than to a comparable professional in a general medical hospital. Moreover, while 80 percent of the psychiatric patients considered themselves spiritual or religious, only 20 percent had -a pas tor or spiritual advisor to consult.3
Some faith groups have developed outreach programs to help clergy and congregations support and care for those with mental illnesses. These groups can help combat the stigma that is often the "second wounding" associated with mental illness. Families report that the societal stigmas associated with the mentally ill have negative impacts on sufferers that come in the form of a sense of lowered self-worth, difficulty making and keeping friends, lack of success in getting a job or finding a place to live, and simply in overall recovery.
Popular motion pictures depicting mentally ill killers and high-profile news coverage of tragedies involving the mentally ill, contribute to these stigmas.4 The families of the mentally ill believe that accurate, factual information about mental illness is the best remedy for these kinds of societal attitudes.
The truth is that people with schizophrenia are usually less violent than others. They are often timid and emotionally vulnerable. Very few are dangerous. They do not have a "split personality" as portrayed in the famous classic, Dr. Jekyll and Mr. Hyde. Problems with violence and aggression may arise among a few individuals who do not continue their medications, especially if they abuse drugs or alcohol.
Unfortunately, individuals in the U.S. who suffer from schizophrenia or other severe forms of mental illness do not receive treatment, and they become homeless, use alcohol and/or illicit drugs, and may end up in prison. The National Law Center on Homelessness and Poverty estimates that at least 25 percent of our nearly one million homeless suffer from some form of mental illness.
There are now far more mentally ill persons in U.S. prisons (approximately 250,000) than in state hospitals (approximately 58,000). Until recently, state mental hospitals served as the places of last resort for those who could not find adequate treatment in the private sector. The increasing closure of these institutions has become a major reason for the lack of treatment of the severely mentally ill.5 The serious lack of appropriate treatment for the mentally ill is an issue that needs the active involvement of the faith community.
1 J. F. Westermeyer, M. Harrow, and J. T. Marengo, "Risk for Suicide in Schizophrenia and Other Psychotic and Non-psychotic Disorders," Thefoumal of Nervous and Menial Diseases, 179 (1991): 259-266.
2 M. S. Keshavan, P. Vaulx-Smith, and S. Andfeson, "Schizophrenia" in Handbook of Adolescent Psychopathology, V. B. Van Hasselt and M. Hersen (eds.), (New Yorfc texingron Books, 1995), 465-496.
3 G. Fitchett, L. A. Burton, and A. B. Sivan, "The Religious Needs and Resources of Psychiatric Inpatients," The Journal of Nervous and Mental
Diseases, 185 (1997)': 320-326.
4 O. F. Wahi and C. R. Harman, "Family Views of Stigma," Schizophrenia Bulletin 15 (1989) 1:131-139.
5 H. R. Lamb, "Deinstitutionalizatipn at the Beginning of the New Millennium," Harvard Review of Psychiatry, 6(1998) 1:1-10. '
