12 Things Psychiatrists Wish You Knew About Schizophrenia
Psychiatrists stress that you're not getting the real story from Hollywood's portrayals of this mental illness. Here's what schizophrenia really is and what you need to know.
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The misinformation about schizophrenia
“There is an unwarranted and unnecessary stigma surrounding mental illness, and especially schizophrenia,” Michael Birnbaum, MD, director of the Early Treatment Program at Zucker Hillside Hospital in Glen Oaks, New York. “We’re sometimes fearful of things we don’t understand.” People often get their knowledge about the condition from movies or television shows. “Myths about schizophrenia are most likely perpetuated because fear sells,” says Philip Yanos, PhD, professor and director of Clinical Training at the Clinical Psychology Training Program John Jay College of Criminal Justice, and author of Written Off: Mental Health Stigma and the Loss of Human Potential.
What is schizophrenia?
Schizophrenia is a severe mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may feel like they have lost touch with reality, according to the National Institute of Mental Health (NIMH).
Who is at risk?
Several factors can raise the risk, says the NIMH. It may run in families, though scientists also think that brain chemistry and structure play a role. Numerous environmental conditions can raise risk, explains Kim T. Mueser, PhD, a clinical psychologist, and professor of occupational therapy, psychological, and brain sciences at the Center for Psychiatric Rehabilitation at Boston University in Massachusetts. He’s also the co-author of The Complete Family Guide to Schizophrenia: Helping Your Loved One Get the Most Out of Life. Some environmental risks include negative childhood experiences, living in an urban area, poverty, and being a member of a minority, Dr. Mueser says. If an expecting mother smokes or misses out on proper nutrition during pregnancy, the child may have an increased risk of schizophrenia, he says; a father over 50 at conception also boosts risk. In addition, persistent marijuana use has been found to be a risk factor for developing schizophrenia, says Dr. Yanos.
The condition isn’t as rare as you think
According to the Schizophrenia and Related Disorders Alliance of America, about 1.1 percent of the world’s population has schizophrenia. About 3.5 million people in the United States are diagnosed with the condition. Three-quarters of people with schizophrenia develop it between 16 and 25 years old.
Schizophrenia symptoms vary
Hallucinations, delusions, and bizarre behaviors are at the top of the list. Symptoms also include diminished emotional reactions, such as reduced facial expressiveness and voice tone, says Dr. Mueser. They may also get less pleasure from daily life, have difficulty starting and finishing activities, and interact less with others. People diagnosed with schizophrenia often experience social anxiety and depression, says Dr. Yanos. “Symptoms fluctuate in intensity over time,” he says.
Although schizophrenia is incurable, there are medications that can help. “Recovery—defined as having the ability to live a satisfying and contributing life—is possible,” says Dr. Yanos. “This means that, with treatment and support, people with schizophrenia can work, have relationships, and contribute to their communities in ways that are consistent with their talents and abilities.”
The key is getting the right treatment—and getting it right away. “We know that earlier treatment leads to better outcomes,” Dr. Birnbaum says. Doctors may prescribe medication, therapy, social skills training, illness self-management, and cognitive remediation (to improve brain functions like attention and memory). “Research supports that a proportion of people recover without medication,” says Dr. Yanos. (Here are the signs therapy is working for you.)
Medication doesn’t have to dull personality
You may think that lethargy, listlessness, and vacant eyes are the inevitable medication side effects of schizophrenia medications. “People are usually quite energetic when psychotic,” says Dr. Yanos. “The ‘zombie’ stereotype is associated with the initial reaction to the medication, which dissipates over time. It’s also more associated with older antipsychotic medications; newer medications have less potent side effects.” Antipsychotic medications can help reduce delusions, hallucinations, and confusing thoughts.
People with schizophrenia don’t have multiple personalities
People often confuse schizophrenia with dissociative identity disorder (DID is how it’s abbreviated: It was previously known as multiple personality disorder). It’s a misconception that people with schizophrenia switch between personalities. The conditions are actually quite different: DID is when a person switches to other identities, according to the American Psychiatric Association. Each identity may have a name, voice, gender, and mannerisms. People with this rare condition are often victims of severe abuse.
Schizophrenia doesn’t make people dangerous
While some people with schizophrenia commit crimes, the majority are nonviolent, especially if they’re getting treated. “Violence committed by psychiatric patients—and people with schizophrenia in particular—is more likely to attract media attention, as compared to more mundane topics about mental illness such as someone getting a job, living independently, or having a family,” says Dr. Mueser.
A 2014 study in the journal of the American Psychological Association found that of past violent offenders who had schizophrenia, only 23 percent of their crimes were related to symptoms. When they do commit violent acts, they usually also have another condition such as substance abuse. “Unfortunately, people with schizophrenia are occasionally misrepresented as violent and unpredictable,” Dr. Birnbaum says. “In fact, people with schizophrenia are more likely to be the victims of violence as opposed to the perpetrators. People with schizophrenia are no more violent than the general population.”
Schizophrenia develops slowly
“The disorder usually develops gradually,” says Dr. Mueser. Symptoms often appear during adolescence. Early signs can include difficulty in managing relationships, organizing information, and dealing with school, work, or social settings. “The person may have some odd thoughts or beliefs,” adds Dr. Mueser. (Find out brain facts you never knew.)
There’s more to schizophrenia than hallucinations
While people with schizophrenia may have delusions and hallucinations, they may also lack motivation, have disorganized speech, and find it difficult to build relationships. They have trouble paying attention and doing some tasks. (Don’t miss short rituals you can do every day to boost your mental health.)
They can hold down a job
Schizophrenia may make it harder for people to get a job and work every day, but with the right treatment, they can find employment that’s right for them. Social skills counseling, job training, and vocational training can be helpful. “The most effective approach to improving work performance is helping sufferers find jobs in areas that interest them and then providing the support to help them succeed,” says Dr. Mueser. “That’s much more effective than trying to provide training first, followed by a job search.”
It doesn’t make people lazy
People with schizophrenia may struggle to keep up with good hygiene, laundry, and other daily needs. The condition can lead to a lack of awareness, says Dr. Yanos. “Being diagnosed with a disorder that is stigmatized as ‘hopeless’ is also incredibly discouraging and can impact motivation,” he says. They just need some help. But that doesn’t mean they’re lazy. Next, find out the myths about mental health that need to be set straight now.
- Michael Birnbaum, MD, director of the Early Treatment Program at Zucker Hillside Hospital in Glen Oaks, New York
- Philip Yanos, PhD, professor and director of Clinical Training at the Clinical Psychology Training Program John Jay College of Criminal Justice, and author of Written Off: Mental Health Stigma and the Loss of Human Potential
- National Institute of Mental Health: "Schizophrenia"
- Kim T. Mueser, PhD, a clinical psychologist and professor of occupational therapy, psychological, and brain sciences at the Center for Psychiatric Rehabilitation at Boston University in Massachusetts
- Schizophrenia and Related Disorders Alliance of America: "ABOUT SCHIZOPHRENIA"
- American Psychological Association: "How Often and How Consistently do Symptoms Directly Precede Criminal Behavior Among Offenders With Mental Illness?"
- American Psychiatric Association: "What Are Dissociative Disorders?"