“It’s like a waking nightmare. You’re terrified, you’re confused… People were talking about me and laughing at me… I wasn’t supposed to speak, because speaking would spread my evil around. It was extremely painful.”1 Such was the agony that Yale graduate and accomplished author Elyn Saks faced throughout her life. The reason behind her suffering? Schizophrenia, a cause of social exclusion for 51 million people worldwide.
Schizophrenia is a chronic mental disorder characterized by the lack of fully developed cognitive skills, the inability to differentiate between real and imaginary, and unusual responses to emotional or social situations.2 Although public awareness surrounding schizophrenia is gradually increasing, knowledge and empathy for patients of the disease appears to be decreasing. Often, schizophrenics are incorrectly perceived as delusional individuals who prevent societal progress. Their victimization, caused by such social stigma and prevalent misconceptions, is frequently overlooked. In reality, it is extremely rare that schizophrenics possess violent or dangerous qualities.3 Schizophrenics are thus subject to societal exclusion and prejudice, as details about the several facets of the intricate disease are often neglected or unknown to the public.
One important aspect of the disorder is that there are in fact five different subtypes, each characterized by a unique pool of symptoms that the several patients of the disease exhibit.4 The first and most common of these subtypes is known as the paranoid subtype, the chief features of which are auditory hallucinations and delusions. Secondly is the catatonic subtype, which is marked either by immobility or, on the other end of the spectrum, agitated and excited movement in the patients. The third is the disorganized subtype, which hinders effective communication for its victims, and the last two, known as the residual and undifferentiated subtypes, are characterized by the patient either not showcasing the symptoms of schizophrenia or fluctuating between all of the symptoms of the five subtypes, respectively.
This complex disorder also induces great difficulty with openly sharing personal emotions and understanding societal norms and sentiments, schizophrenics are constantly misinterpreted or discriminated against in their respective communities, with many enduring humiliation and prejudice due to their various socially abnormal traits. Schizophrenics have the tendency to amplify their experiences, resulting in overreactions and unnecessarily intense emotions.2 Some schizophrenics can interpret mildly annoying behavior as highly unjust and cruel,which can then trigger hostility and discomfort in their surroundings as a result. Remembering events and speaking rationally or just cohesively is also a great struggle, and professional careers and opportunities are put at great risk if their ability to recall simple concepts or ideas is blocked; for people who have the disorganized subtype of schizophrenia, effective communication is virtually impossible.5 These individuals are incomprehensible due to a lack of proper enunciation or articulation, and they cannot formulate proper syntax and order words into conversational phrases. This incapability to speak fluently prevents them from interacting with their peers and society as a whole, ostracizing them further.
Due to a potential underdevelopment of cognitive senses, some patients of schizophrenia also find it difficult to perform reflexive actions of personal grooming, such as taking a bath or brushing teeth.2 Strange body language, such as contortion of their faces or assuming unusual body positions, can be perceived as disrespectful or rude and prevents them from forming close bonds or friendships with others. This is compounded by a failure to sufficiently understand social norms that causes them to become socially inept; uncomfortable cases can occur when a schizophrenic individual’s emotional responses to a situation fails to match responses considered normal for other individuals, an example being laughing during a somber and serious event such as a funeral.2 In this way, their inability to exhibit “normal” behavior drives misplaced judgments about their personalities, as lack of understanding entails the perception that schizophrenics are not mentally impaired, but inherently bad people.
The level of discrimination and abuse that schizophrenics face is mirrored in their high unemployment rate.7 According to the statistics provided by the John Hopkins Center for Research on Services for Severe Mental Illness, 73 to 90 percent of the two million American schizophrenics are unemployed.8 However, unknown to most, many schizophrenics are in fact capable of working effectively and successfully. For example, those with the paranoid subtype may have the ability to work efficiently and somewhat engage in relationships with others.2 Their unemployment can be mainly ascribed to the significant social stigma attached to schizophrenia, as they are “often victims of discrimination that come from… colleagues [and] institutions.”8 Even in the rare situation that a schizophrenic obtains a competitive or esteemed position, they are often discouraged or unable to maintain it due to the pressure of a judgmental work environment.6
Since those suffering from schizophrenia struggle with finding and maintaining a stable job, the financial burden is placed on their families, who must pay for any medication or assistance that is required for their schizophrenic relative.8 In consequence, schizophrenia naturally puts great strain on familial relations with exasperated parents or guardians. Family members can feel guilty or resentful because they believe they played a key role in the growth of their child’s disorder or face tremendous stress from knowing that they are not the ones who are suffering through the disorder;likewise, the children of schizophrenics are susceptible to feelings of confusion, anger, or embarrassment as they are entrapped by the social stigma surrounding their parents’ condition and excluded from the community.9 The struggles of their parents also inevitably influences their own decisions and self-image, confusing or traumatizing the child further. Sibling rivalries often arise as well, as schizophrenic children understandably receive the most attention from their parents to the envy of the other siblings.9
Unfortunately, physical abuse is another common response of the community to schizophrenia.2 The widespread perception of schizophrenics as aggressive and dangerous causes individuals to “protect” themselves by attacking schizophrenics. Not all schizophrenics are violent; many are actually capable of peaceful living and are not constantly aggressive,3 the best example being those of the residual subtype, which is characterized by a nearly perfectly stable mental state and the lack of hostile or strange behaviors that are present in other forms of the disease.2
While a permanent cure for both positive and negative symptoms of schizophrenia has yet to be discovered, research has indicated that a loving upbringing, support, and encouragement from a family can often prevent schizophrenia from developing or becoming more severe.1 Awareness, empathy, and understanding of the struggles of schizophrenics could help bring smiles to both their faces and ours.
1. Sachs, Andrea. “A Memoir of Schizophrenia.” Time Magazine. August 27, 2007. http://www.time.com/time/arts/article/0,8599,1656592,00.html
2. “Schizophrenia Facts and Statistics.” The Internet Mental Health Initiative, Schizophrenia.com.
3. Cheung et al. “Violence in schizophrenia: Role of hallucinations and delusions.” Schizophrenia Research. 1997;26(2-3): 181-190.
4. Smith, Melinda & Segal, Jeanne. “Schizophrenia: Signs, Types & Causes.” HelpGuide.org. Last updated November 2012.
5. “Understanding Schizophrenia.” The University of Texas, Harris County Psychiatric Center. Last updated September 2006.
6. Fitzgerald et al.”Victimization of patients with schizophrenia and related disorders.” Australian & New Zealand Journal of Psychiatry. 2005 39:169-174.
7. Perkins, Rachel & Rinaldi, Miles. “Unemployment rates among patients with long-term mental health problems.” The Psychiatrist. 2002; 26: 295-298.
8. “Improving Chances for Employment: Negative Symptom/Positive Symptom Reductions in Schizophrenia.” The Center for Research on Services for Severe Mental Illness, Johns Hopkins Bloomberg School of Public Health. Last updated Nov. 12, 2002.
9. Veague, Heather Barnett. “Stress on Families – Schizophrenia.” Armenian Medical Network. May 12, 2009.
10. Brooks, Ashley. “The Effects of Schizophrenia on a Family.” eHow.com, Health.
Image Credit: http://www.nih.gov/researchmatters/october2007/10292007flaws.htm”>http://www.nih.gov/researchmatters/october2007/10292007flaws.htm
Image Credit: http://www.yalescientific.org/wp-content/uploads/2010/12/Schizophrenia_William-Zhang_JZ.png