Over 30 years ago, Elyn Saks was diagnosed with schizophrenia.
She was told she'd probably live her life at a care facility watching TV,
or maybe find work as a cashier, if she was lucky.
Today she's a dean at the University of Southern California law school,
a psychoanalyst, and a MacArthur Fellow.
Her story reveals just how much we've learned
about schizophrenia in the past few decades and about how to treat it.
But, there are some myths about schizophrenia
that haven’t caught up to the science, so here’s the truth behind some of them.
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First, having schizophrenia doesn't mean you’re indecisive,
or you change your mind a lot, or you have multiple personalities—
which apparently nearly two-thirds of Americans think is a thing.
Maybe they’re thinking that because “schizophrenia”
comes from Greek words for "split mind."
But that's because the patients split from reality, not themselves.
People with schizophrenia often experience hallucinations:
false sensations or perceptions.
65% of patients report hearing voices, for example,
making it one of the most common symptoms.
But the hallucinations can also be visual,
like seeing movement in the periphery of their vision,
or tactile, like feeling things crawling on them.
And perhaps not surprisingly, patients often present with delusions as well—
false beliefs, like the idea that people are spying on them.
Psychologists think those delusions probably stem from
patients trying to make sense of their unusual hallucinations.
Like, if you're hearing voices and no one else is in the room,
the idea that there are spies secretly spying on you doesn’t seem that far-fetched.
A patient might even come to believe they’re someone else.
But that’s not the same as having multiple personalities
or switching between them, like with dissociative identity disorder.
There are also other emotional and behavioral changes
that tend to accompany these symptoms,
like disorganized thoughts and speech, and flat affect,
where someone basically never shows emotions outwardly.
In extreme cases, schizophrenia can result in catatonia,
which is the inability to move or respond, although that’s super rare.
For decades, people thought that all this was the result of bad parenting—
especially bad mothers.
Because of that, the first treatment was usually to
immediately remove the patient from their family—
which isn’t a good idea if the family is supportive.
From the research we’ve done since then,
it’s clear that genes play the biggest role.
Schizophrenia is about 50% heritable,
which means that genetics are fairly predictive—
in fact, in identical twin studies, it was shown that
if one identical twin has schizophrenia,
there’s a 50/50 chance that the other one will.
And if one of your parents has it, there’s about a 10% chance
that you’ll be diagnosed, too.
That makes it one of the most highly heritable psychological disorders.
Your environment can play a role,
but it’s not nearly as important as psychologists used to think.
For example, a 2004 study found that children adopted to a home
with lots of conflict and chaotic relationships
were more likely to be diagnosed,
but that was only if they also had genetic risk factors,
like someone else in their family had it.
A rocky home life had no effect on the rate of diagnosis
in the group without genetic risk factors.
Which makes sense, now that we know more about
what's actually happening in the brains of people with schizophrenia.
For a long time, schizophrenia was thought to be caused by
too much of the neurotransmitter dopamine in the brain
because drugs that block dopamine helped with some of the worst symptoms.
And the idea seemed to make sense,
because floods of dopamine can cause hallucinations—
that’s exactly how some psychoactive drugs work.
The trouble is, these drugs sometimes made other symptoms worse,
for reasons that aren’t entirely clear.
So more recent research has looked to brain anatomy
to understand the root of the disorder.
Specifically, researchers looked at changes to gray matter,
the darker-colored tissue that’s mostly on the surface of the brain.
Everyone loses gray matter between childhood and adulthood
as part of a normal process called synaptic pruning,
where some connections are lost, but the ones you keep get stronger.
But patients with schizophrenia lose a lot more gray matter.
And those losses start in the parietal lobe,
an area of the brain that handles sensory information
and some sound processing, among other things,
which might help explain the hallucinations.
There’s one more persistent myth that needs to be cleared up:
the idea that schizophrenics are wild and dangerous,
and need to be locked up for their own—and everyone else’s—safety.
That’s just not true.
Although sometimes people with the disorder behave in unusual ways,
they're typically not aggressive or violent.
And lifelong hospitalization isn’t as common these days.
Some people who experience these symptoms recover completely,
and most others can control their symptoms with medicine and therapy.
When it comes to medication, newer drugs that target
multiple neurotransmitters seem to be more effective
than the medications used a few decades ago.
That’s probably because in addition to blocking dopamine,
and therefore dopamine-induced hallucinations,
they also stimulate serotonin production.
Since serotonin is one of those feel-good neurotransmitters,
having more of it likely improves some of the other symptoms
like withdrawal and flat affect.
Recent research has also shown that good ol’ talk therapy can help, too.
A 2016 study of 400 patients found that those who received
a comprehensive approach, with low doses of medications alongside therapy,
reported a better quality of life than those who
managed their illness only with medication.
And remember Elyn Saks, the researcher from the beginning of this episode?
Her work centers around how some patients become high-functioning like herself:
the factors that helped them earn degrees and have professional careers.
Many used cognitive strategies like asking themselves
if their hallucinations were reasonable,
in addition to strategies like distracting themselves with their work.
Now, don't get me wrong—
schizophrenia is a difficult disorder to treat,
and has different standards of recovery than
more common disorders like anxiety or depression.
But a diagnosis doesn’t mean you're doomed to live in a mental health facility,
or that you're a danger to society—
just like it doesn’t mean you’re indecisive or had a terrible mother.
In fact, studies estimate that as many as three-quarters of patients
recover fully or at least enough that they can lead fairly normal lives
if they have a strong support network to rely on and get the help they need.
Thanks for watching this episode of SciShow Psych!
While schizophrenia might not be “multiple personalities,”
you can learn what that actually is by watching our episode
on Dissociative Identity Disorder.
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