Schizophrenia is much more common than most people think. According to the World Federation of Mental Health (WFMH), schizophrenia affects one in every 100 people. But schizophrenia remains largely mysterious, because science still can’t explain how brain circuits misfire in those with schizophrenia. And schizophrenia is scary because it typically doesn’t start until adolescence or early adulthood, and it can come on quite suddenly.
“Here we have a disease beginning at this time of life — just as people are graduating from school or reaching for their independence — which, if left untreated, really can derail their lives,” says Dolores Malaspina, MD, a professor of psychiatry at the NYU School of Medicine.
Part of the problem with recognizing schizophrenia is the stigma that’s still attached to serious mental illness; people who have a close relative with the disease are often ashamed to talk about it. Meanwhile, the most extreme cases — the ones involving violence and wild delusions — are the ones that make it into the news headlines. Here are the top 10 misconceptions about schizophrenia and what you really need to know.
Myth: People With Schizophrenia Are Psychotic
In many cases, it takes a psychotic episode to bring schizophrenia to the attention of family and friends. But not all people with schizophrenia are psychotic. And not all psychoses are caused by schizophrenia. What’s the difference? Psychosis is defined as breaking with reality; someone might hear voices, become obsessed with false ideas, see things that aren’t there, or have paranoid delusions. Some people with schizophrenia have these symptoms, but others have a different set of symptoms. Meanwhile, people with bipolar disorder or major depressive disorder can become psychotic, as can those addicted to drugs.
Myth: Young Adults With Schizophrenia Had Earlier Problems
It’s not easy to generalize about the childhoods of people who develop schizophrenia. About half of people with schizophrenia will not have given any sign that something might go wrong; they may even have been athletes or exceptional students. For the other half, it’s possible with hindsight to recognize earlier signs, such as trouble in school, social problems, or extreme shyness. The problem is, these signs aren’t specific to schizophrenia, so they aren’t all that useful except in retrospect.
There is an early phase of schizophrenia known as the “prodrome” that can be recognized by a cluster of symptoms, including feelings of persecution, paranoid thoughts and ideas, social problems, a dramatic decline in school performance, and increasing isolation. If you notice dramatic changes in a teenager’s behavior, involve a psychologist who can distinguish between routine adolescent issues and mental illness.
Myth: Schizophrenia Is Easy to Recognize Because People Act “Crazy”
Some people do have wild, unpredictable behavior, that’s for sure, especially when they’re in the midst of a psychotic episode. But there’s one type of schizophrenia, known as disorganized schizophrenia, that has very different symptoms from what you might expect. Instead of acting out, someone with disorganized schizophrenia may seem to be turning inward, says emergency medicine doctor Mark Morocco, an associate professor at UCLA Emergency Medical Center.
You might notice what experts call a “flat affect,” such as a lack of eye contact and emotional response, or unusual emotional reactions such as laughing inappropriately or lashing out illogically. Withdrawal — to the point of refusing to go out in public — wearing strange clothes, and refusing to bathe or wash are also signs. Often people with disorganized schizophrenia begin speaking in a flat, staccato pattern with little or no inflection, and they say things that don’t make sense.
Disorganized schizophrenia can be very difficult to distinguish from other problems common to teenagers and young adults, such as drug abuse and depression. So you’ll need an experienced psychiatrist to diagnose it.
Myth: Schizophrenia Runs in Families
There is a genetic component to schizophrenia, as there is in many types of mental illnesses. In fact, a study published in Lancet in February 2013 found that the same genetic changes underlie all five of the most common mental illnesses and disorders: schizophrenia, bipolar disease, autism, ADHD, and major depression. This doesn’t mean, however, that you inherit a gene for one of these and that’s it. The researchers believe “hundreds, and perhaps thousands of genes” contribute to the development of these disorders. It’s also clear that these genes contribute just a predisposition; it still takes environmental triggers to “turn on” mental illness. Scientists are still exploring the environmental factors implicated in schizophrenia, but they include exposure to viruses, STDs, and toxins during pregnancy; and child abuse, social stress, and drug use during the teen years.
Myth: People With Schizophrenic Delusions Know Something’s Wrong
Unfortunately, while the behavior of someone with schizophrenia is so unusual that you’d think they’d know something was “off,” that’s rarely the case. In fact, one of the things that makes schizophrenia so difficult to deal with is that the person with the disorder can’t distinguish reality from his delusional thoughts and perceptions. In fact, he believes deeply in his delusions. And because so often the delusional thinking is paranoid, as in “they’re out to get me,” you may end up playing right into the delusion by trying to convince your loved one that his perceptions are wrong. (Think about it: If the government was trying to trick you with a conspiracy, wouldn’t it deny that the conspiracy was real?)
Myth: People With Schizophrenia Get Worse Over Time
It’s easy to fear, when someone you love is in the midst of a psychotic episode, that his disease is progressing and that the worsening of his symptoms will be permanent. In reality, experts now know that schizophrenia tends to be episodic, with periods of recovery interspersed with periods of recurrence. A great deal of current research is focused on identifying the risk factors that trigger recurrence; right now we know that stress is a big one. So is a failure, such as at a job, in school, or in a relationship. Individual personality plays a role, too; people who are vulnerable to anxiety, were poor achievers before the onset of schizophrenia, or have other cognitive issues in addition to schizophrenia seem to be more vulnerable to recurrence. Having a stable routine is extremely important in maintaining schizophrenia treatment, because it’s easier to remember to take medication when you have a routine.
Myth: People With Schizophrenia Are Violent
It would be nice if it were so easy to predict violence, but this idea — although widespread — is simply incorrect. According to those who work with mental illness, people with schizophrenia are much more likely to withdraw into social isolation when their disease asserts itself than they are to lash out. Some people with schizophrenia have violent outbursts, it’s true; but evidence shows that it’s often those who also abuse drugs and alcohol who become violent. Sadly, violence against oneself is common in schizophrenia; as many as 10 percent of those with schizophrenia die by suicide. So it may be more important to be alert for suicidal thoughts than violent ones.
Myth: Schizophrenia Treatment Requires Hospitalization
When someone’s having an acute episode and may pose a danger (to themselves or others) or needs to be kept stable while medications are adjusted, inpatient treatment in a psychiatric hospital is necessary. But this isn’t the case most of the time for most people with schizophrenia. Outpatient treatment is the norm now for the majority of people with schizophrenia, many of whom live independently.
Myth: The Medications That Treat Schizophrenia Stop Working Over Time
This is probably one of the most destructive misconceptions about schizophrenia, because it implies — very discouragingly — that even successful treatment is only temporary. The truth is that using medication to treat psychiatric illness is always a trial-and-error effort, and medications and dosages have to be adjusted frequently to compensate for changes in people’s body chemistry, lifestyle, diet, age, and many other factors.
Happily, there are many different medications used to treat schizophrenia, and more are being identified all the time; 15 new medications are currently in government clinical trials. There are also new delivery methods, such as injections for people who can’t be relied on to stick to a drug regimen.
Myth: People With Schizophrenia Can Never Recover
This was once the conclusion of society, who locked away those who were “crazy” or delusional for the rest of their lives. Today, according to the research on schizophrenia, it’s only one subgroup of patients who don’t recover even with treatment. For the majority, if schizophrenia is diagnosed quickly and treated aggressively, there’s a good prognosis for being able to live comfortably in society. And a 26-year study published in Current Directions in Psychological Science in 2010 found that a significant number of people with schizophrenia do experience full recovery, some of them without treatment.