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There are memories of childhood, and then there are those stories that you were told over and over. It becomes unclear whether they actually happened, you misremembered, or you just recall being told the stories at dinner all those endless childhood nights.

One thing I do remember is that both my mother and father were affectionate. I remember having trouble sleeping. I still have trouble sleeping. I needed my bedroom door open, the hallway light on, the closet door shut to keep out monsters. My mother would sit by my bed and sing a song to me in German that had the word “Shlaf,” in it. Sleep. She would kiss me and leave.

But I wanted my father, too. He would lie next to me, with his arm around me. It may sound creepy, but it wasn’t. It was just nice.

But there’s one moment that I’m not sure is a memory or the endless repetition of a story, a teasing story, but one that is now just a story. We are at the kitchen table in our very modest house in Indiana. I’m three, maybe four. I have my arms wrapped around my father’s legs. I say, “I’m going to marry Daddy.” My mother laughs, and says, “What about me?” And I say, “you’ll be old, but he’ll be shiny and new.”

A Drawn Out Love

Twice a year until I was in my twenties, we would visit my dad’s mother in Memphis. My grandmother was white and in typical Southern, racist ways, she had an African American maid, Pearl. Pearl had worked for her since my father was seven. She rode in the limo with us to bury my grandmother, whom she outlived. Every visit that I remember, she would serve us breakfast and she would laugh and say to me, “You looooved your daddy,” drawing out the word love.

A drawn out love. How I loved my father and still do, even though he’s dead. You can love a dead person. A person dies, but love doesn’t. Something deeper than memory.

A clear memory, a real one rather than a story, is of the first time my father tried to kill himself. We never talked about it, so it can’t be an often-repeated story. Who would want to repeat that night?

My mother was sitting at the kitchen table crying. My mother never cried. I was five or six. Where was my father? Why was my mother crying? It was late. It was past dinner time. He was never late, we always had dinner together as a family. It was dark out and I wasn’t in bed. Everything was wrong. Then the yellow station wagon drove up into the garage. I ran into the garage. My father walked out. Normally, he would hug me, pick me up. But he didn’t look at me. His lips were blue. “Daddy? Daddy?” I went after him as he walked through the garage door into the kitchen, where, unbelievably, my mother still sat crying. He didn’t say anything back to me.

Then things again become unclear in my memory. Policemen were there. They left. My father left. Somehow, I went to bed, but I don’t remember how. In the morning, my mother told me that Dad was sick. We went to visit him, that I do remember.

My father was a French scholar at the University. When we visited him in the hospital, he gave us some crafts he’d made. One was a tiny stool with a stenciled design painted on it. Something a child would make. I think he made a leather belt that we saw at another visit. He was very quiet. He was always somewhat quiet, but he seemed — broken. I didn’t understand then the concept of a broken man, but somewhere in my child’s brain, I did know something was very wrong with my father. My love.

It changed my life.

Typical and an Exception

There is much literature on paranoid schizophrenia. There is an unfortunate amount of television shows that depict paranoid schizophrenics as dangerous and violent. But the majority of schizophrenics harm themselves, not others. The majority of schizophrenics do not stay married, do not remain fathers to three children. The majority end up in and out of hospitals, homeless, in and out of work. Permanently broken.

My father was the exception and also typical.

No medication really worked. Unlike depression and anxiety, the effectiveness of treatments for paranoid schizophrenia is poor. You can numb those with paranoid schizophrenia, tranquilize them, but underneath the haze, the demons still lurk.

My father was typical in that way and unique in that his wife stayed with him until the end. He presented as a normal person for most of his life. There were breaks, for sure, but mostly no one had any idea he was suffering from paranoid schizophrenia. He was known as a gentle, musical, loving, funny French scholar. He had friends. He loved his wife and children. In that way, he was unique, lucky, blessed. He was special.

In my teens, I wanted to know more. I asked my mother. She told me that when he was eighteen — the typical time for schizophrenia to present — he had what was then called a nervous breakdown and had to be hospitalized. He dropped out of Williams College. He thought he was Jesus Christ, among other things. This was the sixties and he was aggressively treated with electroshock therapy. This upset me for years, if not decades. How could someone do that to my father? How barbaric.

One of the first depictions I remember of electroshock was a movie about Edie Sedjwick. In it, they show her with a leather strap in her mouth, and as she gets shocked her entire body convulses.

Mental illness is still stigmatized and not well understood. It may seem in these years of Trump that the world is getting worse, but the mentally ill are no longer subjected to treatments that amounted to torture, as they once were. They are not chained to walls, subjected to earlier versions of electroshock therapy, not dumped in ice water, put on the rack, or whatever other medieval horrors you can think of.

Something very common seems to happen in the progression of medicine. As time goes on, the medical establishment discovers that smaller doses work better than larger doses. Birth control is given in much smaller doses than it once was, the same goes for the morning-after pill, and the same goes for electroconvulsive therapy (ECT), formerly electroshock.

My father was probably given what now would be considered abnormally large doses or electroshock. Then there is schizophrenia medication. It keeps getting better and his medications kept changing as the years went on.

In my teens, I became involved in keeping track of my father’s medication. My mother would, understandably, get overwhelmed by the management of my father’s illness. Also understandably, she would often retreat into denial.

In college, she would call me and complain that Dad was being difficult, annoying, a pain. That was a signal to me: he needed to see a doctor, he needed a medication change. He needed — something. These conversations with my mother were so hard. She was his lifeline, but how could she handle it? Forever? Alone? I was the bearer of bad news. I’d say, “Mom, he’s mentally ill. He needs help.”

My Father’s Messages

The way he expressed his illness most explicitly was, ironically — as I’m a writer — through letters. I didn’t keep those from my young adulthood, but I kept the ones from the end of his life. They are heartbreaking, but they are proof. They are his suffering, something I wished, and will perhaps always wish, I could have alleviated.

This letter is from 2009. His handwriting was beautiful.

I wanted to help him. I wanted him not to feel so alone with his problems. All I wanted were those two things, but what could I do? My son and I were not sending “messages.” He was paranoid. I called him. I flew to visit him. I took him to his psychiatrist and asked if we could change his medication.

In another letter he threatened to kill himself. He was suffering so, from all the “messages.” In the session with his psychiatrist, I begged for help, much like my father begged me for help. I also begged my father. “Please don’t hurt yourself.” I may have said, “I’m here for you, I need you.” I don’t remember exactly. But I do remember him looking at me and saying, “you don’t what it feels like to be me.”

I didn’t and don’t. And, despite my BA in psychology, despite my year of working with the mentally ill in halfway houses during college in Boston, I will never know his pain. He knew I loved him. I know he loved me. But that wasn’t enough. The drugs weren’t enough, love wasn’t enough. In the end, the messages won.

Somewhere I have his suicide note. I didn’t read it until the one-year anniversary of his suicide.

Uncertain Comfort

I know for certain that when he had gone missing I got on a plane and by the time I arrived he had thrown himself head first out of the second story window of a homeless shelter. I know for certain where the desk was where he wrote the note. I saw the window from where he jumped, I walked below it, where his body landed. It was next to a garbage dumpster.

I don’t know for certain how long he bled out. I don’t know for certain how much pain such a short fall caused. I worry about those things, less than I did, but still. It hurts to think of him suffering.

The people at the homeless shelter were astonishingly chipper. I said, “he knew I was coming.” And the man’s eyes, whose face I can still see, brightened. “Yes,” he said, “when he heard you were coming he seemed so relieved. He went to the desk and wrote the note and then jumped. He was finally free of his pain.”

Free of his pain. I called a dear friend and told him that my father had died by suicide, and I was so worried about his pain, his suffering. The friend said the same thing; “Well, he’s not in pain anymore.”

This didn’t comfort me at the time. Honestly, it still doesn’t.

I know for certain I am here to keep his spirit alive, all his love and kindness and humor and intelligence — all his beauty, and all his pain. He was so much more than his illness. It’s been almost ten years since his death, and I think that’s the one thing to take away from such an experience. Our mentally ill loved ones are complex, beautiful people, who happen to be ill. They are not just their illness.

There are memories of childhood, and then there are those stories that you were told over and over. Refusing to acknowledge my father’s illness, or the destructive power of it, wouldn’t be helpful. But to know how much more to him there was than his illness, is vital. Ultimately, the mentally ill are not so different than those who don’t identify as mentally ill — they are here to live the best lives they can. That is all any of us can all do. That, and keeping them alive in memory.

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Though traditional schizophrenia treatment often involves high doses of anti-psychotic medications — which can be effective but often come with unpleasant side effects such as weight gain, grogginess and emotional numbing — many people are now seeking therapy for schizophrenia. As a result, as many as a quarter or more of people with schizophrenia stop taking medication within the first year. And that’s where therapy can help. In addition to medications, many people with schizophrenia also benefit from some form of psychotherapy or social support treatment.

Therapeutic Ways to Treat Schizophrenia

While psychotherapeutic interventions can be helpful in managing symptoms of schizophrenia that persist despite medication, it’s important to note there’s more than one kind of therapy to help treat the disorder. Below are five ways therapy can help treat schizophrenia.

Individual psychotherapy

Individual psychotherapy for schizophrenia patients involves regularly scheduled talks between the patient and a mental health professional such as a psychiatrist, psychologist, psychiatric social worker, or nurse. The sessions (most effective if held on a regular basis) may focus on current or past problems, experiences, thoughts, feelings, or relationships. By sharing experiences with a trained empathic person — talking about their world with someone outside it — individuals with schizophrenia may gradually come to understand more about themselves and their problems. They can also learn to sort out the real from the unreal and distorted world that their disorder fosters.

Self-help groups

Support groups help people with schizophrenia and their families feel less alone. Members of the group offer each other emotional support, acceptance, and advice. Some groups also get involved in advocacy efforts that fight stigma and work to improve the lives of all people who have mental illness. By speaking to other schizophrenics about one’s symptoms, and participating in dialogue about mental illness aids, one can see their own problems in the experience of others — and perhaps gain further understanding and perspective on their illness.

Further, self-help in other forms is important. Pursuing self-help strategies such as changing your diet, relieving stress, and seeking social support may not seem like effective tools against such a challenging disorder as schizophrenia, but they can have a profound effect on the frequency and severity of symptoms, as well as improve your mood and increase your self-esteem.

Social skills training (SST)

SST uses the principles of behavior therapy to teach communication skills, assertiveness skills, and other skills related to disease management and independent living. Skills are broken down into several discrete steps. After reviewing the steps, the therapist models the skill by demonstrating via role play. Participants —SST is often done in small groups, led by two co-therapists — then do role-plays to learn and practice skill. Therapists and group members provide constructive feedback to the individual after each role play and each participant is given an opportunity to practice the skill several times. Repeated practice and overlearning of skills are important aspects of SST.

Psychosocial therapy

Psychosocial rehab focuses on social and vocational training. People learn skills they need for interacting with others, living in the community, and getting and keeping a job. For example, someone might learn how to apply for a job, use public transportation, budget money, and remember appointments.

Cognitive behavior therapy (CBT)

In CBT, a psychotherapist helps a person change potentially harmful or destructive beliefs and behaviors — actions and thoughts that may have developed as early as childhood and early adolescence. Cognition refers to thought patterns, and a therapist can help people with schizophrenia transform their harmful or negative cognitive patterns into healthier and more positive beliefs.

CBT hinges itself on initially setting goals, meeting them, and obtaining a measure of self-awareness and confidence in order to progress and succeed in therapy.

The First Step is Getting Help

Currently, there is no cure for schizophrenia, but the illness can be successfully treated and managed — both via medication and supplemented with therapy. The key is to have a strong support system in place and get the right treatment for your needs.

That said, the first step in seeking help is often the hardest. Many times a person with schizophrenia doesn’t feel like anything is wrong — they don’t recognize their own behaviors or thoughts as bizarre or out of the ordinary. Some people with schizophrenia fear that they’ll face stigma or be labeled negatively if they seek medical help.

Many people find it helpful to start with a mental health specialist to begin the process. Such professionals are trained to recognize the symptoms of schizophrenia and make an accurate diagnosis, ruling out other possible diagnoses, or problems that may be causing the symptoms.

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I was diagnosed with schizoaffective disorder at age 19. Schizoaffective disorder is thought to be a unique combination of schizophrenia and a mood disorder like bipolar, presenting with symptoms like difficulty communicating, episodes of depression, delusions, and even hallucinations. It presents differently from person to person, and there’s still a lot to be learned about it. Though it has negatively impacted my life in many ways, it’s been especially difficult to navigate in my social life.

Before the onset of my mental illness, I was outgoing and had a vibrant social life. While I also always struggled with ADHD, I had a lot of fun in high school. I was the captain of the high school football team and felt committed to my schoolwork. Nonetheless, schizoaffective disorder ultimately incapacitated me to the point where I couldn’t speak a coherent sentence, let alone carry on a conversation or complete routine day-to-day functions. The change was stark.

In my quest to recover my health and have a fuller life, I began talk therapy at age 25, and resolved to improve my cognitive abilities and start to define life goals. One of the goals that came up first was to be in a supportive relationship , and to one day have a family.

Casual Dating with Mental Illness

After two years of work on myself, I progressed to the point where I actually felt ready to “out myself out there” and go on dates. I had a full-time job and was saving money. I was 27 and still living at home which was a drawback, but my confidence was growing.

The first few dates I went on were fun and relatively laid-back. Deep down, though, I was drowning in insecurities. Because I had a reading disability, my job was an entry-level position in retail where I made very little money.  I was dating a woman who managed a retirement home, and was more connected to her “career” than I was to my day-job. There were countless things I worried about.

That relationship only lasted about two months. It ended with a text message from her in which she said I was a “nice guy,” but didn’t think we were going to work out. A lot of this outcome, I think, had to do with my social ineptitude from psychosis, which often left me literally speechless, caught in my own world without an ability to express myself. In moments of psychosis, I would open my mouth to speak, but nothing would come out. She sometimes would ask if I was OK and needed help. I didn’t tell her what I was experiencing because I thought she would respond by leaving me. The stigma of mental illness is real, after all.

What Does Psychosis Look Like When Dating?

Psychosis trapped me in my mind and made it difficult for me to be in the moment and present in the room. People would be talking, but it was a struggle to process any information. When my girlfriend and I were dating, there would be many occasions when she’d be expecting an answer, but I hadn’t even mentally digested what she was saying in the first place. She would eventually say something like, “Hello, are you even listening?” I would tell her yes but couldn’t recall what she had said because I had not finished analyzing it.

My slow comprehension definitely made for some awkwardness and contributed to the relationship not working. At the time, I wanted to blame my inability to date on factors like an inadequate job, or living at home at age 27. In reality, I simply wasn’t mentally healthy enough to be engaging with other people  romantically.

For the next year or so, I continued to work on my mental health in therapy with  a focus on improving my social skills. I soon started dating a friend, and began my first long-distance relationship.

Still, I had a lot to learn. The thing I realized is that love and life are constantly evolving. I had to continue learning and improving my relationship skills to keep up with folks for whom dating came more naturally.

The Power of Honesty

Six months into the relationship, I decided to tell her about my illness.

“I have something I need to tell you,” I said.

She looked at me with concern, and I choked up. I was terrified that my diagnosis would end the relationship. I couldn’t speak much at all, so I pulled up my phone and showed her my website that contained my writing about my schizoaffective diagnosis.

“What’s this?” she asked.

“It’s my website,” I said in a barely audible voice. “I have schizoaffective disorder.” My breathing began to seize up and I became tense.

“You do?” she asked.

“Yeah,” I said. I felt like a train was going to run me over.

“Oh, OK. Well that doesn’t matter,” she said.

I laughed a little. “It doesn’t?” I asked.

“No, not at all,” she said. “We need to get you a beer. This is too much stress. Come on. I’ll drive.”

After this conversation, I felt more at ease. I started disclosing more insecurities. At times, I might have opened up too much. About a week later, the relationship ended, but ironically, I don’t quite think it had anything to do with my diagnosis.

Because of schizoaffective disorder, I never matured at the same rate as my peers. Because I was dealing with psychosis in my early-to-mid-20s, I had been isolated from others and hadn’t practiced having social interactions with people my own age . During those years, I had lost track of what was socially acceptable to say and what wasn’t. Sometimes I would try to make jokes that weren’t relevant to the conversation we were having. My sense of humor needed to catch up with my age.

The Education is Ongoing

Looking back, I realized that this longer-term, long-distance relationship with my friend was a step in the right direction. It was a failure that opened new doors. The experience gave me confidence in who I am, and affirmed for me that I need to keep progressing with my health and education on dating.

Since then, I’ve spent time dating intermittently but not being in any real relationships. Today, I’m now a manager at a local butcher, and I live out on my own. I feel more secure about who I am, although I still fixate on my inadequacies, just like anyone else — like the fact that I don’t make a lot of money.

Being in therapy, I am learning I also learned I had a lot of confusion as to what I wanted and identify more clearly what kind of relationship I’m looking for, and what kind of person I want to be. I’ve asked myself what love is and learned that, for me, love is aboutmaking sacrifices for the overall happiness of both people in the relationship. Mental illness or not, this is a commitment I’ve made as I continue to work on myself.

I may have schizoaffective disorder, but other people have challenges they deal with, too. It’s the imperfections that give us all value and define who we are.

For a while, I was looking for the perfect woman. A friend then told me, “None of us are right and none of us are wrong, some of us are just more right for each other than others.”

It’s true, and believing that requires that we accept ourselves more in the process. When I previously felt diffident in my ability to date and have a relationship, redefining what I was looking for gave me the strength I needed to accept myself and make changes in my life based on what supports my well-being. That, to me, is part of the foundation of finding real, sustainable love.

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During my first episode of schizoaffective disorder, I experienced psychosis to the point where I had difficulty speaking more than several words at a time. I had referential thinking and lost my ego boundary. Everything external and internal blended together.

I believed there was a telekinetic network and my thoughts were being disseminated to everyone in the world.

The meaning of this diagnosis was something I repudiated at first. I didn’t accept as an inherent part of who I was. At first it made me think I was weird and different than everyone else. I didn’t like feeling that I was separate from those who were healthy and “normal.” My self-perception at the time was that I was kind of a weird person, so hearing this diagnosis reinforced that notion.

As I grew older and out of the awkward stages of my early and mid-twenties, it became easier to separate myself from the illness. When I became more comfortable with who I was, I was able to think of my mental health condition as not one and the same as my personality. This new mindset allowed me to compartmentalize the diagnosis into a series of symptoms.

Another issue I faced was that I attributed everything — all that horror — that had happened in college to schizophrenia. I felt that if I disclosed the diagnosis, that would immediately reveal all the embarrassing moments I had experienced from my episodes; all the chaos, psychosis, and disorientation. I was also nervous about meeting new people. It’s strange to say, but I didn’t realize when first meeting new people that they didn’t already know all about my condition. I also assumed that everyone who had schizophrenia had exactly the same experience.

In later years I realized the only commonalities are some of the symptoms. Sufferers experience auditory and visual hallucinations, referential thinking, speech impairment, and psychosis. When I disclose my mental illness, it’s simply a series of symptoms that I’ve been dealing with. It’s the same as any other diagnosis.

The other issue I struggled with when diagnosed with schizoaffective disorder was the stigma surrounding the diagnosis. At first I actually imagined it might be cool, a label that set me apart. Maybe the idea came from watching too much TV.

After the dust cleared from my second episode, however, I realized this diagnosis was a huge problem for a number of reasons. I struggled to socialize and interact with new acquaintances. People would joke about mental health conditions, and it was difficult for me to cope with because I took it personally. Hearing people disparage those with mental illness was painful.

It hurt because it felt like they were talking about me. I also couldn’t stand up for myself because I worried my friends wouldn’t want to spend time with me if I disclosed my diagnosis or defended others with mental illness. The stigma against mental illness is still strong and I felt it acutely.

After disclosing my illness to about five or six friends, I realized that the good people in my life didn’t care about schizoaffective disorder diagnosis. Disclosing the illness actually strengthened some of my relationships — people knew the reasons I was socially awkward at times. They became more accepting. And the disclosure also acted as a useful test — who would actually want to be friends with someone who was so closed minded as to discriminate against those with mental health challenges?

As far as feeling that mental health stigma kept people from associating with the mentally ill, I realized this was more about my own insecurity, my own unhealthy or irregular thoughts and behaviors. Friends who know I have schizoaffective disorder are always tactful when they talk about mental health, and they come to me as a resource when they, or someone they know, is going through a tough time. I learned that most of the disparagement against those with mental illness came from a lack of education. It wasn’t necessarily even malicious.

My diagnosis of schizoaffective disorder is simply a statement of symptoms. These mental health issues have nothing to do with who I am. I like to say that if someone has a cold, this doesn’t mean they have a sick personality or they’re a bad person.

For the first several years of recovery I hated to think about the diagnosis because of all the symptoms I was suffering from. As I became healthier, however, I was more comfortable with the diagnosis because it wasn’t impacting my daily life. As I made progress with therapy, I gained control over the illness alleviated the fears I had initially. The progress made my symptoms more manageable and easier to talk about. I finally had control of my life.

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Schizophrenia is perhaps the most misunderstood of all mental illnesses, mostly due to the sheer amount of misinformation out there. Some of this is due to movies and TV, while some can be attributed to stereotypes about mental illness. There are several cultural and demographic myths regarding schizophrenia — these are the four most common.

Myth #1: People with Schizophrenia All Have the Same Symptoms

There are many different types of schizophrenia, and they can all affect a person in different ways. Symptoms of paranoid schizophrenia, such as delusions that someone is out to get the sufferer, are different from catatonic schizophrenia symptoms, which include a lack of emotion and decreased motivation.

Mental illnesses affect people differently. It is possible to encounter two sufferers with the same type of schizophrenia who behave differently. Schizophrenia isn’t all about being paranoid and hearing voices.

Myth #2: Women are More Likely to Have Schizophrenia than Men

Although some people believe women are more likely to be diagnosed with schizophrenia and other mental illnesses than men, studies show that the rate of schizophrenia is two to three times higher in men than women. This could be because women are more likely to seek out treatment for their mental health than men, but also because there are genetic components of the disorder as well.

This myth has some unfortunate implications and side effects. Schizophrenia is a serious illness that requires treatment and medication. Men and women who do not receive this treatment are more likely to become a danger to themselves and others. There is still a serious stigma in our culture against men who seek help for their mental health issues. This barrier can lead to severe consequences when men do not receive the treatment and therapy they need.

Myth #3: People with Schizophrenia have Multiple Personalities

This is another myth that refuses to die. In fact, according to a 2008 study by the National Alliance on Mental Illness, 64% of people still believe schizophrenia means having multiple personalities. While people with multiple personalities do exist, most do not live with schizophrenia. The condition people are actually thinking about is called dissociative identity disorder (previously multiple personality disorder).

Part of the reason why people believe schizophrenia is the same as dissociative identity disorder is because schizophrenia derives from a Greek word meaning “split mind.” The “split mind” aspect refers to how people with schizophrenia have minds that tend to isolate them from the rest of the world, as if they were split off. The phrase doesn’t mean the mind itself is split.

Myth #4: People with Schizophrenia are Dangerous

Thanks in part to movies, TV, and other forms of pop culture that portray all people with mental illness as unpredictable criminals and killers, this is one of the most common myths about schizophrenia. The vast majority of those who live with the illness aren’t violent at all. According to studies of people with schizophrenia who have committed violent crimes, only 23% of those offenses were directly related to their symptoms.

The Reality

With proper treatment and schizophrenia medication, it is possible to live a full life with schizophrenia. Many famous people such as football star and sports analyst Lionel Aldridge, former Fleetwood Mac guitarist Peter Green, and mathematician John Nash have all lived with schizophrenia. Life was often difficult for them, yet they learned to thrive.

There is hope for those who live with this frightening yet misunderstood condition. By combatting the stigma of the illness, we can help them be at peace and free of judgment.

Bio: Mike Jones is a health and fitness writer. He hopes people will stop stigmatizing others dealing with a mental illness and start fighting against common schizophrenia misconceptions. More of his work can be found on Twitter.

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The cause of schizophrenia is unknown. Although there are various theories, it’s generally diagnosed when symptoms meet the standard definition of the disorder, and when other similar conditions — such as bipolar disorder — have been rejected.

Delusions and Hallucinations

Schizophrenia is a severe, long-term mental health disorder that doctors classify as a kind of psychosis. This means that sufferers can’t correctly perceive what is going on in the world around them, and interpret events that are occurring in a different way than others. Symptoms may involve hallucinations, delusions, an inability to feel emotions or pleasure, and disorganized thinking, among others. The disorder usually appears in those in their teens and twenties, although it can show up in those in their thirties (more often in women).

Schizophrenia can be hereditary, and around 10 percent of people whose first-degree relatives are sufferers are affected. The disorder can’t be cured, but the symptoms can be managed to the point that sufferers can, for instance, hold a job, and maintain relationships. Recent research points to a cause that is both genetic and environmental, and treatment usually involves a combination of antipsychotic drugs and cognitive behavioral therapy.

Paranoia and Disorganization

As the root cause of the disorder is unknown, schizophrenia is best understood by its symptoms. There are two main subtypes of schizophrenia — the paranoid subtype and the disorganized sub-type. The paranoid subtype suffers from auditory hallucinations — “hearing voices” — or delusional thoughts, or both, relating to persecution and conspiracy. The sufferer often thinks that a person, or a group of people — often family members — are “out to get” him or her.

The hallucinations revolve around a specific theme, which usually remains constant for the sufferer, and the individual’s actions generally relate to the content of this theme. The brain of a person suffering from schizophrenia mistakes the thought of a voice giving instructions as a real voice.The voices appear to be genuine to the sufferer. Delusions include the thought that, for instance, people talking on television are sending special messages, or giving instructions, to the sufferer.

The feelings of persecution can lead to hostility toward others, although those experiencing schizophrenia are rarely violent. As the condition progresses, memory and mental coherency can suffer. One problem is sufferers might not talk about their auditory hallucinations, so the disorder may be difficult to spot in the early stages. The paranoid subtype can more easily be treated, and sufferers can stabilize to a level where they can work, have relationships, and lead relatively normal lives.

The disorganized subtype suffers from disorganization of the thought process — sufferers become muddled and confused. This subtype experiences less pronounced hallucinations and delusions, but may not be able to think clearly enough to function normally. They might not, for instance, wash or perform other acts of personal hygiene. The sufferer will lose the ability to experience emotions, a condition which is called the “blunted” or “flat” affect, and may respond in an inappropriately cheerful manner to events, for example, by laughing at a funeral. Communication becomes difficult, and speech becomes garbled, with words being used in the wrong order. This is sometimes referred to as “word salad.”

Nature and Nurture

What causes schizophrenia? The root cause is unknown. Environmental, biological and, more recently, genetic causes have been explored. Some researchers believe that there is an environmental element — a virus, or malnutrition in the womb — that works in conjunction with genetic or biological factors to cause the condition. The focus until recently has generally been biological, and dopamine has been the subject of much investigation.

Dopamine is a chemical that works as a neurotransmitter in the brain — that is, it’s used to send signals to nerve cells. When drugs like clozapine are used to block dopamine, schizophrenia patients see an improvement. This has led to the suggestion that schizophrenia sufferers may produce too much dopamine, and this may be a cause of the condition. NMDA receptors — receptors that are found in nerve cells and are activated when glutamates bind to them — have also been considered as a cause.

Genes May Hold the Key

Recent research, however, has focused on genetics, with one influential study cataloguing 108 genes that are implicated in causing schizophrenia. Another important study focused on a specific gene, C4, as a specific cause of schizophrenia. The C4 gene is involved in the immune system. In the blood, it binds to microbes to signal that they should be engulfed by cells of the immune system, and therefore destroyed.

In the brain, C4 has a different purpose, and binds to neurons at the points where they connect to other neurons. This is to signify that the connection between the neurons (called the synapse) should be engulfed and destroyed. Schizophrenia often first appears in teenagers due to a developmental phase in the brain at this age when the synapses are pruned. Researchers believe that schizophrenia could be a result of the C4 gene marking too many synapses for pruning. This is an exciting step forward, and more research is being carried out on the C4 gene. If a root cause for schizophrenia is discovered, it’s possible that a cure can be found.

Meanwhile, doctors continue to manage the symptoms in patients with schizophrenia by using a combination of drugs and cognitive behavioral therapy. “Typical” antipsychotic drugs like chlorpromazine have been used to treat schizophrenia since the 1950s, although these can have side effects like movement disorders. “Atypical antipsychotic” drugs like clozapine are used if patients fail to respond to typical antipsychotic drugs. Clozapine works by blocking dopamine receptors in the brain. It’s effective, but it must be closely monitored, as a side effect can be a dangerously low white blood cell count.

Therapy Aids Recovery

Psychosocial therapy can aid patients whose conditions have stabilized due to the use of antipsychotic medication. Therapists can encourage schizophrenia patients to stick with their medication, and can help with a patient’s self-management of the disorder, their relationships, and integration into society (like employment).

Cognitive behavioral therapy, which focuses on solving the current problems of a patient by breaking them down into smaller parts that can then be analyzed, can help schizophrenia sufferers work out whether their perceptions are true representations of the outside world. Therapy is an important part of the management process for schizophrenics.

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