Schizophrenia Analysis, Treatment and...Detractors

By Ofer Zur, Ph.D.


Schizophrenia has been one the most puzzling, disturbing and fascinating mental illnesses of all time, which affects nearly one percent of Americans. Historically, individuals with Schizophrenia were thought to have “split personalities.” Eventually, clinicians came to recognize clear differences between Schizophrenia and Dissociative Identity Disorder.

Now, those in the general population have an even clearer understanding of the nature of Schizophrenia as a result of exposure to films such as “A Beautiful Mind,” “Clean, Shaven” and “The Fisher King.” Even with improved awareness in both clinical and general populations, there is still active debate about the illness and its diagnosis and treatment. For my view of the “Village” and Community of Care go to


Schizophrenia — Recap:

  • Schizophrenia is a chronic, severe and disabling brain disorder that affects about one percent of Americans.
  • While schizophrenia occurs in 1 percent of the general population, it is seen in 10 percent of people with a first-degree relative who has the disease.
  • Research has shown that schizophrenia affects men and women equally and occurs at similar rates in all ethnic groups around the world.
  • The modern term, “Schizophrenia,” comes from the Greek word “shjzofre’neja,” meaning “split mind.”
  • Despite misunderstanding by much of our population, schizophrenia is neither “split personality” nor “multiple personality.”
  • Schizophrenia is characterized by profound disruption in cognition and emotion, affecting the most fundamental human attributes: language, thought, perception, affect and sense of self.
  • Due to the disabling “voices” that many schizophrenic people hear, it can be very difficult for them to maintain a job or even manage consistent self-care. As such, the burden on their families and society is significant.
  • The National Institutes of Health says the total costs of the illness approach $30 billion to $65 billion annually.
  • Individuals with schizophrenia may experience positive, negative or cognitive symptoms, all of which can inhibit normal function.
  • Psychotic symptoms (such as hallucinations and delusions) usually emerge in men in their late teens and early 20s and in women in their mid 20s to early 30s. They seldom occur after age 45 and only rarely before puberty.
  • While many of the older antipsychotic medications, such as Thorazine, were associated with adverse side effects, such as Tardive Diskinesia (TD), there are many antipsychotics available today that have far fewer side effects.
  • TD is primarily characterized by random movements in the tongue, lips or jaw, as well as facial grimacing, movements of arms, legs, fingers and toes, or even swaying movements of the trunk or hips. TD can be quite embarrassing to the affected patient when in public. The movements disappear during sleep. They can be mild, moderate or severe.
  • Some of the atypical antipsychotics currently in use include risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), and ziprasidone (Geodon). Each has a unique side effect profile, but in general, these medications are better tolerated than the earlier drugs.
  • The risk of suicide amongst those with schizophrenia is far higher than in the general population. And, while Clozaril is associated with several serious side effects, it is one of the only anti-psychotics that effectively reduces the risk of suicide in schizophrenic patients.
  • Some of the atypical antipsychotics can be administered by injection, reducing the risk that the patient will “forget” their daily or twice daily medications.
  • A study in the New England Journal of Medicine found that 74% of the patients in the study discontinued antipsychotic medication before the end of their treatment due to inefficacy, intolerable side effects or other reasons.
  • One FDA Public Health Advisory warned that elderly patients with behavioral disturbances who were being treated with atypical antipsychotics ran a significantly higher risk for death than folks not being treated with antipsychotics.
  • Studies out of the United Kingdom suggest that CBT can be an effective tool for diminishing delusions, as well as for reducing the experience of voices in those with schizophrenia.
  • There are numerous studies suggesting that patients treated with neuroleptics receive more hospitalization than those not treated with neuroleptics.
  • Contemporary researchers and clinicians regard recovery from schizophrenia not only as the cessation of symptoms but also as the development of new meaning and purpose as one grows beyond the catastrophe of mental illness. While there is no known cure for schizophrenia, the recovery model provides new hope for those with this disease.
  • Facilities that provide psychosocial rehabilitation provide patients with work and social skills training, education about their disease and why medications are important, symptom management and, often, therapy for dealing with the trauma of having schizophrenia. There are nearly 4,000 such facilities across the country.
  • In the words of R.D. Laing, “Madness need not be all breakdown. It may also be breakthrough. It is potential liberation and renewal as well as enslavement and existential death.”
  • Szasz continues to fight for the normalization of schizophrenia, perceiving the symptom profile of those diagnosed and labeled with schizophrenia as an illness of fit between individual and environment. According to Szasz, these individuals are coping in the way that they have learned to manage their environments, and they do not have “brain disease” as many scientists have suggested.


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