All people have behavioural and psychological traits, such as being happy, being sad, being angry, having belief in a thing, being talkative, flinching from danger, being self centred and so on. The list is very long and changes subtly from culture to culture. When one of these becomes dominant they can progress into a disorder and then into a mental illness.
Frequently these disorders and mental illnesses can be managed by treatment, which can include therapy, lifestyle changes and possibly medication. Most of these disorders are where there is an over expression or under expression of a normal human trait, possibly due to a chemical/hormone imbalance or a behavioural trait that is learned and can be unlearned.
Then there is schizophrenia. Schizophrenia is defined by positive and negative traits. Positive traits are behaviours and experiences that most people don’t have while negative traits are an absence of traits most people do have. An example of a positive trait is the soft drink dispenser asking you about your day where no one else hears it or experiences it (this excludes pranks or “smart dispensers” that talk to everyone), while an example of a negative trait is an absence of joy.
Along with positive and negative traits there is frequently a cognitive dysfunction. To a mainstream person, a person with schizophrenia will use chains of logic that almost make sense, but don’t. Dysfunction can also be lost memories, lost skill sets (I use to be able to do this, but now I can’t) and strange beliefs.
As with all conditions, schizophrenia presents on a spectrum. Simplistically we can look at a simple linear functionality spectrum, from managing fine in the community without medication, managing with medication and treatment, to not managing. However the reality is that the spectrum is multi-axial. That is based on how much of each of the above signs and symptoms are present and how capable is the person experiencing this is able to compensate and manage.
Schizoaffective disorder is a combination of Schizophrenia and Affective (mood) Disorder, where both symptoms of schizophrenia and mood disorder are present, but not quite enough of either to diagnose the person in either category. Often people will receive this diagnosis before being upgrade, if necessary, to the schizophrenia diagnosis later.
Please note that this is all a simplified version of what schizophrenia is and is not a diagnostic guideline.
Often people diagnosed with schizophrenia will be referred to, or refer to themselves, as schizophrenic. This is very common in mental illnesses and some other illnesses – to mistake oneself for the diagnosis. I am schizophrenic, I am autistic, I am diabetic, I am broken armian, I am chronic pain, I am momentary headache. The fact is, you are a person first, diagnosed with one or more of these issues as a description – not an identity.
Highly creative people are able to look at disparate information and make sense out of it. Examples of some of these creative people are artists and scientists. This ability is all about making unusual links and then testing to see if it is feasible and doable. Uncreative people are not able to make these links and follow more traditional means of connecting information together. People diagnosed with schizophrenia are thought to lack the second part of this ability – testing. That is, reality testing to check if it is feasible and doable. The hypothesis is that people with schizophrenia lack the important reality testing part that rejects ideas, thoughts and visions that shouldn’t work and/or exist and instead assume that these ideas are real and accurate.
Another angle on this hypothesis is that the brain misfires certain inputs (stimuli from outside the body, such as sight, touch, smell etc) or the processing of internal inputs (memories, thoughts) and ends up with a bizarre result. This bizarre result is then accepted as accurate rather than rejected before the conscious mind is aware of it. All brains misfire and come up with unusual result, but generally these ideas are rejected before much attention is given to them. A hypothesis about schizophrenia is that either this rejection isn’t very good, or that there are so many misfires that the brain assumes it must be true. Any lie told often enough takes on a hint of truth, so enough repeats of the wrong idea will start to seem right.
Schizophrenia seems to have a genetic component. If you have a family member with schizophrenia traits, then it is more likely that you will inherit it. This isn’t much of an increase though. Instead of it being about 1 in 200 people, you are now 1 in 100 people – which is not much of a shift. It can also be spontaneous, with no family history of schizophrenia. Most often it is developed during the early to mid teens. Some mind altering substances are thought to cause schizophrenia in some people, but the evidence for this is weak. Did the drug cause schizophrenia, or was the person already experiencing some symptoms that they were trying to treat with illicit drugs? Which was first? Or even if there were no preceding symptoms of schizophrenia, was the person going to develop them anyway, and drugs were a correlation rather than a causation? What has been evidenced is that some illicit drugs have a higher correlation with schizophrenia diagnosis than others.
Not all people with schizophrenia need treatment. It is estimated that roughly 1 in 3 people who experience these symptoms manage themselves without input from mental health teams and or medication. They experience full and generally happy lives. Another 1 in 3 of these people respond well to treatment, where they find the skills learned through therapy and or antipsychotic medication mean they can lead a fairly high quality community life. Unfortunately it is estimated that roughly 1 in 3 people don’t respond well to medication or therapeutic input, struggling to find meaning and quality in their life. The exact statistics are difficult to get as not all people who experience symptoms are diagnosed or have any interaction with mental health.
If you are in the last of these 3 subcategories, take heart. Many people who didn’t respond well to the medical model of treatment found good support from peers (those with similar experiences) via the Hearing Voices Network – a worldwide organisation. Even those in the first two categories have frequently found positive value in connecting to others. It isn’t for everyone, but it does exist and can help.
Another thing to look into is the recovery model. The idea here is that you have a thing, and it is big and somewhat disruptive. How can you manage that big and disruptive thing, minimising its impact? And wherever that big thing doesn’t disrupt your life, how much comfort and meaning can you get? Recovery is about recognising that this diagnosis is about a thing you have, it isn’t defining you. I have an arm – does that make me an arm? No. I am a person who is more than my arm. You have schizophrenia, that doesn’t make you schizophrenia.