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Schizophrenia is a very serious mental illness where individuals are unable to differentiate between reality and imagination. It is the most common type of psychotic illness and is thought to affect up to 1 in 100 people in the UK during their lifetime.
Schizophrenia results in a disturbance of thoughts and feelings and can lead to odd and troubling behaviours. It is often mistaken for, and incorrectly labelled as, ‘split personality’, which makes the perception of it inaccurate and therefore more difficult to understand.
It is usually diagnosed between 15 and 35 years of age and men and women are equally affected. Of the people who are diagnosed with schizophrenia, 1 in 4 will make a full recovery within five years of their first episode of the condition, with 2 out of 3 individuals making a recovery only to have another episode at some point in their lifetime. Sadly, up to 1 in 5 people will continue to have problematic episodes of schizophrenia throughout their lifetime, which can have a negative impact on their quality of life.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) defines schizophrenia as being: “characterized by delusions, hallucinations, disorganized speech and behaviour, and other symptoms that cause social or occupational dysfunction.”
A slightly more accessible definition comes from the Cambridge English Dictionary, which defines it as: “a serious mental illness in which someone cannot understand what is real and what is imaginary.”
Media coverage of Schizophrenia
Much of what is reported and portrayed in the media about individuals who have schizophrenia is inaccurate, misleading and stigmatising. Individuals are shown to be unpredictable and dangerous, when in fact 90% of those who experience the condition do not hurt themselves or anyone else. The portrayal of schizophrenia is biased because the media tend to only report sensationalised cases where there has been some form of ‘incident’, often linked to aggression and violence.
In films, individuals who have schizophrenia are depicted as those to be laughed at because of their bizarre behaviours, or to be pitied because they appear to be a burden to both society and to themselves. However, the most common portrayal of someone who has schizophrenia is that they are violent and dangerous, which is what many people are taught to believe is a common characteristic of all people who have schizophrenia. A recently released film ‘The Voices’ is a black comedy that portrays the schizophrenic lead character as a murderer who is told to kill people because of the voices in his head.
When a film with a portrayal such as this is highly publicised and successful, it is difficult for the public to see a more realistic and accurate portrayal of schizophrenia because, like many mental illnesses, it is not often discussed and is very misunderstood. Filmmakers have some responsibility for the biased way in which schizophrenia is depicted and therefore the way that people who have the condition are feared.
News and television coverage is also highly biased and responsible for schizophrenia being feared and misunderstood. This was highlighted by research carried out by Crisp et al. (2005) who interviewed 2,000 people in 1998 and again in 2003 to see if general attitudes towards mental illness had improved. It was found in 1998 that 71% of people who took part believed that people with schizophrenia were a danger to others. This reduced to 66% in 2003 but this figure still represents the fact that two thirds of the people who were interviewed thought that schizophrenia meant that someone who has the condition is inevitably violent.
Just over half of the people interviewed in both years thought that people with schizophrenia would be hard to talk to and, shockingly, almost 10% in each interview thought that people with the condition should be able to “pull themselves together.” This final statistic reflects how poorly understood schizophrenia actually is – asking someone who has this condition to “pull themselves together” is not helpful and may actually make the individual feel worse about their illness, which may already make them feel like a burden on society. Such negative feelings can lead to a risk of isolation and other mental illnesses such as anxiety and depression.
These statistics also compare very unfavourably with those people who have depression, where less than 25% of participants in both interviews believed that individuals who had depression were dangerous; this also serves to highlight the huge amount of stigma surrounding mental illnesses in general.
Stigma is related to prejudice and discrimination, which are all made worse by negative media coverage. It is little wonder that people who have schizophrenia are seen as people to avoid when newspapers have headlines such as:
- “Schizophrenic stabbed brother, nine, to death hours after health workers said he was no threat.”
- “Paranoid schizophrenic released into community to murder.”
Headlines such as these serve simply to fuel fear amongst members of the public but also mean that individuals who believe that they may have schizophrenia are reluctant to speak about it or to seek appropriate help because they fear what the reaction will be. For example, if someone confessed how they felt to work colleagues, they may find that they were shunned and left out because others felt unable to relate to them or feared their behaviour would become wildly unpredictable. By not speaking about the condition, this makes the possibility of discussing it and reducing some of the stigma and fear even less, and so it continues to be feared and misunderstood.
The media’s use of negative language also reinforces fear in members of the public who read about ‘psychos’, ‘maniacs’ and ‘mental people’. If the condition was explained using technical but accessible language, it might be argued that this would be very beneficial in helping people be more open about their condition. Similarly, if the media paid more attention to individuals who managed their illness successfully then this might also help to reduce stigma and discrimination.
The causes of Schizophrenia
Like many mental illnesses, trying to identify a single cause for schizophrenia is very difficult and it is likely that the condition is caused by a combination of factors that will be unique to the individual.
Possible causes may be due to:
- Brain chemistry and structure
- Major life events and traumas
- Substance abuse
- Pregnancy and birth complications
Schizophrenia is thought to run in families but with no single gene being responsible; instead it has been argued that a combination of genes may be a risk factor for inheriting the condition. An individual is ten times more likely to be affected by schizophrenia if they have a parent who also has the condition.
Other research has shown that if one identical twin (where DNA is identical) has it then the chances of the other twin also experiencing it are 1 in 2. This reduces to a 1 in 7 chance for twins who are non-identical (also known as fraternal).
Therefore, there does seem to be some link to genetics, but the fact that not all identical twins develop schizophrenia if one of them has it, leads researchers to believe that there must be other factors that go alongside genetics as a potential cause.
Brain Chemistry and Structure
The neurotransmitter ‘dopamine’ has long been thought to have some part in the development of schizophrenia. It is argued that an individual who has too much dopamine in one area of their brain whilst lacking it in another, will develop symptoms of the condition. This theory is backed up by the fact that some illegal drugs will cause an increase in levels of dopamine, and when this happens symptoms of schizophrenia will become apparent in an individual who does not have a diagnosis of the condition.
The structure of the brain has also been thought to be linked to schizophrenia, although it is not known whether schizophrenia causes a difference in brain structure or differences in brain structure cause schizophrenia. Many people with the condition have been found to have enlarged brain ventricles, which are thought to be the result of poor brain development. Also, it has been noted that people with schizophrenia have a smaller hippocampus and poor neural connections, all of which are thought to play some part in the development of schizophrenia.
Major Life Events and Traumas
Although a major life event is unlikely to be a single cause of schizophrenia, it may act as a trigger for someone who is already susceptible to it because of another factor. A major stressful event such as the death of a loved one or becoming unemployed causes big changes in someone’s hormone levels as they try and recover from the shock. It is not known exactly how, but these changes are thought to be involved in the development of schizophrenia.
Poor family relationships are thought to be an event that is involved in schizophrenia particularly for children who are repeatedly exposed to contradictory messages from their parents. For example, Bateson et al. (1956) found that children may not respond appropriately to certain instructions and interactions because they do not know which of the contradictory messages to act upon. This, it is argued, can lead to the child not knowing what is real and what is not – something which is a major symptom of schizophrenia.
Like other potential causes of schizophrenia, substance abuse is not thought to be a direct cause but can increase the risk of its development. Some drugs make individuals even more susceptible, such as cocaine and amphetamines, because these two drugs can lead to psychosis, which may trigger the onset of schizophrenia.
Three major studies have found that individuals under the age of 15 who use cannabis regularly are up to four times more likely to develop schizophrenia by the time they reach the age of 26.
If an individual already has a diagnosis of schizophrenia, then substance abuse can make the symptoms worse. Additionally, if the individual is taking prescribed medication to treat the symptoms of their condition, then alcohol and some illegal drugs can reduce the effectiveness of the medication.
Pregnancy and Birth Complications
It has been found that some individuals who experience schizophrenia may have been subject to a traumatic or complicated birth. Factors such as a lack of oxygen at birth (known as asphyxia), low birth weight or being premature may affect brain development, which can be a risk factor in the development of the condition.
Feelings associated with Schizophrenia
The feelings that occur because of schizophrenia will largely depend on how the individual experiences the condition, as the effects can be very varied. Additionally, the symptoms of schizophrenia usually present themselves as either positive or negative – individuals may experience one or the other but can also have some periods of time when they may experience both types.
|Positive Symptoms||Negative Symptoms|
Hallucinations are episodes where an individual will see or hear things that are not actually there. They can be very frightening, especially when the things that they hear are instructing them to do things that they do not want to do. These types of auditory hallucinations may begin as soft or distant voices, but as the symptoms intensify, the voices may get louder and more demanding. The risk of suicide increases for individuals who experience persistent auditory hallucinations.
Visual hallucinations involve the individual seeing things that do not exist in real life. This may mean that they become very distressed if they can see a deceased relative or something that may be frightening such as an alien or another supernatural creature. This type of hallucination is less common than an auditory one but is just as frightening.
Delusions mean that the individual is experiencing a fixed, irrational belief that others would think completely unbelievable. For example, many individuals who have schizophrenia experience something known as ‘delusions of grandeur’. This means that they think that they are someone of utmost importance such as God, Satan, the Pope or the Prime Minister, and because of this they will begin to act in a way that reflects who they think they have become.
For many people who develop schizophrenia, paranoid delusions can be the most frightening aspect of their condition. This type of delusion means that the individual fears that someone or something is plotting against them and that someone wants to harm them. This may not just be a person; many paranoid delusions involve inanimate objects such as furniture, where the individual may genuinely believe that their sofa is capable of eating them or that their toothbrush can read their mind.
Other types of delusion involve delusions of guilt, where the individual believes that they have committed a crime that they have not; delusions of control, where it is thought that other people are controlling their behaviour; and delusions of misidentification where the individual believes that the people that they know have been replaced by others.
Disordered thinking involves individuals having problems with the way that they think. This can lead to lack of concentration and focus and issues with both communicating and understanding what is happening during an interaction. Many people who experience advanced schizophrenia will have a symptom known as ‘word salad’, which means that their speech is severely jumbled and unintelligible and so will make no sense to people who are listening.
Individuals may also include their own made up words into a conversation that seem to make total sense to them but not to the other parties of the conversation. This can lead to much confusion and an inability to follow what is being said in the conversation.
The speech of someone with schizophrenia may also flip quickly from one topic to another for no reason or it may stop mid-sentence with the individual reporting that someone has removed the thought from their head, which is why they cannot find the ability to say it.
Disordered movement is a symptom that may make the individual feel as though they are out of control of their usual bodily movements. Symptoms of disordered movement include:
- Highly excitable or repetitive movements; such as hand-rubbing, grimacing or rocking
- Frozen posture where the individual is so still that they cease to blink
- Feeling that everywhere is too bright
- Clumsy movements
- An awkward walking movement
- Involuntary movement of the mouth or tongue
- Limbs that jerk or tremor uncontrollably
- Sleeping too much or not sleeping at all
Flat emotions usually occur as a result of the individual feeling as though they are completely detached from reality. Individuals may appear to be experiencing severe depression and this can lead to a state of catatonia – where they do not move at all.
The flattening of emotions means that the individual will likely find no pleasure whatsoever in activities and routines that they previously found enjoyable. This can lead to the individual becoming isolated from others and may also have a negative effect on their ability to remain in meaningful employment. The individual will report that they do not want or need anything and that they just want to be left as they are.
Feeling unmotivated can lead to a lack of personal care, which means that individuals may not bathe or shower, they may not brush their teeth or change their clothes and they may not even be able to summon the energy to cook a meal and eat it. These symptoms can be dangerous as the individual becomes susceptible to personal neglect which, if left unmonitored, could be extremely serious.
Finally, lifeless speech and body language of someone who has schizophrenia may be misinterpreted as a lack of interest in what someone else is saying to them. However, this is untrue as these symptoms are simply characteristics of the condition. The symptoms make it difficult for anyone to see how the individual is feeling because there is no point of reference whatsoever. Usually if someone is feeling happy or sad, this will be reflected in their body language even if they are not speaking, but for someone who has schizophrenia, it can be impossible to infer any kind of mood at all.
Ways Schizophrenia affects people
Although schizophrenia can be a very debilitating illness, some individuals are able to carry out their lives in the way that they did before their diagnosis. However, for others it can have a huge impact on their ability to take part in daily activities and routines and has a very negative impact on their overall well-being.
When a diagnosis is initially made, this can make the individual very fearful of what their life will be like in the future. The stigma and discrimination that is associated with schizophrenia, and with mental illness in general, can make it extremely difficult for individuals to feel comfortable talking about their condition and this can lead them to feel as though they are continually required to hide it from others. It may also lead them to experience a lack in confidence, and when they are ‘labelled’ as schizophrenic, many individuals fear that this is how they will be seen and no longer as the unique person they were before.
The need to hide their condition may cause individuals to drop out of their normal activities and routines in general. They may fear continual judgement or, in some cases, may fear that their symptoms will appear suddenly, and they do not want this to happen when they are with others.
The stigma attached to schizophrenia also makes it very difficult for those who develop the condition to make and maintain new relationships. They may find that they are completely shunned by their existing friends who are afraid of their condition or that they simply do not know what to say to the person who has been affected.
Those individuals who are married or in a long-term relationship may find that their condition means that they do not deal with stress very well and may turn to drugs or alcohol as a coping mechanism, which will likely put severe strain upon the relationship. Also, many people who have schizophrenia have problems remaining in employment, which can lead to financial difficulties; another issue that may put a strain on existing relationships.
One of the symptoms of schizophrenia is inappropriate behaviour and this can cause embarrassment for the friends and family of the individual. For example, the individual may laugh at an event that is sombre and serious, such as a funeral; or they may speak to someone insultingly without actually intending to cause offence.
Making new friends is difficult because admitting that the individual has schizophrenia will sadly put many people off wanting to form a relationship with them. This is because they are fearful of what the symptoms may do to the individual. These fears normally occur because of negative media portrayals of the condition. However, it may also be the case that those who have schizophrenia may not want to make new friends or stay with existing ones because their paranoia makes them feel as though everyone, regardless of who they are, is plotting against them.
The auditory hallucinations that someone with schizophrenia may have will almost certainly impact their life because they may find it difficult to get rid of them or to ‘fade them out’. This means that they cannot concentrate or focus, meaning that academic or employment performance will suffer; sadly, auditory hallucinations are also thought to be a major contributor to the statistic that reveals that 40% of people who have schizophrenia will commit.
The lack of friends can lead individuals to social isolation and it is often found that people who have schizophrenia have little contact with other people outside of their close family. Some have no support network at all and this will deepen the risk of isolation.
How Schizophrenia affects others
The diagnosis of schizophrenia can be just as devastating and fearful for an individual’s family and friends as it can be for the individual themselves. Parents may blame themselves for passing on a ‘faulty’ gene or for not raising them properly, even though there is very often substantial evidence to the contrary.
A diagnosis of a serious mental illness such as schizophrenia can make others in a person’s life feel as though they are not doing enough to help. Many friends and family members will find it very troubling to watch someone struggle with the condition and feel as though they are powerless to help them. In severe cases, many family members and friends may feel responsible that they were not quick enough to help or did not notice significant changes if the individual tries to harm themselves. If there is a constant fear that this might happen, it can be intensely distressing for everyone involved.
Many partners will worry about the effect that the diagnosis has on their children, especially if it has been suggested that the individual has developed schizophrenia due to inherited genetic factors. Many partners may also struggle with coping with the individual whose symptoms might be overwhelming. This is especially the case if the individual is one of the few people whose symptoms mean that they do become aggressive and violent. In this case, the partner may feel they need to end the relationship for their own or their children’s safety but feel guilty in doing so because it would be like abandoning the individual in their time of need.
If the individual has to leave their job, either temporarily or permanently, this might cause financial strain, which can add to the struggles already created by the symptoms of schizophrenia. Problems with money can lead to families getting into debt and, in worst-case scenarios, they may even lose their home if they cannot make rent or mortgage payments. Individuals who live alone are far more subject to homelessness when they have schizophrenia, with statistics showing that up to a third of people who experience the condition are homeless at one time or another.
Some family members may become overprotective of the individual and feel the need to hide their diagnosis from others. Whilst it is instinctive to protect loved ones, overprotection may actually cause more harm because it leads to an over-reliance on others, which may be a factor in how effectively the individual manages to recover their independence again.
Many family members will become formal or informal carers for the individual and this can cause huge strain on relationships. Carers often neglect their own well-being in order to care for someone else, which means that they too become susceptible to mental health issues such as stress, anxiety and depression.
Finally, the medication that is used to treat schizophrenia can have an effect on families due to the side effects that it can cause. These can include sleeping more, having less energy, loss of libido and, sometimes, increased anxiety; all of which can impact family and relationship activities.
Interventions for Schizophrenia
Schizophrenia is commonly treated with a tailored combination of therapy and medication that is specific to the particular individual’s requirement. However, there are four main types of medical intervention in total that may be needed for someone who has schizophrenia:
- Community Care
Antipsychotics tend to be prescribed in cases of schizophrenia and bipolar disorder but are also prescribed for certain cases of severe depression and anxiety. They work by boosting or reducing the effect of certain chemicals (neurotransmitters) in the brain. The main neurotransmitter which is affected by this type of medication is dopamine. The way in which the drug is administered will determine how quickly it works – if it is taken in regular tablet form it can take up to several days before any difference is noticed. However, if it is administered by a direct injection into a muscle, it can work within an hour. There are also slow releasing antipsychotics that are now available. These involve the individual having one injection every two to four weeks depending on the level of their condition.
There are two different categories of antipsychotics: typical antipsychotics and atypical antipsychotics.
|Typical Antipsychotics||Atypical Antipsychotics|
|Date||Known as first-generation psychotics developed during the 1950s||Known as newer-generation psychotics developed during the 1990s|
The particular antipsychotic a person will be prescribed will be unique to that particular individual and their condition. A thorough physical examination of the individual should be carried out before they begin taking any antipsychotics as well as a detailed discussion between the individual and their doctor/psychiatrist about which antipsychotic will suit them best.
For any kind of medication that may be used long term, the individual should be given a medication plan, which will show what drugs they are taking, what the dosage is, what the frequency is and it should enable them to also identify how well it is working and any side effects that they are experiencing.
If it is found that the person is not benefitting from regularly taking their antipsychotic medication, then they will be prescribed an alternative form before changing their treatment plan further.
Although other methods will be tried before admitting someone to hospital, hospitalisation is sometimes necessary in order to stabilise someone who is having an episode of psychosis. Many individuals will realise that their condition is serious enough to warrant hospital treatment and, as such, will voluntarily attend in order to be supported. However, some individuals may not realise this and they will have to be detained under the Mental Health Act 1983, sometimes referred to as being ‘sectioned’. This happens when the individual is seen to be a threat to themselves or to others, and is, in fact, quite rare.
Whilst in hospital, the person may have an injection to calm them down so that they are able to discuss what is happening to them in a more rational manner. Some may behave aggressively but this is not as common as people may be led to believe. However, whilst someone is in hospital, they will be closely monitored to watch for signs of suicidal behaviour or behaviour that may harm others. For those individuals who do have to be hospitalised, they will normally need 1-2 weeks of inpatient treatment before they can be discharged. For some individuals whose behaviour continues to be a threat to them or to others, the period of treatment can be considerably longer.
ECT – electro-convulsive therapy – is only used on individuals for whom all other types of treatment have failed. It is used for someone who is at severe risk of suicide and is therefore classed as being a danger to themselves on a consistent basis. This procedure will be carried out in a hospital by a trained professional and the individual does not have to give consent to undergo it if they have been detained under the Mental Health Act.
ECT can be used if someone is experiencing a severe and long-lasting manic episode. ECT involves having electrical currents sent through the brain in order to try and relieve some of the symptoms. No one is certain how ECT actually works but it is believed that it changes patterns of blood flow and chemicals in the brain. It is a controversial treatment, often depicted as cruel and barbaric in the media; however, for some, it can be a lifeline back to a normal life and is thought to be successful in up to 75% of cases, but this is only in cases where the individual also has a course of medication or follow-up ECT treatments as well.
After an individual’s first episode of schizophrenia they will be referred to an early intervention team. This team will provide the individual with help and support. Most individuals require further assistance to help manage their condition, and before making the decision to admit someone to hospital alternative treatment via a community mental health team may be put in place. A community mental health team is made up of a number of health and social care professionals:
- Community mental health nurses
- Counsellors and psychotherapists
- Occupational therapists
- Psychologists and psychiatrists
- Social workers
Treatment through community mental health teams is the preferred mode when treating someone with schizophrenia. The aim of this type of treatment is to provide ongoing and consistent support to individuals whilst ensuring that their independence stays in tact so they are able to live as normal a life as possible.
Individual’s with schizophrenia are normally entered into a treatment process known as the care programme approach (CPA). The four stages to CPA are:
- Assessment – the health and social needs of the individual are assessed
- Care plan – a care plan specific to the individual will be created (ensuring that a person-centred approach to care is applied throughout their treatment)
- Care coordinator appointed – these are sometimes known as key workers and are usually an individual’s first point of contact with other health and social care professionals within the community mental health team
- Reviews – an individual’s treatment will be regularly reviewed so that any changes that are required can be updated to their care plan
Although a CPA is common, not everyone will be treated using this approach. Some individual’s may be treated by their GP whereas other’s may be treated by a specialist.
Specialists are likely to be a psychiatrist but may also be a community psychiatric nurse. Both individuals are able to assess the severity of mental illness but only the psychiatrist is able to prescribe medication, so he or she may be seen initially with follow-ups by the community team.
A psychiatrist is also a medically trained doctor and so they are also able to carry out physical examinations if this is what they feel is required during an initial visit. Other aspects of that visit will likely include:
- Asking about the problem that has brought the individual there
- Asking about the individual’s life and their thoughts about their current circumstances
- Taking blood pressure and temperature as part of a physical exam
- Collating information from other sources such as family, GP or social workers to get a better picture of what has gone on so far and so gain a ‘holistic’ view of the current issue
Once the psychiatrist has reached a diagnosis, they can prescribe medication and will very likely organise a follow-up appointment, either with themselves or with someone in the individual’s local community mental health team.
The above methods of treatment are required for individual’s whose schizophrenia can be managed. For someone whose condition is more serious – or they are currently going through an acute and severe psychotic episode – they may be referred to a crisis resolution team (CRT). CRTs are put in place to assist individuals going through an acute and severe episode. Although hospital admission may be the only option for some individuals, CRT is in place to help, where able, and to provide support and treatment to individuals either in their own home or near it in a day care centre or crisis residential home.
Therapy may be useful when an individual has recovered from an initial period of psychosis, and there are several types which may be available to them:
Psychotherapy is a type of ‘talking therapy’, which may be useful in getting to what the root cause of the trigger of the schizophrenia may have been. It is useful because it can identify subconscious trauma that the individual cannot bring into their conscious mind because it is too painful. Because they cannot think about it, they cannot identify the cause and therefore they cannot resolve it.
Many individuals will undergo months of psychotherapy before having a ‘breakthrough’ in identifying why they are experiencing mental illness, but once the cause is identified then this will enable the individual and the therapist to work together to resolve any ongoing issues that the initial trauma has caused.
Other types of therapy such as CBT (cognitive behavioural therapy) and person-centred counselling may also be useful when the individual is beginning to make a recovery to try and ensure that there is no relapse. They can help because they can help to reduce the levels of stress and anxiety that might predispose a schizophrenic episode. CBT can help to teach individuals to recognise examples of delusional thinking to help them avoid acting on these thoughts. However, when the individual is experiencing severe psychosis, neither of these two types of therapy are likely to be useful because the individual will not be able to concentrate enough to find the discussions that take place in therapy to be useful.
Family therapy might also be a useful possibility for someone who is experiencing schizophrenia and who is in a position to benefit from this type of intervention. Families are taught ways in which they can support their loved one, even through the most difficult and distressing times of their illness. It is thought that individuals who are continually exposed to negative talk within a family, such as negative judgements and criticisms, are more likely to relapse than those who live in a positive family atmosphere. Therefore, family therapy will help family members to rethink how they speak to the individual and to each other in order to try and prevent a recurrence of the condition.
Arts therapy involves registered arts therapists working with people with schizophrenia to help them promote creative expression. Research has shown that some individuals find that expressing their thoughts in a non-verbal and creative way can help reduce the negative symptoms of their schizophrenia. Art therapists can work either in small groups or individually, so it not only provides an individual with a new experience but also introduces them to others going through similar experiences with their condition and helps them develop new ways of relating to others.
Ways of managing Schizophrenia
As with many other types of mental illness, there are several factors that can help the individual to manage their illness:
- Avoiding unnecessary stress
- Recognising and avoiding triggers
- Talking openly about the condition
- Joining a support group
- Taking up a new activity
- Maintaining a routine
- Contact support services when required
- Staying in touch with friends and family
Avoiding any unnecessary stress is vital in ensuring that the individual remains calm and relaxed so that their anxiety levels are not raised. Raised stress levels cause an increase in the hormone cortisol, and unbalanced hormones are thought to be a significant factor in the onset of schizophrenia. Stress levels may be managed by learning breathing and relaxation techniques such as listening to music or going out on long walks.
Knowing the triggers of what might cause the onset of schizophrenia can also help because the individual will know what it is that they need to avoid. For example, if they know that being involved with certain groups of people will cause them stress and anxiety, then they know that those people would be best avoided. This also goes for substance misuse; if the individual can be convinced that drinking and taking drugs contributes to their condition then it is more likely that they will avoid doing this (although, for those who may have an addiction issue, this is not always possible).
Arguably, the best self-help measure for anyone who is experiencing any type of mental health condition is to talk about it. This does not necessarily mean with a medical professional as it can be just as useful to discuss issues with friends and family. Talking through any problems can provide comfort and reassurance, and it can help to reassure individuals that schizophrenia is not a life sentence and that there is a future even with their diagnosis.
Talking about the issues might be even more useful if the individual joins a support group because these will almost certainly help the individual and any carers to feel less isolated. Support groups are also a very good source of information and advice, which may be useful for someone who has schizophrenia. Support groups can help everyone to realise that they are not the only ones in this situation and that the condition can be effectively managed (something that may feel very difficult, especially if the individual is experiencing a particularly severe episode of their condition).
Taking up a new activity or hobby can act as a distraction from illness and possible triggers and it can also bring enjoyment and fulfilment to someone’s life. A hobby also enables an individual to have feelings of satisfaction that they are doing something that may make a difference to their own or someone else’s life. Hobbies help people to feel happy and this can be very influential on someone’s overall well-being. The activity may even mean that the individual goes and speaks to others who have been newly diagnosed with schizophrenia, and the thought that they are helping someone like themselves can be very positive in raising self-esteem.
Keeping to a routine can help individuals feel as though they are in control of their lives, and if they are feeling especially low in mood, it can give them a reason to get out of bed. Lack of control is another major factor in the onset of mental illness, so enabling the individual to take control of as much of their life as they possibly can may also lessen the impact of many of the symptoms of schizophrenia. Routines also make it easier to identify any changes in behaviour that might be the sign of an onset of the condition, so this makes the routine even more important – having other people monitor signs of a change in routine may help an individual to know a trigger is upon them if they have missed it themselves.
Individuals should be encouraged to rely on their support network when they need it and to ask for help from health professionals who may be able to help them stop an episode of schizophrenia being worse than it needs to be. Individuals will be better enabled to do both of these things if they remain in contact with people around them and continue to discuss any aspect of their condition that might be causing them distress.
Finally, it is staying in touch with friends and family that will enable the individual to feel supported. It also offers an opportunity for them to talk about their condition and have others understand how it feels so that they can be in a better place to provide support. Staying in regular contact with friends and family also lessens the possibility that the individual will isolate themselves, which is another factor that may very likely make the symptoms of schizophrenia even worse.
How others can help people with Schizophreni
Having schizophrenia can be a very frightening experience and so it is vital that the friends and family of the individual who has the condition are patient and understanding about the mood changes that occur as a result. This is not always going to be easy because the individual can be very difficult to communicate with because of the symptoms of the condition. However, they should be continually encouraged to talk about their feelings so that they do not feel as though they need to keep everything inside themselves and that they can rely on the support of others when they need it.
The delusional beliefs of the individual should not be challenged because this may make the individual feel more confused and agitated because of their loss of contact with reality. Instead the individual should be monitored to ensure that their delusions are not putting them at risk of harm and that they are enabled to talk about whatever they feel they need to whilst experiencing what can be very frightening symptoms. The wishes of the individual should be respected, which means that if they want to be left alone, then this is what should happen (although it would be better for everyone’s peace of mind if they were still monitored whilst they spent time on their own).
If it is possible, family and friends should have as much knowledge about the condition as they possibly can. Therefore, educating themselves may enable them to monitor the signs and symptoms that might accompany the start of an episode of schizophrenia and they will be much better placed to provide support quickly to try and stop an episode being more severe than it needs to be. If someone is acting as a carer then they should get as much information as possible about their legal rights and entitlements and ensure that they take good care of themselves as well, because caring for someone with a mental illness can be a very challenging role.
Finding support groups will almost certainly help the individual and any carers to feel less isolated. Support groups are also a very good source of information and advice, which may be useful for someone who has schizophrenia. Support groups can help everyone to realise that they are not the only ones in this situation and that the condition can be effectively managed, which is something that may sometimes feel very difficult, especially when the diagnosis is new and no one has had the chance to get used to the symptoms that it can cause.
Those around the individual must be prepared to be flexible to accommodate their needs, which may change very quickly. For example, someone who is going through an episode, or who has recently gone through one, may cancel plans at the last minute because they cannot face the thought of a social situation. Whilst the continual shift in mood of the individual can be difficult, it is important that their family and friends remain supportive because this will certainly have a positive effect on the individual’s perception of their ability to cope.
Helping with appointments might be necessary because the symptoms of schizophrenia mean that the individual may find it difficult to take information in and to communicate their needs in an effective manner. Just being at an appointment for support can also make a big difference in whether or not the individual actually attends, as many will be very reluctant to do so or be completely unaware that their behaviour is causing concern.
Finally, to ensure that the individual retains as much of their independence as possible, it is vital that they are given responsibility of their own life back when they are well. This does not mean, of course, that they should feel abandoned but that they are back in control of deciding things for themselves, which is something that they may have found difficult whilst experiencing a schizophrenic episode.
Local resources for Schizophrenia
Earlier, we discussed the different treatments available for individual’s with schizophrenia. These included medication, hospitalisation, community care and therapy. However, there are other resources available to individuals too, but, as we mentioned, a psychiatrist may refer someone who has schizophrenia to their local mental health team; which is a preferred treatment method for someone with schizophrenia. These teams consist of a variety of health professionals who may be able to help someone live with their condition to take steps to manage it effectively. For example, there may be psychiatric nurses, occupational therapists, counsellors and support workers who, along with the individual, will put together a plan of support so that everyone can work together in enabling the individual to retain a sense of normality and live in a meaningful manner.
Libraries are an excellent local source of information where individuals can educate themselves about their condition. Often the understanding of why someone is behaving in the way that they are can act as a way of reducing stress levels, and this can lead to a decrease in the chances of an episode of schizophrenia being triggered. If someone cannot face leaving their home, they can access information and some online therapy courses from their home but they must ensure that this comes from a reputable source.
Health centres often have walk-in appointments where individuals can attend to discuss any problems that they are having with their mental illness. Professionals will be on hand to assist in giving advice about the issue, possibly pointing them in the direction of a GP appointment or for ways in which they can reduce the possibility of symptoms reoccurring. Many health centres are able to offer discounted memberships at local gyms where individuals can attend to improve their confidence and self-esteem or possibly partake in lessons such as yoga and Pilates, which are known to be beneficial at reducing levels of stress and anxiety.
Support groups are very common for mental health problems, and organisations such as Mind offer them in many towns. It is said that the people who experience the issue are the biggest experts about it, and joining a support group can be rewarding on many levels. Individuals feel understood and accepted when they are speaking with others who have gone through or are going through the same thing that they are. Helping someone else is also good for an individual’s self-esteem and confidence, and it can also be very rewarding.
The Samaritans are an organisation available to people around the clock to provide advice and support for people who are in distress. Their service is completely confidential and can prove to be a lifeline for individuals who have no support network and feel as though they have nowhere else to turn.
The Hearing Voices Network is an organisation that has been set up to increase awareness of the effects of auditory and other types of hallucinations. Their website offers free downloads for people who want to know more about these symptoms and these can be extremely useful for individuals and their families in finding out more about one of the most common and frightening symptoms of schizophrenia. The website also offers excellent advice for people who do not yet have a diagnosis and may be unsure about how they can get help for their condition.
Interested in a mental health qualification?
We offer the TQUK Level 2 Certificate in Mental Health Awareness.