What Do We Know about the Group of Mental Disorders Called Schizophrenia? Part 1: Etiology

Many autobiographical and fictional accounts of “schizophrenia” have appeared in the popular literature in recent years. Several have become best-sellers and were read by thousands of people around the world. Among the better known are Hannah Green’s I JVever Promised You a Rose Garden 1 and The Eden Express by Mark Vonnegut.2 Green’s book was even turned into a movie. However, the people described in these books may actually have suffered from depression and not schizophrenia, as the authors claimed. Thus, they have unintentionally misinformed their readers about schizophrenia, one of the most debilitating and least curable of the mental disorders. In 1981, Carol North and Remi Cadoret, University of Iowa School of Medicine, Iowa City, reviewed five popular books on “schizophrenia, ” including the two mentioned above. j They treated the books as case histones, analyzing each page for any symptoms described by the authors. The researchers diagnosed the mental disorders represented in each book using the third edition of the Diagnostic and Statistical Manual of Mental Disorders,~ a standard reference work published by the American Psychiatric Association. They concluded that the popular accounts dealt mostly with depressive disorders, not schizophrenia. I’ve discussed depression previously in a three-part essay.5-7 But confusion about the true nature of schizophrenia is apparent in the scientific literature as well as the popular press. Schizophrenia is a general term, like cancer, that covers a variety of diseases with different causes, treatments, and outcomes. In the first part of this essay, I’ll review current research on the causes of schizophrenia. The second part will focus on the diagnosis and treatment of schizophrenia. Briefly, schizophrenia is one of the psychoses, that is, major mental diseases characterized by a loss of contact with reafity. Schizophrenic symptoms have been classified as being “positive” or “negative. ” You should keep in mind that thk distinction is made only for convenience. Positive symptoms are those whose presence reflects pathology—delusions, hallucinations, and thought disorders.e,g For example, schizophrenic delusions include the belief that one’s thoughts are being broadcast for everyone to hear, or that thoughts are being inserted into one’s mind or controlled by some external agent. The most common schizophrenic hafhscinations are auditory—a single voice provides a running commentary on the individual’s actions or thoughts, or two or more voices carry on a conversation. The schizophrenic’s disordered thinking is characterized by loose or illogical associations, abrupt and nonsensical changes of subject, and incoherence.