In a society where mental health is stigmatised, the average person (having not experienced or learnt about any mental illnesses themselves) is likely to be unaware of the true facts about mental illness (and ironically this increases stigma). So here is your first lesson about a couple of mental illnesses:
What is Schizophrenia?
Schizophrenia is commonly thought of as a ‘split personality’ – this is wrong. It is now more likely to be thought of as ‘split from reality’ as sufferers often experience hallucinations and believe them to be real. Psychologists currently argue that there are different types of schizophrenia (disorganised, paranoid and schizophreniform disorder) but as a whole, it is characterised as various combinations of psychotic symptoms, e.g. delusions. Other symptoms of schizophrenia may be disorganised speech, social withdrawal and emotional disturbances.
Schizophrenia is a very complex mental health disorder and as such is difficult to explain and difficult to diagnose. Clinicians follow the Diagnostic and Statistical Manual in order to diagnose mental health problems and so this sets out the criteria for what schizophrenia is. The onset of schizophrenia tends to be in late adolescence or young adulthood.
MISCONCEPTION: Schizophrenia is more common in men than women.
TRUTH: Schizophrenia is equally common across gender but onsets tend to be 4 to 5 years earlier in men than women (Reicher et al, 1991).
What are the causes?
As with most mental health illnesses, no one cause is suggested for schizophrenia. Instead, it depends on the particular person and may also be an interaction of factors (this isn’t the most satisfying answer I know, but that’s the trouble with people being so different and mental illnesses having so many different variations).
Genetic factors have long been considered a possible cause as studies on twins tends to show that the concordance rates (the likelihood both individuals will have the same characteristic) are higher for identical (or MZ) twins than non-identical twins (DZ), with the concordance rates at 48% and 17% respectively (Gottesman, 1991). However studies such as these do not recognise that the environmental influences are likely to be shared between the participants (as well as their genes).
There are other biological theories that include the dopamine hypothesis which suggested that people with schizophrenia have an excess of dopamine resulting in hallucinations and other symptoms typical of the disorder.
There is also a compelling argument for the importance of environmental factors such as family interaction. Expressed emotion is at the heart of a considerable body of research and suggests that patients with families with high expressed emotion (hostility, high criticism or overprotectiveness) are more likely to relapse (48% compared to 21% in low expressed emotion settings; Kavanagh, 1992). It is now generally accepted that there is a diathesis-stress model in play, i.e. that some people are genetically predisposed to schizophrenia but that their environment is likely to bring this out. Schizophrenia is often treated with medication (typically anti-psychotics), talking therapies and a wide range of support from the patient’s friends and family.
What is Obsessive Compulsive Disorder?
Another frequently misunderstood mental illness is OCD. Programmes such as ‘Obsessive Compulsive Cleaning’ and a general lack of societal knowledge or acceptance of disorders means that this disorder tends to be underestimated – you hear people on a day to day basis say “My OCD is going mad because my room is messy” but this demeans the very difficult and challenging thoughts of someone suffering from OCD.
MISCONCEPTION: OCD is about needing to constantly clean because of a fear of germs.
TRUTH: Patients with OCD may have compulsions that result in any behaviour, however it is common for fear of contamination to be linked with OCD and thus the behaviour may be compulsive cleaning.
OCD is an anxiety disorder and people suffering with OCD tend to experience obsessive or compulsive thoughts that are linked to a serious threat. The obsessions or compulsions are unwanted, intrusive cognitive thoughts that are repetitive. Many patients with OCD will believe that if they do not lock their door 17 times before they leave, a family member will die, for example. Obviously these thoughts are extremely distressing and although the patient will often recognise that their thoughts are not rational, they will be unable to ignore or dismiss them. We may all have the occasional intrusive thought that is unwanted, but patients with OCD have more of them, more frequently and the thoughts are associated with higher levels of discomfort. The compulsions are the thoughts that encourage a particular behaviour which reduces anxiety.
It is thought that patients with OCD attempt to suppress the obsessional thoughts and in doing so make the thought more intrusive and salient (as with the suppression of thoughts in the general population). This results in a vicious cycle. Treatment for OCD involves exposing the patient to the situation that increases their anxiety while preventing their typical compulsive response (which may be very scary for patients who believe that if they don’t complete the compulsive behaviour their mum or dad may die for example) (Turner & Beidel, 1988).
Currently, 1.2% of the population are suffering with OCD and 220,000 people in the UK are suffering with schizophrenia – let’s acknowledge these illnesses as real and tough, and start providing help, instead of stigmatising patients.