This paper reflects the research and thoughts of a student at the time the paper was written for a course at Bryn Mawr College. Like other materials on Serendip, it is not intended to be "authoritative" but rather to help others further develop their own explorations. Web links were active as of the time the paper was posted but are not updated.
2004 First Web Paper
I have always been interested in mental disorders, particularly ones with dramatic debilitating affects on an individual's behavior and their brain. Illnesses such as severe depression, bipolar disorder and the more intense schizophrenia have intrigued me my whole life. Diseases of the mind seem to be uniquely connected to each other, and connected to humanity in a very intimate yet dissociative way. It seems to me that the brain is the great mystery of the universe, and even greater a mystery is that of the mind. With all our modern scientific advancements, what prevents us still from overcoming these obstacles as a society? Why can we not yet see into the mind enough to heal it from a disease like schizophrenia?
This course has prompted me to look at these issues more intensely and as I go through other courses and encounter certain situations throughout the semester, I have been constantly reminded of this mind/body connection. A few weeks ago I was reading the January edition of Scientific American that had an interesting article on Schizophrenia inside. It spurred my interest and I began to look online for more information about schizophrenia's symptoms, effects, treatment and research. What do we know about this disease and how are we beginning to answer the question of mind/body connectedness through the search for cause and cure of schizophrenia?
Schizophrenia typically makes its appearance in an individual during their late teens and early twenties. This may be different for men and women, with women developing symptoms up until their thirties (1). I found this particularly interesting and wonder why this would be the time period for developing such a destructive disease. I wonder if it has anything to do with stress and the challenges of adolescence and early adulthood. Those times of particular pressure may force the brain to self-destruct in a way. Often, homelessness, poverty and unemployment are associated with schizophrenia, however these are usually secondary to the illnesses devastating effects (3).
Symptoms of schizophrenia vary wildly. They range from observed behavior such as apathy, decreased speech and movement, sleeping problems, poor health or appetite problems, and money management problems to symptoms that are harder to detect such as delusions and hallucinations, obsessive thoughts and compulsivity, sad or depressed mood, poor concentration, distrust, and anxiety (2). Unfortunately, many of these symptoms can be misdiagnosed as they mirror other mental illnesses. Schizophrenia may early on be thought to be depression or bipolar disorder and will be treated inappropriately. The most disturbing symptoms of schizophrenia are a distorted perception of reality caused by hallucinations and delusions. These can alter one's personality turning them into a very different person..
Treatment of schizophrenia is also varies, with inconsistent results. Most frequently, medications are prescribed to inhibit the intense symptoms patients suffer. Treatment more often than not is a life-long control management problem that is dependent on compliance and dedication by an individual who is not always competent enough to maintain such a regimen of treatment. Psychotherapy is sometimes used, though more frequently some form of counseling is used for family members rather than the patients due to the emotional burden supporting someone with schizophrenia can cause (3). A combination of different types of medications has been used to treat the varying symptoms of schizophrenia including antipsychotic, antidepressant and antianxiety medications. These medications, especially when taken in high doses and for long periods of time may have seriously detrimental physical and mental side effects that further discourage patients from sticking with their harsh regimen of treatment (4).
Treatment also depends on the causes of schizophrenia and is therefore always changing due to new evidence supporting one cause or another. This was my original question and interest in writing this paper, discovering the connection between cause and treatment and those links between the mind and body. For a long time, medications were serotonin-dopamine antagonists, treating supposedly the deficit in the brain causing schizophrenia. More recently though, it has been discovered that dopamine is not the primary brain agent causing the illness. Schizophrenia is actually caused by a multi-faceted system of breakdowns in the function of the brain.
This brings me to my main concern. According to the January Scientific American, "scientists have long viewed schizophrenia as arising out of a disturbance in a particular brain system – one in which brain cells communicate using a signaling chemical, or neurotransmitter, called dopamine" ((5), p. 50). It has recently been found, however, that like the multiple system attack of schizophrenia, the disease may be caused by glutamate, a neurotransmitter that plays a role in many different functions of the brain. Scientists discovered that the NMDA glutamate receptor is blocked or inhibited in schizophrenia patients. Glutamate is a more "pervasive neurotransmitter," affecting dopamine receptors as well. This abnormality would also explain why dopamine was originally thought to be the agent responsible for schizophrenia. As I am not a biologist, some of this is a bit confusing to me.
What I have found interesting is the fact the giant step forward in knowledge this discovery has provided. It answered a tremendous number of questions, including the question of how one neurotransmitter caused such a wide range or problems. Really, it didn't – it was part of a larger process and malfunction. This indicates to me that perhaps the mind and body are connected at a more scientific level. We, at this time, lack the explanatory skills and evidence to prove exactly how it works but perhaps someday we may better comprehend the intricate ways in which our nervous system and intelligence operate.
I did have some additional questions after doing my research. From a social perspective, I wonder about the resources available to both the patients suffering from the disease as well as those more peripherally affected such as family members and friends. Why do many suffering from schizophrenia end up on the street without jobs and cut off from resources? I stumbled onto a web page listing the schizophrenia diagnosis criteria available to physicians online (6). The behaviors and symptoms listed were quite specific but also very familiar to me. Schizophrenia exists within our collective memory. I was reminded of the social theoretical field of symbolic interactionism that posits that people occupy a role expected of them. The sociology of deviance and medical sociology are particularly applicable here. It is interesting to wonder though, the effect of a shared knowledge of symptoms and expected behavior within the sick role has upon one finding themselves labeled as 'mentally ill' or 'schizophrenic.'
There is a lot of information out there about schizophrenia. I feel as though I've only scratched the surface. Social and psychological effects of the disease are far reaching, both on those who suffer but on family members, friends and the wider society as well. It is good to know that progress is being made in the search for a cause and treatment, though I wonder if we will ever really know exactly how the mind interacts with the brain and why things go wrong and how to fix that.
5) Scientific American. January 2004. Volume 290, Number 1. By Daniel C. Javitt and Joseph T. Coyle. "Decoding Schizophrenia."