As a mental health policy expert, Elyn Saks is highly accomplished in his domain. She graduated from Yale Law School, teaches law, psychology, and psychiatry at the University of Southern California School of Law, and has received numerous honors, including a prestigious MacArthur Fellowship.
She also lives with schizophrenia – a diagnosis she revealed in her memoir, “The Center Cannot Hold: My Journey Through Madness”.
Great accomplishments and serious mental illness are not mutually exclusive, but many people may not know much about schizophrenia beyond media portrayals associating it with violence, failure, or deviance.
Schizophrenia is a lifelong psychotic disorder that affects less than 1% of the US population, but it is one of the most stigmatized mental illnesses. It affects the way people think, feel and act and is most often characterized by delusions and hallucinations, impaired cognitive thinking and difficulty socializing with others, which can make it difficult for some – but not all – access to treatment or maintaining employment and housing.
If left untreated, schizophrenia can lead to consequences such as substance use, homelessness, social isolation, and even suicide. People have also associated with mass violence or shootings, whichhave been linked in some previous research articles. However, psychologists warn that the relationship between schizophrenia and violence is often oversimplified and rarely causal.
“While there is a relationship between mental illness and violence, it is not the best predictor. There are other risk factors that come into play but are often singled out (in reports),” says Patrick Corrigan, professor of psychology at the Illinois Institute of Technology.Other predictors include gender, age, history of substance use and history of legal problems, but “when we just focus on mental health, it adds stigma and fear.”
The reality is that many people can manage the disorder to live fulfilling lives.
“A common misconception is that we are incapable of taking care of ourselves and that’s not true,” Saks says. “For some people it is, but not for all of us. We can have relationships – romantic and friendly. But we often don’t see that (in the media) because of the emphasis on sensationalism and about ‘tampering’ us.”
What is schizophrenia?
When people imagine schizophrenia, they often envision Eratic behavior, “talking to each other and talking nonsense,” Corrigan says. But what is it really?
The exact causes, probably a combination of genetic and environmental factors, are unclear. But common symptoms include visual hallucinations and delusions, which cause people with schizophrenia to see or hear things that deviate from reality. In his own experience, Saks “sometimes had the belief that I had killed hundreds of thousands of people with my thoughts” or “had hallucinations of a man standing in front of me with a raised knife in the middle of the night.”
Others may also experience what psychologists call negative symptoms, such as anhedonia (inability to experience pleasure), flat affect (lack of emotional expression or reaction) or they may withdraw from relationships and work. These symptoms tend to be more difficult to treat.
“People who meet the criteria for schizophrenia probably have a number of different things, and it’s not always uniform for everyone,” he added. said Guillaume Charpentier, psychiatrist and professor at the University of Maryland Medical School whose research focuses on schizophrenia.
“Some will have cognitive issues. Others will have impaired motor symptoms. But what they share is that they somehow have false belief systems that lead to this diagnosis.”
Another popular assumption is that a diagnosis of schizophrenia involves several different personalities.. This is a stereotype probably stemming from its misleading nomenclature: the Latin prefix schizo means “divided”.
But experts warn that multiple personalities, more formally known as dissociative identity disorder (DID), is a separate diagnosis that “may have a higher rate of dissociation, that out-of-body feeling, but it doesn’t ‘involves any kind of hallucinations or delusions (as in schizophrenia)’, according to Corrigan.
Can schizophrenia be cured?
Certain treatments have been proven to help maintain symptoms at the bay. Antipsychotic medications can reduce hallucinations and delusions, while therapies and rehabilitations can address specific concerns, such as teaching cognitive techniques or improving social skills for interacting with others.
“I resisted drugs for many years, because I didn’t like the side effects,” Saks says. “But also, I didn’t like to think I had a mental illness, which I resisted for many years.”
Thanks to therapy and medication, “my life has improved,” Saks says. “I wouldn’t dream of getting off the meds now, and therapy has been just as important in dealing with what’s going on, understanding the things that bother me, and better understanding my relationships.”
However, these interventions, “very important to know”, are not curative. “Nothing comes close to a complete cure or prevention, so in that regard we still have a long way to go,” Carpenter said.
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“The stigma is very real and can be very deadly.” What needs to be done?
As an accomplished schizophrenia professional, Saks says the need to debunk myths about mental illness is crucial to understanding the complex disorder and encouraging treatment and social support.
A 2012 study found that a majority of schizophrenic characters in 41 films displayed violent behavior, with one-third of those characters displaying murderous tendencies.
While it is true that some may exhibit aggression or unpredictability when their symptoms are untreated or when associated with substance use, research has shown that most are not actually violent: serial killers are more likely to have antisocial personality disorders (such as sociopathy or psychopathy), according to the American Psychiatric Association, and people with schizophrenia are at increased risk of being victims, rather than perpetrators, of violence.
“Stigma is very real and can be very deadly,” says Carpenter, who fears it may exacerbate feelings of hopelessness and isolation. “When there are so many misconceptions about what schizophrenia really is, large numbers of people are treated inappropriately or without the therapeutic techniques available.”
A good education is essential to de-stigmatize and treat schizophrenia. But the next, and “most important” step is to make psychosis more accessible and understandable. Mental illness can pose limits in real life, but Saks wants people to know that their experiences should be described as multiple and unique, rather than demonized as something to fear.
“Putting a human face on this mental illness reduces the stigma,” she insists. “And people with schizophrenia should be able to tell their stories without fear of jeopardizing their professional lives or their relationships.”
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