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SCHIZOPHRENIA: THE TWO FACES OF ILLNESS
All this has led psychiatrists to identify two kinds of schizophrenia patients: those who respond to the drugs, with control of the dopamine system, and those who don’t. Responsive patients show the outward signs of the disease – hallucinations, delusions, and strange behavior; the
non-responders are withdrawn, unemotional, seemingly devoid of feelings of pleasure.
For decades psychiatrists have held that many types of schizophrenia exist and that it may be the result of many different, separate diseases.
Dr. Richard J. Wyatt, chief of the Neuropsychiatry Branch of the National Institute of Mental Health, at St. Elizabeth’s Hospital in Washington, D.C., draws this parallel with mental retardation: “A hundred years ago, we said that low IQ meant mental retardation. Since then, we’ve found a whole series of diseases that cause brain damage leading to a low IQ and retardation. Identifying the symptoms of schizophrenia is like having the results of an IQ test. I suspect that we’ll find a number of diseases that make up the schizophrenia syndrome.”
Scientists have discovered certain kinds of brain damage in some schizophrenics but not others and have found a low blood flow in the thinking part of the brain in some schizophrenics. A doctor in England found evidence of a virus-like particle. A U.S. physician found strange antibodies in the spinal fluid.
During the 1940s and 1950s, many psychiatrists believed angry relations between members of families caused schizophrenia in their children. As a result, many parents were tortured by guilty feelings of taking the blame for their child’s illness. Most experts now reject that theory as unproved. Once again, however, evidence reveals that, even though families’ behavior does not cause schizophrenia, the way families act toward their sick family members can prevent or trigger a relapse. In London, Dr. Julian Leff and his colleagues have identified family characteristics that affect schizophrenic patients. If a family’s responses are warm and loving, for example, a relapse is prevented; but if they are hostile, critical, or over-involved, the patient suffers more frequent episodes.
These findings set off a series of studies to learn whether doctors and social workers can train families to change behavior and ease sick family members. Nina Schooler, assistant chief of the Schizophrenia Research Branch at the National Institute of Mental Health, heads its multicity project. “People with schizophrenia are sensitive to stress, particularly interpersonal stress,” she says. “We are working to educate the family to protect the patient against it.”
Researchers also are trying to learn whether a patient can manage on less medication. The daily dose is reduced, or drugs are given to a patient only when the family detects the signs of odd behavior that warn of an oncoming episode.
Sarah Edwards estimates that, for the first 6 years of Ben’s illness, the family spent $250,000 on his medical treatment. Ben now lives alone; his disease is stabilized. At his sister’s wedding, says his mother, “It was hard to believe he was not OK. He is not so frightened as he once was and can control his own life.”
Out of the need for family support has grown the National Alliance for the Mentally 111, a group of parents and other relatives who teach themselves the facts of schizophrenia and where to find help. They learn that:
Ђў schizophrenia is probably a brain disorder,
Ђў drugs don’t always quiet symptoms,
Ђў most victims have their first episode in their late teens or early 20s,
Ђў it attacks boys more than girls, and
Ђў there is no cure – yet.
The family sessions help. “I get understanding from people who know what I am talking about,” Mrs. Edwards says. “I ache so. I share my problems with people who are worse off.”
*13/266/5*
