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Schizophrenia is a serious mental illness, the causes of which are not yet known for certain, which affects one person in a hundred. It usually develops in the late teens or early twenties, though it sometimes starts in middle age or even much later in life. The earlier it begins, the more potential it has to damage the personality and the ability to lead a normal life. Although it is treatable, relapses are common, and it may never clear up entirely. It makes working and studying, relating to other people and leading a full, independent life very difficult, and causes families much distress. This leaflet explains what it is like and what to do about it.
Isn’t schizophrenia a split personality?
No. Far too many people have the idea that someone who suffers from schizophrenia can appear perfectly normal at one time and be a deranged killer at another. This is nonsense! People who suffer from schizophrenia are rarely dangerous. People misuse the word schizophrenia in two different ways. They may mean ‘having mixed or contradictory feelings about something’ or ‘behaving in very different ways at different times’. These behaviours are a normal part of human nature.
What are the symptoms of schizophrenia?
Thoughts, feelings and actions are somewhat disconnected from each other, so that what a person says may be out of keeping with what they feel or do, or what they do may be out of keeping with what they say or feel. This may be easier to illustrate by describing the symptoms. These are divided into positive symptoms, which are abnormal experiences, and negative symptoms, which are an absence of normal behaviour.
Positive symptoms
We normally feel that we are in control of our thoughts and actions, but schizophrenia interferes with this feeling. It may feel as though thoughts are being put into the mind or taken out by some outside, uncontrollable force. The body may feel as if it has been taken over. At worst, the whole personality seems under the influence of an alien force or spirit. This is a terrifying experience. In ‘high-tech’ societies, such invisible influences capable of working over a distance may be attributed to radio, television or laser beams, or a computer somehow installed in the brain. In traditional and religious communities, witchcraft, angry spirits, God or the Devil may be held responsible.
The word ‘hallucination’ refers to the experience of hearing, smelling, feeling or seeing something, without there actually being anything there to hear, smell, feel or see. Hearing very real sounding ‘voices’ when there is no one there is the commonest hallucination in schizophrenia. ‘Voices’ are heard in some other mental illnesses, but in schizophrenia they typically talk about, as well as to, the person.
Delusions are false and usually unusual beliefs, which cannot be explained by the believer’s culture or changed by argument. Delusions may be fantastic—‘I’m God’s messenger!’ ‘I’m the richest person in the world!’ ‘I’m persecuted by men from Mars!’—or apparently reasonable—‘My husband is unfaithful’ ‘Everyone at work is against me’. Persecutory delusions are especially distressing for the family if they are seen as the persecutors. Delusions may come out of the blue or may start as an explanation for hallucinations or the sensation of being taken over.
Negative Symptoms
These affect interest, energy, emotional life and ‘get-up-and-go’. As a result, the person may not bother to get up or get out, may not wash or tidy up, and may never get excited or enthusiastic about anything any more. The person will tend to avoid meeting people, will say little or nothing, and may appear emotionally rather blank.
Speech and behaviour
Sometimes schizophrenia interferes with a person’s train of thought, so it may be difficult to follow what they say. Behaviour may be affected by hallucinations—talking or shouting back at the ‘voices’, or doing what they say (which may even mean self-harm or suicide). Often false beliefs do not affect behaviour—the ‘Messiah’ does not spread the Word, the ‘Archduke’ lives quietly on social security—but persecutory delusions may lead to the person accusing members of their family or strangers and, rarely, to attacks which may be dangerous.
What is the Outlook?
Before 1950, many people with schizophrenia spent most of their lives in mental hospitals. Things have changed since then and most people with the illness are treated outside hospital for most of their lives.
After a first episode of schizophrenia, about a quarter make a good recovery within five years, two thirds will have multiple episodes with some degree of disability between these episodes, and 10-15% will develop severe continuous incapacity.
What treatment is available?
When a person first becomes ill they are usually treated in hospital in order for a full assessment and diagnosis to be made. Afterwards, they can often be treated whilst living at home, especially if they have a supportive family. Drugs help to alleviate the most disturbing symptoms of the illness. However, they do not provide a complete answer. Support from families and friends, other forms of treatment and services such as supported housing, day care and employment schemes also play a vital part.
People with schizophrenia do not always realise they are ill and may refuse treatment when they badly need it. In these circumstances, the Mental Health Act (in England and Wales) and similar legal arrangements in other countries, permit compulsory admission to hospital if the person is a danger to him or herself or others or is in urgent need of treatment. Such an admission may last for up to 6 months and may be renewed, but the person detained has the right to appeal against this to an independent tribunal.
Medication
Since 1954, a number of drugs have been available for the treatment of schizophrenia. Most work by blocking the path of a particular chemical messenger, dopamine, in the brain. The drugs usually suppress positive symptoms; delusions and hallucinations gradually go away in a few weeks. There are, however, side-effects, especially stiffness and shakiness, like Parkinson’s disease (which can be reduced by giving anti-Parkinson’s drugs). Anti-schizophrenia drugs may also cause slowing, sleepiness and weight gain. The worse consequence is unwanted and lasting movements of the mouth and tongue—tardive dyskinesia (TD for short)—which affects a number of people who have taken anti-schizophrenia drugs for a year or more, and may not go away even if the drugs are stopped.
Fortunately, new drugs are now available which block different chemical messengers and are much less likely to cause side-effects. They may also help the negative symptoms, on which the older drugs have very little effect. Because of the risk of repeated episodes, it is usually advisable to take drugs for years, if not for ever.
Rehabilitation
Schizophrenia makes it difficult to deal with the demands of everyday life. Ordinary activities like washing, answering the door, shopping, making a phone call or chatting with a friend can seem like huge hurdles. To some extent drugs help to overcome such problems. However, treatment is more effective in the long run when it includes the support given by trained professionals and there is access to a wide range of services.
After an acute illness, it is often helpful to attend a day unit, starting with physical activities, like ball games, and going on through creative pursuits, like painting, to more demanding ‘worklike’ activities. The idea is to help people get into or back to work. Cognitive and other talking therapies may also help. For those people whose illness is more prolonged and severe, a specialist rehabilitation service, including residential care, may be available.
The Family
How do families react if a relative develops schizophrenia and becomes odd and unpredictable? They may regard the change in behaviour as rebellious, perverse and unacceptable without at first realising that it is due to mental illness. When they do, it can be very hard to digest—‘Was it our fault?’ ‘What happens next?’ Families need as much help and information as possible from the psychiatric team and the various voluntary organisations concerned with schizophrenia (see list at the back of the leaflet). The psychiatric team can also help by listening to worries and concerns and advising on drugs and their side-effects as well as suggesting small, manageable tasks which may aid rehabilitation.
The National Schizophrenia Fellowship (NSF) runs over 160 community self-help groups which offer friendship, support, advice and understanding for the families of people with schizophrenia.
Organisations
MIND (National Association for Mental Health)
Granta House
15-19 Broadway
Stratford
London E15 4BQ
Tel: 0181 519 2122
National Schizophrenia Fellowship (NSF)
National Office
28 Castle Street
Kingston-upon-Thames
Surrey KT1 1SS
Tel: 0181 547 3937
Advice Service: 0181 974 6814
(Monday-Friday 10am-3pm)
A national voluntary organisation that helps people with a severe mental illness, their families and carers. NSF has 160 members’ support groups, produces a variety of publications and operates a range of services including employment projects, day care centres, drop-in facilities, training initiatives and accommodation schemes across England, Wales and Northern Ireland.
VOICES FORUM
c/o National Schizophrenia Fellowship (NSF)
28 Castle Street
Kingston-upon-Thames
Surrey KT1 1SS
Tel: 0181 547 3937
Recommended Reading
Does Severe Mental Illness Run In Families?
Dr. Adrianne Reveley, National Schizophrenia Fellowship 1993. 20p
Living With Schizophrenia
B Lintner, Macdonald Optima 1995.
ISBN 0 356 210 928. £7.99.
Surviving Schizophrenia—A Family Manual
E Fuller Torrey, Harper Collins 1995 (3rd edition).
ISBN 0 860 950 765. £9.95.
How to re-order additional copies of this leaflet.
Additional copies of the Schizophrenia leaflet can be obtained from either the National Schizophrenia Fellowship (NSF), 28 Castle Street, Kingston upon Thames, Surrey KT1 1SS or the Royal College of Psychiatrists, 17 Belgrave Square, London SW1X 8PG. For up to 3 copies please send an sae with a second class stamp. For orders of more than 3 copies, please ring either 0181 547 3937 or 0171 235 2351 for advice on the cost of postage.
Other Leaflets
National Schizophrenia Fellowship (NSF)
Further publications including, Care and Aftercare, Cognitive Therapy, Disability Living Allowance, Finding The Right Medication, IRISS Resource Pack, Notes On Wills And Trusts, Psychiatric Diagnosis, Silent Partners—The Needs And Experiences Of Illness, Sudden Death, and What IS Schizophrenia? are available. For a copy of the publications/ recommended reading list please send a sae with a second class stamp to NSF, 28 Castle Street, Kinston upon Thames, Surrey KT1 1SS.
Royal College of Psychiatrists
Further leaflets are produced in the Help is at Hand series as follows: Anorexia and Bulimia, Anxiety and Phobias, Bereavement, Depression, Depression in the Elderly, Postnatal Depression, Sleep Problems, Social Phobias and Surviving Adolescence. Individual copies are available, free of charge, by sending an sae with a second class stamp to the Royal College of Psychiatrists, 17 Belgrave Square, London SW1X 8PG. A leaflet on ‘Depression in the Workplace’ is available from the above address, together with a remittance of 40p.
Printed February 1996. Published as a service to the National Schizophrenia Fellowship and the Royal College of Psychiatrists by Zeneca Pharma
言语和行为
有时精神分裂症影响患者的思路, 所以可能很难理解他们在说什么。行为可能会受到幻觉的影响,斯声力竭地说话或喊叫talking or shouting back at the‘voices’或者说什么做什么(甚至包括自伤或自杀)。通常错误的信仰不影响行为 – 上帝不再传播福音,贵族破落过着平民的安静生活 - 但迫害妄想症可能导致患者指责其家庭成员或陌生人,或者在极少数情况下攻击具有潜在危险的事物。
心声论坛(VOICES FORUM)
c/o National Schizophrenia Fellowship (NSF)
28 Castle Street
Kingston-upon-Thames
Surrey KT1 1SS
Tel: 0181 547 3937
推荐读物
严重精神病可在家中治疗吗?
Dr. Adrianne Reveley, 全国精神分裂症基金会,1993 年,第20页。
与精神分裂症者共同生活
B Lintner, Macdonald Optima 1995.
ISBN 0 356 210 928. £7.99.
残留的精神分裂症-家庭手册
E Fuller Torrey, Harper Collins 1995 (3rd edition).
ISBN 0 860 950 765. £9.95.
如何续订本传单
额外的精神分裂症传单可从全国精神分裂症基金会或皇家精神学者学院获得。地址分别为the National Schizophrenia Fellowship (NSF), 28 Castle Street, Kingston upon Thames, Surrey KT1 1SS 和 the Royal College of Psychiatrists, 17 Belgrave Square, London SW1X 8PG. 若少于三份传单,请寄送回执信封和一张二等邮票。若超过3 份传单, 请拨打0181 547 3937 或0171 235 2351咨询邮资。
精神病皇家医学院
进一步传单are produced in the Help可参见备案系列: 厌食和饥饿症,忧虑和恐惧, 居丧, 消沉, 老年消沉, 产后消沉, 睡眠问题,社会恐惧症和度过青年期。可免费索取单个读本。来信请寄送回执信封一张以及一张二类邮票至the Royal College of Psychiatrists, 17 Belgrave Square, London SW1X 8PG. 关于“工作场所的消沉”的传单可在如上地址获取,请与40p 一起汇至。