Mental Illness | Introduction
“The incredible pessimism associated with schizophrenia has frustrated psychiatrists for a long time.”
—Patrick D. McGorry, psychiatry professor, Wall Street Journal, August 25, 1999
Matthew was preparing to take the entrance exam to law school in 1995 when he started seeing double. Subsequent medical exams revealed that he had a lesion on his brain. During the next eighteen months, Matthew began to suffer from stress, rages, and sleeplessness. He also found it difficult to concentrate and became withdrawn from his family and friends. Matthew’s symptoms and his age at their onset are characteristic of schizophrenia and he was diagnosed with the disease.
Contrary to popular belief, people with schizophrenia do not have multiple personalities. Instead, they experience a change in their perception of reality. Hallucinations (in which the person hears, sees, smells, or feels something that is not actually present) and delusions (in which a person’s false beliefs cannot be shaken by the truth) are two of the most common symptoms of schizophrenia. The third “positive” sign of schizophrenia is thought disorder, in which the words spoken by a schizophrenic make absolutely no sense to listeners. Other signs of schizophrenia are called “negative” symptoms and include social isolation and withdrawal, mood swings, an inability to derive pleasure, a decreased ability or willingness to speak, and the loss of memory, reasoning, and the ability to solve problems.
Males with schizophrenia usually start to show signs of the brain disorder while in their late teens to early twenties; women generally do not experience symptoms until their twenties and occasionally as late as thirty. About one percent of the population develops schizophrenia, but for people who have close relatives with schizophrenia, the chances of developing the disease are about one in ten.
Psychiatrists who treat schizophrenia rely primarily upon antipsychotic drugs to keep the disease and its symptoms under control. These drugs are separated into two categories: typical and atypical, each with its own actions on the brain and side effects. Typical antipsychotic drugs have been used since the 1950s and their side effects include involuntary muscle spasms, muscle rigidity, and restlessness. Atypical drugs appeared in the early 1990s, and although they are costlier than typical antipsychotic drugs, they have been rapidly gaining in popularity. The atypical drugs are effective at treating the “negative” symptoms of schizophrenia— the social isolation and withdrawal, mood swings, and apathy. However, the atypical drugs have side effects of their own—lethargy, weight gain, constipation, and a dangerous blood condition that can result in infection and death.
In addition, psychotherapy can help the patient and the patient’s family understand and cope with the disease. Because of the drugs’ debilitating side effects, schizophrenia patients are sometimes reluctant to continue taking their medication when they feel healthy. Without the drugs, though, the patients will suffer a schizophrenic episode from which they will never fully recover. Psychotherapy helps schizophrenia patients stay on their drug regimen.
Scientists are now working on a new option for treating schizophrenia—prevention. Matthew’s younger brother Josh is participating in a clinical drug trial at Yale University that is studying whether aggressively treating a patient for schizophrenia before it is diagnosed can prevent the onset of the disease. The nineteen people included in the study have a high risk of developing schizophrenia. Like Josh, they have a close relative who has been diagnosed with schizophrenia. They have also started exhibiting early symptoms of the disease, such as confusion, suspiciousness or paranoid thinking, poor rapport with others, passivity or disinterest in social activities, and “flat” emotions. The participants are treated for one year with either Zyprexa, a new atypical drug that researchers hope will prevent the onset of the disease, or a placebo. They also undergo therapy. During the second year, the patients are taken off the drug and monitored to see if they develop schizophrenia. If any of the study volunteers do develop schizophrenia, they are immediately placed in a standard treatment program; researchers will examine the severity of their disease to determine if the preventive treatment had any effect in lessening the disorder’s symptoms.
The theory behind the drug trial is to prevent damage to the brain before it occurs. Scientists believe that the brain undergoes massive changes during late adolescence and young adulthood, when schizophrenia normally appears. While these changes are harmless to most people, they can irreversibly damage the brain of those who are at risk of schizophrenia and thus bring on the disease. Antipsychotic drugs have been found to be effective in repairing some of the damage in diagnosed schizophrenia patients. Thomas H. McGlashan, a Yale psychiatry professor who is in charge of the two-year clinical trial, hopes that administering these drugs before the changes occur will prevent or reduce the damage in the brain. He believes researchers have “a limited opportunity” in which they can try to prevent the onset of the disease. Preliminary results from a similar earlyintervention study in Australia conducted by University of Melbourne psychiatry professor Patrick D. McGorry have found that none of the patients who took the antipsychotic drug Risperdal developed schizophrenic symptoms, while over one-third of those who were not given the drug developed symptoms.
There are several areas of concern about McGlashan’s study, however. Many of the warning signs of schizophrenia are typical adolescent behaviors or may be indicators of other mental illnesses. For example, moodiness, withdrawal, apathy, and difficulty in concentrating may be normal teen behavior or symptoms of depression rather than signs of schizophrenia.
Some researchers also believe it is risky and dangerous to give powerful drugs to adolescents and young people whose brains are still developing. While David Lewis, a professor of psychiatry and neuroscience at the University of Pittsburgh Medical School, is excited about the prospect of preventing schizophrenia, he believes “the basic science that supports it is limited.” He adds, “We need to be concerned about unintended adverse effects that may occur if interventions are made at a young age.” Lewis points out that the effects of the drugs on developing healthy brains is unknown, as are any possible effects on the patients later in life.
New treatments for mental illness are constantly being proposed, administered, and studied. Psychiatrists, researchers, and scientists like McGlashan hope that perhaps one day mental illness can be prevented or even cured instead of just being treated for its symptoms as is done now. The viewpoints in the following chapters examine the effectiveness of methods used to treat mental disorders as well as the prevalence of mental illness in the following chapters: How Should Mental Illness Be Defined? How Should Society Deal with the Mentally Ill? What Mental Health Issues Do Children Face? and What Mental Health Treatments Are Beneficial? In these chapters, the authors give some perspective on the social, legal, and medical issues facing the mentally ill.
