By Mary Beth Ellis

S E R I E S C O N S U L T A N T Anne S. Walters, Ph.D. Emma Pendleton Bradley Hospital Warren Alpert Medical School of Brown University

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Foreword: Dr. Anne S. Walters, Ph.D.. ......................................... 6 Chapter 1: What Is Schizophrenia?............................................ 11 Chapter 2: The History of Schizophrenia. .................................. 27 Chapter 3: Causes of Schizophrenia.......................................... 41 Chapter 4: Treatments for Schizophrenia.................................. 53 Chapter 5: Living with Schizophrenia. ...................................... 65 Chapter 6: How Families Cope with Schizophrenia..................... 77 Chapter Notes. ....................................................................... 86 Series Glossary of Key Terms. .................................................. 88 Further Reading. .................................................................... 90 Internet Resources.................................................................. 91 Organizations to Contact......................................................... 92 Index..................................................................................... 93 Author’s Biography / Credits................................................... 96 CONTENTS KEY ICONS TO LOOK FOR: Words to Understand: These words with their easy-to-understand definitions will increase the reader’s understanding of the text while building vocabulary skills. Sidebars: This boxed material within the main text allows readers to build knowledge, gain insights, explore possibilities, and broaden their perspectives by weaving together additional information to provide realistic and holistic perspectives. Educational videos: Readers can view videos by scanning our QR codes, providing them with additional educational content to supplement the text. Examples include news coverage, moments in history, speeches, iconic sports moments, and much more! Text-Dependent Questions: These questions send the reader back to the text for more careful attention to the evidence presented there. Research Projects: Readers are pointed toward areas of further inquiry connected to each chapter. Suggestions are provided for projects that encourage deeper research and analysis. Series Glossary of Key Terms: This back-of-the-book glossary contains terminology used throughout this series. Words found here increase the reader’s ability to read and comprehend higher-level books and articles in this field.


Dr. Anne S. Walters, Ph.D.

Almost one in seven children and adolescents in the United States has a diagnosable mental illness, according to the National Institute of Mental Health (NIMH), the leading federal agency for research on mental disorders. That’s more than the number of children and adolescents suffering from cancer, AIDS, and diabetes combined. NIMH

research has found that almost 50 percent of these young people will experience an episode of mental illness before the age of eighteen. The rate of mental illness is even higher among young adults between the ages of eighteen and twenty-five. This is not a uniquely American problem, however. The World Health Organization (WHO) reports that mental disorders are the leading cause of disability among young people in all regions of the world.


The most common behavioral health diagnoses in children include attention deficit hyperactivity disorder (ADHD), behavior problems, anxiety, and depression. Some of these conditions commonly occur together. For example, about three in four children (73.8 percent) between the ages of three and seventeen who have been diagnosed with depression also suffer from anxiety, and almost one in two (47.2 percent) exhibit behavioral problems, according to the Centers for Disease Control and Prevention. What do these numbers mean? To start, it means that mental illness is very common. Most of you reading this will have at least one friend or family member who either is currently struggling or has struggled in the past with a psychiatric illness. That number may even include you and may mean that you have symptoms of both anxiety and depression. In addition, mental illness is becoming more common. Suicide rates have increased in children and adolescents over the past ten years, and this is a major concern at present for professionals in the behavioral health field. No one is sure what has caused these increases, though some speculate it is related to “cultural trends.” A combination of factors such as social media and technology advances or the opioid crisis may all play contributing roles. Other professionals have wondered about how violence in our schools might impact youth


mental health, and still others have pointed to the potential effects of decreased sleep on these illnesses. Despite there being more widespread information about the prevalence of mental health issues for children and adolescents, only slightly more than half of these children receive treatment. What gets in the way? One of the barriers to seeking treatment is the fear that others will find out. Children, adolescents, and even parents fear the stigma of being identified as having a mental illness. Despite progress in the diagnosis and treatment of these illnesses, the stigma that surrounds mental illness is still very profound, even today. Parents fear that their children will experience shame. As long as this stigma exists, it affects the likelihood that children or their families will seek help. Other barriers include doctor and hospital wait lists, concern about medical expense, a shortage of available mental health providers, and lack of knowledge about treatment options. Some of the movements toward reducing stigma have been helpful in this regard. Notable examples are actress Glenn Close and her foundation aimed at reducing the stigma for those with bipolar disorder, or Olympic athlete Michael Phelps speaking out about his own depression. The good news in all of this is that in recent years, evidence-based treatment has become available. The term “evidence based” refers to treatment that has been tested via research and


proven to be effective for various types of mental illness. For example, we know that a form of treatment called “Coping Cat” utilizes a cognitive behavioral form of treatment that is effective for childhood anxiety, and that effectiveness is improved with the use of certain medications as well. Cognitive behavioral therapy (CBT) targets the way that we negatively interpret or perceive situations, and teaches us to “restructure” those thoughts, leading to different feelings and experiences. We know CBT is helpful because researchers have performed studies comparing patients who get this form of treatment with patients that receive other forms of treatment. Our readers will learn more about all these topics in the volumes ahead. We hope that having more information will help you to combat the stigma that surrounds mental illness, and therefore reduce the length of time it takes a child and family to seek treatment. Our hope is that this series will spark conversation and provide important information for children, parents, and school personnel about the various diagnoses that are most common in childhood and adolescence. With this series, we hope you will understand much more about mental illnesses, what is involved, and what to do to help those who might be suffering like family, friends, or even you.



auditory: of, relating to, or experienced through hearing delusion: a belief or perception that is not real paranoid: characterized by or resembling mental illness characterized by systematized delusions of persecution or grandeur usually without hallucinations psychosis: a removal from facts or real life, usually characterized by delusions and hallucinations schizophrenia: a life-impacting mental disorder that can involve hallucinations, unusual behavior and speech, and the inability to care for oneself


1 chapter

What Is Schizophrenia?

From the conversation that I had with the group leader, I came to believe that I was to be punished for disobeying God and Jesus and not fulfilling my penance. I left the meeting in an agitated state and began to believe I was in jeopardy of going to hell. After spending the next twelve months believing that I had actually been condemned to hell with no chance of repentance … I described what I experienced. As it turned out, I had actually had a twenty- to thirty-minute hallucination that had begun when I met privately with the group member and lasted until the end of the meeting.… All I know for sure was the twenty- to thirty-minute memory was a symbolic message which I misinterpreted as actual reality. 1 The man who wrote this is an intelligent adult, a computer programmer with a family. He has also suffered much of his life from schizophrenia . The term “schizophrenia” often appears in popular culture, but among all major behavior disorders, it is perhaps the most poorly understood. Many back away from its patients as menacing or dangerous. They might use the term as an insult to others; the term “schizo” is frequently employed to rebut an argument or attack


another person’s character, intelligence, or mental stability. Forming a basic comprehension of its symptoms and treatments can help those who experience its onset, as well as encourage understanding for those who combat it, in addition to their families and caregivers. Schizophrenia is best defined as “a serious mental disease that affects a person’s thoughts, behavior, moods, and ability to work and relate to others.” 2 It can involve hallucinations, unusual behavior and speech, and the inability to care for oneself. Schizophrenia is not contagious, but it is chronic, meaning that the person who experiences it will almost always require some level of management or care. However, scientists are constantly learning more about what causes schizophrenia, as well as how to best treat it. Many who have schizophrenia lead empowered and fulfilling lives. A diagnosis of schizophrenia is not fatal, nor is it hopeless. About one in seven people diagnosed with schizophrenia can live the rest of his or her life in recovery. Symptoms of Schizophrenia The symptoms of schizophrenia vary from person to person, and their intensity can differ as well. They might increase and lessen in severity. It’s important to understand that experiencing just one of these symptoms does not necessarily mean that a person has schizophrenia. These symptoms can appear with other diseases or behavioral disorders as well. Only a team of qualified health professionals, working together with data gathered over time, can reach a diagnosis of schizophrenia. Schizophrenia symptoms are usually divided into “positive symptoms” or “negative symptoms.” This doesn’t mean that they are “good” or “bad” but that they are evident to others (positive) or missing from usual human activity or interaction (negative).

12 Behavioral Disorders: Schizophrenic Spectrum and Other Psychotic Disorders

Positive Symptoms of Schizophrenia

Delusions: Suffering from delusions is perhaps the most distinctive symptom of schizophrenia. The author of the passage in the beginning of this chapter was suffering from an extended delusion. When a person is experiencing delusions, he or she believes in a form of reality which exists only in his or her mind. For example, the person might become paranoid , under the impression that others are surveilling, are providing a challenge, have formed a romantic relationship, or are attempting to start a fight. In addition, delusions can focus on the self. The patient could assume he or she is famous or a specific celebrity.

The phenomenon of hallucination can be an affliction of schizophrenia.


What Is Schizophrenia?

Delusion can also include the belief that one has special abilities or is needed to prevent a government misdeed or tragic event. Some might assume they are targeted by significant signals, that their health is in danger, or that they are in some way under attack by some power inserting thoughts into their brains or removing memories. Hallucinations: A hallucination is different from a delusion in that it is a specific visual or auditory experience that is not real. Hallucinations can include smells and phantom sensations as well. The patient might see an object such as a dragon or a person from his or her past, undergo what seems like a spiritual experience, or hear voices in his or her head issuing commands or information. Hallucinations can reinforce delusions, and vice versa. When experienced together, the phenomenon of delusions and hallucinations is usually referred to as “ psychosis .” Psychosis is not exclusive to schizophrenia—it can function as a symptom of other mental illnesses, including bipolar disorder—but it is one of the most devastating and significant aspects of living with this difficult disease. Patients in psychosis experience delusions and hallucinations as though they are reality. While it is possible for those who have been in psychosis to control the symptoms with prescriptions and other forms of medical attention, this symptom of schizophrenia can drastically interfere with living a normal life. Psychosis takes place without the patient wanting it in any way. Unusual Movements: Those who suffer from schizophrenia might move in distinctly odd ways, either seated or standing. Sometimes they experience bursts of activity or seem frantic, even conducting themselves without any apparent goal in mind. They may seem upset or restless and lose the ability to follow directions. If they are in psychosis, their facial expressions or speech might not seem to make any sense. A patient might rock, refuse to walk, or make sudden movements.

14 Behavioral Disorders: Schizophrenic Spectrum and Other Psychotic Disorders

Confused Speech: A schizophrenia patient’s brain is affected in many ways. The person could lose the ability to construct an understandable sentence or to show comprehension toward those attempting to communicate. Young people who are showing symptoms of schizophrenia might suddenly seemmuch less verbally mature than they actually are. Negative Symptoms of Schizophrenia Lack of Eye Contact: The patient does not look directly at anyone else, shifting his or her gaze away and seeming to disengage from conversation or human connection. He or she might have difficulty understanding, recognizing, or labeling emotions in others. Loss of Interest: In younger patients, this might be marked by a sudden drop in academic performance or disinterest in sports, clubs, or activities. Older patients could struggle to exercise, suddenly turn their back on their careers and hobbies, or vanish from relationships. Unattended Hygiene: Since schizophrenia patients can experience a loss of motivation to perform even everyday tasks, they might neglect simple grooming. Patients might neglect their appearance to the point of refusing to bathe, change clothes, or brush teeth. Social Withdrawal: Sometimes because of psychosis or the way the brain is processing information, a schizophrenia patient might pull away from friends, family, or other people altogether. They avoid not only conversation but all forms of contact, and prefer to stay in an isolated area. Blank Expression or Lack of Emotion: This is sometimes referred to as “blunted affect.” It involves a noticeable reduction in usual facial expression, body language, and speaking ranges. People with schizophrenia might markedly fail to react as most people would to


What Is Schizophrenia?

Blunted affect is a symptom that leaves schizophrenics unable to react appropriately or naturally, mustering only a blank stare instead.

16 Behavioral Disorders: Schizophrenic Spectrum and Other Psychotic Disorders

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