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Tuesday, February 9, 2016

Who invented Schizophrenia

Schizophrenia has always been a mystery. Ever since Emil Kraepelin claimed he had discovered an incurable, degenerated illness at the turn of the 19th century, no cure or concrete causes of Schizophrenia has been found.  Schizophrenia is the collective name of negative, cognitive and positive symptoms, like depression, delusions, hallucinations and paranoid thoughts. Even though there are other theories which explain the cause of Schizophrenia the two most common used models are the Medical or Disease Model and the Social Model. The Medical Model claims that a biological defect in the person’s brain is responsible for the illness. The Social Model claims that when a person is confronted with an extremely stressful event, his or her mind puts a defense mechanism in place.   
We all know of a person that is or has been suffering from depression. People who have experienced this devastating illness know but all too good what it can do to the mind. In most cases depression can be conquered with the help of medication or therapy. However when life seems to be going well and new horizons are being discovered one doesn’t expect to see shadows moving or get panic attacks; especially when the person is young and life is only just beginning. Nevertheless there are many young people between 14 and 26 who experience these symptoms. Some have experienced trauma but others didn’t.
Adolescence is a period wherein a person develops the last parts of the body and brain. These are enormous changes and are usually causes much psychological pain and confusion. Many discoveries like sexuality are made in this period. To contribute to this confusion and pain, major changes like study, exams, jobs and relationships are thrown in. Often they come all at once. It is also in this period that many young people experience with drugs and alcohol. Needless to say that causes many problems and damages not only a person’s liver but also the person’s brain. Withdrawal from it after excessive use can cause anxiety, bad dreams, depression, shaking and vomiting; these are just the mild to moderate withdrawal symptoms. The more serious symptoms are; hallucinations – known as delirium tremors and black outs.
Alcohol use is affecting the neurotransmitters in the cortex, the cerebellum, the hippocampus, the amygdala, the superior and the inferior colliculi. Cannabis is mainly affecting the nucleus accumbens, caudate but also the cerebellum and the hippocampus.  These are all located in the mid brain which contains dopaminegic neurons.
When in the case of excessive drugs, alcohol use or when experiencing extreme stress; which adolescence may be filled with, the stress hormones suppress the activity of the hippocampus. As a result the hippocampus loses its ability to function normal. The amygdala and the hippocampus are deeply involved in responding to stressful events. Charles Nemeroff discovered that the hippocampus is 15% smaller in a person with depression. In some cases the hippocampus might not be able to distinguish between a piece of asphalt on a warm day or a turbulent river. In normal circumstances the amygdala sends alarm messages to the cortex when needed. The hippocampus assists in the transfer of this information. When the cortex realises that the danger is over it instructs the amygdala to stand down. This is supposed to happen in a normal situation. However when this process is distorted the person might develop anxiety, which may include paranoid thoughts and or delusions. The person might also have difficulty in concentrating and have low motivation. Anxiety is a very complex phenomenon and a panic attack can be extremely freighting. Some people even see shadows moving or see human or animal figures that aren’t real. This is the brain’s way of dealing with the situation at that moment. A similar thing is happening when we dream; we digest the things we’d done and work through situations we yet have to understand.
Schizophrenic symptoms are frequently also found in other mental disorders, like post traumatic stress disorder, bipolar disease and obsessive compulsion disorder. In the 1800’s before psychoanalyses and psycho-pharmacology, 70 % of patients in hospitals were discharged after their first admission receiving ‘moral treatment’. They had either improved or recovered from their symptoms. By 1900 the ‘moral treatment was abandoned and replaced with more scientific somatic treatment, discharge rates dropped to 20-30%. Moral treatment included;
  • striving the patient as an individual
  • developing a full and accurate history
  • encouraging work and sociallising
  • never humiliating patients
  • only use physical force to prevent a patient form harming themselves or others, never as punishment.

Kleinian analysts see Schizophrenia as a defense against overwhelming abolition and tormenting anxieties. They interpret unconscious matters at the level of greatest anxiety, to develop awareness of the links between reality and fantasy.
The dopamine hypothesis is currently the most widely accepted biochemical theory. According to this hypothesis, Schizophrenia is caused by hyperactive transmissions in neurons in the brain which use dopamine as a chemical messenger. By administer patients with anti psychotic drugs these dopamine neurotransmitters are blocked.  Some psychiatrists have come to the conclusion that drugs are not the answer to curing Schizophrenia and other mental illnesses. Post mortem on people who suffered from Schizophrenia stated signs of increased dopamine levels. However it has also been discovered that anti psychotic drugs not only causes a blockage of dopamine, but also kicks off an attempt of the brain to compensate for the blockage. In other words, over activity in the dopamine system is caused by the anti psychotic drugs that are supposed to threat the illness.

References: Haracz J, The dopamine hypothesis, Schizophrenia Bulletin 8:438-6
Tyler A, Street drugs, Holder and Stoughton, London 1995
Read J, Mosher L.R, Bentall R.P., Models of madness, Routledge New York USA, 2006
Colbert Ty C, Broken brains or wounded hearts, Kevco Publishing, Santa Anna, California
Scot-Peck M, The road less travelled, Arrow books London, 1990  

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