Write On: Schizophrenia. What’s the Frequency?

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There seems to have been a lot of schizophrenia talk popping up lately like in a previous Write On with Dr. Brian Cohn. and a random conversation on the origins of an R.E.M. song I had with Dr. Sarah K. Stephens the other day. I, of course, wanted to delve deeper into the topic so I asked Sarah who is a developmental psychologist with a Ph.D. from Penn State University to answer some burning questions I had on the topic.

The R.E.M. song we were talking about is called What’s the Frequency, Kenneth? And is inspired by a series of events in the 80’s in which Dan Rather was assaulted by an individual who thought that he was being sent radio waves from his TV set and the nightly news anchors like Dan Rather. You immediately said, “Oh, schizophrenic.” What about this screams schizophrenic?

The disconnection from reality, paired with perceived external experiences that are not actually occurring. The most classic and well-known symptoms of schizophrenia involve delusions, where an individual maintains beliefs that are entirely irrational and countered by evidence in reality (e.g., delusions that one is being controlled by the government through radio waves), and hallucinations, where an individual sees, hears, smells, etc. phenomena that do not exist in reality. It seems the assailant in this case experienced both of the symptoms as part of his condition.  

How common is schizophrenia?

It occurs in 1% of the population, approximately.

Does schizophrenia have a typical demographic?

I’m unaware of any demographic distinctions in schizophrenia, such as well-established differences in prevalence according to gender or race, but this is a complicated question. Prevalence estimates in part rely on accessing patients who are pursuing treatment. Given our country’s struggle to provide accessible mental health care for its population, it is a possibility that estimates of the prevalence of any mental health condition may not be fully representative and that communities or individuals without ready access to care or who encounter cultural stigma in seeking out mental health treatment are underrepresented. There are methodological techniques for addressing this potential for bias, but they are not always used in studies.

The majority of cases of schizophrenia, though certainly not all, show significant symptoms when an individual is in their late teens or early adulthood. Likewise, there are some differences in symptom presentation between men and women. For example, women tend to develop symptoms, on average, later in life than men.  

When thinking about risk for developing schizophrenia, the most important predictor is a history of schizophrenia in your biological family, especially in first-degree relatives, such as parents or siblings. Schizophrenia has one of the strongest genetic bases of any mental illness, though it’s important to remember that even in this case there are many environmental factors that play a role as well. Even in the case of identical twins, who share 100% of their genome, the concordance rate (or likelihood that, if one twin develops schizophrenia, the other will as well) is only 45-50%.

I have trouble distinguishing schizophrenia, bipolar and split personality disorder. What are the differences?

Regarding the distinction between schizophrenia and dissociative identity disorder (the current diagnostic term for what is often commonly thought of as split personality disorder), I think it best to refer to my former colleague at Penn State Hershey Medical Center, Dr. Randy Welton (currently of Boonshoft School of Medicine at Wright State University), and his analysis of the differences between the two. Thanks to several stories over the years in the popular media, schizophrenia, and dissociative identity disorder have been misconstrued as one and the same. Dr. Welton provides a detailed assessment of how, in fact, they are not. It’s important to keep in mind, as well, that dissociative identity disorder is not well understood in our field and, in many ways, remains a controversial diagnosis, unlike schizophrenia, which is well-established as a disorder.   

Bipolar disorder is a mood disorder, whereas schizophrenia is a psychotic disorder. What this means is that bipolar disorder is categorized as an illness whose symptoms revolve around an imbalance or dysfunction in emotional experiences, whereas schizophrenia is an illness that involves a disconnection from reality.  It’s important to keep in mind that each of these disorders has related permutations that differ in severity and expression of core symptoms, and to think of schizophrenia or bipolar as looking entirely the same from one patient to another is oversimplifying the disorder.   

It’s important to note that the two disorders can sometimes be misconstrued as the same because of some overlapping symptoms. For example, bipolar disorder typically involves cycles of depressive mood states with manic, extreme high-energy mood states. During the manic portion of the disorder, hallucinations (e.g., hearing voices) might be experienced by a person with bipolar disorder. Likewise, schizoaffective disorder is a diagnosis that recognizes patients who are experiencing both schizophrenia and bipolar or another mood disorder.

It would certainly be convenient for mental illness to compartmentalize itself into distinct, non-overlapping conditions, but in reality this is often not the case, and the complexity of mental health continues to challenge us to develop better understanding and treatments for patients.  

In your upcoming book from Pandamoon Publishing titled A Flash of Red, you describe some troubled individuals who are struggling with their own disconnections from reality, either through addiction or mental illness. Would I be correct in guessing that one of the main characters has a history of schizophrenia (or thinks she does)? Why did you choose to write about it?

Without giving too much away, I can definitely confirm that one of the central themes in A Flash of Red is how each of us defines our own realities, and what happens when we go too far in our self-delusion. I have always been fascinated by the mind and the utter complexity it presents to us on an academic level, and yet how banal these incredible processes of thought and self-understanding become in our daily lives. In A Flash of Red, I wanted to explore what it means when we take these experiences of self for granted, and as a result lose ourselves and those we love in the process.   

Thanks,  Dr. Sarah!

It was my pleasure

 

 

 

A few weeks back Sarah K. Stephens and I decided to collaborate on a project we are calling Write On. Sarah is a developmental psychologist with a Ph.D. from Penn State University and I am a misanthropic code monkey residing in Des Moines, IA. We both have debut novels out later this year from Pandamoon Publishing.  In short, Write On will explore topics that interest us and in so doing provide a resource for writers or other interested parties as they research what can often be confusing and difficult subject matter.

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