Abstract
This paper explores a psychological disorder such as schizophrenia. This disease or disorder has very diverse symptoms and is considered to be one of the most complex diseases. This work aims at the detailed study of schizophrenia based on the various support materials to which the references are made. During the long years of study, description, and diagnosis, a number of the scientific materials have developed, which allows studying this topic in detail. This study includes the historical connotations, types of diagnosis such as the DSM, the definition of the causes of the disease, its symptoms, as well as the methods of treatment and the different requirements in order to prevent the disorder. In addition, the work includes an analysis of the cross-cultural issues, which helps to determine the degree of one's predisposition to the disorder on the basis of the cultural and similar secondary differences. However, it is crucial to take into account the differences in views on the disorder. These differences include the historical analysis, starting with the very first mention of this disorder until today. The paper includes the materials related to the Christian view of the disorder, i.e. some examples from the Bible, which makes this study more extended.
Key Words: Schizophrenia, DSM, cross-cultural issues, prevention, treatment, genes.
Introduction
Undoubtedly, schizophrenia is one of the most complex and ambiguous types of the mental disorders. Humanity has been familiar with this disease for many centuries. Previously, it was a very difficult and practically unsolvable puzzle, but over the past 100-150 years, it became analyzable with the development of such sciences as psychology and psychiatry. This analysis provided a more accurate understanding of the disorder, as well as the ability to create a more professional classification of its subtypes. Basically, DSM-V, i.e. Diagnostic and Statistical Manual of mental disorders, is commonly used for a more detailed analysis of schizophrenia and for the diagnosis and management of mental health statistics. This manual has a few basic factors and axes to help make a detailed diagnosis of a patient and deliver the most correct diagnosis. The diagnosis of schizophrenia from the viewpoint of the DSM-V includes the methods for determining the presence of disorder, psychopathy, or physical disorders that may accompany the disease. In addition, this diagnosis determines the aggravating factors and complications and finally reveals the main trends in the general level of the social adaptation of a patient.
Historical Aspect: The Disorder in Its Historical Context
The history of Schizophrenia is a long process, which consists of thousands of different studies that are intertwined and often even contradict each other. The first mention of schizophrenia can be attributed the back to ancient times, but then very few people understand the real essence of this phenomenon, attributing all its "commonplaces to the supernatural forces" (Heinrichs, 2001, p. 119). Therefore, if one talks about the first studies of schizophrenia, it should dwell on the "weakening of the mind," that is the way disorder was determined in the middle of the 18th century (Snowden, 2008, p. 444). The basis of the doctrine of dementia was a concept that described the process of weakening or a pattern that characterized the disease. This concept also integrates all clinical manifestations of the disease in the same group, which was called the "dementia praecox" (Heinrichs, 2001, p. 22). This group also included the subgroup diseases such as "hebephrenia, chronic delusional psychosis", etc. (Alanen, 1997, p. 30). These notions are referred to Emil Kraepelin (1896, 1919), who essentially created the concept and "dementia praecox" and thus laid the foundations for the study of schizophrenia (Heinrichs, 2001, p. 22). The scientist provided some of the "earliest and most detailed descriptions of this “precocious” mental decline, or dementia, that was termed schizophrenia only later by Bleuler (1950)" (Heinrichs, 2001, pp. 22-23). Bleuler considered the primary elements of disorder that were characterized by the mild impairments of certain functions of thinking to be the main criterion of a diagnosis. Having studied the psychopathology of schizophrenia, Swiss psychiatrist described the disorders such as "autism and ambivalence", which eventually went into the foundation of the world of psychiatry (Snowden, 2008, p. 444). Bleuler referred to a form of schizophrenia distantly, focusing his interests on the delusional and latent cases of the disease course; according to Andreasen, "delusions — implausible, rigidly maintained, often fantastic beliefs — are probably the most common, peculiar, and dramatic symptoms of schizophrenia" (Heinrichs, 2001, p. 34).
Cause of the Illness: Current Research as to the Cause of Schizophrenia
Schizophrenes' thinking, as well as oral and written language, loses focus, consistency, and logic nature. According to, it feels like "as if someone else is in control or as if your brain has a mind of its own" (Miller & Mason, 2011, p. 29). That is, the process of thinking becomes the object of attention of patients, losing their automatic nature. Sometimes the patient feels as if physically change of thought; hence, the very nature of thought changes too. Losing the image-bearing component, the tendency to abstraction and symbolism begins to dominate (Heinrichs, 2001, p. 218). For a long time, the causes of schizophrenia have remained unknown. There is no a single correct opinion about the causes of the disease even today. Schizophrenia is characterized by the significant changes in the emotional sphere, i.e. "the withdrawal or blunting of emotional expression" (Jenkins & Barrett, 2003, p. 3). On the one hand, there is a progressive "depletion of emotional reactions", while on the other hand, they are inadequate and paradoxical (Alanen, 1997, p. 10). Most often, this disorder occurs in late adolescence and early adulthood, but it can develop at any age, which greatly complicates the search for the original cause of the disease. In search of the causes of disease, much attention is paid to the related ties, that is, a "genetic inheritance contributes to the illness" (Miller & Mason, 2011, p. 52). "Most clinicians accept that it is a devastating disorder or group of disorders affecting about 1% of people worldwide" (Snowden, 2008, p. 444). Most often, the disorder can be traced on the second level of kinship: i.e. "from parents to offspring" (Heinrichs, 2001, p. 81). That is, the mutations in DNA structure, which can be exacerbated by the external psychological influence, are likely to be the main causes of schizophrenia.
Treatment of Schizophrenia
Currently, psychotropics with antipsychotic, antidepressant, tranquilizing and stimulating effects are the main methods of treatment of schizophrenia (Heinrichs, 2001, p. 4). The widely used shock treatments now are used for the narrower indications (Jenkins & Barrett, 2003, p. 15). All biological treatments are combined with the psychotherapy and the measures for employment and social adaptation. The variety of clinical manifestations of schizophrenia excludes any the standard methods of treatment. Basically, the form and type of the stage of disease and the syndrome structure that determines the patient's condition are the most important factors that determine the therapeutic tactics. Treatment of schizophrenia, taking into account its tendency to chronicity and the frequent manifestation of relapse, includes both therapeutic and prophylactic treatment (Alanen, 1997, p. 252). Finally, it is necessary to take into account the individual characteristics of a patient's respond to drugs. There is a variety of types of treatment and its different approaches. Basically, pharmaceutical treatment is the main type of treatment that uses a variety of drugs; however, the various therapies, both social and psychological, are also crucial (Alanen, 1997, p. 255). Most often, these methods are combined, which allows creating a more effective and comprehensive treatment. There are also a lot of viewpoints regarding the recovery of patients with schizophrenia. Nevertheless, the results and statistics show that a full recovery is extremely rare – "only 20% of full recovery" (Alanen, 1997, p. 36). After recovery, a person becomes more social, but nevertheless, he or she continues to experience the problems related to the interpersonal communication and social life.
Prevention: Research as to the Prevention of Schizophrenia
There are several common opinions regarding the prevention of schizophrenia. If one talks about the serious research, all materials relating to the prevention are associated only with the different types of psychological and "readable" physiological (Jenkins & Barrett, 2003, p. 44). Firstly, from a scientific standpoint, an early identification of preschizophrenic people can help the disease process to be analyzed before the "masking effects of acute symptoms and medication take place" (Heinrichs, 2001, p. 56). According to Alanen (1997), "the prevention of schizophrenia is part of a large-scale development of constructive and prophylactic mental health work at the level of families, communities, and societies" (p. 252). It is quite difficult to identify and prevent schizophrenia. If a patient begins to experience certain symptoms, which his or her familiars may notice, then there comes a time when one should think about the urgent treatment. However, one can prevent schizophrenia relying on one's own family tree. For example, the adoption study findings showed that "a psychically healthy family environment may protect even children with a hereditary predisposition from becoming schizophrenic" (Alanen, 1997, p. 252). However, relatives' illness may become the most effective way to prevent schizophrenia. In such cases, it is necessary to contact the research center of mental illness, pass the certain medical tests, and undergo the basic psychological tests. Stress, drug use, and other diseases and damage of the brain may contribute to schizophrenia. In addition, it is also important to have an aftertreatment rest after the long-term psychological stress. Hence, avoiding any stress situation can contribute to the prevention of schizophrenia. Moreover, knowing how to prevent drug abuse, alcoholism, and sexually transmitted diseases is also important because these illnesses can add lots of stress to one's life (Miller & Mason, 2011, p. 141).
Cross-cultural Issues
Psychologists and other experts in the field of social sciences have long been interested in the influence of culture on psychopathology or pathological behavior. Historically, the literature on the subject is divided between the two viewpoints. According to the first viewpoint, culture and psychopathology are complexly intertwined, and abnormal behavior can only be understood within the culture in which it takes place. The first cultural evidence on the symptoms of schizophrenia and related psychotic disorders are summarized in a review by Karno and Jenkins (1997): "Given the depth and breadth of the ways in which culture mediates nearly every aspect of schizophrenia, it was a significant milestone when “culture” was incorporated into DSM-IV" (Jenkins & Barrett, 2003, p. 3). This point of view is called cultural relativism. According to the opposite view, despite the fact that culture plays a role in certain forms of pathological behavior, there are cross-cultural analogies and even universals in the psychological mechanisms and the subjective perception of many mental disorders. The cross-cultural studies offer an abundance of evidence to show that the abnormal behavior and psychopathology have both universal and culture-specific aspects. Hence, "a combination of laboratory and field methods would be an ideal marriage in order to study, for example, the social consequences of diminished emotional expression and inability to describe one’s feelings to others" (Jenkins & Barrett, 2003, p. 343). One result that surprised the researchers showed that the disease occurs in patients from developing countries more often than in those who live in developed countries. The patients in India and Nigeria (who suffer from "the symptoms of colonialism") recovered faster than the patients from England or the United States (Jenkins & Barrett, 2003, pp. 238-239). These differences have been attributed to the cultural factors such as a large number of relatives and a tendency to return to one's former job in the developing countries. The researchers also found differences in the manifestation of symptoms in different cultures. These findings may be due to the cultural differences in values related to self-awareness.
Biblical Worldview
The consideration of such mental disease as schizophrenia from the biblical perspective began earlier than the examination of these disorders from the medical standpoint. Treatment of schizophrenia from the Christian point of view differs from the modern interpretation. The Scriptures describe the various supernatural phenomena that explain the emergence of disorders of consciousness. For example, the direct communicative relationship between the individual's non-verbalized thoughts and the personal, omniscient God serves, perhaps, as "a cultural model for disorders of the privacy of thinking" (Jenkins & Barrett, 2003, p. 96). Thus, mental disorders can occur as a result the effect of evil spirits per person. The faithful Christians do not deny the fact that a personality disorder can be caused by physiology, but they believe that this disorder is the reason for the obsession with the devil. As a result of possession by an evil spirit, soul becomes unnatural, it languishes and suffers. Few researchers believe in the "authentic" biblical descriptions of cases of mental illness. It is impossible to accurately determine the clinical picture of the most of the examples in the Bible. Most researchers believe that such instances describe people with a variety of brain injuries or diseases such as epilepsy, viral encephalitis, and others. According to Hancock & Tiliopoulos (2010), "religious schizotypes appear to use religious frameworks to make sense of anomalous experiences, reducing associated distress or breakdown into schizotypal personality disorder or psychosis" (p. 262). Hence, such diseases often have the psychotic symptoms too.
Conclusions
Schizophrenia is a serious and complex psychological disease that has complex and contradictory symptoms. For many years, schizophrenia has been studied by many different researchers in the field of psychiatry, biology, and genetics. As it is evident from the historical context, the disorder has a long history and many references in the various spheres of human activity. Today, there are more than 1% of patients with schizophrenia among the world's population. There are several points of view regarding the causes of the disease, however, none of them are proved purely. However, the occurrence of schizophrenia is directly linked to people's genes and the mutations that can be transmitted within the family. Preventing the disorder is almost impossible, since its first manifestations signal about the necessity of an immediate treatment. It is important to study the illness from the cross-cultural aspect that has an impact on the severity of the disease and recovery. A medical treatment is still considered to be the main method of cure, but it becomes more efficient with using different types of therapy. As for future research, it is necessary to say that the study of the human brain and the genome are likely to become the most productive in the search for more effective treatment and prevention of schizophrenia.
References
Alanen, Y. O. (1997). Schizophrenia. London, GB: Karnac Books. Retrieved from http://www.ebrary.com
Hancock, L., & Tiliopoulos, N. (2010). Religious attachment dimensions and schizotypal personality traits. Mental Health, Religion & Culture, 13(3), 261-265. doi:10.1080/13674670903334678
Heinrichs, R. W. (2001). In Search of Madness: Schizophrenia and Neuroscience. Cary, US: Oxford University Press (US). Retrieved from http://www.ebrary.com
Jenkins, J. H., & Barrett, R. J. (Eds.). (2003). Cambridge Studies in Medical Anthropology: Schizophrenia, Culture, and Subjectivity: The Edge of Experience. Cambridge, GB: Cambridge University Press. Retrieved from http://www.ebrary.com
Miller, R., & Mason, S. E. (2011). Diagnosis: Schizophrenia: Schizophrenia. New York, US: Columbia University Press. Retrieved from http://www.ebrary.com
Snowden, A. (2008). Schizophrenia: early history of diagnosis. Nurse Prescribing, 6(10), 444-448 5p.
