Schizophrenia. Does this word conjure thoughts of mentally unstable, violent individuals with split personalities? For many, it does. And it is these misconceptions about the disorder that mental health organizations around the world are trying to break.
Today is World Mental Health Day, and this year's theme is "Living with Schizophrenia." Around 26 million people worldwide are living with the disorder, with 2 million in the US.
As defined by the National Institute of Mental Health (NIMH), schizophrenia is a severe, disabling brain disorder.
People diagnosed with schizophrenia can often experience delusions and hallucinations, which cause them to see or hear things that are not there and believe things that are untrue. The disorder can also impair a person's emotions, memory and the ability to socialize and relate to others.
The exact causes of schizophrenia are unclear. As such, current treatments focus on easing the symptoms of the disorder. Antipsychotic medications, such as clozapine (Clozaril) and haloperidol (Haldol), are usually the first port of call when treating people with schizophrenia.
Psychosocial treatments, such as cognitive behavioral therapy (to help improve behavior and thinking) and rehabilitation (to improve social interaction) are also available for patients with schizophrenia who have already been stabilized with antipsychotic medications.
Such treatments can be effective for the majority of people with schizophrenia, allowing them to function more normally in day-to-day life.
"People who have a relationship with someone who is successfully treated appreciate the reality that people living with a schizophrenia brain illness are delightful, wise, thoughtful individuals with the same goals and aspirations that others not diagnosed have," Linda Stalters, executive director of the Schizophrenia and Related Disorders Alliance of America (SARDAA), told Medical News Today.
But it seems society as a whole has other ideas about what people diagnosed with schizophrenia are like.
People with schizophrenia 'feared'
"Unfortunately, there is still a great deal of misunderstanding around schizophrenia," Brian Semple, of UK charity Rethink Mental Illness, told MNT. "Many people assume that it means having a split personality or that it makes you violent, neither of which is true."
The National Alliance on Mental Illness (NAMI) claim that 64% of people believe a split personality - frequently switching between normal and bizarre behavior - is a symptom of schizophrenia. This promotes a perception that people with schizophrenia are unpredictable, which causes society to fear them.
- Schizophrenia runs in families. It affects around 1% of the general US population, but around 10% of people who have a first-degree relative with the disorder
- Onset is most common between the ages of 16 and 30
- Around 50% of people with schizophrenia have received no treatment for the disorder.
"I think people with a diagnosis of schizophrenia are still feared and perceived as dangerous," said Dr. David Crepaz-Keay, head of empowerment and social inclusion at UK charity the Mental Health Foundation, who has lived with a diagnosis of schizophrenia for around 35 years.
"There is no significant evidence to support the notion of a link between a diagnosis of schizophrenia and violence, but the perception persists."
Dr. Crepaz-Keay is not wrong. A 1999 report - Mental Health: A Report of the Surgeon General - claims that 61% of Americans believe people with schizophrenia are likely to be violent toward others.
Past studies have indicated that people with schizophrenia are more likely to be violent than individuals without the disorder. But many of these studies state that increased violence in people with schizophrenia mainly occurs alongside substance and/or alcohol abuse - a factor that can increase violence in populations without schizophrenia.
This is echoed in a 2009 study from the University of Oxford in the UK, which compared the risk of violent crime in people with schizophrenia with more than 80,000 controls.
Dr. Seena Fazel and colleagues found that people with schizophrenia and drug or alcohol abuse were four times more likely to commit a violent offense than those without the disorder, but that this risk reduced to 1.2 times when drugs or alcohol abuse were taken out of the equation.
"These problems are prevalent in schizophrenia, but there are evidence-based treatment strategies for drug and alcohol abuse and so the risk of violence can be reduced," Dr. Fazel noted.
A 2006 study, also conducted by Dr. Fezel and colleagues from the Karolinska Institutet in Sweden, found that only 1 in 20 crimes are committed by someone with a mental health disorder - which the researchers say is much lower than what most people would think.
"In many ways the most interesting aspect of our findings is that 19 out of 20 people committing violent crimes do so without having any severe mental health problems," Dr. Fezel told the BBC.
A spokesman for the Sainsbury Centre for Mental Health in the UK added:
"This study shows clearly that people with severe mental health conditions commit a very small proportion of violent crimes and that the widely held prejudices about schizophrenia are inaccurate and unfair."
Negative perceptions of schizophrenia a barrier to treatment, social support
Perhaps unsurprisingly, society's negative perceptions about people with schizophrenia can stop individuals with the disorder from getting the help they need, in terms of both treatment and social support.
NAMI report that only 46% of people say they would tell a friend if they had been diagnosed with schizophrenia, while 27% say they would be embarrassed to tell others if one of their own family members had been diagnosed with the disorder.
Stalter told MNT:
"Someone who hears the negative and pejorative comments about people with severe mental illness will not admit to having any symptoms and then will not seek help even when they are in the early stages and recognize that their thoughts might be inappropriate.
Not only do the symptoms cause isolation, but people abandon their friends and the families, leaving them without the support that they need."
Schizophrenia and employment
The negative perceptions surrounding a diagnosis of schizophrenia does not only present a barrier to treatment and social support. It can hinder the ability of people with schizophrenia to live a fulfilled life.
And for many individuals with schizophrenia, a sense of normality comes with the ability to work. But employment is challenging for people with the disorder.
Only around 15% of people with schizophrenia in the US are employed. This figure is even lower in the UK, at 8%.
"Diagnosis often comes at vital life stages and interrupts education and training, which puts people at a disadvantage in the labor market," Dr. Crepaz-Keay told us. "Many of the traditional treatments for schizophrenia have negative effects that make education, training and work more difficult, particularly (but not exclusively) those that affect concentration, coordination and balance."
But aside from these challenges, Dr. Crepaz-Keay noted that there is a great deal of employer prejudice at play, which is echoed in a report from The Working Foundation at the University of Lancaster in the UK.
"There is a general belief that 'people with schizophrenia are not able to do things very well,' that 'they will fail,'" said a psychologist in the report. The report also reveals that up to 70% of people with schizophrenia have experienced some form of discrimination, which has hampered their motivity to work.
"I've got a really negative outlook of work, especially through my experience. Even though you want to work, it is just sometimes the experience of mental health, it just gives you that limitation on what you can handle at work and what you can do and what you cannot do," stated an individual who had been diagnosed with schizophrenia.
Commenting on the issue, Semple told us:
"For many people who have schizophrenia, having a job can be a really important way of staying well and managing their condition. But people with mental illness often get very little support to go back into work if they have been unwell.
We really need to improve attitudes to schizophrenia in the workplace. Many employers assume that if you have a mental health problem, you won't be able to hold down a job."
Semple said that it is important to note, however, that some people with severe mental illness are unable to work. "Those people must be supported too, and should not be demonized," he added.
Are society's perceptions of schizophrenia changing?
It seems there is more focus than ever on breaking the stigma associated with schizophrenia.
As well as "Living with Schizophrenia" being this year's theme for World Mental Health Day, SARDAA are holding a conference titled "Call to Action: Shattering Stigma" on October 24th, which aims to educate people on the truths of the disorder.
In the UK, Rethink Mental Illness have teamed up with MIND - a UK mental health charity - to launch a campaign called "Time to Change," which also aims to tackle the discrimination of people with schizophrenia.
Organizations around the world are working hard to educate the general public about schizophrenia, and Semple said there is some evidence to suggest such focus is changing people's attitudes toward the disease.
But Dr. Crepaz-Keay told us he believes that schizophrenia remains a "significant taboo."
"While there has undoubtedly been a significant increase in understanding of, and attitudes toward, many diagnoses, including bipolar disorder and depression, this does not seem to be the case with schizophrenia," he said.
So what can be done to change the public's attitudes toward schizophrenia? "Moving the focus onto what people can do, rather than what they can't or the help they need is an important part of improving our public image," said Dr. Crepaz Keay.
"There are many people who receive a [schizophrenia] diagnosis and continue to have full and productive lives, and I would consider myself to be one of them."
Schizophrenia is one of two broad groups of mental health disorders that produce psychosis. The other group, mood disorders, includes bipolar disorder. Our Knowledge Center article - "What is psychosis?" - provides more information.