By Ronald Pies
Schizophrenia is a mental disorder characterized by gross distortion of reality, language disturbances, fragmentation of thought and other troubling symptoms. The cost of caring for schizophrenic patients comes to more than $17 billion per year in this country -- but this figure can never capture the emotional cost borne by patients and their families. While schizophrenia is often made worse by stress, it is not caused by bad parenting, "cold" or over-involved mothers, or any other known psychological factor. Rather, schizophrenia probably stems from a combination of genetic factors, biochemical abnormalities in the brain and perhaps very early damage to the developing fetus. Nevertheless, emotional stress -- including pressure from well-meaning family members -- can make the illness worse. What can families do to help their schizophrenic relatives, and to cope with this devastating illness?
Education is certainly paramount. Many parents still blame themselves for causing their son's or daughter's illness; others accuse the afflicted family member of laziness or self-indulgence. This sort of assigning blame is founded in error, and can make matters worse for the individual with schizophrenia. For example, when a family member tells the sufferer, "You don't need those lousy medications! You need to pull yourself together and get a job!" he or she may mean well, but may actually do more harm than good. Individuals with schizophrenia virtually always need to take antipsychotic medication -- they cannot "pull themselves up by their bootstraps" through an act of will.
On the other hand, babying or coddling a family member with schizophrenia is also unhelpful. There is a realistic middle ground that can be reached through family education and support. This can come from mental-health professionals, mental-health advocacy groups and from patients themselves.
Medication and Job Counseling
Use of the latest "atypical" antipsychotic medications, such as clozapine (Clozaril) and olanzapine (Zyprexa), has made a big difference for many individuals with schizophrenia. These newer medications are better tolerated than older agents like haloperidol (Haldol) and work on a wider range of symptoms. Families can advocate for the use of these newer agents, and encourage their loved ones with schizophrenia to take their medications on a regular basis. But medication is not the whole story.
While it is foolish to "push" schizophrenic individuals into high-pressure jobs for which they may not be ready, it is also unwise to assume that schizophrenia amounts to a permanent disability. Many individuals with this illness can rejoin the workforce, with appropriate vocational rehabilitation and lots of emotional support.
In fact, a recent study by Dr. R.E. Drake and colleagues at Dartmouth Medical School found that many patients get into the job market faster than was once thought. Rather than getting "stalled" in the usual sheltered workshops, the patients in this study were able to secure competitive jobs quite rapidly, and hold these jobs. This was probably because the patients received ongoing counseling, transportation assistance and help in dealing with their employers.
The Right Kind of Therapy
The right kind of psychotherapy is also important. Individuals with schizophrenia need to learn how to cope with the realities of their illness. In this regard, family members can be a tremendous help. Dr. M.I. Herz and colleagues at the University of Rochester conducted an 18-month study in 1995 of 82 schizophrenic outpatients at high risk for relapse. Forty-one patients were randomly assigned to "standard treatment" and 41 to "early-intervention treatment" (EIT). The latter consisted of weekly group or individual sessions, in which coping skills were emphasized, as well as reporting any changes in symptoms over the preceding week. Patients and family members were also taught about schizophrenia and how to recognize very early signs of a psychotic relapse.
When such signs were reported, more frequent office visits and/or adjustment of medications would occur. Results showed that patients in the standard treatment group were hospitalized for a total of 351 days, vs. only 73 days for those in EIT. Thus, family members who are educated about schizophrenia can make a big difference in the lives of their loved ones.
Finally, family members can join and support mental-health advocacy groups like the National Alliance for the Mentally Ill (NAMI), which provides important services to both patients and their families.
Facts about Mental Illness
- Mental illnesses are physical brain disorders that profoundly disrupt a person's ability to think, feel and relate to others and their environment.
- Mental illness is more common than cancer, diabetes or heart disease.
- In any given year, more than five million Americans suffer from an acute episode of mental illness.
- One-in-every-five families is affected in their lifetime by a severe mental illness, such as bipolar disorder, schizophrenia or major depression.
- A conservative estimate is that a total of 12 percent (7.5 million) of the country's 63 million youths under age 18 have mental, behavioral or developmental disorders. Yet only one-fifth of these children and adolescents who need mental-health treatment receive it.
- The treatment success rate for schizophrenia is 60 percent; for major depression, 65 percent; and for bipolar disorder, 80 percent. Comparatively, the success rate for the treatment of heart disease ranges from 41 percent to 52 percent.
- The number-one reason for hospital admissions nationwide is a psychiatric condition. At any moment, almost 21 percent of all hospital beds in the United States are filled by people with a mental illness.
- The total price tag of mental illnesses in the United States is $81 billion, including direct costs (hospitalizations, medications) and indirect costs (lost wages, family caregiving, losses due to suicide).
- Despite media focus on the exceptions, individuals receiving treatment for schizophrenia are no more prone to violence than the general public.
- On any given day, approximately 150,000 people with severe mental illness are homeless, living on the streets or in public shelters.
- Roughly 80 percent to 90 percent of people with serious brain disorders are unemployed.
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