Psychology for Dummies (58 page)
Read Psychology for Dummies Online
Authors: Adam Cash
Tags: #Psychology, #General, #Body; Mind & Spirit, #Spirituality
One of the most well-known examples of mental disorder is when someone seems to have lost touch with reality. What’s strange about Mr. Smith in the vignette at the beginning of this chapter is that it seems like the neighbor’s plot is all in his imagination. When someone loses touch with objective reality, imagining things and acting on those imagined things we say that he is suffering from a class of disorders known as the
psychotic disorders.
The psychotic disorders, are considered possibly the most severe of all mental disorders. In addition to losing touch with reality, people who are suffering from a psychosis have severe functional deficits related to basic self-care (eating, shelter, and personal hygiene), social and occupational functioning, and thinking.
The most common form of psychosis is
schizophrenia.
Psychiatrist Eugene Bleuler used the term schizophrenia to describe people who exhibited signs of disorganized thought processes, a lack of coherence between thought and emotion, and a state of disconnection from reality. Today, the
DSM-IV
criteria for schizophrenia include:
Delusions:
A delusion is a firmly held belief that is maintained in spite of evidence to the contrary. One common type of delusion is a
paranoid
or
persecutory delusion,
which involves intense fear that one is being followed, listened to, or otherwise threatened by someone or something.
In the chapter-opening vignette, Mr. Smith appears to be experiencing a paranoid delusion. He “knew” that the neighbor was out to get his house! Another common form of delusion is the
grandiose delusion,
in which a person experiences an extremely exaggerated sense of worth, power, knowledge, identity, or relationship. Someone who is grandiose may believe he can speak to supernatural beings or that he is a supernatural being himself. Or, he might just think that he’s the president of the United States.
Hallucinations:
The
DSM-IV
defines a hallucination as a “perception that has the compelling sense of reality of a true perception but that occurs without external stimulation of the relevant sensory organ.” Hallucinations can be auditory (hearing voices or sounds), visual (seeing demons or dead people), olfactory (smells), gustatory (tastes), or somatic (experiencing physical sensations within the body). Most hallucinations are auditory and often involve someone hearing a voice or voices commenting on his or her behavior.
If Mr. Smith experienced hallucinations, he may have heard voices say, “He’s gonna get you!”
Command hallucinations
are a potentially dangerous form of auditory hallucination because they involve a voice or voices telling the sufferer to do something, often involving violent or suicidal behavior. “Kill yourself!”
Disorganized speech and thought:
Have you ever had a conversation with someone, and you had no idea what she was talking about? Was it gibberish? Disorganized speech and thought are characterized by verbalizations that are extremely tangential(mostly irrelevant), circumstantial (beating around the bush) or loosely associated (jumping from one unrelated thought to another). These abnormal styles of communicating may be evidence of a
thought disorder.
An extreme form of thought disorder is called
word salad
— when a person’s speech is so incoherent that it sounds like another language or nonsense.
If Mr. Smith exhibited thought disorder, he might have sounded something like this: “I think the garbage came by and slipped, but he knows law enforcement, badges, peeking through.” Sometimes people even make up words that don’t exist called —
neologisms.
“I think the glerbage came by and sluppered the inequitised frames from me.”
Grossly disorganized or catatonic behavior:
When a person behaves in a disorganized manner, she may act extremely silly or childlike, easily get lost or confused, stop caring for herself and her basic needs, do strange or bizarre things like talk to herself, or be extremely socially inappropriate. Catatonic behavior involves complete immobility, absolute lack of awareness of one’s surroundings, and sometimes being mute.
Negative symptoms:
A negative symptom refers to the absence of some usual or expected behavior.
The absence of the behavior is what is abnormal. Three negative symptoms are seen most often with schizophrenia:
•
Flat affect:
When a person exhibits no emotionality whatsoever
•
Alogia:
Describes a condition in which a person’s thought processes are dull, blocked, or generally impoverished
•
Avolition:
When a person has no ability to persist in an activity; looks like an extreme lack of motivation
When a person experiences these symptoms, he may be suffering from schizophrenia. Why do I say “may?” Someone might exhibit these signs for a lot of reasons: drugs, sleep deprivation, or some physical disease. Making the diagnosis of schizophrenia is both a complex and very serious task. Specific time frames and
rule-outs
are involved. Rule-outs involve eliminating other possible or plausible explanations.
Schizophrenia strikes about one in every 10,000 people. Generally it is diagnosed in individuals between the ages of 18 to 35. Sometimes, but rarely, it is diagnosed in childhood. It typically begins in the late teens and early twenties and is fully present by the mid- to late twenties. It can develop rapidly or gradually, and there can be periods of less severe symptoms. Other sufferers may be chronically and persistently ill. Periods of illness can be characterized by a marked inability and diminished capacity to function in everyday life, often leading to school failure, job loss, and relationship difficulties.
Don’t be fooled by how easy it is to list the symptoms and describe them, they are very serious. Individuals with schizophrenia often face enormous challenges in society and sometimes end up in jail, in hospitals or similar institutions, or living on the streets because of their illness.
This used to be a debate that focused on the old issue of nature versus nurture. Are the causes of schizophrenia organic (biochemical/physiological) or functional (resulting from experience)? At the moment, perhaps because of the elevated status of science, the organic explanations are far more widely held, but the best answer may lie in a synthesis of the two points of view. This is still very difficult to tackle because numerous theories for the cause of schizophrenia exist, each with varying degrees of scientific support. The predominant theory in practice today is really a synthesis of two different areas of research; it’s called the
diathesis-stress model.
First, some definitions. A
diathesis
is a predisposition to a particular disease.
Stress
can be defined as any number of psychological and social factors. So, the diathesis-stress model holds that schizophrenia is the consequence of a stress-activated diathesis or predisposition.
One proposed biological diathesis for schizophrenia is an underlying problem with brain chemistry. Other researchers have found malformed parts of the brain. These biological abnormalities can lead to problems with thinking, speech, behavior, and staying in contact with reality. For the stress component, psychological factors address the matter of the reality distortion associated with schizophrenia. Why do schizophrenics make a break from reality? Generally, there is a belief that the world is experienced as so harsh, and its conflicts so intense, that a vacation from it is necessary. Research has shown that psychic trauma, such as child abuse, can be related to psychotic breakdowns. This type of trauma certainly constitutes a harsh world in need of escaping. The research, however, does not state that child abuse causes schizophrenia in all or even a majority of cases, but it has been seen as a potentially overwhelming stressor. Trauma is a form of extreme stress, regardless of the source. This stress might interact with the diathesis, the predisposition, and lead to psychotic symptoms.
A social factor related to schizophrenia that has shown promise in recent research is a phenomenon known as
expressed emotion.
Expressed emotion (EE) refers to negative communication by family members directed at the person suffering from schizophrenia. EE often consists of excessive criticism. Family members might comment on the patient’s behavior, “You’re crazy!” for example. EE also includes emotional over-involvement of family members that can overwhelm the patient. Let me be perfectly clear though: I am not saying that criticism and over-involvement cause schizophrenia, but only that they may contribute to the stress component of the diathesis-stress model, as many other stressors may.
You may think that you’ve developed schizophrenia after reading about its causes. Don’t get too caught up in the detail. The bottom line is that a lot of the research out there is inconclusive. What we do know is that there are some underlying brain abnormalities in schizophrenics that may interact with certain kinds of stress in a way that produces the disorder. The devastating effects of this disorder keep researchers working hard to get to the bottom of things. We’ve come along way, but there’s still a long way to go.