John has schizophrenia. Unlike the Nobel Peace Prize winner who glamorized this psychotic condition in the movie, A Beautiful Mind, nothing is extraordinary about John or his schizophrenia. He has the second most common name in the U.S. and has the most common classification of psychosis. According National Institute of Mental Health (2009) the prevalence rate for schizophrenia is 1% of the population-or 1 in 100 people–making schizophrenia one of the most common types of mental disorders. In fact there is nothing extraordinary about John except that he’s my brother; my only fully biological brother.
Understanding the “nature” of schizophrenia and its causal factors is important to me. My hope is that review of scholarly research will help me better understand how and why this devastating disease has manifested in his life and to discover the factors necessary to ensure a future free from re-incarceration and relapse.
According to the Diagnostic and Statistical Manual of Mental Disorders-TR-IV, the signs of schizophrenia include delusions, hallucinations, disorganized speech, grossly disorganized behavior and negative symptoms such as apathy. Other signs include dysfunction in work, relationships and self-care. The DSM notes that these signs should be manifest for at least six months (American Psychiatric Association, 1994, p. 285-286).
Observations of my brother’s actions, activities and speech have led me to conclude that John has paranoid schizophrenia of the nondeficit subtype. Nondeficit means that he is mostly free of the negative symptoms associated with schizophrenia (American Medical Network, 2009).
John began showing the signs of dysfunction at work, in his relationships, and in his self-care during his late twenties. By the time he was 35 it became obvious that he was not mentally sound. He spoke very openly about communicating to Martians through his radio which he had adapted for that special purpose. His special adaptation consisted of aluminum foil pressed around the end of the radio’s antenna. He also reported speaking with angels and demons which were disguised as trees and expressed how he was part of the great battle between good and evil. He often expressed his new found “knowledge and interpretation” of Biblical scriptures to validate his new reality. By this time John had lost his job and his dear wife filed for a divorce.
Shortly thereafter he attempted to burn a candle in the oven right before bedtime because voices told him to do it. The kitchen caught on fire but John was rescued by my grandfather who lived next door and just happened to be walking outside and saw the flames.
Research reveals there is no single cause that can be attributed to schizophrenia. Instead the combination of biological and environmental factors is the most likely culprits of this developmental disorder (Encyclopedia Britannica, 2009). The theory is that schizophrenics have preponderance activated by environmental factors. Early biological research revealed an excess of dopamine receptors in the brain in people affected by schizophrenia. More recently holes in unstable regions of the DNA have been discovered in people with schizophrenia, autism and mental retardation (Singer, 2009).
Further there seems to be little evidence of this genetic vulnerability prior to the onset of symptoms. Research has also shown that in 90% of the time neither parent of a child who later develops schizophrenia showed any psychosis or schizophrenic tendencies (Butcher, Mineka, & Hooley, 2008). At the time that my brother began his decline, neither parent had exhibited signs of mental illness. However, in a recent conversation with my father, who is an alcoholic, I began to notice a bit of odd behavior. He handed me a postcard to see if I noticed the angel in the background. My stepmother quickly reprimanded him and he changed the topic. At the time of this conversation he was not drunk even though he was drinking. That comment is hauntingly reminiscent of my brother’s comments about seeing demons and angels.
Regarding environmental factors, Iyer et al. (2008) shows depression and anxiety to be the most prevalent proximal stressors. However in my brother’s situation, substance abuse may actually be the culprit. By the time John was in his late twenties he was drinking heavily and began using methamphetamines. What is unclear to me is if the alcohol and drug use was a proximal causal factor or if they were the result of the early onset of schizophrenia. I’ve not yet found research that clearly distinguishes between the two. Research by McMillan et al. (2009) reveals that 54.8% of people with schizophrenia have an alcohol dependency with 50% having a substance-related comorbidity. However I’ve not yet found research that proves the substance abuse “set off” the schizophrenia.
Lack of clarity of diagnosis was certainly a key factor in John’s degeneration. Since John had been known to use methamphetamines during his late 20s and had even attempted several times to produce his own from common household substances, everyone assumed his actions were drug induced. It was not until he was arrested at 35 and found incompetent to stand trial that he began to receive the psychiatric care that was needed.
A year after receiving treatment in a psychiatric facility, John was released and sent back to live with our grandparents who had raised him from infancy. Since then he has relapsed on several occasions, which in turn, led to additional incarcerations and subsequent psychiatric help only to once again be released back into society. This dysfunctional cycle is primarily due to my grandmother’s insistence that John be allowed to drink alcohol. Several violent episodes have ensued; one in which he attempted to kill my grandfather. In another episode John threw knives across the living room at an imaginary enemy. Regardless of his behavior, my grandparents have refused to press charges or keep alcohol out of the house.
Despite John’s prior troubles, his long-term outlook with schizophrenia appears bright. Treatment options for my brother exist in the form of atypical antipsychotics which minimize hallucinations and delusions, but it is clear that the issue of substance abuse has to be eliminated in order for John to remain in a non-institutional environment. Research confirms the danger schizophrenia poses to those who abuse alcohol. Elbogen et al. shows a negative correlation between violence and schizophrenia except in the cases of substance abuse (2004). Medication adherence is another key factor for his success. He has a tendency to abuse his antipsychotic medication. John’s false sense of reality coupled with the alcohol and substance abuse poses a threat to his family and to himself unless his environment can be controlled.
Currently John is once again incarcerated and waiting for transport to another treatment facility. The hope is to rehabilitate him so that he can integrate back into society.