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.
There is no test that can make a schizophrenia diagnosis. People with schizophrenia usually come to the attention of a mental health professional after others see them acting strangely.
Doctors make a diagnosis through interviews with the patient as well as with friends and family members.
Psychiatrists have the most experience with diagnosing schizophrenia. A psychiatrist or other licensed mental health professional should be involved in making a schizophrenia diagnosis whenever possible.
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.