Schizophrenia is a severe and persistent mental disorder that affects 1% of the population. The disorder is marked by the distortion of experiences, thoughts, and feelings, and often weakens the ability to function in such areas as education, work, interpersonal relations, and self-care. Schizophrenia poses significant challenges for both clients and families.
What are the symptoms of schizophrenia?
Schizophrenia is characterized by a wide range of "positive" and "negative" symptoms. Positive (psychotic) symptoms-those that occur in people with schizophrenia but not in others-include:
- hallucinations (false perceptions), such as hearing voices
- delusions (false beliefs), such as a conviction that one is being persecuted
- disorganized thinking or speech
- bizarre behavior
"Negative" symptoms-those that are absent in people with schizophrenia but present in others-may also occur, including:
- apathy and inability to follow through on tasks
- inability to experience pleasure and to enjoy relationships
- inability to feel and express emotions
- inability to focus on activities
- impoverished thought and speech
Schizophrenia frequently causes problems in social and cognitive functioning. For instance, people with the disorder may experience problems communicating with others and maintaining attention and concentration.
What causes schizophrenia?
Schizophrenia is associated with abnormalities in brain activity, chemistry, and structure. Approximately one third of people with schizophrenia have a family history of the disorder. Many other biological, psychological, and social factors may also play a role. In fact, there is much that we don't know about schizophrenia-and what we do know points to its enormous complexity.
There is considerable agreement among professionals that schizophrenia involves a vulnerability (or biological predisposition) to develop certain symptoms and that a range of factors can interact with this vulnerability to affect the course of the illness. Some factors, such as substance abuse, are associated with worsening of symptoms and increased likelihood of relapse. Other factors, such as the treatments mentioned below, can improve the symptoms of the illness and make relapse less likely.
In fact, over time and with effective treatment, approximately two thirds of individuals with schizophrenia experience significant recovery and go on to establish satisfying and productive lives in their community. In recent decades, we have greatly increased our understanding of schizophrenia and its treatment. As a result, practitioners can now offer genuine assistance to clients and their families.
What are the treatments for schizophrenia?
Many effective treatments are now available for schizophrenia. These treatments can result in reduced symptoms, decreased relapses and hospitalizations, improved quality of life, and increased ability to function in home, school, work, and leisure settings. Effective treatments for schizophrenia include:
- a new generation of antipsychotic medications that have fewer unpleasant side effects and that are more effective in treating the positive and negative symptoms of schizophrenia and in reducing the risk of relapse
- Assertive Community Treatment that offers services in the community, on a 24-hour basis, by a multidisciplinary treatment team
- supported employment that assists clients to obtain jobs at competitive wages in normal work settings
- training that assists clients to improve their social skills and manage their illness
- cognitive interventions that help clients cope with persistent symptoms and with limitations in attention, memory, and other cognitive functions
- integrated mental health and substance abuse treatment
- family interventions designed to reduce the client's risk of relapse and re-hospitalization, and to address the needs of families themselves
How does schizophrenia affect families?
Schizophrenia has a devastating impact on all members of the family. For example, family members usually need to cope with:
- their caregiving responsibilities
- their own emotional distress
- the symptoms of schizophrenia
- increased stress and disruption
- the mental health system
- social stigma
As caregivers, families share three essential needs: for information about schizophrenia and the mental health system, for skills to cope with the disorder and its consequence for their family, and for support for themselves. Of course, each family has unique concerns and needs, which are likely to change through time. Even within a given family, the needs of individual members differ for parents, spouses, siblings, and offspring of people with schizophrenia. Communities differ as well. Some communities offer excellent services for clients and families, while others offer relatively few.
What services are available for families?
Many services can assist families to cope with schizophrenia. These include:
- consultation with professionals who can assist them to deal a with a wide range of illness-related concerns
- short-term educational programs, which provide information about schizophrenia and its treatment, caregiving and management issues, and the mental health system and community resources
- long-term psychoeducational programs, which offer support, education, and skills training in stress management, communication, and problem solving
- individual, marriage, family, or group therapy to help family members resolve illness-related concerns and deal with other family issues
- family support and advocacy organizations, such as NAMI (the National Alliance for the Mentally Ill), which offers ongoing support groups and a 12-week Family-to-Family Education Program
A Marriage and Family Therapist can assist families to identify their most pressing needs and to make an informed choice about their use of services. In addition, therapists can offer consultation, education about mental illness, and skills training. All of these services can assist family members to gain insight into the meaning of schizophrenia for themselves and their families, to learn more effective methods of coping, to reduce their level of distress, to develop more positive feelings about themselves and their future, and to obtain support in creating a more fulfilling life.
How can families help?
Families can play important roles in their relative's treatment, rehabilitation, and recovery. For instance, people with schizophrenia may have difficulty maintaining attention and processing information, so families need to practice good communication skills. Likewise, because schizophrenia is associated with unusual vulnerability to stress, families can help their relative by maintaining a supportive environment and by resolving family problems in a constructive manner. The course of schizophrenia is typically marked by alternating periods of remission and relapse, so families also need to learn and respond to the signs of impending relapse. In fact, professionals now believe that a majority of relapses can be prevented.
Here are some other suggestions:
Learn about schizophrenia and community resources.
- Assist your relative to obtain effective treatment.
- Develop skills for coping with schizophrenia.
- Understand the meaning of the illness for your family.
- Obtain services that can meet your family's needs.
- Strengthen your own support network.
- Focus on the strengths of your relative and your family.
- Develop realistic expectations.
- Create a balance that meets the needs of all family members.
- Maintain a hopeful attitude.