Schizophrenia (literally "split mind") is often thought of as a split or dual personality. However, this disease is best defined as a disorganization of normal thought and feeling. It is probably caused by the malfunctioning of the cells through which information flows within the brain. Symptoms usually appear in late adolescence or early adulthood, and extreme mental stress almost always triggers them. The illness is lifelong, but acute attacks tend to come and go, and usually occur at times of emotional upheaval or personal loss.

What are The Symptoms?

Some popular novels, plays and movies have encouraged us to think of schizophrenia in extremely narrow and dramatic terms. Schizophrenia has been presented quite often in terms of the split personality, two seemingly individual and separate people living with­in the same body.

For most people with schizophrenia, an attack begins with a gradual, or occasionally sudden, withdrawal from day-to-day activities. The person's speech may become increasingly vague, and he or she may seem to be unable to follow a simple conversation. An acute attack happens unexpectedly. Often the onset is so gradual that it is difficult to know when psychotic symptoms appear. Among such symptoms are apparently disconnected remarks, along with blank looks, that are followed by sudden statements that seem to spring into the speaker's mind.

Schizophrenics often believe that others hear and "steal" their thoughts. Sometimes they fear they have lost control of bodily movement as well as thought, as if they were puppets. They frequently believe they hear voices, often hostile ones. Less commonly, they have hallucinations of odd physical sensations, of being given poison, or otherwise being attacked by others. In time many schizophrenics build up a set of beliefs in a fantasy world. They may express exaggerated feelings of happiness, bewilderment, or despair. They may laugh at a sad moment or cry without cause. Or they may seem devoid of feeling, so that it becomes almost impossible to make emotional contact with them.

There are several types of schizophrenia that are characterized by the predominant symptoms, but the only practical distinction that most doctors now make is between the paranoid and other types. The main symptom of a person with paranoid schizophrenia is constant suspicion and resentment, accompanied by fear that people are hostile or even plotting to destroy him or her.

What are The Risks?

Most young and middle-aged patients in mental hospitals are there because they are schizophrenic. About 1 person in 1000 has been treated for the disorder. Men and women are equally susceptible. Paranoid schizophrenia is most common in early adult­hood (late 20's through 30's).

The abnormality of brain chemistry that underlies schizophrenia can be inherited, but if it runs in your family, you will not necessarily have schizophrenic attacks. You may, however, have either a "schizoid personality" (a tendency towards extreme shyness and withdrawal) or a "paranoid personality" (a tendency towards over-sensitivity and distrustfulness) .

People who have attacks of schizophrenia in its most severe forms may physically harm themselves or others, or may try to commit suicide .

What Should be Done?

If you suspect that someone in your family is schizophrenic, try to get them to see a physician. It may not be easy. People who are becoming mentally ill often refuse to admit it. Even those who realize that something is wrong have a fear of being "put away." But medical care is vital. Do not leave a person who seems extremely disturbed alone. The presence of a relative or friend to reassure them, or even keep them from hurting them­selves until help arrives, may be essential. People with symptoms similar to those of schizophrenia are usually admitted to a hospital for a preliminary period of observation. During this time tests are carried out to make sure these symptoms are not due to a physical illness such as a brain tumor.

What is Treatment?

Severe cases must be treated in a hospital. Treatment usually involves the use of drugs, psychotherapy and rehabilitation.

The most effective drugs are regular doses of special tranquilizers designed to modify abnormal brain chemistry. As symptoms gradually disappear, doses are reduced, and all medication may be discontinued when the acute attack ends. Some people, however, need long-term medication. They may either take pills regularly or be given an injection every two to four weeks. Occasionally antidepressant drugs are also prescribed . In rare cases electroshock therapy (EST) may be recommended.

Techniques of psychotherapy vary, but the goal is the same: to help the patient understand the stresses that contributed to the current attack. This can help the person learn how to prevent future stresses from leading to further illness.

The final stage of treatment is rehabilitation, which helps people who are recovering from attacks to regain normal skills and behavior patterns. In the early stages of hospital treatment schizophrenics are generally given occupational therapy. As their condition improves, they are given increasingly complex tasks and pressures, and these eventually approximate the tasks and pressures of the world outside. Once the acute phase of the illness is over, the schizophrenic prepares for a return to the outside world by making periodic visits from hospital to home or to a half-way house.

What are The Long-Term Prospects?

Many people recover from an attack of schizophrenia well enough to return to a relatively normal life. But they may have further attacks. In some people the condition be­comes chronic. Such a person will always be withdrawn and emotionally unresponsive, but they generally avoid severe attacks of the disorder with the aid of constant medication.