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Definitions and symptoms, and an overview
of causes and relations with religion
What is schizophrenia?
How might it be affected by religious
and cultural factors such as the value placed on visions in some
religions?
Ann is 26, a trained commercial artist, and married to Henry with whom she
had been going out since she was 18. Both found their marriage boring. Ann
began going out dancing and met another man. As a Catholic, Ann could
not consider divorce. But one evening she announced that she was going to
marry the other man, go with him to South America and have twenty babies.
She spoke very rapidly and much of what she said was unintelligible. She also
said that she was seeing visions of the Virgin Mary, and in the office tried to
get her colleagues all to kneel and say the rosary. When she was taken to see
a priest, she spat at him. A psychiatrist recommended hospitalisation. (based
on a case description in Comer, 1999)
Schizophrenia is a generic name for a group of conditions which
come under the general heading of psychosis or madness. There is a
serious deterioration of functioning, strange beliefs or experiences,
inappropriate emotional states, and sometimes motor disturbances.
Emil Kraepelin (1896) distinguished two forms of insanity:
dementia praecox and manic-depressive psychosis. He thought that
sufferers from dementia praecox would gradually deteriorate, while
people with manic depression would have periods of remission
between psychotic episodes. He was convinced that psychoses were
illnesses, and this view remains controversial, even today, when some
feel that the illness label is inappropriate: Bentall & Beck (2004) have
cogently argued this view in the light of much recent evidence. In
1913 Bleuler coined the term schizophrenia, to replace Kraepelin’s
dementia praecox. The term schizophrenia has caused some confusion
because lay people may believe that it implies a split personality
(as in R. L. Stevenson’s Dr Jekyll and Mr Hyde), whereas in fact
Bleuler meant that different psychological functions were split from
each other. Although the term schizophrenia is confusing, it has
persisted.
For a diagnosis of schizophrenia, a person must have been having
psychotic symptoms for at least aweek, and showa marked deterioration
of functioning in self-care, work or social relations. There would
be no major changes in mood – no marked depression or elation.
There should have been some disturbances for at least six months
and there should be no evidence of an organic cause (drugs or a medical
condition). What are the characteristic psychotic symptoms? For
diagnosis of schizophrenia, these must include:
At least two of:
Delusions
Prominent hallucinations
Incoherence, or marked loosening of association (in speech)
Catatonic behaviour (rigid, frozen posture)
Flat or very inappropriate affect (mood).
OR Bizarre delusions (for example, that one’s thoughts are being
broadcast).
OR Prominent hallucinations of a voice.
(from Lazarus & Coleman, 1995, based on DSM-IIIR)
The DSM-IV classification lists a large number of related disorders
in the schizophrenia group:
Schizophrenia
paranoid type
disorganised type
catatonic type
undifferentiated type
residual type
Schizophreniform disorder
Schizoaffective disorder
Delusional disorder
Brief psychotic disorder
Shared psychotic disorder
Psychotic disorder due to a medical condition
Psychotic disorder due to substance abuse
Other psychotic disorder.
This range of diagnoses could be important for some purposes,
but for our purposes we might just bear in mind one distinction,
suggested by Fenton & McGlashan (1994) and by Crow (1995),
between type I and type II schizophrenia (though of course in reality
not every person will be clearly of one type or another).
Type I schizophrenics typically present mainly the ‘positive symptoms’
– disordered thought and speech, delusions and hallucinations.
They are said to have a relatively good adjustment prior to breakdown,
often respond fairly well to traditional medication, and have
a fairly good long-term outcome. Type II schizophrenia presents
with few or no positive symptoms, showing predominantly ‘negative
symptoms’: withdrawal, lack of self-care, flat emotional state, and
speaking very little. Pre-morbid adjustment is relatively poor, and
so, sadly, is response to medication. The long-term outcome may
be less good for type II than for type I schizophrenia. It is suggested
that the biological bases of the types of schizophrenia differ – type I
schizophrenics generally show abnormal neurotransmitter activity,
whereas type II schizophrenics are shown by fMRI and other methods
of examining brain structures to have brain structures which
differ from normal. Whereas Ann, described above, might be considered
a type I schizophrenic, Richard, described below, might be
type II.
After leaving the army, Richard held a job for two years, but he felt very low
in self-confidence and suffered attacks of anxiety. Eventually, he gave up work
and refused to look for another job, becoming slower and slower in dressing
and taking care of himself. He stayed at home and when he went out was
uncertain what to do and where to go – he saw signs guiding his behaviour,
for example, red lights and arrows were seen as signs from heaven about which
direction to go in. But he became so tortured by uncertainties, and so afraid
of doing the wrong thing, that ultimately he stayed at home, in bed, unable
to move, eat, speak or take care of himself. (based on a case description in
Comer, 1999)
What causes schizophrenia? Few would dispute the by-now strong
evidence that genetically, biochemically and in terms of brain structure
there are biological predispositions to develop schizophrenic
illness, particularly under stress. Nevertheless, there are psychological
features in schizophrenia, and some (but not all) psychological
therapies can have an important role to play in alleviating symptoms
and improving quality of life (Hingley, 1997; Garety & Freeman,
1999; Hornstein, 2000; Barnes & Berke, 2002; Pilling, Bebbington,
Kuipers et al., 2002a, 2002b). Social factors may play an important
role in precipitating schizophrenia – for example, some forms of
stress (Brown&Harris, 1989; Leff, 2001; Myin-Germeys, Krabbendam,
Delespaul & Van Os, 2003). More notably, the custodial environment
of older traditional-type psychiatric hospitals is thought
to have contributed significantly to the deterioration of inmates,
causing ‘iatrogenic’ illness (literally, illness caused by treating for
illness). So careful attention to social environment will be important
in improving the quality of life and preventing deterioration among
people suffering from schizophrenic disorders, and many sufferers
can be enabled to lead a normal life.
You probably noticed that in both the brief case histories just
given, religious beliefs and behaviour figured. However, there is no
very strong evidence that religious beliefs and behaviours actually
cause – or even exacerbate – the illness. We will be looking at the
relations between religion and schizophrenia in some detail in this
chapter, but at this point it is worth noting that although there are
often religious symptoms in schizophrenia, religion as such is not
clearly related to schizophrenia in correlational studies.
For example, a measure of psychoticism developed by the
Eysencks (Eysenck & Eysenck, 1985) has been shown to correlate
negatively with measures of religiosity (e.g. Francis, 1992; Lewis
& Joseph, 1994; Eysenck 1998, Lewis, 1999). A more elaborate
measure is of schizotypy (the Multidimensional Schizotypal Traits
Questionnaire, Rawlings & MacFarlane, 1994), which assesses
personality traits which might indicate prodromal schizophrenia,
including discomfort in close relationships, and odd forms of thinking
and perceiving. Schizotypy is reported to have more complex
relations with a measure of religion, the Francis Scale of Attitudes to
Christianity (Francis & Stubbs, 1987). In a study of several hundred
British adolescents, Joseph & Diduca (2001) reported that when the
subscales of the schizotypy questionnaire were examined, perceptual
aberrations related positively to religiosity, but magical ideation
and impulsive nonconformity related negatively to religiosity.
Thalbourne & Delin (1999) noted a common thread underlying creativity,
mystical experience and psychopathology including schizotypy.
They called this common factor transliminality, and they
defined it as ‘a largely involuntary susceptibility to . . . psychological
phenomena of an ideational and affective kind’. Transliminality
related to measures of religiosity, dream recall and mystical experience.
This rather mixed bag of evidence from correlational studies
confirms that there is no simple relationship between schizophrenia
and possible predisposing traits, and religion. This research
also highlights the difficulties – which we will be discussing later in
this chapter – of distinguishing pathological from non-pathological
visions and other experiences, often religious in meaning. It also
draws attention to another theme, to which more attention is given
elsewhere – the often reported beneficial effect of religion on mental
health.
