Schizophrenia: myths and misconceptions of fiction writers

May 24 is world schizophrenia day. There are some popular misconceptions about schizophrenia that keep recurring in media and films about schizophrenia. Interestingly, in most of our films, the disorder mostly have symptoms that would help the writer to manipulate the story.

I can imagine the argument against this- ‘writing is about finding dramatic possibilities. One should not get too serious about the factual aspect of it. This is not a documentary.’ But it is a lousy argument. If a writer is writing a court drama and to heighten a plot point, if he makes up some laws which are not in Indian penal code, will we accept it?

Basically inaccurate depiction of mental illness is the product of laziness of the writer. First, the reluctance to google the particular illness and spent some time reading about it. Second, the laziness to really work around the irrevocable facts about the illness while trying to create drama. Instead they go for the easy path of molding the illness according to the needs of the story.

Now this can be really damaging from a bigger perspective. Because stigma and lack of awareness have been big problems worldwide in creating barriers in mental health care. And films and media are important determinants of public perceptions about mental illness.

Below are some common misconceptions that keep recurring-

1) ‘Schizophrenia is a behaviour or a state of mind.’

Often you read about a person who is very ‘schizophrenic’ or ‘psychotic.’  What this means is different for different writers. Some times they are referring to weird or aloof behaviour. But using name of a medical illness to denote a behaviour is in itself weird. If some one talks very sweetly, would you call him ‘diabetic?’

Schizophrenia is a medical illness with specific genetic, neurobiological, neurophysiological manifestations. Psychosis is a cluster of symptoms like auditory hallucinations, delusions, catatonia that is part of schizophrenia. So if just behaving weird makes you psychotic or schizophrenic, then all the corporate heads gunning for the next acquisition can be called ‘cancerous.’

2) ‘Schizophrenia is split personality.’

Schizophrenia is often mistaken for multiple personality disorder which has been the bread and butter for many writers. Interestingly, American psychiatric association is still not convinced whether multiple personality disorder really is a valid mental disorder. The cases have been very rare and there have been many inconsistencies in the accounts and behaviours of patients with multiple personality disorder. A patient with schizophrenia may exhibit many false bizarre beliefs but his personality or content of memory don’t suddenly change to something entirely different.

3) ‘Schizophrenia is all about delusions and hallucinations and other weird behaviours.’

Schizophrenia is a chronic neurobiological illness with cognitive impairment, social withdrawal, loss of motivation etc. Weird false beliefs especially of a persecutory nature (ex: ‘people are trying to control my mind and body’) and persistent auditory hallucinations can occur but they are not inevitable in every case or in all phases of the illness. Someone can be diagnosed as schizophrenia even when delusions or hallucinations are not present if other criteria are met. The social burden related to the illness is mostly due to the cognitive impairment or the withdrawal and not due to the delusions or the hallucinations. It is no wonder that schizophrenia was called ‘dementia precox’ (young age dementia) in early times.

4) ‘Schizophrenia means that psycho hiding in your closet with a hatchet.’

Schizophrenia is often perceived in relation to violence but the reality is, aggression is rare in these patients. Sometimes these patients may become agitated due to false persecutory beliefs or incessant hallucinations. But mostly, schizophrenia patients are anxious, fearful, withdrawn and even apathetic.

5) ‘Schizophrenia is incurable and means total insanity.’

Around 1/3rd of patients get completely remitted while another 1/3rd maintain well on medications. The last 1/3rd can be resistant to all kinds of treatment options. Even in people who don’t get remitted completely, there is a trend of improvement with age. On medications, many people lead almost a normal life with productive work and a fulfilling family life. The outcome is poorer in people where treatment has been delayed by years.

6) ‘Schizophrenia (and mental illness in general) is about unhappy childhoods.’

For us every mental illness is about some acute trauma faced by the protagonist (and the illness disappear in an equally dramatic manner). It is rather strange that even though scientific research has expanded, our popular media is still stuck on the early twentieth century psychological/social theories about mental illness.

But current understanding of most mental diseases is more in a bio-psycho-social model. Most schizophrenia patients have typical genetic and brain imaging findings which are present even before the symptoms develop. Social factors are important through their interaction with genetic/other biological factors but not on their own.

Think about this way- schizophrenia is caused by increased dopamine in some parts of the brain. Usually there is a dramatic improvement in symptoms within 2-3 weeks with medications. Isn’t it a miracle that some molecules can change the aberrant patterns of your thought without changing anything else about your environment?

Photo by shawn_corbett

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