Portfolio of Hope

1. What is schizophrenia?

Schizophrenia can be defined as being a severe type of long-term psychosis. It involves the breakdown of the relationship between thought, emotion, and behaviour, causing the sufferer to experience a skewed perception, with fantasy and delusion replacing reality. This is what causes people to see, hear, and/or believe things that are not real.

2. How does media coverage cause fear and misunderstanding regarding schizophrenia?

Schizophrenia is a largely misunderstood illness, and the media certainly does nothing to help resolve the misinformation spread about such a complex issue.

In films, people with schizophrenia are often portrayed as being dangerous and violent, with their unpredictable and erratic behaviour being what is focused on. Only a select few symptoms of schizophrenia are shown- hearing voices, seeing things etc- with the other symptoms being ignored. This causes confusion regarding what schizophrenia is. Is it just hearing voices, or is it more?

The stigmatisation caused by such a negative portrayal of mental illness in the media causes many people who are struggling to feel embarrassed and filled with shame, therefore refraining from seeking help, something which is critical for one to embark on their ‘road to recovery.’

3. What are the possible causes of schizophrenia?

There is no one cause of schizophrenia, however there are certain things that can increase the risk of someone developing the illness. Genetics are thought to play some role, with schizophrenia evidently being shown to run in families.

Another physical/genetic role that is thought to cause schizophrenia, is brain development. Research has shown that the brain development of babies who were born either; underweight, in premature labour, or with a lack of oxygen, is compromised.

Further research into people with schizophrenia has highlighted that those with the condition have a slightly different brain structure to those without it, suggesting that schizophrenia is, at least partly, a disorder of the brain.

Neurotransmitters must also be mentioned here, as some studies indicate that an imbalance between the two chemicals that carry messages between brain cells (dopamine and serotonin) may form the basis of the illness, therefore suggesting that neurotransmitters are part of the cause of schizophrenia.

There are also psychological and environmental factors that increase the risk of someone developing schizophrenia. These factors are known as ‘triggers’, of which there are many.

The main psychological factor that can trigger schizophrenia, is stress. Stressful life events such as bereavement, loss of employment/housing, divorce, breakdown of a relationship, and abuse, can trigger the development of schizophrenia in someone already vulnerable to it.

Drug abuse is another environmental factor that can heighten the chances of someone developing schizophrenia. This is because taking some drugs, such as cannabis, cocaine, LSD, or amphetamines, are known to trigger symptoms of schizophrenia.

4. What feelings might an individual with schizophrenia experience?

The symptoms of schizophrenia are wide ranging, though the most well known are undoubtedly hallucinations and delusions, the things that cause people with the condition to see/hear things that are not there but lead them to believe that they are there with such conviction.

Hallucinations can be both pleasant or unpleasant, although usually they are the latter- critical and abusive. This can leave people with low self-esteem as there is a constant voice in their head telling them that they are ‘not good enough.’ As this voice is uncontrollable, it can result in people feeling as though their thoughts are ‘not their own’, but that they have in fact been ‘planted in their mind by someone else.’ These feelings are unsurprisingly scary for people subject to them, and they can leave people feeling as though their body has been ‘taken over’, with someone else dictating their every thought and action. Such thoughts can in turn result in one loosing interest in their appearance and hygiene, as their whole being essentially feels so ‘foreign’ to them.

Delusions often cause people to become extremely paranoid. They may believe that they are being watched or followed, or even poisoned, usually believing that the person harassing them is a family member or a friend. They might also believe that people in the media are communicating messages specifically to them, a different type of paranoia, though an equally as dangerous one. These feelings can be incredibly frightening, as no matter how much people try to convince them that their thoughts are not real, they seem so real to them, and therefore they cannot accept what they are being told is the truth. It can therefore lead to a lot of confusion, and a lack of trust developing if the individual feels as though they are being lied to.

Other symptoms of schizophrenia include becoming socially withdrawn and unresponsive, taking no interest in everyday social interactions, and feeling emotionless and flat. Such feelings can lead to one becoming very isolated and experiencing a deep sense of loneliness. Even in the rare cases when an individual with schizophrenia does choose to engage in social interactions, they will input little to conversations. This is because they will experience a lack of concentration, a result of the thoughts in their head feeling so ‘alien’ to them that there is no room left for their real thoughts to come through.

5. In what ways does schizophrenia affect the lives of those diagnosed?

Schizophrenia can lead to people not wanting to leave their house due to the paranoia they experience on a regular basis.

Combined with the fact that people with schizophrenia are likely to become socially withdrawn as they cannot concentrate and have a general lack of interest in life, they are at risk of becoming isolated, the worst thing possible for someone with such a severe mental illness.

Not wanting to leave the house and, in the instances when they do leave the house, avoiding all social interaction, means that the lives of those diagnosed will be extremely limited. They would likely lose their friendships/relationships, as well as their job and any other commitments they previously had. This is because people who don’t understand schizophrenia, or who don’t even realise their loved one has the condition, will interpret their behaviour as them simply ‘exhibiting an attitude of rudeness’ towards them.

6. How might an individual’s schizophrenia affect others?

Schizophrenia does not just affect the diagnosed, but the loved ones of the diagnosed too. They might feel as though they have ‘lost’ their loved one as their thoughts have been taken over by something else.

The impact that schizophrenia has on the lives of the individuals diagnosed with the illness, in particular the fact that they do not want to leave their house, will, of course, have a massive impact on families, since they will be unable to do things together. This can put immense strain on relationships, which can in turn affect the mental health of everyone involved.

If an individual with schizophrenia is experiencing paranoia, they might ‘point the finger’ at a close family member/friend, claiming that they are the source of their problems. In this case, the accused person is likely to feel extremely guilty, wanting to defend their innocence, of course, but being unable to get through to them that they are not trying to hurt them. This can be incredibly frustrating and upsetting for people to witness, particularly for the people directly involved. People must separate the person from the illness, although when you are being accused of something, it can be difficult not to become defensive, however this can just lead to further conflict, hence why it is important to refrain from ‘taking things personally.’

7. What are some examples of possible interventions and treatments for schizophrenia?

• Detention (voluntary or compulsory.)

Schizophrenia of a more severe nature may require one to be admitted to a psychiatric ward, either in a general hospital, or in a specialist clinic. If deemed necessary, people with schizophrenia can be admitted to hospital voluntarily, however if they refuse to go into hospital for treatment, they can be detained under the mental health act, meaning that they have no choice but to go to hospital, regardless of whether this is what they want or not. The criteria for someone being detained under the mental health act (sectioned) is if they are a risk to themselves, or to others.

• CRT (crisis resolution teams.)

CRT’s treat people with serious mental health conditions such as schizophrenia in a home environment, meaning that they do not have to be admitted to hospital. This is a much less restrictive type of intervention, therefore giving people more freedom.

• CPA (Care Programme Approach)

There are four stages to a CPA, those stages consisting of an assessment, the creation of a care plan, the appointment of a key worker who will be the patients first point of contact, and regular reviews. Within the CPA, the patient will receive psychological therapy, usually a combination of CBT, family therapy and, in some cases, arts therapy. Each therapy has a specific purpose, with CBT helping one to recognise their delusional thoughts and avoid acting on them, family therapy serving to explore ways of supporting someone with schizophrenia amongst discussing general information regarding the condition, and arts therapy encouraging people to express their experiences with schizophrenia in a creative, unspoken way.

• Antipsychotics.

Antipsychotics work by blocking the effect of dopamine on the brain. This helps to alleviate feelings of anxiety or aggression caused by the effect that this hormone has on the brain. Antipsychotics can be administered either orally as a pill, or as an injection. Whilst some people only take them on a short-term basis while the symptoms of an episode last, the majority of people take them for a longer period, usually 1-2 years after experiencing their first episode.

8. How can an individual with schizophrenia help to manage their own illness?

The first step that someone with schizophrenia should take when trying to manage their illness, is to write down a list of their ‘early warning signs’- behaviours that suggest that a schizophrenic episode may be imminent. Such warning signs include feeling anxious/stressed, difficulty sleeping, feeling suspicious/fearful, and hearing quiet voices.

Recognising warning signs is key to seeking help and support before the episode progresses and becomes worse, by which stage the individual suffering would be unable to reason with themselves. It is for this reason that someone with schizophrenia should also ensure that they have an advance statement written up. This is a series of written instructions detailing what someone would like their family or friends to do in the event that they experience a schizophrenic episode in which they do not have capacity to make decisions.

When someone with schizophrenia does feel themselves becoming unwell, they should ensure that they keep attending appointments, even if, and especially if, leaving their house is the last thing they feel like doing. In between appointments, it can be helpful to have a mood diary to record and track any changes in mood.

There are certain things that everyone should be doing, whether they have a mental illness or not, such as ensuring they are getting enough sleep, and eating a balanced diet. These things are even more important to ‘keep on top of’ if you are also battling a severe mental health condition such as schizophrenia, since maintaining a healthy routine helps with the management of symptoms by reducing stress levels and promoting calmness. Further ways to reduce stress include spending time in nature, engaging in exercise, and seeking out a peer support group.

Everyday should have a period set aside for the individual to do the things they really enjoy, whether that be drawing or listening to music, since this will aid them in maintaining their mental health.

Another important thing to try and incorporate into everyday is socialising with others. It is so important to maintain relationships during this time, as without support from loving family/friends, battling schizophrenia can be an incredibly lonely and isolating experience.

9. How can other people help the individual with schizophrenia to manage their illness?

The recommended first course of action for anyone wanting to help a close friend/family member with their schizophrenia is to communicate with them directly, asking them what they would find useful. By knowing what would help the individual the most, loved ones can be sure to offer them adequate support in their time of need, whether that be by picking up their grocery shopping for them and cleaning around the house, or taking them to appointments and reminding them to take their medication.

Anything that helps to reduce stress is a great way to help someone with schizophrenia, as we know that stress is a major trigger of schizophrenic episodes. To encourage them to forget any stressful thoughts they may have, a structured and supportive environment should be created, whereby they are reminded of everything they are good at, as well as prompted to engage in all the things they enjoy doing. Engaging in their hobbies should help them to maintain a state of positive mental health.

Additional ways in which people can practically help individuals with schizophrenia include encouraging them to look after themselves if they are neglecting their appearance, checking in with them regularly for a chat, supporting them in making decisions, and helping them to access appropriate support. They should also encourage their loved one to create a crisis plan if they have not already done so.

10. What are some local resources available to people experiencing schizophrenia?

• Doncaster Crisis Accommodation & Helpline

Doncaster Crisis Accommodation provides short-term accommodation for people experiencing a mental health crisis. During the stay in the shared ‘recovery house’, staff are on hand to provide emotional and practical support across a 24-hour period. The service also offers a free 24/7 helpline which provides support and information relating to several mental health issues. Aside from these services, weekly workshops are also delivered, whereby a range of activities are encouraged, such as arts and crafts and relaxation techniques. They also have a one-to-one support service providing advise to the loved ones of those diagnosed with a mental health condition.

• Doncaster Early Intervention in Psychosis Service

This service is for anyone who either has or is supporting someone that has mental health difficulties in which psychosis is displayed. This includes schizophrenia, a type of psychotic disorder. The service provides people with advice and guidance regarding how to manage their symptoms and offers a peer support service for people to share their experiences to try and help each other out.