Understanding schizophrenia: The reality behind the disorder and its media portrayal

If you have managed to get through the first few gruesome and disturbing episodes of the new Ryan Murphy series “Monster: The Ed Gein Story,” you will gain insight into the schizophrenic disorder that plagued the notorious serial killer.

True crime fans know Ed Gein as the "Plainfield Ghoul” whose horrific acts in the 1950s inspired famous fictional characters like Norman Bates in “Psycho” and Leatherface in “The Texas Chain Saw Massacre.”

Unfortunately, the portrayal of mental illness in the media, especially in true crime and horror, often causes harm.

Think about movies like “Split” where the main character has a "split personality”, a condition actually called Dissociative Identity Disorder (DID), and is shown as a violent, evil person.

When characters like this are constantly shown as villains, it creates fear and makes the public believe that these brain disorders are always linked to evil and danger.

This storytelling just spreads fear and misunderstanding.

Schizophrenia is a complex, chronic, and severe mental disorder that affects how a person thinks, feels, and behaves.

It is a brain disorder, not a flaw in character or a lack of moral strength.

And no, it is not the same as having a "split personality", which is commonly mixed up.

Schizophrenia affects a person's ability to understand reality, which causes a major problem in their daily life.

What does schizophrenia look like?

The symptoms of schizophrenia fall into three main groups: positive, negative, and cognitive.

Positive symptoms

These are behaviours that are not usually seen in healthy people. They are often the most noticeable and can be very upsetting.

• Hallucinations: Hearing, seeing, feeling, smelling, or tasting things that are not there. The most common are auditory hallucinations, like hearing voices. Imagine hearing a constant, loud chatter or even mean commands that no one else can hear.
• Delusions: Strong, false beliefs that are not based on facts and that a person holds on to even when proven wrong. Examples include believing others are plotting to harm them or that a TV show is sending them secret messages.
• Disorganised thinking: Difficulty arranging thoughts or connecting them logically. This can manifest as speaking in a way that is difficult for others to follow or jumping from one topic to another without a clear reason.

Negative symptoms

These refer to the reduction or absence of normal mental functions and behaviours. They are often mistaken for laziness or depression.

• Avolition: A lack of motivation or drive to start and keep up with activities.
• Alogia: A reduction in speech output or content.
• Anhedonia: The inability to feel pleasure from once enjoyable things.
• Social withdrawal: Choosing to spend little to no time with other people.

Cognitive symptoms

These involve problems with attention, concentration, and memory.

• Difficulty focusing or paying attention.
• Trouble understanding new information and making decisions.
• Poor working memory which is the ability to use information immediately after learning it.

Keep in mind that not everyone with schizophrenia has all these symptoms, and the symptoms' intensity can differ greatly from person to person.

What happens without treatment?

Getting treatment for schizophrenia is not just about feeling better right now; it is vital for a person's long-term health and safety.

When a person with schizophrenia does not receive treatment, their symptoms often get much worse and become more severe and frequent.

The untreated symptoms can lead to very serious and complicated problems that affect almost every area of their life.

• Worsening symptoms: Hallucinations and delusions can become overwhelming and constant. The disorganisation of thoughts makes it nearly impossible to hold a job, maintain friendships, or even manage daily tasks like self-care.
• Safety risks: Untreated schizophrenia is linked to a higher risk of suicide, which is sadly a major cause of premature death for people with the disorder. They may also engage in risky behaviours because of their delusions, like walking into traffic if they believe they are invulnerable.
• Life breakdown: Without treatment, the illness can quickly lead to social isolation, financial problems, and often homelessness. Their ability to think and process information also gets worse over time. The longer the psychosis goes untreated, the harder it can be to recover fully.

A look at South Africa

Globally, schizophrenia affects about 24 million people, or 1 in 300 adults. South Africa has a similar number of cases.

According to a study published in the South African Medical Journal in 2018, it's estimated that the number of people in South Africa who will have schizophrenia at some point in their lives is between 0.7 per cent and 1.1 per cent of the population.

This means that a significant number of South Africans live with this condition every day.

The study pointed out that getting exact numbers can be tricky in diverse populations.

It also noted that schizophrenia is a major health issue that is made harder by things like poverty and difficulty accessing mental healthcare.

Treatment and management of the illness

While there is no cure for schizophrenia, it is a condition that can be managed effectively with the right treatment plan.

The main goals of treatment are to lessen symptoms, prevent the illness from getting worse, and improve a person's overall quality of life and ability to function.

• Medication (Antipsychotics): These medicines are the most important part of treatment. They work by affecting brain chemicals, especially dopamine, to help reduce hallucinations and delusions. However, finding the best drug and dose can take time and patience.
• Psychotherapy: Different kinds of talk therapy are very helpful.
• Cognitive Behavioural Therapy (CBT): This helps people identify and challenge their confused or false thoughts and beliefs.
• Life skills and support: This training can help people learn social skills, manage their money, and find or keep a job. These steps encourage greater independence.

Living with schizophrenia is difficult, but with an early diagnosis and ongoing treatment, many individuals can live meaningful and productive lives.

Society needs to look past the scary, over-dramatised stories and see schizophrenia for what it is: a serious medical condition that needs understanding, empathy, and proper care.

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