By Timothy Tunner, PhD, MSW

Schizophrenia is one of the most debilitating of all mental illnesses. It affects approximately 1 percent of the population from all realms of society throughout the world. The onset for most people is in their late teens to early 20s, though it can start earlier or later as well. The average age of onset is 18 in men and 25 in women, though the disease affects men and women equally.

What Causes Schizophrenia?

Scientists today widely accept that schizophrenia is a bio-psychosocial illness, meaning that it is caused by a combination of biological, psychological and social factors.

Each person has a different biological predisposition for developing the illness, based on the genetic makeup of their brain. Psychological and social stressors (also known as “environmental stressors”) have an impact on the brain and its development.

If the person’s likelihood of developing the illness is high, and the psychological and social stressors are also high, then they are likely to develop schizophrenia. A person who has a very high predisposition for developing the illness may not need a lot of psychological and/or social stressors, whereas a person with a low predisposition of developing schizophrenia would be able to handle a lot of stressors without develop the illness.

It’s believed that people develop schizophrenia over time, so it would be difficult to say that one event was solely responsible. Scientists believe that very early stressors on the brain as it develops and grows — in some cases even before birth — may be particularly potent, and can alter a person’s biological predispositions. The illness will actually begin to develop later, when an adequate amount of environmental stressors impact a person with a high-enough predisposition, at which time a person will start to have symptoms.

Research suggests that there is also a period between the actual onset of the illness and a person’s first psychotic episode. This period can range from a few weeks to years. There may also be warning signs in a person’s youth — such as a child being unusually shy and withdrawn from others. This does not mean that children with such characteristics will develop schizophrenia, but researchers have found that many (but not all) individuals who later developed schizophrenia displayed such characteristics during their childhoods.

Family studies provide evidence that both biological and environmental impacts together cause the illness. A person with a direct biological family member who has the illness has a ten-times greater chance of developing the illness than someone without an affected direct family member. On the other hand, around 50% of identical twins of individuals with the illness never develop schizophrenia. Evidence thus seems clear that there is a biological component, but that there must also be environmental causes for schizophrenia to develop.

Symptoms of Schizophrenia

Symptoms of schizophrenia are mostly divided into categories of positive, negative, and disorganized symptoms.

“Positive” symptoms refer to when a person sees or experiences things that are not real. For example:

• Hallucinations are when a person senses something that is not there. The most common hallucinations are visual and auditory, but a person may have hallucinations from any of their five senses.
• Delusions are false beliefs a person is convinced are true. For example a person may believe that they are a famous person, such as Napoleon.
• Persecutory delusions are another common type. A person with such a delusion may believe that the CIA or others are after them or watching them.

“Negative” symptoms generally refer to a lack of things that should be there. For example:

• Flat or expressionless emotion
• Lack of interest in life or pleasure.

“Disorganized” symptoms are those where a person has difficulty keeping their thinking, speech, or other activities organized or coherent. For example, an individual, for example, might:

• ramble in an incoherent jumble of words, which is called a “word salad.”
• walk around doing and saying things that make no apparent sense to other people.

Progress and Treatment

Between new medications, enhanced prescribing knowledge, and knowledge demonstrating effective treatments, we have a greatly improved understanding of how to treat the biological, psychological and social aspects of a person with schizophrenia .

Sometimes a psychiatrist will want to prescribe different medications if a person has more negative than positive symptoms, so it is important for the doctor to know all symptoms that a person is having.

These options make recovery a very real possibility for people with schizophrenia. A social worker can be a great asset for a person with schizophrenia to improve their quality of life.