Chronic and Disabling Brain Disorder - Essay Example

? Schizophrenia Introduction For many decades now, schizophrenia, a chronic and disabling brain disorder, has affected populations all over the world, with great impacts not only to the families of the patients, but also to their societies in general. One of the most significant issues that scholars have focused on through scientific investigations and discussions in various academic discourses is whether schizophrenia is a mental disease or a psychological condition that results from the emotional disposition of individuals. In addition, research in medical cycles has also laboured to establish the connections between schizophrenia and genetic factors and/or environmental factors, though it is still not very clear whether the illness is singly caused by genetic or environmental factors, or a combination of both. This paper focuses on the question of whether schizophrenia is a psychological condition or a brain disease by examining whether there is a clear way of making a distinction between a psychological condition and a brain disease especially given that human behavior always involves the brain. The psychological condition versus brain disease argument Firstly, this paper argues that the question of whether schizophrenia is a mental disease or a psychological disorder is as much conceptual as a matter of science particularly because there is no clear way of making a distinction between a psychological condition and a brain disease given that human behavior always involves the brain. In this respect, Schizophrenia is as much a mental disease as it is a psychological disorder since patients who suffer from this illness are more likely to present with distorted thought processes, and poor emotional responses, while delusions such as paranoia, auditory hallucinations, disorganized thinking, or low emotional intelligence are some of the common symptoms of the illness. Additionally, schizophrenia is normally accompanied by a great deal of social dysfunction, and the symptoms of this illness often occur in young adulthood; diagnosis of schizophrenia is based on physical observable behaviour. The most pervasive risk factors that predispose individuals to the illness include genetics, the initial environment, and neurobiology, in addition to, psychological and social processes in the environment. Current studies reveal that there has been no single isolated organic cause of schizophrenia, but researchers are focusing their energies in establishing the neurobiological connections. It is a common phenomenon for schizophrenia to be confused with dissociative identity disorder, which is also referred to as ‘split-personality’ or ‘multiple personality disorder’; however, the term schizophrenia refers to a splitting of mental functions. Antipsychotic medications are widely used to suppress the condition, alongside psychotherapy, vocational, and social rehabilitation, as well as, involuntary rehabilitation in extreme case; apart from affecting cognition, schizophrenia also triggers chronic problems with behaviour and emotion. Other comorbidities such as depression and anxiety disorders have also been associated with schizophrenia, in addition to social problems such as perennial unemployment, poverty, as well as, homelessness. Literature review According to Malmgren (2006), brain disease or disorder could be either a process that is tied to an underlying biological cause in the brain, or a condition that results from organic rather than mental causes. Based on the first criteria, schizophrenia alongside psychogenic conditions can be categorized as brain disorders, however, it cannot yet be established affirmatively whether the exogenous components of schizophrenia are organic or mental in nature. DSM-III, unlike DSM-IV makes a distinction between organic and other mental disorders, and such a distinction implies that not all mental disorders have a biological foundation. Helge points out that the organic mental syndromes that are known in adults differ significantly from typical schizophrenia, and the schizophrenia-like syndromes produced by brain tumours notwithstanding, there are no core symptoms for schizophrenia. Eventually, this course of argument proposes that schizophrenia is probably a partly socio-genic brain disorder, though psychogenic contribution must also be examined further. Sass, Louis and Parnas (2003) contend that schizophrenia is a self-disorder in which a person’s awareness of their self is highly distorted; they further reveal that the major symptoms of schizophrenia can be understood in a unified manner despite their heterogeneous nature. They base their study on the premises that schizophrenia involves profound transformations of the self because the schizophrenic’s ego undergoes various alterations; additionally, the schizophrenic experience a split-self and they lose the feeling of engagement and the capacity to think positively. As a disorder of the consciousness and self-experience, schizophrenic individuals often present with a diminished sense of self-affection, hyper-reflexivity, and allied alterations of awareness of their surroundings. Forbes et al (2009) conceptualize schizophrenia as a heterogeneous disorder that potentially encompasses various disease processes that undermine a range of human processes such as thought, perception, emotion, drive, and behaviour. Their study is based on the fundamental findings in the medical field that have linked memory impairment to the neuropsychology of schizophrenia; in this respect, it is increasingly becoming clear that memory dysfunction is closely associated with various core symptoms of schizophrenia. According to Jim van and Kapur (2009), schizophrenia remains to be a very mysterious and costly mental disorder, not only in terms of human suffering, but also in terms of social expenditure in management and control of the disorder. Further, their literature contends that apart from affecting mental health, schizophrenia also results to high mortality rates because patients with this disorder are most likely to die 12 to 15 years earlier than the rest of the population; schizophrenics experience bizarre delusions, negative, and affective symptoms that last for a long duration. Strauss et al (2012) examine the self-reported psychological, social, and emotional wellbeing of chronic outpatients that suffer from Schizophrenia and their study demonstrates that schizophrenics endorse the least psychological wellbeing measures all over the world. For instance, schizophrenics feel less positive about themselves, they don’t perceive themselves as growing, and they are less open to new experiences; additionally, schizophrenics are disillusioned in life, cannot manage complex situations, have no sense of self-direction, and do not derive any value or satisfaction from relationships with others. Burns (2004) views schizophrenia as a complex and prevalent disorder that leads to a great deal of suffering and impairment in both patients and their families, and schizophrenics often seek to understand the meanings behind bizarre and perplexing experiences. He further theorizes that schizophrenia is a disorder of the social brain and the condition arose as a high-cost compromise in the course of the evolution of complex social cognition. His work is embedded in the research findings of Palaeoanthropology and comparative primate research, which suggests that hominids developed cortical relations to control social cognition and the intellectual fundamentals of social living. He advances an argument that the cerebral adaptation that took place was due to a certain ontogenetic mechanism, and as a result, the hominid brain was predisposed to both environment and genetic forces. Braff et al (2007) classify schizophrenia as a complex psychiatric disorder whose genetic component can be inferred from studies on twins and family; they contend that such neuropsychiatric disorders are multifactorial and can be attributable to the combined influence of genetic, epigenetic, stochastic, as well as non-genetic factors. Holzinger et al (2003) document findings from three studies that attempted to expose schizophrenic’s beliefs concerning the causes of their illness; their findings report that schizophrenics mostly endorsed acute stress that arises out of encounters with life-changing events and chronic stress related to work situations or pressures from relationships and family as the main causes of their illness. Patients favour psychological rather than biological explanations as the probable cause of schizophrenia, and this is the same case for the population, which endorsed psychosocial stress as the main risk factor for the illness. Ledgerwood, Ewald, and Cochran (2003) reveal that schizophrenics present with positive symptoms such as hallucinations, delusions, and paranoia schizophrenia, and negative symptoms such as withdrawal, flattened emotional responses, as well as memory impairment. They also point out to the assertion in various researches that view schizophrenia to be a neurodevelopmental disorder whose primary neurological insult takes place during the foetal development. However, they also highlight the lack of clarity in the etiology of schizophrenia and the diagnosis of the illness basing on phenotypic similarities instead of etiological evidence; they propose the recognition of schizophrenia as a collection of illnesses with multiple etiologies. Agrawal and Hirsch (2004) contend that conditions like schizophrenia have been identified for centuries but they have remained to be poorly conceptualized; they give reasons why schizophrenia has been considered a social disease including its high prevalence in lower socio-economic populations, and the association between life events and the illness. Nonetheless, they also argue for the case of schizophrenia as a brain disease by presenting evidence of research that shows a high risk of schizophrenia in siblings of patients with the condition than in the general population. They also highlight evidence of adoption studies that show the effect of environmental factors in the heritability of the disease, which indicate that there is no risk of the illness in healthy individuals adopted by schizophrenic parents. Additionally, twin studies rule out the possibility of environmental influences on the disease, thus providing substantial evidence of the significance of the genetic component in schizophrenics. This research shades light on the debate of whether schizophrenia is a brain disease by concluding that a number of the structural and functional abnormalities inherent in schizophrenics support the biological model of explanation rather than the psychological one. In this regard, schizophrenics are biologically vulnerable at the first place and the fact that they are sensitive to social-environmental factors does not make these factors the primary causes of the illness. Lewis and Levitt (2002) define schizophrenia as a severe brain disorder that degenerates to a lifetime disability and emotional distress for the victims, yet its risk factors remain unclear, but they also highlight that previous studies have focused on establishing the genetic and environmental linkages. They also contend that the risk of this disease is highly linked to the degree of biological closeness to the individuals with the condition; in this regard, close relatives have a high risk of developing the disease than the general population. They further highlight statistics that indicate nearly 60% of schizophrenics have no close relatives with the disorder, despite the close associations between the condition and genetic factors, thus, suggesting that the complexity of the genetic predisposition to the disease and the possibility of sporadic forms of the disease. According to Sawa and Snyder (2002), schizophrenia is a debilitating mental illness that is multifactorial in origin and is linked to both genetic and environmental risk factors; the symptoms of this disease manifest in young adulthood and persist throughout one’s lifetime. They also highlight that the disease is diagnosed basing on positive symptoms such as delusions, hallucinations, and bizarre thoughts, as well as negative symptoms such as social withdrawal, and poor motivation. According to the Medical news today (2013) schizophrenia is a mental condition that manifests in late puberty or sometimes in early adulthood, and this brain diseases involves illusions, loss of disposition, and confusion; similarly, schizophrenia is also characterized by social withdrawal, neurosis, and weird behaviour. For instance, schizophrenics may hear ghost voices or claim that other people are reading their minds or targeting them, which might not actually be the case, and these negative impacts of schizophrenia affect even the family members of the patient, and the society. Beck et al (2009) suggests that schizophrenia has diverse symptoms, and point to the consensus that the disease can be attributed to at least three dimensions, psychotic, disorganized, and negative symptoms. According to Goleman (1990), a study of the brain structure differences linked to schizophrenia in twins provides substantial evidence that the illness is a brain disorder and not a mere psychological condition. Schizophrenia is responsible for the subtle abnormalities inherent in the brain structure of schizophrenics, and despite the strong connection between the disease and genetic factors, other factors other than genetics can be blamed for the illness. The study further highlights that schizophrenics have a smaller brain volume, especially in critical areas that involve thinking, concentration, memory, as well as, perception, unlike people with a normal brain. This research also highlights that schizophrenics present with distorted thinking, and their perception of reality is equally distorted likewise, thus, the disease is the most disabling mental disorder because none of the medications can cure it. Vedantam (2007) presents that schizophrenia is a serious mental disorder that is characterized by hallucinations, psychotic symptoms, and disordered thinking in patients, and the increased risk of developing this illness is linked to maternal infections that occur during the first and second trimesters of pregnancy. This literature further asserts that the genetic factors may play a significant role in determining who gets schizophrenia, but the environmental factors cannot be overlooked all together. Discussion A synthesis of the above literature reveals the age-long substantial efforts by scholars in dedicating their writing to examining the ways of making a distinction between a mental condition and a psychological disorder by examining whether schizophrenia is a mental disease or a psychological condition. Schizophrenia is a common topic of discussion in scholarly discourses and the different literature examined in this study exposes that the most significant theme under consideration in many of these writings on the topic is the causative factors of the illness. Whereas some writings argue persuasively in favour of the genetic factors as the main cause of schizophrenia, some take a stand that the illness cannot be accounted for by genetic factors alone, thus, bringing in the possibility that environmental factors may also be playing a significant impact in the development of the disease. The question of whether schizophrenia is a mental disease or a psychological disorder is as much conceptual as a matter of science particularly because there is no clear way of making a distinction between a psychological condition and a brain disease given that human behavior always involves the brain. In many instances, patients are more likely to endorse acute stress out of experiences of life-changing events and chronic stress related to work situations or pressures from relationships and family as the main cause of their illness. Conclusion Ultimately, current research in the field reveals significant and persuasive body of literature that settles the debate of whether schizophrenia is a mental disease or a psychological disorder conclusively. Insofar as recent studies are concerned, there is no reasonable doubt that schizophrenia is as much a mental disease as it is a psychological condition since mental states cannot be isolated from the brain in practical senses. Scholars in the field agree that the brain structure differences associated with schizophrenia in twins provide a substantial proof in support of the conclusion that the illness is a brain disease but since psychological states are determined by the brain, schizophrenia is inevitably a psychological disorder as well. This revelation is very significant in the medicine because it is more likely to transform the field by changing both the practitioners’, the patients’ and the general populations’ attitudes towards schizophrenia, leading to more advanced and effective approaches in the diagnosis and management of the disease. References Agrawal, N., & Hirsch, S. R. (2004). Schizophrenia: Evidence for conceptualizing it as a brain disease. Journal of Primary Prevention, 24(4), 437. Beck, A.T et al (2008). Schizophrenia: Cognitive Theory, Research, and Therapy. NY. Guilford Publications. Braff, D.L. et al (2007). Deconstructing Schizophrenia: An Overview of the Use of Endophenotypes in Order to Understand a Complex Disorder. Schizophrenia Bulletin, 33 (1): 21-32. Burns, J. K. (2004). An evolutionary theory of schizophrenia: Cortical connectivity, meta-representation, and the social brain. Behavioral and Brain Sciences, 27(6), 831-55; discussion 855-85. Forbes, N. F., et al (2009). Working memory in schizophrenia: A meta-analysis.Psychological Medicine, 39(6), 889-905.  Goleman, D. (1990). Health: Psychiatry; brain structure differences linked to schizophrenia in study of twins. New York Times. Retrieved from http://www.nytimes.com/1990/03/22/us/health-psychiatry-brain-structure-differences-linked-schizophrenia-study-twins.html Holzinger, A., et al (2003). Patients' and their relatives' causal explanations of schizophrenia. Social Psychiatry and Psychiatric Epidemiology, 38(3), 155-62.  Ledgerwood, L. G., Ewald, P. W., & Cochran, G. M. (2003). Genes, germs, and schizophrenia: An evolutionary perspective.Perspectives in Biology and Medicine, 46(3), 317-48.  Lewis, D. A., & Levitt, P. (2002). Schizophrenia as a disorder of neurodevelopment. Annual Review of Neuroscience, 25, 409-32. Malmgren, H. (2006). Is schizophrenia a brain disease? PPT. Retrieved from http://www.phil.gu.se/posters/schiz_Leiden.pdf Medical news today. (2013). What Is Schizophrenia? Medical news today. Retrieved from http://www.medicalnewstoday.com/articles/36942.php Sass, L.A. and Parnas, J. (2003). Schizophrenia, Consciousness, and the Self Schizophrenia Bulletin, 29 (3): 427-444. Sawa, A., & Snyder, S. H. (2002). Schizophrenia: Diverse approaches to a complex disease. Science, 296(5568), 692-5.  Strauss, G. P., et al (2012). Negative symptoms and depression predict lower psychological well-being in individuals with schizophrenia. Comprehensive Psychiatry, 53(8), 1137-44.  Van Os, J., & Kapur, S. (2009). Schizophrenia. The Lancet, 374(9690), 635-45. Vedantam, S (2007, Nov 27). A theory that raises questions; schizophrenia risk may start in womb. The Washington Post. Retrieved from http://www.washingtonpost.com/wp-dyn/content/article/2007/11/23/AR2007112301327.html Read More