Society�s views on �madness� have altered as
psychopathology has replaced the devil as its cause. However, there is still
some contention about whether there is something qualitatively different about
cognitive dysfunction, marking it as a genuine pathology, or whether disorders
are simply cases of marked anomalies with particularly intense symptoms
relative to the majority of the population. Whether such illnesses are
considered to be distinguishable abnormalities or deviances purely in terms of
the degree of difference from the norm, psychopathologies cause considerable
anguish and disability.
Schizophrenia is a term used
to describe a group of serious disorders, affecting up to 1% of the population
and accounting for about half the beds in mental health hospitals. Often mild
symptoms remain undiagnosed until the twenties, but it can be a chronic
condition that usually affects the young, if anything declining with age.
Because of the difficulties of diagnosing a pathology which Bleuler
characterised simply as an �abnormal disintegration of mental functions�,
especially in its early stages, DSM-IV classifies schizophrenia being present
in subjects displaying a number of pathologies in related areas persisting for
6 months.
Progress in its study has
been slow, for a number of reasons. In the first place, the term
�schizophrenia� is used to categorise an extremely wide range of disorders,
including disorders of cognition, emotion, behaviour and social integration.
As mentioned above, the
dopamine hypothesis seems to apply more to patients suffering from the positive
(Type II) forms of schizophrenia. In patients with the negative form, enlarged
ventricles and shrunken brains are noticeable. Moreover, autopsies indicate
further organic damage in the cerebellum and basal ganglia, but especially in
the frontal and temporal lobes (Martin and Albers, 1995). There, cell
derangement and missing or abnormally sized neurons must affect brain function,
as backed up by fMRI and PET scans.
The effects of schizophrenia
can be contrasted with those of Parkinson�s disease, which is often seen as the
opposite side of the same coin, caused by a long-term decline in the presence
of dopamine and the dopaminergic pathways, while the former seems to be linked
with the dopamine receptors being over-stimulated. Yet, radically different
effects are observed, and in different areas of the population. Parkinson�s
disease tends to strike in the elderly (approximately 1% of the elderly
population suffer from it), causing a marked decline in levels of dopamine,
with worsening effect on the motor system, especially the basal ganglia.
Schizophrenia is a massively
debilitating disorder � only 20% of schizophrenics interviewed thirty years
after diagnosis appear to have been able to lead normal lives (Andreason
& Black, 1996), while 45% were incapacitated. However, there are
increasing grounds for optimism.