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Voices and visions of schizophrenia
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Voices and visions of schizophrenia

A combination of elements such as genetics, environmental stressors, physiological abnormalities, and psychological factors can lead to the development of schizophrenia
Faces of schizophrenia
Different faces of schizophrenia | Representational image | Shutterstock

Parveen Babi: A Life by Karishma Upadhyay offers a glimpse into the life of the legendary Hindi cinema actress who played bold and unconventional roles on-screen, but had to deal with paranoia and hallucinations off-screen. She was eventually diagnosed with paranoid schizophrenia in the 1980s.

Schizophrenia is a neuropsychiatric condition characterised by a disrupted connection between thoughts, emotions, and actions. “The result is distorted perception, delusional thoughts, extreme behaviour and emotions,” explains Dr Mehar Nithyan, chief psychotherapist and founder of Calmscious, Salem, Tamil Nadu.

A person with schizophrenia feels withdrawn from reality, lacks social interactions, and has fragmented thoughts. “That is having less elaborate memories, making them incapable of associating these memories to their life,” says Dr Nithyan.

The world of illusions

Dr Sneha V, consultant psychiatrist based in Bengaluru, explains that delusions of a person can take various forms. “So, it could be something like [a feeling of being a victim] of black magic or that someone has inserted a chip in their brain or that they are being poisoned,” she says.

People with paranoid schizophrenia have an underlying and constant fear that ‘someone is out to harm them’ — be it friends, family, neighbours, or strangers.

According to Dr Sneha, individuals with these delusions may experience auditory hallucinations, perceiving negative comments directed towards them, or feeling constantly watched and monitored. They may also have visual hallucinations, such as seeing threatening shadows or birds. “These perceptions can greatly impact a person’s ability to function in daily life, causing them to avoid school, work, and social situations,” she says.

The chemical chaos within

Studies indicate that these symptoms of hallucinations are a result of neurotransmitters playing truant. The chemical messengers help transmit signals from one neuron to another.

For example, a study found that people with schizophrenia have higher levels of dopamine, a neurotransmitter, in specific brain regions called the mesolimbic pathway. These regions take care of movement, motivation, reward and pleasure.

Another research shows that excessive dopamine activity in the mesolimbic pathway causes hallucinations, delusions, and disordered thinking. Whereas lower dopamine levels in the prefrontal cortex region, where cognitive processes like decision-making and working memory occur, can result in symptoms like social withdrawal and apathy.

Read more –  Leading from the front – the prefrontal cortex

Other neurotransmitters, such as serotonin, glutamate, and GABA, have also been linked to the development of schizophrenia. For example, studies have found that people with schizophrenia have lower levels of glutamate in some brain regions. This contributes to cognitive deficits like difficulty concentrating, finishing a task or following instructions, commonly seen in this condition.

 Inside the chaotic mind 

Research has also revealed that schizophrenia causes structural and functional changes in the brain. Precisely, how synapses form and in neuronal migration.  The migration of neurons happens because they originate in one place and move to their action area, where they will remain for life.  These impairments are due to the abnormal working of proteins responsible for facilitating these processes. This is present especially in regions involving short-term and long-term memory.

Dr Nithyan agrees that some chemical and structural changes in the brain can affect a person’s thoughts. However, she adds that a traumatic event can cause hormonal imbalances in the brain, which can worsen the symptoms of the condition. “Some emotional conditions can also trigger imbalances in the brain,” she says.

Dr Sneha explains that schizophrenia can also occur from gene mutations important for brain development. “Genes and family history also add to the risk factors of schizophrenia,” she says.

In individuals with genetic predisposition, a secondary trigger like substance misuse can lead to the onset of paranoid schizophrenia. However, Dr Sneha clarifies that while cannabis use alone does not cause schizophrenia, it can precipitate the condition in individuals with pre-existing vulnerability. She cites the example of a 20-year-old with a pre-existing vulnerability and a family history of mental health issues. He developed symptoms of schizophrenia during his adolescence due to extensive cannabis use.

The search for the culprit

Research has identified the cause of schizophrenia. It is a complex interplay of genetics, environmental stressors, physiological abnormalities, and psychological factors. This combination of elements can make an individual more susceptible to developing the condition.

Dr Nithyan highlights past traumatic events as the most significant cause of this condition. She recalls the case of a 42-year-old woman diagnosed with schizophrenia who approached her with delusions and hallucinations. A clinical examination revealed that the woman had a history of childhood mistreatment and emotional abuse, which led to her developing feelings of anxiety, depression, and being abandoned, betrayed, and manipulated.

Dr Sneha adds that pregnancy-time complications like hypoxia (reduced oxygen levels in the infant’s brain). Prolonged labour or viral infections can also affect specific brain regions in the child causing schizophrenia in later life.

Shattering the silence 

Schizophrenia is a biological condition with genetic and brain changes. Current medical practices such as surgery or gene therapy cannot treat this condition completely. “Treatment for schizophrenia is focused on managing symptoms, rather than curing the disease itself,” says Dr Sneha.

Dr Nithyan says that the 42-year-old woman who consulted her has overcome the difficulties associated with schizophrenia. She now works as a schoolteacher in Salem.

According to the biographer Karishma Upadhyay, Babi’s story highlights that even someone who appears to have a seemingly perfect life can still struggle with mental illness. Furthermore, it is a reminder that one’s external appearance may not necessarily reflect their inner turmoil.

Dr Sneha says that while there is no known cure for the negative and cognitive symptoms associated with schizophrenia, positive symptoms like delusions and hallucinations can be treated through medication and therapy. “With proper care, including medication, therapy, and community involvement, individuals with schizophrenia can lead fulfilling lives and manage their symptoms effectively,” she says.

 

Read more: Positive and negative symptoms of schizophrenia

Read more: Schizophrenia treatment turns to yoga, with hope.

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