Schizophrenia, in many ways, is the most severe of the mental illnesses. One in
every one hundred Americans has schizophrenia. This disease, once thought to be
psychological, is clearly a brain disease. Throughout the world, whether in Washington
or New York City or in rural Kenya, the rate of schizophrenia is still the same:
one percent of the population. Schizophrenia is not a cultural artifact but a
brain disease in which vulnerability is caused by genes; something happens during
brain development that converts this genetic vulnerability into disease. Exactly
what happens is the subject of neuroscientific research.
In some ways, schizophrenia is like other diseases. People who develop diabetes
or heart disease have a genetic vulnerability, and then external circumstances
convert this vulnerability into disease. Rather than being unusual and mysterious
entities, mental illnesses are real diseases of an organ - in this case, the brain.
Schizophrenia is particularly tragic because its onset usually occurs in the
late teens or early 20s, just when families, society, and educational institutions
have already put their full effort into launching a person into the world. Tragically,
then, we lose them, often to chronic and persistent hallucinations and delusions,
fixed false beliefs about the world, and an inability to live up to their potential;
often they withdraw from society and lose their ability to cope with everyday
Our current medications do a better job of controlling symptoms with fewer
of the terrible side effects that characterized older drugs. They are far from
perfect, however; they palliate, but they do not cure, and their side effects
are still far from benign. More research is desperately needed.
Medication, furthermore, is not the only component of optimal treatment. People
with schizophrenia need medication, yet to treat someone this ill a doctor cannot
just write a prescription and send the person away. The medical treatment of
mental illness has to be embedded in thoughtful and comprehensive psychosocial
and rehabilitative treatments. For the most impaired, such treatment must include
assertive outreach or else the most effective pills will stay in the bottle
and the most effective crisis interventions will go unused. Too often, the result
is needless tragedy.
As good as our current treatments are, they are not cures. We continue our
research because we are a long way from cures and a longer way from prevention.
This situation mirrors that in many other severe chronic diseases. Insulin controls
the symptoms of diabetes but does not cure the disease. The best drugs we now
have for schizophrenia and for other severe and persistent mental illnesses
control symptoms but do not cure the illnesses. And we have not yet resolved
the vital issue of delivering these available treatments to the people who need
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