ok.as to where i don'become suical or homicidal. i have both those tendencies. usually the homicidal. they taught me too well. i've hurt lots of people for those veterans who see combat, the's additional stressth they, and so it's not surprising th being exposed to combat situations and atrocities of varis kinds in vietnam led many peoe with the vulnerabityto schia to break down and ha the first . it isn't only der the stress of war that symptoms of schizophrenia manifest. the challenges of new adulthood, whichand often involvte teens loss of ionapport, 2os may corite tohe onset of schiphrenia. all of these may act as triggers

for the init schizophrenic episode. interestingly, onset for schizophrenia at this age, under 25 usually applies to men. onset for schizophrenia in women isater, after age 25. there are her psychologil faors that may contribute to the onset of schizophrenia. childhood experiences, unconscious conflicts, the natur some time,mily-- al, e usal factors. one itional the if conoveral viewily-- al, is the concept of the schizophrenogenic family in which overprotective or rejecting qualities the parents, especially theother, are thght to be associated of schizophrenia in the child. the first theory was advanced by some of the earlier psychoanalytic theorists, and italks about thschizophrenia as a result of certain famildynamics. it's what we refer to as the schizophrenogenic family, the schizophrenogenic mother, or schizophrenogenic father,

referring to schizophrenia caused by mother, father, family. to indicate that there isso, and research evidence in this theory, in some cases. this idea,hat the family constellation and its dynamics is the major cause has recently been modified. a broader approach to the roles has been developed. important question that's come out of more modern thinking in terms of psychopathology and psychology is whether possibly that an impairnt in a child can cause a family to react in a disturbed fashion, that it's possible that it's not all a one-way street ere the patient is a passive recipient of the family disorder, but that the family is reacting to the disorder already evident in subtle forms in the child. dr. n silver of chestnut lodge

plifies the notion of these complex mily interacons. what's more alive an blaming the other is looking at the effect that the schizophreniindividual or t preschizophrenic individual has othe family. denise ford, who's on the medical staff here, did her ph.d. thesis on the subject, d it was realla inating piece of work, with early and developing who's schizophrenia alters the communication and mood pattern so there's a terble resonating in tthat takes place as things kind of fall apart, so there's a terble resonating as the psofallapt, place the effe of that on the other family members-- the grief, the glt, the apprension, the desperation--i think, really, that, uh, then evolves

in the tragedy of this illness. whathere is good evidence for is that the family, just as awhere a persontion with a serious disabling and often bie and unpredictable lness is living and interacting, the family situation can be affected,e lness this is a chronic, disabling,an. by this kind of an illness. it's difficultor the patient. it difficult forhe fily, especially when the young person involved has had very promising rlier life ansuddenly is afflted by this illness anbecomes disabled. the family eeriences great amounts of stress. i think that he was more or ls separated from the famy and wanting to be secretive about what he was doing. jeff's parents discuss the disruption in their family

when they firsrealized their son had schizophrenia. inhe vy rly stage, of crs we were entirely, i mean, the whole experience s so new to us, and we ctainly did not connect the experience with schizophria that's something thawe lrned about as time went on, and, uh, having no background wain this illness,y. why, we just didn't know how to take it, but as time went on, we realized that there was somg and that there was illns involv... and, uh, we did as much as we could to learn about the illness, and for months, after we tried one psychiatrist after another,

and no one seemed to be able to--be able to help directly. well, jeff sort of acted up at one poi. like, i forget exactly what he did, but he acted crazy. that's the only way to describe it. psychotic outbreaks. and we took m to-- the doctor said he should be hospitalized, but gradually we realized that it was a full-blown cas of schophren, and we realized that we uld have to deal with the illness. dung the 12 yes jeff's been camillo stated hospital, his parents have visited him every saturday, giving him support at seems crucial ring t courseof this di so, too, did family and friends of dav

a former chestnut lodge patient who lives and works in boston. thousupport,here's no way a patient can make i u can't pullf upby your rings. e thing s always aware of thouwas my inten gratitude for people around me. i couldn't express it, but i'd go to bed thinking, "wt would i do if i was on the streets?" was en i was informed that i couldn't live at home anymore. it didt occur to me that i'd have so much support. as it became more apparent that there would be people there for me, i became more optimistic aboumy future. there was never a question that i'd stop fighting. i just thought i'd lose the fight. there is nothing that happened in the field of abnormal psychology,

and particularly in the work with schizophrenia, that has revolutionized the work more than the drug treatment of schizophrenics. until this point, up until the point when drugs were introduced in the 196, '7os, and '8os, the treatment of choice was electroconvulsive therapy, what is colloquially referred to as shock treatment. shock treatment's almost never used in schizophrenia anymore. it's used in other disorders more frequently. umdrug treatment has radically reduced the length of hospitalizations. for example, in the 195os, the avage schizophrenic would stay 353 days in a hospital-- in a pchiatric hospital. in 196o, after the beginning of drug treatments, the average schizophrenic would stay in a hospital 113 days. tremendous change. and in the 198os, thaverage hospitalization foschizophrenia is 18 days. you can see how enormous those differences are.

ug treatments ret the episode of schizophrenia within weeks for about 9o% of schizophrenics. now, that doesn't mean cure schizophrenia. it means that it remits the symptom, the episode, and iare about half whenwn someone is treated with drugs when you compare with somedy who is not treated with drugs. the spect scan offers a valuable opportunity see how drugs afft the prefrontal cortex in acute schizophrenics. this spect scan showthe acvity in a normal individual's brain when carrying out a cognitive task. the ominent red spot in the right frontal cortex indicates there's activity in this part of the brai that's used for planning and other executive functions. in the unmedicated chronic schizophrenics, there's no red spot in the top right.

this means that the prefrontal cortex hasn't been activated in these patients. once on phenothiazine medication, the scans of chronic schizophrenics show a marked difference. although there's no prominent red spot, as in the normals, it reflects more normal functioning in that brain region. for most medicated patients, symptoms of schizophrenia can be reduced markedly thfollowg patitstic are presented off d then on the phenothiazine, or antipchotic drugs. althgh the medication doesn't move the symptoms completely, as you'll see, it can make possle a dramatic change in thought process and behavior. haveou had anfeelings that pe were against you? no. nothinlike that? pe were against you? i don't like my eyes coming apart, though. yos... whatbout yourair, tom?

, one time, i t the idea th the funnys were tryinto drive me insane. d read them, and then i'd get all hyrtensed about that. i dn't necessarily knowanything, but th'd upsete greatly. theye pulling your guts and insides-- mm-hmm and suckg you dry. who is they? do you know? my sters and. and nurses and ian't sewho, really. don't know w gets up there and es it, but i know thamy sisters done some bad thgs. u actual feel don't kyour inses gets up therbeing ll o?, ye.

is it painful? yeah. it scares me. um, at the mall, was nuts then. i was, uh, kneing and praying. inublic? righoutside this restaurantathe. one the chefs came out stood there and look at anturn around and went bk in. ere was a time where they we kinge kneel and pray a lot. [dennis schulman] the main effects of the drug are significt, but like eve drug, whether we talk about aspirin or antihypertensive medication, drugs have side effes. the side effects in e case of the antipsyotic medication typically e the dryness of the mouth, the stiffening of the muscles, the tremors of the hands and the legs, and the worst one by far is a condition calledtardiv. and the legs,

what tardive dyskinesia is is disfiguring disturbance of mor control, rticularly in the face wi ismacking of the lips, chewing that goeon-- and somes people misinterpret tse symptoms as part of the schizophrenia when in fact it's a by-product of the drugs that were the treatment for schizophrea. the horrible problem about tardive dyskinesia is that people can develop it even if they're no longer on the drug, and there no way to reverse it. the main effect of t drug, the thing the drug does do, is that in many cases it normalizes the person's overt behavior. anit increases their ability theito communite.cess but again, i cannot emphasize enough that drugs do not cure schizophrenia. they treat theymoms that make it possible

for the person to function at a much higher level than they would without the drugs, but it's not a cure inheypical sense. it's like the chare brown characte has his dust blank-- has his blanket, and it's a security for him. and it's like the medication, when you first get on it, it's like a security for you, but after a while, you notice that it doesn't do any good. it's not stopping the voices. metimei hear friends,ces whersomemes family.m. sometimes my friend paul talks me. leslie's voices are likely to plague him for the rest of hilife, but for many patients with schizophrenia, medications do provide a means for effectively relieving major symptoms, allowing a return to living in the community asome level.

in addition to medication, there are a variety of psychosocial intervenons that can help ease this transitio from in- to outpatient they include family erapy, which focuses on improving faulty communications ancan reduce relapse rates. group therapy, in which several pele wschizophrenia meet wh a leader and work on soal interactions and relationship skills, and milieu therapy, an inpatient program that provides a therapeutic community in whichatients share responsibilities andecision-making with a professional staff, praring them for life outside the hospital sting. at the los angeles veteran's administration medical center, the skilraining program alsoddresses issues of independent living, such as managing medication and its side effects. what are some things you thi you might be looking for to tell you the efct of the medicine? hypeension. hypertension. think about the medine you' taking.

what medine do you take? mellaril. well, i did. so with mellaril, you would be looking for the effect of mellaril on you, right? yes. sleepiness, um, anxiy. at about anxiety? i get it when i took mellaril. ok. mellaril made you anxious, so iwas a side effect that youere havi? one of the things you'll be monitoring is the side effects of it, right? would you be monitoring, randy about youredicine? i happen to take a lot of medicin, mainly sinequan. navane for voices, sinequan for depression and schizophrenia. i take cogentin. i take klonopin. i take, uh, uh, clonidine, and with all these different medications, i take them at different time schedules. one of the things that i always look for is how my appetite is,ferent whether or not i slept well,

drowsiness, if i'm tired or not, if i'm alert or not, whether i'm constipated or not. all right. besides helping patients manage the panoply of drugs they take, skills tining helps them learn to talk to doctors, make social nversation, and do such everyday tasks as plan and cook dinner. these are the same executive functions of the prefrontal cortex that the spect scan seen earlier showed to be abnormal in sizizophrenic patients. social skills training is a way of helping the patient arn w cop ma of emave cognitive difficulties where they c always proces information fectivel they may getart a message. ey get the messagestord. they may n it at all. swe ceam ep bst,in soci skipiecby piece,

how tand e developsopproiate rn. anhe theorgaze it importantt to tnk ofn as being permanently suffering from schizophrenia or being schizophrenic. a person can go for hours or days or weeks or months and not have these disabling symptoms of schizorenia.atment so treatment, to be most helpful and to enable a person to be effective in getting back on tck in life, has to be linked to the person's current state. when thecome to us, we can teach theboth how to improve the way in which they communicate and al to enfy thkindof infortion that people need to help them. for instan, wi a doctor, they're not feeli well, they can say, "doctor, i'm shang a lot

"i can't write i can'hold a cup of coffee, and it really bothers me a lot, "ani'd like you to fix it." that kind rponse is far more kely torovide the phycian wh some real conc infmation about the extent of the proble how long is lasted, and what way it's disablior di. and medication, various kinds of psychotherapy are usedg in the treatment of thechizophrens. the goals are to help patients understand their illness, to help them identify and manage their needs, including that of aafe environment, anto help them gain control over both their thghts and behavior. and in the psychodynamic treatmt of schizophrenics, it's different than treatment of anxiety disorders.

in anxiety disorders, the focus of the treatment is on insight, whereas the psychodymic treatment of schizophrenia has to do with developing a new parental relatiohip. it's the nature of the positive relationship between the patient and the analyst that is curative in this form of treatment. some psychotherapists believe that insig is possible, but it's through the therapist-patient relationship that progressis most often. dr. silver'sork inlv what she calls "rebuilding bridges," teaming upita tit by talking, listeng, drand being a constant source of support throughout the illness. by andarge, the patients i've worked with have been sick for many years. they've worked with manyoctors. they've had many expiences of defeat. they've been on many medications, either individually or in combinations,

and, uh, come pretty much immersed in unthinkabldefeat, and the work that i do iso meet with them and gradlly to find a place wherwean relate. um, areas of--of, um, maybe mutual interest or a gradual develment of intest t of fragments of contact. , and, uh, with the understanding that we may be working togethe t for a very long time,ct. and that if the going gets rough, that i'm here to go the distan thatwith them.eason touit, david was dr. silver's patient at chestt lodge. my relationship with my doctor was one of distrust, admiration, and gratitude with a slight bit of trust. very slit.

it's getting bigger because i'm still in contact with her. initially, the patients will hardly ever believe it's that anything goodause i'm sis going to come of it.r. gradually, vy often, there's a rekindling of hope, and as the relationship with the doctor gbecomes something that they trely feel they can depend on, that, then, geralizes, and ey'll more reachable to other people in theommuni d enill startreaching outothers i ubt that at any point research will ever find a single cause of schizophrenia. when we talk about schizophrenia, wee talking about a complex, multitheoretical ideological system that in some cases, certain types of ideological factors are primary. in other cases, certain other ideological factors are primary,

but th search for the single caus i think by definition, will end up being fruitls. what we have to do is get better at doing research on combining theory and combining treatmts. no matter what the future brings in terms of at people with schophreniay pe can be hped to liv more normal lives. in most any city, you can entify peoplewith piatrs because of how they conduct themselves, because of how they interact and ta. we try to teh them the kis of skills that will able them to fade into the crowd inpite of their illness. what we pe for with schizophrenia in the current state of the art inpiteis effective control, rehabilitation, and management,

and that in this sense, the role of the psychotherapist, the behavior therapist, e social therapist, the rehab therapist, all the other social a psychological interveners, is important. even if we take the hard view that schizophrenia is exclusively understood as a biological disease caed by biological factors and maintained by biological factors, nevertheless, there is fairly strong evidence that there are psychological and social interventions which can help that schizophrenic patient, usually in conjunction with antipsychotic drugs, can help that schizophrenic patient to make a better adjusent to the world than was made before. there's been some changes. i learned how to slow down my speech when i take my time and speak slowly. i was ying--working-- i'm at an age where a man is-- when he's pastge 3o, he's a conrmed bachelor,

and i've been trying- i'm to get married. a man is-- they help me talk to ladies. i'm a paranoid schizophrenic progress, and i'm getting better each and every day. the point i make with my father when we talk about this is that he says, "you're doing so well and trying so hard," and i always tell him, "i was always doing better. "i was always doing better than anyone expected "i was always doing better than i expected of myself when we say,"hey, i'm, because was always fighting." "and i'm trying to deal th something, and it's ruing my life, or i don't know how to relate," hey, it's ppening, and you have to acknowledge that, but science doesn't want to acknowledge that. that's part how they mess up your kids. they called me a cub scout.t they said was deluded.t.

he didn't believe me. my parents and i my new experiment,and theyer and, uh, my neprogram. we meet eversaay ateast, anon the phone during the morning hours, and i like them a t, and i ve them. they'll always do the best for me. i didn't mean to leave them early in li. after all, 19 years old can be very young to leave home. some pple don't leave until they're 5o. all i know is that my parents and i get along very well, to make a long story short. hopefully, if i can'tlive on and have my own individual le, then i'll live in a boarding care home where i can build up my self-esteem, my o life, and try manage in brding care home setting

until i can mat on my own, if ever, again. ptioning performed by the national captioning institute, inc. captions copyright 1991 alvin h. perlmutter

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