Schizophrenia causes significant impairments in peoples’ overall functioning and, for several years, has been noted as one of the top 15 leading causes of disability for people globally. 

The typical onset of schizophrenia is late adolescence and early adulthood, but there are rare cases where children younger than 13 years of age experience childhood schizophrenia. Men are more likely to develop schizophrenia earlier and experience more severe “negative” symptoms and comorbid substance use, in comparison to women. However, after 40 years of age, women are more likely to experience psychosis and schizophrenia in comparison to men.  

What is Schizophrenia?

Schizophrenia is a mental disorder characterized by chronic dysfunction in behaviour, thoughts, social interactions, and emotional responsiveness. Specifically, in Canada and the rest of North America, according to the Diagnostic Statistical Manual 5th edition (DSM 5), to meet the diagnostic criteria for schizophrenia, an individual must experience at least two of the following symptoms for a minimum of 1 month:

• Delusions- possessing fixed beliefs about something or someone even amidst evidence to disprove these beliefs. 
• Hallucinations- feeling, seeing, hearing, tasting, or even smelling sensations that are not perceivable by others.
• Disorganized thinking and speech- speaking in a nonsensical manner and jumping from one topic to another unrelated topic.
• Disorganized or catatonic behaviour- engaging in odd or childlike behaviour like laughing at inappropriate times or having slowed down or lack of movement and responsiveness to stimuli around them.
• Emotional blunting- impairments in showing a range of different emotions. 

These symptoms all fall under the term, psychosis, a condition that involves becoming detached from reality. Psychosis is a major part of schizophrenia, other psychotic disorders in the schizophrenia spectrum disorder (SSD) family and sometimes other mental illnesses like depression, otherwise known as depression with psychotic features. Alongside psychosis, there may also be functional impairments in the individual’s life including work capacity, interpersonal relationships, or activities of daily living (ADL) like grooming or remembering appointments. If psychosis and overall dysfunction in ADL mutually occur persistently for at least 6 months, a diagnosis of schizophrenia is likely warranted. 

I mention the term SSD family because while schizophrenia is more well-known, it is one of many psychotic disorders. Although all psychotic disorders involve psychosis, schizophrenia is different in that it is the interplay of two or more psychotic symptoms. Conversely, some other psychotic disorders involve mainly one of the psychotic symptoms which may endure for a significant duration such as delusional disorder, or may intersect with other forms of mental illness such as mood disorders in the case of schizoaffective disorder. 

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A growing concern, especially amongst many young people, has been substance or drug-induced psychosis, which is the onset of psychosis triggered by excessive usage of or withdrawal from a drug.  Drug-induced psychoses are typically short in duration until the drug has fully left the body; however, if symptoms persist, even when the effects of the drug have dissipated, then there may be an underlying mental illness like schizophrenia. 

Postpartum psychosis (PPP) is another type of psychosis that may affect women who recently gave birth within a few weeks. Some reasons underlying PPP include hormone changes, sleep deprivation, social isolation and/or family or personal history of mental illnesses.

What causes schizophrenia?

While all mental disorders are complex, the cause of schizophrenia is noted to be one of the most complicated to decipher. What we do know is that a significant part of its etiology- the origin of a disease/illness- is genetic but is further compounded by other influences, especially psychosocial factors. 

Genetically, schizophrenia and other SSD are noted to have a strong heritability factor. That is, this illness more than likely runs in the family. Some researchers point to rare gene variants (mutations)- the deletion, duplication, or insertion of segments- in our DNA which may increase the risk of schizophrenia. Others suggest that specific single nucleotide- one of the four bases of our DNA sequence- variations in our genome sequence may make someone susceptible to developing schizophrenia. These variations are called single nucleotide polymorphisms (SNP’s). 

A newer genetic field known as epigenetics, has been of interest to researchers since this field focuses on how the interaction between the environment and our genetic make-up influences how our genes are expressed. In this framework, schizophrenia is theorized to be caused by exposure to stressful environments, whether in utero or outside of the womb, which causes some dysfunction in the expression of genes that may be associated with schizophrenia. 

Psychosocially, exposure to acute or chronic psychologically traumatic phenomena such as childhood sexual abuse, prolonged social isolation such as solitary confinement, and social defeat- the negative experience of being continually excluded from the majority group- are documented triggers for psychoses. It is unclear whether these situations “cause” schizophrenia, but since these circumstances can trigger the onset of psychosis, they also increase the risk, particularly if prolonged, of schizophrenia or some form of SSD. 

Black people and schizophrenia

In Ontario, home of the largest concentration of Black people in Canada, a seminal study revealed that Black immigrant and refugee populations of the Caribbean and African Diaspora are purported to have the highest risk of developing psychotic symptoms in addition to schizophrenia. Yet one must ask: why?  

The late Jamaican psychiatrist, Dr. Frederick Hickling, pointed to the fact that the rates of Black people developing schizophrenia in regions like the Caribbean are either lower or comparable to the rates of White populations in Western countries. Yet, these rates increase astronomically among Black Diaspora populations in Western countries. Indeed, Dr. Hickling and Dr. Kwame Mckenzie, a psychiatrist based in Canada, argue that stressful environmental factors in Western countries such as social isolation, acculturative stress- struggles adjusting to new cultural ideals and practices of the host society- and racial discrimination are instrumental in the genesis of schizophrenia for Black Diaspora populations. 

Moreover, living with schizophrenia does not eliminate people’s ability to recognize the harmful effects of racism. Dr. Amy Gajaria, a child and adolescent psychiatrist based in Canada, asserts that both general delusions as well as general paranoia about racism can coexist and must be teased apart. 

Treatment for Schizophrenia

Although some patients and researchers debate the necessity of lifelong adherence to anti-psychotic medication, most people with schizophrenia are often advised to remain on anti-psychotic medication indefinitely. Alongside anti-psychotic medication, psychotherapy, typically provided by a psychologist or social worker with a specialization in mental health and illness, is typically suggested with the goal of helping patients with this illness to examine and understand their delusions and hallucinatory experiences, including possible triggers. Psychotherapy also helps the patients build life skills, regulate emotions, and help themselves reconnect with people interpersonally. A combination of psychotherapy and medication is recommended to recover as best as possible.  

Healthy diets are also important as people with schizophrenia are at risk of co-morbid conditions like diabetes and hypertension, often due to poor eating and lifestyle habits. A healthy intake of omega-3 fatty acids for instance- which can be obtained from some of our traditional foods like mackerel and kidney beans (the peas in “rice and peas”) - are important for possibly easing some schizophrenia-related symptoms and helping to produce overall good health.

Moving forward 

Schizophrenia is a chronic mental illness with no known cure. I know, this paints a bleak picture; but it does not have to be. With proper treatment, you or your loved one diagnosed with schizophrenia or other SSD’s can still go on to live full and wholesome lives. 

Hope should not be lost on those living with schizophrenia. We must embrace and integrate them into our community and help support them in their life journey.