True Life Producer/Director, Craig D'Entrone, figured a lot of people who watched tonight's True Life: I Have Schizophrenia might have more questions about the disease. Craig enlisted Dr. Ken Duckworth, medical director for NAMI (National Alliance on Mental Illness) to help out.
The True Life team wrote some questions to get the conversation started, but if you have questions for Dr. Duckworth, please post them in the "Comments" section. Dr. Duckworth will read them and post answers.
Q: Josh, Amber, Ben, and Sarah have such different symptoms. So what exactly is schizophrenia?
Dr. Duckworth: They all have different symptoms because there are many forms of schizophrenia. Symptoms of psychosis (loss of reality testing—the inability to perceive stimuli normally) such as hearing voices that others cannot hear, having fixed false beliefs (called delusions) for more than 6 months coupled with a decline in daily functioning are the criteria for the diagnosis. Given the complexity of the brain, people do not necessarily experience these symptoms in the same way. These symptoms may be rooted in what is likely overlapping brain system breakdowns that all have loss of reality testing as a core feature. We still have lot to learn about the biological underpinnings of schizophrenia.
Q: What causes schizophrenia and when does it usually start?
Dr. Duckworth: We know schizophrenia usually starts in the teen years through the early to mid twenties. Women often have onset a few years later than males.
We do not know the cause. The current thinking is that some genetic risks interact with environmental stressors to cause the problem. Often people seem isolated or odd for years before they develop active symptoms.
Q: Ben takes so many pills. How does he still have delusions?
Dr. Duckworth: Ben takes a lot of pills but medicines do not cure schizophrenia. Most people find meds help reduce the intensity of symptoms. A few find their symptoms stop completely. Some people don’t see they are ill at all, like Josh, and are resistant to taking meds —so it is very hard to judge if the medicine is helping them. Also, drugs of abuse work against the medications effectiveness. Unfortunately, there are also people who do not respond well to the medications. New medicines are coming out and may be able to help where other treatments have not.
Q: Amber says therapy has made a big difference for her. If schizophrenia is about having chemical imbalance in your brain, what are the benefits of therapy?
Dr. Duckworth: Amber benefits form talk therapy as she’s working to understand what has happened to her and how best to rebuild her life. She has been dealt a difficult card and therapy can help her play it the best way she can. Schizophrenia’s symptoms are a brain based, and the experience is mind based and that is where therapy can help. Therapists can also offer practical coping skills and strategies for getting along in everyday life, like going to class or work, going to stores or restaurants, and general social interactions. Friends, support groups like NAMI, school and work can also make a big difference in the individual’s experience.
Q: Josh smokes a lot of marijuana. How does smoking marijuana generally affect someone with schizophrenia?
Dr. Duckworth: Josh smoking marijuana raises his risk for trouble in several ways. Marijuana raises the risk that a person will develop schizophrenia in the first place--one estimate says 10% of people with schizophrenia smoked marijuana heavily before age 15. We also know that people who use marijuana who also have schizophrenia do not do as well when it comes to the important elements of being independent, like holding down a job, maintaining personal relationships, or keeping an apartment. Finally marijuana may make hallucinations worse. Narcotics Anonymous, Smart Recovery and AA are helpful pieces to the puzzle for many people with co-occurring substance issues. Most kids associate using alcohol with normal life and social interaction, so this is a real challenge in treatment for younger people with the illness.
Q: Is this true of other drugs too? What about just drinking?
Dr. Duckworth: Using hallucinogenic drugs like ketamine, peyote and LSD can also trigger psychotic symptoms, just like marijuana. Heavy alcohol use can indicate impending alcoholism, but may indicate trouble with other problems, like depression, bipolar disorder or ADHD. To that end, excessive drug or alcohol use may also be an attempt at "self medicating." Suicide rates are higher as are incarceration rates for people who use illicit drugs with major mental illness like schizophrenia.
Q: How do I know if what I’m experiencing (or my friend is experiencing) is schizophrenia?
Dr. Duckworth: If you know a person who is experiencing hallucinations they should get a work up by a doctor. Sometimes the problem is related to using certain drugs (see above) or a medical problem. It may be associated with another psychiatric concern like bipolar illness or depression, so getting a good evaluation and early treatment usually is helpful. Many people wait years to get help, unfortunately.
Q: Ben says when he heard Marcus it was a very intimidating voice and Sarah’s voices tell her to hurt herself and other people, but Josh talks about his voices like they are his friends. Is Josh’s experience unusual or can people with schizophrenia hallucinate good and bad things?
Dr. Duckworth: Voices are very personal experience and vary from person to person. Most commonly people find them to be negative and critical. I have met people who are comforted by their voices or who can find at times humor in what the voices say. But most people suffer with their voices in my experience, and have to learn to manage how they think about them, a technique called cognitive behavioral therapy. Some people find voices demeaning or tell them they should harm themselves, so a more individual understanding of these voices for the person is needed.
Q: Amber doesn’t really seem like she’s sick at all. Can schizophrenia go into remission?
Dr. Duckworth: Amber is doing well. Studies show many people do well over time with the condition. Since she is 19 and was only diagnosed a year ago, she illustrates that earlier intervention may benefit people. Many people report that their symptoms get less intense as they age, and they may find a place for themselves in a job, a relationship, or both. Amber’s involvement in NAMI is also a sign of her recovery from the condition. Her symptoms may return and this is where her coping strategies, supports and treatment relationships are all in her favor for dealing with recurrences.
Q: Is Josh’ mom doing the right thing by kicking him out?
Dr. Duckworth: Josh’s mom faces a real dilemma with how to handle Josh’s disinterest in getting help and his regular use of pot. Many parents have told me it can be a “damned if you do damned if you don’t” feeling for parents in this situation. If Josh was injured or suicidal, she would have to live with those difficult outcomes. I encourage parents to get help from a group like NAMI (www.nami.org), which has over 1110 affiliate groups for support and advocacy. There she can learn from other parents who have faced this dilemma, explore treatment options in her area, fight for better services, and not worry alone. Supporting people who live with schizophrenia and their families is one of the core reasons NAMI has come to exist across the nation.
Check out the resources on Think MTV to learn even more about Schizophrenia and other mood disorders, and find the support you need.