Schizophrenia and a lack of desire to interact with

Schizophrenia
and the Entertainment Media

 

            Schizophrenia is a disease that’s fascinated me since
childhood for a number of reasons.  I
grew up with two aunts that have schizophrenia, one from each side of the
family, and my grandmother used to tell me stories of her sister who had the
disease.  It used to worry me that I
might get schizophrenia at some point in my life because relatives that have the
disease didn’t show any symptoms until their college years.  Another reason I’m so interested in schizophrenia
is because one aunt with schizophrenia has a twin sister and her twin has never
had any symptoms of the disease at all. 
I also find it strange that my two aunts with schizophrenia didn’t have
similar presentations of the disease except that they both loved cigarettes which
is an oddly common addiction amongst schizophrenics (Tidey, Cassidy, &
Miller, 2016).  One aunt is able to live
on her own as long as she stays on her medicine and she can hold a logical
conversation.  The other aunt had to live
in a facility her entire life and would just nod and smile at you when you talked
to her.  The complexity and mystery
surrounding this disorder have always inspired me to learn more about it.   

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            Schizophrenia affects between 0.6% and 1.9% of the U.S.
population afflicting males and females equally (Patel, Cherian, Gohil, &
Atkinson, 2014).  Schizophrenia alters
the way a person perceives reality as well as impairing their mood and
behavior.  Symptoms of schizophrenia
which typically present during late adolescence or early adulthood are
classified as positive, negative, or cognitive. 
Positive symptoms include hallucinations, delusions, and bizarre
thoughts.  These symptoms are said to be
positive not because they are good, but because they denote an excess of normal
function whereas negative symptoms indicate a loss of function.  For example, loss of motivation, numbed
emotional responses, and a lack of desire to interact with people are negative
symptoms of schizophrenia.  Cognitive
symptoms refer to an impaired ability to concentrate, remember, understand, or
express oneself (Patel et al., 2014). 
The positive symptoms seem to get the most attention by the media while
negative and cognitive symptoms are often ignored. 

            Even though researchers have been studying schizophrenia
for over a hundred years’ no one knows what causes it, there’s only theories.  Genetics has a lot to do with it and
researchers believe that heritability accounts for 70% of disease risk in
schizophrenia (Moran et al., 2016). The disease runs in families and when one
identical twin has schizophrenia there is almost a 50% chance the identical
sibling will have it as well.  On the
same note, an identical twin has a 50% chance of avoiding schizophrenia when
their genetically indistinguishable counterpart has the disorder indicating
that the environment plays a part as well (Moran et al., 2016).  Some environmental influences such as
prenatal infections with the flu or Toxoplasmosis Gondi have been shown to
increase the risk of developing schizophrenia (Moran et al., 2016).  Drug abuse and stress are thought to play a
part in triggering schizophrenic psychosis as well (Dean, 2012).

            The most dominant theory regarding the pathophysiology of
schizophrenia, and its pharmacological treatment, revolves around an excess of
dopamine in the mesolimbic, or reward pathways of the brain and a lack of
dopamine in the prefrontal cortex (Brisch et al., 2014).  Other neurotransmitters like serotonin, glutamate,
and gaba are thought to play a role in the symptoms of schizophrenia too but
the specific effect they have on the disease is speculative and not as well-known
as dopamine (Patel et al., 2014). 

            Excessive dopamine synthesis and release is believed to
be a major cause for the positive symptoms of schizophrenia. All antipsychotic
medications that relieve the symptoms of schizophrenia antagonize the dopamine
pathways in some way shape or form (Howes et al. 2012).  Also, stimulant drugs like amphetamines that
increase the release of dopamine in the brain can cause symptoms of psychosis
reinforcing theories that dopamine is a major causative agent in schizophrenia
(Yang & Tsai, 2017).  The original
antipsychotics used to treat schizophrenia are known as typical antipsychotics
and they shut down dopamine 2 receptor sites hard but at the cost of severe
side effects.  Furthermore, while the
typical antipsychotics address the excess dopamine in the mesolimbic pathways
they do nothing about a lack of dopamine in the prefrontal cortex which is also
associated with schizophrenia (Sullivan, Clark, & Berg, 2015). 

            A second generation of antipsychotics known as atypical
antipsychotics were developed to address the shortcomings of the first
generation meds.  These atypical
antipsychotics are thought to have a weak affinity for dopamine 2 receptors and
a strong affinity for 5-ht2 receptor sites, or serotonin binding sites.  Additionally, atypical antipsychotics can
antagonize dopamine receptors in some areas while they agonize dopamine
activity in other areas (Sullivan, Clark, & Berg, 2015).  The effectiveness of these drugs in treating
schizophrenia and their affinity for 5-ht2 receptor sites brought the attention
of researchers to the neurotransmitter serotonin.  While little is known about how serotonin
itself effects the pathology of schizophrenia it has been found that activity
at serotonin receptors 5-ht2a and 5-ht2c, modulate the release of dopamine in
the brain (Sullivan, Clark, & Berg 2015). 
Whether serotonin influences characteristics of schizophrenia by itself
is unknown.    

            Glutamate a ubiquitous excitatory neurotransmitter in the
brain may play a role in the negative and cognitive symptoms of
schizophrenia.  Post-mortem studies have
found lower than normal levels of glutamate in the cerebrospinal fluid of
schizophrenics. Drugs that block glutamate mediators that link glutamate to the
brains cortex, limbic system, and thalamus cause schizophrenia like symptoms in
healthy individuals (Yang & Tsai, 2017), while drugs that enhance the
functioning of glutamate receptors have been shown to improve the symptoms of
schizophrenics when used in conjunction with antipsychotics (Saleem, Shaukat,
Gul, Arooj, & Malik, 2017).

            Gaba, an inhibitory neurotransmitter is currently being
evaluated for its role in the pathophysiology of schizophrenia.  Lower levels of gaba correlated with poor
scores on attention tests in schizophrenic patients.  Post mortem studies show that schizophrenics
have a reduced level of gaba and older living patients have lower levels of it
as well.  However, studies also show that
younger schizophrenic patients have higher levels of gaba meaning it’s likely that
antipsychotic medication has an effect on its levels (Rowland et al., 2013).  The exact role of gaba in schizophrenia is
still unknown.   

            While the pathophysiology of schizophrenia is of great
interest to scientists and medical researchers, it’s not really discussed or
portrayed when schizophrenia is the subject of entertainment.  Instead, the media tends to focus on the
positive symptoms of schizophrenia like hallucinations, delusions, and paranoia
because these symptoms make for better entertainment.  So when judging whether or not the media has
been accurate in presenting schizophrenia this paper will only use the symptoms
of schizophrenia as the basis of what is true and what is not.  It’s also important to note that no two cases
of schizophrenia are exactly alike.   In some rare cases, schizophrenia symptoms
begin start age five and other times it starts at age 40.  One schizophrenic might lose 30 intelligence
quotient points while another person retains normal cognitive function.  Some schizophrenics are paranoid, but move
around freely while others are catatonic and stare at the wall all day
long.  This means that in most cases,
it’s hard to be inaccurate in portraying the disease because so many
combinations of symptoms are possible in schizophrenia.  With this in mind, this paper will mention
when the media presents schizophrenic symptoms that are possible but are very
unlikely or atypical.

            The first movie titled Donnie Darko features a schizophrenic 16-year-old named Donnie
Darko who narrowly avoids death in the first few minutes of the movie.  The movie starts at midnight when a jet
engine from parts unknown plummets from the sky into Donnie’s room.  Donnie would have died but he is awoken by
Frank, a man in a scary looking rabbit costume that only Donnie can see and
hear.  Frank lures Donnie out of his room
telling him that the world is going to end in about a month as the jet engine
smashes into his room.  Later on Donnie’s
family has dinner and it’s revealed that Donnie has a history of emotional and behavioral
problems when Donnie’s younger sister reveals that Donnie hasn’t been taking
his medication.  Shortly after dinner a
scene shows Donnie taking his medication while standing in front of the
bathroom mirror.  During this scene,
Frank, the man in the scary rabbit suit that Donnie hallucinates, appears and
tells Donnie to break the water-main at his school.  Donnie has a few of these hallucinations
throughout the movie where Frank compels him to commit dangerous acts of
vandalism or arson.  When Donnie commits
these acts under Franks command, he does so with a shuffling gait and blunted
affect.  However, when Donnie is with
friends and his girlfriend he seems fine although a little awkward at times
which could be said about any normal teenager. 
Midway through the movie Donnie sees and hears Frank during a session
with his psychologist and afterwards the psychologist tells Donnie’s parents
that she believes he is suffering from paranoid schizophrenia.   

            Discussion of any more of the film might spoil it and
enough of its schizophrenic material has been summed up to make a judgement on
it.  The movie has been accurate because
Donnie’s history of emotional and behavioral problems is consistent with the
prodromal phase of schizophrenia.  The
prodromal phase is a period characterized by significant social disability that
occurs several years before the emergence of psychosis. Donnie’s history of emotional
and behavioral problems could be considered the prodromal phase of his
schizophrenia (McGory & Yung, 2010). 
The movie has been accurate with its portrayal of command
hallucinations, hallucinations in which an imaginary voice or person tells the
schizophrenic to do things.  Command
hallucinations are associated with an acute psychotic state and are especially
dangerous during a person’s first psychotic break because they increase the
risk of that person committing suicide or homicide (Saha, Singh, & Nischal,
2015) (Ventriglio et al., 2016). 

             Jake Gyllenhaal,
who plays Donnie, does an excellent job showing a blunted affect and awkward
gait which are negative symptoms associated with schizophrenia.  However, Donnie only shows these negative
symptoms when he’s actively hallucinating when it would be more likely that a schizophrenic
would have these symptoms even when not hallucinating.  The movie is also less accurate in showing
Donnie’s behavior at school and his social interaction with friends. Donnie is
able to keep and maintain healthy relationships with friends and his grades at
school are very good, which is inconsistent with an adolescent experiencing his
or her first psychotic break but not impossible (Patel et al., 2014).  I think that the makers of this film gave
Donnie good social skills and relationships on purpose despite his diagnosis of
paranoid schizophrenia.  Donnie’s strong
relationship with his girlfriend is a key part of the movie’s plot so it was
necessary to ignore the symptom of social isolation, which often accompanies
paranoid schizophrenia in order for the movie to work.  

            The next movie we’ll examine is called A Beautiful Mind.  This movie was inspired by the true life
of John Nash, a mathematician and schizophrenic who won the Nobel prize in
economics along with other prestigious awards throughout his life.  Within the first five minutes of the movie a
young John Nash is shown interacting with graduate school colleagues.  Russel Crowe, the actor that plays John Nash,
does an excellent job acting like a schizophrenic with his downcast eyes and
his awkward social skills and mannerisms. 
It soon becomes clear in following scenes that John Nash lacks social
grace and prefers his own company which is common amongst paranoid
schizophrenics and a sharp contrast to Donnie Darko’s more social personality.  After graduating Nash gets a position
teaching at MIT along with working for the pentagon cracking U.S. enemy
codes.  It is at this point in his life
that Nash has a hallucination that a government agent named Parcher is giving
him a complex government mission to scour magazines and newspapers for Soviet
codes. 

            Therefore, John is left with the delusion that he is
doing top secret work for the government when he is really just working on
nonsense.  John’s delusion becomes more
and more elaborate to the point where he becomes afraid for his life thinking
that others are conspiring against him. 
John even assaults someone while trying to flee from imaginary enemies
which leads to his hospitalization where he is diagnosed as a paranoid
schizophrenic.  John is given treatment
for a year and is released on medication. 
The medicine takes care of John’s psychosis, but it deadens his
mathematical genius which causes him to stop taking medication and have a
relapse of symptoms.  After being
confronted by his wife over his relapse and medicine noncompliance John assures
her that he knows he is psychotic and that he can overcome his disease by sheer
willpower.  John learns to live with his
hallucinations and delusions and works around them as though they were merely
distractions.  John gets his job back as
a professor at MIT and lives the remainder of his life as a successful and a
highly acclaimed member of society. 

            This film was mostly accurate. Paranoid delusions are the
most common type of delusion and they often occur alongside hallucinations (Joyce
& Roiser, 2010).  Nash also experiences
his first psychotic break in his late twenties to early thirties, which is also
typical of the disease (Patel et al., 2014). 
Also, when John stops taking his medication he has a complete relapse of
his psychotic symptoms which happens with 60-80% of schizophrenics who come off
of their medicine (Patel et al., 2014). 
The film starts to show a very atypical recovery from schizophrenia after
John Nash’s recovery from his second psychotic break.  John is able to overcome his hallucinations
and delusions by using logic, understanding they aren’t real, and then ignoring
them without using medication. 
Antipsychotics are the cornerstone of treatment for schizophrenia and
most schizophrenics will not be able to function without them, but John is able
to recover without them.  Furthermore,
even with medication a person would need a great deal of therapy and support
from friends and family to live a successful life with schizophrenia and this
film didn’t show John receiving any of these things.  Instead, the movie showed a decade long montage
where John ignores his hallucinations until he is able to function
normally.  I guess the movie glossed over
John’s long road to recovery because there is only so much content you can fit
into a two-hour movie and time was better spent glorifying a remarkable man
that lived a difficult life.  If A Beautiful Mind, weren’t based on a
true story, I would have thought John Nash’s recovery fictitious based on how
the film presented it, but the storie’s validity just goes to show how unique schizophrenia
can be.             

            The final film discussed will be 1971’s The Ruling Class.  This movie is a comedy and it was made over
40 years ago so it isn’t very accurate or sensitive towards schizophrenia.  This film starts off with the Earl of Gurney,
an English ruler of some sorts, dying. 
In his will the Earl leaves his titles and estates to his only surviving
heir Jack, a paranoid schizophrenic. 
Jack resides in a private institution where he can come and go as he
pleases leaving him able to accepts his late father’s titles and estate.  According to Jack’s psychiatrist, Jack is a
paranoid schizophrenic with delusions of grandeur believing that he’s Jesus
Christ.  So Jack, played by famous actor
Peter O’Toole, parades around dressed like Jesus, blesses people, and sleeps on
a cross instead of a bed.  Jack also has
bizarre hallucinations from time to time throughout the film.  When people call Jack by his real name rather
than Jesus Christ, Jack makes claims that people are plotting against him and throws
tantrums.  Jack’s delusions get him into
all sorts of trouble and shenanigans so his family tries to come up with a plan
to lock him up in an institution.  Family
members ask Jack’s psychiatrist to lobotomize him but the doctor refuses.  Eventually the psychiatrist is convinced to
give Jack a primitive form of electroconvulsive therapy.  The electroconvulsive therapy seems to work
when Jack responds to the name Jack rather than Jesus, but it turns out that now
he thinks he’s the infamous killer Jack the ripper. 

                  One thing
that The Ruling Class gets right is
that schizophrenics do experience delusions of grandeur.  Studies have shown that when delusions are
religiously themed, they are held with more conviction and pervasiveness than
other delusions. (Grover, Davuluri, & Chakrabarti, 2014).  Although the year the movie takes place is
unknown, it definitely takes place before 1971, so it can be said that another
thing that the movie gets right is that treatment options were very limited at
the time.  It’s easy to say this because
treatments for schizophrenia aren’t so great presently.  After this, nothing about the movie is
accurate which is forgivable because the movie’s intentions were to make people
laugh.

            Of the three movies discussed in this paper, only A Beautiful Life showed a schizophrenic
character in a positive light. 
Unfortunately, while showing the world that a schizophrenic can be a
valuable member of society, the movie downplays the importance of medication.  In Donnie
Darko, Donnie’s command hallucinations led to positive circumstances severely
downplaying how dangerous these symptoms can be for a schizophrenic.  The
Ruling Class made a mockery of the disease and showed its audience a
delusional clown for a few cheap laughs. 
All three of these movies emphasized the positive symptoms of
schizophrenia while largely ignoring the negative symptoms.  So even though all of these movies were
accurate in some form, none of them gave its audience a typical run of the mill
case of schizophrenia.  Movies showing
schizophrenia like this are hard to come by.

            When searching for movies with schizophrenia it became
clear that many critics and movie fans confuse split personality disorder,
antisocial personality disorder, and other mental illnesses with
schizophrenia.  Furthermore, searches for
movies with schizophrenia led predominately to horror films, then science
fiction, and then least commonly to stories based on true life.  It’s clear that the media is trying to
educate the public on schizophrenia and you can’t really blame them because
watching a two-hour movie about the real thing is depressing and boring.  I read plenty of plot summaries for films
based on true life and the only one that sparked my interest was A Beautiful Mind.  I’m interested in schizophrenia and I
couldn’t bring myself to watch the true to life films so imagine drawing the
attention of someone with no interest in the topic.    

            One solution is for the media to incorporate
schizophrenia in small informative doses. 
Maybe the main character of a television series has a schizophrenic
sibling who takes their medication daily while working at a book store, or
their schizophrenic neighbor needs a little help every so often when they get
confused.  Little bits like this could
present schizophrenia in an informative way without taking up too much time and
mental effort from the audience.     

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