During the 1950s, mentally disordered people who were harmful to society and
themselves could be treated with medications and were able to return safely to their
communities. During the 1980s, the cost of health care increased more than any other
cost in our national economy. As a result, strategic planning has been made to reduce
costs. "The political decision made to deinstitutionalize chronic mental patients started
with the appearance of phenothiazine medications. Dramatically reducing the instability
influenced by psychosis, these medications were of great significance to many
individuals with serious mental disorders. At both the state and federal levels,
legislators looked at the high cost of long-term psychiatric hospitalization. Social
scientists guaranteed them that community-based care would be in the best interests of
all concerned: the mentally ill and the general, tax-paying public (Barry 13)." It was
believed that a social breakdown syndrome would develop in chronically mentally ill
persons who were institutionalized.
The characteristics of this syndrome were
submission to authority, withdrawal, lack of initiative, and excessive dependence on the
While deinstitutionalization was kindhearted in its primary logic, the actual
execution of the concept has been greatly undermined by the lack of good community
alternatives. At this time a large amount of the individuals using community mental
health treatment services are the homeless. Nearly half of the homeless are chronically
mental ill. These individuals are often separated from their families and all alone on the
dangerous street. These homeless schizophrenics stay away from social structures
such as community health treatment centers. Since they start a new life of
independence they often stop taking their medications, become psychotic and out of
place, and begin to live on the street. Since the schizophrenics are deinstitutionalized
they are thrown into a whole new world of independence. Since their brain functions
different than the usual human being they can't cope with the problems of life. The
schizophrenics drive themselves crazy wanting to kill themselves and others in order to
escape from this perplexing world.
Schizophrenia is the most common psychoses in the United States affecting
around one percent of the United States population. It is characterized by a deep
withdrawal from interpersonal relationships and a retreat into a world of fantasy. This
plunge into fantasy results in a loss of contact from reality that can vary from mild to
severe. Psychosis has more than one acceptable definition. The psychoses are
different from other groups of psychiatric disorders in their degree of severity,
withdrawal, alteration in affect, impairment of intellect, and regression.
The severity of psychoses are considered major disorders and involve confusion
in all portions of a person's life. Psychosis is seen in a wide range of organic disorders
and schizophrenia. These disorders are severe, intense, and disruptive. A person with
a psychotic disorder suffers greatly, as do those in his or her immediate environment.
Individuals suffering from withdrawal are said to be autistic. That is, the person
withdraws from reality into a private world of his or her own. The psychotic individual is
more withdrawn than a person with a neurotic disorder or any other mental disorder.
The affect, mood, or emotional tone in a person with a psychotic disorder is immensely
different from that of normal affect. In the mood disorders, one observes the
exaggeration of sadness and cheerfulness in the form of depression and mania. In the
schizophrenic disorders, affect may be exaggerated, flat, or inappropriate.
In psychotic disorders, the intellect is involved in the actual psychotic process,
resulting in derangement of language, thought, and judgment. Schizophrenia is called
a formal thought disorder. Thinking and understanding of reality are usually severely
impaired. The most severe and prolonged regressions are seen in the psychoses,
regression. There is a falling back to earlier behavioral levels. In schizophrenia this
may include returning to primitive forms of behavior, such as curling up into a fetal
position, eating with one's hands, and so forth. The symptoms of schizophrenia usually
occur during adolescence or early adulthood, except for paranoid schizophrenia, which
usually has a later onset. The process of schizophrenia is often slow, with the
exception of catatonia, which may have an abrupt onset. As an adolescent, a person
who later develops schizophrenia is often antisocial with others, lonely, and depressed.
Plans for the future may appear to others as vague or unrealistic.
It is possible that there may be a preschizophrenic phase a year or two before
the disorder is diagnosed. This phase may include neurotic symptoms such as acute or
chronic anxiety, phobias, obsessions, and compulsions or may reveal dissociative
features. As anxiety mounts, indications of a thought disorder may appear. An
adolescent may complain of difficulty with concentration and with the ability to complete
school work or job-related work. Over time there is severe deterioration of work along
with the deterioration of the ability to cope with the environment. Complains such as
mind wandering and needing to devote more time to maintaining one's thoughts are
heard. Finally, the ability to keep out unwanted intrusions into one's thoughts becomes
impossible. As a result, the person finds that his or her mind becomes so confused and
thoughts so distracted, that the ability to have ordinary conversations with others is lost.
The person may initially feel that something strange or wrong is going on.
He or she misinterprets things going on in the environment and may give mystical or
symbolic meanings to ordinary events. The schizophrenic may think that certain colors
hold special powers or a thunderstorm is a message from God. The person often
mistakes other people's actions or words as signs of hostility or evidence of harmful
intent. As the disease progresses, the person suffers from strong feelings of rejection,
lack of self-respect, loneliness, and feelings of worthlessness. Emotional and physical
withdrawal increase feelings of isolation, as does an inability to trust or sociate with
others. The withdrawal may become severe, and withdrawal from reality may be
noticeable from hallucinations, delusions, and odd mannerisms. Some schizophrenics
think their thoughts are being controlled by others or that their thoughts are being
broadcast to the world. Others think that people are out to harm them or are spreading
rumors about them. Voices are usually heard in the form of commands or belittling
statements about his or her character. These voices may seem to appear from outside
the room, from electrical appliances, or from other sources.
There are many different factors that lead to schizophrenia. The main way to
acquire schizophrenia is through heredity. A person has a 46% chance of getting
schizophrenia if his or her mother and father has it. One identical twin has a 46%
chance of getting schizophrenia if the other twin acquires it (Coon 546). There are also
some environmental factors that lead to schizophrenia. One is if the mother gets the flu
during the second trimester of pregnancy causing brain damage to the unborn child.
Another factor is complications at birth that could affect the child mentally. Another
factor causing schizophrenia is stress because the mind is overworked and eventually
can't function properly. An important factor concerning schizophrenia is how a child is
raised. If the child has abusive parents, he or she will have serious mental problems in
Early in this disease, there may be obsession with religion, matters of the
supernatural, or abstract causes of creation. Speech may be characterized by unclear
symbolisms. Later, words and phrases may become puzzling, and these can only be
understood as part of the person's private fantasy world. People who have been ill with
schizophrenia for a long time often have speech patterns that are disoriented and
aimless and deficient of meaning to the casual observer. Sexual activity is frequently
altered in mental disorders. Homosexual concerns may be associated with all
psychoses but are most prominent with paranoia. Doubts concerning sexual identity,
exaggerated sexual needs, altered sexual performance and fears of intimacy are
prominent in schizophrenia. The process of regression in schizophrenia is
accompanied by increased self-fixation, isolation, and masturbatory behavior.
The schizophrenic person finds himself or herself in a painful dilemma. He or
she retreats from personal intimacy or closeness because of the intense fear that
closeness will be followed by ensuing rejection or harm. This retreat from intimacy
leaves the person lonely and isolated. This dilemma often becomes the nurse's
dilemma. The nurse wishes to form a productive emotional bond but at the same time
seeks to lessen the client's anxiety. For the schizophrenic person, moves toward
emotional closeness will eventually increase anxiety.
The dopamine theory of schizophrenia is based on the action of the neuroleptic
drugs, better known as antipsychotic drugs. Neuroleptics are the drugs of choice for
treating the symptoms of schizophrenia. The neuroleptics are believed to block the
dopamine receptors in the brain, limiting the activity of dopamine and reducing the
symptoms of schizophrenia. Amphetamines, just the opposite, enhance dopamine
transmission. Amphetamines produce an excess of dopamine in the brain and can
provoke the symptoms of schizophrenia in a schizophrenic client. In large doses,
amphetamines can simulate symptoms of paranoid schizophrenia in a
nonschizophrenic person. Some symptoms of schizophrenia are due basically to
hyperdopaminergic activity. Other symptoms, such as apathy and poverty of thought,
are related to neuronal loss.
Drugs reduce most of the disturbing, disorganizing, and destructive aspects of
the schizophrenic person's behavior. Drugs, however, do not improve or affect the
fundamental stupor, unresponsiveness, lack of ambition, and symbolic defects. Group
therapy is especially useful for clients who have had one or more psychotic breaks. It
has been shown that groups can benefit the client in the development of interpersonal
skills, resolution of family problems, and the effective use of community supports.
Groups allow opportunities for socialization in safe settings, the expression of tensions,
and sharing problems. The most useful types of groups for schizophrenics are groups
that help the client develop abilities to deal with such issues as day-to-day problems,
sharing consistent experiences, learning to listen, asking questions, and keeping topics
in focus. Groups available on an outpatient basis over a long period of time allow for
individual growth in these areas. It would help greatly if better rehabilitation programs
were offered after hospital treatment. One such approach is the use of half-way
houses, which can ease a patient's return to the community. The half-way houses offer
patients supervision and support, without being as restrictive as hospitals. They also
keep people near their families. Most important, half-way houses can reduce a
person's chances of being readmitted to a hospital.
Although the therapy and drugs help the schizophrenics deal with their problems
tremendously there is not enough to go around because states are closing their mental
institutes for financial reasons. Even though the cost of mental institutes are high, the
schizophrenics are better off being kept in them because they could cause a huge
uproar on the streets. Without the mental institutes the schizophrenics will get worse
because they are unable to live independently. Many schizophrenics might even be
harmful to society because their brain is out of control. The paranoid schizophrenics
could go on a rampage and try to kill everyone in sight because they think that
everyone is out to hurt them. This could be the future of our world if we don't take time
to treat these schizophrenics who desperately need it no matter what the cost.
Barry, Patricia D. Mental Health and Mental Illness. Philadelphia: J. B. Lippincott,
Coon, Dennis. Introduction to Psychology. New York: West Publishing Company, 1995
McCuen, Gary E. Treating the Mentally Disabled. Hudson, Wisconsin: Gary E.
Varcarolis, Elizabeth M. Psychiatric Mental Health Nursing. Philadelphia: W. B.