Even as the public’s understanding of mental illness continues to evolve, some conditions are still commonly misunderstood and misrepresented. Fears and assumptions about a person’s behavior can lead to oversimplifications, stereotypes, and sometimes outright incorrect information.
This is often the case when it comes to schizophrenia, a mental disorder that can cause disruptions in thought processes and delusions that aren’t based in reality. According to the Treatment Advocacy Center, the number of people living in the United States with schizophrenia is estimated at 2.6 million adults, or about 1.1 percent of the population.
Even though schizophrenia is relatively rare, it’s one of the top 15 leading causes of disability worldwide. It’s estimated that the average life potential lost for people with the disorder is 28.5 years, according to the National Institute of Mental Health.
Here we cover seven important myths and facts about schizophrenia to help you separate the truth from fiction.
1. Fact: A Person’s Genes Can Increase the Risk of Developing Schizophrenia
“We know there is an underlying genetic component to schizophrenia,” says Jacob S. Ballon, MD, a professor of psychiatry and behavior sciences and the codirector of the INSPIRE Clinic, which provides interdisciplinary care for people experiencing psychosis, at Stanford University in Palo Alto, California.
There’s something called the polygenic risk score that can help determine what a person’s risk for different conditions may be, taking into account multiple genetic variants. “Unfortunately, that doesn't provide enough information to make a diagnosis or really guide a clinical treatment in schizophrenia,” says Dr. Ballon. That may never be possible because of the genetic complexity of the disease, he says.
“It’s not just one gene that causes the illness — it’s many, many genes that together are complicated and beyond our level of understanding,” he says. By using the current statistical model for schizophrenia that takes into account all known factors that relate to someone developing the illness, experts estimate that the genetic component constitutes about 10 percent of the risk, says Ballon.
RELATED: What Is Schizoaffective Disorder?
2. Myth: People With Schizophrenia Have Multiple Personalities
This myth certainly is persistent, but it’s hard to say where it started, says Ballon. “One of the best explanations I’ve heard comes from breaking down the word schizophrenia. Etymologically it comes from 'schizo' meaning split and 'phrenia' meaning mind,” he says. Putting those two meanings together might lead people to draw the wrong conclusion and think someone with schizophrenia has two or more personalities.
“When a person displays multiple personalities, it’s called dissociative identity disorder (DID). It’s a different disorder and has different risk factors,” says Ballon, adding that DID is more closely related to the experience of trauma.
3. Fact: Marijuana Use Is Associated With an Increased Risk of Schizophrenia
“The association between the two is concerning. Let’s first look at the increased risk for psychosis associated with marijuana use, and the resulting increased risk for schizophrenia,” says Ballon. An Australian study published in Archives of General Psychiatry showed that regular cannabis users double their risk of developing psychosis from .07 percent to .14 percent.
“We know epidemiologically, as more potent strains of marijuana enter a community, so too does the rate of psychosis increase,” says Ballon, referencing work by Robin Murray and colleagues published in World Psychiatry in September 2016.
Marijuana Is More Potent and More Available Than in the Past
“Take the state of California, where marijuana use is now legal. Marijuana is more potent, people use it more often, and they use it more deeply,” says Ballon. All the things that we learned about marijuana a generation ago are probably not accurate anymore because the marijuana is so much stronger and used so much more frequently by the average user, he says.
In the next several years, we may see an unintended consequence of legalization in certain parts of the U.S. — a rise in the number of people with certain mental health conditions. “Time will have to tell, but I would be worried about it,” says Ballon.
RELATED: Can Marijuana Cause Schizophrenia?
4. Myth: People With Schizophrenia Are Prone to Violence
“People with schizophrenia as a group are not more prone to violent behavior,” says Ballon. “If you look at some of the most significant crimes that have happened, it may seem that a disproportionate amount of those crimes were committed by people with mental health problems, maybe even people with schizophrenia chief among them, says Ballon. “But if you look at people with schizophrenia, are they more likely to be violent than the average person, especially if they’re not in the midst of a crisis, then the answer would be no, they’re not,” he says.
Research published in PLoS?Medicine?found an association with violence and schizophrenia and other psychoses, but most of the excess risk was due to substance abuse in those people. The authors concluded that the risk of violent behavior in people with psychosis and substance abuse was similar to that of the risk for people with substance abuse and no psychosis.
5. Fact: People With Schizophrenia Have a Higher Risk of Suicide?
People with schizophrenia have a higher risk of?suicide, says Ballon. It’s estimated that about 10 percent of people with the condition will die by suicide, and suicide attempts for people with the condition are even higher. Canadian research published in 2016 in?Schizophrenia Research and Treatment found that the lifetime prevalence of suicide attempts among people with schizophrenia was 39.2 percent compared with 2.8 percent in the general population.
These attempts can be at any number of points at the course of the illness, says Ballon. “It can be when a person may be having symptoms and hearing voices telling them to kill themselves. It could be shortly after a person is recovering from many symptoms — they may look at what happened in a different way and be worried about their future and more likely to want to harm themselves at that point,” says Ballon.
This can be especially true when people are taking on certain internalized stigmas about what they’re likely to achieve when they have a mental illness, says Ballon. “They feel like they’re not going to be able to have the life they were expecting; they may be at great risk at that point,” he says.
“There’s an overlap between schizophrenia and depression as it is, and that in and of itself may also increase the risk of people wanting to harm themselves,” he adds.
6. Fact: It Is Common for People With Schizophrenia to Have Delusions That Aren’t Based in Reality
“The simplest explanation of a delusion is a fixed false belief that a person can maintain despite evidence to the contrary, and there can be a number of different types,” says Ballon. “There are persecutory delusions, where a person feels watched or followed. They might feel like the government is after them or that they have special information that somebody else might need to obtain from them. That can make a person feel very worried or scared.”
Another type is somatic delusions, where a person might feel contaminated, says Ballon. “The person might feel like something is wrong with their internal organs or maybe they think they have an illness that there isn’t any reason to believe they have,” he says.
“There can be delusions of grandeur where a person feels like they have special abilities or power in certain things. They might believe that they’re the president of the United States or Jesus. Maybe they believe they control the weather,” says Ballon.
“The hard part is that you can’t really talk somebody out of a delusion, so it can be very challenging to work with,” says Ballon. It’s important to keep in mind that the delusions themselves may indicate that a person is playing with a different set of facts about what’s going on in the world than most of us and their behavior may reflect that, he says. “Sometimes it’s helpful to step back and realize that although someone’s behavior may seem not to make sense, it can make more sense in the context of what may be some delusional thinking,” says Ballon. That can be a step toward empathizing and understanding, he says.
7. Myth: There Isn’t an Effective Way to Treat Schizophrenia
“There are a number of people who are treated for schizophrenia and are doing quite well,” says Ballon. He has treated people who work for large technology companies and other successful businesses, people who have graduated from college, and some who are getting married.
He cites Elyn Saks, PhD, a MacArthur Fellowship grant recipient and the associate dean at the University of Southern California Gould Law School, as an exceptional example of someone thriving with schizophrenia. Dr. Saks has written a book and given a TED Talk about her life with schizophrenia.
“Are these kinds of examples what every person with schizophrenia is going to experience? No,” says Ballon. “There’s going to be some definite variety there,” he says.
Along with the examples of people who are managing their condition well, there will be those who might more closely resemble the picture that many people have when they think of the condition — people on the street talking to themselves, he says.
Ballon says he tries to include the patient and the family in the decision-making process when it comes to treatment. “I want to make sure that we’re addressing more than just the psychotic symptoms for somebody, which means doing things beyond the medicine they take,” he says.
If people are able to participate in psychotherapy they can better extend the value of the medication and also apply some helpful principles to actual experiences in their life, says Ballon. “I want people to get help and support with school and employment because I believe they’ll be able to get back on an upward trajectory much more quickly if they get help at an early stage,” says Ballon.