May 24 World Schizophrenia Day: Support is needed, not stigma!

May 24 is World Schizophrenia Day. According to World Health Organization data, schizophrenia affects 21 million people worldwide. Schizophrenia is not a rare disease as is often thought! One in every 100 people has a risk of developing this disease during their lifetime, and it does not stem solely from genetic predisposition. Environmental factors also play a major role. Being an immigrant, being in a minority position in society, or even living in a socioeconomically disadvantaged region can increase the risk of schizophrenia. Schizophrenia is a chronic and episodic psychiatric disorder that leads to impairments in thought, perception, emotion, and behavior. It usually begins in late adolescence or early adulthood.

However, the biggest problem for patients is not the disease itself, but being stigmatized by society! Prof. Dr. Alp Üçok from Moodist Psychiatry and Neurology Hospital, an expert who has been working with schizophrenia patients for years, issues important warnings on this subject:

“NO ONE WILL EVER SEE THE GOOD THINGS WE DO, SOCIETY ONLY SEES US IN BAD NEWS”

Prof. Dr. Üçok states: “Schizophrenia is a chronic disease, just like diabetes or hypertension. However, this does not mean it cannot be treated. Treatment is possible, but due to prejudices in society, patients hesitate to go to the doctor and show resistance to treatment. He underscores that the statement, ‘People will never see us doing anything good because we are only reflected in the media with bad news,’ is very meaningful and the clearest expression of the situation.”

“Schizophrenia patients can be successful in their jobs and lead a normal life. However, because they are always mentioned with negative examples in the news or in society, people cannot see this reality. Yet, many violent incidents are not caused by a mental illness. Every year in Turkey, many women are subjected to violence and murdered, but the vast majority of the perpetrators are not psychiatric patients! Despite this, schizophrenia patients are unfairly stigmatized.”

CANNABIS USE AND CHILDHOOD TRAUMA: THE MOST IMPORTANT ENVIRONMENTAL RISKS

The prevalence of schizophrenia is 1 percent, but this rate rises to 10 percent in those with a family history of the disease. In other words, genetic factors are effective but not solely decisive.

The expert doctor states that one of the biggest risk factors in this situation is substance use:

'Cannabis use is becoming widespread in the world, but its harms are being ignored. We recommend that people use medication for treatment, and they say, “I am against chemicals,” but they do not know the chemicals inside cannabis.'

In addition to cannabis, childhood traumas also increase the risk of schizophrenia. Physical and emotional neglect, violence experienced during childhood, or sexual trauma can alter the brain's response to stress, leading to psychosis in later years.

Prof. Dr. Alp Üçok: One in every hundred people carries the risk of contracting this disease during their lifetime. However, the frequency of occurrence in patients' families rises to 10 percent. That is, in 1 out of every 10 patients, the disease is seen in the family. Genetic mutations, which we call changes in the gene structure, can also lead to the disease. Genetics has a role, but environmental factors also have a role. The most important factor is substance use. Unfortunately, as cannabis becomes widespread in the world, the belief that cannabis is harmful is also decreasing. We give people medication, they say, “I am against chemicals,” but they do not know that there are chemicals in cannabis. However, in some individuals, psychosis continues even if they stop using cannabis. Furthermore, there are sexual, physical, and emotional traumas increasing in society. These, such as a child being exposed to violence when they are small, being exposed to sexual violence, and the neglect of basic emotional and physical needs, can lead to psychosis just as they can lead to depression. This affects the hormonal responses given by the body, the amount of cortisol secretion increases, and the system that works to protect it from threats begins to work against it.

Expressions like “I didn't receive love when I was a child” are common, but if these are truly serious, they increase the risk of psychosis. If we ask, is it increasing? The living conditions that lead to schizophrenia are increasing. Violence, substance use, living in big cities—these increase schizophrenia, so the rate of schizophrenia may also be increasing. In parallel with this, there is no dramatic increase. Because it is not possible to attribute it to a single cause.

For example, living in poor living conditions in an affluent neighborhood is also associated with an increase in the risk of schizophrenia. Being in a minority position, being an immigrant, or having a different religious or ethnic group increases the risk of psychosis in a person. The reason for this is that the gray matter in the brain is seen to be thinner. These are all hormonal and genetic changes. The event is not just about what happens when being born from a mother and father. Injustice in income distribution, inequality in education, and being a minority can also be risk factors. In other words, schizophrenia can emerge not with vague expressions like “They weren't loved, they didn't receive attention, they weren't happy,” but with the coming together of truly clear, measurable risk factors.

SCIENTIFIC FACT: SCHIZOPHRENIA IS TREATABLE, LIFE GOES ON

Psychiatrist Dr. Erhan Yüksek draws attention to the International Schizophrenia Study conducted by the World Health Organization, which lasted between 15 and 25 years: the study strongly reveals that schizophrenia is a disease with high potential for recovery. Within the scope of this study, hundreds of patients from 16 different countries were followed for 15 to 25 years, and striking results were obtained.

Yüksek says: “Recovery is not just the disappearance of symptoms; it is the person leading a productive, meaningful, and connected life.”

The prominent data of the study were as follows: While two-thirds of the subjects in Cali, Colombia, were working full-time during the follow-up, it was observed that more than 60% of the subjects in Nottingham, England, were free from all psychotic symptoms. In the strong results of the England example, the multidisciplinary organization of Community Mental Health Teams and ensuring long-term follow-up played an important role. According to this study, even 15% of patients who did not recover in the initial period showed recovery in the late period.

It was observed that individuals receiving medication, especially those living in developing countries, showed a higher rate of functional recovery thanks to strong family ties and social support.

These data show that schizophrenia is not just a biological but a social disease; with the right support, the potential for recovery is very high.

Schizophrenia is a dynamic process that fluctuates and is open to change. This study shows that a large portion of schizophrenia patients can eventually get rid of their symptoms, return to social life, and lead a productive life. Negative prejudices regarding schizophrenia unfortunately act as an obstacle to even sharing recovery stories. However, scientific data now state this much more clearly: Schizophrenia, when handled at the right time and in the right way, contains a promising recovery process.

In conclusion; schizophrenia is a health problem that society must face. It is treatable, recovery is possible, and life goes on. However, stigma and prejudices slow down this process.

SCHIZOPHRENIA Symptoms are divided into three main groups:

1. Positive Symptoms (symptoms that are the result of the malfunctioning of mental functions):

• Hallucinations: Most frequently auditory hallucinations (hearing voices)

• Delusions: Unreal, fixed beliefs (e.g., thinking one is being followed)

2. Negative Symptoms (results of normal mental functions working in a missing, diminished form):

• Blunting of affect (erasure of emotional expressions on the face)

• Social withdrawal

• Poverty of speech

3. Cognitive Symptoms:

• Distractibility

• Impairment in memory and executive functions

• Difficulty in organizing thoughts

The psychotic period is the flare-up phase of the disease. During this period, the individual;

• May lose their perception of reality,

• May hear voices that are not there,

• May believe in unreal thoughts with certainty,

• Communication with the environment is disrupted.

During this period, the patient may be fearful, withdrawn, or agitated. However, with treatment, these symptoms can often regress and the person can return to a functional life.