People are different and as a consequence, they behave differently. People have varying ways of thinking, talking and feeling. People have varying ways of seeing the world and going about their lives. Such a fact can be attributed to the unique qualities in every person that cannot be duplicated exactly to another.
However, there are certain strange and weird behaviours that border beyond mere peculiarity and cannot be simply disregarded for being so deviant. These could be instances when a mental illness is already suggested. As such, there arises the strong need to be conscious and aware of such behaviours.
There must be enough capability that will help detect the signified mental disorders or abnormality in the mental and psychological makeup. It must be kept in mind, however, that such necessity arises not for the purpose of discriminating among people who suffer from the disorder but to be able to properly address the situation because the manifestations of mental illnesses will be addressed and resolved if they are properly diagnosed and assessed.
Furthermore, there are also certain realities to take into account. There may be certain special needs and treatment that have to be given attention. This paper, for one, will explore the occurrence of schizophrenia and how it affects or is being affected by another reality, the learning disability of a person. Schizophrenia is one acute mental illness that may require special regard.
Opportunities for better health among people with mental illnesses are ever present, but they will remain to be unrealized if they are not known to the people. Thus, this paper aims to explore all these matters mentioned in relation to learning disabilities and the particular mental health problem of schizophrenia to better know the needs of the disorder as well the attitude of the people and the options offered today by the modern world.
Mental illnesses or disorders are basically problems in the way a person feels, thinks, talks or behaves. Various mental illnesses are classified into categories to easily identify among the symptoms and to easily address the problem. The two major groups are the ‘personality disorders and psychoses’. There are also considerations of putting anxiety disorders in another category (Turner, 1999).
Personality disorders can manifest in different cases. It has ‘milder’ versions where a person merely possesses peculiar and weird traits that can make him or her look eccentric in the eyes of other people. However, there are some more serious complications that can lead to having anti-social attitude and extreme difficulty to communicate and connect to other people. Such conditions can make being with other people as almost impossible (Turner, 1999).
The person suffering from the personality disorder can also bring so much distress to the people they deal with. There is no exact cause to attribute this type of disorder. It was only claimed that it is something that may be inherited or learned. Basically, some were able to find this to develop among people brought up in a certain environment and discipline. They may have the predispositions early on and this was only aggravated by the surroundings (Turner, 1999).
Psychosis on the other hand is a more serious category. It is characterized by the development of a distorted perception. Basically, the reality of the person is viewed in a very vague way. Psychosis disorders tend to not have a definite age or time of manifestation. They just develop unexpectedly and this can be aggravated even more by the occurrence of stressful events. There are two sub-groups in the psychosis category, schizophrenia and affective psychosis (Green, 2001). In this regard, the former category or schizophrenia and its relationship to another disorder, the learning incapability, shall be discussed in detail in the rest of this paper.
Nature and Manifestation of Schizophrenia
Throughout centuries, societies have dealt with ‘mad’ and ‘crazy’ people. Such mad characters figure in various pieces of literature. However, it was only in 1893 when a psychiatrist, Emil Kraepelin first gave the term ‘dementia praecox’ to the illness. This was later revised to ‘schizophrenia’ by another psychiatrist Eugen Bleuler because dementia does not properly fit the manifestations of the disorder (Turner, 1999).
From then on, many people have developed this notion that schizophrenia can be labeled to as the split personality disorder where an individual gives life to two personalities, just like the case of Dr. Jekyll and Mr. Hyde. However, this is purely a misconception. Schizophrenia and ‘split personality,’ or the dissociative identity disorder, are completely different situations. At some point, people may have mistaken the two because schizophrenia comes from the two Greek words ‘schizo’ and phrēn which literally means ‘split mind’ or ‘shattered mind’ (Turner, 1999).
Schizophrenia is basically a disease characterized by a distorted perception. It can start with simple deviation from reality like seeing the colour of things in a different hue than they really are. As the disorder advances into the system, the consequences can get graver. It can lead to hearing and seeing things that are not really there and being frightened that someone is out there to hurt him or her (Turner, 1999).
There has no direct common cause identified yet that all experts would agree with. Some studies claim that people who are related by blood to someone with schizophrenia will have a higher risk of developing the illness. There are also those who focus on the early stages of human growth, from the time of prenatal development. It is said that people with schizophrenia have a distinct brain structure (Harrison and Owen, 2003). Some also believe that this is due mainly to the stressful and drastic events confronted by the individual. There are also who proposes that most schizophrenic tendencies are brought about by excessive exposure to certain substances and drugs.
Today, the trend is to adopt the ‘stress-vulnerability’ approach where in the aspects psychology, biology and culture are all factored in to properly evaluate and attend to the disorder (Green, 2001). Through this ‘stress-vulnerability’approach, it is aimed that the various manifestations of the illness as well the triggers that led to such occurrences can be properly ascertained.
Diagnosis and Assessment Schizophrenia
Diagnosing a schizophrenic condition is a must so that the problem can be addressed early on. Most studies would suggest that the first occurrences of schizophrenia can take place in the early adulthood or adolescence stage. There are many indications that the illness can be detected or suggested at this stage like the performance behaviour, interpersonal relationships and the way the person will care for the self (Torrey, 2001). There are also certain criteria to look upon in order to diagnose schizophrenia. The Diagnostic and Statistical Manual of Mental Disorders or the DSM-IV (2000) of the American Psychiatric Association provides the most reliable criteria.
A person may demonstrate certain characteristics that have to be immediately brought to the specialists if they occur for a considerable amount of time. Such characteristics include delusional behaviour, hallucinations, lack enthusiasm or motivation and even withdrawing from emotional display that affect the relationship of the individual with their families or friends. Hallucinations can be evident in the common expectation among people with schizophrenia of hearing a voice or many voices talking to each other (“DSM-IV”, 2000).
The individual may also have problems in his or her speech like using jumbled phraseology or speaking about vague ideas. This symptom shows how confused the thoughts can get. Another remarkable trait is the extremely ‘disorganized behaviour’ where the individual may suddenly act inappropriately in a given context. The social aspects of the person are also strong indicators of a possible case of schizophrenia. If a person fails in aspects of interpersonal relations, work and even of caring for the self for an extended period of time that are marked together with the symptoms above, these can be considered as a dysfunction already, characteristic of the disorder (“DSM-IV”, 2000).
The preceding symptoms can be designated either as ‘positive’ or ‘negative.’ Occurrences such as delusions, hallucinations or confused thoughts are considered the ‘positive symptoms.’ On the other hand, the negative symptoms include those that deprive certain behaviours of their necessary qualities to be considered as normal like lack or absence of emotional response or extreme difficulty in speaking (Bertelsen, 2002).
These symptoms mentioned can take on various combinations that will be identified according to the categories designated in the studies of schizophrenia. Traditionally, schizophrenia used to have three categories only, the ‘catatonic,’ ‘hebephrenic’ and the ‘paranoid’ type.
The DSM-IV (2000) today now lists five sub-categories of schizophrenia, catatonic, disorganized, paranoid, residual and undifferentiated. The catatonic type manifests the critical symptom of seeing the person behave differently like being suddenly put into a trance and the muscles of the body get rigid and stiff. Catatonia can also be manifested in repetitive movements that do not impress any purpose (“DSM-IV”, 2000). The disorganized type has the striking characteristic of disorganized thoughts and speaking of incomprehensible terms.
Those who fall under the paranoid type are the delusional ones. They may have a more coherent way of speaking but their thoughts will usually sound as mere make-believe to the listener. The residual type sufferers can display some positive symptoms but only at a very subtle level. Finally, the undifferentiated type embraces those people who display psychotic tendencies but are not that critical yet to be considered as catatonic or paranoid (“DSM-IV”, 2000).
To ordinary people, the ultimate symptom of schizophrenia is the occurrence of ‘hearing voices.’ The experience of this is unique among schizophrenics because the voices they hear are not something that sounds like a ‘conscience’ inside the head. The voices can be something commented by a person that was created in the distorted reality of the patient. It is also possible to develop among individuals with schizophrenia a sense of ‘hero mentality’ where the sufferer believes that he or she has been given a special gift and it is imperative to fulfil a mission to save the world. There are reverse episodes on the other hand that the patient may believe that he or she is being persecuted for something (Green, 2001).
These characteristics and manifestations are not to be considered as an exclusive list of the condition. There are many ways for schizophrenia to convey itself. It can be evaluated from certain acts or omissions on the part of the sufferer. The manifestations may also depend on the phase the disorder could be. It might not be obvious at the onset, but one must not wait also until the condition worsens. The important message to take here is that schizophrenia is a complicated condition. Any prolonged act that would suggest the existence of such must immediately put the person on alert (Torrey, 2001).
Needs of People with Learning Disabilities and Schizophrenia
This focus on the schizophrenia disorder should also make one focus on the reality of learning disability. This learning disability or difficulty is basically a condition that may be inherent in the person wherein one is limited in the capacity and capability to learn. This could reflect an instance where the person can only acquire and process information within the age range of a little child (Green, 2001).
The learning disability can be detected as early as the development stage during childhood. This is where physicians can observe that the difficulty of the child in the learning processes is not something that can be outgrown (Cott, 1975). This calls for immediate intervention so that things can be improved as early as possible. There are more adverse consequences to face if the child will be unable to transcend such a situation like living a lifetime with so much unrealized potential because the disability had been neglected. The disorder can also lead to a more permanent psychological and mental impairment (Cott, 1975).
Basically, learning disability is caused by the dysfunctions in the brain. In this aspect, the dysfunction is very nominal. The child may be within the above-average intelligence, but the behaviour towards the learning processes is somewhat deviant. They look completely normal until they enter the classroom setting where the problems become too obvious (Cott, 1975). Children with this problem are often found to be very hyperactive, impulsive, difficulty in concentration and coordination and confused or struggling when they speak (Cott, 1975).
At first sight, the learning disability of a person does not seem to have any correlation with schizophrenia. However, there are studies that would show that there is a distinct link between the disability and the mental disorder. Experts in the field of learning disorders have distinguished between ‘specific learning disabilities’ and ‘general learning disabilities.’ The latter is the one used to refer to children with severe problems in their communication and behavioural skills.
This is the point where learning disability can be linked to the mental disorder schizophrenia. There are various ways by which the two have been connected in studies and research. Basically, in families where there are learning problems, cases of schizophrenia also figure. Furthermore, majority of adult schizophrenia patients also hold history of learning problems and hyperactivity in the early stages of their development (Cott, 1975). Statistics also show that the occurrence of schizophrenia is more likely to be found among people suffering from learning disabilities. They have three times higher probability compared to the ordinary people. Such claims had been attributed to the unnecessary application or improper use of the medications prescribed (Emerson, 2001).
Such a misfortune had been attributed to lack of strong policy to effectively and efficiently address the situations of people suffering from learning disabilities. Thus, there is a strong need to come up with significant changes that shall implement ‘mainstream and specialist’ services to be provided to the patients (Greig, 2003).
There are also those who blame the clinicians and health managers for their neglect to the patients, especially those with the learning disabilities. It is important to provide appropriate care to people with learning disabilities, even if their conditions are not as acute as the others to avoid worsening the situation (Greig, 2003). Thus, to further give a concrete idea of what is being called for, the needs of the people with learning disabilities can be taken hand in hand with the obstacles they confront today.
People who suffer from learning disabilities and schizophrenia are in great need of proper care. They are more likely to have problems in different aspects of their lives like health, coping mechanisms, social skills and even in the way they will feel about themselves. They are also susceptible to major and drastic changes happening in their respective environments. However, such needs may not be immediately furnished to people with learning disabilities because of certain factors. There are many possible causes that may give rise to the mental health problem yet one reason why the conditions worsen is that the persons concerned tend to be not aware of proper health care for the patient (Nocon, 2004).
Certain factors weaken the access of some people suffering from mental illnesses to the proper health care. They may not be able to recognise the disorder right away because of the lack of awareness for such situations (Jeste, 1996). They may also be deterred by the expenses of the health services. There are studies claiming that there is a strong link between a poor economic status and the state of ill health (Nocon, 2004). There are also those who had bad experiences in hospitals and clinics that they will refuse to go back (Alborz et al., 2003). As such, they may not access the services because they are hindered by their circumstances.
People suffering from the mental illness or learning disability may also fear the stigma brought to them by the situation. There is a fear of being isolated by normal people or losing the company of present peers. Throughout history and as depicted in numerous literatures, the ‘madman’ figured and played roles in the society, but they are far from being the most-loved and appreciated in the community. As a consequence, the sufferer may not be able to get help because of the effort to conceal the situation (Keywood et al., 1999). At this point, the support system of the patient is definitely a necessary and indispensable element.
The support system can come from the family, a professional like the psychiatrist or physician, the health care provider, friends, extended families and even people from the church. The role of the support system may become very crucial especially when the sufferer refuses to get the proper treatment. For the person with learning disability, the moral support may be more crucial in moments of frustration and exhaustion. For the person with schizophrenia, the family can help in effectively convincing the sufferer away from the delusions and hallucinations (Torrey, 2001).
Another obstacle at hand is the communication problem. The conditions of patients with learning disabilities and schizophrenia can sometimes leave them incapable of properly communicating to other people what really is happening inside them. There may be instances when the health care provider may not be able to understand what is being complained of by the patient. The other way around can also happen. As such, there may be instances when professionals will make use of mere assumptions or generalizations on the situation. This is not a good picture, but this could happen. As such, physicians, psychiatrists and health care providers must work hand in hand with the family members who can understand the patient more for easier facilitation of the consultation (Alborz et al., 2003).
There is also a strong need to make the people aware of the true consequences of this mental disorder to avoid giving the patients a discriminated treatment from their neighbours. First, the families of the sufferer must be aware of the problems being gone through. Also, other people must be made aware that the distortion in the mentality of schizophrenics may affect their social skills and the way they interact but this does not necessarily mean that they are extreme deviants or constantly violent.
There are instances when patients complain of negative treatment and attitude towards them even in the very institutions that are supposed to take care of them. As such, this calls for reform in the policy making body of the said institutions (Keywood et al., 1999). Most of them will be able to live relatively normal lives, just give them the right attention, support and medication (Torrey, 2001).
It is therefore very imperative that a more positive attitude be developed in approaching the situations of the people with schizophrenia and learning disabilities. For one, helping the patient to get what he or she needs in the situation will require a more proactive approach and a good amount of patience to understand any hesitation or refusal (Keywood et al., 1999). This may also be further supported by proper education or training of the people who deal with the patients. Competent staff must be maintained at all times. They must be made to realize the significance of their duty and that they are very crucial in any improvements in the condition of the patients and the families (Keywood et al., 1999).
Treatment for Schizophrenia in People with Learning Disabilities
Given the considerations above, people must take seriously any indication of schizophrenia, especially for those who are also suffering from learning disabilities. It cannot be denied that the findings of the studies mentioned above are very convincing in showing the predisposition to acquire schizophrenia later on among people with learning problems. Thus, the situation must be immediately consulted for treatment and intervention by experts and professionals (Torrey, 2001).
Among patients suffering from schizophrenia, drug treatment is the most common way to minimize the adverse effects. These are anti-psychotic drugs or psychoactive medications that are classified into three groups, the phenothiazines, thioxanthenes, and butyrophenones. Basically, the ‘anti-psychotic drugs’ are deemed to be very effective in curtailing the symptoms of the disorder. They are also deemed capable of preventing degeneration among the patients by blocking the dopamine action in the brain. Thus they enable the patients to at least live normal lives without fear of experiencing symptoms like hallucinations and delusions (Torrey, 2001).
These medications, however, may have their side effects like feeling of drowsiness or drying of the mouth. These are minor side effects which are far outweighed by the fact of dispensing with the undesirable symptoms of schizophrenia. On the other hand, there are also findings that the drugs can lead to a long-term consequence of tardive dyskinesia where eventually, the mouth and the tongue may end up making unusual motions that are beyond the control of the person (Torrey, 2001).
These realities should urge people to pursue first the other form of treatment, psychotherapy, as much as possible before resorting to intake of medications. There are schizophrenic patients who may not really need the drugs.
These are patients with conditions where they only need help to defeat the difficulties they have in their personalities like their social and speech skills. Basically, the psychological treatment can help in reforming the way the patient evaluates his or her situation. The distorted view of the reality can be rectified by helping the person understand the condition and the context of the reality. This way, the patient too can learn from the experiences and once again rediscover how it really is to relate to other people (Nocon, 2004).
The ideas presented above are the usual ways of treating schizophrenia. In much the same way, people with learning disabilities must also be properly diagnosed and treated to prevent the tendency to aggravate the condition into developing schizophrenia. Basically, intervention must be made as early as possible, since learning disabilities manifest during the childhood years. Immediately, the parents must consult a physician or expert psychiatrist to evaluate the options.
Basically, the dysfunctions in the brain of the patient must be evaluated according to the different circumstances faced by the child with learning disability. There are cases when the problem is grounded merely an inherent trait by the child. Some are due to things deemed as ‘social deprivations’ like the stress experienced at home and at the classroom. While other cases can be attributed to the emotional disturbance of a child due to peculiar or drastic events that took place (Cott, 1975).
From here, the kind of intervention will depend on the circumstances just mentioned. The various options for intervention may include special education classes, child psychiatry, clinical pharmacology or resorting to the aid of social work (Cott, 1975). There are various studies to support the cause of choosing special education or psychotherapy for the person suffering from the learning disorder. Such methods can provide the right atmosphere of social and psychological support needed by the patient and the family.
On the other hand, it was suggested earlier that for cases of ‘general learning disabilities,’ the problem may require more serious action as it has a more severe complication and can even serve as a predisposition to schizophrenia (Cott, 1975). In this regard, there are claims that recommend the resort to taking in medications. There are certain ‘biochemical disorders’ in the system of the patient that blocks the potential to learn and it can only be resolved by taking in vitamins and maintenance to attain the right nutritional balance for the brain (Cott, 1975).
However, there is also a threat posed in choosing this option. As earlier stated in the discussion of schizophrenia, drug medications do have their side effects that are not favorable especially if the medications will be implemented to children. Also, there is the problem of improper dosage and application of the medication that can further aggravate the situation to degenerate to schizophrenia (Emerson, 2001).
Thus, the treatment for schizophrenia among people with learning disabilities must be carefully and properly administered. This will again require that a proper evaluation must first be conducted before proceeding in any intervention, especially if drug medications are involved. What has to be really done is to consult the situation to experts who shall carefully deliberate on the situation rather than rush on things. The medications can be helpful only to a select number of the population suffering from the learning disorder (Cott, 1975).
While the odds of being classified under such are very slim, resort to the more wholesome way of solving the problem, like providing a healthy diet to provide the right nutrients and vitamins to the body and dedicating enough time to show support and love to the patient (Cott, 1975). These can merely entail simple things but this could mean a lot to the overall condition of the patient, both on the physical and psychological level (Torrey, 2001).
The reality of schizophrenia occurring to any of the members of the household is definitely not a desirable state. It puts a whole new challenge to the sufferer and to the family. However, the important thing is that should this event occur, the proper steps and response should be made. Schizophrenia is not a hopeless disease. Learning disability is neither a hopeless disease. Both have certain consequences that can lead to complications, but this must be taken in a more courageous stance. Both have been carefully studied already in the field of psychology and medicine. Thereby, there are options now to successfully weather this challenge.
Persons who suffer from such illnesses did not choose to be situated as such. Everybody wants to live a normal life and this must be granted as much as possible. Thus, the important thing at this point is to properly ascertain the needs of the person suffering from learning disability and schizophrenia. Familiarize with the various consequences a given condition can bring. Know the options when it comes to treatment, aid and supplements. Be aware also of the different options available in the community and in the clinical field. The health needs of the patient must be given utmost importance and value because they are also persons who deserve to live a normal life and to realize their potentials in this lifetime.
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