Breaking the Stigma: What You Need to Know About Schizophrenia

Because dignity begins where assumptions end. Understanding the illness, embracing the individual.

Growing up in a family of medical specialists meant that I inadvertently exposed myself to clinical discussions about a range of medical issues from the very minor to the most serious. I realise now that this environment shaped my understanding of health, and it also nurtured my interest in mental wellbeing.  Over the years, what has increasingly mesmerised me and often saddened me is how casually and cruelly some people speak about mental illness. I am particularly uncomfortable when I hear serious psychiatric conditions being discussed by people who do no know enough about these illnesses. After all, conditions such as schizophrenia or psychosis deserve far more kindness and consideration. Unfortunately, a lot of the blame for this false portrayal of mental illness lies squarely with the media and the film industry. Schizophrenia is an enduring and potentially debilitating illness. The fact it is sensationalised as somehow monstrous and dangerous is far removed from the real human experience of those living with this condition. This distortion does not portray the harsh reality and only succeeds in feeding fear, misunderstanding and stigma. 

Bryan Charnley's depiction of schizophrenia (Bethlem Museum of the Mind)

Let’s be clear, schizophrenia is a personal struggle. It is a terribly misunderstood illness, sometimes, leading to fear and shame. The symptoms are complex, making diagnosis and treatment challenging. Furthermore, while there is no cure, with the right support and early intervention, many people manage to live meaningful and fulfilling lives.  In this blog, I want to take the time to strip back the complexity and talk about schizophrenia in a clearer, more human way, looking at its symptoms, causes, treatments, and the lived experience of those who carry its weight.  Hopefully, if knowledge can breed empathy, then awareness might help in chipping away at the stigma. Ultimately, every single one of us, regardless of our mental status deserves to be seen and treated with dignity. 

Schizophrenia is a complex mental health condition influenced by many factors. It affects how a person thinks, feels, behaves and often their perception of reality is distorted.  But, despite the stereotypes, schizophrenia does not usually make the person violent or dangerous. That myth really needs to be laid to rest!  This condition typically shows up in early childhood and is diagnosed between the ages of 18 – 25 years in men and a little later for women.  Around 1 in every 100 people worldwide are affected and for some it can have a life-altering devastating impact like losing the ability to keep up with work, relationships and even day-to-day tasks.  

The symptoms are grouped into three categories. First the positive symptoms are experiences such as hallucinations, delusions and disorganised speech. Then there are the negative symptoms which can go unnoticed such as lack of emotional expression or lack of motivation. Finally, the cognitive symptoms such as problems with memory, reduced attention and or difficulty in planning.  So, you can immediately see that these are very complicated issues to identify and even trickier to pin down in a diagnosis. And if that sounds complicated already, well… it is. Imagine that this is before we even get to the causes, which are even more layered and not yet fully understood by experts in the field.

What might be causing it?

The scientific community continues to be committed in exploring the causes of schizophrenia.

One of the most widely supported ideas is the genetic vulnerabilities which suggest that a collection of genetic variations increase the risk.  Another theory proposes a neurodevelopmental angle such as brain development or complications during birth might set the stage for the condition later in life. But the most acknowledged theory focuses on the brain’s chemical balance. 

At this point, I want to reiterate that our brains are incredibly sophisticated, perfect machines, relying on a delicate dance of electrical signals and chemical messengers to help us move, feel, think - and yes, stay alive.

Communication is carried out by numerous chemical messengers called neurotransmitters that allow neurons in the brain and the body to talk to each other.  You might have heard of a few neurotransmitters like dopamine, serotonin or melatonin which together with the others play a meaningful role in our daily functioning. Interestingly, for the brain to function smoothly, these chemicals must be in a perfectly balanced state called homeostasis. If there is a disruption in this balance, the brain's communication is affected and causes specific symptoms of schizophrenia. Out of the many neurotransmitters, scientists have found strong links between dopamine and glutamate to schizophrenia. These chemical imbalances might help us explain the complex symptoms seen in people living with schizophrenia. 

Dopamine: The Classic Theory 

In 1951 a drug called chlorpromazine was first synthesised in France.  A year later, when this antihistamine which was developed for nausea and allergies was used in medical settings, doctors noticed that patients with psychosis began to calm down. This accidental discovery led to a new class of drugs called antipsychoticsbeing developed.  It is important to note that psychosis is not exclusive to schizophrenia and anyone of any age can suffer the symptom. Some individuals might experience delusions where they believe they are being sent messages through for example the TV or hallucinations where they hear critical voices that are not there.  Sometimes, people might speak or behave in a manner that is inappropriate for the place or appear to be disconnected from their environment. These symptoms are deeply distressing and often misunderstood.

With innovation in technology, brain imaging has taken huge strides. Studies have indicated that schizophrenia causes change in the dopamine activity. Dopamine is a key brain messenger which is involved in movement, emotion and even decision making.  To perform a particular function, dopamine must follow a specific footpath.  There are four main dopamine pathways that are thought to be involved in schizophrenia: 

1. Nigrostriatal pathway helps control body facial movement. 

2. Mesolimbic pathway which is associated with positive symptoms like hallucinations and delusions. 

3. Mesocortical pathway which is involved in negative symptoms like emotional flatness or cognitive difficulties.

4. Tuberoinfundibular which is involved with hormone regulation. 

By blocking dopamine receptors along these pathways, antipsychotics can produce therapeutic effects such as reducing distressing symptoms, but they also cause side effects. Studies on these dopamine pathways have also found that too much dopamine in the mesolimbic pathway contribute to positive symptoms and too little dopamine in the mesocortical pathway appears to be associated with negative and cognitive symptoms. On the other hand, too much reduction of dopamine in the nigrostriatal pathways can cause motor issues like those seen in Parkinson’s disease.  This information gives us some insight into the delicate chemical balance, but it does not tell us the whole story.

Self-Portrait of a Schizophreni: Painting by Aman Abdil - Saatchi Art Ireland

Gaps in the Theory

Scientists considered the theory groundbreaking but limited.  They found that although antipsychotics were effective in reducing the positive symptoms, they gave little relief to negative and cognitive symptoms which truly affect a person’s ability to function on a day-to-day basis and connect with others. What is more puzzling is that some people do not respond to dopamine targeting medication while others relapse even with proper drugs. The dopamine theory could not explain these inconsistencies. It is precisely these irregularities that makes treating this mental illness so challenging and is a humbling reminder of the sophistaction of the brain and this illness.

The Glutamate Hypothesis.

Another theory that is gaining traction focuses on the brain’s most plentiful neurotransmitter. Glutamate is vital for proper brain function and plays a role in learning and memory. Emerging studies suggest that a disruption in the glutamate function involving a type of receptor known as NMDA (N-methyl-D-aspartate) might be involved in schizophrenia. What is very interesting is that when NMDA receptors do not function efficiently, communication between brain regions and those involved with thinking, emotion and social behaviour goes haywire. Additionally, drugs like ketamine and phencyclidine (known as PCP or angel dust) block NMDA receptors and can induce the full spectrum of schizophrenia-like symptoms. These include hallucinations, and cognitive and negative symptoms that dopamine-based theories have not been able to completely explain. This tells us that schizophrenia is not simply about too much or too little dopamine, but a system wide communication breakdown in the brain. 

Treatment: Managing not Curing

At this point there is no cure for schizophrenia. That does not mean there is no hope. A combination of medication, psychotherapy and specifically cognitive behavioural therapy (CBT) with social support can make a meaningful difference in managing symptoms and helping individuals live more fulfilling lives. Currently scientists are interested in targeting the glutamate system by developing a personalized treatment.  The idea is to tailor the intervention based on the individual’s unique neurobiology, genetic profile and the life experiences of that person. Although an exciting new direction is evolving, for now, antipsychotics remain the first line of treatment. For many they are life changing but sadly are not for everyone. Some people struggle with side effects which makes it difficult for them to stick with the protocol. A drug called clozapine is often prescribed for treatment-resistant schizophrenia but again even this does not deliver a universal fix. 

The most frustrating challenge are cognitive symptoms like poor memory, difficulty concentrating, and impaired decision-making which are still the most disabling in the long term. And unfortunately, none of these interventions can reliably target those symptoms. Still, we must have hope as knowledge is forever evolving.  With continued exploration, scientists will understand this condition better and have the ability to treat schizophrenia more effectively. 

At the Heart of it all: People

At the end of the day, schizophrenia is not about brain chemistry and clinical terms, it is about people. Real people, living real lives and having to navigate confusion, fear and stigma. They did not choose this path and cannot even explain their experiences. This is why genuine understanding matters. 

The more we educate ourselves, the more we dismantle the fear and judgment that surrounds mental illness.  The more we educate ourselves, the more we understand. The more we comprehend the more compassion we can offer. Likewise, the more we support scientists, with funding and resources the closer they can move to unlocking the complexities of this condition. By shifting the focus, the world has a better chance at moving on from just managing symptoms to achieving true recovery.  Because at the core of every theory, every treatment, every neurotransmitter and every is a are human beings who deserves to be seen, heard, and supported with dignity.

NivsD (Wed 21st may 2025)

Further Reading

·      Kandel et al., Principles of Neural Science

·      Howes, O.D., & Kapur, S. (2009). The dopamine hypothesis of schizophrenia: Version III – the final common pathway

·      Brisch et al., (2014). The role of dopamine in schizophrenia from a neurobiological perspective

·      Abi-Dargham et al., (2009). Dopamine dysfunction in schizophrenia

·      Howes, O., & McCutcheon, R. (2014). Glutamate and the pathophysiology of schizophrenia

·      Mortimer et al., (2010). Clozapine in treatment-resistant schizophrenia

·      Ruderfer et al., (2013). Polygenic risk and schizophrenia

·      World Health Organization (WHO) – Schizophrenia factsheet

·      Ban, T.A. (2007). Fifty years of chlorpromazine: a historical perspective. Neuropsychiatric Disease and Treatment, [online] 3(4), p.495. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC2655089/.