2. A Terrible Brain Disease

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This is the second in a series of seven articles called “Breaking the Silence,” by Patricia A. Forsdyke Past President of the Kingston and Napanee Chapter of the Schizophrenia Society of Ontario


I began my psychiatric nursing training in 1961, just after the first effective psychiatric medications were introduced. The older nurses were still wondrous at the results. They had little doubt about the nature of mental illnesses.  Before their eyes, broken brains started to work again. People who had been mad for years were now sane. My Aunt Evelyn was not quite so lucky.

Those were the days of tea dances in the private asylums. When patients were well enough they would whirl around the great ballroom. On one occasion, I remember a fashion parade that had been arranged by Maureen, a former inpatient. Maureen was a model, and she strode down the catwalk in the Victorian ballroom with great style. Her beautiful clothes had been loaned from a posh London store. An elderly psychiatrist sitting next to me said, “You would never guess that her head was full of such terrifying delusions just eight weeks ago.”  I was to reflect on this in future years. We all saw the bizarre behaviour, but often only the psychiatrist and the family were privy to the secret delusions.

Then there was beautiful Mary, who was a few years older than myself. She was on her way back to sanity. She was then an involuntary patient. Her first breakdown found her unkempt, withdrawn and very delusional, secluded in her London apartment. When I met her she was incredibly well-dressed and groomed, as though she feared that any sign of dirt would prolong her imprisonment in the asylum. Her efforts were heroic. On good days, she would go to occupational therapy to practice her typing. Each morning early, like Cinderella, she would polish her room. The floor would be turned into an ice rink. Then she would emerge for breakfast, dressed like Audrey Hepburn. She never spoke to other patients. She deigned to speak to me, probably because I had trained at the same hospital as her father, who was a doctor.

Once, in a frenzy, she intercepted me at the railway station, begging me to aid her escape to London. Fortunately, I had no spare money. As a result of medication, Mary was soon to be on the mend. Today, Mary would almost certainly be untreated, filthy, petrified and holed up in a flat, or more likely, she would be on the streets. Without a doubt, she would have been unable to cope with today’s hostels.

Schizophrenia can now be treated successfully. Untreated, it creates havoc and destroys lives. The earlier that schizophrenia is treated the better the prospects. The average age of onset in all countries is about 18 for men and 24 for women. Though the illness presents itself late in an individual’s development, it now seems likely that the disease has its origins in the early stages of life, probably before birth. Women have a slight advantage because of a later first psychotic break. They may have completed more education and be more mature before they have their first break with reality. But for all, the disease derails lives full of promise, and it seems to strike most often when brains are beginning to do adult work.


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Loss of brain volume associated with schizophrenia is clearly shown by magnetic resonance imaging (MRI) scans comparing the size of ventricles (butterfly shaped, fluid-filled spaces in the midbrain) of identical twins, one of whom has schizophrenia (right). The ventricles of the twin with schizophrenia are larger. This suggests structural brain changes associated with the illness. Note that such MRI scans cannot be used to diagnose schizophrenia in the general population, due to normal genetic variation in ventricle size — many unaffected people have large ventricles. Source:  Daniel Weinberger, M.D. NIMH Clinical Brain Disorders Branch

Brain scans reveal reduced frontal lobe activity in afflicted individuals. Medication seems to thrust the brain back into more normal activity. Many parts of the brain are compromised and the executive function of the brain does not quite measure up. We’ve all seen a person wearing Arctic clothing in the middle of the summer, or people in shirt sleeves and no socks or shoes when it’s 20 degrees below. Canada is not California. Some lose limbs to frost bite.  Some schizophrenics have heart attacks and don’t respond to the pain. Schizophrenics are often out of touch with their bodies until they receive treatment.

The person may have been a great student before things came unglued. There is much scientific evidence that there is different circuitry in the brains of affected individuals. The brain transmitters misspeak. A large sample British study of children born in 1940 found that those individuals who went on to develop schizophrenia showed some neurological differences early on in life. They were later (on average) at milestones (sitting, standing, speaking, etc.) There is a strong indication that something had gone wrong in the development of the brain in the second term of pregnancy.

So often we hear people separate mind and body, but the mind is a function of the brain. A human brain weighs about a couple of pounds. A broken one is very disabling. Just because you can’t see a wheelchair, do not doubt that mental illness is disabling. The government must be sensitive to the needs of the mentally ill as it implements workfare. Government forms are a nightmare even for healthy minds. Imagine how stressful they must be for those battling mental illness.

Like the engine of a car, our brains can misfire. With schizophrenia, the main organ is in trouble. The only fix that can realign the brain’s circuits is medication. As with Multiple Sclerosis, talk won’t do it.

Modern brain scans can actually show where the brain is active during an hallucination. Post mortems performed on brains of chronic schizophrenics show that there are abnormalities in various regions.  In severe forms of schizophrenia there is a loss of tissue in crucial areas of the brain and the ventricles are larger. As with many illnesses, there is currently no cure, but schizophrenia can be managed.


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NIMH scientist shows PET scans from a study of identical (monozygotic) twins, who are discordant for schizophrenia (only one has the disorder) demonstrating that individuals with schizophrenia have reduced brain activity in the frontal lobes (top of scan).

Source: William Branson NIH Medical Arts

The exact causes of schizophrenia are not yet known. A viral assault is one suspect. Certainly there seems to be a genetic pre-disposition.  Often those afflicted have a family history of mental illness: an aunt, uncle or grandfather who was whispered about, did strange things, never came out of their room, hid in the attic, or died by suicide.

In 1961, my peers and I were into all the latest psychiatric fads. The old nurses and doctors knew better: they were dealing with broken brains.  They were often more humane. They would give sedative medicine to rest the patient from their tormenting symptoms when little else was working. Today, hospitals release, or won’t admit, patients who are in torment.

An American psychiatrist, on our ward in 1961, was heavily into intensive psychotherapy on very disturbed patients. With hindsight it was terrible to have let this happen. His talk therapy was like putting sophisticated software into a time-warped computer. The effect was sometimes fatal. Two patients committed suicide around that time. Soon, I would change my understanding of serious mental illness. I became a staff nurse on a neurological ward and it struck me that schizophrenia could be nothing other than a brain disease.  Despite the evidence, a few professionals are still not grasping that fact.

 

Read previous article in series, “When Madness Comes”          Read next article in series, “Violence A Real Danger if Disease Not Treated”


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