MHM Magazine

Issue 1 | 2025 | MENTAL HEALTH MATTERS | 1 MHM Schizophrenia is a complex and multi-factorial mental illness. Often our understanding of it becomes reductionist, adding to the burden of stigma these patients experience. There are multiple ways of conceptualising the illness - looking at neurotransmitters: dopamine and glutamate, the environment and genetics. I’ve come to appreciate the neurodevelopmental perspective which follows the development of schizophrenia (or at least the vulnerability thereto) all the way from the womb and early development and into young adulthood and the onset of illness. When the structural and functional organisation of the brain in utero goes awry (and this can be a result of various maternal, foetal and environmental factors), it naturally follows that the function of our neurotransmitters also descends into chaos and precipitates the illness that we come to diagnose. In this model of understanding the illness, it’s posed that the reason for the delayed onset of the illness lies within the compensatory mechanisms of the brain ultimately crumbling is a result of pruning of a multitude of synapses in adolescence/early adulthood. It's not the purpose of this editorial to discuss the symptoms and presentation of schizophrenia, but an understanding thereof will deepen the meaning of the following discussion. The root of misunderstanding The term “schizophrenia” was first coined by Swiss psychiatrist, Eugen Bleuler, in 1908. The illness is known to be heterogenous and has been described in many forms long before this term was used. Historically, the illness has been attributed to spiritual and supernatural forces as is often the explanatory model in African cultures. In the Middle Ages this understanding has led to the inhumane treatment of patients with Schizophrenia, often confining patients to asylums. With the advent of psychiatry as a discipline, electroconvulsive therapy and antipsychotics, schizophrenia has become more understood and more humanely managed, although the stigma remains. Shifting the Paradigm Advances in neurobiology and psychology in the 20th and 21st centuries have begun to unravel the complexities of schizophrenia, creating an understanding of the biological and psychological factors that create this disconnect between thoughts, emotions, behaviours and external reality. Adverse childhood experience, a concept that has also gained traction in the scientific world has been shown to have a significant influence on the development or at least precipitation of schizophrenia. Furthermore, substance use, and stress also impact on the illness - either facilitating onset or relapse of psychosis. I wonder what the impact of the legalisation of cannabis use will have on the prevalence of schizophrenia or schizophrenia-like psychosis but if I had to venture a guess- it’s not good. Studies have shown that by eliminating cannabis use, first onset psychosis can be reduced by 50%, if not more. But I digress… One of the most significant breakthroughs in the management of schizophrenia came with the development of antipsychotics in the mid-20th Century. Whilst we do not consider these medications a cure or the be-all, end all of schizophrenia management, they have drastically improved symptomatology of so many individuals suffering from this illness, despite their often unpleasant side-effect profiles and increased metabolic risk. We have to remain cognisant of the fact that the treatment of SCHIZOPHRENIA- A DEEP DIVE INTO UNDERSTANDING THE ILLNESS, STIGMA AND CREATING MEANING EDITORIAL Dr Jozef Breedt Psychiatry Registrar