Schizophrenia in society and culture

Schizophrenia is a thought disorder that affects a person's thinking, emotions, and behavior.

Schizophrenia can cause such severe disability that many people with this disorder do not have jobs, they live in poverty, and/or they are homeless.

There are medicines that can help treat schizophrenia. These medicines are important for the pharmaceutical industry.^[1][2][3] Unfortunately, the cost of treating schizophrenia (including medical bills and other expenses) is very high.

Studies show that people with schizophrenia often have higher suicide rates and more health problems compared to people without the disorder.^[4] They also face challenges in society that make it harder for them to get better.^[5]

Famous people like John Forbes Nash and Vaslav Nijinsky had schizophrenia, and shared openly about the disorder.^[6][7]

Society

Schizophrenia can lead to unemployment, poverty and homelessness.^[8] It is unknown how many people have schizophrenia; the number changes depending on what measures a person uses to diagnose schizophrenia.^[9] More research on mental health is needed to work out how to help people with schizophrenia.^[10]

Disability

Schizophrenia is responsible for a large portion of global disability. 1% of worldwide disability-adjusted life years is due to schizophrenia.^[11] In a 1999 paper, people with schizophrenia ranked hallucinations (a big symptom of schizophrenia) as the third-most-disabling symptom of the disorder. The disorder can strongly affect people's ability to function and their quality of life.^[12]

Financial aspects

Main articles: Market and Schizophrenia in society and culture § People with schizophrenia

Schizophrenia has a major effect on the United States economy. A 2005 paper guessed that in 2002, the disorder cost $62.7 billion in the United States alone.^[13] These costs include medical expenses, long-term care, and indirect costs like less productivity at work, unemployment, and costs from law enforcement. Also, antipsychotic medications, commonly prescribed for schizophrenia, are used for many other conditions, leading to a large number of prescriptions. In the European Union, around 16.5 million people got daily antipsychotic prescriptions in 2018,^[14] with large increases seen in England between 1998 and 2010.^[15]

Pharmaceutical market

The market size for schizophrenia drugs was valued as $9,000,000,000 in 2021. ^[16] Pharmaceutical firms offering drugs in this market include:

• Acadia Pharmaceuticals
• BioXcel Therapeutics
• Boehringer Ingelheim
• Eli Lilly
• Gedeon Richter
• Intra-Cellular Therapies
• Johnson & Johnson
• Karuna Therapeutics
• Lundbeck
• Luye Pharma
• MedinCell
• Minerva Neurosciences
• Neurocrine Biosciences
• Novartis
• Otsuka
• Reviva Pharmaceuticals
• Sunovion Pharmaceuticals
• Teva ^[17]

Mortality

External

In 2020, researchers studied 160 people who had committed homicide in England or Wales, and were admitted to hospital for schizophrenia between January 1997 and 31 December 2012. Of the 160 study participants, about 150 (94%) had a history of alcohol and/or illegal drug consumption, and/or did not have their prescribed medication.

In a study of the actus reus of homicide in England and Wales during the years 1997–2003, diagnosed schizophrenics were more likely to use an object with a sharpened edge, like a knife. In most cases, schizophrenics who committed homicide killed family members or a spouse in their homes. ^{[18][19][20][21][22][23]}

Internal

Individuals with schizophrenia have a higher risk of suicide compared to most people, and also have a higher prevalence (chance) of physical health issues.^[24][25] In 2015, around 16,900 deaths were linked to schizophrenia-related causes.^[26] A study involving over 4 million individuals diagnosed with schizophrenia showed that suicide, injury-poisoning, and unknown non-natural cause were the most common reasons for death, followed by pneumonia.^[27] Also, one study identified antipsychotic medication as the primary cause of pneumonia.

Social challenges

Many people with schizophrenia pull away from others and have difficulty with social interactions. A 1999 paper showed this as a major challenge in schizophrenia recovery.^[28]

The word "schizophrenia" is used as a metaphor in newspapers worldwide.^[29][30][31]

Symptoms amongst non-patient groups

Studies have found that even mental health nurses^[32] and people without schizophrenia^[33][34] experience auditory hallucinations. However, in people with schizophrenia, auditory hallucinations tend to be more constant, intrusive (forcing in), and disturbing.^[33]

Tobacco

Studies around the world have shown a strong link between schizophrenia and smoking tobacco.^[35][36] Smokers with schizophrenia tend to smoke heavily and to smoke cigarettes with a high nicotine content.^[37]

Culture

Art

• 
  My Eyes at the moment of the apparitions by August Natterer
• 
• 

People with schizophrenia

In 1908, the sister of Dr Eugen Bleuler was taken to a Zurich hospital with a catatonic illness. Dr Bleuler soon became the director of the same hospital, where he diagnosed his sister with schizophrenia. ^[38][39][40]

Vaslav Nijinsky (born 1889 ^[41] died 1950) ^[42] was a dancer; his parents were also dancers. ^[43] Starting around 1913, he was known by the nicknames ^[44] "the God of dance" ^[45][44][46] and "God's clown". ^[43] During or sometime after March 1919, Dr Bleuler diagnosed Nijinsky as "a confused schizophrenic with mild manic excitement," which meant she didn't need to go to a hospital.^[42]

Camille Claudel was a sculptor. She was diagnosed retrospectively (looking at the past) in 1913. ^[47]

Eduard Einstein, one of Dr. Albert Einstein's children, was diagnosed with schizophrenia by Dr Blueler in the 1930s^[48] and lived his life in a hospital. ^[49][48][50]

John Forbes Nash

John Forbes Nash was diagnosed with schizophrenia in 1959. John was a mathematician from the United States. He was given the Nobel Prize in Economic Sciences in 1994 for "equilibria (balance) in the theory of non-cooperative games".^[51]

Alternate realities: psychoanalytic and religious

Some researchers believe that in some special situations, experiencing psychosis^{[broken anchor]} is proof of genius. ^[52]

The autoplastic nature of the psychotic's derangement enters unaltered ... into a work of art"

— K.R. Eissler ^[53]

A 2016 paper showed similarities between schizophrenia and mysticism. ^[54]

Presentation in biography and cinema

A book and then a movie, both called "A Beautiful Mind," were made about the life of John Forbes Nash.^[51]

The movie “The Soloist” tells the story of Nathaniel Ayers, an experienced musician who left the Juilliard School in New York City after he started having symptoms of schizophrenia. He later became homeless in Los Angeles, California, in the notorious (negatively well known) Skid Row part.

References

1. https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443
2. https://my.clevelandclinic.org/health/diseases/4568-schizophrenia
3. https://www.merckmanuals.com/home/mental-health-disorders/schizophrenia-and-related-disorders/schizophrenia
4. https://annals-general-psychiatry.biomedcentral.com/articles/10.1186/1744-859X-6-10
5. https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/schizophrenia-poor-physical-health-and-physical-activity-evidencebased-interventions-are-required-to-reduce-major-health-inequalities/67A0294716A06B7A5254F47F00063937
6. https://www.nobelprize.org/prizes/economic-sciences/1994/nash/facts/
7. https://academic.oup.com/brain/article/142/1/220/5144594
8. Charlson FJ, Ferrari AJ, Santomauro DF, et al. (17 October 2018). "Global Epidemiology and Burden of Schizophrenia: Findings From the Global Burden of Disease Study 2016". Schizophrenia Bulletin. 44 (6): 1195–1203. doi:10.1093/schbul/sby058. PMC 6192504. PMID 29762765. people with schizophrenia are more likely to be unemployed, homeless, living in poverty
9. van Os J, Kapur S (August 2009). "Schizophrenia" (PDF). Lancet. 374 (9690): 635–45. doi:10.1016/S0140-6736(09)60995-8. PMID 19700006. S2CID 208792724. Archived from the original (PDF) on 2013-06-23. Retrieved 2013-04-15.
10. "The Curse of Schizophrenia". Wall Street Journal. 1999-09-20. ISSN 0099-9660. Retrieved 2023-12-16.
11. Picchioni MM, Murray RM (July 2007). "Schizophrenia". BMJ. 335 (7610): 91–5. doi:10.1136/bmj.39227.616447.BE. PMC 1914490. PMID 17626963.
12. Ustun TB; Rehm J; Chatterji S; Saxena S; Trotter R; Room R; Bickenbach J; and the WHO/NIH Joint Project CAR Study Group (1999). "Multiple-informant ranking of the disabling effects of different health conditions in 14 countries". The Lancet. 354 (9173): 111–15. doi:10.1016/S0140-6736(98)07507-2. PMID 10408486. S2CID 26454481.
13. Wu EQ (2005). "The economic burden of schizophrenia in the United States in 2002". J Clin Psychiatry. 66 (9): 1122–9. doi:10.4088/jcp.v66n0906. PMID 16187769.
14. Guidance Antipsychotic medicines Published 25 August 2005 Medicines & Healthcare products Regulatory Agency Guidance UK Government
15. Stephen Ilyas and Joanna Moncrieff "Results TABLE 1" In: Trends in prescriptions and costs of drugs for mental disorders in England, 1998–2010 The British Journal of Psychiatry, 200(5), 393-398. doi:10.1192/bjp.bp.111.104257
16. Schizophrenia Market Size and Trend Report including Epidemiology and Pipeline Analysis, Competitor Assessment, Unmet Needs, Clinical Trial Strategies and Forecast, 2021-2031 Published: September 21, 2022 GlobalData Plc: John Carpenter House, John Carpenter Street, London
17. Key Players GlobalData Plc: John Carpenter House, John Carpenter Street, London
18. Alison Baird, Roger T. Webb, Isabelle M. Hunt, Louis Appleby and Jenny Shaw Homicide by men diagnosed with schizophrenia: national case–control study BJPsych Open, 6(6), E143. doi:10.1192/bjo.2020.129
19. Cathryn Rodway, Cathryn Rodway, Nicola Swinson, Alison Roscoe, Alison Roscoe, Kirsten Windfuhr, Kirsten Windfuhr, Louis Appleby, Jenny Shaw Methods of homicide in England and Wales: a comparison by diagnostic group The Journal of Forensic Psychiatry & Psychology, 20:2, 286-305, DOI: 10.1080/14789940802360870
20. GLOSSARY Actus reus definition LexisNexis
21. Mens rea and actus reus The Incorporated Council of Law Reporting for England & Wales
22. OVERVIEW actus reus non facit reum nisi mens sit rea Oxford University Press
23. Valeria Abreu Minero, Edward Barker, and Rachael Bedford "4.1. Schizophrenia/delusional disorder and sharp instruments" in Method of homicide and severe mental illness: A systematic review Aggress Violent Behav. 2017 Nov;37:52-62. https://doi.org/10.1016/j.avb.2017.09.007. Epub 2017 Sep 28. PMID: 31354381; PMCID: PMC6660311.
24. van Os J, Kapur S (August 2009). "Schizophrenia" (PDF). Lancet. 374 (9690): 635–645. doi:10.1016/S0140-6736(09)60995-8. PMID 19700006. S2CID 208792724. Archived from the original (PDF) on 23 June 2013. Retrieved 23 December 2011.
25. Hor K, Taylor M (November 2010). "Suicide and schizophrenia: a systematic review of rates and risk factors". Journal of Psychopharmacology. 24 (4 Suppl): 81–90. doi:10.1177/1359786810385490. PMC 2951591. PMID 20923923.
26. Wang H, Naghavi M, Allen C, et al. (October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015". The Lancet. 388 (10053): 1459–1544. doi:10.1016/S0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
27. Christoph U Correll, Marco Solmi, Giovanni Croatto, Lynne Kolton Schneider, S Christy Rohani-Montez, Leanne Fairley, Nathalie Smith, István Bitter, Philip Gorwood, Heidi Taipale, Jari Tiihonen Mortality in people with schizophrenia: a systematic review and meta-analysis of relative risk and aggravating or attenuating factors World Psychiatry. 2022 Jun;21(2):248-271. doi: 10.1002/wps.20994. [Discussion: ("RR=9.76-8.42") & "RR=7.00" c.f. (i.e. 6, 5, 4) (4.0 ≠ 3.00 - 3.999 rec.) "RR=3 to 4", "RR=2 to 3", "RR=1.33 to 1.96"]
28. Maj, Mario and Sartorius N. (15 September 1999). Schizophrenia. Chichester: Wiley. p. 292. ISBN 978-0-471-99906-5.
29. Christina Athanasopoulou, Maritta Välimäki 'Schizophrenia' as a metaphor in greek newspaper websites Stud Health Technol Inform. 2014:202:275-8.
30. Arun K Chopra, Gillian A Doody Schizophrenia, an illness and a metaphor: analysis of the use of the term 'schizophrenia' in the UK national newspapers J R Soc Med. 2007 Sep;100(9):423-6. doi: 10.1177/014107680710000919. PMID: 17766915; PMCID: PMC1963407.
31. Kenneth Duckworth, M.D., John H. Halpern, M.D., Russell K. Schutt, Ph.D., Christopher Gillespie, M.A. Use of Schizophrenia as a Metaphor in U.S. Newspapers Psychiatric Services Volume 54 Issue 10 October 2003 Pages 1402-1404 https://doi.org/10.1176/appi.ps.54.10.1402
32. Millham RN BA MSc, Mental Health Nurse, Easton BSc MA CPsychol ASBPSS, Clinical Psychologist/Senior Lecturer Prevalence of auditory hallucinations in nurses in mental health Psychiatric and Mental Health Nursing Volume5, Issue 2 April 1998
33. C. Choong BMBS, BMedSci, M. D. Hunter MBChB, MRCPsych & P. W. R. Woodruff MBBS, PhD, MRCP, FRCPsych Auditory hallucinations in those populations that do not suffer from schizophrenia Curr Psychiatry Rep 9, 206–212 (2007). https://doi.org/10.1007/s11920-007-0020-z
34. HONIG, ADRIAAN M.D., Ph.D., MRCPsych.1; ROMME, MARIUS A. J. M.D., Ph.D.2; ENSINK, BERNARDINE J. M.Sc., Ph.D.2; ESCHER, SANDRA D. M. A. C.2; PENNINGS, MONIQUE H. A. M.A.2; DEVRIES, MARTEN W. M.D., Ph.D.Auditory Hallucinations: A Comparison between Patients and Nonpatients The Journal of Nervous & Mental Disease 186(10):p 646-651, October 1998.
35. De Leon J, Diaz FJ (2005). "A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors". Schizophrenia Research. 76 (2–3): 135–57. doi:10.1016/j.schres.2005.02.010. PMID 15949648. S2CID 32975940.
36. Keltner NL, Grant JS (2006). "Smoke, Smoke, Smoke That Cigarette". Perspectives in Psychiatric Care. 42 (4): 256–261. doi:10.1111/j.1744-6163.2006.00085.x. PMID 17107571.
37. American Psychiatric Association. Task Force on DSM-IV. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. American Psychiatric Pub. ISBN 9780890420256. p. 304
38. Mark L. Ruffalo M.S.W., D.Psa. A Lesson from Bleuler on Schizophrenia Psychology Today 28 October 2019
39. Jessica Resnick 2017-04-06 Paul Eugen Bleuler (1857–1939) Arizona State University
40. Tina Joos-Bleuler Being a Member of the Bleuler Family Schizophr Bull. 2011 Nov; 37(6): doi: 10.1093/schbul/sbr135 PMCID: PMC3196944 PMID: 22013083
41. Nijinsky Living with Schizophrenia
42. Emilio Fernandez-Egea One hundred years ago: Nijinsky and the origins of schizophrenia, 25 October 2018: Brain, Volume 142, Issue 1, January 2019, Pages 220–226, https://doi.org/10.1093/brain/awy262
43. Vaslav Nijinski Choreographer Opéra national de Paris
44. Carol Diethe Historical Dictionary of Nietzscheanism Historical Dictionaries of Religions, Philosophies, and Movements, No. 75 Second Edition p.208 The Scarecrow Press, Inc. 2007
45. Emilio Fernandez-Egea One hundred years ago: Nijinsky and the origins of schizophrenia, 25 October 2018: Brain, Volume 142, Issue 1, January 2019, Pages 220–226, https://doi.org/10.1093/brain/awy262 "The God of Dance in Paris" - "Psychosis in his own words": "a classic self-portrait of the symptoms of schizophrenia - Delusions of influence "I realised that God did this on purpose so that I would correct my notebook. God writes all this for me and men’s’" - grandiose delusions with omnipotence"...
46. PIPPA CRAWFORD Nijinsky on Nijinsky: the Decline and Fall of the Ballet Russes Archived 2023-11-02 at the Wayback Machine Pushkin House 3 March 2020
47. J Oules [Camille Claudel. Her psychiatric case history] https://pubmed.ncbi.nlm.nih.gov/8279734/ Ann Med Psychol (Paris). 1993 Aug-Sep;151(7):485-98.
48. Paul Halpern April 21, 1936 Medium
49. Clare Fitzgerald Albert Einstein forgotten son eduard the Vintage News
50. Mileva Einstein-Maric Biography.com
51. John F. Nash Jr. Facts Nobel Prize
52. John E. Gedo Nietzsche and the Psychology of Genius American Imago Vol. 35, No. 1/2, MYTH, CREATIVITY, PSYCHOANALYSIS: Essays in Honor of Harry Slochower (SPRING-SUMMER, 1978), pp. 77-91 (15 pages) Published By: The Johns Hopkins University Press
53. K.R. Eissler in: Anne Wilson Wangh Vaslav Nijinsky: Genius and Schizophrenic American Imago Vol. 35, No. 3 (FALL, 1978), pp. 221-237 (21 pages) Published By: The Johns Hopkins University Press
54. Josef Parnas, Mads Gram Henriksen Mysticism and schizophrenia: A phenomenological exploration of the structure of consciousness in the schizophrenia spectrum disorders Consciousness and Cognition Volume 43, July 2016, Pages 75-88

Bibliography

Killaspy H (September 2014). "Contemporary mental health rehabilitation". East Asian Archives of Psychiatry. 24 (3): 89–94. PMID 25316799.