5
WHY ME?
It is natural to want to know why this happened to you. Although there is no complete scientific explanation why some people develop schizophrenia, the same is true for many illnesses. There are many mysteries that scientists are just beginning to unravel.
Some people with schizophrenia wonder if they did something wrong that brought on this illness. Was there too much stress in their lives? Did they do too many street drugs? They often feel guilty or ashamed, angry or sad, even helpless. Remember not to blame yourself or your family. Stay up to date with the latest research findings.
BETH
Special contributors: Handan Gunduz, M.D. and Anil Malhotra, M.D.
BETH: I was nineteen, and I was in college at the University of Buffalo. It was the beginning of my sophomore year. I remember bits and pieces of it. I remember my friends said that I was acting weird. I was dating somebody, and I thought we were going to get married. I was just not in reality at all. I was lying on my bed, and I was thinking there was a war going on. My roommates took me to the emergency room, and I stayed in the hospital for two weeks. Then they transferred me here. I never knew there was anything wrong with me. When they were doing testing I thought I was special, that people wanted to interview me, and that’s why I was there. I was taking Haldol and Cogentin when I was upstate. Then I came to Hillside in a little bit better condition, still not understanding what was going on. I was there for a month or two and I couldn’t finish up my semester at school. I don’t think anybody had said the word schizophrenia when I was there. I was really upset afterward. I really didn’t know what was happening. I thought I was on a cruise. I definitely had delusions of grandeur.
I wound up going to a local college and finished up my prerequisites for my program. I lost a whole year, and I was very upset about that. They just took me away from my school and my friends. I was furious. Then I had to apply to my program all over again, so I worked for another semester.
Nobody in my family has ever had a mental illness. I was a good kid. I always ask, “Why me?” I never thought it could happen to me. I still don’t know. I just think it’s not fair.
BIOLOGICAL CAUSES
Although the exact cause of schizophrenia is not known, it appears to be a biological disease. It is not caused by how someone is raised. We know that schizophrenia frequently runs in families. In other words, a person is more likely to develop schizophrenia if he or she has a relative with schizophrenia rather than no relatives with this illness. This indicates that genetic factors play a role.
Another factor that has been associated with developing schizophrenia is a history of obstetric complications. Many studies have shown that mothers of people with schizophrenia had more complications than average during their pregnancies, at birth, or right after birth. Decreased oxygen availability to the baby’s brain around birth is known to damage certain regions of the brain that, later in life, play a role in its complex functions.
Some studies have indicated that viral and autoimmune mechanisms may be involved in risk factors for developing schizophrenia. After the 1957 flu epidemic, children born to mothers infected with flu in their second month of pregnancy were found to be twice as likely to develop schizophrenia as children whose mothers were not infected.
Some scientists are also expressing concern about marijuana use and schizophrenia. They believe that the chemicals in marijuana may change the way the brain develops, especially for younger teenagers. The effects of marijuana use on the brain continue to be explored in ongoing research.
These studies indicate that there may be problems in the way the brain matures that are due to genetics or to irregularities in the development of the brain. Although our knowledge about what causes schizophrenia is limited, with the advancement of scientific techniques, researchers are now able to design and conduct more powerful studies of this illness.
“Why Me?”
JACKIE: I went through a couple of years where I had a lot of regrets and I thought if I hadn’t done certain things in my life it would never have happened to me. I blamed myself a lot. I also blamed my ex-boyfriend. I felt the way he treated me was the cause. Mainly I blamed myself for everything. It took me a couple of years to get over that.
THOMAS: Well, sometimes I think, “Why does this have to happen to me?” I am not really a bad person. I thought I was reasonably healthy. I used to think I did something bad, so I deserved it. Now I think there was no reason for this; it just happened.
AUDREY: At the start of the illness I would ask, “Why me?” Now I ask myself, “Why not me?”
BEAUX: “Why me?” is feeling sorry for yourself. It’s uncontrollable.
BUCK: The first thing that I wanted to ask the doctor was why this happened to me. Sometimes I wonder if I did something wrong to deserve this illness. I don’t know why it happened to me. I guess it’s just part of life that you have to go through.
LUCINDA: Why not me? Worse could have happened. I could have been diagnosed with cancer. Schizophrenia is a treatable illness.
TABLE 5.1
Genetic Chance for Developing Schizophrenia
| RELATIVE WITH SCHIZOPHRENIA | APPROXIMATE CHANCE OF DEVELOPING SCHIZOPHRENIA | APPROXIMATE CHANCE OF REMAINING FREE OF SCHIZOPHRENIA |
|---|
| Sibling | 8% | 92% |
| Twin (identical) | 50% | 50% |
| Twin (fraternal) | 12% | 88% |
| One Parent | 12% | 88% |
| Two Parents | 40% | 60% |
ILAN: I think the “why me” for me came the second time around. The first time, being a religious person, I thought that I was being punished in some way or it was something that was supposed to happen. I thought it was good for me. “Even though I don’t see it now,” I told myself, “I’ll understand it in the future.” So in between the first day hospital and the second hospitalization I tried very hard to be more observant, very religious. So I was thinking, “Why me? What did I do this time that I deserve to come back?”
GARY: I remember asking myself “Why me?” after my discharge. It seemed like I said that for a good year.
MIKE: I never would have expected anything to happen to my mind. It was very unexpected and it was hard to deal with. I always questioned why I had to go through this. Was there a purpose behind it? Did I do anything to cause this to happen?
Now I know that I had nothing to do with getting this illness. I don’t blame myself. I don’t blame anyone else for this illness. It just happens.
WHY SOME PEOPLE DEVELOP SCHIZOPHRENIA
Schizophrenia is a biological illness. Scientists are not sure what causes it.
They believe it is related to genes, viruses, and problems at birth. They also are looking closely at differences in brain structure and environmental factors, such as early marijuana use and life stressors. Scientists do not believe schizophrenia is a result of how your parents raise you or a weakness in your character.
Psychiatric Genetic Research
Psychiatry is one of the youngest fields of medicine. As a result, our understanding of psychiatric disorders is still in its infancy. There are numerous mysteries about the underlying biological processes involved. There are also questions about treatment. One of the most puzzling questions commonly asked by patients is “Where did this come from?” or “How did I get this?” Nature versus nurture is one of the oldest scientific debates that attempts to answer this question. Essentially, the controversy is about whether we are influenced more by the biological traits we inherit from our parents or by the environment in which we are raised. One of the reasons this is such a difficult question to answer is that people in research studies usually share both similar biological traits and similar backgrounds. This makes it hard to separate the influence of biology from the influence of the environment.
FIGURE 5.2
NEURON AND DNA
When we look at the influence of biology we are talking about genes, which are the basic unit of heredity. Genes are inherited in pairs, 23 pairs in all. The field of genetics attempts to understand how a person’s characteristics and traits may be inherited biologically from his or her parents. Characteristics can be physical (for example, eye color, hair color, height) or behavioral (for example, musical ability). Genetic studies of psychiatric illness attempt to track how frequently psychiatric illnesses occur within families. They also attempt to identify which genes might be responsible for transmitting an illness from one generation to another. Studies of monozygotic twins, otherwise known as identical twins, were among the first genetic studies. Identical twins were studied because they are 100 percent genetically similar, while other pairs of family members are only 50 percent genetically similar. In order to focus on the influence of the environment, researchers turned to twin adoption studies. These studies looked at identical twins who had been adopted away from their biological parents and raised separately. However, because adoptive families are often carefully chosen so that the twins will grow up in similar environments, this makes it difficult to distinguish between environmental and hereditary influences. Therefore, these studies were not able to offer a lot of additional insight. Another type of study is the high-risk study, in which children with at least one ill parent, usually the mother, are studied over many years to identify risk factors and early signs of an illness. This type of research is important in helping us to identify potential causes of an illness.
Although an illness “runs in a family,” that does not necessarily mean that the cause of that illness is purely genetic. Environmental influences such as stress, a virus, birth complications, and nutrition can help determine whether one will or will not develop a particular illness even if a genetic predisposition is present. One of the current theories is that the interaction of genetics and environment causes a psychiatric illness to emerge. According to this interactionist theory, individuals who develop a psychiatric illness are genetically predisposed to it, but environmental or developmental factors may trigger its onset. For example, among identical twins the probability that one twin will develop schizophrenia if the other twin has already been affected is about 46 percent (C. A. Prescott and I. I. Gottesman, “Genetically Mediated Vulnerability to Schizophrenia,” Psychiatric Clinics of North America 16 [1993]: 245–267). This leads us to wonder why the other 54 percent do not develop schizophrenia, whether the twins grow up together or apart. If genetics were the whole story, then we would expect both twins to be equally affected all the time. This implies that more than simple genetic inheritance contributes to the illness.
Newer types of genetic research examine the relationship between a person’s genetic makeup and the characteristics they display. An important concept is that one’s genotype, the specific genetic information inherited from one’s parents, does not necessarily dictate one’s phenotype, one’s observable physical and behavioral characteristics. In other words, we are all coded with some genetic information that is never expressed in an observable way. This might occur for different reasons. Sometimes it may be because we have two different sets of genes, dominant and recessive, that give the body opposite sets of instructions about how to develop. Dominant genes hide the presence of recessive genes, and we never see the genetic information those genes contain, although it is still there. Another reason this might occur is that phenotype may not be linked to one gene alone but may reflect the influence of many genes. For example, linkage studies have been used to identify genes responsible for inherited human disease. These studies try to match particular traits to specific positions on the chromosomes that carry the genes. Association studies explore the relationship between specific traits (such as the presence or absence of an illness) and particular genes. These studies look at the DNA, the genetic material of which genes are made. DNA is collected from large groups of people with schizophrenia and their families and is then compared to the DNA of people without the trait. Researchers are now beginning to identify genes that might be implicated in the development of different psychiatric disorders, including schizophrenia.—Anil Malhotra, M.D., Unit of Molecular Psychiatry, Zucker Hillside Hospital
“My Background, My Genes”
SAM: I felt I was doing everything right. I know I was doing the job better than others. I didn’t do anything wrong. I was moral and religious. I still am. I’ll never be like the other kids in school. If I get married and have children, they may have it.
AMBER: I sometimes wonder why this incident happened to me. I was under a lot of stress. At the time I was looking for a job. It was a very stressful time for me, and that could be a reason why this happened. Also, my uncle had a mental disorder. I don’t know exactly what it was, so I can’t say if it was a genetic thing or not.
BUDDY: I used to think about “why me,” but coming here made me understand that I’m not the one to blame. It is just something that I had no control over, that I was born with.
ALEXIS: I know that this is hereditary and I accept that.
SHARON: I know it’s not my fault. I think the illness was caused by my background, my genes.
JAMES: I thought, “Why me?” when I came out of the hospital, and I still do to this day. I wondered, but then once I got out and I remembered what some of the doctors were telling me, that it was a chemical imbalance, that made it much better. I never thought it was my mother and father or my family that drove me to get sick, although I did have some stressful times in my life. I know we all do. I guess we all have different degrees that we can handle, but once the doctors told me it was a chemical imbalance I never believed it was caused by stress.
VANESSA: I couldn’t understand why it happened to me.I was working. I had a nice job, two children. I just didn’t understand why, what was going on.
ONE GENOME, 22,000 GENES, 23 PAIRS OF CHROMOSOMES
The human genome is how we describe all of a person’s genetic makeup.
The genome has approximately 22,000 genes.
Genes are like codes that tell the body how it will look and act.
The 22,000 genes are contained within 23 pairs of chromosomes.
We inherit our chromosomes in pairs, 23 from each parent.
We inherit genes that carry traits that may make us vulnerable to a disease. Sometimes there are changes in the gene structure during the process of copying genes from the parents’ genes to the developing embryo.
There may be other reasons genes are altered that are now being explored. Recent research is findng very small changes in genes may also play a role in developing schizophrenia.
Research continues to try to understand:
• which genes or combination of genes play a role in schizophrenia
• the interaction between genes and the environment
• who is at risk for developing schizophrenia
• what is going wrong for the genes involved.
For additional information about genetics and schizophrenia:
