What Causes Schizophrenia?

There's no agreement on what causes schizophrenia. Some research suggests that anyone can be driven into a psychotic episode under highly stressful conditions, such as a dysfunc- tional family environment or the experiences of combat.

However, evidence also suggests that some individuals are predisposed to schizophrenia due to heredity or specific pat- terns of brain chemistry. For example, the presence of biochemical abnormalities, such as an excess of the neuro- transmitter dopamine, has been linked to schizophrenia.

These days, the dominant model for understanding the causes of schizophrenia is the predispositional model. The basic idea here is that people are variably predisposed to developing this kind of psychosis depending on the interaction of genetic and environmental factors.

Personality Disorders

Personality disorders impair a person's ability to get along with others. There are a variety of these disorders, ranging in severity from excessive dependency on others (dependency disorder) to borderline and schizotypal disorders that approach full-blown psychosis. As you might expect, the less severe disorders are more common and are easier to treat. In gen- eral, a personality disorder is characterized by inflexible, maladaptive behavior that cripples one's capacity for normal social relationships. Your textbook focuses on three kinds of personality disorders:

1. Antisocial personality disorder-People with antisocial personalities are often called sociopaths or psychopaths. A common way of thinking of people with antisocial personalities is that they lack a developed conscience. A psychopath is likely to be selfish, impulsive, emotionally shallow, and manipulative. The basic motto of a psy- chopath might be "My way or the highway, and I get to decide which highway."

While psychopathic tendencies are often associated with criminal or amoral behavior, psychopaths sometimes ascend to positions of power and responsibility. Even some people in high levels of government and corporate life are said to have psychopathic tendencies. The most striking feature of the antisocial personality is emotional coldness. The fate of others means little or nothing to them. They may be very clever at expressing sympathy, but they're all but incapable of empathy. They fail to identify with the wants, needs, and suffering of others.

2. Borderline personality disorder-People may have diffi- culty developing a secure sense of personal identity. They cope with this issue by relying on relationships with others to define their identity. Emotional instability and impulsive, episodic behavior are common, since these folks simply can't handle rejection of any kind.

3. Narcissistic personality disorder-One observes an inflated sense of self-importance. Characteristic of this disorder is a sense of entitlement demanding special treatment from others. A major pattern in this disorder is an inability to experience empathy or compassion for others.

Childhood Disorders

"Almost 20% of children and 40% of adolescents experience significant emotional or behavioral disorders." (You should memorize this line from your text.) Read on for rather star- tling statistics related to depression and other problems.

Two common childhood problems get special attention.

Attention-deficit hyperactivity disorder (ADHD) includes inatten- tion, lots of inappropriate activity, impulsiveness, and a
low tolerance for frustration. Actually, all of these kinds of behavior show up in most children from time to time. A diagnosis of ADHD, therefore, is one of degree. Given that fact, ADHD is a controversial disorder. Some feel that it's overdiagnosed, possibly with the complicity of pharmaceutical interests that market the standard treatment-a drug called Ritalin, which, oddly enough, is chemically related to amphetamines.

Autism is getting increasing attention these days. That's because research indicates that the incidence of this devas- tating disorder in young children is increasing. To learn more about autism, Google "autism symptoms" or "autism prevalence" and see what you find.

Other Disorders

Your text discussion isn't meant to be exhaustive. It hits important highlights. Other kinds of disorders with signifi- cant public health impacts include alcohol and drug abuse, eating disorders, post-traumatic stress disorder (PTSD), and organic mental disorders, such as Alzheimer's disease. In this, the age of the Internet, you can learn more if you're interested in learning more.

Psychological Disorders in Perspective

Prevalence of Psychological Disorders

The essence of this section is an overall view of the incidence and prevalence of mental and emotional disorders in the United States. It's based on an interview sample of 8,000 men and women between the ages of 15 and 54, drawn so as to represent the U.S. population at large. The findings are sobering. Of those interviewed, 48% had experienced a disorder at some point in their lives. Additionally, 30% had or were experiencing a disorder in the year of the interview, and the number of persons suffering from more than one disorder simultaneously (called comorbidity) was significant. By far, the most common reported disorder was depression. Of course, the United States isn't alone in having a high prevalence of psychological disorders.

The Social and Cultural Context of Psychological Disorders

This final topic for the chapter introduces you to some of the perplexities of classifying psychological disorders in different cultures. Are patterns of psychological disorders particular to different cultures? For example, Japan is a collectivist cul-

ture. That is, a person's sense of self-worth and identity is strongly intertwined with loyalties to family, peers, and coworkers. By contrast, the dominant culture of the United States is individualistic. American identities are based on competition, personal achievement, and self-reliance. Would the causes of depression be different in Japan and the United States?