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Is it possible to have 'mild' schizophrenia? The three-phase course of the illness

Michał Marciniak

You can read this text in 10 min.

Is it possible to have 'mild' schizophrenia? The three-phase course of the illness

PantherMedia

Anger and joy

The doctor makes a diagnosis. Paranoid schizophrenia. A pale fear falls on the patient. It's incurable, why me (or more often why this has happened to our decent family), what to do - such thoughts swirl around in the head like black smoke coming out of a chimney. By the time the doctor explains what the illness is, how it is likely to progress and what the treatment options are, the patient is already painting their own picture, which usually has a black background that is not always the most appropriate. So how does the illness usually progress? Is it possible to have mild schizophrenia?

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Table of contents:

  1. Onset of the illness
  2. The three-phase model of schizophrenia
  3. Overwhelming phase
  4. Adaptation phase
  5. Degradation phase
  6. Summary

Onset of illness

It is difficult to provide a traditional model for the development of schizophrenia. Each case is actually unique in its own way. It is not without reason that early researchers of this illness often spoke of a "schizophrenic group disorder" instead of a single schizophrenia, thus expressing their observations that the illness can progress in a variety of ways. Nevertheless, attempts were made to distinguish possible origins of the illness.

Usually, the symptoms of schizophrenia have their onset in young people, between the ages of 20 and 30. The name of the illness comes from the Greek words schizein (to split) and phren (mind), i.e. the axial problem is the splitting of the different components of the mind that make up a person's personality. Realising what the name of the disease means, the most common age of onset is not surprising. After all, it would be difficult to have a split personality in a child whose 'self' is only at the formative, developmental stage. Similarly, in older people, the personality is already so consolidated that the disease process cannot disturb its construct.

Symptoms therefore appear in younger people. Basically, we can distinguish three possible origins of the illness:

  • Sudden - the onset of the illness, usually combined with massive psychotic symptoms, cannot go unnoticed by those around the patient. Figuratively speaking, such an onset can be said to be like the breaking of a string - the glue that binds the personality together in a state of relative stability.
  • Slow - the internal disintegration is rather gradual. Before the onset, there may be only discrete changes in behaviour, a search for solitude, a tendency to leave the social group.
  • Neurotic - the patient may present with hysterical, anankastic, hypochondriacal symptoms, but when we come into contact with her we have the conviction that the problem lies deeper, that this behaviour of hers is only the tip of the iceberg. "Conviction" and "a sense of schizophrenia" are of course not scientific diagnostic methods, but they can give an idea of what the patient's "schizophrenic expression" described in the literature is.

Often, the onset of the illness is overtaken by a single behaviour of the patient that deviates in a significant way from his or her previous lineage. It is an extreme change in behaviour. Such a harbinger of illness is referred to in the language of psychiatry as a paragnomenon. However, there is no standard time before which such a symptom occurs. However, it usually does not cause concern to those around the patient and it is extremely rare for a psychiatric consultation to occur at this stage of the illness.

Three-phase model of schizophrenia

It is difficult to define a typical course of the schizophrenic process. A great deal depends on the type of schizophrenia that is diagnosed in the individual patient. Three phases of schizophrenia are often distinguished, which are similar to the phases of chronic somatic diseases (e.g. with cancer). In the first phase, the body mobilises the forces of the immune system to defend itself. A cytokine storm takes place in the body, more and more effector cells flow into the disease site, the inflammatory process spreads, which causes an increase in temperature - the body fights back. The second phase is a time of quieting. Unfortunately, this is only apparent, because the enemy, i.e. the disease, does not sleep and continues to multiply in the body. Finally, the end phase is reached when the escalation of the disease overwhelms the body's defences and the body stops fighting.

In schizophrenia we can distinguish phases:

  • Overwhelm - rapid entry into the delusional world.
  • Adaptation - the natural coexistence of the real and delusional worlds.
  • Degradation - progressive cognitive atrophy.

However, it is never possible to predict how long the different phases will last, or whether they will occur at maximum intensity in each patient, or whether they will go unnoticed by those around them. In the simple and hebephrenic form, it is sometimes the case that the patient enters a degradation phase from the outset, which can be described as a severe form of schizophrenia. It is not uncommon for the illness to progress in leaps and bounds, with only subtle residual symptoms of personality degradation between episodes - and even then only if the patient's schizophrenic chart is known. We will call such a course the mild form of the illness.

Adaptation, Degradation, Ovladniecie, Schizophrenia, Three-phase-course-of-disease
Schizophrenia, photo: panthermedia

Overwhelming phase

In the overpowering phase, the patient is thrown into a new world. And in it he experiences new sensations, colours, ecstasies of all kinds, altered proportions, different physical laws. He willingly enters this world, in which he feels that he can finally be himself - he does not have to hide his outstanding abilities, be ashamed of his mission (grandiose delusions). After all, everyone should understand that the second nature of the sick person comes from a god. However, the exciting new world very quickly turns into an unknown, mysterious, sinister place. Enchantment very quickly turns into fear, loneliness, a sense of incomprehension. The patient himself reacts to his inner experiences in a way on the basis of which we qualify the form of schizophrenia:

  • Simple schizophrenia - the patient is primarily present with negative, disabling symptoms. He withdraws from social life, closes in on himself, gives up his previous activities.
  • Paranoid schizophrenia - the patient discovers the truth. He already knows why someone smiled and another gave him a hateful look. He knows that this is surely the result of a conspiracy being foisted on him. It frightens him that others can hear his thoughts, that they can control them. He feels constantly watched.
  • Hephebephrenic schizophrenia - the patient does things to spite the incomprehensible and sinister world, in his or her mind to spite himself or herself, "fooling around".
  • Catatonic schizophrenia - the patient loses power over his body. He once freezes motionless or makes strange, often violent movements. He has the impression of being controlled from outside.

Adaptation phase

In the adaptation phase, the so-called double orientation is characteristic. The patient steps with one foot in the real world, but translates it into his schizophrenic world. While in hospital he understands that he is being treated by doctors, but at the same time he identifies the staff with angels, phantoms, etc. Or when watching the news he is interested in it, but because he expects to find in it confidential information directed only to him. The patient simply 'knows' what reality means so 'really'.

Also in this phase, perseverations, i.e. the repetition of a fragment of an action (motor perseverations) or speech, inappropriately to the situation, are characteristic. Perseverations are the result of partial degradation of the human central nervous system. Instead, they are part of the standard activity of animals lower on the evolutionary ladder, whose nervous system is much poorer. The patient's repeated gestures and words seem on the surface to be inappropriate, meaningless, but when we manage to enter his world of inner experiences, it turns out that they are a compatible element of the schizophrenic world.

It is very difficult to lead the patient back to the path of health once his mental state has entered the phase of adaptation. The schizophrenic world thoroughly penetrates the patient's thinking, causing very strong inner experiences. After all, it is a rule that we remember much better events that are accompanied by a strong emotional charge. We will not remember that we went to the newsagent's on 7 May to buy a newspaper, but if we go skydiving immediately after shopping, the chance of a memory trace is much greater. The same happens with a schizophrenic patient. The imaginary world is associated with a range of emotions, often negative, which very effectively perpetuate the memory of it. When the patient emerges from a psychotic episode, i.e. gains at least a partial insight into the real and the unreal, he or she is usually surrounded by emptiness. Friends do not answer the phone, there is only the news of dismissal waiting at work, loved ones are suddenly very busy - the sick person's world presents itself in ruins, like a forest after an extensive fire. Under such conditions, it is much easier to return to a world rich in experiences, events, additional people, interested beyond measure. To an imaginary world. Hence, relapses often occur in this phase, which increasingly exacerbate the mental deficits of the patient. To the point where we start talking about ..

...The degradation phase

This phase of schizophrenia can be described in one word as extinction. Often in old age the picture of the illness is milder, the symptoms are residual, catching up... But along with the illness the mental silhouette of the patient, that is, what constitutes his distinctiveness, uniqueness, is also extinguished, unfortunately. There is a disintegration of personality, which now dominates the symptoms. The earlier phases of the illness were more of a splitting and now a gradual disappearance of mental activities.

This can be a very distressing picture for the family and those around the patient, but also for the psychiatrist who sees the impotence of the treatment he has coordinated.

Once the patient is in this phase of schizophrenia, the prognosis for recovery is decidedly unfavourable. However, with appropriate drug treatment and therapy involving maximum socialisation, for example in the form of the patient taking up employment, very promising results are possible. Schizophrenic patients, due to the stereotypical nature of their activities, are often very conscientious in doing work that is monotonous for healthy people.

Adaptation, Degradation, Ovladniecie, Schizophrenia, Three-phase-course-of-disease
Schizophrenia, photo: panthermedia

There are also known cases of people with spontaneous remission of the illness after a strong emotional shock (e.g. during World War II). Then they returned from dementia to an active life in society.

However, the grey and sad picture of the third phase of schizophrenia does not have to look like this at all! The impression of greyness is often the result of a misplaced view of the patient, with no real insight into his or her inner self. This can be compared to a colourful landscape, which, when set at the position of the horizon, i.e. in the distance, will also appear grey.

Summary

Schizophrenia is an illness with a very varied course. It usually affects people who, already formed, are entering adult life. Wanting to plan many things, to "arrange their lives", they come across an illness which evidently destroys this order. In addition, at the very beginning of the illness, which can also vary, it is impossible to determine how quickly it will progress.

Her own journey with schizophrenia was very frankly and picturesquely described by Elyn R. Saks in her autobiographical book "Schizophrenia. "Schizophrenia. My journey through madness'. I recommend that you take a look at this reading, because no observer's words can ever fully convey the world of the sufferer's experiences. Elyn R. Saks, very aware of her illness, tells the beautiful story of her life, in which she has achieved a great deal. This is mainly due to her own commitment to her treatment, which would not have succeeded if it had not been for her husband and her friends, who bravely stand by her side throughout the illness. She does not run away from work, which also, in my opinion, contributes greatly to her mental well-being.