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domingo, 28 de noviembre de 2021


I guess that, for most people, someone with schizophrenia does, says, or believes strange things, as almost everyone does, but to such a degree that it is already out of the ordinary.

If we ask a psychiatrist, he will turn to the DSM-5 diagnostic manual and recite a series of characteristic symptoms: disordered thinking and expression, delusions, hallucinations, and various mood disturbances. Since these symptoms are also typical of many other disorders, to characterize schizophrenia, in particular, we have to use statistical data such as their duration or intensity. There are no diagnostic tests to determine schizophrenia; diagnosis is based on the psychiatrist's opinion.

But the symptoms are not the disease itself but its external manifestation. Nobody knows what the cause and mechanism of schizophrenia are. The experts consider that it is a permanent and incurable condition, or, in other words, we do not know how to cure it because we do not know what it is.

We know, nevertheless, that patients with these symptoms show alterations in the size of some areas of the brain and imbalances in the concentrations of various neurotransmitters, such as dopamine, serotonin, and glutamate. These are the substances neurons use to communicate among them, so it is not surprising that their alteration leads to mental disorders.

In the 1950s, Paul Charpentier discovered the first antipsychotic drug. The effect of these drugs is precisely to try and regulate these neurotransmitters' concentration imbalances, reducing or even eliminating the symptoms.

From that time on, the treatment consisted mainly of taking these medications. That represented an advance in contrast with the previous situation: Patients were usually sentenced to internment for life, possibly subjected to quite brutal treatments aimed to calm them in case of crisis. Nowadays, patients can often receive outpatient treatment, and hospitalizations are shorter or unnecessary.

However, these medications are not exempt from problems. In addition to having quite marked and unpleasant side effects, especially the older ones, they can sometimes cause even the patient's death. They are also not effective in all cases. Antipsychotics help many people, but the treatment is useless for many others.

With the rise of genetics at the end of the last century, researchers tried to attribute a genetic origin to almost all diseases, schizophrenia among them. Genes are portions of DNA that reside in the nucleus of the cells of our body. Some act as a kind of "recipe" to build proteins; others have a regulatory function on the activity of other genes. There are also many genes with no apparent or known function.

Proteins are essential molecules for our bodies. In addition to being part of all the organism's structures, they build an infinity of biological machines that perform the functions that allow cells to continue living and working. Every cell has millions of these machines, and neurons are no exception. Everything that has to do with the transmission of impulses between neurons depends on the proper functioning and the correct amount of these elements.

There are at least two copies for each gene, one from the mother and one from the father. There are more than two copies of the same gene in many cases. The number of copies is relevant because that influences the manufacturing of more or fewer proteins of a specific kind, so our body has more or fewer machines that perform a particular function.

Some of these machines help transform the information contained in genes into new proteins. Genes can be in an active or inactive state, and only in the former can proteins be built from them. Those states can change over time. This way, the body can regulate the number of proteins of each type manufactured at any given time within the cell.

Apart from the natural mechanisms of the cell that change the activation states of genes, there are external mechanisms that can also cause these changes. Traumas, stress, toxic substances and pollution, for example, can cause them too. Moreover, parents can also transmit these changes to their descendants, so the life history of progenitors can be significant in developing diseases related to these imbalances.

Returning to the issue of antipsychotic medication, another problem with that medication is that the patient becomes a passive subject in charge of the health system, which protects and directs him in his recovery process. Treatment may help with the regulation of brain function, but if the effects of the environment are decisive in the development of the disease, drugs can do little to change them.

Given this, most professionals consider that medication should be complemented with therapy and perhaps help to modify patients’ lifestyles and living conditions. However, not all patients are lucky enough to count on these resources.

One of the most successful approaches in this sense seems to be the mixed associations of patients and mental health professionals, psychologists and psychiatrists. The doctor-patient hierarchical scheme disappears, becoming a group with horizontal equality relationships. The term "patient" for the affected person also disappears. In these groups, everyone participates actively, to the best of their ability, sharing their experiences. It is not surprising that many of the former patients eventually adopt the role of therapists once they overcome their problems.

The medication goes from being the treatment's centre to only an accessory tool. It is only taken if needed and only in the minimum effective dose. This way, the person can participate in this collaborative recovery process with minimum hindrances. The objective is for the person affected by the disorder to abandon the passive role of the patient and become their recovery process' director. The rest of the group members are mere, though valuable, collaborators. That person becomes an active and productive community member, which reinforces his self-esteem and personality. The success of this approach appears to be far greater than that of the classical one. It is already being adopted worldwide in some health institutions as well.

In conclusion, pills are not the answer for all problems, especially those of unknown origin. Those who suffer from these disorders have a lot to say about them. They are true experts, and when placed in the proper context of collaboration and human warmth, they are a key element in the search for successful treatments.

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