Schizophrenia: More Than a Diagnosis, a Human Story that Worth Understanding

Today, I want to talk to you about a subject that is, unfortunately, surrounded by fear, silence, and misinformation: schizophrenia. Upon hearing the word, you likely pictured the distorted images that film and television have presented to us for decades. Violent, unpredictable, and aggressive individuals. Let me tell you that this image is distorted and deeply unfair.

Schizophrenia is a real, complex, and treatable brain disorder, and those who suffer from it are, above all, human beings who feel pain, love, work, and dream. My aim today is to help you view this topic through a different lens: that of science, but also that of the soul.

A bit of history: how we named what we didn’t understand

To understand something, it helps to know where it comes from. Schizophrenia did not originate with modern diagnostic manuals. It has been with humanity since ancient times. As early as ancient Greece, Hippocrates spoke of “madness” as an imbalance of the humors rather than a divine punishment. An early attempt to view such suffering through the lens of medicine rather than superstition. For centuries, however, the notion of demonic possession or heavenly punishment prevailed. Many people with these conditions ended up locked away, chained, or abandoned.

It was not until the late 19th and early 20th centuries that psychiatry began to bring order to the chaos. In 1893, the German psychiatrist Emil Kraepelin described what he termed “dementia praecox.” Grouping together clinical presentations characterized by progressive deterioration and early onset.

Years later, in 1911, the Swiss psychiatrist Eugen Bleuler coined the term *schizophrenia*. Which literally means “split mind” or “divided mind.” Bleuler intended to describe something quite different from what people often misunderstand today. It is not a matter of “split personality,” but rather a fracture between psychological functions—thought, emotion, and behavior—that normally operate in an integrated manner.

Throughout the 20th century, psychiatry refined this concept. Today, international diagnostic manuals—such as the *Diagnostic and Statistical Manual of Mental Disorders* (DSM-5) and the *International Classification of Diseases* (ICD-11). They provide clear, consensus-based criteria for identifying the condition. Yet, beyond the labels, the crucial point is to understand that we are dealing with a disorder of brain function.

I’m going to define it simply. Schizophrenia is a chronic, complex psychiatric disorder that affects the way a person thinks, feels, perceives reality, and relates to others. It is not a single disease, but a set of symptoms with varied manifestations. Also that is why today we prefer to talk about the schizophrenic spectrum.

Its central characteristic is the so-called psychotic symptoms, which imply a loss of contact with reality. But not everything is psychosis, it also includes difficulties in motivation, social relationships, cognitive performance and emotional life.

The causes: a puzzle of many pieces

There is no single cause of schizophrenia. Current science understands it as a multifactorial disorder. So the result of the interaction between genetics, brain development and the environment. I’ll explain it to you in parts.

-Genetics plays an important role, but not a determining one. If one identical twin has schizophrenia, the other has about a 50 percent chance of developing it. This tells us that there is a hereditary burden, but also that genes do not explain everything. There is no “schizophrenia gene,” but rather multiple variants that, combined, increase vulnerability.

-Brain development is another pillar. During intrauterine life and adolescence, very delicate neuronal maturation processes occur. Alterations in the migration of neurons, in synaptic pruning (that natural “cleaning” of connections that the brain makes) or in the balance of neurotransmitters such as dopamine and glutamate, can predispose the appearance of symptoms.

-The atmosphere also counts. Factors such as complications during pregnancy or childbirth, maternal infections, malnutrition, cannabis and other drug use, chronic stress or early traumatic experiences can act as triggers or aggravating factors in vulnerable people.

In short, it is the result of a complex dance between genes and life.

The symptoms of schizophrenia are usually classified into three large groups. It is important to know them in order to identify them and lose fear of them.

–Positive symptoms (what is “added” to the normal experience):

• Hallucinations: perceptions without a real object, auditory ones being the most frequent. The person hears voices that can comment on their actions, insult them or give them orders.

Delusions: False and firmly held beliefs, despite evidence against them. They can be about persecution, grandiosity, reference (feeling that others are talking about you) or control.

• Disorders of the course of thought: speech becomes disorganized, jumping from one topic to another without logical connection.
• Disorganized or catatonic behavior: from unexplained agitation to immobility and negativism.

Negative symptoms (what is “lost” compared to previous life):

• Apathy, lack of motivation.
• Affective flattening: the person does not seem to feel joy or sadness.
• Social withdrawal and language impoverishment.

Cognitive problems also often occur, such as difficulties with attention, working memory, and executive functions, which impact study, work, and daily life. These symptoms usually appear between late adolescence and early adulthood, and their onset may be gradual (insidious) or abrupt.

How does it evolve? Course forms

Not all patients evolve the same. We can describe several patterns. In the episodic course, with recovery between outbreaks, the person presents acute episodes and then returns to functioning close to the previous level. It is the most favorable pattern. In the episodic course with progressive deterioration, each outbreak leaves consequences on functioning. If the course is continuous, the symptoms persist stably, without clear remissions. And, finally, there is the course with a predominance of negative symptoms. In which the deterioration is slow and progressive, with fewer acute episodes but greater functional impairment.

Factors such as early onset, substance use, lack of timely treatment and psychosocial stress influence a worse prognosis. On the contrary, a late start, good family support, adherence to treatment and rehabilitation significantly improve the outcome.

The treatment is comprehensive and combines several strategies

1.Antipsychotics: they are the cornerstone. They reduce positive symptoms and prevent relapses. There are typical and atypical ones, with different side effect profiles. Adherence is crucial, abandoning medication is the main cause of relapse.

2. Psychotherapy: Cognitive behavioral therapy for psychosis helps manage persistent symptoms, improve adherence, and reduce suffering. Family psychoeducation is equally valuable.
3. Psychosocial rehabilitation: social skills training, occupational therapy, and vocational and educational support. The goal is not merely to eliminate symptoms, but to restore a meaningful life.
4. Early intervention: programs for early detection and treatment of first psychotic episodes have been shown to alter the course of the illness.
5. Lifestyle: regular sleep, avoiding harmful substances, exercise, and support networks.

Treatment is not a one-size-fits-all prescription; it is tailored to each individual. And while schizophrenia cannot currently be “cured” in the sense of being eradicated. It can be managed, and many people lead full, productive, and happy lives.

Stigma: the wound inflicted by society

We come, perhaps, to the most painful point. If schizophrenia is already difficult due to its symptoms, stigma makes it even more cruel. Stigma consists of the negative beliefs, attitudes, and behaviors society holds toward those with this disorder. It manifests in language (using “schizophrenic” as an insult). In the media (associating the illness with violence, when in reality, people with schizophrenia are more often victims than perpetrators). Also in the workplace (open discrimination), and within the family itself (concealment, shame).

Stigma has devastating consequences: it delays seeking help, increases isolation, lowers self-esteem, hinders access to employment and housing, and harms physical health. Combating stigma is now an essential part of treatment.

How can we fight it? Through accurate information, respectful language, direct contact with people living with the condition. Inclusive public policies, and above all empathy. Behind every diagnosis is a person with a name, a history, and dignity.

Schizophrenia is neither a life sentence nor a source of shame. It is an illness that deserves the same seriousness and empathy as cancer or diabetes. The person suffering from it is no stranger: it could be a family member, your neighbor, a coworker, your child, or a friend. And all of us, in our own way, can help make society a kinder place for those living with it.