Schizophrenia
“‘My greatest fear is this brain of mine….The worst thing imaginable is to be terrified of one’s own mind, the very matter that controls all that we are and all that we do and feel.’”27
Affecting only 1% of the entire world’s population (WHO, 2008), this disease is considered the cancer of psychological disorders: in this disorder the brain continually plays tricks on its owner. The term, schizophrenia, meaning “split mind” refers to “a split from reality that shows itself in disorganized thinking, disturbed perceptions, and inappropriate emotions and actions.”28 Disorganized thinking is presented with “fragmented, bizarre, and often distorted by false beliefs, called delusions.” These can include random events that may be perceived to be centered/focused on the individual. In Wagner and Spiro’s book, Divided Minds, Wagner writes about her understanding of President Kennedy’s assassination as having been her fault. As a sixth grader, she was fearful that others would learn that she was responsible for the event.29 Delusions tend to become more complex and intense over time. They may be occasionally dangerous or grandiose in that the individual feels that he or she is able to control something such as the weather, that a movie star is in love with them, or that they can actually control another person’s mind.
Individuals may also suffer from hallucinations in which they experience the sensory stimulation of seeing, feeling, tasting, smelling, hearing, things that are not there. These hallucinations are either exaggerating something-- such as lights that are too bright or colors that are too brilliant or indicating something that is not actually there. They are usually auditory, such as hearing sounds or a persistent voice or voices (usually male and not complimentary).30 Delusions and hallucinations are considered the positive symptoms of the disease. There are also inappropriate emotions and actions, such as laughing when crying is socially called for or exhibiting compulsive acts or catatonia. The absence of appropriate behaviors is referred to as negative symptoms of the disease. At times, these behaviors and reactions that are considered socially inappropriate disrupt relationships and make holding a job difficult.
The onset of schizophrenia usually begins in late adolescence and affects women and men equally. This can occur in two ways: either a sudden reaction to a stressful situation (acute) or slow occurring (chronic). At least two or more of the above mentioned symptoms must be present for a significant portion of one month of active symptoms.
Like depression, schizophrenia runs in families. Identical twins have the highest probability of having the disease with a 30% chance of developing the illness if another has it. Having a parent (mother = 9% and father, brother or sister = 7%)31 who has it makes it more likely. There are predisposing genes – research has concluded that there are hundreds of genes with small effects that predispose people to getting schizophrenia when exposed to other factors.
There are also neurochemical changes including an excess of dopamine that may be the reason for hallucinations and paranoia. The negative symptoms of the disease caused by the lack of neurotransmitter, glutamate, may include social withdrawal, apathy, inattention, and lack of communication. MRIs have resulted in evidence that indicate that the brains of schizophrenics look different. There are structural and neuropathological changes. Most of these differences are present even before the disease presents itself. Within the brain, the cerebral ventricles are larger. Further brain anatomy evidence includes shrinkage of cerebral tissue, cell loss, and changes in hippocampus, amygdala, among other structures. There is also low brain activity in the frontal lobes and notable decline in the brain waves produced in reasoning and decision-making.
Additionally, prenatal difficulties such as “intrauterine starvation or viral infections, perinatal complications, and various nonspecific stressors”32 may influence the development of the disease. This idea is a bit more vague and less developed in its understanding.
Overall, when determining outcomes (recovery – defined loosely), women tend to fare better than men. Those with no family history also do better, as will those with a relatively normal childhood and those who experienced a sudden onset of the disease. Other factors that indicate a more positive outcome are the presence of normal emotions and a good awareness of the disease.33 The younger the individual is at the onset the worse the outcome. Data ten and thirty years out indicate that 25% are completely recovered, while 10 and 15% respectively are dead-- mostly as a result of suicide.
Clean, Shaven
Lodge Kerrigan directed this controversial 1993 film. Reviews state that it is difficult to watch – which I also found to be true. However, despite the rawness of the images, such as when the main character, Peter Winter, digs into his scalp with scissors and rips off his fingernail (I did have to turn away for that scene!), the film does a wonderful job of depicting the thought processes/experiences of a person with schizophrenia. The 79-minute film could be shown in its entirety during one class of ours. However, I believe that I will show only a portion of it, knowing that many of my students will then continue to view it on their own outside of school. The goal of this unit is for students to demonstrate mastery or understanding of the psychological disorders of depression and schizophrenia, and that will be able to happen with the synthesis of written texts and film.
Peter (the main character) has just been released from a mental institution and is traveling back to his hometown to try and reconnect with his young daughter, whom his mother/her grandmother has given up for adoption. The viewer may be confused by Peter’s obsession with young girls and a recent murder, but should not be swayed by this side story to appreciate the true value of the film – its depiction of a schizophrenic. Although one may believe – at first viewing – that he is guilty of hurting/killing two young girls, there is no clear-cut evidence to confirm this. A detective is “after” him, trying to pin the girls’ murder on him. Again, this is not the true story. As Kerrigan indicated, "I really tried to examine the subjective reality of someone who suffered from schizophrenia, to try to put the audience in that position to experience how I imagined the symptoms to be: auditory hallucinations, heightened paranoia, dissociative feelings, anxiety." These symptoms are evident throughout the film and will give students the opportunity to see what they have read about on screen.
When we go to a movie, we have a desire to see, hear, and to know the story. In this film, we are told the painful story of Peter, a man who suffers from schizophrenia that is not controlled. We see what our textbook refers to as “madness” in action. Using the film chapters 1 – 6 (about the first 23 minutes) students will experience numerous examples of the symptoms of the disease. Auditory hallucinations are depicted by the static and bizarre sounds that we hear as the film opens up. Flashes of images are shown, trees moving and making loud, close noises, hay moving in the wind and birds in the background. Then, darkness ensues with intermittent flashes of lights. Afterwards, the static becomes louder and louder –-coming closer to the viewer, if you will and is coupled with what seem to be airplane noises and then a child’s laughter while what we see are electric or telephone wires. All of these sounds/noises are coming at the viewer, who is unable to really distinguish between them. This reminds me of when we watched The Conversation for our May seminar. Seminar Leader Peucker focused on the questions: What is the origin of the sound? Is it within the story? She mentioned that what is happening on screen may have nothing to do with the sound. In this case our attention is split between the eye and the ear. Sounds are more than dialogue. As viewers of the film, our emotions and physical body react to these sounds.
Mise-en-scene helps one to understand how a film is produced and to arrive at the meaning behind it. It is defined as everything that is in front of the camera: “settings, props, lighting, costumes, makeup, and figure behavior (meaning actors, their gestures and their facial expressions).”34 The more details in the mise-en-scene, the more visual information is given to the viewer and “the more precise our audience’s emotional response will be to the image we are showing them.”35
When we are first introduced to Peter, he is cowering in a corner of a barren, cement-walled room with chicken wire on the window. His hands and arms are trying to cover his head/face. He wears institutional blue pants and gray shirt. His face is terrified—he is shivering and shaking. His electric blue eyes move rapidly back and forth, not able to focus – listening to all the noises/voices that he hears. Later, after he appears to be breaking into a car, he turns on the radio while driving. The sounds are the auditory hallucinations he is experiencing coupled with static. The viewer is left to try to understand what words are being said and to determine if they or how they may tie together. It’s confusing, disturbing, and unintelligible at times – emulating what Peter experiences as a schizophrenic. Some of the sentence fragments he hears include “acts were not spontaneous or impulsive but like a wild animal that stalks its prey”, “this court believes under the circumstances of the case”, “suffered dead 25 caliber lodged in my head bullet as a result of this violent act.”
In filmmaking, sound includes dialogue, music, and sound effects. This film does not have a lot of dialogue. The dialogue, or conversations between two people – son and mother; detective and adoptive mother, father and son-- are rare and short. The words are uttered in a way that makes it seem as if all the characters have difficulty communicating. Music is not really evident in the film. It’s the sound effects that play a central role in helping the viewer to truly understand Peter’s disease.
How a film positions a spectator is another important point that was brought up in our seminar. In this film, we see two ways in which this is happening. First, a shot in filmmaking is what occurs in between the turning on and off of the camera – it is a unit of length or duration. We see what Peter is seeing through quick cuts. I believe that this technique is used so we can try to understand how he is concentrating – in short, quick bits of time. Second, using the close-up: “The closer the camera is to the subject, the more emotional weight the subject gains.”36 The “most profound emotional experiences (such as grief) are expressed much more powerfully through the human face than through words.”37 Close-ups of the face are used consistently throughout this film, indicating not just the significance of Peter’s mother’s mouth drinking tea, but the heightened awareness of sounds (her voice), sights (her disapproval), or thoughts (inadequacy) that Peter is aware of. The evoking of emotion is evident here in that we can vividly see the pain that is on his face, the turmoil that he feels. We can begin to understand what it must feel like to have your brain play tricks on you, to be mad.
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