As a high school kid, Moe Armstrong had lots going for him. ”We were poor people,” he says, but he was captain of the football team in Bushnell, Ill., and with his high hopes for a military career, was clearly his parents’ ”dream.”
While serving in Vietnam, however, Armstrong, now 55 and living in Cambridge, says he ”cracked up.” He heard ”rustling and whistling sounds,” then voices. He had visual hallucinations, too, but thought he was just ”nervous because of the war.”
In fact, what he suffered was a pyschotic break, a loss of contact with reality – a sign of schizophrenia.
Actually a spectrum of brain diseases, schizophrenia afflicts more than 2 million Americans and is a terrifying illness. Not only are patients subject to repeated psychotic episodes including hallucinations and delusions, many also suffer a near-total deadening of emotions, a hallmark of the disease.
The disease is not curable, but it is treatable especially with newer drugs with more tolerable side effects than older ones. And with lots of emotional support from families and strict adherence to medications, some people – perhaps one in five – recover enough to live on their own and even hold down jobs.
But the more scientists look for environmental triggers, probe for suspect genes and peek into patients’ brains with scanning devices, the more they understand why schizophrenia is such a difficult disease to treat – and to live with.
”It’s terrifying,” says Dr. Daniel B. Fisher, a Lawrence psychiatrist who heads the National Empowerment Center, an advocacy group. Fisher was diagnosed with schizophrenia 30 years ago, but says he is healthy now.
But his psychoses – and hospitalizations – were horrific. ”I was convinced the TV was talking to me and me alone,” he recalls.
A neurochemist before he became a doctor, he believed he was the enzyme he was studying. At times, he became totally catatonic – withdrawn from others and unable to move or talk.
No one knows precisely what causes such bizarre thoughts – and such extreme dampening of emotion – but there are clues.
Brain studies, both of living patients and of those who have died, show abnormal circuits in two regions that govern emotions – the cingulate cortex and the hippocampus, says Dr. Francine Benes, director of the lab of structural neuroscience and the brain bank at McLean Hospital in Belmont.
The cingulate cortex is, literally, the center for gut feeling – for conscious processing of data from visceral organs such as the heart, the lungs, the stomach. Schizophrenics can’t process these emotions, which leaves them feeling like robots. ”That’s the most insidious part of this disease, the loss of the sense of self,” says Benes.
The brains of schizophrenics show enlargement of cavities called ventricles, too; some also show atrophy in other regions and decreased metabolic activity in others.
Indeed, schizophrenics often lose gray matter, the brain cells needed for thinking, says Ruben Gur, a professor of neuropsychology at the University of Pennsylvania Medical School. Memory can be affected, too.
No one knows why gray matter in the frontal and temporal lobes disappears in schizophrenia, but it may be that nerve cells deeper in the brain fail to migrate to the outer layers. It may also be due to excessive ”pruning.”
In normal adolescence, the brain destroys some neurons, perhaps so that, by destroying some connections, others are strengthened.
In people with schizophrenia – which usually strikes between age 16 and 30, there may be too much pruning, says Dr. Judith Rapoport, chief of child psychiatry at the National Institute of Mental Health.
But it’s not just anatomy that’s different in schizophrenics’ brains, it’s chemistry, too. In healthy people, there’s a balance between neurotransmitters that increase the firing of brain cells and those that dampen these signals.
In schizophrenics, there may be too much of two transmitters, dopamine and glutamate, which may lead to over-excitation of the brain – and hallucinations.
Dopamine acts by inhibiting cells that make a calming neurotransmitter called GABA. If there’s too much dopamine around, GABA shuts down. In addition, without GABA, cells that make glutatmate fire more often, further boosting excitation.
The older anti-psychotic drugs – Thorazine, Prolixin, Haldol, Navane, Stelazine, Trilafon, and Mellaril – work by blocking a type of dopamine receptor on brain cells called D-2. The net effect is to reduce the effect of dopamine, which controls some symptoms.
But blocking this receptor causes unpleasant side effects, including muscle stiffness, spasms, and tardive dyskinesia, in which the tongue protrudes and patients often smack their lips.
The newer ”atypical” drugs – Risperdal, Clozaril, Zyprexa, and Serlect – act on different receptors and seem to trigger fewer side effects. (Clozaril, however, brings its own problems, notably destruction of white blood cells, which can lead to serious infections and even death; for this reason, people taking Clozaril have to have blood tests every week or two.)
Scientists are working on new drugs in hopes of further reducing the side effects that often prompt patients to stop taking their medications.
Researchers are also trying to identify environmental factors that may trigger schizophrenia in susceptible people.
The notion that bad mothering or ”schizophrenogenic” families cause the disease has been completely rejected. Researchers now think that problems during pregnancy and childbirth, such as viral infections, prolonged labor, fetal distress, and other obstetrical complications, may be involved.
Spotting warning signs of schizophrenia is tricky, though researchers have been able to distinguish kids who later got the disease by looking at home movies taken when the children were two years old. The kids at risk were clumsier, had odd head movements, lacked emotional warmth, and seemed very shy, according to the June 1999 Harvard Mental Health Letter.
Other studies suggest that kids at risk for schizophrenia are slow to acquire motor skills, learn language, and pay attention, but these deficits are often subtle, until adolescence.
By adolesence, the signs are clearer: schizophrenics are often isolated and show ”flat affect,” or deadened emotions.
If a child shows these symptoms and there is a family history of schizophrenia and obstetrical problems, it makes sense to consult a child psycyhiatrist, says Benes of McLean.
It would also help, says psychiatrist Fisher, if people without schizophrenia were kinder to and less fearful of those who have the disease. Though lay people often assume schizophrenics are violent, they are no more prone to violence than the general population.
Families need support, too, says Mary Rappaport, whose brother has the disease.
”I lost a sister to brain cancer. As hard as that was, it’s a more painful loss in many ways to lose a loved one to one of these severe mental disorders because they are still here, but they are not the same people they used to be,” says Rappaport, spokeswoman for the National Alliance for the Mentally Ill.
And recovery can happen – and did for Moe Armstrong.
Despite hospitalizations in Vietnam and California, Armstrong said he didn’t understand he had schizophrenia, though he knew he was ”too mentally ill to live in civilization. So I went and became a bush Vet.” He lived in the mountains of New Mexico, guzzling booze, cheap food, and whatever drugs he could get his hands on.
Eventually, he weaned himself from most drugs and earned two master’s degrees. He still hears voices, but has learned that when they start, if he lies down in a quiet room, they become less insistent. He is also taking an experimental medication.
And, through his work with a mental health services organization called Vinfen, he has a mission: ”To teach other people and learn from other people how to live with major mental illness.”