Mental Health and Illness

Introduction to Schizophrenia 

Schizophrenia is a serious mental illness where the patient might not be able to get in sync with their own reality (Cabassa, 2017). These patients might also be suffering from auditory or visual hallucinations. These hallucinations might hamper with the person’s functional as well as intellectual ability. It also inhibits the person to make sound and effective decision-making. The daily activities of the person might also be affected with this medical condition. There is a dire need of early detection and intervention in this condition as it can be beneficial for the patient largely in reducing the negative impact of the illness on the patient. The patients can be mild symptoms in the beginning which can turn into severe on constant subjection to triggers (Strik, 2017). Symptoms reflected by the patients are generally positive, negative and cognitive. Positive symptoms are inclusive of reflection of psychotic behaviour in an individual.

These behaviour patterns are usually not observed in a healthy individual. Negative symptoms might involve abnormal display of emotional outburst (Carrà, 2019). The person may also be having a reduced facial expression and reduced level of interest in things around them. People suffering from these symptoms also often go into isolation and withdraw themselves from social gathering all together. Cognitive symptoms are inclusive of the patients having symptoms like memory loss. They might tend to develop forgetfulness and this can also alter with the thinking process for them (Maas, 2017). This is the main factor that might hamper with the critical thinking and decision-making of the person. This also hampers with the attention span of the person, making it difficult for them to complete any task assigned to them. The main character of the movie Shutter Island is also suffering from schizophrenia and the essay will help in highlighting the issues related with patients suffering from mental health illness.

Pathophysiology and Aetiology

The main feature of this condition of schizophrenia is that it hampers with the pattern of the thinking of the brain. This imbalance in the thinking pattern of the brain is brought by certain neurotransmitters such as dopaminergic, glutaminergic and GABAergic. Few studies have also shown that the patients having deficiency of acetylcholine muscarinic receptors also tend to develop schizophrenia (Bertrand, 2018). There is an onset of inflammation in the brain layers, that usually manifests in the early stages of life. This clinical manifestation usually tends to increase with the advancing age, reflecting back the same in the person affected by the same.

The symptoms are more exponentially visible in elderly population. As with advancing age the neural synapse tends to loosen up, the symptoms in patients also deteriorates in the patients.

Few of the common aetiological elements that play a key role in schizophrenia can be of multiple sorts. Genetics can be observed to have a key role in relation to any mental health condition. However, in schizophrenia the exact genetic reason or phenotype expression associated with it is still unknown. Schizophrenia can be carried to a family member having a history of the same, the reason for it still being unclear. There is combination of genes pertaining to the manifestation of schizophrenia in an individual (Misiak, 2018). If a woman is having schizophrenia, it is likely that twins beared by her are sure to have schizophrenia as diagnosis as well. It is still not the main factor contributing to the diagnosis of schizophrenia in a person. Neurotransmitters might also have a valid connection in development of schizophrenia. There is a strong connection between the imbalance in the neurotransmitters functioning and development of schizophrenia. The treatment of schizophrenia is also based upon reducing the effect of these neurotransmitters trying to maintain a balance in their production and functioning. Dopamine and serotonin are the main neurotransmitters that observed to be altered in a person suffering from schizophrenia (Zai, 2017).

Development and manifestation of schizophrenia also alters with the alteration of the response to neurotransmitters as per specific individuals. Another underlying issue is the patient being subjected to various triggers. The triggers can be person or the environmental factors that may have a direct or indirect impact on the person’s behaviour. These triggers can act as a catalyst in people and might hamper with the process of normal thinking of a person. They have a profound affect on people, especially who might be at a certain risk of developing schizophrenia. These triggers can also be observed in the form of stress. The stress can be originating from a personal loss or misery or can be given by environmental and external factors. Negative working or social environment of an individual can subject them to psychological stress, leading to the reflection of symptoms of schizophrenia. One of the common environmental factors is the scene of war faced by many veterans. The recruits are often observed to be struggling with after war thoughts, acting as a trigger for the development of symptoms of various mental disorders in them (Łaba, 2016). These triggers can accelerate the mild symptoms in the person leading them to cause self-harm of injury to other individuals, places in closed vicinity to them.

Assessment and Treatment Intervention

The film helped in revealing the fact as to how mentally ill patients were treated in earlier times. The movie clearly portraited the negativity that was present in the closed vicinity of the surrounding of the mental health facility. Two of the doctors that were closely engaged in treating the patients in the facility, made use of both positive and negative thoughts as the basis for treatment modality.

Dr. Jeremiah, was observed to be having old school treatment methods. The questions that were placed by Dr. Jeremiah in front of Teddy in the movie, can be observed to be very complicated and twisted in nature. The body language of the doctor is also threatening for Teddy at times, during several interactions made with him (Bhatia, 2019). The approach followed by Dr. Jeremiah can be understood as negative one, trying to push Teddy into thinking that he might be a crucial part of those violent happening’s Teddy had to go through. He also makes a breakthrough in the same, as he was able to confuse Teddy at several occasion, by instilling negativity in him.

Dr. John Cawley, on the other hand can be reflected as having a positive approach in making Teddy understand his current situation. He can be observed to be very understanding in nature and has all of the good intentions of helping the patient out in full capacity and minimizing the harm as well. Dr. John Cawley, can also be observed to be opting for many conventional approaches, in order to help the patient, by leaving behind clues that acts as trigger for the patient to think beyond the boundaries (Hodgins, 2017). He is also observed to be having patience and calm while helping the patient and trying to develop a thinking process for him. Dr. John Cawley, also allows the patient to be an integral part of the process, by keeping a close consideration for his requirements and needs. He can also be observed to be advocating against the harsh treatment methods for the patients. He is inconsiderate for psychosurgery or other intervention methods and rather treat the patient with a positive approach and with due understanding. Dr. John Cawley, is also seen to not have a prejudice for his patient and respects the patient’s integrity (Foureur, 2019). This shows level of compliance and ethical consideration, while managing care for the patient.

Dr. Sheehan, is also supportive of Dr. John Cawley’s methods. He is also found to be supportive of the conventional methods, rather than using invasive approach for treating Teddy. The use of role-play method used by the doctors, helps the patient in pondering upon the terms of events from the past. In times where Teddy finds himself struggling between his thoughts, both doctors are also observed to be providing the patient with a sense of calm and composure and are empathetical as well with them. By doing so, both the doctors have been able to maintain strong and robust communication channels with the patient (Vogel, 2016). This constant engagement between the doctor and the patient, can be seen to be useful for the patient, ensuring to keep him in sync with the reality. This is observed to be providing a constant solace to the patient as well, helping him in calming his triggers and reducing his symptoms.

Impact of Illness

Dealing with mental health related patients can be a challenging issue. With people suffering from schizophrenia, it is an added challenge to help the patients in coming to terms with their reality. The health condition can be very deteriorating effect on the patient and close relations as well (Swerdlow, 2018). The families are also subjected to be dealing with emergent and stressful situations while helping the patients in managing their condition. These symptomatic events can bring about a constant disruption in the well-being a sound functioning of the family of the patient suffering from the condition. The family plays a vital role in the treatment course of the person as they are observed to be bearing equal stigma of the disease as the patient themselves (Cervello, 2017). It is imperative to make the patient’s family as an integral part of the treatment course and keep them informed regularly. The impact on the patient’s family can also be directly reflected in the movie of shutter Island. The wife of the patient is also suffering from bipolar disorder. She also accused herself of killing her own children. However, it is the main character Teddy in the movie, who had murdered the wife and the children.

The patient however, has no such memory of committing these crimes and tends to deny any accusations completely. This confusion has led the patient to develop certain instincts of self-destruction and harm due to lack of patience, in dealing with his constant turmoil. Teddy also feels helpless in the end, due to not being able to have any way out of his current misery. The ego of the patient is also hurt in the process as he is feeling a bit incompetent in dealing and understanding the situation. This ego of Teddy was observed to be overridden his conscious thoughts, that led him to killing his own wife and children. This incidence is also observed to be divided in between two alternatives, namely, ego and super ego, which is ideally enforced upon him and forced him to take such actions. In the movie the main subjects often observe blood while carrying his dead wife. The same can also be analysed from the point of view of any inner conflict, as observed by the subject. The second symbol is represented by fire (Beheshti, 2016). This can be concluded as an indicator of destroying something old, in order to make way to create something new.

The subject, Teddy in the movie has also served his country in war times. Killing his own wife might also be a self-heroic act for him, leading him to the desired and long lasting contentness. The main character in the movie also suffers from a deep-rooted conflict with his family. He is good at socializing and engaging within the communities, whereas, at the same time faces difficulties in interacting with his family on a personal level. He is also more addicted to his work as compared to being devoted to the duties of his family. The internal conflicts of the patient have been forcing him to opt for aggressive behaviour and means with his family, though he wishes to subside the same (McGuire, 2017). This speculation and theory of thinking everyone is after them, is usually observed with the patients having schizophrenia. There is also a difference of opinion and a lack of understanding of reality in the patients suffering from this condition. As a result of the same, the main character of the movie is often seen to be accusing his wife for killing their three children, whereas, it is Teddy who had committed that crime. The ongoing hallucinations and delusions, restricts the patient from segregating between the real and the fake and what lies in plane site. This has been rising suspicion with the patient from time to time, leading to more conflicts arising from the situation and making it complex to be treated.

Stigma and Discrimination

Mental health related issues have always been associated with stigma. This stigma has been reflected directly on the life of the patient and their families, who are being affected from the illness. Stigma mainly arises when the situation is being looked down upon and there is no resolution for the situation to deal with. The stigma associated with the medical situation also places a hurdle in the process of defining or analysing an apt intervention strategy that can be helpful for both the patients and their families as well for the healthcare professional engaged in the service of the patient (Angermeyer, 2017). Negative element tagged with stigma for the condition is mainly observed upon the overall health of the patient. The situation has been changed however, over the due course of time, the situation reflected in the movie reflects the opposite of the same. The movie reflects on the situation as to how mental illness was treated as condition back in 60’s. The patients in the movie are kept far away from normal individuals isolated on an island. There is no contact with the outer world of the patients and they are being treated in the confined boundaries of the institution.

The zones on the islands are also restricted and they are not allowed to roam around that freely in the premises. Back in those days these people were treated as a harm to the normal population and thus, they were segregated from the normal population. The movie also reflects upon the limitations of the treatment interventions available to manage these patients in older times. Lobotomy was the only final management treatment that was in place for the patients. It was not only the main intervention strategy used, but also the top priority treatment facility used for the patients. The movie also plays a crucial role in highlighting the fact of fear and insanity attached with the issue of mental health. Even the surroundings of the asylum centre reflected sheer negativity in the situation, adding to the misery of the patients admitted in the facility. This part of the movie also reflects on the fact as to how the patients were ill treated for their mental health and were given less importance medically as compared to their counterparts.

There is also a constant myth associated with the mental health patients, that they might bring some harm to the normal individuals or the normal patients. The same is untrue to be quoted widely. The people suffering from mental health related issues undergo an emotional turmoil as they are unable to have an understanding of their own health status (Hasan, 2018). The insane mental status of the patients has been explained beyond repair in the movie. The current physical and mental state of the patients is also beyond the sheer scope of explanation in the movie. There is a conflict between the rights and provisions given to the patients in the clinical setting. These stereotypes can however, be directly associated with the ancient methods of treating the patients as in the current scenario the situation is a bit different. With modern day interventions the patients can be observed to be treated with profound and less invasive methods of treatments (Gwarjanski, 2018).

The movie also highlights on the part of anxiety faced by the patients, as they are constantly trying to escape the surroundings. The final dialogue of the movie also gives a picture as to how the patient is always in favour of conventional methods of treatment in comparison to the non-conventional methods. The patients are also in sync with their reality, but somehow, out of fear and disregard, chose to not open up that frankly to their care giver. The violence observed at the societal level can also be associated with the growing mental health cases. Various studies have shown that when patients suffering from mental health conditions are forced to be institutionalized, they tend to get more violent and difficult to be dealt with (Dawson, 2018). Another major stigma that the movie depicts is the fact of giving up on these patients too soon. The movie also reflects upon the fact as to how the treating bodies tend to assume that the patient’s scenario is beyond the medical help and that more radical means should be adapted. Dr. Cawley, on the other hand understands the miseries of the patients and is in favour of helping the patients through orthodox methods. He also tries to recreate the whole scenario so that the patient might come back to his reality. Whereas, the other doctors in the movie can be seen to be forcing upon the means of psychosurgery procedure to treat the patient. This can also be observed as an act of challenging the morality of the patient, by dehumanizing him all together.

Conclusion on Mental Health and Illness

The movie very well represents the issue of stigma and discrimination associated with mental health issues and the patients suffering from the same. The patients in the movie were kept apart from the normal crowd far away in isolation in an island. The counsellor however, given all of the limitations in the surrounding, was trying to help the patient by providing him hints and clues. He tries to help the patient with helping him come to terms with his reality. Despite all of his efforts he fails at helping the patient in doing so. Lobotomy can be a treatment option for such patients, but it can also be given in congruence with other treatment interventions. The main character of the movie can be observed to be struggling between the behavioural roles and the realistic orientation. Behaviouristic role play interventions can be helpful for the patient in segregating the myths from the realities. The movie also reflects on the communication gap between the counsellor and the patient. Despite of installing clues and information the patient was not able to identify the same. The movie also clearly represents on the fault in the working of the system in terms of treating mental health patients with equality. There is a dire need of person-centred care approach needed to tackle such patients tagged along with certain amount of compassion and understanding as well. This will be helpful for the patients to adjust well with the treatment modalities and they will be comfortable enough to open about their feelings as well.

References for Mental Health and Illness

Angermeyer, M. C., van der Auwera, S., Carta, M. G., & Schomerus, G. (2017). Public attitudes towards psychiatry and psychiatric treatment at the beginning of the 21st century: a systematic review and meta‐analysis of population surveys. World Psychiatry, 16(1), 50-61.

Beheshti, R., & Shafieyan, M. (2016). Foucauldian Docile Body in Dennis Lehane’s Shutter Island. Theory and Practice in Language Studies, 6(10), 2052-2059.

Bertrand, D., & Terry Jr, A. V. (2018). The wonderland of neuronal nicotinic acetylcholine receptors. Biochemical Pharmacology, 151, 214-225.

Bhatia, T. K. (2019). Language and thought disorder in multilingual schizophrenia. World Englishes, 38(1-2), 18-29.

Cabassa, L. J., Camacho, D., Vélez-Grau, C. M., & Stefancic, A. (2017). Peer-based health interventions for people with serious mental illness: a systematic literature review. Journal of Psychiatric Research, 84, 80-89.

Carrà, G., Crocamo, C., Angermeyer, M., Brugha, T., Toumi, M., & Bebbington, P. (2019). Positive and negative symptoms in schizophrenia: A longitudinal analysis using latent variable structural equation modelling. Schizophrenia Research, 204, 58-64.

Cervello, S., Arfeuillère, S., & Caria, A. (2017). Schizophrenia in movies: On-screen representations and fight against stigma. L'Information Psychiatrique, 93(6), 507-516.

Dawson, N. L., Lachner, C., Vadeboncoeur, T. F., Maniaci, M. J., Bosworth, V., Rummans, T. A., ... & Burton, M. C. (2018). Violent behavior by emergency department patients with an involuntary hold status. The American Journal of Emergency Medicine, 36(3), 392-395.

Foureur, N., & Galmiche, P. (2019). Autonomy integrity: Another way to understand autonomy in psychiatry?. Clinical Ethics, 14(4), 178-186.

Gwarjanski, A. R., & Parrott, S. (2018). Schizophrenia in the news: The role of news frames in shaping online reader dialogue about mental illness. Health Communication, 33(8), 954-961.

Hasan, A. A. H., & Musleh, M. (2018). Self‐stigma by people diagnosed with schizophrenia, depression and anxiety: Cross‐sectional survey design. Perspectives in Psychiatric Care, 54(2), 142-148.

Hodgins, S. (2017). Aggressive behavior among persons with schizophrenia and those who are developing schizophrenia: Attempting to understand the limited evidence on causality. Schizophrenia Bulletin, 43(5), 1021-1026.

Łaba-Stefanek, A., Dziwota, E., & Olajossy, M. (2016). Genetic and environmental factors in the etiology of schizophrenia-towards mainstreaming. Current Problems of Psychiatry, 17(4), 243-249.

Maas, D. A., Vallès, A., & Martens, G. J. M. (2017). Oxidative stress, prefrontal cortex hypomyelination and cognitive symptoms in schizophrenia. Translational Psychiatry, 7(7), 1171-1178.

McGuire, J., Brüne, M., & Langdon, R. (2017). Outcome-focused judgements of moral dilemmas in schizophrenia. Consciousness and Cognition, 52, 21-31.

Misiak, B., Stramecki, F., Gawęda, Ł., Prochwicz, K., Sąsiadek, M. M., Moustafa, A. A., & Frydecka, D. (2018). Interactions between variation in candidate genes and environmental factors in the etiology of schizophrenia and bipolar disorder: a systematic review. Molecular Neurobiology, 55(6), 5075-5100.

Strik, W., Stegmayer, K., Walther, S., & Dierks, T. (2017). Systems neuroscience of psychosis: mapping schizophrenia symptoms onto brain systems. Neuro Psychobiology, 75(3), 100-116.

Swerdlow, N. R., Bhakta, S. G., & Light, G. A. (2018). Room to move: plasticity in early auditory information processing and auditory learning in schizophrenia revealed by acute pharmacological challenge. Schizophrenia Research, 199, 285-291.

Vogel, B., Brueck, C., Jacob, H., Eberle, M., & Wildgruber, D. (2016). Integration of verbal and nonverbal emotional signals in patients with schizophrenia: Decreased nonverbal dominance. Psychiatry Research, 241, 98-103.

Zai, G., Robbins, T. W., Sahakian, B. J., & Kennedy, J. L. (2017). A review of molecular genetic studies of neurocognitive deficits in schizophrenia. Neuroscience & Biobehavioral Reviews, 72, 50-67.

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