New therapies help people with schizophrenia – but access is woefully inadequate

Misunderstandings about schizophrenia are widespread, including the idea that it causes people to swing between extreme behaviors or personalities. For example, someone might suddenly desire an expensive item they cannot afford, then dismiss the idea entirely. These casual descriptions are inaccurate and oversimplify the condition. As a professor of psychology studying schizophrenia, the author notes that even health officials and policymakers often hold these flawed views. Schizophrenia is not about mood swings but involves persistent challenges with thinking, memory, and social interactions. The disorder was first described in 1899 by German psychiatrist Emil Kraepelin, who called it dementia praecox (early-onset dementia) and identified symptoms like hearing voices or holding unusual beliefs. Today, schizophrenia is diagnosed using the Diagnostic and Statistical Manual for Mental Disorders (DSM), which remains based on many of Kraepelin’s original observations.

Schizophrenia is a complex condition that affects thinking, memory, and social skills, not just hallucinations or delusions. While Kraepelin believed the disorder always worsened over time, research shows this is not true for everyone. About 40% of people diagnosed with schizophrenia experience mild or no symptoms and can maintain jobs and relationships for long periods. However, for many others, the condition is disabling and isolating. The World Health Organization (WHO) ranks schizophrenia among the top 10 causes of disability globally. The disorder also contributes to serious social issues: at least 1 in 5 homeless people in the U.S. has a severe mental illness, often schizophrenia, and 15% of inmates in state prisons have severe mental illnesses like schizophrenia. These statistics highlight the urgent need for effective treatments and support systems.

One of the most central but often overlooked aspects of schizophrenia is difficulty with cognition, or mental processes like attention, memory, and problem-solving. For example, a person might struggle to follow a conversation, remember a new password, or recall what they ate for breakfast. These challenges persist even when other symptoms, like hallucinations or delusions, are under control. Social cognition—understanding emotions, intentions, and perspectives of others—is also affected. People with schizophrenia may misinterpret neutral comments as hostile or fail to recognize when friends or family are trying to help. These cognitive difficulties can be easy to overlook when dramatic symptoms, such as believing one is the son of Jesus Christ or that organs have been replaced, are present. The author emphasizes that these struggles are a core part of the disorder and require targeted support.

Over the past 15 years, researchers have developed new therapies to address the cognitive and social challenges of schizophrenia. One approach is cognitive remediation, which includes exercises to improve mental sharpness, such as practicing memory tasks like locating items in a refrigerator and applying these skills to real-life situations like shopping. Another therapy focuses on social cognitive training, teaching people to better understand emotions and intentions, reducing the likelihood of jumping to negative conclusions. For example, a comment about the texture of a meal might be misinterpreted as an insult, but training helps people recognize neutral or positive intentions. These therapies aim to teach flexible thinking and a broader range of strategies for navigating the world. While not a cure, they offer hope for improving daily functioning, even for those with severe forms of the disorder.