“For my part I know nothing with any certainty, but the sight of the stars makes me dream.”
- Vincent van Gogh

Vincent van Gogh is not only famous for his paintings but is also known for having cut-off his ear and presented it to his lover. Strange as it may seem, diseases of the mind are yet relatively unexplored and unexplained horizons of medicine.

This is the story of a little girl called Jani who lived in a place called ‘Calilini’ with her friends ‘400 the cat’, ‘Wednesday the rat.' They lovingly called her ‘Rainbow’ and ‘Blue eyed tree frog’. She calls ‘Calilini’ her world, which is on the border of our world. She plays with her friends all day, exploring new places, while introducing a girl she met recently, ‘200 degrees’. As benign as they may seem, Jani and her friends get violent at times. Jani clasps her hands in front of her chest and rubs them vigorously.

Unfortunately, her friends are always up to some mischief. They’re asking her to jump out of the window because she desperately needs to ‘get away’. And this isn't the least of Jani's troubles.

Jani had always been a very restless child. As a new born, her mother had a tough time putting her to sleep as she slept for only 3-4 hours a day. By the age of 3, her imaginary friends began appearing while she was turning into a violent child kicking, hitting and scratching little child. Jani found it hard to concentrate on anything for very long. She kept switching between playing with her dog and making cookies.

Her parents have begun a foundation in Jani’s name to help raise funds for her treatment and spread awareness about this disease. Featured on many popular American TVshows such as The Oprah Winfrey Show, Dr. Phil’s Show, Jani is receiving the best treatment possible so that she can enjoy a relatively stable childhood. It is a tough battle for her and her parents, as Schizophrenia has no definite cure.

Schizophrenia is a heterogenous syndrome characterized by perturbations of language, perception, thinking, social activity, affect and volition. The syndrome commonly begins in late adolescence (childhood onset is very rare) has an insidious onset, and often poor outcome. Symptoms of schizophrenia are subtle in the beginning but as the condition aggravates, the true nature of the illness surfaces.

There are primarily three kinds of symptoms:

Positive Symptoms

These are not seen in healthy individuals and people exhibiting such symptoms ‘lose touch with reality’. Positive is another term for psychotic symptoms; hallucinations, delusions, thought disorders and movement disorders.

Negative Symptoms

These are disruptions to normal behaviour and emotions. For example, lack of facial expressions, not wanting to live.

Cognitive Symptoms

These include impaired execution of actions, trouble in learning and paying attention.

The basic issue is the way the affected people think and deal with abstract and concrete thoughts. As they disease progresses, the thinking becomes more and more bizarre and they lost touch with reality because they find it difficult to differentiate between the abstract and the concrete. 

The difficulty in thinking is see in their dissociated pattern of thinking. Schizophrenics find it very hard to sustain a train of similar thoughts. They jump from one thought to the next and the person listening to them finds it difficult to keep up. 

Schizophrenics also have a problem in differentiating between the abstract and the concrete. This is clearly demonstrated when one gives a patient a proverb and asks him/her the meaning. The patient is most likely to explain the proverb literally than in the context which it is meant for.

With worsening the patients develop hallucinations and delusions. A lot of the times these hallucinations involve people talking to the schizophrenics from the outside and forcing them to hurt themselves. This causes the patients to become aggressive and as a result, more than hurting other people, schizophrenics hurt themselves. There is a high possibility of suicide in schizophrenics.

As a patient suffering from schizophrenia gets older, the delusions and hallucinations vanish but extreme social withdrawal sets in. They not only get set apart from society, they themselves loose all interest in interacting with society. They find reasons to not do so. 

The exact cause of schizophrenia is yet unknown. Although many hypotheses have been presented, a definite conclusion cannot be drawn as to why schizophrenia occurs. 

Schizophrenia is primarily a neurobiological-biochemical disorder and the dopamine hypothesis is widely accepted to explain it. This has been proven by post mortems on schizophrenic patients which show an elevated level of dopamine in their brains and also excess of dopamine breakdown products in their cerebrospinal fluid.

Recent findings have shown changes in markers in a number of neurotransmitter systems in the brains of subjects with schizophrenia which include dopaminergic, serotonergic, cholinergic, glutamergic and GABAergic systems of the CNS. Changes in neurotransmitter systems appear to be regionally specific with the Frontal cortex, Hippocampus and Thalamus being particularly affected.

Schizophrenia may be regarded as a neurodevelopmental disorder as well. This particularly fits into Jani’s case because she had begun showing signs of the illness as early as 3 months from birth. The ways in which the brain can develop defectively resulting in schizophrenia are enlarged third and lateral ventricles, increased amount of neurotransmitters especially dopamine, reduced hippocampus, amygdala, frontal and temporal cortices.

Scientists believe that genes have a major role to play in schizophrenia. Minor genetic variability in a number of genes causes this disease. Schizophrenia is also inherited in most cases. In Jani’s case, Susan’s (Jani’s mother) great uncle was schizophrenic and Michael’s (Jani’s father) mother was delusional and disturbed.

Despite the recent advances in neurobiology, Schizophrenia remains a mystery to the medical society. Times have changed since van Gogh and scientists and doctors definitely have a better understanding of the disease today. Efforts in research continue to unravel the myriad facets of Schizophrenia in an attempt to understand this syndrome completely one day.