As an expert in mental health policy, Elyn Saks is highly accomplished in her field. She graduated from Yale Law School in the United States, teaches law, psychology and psychiatry at the University of Southern California Law School, and is a recipient of many honours, including a prestigious MacArthur fellowship, awarded to people who exhibit extraordinary ability and dedication in their field. She also lives with schizophrenia – a diagnosis she revealed in her memoir, The Center Cannot Hold: My Journey Through Madness . High achievements and severe mental illness are not mutually exclusive, but many people may not know much about schizophrenia beyond media depictions associating it with violence, failure or deviancy. Schizophrenia is a lifelong, psychotic disorder that is estimated to affect fewer than 1 per cent of the global population, but is one of the most stigmatised mental illnesses. It affects how people think, feel and act, and is most commonly characterised by delusions and hallucinations , impaired cognitive thinking and difficulty socialising with others, which can make it difficult for some – but not all – to access treatment or maintain employment and housing. If left untreated, schizophrenia can result in substance use, homelessness, social isolation and even suicide . People have also associated it with violence and mass shootings. However, psychologists warn the relationship between schizophrenia and violence is often oversimplified. “While there is a relationship between mental illness and violence, it’s not the best predictor. There are other risk factors that come into play but are often cherry-picked out [of reports],” says Patrick Corrigan, a professor of psychology at Illinois Institute of Technology, in the US. Other predictors include gender, age, substance use history and history of legal problems, but “when we focus solely on mental health, it adds to the stigma and fear”. The reality is that many people can manage the disorder and lead fulfilling lives. “A common misconception is that we’re unable to care for ourselves, and that’s not true,” Saks says. “For some people it is, but not for all of us. We can have relationships – romantic [ones] and friendships. But we often don’t see that [in the media] because of the emphasis on sensationalism and ‘othering’ us.” What is schizophrenia? When people think of schizophrenia, they often envision erratic behaviour, “talking to yourself and saying nonsense”, Corrigan says. But what is it really? The exact causes – probably a combination of genetic and environmental factors – are unclear. However, common symptoms include visual hallucinations and thought delusions, which cause those with schizophrenia to see or hear things that aren’t real. Putting a human face on this mental illness does reduce stigma, and people with schizophrenia should be able to come forward with their stories. Elyn Saks Saks says she “would sometimes have the belief that I killed hundreds of thousands of people with my thoughts”, or “had hallucinations of a man standing in front of me with a raised knife in the middle of the night”. Others may also experience what psychologists call “negative symptoms”, such as anhedonia (the inability to experience pleasure), flat affect (being unable to express emotion), or they may withdraw from relationships and at work. These symptoms tend to be more difficult to address. “People who meet the criteria for schizophrenia likely have several different things going on, and it’s not always uniform across all people,” says William Carpenter, a psychiatrist and professor at the University of Maryland School of Medicine in the US, whose research focuses on the condition. “Some will have trouble with cognition. Others will have impaired motor [skills]. But what’s shared among them is they, in some way, have false belief systems that lead to this diagnosis.” Another common misconception is that schizophrenia sufferers have multiple personalities. It’s a stereotype that likely stems from the word itself being a misnomer: the Latin prefix schizo means “split”. But Corrigan says that that multiple personalities, more formally known as dissociative identity disorder (DID), is a separate diagnosis that “may have a higher rate of dissociation – this out-of-body feeling – but it doesn’t involve any kind of hallucinations or delusions [as in schizophrenia].” Poll on public opinion of schizophrenia shows wide misconceptions Can schizophrenia be cured? Certain treatments have been proven to help keep symptoms of schizophrenia at bay. Antipsychotic medications can reduce hallucinations and delusions, while therapy and rehabilitation can address specific concerns – such as teaching cognitive techniques or enhancing social skills to improve interaction with others. “I resisted medication for many years because I didn’t like the side effects,” Saks says. “But also, I didn’t like to think that I had a mental illness, which is something I resisted for many years.” New drug for schizophrenia ‘can save Hong Kong government HK$398 million in medical costs’ With therapy and medication “my life got better”, Saks says. “I wouldn’t dream of getting off medication now, and therapy has been equally important in processing what’s happening, understanding things that get in my way and understanding my relationships more.” However, Carpenter says these interventions, which are “very important to know about”, are not curative. “Nothing is approaching the cure or full prevention, so in that regard, we still have a long way to go.” What needs to be done? As a successful professional with schizophrenia, Saks says the need to debunk myths about mental illness is crucial to understanding the complex disorder and encouraging treatment and social support. A 2012 study found that the majority of characters with schizophrenia in 41 movies displayed violent behaviour, with a third of those characters displaying homicidal tendencies. I’m bipolar and seeing the word in headlines on a divided world doesn’t help While it’s true that some people with schizophrenia may exhibit aggression or unpredictability when their symptoms go untreated – or when combined with substance use – research suggests most sufferers are not violent. Serial killers are more likely to exhibit antisocial personality disorders – such as sociopathy or psychopathy – according to the American Psychiatric Association, and those with schizophrenia are at an increased risk of becoming victims, rather than perpetrators, of violence. “The stigma is very real and it can be very deadly,” says Carpenter, who worries it can exacerbate feelings of hopelessness and isolation among those with schizophrenia. Mental health charity’s new CEO brings her life experiences to the job “When there are so many misconceptions about what schizophrenia really is, then large numbers are treated improperly or in ways devoid of the therapeutic techniques that are available.” Proper education is key to combating these issues and treating schizophrenia. But the next, most important step is making psychosis a more approachable and understandable topic. Mental illness can pose real-life limitations, but Saks wants people to know their experiences should be depicted as multifaceted and unique, rather than demonised as something to be feared. “Putting a human face on this mental illness does reduce stigma,” she says. “And people with schizophrenia should be able to come forward with their stories without being afraid of jeopardising their work life or relationships.” Like what you read? Follow SCMP Lifestyle on Facebook , Twitter and Instagram . You can also sign up for our eNewsletter here .