Zacarias Moussaoui: Wicked But Not Schizophrenic

Christopher Wanjek

Date: 25 April 2006 Time: 04:33 AM ET

Two recent events have pushed schizophrenia into the headlines. One is a medical advance. Doctors may have found a biological underpinning of this horrible mental disease. The second is the questionable diagnosis of Zacarias Moussaoui, the unapologetic 9/11 terrorist, as a paranoid schizophrenic.

It is unclear, however, whether either news story will help end the longstanding misconception that schizophrenia is a disease of split personalities and violence.

Schizophrenia covers a wide range of mental conditions, and none of them involves a split personality. The signature characteristics include delusions, hallucinations, disorganized speech, odd behavior, or a lack of motivation or emotion.

Zacarias Moussaoui

A split personality, on the other hand, is dissociative identity disorder, or DID, and it is exceedingly rare. Actor Jim Carrey's character in the comedy "Me, Myself & Irene," who had a split personality, was mislabeled as schizophrenic.

While it is true that Hollywood always gets science and medicine wrong, this movie committed a far greater sin. You see, DID sufferers experience severe physical and emotional trauma at a very early age—often incest combined with physical abuse and torture from both parents, offering no escape from their horror. How's that for a comedy premise?

As for Moussaoui, the so-called 20th hijacker from the September 11 attacks, one could say he has a split personality: Half of him is filled with hate, while the other half is filled with stupidity. But he's the worst poster child for schizophrenia because, by and large, those suffering from schizophrenia are not violent.

The face of schizophrenia

Schizophrenia is surprisingly common, affecting 0.5 to 2 percent of populations worldwide. This range reflects the difficulty in diagnosis. Most people with schizophrenia lead meaningful lives. More than half will have bouts of the disorder just a few times in their lifetime, though they can be debilitating, lasting weeks to months. Sufferers can keep episodes at bay or even minimize episodes when they happen with a combination of medication and psychiatric treatment.

Roughly a third endure chronic schizophrenia, which requires continuous, long-term treatment and often hospitalization. Unfortunately institutional space is in short supply. Studies find that about a third of America's homeless are schizophrenic.

Some deeply schizophrenic people can be violent, by virtue of delusions or hallucinations directing them. A large and respected study from 1990 found that only 8 percent of schizophrenics were violent, however, compared to the 34 percent of substance abusers who were violent. Other studies show that schizophrenics are more likely to be the victims of violence, for they have too weak of a mental state to protect themselves.

The hyper-violent Moussaoui appears delusional, but the absence of vivid and horrifying hallucinations, a common characteristic of paranoid schizophrenia (one of five main subtypes of schizophrenia), casts doubt on his diagnosis. It could be that he is quite sane and simply wicked.

No known cause or cure, but hope...

As with many diseases, schizophrenia seems to be influenced by genes and the environment. Environmental factors include stress and trauma, particularly in childhood. In 2002 researchers in Iceland found that a gene called neuregulin-1, known for about ten years prior to be involved with brain activity, was associated with schizophrenia.

Note to Readers

As Geoff C. pointed out, my "simple math" in my last column about oxygen drinks was a little too simple. Oxygenated drinks contain no more than 125 mg/liter; air contains about 250 mg/liter. (Although air is about 20 percent oxygen and the oxygenated water is 5 percent dissolved oxygen, the density is different, so this isn't quite 4:1.) Each minute we inhale about 12 times and breathe in about 4 liters of air. So you need to drink two liters of oxygenated water (at 125 mg/l) just to keep up with three good breaths (about a liter of air). —CW

This has been a complicated field of research. Neuregulin is one of ten genes now associated with schizophrenia, and neuregulin itself is one of the largest genes in the human genome, generating six different proteins.

As reported earlier this month in the Proceedings of the National Academy of Sciences, Amanda Law of the University of Oxford and Daniel Weinberger of the National Institutes of Health may have found how this gene goes wrong. In examining several dozen brains of deceased schizophrenia patients, the doctors found abnormally high levels of neuregulin protein Type 4. Knowing how to regulate this protein could lead to a cure, regardless of whether the disease is inherited or environmentally induced.

The term schizophrenia comes from the Greek words for "split mind," so we're not too much at fault in thinking this means split personality. In 2002 Japan officially changed its name for the disease from seishin bunretsu byo (mind fragmentation disease) to togo shicchou sho (integration disorder). It may take a name change in English to clear up misconceptions and prejudices.

Christopher Wanjek is the author of the books “Bad Medicine” and “Food At Work.” Got a question about Bad Medicine? Email Wanjek. If it’s really bad, he just might answer it in a future column. Bad Medicine appears each Tuesday on LIveScience.