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Doctors Describe Dangers of Leaving Schizophrenia Untreated

Psychiatrists say the scariest aspect of Wendell Williamson's deadly bout with schizophrenia is that without the proper treatment and medication, history could repeat itself.

In 1995, Williamson went on a shooting spree on Henderson Street that claimed the lives of two people -- a UNC lacrosse player and a Chapel Hill business manager. A policewoman was severely injured. Once the gunfire ended and the verdict was in, Williamson was deemed not guilty of murder by reason of insanity.

The cause of Williamson's insanity?

Paranoid schizophrenia.

Schizophrenia, which literally means "split in the mind," is a division between the emotional and cognitive parts of the brain.

"Schizophrenia is a serious and not rare brain disease," said Robert Golden, professor and chairman of the UNC Department of Psychiatry. "Anywhere from 0.1 (percent) to 1 percent of our population will have it emerge, and usually it presents itself in the late teenage or early adult years."

Jeffrey Lieberman, director of the Mental Health and Neuroscience Clinical Research Center, said there are several factors that contribute to the disease's emergence.

"It's very common for kids when they go to college or are in graduate school or enter the military to begin to develop the symptoms," Lieberman said. "It's a combination of the illness coming out of that stage of life and the stress of having to deal with being away from home, entering college, doing work in graduate school."

It was during 1992, Williamson's first year in the UNC School of Law, that he noticed that something wasn't right. That same year, Williamson was committed involuntarily to Student Health Service. He was released without medication.

Two years later, Williamson had an outburst during class, which caused him to be recommitted.

After the outburst, Williamson was prescribed medication, but like most mentally ill patients, psychiatrists say, he deemed himself well enough to stop taking the psychotropic pills.

"One of the most daunting problems in schizophrenia is lack of adherence and non-adherence to treatment," said Marvin Swartz, professor of psychiatry at Duke University.

"That's just a terribly daunting problem because schizophrenia affects people in a way so they often don't recognize that they themselves are sick and don't recognize they need treatment," Swartz said. "They often go off their drugs as a result."

Acts of violence are sometimes the end result.

An association between the illness and violent outbursts has some psychiatrists worried that violent behavior on the part of people suffering from schizophrenia will cause the public to discount the severity of the disease, making treatment essential.

Treatment of schizophrenia is based on how well an individual responds to medication. "You do have to tailor the medication to the patient, and there's a lot of individual factors," Swartz said. "Some people respond better to one medication than another. So, no, it isn't a one size fits all."

But Swartz said that if left untreated, schizophrenia can become more difficult to control.

"What (Williamson's) case illustrates is the potential progression of the illness in untreated schizophrenia," Swartz said. "People who are treated can have a very good course, and there's a lot of hope for their recovery that they can function pretty well in the community."

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Golden said that prior to advanced treatment and therapy, people considered schizophrenic patients were "doomed from the womb."

"What that meant was schizophrenia does have a genetic component, and if you had the genes and developed schizophrenia, your life was doomed," he said.

But Golden said the illness does not have to become a chronic issue because most symptoms go into remission after treatment.

Golden said symptoms such as nervousness or paranoia can be signs of the disease. Another indicator of the disease's onset would be a person who is normally social becoming more of a recluse.

"A strange way would be if they seem to become nervous or paranoid," Golden said. "Obviously they must be encouraged to come in and get treatment. If they change their style, that might not be schizophrenia, but if someone begins to act very differently, they should be encouraged to get an evaluation."

Golden characterized the disease as an equal-opportunity illness. "It really cuts across cultures and socioeconomic roots and seems to have a genetic basis," he said. "We have not yet identified precisely what the genes are, but that is an area of active investigation."

But Lieberman said the real danger level of schizophrenic patients is entirely dependent upon whether they regularly take their medication. He cited Williamson as a classic example of someone who didn't. "As with a lot of people who have schizophrenia, (Williamson is) only dangerous when he's actively symptomatic," Lieberman said. "The problem is he's already committed this crime, so what kind of penalty does he have to pay for that?

"He needs to remain in treatment, that's for sure. When he's on medication, he's not dangerous, and he's reasonably responsible. The main risk would be if he were off medication."

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