A Crash Course on Schizophrenia

From my experience working in mental health and describing to people what I do for a living, I have come to the conclusion that Schizophrenia is one of the least understood psychiatric diagnoses.  I will describe some of the symptoms, and how a person comes to be diagnosed.  Then I will try to speak to some of the prevalent misconceptions.

As you, intelligent friend, will remember from an earlier article about finding a therapist, the first thing to be done is rule out physical reasons for the person’s symptoms.  Additionally, a mental health professional will need to rule out substance use that could be causing the symptoms.  Perhaps the person is experiencing hallucinations due to a psychedelic drug?  Once these factors have been ruled out, the clinician can screen for the symptoms of Schizophrenia.

The person must have experienced at least two of these for most of the time over a one-month period, with some level of disturbance occurring for at least six months:

• Delusions: A delusion is a false belief.  Common delusions experienced by a person with Schizophrenia include persecutory delusions.  This means the person believes they are being targeted by someone.  Often they will say they are being followed, hurt, poisoned, or tormented by someone.  Referential delusions mean that a person believes that the words or gestures of someone are directed at them.  They may tell you that a song on the radio is about them, or a television show.  Delusions of grandeur mean that the person believes that they are someone of great importance.  In my time working inpatient mental health, I have met two directors of the CIA, one head of the FBI, and about half a dozen Jesus’s.  Thankfully, I only had one Jesus on my unit at a time.  That could have gotten messy!  Speaking of Jesus, the next type is religious delusions.  Types of delusions may overlap.  A person could have a religious delusion and a delusion of grandeur that he is Jesus.  Someone else could believe that they are the lead singer of a famous rock band, and that the band’s new song contains messages to him or her.  Somatic delusions are delusions about one’s body.  The patient may say that he has a radio transmitter implanted in his teeth.  Delusions of control occur when someone believes they are being controlled by an outside source.  I have had patients believe we were able to steal their thoughts from their minds, and put new ones in.  Delusions of any type can be very scary for the person who has them.  People experience these beliefs as being as real and logical as anything you or I know to be true.  Delusions are not often treatable.  At best, we are able to get the person to understand that other people don’t experience what they are experiencing.  But their delusions are often accompanied by our next topic, hallucinations.
• Hallucinations are sensory experiences in the absence of stimulus:  hearing, seeing, smelling, touching, or tasting something that’s not there.  The most common is auditory, meaning the patient hears things no one else does.  Usually, these are voices no one else hears.  They are often quite frightening for the person.  The voices tell them bad things about themselves.  They may also command the person to do things.  This is a tormenting experience.  A person with Schizophrenia may commit a crime that the voices tell them to, believing it will make the voices go away.  Sometimes the voices talk to each other, or warn the patient they are in (false) danger.  Any sense can be affected by hallucinations, but auditory hallucinations are the most common.
• Disorganized Speech - A person with Schizophrenia may have trouble organizing their thoughts into words.  The words they say may be out of order, or unrelated to one another.  This is called word salad.  Loose associations are another type of disorganized speech.  The person may jump quickly from one topic to another, to another.  The topic will be related, but the sentences will not go together to make a coherent thought.
• Extremely Disorganized Behavior - A person with Schizophrenia may do things that don’t make sense to anyone else.  I had a patient who wore a heavy sweater no matter what the weather.  This was in a place where summer temperatures were at least in the 90’s every day. 
• Negative Symptoms - Negative symptoms refer to the absence of something.  This includes something called “flat affect.”  Someone with flat affect will have less facial expressions, emotions, and/or vocal tone than what is otherwise socially accepted.  They may have reduced enjoyment of activities, or difficulty initiating tasks.  This may make a person appear lazy or unwilling, but it’s different.  It is a symptom of the Schizophrenia, not a defect of character. 

I hope that this entry has given you a better understanding of what a person with Schizophrenia experiences.  One of the hardest things about working in mental health is helping people who don’t have a particular mental illness to understand those that do.  It can be extremely frustrating when a loved one is experiencing a delusion, for example.  You know that what they are telling you isn’t real.  It may be interfering with your relationship with them.  But no matter how many times you present them with evidence to the contrary, they won’t budge.  It’s not personal.  They’re not doing it to make you mad.  They truly cannot help it.  They believe their experience just as strongly as you believe yours.  

Many symptoms of Schizophrenia can be greatly reduced with antipsychotic medications.  Medications currently available have fewer and less severe side effects than the first generation of these meds.  It is important to note that these medications take time to work.  It can take weeks, or even a couple of months to get enough of the medication in a person’s body to make a difference.  This is called a therapeutic level (look how smart you’re going to be now!).

Individual therapy, social skills training, family therapy, and supported employment may also be useful to help the person be as productive as possible.  These may help the person learn to better manage their symptoms, which will help them to feel and be that much more productive.  See how that can set someone up to succeed?  Just like anything, when we feel better, we do better, and when we do better, we feel better.  

I hope that this entry can clear up some misunderstandings about Schizophrenia.  People with Schizophrenia are not inherently dangerous.  Treatment is available which can help a person be productive and successful.  Like anything worth having, it’s work.  But that’s what makes it worth having in the first place.

Be well.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.