Many books, articles and blogs have discussed schizophrenia and often there are differences in terminology. As an ex-mental health nurse/ward manager and someone who has experienced a lengthy psychotic episode, this is my take on schizophrenia.
Schizophrenia can be separated into positive and negative symptoms. These are not positive and negative in the way you might think. A positive symptom is one that adds a behaviour, thought or feeling, whereas a negative symptom takes away a behaviour, thought or feeling.
Schizophrenia has five types of symptoms: hallucinations, delusions, disorganized speech, disorganized behaviour (the positive symptoms), and negative symptoms. However, the symptoms of schizophrenia vary dramatically from person to person, both in pattern and severity. Not every person with schizophrenia will have all the symptoms, and the symptoms of schizophrenia may also change over time.
Most people with schizophrenia are not violent. More typically, they prefer to withdraw and be left alone. In some cases, however, people with mental illness may engage in dangerous or violent behaviours that are generally a result of their psychosis and the resulting fear from feelings of being threatened in some way by their surroundings.
- Hallucinations
People with schizophrenia might hear (the most common hallucination), see, smell, taste or feel (the five senses) things no one else does i.e. hearing voices talking in the first person, to them or about them, they might see other people, animals, faces, things that we can’t see. One patient could smell sh*t everywhere he went, causing him to retch and another said he could taste tin or metal so someone was trying to poison him. He wouldn’t eat the hospital food or take the drinks. He’d only drink bottled water that he brought in from home. One patient felt like he had spiders crawling all over him and inside his body.
2. Delusions
A delusion is a firmly-held belief that a person has despite evidence that it isn’t true. Delusions are extremely common in schizophrenia, occurring in more than 90% of those who have the disorder. Often, these delusions involve illogical or bizarre ideas or fantasies, such as:
Delusions of control – Belief that your thoughts or actions are being controlled by outside, alien forces. Common delusions of control include thought broadcasting “My private thoughts are being transmitted to others so people can hear what I’m thinking”, thought insertion “Someone is planting thoughts in my head”, and thought withdrawal “The CIA is robbing me of my thoughts”.
Delusions of grandeur – Belief that you are a famous or important figure, such as Jesus Christ or Napoleon. One of our patients believed he wrote all Michael Jackson’s lyrics. Alternately, delusions of grandeur may involve the belief that you have unusual powers, such as the ability to fly.
Delusions of persecution – Belief that others, often a vague “they,” are out to get you. These persecutory delusions often involve bizarre ideas and plots e.g. “Martians are trying to poison me with radioactive particles delivered through my tap water” or “they’ve put a chip in my neck so they can follow me, they followed me to San Francisco once and had me deported back to the UK.” He had actually been deported once it was noticed he had been on Section 3 of the Mental Health Act 1983 as you cannot enter the States if you have been on Section 3*.
Delusions of reference – A neutral environmental event is believed to have a special and personal meaning. For example, you might believe a billboard or a person on TV is sending a message meant specifically for you.
3. Disorganised speech
People lose their train of thought during conversations, make loose associations of topics (jumping from one topic to another), and give answers to unrelated questions. They might make up words that only they know the meaning to (word salad), rhyme without noticing they’re doing it, and repeat the same things over and over again when trying to keep up a conversation.
4. Disorganised behaviour
Patients often have a very hard time functioning independently and this is easily seen in the difficulty they have in starting or finishing a task without help from other people. Mundane tasks such as taking a shower or cooking a simple meal become massive tasks. Patients start to lose independence and not being able to perform normal everyday activities and they start to lose routines to the point where they can be completely lost.
5. Negative symptoms include:
Blunted affect – reduced intensity and range of emotional expression including vocal, facial expression, body movement and hand gestures.
Alogia – decreased quantity of speech, reduced spontaneous speech and loss of conversational fluency.
Amotivation – lack of motivation i.e. in school, work, personal hygiene etc.
Anhedonia – inability to feel pleasure in normally pleasurable activities.
Asociality – lack of motivation to engage in social interaction and/or the preference for solitary activities
6. Suicide
Five to 6% of people with schizophrenia die by suicide, about 20% make suicide attempts on more than one occasion, and many more have significant suicidal thoughts. Suicidal behaviour can be in response to hallucinations and suicide risk remains high over the lifespan of individuals with schizophrenia.
7. Early warning signs of schizophrenia
In the early phase of schizophrenia, a person might seem reclusive, unmotivated, eccentric and emotionless to others. They might start to say odd things, isolate themselves, show a general indifference to life and begin neglecting their appearance. They may abandon activities or hobbies, and their performance at university, school or work can deteriorate.
8. The most common early warning signs include:
- Odd or irrational statements; strange use of words or way of speaking
- Depression, social withdrawal
- Flat, expressionless gaze
- Inability to cry or express joy or inappropriate laughter or crying
- Oversleeping or insomnia; forgetful, unable to concentrate
- Hostility or suspiciousness, extreme reaction to criticism
- Deterioration of personal hygiene
Medicalexpress.com 
Minddisorders.com 
Spectator.co.uk
If you are worried that odd or out of the ordinary behaviour is causing problems in your life or the life of a loved one, please seek medical advice. The earlier you get treatment, the better the prognosis.m
Is there anything else you would like to know about schizophrenia? Is there anything you think I’ve missed?
* Section 3 of the Mental Health Act is commonly known as “treatment order” it allows for the detention of the service user for treatment in the hospital-based on certain criteria and conditions being met.
For immigrants with a mental disorder or disability, seeking entry to the United States is not easy. U.S. immigration law imposes barriers to entry for persons with certain kinds of physical or mental illness, particularly when it appears that the chances of harm to persons or property are high or when an immigrant may likely have no financial support in the United States.
These barriers can be compounded by immigration officials who lack up-to-date scientific knowledge or who may unknowingly prejudice such cases. There are ways round these barriers and travellers must ensure they have the legal documents required for entry into the States (https://www.alllaw.com/articles/nolo/us-immigration/mental-illness-barrier.html )
I’ve witnessed ALL of these behaviors during my years as a Correctional Officer.
I’m sure you have Mark. It’s painful to see.
Very interesting and informative!
Thank you x
I lost my heart to schizofrenia, it is one of the most interesting ‘illness’ to ‘work’ with, to encounter and to learn from. What I found so interesting is ‘their’ relationship to time and language. In my belief people with schizofrenia have a difficult time trying to create a ‘lie’ and that just melts my heart. That is just my view and personal belief.
Me too Kacha that’s why I did all my continued professional development in courses about schizophrenia, treatments and talking therapies. Otherwise, all they had was medication 🙁
The schizofrenic mind is in the centre and a big reason why psychiatry needs to exist. You need to understand the origins to know where your loyality should be. That’s why I worked with ‘long stayers’, people in the chronic population.
I always saw one metaphor I made up (or picked up somewhere): when you put all the people of the world on a carousel and the middle is the norm, resourses, all the good things you can have in life. Imagine it starts spinning very hard. The people who are on the outside, that is who you should help. Schizofrenia makes it difficult to hold on to resourses, social interactions and finances. I could go on and write books about it. But that thinking also made it difficult for me to keep working in MH. Other ‘more normal’ people are being treated in the beds who are more needed for others. Rant almost over here 🙂
Thank you for providing the place for me to rant a little. All I want to say that medication is important but the other things you mentioned are also life saving interventions, so thank you for investing in it.
I’m sure you made a big difference for a lot of people. <3
Aaaww, Bless you. Rants allowed 🙂 You’re right about the beds often being used for those that don’t actually need them so much. We had that a lot too and often had 6-8 patients over on each of our ward – with no extra staff!! Even more frightening for people with schizophrenia – no safe beds or rooms for them cos everyone was doubled up! Still, I loved my job x
6 to 8 that is incredible! We had 1 ‘black bed’ but that wasn’t to easy to get away with. Staff needs to be motivated enough to carry through.
“create a lie” ? could you please explain this comment? I hear voices and for my experience it has changed based on my personal mind set. Its a battle, but a battle that can be controlled so to speak.
I treat them as I would an external individual. I take no shit, and I only listen to positives.
Oh yes of course I’m glad you asked. What I try to say, is that in my experience (!) , people with schizofrenia are more honest and can’t lie that good (as compared to others).
I feel as ‘they say it like it is for them in the moment’. I never felt ‘decieved’ or ‘played’ with as a care-giver. I hope this makes more sense to you. But if not, please tell me!
Yes, I agree with that. I know everyone has thier own experiences. I only know that for myself being honest but tactful is how Ive been. Unfortunately my providers only desire to medicate me and my honesty gains me the label of “hypervigilant” and a new diagnosis or med. I started taking control. I dont see why someone would lie to a professional, honestly. What is there to gain?
Being honest and staying true to yourself is more difficult sometimes then maybe creating some drama, a lie or other ‘fluff’.
Good that you can take control, it seems a very important step. (I’m trying than too).
Medications and diagnosis are good but to recover involves a lot of personal work that can be helped by some medications.
I thank you for your honesty and for asking the questions you had. Clearing things up is the way to go.
You’d be surprised about how people lie to professionals. Sometimes, to protect themselves as they don’t want to be admitted or have treatment forced on them. And just sometimes, you’ll get people lying to get more medication.
I never thought about hallucinations involving smell and taste before. That must be even harder to deal with in some ways, since people generally talk about hallucinations only in the sense of sight and sound.
That’s what makes working with schizophrenia so interesting for me and helping people to make sense of where that hallucination may have started and to help reduce the impact they have on the patients. Thanks for commenting, as always.
I have a close relative who is schizophrenic.
I have had interactions with this person. Some times are good, other times are total chaos.
It is often difficult for the families too, I know.
My mum has paranoia schizophrenia. She was diagnosed with it at a much younger age. Way before I was born and before she went with anyone.
There have been bad patches with my mum. I have been aware something wasn’t right from age of about 9 years old, but it was from 11 and onwards that I have been worried about my mum, because I was more aware.
I have been a carer to some degree since my teens. I received no support and would not have known that age how to get it. It was only this year I have felt I have got support. But after my burnout later, back in August, I cannot do it no more. This year has been awful, as my blog will explain, since my mum took an overdose back in Feb and there is tension and resentment, since July when I watched her try and throw her support away, while I am crying for it. I have had enough. I won’t be that carer anymore.
Since I took that step back in July, mum was sectioned later in September and after that, sectioned under Section 3.
I seen her for the first time last Friday, but I only lasted 5 minutes. I don’t plan to go back and see her anytime soon and when and if she does ever get to be out, back in her own home, mum will have a shock f how distant I will become. Mum doesn’t get the damage she done to me back in July.
Mum will have a shock too that she will have to conform to carers in her own home daily, or assisted living, when one day she can go home, if she is to avoid a care home type facility, as her doctor will put one of these in place to ensure the situation she is in, doesn’t happen again. It’s so they can make sure she takes her meds accordingly, whether by tablet, or injection. Again, it’s when the time comes to discharge. But after seeing her and seeing she is unwell as expected, I doubt this will happen this year.
Oh wow, you’ve had a bad time of it lately and I can understand how hard it must have been for you. It sounds like your mum’s in the right place for now and hopefully her team will sort our a care package for her. I can appreciate how hard it must have been for you as a child and then becoming her carer. Hoping you’ll get a well earned rest and you look after yourself now. Caz x
Thank you. Yes, mum is in the right place for now. I know she’s safe there.
Mum is back on same mental health ward as before, so they know her.
First talking to her doctor before she was sectioned, I told them how I can’t do it no more. The doctor agreeded and said it’s hard in a day, let alone from all the years I have been doing it.
The time when mum can be discharged, the care package will be so I am just a daughter and not a carer. But mum will have a shock when she finally reallises the lasting damage of this year. There won’t be that closeness again.
As for when one time newspapers made Schizophrenia look bad, by making it front page news; making people look dangerous. I already hated the word ‘Schizophrenia’ before I knew how tabloids would go all wrong with their news reports. But when I knew how they portrayed it, I can understand for anyone that wouldn’t reveal they were Schizophrenia and instead just say mental health.
Newspapers created lasting damage how they would portray, just for their headline news.
Aaawww, hopefully after you’ve had a good rest you can start to rebuild that relationship – slowly. Gosh, I know, I was awful when we were young too – now even though I don’t nurse – medically retired – I still see lots of ex-patients around and I so feel for them. Caz x
Yes, slowly it will be, if it happens. At the moment now, all I want to do is keep my distance. X
It is difficult not to be impressed by your knowledge and your ability to describe these difficult conditions. Understanding goes a long way. And you obviously understand.
Ah, thank you Brian. That’s nice to hear.
Its always interesting to me to hear/read/listen to thoughts of a medical professional, and most of all someone who does not have this diagnosis. I personally hear voices, and for me, the negatives you list have become my positives. I see it all in a more spiritual manner. Some call this delusions, but this is MY reality and I am the one navigating it all. I am very high functioning and actually like being social. I am very open about my experiences.
I dont view my “hallucinations” as a negative anymore either. I no longer fear them. I just allow them to play out and analyze it all. Its a great source to use in a blog, or journaling. Most of all the educate others.
I agree with you. There’s a very large movement that ‘hear voices’ but don’t agree to having a diagnosis of schizophrenia. And there’s lots of people who want to ‘keep’ their voices as they get a lot from them. One little old lady begged us not to take away her voices with medication otherwise she would feel. lonely. I’m glad you’re high functioning and enjoy socialising. Happy to hear you’re open to your experiences too.
I sort of feel lonely when I cant hear them. They use to be so loud. Mine arent malevolent in nature. It hasnt always been this way. I take a couple meds but in the past year ive tried10 different meds. Now trying to secure a med that helps my scattere, non attentive brain
I understand that often sometimes it’s the only ‘company’ some of my patients had. It’s not one size fits all in mental health, is it? We have to often try many meds before we find the ‘right’ one for us. Thanks for your comments.
This is a great write-up. Thank you for taking the time to share it!
Aww thank you Milo and I hope others might find it interesting too 🙂
🙂