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.
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.
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
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
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 )