Understanding Schizophrenia
Rounding out our series of misunderstood and unfairly stigmatized mental health diagnoses, we have Schizophrenia. This is definitely the most unfairly maligned of metal health diagnoses and is erroneously used interchangeably with terms like “psychopath”. I see it every day (largely when people are referring to the unhoused population [which is a separate conversation but does have some venn diagram overlap with this series regarding challenging our own biases and accessing empathy]) being used as a catchall to define any mental illness and is often said with a tone suggesting that people with this diagnosis are to be feared, avoided, and sequestered from the general population. This could not be more untrue and it is deeply troubling that as a larger society we don’t get that.
As with our previous conversations, let’s start with the facts. What is schizophrenia. According the National Institute for Mental Health, schizophrenia is “a serious mental illness that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality.” This loss of reality is a result of experiencing symptoms like hallucinations or delusions which we’ll get into in detail shortly. People with schizophrenia are often diagnosed in late adolescence through the age of about 30, generally after experiencing their first psychotic episode (which is a period of time experiencing either hallucinations or delusions). It’s important to note that psychotic episodes are absolutely NOT synonymous with violence or violent potential.
Typical hallmarks associated with schizophrenia include:
· Psychotic symptoms
o Hallucinations
o Delusions
o Thought disorder-thinking in ways that are unusual or illogical (may jump from topics or struggle to organizing their thoughts)
o Movement disorder- exhibiting seemingly abnormal body movements
· Having trouble planning and sticking with activities
· Having trouble anticipating and feeling pleasure in everyday life
· Talking in a dull voice and showing limited facial expression
· Avoiding social interaction or interacting in socially awkward ways
· Having very low energy and spending a lot of time in passive activities. In extreme cases, a person might stop moving or talking for a while, which is a rare condition called catatonia.
· Having trouble processing information to make decisions
· Having trouble using information immediately after learning it
· Having trouble focusing or paying attention
Because a hallmark of schizophrenia is experiencing a psychotic episode, it’s important that those are understood well. Hallucinations are one type of psychotic symptom. Hallucinations are when a person sees, hears, smells, tastes, or feels things that are not actually there. The most stereotypical hallucination associated with schizophrenia is hearing voices. This is NOT the same as dissociative identity disorder (colloquially known as multiple personality disorder) where a person may have several separate, distinct, alters. Oftentimes hallucinations (voices in particular), are frightening for the person experiencing them.
Separately, delusions are when a person has strong beliefs that are not true and may seem irrational to others. “Delusions of grandeur” is a phrase that is often used colloquially and are associated with the beliefs that a person is famous or has more power, wealth, or intelligence than may be true. The most common delusions associated with schizophrenia are paranoid or persecutory delusions with often show up as the belief that someone or something is after them. Other common types of delusions are delusions of control (someone is trying to control my thoughts or behaviors), delusions of erotomania (others are in love with me), delusions of reference (belief that things are messages specifically for them), and the aforementioned delusions of grandeur. Thinking about experiencing delusions, especially persecutory delusions, would be terrifying. It’s important in accessing your own empathy and challenging your own biases to think about how you might act or feel if you were hearing scary things or believing that you were in danger. For people experiencing a psychotic episode, this is their perceived reality. Behavior makes sense in context.
The great news for people with schizophrenia and their loved ones is that treatment is available! There are a number of antipsychotics on the market that help to quell symptoms like hallucinations and delusions. Coupled with things like therapy, and job skills training a totally “normal” life is possible with “normal” being defined as being able to reach life goals, complete education, pursuing a fulfilling career, and creating and maintaining healthy, loving, relationships.