Modified: 2020-04-22
So, eventually, and without treatment, schizophrenics end up in their own world, literally. That world contains their unique perceptions as well as their unique hallucinations and delusions, which serve to maintain their perceptions. For example, auditory hallucinations are common. Nearly any mental health facility will probably admit you quickly if you admit to "hearing voices." David Berkowitz, the "Son of Sam" killer, admitted to hearing voices from his neighbor's dog that told him to go kill. Delusions are also common, especially delusions about drugs. One patient, for example, insisted that some crumpled flowers were opium poppies (they were not). In therapy, such patients are usually challenged when they make such statements. Left unchecked, such delusions spin the patient deeper into the schizophrenic vortex.
Schizophrenia is not just one condition. Clinicians today no longer use the same terms as in the past. Those were:
The onset of the condition is usually gradual. Sufferers with social networks are more likely to be treated, as their friends and family notice changes. But those who live alone may become more asocial, and simply change their lifestyle as the schizophrenia progresses. Many of the street characters seen in large US cities are undifferentiated schizophrenics.
Often the schizophrenic split causes immobility. It is as though the conflict of realities is resolved by immobility, passivity, and lack of verbal behavior. In inpatient settings, catatonics may spend many hours in one place, not moving. If someone talks to them they do not respond. If their limbs are moved for them, they often leave them where they were last placed. This phenomenon is called waxiness, because it is like they are wax dolls. They do not respond well to insight therapy, or to any other therapy that depends largely on conversation. The benzodiazepine drugs, will usually bring them out of the catatonia, to a point where insight therapies can have some effect.
Some schizophrenics are likely to make up their own words, neologisms, or string long chains of words or sounds together in a bizarre way (word salad). In the movie, "The Ruling Class," Peter O'Toole does a masterful job of displaying the symptoms of disorganized schizophrenia in an extended scene. It is nearly impossible for an unaffected individual to maintain such behavior for a long time. It is that bizarre behavior that gets disorganized schizophrenia noticed and then treated.
Many hallucinations and delusions have a distinct paranoid quality. Paranoia, in general, occurs when individuals believe that others are out to get them. Some schizophrenic hallucinations are paranoid in quality. In one case, for example, a young man believed that he was the target of drug dealers' revenge. He further believed that they drove a red Volkswagen automobile. Every time he saw a red volkswagen he would quickly hide, even when a long way from home (e.g., 2000 miles away). That behavior illustrates a delusion of reference. Normals have these often, as when seeing a person in Europe, and you believe them to be an acquaintance, but you do not know them. Schizophrenics, however, are much more likely than normals to have such delusions. Eventually, the young man grew so paranoid that he could not sleep. He had to be hospitalized when found outside fighting with imagined adversaries the morning after a sleepless night. Paranoid schizophrenics obviously pose a danger to themselves or to others. Catatonics also obviously need care, and disorganized schizophrenics do such outlandish things, that they, too, are likely to receive care.
I had an extended encounter with a schizophrenic once. It happened at the Milwaukee public library. I was waiting for a book to be retrieved from the basement, so I was passing the time at a second floor poster exhibit. I happened to make eye contact with a young woman who was coming up the escalator. What drew my attention toward her in the first place was that she was riding up the escalator with one arm and index finger pointed skyward at a 45 degree angle. She was also dressed in an unusual manner; she had a shawl, and a long, flowing, skirt on. As she passed near me, she said, "Follow me." I did not. I thought no more about her, until, on the way down the escalator, I noticed her arm and finger pointing over my shoulder. I left the escalator, and proceeded to the librarian's desk with her behind me, in step, and with her arm still over my shoulder. The librarian gave me a startled look as I approached, so I just shrugged and took the book. I made my way to a library table with her still behind me. As I pulled out a chair, she stopped me, pulled out another chair, and bade me sit in it; I did.
We sat there, together and alone; then she put her purse, a large carpetbag , on the table. As I watched intently, she removed a small wadded up red ticket and a brown and white woman's patent leather pump (a shoe). Inside the shoe was a small bar of hotel soap, still in the wrapper, that she also carefully removed, and placed in front of me.
I now was sure that I was dealing with a schizophrenic. Those items above very likely were laden with delusional content. To her, they were not the items I, and the rest of the world, perceived. At this point, I also inferred that she had probably been in treatment previously, and had be judged not to be a danger to herself or to others. Today, patients who wish to be discharged from treatment, and who meet that standard, may no longer be kept in inpatient care. So, with that knowledge, I planned my escape. I was worried that she would follow me home.
I simply gave her one of my library books, and told her to watch it for me. I returned the reference book the librarian had given me earlier, and left the library in a hurry. I never saw her again. There are many like her in America. They live in their own worlds, but do not cause others a great deal of discomfort, so they are usually left to their own devices. Other forms of schizophrenia cause their sufferers to become more seriously in trouble, so those patients are usually hospitalized and treated.
Another way to look at schizophrenia is in terms of its development. When schizophrenia was first described by Bleuler, he called it dementia praecox, or dementia of the young. He did so because many of its victims were teenagers and young adults. Those patients likely had what today we would call reactive schizophrenia, or a schizophrenia that develops fairly rapidly, and usually in response to some particular set of events. The prognosis for reactive schizophrenia is actually quite favorable. On the other hand, some schizophrenias develop quite slowly, over the course of many years. These cases are called process schizophrenia, and the prognoses here are usually unfavorable.
Finally, some schizophrenias can be traced to specific conditions, such as drug overdose. In such cases, the schizophrenic symptoms usually disappear when the substance is removed. In one particularly bizarre case, a navy pilot became schizophrenic, and tests revealed he had been taking PCP, a potent drug (angel dust is one street name). The pilot swore he had never taken the drug, but the tests were positive and he was discharged. The pilot persisted, and he later found that he had taken the drug unknowingly via his clothes. It seems that, on a commercial flight, his luggage had been soaked by a leak of liquid PCP from someone else's luggage. Over a period, he had built up enough of a PCP dose by wearing the clothes that had been soaked in PCP. He presented his findings, and was reinstated.
So, schizophrenia is a complex condition that manifests itself in several forms. All forms are characterized by hallucinations and delusions, and the formation of a schizophrenic split in personality. But that split is completely unlike that found in dissociative identity disorder or multiple personality.
- How to Manage 5 Common Symptoms of Schizophrenia--article, basic, long, links
- Linked article abbreviated for popular use; original appeared in Hospital and Community Psychiatry (1997). Describes five common symptoms of schizophrenia and gives advice on how to manage them: paranoia, denial of illness, stigma, demoralization, and terror of being psychotic. http://www.schizophrenia.com/ami/coping/symptom.html