Schizophrenia

Modified: 2024-07-22 12:26 PM CDST

• Schizophrenia is a complex form of psychopathology usually characterized by the presence of hallucinations and delusions.
  • Schizophrenia is not like dissociative identity disorder or multiple personality, although there exists a "schizophrenic split" in the personality.
    • That split is the source of confusion between it and multiple personality. In schizophrenia, patients are torn between their own, distorted perceptions of reality and the world's, shared perceptions.
      • The split comes as the schizophrenic's distorted perception comes to dominate activity and behavior.
    • Schizophrenics may cope with maintaining two competing views of reality for a long time, but at last they cannot, and they give in and accept their distorted view.
      • That point is when they begin to have trouble coping with the world.
        • 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:
• Undifferentiated schizophrenia
• Catatonic schizophrenia
• Disorganized or Hebephrenic schizophrenia
• Paranoid schizophrenia
• 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. (catatonia)
  • 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 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.
      • His behavior was similar to that on the movie "Fight Club."
  • Paranoid schizophrenics obviously pose a danger to themselves or to others.
  • Catatonics also obviously need care
  • 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. She was right behind me!
    • 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, armed 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
  • 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.

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