This is the second in a short series of posts on schizophrenia which I’m writing in commemoration of the theme for the 2014 World Mental Health Day (October 10): “Living With Schizophrenia.” If you haven’t read my first post, you can find it here. (The link opens in a new tab, so you’ll have no problem returning here. Plus, you’ll find my fictional story depicting what it’s like for someone actually experiencing schizophrenia.)
In my last post, I talked about the schizophrenia and what it’s like to experience it. Today’s post is about how to recognise what might be schizophrenia (plus a bonus for you at the end: a link to a free online test!).
Why should you need to recognise schizophrenia?
Because it comes in various shapes and sizes, and anyone can have it. And the idea of it that most people have will definitely ensure that most of the people who have to deal with schizophrenia end up untreated.
Like I said in my last post, the typical picture most people have of mental illness—poorly clothed, mumbling under the breath, roaming the streets—is very likely a person with schizophrenia. Ask the average person around here what the likely cause is, though, and you’ll probably hear something related to evil spirits or hard drugs. (Someone I know once just suggested treating schizophrenia by hitting the person “with a dose of reality!”)
No. Schizophrenia isn’t just mental, it’s physical. It not just something in the mind, but very definitely affects the brain also. It’s treatable, but treatment is best when it’s early. And when someone is affected by it, it’s absolutely important that we recognise it for what it is, and recognise it early.
What symptoms of schizophrenia might it be useful to know?
Schizophrenia is marked by unusual symptoms (some of which I tried to represent in the fictional example I used in my previous post). No two people with schizophrenia have the same experience, and the types of symptoms I’ll talk about aren’t necessarily all present in every one who has the illness. So consider these simply as guidelines to help you understand it better, and hopefully recognise if you or someone you care about may have experience it.
Here are some of the more characteristic ones:
What delusions are. People with schizophrenia often have unusual beliefs. The commonest type are persecutory delusions, where the person believes there are people who are after them or “out to get” them. Other beliefs may include delusions of grandeur (“I am God”), or delusions of reference, which is believing people are talking about them (whether physically present or just in the papers or on TV). These beliefs are typically unexpected given the person’s culture and education and general background (so what is delusional in one person might not be in another), and they usually cannot be countered by logic—they weren’t arrived at that way, anyway. Delusions occur because schizophrenia causes thought processes to break down to the point where the person can jump from one thought to another without a clear logical basis, or cause things to appear true in a way that can’t even be debated.
What delusions might look like to someone else. Suspiciousness is major, especially with persecutory delusions. The person might stop eating food for fear of being poisoned, or relate less with people to minimise risk of danger from them. Other kinds of delusions might be apparent from things they say, like in the examples I gave above. If you ask about the beliefs, they may say things like, “I just know,” or become irritable at being questioned, partly because they themselves do not know.
What hallucinations are. Basically sensory experiences only the person with schizophrenia perceives. So they might hear, see, even smell or feel stuff that others don’t. The commonest by far is the hearing type (“auditory hallucinations”), and they can play out in various ways: an affected person may hear sounds (rushing water, or a buzzing sound) or see lights or vague images, or actually hear voices and see people no one else hears or sees. If it’s voices, they may be single or more than one, they may or may not sound like people they know, and they may talk to the person or about them.
What hallucinations might look like to someone else. Since hallucinations by definition are known only to the person perceiving them, the only way to know of them is if they tell you. Or, as in the fictional story in my previous post, if they talk back, which may appear as the person talking to themselves. (Now you know why that happens!)
Check out this great video that depicts what hallucinations feel like. (If you think it’s creepy, consider that, for some people, this is everyday experience. For some it’s even every minute.)
(Oh, and by the way, those aren’t evil spirits, like I heard someone say when they saw this video! That’s really how the voices are like, based on reports from both academia and my own clients.)
Disorganized speech and behavior
What disorganisation is. Disorganised speech and behaviour are kind of related to the breakdown in thought processes I talked about earlier. When a person’s thoughts are not connected as they should normally be, it shows up in the speech of the person. It can show up in behaviour too: the person doing things that don’t seem to make sense, or doing things that have no practical purpose that anyone can see.
What disorganisation might look like to someone else. You may find that sentences don’t flow properly, or that things the person says don’t really make sense. (Again, now you see where that particular behaviour comes from.) They might do things like hoard trash. (At least that’s what others would think. They would usually have some “reason” for it.)
What negative symptoms are. Negative symptoms in schizophrenia are symptoms that represent normal functions. (The ones I’ve mentioned so far are considered as “positive” symptoms: the person starts to do and experience things they couldn’t or weren’t before.) So negative symptoms include things like:
- not taking care of personal hygiene
- not being motivated to do stuff or even make progress in life,
- not interacting with people and withdrawing instead
- not talking as much as is normal for the person (of course, if the person is an introvert, that needs to be taken into consideration here)
- not even responding emotionally as expected
These negative symptoms are huge. They are the most important symptoms in schizophrenia. Here are a few reasons why:
- They are the earliest to appear. This alone is major. Because if they’re the first to appear, and we know how important early treatment is…well, you get the picture.
- They are the easiest to miss. So this is where the paradox comes in. As important as negative symptoms are they are still easy to miss by most people.
- They are the slowest to improve with treatment.
What negative symptoms might look like to someone else. This isn’t as easy to describe: I wouldn’t want people going round assuming every one who may not be keen on self-hygiene is schizophrenic! It’s important to separate these symptoms from the person’s normal behaviour. That said, not everyone whose behaviour changes like that is schizophrenic. (As I say again and again, only a mental health professional can properly make a diagnosis of mental disorder. All of this is just to give you a guide to know when you might need to consider seeing one.)
The list of possible symptoms in schizophrenia is a lot, and I can’t go into detail here, but here a some others that are pretty common, although they can be seen in other disorders too, both mental and physical:
- Poor sleep, sometimes because of the thoughts or even the voices.
- Poor appetite (or just refusal to eat), usually with marked weight loss.
- Increased religious behaviour, especially in this part of the world, where the symptoms are likely to be interpreted by the person as spiritual in origin; fasting is common and is another reason for weight loss.
- Wandering, which is how many people with schizophrenia end up on the street.
- Unusual postures (sometimes really weird), or maintaining normal postures for unusually long (like standing for long minutes or even hours).
- Difficulty paying attention or concentrating, and by now, you can easily see why: the distraction from all the stuff going on in their minds.
- Feeling like something else is in control of thoughts and actions; the sense of disconnect causes thoughts and actions to seem as though they originate from outside one’s mind.
- Being irritable, again because of the distress from everything going on. They may be aggressive, but this is not as common as most people think. In fact they are more likely to be victims of aggressiveness or violence themselves.
On a final note…and a FREE online test
All of this stuff doesn’t usually happen at once. It takes time. Typically most people take a good long while to develop these symptoms: months, and sometimes even years. Like I said, the negative symptoms commonly show up first, and are hardly ever the reason most people with schizophrenia receive medical attention for the first time. That usually doesn’t happen until after they start showing the more disturbing positive symptoms, or maybe become aggressive.
Like I promised, here’s a free online test for schizophrenia that you might find useful. It’s not the same as actually seeing a doctor, but it might help you make the decision if you’re still undecided.
In fact, and this is really sad, many people with schizophrenia who never actually become aggressive don’t get to hospital, because no one thinks anything is seriously wrong. It’s time we changed that.
And that’s why I’ve written this post.