The World of People With Schizophrenia: What it’s like
to have it.
Distorted
Perceptions of Reality
People with schizophrenia may have perceptions of reality
that are strikingly different from the reality seen and shared
by others around them. Living in a world distorted by hallucinations
and delusions, individuals with schizophrenia may feel frightened,
anxious, and confused. In part because of the unusual realities
they experience, people with schizophrenia may behave very
differently at various times. Sometimes they may seem distant,
detached, or preoccupied and may even sit as rigidly as a
stone, not moving for hours or uttering a sound. Other times
they may move about constantly—always occupied, appearing
wide-awake, vigilant, and alert.
Hallucinations and Illusions
Hallucinations
and illusions are disturbances of perception that are common
in people suffering from schizophrenia. Hallucinations are
perceptions that occur without connection to an appropriate
source. Although hallucinations can occur in any sensory form—auditory
(sound), visual (sight), tactile (touch), gustatory (taste),
and olfactory (smell)—hearing voices that other people
do not hear is the most common type of hallucination in schizophrenia.
Voices may describe the patient’s activities, carry on
a conversation, warn of impending dangers, or even issue orders
to the individual. Illusions, on the other hand, occur when
a sensory stimulus is present but is incorrectly interpreted
by the individual.
Delusions
Delusions are false personal beliefs that are not subject
to reason or contradictory evidence and are not explained
by a person’s usual cultural concepts. Delusions may
take on different themes. For example, patients suffering
from paranoid-type symptoms—roughly one-third of people
with schizophrenia—often have delusions of persecution,
or false and irrational beliefs that they are being cheated,
harassed, poisoned, or conspired against. These patients may
believe that they, or a member of the family or someone close
to them, are the focus of this persecution. In addition, delusions
of grandeur, in which a person may believe he or she is a
famous or important figure, may occur in schizophrenia. Sometimes
the delusions experienced by people with schizophrenia are
quite bizarre; for instance, believing that a neighbor is
controlling their behavior with magnetic waves; that people
on television are directing special messages to them; or that
their thoughts are being broadcast aloud to others.
Disordered Thinking
Schizophrenia often affects a person’s ability to “think
straight.” Thoughts may come and go rapidly; the person
may not be able to concentrate on one thought for very long
and may be easily distracted, unable to focus attention.
People with schizophrenia may not be able to sort out what
is relevant and what is not relevant to a situation. The person
may be unable to connect thoughts into logical sequences,
with thoughts becoming disorganized and fragmented. This lack
of logical continuity of thought, termed “thought disorder,”
can make conversation very difficult and may contribute to
social isolation. If people cannot make sense of what an individual
is saying, they are likely to become uncomfortable and tend
to leave that person alone.
Emotional Expression
People with schizophrenia often show “blunted”
or “flat” affect. This refers to a severe reduction
in emotional expressiveness. A person with schizophrenia may
not show the signs of normal emotion, perhaps may speak in
a monotonous voice, have diminished facial expressions, and
appear extremely apathetic. The person may withdraw socially,
avoiding contact with others; and when forced to interact,
he or she may have nothing to say, reflecting “impoverished
thought.” Motivation can be greatly decreased, as can
interest in or enjoyment of life. In some severe cases, a
person can spend entire days doing nothing at all, even neglecting
basic hygiene. These problems with emotional expression and
motivation, which may be extremely troubling to family members
and friends, are symptoms of schizophrenia—not character
flaws or personal weaknesses.
Normal Versus Abnormal
At times, normal individuals may feel, think, or act in ways
that resemble schizophrenia. Normal people may sometimes be
unable to “think straight.” They may become extremely
anxious, for example, when speaking in front of groups and
may feel confused, be unable to pull their thoughts together,
and forget what they had intended to say. This is not schizophrenia.
At the same time, people with schizophrenia do not always
act abnormally. Indeed, some people with the illness can appear
completely normal and be perfectly responsible, even while
they experience hallucinations or delusions. An individual’s
behavior may change over time, becoming bizarre if medication
is stopped and returning closer to normal when receiving appropriate
treatment.
Are People With Schizophrenia Likely To Be Violent?
News and entertainment media tend to link mental illness
and criminal violence; however, studies indicate that except
for those persons with a record of criminal violence before
becoming ill, and those with substance abuse or alcohol problems,
people with Schizophrenia are not especially prone to violence.
Substance
Abuse
Substance
abuse is a common concern of the family and friends of people
with schizophrenia. Since some people who abuse drugs may
show symptoms similar to those of schizophrenia, people with
schizophrenia may be mistaken for people “high on drugs.”
While most researchers do not believe that substance abuse
causes schizophrenia, people who have schizophrenia often
abuse alcohol and/or drugs,
and may have particularly bad reactions to certain drugs.
Substance abuse can reduce the effectiveness of treatment
for schizophrenia. Stimulants (such as amphetamines or cocaine)
may cause major problems for patients with schizophrenia,
as may PCP or marijuana. In fact,
some people experience a worsening of their schizophrenic
symptoms when they are taking such drugs. Substance abuse
also reduces the likelihood that patients will follow the
treatment plans recommended by their doctors.
Most individuals with schizophrenia are not violent; more
typically, they are withdrawn and prefer to be left alone.
Most violent crimes are not committed by persons with schizophrenia,
and most persons with schizophrenia do not commit violent
crimes. Substance abuse significantly raises the rate of violence
in people with schizophrenia but also in people who do not
have any mental illness. People with paranoid and psychotic
symptoms, which can become worse if medications are discontinued,
may also be at higher risk for violent behavior. When violence
does occur, it is most frequently targeted at family members
and friends, and more often takes place at home.
