As we continue our discussions on the basics of schizophrenia, it has come time to address the specifics of the experiences of those progressing into or having been diagnosed with schizophrenia. Schizophrenia is a very complex diagnosis and shares similarities with other types of disorders. Based on the Diagnostic and Statistical Manual of Mental Disorders, which is up to it’s 5th edition now and continually being refined, psychiatrists and psychologists can help narrow down specifically which syndrome is being experienced by the patient. The symptoms we will discuss below all fall under the cluster of symptoms featured in a true schizophrenic diagnosis.
In general, this mental illness can be characterized as an interference in thinking and feeling. This disruption affects every part of human cognition, resulting in difficulties in sensory perception, interpretation, cognition, emotion, and self-conception. This cluster of symptoms is far reaching within the schizophrenic’s internal world and external world. Internal stimuli can arise which result in the experience of hearing voices, seeing images, or other perceptions, which cannot be validated by any other person. These are called hallucinations and are aberrations of sensory experience. Internally, the experiencer can apply false meaning to these events, finding relation and interconnection between items where there is no true relation. These delusions of reference can further confuse or inspire the schizophrenic to chase these beliefs, more deeply engraining the individual into their illness.
Positive Symptoms Versus Negative Symptoms
The symptoms of schizophrenia are generally regarded as one of two types: positive or negative. Of course, there are specific parameters involved in giving a diagnosis of schizophrenia based on these symptoms, including the duration and number of symptoms present at any given time that are unrelated to other issues such as substance abuse. We will not be dealing with these parameters, only on the symptoms themselves. So what are the differences of positive and negative symptoms, then?
Positive schizophrenia symptoms are those that result in an outwardly excessive expression of normal functioning, whether simply an extreme range of expression or some form of distortion of expression. These are oftentimes indicative of bizarre beliefs, delusions, or hallucinations that are arising internally.
Negative symptoms are essentially the opposite of positive, or the inverse, rather. Rather than there being an excessive expression of some emotion or action, there is a diminished expression indicative of a loss of emotion or cognitive functioning. It is difficult for another person to understand the negative symptoms of schizophrenia because the experience must be communicated to them, and by definition communication will be at a low. Negative symptoms can persist in the absence of positive symptoms, making a person appear to be improving in their condition although they could be worsening.
A difficulty concerning positive versus negatives symptoms has to do with the medication prescribed to help alleviate positive symptoms. These medications often feature a side effect that leaves the schizophrenic feeling emotionally blunted. This flattened affect and loss of the need to push their will upon the outside world can appear like the manifestation of negative symptoms and may be indistinguishable altogether. Among these are anhedonia, dysphoria, and concentration issues. In less technical terms, these mean that the person loses interest in trying to derive pleasure from activities, and feels depressed, anxious, and hopeless.
Let’s take a look at some of these positive and negative symptoms separately so we can gain a deeper understanding of each.
Positive Symptoms of Schizophrenia
The most outwardly obvious positive symptom of schizophrenia is that of hallucinations. The schizophrenic may experience a distortion of existing perceptual stimuli or may generate entirely separate stimuli internally which can be confused with outward and “real” experiences. These can include auditory hallucinations that resemble hearing an external voice or internal voice that is not coming from anyone actually there nor from the person’s own thoughts. Other types of hallucinations include visual, gustatory, olfactory, and kinesthetic, which all resemble the auditory hallucination, but with other senses such as sight, smell, taste, and feeling.
Another very common positive symptom is that of the delusion. The schizophrenic may develop strange beliefs that, while logically consistent, are simply bizarre and unlikely, such as finding hidden messages in all printed materials or that all of their loved ones have been replaced by cyborg clones. The types of persecution and paranoid delusions are very common and lead to anxiety and fear. A common feature is the delusion of reference, leaving the schizophrenic to interpret messages in the world that are interconnected and intertwined and left there for him or her in particular to find and untangle.
A type of symptom that involves a disordering of thinking and associations is called disorganized speech. It is called “disorganized speech” because that is the outward, observable symptom, which arises from a disorganization of thought. A common layman’s term for this symptom is called “word salad” or “diarrhea of the mouth” in which the schizophrenic spews forth a series of concepts and sentences that seem to jump from topic to topic and are not consistent as you would expect for a normal conversation. Moving from tangent to tangent can impair the ability to communicate well and leave their expressions as incoherent to the listener. This same type of symptom can be seen in the disorganized behavior, which is purposeless, unpredictable, and bizarre. These behaviors feature no reason or inspiration behind them as those arising from delusions might have.
Another type of behavioral symptom that arises is called the catatonic behavior. It is characterized by a delayed and decreased reaction to stimuli in the environment surrounding the ill person. It can be as gross and exaggerated to the point where the person sits motionless, like someone in a catatonic state, and thus the name, or maintains some rigid posture or repeated motion that seems meaningless.
Some other symptoms of schizophrenia, but less prominent, include the following:
- Reactions that are inappropriate to the situation or stimuli
- Unusual and repetitive motor movements such as rocking or hand movements
- Depersonalization and derealization and other extreme anxiety conditions such as panic disorder
- Preoccupations with bodily processes or mental concepts
Negative Symptoms of Schizophrenia
The main types of negative symptoms related to schizophrenia are less than the positive, but are broad enough to cover a spectrum of experiences. The first of these is the flattening of the affect, meaning that the expression of emotion is lessened greatly. This reduction can include a diminished intensity or a tightening of the range of expression. The schizophrenic experiencing this symptom may show very little through their facial expressions or body language, choosing to not make eye contact or react in anyways facially.
A similar symptom is that of alogia, which refers to a lack of vocalizations. The psychologically ill person may speak less than usual or not at all. When they do speak, their replies or phrases may be very short, concise, or simplistic. This outward display is thought to reflect a difficulty in intellectualization. The person’s thoughts are either slowed or blocked altogether.
Avoltion, which means an absence of volition or will-power, refers to the difficulty in sustaining goal-directed initiatives. This behavior may cease immediately due to disinterest or lack of enthusiasm. This is seen outwardly as a lessening of involvement of activity of any kind, including hobbies and socializing.
Cognitive Symptoms Related to Schizophrenia
This last class of symptoms involved in a schizophrenic diagnosis are as subtle as the negative symptoms and are not an “official” classification of symptoms yet, but are being considered. Known as cognitive symptoms or disorganized symptoms, they reflect problems in the cognition of the schizophrenic. Thinking becomes disturbed and leads to an increased difficulty in concentrating, decision-making, comprehension, and short term memory issues. Problems with the working memory can lead to problems in everyday functioning, resulting in additional emotional and financial distress.
The Difficulty Surrounding the Lack of Insight into Your Own Sickness
The most-difficult part about “catching” the development of schizophrenia is that the person becomes increasingly isolated socially. This means there is nobody able to observe the schizophrenic’s strange behavior, and the schizophrenic has a lack of awareness that anything is wrong. This lack of insight into their own problem can be devastating, allowing these symptoms to progress to dangerous levels. If you are witnessing any of your friends or loved ones behaviors changing and becoming more isolative, make an effort to keep in touch with them regularly so that you may help them if it is larger issue.