Symptoms of Schizophrenia
481 Schizophrenia Hegarty et al., 1994). It has been estimated that 10 to 13 percent of homeless individuals suffer from schizophrenia (Fischer & Breakey, 1991; Olfson et al., 1999). One of the best predictors of the outcome of schizophrenia is premorbid adjustment, the level of functioning a person had achieved before schizophrenia symptoms ﬁrst appeared. Improvement is more likely in those who had reached higher levels of education and occupation and who had established supportive relationships with family and friends (Rabinowitz et al., 2002; Watt & Saiz, 1991). Symptoms of Schizophrenia LINKAGES Do people perceive hallucinations as real sensory events? (a link to Sensation and Perception) hallucinations False or distorted perceptions of objects or events. The main problems seen in people displaying schizophrenia relate to thinking—both how they think and what they think (Heinrichs, 2005). Indeed, the very word schizophrenia, or “split mind,” refers to the oddities of schizophrenic thinking, including a splitting of normally integrated mental processes, such as thoughts and feelings. So the person may giggle while talking about sad events and claiming to feel unhappy. Contrary to common usage, schizophrenia does not refer to the “split personality” seen in dissociative identity disorder (multiple personality disorder), discussed earlier in this chapter. Schizophrenic thought and language are often disorganized. Neologisms, or words that have meaning only to the person speaking them, are common. The word “promulﬂagitating” in the preceding letter is one example. That letter also illustrates loose associations, the tendency for one thought to be logically unconnected or only loosely connected to the next. In the most severe cases, thought becomes just a jumble known as word salad. For example, one patient was heard to say, “Upon the advisability of held keeping, environment of the seabeach gathering, to the forest stream, reinstatement to be placed, poling the paddleboat, of the swamp morass, to the forest compensation of the dunce” (Lehman, 1967, p. 627). The content of schizophrenic thinking is also disturbed. Often it includes a bewildering assortment of delusions (false beliefs), especially delusions of persecution. Some patients believe that space aliens or government agents are trying to steal their internal organs, and they may interpret everything from TV commercials to casual hand gestures as part of the plot. Delusions that such common events are somehow related to oneself are called ideas of reference. Delusions of grandeur may also appear; one young man was convinced that the president of the United States was trying to contact him for advice. Other types of delusions include (1) thought broadcasting, in which patients believe that their thoughts can be heard by others; (2) thought blocking or thought withdrawal, the belief that someone is either preventing thoughts or “stealing” them as they appear; and (3) thought insertion, the belief that other people’s thoughts are appearing in one’s own mind. Some patients believe that their behavior is being controlled by others; in one case, a man claimed that the CIA had placed a control device in his brain. People with schizophrenia often report that they cannot focus their attention, and they may feel overwhelmed as they try to attend to everything at once. Various perceptual disorders may also appear. The person may feel detached from the world and see other people as ﬂat cutouts. The body may feel as though it is a machine or as though parts of it are dead or rotting. Hallucinations, or false perceptions, are common, often emerging as voices. These voices may sound like an overheard conversation, or they may urge the person to do or not to do things; sometimes they comment on, narrate, or (most often) criticize the person’s actions. Hallucinations can also involve the experience of nonexistent sights, smells, tastes, and touch sensations. Emotional expression is often muted—a pattern called ﬂat affect. But when schizophrenics do display emotion, it is often exaggerated or inappropriate. For example, they may cry for no apparent reason or ﬂy into a rage in response to a simple question. Some people with schizophrenia are quite agitated, constantly ﬁdgeting, grimacing, or pacing the ﬂoor in ritualized patterns. Others become so withdrawn that they move very little. Lack of motivation and poor social skills, deteriorating personal hygiene, and an inability to function in everyday situations are other common characteristics of schizophrenia.