Schizophrenia: Living in a Different World
Page Two
Individuals suffering from schizophrenia have disturbances in one or more (and usually several) of the following areas:
-
Their ability to perceive and interpret reality accurately
-
Keeping unconscious and unwanted thoughts and feelings from intruding into their conscious lives
-
Reasoning logically
-
Knowing the difference between their experiences and thoughts and the experiences and thoughts of others
-
Relating to others
-
Organizing their thoughts, feelings, perceptions, relationships, and intellectual abilities into a solid, cohesive, well functioning self.
In short, people suffering from schizophrenia tend to be severely emotionally, intellectually, socially, and spiritually disorganized.
The most prominent psychotic symptoms are hallucinations and delusions.
Hallucinations are erroneous sensory perceptions. They can occur in any of the five senses, but auditory hallucinations are the most common. The type of hallucination James experiences, hearing voices, is the most typical auditory hallucination. People can hear other sounds that are not there, but hearing voices is by far the most common. The voices a person hears may be either familiar voices or unfamiliar ones, but they are always experienced as separate from the person's own thoughts. The voices may say many different things, but they are often judgmental or threatening in nature. When voices keep a running commentary on the person's behavior or when multiple voices converse with each other, this type of auditory hallucination is thought to be especially characteristic of schizophrenia. James describes the voices he hears as providing a constant (though sometimes quiet) commentary on his every move and thought. People can have hallucinations, however, without being schizophrenic. Nonauditory hallucinations like olfactory hallucinations (smelling things that are not there) or visual hallucinations are less indicative of schizophrenia. It is essential to rule out other causes (such as organic brain damage or drug use) before assuming that someone who is experiencing hallucinations is schizophrenic.
Delusions are erroneous beliefs that are a severe distortion of reality. These beliefs are strongly-held, yet false. When people have delusions, they grossly misinterpret their experiences or perceptions. About one-third of individuals with schizophrenia experience paranoid symptoms such as persecutory delusions. They believe they are being followed, tormented, tricked, etc. Another common type of delusion is a delusion of reference in which people believe that certain things in their environment refer to them or are meant specifically for them. For example, James' belief that women crossing their legs is a sign that those women desire to seduce him is a referential delusion. In addition to persecutory and referential delusions, people may also have religious, grandiose, or somatic delusions. James also experiences religious delusions, in which he believes that the voices he hears are demonic voices leading him to become the antichrist. Delusions may be bizarre (i.e., aliens have taken over the President's body) or nonbizarre (i.e., co-workers are plotting against me behind my back and taping my phone conversations).
 Schizophrenia occurs about equally
in men and women, but it tends to be
milder and begin later for females.
The presence of psychotic symptoms, like hallucinations and delusions, does not, by itself, equal schizophrenia. Psychotic symptoms are also found in a number of other mental disorders. Severely depressed people, for example, can become psychotic. In the depths of depression, this ability to differentiate between reality and fantasy can become severely impaired. Certain drugs can also produce psychotic symptoms. That does not mean, however, that the individual is schizophrenic.
Individuals with schizophrenia usually have a blend of symptoms that involve both an excess (or distortion) of normal functions and also a loss of normal functions. Distortions or excesses include symptoms like hallucinations, delusions, disorganized speech (people with schizophrenia sometimes use sentences or words that are extremely illogical or nonsensical) and disorganized or catatonic (meaning frozen or rigid) behavior. Symptoms involving a loss of normal functions include a lack of emotional expressiveness, a severe poverty of speech, social withdrawal, poor hygiene, and an inability to initiate or persist in goal-directed activity. These symptoms usually occur relatively early in life and are chronic and debilitating.
Prevalence and Course
It is estimated that about 1 in 100 people will be diagnosed with schizophrenia in their lifetime. Over two million Americans suffer from this mental illness. This rate of about 1 percent is relatively consistent throughout the world.
Schizophrenia occurs about equally in men and women, but it tends to be milder and begin later for females. Men typically show the first clear signs of schizophrenia in their early to mid-20s. The onset for women is more likely to be in the late 20s. About half of those diagnosed with schizophrenia in their 20s will experience some disability throughout their lives. Another 25 percent will require lifelong care due to the dramatic impact of schizophrenia on their daily lives. After an individual diagnosed with schizophrenia is released from the hospital for the first time, there is a 50 percent chance that he or she will be re-hospitalized within two years. James, like most men with schizophrenia, was first diagnosed in his early 20s. He appears to fit within the 25 percent of patients who will require lifelong care, as evidenced by his twice yearly hospitalizations since his first hospitalization ten years ago.
The course of schizophrenia can vary a great deal from person to person. For some, it begins in the early teens. For others, the late 20s or older. For some, the onset is gradual. For others, it is sudden. Some individuals with schizophrenia experience periods of intense symptoms followed by periods of remission and quite adequate functioning. Up to one-third of schizophrenics, however, have chronic symptoms with few or no periods of remission. While complete remission of schizophrenia is uncommon, most people with schizophrenia become more stable after five to ten years. Their symptoms do not become worse as life progresses. And some, although clearly the minority, return to a very normal level of functioning.
 Continued on Page Three
|
