Schizophrenia: Madness/Craziness


Have you ever seen a person who sees giants/ghosts believing that giants command him /her to do something weird? Or a person who shows no interest or flat affect even on a serious event?

One common man was saying that ‘I am the famous personality of the world, I can end the wars, I can make everything right because I am immortal.

The woman has not eaten food for weeks because she believes there is a snake inside her stomach and she would never feed him.

All these people are schizophrenic: being disconnected with reality. People diagnosed with schizophrenia can see, hear, smell and think is all real.

A psychotic disorder in which personal, social and occupational functioning deteriorate as a result of unusual perceptions, odd thoughts, disturbed emotions and motor abnormalities.

Prevalence of Schizophrenia:

Approximately 1 of every 100 people in the world suffers from schizophrenia during his or her lifetime. People with schizophrenia also are much more likely to attempt suicide than the general population. Because of the high risk, now they receive suicide risk assessment during treatment and when they are discharged from treatment program.

Although schizophrenia appears in all socioeconomic groups, it is found more frequently in the lower levels. This has led some theorists to believe that the stress of poverty is itself a cause of the disorder.

Equal numbers of men and women are diagnosed with schizophrenia. The average age of onset for men is 23 years, compared with 28 years for women. Almost 3 percent of all those who are divorced suffer from schizophrenia sometime during their lives, compared with other people.

The exact prevalence of schizophrenia in Pakistan is not known.

Most of Pakistan’s population lives in rural areas, has low literacy rates, and no knowledge of the disorder, therefore people with schizophrenia are thought of as being possessed by a spirit. Instead of consulting a psychiatrist they seek treatment from faith-based healers. Sometimes patients are beaten by a so-called therapist with the notion that they are inflicting pain to an evil spirit and not to the patient.

Symptoms of Schizophrenia:

Many clinicians consider that schizophrenia is not a single disorder in fact it is group of different disorders that happen to have some features common. Anyway, whether schizophrenia consist of several disorders or a single disorder, people who are struggling with this disorder are living very painful lives.

There are 3 group of symptoms:   

  • Positive symptoms (extreme emotions, behaviors and thoughts)
  • Negative symptoms (deficiency of emotions, behaviors and thoughts)
  • Psychomotor symptoms (strange gestures and movements)

Most of the people with schizophrenia have both kinds of symptoms but, in some cases, people are dominated by positive symptoms and in other cases, some people are dominated by negative symptoms

Positive Symptoms 

These are “extreme excesses” or unusual additions to behavior of a person. Hallucinations, Delusions, disorganized speech and inappropriate affect are the common positive symptoms found in schizophrenia.

1. Delusions

Most of the People with schizophrenia progress delusions. These are the ideas that they consider true passionately but in reality these ideas have no base. People have many delusions but some people with schizophrenia hold single delusion that governs their behavior and lives.

  • Delusions of persecution: The most common type of delusions are the delusions of persecution. People having these type of delusions consider themselves victim of being attacked, threatened and spied on.
  • Delusions of reference: People with these delusions attach personal and special meanings to the various events and actions of others. For example, arrows on street signs, they consider them as a indicators of the direction that he/she should take.
  • Delusions of grandeur: These people consider themselves to be religious saviors or great inventors or some empowered persons who can make everything right.
  • Delusions of control: People with this delusion have faith that their thoughts, actions and feelings are controlled by others.

2. Disorganized Thinking and speech

Schizophrenic people don’t think logically and may speak in abnormal or weird means. Frequently such thought disorders take the form of positive symptoms (excesses behaviors). For example:

  • In loose associations, people quickly shift from one to another topic, considering that their illogical speeches make any logic.
  • People who use neologisms, they invent their own words that usually have meaning only to to them.
  • Some may use the perseveration, people with this thought disorder repeat their statements and words again and again.
  • Other may use clang, can also called ‘rhyme’ to express themselves and to think. One person replied on asking how he was feeling, “Well, hell, it’s well to tell.”

3. Hallucinations and Heightened perception:

Person with schizophrenia may feel that their senses are being engulfed or flooded by all the sounds and sights around them. This situation makes it nearly impossible to attend anything important for them. As one schizophrenic person described his situation: (I am speaking to you just now, but i am not able to pay attention to your words as everything seems to grip my attention. . . . Noises going on next door are griping my attention so i find it difficult to shut these out, that’s why it is making me more difficult to concentrate on what i am saying or you are saying to me).

People with schizophrenia faces another perceptual problem called hallucinations. These are the perceptions of something without external stimuli or in the absence of stimuli. Auditory hallucinations are the most common type in schizophrenia. In auditory hallucinations people hear voices and sounds that seem to them are coming from outside the head. These sounds or voices directly talk to them, sometimes giving commands or orders to do something, sometimes giving danger warnings.

  • Tactile hallucinations: Feelings of burning or sensations of electric shocks.
  • Somatic hallucinations: Feeling of as there is something weird is inside the body, for example; as crawling of snake inside the stomach.
  • Visual hallucinations: Seeing different things or even persons that are not present in reality.
  • Gustatory hallucinations: People with gustatory hallucinations find that their drink or food is strange in taste.
  • Olfactory hallucinations: These people smell odors that no one else does, such as the smell of poison or smoke.

Hallucinations and delusional ideas often occur together. A woman who hears voices issuing commands, for example, may have the delusion that the commands are being placed in her head by someone else.

4. Inappropriate affect

Most of the people with schizophrenia may display emotions that are not appropriate or unsuited to the situation. These people may become upset when they should be happy and may smile when they hear terrible news.

Negative Symptoms 

These are the deficits of emotions and behaviors. Negative symptoms are the features that are lacking in a person. Here are some negative symptoms that schizophrenic may have; Flat affect, loss of volition, Poverty of speech and social withdrawal are frequently found in schizophrenia.

1. Poverty of speech 

Poverty of speech also known as alogia, is decreases in speech content or speech. People with this negative symptom may think or speak very little.

2. Restricted or Flat affect

People with schizophrenia may have flat or blunted affect. They show less sadness, joy or anger than other people. Some people may show almost no emotions at all, a situation known as flat affect. Some cases of people may have a problem of lack of enjoyment or pleasure, a condition known as anhedonia.

3. Apathy or loss of volition

Apathy is feelings of energy draining or loss of interest in normal activities and not able to start or follow normal course of life. Many schizophrenic people experiences avolition.

4. Social withdrawal 

Schizophrenic people withdraw themselves from social interactions and only pay attention to their own fantasies and ideas. As they have confused and illogical ideas, their withdrawal has effect of distancing them further from the reality.

Psychomotor Symptoms

Many people with schizophrenia may have psychomotor symptoms. Some make odd movements or some move slowly. Extreme forms of psychomotor symptoms mutually called catatonia.

  • Catatonic stupor: People in catatonic stupor stop answering to their atmosphere. They remain silent and motionless for long sections.
  • Catatonic rigidity: In this form, people keep an upright and rigid posture, for hours and repel struggles for movement.
  • Catatonic posturing: Some people may show strange positions for very longs time period. For example; holfing their arms at a 90-degree angle for hours.
  • Catatonic excitement: Finally, some people may show diverse kind of catatonia. They move enthusiastically, at times madly, like waving their arms and legs.

Phases or Courses of Schizophrenia:

This disorder usually first occurs in late teens and mid-thirties. its courses varies case to case but sufferers seem to go through 3 phases that are following:

  • Prodromal phase: During this phase, person starts to weaken or deteriorate but symptoms are not obvious yet.
  • Active phase: During active phase, symptoms developed properly. The cause of triggering this phase could be trauma and stress.
  • Residual phase: Many schizophrenic people may sooner or later enter in residual phase. In this phase they return to first phase like symptoms but somehow have some negative symptoms like flat effect. Some patients recover completely but the majority may stay in residual phase for the rest of their lives.

Each phase has their own duration, it may vary case to case. Each phase may be last for days, months or years. People may have relapses whenever they encounter stress in life.

You may also see how people develop depression that may become the cause for depressive people to slip into schizophrenia.

Pakistani media industry has done their role for schizophrenia awareness and recently HUMTV has made drama serial ‘Saraab’, a worthwhile story to grace our screen. So, if you want to know how schizophrenia exist in our society. Go watch that drama.

Etiology and treatment will be discussed in the next article.

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