An example of this bizarre thought patterns would be the person believing that .... schizophrenia then I suggest you hire out the movie âA beautiful mindâ starring.
HOW’S YOUR MENTAL HEALTH? A series of articles designed to promote discussion and educate on issues concerning mental health. Linet Hilsberg RN, MHN, MPH, CH, Cert IV WTA www.scenicrimcounselling.com
SCHIZOPHRENIA (pronounced‐ skitz‐o‐fre’ne‐ah) This is a general term given to describe a large group of mental disorders which are characterized by mental deterioration from a previous level of functioning and characteristic disturbances of multiple psychological processes, including delusion, loosening of association, poverty of the content of speech auditory hallucinations inappropriate affect, disturbed sense of self and withdrawal from the external world. So what does all this gobbledygook mean? In the late 1800’s, Emil Kraepelin first described the course of the disorder he called dementia praecox, ( in Latin ) a term still used by some European psychiatrists. In the early 1900’s Eugen Bleuler renamed the disorder schizophrenia. This term literally means “split personality” referring to portions of the psyche that are contradictory. He determined that there was not just one type but a group of schizophrenias, More recently Kurt Schneider differentiated these behaviors, associated and classed them into “first rank” symptoms (psychotic delusions, hallucinations) and ”second rank” symptoms (all other experiences and behaviors associated with the disorder). (It does not mean MULTIPLE PERSONALITY DISORDER, which is the presence of distinct, autonomous alternate personalities.) WHAT DO WE LOOK FOR? The clinical picture of someone who suffers from this is complex, individuals differ from one another and the experience for a single individual may be different from episode to episode.
Initially, the illness behaviors may be both confusing and frightening to the person and the family. The changes may be subtle; however, at some point the changes in thought and behavior become so disruptive or bizarre that they can no longer be overlooked. These might include episodes of staying up all night for several nights, incoherent conversations, or aggressive acts against self or others. An example of this bizarre thought patterns would be the person believing that there is a UFO and aliens on top of the traffic lights and they are beaming down frozen meat balls which are tranquilizing all the animals. As symptoms progress the person is less and less able to care for their basic needs such as eating, sleeping and hygiene, substance use of illicit drugs is also common. The ability to function at school or work deteriorates and dependence on family and friends increases. In this acute phase, the person is at high risk of suicide and normally hospitalized to protect themselves or others. Initial treatment focuses on alleviating symptoms through medications, decreasing the risk of suicide through safety measures and normalizing sleep patterns and reducing illicit substance use. Once the person is stabilized, symptoms become less acute and may still be present. The person has to adjust to the idea that they have a mental illness as they start to socialize with others, rehabilitation begins. Diagnosis in children (with studies completed) indicate that developmental abnormalities including delays in speech and motor development, problems in social adjustment and poorer academic and cognitive performance have been found to be present in individuals who experience schizophrenia in adulthood, Specific factors that may predict this include problems in motor and neurologic development, deficits in attention and verbal short‐term memory, poor social competence, and thought disorder‐like symptoms ( Niemi, Suvisaari, Tuulio‐ Henriksson, & Lonnqvist 2003). HOW IS IT FOR THE PERSON? Schizophrenia robs people of mental health and imposes social stigma. People with schizophrenia struggle to maintain control of their symptoms, which
affect every aspect of their life. The person with this illness displays a variety of interrelated symptoms and experiences deficits in several areas. More than half of the patients report the following symptoms: • • • • • • • • • • • • • •
tension and nervousness, lack of interest in eating, difficulty concentrating, disturbed sleep, decreased enjoyment and loss of interest, restlessness, forgetfulness, depression, social withdrawal from friends, feeling laughed at, more religious thinking, feeling bad for no reason, feeling too excited, and hearing voices or seeing things.
Because schizophrenia is a disorder of thoughts, perceptions and behavior it is sometimes not recognized as an illness by the person experiencing the symptoms. Many people with thought disorders do not believe that they have a mental illness. Their denial of this and the need for treatment poses problems for the family and clinicians. Ideally in lucid moments, patients recognize that their thoughts are really delusions, that the perceptions are hallucinations and that their behavior is disorganized, in reality, many patients do not believe that they have a mental illness but agree to treatment to please family and their doctors. MENTAL STATE AND APPEARANCE The person may look eccentric or disheveled or have poor hygiene and bizarre dress. The posture may suggest lethargy or stupor. Often the person displays altered mood states showing heightened emotional activity or limited emotional responses. The Affect (the outward expression of mood) can be flat (emotional expression entirely absent). Blunted (expression of emotions present but greatly diminished) and full range.
Speech patterns may reflect obsessions, delusions and pressured thinking or flight of ideas. This is an indicator of thought content and other mental processes which is usually altered. Delusions can be distinguished from strongly held ideas by the “degree of conviction with which the belief is held despite clear contradictory evidence” (APA 2000, p299) and culture must be considered when evaluating delusions. TYPES OF DELUSIONS Non‐bizarre delusions generally have themes of jealousy and persecution and are derived from ordinary life experiences. An example of this would be that a woman believes that her husband, from whom she has recently separated, is trying to poison her, or a man believes that members of the Mafia are trying to kill him because, when he was in high school, he reported to the principal that several of his classmates were selling drugs at school. (APA 2000). Bizarre delusions are those that are implausible, not understandable, and not derived from ordinary life experience. Bizarre delusions often include delusion of control (that some outside force controls thoughts and actions,) thought broadcasting (that others can read or hear one’s thoughts), thought insertions (that someone has placed thoughts into one’s mind) and thought withdrawal (that someone is removing thoughts from one’s mind). A classic example of this is a person who is convinced that a computer chip is placed in her person during a gynecology examination and this is directly influencing her physical movements and thoughts. Hallucinations are the most common example of disturbed sensory perception observed in patients with schizophrenia. These can cover all senses however, auditory are the most common. Persons hear voices conversing with each other or carrying on a discussion with someone who is not there. An example of this would be a person trying to sleep when he is woken up by someone calling his name from outside his bedroom window, he goes to investigate only to find that there is no one there. This can be very tiring for the person suffering from these as they have to concentrate and listen to what is being said by these voices as well as try to have a conversation with their family member or friend. To a person who
hears these voices, they are real and it is very hard for others to understand what it is like. A way to experience these hallucinations to gain a better understanding of the person suffering from schizophrenia is while you are talking in a group, to have a friend stand behind you and consistently talk to you to try to draw you into conversation. If you last more than 5 minutes with this continuous distraction without becoming frustrated, you are doing well. If you want to understand the reality of what it is like to suffer from schizophrenia then I suggest you hire out the movie “A beautiful mind” starring Russell Crow who portrays the symptoms quite accurately. References: American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders (4th ed., Text revision). Washington DC. Niemi,L.T., Suvisaari,J.M., Tuulio‐Henriksson, A., & Lonnqvist,J.K, (2003). Childhood developmental abnormalities in schizophrenia: Evidence from high‐ risk studies. Schizophrenia Research, 60(2‐3), 239‐258