To better understand schizophrenia, it’s best to learn more about both the science behind the symptoms and the stories of those who’ve experienced them.
Our understanding of schizophrenia has improved dramatically over the last century.
Advances in medicine have led to a better understanding of how the disorder works, leading to the development of more effective treatments.
But having scientific knowledge of schizophrenia is quite different from knowing how it feels on a personal level.
Learning more about the scientific evidence behind the major symptoms as well as the deeply personal experiences of some of those who’ve lived with the disorder may allow you to better understand this challenging and chronic condition.
Schizophrenia is a complex psychological disorder affecting approximately 1.5 million people in the United States. It impairs thoughts, judgment, behavior, and the ability to interpret reality.
Schizophrenia symptoms may be divided into positive, negative, and cognitive symptoms.
Positive symptoms “add” something extra to how the person felt before onset. These are the symptoms of psychosis we most often associate with schizophrenia, including:
- Hallucinations. This means perceiving things that are not consistent with objective reality. It can include all five senses (seeing, hearing, feeling, tasting, or smelling), but auditory hallucinations are the most common, particularly hearing “voices.”
- Delusions. These are fixed false beliefs that persist despite evidence to the contrary. Paranoid (or persecutory) delusions are the most common.
- Disorganized thinking and speech. This may include poor working memory, inflexible thinking, or confused thinking and speech that makes no logical sense to others. For example, a person may jump from topic to topic during conversation.
- Disorganized or abnormal movements. This refers to repetitive or perhaps agitated or childlike movements. It can also include catatonia, which is when a person appears as if in a daze or “frozen.”
Negative symptoms “take away” from the individual’s personality and may seem less like symptoms of a mental disorder. These may include:
- loss of interest in social activities
- dulled emotions
- loss of motivation
- anhedonia (inability to feel pleasure)
- lack of spontaneity or initiative
- concentration difficulties
- deficits in word fluency
People with cognitive symptoms may find it difficult to:
- process information and make decisions
- use information they learned
- focus or pay attention
How is schizophrenia treated?
Schizophrenia is most effectively treated through a combination of medication and talk therapy (psychotherapy).
While medications like antipsychotic drugs help reduce symptoms like hallucinations and delusions, talk therapy can help manage symptoms and improve quality of life by:
- relieving stress
- teaching self-care methods
- helping cope with delusions and hallucinations
- improving social and work skills if needed
Some research indicates that a combination of medication, individual and family therapy, and supported employment and education (SEE) may be particularly beneficial to those early in the disease stage.
Advances in technology and medicine have led to new scientific insights into the possible mechanisms behind schizophrenia. Studies suggest that schizophrenia likely involves different parts of the brain.
Much research has been dedicated to investigating the role of different brain chemicals, such as:
These chemicals, called neurotransmitters, play a role in how we think, feel, behave, and move.
The immune system may also be involved in the disorder.
First introduced in the 1960s, dopamine dysfunction is one of the longest-standing hypotheses of schizophrenia.
Dopamine is a vital brain chemical involved in many important functions we often take for granted, such as:
- the regulation of body movements
The theory of
- positron emission tomography (PET) scans
- animal studies
- postmortem research
- clinical evidence showing how certain drugs can block or enhance dopamine receptors
At the same time, the negative symptoms of schizophrenia, such as reduced motivation and poor memory, are linked to underactive dopamine receptors (D1 receptors) in other parts of the brain.
Current antipsychotic medications can treat the positive symptoms of schizophrenia by blocking D2 receptors. But these drugs are not effective for treating the negative symptoms.
In fact, there has been limited research on the negative symptoms of schizophrenia, and treatments for these symptoms are considered a major unmet need.
And while antipsychotic medications successfully help a majority of people with schizophrenia, about
This suggests a more complex mechanism behind the symptoms. Some
Glutamate is an excitatory brain chemical, and some
Still, it’s harder to pinpoint glutamate’s role in schizophrenia, because unlike dopamine, which follows certain pathways, glutamate occurs throughout the brain. So dysfunction in this system could be linked to a wide range of problems in a multitude of ways.
While evidence is growing, more research is needed to figure out the role of glutamate in schizophrenia.
Some research also implicates the immune system in schizophrenia.
For example, one study found that a leaky blood-brain barrier may trigger the immune system to get improperly involved in the central nervous system. The resulting inflammation may contribute to symptoms seen in psychiatric conditions, such as schizophrenia.
Though science may help us understand how schizophrenia may affect the brain, even the best research in the world can’t explain what it feels like to have the disorder.
Many people living with schizophrenia have written insightful accounts of their experiences with the disorder.
In his classic book, “Surviving Schizophrenia: A Manual for Families, Patients and Providers,” psychiatrist and schizophrenia researcher E. Fuller Torrey, MD, quotes people with schizophrenia who describe the disorder in detail.
One person expresses the fear involved with not having control of your own mind:
My greatest fear is this brain of mine… The worst thing imaginable is to be terrified of one’s own mind, the very matter that controls all that we are and all that we do and feel.
Individuals with schizophrenia often experience changes in their senses. It may be that noises — including background noises — appear louder to them, or their visual perception may be affected.
Dr. Torrey quotes one person’s experience:
Colours seem to be brighter now, almost as if they are luminous paintings. I’m not sure if things are solid until I touch them.
For the person with schizophrenia, these changes in perception may improve the appearance of something or cause it to become ugly or frightening.
Plus, this type of sensory overload can make it very difficult to socialize with others. Dr. Torrey quotes one young man’s experience:
Social situations were almost impossible to manage. I always came across as aloof, anxious, nervous, or just plain weird, picking up on inane snippets of conversation and asking people to repeat themselves and tell me what they were referring to.
In her much-praised memoir “The Center Cannot Hold: My Journey Through Madness,” Elyn R. Saks, author and professor of law, psychology, psychiatry, and the behavioral sciences, describes her journey with schizophrenia, including the confusion involved in losing your “center”:
But explaining what I’ve come to call ‘disorganization’ is a different challenge altogether. Consciousness gradually loses its coherence. One’s center gives way. The center cannot hold. The ‘me’ becomes a haze, and the solid center from which one experiences reality breaks up like a bad radio signal.
If you’re interested in books on living with schizophrenia, here are some suggestions:
- “Surviving Schizophrenia: A Manual for Families, Patients and Providers” by E. Fuller Torrey
- “The Center Cannot Hold: My Journey Through Madness” by Elyn R. Saks
- “The Collected Schizophrenias: Essays” by Esmé Weijun Wang
Schizophrenia is a complex disorder that can lead to challenging symptoms if left untreated.
However, with proper treatment that involves medication and psychotherapy— and a good support system — many people with schizophrenia experience greatly improved symptoms and go on to lead fulfilling lives.
Researchers continue to unravel the mechanisms behind schizophrenia through the use of advanced imaging techniques and genetic and behavioral studies. These approaches are encouraging for new and effective treatments.
If you think you or someone you know may have symptoms of schizophrenia, consider taking our short quiz to learn more. Still, keep in mind that only a mental health professional can properly diagnose the condition.
If you’re interested in learning more about living with schizophrenia, consider listening to our “Inside Schizophrenia” podcast.