Written by Jehron Baggaley
A homeless man on the streets of Mexico City who believes he is the son of God. A young Indonesian woman who seems to be frozen, her muscles refusing to move and her face showing no expression. An American college student whose life is deteriorating as he lives in fear that CIA is trying to abduct him and sell his organs to interdimensional aliens. Despite sounding like these three people couldn’t be more different from each other, they all share one thing in common: a diagnosis of schizophrenia.
It’s a disease you’ve likely heard of already, whether from a movie or TV show, or simply because its name is so widespread. After all, it’s one of the most debilitating mental illnesses in existence, and there’s certainly no shortage of horror stories that have resulted from its symptoms, so perhaps its infamy is well-earned. But the Hollywood portrayal, as well as the general public’s knowledge, tend to be wildly exaggerated while simultaneously seeming to only scratch the surface of this incredibly complex disorder. It’s a mysterious disease that dramatically affects one’s mood, behavior, personality, and their very perception of reality. Today we’re going to unravel the twisted web of symptoms, horrors, and hope for those with schizophrenia – a true monster of the mind.
Before we get into the symptoms that generally denote schizophrenia, let’s make a couple things very clear: firstly, schizophrenia is NOT Dissociative Identity Disorder, or DID, which you may know by its previous name – Multiple Personality Disorder. This is a completely different diagnosis, but there is a common misconception that having multiple personalities and randomly switching between them is a symptom of schizophrenia, which is not true.
Additionally, this post will include details of some of the crimes committed under the grip of this disorder, so viewer discretion is advised, but we would also like to clarify that not everyone who suffers from schizophrenia is a violent person, and the symptoms do not always lead to violent actions. We will get deeper into this at the end of the post, but it’s important to not spread the myth that every single person with schizophrenia is a danger to themselves or others.
As a final note, if you suspect that you or someone you know is suffering from schizophrenia, do not attempt to diagnose others or self-diagnose. This should always be done by a mental health professional, as many of the symptoms we will cover here overlap with other mental illnesses, such as depression or anxiety.
And with that out of the way, let’s get into it.
The latest models of diagnostic criteria divide the main symptoms most associated with schizophrenia into two separate categories: positive and negative. And no, this doesn’t mean there are good and bad symptoms, the terms positive and negative refer to phenomena that are either present when they shouldn’t be in a normal individual, or behaviors that are absent when they would appear in an unaffected person.
So let’s start with the positive, or present, symptoms. The most well-known and widely depicted of these is sensory hallucinations. These can affect any of the body’s senses, but the most commonly reported one is auditory, which usually includes the patient hearing voices in their head. These voices can be anything from benevolent and soft spoken to screaming, raging, violent, and demanding. There can even be more than one voice at a time, leading them to argue with each other for dominance, and sometimes the voices are even interactive, meaning the patient can ask them a question and receive an answer.
But it’s important to remember – these voices by themselves aren’t the only symptom in schizophrenia, they’re almost always accompanied by a seriously altered state of reality. If you or I suddenly heard a voice in our head demanding that we murder the person next to us during our morning commute on the train, we’d more than likely dismiss it as a startling hallucination and get ourselves checked out by a doctor. In fact, hearing voices can accompany a very normal person going through something like a rough spell of anxiety. But for someone with schizophrenia, these commands they hear from the voices can be as real as the world around them, and they can have a strong influence on someone’s actions as the person often feels persuaded or even compelled to obey after some time.
Take for instance the tragic story of a 33-year old woman from Texas, whose name we’ll leave out of the story, who in June 2009 had just recently given birth to a baby boy. She had been diagnosed with post-partum depression, a relatively common mood disorder that affects about 1 in every 10 mothers, but things took a serious turn for the worse when she began experiencing vivid auditory hallucinations. And, when the boy was just a few weeks old, she left the house to check herself into a hospital, where she reported hearing voices. After this, everything spiraled out of control. She checked herself out of the hospital, drove home, and, against the wishes of the baby’s father, threw the baby into the car and sped off, apparently to go to stay at her mother’s house. The father had no idea what was going on, and was even more confused when she called him to say that she had met someone new and never wanted to see him again.
Then, a couple days later, she and the baby reappeared at the house. The father was initially ecstatic that the family was being reunited, but, sadly, this would be the last day of his baby’s life. Later that night, just after 1:00 AM, the woman murdered her own son by decapitating him with a steak knife, after which she proceeded to eat parts of his body, including the brain, toes, and nose. After her subsequent arrest, she told detectives that the devil had been speaking to her, and he had made her commit the atrocious act, a tell-tale sign of schizophrenia, which, it was later discovered, she had been diagnosed with the year before.
What’s interesting in this case is that the malevolent voice presented itself as the devil. This is likely because the woman was known to be a devout Jehovah’s Witness, and so the concept of a devil was familiar to her. This is, in fact, a common theme across many types of symptoms – they often reflect one’s cultural upbringing. So while in this case, the woman thought that the devil was the entity speaking with her, others might think they are hearing the voice of God, their ancestors, or even aliens.
The second most common sensory hallucination is visual. These can be full-on visions with religious figures, ghosts, and vivid scenery in strange locations, or they can be as simple as appearing or disappearing objects and people throughout someone’s day to day life. Some people react to these with awe and wonder, believing that they are truly witnessing something extraordinary and perhaps rather pleasant, while others are far less fortunate and are subject to utter terror and fright when terrifying, reality-shattering hallucinations come and go with no warning.
Less common than auditory and visual hallucinations are those of touch, smell, and taste, which aren’t seen with nearly the same frequency, but are still a possible symptom. And, interestingly, patients are more likely to experience hallucinations involving two or more senses than they are to experience events with just a single sense, so you can imagine just how convincing they can be.
Another positive symptom, one that is a hallmark of schizophrenia, is delusions. These delusions come in a variety of wild forms, but we’ll start with delusions of grandeur. Delusions of grandeur cause the patient to believe that they are of either of extreme, royal importance to the world, inconceivably intelligent, or, in some cases, even a divine being. These beliefs can also be seen in someone who has narcissistic personality disorder or is in a manic phase of bipolar disorder, but they are generally more extreme in patients with schizophrenia. Someone suffering from these delusions as a symptom of schizophrenia might regard themselves as a misunderstood genius who could solve all the world’s problems if they had enough power, or, in more severe cases, they might even think they are an important religious figure, such as the literal reincarnation of Jesus himself.
These types of delusions might sound more like a thorn in the side of social skills and less of a danger, but they can in fact lead to violence in some cases, and there are even multiple examples of this in recent news. Take for instance a man from Utah who was recently charged with two counts of murder. The people he killed in June were complete strangers to him, and the murders took place in two different cities, with him not even attempting to hide the bodies, one of which he stabbed in a grocery store parking lot and the other he assaulted and then hanged with gym equipment. Once arrested, he claimed was he doing his duty to ‘purge’ the cities. Whatever he was purging them from isn’t exactly clear, but he said that he knew it was his noble responsibility to bear, bestowed upon him by some vague ‘higher power’.
But not all delusions of grandeur pose a threat to others – in fact, some of them pose the greatest threat to the one experiencing the delusions. Believing themselves to be the ‘chosen one’ or something equally mystical, patients can seriously think they’ve become invincible, causing them to take immense risks like walking in front of speeding traffic.
Other examples of this delusion include things like the patient believing that they are a top-secret spy reporting directly to the president of the United States, or that they are in fact the true president and an imposter has taken their place. Again, this sounds completely outlandish to most of us, but no amount of casual reasoning or asking for evidence will do much to change a person’s mind when they’re suffering from one of these delusions.
But of all the delusions one can suffer from, the most textbook type are persecutory delusions. These are the stereotypical ‘everyone is out to get me’ types of beliefs that many people immediately associate with the disorder, and for good reason – during the first onset of serious symptoms, known as first episode of psychosis, up to 70% of all patients experience some form of persecutory delusion. These can be anything from thinking everyone in the grocery store is carefully monitoring and reporting their every move, all the way to firmly believing that the CIA has planted microchips in the birds that chirp outside their house every morning.
Often times these persecutory delusions will have something specifically related to the patient’s thoughts, such as ‘the devil is stealing my thoughts’, or, on the flip side, ‘the government is implanting thoughts into my head.” Patients will often be extremely suspicious of everyone, even those they’ve known for a long time and previously trusted. In fact, the center of these persecutions doesn’t even necessarily have to be the person with the disorder: In March 2022, a man in the UK escaped from his hospital ward and tracked down his father, who he proceeded to assault by punching and kicking him, and finally stomping on him. And why? Because, thanks to this type of delusion, he had become completely convinced that his father was planning to attack his mother, despite absolutely no history of violence in the family, and decided he had to take matters into his own hands. The father tragically died a few weeks later from his injuries.
One interesting way these delusions can be discovered is when a person files a police report seeking protection from a stalker. However, upon investigating, the police find that no such stalker even exists, and that the person filing the report hasn’t even seen their face, they simply ‘know that they’re being watched’.
In the past, if a patient’s main symptoms were these types of paranoid, persecutory delusions, they would have been diagnosed with Paranoid Schizophrenia, but, in recent years, this diagnosis has been completely removed, and instead general paranoia is merely one of the positive symptoms under schizophrenia’s broader umbrella.
So that’s about it for the positive symptoms, usually coming down to various types of hallucinations and delusions. These are the ones most popular in media, the ones other people are most likely to notice, and often the ones that are most likely to get someone into trouble with the law. But, these are only one side of the schizophrenic coin.
Negative symptoms are behaviors or phenomena that are absent or diminished, and they often begin emerging in someone before the positive symptoms begin to take effect, in some cases even years in advance.
One of the most commonly experienced negative symptoms is avolition, or extreme apathy and a severe lack of motivation. This usually manifests itself as missing school, falling behind at work, and losing all interest in self-care, such as showering, brushing teeth, or eating properly. Unfortunately, to others, this behavior is often interpreted as simple laziness, and not much compassion is given at a time when it could seriously help. This, along with becoming increasingly asocial, can damage important relationships with friends or family in someone’s life and, because they also lack any desire to repair them, this can leave someone more and more isolated in their social withdrawal as the symptoms increase in severity. And to top it all off, these symptoms are often accompanied by anhedonia, a total lack of pleasure, or even alogia, a decline in speech complexity.
Along with being seen as just general laziness or ‘odd behavior’, some of the social withdrawal, lack of self-care, and absent sex drive can be misinterpreted by some people as depression because these by themselves are classic symptoms of major depressive disorder. But it’s when combined with a few other negative symptoms that schizophrenia is really set apart from other mental illnesses: and that’s the way it causes people to express their emotions.
One half of this is blunted affect, a condition where a patient fails to express emotion at all, whether it be positive or negative. Remember, it’s not depression, where the mood is mostly negative, and it’s not a side-effect of a medication – their mood is just overly neutral regardless of the situation. In more serious cases, something like the news of the death of a loved one would elicit no response – their face would remain straight, no tears would form, their voice wouldn’t change pitch or volume – none of the responses associated with emotional expression.
But it gets even stranger – instead of showing no emotion whatsoever, schizophrenia can also cause inappropriate affect, where, compared to showing nothing, the person definitely shows emotion…just, the wrong one. Imagine being in a funeral full of people and someone suddenly begins quietly chuckling to themselves. This is called paradoxical laughter, and it has been recorded in patients with schizophrenia since the 1940s. Many of them report feeling tension in their heads as they try to work out which emotion will surface, and end up laughing as a way to relieve the tension, while others are completely unable to explain why they are suddenly amused.
Even stranger still – another negative symptom is a lack of normal muscle movement. This can range from strange, jerking arm motions all the way to complete catatonia, where a person is frozen in a trancelike state and barely moves for hours on end. This can be so extreme that the person can resemble a statue more than a living being, even in somewhat disturbing positions with their arms raised up in the air that would be incredibly painful for the rest of us to hold for extended periods of time. If left undisturbed, these long periods of immobility can lead to permanent muscle issues, lung complications, and the patient may even refuse to swallow food or water during an episode. If left untreated completely, the more serious cases can even result in death.
Even in instances where the catatonia doesn’t last for, let’s say, days on end, it can still appear with alarming frequency, with some patients reporting having shorter frozen states multiple times a week or even day.
Now, there are a few symptoms which don’t fall neatly into this positive-negative bundle that we’ve described, which are the cognitive issues that have been observed to accompany schizophrenia. This includes general issues with something called neurocognition. Put simply, neurocognition is the brain’s ability to perceive and process information, so patients with schizophrenia are commonly seen to have issues with things like remembering and repeating a short string of a few words. Their reaction time can be significantly slowed, and they can even have a very difficult time understanding what’s going on in optical illusions. It’s pretty clear to see how these symptoms would seriously affect someone’s day to day functioning and ability to hold a job.
But of these cognitive issues, some of the most debilitating are those regarding speech. This falls partly under the negative symptoms, where some patients stop speaking in long sentences and instead use short, quick responses, but it goes much deeper than that. In severe cases, speech can be reduced to something known as a ‘word salad’ – a seemingly random pile of unrelated words jumbled into a sentence together, such as:
“Friend menu glasses ride tree blanket Jupiter”
Another form of word salad, called clanging, is when someone’s speech gets randomly stuck on a loop of rhythm or rhyming, such as
“Today I woke up, then I went to the store chore floor more door four”
These are rather bizarre, but at least they’re words – in more severe cases the person can become completely unintelligible, muttering to themselves endlessly with little ability to communicate whatsoever
Causes & Treatment
So that’s a lot of symptoms. A lot of wild, intense symptoms that vary in intensity and expression. But you feel fine right now, you’re reading this post and understanding it, you can move your limbs freely and you don’t have regular hallucinations, so you’re safe, right? Well, this is perhaps the most terrifying part of schizophrenia – it can happen to anyone.
Generally, the onset of the disease occurs between the late teens and early thirties, with males usually in the early 20s and females averaging in the late 20s. Less often, it can occur before adulthood, known as early-onset, and it can even appear as late as one’s 50s. It’s possible that it develops even later, such as in one’s 70s, but at that point its difficult to tell the symptoms apart from those of other conditions that come with an aging mind.
But here’s the scary part: its onset has been known to be sudden. In many cases, the symptoms gradually develop over years before a diagnosis takes place, but sometimes, about 25% of the time, it happens rapidly. Imagine going to bed one night with the only worry on your mind being a tough exam the next week or an extra long shift at work – but when you wake up, you now have a voice in your head that narrates your every move – it talks to you, it argues with you, and it even screams at you, but most importantly, it doesn’t seem to go away, day after day. This, unfortunately, is a reality for many who have a sudden onset.
For the other 75%, the signs of schizophrenia develop slowly over years, with negative symptoms and cognitive problems usually manifesting first, and eventually progressing into the positive symptoms of psychosis.
The National Institute of Mental Health estimates that schizophrenia affects around .5% of the population of the United States, though other estimates often place it a full 1%. That might sound like a tiny number, but it means that in the US alone there are as many as 3 million people or more with the disorder.
Treatment of the disorder sees mixed results. Antipsychotics are generally prescribed, and these can be quite effective at handling the hallucinations and delusions, but they don’t work for everyone, and they come with a whole host of nasty side effects, including an increased risk of developing diabetes and involuntary muscle twitching. About half of all patients who take antipsychotics will respond well to them, but the symptoms rarely disappear entirely. This is why its important for the medication to be accompanied by another form of treatment, such cognitive behavioral or family therapy to learn how to manage day-to-day life with the symptoms. But getting someone to do all of this is another problem in itself, as between 30 and 50 percent of all people diagnosed deny that there is anything wrong with them at all and outright refuse treatment.
In patients deemed to be a danger to themselves or others, this refusal of treatment can be overridden by a court order, and doctors can administer courses of forcefully injected antipsychotics, which sounds like a nightmare, and it’s most certainly horrifying for the person restrained to the chair.
Perhaps in the future better treatments will become available as we learn more about what causes schizophrenia, because at the moment the cause of the disorder remains pretty murky.
What we do know for sure is that there is some genetic component, as your chance of developing the disorder goes up to 13% if you have a parent with it, and up to a staggering 40% if you have an identical twin with it. One woman in the 1930s gave birth to quadruplets who all developed schizophrenia, and the odds of this happening by random chance without genetics at play are unfathomably slim. But dozens of studies have still failed to find any specific genes that can be associated with the disorder on a consistent basis.
The best guess at the moment is that there simply isn’t a single cause. It’s likely that the DNA you inherited from your parents can give you a genetic predisposition to the disorder, and this vulnerability can be turned on, or activated, by experiences in life or exposure to certain chemicals, such as various drugs. Of these drugs, cannabis seems to be a big one – there are a lot of studies on this, but one example is from Sweden, where researchers found that those who use cannabis regularly are 6x more likely to develop schizophrenia than the average person.
This doesn’t mean that smoking a joint or two will set you on a path to psychosis, but it does mean that if you have the elusive genetic factor, whatever it may be, cannabis and other substances may make it more likely to become active in you.
Along with substance use, there are a few things that researchers are pretty confident in linking to developing schizophrenia – For example, living in an urban environment as opposed to one in the countryside makes your chances of developing it much higher, as does a history of child abuse, recent immigration to a new country, and poverty. All of these seem to be strongly associated with stress levels, so there’s probably a connection with high levels of stress, especially in adolescence.
As for specific life events that can trigger the onset, giving birth seems to be one of the most commonly observed. A famous case in the early 2000s featured a woman who seemed to be entirely normal, at least to her friends and family. When she married her husband, they announced that would have as many babies as nature would allow, and true to their word, after just a few years they had four of them. But after the fourth deliver, something in the mother changed. Her husband found her shaking in the corner and chewing on her fingers, oblivious to the world around her, and after she attempted suicide was put on antipsychotics, which seemed to do the trick as everything generally went back to normal, but this was only temporary. She soon relapsed into psychotic states and had to be institutionalized twice in 1999. She was originally diagnosed with postpartum psychosis. When she was eventually released, her psychiatrist begged her to not have any more kids, as it would be too high of a risk for her mental health. Just 7 weeks later though, they conceived their next child, who was born in 2000. After this fifth birth, she stopped taking her meds, began obsessively reading the Bible and entered catatonic states with increasing frequency.
This all culminated when one day her husband left for work, leaving his wife with a single hour before her other caretaker arrived. Sadly, one hour unsupervised was all she needed to drown all five of her kids, one by one, in the bathtub. She later told the court that killing them before they lived a sinful life was the only way to save them from hell. She had experienced depression as a teenager, perhaps the negative symptoms beginning long in advance, but she was stable and happy, even doing her best to homeschool her kids – the positive symptoms and intense delusions seemed to all spiral out of control just after the birth of her fourth child.
But again, most of these correlations are just that- correlations. A more concrete target are dopamine receptors – one theory posits that those with schizophrenia have too many of these dopamine receptors, or they’re simply faulty, which does a few things to their brain, and we’ll try to keep this as simple as possible. Firstly, dopamine is the neurotransmitter, or brain chemical, associated with things like motivation, reward, and mood. If these pathways are overloaded or not working, basic day-to-day action and reward sequences, like showering or cleaning, might seem pointless – behavior often noticed among the negative symptoms.
Additionally, its thought by some researchers that these high levels of dopamine can affect our mind’s internal filter, which could be responsible for many of the positive symptoms such as delusions and hallucinations. This could be why antipsychotic medications generally work for these stronger positive symptoms, as many of them reduce dopamine levels in the brain. The links between dopamine and schizophrenia go all the way back to the 1960s when antipsychotics were first beginning to be introduced.
But, it’s not the complete picture. There are other neurotransmitters involved, and some patients even have totally normal levels of dopamine, so it clearly isn’t the only cause. But, it is a step in the right direction, and if the disorder truly does have a large biological aspect, it can mean there’s hope for a future cure.
We may have painted modern-day treatment in a bad way – it’s true that for many people, medication simply doesn’t work, and that for others, therapy is no help. It’s true that some even refuse to be treated at all. But, schizophrenia isn’t a death sentence, and there is hope for those in its clutches.
With proper support and specialized treatment, especially if the treatment occurs early in the onset, it is possible to manage the symptoms, and those affected even recover and go on to lead a fairly normal life. Eleanor Longden, for example, was a college student when she was suddenly subject to terrifying voices in her head, spiraling her life into hospitalizations, various drugs, and a diagnosis of schizophrenia. But, through years of battling with her symptoms, Eleanor was able to learn to manage and cope with them, and even went on to earn a Master’s degree in Psychology, hoping to inspire and help others with similar struggles, eventually leading to her giving a TED Talk on the subject. Quite a recovery.
And as mentioned at the beginning of the post, not everyone with schizophrenia is violent. In fact, the majority of patients diagnosed with the disease are actually far more likely to become the victims of violence themselves than to harm someone else. People with schizophrenia are more likely to die at a younger age from heart failure, and nearly 5% of them commit suicide. They’re more likely to be scammed, more likely to be alone, and far more likely to end up homeless or in prison. This is all along with the immense financial burden that can accompany it – not only the direct costs of healthcare and medication, but also the indirect costs of earning less money due to a lack of productivity or difficulty holding a job. These are people that, instead of being ostracized, desperately need all the help society can offer them.