When one listens to persons with schizophrenia and observes their behavior, some or all of the following symptoms can be noted: alterations of the senses may be either in the direction of extreme enhancement or blunting, and all sensory modalities may be affected. The mind itself may seem flooded with thoughts.
A fundamental defect of the schizophrenic mind is the inability to sort, synthesize, and respond to incoming data. Logical thinking and attention span are often radically impaired, and at various times persons describe an utter lack or poverty of thoughts.
Delusions refer to ideas strongly believed by the individual, but not by others in his or her culture. These will appear to others to be contrary to reason and logical inference. Hallucinations usually consist of visual or auditory data perceived as real to the individual, but to no one else. Inner voices may admonish, threaten, whine, guide, entertain, or simply narrate, and may vary from a whisper to a thunderous shout. Often, voices take on some special peculiarity such as speaking slowly or in rhythms. There may be one voice or many.
Accompanying the variety of phenomena just described is often the sense that one has lost one's sense of "I," that it has died away, and yet one still lives. Emotional life may initially exist as guilt, excitement or fear, shame, rage, or mirth, but these feelings are experienced as foreign and overwhelming. As the dysfunction progresses, a flattening of emotions is experienced - the sense that there are no feelings left at all.
Apathy, slowness of movement, underactivity, and lack of drive are often associated with this process. Other behavioral changes may include withdrawal, mutism, ritualistic gestures, bizarre dress and actions, and self-mutilation.
To experience such changes in oneself is to suffer an unspeakable blow to one's sense of being and direction, of hope, and of self-esteem. Understandable in this context are occasional violent outbursts (family members are at greatest risk), suicidal threats or acts, the desire to be completely taken care of (either in hospital or by one's family), and frequent drug and alcohol abuse.
First-hand accounts of acute episodes communicate the phenomenology of schizophrenia - of "losing one's mind:"
"When I am ill, I lose the sense of where I am. I feel 'I' can sit in the chair and yet my body is hurtling out and somersaulting about three feet in front of me". Gradually, I can no longer distinguish how much of myself is in me and how much is already in others. I am a conglomeration, a monstrosity modeled anew each day". My ability to think and decide and will to do is torn apart by itself " instead of wishing to do things they are done by something mechanical and frightening."
"When I am melting, I have no hands. I go into a doorway in order not to be trampled on. It is as if something is thrown in me, bursts me asunder."
"The voice said slowly, 'You've never been any good or use on earth. There is the ocean. You might just as well drown yourself. Just walk in and keep walking.' As soon as the voice was through, I knew by its cold command, I had to obey it."
"The noises of the city are different " with an incessant sound of dismay, sometimes fading away and coming back like waves. There is a whispering in the air, diffuse. Gradually words become clearly distinguishable. They are about her. She looks backward and there they are - peculiar men with grotesque faces who follow her. She runs home in a state of panic."
As Jaynes has noted, there is much dispute about what schizophrenia is, whether it is one disease or many, and how those suffering from it can best be helped. The combined effects of hospitalization, antipsychotic drugs, prior therapy, and societal attitudes create a maze of research problems. To date, there is evidence of interactional and causal connections between factors on the genetic, societal, family, biochemical, and brain structural levels.
Recent research points to the theory that schizophrenia is a disease of the brain which may include both structural and functional differences from the norm. Although controversial, nutritional remedies have suggested metabolic components to the illness and a need for high dosages of certain vitamins, minerals, or amino acids.
Successful approaches to treatment in recent years have been multidimensional, emphasizing the importance of the ill person maintaining a balanced life style, including exercise, sleep, nutritional intake, and interpersonal relations. Family dynamics and events in infancy are now seen as relatively minor causational factors. However, their interaction with constitutional factors is seen as being important both initially and in regard to cycles of recovery and the on-going management of the illness. While cross-cultural data are still sparse, it is believed that schizophrenia can be distinguished by nuclear features that are present cross culturally.
In some cases, parents and siblings report indications in the person who later takes ill which set the individual apart: perhaps an extreme sensitivity, or hyperactivity, or tendencies toward hostility. In many other cases, individuals with extraordinary promise (seemingly quite healthy all through childhood) simply develop symptoms at the time of leaving the family nest.
Initial signs are the tendency to withdraw from family, school, or work. Habits begin to change as individuals begin to stay awake all night alone, or become incessantly active in a frenzied manner. Anger, evasiveness, or suspiciousness may lead to incoherent conversation.
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