By Franklyn Okoye, DSW
Hallucinations are things that are heard, seen, felt or even smelled or tasted that don’t seem to come from anything ‘real’. Although hallucinations can occur in any sensory form, hearing voices that other people do not hear is the most common type of hallucination in schizophrenia. Voices are usually thoughts that are in the mind of the person and they can take different forms, perhaps loud and frightening or a commentary at normal volume. The thoughts can appear to be so loud that the person may believe that people nearby will also be able to hear them. In order to make sense of hearing these things, the mind will often make the person believe the voices are in fact coming from somewhere outside of their head
Delusions are beliefs that are not based on reality, and are not explained by a person’s cultural, religious or other beliefs. Delusions may take on different themes. For example, people suffering from paranoid-type symptoms (roughly one-third of people with schizophrenia) often have delusions that they are persecuted or plotted against, or false and irrational beliefs that they are being cheated, harassed, poisoned or conspired against. These people often believe that a member of their family or someone close to them is making these things happen. Delusions of grandeur, in which a person believes he or she is a famous or important person, may also occur in schizophrenia.
Sometimes the delusions experienced by people with schizophrenia seem quite bizarre to others; for instance, believing that a neighbor is controlling their behavior with magnetic waves; that people on television are directing special messages to them; or that their thoughts are being broadcast aloud to others. A person experiencing delusions may try to keep them secret, knowing that others would not understand. Other individuals are gradually overwhelmed and begin to act strangely according to the content of the delusions.
In some cases, especially with hindsight, families may realize that their relative’s behavior has been changing over a period of time in subtle ways. They may for instance have become slower to think, talk and move, they may have become indifferent to social contact, and their sleeping patterns may have changed so that they are happy to remain up all night and sleep all day. Body language may also be affected. These include the so-called ‘negative symptoms,’ and they will affect the person in a different way from positive symptoms.
The overall result is a reduction of motivation, and the extent of this can vary from minor to severe. Negative symptoms are much less dramatic than positive, but they tend to be more persistent. Recognizing these changes can be particularly difficult if the illness develops during teenage years, when it is quite normal for changes in behavior to occur, particularly where the young person is experimenting with new freedoms and lifestyles.
Negative symptoms describe a lack of important abilities. For example, someone with negative symptoms may show a lack of emotion or an inability to enjoy regular activites. They may have low energy and sleep much more than normal. They may have a blank facial expression and have a difficult time speaking. They may also have inappropriate social sklls, are unable to make friends, and may isolate themselves sociallly, preferring to be alone most of the day or only with close family.