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Schizophrenia is a common mental disease whose characteristics may include separation of the intellect from the emotions, inappropriate emotional reaction, and distortions in normal logical thought processes, withdrawal from social relationships, delusions and hallucinations.
Schizophrenia was first described as a simple disorder by German psychiatrist Emil Draepelin in 1896. David Holmes developed an influential classification of psychoses into two types: dementia paracox, now called schizophrenia, and manic-depressive psychoses (284). "Dementia" is referred to as intellectual deterioration and "paracox" to the fact that the symptoms first occur in early adulthood. Later Holmes introduces a Swiss psychiatrist Eugene Bleuller who renamed the disorder "schizophrenia" to express his view that a prominent feature of the disorder is a splitting of psychic functions. He was among the first to describe the symptoms of schizophrenia carefully and among the first to believe that these disorders are curable (284-285). There are several diagnostic subtypes of schizophrenia. David Holmes lists these types as follow: simple schizophrenia, disorganized schizophrenia, which is also called hebephrenia, catatonic schizophrenia, paranoid schizophrenia, controversial types, and atypical forms of schizophrenia (272-276).
The most common type of schizophrenia is the simple type, which is also known as undifferentiated. It begins slowly, and generally goes back to a time preceding puberty. The major changes occur after puberty. According to John Neale and Thomas Oltmanns, the patient slowly becomes quite inactive and limits his/her life as much as possible. He/she refuses to go out, to go to school or to work, and gradually allows his/her life to become very restricted (52). When a person refuses to go out of the house, it is like developing agoraphobia, which is fear of being in public places. "Often individuals with this problem also have a fear of being alone because if they are experiencing fear of being alone because if they are experiencing fear, they want friends around to help them" (Holmes 79). Because of this separation from the outer world the patient's activities are reduced to a minimum and are extremely slow. The sleep pattern is also altered. David Holmes explains that often patients sleep during the day and stay up until very late at night or until the early hours of the morning. This is also referred to as disturbed sleep patterns. Some individuals also begin sleeping more than usual, which is called hypersomnia (172-173). Disturbed eating patterns are also common in this type of schizophrenia. Patients become over concerned with their appearance or with their weight. "They may go into periodic eating sprees that alternate with periods of almost total starvation" (Arieti 48). According to David Holmes, this type of schizophrenia is essentially a wastebasket category consisting of individuals who cannot be placed in any of the preceding categories or who meet the criteria for more than one of the defined types (276).
Another common type, which is also the most devastating, is disorganized schizophrenia, which is also known as hebephrenia. Disorganized schizophrenia shows the greatest degree of psychological disorganization. According to David Holmes' book, Abnormal Psychology, disorganized schizophrenics are "Frequently incoherent, have blunted, inappropriate, or silly moods, are socially withdrawn, and show behavioral oddities such as grimaces and unusual mannerisms" (275). The moods of individuals with schizophrenia are typically described as blunted, flattened or inappropriate. In other words, these individuals are not as emotionally responsive as they should be to environmental or interpersonal situations. For example, "When hearing of a death in the family or watching a very funny film, a person who has schizophrenia may remain impassive and show little or no emotional response. Yet in other situations, the same person will be emotionally volatile, but in a way that is inappropriate and inconsistent with what would be expected in the situation" (Holmes 269). For example, when discussing an injury or some other serious topic, the individual may break into laughter. John Neal and Thomas Oltmanns, authors of the book Schizophrenia, also mention that these are "meaningless giggles, or apparent self satisfied and self-absorbed smiles" (53). The symptoms start generally in adolescence or at an early age and take a progressive course. Patients with this type of schizophrenia also have frequent disorganized thinking. Holmes also quoted Bleuller, a Swiss psychiatrist, in his book. Bleuller's words were "It has been suggested that the thought processes of these individuals are characterized by a loosening of the associated links between thoughts, so that the individuals frequently spin off into irrelevant thoughts" (267). For example a person would be talking about his shoes and then with no apparent transition will begin talking about planes and helicopters. These people jump from one idea to another without explaining or mentioning that they are changing the subject.
Therefore, their thought processes have been described as over inclusive, meaning that the person tends to include irrelevant ideas in their thoughts and conversations. Also, if a person goes for a job interview or for a test that involves random thought responses, he/she won't do well. When I interviewed a woman who had some symptoms of schizophrenia, she said that she felt helpless and that she did poorly in school and at work. Finally she dropped out of school temporarily and checked herself into a hospital where she was treated for her symptoms. Sometimes the patients feel very depressed about their behavior and therefore separate themselves from others. According to an article in the Journal of Abnormal Psychology "Antisocial behavior and creativity might be one of the causes of schizophrenia" (Berenbaum 153). The thought process also leads a patient's mind to cognitive flooding or stimulus overload. Some of the patients lack the ability to screen out irrelevant internal and external stimuli. According to E. Fuller Torrey, "There is a filter that most of us have for eliminating extraneous stimuli that is missing or broken. As a consequence, persons with schizophrenia are forced to attend to everything around and within them, and they feel as if they are being flooded to the point of overload with perceptions, thoughts, and feelings" (180). This disorder leads to language disorders, which are prominent, especially in cases of rapid regression. This only complicates the situation.
A less common type of schizophrenia is catatonic schizophrenia. It is characterized by an extreme decrease in motor activity, often accompanied by muteness. According to Silvano Arieti, this type has two phases. The first, more characteristic phase, is one of the unconscious. In this phase, patients are unresponsive to external stimuli, although apparently they are aware of what is going on around them. At the same time, they display extreme compliance, repeating sounds heard and motions seen and holding postures for prolonged periods of time until their limbs ar rearranged for them. These holding postures are also referred to as waxy flexibility (39-40). "Patients with this symptom pattern are like wax statues in that they are generally mute, and when placed in a particular position, they will remain in that position for long periods of time" (Gottesman 113). The patients seem completely paralyzed and in this condition they cannot dress or undress themselves and do not have the ability to feed themselves or to talk in the presence of other people. If they do more, they do so very slowly and as though they were dragging a 10-ton weight. They may even report feeling as if they have the weight of the world on their shoulders and just cannot move under this burden. At Washington Adventist Hospital, several patients were observed who were being treated for this type of disorder. One of the patients was so immobile that he didn't blink his eyes, and thy had to be taped shut so that the surface would not dry out and be damaged. In the other phase of catatonic schizophrenia, David Holmes explains that patients exhibit great excitement and hyperactivity, which is manifested sometimes in repeated and purposeless motions and speech patterns and sometimes violent behavior (275-276). Many of the movements of patients like repetitive finger and hand movements are random and purposeless but in a few cases they are related to the patient's delusions. For example, "Individuals with delusions of persecution may direct large amount of activity toward hiding or defending themselves from their persecutors" (Holmes 270). These rapid activities are also called psychomotor agitation, which means that patients are unable to sit still. These patients are restless and constantly fidgeting or pacing. Silvano Arieti says it is noteworthy that the activities of these individuals are random rather than focused on achieving any particular goal, and that their activities do not gain them anything (39) In this type of schizophrenia, patients may also be driven to more violent behavior, such as committing suicide. According to an article in New Scientist titled "Understanding the Inner Voices", "The only person a schizophrenic is likely to harm is himself or herself, one study found that almost a third of schizophrenics had tried to commit suicide at sometime" (26) Although catatonic schizophrenia was quite common several decades ago, individuals with this disorder are now very rare.
Another type of schizophrenia is paranoid schizophrenia. According to David Holmes, Patients with this disorder manifest delusions of a persecutory nature, and frequently, auditory hallucinations (276). Paranoia, in psychology, is a state of mind characterized by delusions of grandeur or by an unfounded belief that one is being persecuted by others, or both. This type of schizophrenia can occur as early as at the time of puberty. "The older the patient, the more difficult it will be to decide whether his/her symptomatology is a schizophrenic one or one that is better classified as a paranoid state or paranoia" (Arieti 35). Paranoid patients are found to be more intelligent than the other schizophrenic patients. David Holmes explains the dominant symptoms in this type as delusions of persecution and grandiosity. These delusions are beliefs that are held despite strong evidence to the contrary (276). The most common delusions are delusions of persecution in which individuals think that others are spying on them or planning to harm them in some way. Also common are delusions of reference in which objects, events, or other people are seen as having some particular significance to the person. For example, "One patient believed that if a woman across the room folded a newspaper in a certain way, that was a sign that he was being followed by spies. Similarly, another patient interpreted a television advertisement proclaiming Coca-Cola as the real thing, as a message that the people she was with at that time could be trusted" (Holmes 266). Paranoid disorder also includes delusions of identity in which patients believe that they are someone else. Common examples given by Silvano Arieti include delusions that they are Jesus, Joan of Arc, the president of the United States, or some other famous person. Patients with paranoid schizophrenia also sometimes have hallucinations with persecutory or grandiose content. These hallucinations are perceptual experiences that do not have a basis in reality (47-48). An individual who hears, feels, smells, or sees things that are not really there is said to be having a hallucination. According to David Holmes, auditory hallucinations are the most common. They frequently involve hearing voices that comment on the individual's behavior, criticize the behavior, or give commands. For example, "A woman hears monks chanting, Cut yourself and die. Cut yourself and die" (Holmes 265). Less frequently, hallucinations involve hearing other sounds, such as motors. Tactile and somatic hallucinations in which the individual imagines tingling or burning sensation of the skin or internal bodily sensations are also common. Finally, visual and olfactory hallucinations, which involve seeing, or smelling things that are not there are also observed in persons with schizophrenia (265). For example, a patient may see insects crawling all over his/her body that no one else can see. Similarly, an individual may hallucinate that he/she stinks and therefore take several showers in one day. It is important to realize that to the individuals having them, "hallucinations appear to be real perceptions, and the individuals are unable to distinguish hallucinations from real perceptions" (Arieti 76).
In addition to the four classic types, which are described above, there are some types called ill-defined or controversial types. John Neale and Thomas Oltmanns say that these include the latent type, residual type, occult type, and chronic type (54-55). Latent type is "For patients having clear symptoms of schizophrenia but having no history of psychotic schizophrenic episodes" (Neale 54). This type is confusing, because the individual is having clear symptoms but has no previous record of insane events. Neale at leastand Oltmanns explain that individuals who are diagnosed with residual type have had at least one schizophrenic episode in the past and currently show some signs of schizophrenia such as blunted emotions, social withdrawal, eccentric behavior, or thought disorder, but these symptoms are generally muted (54). Another type listed under ill defined is occult schizophrenia. Occult means, "concealed, hidden, not immediately known, perceivable only by investigation, and covert rather than overt" (Arieti 42). Occult type patients have hidden symptoms and they don't show at first glance. For example, an individual might be suffering with social phobias but that doesn't show until he/she is asked to give a speech to the class. Another ill-defined schizophrenia is the chronic type. Chronic schizophrenia is "For patients who show mixed schizophrenic symptoms and who present definite schizophrenic thought, affect and behavior not classifiable under the other types of schizophrenia" (Arieti 42). This classification is mostly made in the absence of delusions, hallucinations or catatonic symptoms. At times it is a question of individual preference to use this diagnosis rather than the simple or hebephrenic type.
According to Silvano Arieti, atypical and rare cases of schizophrenia have also been recognized. Childhood schizophrenia is perhaps the most important of these atypical forms, and yet it is even doubtful that this condition is related to adult schizophrenia (43-44). Schizoaffective type is characterized by recurring episodes that present a mixture of disorders. Schizophrenia in old age is called late schizophrenia. David Holmes explains that this type is like involutional depression. Old age and the approach of old age can be a stressful period because of the loss of family, friends, status and respect. It also can be because of increase in illness and the financial problems associated with aging, and the fact that the future is limited and may appear bleak. Very few psychiatrists accept this type, because they feel that a young age is necessary for occurrence of this disorder (179).
Finally, postpartum schizophrenia is a type in which "Schizophrenic syndrome occurs in the mother after childbirth" (Holmes 181). In this type the mother feels very insecure about her baby. This can be a very serious disorder and can sometimes lead to the mothers killing their own babies.
Schizophrenia is a serous and complicated mental disorder. As each type is unique and has its own symptoms, diagnosis and therefore treatment of the disorder is difficult. While some drugs have been successful in managing symptoms of schizophrenia, there is not cure. The severity of the disorder varies with the different types, but all are degenerative in nature and recovery is unheard of. With all that is still unknown about schizophrenia it is possible that still other types will be identified in the future.
Arieti, Silvano. Interpretation of Schizophrenia. New York: Basic, 1974. C3
Bennett, Julie. Personal interview. 18 Nov. 1994
Berenbaum, Howard, and Frank Fujita "Schizophrenia and Personality: Exploring the Boundaries and Connections Between Vulnerability and Outcome." Journal of Abnormal Psychology Feb. 1994: 148-158
Gottesman, Irving I. Schizophrenia Genesis: The Origins of Madness. New York: Freeman, 1991. C5-8
Holmes, David S. Abnormal Psychology New York: Harper, 1994. C12-14.
Neale, John M., and Thomas F. Oltmanns. Schizophrenia New York: Wiley, 1980. C1,7.
Torrey, E. Fuller, and others. Schizophrenia and Manic-Depressive Disorder New York: Harper, 1994. C4,8,11..
"Understanding the Inner Voices." New Scientist 9 jul. 1994: 26-31.
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