Psychological Disorders for Writers: Schizophrenia

The manuscript that I’m currently working on has a character with a diagnosis of schizophrenia. This character is the father of my protagonist, and seeing what she’s seen, experiencing what she’s experienced, has left a life-long impact. Although there’s a lot more complications around Em’s father and his beliefs and actions, I do know that if a psychological disorder is going to be woven into your narrative, then it needs to be done authentically and accurately. It’s certainly a bonus being a psychologist on those days! So let’s look at what a diagnosis of schizophrenia will mean for your character.

First of all, let’s bust the myth that schizophrenia is split personality disorder (although I think most people know this by now). Multiple personality disorder, the current term is dissociative personality disorder, results in two or more split identities and is a completely different psychological disorder to schizophrenia (they’re not even in the same category of psychological disorders). Schizophrenia is an illness that disrupts the functioning of the human mind. It causes intense episodes of psychosis involving delusions and hallucinations, and longer periods of reduced expression, motivation and functioning. It is treatable, but can also be significantly debilitating.

If you’re like me, and have a character with schizophrenia, this is what you will see within the pages of your book:

Delusions

Delusions are fixed beliefs that are not amenable to change in light of conflicting evidence. They tend to be grouped into the following themes:

  • Persecutory delusions — the belief that one is going to be harmed, harassed, and so forth by an individual, organization, or other group are most common,
  • Referential delusions — the belief that certain gestures, comments, environmental cues, and so forth are directed at oneself are also common,
  • Grandiose delusions — when an individual believes that he or she has exceptional abilities, wealth, or fame,
  • Erotomanie delusions — when an individual believes falsely that another person is in love with him or her are also seen,
  • Nihilistic delusions — involve the conviction that a major catastrophe will occur and,
  • Somatic delusions — focus on preoccupations regarding health and organ function.

Delusions can be bizarre or non-bizarre. Bizarre delusions are clearly implausible, not understandable and do not derive from ordinary life experiences. An example of a bizarre delusion is the belief that an outside force has removed our internal organs and replaced them with someone else’s without leaving any wounds or scars. Others include a loss of control over mind or body, such as the belief that one’s thoughts have been ‘removed’ by some outside, that alien thoughts have been put into one’s mind or that one’s body or actions are being acted on or manipulated by some outside force. An example of a non-bizarre delusion is the belief that one is under surveillance by the police, despite a lack of convincing evidence.

Hallucinations

Hallucinations are perception-like experiences that occur without an external stimulus. They are vivid and clear, with the full force and impact of normal perceptions, and not under voluntary control. They may occur in any sensory modality, but auditory hallucinations are the most common. Auditory hallucinations are usually experienced as voices, whether familiar or unfamiliar, that are perceived as distinct from the individual’s own thoughts.

Disorganised Thinking

Your character may have muddled, disrupted thoughts and speech. They may switch from one topic to another, answers to questions may be obliquely or completely unrelated. In rare cases, speech can be so severely disorganized that it is nearly incomprehensible (what psychologists call a ‘word salad’). This symptom is most often apparent during the period before the full development, or after the development of psychotic symptoms.

Abnormal Physical Behaviour

People with schizophrenia may have unusual, inappropriate or extreme actions. It may manifest itself in a variety of ways, ranging from childlike ‘silliness’ to unpredictable agitation. Although violence and aggression are reported, they certainly aren’t prevalent as the media and stereotypes would have you believe. The other end of the spectrum includes catatonic behaviour; ranging from resistance to instructions, to maintaining a rigid, inappropriate or bizarre posture, to a complete lack of verbal and motor responses. Other features are repeated stereotyped movements; staring, grimacing, and the echoing of speech.

Negative Symptoms

Negative symptoms in psychology relate to the absence or loss of a behaviour (as opposed to negative emotionality). Two negative symptoms are particularly prominent in schizophrenia; diminished emotional expression and a decrease in motivation. Diminished emotional expression includes reductions in the expression of emotions in the face, eye contact, intonation of speech, and movements of the hand, head, and face that normally give an emotional emphasis to speech. A decrease in self-initiated activities can result in your character sitting for long periods of time and showing little interest in participating in work or social activities. Other negative symptoms include diminished speech output, a decreased ability to experience pleasure from positive stimuli or a decrease in the recollection of previously experienced pleasure.

As you can see, schizophrenia is a highly heterogeneous psychological disorder. Treated, many individuals live productive and successful lives. Untreated, either through choice or circumstance, and individuals will find it challenging to perform activities of daily living. Just remember though, don’t define your character by their psychological disorder. They were someone before their mental illness, someone with a mental illness, and a truly authentic character will reflect this.

What do you think? Do you have a character with schizophrenia? Does these points help you in creating a character with schizophrenia? Comments and feedback are always appreciated. Connecting with others is why I write. You can comment below, or connect with me on Facebook, Twitter or Instagram.

Have a wonderful week,

Tamar

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