Schizophrenia is considered to be the third-most-disabling condition after quadriplegia and dementia, even ahead of blindness. This may come as a shock to some, as blindness is quite debilitating. However schizophrenia not only has a direct effect on the sufferer’s social and occupational life, but can produce many physical ailments as secondary illnesses.
Psychotic disorders, including schizophrenia and schizoaffective disorders are typically “scary” to those who have no experience around those affected by the illnesses. Our culture has created a narrative that schizophrenics are serial killers or are particularly violent. While a sufferer of a psychotic disorder may become confused and aggressive at times, it is actually a fairly rare occurrence, and those with severe mental illness are actually MUCH more likely to be VICTIMS of violence than the culprit. Another myth is that schizophrenics have “multiple personalities,” when this is NOT the case.
So what are schizophrenia and schizoaffective disorder? I will primarily be discussing schizophrenia, however schizoaffective disorder is diagnosed when a patient has both the below features of schizophrenia, as well as features of a mood disorder (typically major depression, or bipolar disorder.)
There is no objective “test” for schizophrenia, like the typical “four question” test VA examiners use for PTSD diagnosis. In order to make a diagnosis of schizophrenia, a patient must have 2 or more of the following symptoms:
Delusions – Delusions are fixed beliefs that are not based on “reality.” Most commonly, the delusions are persecutory, such as believing a person or a group wishes them harm. This typically manifests itself in different ways depending on the person and their culture. For one person, the delusion may be “the CIA is following me” for another it may be religious “the devil wants to hurt my family.” Other delusions may be grandiose, with the sufferer believing he/she is God or Jesus, or has the ability to read minds, or have heightened perception. This last belief seems to be fairly common, and many people with schizophrenia may believe that harmless gestures or words spoken by others have hidden meanings.
Hallucinations – Auditory hallucinations are the most common hallucination in schizophrenics, and typically these hallucinations are in the form of voices. Around 75% of schizophrenics experience auditory hallucinations. Interestingly, different studies have found that even in people with no mental illness, around 10-30% will experience some auditory hallucinations in their lifetime. Voices can be male or female, and may be completely benign or malevolent. We mostly think of voices that are “evil,” and tell the patient that they must do immoral things. While this type of voice is common, many voices are pleasant and supportive, and a patient may miss them when they cease. A great video demonstrating what it is like to experience schizophrenic symptoms can be found here.
Disorganized speech – With all of the above going on, it should come as no surprise that schizophrenics have difficulty concentrating on one train of thought. Their speech can become very disorganized, sometimes turning on a dime, or stopping for seemingly no reason. A video demonstrating disorganized speech can be found here.
Disorganized or catatonic behavior – Just as with speech, an individual’s behavior can be seen as bizarre or disorganized to people not experiencing psychosis. When the symptoms are extremely severe, the patient may no be able to move, speak, or respond to stimuli. This is known as catatonic behavior.
Negative symptoms – All of the above symptoms are known as “positive” symptoms, because they “add” to the patient. However, some of the most debilitating and disabling symptoms are the “negative” symptoms, which “remove” from the patient. These include depression, cognitive, and movement problems.
As we can see, it is not surprising that schizophrenia is regarded as one of the most disabling conditions, with severe negative effects on both social and occupational function. In part two, I will discuss the intricacies of getting your schizophrenia service-connected, and go into detail about the many disabilities that can arise as secondary to schizophrenia and schizoaffective disorder.
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