Schizophrenia is a misunderstood and often underestimated mental illness. It is a lifelong battle which devastates not only patients, but families and support systems who struggle to assist with maintenance of stability and functionality. Movies and television still confuse it with Dissociative Identity Disorder (formerly Multiple Personality Disorder), and it is most often noted for its psychotic symptoms of paranoia, hallucinations, and false beliefs (delusions). However, hallucinations and delusions make up only part of the disease’s symptoms.
Those positive symptoms of the disease, so named because they are experienced by people with Schizophrenia, but not by those who are typically functioning, comprise only a fraction of the illness. Prevalent in the internal experiences of a person living with Schizophrenia is another group of less obvious symptoms which diminish functioning and are resistant to treatment by antipsychotic medications. While those symptoms might be less obvious to the casual observer, they are no less pervasive or debilitating.
The term negative symptoms refers to traits which result from diminished personality characteristics existent in patients prior to onset of illness. These are symptoms which minimize functioning, and snuff out capacity to perform activities of daily living. They are also more likely to vex support systems because negative symptoms impair relationships through inhibited social skills.
Negative symptoms may be referred to as the Four A’s of Schizophrenia, and are as follows:
Apathy is a significant negative symptom which effects patients throughout the Schizophrenia spectrum. The result of this symptom is reduced of zest for life, and restricted range of affect. Restricted range of affect pertains to a person’s inability to feel or display a full range of affect responses from happiness to sadness. Typical responses to stimuli, such as laughing or crying, may not be within the range of patients’ capabilities.
Anhedonia is also common, and is well characterized as diminished ability to experience pleasure. Results of this symptom are lost interest in activities once deemed a source of joy and pleasure. Hobbies are no longer enjoyed, pleasure is no longer derived from close relationships, and libido is reduced. It important for support systems to monitor these changes in behavior as Schizophrenia increases risk of suicide in patients who lived successful or affluent lives prior to diagnosis.
Schizophrenia is often misunderstood because the combination of apathy and anhedonia presents as depression, which is why the presence of at least one positive symptom is crucial when arriving at a diagnosis of Schizophrenia. It is also important to note the distinction between sad mood and flat mood. Because these symptoms restrict range of affect, we cannot assume sadness.
Avolition refers to the experience of diminished motivation. This symptom reduces desire for accomplishments or goal-oriented behavior. By itself, or combined with other negative symptoms, avolition can be misconstrued as a symptom of major depression or persistent depressive disorder (dysthymia), as patients may be unwilling to leave their beds or homes for extended periods of time. Avolition also results in reduced interest in self-care, including poor hygiene and grooming.
Alogia refers to poverty of speech. It is sometimes misconstrued as a product of low cognitive functioning or social anxiety. People who experience alogia lose the ability to engage in small talk, and no longer pick up on social cues to the extent they may be mistaken for autistic. Alogia should not be identified as an inability to communicate, but instead an interruption in the flow of thought. It is a component of Schizophrenia sure to challenge the patience of therapists, as reduced speech interferes with the therapy dynamic.
Although positive symptoms of Schizophrenia distort functionality, negative symptoms diminish it, and prevent patients from obtaining, or keeping jobs, and engaging in social relationships. There is little opportunity for academic achievement, as drive and desire are no longer present. The experience of these brutal impairments leave patients isolated and with little chance of living a fulfilled life.
While antipsychotic medications such as Haldol, Seroquel, or Zyprexa have proven successful in the treatment of positive symptoms, they do little to restore patients to maximum functionality as these medications are not effective in the treatment of negative symptoms.
It was once believed therapy was not efficacious for persons living with Schizophrenia, but that has changed with the advent of therapeutic modalities such as Cognitive Enhancement Therapy which can help reduce the effects of negative symptoms while medication tackles positive symptoms.
No matter how effective a treatment modality may be, what cannot be overstated is nothing in the battle against mental illness can replace support from family and friends. Familial support increases the likelihood of treatment compliance.
Even without mental illness, none of us of thrives when removed from community.
Schizophrenia is among the most devastating mental health diagnoses because the disease is a life long battle and creates immense impairment of functioning and reduced quality of life. But the combination of medication, progressive therapies, and community support works to create opportunities for patients to move out of the dark corners in which they have been pushed, and into the light where they may one day flourish.
