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Schizophrenia.com, paranoid schizophrenia - Schizophrenia positive symptoms; understanding hallucinations and delusions
Schizophrenia is a (biological) disease (of the brain) that ebbs & flows. Acute periods are called "relapses" when patients experience sensations that are an addition to their usual repertoire of feelings. Because they are additions, they are referred to as "positive symptoms" but they are far from positive in the sense of being wanted. They are the hallucinations, delusions & thought confusions which return periodically, triggered, probably, by a variety of stresses. They respond, in general, to decreased stimuli, calm interactions, & antipsychotic medicine.
Interspersed between the acute periods are various stages of convalescence during which patients frequently experience "negative symptoms". These are subtractions from the normal repertoire of feelings such as loss of interest, loss of energy, loss of warmth, loss of humor.
Delusions
Delusions are false beliefs or misinterpretations of events & their significance. For instance, a person may get accidentally bumped in the subway & may conclude that this is a Government plot to harass him. He may be awakened by noise from his neighbors apartment & may decide this is a deliberate attempt to interrupt his sleep. Everyone tends to personalize & misinterpret events, especially during times of stress or fatigue. What is characteristic of the schizophrenic however, especially during an acute period, is that the conviction is fixed & alternate explanations for the events experienced are not even considered. Usually attempts at reasoning or discussion about possible other meanings of the bumping or the noise in the night can only lead to the further conviction that the reasoner must be in on the plot, too. Arguing with a delusion only leads to further mistrust or anger. The beliefs are tenaciously held, against all reason, & they are characteristically not shared beliefs. They are held only by the person himself & by no one else.
Families & friends must first realize that delusions are a result of illness & not stubbornness or stupidity.
Although fixed delusions can be irritating, emotional reactions should be avoided, as should taunts or threats.
Talking Nonsense
This generally occurs when a person is in the active phase of his illness. It can re-emerge sometimes when medications are too low or stress is too high. What the patient says becomes incomprehensible to those around him either because sentences are unconnected to each other, or else because there seems to be no point to the stories told, or else because topics seem to switch with great frequency. Words may take on special meanings in schizophrenia either because they trigger private associations or because attention is paid to individual sounds rather than hole words. For instance "psychiatry" may sound like "sigh Kaya tree" & the topic may switch suddenly from a discussion of psychiatry to a discussion about mystical trees. Certain words may be avoided because they sound harsh or evil. Sometimes intonations are changed for similar reasons. Sometimes language is used as an incantation to ward off threats. Difficulty making sense to others is a symptom of the acute phase of the illness. It is almost impossible to communicate with patients when they are in this phase & it is very frustrating to family.
Try to communicate non-verbally. Sometimes communication through writing works, as thoughts tend to be more organized in writing. Do not force yourself to listen & understand; it will usually lead to headache & irritation.
Do not tease or mimic him.
Most people use one side of their brain for language & the other side for art or music or movement. If the language side is disturbed, it might be a good idea to concentrate on the other side & encourage patients to draw, sing, or play an instrument, to exercise or dance.
Preoccupations These are fixed ideas, not necessarily false (like delusions) but overvalued. They take on extraordinary importance & take up an inordinate amount of thought time. One idea often returns & returns. Frequently it is a worry about doing the right thing or doing it well or in time. Characteristically, the worry grows & becomes unrealistic. A common sequence of events is for the worry to take up so much of a person's time that the "right thing" does not get done & its not being done is then attributed to the bad motives of others. Or it may be rationalized as God's wish.
To them they explain the facts better than any other explanation. Sometimes these preoccupations have a mystifying character to them. They seem to require puzzling over & decoding.
The schizophrenic spends much time in this kind of puzzling activity & that is why he thinks he has solved mysteries that others haven't, since they spent no time at it.
They feel they have important work to do to try & come to the bottom of the puzzle & they do not appreciate offers of conversation or shared activities at those times.
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