The inner world of schizophrenia patients

1. Changes in sensory perception:

The changes in sensory perception are particularly obvious in the early stages of schizophrenia. According to research About 2/3 of patients have this change, and all sensory receptors will become intense or blunt.

1. Hearing changes, as described by the patient below: I heard all the sounds in heaven and on earth and many sounds in hell. Like if someone turned everything up loud, I would notice all the background sounds. Although I don't pay attention to anything in particular, everything catches my attention. When I talk to you now, I can hear the sounds in the next room and the corridor. I can't help paying attention to them, so I don't pay attention to what I'm saying. What to say to you, sometimes even the most boring and boring things attract me and make me spend a lot of time on them.

2. The visual changes are even more obvious than the changes in sound. As described below, things become more vivid and clear, as if they are glowing pictures, and they look flatter, as if they are just a Flat surfaces, and it’s not just the colors that catch my attention, it’s all the little things that make me look at them for a long time, like the lines on the edges and so on. Everything looked scary, the people looked like demons - with black outlines and glowing eyes, and all the objects - chairs, houses, things had a life of their own. They have a threatening stance and an animal-like appearance. They looked deformed, as if they had undergone plastic surgery. They look like they are made of rubber.

3. In addition to changes in hearing and vision, there may also be changes in touch: being touched is very scary. Contact with anyone will make me feel like I am being electrocuted. I felt like there was a mouse in my throat, and his body seemed to be disintegrating in my mouth. One doctor described his patient's paranoid fear of his genitals constantly turning black, requiring the doctor to check them every minute. , due to hypersensitivity of perception, patients will be overwhelmed by external stimuli. They will see and hear everything. For normal people, our brains will naturally filter images and sounds, allowing us to focus on our When it comes to selected things, the filtering system of patients with schizophrenia is damaged, so that all external sensory stimuli act on the brain at the same time like a flood.

2. Abnormalities in understanding and responding to information

The brain function of normal people can classify and understand the information coming in from the outside world, and then selectively make correct responses. These reactions are learned, logical, and predictable. Patients with schizophrenia have impairments in classifying, understanding and responding to information. Therefore, not only do they have problems thinking, but they are also affected in visual, auditory stimulation, emotional and behavioral responses. It is as if there is a problem with the brain's switchboard and they are unable to process the information. The incoming information, thoughts, ideas, memories, and emotions are properly classified and completely mixed together. For example, normal people can automatically convert the sentences they hear into thoughts. We don't need to focus on individual words, just think about the meaning of the entire sentence. But for patients, as they described: If people speak It has to be relatively simple, and I can still concentrate, but if the sentence is too long, I can't understand the meaning; to me it is just a bunch of words, and I have to work hard to put it together, which must cost me a lot of money. The words they spoke seemed to be in a foreign language and I couldn't understand what they were saying. This is not only true for hearing, but also for vision, as described by the following patient: Everything is broken into pieces, and I have to work hard to put them back together. For example, when I see a watch, I see it is a strap, The face, the hands, I have to think hard to understand that this is a watch. Another patient described his experience of seeing a psychiatrist. He saw teeth, nose, chin, eyes and other parts. Every part made him feel very scared and he could not recognize who he was. This deficit in visual understanding is common in people with schizophrenia, who may misidentify people and say they look like certain people. For example, a patient said: I was in a certain hospital this morning. I seemed to be filming a movie. I saw stars all around me. In addition to the above problems, schizophrenia patients often cannot process more than two kinds of information at the same time. For example, the patient said: I can't watch TV because I can't watch the screen and listen to the sound on the TV at the same time. This difficulty in watching TV is very typical, so in mental hospitals, it is rare to see patients sitting and watching TV all the time; sometimes they sit and watch TV and cannot describe what they see. This situation has nothing to do with the patient's intellectual education. Even some patients who have graduated from college have no solution. If you asked him why he didn't watch television, he would tell you that he couldn't understand what was going on. Or in order to cover up this lack, they will tell you that they are tired and don't want to watch TV. The programs they are more acceptable are cartoons or travel programs, because these are purely visual stimulation and do not require the integration of hearing and vision.

In addition to the lack of classification and understanding of information, it is also obvious that there is a problem in responding to stimuli, and inappropriate responses are often made.

Therefore, schizophrenia patients will also have problems getting along with other people. Many patients would rather be alone, withdraw, and try to talk and communicate with other people as little as possible, because these processes are difficult and painful for them. They will try their best to to avoid.

The language expression problems of schizophrenia patients include phonological linkage: patients only pay attention to the sound part and ignore the meaning of words.

1. Idiom thinking disorder: When asking the patient about idioms, the patient only pays attention to the words and cannot understand the meaning of the entire idiom. For example, the idiom says that people who live in glass houses should not throw stones at others. , the patient will only notice the glass house and the stone, and describe what kind of glass house and what kind of stone.

2. Speech disorder: As described by the patient: I can’t express what I want to say. There seems to be a barrier in my brain. I can’t say what I want to express correctly. Sometimes I casually Find a word instead.

3. An extreme example is language salad: what the patient expresses is completely meaningless and incoherent words.

4. Another common symptom is interruption of thinking, just like the switchboard in the brain suddenly loses power and stops for several seconds, and then continues to operate. As the patient described: When I think Halfway through, he will suddenly stop on a word or idea and be unable to continue, and his whole mind will be unable to think of anything else. Another patient described this: When I was reading, I suddenly fell into the quagmire of a certain word, as if I was hypnotized. This word sucked me in, and I couldn't think about it anymore.

5. A common symptom is contradiction. The patient cannot handle two opposite thoughts and feelings appearing in the brain at the same time. As the patient said: I have two opposing thoughts in my brain about various things. All the thoughts were contradictory, and then the whole brain seemed to be broken into pieces and the whole person was disintegrated.

Because of these problems in classifying, understanding and responding to stimuli, schizophrenia patients appear to normal people to be incoherent and unable to understand, have no logic, have difficulty thinking and withdraw, etc. In this condition, the patient's judgment is impaired. In the early stages of the disease, these symptoms are vague and unnoticeable, but as the disease becomes more severe, these deficits become more and more obvious. Every schizophrenic patient has more or less some of the above symptoms.

3. Auditory hallucinations and delusions

Auditory hallucinations and delusions are the most common and well-known symptoms of schizophrenia. Most of the auditory hallucinations and delusions are caused by the patient’s perception of external things. caused by distortion of feelings. Delusions are erroneous thoughts that patients have, and they are incorrect according to the customs and culture in which they live. Usually delusions come from patients misinterpreting the feelings they receive and associating unrelated things around them as being related to themselves. For example, when you are walking on the street and someone across the street coughs, you may not feel it or feel anything. Will notice him. But for a schizophrenic patient, he not only hears the cough, but also immediately thinks that the cough is directed at him and has some special meaning to him, and then thinks that the cough is a warning to another person, telling him that The patient comes. In this case, if you try to reason with the patient and tell him that nothing happened, the patient may still think that you are with them and just want to cover up the matter. So because the patient has some senses Perception is overly sensitive and the ability to reason logically is affected. The combination of these conditions may cause the patient to have delusions.

Delusions of being victimized, monitored, and attacked are the most common. Some patients may attack others out of self-defense, but after all, they are still a minority among all schizophrenia patients.

Another common delusion is grandiose delusions, for example, the patient feels that he has the power to control the weather, can control the movement of the sun and other planets, or thinks that he is Jesus Christ. As the following patient said: I feel like I am a star, and I am taking pictures. Every time I arrive at a place, there are invisible cameras and microphones recording all my things, words and movements, and they are taking pictures of me. Grandiose delusions can sometimes be dangerous. For example, if a patient thinks he can fly, it may cause accidents. There is a special kind of grandiose delusion, usually in which people feel that famous people love and pursue them. For example, some patients will feel that there is a very famous politician who loves him and spends all his time and money following his actions, but maintains a certain degree of delusion. distance. He also had a set of reasons to explain why the man didn't dare to let him know that he was following his actions. In addition, some patients feel that they have the ability to control other people's minds. For example, there is a female patient who has been afraid to leave the house for five years because she felt that if she went out on the street, she would affect other people's minds and they would all look at him. He is like a magnet, no one else can do anything but turn around and look at him.

Another typical symptom is thought spreading, where the patient feels that the thoughts in his mind will be spread.

Delusions are sometimes fixed, and sometimes they fluctuate. For example, some patients may think that A wants to kill him. On the first day, he may keep a distance from A, but on the second day I had a pleasant conversation with Person A again, but on the third day I started to keep my distance from him again.

Patients' hallucinations can range from over-sensitivity to vision to actual hallucinations. When vision is over-sensitized, patients see light that feels particularly bright and vivid.

A further step is delusion, in which the patient distorts visual information, such as seeing a dog as a tiger. More serious are true hallucinations, in which patients feel they see, hear, feel, smell or eat something without any external stimulation. These experiences are very real for patients. So we can see the patient talking to himself, speaking to the sounds he hears. Auditory hallucinations are the most common hallucinations. They may be simple sounds, repeated sentences, or even hearing multiple people talking and last throughout the day. The most common time for auditory hallucinations is before going to sleep. The content is usually accusatory and scolding the patient. Sometimes it is a swear word. The patient may be embarrassed to tell the medical staff. Some patients may also hear pleasant sounds. The mechanism of auditory hallucinations is unknown. Many parts of the brain are responsible for auditory functions. Some people believe that auditory hallucinations occur due to increased blood flow in the auditory functions near the temporal and frontal lobes. Others believe that auditory hallucinations occur in the language area of ??the cerebral cortex. question. Interestingly, some patients who are born deaf also experience auditory hallucinations. It is important to note that when assessing delusions and hallucinations, it is important to consider the patient's cultural background. For example, visual hallucinations occur in some religious groups. Generally speaking, religious hallucinations are more likely to cause visual hallucinations, and they are often instructive, guiding, and more pleasant. Patients with schizophrenia have more auditory hallucinations. Even rarer are olfactory hallucinations and gustatory hallucinations. For example, a patient uses quinine for abortion when she is unmarried and pregnant. This makes her feel guilty, and she will smell it whenever she thinks about abortion in the future. Quinine on the palate.

4. Changes in the sense of self

Normal people have a clear concept of their own body, know where their hands and feet are, and can distinguish them from other external things, while schizophrenia Patients often feel that their body has changed. For example, they may feel that the body's skeleton is distorted or that the flow on their forehead has become very numerous and heavy, which is noticeable; or they may feel that their eyes appear hollow and sunken deep in the skull; or The limbs appear to have very weird shapes, become smaller or more elongated, or are placed in the wrong position; or your face seems to be twice as long; or you feel that every part of your body has its own life and becomes dissociated. For example, the patient feels that his knees are shaking, his chest is bulging like a mountain, various parts of his body are separated, and his hands and feet are split into different parts. As the patient said: I have to check to know if my hands are still in my pockets. These are problems with the patient's sensory receptors.

In addition, the boundaries between oneself and others are confused. For example, the patient feels that his mother has already drank a cup of tea, so he should not drink any more tea. Another patient described: I saw the night shift nurse walking into the ward, and suddenly realized that he was me. I was looking at myself from another perspective. Another patient described that when I urinate, the whole world starts to rain. The rain came and I suddenly felt very scared.

Gender confusion is not uncommon. For example, a male patient described that his chest gradually swelled and could be seen by anyone passing by. These changes in self-perception may be accompanied by delusions and hallucinations. Even more serious, as the patient said: I woke up early in the morning and found that I had been turned into a bee.

5. Emotional changes

In the early stages of schizophrenia, patients may become depressed, fearful, and have ups and downs of emotions. However, by the end of the disease, emotions will become dull and unable to feel. mood. Depression is very common in the early stage of the disease. Patients often feel that they experience depression before delusions and auditory hallucinations. Most of these depressions are physiological, and some may also come from the patient's understanding of his illness. Secondary depression.

In addition, in the early stages of the disease, the patient may experience various emotions that become very intense and change very quickly, like religious ecstasy. The patient feels that all his problems are gone, so All wishes will be fulfilled; sometimes you will feel that your body is surrounded by a kind of warmth. In addition, sometimes patients feel self-blame or fear. This fear has no reason and no specific goal. As the patient described: I was sitting in the basement, so scared that I couldn't control myself. Even a fly would scare me. In addition to having problems controlling their own emotions, patients are also unable to correctly assess the emotions of others and respond appropriately to other people's emotions, which will cause difficulties in the patient's social skills and making friends. These emotional abnormalities of the patient may be related to the switchboard problem in the brain described earlier. The patient experiences wrong information and displays wrong emotions. As the patient described: When I am talking, many other messages often come into my mind at the same time. The other party is talking about very sad things, but there are very funny things in my mind, which makes me laugh inappropriately. In addition, the patient becomes emotionally apathetic and unable to empathize with others, and this emotional apathy becomes more and more obvious as the disease progresses.

6. Changes in movements

The movements of patients with schizophrenia often become slow and a bit clumsy. This is not necessarily a side effect of the drug. The disease itself may cause this change. The natural swing of their hands when walking will be reduced, and sometimes the blinking will also be reduced. The most severe case is the so-called catalepsy, in which patients can maintain the same posture for several hours.

7. Changes in Behavior

Changes in behavior usually come from the influence of other symptoms. For example, the patient is overly sensitive to external stimuli and cannot integrate these stimuli. The patient will retreat into a corner. Or keep your body still. Sometimes this withdrawal occurs because the patient is lost in his own thoughts, or sometimes it is an attempt to slow down the flow of external stimuli into the brain.

As described by the following patient: I feel like if I move faster, the world seems to be disintegrating. Everything seems to be mixed together and become a mess. I can't distinguish each situation. ; and if I remain completely still in this position, things seem to become easier to understand.

Another reason for slow movement of patients is the occurrence of unexpected sensory stimulation. As described by the following patient, I suddenly seemed to be hypnotized, because a terrible experience occurred, and suddenly there was a very terrible feeling. Loud sounds, as if someone had suddenly turned a huge radio on, these sounds caused me to stop all activities.

Another common thing is ritualized behavior. For example, patients sometimes walk in circles repeatedly, or keep entering and exiting the same door. For example, a female patient below described what happened when she was making a cake: When I Halfway through making the cake, the ingredients of the cake suddenly changed, and everything had a special meaning. I found that when beating eggs, I had to do it in a clockwise direction. At a certain moment, I had to stand up and face east. The egg whites had to be poured from left to right, and everything suddenly had a complicated meaning that I didn't understand, but I had to do it.

In addition, there are some special behaviors that may seem weird to others, but are important to the patient. For example, a patient shook his head rhythmically from left to right, indicating that this could shake certain thoughts out of his mind and help him clear away unwanted thoughts. Sometimes this behavior was mistaken for obsessive-compulsive behavior.

Another situation is the so-called language imitation and behavioral imitation. Verbal mimicry is when a patient repeats someone else's words like a parrot. Some believe that the patient repeats these words in order to absorb their meaning. Patients imitating the actions of others is called behavioral imitation. Some people believe that patients use this method to distinguish between themselves and others. Therefore, the patient's behavior is logical to himself, but seems crazy to outsiders. For example, a patient broke the nurse's second pair of glasses in succession. The patient explained that I felt that the doctors and nurses wanted to harm me. The nurse's glasses were meant to frame me by reflecting light on me, so I had to knock off her glasses. Even more bizarre behavior, such as taking off her clothes in public, was explained by the patient as her desire to become pure.

Disease awareness refers to whether patients understand that there is something wrong with their brain function. Some patients will tell people around them that their brain seems weird in the early stages of the disease. I don't know what happened to my brain. Everything seems to be different from before. One teenage patient knew there was something wrong with his brain and spent months researching it in the medical library. But as the disease became more severe, this awareness diminished because the brain's The functional impairment is getting more and more serious, and patients are no longer able to think rationally, but surprisingly, many patients still have a sense of illness. For example, one young patient said: I would rather lose my arm to get my old mind back. We can imagine what happens to patients. Their feelings change. They are unable to understand the meaning of messages. They have delusions and auditory hallucinations. There are also problems with the boundaries of the body. They cannot control their emotions and behavior. Imagine what it would be like if you couldn't trust your head. As one patient described, our brains are malfunctioning, but we must use this malfunctioning brain to evaluate ourselves and the world, so it is understandable that patients often feel depressed.

Another way to understand the world of patients is to view some artworks and paintings, such as the famous paintings of Van Gogh.

When we understand the inner world of patients better, we will have empathy for them and know how to help them