The inner world of schizophrenic patients
First, the change of sensory perception:
The change of sensory perception is especially obvious in the early stage of schizophrenia. According to research, about two-thirds of patients have this change, and all sensory receptors will become strong or passive.
1. The change of hearing, as described by the following patient: I heard all the voices in heaven and earth, and also heard many voices in hell. It's like someone turns everything up, and I notice all the sounds in the background. However, I don't pay special attention to anything, but everything will catch my attention. If I talk to you now, I can hear the voices in the next room and corridor. I can't help but pay attention to them, so I don't pay attention to what I said to you. Sometimes even the most boring things attract me and make me spend a lot of time on them.
2. The change of vision is even more obvious than the change of sound. As mentioned below, everything becomes more vivid and clear, just like a glowing picture, and it looks very flat, just like a plane. Moreover, not only these colors attract my attention, but all the little things will make me stare for a long time, such as the lines on the edge, and so on. Everything looks terrible. People look like demons-with black outlines and shining eyes. All objects-chairs, houses and things have their own lives. They have a threatening posture and an animal-like appearance. The child looks deformed, as if he had had plastic surgery. Children look like rubber.
3. In addition to the changes in hearing and vision, the sense of touch may also change: being touched is terrible, and touching anyone will make me feel electrocuted. I feel like a mouse in my throat, and his body seems to disintegrate in my mouth. A doctor described that his patient felt that his genitals were getting darker and darker, and he had delusions and fears and asked the doctor to check every minute. Because of excessive sensitivity, patients will be overwhelmed by external stimuli, and they can see everything and hear everything. Normal people, our brains naturally filter images and sounds, so that we can focus on what we choose.
Second, the understanding and response to information is abnormal.
Normal people's brain function can classify and understand information from the outside world, and then make correct responses selectively. These reactions are accumulated through learning, which are logical and predictable. Schizophrenia patients have defects in the classification, understanding and response of information, so they not only have problems in thinking, but also are affected in visual and auditory stimuli, emotions and behavioral responses, just like there is a problem with the brain switchboard, which cannot correctly classify the incoming information, thinking, thoughts, memories and emotions, but are completely mixed together. For example, normal people can automatically convert the sentences they hear into ideas. We don't need to focus on a single word, we just need to think about the meaning of the whole sentence, but for patients, as they describe: if people speak simply, I can concentrate, but if the sentence is too long, I can't understand the meaning; To me, it's just a bunch of words. I must try to piece it together. It takes me a lot of effort. What they say seems to be a foreign language. I can't understand what they are saying. Not only hearing, but also sight, as described by the following patient: everything is broken into pieces, and I have to try to put them together. For example, when I see a watch, I see the strap, the surface and the hands. I have to work hard to understand that this is a watch. Another patient described his experience of seeing a psychiatrist. He saw teeth, nose, chin, eyes and various parts, which made him very scared. He can't recognize who he is. This defect in visual understanding is very common among schizophrenics, who mistake people for others and say that they look like some people. For example, a patient said: I was in the hospital this morning. I seem to be making a movie. I see the stars around me. In addition to the above problems, schizophrenics 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 TV at the same time. This kind of difficulty in watching TV is typical, so in mental hospitals, it is rare to see patients sitting and watching TV all the time; Sometimes they sit and watch TV, but they can't describe what they see. This situation has nothing to do with the patient's intelligence education level, and even some patients who graduated from college can't help it. If you ask him why he doesn't watch TV, he will tell you that he can't understand what is on. Or they will tell you that he is tired and doesn't want to watch TV, in order to cover up this deficiency. They are more acceptable to cartoons or travel programs, because these are only visual stimuli and do not need to integrate hearing and vision.
In addition to the lack of classification and understanding of information, there are obvious problems in the response to stimuli, and inappropriate responses are often made. Therefore, patients with schizophrenia will also have problems getting along with others. Many patients prefer to rest alone and talk to others as little as possible, because these processes are difficult and painful for them, and they will try their best to avoid them.
The problems in language expression of schizophrenic patients include phonological connection: patients only pay attention to the sound part and ignore the meaning of words.
1. Thinking disorder: When asked about idioms, patients only pay attention to words, but can't understand the meaning of the whole idiom. For example, people who live in glass houses should not throw stones at others. Patients will only pay attention to glass houses and stones, but will describe what kind of glass houses and stones.
2. Dyslexia: As the patient said, I can't express what I want to say. Now my brain seems to be blocked and I can't say what I want to express correctly. Sometimes I just find a word to replace it.
3. The most extreme example is the language salad: the patient expresses completely meaningless and incoherent words.
A common symptom outside is the interruption of thinking, just like the switchboard in my brain, which suddenly stops for a few seconds and then continues to operate. As the patient described, when I was thinking, I suddenly stopped at a word or an idea and couldn't operate. My whole brain couldn't think of anything. Another patient described: when I was studying, I was suddenly caught in a quagmire by a sentence, as if I were hypnotized. This word attracts me, and I can't think about it any more.
5. A common symptom is contradiction. The patient can't deal with his brain, and he has two opposite thoughts and feelings at the same time. As the patient said, I have two opposite ideas about all kinds of things in my brain, both of which are contradictory, and then the whole brain seems to be in pieces, and the whole person has disintegrated.
Schizophrenia patients have these problems in the classification, understanding and response to stimuli, and in the eyes of normal people, they are incoherent, illogical, thinking disorders and atrophy. In this case, the patient's judgment is impaired. In the early stage of the disease, these symptoms are vague and not obvious, but with the severity of the disease, these deficiencies become more and more obvious. Every schizophrenic patient has some of the above symptoms to some extent.
Third, fantasy and false hearing.
Auditory hallucinations and delusions are the most common and famous symptoms of schizophrenia, which are mostly caused by patients' distorted feelings about external things. Delusion is the wrong idea of patients, which is incorrect for their customs and culture. Usually paranoia comes from patients misinterpreting their feelings and connecting unrelated things around them with themselves. For example, when you are walking in the street, there is a person coughing in the street, and you may not feel or notice him. But for schizophrenics, he can not only hear a cough, but also immediately think that this cough is aimed at him and has some special significance to him, and then think that this cough is warning another person and telling him that the patient is coming. In this case, if you try to argue with the patient and tell him that nothing happened, the patient may still think that you are with them and just want to cover it up. Therefore, because patients are too sensitive to some sensory perception,
The illusion of being killed, being watched and being attacked is the most common. Some patients may attack others for self-defense reasons, but after all, they are still a minority among all schizophrenics.
It is also common to exaggerate delusions, for example, patients feel that they have the power to control the weather, control the movement of the sun and other planets, or think that they are Jesus Christ. As the following patient said: I think I am a star. I'm making a movie. Everywhere I go, I have an invisible camera and microphone to record all my things, words and actions. They are taking pictures of me. It is sometimes dangerous to exaggerate delusions. If the patient thinks he can fly, it may cause an accident. There is a particularly exaggerated delusion, usually that celebrities love him and pursue him. For example, some patients think that a famous politician loves him very much and spend all his time and money tracking his actions, but keep a certain distance. He also has a set of reasons to explain why the man dare not let him know that he is following his actions. In addition, some patients think that he has the ability to control others' psychology. For example, there was a female patient who was afraid to leave the house for five years because she thought that if she went out, it would affect others' hearts and others would look at him. He is like a magnet, and others can't help turning to look at him.
Another typical symptom is the diffusion of thoughts, and patients feel that the ideas in their brains will spread.
Delusions are sometimes fixed and sometimes fluctuating. For example, some patients may think that A wants to kill him. On the first day, he may keep his distance from A, but on the second day, he will have a good chat with A, and on the third day, he will keep his distance.
Patients' hallucinations can change from over-sensitivity to vision to real hallucinations. When the vision is over-sensitive, patients feel particularly bright when they see light. Furthermore, patients have the illusion of distorting visual information, such as treating dogs as tigers. What is more serious is the real illusion, in which the patient feels seeing, hearing, feeling, smelling or eating something without any external stimulus. These experiences are very real for patients. So we can see the patient talking to himself and to the voice he heard. Auditory hallucinations are the most common hallucinations. They may be simple sounds, repeated words, or even hearing many people talking, and they will last all day. The most common time of auditory hallucination is before going to bed. The content is usually accusatory, scolding patients and sometimes swearing. The patient may be embarrassed to tell the medical staff. Some patients will also hear pleasant sounds. The mechanism of auditory hallucination is unknown. Many parts of the brain are responsible for hearing function. Some people think that the auditory function near temporal lobe and frontal lobe is caused by the increase of blood flow, while others think that there is something wrong with the language area of cerebral cortex. Interestingly, some patients who are born deaf will also have auditory hallucinations. It is worth noting that when evaluating delusions and hallucinations, it should be based on the patient's cultural background. For example, some religious groups have hallucinations. Generally speaking, religious hallucinations often have hallucinations, which are indicative, guiding and enjoyable. Schizophrenia patients have more auditory hallucinations. In addition, even rarer are olfactory hallucinations and taste hallucinations. For example, the patient is unmarried and pregnant, and using quinine as an abortion makes her feel guilty. In the future, she will smell quinine when she thinks about abortion.
Fourth, the feeling of self-change
Normal people have a clear concept of their own body, know where their hands and feet are, and can be separated from other external things. Schizophrenia patients often feel that their bodies have changed. For example, they may feel that the skeleton of their bodies is distorted or the flowing sea on their foreheads becomes heavy and obvious. Or feel empty eyes, trapped in the skull; Or the limbs are very strange in shape, smaller or slender or misplaced; Or your face seems to have doubled; Or feel that every part of your body has its own life and becomes free. For example, the patient feels that his knees are shaking, his chest is bulging like a mountain, all 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 hand is still in my pocket. These are all patients' feelings about themselves.
In addition, the boundaries between yourself and others are confusing. For example, if the patient thinks that his mother has drunk a cup of tea, he should not drink any more tea. Another patient described: I saw the night nurse walk into the ward and suddenly realized that he was me. I'm looking at myself from another angle. Another patient described that when I urinated, the whole world began to rain, and I suddenly felt very scared.
Gender confusion is not uncommon. For example, a male patient described that his chest was gradually bulging, and as long as anyone passing by could see it, these changes in self-perception might be more serious with the connection between delusion and hallucination. For example, the patient said, I woke up in the morning and found myself turned into a bee.
V. Changes in mood
Early schizophrenics may become depressed, afraid and emotional ups and downs, but at the end of the disease, their emotions will become passive and there is no way to feel them. Depression is common in the early stages of illness. Patients often feel depressed before delusions and auditory hallucinations. Most of these melancholia are physiological, and some of them may come from the secondary depression caused by the patient's understanding of his illness.
In addition, in the early stage of the disease, patients may experience that various emotions become very strong and change very quickly. Like religious ecstasy, patients feel that all their problems are gone, so their wishes will be satisfied; Sometimes I feel my body is surrounded by a warmth. In addition, sometimes patients feel remorse or fear. This fear has no reason and no clear goal. As the patient described: I was sitting in the basement, scared out of control. Even a fly will scare me. In addition to controlling their own emotional feelings, patients can't correctly evaluate others' emotions, and can't respond appropriately to others' emotions, which will make it difficult for patients to socialize and make friends. These emotional abnormalities of patients may be related to the problem of the switchboard in the brain mentioned above. When patients experience the wrong information, they will show the wrong emotions. As the patient described, when I was talking, many other information often appeared in my mind at the same time. The other person is saying something very sad, but there are ridiculous things in my mind that make me laugh inappropriately. In addition, the patient's mood has become indifferent and unable to empathize with others, and this kind of emotional apathy has become more and more obvious with the progress of the disease.
Six, the change of action
Schizophrenia patients tend to become dull and clumsy, which is not necessarily a side effect of drugs, but the disease itself may lead to this change. When they walk, the natural swing of their hands will be reduced, and sometimes the blinking will be reduced. The most serious case is the so-called rigid schizophrenia, in which patients can maintain the same posture for several hours.
Seven. Behavior change
Behavior changes usually come from the influence of other symptoms, for example, patients are too sensitive to external stimuli, unable to integrate these stimuli, patients will retreat in the corner, or keep their bodies still. Sometimes, this retreat is because the patient is deeply immersed in his own thinking world, or sometimes it is to slow down the speed of external stimuli entering the brain.
As the following patient described: I feel that if I move faster, the world seems to be disintegrating, and everything seems to be mixed together, becoming a mess, and I can't tell every situation; If I keep this posture completely motionless, things seem to become easier to understand.
Another reason for the patient's slowness is unexpected sensory stimulation. As described by the following patient, I suddenly seem to be hypnotized. Because of a terrible experience, suddenly there was a loud noise, as if someone suddenly turned on a huge radio and stopped all my activities.
Another common ritual behavior, such as patients sometimes walk in circles repeatedly, or keep going in and out of the same door. For example, the following female patient described what happened when she was making a cake: I was halfway through making a cake, and the material of the cake suddenly changed, and everything had a special meaning. I found that I had to beat eggs clockwise. At some point, I had to stand up and face the east. protein had to fall from left to right. All of a sudden.
In addition, some special behaviors are weird to others, but important to patients. For example, the patient shakes his head rhythmically from left to right, which means that it can shake some thoughts out of his mind and help him get rid of unwanted thoughts. Sometimes this kind of behavior can be mistaken for coercion.
Other situations are so-called language imitation and behavior imitation. Language imitation means that patients repeat what others say like parrots. Some people think that patients repeat these words in order to understand the meaning of absorbing them. The imitation of others by patients is called behavioral imitation. Some people think that patients use this method to distinguish themselves from others. So the patient's behavior is logical to himself, but crazy to outsiders. For example, a patient broke two pairs of glasses of a nurse in a row. The patient explained that I think doctors and nurses want to hurt me. The nurse wears glasses to make me reflect light, so I have to take off her glasses. Even more bizarre behaviors, such as undressing in public, the patient explained that she wanted to be pure.
Sickness refers to whether the patient knows that there is something wrong with his brain function. Some patients will tell people around them at the beginning of the disease that his brain seems strange. I don't know what happened in my head. Everything seems different. A teenage patient knew that there was something wrong with his brain and spent several months searching for relevant information in the medical library. However, when the illness is serious, this feeling of illness is reduced, because the brain function defect is getting more and more serious, and patients can't think rationally. Surprisingly, many patients still feel sick. For example, a young patient said: I would rather lose my arm for my old brain. We can imagine what will happen to the patient. Their feelings have changed, they can't understand the meaning of information, they have delusions and auditory hallucinations, their physical boundaries are confused, and they can't control their emotions and actions. Imagine what happens when you can't trust your brain. As a patient described, our brain is defective, but we must use this defective brain to evaluate ourselves and the world, so it is understandable that patients often feel depressed.
Another way to understand the patient's world is to watch some works of art and paintings, such as Van Gogh's famous paintings. When we know more about patients' inner world, we will have empathy for them and know how to help them.