Positive Symptoms Of Schizophrenia: The Disorganized Dimension And Negative Symptoms

Positive Symptoms: The Disorganized Dimension

Disorganized thinking becomes apparent in patients' speech patterns as schizophrenia progresses. Affected people lose their train of thought during conversations, make loose associations of topics (tangentially jumping from one topic to another apparently at random, or on the barest of associations), and give answers to unrelated questions. Speech may be highly circumstantial, meaning that affected people may speak continuously, providing numerous irrelevant details and never getting to the point. Occasionally, speech is so disorganized that it becomes a completely jumbled "word salad" devoid of discernible meaning despite being full of words.

Disorganized behavior may range from simple problems sustaining goal-directed self-care behaviors such as personal hygiene to unpredictable and bizarre socially inappropriate outbursts. For example, people may not dress according to the weather, (i.e., they may wear a heavy coat in the middle of summer), they may wear odd or inappropriate makeup, they may shout at people for no apparent reason, or they may mutter to themselves continuously, etc. They may even strip off their clothing and run naked through the streets, while chewing on road kill. Most anything is possible.

Catatonic motor behaviors are a type of disturbed behavior (and a negative as opposed to a positive symptom) that sometimes occurs when schizophrenia goes untreated. In catatonia, peoples' reaction to their surroundings becomes remarkably decreased. They may assume a rigid, uncomfortable looking posture and then not move for hours or days, resisting efforts to move them. Catatonic patients may also display "waxy flexibility", meaning that they allow themselves to be moved into new positions, but do not move on their own. Most of the time, this is not an act or a show but rather a genuine and unpremeditated symptom of the illness that patients cannot help. Catatonia is observed with less frequency today than in past years due to advances in treating schizophrenia.

Negative Symptoms: Affective Flattening, Alogia, and Avolition

"Affect" refers to emotional expression. Affective flattening, distinguished by a restricted range of expressed emotions, is a fairly common negative symptom among some schizophrenia patients. Patients with affective flattening show relatively immobile and unresponsive facial expressions, often accompanied by poor eye contact and little body language or movement.

Alogia refers to difficulty with speaking. In some schizophrenic patients, alogia manifests as reduced total speech output, and reduced verbal fluency (the ease with which words are chosen). Patients displaying alogia struggle to give brief answers to questions, for example.

Avolition describes a loss of motivation; the will or desire to participate in activities or to do things. Some schizophrenic patients show avolition in that they will sit still for long periods of time, seemingly indifferent to their surroundings, and without displaying any interest in work or social activities. In extreme cases, this behavior becomes catatonia (as described above).

Comments
  • Patricia S Wiggins

    Your comment regarding people in psychosis as "strip off their clothing and run naked through the streets, while chewing on road kill. Most anything is possible. " is insulting and stigmatizing. Shame on you!

    Editor's Note: No insult is intended. The example is taken from real life and illustrates one way that shared social reality can be lost during a psychotic episode.

  • Janet Ashdown

    I was very pleased to read the comment re: stigma and appropriateness around your description of an individual who suffers from schizophrenia being capable of "anything", such as "running around naked while chewing on road kill". However, your editor's reply that you are merely using an example of how people can lose "shared social reality" while suffering from an acute phase of this illness does not address the issues that Ms. Wiggins raised. You have used an example of behaviour, couched in florid language, that certainly focuses on shock value and fear mongering. Anyone involved in mental health, either as a client or a service provider (of which I am both), realizes the impact of language and the difficulties presented by stigma around mental illness. People who have diagnoses and use medication to help them stay part of "social reality" will have a greater chance at wellness if that "social reality" is less fearful, less controlling, more respectful and more inclusive.

  • Renea Mohammed

    As a person who lives with schizophrenia, I find myself deeply distressed by your sensationalistic and disgusting choice of examples to illustrate the loss of contact with reality that those who suffer from illness may experience. Schizophrenia is devastating. Part of the reason that it is so devastating lies in the stigma and negative sensationalism that surrounds it. Stigma gets in the way of people seeking treatment. Stigma is a barrier to people being accepted by society. Stigma can be just as painful as the symptoms of the illness. If your website is intended to be helpful to those affected by mental illness or for those who care about them, I urge you to remove the offensive and unnecessary statement: “They may even strip off their clothing and run naked through the streets, while chewing on road kill.” In general, I hope that you will attempt to write about those who suffer from mental illness with sensitivity and respect. Please remember that no one chooses to have a mental illness.

    I would also like to suggest that you include some positive stories of recovery that will provide your readers with hope. Many people with conditions like schizophrenia go on to live meaningful and productive lives. People need to hear this.

  • Anonymous-1

    my son is now being diagnosed as having the prodromal stage of schizophrenia this article is scarry to say the least i am looking for some hope or guidance and this is definatly not it.

  • Catherine

    I am a mom of a 23 yr old son with schizophrenia, and I love him with all of my heart...thankfully appropriate meds are keeping him more lucid, productive and stable now than ever before but there was a time I fought with him trying to eat and play in feces and many other horrendous behaviors, several every bit as disgusting as the road kill comment...bottom line is the real truth hurts, and it is not pretty, but the truth is what the public needs to understand...not to simply "shock and aw" but to try to educate accurately and invoke compassion, empathy, and understanding at the real burden many of those afflicted with this illness carry when it goes unchecked and the tremendous difficulties that loved ones face when trying to help their family member achieve stability...I was not offended by the comment, I nodded in total understanding of how that can come to be.

  • Catherine

    chronic schizophrenic behavior when witnessed, can be VERY insulting and traumatizing both to the consumer and the loved ones or hapless passerbys viewing it at the time...AGAIN...it is still the TRUTH in many severe cases and there are more severe cases than many people care to believe...My son was pretty severe when he was diagnosed...and referring to episodes in his case in a more so called 'appropriate' or 'tasteful language' does not help him or me in any way what so ever....Yes he has happy stories too...like the first time he successfully cooked dinner by himself using normal foods that people could actually eat...or when he wrote a letter to a friend using language that could be understood...and as for the feces incident, he now recalls that with as much distaste as anyone would but he also knows he was not himself when it happened. Shoving the ugliness under the rug is not a uselful social tool...Not every fact of life is palatable to everyone.

  • Anonymous-2

    It seens as there are many people who finds this upsetting you would take it off this page.

    Editor's Note: While we are sympathetic to people who find the roadkill image unsettling, it is the case that the scenario described and similar variations do occur, and we want to represent what does occur. If anyone cares to suggest a rephrase of the observation, we'll consider a substitution, but we don't feel that we should not talk about these things simply becuase they make people uncomfortable. In this case, reality can sometimes be uncomfortable.

  • La'Oshiaa

    I HAVE SCHIZOPHRENIA!

    I mean I just read this and I have the disorganized part. It describes nearly every conversation I've had. Every frickin conversation. I can't tell jokes, I can't repeat a story, I can barely pass messages voice wise without people looking iat me like im crazy. Hell the only people i can talk to are family and peopel im around on a daily basis. If not im a stutter I end up saying the wrong things or the wrong words.

  • Anonymous-3

    This describes my brother to a T, both the positive and negative aspects. He hears voices in fans, radios, walls, in his house. He has followers: people in certain types of white cars, airplanes going over my house (I live directly in the flight path). He lives in his car in his driveway or at my house in bad weather. He can't control his gambling. The only way he is fully functional is at work. Right now, I'm supporting him, which isn't good, because I can't even support myself and am losing my house.

    How can I get him some help that doesn't cost anything, or very much? I can't afford anything, since when I threw out the man who broke some of my bones, I also lost his income. My house is in repossession, the IRS is after me, and so are some credit card companies, all as a result of getting rid of the man who tried to kill me. I have NO money.

    Editor's Note: If you are concerned about the IRS, you are living in the USA. In the USA, Community Mental Health Centers are the place where severely mentally ill with little means can receive care. The telephone number for the center nearest you will be in the "government" section of your yellow pages directory. Be warned that these centers have precious little resources and that there can be difficulties in getting care.

  • Anonymous-4

    Please don't kill the messenger! If you critics want to do something useful, start actually working in the field of severe mental illness. Excellent article. Well done.

  • raven

    lol I think thats the funniest think I ever heard,I am still laughing about that one.Maybe you can help me here.I was 8 yrs old when, I seen myself standing in front of me all dirty ,clothes a mess ,then something picked me up and started shake the me in front of me,I felt uncomptable every time I seen it ,red neone signs falling hiting the ground when I was a teen this happens at night.now I just dont know my family says something is wrong with me but I see nothin wrong at all they need to lissen to me then amybe they can understand what i saying ,not tell me I go off on the deep end.I do see things hear things but how can one make out which is real and which is not?

  • Lisa

    I can relate to your comments. I found this article informative with a sense of humor. And being the mid twenties wife of a schitzophrenic man for five years. He has done some very odd things, not to be taken lightly, then again some things were very funny. I find it a stuggle, because I love him so much, but he refuses treatment. He is an artist, highly intelligent, a father etc. But sometimes he chews on sticks, pine cones, and trees in general. He bathes himself with grass in feilds, and at these points I dont know whether to laugh or cry. I usually always laugh though. Because I love him, and I know he loves me too. I treat him like Id treat anyone else, without baby hands, but kind and loving.

  • Anonymous-5

    mine i would assume is mild by comparison i only see things that arent there and the like but i can offer a suggestion to thoes who want it. i got a therapy dog , he works wonders for me if i see something i watch the dog if he doesnt react to it then i dont bother with it , such as cars that i think are there and what not he barks at real things LOL . so a dog can help and he keeps me calm and foucoused since i have to feed him and walk him and waht not. so a though for some of you out there

  • not given for privacy reasons

    Your section on the life of a schizophrenic patient is interesting. I am a schizophernic patient who has suffered from physcosis. Have you ever considered the damage that it causes to say that people cannot make a full recovery and that there will always be something different about them? Is that your place to judge or decide what somebody else's body is going to do? We all know that when you are expected to be something, we beciome that, even just a little.

    People do make recoveries and don't need assistance in their lives. I work fulltime and am a fulltime student. I have no postive or negaitve symptoms. I don't have assistance at work or at home, nor do I need it. The only area where I need help is with a sympathic and understanding ear when faced with stigma, which is part of what you are expressing. I do hope that in the future, you will find away not to define an entire group of people based upon what you think (or have been told) is possible. It is possible for people to walk again after loosing the ability and it is possible for people to live normal lives with a schizophrenic dioagnosis without assistance at work or at home or acting in odd ways.

    The only thing I can say to you is that the expereince of having a mental illness is a lot like having a bad case of diarehea that is brodcast on national television. First off, it is embaracing, but then there is the way that people want to react to that by standing around and acting like their own shit doesn't stink. . .

  • Michael Pittman

    That was truely hillarious , even to me. I am 41 years old and I was first diagnosed with schizophrenia in 2000. However, looking back to my early childhood I realized I have always had these bizzare behaviors . No , not running naked or the roadkill stuff , but The distorted reality , lack of self control and basic self care. This disorder can make a person act very strange and bizzare. It has devastated my life and relationships. Medicines work for some people , but to me they just don't. I have no clue right now what I am commenting on.

  • Ash

    All the people that are offended by the road kill comment are people that must be in denial of the real life cases and examples that do exist. Yes language does create a shock factor but that shock factor is sometimes needed to show others just how serious this mental illness is and can be. Some people believe that Schizophrenia only consists of harmless delusions & hallucinations, while others believe all are violent The point is that running naked with road kill happens to be a REAL EXAMPLE THAT OCCURRED IN A CASE STUDY! Do your research, check & you will see it's true, so do not get upset b/c the segment is thorough in the explanations of examples. Also 1person said there should be a part that talks about those that have recovered & led "normal" lives to give hope, I guess I need to remind u that the article 1st states exactly that, it says many people have gone on to live ordinary "normal" lives, and does make it clear that there is hope. Do not read just parts BUT THE WHOLE ARTICLE B/F commenting!

  • chantelle

    i think i have schizophrenia. My father was schizo like very seriously. but like when im talking to my friends they always ssay oh ur so random. like my thoughts jump from thing to thing. exactly like disorganized thought. its heriditary i heard then i been smoking lot of weed and its just gotten worse. my speech is delayed when responing... do i have it then. maybe just mildly?

  • Dr. Allan N. Schwartz

    Hi Chantelle,

    There is no way I can know whether or not you have schizophrenia. It is true that it can be inherited and the fact that your father had this does increase the possibility that you might have it as well. Only a psychiatrist could do a proper diagnosis and it seems to me that making an appointment is something you might want to do so that you get an answer to this question.

    What I can tell you is that marijuana hastens the appearance of schizophrenia in those who are vulnerable to it. It is in your best interests to stop smoking. Of course, that is completely up to you but, it is now well established that, for some people, it can bring on schizophrenia.

    Dr. Schwartz

  • Donna

    Is throwing away dirty clothing as oppose to washing the dirty clothing a symptom for an individual with a diagnosis of schizophrenia. I would like to help this individual and any input would be greatly appreciated.

  • Anonymous-6

    my son is 24 years old and is starting to show signs of mental illness. I don't know what to do. He don't reconize that he need help. well I have faith that his life will get better. I hope that happen before I'm dead. life is so unfair sometime.

  • diane

    Schizphrenia is a brain disorder. It is not a one size fits all illness, of course each ill individual will experience different symptoms at certain stages of their illness. It is an illness that causes odd behaviors and actions to various degrees. The ill individual at that moment could have odd inappropriate laughter to yes eating road kill. My son is 9 and has parinoid schizophrenia and he has been in treatment for 3 yrs now and symptoms have reduced tremendously!

  • Gail Russell

    I am a sufferer of Schizophrenia and have had a lot of the symptoms spoke about in the article. I feel that if I had positive advice from Psychologists and Psychiatrists and family and friends I would have had a better time with recovery. I hear voices and have delusions. Just hearing the name the advice is take a pill. There are no hugs no you will be alright it is a death sentence. Your going to commit suicide and be poor the rest of your life. It would be nice to have someone to talk to that doesn't take God out of your life or say Church can't help or Jesus can't even help with your condition. I just wish and hope for some positivity and love and healing from the Psychological community that then allows friends and family to have a better perspective instead of being scared or withdrawing from the person afflicted with this mess. I'm still here even though I'm supposed to be dead by now. I've been suffering for about 8 years.

  • Denise

    My nephew has been recently diagnosed with this illness. I am here as a result of doing an online search for typical symptoms of this disease as he has just been re-admitted to the hospital for engaging in many inappropriate social behaviours, but namely for eating his own feces! I am grateful that I have been able to read about the other "unlovely" things that others do I now know that his conduct is not unlike the rest. Knowledge is power and it is comforting to know one is not alone in difficult situations.

  • Candace

    I don't know why so many of these people are bent out of shape over the roadkill comment. I've been around mentally ill people my entire life, in hospitals and out. I've seen EVERYTHING, maybe not somebody eating roadkill, but actually worse than that, It happens. Some mentally ill people get better and others are lifers. Just deal with it.