Schizophrenia belongs to a group of illnesses called ‘psychoses’. This means that at some stage of the illness, psychosis generally occurs. The term psychosis refers to a temporary or permanent state where a person loses touch with reality, due to a malfunction in the brain. This means that a person suffering from schizophrenia may hear voices which no one else can hear, and which often say cruel or critical things, or see things that other people can’t see, or smell things that other people can’t smell. These features of psychosis are collectively known as hallucinations. A person suffering from schizophrenia may also develop delusions. These are fixed, false beliefs with no basis in reality – for example, believing that people on television are talking about them, or that their thoughts are being controlled by other people. This can be very frightening, and may lead to bizarre behaviour, such as avoiding people or saying odd things to friends and family.

Schizophrenia can affect people in different ways – it has even been said that no two cases of schizophrenia are identical.[1]  Often people exhibit a combination of symptoms – but in some cases, different types of symptoms might emerge at different points of the illness.

Symptoms of Schizophrenia

The symptoms of problems of schizophrenia generally fall into two categories: psychotic (or positive) symptoms and negative symptoms. The positive symptoms of schizophrenia are so called because they seem to be experiences that are ‘added on’ to a person – in contrast to negative symptoms, which are considered to be features that are ‘lost’ by a person experiencing schizophrenia.

Positive Symptoms

The positive symptoms of schizophrenia are mostly seen in the acute, or florid stages of the illness. They reflect distortions of reality – and may come on gradually, or very quickly.  These symptoms are more responsive to medication than negative symptoms.

Auditory hallucinations are the most common of all positive symptoms. They are mostly experienced as voices. To a person with schizophrenia, these voices sound just like people speaking to them – people with the illness cannot differentiate between what is real (a friend speaking to them) and what is a hallucination. Voices might be heard in the second person (for example someone saying “You stink”, “You’re ugly”. Sometimes, voices might command a person to do something  (by saying, for example, “Jump off the bridge”, “Take an overdose”). People with schizophrenia may also have third person hallucinations, which most commonly takes the form of two or more voices taking among themselves, or commenting on the person’s behaviour. Third person hallucinations are considered to be more typical of schizophrenia than any of the other psychoses.

In addition to voices, auditory hallucinations can involve noises, such as buzzing, screeching, and ringing.

Additionally, people with schizophrenia may think that their own thoughts are being broadcast, or can be heard by other people. They also might think that other people’s thoughts are being forced into their own minds, or that their thoughts have been stolen from their heads.

Hallucinations of all five senses may be experienced. In addition to auditory hallucinations, people may have tactile hallucinations (feeling as though they are being pushed, touched, or held down), visual hallucinations (seeing things that aren’t there, feeling that colours are brighter than they should be), hallucinations of smell, and hallucinations of taste.

Delusions are also common in schizophrenia. People develop fixed, unshakable beliefs based on their psychotic reality, and it is very difficult to try and reason with someone experiencing delusions, because to the person, the delusions are very real. They might believe that they are being hunted by government agents, or that aliens are communicating with them through the radio or television. Sometimes, delusional ideas can be grandiose, such as someone believing that they are able to control the weather or are a member of a royal family.