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(1) Schizophrenia: Split Self

Introduction: Schizophrenia is actually not as scary as we think, simply because patients experience a world different from ours, and everything they do is based on their own The world reacts and they are left helpless and ununderstood. This article includes: 1) explanation of the definition of schizophrenia; 2) symptoms of schizophrenia, a detailed description of the patient's way of thinking, and behavioral symptoms, such as confusion in thinking and speech, irritable and nervous behavior, and depressive-like phenomena; 3) diagnosis Method (brief description); 4) The cause of the disease, such as genetic inheritance, environmental influences, nerve conduction problems, and brain structure problems; 5) Treatment of the disease (brief description), including biological treatment, psychological treatment and rehabilitation treatment; 6 ) How to treat schizophrenia patients around you; 7) Quote.

Schizophrenia (English: Schizophrenia) is a type of mental illness, different from split personality. Its previous name is: schizophrenia. It is a literal translation of the English name Schizo phren ia. Common symptoms include Delusions, hallucinations, gibbering, overall chaotic or rigid behavior, and negative symptoms. After the onset of the disease in adults, the interpersonal, occupational, and self-care functions are significantly lower than before the onset of the disease; in children and adolescents, after the onset of the disease, the expected interpersonal and academic performance cannot be achieved. Or occupational function. The prevalence rate in Taiwan is 0.4 (113,183 people), and the incidence rate is 1 for both men and women. The lifetime prevalence rate is about 1. Diagnosis of schizophrenia often occurs in adolescents. Based on the diagnostic criteria of DSM-5.

Studies believe that genetics, childhood environment, neuroscience, and psychological and social processes are important factors in causing schizophrenia; certain recreational or prescription drug use can also cause it. Or worsening symptoms. Today's psychiatric research focuses on the role of neuroscience, but so far no reasonable physiological cause has been found.

Simply put, people with schizophrenia have internal and external problems. Real life is out of touch, and they will have a lot of delusions and hallucinations, but they have no way of telling you what is true and what is false. Let’s put it this way, as long as they think it is true, it is true! It's hard to change their views no matter how much they talk or talk, and they don't know why things are so irrational, but they just believe them!

Many people have fantasies. And imagination, for example, when you were a child, you could hold two stones and play by the river with your imaginary friends all day long; or you could buy a lottery ticket and imagine what it would be like to win the jackpot. But these normal imaginations are very different from the imaginations in the minds of schizophrenia patients. The difference lies not only in the content of the imagination, but also in the way they treat the imagination and the subsequent behavioral consequences.

Ordinary people. After imagining, they will touch their nose, return to reality, and admit that all this is just a dream (of course it may also be a nightmare), but schizophrenia patients will think that all these imaginations are real. Let us call it the patient's mind. The imagination is called "delusion", and the result of the delusion may bring about some "hallucinations"

First of all, their imagination is basically surreal. For example, the wife can use the microwave to send radio waves and abandon her home. The idea of ????being implanted into their brains. Or their intestines were operated on at night and turned into a snake squirming inside the body.

Secondly, this does not happen overnight. ! These delusions occupy all of his life. He will also search for all kinds of evidence in his life to support his opinions, and they will shake the evidence in their hands and shake your shoulders more carefully than the police. , coercing you to believe them (in fact, this also means that they believe you. In serious cases, they will either not touch you because they are worried about getting dirty; or you are the perpetrator in their minds, and it is too late to prevent you).

Furthermore, they will never think that they are wrong! Even if there is clear evidence in front of them and you tell them, "Look, your idea is ridiculous," what do you think they will say? That’s right! All that evidence is a conspiracy to force him to remain silent or brainwash him! Moreover, patients with delusions may always feel that others know their inner thoughts, or the privacy of themselves and their families. Patients believe that others already know these things before the patient expresses them, although they do not know how others understand their inner thoughts. ideas.

These symptoms, which sound extremely funny, are also important criteria for judging schizophrenia. Hallucinations include visual hallucinations, auditory hallucinations, olfactory hallucinations, etc. The vast majority of patients with schizophrenia will experience hallucinations to some extent, among which auditory hallucinations are the most common. For example, Xiaoli often hears boys in the class calling herself obscene, and hearing The radio is broadcasting notices that students are ostracizing themselves. This is a kind of auditory hallucination. These sounds obviously do not exist, but the patient firmly believes that they exist.

An introduction to the main classifications of delusions will be presented to you in detail in the table below.

Every sentence spoken by this patient seems to have correct grammatical structure, but there is no connection between each sentence, and the logic is confusing, making it impossible for the listener to understand the patient. What I want to express is that I feel that the other party always answers the question incorrectly and cannot communicate. This is an important symptom of schizophrenia - "broken thinking", which means there is a lack of internal connection between the contents of thoughts.

In addition to broken thinking, schizophrenia patients also show various other abnormalities in thinking forms. For example, some patients will have the phenomenon of "new words", which is to combine similar words together. , and then give it a new meaning, such as putting "日" and "西" together to form one word, which means a day and night.

In addition, there are some patients who will give some special meaning to ordinary daily things. For example, a schizophrenic patient insists that the TV is bourgeois, the table is proletarian, and the TV is placed on the table. The upper class means that the bourgeoisie is superior to the proletariat, so they ask their families to move the TV set under the table, saying that this means the proletariat has won.

"Running thinking" means that the patient talks a lot, quickly, eloquently, and even humorously, and there are some logical connections between these words.

Confusion in thinking and speech is one of the most common symptoms of schizophrenia. Along with weird thinking and speech, schizophrenia patients will also have corresponding weird behaviors. We learn from TV The weird behaviors called "neuroses" that people hear and see in books and even in life are mostly typical symptoms of schizophrenia. They are patients with relatively intense confrontational behavior. They will be suspicious at first, and then start to avoid interpersonal communication. In the later stage, most of them will have hysterical symptoms. They smash things and beat people. Some patients will hurt themselves or even commit suicide.

In addition to these obvious intense symptoms, some patients with schizophrenia will also experience some freezing symptoms, which academic circles call catatonic behavior. We just learned that neurotransmitters inside the brain affect our brain activity, thus controlling our consciousness, movements and behaviors. Patients with catatonic behavior appear to be unable to use their brains to control their body movements, and their limbs can be manipulated like Transformers models. Some patients' elbows are so stiff that normal people can't even move them; sometimes they will forcefully grab things around them, as if they are eager to find a support point; and sometimes they will forcefully refuse others' suggestions. Some simple requests are like being unable to control one's own body.

Like murderers, schizophrenia patients who act out weird thoughts at all times and are always dishonest are easier to identify. They mainly have positive symptoms, which are what we usually think of as "madmen". They yell and behave strangely all day long and have many incredible ideas.

But other patients mainly have negative symptoms. These people are particularly quiet, staying in the corner obediently, not doing anything, not talking, not participating in social activities, and not interested in anyone or anything. . When you meet them, you may just think that they are introverted and don't like to talk, or that they have been severely hit recently and are a little depressed. But chances are, their situation is more complicated than you think. To put it simply, positive symptoms mainly refer to some abnormal concepts, behaviors and sensory experiences, while negative symptoms refer to the lack of and regressive behaviors of schizophrenia patients, mainly including emotional apathy, poverty and lack of motivation. Some patients have mainly negative symptoms when they first develop the disease, and some patients have mainly positive symptoms in the early stages of the disease and when symptoms are fully developed, but in the later stages, they have mainly negative symptoms.

Have you ever thought that the negative symptoms of schizophrenia look a bit like depression?

Among schizophrenia patients, 25% are depressed, some are depressed because of the side effects of antipsychotic drugs, and some are depressed because they feel that they are unfortunate to have schizophrenia. Having said all this, depressive symptoms are actually two different things from the negative symptoms of schizophrenia, but their manifestations are somewhat similar.

So how to distinguish depression from schizophrenia with mainly negative symptoms?

Schizophrenia patients with predominantly negative symptoms are separated from reality, like a piece of breathing wood that has no response to you at all. Some patients with severe depression look like wood, but you can still read their worries in their eyes. If you feel carefully, you may feel that they still have some emotional communication with their surroundings and are not completely separated.

Positive symptoms: Positive symptoms represent an increase in certain behaviors and abilities, and are behavioral manifestations that are relatively easy to detect. These symptoms often lose touch with reality. Positive symptoms include delusions, hallucinations, disorganized speech and thinking, and disorganized behavior.

Negative symptoms: Negative symptoms are of course the opposite of positive symptoms and represent the lack or reduction of certain abilities. Negative symptoms may be mistaken for laziness or depression, but are difficult to identify as part of schizophrenia symptoms.

In the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) formulated by the American Psychiatric Association (APA), the diagnostic criteria for schizophrenia are as follows—Characteristic symptoms: two of the following The above should all appear within one month (if effective and successful treatment, the time limit can be shorter) and a significantly longer period of time.

(1) Delusions; (2) Hallucinations; (3) Disorganized speech (for example, often talking about "off the rails" or being lax); (4) Obvious disorder or catatonic behavior; (5) Negativity Symptoms include dull emotion, poor speech, or loss of will.

(Note: If the delusions are absurd and weird or the hallucinations are a live broadcast of the patient's behavior or thoughts, or there are two or more voices talking to each other, only one item is sufficient.)

The diagnostic criteria for schizophrenia in the Chinese Classification and Diagnostic Criteria for Mental Disorders (CCMD) are as follows: Schizophrenia is a group of mental illnesses of unknown etiology, which mostly onset in young adults and often have a slow onset. There are many obstacles in thinking, emotion, behavior, etc., as well as uncoordinated mental activities. Usually the consciousness is clear and the intelligence is good. Some patients may suffer from cognitive impairment during the disease process. The natural course of the disease is often protracted, with repeated exacerbations or deteriorations, but some patients can maintain recovery or basically recover. Symptom criteria: There are at least two of the following, which are not secondary to disturbance of consciousness, intellectual disability, high or low emotion, and are separately specified for simple schizophrenia:

(1) Recurrent verbal auditory hallucinations.

(2) Obvious thinking slack, broken thinking, incoherent speech or poor thinking or poor thinking content.

(3) Thoughts are inserted, removed, spread, thinking is interrupted or forced thinking.

(4) Passive, controlled or insightful experience.

(5) Primary delusions (including delusional perceptions, delusional moods) or other absurd delusions.

(6) Logic inversion, pathological symbolic thinking or new vocabulary.

(7) Emotional perversion or obvious emotional apathy.

(8) Nervous syndrome, weird behavior or stupid behavior.

(9) Obvious decrease or lack of will.

Severity criteria: Impaired insight, severe impairment of social functions or inability to hold effective conversations.

In general, schizophrenia is a brain disease that may be caused by psychological stress. Schizophrenia may be caused by brain dysfunction. Because most people with schizophrenia develop symptoms under stress, psychological stress may be a trigger for the disorder. Until now, the true cause of schizophrenia has not been determined, but it is believed to be biochemical changes in the brain. Due to changes in biochemical substances, patients develop hallucinations, delusions and other thought disorders. We also know that some drugs can improve the symptoms of schizophrenia because these drugs are made of chemicals that balance the brain's biochemistry.

Although countless scientists continue to study, we have still not been able to discover the real cause of schizophrenia. The only thing that is very certain is that for schizophrenia to break out, it is generally a combination of congenital causes (heredity) and acquired conditions. A combination of causes (circumstances). It cannot provide a radical cure for schizophrenia patients, but with our current knowledge, we can already provide many treatments that are helpful to the patients.

0 genetic relationship

If five-year-old Wang Xiaobao’s relatives and friends have never had a history of mental illness, then the chance that Xiaobao may develop schizophrenia in his lifetime is probably 1. If Xiaobao grows up in the future and accidentally becomes the spouse of a schizophrenic patient, then the chance of Xiaobao developing schizophrenia in his lifetime will quietly increase by 2 percentage points to 3.

25 Gene Relationship

Let’s look at it. Wang Xiaobao’s uncles, aunts, uncles and nephews share about 1/4 (25) of the similar genes with Xiaobao. If any of these people have had With a history of schizophrenia, the probability that Xiaobao may suffer from schizophrenia is probably around 3.

50 genetic correlation

Brothers and sisters share 50 genetic correlation with us, so if one of Xiaobao’s brothers and sisters is a schizophrenia patient, then Xiaobao will have 50% genetic correlation in his life. The risk of developing schizophrenia is about 10. If one of the parents is a schizophrenic patient, the probability that the baby will develop schizophrenia symptoms is 13. Even if it's twins (fraternal twins), it's probably 14.

Strong genetic relationship

One is that Xiaobao’s parents are both schizophrenia patients. The other is twins who look exactly like Xiaobao (identical twins). Basically, we can say that in this case, the genes of both parties are almost 100% shared! Even so, Xiaobao's risk of schizophrenia in his lifetime is only 46.

Another breeding ground for schizophrenia symptoms is the environment. We are not talking about the "external" environment. External environmental factors like neighbors may not necessarily start the seeds of a person's internal schizophrenia symptoms. On the contrary, the members within their family - father, mother, grandfather, grandmother, grandfather, grandmother, brothers and sisters have a much greater influence on them than the external environment! Research has found that patients with schizophrenia generally have problems with their family communication patterns, and they are unable to establish close relationships with their families, so scholars suspect this is one of the causes of the disease. In this regard, scholars have put forward several theories to explain:

Many studies have focused on the role that neurotransmitters in the brain may play in the development of schizophrenia. Most previous studies have focused on a neurotransmitter called dopamine, believing that excessive activation of dopamine in the brain causes schizophrenia. There is some evidence that strongly supports the dopamine theory, but there are also some research results that do not support it.

Drugs that block dopamine receptors act on the receptors very quickly; however, it sometimes takes several days for these drugs to show behavioral changes in people with schizophrenia. The mode of action of dopamine blockers may be indirect, and these drugs may affect systems more influential in the symptoms of schizophrenia. Based on the above research results, some drugs have emerged - clozapine, which can block serotonin and dopamine at the same time.

Are the brains of schizophrenia patients different from ordinary people? The brains of people with schizophrenia appear to be a little different from the brains of healthy people, but the differences are small. Sometimes people with schizophrenia have larger ventricles (fluid-filled cavities in the center of the brain), lower amounts of gray matter overall, and more or less metabolic activity in certain areas of the brain. Microscopic studies of brain tissue after death have shown subtle changes in the distribution and characteristics of brain cells in schizophrenia patients. Many of the changes appear to occur prenatally because they do not accompany glial cells. If the brain is damaged after birth, glial cells will always appear. One theory is that problems during brain development can cause faulty connections that remain dormant until adolescence. The brain undergoes major changes during adolescence, and these changes may trigger psychotic symptoms.

Treatment for schizophrenia can be divided into three types: biological treatment, psychological treatment and rehabilitation treatment. Let’s use a short story to explain these treatments in detail.

Biological treatment, in a narrow sense, means sending the patient to the hospital for injections and medication. Broadly speaking, biological treatments include electroconvulsive surgery and surgery in addition to medication. However, the method of electroconvulsion is less commonly used, and the use of general anesthesia and muscle relaxants improves safety. Surgery can be traced back to the 1930s. A foreigner from Portugal used to remove the white matter of the frontal lobe to treat schizophrenia. This method became so popular that he even won the 1949 Nobel Prize. Unfortunately, people eventually discovered that this surgery had too many side effects, so this method was quickly eliminated! After all, psychosurgery is risky, so don’t do it unless you have no choice but to do it.

There are three main schools of psychotherapy: psychoanalysis, cognitive behavioral and family therapy. For patients with schizophrenia, different schools of treatment follow their own rules, but they all achieve the same goal by different approaches. They all hope to improve the psychological function of schizophrenia patients, that is, to allow them to cultivate their internal strength. But not all patients with schizophrenia are suitable for psychological treatment. The prerequisite for using psychological treatment is that the patient has normal thinking activities, and it is best to enter the recovery period.

Finally, let’s talk briefly about rehabilitation treatment. Why is there rehabilitation treatment? Wouldn’t it be possible to be treated in a mental hospital and fully recovered before being released? This should take into account my country's basic national conditions. According to data released by the Mental Health Center of the Chinese Center for Disease Control and Prevention in early 2009, the number of patients with various mental illnesses in my country exceeds 100 million. More monks and less rice, more patients and fewer hospitals! Therefore, it is very necessary to set up service points for rehabilitation treatment in grassroots communities. Of course, some hospitals will also provide rehabilitation treatment in the later stages of treatment. It is said that some hospitals provide music therapy, calligraphy therapy, and even cooking therapy!

Your worries are normal and completely understandable. Seeing strangers walking and talking to themselves can be a nerve-wracking sight, let alone someone you believe is mentally ill. However, the data can clearly tell you that as long as they receive treatment, the probability of schizophrenia patients actually engaging in violent behavior is not higher than that of the average person (that’s you and me). In fact, people with schizophrenia are often the biggest victims of their own mental illness. They may become withdrawn and avoidant due to fears derived from delusions and confusion about reality.

So, how to treat patients with schizophrenia? Many psychotherapists have pointed out that, if conditions permit, leaving family and living in a different environment is very beneficial to the patient's recovery.

Because family members are too cautious when facing patients, they may cause or aggravate patients' suspicion of the surrounding environment. Just imagine, you and another roommate are whispering in a low voice to prevent the sick roommate from hearing. How would the sick roommate feel? If he is in the period of illness, it is likely to trigger delusions of being talked about and persecuted. If he has recovered well, such special treatment will also make him feel overwhelmed.

Our suggestion is that even if doubts are unavoidable, try to treat patients with schizophrenia in a natural, unpretentious, and unpretentious manner - especially since we already know that the patient has basically recovered from the onset of illness. When it returns to normal. Don't worry that speaking loudly will scare them, or that a little dissent will irritate them. Although it is not easy, trying to treat them as normal people is the first step in helping them return to a normal life. For patients who are in the onset stage, it is most necessary for them to receive professional treatment and help in a timely manner. With certain knowledge, I believe you can handle this situation well.

Yes, it seems that at present, we still cannot determine the cause of this disease, and we cannot cure schizophrenia. However, let us think about it again. The various diseases that exist in our lives, such as heart disease, hypertension, diabetes, malignant tumors, nephritis, osteoporosis... are all incurable. However, people who suffer from these diseases are still Live a basically normal life. Why do patients with schizophrenia receive special treatment because they cannot be "cured"?

If conditions permit, with psychological counseling and professional support and advice, I believe that most schizophrenia patients may still be able to survive the dangerous and difficult adolescence and early adulthood. Live a happy and fulfilling life. Harsh and cold statistics also support this: 58% of patients can live independently after receiving treatment, and 42% of patients can still work to earn money to support themselves.

"91 Centimeters Away" is a French animated short film that explores the world of schizophrenia patients. The director believes that schizophrenia is not as scary as we think. , simply because patients feel a world different from ours, and everything they do is in response to their own world. They are lonely, helpless, and ununderstood.

The content of this article is mainly summarized from the first chapter "Split Self-Schizophrenia" by Wang Yu/Wu Xia's "Abnormal Psychology: A Guide to Identifying Abnormal Humans". This article excerpts a large number of Original content, copyright belongs to the original author, and will be deleted if infringed upon! This book is a good popular science book on abnormal psychology. The author's language is simple and easy to understand. It can cultivate a better interest in psychology and also help you understand the symptoms of some common mental illnesses in a more vivid way.

In-depth reading: Jeffrey S. Nevid and Spencer A. Rathus, professors of psychology at St. John's University, and Beverly A. Greene of New York University co-authored "Abnormal Psychology: Perspectives in a Changing World (6th Edition)" (Set of two volumes)".