Okay, this might be an annoying question so feel free not to answer, but do you have advice for writing a character who has schizophrenia? It seems like many schizophrenic characters are written poorly, and I was wondering if you have any specific things to do or to avoid.
I think schizophrenic characters are written poorly because everyone thinks they know what schizophrenia is, but no one actually does.
What you typically get in fiction is someone hallucinating without knowing they're hallucinating- in a fight with someone who isn't there, curled in a ball rocking with their hands pressed over their ears. And if you're just briefly meeting a side character, that's probably the fastest way to establish their issues.
But if you have a main (or fleshed-out supporting) character with schizophrenia, you have to know there is a lot more to the disorder to write it well.
Schizophrenia has three types of symptoms: Positive, Negative, and Cognitive.
Positive symptoms include things that aren't there in a healthy brain, but are in schizophrenia. These are things like hallucinations, delusions, and paranoia.
Negative symptoms include things that are present in a healthy brain, but not present in schizophrenia. These are things like a lack of motivation, decreased ability to feel pleasure, social withdrawal, and poverty of speech.
Cognitive symptoms are changes in thinking. These are things like problems with executive function, impaired working memory, struggling to concentrate, delayed processing, and trouble reading social and emotional cues from others.
Writing Positive Symptoms:
Most people with schizophrenia have auditory hallucinations, meaning they hear voices that aren't there. These can be voices narrating their life, telling them (usually mean) things about themselves, or commanding them to do something. Some people have other types of hallucinations, like visual hallucinations (seeing something that isn't there) or tactile (feeling something that isn't there).
The person may or may not know that a hallucination is not real. Knowing a hallucination isn't real doesn't make it go away.
You know when you're in a dream and everything makes sense, but then you wake up and realize the dream was really bizarre? That's kind of what delusions are like. You're so sure a thing you're thinking makes total sense, but everyone you're trying to talk about the thing with thinks you're crazy. And its frustrating because it makes so much sense to you. And no one else seems to get it.
Common delusions are things like thinking someone is out to get you, thinking others can read your mind or can put thoughts in your mind, thinking you're special, or thinking you have something medically devastatingly wrong with you.
Medications are really good at treating hallucinations, delusions, and paranoia.
Writing Negative Symptoms:
Nothing feels good, or you spend a lot of time trying to feel good and failing (a lot of comorbid substance use disorders in people with schizophrenia)
You just can't think of anything to say that makes sense, or it takes so long to come up with something to say that the moment has passed. So you just... don't say things.
"Flat affect" means your face is kind of blank and doesn't emote normally. Resting schizophrenia face.
You don't know how to make friends unless you have been specifically trained in the art and technique
Catatonia is where you're conscious but can't move (or move really weirdly) or communicate. But you're in there. And it's terrifying.
Sometimes if negative symptoms are primary this can get misdiagnosed as depression or autism
There are no medications that treat negative symptoms, but sometimes antidepressants can help.
Writing Cognitive Symptoms:
These are honestly some of the hardest symptoms to live with
The degree of cognitive symptoms a person has pretty much determines how disabled they are by schizophrenia.
Problems with following conversations with more than one person
Problems dialing a phone number because you can't hold the numbers in your head long enough
Trouble following verbal directions
Confusion. Just not understanding what is going on.
Having a "loading" period between a piece of information entering your brain and understanding what was said or read.
Difficulty starting tasks and staying on tasks
These are some of the first symptoms to present (usually in young teens) and are sometimes misdiagnosed as ADHD, because of the concentration problems
There are no medications that can treat cognitive symptoms
Medications and therapy (usually something called CBT-P, or Cognitive Behavioral Therapy for Psychosis), are mostly effective for positive symptoms. Because of this, negative and cognitive symptoms are often the more disabling part of the condition. You can modulate your character's level of disability by expressing more or less of their negative and cognitive symptoms.
