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Plain text: Writing a Schizophrenic character: Everything But Hallucinations

Hey! Mod Bert here. 

So: you’ve decided to write a character with schizophrenia or schizoaffective disorder (there are other disorders on the schizophrenia spectrum but I will be focusing on these for today)

You’ve done it, you have their hallucinations and maybe even delusions picked out. Maybe they are one of many who experience auditory hallucinations or maybe they also have visual hallucinations or a combination. Maybe they have olfactory hallucinations as well. They may have persecutory delusions or delusions of reference or something like Cotard’s delusion or clinical lycanthropy. Awesome, you’ve done it!

What, I hear you say? What do you mean that’s only 2 of the 5 components needed to be diagnosed with schizophrenia? What do you mean, you don’t need to hallucinate at all to be schizophrenic?

What Goes Into a Diagnosis of Schizophrenia

Plain Text: What goes into a diagnosis of schizophrenia

Not a lot of people realize there’s more to schizophrenia and schizoaffective than just hallucinations or delusions. There are 5 diagnostic criterias that are needed for schizophrenia, and only 2 of the 5 are needed for a month, with larger symptoms happening for six months or more. Let’s get into it.

Delusions

Hallucinations

Disorganized speech or thinking*

Disorganized or unusual motor behavior (catatonia)*

Negative symptoms (avolition, anhedonia, flat affect)*

I’m going to focus on disorganized speech/thinking, catatonia, and negative symptoms.

Disorganized Speech/Thinking

Plain Text: Disorganized Speech/Thinking

Schizophrenia and related disorders are often called “thought disorders” for a reason. Speech and thinking can be extremely affected, and for people like me this can be one of the first and most striking examples of an episode coming. Some people will always have disorganized symptoms that will flare during episodes. A myth is that schizophrenia can be indistinguishable with medicine: most people will have some level of symptoms even during moments of peace or “remission”. More on remission later. 

So, disorganized speech. Some examples are: word salad (schizoaphasia), thought blocking, poverty of speech (alogia), pressurized speech, clanging, and echolalia.

Word salad: a combination of words that do not make sense together. Often called schizoaphasia for its similarity to jargon in Wernicke’s aphasia, this is instead a disconnection with the brain and not due to damage to the language part of the brain.

(Example: the salad would be yellow in the fat cow).

Thought blocking: A severe loss of thought, often paired with connecting two trains of thought that are not connected

(Example: I went to the………Do you like grapes?)

Poverty of speech: A lack of organic responses to speech or organically speaking, it can be severe enough that a person only responds to questions or in one word responses. Can also happen in severe depression.

(Example: Person A: Did you do anything fun today?

Person B: Yes.

Person A: Oh, what did you do?

Person B: Store

Person A: How was it?

Person B: Fun)

Pressurized speech: A sort of frenzied way of speaking associated with psychosis or mania.

Clanging: Connecting phrases together because of what they sound like instead of meaning

(Example: I went bent tent rent).

Echolalia: Repeating word’s and phrases. Commonly also associated with Autism Spectrum Disorder. 

(Example: Person A: I went to the store.

Person B: To the store.)

These are not the only examples but they are some ones I thought I'd highlight, either because they’re well known or I have experience with them, or because they’re famously thought of with other disorders as well and I wanted to point out how things overlap.

Personal experience: I had severe alogia for the duration of my last and worst episode. People thought I was mad at them because of the clipped way I spoke and the lack of really speaking. It got me in a lot of trouble. I didn’t realize what I was saying was different or weird (I have the least insight when it comes to my speaking patterns affected by my schizoaffective, meaning I can’t hear any difference and all of this is from repeated conversations with my mom, who was my caretaker for a bit and knows the most about my speech and what it means). The best solution was talking with people and being honest and educating myself and others. I don’t know about others, but I couldn’t have used AAC at that time.

Catatonia

Plain text: Catatonia

Fun fact: catatonia means unusual motor behaviors! Any unusual motor behaviors mean catatonia. This includes what we think of when we think of catatonia in schizophrenia (inability to move) as well as the opposite (being unable to stop moving) as well as strange movements and ways of holding and moving the body! Catatonia in the DSM-5 includes 3 or more of these 12 behaviors:

-Agitation unrelated to external stimuli

-Catalepsy

-Echolalia

-Echopraxia

-Grimacing

-Mannerism

-Mutism

-Negativism

-Posturing

-Stereotypy

-Stupor

-waxy flexibility

I have some experiences with catatonia-like symptoms but since they were never identified as such I’ll skip those for now. I will say that catatonia is a symptom that can happen in many disorders besides schizophrenia as well.

Negative Symptoms! Yay!

Plain text: negative symptoms! Yay!

So a positive symptom (Hallucinations or delusions) are symptoms that add something to reality or a person. Negative symptoms are symptoms that take away. There are 5 A’s:

-Alogia (Again, poverty of speech, our favorite)

-Avolition (Lack of energy and motivation)

-Affect (Blunted affect, or a flat way of speaking)

-Anhedonia (Lack of pleasure in things that used to bring you pleasure, often thought of with depression)

-Asociality (Lack of interest in social events and relationships)

There are also often cognitive changes including thinking and memory, information recall, understanding, and acquisition, and so forth. 

Schizophrenia and schizoaffective often (but not always) happen with what’s called a prodromal period. This period can be months to years (mine was a little less than a year) and mainly consists of negative symptoms. Slowly, positive symptoms are added. There are thought to be stages to schizophrenia including prodrome, active phases, and remission.

I’ll talk about that a little for a second because I’m currently in remission and no one knows what that means. I was diagnosed with schizoaffective depressive type in January 2021. As of February 2024, I no longer qualified to be rediagnosed because my symptoms were strongly under control and no longer severe enough to qualify for a diagnosis. They also didn’t distress me or impact my daily life severely. Day to day now I still have mild symptoms and take my antipsychotics (trying to go off them have made it clear that I still have some symptoms I choose to keep medicating) but I haven’t had a delusion in 2 years and been hospitalized in 3. There’s always a possibility of another episode but I work with my team to keep myself one step ahead if that happens.

What I want from a character with schizophrenia

Plain Text: What I want from a character with schizophrenia

Alright the writing advice part. What do I want from a character with schizophrenia or schizoaffective (which is schizophrenia plus either depression or bipolar). 

-Characters with caregivers.

-Characters using coping strategies (recording hallucinations to tell if theyre hallucinations, taking medication, having service animals that greet people so they know if they’re a hallucination, using aids for the cognitive symptoms like sticky notes and organizational tools)

-Characters who know other characters with their disorder, either online or in support group or through running in similar circles

-Characters having autonomy

-Characters who aren’t the killer or horror victim. I know it’s cool to have the schizophrenic protagonist in horror, and I love horror, but I don’t want to read about the horror being symptoms the whole time

-Characters who are in magical scenarios, who are in fantasy and sci-fi. The schizophrenic princess and the schizoaffective robot technician aboard the spaceship.

-Medication and hospitalization treated casually. Sometimes we need higher care. That’s morally neutral

-Characters with negative symptoms and speech symptoms.

-Characters with catatonia! 

-Characters with other disorders as well

-characters with side effects from medicine treated casually

-Characters with cognitive symptoms