Understanding Schizophrenia

By David Hennessy, Clinical Psychologist

Schizophrenia is one of the most widely misunderstood mental health conditions. Popular portrayals often focus on extreme or frightening stereotypes, yet the reality is usually far more complex and human.

People living with schizophrenia are individuals with strengths, relationships, goals, interests, and hopes for the future. While the condition can significantly affect thinking, perception, emotions, and daily functioning, many people with schizophrenia are able to live meaningful and fulfilling lives with appropriate support, treatment, and understanding.[1,2]

Understanding schizophrenia begins with moving beyond myths and recognising the lived experience of those affected.

What Is Schizophrenia?

Schizophrenia is a chronic mental health condition characterised by disturbances in perception, thinking, emotions, behaviour, and social functioning.[1]

The condition affects approximately 1% of the population worldwide and commonly emerges during late adolescence or early adulthood, although onset can occur later in life.[3]

Schizophrenia is often described as a psychotic disorder because some people experience psychosis, which refers to difficulties distinguishing between what is occurring internally and what is occurring in external reality.[4]

Psychosis can occur in schizophrenia, but schizophrenia involves much more than psychosis alone.

Common Symptoms of Schizophrenia

Symptoms are often grouped into three broad categories.

Positive Symptoms

Positive symptoms are experiences that are added to a person’s usual functioning.[1]

These may include:

• Hearing voices that others do not hear

• Seeing, feeling, smelling, or sensing things others do not experience

• Strongly held unusual beliefs

• Suspiciousness or paranoia

• Disorganised thinking

• Disorganised speech

The term “positive” does not mean beneficial. It simply refers to experiences that are present in addition to typical functioning.

Negative Symptoms

Negative symptoms involve reductions in typical functioning and can sometimes be more disabling than positive symptoms.[5]

Examples include:

• Reduced motivation

• Reduced emotional expression

• Social withdrawal

• Loss of interest in previously enjoyed activities

• Reduced speech output

• Difficulty initiating activities

Negative symptoms are frequently misunderstood as laziness or lack of effort. In reality, they often reflect genuine neurological and psychological changes associated with the illness.[5]

Cognitive Symptoms

Research increasingly highlights cognitive difficulties as a central feature of schizophrenia.[6]

These may include:

• Difficulties with attention

• Problems with concentration

• Reduced working memory

• Slower information processing

• Challenges with planning and organisation

• Difficulties interpreting social situations

Cognitive symptoms can significantly affect education, employment, and daily functioning.[6]

What Causes Schizophrenia?

There is no single cause of schizophrenia.

Current evidence suggests that schizophrenia develops through a combination of biological, psychological, and environmental influences.[7]

Genetics

Genetic factors contribute substantially to risk. Having a family member with schizophrenia increases the likelihood of developing the condition, although most people with schizophrenia do not have an affected parent.[7]

Brain Development

Research suggests that differences in brain development, brain connectivity, and neurotransmitter functioning contribute to vulnerability.[8]

Stress and Life Experiences

Stressful life events, trauma, social adversity, and significant life transitions may contribute to the onset or worsening of symptoms in vulnerable individuals.[9]

Importantly, schizophrenia is not caused by poor parenting, lack of willpower, personality weakness, or character flaws.

What Does Schizophrenia Feel Like?

Experiences vary considerably between individuals.

Some people describe hearing a running commentary on their actions. Others describe voices that criticise, threaten, or confuse them.[10]

Some people experience unusual beliefs that feel completely real and understandable at the time.

Others report feeling overwhelmed, disconnected, frightened, suspicious, emotionally flat, or unable to organise their thoughts.

Many people describe the experience as confusing and frightening, particularly during an initial episode.[4]

Treatment for Schizophrenia

Modern treatment approaches focus on recovery, symptom management, wellbeing, and meaningful participation in life.[2]

Treatment commonly involves:

Medication

Antipsychotic medication is often an important component of treatment and can help reduce psychotic symptoms for many people.[11]

Psychological Therapy

Psychological approaches can help individuals:

• Understand their experiences

• Develop coping strategies

• Reduce distress

• Improve emotional wellbeing

• Increase functioning

• Support recovery goals[12]

Approaches may include:

• Cognitive Behavioural Therapy for Psychosis (CBTp)

• Acceptance and Commitment Therapy (ACT)

• Supportive psychotherapy

• Trauma-informed approaches

Family Support

Family psychoeducation and family interventions can improve communication, reduce relapse risk, and support recovery.[13]

Community and Social Supports

Stable housing, meaningful activities, social connection, education, employment support, and community participation often play important roles in long-term recovery.[2]

Recovery Is Possible

The word recovery can mean different things to different people.

For some individuals, recovery may involve significant reduction in symptoms.

For others, recovery may involve learning to live well despite ongoing symptoms.

Modern recovery-oriented practice emphasises:

• Hope

• Meaning

• Personal strengths

• Self-determination

• Community participation

• Quality of life[14]

Many people living with schizophrenia build meaningful relationships, pursue education, work, contribute to their communities, and achieve goals that matter to them.

Common Myths About Schizophrenia

Myth: Schizophrenia Means Having Multiple Personalities

This is false.

Schizophrenia is entirely different from dissociative identity disorder.[1]

Myth: People With Schizophrenia Are Violent

Most people living with schizophrenia are not violent.

People with schizophrenia are more likely to experience victimisation than to perpetrate violence.[15]

Myth: Recovery Is Impossible

Research consistently demonstrates that many individuals experience substantial improvement and meaningful recovery over time.[14]

Frequently Asked Questions

Is schizophrenia rare?

Schizophrenia affects approximately 1% of people worldwide, making it uncommon but not rare.[3]

Can schizophrenia be cured?

There is currently no known cure. However, many people experience significant improvement and can live meaningful lives with appropriate support and treatment.[2]

Do all people with schizophrenia hear voices?

No. Hearing voices is common but not universal. Symptoms vary considerably between individuals.[1]

Can stress cause schizophrenia?

Stress alone does not cause schizophrenia. However, stress may contribute to symptom onset or relapse in vulnerable individuals.[9]

Can psychology help schizophrenia?

Yes. Psychological therapies can help reduce distress, improve coping, support recovery, and enhance functioning alongside medical treatment.[12]

Related Articles

• Schizophrenia vs Schizoaffective Disorder

• What Can Psychosis Feel Like?

• Psychology Support for Schizophrenia and Schizoaffective Disorder

• Trauma and Psychosis

• Acceptance and Commitment Therapy (ACT)

• Supportive Psychotherapy

Educational Disclaimer

This article is provided for educational purposes only and is not intended to replace individual medical, psychiatric, or psychological advice. If you are concerned about symptoms of psychosis or schizophrenia, seek assessment from an appropriately qualified health professional.

References

[1] American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing.

[2] National Institute for Health and Care Excellence. (2014). Psychosis and schizophrenia in adults: Prevention and management (CG178). https://www.nice.org.uk/guidance/cg178

[3] McGrath, J., Saha, S., Chant, D., & Welham, J. (2008). Schizophrenia: A concise overview of incidence, prevalence, and mortality. Epidemiologic Reviews, 30(1), 67–76. https://doi.org/10.1093/epirev/mxn001

[4] World Health Organization. (2022). Schizophrenia. https://www.who.int/news-room/fact-sheets/detail/schizophrenia

[5] Galderisi, S., Mucci, A., Buchanan, R. W., & Arango, C. (2018). Negative symptoms of schizophrenia: New developments and unanswered research questions. The Lancet Psychiatry, 5(8), 664–677. https://doi.org/10.1016/S2215-0366(18)30050-6

[6] Green, M. F., Horan, W. P., & Lee, J. (2019). Nonsocial and social cognition in schizophrenia: Current evidence and future directions. World Psychiatry, 18(2), 146–161. https://doi.org/10.1002/wps.20624

[7] Hilker, R., Helenius, D., Fagerlund, B., Skytthe, A., Christensen, K., Werge, T., Nordentoft, M., & Glenthøj, B. (2018). Heritability of schizophrenia and schizophrenia spectrum based on the nationwide Danish Twin Register. Biological Psychiatry, 83(6), 492–498. https://doi.org/10.1016/j.biopsych.2017.08.017

[8] van Erp, T. G. M., Walton, E., Hibar, D. P., Schmaal, L., Jiang, W., Glahn, D. C., Pearlson, G. D., Yao, N., Fukunaga, M., Hashimoto, R., Okada, N., Yamamori, H., Bustillo, J. R., Clark, V. P., Agartz, I., Mueller, B. A., Cahn, W., de Zwarte, S. M. C., Hulshoff Pol, H. E., … Turner, J. A. (2018). Cortical brain abnormalities in 4474 individuals with schizophrenia and 5098 control subjects. Biological Psychiatry, 84(9), 644–654. https://doi.org/10.1016/j.biopsych.2018.04.023

[9] Hardy, A. (2017). Pathways from trauma to psychotic experiences: A theoretically informed model of post-traumatic stress in psychosis. Frontiers in Psychology, 8, 697. https://doi.org/10.3389/fpsyg.2017.00697

[10] Waters, F., Fernyhough, C., & Allen, P. (2020). Hallucinations and voice hearing in psychiatric and non-psychiatric populations. Schizophrenia Bulletin, 46(6), 1367–1373. https://doi.org/10.1093/schbul/sbaa117

[11] Leucht, S., Chaimani, A., Cipriani, A., Davis, J. M., Furukawa, T. A., Salanti, G., & Huhn, M. (2019). Comparative efficacy and tolerability of 32 oral antipsychotic drugs for acute schizophrenia. The Lancet, 394(10202), 939–951. https://doi.org/10.1016/S0140-6736(19)31135-3

[12] Bighelli, I., Salanti, G., Huhn, M., Schneider-Thoma, J., Krause, M., Reitmeir, C., Wallis, S., Schwermann, F., Pitschel-Walz, G., Barbui, C., Furukawa, T. A., & Leucht, S. (2018). Psychological interventions to reduce positive symptoms in schizophrenia: Systematic review and network meta-analysis. World Psychiatry, 17(3), 316–329. https://doi.org/10.1002/wps.20577

[13] McFarlane, W. R. (2016). Family interventions for schizophrenia and the psychoses: A review. Family Process, 55(3), 460–482. https://doi.org/10.1111/famp.12235

[14] Slade, M. (2009). Personal recovery and mental illness: A guide for mental health professionals. Cambridge University Press.

[15] Large, M., & Nielssen, O. (2011). Violence in first-episode psychosis: A systematic review and meta-analysis. Schizophrenia Research, 125(2–3), 209–220. https://doi.org/10.1016/j.schres.2010.11.026