Many of us often have the experience of thinking we heard someone calling our name and then
realizing that wasn't really the case, and we just move on, and we forget about it. Sometimes
we notice coincidences, like, "Oh, there were a couple of cars on the street," and again,
we pay no attention to it. But for someone with schizophrenia these experiences take
on a vastly different kind of feeling. So you might notice, "Oh, there were three red
cars on the street," and instead of just forgetting about it, you start thinking, "Well, why were
there three red cars on the street? Maybe it has something to do with me. Maybe these
people are actually coming to monitor me or do something that would harm me," and you
start working through some kind of plot or conspiracy related to that coincidence you noticed.
The symptoms that people are most familiar with in schizophrenia are often hearing voices
or having paranoid delusions and paranoid thoughts. We now know that, in addition to
those kinds of symptoms, many people with schizophrenia have trouble focusing, paying
attention, and remembering things. Many people talk about hearing voices and mean different
things. Sometimes people will say, "Oh, yeah, when I'm thinking about what to do, I hear
a voice in my head that tells me this would be the right thing to do, or this would be
the wrong thing to do, or that gives me an idea." And when individuals with schizophrenia
talk about hearing voices, they describe it very, very differently. It's really a voice,
that they can't tell the difference between that voice and a voice coming from a person
sitting right next to them in a room. And it sounds absolutely real. It sounds loud.
Sometimes it's so loud that they can't stop paying attention to it. And sometimes the
voices are just calling their name, but sometimes the voices are saying much more complicated
things. Sometimes they're giving them commands, telling them what to do. Sometimes they're
commenting on what they're doing, often in a negative or derogatory way.
It comes as no surprise that the brain is a complicated place. There's information flying
all over the brain, and the brain has to get that information to the right place and decide
what to do with it. We think that, perhaps, in schizophrenia some of the problems come
because information isn't getting to the right place, or, sometimes when information does
get to the right place, the brain doesn't know what it should pay attention to and what
it should ignore. This is really important. In our everyday lives we might hear a car
alarm in the background, and we have to know not to pay attention to that, but we might
also hear a baby crying in the background, and that probably is something that we need
to pay attention to. And so, if your brain's not able to act as an executive and say, "This
is what's important and this is what's not important," it becomes very difficult to sort
through those everyday situations in ways that are really important for living and holding
down a job or managing your life.
Seeing things - visual hallucinations, are more uncommon in schizophrenia. They do sometimes
happen, and sometimes they take the form of people seeing ghosts or seeing people who
aren't really in the room. Sometimes they look at a picture and they see something more
than what the picture shows, often something with nefarious intent. Those are the kinds
of experiences that individuals with schizophrenia will sometimes describe. Some people have
them; some people don't. Even for people who have them, they can come and go at times.
But these other symptoms that we now understand better and are starting to recognize more,
they're much more fundamental to the disease, and they're much harder to deal with. And
those are the symptoms like having trouble paying attention, having trouble remembering
information, and having trouble being able to organize your activities and switch from
one activity to another activity. These are things which individuals with schizophrenia
start to find are harder than they were before they became ill. So, all of a sudden, they
have trouble paying attention in class. They have trouble focusing on what they're reading.
They have trouble doing jobs that require them to switch between one kind of thing and
another kind of thing quickly. And that obviously stands in the way of people being able to
live their lives to the fullest, being able to work, being able to manage their household,
being able to manage their families and family relationships. Those symptoms we often call
'cognitive' symptoms, symptoms related to attention, and memory, and concentration,
and focus. They're really one of our biggest challenges right now in schizophrenia.