Sense of Self and Emotions
People with schizophrenia may be confused about where they stop and objects and people in the world around them begin. Understandably, they also experience emotional changes that have a major effect on their lives. The changes can range from overemotional states to an apparent lack of emotional responses.
Distorted or lost sense of self
It is not unusual for people with schizophrenia to experience strange sensations concerning the relationship of their bodies — and sometimes their identities — to things and people in their surroundings. Placing a hand on a table may raise uncertainty in a person's mind about where the hand stops and the table begins. Limbs may appear to change in size. A person may feel disconnected from parts of their body.
These sensations might be related to the abnormal processing of sensory information that is responsible for the exaggerated, intense, and distorted sights and sounds people with schizophrenia frequently experience. They share some similarities with hallucinations and delusions and undoubtedly can overlap with these positive symptoms.
They differ, however, by affecting the person's identity and sense of self. A person with a delusion may be convinced he is being hunted by government agents, but he may still retain his sense of self, which feels threatened. Another person may hear tormenting voices but still retain her identity; after all, she can still distinguish between the voices and herself.
A person experiencing an altered sense of self, however, may feel inanimate or cut off from “who he was” before his illness. He may feel like a robot, an automaton, a machine, or something under the control of an outside force.
Other people report that they become convinced they are someone else whom they are watching. It is not clear what aspect or aspects of the schizophrenic disease processes accounts for these feelings or sensations, but it clearly reflects changes in higher brain function.
Emotions Here and Gone
People with schizophrenia undergo a range of emotions as their illness develops, including shame, embarrassment, fear, and guilt. It is not unusual for a person to be depressed after experiencing a psychotic episode but many individuals develop clinical depression before they show any positive signs of schizophrenia. Depression may be present at other times during the course of the illness caused, at times, by the person's realization that they have a serious illness. If it becomes very serious, a doctor may prescribe an antidepressant, a step that can not only relieve emotional suffering but save the person's life since the risk of suicide is higher than average in people with schizophrenia.
Emotional expressions may change quickly in some people and exaggerated feelings may also occur; fear may become paralyzing, guilt incapacitating and happiness euphoric. Dr. E. Fuller Torrey cautions in Surviving Scizophrenia that while exaggerated emotions are common in the early stages of the illness, they are rarely seen beyond that period. In fact, he warns that “if the person retains exaggerated feelings to a prominent degree beyond the early stages of the disease, it is much more likely that the correct diagnosis will turn out to be manic-depressive illness.” The following list details some of the emotional changes that may be triggered by schizophrenia. It is adapted from Torrey's Surviving Schizophrenia.
What is inappropriate affect?
For a psychologist or psychiatrist, affect refers to the expression of emotions. Inappropriate affect is an unusual emotional response seen in some patients with schizophrenia. It causes them to respond to news or to an event in a manner opposite the way most people would respond. Informed of good news, a person with inappropriate affect might show signs of sorrow. Informed of bad news, a person might laugh.
Some Aspects of Emotional Changes in Schizophrenia
Rapidly changing emotions
Lack of emotions
At the other extreme is a near total lack of emotional expression. It seems as if emotional feelings are turned off in many people who have struggled with the disease for years. This might be related to the commonly observed inability to appreciate what other people are feeling. This seeming self-centeredness appears to be another consequence of the disease process.