One of the most dramatic symptoms of schizophrenia described in DSM-IV is the presence of psychosis, a disturbing mental state in which a person may be fully alert but his contact with reality is lost or very seriously distorted. Common examples are hallucinations (such as hearing voices), delusions (such as feeling that one is being controlled and/or threatened by outside forces), and disorganized thinking or incoherent speech (such as belief in very strange ideas; irrational thoughts). Psychiatrists refer to these as positive symptoms.

The disease is also characterized by negative symptoms, which at first examination may seem less dramatic than positive psychotic symptoms. Negative symptoms include apathy and lack of speech, motivation, and emotional display. Unfortunately, they can be just as debilitating as positive symptoms over the course of a patient's lifetime. Intellectual abilities also can be affected, making it difficult for someone with schizophrenia to concentrate, remember, and learn new tasks. In young people, this typically results in a drop in grades and poor academic performance.

Symptoms of Schizophrenia

• Delusion

• Hallucinations

• Disorganized thinking

• Disorganized speech

• Social withdrawal

• Lack of emotional expression

• Apathy, lack of motivation

Adapted from the DSM-IV.

Targeting Adolescents and Young Adults

Roughly half of the people who develop schizophrenia first show symptoms before age twenty. However, the disease can appear as early as the mid-to late teens and as late as the mid-thirties. Most cases develop between ages fifteen and twenty-five.

Varied Outcomes

The disease manifests itself differently in different people for reasons that are not yet understood. Some patients experience episodes of worsening symptoms that last days or weeks, but in between these serious episodes they experience minimal symptoms or no symptoms. Others may have symptoms that are milder but more chronic. Usually, medications can readily control symptoms in these people. There will be times, however, when patients' symptoms may suddenly get worse and their treatment needs to become more intense.

Some people recover relatively quickly. Some may respond to treatment and resume normal lives. For many, however, schizophrenia is a chronic condition whose symptoms may range widely in severity. Nevertheless, symptoms are almost always improved by treatment.

Negative symptoms tend to linger longer than psychotic symptoms. One reason the disease is so challenging is the lack of a single symptom common to all of its subtypes.

A Person, not a Disease

Many mental health care providers and advocates refer to people who have been diagnosed with schizophrenia as “consumers of mental health care” or just “consumers.” At least one study indicates that this is preferred by patients and their relatives. Others discussing the topic avoid using “consumers” because it can be confused with other types of consumers, such as shoppers. Some people use a version of the phrase “people with (or diagnosed with) schizophrenia.” All of these are used in this book.

Most experts and patients agree that it is best to avoid equating a person with the disease that affects him. Avoid calling someone with schizophrenia a “schizophrenic.” It is like calling someone being treated for breast cancer a “cancer” or a “tumor.” It dehumanizes people by equating them with the disease they are fighting. It also stereotypes them. In a society that still places a stigma on mental illness, stereotyping someone in this way makes her struggle to regain health and independence even more difficult than it already is.