It’s difficult for a person who isn’t ill to understand the internal experience of schizophrenia. When people describe experiences to one another, they assume a shared understanding of what it feels like to think and to perceive the world with our senses. We expect that we can talk about what we are thinking, without having to describe the ways in which our brains connect different pieces of sensory information and memory to make a thought.
In someone with schizophrenia, the most basic processes of perceiving and thinking are affected by the illness. Every individual with the illness will have a unique experience of the world, but there are common themes. One way to try to understand them is to look at the experience of each of the basic symptoms of schizophrenia. An individual’s experience, of course, won’t be broken into these neat categories.
Although disconnected from reality as most people know it, people experiencing psychosis also experience true sadness or depression (as opposed to or in addition to negative symptoms, discussed below). Psychiatrist Amy Koreen found that this depression lifts when the psychosis is relieved by antipsychotic medications, without antidepressants.
Research like this underscores the fact that people with schizophrenia truly suffer from their illness. Their sadness is a natural response to being trapped in a terrifying and isolating situation. A stunning first-person account of schizophrenia, “Autobiography of a Schizophrenic Girl” describes very clearly the sadness and loneliness the young author felt when gripped by psychosis.
What’s It Like to Have Delusions?To have a delusion is to be obsessed with an idea, and to have absolute certainty that the idea is correct. A person’s thinking may be clear in other ways, with an otherwise logical ability to reason starting with the absolute conviction of the incorrect premise.
Delusional ideas have a lot of power to preoccupy someone’s thoughts. Sometimes people with delusions can convince others that their delusions are true. This happens most often when the delusion is in the realm of common human experience, like an unfaithful spouse or a boss who’s “out to get me.” Some delusions are clearly recognized as abnormal, like when someone is convinced they’re a famous person or that their thoughts are being controlled by aliens.
Even after responding well to antipsychotic medications, a person may continue to believe their delusions are true. However, they may have developed an insight that other people think the ideas are probably delusions. Psychologists might call this a meta-awareness of the symptom, or an awareness that exists above the level of the symptom itself.
What’s It Like to Have Hallucinations?Hallucinations and delusions can go hand-in-hand. For example, hearing voices speaking to you from the radio is an hallucination. Being absolutely convinced that the voices are real and the things they tell you are true has a component of delusion. It is possible to experience hallucinations while being aware that they aren’t real. As with delusions, this would require a meta-awareness of the unreality of what appears to be a real experience.
We human beings usually rely on our perceptions to tell us what’s real. We’re unaware that different people experience the same situation differently, because usually those small differences don’t come up in conversation. For example, someone can go their entire life without knowing they’re color blind, because they don’t know what they’ve never experienced.
Likewise, at a party, an outgoing person may perceive friendly, receptive faces, while a shy person may perceive the same faces as being indifferent or even critical. Both of these perceptions are within the real of normal human experience, and neither is pathological.
A person with schizophrenia, however, may actually hear people saying things that are critical or insulting, when those conversations aren’t actually taking place. That would be a type of auditory hallucination.
Visual hallucinations can take many forms as well. A person with schizophrenia may find their attention drawn to one particular person’s face, notice that the teeth are very white, and then perceive the mouth and teeth growing to fill the room. This perceptual distortion would feel just like a real visual perception, and the person may believe it actually to be occurring. If they're frightened by the perception they might try to hide their fear, or they might cry out or run away.
Some people have persistent visual hallucinations, such as small children or animals that frequently appear or follow them around. They may even hold open doors for these hallucinations to pass through when they leave a room.