Schizophrenia. Yes, it does translate to “split mind”, but that doesn’t mean that we’re dealing with multiple personalities here. Instead the “split” is with reality.

The National Institute of Mental Health (NIMH) has published a nice, concise discussion on schizophrenia here: http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml. It’s a good place to start. For information on rates of schizophrenia, see the CDC: http://www.cdc.gov/mentalhealth/basics/burden.htm.

Okay, so you’re now armed with gobs of information about schizophrenia. What does that mean for your characters? A lot of mystery writers have as their perpetrator someone with schizophrenia or at least claiming to have schizophrenia. Certainly, some criminals have had schizophrenia. However, it is far more likely that a schizophrenic will be the victim of a crime rather than being the perpetrator. Schizophrenics are also much more likely to attempt suicide than they are to murder. Sure, the delusion that people are trying to kill you can lead a schizophrenic to murder. It’s just not very common at all. So, you can use your schizophrenic as victim, witness or perpetrator.

Now that you’ve decided to have a schizophrenic character, how do you portray him or her? Getting into the pov of such a character will be hard to do convincingly (at least to shrinks like me! J). Your character is likely to be hearing at least one voice that’s saying some pretty nasty things about him or her. The patients I’ve worked with never actually told me what the voices were saying, but did say that the voices were horrible in their comments about the patient. And they couldn’t turn it off!

How untreated schizophrenics think, I just don’t know. None of my patients have ever told me. My guess is that their thinking is jumbled and illogical. According to the NIMH, they have trouble with short-term or working memory. They have trouble using information to make decisions and control their behavior, so they’re likely to act impulsively. They are likely to be fearful if their delusions are of the paranoid sort*.

A few other symptoms are likely to be apparent. One of these is “flat affect”. This means that the individual shows little, if any, emotional response to the things going on around them. Be aware that the medications used to treat schizophrenia can also make the person “flat.” Conversation is likely to be limited and the patient has difficulty following through on plans.

Some patients, rather than being “flat”, do exhibit irritability. I recall one individual, who was not being treated by our clinic, who hung around the smoking area at the hospital where I worked. He appeared angry and quite intimidating. He usually tried to bum cigarettes. While I didn’t give him any (I only brought out one for myself), but I made a point to treat him politely. And he did respond to that, calming a bit and responding nicely. I think, with absolutely no proof, that his irritability was based more on what was going on in his mind. Perhaps he was angry about the voices he heard.

I’m going to end this here with the promise to write more about schizophrenia at a later time. If you have any questions or requests or comments, please let me know.

PS:

I’d like to make a couple comments about the current murder trial of Eddie Ray Routh, accused of killing “American Sniper” Chris Kyle and his friend. The family is claiming two things: that Routh was “crazy” and that he had PTSD. People with PTSD don’t have delusions about demons. They may have flashbacks in which they think they are back in a traumatic situation. Back when I was in the Air Force in the late ‘80’s, an individual came into the ER with a rifle. He believed he was in Viet Nam and that it was 1968. He was disarmed and taken to a mental health unit. This was a flashback, not a delusion. I know it’s hard to make the distinction, but it’s important. So, what’s going on with Routh? I’m not sure. It may be that there are more than one illness going on here. Or maybe just (!) schizophrenia that happened to emerge during or shortly after his deployment. He was the right age.

*“Paranoid” is not being worried or anxious or simply fearful. It’s the belief that someone(s) are plotting against you, trying to harm you.