Elizabeth is one of our intermediaries and she has written a post to explore how the condition is misunderstood.

We provide communication support for defendants in criminal courts and respondents in family proceedings. We all have a strong passion for equality and fairness and every day we work with individuals that have a wide range of diagnoses. One of which is schizophrenia.

Mental health remains a hugely complex and misunderstood topic. Do the general public truly and fully understand schizophrenia, or are we surrounded by myths, stigmas and prejudices?

What we need know about schizophrenia?

Statistics

• In England, approximately one adult in every 100 will live with a diagnosis of schizophrenia
• Schizophrenia affects 20 million people worldwide but is not as common as many other mental disorders
• About 20% of people with schizophrenia attempt suicide
• Approximately 5 or 6 percent of people with schizophrenia die by suicide

The statistics may acknowledge that schizophrenia is less common than other mental disorders however the prevalence still shocked me as being higher than expected.

The NHS defines schizophrenia as a severe long-term mental health condition that causes a range of different psychological symptoms. Doctors often describe schizophrenia as a type of psychosis. This means the person may not always be able to distinguish their own thoughts and ideas from reality.

What are the common symptoms?

Things that might start happening include:

• Delusions – unusual beliefs not based on reality
• Hallucinations – hearing or seeing things that do not exist outside of the mind
• Disorganised speech
• Difficulty making decisions
• Difficulty concentrating
• Movement disorders

Things that might stop happening:

• Showing interest in everyday activities
• Caring about your personal hygiene
• Wanting to avoid people, including friends
• Difficulties remembering things

Schizophrenia also shares traits with other mental health disorders including depression, anxiety, OCD, panic disorder, PTSD, substance use disorders and personality disorders. So, we must bear in mind that people can be suffering in multiple ways.

Is schizophrenia misunderstood?

Whilst researching I realised there is lots of incorrect information floating around which is distorting people’s knowledge and understanding, and the media, TV shows, and films often use stereotypes.  

Myths

• Schizophrenia causes someone to be violent
• People with schizophrenia have a split personality
• They can’t hold a job down
• There is a dramatic change of character
• Schizophrenia makes people lazy
• Schizophrenia requires long term hospitalisation
• It is caused by bad parenting
• If your parent has schizophrenia, then you will have it too
• People with schizophrenia aren’t intelligent
• You can never recover from it

These statements are all false. People think schizophrenia is about having a split personality or multiple personalities, or someone behaving irrationally. This all highlights that not everybody understands the true complexity of this diagnosis.   

What is it really like to live with schizophrenia?

People need support with mental health conditions, not prejudice. We should not judge situations, feelings or lives of those that we have never experienced or that we cannot comprehend. If we do not take the time to be educated, or to ask questions, then we won’t understand.

So, what is it really like to live with schizophrenia? These quotes are from real life stories and accounts of people who live with schizophrenia every day of their lives.

“Cognitive symptoms make it hard to pay attention and hard to focus”

“Your brain is just racing, it can’t stop”       

“My first symptom of schizophrenia was pretty much just zooming out, thinking I was in a different place. Then it turned into kind of voices in my head”

“I get plagued by thoughts that are just so repetitive in my head and they just go around over and over again, when really you just want them to be nice and quiet and silent”

“It can be lonely, the paranoia, the fear, the voices. Everything that goes along with it”

“I started seeing things, and hearing voices. I didn’t want to get dressed or even get out of bed. I didn’t understand what was going on”

“Schizophrenia is different for everyone”

“Everything was getting bigger, smaller, louder, quieter; my ability to process information coming in through my senses started breaking down”

“Hallucinations are often auditory but can be accompanied by odours, visions, and tastes”

How does schizophrenia affect communication?

We know that hallucinations and delusions are commonly associated with schizophrenia, but this neurological disorder can also affect communication skills in many ways such as, disorganised speech, trouble expressing emotions, slower processing speed and working memory deficits.

More specifically:

Alogia refers to a lack of speech by the inability to put thoughts together. For example, someone may pause for a long time between words.

Disorganised thinking in speech leads individuals to lose their trail of thought during a conversation, become tangential jumping from topic to topic, give answers to unrelated questions, speak continuously providing irrelevant details, or even speech becoming completely jumbled.

Affect refers to a restricted range of expressed emotions. People with affective flattening show relatively immobile and unresponsive facial expressions, little body language or movement and poor eye contact.

Schizophrenia can also create disturbances in receptive language and understanding the messages of others.

Any one of us may be speaking to someone who displays these symptoms, yet not have any idea that they are diagnosed with schizophrenia. It is an invisible condition and so there are no obvious or physical signs to let us know.

How do intermediaries help?

We are professionally trained to assist people with communication difficulties. We use a whole range of strategies and techniques to help people understand and participate throughout life changing court proceedings. Ensuring that their voice is heard. No matter what difficulties they possess. We also keep learning and educating ourselves so we can adapt our work to meet the needs of individuals with diagnosis such as schizophrenia.

Whilst Communicourt intermediaries have undergone extensive training, and obtained degrees, our intermediaries possess more than that. We are calm and patient. We know when to listen. We know when to intervene. We do not judge. We are able to pick up on signs and cues, that others perhaps cannot. Lastly, we love the job we do.

Case study 1: an intermediary assessed a man diagnosed with paranoid schizophrenia

Mr X alluded to experiencing paranoid thoughts throughout the assessment.

“I can’t sit and stand in front of people, I don’t like people looking at me, I hate it. I always feel like that, everywhere I go I think people are looking at me, it’s why I just stay in all day”.

He added that he thinks people are “planning things” when they look at him.

I asked him if he currently experiences auditory or visual hallucinations. He reported, “I’ve heard voices before. It’s more when I’m by myself” and “… most of the time I just hear someone calling my name, so I look around to see where it’s coming from”.

He reported emotional management difficulties related to his diagnosis, for example, he expressed his mistrust of people and his worries about being in the busy court room for his trial.

I recommended to the court that Mr X attended his trial, accompanied by me, via a live video-link, in a separate room to the main court room. Mr X reported anxieties relating to his diagnosis of schizophrenia and having to sit in the main court room, due to the amount of people present in court and his beliefs that everyone will be staring at him. If he is unable to manage his emotions in the court room, it will likely have a detrimental impact on his ability to attend to the evidence.

If Mr X was not permitted to attend his whole trial via a video-link, I recommended consideration should be given to the use of one if he was to give evidence.

My other recommendations included:

Introduce each new topic of conversation to assist Mr X’s engagement, understanding and concentration. Mr X appeared to relax into the assessment process when I clearly outlined topics and tasks and told him what to expect.

Maintain a neutral tone while questioning Mr X. Avoid asking questions in an adversarial manner. This may assist Mr X to manage and regulate his emotions during cross-examination. He responded well to questions during the assessment, where the tone of questioning was informal and non-confrontational.

Breaks are also likely to assist Mr X to manage his emotions. I would monitor Mr X’s emotional state and draw the judge’s attention to any difficulties he is having, or if he needs any additional breaks.

Case study 2, an intermediary worked with a woman during family court proceedings

As soon as I started to work with Ms X, I picked up on various symptoms that she was presenting with.

For example –

Delusions – Ms X often did not trust who the professions were and what their role was. For example, she believed the local authority’s barrister was the clerk. Ms X could not shift her disbeliefs.

Trouble concentrating – Ms X struggled to focus on the evidence being heard in court and during conferences when checking her understanding, she did not retain the correct or relevant information.

I recommended that the court should do informal introductions. All professionals individually introduced themselves to Ms X in a relaxed environment outside of the court room. This was to help Ms X understand who acted on behalf of who and what their role was.

My other recommendations included:

Visual stimuli. I recommended Ms X should be positioned so that she could clearly see each lawyer or witness as they were speaking which successfully aided her focus and concentration. 

Promote trust. To alleviate any feelings of mistrust, I recommended all professionals avoided engaging in general ‘chit chat’ with each other whilst in the court room to clearly demonstrate clear boundaries of the opposing teams. I also advised all professionals to speak openly about the proceedings in front of Ms X, which stopped Ms X from thinking that information was being hidden from her. Both recommendations promoted better engagement from Ms X and ability to effectively participate in the hearing.

National schizophrenia awareness day is a chance to think about all those people who live with this misunderstood condition. Rethink Mental Illness shines a spotlight on the condition and the dedicated work to improve the quality of life for people living with schizophrenia and their carers. Find out more.