Do schizophrenics 'know' that they are not thinking straight?

I’m not sure if this has a definitive answer or not, so I’m asking in this forum about people’s experiences.

There’s someone I know professionally who has recently been diagnosed as schizophrenic but, according to his wife, he won’t take any medication for it. I’m not sure if it’s a smart move but wonder if I can talk any sense into him? I figure if he knows that something is a little wrong then it might be possible to get him on the medicine. :frowning:

Depends on the person, but largely no.

The problem with schizophrenia, like most mental illnesses, is that the part of the body responsible for “knowing” and for deciding what to do about it is the part of the body that’s broken. It’s like expecting someone with a badly broken leg to walk it off. If he could walk, the leg wouldn’t be broken!

IME, most schizophrenics may notice a mood shift, and if they’ve had it for a long time before, they can identify the voices or visions as not being heard by other people, but they don’t notice the disorganized thinking. They simply think the people around them are acting weird, or thinking stupidly. And, of course, not every schizophrenic has the same symptoms, so there may be no mood shift or hallucinations to notice.

Please note, most schizophrenics are NOT violent, contrary to popular opinion, so it’s not like you need to be afraid of the guy (unless he has a personal history of violence), but no, you shouldn’t rely on him to notice that his brain isn’t working right. As for whether or not you talking to him will help him notice it… sigh I don’t know.

I’m playing the same game right now with a patient of mine who has a diagnosis and has been pretty functional these last four months, but I see him slipping. Right now, he’s blaming his doctor and his social worker, and I’m “the only one he trusts”, so I’m trying to keep him open to the idea that maybe, just maybe, his doctor isn’t conspiring with his social worker against him, but it’s hard. I’m afraid I may not be able to help until it’s reached hospitalization level. And I’m supposed to be trained in this stuff. I wouldn’t expect a layperson to handle it. If you want to give it a gentle shot, you probably won’t do any harm, but please don’t be too disappointed if it doesn’t help.

What WhyNot said. One of the reasons schizophrenia can be so hard to treat is that many schizophrenics don’t recognize that they are mentally ill. I have an uncle who is schizophrenic. He has been resisting medication for about four decades. ‘‘I know people say I’m mentally ill, but I don’t think I’m mentally ill. I just want people to stop putting dead bodies in my cigarettes, you know?’’ FWIW, there is research indicating that the earlier a person receives treatment, the more likely they are to comply to treatment.

Thanks WhyNot :frowning: (and Olive, on edit)
He does have a history of violence (but never against me) and he does think that I’m conspiring against him (according to his blog). Maybe I’ll keep my distance for a bit and let the professionals handle it. Thanks again.

I knew a guy, casual friend I guess you could say as we hung out in the same group, who was diagnosed as schizophrenic and he was well aware that his auditory and visual hallucinations were not “real” BUT he did think they often had good insights and I had to agree with him sometimes “your dad fucking hates you!” was right pretty much.
The problem was a lot of his internal er chatter and intuitions(that everyone has) would manifest as voices, so say you see someone is just acting strange so you say nah something if off about this guy, well he would hear a voice tell him that.

It depends on the person but for a lot of people anti-psychotic drugs turn you into a non-functioning zombie, so I can understand why some schizophrenics want to learn to control and accept their illness rather than becoming a 25 year old dementia patient.
*That dude was very strange BTW, for one thing he was obsessed with white power groups and white supremacy but his on again off again girlfriend he did nothing but talk about was a Somalian immigrant.:smack:

Yep, I have a friend who is a classic paranoid schizophrenic–he *knows *the government is trying to coerce him into a gay sex ring and that he is the chess champion of the world, and that he and various celebrities have mind melds. And of course, I *cannot *reason him out of this–he gets rather defensive when I try.

He refuses to see doctors, as he had a bad experience years ago being committed to a snake pit asylum and drugged up, so I really cannot fault him there. Also, the doctors are all in on the gay sex ring.

It’s very sad–he is no danger to anyone but himself, and I just do not see a happy ending for him at all, poor bastard.

Those who do realize it are a lot more likely to go to the doctor when needed. I’ve had conversations and read interviews with some who do notice and who mentioned that, once they understood the illness, those times when they notice they’re getting off their meds are what terrifies them most. What if the docs can’t find whetever is going to work this time? What if there is ever a “this time” when nothing works?

But many mentally-ill people begin by not understanding that they’re mentally ill, not only schizophrenics. The negative reactions of many people when hearing that someone has a mental-illness diagnosis are not better when the person diagnosed is themselves.

Yup, I have a friend who had a severely delusional mother, to the point that she was raised by her grandparents instead. Fast-forward to my friend in her early 30s, when she starts suspecting that people are watching her and plotting against her, even her own husband. Her terror becomes so great that she got in her car and fled halfway across the state, before finally stopping and out of desperation calling her husband, trying to explain that everyone was conspiring against her, even him, but it just didn’t make any sense to her and she trusted he wouldn’t hurt her. I’m sure that her experiences with her mother - and probably some lingering worry over whether it was genetic - probably helped her with experience of how someone who’s delusional really acts.

Turns out that severely manic cycles in bipolar disorder can have delusional components associated with them. These days (years after her “breakdown”) she’s on medication and seeing a therapist, continuing to work as a (very beloved) teacher, and her mood is much more stable. She and her close friends are good at seeing when she might be getting off-track - we had a talk with her a year ago when it seemed like she was taking on way too many projects, and I had a number of phone conversations with her during depressive swings - and she’s pretty proactive about seeking out adjustments in meds or other therapies at those times. But she did have a lot of “is this going to be my whole life?” feelings during her down times.

And if there is, that just proves the masseurs are in on the sex ring, too. [insert handbasket smiley]

A-frikkin-men to this. Paranoia with paranoia sauce, garnished with some fresh paranoia all served with a side of paranoia. Plus, walls and floors ripple like water and the furniture never seems to be where I remember it.

Ramble: This has been my particular flavor for as long as I can remember, but I never really understood I was a nutcase until 5 or 6 years ago. I can remember times when I was out of control, and I can remember how I felt, at the time, like I was acting appropriately for a given situation. Looking back objectively, it is clear my judgment was impaired. These days I have some hard and fast rules of behavior that I will not break no matter how I feel at the moment. Seems to help. The way I see it, everyone pretty much acts in a way they believe to be appropriate. Problem is, if your perception is impaired your behavior will be off. It’s sort of like how drunk people will sometimes behave poorly, but at least they have the benefit of knowing they’ve been drinking. When your own brain chemistry decides to change, it does so without letting you know what’s going on.

I’ve worked on mental health inpatient units. It’s true that the majority of patients don’t recognize that they are mentally ill ( “lack of insight” is a classic part of many mental illnesses). In those cases, you shouldn’t even bother trying to “talk them into” believing they are mentally ill - it won’t work and will likely just make them angry.
Some of them do have enough insight to realize that they are not doing well and even will show up to the hospital voluntarily for treatment because (for example) the voices are scaring them and making it hard to concentrate. They often will have other explanations besides mental illness for why the voices are happening (I’ve heard patients say that the voices are caused by the Devil for example). Many will voluntarily agree to take medications when the illness is at its worst. If your friend trusts you enough to talk about things like hearing voices or feeling depressed, I wouldn’t try saying “This is because of your mental illness” but I would try saying “let’s call your psychiatrist or let’s go to the hospital and see if they can help you feel better”.

However, even in those cases, many of them have a hard time accepting that they need to be on medication for a lifetime to be functional and will often end up going off the medication pretty quickly once they feel better. That’s why a lot of severely mentally ill people keep going in and out of the hospital - it’s a cycle where something really bad happens to bring them into the hospital, they start medication and begin to do better, they leave the hospital, go off their meds because they feel better, and end up back in the hospital. Over and over again.

In your friend’s case, I would encourage you and his wife to watch him closely for any signs of dangerous behavior or thoughts. In the majority of places (laws vary by state, but this is pretty standard) if a mentally ill person is doing anything suicidal/homicidal or that shows that he is incapable of caring for himself to the extent that he is at risk of serious harm, you can call the police to have him brought to the hospital for a psychiatric evaluation. It’s always better if you can convince the patient to come voluntarily, but if he is not willing to go voluntarily, and you have genuine concerns for his safety or someone else’s safety, don’t be afraid to call for help.
Most mentally ill people are not dangerous at all, but there are cases where (for example) someone who is very paranoid may be confused enough to hurt someone innocent because they perceive the person as being involved in a conspiracy to harm them, or when a very ill person might talk about suicide even though when they’re thinking clearly they may not be suicidal at all.
Schizophrenia patients who have involved, concern family members to help with things like reminding them to take their meds often do A LOT better than the ones who don’t have good support, so don’t despair.

To give him credit, he would laugh at that–for all his problems, he is smart and has a sense of humor. Which makes it all the more frustrating!

Ever heard the phrase ‘you can’t reason someone out of a position they didn’t reason themselves into’? It could pretty well be the definition of mental illness. IMHO the best you can do for a friend who’s dealing with an illness that they don’t want to acknowledge is to continue as normal a friendship as possible. You can’t change his mind for him, he has to be the one to decide that the illness sucks and he wants to try to get rid of it.

The only data point I have to add to the conversation is a friend who’s dealing with a mixture of Bipolar and Schizophrenia - as others have mentioned, they can overlap quite a bit. She’s very much ON her meds and has worked through a lot of therapy. At this point she’s pretty good at managing her own symptoms and is confident about asking trusted friends for reality checks when she needs them. You wouldn’t know she was dealing with a mental illness if she didn’t tell you. Like most schizophrenics, she’s not violent at all, even when she’s in full-fledged paranoia mode. This is probably the best-case outcome for Schizophrenia.

I hope things turn out well for your friend.

Would you be willing to share with us what some of those hard-and-fast rules are?


  1. Your acquaintances and family members are not discussing plots behind your back, and are not toying with you for their own amusement. (This one is the most difficult because it demands a denial of a gut feeling, something you simply know to be true)

  2. Rarely laugh for more than one breath, never for longer than anyone else in the room. If you can’t help yourself, remove yourself from the situation. (A funny situation readily changes into me being the funny thing, the life of the party–I am not. Too much laughter will escalate into mania that will last for several days)

  3. Do not yell at anyone. Do not say anything unconstructive. Never express anger. (I slip too quickly into rage if I allow myself to become angry. Outward expression of the emotion is suppressed until I can reason through the event)

  4. Do not dwell on feelings of inadequacy, fight them with facts. (This is a difficult mental exercise that is performed for 2 or 3 days, it absolutely slaughters a depression that will otherwise last for weeks without breeding mania)

  5. Resist praise, say “thank you” to shut someone up if you have to but do not encourage praise. Stay humble. (This works two ways, it nips grandiose feelings in the bud, and people respond better in the long run to competence & humility than to confidence.)
    It’s kind of a trade off. If I force myself to stay on an even keel, people will sometimes think I’m dumb or upset. But if I don’t follow the rules I become who I really am, and I don’t like him.

I would add to Inigo’s list: Don’t make any major life decisions without running them by someone else first.

It definitely is an interesting sensation to not be able to trust yourself. I mean, if nothing else, you should always be able to believe you have your own best interest at heart, but when going through these changes (bipolar here, with a recent episode of acute mania), everything you are doing makes sense, even if it is absolutely bonkers.

I was aware enough to determine something was wrong, and I needed to seek help and get some med management, but loss of executive function is a major component to a lot of mental issues. You sort of turn over control to the amygdala. So, having a robust support system is really important, because you have to rely on others to tell you if what you are doing makes sense or not.

I used to be live-in staff at an apartment complex for schizophrenics and I think the answer is “depends on the individual schizophrenic”. Some do, some don’t, and some know when they’re having delusional thinking when they are transitioning into a psychotic episode but once in the episode itself it’s their reality, then when they’re out of it again due to medication/hospitalization/time they know they were wrong but were honestly convinced of it at the time.

One resident who heard voices when sick told me that even on medication he still heard the voices when he was medicated, but when he was medicated he knew they weren’t real. He told me that he was hearing them even as he was talking to me, “I really do, right now, know that they aren’t real… but that doesn’t make them sound any less real than the voices on that TV set”. He said that he would also talk to them sometimes even when he did know they weren’t for the same reason non-delusional people will sometimes talk to a TV set or themselves, BUT he tried not to because he believed that the more you did the more you slipped.

Some had a sense of humor about their episodes when said episode wasn’t harmful to anybody. One of them told me “I raised Elvis from the dead the other night!” and I asked him, being polite, “Did you really?” His response: “Probably not come to think of it, but I sure as hell got everyone else who could hear me up.”

Having never been schizophrenic (as far as I know), I can’t really comment on this.

But here’s something to think about. When you’re depressed – and I’m not talking about a clinical diagnosis, just a case of the blues – do you know you’re depressed? Or do you feel like life sucks, life always has sucked, and life will continue to suck until quarter past infinity? For me it’s the latter, and everyone I’ve talked to about it can relate. On the flip side, when you’re happy, doesn’t depression seem like a really irrational and stupid choice that you can easily avoid?

The thing is, even for mentally healthy people, we tend to live inside of our emotions and rationalize them as the normal state of being. I’m sure that for someone who is mentally ill, this is triply true.

Thank you. That was very insightful, and I appreciate you sharing.

A former acquaintance of mine had a schizophrenic son in his mid-20s. He was going through a delusional phase because his meds had quit working. Friend told me that her son loved to go to the Y to swim because he believed he was a dolphin. I asked if he really believed this, and she said it appeared he did. I found this absolutely astonishing. How can a person believe he’s a dolphin? If it’s truly possible, maybe I just think I’m a human being.

Very very strange.