The Mind Distorted: A Series on Schizophrenia and Psychosis (Part 1)

“I paint objects as I think them, not as I see them.” Pablo Picasso, The Weeping Woman (1937)

Despite being one of the most debilitating mental illnesses, schizophrenia remains widely misunderstood. Popular culture often depicts it inaccurately—commonly as “split personalities” or unpredictable violence. These misconceptions distort public understanding of the disorder and contribute to confusion across a variety of settings, including health care and legal arenas.

Schizophrenia is a form of psychosis, falling under the broader category of thought disorders. Thought disorders affect not only what a person thinks, but how they perceive, process, organize, and comprehend information. These disruptions in thought result in profound alterations in reality, allowing for observable symptoms such as delusions, hallucinations, and disorganization.

While the clinical presentation of psychotic disorders varies, the core symptoms typically fall into several domains:

• Delusions – Fixed, false beliefs that are resistant to logic or contrary evidence (e.g., believing one is being watched, followed, or controlled).

• Hallucinations – Sensory experiences that occur in the absence of external stimuli, most commonly hearing voices that others do not hear.

• Disorganized thinking and speech – Thoughts may become fragmented, illogical, or incoherent, often reflected in nonsensical, tangential, or loosely associated speech.

• Disorganized or catatonic behavior - Unpredictable, purposeless, or markedly abnormal motor activity ranging from agitation to immobility. This can include bizarre movements, inappropriate affect, or unresponsiveness to external stimuli.

• Negative symptoms – These include diminished emotional expression, lack of motivation, reduced speech output, and social withdrawal.

• Cognitive impairments – Many individuals experience difficulties with memory, attention, and executive functioning, which can further complicate day-to-day functioning and communication.

Schizophrenia affects approximately 1% of the global population. While are typically higher in certain environments (e.g., large urban areas), its prevalence nonetheless cuts across cultures, socioeconomic groups, and ethnicities. Psychotic disorders account for a disproportionate share of psychiatric hospitalizations and is the most common diagnostic class among individuals adjudicated incompetent to stand trial or acquitted not guilty by reason of insanity.

Schizophrenia typically emerges in late adolescence or early adulthood, although earlier or later onset can occur. In many cases, the onset is gradual, with subtle changes in behavior, emotional expression, or thinking patterns that progress over time. This is referred to as the prodromal phase, and it often precedes the individual's first psychotic episode. For many, the illness can be relatively well managed with antipsychotic medication. However, some individuals are treatment-resistant, meaning that they continue to exhibit symptoms and functional impairment despite treatment.

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Arguably one of the most debilitating aspects of psychosis is the lack of insight. As noted, psychosis involves a break from reality—an impaired ability to recognize the disordered nature of one’s thoughts and perceptions. A lack of insight is not just a symptom of psychosis—it is what makes psychosis possible. The individual’s inability to recognize their thoughts or perceptions as disordered is what allows delusions and hallucinations to feel real. This phenomenon is also known as anosognosia, meaning the individual is unaware of their own impairments.

While hallucinations and delusions often receive the most attention, psychosis is ultimately a disorder of thought itself. To understand the schizophrenic experience, it is important to understand how thought can become disordered—both in its content (what a person believes) and its form (how thoughts are structured). In upcoming articles, we’ll examine each of these domains in more depth to better understand how psychotic symptoms arise and how they shape the individual’s lived reality.

Sami Farhat, Ph.D.

Forensic psychologist and owner of ForenPsych Evaluations