When we think of the symptoms of schizophrenia, perhaps the first examples that emerge in our minds are the chaotic thoughts, disturbing suspicions and invisible voices tormenting the sufferer. These are indeed the most striking manifestations of an acute psychosis – delusions, hallucinations and thought disorder – but as I wrote a few months ago, these symptoms are not exclusive to schizophrenia and can even occur (albeit often in milder forms) in healthy people.
Contrary to popular belief, these ‘positive symptoms’ (‘positive’ as in ‘additions’ to normal experiences) are not actually the most common occurrences in a schizophrenic disorder. The most frequent symptom is in fact a lack of awareness into the unreality of their own psychosis: in medical terms, a ‘lack of insight’ which is thought to occur in 97% of patients compared with 74% for auditory hallucinations and 70% for ideas of reference.
Explanations for this lack of insight range from ego-defence mechanisms to abnormalities in the cortical midline structures (a group of brain regions considered key in differentiating self and other); either way, it is widely accepted that lack of insight contributes significantly to treatment non-adherence and sometimes eventual relapse, simply because many patients do not believe their experiences are not real and are symptoms of mental illness.