Schizophrenia is a serious mental disorder that affects how a person thinks, feels, and behaves. The main symptoms of schizophrenia include hallucinations, delusions, disorganized thinking and speech, and impaired cognitive functioning. Many people with schizophrenia are not aware that they have the illness, especially in the early stages. This lack of insight can make the disorder difficult to treat and manage effectively.
What are the signs and symptoms of schizophrenia?
The signs and symptoms of schizophrenia typically start between the ages of 16-30. They fall into three broad categories:
- Positive symptoms – These refer to an excess or distortion of normal functions. Examples include:
- Hallucinations – seeing, hearing, feeling, tasting or smelling things that are not actually there
- Delusions – fixed, false beliefs not based in reality that the person holds even when presented with contradictory evidence
- Disorganized thinking and speech – switching topics erratically, making up words, speaking incoherently
- Negative symptoms – These refer to a lack or decline in normal functions. Examples include:
- Social withdrawal
- Loss of motivation and interest
- Restricted emotional expression
- Difficulty experiencing pleasure
- Cognitive symptoms – These affect concentration, memory, and executive functioning skills. Examples include:
- Poor concentration and attention
- Impaired working memory and ability to plan and organize
- Slowed thinking
- Difficulty understanding information and using it to make decisions
The symptoms of schizophrenia vary dramatically from person to person. Some people may experience mainly positive symptoms, while others have more negative and cognitive symptoms. The severity can also fluctuate over time, with periods of stable functioning interrupted by acute psychotic episodes.
Why might someone not know they have schizophrenia?
There are several reasons why someone with schizophrenia may be unaware of their illness:
- Lack of insight – This is a key feature of schizophrenia, particularly in the early stages. The person is unable to recognize that their experiences, such as hallucinations or delusions, are not real.
- Denial – Some people go through periods of denying they have a mental health problem to avoid the stigma associated with schizophrenia.
- Positive symptoms overshadow negative symptoms – Positive symptoms like hallucinations are more overt, while negative symptoms like social withdrawal are often attributed to other causes.
- Gradual onset – Symptoms may develop gradually over several years, so the person adjusts to them without realizing they indicate an illness.
- Cognitive deficits – Problems with concentration, memory and organized thinking make it difficult for the person to accurately assess changes in their mental state.
- Lack of diagnosis – Without seeing a doctor, the person remains undiagnosed and unaware of the cause of their experiences.
Denial and poor insight tend to improve with treatment and time, allowing the person to gain awareness of their illness. But a lack of awareness can make getting effective care very challenging early on.
Can people function normally without treatment?
The short answer is no. Schizophrenia is a chronic condition that causes significant disruptions in thinking, emotions, behavior, and functioning. Going untreated can be extremely detrimental.
That said, some people with undiagnosed schizophrenia can appear to function fairly normally at times, holding down jobs or relationships for periods. There are several reasons for this:
- They may experience milder symptoms that allow them to get by for stretches.
- They develop coping strategies to mask their symptoms and adapt to their disordered thinking.
- Positive symptoms like hallucinations may come and go, or only appear occasionally.
- Negative symptoms and cognitive deficits emerge slowly and progressively.
- They force themselves to keep going to work and fulfill responsibilities despite symptoms.
- Supportive family and friends help take care of them and overlook abnormal behaviors.
Even high-functioning people with untreated schizophrenia struggle more than they let on. Trying to live an outwardly normal life without treatment takes an immense toll. The illness inevitably catches up with the person, causing them to spiral into more severe or disabling symptoms. Getting appropriate treatment and support is crucial for managing schizophrenia and living a fulfilling life.
What are the risks of leaving schizophrenia untreated?
Leaving schizophrenia unmanaged with medication and therapy carries serious risks:
- Worsening symptoms – Positive symptoms like hallucinations and delusions usually get more severe over time without treatment.
- Difficulty working or attending school – As cognitive deficits and negative symptoms progress, functioning significantly declines.
- Social isolation – Paranoia, lack of motivation and impaired social skills increasingly isolate the person.
- Self-care neglect – The person has more difficulty tending to their basic needs like hygiene, nutrition and health.
- Substance abuse – Many people with schizophrenia turn to drugs or alcohol to try to cope with their symptoms.
- Unsafe behaviors – Active psychosis may lead to reckless, impulsive or violent actions based on hallucinations or delusional beliefs.
- Increased suicide risk – Schizophrenia carries one of the highest risks for suicide of any psychiatric disorder.
- Legal problems – Bizarre behaviors can lead to arrests, incarceration, or involuntary hospitalization.
- Homelessness – An inability to work and function independently may leave the person homeless and destitute.
Leaving schizophrenia untreated prevents the person from getting their symptoms under control and having the best quality of life possible. It essentially allows the disorder to take over their world.
What happens when untreated schizophrenia is finally diagnosed?
There are a few different scenarios that commonly lead to someone with undiagnosed schizophrenia finally getting diagnosed and treated:
- A major life stressor triggers an acute psychotic break, requiring hospitalization.
- Bizarre or dangerous behaviors attract the attention of authorities and mental health workers.
- The person’s mental health deteriorates until they can no longer care for themselves independently.
- Concerned loved ones intervene and compel the person to get help.
- The person voluntarily seeks help due to suicidal thoughts or an awareness they are unwell.
Being diagnosed with schizophrenia after years of being untreated comes as a shock for many people. Some feel relief at finally having an explanation for their abnormal experiences. Others struggle enormously with denial, rejection of the diagnosis, and refusal to comply with recommended treatment. Still others vacillate between moments of insight and acceptance, and rejecting the reality of their illness.
People in these scenarios often lack trust in mental health services and medication due to the long duration of untreated illness. They may require extensive psychoeducation about schizophrenia and time to build a therapeutic alliance with providers. Family support also helps them navigate this difficult transition period.
What is the treatment outlook for longtime undiagnosed schizophrenia?
The treatment outlook depends greatly on the person’s symptom profile, severity, and duration of untreated illness. In general:
- Response to antipsychotic medication may be poorer due to established pathological brain changes from long-term progression of schizophrenia.
- Long-standing delusions tend to be more resistant to change.
- Negative symptoms and cognitive deficits are less likely to improve significantly.
- The person may struggle more to function independently, depending heavily on family/others.
- The person is at very high risk of suicide during initial treatment or psychotic relapse.
- Intensive psychosocial support ensures the best outcome during transition to treatment.
While longtime undiagnosed schizophrenia can be challenging to treat, starting medication and psychosocial interventions is still absolutely essential. Ongoing treatment can help control symptoms, improve quality of life, and prevent deterioration from active psychosis.
With extensive support, some people with chronic untreated schizophrenia can learn to manage their illness successfully. But even modest gains translate into a significant difference in their wellbeing and stability.
Table summarizing key points
| Reasons someone may not know they have schizophrenia | Risks of leaving schizophrenia untreated | Scenarios leading to diagnosis |
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Conclusion
Schizophrenia is a challenging mental illness that often goes unrecognized and undiagnosed for years. A lack of insight, gradual symptom progression, denial, and high-functioning periods allow some people with schizophrenia to soldier on without treatment or support. But eventually, the harsh realities of uncontrolled schizophrenia catch up with them. Leaving schizophrenia untreated comes at an immense personal cost, causing profound suffering and disability. While longtime undiagnosed schizophrenia can be difficult to treat, starting medical and psychosocial interventions is critical. With extensive support, recovery is possible.