What's Going On In The Schizophrenic Brain?

Reviewed by Aaron Horn, LMFT

Published 08/25/2022

Schizophrenia is a condition that affects millions of people every year. It is depicted in media and pop culture and even used as a passing cliché. Some countless characters and personalities are defined by their struggle with schizophrenia. It is a common sight in our world, even if most of your interaction with schizophrenia is in the context of fiction.

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But how much do you actually know about the effects of schizophrenia on the brain? What is actually going on in the schizophrenic mind? Here, you’ll learn about what schizophrenia is and how to identify the symptoms of schizophrenia. You’ll also get some key insight as to what goes on in the mind of a person with schizophrenia and how these processes contribute to their mental health.

What Is Schizophrenia?

In the simplest terms, schizophrenia is an intense and serious mental illness that impacts a person’s most vital mental health aspects, such as how they think, feel, and behave. This means that schizophrenia has the potential to impact every single aspect of a person’s life, as well as the lives of those around them.

There is a persistent belief that schizophrenia is the same as multiple personality disorder; however, this isn’t the case. This idea that schizophrenia and multiple personality disorder are linked is perpetuated in media and pop culture references. Many fictional characters who supposedly suffer from schizophrenia are shown as talking to or hearing from many different voices in their heads or slipping between different thoughts, feelings, and behavior patterns. But this is an untrue depiction of schizophrenia. That’s because schizophrenia doesn’t cause people to have several different discrete and separate personalities, nor is it directly linked to multiple personality disorder.

So, by understanding what schizophrenia is not, you can better understand what actually constitutes schizophrenia. Schizophrenia is characterized by some clear symptoms that doctors use to assess when issuing a diagnosis.

What Are The Symptoms Of Schizophrenia?

Like all other illnesses, doctors use a list of symptoms to diagnose a patient with schizophrenia. These symptoms are spelled out in the American Psychiatry Association’s (APA) publication called the DSM-5. This is the most up-to-date diagnostic manual for mental health professionals. The APA defines schizophrenia with the following diagnostic criteria:

“The individual experiences two or more of the following for a significant portion of time during a 1-month period. And at least one of these must be (1), (2), or (3):

1) Delusions

2) Hallucinations

3) Disorganized speech (incoherence or derailment)

4) Completely disorganized or catatonic behavior

5) Negative symptoms, such as diminished emotional expression

For a significant amount of time since the disturbance began, the level of functioning in one or more major areas (e.g., work, interpersonal relations, or self-care) is clearly below the level achieved before onset.

  • There is a failure to achieve the expected level of interpersonal, academic, or occupational functioning in children or adolescents.

Signs of the disturbance continue for 6 months or longer. This period must include at least 1 full month of symptoms that meet the first criteria and may include periods of residual symptoms. During these residual periods, the disturbance signs may be manifested only by negative symptoms or by two or more symptoms outlined in the first criteria, only in a lesser form.

The disturbance cannot be better explained by schizoaffective disorder, depressive, or bipolar disorder because either:

No major depressive or manic episodes have occurred concurrently with the active-phase symptoms or…

If mood episodes have occurred during active phase symptoms, it’s been for a minor amount of time.

The disturbance cannot be attributed to the physiological effects (e.g., a drug of abuse or medication) or another medical condition.

If the individual has a history of autism spectrum disorder or a communication disorder of childhood-onset, the additional diagnosis of schizophrenia is only made if delusions or hallucinations, as well as the other required symptoms of schizophrenia, are present for a month or more” (American Psychiatry Association, DSM-5).

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As you can see from this detailed description of the symptoms of schizophrenia, a doctor has to adhere to strict diagnostic guidelines. But you don’t have to be a doctor to recognize the symptoms of schizophrenia. The most notable – and recognizable – symptoms of schizophrenia include:

  • An episode of psychosis, such as displaying psychotic symptoms such as alter perceptions, abnormal thinking, and out-of-the-ordinary behavior
  • Acute and noticeable changes in the person’s sensory perception, such as vision, hearing, touch, taste, or smell
  • Hallucinations involve hearing or seeing things that aren’t really there
  • Irrational fear, paranoia, and delusions that are not rooted in reality
  • Unusual thinking thought disorder or disorganized speech.
  • Negative symptoms, such as being disinterested in things that they are usually quite interested in, withdrawal from their normal social circles, and difficulty functioning in their day-to-day lives
  • “Flat affect,” or fewer and less obvious facial expressions or voice tones.
  • Cognitive symptoms, such as difficulty paying attention or concentrating.
  • Problems with their memory
  • Difficulty making decisions and processing necessary information

If you’re interested in learning if you or someone close to you presents high levels of schizophrenia symptoms, you can check out this schizophrenia quiz. The quiz will guide you through some of the more common and observable symptoms of schizophrenia. It will also offer free resources to learn more about the symptoms and treatment for schizophrenia.

What Does Schizophrenia Do To The Brain?

While no direct cause for schizophrenia has been discovered yet, doctors have shown that schizophrenia is linked to physical changes in the brain. These brain structure changes are most obvious in the prefrontal lobe, which deals with working memory, and the medial temporal lobe, which deals with declarative memory.

This means that the brain structures responsible for processing sensory input are largely affected in patients who suffer from schizophrenia. This explains why hallucinations and disruption in receiving and reacting to sensory input are common among people with schizophrenia.

Doctors and researchers study these connections between schizophrenia and a patient’s brain structure by performing a series of MRI scans. These scans show that patients who have experiences episodic psychosis due to schizophrenia also show abnormal brain activity (especially in the prefrontal lobe and the medial temporal lobe). They have also found that people who suffer from schizophrenia are more likely to have less grey matter in their brains. These structural discrepancies become clearer as the schizophrenia develops.

The link between the physical structures and schizophrenia is quite strong, according to the latest research. Scientists and doctors still don’t know if these structures cause schizophrenia or if schizophrenia contributes to these physical abnormalities, but there is a definite connection.

How Is Schizophrenia Treated?

Schizophrenia is often treated with intensive therapy that focuses on psychosocial treatments. Such treatments include cognitive behavioral therapy and cognitive remediation interventions. Throughout the course of these treatments, the mental health professional seeks to understand the thought processes that underlie their patient’s behavior. In this way, the therapist also tries to get the patient to recognize how their thought patterns play a role in how they feel and behave.

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There are also more socially driven treatment options, such as skill training and supported employment. With these methods, mental health professionals work together with their patients to navigate the larger social setting in which they deal with schizophrenia. In this way, the mental health professional tries to mitigate the effect of schizophrenia on the patient’s life in general. They try to help their patient become invested members of society to work towards achieving their goals despite their struggle with schizophrenia.

In some cases of schizophrenia, the patient might have to undergo coordinated specialty care. This method of treatment is usually prescribed for people who are still in their first episode of psychosis. The patient works together with various mental health professionals to treat and manage the symptoms of schizophrenia to keep it from getting worse as time goes on.


Schizophrenia is a serious mental health issue that affects millions of people. While there is no one cause that researchers and doctors can point to for schizophrenia, it is related to a patient brain's physical structure. Schizophrenia is diagnosed according to a strict and stringent list of official symptoms found in the American Psychiatry Association’s DSM-5. There are also more commonplace symptoms that you can observe. These symptoms usually manifest in a person’s cognitive actions or general behavior. Treatment for schizophrenia usually includes intense therapy, social support, and special understanding from the patient’s loved ones.

Frequently Asked Questions (FAQs)

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