522 CHAPTER 12
The man who made this drawing said, “This belt
buckle symbolized safety for me in my stay in
the hospital. I felt no harm would come to me
while I wore it. I also left it visible to me on my
nightstand next to my bed at night. I thought
several times the belt buckle saved me from
whatever was going on. My belt buckle seemed
as though it was wearing thinner, using up its
strength a little at a time in helping me” (Emmons
et al., 1997, p. 183). Although many people have a
good luck charm, the fact that this man believed
that his belt buckle was getting thinner because
it was “using up its strength” suggests that he
had a delusional belief about it.Drawing by Craig Geiser from Living with Schizophrenia by Stuart Emmons, Craig Geiser, Kalman J. Kaplan, Martin Harrow. Taylor & Francis, 1997.
(as when imagining a conversation or talking to oneself) and verbal information
that is externally generated (as when another person is actually talking) (Brunelin
et al., 2007). People with schizophrenia are also more likely to (mis)attribute their
own internal conversations to another person (Brunelin, Combris, et al., 2006;
Keefe et al., 1999); this misattribution apparently contributes to the experience of
auditory hallucinations.Delusions
People with schizophrenia may also experience delusions—incorrect beliefs that per-
sist, despite evidence to the contrary. Delusions often focus on a particular theme,
and several types of themes are common among these patients. For one, paranoid
delusions involve the theme of being persecuted by others. Pamela Spiro Wagner’s
paranoid delusions involved extraterrestrials:I barricade the door each night for fear of beings from
the higher dimensions coming to spirit me away, use-
less as any physical barrier would be against them. I
don’t mention the NSA, DIA, or Interpol surveillance
I’ve detected in my walls or how intercepted con-
versations among these agencies have intruded into
TV shows.
(Wagner & Spiro, 2005, p. 2)
In contrast, delusions of control revolve around
the belief that the person is being controlled by
other people (or aliens), who literally put thoughts
into his or her head, called thought insertion:I came to believe that a local pharmacist was tor-
menting me by inserting his thoughts into my head,
stealing mine, and inducing me to buy things I had
no use for. The only way I could escape the infl u-
ence of his deadly radiation was to walk a circuit
a mile in diameter around his drugstore, and then
I felt terrifi ed and in terrible danger.
(Wagner, 1996, p. 400)
In this example, note that Wagner believed that it is possible for the pharmacist to
insert his thoughts into her head and thus control her.
Another delusional theme is believing oneself to be signifi cantly more powerful,
knowledgeable, or capable than is actually the case, referred to as delusions of gran-
deur. Someone with this type of delusion may believe that he or she has invented a
new type of computer when such an achievement by that person is clearly impossible.
Delusions of grandeur may also include the mistaken belief that the individual is a
different—often famous and powerful—person, such as the president or a prominent
religious fi gure.
Yet another delusional theme is present in delusions of reference: the belief that
external events have special meaning for the individual. Someone who believes that
a song playing in a movie is in some kind of code that has special meaning just for
him or her, for instance, is having a delusion of reference.
Whatever the theme of the delusion, according to DSM-IV-TR, if it is bizarre
or clearly implausible, then additional symptoms are not needed for a diagnosis of
schizophrenia. An example would be a patient’s belief that his or her organs have
been replaced, despite the absence of a surgical scar.Disorganized Speech
People with schizophrenia can sometimes speak incoherently, although they may
not necessarily be aware that other people cannot understand what they are saying.
Speech can be disorganized in a variety of different ways. One type of disorga-
nized speech is word salad, which is a random stream of seemingly unconnectedDelusions
Persistent false beliefs that are held despite
evidence that the beliefs are incorrect or
exaggerate reality.Word salad
Disorganized speech consisting of a random
stream of seemingly unconnected words.