548 CHAPTER 12
To develop a sense of the consequences of having such cognitive diffi culties,
imagine the experience of a man with these defi cits who tries to go shopping for
ingredients for dinner. He may fi nd himself in the supermarket, surrounded by hun-
dreds of food items; because of his attentional problems, each item on a shelf may
capture the same degree of his attention. Because of defi cits in executive function-
ing, he loses track of why he is there—what was he supposed to buy? And if he
remembers why he is there (“I need to get chicken, rice, and vegetables”), he may
not be able to exercise good judgment about how much chicken to buy or which
vegetables. Or, because of the combination of his cognitive defi cits, he may fi nd the
whole task too taxing and leave without the dinner ingredients.Beliefs and Attributions
As mentioned earlier, cognitive diffi culties often develop before symptoms of schizo-
phrenia emerge. The early infl uence of the cognitive defi cits affects what the person
comes to believe. For example, because children with these cognitive defi cits may
do poorly in school and often are socially odd, they may be ostracized or teased by
their classmates; they may then come to believe that they are inferior and proceed
to act in accordance with those beliefs, perhaps by withdrawing from others (Beck &
Rector, 2005).
In addition, if people with schizophrenia have delusional beliefs, the delusions
almost always relate to themselves and their extreme cognitive distortions (e.g.,
“The FBI is out to get me”). These distortions infl uence what they pay attention to
and what beliefs go unchallenged. People with schizophrenia may be infl exible in
their beliefs or may jump to conclusions, and their actions based on their beliefs can
be extreme (Garety et al., 2005). Moreover, they may be very confi dent that their
(false) beliefs are true (Moritz & Woodward, 2006). For example, a man with para-
noid schizophrenia might attribute a bad connection on a cell phone call to inter-
ference by FBI agents or aliens; he searches for and fi nds “confi rming evidence” of
such interference (“There’s a bad connection when I call my friend and they want to
listen in, but there’s no static when I call directory assistance and there’s no need for
them to listen in”). Disconfi rming evidence—that cell phone service is weak in the
spot where he was standing when he made the call to his friend—is ignored (Beck &
Rector, 2005).
People with paranoid schizophrenia tend to blame negative events on others,
specifi cally the subjects of their delusions (Garety & Freeman, 1999). So, for in-
stance, if a man with paranoid schizophrenia is waiting for a commuter train and
hears an announcement that the train is delayed, he might think, “The FBI is tryinga discovery—to me it was a discovery—that somehow the enemy had developed a new weapon
by which they could psychologically hypnotize certain high-ranking offi cials. And I became
very confi dent that I had stumbled onto this discovery. And because it was a psychological
sort of thing I would share this with a person who would be likely to know most about this kind
of stuff and that was the base psychiatrist. So I called him up and he agreed to see me right
away, and I went down and told him about my discovery, and he listened very politely and
when I got fi nished to get up and leave there were these two gentlemen in white coats on either
side of me—either shoulder. And I often say I think one of them looked like he might be elected
governor of Minnesota somewhere along the way. But they escorted me down into a seclusion
padded room [sic]. And within a day or two I discovered that they had me labeled as paranoid
schizophrenic. Of course I immediately recognized that the psychiatrist was under the control
of the enemies with their new weapons. I spent about fi ve months mostly in Bethesda, which
is the Navy’s major hospital, and was discharged with a psychiatric condition. However, that
was my discovery that I was diagnosed with... schizophrenia. The way the disorder works is,
I didn’t have a disorder, I had “made this discovery”. So it was a number of years before I
came to this conclusion that there was something wrong here and I was hospitalized about
ten times, almost always involuntarily... over about a ten year period of time.
(WCPN, 2003).
Psychologist Fred Frese was diagnosed with
paranoid schizophrenia in 1965 when he was a
Marine Corps security offi cer. He was hospitalized
many times over the next 10 years but was able to
earn a Ph.D. in psychology in 1978. Over the past
30 years, he has written about mental illness from
both sides of the experience, been an advocate
for the mentally ill, and served as Director of
Psychology at Western Reserve Psychiatric Hospital.Courtesy of Fred Frese
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