How can I role-play schizophrenia?

Question

I'm currently playing a character in a medieval fantasy setting (Pathfinder 1st edition for the record), and my character has recently become schizophrenic. Schizophrenia is the mental disorder characterized by abnormal social behavior, failure to understand what is real and sometimes even hallucinations.

I am quite used to role-playing psychotic characters, but I have no idea how to play this one without falling in a ridiculous stereotype.

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Please note that schizophrenia is not characterized by multiple personalities. That is a separate (much rarer and more controversial) disorder, known as dissociative identity disorder. Media sometimes confused the two (probably since schizophrenia means "split mind" in Greek), but this question is using the proper meaning of the word.

Answer 1

This is an interesting question. I ran a very long-running AD&D 2e/Call of Cthulhu mashup where we put a lot of work into realistic mental disorders from the PCs. As each PC went through more and more, they all started to display signs of mental disorders. (In fact, interestingly, it was a deep in character campaign and when I asked players to start playing their characters "a little crazy" it was remarkable that they were all different, they could all be pretty easily diagnosed using DSM-IV criteria, and the chosen disorder seemed to be the one that the player could tend towards IRL...)

First step is to check the definition of the disorder. From the DSM-V, schizophrenia consists of:

Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these should include 1–3.

1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms (i.e., diminished emotional expression or avolition)

It can also help to look at well realized examples of schizophrenia in other media - the movie Clean, Shaven is my favorite here.

Now, of course trying to depict someone very mentally ill can be a challenge to also be functional - what we did was to start with the schizotypal personality disorder. This is a more mild form and often a 'stepping stone' to full blown schizophrenia. It's a little more accessible to the layman as well, here's the list of possible symptoms:

• Inappropriate or constricted affect (the individual appears cold and aloof);
• Behavior or appearance that is odd, eccentric or peculiar;
• Poor rapport with others and a tendency to withdraw socially;
• Odd beliefs or magical thinking, influencing behavior and inconsistent with subcultural norms;
• Suspiciousness or paranoid ideas;
• Obsessive ruminations without inner resistance, often with dysmorphophobic, sexual or aggressive contents;
• Unusual perceptual experiences including somatosensory (bodily) or other illusions, depersonalization or derealization;
• Vague, circumstantial, metaphorical, over-elaborate or stereotyped thinking, manifested by odd speech or in other ways, without gross incoherence;
• Occasional transient quasi-psychotic episodes with intense illusions, auditory or other hallucinations and delusion-like ideas, usually occurring without external provocation.

In our case, the player of the schizophrenia-tending wizard started to behave and appear "oddly" - dressing inappropriately (women's underwear under his robe), having trouble forming relationships (paid another PC to pretend she was sleeping with him), collecting eyeballs (somewhat plausible as a wizard hobby, but...), belief in a personal deity that wasn't externally recognized (lived in fire), extreme suspicion of the blind gnome in the party. He'd also follow the orders of one party member without question. Whenever he had significant setbacks he'd have audial hallucinations that would "drown out" what others were saying and could make him exclaim things like "SHUT UP SHUT UP!" at times, which was very disconcerting to his fellow party members. He did a really good job of it, didn't lay it on too thick in normal circumstances unless he was failing a lot of Sanity checks, but it was clear and reasonably realistic. (The other party members were a megalomaniac, borderline personality disorder/bipolar, a depressive/catatonic type, and an anxiety disorder).

So in general I'd recommend starting from a deep in character perspective - mental disorders become goofy stereotypes if the character is a goofy stereotype already. Research the disorder, including its milder forms, and slide into it.

Answer 2

You need the co-operation of your GM here. The classic symptom of schizophrenia is the inability to distinguish the real from the imagined. Therefore, you need situations where your character perceives something the others don't, which your GM can provide you with by passing notes saying "You hear something around the corner" or "You see something sinister and inhuman in his eyes" or the like.

But importantly, he will also have to pass you notes that are true, that are equally fantastic (not too hard in a fantasy setting), and that the other characters also don't perceive. In many cultures and in the West centuries ago, people we would now label schizophrenic were considered to be prophets. That's where the (now pejorative) term "touched" comes from: "touched by God".

Your GM (perhaps with your input) will need to determine how often or likely it is that these perceptions reveal something material. It might be on a die roll (e.g., a 6 on a secretly rolled d6 means the perception is true), or there might be some other criterion. But your character would not know the difference until he takes (or fails to take) action.

Answer 3

Everything I have read and seen of the disease is that prior to the drug commonly known as thorizine victims are mostly nonfunctional in society. The victim doesn't know what is real and not real, so you could play them as randomly seeing the effects of a Phantasmal Force (assuming D&D type game there) but not all of them would be attacking the victim but might try to talk them into hurting others. Every voice they hear is the voice of "god" and therefore is difficult to ignore let alone disobey.

There are a number of examples posted in video interviews with schizophrenics I would start there. The one linked here is an hour documentary on the disease, enjoy... scary way to go. Seek a cure in your campaign world soon :)

Unless you are determined to have them slightly toned down and a mild case the focus would be on curing it, as a schizophrenic Paladin could easily become a murderer rather shortly in severe cases. I suppose a good example of a "mild" and manageable case would be that found in John Forbes Nash, Jr his story was portrayed in A Beautiful Mind. Not being a psychiatrist but I think his version had a touch of megalomania in it since his delusions were about self-import partially.