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"Is there, currently, any set of criteria or symptoms that have been established as the agreed-upon standard for diagnosing schizophrenia?" asked Rip.

"DSM-IV is probably about as close as you'll get to a generally agreed-upon standard at the present time," I replied. "However," I added, "these guidelines have a variety of biases which shape and orient them.

"For instance, DSM-IV is solidly rooted in a medical/biological model of human nature and behavior. Moreover, this diagnostic tool also is, to a considerable degree, colored by a Western cultural perspective in general and American clinical experience in particular."

"As far as this standard ...ahh, DSM-IV ... is concerned, what are some of the symptoms that are generally believed to be associated with schizophrenia?" Rip inquired.

I reflected for a few seconds and said: "One important factor would be the length of time for which certain kinds of symptom have been persisting. Generally speaking, even when the 'right' sorts of symptom are present, if these symptoms have not been in evidence for at least six months, the mental condition might not be diagnosed as schizophrenia.

"Instead, if the symptoms have lasted for two weeks or less, then the condition might be considered to be some sort of brief reactive psychosis that may have been precipitated by intense stress of some kind. Or, if the symptoms have been present for more than two weeks, but less than six months, then the condition might be treated as some form of what is known as a 'schizophreniform disorder'.

"If the symptoms have persisted for the requisite six month period, then there are about six, or so, diagnostic categories which are compared to the symptoms being exhibited by the individual. These categories encompass themes of thought, perception, attention, motor behavior, emotion or affect, and life functioning.

"For instance, there may be different kinds of disturbance in thinking that could be evidence of the presence of schizophrenia. These disturbances may be either in the character of the structure or forms which such thoughts assume, or these anomalies may concern the content of such thoughts.

"In the case of problems with the form of thought, the individual's ideas tend not to be connected to one another, or the individual will have great difficulty sticking to any one topic. Form-of-thought problems also could include such things as the individual's inclination to use neologisms - that is, to make up words which may have meaning for the speaker, but which, in all likelihood, have little, or no, meaning for the listener. The individual may also make use of, what are known as, 'clang associations' in which lots of rhyming words appear in the individual's day-to-day discourse.

"Disorders in thought content could include a profound lack of appreciation for, or awareness of, the existence of a serious problem of mental disturbance in oneself. The schizophrenic often does not see anything wrong with the way he or she is behaving or performing.

"Another kind of disorder in thought content concerns delusions of one sort or another. The character of these delusions can vary considerably.

"Perhaps, the classic form of schizophrenic delusion, at least in the popular literature, is the one that is paranoid in nature. However, there are many other kinds of possible delusion.

"The individual, for instance, may believe that someone is stealing his or her thoughts. Alternatively, the person may believe that an external agency is broadcasting or inserting thoughts, feelings and impulses into one's consciousness.

"Another category of symptoms concerns various kinds of perceptual disorders. The most striking symptom in this category are hallucinations in which the individual has a sensory experience of some kind in the absence of any environmental stimulus.

"In three-fourths of the cases, this kind of perceptual distortion comes in the form of auditory hallucinations. The individual will report, for example, hearing different voices arguing or commenting about various issues.

"There are other kinds of perceptual distortions as well, besides these more common auditory ones. Some people do have visual hallucinations. Others may experience sensations of burning, electric tingling, or numbness. Still other individuals may feel that insects or snakes are crawling around beneath their skins or in their abdomens.

"Another category of mental disturbance that is used to try to diagnose the presence of schizophrenia involves the phenomenological quality of an individual's awareness or attention. Schizophrenics frequently report that the world seems unreal or colorless or flat.

"In addition, their awareness of the world may have a substantially alien quality to it, in the sense that everything is experienced as being strange and unfamiliar. Or, the individual may experience their engagement of the world in a depersonalized fashion, such that the body seems to go about its business in the world in a mechanical fashion which is devoid of a sense of personhood or identity as an individual.

"A fourth category of symptoms revolves around motor activity. The schizophrenic individual sometimes manifests, for extended periods of time, strange facial contortions, or they may exhibit a complex, peculiar series of movements involving hands, fingers, arms and legs.

"Probably, the most well-known examples of motor disturbance in schizophrenics are catatonic immobility and catatonic agitation. In the former case, the individual tends to be, as the term suggests, immobile and may assume various kinds of unusual and awkward postures that are held for long periods of time.

"In the case of catatonic agitation, the individual tends to be constantly on the go and in a very excited state. In this condition, the individual expends tremendous amounts of energy with little, or no, regard being given to whether an activity is important or unimportant.

"A fifth category of symptoms which plays a role in helping to diagnose the schizophrenic condition involves the character of an individual's affective or emotional engagement of experience. In general, there are two distinguishing features to this affective component in the lives of schizophrenics.

"Various studies, such as the World Health Organization's International Pilot Study of Schizophrenia, have shown that approximately two-thirds of all schizophrenics report or exhibit virtually a total absence or flatness of affect in their daily lives. This flatness may manifest itself as a deep-seated apathy concerning oneself and one's surroundings, or it may show up as an inability or unwillingness to respond to any kind of emotional stimulus from the human beings forming one's environment.

"Individuals showing this kind of affective flatness will often be seen staring vacantly for long periods of time. The muscles of their faces tend to be flaccid or loose and lacking definition, and their eyes are lifeless. If they speak at all, their voices sound toneless, mechanical and devoid of any emotion.

"The other kind of affective disturbance that is prevalent in schizophrenics has to do with the display of affect or emotion which is inappropriate to a given context or situation. The individual might laugh uproariously when sadness or tears would be appropriate, or the person might cry when happiness would be the usual or expected response.

"Much more rarely, one may encounter individuals who display a constant, rapid shifting between, or among, various emotional states. When this does occur, such a symptom often carries a lot of weight with some people in reaching a diagnostic determination of schizophrenia.

"The final category of symptoms that is considered in diagnosing schizophrenics concerns disturbances in the way the individual goes about attending to their various needs of life. These life-functioning skills would include things such as: personal hygiene and grooming; an inclination to make friends and to socialize with other individuals; as well as the capacity to hold a job or to deal with responsibilities in school.

"In my opinion, this last category is somewhat more nebulous, subjective and less helpful than some of the other categories of symptoms that I have mentioned. There are a lot of different kinds of mental disturbance which would entail life-functioning problems very similar to the ones that I have summarized and, therefore, don't necessarily provide a good way to diagnostically identify the nature of the condition with which one is confronted.

"In fact, if one were to rely solely on this last category, then quite a few teenagers would stand an excellent chance of being diagnosed as schizophrenic. On the other hand, when one combines this category with the other five categories of symptoms, then considerations of the quality of life-functioning sometimes helps to round out the general clinical picture of schizophrenia."

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