Can schizophrenics who are deaf since birth hear voices?

Can schizophrenics who are deaf since birth hear voices?

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I am interested in how schizophrenia can be expressed in them, and whether it depends on the perception of the world. Maybe they see text pop-up in the air, or something like that?

A quick Google search reveals some answers such as Atkinson, J. R. (2006).

Around half of all deaf people diagnosed with schizophrenia report experiencing “voices,” during which they sense someone communicating with them in the absence of any external stimulus. This closely parallels prevalence rates of auditory verbal hallucinations (AVH) in hearing people with schizophrenia (50-70%). There is no evidence reported for increased frequency of psychotic hallucinations in congenitally deaf people. However, greater proportions of visual and tactile/somatic hallucinations have been noted. Around 50% of deaf people with a diagnosis of schizophrenia report visual hallucinations, and a similar proportion describe tactile/somatic hallucinations, despite the low occurrence of these phenomena in schizophrenia generally (15% and 5%, respectively).

The abstract points out that:

The study of voice-hallucinations in deaf individuals, who exploit the visuomotor rather than auditory modality for communication, provides rare insight into the relationship between sensory experience and how “voices” are perceived. Relatively little is known about the perceptual characteristics of voice-hallucinations in congenitally deaf people who use lip-reading or sign language as their preferred means of communication. The existing literature on hallucinations in deaf people is reviewed, alongside consideration of how such phenomena may fit into explanatory subvocal articulation hypotheses proposed for auditory verbal hallucinations in hearing people.


Atkinson, J. R. (2006). The perceptual characteristics of voice-hallucinations in deaf people: insights into the nature of subvocal thought and sensory feedback loops. Schizophrenia bulletin, 32(4), 701-708. doi: 10.1093/schbul/sbj063 pubmed: PMC2632268

What happens in the brain when a deaf (from birth) person reads?

I was thinking about how when I read silently to myself, I "hear" the words I'm reading in my head. When I read the word "window" I "hear" it, know what it is, and continue on. I don't "see" in my mind's eye a picture of a window unless I need to (e.g. to solve a puzzle I might picture various kinds of windows).

Then I wondered, for someone who has never heard the the pronunciation of the word or know what it sounds like, what happens when they read the word "window"? Do they picture it in their mind's eye or does something else entirely different take place?

Iɽ like to add a follow up question.

I recall hearing that deaf schizophrenics experience sign hallucinations rather than voices in their heads. Would this be in the same relative area as to what would be happening here with deaf people reading?

It's an interesting issue. Atkinson (2006) claims that of deaf individuals diagnosed with schizophrenia, only 50% experience visual hallucinations and a similar number report tactile hallucinations. Worth noting that among hearing individuals the rates of each of those is much lower (she cites 15% and 5%, respectively).

Is this the same as reading for deaf individuals, I would say kind of but not really. Part of the hallucination is that it is communicative, the "voices" speak, and it would make sense that for most individuals they would speak in the schizophrenic's native language. If a sign language is the native language, you might well expect some kind of visual/tactile hallucination. In the same way for a native signer when they read you might expect them to be referencing their native language.

But it's a bit complicated because deaf individuals often have wildly different experiences in learning language. I think this Quora post on how deaf individuals are taught to read gives some good insight. An important thing to keep in mind is that sign language is not generally a transliteration of a spoken language. You can't, for example, take an English sentence, convert each word into an American Sign Language sign, and then sign them in order to get an ASL sentence. Doesn't work that way because ASL is it's own language with it's own grammar which differs quite substantially from spoken English. For someone profoundly deaf, with no exposure to spoken English, learning to read is not just a process of mapping written words to meanings, but also potentially one of learning a new grammar.

Deaf children and adolescents

Early severe and profound deafness

About one in 1500 children is severely or profoundly deaf from early life owing to causes that include genetic (mainly recessive) factors, to maternal rubella, neonatal jaundice and meningitis. They cannot take natural advantage of the critical early period of language development by hearing their own and others’ voices. Deaf children in deaf signing families acquire language (in sign) at the appropriate age, but the 90% of deaf children who are in hearing families risk significant delays and limitations in language development, with adverse consequences for psychological, emotional, social and educational development.

For centuries, controversy has raged about whether deaf children should be taught spoken or signed language ( Reference Sacks Sacks, 1989 Reference Ree Ree, 1999). Sign language was banned in UK schools in the 1880s and has reappeared only in the past 20 years (Table 1).

Table 1 Language options for deaf children – the controversial issues

Oralism Signing/English (written and/or spoken) bilingualism
It is a hearing world. Most, if not all, deaf children can speak Oralism can lead to unacceptable failures and delays. ‘The deaf are virtually the only neurologically normal people who make it to adulthood without having acquired a first language’ ( Reference Pinker Pinker, 1994)
Sign is not a ‘proper’ language Sign has the same structures and mechanisms as spoken languages and is processed in the same area of the brain
Delay in speaking is not important The ‘critical period’ for first language acquisition peaks at about 3 years old. Signing allows this to happen on time
Signing will prevent speech There is no evidence for this belief when bilingual principles are applied to development
Signing will confine a deaf person to a limited life Deaf signers have a positive self-identity and the confidence to function in the deaf and hearing worlds

The view that deafness is a solvable medical problem has been reinforced by modern developments in hearing aids and paediatric cochlear implants and the mainstreaming of deaf children in schools. There is consequently a risk that issues regarding identity, language development and appropriate peer groups for deaf children are sidelined. Local education authorities decide communication policies, and at present some counties in the UK have strictly ‘oral’ policies and others have well-developed signing/English bilingual programmes. There are still a few residential deaf schools. They provide out-of-area placements for children whose parents want an approach that differs from that of the county in which they live. Most also take deaf pupils who have additional problems.

Deaf children have an increased prevalence of mental health problems (45–50% v. an average of about 25% for the general population Reference Hindley, Hill, McGuigan and Kitson Hindley et al, 1994 Reference Hindley, Hindley and Kitson Hindley, 2000). Reasons for this include:

• an excess of organic problems (usually due to the cause of the deafness)

• an excess of emotional, psychological and behavioural disorders

• delays in access to service, which increase the duration of mental health problems.

In the past, these factors compounded. Conditions such as mild-to-moderate learning disability, attention-deficit disorder and autism were not detected as the children's problems were attributed to their deafness. There were low expectations of all deaf children and the difficulties of teaching them to speak took precedence over successful education and emotional development. Reference Conrad Conrad (1977) showed that deaf school leavers had an average reading age of 8–9 years. Gregory, in Deaf Children and their Families (1995) and its follow up volume Deaf Young People and their Families ( Reference Gregory, Bishop and Sheldon Gregory et al, 1995), showed the human cost of old-fashioned educational policies. Nearly 20% of a cohort of deaf young people who had a normal IQ score were unable to complete an interview in either speech or sign.

Some psychiatrists concluded that troubled young deaf people had a specific syndrome, which Reference Basilier Basilier (1964) called ‘surdophrenia’ (‘deaf mind’). However, deaf children from deaf families do not show this increased level of mental health problems.

Deaf children, particularly those from hearing families, may be exposed to an excess of the risk factors that can affect all children and lead to adjustment disorders in adolescence. These factors include academic failure, low self-esteem, rejecting relationships, inconsistent discipline, failure of age-appropriate development, and abuse (sexual, physical and emotional). Most of these are secondary to negative attitudes to deafness and, above all, to failure to develop age-appropriate communication. Unfortunately, old controversies about educational strategies persist, but neonatal screening, increasing awareness of communication choices and better monitoring of deaf children's early development (including their progress in speech and/or sign) should prevent the extreme delays in language development seen in the past. Personal development programmes in schools and better mental health services should mean that deaf children have access to prevention, assessment and treatment of their problems before they escalate and persist into adult life. In both areas, it is vital to employ deaf professional staff.

Children and adolescents with partial or intermittent deafness

Children with intermittent deafness, for example because of glue ear, can show emotional and behavioural problems when their hearing is reduced. They feel uncertain, frustrated and left out.

Children with ongoing partial deafness may benefit greatly from hearing aids and usually develop good speech. However, background noise and group interactions can create many problems. Virtually all partially deaf children are placed in mainstream schools, with or without support from a special unit, teachers or communicators. The deaf child is often the only one in his or her class or year and is at risk of being isolated, teased or bullied. Children can internalise negative attitudes that they perceive in others, and low self-esteem can lead to further difficulties in the transition to adult life. Young people with such hearing difficulties can be left feeling that they do not belong with either deaf or hearing people.

Acquired deafness

People who became deaf in adult life usually consider this in purely negative terms. They are unlikely to learn sign language or to join the deaf community. Deafened people often undergo a bereavement reaction and, unless they can work through this, they may be left with anger and denial. Many people do not make the necessary practical adjustments to their lives because of reluctance to acknowledge the extent of their hearing loss. Problems due to deafness in old age may be missed or attributed to depression or dementia. Because two-way communication is affected, a deafened person's family and friends may become frustrated, and the risk of social withdrawal is increased. Even with an aid or implant, speech reception is not clear and background noise is intrusive. Group conversations can be almost impossible and music is just a noise. In these circumstances, depressive illness may be missed.

Paranoid symptoms have been described in acquired deafness ( Reference Eastwood, Corbin and Reed Eastwood et al, 1985). The deafened person feels increasingly vulnerable and isolated, often uncertain about what is happening. Depression and memory problems due to the depression itself, to head injury (perhaps the cause of the deafness) or to any coexisting dementia increase the risk of paranoid symptoms.

A deafened person needs factual advice and emotional support. Any depressive illness should be fully treated. The National Association of Deafened People and the Royal National Institute for the Deaf (RNID) are valuable sources of information and advice.

Prevalence of Schizophrenia and Voice-Hallucinations Among Deaf People

Voice-hallucinations have traditionally been seen as a core symptom of schizophrenia, 4 , 5 and most of the literature focuses on this diagnostic group. The prevalence of schizophrenia within the deaf community appears toꂾ roughly equivalent to the general population, although no reliable epidemiological data exists. 6 – 8 Around half of all deaf people diagnosed with schizophrenia report experiencing “voices,” during which they sense someone communicating with them in the absence of any external stimulus. 9 , 10 This closely parallels prevalence rates of auditory verbal hallucinations (AVH) in hearing people with schizophrenia (50�%). 11 , 12 There is no evidence reported for increased frequency of psychotic hallucinations in congenitally deaf people. However, greater proportions of visual and tactile/somatic hallucinations have been noted. 3 , 10 , 13 Around 50% of deaf people with a diagnosis of schizophrenia report visual hallucinations, and a similar proportion describe tactile/somatic hallucinations, despite the low occurrence of these phenomena in schizophrenia generally (15% and 5%, respectively 14 ). Interestingly, both types of hallucination usually co-occur with reports of “voices,” 10 raising the possibility of a direct relationship between these phenomena.

6-10 Hallucination Facts

6. 68% of people in one study experienced “phantom vibration syndrome,” a sensory hallucination where you mistakenly think your phone is buzzing. – Source

7. Fatal Familial Insomnia is an inherited brain disease that eventually causes one to be incapable of sleep. It has no known cure. It involves progressively worsening insomnia, which leads to hallucinations, confusional states like that of dementia, and eventually, death. – Source

8. Smell hallucinations are called phantosmia and can be caused by infections, neurological damage, or epilepsy. – Source

9. The first sensory deprivation tank was created in 1954. Since then people have experienced hallucinations, out of body experiences and even parallel universes while in these chambers. – Source

10. Blind people experience visual hallucinations when they take LSD. – Source

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A psychiatric diagnosis is usually given by a doctor or mental health specialist on the basis of what someone says about their thoughts, feelings and experiences, alongside observations about their behaviour. In the US, clinicians use the DSM-5 to make a psychiatric diagnosis, whereas in the UK they mainly use the ICD-10 system.

Around 75% of people with a diagnosis of schizophrenia question icon hear voices. Voices can also occur in people who have a diagnosis of psychosis question icon , bipolar disorder question icon , borderline personality disorder question icon , dissociative identity disorder question icon , PTSD question icon , anorexia question icon or severe depression.

Many people think that voices that are loud, commanding, and come from an external location are more of a worry than those that are experienced as occurring ‘inside the head’. In the past, people thought that these kind of voices were typical of schizophrenia. However, research suggests that the volume, content or perceived location of a voice is not relevant to the type of diagnosis a person may receive. There is little evidence for the once widespread view that ‘internal voices’ – i.e. voices that occur ‘inside the head’ – are somehow more benign than those that appear to come from an external location.

Some people who hear voices find psychiatric diagnoses helpful, others find them stigmatising and harmful. What is important to understand is that hearing voices is not in itself a sign that someone has a mental health problem, regardless of whether the voices shout or whisper or are experienced as ‘internal’ or ‘external’. In some people’s experience, it’s not the voices themselves which are upsetting. Rather, it’s difficulties in coping with voices, and the stigma question icon and negativity that surrounds the experience, which causes the most distress.

Did you know?

Researchers and clinicians differ over the question of whether psychiatric diagnoses pick out ‘real illnesses’.

Some think they are best understood as describing patterns of experience, thoughts and behaviour that may be distressing or disruptive. On this view, psychiatric diagnoses are useful classificatory tools – they can help health professionals communicate with each other or decide which forms of treatment might help – but they can’t tell us anything about the underlying causes of someone’s moods or experiences.

If you’re interested in these different views about diagnosis you can find out more about them here and here.

Jackie Roth, deaf since birth, is an advocate and a broker for the disabled

When clients hear broker Jackie Roth speak, they assume — correctly — that English is her second language.

Some presume — incorrectly — that she's from France.

"People ask where I'm from, and I say, 'Brooklyn,' " and they say, 'No, no, where are you from originally,' and I say, 'BROOKLYN,' " says Roth with a smile.

The star Douglas Elliman broker first communicated in sign language, and didn't speak English until she was 5.

Deaf since birth, Roth is a rarity in New York's real-estate world: a broker with a disability.

"I can't think of any," says Peter Slatin, the legendary real-estate writer who became a disability advocate when he lost his sight. "It's remarkable what she's doing."

And she's doing remarkably, too.

Since joining Douglas Elliman in 2006, Roth has become one of the brokerage's Top Producers, a distinction placing her in the top 1% of the 4,000-strong agency.

Now Roth is launching a group within the company to help pair clients who have disabilities with brokers able to meet their needs.

"Because I hear differently, I see and experience the city differently, and I want to bring that experience to others to help them find a home," Roth says.

The team of brokers aims to be particularly attuned to the wants of clients with special needs. They're even building a nationwide network to help these buyers and renters.

"It's not about disability, it's about ability," Douglas Elliman CEO Dottie Herman says. "She's one of my best brokers, but she's also one of the best people I know."

But breaking into the industry wasn't easy. Like with so much else in life, Ross was told she'd never make it.

"I went to another brokerage in 2005, and the manager there basically laughed in my face," Roth says.

He told her real estate is all talk — fielding phone calls and negotiating deals. "He said, 'How's a deaf person gonna work the phones?' " Roth recalls.

She admits that a generation ago, the manager might have had a point, but now, thanks to technology, she can pull up a sign-language interpreter on her phone and video-chat in real time.

"I can do a lot just with my iPhone," Roth says.

Roth got her first hearing aid, a sophisticated implant, as a toddler, and she was the first person in her family in three generations to learn to speak.

She grew up in Crown Heights and later in Forest Hills, Queens. Roth's dad worked for The News setting type — the paper's printing plant was one of the largest employers of the deaf back then.

Before real estate, Roth found her voice on the stage. After flirting with psychology in college, she joined the acting troupe at Gallaudet, the university for the deaf in Washington, D.C., and discovered she had a knack for it.

When she returned home to New York, Roth got plenty of rejections, but no more than the average actor, and she even enjoyed considerable success despite her deafness, working Off-Broadway and around the country. She did numerous commercials, most notably a national spot for Bayer aspirin in which she signs into the camera.

She even made it to Broadway in 1982, in "Children of a Lesser God," about a romance between a deaf woman and her language teacher. Roth was the understudy for Oscar winner Marlee Matlin, and the lead in a national tour of the show. The Washington Post called her "a delicate yet determined star."

Rather than wait tables when she wasn't acting, Roth taught and translated sign language and was an activist. "I had to fight injustice for myself, so I wanted to fight it for others, too," she says.

She lowered the curtain on her acting career and turned to real estate in 2005. "The city really is my first love, so there's no better job," Roth says.

At first, many clients came from the stage. One was Camryn Manheim, star of "The Practice." But the two actually met during Roth's teaching sessions. Manheim needed language credits to get into the University of California, Santa Cruz, and having failed both French and Spanish, decided on sign language.

The pair lost touch until Manheim was looking to rent out her Lower East Side loft and heard Roth was now a broker.

"She has an incredible ability to make people feel special," Manheim says. "She sees things others don't."

Roth has a sixth sense for real estate, and credits her acting and lip-reading abilities for giving her an uncanny ability to read people.

"As soon as somebody walks into one of my listings, before they even open their mouths, I can tell if they're the one," Roth says. "It's just screaming across their face."

Clients like Lauren Ridloff and her husband, Dan, who are deaf, feel that were it not for Roth, they never would have landed a place.

"Finding an apartment in New York is hard enough as it is," says Ridloff.

After problems with brokers over the years — getting bogged down in lengthy email correspondence or being plain turned down — the couple turned to Roth when they were ready to buy.

They wanted a home in Williamsburg and settled on a new condo, but when the recession hit, the building saw delays and construction issues. "Jackie fought so hard to get our deposit back," Ridloff says. "Working with brokers, attorneys, it was like magic."

The couple then settled on a red-brick rowhouse on S. Second St. There were issues with the closing, and the deal wound up in court, with Jackie seeing it through.

Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality. Although schizophrenia is not as common as other mental disorders, the symptoms can be very disabling.

Impactful Schizophrenia Research Discoveries by Foundation Grantees:

For our most recent research summaries, click here.

Schizophrenia is a severe and debilitating brain and behavior disorder affecting how one thinks, feels and acts. People with schizophrenia can have trouble distinguishing reality from fantasy, expressing and managing normal emotions and making decisions. Thought processes may also be disorganized and the motivation to engage in life’s activities may be blunted. Those with the condition may hear imaginary voices and believe others are reading their minds, controlling their thoughts or plotting to harm them.

Most people with schizophrenia suffer from symptoms either continuously or intermittently throughout life and are often severely stigmatized by people who do not understand the disease. Contrary to popular perception, people with schizophrenia do not have “split” or multiple personalities and most pose no danger to others. However, the symptoms are terrifying to those afflicted and can make them unresponsive, agitated or withdrawn. People with schizophrenia attempt suicide more often than people in the general population, and estimates are that up to 10 percent of people with schizophrenia will complete a suicide in the first 10 years of the illness — particularly young men with schizophrenia.

While schizophrenia is a chronic disorder, it can be treated with medication, psychological and social treatments, substantially improving the lives of people with the condition.

A moving presentation by Dr. Kafui Dzirasa on Schizophrenia

There are several factors that contribute to the risk of developing schizophrenia.

  • Genetics
  • Environment
  • Brain chemistry
  • Brain structure
  • Brain development

Scientists believe that many different genes may increase the risk of schizophrenia development, but that no single gene causes the disorder by itself. It is not yet possible to use genetic information to predict who will develop schizophrenia. Scientists also think that interactions between genes and aspects of the individual’s environment are necessary for schizophrenia to develop.

View Webinar on Identifying Risk Factors and Protective Pathways for Schizophrenia

  • Paranoid schizophrenia — feelings of extreme suspicion, persecution or grandiosity, or a combination of these.
  • Disorganized schizophrenia — incoherent thoughts, but not necessarily delusional.
  • Catatonic schizophrenia — withdrawal, negative affect and isolation, and marked psychomotor disturbances.
  • Residual schizophrenia — delusions or hallucinations may go away, but motivation or interest in life is gone.
  • Schizoaffective disorder — symptoms of both schizophrenia and a major mood disorder, such as depression.

Schizophrenia can have very different symptoms in different people. The way the disease manifests itself and progresses in a person depends on the time of onset, severity, and duration of symptoms, which are categorized as positive, negative and cognitive. All three kinds of symptoms reflect problems in brain function. Relapse and remission cycles often occur a person can get better, worse and better again repeatedly over time.

  • Positive symptoms, which can be severe or mild, include delusions, hallucinations, and thought disorders. Some psychiatrists also include psychomotor problems that affect movement in this category. Delusions, hallucinations and inner voices are collectively called psychosis, which also can be a hallmark of other serious mental illnesses such as bipolar disorder. Delusions lead people to believe others are monitoring or threatening them, or reading their thoughts. Hallucinations cause a patient to hear, see, feel or smell something that is not there. Thought disorders may involve difficulty putting cohesive thoughts together or making sense of speech. Psychomotor problems may appear as clumsiness, unusual mannerisms or repetitive actions, and in extreme cases, motionless rigidity held for extended periods of time.
  • Negative symptoms reflect a loss of functioning in areas such as emotion or motivation. Negative symptoms include loss or reduction in the ability to initiate plans, speak, express emotion or find pleasure in life. They include emotional flatness or lack of expression, diminished ability to begin and sustain a planned activity, social withdrawal and apathy. These symptoms can be mistaken for laziness or depression.
  • Cognitive symptoms involve problems with attention and memory, especially in planning and organizing to achieve a goal. Cognitive deficits are the most disabling for patients trying to lead a normal life.

Schizophrenia affects men and women equally. It occurs at similar rates in all ethnic groups around the world. Symptoms such as hallucinations and delusions usually start between ages 16 and 30.

Men tend to experience symptoms earlier than women. Most of the time, people do not get schizophrenia after age 45. Schizophrenia rarely occurs in children, but awareness of childhood-onset schizophrenia is increasing.

It can be difficult to diagnose schizophrenia in teens. This is because the first signs can include a change of friends, a drop in grades, sleep problems and irritability — behaviors that are common among teens.

Learn more about childhood-onset schizophrenia from this expert researcher:

For more information about youth and schizophrenia, check out episodes from season four of Healthy Minds With Dr. Jeffrey Borenstein which are available to view on our website.

A combination of factors can predict schizophrenia in up to 80 percent of youth who are at high risk of developing the illness. These factors include isolating oneself and withdrawing from others, an increase in unusual thoughts and suspicions, and a family history of psychosis. In young people who develop the disease, this stage of the disorder is called the “prodromal” period.

Currently, schizophrenia is diagnosed by the presence of symptoms or their precursors for a period of six months. Two or more symptoms, such as hallucinations, delusions, disorganized speech, and grossly disorganized or catatonic behavior, must be significant and last for at least one month. Only one symptom is required for diagnosis if delusions are bizarre enough or if hallucinations consist either of a voice constantly commenting on the person’s behavior/thoughts, or two or more voices “conversing.” Social or occupational problems can also be part of the diagnosis during the six-month period.

Foundation-funded research to find markers, such as abnormal brain scans or blood chemicals that can help detect early disease and allow for quicker interventions is now being done. Scientists are also working to understand the genetic and environmental mechanisms that combine to cause schizophrenia. As more is discovered about chemical circuitry and structure of the brains of people with the disease, better diagnostic tools and early intervention techniques can be developed. This is crucial for schizophrenia as it is believed that with every psychotic episode, increased damage is done to the brain.

While no cure exists for schizophrenia, it is treatable and manageable with medication and behavioral therapy, especially if diagnosed early and treated continuously. Those with acute symptoms, such as severe delusions or hallucinations, suicidal thoughts or the inability to care for oneself, may require hospitalization. Antipsychotic drugs are the primary medications to reduce the symptoms of schizophrenia. They relieve the positive symptoms through their impact on the brain’s neurotransmitter systems. Cognitive and behavioral therapy can then help “retrain” the brain once symptoms are reduced.

These approaches improve communication, motivation, and self-care and teach coping mechanisms so that individuals with schizophrenia may attend school, go to work and socialize. Patients undergoing regular psychosocial treatment comply better with medication, and have fewer relapses and hospitalizations. A positive relationship with a therapist or a case manager gives a patient a reliable source of information about schizophrenia, as well as empathy, encouragement, and hope. Social networks and family member support have also been shown to be helpful.

For more information about potential breakthroughs, treatments, and prevention strategies for schizophrenia, check out episodes from season four of Healthy Minds With Dr. Jeffrey Borenstein which are available to view on our website.


Treating negative symptoms is tricky due to the very nature of the negative symptoms someone experiencing a lack of motivation, enthusiasm, or desire to be social, for instance, may be hesitant to seek and stick with treatment.

In addition, the drugs used to treat positive symptoms of schizophrenia can increase secondary negative symptoms and do not work on primary and persistent negative symptoms.   This is why effective treatment ideally includes a combination of drugs, therapy, and support.

Atypical Antipsychotics

Second-generation medications known as atypical antipsychotics are the first-line treatment for schizophrenia.

There are many different atypical antipsychotics used to treat schizophrenia, including:  

Typical Antipsychotics

Typical antipsychotic medications (Haldol (haloperidol) and Thorazine (chlorpromazine), which can be used for the treatment of positive symptoms of schizophrenia such as hallucinations and delusions, are not effective in treating negative symptoms, such as lack of emotion, motivation, or interest in social activities.  

While effective against positive symptoms, these older, first-generation antipsychotics have a number of neurological adverse effects, such as parkinsonism (when medications cause symptoms similar to Parkinson's disease),   that can increase secondary negative symptoms.

These drugs, also known as neuroleptics or major tranquilizers, can help treat negative symptoms that are secondary to positive symptoms.

For example, people can be socially isolated due to paranoid beliefs or voices commanding them not to leave their home. In such cases, antipsychotics that decrease paranoia and auditory hallucinations (hearing voices or sounds) will improve social affiliation.


While it is by no means a cure, combining antipsychotics with antidepressants has been shown more effective than taking antipsychotics alone. Antidepressants work by increasing the availability of one or several of the following neurotransmitters:

  • Dopamine (decision-making, motivation, signaling of pleasure and reward)
  • Norepinephrine (alertness and motor function)
  • Serotonin (mood, appetite, sleep, memory, social behavior, sexual desire)  

Psychosocial Interventions

Psychosocial interventions, including behavioral therapy, support therapy, and family psychoeducation, aim to change a person's behaviors toward a more healthy interaction with society. These therapies can provide people with persistent negative systems as well as their families with tools to identify and cope with deficits in cognitive and emotional functioning and social skills.

Supportive Therapy

Supportive therapy provides an opportunity for companionship, non-judgmental validation, common-sense advice, and reassurance from a trained therapist.   Often, your therapist will step in on your behalf to facilitate communication with family members as well as authorities like schools and social agencies.

Behavioral Therapy

Behavioral therapy, including social skills training and cognitive-behavioral therapy (CBT), can teach you to recognize and engage in behaviors and activities that will improve the quality of life and day-to-day living.  

For example, during social skills training you will be taught how to express feelings and needs, ask questions, and control voice, body, and facial expressions. CBT can teach you or someone you love to identify and change the deficits that have a negative influence on behavior and emotions.

Family Psychoeducation

Family support plays a key role in the treatment of negative symptoms. Psychoeducation for patients and families is helpful in decreasing stigma and improving opportunities for ongoing social engagement.   It can also offer families effective strategies for communicating and coping with a loved one with schizophrenia.

What Can Be Done to Help the Deaf Community?

A research study of cultural and linguistic barriers to mental health found that many deaf people have a fear of being incorrectly committed because they are unable to communicate with the staff. One participant is quoted as saying, "Even if I were just asking for directions at the information desk [of a psychiatric hospital], miscommunication could lead to my being committed mistakenly . I don't want to go there, even for a visit!"

This study further indicated that participants felt professionals erroneously consider a nominal level of communication to be adequate. One practitioner looked at bipolar disorder in patients who had become deaf before they learned to speak, and found that those making diagnoses often emphasized appearance over documented symptoms and other information.

While it will be difficult to solve these problems, some solutions are possible. Hearing-impaired people should be encouraged to consider careers in the mental health field, and mental health professionals should secure more translators to work with the mentally ill.

The National Association of the Deaf notes that deaf people have the right to push for referrals to mental health professionals who have experience working with those who are deaf or are hard of hearing. The organization also says that deaf people have the right to communicate "in the language and mode of communication that is effective for you," and to clearly understand the diagnosis and recommendations for their treatment.

Clinicians who have little or no experience working with the hearing-impaired should use extreme caution and seek second opinions when diagnosing the deaf. In addition, research and effort are needed to bridge the language barriers which now make it so difficult to communicate.