Effective Strategies for Managing Auditory Hallucinations
Intro
Auditory hallucinations are intricate experiences where individuals perceive sounds, often voices, that are not present outside their minds. This phenomenon is most frequently associated with schizophrenia, a mental health disorder that affects how individuals think, feel, and behave. Understanding this aspect of the disorder is crucial, as it significantly impacts the daily lives of those affected. In this article, we explore various strategies for managing these distressing experiences, aiming to empower individuals living with schizophrenia.
Recent research emphasizes the prevalence of auditory hallucinations, revealing that over 70% of people with schizophrenia encounter them at some point. T his underscores the dire need for effective management strategies.
Throughout this article, we will cover therapeutic methods, medication options, self-help techniques, and the importance of a supportive environment for those managing auditory hallucinations. Drawing from scientific studies and expert insights, we aim to offer a comprehensive perspective that informs and supports individuals, caregivers, and professionals tackling this pervasive issue.
Recent Advances
Latest Discoveries
Recent advancements in neuroscience have opened new avenues for understanding auditory hallucinations in schizophrenia.
One notable discovery is the role of neural circuits involved in auditory perception. Research indicates that irregularities in these circuits contribute to the misinterpretation of external sounds as internal voices. This finding has implications for targeted therapies that aim to recalibrate these neural pathways.
Another important advancement is the identification of stress as a significant trigger. Several studies show that heightened stress levels can intensify the frequency and severity of auditory hallucinations. Understanding this connection provides a clearer picture of management strategies that can be adapted for individuals experiencing these symptoms.
Technological Innovations
Innovations in technology play a critical role in addressing auditory hallucinations. One significant development is the use of virtual reality (VR) to simulate environments that help individuals confront their hallucinations in a controlled setting. Studies have demonstrated that VR can empower users by providing coping techniques to manage their responses to these experiences.
Furthermore, mobile applications designed for mental health support are emerging as valuable tools. These apps offer features such as mood tracking, guided meditation, and immediate resources for when hallucinations occur. Such innovations can enhance the self-help strategies individuals employ.
Methodology
Research Design
To ensure a thorough exploration of auditory hallucinations in schizophrenia, a mixed-methods approach can be beneficial. This design incorporates qualitative interviews with individuals affected by the disorder as well as quantitative metrics from clinical assessments. By combining these methodologies, we can gather richer insights and more comprehensive data.
Data Collection Techniques
Data collection can utilize various techniques
- Interviews: Engaging with individuals provides personal insights into their experiences.
- Surveys: Standardized questionnaires can measure the severity and frequency of hallucinations.
- Clinical Observations: Observing individuals during therapy sessions can yield valuable information regarding their coping strategies.
Utilizing this diverse array of data collection methods fosters a better understanding of the complexities surrounding auditory hallucinations.
Understanding the subjective experience of auditory hallucinations is crucial for developing effective interventions.
Understanding Schizophrenia
Understanding schizophrenia is crucial for comprehending the multifaceted nature of auditory hallucinations that individuals encounter. Schizophrenia is a complex mental disorder that can significantly impair a person's thoughts, emotions, and behavior. Recognizing the distinctions within the symptoms and variations of this condition can provide clarity on how to address and manage the experiences of those living with it.
A thorough understanding of schizophrenia leads to better support strategies, therapeutic approaches, and insights into treatment modalities. Moreover, it allows family, friends, and caregivers to offer appropriate assistance and empathy.
Definition and Overview
Schizophrenia is defined as a severe mental disorder characterized by a disconnection from reality. Individuals with this disorder may experience disturbances in their thought processes, perceptions, and emotional responsiveness. The onset of symptoms typically occurs in late adolescence or early adulthood, although it can also emerge later in life. The core features include delusions, hallucinations, disorganized thinking, and significant social or occupational dysfunction.
Symptoms of Schizophrenia
Understanding the symptoms of schizophrenia is important as it frames the various challenges a person may face. It also highlights the urgency and necessity of effective management methods. The symptoms can be categorized into three main types: positive symptoms, negative symptoms, and cognitive symptoms.
Positive Symptoms
Positive symptoms refer to an excess or distortion of normal functions. This includes hallucinations, delusions, and disorganized thinking. Hallucinations, notably auditory hallucinations, are the most recognized positive symptoms. They may involve hearing voices that do not exist. These can be distressing and overwhelming, often contributing significantly to the individual's suffering. The presence of positive symptoms emphasizes the need for immediate intervention and management strategies which can mitigate their impact on daily life.
Negative Symptoms
Negative symptoms manifest as a decrease or loss in normal functions, affecting the individual's social interactions and emotional expression. Key characteristics include apathy, lack of motivation, and reduced emotional expression. These symptoms can profoundly affect an individual's ability to function in daily life. Recognizing negative symptoms can be beneficial for understanding the overall management of schizophrenia. They signify a need for supportive interventions that focus on enhancing the quality of life.
Cognitive Symptoms
Cognitive symptoms involve issues with memory, attention, and the ability to process information. These symptoms might not be immediately apparent but play a crucial role in the general functioning of individuals with schizophrenia. They are often overlooked yet can severely hinder effective social interactions and problem-solving abilities. Enhancing cognitive functions can lead to improved outcomes for those dealing with the disorder.
Prevalence and Demographics
Schizophrenia affects approximately 1% of the global population, transcending gender, race, and geographical boundaries. While equally prevalent among men and women, men typically exhibit earlier onset and often have a more severe form of the disorder. Understanding the demographics is essential in tailoring treatment options.
The prevalence highlights a need for ongoing research and efficient public health strategies to address the needs of those affected, as well as their families and communities.
The Experience of Auditory Hallucinations
Auditory hallucinations are one of the most distressing symptoms experienced by individuals with schizophrenia. Understanding their nature is critical in addressing the broader impacts of schizophrenia. The experience of hearing voices can significantly affect a person’s daily life, social interactions, and overall quality of life. Addressing these hallucinations involves a comprehensive approach that includes psychological, pharmacological, and social support strategies. This section aims to explore various dimensions of auditory hallucinations, examining their characteristics, impacts, and variability.
Nature of Voices Heard
The voices that individuals with schizophrenia hear can differ widely in their characteristics. They may be internal or external, sometimes spoken by recognizable figures or even strangers. The content of these voices can range from neutral to threatening, deeply affecting the individual's mental state. Various descriptors are used in research to categorize these voices:
- Familiarity: Some voices may sound like loved ones, while others may be entirely foreign.
- Tone: The emotional tone can be soothing or aggressively hostile.
- Volume: They may whisper or shout, increasing the distress experienced by the affected individual.
Understanding the nature of the voices can help tailor interventions more effectively, as individuals may respond better to specific coping strategies that consider the characteristics of the voices.
Impact on Daily Life
Auditory hallucinations can have profound effects on a person’s daily functioning. They can hinder the ability to concentrate, disrupt sleep patterns, and influence personal relationships. As individuals grapple with these voices, they may withdraw socially to avoid judging eyes or judgment about their experiences. Some common impacts include:
- Social Isolation: Fear of disclosing experiences can lead to loneliness.
- Employment Challenges: The inability to focus or complete tasks may affect job performance.
- Emotional Distress: The negative nature of voices can lead to anxiety, depression, and in some cases, suicidal ideation.
The experience of auditory hallucinations can transform ordinary situations into sources of distress, illustrating the urgent need for tailored support and intervention.
Variability in Experience
Experiences of auditory hallucinations are not uniform and can vary greatly between individuals. Various factors contribute to this variability.
Individual Differences
The subjective nature of auditory hallucinations means that individual psychological and personality traits can heavily influence how one experiences these voices. People may confront their hallucinations differently based on:
- Coping Strategies: Some individuals may have inherent skills to manage their experiences better than others.
- Personal History: Past trauma can impact how one perceives and interacts with the hallucinated voices.
- Support Systems: The presence or absence of social support can result in differing levels of distress associated with these experiences.
Understanding individual differences allows for a more personalized approach to therapy, enhancing the overall efficacy of treatment.
Triggers and Contexts
Triggers and contexts play a critical role in the experience of auditory hallucinations. Various elements in one's environment can prompt or exacerbate the onset of these voices. Key aspects include:
- Environmental Stimulation: Crowded or noisy environments may increase the likelihood or intensity of hallucinations.
- Daily Stressors: Situational stress, such as relationship issues, can trigger episodes.
- Substance Use: Alcohol or drugs can lead to heightened experiences of auditory hallucinations.
Identifying triggers is essential for developing strategies that minimize their impact. By understanding the contextual aspects, therapeutic interventions can be more effectively adjusted to meet individual needs.
Psychological Approaches to Management
Psychological approaches play a vital role in managing auditory hallucinations related to schizophrenia. These techniques address not only the symptoms but also the underlying thought processes contributing to the experiences. Using a psychological lens is essential as it offers an array of therapeutic methods that can empower individuals to regain a sense of control over their minds and improve their overall quality of life. Furthermore, these strategies are often tailored to the unique experiences of each individual, recognizing that no two journeys with schizophrenia are identical.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) is one of the most widely researched psychological approaches utilized in treating individuals experiencing auditory hallucinations. CBT emphasizes the relationship between thoughts, feelings, and behaviors. This therapy works by helping individuals identify and challenge distortions in their thinking. For those with schizophrenia, it can clarify the nature of the hallucinations, allowing for a better understanding of these experiences.
In CBT, patients learn to reframe their thoughts about the voices they hear. For instance, rather than viewing the voices as authoritative or threatening, they can be encouraged to consider them as mere products of the mind. This reframing helps reduce the emotional response to the hallucinations. Studies show that patients engaging in CBT often experience a decrease in distress and an improvement in their ability to cope with intrusive thoughts.
Mindfulness-Based Interventions
Mindfulness-Based Interventions (MBIs) provide another avenue for managing auditory hallucinations. This approach centers on developing an awareness of the present moment while accepting thoughts and feelings without judgment. Individuals are taught skills to observe their auditory experiences rather than to react impulsively to them. Mindfulness can lead to an increased sense of inner calm, making it easier to endure unsettling moments without additional fear or anxiety.
Research has suggested that MBIs can be effective in reducing the severity of hallucinations and improving overall well-being. These strategies can help individuals understand that while hallucinations may occur, they do not define one’s identity or worth. As a result, participants often develop a healthier relationship with their symptoms.
Supportive Psychotherapy
Supportive psychotherapy offers a more relational approach, providing a space where individuals can express their emotions without fear of judgment. In this therapy, practitioners validate the experiences of their clients, while guiding them through the emotional turmoil that often accompanies auditory hallucinations.
The benefits of supportive psychotherapy include fostering a strong therapeutic alliance, which is crucial in building trust. This trust allows clients to explore their feelings and experiences more deeply, which can diminish feelings of isolation and hopelessness. By focusing on strengths and resilience, supportive psychotherapy can help individuals build coping mechanisms that serve them in stressful situations.
The potential of psychological approaches to manage auditory hallucinations in schizophrenia lies not only in symptom reduction but also in enhancing overall life satisfaction.
Pharmacological Treatments
Pharmacological treatments play a critical role in managing auditory hallucinations associated with schizophrenia. These treatments often serve as the foundation upon which other therapeutic approaches can build. While psychological interventions are essential, medication primarily addresses the biochemical imbalances that contribute to these symptoms. The focus in this section is on antipsychotic medications, their types, and the challenges related to medication adherence.
Antipsychotic Medications
Antipsychotic medications are specifically designed to reduce the severity and frequency of psychotic symptoms, including auditory hallucinations. Two main categories exist: typical antipsychotics and atypical antipsychotics.
Typical Antipsychotics
Typical antipsychotics, also known as first-generation antipsychotics, have been used for decades. Their key characteristic is the primary action on dopamine receptors, particularly the D2 subtype. By blocking these receptors, typical antipsychotics can help diminish the intensity of hallucinations.
One notable advantage of typical antipsychotics is their efficacy in quickly reducing acute symptoms. Commonly prescribed medications in this category, such as Haloperidol and Chlorpromazine, are widely recognized for their effectiveness. However, they come with significant drawbacks.
The unique feature of typical antipsychotics is their potential to cause extrapyramidal symptoms (EPS), which are movement disorders including tremors and rigidity. These side effects can lead to non-compliance in patients, which is a crucial consideration in treatment strategies.
Atypical Antipsychotics
Atypical antipsychotics, the newer generation, offer a different mechanism of action. They also target dopamine receptors but do so in a way that affects serotonin receptors as well. This approach leads to a more balanced modulation of neurotransmitters. Key medications in this category include Risperidone and Aripiprazole, known for their broader efficacy in treating both positive and negative symptoms of schizophrenia.
A significant benefit of atypical antipsychotics is their lower risk of EPS compared to typical antipsychotics. Most patients tolerate them better, which can improve adherence to medication. However, they can carry the risk of metabolic syndrome, which includes weight gain and diabetes, making it crucial to monitor patients closely.
Medication Adherence Challenges
Despite the benefits of pharmacological treatments, medication adherence poses a significant challenge in managing schizophrenia. Factors influencing adherence include medication side effects, stigma associated with mental illness, and the complexity of treatment regimens.
Often, patients stop taking their medication due to the unpleasant side effects or a lack of belief in the efficacy of treatment.
"Inconsistent medication adherence can severely undermine treatment success, leading to relapse and worsening of symptoms."
Health practitioners must engage in open dialogues with patients about these challenges. Strategies to improve adherence might include simplifying medication schedules, providing education on the importance of consistent use, and regular follow-ups to monitor both symptoms and side effects.
Self-Help Techniques and Coping Strategies
Self-help techniques and coping strategies are essential in managing auditory hallucinations in individuals with schizophrenia. These approaches empower individuals to take control of their experiences, fostering a sense of agency. Practical methods not only help reduce the distress associated with auditory hallucinations but also encourage overall mental well-being. When integrated into daily life, these techniques can complement more formal therapies, providing a holistic approach to managing symptoms.
Lifestyle Adjustments
Exercise and Nutrition
Exercise and nutrition are crucial aspects of lifestyle adjustments that can positively influence mental health. Regular physical activity enhances mood, reduces stress, and promotes better sleep, all of which can mitigate the intensity of auditory hallucinations. The key characteristic of exercise is its ability to release endorphins, which can naturally elevate mood and decrease feelings of anxiety. For individuals dealing with schizophrenia, participating in activities like walking, swimming, or yoga can be a beneficial choice.
Moreover, a balanced diet rich in nutrients supports brain health. Nutritional deficits can exacerbate psychiatric symptoms. Unique features of nutrition include the impact of omega-3 fatty acids, found in fish like salmon, which have been shown to improve cognitive function. However, while exercise and nutrition offer several advantages, they require consistent effort and motivation, which can sometimes be challenging for those experiencing severe symptoms.
Sleep Hygiene
Sleep hygiene plays a vital role in the management of auditory hallucinations. Poor sleep can worsen cognitive functions and increase the likelihood of experiencing hallucinations. The key characteristic of sleep hygiene is establishing habits that promote restorative sleep. Practices may include maintaining a regular sleep schedule, creating a calming bedtime routine, and ensuring a comfortable sleep environment. These practices foster overall health and mental clarity, which can help individuals manage their symptoms more effectively.
A unique feature of sleep hygiene is its accessibility; individuals can implement these techniques independently. However, challenges can arise, such as insomnia or irregular sleep patterns, which may complicate the effectiveness. Addressing these issues is crucial for optimizing sleep, ultimately reducing the frequency and intensity of hallucinations.
Developing Coping Skills
Coping skills are critical in providing individuals with strategies to handle distressing auditory experiences. Developing these skills involves recognizing triggers and practicing techniques that focus on grounding oneself in reality. Techniques such as mindfulness meditation, deep breathing exercises, or maintaining a journal to express emotions can help individuals manage symptoms during challenging episodes.
Learning to cope effectively not only improves immediate responses but also equips individuals with tools for long-term management. The journey to develop coping skills may require support and guidance, particularly from mental health professionals, yet it empowers individuals to address their hallucinations with confidence.
The Role of Social Support
The role of social support in managing auditory hallucinations associated with schizophrenia cannot be overstated. Social support encompasses the emotional, informational, and instrumental assistance received from others, which plays a critical role in enhancing an individual's ability to cope with their condition. Being surrounded by supportive individuals can significantly reduce the feelings of isolation and distress, which are often prevalent in those experiencing schizophrenia. Social connections can instill a sense of belonging, help individuals feel understood, and provide material assistance when needed.
Importance of a Support Network
A robust support network is essential for anyone dealing with mental health challenges. For individuals suffering from auditory hallucinations, having a few trusted people provides a safety net. These individuals can help in various ways:
- Emotional Support: Friends or members of a support group can offer encouragement and compassion, which fosters resilience.
- Practical Help: Support networks often provide resources such as information on accessing mental health services or assistance with daily tasks.
- Shared Experiences: Relating to others who have similar experiences can help reduce the stigma surrounding the condition.
- Monitoring Well-being: People in the support network can help recognize changes in behavior, signaling when professional help is necessary.
The presence of a dependable support network can enhance treatment outcomes and increase the likelihood of adherence to prescribed therapies.
Engaging with Peers
Engagement with peers who have similar experiences is beneficial for individuals with schizophrenia. Peer support groups provide a platform for individuals to share stories, discuss coping strategies, and offer each other emotional aid. The benefits of peer engagement include:
- Understanding and Acceptance: Peers tend to have firsthand experience with auditory hallucinations and can offer insights based on their own journeys.
- Empowerment: Sharing their own experiences can empower individuals and enable them to help others.
- Reduced Isolation: Gathering in groups provides a sense of community, reducing feelings of loneliness.
- Skill Development: Peers can teach coping mechanisms that have worked for them, offering practical strategies for managing symptoms.
Family Involvement
Family involvement is crucial when addressing auditory hallucinations in schizophrenia. An understanding family can provide unwavering support and help establish a nurturing environment. This can be achieved through:
- Education: Family members who educate themselves about schizophrenia can better understand what their loved ones are experiencing and how to assist them effectively.
- Open Communication: Encouraging dialogue within the family about experiences with hallucinations can demystify the condition and reduce stigma.
- Participation in Treatment Plans: Families engaged in treatment plans are often more effective in supporting medication adherence and tracking any changes in symptomatology.
- Crisis Management: Involving family members in crisis management plans can provide immediate support during distressing episodes, enhancing safety and comfort.
In summary, the support from both peers and family creates an encompassing framework for individuals experiencing auditory hallucinations. The presence of a strong support system contributes significantly to managing symptoms and improving overall well-being.
Innovative Research and Therapies
The field of schizophrenia treatment is constantly evolving. Innovative research and therapies are crucial in addressing auditory hallucinations. New approaches in this area can lead to better outcomes for individuals facing these challenges. As such, understanding both emerging pharmacological treatments and neuromodulation techniques becomes essential.
Emerging Pharmacological Treatments
Recent studies suggest that new medications are being developed that target the specific mechanisms associated with auditory hallucinations. These emerging pharmacological treatments may offer hope for those who do not respond well to traditional antipsychotics.
- Serotonin-Dopamine Activity Modulators (SDAMs): SDAMs represent a new class of antipsychotics that aim to balance serotonin and dopamine signaling in the brain. This balance is crucial as both neurotransmitters play roles in the experience of auditory hallucinations.
- Acamprosate: Originally used for alcohol dependence, some researchers are examining its benefits in schizophrenia. It has shown promise in reducing auditory hallucinations by modulating glutamatergic transmission.
- Aripiprazole: This atypical antipsychotic works differently from its predecessors. Studies indicate that it can effectively minimize the frequency of auditory hallucinations in some patients.
Neuromodulation Techniques
In recent years, neuromodulation techniques have gained attention for their potential in managing symptoms of schizophrenia, including auditory hallucinations. These techniques involve altering nerve activity to treat various conditions.
- Transcranial Magnetic Stimulation (TMS): TMS is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain. Research has indicated that it may help reduce auditory hallucinations by targeting specific brain regions associated with voice perception.
- Deep Brain Stimulation (DBS): Although primarily studied for movement disorders, DBS has shown early promise in treating refractory auditory hallucinations. By delivering electrical impulses to targeted areas, it may alter neural circuits involved in these experiences.
- Electroconvulsive Therapy (ECT): ECT remains a topic of debate. However, some evidence suggests it can be effective for treatment-resistant cases, helping reduce the severity of auditory hallucinations.
"Innovative therapies offer new hope for those who struggle with auditory hallucinations, providing options beyond traditional treatments."
The focus on innovative research and therapies is vital. As our understanding of the neurobiology of schizophrenia evolves, these newer approaches hold promise. By remaining open to advancements in pharmacological options and neuromodulation techniques, there may be better ways to manage auditory hallucinations in the future.
Long-Term Management of Symptoms
Long-term management of symptoms in schizophrenia, particularly regarding auditory hallucinations, is critical for the overall well-being of affected individuals. The objective here is to establish a comprehensive strategy that focuses on both stability and quality of life. This management involves monitoring changes in symptoms, developing effective crisis management plans, and utilizing support from mental health professionals and caregivers.
Managing symptoms over an extended period allows individuals to recognize patterns in their experiences. This knowledge contributes to better coping strategies, reduces anxiety associated with unexpected symptom flare-ups, and enhances collaboration with healthcare providers. Consequently, focusing on long-term strategies can greatly improve the ability to function in daily life, fostering independence and promoting recovery.
Monitoring Changes
Monitoring changes in symptoms plays a fundamental role in long-term management. Individuals and their caregivers need to be vigilant about how auditory hallucinations change over time. This includes documenting the frequency, intensity, and context of the voices heard. Regular monitoring provides essential insights into potential triggers or situational factors that exacerbate symptoms.
Several methods can be utilized for effective monitoring:
- Journaling: Keeping a daily log helps track symptoms. This practice can identify patterns and triggers that influence the frequency or intensity of hallucinations.
- Self-assessment scales: Tools, such as the Brief Psychiatric Rating Scale (BPRS), can provide a structured way for individuals to express their experiences.
- Professional evaluations: Regular check-ins with mental health professionals ensure an updated understanding of changes and adjustments in treatment plans.
By paying close attention to these changes, individuals and their support systems can better anticipate crises and apply proactive strategies to manage symptoms effectively.
Crisis Management
Crisis management is a critical component of long-term care for individuals who experience auditory hallucinations. It is essential to have a detailed plan that can be activated when symptoms escalate to a disruptive or dangerous level. Developing a crisis intervention plan involves several key elements:
- Recognizing warning signs: Identifying early indicators of a crisis, such as increased irritability or withdrawal, allows for timely intervention.
- Establishing a support network: Having a list of trusted individuals—family, friends, or mental health professionals—who can provide immediate help is valuable.
- Designing a personalized plan: Each person experiences auditory hallucinations differently. Therefore, personalizing the crisis intervention plan to reflect individual needs and preferences is crucial.
- Communication strategy: Ensuring open channels of communication with caregivers and professionals can facilitate smoother intervention during a crisis.
Having a crisis management plan can significantly reduce distress and promote safety for the individual experiencing hallucinations.
In summary, the long-term management of symptoms associated with schizophrenia, particularly auditory hallucinations, requires a proactive approach. Monitoring changes and implementing crisis management strategies are vital components in enhancing the recovery journey for affected individuals. These strategies not only empower individuals but also provide a framework for navigating the challenges that arise from their condition.
The End and Future Directions
The exploration of auditory hallucinations in schizophrenia is critical for understanding the disorder's impact on individuals. In this article, we have discussed various dimensions surrounding this phenomenon, emphasizing effective strategies for management. This section succinctly reviews important aspects and highlights future considerations that both researchers and practitioners should keep in mind.
Summary of Key Insights
The key insights from the discussion include the complexity of auditory hallucinations and their profound effects on daily living. We examined the psychological approaches like Cognitive Behavioral Therapy and pharmacological treatments, notably antipsychotic medications, which provide a base for managing symptoms. Self-help techniques also play a vital role, as they empower individuals to employ coping strategies that suit their lifestyles.
Moreover, social support emerges as a crucial element, illustrating the importance of networks that foster understanding and care. Innovative research is underway, giving rise to novel therapies and approaches, such as neuromodulation techniques. Recognizing the multifaceted nature of schizophrenia aids in developing a comprehensive management plan.
Call for Continued Research
Continued research is essential in the realm of auditory hallucinations and schizophrenia. It is necessary to explore the underlying mechanisms that provoke these experiences. Unraveling the relationship between brain function, psychological factors, and environmental influences is paramount. Future studies should also focus on long-term outcomes of existing therapies, including the effectiveness of emerging treatments. Additionally, incorporating patient perspectives into research can lead to more tailored interventions that address individual experiences of auditory hallucinations.
In the quest for understanding this complex disorder, collaboration among researchers, clinicians, and affected individuals is vital. By sharing insights and data, we can drive forward progress that ultimately benefits those living with schizophrenia.
