A blog post critiques a throw-away line from “The Dark Knight”’:

It’s interesting how the general public has such a different view of schizophrenia than what a health care professional is taught. I wonder if it’s simply because psychiatry is such a relatively new field, and neuropsychobiology is practically brand new. Maybe schizophrenic just meant something entirely different than what it does now.

While people tend to remember the so-called “positive” symptoms of schizophrenia better—”auditory hallucinations, delusions, so-called formal thought disordered—there are so-called “negative” symptoms as well that are basically lacunae of certain characteristics—”apathy, non-emotionality, inability to relate normally to other people. These are evidence of executive dysfunction, a hallmark of many mental illnesses. The “negative” symptoms tend to make it less likely that a schizophrenic will actually turn violent and assault you.

If you’re worried about being assaulted by a person with a mental illness, I’d watch out for little old ladies with Alzheimer’s dementia. They can really throw a mean sucker punch, and woe to you if you didn’t expect it. Another mental illness that makes a person more likely to assault you is mania. When lay people think of “crazy”, I really think manics fit the stereotype better than schizophrenics do. About the only thing good about mania is that the prognosis is far better than in schizophrenia, dementia, or the personality disorders. Other potentially assaultive conditions include anti-social personality disorder (which is basically the updated name for what used to be known as a sociopath) and borderline personality disorder.

In an episode of synchronicity, I just finished Philip K Dick’s novel Martian Time Slip, which, among other things, features an autistic child and another character who suffered some sort of psychotic break. Dick uses the term “schizophrenia” quite loosely, and I’m thinking he’s confusing it with psychosis. It’s perfectly possible to have a psychotic episode without being schizophrenic. It’s actually more likely to happen in patients with major depression, and they will be the majority of psychotic people you will meet since major depression is a lot more prevalent than schizophrenia. It’s also possible to be schizophrenic without being psychotic, particularly if you’re on some sort of neuroleptic medication. We can actually treat “positive” symptoms fairly well. Unfortunately, we haven’t really figured out the “negative” symptoms. There is also a big, easy-to-tell difference between schizophrenic apathy and a cluster B personality disorder such as avoidant/dependent personalities who also have a hard time dealing with their environment and with other people. The former simply don’t care, in the sense that they don’t perceive the lack. The latter are acutely aware of their problem.