As you read the word ‘schizophrenia’, what do you imagine? Perhaps you think straight away of Split Personality Disorder. Perhaps you jump to the far-fetched idea of dancing pink elephants and a mysterious voice commanding a crazy person to rule the world.

Or perhaps the only thing you could say about schizophrenia is: “That’s the one where they hear voices, right?”

The reality is that most people know very little about this mental illness. Here in Cambridge, there is huge awareness of illnesses like depression and anxiety – a blessing to those who can access support systems without fear of stigma. But illnesses that are rarer, such as schizophrenia, remain outside of common knowledge.

In 10,000 people, 72 will have a diagnosis of schizophrenia. It develops most commonly between the ages of 15 and 25, and, for reasons unknown, often presents more severe symptoms in men than in women.

Auditory hallucinations are perhaps schizophrenia’s best known feature. The hallucinations are usually a voice, or many voices, but the nature of them varies hugely. Some people with schizophrenia hear echoes of their thoughts, and others hear a third-person narration of all their actions. Often, people with schizophrenia describe the voices they hear as angry, hateful and deriding. Janet, writing online about her own experiences, describes one particular voice that she called the Controller:

“The Controller started demanding all my time and energy. He would punish me if I did something he didn’t like. He spent a lot of time yelling at me and making me feel wicked. I didn’t know how to stop him from screaming at me and ruling my existence. It got to the point where I couldn’t decipher reality from what the Controller was screaming. So I withdrew […] I really thought that other “normal” people had Controllers too.”

Another defining symptom of schizophrenia is delusional perception – perceiving abnormally significant meaning from an insignificant event. One person learned about fractals and suddenly thought he was a genius and could solve the universe with maths.

Another person saw a coin on the ground and believed they were destined to be the next President.

Other symptoms of schizophrenia involve thoughts; perhaps the belief that one’s thoughts are controlled by an external force, or that they are broadcast so that everyone around can hear. This belief grows out of paranoia. Matt’s delusions about his thoughts arose because he felt he was always being watched by what he calls ‘THEM’.

This suspicion deepened until he saw every event in his life as something caused by THEM, and he could not separate any part of reality from THEM. At this point, it seemed THEY were controlling his thoughts – and hearing them, too.

This sense of being under control by an external force can apply to the emotions, senses, and even actions of someone with schizophrenia. With this in combination with paranoia, the world becomes a dangerous and unfamiliar place. Lily’s son would stare for hours at his hands, not recognising them. Mark’s family appeared to be unrealistically short, and he concluded that they had been replaced. The world of a schizophrenic is difficult to imagine; it seems to be as chaotic and uncontrollable as the world we all experience in dreams.

Yet people with schizophrenia can reconnect with the reality that the majority of us experience and continue with relationships, studies, and careers. The treatment is by no means ideal; many antipsychotic drugs dampen dopamine activity, the main neurotransmitter associated with pleasure and reward, and therefore have side effects such as depression and anxiety, which can dull the personality.

Understandably, these side effects lead people with schizophrenia to stop taking their medication, and can even contribute to their paranoia, for example, ‘the doctors are trying to silence me’. The worst-case scenario is the ‘revolving door’ patient, who is hospitalised, treated, discharged, and then stops taking medication due to the side effects. The schizophrenia often then returns.

A person with schizophrenia can try dozens of different drugs before they achieve stability in the long-term. Although new drugs are continually being developed, it is extremely difficult to improve treatments when so little is known about the causes of schizophrenia. It runs in families, so it is likely to be partly genetic. But it is also more common in people who have migrated, and in people who have smoked cannabis – so there are clearly environmental factors too.

As of yet, schizophrenia has no clear-cut molecular or cellular pointers. Depression, on the other hand, has a strong association with neurotransmitters such as serotonin. With so little known about it in the medical sphere, it is not so surprising after all that the typical layperson has only an impression of what schizophrenia is. A list of causes, symptoms and treatments can only do so much when someone is experiencing a reality far different to the one that the majority experience – and experiences it alone.