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Schizophrenia
The 'Schizo'
The Outdated and Ignorant View of A Schizophrenic Person
Perhaps more so than any other disorder, symptoms of schizophrenia (particularly the positive symptoms of schizophrenia) is the closest thing we have to a modern day term that describes “insanity”. What other conceivable experience could be harder to imagine and relate to than one whose perceptions do not align with reality? Hearing voices from people who aren’t there? Feeling demons forcing your hand and not knowing whether it was real not not? Thinking every friend and colleague and passerby could read your thoughts and plotted to kill you? Or that people from Mars were telling you government secrets? All these perceptions could only possibly be those of another sort of human entirely. Someone not coherent enough to see the absurdity of such things. But not me, I see how ridiculous those beliefs are because of course it would be insane to think otherwise. Poor sap who spends their days in the psychiatric hospital lost in a world that anyone should reasonably be able to rationalize the past.
Some things my brain tells me about the “schizo”, they’re too crazy to accept objective perceptions about what is going on around them. I pity them for being unable to see things the way they are, and not only that but they are utterly lost in their own world and caught up in believing things no rational person would believe. They must be too slow to not comprehend the things that everyone around them can clearly see and grasp. They don’t see people the same way because they don’t listen or empathize with me, this makes it fundamentally impossible to connect with them on a human to human level. Talking to them would therefore be a waste of energy and any attempt to connect would be futile.
There is no hope for them to function as a normal person and integrate with the rest of us, they can’t even go a day without taking medication before getting lost in their own world. They fear everything and live in a state of constant paranoia and irrational distress, rather than worrying about the things that would actually improve their lives. Their priorities are misplaced and any actual distress is the result of a delusion which lessens the impact of it. Their thoughts and beliefs and perceptions and feelings are based in a different reality and thus make them not worthy of standard human empathy or compassion.
I have no idea how to react around them because nothing I say seems to matter or get through to them so trying to do so is pointless. They see everything and everyone as a threat and don’t have a real concept of cause and effect or consequences, this means that they will probably hurt me or people around them and thus should be separated from society and avoided. They cannot be trusted to take care of themselves much less anyone else and pose a danger to everyone around them. They will probably hurt whoever is around them when given the chance. They distrust everyone which means they can never be taken seriously or listened to because everything they say is insanity. At the very least, the schizo should be able to see the absurdity of their worldview and the fact that they cannot reflect the brokenness of their character.
Schizophrenia Spectrum Disorder
The Current Understanding of Schizophrenia as a Psychiatric Disease
The diagnosis 'Schizophrenia Spectrum Disorder" can apply to anyone who regularly experiences a number of symptoms that fall along the 'spectrum'. Hallucinations and delusions are what most people think of as being characteristic of this disorder, however there are a number of other symptoms such as disorganized thoughts and articulation, catatonia, flat or emotionless affect that characterize the spectrum; and a person with this diagnosis doesn't necessarily have to experience hallucinations and/or delusions.
The cause of schizophrenia is almost certainly multifaceted and involves a combination of impossibly complicated set of bimolecular processes depending on a dynamic interplay between genes and environment. There are likely a variety of different biological "causes" which have overlapping phenotypical effects which constitute the schizophrenia spectrum. So, what we classify as being one disorder, is likely dozens or even hundreds of different disorders.
Neurobiology of Schizophrenia: Major Findings
PFC Development Link to Schizophrenia Onset
Schizophrenia onset often occurs in a persons late teens or early twenties; this fact helped researchers to like the onset of the disease to the final stage of neural circuit formation and maturation in the prefrontal cortex (which is the last structure to develop in the human brain usually in the early 20s and cooccurs with the onset of symptoms of schizophrenia). It is suggested that schizophrenia may be related to a disruption of final stage excitatory neurotransmitter circuit development like dopamine and GABA processes. (Mukherjee et al., Long-Lasting Rescue of Network and Cognitive Dysfunction in a Genetic Schizophrenia Model, Cell (2019), https://doi.org/10.1016/j.cell.2019.07.023)
Epidemiology, Genes, Environment, Biological Cause for Schizophrenia?
No genotype has ever been shown to be strongly associated as a risk factor for schizophrenia. Although environmental factors such as living in large cities, being an immigrant or POC, cannabis use, and early life trauma have higher rates of schizophrenia none of these factors alone can account for the disease. Recent studies have employed complicated gene-environment models to predict schizophrenia risk. Results from such studies increasingly point to a complicated gene-environment synergistic bimolecular effect, or likely hundreds or even thousands of such affects or (biological causes) that produce the symptoms of the spectrum we have grouped into one disease category.
The Hallucinating Brain
fMRI studies have looked at brain activation in patients experiencing auditory hallucinations compared to brain activation during the perception of an actual auditory stimulus. Interestingly, auditory hallucination activation is strikingly similar to activation during auditory perception, but not to activation during someone imagining an auditory sounds.
Misidentified Sensations and Contextual Cues
Someone who has been diagnosed with schizophrenia is oven looked down upon as being incompetent or confused because of their disorder. We need to change this view by redefining what it means for somebody to have schizophrenia. Rather than being a broken human or having a disease that limits their humanity, people with schizophrenia are faced with false sensory perceptions and contextual inferences that alter the logical conclusion about the world around them. Their subjective experiences bombards itself by being overactive in how it interprets stimuli, which causes their brain to produce needless pathways of perception that become activated by stimuli that we have evolved to understand a different way.
Misidentified Sensations and Contextual Cues
When did you start to experience symptoms and what symptoms were you experiencing that lead to your diagnosis of schizophrenia spectrum disorder?
It started a couple of weeks before I went to college (fall of 2019). I started having really bad anxiety attacks, I would just sit on the floor, crying, but at the same time it was just like laughing and there was kind of just like laughing around the room and like shadows were waving and everything. I got to school, and I don't really have many memories from the entire time I was at school for that semester. But the ones I do remember would be like, I watched hell open behind me in a mirror. My girlfriend's eyes would be black fire. I started thinking everyone was out to get me, like paranoia in my classes.There was a hellhound I remember that blew through the wall at the end of the hallway and chased me back into my room.
So you had visual hallucinations?
Yep. And when I laid down at night there was, like, laughing going on around me. It was not great. So that made me medically withdraw from that semester. And then I came home, had the same stuff happening for a couple more months after I got home. And then I tried to go back to school. Then in March of last year I had another break down. And I also don't remember much from that period, but I ended up listening to some voices and catching part of a house on fire.
Doing jail time for that, dropping out of school again for that. And now we’re here. So when I got home, I went to a psychiatrist. And then she kind of passed me on to my current care team which is a whole host of people that are helping right now.
Did you have a concept of what your disease really was before being diagnosed, and how did your understanding of your disease change from before you were diagnosed to now?
Um, I had a pretty basic understanding of like most mental disorders I was actually going to school for psychology ironically enough. So yeah, I kind of knew what it was, knew about some of the prodromal symptoms. So just normal everyday stuff, but then when it started happening to me... it wasn't like anything I'd ever read, because it was so gradual, then it just turned my entire life into this hellscape, that I couldn't escape from. It was just awful. (chokes up)
So when did you first start to receive treatment for your disorder and how did that go?
I went to the school doctor when I was at college, and I explained all my symptoms to him and he just gave me an antidepressant which kind of threw me into a manic phase and did not help in the slightest at all. It was terrible. So then when I came home I started seeing an actual psychiatrist and a therapist separately and then moved on to my current care team which is like psychiatrists, therapist, peer management, like med management, just a whole bunch of people.
Do you remember what medication and was that sent you into the manic state?
Prozac.
Could you say that your symptoms are pretty well managed now with your current regimen?
I just started a new med, I have a really big issue with taking meds, I have a pill phobia. So it's really hard for me to take meds so I was prescribed like three or four and I just wasn't taking them. So I just recently started taking just one. And I missed one night or two nights in a row and I didn't sleep for four days. So that was fun… that was earlier this week. It's been okay... I had a lot of anxiety at work today. But it's not as bad as it was before.
Do you know what you're on now?
Risperdal.
What aspects of treatment were the most helpful of the the most difficult for you
Most helpful would probably just be getting on any med at all. Like especially when I was in jail. It was a really stressful situation, but they force you to take the medication there. And so for those couple months that I was in there, I was like, actually pretty stable. Wasn't having a ton of symptoms. So when I actually take them, it helps a lot. But at the same time, it's the hardest thing because I'm really against taking medication
So the most helpful thing is also the hardest thing?
Yeah. And I guess the other hardest thing is just accepting the diagnosis. I'm still struggling with that, I'm trying to work through all that. And this interview is actually part of how I’m doing that.
So, what is life like for you now trying to manage your disease?
More doctors than I want to see. I don't like doctors either.Struggling at work a little bit, feeling like I'm not good enough, ever. Lots of late nights just stressing about things.I don't go out in public much kind of just stick to myself, I don't have very many friends.
So you’re living at home still?
Yeah, hoping to move out sometime in the next year or so.
What do you think your life would look like if you woke up in the morning and were magically cured of your disease?
I’d go back to school. It kills me inside because my entire life I've always been expected to like go to college, I wanted to get my PhD and everything. And then it's kind of just ripped away from me and I'm stuck here not knowing what I can even do, because I tried to go back after getting treatment and then it just spiraled again so I feel like I can't do it.
What Fictional portrayals of your disease have you seen, and do you feel like they accurately represent your disease or do they totally get it wrong?
Fictional portrayals let's see… A Beautiful Mind, a couple books I don't really know like which ones specifically off the top of my head, movies and video games would be most of it. And like, other than A Beautiful Mind, it's generally like [people with schizophrenia] are kind of violent in [media], or like, incapable of integrating into society. They always need to be, like, locked away.
And like, mentally, if I'm off my meds sometimes I'm not like the greatest person to hang around but I'm not a danger to anyone but myself. I think[ media] vilifies it. I think that the stigma against [schizophrenia] is brutal. I don't tell anyone about it that I care what they think.
Did anything change concerning your relationships with your friends and family because of your disease? Do you feel supported by them?
My mom and I kind of have a ‘don't ask, don't tell’ thing going on, like she knows I’ve got issues that I'm getting help for it but she doesn't ask about them. And I don't tell her about them because I figure it's not her job to be a therapist, but she still supports me. She still loves me. As far as my friends go, I have one friend who's going through some similar stuff and we can kind of chat about whatever we need to. And then I can talk to my girlfriend about it. But she doesn't really understand it all that well because she's more mentally healthy and I wish her to stay [that way].
So she can't really relate but she supports me. But she definitely walks on eggshells a little bit more, which sucks.
How would you suggest people treat a family member or a really close friend who has your disease?
Like a normal person. And if we're saying crazy shit, just tell us the truth. Don't try to like sugarcoat things or like try to meld the truth into something that we're believing, just say the truth.
How should people treat a stranger, or unfamiliar person who has your disease, like how would you suggest people interact with someone if they know that they have schizophrenia or schizophrenia spectrum disorder?
Personally if I'm like showing symptoms to the point where a stranger could notice it, then I just pull out of society for a while so I can get a handle. But don't mess with them, don't try to aggravate their symptoms, because it really screws with them. I don't know... just [treat them] like a normal person I guess.
Do you have any instances you can recall right now where somebody did the right thing or said the right thing to you while you were having psychosis, or while you were unwell that you feel like helped you at all?
Like a stranger or someone?
Anyone.
Just my girlfriend just being there. That's all I needed was just someone to be there that I knew wouldn't be against me.
In what situations, do you hide your disease from people? Do you hide it because of shame, stigma, or for some other reason?
Pretty much every situation. Including you, there's maybe four or five people that know. My mom doesn't even know my diagnosis
Your mom doesn’t know?
Yeah, she just knows I have stuff going on; she doesn't know the specifics. So it would be like a friend and my girlfriend and like maybe one other friend and then my care team.
And why do you hide it?
I don't think that needs to be what people know me for, I have more important things to offer.
So you worry that if people know, that’s all they would be able to see?
Yeah.
Is there anything you want people to know about your disease that you feel like a lot of people don't understand?
[Schizophrenia] is not dangerous to other people the majority of the time. It's just personal hell. Just give us some slack.
What has your disease taught you about life in general?
Don't expect good things. I had a whole, like, future plan what I was gonna go do, pretty much all ripped away so… don’t plan for things because you can’t ever necessarily do them. But like, it’s also not the end of the world I guess, I can always do something else it just won't be what I wanted. I’ll just have to find a new way to go.
Is it usually just delusions that people are talking about you or are out to get you? Or are they ever more elaborate?
The most elaborate one I've had would be an entire false memory that I have from one night. So it was like a whole night that was just really weird. It started off: I was like, laying in my bed and I remember my friend was also in my bed, and like, it's not a large bed so it would be really weird if he had been in the bed with me. We were just talking for like half an hour and then we went and got in our cars. And we were like speeding around cause we really enjoy cars. We're both car guys, I had an EVO at the time, it was a good time. We were just spinning around and we went up this one hill and there was a cop on the other side, so we were like “screw it, we're running”. So we dip past him and he flips his lights on and comes chasing after us. And I don't remember how it got there but it ended up we had twenty four cop cars and two police helicopters and a couple Humvees after us. And this is a very vivid memory that I have. And at some point, they caught up to us eventually and came up to the window to knock on it and it just went black… and then it was the next day.
It was a whole memory? Not like a dream?
It’s just a straight up memory that I have, yeah. And I’m still very confused about it because I don’t know what actually happened.
You don’t have to answer this if you don't want to, but did you ever experiment with drugs in high school and took anything that might have influenced your disease?
I have a very interesting story about acid though If you’d be comfortable with me sharing on camera.
Let’s do it.
So after I came back, this was like a month after the fire thing. A friend knew I wasn't doing well from college and they were like “hey you should try acid to help, it'll heal everything in your brain” and not knowing much about it I was like, “sure, let's do it”. So I took it. And it was definitely not acid, it was definitely a research chemical, because I'd done acid like once or twice before that and it was not the same. So it sent me into a full on psychotic episode. I had no frame of space or time and ended up outside with my dog barefoot. I ran up and down the street, and then there were demons circling above and like figures coming out of the woods and they were all coming to kill me. I remember they were all whispering or whatever. So I shoved my dog off into the woods and then tried to slit my wrists in the street with a block of wood, (sarcastically) probably the smartest thing I've ever done. And then I went and threw a candle at my mom, got into a fistfight with my neighbor, hit my other neighbor with a two-by-four, got tased by police and sedated and sent to the hospital. Yeah that was probably the worst day of my life.I still have flashbacks to that... it was very uncomfortable.
So you said your mom was there and you threw a candle at her?
I threw a candle at my mom.
And she still doesn’t know that you have this disease?
She knows that was an acid trip. We had a chat about that, but as far as she knows I just have like some.... I think she thinks I'm bipolar because of my mom, my actual mom. So, I don't know, I don't ever ask.
Have you ever met your biological family?
I have not, no.