I’m curious if my roommates brother had schizophrenia. He was supposed to stay on medication, but the side effects were really hard on him, and from time to time he would stop the meds, saying that he thought he could be OK without them. But he would rapidly deteriorate and start hallucinating, including hearing voices that were telling him to do things. He would then do something or other that would trigger authorities catching him and institutionalizing him (against his will) for a while, and he’d be on medications again, and would stabilize and eventually be released again. He kept cycling this way. This was late 1970’s. I never heard his condition named, and now I wonder if it was schizophrenia. From a little browsing around, it seems that it could have been, and I haven’t turned up any alternative explanations.
I’m just curious, and participating in a discussion about how to be an ally to people with mental health issues soon. We’ve never touched on schizophrenia but I think it’s time.
Sounds like pretty classic schizophrenia to me. Had a guy in our neighborhood as a kid that followed that arc quite closely. I gather it’s quite a common behavior pattern.
Yes, psychoses aren’t just schizophrenia. But I gather the other disorders wouldn’t follow the cycle my roomate’s brother did, would they? Or are there other disorders with the “meds - no meds - getting out of control - forced hospitalization - back to meds” cycle?
I mean, I’ve had hallucinations while on powerful meds after surgery, or with high fever…
I don’t want to speculate too much since there are so many unknowns, but I can say it’s not uncommon for people with mental disorders to dislike their meds. Even when they’re working tolerably well, they can make you feel poorly in various ways. And if you for whatever reason aren’t in a position to get see your doctor regularly and get constant adjustments, it can be even worse.
So yeah, the cycle of “meds, no meds, episode, hospitalization” absolutely happens and is not confined to any particular disorder.
People with Bipolar Type I (prone to manic episodes) often ‘go off their meds’ because manic episodes are often very emotionally fulfilling and seemingly productive (although for the most part work done during mania is not actually very productive in hindsight), and most medications that inhibit mania also tend to subdue the productive hypomanic phases as well, leaving them feeling ‘numb’ and indifferent. However, with few exceptions where a bipolar patient has a co-morbidity with schizophrenia, people with bipolar disorders do not actually suffer from hallucinations although they may be subject to irrational reasoning, problems correctly recalling their or someone else’s statements, severe mood swings, et cetera that are also common features of schizophrenia. Both classes of mental disorder have at least some genetic basis and tend to manifest in later teens or early adulthood and depending upon presentation can be misdiagnosed as one another since there is no specific physical test or exclusionary critiera for them.
Your brother’s presented signs and trend sound very much like a classical case of schizophrenia. Unfortunately, although most people with the disorder to respond well to pharmacological treatment, the side effects of medication are both physically and emotionally uncomfortable, and there is no ‘cure’ or permanent behavioral modification that has been shown to have any efficacy. If you look around you can find quacks that claim to have various naturopathic or behavioral treatments, and these will sometimes seem to have a positive effect (possibly just due to timing, as schizophrenics can go for months or even a few years between episodes earlier in the progression of the condition) but have never been found to maintain a stable condition or eliminate schizoid episodes. Untreated, the condition almost always results in degraded affective function (managing emotional states) and executive function (decision-making); an increasing tendency to aural, visual, and sometimes tactile and other sensory hallucinations; an inability to hold a job or maintain a permanent residence; frequently drug and alcohol addiction as a means of ‘self-medicating’ (often counterproductively as many drugs will ultimately exacerbate hallucination and paranoia on top of the health of effects, particularly with alcohol that interferes with executive function and can produce chronic health problems especially when combined with mood-controlling treatment); and health problems associated with homelessness, lack of physical hygiene and medical/dental care, and drug/alcohol abuse.
Even with treatment a lot of schizophrenics tend to decline in later middle age and suffer premature dementia, which makes pharmacological maintenance and treating other physical health issues more difficult. It is a terrible condition, all the more because during lucid periods most people with schizophrenia are quite aware of their condition and carry shame for their inability to control their behavior. It is frequently co-morbid with depression or personality disorders, although whether these are a result of the conditions caused by schizophrenia or an ancillary result of the root cause of it is unclear (probably a bit of both for most schizophrenics).
The incidence of schizophrenia is estimated to be between 1:150 to 1:400, so the odds are that you have at least a passing acquaintance with someone who is or will become schizophrenic. In previous eras schizophrenics were institutionalized or imprisoned, essentially removed from society based upon their behavior; since we no longer have a good system of state-supported institutions they are often now either homeless or are imprisoned for drug violations or petty crimes. Popular media often treats schizophrenics as violent and dangerous while advocacy groups downplay the hazard they oppose but the reality is somewhere in between for schizophrenic people not on pharmacological maintenance; generally speaking they are more of a danger to themselves, but in a paranoid phase or under the influence of methamphetamines they can be prone to violent outbursts. This is problematic because the response is often to call police who treat the situation as a criminal complaint rather than a mental health intervention, and take actions that often exacerbate the paranoid and aggressive behavior rather than subdue it.
I have known a small handful of people with schizophrenia, several of them quite brilliant and creative when they were in a lucid phase. There is an informal correlation with intelligence and creativity although it is difficult to say if the characteristics are causally linked or just more apparent because intelligent people tend to be those with better access to effective treatment. It is very difficult to watch someone spontaneously begin to suffer this in already difficult teenage or early adult years, and even worse in a way to see someone who has managed it through most of adulthood but start to decline in latter middle age, still quite aware of their progressive loss of control.
Oh, damn, that sounds pretty awful. I had some idea it might be but your description is rich enough to really drive it home.
I should clarify: the person I’m referring to isn’t my brother, he is/was the brother of my roommate at the time. I’m not aware of knowing anybody today with schizophrenia (though statistically it’s quite likely I do). But there are many things like this – not being aware of anybody you know having a condition is very different from not knowing anybody with the condition.
I would like to be a better ally to people all along the mental health spectra, and am aware of various other conditions in a more familiar way, but schizophrenia hasn’t been on my map yet and I’m trying to improve that.
It certainly sounds like it could be. My late adopted SIL was schizophrenic and my wife and her family did not have the resources to manage it properly, and she had two kids. The whole thing was terrible and came close to destroying our marriage.
Friends of ours have a schizophrenic brother and he is managed by parents and a few siblings’ families.
Never let anyone convince you that “the system” will magically look after things. It truly takes a team to look after someone like that. It’s very sad.
I think the best and most effective thing that you can do is to just try to de-stigmatize the condition and treat anyone you know with this condition with decency and empathy. It is difficult to deal with someone who is having a severe schizophrenic episode because they are probably not capable of being fully rational and may be subject to extreme paranoia or hallucinations, but when lucid schizophrenic people are like anyone else albeit more prone to anxiety and depression as well as self-medication. Having empathy is important but at a societal level also ensuring that they have the best availability to mental health care and a support system to get them to be consistent about maintenance to prevent schizoid episodes from spiraling into crises.
There is a somewhat misguided movement that schizophrenics should have full legal autonomy even when in the middle of a delusional state which is ultimately bad because in such a condition they will self-harm and often refuse help, but it is also important to respect their rights and personal autonomy as much as possible because inside of the disorder they are a real person if afflicted by imagined threats. The legal and moral issues around this are tricky and in the United States statute law and law enforcement is still largely stuck in a pre-1960s view of mental illness across the board and in particular with schizophrenia, essentially criminalizing a condition that the sufferer cannot control. Reading up on that and the treatment and management alternatives applied in other countries (particularly the Nordic nations that have spent considerable time in researching de-escalating and non-punitive interventions) may be insightful, although I don’t have any specific references to offer.
I’m curious about schizophrenics being aware of their condition. How would that impact effects like paranoia? If a guy feels that others are out to persecute him but also knows that he is himself paranoid, then why wouldn’t that lessen his certainty in his paranoid thoughts? Similar for other delusions.
Unless schizophrenics are only aware of their condition when they’re not fully in its grip, but when they are they decide they’re not really schizophrenic after all and that their view of the world is an accurate one?
“How can he see he’s got flies in his eyes if he’s got flies in his eyes?” — Joseph Heller, Catch-22
Some self-aware schizophrenics do know that their paranoia is irrational but if you’ve ever had a drug-induced episode of paranoia you’ll know that just being aware that it is irrational doesn’t lessen the anxiety or general feeling of doom about it. Some people with schizophrenia do manage to self-manage to a greater or lesser extent (renowned mathematician and game theories John Nash, the subject of Sylvia Nasar‘s A Beautiful Mind and the highly fictionalized movie ‘based’ on it, managed his condition without drugs for decades while remaining at least marginally functional as a researcher) but it takes a lot of effort and tends to be a losing proposition. Imagine if you tried to drive with loose steering knuckle that kept pulling more and more aggressively to one side but occasionally jerked the other way, and it just kept getting worse and worse, and then every once in a while it starts raining which then switches to sleet and black ice.
Where’s @AHunter3 ? Last time I checked, he was diagnosed as schizophrenic and had some valuable and interesting things to say about the US mental health system.
My maternal grandfather was diagnosed as paranoid schizophrenic ( I don’t remember him all that well. But from what I do remember and stories told by my grandmother and mother, I’m amazed the man didn’t end up lobotomized). AFAIK I was never diagnosed as schizophrenic. I’m bipolar with social anxiety disorder, adhd, ocd, and a long list of other problems. But, no schizophrenia.
My brother was diagnosed with schizoaffective disorder. Basically, it’s schizophrenia plus being bipolar. (That’s probably oversimplifying it.)
He does have delusions. Sometimes I would talk to him and he thought I was somebody else, or that I was preventing him from being with a person. (I am nowhere near him and haven’t seen him in-person for about a decade, and have rarely even spoken to him in years.)
Unfortunately, between that, drug addiction, and his propensity for violence and crime (which is not even necessarily related to drugs or mental illness) it has been difficult or even impossible to treat him with decency and empathy. Though trust me, for the past 40 years I’ve tried. Right now he’s incarcerated, so it’s somewhat moot.
Unless the person also has down syndrome. Bipolar is over-diagnosed in people with intellectual disabilities but folks who have down syndrome and actually are bipolar have an unusually high chance of the disease including psychotic features like hallucination and delusion.
I have never sought out psychiatric treatment or wished to receive it. I did seek out counseling, someone to listen to me, and I thought they’d give me advice or explain some things to me that would let me grow and deal with other folks better. It was nice to have someone’s ear when I got it but honestly I never got any useful feedback, and whatever benefit I received I could have received from explaining all the same things to an untrained professional.
SOME people tout the benefits of psychiatric pharmaceuticals, and I don’t want to come across as someone telling you they’re horrible poisons that hurt everyone who takes them. But I found them mind-numbing and feeling-flattening when I took them voluntarily for a short period, so I quit, and was glad that I did. And on the few occasions when I’ve had them imposed upon myself involuntarily I experienced it as an act of assault. No one should be allowed to modify the brain functions of another without their permission. It should be internationally illegal.
I identify as “schizophrenic” not because I’ve read up about it extensively and decided that, yeah, the doctors who diagnosed me really nailed it. I identify as “schizophrenic” because there is no mechanism in our society to say “Well, the doctors SAID I was schizophrenic, but I’m not”. One is immediately tagged as being in denial. “See, that proves how sick you are, you see, you’re schizophrenic which is why you can’t perceive that you’re schizophrenic”. Besides saying it that way implies that the other people who are diagnosed “schizophrenic” are utterly different, deserving of the label — No, no, I don’t belong in here with these crazies — and that’s not how it was. I have, in fact, been in an auditorum packed to the gills with psychiatric survivors, activists who oppose psychiatric forced treatment, and found myself ot have a lot in common with other folks with diagnosis like my own. So I reserve judgement on whether I have some kind of functional organic difference from people who don’t share my diagnosis.
What I will say is that my difference is not a sickness, not an inferiority, not a deficit. Not if I don’t experience it as such. Like being gay, having this difference merely makes a person different. Regardless of attitudes to the contrary that others may hold.
Anyone who is significantly different in their cognitive and emotional state from others around them is going to have it more difficult than those who are typical and normative, even if it is not an inferiority or a deficit, because we’re social and we need to interact. So it’s harder. Some of us never get good at it. Some of us do, despite the extra challenges.
One characteristic of schizophrenia is that the disease tricks the patient into thinking that the treatment is causing the disease, not reducing its symptoms, and that’s one reason why medication compliance is so challenging in that population.
The meds used to treat it now have terrible side effects, but they’re almost insignificant compared to what was available in the 1970s.
Sounds like a classic case of paranoid schizophrenia if you ask me. I’ve seen quite a few who followed the described pattern closely. Auditory hallucinations, especially in the form of hearing voices, is a common feature of this. The recurring episodes are indicative as well.
A few remarks on the reactions:
Bipolar I can have psychotic episodes as well, but by definition only during a mood episode and usually themed as such (mood -congruent delusions). In the manic phase, delusions of grandeur are common, which can flip into paranoia pretty quickly. Paranoia is the other side of the coin so to speak. If you have a special mission then of course there will be people to thwart you. In depression, there’s sometimes delusions of guilt, poverty or physical deterioration, up to being convinced you’re dead (Cotard syndrome).
A schizoaffective disorder is basically the two combined, but psychosis can occur without accompanying mood episodes and the long term perspective is worse in terms of cognitive deterioration and negative symptomatology (apathy, inhibited executive functioning, social withdrawal ).
For psychosis in general, a key symptom is lack of insight. If you know you’re crazy you are not delusional. It’s rare but it does happen, mostly with more intelligent /introspective people . I can remember one patient in particular who requested to be re-admitted within a few months of discharge after a truly horrible episode because the voices were becoming more convincing again and he correctly deduced it was his illness and not an outside force. But given the cognitive deterioration accompanying schizophrenia this is rare.
People with Down Syndrome or other pre-existing mental retardation are especially prone to psychosis in general, because of the reduced ability to form adequate coping skills to stress. In older days we used to call those ‘debility psychosis’, a term now obsolete.
As to being an ally, since I’m a psychiatrist I usually start out as the villain in the story of a psychotic episode, because I’m the one wielding the power, in a way. At the same time I’ve usually been able to establish some sort of rapport over time. When people are floridly psychotic, they don’t have a disorder, the disorder has them. It’s very little use to try to reason someone out of a psychosis. If that were possible, they would have done so themselves. What helps to reduce paranoia is being transparent and honest, also about whether or not you think the other person is crazy. And try to find common ground. Pets, music and hobbies are good topics for this. Keep in mind that even when someone is psychotic, they are still more like you than not, on account of being fellow human beings.
Thanks for making this into a thread, mentally ill people need all the support they can get and usually receive so little .
It’s not a “trick”. If you think psychiatric antipsychotic pharmaceuticals are a carefully tailored interrupt to some well-known aberrant neurological or neurochemical brain process, you are mistaken.
Psyhiatric pharmaceuticals are broad blunt instruments. It’s unlikely that you’d enjoy them. They basically turn down the volume on the entirety of thinking and feeling processes — they used to be called “tranquilizers” which is an apt name. Whether they manage to turn down the volume a little bit more for the most bothersome and worrisome of cognitive processes than for the rest of them is a matter of some speculation, but even if it does, it leaves the person with a mind less capable of formulating thoughts, and less capable of feeling anything for or about anything with any intensity.
That reminds me of a story I was told by one of my high school teachers.
From what I recall, I believe it was the 70s, he was in college and was out for a walk (it was summertime and he was out of school). Police saw him along the side of the road and picked him up. He looked similar to a guy they’d been on the lookout for, someone who was mentally ill and considered dangerous.
My teacher insisted that they had the wrong person, but they figured, of course this guy is going to say that. He had no ID on him, he was a young guy just out for a walk enjoying the nice weather. They put him in a facility for 3 whole days, confined and drugged, until they finally figured out they had the wrong guy.
They released him, said “oops”, and that was that. Pretty shitty and he had a dim view of the police and mental institutions for a long time after. I didn’t blame him.