Saturday, February 10th 2007, by nednednerb

My first doctor, a practicing psychiatrist, tells me I am an excellent case of schizophrenia, high-functioning and well-adjusted. She told me that I’m lucky for my ability to converse in psychiatric discourse at a somewhat intellectually matched level with her. She said she’s never known a patient who was so knowledgeable and en-languaged about his condition; in addition, before I got very sick, I had always done well at school, had been open to volunteering in my school and community, and had also possessed a healthy dose of teenage angst to change my world. Before I saw any doctor for it, I had already self-diagnosed and learned much on my own, feeling that schizophrenia intriguingly and weirdly challenged my mind, at least before I totally lost connection with reality.

Schizophrenia is a chronic form of psychosis, described by psychiatrists as a drastic disconnect from socially shared mental and emotional reality. The presence of delusions and hallucinations characterizes psychosis. Delusions are persistent, often destructive beliefs held onto in spite of any provided rational evidence to the contrary. For example, I had a delusion once that weather like the wind could be directed by my thoughts. Hallucinations on the other hand are perceptions that occur to an individual’s senses, but which are not really based in an external stimulation of the senses. My delusion about the wind was not a hallucination because I really felt the wind moving. A dream, for instance, is technically a hallucination, because what we see in a dream is not really where one physically sleeps. For the schizophrenic, voices and strange objects might be perceived just like when one is dreaming, but these perceptions occur in waking life when there is no outer source for them. The difference between delusions and hallucinations is the same difference between belief and sense perception. The two relate as perceiving events through the senses provides material for a belief about events to form. This idea figures into my overall ideas on the subject of schizophrenia in a significant way.

Before I was severely ill, my mind slowly filled with weirdness. I remember during my teenage angst that I felt a need to express certain views, but I felt none would listen to what I most wanted to say. I felt alone and developed a habit of imagining myself in conversation with the others that I really wanted to speak to. It was a tactic to test out concepts and simply explore by myself what I wanted to say, since I did want to say a lot. It occurred to me eventually that I almost literally heard speech of my friends and argumentative quarries when I imagined their responses. I thought in isolation about what exactly I might say if I were to open up and express issues important to me. I would go for a walk out back behind my house into the forest, find a spot, and pace back and forth while imagining and muttering under my breath both my words and the words of others. The experience gave me an eerily realistic sense of meaning that was exchanged and developed through the imagined dialogue.

This progressed until I could not shut off the perception of imagine-hearing others make statements, even when with them at school. I began to make up responses and follow-through statements in the direct midst of actual conversation. It happened when I would walk by a group that was talking, and the “sound” of these extra statements began to feel a lot like my own thoughts but attached to other personalities than my own. I had been reading ancient to new-age spirituality as well, and at the weirdest times, I imagined with some disbelief that I might actually share thoughts with others. The characters seemed consistent, and the thoughts kept appearing in my mind without any impetus or desire of mine to think about them, but I also didn’t resist when I thought I could learn from it as I initially intended by testing out hypothetical conversations.

My last year of high school in 2002 went like this. Later that summer, however, a real trauma occurred(1), and I became even more disconnected from reality than during school. I gained so such emotional stress that while not going into the story, I can say a situation completely debilitated my already faltering psyche. I could no longer contain my already rampant imagination or maintain rationality. I started hallucinating extremely, totally blinking out with huge memory gaps and not noticing even several days going by—at that point I desperately needed help. And, it was at that crisis point that the struggle with my delusions truly began. How in high school I became prone to psychosis will elucidate the later points I make about schizophrenia. I think it is important to keep in mind that inadvertent ideations tend to confound schizophrenics; right before I got sick and in the midst of it, I felt I could not at all stop the flood of my thoughts.

In a state of recovery since becoming psychotic in the Fall of 2002, I attest to the following point: without many kinds of help, I would not have had the ability when totally convinced of my delusions and hallucinations to overcome them. A nightmare of horrors deeply daunts the individual who becomes severely schizophrenic. I happened to be watching TV the late night that the ambulance took me away, and at that crisis point, I thought that the television images and words were talking metaphorically about me. Around the same time, I experienced hallucinations of people that I talked with, so vivid that I could see colour in their eyes, feel their breath, and feel the touch of their hands and arms. With schizophrenia, an individual experiences profound changes in the function of his or her mind, and these changes have a potential to disrupt mental life by making it unmanageable and unbearable; they no longer share the reality had by everyone else. Luckily, the people I hallucinated were friendly and non-threatening to my emotions, which was a relieving way to emerge from the trauma that occurred within real events(1). Although, talking to people who weren’t there and unaware of what was happening, I was in a sick state. Psychosis intensely affects perception and imagination, leaving one susceptible to startlingly vivid hallucinations and intensely held delusions. Recovery must be guided with sensitive care, because insight toward sanity for a psychotic hardly derives from the distortion of insanity. All I can remember is one room and its two windows, a forest I sought out of the top of a mostly opaque window and a hall with desks around the corner out another. The door was kept locked unless I was given a pill to take. I was there a whole week, and I remember taking the med only once. They said (as I later heard) that I was often seen talking and looking around as though interacting with people. Apparently, I was cooperative with treatment, but I had no idea where I was. A grounded mind supported by good knowledge is the essence of recovery for a schizophrenic. I needed grounding alright. For the times I remember, I felt like I needed electrical grounding.

Recovery began for me as it does for most Canadians that become psychotic: I received the attention of a psychiatrist and then encountered psychiatric methods of treatment, beginning first and foremost with medication. Doctors, informed by science and not personally swayed by the torrents of a psychosis, have useful knowledge, and their help for grounding the afflicted begins in giving them a medicine. Anti-neuroleptics or anti-psychotics, as they are called, most directly aid schizophrenia by controlling what has become the chaotic chemistry of the brain, full of processes that doctors can associate with hallucinations and delusional impulses. Different drugs help various individuals by balancing their brain chemistry, thereby helping to balance their minds by controlling and limiting what manifests to perception. This medical knowledge grows and improves the chance of recovery for schizophrenics who have access to the most effective drugs(2).

Medicine at least allows recovery to begin, but the afflicted individual must, I believe, attain also a coherent mental framework to make chemical treatment effective. No schizophrenic individuals will be okay if given only adequate doses of some pill but are then deposited in the street before working through their onset and lingering psychosis. I responded well to medicine and my hallucinations faded. Medicine indeed helped to settle my teetering mind, but much was yet amiss.

After my initial hospitalization and “settling” closer to sanity as the nurses and doctors described, I was still convinced by some strong beliefs that I only later learned referred to the unreal. I realized at some point that real people had not seen the things I hallucinated, but I still thought the visions were more substantive than waking dreams. Delusions still swayed my judgment to a bad end, for example discontinuing the stabilizing med. Utterly convinced by my experience right before the first ambulance ride to a psych ward, I consciously supported my delusions. After watching TV that time feeling so powerfully that it was about me, I readily convinced myself any image through my senses could carry a metaphorical message like the TV had seemed to. In the hospital, medication ended the strong and active hallucinations that had onset during severe psychosis, but an inclination to form delusions remained. I did not yet doubt the hallucinatory images or feelings that had occurred, so like ghosts in my memory, the response lingered of looking for a message like the one imagined from the TV. Choosing to stop taking my med and spending a whole night watching TV again like that, I required a second hospitalization to “settle” again, but I started to recognize the presence of persistent delusions. They did not dissipate even as my heart and mind grew calmer and as my thoughts composed some measure of reason. Exploring the confused, I entered confusion, unable to understand. I needed more help than a pill, because even on it, I could inappropriately desire the alternative to its settling effect.

Where pills do not and cannot reach, I have found the mind responds to aberrant perception by intentionally creating and maintaining delusions. In recollection, many delusions and strange concepts came to me directly from trying to figure out or think through the weirdness of various hallucinations and feelings that invaded my unadjusted and untreated, schizophrenic mind. In the period during high school, feelings dwelled in me and led to preoccupations, which I think might have advanced the neural pathways needed for hallucination, my mental future at which the spontaneous inner conversations hinted. In the period during my hospitalizations, the perceptual symptoms grew more hallucinatory, and the near-delusions from high school evolved and shifted with my changing perceptions. The conversations and thoughts of others I imagined happening inside me during high school were overridden during psychotic onset by more intense feelings that a worldly separate thinker was communicating straight into my thoughts. The base perceptions underlying my beliefs changed drastically, in the nature of how thoughts appeared to my mind: the thoughts coursing through my mind grew even more intrusive and automatic. My explanations kept changing in a struggle. Instead of fake-talking in my head to my friends, or thinking I maybe heard my friends’ thoughts telepathically, I began to think my mind totally invaded by a foreign communicating entity or spirit.

Consider another case of strange perceptions: most people who ingest psychedelics to create hallucinatory images tend to avoid strange beliefs that persist after the chemicals are flushed from the system. When a person using a drug forgets that the drug causes what they perceive, they may become prone to cognitive disorder. Doctors describe “toxic psychosis” as a result of some drug use where the user “does not come down” as anticipated. People are susceptible in this way because they usually try to explain and understand objectively what is happening to them, which will not likely succeed for an experience not based at all in objective reality. Being literally convinced of a hallucination can prolong it chemically in the brain, I figure. I see an analogy: not knowing oneself is dreaming prolongs the perception of dreams or to say that more familiarly, discovering that oneself is dreaming often immediately rouses one from slumber. The brain works in mysterious ways and can make the mind strange when creating representations to the mind that are not based in sense stimulation.

Hallucinations for the schizophrenic generally occur over a far longer period of time than for a psychedelic user or a dreamer, so one afflicted tends to struggle a long and arduous time trying to reconcile a coherent worldview. Memory and thoughts of a drug user or dreamer can turn into specific albeit loony perceptions that are sometimes incredibly meaningful to the experiencing mind, and the long-term experience of schizophrenia fills a mind like some dreams do with meaning to comprehend or think about. The biggest problem I believe exists for schizophrenics in thinking the ‘waking dreams’ are real and in working on with ‘the faculty of reason’ to reinforce the imagined but inappropriate ideas of some principles or facts that are supposed by the schizophrenic to explain intrinsically bizarre or hallucinatory perceptions. I believe the delusional response requires deep psychological and cognitive treatment to offset perhaps years of intentional but unbalanced thought tendency. This is my best sense of my own case with schizophrenia at the very least, but I know it’ll hold to some others.

Because delusions are a mental response(3), any treatment can have little lasting effect until one is convinced of the truth despite being also swayed by feelings. For schizophrenics, some kind of truth or some insight must develop before they possibly clarify or abandon what is untrue and insane. Coherent thought breaks down when one believes totally in a different reality than the one shared, and reparation in logic and in understanding needs correct and true ideas as well informing the ill mind.

Faulty beliefs seem to me to form in articulate and rational-like streams of thought. They appear more verbalized into language and actively put together compared to odd feelings just bubbling up or absolutely bizarre hallucinations presenting themselves suddenly. For example, some people have intense paranoia and work hard to ideate complicated conspiracies because of a recurrent, unintentional feeling that they are being strangely stared at by complete strangers. After the peak of my own disarray, I continually perceived creepily profound meanings in ordinary statements, or built strange meanings myself into what I witnessed. I cannot yet comfortably watch TV without seeing at least a potential for the meanings that used to flow in with clear meaning to my mind as directly as I hope these words communicate my experience to you.

I thought for a while that every word I received could metaphorically convey a message, and this intense feeling gave me the reason to seriously speculate about an entity or aliens directly communicating with me. I thought some entity could reach through time to coordinate events to enfold me in a rapture of symbolic learning. No kidding! Reading, radio, TV, and conversation with others—these seemed to flow in a continuously meaningful and never-ending message to myself. Sometimes what people said took on such significance in my mind that I felt the extreme meaning I gleaned in some statements could be rationalized through the existence only of powerful, indeed omnipotent beings. I transferred at various points between the angst-ridden desires in high school to speak my mind toward the unavoidable perception of an intangible entity’s speaking of its mind through my consciousness. I would not imagine that the profound meaning could simply be in my mind, so I made up pseudo-theories that aberrant perception seemed to validate easily. I did not accept my own mind’s inner work, disposition, or personality, what have you, as the possible source for these feelings which were so strong.

Mine was a breakdown of interpretation. To understand what happens during the perception of events, people use language, or to say it another way, if asked we can usually give some words that clearly convey the sensed meaning of our experience. Similarly to ordinary speech, delusion formation in schizophrenia involves mentally active expression, but about a strange perceptual world. I’ve hinted consistently at a distinction between communicative expression and passive perception, and I find it is an essential distinction for me to investigate in my ongoing recovery from untruth. I keep clear to myself that there is a big difference between having a spontaneous thought or perception and then deciding which thoughts to nourish with faith in an external to me (like the entity). A schizophrenic must, to overcome, not only question whether what they actually see or actually hear is also actually real, but question as well whether they are thinking as clearly as they could be. Philosophy class makes me laugh when someone asks “what’s this thing people call reality? What if, really, all life is but a dream?” Hah, I’ve questioned that, but it dug way deeper.

In my mind I know that mainly good ideas, some given by friends or my doctor and some gained myself, have helped me sort through the surrealism and hold on to some sound reason. I attribute my recovery to many factors, but I want to emphasize the overcoming of delusions, reiterating it was hard because they stuck around far beyond medical treatment and awakening from hallucination. I’ll speak of one delusion I overcame and of how I overcame it: to avoid believing in higher beings (or whatever) to explain strange encounters of strange meaning with ordinary people, I held instead to the idea that my mind can quickly glean profound meanings. These meanings once seemed to specially arise for me, but genuinely, they arise from my mind. I now imagine a hyperactive subconscious in conversation with itself to be my mind when I get a little schizophrenic. This idea is so much more comfortable than thinking seriously and mysteriously that you (someone, anyone) are not truly yourself at least for a moment that another being, one interested in me, speaks through you. Weird, eh? With a mental choice I offer a weird part of my experience a poetic response instead of a delusional response. Luckily, I still get the old feeling of wonderful and exhilarating meaning sometimes, but a few insights toward sanity help me have these interesting experiences and also keep sane inside them.

Not every schizophrenic is so lucky with their course through the disorder. The Public Health Agency of Canada released(4) A Report on Mental Illness in 2002, the same year I was diagnosed. In the relevant chapter, it says “the chronic course of the disorder contributes to ongoing social problems. As a result, individuals with schizophrenia are greatly over-represented in prison and homeless populations.” Further, the report says between 2 and 3 out of 5 schizophrenics attempt suicide and about 1 succeeds. As a rough average, about 1 in a 100 individuals in the general population faces a life of schizophrenia. If Malaspina (the school I attend) had 8000 students, anywhere in the range from 45 to 140 individuals with the illness might walk by me daily on campus. My doctor asked me once to tell her if I had delusions that would not go away so she could consider raising my dosage of meds. She worries for me, because she knows from trying to help them that many schizophrenics never get over their lingering psychosis. I shared more of my own perception of how I’ve done so well because I consider my own mind more invaluable than my meds for stopping delusions.

I told my doctor this summer more thoroughly that the medicine never surely stopped the delusions, and she seemed sort of aghast for just a moment wondering if I had been lying to her about feeling better. The meds have stopped the most vivid hallucinations as well as allowed me to sleep, but the crux of my recovery conjoining these vital parts of it are recurrent choices of how to respond to strange feelings, and the delusional response weakens gradually. Sanity is with- in -sight, to play a little friendly word salad! Ah, I find so much joy when characteristics of schizophrenia, like a far-reaching imagination and play with language, two abilities which used to hurt my mind as symptoms, can now be used for beneficial expression. I would like more people to have a general knowledge about how delusions form, because I find the process so integral to individual suffering. It would be good for more people to know better how to engender that grounded mental framework that guides the disrupted and distorted individual to inner peace. We schizophrenics need real help out of illusions.



Footnotes: 1) A thorough enough account for understanding the events which took place goes quite beyond the scope of this writing, and exploring them would surely distract the reader from what I seek to emphasize. The events lacking mention do not pertain to what herein I have to say about schizophrenia and the delusional response.
2) Different drugs work with varying degrees of success for different individuals. My doctor says sometimes a mixture of various medications is necessary for some.
3) I allude to in discussion of my “high school conversations” but never explicitly state that sentences and words can appear in a hallucinatory fashion like when hearing voices in the head, but I do hold an important distinction between sentences that might pop into mind as hallucinations and between delusions which I primarily conceive as statements consciously derived by meticulous, reason-guided articulation about what might first pop into the mind unabated as raw perception or feeling.
4) The report can be found for reading online.