schizophrenia
<eta: this post was previously titled schizophrenia 101, which incorrectly suggested that it was an authoritative or comprehensive discussion of the topic. it is not. it is a pile of information colored significantly by my own experiences and perspectives.thanks to those who raised this with me.>
full disclosure: this post in the mental health series is the one based primarily on books and articles rather than personal experience, so is more about interacting with people with schizophrenia than actually being one. any errors or misrepresentations are mine alone and i apologize in advance for any.
the main thing i want to get across about schizophrenia is that when the term is used in casual conversation, it is usually used incorrectly. a “schizo” coffee is half caffinated and half decaf, people who are described “schizo” usually display multiple and distinct character traits. here’s the sample sentence from the urban dictionary: “That bitch is a schizo. One minute she’s a Sunday school girl, the next minute she’s crack whore that would make a sailor blush.”
so, to be very clear: schizophrenia has nothing to do with multiple personality disorder (now called dissociative identity disorder, DID). schizophrenics rarely, if ever, display the fragmented identities and personalities associated with DID. not that these things or people would be correctly described as having DID, either, which is a really serious identity fragmentation, usually as a result of extreme trauma at a very young age - not a girl who can act both refined and vulgar in different contexts. but to call those people or things “schizo” makes as much sense as saying “she was so hyper and couldn’t sit still or stop talking - she’s such a depressive.” which is to say, none at all.
so that’s what schizophrenia isn’t - what is it? the hallmark of schizophrenia is psychosis, or some kind of significant break from reality. this could take the form of hallucinations (visual, aural, tactile, etc), delusions (demonstrably false beliefs, stereotypically about aliens or being tracked by the FBI), or “disorganized thinking” (incoherent or confused speech, loose associations between thoughts or topics). these symptoms must last for at least 6 months and significantly disrupt functining in work, social functioning, and/or self-care for a person to get a formal diagnosis.
there are different subtypes of schizophrenia: paranoid (characterized by, obviously, psychosis about being tracked or persecuted), disorganized (disorganized speech and thought, inappropriate emotional affect), and catatonic (where the person is primarily catatonic). the paranoid subtype is the most common, but the total prevalence of schizophrenia is about 1.1% of the population.
some important things to know about schizophrenia: despite the typical portrayal in the media, schizophrenia is not at all the same as sociopathy. schizophrenics are not necessarily criminals or serial killers or going to stab you and your intern while you work in the ER. they are not inherently dangerous at all.
when interacting with someone with schizophrenia, my most important tip is not to try to contradict or argue with them about the reality of their delusions or hallucinations. when i had a psychotic break due to my mania, i believed i could fly. and i say “believed,” but i really mean “knew with the certainty that you know you can type by pressing keys on the keyboard.” rational argument was useless and only made me feel uncomfortable and misunderstood. there was never going to be a point where i said “oh, i get it, i can’t actually fly.” (well, that point came, but only after some sedation and the psychosis passed.)
so when i meet with a client and they tell me that sometimes they may need to lie down on the floor to avoid the scanning beams of the tellurian aliens, i would never try to tell them that aliens don’t exist or that they’re not scanning him or any of that. to him, that is reality. and to respect him as a person, i have to respect his reality.
it’s sometimes tempting to giggle at these things. haha he thinks he’s being tracked by the FBI because he’s the reincarnation of napolean! but think about what it would feel like if you knew you were being tracked by the FBI, if you saw evidence of it everywhere, if that were your reality. that would be fucking terrifying, especially if everyone you talked to wouldn’t believe you and told you you were crazy. that is that person’s everyday experience and to laugh at that is to dismiss the very real pain the person is experiencing. and arguing that in some theoretical objective reality the person isn’t being tracked or monitored is totally irrelevant to the person’s experience, except to minimize their feelings.
