7 (and more) facts about Schizophrenia

Many books, articles and blogs have discussed schizophrenia and often there are differences in terminology. As an ex-mental health nurse/ward manager and someone who has experienced a lengthy psychotic episode, this is my take on schizophrenia.

Schizophrenia can be separated into positive and negative symptoms. These are not positive and negative in the way you might think. A positive symptom is one that adds a behaviour, thought or feeling, whereas a negative symptom takes away a behaviour, thought or feeling.

Schizophrenia has five types of symptoms: hallucinations, delusions, disorganized speech, disorganized behaviour (the positive symptoms), and negative symptoms. However, the symptoms of schizophrenia vary dramatically from person to person, both in pattern and severity. Not every person with schizophrenia will have all the symptoms, and the symptoms of schizophrenia may also change over time.

Most people with schizophrenia are not violent. More typically, they prefer to withdraw and be left alone. In some cases, however, people with mental illness may engage in dangerous or violent behaviours that are generally a result of their psychosis and the resulting fear from feelings of being threatened in some way by their surroundings.

  1. Hallucinations

People with schizophrenia might hear (the most common hallucination), see, smell, taste or feel (the five senses) things no one else does i.e. hearing voices talking in the first person, to them or about them, they might see other people, animals, faces, things that we can’t see. One patient could smell sh*t everywhere he went, causing him to retch and another said he could taste tin or metal so someone was trying to poison him. He wouldn’t eat the hospital food or take the drinks. He’d only drink bottled water that he brought in from home. One patient felt like he had spiders crawling all over him and inside his body.

2. Delusions

A delusion is a firmly-held belief that a person has despite evidence that it isn’t true. Delusions are extremely common in schizophrenia, occurring in more than 90% of those who have the disorder. Often, these delusions involve illogical or bizarre ideas or fantasies, such as:

Delusions of control – Belief that your thoughts or actions are being controlled by outside, alien forces. Common delusions of control include thought broadcasting “My private thoughts are being transmitted to others so people can hear what I’m thinking”, thought insertion “Someone is planting thoughts in my head”, and thought withdrawal “The CIA is robbing me of my thoughts”.

Delusions of grandeur – Belief that you are a famous or important figure, such as Jesus Christ or Napoleon. One of our patients believed he wrote all Michael Jackson’s lyrics. Alternately, delusions of grandeur may involve the belief that you have unusual powers, such as the ability to fly.

Delusions of persecution – Belief that others, often a vague “they,” are out to get you. These persecutory delusions often involve bizarre ideas and plots e.g. “Martians are trying to poison me with radioactive particles delivered through my tap water” or “they’ve put a chip in my neck so they can follow me, they followed me to San Francisco once and had me deported back to the UK.” He had actually been deported once it was noticed he had been on Section 3 of the Mental Health Act 1983 as you cannot enter the States if you have been on Section 3*.

Delusions of reference – A neutral environmental event is believed to have a special and personal meaning. For example, you might believe a billboard or a person on TV is sending a message meant specifically for you.

3. Disorganised speech

People lose their train of thought during conversations, make loose associations of topics (jumping from one topic to another), and give answers to unrelated questions. They might make up words that only they know the meaning to (word salad), rhyme without noticing they’re doing it, and repeat the same things over and over again when trying to keep up a conversation.

4. Disorganised behaviour

Patients often have a very hard time functioning independently and this is easily seen in the difficulty they have in starting or finishing a task without help from other people. Mundane tasks such as taking a shower or cooking a simple meal become massive tasks. Patients start to lose independence and not being able to perform normal everyday activities and they start to lose routines to the point where they can be completely lost.

5. Negative symptoms include:

Blunted affect – reduced intensity and range of emotional expression including vocal, facial expression, body movement and hand gestures.

Alogia – decreased quantity of speech, reduced spontaneous speech and loss of conversational fluency.

Amotivation – lack of motivation i.e. in school, work, personal hygiene etc.

Anhedonia – inability to feel pleasure in normally pleasurable activities.

Asociality – lack of motivation to engage in social interaction and/or the preference for solitary activities

6. Suicide

Five to 6% of people with schizophrenia die by suicide, about 20% make suicide attempts on more than one occasion, and many more have significant suicidal thoughts. Suicidal behaviour can be in response to hallucinations and suicide risk remains high over the lifespan of individuals with schizophrenia.

7. Early warning signs of schizophrenia

In the early phase of schizophrenia, a person might seem reclusive, unmotivated, eccentric and emotionless to others. They might start to say odd things, isolate themselves, show a general indifference to life and begin neglecting their appearance. They may abandon activities or hobbies, and their performance at university, school or work can deteriorate.

8. The most common early warning signs include:

  • Odd or irrational statements; strange use of words or way of speaking
  • Depression, social withdrawal
  • Flat, expressionless gaze
  • Inability to cry or express joy or inappropriate laughter or crying
  • Oversleeping or insomnia; forgetful, unable to concentrate
  • Hostility or suspiciousness, extreme reaction to criticism
  • Deterioration of personal hygiene

If you are worried that odd or out of the ordinary behaviour is causing problems in your life or the life of a loved one, please seek medical advice. The earlier you get treatment, the better the prognosis.m

Is there anything else you would like to know about schizophrenia? Is there anything you think I’ve missed?

* Section 3 of the Mental Health Act is commonly known as “treatment order” it allows for the detention of the service user for treatment in the hospital-based on certain criteria and conditions being met.

For immigrants with a mental disorder or disability, seeking entry to the United States is not easy. U.S. immigration law imposes barriers to entry for persons with certain kinds of physical or mental illness, particularly when it appears that the chances of harm to persons or property are high or when an immigrant may likely have no financial support in the United States.

These barriers can be compounded by immigration officials who lack up-to-date scientific knowledge or who may unknowingly prejudice such cases. There are ways round these barriers and travellers must ensure they have the legal documents required for entry into the States (https://www.alllaw.com/articles/nolo/us-immigration/mental-illness-barrier.html )

My journey through psychotic depression – Part III

If you haven’t read Part I and Part II and you want to, you can find them here (Part I) and here (Part II).

If you see anything of yourself or your own experiences in this post, perhaps you’ll feel relieved that you are not alone. Maybe you’ll even recognise some of the symptoms in a friend or family member? Or it’s feasible you’ll gain insight into different mental health problems and see how difficult it is for people who experience mental ill health?

……….I was struggling desperately. I couldn’t see an end to the pain. I felt scared, worthless, hopeless and I honestly felt suicidal. It was then that I had my own ‘break down‘. And that’s exactly what it felt like; both physically and mentally, I was broken.

Panic attacks

I was having panic attacks throughout the day and particularly at night, keeping me awake. Alongside the huge purple sacks under my eyes, the weight loss, dizziness and nausea, I looked bloody awful and felt even worse.  It was torturous; twenty-four-seven, week on week and, with no end in sight, I wished I was dead.

Natural Stress Relief

Girl sitting on the rock by the peaceful sea at sunset.

I tried every natural and herbal stress relief, sleep inducing, over-the-counter remedy known to man, without effect. As an aromatherapist, I made up lots of pretty little bottles of stress relief oils then bathed in them and doused myself liberally. However, despite all the lovely citrusy, spicy and fruity oils, all I could smell was the lavender, reminiscent of my grannies old underwear drawers. This didn’t work either.

Soothing massage

As a qualified massage therapist, I was aware of the benefits so I booked massagemyself in for a few sessions. However, the first lady almost pecked at me like a small bird trying to feed itself for the first time; there was no pressure applied and she missed areas of my body out! The second time, I went for seated massage, which ought to involve sitting on the massagemassage seated chair with your upper body leaning forward, your arms on armrests and your face peeking through a hole. Looks comfortable, right? This lady, who’d attended the seated massage course with me, had me sit on a swivelling office chair! With my muscles tensing, I tried using my feet and legs to keep the chair from spinning, to no avail so told her to stop. She couldn’t understand why I refused to pay?

Exercise

running machinejpg

I joined the local gym and went seven days a week, twice on Sunday; pounding the treadmill and pedalling like fury on the exercise bike. I got so wound up if I couldn’t go to the gym for any reason but made up by jogging on the spot and running up and down our stairs. I tried most everything to relieve the constant anxiety and to wear myself out so I could sleep, but even the excessive exercise proved fruitless.

Hallucinations and paranoia

I was permanently exhausted and after three nights in a row without sleep, I started to hear, see and feel odd things. People (I didn’t recognise the voices – but they were very real) were talking to me and about me, saying I was no good, I was dirty, together with lots of other negative comments and expletives. I could see things; mice running along my wooden floorboards and unidentifiable faces at my windows. Worse still, one night I was wide awake curled up on my kitchen floor, with my back against the heater and it came to me – I’d killed someone.

I Big treeremembered how and where I’d buried that someone; by a huge tree outside my aunt’s flats, but I couldn’t think who it was that I’d killed. The next day, I saw a police car and thought ‘This is it. They’re coming for me.’ Jeez! I was terrified. For months, if I saw a police car down our street, I’d turn and retrace my steps or go round to my back door. If the police were in the square at the back, I’d whizz round the front. I sometimes wondered if I should just hand myself in and let them find out who this someone was that I’d killed. In hindsight, obviously if they were after me, they would have got me. 

Mad, nuts or crazy

Although close friends and family were aware of my break-up with thedepressed girl boys’ dad and knew how devastated I was, I couldn’t tell anyone what was going through my head. I was afraid they’d think I was mad, nuts, crazy and that I should be locked away. Seeing mice or rats scurrying under my sofa and the unknown ugly faces frightened me, but if I closed my eyes at least I would get some temporary relief. However, the voices were incessant and unbearable; the constant rabble of people discussing what only I knew as my fears. They played on them, they were cruel, repeating the negative thoughts I’d so often had myself. They knew which buttons to push.

Trying to sleepRelaxing music

When I attempted to sleep in my bed the voices seemingly delighted in keeping me awake with their constant and irrepressible verbal abuse. One day, after work and before picking up my youngest, I bought a cd player, ear plugs and a few ‘out there’ cds with relaxing music, water sounds and dolphins in the background. I played these throughout the nights but still, my heart pounded in my chest and thundered in my ears, my breathing was irregular and the panic attacks raged.

By the time I got the boys up for school, I was a wreck; my eyes were red-rimmed and it felt like there sand in them. I was sluggish and jittery, but I somehow managed to hide it from the boys. My job at a high end clothing company was demanding, which helped abate the voices for a few hours but the anxiety, depression negative thoughts and panic remained. Colleagues at work noticed the 4 stone weight loss and saw how my clothes fell from my gaunt body. It certainly wasn’t a good image for the brand. Fortunately, a good friend in the sewing department kindly offered to take them in.

hypnosisHypnosis

I even tried extortionately priced hypnotherapy but I couldn’t relax enough to go into a trance-like state. However, I’d bought myself a Paul McKenna relaxation video and when the boys were I bed I’d get it out. I’d half sit, half lie in one of my padded beach chairs, directly in front of the t.v so I could get the full effects of both the visuals and the sounds. Amazingly, I managed to relax and as the video ended, I’d carefully take this relaxation up to bed with me and finally managed to get a few good hours sleep. Sometimes it didn’t work and I suffered the torture again but I was so grateful for the times it did work.

What’s the problem?

After a while, not sure how long as I was in a constant haze back then, I took the boys to see our GP about their asthma. Once he’d seen them he sent them out, turned to me and, with his hand resting lightly on my arm, he said “Tell me, what’s the problem? You so thin and though you smile, I think you very sad.” The floodgates opened and it all came tumbling out; I sobbed and wiped the tears and snot on my hand as I explained how the boys’ dad had been seeing someone else and about the breakup around eighteen months ago. He told me to let the boys go home, he would make some telephone calls and I was to come back in to see him.

Having spoken to a colleague who agreed to see me, like – now, at our local general hospital, Dr Nga was going to drop me off! I knew it was a general hospital, rather than a mental one, but I soon found out that there was one mental health ward there.

The asylum

I thought back to how, as kids we’d all say stupid things like “The men in white coats will come to get you.” or “You’ll end up in Stratheden, (our nearest asylum) you will.” We were all terrified just at the mention of the asylum.

Well, one day mum said my stepdad was taking her to hospital for a few days and I asked if I could go with them. Dad said no, mum said “Yes; she’ll be fine.” So off we went and when I noticed we’d gone past the hospital, I didn’t think too much of it – until I saw the huge sign looming up – Stratheden Hospital.

Stratheden Hospital
Stratheden Hospital –CC0 1.0 Universal

I assumed and hoped we’d just drive past that too. However, when we pulled up at the foreboding buildings and the grounds surrounded by high metal railings – and gates that were opened by the porter who otherwise sat in his wooden lodge, reading a paper. I was petrified and felt a certain shame; my mum was going into an asylum. Oh my God!

From the car park I could see people roaming around, some with an odd gait, others making strange utterances. A lady with long scraggly grey hair, wearing unusual clothing, waved at me frantically then cackled like an old witch. Not sure if it was designed to frighten me, but that she did! Mum and dad got out of the car but I wasn’t allowed to go into the building with them so was left sitting in the car and told not to open the doors to anyone. Ha, as if.

ECTIn later years I would learn that mum had been in an asylum once before and on both occasions she had ECT (Electroconvulsive therapy),  which is given under general anesthesia. Doctors use a course of ECT

  1. if you have severe or life-threatening depression where your life is at risk so you need urgent treatment
  2. and to treat severe depression where there’s a lack of response or intolerance to medication.

I’d say it looks barbaric but ECT is said to be one of the fastest and most effective ways to relieve symptoms in severely depressed or suicidal people. Some people find ECT helpful while others don’t and repeated ECT is only recommended if you have previously responded well to it, or if all other options have been considered.

Back to the future

Dr Nga had dropped me off at the hospital and fortunately, although I had suicidal thoughts, the Consultant Psychiatrist and the Psychology team were confident that I had no intention of killing myself – I’d said even though I felt suicidal, I knew I couldn’t do that to my sons. I couldn’t possibly leave them with that legacy. So, no admission was necessary and three years of weekly painful, gut-wrenching counselling followed – on and off, because sometimes I was too afraid of myself and my responses to the psychologist. I didn’t want to hear what I had to say, so how would the counsellor feel?

I do hope you’ll continue to read My story, Part IV (The finale) which will follow shortly. You’ll learn about my suicide attempt and the hell I went through during my Psychotic Depression.  Thank you for staying with me.