Mental health and the world of a paranoid schizophrenic

By Vanessa Cort

ONCE again the topic of mental health has drawn global attention with the death by suicide of Twitch, a feature dancer on the widely watched American Ellen show, named after its host Ellen Degeneres.

This has come ‘on the heels’ of the local tragedy involving the young mother, who murdered her grandmother, and was subsequently diagnosed with postpartum depression (PPD).
And through the words of a cynical, humorous and brutally frank character, I recently gained insight into the world of a paranoid schizophrenic, who was undergoing treatment with an experimental drug.

Knowing my love of reading and my interest in mental health, my granddaughter lent me the novel, “Words on bathroom walls”, which received wide critical acclaim when it was published five years ago and has since been made into a major motion picture.

In this candid account of a teenage boy’s battle with the illness, writer, Julia Walton, explores the many facets of this debilitating condition with sensitivity and wit.
Indeed the young man, Adam, immediately reveals one of the quirks of the illness by refusing to speak to his therapist, preferring to write down random thoughts and the answers to imagined questions in a journal, which he then gives to the doctor.

However it soon becomes clear that his world is peopled by an array of characters and voices that no one else can see or hear but who seem very real to him, to the extent that he actually names some of them.

This made me immediately think of the people I have seen walking our streets, some of them clearly homeless, muttering, gesticulating and carrying on running conversations with ‘invisible’ friends, family members or even foes.

The people we often dismiss as ‘mad’ and here again, Adam, in his tongue-in-cheek way, says he prefers the word ‘crazy’ to the term ‘mental illness’, declaring that it has more “dignity”. Something akin to calling a spade, a spade, rather than using some concocted euphemism.

But this comment came from his desire to be ‘seen’ and understood, while poking fun at a society which he feels hides behind terminology that actually conceals fear and distrust.
Significantly, Adam’s ability to articulate and to cope with his illness, while leading a relatively ‘normal’ life, are a result of regular therapy sessions and the medication.

Psycom, a clinician site, talks about the positive and negative stages of schizophrenia – the former being hallucinations and delusions and the latter, which marks the onset of the illness, being social isolation, inability to pay attention and lack of motivation.

According to the site, “The paranoia in paranoid schizophrenia stems from delusions – firmly held beliefs that persist despite evidence to the contrary – and hallucinations – seeing or hearing things others do not.”

In the novel Adam not only named some of the ‘people’ he saw but described their behaviours. Prior to taking the medication he was sometimes able to recognise that these characters were not real, but was unable to control his reaction to them. He also felt compelled to respond to the voices even in the presence of other people.

As Psycom explains, “A patient may hear a voice or voices in their own head that they do not recognise as their own thoughts or internal voice”. These voices can be demeaning or hostile, driving a person to do things they would not do otherwise.

This was certainly true in Adam’s case as while some of his voices seemed to be empathetic others were very critical and disparaging of him telling him he was crazy, not worthy of living and a burden to his family, causing him to sometimes shout out loud or run away.

In addition he still had problems differentiating the real from the imagined, despite the medication, which had begun to lose its efficacy as his body became accustomed to it, and constantly berated himself for not being ‘normal’.

His condition was kept a secret from everyone but the governing body of the school he attended because at a previous school he was ostracized when others learned of his illness.
The stigma is real. People become fearful of persons with the illness, imagining them capable of all kinds of violent actions, fueled by the voices, or shuns them for what they perceive as ‘weird’ behaviour. And families have a hard time explaining a condition that they themselves do not fully understand.

What the book makes clear, however, is that the illness, while not curable is treatable, particularly when it is diagnosed early and the patient has the support of family and friends.
The Help Guide Organisation confirms, “Recognising the signs of schizophrenia in yourself or a loved one can be frightening. But with the right treatment and self-help you can manage the disorder and lead a fulfilling life”.

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