Schizophrenia


Schizophrenia

Sarah Hill
Joanie Panganiban
Definition and Introduction to Schizophrenia
Definition: Devastating psychotic disorder that may involve characteristic disturbances in thinking (delusions), perception (hallucinations), speech, emotions and behavior. It is an altered sense of reality displayed by inconsistency in mental functions and expected actions. Schizophrenia is a disturbance represented by many different causes and symptoms that result in a wide variety of clinical manifestations.
Introduction to Population: Schizophrenia is a cyclical mental disorder that most commonly manifests itself in early adulthood, between the ages 18-30. It affects men and women of all races equally. The word schizophrenia comes from the root words Schizo, meaning to split, and Phrene, meaning mind. Popular belief is that schizophrenia is split personality or multiple personality, but in fact it is not. Split mind just refers to a disruption of the usual balance of emotions and thinking. 1% of the population is diagnosed with schizophrenia.
*Causes: There is no proven known cause for schizophrenia, but there are several theories to explain it.
Diagnosis
The diagnostic criteria from the DSM-IV states:
A.      2 or more of the following each present for a significant portion of time for a 1 month period.
1.      Delusions
2.      Hallucinations
3.      Disorganized speech (frequent derailment or incoherence)
4.      Grossly disorganized or catatonic behavior
5.      Negative symptoms (affective flattening, alogia, avolition)
B.      Social/occupational dysfunction – in one or more major areas of functioning such as work, interpersonal relations, or self care
C.      Duration – continuous signs of the disturbance persist for at least 6 months
Diagnosing a person with schizophrenia should be done by a licensed mental health professional. It is usually done by interview of the patient and their family. Other illnesses need to be ruled out, as sometimes people suffer from severe mental schizophrenia symptoms or even psychosis due to undetected underlying medical conditions. Before reaching a diagnosis of schizophrenia, a medical history must be taken and a physical examination and laboratory tests are required to rule out other possible causes. As commonly misused substances or drugs can cause schizophrenia-like symptoms, blood or urine samples should be tested for the presence of these drugs.
Having excluded other causes, the doctor then needs to make a diagnosis based solely on the symptoms observed in the patient and reported by the patient and his/her family. This can lead to problems and delays because many symptoms may not be obvious until the illness is relatively advanced.
Source: Firth, C., & Johnstone, E. (2003). Schizophrenia: A Very Short Introduction. New York; Oxford University Press, Inc.
Causes: There is no exact known cause for schizophrenia. There are theories and ideas about why it happens and who is affected, but nothing solidly known.
Genes – are responsible for making some individuals vulnerable- no one gene is responsible, rather, thousands of gene variances combine to produce vulnerability
Dopamine theory – dopamine system is too active
Brain Abnormality – enlarged ventricles and less active frontal lobe
Prenatal and Perinatal – fetal exposure to viral infection (influenza), pregnancy complications (bleeding), delivery complications (asphyxia or lack of oxygen)
Environmental stress may trigger the expression of the disorder
Characteristics/Symptoms
There are different kinds of symptoms that people with schizophrenia can have.
Positive Symptoms:
·         Delusions: false beliefs or thoughts
o   Paranoid delusions – delusions of perdecution, for example believing that people are “out to get you”, or the thought that people are doing things when there is no external evidence that such things are taking place.
o   Delusions of reference – when things in the environment seem to be directly related to you even though they are not. For example it may seem as if people are talking about you or special personal messages are being somunicated to you through the TV, radio, or other media.
o   Somatic Delusions – false belifs about your body. For example that a terrible physical illness exists or that something foreign is inside or passing through your body.
o   Delusions of grandeur – For example when you believe that you are very special or have special powers or abilities. An example of a grandiose delusion is thinking you are a famous rock star.
·         Hallucinations
o   Visual – seeing things that are not there or that other people cannot see
o   Auditory – hearing voices that other people cannot hear
o   Tactile – feeling things that other people do not feel or something touching your skin that is not there
o   Olfactory – smelling things that other people cannot smell or not smelling the same thing that other people do smell
o   Gustatory – tasting things that are not there
·         Neologisms – making up words that have no meaning
·         Feeling under constant surveillance
Negative Symptoms:
·         Lack of self confidence
·         Colorless speaking tones
·         Inappropriate reactions to events (such as laughing hysterically over a loss)
·         A general loss of interest in life andn the ability to experience pleasure
·         Flat affect: no emotion
·         Catatonic behavior
·         Loss of hygiene
Cognitive Impairment:
·         Disordered thinking – thoughts jump between unrelated subjects
·         Trouble concentrating
·         Difficulty remembering simple tasks
Affective (Mood) Symptoms:
·         Depression accounting for a very high suicide rate
There are four different types of schizophrenia:
Paranoid
·         Anxiety, anger, argumentative
·         Falsely believe others are trying to harm them, out to get them or their loved ones
·         Delusions and auditory hallucinations
·         Relatively normal intellectual functioning
·         Being some other person
Disorganized
·         Trouble thinking and expressing ideas
·         Childlike behavior
·         Little emotion – flat affect
·         Bizarre behavior – Ex. Laughing when a stop light changes color
·         Disorganized behavior distracts from other activities of daily life
Catatonic
·         State of unrest or vey inactive
·         Rigid posture
·         Odd facial expressions, grimace
·         Less responsive to others
·         Cannot take care of themselves
Residual
·         Has experienced one or more symptoms before, but now has less symptoms
·         May be in “remission”
Prognosis/Progression:
There is no known cure for Schizophrenia. Fortunately, there are effective treatments that can reduce symptoms, decrease the likelihood that new episodes of psychosis will occur, shorten the duration of psychotic episodes, and in general, offer the majority of people suffering from schizophrenia the possibility of living more productive and satisfying lives. With the proper medications and supportive counseling, the ability of schizophrenic persons to live and function relatively well in society is excellent. The outlook for these patients is optimistic.
Ten years after initial diagnosis, approximately fifty percent of people diagnosed with schizophrenia are either noted to be completely recovered or improved to the point of being able to function independently. Twenty five percent are improved, but require a strong support network, and an additional fifteen percent remain unimproved and are typically hospitalized. Unfortunately, ten percent of the affected population sees no way out of their pain except through death and ends up committing suicide. Long-term statistics for thirty years after diagnosis are similar to the ten year mark, except that there are even more people who improve to become independent. However, there is also an increase in the number of suicides to fifteen percent. Over time, women appear to have a better chance at sustaining recovery from symptoms than do men.
It is an unfortunate fact that people with schizophrenia attempt suicide more frequently than do people in the general population. This may occur for many reasons, including fears and anxieties associated with psychosis or depression and hopeless feelings that may occur when it is realized that a serious, chronic and life-changing disease has occurred. It is always difficult to predict which people are serious suicide risks, and this is the case for the schizophrenic population as well. While people in the general population talk about suicide from time to time, professional mental health help should be sought right away for people (schizophrenic or otherwise) who make a habit of discussing suicide, who express any sort of plan to commit suicide, who stockpile pills, tools (rope, razors) or weapons for the purpose of suicide or self-harm, or who act out a suicide or self-harm plan, however half-heartedly. The impulse to suicide is most always a temporary crisis that can be overcome with time and proper care. Given the right treatment, the chance for a reasonably balanced life is good.

Treatment
Because the causes of schizophrenia are still unknown, treatments focus on eliminating the symptoms of the disease. Treatments include antipsychotic medications and various psychosocial treatments.
Antipsychotic medications
Antipsychotic medications have been available since the mid-1950's. The older types are called conventional or "typical" antipsychotics. Some of the more commonly used typical medications include:
  • Chlorpromazine (Thorazine)
  • Haloperidol (Haldol)
  • Perphenazine (Etrafon, Trilafon)
  • Fluphenazine (Prolixin).
In the 1990's, new antipsychotic medications were developed. These new medications are called second generation, or "atypical" antipsychotics.
One of these medications, clozapine (Clozaril) is an effective medication that treats psychotic symptoms, hallucinations, and breaks with reality. But clozapine can sometimes cause a serious problem called agranulocytosis, which is a loss of the white blood cells that help a person fight infection. People who take clozapine must get their white blood cell counts checked every week or two. This problem and the cost of blood tests make treatment with clozapine difficult for many people. But clozapine is potentially helpful for people who do not respond to other antipsychotic medications.19
Other atypical antipsychotics were also developed. None cause agranulocytosis. Examples include:
  • Risperidone (Risperdal)
  • Olanzapine (Zyprexa)
  • Quetiapine (Seroquel)
  • Ziprasidone (Geodon)
  • Aripiprazole (Abilify)
  • Paliperidone (Invega).
When a doctor says it is okay to stop taking a medication, it should be gradually tapered off, never stopped suddenly.
What are the side effects?
Some people have side effects when they start taking these medications. Most side effects go away after a few days and often can be managed successfully. People who are taking antipsychotics should not drive until they adjust to their new medication. Side effects of many antipsychotics include:
  • Drowsiness
  • Dizziness when changing positions
  • Blurred vision
  • Rapid heartbeat
  • Sensitivity to the sun
  • Skin rashes
  • Menstrual problems for women.
Atypical antipsychotic medications can cause major weight gain and changes in a person's metabolism. This may increase a person's risk of getting diabetes and high cholesterol.20A person's weight, glucose levels, and lipid levels should be monitored regularly by a doctor while taking an atypical antipsychotic medication.
Typical antipsychotic medications can cause side effects related to physical movement, such as:
  • Rigidity
  • Persistent muscle spasms
  • Tremors
  • Restlessness.
Long-term use of typical antipsychotic medications may lead to a condition called tardive dyskinesia (TD). TD causes muscle movements a person can't control. The movements commonly happen around the mouth. TD can range from mild to severe, and in some people the problem cannot be cured. Sometimes people with TD recover partially or fully after they stop taking the medication.
TD happens to fewer people who take the atypical antipsychotics, but some people may still get TD. People who think that they might have TD should check with their doctor before stopping their medication.
How are antipsychotics taken and how do people respond to them?
Antipsychotics are usually in pill or liquid form. Some anti-psychotics are shots that are given once or twice a month.
Symptoms of schizophrenia, such as feeling agitated and having hallucinations, usually go away within days. Symptoms like delusions usually go away within a few weeks. After about six weeks, many people will see a lot of improvement.
However, people respond in different ways to antipsychotic medications, and no one can tell beforehand how a person will respond. Sometimes a person needs to try several medications before finding the right one. Doctors and patients can work together to find the best medication or medication combination, as well as the right dose.
Some people may have a relapse-their symptoms come back or get worse. Usually, relapses happen when people stop taking their medication, or when they only take it sometimes. Some people stop taking the medication because they feel better or they may feel they don't need it anymore. But no one should stop taking an antipsychotic medication without talking to his or her doctor. When a doctor says it is okay to stop taking a medication, it should be gradually tapered off, never stopped suddenly.
How do antipsychotics interact with other medications?
Antipsychotics can produce unpleasant or dangerous side effects when taken with certain medications. For this reason, all doctors treating a patient need to be aware of all the medications that person is taking. Doctors need to know about prescription and over-the-counter medicine, vitamins, minerals, and herbal supplements. People also need to discuss any alcohol or other drug use with their doctor.
To find out more about how antipsychotics work, the National Institute of Mental Health (NIMH) funded a study called CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness). This study compared the effectiveness and side effects of five antipsychotics used to treat people with schizophrenia. In general, the study found that the older typical antipsychotic perphenazine (Trilafon) worked as well as the newer, atypical medications. But because people respond differently to different medications, it is important that treatments be designed carefully for each person. More information about CATIE is on theNIMH website.
Psychosocial treatments
Psychosocial treatments can help people with schizophrenia who are already stabilized on antipsychotic medication. Psychosocial treatments help these patients deal with the everyday challenges of the illness, such as difficulty with communication, self-care, work, and forming and keeping relationships. Learning and using coping mechanisms to address these problems allow people with schizophrenia to socialize and attend school and work.
Patients who receive regular psychosocial treatment also are more likely to keep taking their medication, and they are less likely to have relapses or be hospitalized. A therapist can help patients better understand and adjust to living with schizophrenia. The therapist can provide education about the disorder, common symptoms or problems patients may experience, and the importance of staying on medications. For more information on psychosocial treatments, see the psychotherapies section on the NIMH website.
Illness management skills. People with schizophrenia can take an active role in managing their own illness. Once patients learn basic facts about schizophrenia and its treatment, they can make informed decisions about their care. If they know how to watch for the early warning signs of relapse and make a plan to respond, patients can learn to prevent relapses. Patients can also use coping skills to deal with persistent symptoms.
Integrated treatment for co-occurring substance abuse. Substance abuse is the most common co-occurring disorder in people with schizophrenia. But ordinary substance abuse treatment programs usually do not address this population's special needs. When schizophrenia treatment programs and drug treatment programs are used together, patients get better results.
Rehabilitation. Rehabilitation emphasizes social and vocational training to help people with schizophrenia function better in their communities. Because schizophrenia usually develops in people during the critical career-forming years of life (ages 18 to 35), and because the disease makes normal thinking and functioning difficult, most patients do not receive training in the skills needed for a job.
Rehabilitation programs can include job counseling and training, money management counseling, help in learning to use public transportation, and opportunities to practice communication skills. Rehabilitation programs work well when they include both job training and specific therapy designed to improve cognitive or thinking skills. Programs like this help patients hold jobs, remember important details, and improve their functioning.21,22,23
Family education. People with schizophrenia are often discharged from the hospital into the care of their families. So it is important that family members know as much as possible about the disease. With the help of a therapist, family members can learn coping strategies and problem-solving skills. In this way the family can help make sure their loved one sticks with treatment and stays on his or her medication. Families should learn where to find outpatient and family services.
Cognitive behavioral therapy. Cognitive behavioral therapy (CBT) is a type of psychotherapy that focuses on thinking and behavior. CBT helps patients with symptoms that do not go away even when they take medication. The therapist teaches people with schizophrenia how to test the reality of their thoughts and perceptions, how to "not listen" to their voices, and how to manage their symptoms overall. CBT can help reduce the severity of symptoms and reduce the risk of relapse.
Self-help groups. Self-help groups for people with schizophrenia and their families are becoming more common. Professional therapists usually are not involved, but group members support and comfort each other. People in self-help groups know that others are facing the same problems, which can help everyone feel less isolated. The networking that takes place in self-help groups can also prompt families to work together to advocate for research and more hospital and community treatment programs. Also, groups may be able to draw public attention to the discrimination many people with mental illnesses face.
Once patients learn basic facts about schizophrenia and its treatment, they can make informed decisions about their care.
Since schizophrenia may not be a single condition and its causes are not yet known, current treatment methods are based on both clinical research and experience. These approaches are chosen on the basis of their ability to reduce the symptoms of schizophrenia and to lessen the chances that symptoms will return.
Medication for the Treatment of Schizophrenia
Antipsychotic medications have been available since the mid-1950s. They have greatly improved the outlook for individual patients. These medications reduce the psychotic symptoms of schizophrenia and usually allow the patient to function more effectively and appropriately. Antipsychotic drugs are the best treatment now available, but they do not “cure” schizophrenia or ensure that there will be no further psychotic episodes. The choice and dosage of medication can be made only by a qualified physician who is well trained in the medical treatment of mental disorders. The dosage of medication is individualized for each patient, since people may vary a great deal in the amount of drug needed to reduce symptoms without producing troublesome side effects.

The large majority of people with schizophrenia show substantial improvement when treated with antipsychotic drugs. Some patients, however, are not helped very much by the medications and a few do not seem to need them. It is difficult to predict which patients will fall into these two groups and to distinguish them from the large majority of patients who do benefit from treatment with antipsychotic drugs.

A number of new antipsychotic drugs (the so-called “atypical antipsychotics”) have been introduced since 1990. The first of these, clozapine (Clozaril�), has been shown to be more effective than other antipsychotics, although the possibility of severe side effects – in particular, a condition called agranulocytosis (loss of the white blood cells that fight infection) – requires that patients be monitored with blood tests every one or two weeks. Even newer antipsychotic drugs, such as risperidone (Risperdal�) and olanzapine (Zyprexa�), are safer than the older drugs or clozapine, and they also may be better tolerated. They may or may not treat the illness as well as clozapine, however. Several additional antipsychotics are currently under development.

Antipsychotic drugs are often very effective in treating certain symptoms of schizophrenia, particularly hallucinations and delusions; unfortunately, the drugs may not be as helpful with other symptoms, such as reduced motivation and emotional expressiveness. Indeed, the older antipsychotics (which also went by the name of “neuroleptics”), medicines like haloperidol (Haldol�) or chlorpromazine (Thorazine�), may even produce side effects that resemble the more difficult to treat symptoms. Often, lowering the dose or switching to a different medicine may reduce these side effects; the newer medicines, including olanzapine (Zyprexa�), quetiapine (Seroquel�), and risperidone (Risperdal�), appear less likely to have this problem. Sometimes when people with schizophrenia become depressed, other symptoms can appear to worsen. The symptoms may improve with the addition of an antidepressant medication.

Patients and families sometimes become worried about the antipsychotic medications used to treat schizophrenia. In addition to concern about side effects, they may worry that such drugs could lead to addiction. However, antipsychotic medications do not produce a “high” (euphoria) or addictive behavior in people who take them.

Another misconception about antipsychotic drugs is that they act as a kind of mind control, or a “chemical straitjacket.” Antipsychotic drugs used at the appropriate dosage do not “knock out” people or take away their free will. While these medications can be sedating, and while this effect can be useful when treatment is initiated particularly if an individual is quite agitated, the utility of the drugs is not due to sedation but to their ability to diminish the hallucinations, agitation, confusion, and delusions of a psychotic episode. Thus, antipsychotic medications should eventually help an individual with schizophrenia to deal with the world more rationally.













TR Implications
Therapeutic Recreation contributes to the recovery of individuals who experience developmental, cognitive, emotional, social, or physical difficulties.
Recreation Therapists help patients figure out "what do you do for fun, and how can we help you get those things back into your life?"
Individuals with Schizophrenia need to develop appropriate behavior. People with Schizophrenia experience disruptions in social skills, work, hygiene, daily living skills, recreation, and leisure skills. Thereaputic Recreation is one that helps with people with Schizophrenia. TR Interventions have many benefits, such as, an outlet for hostility and other emotions such as depressed feelings and anxiety.  TR also helps develop social skills, independence, new skills and interests, and individual and group decision-making. TR lessens symptoms  and improves the physical, emotional , and mental health status of individuals.
Individuals with schizophrenia experience disruptions in different areas of functioning such as social skills, work, hygiene, daily living skills, recreation, and leisure skills. Therapeutic Recreation Specialists can provide opportunities for clients to practice living normally and help them develop appropriate behaviors for daily living. TR benefits include an outlet for emotions such as depression or anxiety, developing new social skills, independence, improvement of self-image, and an improvement of daily living and quality of life.
Basic Suggestions for TR:
-          Be aware of the clients current medications
-          Encourage family support
-          Group involvement/support groups
-          Community involvement
-          Life Skills (Job training, money management skills, social skills trainging)
-          Vocational counseling
Specific suggestions for TR:
-          Active activities: exercise, sports, walking, running, dancing, etc.
-          Passive activities: table games, discussing current events, etc.
Benefits of both active and passive activities include increase in verbal and informal conversation skills improved problem solving and decision making skills, reduction of negative thoughts, and limited feelings of depression.
*Remember: always get to know the client’s individual interests and skills (strengths and weaknesses).
Source: Fall 2011 Schizophrenia packet.

Resources
National Institute of Mental Health
This website provides information about what Schizophrenia is, the signs and symptoms, treatments, and statistics. There are many links on this site that connect to different aspects of schizophrenia.
National Alliance on Mental Illness
There is a link on this site to a new brochure on schizophrenia. The brochure is very informative and encouraging for people who are diagnosed with schizophrenia and their families.
Schizophrenics Anonymous
This is a support group for people dealing with schizophrenia. To find the closest group contact your local Mental Health America affiliate or you local NAMI.
Utah State Hospital
1300 East Center Street
Provo, UT 84604
Phone: (801)344-4400
Fax: (801) 344-4225
Email: jgierisch@utah.gov

Personal Account
Floating In Anchorless Reality
Coping, Recovery
Schizophrenia – Floating In An Anchorless Reality
by Janet Jordan
Schizophrenia Bulletin, Volume 21, No. 3, 1995
First Person Account series
The schizophrenic experience can be a terrifying journey through a world of madness no one can understand, particularly the person traveling through it. It is a journey through a world that is deranged, empty, and devoid of anchors to reality. You feel very much alone. You find it easier to withdraw than cope with a reality that is incongruent with your fantasy world. You feel tormented by distorted perceptions. You cannot distinguish what is real from what is unreal. Schizophrenia affects all aspects of your life. Your thoughts race and you feel fragmented and so very alone with your “craziness.”
My name is Janet Jordan. I am a person with schizophrenia. I am also a college graduate with 27 hours toward a master’s degree. I have published three articles in national journals and hold a full-time position as a technical editor for a major engineering/technical documentation corporation.
I have suffered from this serious mental illness for over 25 years. In fact, I can’t think of a time when I wasn’t plagued with hallucinations, delusions, and paranoia. At times, I feel like the operator in my brain just doesn’t get the message to the right people. It can be very confusing to have to deal with different people in my head. When I become fragmented in my thinking, I start to have my worst problems. I have been hospitalized because of this illness many times, sometimes for as long as 2 to 4 months.
I guess the moment I started recovering was when I asked for help in coping with the schizophrenia. For so long, I refused to accept that I had a serious mental illness. During my adolescence, I thought I was just strange. I was afraid all the time. I had my own fantasy world and spent many days lost in it.
I had one particular friend. I called him the “Controller.” He was my secret friend. He took on all of my bad feelings. He was the sum total of my negative feelings and my paranoia. I could see him and hear him, but no one else could.
The problems were compounded when I went off to college. Suddenly, the Controller started demanding all my time and energy. He would punish me if I did something he didn’t like. He spent a lot of time yelling at me and making me feel wicked. I didn’t know how to stop him from screaming at me and ruling my existence.
It got to the point where I couldn’t decipher reality from what the Controller was screaming. So I withdrew from society and reality. I couldn’t tell anyone what was happening because I was so afraid of being labeled as “crazy.” I didn’t understand what was going on in my head. I really thought that other “normal” people had Controllers too.
While the Controller was his most evident, I was desperately trying to make it in society and through college to earn my degree. The Controller was preventing me from coping with even everyday events. I tried to hide this illness from everyone, particularly my family. How could I tell my family that I had this person inside my head, telling me what to do, think, and say?
However, my secret was slowly killing me. It was becoming more and more difficult to attend classes and understand the subject matter. I spent most of my time listening to the Controller and his demands. I really don’t know how I made it through college, much less how I graduated cum laude. I think I made it on a wing and a prayer. Then, as I started graduate school, my thinking became more and more fragmented. One of my psychology professors insisted that I see a counselor at the college. Well, it appeared that I was more than he could handle, so I quit seeing him.
Since my degree is in education, I got a job teaching third grade. That lasted about 3 months, and then I ended up in a psychiatric hospital for 4 months. I just wasn’t functioning in the outside world. I was very delusional and paranoid, and I spent much of my time engrossed with my fantasy world and the Controller.
My first therapist tried to get me to open up, but I have to admit that I didn’t trust her and couldn’t tell her about the Controller. I was still so afraid of being labeled “crazy.” I really thought that I had done something evil in my life and that was why I had this craziness in my head. I was deathly afraid that I would end up like my three paternal uncles, all of whom had committed suicide. I didn’t trust anyone. I thought perhaps I had a special calling in life, something beyond normal. Even though the Controller spent most of the time yelling his demands, I think I felt blessed in some strange way.
I felt above normal. I think I had the most difficulty accepting the fact that the Controller was only in my world and not in everyone else’s world. I honestly thought that everyone could see and hear him. It progressed to where I thought the world could read my mind and that everything I imagined was being broadcast to the entire world. I would walk around paralyzed with fear that the hallucinations were real and the paranoia was evident to everyone.
My psychosis was present at all times. At one point, I would look at my coworkers and their faces would become distorted. Their teeth looked like fangs ready to devour me. Most of the time I couldn’t trust myself to look at anyone for fear of being swallowed. I had no respite from the illness. Even when I tried to sleep, the demons would keep me awake, and at times I would roam the house searching for them.
I was being consumed on all sides whether I was awake or asleep. I felt like I was being consumed by the demons. I couldn’t understand what was happening to me. How could I convince the world that I wasn’t ill, wasn’t crazy? I couldn’t even convince myself. I knew something was wrong, and I blamed myself. None of my siblings have this illness, so I believed I was the wicked one.
I felt like I was running around in circles, not going anywhere but down into the abyss of “craziness.” I couldn’t understand why I had been plagued with this illness. Why would God do this to me? Everyone around me was looking to blame someone or something. I blamed myself. I was sure it was my fault because I just knew I was wicked. I could see no other possibilities.
In the hospital, every test known to man was run on me. When the psychiatrist said I had paranoid schizophrenia, I didn’t believe him. What did he know? He didn’t know me. He was just guessing. I was certain he was trying to trick me into believing those lies. Nevertheless, he did start me on an antipsychotic medicine and that was the first of many drugs I have been given over the years.
This first medicine was Thorazine, the granddaddy of all psychoactive medicines. I have also, at one time or another, tried Mellaril, Stelazine, Haldol, Loxitane, Prolixm, and Serentil, to name a few. These medicines seemed to work for a while, but the symptoms always came back and the side effects were not pleasant. Many times, though, I began to think my medicine was poisoning me, and I would quit taking it. Then, the “craziness” would return in full force.
I would usually end up in the hospital and, with more medication, doctors would stabilize the psychosis. I tried to commit suicide twice during these periods. I wanted to punish myself for having this devastating illness. The Controller was trying to ruin my life. He was making me miserable. Yet, I clung to him like a sinking ship, even though I felt like I was drowning, slowly but surely.
I was truly blessed when I started seeing my present therapist. I have been seeing him for the past 19 years. He has been the buoy in the raging waters of my mind. I was blessed again when I became the patient of my present psychiatrist. He has been taking care of me for over 16 years. They both have been my saviors. They have not hesitated to try new medicines and new approaches. No matter how bad things have been, they have always been there for me, pulling me back into the realm of sanity. They have saved my life more than once.
In fact, it was through them that I started taking Clozaril, a true miracle drug. It doesn’t have half the side effects that the other neuroleptics have, and I have done remarkably well on this medication. The only problem with this medicine is its extremely high cost, which is why most people with schizophrenia are not taking it. Fortunately, my medical insurance covers the high cost of this drug. In fact, my medical insurance has paid for all of my hospitalizations and treatment. Sometimes I get scared that they will drop me, but I choose not to dwell on this fear.
I do know that I could not have made it as far as I have today without the love and support of my family, my therapists, and my friends. It was their faith in my ability to overcome this potentially devastating illness that carried me through this journey. There are so many people with serious mental illnesses. We need to know that we, too, can be active participants in society. We do have something to contribute to this world, if we are only given the opportunity.
So many wonderful medications are now on the market, medications that allow us to be “normal.” It is up to us, people with schizophrenia, to be patient and to be trusting. We must believe that tomorrow is another day, perhaps one day closer to fully understanding schizophrenia, to knowing its cause, and to finding a cure.
Thank you very much for listening to me. It is my hope that I have been one more voice in the darkness – a darkness with a candle glimmering faintly, yet undying.

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