First Person: Schizophrenia From the Inside Out

By Jack Bragen
Tuesday August 03, 2010 - 01:42:00 PM

Most Americans seem to view those who are mentally ill as a bit less than real human beings. After all, people with mental illnesses seem to lack basic social skills, may have poor grooming, and may come across to you as not having the same basic awareness that seems to make a person a whole person. That person smoking in front of a building and talking to himself might be one of them. That person sitting on a bench eating a sandwich while rocking her upper body forward and back also might be one of them. Mentally ill people might seem like a crude and ill-formed version of our species, a defect. 

Mentally ill people sometimes look and act differently from the un-afflicted. This is a catalyst for the myth that they don’t have basic emotions, including the capacity for suffering, and even the sentience, that is the birthmark of human beings. I’m here to say this is wrong. When people perceive other people as freaks, people get hurt. 

You may have seen a person on the street or elsewhere in the midst of experiencing psychosis. Such a person could be behaving in ways that people don’t understand, and may even be acting threatening. People may comment that such a person is dangerous and needs to be “put away.” The perspective of the one who has the illness never seems to be taken into account, especially by uninformed people who often don’t credit the mentally ill person as having a perspective. 

Some psychiatrists are among those with the least compassion for people with mental illnesses. Those few hurtful psychiatrists seem to assume the following: that the people they are treating aren’t capable of advanced thought; also that mentally ill people are stuck in perpetual psychological infancy; and that mentally ill people aren’t sentient. 

Living through a psychotic episode is a hellish experience. It is an experience that not all afflicted people survive, and one that’s just as difficult for family members as it is for the ill person. 

A young adult may suffer a psychotic episode at the onset of schizophrenic illness and may experience repeat episodes triggered by stress or by stopping anti-psychotic medication. 

The human brain is the organ in our bodies that allows a grasp of the environment. During a psychotic episode, the brain is literally out of order. A psychotic episode makes human consciousness disconnect from the actual environment, and creates a false, paranoid, and splintered pseudo-environment; generated internally. The afflicted person’s memory, both retrieval and storage, usually remains intact and functional. 

When I experienced psychotic episodes, to me it was as if the world had gone insane. My mind was playing tricks on me, to say the least. It is as if I had lived through nuclear Armageddon, or at times as if I had become “the devil” himself, at times believing I had become the successor of Jesus; at other times I believed I was an astronaut; at times I believed I was the subject of a giant experiment; at times I believed I was in telepathic communication with extraterrestrials. 

You might think that going through all of this fantasy would be a lot of fun. Yet, on the contrary, for me, a psychotic episode entailed massive and very deep pain. While it would be fun to watch all of that material on a movie screen, the belief that it was “for real,” generated by my malfunctioning brain, eliminated any enjoyment and made it a terrible ride. 

The above two paragraphs describe the most intense part of a psychotic episode. The beginning of a psychotic episode can be less intense and can include being more paranoid than usual. The subject begins to lose the insight that would otherwise make him or her question the reality of the delusional thoughts. At the beginning of the psychotic episode, the subject may still behave in a fairly “normal” way. 

When the subject returns to reality, and this may happen after being put into inpatient treatment, he or she begins to realize that he or she had just had a psychotic episode and that none of the “crazy events” were real after all. This can be a huge relief, and can also be a disappointment if some of the delusions were “false positives.” 

When I say “false positives” I am referring to someone falsely believing that they had won the lottery, or to the false belief that a romantically desired person also wanted the subject, or the belief the subject had that he or she was about to do something very important. 

During a psychotic episode, the subject’s behavior can appear crazy to other people. The person’s actions are guided by a false and disconnected version of reality, and as a result, a psychotic person’s actions are often strange and sometimes dangerous. If parts of the person’s brain are still “tracking” reality, it can serve as somewhat of a failsafe mechanism. 

(FYI: When I use the term “the subject,” or “a psychotic person,” it refers to either myself or to the millions of people who suffer from the same mental disease as I and who have gone through similar experiences. Use of detached terms can make the experiences easier to describe.) 

After recovery from a psychotic episode, most people who are afflicted with this disease will still suffer low-level symptoms, including delusions. These low level delusions can persist for decades, and can make attempts at having a normal life much more difficult. The low level delusions, which can often be hard to fully fix with medication, can often respond to other therapies. This can include things like “reality checking,” and other forms of cognitive therapy. 

The cognitive insight that I am capable of a delusion and my ability to pinpoint and correct delusions are traits that I have cultivated, and are my best protections from the disastrous results that are possible from acting on one. 

The tendency to have delusions is quite disabling and so are the medications that are used to reduce them. Delusions impair a person’s day-to-day grasp of their environment. The medications slow down the brain while making the body sluggish. This is part of the reason why it is very hard for a schizophrenic person to succeed in life. Living with this disease and its social stigma requires bravery.