Columns

The term "decompensate" is offensive to me. I would guess it is also offensive to others to whom this word has been applied. However, for lack of a better word, deterioration of people who are subject to psychosis is a real potentiality, even though it is often preventable. 

It usually starts small, and then gradually worsens. You could start out having some thoughts that might be categorized as "obsessive-compulsive." This could include superstitious thoughts, or just unusual thoughts, which in some cases connect different events that are actually unrelated. 

{In the tradition of intellectualism, people should be allowed to have "unusual thoughts." Therefore, when dealing with psychiatric issues, sometimes a fine line must be walked, between having the freedom to contemplate, versus remaining mentally healthy and staying out of the hospital.} 

Sometimes it is very difficult to detect the beginnings of worsening psychosis. The delusional thoughts could be subtle, and could sneak their way past your detection. Often, the thoughts seem to hang around in peripheral consciousness. 

However, at some point these thoughts build up a bit, and begin to shape one's perceptions on a larger scale within the mind. At some point, delusions become assumptions. When this happens, we could be approaching the point of no return, and may need to get more help than we are getting. 

Deterioration in one's mental condition can take place over months, or even years. Or it could happen very fast, especially if there is a change in brain chemistry, caused either by stopping medication, or by ingesting an illicit drug. 

{If you have been taking antipsychotics for months or years, stopping them is a very bad idea. The backlash can have devastating effects on the brain.} 

However, it is important to realize that taking antipsychotics is not a guarantee of not becoming psychotic. We ought to have supports in place. Additionally, exercises can be done to clean out some of the erroneous thoughts. Unfortunately, I do not have room in this column to say very much about such exercises. However, I encourage journaling, in which you write out your thoughts onto paper. You can then look at them later, and you might see these thoughts from a different perspective. 

It is good to become more aware of thoughts, including those in peripheral consciousness, as well as subtle thoughts that often escape detection--thoughts that are the small beginnings of a big problem. You are better off, the sooner that you recognize problematic thoughts, the ones that are usually inaccurate and that have the potential to multiply. 

Treating and managing mental illness is the same as treating and managing any other chronic medical condition. People are under the erroneous impression that mental illness is not "medical." It is medical. The illness is treated with medicine, and it has its origins in a bodily organ. 

As with diabetes or heart disease, for example, treatment must be maintained to produce a better outcome. Diabetes, in more recent times, physicians are inclined to treat "aggressively" in order to minimize damage to the body from excessive blood glucose. Psychiatric conditions, if treated aggressively, allow the brain to be in better condition and this will cause the patient to do better in life. In this case, the term "aggressively" is roughly synonymous with proactively. 

No one can credibly claim that having schizophrenia is easy. Relapses often try to sneak up on us. I've been successful at avoiding complete relapses for a very long time. I've remained out of inpatient psychiatric wards since 1996. However, I have had partial spikes in symptoms, which I was able to get resolved, with help, on an outpatient basis. 

If you have severe schizophrenia, you must avoid arrogance and complacency. And, you must, on an ongoing basis, take care, in order to stop relapses before they happen.