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Saturday, February 16, 2008

Schizophrenia can be silent: Stephen Kazmierczak

The illness is, at the very least, quiet.

It is an illness that features psychosis, delusions and auditory or visual hallucinations, thoughts beyond reason (the FBI is listening into my conversations, or I actually AM G-d). It is a blurring of the boundary between what we think of as sensate reality, and thought.

One with this disorder has difficulty knowing with certainty where certain thoughts come from, the origins of voices, ideas. A person with paranoid schizophrenia might assign his or her own negative thoughts to another person in the same room, will assume that the other is thinking certain things, even saying things that have never been said.

It's very confusing, this cognitive dysfunction.

And people wonder why I don't get all excited when they say that they're forgetting things lately, that their cognitive functioning is a little off.

Try having schizophrenia.

Among the more disturbing features of severe paranoid schizophrenia are the delusions, which are never happy. It's not the kind of thing whereby the person thinks, Oh, yes! I just heard that I'm going to get that job! I heard it on the radio!

It's more like,
G-d told me that The World is Coming to an END and He ordered me to tell everyone. You're all, every last one of you, sinners.
It's about hearing voices that no one else can hear, seeing things that no one else can see.

And yet you know that others think you're crazy when you mention these events. Your logical conclusion? Don't talk about them. Don't tell others. This is obviously the topic that we don't talk about in company.

I believe that this is how it is in the initial phases of the illness. Later on you might become more boistrous, perhaps even an individual carrying a placard that says, The World is Coming to an End. But initially, before it gets too scary, before the voices in the head are irrepressible, before faces of others change into monsters, smiles into demonic raging, a person suffering from this type (paranoid) schizophrenia is likely to be incommunicative about the illness and what is going on his head.

Hallucinations are rare, but voices or delusional thoughts, usually obsessions with death, sin, violence, and knives, are more common in severe types of paranoid schizophrenia. It's no wonder that an individual haunted by voices or negative thoughts might pay attention to firearms.

A person with schizophrenia who is obsessed with death might inadvertently see guns, perhaps on a walk past a gun shop, or see weapons on television. The visual imagery triggers a voice or a thought, channels a message to acquire them. The mind says, Buy them. Buy the guns. Kill someone. Kill yourself. You are scum. You should die. And so should they.And the voice may not shut up. It is very painful.

And the guns, well, they're so plentiful!

A person who suffers from severe bi-polar (manic-depressive) disorder might also blur boundaries, reach the pale of psychosis. But we hear from them when they're depressed. They tell us how sad things are, how exhausting, how impossible. And we hear from them when floridly manic. They do not stop talking, words never stop, and the range of severity can be remarkable between episodes, remarkable between patients, too. Only the very few with this disorder have a compulsion to shoot off firearms, and that's often for the sheer stimulation, or when stressed to the maximum.

Policemen with this disorder have to be watched because they carry firearms. Of course, we could say that anyone with firearms should be watched. Anyone.

When people with bi-polar disorder get delusional, hear voices, or see things that no one else can see, we call the disorder schizo-affective disorder. Individuals with bi-polar disorder who manifest psychotic features like these really don't have bi-polar disorder at all. It may have seemed, perhaps, that they had bi-polar disorder, and the medications that work for bi-polar disorder worked for them at one time, but at some point during the course of the illness, the hard features of psychosis predominated.

Those who suffer with schizophrenia or schizo-affective disorder are often turned inward, much more-so even, than individuals suffering from the severe insular depressive withdrawal characteristic of unipolar depression or bi-polar disorder. But they can hold their own in the pre-morbid stages, fake being okay. And on medication, they are okay, or can be.

A person suffering from schizophrenia who has been treated successfully is just like you and me: thoughtful, caring, interested in people, life. Better than you and me, for this person has accepted a disability, suffered, worked to change, to rewire, so to speak.

How many times do you and I say, Oh, I have to change! But we don't. We don't hurt enough, you see.

In answer to those questions, when the symptoms of people with bi-polar disorder reach psychosis, when we call it schizo-affective, then yes, the disorder can be very dangerous. I couldn't tell you that Mr. Kazmierczak did not suffer from schizo-affective disorder, except that his tattoo, a tricycle in a pool of blood, indicates paranoid schizophrenia to me, not schizo-affective disorder.

I wonder if some people who present with bi-polar disorder that manifests under stress as schizo-affective disorder is really schizo-affective disorder, period. But the schizophrenic piece, the shattered ego that is definitive schizophrenia, is silent, predominantly, so it never captures attention. Then under marked stress, like skin stretched too far, it tears through the surface.

In severe paranoid schizophrenia the voices might say things like:
Don’t tell anyone else about us! Don’t tell anyone! We’re your only friends. Do what we say. Take that knife. Take it. Cut yourself. And then, when you are finished, cut . . .(name).

Shoot . . . (name). Get a gun and shoot. Shoot them all.
Yes, like in a horror movie.

The onset of schizophrenia is late adolescence, sometimes early adulthood.

The onset of Stephen Kazmierczak's mental illness seems to have been post-high school, coinciding perhaps with the stress of leaving home, facing college, or coping with social rejections or relationships.

His parents didn't cause it, unless you can blame genetics. They're not to blame for their parenting. They knew he was sick and sought treatment. He had been hospitalized for cutting, had an extended hospital stay. He could not be controlled at home, so he lived at Thresholds post-hospitalization, a half-way house for individuals suffering from psychotic disorders. Residents of half-way houses usually are no longer benefiting from the hospital (and it's too expensive) and cannot live at home. Yet they're not ready to be on their own. Too suicidal, usually.

It is very painful and very embarrassing to have this problem. You're not so different from anyone else in so many ways until you get really sick. Until you get really sick, you can study, you can learn. You understand social cues. You aim to please others, tell them what they want to hear, strive to do well in all that you do. People with the illness who haven't become very sick might harbor certain symptoms, negative feelings, might have a dreamlike grasp of reality. But they perform well, seem well to most everyone.

The first psychotic episode is news, and can be violent. It might be the voices or audible thoughts, ordering harm to one's self or others. It may be a tantrum. If it's voices that torment, they're not something that's necessarily or willingly talked about, shared with others. The negative thoughts, the paranoia, can keep a person up at night, all that noise in the head, yet one can’t tell others, won't tell others, won't talk about it, usually.

People with schizophrenia know that they suffer, but don’t want to tell anyone. They really can't tell anyone because it is so hard to put thoughts together, to put them into words, to perform socially. This is real illness.

Schizophrenia is a stress sensitive disorder. We try very hard to keep life quiet for people who suffer from it. We dial down the anger, the conflict, the worry, the problems of life. These patients are delicate. They’re sensitive. We think they have fractured egos.

What’s a fractured ego?

Your ego is you. It’s your identity. It’s who you say you are . I like ice cream. Ego. I can ride a bike. Ego. I can do well in school. Ego. I relate well to others. Ego. I don’t relate well to others. Still ego. I feel happy. Ego. I feel sad. Ego. I am a member of this family. Ego. I am voting for Hillary. Ego.

It's all about the "I" and it's definable. Can a person have too much? Too much ego really means conceit, or self-centeredness in our ordinary lexicon. But in the psychological lexicon, in some ways, no, a person can't have too much ego. It's good to be multi-faceted, complicated, complex, to have much identity, much that one can say is Me. Many skills, many ideas, many friends, relationships.

When the ego is fractured, the “I” is confused with the “I” of everyone around, even people who don’t exist, voices in a head are self. Who is it who is telling me these things if not me? Or they are my people, for sure, they're always with me. They're me.

Therapy is about gluing identity back together again, if that’s possible, and dissociating unwelcome people in that soup of identity.

A boy like Stephen Kazmierczak had an identity and lost it when he got sick. His parents missed him, I’m sure, the little boy that they knew. He “changed.”

You know that Seung-Hui Cho, the young man who murdered 33 people at Virginia Tech on April 16, 2007, was not autistic. He did not suffer from Asperger’s. He suffered from paranoid schizophrenia, although it does seem that he had his illness from early childhood, had childhood schizophrenia. You can find links to my posts on Mr. Cho if you scroll down at the sidebar, all the way down. It was a topic I had hoped to forget about.

So yes, we have another case of schizophrenia and another case of too many guns, too easy access to too many guns.

When, oh when, will our legislatures make it a crime to sell guns to individuals who have had a history of mental illness? When will they take people who sell guns to people who have suffered from mental illnesses and throw them in jail? Like they do with child molesters? It is a molestation, handing someone with schizophrenia a gun.

Someone please tell me this is changing. The face of schizophrenia is the same as it always has been.

And sure, Stephen Kazmierczak's crime could have been committed because he was angry, jilted by a girlfriend, perhaps. But how many people do you know who have been jilted by girlfriends who buy guns and attack an entire lecture hall of students? Has the face of anger suddenly changed?

People get angry. People stalk. People get violent. But THIS violent?

This is mental illness combined with guns. Guns kill people and they are accessible. We have to collect them and throw them all away.

therapydoc

21 comments:

Linda said...

My 34 year old cousin committed suicide due to his schizophrenia. He didn't want to take the meds prescribed to him. I'm wondering - are there a lot of side effects, or some other reason why one would not want to take these meds? And how well do the meds control the disorder?

therapydoc said...

Medication can have uncomfortable side-effects, very dry mouth, weight gain, fatigue, even more cognitive retardation. So it's not often fun.

But yes, it helps control the disorder. Getting the right drug, the right cocktail can be trying, though. I'm not an expert on it. Medication is the domain of psychiatry.

Leora said...

As someone who has had experience with psychiatric meds, although thankfully never for schizophrenia, there are a variety of subconscious reasons why one might go off meds. The side effects are only one. The point is, although meds may help someone get on the path to a more stable life, especially in combination with talk therapy, they are no cure-all, and we cannot depend on them to protect society.

Gun Control! Mental Health Education for Teens! said...

Thank you! In your previous post, you advocated for metal detectors as a defense against terrorism. I applaud your shift in this post to GUN CONTROL, in recognition that Mr. Kazmierczak was mentally ill, not a terrorist.

Gun control won't cure mental illness, but it goes a long way towards a safer society.

As for the problems of mental illness, education seems critical -- particularly directed at people who are high school-age and college-age. Awareness of both the signs/symptoms AND the resources available for help will save lives.

Please consider volunteering a small amount of time (once a month? once a semester?) to partner with other mental health professionals and with your local schools to educate students (teachers, and parents), raise awareness, and work toward prevention of yet another tragedy.

Thank you.

therapydoc said...

Gosh, what do I say? Sure, I'll try.

Anonymous said...

they treat md for sa and you dont know how hard it was to tell anyone about the voices and the people and etc up there...thankfully, It got too bad to hide and i had to talk about it and get treatment which has helped and my friends have helped immensely!

therapydoc said...

yeah, like the Beatles song :)

Anonymous said...

My older brother, only eleven months older than me, started exhibiting signs of schizophrenia in high school. We did not recognize it at the time since we are not mental health experts. We just thought "Joe" had some crazy ideas. Then he started using recreational drugs, marijuana, alcohol, LSD around the age of 19 or 20. Who knew?
His thoughts centered around UFOs, an extremely inflated sense of self, religion, sex and the government. He took off to California in his 20's and ended up living in a car.
Before he came back home, I was in nursing school in 1983. One day we were having a lecture on major mental illnesses and after that class I approached my dear friend and said, "Oh my God, she was describing my brother!" My fears became reality. A couple of years later he called home and requested bus fare to come home. I spent the next six months trying to convince my parents that "something is wrong with Joe." Dear mother was in complete denial, I guess the idea that one of her children was mentally ill was too much for her to handle at the time. Dad was easier to convince and tried to take Joe to the local mental health facility. On the way there, Joe asked my dad where he was taking him and when dad told him, Joe said that if my dad did not turn the car around and take him home, he would jump out of the car and they would never see him again. That was when Joe took the family hostage. He continued spiraling down further and further as the years passed by. I finally had to stop going over to my parents house, I described it as "it's an asylum and the inmates are running the place."
I remember a conversation with my folks, telling them that if they would not do anything about him, that I would have him committed after they died. I kept hoping that he would get himself in some trouble with the law so that he could get arrested and then perhaps he would get the help he needed.
After about 8 years of living with the disease, he aggressively confronted the rural mail man. In my brother's mind, the mail man was sneaking around my parents house with a shotgun, with the intention of killing them. This was not the first time he had such delusions towards innocent people. My parents finally realized that they had to do something and took the necessary steps to get him on a psych ward. They called me a day or so afterwards to tell me and my first response was, "Thank God."
I'll never forget the day my father was telling me about having to call the sheriff on my brother. It was the first and only time I have ever seen my father cry.
Now Joe goes in for his monthly injections. I'm not sure what meds he is on, he won't tell me. The side effects are devastating. Perhaps if he had gotten help sooner, he might have had a better chance.
Being the sibling of a schizophrenic is not fun. At times I wondered about myself. I brought my concerns up to my therapist at one point and he asked me, point blank, "Are you seeing things that are not there? Are you hearing voices?" To which I can thankfully reply, "No."
Another time my mother was blaming herself for all the mental illness that seems to run rampant in our family and I said to her, "You can't blame yourself for something that is genetic."
It is such a sad situation all around. My brother was/is a very intelligent man. He exists, nothing more.

therapydoc said...

Don't sell him out. They're (you know, them) doing great things with the brain. Within years there will be some kind of probe that will zap that paranoid spot and poof he'll feel just fine.

I think.

I really do. Just not sure when, exactly.

Beachwriter said...

I tend to read so many different things about schizophrenia and other mental illnesses. I just went to a mental illness conference and they stated that schizophrenias are not violent towards others or themselves.

Bipolars may hear things or hallucinate to some degree, but I don't think that they are capable of going into a psychotic episode and become sociopaths. Just my opinion:)

All of this is very sad and I truly don't think that any one has all the answers.

jeanie said...

My ex had PS - had because he died as a result of the disease several years ago.

I think a major reason he did not like the meds was that every time he finally had them, he was in a full psychotic state and therefore the meds were quite strong to knock him out.

A family friend has lived with the disease for 30+ years - her family call Christmas "mango season" because it seems to be that time of year that she goes off her meds and life becomes "tropical", but they and her are such a wonderful display of the fact that this disease can be managed - not always 100% successfully, but far better than not at all.

therapydoc said...

The people with schizophrenia that I treat are generally already taking medication. They're wonderful, if slightly anxious, and are able to see themselves realistically and talk about their illness.

So for sure it can be managed. Trickier for some than others, I guess.

I've had scary experiences when MAKING the diagnosis with a patient for the first time. That can be hard, feeling that pain and trying in vain to see inside very sick people, telling them that they're going to need a lot more help than this doc can provide on her own.
But once it's in control, it's a whole other matter, and very fascinating, but also very demanding.

chana said...

I recently read "The Center Cannot Hold" by Ellyn Saks - she's an academic in California living with schizophrenia. A very compelling story.

Brodmann's Area 25 - I would have that zapped in a heartbeat, if I could! Been saying that for years...

Liza's Eyeview said...

It's very interesting reading your post, as I am a B.S. Psychology major myself. It brought back memories of my "clinical psychology" classes. Sad, but true, schizophrenia is a very hard illness to have, for the patient and his whole family. This also reminded me to the movie "A Beautiful Mind"...

I agree, guns should not be sold to someone with background of mental illness... a dangerous combination.

Anonymous said...

you should do a post like living with or living with someone who has schizo-affective disorder.

therapydoc said...

Okay. But give me a few weeks.

The Stooge said...
This comment has been removed by a blog administrator.
Angie said...

I really, desperately, hope and pray that probe that will zap out the paranoid part is coming soon. I worry about my children - someday they will be adolescents, at risk of this terrible disease. As a parent, how in the world do you live through that? Watch helplessly as the wonderful child disappears?

Jack said...

When, oh when, will our legislatures make it a crime to sell guns to individuals who have had a history of mental illness?

Theoretically a background check should show something, a red flag of some sort.

But I suspect that it is often hidden, news of the illness that is.

A.Decker said...

Not to dismiss the horror and sadness that prompted this one, but I really...'relish' might be the word, when you give us details on specific disorders. My mind feels healthier for taking in this information.

Also, I love that the first thing you said to anonymous with the older brother is 'don't sell him out.'

You usually make me laugh, Doc, but when you don't, you move me with your caring. Whatever you do, please don't pull all the way back from your computer, eh?(re:the next post)

~Cheers! I'll be back.

Anonymous said...

Having one of the diagnosis mentioned, I do agree with the gun control. However, it should be noted that I lived most all my life with them available in the house and never had a problem. My brother, however, who was not diagnosed with any mental disease, is highly abusive (psychological). He took great care to get door locked to the closet where they were located. A closet I had gone into for years to pick up clothes to wash or to clean. Better look within the family structure and not just at the person diagnosed. Oh, by the way, I had been diagnosed for years, and yes, extremely high functioning-something most in this small southern town can't seem to get their head around. (I've moved out and after much greiving am moving out of the area).