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.

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