MIND MOVES:Next time you hear the word schizophrenia, reflect for a moment . . ., writes Terry Lynch
THE ANNUAL conference of Schizophrenia Ireland takes place in Wexford next weekend. The theme of this year's conference is Recovery and the Family. This seems an appropriate time to explore schizophrenia, one of the least understood conditions across the entire health spectrum.
One in every 100 people becomes diagnosed with schizophrenia. For every diagnosed person, the lives of several others are dramatically changed, particularly family members.
Shrouded in mystery, stigma and ignorance, the very word schizophrenia can strike fear and dread within us. Ironically, terror and dread are among the most commonly felt experiences of people diagnosed with schizophrenia.
Many of us fear those so diagnosed, yet the majority of people diagnosed with schizophrenia are the most gentle people you could meet.
Contrary to popular perception, a split personality is not a characteristic of schizophrenia. The best known features include hallucinations, delusions, disordered thinking, paranoia and withdrawal.
However, an array of other lesser-known features are also ever-present characteristics of this condition.
These features include being regularly consumed by a sense of total overwhelm; ever-present terror; major loss of key aspects of self such as self-belief, self-confidence, self-expression, self-esteem, self-reliance and autonomy; colossal self-doubt; virtually absent willpower and motivation; massive passivity; depression; intense anxiety; enormous social awkwardness; great fear of risk including within relationships and social contact; terror of living; crisis of identity; no sense of belonging; little sense of being able to deal with the world effectively; profound helplessness, hopelessness and powerlessness; total lack of inner belief that one can change things or make life better for one's self; constantly feeling very unsafe; not being able to make one's self feel safe or protect one's self; greatly increased proneness to stress; totally stripped of one's defences.
In my experience, these features are central to the experience of schizophrenia. They provide invaluable clues towards a deeper under- standing of the better known features of schizophrenia, and of the nature and the experience which becomes diagnosed as schizophrenia.
One does not have to be a rocket scientist to grasp how difficult ordinary everyday life can be for people continuously experiencing the above.
Traditionally, schizophrenia has been interpreted as evidence of total loss of contact with reality, utterly irrational, beyond comprehension. However, many people diagnosed with schizophrenia, many support groups and carers believe with considerable conviction and justification that the symptoms of schizophrenia can have profound meaning, importance and purpose for the person.
My experience suggests that rather than having lost total contact with reality, many experience reality to be so harsh, so impossible to live and survive in, that they set about limiting their contact with everyday life.
They create interpretations and experiences of reality they can live with and tolerate, which do not overwhelm them as much as everyday reality continuously does.
Many seek safety, certainty and solace in daily rituals and rigid behaviour. Many of their experiences are outward projections of the lesser-known, inner-felt aspects of schizophrenia described above, particularly terror, overwhelm and powerlessness.
As time passes, many find themselves increasingly disconnected from the reality of much of everyday life including relationships, social situations, social interaction, the cut and thrust of life. Believing that these aspects of life are totally beyond them, many increasingly attempt to blot these out of their awareness, in a desperate attempt to reduce the pain associated with fully acknowledging their absence in their lives.
This results in complicated and convoluted constructs of life and living designed to create safety, minimise threats and reminders, difficult for others to understand but making perfect sense when seen from the person's perspective.
The withdrawal process often precedes better known features of schizophrenia by several years. The person subtly, silently increases their withdrawal, knowing no other way of dealing with and surviving even the ordinary challenges of everyday life.
In my experience, people with a truly solid sense of self generally do not develop schizophrenia. Schizophrenia often manifests at times of change which the person, having a very fragile sense of self, believes they cannot handle. Sometimes the perceived threatening change is obvious, such as leaving school, commencing college or work, leaving home.
Sometimes the change is more gradual and, therefore, less obvious to others though experienced as overwhelming by the individual, such as coping with adolescence, puberty, the challenge of becoming an independent adult, relating, peers, sexuality. It is no coincidence that the majority of presentations of schizophrenia occur in the teenage years and early 20s, the decade of greatest change in life.
Next time you hear the word schizophrenia, reflect for a moment before you pass judgment. Remember that at the heart of the experience of schizophrenia there is a person, a human being, who is typically experiencing enormous ongoing inner turmoil, shutting themselves off from the world as a frantic last-ditch act of self-protection, as seen from their perspective.
Next time you meet someone who has been diagnosed with schizophrenia, remember that they are far more scared of you than you are of them.
• Terry Lynch is a practising psychotherapist and GP in Limerick