"SO, WHAT is schizophrenia?" a 10-year-old I know asked on the way into the art store to buy an easel for her clubhouse.
I took inventory. Schizophrenia is a biological illness caused by excessive stimulation in one part of the brain, dismally balanced by deficits in another. It is not due to angry mothering. A virus may or may not be involved. Being born in certain months of the year seems to increase the risk. It is genetic and ruinous. According to the Diagnostic and Statistical Manual, that Blue Book of psychiatry, a number of specific symptoms must be met - delusions and/or hallucinations, and/or disorganized thought forms, and functional deterioration. Over half of all patients also have substance abuse, and many die prematurely. Most require numerous hospitalizations. Symptoms are fine-tuned by medications that cause their own problems. There is little to like about the illness and less about the treatment. Schizophrenia is a five-syllable diagnosis stamped on a patient's chart for life.
None of that seemed like the right answer.
So, I told her some stories - stories to those who hear them, lives to those who lead them. I told her about a man who ate only white foods, another man who doused his face with a plant sprayer to ward off the devil, a third man who spoke to visitors only in his language, which seemed to involve rhyming words that began with "ch," and a fourth who thought his eyeglasses were watching him. I told her about a woman who believed she was royalty from a different planet and another woman who thought her parents were impersonators trying to replace her true family.
Windows cracked, doors split open, and eyes peered out. I was remembering other faces now. The Diagnostic and Statistical Manual describes hallucinations and delusions, but it doesn't begin to describe how personal and particular they are. This is told best by those in their grip.
"There are people dead in the grave holding onto people still walking around," a patient said to me. "I have a different style of life view," said another. He was on his way from Pennsylvania to Colorado; over the years he had taken buses through 42 states trying to stay one step ahead of his voices. "Sometimes I go to a new place and they don't show up until the next day," he said. "But I know one thing. They never show up at 2 a.m." Why's that? I asked. "Because," he said, irritably, "they're sleeping."
But what is schizophrenia? The 10-year-old still wanted to know. She wasn't satisfied.
From the halls of a state hospital that closed 15 years ago, a face like Father Christmas looked out with an answer. He had lived there for a decade. He believed he was powered by a race-car quality engine (how many of us believe we are what we are not, only with lesser consequences?). He was undergoing an examination by the chief psychiatrist on the unit, who was teaching us youngsters how to diagnose.
"How are you?" the chief asked Father Christmas. (Open-ended inviting question.)
"Mediocre," he said.
"Tell me about yourself." (More of the same.)
"I'm 68 years old. I have 56 brothers in the Boer War."
"How old does that make you?" (Gently trying to point out absurdity.)
"I'm 200 years old."
"Is that crazy?" the doctor asked. (Humor.)
"No. I'm the
"OK," said the doctor. (Never question delusion.) "OK, can you tell us who the president is? "
"Absolutely not."
Father Christmas stood up and started walking. This was the question too insulting to tolerate. He turned at the door.
"I'm not neurotic, you know," he said.
That is schizophrenia; someone living with psychotic symptoms, enduring assured but unhelpful questions of experts who do not. It is easy to depersonalize on the one hand and romanticize on the other. It is pain, sly humor, dignity, and a world of insight on the head of a pin with no ability to control it.
This was conversation to have with the young artist at a future time, though, because for now her arms were filled with clubhouse supplies and she had probably heard about as much as she wanted to know.
Elissa Ely is a psychiatrist.
