"Well, you're usually on time for our appointments, but today you're 35 minutes late. I'm just wondering what might have happened."
James is quiet for several minutes. He finally lifts his eyes from the floor to gaze at the ceiling. "It was a bad day."
"A bad day?"
"I was laughing—at work. I had to leave in the middle of the day. They would have thought I was crazy." James speaks in a flat, monotone voice. Even while talking to his therapist, he keeps his eyes averted.
"When did you leave work?"
"And then what did you do?"
"I drove around. And I came here."
"It's 6:30, James. Our appointment was at 6:00. You've been driving around since 1:00 this afternoon?"
"Yes." After a pause James adds, "They told me not to come. They said I should never have come here in the first place—to you or Dr. Johnson. They said it was bad—I was bad. I told you too much. I should never have come."
Taken literally, schizophrenia means
"split mind." This "split" can be
understood as a split from reality,
as well as a split within the mind.
Throughout this conversation, James is unable to maintain eye contact. He sits slouched in the chair and barely moves until the session concludes. The "they" James refers to are voices that he began hearing in his head in his mid 20s. These voices influence and direct his daily activity. James believes these voices tell him important things that other people do not know. He feels he is special because of his contact with these voices. He thinks he is able to see into the future and have special and important knowledge. However, sometimes these voices terrify him. For example, a few years ago James found himself cutting his wrists in obedience to these voices. He said he did not want to hurt himself, but he felt unable to disobey the command.
Imagine the World of James
Imagine for a moment that you are James. You hear voices that no one else hears. These voices provide a running commentary (often judgmental) on your thoughts and activities. Sometimes the voices are quiet, but they are never completely silent. You hear them at night in bed. You hear them in the car. You hear them while you are at work. When having conversations with other people, you must struggle to distinguish the voices in your head from the voices of other people talking to you. If you tell people about the voices you are hearing, people think you're "crazy."
At times they are so loud you feel powerless and completely under their control. They are so loud, in fact, that you have trouble hearing cues in the real world. When someone speaks to you, you are unsure if they spoke out loud or if it was in your head. Because of the constant noise in your head, you have problems concentrating. You feel little control over your body. You find yourself laughing hysterically at work and in other places, but you don't know why. You see signs and symbols in everyday objects and activities. When women cross their legs, you think they're trying to seduce you. You become angry that all these women are trying to seduce you when the voices are commanding you to purify your body and your mind.
You have a therapy appointment that your doctor told you is essential if you want to stay out of the hospital, but you find yourself miles away from the clinic. You have been in and out of the hospital about twice a year for the last ten years. You do not want to be put in the hospital again. You are unsure how you ended up so far away from the clinic, because you have been going there for several years. You know you are supposed to go to the appointment, but the voices are telling you that you are stupid and will be hurt if you go. You don't know what to do. You are confused. You are terrified. You are suffering from the debilitating and chronic mental disorder known as schizophrenia—the disorder many claim is the most severe of mental disorders due to its dramatic impact on all areas of your intellectual, psychological, social, and spiritual life.
What is Schizophrenia?
Taken literally, schizophrenia means "split mind." This "split" can be understood as a split from reality, as well as a split within the mind. Schizophrenics unconsciously disown portions of their thoughts and feelings and imagine that those thoughts are located in someone else or some place else. The voices James hears, for example, seem to him to be coming from outside himself, but they actually originate within him. Because James "splits" off (disowns) these thoughts and attributes them to an external voice, they no longer feel like parts of himself. He is "split" from big portions of his mental world. At the same time, when James imagines that some of his thoughts are actually coming from the outside world, he splits off or separates himself from sizeable portions of external reality.
Contrary to how the media often portrays it, however, schizophrenia does not refer to split personalities or multiple personalities. Multiple Personality Disorder (now called Dissociative Identity Disorder) is not the same as schizophrenia, but is a much more rare disorder characterized by the presence of at least two distinct personality states within one individual. James splits off portions of his mind but he has not created additional personality states. Schizophrenia is a mental disorder characterized, not by multiple personality states, but by a cluster of psychotic symptoms. Psychosis generally refers to severe impairment in distinguishing what is real from what is not real.
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