A schizophrenic's support system may come from several sources, including the family, a professional residential or day program provider, shelter operators, friends or roommates, professional case managers, churches and synagogues, and others. Because many patients live with their families, the following discussion frequently uses the term "family." However, this should not be taken to imply that families ought to be the primary support system.

There are numerous situations in which patients with schizophrenia may need help from people in their family or community. Often, a person with schizophrenia will resist treatment, believing that delusions or hallucinations are real and that psychiatric help is not required. At times, family or friends may need to take an active role in having them seen and evaluated by a professional. The issue of civil rights enters into any attempts to provide treatment. Laws protecting patients from involuntary commitment have become very strict, and families and community organizations may be frustrated in their efforts to see that a severely mentally ill individual gets needed help. These laws vary from State to State; but generally, when people are dangerous to themselves or others due to a mental disorder, the police can assist in getting them an emergency psychiatric evaluation and, if necessary, hospitalization. In some places, staff from a local community mental health center can evaluate an individual's illness at home if he or she will not voluntarily go in for treatment.

Sometimes only the family or others close to the person with schizophrenia will be aware of strange behavior or ideas that the person has expressed. Since patients may not volunteer such information during an examination, family members or friends should ask to speak with the person evaluating the patient so that all relevant information can be taken into account.

Ensuring that a person with schizophrenia continues to get treatment after hospitalization is also important. A patient may discontinue medications or stop going for follow-up treatment, often leading to a return of psychotic symptoms. Encouraging the patient to continue treatment and assisting him or her in the treatment process can positively influence recovery. Without treatment, some people with schizophrenia become so psychotic and disorganized that they cannot care for their basic needs, such as food, clothing, and shelter. All too often, people with severe mental illnesses such as schizophrenia end up on the streets or in jails, where they rarely receive the kinds of treatment they need.

Those close to people with schizophrenia are often unsure of how to respond when patients make statements that seem strange or are clearly false. For the individual with schizophrenia, the bizarre beliefs or hallucinations seem quite real - they are not just "imaginary fantasies." Instead of "going along with" a person's delusions, family members or friends can tell the person that they do not see things the same way or do not agree with his or her conclusions while acknowledging that things may appear otherwise to the patient.

It may also be useful for those who know the person with schizophrenia well to keep a record of what types of symptoms have appeared, what medications (including dosage) have been taken, and what effects various treatments have had. By knowing what symptoms have been present before, family members may know better what to look for in the future. Families may even be able to identify some "early warning signs" of potential relapses, such as increased withdrawal or changes in sleep patterns, even better and earlier than the patients themselves. Thus, the return of psychosis may be detected early and treatment may prevent a full-blown relapse. Also, by knowing which medications have helped and which have caused troublesome side effects in the past, the family can help those treating the patient to find the best treatment more quickly.

In addition to involvement in seeking help, family, friends, and peer groups can provide support and encourage the person with schizophrenia to regain his or her abilities. It is important that goals be attainable since a patient who feels pressured and/or repeatedly criticized by others will probably experience stress that may lead to a worsening of symptoms. Like anyone else, people with schizophrenia need to know when they are doing things right. A positive approach may be helpful and perhaps more effective in the long run than criticism. This advice applies to everyone who interacts with the person.

Antipsychotic drugs, like virtually all medications, have unwanted side effects along with their beneficial effects. During the early phases of antipsychotic drug treatment, patients may be troubled by side effects such as drowsiness, restlessness, muscle spasms, tremor, dry mouth, or blurring of vision. Most of these can be corrected by lowering the dosage or can be controlled by other medications. Different patients have different treatment responses and side effects of various antipsychotic drugs. A patient may do better with one drug than another.

The long-term side effects of antipsychotic drugs may pose a considerably more serious problem. Tardive dyskinesia (TD) is a disorder characterized by involuntary movements most often affecting the mouth, lips, and tongue, and sometimes the trunk or other parts of the body such as arms and legs. It occurs in about 15 to 20 percent of patients who have been receiving the older, "typical" antipsychotic drugs for many years, but TD can also develop in patients who have been treated with these drugs for shorter periods of time. In most cases, the symptoms of TD are mild, and the patient may be unaware of the movements.

Antipsychotic medications developed in recent years all appear to have a much lower risk of producing TD than the older, traditional antipsychotics. The risk is not zero, however, and they can produce side effects of their own such as weight gain. In addition, if given at too high of a dose, the newer medications may lead to problems such as social withdrawal and symptoms resembling Parkinson's disease, a disorder that affects movement. Nevertheless, the newer antipsychotics are a significant advance in treatment, and their optimal use in people with schizophrenia is a subject of much current research.

Another possible serious side effect of atypical antipsychotics is hyperglycemia and diabetes. Many schizophrenia patients taking antipsychotic drugs tend to gain weight and it's not known whether the antipsychotics cause diabetes or it could be that this patient population is already susceptible to type 2 diabetes. In either case, antipsychotic drug labels now carry a warning that glucose levels in patients should be monitored by a physician.

Antipsychotic medications reduce the risk of future psychotic episodes in patients who have recovered from an acute psychotic episode. Even with continued drug treatment, some people who have recovered will suffer relapses. Far higher relapse rates are seen when antipsychotic medication is discontinued. In most cases, it would not be accurate to say that continued drug treatment "prevents" relapses; rather, it reduces their intensity and frequency. The treatment of severe psychotic symptoms generally requires higher dosages than those used for maintenance treatment. If symptoms reappear on a lower dosage, a temporary increase in dosage may prevent a full-blown relapse.

Because relapse of schizophrenia is more likely when antipsychotic medications are discontinued or taken irregularly, it is very important that people with schizophrenia work with their doctors and family members to adhere to their treatment plan. Adherence to treatment refers to the degree to which patients follow the treatment plans recommended by their doctors. Good adherence involves taking prescribed antipsychotic medication at the correct dose and proper times each day, attending clinic appointments, and/or carefully following other treatment procedures. Treatment adherence is often difficult for people with schizophrenia, but it can be made easier with the help of several strategies and can lead to improved quality of life.

There are a variety of reasons why people with schizophrenia may not adhere to treatment. Patients may not believe they are ill and may deny the need for medication, or they may have such disorganized thinking that they cannot remember to take their daily medication doses. Family members or friends may not understand schizophrenia and may inappropriately advise the person with schizophrenia to stop treatment when he or she is feeling better. Physicians, who play an important role in helping their patients adhere to treatment, may neglect to ask patients how often they are taking their medications, or may be unwilling to accommodate a patient's request to change dosages or try a new treatment. Some patients report that side effects of the medications seem worse than the illness itself. Further, substance abuse can interfere with the effectiveness of treatment, leading patients to discontinue medications. When a complicated treatment plan is added to any of these factors, good adherence may become even more challenging.

Fortunately, there are many strategies that patients, doctors, and families can use to improve adherence and prevent worsening of the illness. Some antipsychotic medications, including Haldol (haloperidol), fluphenazine (Prolixin), perphenazine (Trilafon) and others, are available in long-acting injectable forms that eliminate the need to take pills every day. A major goal of current research on treatments for schizophrenia is to develop a wider variety of long-acting antipsychotics, especially the newer agents with milder side effects, which can be delivered through injection. Medication calendars or pillboxes labeled with the days of the week can help patients and caregivers know when medications have or have not been taken. Using electronic timers that beep when medications should be taken, or pairing medication taking with routine daily events like meals, can help patients remember and adhere to their dosing schedule. Engaging family members in observing oral medication taking by patients can help ensure adherence. In addition, through a variety of other methods of adherence monitoring, doctors can identify when pill taking is a problem for their patients and can work with them to make adherence easier. It is important to help motivate patients to continue taking their medications properly.

In addition to any of these adherence strategies, patient and family education about schizophrenia, its symptoms, and the antipsychotic medication is prescribed to treat the schizophrenia is an important part of the treatment process and helps support the rationale for good adherence.

Distorted Perceptions of Reality

People with schizophrenia may have perceptions of reality that are strikingly different from the reality seen and shared by others around them. Living in a world distorted by hallucinations and delusions, individuals with schizophrenia may feel frightened, anxious, and confused.

In part because of the unusual realities they experience, people with schizophrenia may behave very differently at various times. Sometimes they may seem distant, detached, or preoccupied and may even sit as rigidly as a stone, not moving for hours or uttering a sound. Other times they may move about constantly - always occupied, appearing wide-awake, vigilant, and alert.

Hallucinations and Illusions

Hallucinations and illusions are disturbances of perception that are common in people suffering from schizophrenia. Hallucinations are perceptions that occur without connection to an appropriate source. Although hallucinations can occur in any sensory form - auditory (sound), visual (sight), tactile (touch), gustatory (taste), and olfactory (smell) - hearing voices that other people do not hear is the most common type of hallucination in schizophrenia. Voices may describe the patient's activities, carry on a conversation, warn of impending dangers, or even issue orders to the individual. Illusions, on the other hand, occur when a sensory stimulus is present but is incorrectly interpreted by the individual.

Delusions

Delusions are false personal beliefs that are not subject to reason or contradictory evidence and are not explained by a person's usual cultural concepts. Delusions may take on different themes. For example, patients suffering from paranoid-type schizophrenia symptoms - roughly one-third of people with schizophrenia - often have delusions of persecution, or false and irrational beliefs that they are being cheated, harassed, poisoned, or conspired against. These patients may believe that they, or a member of the family or someone close to them, are the focus of this persecution. In addition, delusions of grandeur, in which a person may believe he or she is a famous or important figure, may occur in schizophrenia. Sometimes the delusions experienced by people with schizophrenia are quite bizarre; for instance, believing that a neighbor is controlling their behavior with magnetic waves; that people on television are directing special messages to them; or that their thoughts are being broadcast aloud to others.

Disordered Thinking

Schizophrenia often affects a person's ability to "think straight." Thoughts may come and go rapidly; the person may not be able to concentrate on one thought for very long and may be easily distracted, unable to focus attention.

People with schizophrenia may not be able to sort out what is relevant and what is not relevant to a situation. The person may be unable to connect thoughts into logical sequences, with thoughts becoming disorganized and fragmented. This lack of logical continuity of thought, termed "thought disorder," can make conversation very difficult and may contribute to social isolation. If people cannot make sense of what an individual is saying, they are likely to become uncomfortable and tend to leave that person alone.

Emotional Expression

People with schizophrenia often show "blunted" or "flat" affect. This refers to a severe reduction in emotional expressiveness. A person with schizophrenia may not show the signs of normal emotion, perhaps may speak in a monotonous voice, have diminished facial expressions, and appear extremely apathetic. The person may withdraw socially, avoiding contact with others; and when forced to interact, he or she may have nothing to say, reflecting "impoverished thought." Motivation can be greatly decreased, as can interest in or enjoyment of life. In some severe cases, a person can spend entire days doing nothing at all, even neglecting basic hygiene. These problems with emotional expression and motivation, which may be extremely troubling to family members and friends, are symptoms of schizophrenia - not character flaws or personal weaknesses.

Normal Versus Abnormal

At times, normal individuals may feel, think, or act in ways that resemble schizophrenia. Normal people may sometimes be unable to "think straight." They may become extremely anxious, for example, when speaking in front of groups and may feel confused, be unable to pull their thoughts together and forget what they had intended to say. This is not schizophrenia. At the same time, people with schizophrenia do not always act abnormally. Indeed, some people with the illness can appear completely normal and be perfectly responsible, even while they experience hallucinations or delusions. An individual's behavior may change over time, becoming bizarre if medication is stopped and returning closer to normal when receiving appropriate schizophrenia treatment.

Schizophrenia is found all over the world. The severity of the symptoms of schizophrenia and long-lasting, chronic pattern of schizophrenia often cause a high degree of disability. Medications and other treatments for schizophrenia, when used regularly and as prescribed, can help reduce and control the distressing symptoms of this psychotic illness. However, some people are not greatly helped by available treatments or may prematurely discontinue antipsychotic medication treatment because of unpleasant side effects or other reasons. Even when treatment is effective, persisting consequences of the illness - lost opportunities, stigma, residual symptoms, and medication side effects - may be very troubling.

The first signs of schizophrenia often appear as confusing, or even shocking, changes in behavior. Coping with the symptoms of schizophrenia can be especially difficult for family members who remember how involved or vivacious a person was before they became ill. The sudden onset of severe psychotic symptoms is referred to as an "acute" phase of schizophrenia. "Psychosis," a common condition in schizophrenia, is a state of mental impairment marked by hallucinations, which are disturbances of sensory perception, and/or delusions, which are false yet strongly held personal beliefs that result from an inability to separate real from unreal experiences. Less obvious symptoms, such as social isolation or withdrawal, or unusual speech, thinking, or behavior, may precede, be seen along with, or follow the psychotic symptoms.

Some people have only one such psychotic episode; others have many episodes during a lifetime but lead relatively normal lives during the interim periods. However, the individual with "chronic" schizophrenia, or a continuous or recurring pattern of illness, often does not fully recover normal functioning and typically requires long-term treatment, generally including medication, to control the symptoms.

Basic knowledge about brain chemistry and its link to schizophrenia is expanding rapidly. Neurotransmitters, substances that allow communication between nerve cells, have long been thought to be involved in the development of schizophrenia. It is likely, although not yet certain, that the disorder is associated with some imbalance of the complex, interrelated chemical systems of the brain, perhaps involving the neurotransmitters dopamine and glutamate. This area of research is promising.

Is Schizophrenia Caused By A Physical Abnormality In The Brain?

There have been dramatic advances in neuroimaging technology that permit scientists to study brain structure and function in living individuals. Many studies of people with schizophrenia have found abnormalities in brain structure (for example, enlargement of the fluid-filled cavities, called the ventricles, in the interior of the brain, and decreased size of certain brain regions) or function (for example, decreased metabolic activity in certain brain regions). It should be emphasized that these abnormalities are quite subtle and are not characteristic of all people with schizophrenia, nor do they occur only in individuals with this illness. Microscopic studies of brain tissue after death have also shown small changes in distribution or number of brain cells in people with schizophrenia. It appears that many (but probably not all) of these changes are present before an individual becomes ill, and schizophrenia may be, in part, a disorder in the development of the brain.

Developmental neurobiologists funded by the National Institute of Mental Health (NIMH) have found that schizophrenia may be a developmental disorder resulting when neurons form inappropriate connections during fetal development. These errors may lie dormant until puberty when changes in the brain that occur normally during this critical stage of maturation interact adversely with the faulty connections. This research has spurred efforts to identify prenatal factors that may have some bearing on the apparent developmental abnormality.

In other studies, investigators using brain-imaging techniques have found evidence of early biochemical changes that may precede the onset of disease symptoms, prompting an examination of the neural circuits that are most likely to be involved in producing those symptoms. Meanwhile, scientists working at the molecular level are exploring the genetic basis for abnormalities in brain development and in the neurotransmitter systems regulating brain function.

Why I decided to publicly acknowledge my mental illness (schizoaffective disorder) and not keep my mental illness a secret.

There was a long time that I tried to keep my mental illness a secret, but I eventually decided to acknowledge it publicly. It was a difficult decision, but ultimately I have decided it is a better way to live. I can be open and honest, without feeling that I need to lie to protect myself. If there are negative consequences to speaking openly about my illness, I take a great deal of comfort in the inspiration that my writing has been to others who suffer.

I was moved to write this particular article today after I saw the movie A Beautiful Mind last night.

It is the story of John Forbes Nash, a brilliant mathematician who was struck down early in his career by severe schizophrenia. He suffered in obscurity for decades (tormented by hallucinations and paranoia) before he recovered in the early 90's. Dr. Nash was awarded the 1994 Nobel Prize in Economics for the pioneering work he did on Game Theory as his Ph.D. thesis in the early 1950's.

Throughout my life, I have always felt it important to speak out about the things that I believed in. That's why I posted John J. Chapman's Make a Bonfire of Your Reputations on my website after I first read it in The Cluetrain Manifesto.

However, I have not always been such an eloquent speaker. It took me a long time to learn to write well, and when I was young I was unable to speak convincingly at all. It has happened quite a few times that speaking out caused me trouble, and it was especially difficult to get anyone to listen during the times my illness made it difficult to organize my thoughts.

It is likely that you've heard or read the ramblings of a mentally ill person and written them off as inspired by delusions. But there is often truth behind even the most paranoid manifestoes, sometimes a terrible truth, if only you were able to decipher their real meaning.

I have found that getting people to listen to me doesn't require that I avoid embarrassing or forbidden topics, only that I discuss them eloquently enough that I gain my readers respect by the way I express my ideas. I'd like to suggest that you learn to write and speak well too, if you have something to say that you think others won't want to hear.

One of the reasons I used to work so hard to keep my illness a secret is that while in the grip of my symptoms I did a lot of things that I regret. Most people regarded me as a pretty weird guy in general, and having such a reputation to live down does not help when trying to establish a career in a competitive industry or in trying to find the affection of a loving woman. It might well happen that some who knew me when I was the most ill might post embarrassing comments in response to this article. It might also happen that potential consulting clients - or my current ones - read this and wonder about my competence.

It is a risk that I accept in order to live true to myself. While at times I am in the grip of insanity, I take full responsibility for everything I have ever done. The best defense that I have is to let my words speak on my behalf.

As Maggie Kuhn, the founder of the Gray Panthers said:

Stand before the people you fear and speak your mind - even if your voice shakes.

next: Living With Schizoaffective Disorder, Reading

Here's how the symptoms of  schizoaffective disorder appeared and how they impacted my life.

I have experienced various symptoms of mental illness for most of my life. Even as a young child, I had depression. I had my first manic episode when I was twenty, and at first thought it was a wonderful recovery after a year of severe depression. I was diagnosed as schizoaffective when I was 21. I'm 42 now, so I have lived with the diagnosis for 21 years. I expect (and have been emphatically told by my doctors) that I'm going to have to take medication for it for the rest of my life.

I have also had disturbed sleeping patterns as long as I can remember - one reason I'm a software consultant is that I can keep irregular hours. That's a primary reason why I went into software engineering at all when I left school - I did not think my sleeping habits would allow me to hold a real job for any length of time. Even with the flexibility most programmers have, I don't think the hours I keep now would be tolerated by many employers.

I left Caltech when my illness got really bad at the age of 20. I eventually transferred to U.C. Santa Cruz and finally managed to get my physics degree, but it took a long time and a great deal of difficulty to graduate. I had done well in my two years at Caltech, but to complete the last two years of classes at UCSC took me eight years. I had very mixed results, with my grades depending on my mood each quarter. While I did well in some classes (I successfully petitioned for credit in Optics) I received many poor grades and even failed a few classes.

next: Schizoaffective Disorder is a Poorly Understood Condition

Here's what to do if you think you are mentally ill plus help with choosing a psychotherapist.

If you feel you may be suffering from a mental illness, I urge you in the strongest terms to seek the advice of an experienced mental health professional - a psychologist or psychiatrist.

(Psychiatrists are medical doctors who specialize in mental illness. They have M.D. degrees and are licensed to prescribe medicine. Psychologists hold graduate degrees and practice "talk therapy".)

This is important for more reasons than to simply relieve your suffering.

As I said before if left untreated mental illness can cause permanent damage. Besides the kindling that occurs with untreated manic depression, there is the damage that bad decisions or the inability to maintain relationships can do to your life. If you get severely depressed, there is the danger of suicide. It is much easier to deal with a mental illness before you become desperately ill. Look at it this way: an office visit is much cheaper than a hospital stay.

Accurate diagnosis is important. It is difficult to diagnose many mental disorders, and if you're misdiagnosed you may not receive the treatment you need. It is common to mistake manic depression for schizophrenia and vice versa. Other illnesses that can be confused with manic depression include Attention Deficit Disorder and Borderline Personality Disorder.

There is the danger that antidepressants may cause one to become manic. An occurrence of even one manic episode in your lifetime is enough for a diagnosis of manic depression. I feel the history of every patient who receives antidepressants for the first time should be investigated to determine the danger that their medicine may cause mania. Although general practitioners - regular medical doctors - may legally prescribe antidepressants, I am strongly of the opinion that it is unethical for them to do so except in emergencies, as they do not have the training or experience to determine whether one might be manic-depressive.

Fooling Yourself With Self-Diagnosis

Do not engage in the self-deception of self-diagnosis. It is common for people to hear about illnesses of all sorts on Oprah or Donahue (or the Internet!) and to then fool themselves into thinking they share the diagnosis with the talk show guest. If you research an illness carefully enough before you consult a doctor, you can even fool him into agreeing with your diagnosis.

Failure to diagnose correctly can be life-threatening. A number of serious medical conditions cause disturbances in thought and affect, for example, stroke, brain injury as well as cancer of the brain, thyroid or adrenal gland. When the grandmother of Mindfulness author Ellen J. Langer complained to her doctor that a snake living in her head was giving her headaches, he diagnosed her as senile and refused to investigate further. It was only after her death that an autopsy found the brain tumor that killed her.

A mental disturbance can be caused by heavy metal poisoning - the Mad Hatter in Alice in Wonderland was inspired by real hat makers who were sickened by the mercury used in the manufacture of felt hats.

Drugs of abuse can cause mental disturbances that last long after the drug itself has worn off. Besides the damage that addiction can do to your life and that of your loved ones, drugs, including alcohol, can cause such things as paranoia, anxiety and depression.

It is common for people with psychiatric illnesses to "self-medicate", but this ultimately causes more problems than it solves. Besides the alcoholic drowning their sorrows with drink, I have heard that alcohol suppresses hallucinations for the schizophrenic. Many times I have been warned by my doctors of the tempting danger that drugs hold especially for the manic-depressive.

Neuroses can be caused by unresolved traumas early in life. For example childhood sexual abuse and violence, or living through times of famine and war. Having an addicted family member usually causes the entire family to behave in dysfunctional ways that leave lasting scars on everyone.

Perhaps you carry a terrible secret, a secret that you've never told anyone. Carrying the memory of childhood trauma continues to cause damage in adulthood far out of proportion to the original injury. Perhaps it is time to find someone you can trust to share your secret with. The injury you suffered can never be undone, but it is within your power to change how you live with it today.

Diagnosing Mental Illness

Mental illnesses can be mistaken as physiological ones: I have heard of a woman who was diagnosed and treated as epileptic when she was a young girl, then suffered for years because the medicine did not relieve her symptoms. It was only when she turned 16 and wanted to get a driver's license that further investigation found she really suffered from anxiety.

My diagnosis at Alhambra CPC included CAT scans of my head, blood and urine tests, an electroencephalogram and neurological tests to rule out such things as tumours and poisoning. A psychiatrist will usually do a thyroid panel before treating someone for manic depression. (There was another patient at Alhambra who arrived in a catatonic stupour and slowly awakened during our time there. It turned out that he had a physiological condition that caused the buildup of ammonia in his blood.)

However, there is no blood test for psychiatric illness; at best blood tests can rule out other physiological conditions. Tests such as Positron Emission Tomography can detect such things as the excessive metabolization of sugar in the right brain hemispheres of manic people, but PET scans are very expensive and so only commonly performed for research purposes.

Diagnosis of a mental disorder is made from the patient's history, observation of the patient's current behaviour, talking with the patient, and psychological diagnostic tests.

I had the Rorschach Inkblot Test, the Thematic Apperception Test, in which I explained what I thought to be happening in some pictures, and the Minnesota Multiphasic Personality Inventory in which I answered a lengthy questionnaire about my thoughts and feelings.

I also took an IQ test. Being manic I was feeling quite intelligent, so I was appalled to find that my score was off about 20 points from the two IQ tests that school psychologists had given me as a child. The psychologist who tested me in the hospital reassured me that my brain was not degenerating, but that psychosis caused a temporary decrease in intelligence. She said my intelligence would recover when the episode passed. However, she warned me that my intelligence would fail to recover fully if I had repeated manic episodes.

Need Help Paying for Mental Health Treatment?

If you don't have the money to pay for treatment you may still have options depending on where you live. Even in the United States, which does not have publicly funded health care for most illnesses, there are government-supported mental health clinics in many communities, as well as private non-profit clinics that charge their patients based on their ability to pay.

Many psychologists and psychiatrists offer sliding scales, where they charge lower-income patients less money. Not everyone offers this, so you have to call around.

Some psychiatric medications are expensive; treatment with clozapine for schizophrenia, for instance, costs thousands of dollars a year. The government might assist in the cost of your medicine and some drug companies offer "compassionate drug plans" in which qualifying patients receive their medicine free of charge directly from the drug company. In addition, the drug companies often give psychiatrists free advertising sample packs of drugs, which the psychiatrists then give to their patients who cannot afford to buy them.

next: Therapy for Treatment of Schizoaffective Disorder

Auditory hallucinations are a key sign of schizophrenia. Find out what it's like hearing voices and having a visual hallucination.

Yet it is in place to appeal to the fact that madness was accounted no shame nor disgrace by men of old who gave things their names; otherwise they would not have connected that greatest of arts, whereby the future is discerned, with this very word 'madness', and named it accordingly.
-- Plato Phaedrus

Auditory hallucinations are the key sign of schizophrenia. After the summer I was diagnosed, when I related my experience to a fellow UCSC student who studied psychology, he said that the fact that I heard voices by itself made some psychologists consider me schizophrenic.

Everyone has an inner voice that they talk to themselves with in their thoughts. Hearing voices is not like that. You can tell that your inner voice is your own thinking, that it's not something you're actually hearing someone saying. Auditory hallucinations sound like they're coming from "outside your head". Until you come to understand what they are, you cannot distinguish them from someone actually talking to you.

I haven't heard voices very much, but the few times I have is quite enough for me. While I was in the Intensive Care Unit at the Alhambra Community Psychiatric Center that summer of '85, I heard a woman shout my name - simply "Mike!" It was distant and echoey, so I thought she was shouting my name from down the hall, and I would go look for her and find no one.

Other people hear voices whose words express much more disturbing things. It is common for hallucinations to be harshly critical, to say that one is worthless or deserves to die. Sometimes their voices keep up a running commentary about what's going on. Sometimes the voices discuss the inner thoughts of the person who hears them, so they think everyone around can hear their private thoughts discussed aloud.

(One might or might not have a visual hallucination of someone actually doing the speaking - the voices are often disembodied, but for some reason that doesn't make them any less real to those who hear them. Usually, those who hear voices find some way to rationalize why the speech does not have a speaker, for example by believing that the sound is being projected to them over a distance via some kind of radio.)

The words I heard weren't disturbing in themselves. For the most part, all my voice ever said was "Mike!" But that was enough - it wasn't what the voice said, it was the intention that I knew to be behind it. I knew that the woman shouting my name was coming to kill me and I feared her like nothing I've ever feared.

When I was brought to Alhambra CPC, I was on a "72-hour hold". Basically, I was in for three days of observation, to allow myself to be studied by the staff to determine whether lengthier treatment was warranted. I had the understanding that if I just stayed cool for three days I would be out with no questions asked and so although I was profoundly manic, I stayed calm and behaved myself. Mostly I either watched TV with the other patients or tried to soothe myself by pacing up and down the hall.

But when my hold was up and I asked to leave, my psychiatrist came to tell me he wanted me to stay longer. When I protested that I'd met my obligation, he replied that if I didn't stay voluntarily he would commit me involuntarily. He said something was seriously wrong with me and we needed to deal with it.

He told me I'd been hallucinating. When I denied it, his response was to ask "Do you ever hear someone call your name, and you turn, and no one is there?" And yes, I realized he was right, and I didn't want that happening, so I agreed to stay voluntarily.

Hallucinations aren't always menacing. I understand some people find what they have to say familiar and comforting, even sweet. And, in fact, another voice I think I heard (I can't be sure) came when I was hanging out by the nurse's station in the ICU. I heard one of the nurses ask me an inconsequential question and I answered her only to be surprised to find her looking down at her desk, ignoring me. I think now she hadn't addressed me at all, that the question I heard was one of my voices speaking to me.

I became very determined that the voices were going to stop. They really bothered me. I worked hard to determine the difference between real people talking and my voices. After a while, I was able to find a difference, although a disturbing one - the voices were more convincing to me than what real people actually said. The concreteness of my hallucinations' apparent reality always struck me immediately, before I ever heard what they said.

Some of my other experiences are this way too: the conviction of their reality always strikes me before the actual experiences do. People have often told me I should just ignore them, but I haven't had that choice, by the time I can make the decision to ignore something I have already been frightened by it.

After a while, I decided I just wouldn't listen anymore. And after a short time, the voices stopped. It only took a few days. When I reported this to the hospital staff, they seemed quite surprised. They didn't seem to think I should be able to do that, to just make my hallucinations go away.

Still, the voices bothered me enough that for years afterwards, it startled me to hear anyone call my name when I didn't expect it, especially if someone I didn't know was calling someone else who happened to be named "Mike". For example, there was someone named Mike who worked on the night shift at the Safeway grocery store in Santa Cruz when I lived there, and it would frighten me when they would call his name on the public address system, asking him to come help at the cash register.

next: Schizoaffective Disorder and Dissociation