This problem can be viewed as an illness phobia and many of the difficulties and recovery techniques described in that website article will apply here. However, from those coming to Anxiety Care with the problem, there is usually a very strong obsessional thinking element to this particular fear and the booklet ‘obsessional thinking’ might also be a useful read in conjunction with this article.
What is schizophrenia?
What it is NOT is multiple personality disorder, which is a completely separate and rare problem. Many people believe this is the ‘typical’ schizophrenic: someone who is host to numerous totally different personalities that ‘take over’ the body at different times: some of them invariably dangerous. Schizophrenia, in fact, has a number of different symptoms that interfere with the sufferer’s ability to think clearly, make rational decisions, relate to other people and cope with emotions. In the latter case a schizophrenic may display inappropriate emotions in some situations.
The ‘thought’ aspect can include difficulty in concentrating that makes work or study very hard or even impossible. Here thoughts may seem to wander from one subject to another where the original thought is quickly lost and the process may feel as if these thoughts are becoming indistinct or hazy. Someone with this problem may find it difficult to make him- or herself understood in conversation and may use inappropriate groups of words or nonsense words.
The more extreme thought problems and the ones most lay people are familiar with; are what is commonly referred to as ‘hearing voices’. In this situation a sufferer may feel that someone else’s thoughts are in their mind or that they are hearing some outsider speak to them when there is nobody present, probably urging them to do things, even dangerous things that they may feel powerless to resist. This can seem so real that the sufferer finds it difficult to believe that other people cannot hear these voices and does not understand that it is the brain mistaking personal thoughts for real experiences. People with severe depression may also hear voices that talk directly to them, however the voices heard by a schizophrenic may also seem to talk to each other.
When it feels as if some powerful presence is controlling one’s body and mind it will often seem necessary to find an explanation and people suffering in this way may believe that they are the subject of radio or TV ‘waves’, lasers or even aliens. Some people with thought problems may also believe that the TV or radio is discussing their personal and private lives or giving information that is specific to them alone and may find it difficult or impossible to believe that other people exposed to these programmes have not picked up the same information. When these delusions focus on this person feeling harassed or persecuted by some outside force or a particular person or group of people, these are known as paranoid delusions. Research suggests that up to 75% of schizophrenics will hear voices at some time during their illness.
Other symptoms that may seem to take away the quality of life rather than add another dimension to it as described above, can be a general reduction in energy, emotion and interest in life. A person with these negative symptoms may avoid other people, stay in bed and not bother with washing themselves or keeping their clothes clean. Such broad based symptoms can obviously be part of other problems such as depression and many parents may feel that their teenage children often fill these criteria.
Causes and onset
The cause of schizophrenia is not known but it is believed that it is most likely to be due to abnormalities of brain chemistry and/or brain structure. However, a physical test such as a brain scan would not be able to prove a person was or was not, schizophrenic; such a test could only rule out other physical reasons for certain behaviour. There are probably genetic elements involved in developing schizophrenia, and stress can be a factor but as a ‘last straw effect’ not a cause in itself. There is also research that suggests that illegal drugs such as marijuana, ecstasy and LSD can aggravate a present tendency into the full disorder. Amphetamines tend to generate schizophrenia-like symptoms, which cease when the person stops taking the drug.
About 1% of the population will suffer from this illness at some time in their lives and those with a parent who has the problem may be ten times as likely to contract schizophrenia: but this is still a 90% chance of not contracting it. Age of onset is rarely before age fifteen and women tend to contract it later than men: in the late twenties or thirties. The disorder appears equally in men and women.
Anxiety and obsession
Many people contacting Anxiety Care have used marijuana in the recent past and have experienced mental symptoms such as panic, confusion or paranoia that, even if minor and very temporary, have stayed with them in the form of a growing anxiety that they have, in some way, generated schizophrenia within themselves. If they, or in fact anyone have a tendency towards obsessional thinking, these fears might focus on intense monitoring of all thoughts and emotions that could conceivably ‘prove’ that they have this illness. Once this is done, the job becomes a life’s work unless help is obtained. That is because our thoughts tend to be random and very reactive: we encounter a situation and our minds throw up a range of thoughts and memories that relate to our past experience of this situation, some of them odd and barely relevant. If there is a good deal of emotion involved, the thoughts will be more intense and possibly broader in scope and even less relevant. If our minds are set to fear certain emotions, the thoughts that touch on these are likely to seem very powerful and relevant, simply through the anxiety they cause.
In this way, perfectly ‘normally-weird’ thoughts are easily grasped as ‘proof’ that this person is becoming schizophrenic. Our thoughts can be as random as the endless pages thrown up by an online search engine when we ask it about something: probably more so as our thoughts will leap on from one area to another as described in the obsessional thinking article. For example, thinking about one’s car might go to trips out, happy family days, the children, what they are doing now…etc. It could equally go to busy roads, being late, stress and unhappiness; or crashes; or high insurance. The list is almost endless. When a person’s mind is set to worry and suspicion, the thought process will tend to go that way almost automatically. That is, with the car; the end thought is more likely to involve fear of accidents or stress than happy days by the sea.
Another area of fear is that of violence. Many obsessional people mistake normal anger, even a temporary urge to strike someone, as a sign that they are becoming homicidal maniacs. They ignore the fact that most of us will experience this level of emotion at some time. A quick ‘straw poll’ among charity users and volunteers showed that many, when asked to think about it, had felt like hitting someone in the previous week. They had simply acknowledged the urge and let it go. However, someone keyed to be frightened by his or her violent or aggressive feelings would probably become very distressed by such thoughts. As the brain throws up similar past situations when we think about something, a person experiencing such an urge would then remember many other times he/she had felt that way and could easily be persuaded that he/she is dangerous. This can be particularly worrying if the urge is against a loved one. Many people with obsessional thinking problems seem to find it difficult to acknowledge that they can be angry with, and have aggressive thoughts against, people they love. This is very common when an infant has driven its mother to distraction and she suddenly feels like smacking it hard. Most mothers feel a little guilty at this point and then put the thought aside. The mother afraid of her violence does not. This can work equally when the person generating these feelings is a spouse, parent or older child.
Testing for schizophrenia
Many people with a fear of schizophrenia go for psychiatric testing, and although seeking reassurance is not a good way to deal with such a problem as it simply generates a reliance on this form of help and rarely lasts, this can be an option. When this is done, the person involved must try to accept the verdict. However, the mind tends to start looking for exceptions to any absolute ‘yes’ or ‘no’, particularly when there is heavy emotion involved. So it is not at all unusual for a person fearing psychotic illness to begin to doubt a diagnosis very quickly. This is usually on the grounds that the specialist: misheard, was trying to make the person feel better, was incompetent, missed something, that the symptoms got worse after the test, that new symptoms unknown to the tester are involved, etc., etc. The latter beliefs will then send the sufferer plunging into his or her mind in search of that item of ‘proof’ that was missed.
Many people fearing psychotic illness involve extremely tortured logic to maintain the disorder. One person used his knowledge that he wasn’t schizophrenic to prove that he was. That is, having been diagnosed as free of psychosis, he viewed his overpowering belief that he was schizophrenic, as delusional: which can be a schizophrenic symptom. Then, as a delusional person, this proved to him that he was schizophrenic. In this case, the fact that up to 10% of normal people are more delusion than some severe psychotics and that his belief was obsessional rather than delusional, had no effect.
This, ‘delusional or obsessional’? problem often occurs with OCD and with some people suffering with severe illness phobias (see HC in the ‘Obsessional Thinking’ article). And there probably isn’t a single answer. Whether a belief is simply very strong but open to negotiation, or whether it is totally believed regardless of proof to the contrary may well depend on how deeply involved in the problem the sufferer is at any specific time. That it, the beliefs may be on a continuum of certainty from ‘probably’ to ‘absolute’, depending on the mix of fear, depression or outside influences involved from day to day. This is, naturally viewed by some sufferers as proof that their schizophrenia waxes and wanes, rather than accepting the more rational belief that they have a severe anxiety disorder. And, of course, when pointed out, this choice of irrational over rational will prove to some people that they are psychotic as in the case above.
A person obsessed with the belief that they are, or will become, psychotic will not be persuaded differently by tests, at least long term. There will always be a reason to doubt the tests findings eventually: always. The answer is to stop seeking reassurance and, perhaps to take medication: one or other of the Serotonin Re-uptake Inhibitors seem to be current medication of choice. Sometimes the fears are so great and take up so much of the person’s time that only chemical help will reduce them enough for the sufferer to believe that he/she has a chance of overcoming them by personal effort.
If the family have been drawn into the reassurance seeking, they must work out a programme of refusal with the sufferer. This needs to be negotiated when the person involved is in a receptive mood. The family rules may, at first, allow one reassurance-seeking question a day, or questions aimed at only one family member, or at one specific time, or some mix of this. It has been seen, within the charity, that when the sufferer knows that he/she can ask a question at a certain time, the driving need for instant relief tends to abate and, often, the question itself does not need to be asked when the time comes round as the anxiety that generated the need has dropped. Refusal to give reassurance needs to be done calmly, never in anger. Specific wording should be used, perhaps: ‘we agreed that I would not reassure you.’
Or, if a time or a person is involved: ‘we agreed that you would only ask xxxxx’; or ‘we agreed that you could only seek reassurance from 8pm to 8.15pm.’
Nobody can force a person to drop these beliefs, it has to be learnt by the person suffering them, and given up by choice. Logic applied by well-meaning outsiders does not work, nor do appeals to ‘grow up’ or ‘pull yourself together’. That the fears are less disabling some times than others does not mean that the sufferer is putting it on: that is the way anxiety disorders work. Nobody lives in this hellish, terror-filled world of the mind by choice. But sometimes getting out can seem impossible.