"Schizophrenia" is a name, not a disease. It presents in many different ways and has many different outcomes. There is certainly not one cause of "schizophrenia"; there may be hundreds of contributing factors working through bewilderingly complex interactions. Figuring all this out will likely be the painstaking work of many decades. Eventually, what we now call "schizophrenia" will turn out to be hundreds of much better-defined conditions.
There are many effective treatments for "schizophrenia," but no one size fits all. Most people need medication, at least during the acute phases. Psychotherapy, social-skills and vocational training, and recovery through peer support and empowerment are all enormously helpful. But nothing works if the person is homeless, so decent housing is a prerequisite.
You are about to read the remarkable life story of a remarkable man. In his memoir The Mindful Son: A Beacon of Hope Through the Storm of Mental Illness, James Hickman describes how he overcame poverty, orphanhood, and schizophrenia to become a licensed clinical social worker, a psychotherapist, a leader in the mental-health-advocacy movement, and an inspiration for many others.
Mr. Hickman writes:
I never thought seriously about becoming a psychotherapist until I was institutionalized in a state psychiatric hospital. I found myself there after experiencing my second psychotic break with reality in 1998, at age 23.
This was the first time since being diagnosed with schizophrenia two years before that I was able to admit to myself that I had a mental illness. Being around so many other people experiencing similar phenomenon had a profound effect upon me. I thought I was Elvis, in the Mafia, and some kind of religious figure, all wrapped up in one. Many of the other people there had similar strange beliefs. At some point it dawned upon me that we couldn't all be right. This type of logical reasoning combined with the antipsychotic medication helped me to recover my usual state of mind within two weeks of my hospitalization.
I was in the hospital for an additional month until the psychiatrist said I was ready to be released. While there I began sharing the logic that helped me to end my psychotic thinking with the other patients there.
One young man, who was about my age, comes to mind. I asked him, "You're telling me that you are some kind of messiah. I thought the exact same thing about myself. How can we both be right? I mean would there really be two messiahs at the same time, let alone all the other people who claim to be messiahs?" When my new friend's own psychosis abated, a few days later he was feeling rather foolish for what he had been thinking. He said, "I can't believe I thought all of that stupid stuff. It doesn't even make any sense." I responded, "Hey, don't feel so badly about it. I was thinking the exact same thing. It's all part of a chemical imbalance." My friend smiled as our conversation turned to questions related to the next stage of our recovery, where would we live after we left the hospital.
One reason why this logical reasoning seemed to come naturally to me was because I had a scientific understanding of the universe. My step-father, Dave, was a mechanical engineer and also the smartest man I ever met. He helped me understand how the brain was basically like a very complex machine. For this reason I had an easier time grasping the concept that the chemicals which made the mind work properly could get fouled up and create the experiences that were part of a mental illness.
I remained resistant to the concept that I would need the medication to control my brain's functioning for a couple of more years. But when I began to feel my perception of reality disintegrate again, the logic kicked in and I started taking the medication in time to prevent further hospitalizations. I've never been off of the medication since then and never had a relapse of the psychotic symptoms which had before been so crippling to me. Another factor that reinforced my decision to take my medication was my therapist's warning to me that with each psychotic break I would lose a little more of my original self.
My experiences with other people with schizophrenia who refuse to take their antipsychotic medication have backed up what she told me. I've seen people who have had so many psychotic breaks with reality that they lose the ability to recover their rational mind.
During my time at the state hospital, I made another friend who was a middle aged woman being treated for what I would come to learn was bipolar disorder. As we sat outside smoking cigarettes, she asked me, "Hey, wouldn't it be great to be mental health professionals ourselves? Who would do a better job at it than us?" "Yeh" I said. "That's true, but I wouldn't even know where to begin acquiring the credentials necessary to do such a thing." "You just go back to school. They need people to do this kind of work, and you'd be a natural. I'm going to begin work on it, myself."
In 2002, I reached a turning point when I met a young lady who had my same mental illness, schizophrenia, except she was working in a professional capacity as a software engineer. Our friendship inspired me in profound ways.
I was working as a security officer but, I began to believe that I could be working in some professional capacity, just as she was. It was then, walking around the engine plant I guarded, that I had a calling to become a psychotherapist for other people with mental illness.
"Why just be a security guard when I can be helping to change people's lives for the better?" I asked myself, and couldn't think of a good reason not to do it. By this point I had spent years as a volunteer for the National Alliance on Mental Illness, in Huntsville, AL, and had even been a co-founder and first President of the city's own consumer run drop-in center. Consumer run drop-in centers are like club houses for people with mental illnesses, where they can engage in recreational activities and peer support.
I continued to have a good rapport with other people with mental illnesses, just as I had in the state hospital, and was viewed as a leader. I also had a good rapport with the mental health professionals who worked with me, and thought that they would welcome me joining their ranks. I said to myself, "Jonah only needed to be swallowed by a great fish once, before hearing his calling. The accumulation of my experiences is leading me down the path of being a mental health professional." I enrolled in the Master's of Social Work program at Alabama A&M University, which was in my hometown of Huntsville, AL.
I've been a psychotherapist for ten years now and have even written a book about my experiences. In doing so, I've had the opportunity to help countless people find recovery from mental illness by teaching them to think more rationally. The same logical reasoning that helped me through my psychosis also helps my clients not only with psychosis, but with depression and anxiety as well.
I challenge my client's to ask themselves questions to think more logically. For example, "Is it really the end of the world because I can't make everyone happy all of the time?" or "Is it really just awful because a situation didn't go exactly how I wanted it to? Isn't the world oftentimes a chaotic place?" or "Why shouldn't things break down sometimes? What about the law of entropy?" or "Why is it terrible if not everyone likes me at all times?"
Therapy isn't all about logical thinking, but it does play an important role. Therapy is, in fact, an art based on science. This is why logic and reasoning can play a crucial role in anyone's recovery.
Thanks so much, Mr. Hickman, for sharing your life adventure. You are an inspiration and great example for others. In a recent blog post I described the importance of finding common ground between psychiatry and recovery. Your recovery embodies the synthesis: Resilience, self-help, peer support and advice from others in your position, medicine, and the help of a psychiatrist all contributed to your success. And you helped yourself by helping others. I am especially impressed by your use of logic to regain a firm hold on reality. I have also found logic very helpful, although not everyone has your capacity to be logical even in the midst of a psychotic episode.
We have to get over the idea that "schizophrenia" is one thing, and we also have to get over the ideology that there is one best or uniform way of helping people recover from it.
Allen Frances is a professor emeritus at Duke University and was the chairman of the DSM-IV task force.