Four years ago today my little brother took his own life, at the age of 23. We knew he was depressed and anxious for several years. These things run in the family quite pervasively so it didn’t seem that unusual or dire of a situation. He had gotten counseling, therapy, and psychiatric help, though he was never satisfied with the treatments that he tried.
We had no clues to how seriously ill he was until 6 or 7 months before his death, and it took a few months after that for it truly sink in. He was finally diagnosed with schizo-affective disorder (kind of a combo of schizophrenia and a mood disorder) a few months later. After various attempts at rehab, stays at jail and a few different mental hospitals, and two earlier unsuccessful suicide attempts, he ended his own pain and fear and madness on 6/11/11.
By the time he was 20 I think it should have been obvious that something more serious was going on. He was ‘farting around’ with school, despite being extremely intelligent. He was taking dead-end job after dead-end job, and getting fired. He became obsessed with becoming a poker dealer and talked somebody into paying for him to go to poker dealer school, and moved away temporarily to work at a casino. He developed a major gambling problem and ended up filing for bankruptcy. He started doing drugs, which he had actually never even experimented with as a teenager. He would buy or get gifted cool things, and then a couple weeks later he’d be selling everything. He was clearly a train wreck. I feel like I just thought he was Timmy being Timmy, and did not take these issues seriously, until it was too late.
Maybe we could have helped him. There are so many things I would do differently now. But the biggest, most important one is this: if only we had known the early warning signs of this kind of illness. If we had recognized some of these signs at age 16, 18, even 20 when he was doing things that just made us shake our heads and ask, “What are you thinking? What are you doing?” It wasn’t until he was basically in constant torment from the voices in his head that he admitted them to us. That was the first time I realized, “Wow, this kid is really mentally ill.” Duh. Early treatment is a huge part of successful schizo-affective or schizophrenia treatment. But you can’t treat what you don’t know about!
For a full list of early symptoms (often starting as early as 15 in males), see this article: http://schizophrenia.com/earlysigns.htm
I will comment on some of them below.
Please remember that only a qualified psychologist, psychiatrist (or in some areas a social worker) can properly diagnose schizophrenia, or any other brain disorder. A psychologist or psychiatrist will use the clinical history of the person, as well as the symptoms and criteria in the DSM-IV (in the United States) to make a diagnosis.
Examples of Physical Symptoms—-
–A blank, vacant facial expression. An inability to smile or express emotion through the face is so characteristic of the disease that it was given the name of affective flattening or a blunt affect.
Timmy definitely did smile, but I can easily picture his vacant expression also, thinking back. I attributed this to depression.
Other than that, the physical symptoms don’t jump out as applicable to me.
Examples of Feelings/Emotions—-
–The inability to experience joy or pleasure from activities (called anhedonia)
–Sometimes feeling nothing at all
–Appearing desireless- seeking nothing, wanting nothing
–Feeling indifferent to important events
All of the above definitely applied to Timmy at different times. Again, he was never able to satisfactorily treat his depression, which is what I assumed all of these were tied to.
Examples of Mood—-
–Depression- feeling discouraged and hopeless about the future
–Low motivation, energy, and little or no enthusiasm
–Suicidal thoughts or suicidal ideation
Timmy definitely had depression and severe anxiety. The suicidal thoughts didn’t come about until the very end, as far as I know.
Changes in Behavior associated with schizophrenia —-
–Dropping out of activities and life in general
–Lack of goal-directed behavior. Not being able to engage in purposeful activity
–Deterioration of academic or job-related performance
Timmy was extremely bright, but had a really hard time completing a semester of school or staying in a job for any length of time. He got fired from many jobs, for really dumb reasons, or for not showing up.
–Inability to form or keep relationships
–Social isolation- few close friends if any. Little interaction outside of immediate family.
–Increased withdrawal, spending most of the days alone.
–Functional impairment in interpersonal relationships, work, education, or self-care
He definitely had some friends, but over the last few years of his life became more and more isolated. I attributed this to his depression, anxiety, and drug use.
–Neglect in self-care- i.e. hygiene, clothing, or appearance
Timmy was never super concerned with appearances, but this didn’t really become a noticeable issue until the last several months.
–Drug or alcohol abuse
–Smoke or have the desire to want to smoke (70-90% do smoke) – note: this is a very normal behavior for people who do not have schizophrenia also!
Yep. Looking back, when he started doing drugs I think it was to try to mask the symptoms he was starting to notice.
Examples of Cognitive Problems Associated with Schizophrenia —-
–Ruminating thoughts- these are the same thoughts that go around and round your head but get you nowhere. Often about past disappointments, missed opportunities, failed relationships.
–Obsessive compulsive tendencies- with thoughts or actions
Timmy definitely had this going on for awhile. As a teenager he was constantly overly focused on ways to ‘get rich quick’. This changed over to a focus on atheism, and then a focus on finding the exact right drugs to ‘fix’ himself. He actually did a ton of study and research on mental illness, various medications, and drugs, and tried most of them.
–Lack of insight (called anosognosia). Those who are developing schizophrenia are unaware that they are becoming sick. The part of their brain that should recognize that something is wrong is damaged by the disease.
This is why it is so important for friends and family members to be knowledgeable and pay attention!
–Trouble with social cues- i.e. not being able to interpret body language, eye contact, voice tone, and gestures appropriately. –Often not responding appropriately and thus coming off as cold, distant, or detached.
–Difficulty expressing thoughts verbally. Or not having much to say about anything.
–Speaking in an abstract or tangential way. Odd use of words or language structure
I noticed some of these things, but since there are plenty of odd ducks in our family it didn’t stand out too much.
Examples of Delusions—-
The most common type of delusion or false beliefs are paranoid delusions. These are persecutory in nature and take many forms:
–Overpowering, intense feeling that people are talking about you, looking at you
–Overpowering, intense feeling you are being watched, followed, and spied on (tracking devices, implants, hidden cameras)
–Thinking that someone is trying to poison your food
–Thinking people are working together to harass you
–Thinking that something is controlling you- i.e. an electronic implant
–Thinking that people can read your mind/ or control your thoughts
–Thinking that your thoughts are being broadcast over the radio or tv
–Delusions of reference- thinking that random events convey a special meaning to you. An example is that a newspaper headline or a license plate has a hidden meaning for you to figure out. That they are signs trying to tell you something.
–Religious delusions- that you are Jesus, God, a prophet, or the antichrist.
–Delusions of grandeur- the belief that you have an important mission, special purpose, or are an unrecognized genius, or famous person.
–Delusions that someone, often a famous person, is in love with you when in reality they aren’t. Also called erotomania or de Clerembault syndrome.
Examples of Hallucinations—-
–Hallucinations are as real as any other experience to the person with schizophrenia. As many as 70% hear voices, while a lesser number have visual hallucinations.
–Auditory hallucinations can be either inside the person’s head or externally. When external, they sound as real as an actual voice. Sometimes they come from no apparent source, other times they come from real people who don’t actually say anything, other times a person will hallucinate sounds.
–When people hear voices inside their heads, it is as if their inner thoughts are no longer alone. The new voices can talk to each other, talk to themselves, or comment on the person’s actions. The majority of the time the voices are negative.
–Visual hallucinations operate on a spectrum. They start with the overacuteness of the senses, then in the middle are illusions, and on the far end are actual hallucinations.
These symptoms are kind of smacks in the head with a 2×4 once you know about them. Unfortunately, I have no idea when this started for Timmy, as he didn’t feel comfortable telling me about them until it had gotten very, very bad. He was tormented night and day with some truly horrible voices and accusations in his head all the time. In November of 2010 when he got arrested for screaming and ranting on the side of the road (trying to exorcise them, he said) and while in jail he beat his head against the wall hard enough to fracture his skull and require brain surgery – again, trying to get the voices out of his head – That’s when he told us about the voices. I am sure that he had started experiencing minor instances of delusions and hallucinations way before it got to that point! People need to feel safe talking to those they love when they first start to experience some of these symptoms.
Please refer to the full list of symptoms if there is someone in your life that you are worried about. The classic trajectory for young men getting schizophrenia is: depressed and withdrawn as a teen, start doing drugs, going to jail, etc., ‘become’ schizophrenic, parents blame the drugs. Obviously there are tons of drug addicts and criminals who are not schizophrenic, but please, please keep your eyes open, keep the dialogue open with the person in question, and do your research!