Schizophrenia disorder de-mystified

When my family member first received the diagnosis of schizophrenia disorder in 1996, it seemed like the right description of what he was going through at the time.  In fact, it only took one profound meditation experience for me to see it clearly.  But then it took another 20 years of being together with my family member seeing this condition improve, about a dozen years of educating other families, and about 17 years of meditation to test my perspective and be able to explain it in everyday language.  Below I'd like to do that.  Also, in seeing this diagnosis accurately, it means that this condition does not have to be chronic and actually offers hope for full recovery.  That's the good news.

Before we launch in, remember, I am not a psychiatrist or medical professional.  If you want a medical perspective on this, there are plenty of helpful websites which provide that information.  This article will present the diagnosis from a caregiving and meditation perspective.

Also, when you get a chance, I recommend that you read the diagnostic criteria for schizophrenia in the DSM IV or V.  It sets out in detail what I will cover in very general and much shorter language.  

Here's the key idea:  the diagnosis of schizophrenia disorder is like naming a family movie clip.  Some movie clips might be named "growing up", "fun times on the beach", "dad's last months", etc.  How do you know what to name a clip?  If you're a movie editor, you look at the behavior of the people in the clip.  

In 1996, my family member read a list of symptoms for schizophrenia and he realized that's what he was going through.  And so did the psychiatrists.  They looked at this movie clip they were seeing, which starred my family member, and decided that his behavior and reported experiences fit the diagnostic criteria of schizophrenia disorder.

The diagnostic criteria includes 3 main categories for the diagnosis "schizophrenia disorder":

  1. Characteristic symptoms
  2. Social or occupational dysfunction
  3. Significant duration

So, as a quick example, if someone is hallucinating and not able to work for 9 months (and certain exceptions are ruled out) they may be given the diagnosis schizophrenia disorder.  

Let's take a look at those 3 categories.  With your help, I'd like to explain schizophrenia disorder, and help you see that it is a severe but transient disturbance of the mind rather than necessarily a chronic condition.

1.  Characteristic symptoms:  In general, these can include delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and so-called negative symptoms which can include reduction in emotional response and reduction in speech.  

Now, look back on your own life.  Have you ever been in love and made some really bad choices?  (Low-level delusion.)  Have you ever gotten very drunk or smoked marijuana and got lost in a new feeling or thought?  (Low level hallucination.)  

In fact, you don't even have to be on substances to know a low-level hallucination:  do you experience chatter in your mind, a constant running narration of what is happening or what happened or what might happen next? This is equivalent to repeatedly being sucked into your mind rather than being present to what is happening here and now.  

To continue the exercise:  has a dear friend or family member passed away and when it happened, were you so shocked or bewildered that you could not speak coherently or you simply didn't see the point of speaking?  (Disorganized or reduced speech.)  

Have you ever gone through puberty?! 

I think you get the picture.  

The point is that in your everyday experiences, you actually go through mini-delusions, mini-hallucinations, mini-disorganized speech, etc.  Do those little mini-conditions go away?  Yes.  They come, they stay for a while, and they go away.  So, in this way you have a little sense for what schizophrenia disorder is.  It is simply a much more amplified version of what you go through every day.

In fact, if you pay really close attention to your states of mind every day, you will know without a doubt that they are little, transient disturbances of the mind.  

2.  Social or occupational dysfunction:  your family member's work or interpersonal relations have slipped significantly from where they used to be.

Ok this one is pretty easy.  Have you ever failed at an exam?  Have you ever made a mess of your love-life?  Have you ever told a friend off?  Have you ever gotten fired?  Have you ever had problems with someone at work?  And have you noticed that this dysfunction seems to stay a little while, then it maybe has a hangover effect (you beat yourself up), and then it is over? If so...well you had social or occupational dysfunction...and your loved one simply went further.  The dysfunction they experienced was deeper, and possibly longer.

3.  Significant duration:  your loved one must have experienced this disturbance for at least 6 months or so. 

Reflect back on your life and note when you have experienced a lot of stress.  What was your state of mind like?  Maybe you just had a child and you are losing tons of sleep.  Maybe your parent died at the same time your child was sick and you had big projects to do at work.  And you got sick, were down, couldn't sleep well, and maybe it just did not go away for a while.  In fact, this sort of stress and its accompanying symptoms can last quite a while...a significant duration.  

So if you put it all together, you have actually experienced the various components of a mini-schizophrenia disorder.  They are the mini-delusions or hallucinations all day long as you are lost in thought, the mini-dysfunctions in your friendships or work processes and the longer periods when you are in a funk.  Put it all together, dial up the volume, and you've got schizophrenia disorder.

Great.  "I've got it too," you're thinking.  Sure!  Most people on this planet have some low level wackiness that comes and goes and is undiagnosed simply because it does not cause enough problems.  Should that get us down?  No.  It's called the human condition. And it also shouldn't be a reason to think that it will last forever.  In fact, the criteria don't say "lasts until death".  No, it's simply a significant duration.

This is true of your life too, I bet.  Much as there have been times of distress in your life, there have probably also been long periods of clarity, functioning, and healthiness.  So, bad times and good times are transient.  They come, they stay, they go.  Getting back to the movie clip analogy, the movie keeps rolling and new sets of inner experiences and outer behavior show up, and if we want to, we can give them a new title, a new label. 

This is how we should be seeing schizophrenia, in my opinion.  Yes, it is a severe condition, but it is also transient.  If we refer to it by saying that person "has schizophrenia", or even worse "is schizophrenic" rather than "is going through schizophrenia" or "went through schizophrenia", I think we are doing them harm.

The movie keeps going.  The states of mind are always changing.  Disturbances happen, they settle down, and so on.  So, what is schizophrenia disorder?  It is a severe mental/emotional/perceptual disturbance that is connected with low functioning and lasts a certain amount of time.

Put even more simply, it is a severe, transient disturbance of the mind.

Severe Transient Disturbance of the Mind

Why is it important to see schizophrenia disorder this way?  Because it informs your caregiving.  It means this is not a life sentence.  It means there is potential for change, full recovery, and real healing.

It means your family member doesn't have to be permanently pigeonholed into that diagnosis, feel they are less than other people and hide from society.

It means your family member does not have to be medicated their whole life and deal with all the associated problems.

So what can you actually do to learn to see the diagnosis in a helpful way and really be attuned to your family member's changing condition?  

I suggest watching your own mind very carefully.  Pay attention to how it changes from moment to moment.  You will gain a depth of understanding of this diagnosis that you simply cannot have without self observation.

This self observation is meditation.  During meditation, you'll notice your own states of mind much more clearly and be able to make a note of how it changes from hour to hour.  Happy, less happy, a little tired, a little down, flat, back up, excited, slightly confused, really confused, a little clearer, etc.  You'll see periods of intense mental chatter in your mind, and periods of relative stillness.

This is one of the reasons I recommend meditation for caregivers.  It not only helps you understand your own mind, but also helps you understand your family member's mind much better.  

With that understanding, you can respond more appropriately, from moment-to-moment and as soon as their disturbance starts to dissipate a little, you are there with them, not pushing them back into a diagnosis of a bygone period in their life, but ready to help them take the next step.

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