Schizophrenia: A Strengths Perspective: Life Lessons Learned from Living with Schizophrenia is the final volume in my trilogy of books on schizophrenia. Of course, each book has its own purpose, story, and goal. “On Conquering Schizophrenia; From the Desk of a Therapist and Survivor; With Purview on Metaphysics, Philosophy, and Theology” was a longtime labor of love. It is philosophical, theoretical, and ultimately spiritual. “The Essential Schizophrenia Companion; With Foreword by Elyn R. Saks, PhD, JD” entails my mission to provide what I deem to be the absolute “essentials” for understanding schizophrenia. Such essentials include developing an insight into one’s illness, learning to manage one’s behavior (especially when acutely symptomatic), understanding the nature of psychosis, harnessing potential protective factors, and learning and developing one’s cognitive–behavioral skills to support a stable and long-term recovery. It is my hope that once these are read, that a reader will be up to speed in comprehending schizophrenia. Both “On Conquering Schizophrenia” and “The Essential Schizophrenia Companion” carry the aims of education, ultimate recovery, and knowing that ample quality of life can be achieved despite schizophrenia.
This newest book has been an idea of mine for over a year. It has teased my intellect for some time. It is very interesting to me how a book becomes a book. Of course, it begins as an idea. But I have found that this idea must first bubble, like water in a pot on the stove. It begins as calm water until it eventually bubbles and boils. Once boiling, the idea begins to form and the pen is laid to paper. Schizophrenia: A Strengths Perspective: Life Lessons Learned from Living with Schizophrenia has boiled and it is due time for me to present this work.
The idea behind this book is a personal passion. The perception of schizophrenia is nearly unanimously dictated by what is referred to as the “medical deficit model”. The medical deficit model entails the deficits associated with schizophrenia. These deficits are categorized according to medical “symptoms”. Such symptoms include auditory hallucinations, visual hallucinations, delusions, and mood disturbances (including paranoia). Such deficits are viewed as abject hinderances to one’s general well-being and as detrimental to a person’s ability to function. Personally, I am no stranger to all such symptom deficits.
Auditory hallucinations are hearing voices with no logical source. Sometimes these seem to come from the environment, and other times they are from inside one’s own head. While they also can be perceived as coming from another person, any such voice will lack proper interpersonal validity. They can be confounding. Visual hallucinations have been less common than auditory ones in my case, but they are visual conjurings absent requisite validity nevertheless. Over my many years, schizophrenia has induced an abundance of mood disturbances. Anxiety and depression have certainly reigned, and one might say “cavorted”, but, in particular, the rascal of “paranoia” has dominated. Paranoia in schizophrenia is different than a mundane sort of suspiciousness. Paranoia, meaning the clinical paranoia associated with schizophrenia, is a fulsome and pervasive feeling of persecution from an unrelenting perceived personal vendetta and attack by others. It has the notable earmark of it being with malevolent interpersonal intent. Clinical paranoia is terrifying, but from this too I have learned to overcome.
According to the medical model, under the umbrella of each symptom are a myriad of subtypes and formations. For example, delusions can be categorized according to the clinical subtypes, known as the grandiose, persecutory, somatic, bizarre, and religious. I have experienced all such subtypes and, admittedly, they do me no favors. Delusions can also be categorized on a spectrum of agreeability based on one’s observing mind (or perhaps one’s ego). If a delusion is characterized as “syntonic”, it follows that the delusional belief is agreeable to one’s intellect or that it supports one’s ego. For example, if I believed I had great wealth (but this was actually unfounded) and found such an idea to be positive and a prop, this could be labeled as syntonic; that is, agreeable and pleasing to my sensibilities. Conversely, if I assume a delusion of a “dystonic” characteristic, this would entail an idea or reference that is disagreeable to my ego and sensitivities, and it would be causative of emotional distress. If I believed the world, the entire human population, and God were out to persecute me, this would entail dystonic ideation. In no manner is this delusion pleasing—it is very disturbing. Such a disturbing belief can be labeled dystonic. All delusions can be located on the syntonic–dystonic spectrum. If the delusion leans towards “pleasing”, it is said to be syntonic and if the delusion disturbs, it is said to be dystonic. This spectrum is very broad with personal experiences ranging across a broad range of capabilities.
Auditory hallucinations can also be subtyped. Two of the most prominent subtypes are known as “persecutory” and “command” auditory type hallucinations. Persecutory auditory hallucinations entail a subject hearing voices of a derogatory and persecutory nature. For example, hearing a voice that says, “Everyone hates you and we all want you dead,” is a sort of persecutory auditory hallucination. In my case, at one time in the course of my illness, auditory hallucinations were grueling and gruesome. They added an additional layer to an already to dystonic psychosis. But I have learned and overcome them since then. Nevertheless, persecutory auditory hallucinations can be distressing. The second subtype of auditory hallucinations is known as command auditory hallucinations. Such voices will direct (or command) the subject to undertake a certain type of action or actions. For example, the voice may command, “I want you to kill yourself.” I mention this specific example to highlight the important need for those with schizophrenia, and their families, to understand the underlying potential peril of command auditory hallucinations. Personally, I have experienced this sort of danger. Very early in the course of my illness, command auditory hallucinations were extremely dangerous to my survival. I was fortunate to endure them, especially when these were an unknown entity to me. Command auditory hallucinations can cause someone with schizophrenia to commit suicide, particularly when an individual is unfamiliar with the phenomenon. As a therapist, when working with those with schizophrenia, I am always very upfront about telling my clients to never follow the commands of any auditory hallucinations. They can be perilous. Finally, visual hallucinations are not clinically parsed according to subtypes but they can surely be evaluated on the syntonic–dystonic spectrum.
When someone is actively psychotic, that is, divorced from reality due to a combination of symptoms, one’s ability to function can be significantly impaired. Schizophrenia, in clinical speak, is oftentimes referred to as an “SPMI”, this being the abbreviation of “severe and persistent mental illness.” Given the dual characteristics of severity and persistence (or chronicity), it can be understood that schizophrenia comes with challenges. Sometimes, those with schizophrenia have better times than others. Sometimes, symptoms diminish or abate somewhat. The illness of schizophrenia is not homogeneous, it is heterogeneous. Homogeneous indicates uniformity whereas heterogeneous indicates variability. The complete symptom profile of each person will be variable. Nevertheless, for those with schizophrenia, common themes and common symptoms occur. Exactly as described? No. Similar? Yes. Based on the severity and persistence of one’s illness, it will often follow an according prognosis with specific recovery outcomes. For example, sometimes, working may be well tolerated, but at other times it is simply not viable. Interpersonal behavior may be easier sometimes compared to other times. Routine daily functioning, for example, activities such as good hygiene, chore engagement, and participation in daily personal responsibilities, may wax and wane based on the acute symptom profile status. I will have you know, however, that I passionately believe in and espouse recovery. Recovery entails a sense of stability, both for the individual and their family (if indeed family applies). Recovery is the wider aim; it entails a temporal sort of homeostasis. Homeostasis is the phenomenon of a system’s ability to regulate and stabilize itself over time. When a temporal sort of stability is achieved by an individual and their family, recovery is actuated. Acuity may flare, but, according to the wider scope, the system remains stable and the individual and family remain in a comfortable system balance. Recovery is a temporal perspective and it undermines the persistence to schizophrenia. Severity indeed may be triggered by the formation of acute symptoms, but one can learn to manage such flares ups in favor of an extended temporal stability. Recovery equates to a comfortable system stability over time. The work to be done here is the achievement of this stability and therein lies my mission to help.
The medical model is the overwhelming primary view of schizophrenia. Please do not misconstrue my intentions here, I have no qualms with the medical model. In fact, I deem it accurate. I mean that. Although the “deficit” model is equated to the medical model, it does not mean a lack of personal individual strengths—not in the least. The medical model, as a “deficit” model, equates clinical framework and conceptualization, but it is certainly not any sort of personality dig. It is a model that addresses inherent problems. It is not a value judgment of “lacking” character. So please do not assume that I reject the medical model, because certainly I do not. I embrace it. It saved my life.
Schizophrenia entails a unique and different type of perspective. It is simply a new and different perspective, and complimentary one at that. I have lived with schizophrenia for more than 25 years now. I have taken antipsychotic medication each and every day for these 25 years. In this sense, the medical model has buoyed my recovery. I fear what that the results may have been without my medications.
In this book, however, I am driven by a unique perspective. It is a perspective that glimpses the personal strength gleaned from living with schizophrenia. I consider schizophrenia both a friend and a foe. It has instilled in me both terror and triumph. In my early 20s, with the initial onset of my schizophrenia, the symptoms were an absolute terror. It is important to know that, at the time, I had no reference points regarding schizophrenia. I knew nothing of its characteristics from my generalized education, nor was it present in my family and lineage. I was ignorant of it. Given this, with its initial onset, its inducements intensely frightened me and I had no insight. I was experiencing a terribly disturbing psychosis, and I did not know that it was psychosis, which further lent to my psychosis two-fold. Ignorance and schizophrenia are not bliss. Now, when I think back on that time, I count my lucky stars that I survived. It was a time of great peril for me. Because of the disturbing psychosis, I often thought about suicide. At the time, I was experiencing persecutory perceptions. I believed that everyone was fervently against me. I felt entirely persecuted and alone. I thought I was hated by all others and it was terrifying and persistent. I was significantly delusional but, at the time, I perceived it to be my accurate and unrelenting reality. Oftentimes, the initial onset phase can be similarly perilous for many with schizophrenia, in particular due to its novelty and a lack of understanding and recognition. I consider it a personal triumph that I persisted amid my fright and survived the onslaught. It was the darkest of times, but I escaped physically unscathed. A triumph of great proportions.
In my experience with schizophrenia, I have experienced the full spectrum, from defeat to redemption. In terms of psychological defeat, I have at times felt a deep sense of hopelessness and despair. When your reality appears thoroughly doomed, it is difficult to remain optimistic and hopeful. A lack of hope can be a primary variable supportive of depression and I navigated these psychological waters. I have learned, however, from this sense of hopelessness. I have learned that hope is indeed a variable and, further, it can be cultivated and coddled. In returning from a sense of hopelessness to optimism and an irrefutable sense of persistent hopefulness, I found redemption. Schizophrenia, at once, instructed me on psychological defeat but failed in its persuasion. Rather, I gleaned a potent intangible lesson on the personal characteristics of unrelenting hope. This reigns as the key to my redemption.
Schizophrenia has instructed me regarding dark times versus brighter times. Schizophrenia has taught me about the value of suffering and it has provided me lessons on the spectrum of psychological dark versus psychological light. I have learned from schizophrenia that life often casts shadows, and further, I have learned that this is universal to us all, not only to those with schizophrenia. At times, we all tread amid psychological dread. Schizophrenia taught me about bleakness. But, more importantly, it taught me not to fear dark times as it is simply parcel to being a human. Schizophrenia has also, conversely, instructed me on how to be grateful and appreciative of life’s lighter moments. I have only come to appreciate the lighter times of life relative to my travails amongst shadows. Schizophrenia taught me the universality of suffering, but, at the same time, it instructed me regarding appreciation and gratefulness when things are copacetic. No longer do I fear dark times, or abjectly try to avoid them, for this is forlorn. Schizophrenia has taught me about the full psychological spectrum of the dark versus the light. According to this lesson, I have learned about the inimitable texture of life and this now exists as a boon.
Schizophrenia, a once treacherous and unwanted foe, ultimately has forged intangible positive personal qualities. It has instigated positive perspectives, both of self and of the world around me. Schizophrenia has taught me a great deal regarding myself, others, and about life in general. I am now inspired—my idea at a full boil—to share with you, my cherished reader, such life lessons. Each chapter presents a lesson. And each lesson was derived from my experiences with schizophrenia.
I feel I have been exposed to too much of a generalized doom and gloom regarding schizophrenia. Certainly, and by vast majority, media representations are unfavorable. A certain sort of generalized societal stigma too often prevails. Those living with schizophrenia are often portrayed as dangerous, unstable, and the prototype of “crazy”. Those living with schizophrenia are often publicly perceived as incapable of living productive lives and are incapable of significant contributions. I am compelled to push back on such misguided notions. I do not believe I have ever seen, read, heard, felt, or sensed a celebration of schizophrenia. As such, Schizophrenia: A Strengths Perspective: Life Lessons Learned from Living with Schizophrenia is a celebration of sorts. It is about healthy coping perspectives, gleaned from schizophrenia, and applied to our shared normative knowledge, life itself.