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Am I Schizophrenic?


Two questions came in recently, I believe, from different people wondering if they might have Schizophrenia. Taken together they illustrate the difference between worrying over the condition, and possibly experiencing it.

The first reader writes:

Hi, I was just wondering if and when symptoms of schizophrenia would develop. My mother had a serious case of schizophrenia and i believe that my grandmother also suffered from the illness. I talk to myself sometimes and i do get kind of paranoid about people talking about me behind my back, however i don’t hear voices and I don’t hallucinate and I don’t partake in drugs because I’m scared of becoming schizophrenic. I’ve actually spent a lot of my time researching the illness in hope to prove to myself that I don’t. I’m a 19 year old male, so that means that if symptoms were to occur it would start soon. Is there anyway to prevent it from occurring if it hasn’t already?

The second reader has this to say:

I know you probably get a thousand of these questions a day. I really don’t know how to ask this so ill just tell u some of the things i CATCH myself doing that i feel aren’t normal. I guess the main thing is; i feel like the universe is a conscious being and its "job" is to cause me pain through annoyance and setting me up and i can almost see it laughing at me sometimes. It seems like it catches everything and plans ahead for elaborate setups. I’ve caught myself crying and cursing at it…then i think omg I’m ill. but when I’m upset i forget and its real all over again. its like i know its not real but even know as im writing this i don’t know for sure. i feel as if there are two parts of my mind fighting for control;one is trying to fly into the abyss of insanity and the other is holding on for dear life,thats why i use the word CATCH because ill be flying then ill say wait….this isn’t normal. i use the term poking. the universe is always poking me. oh my god writing it makes it sound so crazy. I took an iq test when i was around 6 or 7 and "supposedly" scored like 136 or something sometime i feel like i was lied to because i don’t feel very bright next to others, except when it comes to consciousness. it seems everyone is in a fog. (I know i jump around allot.) sometimes when I’m deep in thought i vocalize what I’m thinking without even realizing it,or hearing it really. I CATCH myself doing it. i also have extremely violent dreams most of the time it seems like a "task". but i am always somewhere where there are a set number of people normally with guns and i have to find weapons from my surroundings.(for example: i’m in an abandoned house there are like 5 or 6 guys and all i can remember is killing one of them with a metal clothes hanger i unwound. and I’m not trying to be sinister but i almost enjoy my dreams its like trying to work out a problem. i really don’t know what else to mention. It would be greatly appreciated if you could give me your opinion. Thanks.

See my response to these two questions below:

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Schizophrenia is a serious mental illness characterized primarily by the presence of psychotic symptoms, usually on a chronic basis, although there is frequent waxing and waning of symptom severity observed. The term "Psychotic" refers to a condition where reality cannot be reliably distinguished from fantasy. Psychotic symptoms are usually described as having two related aspects. The first aspect has to do with a dysfunctional perceptual process known as hallucination wherein people perceive things to be happening which are not actually happening. The most common form of hallucination is the perception of hearing people (or non-human entities such as an angel, devil or God) speak out loud to you. The second aspect of psychosis is known as delusionality, which has to do with the development of beliefs that are not based on reality, or upon shared culturally derived beliefs. Various kinds of delusions occur commonly, but a certain level of grandiosity (e.g., an unrealistic belief in one’s own importance) is common. Some people become delusionally paranoid and grandiose, for example, and come to believe that they are being hunted by sinister forces who are out to harm them. Other people develop an erotomanic delusional belief system, and come to believe that someone is in love with them, who isn’t actually. Delusions are often labeled different depending on whether they are semi-plausible or bizarre. It is semi-plausible to be the subject of a man hunt by the FBI, or that one’s wife might be cheating on you. It is bizarre when alien beings are beaming knowledge directly into one’s head with a thought ray.

Though perhaps a family of diseases with different origins rather than a unitary disease process, Schizophrenia does seem to run in families. Studies show that first order relatives of people who have the illness are more likely themselves to develop the illness, or to develop related but less severe illnesses. Because the overall incidence of people developing Schizophrenia is low in the first place, however, it is still unlikely, overall, that the average first order relative of a person with Schizophrenia will develop the condition.

Schizophrenia can occur at any age. There are children with schizophrenia, as well as people who did not develop the condition until much later in life. However, there is a sort of "most common" age of onset, namely during young adulthood during the late teens through the middle twenties.

The person who wrote the first letter does appear to have some cause to be concerned that he may possibly develop Schizophrenia, given the likelihood that his first order relatives may have had the illness, based on the other information he has provided, it does not appear likely that he has the condition at this time. He denies any odd perceptual experiences such as hearing voices of people who aren’t there. He does report feeling paranoid at times, and he does talk to each other, but these are things that normal people do and experience, and not necessarily anything to be alarmed about. Though this individual may be at elevated risk due to his family history, and though this individual may not be through the most frequent period of onset with regard to his age, the chances he will develop schizophrenia are still pretty low. It’s not surprising that he is fearful, but based on what he has written, he doesn’t appear to have much to worry about at this time. The future, as always, is unknowable.

The first author asks whether there are ways to prevent Schizophrenia from occurring. I don’t know the latest research on this topic, but I would recommend that anyone seriously concerned about such a risk consult with a psychiatrist. I know that courses of antipsychotic medication have been offered to at risk youth in the past to see if they might have a prophylactic effect; the idea being that if an initial psychotic episode can be prevented from occurring, an at risk person might be prevented from developing the most disabling and chronic aspects of the illness. I do not know the results of this research, however, or whether the basic idea ever panned out.

Where the first author comes across as worried, the author of the second question comes across more as paranoid. He describes a feeling that the universe is out to get him; to harm him in some fashion. He describes periods during which he is embedded in this perception that the universe wants to harm him, and then periods where he has some perspective on it and sees that it is a paranoid perception. He describes some other things as well, such as the fact that he has scored well on an IQ test in the past, and that he has vivid, creative and violent dreams, but it is harder to make sense of what these facts might mean. Lots of people have vivid and violent dreams these days ( The prevalence of first person shooter video games has seen to that). And intelligence and Schizophrenia are only weakly related to one another, if at all.

Paranoia is often a prominent feature of Schizophrenia, but the presence of the one does not inevitably require the presence of the other. Psychosis can be associated with several other mental illnesses, including mood disorders, drug problems and cases of dissociation. It is also not clear that the level of paranoia this young man is describing rises to a truly psychotic (and thus diagnosable) criteria. It is impossible to know if this young man has Schizophrenia, or some other psychotic illness or reaction, but it is at least plausible that this is the case. It would be a good idea for this second young man questioner to see a psychiatrist for an accurate diagnosis and possibly for treatment if that is warranted.

We have an entire topic center devoted to providing information about Schizophrenia which both of these young men, and anyone else interested in Schizophrenia and psychosis should consider reading.

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