My sensible, confident son was in his first year of graduate school at MIT when he told me on the phone, “When I walk on the street people are making fun of me—in an organized and systematic way.” I felt weak with fear and dread and loss. And I had no idea what had hit him.
I didn’t know that he was reporting common symptoms of schizophrenia and related illnesses. I didn’t know what schizophrenia was, or more generally what severe mental illness was.
Aaron’s voices were always mean. On the street or at the laundromat he was harassed. In his classes he heard other students insult him. His food and coffee tasted bad because sensory perceptions, including perceptions of taste and smell, are distorted by schizophrenia. To him the unpleasantness of his coffee was an indication that he was being poisoned, or perhaps surreptitiously fed the medication he refused to take. He also found the air smelled strange at times, and so thought it was toxic. He believed newscasters were speaking directly to him, that people “knew things [about him] that nobody should know.” This intelligent, levelheaded young man could no longer make sense of his experience. His paranoia made his world threatening and malicious. Delusions dominated his thinking. The saddest delusion, for me, was his belief that his father and I were cooperating with the people who tormented him.
He would telephone and demand frantically that I “stop it.”
“You have to stop, Ingrid. You can’t do these things. It’s not legal.”
“Do what?” I would say.
He always answered in the same baffling way: “You know. You and Arthur are complicit. It’s criminal, what you’re doing.”
“What is it you think we’re doing?”
“Don’t pretend you don’t know. I know I’m being drugged. If ever I get the upper hand—things will be different.”
“Aaron, we aren’t doing anything. You’re being crazy.”
“I’m not simply mad. If there was any way, any way, I would exercise it to seek reparations for the things being done to me. But I’m powerless. It’s like I’m in a police state.”
It was wrenching to hear his words, and his threats were worrying. “You could choose to take medication,” I said. “You’re not being drugged.”
“I’m not sure you realize there are no choices.”
Trapped in the circularity of Aaron’s accusations and my questions, I was utterly frustrated—by his refusal to explain, by his rejection of medication, and by the impossibility of satisfying him. There was an element of truth in his statement that there were no choices. If he had to live with his predicament, we had to also.
When I began to read about schizophrenia, I learned that Aaron’s paranoia, his hallucinations (that is his voices), and his delusions were all caused by changes to his brain.
Even his inability to recognize his own illness, called anosognosia, is caused by damage to the brain (unlike the psychological defense we call denial). This inability, or failure of insight, has been recognized for many years in those with brain damage, for instance in the stroke victim who insists he can control a paralyzed leg. Only since the 1990s has it been studied as an issue for people with schizophrenia.
Most of us are well aware of alterations in our mental abilities: we notice when we’re intoxicated or forgetful or dulled by fatigue. It’s hard for us to imagine that we might experience major changes in sensory perception, much less hallucinations, and fail to register that something is amiss. But Aaron’s illness blocked him from recognizing his illness. As a result, he believed the evidence of his senses, filtered through his paranoia. If he heard voices, then people were talking. If food or coffee tasted bad, there was something wrong with it. If newscasters seemed to him to know more about him than anyone outside of his family, his family was giving them information. These interpretations of mine are as close as I can come, and can only be the crudest approximations of Aaron’s understanding. My intention is to show the catch-22 that so many people with schizophrenia have pointed out: when you have a brain disorder, your only tool to deal with it is your disordered brain.
(There’s a good description of the problem of anosognosia and of studies comparing the brains of individuals with schizophrenia with and without anosognosia at http://www.treatmentadvocacycenter.org/key-issues/anosognosia/3628-serious-mental-illness-and-anosognosia)