Thursday, November 21, 2013

Schizophrenic doesn’t mean ambivalent…and other misconceptions

Elizabeth Zelvin

As a mental health professional, I can’t help getting irritated when novelists allow characters to describe themselves as “schizophrenic” when they really mean they simply can’t make up their minds. And many do. It’s one of the pet peeves that shrinks who write mysteries share when they find themselves on a panel together at Bouchercon or Malice.

“Call me schizophrenic,” Cinderella said, laughing gaily. “One minute I want to go to the ball, and the next I think I really need to stay home tonight and give the house a good cleaning.”

Schizophrenia is a thought disorder. It’s not reversible, and though it can be managed with medications, they don’t work in every case. Schizophrenics have auditory hallucinations, ie they hear voices. When you see them talking, apparently to themselves, in the street, they’re actually holding a conversation with those voices. Here’s a true story, part of a poem I wrote while interning at a psychiatric day center while studying for my social work degree. It’s called “The Limitations of Therapy,” and it appears in in my book, Gifts and Secrets: Poems of the Therapeutic Relationship.

I want so much to touch her
to hold her hand
to hold her in my arms
leaning forward in my chair
I say, so gently, You know
you don’t have to listen to those voices

That’s just what they say about you!
says Maria

One difference between the schizophrenics and today’s ubiquitous cellphonistas is that one group is delusional: they think that nobody can hear them as they discuss their love life, their financial concerns, and their medical issues on crowded buses and lines in the bank or post office. Hmm, which group would that be?

If you really want to write a schizophrenic character—or figure out whether one you’re reading about rings true—look for other thought-disorder symptoms such as flight of ideas and ideas of reference. Flight of ideas means the schizophrenic’s speech may be firmly tethered in reality at the beginning, but gradually become more and more incoherent or illogical until it’s obvious something is very wrong. Ideas of reference are the extreme of taking things personally. Schizophrenics think the guy talking on their TV is speaking directly to them. Paranoid ideas are a form of ideas of reference: they think the two people holding an intense conversation at the far end of the room are talking about them, and it’s not a pleasant conversation.

The other thing that schizophrenic doesn’t mean is dissociated. Not only novelists, but some mental health professionals as well, still think that the most severe dissociative disorder, dissociative identity disorder (DID)—formerly called multiple personality disorder—is rare.

“Sometimes I’m very vibrant and bubbly and outgoing,” she said, “but I’m really a very shy person. I’m schizophrenic that way.”

Nope, that character is neither schizophrenic nor dissociated. Professionals who work with abuse survivors—and that includes many alcoholic and drug addicted people—know that DID or some lesser degree of dissociation is common among those who experienced sexual trauma as children.

How does a five-year-old cope with being raped by a parent? By going far, far away in his or her mind, so that the abuse is happening to somebody else. One split-off part of the mind may remain a child, while another may become an icily unemotional, supercompetent adult. I’m oversimplifying, but that’s the gist of it, and it’s a powerful and deeply rooted system of psychological defenses.

It may be hard even for therapists treating clients with DID to remember that all the personalities, called alters, are part of a single human being who needs to be helped first toward co-consciousness (not all what one client of mine called “the parts” are aware of the others) and then toward integration. Getting to meet different personalities may seem cool, but having a client suffer an abreaction—a kind of flashback in which he or she becomes that terrified child being molested, even tortured—is one of the scariest, most challenging situations a therapist can encounter. A multiple who wasn’t traumatized as a child or who can snap out of it at will is not a realistic character. A therapist who gets emotionally involved with one of the alters and wants to save it from “dying” is not a very good therapist.


Kate Gallison said...

I heard a rumor that some of our Lambertville schizophrenics are being issued cell phones so that they can blend inwith the general population while talking to their voices.

Elizabeth Zelvin said...

LOL, Kate. :)

Susan Oleksiw said...

Thank you for this important post. One of my relatives was diagnosed with schizophrenia as a young man and he was especially sensitive to the many slang terms people use--crazy, loopy, lunatic, off-ones-rocker, etc. He nudged us into a deeper awareness of language and its impact on others.

Julie Lomoe said...

Excellent post, Liz. Misuse of the term "schizophrenic" has long bugged me as well. Most often I hear people use it to describe "split personalities," which you correctly describe as dissociative identity disorder. The protagonist in my nearly finished novel has D.I.D., but he's also a vampire, so I don't have to be slavishly accurate.

Anonymous said...

Thank you for this very important post. Most people are very ignorant and discriminatory against people with this disorder. My Brother was affected when he was young and suffers from societal discrimination every day of his life. I appreciate your bringing forth the truth. Books that use this disorder as a joke are authors I never return to read again. Its representative of the ignorant society we live in and how the mentally ill suffer discrimination. As a advocate and care taker for my Brother I find the slang terms offensive and they have a terrible impact. Thank You.