On 'Self-Awareness' and Schizophrenia

Some people with schizophrenia think their voices and delusions are true. I have been on my medications for years now, and even I have to tell myself that I am not that popular.

You probably think that sounds simple enough. If I don’t do that, I do my best to ignore them. I believe that some people with schizophrenia do hear positive voices in their head. I thought I could hear the voice of God, and it was God who told me to refer myself to mental health at Fort Irwin, California. I also thought it was a voice of God who told me that I would get the help I needed in my second stay in the psych ward. Believe it or not, I think it was that voice that helped me become self-aware — to question what I was feeling or in some cases to ask if something was really going on.

I sometimes hear negative voices, too. They can be insulting and they can tell me to kill myself. This is part of the struggle. It’s something I don’t like to talk about. When I hear these negative voices, I do my best to stimulate my brain and be active, or I try to ignore them.

The realization that what is going on in your head isn’t really going on is a tough pill to swallow. For a doctor to tell a patient to be self-aware or to tell them that the voices aren’t real can be taken the wrong way. So waiting is important. Wait until the medication takes hold, and then even the patient will wonder why the voices and delusions have subsided. I felt like I received an epiphany when this happened to me. It was cathartic.

I am sure doctors and other people in the mental health field struggle with this. I never had a person in the mental health field tell me to question what was going on inside my own head until later on in my recovery. I never had anyone, for that matter, tell me that my delusions weren’t real. I think if a doctor had told me my delusions were not real, I probably wouldn’t have believed it.

Maybe there should be better “bedside manner.” I respect doctors, but maybe instead of putting themselves on a higher level, they should be a friend or maybe a neighbor. How can doctors do this? Maybe they should start a meeting by talking about what movie they just saw. Talk about the last football game they just saw on TV. If they don’t like sports, talk about their kids or a nephew or niece. They may not want to go into talking about the holidays because even people without a mental illness can feel lonely or depressed during these times. In conclusion, build a relationship. Show some sensitivity.

I have had some doctors (don’t want to mention any names) that I felt the less I say the better I am. This attitude will not help the patient or the doctor. There are some doctors who feel numb to the mental health field. They may even feel that it is all the patient’s fault. I ask all doctors and staff of the mental health field not to give up on us. We need you to be optimistic. Some of you in the field know we do get better.

You may have heard about peer counseling. This is a good program. The patients who have maintained their stability and stayed on their medication for awhile should be invited back to the psych ward. This would help the patient who has stayed on their meds because it will show them how far they have come. This would help the patient who is actually in the psych ward because the patient sees the peer counselor as someone who has walked in their shoes. They could discuss their past delusions with other patients as long as it isn’t stressful. Both people may find some things in common. Both would experience hope by seeing how far they can go and how far they have gone. Imagine, inspiring a mental health patient into going into the field of public service. Here are examples of questions that a peer counselor/public servant could ask:

• “What medication do you take?”
• “How long have you been in here?”
• “Do you know it does get better?”
• “Do you write in a journal? You should start.”
• “How’d you sleep?”
• “Who’s your doctor?”
• “Everyone falls; it is whether or not you can pick yourself back up again.”
• “You know you will have to stay on your meds.”
• “No one is after you; you are safe in here.”
• “You know if you are not compliant, they make you stay longer.”

To name a few conversation starters. Of course, the staff should make the decision whether or not the patient in the psych ward can handle a visitor. I assure you, it is possible to feel lonely in the psych ward even when you are around people who have some of the same symptoms you have. It would be nice to have some positive energy on the other side of the table. How can doctors be self-aware? I know that psychiatrists are in high demand. There is probably not enough to go around in some cases. The ones we have are probably overworked.

Dennis Leary said, “Happiness comes in short doses.” I think that means grab hold of the simple things. That can be a diet soda, a cup of coffee or tea, or an observing nature when you have the chance. Maybe they should have a break room that plays cool jazz (for those of you who don’t know too much about cool jazz, you should buy Miles Davis’s “Kind of Blue” to start) or find some other way to relax when you take a break. Anyway, for those of you in the mental health field, thanks for your service. Finally, we all have to be self-aware in our little piece of the world. We all have to know what is going on in our environment whether it is in our minds or outside. This will help us be mentally strong and emotionally strong.

This piece originally appeared in the Schizophrenia Bulletin, Volume 39, Issue 3, May 2013, Pages 483–484.