If you were going psychotic and hearing voices, you would not even know they were voices. When you first heard them, if you were in your home, you would go around looking for the person hiding in your house because it would sound exactly like a person talking in your home. You would search everywhere, under the bed, behind the couch, everywhere someone could hide.
I spent a year hanging out with a paranoid schizophrenic every day. He heard voices all the time, but he was convinced they were coming form the radio or the vents or wherever. For instance, he kept demanding that we take apart the radio in my car to find the recorder in there that was putting out the recordings.
When he first came over to my house, he said he heard someone down in the cellar, so we went down there to look, and there was no one there. I thought it was pretty weird at the time, and I did not know what to think of it, as I had just met the guy, and I did not know he had schizophrenia.
After I hung around with him a while, I started to put two and two together and realized that he was slowly developing paranoid schizophrenia. I figured this out because I had been studying mental illness for 25 years. I had never dealt with a paranoid schizophrenic up close and personal like that before, but he seemed to be a textbook case based on everything that I had read.
He was 28 years old, and the symptoms seem to have started when he was about 23 and at college. There is often a long slow prodrome with paranoid schizophrenia. So while it does have a later onset often in the late 20’s and early 30’s, there has often been a long slow prodrome going on characterized by slow deterioration for even up to five or ten years.
Paranoid schizophrenics do seem to function somewhat better than the rest of schizophrenics, possibly due to this later onset. Some of them have even married, had children, started on careers or opened businesses when the disease hits, so they have had some illness-free years in which to develop their personalities. Hence the personality is more intact in paranoid schizophrenia than with the other forms.
Later I would be over at his place, and he would hear the voices coming out of the vents. He lived with his Mom, and he insisted that his Mom put a recorder in there to harass him, and he wanted me to help him take the vent apart to “look for the tape recorder.” He had a lot of arguments with his Mom about her “putting the recorder in the vent.”
It was very difficult to deal with the guy because he heard the voices, and they were so loud and clear that he would whip around and say, “You hear that?” and he would point to the car radio or the vent or wherever. I always said no, and it was making him mad because the sound to him was clear as a bell, and it was absurd that I could not hear it. So he was always accusing me of being a liar and saying I did not hear the voices when really I did.
After a while, I started making excuses and saying things like I had a problem with my hearing.
The problem is do not want to agree with the person when they say they hear voices because you are just reinforcing their craziness, and pretty soon you will be working with the person to take your car radio apart to “find the microphone.”
Furthermore, it’s best not to reinforce their delusions either because you will just strengthen the craziness.
Actually it probably would not hurt to say you hear the voices too or agree with their delusions, but I always worried that it might make them worse.
For instance, a schizophrenic says someone is persecuting them. Well, you can either agree or not agree. If you agree, you run the risk of reinforcing their belief, and they might get so reinforced, convinced and angry that they assault the person.
Another problem is that I would take him places with me sometimes, say to my doctors appointments, while we were running about trying to get him an apartment. While there, say as we were leaving, he would insist that someone in the waiting room had said some particular insult to him. Actually no one had said anything to him, much less the insult that he heard. He would want to go back in the waiting room and challenge the person over the insult, and it would be rather difficult to convince him not to do that.
He had done very well in college and was a great basketball player but not such a good student. At one point, he had moved into an apartment with other people, but that all ended when he accused them of messing with him through the walls of the apartment. He also accused people of breaking into his car. He would go out to his car, and it would seem like someone had broken into it or messed with stuff inside. He eventually had to move out due to this, and he moved back home to live with his Mom.
I kept trying to get him into an apartment down in Fresno, but things kept falling apart. He would get into the new place, and it would have the damn recorders in it too, and he would accuse the guy was rented it to him of putting the recorders in there. I met one of the men who rented to him, and he was dumbfounded, shaking his head, and could not make sense out of my friend at all. His attitude was “Good God, what the Hell is the matter with this guy!?”
My friend was a mulatto, and he had a very charming personality along with being very goodlooking. Everywhere we went, he would walk up to young White women and chat them up in his usual engaging manner, and they would usually be very interested in him. He was quite a charmer and could really talk to the girls. It was insulting as the girls would always rather talk to the insane guy than to me who was not nuts, although I was in my 40’s at the time I must admit.
If you were out in public with him, and he was chatting up women or whatever, he would typically not seem crazy at all. Instead he would seem to be a perfectly normal, charming, extroverted guy.
I was never afraid of him. Everyone kept telling me he was dangerous, and they were all trying to get me to get rid of him as a friend. He didn’t seem violent to me, and I can read people pretty well. He did yell a lot but not usually at me – more at the folks who were “persecuting him.” The whole time I was with him, I would be looking at him and trying to read his mind (I am a very good mindreader) to figure out if he was going to do something violent. I never got any vibes off of him that he was going to be dangerous, so I wasn’t really worried about him.
However, people close to me eventually convinced me to ditch him, which was not easy. I saw him a few times later around town and gave him a couple of rides. Later he had somehow gotten a job at the local supermarket, but by that time, he was deteriorating even more, and he had become very quiet and would almost ever talk.
I later heard that he was down in my city roaming around on the streets and hanging out at the mentally ill drop-in place.
My friend would never admit to being even slightly mentally ill, and after a while I stopped confronting him about it. But I did try to get him to see a psychiatrist I knew under the guise of giving him some pills for his nerves to calm him down along with some other phony excuses. She was good at dealing with psychotic people who would not admit they were ill, and she would often succeed in surreptitiously giving them some antipsychotics under the guise of calming their nerves or other phony excuses. You have to be a bit sneaky with these people when they will not admit they are ill. I have known people who had psychotic or seriously mentally ill relatives who they were considering dosing with antipsychotics in their orange juice or coffee. I actually think that would be a morally proper act.
The problem in psychosis is that the person typically has no idea that they are ill. Whether they do not want to admit for psychological reasons such as stigma or whether they can’t realize they are ill because psychosis blinds the person to the fact that they are ill, I am not sure. I suspect some of both. Some people are episodically mentally ill, and when they get better, they will often not admit that they had been ill due to stigma or ego reasons.
The problem in psychosis is that the part of the body that is needed to recognize that you are ill is itself sick. The person can’t figure that they are ill because in order to do that, you usually have to be at least somewhat sane. In fact the presence of insight is an excellent diagnostic feature in mental illness, and the greater the insight, the better the prognosis.
Insight is also a very serious problem in Bipolar Disorder, even in the milder phase known as Hypomania.