One of the many purposes of this site is to enlighten people about human psychology and in particular about abnormal psychology or mental illness. Even though most of us shout to the heavens about how sane we are, for some reason, we are terrified of discussions of mental illness. I notice that whenever I bring up the subject, it very quickly gets shut down.
There’s something strange going on. People are very afraid of mental illness, even the most minor, harmless and neurotic kinds. The psychotic stuff makes people very nervous too.
I don’t get it. People like me who are fascinated by mental illness and can talk about it all day long don’t understand. What’s the worry? Psychotics are frightening to be around, but not as much as you think. Anyway, if you’re just talking about them, it’s not like the conversation is going to jump out and kill you. Fear of discussing neurosis must be based on the idea that most of us are afraid that we might become neurotic, or more neurotic, ourselves at some point.
It never fails to bother me that most folks can’t tell the difference between neurosis and psychosis. Granted, there are some borderline folks, but generally the distinction is quite clear. If you have spent a lot of time around the two types, it’s like they are people from two different planets.
I remember 25 years ago, I was having a lot of anxiety issues. I thought I was mentally ill and recovering from a nervous breakdown, which I was more or less. So I went to this meeting of a group called Recovery.
Well, it turns out it was for schizophrenics. There were two normals running the show, there were the schizophrenics, and there was me. As nuts as they were, the schizophrenics very quickly figured out that I was not one of them, anxious as I was. The leaders figured it out too. It’s funny that people who are totally nuts can make obvious distinctions that supposedly sane folks cannot.
I do a lot of work with folks who have OCD, since I have it. It’s quite common for these people to tell me that people think they are schizophrenic, and they are often diagnosed with various forms of “psychosis,” by idiot shrinks.
People with OCD can go psychotic, but it’s rare, they are not all that nuts, there is extremely prominent anxiety, it’s pretty easy to pull them out of it – usually only after a few weeks or so – and of course they are never dangerous. It’s just some guy sitting in a chair shaking so hard he can hardly get out of the chair to go outside.
As Freud noted in his class study of the Rat Man, “They are not crazy. Nevertheless, OCD is certainly a crazy illness!” Freud was very insightful. “They are not crazy,” – in other words, they are not psychotic. “It’s a crazy illness,” – it’s very strange, and when they are very ill, they appear psychotic. The Rat Man was a wild case of OCD. The guy had an obsession that there were rats crawling into his anus. Of course that’s impossible, and most people figuring something who thinks that way is psychotic. But the Rat Man was not psychotic.
OCD one of the nuttier of the neuroses, but only on a surface level. This is because when it gets really bad, the anxiety and mental distortion are so extreme that an OCD person appears psychotic. However, a good clinician can pretty quickly figure out that they are not.
Let me give you an example.
An OCD guy I know, in a bad episode, was afraid to turn around in the shower. Why? He was worried that he was a child molester (though he wasn’t, and none of these folks ever molest anyone), and in the shower, he would get the idea in his head that there was a naked 9-year old girl in back of him. Logically, he knew that she wasn’t there, but OCD is powerful form of magic, and it almost convinces you that its bullshit is true. So he was afraid to turn around, because he was afraid that the naked 9 year old girl might be there.
To most people, that’s psychosis. Except that it’s not.
A schizophrenic person simply says matter of factly that when they take a shower, there’s a naked 9 year old girl in back of them showering with them, and this bothers them.
I knew another guy who had severe OCD that was not responding to treatment. He had harm OCD, with thoughts of attacking and killing people in general and those around him. He was also a dwarf with severe physical problems, which made his thoughts even more ludicrous. His Mom gave him a knife at one point and said, “Just do it! Stab me!” Of course he didn’t. They never do these things.
Why they never act on these horrible thoughts is an interesting subject, but it’s best for another post.
Anyway, the guy had various fears, and at one point, he got an intense worry that he was The Devil. OCD was telling him that he was The Devil. Most people will say this is psychotic, but I doubted it, though I found it disturbing. I questioned him further. “You know you’re not really The Devil, right? Or at least it’s unlikely you are?”
His response was interesting. “Logically, I know that,” he said. These people often say that, and it’s quite curious. It’s as if the mind is split between a part of the mind that knows this is all bullshit and an OCD part, terrifying and full of gale-force anxiety, that is telling you all sorts of scary crap. The OCD part has a powerful pull to it due to the psychological force of anxiety and fear, which can actually seem to bend emotions, self-image, reality and even perceptions.
At that point I knew the guy wasn’t psychotic, and I blew it off.
In contrast, a schizophrenic person simply reports that he is The Devil. Maybe it bothers him, maybe it doesn’t, but that’s just the way it goes. He’s describing obvious reality, like the sun rising in the east.
It’s hard to explain logically the difference between the two experiences, but if you’re intelligent and think about it a while, you should be able to figure out the clear-cut difference.
Here we see an example of something that looks like schizophrenia, except it ‘s not. It’s some kind of anxiety disorder. I’m not sure which, but it may be OCD:
Like I stated in my previous thread, I have not yet been diagnosed with anything because I have yet to see a doctor. I was wondering if there is any medication that one could recommend for me. This is the third week I have really been feeling strange, and I don’t know if I should start on medication yet even if a doctor recommends it.
My symptoms are:
Always hearing a different song in my head when my mind is idle (I know that it is in my head, not external).
Feeling uncomfortable talking to people or making eye contact (this comes and goes, really bad after a night of drinking, not bad after a good workout and sauna).
Depersonalized feeling, even when I am talking and joking around with friends, I feel outside of myself in a way, always worrying that I could be schizophrenic.
Forgetful (always have been, recently a bit more then usual).
After a recent night of drinking, I even started to see objects sort of move or grow or something in the corner of my eye or only when I concentrate on them (this isn’t 24/7 tho).
There are a few things going on here. The person is worrying that they might have schizophrenia. A person with schizophrenia typically does not do that. Suppose your name is Jim Brown. Do you worry that your name is Jim Brown? Of course not.
Schizophrenia so contorts reality that the person does not know that they are ill. They don’t have the foggiest clue. The schizophrenic reality is simply their reality, and they don’t think it’s an illness. It’s just what’s happening.
When they get on drugs, they get much better and start figuring out that they are ill, but that’s different. Schizophrenics often have to rely on loved ones to tell them when they are going psychotic because they don’t have the foggiest clue when they are ill and when they are not. Some can sort of figure it out, but that doesn’t mean that it isn’t real.
Schizophrenic hallucinations are quite real and are not the sort of anxiety-driven nonsense that this excessively introspective individual is experiencing. If you worry that you’re hearing things or seeing things and start overemphasizing your perceptions and freaking out about them, you’re probably going to start thinking that you are seeing things and hearing things.
The visual hallucinations will often be peripheral vision things, but even normals see weird stuff out of the corners of their eyes all the time. Normals just re-analyze it, figure out what it really is, and move right along.
Sane people often think they hear things too. I’ve noticed that sometimes in the rain, I think I hear stuff. It was raining the other night in the parking lot, and I thought I heard someone yell, “Bob!” I turned around, and of course no one was there. I thought about it a little bit and then just drove away and decided not to think about it anymore. I know enough about psychotic hallucinations to know that that was not one. Once I start hearing stuff all the time, maybe I’m going to get worried, but until then, forget it.
These anxious types are overhyping their sensory organs, worrying way, way too much, and misinterpreting all sorts of normal sounds. Probably anyone can do this if you work yourself into a nutty enough frame of mind. Whatever it is, it’s not schizophrenia, nor is it psychosis.
It’s basically an anxiety issue, not a psychotic issue.
In general, these are different trajectories of craziness. One dichotomy is anxiety/psychosis. You’re either going crazy in an anxiety way, or you’re going crazy in a psychotic way. True, psychotic people can get anxious, but it’s for different reasons than the anxiety-disordered. You might get pretty anxious too if you were convinced that the Mafia had a murder contract out on you! See what I mean? The anxiety-in-psychosis and the pure anxiety disorder are coming from fundamentally different places.
Later in the thread, one fellow adds this helpful bit of diagnostics:
This doesn’t sound like schizophrenia. From what you’ve said it sounds like depersonalization disorder with comorbid social anxiety and OCD. It isn’t common, but this does occasionally occur with heavy cannabis use. It is also notoriously hard to treat. Maybe a benzodiazepine for the anxiety. Antipsychotics don’t usually work very well for depersonalization, but some individuals respond to them. I think the standard treatment is SSRI’s with a benzo. Sometimes Lamictal. Lamictal and low dose benzos would have the least side effects.
Sounds about right to me, but I’m no clinician.
Also later in thread is another guy with similar symptoms who thinks he has schizophrenia, but he doesn’t. He probably has a condition like what the fellow above has offered for a diagnosis.
Schizophrenia is a pretty clearcut illness. People who are actively ill are pretty easy to spot and typically don’t make a lot of sense when they talk. I can’t understand why someone would accuse a person with a run of the mill anxiety disorder of having something as complex and devastating as schizophrenia. The smartest people can be so damned ignorant.