A psychologist with schizophrenia talks about what helps him function effectively

Taken from the book: “Abnormal Psychology” by David Homes.  Harpers Collins. ©1991.

Frederick J. Frese III is a psychologist who has struggled with schizophrenia for over 20 years. He described the onset of his symptoms and talked about his occasional “breakdowns”. Most of the time, however, he functions effectively, and in the following comments he describes some of the things that help. Dr. Frese believes it is important that the person whit schizophrenia be aware of the nature of the problem in order to develop effective coping strategies. He said:

Person whit schizophrenia needs to carefully study how they function. Until they can identify their deficits, it is very difficult to start building compensatory mechanisms that will enable them to function better… persons recovering from schizophrenia should be able to identify, and be on the lookout for, the sorts of persons, places, and things that can cause the type of stress that may precipitate their breakdowns. They should know to get to environments that are helpful.

Just as a diabetic must take action to control his or her blood-sugar level, persons recovering from schizophrenia must learn to monitor and take measures to counteract an imbalance in subcortical neurochemical activity. But unlike diabetes, schizophrenia seriously interferes with rational processes, and once the irrationality begins, the person may have great difficulty in acting in a rational or responsible manner.

To overcome the irrationality, Dr. Frese also emphasizes the importance of feedback from others:

Because of our disability, it is very difficult for us to know what we do that normal do not understand. Therefore, it is very helpful to have a trustworthy normal around to let us know what it is about our thoughts that perhaps it would be better not to share with everyone else. In my case, my wife constantly gives me feedback whenever I am saying or doing things that normal people may consider bizarre or offensive. Some things are rather obvious. If you are hearing voices, it is generally best not to talk back to them while normal are around. If your thoughts are dominated by the importance of the colors or similar sounds in the environment, you probably do not want to reveal too much about this to others.

Whit help, other disabled persons learn to compensate for their disabilities and frequently lead dignified, productive lives. The blind learn to use canes and seeing-eye dogs; those with limited use of their legs learn to use crutches and wheelchairs. For the mentally ill, however, the parameters of our disability are often not easily defined. We need help and feedback so we can understand exactly the nature of our disability.

Whit regard to the results of psychological testing, Dr. Frese said:

Assessment results that us we have “gross pathology”, “extreme confusion” or “diffuse brain damage” are not really helpful. We need very specific information. Perhaps new assessment instruments need to be developed, possibly with input from us, so that we can better learn how it is that we are different from others or where our psychological blind spots are.

Unfortunately, feedback is not always enough. Sometimes the symptoms overwhelm the person, who then loses the ability to function. When that occurs, some flexibility on the part of other people in the environment is necessary. Dr. Frese commented:

Schizophrenia tends to be an episodic disorder. We are going to have periodic breakdowns. This makes holding employment very difficult because the usual practice is to terminate employees who require frequent periods of leave. Work for us should be structured so that our disabilities are taken into account. Many of us are well educated and/or have useful skills when we are not having episodes. Why can´t jobs be structured for us so that our episodic breakdowns do not automatically result in our loss of employments? As with those in the general population, we like and needs to be a little more flexible in understanding that we are going to behave strangely from time and there are going to be time when we do not function well at all.

"Abnormal Psychology" by David Holmes. Part 4, p. 303. Case study 15.1.