The Nitty-Gritties of Schizophrenia
Last week I covered what schizophrenia looks using real-world experiences. This week, I’m going to dive into the disease on a more technical level. As per usual, none of this information is to be used to diagnose or treat anyone, but as a tool for writers to create characters who are close to life as possible and not mere caricatures of mental illness.
Life with schizophrenia is hard for the person experiencing the symptoms as well as the family providing care. But consider this, there was only one treatment plan for schizophrenia 100 years ago: institutionalization. Although institutionalization is still part of treatment, it is often not the only part. Thanks to new treatments and medications, many people with schizophrenia live at home or in group homes in the community. Some even have jobs. I’ll be the first to say that mental health has a LONG way to go, but I believe it is important to keep in mind where we came from.
A person with schizophrenia may manifest the following (Videbeck p. 252):
Ambivalence: Holding seemingly contradictory beliefs or feelings about the same person, event, or situation.
Associative Looseness: Fragmented or poorly related thoughts and ideas. Thoughts are tangential—not flowing from point to point but all of the place. For example, one sentence might be about baseball and the next about frogs in a pond without a coherent link.
Delusions: Fixed false beliefs that have no basis in reality
Echopraxia: Imitation of the movements and gestures of another person whom the client is observing.
Flight of ideas: Continuous flow of verbalizations in which the person jumps rapidly from one topic to another
False sensory perceptions or perceptual experiences that do not exist in reality. These can be auditory (voices), visual, smells, and tactile (feelings, like skitters across the arms).
Ideas of reference: False impressions that external events have special meaning for that person. (The person on the TV is talking to them specifically.)
Perseverations: Persistent adherence to a single idea or topic; verbal repetition of a sentence, word, or phrase; resisting attempts to change the topic.
The above list are considered “Positive Symptoms” as in they are added to the person. Most positive symptoms are treatable, but there are “Negative Symptoms” or symptoms that seem to be lacking in a person that generally linger after the positive symptoms abate. These are them:
Alogia: tendency to speak very little or to convey little substance of meaning
Anhedonia: Feeling no joy or pleasure from life or any activities or relationships (characteristic of depression, but is it any wonder with everything else possibly going on? Geez.)
Apathy: Feeling of indifference toward people, activities and events.
Blunted Affect: Restricted range of emotional feeling, tone, or mood
Catatonia: Psychologically induced immobility occasionally marked by periods of agitation or excitement; the client seems motionless, as if in a trance
Flat affect: Absence of any facial expressions that would indicate emotions or mood.
Lack of volition: absence of will, ambition, or drive to take action or accomplish tasks.
Keep in mind that the person experiencing these bizarre behaviors or thinking patterns may be fully aware of them. I once entered a patient’s room to find her smashing invisible bugs on her bedside table. She told me she knew the bugs weren’t real, but smashing them made her feel better. The extent of the awareness of symptoms is difficult to know since there is a huge communication barrier in many schizophrenic patients. The number of delusions, hallucinations, and their strength are all difficult barriers to break through.
Not every person with schizophrenia will have all of the above symptoms. In fact, schizophrenia is less of a single illness and more of a syndrome. Here are the five major types according to the DSM-IV-TR:
Paranoid Type: Has persecutory (feeling victimized or spied on) or grandiose delusions, hallucinations, and occasionally, excessive religiosity (delusional religious focus) or hostile aggressive behavior
Disorganized: Has grossly inappropriate or flat affect, incoherence, loose associations, and extremely disorganized behavior.
Catatonic Type: has marked psychomotor disturbance, either motionless or excessive motor activity. The excessive movement is not influenced by external stimuli. May also have mutism, echolalia (repetitive nonsensical speech) or echopraxia (imitation of the movements and gestures of someone the person is observing.)
Undifferentiated Type: Sort of a mix of the above
Residual Type: Has a history of one previous, but not current, episode.
Schizophrenia generally starts around age 15-25. There is a genetic component to the disease, but having a genetic predisposition to the illness is not a guarantee it will present. Studies on identical twins show a 50% chance of the previously unaffected twin getting the disease. Through various imaging techniques, we have been able to see that those suffering with schizophrenia have alterations in their overall brain structures. How these came about are still a mystery although some theorize it comes about through viruses, trauma, or immune responses. Basically, the theory is that certain people have a genetic predisposition to get schizophrenia if a certain thing occurs to turn on those genes. For example, a virus comes along and triggers those genes and the brain deteriorates. There’s a similar theory regarding the onset of juvenile diabetes.
While there can be a sudden onset of schizophrenia, most people generally develop signs and symptoms slowly over time. It starts with social withdrawal, unusual behavior, loss of interest in school or work, and neglected hygiene. Generally, the diagnosis is made when delusions, hallucinations, and disordered thinking begin to appear. The age at which schizophrenia appears often determines the overall impact of the illness. The younger the onset, the worse they tend to do. Also, a slower onset predicts a worse outcome than a sudden onset.
Two years after initial onset, two patterns typically emerge. Either the person continues to experience psychosis and never fully recover (although symptoms may shift in severity over time), or they alternate between episodes of psychosis and near complete recovery.
The intensity of the psychosis also seems to diminish with age. Some may be able to function, live independently, and succeed at jobs with stable expectations and supportive work environments. Most, however, have severe difficulty functioning in their communities.
It is important to keep in mind that a person showing initial signs and symptoms of schizophrenia might lose all symptoms within a period of six months. This is called Schizophreniform disorder. Others might experience a brief psychotic disorder where delusions, hallucinations, or disorganized speech may last from 1 day to 1 month. It may or may not have an identifiable stressor or follow childbirth.
There is SOOOOOO much to tell when it comes to schizophrenia and this post has already become way to long. Next week, I’ll be creating a post that brings together all of this information in a usable form.
As I was researching this, I came across this article I found very informative but did not use as a source: http://www.drjack.co.uk/the-future-of-schizophrenia-by-dr-jack-lewis/
Psychiatric-Mental Health Nursing, by Sheila L. Videbeck, fifth ed., Wolters Kluwer/Lippincott Williams & Wilkins, 2011.
60 notes · View notes
Okay so I don't know why people say sex or love is what makes us human. Lots of organisms in nature have sex or mate for life. You know what makes us human? Cooking. Nothing else in nature cooks except humans. Checkmate aphobes. Sincerely, an ace cook.
is that true??
116K notes · View notes
Schizophrenia for Writers
Schizophrenia for Writers
Schizophrenia is probably the most well-known illness, as in most have heard about it, but do people really know what it looks like? Probably the best image brought up by the population is a homeless person walking around in circles talking to the air. It can be startling to encounter someone in the middle of an episode like that. Schizophrenics have a tendency to be more aggressive and hostile than the general population. But after working with several schizophrenics, I have less fear and more sadness for those suffering with this debilitating illness.
I was initially going to crack open my textbook like usual and tell you all the ‘official’ things about schizophrenia, but I’m going to put that off until next week. Instead, I’m going to tell you what I’ve seen from my nursing practice.
My first up-close encounter with schizophrenia in the clinical setting was with Mary*. Mary was a well-known frequent flier of the psychiatric institute I was completing my nursing clinical hours in. I was given Mary’s file to read then sent to speak with her for an hour. Since my previous vision of schizophrenia was of homeless people walking talking to the air, I was quite nervous about even approaching Mary, let alone sitting in the drab stone-walled courtyard on a bench and chatting.
Mary, however, acknowledged me with a courteous nod. She never smiled at me, but she was never hostile or aggressive toward me. Instead, she talked about her life as I would expect anyone too, with earnestness about her life experiences. She had no verbal slurring or strange repetition of words. I could have walked up to this woman at Walmart and never known she was schizophrenic.
Mary told me all about her conniving sister who was hell-bent on destroying her life. If Mary had a chance at getting a job, her sister would call the manager and convince him not to hire her. When Mary tried to move away, her sister followed her to the next state over and continued to keep her under her thumb. Even while she was being institutionalized, her sister was stealing her social security check and paying the people inside to watch her. And the people here—oh she’d tell you about them. Everything you ate or drank was laced in parasites that would eat you from the inside out. The pills were laced too, which was why she was refusing to take hers.
Of course, very little of this (if any) was true. But Mary believed it was. Because everyone was out to get her, she had no hope of securing a good job, good employment, or establishing any lasting relationships in her life.
The next week, I met Todd*, a 20-year-old schizophrenic who, per the staff, had been practically abandoned in the institution by his family. Todd was heavily medicated when I met him. His posture was stooped, his speech was slurred, and his reaction time was comically slow. I asked him about his life, and my heart broke. Todd had accepted his diagnosis and knew he was mentally ill, but with this knowledge came the fact he would never be able to have a family or a real relationship of any kind. Or have sex. When he said this last part, he slapped his hand over his mouth—with exaggerated slowness due to the meds. It would have been funny had it not been sad and possibly true. He drew me a picture before I left. The drawing was the skill of a 3rd grader in markers. I still have it.
Then we have Johnnie*. Johnnie was a patient of mine at the hospital. He came in for a bacterial gut infection which we treated in half a week, but while he was in our care, the psychiatric hospital discharged him. Getting an empty bed in a psychiatric hospital is nearly impossible, but Johnnie was so unwell we could not discharge him to the streets either.
Hospitals are not designed for long-term care of anyone, especially psych patients. Johnnie would walk down the hall outside his room and bang his head against the walls. Because of this, he was forced to stay in his room the whole time. Johnnie would scream and wail so loud you could hear him throughout the whole floor. Patients would complain, but what could we do? He would try to hit nurses and fight. He jammed his hand into his mouth and bit until it drew blood. We tried to place him in an institution somewhere—anywhere, but no one would take him. I don’t know how many combinations of medications we tried, but we couldn’t find the right balance to keep him calm. So what was the solution?
Johnnie was tied to his bed. Still screaming, still fighting. His wrists became sores from pulling against the restraints. He stayed in the hospital like that for a month.
Johnnie was pretty much non-communicative, but we can imagine his thoughts knowing how Mary thought. He thought we were trying to kill him, so we tied him to a bed. That helped.
Johnnie was just a little older than Todd. Similar dreams, similar hopes—like all of us, but this was his life. Terrified, trapped, and being harmed by the people who should be helping him.
Our system is broken.
And so is our view of mental illness. Yes, schizophrenics commit violent crimes more often than the general population, but they are victims of crimes more often too. What if someone raped Mary? She could report it, but would anyone believe her? What if someone beat up Todd? He could report it, but would someone think it was self-inflicted?
I don’t know what to do about our broken system. But I do know, as writers, we have a responsibility to portray characters accurately. So, think on this before you write a schizophrenic character. Are they flat and cartoon-like? Or do they have hopes, loves, and broken dreams as well?
52 notes · View notes
being a writer is hard
32K notes · View notes
Me: …The hell is it called the ‘drawing room’ for? Was drawing really such a wide-spread hobby, and if so, why do I never see any art equipment in the reconstructions of any of these rooms?
Historian, curator and documentary presenter Dr Lucy Wosley: Actually it was originally called the ‘withdrawing room’, as in the place one withdrew to, and where only family and important guests were allowed to enter. The name got shortened over time.
67K notes · View notes
My mom works at a children's home. Had a kid who would freak out and run and hide anytime the house parent got out a can of green beans. Found out later their abuser made them stand on the edge of a chair for hours while they were being force fed canned green beans. But the child was too young to explain all that at the time. Be patient with each other out there. You dont know what other people have lived.
Do you have any triggers?
Jello, Popsicles, Soup Broth.
136K notes · View notes
I know this is a writing blog but the nurse ij me couldnt help but post.
Effects of stopping smoking. Maybe try again?
48 notes · View notes
51 notes · View notes
BRINGING BACK THAT LOVING FEELING . . . ABOUT BOOKS!
A READING SPECIALIST AND DYSLEXIA THERAPIST'S TAKE ON WHY KIDS STOP READING
A Guest Blog by Cheryl King
After 13 years working with mostly struggling readers in some capacity, I have learned and used a plethora of before-, during-, and after-reading strategies, activities, and lessons. And I’m absolutely certain that at least some of them have made an impact on my students.
At this very moment, there must be a group of former students sitting around a reading circle and saying, “Hey, remember when Mrs. King taught us ‘Say Something’?” (Hat tip Kylene Beers, whose literacy expertise has kept my toolbox filled to the brim with fantastic resources.) Or there’s a young lady in a college writing course thinking, “Mrs. King was so right when she told us to read like a writer and write like a reader.” (I honestly can’t remember where I first learned this, but it has spread like wildfire in the world of literacy education.) And most definitely, somewhere there are young men who years ago claimed to be nonreaders and are now saying, “Man, I’m so glad Mrs. King had us do the ‘Tea Party’ before-reading strategy and then taught us Notice & Note.” (Again, hat tip Kylene Beers, and add in Bob Probst.)
No doubt these strategies, plus dozens more, are important when teaching struggling readers, but it’s unlikely any of those fantasy conversations are actually taking place. However, there is something else that may truly make a difference in young readers’ (and nonreaders’) lives. One of the common threads I’ve found as a literacy educator working in public schools is that around sixth grade, many students stop reading for pleasure. Even my eldest son, who grew up with his nose in a book and has never struggled with reading, dropped off of the Reading Is Fun bandwagon between sixth and seventh grade. When pressed for reasons, he always answered that school took the fun out of reading. With standardized reading passages and forced analyzing a story to death, it’s no wonder. But if that’s happening to strong readers, imagine the plummeting interest in pleasure reading of not-so-strong readers.
With this knowledge, one of my topmost goals each year in the classroom was to help bring back the love of reading for middle-school-aged kids. I studied and listened to and read such greats as Penny Kittle and Kelly Gallagher, I researched and learned and tried so many methods to achieving this goal, and I’d like to share three ideas:
1. Book talks and read-alouds
There is almost nothing that gets kids as excited about a book as when their teacher (or librarian or any family member) talks it up. Read an excerpt from your favorite part and tell them why you love it. Whenever I did this in the classroom, students were lined up to check out the book. And don’t be fooled – even teenagers enjoy being read to, though they may deny it. One of my favorite trends from the past few years is Classroom-Book-A-Day, which builds community in the classroom with a pleasure reading of a picture book each day.
2. Make it fun
Anything is better for kids if you turn it into a game. There is a reading game I found online called Bring Your Own Book. Everyone grabs a book, and you draw a card and read it out loud. The card may say something like, “A line from a teenager’s diary” or “A sentence in a fortune cookie,” and everyone flips through their book and skims for something that fits. They now have additional versions of the game, including a Scholastic one for younger readers.
3. Exposure, exposure, exposure It’s important to give kids exposure to a wide variety of reading material, from all genres of fiction to graphic novels to informational texts. One of the ways I loved to do this was to have a “Book Tasting.” I set up my classroom like a restaurant, and on the menu were collections of books of all types and reading levels. Kids got a few minutes at each table to sample the selections and write down their thoughts. In the end they had a bookmark with their top choices to refer to for independent reading time or library visits.
There are myriad other ways to get kids excited about reading, but these have been the biggest hits for me. Now maybe my former students will pick up my debut novel, Sitting on Top of the World, read it, enjoy it, and say, “Hey, remember when Mrs. King taught us that cool annotation strategy?”
Sitting on Top of the World releases June 15 and is available on Amazon and Barnes and Noble. Check out her author website, Cheryl King Writes Things and her TeachersPayTeachers!
9 notes · View notes
1M notes · View notes
Meditation buddy for this morning. Now how am I supposed to get up and moving with someone this cute snuggling with me!
17 notes · View notes
What a great morning for a toddler/mom walk!
10 notes · View notes
One of the best tips for writing descriptions of pain is actually a snippet I remember from a story where a character is given a host of colored pencils and asked to draw an egg.
The character says that there’s no white pencil. But you don’t need a white pencil to draw a white egg. We already know the egg is white. What we need to draw is the luminance of the yellow lamp and the reflection of the blue cloth and the shadows and the shading.
We know a broken bone hurts. We know a knife wound hurts. We know grief hurts. Show us what else it does.
You don’t need to describe the character in pain. You need to describe how the pain affects the character - how they’re unable to move, how they’re sweating, how they’re cold, how their muscles ache and their fingers tremble and their eyes prickle.
Draw around the egg. Write around the pain. And we will all be able to see the finished product.
54K notes · View notes
How I Published my Novel: Using Indie Publishing Presses
If you have been following me long, you will know I wrote my novel, SURVIVING MIDAS, with intentions of getting it published. I went through the process of querying agents, taking part in #PitMad, and checking out countless manuscript wish lists. I am proud to say that my new novel will be release on August 24th, 2021. This is my story.
When I first wrote SURVIVING MIDAS, I thought ‘this is the greatest novel ever! People are going to love it!’ Actually, no. I didn’t think that. I thought it was crap, but it was the best crap I could produce. I had been down this publishing route before, spent more money than I’d like admit, and for nothing. My biggest fear is that it would happen again. So I did what I did not do last time: RESEARCH!
It’s amazing how many things you can learn if you just do a little research. I’m going to take you a bit on the journey that took me several years. If you are an experienced author, this probably won’t be new to you.
First off, I found out the press I went with last time was called a ‘vanity press’—a press that will print just about anything one sends them, but makes it sound like your novel was stupendous! Even if it’s littered with errors, plot holes and inconsistencies! I wrote another blog post on this if you are interested in this (not technically) scam. (click here for previous post). They prey on inexperience writers, getting them to pay for something they should be paid for. It’s a well-known racket too, but I was not plugged into a community of writers, so I had never heard of it. So the very next thing I did was get into a critique group.
I found my home on critiquecircle.com and have made several friends through that website. The site works on a point system where you receive points for critiquing someone else’s work so that you can post your own work. I put my first chapter up for review and immediately found out that it sucked. Like REALLY sucked. It was tough facing up to it, but I learned so much so quick! Then, as you critique other’s works, you begin to recognize mistakes and inconsistencies in your own work as well making you an excellent self-editor.
After getting my work critiqued (and swallowing my pride so I could make changes), I started the tedious and soul-crushing work of querying literary agents. I queried over 150 agents and I still do not have an agent. Here’s the deal: the barrier to entry is super high for writers. There are thousands of debut authors out there trying to gain the attention of a single literary agent. Publishing houses are looking for certain things, usually trending things. If your story is not on trend or so unique that a bookseller will have trouble setting it on the bookshelf, you will not get an agent.
My story is an older young adult novel dealing with drugs, trauma, abuse, and underworld crime bosses. It has a little romance, a few elements of literary fiction, and drama. It’s a lot. It doesn’t fit neatly into a box (and is far more unique than most things on the shelf today IMO). I’m marketing it as an older YA contemporary suspense. But you see my point: there’s not much on the market like it today.
So how did I get a publisher?
I participated in #PitMad on Twitter last November. You create a small blurb the length of a tweet and promote it all day in order to snag the attention of literary agents. Within fifteen minutes, City Limits Publishing liked my tweet, which is a request for querying. I did not receive another like from an agent the rest of the day.
I looked up City Limits Publishing. It is a small agency that opened in 2020. They publish a wide variety of books ranging from children’s to romance to mystery. I did not recognize any authors, and the literary agents I spoke too had not known of them. Keep in mind I have been scammed before, so my suspicions were on high alert. But they did not charge for publication and the royalties were higher than the general market.
I deliberated on this group for a long time. And finally, I gave them a chance.
And now my novel is coming out on August 24th!
So, what is the biggest fear I’m facing now with my publisher? Of course, the size of the press is concerning for the following reason: most of the marketing is going to fall on the author because of the small size of the platform; they might not be able to afford top of the line editors; the cover designs might be cheap. But go to City Limits Publishing and tell me what you think about their book covers. I think they’re gorgeous!
So what about marketing and editing?
City Limits is still a small press, so I’m going to have to do most of my marketing. Thankfully, the group has sent me a guide on developing social media presence, targeting audiences, designing websites, etc. and I’m actively doing all that. As it relates to editing, I don’t really know the quality of their editors because my piece did not require much editing! I mentioned my critique partners before. Thanks to their input, I had no plot holes and my scenes were written clearly. The story structure was intact, and received quite a bit of praise from the editing department about that!
Would I recommend all authors going indie? I honestly don’t know. It depends on what you want/can do. I could not afford to self-publish, so having someone pay for the creation of my book was important. I am doing most of the marketing, but in this day and age, who’s not? My book is not being put out by one of the Big 5 presses, but my percentage of royalties earned is much higher. My book will not be on the bookshelf in most of the big box stores, but will be available online for purchase at those outlets.
There are pros and cons to every method of publishing. This is still a risk, but so is all of life. But we make the most of it no matter what!
25 notes · View notes