You want anecdotes?
Well, generally, the situation rarely arises that schizophrenia manifests itself in someone I've known a while: it's far more likely that they've been referred to a psychiatrist because they've been acting in a way which concerns friends and relatives, and a "reason" or "cause" is being sought. Depending on their degree of paranoia, the individual might have confided their own theory of what's going on (spirits of the dead, telepathy, picking up radio waves, etc.) but often, they're too afraid or disordered to tell anybody what's going on. Not infrequently, the initial "withdrawal" stages of schizophrenia is misdiagnosed as depression or drug misuse - and often one or both of these is also present. So yeah, if they're too paranoid to talk, it ain't easy. Trying to base a diagnosis of psychosis on someone's outward actions alone is possible but extremely dodgy; generally, one needs at least some access to their thought processes too.
(I'm not sure why we've stuck on talking about schizophrenia, as opposed to psychotic states in general, but I guess I'll stick with it.)
What's also difficult is knowing how much the person has changed of late: easy if one has access to reliable corroborative accounts from friends/family ("In the last month or two, he's stopped going out altogether") but in their absence, one has to try to determine whether their current state represents an acute episode of illness, drug intoxication, organic illness (head injury, diabetic hypoglycaemia, etc.) or whether they've always been a paranoid type of individual and this is their personality. So... lack of reliable information on "premorbid personality" makes things harder.
Other diagnostic dilemmas include apparent delusions and/or auditory "voices" in the presence of depression, drug/alcohol intoxication or withdrawal, learning disability (and I'll include the autistic spectrum here), physical illness (some examples above), serious physical or mental stressors (bereavement, abuse, extreme fatigue, chronic poverty), body dysmorphic disorders (when is one's conviction that one has an enormous nose/too many limbs psychotic?), different cultural norms and odd personality types.
Only in the textbooks does schizophrenia present "classically"; in real-life situations, it's almost always muddied by at least one of the above problems. They can present similarly to or coexist with schizophrenia.
The psychiatrist's role within society is both his strength and his weakness. He's trained medically, so is aware of the interactions of physical and psychiatric (if the two can really be separated) symptoms, the pharmacodynamics of medications and their side-effects - but is perceived as a doctor/authority figure with all the benefits/problems/"baggage" that brings. Legally, he's in a position to enforce treatment upon those who need it - but needs to be aware himself of a) the abuse potential of the Mental Health Act, and b) the tension this creates with those who fear being "locked up".
I'm not sure if that begins to answer your question, Ria...
[ 28-01-2002: Message edited by: Ganesh v4.2 ] |
note that I say psychotic behavior and actions rather than psychosis. to me this does make a difference.)