“Macha”: An Anti-Psychotic Community

"Macha"

Macha had always been unapproachable
Not just by her classmates and peers
but her teachers, her parents
felt powerless to relate with her
she wasn't unfriendly
nor her demeanor unpleasant
She was, simply put, an enigma
impossible to define
impossible to predict
Her style was not normal
nor was it rebellious
Her choice of music was unnerving
Celtic lullabies to death metal
There was no label
nothing relatable
The school counselor was suspicious
any child who didn't get along
didn't communicate
anyone undefinable
unpredictable
wasn't necessarily dangerous
but definately had something wrong
Were the parents abusive?
No cigarette burns to tell
No bruises, no cuts
Nothing at all
She seemed happiest alone, though
and there was crime in that
there were rumors too
of other things
unusual things
that she spoke to empty chairs
giggled at the oddest times
"spaced out" a bit too much in class
smiled at phantoms
and spent three days
walking a dead cat.
How much of this was true
was certainly questionable
She denied everything
As did her best friend
whose pleading was hopeless
considering her lack of substance
When they were alone,
Macha would explain that others
couldn't perceive her
because she wasn't real
but her friend simply couldn't understand
She knew that Macha wasn't crazy.
And only crazy people saw things others didn't
After several tests, Macha was defined.
Predicted.
Labeled.
Schizophrenic.
A single word that meant nothing
yet explained it all
A few weeks in the hospital
and a regular dose of antipsychotics
coupled with antidepressants
to relieve unpleasant side effects
And she should be Perfectly
normal
in no time.

"Macha, Patient 47A"

The binding on her wrists were tight, because they knew she would fight it.
She had dislocated her thumb three times in the past week trying to escape
She went for the gag first every time. It was remarkable.
The binds were as padded as could be without being escapable,
yet somehow, she had managed to make her wrists bleed again
she would make anything she could bleed when she got the chance
they had had to clip her nails uncomfortably short
so she wouldn't attempt to scratch her captors to death
or failing at that, gouge her way into her own throat
Fortunately the medications kept her mouth dry
or they would have had to swab out her spit
to keep her from choking on it.
They had to keep something in her mouth at all times
lest she bite off her own tongue
She was a difficult one to manage
with eyes that glowered with ire and defiance.
It had started with refusal to take meds.
Then institutionalization,
Now this.
Most of the staff refused to be anywhere within her general vicinity.
one member had even offered a letter of resignation.
When it was apparent that her behavior would not cease
They locked in a medicated stupor
tranquilized at the slightest upset
A drugged, unwilling surrender.

Epilogue: Are Antipsychotics Anti-Psychotic?

My purpose in creating the fictional “Macha,” as well as my artistic renditions of the work, is to address the typically unquestioned authority of antipsychotic medication as the first and last solution to mental disorders such as schizophrenia. The use of such drugs as exclusive treatment is a current and growing trend in the United States, and it is my belief that this is primarily due to intolerance or misinformation. Although it may be true that medication is widely accepted in psychiatry as an adequate suppressant of symptoms and is often necessary for the treatment of the most severe and dangerous forms of illness, there is an insurmountable amount of evidence to suggest that it does so at the cost of cognitive improvement, recovery, little permanent benefit, and with devastating long-term side-effects. Therefore, it should only be considered as a temporary solution, and even then, only in the most ominous of circumstances.

I created Macha to be an example of what happens when medication is considered before alternative, less detrimental and more productive methods of treatment have been exhausted. As in Macha's case, there is a high probability that the popularity of medication is due to its instant gratification, a deficiency in information, lack of required effort, and the dearth of tolerance and patience for mental illness. Antipsychotic treatments, as they function currently, aren’t designed for patients so much as for the short-term suppression of the unnerving characteristics of psychosis. The alternative–facing the unsettling nature of this disease, understanding it, and supporting those who experience it– should be the goal of not only patients’ guardians, but their communities, and society as a whole.

There is such an overwhelming amount of evidence and research to suggest that medication is not only an unproductive treatment but a hindrance to recovery, that it is astounding how widely accepted, promoted, prescribed and suggested antipsychotic medication is today. It is so unbelievable, that even as an informed individual backed by a small army of researchers with conclusive evidence to support my current conclusions, I am forced to second guess myself out of sheer lack of acknowledgement. How can so much evidence be ignored by practitioners? Are educators ignoring pertinent data? Are the doctors? Is the prescription of pharmaceuticals more profitable and thus ultimately better received? Whatever the reason, the current status quo among professionals is disregarding this research, and conclusively condemning the majority of uninformed patients to detrimental, unproductive and oft times unnecessary forms of treatment. Since the majority of patients trust and rely on their doctors for information, the current state of affairs is grim indeed.

A common misconception is that medication is required for the recovery of individuals with mental disorders such as schizophrenia. However, schizophrenia reverses naturally in the majority of its victims, and the highest rate of recovery has been observed in non-industrial countries where antipsychotics are not used. A fifteen-year multifollow-up study published by The Journal of Nervous and Mental Disease supports this claim, documenting the extreme disparity in recovery between schizophrenic patients who took antipsychotic medication and those who remained without it. According to their study, at the end of the fifteen-year period, twelve out of sixty-four patients were in a period of recovery. Of the sixty-four, twenty were not on any form of medication and eight of those twenty (fourty percent) were in a state of recovery; two of the thirty-nine patients on antipsychotics (five-percent) were recovering; and two out of five patients on medications but not antipsychotics were recovering. This article is not alone in its conclusion. One need only begin to browse the vast number of references it cites for further evidence. For even more authoritative research backing this conclusion, browse this index of authoritative articles dedicated to the subject.

M.D. Matt Irwin offers an explanation for why this lack of recovery in patients might occur. According to his extensive research, the physiology of people who have been exposed to antipsychotics and other drugs naturally adapt through “alterations in receptor number and function.” This "creates a physiological dependency which reinforces psychological dependency." The current emphasis of psychiatrists on drug treatment might also cause issues of social, psychological and spiritual nature to go unaddressed. A combination of these factors could worsen the outcomes, especially since tolerance of severe adverse effects of antipsychotics among patients is low and many choose not to take them unless forced to do so.

Obviously, the difference in recovery between patients on and off antipsychotic medications is not marginal. Even so, it can not be denied that there are plenty of cases of schizophrenia that are too severe to simply “cope with” and “tough out”. In such situations, antipsychotics might be necessary for short to mid-term therapy but should never be used as a primary or sole form of treatment. This is why anyone with a mental disorder or the guardian of anyone with a mental disorder–be it schizophrenia or otherwise–absolutely must educate themselves on evidence-based, alternative methods of treatment–treatment which offers permanent recovery benefits whether or not the individual requires a term of medication. A method that has been proven effective in multiple cases is cognitive behavior therapy (CBT). This system uses mental techniques such as developing alternative explanations for symptoms, and altering thought processes to “reduce the severity of, or distress from, the symptom regardless of whether the patient accepts a diagnostic label.” One of the greatest advantages of cognitive behavior therapy is that it does not rely on the patient accepting his or her symptoms as a function of a mental illness in order to be effective. In fact, in the United States, American-based guidelines for treatment of schizophrenia such as those issued by the American Psychiatric Association and the schizophrenia patient outcomes research team recommend cognitive behavior therapy for treatment-resistant patients for this very reason. However, it is unfortunate that in the United States only the stubbornly defiant are receiving what the United Kingdom has already accepted as adequate, acceptable and readily available treatment. An article printed in the American Journal of Psychiatry titled “Cognitive Behavior Therapy for Schizophrenia” specifically addresses the lack of cognitive behavior therapy as a primary method of treatment in the United States in comparison to the UK and the severity of this issue due to its empirically researched and supported benefits.

One example of such an examination is an piece studying cognitive behavioral therapy in schizophrenics with command auditory hallucinations, which found that patients undergoing this form of therapy had fewer episodes, complied to auditory hallucinations less, and generally acted in less ways to appease them. Although the hallucinations did not cease, they became less of a hindrance and burden on the lives of patients. Conductors of another, similar study discovered that after one year, patients who had undergone cognitive behavioral therapy, starting at the time of hospitalization and while acutely psychotic, benefited greatly over those who did not receive this therapy. They noted that the benefits extended to both the positive and negative symptoms of schizophrenia as well as overall social interaction.

Even though the severity of schizophrenic symptoms may require temporary treatment with antipsychotics, this represents a minority of cases. Those who wish to undergo such treatment, and guardians who are considering putting their children on antipsychotics should be fully aware of the long-term consequences, increased relapse rates, drug withdrawal symptoms, decreased probability of recovery and side-effects. They should also be relieved of any disillusions that these pharmaceuticals are a completely safe and effective form of treatment, because there is plenty of evidence to suggest otherwise. The greatest offense a guardian, or the community responsible for an individual’s care can commit, is medicating a person with a mental disorder out of sheer convenience. Antipsychotics are quick, easy and deceptively effective at suppressing symptoms, but their aid ends there. In and of themselves they are not, and should not be considered a healthy, productive form of treatment.

Mental Links: A Guide to the Authorities on Mental Health

My endeavor in writing this blog is to not only spark a discussion within the web about literature and mental health, but also to be a conduct toward valid and accurate information about these subjects. Towards that end, I felt it necessary to search the web and provide a number of sources that individuals can turn to for their own research on mental health. I kept in mind the Webby Awards Criteria while evaluating the usefulness and utility of these sites, but most of all, with most of my resources being based in the academic field of mental health, I strove to make sure the information on the sites held enough authority to be referenced. The American Psychiatric Association is one such website. It serves as a member driven locale and a networking hub for psychiatrists and members of the association. It’s news feed is current and informative, and many useful links to education and career based resources in psychiatry can be found here. Unfortunately, the American Psychiatric Association lacks the visual appeal and navigational ease of the American Psychological Association, which is the Washington DC based organization which represents psychology in the United States. It has a very strong infrastructure and uses intriguing, relevant and interesting graphics to the utmost effectiveness. This site’s navigational tool system makes the navigation of a seemingly overwhelming amount of content easy on the user, something that Psychnet-Uk lacks. This is unfortunate, because although Psychnet-Uk lacks the visual appeal and ease of perusal of the American Psychological Association, it is an invaluable web directory of everything mental health. A directory which will inevitably lead you to Mayoclinic: a not-for-profit medical organization committed to the diagnosis and treatment of virtually all varieties of complex illness. Mayoclinic is not only a resource of high authority, it’s an experience. Navigation through any range of diseases, drugs, treatments and more can be pulled up immediately through their easy-to-use site map. They have podcasts and blogs which are updated daily coupled with captivating visual media such as slideshows and videos, all informative and on topics relative to health. Another incredible data resource is the National Alliance on Mental Illness. This site’s “Inform Yourself” section has the authority of a legion of professionals, yet communicates the complexities of mental disorders and medication in a way that is not only enlightening, but easy to understand and directed towards the general public. These sections also suggest relevant and authority-driven medical journals for further information. For a similarly informative and easily comprehensible experience on schizophrenia and depression in particular I would recommend exploring NARSAD, a charity for their research. NARSAD keeps its web-based data concise, and offers a general overview of these conditions while offering ways for the general public to help through charity. Unfortunately, NARSAD lacks in that its news feed hasn’t been updated in several months. A weakness that the National Institute of Mental health does not fall prone to. Less is more for the NIMH website. Although there are few graphics, the site retains its visual appeal and the abundance of insightful data in the “Mental Health Topics” section is executed in a way that keeps pages dynamic and the user interacting with the site. Its news section is a current resource which not only covers information relative to the National Institute, but also to press releases and current news in the field of mental health. Although the site is fairly easy to browse, no site in this linkroll compares to the ease of the Navigation found at the National Mental Health Association. The perusal of mental health related information at this site can be searched for alphabetically “by issue”, “by audience”, or by “disorders and treatments”. Everything is organized in scroll boxes, keeping page scrolling to a minimum and facilitating the research process. Even though the National Mental Health Association’s site is well-engineered, it has less than engaging visuals, something WebMD has in abundance. For a health-related resource, WebMD is the ultimate visual experience. Its images are eye-catching, provocative, and displayed in a dynamic slide-show format which keeps the page fresh. It’s “latest headlines” section makes it easy to keep up to date on current WebMD news and you can navigate nearly their entire site effortlessly from the homepage without needing to dig deep into site-maps. It even has a list of top 12 health topics for easy navigation. Recognized by several professionals and reviewers as a credible and in-depth resource, WebMD holds the most professional, well-developed and well-designed site in my link roll. Due to my emphasis in this blog being upon Mental health in literature, I thought it necessary to add at least one link to a writing resource I find invaluable: Writing.com. Writing.com offers information on everything about writing, from self-publishing to copyrights. It’s focus, however, is not as a resource of information, but rather as a member driven, interactive atmosphere. The site’s main function is as a forum in which writers can post their work on the site and get quality feedback from interested readers. Aesthetically, however, Writing.com is lacking. The home page is unwelcoming to new guests, featuring little in the way of captivating material, with little to garner the attention of the guest aside from the registration form, which is untactfully placed front and center. If you can overlook this one minor flaw, however, and dig deeper into the site, I believe you will be pleasantly surprised. If you wish to access any of these resources quickly and easily for your own personal use, feel free to use the linkroll found on the right of my blog page.

Over-Medicated, Under-Treated: The Reality of Antipsychotic Pharmaceuticals

Having only entered the external blog realm within the past week, I wasn’t sure what to expect when I began the search for authoritative, informative blogs on the subject of mental disorders. I began my exploration of the mental-health blogosphere with an emphasis on medication and schizophrenia and was taken aback by the severe lack of current informative news relative to the field. Fishing through the overwhelming number of Britney Spears related posts, I was eventually forced to negate her from the search entirely only to be overwhelmed with news articles on schizophrenic-related crimes dealing with individuals who apparently refused to take their medication. There were only two actual crimes in question, but tens of blogs found it necessary to cover them and all seemed focused on the mental disorder as the prime suspect. What I find so alarming about the initial results of my search isn’t Britney’s apparent downfall or the number of crimes accounted for, but the domination of this negative, nonconstructive and harmful media in the field of schizophrenic mental health.
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One of the first, truly informative blog posts I came across was “Injectable Longer Lasting Zyprexa May Be Approved”, an article on a new, injectable form of Zyprexa – an antipsychotic drug which is currently being considered by the FDA for child and adolescent as well as adult treatment. It’s an unforgiving drug with enough unpleasant side effects to keep anyone with a decent amount of sense away from it. Unfortunately, as an injection, it will probably see most of its use in forced medication, for people who will not take the Zyprexa pills willingly. After reading this article through a couple times, I came to an appalling revelation. Who would forcibly medicate a child with Zyprexa? Almost any concerned and uneducated parent. Considering the maelstrom of misinformation and negative media I encountered within my first few hours of blog-searching, it’s difficult to believe that anyone with average exposure to the media wouldn’t immediately draw connections between schizophrenia, crime, and the need to medicate - a connection which is completely false. Yes, the disorder needs to be addressed, but there are several alternative methods of treatment which have proven effective in several cases and should be exhausted before medication is even considered.

As Dr. Peter Breggin illustrates in his post “Brain Disabling Treatments in Psychiatry: Drugs, Electroshock and the Psychopharmaceutical Complex”, there is no “wonder” in anti-psychotic drugs. Medication for mental disorders do not “cure”, but merely hinder cognitive ability to “suppress” symptoms. They are misleading both in their initial effects and in their withdrawal symptoms. While on the drug, the patient will inevitably be perceived as doing better, when in fact, not only are the side-effects destroying the victim’s body, but the brain is doing worse. When off the drugs, the withdrawal symptoms can cause misleading psychotic episodes which could lead parents to believe their child is actually worse than before and seek more, possibly stronger medication. Instead of passing anti-psychotic drugs to force on unwilling patients in an effort to suppress symptoms, we should be researching alternative, healthy methods of helping victims of this disorder cope with their illness without destroying their minds, their bodies and inevitably their lives. However, before this can ever become a reality, the proliferation of nonconstructive, misleading information in the media about the disease and its treatments needs to be addressed.

I have offered my comments on the injectable Zyprexa drug as well as Dr. Breggin’s views on medication for mental disorder below:

“Injectable Longer Lasting Zyprexa May Be Approved”
Through the tone of your post, I can at once gather a sense of apprehension concerning the release of this new, injectable form of the Zyprexa and I am appreciative that you are revealing medications such as this for what they are rather than allowing them to remain naively considered “wonder drugs”. Your article is truly informative, and reveals several things about the Zyprexa drug that I was not aware of upon entering the post. I knew that Zyprexa could have devastating side effects, such as heavy weight gain, diabetes and sedation, but I was unaware that Zyprexa had actually made an effort to restrain information about these side effects to patients prescribed this medication. I find this to be revealing of Eli Lilly’s intentions in the pharmaceutical industry and something which patients or their guardians should be aware of before considering the drug. I also find it amazing that doctors prescribe this drug off-the label for anxiety and depression considering its side-effects. I suppose they never take into consideration that considerable weight gain and diabetes can cause even greater anxiety and depression than the disorder itself, not to mention that drugs such as these often fail to address feelings of hopelessness despite their effectiveness at ridding other symptoms. What I find most alarming about your post is that this drug is being considered for use on children and adolescents. Unlike adult patients, who can often at least have some control over their forms of treatment, children are completely dependent on their parents’ decisions; and I believe that many parents would decide to have a “fat, stable child” as opposed to an “unwell, skinny one” without ever consulting the child. And unfortunately, Zyprexa’s misleading marketing campaigns coupled with the vast amounts of negative media related to schizophrenics in general will have parents deciding on it before exhausting alternative forms of treatment that could potentially lead to a completely healthy, stable child. The 250% increase of antipsychotics in Florida children alone, not to mention its use off-the-label, reveals that this is already happening. I believe that posts such as yours are a step in the right direction. The first stride towards healthier treatment for schizophrenics is awareness about the reality of antipsychotics such as Zyprexa.

“Brain Disabling Treatments in Psychiatry: Drugs, Electroshock and the Psychopharmaceutical Complex”
In the sea of misinformation about the nature of mental disorders and their treatments, I found your blog post to be a breath of fresh air. Given the rise in popularity of antipsychotic drugs such as Zyprexa both on and off the label, a truly informative post such as yours, which reveals the true nature of antipsychotic drugs, is long overdue. The brain disabling function of antipsychotic medications as a means to suppress symptoms is certainly something that a patient or guardian should be aware of before accepting these drugs over alternative forms of treatment. I also somehow doubt that the withdrawal symptoms of these medications are being addressed, and that most patients are even aware of them. Considering the emulation of psychotic episodes that these withdrawal symptoms have, I don’t find it hard to believe that patients would be perceived as worse when off the medication when their condition might actually be improving. Bearing in mind that many mental disorders often improve over time, this could definitely have severe consequences for the unwitting patient. Although I understand that this is a mere summation of points expounded upon in greater detail in your book, I think it would be beneficial both to your post and to the community, to elaborate on some of the alternative methods of treatment that patients with mental disorders could consider besides medication. Currently it seems that pharmaceutical treatment has complete domination as the end-all be-all legitimate form of treatment for patients with mental disorder, and this absolutely should not be the case. But until other effective forms of treatment start to take a foothold both on the information highway and in the media, awareness levels will remain too low for medication to ever be challenged.

Elissa: A Case of Schizophrenia

The first time she saw it, she was mortified.
A freakishly self-mutilating clown
tearing at its face as it laughed
It giggled like a girl
but that was the only girlish thing about it
Looking at it, watching it, she felt her flesh crawl
the hair at the back of her neck stood on end
this thing wasn’t right
No one else seemed to notice but her
It was obvious they were conspiring.
They paid this clown to scare her.
On the playground they were always laughing
the other kids
but there was never anything funny
She was the joke.
She knew it.
They never looked at her.
They didn’t have to.
There was nothing else to laugh at
Giggling, giggling
Just like the clown
They giggled just like it
All around her, giggling
Mutilating laughter.
The clown stepped closer
she wanted to run
her feet were frozen solid
tried to slap it away
with arms that defiantly hung
limp at her sides
closer
closer

She couldn’t see
Tasted like vomit
Where was she?
Tried to open her eye-lids
but she could only roll
her eyes up into her skull
She couldn’t remember how to open her eyes
It felt like hours passed
before the sickeningly bright light spilled in
Rolled her tongue in her mouth.
Spat out bitter, acidic flecks.
"Are you Okay?"
"Are you Okay?"
"Give her some room. I think she passed out."
"Probably the sun, she should be fine now."
The world swam with faces
colors, lights
Sounds…people talking, asking questions
"I’m Okay." She heard herself say. "Is it gone?"
"Is what gone?"
"The clown."
Confused voices. "What…clown?"
She felt breath on the side of her face
warm, rancid breath
it smelled like vomit.
She rolled her head to the left
That clown.
She wanted to scream but she couldn't
she couldn't force her voice out of her throat
her mouth worked at the words she wanted to say
no voice came
She looked the other way
Still there.
Again.
Still there.
She couldn't move the rest of her body
Couldn't hold her head straight
the clown was making a point.
And then she heard it
A voice like nails
clawing furiously at a chalkboard
There were no words but she understood the meaning
Don't be afraid. I'm on your team.
Elissa blacked out for the second time that day.

It was a dark place.
She wasn't sure where she was
Her chest tensed as she strained her eyes
trying to force her eyes to adjust
Her eyes darted about but it looked the same everywhere
Was it there?
Despite her fear, she felt comfortable, soft
Familiar
As her eyes adjusted she recognized
the blades of her overhead fan
the unique shape and color of her ceiling
Her room
The tense feeling that had gripped her
immediately vanished
She was safe here
Her neck muscles loosened
sinking her head back down into her pillow.
As the minutes passed, she felt them again
those eyes staring back at her
her nails dug deep into her palms
trying to hold back her panic
I changed sides, I’m on your team now.
The clown squealed in its raspy, wordless voice
Why? She asked shakily
She didn’t want to talk to it
She also didn’t want to make it angry
Because I’m just like you.
No you’re not.
Everyone hired me to fuck with your head.
You shouldn’t say bad words like that!
Fuck fuck fuck fuck fuck fuck fuck fuck
Stop it!
They want you put in the crazy plaaaace
Why!? Why does everyone hate me!?
‘Cause you’re lunie ‘lissa, lunie ‘lissa
No I’m not! I’m not lunie ‘lissa! Elissa cried
They want you all locked up so they can stab you with needles til’ you die.
Elissa stared at him in shock.
She couldn't believe it. Who?
Everyone.
Everyone?
Everyone.
At the playground?
In the world.
Everyone in the world?
In the world.
Even mama?
Even mama.
You’re a liar.
Even mama.
I’m not listening to you anymore! You’re still on their team!
even mama even mama even mama
He started yelling it over and over. Elissa screamed.
The clown giggled his girlish giggle when her mother came inside
What’s wrong honey? I heard screaming.
Mama was out of breath.
Get it away get it away! get it away from me! Elissa screamed
Get what away? Honey, there’s nothing here.
The clown hissed Even mama
Elissa’s eyes were wide
the shock of betrayal clawed at her heart
You want me to go away too mama? Even you?
Elissa baby what are you talking about? Come on, you can sleep in mama’s room tonight. You’ll be safe from the boogey man in there.
There was no boogey man. Everyone knew that.
This was proof.
Only a crazy person would believe in the boogey man
Mama was in on it too.
Elissa froze. She understood everything now.
They hired the clown to make her crazy
pretending it wasn’t real
But Elissa was smart
If she pretended the clown wasn’t real
when they were around
they would be the ones who went crazy

Epilogue: Making Elissa Convincing

While replicating the schizophrenic condition in a fictional character with unerring precision might be considered a task far from reasonable, with adequate research as a foundation it is possible to develop a convincing sketch of the condition within such a character, as I sought to do with Elissa.

Elissa is an undifferentiated schizophrenic. However, in writing Elissa’s story, or a similar case, one is immediately faced with an overwhelming obstacle. Assuming the writer is not incredibly familiar with schizophrenia, he has little true to the condition to offer the reader as evidence. Even if the writer contains some general knowledge on the subject, if all the misconceptions he might possess are not removed and/or replaced, the knowledgeable reader will quickly become “wise to his game”. This was my position when I first began writing “Elissa”. I knew nothing true of schizophrenia, and as a result, my initial character had nothing in the way of schizophrenia to offer the reader. If I had created Elissa without first delving into the subject, anyone who read my work with knowledge of the disorder would have been left thoroughly unconvinced that Elissa was “real”; and when writing a character driven story, if the main character fails to be adequately convincing, the story will almost always fail as a result.

It is necessary to take all information about a subject, in this case schizophrenia, into account when developing a character that will interact with or contain these traits. As I began to research the nature of the schizophrenic disorder, quite a few peculiarities that I was not aware of sparked my interest. A schizophrenic may or may not suffer from all of his or her symptoms continuously. When creating Elissa, this was something to consider. Would her symptoms be continuous, episodic, or a combination of the two? Which led to more questions: what symptoms would she be capable of suffering from realistically, and what is the nature of these symptoms?

The symptoms of schizophrenics can differ greatly. These differences lead to various "types" of schizophrenia: paranoid, disorganized, catatonic, residual and undifferentiated. In the case of undifferentiated schizophrenia, episodes might contain symptoms from various or even all of the other types. After carefully reviewing all of the possible symptoms that Elissa might suffer from, I decided that a combination of the symptoms regularly associated with catatonia and paranoia described her best, making her diagnosis “undifferentiated schizophrenic”.

Elissa does not suffer from all of the symptoms of catatonia, paranoia, or schizophrenia as a whole. This is because after consulting several first-hand accounts of individuals with the schizophrenic disorder, it became apparent that symptoms vary greatly but rarely if ever include all known symptoms. It would also be incredibly difficult to create a functioning main character that suffered from so lengthy a list. While this is true, there is also a minimum number of symptoms for an accurate diagnosis. To make Elissa’s condition as convincing and accurate to the schizophrenic disorder as possible, I placed her in the middle of the minimum and what I determined from my research to be a realistic maximum.

Next, unfortunately for Elissa, came application. During Elissa’s schizophrenic episodes, she consistently suffers from visual hallucinations of a frightening, clown-like figure coupled with auditory hallucinations similar to those of nails on a chalkboard. Another curious element to her illness that isn’t uncommon to paranoid schizophrenics is that she suffers from delusions of reference. That is, she sometimes believes that events, objects, the behaviors of others, and other stimuli have a particular and unusual significance to herself. There are two definite instances in which Elissa suffers from this. She believes that because children are laughing, and she doesn’t know what they are laughing about, they must be laughing at her. She also perceives special meaning from the sound of nails on chalkboard. Although this is an auditory hallucination, she is still deriving special meaning from it which simply is not there. Elissa also suffers from two other symptoms of paranoid schizophrenia which, in her case, go hand in hand: delusions of grandeur and irrational fear. Elissa believes that, for whatever reason, it is on the agenda of “the entire world” to drive her insane through a clown that “they” hired, after which “they” will proceed to lock her up and stab her with needles until she dies. The symptom which makes Elissa’s “type” of schizophrenia undifferentiated rather than paranoid is her body’s motor functions are prone to shut down – a symptom of catatonia. During her initial episode, she is unable to lift her arms and then loses consciousness completely. After she regains consciousness, she begins moving her head in a repetitive manner – another common trait of catatonic schizophrenics. Aside from this, she speaks irrationally, suffers from social withdrawal, and is beginning to experience deterioration in her personal relationship with her mother. These are secondary traits caused from the primary symptoms, but nonetheless they are characteristics taken into account when making a diagnosis so they are important to be aware of when considering the actions of the character in question.

“Elissa” is a depiction of what it might be like for an undifferentiated schizophrenic child suffering from symptoms of catatonia and paranoia in the early and most frightening stages of the disorder. However convincing Elissa’s symptoms might appear, they are the result of research on both scientific studies and victims’ personal experiences with the disorder.