How your mind can turn against you

An excerpt from Fallible: A Memoir of a Young Physician’s Struggle with Mental Illness.

Jason had an entire group of voices in his head that he called “the committee.” They talked nearly constantly, sometimes in a flat roar but often escalating to shouting. He described it as like being at a party—always something going on, a dull rumble with occasional distinct voices.

Sometimes the committee had conversations amongst themselves, and sometimes they spoke directly to Jason. The voices usually spoke about either positive or neutral topics, but occasionally they ganged up on Jason and became hostile, yelling obscenities at him, telling him he was worthless, or trying to convince him that the solution to his problems was to attack someone—even himself. He had acted on the committee’s recommendation to hurt himself before, as recently as a few weeks earlier; sometimes he even persuaded himself that dying was the only way to shut them up. He took a gun from his friend’s house so as to shoot himself in the head. His girlfriend saw him leave the house with the gun and stopped him before he went through with it. He had been in the psychiatric hospital since then.

Through the help of his therapist, Jason knew that the committee didn’t comprise real people but was something his brain had created for some unclear reason. He mostly distinguished between the din of the committee’s activity and people in the “real” world, though sometimes that distinction blurred, and he struggled. Cigarettes calmed the committee for a short time, but the voices always started conversing again. Alcohol didn’t make a difference, but that didn’t stop Jason from trying to convince himself that it did, often all day long. Cocaine made them talk even louder. He hadn’t been able to hold down a job for much more than a few months at a time, and he couldn’t count how many personal relationships the committee had sabotaged.

Jason had been on numerous medications to quiet the committee and enhance his ability to discern the external world from his internal realm; some worked better than others, but all caused considerable side effects. He gained nearly one hundred pounds upon starting a new antipsychotic, leading to the development of diabetes. He ended up with long-term kidney damage from one medication, his liver injured by another. During the times of a medication trial, he often ended up in the psychiatric hospital for weeks at a time, suffering psychotic breaks that caused a cascading chaos in his broken mind.

Jason saddened me. His intelligence became more apparent the longer you spoke with him; he nearly completed his mechanical engineering degree before the committee went into session. He had a fairly normal life until about twenty-three when his uncle, who had been like a father to him, passed away. Jason snapped. He hadn’t heard voices before then, and he hadn’t been able to avoid them since. That was the first time someone had hospitalized him. As you may have guessed, Jason had schizophrenia, a psychotic disorder that often causes auditory or visual hallucinations (and sometimes both). Thankfully, Jason didn’t see non-existent things.

Jason didn’t know his father, but didn’t inherit any psychiatric problems from his mother’s family. He didn’t have any other medical problems until he started taking medications for the schizophrenia. He was now in his mid-thirties, but he looked at least twenty years older. His smile showed crooked, yellowing teeth and revealed deep skin chasms at the corner of his eyes as opposed to shallow crow’s feet. His skin was steeled and leathery, probably the result of hard living and smoking. He spoke in a halting but clear timbre, sometimes pausing and whispering under his breath, a habit he had developed to quiet the committee. He exuded calm and seemed pleased to be the center of the group’s attention, as much to break the boredom of his day as anything else. His hair was short, and they only allowed him a basic wardrobe while in the hospital—a faded blue sweatshirt and some loose pajama pants—so he had no items to fashion into a weapon to harm himself.

Jason’s experience is quite common. Schizophrenia often appears in young adulthood, frequently after a very stressful experience. Through my time working at the group home for the mentally ill followed by medical school, I had seen several people with the disorder. It scared me every time. It’s hard for me to fathom how convincingly your mind can turn against you.

I met Jason during a first-year class in medical school; we were learning how to obtain a basic history from a patient. The twenty of us in the group took turns interviewing different patients. They assigned my group to the psych hospital, which made for some interesting conversations. Jason was the focus of my first interview, and I imagined that my nerves were as loud as Jason’s committee. Not only was I nervous because of having to perform in front of this group, an exercise that became a common occurrence throughout my medical training, but also because I saw a bit of myself in him.

Was I that different? I had severe anxiety necessitating medication, compounded by stress, my own narcissistic tendencies, and a series of life choices—but Jason had something much worse. It all gave me pause. I was now twenty-four, just barely older than Jason when the committee took residence. Would I soon begin hearing voices as well?

I supposed that beginning the long and arduous road of medical education while having an infant at home with a lonely wife in a new place more than a thousand miles from our family counted as enough of a stressful event to trigger whatever may lay dormant in my brain.

Why did this happen to Jason and not me? What if it did happen to me? Was there any way to prevent it? Or was I simply overreacting?

Kyle Bradford Jones is a family physician and can be reached on Twitter @kbjones11. He is the author of Fallible: A Memoir of a Young Physician’s Struggle with Mental Illness.

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