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| The slightly less popular spin-off... |
I was five the last time I saw my grandfather, alive. Every summer he would come from California, bearing gifts of plain donuts, paint-with-water books, and once even a swing set he put together in our backyard. But the year I turned five was also the year he stopped separating reality, and the voices only he could hear. As he walked my twin and I through our neighborhood, played games with us, and listened to our childish babbling, he warned us to steer clear of the FBI, because they had it out for him. "You don't trust the FBI." He would say, seriously. We would solemnly nod our heads, then go back to a high-stakes game of Hi-Ho-Cherry-O. Before he left that final visit, he and my parents fought because he was sure my father had either stolen his Mexican gold, or let someone from the government into the safe to get it.
However, there was no Mexican gold. Ever. There was no government conspiracy. Ever. My retired ironworker grandfather suffered from paranoid schizophrenia, and was found dead as the result of a coronary in an El Paso hotel the year I graduated high school. He wasn't speaking with anyone in the family anymore. Paranoid schizophrenia, according to the DSM, is a disorder that is seemingly triggered by life stressors, such as the start of college or the first full time job. Symptoms can include "delusions, hallucinations, disorganized behavior and/or speech". According to the National Institute of Mental Health, about one percent of Americans have schizophrenia. In my grandfather's case, he suffered from what experts refer to as "delusions of persecution" meaning he was always under the impression that someone was after him. The National Institute goes deeper into the history of schizophrenia, suggesting that is is also linked to genetic disposition. While experts are quick to say a genetic predisposition will not cause the onset of the disorder, genetics need to be considered in preventative treatments, and avoiding environments or stressful situations that can trigger the disorder. There is currently no blood test for a diagnosis with this disorder, though schizophrenia is not by any means a new disorder.
German physician Dr. Emile Kraepelin gave schizophrenia identification as an illness in 1887, but the disorder is believed to have existed long before then.
Initially, he dubbed schizophrenia as an 'early dementia' in order to differentiate from other form of dementia, such as Alzheimer's, which doesn't typically occur until late in life. A Swiss psychiatrist, Eugen Bleuler, introduced the term "schizophrenia" in 1911, only a few years before my grandfather was born. Schizophrenia's greek roots schizo and phrase translate literally into split-mind. Bleuler felt this 'early dementia' required its own category, because unlike most dementia disorders such as Alzheimer's, schizophrenia doesn't always translate into mental deteriorations, and can manifest itself later in life. Schizophrenia was then divided into five categories: disorganized, catatonic, paranoid, residual, and undifferentiated. In addition, men were and still are more likely to exhibit symptoms earlier than women, but diagnosis show a relatively even split between male and female identities. But without more information or treatment available, the label 'schizophrenic' was only treatable through institutionalization, shock therapies, and other forms of psychotherapy.
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In the 1950's, four in every one thousand Americans were institutionalized for some form of a 'severe' mental disorder, doubled from the two in every one thousand at the beginning of the century. At this time, my grandfather would have been a man in his early thirties, married to my grandmother, in the throes of raising blended families, and an alcoholic in post World War II California. As doctors and researchers argued genetics versus environment, the only treatment option for a man like my grandfather (had he been aware of the disorder at all) would have been institutionalization, something they no doubt couldn't afford. My grandfather chose the slightly more affordable alternative; alcohol. According to the National Institution of Mental Health, violence is not typical of people who suffer from schizophrenia, but substance abuse is incredibly common. Since the effects of many abused drugs, like cocaine, mirror symptoms of schizophrenia, it is often hard to discern addicts from those suffering psychiatric disorders, especially when a person takes on both roles. My grandfather was a schizophrenic alcoholic, but to society he was merely an alcoholic. No one knew what was wrong with him, and he wouldn't have been able to afford a doctor, nor would he have seen one even if it had been affordable. As we saw in 'Tough Guise', throughout our nation's history we have held our ideal of a man to a high standard, free of both physical and mental imperfections. A Marlboro Man. A Jon Wayne. An industrial laborer, working class or impoverished, with the goal of presenting as masculinely as possible, would never seek to label himself as "sick". With his use of alcohol to self medicate, my grandfather became increasingly agitated and violent toward my grandmother, further deviating his diagnosis from mentally ill to a "chosen" deviance as an alcoholic wife-beater.
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| He looked a little more like this Marlboro Man, if we're being honest. |
Alcohol, while legal, is linked as a cause of almost four percent of deaths worldwide. Road accidents, alcohol poisoning, and liver damage among other issues kill more people than AIDS, and is a causal factor in 60 types of diseases and injuries according to Reuters. Alcohol-related psychosis presents similarly to schizophrenia, though theoretically if the alcohol consumption stops, so will the psychotic episodes, after the withdrawals cease. However, schizophrenics who self medicate with alcohol often develop what is known as Alcohol Use Disorder, which manifests itself similar to alcoholism, but is different in that if the original issue is cured or treated, the alcoholism ceases. Unfortunately, studies have shown that patients with "co-occurring mental and substance use disorders have rarely received needed treatments". This can happen for multiple reasons. Patients with severe mental disorders have already been demoralized and stigmatized, creating reluctance to seek treatment or accept help. Even today, there are still few resources available not only to help schizophrenia specifically, but even fewer are available to help a patient recovering from schizophrenia and Alcohol Use Disorder in tandem. Relapse is common in alcoholics, and in treating a disorder with no cure, relapse is even more likely. But while there are not any sure-fire cures, the development of anti-psychotics has made major strides in the last sixty years of medicine.
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| It's a very lonely, yet crowded freedom... |
As my grandparents were divorcing in America, in Paris, a surgeon named Henri Laborit was attempting to reduce surgical shock in his patients. He was attempting to use another form of anesthesia, trying to calm the brain chemicals that cause shock. He experimented with the effects of antihistamines, and found surprising success with a drug called chlorpromazine (Thorazine, the designer drug name), which calmed even the most violently psychotic or catatonic patients, and "for the first time, we could see that they were sick individuals to whom we could now talk." according to one physician. In 1954, after two years of testing in the U.S., the drug was approved by the U.S. Food and Drug Administration. In the ten years that followed, an estimated 50 million people worldwide took the drug, doubling the drug company's profits multiple times. Many people have benefited from the use of anti-psychotics, as they provide a "calming effect" without sedation. However, side effects range from minor inconveniences like dry mouth, to feelings of melancholy, to the appearance of Parkinson's symptoms.
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| Self medication at its finest... |
Given the choice between shaking hands, strict pill schedules, and feeling lost in a life without the voices, relapse is a common part of schizophrenia. Stopping medication is the most common cause of a relapse. Watching for early signs of relapse is the best prevention for relapse, but for many people struggling or suffering from schizophrenia, they are isolated already from a support system, which is crucial for recovery and management for most people. Whatever medication and help my grandfather was taking when he reconnected with my mother slowly lapsed out of his life. By the time I was five, he'd slipped back into his own mental prison, one he would never escape from. One of his sons had already committed suicide as a young man to escape the voices, and another had slipped into reclusion from society as a means of coping. As much as he wanted to recover, as much as he had wanted to stay in the present, ignore the voices, and have a chance at a real family connection, the mental struggle and stigma overpowered my grandfather, as well as my uncle. The last time I heard anything about my uncle, he'd moved to Arizona to escape delusional threats as well.
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| Not all the voices are on your team, either... |
It hurts to have a loved one die. I'd argue it hurts more to lose them to an invisible illness. When my grandmother developed lung cancer, I could see the tubes, the IVs, the hospital bed, the sickness killing her. I could blame cigarettes, I could blame tobacco, I could blame her addiction. When my grandfather's schizophrenia reared its head, it looked like silly games from a man I loved very much, and now have very little memory of. It looked like a grandfather who stopped caring, and stopped showing up every September. It looked like him abandoning his family, again. There's a heavy stigma today in regards to mental illness. Tyler Durden famously comes face to face with himself in Fight Club, unaware he's been fighting himself the entire film. Historically, Joan of Arc claimed she spoke with God, but the voices she heard have been long suspected to have been schizophrenia instead of the christian God. Natalie Portman dances herself until she literally dies in Black Swan, the ending wrapping up a film littered with delusions of conversations, encounters, and relationships that never happened. Watching the children's movie, Cars, a character says to another, "You keep talkin' to yourself, people will think you're crazy." Mary Todd Lincoln, President Lincoln's wife, infamously suffered from what many now suspect to be schizophrenia, and has become the butt of many jokes featured in mainstream, on shows like Glee and American Dad. Who would want to come out as schizophrenic when labels like "crazy" or "delusional" are thrown around as insults or jokes on a regular basis? Crime dramas like Law and Order thrive on painting a picture oh homicidal schizophrenics, when the reality is that a very tiny fraction of people suffering from schizophrenia are violent on their own. Though coming out as schizophrenic is less likely to mean commitment to an institution, it still means living with a new master status, a new stigma.
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| "Crazy talk" from Mrs. Lincoln, est. 1863 |
Films like A Beautiful Mind have painted pictures of tortured geniuses with scattered thoughts and fractured perceptions, who are only able to recover with time, medication, therapy, and support. John Nash went on to win a Nobel prize, but doesn't credit his success to his use of medication (which he claims to have only used -infrequently- under pressure) but to the support of his wife, and the passage of time. Regardless, Nash's master status has become a great man, a smart man, an accomplished man- all in spite of his illness. Everything he does is forever tainted with his struggle with schizophrenia, as is the problem with labels and stigma. Thinking back to everything we've watched this semester, I am reminded of Mark Zupan's friends, snickering in the bar during their interview for Murderball. They laughed at the thought of anyone thinking Mark had become a grumpy man because of his wheelchair, "He was very much an asshole before he was in the wheelchair." My grandfather was a lot of things on the outside; a wife beater, an iron worker, a drunk, a deadbeat dad, musical, hot tempered and red headed. Inside, he was a tormented man, hearing people that didn't exist and seeing things that never happened. But to me, he was a shiny headed man who called me Christy, who pushed me on the swing set with my brother, who listened to me pretend to read books when in reality I couldn't read a stoplight. He bought us candy when my mother insisted we didn't need it, he played all of our made up, rule-less games, he seemed to relate us as children in a way only grandparents seem to be able to do. He loved us, and for the brief time I knew him, he was a good grandpa, and that was his master status for me. In the years that have passed since his death, I've learned so much more about the man I didn't know, the man I didn't see. It might matter in putting some things in perspective, in explaining who we was, why he left, and why he never came back. But I learned all of these things because it wasn't the first thing I knew about him, his disorder was not my first impression, my first memory.
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| 15 miles uphill, in the snow, both ways... |
In conclusion, labeling is a double edged sword when it comes to invisible illnesses, as it is with most things. In recognizing my grandfather's disorder, labeling makes it easier to see what went wrong, what might have helped him, how different he might have been. But labeling made him reclusive and paranoid, trying to avoid a diagnosis became a very large part of his life toward the end, as he lied to doctors and lived off the grid. It made people see him as a crazy old man, an alcoholic living with the consequences of his actions. It hurt the people he loved, it made them afraid of him, it made them afraid that people closely related to him might one day start to show signs of the same paranoia. A label might have afforded my grandfather treatment had he not been so afraid to have one. Though it became such a large part of his life, I still think of schizophrenia as only one part of the man he was, only one part of his master status. I think I'll always see him as the spindly old man holding my first baby doll and a plain doughnut, smiling because at least for the few memories I have of him, he was just a happy old grandfather.
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| These will always remind me of him, and my life before sprinkles... |
Credits
Drake, R. and K. Mueser, "Co-occuring Alcohol Use and Schizophrenia."Alcohol Research and Health. Vol 26, No. 2, 2002. Web. 27 April, 2012
"Drug for treating schizophrenia identified." Pbs.org., 1998. Web. 29 Apr 2012.
The Internet Mental Health Initiative, "History of Schizophrenia." Schizophrenia.Com, 2010. Web. 29 Apr 2012.
- Jhally, Sut, Susan Ericsson, Sanjay Talreja, Jackson Katz, and Jeremy Earp. Tough Guise: Violence, Media, and the Crisis in Masculinity. Northampton, MA: Media Education Foundation, 1999
Milnor, J.. John Nash and "A Beautiful Mind". 1998. Web. 29 Apr 2012. .
National Institution of Mental health, "Schizophrenia." National Institution of Mental Health., 2012. Web. 27 Apr 2012.
Rubin, Henry Alex, et. al., Murderball. New York, NY: Thinkfilm, 2005.
Photos
Winnie the Pooh
Cyanide and Happiness
Bird
Kramer
Black Swan
Cyanide and Happiness (Beer)
Vic
Durden
Mary Todd (American Dad Screen Shot, episode "Black Mystery Month")
Cake Doughnuts
Grandpa
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