I want a box of cookies, but I’m afraid to leave my apartment. It’s getting dark out and I’m afraid to walk to the grocery. I’ve seen shape-shifters on the bus recently, and they seem to be growing in numbers. The last infestation was over four years ago, before I’d checked myself into the psych ward. Since then I’ve been medicated regularly after several years of med-noncompliance, and the beasts have been left to memory. Until now.
My daily meds work to keep me emotionally smooth, though that often mimics my natural flatness. My monthly anti-psychotic injection helps keep the voices and visions at a minimum. Dealing with what is probably symptom breakthrough is something that I can work with my therapist on because it’s likely my schizophrenia piercing its way through my mind after going untreated for so long. Still, I’d prefer not to worry about demons.
I can write about it because I can talk about it. So far, only with my therapist, but that’s a start. The current delusions aren’t permanent—they’re brief thoughts that take hold for a short while. They leave a mental residue that sticks to the palette of my brain.
I’ve been experiencing flashes of irrational fear, not informed by any outside influences. None of my typical phobias come up (spiders, heights, drowning), while more abstract fears like my furniture being haunted, or my food being poisoned, do. That these invasive thoughts align with my darker thoughts is of even more concern. Acting in much the same way as the cloying montages of fear, those grave ideas intrude upon my waking hours and attempt to influence my decision making.
While the atypical antipsychotics I’m administered effectively tamp down the weightier positive symptoms (delusions, hallucinations, disorganized thinking), sometimes a sliver of one slips through, and I respond to it from one of two perspectives—either the new practice of objectivity attained through therapy, or the old experience of subjectivity that put me in the position of not knowing what was real and what wasn’t. No one could convince me otherwise, should it be that I was caught in that twilight existence, certain that my thoughts were truth when, in fact, they were not in alignment with the common reality.
As I researched the puzzle of symptoms versus side effects, I discovered that brief psychotic events were not uncommon. The medications used to treat schizophrenia are not one hundred percent effective in eradicating all symptoms. According to the manufacturer’s information, there is a chance of symptom breakthrough. Further research suggested that oral medications could augment the daily regimen to aid in closing the gap left by an injectable, should a psychiatrist recommend it. Dosages could also be increased if the oral meds weren’t an option. There’s no guarantee that chems are going to stem the symptom leakage. Increasing the strength of the meds also increases the risk of side effects. I’m already on an above-average dose, and I supplement it with oral medications three times a day.
As for negative symptoms, both avolition (a lack of motivation; showing little interest in everyday activities such as getting dressed or bathing) and alogia (not being able to think clearly; having difficulty with speech) are present, and subtract from my quality of life, but don’t upset me all that much. It’s the positive symptom of delusion that really vexes me, especially delusions of reference and paranoia. Adamantly adhering to beliefs and ideas that are false puts me in an awkward position, socially speaking. I hear myself talk about my “Spidey sense” and I feel like a fool, even if it’s just in conversation with my therapist. I keep my thoughts to myself, but they haunt me like a focused ghost.
When I told my case manager about dark thoughts impeding my enjoyment of simple things like watching movies or reading a book, she reminded me that those thoughts could be generated by my disorder. Not meaning to be dismissive, but to simplify things. It made sense to me. Coupled with my psychiatrist’s concurrence with the medication’s side effects and efficacy I’d read about, I had to accept that my schizophrenia would not be “cured,” but could be managed. So I take my meds and talk with my therapist. Because the delusions don’t feel like delusions, they feel real. The ideas feel real. The fear feels real.
I trust my meds to do what they’re meant to do. I trust my treatment team to help me stay steady when times get tough. I don’t feel like I’m at risk for a relapse since I pay close attention to my thoughts and discuss them openly. That’s what all these years of hard work have been for. To help me manage schizophrenia. To live a better life. To keep the wolves at bay.