I have schizoaffective disorder, a combination of manic depression and schizophrenia. Discover what it's like to be schizophrenic.

Be careful when you wrestle with monsters, lest you thereby become one. For, if you stare long enough into the abyss, the abyss also stares into you.
-- Friedrich Nietzsche

What It's Like Being Schizophrenic

Now I want to tell you about the symptoms that schizoaffective disorder shares with schizophrenia - the disorders in thought.

I find this difficult. It seems I haven't ever written much, publicly anyway, about what it's like to be schizophrenic. I think right now will be the first time I have written about it at any length. I have found it difficult to communicate my experience as compellingly as I had set out to do. It's taken some time to understand why.

The problem I have is that it is dangerous for me to have the kind of experience that would allow me to write vividly about my illness. I have found in the past that to experience memories of my symptoms with too much clarity causes me to experience the actual symptoms again. It can happen that simply reflecting on my past in a deep way can bring about insanity. This happened once during a time when I was corresponding regularly with a bipolar friend, and when I told her what it was like to really remember, she very anxiously pleaded with me to stop, let go and forget lest I be drawn into the darkness again.

After some reflection, I realize that the danger is in remembering the feelings I have had when I've been symptomatic. There is no problem with recalling the events, looking at old photos from the time, or reading what I wrote when I was wigging. What is dangerous is remembering the feelings by actually feeling them again. Remembering that I felt afraid is OK, what is not is to actually feel the same fear I once felt. To write the best I could hope to I would have to recall the actual feelings again, and I think it is best I not do that.

For that reason, I have found it necessary to approach this topic with a certain protective detachment that has resulted in the clinical tone my article has so far. I hope you can forgive me for it. I'm finding it a little more difficult to stay so detached as I write about being schizophrenic. Maybe I will be able to write more effectively here but just between you and me I find the experience more than a little frightening.

For a long time, I have found it easy to admit to being manic-depressive. I do it casually sometimes, even flippantly. Even before I decided to go public with my illness, I was comfortable telling trusted friends that I was manic-depressive. But I have always been much more reluctant to own up to actually being schizoaffective. What I said before, that I describe my illness as I do because no one understands schizoaffective disorder, is only part of the truth. The full truth is that even now, after so many years, I still find it hard to face the part of myself that is schizophrenic.

Many manic depressives will tell you that despite the pain it causes that there is something romantic about being manic-depressive. As I said manic depressives are known to be intelligent and creative people.

However, despite its extremes, the symptoms of manic depression are mostly familiar human experiences. It is not hard to find completely healthy people who act just like I do when I'm either hypomanic or moderately depressed. It's just the way they are. Psychotic mania and psychotic depression are not so familiar, but they are different in degree, not in kind.

The schizophrenic symptoms I experience are just plain... different.

This really gives me a serious case of the creeps.

next: Schizoaffective Disorder and Hearing Voices

What do you do if antidepressants aren't effective in treating your depression?

There are people for who it seems no antidepressant will help, but they are rare, and for those who cannot be treated by antidepressants, it is very likely that electric shock treatment will help. I realize that's a very frightening prospect and it is still controversial, but ECT (or electroconvulsive therapy) is widely regarded by psychiatrists as the safest and most effective treatment there is for the worst depression. Most effective because it works when antidepressants fail, and safest for the simple reason that it works almost immediately, so the patient is not likely to kill themselves while waiting to get better, as can happen while waiting for an antidepressant to yield some relief.

Those who have read such books as Zen and the Art of Motorcycle Maintenance and One Flew Over the Cuckoo's Nest will understandably have low regard for shock treatment. In the past, shock treatment was poorly understood by those who administered it and I have no doubt that it has been abused as depicted in Kesey's book.

Note: While you may have seen the Cuckoo's Nest movie, it's really worthwhile to read the book. The inner experience of the patients comes through in the novel in a way that I don't think is possible in a motion picture.

It has since been found that the memory loss that Robert Pirsig describes in Zen and the Art of Motorcycle Maintenance can be largely avoided by shocking only one lobe of the brain at a time, rather than both simultaneously. I understand the untreated lobe retains its memory and can help the other one recover it.

A new procedure called Transcranial Magnetic Stimulation promises a vast improvement over traditional ECT by using pulsed magnetic fields to induce currents inside the brain. A drawback for ECT is that the skull is an effective insulator, so high voltages are required to penetrate it. ECT cannot be applied with much precision. The skull presents no barrier to magnetic fields, so TMS can be delicately and precisely controlled.

At the hospital back in '85, I had the pleasure to meet a fellow patient who had once worked as a staff member at another psychiatric hospital sometime before. He would give us the inside scoop on everything that was going on during our stay. In particular, he had once assisted in giving ECT treatments and said that, at the time, it was just starting to be understood how many times you could shock someone before, as he put it, "they wouldn't come back". He said you could safely treat someone eleven times.

(It actually seems to be common for those who have a mental illness to work at psychiatric hospitals. The Quiet Room author Lori Schiller worked at one for a while and even now teaches a class at one. A bipolar friend worked at Harbor Hills hospital in Santa Cruz when I knew him back in the mid-'80s. At her first job, Schiller managed to keep her illness a secret for some time until another staffer noticed her hands shaking. That's a common side effect of many psychiatric medications, and in fact, sometimes I take a drug called propranolol to stop the tremors I get from Depakote, which got so bad at one point that I couldn't type on a computer keyboard.)

You're probably wondering whether I have ever had ECT. I haven't; antidepressants work well for me. Although I feel it is probably safe and effective, I would be very reluctant to have it, for the simple reason that I place such a high value on my intellect. I would have to be pretty convinced that I would be as smart afterward as I am now before I would volunteer for shock treatment. I would have to know a lot more about it than I do now.

I've known several other people to have ECT, and it seemed to help them. A couple of them were fellow patients who were getting the treatment while we were in the hospital together, and the difference in their whole personalities from one day to the next was profoundly positive.

next: What It's Like Being Schizophrenic

Melancholia, a type of depression, is what I struggle with. If I didn't take antidepressants, I'd be depressed most of the time. Read more.

Many manic depressives long for the hypomanic states, and I would welcome them myself if it weren't for the fact that they are usually followed by depression.

Depression is a more familiar state of mind to most people. Many experience it, and almost everyone has known someone to experience depression. Depression strikes about one-quarter of the world's women and one-eighth of the world's men at some time in their lives; at any given time five percent of the population is experiencing major depression. Depression is the most common mental illness.

However, in its extreme, depression can take on forms that are much less familiar and can even be life-threatening.

Depression is the symptom that I tend to have the most trouble with. Mania is more damaging when it happens, but it is rare for me. Depression is all too common. If I did not take antidepressants regularly, I would be depressed most of the time - that was my experience for most of my life before I got diagnosed.

In its milder forms, depression is characterized by sadness and a loss of interest in the things that make life pleasant. Commonly, one feels tired and unambitious. One is often bored and at the same time unable to think of anything interesting to do. Time passes excruciatingly slowly.

Sleep disturbances are common in depression too. Most commonly, I sleep excessively, sometimes twenty hours a day and at times round the clock, but there have been times when I had insomnia as well. It's not like when I'm manic - I get exhausted and wish desperately to just get some sleep, but somehow it evades me.

At first, the reason I sleep so much when depressed is not because I am tired. It is because consciousness is too painful to face. I feel that life would be easier to bear if I were asleep most of the time and so I force myself into unconsciousness.

Eventually, this becomes a cycle that is difficult to break. It seems that sleeping less is stimulating to manic depressives while sleeping excessively is depressing. While sleeping excessively, my mood gets lower-and-lower and I sleep more-and-more. After a while, even during the few hours I spend awake, I feel desperately tired.

The best thing to do would be to spend more time awake. If one is depressed, it would be best to sleep very little. But then there's the problem of conscious life being unbearable and also finding something to occupy oneself during the interminable hours that pass each day.

(Quite a few psychologists and psychiatrists have also told me that what I really need to do when I am depressed is get vigorous exercise, which is just about the last thing I feel like doing. One psychiatrist's response to my protest was "do it anyway". I can say that exercise is the best natural medicine for depression, but it may well be the hardest one to take.)

Sleep is a good indicator for mental health practitioners to study in a patient because it can be measured objectively. You just ask the patient how much they've been sleeping and when.

While you can certainly ask someone how they're feeling, some patients may be either unable to express their feelings eloquently or may be in a state of denial or delusion so that what they say is not truthful. But if your patient says he's sleeping twenty hours a day (or not at all), it is certain that something is wrong.

(My wife read the above and asked me what she was supposed to think about the times when I sleep twenty hours at a stretch. Sometimes I do that and claim that I'm feeling just fine. As I said, my sleeping patterns are very disturbed, even when my mood and my thoughts are otherwise normal. I have consulted a sleep specialist about this and had a couple of sleep studies done in a hospital where I spent the night hooked up to an electroencephalograph and electrocardiograph and all manner of other detectors. The sleep specialist diagnosed me with obstructive sleep apnea and prescribed a Continuous Positive Air Pressure mask to wear when I sleep. It helped, but did not make me sleep as other people do. The apnea has improved since I lost a lot of weight recently, but I still keep very irregular hours.)

When depression becomes more severe, one becomes unable to feel anything at all. There is just an empty flatness. One feels like one has no personality whatsoever. During times I have been very depressed, I would watch movies a lot so I could pretend I was the characters in them, and in that way feel for a brief time that I had a personality - that I had any feelings at all.

One of the unfortunate consequences of depression is that it makes it difficult to maintain human relationships. Others find the sufferer boring, uninteresting or even frustrating to be around. The depressed person finds it difficult to do anything to help themselves, and this can anger those who try at first to help them, only to give up.

While depression initially can cause a sufferer to feel alone, often its effects on those around him can result in his actually being alone. This leads to another vicious cycle as the loneliness makes the depression worse.

When I started graduate school I was in a healthy state of mind at first, but what drove me over the edge was all the time I had to spend alone studying. It wasn't the difficulty of the work - it was the isolation. At first, my friends still wanted to spend time with me, but I had to tell them I didn't have time because I had so much work to do. Eventually, my friends gave up and stopped calling, and that's when I got depressed. That could happen to anyone, but in my case, it led to several weeks of acute anxiety that eventually stimulated a severe manic episode.

Perhaps you're familiar with The Doors' song People are Strange which neatly summarizes my experience with depression:

People are strange
When you're a stranger,
Faces look ugly
When you're alone,
Women seem wicked
When you're unwanted,
Streets are uneven
When you're down.

In the deepest parts of depression, the isolation becomes complete. Even when someone makes the effort to reach out, you just cannot respond even to let them in. Most people don't make the effort, in fact, they avoid you. It is common for strangers to cross the street to avoid coming close to a depressed person.

Depression may lead to thoughts of suicide or obsessive thoughts of death in general. I have known depressed people to tell me in all seriousness that I would be better off if they were gone. There can be suicide attempts. Sometimes the attempts are successful.

One in five untreated manic depressives ends their lives at their own hands. There is much better hope for those who seek treatment, but unfortunately, most manic depressives are never treated - it is estimated that only one-third of those who are depressed ever get treatment. In all too many cases, the diagnosis of mental illness is made post-mortem based on the memories of grieving friends and relatives.

If you come across a depressed person as you go about your day, one of the kindest things you can do for them is to walk right up, look them straight in the eye, and just say hello. One of the worst parts of being depressed is the unwillingness that others have to even acknowledge that I'm a member of the human race.

On the other hand, a manic-depressive friend who reviewed my drafts had this to say:

When I am depressed I don't want the company of strangers, and often not even the company of many friends. I wouldn't go as far as to say I "like" being alone, but the obligation to relate to another person in some way is loathsome. I also become more irritable sometimes and find the usual ritual pleasantries unbearable. I only want interaction with people with whom I can really connect, and for the most part I don't feel like anyone can connect with me at that point. I begin to feel like some subspecies of humankind and as such I feel repulsive and repulsed. I feel like people around me can literally see my depression as if it were some grotesque wart on my face. I just want to hide and drop into the shadows. For some reason, I find it a problem that people seem to want to talk to me wherever I go. I must give out some kind of vibe that I am approachable. When depressed my low profile and head-hanging demeanor is really meant to discourage people from approaching me.

Thus it is important to respect each individual, for the depressed as for everyone else.

next: Effectiveness of Antidepressants

Michael David Crawford
April 11, 2003

You may be surprised to hear that I suffer from a devastating and poorly understood mental illness. I'd like to tell you what it's like to live inside my head.

There's hope for people suffering from mental illness. Even if you don't suffer, I want to help you to better understand the many mentally ill people you are likely to encounter as you go through life, and explain why you don't need to shun them. I want to demonstrate that in fact, friendship with the mentally ill can be a rewarding experience.

Read on, and I will tell you how I recovered from schizoaffective disorder - but have not been cured. I will tell you how I learned to live with mental illness every day.

article references

next: The Best of Both Worlds

Self-Portrait

Eyeball Tree

Bug

next:   What To Do If You Think You're Mentally Ill

Read about my dissociation experience. Dissociation is something that comes with having schizoaffective disorder.

At times, particularly that summer of '85, I would have the experience that I was not participating in my own life anymore, that I was a detached observer of, rather than a participant in my life.

The experience was like watching a particularly detailed movie with really high-fidelity sound and a wraparound screen. I could see and hear everything going on. I guess I was still in control of my actions in the sense that some guy who everyone else referred to as "Mike" seemed to be speaking and doing stuff from the same point of view as I was watching from - but that person was definitely somebody else. I didn't have the feeling that the part of me who was called I had anything to do with it.

At times this was frightening, but somehow it was hard to get worked up about it. The person who was feeling and exhibiting the emotions wasn't the one called I. Instead, I just sat back and passively observed the goings-on of the summer.

There was a philosophical theory that I had long been interested in, that I think I first encountered in a science fiction story I read when I was young. Although I was originally fascinated with it in a conceptual and academic sort of way, solipsism took on terrible new importance to me that summer - I didn't believe anything was real.

Solipsism is the notion that you are the only being that exists in the Universe, and that no one else really exists, instead, it is a figment of your imagination. A related concept is the idea that history never happened, that one has just this instant sprung into being with one's lifetime of memories readymade without the events in them ever having actually occurred.

At first, I found this interesting to experience. I had always found ideas like this fascinating to discuss and debate with my schoolmates, and now I would talk about it with the other patients. But I found that it was no longer an interesting concept that I held at a distance, that instead, I was experiencing it, and I found that reality terrible indeed.

Also related to solipsism is the fear that everything one experiences is a hallucination, that there is some other objective reality that really is happening but which one is not experiencing. Instead one fears that one is living in a fantasy. And in fact, that is not far off from what many of the most ill psychiatric patients face. The concern I had is that (despite my experience of actually being in a psychiatric hospital) I wasn't really free to move around the ward and talk with the doctors and the other patients, but that I was actually strapped in a straightjacket in a padded cell somewhere, screaming incoherently with no idea of where I really was.

There. I told you this was creepy. Don't say I didn't warn you.

I once read somewhere that solipsism had been disproved. The book that claimed this didn't provide the proof though, so I didn't know what it was, and this bothered me tremendously. So I explained what solipsism was to my therapist and told him that I was upset to be experiencing it and asked him to prove to me that it was false. I was hoping he might give me a proof of reality in much the same way as we worked proofs in Calculus class at Caltech.

I was appalled at his response. He simply refused. He wasn't going to give me a proof at all. He didn't even try to argue with me that I was wrong. Now that scared me.

I had to find my own way out. But how, when I knew that I could not trust the things I heard, saw, thought or felt? When in fact my hallucinations and delusions felt much more real to me than the things that I believe now were really happening?

It took me quite a while to figure it out. I spent a lot of time thinking really hard about what to do. It was like being lost in a maze of twisty passages all alike, only where the walls were invisible and presented a barrier only to me, not to other people. There on the ward we all lived in the same place, and (for the most part) saw and experienced the same things, but I was trapped in a world I could find no escape from, that despite its invisibility was a prison as confining as Alcatraz Island.

Here is what I discovered. I'm not sure how I realized it, it must have been by accident, and as I came across it accidentally a few times the lesson began to stick. The things I felt, not with my emotions, but by touching them, by feeling them with my fingers, were convincingly real to me. I could offer no objective proof that they were any more real than the things I saw and heard, but they felt real to me. I had confidence in what I touched.

And so I would go around touching things, everything in the ward. I would suspend judgment on things that I saw or heard until I could touch them with my own hands. After a few weeks the feeling that I was just watching a movie without acting in it, and the concern that I might be the only being in the Universe subsided and the everyday world took on a concrete experience of reality that I had not felt for some time.

I wasn't able to think my way out of my prison. Thinking was what kept me imprisoned. What saved me was that I found a chink in the wall. What saved me was not thought but feeling. The simple feeling that there was one small experience left in my world that I could trust.

For years afterwards, I had the habit of dragging my fingers along walls as I would walk down halls or rapping my knuckles on signposts as I passed them on the street. Even now the way I shop for clothes is to run my fingers over the racks in the store, searching by touch for material that feels particularly inviting. I prefer coarse, robust and warm material, rough cotton and wool, dressing in long-sleeve shirts even when it is hot out.

If left to my own devices I would (and used to) buy clothes without any regard to their appearance. If my wife didn't help choose my clothes they would always be hopelessly mismatched. Fortunately, my wife appreciates my need for tactilely appealing clothes and buys me clothes that I find pleasant to wear and that she finds pleasant to look at.

The importance of touch comes out even in my art. A friend of mine remarked once about my pencil drawing - pencil is my favorite medium - that I "have a love of texture".

It is typical of schizophrenic thought that a simple but disturbing philosophical idea can overwhelm one. No wonder Nietzsche went mad! But I will explain later how studying philosophy can be comforting too. I will tell you how I found salvation in the ideas of Immanuel Kant.

next: Schizoaffective Disorder and Paranoia

Detailed account of living with Schizoaffective Disorder.

Being schizoaffective is like having manic depression and schizophrenia at the same time. It has a quality all its own though which is harder to pin down.

Manic depression is characterized by a cycle of one's mood between the opposite extremes of depression and a euphoric state called mania. Schizophrenia is characterized by such disturbances in thought as visual and auditory hallucinations, delusions and paranoia. Schizoaffectives get to experience the best of both worlds, with disturbances in both thought and mood. (Mood is referred to clinically as "affect", the clinical name for manic depression is "bipolar affective disorder".)

People who are manic tend to make a lot of bad decisions. It is common to spend money irresponsibly, make bold sexual advances or to have affairs, quit one's job or get fired, or drive cars recklessly.

The excitement that manic people feel can be deceptively attractive to others who are then often conned into the belief that one is doing just fine - in fact, they are often quite happy to see one "doing so well". Their enthusiasm then reinforces one's disturbed behavior.

I decided that I wanted to be a scientist when I was very young, and throughout my childhood and teenage years worked steadily towards that goal. That sort of early ambition is what enables students to get accepted into a competitive school like Caltech and enables them to survive it. I think the reason I was accepted there, even though my high school grades weren't as good as the other students, was in part because of my hobby of grinding telescope mirrors and in part because I studied Calculus and Computer Programming at Solano Community College and U.C. Davis during the evenings and summers since I was 16.

During my first manic episode, I changed my major at Caltech from Physics to Literature. (Yes, you really can get a literature degree from Caltech!)

The day I declared my new major, I came across the Nobel Prize-winning physicist, Richard Feynman, walking across campus and told him that I'd learned everything I wanted to know about physics and had just switched to literature. He thought this was a great idea. This, after I'd spent my entire life working towards becoming a scientist.

next: Noticing the First Signs of Mental Illness

I devoted a great deal of time to making telescopes when I was a teenager; in fact, I once intended to devote my life to astronomy and building large observatory instruments. When I started college, I majored in astronomy at CalTech, and some of the happiest times in my life came when I assisted CalTech professor, Jeremy Mould, in observing with the 200 inch and 60 inch telescopes at Palomar Mountain.

But I have not worked with glass in almost 18 years, the last time being some time spent polishing my 10 inch mirror the summer after my freshman year at Tech in 1983.

I've strayed a long ways from astronomy and telescope making; now I'm a software consultant, and I spend most of my free time just hanging out on the Net. But for some time my wife has been urging me to develop some interests outside of computers.

I've decided to return to making telescopes. One reason for this are my memories of the great peace of mind that would come over me while grinding and polishing, and while observing on dark nights. Another reason is that I have somewhat greater resources available to me now as an adult computer consultant than I did as a teenager - it was everything I could do to get the components for my 8 inch Newtonian, but now I can foresee being able to build a much larger instrument. One can see much dimmer objects in a larger scope, and objects just visible in a smaller scope will be spectacular in a large one, because it captures more light.

I had planned to start off again by completing the polishing and figuring of my 10 inch mirror - it is not quite polished out to the edge, and the figure is not spherical. After making it spherical I must then carefully parabolize the mirror. But I recently moved to Maine and all my stuff is in storage back in California. It's going to be a while before I can get it here. I think it would do me some good to start over from scratch as well, so I can relearn the tricks of the trade.

back to best of both worlds

next:   When Did It Happen?

I met Michael while in a restaurant with my best friend. We'd both been through a bad time with relationships and had vowed we'd had enough of men, but when I saw Michael my good intentions went straight out the window!

He was sitting at a table with a mate and I could see him looking over. The next thing I knew, he'd picked up their table, carried it over and placed it next to ours. I laughed so much. Michael was lovely - so funny, outgoing and a bit of a party animal. When he kissed me, I turned to putty. We were meant to be together.

I was 23 at the time with a 17-month-old daughter, Kayleigh. Michael was wonderful with us both and 16 months after we met, we were thrilled when I became pregnant. In July 1995, Michael proposed. We began looking for a house and couldn't wait for the baby to arrive.

Symptoms of a Schizophrenic Began to Appear

But then Michael began to behave strangely. A few months earlier, he'd broken his leg, ending his dreams of becoming a semi-professional footballer. He was very low, and became depressed and withdrawn. Then he started having hallucinations.

He was in the bath one day when he started seeing black clouds around him and said the water had turned black. I knew something was terribly wrong and called a doctor, but she just said he was overworked and he would be fine after a good night's sleep.

A few hours later, I woke to find Michael was missing. So was Kayleigh. The police found him wandering the streets in his pajamas with Kayleigh in his arms. Then when he got home he refused to come inside, saying could I see the beautiful lights in the trees and growing more and more agitated.

He caused such a disturbance that the police came and took him to a secure psychiatric unit. The doctors felt it would be better if I didn't see Michael for a while. By now five months pregnant, I could feel our baby kicking, but Michael wasn't there to share it. It was dreadful.

Soon, Michael, a storeman, was let home at weekends. He was on 26 tablets a day and was a shadow of himself. He sat in a chair, rocking backward and forward.

I was scared of what the future held for us and when a community psychiatric nurse said he had schizophrenia, I was shocked. People think of schizophrenics as violent characters. But Michael was only a danger to himself.

In February 1996, our son Liam, who's now seven, was born. Michael was on so much medication he couldn't cry, and instead made a yelping noise, like a dog. I was desperate, but then Michael's firm got him into a private clinic and different medication worked wonderfully.

As he got better, we started to rebuild our lives. When I gave birth to our daughter Rhianna five years ago, Michael held my hand and, this time, he cried.

On Valentine's Day in 1998, we got married. It was a public statement of our love. We'd always been close, but everything we've been through has made us even stronger. Mike's doing well now - he's on just one tablet a day and all the symptoms have disappeared. We're soulmates and I never doubted for a second that we wouldn't pull through.

In the early spring of 1966, I was hospitalized and diagnosed with paranoid schizophrenia. Over the course of the following decades, I recovered sufficiently to become a psychologist and devote virtually all of my professional life to caring and advocating for others whose disabilities are similar to my own. Although accounts of my adventures with relapse and recommended coping strategies have been published elsewhere (Frese, in press; Frese, 1997; Frese, 1994; Schwartz et al., 1997), this article focuses specifically on the mental process accompanying schizophrenia, which is traditionally termed disorganized thinking or formal thought disorder.

Due to the cognitive processes that are involved in disorganized thinking, those of us with schizophrenia may exhibit a tendency toward circumstantiality, meaning that in conversations we wander from the topic at hand, but we are generally able to return to the topic after our diversionary side-trips. As this mechanism progresses, however, we increasingly become unable to return to the topic, slipping off the track, exhibiting derailment, loose associations and tangentiality. If this phenomenon further exacerbates, we may find ourselves in states of linguistic disorganization, incoherence, or in the production of "word salad." This disorganized thinking has been argued by some to be "the single most important feature of schizophrenia" (American Psychiatric Association, 2000).

My experience suggests that a model based on the thinking of the philosopher Edmund Husserl, as described by Schwartz et al. (1997) and Spitzer (1997), can be particularly helpful in rendering an increased understanding and appreciation of this process. According to these authors, the disorganized thinking of schizophrenia can be conceptualized as a cognitive process of over-inclusion, or "an expansion of the horizon of meaning" (Schwartz et al., 1997). From time to time, often as a function of stress or excitement, our neurotransmitting mechanisms become increasingly active.

During these times, we begin to conceptually broaden, or overemphasize, the connectedness of words, as well as of other sounds and sights, in a non-linear, quasi-poetic, manner. Our thinking becomes dominated by metaphors. We have a heightened awareness of similarities in the sounds of words. We become particularly aware of rhyming, alliterations and other phonological relationships among words. Words and phrases are likely to engender thoughts of music and lines from songs. We are more likely to perceive amusing relationships among words, and between words and other stimuli. In more poetic terms, our mental processes become increasingly influenced by the muses. As a part of this phenomenon, we may also begin to perceive certain mystical or spiritual aspects of everyday situations. Sometimes these experiences can be quite moving, frightening and even life-altering.

If one's mental horizons are allowed to expand too far, there will be serious consequences. If not contained, this cognitive process can become quite disabling. Fortunately, modern medicines and other forms of treatment enable increasing numbers of us to avoid the worst of these consequences. The mind's tendency to expand its horizon of meaning can be kept in check. Our sensitivity to semantic and phonological relationships does not have to become so acute that we can no longer focus on the problems of everyday life.

The DSM-IV-TR states that "less severe disorganized thinking or speech may occur during the prodromal or residual periods of schizophrenia" (American Psychiatric Association, 2000). However the DSM-IV-TR does not make it clear that, even in recovery, our thought processes tend to be colored by the same mechanisms which, when intensified, can become disabling. Even with treatment, the cognitive processes of those of us with schizophrenia continue to be affected to some degree. Even when we are in a relatively normal state, our minds often continue to be subject to perceiving relationships of which others are unaware, relationships that affect our sense of reality and truth. Because we have this tendency to "listen to a different drummer," we often experience difficulties in communicating with our more "normal" friends. Sometimes others perceive what we say and do as strange or bizarre. Even while in recovery, we may still meet one or more of the DSM-IV-TR criteria for the three schizophrenia-spectrum personality disorders-paranoid, schizoid or schizotypal.

In conclusion, there has recently begun to appear in the literature a call for reconsideration concerning the disorganized thinking aspect of schizophrenia. Recognizing this process as a function of an expanded horizon of meaning may provide an improved vehicle for a better appreciation of the phenomenological world of people with schizophrenia. Such improved understanding could be valuable in assisting those of us with this condition to more easily integrate our social and vocational efforts into the activities of the everyday world.

Dr. Frese served as director of psychology at Western Reserve Psychiatric Hospital from 1980 to 1995. He is currently coordinator of the Summit County, Ohio, Recovery Project, and is First Vice President of the National Alliance for the Mentally Ill.