Regardless of our kids' trials and tribulations during childhood and into the early teen years, the furthest thing from most parents' minds is that their young adult child may develop a serious mental illness. Unfortunately, it's an equal opportunity disease that can strike even model kids who've rarely experienced a difficult day in their lives. The incurable brain diseases of schizophrenia, schizoaffective disorder, and bipolar disorder combined strike one in every 25 people — typically as they enter adulthood.
My son (who I'll call Sean) was diagnosed with schizoaffective disorder at the age of 19. This disease is the combined illness of schizophrenia and bipolar disorder.
The first several years of his adult life were spent inside a living hell—literally. The early-stage was marked primarily by delusions and paranoia: there was a government conspiracy against him, Li'l Wayne and Drake were writing derogatory songs about him, and pimps were trying to kill him. But this was only the beginning of a downward spiral.
The first year of treatment showed only mild success. Antipsychotics are relatively fast-acting and, if monitored, can be quickly adjusted or changed. Unfortunately, throughout the country, there's a severe shortage of psychiatric beds, a lack of adequate federal and state funding for mental health care services, and laws as sick as those who are ill. So, he was in and out of the hospital within days, still in psychosis. Further hindering recovery, he was allowed only one 30-minute psychiatric appointment per month despite having a severe brain disease.
There are two broader problems with treatment for the SMI in America. These are laws and funding.
Well-intended laws were created decades ago to protect the rights of seriously mentally ill individuals. But legislators didn't take into account that those with SMI are often unaware of their illness due to a symptom called anosognosia. As a result, those with SMI are most often unwilling to seek treatment.
Mental health hospitals have shut down in droves in recent decades. At the same time, public funding for treatment has dwindled drastically. This has impeded the development of adequate outpatient services and housing for seriously mentally ill people.
Important to note, new research indicates episodes of psychosis may cause more damage to the brain. The lack of timely, adequate, and appropriate treatment often results in each episode becoming increasingly more severe, reducing the likelihood of recovery.
This had proven true for Sean. A year into his illness, he received a message from a game of Scrabble to cut off his ear or toe or to break a leg to save the world. In the middle of the night, I awakened to his blood-curdling screams. He had jumped 15 feet from a tree, fracturing his back instead. Just before this feat, he attempted, unsuccessfully, to silence the commands. He branded his arm with a fork, a scar that remains today. He was admitted for psychiatric care, but released within seven days with little improvement.
Over the next three years, he was hospitalized with increasing frequency, always released within days. He was paranoid and lived in constant fear with the belief his family and friends wanted to kill him. He hallucinated that I said such horrific things to him as, "I'm going to chop off your head," or "I'll bury you alive." He spent nights awake sitting on his bed prepared to bolt if I broke down the door to kill him.
A few years into the illness, the television told him he was Jeffrey Dahmer, and the President told him to kill me. My son isn't violent. But statistics speak for themselves. Psychosis (hallucinations, delusions, and paranoia) often leads to violent and tragic acts by those who are otherwise nonviolent. It was a several-day battle to get him hospitalized. But he was released in 3 days in the same condition.
Finally, we got a little breather, though. For a couple of months, although his psychosis was still present, it had at least improved. But this often didn't last. With Sean's paranoia that doctors, pharmaceutical companies, and his family were trying to poison him, he often refused medication.
Soon Sean took another downturn. He couldn't comprehend real conversations because the hallucinatory voices were so overpowering. He carried on arguments with these voices, told news anchors on the TV to shut up because they were talking about him, and was angry with the Pope for something the Pope was doing to him.
He repeatedly insisted he was traversing. As a result, there were two of him, or maybe three — and he didn't know which was the real him. He became confused and didn't know where he was and often pleaded with me to get him home. I'd try to reassure him, "you are the real Sean, and you are safe at home." It was heartbreaking.
Finally, several years into my son's illness, I was able to get his psychiatrist to put him on Clozapine, the gold standard for treatment-resistant patients. Although Sean still experiences mild psychosis and is disabled, he's seen a remarkable improvement.
But my son and I aren't alone. This plays out for millions of seriously mentally ill people and their families day-after-day, week-after-week, and year-after-year as loved ones spiral further into the abyss.
In recent years, legislative proposals have been introduced. There've been some very small strides in changing laws to improve the care and treatment for those with SMI. Still, there's a long way to go to ensure appropriate and adequate treatment for all the sons, daughters, parents, and siblings in America suffering from serious mental illness — and for the countless people who in the future who will be struck by this dreadful fate.
Signs of schizophrenia to watch for in your teen or young adult child
It's often difficult to recognize SMI as it's developing. That's because many symptoms of these illnesses are also typical problems associated with the teen years. There's no cure for schizophrenia, schizoaffective disorder, or bipolar disorder. Still, recovery is possible for many with these brain diseases. But early detection is crucial to the prognosis.
Schizophrenia
With schizophrenia, the symptoms usually, though not always, develop gradually over months or even a couple of years. They show up as changes in behavior, thinking, and emotions.
Changes in behavior may include:
- Poor hygiene
- Talking to oneself or odd speech
- Difficulty with making or maintaining friendships
- Substance abuse
- Unusual facial or body movements
- Unblinking vacant expressions
- Trouble picking up on social cues
- Threatening behaviors
- Increasing isolation
- Inappropriate emotional responses, like laughing at something sad
Emotional changes can be seen in:
- Angry outbursts
- Extreme moodiness or irritability
- Severe anxiety and fearfulness
Changes in thinking might include paranoia:
- Obsessing about the past
- Visual or auditory hallucinations
- Delusional thinking (illogical and nonsensical ideas)
- Difficulty with concentration or following a train of thought
- Trouble distinguishing dreams or television scenes from reality
Bipolar
Bipolar is a mood disorder with swings to opposite extremes. It's believed there may be a correlation between this disease and ADHD. There are a couple of forms of bipolar, one in which mania is more severe. The less extreme state is called hypomania. With bipolar, mood swings in teens can change in the course of just a few hours or days. During adulthood, the swings can last much longer, for weeks or months.
Depressive symptoms to watch for include:
- Loss of interest in activities
- Decline in grades
- Difficulty concentrating
- Prolonged sadness or irritability
- Loss of energy
- Change in sleep patterns
- Change in food intake
- Feelings of guilt or worthlessness
- No longer experiencing pleasure
- Suicidal thoughts
- Anxiety, worrying, and anger
The difference between mania and hypomania is primarily the severity of the state where mania is more extreme. Mania or hypomania can be seen in the following symptoms:
- Decreased need for sleep
- Elated mood to exaggerated optimism
- Increased energy
- Increased confidence
- Extreme focus on projects
- Increased physical or mental activity
- Increased creativity or productivity
- Increased libido to hypersexual thoughts and behavior
- Difficulty concentrating
- Inflated sense of self-importance
- Risk-taking and reckless behavior
- Racing speech and thoughts
- Grandiose delusions
- Hallucinations
Schizoaffective disorder
This disease has combined symptoms of both schizophrenia and bipolar. The symptoms, therefore, can be any combination of symptoms for the two distinct conditions.
Getting help
If your child exhibits signs of SMI, be aware that counselors and therapists often don't have the educational and medical background to diagnose or treat these specific brain diseases. Seek an evaluation at a walk-in mental health crisis center or with a licensed psychiatrist. You can also consult with your family doctor, who can make a referral.
Kimberly Blaker has been an advocate for mental healthcare reform for individuals with serious mental illness. She also owns an online bookshop, Sage Rare & Collectible Books.