Quiet Room - Lori Schiller [108]
I felt that it was one thing to talk about impaired dopamine pathways, or atrophied frontal lobes—explanations that make up the scientific underpinnings of what we know or surmise about the causes of schizophrenia. It was quite another to understand just what it was like to live with a broken brain. For that is what the experience of schizophrenia is like. A person is walking calmly through a normal life when suddenly and without warning, something terrible occurs, something she has no words to explain. Something actually does break inside the brain.
What is there in any human being's experience to prepare him or her to cope with a broken brain? Who can understand what a catastrophe this break is for the human soul? For the thing that has broken is the person's ability to relate to another person. The thing that breaks is whatever it is that connects people to their environment, that allows them to recognize another person as someone outside of themselves.
It is hard for any of us who have not experienced it to understand the internal desolation such a break must cause. It must be worse than the worst experience of solitary confinement. People with schizophrenia are locked out of the outside world, and locked inside their heads with nothing but these wild, out-of-control thoughts banging about inside. For what has also broken is the brain's ability to process emotion and thoughts. In people with schizophrenia the normal emotions—that we all every day categorize, process and either accept into our consciousness or push back into the recesses of our minds—run amok. Emotions that would normally be comfortably catalogued as unacceptable take on a life of their own as voices that seem more real than the real world outside.
We felt that by trying to understand what patients were feeling, we could help them to understand too. And by helping them to understand, we could help them feel less overpowered and less terrified by their symptoms. We could help them understand what had happened to them, and we could help them learn to manage their condition.
Take Lori's out-of-control behavior. Her record suggested that earlier doctors had believed she was breaking things, smashing walls and running away on purpose. They believed her behavior was under her control. They believed she was manipulative, attention-getting, and locked in a power struggle with staff that could be handled only through strict discipline.
I chose to believe otherwise. I saw her behavior as an understandable—if troublesome—response to her scary inner world. As I observed her, I could see how she would get. If we were around as she was accelerating into an out-of-control incident, we could see it happening. As she spiraled out of control, we could talk to her. We could say, “Lori, get away from that window.” But she couldn't hear. I could see the look of terror, the trembling. This woman wasn't playing mind games. This woman was in genuine distress.
And how would she have any idea how to handle that distress without being taught?
I saw the job of the long-term unit as teaching her to recognize her symptoms as phenomena, and to seek help immediately from those around her before they became too much for her to bear.
First though, we had to help her develop relationships with people around her.
People with schizophrenia are filled with an essential longing. They have a longing to explain what is happening to themselves. And they have a longing for a connection, for some relationship that will give them a pathway back toward the world they have lost.
It is precisely this kind of relationship, though, that Lori, and people like her, found most scary and difficult to accept. Because they have difficulty distinguishing what is “me” from what is “not me,” anyone who comes too close threatens the very core of their beings.