I think the entire story below is too long and unexciting; this looks like a better version: There was once a boy who was depressed but somehow was convinced he was schizophrenic. He had a very curious explanation about the absence of voices in his head. According to him, the people around him disliked him and bullied him, said negative things. His parents, however, were always loving and patient. He figured that his mind was playing tricks on him, causing him to not notice that it was actually his parents who were saying all the bad things. Their love and kindness was a façade, a product of his ‘schizophrenia’. So he killed them. Miraculously, the ‘voices’ went away; months after the murder, he claimed he never heard anyone say anything negative to him anymore. But then to an outsider it would make perfect sense that anyone in solitary confinement could say that (the exception being real schizophrenics).
The Psychiatrist’s Account
We will now look at the peculiar case of a patient who was convinced that he was wrongly diagnosed.
In late February of 2002, a Frederick Mitzberg was referred to my clinic for treatment of acute depression. Frederick was 21 years old at that time and was struggling in school, being at risk of repeating his second year of college, for the second time. He came from a lower-middle class family comprising his father who was a shop owner and his mother who worked at a bakery.
Our investigations into his past years and academic performance revealed that Frederick was usually one of the top performers in his class. He was active in track and field, but his sporting days saw an abrupt end when he hurt his back in an unfortunate road accident at age 17. A herniated disc partially fragmented his spinal cord, causing him to lose sensation in most of the left side of his body. It was apparent that his ‘disability’ affected him greatly. His grades plunged in the months after his injury, although he barely scraped through and succeeded in passing the grade. The next year didn’t seem to hold much hope for him and his grades continued to suffer. He decided to take a six month break from school. During that period he went through more intensive rehabilitation sessions in the hopes of reclaiming a normal life. There was evidence that he attempted yoga and meditation as well.
By the time he was ready to resume school, the academic year was drawing to a close. Out of goodwill the school allowed him to sit in his classes under the precondition that he understood and agreed that he would not sit for the promotional examinations, and that he would repeat that year of study.
Things seemed to brighten up for awhile. Despite the awkwardness in adjusting to fit in with his younger classmates, Frederick seemed to be coping at an acceptable level. His grades were not good but they were at least consistent. Despite the apparent progress, his father was not too satisfied with his performance. Business had been bad and the money spent on Frederick’s health had, and was still taking a toll. It might have gone unnoticed at that time, but interviews with Frederick’s schoolmates shed light on his father’s slow but gradually increasing impatience at his son’s lackluster performance. His closest friends recounted that Frederick had once voiced his, and his father’s worry, that he would not be able to complete his education and get himself a good job; his father’s shop was definitely suffering so their future seemed rather bleak.
Soon after his grades began picking up, his father’s worries being a probable motivation for him to do better. Unfortunately though, the increased effort he was putting into schoolwork slowly led him to feel stressed out. In the past he would go for a run or engage in a sport when he needed to clear his head. Although he could walk more normally now, an awkward limp was the closest he could get to running. He did start new hobbies as compensation, alas old habits die hard. He was spotted sitting by the tracks many afternoons, silently watching people train and run about freely.
His school counsellor was alerted to this development and was quick to intervene. She had counselled and monitored him since his return to school. In our interview, we learned that what Frederick missed most was the adrenaline rush from playing competitive sports as well as the ‘high’ he achieved when running long distances. It made sense then that Frederick had tried to shoplift to experience that rush, however rash that decision.
The shop owner did not call the police as he took pity on Frederick, given his condition. Unfortunately, some onlookers were not so sensitive and one reportedly mocked the boy as the rest laughed. It was very likely that incident which caused Frederick to spiral once more into sadness. For the next few weeks he displayed erratic behavior, getting angry at his parents for ‘pitying’ him because he was ‘handicapped’, then disappearing from classes only to be found sitting at the track sobbing. My hypothesis is that he was going through a delayed phase of denial. From my experience, observations and studies, I should remark that it is not uncommon for more intelligent patients to somewhat ‘skip’ the denial stage, or experience it briefly, once afflicted with a significant ailment or life-changing condition. This is probably due to their better ability at reasoning and coming to terms with reality, as well as the higher probability of better social and familial support.
In this case, a trigger event had unhinged the doors that were, up till that point, suppressing strong and violent emotions about his condition. It was at that point that his councilor and therapist thought it absolutely necessary to engage the aid of a psychiatrist.
In my first session with Frederick I noticed that there were dark circles under his eyes, probably an indicator of a lack of or poor quality sleep. His demeanor was of one who had adopted a negative, and fiery outlook towards the world. I was slightly shocked at the severity of his ‘degeneration’, so to speak, as his councillor’s written profile was a stark contrast to the person it supposedly described.
After an initial assessment and the expected refusal to share much, I gave a prescription of chemo stabilizers to regulate his mood as well as induce calmness. It was only a week later that his mother called, saying her son refused to take anything and had thrown the whole box out the window.
Having dealt with such cases before, I knew, more or less, how best to approach this patient. Slowly, we started seeing progress, and within 3 months, Frederick had started to share his feelings. He had become quiet and introverted, shunning almost all company. Feedback from the school told me that he had become disinterested in speaking to his friends and would sometimes anger them. My guess, at that point, was that he was subconsciously giving himself reassurance for distancing himself and for his lack of social interaction. By chasing people away, he had ‘evidence’ that people did not want to be with him anyway.
I started to worry a little when he told me, at our tenth session, that someone had called him ‘schizo’. I was confused as to why that person would say that, but I had my doubts. Frederick could have simply misheard a comment; unfortunately, it stuck to him and he revealed later that he thought he was schizophrenic.
I took pains to explain to him the medical condition of schizophrenia, common indicators and how his situation differed greatly. Somehow, he did not believe me and chose instead to further damage his reputation in school. By the end of the semester, teachers had given feedback that although his grades were improving remarkably, Frederick was becoming very hard to work with. He would argue with classmates and teachers alike, and it wasn’t long before the people around him took to hating him. Whatever pity and empathy they had for him previously was lost, and some had even started teasing him.
While I, as an outsider, could see the reason behind their behavior, Frederick chose instead to be further incensed. I had modified my prescription, and he did take his medications, but it was only later that I discovered how he would swallow a handful of pills at a time.
Through all this, he maintained that he was actually schizophrenic and that I had wrongly diagnosed him. He got angry at me a few times, accusing me of being ignorant and irresponsible. While I was not insulted by his words, I saw them as a sign of a worsening problem, so I started seeing him at school and at home. It was the examinations period, so I felt it absolutely essential that I increased my intervention as his stress level increased with the pressures of the exams.
It was at his school that I managed to observe him as well as speak to him right when he was feeling his strongest emotions. And it was at home that I saw the drastic change in environment; in school he was either left alone or spoken to harshly, but at home his parents were infinitely patient with him. His father, obviously sufficiently stressed about his business, chose to keep quiet more.
Then one day Frederick shared with me something truly disturbing. The conversation is still etched in my memory:
‘I really am schizophrenic.’
‘Why do you say that?’
‘I know I’m supposed to hear voices, but what if that’s not exactly what they meant?’
‘What do you mean?’
‘I read that schizophrenic people hear voices telling them things they don’t want to hear, or giving them instructions. Right?’
‘That happens, sometimes, b-‘
‘EXACTLY. I’m always hearing bad things about me,’
‘Who says these bad things?’
‘…Usually people at school,’
‘Real people?’
‘That’s the thing. If I’m schizophrenic, then it doesn’t make sense. I have an explanation,’
‘Tell me, I’m listening,’
‘I’m always hearing negative things everywhere, but my mother is always telling me good things and my father usually keeps quiet. So I think they’re the ones who are actually saying all the bad things, but my mind is tricking me into thinking that my schoolmates are saying the bad things. For some reason it’s trying to convince me that my parents are as good to me as they have always been, when in reality they hate who I am now,’
‘Frederick, perhaps you should rethink this,’
‘I did, and the more I think, the more it makes sense,’
‘So what now?’
‘Since you’re not going to give me medication for my schizophrenia, I’ll cure it myself. I’ll make the bad things stop, somehow,’
My mind raced to think what could cause such behavior in an otherwise intelligent mind. Because of his habit to overdose, I had stopped giving him medication. Perhaps the lack of it was causing a chemical imbalance? Was there something I missed?
I decided to lie to him, to agree to give him ‘medicine for schizophrenia’. I had my pharmacist fill a bottle of Risperdal with B Vitamin pills, and warned him to take this medication seriously. He was to take one pill a day, not more not less, for one week. Then we would assess his situation.
To my great relief my little trick had worked. Frederick appeared more at ease, and even, I daresay, a little happy. This was the beginning of rapid improvements in his mood and behavior, and in the next 3 months he was back to his quiet mode, although this time he did not alienate himself. It was the school holidays, a few weeks shy of the release of the examination results. Frederick went out with his friends now and then. He told me he didn’t talk much, rather just listened and laughed.
Unfortunately, things did not stay good. On the 1st of March, a day before the release of his exam results, Frederick was arrested as suspect to the murder of his parents. As his doctor, I was allowed to speak to him. A sobbing Frederick told me that he was excited for his results, he knew he would do well. He was expecting a place in a good university and he didn’t want anything to ruin that. He had to make sure the voices would not come back, so as a precaution he mixed rat poison into his parents’ food. He had bought and kept the poison the day I gave him his ‘schizophrenia medicine’, as a failsafe.
The rest is irrelevant to this account.
The Account That Would Have Mattered
Blake McIntyre, Schoolmate
Orphan, has Type 1 diabetes, financially difficult
Frederick is throwing a tantrum in class. ‘You don’t understand! My life is difficult! Don’t just expect me to be nice to all you lucky normal people,’
Blake, offended and hurt, turns to his best friend, and says, ‘Lucky? Normal? What does he know…’
Why It Would Have Mattered
Frederick misheard ‘What does he know…’ as ‘What a schizo…’
