Stigma |

2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

For me this issue ties into my last post about abandonment. You can find this here.

If I idealised or devalued anybody it would be in relation to how they felt about me and if I thought that they would stay, or if they would leave me. As I mentioned in the last post, I would fear abandonment over very minor things. If someone that I was close to did anything to trigger that fear in me then my brain automatically labelled them an ‘abandoner’; they were mean, they didn’t care about me. If the very same person was to get back in touch and say something nice then they were amazing, they would never leave me, they could never do anything wrong. It was exhausting really and back then I never had any real insight into how I was thinking or why I was thinking in that way.

Those that are familiar with BPD terminology will have heard about the ‘favourite person’ phenomena. A favourite person (or FP) is someone that you believe can do no wrong, they are your everything and you place all of your worth on their opinions. A FP can quickly change and become demonised by something minor, but more often than not with me I just became obsessed with keeping them, keeping their good opinion and pleasing them. I would message my favourite person all the time (there have been many), buy them gifts that I couldn’t afford and want to see them all the time.

I still struggle with traits of this now. Sometimes I find that I’m still skipping the grey areas with people or situations. I just see the good and the bad, the true of the false. It’s something that I’m working on though and I wouldn’t say it’s detrimental to my health any more. I do have healthier relationships now, but there have been so many that were just toxic.

I’ve had bad relationships with my family, particularly my parents. I have had various toxic relationships or emotional/sexual encounters. I can see now that I turned people into my FP or demonised people so much that it distorted my perception on what was really happening. Every relationship I was in ended in a train wreck. I hurt myself and countless other people whilst I was living this way.

This black and white thinking in BPD is known as splitting (I.E all good or bad, splitting everything into two categories). I still do split on people if my emotions are high and I’m so wound up that I can’t think straight. An example of this would be if my husband and I had a small argument, I would forget about every nice thing that he had ever done and just all of the bad. He goes from being my awesome normal husband, to the worst husband of all time. This isn’t too much of an issue for me now though, I can now see that I’m splitting when I’m doing it and most of the time I manage to reassure myself that it will pass, once I’ve calmed down and removed myself from the situation.

I do split on situations still though now, EG. we’re very poor/we’re very rich, I’m doing well/I’m doing terribly. Especially if I’ve had a disagreement with someone. It takes some work and some self-care to get a hold of myself.

I’m fortunate to be in a stable place in my life right now. I have my struggles but I can largely gain perspective on my issues in a calm and safe space and can work on them accordingly. For a person with BPD who has had no help and who struggles to find perspective in their behaviour and emotions, the world and everything in it is a very confusing and scary place.

What is the first thing you think of when you try to imagine a person with schizophrenia? Would it be a dishevelled, wild-eyed, delusional person that may or may not lose their mind and hurt you? Would it be a sweet early-dementia-like patient who appears fine most of the time but is prone to hallucinations, delusions and sometimes anger in their confusion? Science, and the real world would say that the latter is a closer portrayal of Schizophrenia.

What is schizophrenia?

Schizophrenia is defined as a psychiatric illness that is characterised by losing touch with reality in a state of what is known as psychosis. It can appear suddenly or can be gradual and progressive. There is no known cure for schizophrenia and so treatment involves the use of drugs to control symptoms, although 25% of those that experience an episode of schizophrenia will recover completely.

The diagnostic criteria from the DSM-V is as follows:

The presence of 2 (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated), with at least 1 of them being (1), (2), or (3): (1) delusions, (2) hallucinations, (3) disorganized speech, (4) grossly disorganized or catatonic behaviour, and (5) negative symptoms.
For a significant portion of the time since the onset of the disturbance, level of functioning in 1 or more major areas (eg. Work, interpersonal relations, or self-care) is markedly below the level achieved before onset; when the onset is in childhood or adolescence, the expected level of interpersonal, academic or occupational functioning is not achieved.

To see the full list of criteria click here

Symptoms in schizophrenia are termed ‘positive’ or ‘negative’. Positive symptoms are those that are brought by schizophrenia; meaning you wouldn’t have them if you didn’t have schizophrenia. These are symptoms such as hallucinations and delusions.

Negative symptoms relate to things that you would have if it weren’t for a diagnosis of schizophrenia. These are symptoms such as being unable to move (catatonia), or feeling less emotional or motivated.

What causes schizophrenia?

The cause of schizophrenia is not understood, but studies have highlighted risk factors for developing the condition, such as genetics, a chemical imbalance, a persons’ environment.

There’s currently a movement, more so in America than the UK but it applies worldwide all the same, that is lobbying to push the World Health Organisation to reclassify schizophrenia as a neurological condition, much like Parkinson’s or dementia.

When a move like this occurs, it’s clear to see just how strongly stigma still clings to mental illness. We live in a world, sadly, where people with a certain ‘type’ of illness are accepted and cared for by both people and officials more than that of another type. It is more socially acceptable and pitiable to be diagnosed with a neurological disorder than it is a psychiatric one; to see a medical doctor and not a psychiatrist.

Raymond Cho, M.D of SARDAA (Schizophrenia And Related Disorders Alliance of America) has been campaigning for the change and is quoted as saying “There is scientific consensus that the illness is a brain-based, highly heritable illness. There is overwhelming evidence that schizophrenia is a neurodevelopmental disorder with disease processes commencing early in neurodevelopment and manifesting as subtle neurologic and behavioural abnormalities long before DSM-defined illness onset.”

It has been found that physical abnormalities are more prevalent in people with schizophrenia than people without, adding weight to the theory that schizophrenia is a condition that develops during foetal development and is therefore neurological in nature.

John Snook, executive director of the Treatment Advocacy Center is bolder still and says that “If schizophrenia was a disease that we just discovered today there would be no question that’s how we would classify it” – Powerful huh?

Symptoms that a schizophrenia patient might experience include:

A chronic lack of interest
Problems with concentration
Problems with memory
Psychotic symptoms – hallucinations and delusions
Becoming overwhelmed in social situations
Avoiding people or situations
Becoming withdrawn
Anxiety
Neglecting self-care
Incoherent speech
Mood changes

Sad, isn’t it? It’s also sad that every one of the above symptoms can be found in dementia too.

As mentioned before, schizophrenia’s most known characteristic is psychosis. You know the symptom that puts fear into everyone that has read the Daily Mail? Here are some other causes of psychosis:

Brain tumour
Brain cyst
Dementia
Parkinson’s disease
Huntington’s disease
HIV
Epilepsy
Stroke
Postpartum psychosis
Bipolar

Almost all of the conditions on the above list would warrant sympathy and compassion from the world populace – would schizophrenia? Psychosis in schizophrenia and bipolar are associated with violent behaviour – what about dementia patients that exhibit psychosis and are violent? Why aren’t we afraid of them?

Because of stigma.

The media portrayal of schizophrenia would have us believe that all schizophrenics are dangerous and unpredictable.

They have a split personality or multiple personalities (completely different disorder and again, nothing to be afraid of.)

Here and here are two heart-breaking stories of dementia patients that have committed murder. Do you think that society is going to begin to fear dementia patients? Society acknowledges that these patients were sick and vulnerable and that absolutely applies to the schizophrenic members of our society; they absolutely deserve the same amount of love, care and compassion as anybody with any illness – I might even argue they would deserve more compassion due to the current climate of stigma. They are far more likely to be discriminated against.

The reality is though, most schizophrenia or dementia patients aren’t always in psychosis and they are not always violent.

Regardless of whether or not the illness is reclassified, why should it matter? It shouldn’t. These patients have an illness that they did not ask for and an illness which (like many others) has a huge impact on all aspects of their lives. Any person with any illness, mental or physical, deserves compassion and understanding. Poorly people have enough to deal with, so let us learn to accept them without labels and judgement, and let’s keep on spreading awareness and changing the world.

Sources:

http://www.soonerthantomorrow.com/blog/2019/2/25/6zrk92dl8f0ipjgp7q1i4hyujwce51

https://www.medicalnewstoday.com/articles/248159.php

https://www.politico.com/story/2019/01/05/schizophrenia-brain-disease-1059386

https://emedicine.medscape.com/article/288259-overview#a2

https://sardaa.org/its-time-to-reclassify-schizophrenia-as-a-brain-disorder/