Schizophrenia involves chemical neurobiological changes in the brain, which can lead to bizarre decisions, poor insight, and even risk-taking. Classic symptoms of schizophrenia include paranoia (irrational fear) and delusions (fixed, false beliefs). And a manifestation of both paranoia and delusions is hiding away.
There are different types of hiding away. Many cut off all friends and family, as I once did. Some people virtually disappear through staying off social media and the Internet, and sometimes they even refuse to do any business transactions online, so there are no records. Some become homeless, as I did. Some travel frequently, going from place to place without ever setting down roots. Others hide away in a relative or friend’s basement or bedroom.
Recently, a family contacted me about their daughter who had just graduated from high school and been accepted at several prominent American universities. However, right after high school, following a psychotic break, she decided to not go to college or work any job. Today, she spends all of her time isolated in her bedroom. She refuses to see old friends, let alone to see a therapist or a doctor. The parents are entirely lost on what to do next. Forcing this young woman to either leave her room or move out is not being considered, as they fear she would quickly become homeless.
As I connect with this family, I remember feelings of shame from when I was homeless, which made me want to disappear. I had failed my classes, even though everyone had such high hopes for me (or so I thought, though my family was always understanding). I wonder if this young woman is in fact able to recognize how far she has fallen. Perhaps it is too painful. Perhaps, for her, it is easier to simply withdraw from the people she knows with their expectations, and virtually disappear, than to cope with her current inability to function. I hope to share with her that medicine might enable her to succeed in school again.
I hear from other families whose son or daughter rarely leave their rooms or basements, except to eat and to shower occasionally. Hygiene is often neglected as well.
Lying or twisting the truth
Other people hide away because of confused or disorganized thoughts, and sometimes through lies. When I was homeless, I frequently lied to others I met, whom I did not know well, about my situation. As an undergraduate, I had always expected to finish my degree and enter a master’s program in my field of molecular biology. While homeless, I often told people I was a graduate student, though I had not finished my undergraduate degree.
In my delusions, I used to believe I would someday make a worldwide impact. I was afraid that my parents, family, and friends would somehow stop me from changing the world. I thought I simply needed to wait for God to perform a miracle, as I lived outside, homeless.
Some of the best interventions for people who are hiding away are counseling, being challenged to make the choice to get out of the house and spend time with others, and talking through social barriers. Counseling can be a powerful intervention. A physician’s involvement is also key. Medicine can improve an individual’s insight about the very most important things and decisions in life. When I developed insight while on my medication, I was amazed at my previous risk-taking, as well as my lies.
After my diagnosis in March of 2007, and on antipsychotic medication for the first time, I suddenly realized there was no reason to hide away. Suddenly, thanks to the medicine, I wanted to get off the streets and return to a healthy and normal life, as well as return to college and work a job again. After finding the right medication, I completed college with my molecular biology degree in 2011, and today I work.
Some of the best ways to get through to a young person with psychosis who refuses treatment are to explain they have a brain disorder—as opposed to a “mental Illness,” which may sound like an emotional disorder rather than a physical problem.
It is also important to compare the person’s present life (a dismal existence in the basement) to their prior life filled with meaningful work and/or school, and supportive friends and family. Treatment is supposed to improve a person’s life and enable them to work toward their goals, including the goal of finding happiness.
It is vital to educate young people about anxiety, depression, bipolar disorder, schizophrenia, and other brain disorders in high school, or sooner. Today, brain disorders like schizophrenia are very treatable, and everyone should be aware of this. Even young people should be able to watch for the warning signs in themselves and in their families and friends.1 Early intervention often leads to the best outcome.
There is hope for young people who won’t come out of the basement, as well as for those who are isolated and living outside under the stars at night, dirty, as I used to be for so many months.
Parents and loved ones have a hard job ahead of them, convincing their loved one to come out of the basement or come off the streets and access treatment. But, in treatment, there is hope.