By Jack Bragen
Thursday June 27, 2013 - 10:21:00 PM

Averting a Relapse

When someone is diagnosed as schizophrenic, symptoms such as delusions can sometimes reassert themselves, even if one has been doing well for a long time.

Going partway into a delusional system can cause a "fight or flight" reaction. Delusions can sometimes be frightening, and this fright can make the delusions more compelling. Once in a fight or flight adrenalized mode, one has momentum toward a possible relapse. 

(A reaction of this kind can entail loss of appetite, loss of sexual function, being hyper and elevated stress. It is a reaction that evolution gave us, originally in order to run from or fight off predators.) 

It is not always a simple matter of "just take your medication and you will be okay." When someone gets an adrenalized consciousness, the medication can be less effective at preventing symptoms. 

It is important for a person with mental illness to know his or her individual warning signs of an impending relapse. These warning signs can include a change in sleep habits, a change in eating habits--or the signs can be subtler. Once alerted that one is in jeopardy of relapsing, preventative measures can be taken. 

Warning signs vary on an individual basis. You can ask the question, what was it like before the previous relapse? Was I anxious? Did I lose appetite? Did I have insomnia? Was I scared? 

Things can get out of hand including when taking the prescribed medication, and can lead to becoming semi-delusional. This in turn can lead to medication noncompliance, which can then cause a full-scale relapse of psychosis. Before getting to this stage, medication can be adjusted to head off such a relapse. 

Other adjustments can be made as well, such as the possibility of calling in sick to work, making sure that one gets enough food and sleep, and getting extra counseling. 

If there has been a disruption, it can require a lot of effort to get oneself back to the normal routine--but it is important to do that. Maintaining a structured schedule is grounding and it is reassuring. 

When suspecting that your judgment could be off base or that you might be somewhat delusional, it is often a good idea to refrain from sending emails, from making any major decisions and from doing any unnecessary monetary transactions. This could avoid you collateral damage which is sometimes irreversible. 

Delusions vs. Naiveté 

Today's society has grown to resemble many people's paranoid delusions. In modern times if you are paranoid, this is probably appropriate. Thus, it can be very hard to distinguish symptomatic thoughts from accurate ones, especially when the thoughts in both categories (accurate vs. symptomatic) can sometimes say the same thing. 

Oftentimes, restabilizing involves entering a comforting state of naiveté and a denial of harsh truths. To paraphrase one of Jack Nicolson's movie lines, sometimes, a person with schizophrenia "can't handle the truth." A comforting version of the world is needed to prevent too much distress. This means that it is even more difficult for someone with paranoid schizophrenia to return to a reality based state of mind. 

The criteria for being psychotic ought to include more than just inaccurate thoughts. Anyone can think things that aren't true--this doesn't make them mentally ill. In order to fit in, however, one must track a commonly accepted version of reality to the extent that one doesn't stand out. Other people's perceptions (of a mentally ill person) play a role in this. 

It is helpful to have a friend or relative who isn't subject to delusions with whom you can share thoughts--to get an opinion on whether the thoughts seem to be correct, or if they are off. You can't tell just anyone what you are thinking. Strangers or people in the general public may not understand what you're talking about, and if they don't know you, could be freaked out. 

Just because anyone can have incorrect beliefs, it doesn't mean that your thoughts aren't psychotic. 

Perhaps the best one can hope for is to be able to meet one's basic needs. If one needs an outlet for one's "crazy thoughts" these thoughts can go into a journal.