hopefully i can kind of stick to the point a little bit.......i apologize for the informal structure of this email but i prefer to write as i think versus losing my train of thought.......first of all i know that my thought patterns are not what would be considered the norm......but i have always been quite intelligent and have found that my abstract way of thinking is quite often helpful in problem solving.........lets just say that my brain is constantly in overdrive........a very intense place to have as the center of your existence so to speak but it is what it is.........i find that other people have trouble following my train of thought alot of times so that causes me to over explain myself quite often........anyhow i find that my speech and thought patterns follow quite a few of the formal thought disorder patterns that have been outlined.......it is not that these thoughts are incoherent to me.....but when you voice them it can be less that effective communication......it is more along the lines that my brain makes connections that other peoples fail to......and of course just like a written essay you know what you mean when you write it so it can be necessary to hear it aloud to catch mistakes in grammar etc.........anyhow first of all i would like to say that i still do not understand why mania and schizophrenia are considered to be so absolutely different......yes there are some markedly different symptoms.....and i am sure that i do not completely understand schizophrenia........but a brain in overdrive is a brain in overdrive no matter what.......someone who is manic has alot of euphoria due to the increased levels of certain neurotransmitters........but imagine that these levels of neurotransmitters stay at excessively high levels almost indefinitely......would this not become the new baseline in that brain.......that person would become rather desensitized to the pleasurable effects of the high levels of these neurotransmitters over time.......and then it would only make sense that external stimuli that normal people have strong reactions to would elicit very little from that individual as desensitized as his brain has become........it is almost like mania, can, overtime morph into what would be classified as schizophrenia.....and then of course depression could occur because this person would feel markedly different and alienated to the outside world because it might seem that nobody would understand them.......and of course relationships would be very difficult........plus after going for such an extended period of time with no strong emotion whatsoever can be very trying to your personal well being......anyhow that was just food for thought because that is what things look like from my perspective.......i have not been formally diagnosed with anything........i find that i can cope with most things........i have a tendency to disarm psychiatrists with my intelligence and rather structured way of presenting myself but i promise you it is no fun to live in my head sometimes........So here i am finally getting to the point......i feel like i have gone from hypomanic.....to manic......back and forth for a long time......and even begin to lean more and more towards alot of Schizo-type thought patterns......especially during rather emotionally trying times......i am 26 years old......i have also found that i become more and more distant from people and live more and more in my own head all the time....which of course allows for further drifting from what is considered the norm......my actual question i guess would be this....have you ever seen anyone continue to live a healthy fulfilling life without the medication.....and if there was an antipsychotic involved....which is what i would treat myself with knowing what i know about myself.....how many people feel like they lose a part of themselves.....a part of what defines them as a person after they begin taking it??? Sorry for all the run around i just feel like they were bases i needed to cover because it is my perspective of the situation no matter how irrelevant it might be......plus you can, at least a little, see my brain at work.

Donald

26 yrs old

gilbert, arkansas

Hello, Donald--

Your letter raises interesting questions. At the outset I should say that I had no trouble at all following your train of thought. I should add also that if your intelligence level is very much above average, and if you express yourself freely without considering the abilities of your listeners to grasp complex associations between ideas, then you may be misunderstood not because you are frankly psychotic, but simply because some of the thoughts which to you seem obvious, and which you express without perhaps dotting every "i" or crossing every "t," may, to your less gifted audience, seem disconnected, wildly confused, incomprehensible, or perhaps even even "psychotic." This effect would be especially amplified if you gave voice to your thoughts in the pressured style which can be the product an overstimulated brain, which characterizes mania, and which is apparent to some extent in your writing.

This is not to say that you are not psychotic—I would need a personal interview with you even to begin to make such a diagnosis—but simply that I see no overwhelmingly apparent signs of it in the wording or tone of your letter. However, in the content of your letter, your reporting drifting into what you have called "Schizo-type thought patterns" indicates to me that you are worried about your state of mind, and worried that you might be moving so far away from others that eventually you would be completely cut off. Indeed, Donald, this is the main reason for concern in schizophrenia: if it is allowed to continue untreated, eventually the sufferer might become so cut-off from normal discourse that even a determined and sympathetic person might be unable to understand the speech, writing, or other communications of the ill person. I think you will understand that if this should happen, the affected person would find himself in a terribly lonely place, and possibly at that point be lost to meaningful contact with anyone even if medication were then tried. That is why symptoms of schizophrenia should be treated as soon as they arise: it is urgent that lines of communication between the affected person and others be kept open and never be allowed to become totally interrupted.

Regarding your speculation that mania and schizophrenia are somehow related and perhaps comprise a continuum of overstimulation by an excess of various neurotransmitters: this is an interesting idea which might benefit from further investigation and development. While it is true psychotic symptoms sometimes accompany episodes of mania, at this point no one really knows enough about schizophrenia, what causes it, or why and how the antipsychotic medications work to mitigate it, so I am in no position to speculate on possible explanatory associations between mania and psychosis. I imagine that the next several years of investigation by means of brain imaging will reveal much more about what really transpires on the cellular level in the brain of psychotic individuals, but at present this is really rather an unknown.

In any case, although you speak of treating yourself with antipsychotic medication, self-treatment of such an illness is a bad idea. The sufferer from psychosis needs not just medication, but a trained and sympathetic person to prescribe the medication, to follow up on its effectiveness, to monitor possible side-effects, to regulate dosage, and, most important of all, to maintain personal contact with the affected person by means of regular therapy sessions which will be aimed at helping that person to deal in a reasonable way with the special problems occasioned by the illness.

To answer your specific questions: I am not an expert on medication for psychotic symptoms, but I do not think that problems with medication have much to do with the feeling of having lost part of oneself, but more to do with possibly unpleasant side-effects, and I have not known any sufferer from psychosis who was able to maintain a healthy life without medication. In any case, if you are struggling with your state of mind and with feeling that you are losing contact with normal consensual reality, I urge you to get the help you need, and right away. After all, if you are prescribed medication and if you find that you do not like what it does, you can always stop taking it.

Be well.