Schizophrenia battled on many fronts

·10 min read

They call it the robber of youth.

It conjures the worst stereotypes of mental illness: people talking to themselves, railing against invisible demons. In more primitive times, they’d be locked up in asylums — out of sight, out of mind.

Today, it’s a treatable disease like any other. And, with it affecting one in 100 people on average in North America, advocates are increasingly determined to bring it out into the sunlight and de-stigmatize it.

Schizophrenia is a disease that can have many faces and one that some experts are starting to rethink in terms of its definition and diagnosis.

It’s characterized by episodes of psychosis, in which a person is unable to distinguish fantasy from reality and experiences feelings of fear, anger or anxiety. In its most intense form, it includes hallucinations, usually imaginary voices that can come across as taunting or demanding.

But psychosis can result from many things — including drug use — and that means a firm diagnosis may initially be elusive.

St. John’s psychiatrist Dr. Kellie LeDrew is part of a team at the Waterford Hospital that treats schizophrenic patients.

“When someone first presents, it can be very difficult to distinguish, so we tend to take a syndromal approach and say this is an episode of psychosis,” says LeDrew, “and then follow the person over the next weeks and months to be more clear around diagnosis.”

Recreational drug use often clouds the issue, since drugs can independently cause a persistent state of psychosis.

“We know now from the literature that cannabis can be an independent risk factor for psychosis, which can lead to a number of mental illnesses, including schizophrenia,” says LeDrew, adding that it’s a factor the same way obesity can be a risk factor for diabetes.

The higher potency in some modern marijuana products puts young people at an even higher risk, she says.

Drug use played a part in Maverick Boyd’s diagnosis.

Maverick, a Churchill Falls native in his mid-20s, has gone through a living hell since he graduated from high school and moved to St. John’s in 2015 to work in a department store.

Before that, he was an active, engaged youth, involved in sports and popular with his friends.

“The first experience I think he had that he can remember of audio hallucinations was when he was working at Walmart in the back room,” his mother, Dawn, said in a phone interview.

“He was living with my sister — he was on night shift — and he came home one morning and she found him out crying on the step. He told her he thought someone was screaming at him in the back of the warehouse.”

Maverick went back to Labrador the next year, and things only got worse.

In May, the family was scheduled to take a trip to Cuba, but that had to be put on hold.

“He was really in hard shape,” Dawn said. “He was erratic, he was insomniac, he was really talking to himself a lot, but it was almost like he was trying to hide it. If I was in the room, he wouldn’t do it, but as soon as I would go upstairs or somewhere else, I could hear him. He’d be talking to himself and yelling, like, really engaged with the voices.”

Instead of heading to Cuba, Dawn got in the car with Maverick and drove straight to St. John’s, a trip that took about two days.

When he finally saw a specialist, however, he couldn’t be diagnosed right away because he was a drug user. It was impossible to determine the cause of his psychosis.

They finally put him on an injected medication called Abilify (aripiprazole), but that made him insomniac and unable to focus on anything.

“He was very emotionless,” Dawn said. “His face was very stony. When he’d look to talk to you, it was like he wasn’t there.”

'From nothing to full-blown psychosis'

The next two years saw more turmoil. Psychiatrists only visited Labrador City every few months, and no one would offer a definitive diagnosis.

Dawn finally decided the drug was doing more harm than good, so Maverick weaned himself off it.

”He started to get better. His brain fog lifted, he was able to talk to you a little bit again and socialize. He seemed like he was doing well.”

About three weeks later, they sat at the table to play cards.

“All of a sudden, he started talking to himself. And I looked at him and said, ‘Maverick, you need to go to the hospital.’ And he said, ‘Yes, Mom, I think I’ll go to the hospital.’ When he said that, I knew he wasn’t feeling right.”

So they jumped in the vehicle and headed to Lab City.

“Halfway there, he was in full-blown psychosis. He was crying, talking to himself. It just ballooned from nothing to full-blown psychosis.”

A psychiatrist happened to be at the hospital and saw Maverick. He told Dawn her son was schizophrenic.

“I said, ‘You’re the first person who’s said to me he’s schizophrenic.'”

The doctor switched Abilify for an oral medication, but the trouble didn’t stop.

Maverick did something many others in his situation fall prey to: he stopped taking the prescribed pills, but kept doing drugs.

After an unsuccessful stint in rehab and an attempted suicide, he was finally admitted to hospital in 2019.

With Dawn’s insistence, he was put on clozapine, a second-generation antipsychotic that comes with a need for regular blood tests to monitor white blood cell counts.

“It’s the only medication that has worked for him, and, for me, I got my son back,” Dawn said.

Her son finally gave up recreational drugs and started improving. He even agreed to go back into hospital to fast-track qualification for supportive housing.

He now lives in St. John’s, where he can visit with his aunt and his grandparents.

Maverick has battled many demons over the past seven years, but he’s conquered one that few are able to overcome so early in their recovery.

Like his mother, he believes there is no shame in his diagnosis. He wants people to know what it’s like. Last week, he agreed to talk to SaltWire Network about his experiences.

In a short phone call, Maverick said he’s trying again to get some work with the help of The Gathering Place.

“I tried to do it once already, and my anxiety would kick in, so I couldn’t. I used to have really bad anxiety. I wouldn’t even be able to talk to you. I had to stop working because of it.”

For years, he couldn’t be sure that what was happening to him wasn’t just drug-induced psychosis.

“I ended up in the hospital before I really understood. That was the first time I really talked to anybody about it. It was like, five years before I understood that it was something else,” he said.

He’s been off the bad drugs ever since, and even stopped smoking.

And he now knows the warning signs.

“If something gets too out of hand, I’ll think about it, and I’ll be like, ‘OK, well, that’s not right.’ Something will happen and I’ll realize that it was just the schizophrenia, that it’s not really happening.”

Asked for his advice to others in a similar predicament, he said proper medication is crucial.

“My advice would be to get on the right medications. Look out for what you think is helping you when it comes to medication, because without the medication, for me … I can’t answer that now. Just take the meds.”

Family disease

Schizophrenia usually presents itself in the late teens or early adulthood. Medical teams look at it as a family disease because the whole family is usually involved in battling it.

One St. John’s dad, “Jim,” says his son was also a vibrant, popular teenager before things started to fall apart.

The signs were subtle at first.

“He thought his friends were hacking into his phone,” Jim says.

Then, on a road trip to Corner Brook, he thought people in the other cars were staring at him. Things spiralled down from there.

Jim even had to call the police to his home at one point, but his son never did harm himself or anyone else. Instead, he trashed his room.

In 2021, his son went into hospital and has been on Abilify ever since.

In this case, the injections worked.

“He went from completely in psychosis — hating everybody, angry, hearing voices — to coming out in five weeks telling me he loved me, and that kind of stuff.”

They’re not out of the woods yet, but they are watching hockey together and putting their lives back together.

“One step at a time, right?”

Antipsychotic drugs have been almost indispensable in treating schizophrenia, but experts are starting to realize that an earlier, more holistic approach may be better.

Several years ago, Western Lapland in northern Finland introduced a program whereby signs of psychosis were nipped in the bud as early as possible through an “open dialogue” approach that involved the entire family.

The results have been miraculous.

“They’ve basically said goodbye to schizophrenia,” says Susan Hyde, executive director of the Schizophrenia Society of Newfoundland and Labrador (http://www.ssnl.org/).

“Very few actually get any medication. It’s usually just to sleep or something. So they’re avoiding the stigma of diagnosis. They never get diagnosed with schizophrenia.”

The incidence rate there is now tallied at about two in 100,000.

“The sooner we can get them in some kind of treatment, the less likely they are to develop full-blown schizophrenia, or full-blown psychosis, or have to go in a hospital,” Hyde said.

“We’d save a lot of money on hospitalization, that’s for sure. There’s a lot of love involved — which, I know, you’re not supposed to talk about.”

LeDrew says that approach is starting to be adopted by experts on this side of the Atlantic as well.

“The goal is to intervene as early as possible, at the start of the illness, to ensure that a person gets the right treatment and to prevent relapse, and set someone up to live with an illness and have the best quality of life and functional recovery,” she said.

But Hyde, who helps run regular family support programs through the society, admits for those who need anti-psychotics, staying on them can prove challenging.

“I know people with bipolar (disease) who’ve been well for 25 years and then they say, well, this is getting ridiculous. I don’t need to be taking this. And the next thing you know, they’re in the Waterford or the Health Sciences.”

She knows from experience.

Growing up in Connecticut, she had to cope with a father, grandmother and aunt who all had untreated schizophrenia. Trauma in childhood can also be a risk factor, and Hyde had to be hospitalized herself later in life.

“I was in the Waterford in 2007 for two months, and now I have the keys to the place,” she said.

“Recovery is possible. You can be sick … but you can get better. You’ve got to work for it. I did.”

Peter Jackson, Local Journalism Initiative Reporter, The Telegram

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