MANY PATIENTS with mental illness, especially schizophrenia, are marginalized. I've seen patients with schizophrenia treated with anger, fear, disrespect, dehumanization, and annoyance. I believe this marginalization is mostly due to people's fear and lack of knowledge, and to patients' unpredictable behavior. When people don't know what a person with schizophrenia is going through during a hallucination, some become afraid and judge or label the patient. This results in dehumanization, transforming the patient from a person to a disease.
During a clinical rotation in mental health while in nursing school, I met a patient with schizophrenia I'll call "Timmy." The following account of our interactions was written from his viewpoint.
Identifying my plight
As I follow the nurse down the hall, I hear a whisper in my ear, "You suck! Jump out the window and kill yourself. Do it now. You know that you want to." A chill runs down my spine as I try to block out the raspy words. I can handle the full-scale voices, but I hate the "Whisperer."
"Nurse, why are spiders all over the walls?" I ask.
"They aren't," she replies, obviously annoyed. I contemplate the tiny creatures climbing all four walls around me and wonder who's wrong, the nurse or me.
Arriving at the psychiatrist's office, the nurse opens the door and rolls her eyes. "He'll be here soon." She flips through her papers as she speaks, mentally somewhere else. Slam. I'm left alone. But I'm not really alone thanks to the spiders climbing up my arms, into my mouth, into my nose, and over my eyes. They taste like peanut butter and jelly.
A man in a brown suit and tie enters the room. His voice sounds like a lethargic train: "According to your symptoms...start you on a higher dose...in treating schizophrenia, we usually...." I decipher only scraps of what he's droning on about because of a second conversation bouncing around in my head like an oversized beach ball.
I'm set apart: Marginalization
"Everyone, please come to the group room for community meeting." A voice from the overhead system pierces my ears. As I walk down the hall, I see the student named Laura who's always so friendly to me. I offer a timid wave. Her face bursts into a big smile, and she waves back. A smile breaks across my own face.
"Today in group we'll be discussing stereotypes," says a robust Black man as he uncaps a marker loudly.
But the Whisperer is back, saying, "Timmy, look outside. See those rocks? You could land right on them!" Disengaged and in a fog, I pretend to pay attention. The sound of my name slaps the Whisperer in the face as he's put on mute.
"Timmy, Timmy! Hey buddy, let's pay attention here. Why do you think marginalization occurs?"
My eyes scan the board; I'm weary and emotionally drained. "Um, what's marginal...."
Interrupting rudely, the leader blurts out, "What's marginalization! Haven't you been paying any attention? Let me put it this way: Why do you think you've become an outcast to society?"
I attempt to start answering again. "Well, I didn't know I'm considered an outcast, but people don't like me because they think I'm weird."
"And why do people think you're weird, Timmy?" The leader is relentless and heartless.
"They think I'm weird because I see things that they don't see and hear voices that they don't hear." I feel myself blush.
"Good! The schizophrenic population is marginalized due to auditory, tactile, visual, and other hallucinations. Let's move on to...."
I go back to my own little world as the Whisperer ties a noose around my mind and pulls it tighter.
What "they" should know
"Back to you, Timmy. What do you think healthcare providers should know about people like you?"
After suppressing a wave of anger, I begin, "I don't actually want to hurt anyone—that's only what the voices tell me to do. I don't actually want to kill myself, but try living with voices in your head who are constantly and ruthlessly pressuring you to do so. Not only do they pressure me, they actually tell me how to kill myself! I'm not here to hurt anyone. I love people. I want to have relationships just like you do. I need relationships just like you do.
"I might see, hear, and taste things that aren't real, but I still see, hear, and taste things that are real. I see you staring at me. I hear you whispering behind my back. I'm not stupid. I can tell that you think I'm psycho.
"I care about what you're saying even though it seems as if I'm not listening. I'm trying hard to listen, but I just can't hear you over the voices in my head. And I get distracted when things crawl into my mouth. I'm trying to focus, but why is your face twisting into the moon?"
As I finish, I realize something hot and wet is running down my face, and I think it's real. The room is silent. For a moment, the voices stop. It sounds like silence.
What "they" can do
"Timmy, the group leader told me you shared a lot in group today. I want to thank you for that and let you know I'm very proud of you. Now I have a question for you: What can we as healthcare workers do to make things better for you?" The social worker is sincere and sweet, making me feel at ease.
I hesitantly begin, "I wish that nurse wouldn't have been so annoyed with me. I wish the doctor would just tell me in a few simple sentences what's going on. I wish the nurse would've helped get the spiders off me—I didn't want to eat them! I wish you guys wouldn't stare at me and talk about 'my condition' in whispers. I wish you guys would stop being so nervous around me and just treat me like a normal human being.
"You should do simple things like say hello and smile at me like Laura does. She makes me feel good. I wish you guys would know that I love people, I want to help others, and I want to be friendly. I'm not a crazed maniac waiting for my next victim. I just wish you guys would see me for me, not for my disease."
"Wow, thank you, Timmy," utters the sweet social worker.
"Why are you crying?" I ask.
We need to remember that patients with schizophrenia are people first. Putting yourself in your patient's place can give you the empathy to deliver the best care possible.