Why Some Patients Succeed

Abstract

All of us who have passed 65 can identify with Dr. Seeman’s finely wrought article. Increasing age has a way of making us appreciate, although retrospectively, whatever physical and mental capacities we had in our younger years. Nothing sharpens the appreciation of something more than losing it. Dr. Seeman, who is highly respected as a clinician and researcher, uses the aging process to reflect upon the disabilities faced by individuals with schizophrenia. Although few of us have had the breadth of experience Dr. Seeman has, all of us who have seen patients with this disorder have known many who were heroic in their efforts to rise above their symptoms and lead as normal a life as possible. Despite cognitive impairments, delusional thinking, and voices that may be very unpleasant, some patients are remarkable in their ability to achieve stability and lead meaningful lives, almost always with the assistance of antipsychotic medication, a supportive therapist of one kind or another, and/or a caring and concerned family. As I think back on the hundreds of individuals with schizophrenia I have gotten to know over the thirty–five years since I became a psychiatrist, two characteristics stand out as having been present in the individuals who have most successfully battled their illness. One is the person’s underlying personality characteristic of being a fighter, the kind of person who never gives up. Such individuals are probably born with this trait, and in most cases demonstrated it even in childhood. If I could select a single personality trait to wish for my patients with schizophrenia, this would be it. Schizophrenia, however, is an equal-opportunity disease, selecting apparently at random individuals who have all possible personality traits. Thus, for every one I have known who stubbornly would never give up, I have known another who was passive and quite happily used his/her disability as a convenient excuse to do as little as possible. Such individuals would undoubtedly have been passive in life even if they had never been afflicted with schizophrenia, but their illness provided them with an excuse to do nothing. Sometimes we psychiatrists attribute such characteristics to negative symptoms when a careful questioning of family members would have revealed that the trait was present in childhood, years prior to the onset of the illness. Schizophrenia, thus, strikes any and all personality types. I learned this early in my eight–year career at St. Elizabeth’s Hospital, the state–hospital equivalent in Washington, D.C. Psychopharmacologically, I had successfully improved the symptoms of a young man with severe chronic schizophrenia so that we were able to discharge him to his home. Every two weeks, his family brought him back for outpatient evaluation with the Psychiatry 68(1) Spring 2005 14