Schizophrenia for writers

​The half-moon serrated teeth of the knife gleamed in the overhead light. One quick jab and—
“Get out! Get out!” Michael pounded his fists against his head, and Randy, his son, jumped in his seat at the kitchen table. A pencil fell from Randy’s hand clattering onto the half-filled math sheets.
The numbers, if only he could decipher the numbers. The boy is hiding them from you. 
Michael’s fingers brushed across the cool metal. At the sight of the blade, in his hand Michael retreated, chest heaving.
It won’t even hurt. You’ll make it quick. But it must done or—
Michael ripped the blade from the counter and rushed for the front door. Barefooted, he stepped into his lawn, barely noticing cold snow.
“Hey Michael!” Louis next door waved at him, a paper sack of groceries in hand.
Michael fell to his knees, studying the blade bouncing light from the setting sun. The voice continued to call to him, telling him what to do. Michael pressed the blade against his arm and pulled. His teeth clenched as the skin tore.
“Oh my god! Michael!” Louis dropped his groceries to the porch. “Michael, what are you doing?!”
“I will not hurt my son!” Michael snarled as blood dripped into the snow. 

Schizophrenia is probably the most well-known illness, as in most have heard about it, but do people really know what it looks like? Probably the best image brought up by the population is a homeless person walking around in circles talking to the air. It can be startling to encounter someone in the middle of an episode like that. Schizophrenics have a tendency to be more aggressive and hostile than the general population. But after working with several schizophrenics, I have less fear and more sadness for those suffering with this debilitating illness.

I was initially going to crack open my textbook like usual and tell you all the ‘official’ things about schizophrenia, but I’m going to put that off until next week. Instead, I’m going to tell you what I’ve seen from my nursing practice.
My first up-close encounter with schizophrenia in the clinical setting was with Mary*. Mary was a well-known frequent flier of the psychiatric institute I was completing my nursing clinical hours in. I was given Mary’s file to read then sent to speak with her for an hour. Since my previous vision of schizophrenia was of homeless people walking talking to the air, I was quite nervous about even approaching Mary, let alone sitting in the drab stone-walled courtyard on a bench and chatting. 
Mary, however, acknowledged me with a courteous nod. She never smiled at me, but she was never hostile or aggressive toward me. Instead, she talked about her life as I would expect anyone too, with earnestness about her life experiences. She had no verbal slurring or strange repetition of words. I could have walked up to this woman at Walmart and never known she was schizophrenic.
Mary told me all about her conniving sister who was hell-bent on destroying her life. If Mary had a chance at getting a job, her sister would call the manager and convince him not to hire her. When Mary tried to move away, her sister followed her to the next state over and continued to keep her under her thumb.

Even while she was being institutionalized, her sister was stealing her social security check and paying the people inside to watch her. And the people here—oh she’d tell you about them. ​
Everything you ate or drank was laced in parasites that would eat you from the inside out. The pills were laced too, which was why she was refusing to take hers.
Of course, very little of this (if any) was true. But Mary believed it was. Because everyone was out to get her, she had no hope of securing a good job, good employment, or establishing any lasting relationships in her life. 

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The next week, I met Todd*, a 20-year-old schizophrenic who, per the staff, had been practically abandoned in the institution by his family. Todd was heavily medicated when I met him. His posture was stooped, his speech was slurred, and his reaction time was comically slow. I asked him about his life, and my heart broke. Todd had accepted his diagnosis and knew he was mentally ill, but with this knowledge came the fact he would never be able to have a family or a real relationship of any kind. Or have sex. When he said this last part, he slapped his hand over his mouth—with exaggerated slowness due to the meds. It would have been funny had it not been sad and possibly true. He drew me a picture before I left. The drawing was the skill of a 3rd grader in markers. I still have it.
Then we have Johnnie*. Johnnie was a patient of mine at the hospital. He came in for a bacterial gut infection which we treated in half a week, but while he was in our care, the psychiatric hospital discharged him. Getting an empty bed in a psychiatric hospital is nearly impossible, but Johnnie was so unwell we could not discharge him to the streets either.

Hospitals are not designed for long-term care of anyone, especially psych patients. Johnnie would walk down the hall outside his room and bang his head against the walls. Because of this, he was forced to stay in his room the whole time. Johnnie would scream and wail so loud you could hear him throughout the whole floor. Patients would complain, but what could we do? He would try to hit nurses and fight. He jammed his hand into his mouth and bit until it drew blood. We tried to place him in an institution somewhere—anywhere, but no one would take him. I don’t know how many combinations of medications we tried, but we couldn’t find the right balance to keep him calm. So what was the solution?
Johnnie was tied to his bed. Still screaming, still fighting. His wrists became sores from pulling against the restraints. He stayed in the hospital like that for a month.
Johnnie was pretty much non-communicative, but we can imagine his thoughts knowing how Mary thought. He thought we were trying to kill him, so we tied him to a bed. That helped.
Johnnie was just a little older than Todd. Similar dreams, similar hopes—like all of us, but this was his life. Terrified, trapped, and being harmed by the people who should be helping him.
Our system is broken.
And so is our view of mental illness. Yes, schizophrenics commit violent crimes more often than the general population, but they are victims of crimes more often too. What if someone raped Mary? She could report it, but would anyone believe her? What if someone beat up Todd? He could report it, but would someone think it was self-inflicted?
I don’t know what to do about our broken system. But I do know, as writers, we have a responsibility to portray characters accurately. So, think on this before you write a schizophrenic character. Are they flat and cartoon-like? Or do they have hopes, loves, and broken dreams as well?

*names changed

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