My son is a student at a local university and in the past few months, he has been withdrawing from family and friends and is doing badly in school. He says that voices argue in his head, and he is unable to stop listening to their arguments. Does he have schizophrenia?
Given his probable age as a student, the fact that he is hearing voices arguing in his head plus the fact that this seems to have been going on for several months, the likely diagnosis is that of Schizophrenia, but as always, this diagnosis can only be made by a doctor who has examined him.
This is one of the most serious mental disorders and for this reason, the diagnosis must not be entertained lightly.
In part, this is because the outcomes of conditions that on the surface seem very similar can be different. A few examples will make these points.
Patients who say they are hearing voices and are not doing well at university could be having other conditions such as depression or even OCD (Obsessive Compulsive Disorder).
In depression, for example, the patient will complain that a voice he is unable to ignore keeps whispering that the patient is evil and that he is a sinner who should die by suicide.
In OCD, the commands to do things would compel him to do as instructed leading to much distress.
In depression, the voice is usually “mood-congruent”, meaning that it is in conformity with the mood of sadness and despair.
Additionally, the voice will be talking directly to the patient and normally there is no conversation as such.
In Schizophrenia, on the other hand, there is more than one voice, and sometimes there are, as in the case of your son, arguments between the voices while at other times, they make a running commentary.
A young man we saw a few weeks ago was complaining that his every action was the subject of comment by voices he could hear but nobody else could.
They would, he explained, say things like “Steve (not his real name) is now eating fish, he is now about to drink some water.” At other times they would say; “he is going to sneeze, and he has no cold, he is a foolish boy”.
The other voice might reply, “Steve is not a foolish boy he is just badly brought up by his mother who is very ugly”; the other voice might then say; “no, the mother is not ugly but she is not a good mother”.
Such conversations would go on for many hours forcing the patient to listen and sometimes make comments on the conversation, giving the impression that Steve was talking to himself.
Unable to stop the voices he would be in distress and be unable to concentrate on anything else.
What you as a parent will be aware of is poor school performance and what you call social withdrawal.
Another typical feature of Schizophrenia is the feeling that one’s thoughts are somehow being controlled by forces they cannot describe.
A man kept 26 Sim cards at a time for fear that enemies were able to control his thoughts through his mobile phone. He would not use a smartphone believing that these were the conduits of such control.
In yet another case, the prominent delusion was that neighbours were somehow inserting their thoughts in the mind of the 25-year-old postgraduate student.
Told that this could not happen because the wall was so thick, he dismissed his parents as being uneducated enough to understand how waves work ‘these days’.
He argued that it was those inserted thoughts that had forced him to give up some subjects in his economics degree programme.
In a variant of this condition, the young man was diagnosed with “morbid jealousy” after inflicting serious injuries on his wife for “unfaithfulness” that existed only in his mind as a delusion.
A 19-year-old who believed he was the male version of the Virgin Mary was shown to have been smoking large amounts of cannabis and was also withdrawn and doing badly in class. In his case drug use was the reason for the psychosis.
The foregoing is not intended to scare you but rather to give you a glimpse of the complex nature of this common condition, and to encourage you to visit the World Psychiatric Association website which has an excellent description of schizophrenia designed for the lay public, and in particular relatives of people with the condition.
On a note of factual encouragement, we have in my practice, several men and women we have followed up for more than 30 years, diagnosed with schizophrenia, and worked until retirement and are now proud grandparents.
Serious as it is in some cases, those diagnosed early, treated properly and with adequate family support tend to do well in the long run.
