Reader’s Question

I am a college student, and one of my friends has started to develop what I think may be symptoms of schizophrenia. He is in one of my morning classes, and he stopped showing up for class. I would joke with him about it but that’s because I thought he was just sleeping in. More recently, we were at a Bible study, and he requested to do the “special time” which is usually just a quick musical performance. We all thought he was going to sing a song, but then he went off on an “explanation” of what’s been going on in his life this semester. The first thing that was odd was that he spoke as though God was directly commanding him. Such as “God wanted me to do this.” He mentioned God testing him, by making him decide on following God or doing his schoolwork, and things of this nature. He then went off on a nonsensical story about God telling him to go into the wilderness, then he saw a 200 pound dead dear and heard monsters in the forest, but God wanted him to keep going, so he clawed his way through some thick brush until he found a purple flower, and God was dancing all around, so he danced with God around the purple flower. He also said something that suggested he thought he was becoming like an old testament prophet. I’m starting to feel pretty confident, if he doesn’t have schizophrenia, there is definitely something wrong. What do you think I should do?

Our Clinical Psychologist’s Reply

I hope you’re studying to a be a psychologist, because your impressions are totally accurate. Schizophrenia typically surfaces between the ages of 18 and 25, and stressful situations such as college attendance, military training, moving away from home, etc. often trigger the first symptoms.

You’ve done a great job describing the symptoms. In social settings (college, friendships, etc.) the individual gradually loses normal social interaction and becomes preoccupied with unusual thoughts, beliefs, and opinions. You have accurately described how his behavior is moving away from what might be normally expected. Schizophrenia is thought to be created by the excessive production or availability of the neurotransmitter Dopamine (and others) in the brain. Dopamine controls our sense of relevancy — that is, what in the environment is related to us and what isn’t related. When Dopamine is low (as in ADHD), children can’t find anything important to them and thus can’t concentrate or focus. As Dopamine increases, we become suspicious, thinking more activities in the environment are related to us than is actually true. Signficant increases in Dopamine make us paranoid and delusional, creating false beliefs that the entire environment is related to us, seeking signs and messages in television programs, casual comments, written works, etc. This is the “paranoia” part of Schizophrenia. This was accurately portrayed in the movie “A Beautiful Mind”, also describing the college-age onset of Schizophrenia.

Your friend is exhibiting classic signs of schizophrenia or an impending psychotic break. He is interpreting that God has a message and purpose for him rather than all of us. While people with faith personalize their religious beliefs, your friend has added fantasies of external control of his thoughts, grandiose thoughts, and what we call “ideas of reference” — the sense that he is receiving intimate messages from routine experiences. I suspect he is also experiencing auditory hallucinations.

What can you do? I would first try to discuss the situation with your friend, offering your perception of how his behavior and beliefs have significantly changed over the past weeks/months and that you are concerned. He may reject your concerns because at first, the increased Dopamine is energizing and he may actually feel excitement or even a type of rapture, with his paranoia telling him you are probably jealous. It’s sometimes helpful to focus on the physical or nonpsychotic side effects such as sleep disturbance, poor concentration, missing classes, forgetting homework, etc. If he is able to recognize that something may be wrong, volunteer to accompany him to a psychiatrist consultation. Prior to your discussion with him, research what mental health resources are available at your college and in the region. If he agrees to seek help, you want to have your information available immediately. Treatment opportunities are often lost when we spend two weeks finding professionals in the area.

Next, bring your concerns to the attention of the teacher or the mental health professional at the college. Small colleges often have a guidance counselor or counseling department. If you know his parents, you may contact them and express your concerns.

His symptoms will likely increase in severity. They will reach the point that he will stop attending classes and isolate himself in his room. His brain is thinking at 1000 miles per hour, and social isolation is an attempt to focus on those thoughts without the distraction of trying to listen and talk to people. He will neglect personal hygiene and may not eat. If he resides in a dormitory, you may want to talk to the resident dorm administrator and ask that he be monitored.

Your friend is blessed to have your friendship and concern. You have accurately recognized that your friend is moving away from traditional faith into a world of bizarre fantasy and grandiosity. As you try to help, he may become rejecting. Don’t take that personally. It may require a team intervention before your friend recognizes that he has a psychiatric concern.