Achieving real change is a lengthy process. Find out how therapy helps and how to find the right therapist.

Q: How many psychologists does it take to change a light bulb?
A: Just one, but the light bulb has to want to change.

Early on, in the year before my diagnosis and for awhile afterwards, I saw a number of psychologists. (I had also seen one for awhile when I got really depressed in eighth grade, and had also seen a couple of school psychologists in elementary and junior high school, but didn't feel any of them helped much because I was such an unwilling patient.) I would typically seek a therapist out because I felt really bad, but after a few months I would feel better and stop going. Early on, I really disliked having anything to do with psychologists and wouldn't see one any more than I absolutely had to.

That's a pretty common phenomenon for therapy patients. It seems that many of the people who seek out therapists are not in a position to get better in any substantial way because they have no commitment to making any real change in their lives.

Achieving real change is a lengthy process and it is often painful. Seeing a therapist just until you feel better for awhile is not likely to effect meaningful change. And, in fact, for a bipolar person it's not likely that the therapist will have made any difference in such a short time - you could consult a brick wall for your depression for a few months and after awhile the inevitable bipolar cycle while make you feel better.

Time for Meaningful Change

There came a point, I think it was around the Spring of 1987, that I noticed that I always kept falling into the same hole and that I was not having any success in making my situation any better. I was on medication for much of the time since I was diagnosed and although it provided some relief, I did not feel that it did much to make my life substantially better either. The symptoms weren't so bad with the medication but I still experienced them and life just plain sucked in general.

I made a really important decision then. It's the sort of decision everyone needs to make if they're going to get anything out of therapy and is one of the more significant turning points in my life. I decided I was going to see a psychotherapist and stick with it and no matter what happened that I was going to keep going even if I felt better. I was going to keep going until I was able to effect meaningful, positive, lasting change in my life.

(Simply deciding to see a therapist for a long time is not enough. You have to decide that you're really going to change and face up to the work it will require and face the fear that it will arouse. Lots of people see therapists for years, even decades, and never get anything out of it beside a little temporary comfort. I know some people like this and I find them incredibly vexing. These people don't want to change and quite possibly will never change. They may even feel that they're good little therapy patients because they attend regular therapy for so long. However, they must be very frustrating to their therapists who spend years trying to get their patients to face themselves only to have every effort deftly deflected.)

Finding a Good Therapist

It's important to pick out a good therapist that you can work with effectively. I don't think nearly all therapists are all that enlightened - I'm sure almost all learn a lot of important theory in graduate school, but I don't think any amount of theory is going to make anyone an insightful human being.

Even if you find a therapist that's good in general, you may not personally be able to work with them. For that reason, it's best to shop around. And that's why it's best not to wait until you really need help to find a therapist - if you feel, as I did at first, that psychologists are only for crazy people, then likely you're not going to see one until you are crazy. When that happens it's hard to take the time to shop around and it's also much harder to pick up the pieces. If you think you're ever going to need to see a therapist, it's best to start when you're in a strong enough position emotionally to see one on your own terms.

At the time I made my fateful decision, I was getting by OK. I was desperately unhappy, but life was manageable. It was not like when I first saw a psychiatrist at Caltech, when I was ready to climb out of my own skin.

I got a very poor impression of the first therapist I saw. Her primary concern was whether I had the financial means to pay for her sessions. She was really quite shrill about the money and kept emphasizing that she did not offer a sliding scale. I had a good job at the time and would have had no problem paying her fee, but in the end decided she was just not someone I cared to be around.

The second therapist I saw was someone I rather liked. I'd responded to her ad in The Good Times offering New Age therapy. (Santa Cruz is a pretty New Age kind of place, one reason I decided to stay there after living in the urban Hell of Southern California.) She seemed like a pretty happy and enlightened woman and was quite pleasant to talk to. She seemed to like me at first too.

But when I explained my history to her - mania, depression, hallucinations, hospitalization and finally my diagnosis, she said she wasn't competent to deal with someone as troubled as I. She said I should consult with someone who specialized in challenging cases. I was really disappointed.

She gave me the names of several other psychologists. One of them was someone I'd seen at the County Mental Health department who I thought was competent enough but I didn't want to see anymore because I did not feel that she cared for me as a person. The next one on the list was the therapist I ended up sticking with.

All told, I saw my new therapist for thirteen years.

That's a lot of head-shrinking. I made a lot of changes during that time. Aside from my emotional growth, I got my career as a programmer started and built it up to eventually become a consultant, dated several women and eventually met and got engaged to the woman I am now married to. I also got my B.A. in Physics from UCSC and started (but unfortunately did not complete) graduate school.

Life certainly hasn't been easy for me as a consultant, especially since the economic downturn, but despite that, I've been doing well mentally and emotionally for quite some time and I credit that to my work with my therapist, not to any medicine I might take. The only professional help I require is a brief appointment with a doctor at the local mental health clinic every month or two to check my symptoms and adjust my medication.

Life's been pretty damn hard but I'm able to deal with it and despite the obstacles I face I am able to maintain my optimism most of the time. That's a far cry from my experience of 1987 when I had few external difficulties but could barely tolerate living through the day - despite medication.

Who is this miracle worker you ask? I'm sorry, I can't tell you, much as I'd like to. When I wrote my first web page about my illness, I had her read it and then asked her if she'd like me to give her name. She said she would rather her name be kept private. I would rather give her the credit she deserves, but I respect her feelings so I won't give her name.

Insights From Therapy

One of the main objectives of therapy is for one to develop insight into one's condition. I would like to discuss the many insights I found but I feel I could not discuss them adequately in the space I have here. I would like to discuss just one of them, as the key point I learned also applies to many other engineers and scientists. If you feel that you would like to know more than I can say in what follows, then I encourage you to read David Shapiro's book Neurotic Styles, especially the chapter on Obsessive Compulsive Style.

One day, after I had been seeing my therapist for about seven years, she said to me: "I think it's time" and handed me a photocopy of the Obsessive-Compulsive Style chapter of Shapiro's book. I took it home to read and found it nothing short of astounding. As I read it, I often burst out in hysterical laughter as I came across something that seemed deeply familiar from my own experience. I still find it very embarrassing to find a lifetime of experience so neatly summarized in a single chapter of a book that was published when I was one year old. I just had to read the whole book so I bought my own copy and have since read it several times.

Obsessive-compulsive style is distinguished from obsessive-compulsive disorder by being a personality trait rather than a psychiatric condition that can be treated with medication. It is characterized by, among other things, rigid thinking and distortion of the experience of autonomy.

Shapiro says:

The most conspicuous characteristic of the obsessive-compulsive's attention is its intense, sharp focus. These people are not vague in their attention. They concentrate, and particularly do they concentrate on detail. This is evident, for example, in the Rorschach test in their accumulation, frequently, of large numbers of small "detail-responses" and their precise delineation of them (small profiles of faces all along the edges of the inkblots, and the like), and the same affinity is easily observed in everyday life. Thus, these people are very often to be found among technicians; they are interested in, and at home with, technical details... But the obsessive-compulsive's attention, although sharp, is in certain respects markedly limited in both mobility and range. These people not only concentrate; they seem always to be concentrating. And some aspects of the world are simply not to be apprehended by a sharply focused and concentrated attention... These people seem unable to allow their attention simply to wander or passively permit it to be captured... It is not that they do not look or listen, but that they are looking or listening too hard for something else.

Shapiro goes on to describe the obsessive-compulsive's mode of activity:

The activity - one could just as well say the life - of these people is characterized by a more or less continuous experience of tense deliberateness, a sense of effort, and of trying.

Everything seems deliberate for them. Nothing is effortless... For the compulsive person, the quality of effort is present in every activity, whether it taxes his capacities or not.

The obsessive-compulsive lives out their lives according to a set of rules, regulations and expectations which he feels are externally imposed but in reality are of his own making. Shapiro says:

These people feel and function like driven, hardworking, automatons pressing themselves to fulfill unending duties, "responsibilities", and tasks that are, in their view, not chosen, but simply there.

One compulsive patient likened his whole life to a train that was running efficiently, fast, pulling a substantial load, but on a track laid out for it.

My therapist focused on my own rigid thinking starting very early in our work together. My experience now is that I have a sense of free will that I did not possess before I began seeing her. However obsessive-compulsive style is a trait that is so deeply ingrained in me that I don't think I can ever be completely free of it. However I find that being able to focus my attention so intensively is an advantage to my computer programming. I find that programming allows me to experience being obsessive-compulsive in a way that I find enjoyable, like taking a holiday to go back to a familiar place from my past.

next: The Reality Construction Kit

A Personal Experience

• Living with Schizoaffective Disorder
• The Best of Both Worlds
• When Did it Happen?
• A Poorly Understood Condition
• Someone You Know is Mentally Ill
• Life on a Roller Coaster
• Melancholia
• The Strange Pill
• A Risky Treatment
• What if Medicine Doesn't Help?
• The Heebie-Jeebies
• Hearing Voices
• Dissociation
• Paranoia
• Geometric Visions
• What to Do if You Think You'r Mentally III
• Therapy
• The Reality Construction Kit
• Why am I Saying All This?
• Recommended Reading

back to:   Living with Schizoaffective Disorder Homepage

Before taking Risperdal, I would see visions in the sky and photograph my hallucinations. Take a look.

One evening as I was walking across a parking lot at the California Institute of Technology, I looked up to see a Yin-Yang symbol in the sky stretching from horizon to horizon. Shimmers of energy radiated from Mt. Wilson to the North. I felt a deep chord resonating through my body, the vibration of the Universe penetrating deep into my bones. I was as tall as giant striding across that parking lot that evening.

At that instant I Knew. I knew my Purpose.

I had been walking to my weekly appointment with my therapist in downtown Pasadena. I hurried on to our meeting, and when I arrived I excitedly explained my revelation to her.

"Mike," she replied, "you're not making any sense".

For a while after I cracked up at Caltech, and every now and then after that, I would see things like Yin-Yang symbols in the clouds. I would see other things too, like the energy waves from Mt. Wilson, which at the time was a powerful symbol for me. Sometimes the Yin-Yang symbols were animated and would spin. The might be recursive, with smaller Yin-Yangs in each of the spots, and so on ad infinitum. I found that I could see them if I stared into the snow on a television set that wasn't tuned to a station.

After I dropped out of Caltech, I started pursuing various artistic endeavors. I learned to draw from Betty Edwards' Drawing on the Right Side of the Brain, and would construct crystalline latticeworks from painted wooden dowels.

I started to teach myself to play piano. I had a friend show me a few basic chords, and then I would just bang on the keyboard randomly until something that sounded like music came out. All the pieces I can play now I composed myself through improvisation - I still can't read music. Much later, in Santa Cruz, I took lessons from a wonderful teacher named Velzoe Brown and learned to play quite a bit better, but still find interpreting musical notation difficult and tedious.

And I first got into photography in a serious way that fall at Caltech. A housemate lent me a nice SLR camera, a Canon A-1, and I would walk around campus and Pasadena taking pictures. My sense of sight was vivid in those days and I found that photography came naturally. The expensive Canon could accurately meter a 30-second night exposure, so a great deal of my photos were ghostly shots in the dark. I still enjoy night photography.

I would photograph my hallucinations too. I would try to anyway, only to be disappointed that they didn't turn out when I got the prints back from the developer. However, I can see, even now, where the seeds of my visions lay in the photographs. For example, I would commonly see Yin-Yang symbols graphically floating in the sky, but in the photographs now I can see the hint of shapes in the clouds where one could easily imagine a real Yin-Yang.

Imagining what they see in clouds is a common game among children. But I would take it an extra step, as the shape would take on a stark reality that didn't look like a cloud at all.

Eventually, the visions in the sky went away, but for much longer I was bothered by illusions that I would see out of the corner of my eye. Lots of people catch glances of things that aren't really there, that go away when you look straight on. But in my case they were rather more distinct than I think most people experience.

My illusions also are based on real objects. The most common (and bothersome) illusion I have is to see flashing police car lights where a real car has a luggage or ski rack. This would combine with my paranoia to give me the urge to dive into the bushes when such cars would drive by.

My medication is effective for me at eliminating the hallucinations. I found it very helpful in bringing me back down to Earth during my graduate school manic episode, but it is expensive and I resented taking it at the time, so I stopped for a few months. I finally decided to go back on the medication and take it faithfully one night while dining in a restaurant with a friend, only to be bothered by flashing blue police car lights and billowing red flames out the window to my left. Each time I turned to look, I would see only the headlights of cars driving up the street towards the restaurant.

In many ways, I miss the visions. Not the squad car lights, but the many beautiful and inspiring things I saw. While living without visions is certainly more placid, it's not nearly so interesting.

The psychologist who did my intake at Dominican Hospital in 1994 told me that in many more traditional cultures, the schizoaffective people are the shamans. If you wonder why there are no more miracles as in the Biblical days, it's because we lock our prophets up in mental hospitals.

And my purpose? Very simple: my purpose is to unify Art and Science. In high school I had been active in the theater and the chorus, and also enjoyed literature and writing, but stopped all my artistic pursuits at Caltech because I had to study so hard. I felt the need to restore balance to my life, and I felt the need to bring that balance to Caltech itself, where I felt the lack of right-brain stimulation was damaging and depressing to both the students and the faculty.

I don't know why that didn't make sense to my therapist. It made perfect sense to a different therapist I saw a half a year later, just as I was about to get myself in a position to be diagnosed. I don't think it's such a bad thing to want to be a well-rounded person or to want to restore balance to a society suffering from a fetishistic obsession with technology.

In the end, I don't think it's such a bad thing at all that I changed my major to literature.

next: Liquid Color

Nullum magnum ingenium sine mixtura dementiae fuit. (There is no great genius without madness.)

-- Seneca

When I don't feel like going to the trouble to explain what living with schizoaffective disorder means, I commonly say that I'm manic-depressive rather than schizophrenic because the manic-depressive (or bipolar) symptoms are more prevalent for me. But I experience schizophrenic symptoms as well.

Manic depressives experience alternating moods of depression and euphoria. There can (blessedly) be periods of relative normalcy in between. There is a somewhat regular time period to each person's cycle, but this varies dramatically from person to person, ranging from cycling every day for the "rapid cyclers" to alternating moods about every year for me.

The symptoms tend to come and go; it is possible to live in peace without any treatment sometimes, even for years. But the symptoms have a way of striking again with an overwhelming suddenness. If left untreated a phenomenon known as "kindling" occurs, in which the cycles happen more rapidly and more severely, with the damage eventually becoming permanent.

(I had lived successfully without medication for quite some time through my late 20's, but a devastating manic episode that struck during graduate school at UCSC, followed by a profound depression, made me decide to go back on medication and stay with it, even when I was feeling well. I realized that even though I might feel fine for a long time, staying on medication was the only way to avoid being caught by surprise.)

You may find it odd that euphoria would be referred to as a symptom of mental illness, but it is unmistakably so. Mania is not the same as simple happiness. It can have a pleasant feel to it, but the person who is experiencing mania is not experiencing reality.

Mild mania is known as hypomania and usually does feel quite pleasant and can be fairly easy to live with. One has boundless energy, feels little need to sleep, is creatively inspired, talkative and is often taken to be an unusually attractive person.

Creativity and Manic Depression

Manic depressives are usually intelligent and very creative people. Many manic depressives actually lead very successful lives, if they are able to overcome or avoid the illness' devastating effects - a nurse in Santa Cruz' Dominican Hospital described it to me as "a class illness".

In Touched with Fire, Kay Redfield Jamison explores the relationship between creativity and manic depression and gives biographies of many manic-depressive poets and artists throughout history. Jamison is a noted authority on manic depression, not just because of her academic studies and clinical practice, as she explains in her autobiography An Unquiet Mind, she is manic-depressive herself.

I have a bachelor's degree in Physics, and have been an avid amateur telescope maker for much of my life; this led to my Astronomy studies at Caltech. I taught myself to play piano, enjoy photography, and am quite good at drawing and even do a little painting. I have worked as a programmer for fifteen years (also mostly self-taught), own my own software consulting business, own a nice home in the Maine woods, and am happily married to a wonderful woman who is very well aware of my condition.

I like to write too. Other K5 articles I have written include Is This the America I Love?, ARM Assembly Code Optimization? and (under my previous username) Musings on Good C++ Style.

You wouldn't think that I have spent so many years living in such misery, or that it is something I still have to deal with.

Full-blown mania is frightening and most unpleasant. It is a psychotic state. My experience of it is that I can't hold any particular train of thought for more than a few seconds. I can't speak in complete sentences.

My Experience with Schizophrenic and Bipolar Symptoms

My schizophrenic symptoms get a lot worse when I am manic. Most notably I get profoundly paranoid. Sometimes I hallucinate.

(At the time I was diagnosed, it was not thought that manic depressives ever hallucinated, so my diagnosis of schizoaffective disorder was based on the fact that I was hearing voices while I was manic. Since then, it has become accepted that mania can cause hallucinations. However, I believe my diagnosis to be correct based on the current Diagnostic and Statistical Manual criterion that schizoaffectives experience schizophrenic symptoms even during times they are not experiencing bipolar symptoms. I can still hallucinate or get paranoid when my mood is otherwise normal.)

Mania is not always accompanied by euphoria. There can also be dysphoria, in which one feels irritable, angry and suspicious. My last major manic episode (in the Spring of 1994) was a dysphoric one.

I go for days without sleeping when I am manic. At first, I feel that I don't need to sleep so I just stay up and enjoy the extra time in my day. Eventually, I feel desperate to sleep but I cannot. The human brain cannot function for an extended period of time without sleep, and sleep deprivation tends to be stimulating to manic depressives, so going without sleep creates a vicious cycle that might only be broken by a stay in a psychiatric hospital.

Going a long time without sleeping can cause some odd mental states. For example, there have been times when I lay down to try to rest and started dreaming, but did not fall asleep. I could see and hear everything around me, but there was, well, extra stuff going on. One time, I got up to take a shower while dreaming, hoping that it might relax me enough that I could fall asleep.

In general, I've had the fortune to have a lot of really odd experiences. Another thing that can happen to me is that I might be unable to distinguish between being awake and asleep, or to be unable to distinguish memories of dreams from memories of things that really happened. There are several periods of my life for which my memories are a confusing jumble.

Fortunately, I have only been manic a few times; I think five or six times. I have always found the experiences devastating.

I get hypomanic about once a year. It usually lasts for a couple of weeks. Usually, it subsides, but on rare occasions escalates into mania. (However, I have never become manic when I was taking my medication regularly. The treatment is not so effective for everyone, but at least that much works well for me.)

next: Melancholia

Whether you have bipolar or schizoaffective disorder, antidepressants can stimulate manic episodes. Find out what works for bipolar depression.

An unfortunate problem that antidepressants have for both manic depressives and schizoaffectives is that they can stimulate manic episodes. This makes psychiatrists reluctant to prescribe them at all even if the patient is suffering terribly. My own feeling is that I would rather risk even psychotic mania than to have to live through psychotic depression without medication - after all, I'm not likely to kill myself while manic, but while depressed the danger of suicide is very real and thoughts of doing harm to myself are never far from my mind.

I had not been diagnosed when I took antidepressants for the first time (a tricyclic called amitryptiline or Elavil) and as a result, I spent six weeks in a psychiatric hospital. That was the summer of 1985, after a year I had spent mostly crazy. That's when I was finally diagnosed.

(I feel that it was irresponsible of the psychiatrist who prescribed my first antidepressant to not have investigated my history more thoroughly than she did, to see if I had ever experienced a manic episode. I had my first one a little less than a year before but didn't know what it was. Had she just described what mania was, and asked me if I had ever experienced it, a lot of trouble could have been avoided. While I think the antidepressant would still have been indicated, she could have prescribed a mood stabilizer which might have prevented the worst manic episode of my entire life, not to mention the ten thousand dollars I was fortunate to have my insurance company pay for my hospitalization.)

I find now that I can take antidepressants with little risk of getting manic. It requires careful monitoring in a way that wouldn't be necessary for "unipolar" depressives. I have to take mood stabilizers (antimanic medication); presently I take Depakote (valproic acid), which was first used to treat epilepsy - many of the medicines used to treat manic depression were originally used for epilepsy. I have to do the best I can to observe my mood objectively and see my doctor regularly. If my mood becomes unusually elevated I have to either cut back the antidepressant I take or increase my mood stabilizer or both.

I've been taking imipramine for about five years. I think it is one of the reasons I do so well now, and it upsets me that many psychiatrists are unwilling to prescribe antidepressants to manic depressives.

Not all antidepressants work so well - as I said amitryptiline made me manic. Paxil did very little to help me, and Wellbutrin did nothing at all. There was one I took (I think it might have been Norpramine) that caused a severe anxiety attack - I only ever took one tablet and wouldn't take any more after that. I did have good results from maprotiline in my early 20's but then decided to stop medication entirely for several years, until I got hospitalized again in the spring of 1994. I had low-grade depression for several years after that (when I tried Wellbutrin and then Paxil). I wasn't suicidal but I just lived a miserable existence. A couple of months after I started taking imipramine in 1998, life got good again.

You should not use my experience as a guide in choosing any antidepressants you might take. The effectiveness of each is a very individual matter - they are all effective for some people and ineffective for others. Really the best you can do is try one out to see if it works for you, and keep trying new ones until you find the right one. Most likely any that you try will help to some extent. There are many antidepressants on the market now, so if your medicine is not helping, it's very likely that there is another that will.

next: What if Medicine Doesn't Relieve the Symptoms of Schizoaffective Disorder?

Reality is something you make. The objective of psychotherapy is to help you construct a new reality.

And so I come to the most important part of this article. If you take nothing else away from what I have written, take this. This is important whether or not you're mentally ill. I think we would all be better off if more people understood the following:

Reality is not something that just happens to you.
Reality is something you make.

Most people never question the reality they experience. Most people are fortunate to have no reason to ever question it; their reality works well for them. The people who have reason to give up their reality are usually forced into it, either because they are insane, or because life just doesn't work for them. There is no satisfying measurable definition of sanity or insanity; instead, some people have a reality that works for them, and some people don't. Some people might be satisfied with their reality but society might not be satisfied with the behavior their reality causes them to exhibit, and so we sometimes commit the mentally ill involuntarily to mental hospitals.

Even if you don't feel the need to question your reality or make a new one, I assert it is worthwhile for you to understand this in the event you ever have to, or ever need to try to help someone make a new livable world for themselves. At the very least, it will help you to understand why some people are so difficult to get along with and help you relate to them. It's not simply that some people hold different opinions, it's that many people, not just the insane, live in a completely different world from the one you experience.

There is an objective reality, but we cannot experience it directly. It is also without significance or meaning. The reality we experience is drawn from the objective reality but sliced, diced, julienned and pureed by the food processor of our bodies, cultures and minds.

This is a very old idea. But I first came to understand it when I took a course at UCSC called Anthropology of Religion, taught by Professor Stuart Schlegel. Among other things Dr. Schlegel discussed the cosmologies of various cultures, and how they created their worlds. He explained this in a theoretical framework first advanced by the philosopher Immanuel Kant.

Kant referred to objective reality as noumenal reality. Noumenal reality is everything that exists, in all its detail and complexity. It is too vast and complex to experience, and much of it is out of reach of our senses because it is too large, too small, too far away, lost in noise or detectable only with frequencies of light or sound we cannot perceive.

Noumenal reality is also without meaning - it is uninterpreted, because in noumenal reality there is no one to interpret it. From Physics I know that all that exists are subatomic particles interacting in incomprehensible numbers and complex ways. The division of our world into spaces and objects is a fiction created by our minds - in the noumenal world there are no objects, just a continuity of space punctuated by infinitesimal particles.

There is no past and future in noumenal reality. There is time. But the only things that exist, exist now. What once was doesn't exist anymore and what is yet to come does not yet exist.

Kant called what we actually experience subjective reality. It is created from noumenal reality first through a process of selection and then interpretation.

We can only see the wavelengths of light our eyes can detect, hear the frequencies of sounds our ears will accept, and understand a limited amount of complexity. Complexity is managed through a process of that combines and simplifies the raw material of noumenal reality into the subjective reality of the objects we perceive. We then apply interpretation to the objects based on our culture and our personalities. There is only so much we can pay attention to or even notice at all. In a very real sense we only see or hear what we want to, although the decision might be made at a very primitive level in our brains. Some sights or sounds are scary and capture our attention because during evolution those of our ancestors who gave significance to such experiences survived to reproduce.

Importantly, many of the selections and interpretations involve choices, although unconscious ones, that are influenced first by our biology, then our culture, then our personality. And the salvation of the mentally ill is that although the choices are made automatically at first, we can make new choices. I'm not saying it's easy, but one can influence one's reality over time and eventually establish new patterns of automatic choices that can result in a reality that is much happier to live in than, say, the world of fear and despair I used to inhabit.

Constructing a New Reality Through Therapy

The objective of psychotherapy is not to provide you with a professional friend to listen to your tales of woe. It is to help you construct a new reality. While you can expect your therapist to be sympathetic when you are in crisis, a good therapist also challenges her client to question their assumptions. Therapy is hard because the answers to such questions are often painful to face.

Everyone who starts therapy hopes to get back to the good old days before they began to suffer, but that's not what therapy will do for them. Instead therapy helps you to let go of those of your beliefs, even your most cherished beliefs, that led you astray. In the end a successful therapy client may be very different than they ever were before, but if the therapist does her work well the client will ultimately be more truly themselves than they ever have been in their lives.

Therapy alone is enough to treat the neurotic individual. But as I said there is a biological component to the construction of reality. Despite all that therapy has done to help me, my brain is unable to regulate its chemistry on its own. That is why I must take medication. If I didn't, the power of my chemical imbalances would overwhelm me. Someone with a mental illness whose roots come from biology must take medicine.

But someone with a biological mental illness must have both kinds of treatment - only rarely if ever does one suffer this illness without developing a neurosis. That's why I feel it is irresponsible for general practitioners to prescribe psychiatric medicine without referring the patient to a psychiatrist or psychotherapist. Giving someone only medicine at best gives them temporary relief from their symptoms without them ever developing the insight they really need to take control of their lives.

So you can see that it is a great benefit that we construct our realities. But it can be terrible too. In Anthropology of Religion, Dr. Schlegel also discussed millenarian movements, that is the phenomenon of people believing the end of the world was at hand.

A Dangerous Mind

Sometimes a person comes along who has the dangerous combination of being both delusional and charismatic. While of course charisma comes naturally for some people, I feel it can also arise as an unusual symptom of mental illness. After all, if manic depressives can experience euphoria as a symptom, cannot the terrible neediness of the paranoid drive them to whatever lengths it takes to attract followers? These people become cult leaders.

One of the other factors in creating a cult is for the group to become isolated. The isolation contributes to the cult members losing their grip on reality. There really is no such thing as "normal" in society - at best there is only what is average, or commonly experienced by most people. If someone strays too far from the mean, their interactions with others will tend to correct them. The lack of that correction is what causes the isolation that many of the mentally ill experience to make them sicker. When a group gets isolated, that's how a charismatic but delusional leader can bend the minds of otherwise healthy people.

I was moved to write my first web page about my illness shortly after the Heaven's Gate mass suicide. When I heard about it I just freaked out and spent a couple of weeks in a seriously troubled state of mind. It was the worst off I'd been in a long time.

It wasn't simply that the incident vividly reminded me of the times I had been suicidal. It was that it made me question the very foundations of my reality. The people who "shed their vehicles" with the aid of barbiturates to go join the extraterrestrial visitors were not depressed, in fact the videotapes they left behind showed them to be apparently happy and healthy people, and intelligent ones too: the cult operated a successful web design firm! What upset me was the realization that despite my best efforts to maintain a firm grounding in reality, I knew that even perfectly sane people could be fooled into killing themselves quite enthusiastically. I knew that I could be fooled too, if I wasn't careful.

This can happen to entire nations. If international and economic conditions lay the right foundation, a single delusional and charismatic leader can incite a whole country to become a murderous cult. In For Your Own Good: Hidden Cruelty in Child-Rearing and the Roots of Violence Alice Miller discussed the violent abuse Adolf Hitler's father subjected him to as a child and how that led to his adulthood as the pathologically violent leader of Nazi Germany.

Such pathology, while too horrible for most people to contemplate, is an expected consequence of the reaction of normal human nature to extreme circumstances. Lest you think it's not worth your concern, I want you to consider for a moment the following: If it can happen to Heaven's Gate, if it can happen in Jonestown, if it can happen in Waco, if it can happen to Cambodia, if it can happen even to a large, populous, powerful, modern and industrialized nation like Germany, then it can happen here.

next: Why I Publicly Admitted I Have Schizoaffective Disorder

Recommended Reading - Books on Schizoaffective Disorder, Books on Schizophrenia, Books on Bipolar Disorder and related mental health issues.

• Schiller, Lori and Bennett, Amanda, The Quiet Room: A Journey Out of the Torment of Madness

• Pirsig, Robert M., Zen and the Art of Motorcycle Maintenance: An Inquiry Into Values

• Kesey, Ken, One Flew Over the Cuckoo's Nest

• Edwards, Betty, The New Drawing on the Right Side of the Brain

• Peck, M. Scott, The Road Less Traveled

• Shapiro, David, Neurotic Styles

• Berne, Eric, Games People Play: The Psychology of Human Relationships

• Langer, Ellen J., Mindfulness

• Locke, Christopher, Levine, Rick, Searls, Doc, Weinberger, David, The Cluetrain Manifesto: The End of Business as Usual

• Aronson, Elliot, The Social Animal

• Jamison, Kay Redfield, An Unquiet Mind

• Jamison, Kay Redfield, Touched with Fire: Manic-Depressive Illness and the Artistic Temperament

• Jamison, Kay Redfield, Night Falls Fast: Understanding Suicide

• Duke, Patty and Hochman, Gloria, A Brilliant Madness: Living with Manic-Depressive Illness

• Duke, Patty and Turan, Kenneth, Call Me Anna: The Autobiography of Patty Duke

• Vonnegut, Mark, The Eden Express: A Memoir of Insanity

• Miller, Alice, Hannum, Hunter (translator) and Hannum, Hildegarde (translator), For Your Own Good: Hidden Cruelty in Child-Rearing and the Roots of Violence

• Cronkite, Kathy, On the Edge of Darkness: Conversations about Conquering Depression

• Nasar, Sylvia, A Beautiful Mind: The Life of Mathematical Genius and Nobel Laureate John Nash

next: Living With Schizoaffective Disorder

Screaming Chocolate Eigenfunctions

next:  Pencil, Pen, Ink and Paper

Just because you're paranoid it doesn't mean they're not out to get you.

Paranoia is the one of my schizophrenic symptoms that bothers me the most. While I've only heard voices a few times, if I weren't taking an antipsychotic drug called Risperdal, the paranoia would happen frequently. As I'm sure you could imagine, being paranoid is distressing and so I'm very careful to always take my Risperdal. Visual hallucinations happen quite a bit too (when I'm not taking my medicine anyway) but except for startling me they happen suddenly, I don't find them as upsetting.

Paranoia is commonly thought to be the delusion that others are plotting against oneself, but it is a little more complicated than that. And you may be surprised to hear that even if one is self-aware enough to know that one is experiencing paranoia, to understand clearly that what one thinks is a delusion, it doesn't make the delusions go away.

The paranoid are commonly thought to be deadly dangerous. While there have been cases of the paranoid attacking those they thought had it in for them, most paranoids are perfectly safe to be around and in fact, are commonly found living among you in a society where they lead more or less normal lives. You don't have to be schizophrenic to be paranoid - it can arise as a neurosis, for example in response to early child abuse, and exist in a pure form without other schizophrenic symptoms like hallucinations.

I was interviewed in the March 30, 2000 edition of the Metro San Jose, in an article called Friends in High Places. I answered an ad seeking bipolar Silicon Valley engineers for anonymous interviews, but I told them they could feel free to use my name and even my photo. If you click the link, down towards the bottom of the page you will see me sitting on the driveway of the house I used to live in in Santa Cruz.

The article quotes me as saying "I can work effectively even when I'm wigging, even when I'm hallucinating, even when I'm severely depressed." And by wigging, I meant that I could develop software while severely paranoid. I've spent a lot of productive hours at the office, laboring at my computer, while trying to avoid thinking of the fact that a Nazi armored division was holding maneuvers in the parking lot.

The article goes on to say:

"Programming is more tolerant of eccentric activity," Crawford says. "Even though I might have been weird, I was a good worker."

The essence of paranoia is that one's interpretation of events is deluded, not the perception of the events themselves. In the absence of hallucinations, everything a paranoid experience is really happening. What the paranoid is mistaken about is why they're happening. Even inconsequential events take on a significance that is personally threatening. This makes it hard to know what is real. Although one can test one's sensory perceptions by, for example, asking other people, it is much harder to objectively test one's beliefs about why something is happening, especially when you don't feel you can trust what other people say.

For example, a stylishly dressed, attractive young woman approached me on the street one day in downtown Santa Cruz and bluntly said "it's all been a plot". It seems that there had been a conspiracy to rob her of her money. She explained it at some length while I listened in awestruck fascination:

She had a book checked out of the library, and meant to return it on time, but a diversion created by the conspirators delayed her. When she finally returned the book, she was assessed a fine. As evidence of the plot, she cited the helicopter that flew overhead, spying on her as she left the library.

Anyone can have an unexpected delay and be charged a fine when they return a library book late. Helicopters fly over Santa Cruz all the time - I have no doubt that she really saw a helicopter. But what was special in her circumstances was why she was delayed: she did tell me what happened (I'm sorry I don't remember) but was convinced that the delay had been caused by those who plotted against her. Many people see helicopters fly overhead; what was special for her is the reason she felt the helicopter to be there.

I don't actually have such a hard time distinguishing most of my paranoid delusions from reality. It's because they're all so ridiculous - I really have spent a lot of time worrying about the military coming to attack me. It's not that I hallucinate my attackers. If I look I can see they're not there. But when I turn away I feel their presence again. I know very well I experience paranoia and I try to tell myself it's not real, but I'm afraid that simply knowing it's a delusion is no comfort at all.

As I said I often feel the fear from my experiences before I have the experiences themselves. People try to tell me to ignore the paranoia but that doesn't help - first I feel panic, and only then do I think the men with guns are out there waiting for me.

The only comfort I can find is to face my fear. If a Nazi Panzer division is tearing up my front yard, the only recourse I have is to steel my courage and go outside to look for them until I'm satisfied they're not there (I have to search carefully - perhaps they're hiding in the bushes). Only then does the paranoia subside.

Walking around Pasadena late in the evening, I was discharged from Alhambra CPC. I came across a large white stone, about three feet across and fairly round. There were some wrinkles in its surface. It looked just like an ordinary stone, but I knew it wasn't - it was someone waiting for me, crouching on the ground, and I feared them. It didn't look like a real person at all - it looked like someone wearing a very clever stone-like disguise.

I stood there paralyzed for some minutes, unsure of what to do, until I summoned all the courage I could muster - and kicked the stone as hard as I could. After that, it was just a stone.

Now about the little joke with which I introduced this section. Everyone, even perfectly sane people, have challenges they struggle against. You don't have to be paranoid to have enemies. Perfectly sane people get robbed, beaten and even murdered all the time. Probably the worst part of all about being paranoid is when the paranoid has a real enemy, and that enemy uses the paranoid's illness against them. You might beg others for help, but the person who is trying to hurt you is easily able to convince them that your complaints are just delusions, and so your pleas fall on deaf ears.

There is a very real stigma against mental illness in our society. Stigma can kill - I once received word from the wife of a European diplomat that his doctors refused to treat his heart condition because he was manic. He died in the hospital of a very real, unimagined heart attack.

There are people who harbor a deep-seated hatred for the mentally ill for the simple fact that we are different. And these people do grievous harm to those who suffer, in large part by using the symptoms we exhibit to convince others not to support our cause, to convince them that the hatred we sense from them is all in our heads.

I have been at the receiving end of some of the worst of this stigma. That is why I write web pages such as this, to promote understanding in our society so that in a hopeful future day the stigma will be gone and we can live among you as ordinary members of society.

next: Music

Schizoaffective disorder is poorly understood. Even mental health professionals know little about schizoaffective disorder.

I've been writing online about my illness for a number of years. In most of what I have written, I referred to my illness as manic depression, also known as bipolar depression.

But that's not quite the right name for it. The reason I say I'm manic-depressive is that very few people have any idea what schizoaffective disorder is - not even many mental health professionals. Most people have at least heard of manic depression, and many have a pretty good idea of what it is. Bipolar depression is very well known to both psychologists and psychiatrists, and can often be effectively treated.

I tried to research schizoaffective disorder online a few years ago, and also pressed my doctors for details so I could understand my condition better. The best anyone could say to me is that schizoaffective disorder is "poorly understood". Schizoaffective disorder is one of the rarer forms of mental illness and has not been the subject of much clinical study. To my knowledge there are no medications that are specifically meant to treat it - instead one uses a combination of the drugs used for manic depression and schizophrenia. (As I will explain later, while some might disagree with me, I feel it is also critically important to undergo psychotherapy.)

The doctors at the hospital where I was diagnosed seemed to be quite confused by the symptoms I was exhibiting. I had expected to stay only a few days, but they wanted to keep me much longer because they told me that they did not understand what was going on with me and wanted to observe me for an extended time so they could figure it out.

Although schizophrenia is a very familiar illness to any psychiatrist, my psychiatrist seemed to find it very disturbing that I was hearing voices. If I had not been hallucinating, he would have been very comfortable diagnosing and treating me as bipolar. While they seemed certain of my eventual diagnosis, the impression I got from my stay at the hospital was that none of the staff had ever seen anyone with schizoaffective disorder before.

There is some controversy as to whether it is a real illness at all. Is schizoaffective disorder a distinct condition, or is it the unlucky coincidence of two different diseases? When The Quiet Room author Lori Schiller was diagnosed with schizoaffective disorder, her parents protested that the doctors really didn't know what was wrong with their daughter, saying that schizoaffective disorder was just a catch-all diagnosis that the doctors used because they had no real understanding of her condition.

Probably the best argument I've heard that schizoaffective disorder is a distinct illness is the observation that schizoaffectives tend to do better in their lives than schizophrenics tend to do.

But that is not a very satisfying argument. I, for one, would like to understand my illness better and I would like those from whom I seek treatment to understand it better. That can only be possible if schizoaffective disorder were to get more attention from the clinical research community.

next: Someone You Know is Mentally Ill