Yes, those late teens and early twenties are inevitably chaotic for us, whether we’re dealing with the demands of university, a new career, or moving out of home. Unpredictable sleeping, developing and changing relationships, fluctuating moods-it’s all part of the package. It is because of this that it can be really hard to distinguish between normal ‘growing up’ angst and the early warning signs of a serious illness.
What makes this particular phase- between approximately 16 and 30- crucial is that it is also when schizophrenia is most likely to emerge.
When schizophrenia does emerge, it’s rarely with the force of a thunderclap, but often insidiously over months and years. This build-up to an acute episode is called the prodromal phase and learning to recognise its early symptoms is one of our most effective weapons.
The Subtle Fade: Social and Behavioral Withdrawal
The first sign that is perhaps not the most striking or unusual but by far the most commonplace is not a breakdown from reality, but a silent and gradual slip out of normal everyday existence. What can be alarming to witness is an outgoing social young person withdrawing to their room, refusing all invitations that a month ago they would have been thrilled by, quitting sports teams or extracurricular interests that he once threw himself into.
Although people need a period of rest it goes deeper than simply “a little break from life.” The withdrawals may coincide with a sharp and precipitous and completely out-of-the-blue decline in school or work performance. A heretofore hard-working student fails classes or a dependable employee is consistently absent from his or her job.
It may look like the person simply is being lazy or rebellious, but to him, his brain is working so hard and experiencing so much it is difficult to cope with everything.
The Mental Fog: Cognitive and Emotional Disconnect
As the person develops schizophrenia the “wiring” of the brain deteriorates. Day to day it is like thinking through a heavy, opaque fog. The person may have tremendous difficulty concentrating on a book, following a film plot or holding onto a conversation. Speech is likely to be vague, meandering or to fade away completely mid sentence.
The person may show a change in their emotions. Their expression and tone may become “flat”, there is no reaction either visually or vocally to either happy or sad events. They may have an out of context reaction and laugh inappropriately, say, when witnessing something extremely distressing.
It can be very frightening to not be able to access your own emotions, and very distressing for their families to observe. Even without full-blown hallucinations or delusions being present, the individual may report an over all uncanny feeling that the world is no longer the same, that something is a little “off.”
This may occur in a paranoid, heightened suspicious way: they might feel that even their closest friends and family are plotting against them, or that they are constantly being watched by strangers and that random, unrelated occurrences (like a particular song on the radio or a car driving by) contain a hidden, secret, personal message directed at them.
Perceptual disturbances can include hearing mumbles, whispers, or seeing peripheral shadows, and though not yet hearing full voices, these “pre-delusions” and pre-hallucinations often take on the experience of the world feeling dangerous and intensely baffling.
The Physical Toll: Changes in Routine and Self-Care
If the executive function-the management system of the brain-starts to deteriorate, the first and more routine tasks of daily life are often the first to deteriorate.
One extremely clear early sign is a dramatic lack of personal hygiene and self care: no showering, wearing the same unwashed clothes for days on end, no washing and grooming habits at all.
Sleep patterns are prone to collapse totally: not being able to sleep for days on end and being up for that time pacing and writing, or an inverse phenomenon in sleeping through days and not night, so that their pattern is wholly reversed.
Seeing many of these in yourself or a loved one should inspire you with more fear, but rather with proactivity and compassion.
Having a few of these symptoms does not automatically mean someone has schizophrenia, it can mean that they have a terrible bout of depression, anxiety or may even be doing some drugs.
Whatever the cause the presence of these are all indicators of a distressed brain that needs to be supported.
Treating the person gently without judgment or accusation is paramount, followed immediately by seeking help from a psychiatrist or mental health professional.
Early detection does more than provide a crisis intervention; it saves the rest of someone’s young life and future from further risk.
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