The Human Need for Recognition

How lovely to see an article co-authored by a person with schizophrenia and his psychiatrist! For hundreds of years, the perspectives of people receiving services (PRS) was never published in medical/psychiatric journals. Then, some journals had a special section for "voices of lived experience" where people receiving services could write short, personal pieces—often they told dark and negative stories about all the pain they have experienced. Later, people with lived experience were on research teams and people with mental health challenges would be co-authors (Hutchinson & Lovell, 2013). Then research projects were designed and led by people with mental health challenges (Sweeney, Beresford, Faulkner, Nettle, & Rose, 2009). Now the language has moved to "lived expertise" to acknowledge the considerable and important and essential expertise of people living with mental health challenges—in clinical situations, in research contexts, for training and education of mental health providers (Oliver & Cataldo, 2019). And here we have a two-authored article by a "patient" (self-described) and his "psychiatrist." And the "patient" is the first author!

I particularly appreciate that the first author was willing to share in detail about his experiences with schizophrenia. Although agreedly atypical from a DSM point of view, they are also similar to what I have heard in my clinical experience. Some people do not want to get rid of their voices, even if the voices say critical things, and they feel a real sense of loss when medication takes away their voices. His description of how his family perceived his inability to continue school and refusal to work as laziness (even going so far as taking him to court—quite extreme!) was also striking. In a study colleagues and I conducted several years ago where we asked people diagnosed with schizophrenia to describe their experiences, people also described that hearing voices and thinking unusual thoughts was so engrossing that it was hard to do anything else (Flanagan et al., 2012). Apparently, what is interpreted in psychiatry as "negative symptoms" are actually not a lack of anything–they are actually very active, engaging effects of hallucination and delusions—it is hard to put sentences together, it is hard to express how you feel, and it is hard to participate in goal-directed behavior like school or work when your voices and thoughts are that intense and engrossing. I know I felt the same way when I had the privilege of doing the Hearing Distressing Voice Similar by Pat Deegan (Deegan, 1996) several years ago—I put on headphones of voices (and they weren't even MY voices who knew all my greatest shames and fears) and tried to go the (virtual) "bank" that is set up as part of the training—I could barely put my thoughts together to discuss the overdraft in my account with the teller given how loud and compelling my voices were. Trying to sustain attention and concentration for even a 10 minute a clinical interview in the "doctor office" section was even harder.

Finally, the loneliness and longing for love and connection—as the first author so aptly put it—"intimacy was out of the question" and "entertainment was always with someone else"—that was universally shared by participants in our study. None of the people described a lack of emotion that is the clinical stereotype with someone with schizophrenia (Andreasen, 1984). In fact, many of our participants also described the dysphoria and despair that the first author described (and in the discussion the question was raised about whether this meant that the first author would be more accurately diagnosed with schizoaffective disorder), but perhaps the despair and mental anguish is a logical and expected emotional reaction to the difficulty of experiencing the symptoms of schizophrenia and being aware of the challenges these symptoms present for the "life" that you have chosen for yourself.

Indeed, the author describes it as a "schizophrenic life" and the title of this article is "I am schizophrenic." Labeling yourself as "schizophrenic" can be a tricky thing (Flanagan & Davidson, 2007). On the one hand, the first author describes how embracing his identity as a "schizophrenic...