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Wednesday, August 8, 2012

Psychology Q&A: Schizophrenia & Police Work?

Disclaimer: The information provided in this post is intended for writing purposes only and does not represent psychological advice.
QUESTION: I keep returning to schizophrenia as an interesting disorder. I'm wondering what exactly can someone who's schizophrenic (and on his medications) do for a living? Can they be a detective or a police officer? Or is there a better disorder for me to use that would allow them to be a detective or a police officer? I wasn't sure if schizophrenia would keep them from being employed as such. Also,  is there a positive side to the schizophrenia -- a creativity or something along those lines that could be harnessed in the right situations? Finally, what type of inner conflict would someone with schizophrenia have to overcome in order to be successful?
ANSWER: Schizophrenia is really one of the most disabling psychological disorders someone can have -- only about a third of people with the disorder are able to live independently. By definition, schizophrenia is a psychotic disorder, which means that the person who has it isn't in touch with reality as other people experience it. Symptoms of psychosis include:

  • Hallucinations: seeing, hearing, feeling, smelling, or tasting things that aren't there; the most common hallucinations in people with schizophrenia are voices
  • Delusions: believing things that aren't based in reality despite all evidence and logic to the contrary
  • Disorganization: this doesn't mean the person is messy; it means their mind is disorganized. This leads to disorganized speech (which means  means that people wander from topic to topic enough that it's noticeably weird; in extreme cases you get a "word salad," which means the words are all just jumbled up) and disorganized behavior (which may be silly, childlike, or aggressive, but is always purposeless)

People with schizophrenia can be articulate and intelligent -- John Nash, the man on which A Beautiful Mind was based, is well-spoken and obviously extremely well educated. But he does hear things (and see things, according to the movie), and he has delusions.

Nonetheless, I think it would be unusual for someone with schizophrenia to be able to be a detective or a police officer, even if he were taking medications. (Which is not to say it's not possible; as I note below, disorders always exist on a continuum, and there are always exceptions to what's "usual." Some people with schizophrenia function very well.) The meds can often suppress the psychotic symptoms, but that doesn't mean the schizophrenia goes away; sometimes symptoms can linger. And the meds tend to work better for what we call "positive" symptoms (like hallucinations, delusions, and disorganization) than they do for "negative" symptoms like catatonia, apathy, mutism, failing hygiene, and other tendencies to withdraw from society.

However, someone who has bipolar disorder (which used to be called manic depression) could be, assuming they'd never been institutionalized and they were functioning well.  Like schizophrenia, bipolar disorder can be crippling, and for some people it can also involve hallucinations and delusions, particularly during a manic phase.

I know that you can't get into the CIA or FBI if you have a history of mental illness, or have been to therapy for a psychological problem. Though I doubt the police are quite as stringent, I suspect they're still on the lookout for these kinds of disorders. So it would probably need to be something that hasn't officially been diagnosed.

Martin Riggs -- Mel Gibson's character from the Lethal Weapon movies -- comes to mind. He's a great example of a great character who went a little (ok, a lot) crazy and was still a police officer.  If you're not familiar with the movies, Riggs's wife dies, and he gets crazy suicidal, which makes him a complete loose cannon. If I had to diagnose Riggs off the top of my head in the first movie, I'd say a major depressive disorder, last (current) episode severe.

While some people have begun arguing that people on the schizotypy spectrum (of which schizophrenia is a part) are more creative than others, according to some of the research I've read, that creativity may be so different from the way other people think that it may not been seen as creativity...just as weirdness. People with bipolar disorder have more classically been seen as creative, though. They tend to be creative within the "rules" of society -- that is, their stuff looks creative, not just bizarre, to other people.

There isn't really an inner conflict someone with schizophrenia has to overcome -- it's thought to be very much a biological disorder. So is bipolar disorder, though the person with bipolar disorder may not seem quite as bizarre, and may function more within the norms of society.

Also remember that with any disorder there's a continuum from "not bad" to "really bad" versions of the disorder. So some people will have any given disorder worse than others, based on the genetics and how stressful their environment has been throughout their lives. Less severe cases may respond better to medications and therapy, and people with less severe cases (or cases that are being managed well) may function well.

Remember, if YOU have a psychology in fiction question you want to see answered here, use the Q&A form on my Archetype site or send an email using my QueryTracker email address to the right. (Please use Q&A in your Subject Line!).

Carolyn Kaufman, PsyD's book, THE WRITER'S GUIDE TO PSYCHOLOGY: How to Write Accurately About Psychological Disorders, Clinical Treatment, and Human Behavior helps writers avoid common misconceptions and inaccuracies and "get the psych right" in their stories. You can learn more about The Writer's Guide to Psychology, check out Dr. K's blog on Psychology Today, or follow her on Facebook or Google+


ChiTrader said...

Thanks for the informative primer on schizophrenia. I was a volunteer Big Brother for a boy who showed many of the symptoms and has been diagnosed with "mild" or potential schizophrenia. He fits the profile very nicely, mainly with hearing voices and disorganized speech. Nice to know he was diagnosed correctly.


Teresa Robeson said...

Even though I have no current plans to use schizophrenia in my stories, this was still a fascinating post to read since I'd not read up on anything listed in the DSM since my abnormal psych class as an undergrad.

I also like to see psychological descriptions of schizophrenia for the general public because one of my pet peeves is people using "schizophrenic" when they actually mean "multiple personality disorder" (which, I recently heard, may be a completely fabricated disorder). :}

Carolyn Kaufman | @CMKaufman said...

Thanks for the comments!

Yes, Teresa, DID (dissociative identity disorder or multiple personality disorder) is more and more commonly thought to be "iatrogenic," which means that therapists (and other folks) are CREATING the disorder in people! One psychologist recently proposed that maybe people who seem to have DID should be diagnosed with borderline personality disorder, as most already seem to meet that criteria. You can read the article here: http://www.scientificamerican.com/article.cfm?id=can-people-have-multiple-personalities

PS - It's also one of my pet peeves when someone says "schizophrenia" when they mean "dissociative identity disorder"!

Mark p.s.2 said...

Which came first, the drugs/medications or the Hallucinations, Delusions and Disorganization?

John Nash has said on youtube he never has had visual hallucinations, but then you don't believe him do you? Cause he's crazy.
Psychiatrists say that if you were REALLY crazy you wouldn’t know it.

Question for psychiatrists: Is psychiatry crazy?
Ones words do not prove one is sane.
Ones actions do prove one is sane , in good deeds and good works.