The Schizophrenic Mind

The first time Chris Coles heard the voice, it spoke to him after midnight. In a gentle tone, it instructed him to meet his friend at a beach cove, right then, and apologize: Chris, the voice told him, had been planning to date the friend's girlfriend. Although Coles was planning no such thing, he did as instructed, arriving at the cove at 2 a.m. It was deserted. He dismissed the incident; imagination, after all, can play tricks in the twilight between waking and dreaming. But the voices kept intruding. Coles saw visions, too. At the beach near his California home, he often saw a profusion of whales and dolphins swimming onto the beach, and a golden Buddha glowing from the bushes by the dunes. "I also had delusions of grandeur," says Coles, now 47. "I felt that I had power over things in nature, influence over the whales and dolphins and waves. I thought I could make things happen magically in the water."

Donna Willey's visions came out of a darker world. She saw "bloody images, cut-up people, dismembered people," she says. Voices, too, began haunting her and, despite medication, still won't stop. "They say terrible things," says Willey, 43. "That what I'm doing is not important. They cuss and yell, trying to get me down, saying I shouldn't have done something that way. They're in my head, and they keep yelling." Even as she talks to a reporter in her office at the National Alliance for the Mentally Ill (NAMI) of Greater Chicago, the demons screech "You shouldn't say that," or "Don't say it that way." "The noise, the chaos in my head--it's hard to keep everything separate," she says.

The disease that came to be termed schizophrenia was first described by German psychiatrist Emil Kraepelin in the 1890s, but it remains one of the most tragic and mysterious of mental illnesses. Whether it brings the voices of heaven or of hell, it causes what must surely be the worst affliction a sentient, conscious being can suffer: the inability to tell what is real from what is imaginary. To the person with schizophrenia the voices and visions sound and look as authentic as the announcer on the radio and the furniture in the room. Some 2.5 million Americans have the disease, which transcends economic status, education, geography and even the loving kindness of family. Neither doctors nor scientists can accurately predict who will become schizophrenic. The cause is largely unknown. Although the disease almost surely arises from neurons that take a wrong turn during fetal development, it strikes people just on the cusp of adulthood. Whatever the cause, it seems not to change in frequency: the incidence of schizophrenia has remained at about 1 percent of the population for all the decades doctors have surveyed it. There is surely a genetic predisposition, but not an omnipotent one: when one identical twin has schizophrenia, his or her twin has the disease in fewer than half the cases. Treatment is improving, but a cure is not even on the horizon.

Diagnosing schizophrenia can take years. Soon after Andrea Yates confessed that she had drowned her five children, one by one, in a bathtub last year, the prison psychiatrist diagnosed her as having postpartum depression "with psychotic features." So had the psychiatrist who treated Yates after her 1999 suicide attempt. Since psychosis--the inability to distinguish reality from imagination--lies at the core of schizophrenia, both psychiatrists recommended that Yates be tested for that disease. Dr. Phillip Resnick of Case Western Reserve University did so. Last week, taking the witness stand for the defense at Yates's murder trial, he testified that she had a combination of schizophrenia and depression when she killed her children. In 1994, after her first child was born, she said she heard Satan's voice telling her to "get a knife" and hurt baby Noah.

If Yates's is the public face of schizophrenia--bedeviled by voices, gripped by evil forces--then John Nash's is the hidden one. As shown in the Academy Award-nominated picture "A Beautiful Mind," the disease, at least in its early stages, can inspire Olympian leaps of creativity and insight. "That's the wonderful paradox of schizophrenia," says Dr. Nancy Andreasen, professor of psychiatry at the University of Iowa. "People see things others don't, most of which aren't there. But because they perceive the world in a different way, they sometimes also notice things--real things--that normal people don't."

Schizophrenia is marked by the persistent presence of at least two of these symptoms: delusions, hallucinations, frequently derailed or incoherent speech, hugely disorganized or catatonic behavior, or the absence of feeling or volition. If the delusions are especially bizarre, or the hallucinations consist of either a running commentary on what the person is doing or thinking, or multiple voices carrying on a conversation, then that alone qualifies the person as schizophrenic. In one subtype, catatonic schizophrenia, the patient often seems to be in a stupor, resisting all entreaties and instructions, or engages in purposeless movements, bizarre postures, exaggerated mannerisms or grimacing. Yates would sit and stare into space for two hours; she would scratch her head bald and pat her foot obsessively. Before the drownings she rarely spoke, testified family members. Police officers responding to the crime described her as emotionless.