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Comment by peterwwillis | Hacker News Reader

Thing is, in their mind, they're not rambling. They believe they are saying something intelligible. They have thoughts, sometimes mixed up, and feelings, and try to express them - but something in the delivery smashes it to bits. So the interesting thing to me is how you can read these ramblings and actually extract feelings and intentions from them, even though they make no sense. Usually it's very sad and lonely.

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Do you think schizophrenics know of their condition, or are they clueless that there's something biologically wrong with them?

To me, that seems to be the hallmark difference between hypomania and "real" mania, and what makes the latter more dangerous and scary-- the loss of insight into the condition, or that there even is anything amiss.

It differs from person to person. I've met people who know that they suffer from schizophrenia, some who are unaware, but know hearing voices is abnormal, and some who has no idea.

There's a big difference between the three. The first, the ones who know and care about it - you probably won't even notice he/she is suffering from it, unless they tell you. The others.. yeah.

Source: used to be a med student and a trained hospital sitter.

I had an accident on vacation once and was hospitalized. As a result, for a short period of time, whenever I would get drunk I would experience 'word salad' - some words I was trying to say would get changed into some other word when they came out of my mouth. But I had no idea it was happening - I heard myself saying one word, but my mouth emanated a completely different word. I only became aware of it when someone told me about it when I was sober. All my other faculties were totally fine, it was just the words got mixed up.

It hasn't reoccurred, but i'm now very aware that what I experience as reality is completely subjective to how my brain is functioning. Anything I experience right now could be a different version of reality. But at the same time, now that i'm aware it has happened, I can keep that in mind and consider it in the future. I have to believe that different forms of mental illness allow for the same kind of self-awareness, but it depends entirely on what parts of their brain are functioning (like if they can control their emotions and think clearly, which is hard enough for "sane" individuals already)

The clinical term for this is "anosognosia", which describes a specific physical, neurological inability to be aware of their illness. They literally have damage in their brain which prevents self-awareness. Something like 50% of cases of schizophrenia have some degree of anosognosia as well.

This is a big part of why schizophrenia is so hard to treat. With other disorders like OCD, patients generally do know they are unwell and are willing to accept treatment to improve it. With schizophrenia, patients are often rigidly convinced they are already healthy and refuse to be treated. They are incapable of understanding that they have an illness.

There is a fascinating internal logic underneath it all.

I had a schizophrenic guy send me regular e-mails for about two months. For reasons still unknown to me, he decided that I was the one person in the world that he could trust.

The first e-mail was very short and looked like spam. It was a brief note about how the death of some professional wrestler wasn't an accident. Then they got longer and longer, and finally he started writing his messages out by hand, scanning them, and e-mailing me the scans.

This revealed something really interesting. He was scanning these things at work. He had what appeared to be a regular 9-5 office job at a large company, and he managed to keep a lid on things enough to hold down that job while writing pages and pages of paranoia to me and scanning them on the office multifunction machine.

The most interesting/amusing/sad part of all of this was a single handwritten page sent a day or two after one of the multi-page manifestos. It said, paraphrased, "I screwed up when I sent you that last e-mail. After I scanned the note, I tore it up as I always do, but this time I wore my glasses. I believe they read it." Evidently, this fellow believed he was under such pervasive surveillance that they (whoever they were) could see things through his own glasses. The elaborate procedures he went through to send me notes were apparently worked out to circumvent this stuff, but they required good operational discipline which he couldn't always handle. Or something like that! It clearly made perfect sense to him.

After a couple of months, I tracked the guy down with the help of some friends and got in touch with the local police so they could check on the guy, as he was clearly getting worse and I didn't think he'd be safe. I didn't hear anything after that until a couple of months later when a brief e-mail arrived from a relative that basically said, "Sorry about him hassling you, he's back on his meds now."

So, a happy ending, I guess. And certainly one of the most interesting things that's happened to me online.

Believing that one might be being surveilled through one's own glasses is a paranoid fantasy that gets closer to reality every day!

This story makes me think of the portrayal of John Nash in a beautiful mind.

being back on his meds is codeword for taken care of by the secret police you know?

What the fuck? Maybe this is too much of an immediate response for me, but why the fuck would you contact the police? Do the police seem like they take care of people like him well? Shit I feel bad for him, the one guy he thought he could trust just snitched on him, even if he was crazy. Must have been hell to undergo that. Maybe you should have posted to a forum about how to help him first, as opposed to helping? Now the police thinks he is harassing random people and has a legal trail just in case they want to discriminate against him.

I was involved in this incident, as one of the friends who helped track him down. I believe contacting the police was a good move because his letters indicated that he was a danger to himself and to others.

Okay thank you. My initial tone was unwarranted. I apologize.

The police conduct welfare checks on people who may need help. Despite the internet's fascination with police abuse, they can be quite helpful to people.

And maybe you shouldn't be so offhandedly judgmental. I actually called a suicide hotline in the area first (the only mental health service I could come up with) and, after I convinced them that I wasn't suicidal, it was their suggestion to contact the police.

But yes, I guess it was terrible that this poor guy got help and got his life back on track.

The ending was profoundly disturbing to me, but I couldn't explain the feeling. Then I realized why.

>"Sorry about him hassling you, he's back on his meds now."

and not

>"Sorry about me hassling you, I'm back on my meds now."

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