Friday, September 20, 2013

Roaring To Life

Yesterday was a pretty tough time in Thomas' therapy. Strangely it affected Thomas' therapist and myself more than it seemed to Thomas. We are now entering an era of family therapy where we are going to work to track down when Thomas' delusions started. I personally thought this was going to be an ambitious project but it turned out to be very enlightening.

Remember how I wrote that Thomas had taken a test to measure his delusions? Well I think I mentioned to you guys that some of them had been resolved but had been rampant in another, younger time in his life. It was those delusions that we worked on pinning down their causes and it was those delusions that held a very painful event for Thomas that he had kept from everyone until now.

I had originally brought Thomas in for therapy for depression and anxiety. The catastrophic event that got me to rush to find him a therapist was that I found out that he had trichotillomania. For those of you who don't know what it is,

"Trichotillomania is repeated urges to pull or twist the hair until it breaks off. Patients are unable to stop this behavior, even as their hair becomes thinner and bald spots appear."

It was a heartbreaking thing to find out that he was doing that and how I first discovered it was by finding a large clump of his hair with a piece of his scalp attached on the floor of his bedroom after a traumatic event. I remember picking it up and being carried back to the time when he had his first haircut and I held a lock of my baby boy's hair in my hands and I remembered how I had thought how he was growing up and would never be my baby again. Then, there I was in that moment in his bedroom, holding that chunk of hair and there was the same sadness, made deeper with the knowledge that the reason I held that hair was because my boy was in such excruciating emotional pain that he felt the need to pull chunks of his hair out to relieve the pain he felt. I was forever changed as a mother in that moment.

Consequently because he did that he had a bald spot. This bald spot led to a cruel bullying event at school and as a result he began to form opinions about the world and the people in it. This time in his life was the era of the beginnings of the formation of his schizophrenia.

Don't get me wrong, it wasn't that one event that determined his schizophrenia but it was certainly an event that caused him to start forming the tell tale false beliefs (delusions) that are a hallmark of schizophrenia. I remember so many other things that happened at that time that also screamed "schizophrenia" and somehow it was all overlooked. After all, when you're not looking for schizophrenia and instead trying to pin down depression and anxiety then that is exactly what you see, depression and anxiety.

What was most striking about the session yesterday was the dawning realization that we were hearing the engines of schizophrenia roar to life. I believe that prior to that time, Thomas struggled with symptoms that now looking back, were very much indicative of schizophrenia but the delusion formation that ran unabated for years after that terrible bullying incident and the subsequent coping from this event, were a very key point in time.

It is a very odd place to be. To be able to sit there and listen to this horrible story about his being teased for his trichotillomania and to hear about the subsequent coping strategies. To be able to hear him say things like he saw for certain that every time he walked the halls of school everyone was pointing and laughing and saying terrible things to him--which to hear him describe that it makes me wonder if he hallucinated that happening since what he describes is an incessant onslaught of abuse that I just can't imagine was possible to sustain for an extended period of time without the intervention of a teacher or anyone for that matter. I could be wrong though. To be able to hear him say exactly how he began to view the world as slightly skewed, all of it makes for a sobering 40 minutes of time.

Here's the kicker for me. While my boy was being teased mercilessly at school, while his grades dropped, while the now very recognizable fledgling signs of schizophrenia were manifesting, while I was hearing over and over the "I don't know's" and the "I can't remember's" that made me crazy, I was busy at home grounding him from any and all things in an effort to force him to get better grades, to shape him up, to make him take responsibility. We fought a lot and I didn't bend much. What absolutely KILLS me is that I didn't know about the bullying, I didn't know about the schizophrenia, I didn't know about any of it and there I was making his time at home miserable too.

So, Thomas was under a lot of stress at a very key point in his life. It was 8th grade, he would have been about 12 or 13, and beginning puberty and often that is when the first signs of schizophrenia manifest. He was fighting a valiant fight for his sanity and was losing. We found the clues to the delusion formation yesterday but now what do we do? The plan is for more detective work, my feelings are mixed. While it's interesting to find the beginnings of the delusional thinking, I find it painful to make Thomas relive some heartbreaking moments in his life in an effort to find them. Perhaps there is silver lining in all of this. I don't know. Time will tell.

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