These are the words of distress that behavioral health professionals hear from families when a son or daughter has his or her first breakdown. Symptoms we used to term a “nervous breakdown” are now more commonly considered the initial signs of mental illness. This experience for families is always a time of grief; however, with proper support, the family and the struggling young person can learn to live —and even thrive—with the condition. Though it is most typical for the first signs of mental illness to occur in one’s late teens or early 20’s, clinicians have seen initial symptoms in much younger children and sometimes much later, in middle age.
My older brother, Dave, first experienced symptoms at age 21. He was working part time, enrolled in college, and had been out to training camp with the Baltimore Orioles. On the outside, he looked like our local hero. But then seemingly out of nowhere, he began experiencing paranoid delusions, hearing voices, and behaving in a bizarre manner. He was admitted to a state hospital where he was diagnosed with paranoid schizophrenia. Fortunately, our family was open to learning about mental illness, was educated, and had always nurtured one another. Dave got the help he needed and was eventually able to live independently, hold down a job, have a car, and participate socially with family and friends.
Families have often asked me what they should look for in their loved ones, and I have included a few domains here as a guide.
Physical signs of schizophrenia, bipolar disorder, and other serious mental illness:
- Blank, vacant facial expression
- Overly acute senses—lights too bright, sounds too loud
- Staring, while deep in thought, with infrequent blinking
- Clumsy, inexact motor skills
- Sleep disturbances—insomnia or excessive sleeping
- Awkward gait (walk)
- Unusual gestures or postures
- Inability to experience joy or derive pleasure from activities
- Indifference to important events
- Detachment from the body
- Hypersensitivity to criticism or insults, hurt feelings
- Sudden irritability, anger, hostility, suspiciousness, resentment
- Suicidal thoughts or suicidal ideation
- Rapidly changing mood—from happy to sad to angry for no apparent reason
- Severe anxiety
Changes in behavior:
- Dropping out of activities and life in general
- Social isolation – few close friends if any; little interaction outside immediate family
- Neglect in self-care – hygiene, clothing, and appearance
- Replaying or rehearsing conversations out loud, i.e. talking to oneself
- Inappropriate responses – e.g. laughing or smiling when talking of a sad event
- Drug or alcohol abuse
- Thoughts that go around and around your head but get you nowhere
- Becoming incoherent or stringing together unrelated words (word salad)
- Racing thoughts
- Overpowering, intense feeling that people are talking about you, looking at you
- Hearing voices
To learn more about what someone experiences when she or he is having early symptoms of mental illness, read the Eden Express: A Memoir of Insanity, the story of Mark Vonnegut (son of Kurt, the famous author). Though Mark is not quite the writer his father was, his descriptions of symptoms are exquisite. Mark did struggle, but eventually, after following doctor and therapist recommendations, he attended medical school and has been a practicing pediatrician since the late 1970’s.