Spring 1996 Mission


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Prisoners of another reality

New drugs help schizophrenia sufferers
as support systems race to keep pace

By Mike Lawrence

Paul is a quiet, strong-looking man of 35. He meets your gaze with steady blue eyes and talks in a deliberate manner, philosophizing about life and the difficulty of suddenly being brought out of his schizophrenic world and thrust into a more "normal" life.

"I still like to be alone a lot of the time," he says, sipping a cup of coffee and slowly lighting a small cigar.

PicturePaul has been through something few have known and even fewer have been able to describe. He has been a prisoner in another reality since he was a teen-ager. He's one of the estimated 3 million Americans suffering from schizophrenia, a chronic mental illness that can ruin lives with a flood of voices and other hallucinations, delusions and diminished abilities to think clearly or interact with others.

But Paul is a pioneer thanks to a new generation of antipsychotic drugs and a team of mental health specialists led by faculty members from the Health Science Center. He is one of a handful of people with schizophrenia who has been brought back to the reality most of us take for granted. Physicians say the new drugs are the closest thing to a cure for schizophrenia we've ever had. But newfound sanity brings with it a need for relearning sometimes even the most basic life skills.

Paul is cautiously mapping out a new life. He's living on his own in an apartment. He works on his car, and has learned to cook and do his laundry. He's more involved with his parents and his sister and two brothers than before.

A social worker at the San Antonio State Hospital helped him get Social Security benefits as well as Medicare and Medicaid benefits when he left the hospital. His apartment rent is partially subsidized by the federal government. Eli Lilly & Co., which makes the research antipsychotic drug he takes, provides his medication for free. He knows the benefits may not last forever and he's working toward becoming self sufficient.

During the bleak years of his psychosis, Paul was admitted to various hospitals in San Antonio. Like most people with schizophrenia, he was headed down a dark lane of existence few can understand and from which there is often no return.

"Sometimes it can be magical, like 'Alice in Wonderland,' but when the hallucinations and delusions turn nasty, they just run you over. There's no stopping them," he says.

His symptoms began in high school when he started having trouble controlling his thoughts. "I used to play an imaginary radio in my head to try to block out the thoughts and voices I was hearing," he says. "It was exhausting, always trying to fight them. I used to avoid being around people because I thought my negative thoughts could hurt them."

Stress often makes the symptoms of schizophrenia worse and like many teens, Paul suffered emotional trauma. "I broke up with my girlfriend because I felt like a freak and I thought she deserved a normal person," he says. "Two of my friends in high school died. I just wanted to die too."

After high school, Paul began to hear more voices. "They sounded like other people in the room. Some close up and others farther away," he says. "Some sounded like they were whispering right in my ear and others talked in a normal tone of voice." He got a job with a trucking company delivering liquor. He soon lost the job.

The voices weren't Paul's only symptoms. "I had a hard time reading," he says. "The words would jump off the page and run around. I had hallucinations of smell. I thought my family was an organized crime family who had kidnapped me. I thought my mother was a Mafia hit man in disguise. I was afraid to shake hands with anyone. I thought my soul would be stolen if I did."

He had many other delusions including believing that he was in Chicago with the architect Mies Van Der Rohe working on Nikita Khruschev and the Russians as a Christian Science practitioner.

"I was hearing voices most of the time. I thought that if I could get away from my house, maybe the spirits wouldn't bother me, so I would walk the roads and highways around San Antonio for hours or days."

In his late 20s, Paul was admitted to a local private hospital for his schizophrenia. "They put me on some strong pills," he says. "They made me drool and become incontinent." The hospital stay was the first of several to come.

"Just because you're mentally ill doesn't mean you're stupid," he says. "At one place, they took my boots and gave me disposable paper shoes. My feet were cold and I asked if I could have my boots back. They told me that they had lost my boots," he says. "I knew it wasn't true and I got very upset. It took quite a few guys to hold me down while they gave me a shot. Sure enough, when I was transferred to another place, my boots reappeared and went with me."

In 1990, San Antonio police picked Paul up while he was at a church. "I was prowling around looking for an elevator that I thought could take me to the real world where the real people lived," he says.

"They took me to a crisis center and then to the San Antonio State Hospital (SASH). I liked the state hospital right away," he says. "It was much better than the other places I had been. There were other people with schizophrenia and it was good to see that I wasn't alone. I felt safe there and they had activities and doctors and social workers who seemed to understand what we were going through. They gave me the drug Prolixin, but it made me move my jaw back and forth and made my legs shake."

With his consent Paul was admitted to the Clinical Research Unit (CRU) at the hospital. Doctors there took him off of all medication and his psychotic symptoms returned immediately. But soon, he was enrolled in a study of a new drug called olanzapine, being conducted by Alexander L. Miller, MD, professor of psychiatry at the Health Science Center and head of clinical research at SASH, and Larry Ereshefsky, PharmD, professor of pharmacology and psychiatry at the Health Science Center and assistant director of the CRU. The study was funded by Eli Lilly.

Paul had little faith in drugs at that point, but he responded immediately. "I noticed that my symptoms began to subside and that there didn't seem to be any negative side effects." He remained on the unit for three months and when he was discharged, he was allowed to remain on the drug. Olanzapine is not yet FDA approved, but he is still part of a study of the long-term effects of the medication.

"I don't fly off the handle anymore and I don't have the depression and anxiety that I used to. I don't drink anymore. Once I started feeling the positive effects of olanzapine, drinking made me feel abnormal instead of normal," he says.

He talks to his parents more now. "We've reconciled our differences," he says. "This medicine has done wonders for me and my family. We're much closer now."

He's returned to church. "I was brought up a Catholic, but drifted away when I was about 15," he says. "I thought God could heal me, but he just wasn't doing it and I didn't have the nerve to tell the priest that I thought I needed an exorcist.

"One night, after I was taking olanzapine and feeling better, I found a Catholic short wave station where they were praying the rosary. Hearing it gave me an incredible spiritual feeling and caused me to convert back to Catholicism. The church helps me."

When Paul was discharged, psychologist Dawn Velligan, PhD, clinical associate professor of psychiatry at the Health Science Center, suggested to him that working on the unit itself might help him. He took the suggestion and now volunteers at the CRU doing data entry, typing, filing and other office duties. He's enjoying the work.

"I would like to give hope to both the doctors and the patients," he says. "I'm really blessed with the CRU and the people there. My life was like living in hell and now it's not. I feel brand new, like I'm starting over."

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