“Why didn't I see this coming?” is a question that many parents may ask themselves. As a mother and a psychologist, I often wondered why I did not identify my son's early symptoms of schizophrenia. The difficulty for me, like most parents, is that early symptoms of schizophrenia often masquerade as other issues, like depression.
Unless you have a first degree relative with schizophrenia, and know that this illness is a possible inheritance, schizophrenia is not really a “go-to” diagnosis. And, as important as it is to diagnosis schizophrenia early, identifying the early signs can be very difficult.
The best thing a parent or caretaker can do is to make sure that any early symptoms are treated professionally. Then as the psychotic symptoms become apparent, and the diagnosis becomes clear, interventions for schizophrenia are more readily accessible because the person has already engaged in treatment.
Jacob’s Depression Seemed “Normal”
During most of his childhood my son, Jacob, loved spending time with friends and always made new ones when we vacationed — and he was never at a loss for energy. However, during his sophomore year in high school, these behaviors slowly began to change. He started struggling to find a good fit with friends and became somewhat argumentative with his fellow percussionist in marching band. I labeled this change as “teen angst.” I thought that with some guidance and experience, he would outgrow this phase.
Jacob’s “teen angst” continued to grow, and he began to require psychological and medical help for depression. According to the Diagnostic and Statistical Manual (DSM), one of the early signs of schizophrenia in about 50% of the cases is depression. This was true in our family’s situation; Jacob was diagnosed and treated for depression several years before he exhibited any obvious symptoms of schizophrenia.
His depression spanned the last two to three years of high school. He met regularly with a psychologist and eventually took anti-depressants prescribed by a psychiatrist. He was able to manage his academics and enjoy after-school and church-related activities, but he was not his usual social self. Even with medication, he would sleep excessively. During one mission trip, he spent a whole day sleeping in the back of the van while everyone else was building a deck for a needy family. During a marching band trip to California, he slept through a tour of Hollywood until I was able to wake him up and urge him to join his friends. On the same trip, he fell asleep on the bus to Six Flags and woke up at the bus terminal.
Excessive sleeping and social withdrawal were key symptoms of his “depression,” but as I realized later, they can also be possible symptoms of schizophrenia. I didn’t think of it because many adolescents experience depression. According to a 2020 survey by SAMSHA, 4.3 million adolescents between 12 and 17 or 17% of US teens were diagnosed with a major depressive episode. Since schizophrenia impacts between 1 to 2% of the population in general, not all people with depression later develop schizophrenia. So how do you know if your son, daughter or loved one who is depressed will later have schizophrenia? That prediction is very difficult, if not impossible, most of the time.
We Could Rationalize Other Unusual Behavior
Jacob, however, did show some of other early warning signs, such as thought disorder — a disorganized way of thinking that manifests in abnormal ways of expressing oneself when speaking and writing. During the first semester of his senior year in high school, and about three months before his official diagnosis of schizophrenia, Jacob’s creative writing teacher asked to meet with me. She was concerned about his writing because he kept qualifying his statements with asides in parenthesis. She said that she had talked to him about his use of parentheses, but he continued to use them anyway. She couldn't figure out why he was so resistant to her instructions.
When I looked at what he had been doing, I quickly rationalized his style to be related to one of his favorite television programs at the time, Mystery Science Theater. It was a popular program that showed movies with a group of characters taking the part of critics and making funny asides or additions to the scripts. That was certainly an easy conclusion for me to make until I discovered a green spiral notebook in his room titled “My Schizophrenic Notebook.” He, again, used parentheses, but this time it was apparent that his thinking was very disorganized. Unlike some people with his diagnosis, his verbal expression was never noticeably disturbed — but his writing showed obvious evidence of thought disorder.
Jacob displayed other “odd” behaviors in his early teens, but they were usually short-lived. Several times, he exhibited brief catalepsy or wooden posturing (one of many manifestations of catatonia). Each time, the behavior seemed to correspond with excessive stress. The third and last time lasted about one hour following the small wedding ceremony for me and his stepfather. Pictures show him sitting on a couch outside the sanctuary in a wooden pose and a distant expression on his face. One of his grandmothers commented that her husband (Jacob’s grandfather) had similar experiences after he returned home from battle following World War II.
While Jacob had a good relationship with his new stepfather, he may have been traumatized by the major change in our family structure. Still, it was an unusual reaction. His grandmother's comment was a logical but unexpected explanation. Since I had known his grandfather for many years and had never seen any signs of psychosis, I tucked the experience away in the back of my mind hoping it would not occur again, which it never did. Catatonia is, however, a common symptom among those hospitalized with schizophrenia.
We Can’t Always Know the Answer
As strange as some of these events were, they did not prepare us for what was to come. Most of the time, even with depression and the few odd behaviors, Jacob looked and acted like most other teenagers. He attended school, worked part-time at a local grocery store, enjoyed playing his drums and participated in school and family events. Any other symptoms of schizophrenia, such as auditory hallucinations, that he may have had before his diagnosis were easily masked by his composure.
Looking back, the only way to tie these unusual events together as prodromal (or early symptoms of schizophrenia) would have been to know that he had a genetic predisposition. That knowledge did not come to light until later.
Jacob had a psychologist to help him with what seemed to be developmental issues related to being a teenager. Later he needed help for what looked like depression so we added a psychiatrist for medication. Because of these interventions, his psychotic symptoms were addressed as soon as they were recognized. Hopefully, in the future, more definitive methods of early identification will be available.
Linda Snow-Griffin, Ph.D. is a retired psychologist from Cincinnati, a mental health advocate and an author. She recently wrote “Hope and Learning, Our Journey with Schizophrenia” about her son's recovery from schizophrenia and how her family coped. The book includes information about schizophrenia, the recovery process, stigma, family impact and caregiver needs.