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Personal Perspectives
Schizophrenia and Decision-Making
Personal Perspective: Despite schizophrenia, people can make detailed plans.
Updated February 24, 2024 Reviewed by Ray Parker
Schizophrenia is a neuropsychiatric brain disorder that involves delusions (fixed false beliefs), paranoia, hallucinations, and sometimes mood symptoms. These symptoms can cause a person to lose touch with reality and can also heavily affect judgment.
Some people experience “negative” symptoms such as apathy, neglecting personal hygiene, and isolating themselves. Others experience cognitive deficits and trouble with memory, attention, learning, and planning. Persons with schizophrenia often struggle to make complicated decisions, maintain relationships, and participate in meaningful activities, including work, volunteering, or school.
However, despite the effects of schizophrenia, many people are still able to plan and execute some good and informed decisions.
Planning a Trip to Africa
Prior to my first psychotic episode, I experienced several warning signs, including a sharp drop in my grades and isolating myself. I was losing interest in a biochemistry major I had once been passionate about. Nonetheless, a few months prior to my first episode, I planned a trip to a slum in Nairobi, Kenya, to see the world, hoping to make a difference in a needy community.
Planning the trip to Africa was difficult. It involved locating a highly educated Kenyan woman doing humanitarian work in the slum. I kept in touch with her by email, and she explained how I could volunteer after I arrived, what to bring, where we would meet after my plane landed, and other details.
I also needed to apply for a visa, which turned out to be much more complicated than I expected, and in the process, my passport was lost in the mail. I successfully filled out the paperwork for a new passport. I also contacted the church where I grew up in Ohio, asking them to support my trip financially. After I visited them, they donated to cover nearly all expenses.
Everything I needed to do in order to make this trip happen was done well. I went the extra mile to prepare for the new world I would soon enter.
But while everything related to Africa seemed to be going well, other parts of my life suffered. I didn’t realize that my personality was changing, and I was no longer really “myself.” I was speaking too fast, unable to concentrate, and still isolating myself. I was actively cutting family and friends out of my life.
For one of my classes, I decided not even to purchase the textbook, relying on class notes alone, when I bothered to study at all. I remember attending classes as always, but I was too busy to study. I finished the semester with Cs. Never in all my academic career had I performed so poorly.
A week before my flight to Africa, my parents visited me in southern California. I was uninterested in seeing them and avoided them for hours at a time. I remember telling them I needed to spend hours in libraries doing a “research project,” just reading more about Africa online.
In reality, this reading was unnecessary and simply a way to avoid them. I realized how disappointed they would be if they found out how much my grades had dropped, which I hid from them. I thought I loved them, but in practice, I did not. I was afraid they might interfere with my plans and kept the details of my trip a secret.
My parents requested that I immediately send them my contact information when I arrived in Africa because up until then, I had given them no concrete information, and I promised to do so. But when I arrived in the slum of Nairobi where I was to stay, I had no physical address, and correspondence was received at a mailbox in the city.
I could have given my parents my host’s cell phone number, but I did not. I think I was worried they would travel to Africa and find me there, taking some very concerning risks. I wanted to make sure that did not happen.
Living in Africa
Upon arrival in Africa, I stopped taking care of myself. I was not accustomed to their food and remained hungry after eating small meals of vegetables and cake made of boiled flour, which my African friends were used to. I had the funds to buy more nutritious food. Instead, I lost a significant amount of weight and was told more than once that I looked thin and pale.
As I was leaving Africa, one of my hosts confronted me, expressing that I was being irresponsible, not taking care of myself, and taking risks. Her criticism was well intended, and I should have welcomed it. Instead, after I returned to America, I never spoke to her again.
Suffering But Holding It Together
When I encounter others with schizophrenia, I often see similar patterns in their lives—holding it together while everything else is falling apart. I see people who do not have any money hop trains and manage to travel hundreds of miles to a city of their choice where they will be homeless. I also see homeless people make smart moves regarding where they will get food. They manage to set up tents with heaters and do whatever is necessary to survive in the elements.
Looking back at my untreated schizophrenia and observing the lives of others, it is surprising how so much of a person’s thinking remains fully intact while other parts of their brain are overcome and controlled by schizophrenia. I remember not being able to work the most basic or simple job, but somehow, I managed to survive with no address for four years.
Because a person’s brain can be working in some rational and sound ways but still be strongly impaired by schizophrenia, they may experience “anosognosia” or a lack of insight. They may strongly believe they are not sick and may be partly right. But I remember thinking my inability to work was my choice, while in reality, I was too sick to work. My mind was not clear, and overall, I was not thinking rationally.
In reaching people with untreated schizophrenia or treatment-resistant schizophrenia, it is important to understand why many people think nothing is wrong and to understand that a part of their brain may indeed be functioning. Restoration, healing, and recovery are possible through education and dedicated adherence to medication and treatment. With treatment, they may be able to come off the streets, live a better quality of life, and even work, attend school, or volunteer.
I am thankful for the psychiatric clinician who convinced me always to take meds in order to find a better life. Through compassionate intervention, I hope others will obtain the insight necessary to access quality care and experience healing.
