They are silent because the division wallsare broken down in the brain,and hours when they might be understood at allbegin and leave again.

—Rainer Maria Rilke, “The Insane”

Schizophrenia is an elusive disease, which makes it a difficult one to relate to among the general population. It is easy to sympathize with someone who is suffering from an evident physical malady, such as a broken leg, or even an invisible illness, like cancer, which generally attacks the body in ways that are not cognitive in nature. One is readily able to put oneself in that person’s place and empathize with their plight. On the other hand, a mental illness like schizophrenia can prove difficult to imagine since it affects the victim’s ability to interpret reality, sometimes without any apparent physical symptoms.

People who do not suffer from the disease may struggle to imagine it; they may ponder how it must feel to have a compromised mind — a mind that struggles to function normally while processing reality. Half a century since CT scans first revealed abnormalities in the brains of schizophrenia patients, scientists assert the disorder is a systemic disruption to the brain’s entire communication system, having found that frayed communication cords are present throughout the brains of people with the disease. It is in fact a kind of fracture then, only of the brain rather than of bone.

On account of the misinterpretations of reality brought on by their compromised minds, people with schizophrenia often say and do bizarre things that further alienate us from other people, even people who wish to help us. For this reason, schizophrenics sometimes simply are labeled and dismissed as crazy, mad, or insane — all of which carry negative connotations that are lacking in the way people view most other maladies. As the schizophrenic novelist Robert Pirsig observed, “When you look directly at an insane man all you see is a reflection of your own knowledge that he’s insane, which is not to see him at all.”

As with other stigmas and stereotypes, the schizophrenic’s individual personality disappears beneath a collection of labels and assumptions. Insofar as perceptions of the disease and its victims are concerned, the wanting amount of knowledge surrounding schizophrenia constitutes a public health crisis in the sense that investment in treatment options requires widespread public awareness about the disorder. Only a quarter of Americans feel as if they are familiar with the disease and a substantial percentage still are fearful of encountering schizophrenics at work or in their personal lives, even if those sufferers are undergoing treatment. It does not help matters that when a schizophrenic appears in the media it is usually in relation to a violent incident, even though people with the disease statistically are less likely to commit violence than non-schizophrenics. In fact, schizophrenics are more apt to function as victims of violence and manipulation than are members of the general population.

Yet how is someone who wishes to understand and aid sufferers of schizophrenia able to set aside the disease’s negative social connotations and lend support when the condition remains a confounding challenge even among the medical professionals who treat it? Hence the ongoing alienation and demonization often experienced by individuals suffering from the disease. Many people continue to think of schizophrenics more as inherently crazy than tragically ill, and thus spare less empathy on us than on sufferers of other forms of illness.

Adding to the disease’s poor public image, most schizophrenics do not constitute skilled self-advocates on account of our poor communication skills. I have often thought of this gap in connection to myself as an abyss yawning between my interior life and those of other people. As Dr. Richard Diver says of his wife-to-be Nicole in F. Scott Fitzgerald’s novel Tender is the Night, “She’s a schizoid — a permanent eccentric. You can’t change that.” Schizophrenics often come across as strange, disassociated loners because our ability to relate to other people has been inherently disrupted. The mental and emotional functions that allow humans to connect have been set askew in some way. For example, when informed of a loved one’s death a schizophrenic may laugh or perhaps demonstrate no response at all. The latter may serve as a manifestation of what psychologists call “flat affect,” in which the person does not lack emotion, but rather experiences feelings that nonetheless go unexpressed. An individual who is exhibiting a symptom of flat affect may not be able to empathize with a person who is sad, angry, or happy. The flat affect experienced by those with schizophrenia is due to an impairment in the way we function on a fundamental emotional level. And it is deemed a negative side effect of the disease since it is not in line with socially-accepted emotional responses and behaviors.

Given the myriad challenges of schizophrenics it is not surprising that we do not live as long as the rest of the population. While general mortality rates in developed countries have declined and lifespans have lengthened by almost a decade over the last forty years, the schizophrenic’s life expectancy is roughly two decades shorter than that of the general population. A major reason for the variation stems from suicide. We are ten times more likely to kill ourselves than normal people, and male sufferers are three times more likely to do so than females. Schizophrenic suicide victims usually are high-functioning enough to know they are sick, are socially isolated, lack hope, and feel a level of dysfunction from the disease in light of previous high achievements. Having fallen into all of these categories at one time or another, I must admit I have come close to contributing to these sad statistics on several occasions.

As one may gather from a discussion of its symptoms, schizophrenia is a dangerous and tragic disease, for to lose the functionality of the mind is to lose oneself. And that in essence is what occurs: the person you were for a long period of time gradually departs, leaving another individual in its place. The new being, challenged and debilitated, finds himself constantly struggling with his own mind and, therefore, the fabric of his existence. Every instant promises a new regression or battle for accurate comprehension. It is a minute-by-minute contest in which the sufferer struggles to remain mindful and functional in a life that feels as if it is not always one’s own.