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News Gram™ December 2004

December 2004 ~ Volume 11, No. 5

If you think it takes a psychiatrist to determine if someone is crazy, i.e., psychotic, schizophrenic, out of touch with reality, you're mistaken. It's in the nature of psychiatric disorders that they are all too recognizable by ordinary people, individuals with no special training in psychiatry. Some people, though, are able to tell if someone they've just met is not tuned in to the same wavelength as those around him. What are the signs and symptoms of being crazy?

Before jumping right in to this issue, let's keep in mind a few points: First, we usually find that the whole person in his strangeness and peculiarity seems out of balance. Second, such a person may appear lost in a world of peculiar beliefs - often called delusions. Third a crazy person usually strikes others as irrational, as a person who does not think consistently and clearly. Sometimes, the emotional side of the person is blunted and there is little in the way of emotional expression. On the other hand, though, there is occasionally a great deal of emotion on the surface, but it may strike others as infantile, not the kind of emotion we expect to see in a mature individual.

In people who have been crazy for a long time, we may note that the way they carry themselves and present themselves to others is somehow odd. Hygiene may be lacking, clothing can appear disheveled and a general appearance of self-neglect is apparent. These days, when people are at some pains to appear casual and unencumbered by the bourgeois trappings of conventional social life, they may wear clothing in a way that suggests poverty over affluence, chaos over order. In most cases, though, such people won't fool us because their easygoing, sometimes rebellious appearance will still suggest a style, an appearance they want to emulate. In the case of psychosis, though, the person isn't trying to look disordered but is more likely doing about the best he can.

Added to the style-less appearance, is a neglectful attitude toward one's body. Men will often not be shaven, will have substantial dirt under their nails and may be malodorous. What has happened inside of them is that they have lost the critical awareness of themselves, the ability to see themselves as others do. Sometimes, the person's entire body will seem to be encrusted with dirt, sand, oily residue and other substances that he or she has not bothered to wash off. Hair may be covered with a greasy patina that even the harshest soap will fail to remove on first try. Of course, not all crazy people fail to maintain their appearance but when a person dresses in a disorganized way, appears filthy and smells bad, the question of psychosis should arise.

It is when we try to interact with such a person that we see how different he or she is from most other people. Ordinary pleasantries such as 'hello' or 'thanks' or 'see you' are not often apparent. When we ask this person how he is or what he has been doing for the past month or so, he may say something like, "I've been walking on water." Knowing such a claim to be irrational, we may ask for an explanation. "Yeah, well, I walk on the surface of the water every morning, precisely at 5:45am," is the sort of reply one might get. He may acknowledge that he might miss a few mornings but otherwise insists that he possesses this ability.

One of the things we find in such individuals is what we call crazy logic. Psychotic people often reason in bizarre ways that will strike others as downright weird. Here's a famous example of such logic: "Napoleon was short. I'm short. Therefore, I'm Napoleon." This kind of thinking is referred to as predicative logic. That is, just because a person shares a characteristic or predicate with someone else does not mean that he or she is that person. Nevertheless, this overly inclusive way of thinking is common among people whose thinking strikes others as strange.

Finally, there is the matter of emotion. Many people who have been crazy for a long time reveal a shallowness to their emotional experience and expression. There tends to be little subtlety to their feelings. Mostly, they display basic emotions such as anxiety, glee or, at times, puzzlement. Most of the time, though, there isn't much emotion at all. It's as if things inside are hollow, bereft of substance and limited in variety. When we look at people who are crazy in one or another way, we see that their whole person is involved, their thinking is fractured and their emotional life is shadowy at best. In other words, being crazy means that virtually everything such a person says or does is altered in a crazy way.

What is most interesting is that there are many people who act, think and feel in ways that most people would regard as strange, peculiar and weird. Most never see a psychiatrist. They are often confined to families that shelter them and don't care much that uncle Jim is a bit off kilter. A fair number of them may be in the work force. Their relationships tend to be shallow and often short-lived. But they achieve a sort of stability that enables them to be a part of the world.

All of which suggests that being crazy has less to do with being sick than being different.

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