Has schizophrenia run in your family

schizophrenia : Overstimulated

Marie Werren * was 22 years old when her life went upside down. When, instead of orienting herself in adulthood and in professional life, she first lost her bearings. When she withdraws, hardly speaks to her mother or friends anymore. But only with this voice.

"I sat in my room from morning to evening, cackling and chatting," says Marie Werren, sliding back and forth on her chair. It's hot, summer, early August. A little breeze comes through the wide-open window into the room on the first floor of the Vivantes Klinikum am Urban in Berlin-Kreuzberg. However, it does not cool down. Marie Werren adjusts her loosely falling T-shirt. Once. Once again. She is nervous. How should she explain that? She knows herself how strange that must sound to an outsider. How crazy. The woman from Friedrichshain flips through her little notebook. Knead your hands. Then she looks up and smiles a little crookedly: "It was actually quite nice."

That was almost three years ago. Three years in which Marie Werren tried to find her bearings again. She spent a lot of time in this hospital. In the clinic for psychiatry, psychotherapy and psychosomatic medicine. And also in the adjoining early intervention and therapy center especially for adolescents and young adults with psychological crises, the »Fritz«. Because Marie Werren had just such a crisis back then, even if she didn't feel that way at first. "I was pretty lonely at that time," she says. “I hardly had any social contacts. But I had the voice. We talked a lot and had a really good time. "

At least until that one day in late autumn 2012 when the voice incited Marie to do something. Where she got the prospective saleswoman to drive to an old internship and make fun of a former colleague there. What exactly happened back then - Marie Werren doesn't want to talk about that. It still weighs on them. Only this much: "I was pretty euphoric, pretty wild." The old colleagues felt pretty disturbed, maybe even threatened. They called the police. And Marie Werren was admitted to the closed department of psychiatry at Urban Hospital - against her will, with a court order.

The diagnosis: Schizophrenia. A mental illness that many people fear. Because it sounds so much like "madness", like a loss of control and reality. For something that is kind of unimaginable. And finally. The disease is not that rare - and not incurable either: "Around one in a hundred Germans experiences a schizophrenic episode at least once in their life," says Andreas Bechdolf. He is the chief physician of the clinic for psychiatry, psychotherapy and psychosomatics at Vivantes Klinikum am Urban and also heads the »Fritz«, where Marie Werren is currently being treated again. "A first psychological crisis in particular is also very treatable: in more than 80 percent of cases the symptoms regress completely." Such a severe psychological crisis usually builds up over several years. It often begins with difficulty concentrating and a creeping social withdrawal - and finally leads to an acute psychosis.

During a psychosis the brain releases too much of the neurotransmitter dopamine. This literally opens all locks and floods the brain with information and stimuli. It can no longer distinguish between important and unimportant, between real and fake. Perception is disturbed, hallucinations occur. Voices that no one can hear, except for those affected themselves. Those who talk to them on friendly terms, just as the voice of Marie Werren did at the time. Or talk about them, comment on their behavior, point out mistakes and inadequacies. Perhaps whispering harmful things into them, encouraging them to act. In addition, delusions occur, those affected feel observed and persecuted, for example, and relate even the most everyday things to themselves. In addition, so-called ego disturbances often occur: the boundary between the self and the environment is blurred, perhaps dissolving completely. "The patients then have the feeling, for example, that other people have access to their thoughts," says Bechdolf.

The first schizophrenic episode usually occurs in young adulthood, at the beginning of 20. "In this phase of life there are big tasks, it is very open and therefore also insecure," says Bechdolf. Mental crises often had a much stronger, more unsettling, frightening effect. It is then important to strengthen the self-confidence of those affected and to show them new life prospects, says Bechdolf.

The causes of schizophrenia are not yet fully understood, but predisposition, including a genetic one, plays a role, among other things. Persistent stress and drug use, for example, are risk factors for the fact that psychoses actually occur. In the beginning, those affected often have difficulties recognizing their illness - and distinguishing what is real and what is not.

That was too The case with Marie Werren: Long before the voice answered for the first time, the young woman was tormented by anxiety. She withdrew more and more. And later made friends with her voice. "The conversations with her were completely normal for me," she says. Her first stay in psychiatry did not change that at first: At the time, she was convinced that a film would be made about her life. And the clinic was nothing more than just another movie set. There is no trace of an insight into illness, as the experts call it. But over time the medication she was given, called neuroleptics (see page 24), began to work. Just like the therapeutic sessions, the individual and group discussions. Marie Werren was doing better - and she overestimated herself: after six weeks in the closed ward, she left the clinic, although the doctors advised her to have further treatment in another ward. But in the world "out there" her problems came back. The fears. The confusion. After a few days she returned to the clinic. Voluntary.

After the complete overstimulation, the brain is overworked and needs to recover. Those affected need rest, a safe and low-irritant environment. No big city bustle. No parties. No challenging or stressful situations. Instead: medical and therapeutic help. Because if left untreated, the risk of a psychosis recurring is around 80 percent. Young adults in particular would often stop treatment after a while, says chief physician Bechdolf. Because they fear the stigma of illness. Because they may not be able to cope with the side effects of neuroleptics that can lead to a loss of libido. And too much overweight.

Marie Werren is coming copes well with her medication. She also did not stop her outpatient therapy after her time in the clinic. Nevertheless, her illness came back: Marie Werren became increasingly entangled in the depression-like so-called negative symptoms of her schizophrenia, so that at some point she hardly left her apartment. “I was listless, didn't feel like doing anything,” she says. She could not sleep at night and was tormented by anxiety. "Every time the floorboards creaked, I thought there was someone in the apartment." Got paranoid, locked the door several times, would have liked to push the shoe cabinet in front of it. For safety. "But that struck me as too bizarre," she says and laughs. “I knew I was just imagining it. But still this fear was there and real. "

At some point it became too much for her. She admitted herself to the clinic, to the "Fritz". Here are mainly young people who have had similar experiences. With whom she can exchange ideas without fear of stigmatization. With which she learns in group therapy to deal with her illness, to control the hallucinated voices, to distract herself, to create a positive self-image. But they also just play basketball with. Or sit, chat and smoke on the banks of the Landwehr Canal on warm summer evenings.

“They also make us real experts for our disease here,” says Marie Werren with a grin. One of the reasons for this psychoeducation: only those who know their illness can seek help at an early stage - before the crisis, the schizophrenic episode, is complete. In general, the following applies: Around a third of those affected show permanent symptoms of the disease, a further third do not experience any more after their first schizophrenic episode. And then there is a third who experience schizophrenic episodes again and again, but always recover well from them and lead a self-determined and "normal" life. That is where Marie Werren is on her way, it seems on this oppressively hot August day. Around three years after the disease threw her life out of joint. * Name changed

You can read more about this in the magazine for medicine and health in Berlin "Tagesspiegel Gesund".

Further topics of the edition:Fact check. Exciting information about mind and soul; You have a tit. When is the psyche really sick ?; Brain research. What neuroscience can and cannot do; Psychosomatic. Body and mind are an inseparable unit; The path to healing. Outpatient, inpatient, rehab? The navigator shows the treatment path; Help in life crisis. Berlin addresses for emergencies. Medication. Effects, benefits and risks of psychotropic drugs; DEPRESSIONS: Get out of the bladder. The way back to life can succeed; Still live well! A victim reports from her everyday life; Winter depression. How artificial light helps against seasonal mood lows; BURNOUT: Illness with chic? Why burnout is just a fad for some; Shut down. A ski jumping legend talks about sport and illness; Burned out. A comedian tells about the dark side of success; ADDICTION: Life without drugs.Weaning is hard work; Children of addicts. A picture book deals with the effects of alcohol addiction on the family; Drug. What drugs are there and how they work; SCHIZOPHRENIA: family affair. Author Janine Berg-Peer on life with a schizophrenic daughter; MENTAL DISORDERS: Live fearlessly. A sick fear is curable; Doctor's letter. How obsessive-compulsive disorder is treated; Eating disorder. When enjoyment is lost; SLEEP DISORDERS: Self-experiment. Slumbering in the laboratory; Dream research. What our nightly head cinema reveals; SERVICE: A comparison of clinics and doctors; Column. Helmut Schümann advises you to take your psyche seriously

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