Why are schizophrenia symptoms worse at night

Schizophrenia: A patient tells her story - back on the way

Marie Werren (name changed) was just about to grow up and learn a trade when an illness threw her off course: schizophrenia. How she found her orientation again after psychosis, madness and a loss of reality

Marie Werren (name changed) 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. 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 24-year-old 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 rearrange her life, to find her way again. So she spent a lot of time in this hospital. In the clinic for psychiatry, psychotherapy and psychosomatics. And also in the adjoining early intervention and therapy center especially for adolescents and young adults with psychological crises, the "Fritz". Marie Werren had just such a crisis back then, even if she didn't feel that way at first. “I was pretty lonely at the time,” she says. “I hardly had any social contacts. But I had the voice. We talked a lot and had a really good time. "

The voice takes over

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 burdens her, makes her uncomfortable. Only this much: “I was pretty euphoric, pretty wild.” The old colleagues felt quite disturbed by her, maybe even threatened. They called the police. And Marie Werren was admitted to the closed department of psychiatry at Urban Hospital - against her will, but with a court order.

The diagnosis: schizophrenia. She was probably predisposed to this mental illness. The fact that she actually broke ground, showed herself in states of anxiety, hallucinations and delusions - in short: an acute psychosis or even schizophrenic episode - is probably due to Marie Werren's way of life at the time: "I celebrated a lot at electro parties back then" says the petite young woman with curly dark hair. “And also took drugs.” Amphetamines such as speed, plus ecstasy and MDMA. Not much, as she says, even much less than the others around her - but still enough to trigger psychosis.

Although the symptoms of such a schizophrenic episode may appear unambiguous from the outside, at the beginning those affected often have difficulty recognizing their illness - and distinguishing what is real and what is not. That was also the case with Marie Werren: Long before the voice answered for the first time, the young woman was tormented by anxiety. She blamed it on false friends, whose acquaintance she had made in the alcoholic and increasingly drug-laden Berlin nightlife. “I had no idea where else it was supposed to come from,” she says today. As a result, she withdrew more and more back then, in her early 20s. And later made friends with that voice instead. “The conversations with her were completely normal for me,” says Marie Werren. They were part of her everyday life. To their reality, even if it was pathologically changed by schizophrenia.

Her first stay in the closed psychiatry did not change that. “I didn't feel sick,” says Marie Werren. On the contrary: she was convinced that a film was being made about her life. And the clinic was just another film set, and their treatment was another twist on the script. There is no trace of an insight into illness, as the experts call it.

Up and down in therapy

"If you had opened a door on the closed ward back then - I would have walked out and not come back," she says. But nobody opened a door. And over time, the drugs she was given, called neuroleptics, began to work. Just like the therapeutic sessions, the one-on-one and group discussions, in which she learned more about her illness - and how to deal with it. She was getting better. But she never really felt at home there in the psychiatric department: The other patients were all much older than her, also mainly because of illnesses such as depression there. “I couldn't do anything with them and neither with me,” says Marie Werren. The fact that her schizophrenia was triggered by the consumption of chemical drugs would also have given her additional rejection and incomprehension. That's why she was happy when she was able to leave the closed ward after six weeks - and ignored the doctors' advice to go to another ward for further treatment. "I just didn't feel like it anymore, just wanted to get out." So she left. But after just a few days in the world “out there”, she changed her mind and returned to the clinic. Voluntary.

Her problems finding their way in everyday life had been too great, their fears and confusion too great. “I just felt that I couldn't go on living like this, that I had to do something,” says Marie Werren. Because after the complete overstimulation during the schizophrenic episode, her brain was overloaded, overworked and overwhelmed. It had to recover first, and just like herself, it needed rest and a safe environment with as little irritation as possible. No big city bustle. No parties. No challenging or stressful situations.

Marie Werren took the chance, took herself out of everyday life. She stayed in the psychiatric clinic for a full ten weeks, but this time in the open ward. Then she continued her therapy on an outpatient basis, in the institute outpatient clinic at the Urban Clinic.

It went well for a while, Marie Werren felt better. But then the disease came back. Slowly. Creeping. From behind. Not loud and clear with a new psychosis, but initially with the so-called negative symptoms, which are similar to depression. “I was listless, didn't feel like doing anything, was always tired,” says Marie Werren. It went so far that at some point she hardly ever left her apartment or bed. At some point, the psychotic madness knocked again: Marie Werren could no longer sleep at night, she was tormented by states of anxiety. "Every time the floorboards creaked, I thought there was someone in the apartment." A burglar, a murderer - she got into her thoughts, became paranoid. Locked the door several times, would have loved to push the shoe cabinet in front of it. For safety. “That seemed too bizarre to me,” says Marie Werren today, a few weeks later on this bright August day, and laughs. “I knew that I was just imagining it. But still this fear was there and real. "

Self-knowledge and reorientation

At some point it became too much for her. Her suitcase had been packed in the hallway for some time. “One morning the sun was shining in the apartment and I saw a lot of small dots on the window. I knew them from my first psychosis, back then I always called them elves. Then I knew: it was high time. ”She took her suitcase and admitted herself to the clinic, this time directly to the“ Fritz ”at Urban Hospital.

Probably just in time. "The doctors said I was lucky," says Marie Werren: Her psychosis was still in its early stages, the schizophrenic episode had not yet fully developed. "But it was enough for me, I definitely didn't want it to get worse - like with my first psychosis." She is therefore very happy about the so-called psychoeducation, which was part of her therapy from the beginning. “There they make us real experts on our disease,” she says and grins. "Only because of this I was able to recognize the symptoms relatively early and seek help."

A friend recommended her to “Fritz”. In contrast to “normal” psychiatric wards, there are mainly young people here who have had similar experiences. With whom she can exchange ideas without fear of stigmatization. With whom she learns in group therapy to deal with her illness, to control her hallucinated voices and to question: Is it true what I am hearing? And why do I hear it? But they also just play basketball with. Or sit, chat and smoke on the banks of the Landwehr Canal on warm summer evenings.

And moreover, piece by piece, the orientation is found again. Makes plans for the future. Developed new life perspectives. And thereby - despite illness, despite possibly recurring schizophrenic episodes - paves a way back to a "normal", self-determined life. That is exactly where Marie Werren is headed, it seems on this oppressively hot August day. Around three years after the disease upset her life, she reoriented herself - also professionally: Instead of selling people things, the young woman decided to help them. She wants to be trained as a so-called ex-in, a companion for people in psychological crises. The abbreviation Ex-In stands for the English Experienced Involvement, which means something like the participation of experienced people: The prerequisite for this work is to have gone through psychological crises yourself. Because sometimes only those who have lost it themselves can give orientation to others.

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