This is for the medically informed folks out there as well as the trusty medical commentator on this site. Does anyone know if it is normal for schizophrenia to onset so quickly like that? Like the wife said, "he was just depressed..." Well, he went from being moody and depressed to having a headache to being paranoid to stabbing two people and running naked around the streets of Chicago. Just wondering if that is the way it happens...

Loved this episode! Have much enjoyed reading everyone else's comments...

-- Terri (tduggan@c-b-e.org), February 18, 2000

Answers

I was wondering as well about the mental illness. Someone else on the discussion board had previously stated that they thought that he had "DID" instead of schizophrenia. What is DID?

-- Laura (alulak@earthlink.net), February 18, 2000.

Ok, Terri... here's my take on the situation... and I am certainly no expert, but I did work in a locked psychiatric facility for a few years, and a bunch of my close relatives are psychiatrists, so I've gotten a decent second hand education about this stuff... Psychotic breaks can be very sudden... and if he was delusional, paranoid, hallucinating and petrified, it doesn't seem implausible that he would act out the way that he did... it is worthy to note that he lashed out at the two people who had preiously physically restrained during the spinal tap episode, which, according to my friend the doctor, was done in a manner that would have been (needlessly) painful for Paul... Anyway, I think something that frightening could set off a dramatic manifestation of a disease that is, essentially, a time bomb. Also, as to the suddenness... I'm not sure it was so sudden. Mentally ill people have moments of lucidity... and if he was hearing voices or whatever, he may have retained enough mental health to sort of keep the unraveling of his grasp to reality to himself for the past few months or so... and in the previous episode, the lawstudent/ college student friend alluded to strange behavior, and a withdrawing from social contact... to be that weird with someone who he had known for so long is a big tip off ... this seems to be consistent behavior for someone who thinks they are losing their mind, a person who is having trouble differentiating between reality and delusion... and finally, the wife's reaction... never under estimate the power of denial. Plus, her commenting on his depression, and the fact that he spends time on the roof (who feels SAFE on a roof? Yikes! Doesn't anyone else have acrophobia) indicated to me that she may have known there was trouble brewing... so, all in all, I think the whole thing could have happened. But who cares about realism -- what phenomenal television drama! I have no idea what DOD (is that someone else's armchair diagnosis?) is...

-- L (lolabronx@hotmail.com), February 18, 2000.

Paul said he stabbed Carter and Lucy because they wanted his organs! (This during the psych consult.) There seemed to be lots of signs.

-- (Sgustafson@home.com), February 18, 2000.

I have a background in psychology and "DID" stands for Dissociative Identity Disorder, better known in popular culture as Multiple Personality Disorder. I'm not really sure why someone would think Paul suffered from this because he showed fairly classic signs of paranoid schizophrenia. Someone wondered if this was the usual course of behavior. Well, does every person in their early 20's who presents with a sudden psychotic break that leads to schizphrenia go out and kill others? No, it really does not happen that way. Not to say that this has not happened before, but we are talking armchair psychology in an ER episode. I can say that this is not out of the realm of possibilities though. There are 2 criteria that must be present for at least a month to be diagnosed with p. schizo and he definitely showed them. He was delusional and had disorganized speech at times. Honestly, if the delusions are really bizarre (and his were) then you can be diagnosed with only that one symptom. It's a bit more involved than that, but this was the "30-second" diagnosis. :)

-- Monika (monika@medmail.com), February 18, 2000.

Remember too that his friend from law school said he'd been acting strange for a while. He'd known his since being undergrads so knew his normal personality. And they were meeting at a coffee shop or somewhere instead of the library because Paul wouldn't meet at the library anymore because he was afraid of something there. I thought his wife just seemed like someone in denial, who didn't want to recognize that her husband might be experiencing anything more than depression. I thought it was probably the first time she'd officially recognized that. Mental illness still carries a stigma even in the year 2000.

-- Diana (DILYNNE@MINDSPRING.COM), February 29, 2000.