I have plenty of acquaintances, and a couple hundred ‘friends’ on Facebook. But real friends, mostly family, I can count on one hand. For me, making friends is like climbing a vertical rock wall with no ropes, requiring a degree of thrill-seeking, and a good deal of risk.

http://well.blogs.nytimes.com/2014/10/23/living-with-schizophrenia-coffee-and-friends/

(Because of firewall issues, this link may not work. The article follows.)

This short New York Times essay describes the burden of living with Schizophrenia. Though just over 1,000 words, I think it explains the challenges of severe, persistent mental illness better than whole books written on the topic.

His description of his illness is particularly moving:

Schizophrenia is the devil on your shoulder that keeps whispering in your ear and, no matter what you try, the little demon won’t stop. He hasn’t stopped in the almost nine years I’ve lived with the illness, and he’s not about to stop now. He’s just quieted down a bit. I’d call him my companion but that would imply a degree of friendship, and there’s no way in hell I’m the little devil’s friend.

I’m reminded of one of my patients who managed to continue college courses after his first episode of psychosis. During our sessions, he would spend much time talking about symptoms (the auditory hallucinations being the most bothersome). One day, I asked about his daily activities. It was summer and he wasn’t taking any classes, but he explained that he would go to the school and check his email account. Asked how many people write him, he responded that he only had one friend, and that this person only sent him an email or so a week.

Such stories also remind us of the attractiveness of the asylums of old. While terrible abuses occurred in some asylums, it should be recognized that many well-meaning people in mental health advocated for and worked at asylums not to keep patients away from society, but to keep society away from patients, allowing them “an idyllic environment that included fresh air and healthy work in the gardens,” in the words of Dr. Paul Garfinkel in his new autobiography.

Reading of the Week. Every week I pick a reading — often an article or a paper — from the world of Psychiatry.

Living With Schizophrenia: Coffee and Friends

By MICHAEL HEDRICK

OCTOBER 23, 2014 11:42 AM

Getty Images

I have a hard time making friends.

Getting to trust people well enough to call them a friend takes a lot of work. It’s especially hard when you are living with schizophrenia and think everyone is making fun of you.

Schizophrenia is the devil on your shoulder that keeps whispering in your ear and, no matter what you try, the little demon won’t stop. He hasn’t stopped in the almost nine years I’ve lived with the illness, and he’s not about to stop now. He’s just quieted down a bit. I’d call him my companion but that would imply a degree of friendship, and there’s no way in hell I’m the little devil’s friend.

Michael Hedrick

I have plenty of acquaintances, and a couple hundred “friends” on Facebook. But real friends, mostly family, I can count on one hand. For me, making friends is like climbing a vertical rock wall with no ropes, requiring a degree of thrill-seeking, and a good deal of risk. For someone to be my friend, they have to accept that I’m crazy, and even getting to the point of telling them that is daunting when all you hear is the devil’s whispering that they’re making snap judgments about you or will be going back to their real friends and laughing about you.

But interestingly, in my efforts to make friends, coffee shops have helped. The simple routine of going to get your fix of liquid energy every day provides a sort of breeding ground for community. You see these people every day,whether you like it or not and, over time, friendships form.

I used to live in a small town called Niwot, about five miles down the highway from Boulder, where I now live. Every morning around 6 I would go to Winot Coffee, the small independent coffee shop, and every morning, without fail, there was a guy my age sitting outside with his computer smoking clove cigarettes. Given the regularity of seeing him every morning, and given that we were some of the only 20-somethings in town, we got to talking.

He was something of an intellectual, heavily involved with the writings of Noam Chomsky, foreign policy, our dependency on oil and the non-GMO food movement. And eventually, through our morning chats, we became friends. I told him about my struggles with mental illness, and he told me about the history of the conflict in the Middle East. He seemed trustworthy, though I could never be sure,, and I never could shake the notion he was judging me as stupid, or simple.

I went over to his house for the first time one evening and found it piled floor to ceiling with strange books on metaphysics and Native American history. He lived in in a deep grove of trees and grew kale and marijuana in his backyard. We ate vegan pizza, and I met his girlfriend, who was 11 years older than him.

One morning at the coffee shop he came to me for advice. He said he was having a hard time with anxiety, that he wasn’t sure of anything anymore. We talked for several hours that morning, exploring the nuances of our anxiety. I shared with him my irrational fear that people were speculating about my virginity, and he told me about his overarching feeling that the world was collapsing in around him.

I think it was too much, because the next day at the coffee shop he wasn’t there, and I never saw him again.

Sometimes being too vulnerable can throw someone off. It was like we had stepped over a line where the friendship got too deep.

There are others, though, who have made it into my inner circle and stuck around. I’d be nothing without their ever-constant ear and their sometimes dark humor that can bring a smile to my face when I want nothing else but to curl up in bed.

I have one friend, Brianna, who has seen me at my worst. I met her a few years ago when I was sitting outside a coffee shop writing in a journal and she waved at me and came over and asked me what I was writing. I was skeptical at first, seeing her blue hair and the wild look in her eyes. I told her what I was writing was nothing, but then she started asking me questions, and before I knew it two hours had passed and she knew that I had been diagnosed schizophrenic after a trip to the U.N. where I thought I was a prophet and was trying to save the world.

It seemed like every time I went to that coffee shop she was there, and it was nice to have someone to sit with and to talk with. She and I are vastly different people. We don’t listen to the same music: she’s into early British punk, hardcore stuff, and I’m on the mellower side, preferring Dave Matthews or Blues Traveler. She’s a fervent anarchist and I’m, again, mellower, taking no sides but believing that everyone should treat each other kindly.

There are times when her quirkiness really gets on my nerves, like when she tells me her stories about magic and fairies, or getting drunk with bikers, and there’s just no way I can relate. She lived in a shack with her boyfriend without water and electricity in the Texas desert for several years and traveled the country selling coffee for an independent coffee shop.

She’s so caring, though, and describes herself as a demon wrangler, working with violent people in mental hospitals and prisons, talking them down from suicide and putting themselves in danger. Six years on, she’s done the same for me.

She’s stuck around despite my delusions that people are out to get me, and she’s asked me out for coffee during some pretty deep periods of depression. I wouldn’t be as nearly as stable as I am today without her. Somehow we get along.

I’m grateful to have her — and a few others, out of the thousands of people I’ve met. Because without them, there’s a good chance I’d still be out in the streets, thinking I was a prophet and talking about aliens and the coming apocalypse.

You only really need one or two good friends anyway.