Carla's early development seemed completely normal, at least to outsiders. There was something a little withdrawn about her demeanor, but she was bright-- unusually bright. She was ready to take the final step in a master's degree program in biology, a slim, attractive, and talented young woman with a promising life ahead of her.

Graduate school was, however, stressful. And there were background factors that placed Carla at risk; an aunt and an uncle had been diagnosed with chronic schizophrenia, and Carla's own family background was chaotic. Her parents were divorced, and Carla had seldom seen her alcoholic father after the separation when she was 7 years old. Perhaps a combination of genetic factors, early environment, and the stress of graduate school combined to be too much for her; she gradually stopped attending classes, failed to meet with her adviser, and disappeared from view.

Her private life presented a more dramatic picture. She withdrew from her friends, although she continued to see her boyfriend. She experienced bizarre delusions, including a belief that if she did not continue to concentrate on the events on TV they would cease to exist. This generalized to the belief that the world depended on her thinking about it to hold it together, a responsibility that she found terribly upsetting. Fortunately for her, when Carla became actively delirious and experienced hallucinations, her boy friend, who stuck by her, was able to get her to the emergency room.

During her hospitalization, Carla was immediately placed on a regime of antipsychotic medication. The bizarre symptoms disappeared in much less time than it had taken them to appear, and Carla was able to resume a nearly normal life. She enrolled in her graduate program again, but never made much progress. Soon she dropped out again and took on secretarial work that she could complete at home. From time to time, she stopped taking her medication; each time, her symptoms reappeared. Through all of this, her boyfriend stuck with her, and at last report they were considering marriage. Her boy friend's devotion continued even after Carla had experienced one of the frequent side effects of taking antipsychotic medication, significant weight gain. She had shifted from being slim to being noticeably obese. However, she was fortunate after 6 years of medication in that she showed no signs of tardive dyskinesia or of intellectual decline. She showed good insight into her condition and, after many misadventures, seemed to recognize the need to continue her medication. There appears to be no immediate prospect that she can function normally without it.    

Several aspects of this case merit attention:

	Even though Carla experienced a chaotic family life, many people who develop schizophrenia come from wonderful, supportive, loving families.
	The present case suggests that a great many stressors may have precipitated the development of symptoms, but in other cases the symptoms develop even in the absence of noticeable stressors, and the mere presence of stressors will not result in schizophrenia.
	Carla was unable to continue her course of study and her life as she planned it.  This is the case in many people with schizophrenia.  However, there are many individuals with schizophrenia who live rewarding, fulfilling lives, have professional careers, and are able to lead the life they dreamed of.  There is a great deal of variability among people with schizophrenia.

                                                                                                                                Last updated  12/19/03