☁️ . . . ⇢ ˗ˏˋ [CREEPYPASTA PORTRAITS] ࿐ྂ
𒆨 PART TWO : Schizoaffective disorder
Warning : Canonically Toby is said to be bipolar and schizophrenic. However I did not find any article nor testimony certifying that a human being could cumulate those two disorders at once. It is entirely a choice of mine to merge his two disorders into SAD as it seemed more fitting but also easier to write. Similarly, SAD is a psychiatric disorder that is actively researched on and sparks controversies and divergent opinions among the scientific community. I advise that you do your own research if the subject interests you.
➢ BASIC DESCRIPTION & SYMPTOMS
SAD is a mental health disorder sharing schizophrenia and mood disorder symptoms. The disease is divided into two subclasses : bipolar type (episodes of hypomania or mania followed by major depression) and depressive type with only major depression episodes. Patients switch from mood disorder episodes to psychotic ones (lasting at least two weeks, the important part is that the episodes are characterized by their length). A patient will have some symptoms of the five subclasses : positive symptoms, negative symptoms, symptoms of mania and depression, other types. Among the symptoms below, a diagnosed schizoaffective may have some from several categories but never all of them. The recurrence of symptoms significantly varies from one patient to another. The disorder is life-long and severely impacts the life and functioning of an individual in society, however the symptoms tend to improve over time as their severity decreases or they may even vanish completely. The disease can only be diagnosed with a clinical interview, no other test can show traces of SAD. SAD appears most of the time during late teenagehood to early adulthood, signs include social dysfunctioning for at least 6 months.
Presence of thoughts, perceptions, behaviors that are not normally present within healthy people. Positive symptoms vary over time in frequency, severity or may disappear completely before reappearing.
╰► Delusions : to believe into something that is not real even if proven otherwise. The belief is not shared nor perceived by anyone else, and commonly includes a fear of getting hurt or controlled. The sick brain believes it so strongly that the sick person cannot usually be talked out of it.
╰► Hallucinations : false perceptions, the individual’s main senses (sight, hearing, smell, touch) are being falsed and perceiving realities that are accessible only to the sick person.
╰► Disorganized thinking and speech : the individual experiences issues to communicate even if they have the impression that everything is perfectly clear for them. This may include a chaotic way of thinking or speaking that may be difficult for others to follow or understand, created words, words spoken in a bizarre order…
Absence of thoughts, perceptions, behaviors normally present within healthy people. The symptoms are persistent over time, but with effort and proper environment they may be significantly improved.
╰► Blunted affect : a reduced or absent reaction to events or social interactions. The person continues to normally experience feelings and emotions but fails at expressing them.
╰► Apathy : lack of motivation, emotion or interest about an activity or a matter that a person once liked. Independently from the person’s will or interests, everything may feel dull and uninteresting.
╰► Anhedonia : decrease or absence of pleasure during any enjoyable activity. This may include hobby, physical or emotional interactions. People with anhedonia may withdraw or show no reaction when interacting with loved ones because of the lack of pleasure resulting from it.
╰► Inattention : hard time focusing at work or school or in social situations. Depending on individuals the attention span might range from fleeting to absent.
╰► Alogia : also called poverty of speech, the person faces severe difficulties in formulating complex sentences. In most severe cases the person may be unable to talk at all.
╰► Avolition/Loss of volition : not to be confused with apathy, a loss of volition designates the generalized inability to pursue one’s goal or activity. The person becomes unable, despite themselves, to accomplish even the simplest tasks.
Depending on the period of life, the patient may experience phases of mania, long episodes in which their emotions are higher and more intense than usual. Sometimes the episodes occur in a lesser intensity, so called hypomania.
╰► Euphoria or exaggerated mood : it is common for patients to experience intense joy or pleasure about everything. Even if positive the emotion might lead to unpredictable behavior and outbursts of energy as everything may feel too much to handle through common ways.
╰► Irritability : to the contrary a nothing may spark anger or extreme irritation like a tiny flame would create a huge explosion. The manic person is like a whistling kettle under high pressure, participating even more in unpredictable behavior.
╰► Abnormally high self-esteem : the way the patient perceives themselves is artificially inflated, causing a feeling of superiority or false impression of power. The most illustrative example is the God complex where one is persuaded they are superior to other beings and nearly untouchable, unstoppable.
╰► Decreased need for sleep : as they grew more restless, the individual sleeps less. The increase of energy alters their sleep schedule and disrupts its balance.
╰► Behaviors seen as “out of character” : extreme talkativeness, obsession to pursue one’s goals, racing thoughts making communication or formulating ideas more difficult, volatile attention, excessive involvement in pleasurable activities without caution regarding the involved risks like having unprotected carnal activities or substance abuse. Everything becomes quicker, more intense, almost too much to handle.
╰► Depressed mood : having and constant and nagging feeling of melancholia and emptiness, as well as a generalized loss of interest. The person may feel low on all points, and feel unable to do anything they usually accomplish.
╰► Change in appetite and weight : because of depression it is common to fall into hypophagia or hyperphagia, with the person either depriving themselves of food or drowning themselves in it, causing related consequences on the weight.
╰► Change in sleep pattern : as they feel restless or exhausted, the individual may sleep way more or less than usual. It can cause hypersomnia or insomnia depending on cases.
╰► Brutal changes in activity levels : similar to sleep pattern, a person can be overwhelmed in energy or exhaustion. They can become inactive or extremely active.
╰► Fatigue : the weight of depression can sometimes be too much to carry and create emotional fatigue making the ill person unable to navigate their everyday life.
╰► Feelings of being worthless, hopeless, or helpless : depression often correlates with low self-esteem as one may doubt their worth as an individual or functioning member of society, wishing for their current situation to end in oblivion or being persuaded that there is not way out of their misery.
╰► Reoccurring and invasive guilt : the individual may be invaded by a heavy guilt following every aspect of their life. Whether it is actions they had done, things they had said, or even events they don’t have any control over, guilt comes to torment them.
╰► Recurring thoughts about death : it may take the form of an obsession about death or invasive visions of one’s death, whether it’s a loved one’s or their own. It can lead to suicidal ideation.
╰► Focusing issues and decreased ability to make decisions : it becomes nearly impossible to focus and every decision, even minor ones, feels like a burden impossible to overcome.
Other symptoms that may indicate a schizoaffective disorder may include enhanced destructive habits. Depending on the symptoms plaguing a patient’s mind they may be influenced into diverse substance abuse (drugs, alcohol…), or drastically change their relationship with the community. One may cut themselves from all social contact and seek it at all costs.
➢ WHAT ARE THE CAUSES OF SCHIZOAFFECTIVE DISORDER ?
The exact causes of SAD are not known, however some theories have been established whether to explain the presence of the disorder or highlight potential risk factors.
╰► Genetics : like many mental disorders, genetics play a role as having a family member already afflicted increases the chances of developing it later in life.
╰► Stress : tough events of life such as loss of a loved one, an accident or a trauma may trigger the disease.
╰► Use of recreational substances : the use of substances increases the risk of developing or worsening symptoms. Whether it’s hallucinogens or stimulants, their use in already vulnerable individuals have a catastrophic impact on already existing symptoms. In some cases, a bad experience can even trigger the dormant disease.
➢ TREATMENTS AND LIFE ACCOMODATIONS
╰► Use of medication : to improve the sick person’s life, medication can be used to lessen the severity and occurrence of the symptoms. To note that medication does not cure the disease in itself, but can significantly improve the quality of life. Seen it as a crutch, as it is not a solution in itself but more a tool to help living with a disabling condition. Medication can take the shape of antipsychotics for the schizophrenia-related symptoms, antidepressants to help with depressive episodes and mood stabilizers for mania.
╰► Psychotherapy : along with carefully gauged medication, the sick person can be accompanied and seek professional therapy. This may help with developing healthy habits or expressing feelings in a controlled and safe environment. It can take the shape of social skills training in young patients to help them get accommodated to social cues, family therapy to prepare the loved ones to manage the disease and support the sick person, and individual supportive counseling that focuses on personal life situations. Despite being a slow and tough way to treat the disease, it is the most efficient way to alleviate the caused suffering as it treats the problem to the root and gives the patient powerful tools to manage the disease in their everyday life.
“Schizoaffective disorder” (Mayo Clinic)
“Schizoaffective disorder” (National Alliance on Mental Illness)
“The diagnostic concept of schizophrenia : its history, evolution and future prospect”, subsection “Positive-negative schizophrenia (“Type I” and “Type II”)” (National Library of Medicine)
“Facts about schizoaffective disorder”, handout (Mental Illness Research, Education and Clinical Centers)
➢ HOW DOES TOBY LIVES WITH SAD
╰► Toby is an unfortunate one as he was afflicted early with schizoaffective disorder, as he was diagnosed in 5th grade, so when he was 10 years old. At the time he was already facing severe bullying by his peers because of his erratic behaviour and his bizarre fears regarding weird insects. At this point he had already switched schools twice. What motivated his diagnosis was his teacher wondering why the new student did not have a single friend halfway through the school year. At this point Toby also had been brought to the principal’s office multiple times for aggressive behavior and self-harm as he often fought tooth and nail with his classmates or burned his own skin with stolen lighter and matches to “kill the Shadow Spiders”. With a few parent-teacher meetings, a medical appointment with a specialist was scheduled, and a proper diagnosis was given.
╰► Following that event, Toby was declared unfitting for the school system and was taken out of the public school for homeschooling instead. That didn’t mean he was well taken care of unfortunately. It is the same period his father lost himself in substance addiction and gambling, and Toby’s gradually worsening mental health was the cherry on top. His health became annoying, a matter that shouldn’t be spoken about. Toby was not going out of the house a lot, and missed a lot of medical appointments with his psychiatrist. The only thing that was correctly handled was the medication he was taking as at least it had the merit to “keep him under a leash” according to his father. Toby experienced a lot of unwanted side effects from the different medications he tested until his family found the one fitting, but it didn’t matter if he suffered. As long as he stayed quiet his suffering did not matter.
╰► His car accident at 17 as for the weight of the guilt and grief surrounding his sister’s death worsened his symptoms to the unbearable. During this challenging period of life that lasted a few months, Toby suffered from a heavy depressive episode and spiraled into self-hatred to the point of wishing to have died instead of his sister. The night Lyra died, Toby chewed on his cheek so hard he caused the mouth scar that disfigured the left side of his face by exposing gums and teeth. He wished so hard to trade his life with hers, by eating his own flesh and making himself bleed it felt like a blood tribute. He sincerely wished to experience some kind of pain, this strange sensation he had never felt but heard only negative things about, just to relieve the guilt. Anything to pay for his fault. Anything for Lyra to forgive him.
╰► Later on in life, Toby discovered the existence of an artist called Karen May Sorensen while browsing the Internet. He read her blogs, admired her art pieces, and found a strange sense of recognition. The painter’s work felt familiar, reassuring and beautiful. She is the icon that influenced him into pursuing art to express his feelings, even more since they both suffered from the same condition. He feeds some admiration mixed with affection for the strange world of Karen May Sorensen, and found a lot of comfort in it during dark days.
╰► Tim Wright, also known under the pseudonym “Masky” was the first one to take his reality seriously. Toby took a lot of time to trust Tim, but ultimately understood that they were alike… Or at least partially alike, with their heavy psychiatric past. Tim helped him understand, and showed patience and understanding. He did not deny what he was feeling, but sought to understand and help him go through it. It was the starting point of their mentor-student relationship, and later in their proxy life adoptive father-son. Toby finally found relief as someone could relate to what he was feeling, and his world became clearer.
╰► Toby is afflicted with the Bipolar Type SAD, and mostly shows symptoms of Type 1 schizophrenia even if he exhibits a few negative symptoms. His delicate situation makes therapy unavailable, but he is under medication to help with the complicated sides of his disease. He takes antipsychotics to lower the frequency of delusions and hallucinations (Author note : not SAD related, I’ll do a separate post on Slender Disease), sertraline (Zoloft) to help with his depressive episodes and lithium for his manic episodes. Even if the medication does not make his symptoms disappear, they do make the symptoms manageable. He takes one dose of antipsychotics everyday as hallucinations and delusions never truly go away. Lithium and sertraline are only used during his manic and depressive episodes, as soon as they’re triggered he takes the medication to go through the crisis smoothly.
╰► Psychotic symptoms are the ones he encounters the most regularly. Toby often experiences delusions, his lack of hallucinations makes them feel even more real. He experiences somatic delusions (feeling something wrong about one’s own body), bizarre delusions (believing into something that can’t happen), mood-congruent delusions (delirium influenced by mood disorders like depression or mania). During a crisis, the following delusions may appear :
➥ Eight-legged parasites : the feeling of insects crawling on his skin. He calls them “Shadow Spiders” and usually pictures them with a thin body and extremely long legs. He believes they appear in the dark and search for any open wound to crawl under his skin and eat his flesh.
➥ Worthless and pitiful : when he is depressed, Toby easily believes that his loved ones will abandon him or mock him for his mental disabilities. That makes him prone to aggressive behavior and social withdrawal as, depending on his logic, if people are not going to stay there’s no reason for him to make any effort. During these moments he rejects social contact while being deathly afraid of being left alone.
➥ What did I do wrong ? : often paired with the lingering impression that he’ll be inevitably left behind, during bad moments Toby is questioning everything he had done during the day, persuaded that every action or word he says causes awful consequences. It worsens the impression of being worthless, and participates in his social withdrawal and destructive habits like relapsing in self-harm.
➥ Burning flesh : triggered by high stress or extreme anger, Toby may fall into the delusion that he is burning from the inside. With his CIPA, he believes that this fire does not hurt him but pushes him towards violence and that the only way to appease the fire is either neutralizing the source of his anger, or setting things on fire as it “free him” from his inner blaze.
╰► Other recurring positive symptom is “bizarre behavior” that manifests under the shape of disorganized thinking and speech. It happens randomly, can sometimes be influenced by stress or strong emotions, sometimes not.
╰► Exceptionnally, Toby can show negative symptoms. Among them there is alogia, apathy and avolition. Those manifest only in case of extremely triggering situations like a huge amount of stress or an unfortunate life event. Or at least this is the similarities he found between the episodes. He loses all will to talk, do anything and nothing can affect him. That state is temporary and quite rare to witness, but exhausting in its brutal appearance and how much it overwhelms everything else.
╰► During depressive episodes, Toby becomes is haunted by a near-constant depressed mood and feeling of emptiness, and this feeling is so unbearable to him that he doesn’t stop moving a single second. Movement and quickly switching from one activity to another makes the feeling more bearable. Depression plagues his mind so much that he becomes unable to focus on anything else, making it extremely hard to push away the haunting thought that he is worth nothing. Sometimes he even feels that he’ll never heal from his traumas or get out of his problems unharmed, making him fall into inaction and isolation. His depressive episodes are triggered by rejection, severe conflicts with the other Creepypastas or proxies and failure in his usual tasks as a proxy.
╰► When Toby falls into mania, he experiences an overwhelming euphoria that turns him into an even more upbeat and erratic individual than he already is, basically acting like he is under imaginary stimulants. He’s always full of energy and lives intensely, as well as never stops talking. Basically a pygmy shrew under cocaine mixed with a whirlwind during a tempest. To the contrary he becomes unusually snappy and may lash out at anyone without fully understanding why. During these moments he becomes very insulting, sarcastic, sometimes physically violent. Erratic behavior is also related to obsessions that the proxy develops, either on a hobby he particularly likes or a goal he set before or during the crisis, and will live every minute to accomplish them without giving his mind or body a break. Mania worsens his tics. Manic episodes are triggered by high levels of stress, like a very complicated mission to handle or an unexpected turn of events.
╰► Despite having increased risks for substance abuse with his disorder, he is repulsed by them because of his parents'addiction. The sight of drugs disgusts him, he hates with a passion the smell of cigarettes and weed. He can barely tolerate alcohol, and sometimes consumes a few bottles here and there, but it quickly feels too much before he’s even tipsy.
To live with his disorder, Toby established regular practices to monitor and control his symptoms, many were helped by Tim/Masky and Brian/Hoodie as they acted as older mentor figures for him. He doesn’t stick perfectly to those habits, but he recognizes how relieving they are.
╰► Regarding his delusions, the most regular practices fight the Shadow Spiders. Toby only lets those he cares the most about and trusts with his heart take care of them. When they’re available, Nurse Ann or Eyeless Jack search for any open wound, even minor ones, to avoid the Shadow Spiders crawling in. If he’s alone, Toby wraps himself in tight bandages to protect himself. When he’s not out on a mission, Tim helps a lot as well. During a crisis of delirium he is one of the only people that can touch Toby without him snapping. When Toby feels intensely the Shadow Spiders crawling on his skin and trying to eat his flesh, Tim usually holds his sleeves to avoid them from entering but also sometimes runs a lukewarm bath for Toby. The logic is simple : since water doesn’t have “normal shadows” since there're no elements that the light can bounce on, Shadow Spiders are trapped. From that point Tim persuaded Toby that staying ten minutes in the water was enough to drown them, or expelled those present under his flesh as blood from the wounds poured in the water. In order to avoid the eight-legged parasites coming taunting him at night, Toby sleeps with LED lights above his bed.
╰► His pyromaniac tendencies are explained by his delusion of burning from the inside out. Regularly setting things on fire helps with taming the blaze within him and avoid it becoming a devouring forest fire. He keeps a silver lighter in his pockets at all times, and plays with it when he feels uneasy. He burns little pieces of paper, of wood, fabric or cardboard.
╰► Another way he found to cope with his disease is throwing himself body and soul into the hobbies he enjoys. For example he often volunteers to go cut wood or hunt, as those activities unplug his brain. During those moments he rekindles with himself, sometimes the friend accompanying him, and that temporary peace is enough to quiet down the static. When things feel too much, walking into nature makes him forget his daily burden for a moment.
╰► Among the most important hobbies helping him express his feelings is art. Toby draws and paints a lot in notebooks he keeps hidden in his bedroom, as he is afraid the others might find them and mock him. The drawings are often disturbing as he portrays his delusions, fears and deepest insecurities. Though his art is strange, abstract and far from being the best on a technical point, towards it he feels relieved and proud of himself. Because he actually did something, he created instead of hurting himself. He started his journey in art at the age of 17, first with tiny scribbles done on torn pieces of paper.
Author's note : Phew, I finally finished this one xd I'm particularly proud of this one, I hope you liked it : )
The next ones are coming to be shorter but also more digest as I'll be talking about Tourette Syndrome and the Slender Disease.
