Distinguishing delusion from reality

At age 8, Adam Williamson began experiencing the visual and auditory hallucinations of schizophrenia.Now he wants to promote others getting earlier interventions to aid in their recovery.

Playing video games is one of the “coping skills” Adam Williamson, 32, uses to subdue the visual and auditory hallucinations he has experienced since childhood.

WARNING: This story contains material that may be upsetting to some readers. Please exercise good judgment and self-care in choosing whether to read it. If you or a loved one need help, call the Suicide Prevention Lifeline at 800-273-8255 or text Crisis Text Line at 741741.

Adam Williamson remembers very little of his childhood. And why would he want to?

For as far back as his memory reaches, Williamson has experienced constant and horrific visual and auditory hallucinations. The visuals, filled with violence and blood and death, are like “seeing a horror movie over and over and you just can’t shut off the video.” The voices repeatedly tell him to harm or kill himself.

“My childhood was dark, it was hard because it was when my illness started to appear,” says Williamson, now 32, who lives with his mother and stepfather in Port St. Lucie, Florida. “My hallucinations began before I even realized what hallucinations were. I’ve blocked out a lot because it was really traumatic.”

In elementary school, a teacher, alarmed by the violent pictures Williamson began drawing in class, contacted his mother, a doctor of audiology, to see if he was being exposed to inappropriate television or movies at home.  She assured the teacher he had not. But disturbing drawings soon gave way to more extreme behaviors.

Williamson would tantrum and scream, try to attack his sister or cut himself. He would put his hands around his own throat and squeeze as tightly as he could, trying to strangle himself. In 1997, at the age of 8, he attempted to hang himself in the principal’s office at school, which precipitated the first of what would be many hospitalizations to come.

Despite his tender age, doctors put him on powerful anti-psychotic medications – which he received by injection since he refused pills, fearing he was being poisoned – and  diagnosed him as having bipolar disorder.

But Williamson believes the diagnosis of paranoid schizophrenia he received more than a decade later is the more accurate one. The first time he read a list of schizophrenic symptoms “everything clicked for me.”

“I saw a lot of things that coincided with what I was experiencing,” he said. “I was dealing with hallucinations, not ups and downs. I was very likely misdiagnosed for years. I think they didn’t want to label me with schizophrenia at such a young age because it’s such a heavy diagnosis.”

The medications tamed, but didn’t eliminate, his symptoms. He returned to school. His mother divorced and remarried a man who was more understanding of Williamson’s illness than his biological father had been, but who also served as the enforcer in making sure he stayed on his medication.

At age 13 – catalyzed, Williamson believes, by puberty and hormones – the intensity of his hallucinations increased, though thankfully, the thoughts of taking his own life did not. He remained in a mainstream classroom and, with considerable effort, was eventually able to graduate from high school. But there were not many bright spots along the way.

“It was hard and I hurt a lot of people and did a lot of inappropriate things because of my illness,” he says. “I had a lot of negative symptoms and as for boundaries…well, I just didn’t have them. I called friends too much, too often. Any friends my age I did have, I lost. It took a long while to learn how not to do that.”

After graduating, he started classes at the local community college, but the strain of a full load of classes put him back in the hospital again. After cycling through “almost every anti-psychotic [drug] on the market,” he was eventually given Clozapine, often referred to as a “last resort” medication -- not so much because it represents the final hope, but because it is federally mandated that anyone taking it receive at least monthly blood testing to monitor a rare but potentially fatal blood disorder that can develop. While all of the anti-psychotics he’s taken have helped to some degree, none has been as effective as this one, which he continues to take today.

He returned to school, this time reducing his course load after realizing it was “all my brain could handle.” In conversation, Williamson sometimes has to stop and ask the speaker to repeat a question.  He says that’s because at the same time that his brain is trying to take in what is being asked, he also trying to ignore a constant alternative soundtrack that’s vying for his attention at the same time.

“Even on medication, the audio and visuals are playing through my head constantly,” he says. “Except for when I’m sleeping, I’m never free of my hallucinations. So when I ask you to repeat a question, it’s because I’ve been distracted by my symptoms. It takes practice to ignore them, as I’m doing now, but when you have no choice, you have to deal with it.”

The academic pressures, he says, were not as difficult as the social strain. The stress and angst of entering a classroom of unfamiliar students and trying to study together with them ultimately prevented him from finishing his degree, though he did earn two certifications.

Over the past half dozen years, he’s developed and ingrained behavioral techniques that help him manage the delusions and distractions. Exercise is as much a ritual as the taking of his daily meds – he tries to run three to five days a week – not only because it calms his mind, but also because it combats the weight gain anti-psychotic medications tend to provoke.  Other “coping skills” he relies on are playing video games, painting, reading (he’s currently deep into E. Fuller Torrey’s “Surviving Schizophrenia,” considered the “bible” for the illness) and playing his guitar.

“You have to use your right hand for strumming and your left hand for finger placement and then you have to think about how to bind those together with the words,” he says. “It takes a lot out of your brain so there’s less room for the symptoms.”

Because he is unable to drive and lives frugally on a small Social Security stipend,  he continues to live at home with his mother and stepfather. Giving up his independence has been a disappointment, but his mother’s support – now, as always -- has been “immeasurable.”

“When I was younger, she’d stay up with me at night when I was actively hallucinating and couldn’t sleep,” he says. “Now, she’s more of a moral support. She’s like my second therapist. I’m able to tell her stuff, run things by her, she asks what I am doing for myself when my symptoms get bad.”

He attributes his recovery to three things – “Mom, medicine and me.” But there is one other factor, equally important. In 2017, at his mother’s urging, he reluctantly attended a peer support group offered by the local National Alliance on Mental Illness (NAMI) chapter in his area.

He didn’t see the point. As far as he could tell, he didn’t need help and was doing fine. But the peer recovery specialist leading the group encouraged him to keep attending regardless, saying even if he felt it wasn’t necessary personally, his presence might help others.

“I didn’t see it as an avenue for friends back then, but I do now,” Williamson says. “More important, it gave me a purpose. It’s actually one of the reasons I don’t act on my symptoms. I really want to help a lot people so they don’t have to experience what I did. I know now I have too much work to do to kill myself.”

His goal, which he admits is ambitious, is to reach, educate and help people with serious illness before their mental state deteriorates. By way of example, he cites the case of Nicholas Cruz, the young man involved in the mass school shooting in Parkland, Florida.

“I want to prevent what Nicholas Cruz experienced, what other people who act on their symptoms experience,” he says. “My symptoms are very similar but I’m not going to act on them because I know they’re not real. People that young, experiencing hallucinations for the first time, they don’t know what’s real and what’s not and they act on it, and then they have to spend the rest of their life in prison.”

He admits he doesn’t yet know “how I’m going to do that.” But one thing he has been discussing in his support group, which he now co-facilitates, is to create a mandatory class in high schools to educate students on mental illness “just like any other illness.” He also believes there should be “more emphasis on mental illness than on gun control” and is working toward certification as a peer specialist to be able to share what he has benefited from with others in recovery.

“I want to help people before they get involved in the system and have no choice,” he says. “I know if I didn’t get the intervention I had when I did, I’d be a lot worse.”

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