It usually takes at least half a year of symptoms - a characteristic pattern of thoughts and behaviors, before psychiatrists will diagnose someone with the mental illness schizophrenia, and oftentimes the period of untreated psychosis lasts much longer. After the diagnosis has been made, the individual with schizophrenia and his or her family members can sometimes look back and describe the first symptoms that presented themselves as the individual became ill. These early or pre-illness symptoms are collectively called the prodrome.

The prodrome is the lead up to the development of the first psychotic episode of schizophrenia, and, unfortunately, it is so nonspecific that it cannot currently be used to accurately predict whether schizophrenia will ultimately develop. Looking back, family members most often report having observed changes in personality such as their relative becoming social isolated and withdrawn. Deterioration of functioning at work or school is often reported, as are attenuated schizophrenic symptoms such as hearing the wind talk to oneself (attenuated auditory hallucinations) or increased suspiciousness of others (attenuated paranoid delusions).

As I prepare today for an upcoming talk, I can't help but think back to my prodromal phase. Perhaps if there were more awareness of mental health issues and better diagnostic efforts, my illness would have been caught early on and I wouldn't have had to endure such a long period (about three years) of untreated psychosis. Be that as it may, in effort to help others I will briefly describe my prodromal phase.

I attended high school in the western suburbs of Minneapolis, graduated at the top of my class with a 4.0 GPA, and then headed west to study at the California Institute of Technology (Caltech). I had done well in school during my freshman year, but by the time my sophomore year approached I no longer had the intense drive and motivation to do my course work. By the end of my sophomore year, I was still passing my classes but was putting little effort into them. During the following summer, I secured a Summer Undergraduate Research Fellowship (SURF) at Caltech doing environmental research on chromium in ground water. It was an excellent opportunity to distinguish myself in the lab; however, I ended up doing half-hearted lab work. At the end of the summer I was supposed to write a report and present my findings. I turned the report in late and never showed to present my work. I noticed this increased laziness at the time, but I attributed it to being slightly unhappy at Caltech.

Additionally, during this summer I moved to an off-campus apartment and reduced my social interaction with friends. Over the course of this summer, I started noticing that my neighbor frequently seemed to be in his doorway when I came and went from my apartment. At first I thought it simply odd, but over the summer I started to believe he was monitoring me. I didn't know why he would do this, but I thought perhaps he was some sort of pervert. I also started becoming fearful that gangs of thugs were following me when I would walk around the streets of Pasadena (a very safe suburb of Los Angeles), and so I started carrying with me a pocket knife and pepper spray that attached to my keychain.

All in all, these changes in my personality and behavior would not amount to a diagnosis, even if there had been some sort of early intervention; they were nonspecific changes that could signify many things (or nothing at all). Only in looking back can I properly say they were part of my prodrome. To conclude then, I can best describe my prodromal experience by noting that I didn't want to do anything anymore. I just quietly and subtly dropped out of life.