Demonic Voices

I was speaking with a patient in one of our outpatient programs last week. He excitedly told me that he was on his way to a psychiatric hospital right after our meeting.
I was puzzled until he added that he was going there for a job interview. He's about to complete a mental health counseling degree at a community college. Immediately, I was struck by the extraordinary progress he has made — from being virtually overwhelmed by his schizophrenia to living very effectively with this disease.
I first met this man over 10 years ago during a series of psychiatric hospitalizations for severe psychotic symptoms associated with his schizophrenia. He was tortured by what seemed to be the voice of God saying terrible things to him.
His auditory hallucinations drowned out the daily life around him and he was overwhelmed with bizarre and frightening delusional thoughts. At times, he wanted to end his life to escape the pain of these incessant unreal experiences.
His psychotic experiences seemed so real that he could not accept the fact that he had a psychiatric disorder — and thus he saw no reason to take any medications. Usually, once in the hospital he would take medications, hoping to be discharged sooner; it often worked because his symptoms did improve. Once back home, however, he would discard his prescriptions and stop taking his medications. Before long, he'd be back in the hospital as the psychotic symptoms became more pronounced.
I'm not sure what helped him turn the corner to taking his medications regularly and staying out of the hospital for longer periods of time. It has been many years now since his last psychiatric admission. Perhaps it was a combination of maturity, faith, support from his wife, education, intensive involvement with the outpatient mental health program, and the right combination of medicines. I suspect all were important to him.
In fact, he was functioning so well that I assumed his symptoms were gone. When I asked him about auditory hallucinations, I was surprised when he responded that he continued to experience the demonic voices.
What was different now was that he had learned to differentiate what was real from what was a symptom of his illness. His schizophrenia wasn't cured, but it was under control. That's like having diabetes — the disease is never cured, but it can be managed with education, support from family and friends, effective outpatient treatment, lifestyle changes, and adherence to medications.