Last year I joined Quora, a question-and-answer website where questions on every subject imaginable are posed and answered by its community of users. The community includes such notables as Barack Obama, Steve Case, and Justin Trudeau, who have answered questions on occasion. If you are curious about how celebrities choose the charitable causes they endorse and want to get an answer from a real celebrity (Ashton Kutcher), Quora is the social media site for you. However, the core of the Quora community are people who are experts in their fields, have an interesting or unusual life experience, or just love to think deep thoughts and write about them.
Tips on parenting, book and movie recommendations, and polite, well-reasoned debates on politics, religion, and philosophy all abound on Quora. One area of topics I regularly follow is for questions related to mental health. Every day, there are questions about the symptoms for different disorders, best practices in mental health care, or what it is like to live with a mental illness. At times, I jump in with an answer. The following is my answer to a question about a person who is troubled by conversations with imaginary friends. I am sharing it with the readers of my blog because it touches on the topic of “prodromal syndrome,” a group of symptoms that sometimes occur prior to the onset of schizophrenia and other psychotic disorders in teens and young adults.
Question
“I am struggling to live the reality of life and I daydream day and night. I have an alternative life in my head, my new alter ego. Am I mentally ill?
It’s like a crutch and I am having conversations with imaginary friends around me. When I don’t daydream I miss them. How can I stop? On the other hand I am not sure if I want to let it go. It gives me buzz and happiness. I feel alive.”
Answer
It sounds like you have mixed emotions about the conversations you are having with your imaginary friends. On the one hand, you say that they give you a buzz and make you feel happy and alive. On the other hand, you say that they are like a crutch, mention that you are struggling with the reality of life, and ask how to make the conversations stop. This kind of ambivalence is common with people in the early stages of a mental health problem. It does not mean you have a mental illness, but if you are asking these questions of yourself and others, it is a good idea to trust your instincts and get checked by a mental health professional.
The fact that you have these questions is a positive sign for your mental health. It means that you know the difference between reality and fantasy, and are aware that imaginary conversations like those you describe are not normal for most people. Not knowing the difference would be a strong sign that a person has a psychotic disorder, such as schizophrenia.
Assuming you are an adolescent or adult and not a frequent drug user, the conversations you describe could mean that you are at risk for developing schizophrenia or a related disorder. On the other hand, you may just have a very active imagination. Either way, you have expressed some discomfort with the situation, in which case it is best to seek professional guidance.
The conversations you describe are sometimes described as prodromal symptoms of psychosis. To simplify, they could be an early warning sign of a more serious problem. While that can be a frightening prospect to consider, the good news is that early treatment can result in much better outcomes for a person seeking help. Specialized treatment early in psychosis (STEP) is a somewhat controversial subspecialty of psychiatry that has shown some promising results in lessening or even averting the onset of schizophrenia in adolescents and young adults.You can read more about it on the webpages for the Yale University STEP Clinic.
If you find you are spending more time in the daydream world of yours than in the real one, or begin to believe the voices may be real, those would be very strong signs that it is time to seek help. Another sign would be if the daydream world intrudes on your real life activities. For instance, if it prevents you from concentrating at school or on the job, or makes you want to avoid contact with people whose company you once enjoyed.
Should you decide to seek professional guidance with this problem, the chances are good that help is available to you in the community where you live. I run a non-profit website www.rtor.org (for “Resources to Recover”), that offers free assistance locating doctors and therapists who can help with the problem you describe.
I wish you the best in dealing with this challenging issue and hope you find a resolution.
The Yale University STEP program, a featured provider in our Directory of Family-Endorsed Providers, is one of the leading clinics in the nation for research and treatment of early psychosis. For information and referrals to Yale STEP in New Haven, CT, please Contact a Resource Specialist for free assistance.
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