Welcome, Silence

North, Carol S. Welcome, Silence: My Triumph Over Schizophrenia. Lima, OH: Academic Renewal Press, 2002.

This remarkable memoir tells the story of Dr. Carol North’s phenomenal recovery from schizophrenia. North was chronically psychotic for almost eight years and yet during this time she was not what one would consider a typical schizophrenic. While she was often debilitated by her delusional thinking, she was also highly motivated, driven, and goal-oriented. Despite severe and crippling psychotic symptoms, she continued to achieve academically in college and in medical school. North graduated from the prestigious Washington University School of Medicine in St. Louis, Missouri and went on to do a residency in psychiatry.

What is most astounding though is her determination and will to succeed in the face of seemingly insurmountable odds. It is not merely the description of going psychotic that makes this book memorable. It is also the fact that while North was going crazy, she was also going through college and two years of medical school. This academic pilgrimage is extraordinary in itself, but to go through it while fighting off hallucinations and delusions is almost unimaginable. Even after being barred from medical school during her second year (most likely due to stigma), she tenaciously found another medical school to attend and flourished academically.

Early manifestations of her disease began in childhood, but its full flowering awaited her late teens. There were voices—advising, criticizing, confusing, suggesting, interfering, commanding—one, many. Her characterization of the voices she heard during this time suggests a deeply disturbed mind: “The voices knew the truth: my schoolteacher was indeed a kidnapper, sparrows were really attack birds, my mother was a mind reader. No, nothing was quite what it appeared to be on the surface. All existence was merely a thin membrane covering a greater, hidden reality” (p. 62). She also experienced visual hallucinations of patterns in the air, paranoid delusions that people were reading her mind, trying to kill her, periods of catatonic immobility and multiple suicide attempts. North vividly describes her auditory and visual hallucinations and the book shows her courageous attempts to make sense out of what is happening to her. During her first year of college, she was hospitalized and officially diagnosed with schizophrenia and it was here that she slid further into psychosis and finally succumbed to the inexorable incapacitation that is so often characteristic of the disease.

Her descriptions of her delusional thinking during the prodrome to her first hospitalization are extraordinarily vivid. To have someone who has actually lived through psychosis describe with clarity not only what her thought process was, but the emotions she experienced truly enables the reader to gain a sense of what suffering from schizophrenia is like. Accounts of schizophrenia are often clinical, a story told from the outside looking in. That is why it is so rare to have the raw diaries of a person with schizophrenia that are so accurate, sensitive, and eloquent. This is a book that forces us to confront our stereotypes. The media all too often portray people with schizophrenia as homicidal maniacs or paranoid outcasts. The fact that North is a successful and respected physician demonstrates that there are high-functioning individuals with this disease. It is also exceedingly brave of North, who is in a profession where the slightest hint of being mentally unstable is viewed as a liability, to be so open about her history. Welcome, Silence was published two weeks before the end of her residency program in psychiatry. Knowing the risks she was potentially taking with her career and credibility as a psychiatrist, she decided to go public anyway because “it was the right thing to do” (p. 318). She hoped her story and experience would reduce misunderstanding and stigma surrounding schizophrenia.

During medical school, North was fortunate to find a skilled and sympathetic psychiatrist in “Dr. Hemingway” who understood her dedication to becoming a physician and who worked with her to stay well enough to remain in school. However, her illness progressed and when it seemed as though all hope was lost, her doctor enrolled her in a controversial and experimental kidney dialysis program. This is what cured her.

One minor criticism of this book is that it does not emphasize enough the rarity of North’s outcome. The chance for recovery from schizophrenia without medication is almost unheard of. Even more unusual is the way that North was cured. She was one of the first people to participate in renal dialysis for schizophrenia. The theory behind dialysis is that it removes some unidentified substance from the blood, presumably a chemical responsible for producing schizophrenic symptoms. This is a controversial treatment that is based on reports of success from a small number of patients and not on any rigorous scientific study. As of now, there has been no documented improvement in schizophrenic patients on chronic dialysis. Even today, North is unable to explain why she was successfully cured of schizophrenia and she openly admits that she has never recommended dialysis treatment for any of her schizophrenic patients. This is because newer medications have been developed that are more effective in treating the symptoms of schizophrenia while minimizing the side effects.

North’s story is buttressed by her recollection of fleeting symptoms and medical records obtained subsequently by her treating physicians. The illumination of the mysterious process of psychosis is facilitated by North’s familiarity with the subjective and clinical aspects of the illness. We should be thankful that North was cured so that she could share her story. Most of those living with schizophrenia must suffer in silence. Many have little means of appreciating their own private hells. North offers us a rare look inside.