Although Ted is thirty-three years old he still lives with his parents. He has held a full-time job pumping gas and changing tires since he graduated from high school. Ted has never created any serious difficulties at home. He insists on taking his meals in his own room, a very small attic bedroom, or in a backyard tool shed, claiming he is annoyed by the small talk of his parents at the family dinner table. He also sometimes giggles for no apparent reason, but his parents have not been upset by these behaviors. Ted has no friends, except for a male cousin, an auto mechanic, with whom he goes bowling occasionally.
He reportedly
occasionally engages in discreet, consensual sex with other mechanics or
construction laborers away from home, although he prefers not to engage such
individuals in conversation or to socialize at gay bars, as he does not enjoy
the notoriety and company of “flamboyant, indiscreet queens.” Ted himself is
very lean and masculine in appearance, although quiet. When he speaks, he
speaks in a low yet barely audible voice, avoiding eye-to-eye contact. However,
he is unfailingly polite and well liked.
Due to financial
difficulties, Ted’s boss is forced to close down the service station, and Ted
is laid off. Despite prodding from his parents he refuses to look for another
job. On the contrary, he takes less and less interest in his personal
appearance, preferring to wear dirty old, scruffy jeans, which he often sleeps
in. He spends the greater part of each day alone in a backyard tool shed. When
he is indoors and thinks he is alone, however, his mother notices that he often
smiles, frowns or gestures as if he were engaged in conversation. After six
months, she is unable to tolerate the strain of having him around all the time,
and takes him to the family physician.
In cases where
the outstanding symptom is gradual but severe interpersonal withdrawal, simple
schizophrenia is diagnosed. Usually, the most florid symptoms are absent,
although thought disorder and an overabundant fantasy life may be apparent to
the trained observer. It is likely that the majority of cases of simple
schizophrenia go undiagnosed, since schizophrenia in this form appears not to
significantly disrupt a person’s ability to work at routine tasks, even though
his social may be severely limited. Thus, simple schizophrenics may come into
treatment only when stressed by the loss of a person who has taken care of them
or the loss of a job around which they have structured their lives, for
example. Sometimes, a diagnosis of simple schizophrenia is made in persons who
enter the mental health system with other psychological or social problems like
alcoholism or vagrancy. Because of the subtle ways in which schizophrenia
manifests itself in this form, diagnosing simple schizophrenia may be quite
difficult. In principle, thought disorder must be demonstrable before the
diagnosis is accepted; interpersonal withdrawal alone is not enough.