Case Study

Valerie is a 50 year old woman who was diagnosed with schizophrenia when she was 29. Prior to her diagnosis, Valerie had completed her BSc at the University of Toronto and began graduate school at The University of Guelph. During university, Valerie was convinced that someone was poisoning her, and made frequent trips to student health. Valerie became fascinated with organic foods and chemicals and was certain that growth hormones in meat were created to poison humans. While she did not have a large circle of friends, Valerie did have a boyfriend, Henry, throughout her undergraduate degree. As she became increasingly delusional, she isolated herself from her friends, and her relationship with Henry broke down.

After starting her graduate degree, Valerie became more obsessed with food and would only allow herself to eat bread and bananas. She began to use marijuana. Now Valerie would spend her days in a smoke filled room scared to go out for fear of coming in contact with contaminated food. During this time she continued to see her doctor for stomach symptoms. One day, while traveling back from a doctor’s appointment, Valerie ran into Henry. Their relationship was soon rekindled, and Valerie stopped using marijuana. Valerie’s stress was substantially decreased now that she and Henry were spending so much time together, and gradually, Valerie became less and less worried about her food being contaminated, and her stomach symptoms ceased.

Within 2 years, Valerie & Henry were married. After 4 years of marriage, however, Valerie’s stomach problems started to come back. She began to make multiple appointments with her family physician, who could not discover any problems with her health. Valerie and Henry were not getting along, and Valerie became worried that he was injecting her food with poison and contaminating the milk she was drinking with deadly bacteria. Valerie & Henry were active members of their church; however, during this time, Valerie began to believe that there were members of the church who had infiltrated, and were trying to destroy their faith community. When Valerie told Henry about her concerns, Henry and Valerie’s pastor became worried about her, and consulted with Valerie’s physician. Henry and Valerie’s family physician informed Valerie that he was admitting her to hospital. Valerie was relieved that someone saw what was really going on; however, on admission, she realized she was on the psychiatric floor and was convinced the government was plotting against her.

After 6 months in a psychiatric facility, Valerie felt better and was discharged. She received a diagnosis of schizophrenia, and was prescribed medication. Valerie took her medication and was able to settle into an apartment. Valerie and Henry got back together for a short time. After 6 months, the side effects of the medication were so severe, she stopped taking them and she and Henry divorced. Two months later, she realized that Henry was spying on her through her apartment window, and she decided to escape by hitchhiking to Vancouver Island.

In Comox – a small town on Vancouver Island, she got a job as a receptionist in a saw mill. Valerie continued to experience paranoia about the food around her and now started to feel that her co-workers in the office were plotting against her. She would see them huddled together before and after work and felt they were mapping out their plan against her. Valerie had contact with a community mental health team and the occupational therapist was working with her to support her at home and work. The OT had met with Valerie’s employer and discussed the difficulty Valerie had been having with her medication and maintaining her focus and attention. Shortly after this meeting, Valerie was fired and she stopped seeing her mental health team. This created a downward spiral for Valerie who continued to live in Comox for another 2 years, taking odd jobs, and living in squalor. Isolation and despair drove her to leave BC and move back to Toronto.

In Toronto, without money, Valerie lived between an abandoned car and local shelters. She went to soup kitchens, but was hungry and had little human contact. Somehow, she found a job taking out the garbage at a local restaurant and was able to find an apartment in a run down building in Toronto. With a little money, she began to drink heavily, alternating between cheap liquor and homemade beer. Valerie's paranoia and delusions shifted and she became convinced that aliens were inhabiting the people around her. She became increasingly distraught and one day was picked up by police and brought to the hospital.

Valerie's second hospital stay was longer than the first, but by the end, the voices had left and she was feeling like she would be able to manage on her own. Her psychiatrist set up regular appointments with her, and she was assigned to an Assertive Community Treatment (ACT) team who would visit her in the community. The occupational therapist talked to Valerie about activities that were meaningful to her, and she began to focus on music and writing (a passion from early university days). Valerie was prescribed new medications. At discharge, Valerie said that she could begin to see hope and wanted to make sure that she kept taking her medications. On discharge, she had plans to rebuild her life.

After just 1 month, Valerie gave up her medications after experiencing strong side effects. Once off her meds, she started missing her psychiatry appointments and moved to a different apartment building. The ACT team lost contact with her. Valerie had purchased a used guitar at Goodwill – she was now convinced that the music was taking over her mind, and she smashed it against the wall. Valerie withdrew from her small social circle she had begun to develop, was fired from her job, and with no money, was evicted from her apartment. Valerie returned to the streets. Thinking that aliens were going to infiltrate her body, she tried to jump from an overpass. Her shirt got caught on the fence and the police once again took her to the hospital.

Valerie was admitted to the same unit as her previous hospital admission. She was re-prescribed medications; however, was adamant about not wanting to be on medications because of the side effects. Valerie refused meds, and her parents were contacted to act as her substitute decision makers. Valerie had not seen her parents in 5 years and was very agitated during their visit. After a lengthy team meeting, her parents signed the community treatment order. Valerie was once again discharged into the community with the support of the ACT team.

Part II

With the community treatment order, Valerie reluctantly took her medication. Her new medication had fewer side effects than her previous meds. Shortly after taking her new medication, Valerie began to feel that she was in control of her body and mind. With the occupational therapist on the ACT team, Valerie made plans to focus again on music and writing. She started to create a story of her life, on audiotape, with the hope of educating others about schizophrenia. The audiotape found its way into the library, and Valerie was contacted to speak about her personal experience with schizophrenia. Five years later, Valerie continues to take her medication and now speaks to approximately 50-60 groups a year about her experience of schizophrenia. Valerie has a cat, and a small, comfortable apartment, and has made a few close friends in her neighborhood.


Disclaimer: This case study has been based on Valerie, a person featured in the video that accompanies this case study; However, the events described in this case study are entirely fictional, and do not depict actual events. This case study was produced for educational purposes only.