Cross-cultural, Daily Living, & Adjustment Issues

Hi Dr. Greg,

I have some very serious concerns about a friend of mine I could use your advice with. I'll call her Alice but that's not her real name.

Alice and I traveled to China together two years ago after graduating from the same college. We've been teaching at the same university for all that time in a smaller city.

I started noticing some big changes in Alice about six months ago. She's never been a "party" type of girl but now she has stopped talking to just about everyone except me and now it is even difficult for me to hold a conversation with her. She seems to be avoiding me whenever she can but it's not like we've had a fight or anything like that.

She's still showing up at her classes but some of the students have also complained to me that she has "changed." I really don't know how to describe this exactly other than she doesn't seem to be "connected" anymore to anyone or anything and she's become very "private" I guess you could say. We used to talk about everything all the time and now I can't even get her to go out to dinner with me. When I "force" myself on her, she avoids eye contact and at times will make a strange sort of smile. When I ask her what she is smiling about, she says "nothing" or acts like she never heard me.

I have asked her repeatedly if she is depressed about anything and she says no. I personally think she's very depressed because she is staying in her bedroom almost all the time and has even stopped bathing regularly. She hasn't even shaved her legs or underarms in over two months and to be honest about it, if you get too close to her, you can smell her body odor. Up until about three to six months ago, she was one of the cleanest people I have ever known. We were roommates in college and this Alice is a completely different person from the one I used to know.

I am losing my best friend and I don't know why. I know for a fact she is not doing drugs of any kind and there is nothing I can think of that would cause her to become so depressed.

What can I do to help her? Do you think medication will help? One problem is I don't really think the local hospitals here are set up to handle something like this and trying to explain all of this through interpreters is not going to be easy. The other problem is that every time I try to bring up seeing a doctor, she becomes angry with me and tells me there is nothing wrong with her.

I could really use your advice. I am beginning to get depressed over this myself because I am watching my best friend fall apart and don't know how to help her.

I am very sorry that you are going through this.

It's always difficult for me to know precisely what is going on without having had the opportunity to examine the person directly.

There may in fact be major affective (depressive) components involved here but I fear and suspect that what you are describing is something far more serious than clinical depression.

Strictly on the basis of the symptoms you have outlined, and without the benefit of having evaluated her in person, Alice appears to be presenting with what is called the prodromal (beginning) phase of schizophrenia: social isolation, progressive deterioration in personal hygiene, an increasing preponderance of "private thoughts" evidenced by mood incongruent smiling (or, more accurately, grimacing).

I am assuming that both you and Alice are somewhere around the ages of 24 to 25 and this constitutes the average age of onset of schizophrenia in women. While it is true that severely depressed people can spend a lot of time in bed and do lose interest in self-appearance and activities that used to bring pleasure, the type of deterioration in personal hygiene and the loss of interpersonal "connectivity" you described are not associated with major depression.

I know I am probably beginning to sound like a broken record in these types of matters, but you absolutely need to involve her family. You cannot handle this by yourself in China.

You need to call her family and explain what you are observing. They need to travel to China and bring her back home for proper evaluation and treatment.

Time is of the essence here. If Alice is in the prodromal phase of schizophrenia, the earlier the diagnosis is made and the sooner she starts medication, the better her prognosis will be.

Thank you so much for your quick response.

I called Alice's father this morning and told him what has been going on. He was silent for awhile and then told me that there is a history of schizophrenia in the family.

He will be in China next week to bring her home.

Thanks again for all your help.