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Schizoaffective disorder and a journey through therapy

Schizoaffective disorder is characterised by hearing voices and experiencing hallucinations that are symptoms of schizophrenia, but also includes the highs and lows of bipolar disorder. The public’s perception of schizophrenia and bipolar disorder are often negative. We tend to hear about these illnesses in the news, when someone had committed heinous crimes or acted in a way that is unacceptable to society. This also means that there is a stigma attached to these disorders.

People often use the word “bipolar” when someone presents with fluctuating mood, or “schizophrenic” when someone presents as “crazy” in their eyes. But these diagnoses are much more complex than that and do not describe the experience of many. 

According to the World Health Organisation (WHO), more than 69% of people with schizophrenia are not receiving appropriate care and 90% of people with untreated schizophrenia live in low and middle-income countries. There are 20 million people worldwide with this diagnosis.

Stigma, discrimination, and violation of human rights of people with schizophrenia are common. People often find it difficult to reach out for help, as they are afraid of how they will be received and treated afterwards, or they may simply not understand what is going on. 

Having a mental illness in an African country can be even more complicated where the understanding of mental health may be different on a societal level due to culture and religion. A 2007 article suggested that people in Zimbabwe view mental health institutions (which are not available in rural areas) as the product of White European culture or the middle class.

They are likely to think that mental health issues are connected with witchcraft, which means that both family members and communities would not seek help from within these institutions. This can often mean that people experiencing these difficulties can feel like a social outcast; it can lead to abuse and mistreatment from their communities, as well as their friends and family. 

Conversation between therapist and client

This article is a discussion between a therapist and a client. It aims to normalise and explore a topic that is often so misunderstood and unspoken about. It also explores the client’s experience of this part of her identity, her journey through therapy and the positive aspect of hearing voices, knowing that she is never alone. 

Therapist: Tell us a little bit about yourself.

Client: I have a diagnosis of schizoaffective disorder. I used to pray I would be healed. That I would not have another psychosis: that the voices that my society saw as so strange and so wrong and so destructive would stop. I have been on every kind of medication you can imagine.

I am Zimbabwean and during my country's chaotic crisis, my medication was going to cost me my entire salary (ZW$3 million) Zimbabwean dollars. Don’t get excited, chewing gum cost ZW$ 2000. I wasn’t wealthy, which meant that I went off my medication for an entire year whilst in Zimbabwe because simply, I couldn’t afford it.

This was the year I fell in love with Mark Walhberg, the actor, and spent the better part of that year explaining to the American actor what the current political landscape of my country was all about, as well as cooking, cleaning, teaching art and drama all the while sharing it with my beloved Mark Walhberg! (Who was not actually there by the way, just in my head.)

In Zimbabwe, I was finally put on free tablets from America, medication they have thrown away to the third world, which made my eyes roll and my tongue hang out like a panting dog.

I moved to England in 2005 in order to escape a chaotic economic and political environment. My psychosis usually descends into a fervent fear for my mum or dad’s safety, when they were alive, still living in a volatile and unstable country like Zimbabwe. But they also begin magically. I fall in love… or I have a crush; and then, as if by magic I hear the voice of my beloved.

This benevolent voice then reaches out to me and is enamoured with me, wanting to know me, talk to me and share the mundane tasks of my life.

Therapist: What is it like living with voices?

Client: You are never alone. Me time, time out for good behaviour, downtime. It is all punctuated with a voice or a group of voices, who perpetually comment or echo whatever it is that you may be currently occupied with, including going to the loo. You name it, they know about it. There is no privacy, nothing is private, and nothing is off-limits.

You think it; they hear it and have something to say about it… Sometimes positive, sometimes negative, and judgemental. It can get quite claustrophobic. I like quietness, even an escape from music which I sometimes find exhausting because I feel I must listen to it and pay attention. I used to find my voices exhausting, and the more exhausted I got, the more critical they got. Then we would fight and argue.

Medication has helped me because it is slow releasing and I am much more stable and rational. I am far more in control of my fears. And since both my parents have died and are safe from the destructive hands of a dictatorship, my fears are more controllable, and I feel less helpless. In addition, living in England, I feel less afraid.

Therapist: How has lockdown affected your illness? 

Client: It gave me the much-needed rest that I had been yearning for that, otherwise, I wouldn’t have taken time out for myself after having COVID-19 symptoms as well as having broken my arm. But, like I said I am never alone.

I have a group of voices who I affectionately refer to as “the peanut gallery”. They are not peanuts, the cartoon, they just continually comment on my life, actions and thoughts like they are sitting in a gallery and I am being watched or examined like an ant under a microscope. Who are they, you may well ask? They are none other than George Clooney, Matt Damon, Brad Pitt, Mark Walhberg, Ben Affleck and Russel Crowe. Idris Elba and Ryan Gosling pop in and join the group from time to time but the foremost mentioned are the main manna. And why them you may ask?

As well as falling in love with people in my real world and hearing their voice adoring me, I have in the last 20 years or so fallen for each of these guys at one time or another. And now, we are just like old friends, and they pop in and out of my consciousness, checking up on me to see if I am OK and sharing my day with me - whatever it may hold. They sat with me in my room whilst I was alone and self-isolating and encouraged me.

I love these guys, they have all been with me since 2002 when I fell for Mark Wahlberg, and they are very good at chasing away other more destructive voices from my real world. I am, however, not about to write them all fan mail and show up on their doorsteps, part of me knows they are not real, but they are there and I can hear them and it is hard to ignore your five senses, especially when they give you a hug when you cry and you are afraid of dying of COVID-19. 

Therapist: What is your advice to other people who experience hearing voices and are currently in quarantine? 

Client: I would say embrace it. My sister who is quite 'normal' is not coping with quarantine because she is alone in a house in South Africa and doesn’t see another person for days. Now, if she had the peanut gallery, she would be much better about self-love. The less afraid I have been of my voices, the less I have prayed or hoped or strived to be just the same as a person without schizoaffective disorder, the nicer my voices have been.

Embrace your differences. We are not all meant to be the same. I don’t for a moment take all the suggestions my voices make, hence the betting game they play with me to predict my next actions. I don’t want to hurt anyone and, if a voice popped into my head tomorrow that told me to do that, I would fight with it and not listen.

But, now that I am no longer so self-loathing because I have a mental illness, not so broken from my home country and in therapy learning how to process, accept and face my past. I am more loving to myself; consequently, my voices are more loving to me.

Therapy has taught me that I am not the crazy lady running down the street, in danger of being sectioned. That I am not a crazy lady at all.

I am loveable and I am different. I have saved the crisis hotline number on my phone, and I often check if it is current, just in case I do feel like running down the street shouting. But the truth is I don’t need that number as much as I used to.

The truth is therapy has helped me see myself differently. For the first time in 20 years, I don’t think I am a disaster waiting to happen. I just have imaginary friends, who happen to like me just the way I am. 


We very rarely consider that people with more serious mental illnesses can also thrive and live a fulfilling, meaningful life, whilst being “different” from the average population. This difference remains part of their identity, which makes up the unique individual that they are.

This client continues to teach private English lessons in East London, specifically focusing on the Tamil community. She is an experienced writer and is currently writing her first biography, discussing her journey from Zimbabwe to England.

She hopes that other people experiencing mental illnesses can embrace themselves too, rather than focus on being “like everybody else”.

Please note: This article was written and published with the full consent of the client and therapist. 

Counselling Directory is not responsible for the articles published by members. The views expressed are those of the member who wrote the article.

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Written by Dorottya Szuk MBACP, Bsc (Hons), PgDip, Integrative Therapist & Coach

Dorottya is a qualified counsellor and coach practicing a unique approach called personal consultancy. She has extensive experience working in the Criminal Justice System with Staff, Ex-offenders as well as victims of crime. She works with individuals in private practice both in South West London and Essex.… Read more

Written by Dorottya Szuk MBACP, Bsc (Hons), PgDip, Integrative Therapist & Coach

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