For seven years, 40-year-old Jean spoke to his daughter every day.

He talked to her while he worked on a Bachelor's of Philosophy degree, and she was with him while he completed a law degree. She even helped him study for the bar admissions exams, though he didn't pass.

Then, at the end of 2004, Jean had a breakdown and was taken to hospital. It was only as he was being treated in a psychiatric ward that he came to a realization about his daughter.

She wasn't real.

Neither were 25 other characters he had gotten to know in his head.

Jean was a schizophrenic who had grown so used to hearing voices, he believed them real. He was also convinced he could read people's minds and tell when they were planning crimes. When he would follow people home and break into their cars, it was because he was convinced that abducted children lay inside.

It wasn't until after Jean was arrested for trespassing, hospitalized, and put on a new medication that the shock of how delusional he had been finally hit him.

"I had spoken to my daughter every day for seven years, but she wasn't real," he remembers in a phone interview with CTV.ca from his home in eastern Ontario.

"When I heard voices in my head, I was hearing full conversations - full conversations, not just snippets," he says. "When I began to hear their thoughts too, I assumed I was telepathic."

Jean (who doesn't want his full name used), had been diagnosed with schizophrenia seven years before he had his breakdown. During that time, he had been in and out hospital numerous times, and on and off medication, never convinced there was anything wrong with him or that the drugs were doing anything.

Dr. Joel Jeffries, a psychiatrist at the Centre for Addiction and Mental Health in Toronto, says that kind of denial is not unusual for people with schizophrenia. Jeffries says one of the greatest hurdles in treating patients is helping them realize they really are ill.

"The main challenge is often denial," Dr. Jeffries tells CTV.ca. "Patients often have a lack of education about their illness. Many patients don't know how to recognize the symptoms of a psychotic episode, so they can identify it early. And they often don't know how to deal with the side effects of their medications."

Those side effects are often what make many schizophrenia patients reticent to take their pills. Conventional antipsychotics, medications that were developed in the 1950s and are still in use today, often leave patients feeling drowsy and "foggy." Others can cause tremors and spasms.

But in the last decade or so, there has been a quiet explosion of new drugs on the market. These new "atypical" medicationsare helping to improve patient compliance.

"These new medications are not necessarily any more efficacious than conventional ones, but they have fewer side effects so they give doctors more options," says Jeffries.

Injection makes drug easier to take

For Jean, everything in his world changed when hospital doctors placed him on a medication called risperidone. Within a week, the voices quieted, and within three months he began to feel normal again, after going for years not knowing what normal was.

He's been on the medication for four years now and says what he really likes is that it is an injectable. He no longer has to remember to take his pills, but instead, sees a doctor every few weeks for a shot.

While the medication has led to weight gain and usually requires him to take a nap every afternoon, Jean no longer worries he'll forget to take his pills.

Jeffries says while the new medications are an improvement, in his nearly 40 years specializing in schizophrenia, he still hasn't seen huge advances in treatments. Finding a medication and a dosage that "fits" a specific patient is still a matter of trial and error, though Jeffries believes the real key is just to get patients to stay on a medication -- any medication -- long enough for it to have an effect.

After decades of research, medicine is not much closer to understanding what causes schizophrenia, which affects about one per cent of the population, says Jeffries.

While it's well-known that schizophrenia runs in families, there are thought to be external factors that trigger it. Even identical twins with identical genetics can see one twin develop schizophrenia while the other remains healthy. But doctors don't understand why.

Nor is it understood why women usually have less severe schizophrenia than men and develop it later in life, (though it's suspected estrogen may play a role).

Most puzzling of all, it still isn't understood why schizophrenia just "clears up" for many patients when they hit middle age or older, or why it can "recur" for many women after menopause (when estrogen levels drop).

Still, Jeffries says, thing are changing. When he first began to practice psychiatry in the 1960s, no one was even allowed to say the word "schizophrenia," preferring the euphemism "nervous breakdown." Patients were often warehoused in institutions and subjected to experimental treatments.

Today, he says, people can speak more freely about the illness, patients and families better understand the gravity of their illness and the need for medication.

Still, myths and stigmas about schizophrenia persist. Jean says that some of the friends he had before he was diagnosed never came back to him, mistakenly believing schizophrenics are inherently violent.

Jean now does public speaking, telling people about his illness and treatment. He's also working as a short story writer and on a business to promote fledgling music artists.

And the voices? Jean says they haven't altogether stopped. But, like the character of John Nash in "A Beautiful Mind," Jean now realizes the voices aren't real; they're just a part of him, the part that makes him unique.