The diagnostic words that start with "schizo-" are a train wreck.
Schizophrenia is characterized by hallucinations, delusions, thought disorder, catatonia, etc. You don't hear much about catatonia these days because it is cleared up by benzodiazepines reliably.
Schizoid people have reduced emotional reactions compared to other people but they are in touch with reality.
Schizoaffective disorder seems to pick a few symptoms from schizophrenia and bipolar but doesn't fit the criteria for either. You might think that sounds less severe but it can be devastating.
The romanticization of schizophrenia of r.d. Liang, "one flew over the cuckoo's nest", szasz and others strikes me as particularly cruel when I see how it keeps people who are suffering from getting help.
I don't think "one flew over the cuckoo's nest" romanticizes mental illness, for me it is about demonizing institutionalization.
It pictures the time when mental illness diagnostic was an easy method to put away anyone annoying or inconvenient (the subject really having a mental illness or not made little difference). It talks about institutional cruelty like torture and lobotomy.
But then I didn't read the book, just watched the movie - perhaps the "romanticization of illness" angle is more pronounced in the book but I'm pretty sure it was not the main theme and the novel did more good than bad for those diagnosed with a mental disorder or developmental disability.
I mostly agree, but I think the movie romanticized the end of institutionalization, making us believe we've progressed "beyond" it, when we merely have people screaming on street corners and sleeping in the gutter. Institutionalization should've been reformed, not all but eliminated (I know it still exists, but only for the most extreme cases).
If someone is not a threat to themselves or others, but has strange beliefs and behaviors, should we really take their freedom away just because we don’t think they are taking care of themselves adequately or we don’t like the sight/sound of them?
As someone with bipolar disorder (very stable since diagnosis and medication) I’m always a bit dismayed when people call for locking ill people up “for their own good.” (Not that you’re necessarily saying that - it’s just something I do see people advocating for sometimes).
I’m in SF and previously lived Tenderloin-adjacent so I’m quite familiar with the unfortunate cycle of mental illness and drug/alcohol abuse from self-medicating. It’s not a pretty sight and I do think we should do everything we can to help these most vulnerable people in society. I’m just not sure taking their liberty is necessarily the best course of action.
This. I'm fortunate enough to be considered only "eccentric" as most people are willing to forgive my weirdness in exchange for other useful personality traits. Not everybody is that lucky.
I think that society probably has the right to enforce basic social norms so I think it is reasonable to for society to intervene if someone is being threatening or violating basic norms (e.g. by defecating in the middle of the sidewalk). Both of which are common in the Tenderloin.
The problem that I see is: what options are available other than violating their freedom by forcing them to undergo treatment or locking them up? You can't, for example, fine someone who doesn't have anything. Besides, I think its unlikely that punishment would accomplish anything
So I guess I'm not sure I see a good solution to the problem.
Well, the support network is far from perfect - having a 5yo son in the autistic spectrum I experience this first hand. Not too long ago my kid would be segregated to a "special" school and I'm glad he is able to attend a regular school although he still needs a dedicated tutor.
Do you think weird people that do not endanger their own life or the life of others should be locked away?
There’s a sizeable gap between “weird people” and defecating/shooting heroin on community sidewalks and public transit. I’m referring mostly to the latter.
We've absolutely progressed beyond lobotomies, caregivers raping or assaulting patients (...more so anyway), and in general lifelong imprisonment in sub human conditions. No were not all the way where we need to be but we're miles ahead of where we were.
> I don't think "one flew over the cuckoo's nest" romanticizes mental illness, for me it is about demonizing institutionalization.
Intent is one thing, effect is another. One Flew Over the Cuckoo's Nest, the book and movie, broke ground upon its release, but one of its secondary effects was to establish the mid-20th-century mental hospital as a gothic setting, akin to the ancient stone manors of old, full of terrible secrets -- not to mention bizarre characters -- that are ripe for literary exploration. Today it's been almost completely tropified, especially since in the current era Great Literature is by definition introspectively psychological. An easy way to establish that your play or movie is "arty" is to set it in such an institution. One of the weirdest instances of this was in The Great Gatsby (2013), which wholly took place in a mental hospital (the plot of the novel being Nick's recollections to his psychiatrist) and implied that Nick admired Gatsby almost to the point of a crush and was so devastated by his death as to need psychiatric attention.
I do recommend you read One Flew Over the Cuckoo's Nest, the novel. It is written from the perspective of Chief Bromden, and his mental illness helps intensify the themes of subtle control, exercised by tyrannical people and institutions, with specific delusions he has that make him sensitive to that control.
> It pictures the time when mental illness diagnostic was an easy method to put away anyone annoying or inconvenient
One of my friends was sent to Napa State Hospital by his step dad because he had epilepsy. When he was seven. It took six years for his dad to win custody, because his dad was a Mexican.
That was the world of One Flew Over the Cuckoo's Nest.
Everything is based on theories and assumptions. Everything is a model and all models are wrong.
The problem with psychology is that it is a much more disjointed science than others (and has been for a long time). You have islands of logic and some overlapping theories but all of them do not follow a unified framework. It is similar to how modern physics is trying to connect quantum theory and gravity.
I'd argue that the scale of such disjointedness correlates with the power of predictability of phenomena in a certain field. It is therefore true that we know nothing and at the same time something about mental health.
Connecting and integrating psychology through evolutionary psych, behavioral theories, cognitive sciences and such is an ongoing area of research and an example of an effort which reduces disjointedness of a field which may result in more succesful predictions and deeper knowledge about mental health.
If there is a comprehensive theory it is that mental disorders and developmental disabilities come in layers.
You might have a genetic predisposition to certain problems, have that exacerbated by traumas, but learn how to compensate for them in some ways. You might do badly at certain things or certain situations but if you have support from other people, understand the difficulty, etc. you can do O.K.
The big trouble I think is that mental illness and developmental disabilities interact with the expectations that people have about others.
For instance much of the satisfaction parents get out of parenting is using their children as "self objects"; they want to dress them up, show them off, bask in their accomplishments, etc. An autistic child can't do that for them and they find that hard to accept.
The marketing of SSRI's is also distorted. They are prescribed a lot by primary care docs who need to be on top of a wide range of medical problems and can't be experts on mental health too. That is a good thing because they help people and it can be hard to get real help from a specialist.
Depression has many symptoms and for many people SSRIs help some symptoms but not others. For me, for instance, SSRIs help me control my emotions in situations where I might get overwhelmed and yell at people. I believe that they increase my self-control as opposed to suppress my emotions.
I have other symptoms that SSRIs don't help with, but I do feel like they've helped me a lot at being a parent.
Yet we know very little, like, we knew how to make fire before Lavoiser discovered the role of Oxygen in combustion.
The various paradigms we use are approximate, not unlike humor and miasma theories were of some help before we understood physiology and discovered the existence of germs.
The main theories of the 20th century (psychoanalysis and chemical imbalance) have been steadily eroded by research, but are still have far too much importance in clinic.
> You might have a genetic predisposition to certain problems, have that exacerbated by traumas.
Once we understand what genes and genes circuits are involved, and how trauma makes it worse, we'll be getting somewhere.
There is a lot of social complexity that means we may not take advantage of those facts. For instance we might get better drugs and other treatments but will that really help the people who are crapping on the street in San Francisco?
Autism in particular challenges the assumptions of society. The one thing aspies really can't do is "see the emperor's clothes". In asperger's day they did not get along well with National Socialism, today they have problems with neoliberalism.
You might fantasize that getting real help for aspies would increase their productivity a lot, mean they pay more taxes and make the help profitable for society, maybe even bend the curve of our civilization.
From another viewpoint there is more talent than there is opportunity. Maybe Aspies are 1% of the people in the top 2% of IQ, salvaging them means a small increase of the talent pool, and if you at the top of some insanely competitive pyramid (etc. academia, business) why spend money to make it more competitive for your kids...
Similarly, social structures tend to constrain the performance of science. We create the script that there is a "depression gene" and people build a career around that, maybe somebody wins a Nobel Prize, but really science is "what scientists do" and is about making stories that make sense to some people at a certain time and saying that some people are winners and others are losers. Go look at a Cochraine report on this or that and you'll see that 5000 studies got done, maybe 5 of those were done right, and there aren't enough samples to really be conclusive.
Astronomy is like this. We "know a lot" but every time somebody does a new study of Cepheid variables we find the cosmic distance scale isn't what we thought it was, the cosmological models are broken, etc.
That is, science manufactures a certainty that isn't there. "Reason" is often a label people use to attack other people. "Reason" magazine for instance has that name to say that socialists, labor unions, regulators, etc. are not "reasonable" and shouldn't be listened to.
The social aspects are also off course crucial. I'm lucky enough to live in a country with a social safety net that's stronger than what you have in the US (there are still homeless folks, but psychiatric care is free in France). Still, I'm well aware that mental care is a luxury.
Psychoanalysis is still very potent here though. The mothers of autistic and schizophrenic people were, for decades, vilified as responsible for the problems of their children.
A friend of mine who was anorexic for years had to endure cruel and demeaning treatments (based on Freudian BS). As she said: "As if it were funny to lose all those kilos :-/".
It's recently been found that, at least in some cases, anorexia is the result of auto-antibodies that stimulate the melanocortin receptor in the brain (the main satiety hormone). Those antibodies occur due to a cross-reaction with a protein secreted by E. Coli (CLPB). Bulimia and binge eating can have the same pathophysiology
(where the antibodies block the receptor instead of activating it). Yet my friend was treated as if she was making it up, "to ultimately affirm herself".
About ten years ago I made a documentary film about homeless people. On my first day of shooting I had an encounter with a schizophrenic guy named Daniel, which I captured on film. I've put a clip of that encounter here:
It's worth watching all the way through. The difference in his attitude when I stopped being afraid of him and started treating him like a human being instead of a threat is dramatic. I learned a lot about life that day.
This is a nice thought, and I do agree that we need more a lot more of this perspective in the world.
But we need to be careful not to downplay the incredibly severe difficulties involved in helping, treating, and even simply co-existing across the months and years with those who have schizophrenia.
I had a good friend stay with me for 2 months who ended up having significant schizophrenia-like symptoms (never found out the actual diagnosis). I tried my best to treat him like a human and get him the help he needed, but I was unable to. I don't want to go into details, but a lot of stuff happened. It was a very difficult time.
Oh, absolutely. I'm not saying that you can just treat schizophrenics like normal people and everything will be hunky-dory. All I'm saying is that not being afraid of them (because most of them (though not all) are totally harmless) is a good first step.
My youngest brother has schizophrenia, which started when he was 19. He just turned 31, and were it not for his family supporting and caring for him, I'm sure he would be homeless or worse. He's one of the most sensitive, gentle people I have ever known. My wife and others who have gotten to know him would agree.
Although he's "stable", thanks to an injection every 3 weeks, he's not going to ever get better. In fact he continues to retreat further and further away from the world and life. Why don't you go to the bowling group, movie night, job placement, etc, I used to ask him (events organized by a local psych facility for their patients, etc). Those people are crazy, he said.
It's a baffling disease. Besides his hallucinations and delusions, the defining feature seems to be that it resists treatment of any kind that would lead to what you and I would call a normal life.
> Why don't you go to the bowling group, movie night, job placement, etc, I used to ask him. Those people are crazy, he said.
It might be tempting to read something like this and think "of course the crazy person thinks normal people are crazy". But I'd argue that "sane" people's reactions to mentally ill people are frequently more irrational and scary than the symptoms of the illness itself.
It might be he doesn't want to associate with people, groups, events that revolve around the diagnosis. Perhaps that labels him an "other" and it feels little much. Why not similar activities with the general population?
That is not meant to belittle the point that delusional people will strongly deny their symptoms, of course. Being close to somebody like that gets tough, especially when the delusions have led to harm to self or others -- even after they get treatment and it works, it's easy to become paranoid of relapse and fear that every small act of legit defiance or assertion of self is a recurrence of symptoms.
Downvoters, I am curious what the objection is. If I may elaborate on the second paragraph, the situation I am describing is one where someone is harming themselves or others, but saying everything is fine and refusing treatment. Then they get treatment, they improve for a while, and maybe you see some behavior that reminds you of that earlier episode, but they insist they're fine again. So you might ask: is this a relapse into delusion? Or are they really fine? Honestly it is tough to answer. When you have seen their condition hurting people and being kind of dangerous, it's easy to get scared of misjudging that situation.
> Why not similar activities with the general population?
This is something that has been recommended for many years. Rahter than day centres where mentally ill people can go, secluded away from the world, we should provide a wider range. Still have those day centres for the people who need it, but focus on helping people reintegrate with their local communities by using "mainstream" services.
This type of belief is exactly what I was referring to when I said that one of the main features of his illness is that it resists anything that we would consider rehabilitating. Attitudes like this add to the sense of shame: "why don't you get out more and try to be normal like us. Everyone thinks it's a good idea for you." Makes me sick.
But it's also true. It's helpful for all people of varying states of mental health, whether you start out with a psychotic disorder or not. We all need and desire social support.
So it becomes this sort of jedi trick of encouraging those things without being pushy. I don't always know how to pull that off.
Ann doesn't want to join a creative writing group for mentally ill people, she wants to join a creative writing group.
Bob doesn't want a work-like scheme for mentally ill people, he wants to keep his current job and wants advice about disclosing mental illness to his employer and asking for reasonable adjustments.
These are the things that me and my friends have been campaigning for for all these years- a socially inclusive recovery model.
This. It's difficult to establish and maintain a sense of normalcy and social integration when you're only being offered a sort of tacit ghettoisation. Support groups can offer very useful support, but they can also become a trap of mutually-reinforcing pathology. Psychiatric inpatient units are a really difficult place to get better, precisely because you're surrounded by a lot of deeply troubled people who generally would rather be anywhere else.
The Camphill Movement offers an exemplary model of how people with learning difficulties can be integrated into a genuine community. What barriers are preventing us from offering similarly strong integration for people with severe and enduring mental illness? Why are so many people with moderately severe mental health problems being excluded from society for lack of relatively modest accommodations?
Extreme agoraphobia, social anxiety, very little to talk about... Most 31 year olds are working, raising children, etc., and don't live in their parents house. Don't underestimate the shame he feels when around others. Outside his family, I think it is overwhelming for him.
I think this is a very important point. He doesn't fit in and humans love to ask one another about their lives. If you give non-standard answers, then you're seen as weird or a failure in life.
I have a brother who went through about a decade of off and on psychosis, had probably over 20 hospitalizations, multiple suicide attempts, he had schizophrenia. So I moved home and lived with him, I never fully believed the diagnosis. He was on such a cocktail of medicine, I don't think anyone could stay sane on all of that. We started getting him off the antipsychs, off the mood stabilizers, no wellbutrin etc. A year later he has had no psychotic episodes, no mania, is trying to quit smoking, and is more social. He still has his days in bed, but hes a real person, not a schizophrenic.
Congrats to your brother. I have heard it's possible for psychotic episodes to be a one-time thing and not recur. I have also seen people not get better. The whole thing is tough. It can be legit to get off the medications, but some people will need it for life. So how do you tell which situation you or a loved one is in?
Sorry, real person was harsh language, but in the depths of psychosis, it sometimes seems like the old person is no longer there.
I was just trying to emphasize that the diagnosis is never final, even after doctors have concluded it to be. In our case we never gave up. I think that the antipsychotic drugs make recovery extremely difficult, which is where alot of patients get trapped. The withdrawl symptoms themselves cause psychosis.
Just to tell another possible path schizophrenia can take. When my mother went off her meds she got significantly worse very quickly and would never quite recover to where she was before hand. But even while medicated she would still get worse each year. In her teens she scored a near perfect SAT(1560) but by the time she was 23 she was no longer able to hold down a job and by her early 30s she could barely string a sentence together that made any sense.
I absolutely absolutely know what you mean. With my twin that has schizophrenia, there are entire months where I'm convinced he's never coming back. That he's permanently gone this time. Then when I give up, there will be just one exclusive random day where he'll be a normal functioning person.
It sounds harsh, but when he's in that illness 'phase', the person seems more like a demon-possessed creature and not even like much of a person. When you hear the things and intonations that the person will say in conversations to themselves in particular.. that's what sounds the least person-like.
It is human nature to want to associate with people who display attributes you wish to see in yourself, and to avoid the converse. The aphorism "you are the average of your 5 closest friends" is based on that idea.
If your brother is self-aware of his illness and doesn't like its effects on him then his response is perfectly understandable to me.
That's not it. The biggest issue is that people who have this disorder can't interpret what other people are saying properly, like someone might be talking about taking a dog on a walk and the person thinks they are talking about how they are a dog. And being around other people who have the disorder makes it even worse because you have people that have delusional ideas and speech inspired by those ideas bouncing off other people that are interpreting that speech in a strange way. Which leads to an amplification of the perception of the disorder.
Thank you so much for sharing this. My fraternal twin has schizophrenia and was diagnosed at 23. We're 25. I don't have schizophrenia.
But his problem is that he refuses to take medication, so not sure where things will end up in the future with him. It's very up and down. One day like yesterday he's hearing voices and talking to himself, then the next day he's sort of normal.
Hearing that someone else also has a family member that is going through that is helpful.
Speaking from experience with my brother, it's an uphill battle. Without meds, he can go into a full-blown psychotic/manic episode and every new relapse damages the brain further and makes it harder to come back. With my brother it's especially bad since he doesn't even hear voices, but has delusions of grandeur and gets very confrontational, thinking he is the devil and wants to hurt people. Just recently (a few months ago) he had his third hospitalization, even though he was receiving abilify injections, and this time it took the strongest meds (haldol, leponex) to stabilize him. But sometimes it needs to get worse before it can get better. Try to convince him to take meds or get him on monthly depot injections. For reference, we are in our early thirties.
> It was during my own nursing training that the currently favoured term of “service user” gained traction, as it was deemed more neutral.
Patients overwhelmingly prefer the term patient, and this holds true every time we ask them what they want to be called.
Service user is a term imposed upon them by well-intentioned mental health professionals and academics who don't recognise their own power dynamic and who do a poor job of coproduction.
> while the council of the Royal College of Psychiatrists recently recommitted to “patient”.
...after they asked people what their preferred term is.
Most of the supposed "mental-health conditions" are manifestations of stress. There are two kinds of stress: biological and emotional.
Biological stress is related to things like being malnourished and/or having hormonal imbalances (thyroid, cortisol, progesterone, etc), not getting enough sunlight (no red light -> winter sickness / UV light-> Vitamin D), etc. Biological stress is worsened when a person is medicated with patent medicines that are approved for treating behavioral symptoms by implementing wrong-theory about the cause of the behavioral symptom (i.e., inadequate serotonin -> depression [0], excess dopamine -> psychosis, etc).
Some scientists rediscovered a few years ago that the behavioral symptom of "psychosis" is strongly associated with an inability to make adequate amounts of the stress hormone cortisol [1].
Emotional stress has to do with people feeling trapped. From the article: "Importantly, what we call psychosis can also be a response to extreme stress or trauma."
Emotional stress leads to the release of cortisol too. If a person's long-term emotional stress exceeds their ability to compensate, their "mental health" will suffer.
One part of this article is about forcibly medicating people whom the professionals think don't realize they need the pills they're prescribed. IMHO, it is an act of violence to force a person to take pills that make them suicidal [2]. The legal systems generally recognize that people have a choice in medical treatments, but struggles with patients who don't even realize they have a problem [3], and/or don't like the treatments the professionals think they need. In the US the courts have decided that people can't be "helped" against their will without a court order. This is why Jared Loughner, the man who shot up Congresswoman Gifford's event, couldn't be helped, even though the people around him noticed that his behavior had changed [4].
The professionals tried to label my girlfriend as "schizophrenic". Really she was just stressed ("lonely"), and was suffering from the adverse effects of various medical interventions. Methadone causes sugar cravings; she'd taken to treating this medication-induced metabolic problem with alcohol a few days before we'd met (alcohol has 7 calories/gram, while sugar only has 4 calories/gram).
In my initial assessment she also reported being injected with a prescription endocrine disruptor maybe 10 years before [5]. This prescription drug has warnings about endocrine disruption [6], but doctors don't appreciate their patients' iatrogenic deterioration when it's associated with this defective drug.
My girlfriend became psychotic when she ran out of alcohol , but rather than treating her for the cause [7] they treat her for the symptom with "anti-psychotics". I consider her involuntary treatment program to be "medical assault". I found a lawyer a while back who was familiar with how the state's involuntary treatment system works, but lawyers are expensive, so I tried to go at it myself. Maybe the legal guild didn't take kindly to a legal-nobody pointing out that their system is ugly.
I guess I'm going to hire the lawyer.
tl/dr: The conventional practices of the mental health industry are wrong. Institutional inertia prevents the profession from fixing itself. Little bits of progress have been made in recognizing the system's contribution to the patient's problems. As I said before, the system needs a re-write: https://news.ycombinator.com/item?id=19545964
Treating DSM categories as if they were a single disease is completely misguided. The DSM describes syndromes, and ignores pathophysiology because we still have little to no idea of what happens in the brain (at least not enough to properly understand the relevant functional aspects).
Genome-wide association studies have recently shown that schizophrenia was in fact several distinct diseases [0]. Their symptoms turn out to be mediated by the same drugs, to the extent that they makes the people who suffer from those ailments manageable.
If your house suddenly becomes cold in the winter, putting on a jacket will help you feel better. You wouldn't infer from that that your furnace is down because of a clothing imbalance.
This is why I think very highly of the transition in DSM V to diagnosing on spectrums. It's not perfect but it really helps get away from putting people into buckets they don't really belong in.
At the expense of putting people on spectrums where two people with the same diagnose have wildly different symptoms and effective treatments, rendering the diagnosis moot.
This is a crisis in "autism", where Asperger's and autism are different on such an extreme scale, yet the language, medical literature, and treatment plans and funding are muddling it up to the detriment of all involved, creating a culture war between people who say their mild Asperger's is a personality type not a disorder, and caregivers of people who cannot speak or provide basic self-care for themselves -- because DSM dumps them in the same diagnosis and society loses the language to disambiguate the scenarios.
I dislike psychiatry grossly because the victims of the field are not compensated by how the errors destroy the victim's life.
I'm a person who was medicated with the older & new generation of antipsychotics for two years of my early 20s because I was suffering religious conversion therapy "best I can describe it" from family and where I was in circumstances any other person would have great amounts of stress. The outcome of unfortunate events made me with a doctor who disliked me for desiring to be a woman (I was born a male) and attempted to convince me it's delusions & hallucinations; when I attempted to communicate I never suffered from either. The medication would result in me doubting myself but I eventually broke away from it all. It was impossible to find anyone to help sue for the tremendous pain (I still suffer to this day from it all) and it's been many years since it all happened.
Anyway I deeply believe there should be a special hell for people who go into this field but I doubt anyone had any will in the outcome for me being any different because I've read philosophy on determinism since then. I think the field has done more damage than good and is a net negative with getting away with it all because of government allowing it. People prefer to believe something is good and when it really isn't.
There is a book "A Road Back from Schizophrenia: A Memoir"[1]. Arnhild Lauveng came back from schizophrenia, got a degree in psychology and wrote the book, describing how it feels to have a schizophrenia. She describes doctors too. A bad ones and also those, who helped her to get back from schizophrenia.
I believe you would like that book, her experiences are like yours.
No, the experience was meaningless like life and nothing more than torture. I believe the field will die slowly and my life was worthless. I plan to act on suicide in the near future because of the torture.
The meaning of your experiences is what you make from it. It is the reason why I suggest you reading this book. A similar experience through different eyes. A psychologist probably might say about a therapeutic effect of this, but I'm not a consulting psychologist, so I rather say in a technical terms: it is hard to find meaning having just one point of data. You need at least two to draw a line.
By the way, did he disliked you because of your desire to be a woman, or for some other reason?
> I plan to act on suicide in the near future because of the torture.
It makes hard to me to speak with you. It feels like a minefield, one wrong step, one wrong word and I became a cause of someone's death.
I'll try to ignore that. Why are you suffering now? If I understood you right, torture ended at least a few years ago. Some kind of "flashbacks"?
> Importantly, what we call psychosis can also be a response to extreme stress or trauma. For many people it might best be understood as... a coping strategy gone awry or a form of storytelling carried out within the mind as a response to unbearable life events.
This. The day that mental health professionals realize this is the day that we start improving outcomes.
> there is no uncontroversial language when talking about mental illness – and that includes the phrase “mental illness”
Glad the author brought up this important point. “Illness” is bogus because it implies disease/biomarkers for which there is no evidence as the article states.
A more useful term would be “mental injury” as it frames the symptoms as a result of trauma. But I think the best term is simply “trauma” or “developmental trauma” when it goes back to childhood.
I’ve often wondered if it’s possible to induce psychosis and symptoms of schizophrenia in a subject via environmental conditioning. This seems practical to test these days, given the expanse of information possessed by large tech companies, and their lack of regulation. Perhaps this would be related research for a larger automated behavior control initiative. Does anyone have any pertinent references or info?
Restated, is it possible to develop (eventually automated) ways to “drive people crazy”. Is it possible to use data and algorithms to manipulate someone into losing contact with reality, for instance, or trick them into manifesting schizophrenic symptoms
I don't think so. One of the primary theories of schizophrenia is that the glial cells in the brain are doing too much synaptic pruning. It's more of an organic disorder than say depression or anxiety which is heavily affected by environment.
I find Xavier Amador very engaging and convincing on how to actually help schizophrenic people who say "I'm not sick, I don't need medicine": https://www.youtube.com/watch?v=Lstn6WNnCRc
Ah, where do I start. Two of my close relatives have schizophrenia, people whom I’ve known since they were born. They were both diagnosed around 19 and are now 29. In the last ten years we’ve tried many medications, hospitalizations, with little to no avail. I never understood the word curse when I was a kid. I read about it in stories and I had seen people curse each other. Living with schizophrenia is the definition of a curse. Lives wasted in an alternate reality. The lives of the care givers and family impacted terribly.
Well, this article didn’t lead to any answers or any insight for me. The whole unexplained opening of poisoning is cryptic and unhelpful. Does this nurse see the nuclear options as poison or was this doctor trying to give Amit cyanide? Who knows.
I’ve spent a month of evenings at Langley-Porter and then again at Zuckerberg, and the staff there didn’t strike me psychzombies. The last thing they wanted to do was to commit to a diagnosis of schizophrenia for my relative. I sat for an hour with the Attending on his outtake and she did everything to assure us that in her expert opinion it wasn’t black and white - drugs were part of the toolset and not The One Answer.
What’s wrong isn’t that people are ignorant. They always have been and always will be. Until you’ve been there, you won’t get it.
What’s wrong is we have brilliant people who are hamstrung by process. At SFGH it’s “If you aren’t a threat, you’re out” 7 days after the 72 hour lockdown. It’s a factory, because that’s all the runway WE give them.
We’re lucky. We’re wealthy enough and there’s enough of us that we can probably make this work.
But the other 90% in those wards? They don’t have anybody. So unless WE want to fund that level of intervention/compassion, the factory and pharmacology is the solution.
DSM and other such systems(icd for example) are for CLINICAL use. I.e. they are not academic. If 2 different mechanisms create the same symptoms and are treated by the same drugs then from a clinical aide of view separating them is pointless. Academic research on the mechanics of diseases is much more nuanced than what an article on a news site can cover. Once something is clearly separated as 2 different entities in a clinically meaningful way via research then the classification system will be updated. What this means is that if e.g. we find a way to differentiate between 2 different mechanisms for schizophrenia with each of the responding better to a different drug( even if those are already existing drugs, it gives us a shortcut to choosing the right medication without trial and error) then DSM will split schizophrenia to schizo due to x and schizo due to y with further guidelines for medication. Or split them into 2 different things entirely.
Schizophrenia can run in families. A family we knew was killed in the middle of the night by their step son with a hammer. Apparently, the disease can have a sudden onset. The mother and step father were teachers, and the whole community was affected. The son (teenager at the time) was diagnosed and has been held in a facility now for many years. The biological father has been in and out of institutions and homeless.
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[ 3.4 ms ] story [ 137 ms ] threadSchizophrenia is characterized by hallucinations, delusions, thought disorder, catatonia, etc. You don't hear much about catatonia these days because it is cleared up by benzodiazepines reliably.
Schizoid people have reduced emotional reactions compared to other people but they are in touch with reality.
Schizoaffective disorder seems to pick a few symptoms from schizophrenia and bipolar but doesn't fit the criteria for either. You might think that sounds less severe but it can be devastating.
The romanticization of schizophrenia of r.d. Liang, "one flew over the cuckoo's nest", szasz and others strikes me as particularly cruel when I see how it keeps people who are suffering from getting help.
It pictures the time when mental illness diagnostic was an easy method to put away anyone annoying or inconvenient (the subject really having a mental illness or not made little difference). It talks about institutional cruelty like torture and lobotomy.
But then I didn't read the book, just watched the movie - perhaps the "romanticization of illness" angle is more pronounced in the book but I'm pretty sure it was not the main theme and the novel did more good than bad for those diagnosed with a mental disorder or developmental disability.
As someone with bipolar disorder (very stable since diagnosis and medication) I’m always a bit dismayed when people call for locking ill people up “for their own good.” (Not that you’re necessarily saying that - it’s just something I do see people advocating for sometimes).
I’m in SF and previously lived Tenderloin-adjacent so I’m quite familiar with the unfortunate cycle of mental illness and drug/alcohol abuse from self-medicating. It’s not a pretty sight and I do think we should do everything we can to help these most vulnerable people in society. I’m just not sure taking their liberty is necessarily the best course of action.
The problem that I see is: what options are available other than violating their freedom by forcing them to undergo treatment or locking them up? You can't, for example, fine someone who doesn't have anything. Besides, I think its unlikely that punishment would accomplish anything
So I guess I'm not sure I see a good solution to the problem.
Do you think weird people that do not endanger their own life or the life of others should be locked away?
Intent is one thing, effect is another. One Flew Over the Cuckoo's Nest, the book and movie, broke ground upon its release, but one of its secondary effects was to establish the mid-20th-century mental hospital as a gothic setting, akin to the ancient stone manors of old, full of terrible secrets -- not to mention bizarre characters -- that are ripe for literary exploration. Today it's been almost completely tropified, especially since in the current era Great Literature is by definition introspectively psychological. An easy way to establish that your play or movie is "arty" is to set it in such an institution. One of the weirdest instances of this was in The Great Gatsby (2013), which wholly took place in a mental hospital (the plot of the novel being Nick's recollections to his psychiatrist) and implied that Nick admired Gatsby almost to the point of a crush and was so devastated by his death as to need psychiatric attention.
I do recommend you read One Flew Over the Cuckoo's Nest, the novel. It is written from the perspective of Chief Bromden, and his mental illness helps intensify the themes of subtle control, exercised by tyrannical people and institutions, with specific delusions he has that make him sensitive to that control.
One of my friends was sent to Napa State Hospital by his step dad because he had epilepsy. When he was seven. It took six years for his dad to win custody, because his dad was a Mexican.
That was the world of One Flew Over the Cuckoo's Nest.
"It's thought that..." when referring to how medications work.
Let's just agree that we all know nothing about mental health.
The problem with psychology is that it is a much more disjointed science than others (and has been for a long time). You have islands of logic and some overlapping theories but all of them do not follow a unified framework. It is similar to how modern physics is trying to connect quantum theory and gravity.
I'd argue that the scale of such disjointedness correlates with the power of predictability of phenomena in a certain field. It is therefore true that we know nothing and at the same time something about mental health.
Connecting and integrating psychology through evolutionary psych, behavioral theories, cognitive sciences and such is an ongoing area of research and an example of an effort which reduces disjointedness of a field which may result in more succesful predictions and deeper knowledge about mental health.
If there is a comprehensive theory it is that mental disorders and developmental disabilities come in layers.
You might have a genetic predisposition to certain problems, have that exacerbated by traumas, but learn how to compensate for them in some ways. You might do badly at certain things or certain situations but if you have support from other people, understand the difficulty, etc. you can do O.K.
The big trouble I think is that mental illness and developmental disabilities interact with the expectations that people have about others.
For instance much of the satisfaction parents get out of parenting is using their children as "self objects"; they want to dress them up, show them off, bask in their accomplishments, etc. An autistic child can't do that for them and they find that hard to accept.
The marketing of SSRI's is also distorted. They are prescribed a lot by primary care docs who need to be on top of a wide range of medical problems and can't be experts on mental health too. That is a good thing because they help people and it can be hard to get real help from a specialist.
Depression has many symptoms and for many people SSRIs help some symptoms but not others. For me, for instance, SSRIs help me control my emotions in situations where I might get overwhelmed and yell at people. I believe that they increase my self-control as opposed to suppress my emotions.
I have other symptoms that SSRIs don't help with, but I do feel like they've helped me a lot at being a parent.
Yet we know very little, like, we knew how to make fire before Lavoiser discovered the role of Oxygen in combustion.
The various paradigms we use are approximate, not unlike humor and miasma theories were of some help before we understood physiology and discovered the existence of germs.
The main theories of the 20th century (psychoanalysis and chemical imbalance) have been steadily eroded by research, but are still have far too much importance in clinic.
> You might have a genetic predisposition to certain problems, have that exacerbated by traumas.
Once we understand what genes and genes circuits are involved, and how trauma makes it worse, we'll be getting somewhere.
There is a lot of social complexity that means we may not take advantage of those facts. For instance we might get better drugs and other treatments but will that really help the people who are crapping on the street in San Francisco?
Autism in particular challenges the assumptions of society. The one thing aspies really can't do is "see the emperor's clothes". In asperger's day they did not get along well with National Socialism, today they have problems with neoliberalism.
You might fantasize that getting real help for aspies would increase their productivity a lot, mean they pay more taxes and make the help profitable for society, maybe even bend the curve of our civilization.
From another viewpoint there is more talent than there is opportunity. Maybe Aspies are 1% of the people in the top 2% of IQ, salvaging them means a small increase of the talent pool, and if you at the top of some insanely competitive pyramid (etc. academia, business) why spend money to make it more competitive for your kids...
Similarly, social structures tend to constrain the performance of science. We create the script that there is a "depression gene" and people build a career around that, maybe somebody wins a Nobel Prize, but really science is "what scientists do" and is about making stories that make sense to some people at a certain time and saying that some people are winners and others are losers. Go look at a Cochraine report on this or that and you'll see that 5000 studies got done, maybe 5 of those were done right, and there aren't enough samples to really be conclusive.
Astronomy is like this. We "know a lot" but every time somebody does a new study of Cepheid variables we find the cosmic distance scale isn't what we thought it was, the cosmological models are broken, etc.
That is, science manufactures a certainty that isn't there. "Reason" is often a label people use to attack other people. "Reason" magazine for instance has that name to say that socialists, labor unions, regulators, etc. are not "reasonable" and shouldn't be listened to.
Psychoanalysis is still very potent here though. The mothers of autistic and schizophrenic people were, for decades, vilified as responsible for the problems of their children.
A friend of mine who was anorexic for years had to endure cruel and demeaning treatments (based on Freudian BS). As she said: "As if it were funny to lose all those kilos :-/".
It's recently been found that, at least in some cases, anorexia is the result of auto-antibodies that stimulate the melanocortin receptor in the brain (the main satiety hormone). Those antibodies occur due to a cross-reaction with a protein secreted by E. Coli (CLPB). Bulimia and binge eating can have the same pathophysiology (where the antibodies block the receptor instead of activating it). Yet my friend was treated as if she was making it up, "to ultimately affirm herself".
http://graceofgodmovie.com/superdanny.mp4
It's worth watching all the way through. The difference in his attitude when I stopped being afraid of him and started treating him like a human being instead of a threat is dramatic. I learned a lot about life that day.
But we need to be careful not to downplay the incredibly severe difficulties involved in helping, treating, and even simply co-existing across the months and years with those who have schizophrenia.
I had a good friend stay with me for 2 months who ended up having significant schizophrenia-like symptoms (never found out the actual diagnosis). I tried my best to treat him like a human and get him the help he needed, but I was unable to. I don't want to go into details, but a lot of stuff happened. It was a very difficult time.
Although he's "stable", thanks to an injection every 3 weeks, he's not going to ever get better. In fact he continues to retreat further and further away from the world and life. Why don't you go to the bowling group, movie night, job placement, etc, I used to ask him (events organized by a local psych facility for their patients, etc). Those people are crazy, he said.
It's a baffling disease. Besides his hallucinations and delusions, the defining feature seems to be that it resists treatment of any kind that would lead to what you and I would call a normal life.
It might be tempting to read something like this and think "of course the crazy person thinks normal people are crazy". But I'd argue that "sane" people's reactions to mentally ill people are frequently more irrational and scary than the symptoms of the illness itself.
That is not meant to belittle the point that delusional people will strongly deny their symptoms, of course. Being close to somebody like that gets tough, especially when the delusions have led to harm to self or others -- even after they get treatment and it works, it's easy to become paranoid of relapse and fear that every small act of legit defiance or assertion of self is a recurrence of symptoms.
This is something that has been recommended for many years. Rahter than day centres where mentally ill people can go, secluded away from the world, we should provide a wider range. Still have those day centres for the people who need it, but focus on helping people reintegrate with their local communities by using "mainstream" services.
Here's a pdf from 2006, but there are earlier examples. https://lx.iriss.org.uk/sites/default/files/resources/Redesi...
So it becomes this sort of jedi trick of encouraging those things without being pushy. I don't always know how to pull that off.
Bob doesn't want a work-like scheme for mentally ill people, he wants to keep his current job and wants advice about disclosing mental illness to his employer and asking for reasonable adjustments.
These are the things that me and my friends have been campaigning for for all these years- a socially inclusive recovery model.
The Camphill Movement offers an exemplary model of how people with learning difficulties can be integrated into a genuine community. What barriers are preventing us from offering similarly strong integration for people with severe and enduring mental illness? Why are so many people with moderately severe mental health problems being excluded from society for lack of relatively modest accommodations?
Schizophrenics are real people first of all.
Congrats to your brother. I have heard it's possible for psychotic episodes to be a one-time thing and not recur. I have also seen people not get better. The whole thing is tough. It can be legit to get off the medications, but some people will need it for life. So how do you tell which situation you or a loved one is in?
I was just trying to emphasize that the diagnosis is never final, even after doctors have concluded it to be. In our case we never gave up. I think that the antipsychotic drugs make recovery extremely difficult, which is where alot of patients get trapped. The withdrawl symptoms themselves cause psychosis.
It sounds harsh, but when he's in that illness 'phase', the person seems more like a demon-possessed creature and not even like much of a person. When you hear the things and intonations that the person will say in conversations to themselves in particular.. that's what sounds the least person-like.
It is human nature to want to associate with people who display attributes you wish to see in yourself, and to avoid the converse. The aphorism "you are the average of your 5 closest friends" is based on that idea.
If your brother is self-aware of his illness and doesn't like its effects on him then his response is perfectly understandable to me.
But his problem is that he refuses to take medication, so not sure where things will end up in the future with him. It's very up and down. One day like yesterday he's hearing voices and talking to himself, then the next day he's sort of normal.
Hearing that someone else also has a family member that is going through that is helpful.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5099166/
https://www.ncbi.nlm.nih.gov/pubmed/29241357
Patients overwhelmingly prefer the term patient, and this holds true every time we ask them what they want to be called.
Service user is a term imposed upon them by well-intentioned mental health professionals and academics who don't recognise their own power dynamic and who do a poor job of coproduction.
> while the council of the Royal College of Psychiatrists recently recommitted to “patient”.
...after they asked people what their preferred term is.
Most real world solutions are shitty and incomplete.
Biological stress is related to things like being malnourished and/or having hormonal imbalances (thyroid, cortisol, progesterone, etc), not getting enough sunlight (no red light -> winter sickness / UV light-> Vitamin D), etc. Biological stress is worsened when a person is medicated with patent medicines that are approved for treating behavioral symptoms by implementing wrong-theory about the cause of the behavioral symptom (i.e., inadequate serotonin -> depression [0], excess dopamine -> psychosis, etc).
Some scientists rediscovered a few years ago that the behavioral symptom of "psychosis" is strongly associated with an inability to make adequate amounts of the stress hormone cortisol [1].
Emotional stress has to do with people feeling trapped. From the article: "Importantly, what we call psychosis can also be a response to extreme stress or trauma."
Emotional stress leads to the release of cortisol too. If a person's long-term emotional stress exceeds their ability to compensate, their "mental health" will suffer.
One part of this article is about forcibly medicating people whom the professionals think don't realize they need the pills they're prescribed. IMHO, it is an act of violence to force a person to take pills that make them suicidal [2]. The legal systems generally recognize that people have a choice in medical treatments, but struggles with patients who don't even realize they have a problem [3], and/or don't like the treatments the professionals think they need. In the US the courts have decided that people can't be "helped" against their will without a court order. This is why Jared Loughner, the man who shot up Congresswoman Gifford's event, couldn't be helped, even though the people around him noticed that his behavior had changed [4].
The professionals tried to label my girlfriend as "schizophrenic". Really she was just stressed ("lonely"), and was suffering from the adverse effects of various medical interventions. Methadone causes sugar cravings; she'd taken to treating this medication-induced metabolic problem with alcohol a few days before we'd met (alcohol has 7 calories/gram, while sugar only has 4 calories/gram).
In my initial assessment she also reported being injected with a prescription endocrine disruptor maybe 10 years before [5]. This prescription drug has warnings about endocrine disruption [6], but doctors don't appreciate their patients' iatrogenic deterioration when it's associated with this defective drug.
My girlfriend became psychotic when she ran out of alcohol , but rather than treating her for the cause [7] they treat her for the symptom with "anti-psychotics". I consider her involuntary treatment program to be "medical assault". I found a lawyer a while back who was familiar with how the state's involuntary treatment system works, but lawyers are expensive, so I tried to go at it myself. Maybe the legal guild didn't take kindly to a legal-nobody pointing out that their system is ugly.
I guess I'm going to hire the lawyer.
tl/dr: The conventional practices of the mental health industry are wrong. Institutional inertia prevents the profession from fixing itself. Little bits of progress have been made in recognizing the system's contribution to the patient's problems. As I said before, the system needs a re-write: https://news.ycombinator.com/item?id=19545964
[0] What has serotonin to do with depression? - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471964/
[1]...
Genome-wide association studies have recently shown that schizophrenia was in fact several distinct diseases [0]. Their symptoms turn out to be mediated by the same drugs, to the extent that they makes the people who suffer from those ailments manageable.
If your house suddenly becomes cold in the winter, putting on a jacket will help you feel better. You wouldn't infer from that that your furnace is down because of a clothing imbalance.
[0] https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2...
This is a crisis in "autism", where Asperger's and autism are different on such an extreme scale, yet the language, medical literature, and treatment plans and funding are muddling it up to the detriment of all involved, creating a culture war between people who say their mild Asperger's is a personality type not a disorder, and caregivers of people who cannot speak or provide basic self-care for themselves -- because DSM dumps them in the same diagnosis and society loses the language to disambiguate the scenarios.
I'm a person who was medicated with the older & new generation of antipsychotics for two years of my early 20s because I was suffering religious conversion therapy "best I can describe it" from family and where I was in circumstances any other person would have great amounts of stress. The outcome of unfortunate events made me with a doctor who disliked me for desiring to be a woman (I was born a male) and attempted to convince me it's delusions & hallucinations; when I attempted to communicate I never suffered from either. The medication would result in me doubting myself but I eventually broke away from it all. It was impossible to find anyone to help sue for the tremendous pain (I still suffer to this day from it all) and it's been many years since it all happened.
Anyway I deeply believe there should be a special hell for people who go into this field but I doubt anyone had any will in the outcome for me being any different because I've read philosophy on determinism since then. I think the field has done more damage than good and is a net negative with getting away with it all because of government allowing it. People prefer to believe something is good and when it really isn't.
I believe you would like that book, her experiences are like yours.
[1] https://www.amazon.com/Road-Back-Schizophrenia-Memoir/dp/161...
By the way, did he disliked you because of your desire to be a woman, or for some other reason?
> I plan to act on suicide in the near future because of the torture.
It makes hard to me to speak with you. It feels like a minefield, one wrong step, one wrong word and I became a cause of someone's death.
I'll try to ignore that. Why are you suffering now? If I understood you right, torture ended at least a few years ago. Some kind of "flashbacks"?
This. The day that mental health professionals realize this is the day that we start improving outcomes.
> there is no uncontroversial language when talking about mental illness – and that includes the phrase “mental illness”
Glad the author brought up this important point. “Illness” is bogus because it implies disease/biomarkers for which there is no evidence as the article states.
A more useful term would be “mental injury” as it frames the symptoms as a result of trauma. But I think the best term is simply “trauma” or “developmental trauma” when it goes back to childhood.
I’ve spent a month of evenings at Langley-Porter and then again at Zuckerberg, and the staff there didn’t strike me psychzombies. The last thing they wanted to do was to commit to a diagnosis of schizophrenia for my relative. I sat for an hour with the Attending on his outtake and she did everything to assure us that in her expert opinion it wasn’t black and white - drugs were part of the toolset and not The One Answer.
What’s wrong isn’t that people are ignorant. They always have been and always will be. Until you’ve been there, you won’t get it.
What’s wrong is we have brilliant people who are hamstrung by process. At SFGH it’s “If you aren’t a threat, you’re out” 7 days after the 72 hour lockdown. It’s a factory, because that’s all the runway WE give them.
We’re lucky. We’re wealthy enough and there’s enough of us that we can probably make this work.
But the other 90% in those wards? They don’t have anybody. So unless WE want to fund that level of intervention/compassion, the factory and pharmacology is the solution.
Such a terrible disease.