Posts tagged psychotic
Posts tagged psychotic
At last, a promising alternative to antipsychotics for schizophrenia
By Daniel and Jason Freeman, the authors of Paranoia: The 21st Century Fear
For many, the side-effects of antipsychotics are worse than the symptoms they’re meant to treat. No wonder some people with schizophrenia refuse to take them.
Imagine that, after feeling unwell for a while, you visit your GP. “Ah,” says the doctor decisively, "what you need is medication X. It’s often pretty effective, though there can be side-effects. You may gain weight. Or feel drowsy. And you may develop tremors reminiscent of Parkinson’s disease." Warily, you glance at the prescription on the doctor’s desk, but she hasn’t finished. "Some patients find that sex becomes a problem. Diabetes and heart problems are a risk. And in the long term the drug may actually shrink your brain … "
This scenario may sound far-fetched, but it is precisely what faces people diagnosed with schizophrenia. Since the 1950s, the illness has generally been treated using antipsychotic drugs – which, as with so many medications, were discovered by chance. A French surgeon investigating treatments for surgical shock found that one of the drugs he tried – the antihistamine chlorpromazine – produced powerful psychological effects. This prompted the psychiatrist Pierre Deniker to give the drug to some of his most troubled patients. Their symptoms improved dramatically, and a major breakthrough in the treatment of psychosis seemed to have arrived.
Many other antipsychotic drugs have followed in chlorpromazine’s wake and today these medications comprise 10% of total NHS psychiatric prescriptions. They are costly items: the NHS spends more on these medications than it does for any other psychiatric drug, including antidepressants. Globally, around $14.5bn is estimated to be spent on antipsychotics each year.
Since the 1950s the strategy of all too many NHS mental health teams has been a simple one. Assuming that psychosis is primarily a biological brain problem, clinicians prescribe an antipsychotic medication and everyone does their level best to get the patient to take it, often for long periods. There can be little doubt that these drugs make a positive difference, reducing delusions and hallucinations and making relapse less likely – provided, that is, the patient takes their medication.
Unfortunately, dropout rates are high. This is partly because individuals sometimes don’t accept that they are ill. But a major reason is the side-effects. These vary from drug to drug, but they’re common and for many people are worse than the symptoms they are designed to treat.
In addition, antipsychotics don’t work for everyone. It is estimated that six months after first being prescribed them, as many as 50% of patients are either taking the drugs haphazardly or not at all.
The conventional treatment for this most severe of psychiatric illnesses, then, is expensive, frequently unpleasant, and not always effective even for those who carry on taking the drugs. But it is what we have relied upon – which helps to explain why the results of a clinical trial, recently published in The Lancet, have generated so much interest and debate.
A team led by Professor Anthony Morrison at the University of Manchester randomly assigned a group of patients, all of whom had opted not to take antipsychotics, to treatment as usual (involving a range of non-pharmaceutical care) or to treatment as usual plus a course of cognitive therapy (CT). Drop-out rates for the cognitive therapy were low, while its efficacy in reducing the symptoms of psychosis was comparable to what medication can achieve.
So what exactly is CT for schizophrenia? At its core is the idea that the patient should be encouraged to talk about their experiences – just as they would for every other psychological condition. Psychosis isn’t viewed as a biological illness that one either has or does not have. Instead, just like every other mental disorder, psychotic experiences are seen as the severest instances of thoughts and feelings – notably delusions and hallucinations – that many of us experience from time to time.
Working together, the patient and therapist develop a model of what’s causing the experiences, and why they’re recurring. These factors will vary from person to person, so what is produced is a bespoke account of the individual’s experience, which is then used to guide treatment. For example, a person so worried by paranoid fears that they won’t set foot outside might be helped to trace the roots of their anxiety to past experiences; to gradually test out their fearful thoughts; and to learn to manage their anxiety while getting on with the activities they enjoy. An individual troubled by hearing voices will be helped to understand what’s triggering these voices, and to develop a more confident, empowering relationship with them.
These are early days. Nevertheless, most of the meta-analyses of CT’s efficacy for psychosis, when added to standard treatment, have indicated definite (albeit modest) benefits for patients, with the latest showing that CT is better than other psychological treatments for reducing delusions and hallucinations. The latest guidelines from the UK’s National Institute for Health and Care Excellence (Nice) recommend it for those at risk of psychosis and, when combined with medication, for people with an ongoing problem.
But not everyone is convinced, and although the research published in The Lancet is encouraging, it was small scale. CT for psychosis is still evolving, and we think that evolution should prioritise three key areas.
First, we must focus on understanding and treating individual psychotic experiences. As we’ve reported in a previous post, there is increasing reason to doubt the usefulness of the diagnosis “schizophrenia”. The term has been used as a catch-all for an assortment of unusual thoughts and feelings that often have no intrinsic connections, and aren’t qualitatively different from those experienced by the general population. Each psychotic experience may therefore require a tailored treatment.
Second, we must build on the recent transformation in understanding the causes of psychotic experiences, taking one factor at a time (insomnia, say, or worry), developing an intervention to change it, and then observing the effects of that intervention on an individual’s difficulties.
And finally, we must listen to what patients want from their treatment – for example, by focusing on improving levels of wellbeing, which tend to be very low among people with schizophrenia.
What about costs compared with drug treatment? A course of CBT is typically just over £1,000, but if it leads to a reduction in the amount of time patients spend in hospital and their use of other services, or a return to work, then it easily pays for itself.
The Nice guidance on psychosis and schizophrenia, updated this year, is unequivocal:
"The systematic review of economic evidence showed that provision of CBT to people with schizophrenia in the UK improved clinical outcomes at no additional cost. This finding was supported by economic modelling undertaken for this guideline, which suggested that provision of CBT might result in net cost savings to the NHS, associated with a reduction in future hospitalisation rates."
If the real promise of cognitive therapy can be fulfilled, we may at last have a genuinely effective, relatively cheap, and side-effect-free alternative to antipsychotics for those patients who don’t wish to take them.
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Parkinsonism a Major Mortality Risk Factor in Schizophrenia
By Daniel M. Keller, PhD
There may be differences between different antipsychotic medications and their possible contribution. ”Specific treatments with clozapine or olanzapine could be related to more comorbidity and mortality,”
Compared with control individuals, patients with schizophrenia have significantly more physical comorbidity, including the novel finding that Parkinsonism is a major risk factor for inhospital mortality in this population, new research shows.
A case-control study of general hospital admissions showed that the most common comorbidity among patients with schizophrenia was type 2 diabetes mellitus (T2DM). Twenty more physical diseases were also more prevalent, many of them associated with diabetic complications. Interestingly, Parkinsonism was a major risk factor for inhospital mortality in schizophrenia.
The research was a collaboration between investigators in Germany and the United Kingdom. Speaking here at the 22nd European Congress of Psychiatry (EPA), Dieter Schoepf, MD, of the Department of Psychiatry at the University Hospital of Bonn, Germany, said that the study population comprised all admissions to 3 general hospitals in Manchester, United Kingdom (N = 369,488) between January 1, 2000, and June 30, 2012.
It included 1418 patients who met diagnostic criteria for schizophrenia at initial admission according to the tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Control patients were 14,180 age- and gender-matched hospital patients at initial admission.
Five Major Findings
The study produced 5 major findings related to comorbidities affecting hospitalized patients with schizophrenia. First, they had a nearly 2-fold increased hospital-based mortality rate (18.0%) compared with control patients (9.7%) during the observation period. And the schizophrenic patients died at a younger mean age (64.4 ± 1.0 vs 66.2 ± 0.4 years, respectively).
Second, "schizophrenics as compared to controls had a more severe course of illness and a shorter survival after their initial hospitalization," Dr. Schoepf reported. For the entire group of schizophrenic patients, survival averaged 1895 ± 35.1 days vs 2161 ± 11.6 days for all control patients. For deceased patients in each group, survival averaged 951.4 ± 62.9 vs 1030 ± 28.0 days, respectively.
Third, patients with schizophrenia had substantially more physical diseases. Among 21 diseases with increased prevalence among the study population compared with control patients, odds ratios (ORs) ranged from 5.3 for fracture of the femur neck to 1.3 for asthma.
"T2DM was the most common disproportionally increased physical comorbidity," Dr. Schoepf said. Its prevalence among schizophrenic patients was double that of the control patients (17.4% vs 8.5%; OR = 2.3; 95% confidence interval [CI], 2.0 - 2.6).
The fourth major finding was that among schizophrenic patients who died, T2DM was the most common physical comorbidity, contributing to about one third (31.4%) of those deaths, compared with 16.9% of deceased control patients.
Parkinsonism affected 1.6% of the study group vs 0.4% of control patients (OR = 4.7; 95% CI, 2.8 - 7.7). It was present in 5.5% of deceased study group patients but in only 1.5% of control patients who died.
Excluding Parkinsonism, a major risk factor for death among the schizophrenic group, the researchers developed a model that identified 9 other mortality risk factors that “had an equal impact on inhospital death in schizophrenics as compared to controls,” Dr. Schoepf reported.
Although the prevalence of these risk factors differed between the 2 groups, their impact on inhospital mortality did not differ when these comorbidities were present in patients in either group. The comorbidities were as follows: T2DM, chronic obstructive pulmonary disease, pneumonia, bronchitis, iron-deficiency anemia, type 1 diabetes, ischemic stroke, nonspecific renal failure, and alcoholic liver disease.
Speaking with Medscape Medical News, session chair Guillermo Lahera Forteza, MD, PhD, professor of psychiatry at the University of Alcalá, Spain, who was not involved in the study, praised it as "impressive…especially the relationship between Parkinsonism and mortality in patients with schizophrenia. I was really shocked about this figure." He added that the relationship between T2DM and mortality has been well known, but the finding about Parkinsonism is something new.
Dr. Lahera Forteza said he has questions about the causes of death in cases in which comorbidities exist. There may be differences between different antipsychotic medications and their possible contribution.
"Specific treatments with clozapine or olanzapine could be related to more comorbidity and mortality," he said, but Dr. Schoepf noted that there are not enough data from this study on this point.
Dr. Lahera Forteza advises physicians “to restudy every treatment when the patient has this kind of comorbidity ― to re-evaluate and reassess the pharmacological treatment in every patient.” In addition, physicians should recognize the impact of lifestyle on these patients, who often smoke, drink alcohol, and do not get enough exercise. Negative symptoms, cognitive impairment, and social stigma can all affect lifestyle and contribute to or exacerbate physical comorbidities.
Dr. Schoepf and Dr. Lahera Forteza report no relevant financial relationships. The study had no commercial funding.
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Stress & Schizophrenia: How to Help Your Loved One & Yourself
By Margarita Tartakovsky, M.S.
Associate Editor, PsychCentral
The authors emphasize the idea people with schizophrenia are “more sensitive to the effects of stress because it can trigger symptom relapses and rehospitalizations.” Helping your loved one deal with stress in a healthy way helps them pursue their personal goals and improves their life.
A common cause of relapse in schizophrenia is “difficulty managing high levels of stress,” according to Susan Gingerich, MSW, a psychotherapist who works with individuals with schizophrenia and their families.
Learning to manage stress isn’t just important for preventing relapse; it’s also important because stress is an inevitable part of facing new challenges and working to accomplish personal goals — “what recovery is all about,” write Gingerich and clinical psychologist Kim T. Mueser, Ph.D, in their book The Complete Family Guide to Schizophrenia.
Learning to navigate stress healthfully is key for family and friends, too. Having a loved one with schizophrenia can be stressful. Taking care of yourself enhances your well-being and daily functioning. And it means you’re in a better, healthier place to help your loved one.
In their comprehensive book, Mueser and Gingerich share excellent tips for helping your loved one and yourself cope with stress (along with valuable information on schizophrenia and how you can support your loved one).
Here are those suggestions and insights on managing and alleviating stress.
Recognizing Stress Signs
What one person finds enjoyable, another can find stressful. In the same way, how people respond to stress will differ. For instance, one person might exhibit changes in mood, such as becoming depressed and anxious, while another person will show physical signs, such as experiencing headaches and a heightened heart rate.
So it’s important to talk to your loved about their individual signs of stress. Talk about your personal signs, as well. Create separate lists for each of your reactions to stress.
Reducing Sources of Stress
The authors suggest thinking about what situations were stressful for your loved one in the past. Then try to avoid that situation or modify it. If your loved one had a tough time at Thanksgiving last year, it might help to shorten their stay or not go next year.
It’s also helpful to support your loved one in creating a stimulating environment with reasonable expectations. For instance, rather than attend a day program three times a week, one man preferred volunteering twice a week delivering meals to housebound seniors.
Plus, it’s important that you take care of yourself. Eat nutrient-rich foods, get enough sleep, participate in physical activities and engage in fun hobbies. Help your loved one identify what kinds of activities they’d like to do, too.
As the authors point out, because of the negative symptoms of schizophrenia, individuals can have a hard time thinking of enjoyable activities. Talk with them about the activities they’ve enjoyed in the past.
Be sure to give yourself and your loved one credit. (Being self-critical just spikes your stress.)
Mueser and Gingerich note how one father acknowledges the positive things that happen on a daily basis: “I’m proud of how persistent my daughter has been in pursuing her art career in spite of the many difficulties she’s encountered. We both have a lot to learn about coping with this illness, but we’ve also come a long way.”
Learning to Cope with Stress
Emphasize the importance of your loved one communicating with others when they’re feeling stressed, since “these feelings can be an early warning sign of relapse,” according to the authors. Make sure you, too, are able to turn to individuals who understand your situation.
Have family meetings to talk openly about the stressor and brainstorm potential solutions. Learn to use relaxation techniques, such as deep breathing, progressive muscle relaxation and visualization (such as imagining a serene beach scene).
Self-defeating thoughts only bolster stress for both of you. Try to practice positive self-talk and teach your loved one to do the same.
Mueser and Gingerich share the example of a father helping his daughter reframe her hospitalization, which made her feel like a failure: “I’m sorry you had to go through that, but I’m proud of you for getting help when you needed it and for being so strong in dealing with this illness. You’re a survivor.”
Don’t underestimate the power of humor. Try to find the lighter side of a stressful situation, according to the authors. It’s not always – or usually – easy, but it helps with stress. Plus, you and your loved one can enjoy a funny film or sitcom to lessen stress.
For some people, religious services and prayer can be very helpful. For others being in nature may feel like a spiritual experience and shrink stress.
Again, regular exercise — around three times a week — that you enjoy is important for both of you. Journaling can provide a great source of stress relief. “Many people with schizophrenia say that writing down what they experience, think, and feel is an important outlet.”
See if your loved one is interested in listening to music or making music themselves, such as singing or taking lessons; visiting art exhibits or creating their own art; playing games with family and friends; and pursuing other hobbies.
As the authors emphasize, people with schizophrenia are “more sensitive to the effects of stress because it can trigger symptom relapses and rehospitalizations.” Helping your loved one deal with stress in a healthy way helps them pursue their personal goals and improves their life.
Plus, working together to develop healthy coping strategies can strengthen your relationship and gives you plenty of opportunities for savoring quality time.
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Substance abuse worsens course of first-episode psychosis
By Afsaneh Gray
The identification of potentially modifiable environmental predictors, such as substance use […] allows us to envisage a preventive approach to chronicity in psychotic disorders
Patients with first-episode psychosis (FEP) who also present with substance abuse have a higher rate of hospitalisation after 12 months than their peers who do not, an Italian study reports.
The difference remained significant even in patients who stop using substances after psychosis onset, the study researchers note.
“The identification of a ‘potentially modifiable’ environmental predictor of the course of the illness such as substance use at sychosis onset allows us to envisage the possibility of ameliorating the course of the illness by managing this factor,” say lead author Ilaria Tarricone (Bologna University) and colleagues.
They carried out a 12-month follow-up study of an incidence cohort of 163 patients who presented with FEP at one of three community mental health centres in Bologna between January 2002 and December 2009. Patients fell into four diagnostic groups: affective psychoses, non-affective psychoses, schizophrenia (including schizoaffective disorder) and substance-induced psychoses.
The frequency of use of cannabis and other drugs was recorded using the Cannabis Experience Questionnaire.
Tarricone and co-workers found that the 50 patients who used substances were significantly more likely to be hospitalised during follow-up than non-users, with 32 (64%) requiring hospitalisation compared with 27 (24%).
The odds of hospitalisation were 5.8 times greater for substance users, after adjusting for age, gender, being single and duration of untreated psychosis., factors which also significantly influenced the chance of compulsory hospitalisation.
And even if patients stopped using substances after the onset of FEP, they still had a significantly higher rate of hospitalisation compared with non-users, at 61% versus 24%.
Substance use was not only associated with an increased likelihood of hospitalisation, but also of compulsory hospitalisation, with rates of 35% versus 12% for non-users.
Male gender and being single were found to be associated with a higher rate of hospitalisations, and substance abuse seemed to affect particularly male, native Italian patients.
Writing in Schizophrenia Research, the researchers conclude: “The identification of potentially modifiable environmental predictors, such as substance use, on the course of the illness and of a specific group of patients who more frequently present this factor, such as native young men in Bologna, allows us to envisage a preventive approach to chronicity in psychotic disorders.”
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You Can Change Schizophrenia’s Name, But the Stigma Will Be the Same
By Marvin Ross
Bill MacPhee, the publisher of SZ Magazine (formerly known as Schizophrenia Digest), has just launched a campaign to change the name of schizophrenia in order to, as he says, “stop stigma.” The name change suggestion is not new, but what is different is his proposal to change the name to MacPhee Syndrome.
Mr. MacPhee argues, “When people hear the word ‘schizophrenia’ they think the worst. They research the word and find the media reference people like James Holmes the Colorado movie shooter or John Hinckley who shot president Reagan.” He goes on to say that when people think of schizophrenia, they never think of someone like him. Mr. MacPhee does have schizophrenia, but he is also the publisher of Magpie Media in Fort Erie, Ont., and a man with a wife and three kids.
His campaign is using crowd source funding to try to raise $75,000 towards a North American tour kicking off April 2 in his home town of Fort Erie, petitioning The Diagnostic and Statistical Manual of Mental Disorders (DSM) and launching a letter writing campaign to encourage them to change the name in their next revision.
The name for schizophrenia was already changed in Japan in 2002. According to a description of that name change process in World Psychiatry, the old name Seishin Bunretsu Byo (“mind-split-disease”) was replaced with Togo Shitcho Sho (“integration disorder”). Before that change, only 7% of doctors always told their patients diagnosed with schizophrenia that they had the disorder, while 37% only told the families and not the patients. Japan had a long history of negative attitudes towards schizophrenia and inhumane treatment to those suffering from it. Prior to 1950, schizophrenia patients in Japan were incarcerated with restraints, so it was understandable that doctors were reluctant to provide that diagnosis. After the change of name in 2004, almost 70% of patients were told their diagnosis.
I haven’t been able to find any data on how well those with schizophrenia are doing in Japan as a result, although the treatment guidelines developed for the new name now recommend community-based care instead of hospitalization; a treatment plan including medication and psychosocial intervention; and therapeutic alliances with other professionals.
It would be interesting to know if as many Japanese with schizophrenia wind up untreated, homeless and in prison as is the case in North America. Our system, as a Toronto Star article on the mentally ill in jail noted, is considered medieval by experts. Criminal defence lawyer Frank Addario is quoted as saying, “It’s like putting you in jail for having cancer.”
In the Western Hemisphere, the term salience syndrome has been suggested as an alternative to the term schizophrenia. “Salience refers to how internal and external stimuli are consciously experienced and how, unwilled or overinclusive attention to some stimuli can become perplexing and foster a search for explanations which are later recognized as delusional” according to a 2013 published research study that attempted to see if changing schizophrenia to salience syndrome would in fact make any difference.
The study found that it would not!
One part of this study involved 161 undergraduate students at the University of Montreal. Students were told of another student called Nathan who had become withdrawn, was missing classes, looked dishevelled and was becoming paranoid. Half were told that he was diagnosed with schizophrenia and half that he was diagnosed with salience syndrome.
They were then asked to respond to the following five questions using a five-point scale, ranging from very unlikely to very likely:
1. Do you think that this would damage Nathan’s career?
2. I would be comfortable if Nathan was my colleague at work?
3. I would be comfortable about inviting Nathan to a dinner party?
4. How likely do you think it would be for Nathan’s girlfriend to leave him?
5. How likely do you think it would be for Nathan to get in trouble with the law?
Students showed no significant differences in their response to these questions regardless of being told the diagnosis was schizophrenia or salience syndrome.
A second study was done with 19 patients in a first episode psychosis clinic and the researchers found that “the majority of participants preferred a diagnosis of salience syndrome, considering it less stigmatizing mostly because of its novelty and the concealing potential of the new diagnostic entity, though many found it hard to relate to and somewhat difficult to understand.”
As Gertrude Stein said, “a rose is a rose is a rose.” Changing the name will not reduce what is.
Mr. MacPhee is to be commended for his efforts to bring awareness to these issues, but stigma exists because we are focusing on the wrong things; that is why I wondered above if many in Japan are still untreated.
That, in my opinion, is the main reason for stigma. The image that the public has of those with schizophrenia is of violent, potential killers and dishevelled homeless people wandering the streets. That is who they see in public and in the news, so it is no wonder that the response is to shun all. Those who are treated are invisible because they are mostly just like us.
Mr. MacPhee and I have both been on the board of the Schizophrenia Society of Ontario, I sometimes contribute freelance articles for his magazine, and I’ve sat and had coffee with him. Most people would not give him a second glance if they passed him on the street, nor would they fear having a coffee with him. He would not be capable of all that he has achieved if he was not getting treatment. And that goes for many people with schizophrenia.
Elyn Saks is a Professor of Law, Psychology, and Psychiatry and the Behavioral Sciences at the University of Southern California Gould Law School and she has schizophrenia. Dr. Fred Frese is associate professor of psychiatry at Northeast Ohio Medical University; clinical assistant professor at Case Western Reserve University; and coordinator of the Summit County Recovery Project. He also has schizophrenia. Dr. Carolyn Dobbins has been a practising psychotherapist for over 25 years and suffers with schizoaffective disorder.
The key to the success of these people and all who are doing well is proper treatment and that is what we fail to provide as well as we should as a society. Dr. Julio Arboleda-Florez of Queen’s University in Kingston, Ontario wrote in an editorial in the Canadian Journal of Psychiatry in November 2003 that “helping persons with mental illness to limit the possibilities that they may become violent, via proper and timely treatment and management of their symptoms and preventing social situations that might lead to contextual violence, could be the single most important way to combat the stigma that affects all those with mental illness.”
It is truly mind boggling that we, as a society, care so little for the suffering of those with serious mental illnesses like schizophrenia that we continue to fail to provide them with proper treatment. We ourselves stigmatize and shun those who we refuse to provide with the treatment that would relieve them of their suffering. And so, if Mr. MacPhee can help emphasize that in his campaign, then I wish him well.
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Living with Schizophrenia
By Mike Hedrick
Living with SchizophreniaI’m sitting in a coffee shop at 7:53 a.m. and I’m minding my own business but I hear barely audible chatter and laughter from the baristas behind the bar and I can only think that there’s something about the way I’m sitting here on my computer writing that’s making them laugh at me.
I wonder if I look OK, if the way my hoodie sits on my shoulders looks funny or if I said something and sounded weird or if the way I’m typing with only the middle fingers on both of my hands warrants some kind of ridicule.
The truth is, I know they’re not laughing at me but every waking hour of every day I’m plagued by the notion that I’m an object of ostracism.
This is a little thing called paranoia and it’s become my bittersweet companion in the last eight years since I was diagnosed with schizophrenia.
It started when I was 20, first with paranoia in college and developing from there until I was getting secret messages from the TV and radio, afraid even to leave my house and consumed by conspiracy theories.
It all came to a head when I somehow became convinced that I was a prophet and undertook a spur-of-the-moment trip across the country to the U.N., convinced that I would be ushered in as the next president or king or something like that.
The trip took me from New York to Boston as I followed meaningful colors and secret messages in street signs and nonverbal communication from random people on the street.
From Boston I took a Greyhound bus to a small town called Woods Hole, where I was convinced there was a hole through the woods to Canada where I could live and work on a farm and grow pot for the remainder of my life.
Unfortunately, there was no hole to Canada. After a few days with a well-meaning stranger I took a train back to Colorado, where my parents picked me up and dropped me off at the psych ward of the Boulder Community Hospital. I spent the next week there.
I’ve made strides in the last eight years to a place where I’m comfortable. I’ve also gained 60 pounds because of the side effects of powerful antipsychotic medications coursing through my bloodstream. I’ve become a hermit because I know the only place I’m really, truly free from ridicule or the very possibility of ridicule is alone in my second-floor apartment on the edge of town.
I’m also still afraid. I’m afraid to make eye contact because I know if I do you’ll see something weird about the way I do it and laugh about it the rest of the day with your friends. I’m afraid to even consider a relationship because I know that if I broach even the subject of vulnerability with someone, they’ll inevitably use it against me and make fun of me and destroy whatever reputation I think I may have.
I know the truth is simpler. I know people are generally pretty good and pretty nice but there’s a devil on my shoulder that will always whisper otherwise whenever things start to go well.
There are countless times I’ve sacrificed any notable improvement as a human being because it took away somehow from my sense of ease, from the quiet, simple, albeit lonely life I need to stay centered.
Among the things I’ve sacrificed are meaningful career opportunities where I’m fully capable of doing whatever job they ask of me — but I know that if I continue to do it I’ll have another nervous breakdown.
Most recently I adopted a dog named Bella. I took her back a week and a half later because I couldn’t handle constantly considering the needs of another living creature. She was a great dog and didn’t have any considerable problems. But because I’m an insecure, paranoid shell of a man who needed personal space to stay sane, she had to go back to the pound.
I’m nowhere near as crazy as I was but I still hear voices and sounds sometimes and they scare the hell out of me.
I’m still delusional that things mean more than they actually do — body language, smiles, voice inflections, behavior intonations. I’m always worried about these things but the worry has become so second nature to me that I don’t think about it.
I’ve gotten to the point where I’m no longer worried about worrying so much and that’s about the best I can ask for.
The point I’m trying to make is that schizophrenia is a hell of drug. It’ll throw a wrench in any notion of a normal life you’ve ever had but it will also make you thank Christ, the universe or Satan for the simple things like a warm cup of coffee in the morning as the sun rises, the strength of a family that’s seen pain, and the joy of a good cigarette.
Some days are good and some days are bad but that’s life, right?
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[In the News] Study Says Comedians Have Psychotic Personality Traits—Here’s What Some Comedians Have To Say About That
By Asawin Suebsaeng
The popular belief that creativity is associated with madness has increasingly become the focus of research for many psychologists and psychiatrists. However, despite being prime examples of creative thinking, comedy and humor have been largely neglected. To test the hypothesis that comedians would resemble other creative individuals in showing a higher level of psychotic characteristics related to both schizophrenia and manic depression. A group of comedians (n = 500+) and a control sample of actors (n = 350+) completed an online questionnaire containing the short version of the Oxford–Liverpool Inventory of Feelings and Experiences (O-LIFE), with scales measuring four dimensions of psychotic traits. Scores were compared with general population norms. Comedians scored significantly above O-LIFE norms on all four scales. Actors also differed from the norms but on only three of the scales. Most striking was the comedians’ high score on both introverted anhedonia and extraverted impulsiveness. This unusual personality structure may help to explain the facility for comedic performance.
If you’ve ever seen footage of comedian Bill Hicks taking on a heckler, you might have thought to yourself, “Wow, that was pretty psychotic.”
Well, according to a recent study published in the British Journal of Psychiatry, you weren’t that far off. For the study, which is titled, “Psychotic traits in comedians,” researchers recruited 523 comedians (404 male and 119 female, most of whom were amateurs) from the United States, Australia, and the United Kingdom. The researchers determined that comedians scored significantly higher on four types of psychotic personality traits compared to a control group of individuals who had non-artistic jobs. The study focuses on two major categories of psychosis—bipolar disorder and schizophrenia—and examines impulsive non-conformity.
"The results of this study substantially confirmed our expectation that comedians would behave like other creative groups in showing a high level of psychotic personality traits," the authors wrote. “They did so across all the domains sampled by the questionnaire we used, from schizoid and schizophrenic-like characteristics through to manic-depressive features.”
The 6-page report also highlights English comedian and actor Stephen Fry, who has been diagnosed with bipolar disorder and attempted suicide in 2012.
However, it’s important to point out that the authors of the study aren’t saying all famous or successful comedians are automatically pathologically bipolar or pathologically schizophrenic, or even that they necessarily require treatment. In other words, labeling someone’s personality traits as in the realm of “psychotic” may sound a bit scary—but it doesn’t mean that person is a psychopath or a menace to society.
Still, some professional comedians aren’t big fans of this. According to Steve Hofstetter, a former Sports Illustrated columnist and one of most booked comic acts on the American college circuit, a large number of comedians have been taking to social media to share and mock the study in the past couple of days. "The new study claiming comedians have psychotic personality traits was written by a troll who talks to me from inside my butthole," Adam Newman wrote, for instance. Hofstetter has a much harsher take.
"The idea that it’s a news story that comedians are rebels is the equivalent of saying it’s a news story that people who spend their lives conducting studies never get laid," the Los Angeles-based comedian says. “And if you look at the actual results of the study, it shows that actors were not that far off from comedians at all. So this was clearly a study conducted on the hypothesis that comedians have mental problems.”
Rob Delaney, the author and stand-up comedian who was named Mitt Romney’s “Twitter nemesis” during the 2012 election, was similarly critical of the comedians-are-psychotic study—but he was significantly less pissed about it.
"My honest opinion is that piece really has no effect on me," Delaney wrote in an email. "Plus, [the study] defangs itself when it says, ‘we’re not saying they’re the dangerous kind of psychopath,’ so really I just think it’s an attention-grabber and not actually a substantive piece of information. Do you need a psychological kink of some kind to function as a comedian, particularly one that makes a living at it? Yes. Is that kink psychosis or close to psychosis? I don’t know and I don’t really care. But perhaps that means I’m a psychopath? Maybe. I know I brutally pursue my goals regardless of whatever the hell else is happening in the world and anticipate success in all my endeavors, even when that feeling is unfounded. So that’s what I think.”
(Lewis Black, Joan Rivers, and Gallagher did not respond to requests for comment.)
So whatever the researchers’ intentions, perhaps their new report hasn’t won them any new friends in the community of stand-up comics. Hell, at least they didn’t author a study telling comedians that they were going to drop dead at a young age.
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Modern “civilized” cultures do not have a good relationship with the wild. It seems we are always doing everything possible to shut it out of our lives, or to kill or tame it to the point where it is unrecognizable. Yet that which is wild is always still lurking, somewhere over the edge of our boundaries and frontiers, and also inside people, both inside the “others” we might approach warily on the street, and even inside our family members and ourselves.
Another name for the Wild is Mystery, or the Unknown. We like to pretend that the Unknown is just a small affair of no great importance, but we are shadowed by a sense that the Unknown or Mystery totally dwarfs and makes a mockery of everything we think we know. So we commonly act as quickly as we can to suppress that sense, to find whatever allows us to go back to thinking we know what we are doing.
And yet, as much as we try to suppress the Wild, we totally need it. Sometimes we need it just as a location where we might find some missing ingredient that our tame world needs to function, and sometimes we need it when the contradictions in our “normal” world become too oppressive and we need to immerse ourselves, at least for a while, in something much vaster.
I am intrigued by the relationship between the experiences we call psychosis and wildness in general. That’s why I especially enjoyed recently reading a book titled “Into the Thicket” by William Brundage, which tells his story of getting lost simultaneously in the wilder areas that existed near his home in Eugene Oregon, and getting lost in the wilds of his own mind.
“Madness” is often associated with one’s mind falling apart, but Will’s story is unique in that he recalls a specific time and place where he had an experience of his mind shattering. It might be best to let him tell the story himself:
“At this point, gasping, I realized that something was going horribly wrong. Futilely I attempted to rein in my mind, but I had no way of doing so. How does one grasp a thought and force it to return, especially when it is flying high and away? Then, there was a moment that I would never wish on anyone – I felt the cracks appear. First one, then hundreds, of small shards broke free from my consciousness. Within a minute, life had spun out of control. Alone with the beating of my heart, I was fighting for survival. The finale came only a minute later. With a thunderous crack, my mind blew into dust and spread over the city like snow. I could feel the reverberations in my ears, but the world was silent.
“As the cataclysm subsided, I looked around myself as if for the first time. Every tree sparkled with dew. The grass shown green like the hills of heaven. The wood smoke smelled like myrrh. Reaching out, I touched the trees around me, and felt my hand touch bark for the first time. There was no thought or feeling, just a realization that I was watching myself be born again. When I looked onto the city, I saw with new eyes the world that I thought I had known. I was no longer myself: my mind was scattered to the wind like chaff. It was sunset when I set my feet along the downward path to Eugene. I had been transfixed for an entire day, staring in mindless rapture at the city I had grown up in.”
For Will, this “wild” experience was just a beginning, a sense that if he could only turn himself over fully to something that waited for him in the wild areas near his home, everything would become right or better in some very important way. This journey required courage, and he found himself increasingly able to face the dangers he encountered without regard to his personal welfare. (Unfortunately, he lacked an adviser such as the friend I had in my late teens who was fond of repeating the quote “discretion is the better part of valor.”) His adventures became increasingly chaotic, till he found himself facing a frosty evening, naked, alone, and deeply cut up by brambles. He had made such a point of not giving in to any fears, but now he found himself abandoning his quest to humbly seek help at the home of a family that ever so symbolically happened to be named “Craven.”
Will speculates in the book on how different the rest of his experience may have been had a mental health system existed that understood the relationship between his personal quest and things like shamanic traditions, a health system that knew how to assist him in continuing his explorations using more sustainable methods. Instead he ended up in a hospital, labeled and drugged.
The rest of the story is about his battle to regain control of his life from that point on, trying to find a balance between the excesses of the mystical wild “Faerie” world that still called to him and the sometimes helpful but often overly repressive world of “modern” mental health treatment. He worked on his own to draw from diverse spiritual traditions to assist his recovery, and from them became inspired to try speaking in a friendly way with his voices, which he describes at first as being like “talking to a drunken man with a gun.”
Eventually though the practice of being friendly toward disturbing parts of his mind paid off, and Will was able to find enough mental calm that he was able to substantially reduce his medication, and to do things like attend school, go to work, including doing some peer support work, and start a family. While he has at least not yet fully left behind the mental health system definition of his experience as “schizophrenia” and he still takes some medication, he has definitely found a valued and enjoyable life for himself at this point.
In a way, such success itself leads to a dilemma for people like Will. Should he try getting off medication completely, even though that might lead to some “wild” mental states that could possibly threaten everything he has managed to achieve in his life? And, to what extent should he allow himself to follow the wild impulses that got him into trouble in the first place?
Toward the end of his book he tells a story about doing some exploring in Scotland, accompanied by his wife, and encountering a wild area that seemed to be seducing him into once again wandering away from the world, from other people including his wife, and from anything coherent in his mind. He reported that his wife sensed something was amiss, and called him back, and he left the area happy he had resisted its call. I found myself wishing he had been able to heed its call, but in a limited way, that he had been able to perhaps draw his wife into wandering into that strange wild realm but without total abandon, instead bringing just enough discretion, just enough wariness, that he and his wife would likely not have come to harm, but might have had an amazing experience beyond the limits of the “normal.”
In the end, the wild is essential to us, but remains threatening as well. I think we do best when we can acknowledge both sides of this complex truth, and see what emerges from that. This means not denying any role for fear (as Will did in his early explorations) but also not giving fear too prominent a role, not letting it be stifling. With work on finding the right balance and dialogue, I hope our society can come into a much healthier relationship with madness, with mystery, and with all forms of wild things.
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[In the News] The Violence in Our Heads
By T. M. Luhrmann
Stanford, California. — The specter of violence caused by mental illness keeps raising its head. The Newtown, Conn., school killer may have suffered from the tormenting voices characteristic of schizophrenia; it’s possible that he killed his mother after she was spooked by his strange behavior and tried to institutionalize him. We now know that Aaron Alexis, who killed 12 people at the Washington Navy Yard on Monday, heard voices; many observers assume that he, too, struggled with schizophrenia.
To be clear: a vast majority of people with schizophrenia — a disease we popularly associate with violence — never commit violent acts. They are far more likely to be the victims of violence than perpetrators of it. But research shows us that the risk of violence from people with schizophrenia is real — significantly greater than it is in the broader population — and that the risk increases sharply when people have disturbing hallucinations and use street drugs. We also know that many people with schizophrenia hear voices only they can hear. Those voices feel real, spoken by an external, commanding authority. They are often mean and violent.
An unsettling question is whether the violent commands from these voices reflect our culture as much as they result from the disease process of the illness. In the past few years I have been working with some colleagues at the Schizophrenia Research Foundation in Chennai, India, to compare the voice-hearing experience of people with schizophrenia in the United States and India.
The two groups of patients have much in common. Neither particularly likes hearing voices. Both report hearing mean and sometimes violent commands. But in our sample of 20 comparable cases from each country, the voices heard by patients in Chennai are considerably less violent than those heard by patients in San Mateo, Calif.
Describing his own voices, an American matter-of-factly explained, “Usually it’s like torturing people to take their eyes out with a fork, or cut off someone’s head and drink the blood, that kind of stuff.” Other Americans spoke of “war,” as in, “They want to take me to war with them,” or their “suicide voice” asking, “Why don’t you end your life?”
In Chennai, the commanding voices often instructed people to do domestic chores — to cook, clean, eat, bathe, to “go to the kitchen, prepare food.” To be sure, some Chennai patients reported disgusting commands — in one case, a woman heard the god Hanuman insist that she drink out of a toilet bowl. But in Chennai, the horrible voices people reported seemed more focused on sex. Another woman said: “Male voice, very vulgar words, and raw. I would cry.”
These observations suggest that local culture may shape the way people with schizophrenia pay attention to the complex auditory phenomena generated by the disorder and so shift what the voices say and how they say it. Indeed, that is the premise of a new patient-driven movement, more active in Europe than in the United States, which argues that if you treat unsettling voices with dignity and respect, you can change them.
The Hearing Voices movement encourages people who hear distressing voices to identify them, to learn about them, and then to negotiate with them. It is an approach that flies in the face of much clinical practice in the United States, where psychiatrists tend to assume that treating such voices as meaningful encourages those who hear them to give them more authority and to follow their commands.
Yet while there is no judgment from the scientific jury at this point, there is evidence that at least some people find that when they use the Hearing Voices approach, their voices diminish, become kinder and sometimes disappear altogether — independent of any use of drugs.
This evidence is strengthened by a recent study in London that taught people with schizophrenia to create a computer-animated avatar for their voices and to converse with it. Patients chose a face for a digitally produced voice similar to the one they were hearing. They then practiced speaking to the avatar — they were encouraged to challenge it — and their therapist responded, using the avatar’s voice, in such a way that the avatar’s voice shifted from persecuting to supporting them.
All of the 16 patients who received a six-week trial of that therapy found that their hallucinations became less frequent, less intense and less disturbing. Most remarkably, three patients stopped hearing hallucinated voices altogether, even three months after the trial. One of those three patients had heard voices incessantly for the prior 16 years.
The more we know about the auditory hallucinations of schizophrenia, the more complex voice-hearing seems and the more heterogeneous the voice-hearing population becomes. Not everyone will benefit from the new approaches. Still, they offer hope for those struggling with a grim disease.
Meanwhile, it is a sobering thought that the greater violence in the voices of Americans with schizophrenia may have something to do with those of us without schizophrenia. I suspect that the root of the differences may be related to the greater sense of assault that people who hear voices feel in a social world where minds are so private and (for the most part) spirits do not speak.
We Americans live in a society in which, when people feel threatened, they think about guns. The same cultural patterns that make it difficult to get gun violence under control may also be responsible for making these terrible auditory commands that much harsher.
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To all appearances, Eleanor Longden was just like every other student, heading to college full of promise and without a care in the world. That was until the voices in her head started talking. Initially innocuous, these internal narrators became increasingly antagonistic and dictatorial, turning her life into a living nightmare.
Diagnosed with schizophrenia, hospitalized, drugged, Longden was discarded by a system that didn’t know how to help her. Longden tells the moving tale of her years-long journey back to mental health, and makes the case that it was through learning to listen to her voices that she was able to survive.
Eleanor Longden overcame her diagnosis of schizophrenia to earn a master’s in psychology and demonstrate that the voices in her head were “a sane reaction to insane circumstances.”
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[Article of Interest] Why Rename Schizophrenia With “Psychosis Susceptibility Syndrome?
By Christian Nordqvist
Renaming “Schizophrenia” is the subject of discussion in a new Forum in the journal Psychological Medicine. Two authors propose a new name “Psychosis Susceptibility Syndrome” and experts comment.
The authors of the article, Aadt Klijn and Bill George, from the Dutch Association of and for People with a Psychotic Vulnerability (Anoiksis), reflect what several commentators have been saying for a long time.
The aim of having the new name - Psychosis Susceptibility Syndrome - is partly to better reflect the signs and symptoms of this mental illness, and to eradicate the stigma, prejudices and misleading significance surrounding the term “schizophrenia” and “schizophrenic”.
Schizophrenia - a word with negative undertones
The term ‘schizophrenia’ is loaded with negative connotations. Even today, when the average man or woman hears the term schizophrenia, it brings up images of dangerous and unreliable ‘lunatics’.
The term affects people both ways, it carries with it a general stigma, and causes self-stigma in those who have been diagnosed. A person with schizophrenia is stamped by society with a negative hallmark. As the patient has been brought up to perceive ‘schizophrenics’ negatively, they take the negative blueprint to themselves, which in turn leads to a negative self-image.
Not only does the term incite prejudice, it is a source of misunderstanding. Most people think schizophrenia refers to a Jekel and Hyde split personality, which is not the case - therefore the term is a misnomer. There are split-personality disorders, but they have nothing to do with what we currently call schizophrenia.
WHO (World Health Organization) was approached recently with a request to adopt the new term, which is currently not recognized anywhere. The Japanese Society of Psychiatry and Neurology renamed Seishin Bunretsu Byo (split mind) to Togo-Shitcho Sho (integration dysregulation syndrome).
Why the name Psychosis Susceptibility Syndrome (PSS)?
Anoiksis chose the term Psychosis Susceptibility Syndrome (PSS) for the following reasons:
-Psychosis - because of the unreality of delusions and hallucinations.
-Susceptibility - patients are not necessarily psychotic all the time (but it is latent).
-Syndrome - according to Medilexicon’s medical dictionary, a syndrome is “The aggregate of symptoms and signs associated with any morbid process, together constituting the picture of the disease.” Syndrome includes the negative and cognitive symptoms also linked to the disease. Negative symptoms might include lack of feelings and energy, while cognitive symptoms could be concentration and memory problems, or a reduced capacity for problem-solving, for example.
The majority of health care professionals, patients and their loved ones agree that the name should be changed. However, most people believe that what really needs changing is the public perception of schizophrenia.
Dr Alison Brabban, Honorary Clinical Senior Lecturer in Clinical Psychology in the Mental Health Research Centre, Durham University, England, and colleagues wrote:
There is no doubt that for many, the diagnosis of schizophrenia can be as debilitating as the associated symptoms. The word ‘schizophrenia’ appears to do more harm than good, more frequently communicating prejudice and misinformation than fact and hope.
It is indisputable that the stigma surrounding the term schizophrenia can in itself lead to misery for many with the diagnosis.
Therefore, any label that removes some of these disadvantages would be a welcome change.
Professor Richard P. Bentall, Lecturer at the Institute of Psychology, Health and Society, University of Liverpool, England, said “Schizophrenia has been a contested label for many years not only because it is associated with stigma, but also because it fails to achieve any of the purposes for which it was originally designed. Rebranding schizophrenia solves none of these problems. By replacing one ill-fitting label with another, we do nothing to advance psychiatric research or to develop better treatment plans for our patients.
It is not hard to locate some of these causes. Without a doubt, one is the media’s treatment of schizophrenia, which consistently over-emphasizes the risk of dangerous behaviour by patients, conveying the impression that people with psychosis are responsible for an epidemic of interpersonal violence. The reality is, of course, quite different. Whereas there is an increased risk of violence associated with psychosis, most of this is attributable to co-morbid substance abuse and most psychiatric patients pose absolutely no risk to their neighbors.
The problem has become not whether to replace schizophrenia, but what to replace it with. Simple re-labelling will do nothing to address the many scientific and clinical limitations of the categorical approach to diagnosis. Nor is it likely to address the problem of stigma, which arises out of background assumptions about the nature of severe mental illness. To persuade the general public to be more accepting of people with mental illness, we must persuade them that psychosis arises, in part, understandably from adverse life experiences (while of course acknowledging that genetic factors must play some role), that it does not necessarily lead to violence, and that recovery is possible.”
A study started off by a team of experts in Sydney, Australia, reported in the journal Schizophrenia Bulletin that homicides of strangers by individuals diagnosed with schizophrenia are extremely rare events.
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Avatars Ease Voices for Schizophrenia Patients
By Lorna Stewart
BBC Health Check
Use of an avatar can help treat patients with schizophrenia who hear voices, a UK study suggests.
The trial, published in the British Journal of Psychiatry, focused on patients who had not responded to medication.
Using customized computer software, the patients created avatars to match the voices they had been hearing.
After up to six therapy sessions most patients said their voice had improved. Three said it had stopped entirely.
The study was led by psychiatrist emeritus professor Julian Leff, who spoke to patients through their on-screen avatars in therapy sessions. Gradually he coached patients to stand up to their voices.
"I encourage the patient saying, ‘you mustn’t put up with this, you must tell the avatar that what he or she is saying is nonsense, you don’t believe these things, he or she must go away, leave you alone, you don’t need this kind of torment’,” said Prof Leff.
”The avatar gradually changes to saying, ‘all right I’ll leave you alone, I can see I’ve made your life a misery, how can I help you?’ And then begins to encourage them to do things that would actually improve their life.”
By the end of their treatment, patients reported that they heard the voices less often and that they were less distressed by them. Levels of depression and suicidal thoughts also decreased, a particularly relevant outcome-measure in a patient group where one in 10 will attempt suicide.
Treatment as usual
The trial, conducted by Prof Leff and his team from University College London, compared 14 patients who underwent avatar therapy with 12 patients receiving standard antipsychotic medication and occasional visits to professionals.
Later the patients in the second group were also offered avatar therapy.
Only 16 of the 26 patients completed the therapy. Researchers attributed the high drop-out rate to fear instilled in patients by their voices, some of which “threatened” or “bullied” them into withdrawing from the study.
New treatment options have been welcomed for the one in four patients with schizophrenia who does not respond to medication. Cognitive behaviour therapy can help them to cope but does not usually ease the voices.
Paul Jenkins, of the charity Rethink Mental Illness, said: “We welcome any research which could improve the lives of people living with psychosis.
"As our Schizophrenia Commission reported last year, people with the illness are currently being let down by the limited treatments available.
”While antipsychotic medication is crucial for many people, it comes with some very severe side effects. Our members would be extremely interested in the development of any alternative treatments.”
A larger trial featuring 142 patients is planned to start next month in collaboration with the King’s College London Institute of Psychiatry.
Prof Thomas Craig, who will lead the larger study, said: “The beauty of the therapy is its simplicity and brevity. Most other therapies for these conditions are costly and take many months to deliver.
”If we show that this treatment is effective, we expect it would be widely available in the UK within just a couple of years as the basic technology is well developed and many mental health professionals already have the basic therapy skills that are needed to deliver it.”
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[Article of Interest] The Problem With How We Treat Bipolar Disorder
By Linda Logan
The last time I saw my old self, I was 27 years old and living in Boston. I was doing well in graduate school, had a tight circle of friends and was a prolific creative writer. Married to my high-school sweetheart, I had just had my first child. Back then, my best times were twirling my baby girl under the gloaming sky on a Florida beach and flopping on the bed with my husband — feet propped against the wall — and talking. The future seemed wide open.
I don’t think there is a particular point at which I can say I became depressed. My illness was insidious, gradual and inexorable. I had a preview of depression in high school, when I spent a couple of years wearing all black, rimming my eyes in kohl and sliding against the walls in the hallways, hoping that no one would notice me. But back then I didn’t think it was a very serious problem.
The hormonal chaos of having three children in five years, the pressure of working on a Ph.D. dissertation and a genetic predisposition for a mood disorder took me to a place of darkness I hadn’t experienced before. Of course, I didn’t recognize that right away. Denial is a gauze; willful denial, an opiate. Everyone seemed in league with my delusion. I was just overwhelmed, my family would say. I should get more help with the kids, put off my Ph.D.
When I told other young mothers about my bone-wearying fatigue, they rolled their eyes knowingly and mumbled, “Right.” But what they didn’t realize was that I could scarcely push the stroller to the park, barely summon the breath to ask the store clerk, “Where are the Pampers?” I went from doctor to doctor, looking for the cause. Lab tests for anemia, low blood sugar and hypothyroidism were all negative.
Any joy I derived from my children was now conjoined with grief. I couldn’t breathe the perfume of their freshly shampooed hair without being seized by the realization that they would not always be under my roof. While stroking their backs, I would mentally fast-forward their lives — noses elongating, tongues sharpening — until I came to their leave-taking, until I reached my death and, ultimately, theirs.
I lost my sense of competence. If a colleague remarked on my intelligence, I mentally derided him as being too stupid to know how dumb I was. If someone asked what I did for a living, I would say, “Nothing” — a remarkably effective conversation stopper. I couldn’t bear the thought of socializing; one night I jumped out of the car as my husband and I were driving to a party.
Despite having these feelings in my mid-30s, when my kids were 8, 5 and 3, I was thriving professionally: I had recently completed my Ph.D. in geography, had just finished co-teaching a semester at M.I.T. as a lecturer and was revising my dissertation on spec for a respected university press. Yet several nights a week, I drove to the reservoir near my home, sat under a tree and, as joggers and their dogs ran past, thought about ending it all. There was a gun shop on the way to my poetry group; I knew exactly where to go when the time came.
My day, once broken by naps, gradually turned into lengthy stretches of sleep, punctuated by moments of wakefulness. My husband and I didn’t explain to the kids that I was depressed. “Mommy’s a little tired today,” we would say. A year or so earlier, a therapist told us to tell the children. “But they’re just kids,” we said. “What do they know?” “They know,” she said. When we eventually spoke to them, my oldest daughter came to me and asked: “Why did you keep it a secret? I thought all mothers were like you.”
After a few weeks of stopping at the reservoir, as suicide eclipsed all other thoughts, I finally told my husband about my worsening psychic pain. The next day I was hospitalized. It was June 1989. Even though we were living in Boston, we decided I should go to Chicago to work with the psychopharmacologist who, 15 years earlier, restored the health of my father, who had also been hospitalized for depression. As the cab pulled away from our house, I turned and saw three children’s hands pressed against the screen of an upstairs window. This is the way the world breaks.
The moment the psych-unit doors locked behind me, I was stripped of my identity as wife, mother, teacher and writer and transformed into patient, room number and diagnosis. I couldn’t open a refrigerator without permission. If I were on suicide watch, I had to ask before going to the bathroom. I was told when to sleep and when to wake, when to eat and when to go to group. My routine, which at home had cleaved so closely to my children’s, now revolved around the clattering sounds of the food trays being brought three times each day from the service elevators into our unit. With my husband and children nearly 1,000 miles away, I was severed from my fixed stars. I missed my children’s smells, the way they used to wrap their bodies around my legs when I was on the phone. I brought my son’s comforter to the hospital for my bed. I remembered him with one leg thrown across the covers, a small foot peeking out from his pajamas.
When my children visited, I had to resuscitate my maternal self, if only for an hour. I dragged myself to the shower, pulled on a pair of clean sweat pants and a fresh T-shirt and ran a streak of lipstick across my lips, hoping to look like a reasonable facsimile of a mother.
My doctor used my first hospitalization as a so-called washout, a period during which he planned to take me off the medication I was on and introduce several drugs in several different combinations. The prospect of polypharmacy — taking many drugs at once — seemed foreboding. I read about Prozac’s giving some people entirely new personalities: happier, lighter, even buoyant. “Who are you going to turn me into?” I asked my doctor.
“I’m not turning you into anyone,” he said. “You’ll be yourself, only happier.”
“I don’t think I even have a self anymore.”
“We’ll find your self.”
I was wary. “Just don’t turn me into Sandy Duncan.”
How much insult to the self is done by the symptoms of the disorder and how much by the drugs used to treat it? Paradoxically, psychotropic drugs can induce anxiety, nervousness, impaired judgment, mania, hypomania, hallucinations, feelings of depersonalization, psychosis and suicidal thoughts, while being used to treat the same symptoms. Before getting to the hospital, my daily moods ranged from bad to worse, each state accompanied by a profound depth of feeling. The first drug I was given was amitriptyline (Elavil), which, in the process of reducing my despair, blunted all my other emotions. I no longer felt anything. It was like going from satellite TV to one lousy channel.
For many people with mental disorders, the transformation of the self is one of the most disturbing things about being ill. And their despair is heightened when doctors don’t engage with the issue, don’t ask about what parts of the self have vanished and don’t help figure out strategies to deal with that loss.
Some in the mental-health field are beginning to recognize this need. Janina Fisher, a psychologist and the assistant director of the Sensorimotor Psychotherapy Institute in Broomfield, Colo., told me that there has been a “sea change” in the role the self plays in the therapeutic dialogue since the decades when I was sick. New therapies and treatment philosophies, founded mostly by clinical psychologists and other practitioners who are not medical doctors, recognize the role of the self in people with mental illness. Patients tell her, “I just want to be that person I used to be.” Fisher encourages her patients to recognize that their mental trauma is a part of their life, but shouldn’t dominate it.
In my own experience with Scheftner, whom I began seeing after my father’s doctor moved away, we talk about the self but only when I bring it up. That’s why I have enjoyed helping to run a support group for people with mental disorders, something I’ve been doing for the last three years. There are usually 8 of us, sometimes 12. We sit in the basement of a local library every Wednesday afternoon. Though we know one another’s innermost thoughts, we are intimate strangers, not friends. Like A.A. and other self-help groups, we’re peer-led: run by and for people with mental disorders. We talk one by one about the past week — small achievements, setbacks, doctor appointments, family conflicts. While the self is not always an explicit topic, the loss of self — or for those doing better, the reconstruction of the self — is a hovering presence in the group.
One day, not long ago, a middle-aged man came to our group. He told us that he spent the past year attending different grief groups, but none of them were right. “Why not?” someone asked. The man said: “Because everyone there was grieving over the loss of another person. I was grieving for myself. For who I used to be before I got sick and who I am now.”
During the 20-odd years since my hospitalizations, many parts of my old self have been straggling home. But not everything made the return trip. While I no longer jump from moving cars on the way to parties, I still find social events uncomfortable. And, although I don’t have to battle to stay awake during the day, I still don’t have full days — I’m only functional mornings to midafternoons. I haven’t been able to return to teaching. How many employers would welcome a request for a cot, a soft pillow and half the day off?
One morning, about five years ago, my husband and I were talking on the family-room sofa. I was still wearing my pajamas and had wool hiking socks on. As he rubbed my feet, he told me he was leaving. It was, at once, a scene of tenderness and savagery. A little later, he threw some clothes into a suitcase and moved out. But my self — devastated, grieving, angry — remained intact.
Today, my mind is nimble. Creative writing has crept back into my life. I’ve made a couple of close friends in Chicago. My greatest pleasure is still my children — they’re starting careers, marrying, on the brinks of their lives. I’m looking forward to grandchildren, to singing the 1950s favorite “Life Is but a Dream” while spinning those babies under the stars of a falling night on a Florida beach. This June, I’m turning 60. I’m having a small party to celebrate my ingathering of selves. My old self was first to R.S.V.P.
[Article of Interest] Childhood Depression May Be Tied to Later Heart Risk
For these kids, obesity, smoking and inactivity more likely in adolescence, preliminary research shows
Teens who were depressed as children are more likely to be obese, to smoke and to be sedentary, a new study finds.
The findings suggest that depression during childhood can increase the risk of heart problems later in life, according to the researchers.
The study included more than 500 children who were followed from ages 9 to 16. There were three groups: those diagnosed with depression as children, their depression-free siblings and a control group of unrelated youngsters with no history of depression.
Twenty-two percent of the kids who were depressed at age 9 were obese at age 16, the study found. “Only 17 percent of their siblings were obese, and the obesity rate was 11 percent in the unrelated children who never had been depressed,” study first author Robert Carney, a professor of psychiatry at Washington University School of Medicine in St. Louis, said in a university news release.
The researchers found similar patterns when they looked at smoking and physical activity.
”A third of those who were depressed as children had become daily smokers, compared to 13 percent of their nondepressed siblings and only 2.5 percent of the control group,” Carney said.
Teens who had been depressed as children were the least physically active, their siblings were a bit more active and those in the control group were the most active, according to the study, which is scheduled for presentation Friday at the annual meeting of the American Psychosomatic Society in Miami. Although the study showed an association between childhood depression and obesity, smoking habits and inactivity later in life, it did not prove a cause-and-effect relationship.
These findings are cause for concern because “a number of recent studies have shown that when adolescents have these cardiac risk factors, they’re much more likely to develop heart disease as adults and even to have a shorter lifespan,” Carney said.
”Active smokers as adolescents are twice as likely to die by the age of 55 than nonsmokers, and we see similar risks with obesity, so finding this link between childhood depression and these risk factors suggests that we need to very closely monitor young people who have been depressed,” he said.
Note: Data and conclusions presented at meetings are typically considered preliminary until published in a peer-reviewed medical journal.
EARTH DAY 2013
By Ron Unger
Earth Day 2013 is a good time to reflect on how problems in our mental health system reflect deep flaws in “normal” conceptions of what it means to be a human being. These flawed conceptions then contribute in a critical way to the climate crisis that threatens us all.
In noticing the connection between flawed ideas about “normality” and the environmental crisis that threatens to bring down our civilization, I’m following in the footsteps of David Oaks, director of MindFreedom, who would likely be writing about this himself if he wasn’t too busy working in rehab, trying to get back functioning after breaking his neck last December. (By the way, MindFreedom really needs donations right now to take it through a period of financial crisis: read why here , or go to http://www.mindfreedom.org/join-donate to make donations.)
A key problem is that within most of the mental health system, individuals are seen as healthy when they “fit in” or adjust to the overall society. To the extent that they don’t adjust, they are seen as “having issues,” and those most out of adjustment are seen as “psychotic.”
At times, it seems to make sense to look at things this way: adjustment seems to solve problems, and not fitting in, or being maladjusted, gets in the way of solving them. People who are severely maladjusted may endanger their own lives or those of others.
Unfortunately, humanity is finding out that in the absence of wisdom, people can fit in with each other and be socially “well adjusted” and yet be causing catastrophic problems, such as by undermining the health of the ecosystems they live within and depend on for survival. Or, as David Oaks likes to put it, “normal people are destroying the planet!”
R.D. Laing once said “It is of fundamental importance not to make the positivist mistake of assuming that because a group’s members are in formation this means that they’re necessarily on course.” Of course, those who break from formation are not necessarily on course either, but if the crowd is heading over a cliff, it is important at some point to break away and start experimenting with other directions. Unfortunately, in our society, young people who experience trouble while they experiment with new directions are simply labeled as “ill” and are seen as in need of being drugged back to some semblance of what is “normal” within the culture, even though the culture itself is headed straight for environmental catastrophe.
It seems we need a more complex idea about what constitutes health, and sickness. I think the notion of “creative maladjustment” as described in Sophie Faught’s previous Mad in America post, “Taking Martin Luther King Jr’s Call For Creative Maladjustment Seriously” is exactly what we need as the foundation for a definition of “mental health” that would lead us towards both a functional mental health system and a functional society.
There seems to be little question that being maladjusted to something that is healthy is problematic. So for example the person who has healthy food but thinks it is all poisoned will have difficulties. But being adjusted to something that is not healthy is also problematic, and can be a much bigger problem. The notion of “creative maladjustment” addresses both sides of this dilemma, suggesting the use of creative discretion in when and how to be maladjusted, rather than either supporting either blind conformity and adjustment, or reckless and undiscriminating maladjustment.
When mental health workers become able to recognize the possible value of maladjustment, they become less sure they have complete answers, and become able to relate to those they intend to help from a position of being fellow human beings searching for positive approaches to life rather than from a role of being authorities in what it means to be “sane.” Mental health workers who recognize the value of searching, and of being maladjusted, can see possible value in “mad” experiences, and can connect on a peer level even when they are relating to people who have experiences that are very different from their own. Being able to connect in this way is, I think, a precondition to being able to be genuinely helpful.
Of course, if one talks about seeing something positive in psychotic experiences, one can expect to be accused of “romanticizing madness.” But somehow, those who worry that people will go too far in seeing something positive in mad experience never worry about the opposite, the possibility that people will “awfulize” madness, that they will see only the negative in it, and so will increase fear of madness and mental health stigma. (It’s actually pretty bizarre that our mental health system will work so hard to convince people that mad experience is nothing but bad, and then turns around and tries to run “anti-stigma campaigns”!)
Recognizing “creative maladjustment” as a better definition of mental health allows mental health workers to honor the spirit of mad rebellion as being of potential value, even if not every manifestation of that spirit is helpful, and even if some manifestations can be highly dangerous! Young people need to know that their efforts to be maladjusted to much of what is going on makes sense, even as they also need to know that it typically takes work and reflection to refine that maladjustment into something that is usefully creative.
Another part of making maladjustment creative is finding ways to come together with others in carrying it out. This need to reconnect with others can seem paradoxical, because there is always the danger that if one connects too much, one will be right back “in formation” with a dysfunctional way of being organized, and a dysfunctional society! The trick is to find a way to be autonomous enough to find a direction based on something deeper than just fitting in or being normal, while also being connected enough to cooperate with others in getting support and in sharing ideas and perspectives. This is much easier to do when the culture, or at least a subculture, supports the idea of something like creative maladjustment.
When I was an alienated young man, it helped me greatly to find others who were maladjusted in their own ways and to find that we could work together in ways that were a lot of fun! It was extremely helpful for us to support each other’s ability to move and create independently, even when the creativity was more silly than serious. A long time friend of mine, John Law, coauthored a book coming out in May on the Cacophony Society, an organization closely related to the Suicide Club, which was the group he and participated in together back in the 1970’s. For me, it was the coordinated maladjustment in the events we created that helped me reconnect with the larger world, and I think we need to give greater recognition to the value of such ways of connecting.
MindFreedom’s current promotion of a “Creative Maladjustment Week” can be seen as just one small step toward the creation of a new ideal in our culture, the ideal of always aiming to be maladjusted toward what is destructive, rather than the flawed idea of mental health as “adjustment.” Communicating the ideal of creative maladjustment to the public can also be a way of increasing awareness about how the process of being “mad” may be part of exploration toward new ways of being, with some of those new ways being possibly that which may ultimately save us from catastrophe.
It will be of little long term use to reform society and the mental health system if the ecological crisis then completely undermines civilization, leading to massive famine, die offs, migrations and wars. Any mental health reforms would likely get lost in the chaos. But I believe mental health reform is still worth working toward at this point, because changing the aim of mental health work, from adjustment to creative maladjustment, could shift the mental health system toward actually supporting exploration in new ways of thinking and being instead of always attempting to suppress it. We need such exploration at this time more than perhaps any other.
I also want to point out that a key part of creative maladjustment is balancing personal fun, joy, and humor with activism and attention to the larger realities. E.B. White is famous for having said ““I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult.” David Oaks helped me learn how to approach life this way, and I think it is key to being an activist and not burning out. It is true that finding the balance can be difficult, but each step of the way can also be incredibly rewarding, and every other way of being in the world makes a lot less sense.
I’m hoping in the near future to write about how to create public events or spectacles that communicate to the public both about the role of creative maladjustment in cultural evolution and renewal, and about the vital necessity of doing something different before the climate crisis escalates into something that kills most all our possibilities.
Till then, I hope you persist in your own forms of creative maladjustment, and in connecting with others on that wavelength, and I also hope that you support MindFreedom International in continuing to do its work of linking together groups all over the planet which working to support people’s access to human rights and to creative maladjustment. Like I said earlier, it is a tricky period financially for MindFreedom as it copes with David being in rehab, but it’s vital we keep this group going that has done so much for keeping these issues alive all over the world. Again, you can read why here , or go to http://www.mindfreedom.org/join-donate to make donations.
Thanks for all that you do to support mental health reform, creative maladjustment, groups like MindFreedom, and all the actions you take in support of insuring a future for the human race on this beautiful planet of ours!