Schizophrenia

A book I read about schizophrenia said that the disease occured in about 1 in 100 people, but in western Ireland it was much more common, possibly up to 1 in 25 people.
Has anyone ever heard of this? If it's true, what's going on in western Ireland? Is there a bad gene in circulation? Some envirnmental factor? Or is a case of bogus statistics?

No one knows the exact cause of schizophrenia-- well, actually, they know what's happening in your brain, they just don't know why. However, it doesn't appear to be genetic-- at least in the "biology is destiny" sense, because the identical twin of a schizophrenic doesn't usually have schizophrenia. I don't know if the odds are slightly higher for the twin or not, but it's not like blue eyes-- if one identical twin has blue eyes, the other will too.

The last theory I heard implicated a viral infection in schizophrenia, but I don't remember the name of the virus.

Schizophrenia is NOT environmental in the sense that it is caused by trauma. It's environmental if you consider a virus to be part of the environment, but if you're thinking that the stress of politically turbulent Ireland is a factor-- No.


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--Rowan
Shopping is still cheaper than therapy. --my Aunt Franny

It's a case of bogus statistics.

Schizophrenia is a disease of the brain which is very common. About 1 in every hundred people throughout the world will be affected during their lifetime, including over 35,000 people in Ireland.

Quoted from: http://www.iol.ie/lucia/si/schiz.htm

The estimated population of Ireland is 3,557,000. Therefore, roughly 1% of the people in Ireland suffer from Schizophrenia.


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"[He] beat his fist down upon the table and hurt his hand and became so
further enraged... that he beat his fist down upon the table even harder and
hurt his hand some more." -- Joseph Heller's Catch-22

You know what just occurred to me? The diagnosis of schizophrenia is made mostly on the basis of the patient's behavior and subjective reporting ("Do people stare at you in restaurants"). A country could have a high incidence of schizophrenia because the psychiatric profession in that country over-diagnoses it (or other countries under-diagnosis it).

I realize that someone has already demonstrated that the statistics are bogus-- I just thought I'd add this FYI.

Just as an example, school districts in the US have wide variences for the occurrance of ADD/ADHD, which is diagnosed on the basis of behavior; there is no subjective test, like a strep throat culture. The difference in school districts is a product of certain schools over-referring students, and local doctors over-diagnosing ADD and ADHD.


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--Rowan
Shopping is still cheaper than therapy. --my Aunt Franny

Not to be a nitpicker, Rowan, but you mean that there is no objective test for schizophrenia.

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"I had a feeling that in Hell there would be mushrooms." -The Secret of Monkey Island

You know what just occurred to me? The diagnosis of schizophrenia is made mostly on the basis of the patient's behavior and subjective reporting ("Do people stare at you in restaurants"). A country could have a high incidence of schizophrenia because the psychiatric profession in that country
over-diagnoses it (or other countries under-diagnosis it).

Actually, according to DSM IV, the psychiatrists' bible, the diagnosis of schizophrenia is entirely based on the patient's behaviour. If you have something like 3 out of of the 6 listed symptoms, you've got it, supposedly. There were studies in the sixties that showed that diagnosis varied wildly between the US and the UK. I imagine it's still largely true. It isn't exactly science, after all.

Rowan:

You know what just occurred to me? The diagnosis of schizophrenia is made mostly on the basis of the patient's behavior

Yes, and welcome to my (our) nightmare! (I have been so diagnosed).

Does schizophrenia exist, in the same sense that, let's say, cerebral palsy exists? Or is it more akin to a diagnosis of "hysteria", or "stress"? There is no test for it; it exists wherever the psychiatric professional sees it. The inter-rater reliability (the ability in blind tests for subsequent psychiatric diagnosticians to arrive at the same diagnosis after interviewing the same potential patient) is no better than random chance. The profession's declarations regarding the cause or etiology of schizophrenia never clarify previous declarations as more data becomes available, but instead contradicts the wisdom of previous articles. What used to be the result of dopamine receptor hypersensitivity is now understood to be related to serotonin uptake, although the statements issued in the 80s regarding dopamine were released as if with final clinical authority. If truth be known, no other branch of medicine, let alone science, could get away with the fuzzily defined variables and assumptions that permeate clinical psychiatry.



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Back to the original question:

My wife lived in Ireland for 13 years and she informs me that the three largest mental institutions in that country are all located in the west. They are located in Galway, Sligo, and Mayo.

My university days are a little hazy now, but I recall two germain facts. The first one was that many things that a psychologist or psychiatrist can't accurately diagnose are labelled "Atypical Schizophrenia" simply because, as there are so many possible symptoms you can't go wrong. Secondly, some time in the late 70's the definition of schizophrenia was altered in the US but not in Europe, leading to huge discrepancies in how many people were diagnosed in the US and the UK, I can't remember which way ireland went, but I presume it was the same as the rest of Europe. One would think that everybody would use the same standards to diagnose schizophrenia, but such definitions have huge consequences on public health budgets and the like, and as such setting these standards is almost always a politicised process.

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It only hurts when I laugh.

Just saw this today & thought I'd share:

http://www.msnbc.com/news/286372.asp

reference schizophrenia being caused by in utero exposure to poliovirus.

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Sue from El Paso
members.aol.com/majormd/index.html

I always thought that "Tommy" was the better album overall, but that the situation was reversed with the movies. What's that? Oh, schizophrenia. . .never mind.

1) The hypothesis as I understand it, is that in utero exposure to polio (other viruses may also be causative) is NECESSARY but not SUFFICIENT to cause schizophrenia. Other factors such as genetic susceptibility, and timing of the infection during a critical period of brain development, would also have to be present.

2) Polio virus, unlike smallpox, has not been eradicated. Immunized individuals still get polio infections; the infections stay confined to the GI tract, however, and do not result in the neurologic comlications which occurred prior to immunizations. Thus pregnant women can & do get poliovirus infections, often without ever realizing it.

3) The whole history of polio is a fascinating study of man's attempts to free himself from one type of disease only to face something far worse. 200 years ago, polio was nearly unknown. In the early part of this century, hygiene & cleanliness among the middle & upper classes improved to the point where children seldom became exposed to the virus until entering school. Just as chicken pox is rarely serious in kids, but can be life-threatening to adults, polio is just one more 24 hour diarrhea in toddlers, but can cause deafness & paralysis in older kids & teens who get it.

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Sue from El Paso
members.aol.com/majormd/index.html

I know what you mean: the hand-washing and bathing that were supposed to get rid of typhus, dysentery, cholera, and other diseases, in part caused the polio outbreak in the 50's.

As I understand it, though, there was another factor: prior to frequent washing and bathing with soap, most people were exposed to, recovered from, and were thus innoculated against polio as babies. But the age of the person wasn't the only consideration. Before the 1950's, babies were almost without exception breast-fed, and were thus getting antibodies from their mothers when they had their first polio exposure.

Children first exposed to polio in grade school weren't being breast-fed, but in the 50's, neither were babies; they were mostly formula fed, so babies who happened to be exposed to polio weren't getting breast milk antibodies.

Anyway, in utero exposure to a virus is a tricky thing. I know several people who are Deaf from pre-natal rubella, and at least two who are JUST Deaf, but had still-born twins.

As I noted before, they are many cases of schizophrenia in people whose IDENTICAL twins are unaffected.

I checked out the article someone posted (well, the address anyway), and it notes that in utero polio isn't necessarily associated with all schizophrenia.

However, I'm no expert-- I'm pretty well-read on the subject, because a couple of schizophrenic people are served by my agency, but I'm not a psychologist or a doctor. If you know of another article with more info about in utero viruses, please post the info: I'd be really interested.

SOmthing I do know: schizophrenia is a "default" diagnosis, in that when certain symptoms present themselves, and no other cause is found (MRI's don't show brain tumors or leisons, toxicity screens are negative, there's been no stroke or head injury, no drug history), then the diagnosis is schizophrenia. This is why I suggest that there may be multiple causes; there's no real evidence that schizophrenia is one thing.


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--Rowan
Shopping is still cheaper than therapy. --my Aunt Franny

Diceman is right, I said subjective when I meant objective. Brain cramp.

I haven't read the polio link yet, although I am just about to, but while it's on my mind-- polio cases are on the decline due to vaccinations. Wouldn't schizophrenia also be on the decline? But it's not.

I'm going to bet there are multiple causes of schizophrenia.

...I suggest that there may be multiple causes; there's no real evidence that schizophrenia is one thing.

This is my view as well. Some cases are probably misdiagnoses of other known diseases, some cases may have an as-yet-unknown medical cause, and some cases are probably non-medical in origin, being instead rather extreme instances of 'normal' reactions to particular circumstances. This is an important issue, as schizophrenics are routinely given medication, often involuntarily, with very serious side effects and no known curative properties.

They are located in Galway, Sligo, and Mayo.

I always liked Galway and Sligo, but you can hold the Mayo.

Well, I don't think many cases of schizophenia are traumatic in origin, since there need to be several episodes of dissociative behavior over a period of time to make a schizophrenia diagnosis.

And while it's true that medications such as Haldol are not curative, in the sense that you don't take it for ten days and your schizophrenia is gone, they can be enormously effective. Insulin injections aren't a cure for diabetes, but they're an extremely effective treatment.

However, we probably mostly agree about medical mishandling of schizophrenia. Once a person gets that label, his doctors stop looking for other things. Treatment is reduced to monitoring medication side-effects.

I would add that people who are forced to take medications by law are, in my experience, people who have committed violent crimes, and taking medication is a condition of probation.

A much bigger problem, if you ask me, is people who yo-yo between institutions and the streets. People are institutionalized and given meds, stabilize on the meds, and are released. Then they get no support whatsoever after release, and sometimes can't get the meds anymore, even when they want them, and end up back in an institution, long enough to get meds and stabilize....


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--Rowan
Shopping is still cheaper than therapy. --my Aunt Franny

Sorry for the delay. Been away for a while.

Well, I don't think many cases of schizophenia are traumatic in origin, since
there need to be several episodes of dissociative behavior over a period of time
to make a schizophrenia diagnosis.

I'm not sure how this rules it out (depending on what you mean by 'traumatic'). In any case, I think in practice the diagnosis of schizophrenia can be pretty lax.

And while it's true that medications such as Haldol are not curative, in the
sense that you don't take it for ten days and your schizophrenia is gone, they
can be enormously effective.

I have a less sanguine view of Haldol. Maybe some patients like it, but I think with many it's the staff who are the fans. It really deadens people.

Insulin injections aren't a cure for diabetes, but they're an extremely effective treatment.

Though I don't know that much about insulin, I doubt it has such serious side effects as a matter of course. Haldol is not good for the noodle in the long run. It seems to me that by prescribing it for an extended period, a doctor is more or less writing off the possibility of a full recovery. And while schizophrenics are officially not supposed to recover, I think this is far from being the case in reality.

I would add that people who are forced to take medications by law are, in my
experience, people who have committed violent crimes, and taking medication is a condition of probation.

I am not very up on this. It was my impression that the family had a bit of sway here. In any case, I believe there are initiatives in several places in North America to give psychiatrists the right to prescribe drugs like Haldol involuntarily solely on their own judgement.

I think we agree on the other stuff.

Roses are red,
Violets are blue.
I'm a schizophrenic,
And so am I

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Brian O'Neill
CMC International Records
www.cmcinternational.com

ICQ 35294890
AIM Scrabble1
Yahoo Messenger Brian_ONeill

And while it's true that medications such as Haldol are not curative, in the
sense that you don't take it for ten days and your schizophrenia is gone,
they can be enormously effective. Insulin injections aren't a cure for
diabetes, but they're an extremely effective treatment.

a) Schizophrenia is not a Haldol-deficiency disease. Non-schizzies are not walking around with a normal serum level of Haldol that schizophrenics lack unless they take their pills.

b) Haldol is extremely effective at disabling neurons. It isn't very specific; it goes after motor neurons, affective neurons; neurons in the spinal cord, neurons in the brain; etc.

c) With the exception of individuals brought in involuntarily, the only things meaningfully correlated with receiving a diagnosis as schizophrenic are prior psychiatric diagnoses as schizophrenic and exposure to psychiatric professionals. It's less funny if you think about it for awhile. If you come into contact with one in 'assessment mode', you are no more and no less likely to receive the schizzy label than the subway guy with the box cutter, up until he hauls off and slices someone up.

d) I'm schizophrenic. Since there is no criterion by which a diagnosis is ever ruled out or rescinded (such as "on the basis of blood test for the schz protein"), the disease consists of the diagnosis thereof. However, I like my mind as it is and fortunately have been able to avoid psychiatric professionals and their pharmaceuticals and shock machines. Unless I do something that constitutes a legally defined offense, my behavior is none of your damn business, and my biochemistry isn't under any circumstances. Put that needle down!


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a) Schizophrenia is not a Haldol-deficiency disease. Non-schizzies are not walking around with a normal serum level of Haldol that schizophrenics lack unless they take their pills.

b) Haldol is extremely effective at disabling neurons. It isn't very specific; it goes after motor neurons, affective neurons; neurons in the spinal cord, neurons in the brain; etc.

To partially rebut a): You are technically correct. Most of us non-schizophrenics do not have a "physiologic" Haldol level which is low in persons with schizophrenia. We do, however, have certain levels of various chemicals in our brains (neurotransmitters) which allow neurons to communicate with one another. Persons with schizophrenia have abnormally high levels of one of these chemicals, dopamine, in some locations. Haldol helps to correct that. Unfortunately, Haldol is not a magic bullet that only affects dopamine levels in those locations; it lowers dopamine throughout the body. It does allow some patients to regain control of their thoughts and actions, who otherwise cannot distinguish external reality from what they see & hear internally. Not all people with schizophrenia need to be on anti-psychotic medications all of their lives; some do.




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Sue from El Paso
members.aol.com/majormd/index.html

This topic is a sore point with me. I was diagnosed as "residually schizophrenic" in 1974, and four psychiatrists since have corroborated the first doctor's findings.
When I was about 10 I was attending Braddock Drive Elementary School, in the L.A. City school system. When we moved back into the area after living in another city for 5 months, my mother decided I should go to another elementary school nearby: Officials at Braddock had told her that I should be sent to a psychiatric children's hospital, or similar institution, in Pasadena (non such known to me to exist, even now). My Mom told them they would send me their over her dead body, and said she would keep me home rather than agree to that! The school officials relented and I finished 6th Grade at the second school.
I have known a family--of a girl I went to high school with--whose mother, since deceased, told me--she was being deadly serious--that there are three topics I should NOT take up with people I don't know well or at all:
1) Don't tell them I am schizophrenic.
2) Don't tell them I have a problem socializing.
3) Don't discuss my dreams with them.
Her point was well taken and I have avoided doing any of those things.

Unfortunately, Haldol is not a
magic bullet that only affects dopamine levels in those locations; it
lowers dopamine throughout the body. It does allow some patients to
regain control of their thoughts and actions, who otherwise cannot
distinguish external reality from what they see & hear internally. -- Sue from El Paso

Well put. Agreed on both counts. I have no problem with the idea that Haldol (and other psychopharmaceuticals) has effects that some psychitrically diagnosed people find desirable some of the time.

Involuntary medication, advocated for everyone who has been so diagnosed, advocated by well-intentioned busybodies who assume the wonderful drugs will fix us up just dandy and who believe that the fact of our having received such a diagnosis means if we say we don't want it, it just goes to prove how demented we are...with *THAT* I have a problem!!



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Persons with schizophrenia have abnormally
high levels of one of these chemicals, dopamine, in some locations.

I thought this hypothesis has recently fallen out of favour. I'm no expert though.

1) Don't tell them I am schizophrenic.
2) Don't tell them I have a problem socializing.
3) Don't discuss my dreams with them.
Her point was well taken and I have avoided doing any of those things.

Wise advice, in my opinion. I think psychiatry is similar in some ways to medicine in general 150 years ago: more likely to do you harm than good.

We have three people served by our agency who carry schizophrenia diagnoses. One takes Risperdal, one take Haldol, and one takes Prozac.

The woman on Haldol has been arrested for assault, and spent four years in an institution; I can't imagine her being unpleasant, let alone violent. She works 32 hours a week, and just got her GED. She says she knows about the "slowed down" effect of Haldol, and she experienced it at first, but in her own words, "I must have been manic before, because the more I relate to people around me, the more I realize I'm at their speed when I take my meds." She says she's now used to her current "speed," and doesn't experience it as a "side-effect" anymore.

The guy on Risperdal hears voices when he is off the meds, and can't ignore them-- they interfere with talking to other people, and therefore holding down a job-- but more importantly to him, they interfere with his listening to his CD player. He himself asked for a med that would "shut up the voices." He loves his Risperdal.

The guy on Prozac is pretty mildly effected by his schophrenia, but he has emotional problems with being different, and says that the Prozac makes him feel better. It might be my judgement that his meds should address his schizophrenia directly, and not the emotional effects of having a disability, but it's his call.

No one in our program is medicated who doesn't want to be. Even children whose parents have chosen to have them medicated usually have participated as much as possible in the decision.


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--Rowan
Shopping is still cheaper than therapy. --my Aunt Franny

To Lazy: I don't know if this UserName represents your approach to psychiatry; I hope it doesn't. I am a member of Mensa, and one member, since deceased, seemed to think psychiatry is "witchcraft" (my psychiatrist said she thinks that's probably accurate, though otherwise, she considered this Mensan to be a fascinating jackass.") I coldly told this Mensan that, without the psychiatrist's help, from 1974 on, I might be living in a cardboard box on Skid Row. He spit back, "If that is all you have the incentive for." In other words I should lift myself up by my own bootstrap. I think I should have quoted Hawkeye to him: "Why don't you lift yourself up by your own jock strap?"

That said, Lazy, I ask, in reference to your suggestion about 'pyschiatry doing me moroe harm than good,'whay do you think would do me good, other than death?

For the unenlightened or misinformed:

Schizophrenia is NOT Multiple-Personality Disorder, although schizophrenia can include MPD as a symptom.

Paranoid Schizophrenia has nothing to do with a persecution complex, in which you think that "everyone's out to get you." Paranoid Schizophrenia simply means that the subject has the typical delusions and auditory hallucinations, but lacks any other symptoms.

Catatonic Schizophrenia includes symptoms like catalepsy and waxy flexibility (which means that you can bend their limbs into a position and they will hold it).

There are some other categories... this was mostly to clear up some misconceptions.

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"If A=B, B=C, and C=D, do not get a job proofreading" --Quid's Theorem

That said, Lazy, I ask, in reference to your suggestion about 'pyschiatry doing me moroe harm than
good,'whay do you think would do me good, other than death?

It may be more accurate to say that the current approach to psychiatry does more harm than good. There is no doubt in my mind that psychiatry is a very necessary medical practice in many cases. There is also no doubt in my mind that our society is way too over medicated. There is so little emphasis placed on coping strategies and self-reliance training, and so much emphasis on medicating problems in lieu of more labor intensive procedures. Pehaps it is part of the whole "HMOs ruining all of health care" issue, and perhaps it is that some doctors don't wish to put in the effort to really help problems.

The real problem with the modern mental health system is that many (but by no means all) doctors place an emphasis on numbing the patient rather than curing them. It's like giving a patient morphine shots in lieu of setting a broken bone: since the medication is blocking the symptoms, there musn't be a problem. We should instead be helping cure the disease through therapy and training rather than by simply prescribing a pill and sending them on their way.

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Jason R Remy

"Open mindedness is not the same thing as empty mindedness."
-- John Dewey Democracy and Education (1916)

To jayron 32: I have no doubt that psychiatry is overused, and abused--witness John Hinckley shooting Reagan and being sent to a mental hospital instead of prison. In my own case, however, it is clear that you have not 'walked a mile in my moccasins'--a phrase I used to that pompous, bigoted Mensan. I was first perceived as needing psychiatric treatment in 1960, when I was 11. (HMOs, of course, did not exist then.) Although you have not seen my doctors' records--and of course, it is illegal and unethical for anyone not professionally involved to know about them--I can and will tell you that I might have been at a severe loss WITHOUT psychiatrists. I was diagnosed, in 1974, as "Residual Schizophrenic," a term which, of course, I don't fully understand. I DO understand that my "interpersonal" relationships, for almost my whole life, have been a disaster. With this in mind it is clear you have not answered my question--and myabe only a psychiatrist could.

No C&P, just a general observation on the perceived underuse of psychotherapy & the over-reliance on antipsychotic meds/sedation.

Psychotherapy has significant limitations. During the 167 hours + 10 minutes/week that a patient in not in the mental health professional's office, there is no reliable way for him/her to distinguish which voices are external & which are internal.

Psychotherapy generally is dependent upon the patient having some insight. Insight requires the ability to leave your reality & consider how things look from the outside. This, frankly, is beyond the capability of a good many people, both schizophrenic and "normal". But for a patient whose reality is constantly changing (someone who is actively psychotic) this is impossible.

Many people with schizophrenia do not require lifelong drug treatment. They do, however, need lifelong follow-up, to ensure that should psychotic features recur, the patient is made aware of this fact before (s)he does some that causes irreparable harm to themselves or someone else.

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Sue from El Paso
members.aol.com/majormd/index.html

Geez, people-- mental illness is ILLNESS. You would never tell someone with cancer that they just don't have enough coping strategies.

I've got a fourteen year old autistic kid right now who is suffereing terribly, because he is very bright and high functioning. His deficits are mostly social, not intellectual, or communicative, and the kids in his school perceive him as weird, not disabled. He gets picked on so much, that some days he just can't bring himself to enter the building. His teachers think he's a discipline problem.

He CAN'T FREAKING CONTROL his autistic behaviors anymore than an epileptic can control his seizures. He just started on anti-anxiety meds, and the difference is amazing. More importantly, HE SAYS HE FEELS BETTER.

He may outgrow some of his impulsiveness, and there are behavior strategies that will help him cope with knowing when his autism is effecting him; he's just beginning to ask for time-outs to take a walk around the building, instead of acting out his frustration. I think this is great, but some of his teacher-- well, it just isn't the SYSTEM. Anyway, we're doing all these things TOGETHER. He's getting relaxation training, he has staff time where he can unload his feelings, and just hang out with someone who doesn't judge him. He's also finally getting help with his schoolwork that is appropriate for someone with autism, and not for someone who's unmotivated (which is what he got before. Made him feel like a total loser). We also seem to finally be getting through to his teachers that ignoring his behaviors is more effective than punishing him, because he can't control them, and so the punishment is especially humilating.

And I want to repeat: he's medicated until HE says he feels good, and feels helped. He's NOT getting medicated until he feels nothing.

I mean, psych meds are like any meds-- sometimes less is more, but none is neglect. You don't need morphine for a sprained ankle, but codeine is totally appropriate, and to deny it is abusive.

People who really want to help know this.


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--Rowan
Shopping is still cheaper than therapy. --my Aunt Franny

Hey Dougie-Monty, what part of when I stated:

There is no doubt in my mind that psychiatry is a very necessary medical practice in many cases.

Obviously it was in your case. The point I was making that in many cases (and as an educator, I have been seen a few myself):

so much emphasis on
medicating problems in lieu of more labor intensive procedures

Medication is a very necessary componentent of any medical treatment, but it can never be the ONLY treatment. Again, just as a doctor woul be in folly to refuse to set a broken bone merely because they had prescribed a pain-killer, many psichiatric doctors are in folly by prescribing meds without addressing the problem itself.

I never stated that psichiatry was unneccessary. I only said that some doctors were practicing it in ways that were ultimately harmful (or at best ineffectual) in dealing with their patients. As evidenced by your presence here, such was not the case with your doctor(s).



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Jason R Remy

"Open mindedness is not the same thing as empty mindedness."
-- John Dewey Democracy and Education (1916)

Right on, Rowan! And Jayron!! I'm glad now we understand each other. I will certainly agree that psychiatry has been abused, as I said earlier. As for the woman who told me not to discuss my dreams, schizophrenia, or social ineptness indiscriminately with strangers: Her daughter told me, "and for heaven's sake, don't announce to everyone your psychiatrist's perception of your 'mental category.' Who knows--she might be wrong." The point is that I tell someone Ï am schizophrenic," they might mistake me for Charles Manson or Norman Bates or some such maniac. Your points are well taken.

Jayron 32 wrote:

Medication is a very necessary componentent of any medical treatment, but it can never be the ONLY treatment. Again, just as a doctor woul be in folly to refuse to set a broken bone merely because they had prescribed a pain-killer, many psichiatric doctors are in folly by prescribing meds without addressing the problem itself.

Tell me about it. I'm schizophrenic and have been taking medication for it for over 10 years now (and yes, Haldol sucks royally). I take the medication (Risperdol) because my parents think it helps, not because I believe it actually does. But anyway, I refuse to undergo psychotherapy because of the practice of our nosy government to share information among its different bureaucracies. For instance, if I want to qualify for help getting back on my feet with a job/school/career, Vocational Rehabilitation requires my HMO to share all of my medical records with them before I am even considered for the help.

Another reason I don't like one-on-one therapy, as I've repeatedly told my psychiatrist, is that I'm very people-phobic. I can't stand being around others for more than about a half hour, then I have to get alone again. So I came up with a solution: internet therapy. Unfortunately, this degenerated into a once-every-two-weeks "How are you doing?" email from my therapist. I get more therapy from talking to ARG220 in the religious threads than I do from that! (g)

I agree that I probably need to undergo therapy other than drugs, but I'm not giving Uncle Sam/Big Brother any more info about myself than I have to. Sound paranoid? Well, that's me. The only way I will ever go through therapy is if I have absolute confidence that the therapist will keep things utterly confidential. Otherwise, no way!

[Lazy]

Sorry about the late response, but I don't check the board that often.

Some people here have had positive experiences with psychiatry. It's not my place to question their judgement on that. I didn't say that psychiatry would harm every single patient more than it would help him. But I still think that it is true in general, just as it was for medicine 150 years ago, that it does more harm than good. This doesn't deny that there are real physical diseases underlying some psychiatric conditions, although to the extent that this becomes known, they tend to be removed from the field of psychiatry to other branches of medicine-- as for example happened with syphillis, which is no longer a 'mental illness', but a real honest-to-goodness verifiable disease with mental symptoms. I assume that some psychiatric conditions are like syphillis in that they have a physical basis that hasn't been discovered yet. I suspect others will turn out to be a little more complex than that.

An important part of the Hypocratic Oath is "First, do no harm'. I believe that psychiatrists often violate the spirit of this, using dangerous treatments for conditions about which very little is known. But of course this is a morally grey area. I can see how others might disagree.

Since others have been very upfront about the sources for their personal biases on this issue, I may as well fess up on mine. When I was 12 (over 20 years ago), I was involuntarily incarcerated in a psychiatric institution and involuntarily medicated. It was an experience I wouldn't wish upon my worst enemy. Getting into details would take far too long, and not be of general interest, but basically I feel the condition that led to my incarceration (completely non-threatening behaviour my parents considered strange) disappeared after a few months, as I feel it would have in almost any situation in which I was removed from my family. I am still living with the side-effects of drugs involuntarily given me then not to cure me, but to ease my symptoms-- symptoms which none of the other patients there could even perceive. They all thought I was normal and was there through some kind of mistake.

On my release, the psychiatrist threatened me with re-incarceration if I ever rebelled against my parents (which mystified me, since I had never been a rebel). The psychologist, who by contrast was almost a human being, said privately that he thought my incarceration had been a mistake.

I hope my story doesn't sound too self-dramatizing. I have lived a normal, happy life since then, am happily married, have a wonderful son, did well in university, etc.etc. But my one-year encounter with psychiatry left me with the worst possible impression of it. I assume there are many more people like me, just as there are counter-examples like some of you.

Whether psychiatry on the whole does more good than bad is a very subjective question. I don't pretend my opinion is The Truth.

As to whether my opinions of psychiatry are lazy, well, I don't think about it very much any more, so maybe they are. Laziness is one of my defining personality traits.

[AHunter3]

I'd like to preserve most of the meaningful discussion threads concerning "mental illness" from the pruining-room floor.

::bump::

[Neurodoc]

Before I went to medical school and actually met real live schizophrenics, I thought that schizophrenia was some sort of extreme neurotic disorder, and that the patients could be "brought around" to a normal way of thinking by "talk therapy" designed to bring them to an "insight" about their disordered thinking. I was a great fan of R.D.L., a British psychiatrist who claimed to have cured schizophrenics with cognitive talk therapy.

In the psychiatry rotations during my 3rd and 4th years of med school I actually got to meet quite a few schizophrenics. It was an eye-opener. These guys and gals clearly had an organic brain problem and there was no way that I or anyone else was going to psychotherapize them into normalcy. I'm still not a great believer in neuropleptic drugs like Haldol (they have awful side effects). But they did stop the delusions and hallucinations when nothing else would.

[Pjen]

Originally posted by Neurodoc
Before I went to medical school and actually met real live schizophrenics, I thought that schizophrenia was some sort of extreme neurotic disorder, and that the patients could be "brought around" to a normal way of thinking by "talk therapy" designed to bring them to an "insight" about their disordered thinking.

Are you aware of the recent advances in Cognitive Behaviour Therapy for people with hallucinations and delusions? Whilst psychotherapy as such may not be overly useful in Psychosis, CBT may be.

Additionally, I am a great believer in Milieu Therapy- changing the social environment in which psychotic people live- especially when hospitalized. This could also be seen as a form of non-medical intervention which works.

Are you saying that Scizophrenia=Illness, end of story, or do you admit some social/psychological factors in cause and prognosis?

[AHunter3]

I am a great believer in Milieu Therapy- changing the social environment in which psychotic people live- especially when hospitalized.

When I escaped from the hospital in which I had been diagnosed schizophrenic and was being held against my will, the change in milieu certainly did me a substantial amount of good.

These guys and gals clearly had an organic brain problem

Is schizophrenia an "organic brain disease"? It was a reasonable hypothesis 100 years ago. After awhile, though, the inability of the psychiatric profession to supply an adequate definition for just what was and wasn't schizophrenia in the first place made etiology a moot point.

In medical research, a diagnostic criterion is supposed to exhibit something called "inter-rater reliability": in double-blind testing, doctors unaware of the diagnoses of previous doctors are supposed to reach the same diagnostic conclusions after examining the same patient in a reassuringly high percentage of cases. In the case of "schizophrenia", the psychiatric profession has failed for over a century to pass that test. In any other branch of medicine, such a diagnostic criterion would have been discarded as having no practical value.

At best, I think they have some support for saying that some people are more likely than others to pass into the mental state called "schizophrenia" under identical circumstances.

In practice, "schizophrenia" is a "disease" consisting of its own behavioral symptoms. If you have the behavioral symptoms, you receive the diagnosis, and there is no corroborating organic test for this supposedly organic brain disease. (That doesn't make it unique among medical ailments, but its a shaky start).

Because I have received the diagnosis, I am one. Neither you nor I nor the best clinical testing laboratory on the planet can support the statement "Gee, I guess someone made a mistake in your case". And less you dismiss that as an exceptional case: I could fill a concert hall with "schizophrenics" who, during a period of involuntary incarceration on a locked ward, were no less lucid than I am. I've been to conferences on the rights of people diagnosed "mentally ill" and I've met them. I am one of them.

In practice, "schizophrenia" is a disease identified by a list of symptoms that includes "has received a diagnosis of schizophrenia". Failure at any given time to exhibit any describable set of symptoms such as those listed in the DSM-IV is never deemed sufficient to rule out "schizophrenia". The diagnosis, dispensed under cavalier and unreliable diagnostic protocols, is, once received, never rescinded. If you are coherent and deny hearing "voices", you are "in remission".

Anyway, on the basis of this very flimsy and shaky construct, treatment is imposed on people who are thought to be incapable of understanding their need for treatment. In actual fact, the treatments they are able to provide are generally dehabilitating, permenantly detrimental to brain and other neural tissues, and unpleasantly experienced, and furthermore don't have much of a "cure rate". (Mostly they seem to interfere with neural activity in a broad unfocused way. Brain is creating undesirable thoughts & feelings & behaviors? OK, dampen all nerve activity. Gee, symptoms lessened!). Yet, despite this evidence which would seem to support the wisdom of choosing not to receive such treatment, the fact of refusing treatment (or attempting to refuse treatment) is cited as proof of the fact that you need it.

The pharmaceutical companies sure do a good job of PR for the efficacy of their "mentally ill pills", though.

[Pjen]

Originally posted by AHunter3

When I escaped from the hospital in which I had been diagnosed schizophrenic and was being held against my will, the change in milieu certainly did me a substantial amount of good.

Accepted as a humorous response, but let be expand.

Many people with psychosis seek out sanctuary when troubled by major symptoms. Unfortunately this is often only provided in hospital settings. However, recently it has been possible to provide milieu therapy in non-medical settings. Setting the tone of response to unusual thoughts or behaviours can have a major ameliorative effect on people who have these problems. Often the response that they get in the 'real world' accentuates and aggravtes their 'symptoms'. Our response to people with major psychosis who do not directly threaten violence to other people has tended to become unipolar- abandon them in the community with minimal support. A visit to any group of homeless will confirm the high level of personally perceived severe mental health problems. Of all social groups, the homeless are at the greatest risk of early non-natural death (average age in Britain for death of the permanently homeless and roofless- 42 years). In this way, society is often abandoning people with psychosis to early death.

And BTW I agree with almost everything else in your post- see the thread:

http://boards.straightdope.com/sdmb/...threadid=74392

where I was trying to discuss the limited validity of OCD and ADHD as valid diagnoses. The same goes for Schizophrenia.

Some people and organizations have made some effort to provide supportive and palliative residential and other services for this group of people, and milieu techniques are very appropriate for these services.

[DocCathode]

While in elementary school, I was diagnosed as
schizophrenic with a schizoid personality. For many years, every doctor who read that diagnoses just assumed it was accurate. In junior high, I began to study psychology. I knew that I had problems (ADHD among them), but I did not fit the criteria for schizophrenia. I eventually found better shrinks. One doctor even wondered if any of the psychiatrists who'd accepted the diagnoses had ever actually had sessions with me.

I am currently diagnosed as manic depressive with ADHD and OCD. My current psychiatrist readily admits that I don't quite fit the criteria for manic depression. She continues to use that diagnosis because it has yielded the most helpful results. Doctor Brodky even took me off all medication for several months to be certain that I wasn't being given a lot of unnecessary pills. Without those pills, I couldn't concentrate, had a massive amount of obssesive thinking and compulsive behaviors, and debilitating panic attacks and death phobia.

I have found both in personal experience and in the books, mental illness is best treated with a combination of pills and other therapies (cognitive, talk, behavioural etc). Sadly, schizophrenics often get only pills. This leads to thorazombies a la Cuckoo's Nest. Discarding medication and giving only therapies, as Pjen suggests, would likely also lead to people unable to cope on their own or escape the control of doctors.

BTW AHunter, I love discussing these issues with you. When this thread is big enough, I'll print it and post copies at my therapists' office.

[DocCathode]

If you are reading this thread and have not had personal
experience with the mental health field, I recommend the HBO
documentary Bellvue. You won't learn many clinical details, but the program does an excellent job of capturing the feel of an residential facility

[Pjen]

Originally posted by DocCathode
Discarding medication and giving only therapies, as Pjen suggests, would likely also lead to people unable to cope on their own or escape the control of doctors.

I am afraid that you misunderstand me. My post about non-pharmaceutical interventions was a reply to a post my neurodoc which said:

'Before I went to medical school and actually met real live schizophrenics, I thought that schizophrenia was some sort of extreme neurotic disorder, and that the patients could be "brought around" to a normal way of thinking by "talk therapy" designed to bring them to an "insight" about their disordered thinking. I was a great fan of R.D.L., a British psychiatrist who claimed to have cured schizophrenics with cognitive talk therapy.

In the psychiatry rotations during my 3rd and 4th years of med school I actually got to meet quite a few schizophrenics. It was an eye-opener. These guys and gals clearly had an organic brain problem and there was no way that I or anyone else was going to psychotherapize them into normalcy. I'm still not a great believer in neuropleptic drugs like Haldol (they have awful side effects). But they did stop the delusions and hallucinations when nothing else would.

Which seemed to imply that only medication would work. I was trying to point out that other interventions were possible.

I have never tried to work with people without the appropriate use of medication where appropriate; I do object, however, to medication being seen as the only, or most important, intervention available.

[Pjen]

Originally posted by DocCathode
If you are reading this thread and have not had personal
experience with the mental health field, I recommend the HBO
documentary Bellvue. You won't learn many clinical details, but the program does an excellent job of capturing the feel of an residential facility

An absolutely frightening place in its time.

I heard that after it was closed down as a hospital that it was reopened as a prison facility and many previous inmates returned there as vagrants and other minor criminals- any truth in that?

[AHunter3]

Pjen, it was indeed intended as humorous. In truth, the best alternative to traditional psychiatric treatment for the severely, uhh,

::searching for an appropriate descriptive term that won't ruffle any feathers::

...for the individuals whose thinking and communicating is pretty incoherent and whose behavior indicates a high likelihood of being dangerous to self and/or others, how's that? ...

...anyway, was the Vancouver Emotional Emergency Center, or VEEC. It was pretty much what you describe as milieu therapy, I think. It was a "safe house" run entirely by former psychiatric inmates and heavily staffed by volunteers who had been through it themselves. There were no psychiatric drugs or street drugs allowed on the premises. People could check out (i.e, it was not an involuntary institution) but if they stayed they were prevented by the volunteers from suicidal or self-destructive acts, or from hurting others. Sometimes, in order to do that 'preventing', some more general restrictions on an individual's behavior were necessary, but the overall tone was to avoid restricting freedom arbitrarily and administratively.

Alumni were expected to do a turn later on as volunteers, and many did.

Regarding the HBO documentary on "Bellvue" -- did you perhaps mean to type "Bellevue"? If so, it is still an extant hospital in lower Manhattan. It still has a psychiatric unit, including an inpatient ward that you can't leave if they don't think you oughta. I'm not positive, but I don't think Bellevue was EVER a dedicated psychiatric-only hospital.

DocCathode, my attitude towards psych meds is "If it gets you through your days and lets you function, who am I to tell you not to take it?", which is also my attitude towards street drugs. That large conference room I described previously, however, contained many people such as myself, people who had either never undergone any prolonged regime with psych meds, or who had gotten on their feet and become independently functional only after detoxing from them. So I must at least partially contradict you when you say

Discarding medication and giving only therapies, as Pjen suggests, would likely also lead to people unable to cope on their own or escape the control of doctors.

infosar as discarding all psychiatric treatments and relying solely on user-run self-help groups or even nothing at all did wonders for many of us.

[iampunha]

Originally posted by Rowan
However, it doesn't appear to be genetic-- at least in the "biology is destiny" sense, because the identical twin of a schizophrenic doesn't usually have schizophrenia. I don't know if the odds are slightly higher for the twin or not, but it's not like blue eyes-- if one identical twin has blue eyes, the other will too.

This is not completely correct. According to studies by the APA (2000), Tsuang in 2000 and Gottesman in 1991, the odds of an identical twin developing schizophrenia if one develops it is 48 percent. The odds of a fraternal twin are 17 percent, and the odds of a first cousin 2 percent. Further, if both parents have it, any child is 46 percent likely to have it, and 13 percent likely if one parents is schizophrenic.

As for the causes . . . type I is related to chemical imbalances (dopamine, this book suggests) while type II is related to structural abnormalities (this would be why the recovery rate for type I is higher than for type II).

The suggestion of a viral cause is a valid one, according to this source (Abnormal Psychology, 4th edition, 2001, written by Ronald Comer), which cites fingerprint differences in identical twins where one has schizophrenia and the other does not. Influenza and antibodies to petiviruses are two suspected possible viral causes (Takei, Os and Murray 1995, Toeery et al 1994, Yolken et al 1993).

I'll leave the discussion of milieu therapy to those who've been involved with it, as this book doesn't appear to come out on either side (which is probably a good thing), but I will say this: inasmuch as it gets people to act a certain way, it's good. But the book does suggest that people act one way and think another, which cannot be wholely conducive to a plan of total wellness for the patient.