I have never heard more nonsense in my life, your telling me a schizophrenic doesn’t know they are hearing and seeing things that aren’t there. Clearly you have never known a schizophrenic person before because I have.
Matt, I know several schizophrenics, I took my neighbor to court to get a restraining order. He told the judge I had highly sophisticated listening equipment tapped into his house. He sees me sitting on his fence at night and in his trees. He told the judge I am doing these things. He believes it. They don’t have a real reality.
Intriguing indeed! We’re obviously very different! But, then, this is the whole problem with psychiatry (and medicine in general) at this stage of development: every patient is unique, and no rules are universal.
I’d never actually talked to anyone with your kind of self-awareness of depressed mental states. I can see how it might be helpful in terms of diagnosis. I apologize if I overgeneralized, when, ultimately, that’s what I think should be avoided in these discussions.
And if the “what happens” is a severe negative reaction to the drug (i.e., some anti-depressants making people suicidal), then what? It’s like injecting people with sypillis to see "what happens.
Except for the bit where it’s a treatment and not a disease. Otherwise, yes, it’s like that.
And the massive amount of testing that is done to nail down what the treatment should and should not do before it is ever injected into a human being.
And as long as that testing is done properly and becomes public, it’s fine. Which doesn’t always happen. There are many real problems here, but Annie-Xmas is wrong to treat it like blind guesswork or infecting someone with a disease.
I am not necessarily aware when it first starts but at some point I will have trouble making a really easy decision (like what to wear or what tuna to buy) and I will know I am headed south.
Not being able to make a decision is one of my most annoying depression symptoms since I am typically very decisive.
Matt, I’m sorry, you’re wrong. Most people with schizophrenia will lack insight into their disease. For an artistic example of same, you might want to watch “A Beautiful Mind”.
Please consider the possibility that other people have just as much experience as you do - or possibly more, since your experience appears to be extremely limited anyway.
Why do you think knowing one schizophrenic person gives you more insight into the disease than people who have spent their lifetime studying the disorder? Lack of insight is a very common problem with schizophrenics. This is a well documented phenomenon, and I guarantee you there are a slew of people here who know schizophrenics who refuse to accept that they are mentally ill.
[QUOTE=Wikipedia article on schizophrenia]
About 30% to 50% of people with schizophrenia do not have insight, in other words they do not accept their condition or its treatment.[13]
[/QUOTE]
[QUOTE=lack of insight in schizophrenia: impact on treatment adherence]
People with schizophrenia commonly lack insight, that is, they are unaware of their illness and the consequences thereof. One of the most important consequences of lack of insight is a failure to recognise the need for treatment, leading to treatment nonadherence. With several scales that now enable objective measurement of insight, it is possible to examine correlates of insight change, including course of illness and treatment adherence. Specific interventions, both pharmacological and psychotherapeutic, have been developed to enhance illness insight and treatment adherence. The extent to which second-generation antipsychotic medications, including a recently released long-acting formulation, improve insight and/or enhance treatment adherence remains to be determined.
[/QUOTE]
According to this study, it’s probably related to frontal lobe dysfunction caused by the illness:
[QUOTE=Poor insight in schizophrenia]
This paper reports on a replication of the Young et. al., study which implicated frontal lobe dysfunction in the etiology of poor insight in patients with schizophrenia. The study also investigated the extent to which defensiveness might play a role in such unawareness. The authors (XFA) had previously hypothesized that frontal lobe pathology may account for the severe forms of unawareness frequently seen in certain psychotic disorders. This study tested this hypothesis using the same neuropsychological tests and insight scale used by Young and his colleagues. Defensiveness was measured using the Balanced Inventory of Desirable Responding (BIDR). The results indicated that defensiveness was modestly correlated with only a handful of the different measures of poor insight. On the other hand, the neuropsychological test results were nearly identical to that of Young and colleagues, indicating that poor performance on tests of frontal function predicted poor insight independent of other cognitive functions tested including IQ. This independent replication adds further evidence in support of the idea that poor insight into illness and resulting treatment refusal stem from a mental defect rather than defensiveness or informed choice.
[/QUOTE]
KASAPIS C, AMADOR XF, YALE SA, STRAUSS D, GORMAN JM.
SCHIZOPHRENIA RESEARCH, 20:123,1996.
I’m actually starting to get a little miffed here. You are propagating blatantly untrue notions of mental illness. This is ethically irresponsible of you. Do you care at all about human suffering? Or is your ego more important than helping the mentally ill?
Agreed. Brooding, obsessive thinking is also known as ‘‘rumination.’’ That is also pretty well documented. We know, for instance, that women tend to ruminate more than men do. There is a strong correlation between depression and rumination.
Effective therapy in this case would involve learning coping strategies that offer alternatives to rumination. Cognitive Behavioral Therapy, for example, might involve teaching the client to switch activities and monitor the impact that has on his/her mood. Acceptance and Commitment therapy might emphasize accepting the feeling states and being present with them as they naturally change. Over the long term, these new behaviors can be acquired, will affect one’s routine way of thinking, and can make a positive impact on mental health.
[QUOTE=Tony]
Easier said than done but very interesting and important nonetheless. I can’t speak for other mental illnesses, since I don’t have personal experience with them, but this should be more mainstream than just whipping out the prescription book so quickly. I’m not saying meds shouldn’t be used at all but just less so than they are now.
[/QUOTE]
The thing is, these treatments are pretty mainstream at this point. Usually both medications and therapy are used in conjunct with one another, as evidence indicates that treatment + medication is more effective than either of these interventions alone. There is no reason to demonize medication like this. It works for some people, it doesn’t work for others, and each person has to weigh that risk for themselves. But there’s nothing wrong with the fact that people who are suffering psychologically have relatively easy access to medication. In fact, I’d call that a net good.
If the system needs to change in any way, I’d say it has way more to do with increasing informed consent than reducing the use of medication in treating mental illness.
One of the cardinal symptoms of schizophrenia is psychosis. One of the cardinal symptoms of psychosis is lack of insite. You could say the cardinal symptom, since it would be hard to argue that some one was psychotic if they had insite. If you’ve got insite, all you have is hallucinations, not psychosis.
But you can have schizophrenia, with hallucinations, without being psychotic. Just like you can have heart disease without being dead.
People who have hallucinations are often distressed by the hallucinations. I’ve read that, I’ve been told that, and certainly the two friends of mine who were schizophrenic were distressed by their hallucinations.
Both my friends started out knowing that they were having hallucinations, and both sought help. I’m told that this is common.
I’m sorry that, in one case, I didn’t realize how distressing this was, and how it would quickly deteriorate into psychosis. It rapidly became more difficult for him to distinguish hallucinations from reality, and he became so distressed he required support.
Apart from that, none of the people I’ve known, that I’ve known were schizophrenic, were psychotic or had lack of insite. 4 of them were holding down jobs, 1 was a student, 1 was unemployed. One of the 4was doing a senior professional job. (Count mounts up over the years!)
I certainly did feel less depressed – I just wanted to report that the drug did have that effect. Not manic though.
I think that all severe mental illness ultimately leads to psychosis, the inability to distinguish internal and external reality. You can get there from deep depression, schizophrenia, drug use, jail time, mania, or a host of other problems. Your mind breaks. It is broken. It doesn’t work correctly anymore.
In my case, I was having difficulty judging what was real and what was just stuff I’d been told. That happens to some people because they are manic, but for me it was a different path.
I was reading this, and it struck me as odd, that you both were describing characteristics that I’ve seen in depressed people, but were saying different things. I considered it for a while. and I’ve formed an opinion (no better than that, I’m sure)
You’re both right.
When you are depressed, you have a high level of self awareness, but poor judgement.
[Orr, G], from your description, you have retained good judgement about this area of your life, even when depressed. From you description, I was recognising the awareness. which is characteristic of moderately depressed people. From [Trinopus] I was recognising the poor judgement.
In the moderately depressed people I’ve known, I think the awareness is a result of the poor judgement. They are concentrating super-hard on the awareness, to try to fix up their sense of judgment, which they are experiencing as a bit broken.
These people were still semi-functional, so obviously their minds were not completely broken. Adequate judgement in some areas, failures in others.
Generalizations. Sorry if I misrepresent either of you.
I’d say that’s a big part of it for me. Using my strengths to shore up my weaknesses. There are other factors at play as well, of course, but I’d say your take on it is accurate in my case.
Just a technical point, really, but the presence of hallucinations in the context of schizophrenia are considered psychotic symptoms, without regard to insight.
I think you got Freud wrong, I have read all of his books.
He was a kind and gentle person. He was criticized for his use of sex in therapy, but he explained it saying: “These concepts are only the tools of my trade, it is love that heals.” He worked with patients for long periods of time teaching them to think about themselves in a rational manner. I believe he used sex because it is a very strong drive in us humans. The words he made up like libido, id, superego, are still in use today. When he got cancer of the mouth from chewing cigars he was disappointed in himself for not being able to overcome it. It killed him.
What a bizarre interpretation of Freud. The idea that “love heals” is so at odds with his theories on insight and catharsis that I’m willing to bet he never said anything of the sort.