::huge sigh::
::plops down soapbox::
Hi, I’m AHunter3 and I’m a schizophrenic.
At least that’s what the psychiatrist with the authority to make the call put down on my chart. Paranoid schizophrenic with delusions of grandeur.
As ultrafilter notes, there’s no lab test and therefore no non-subjective way of arriving at that conclusion. Nor of disputing it. Nor, for that matter, can I honestly report that upon meeting the other people with various “mental illness” diagnoses I felt that I was different from them in any way that would support the notion that they’d made an error, although I didn’t think anything was wrong with me.
And so on the basis of this diagnosis I was held without my consent in a building and forced to take antipsychotic medication that I did not want to take.
Now…I know you are concerened about your sister and you want to believe that there is a scientifically-informed profession focusing on the kinds of problems she’s having, and that they can help her or cure her. So this is probably a public service message you aren’t going to be very comfortable with.
a) No one understands schizophrenia. That’s because once upon a time when medicine and human biological science was much younger than it is today, a wide range of human maladies of the “acting crazy” variety were, for the first time, conceptualized as illnesses rather than moral depravities, demon possession, or other such bullshit – they didn’t know what caused them but they had high hopes that the scientific method would soon reveal them. But what happened over the next century was that whenever these maladies really were understood as the symptoms of an underlying medical condition of some sort – hypothyroidism, epilepsy, tertiary syphilis, various vitamin or mineral deficiencies and electrolyte imbalances, psychoactive effects of ingestion of various mild toxins, etc etc – they were removed from the “mental illness” classification, and the major categories that remain in the “mental illness” bag are the ones that have not yielded their secrets to these investigations. Many of us in the anti-psychiatric / mental patient’s liberation movement (yes there is, and I’m in it) believe that either the behavior/thought pattern called “schizophrenia” is something anyone can experience or be driven to by situation and events (although maybe some are more vulnerable to that than others) and that it has no biological origin (just social, personal, cultural, etc), or else it is a complex of interactions of biological and social factors, and that either way the thrust of psychiatric research – which still follows the reductionistic medical model and seeks a singular cause in the form of a strictly neurological or neurochemical disfunction – isn’t going to find anything useful.
b) The profession is not [solely] a caring profession. Psychiatry from its inception (go Google “Kraepelin” and “Bleuler” if you suffer from the misconception that this mainly had to do with an Austrian named Freud – it didn’t, he’s marginal to the mainstream practice of psychiatry) has had a police function that is disguised and “doublethinked” around. It’s a mechanism for dealing with the inconvenient for the protection and freedom from disburbances of the general public, meaning that the people it exists to please and serve aren’t [necessarily/always] the ones it designates as its patients. It is coercive, as the power to hold such people and impose treatment on them is granted unto the profession, as a rare exception to the general rule that you can’t incarcerate people without charging them with a crime, or take away people’s right to make their own ordinary personal decisions without determining that they lack fundamental competency. And yet these police powers are masked by always describing everything that the profession does in terms of helping suffering sick people by providing them with needed medical treatment. And for this reason the holding and treating of the inconvenient due to their inconvenient is accompanied by applying a diagnostic label to their inconvenient behavior – in other words, historically and as part of what institutional psychiatry is, sociologically speaking – what it’s social function is – the diagnosis is applied as a means to a desired end, the determination that it is necessary and appropriate to hold and treat this person who is disturbing other people. Pragmatically, as an institution, psychiatry could not and does not hold and treat merely those for whom there was an established, sound reason for believing that they have a medical condition of the brain that will respond favorably to available treatment which will benefit the patient.
A mind cannot be “ill”. a brain can be ill, a body can be ill, one can have a congenital illness that causes neurons to do their job inaccurately, and so on. But a person either does or does not have an “illness” regardless of the state of one’s mind, which, with regards to any illness, can only be a symptom.
c) The treatment that psychiatry can provide to people diagnosed “mentally ill”, especially “schizophrenic”, is a very mixed and mostly unpleasant bag. The prevailing treatment of choice for schizophrenia, neuroleptic drugs, work, to the extent that they work, by interfering in a broad, unspecialized way with the way that nerves fire. They are most positively, absolutely, certainly in no shape way or form even remotely comparable to what insulin is for diabetes. There is not an understood deficiency condition that is ameliorated or fixed by adding in neuroleptic drugs which, by their addition, cause the nervous system to function normally. What neuroleptic drugs do is mask symptoms in more or less the same way that turning down the volume on a stereo system with distortion in the speakers can cause the distortion to be less evident. To some schizophrenics, this is a better than nothing – “I don’t hear voices, I can function” - but to many many others it is far far worse – “I can’t think, I’m like a zombie, I’m not even alive like this, I can’t feel, I can’t care about anything except in a dull miserable way”. Oh, then comes the bad news: they all cause permanent brain damage if you use them long enough, including damage to fine and gross motor nerve systems as well as the parts of the brain responsible for thinking and feeling; they, in and of themselves, impair cognition to the point that with or without mental illness you are going to function with greatly diminished capacity if you’re put on this stuff; they are addictive; and they have a wide range of nonpermanent but unpleasant side-effects on both brain and body. Other treatments to which schizzies are subjected are even worse – electroshock, despite the oft-heard declaration that it’s for depression, is used on schizophrenics from time to time and a series of electroconvulsive treatments will do more significant permanent brain damage than neuroleptic drugs and is horribly unpleasant according to most of the people I’ve spoken to who’ve had it done to them.
d) All other things being equal, a person is more likely in the long run to recover from observed symptoms of mental illness such as hearing voices, incoherent or irrational ideation, aggressive or paranoid or withdrawn behavior and mood, etc., if they stay away from psychiatric treatment than if they receive it.
Now, some better news. I mentioned that we have a movement. In addition to organizing against forced treatment and involuntary psychiatric incarceration, and against actual or proposed discriminatory infringement on our civil rights on the basis of psychiatric diagnosis (housing, right to drive, medical confidentiality, etc), we also try to provide user-run self-help services, which are most definitely not coercive. We don’t always know the answers to each others’ problems either, to be sure, but most of the folks who’ve tried it say it’s better to thrash things out with people who know what it’s like than to be treated like a neurological dysfunction by a medical doctor. If you think she’d be interested, I’ll find out what’s available in her area.
My web site, for more reading:
http://members.bellatlantic.net/~adhdah/
Also, do a SDMB search for my username in conjunction with “psychiatry”, threads since the beginning of the board, and what you’ll get is sort of an informal “Ask the Schizophrenic Guy” thread to read.