Schizophrenia

Factual Questions
21

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.

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

22

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.
23

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!!

Designated Optional Signature at Bottom of Post

24

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

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.

25

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.

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

26

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?”

27

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?

28

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.

“If A=B, B=C, and C=D, do not get a job proofreading” --Quid’s Theorem

29

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.

Jason R Remy

“Open mindedness is not the same thing as empty mindedness.”
– John Dewey Democracy and Education (1916)

30

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.

31

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.

Sue from El Paso
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32

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.

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

33

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

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):

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).

Jason R Remy

“Open mindedness is not the same thing as empty mindedness.”
– John Dewey Democracy and Education (1916)

34

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. :slight_smile:

35

Jayron 32 wrote:

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!

36

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. :slight_smile:

37

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

::bump::

38

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.

39

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?

40

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.

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.