Schizophrenia

Factual Questions
41

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/showthread.php?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.

42

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.

43

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

44

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.

45

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?

46

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

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.

47

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.