That happened to a medical student on clinical rotation to a psychiatric floor, once, too. There had been a miscommunication and she’d arrived shortly before a shift change. Night staff saw new person, assumed “new patient”, and she was ordered back to her room. No one would believe her and she was put in restraints face down in seclusion and shot up with Thorazine. Only when the morning shift arrived did anyone put the pieces together and release her.
Yep. Sounds plausible.
I think there was an experiment by some journalist back in the 1970’s where they tried to get admitted to a psychiatric ward and succeeded, despite not having any mental illness. And not being let out at their request, because of course they would deny being ill, all the patients with psychosis do that .
I’ve always tried not to overstep the line into mindfuck with that. It can be very tempting to dismiss someone who disagrees with you on the grounds of lack of insight. Having the power to decide who gets out and who doesn’t is corrupting in and of itself if it’s not carefully monitored.
That’s my experience as well. I’ve never needed antipsychotics, luckily , but for antidepressants that aspect is comparable. These meds don’t fundamentally change the underlying patterns. They do help in giving psychotherapy a better chance of addressing those, but especially under stress these patterns usually turn out to remain right around the corner. Which is a lot better from constantly bumping into them but still.
I cannot remember the formal name of the study. The subtitle was Being Sane In Insane Places. You have the gist right but some of the details off. I’d say more, but I only get 15 minutes for a break.
I have an anecdote that relates to this. I used to work as a case manager for an outpatient mental health center, and we would organize activities in the community for clients to attend if they wanted a little help getting out and socializing. One of our outings was a movie night - we went to the theatre to see Field of Dreams. It was just out, and I knew nothing about it. One of the clients, who happened to be schizophrenic, sat by me and we were chatting part of the time. He stiffened up the first time the disembodied voice said, “Build it and they will come.” But then he looked around, looked at my reaction to the movie, and asked “You can hear that, too?” I said yes. He said “Thank God!” and seemed to enjoy the rest of the movie. I always thought he had pretty decent insight into his condition, even on days that he wasn’t doing so well.
My opinion is everyone is different. I knew schizophrenic people who had little or no introspection or insight, which I could be empathetic toward. I also know some non-schizophrenic people right now who seem to have no insight either, and I find those people quite frustrating.
“On Being Sane in Insane Places” by David L Rosenhan
Originally published in Science, New Series, Vol. 179, No. 4070. (Jan. 19, 1973), pp. 250-258.
PDF of the full article:
https://www.oulu.fi/sites/default/files/content/AOH%20Terveenä%20epäterveissä%20paikoissa.pdf
Here’s the text of it if you don’t like PDF files
I think it’s always good to stress that everyone is different and has different reactions to both psychiatric drugs and psychotherapy. I’ve had positive results with the former and mixed results with the latter (actually, the best results I’ve had with the latter is just self-studying REBT [Rational Emotive Behavioral Therapy].) Granted, my condition (something in the bipolar spectrum along with general anxiety disorder) is quite mild, but it was jagged enough that fits of hypomania would just come out of nowhere a few times a year, and now I’ve been living a much more stable and fulfilling family and peaceful life without feeling like my mental, emotional, or creative faculties have been curtailed. Some of the more negative extremes have been rounded off. And, best of all, my desire to drink to self-medicate has similarly plummeted to the point I am essentially a non-drinker. My life is better now. Would I prefer not to take drugs? Sure. Do I hope to taper off them at some point? Yes. But, for the moment, I like where things are so don’t want to change anything.
This is not to discount your experience – yours is perhaps common or even more common. Just to say that experience with these things varies wildly from person to person.
Totally agree. Wouldn’t want to be without meds myself, because that’s far, far more exhausting for me and everyone around me. For me it was MBCT and self-compassion combined with a very good teaching therapist and psychiatrist that gave me a firmer base to lean on, but that would have been impossible without meds.
Besides, I prescribe them on a daily basis. I only meant to say that I’ve experienced the nasty patterns still being there and popping up if I’m not careful, but a lot more out of the way than they would be otherwise.
Gotcha. I certainly still have hypomanic spurts, but managable ones and simply identifying and understanding what’s going on helps immensely, too.
Very, very true.
My daughter spent some time in a therapeutic residential program. Her closest friend there, “Jane” (not her real name) had a messed-up family history, and a diagnosis of schizophrenia. When she left the program, she was managing for a while. But she ultimately went off her meds, was self-medicating using other drugs, wound up homeless; had a couple of too-short hospital stays which didn’t do anything to stabilize her long-term, etc.
My daughter has not heard from her for a couple months now. We have no clue where she is these days.
I went to college with a woman who has been diagnosed with schizoaffective disorder. She has been open about this diagnosis online, but has also shared that she is unemployed and does not get out of the house much. Another friend from college has been similarly open online about her physical and mental health struggles and chronic unemployment. My understanding is that even with the incidence of schizophrenia estimated at, as Stranger said, 1:150 to 1:400, it does not follow that if you know 150-400 people, one of them is probably schizophrenic. That person is disproportionately likely to be incarcerated, for example, so if you’re not in jail you would not come across them. If not incarcerated, they’re disproportionately likely to be unemployed, so you would not meet that person in an office. You may be less likely to run into them at a concert or festival if they avoid crowds.
And let me hasten to add that I am not implying that people with schizophrenia cannot hold jobs, or be out in public, or are in any way inherently incapable or inferior or criminal. Just saying that the statistical probability of you knowing someone with that disease would be lower than 1:150 to 1:400.
Even the diagnostic process is challenging. We needed an order signed by a judge, which we took to the police HQ, and that ordered the police to take the potential patient to the hospital for a three-day assessment period.
It ultimately required a SWAT team and a one-man battering ram to extract SIL. This was followed by an interview by a psychiatric nurse, during which we were sweating bullets knowing how SIL could BS her way out; she could, for about 15 minutes, hold it together while sounding intellectual, esoteric and slightly eccentric. Fortunately the interview went past that point and she was admitted for the assessment that night.
The next day some patients rights group apparently showed up (how they knew I’ll never understand) and told her that she didn’t have to stay and could refuse meds. We were subsequently told by a doctor that she was severely schizophrenic.
Because we didn’t have the resources she spent the subsequent five or six years living in shelters and flop-houses, unmedicated, until she died from lung cancer. Smoking is actually a big need of schizophrenics. When she died she was renting a very small bedroom in a multiple room rooming house. Her room was maybe a foot or two bigger than her single bed and I removed about 20 garbage bags full of her stuff in one night. We removed more stuff over the next day or two.
I also recall hearing from the Canadian Schizophrenic Society that something like 10% of the homeless population is schizophrenic. Mental illness is a spectacular failure in our society.
It is. Partially because tobacco industry has been marketing to this specific group with tobacco as self-medication, partially because classic antipsychotics (eg haloperidol) deplete ALL dopamine circuits in the brain, including in the mesolimbic system (the reward system) with huge craving as a result. In the Netherlands, there are now specific programs to help inpatients cease smoking, because it knocks about 15 years off of their life expectancy.
That’s the same with us I’m afraid. The fact that health insurance has deprived us of 300 mil/year for the last ten years doesn’t help either .
All these are excellent points, and none of them occurred to me. Now I think odds are fairly good I don’t know anybody with the condition.
I wonder if it would be better for the sake of normalization for most people to know somebody as a schizophrenic? For many identities that were previously closeted but have been coming out, this has been a big help in social justice advancement. I’m guessing this is true for people with schizophrenia that is not, at least presently, expressing itself with psychosis. But if I met somebody who was, at that time, demonstrating psychotic behavior, I might struggle with that.
Case in point; my brother has always had the hardest time staying employed anywhere and is incarcerated.
I did say that I don’t believe his criminal behavior is due entirely to his mental illness, and I still stand by that, but his inability to maintain a steady job most certainly was.
I remember reading that there’s some validity to this idea of self-medicating with tobacco. A quick Google search brought up this link, which is old research, but as far as I know it hasn’t been debunked.
I was at a lecture two weeks ago by a psychiatrist who came up with the marketing angle. I remember even earlier research that kind of says the same as the article you linked. I once did a presentation on the subject when I was still a resident in the inpatient clinic, where people had dark brown nicotine-stained fingers from smoking rollups all day. Living room was always awash with smoke. Really horrible when I look back. Of course, in psychiatry everyone smoked, not just the patients, and a lot of us still do.
Fascinating!!!
I don’t know that I’ve ever heard of the tobacco industry specifically marketing to those with mental illness - where did that theory come from?
“Jane” is indeed a smoker. A fairly significant number of residents at that program are / were. The facility of course banned alcohol and all non-sanctioned pharmaceuticals, but recognized that tobacco was not a battle worth fighting - quite possibly for the reasons cited in the article.
My daughter said she actually considered taking it up, because smoking (banned indoors, but there were smoking areas designated outside) was somewhat of a social activity. Fortunately, common sense prevailed in this case… or we’d have had to drive 500 miles and rip her lungs out with blunt table knives. I suspect the family history (her grandmother died of lung cancer) was a big factor in her not taking that step, plus our having indoctrinated her over the years with how disgusting it was.
@AHunter3 your insight is, as always, very illuminating.
Some of the arguments for forced medication, I gather, are along the lines of “cannot function well enough to live without supervision”. “immediate danger to oneself”, “will be thrown out of housing”, and “has committed a crime and cannot stand trial” (in that case, the meds are intended, in theory, to bring the person into enough touch with reality that a trial would be useful).
Given the abysmal state of long-term mental health care - either inpatient or outpatient - I’m not sure what the right answer is. And even when done with the best of intentions, I gather it’s rare that a facility will keep a patient in long enough to truly figure out what meds actually work, and at the right dosage, rather than simply drugging the patient into enough somnolence that they’re no longer raving and can be booted out.
We are fortunate that our daughter is NOT in that realm. I honestly suspect she may be borderline bipolar, based on how she was behaving before we sent her off to the facility; she’d go from being very upbeat, to breaking down and suicidal over being asked to do the dishes. She definitely has some form of depression, though regular depression meds were NOT doing a lot for her - until she was put on Lamictal for seizures, and hoooooly cow, what a difference that made. Lamictal is used for mood disorders and is among the tools used for bipolar disorder, which is suspicious.
She has also managed to function independently for over 2 years now. It’s heartbreaking to see her so underachieving (she’s scary smart) - she worked part-time doing janitorial work, now part-time as a cashier. She will NOT get her learner’s permit (she had one here, but it’s long since expired). She loses track of important stuff - like she’s lost her SNAP coverage, AGAIN, due to not responding to mailings. And so on.
But, she’s lived alone for all that time, manages to pay her few bills on time (we are subsidizing her rent), cooks for herself, handles her meds with relatively few screwups, and so on.
But where’s the marketing part? I won’t say I don’t believe it but it must be really in media I don’t run into.