You can find some studies that say in non-western cultures schizophrenics have better outcomes and less negative delusions, it is attributed to spirits instead of being an illness etc.
This doesn’t answer the why it is in western societies the delusions are often negative for either the patient or loved ones or inspire violence, is it just the societal view of it?
I mean things like delusions of paranoia, persecution, or that others are trying to harm or murder you, or that inspire violence. There was a famous case where the person had a delusion that a neighbor’s dog told them to kill but I can’t recall the name or incident.
Maybe the negative ones are more likely to reach media attention, but you can read personal accounts that sound overwhelmingly negative and harrowing.
By the modern definition of mental illness, you generally don’t have any mental illness if it doesn’t affect you negatively. The DSM-V criteria for Schizophrenia are on this link, and if you don’t meet A through E, you don’t meet the diagnostic criteria. This means that by definition people who have delusions that improve their lives aren’t considered schizophrenic. http://www2.nami.org/Content/NavigationMenu/Intranet/Homefront/Criteria_Schizophrenia.pdf
Even if we remove that requirement, if the delusions aren’t negative, why would the person be diagnosed and/or treated for it? Think about it - if someone hears voices that nag them get to work on time and encourage them to eat healthy food instead of pizza and fries, they’re not going to end up arrested, involuntarily committed, or voluntarily seeking treatment. And if they’re in therapy for something else, they probably don’t want to get rid of the helpful voices, so would tend not to bring it up. So how would a ‘positive voices schizophrenic’ end up in the numbers?
I don’t remember where I read it, but I remember something about the hallucinations being cultural and in some cultures the “voices” do say nice or funny things.
Yep. Almost all psychiatric diagnoses require “clinically significant distress” before they can be diagnosed. For example, if you tell a psychiatrist that you are sad and cry all the time, but that you’re just fine with that because it really helps you write the poetry that you rely on for a living and you have an awesome and supportive family that would never let you down, the doctor, if he is any good, will nod and tell you that you’re fine, but to come back if the sadness does become a problem. It’s ok to continue living with non-distressing sadness since it’s not causing you trouble. The moment it starts causing a significant amount of trouble for you (e.g. marital breakdown, job loss, legal problems, suicide attempts, etc.), it becomes, by definition, a mental health problem that can be diagnosed and treated. It’s a distinction that makes common sense.
The paper further speculates it is the oppressive system of control and coercion in western countries that causes negative outcomes.
This is probably true, but in all but the poorest or most primitive countries mental health care is often worse and even more oppressive than the modern 1st world.
My impression is that in the west most schizophrenics initial contact with forced commitment or forced medication only happens when there is a negative result that gets authorities or the court involved. When family and friends can’t cover over things anymore. This might be wrong but I did not have the impression there is a culture of hunting down those with neutral or positive delusions or auditory hallucinations at least in modern society.
By worse I mean more oppressive and non-patient controlled, what I mean is there are very few countries where it is non-existent.
That’s also true. Medicine is a clinical profession that relies on identified patients, not massive and intrusive universal screening. If you get a mild cold, don’t see a doctor, and it resolves a few days later, did you really have a cold? Yes, you did, but that fact was not recorded in any medical record, reported to any public health authority, used to support a billing claim against anyone, or added to any statistical study. For nearly all intents and purposes, and essentially all official ones, you never had a cold.
It’s interesting to speculate about what might really be going on in other peoples’ minds. Maybe the seemingly normal guy who lives across the street really thinks that he’s an undercover observer from the Andromeda Galaxy who was sent to Earth to pretend to be human, alert no one of his extraterrestrial origin in any way, and wait quietly for additional orders, which will be clear and simple to recognize and understand, not requiring hyper-vigilance. Nobody would likely ever find out about that belief.
Condition E, excluding the direct effects of psychoactive drugs, is also interesting. This means that if you, as an immediate and direct result of taking LSD, develop delusions that you are a cherry tomato and that King Kong has returned from the grave to lead you and your fellow cherry tomatoes on a quest to re-conquer Greenland to avenge the death of Richard Nixon, who is the new orange, which is the new blue with pink dots, you aren’t schizophrenic, you are tripping.
I would guess that most people in a modern society that had neutral or positive delusions or hallucinations and talked about it or their behavior gave signs of it would be told by others about schizophrenia or at least that it was unusual.
Or being curious themselves they would hit a search engine and find info on schizophrenia.
The literature only reports what the writers consider important.
I’ve been curious about this myself, and so I’ve asked some of my patients with schizophrenia about their auditory hallucinations, not just if they’re having them, but what they sound like and what they are saying, as well as if they’re distressing. Every single one has told me, conversationally, that they hear the voices more often than they report them to their doctor, because most of the time, they’re not bothered by them. When they become distressing is when the doctor hears about it.
One person, for example, hears the voice from the CTA announcements. Most often, it’s making observations, like, “That woman’s dress is pretty,” or offering advice: “It’s cold today, wear a sweater.” These aren’t disturbing to him, they don’t interfere with his day, and so he doesn’t tell the doctor about them. The specifics don’t even go into my nursing notes (which no one writing “the literature” is reading anyway) because they’re not relevant. I might chart, “Reports hearing voices he acknowledges aren’t real, no distress,” but that’s about it. I see him weekly, so I make sure he’s coping okay, and if he is, we focus more on his diabetes than his schizophrenia, and that’s what I chart about, because that’s what we’re working on. (I wish I knew how to convince his voice to remind him to take his blood sugar before he gives himself insulin, in fact. That would be fantastic!) His psychiatrist sees him every six months, unless he’s having trouble coping.
There are also plenty of non-schizophrenics that have at least one auditory hallucination in their lives. I’ve read estimates as low as 2% and as high as 40%.
Perhaps, but isn’t lack of insight a common feature of schizophrenia? That is, people who have it generally believe that their delusions are actually reasonable beliefs and that their hallucinations are real occurrences. This is why they do not typically seek treatment on their own and usually have to rely on interventions such as arrests before they get put into treatment. Presumably, positive delusions would also be associated with lack of insight, so our hypothetical person who is hearing voices nagging him to get to work on time presumably believes that such voices are reasonable to have.
Yea I wondered about that too, I assumed it was because if you have lived with it seems normal.
I have seen accounts where the patient asked for help because they were worried something bad could happen to their loved ones though due to negative hallucinations.
what would be the term to use for someone experiencing ongoing constant neutral auditory hallucinations then if it doesn’t qualify as schizophrenia? It seems odd to say nothing. Most other disorders or conditions still exist even if the negative aspects are too mild or the patient has learned to cope.
So let’s stipulate for the sake of discussion that we have an individual who isn’t distressed by his or her mental content, per se, but it’s definitely a very different mental content than what everyone else around them considers to be ‘real’. And that this person isn’t hurting anyone else either (so we can remove from consideration all worries about public safety and the police functions of psychiatry). What we have left is still someone who is a human being in a milieu of other people who have a culture-in-common that this individual isn’t entirely a part of. Without adding anything else to the situation, just from that alone, can you see how that can be rather frightening to the individual in question? Just from being that cut off. And from the eerie feeling that everyone else is somehow tuned in to some channel that he or she doesn’t get — the Normal Zone!!! Yeah. normal people are fucking creepy sometimes.
Yes. Again, well put.
Human minds and human emotions are not foreign to you and me. For one person to have come to entertained a batch of thoughs impressions ideas etc that are not akin to those of the people around them, there has to be some kind of stress. You can get all medical-clinical about it and conceptualize stress in terms of something that exists in the individual or you can get more political and think about one person with (let’s say) a good portion of today’s understandings about some social issues but having come to those realizations in 1923 or something. That would be stressful.
I take it for granted that societies have pathological characteristics. Sicknesses that individuals can come to recognize, and with that recognition comes stress.
It would seem that a case of constant hallucinations that had only a trivial effect on a person’s life would be seen as a curiosity - perhaps something to write a descriptive case study article on for future students to puzzle over but not something to treat.
I have known three men diagnosed with schizophrenia. One was convinced he was Jesus. Actually, he was generally a joy to be with. One was unspeakably messed up, and I will say no more. The third murdered his family, but never had a formal diagnosis, because true Christians don’t get psychiatric help. Since he then killed himself, we’ll never know.
I can’t help but wonder if the first man, who was diligent about his meds, had met the other what would have happened.
Who diagnosed the third man with schizophrenia? You said he was diagnosed, but that it was not a formal diagnosis. Was this an “armchair psychiatrist” diagnosis, or was there a diagnostic finding that was later invalidated or voided on a technicality or something (maybe the diagnosing doctor had his license pulled retroactively, voiding all of his diagnoses)?
Yes.