Anxiety
PTSD
PTSD
Depression
Borderline and Other Personality Disorders
Bipolar Disorder
Schizophrenia
So, Sophie's Choice got me thinking. Even those struggling with "higher order" mental illnesses have prejudices and pre-conceived notions about those lower down on the scale. The thing that gets me about this is that all of the disorders above can be just as disabling as any other. William Styron, the author of Sophie's Choice, suffered with such immense depression that it threatened his life. He called it, "so mysteriously painful and elusive in the way it becomes known to the self -- to the mediating intellect-- as to verge close to being beyond description." So why, in my interpretation, did he not have the same - respect? - for Schizophrenia?
Have you seen other examples of persons who are great advocates for persons with the same mental illness they suffer from, but still stigmatizes others? I'd love to hear your thoughts.
Have you seen other examples of persons who are great advocates for persons with the same mental illness they suffer from, but still stigmatizes others? I'd love to hear your thoughts.
Sure, psychiatrists. Haven't you noticed how they always claim "schizophrenia" is a special case, almost treatment resistant? Of course, schizophrenia is their golden goose and continues to take up the most number of hospital beds. Then there are "bipolars" who should know better. Many researchers, Richard Bentall, for one, believe these conditions are one in the same. But there are many people with the diagnosis of bipolar who somehow have the impression that "schizophrenics" are the real sickos and they, the "bipolars" are the creative, annointed ones. When I deal with psychiatrists, I like to find out how "schizo-positive" they are, meaning, how much do they value what their schizophrenia patients tell them. And you know what I've found? Psychiatrists (most, not all) are about the worst. How can anybody get better if their doctor (and by default their parent) doesn't believe in them?
ReplyDeleteRossa, this is a prime example of what I am talking about. Take a look at children in particular. Psychiatrists are very, very reticent to diagnose children with any kind of psychotic disorder because - and I've been told this - they don't want the "label" to be stuck with them for life. How is that "label" any different than being diagnosed with epilepsy, diabetes, cancer, depression, ADHD?
ReplyDeleteRossa: Honestly, my experience has been the opposite. All of the psychiatrists I have seen are far better about these things than the social workers, case workers and psychologists, all of whom I have had terrible experiences with and who seem under-prepared to deal with serious pathology (which, quite frankly, they are not as well trained to deal with; their training is focused on other things). Also, it is worth pointing out that most of the money earned by having a patient in a hospital does not go to the doctor (is that what you meant when referring to a "golden goose"?) -- who, in a hospital setting, is on a fixed salary (and they actually make less than private practice doctors) -- but to those who run the hospital itself, who are rarely doctors. Furthermore, I think that if you did a survey, the minority of patients in a hospital at any given time suffer from any form of psychosis -- though they, on an individual level, may be hospitalized more -- with the majority of beds being occupied by suicidal depressives. The case may be different at state hospitals; however, the money argument would still not hold, as doctors are still salaried and those working in state hospitals will make less than those working in non-state hospitals. Schizophrenia is also more likely to be treatment resistant, as we don't have many drugs that are good at treating negative symptoms. This frustrates many doctors, most of whom do want to help, and sometimes they let that frustration impact how they treat patients (they're human, too, and prone to these things, just like the rest of us. They don't like failing and seeing people in pain they can't fix, so their minds try to protect them by having them avoid or not try to help said patients. Doesn't make it OK -- certainly, switch doctors; but it doesn't make them bad people, either. Also, as they are just human, you're going to find just as many bad ones as good ones, just as is true in non-physician general populations). Now, I am going to request that none of us continue to jump on the doctors-are-evil-and-rich-and-don't-listen-and-know-nothing bandwagon that many like to drive around. You need to find a doctor that works for you; however, the generalizations and attitudes bother me.
ReplyDelete(Apologies for the rant, Chrisa).
Chrisa: Yes! This exactly! In the hospital, the majority of patients were there for things such as depression and quite a few of them saw themselves as somehow better, "less crazy", than those with Bipolar and Psychotic Disorders. Then, those with "just" Bipolar saw themselves as somehow above, "less crazy", those who had psychotic features. Those with Bipolar with Psychotic Features then saw themselves as better, "less crazy", than those with Schizophrenia and Schizoaffective. It was incredibly palpable and there was sense that there was a certain level of insanity that was accepted and, if you went beyond that, you didn't belong. This wasn't true for every patient, of course, and overall people were fairly accepting; however, you knew it was there and, as a result of it, you put effort into not letting your "too crazy" symptoms come to light.
ReplyDeleteIn many ways, I see this as human nature. Throughout history, whenever one group has broken through severe oppression, they have turned around and oppressed the more vulnerable. It protects them, turning the focus away from their own group and on to another and showing their previous oppressors that they are really just like them. It's wrong; but it is nothing that is exclusive to mental illness. It is seen in race (discrimination against Latino/s), the LGBT community (gay males looking down on gay females who look down on transgender and transsexuals) and so on. It is a scary cycle.
Of course, in the greater population, all of this is even more obvious. Though all are stigmatized to some extent, the difference between someone saying they have depression and have schizophrenia is often the difference between someone being OK with you being their child's friend and someone wanting you out of their community completely.
A small adjustment to your list, in my opinion:
Tourtees (technically, it's in the DSM)
AD/HD
Anxiety
Depression
PTSD
Bipolar
Borderline and Other Personality Disorders
Schizophrenia
Re: Diagnosing Children: Though I cannot speak for all doctors, I know many are cautious to diagnose children because they have seen such gross overdiagnosis by other doctors and current trends seem to be continuing that way. As an example, many psychitrists advocate for the idea that chronic irrability and rage is actually childhood Bipolar Disorder; however, when you follow these children long-term, the most any study (and the majority of them show much, much less) has shown that these kids continue to suffer from or go on to develop true Bipolar Disorder as adults in under 45%. They are hesistant because research is still not fully conclusive. Obviously, as both you and I know, there is a middle ground somewhere between never diagnosing and diagnosing far too much; it may just take us a while to find it.
ReplyDeleteWell, the problem is, in mental health, the label tends to stick way past its shelf life, particularly for schizophrenia, which people do recover from. However, it's not in psychiatry's interests to promote this (because of the golden goose). If someone with "schizohprenia" does recover, psychiatry claims he went into spontaneous remission, like some sort of act of God. A cancer patient can say, "I had cancer and tests show that I don't have it anymore." There are no medical tests for schizophrenia and nothing that can validate or negate recovery. It's all in the eye of the beholder.
ReplyDeleteErica, rant away. :-)
ReplyDeleteRossa, the only issue with this is that the delay of treatment causes its own issues, like my son who lost more than 30 IQ points from the damage of constant psychosis. To use the cancer analogy, it would be like delaying chemo to see if the cancer is REALLY cancer, meanwhile, it spreads.
Erika,
ReplyDeleteSchizophrenia, or dementia praecox, as it used to be called, is ground zero of psychiatry, along with manic depression and neurosis. Dementia praecos and manic depression were terms coined by Kraepelin in the early part of the last century. Everything else (the pathologizing of human angst) has been an add-on to the DSM. Psychiatry is vulnerable to accusations of label creep, which many psychiatrists would agree is the problem with psychiatry as it is practiced today. But they will not relinquish schizophrenia because it has a "noble" history that has been documented across cultures and time periods. It is also a scary condition, the mysteries of which psychiatry would prefer to keep to itself. Schizopyhrenia is very understandable if you take a humanistic approach.
Chrisa, my only question would be how does one distinguish loss of IQ points, from, say, the effects of the drugs or the mental turmoil that the person is going through? If someone is anxious or on a heavy dose of drugs, they can't perform. My son is about the most intelligent person I know and I delayed treatment, too. When he was floridly psychotic, he couldn't even read a book or a magazine article. He couldn't string two words together in a written list. Had he taken an IQ test, he would surely have lost points. My middle son took an IQ test when he was in second grade, and got a 40, if I remember correctly. He didn't see the point of finishing the rest. Today, he's a banker. Go figure.
ReplyDeleteMy son's IQ at age 4 was tested at 90. At 13, it was 59. That was all pre-meds.
ReplyDeleteRossa: I just read through your blog. I see that you are taking an alternitive approch to treating your son and are opposed to medicinial treatment and contemporray medical theories (either biological or biopsychosocial) on the development of such disorders. I am not going to critisize this, inheritly; but offer my own perspective.
ReplyDelete----
1) For the sake of reasonable argument, please define your terms as you mean them so that the excahnage can be as clear as possible. In this case, what do you mean when you refer to "ground zero"?
2) Schizophrenia has been observed as a disabling disorder (or your preffered term) with a particular set of symptoms. As has Bipolar Disorder, Major Depressive Disorder, Post Traumatic Stress Disorder, Generalized Anxiety Disorder, AD/HD and nearly every other syndrome in the DSM-4. If you believe it is a neurobiological disease, spiritual crisis, result of repressed trauma, etc does not change this fact.
3) Most psychtrists want to help patients and are angered by those who are more focused on profits. The group that harms is a minority and I hear physicains speaking out against the likes of overdiagnosis and 15 minute medication checks everyday.
4) Schizophrenia is hard to treat. This is also a fact. If you use medication, therapy, shaminism, herbals, whatever your preffered meathod, I have never heard of miriculous, over-night recoveries. Recovery does happen; but it is not easy.
5) Medications do have merit. I went on them when I was around thirteen and they saved my life. They brought me back to reality enough to where I wasn't about to seriously injure or kill myself. They also have limitations and the potential for side effects. Each person needs to weigh the pros and cons for him/herself. For what it is worth, I developed severe side effects and was weaned off; I have done well. I don't regret going on them and I don't regret going off of them. Some, when making the same anaysis, will make the choice to stay on them. Each person needs to be looked at as their own person. Functioning and intergration are the ultimate goal and how when gets there will be different from person to person.
6) See above comments about why Schizophrenia is not profitable for doctors.
7) I have no idea what awful part of the world/country you live in which doctors do not want to see psychotic patients getting better and I apologize if that was your expierence; that's wrong. Rest assured, however, that the majority do not think this way. The idea of "social psychitry" -- the branch of psychitry that looks at a person's functioning and community intergration vs just biology and symptoms -- is well implented. Major resrcah centers, such as Mass. General, are doing resrcah on it. The idea of it is that it is incomplete to just look at if a person is expirencing symptoms, you have to look to see what is needed to achieve maximum functioning. I see that as fairly recovery-focused. The same hospital also does resrcah on psychotherapy. Another hospital, the Hospital of UPenn, recently did a study on psychotherapy's role in Schizophrenia; it was encourging. Once again, though, one size will never fit all. Someone needs to take what works and leave what doesn't.
8) If you are talking about complete remission of symptoms without medication, many, yes, are likely to be skeptical. It doesn't mean they don't want these patients better, though.
9) For what's worth, my doctor is rather atypical by modern standards. He believes psychosis comes from the subconsious (don't really agree with it, personally). He also believes that, to stablize patients, medication has merit. He also believes in psychotherapy. All of my appointments with him are full sessions, not medication checks. He uses medication conservitly and was the one who pushed me to go off, because he thought I was ready. I know many others like him.
10) I believe that functioning is a good way to measure recovery. It's not a blood test; but it signifies a met goal.
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ReplyDeleteChrisa: Cautious to diagnose and delay in treatment do not always go hand in hand. One can address the symptoms in front of them while waiting to gather more information to make a full diagnosis. Obviously, letting someone suffer in the name of avopiding labels is never good; that is what should be avoided. Ultimately, I believe that the diagnosis only matters so much -- it can change and morph, two doctors can have a different opinion, etc -- what matters is adressing the problem at hand. My doctor, for example, rarely diagnoses adults, either. He will use words such as "psychosis"; but it rarely impacts how he treats the patients (other than the basics: antidepressants can be bad for those who have had manic episodes). I have heard many other doctors with similar ideas.
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To sum this up, this is my opinion on the treatment of those with SMIs:
"Medication (or, to some extent, even therapy) can take away somebody's reason to die; however, though it can often be the door to allow it to be discovered, it can not give someone a reason to live. To truly find recovery, one must find that reason, too."
Erika: True about delay in diagnosing. In our case, as you know, we went through so many false diagnoses and vague diagnoses (and I didn't have the where-with-all then to research like I did later), we weren't even treating the symptoms.
ReplyDeleteThere is definitely a caste system, I would point out that as you go farther down your ladder the mental illnesses become less recognizable, and recognition is part of empathy.
ReplyDeleteMost people can understand what an anxiety disorder would entail, since everyone has been anxious. When you get to seeing and hearing things, most people have no idea what that would be like, and unknown things are scary.
When you talk about something like post natal depression, it can be BAD, it can even include psychosis, but most of the time it can be cured so it's easier for someone to say they HAD it.
And to top it all off, most people might know someone with a certain mental illness but a lot of people only know about schizophrenia and bipolar disorder from TV....and you know how inaccurate that is.
Erika-
ReplyDeleteI'll try to anwer your questions/comments in the order you posed them.
1. Schizophrenia is the original basis for psychiatry. Freud seemed more concerned with neurosis, not psychosis, but generally psychiatry was put in place to deal with "mad" people - today we might call them "schizophrenics."
3. Unfortunately, psychiatry as a profession has been perverted by greed and the promulgation of false information. This is not news. It's been the subject of media articles and Senate investigations for several years. The harm has been widespread, not just confined to a few. Read what psychiatrist Daniel Carlat wrote about drug reps in his office and how they perversely influence his treatment choices. My son has an excellent psychiatrist, but it took us a long time to find her, and the goal is one day no longer be her patient.
4. "Schizophrenia" is hard to treat. There are no overnight cures. It's long, hard slogging. Although, I have read many times that a "schizophrenic" recovers when he finds someone who understands him. I have also seen and heard about rather quick break-throughs, but there is still work to be done after that.
5. Medications used to be called "major tranquillizers" until they got an image change and they were called neuroleptics, or antispychotics. If they were used for what they are supposed to be used for, to calm the patient in times of great distress (used selectively), that would be one thing. They are now used for too long, in too high dosages. This leads to major health problems and brain damage. Reference: Dr. Nancy Andreasen, New York Times interview Sept. 15 2008. Dr. Andreasen reversed her previous findings on this subject. She now says: "Well, what exactly do these drugs do? They block basal ganglia activity. The prefrontal cortex doesn’t get the input it needs and is being shut down by drugs. That reduces the psychotic symptoms. It also causes the prefrontal cortex to slowly atrophy."
So, yes, everybody should determine their own method of recovery, but first they must be given the facts as to how best to bring that about. This is not what is actually happening because of ghost written articles, drug company paying doctors to be key opinion leaders, and dangling other monetary incentives at them, and the suppression of research findings. Thank goodness for bloggers! It's getting harder and harder for companies and key opinion leaders to pretend it's business as usual.
Rossa,
ReplyDelete1) I won't disagree with that. Psychiatry, as a whole, was created to treat psychopathology. Of course, due to the differences in terminology, it can often be difficult to make comparisons between present and past day diagnosis. You likely had Schizophrenia, Bipolar Disorder, Major Depressive Disorder, Severe Anxiety, PTSD, etc.
2 (3?)) This is not exclusive to psychiatry. Pharmaceutical influences have a strong presence and influence in essentially all fields of medicine. Your primary care physician will see just as many drug representatives as your psychiatrist will and is prone to the same influence. As such, you will find just as many corrupt internists and family practitioners as you will psychiatrists. If you would like to read more on this -- in the context of medicine as a whole, instead of your narrow focus on psychiatry (which I understand, as it is what you have the closest ties to. As someone with both physical and mental illness, however, I can assure you it's not exclusive) -- I suggest looking up the works of Jeremy Greene, MD, PhD. He's an internal medicine doctor who has a PhD in History of Science and the influence of pharmaceutical companies on medical practice, research and education is his main focus.
I have an amazing psychiatrist and am incredibly thankful for him. It also took me awhile to find him. I also have a great primary care physician (to help manage physical conditions). It took me awhile to find him, too.
3 (4?) ) No disagreement. For clarity, however, could you define a "breakthrough" in the context you are using it in? Are you referring to a moment ofn insight, remission or something else?
4 (5?) ) I will break this into two pieces.
ReplyDeletea: Yes, medications used to be known as "major tranquilizers". It is also important, however, to look at the drugs that were present at that time, many of which are still used in certain instances. Thorazine, for example, is a tranquilizer and is used to sedate patients on inpatient units. Even the older antidepressents, tricyclics, were heavy on their sedative effect. Multiple mood stabilizers also have a similar impact. These drugs are all "major tranquilizers".
The newer generation of drugs -- atypicals, SSRIs, etc -- would not be accurately described as "major tranquilizers". They, especially the atypicals, do still have sedating effects; however, they are comparbly mild to what the term "major tranquilizers" was originally coined to describe. SSRIs, though they can cause a blunted affect in certain patients (for different reasons), are not tranquilizing in that sense at all.
You are, however, correct in saying that anti-psychotics likely ( we don't really know) work by slowing down certain portions of the brain. You are also cherry picking your experts and citations. There are some researchers that have stated that anti psychotics cause atrophy, others that have come out saying they don't, some saying that psychosis itself causing atrophy, that the medications reverse atrophy and so on. We don't have enough information to draw conclusions. Someone should, of course, take that lack of clear knowledge into their risk vs benefit analysis.
b: If I only took medication when I was in a state of absolute crisis (ie, take the medication or I would hurt myself), I would have not have functioned. I was suffering from constant and severe anxiety, depression, suicidal impulses, psychosis (including paranoia, voices, delusion, etc) and mood swings. I could not go to school (or function in it), I was destructive to property and would often force myself to sleep so I would not have to be awake and aware. When would have been the best time to give me medication? I was constantly distressed; there were no breaks. I needed something that would keep me stable throughout the day, not just for a few moments. I couldn't even try to learn alternate coping skills: all of my energy was going to keeping myself semi-together, thinking these things through would have been impossible.
I know numerous others with similar stories. If someone is constantly having symptoms, you cannot just give them a PNR every now and then. It won't help them.
It is important to have accurate information; it is also important to have the whole picture. You are narrowly focused on psychiatry and your view on it. You need to understand that the problems facing psychiatry are facing all of medicine (thus, going after psychiatry will not help. Go after the people who refuse to regulate pharmaceutical companies because said companies are paying them) and, when it does come to things in psychiatry, that no research study – including those that support your ideas – are conclusive; any expert that states they are is misrepresenting their research.
Chrisa: Perhaps, the best way for a cautious physician to approach this is to say:
ReplyDelete"I am not comfortable giving a definite diagnosis to your child at such a young age due to the fact he/she is still developing at such a rapid pace. He is, however, experiencing ______, ______ and _____ (insert specific symptoms; ex, hallucinations, feelings of depression and thoughts of suicide) to which I feel we should address by doing _____, _____ and ______ (treatment recommendations; example, intensive outpatient program, anti-psychotic and once a week therapy + medication check appointments)."
That way, everything is clearly stated and a plan is made to address whatever the child is experiencing; however, it prevents a diagnosis from being made prematurely. How do you feel about that approach?
Erika - it's great, except for the fact that most insurance companies won't cover treatment without a diagnosis. Sucks, huh? I actually did another blog post about that conundrum: http://sos-research-blog.com/09/when-doctors-won%E2%80%99t-diagnose/
ReplyDeleteChrisa: My psychiatrist will usually write down an NOS diagnosis to appease the insurance companies; however, it does not mean he actually agrees with it and he will clearly state that to the family/patient. Is it a perfect situation? No; but, as long as everything is communicated clearly, I believe that it can work. Communication is everything.
ReplyDeleteJust to be clear, as I know NOS diagnoises are often looked upon negativly. He does not tell families/patients, "Your child/you have _____ NOS." He says, "For the insurance company to pay for this, I need to write down a diagnosis. So, I am writing down _____ NOS. That, however, is not what I am actually diagnosing you/your child as."
ReplyDeleteErika - If the medications work for you and others, and you feel you are fully informed, then by all means use them. What critics like me say is that many people do not want to be on the drugs in the first place, believe they are harmful, and yet are told a fable by psychiatry that they need the drugs, forever, and they are doomed if they go off them. The debate, if you can call it that, has been stacked in favor of pharmaceutical companies and psychopharmacologists in clear denial of any evidence to the contrary, and by evidence, I include patients telling their doctors that the drugs don't work for them and they want choices. At risk of prolonging this string of comments, here are some break-throughs I've seen with my own son.
ReplyDelete1. Assemblage point shift - within five minutes of finishing treatment got color back in his face and stopped walking hunched over.
2. Family Constellation Therapy - as predicted by the therapy, my son broke out of the shell he had been confined to for the 3 years following his breakdown. Was able to talk to people and take an interest in life.
3. Out-of body experiences - cutting edge therapy which can be achieved a number of ways, such as through LSD lab experiments, and light and sound therapy. Helped him to integrate his body with his mind, which is a big problem with SZ. It's like the mind has no relation to the body and the person does't know how to feel comfortable in a room, when to sit, when to stand. A few OBEs and my son was grounded, meaning he could pass for normal. There is still work to be done, but he's almost there. By "there" I am hoping that he goes back to finish his degree or do something surprising that would earn him a living. The experience of SZ takes some getting over.
Rossa: I am aware of these things (re: pharmaceutical influence) and I do believe in being fully informed, I was also just pointing out that this is not limited to psychiatry. There are people -- quite a few -- that benefit greatly from medication and are best served by being on them throughout one's lifetime (this is true with chronic mental illness and physical illness) and there are others who, in some capacity or the other, function without them and get more out of non-pharmaceutical treatments (both mental and physical conditions).
ReplyDeleteI agree that physicians should be more open to exploring such treatments; however, on the other side of this, those who are adamantly against medication need to step back and see that, for many, they really are needed. The human body, including the mind/brain, is far too complex to say that one model would best fit all; both sides of the debate need to realize this.
I am not pro or against medication; I am not pro or against therapy; I am not pro or against "alternative treatments" (some of which has evidence supporting it. For example, St. John's Wort works better than placebo in some studies for mild - moderate Major Depressive Disorder); and so forth. I am pro-people and finding out what is needed to give them the best life and functioning possible. If that means medications, I will support it; if it means therapy, I will support it; and so forth. In my opinion, the goal should always be a combination of ease of distress and community integration. Each patient will have their own limitations and abilities and the goals should be created around that.
I am not against how you have chosen to treat your son (I am glad that it has worked for him); however, your comment sometimes seem to fail to acknowledge that it is not the right path for everyone and that, for many, a more traditional approach is best.
For what it is worth, as I have said, I am now off medication. I still struggle at times; but I am taking college classes, earning fairly good grades and I am, overall, doing OK. I would never say that this the right path for everyone. It works for me. It's important to find out what works for your son and, if you have found it, that is great. Also remember that others have found it for their children, too, and it may not be the same path.