9 ms·

Why what we think we know about schizophrenia is wrong

80 points by jajag 7y ago

PaulHoule 7y ago
The diagnostic words that start with "schizo-" are a train wreck. Schizophrenia is characterized by hallucinations, delusions, thought disorder, catatonia, etc. You don't hear much about catatonia these days because it is cleared up by benzodiazepines reliably. Schizoid people have reduced emotional reactions compared to other people but they are in touch with reality. Schizoaffective disorder seems to pick a few symptoms from schizophrenia and bipolar but doesn't fit the criteria for either. You might think that sounds less severe but it can be devastating. The romanticization of schizophrenia of r.d. Liang, "one flew over the cuckoo's nest", szasz and others strikes me as particularly cruel when I see how it keeps people who are suffering from getting help.
- scardine 7y ago
  I don't think "one flew over the cuckoo's nest" romanticizes mental illness, for me it is about demonizing institutionalization. It pictures the time when mental illness diagnostic was an easy method to put away anyone annoying or inconvenient (the subject really having a mental illness or not made little difference). It talks about institutional cruelty like torture and lobotomy. But then I didn't read the book, just watched the movie - perhaps the "romanticization of illness" angle is more pronounced in the book but I'm pretty sure it was not the main theme and the novel did more good than bad for those diagnosed with a mental disorder or developmental disability.
  - jquery 7y ago
    I mostly agree, but I think the movie romanticized the end of institutionalization, making us believe we've progressed "beyond" it, when we merely have people screaming on street corners and sleeping in the gutter. Institutionalization should've been reformed, not all but eliminated (I know it still exists, but only for the most extreme cases).
    - flensortow 7y ago
      If someone is not a threat to themselves or others, but has strange beliefs and behaviors, should we really take their freedom away just because we don’t think they are taking care of themselves adequately or we don’t like the sight/sound of them? As someone with bipolar disorder (very stable since diagnosis and medication) I’m always a bit dismayed when people call for locking ill people up “for their own good.” (Not that you’re necessarily saying that - it’s just something I do see people advocating for sometimes). I’m in SF and previously lived Tenderloin-adjacent so I’m quite familiar with the unfortunate cycle of mental illness and drug/alcohol abuse from self-medicating. It’s not a pretty sight and I do think we should do everything we can to help these most vulnerable people in society. I’m just not sure taking their liberty is necessarily the best course of action.
      - scardine 7y ago
        This. I'm fortunate enough to be considered only "eccentric" as most people are willing to forgive my weirdness in exchange for other useful personality traits. Not everybody is that lucky.
      - harimau777 7y ago
        I think that society probably has the right to enforce basic social norms so I think it is reasonable to for society to intervene if someone is being threatening or violating basic norms (e.g. by defecating in the middle of the sidewalk). Both of which are common in the Tenderloin. The problem that I see is: what options are available other than violating their freedom by forcing them to undergo treatment or locking them up? You can't, for example, fine someone who doesn't have anything. Besides, I think its unlikely that punishment would accomplish anything So I guess I'm not sure I see a good solution to the problem.
    - scardine 7y ago
      Well, the support network is far from perfect - having a 5yo son in the autistic spectrum I experience this first hand. Not too long ago my kid would be segregated to a "special" school and I'm glad he is able to attend a regular school although he still needs a dedicated tutor. Do you think weird people that do not endanger their own life or the life of others should be locked away?
  - bitwize 7y ago
    > I don't think "one flew over the cuckoo's nest" romanticizes mental illness, for me it is about demonizing institutionalization. Intent is one thing, effect is another. One Flew Over the Cuckoo's Nest, the book and movie, broke ground upon its release, but one of its secondary effects was to establish the mid-20th-century mental hospital as a gothic setting, akin to the ancient stone manors of old, full of terrible secrets -- not to mention bizarre characters -- that are ripe for literary exploration. Today it's been almost completely tropified, especially since in the current era Great Literature is by definition introspectively psychological. An easy way to establish that your play or movie is "arty" is to set it in such an institution. One of the weirdest instances of this was in The Great Gatsby (2013), which wholly took place in a mental hospital (the plot of the novel being Nick's recollections to his psychiatrist) and implied that Nick admired Gatsby almost to the point of a crush and was so devastated by his death as to need psychiatric attention. I do recommend you read One Flew Over the Cuckoo's Nest, the novel. It is written from the perspective of Chief Bromden, and his mental illness helps intensify the themes of subtle control, exercised by tyrannical people and institutions, with specific delusions he has that make him sensitive to that control.
  - Gibbon1 7y ago
    > It pictures the time when mental illness diagnostic was an easy method to put away anyone annoying or inconvenient One of my friends was sent to Napa State Hospital by his step dad because he had epilepsy. When he was seven. It took six years for his dad to win custody, because his dad was a Mexican. That was the world of One Flew Over the Cuckoo's Nest.
qrbLPHiKpiux 7y ago
Much, if not all, of mental health is based on theories and assumptions." "It's thought that..." when referring to how medications work. Let's just agree that we all know nothing about mental health.
- vkreso 7y ago
  Everything is based on theories and assumptions. Everything is a model and all models are wrong. The problem with psychology is that it is a much more disjointed science than others (and has been for a long time). You have islands of logic and some overlapping theories but all of them do not follow a unified framework. It is similar to how modern physics is trying to connect quantum theory and gravity. I'd argue that the scale of such disjointedness correlates with the power of predictability of phenomena in a certain field. It is therefore true that we know nothing and at the same time something about mental health. Connecting and integrating psychology through evolutionary psych, behavioral theories, cognitive sciences and such is an ongoing area of research and an example of an effort which reduces disjointedness of a field which may result in more succesful predictions and deeper knowledge about mental health.
- PaulHoule 7y ago
  We know a lot. If there is a comprehensive theory it is that mental disorders and developmental disabilities come in layers. You might have a genetic predisposition to certain problems, have that exacerbated by traumas, but learn how to compensate for them in some ways. You might do badly at certain things or certain situations but if you have support from other people, understand the difficulty, etc. you can do O.K. The big trouble I think is that mental illness and developmental disabilities interact with the expectations that people have about others. For instance much of the satisfaction parents get out of parenting is using their children as "self objects"; they want to dress them up, show them off, bask in their accomplishments, etc. An autistic child can't do that for them and they find that hard to accept. The marketing of SSRI's is also distorted. They are prescribed a lot by primary care docs who need to be on top of a wide range of medical problems and can't be experts on mental health too. That is a good thing because they help people and it can be hard to get real help from a specialist. Depression has many symptoms and for many people SSRIs help some symptoms but not others. For me, for instance, SSRIs help me control my emotions in situations where I might get overwhelmed and yell at people. I believe that they increase my self-control as opposed to suppress my emotions. I have other symptoms that SSRIs don't help with, but I do feel like they've helped me a lot at being a parent.
lisper 7y ago
About ten years ago I made a documentary film about homeless people. On my first day of shooting I had an encounter with a schizophrenic guy named Daniel, which I captured on film. I've put a clip of that encounter here: http://graceofgodmovie.com/superdanny.mp4 http://graceofgodmovie.com/superdanny.mp4 It's worth watching all the way through. The difference in his attitude when I stopped being afraid of him and started treating him like a human being instead of a threat is dramatic. I learned a lot about life that day.
- dwaltrip 7y ago
  This is a nice thought, and I do agree that we need more a lot more of this perspective in the world. But we need to be careful not to downplay the incredibly severe difficulties involved in helping, treating, and even simply co-existing across the months and years with those who have schizophrenia. I had a good friend stay with me for 2 months who ended up having significant schizophrenia-like symptoms (never found out the actual diagnosis). I tried my best to treat him like a human and get him the help he needed, but I was unable to. I don't want to go into details, but a lot of stuff happened. It was a very difficult time.
  - lisper 7y ago
    Oh, absolutely. I'm not saying that you can just treat schizophrenics like normal people and everything will be hunky-dory. All I'm saying is that not being afraid of them (because most of them (though not all) are totally harmless) is a good first step.
coleifer 7y ago
My youngest brother has schizophrenia, which started when he was 19. He just turned 31, and were it not for his family supporting and caring for him, I'm sure he would be homeless or worse. He's one of the most sensitive, gentle people I have ever known. My wife and others who have gotten to know him would agree. Although he's "stable", thanks to an injection every 3 weeks, he's not going to ever get better. In fact he continues to retreat further and further away from the world and life. Why don't you go to the bowling group, movie night, job placement, etc, I used to ask him (events organized by a local psych facility for their patients, etc). Those people are crazy, he said. It's a baffling disease. Besides his hallucinations and delusions, the defining feature seems to be that it resists treatment of any kind that would lead to what you and I would call a normal life.
- 0xcde4c3db 7y ago
  > Why don't you go to the bowling group, movie night, job placement, etc, I used to ask him. Those people are crazy, he said. It might be tempting to read something like this and think "of course the crazy person thinks normal people are crazy". But I'd argue that "sane" people's reactions to mentally ill people are frequently more irrational and scary than the symptoms of the illness itself.
  - coleifer 7y ago
    I should have clarified, those groups are organized by a local psych facility, and are for people with mental illness.
  - deleted 7y ago
    [deleted]
- asveikau 7y ago
  It might be he doesn't want to associate with people, groups, events that revolve around the diagnosis. Perhaps that labels him an "other" and it feels little much. Why not similar activities with the general population? That is not meant to belittle the point that delusional people will strongly deny their symptoms, of course. Being close to somebody like that gets tough, especially when the delusions have led to harm to self or others -- even after they get treatment and it works, it's easy to become paranoid of relapse and fear that every small act of legit defiance or assertion of self is a recurrence of symptoms.
DanBC 7y ago
> It was during my own nursing training that the currently favoured term of “service user” gained traction, as it was deemed more neutral. Patients overwhelmingly prefer the term patient, and this holds true every time we ask them what they want to be called. Service user is a term imposed upon them by well-intentioned mental health professionals and academics who don't recognise their own power dynamic and who do a poor job of coproduction. > while the council of the Royal College of Psychiatrists recently recommitted to “patient”. ...after they asked people what their preferred term is.
- thatoneuser 7y ago
  Academics can be the dumbest smart people.
  - Gibbon1 7y ago
    Academia teaches you there are simple solutions to common problems. And that non-academics are stupid. Most real world solutions are shitty and incomplete.
tcj_phx 7y ago
Most of the supposed "mental-health conditions" are manifestations of stress. There are two kinds of stress: biological and emotional. Biological stress is related to things like being malnourished and/or having hormonal imbalances (thyroid, cortisol, progesterone, etc), not getting enough sunlight (no red light -> winter sickness / UV light-> Vitamin D), etc. Biological stress is worsened when a person is medicated with patent medicines that are approved for treating behavioral symptoms by implementing wrong-theory about the cause of the behavioral symptom (i.e., inadequate serotonin -> depression [0], excess dopamine -> psychosis, etc). Some scientists rediscovered a few years ago that the behavioral symptom of "psychosis" is strongly associated with an inability to make adequate amounts of the stress hormone cortisol [1]. Emotional stress has to do with people feeling trapped. From the article: "Importantly, what we call psychosis can also be a response to extreme stress or trauma." Emotional stress leads to the release of cortisol too. If a person's long-term emotional stress exceeds their ability to compensate, their "mental health" will suffer. One part of this article is about forcibly medicating people whom the professionals think don't realize they need the pills they're prescribed. IMHO, it is an act of violence to force a person to take pills that make them suicidal [2]. The legal systems generally recognize that people have a choice in medical treatments, but struggles with patients who don't even realize they have a problem [3], and/or don't like the treatments the professionals think they need. In the US the courts have decided that people can't be "helped" against their will without a court order. This is why Jared Loughner, the man who shot up Congresswoman Gifford's event, couldn't be helped, even though the people around him noticed that his behavior had changed [4]. The professionals tried to label my girlfriend as "schizophrenic". Really she was just stressed ("lonely"), and was suffering from the adverse effects of various medical interventions. Methadone causes sugar cravings; she'd taken to treating this medication-induced metabolic problem with alcohol a few days before we'd met (alcohol has 7 calories/gram, while sugar only has 4 calories/gram). In my initial assessment she also reported being injected with a prescription endocrine disruptor maybe 10 years before [5]. This prescription drug has warnings about endocrine disruption [6], but doctors don't appreciate their patients' iatrogenic deterioration when it's associated with this defective drug. My girlfriend became psychotic when she ran out of alcohol , but rather than treating her for the cause [7] they treat her for the symptom with "anti-psychotics". I consider her involuntary treatment program to be "medical assault". I found a lawyer a while back who was familiar with how the state's involuntary treatment system works, but lawyers are expensive, so I tried to go at it myself. Maybe the legal guild didn't take kindly to a legal-nobody pointing out that their system is ugly. I guess I'm going to hire the lawyer. tl/dr: The conventional practices of the mental health industry are wrong. Institutional inertia prevents the profession from fixing itself. Little bits of progress have been made in recognizing the system's contribution to the patient's problems. As I said before, the system needs a re-write: https://news.ycombinator.com/item?id=19545964 https://news.ycombinator.com/item?id=19545964 [0] What has serotonin to do with depression? - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471964/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471964/ [1] https://psychcentral.com/news/2016/06/04/low-morning-cortisol-levels-linked-to-psychosis/104266.html https://psychcentral.com/news/2016/06/04/low-morning-cortiso... [2] https://en.wikipedia.org/wiki/Akathisia#Drug-induced https://en.wikipedia.org/wiki/Akathisia#Drug-induced [3] Anosognosia - https://en.wikipedia.org/wiki/Anosognosia https://en.wikipedia.org/wiki/Anosognosia [4] Jared Loughner - https://en.wikipedia.org/wiki/Jared_Lee_Loughner#Behavior_change https://en.wikipedia.org/wiki/Jared_Lee_Loughner#Behavior_ch... "In the months leading up to the shooting, Loughner's parents became increasingly alarmed at their son's behavior, at one point resorting to disabling his car every night in order to keep him at home." [5] https://en.wikipedia.org/wiki/Depo-Provera https://en.wikipedia.org/wiki/Depo-Provera [6] "Effects on the Hypothalmic-Pituitary-Adrenal Axis: Some patients receiving medroxyprogesterone acetate may exhibit suppressed adrenal function. Medroxyprogesterone acetate may have cortisol-like glucocorticoid activity and provide negative feedback to the hypothalamus or pituitary. This may result in decreased plasma cortisol levels, decreased cortisol secretion, and low plasma ACTH levels.The use of DEPO-PROVERA Sterile Aqueous Suspension may, due to its cortisol-like glucocorticoid activity, also produce Cushingoid symptoms such as weight gain, edema/fluid retention, and facial swelling." - https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/012541s086lbl.pdf https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/01... [7] https://en.wikipedia.org/wiki/Substance-induced_psychosis#Substances https://en.wikipedia.org/wiki/Substance-induced_psychosis#Su... - "Alcohol is a common cause of psychotic disorders or episodes, which may occur through acute intoxication, chronic alcoholism, withdrawal, exacerbation of existing disorders, or acute idiosyncratic reactions. Research has shown that alcohol abuse causes an 8-fold increased risk of psychotic disorders in men and a 3 fold increased risk of psychotic disorders in women. While the vast majority of cases are acute and resolve fairly quickly upon treatment and/or abstinence, they can occasionally become chronic and persistent. Alcoholic psychosis is sometimes misdiagnosed as another mental illness such as schizophrenia." (emphasis added) (edit: added reference [7])
soup10 7y ago
Most mental health workers know that the popular conceptions about what schizophrenia is and how its managed are wrong.
pygy_ 7y ago
Treating DSM categories as if they were a single disease is completely misguided. The DSM describes syndromes, and ignores pathophysiology because we still have little to no idea of what happens in the brain (at least not enough to properly understand the relevant functional aspects). Genome-wide association studies have recently shown that schizophrenia was in fact several distinct diseases [0]. Their symptoms turn out to be mediated by the same drugs, to the extent that they makes the people who suffer from those ailments manageable. If your house suddenly becomes cold in the winter, putting on a jacket will help you feel better. You wouldn't infer from that that your furnace is down because of a clothing imbalance. [0] https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2014.14040435 https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2...
- thatoneuser 7y ago
  This is why I think very highly of the transition in DSM V to diagnosing on spectrums. It's not perfect but it really helps get away from putting people into buckets they don't really belong in.
  - lupire 7y ago
    At the expense of putting people on spectrums where two people with the same diagnose have wildly different symptoms and effective treatments, rendering the diagnosis moot. This is a crisis in "autism", where Asperger's and autism are different on such an extreme scale, yet the language, medical literature, and treatment plans and funding are muddling it up to the detriment of all involved, creating a culture war between people who say their mild Asperger's is a personality type not a disorder, and caregivers of people who cannot speak or provide basic self-care for themselves -- because DSM dumps them in the same diagnosis and society loses the language to disambiguate the scenarios.
- JamesBarney 7y ago
  That paper looks interesting but also seems very preliminary.
yosys 7y ago
I dislike psychiatry grossly because the victims of the field are not compensated by how the errors destroy the victim's life. I'm a person who was medicated with the older & new generation of antipsychotics for two years of my early 20s because I was suffering religious conversion therapy "best I can describe it" from family and where I was in circumstances any other person would have great amounts of stress. The outcome of unfortunate events made me with a doctor who disliked me for desiring to be a woman (I was born a male) and attempted to convince me it's delusions & hallucinations; when I attempted to communicate I never suffered from either. The medication would result in me doubting myself but I eventually broke away from it all. It was impossible to find anyone to help sue for the tremendous pain (I still suffer to this day from it all) and it's been many years since it all happened. Anyway I deeply believe there should be a special hell for people who go into this field but I doubt anyone had any will in the outcome for me being any different because I've read philosophy on determinism since then. I think the field has done more damage than good and is a net negative with getting away with it all because of government allowing it. People prefer to believe something is good and when it really isn't.
- ordu 7y ago
  There is a book "A Road Back from Schizophrenia: A Memoir"[1]. Arnhild Lauveng came back from schizophrenia, got a degree in psychology and wrote the book, describing how it feels to have a schizophrenia. She describes doctors too. A bad ones and also those, who helped her to get back from schizophrenia. I believe you would like that book, her experiences are like yours. [1] https://www.amazon.com/Road-Back-Schizophrenia-Memoir/dp/1616088710 https://www.amazon.com/Road-Back-Schizophrenia-Memoir/dp/161...
  - yosys 7y ago
    No, the experience was meaningless like life and nothing more than torture. I believe the field will die slowly and my life was worthless. I plan to act on suicide in the near future because of the torture.
    - ordu 7y ago
mindgam3 7y ago
> Importantly, what we call psychosis can also be a response to extreme stress or trauma. For many people it might best be understood as... a coping strategy gone awry or a form of storytelling carried out within the mind as a response to unbearable life events. This. The day that mental health professionals realize this is the day that we start improving outcomes. > there is no uncontroversial language when talking about mental illness – and that includes the phrase “mental illness” Glad the author brought up this important point. “Illness” is bogus because it implies disease/biomarkers for which there is no evidence as the article states. A more useful term would be “mental injury” as it frames the symptoms as a result of trauma. But I think the best term is simply “trauma” or “developmental trauma” when it goes back to childhood.
- theArdvart45 7y ago
  I cringed and abruptly stopped reading your comment at "This."
isnetea 7y ago
I’ve often wondered if it’s possible to induce psychosis and symptoms of schizophrenia in a subject via environmental conditioning. This seems practical to test these days, given the expanse of information possessed by large tech companies, and their lack of regulation. Perhaps this would be related research for a larger automated behavior control initiative. Does anyone have any pertinent references or info?
- JamesBarney 7y ago
  Mind elaborating on the connection between psychosis and automated behavior control.
  - isnetea 7y ago
    Restated, is it possible to develop (eventually automated) ways to “drive people crazy”. Is it possible to use data and algorithms to manipulate someone into losing contact with reality, for instance, or trick them into manifesting schizophrenic symptoms
    - JamesBarney 7y ago
      I don't think so. One of the primary theories of schizophrenia is that the glial cells in the brain are doing too much synaptic pruning. It's more of an organic disorder than say depression or anxiety which is heavily affected by environment.
- 50656E6973 7y ago
  Search "Facebook emotional contagion"
squirrel 7y ago
I find Xavier Amador very engaging and convincing on how to actually help schizophrenic people who say "I'm not sick, I don't need medicine": https://www.youtube.com/watch?v=Lstn6WNnCRc https://www.youtube.com/watch?v=Lstn6WNnCRc
raybon 7y ago
Ah, where do I start. Two of my close relatives have schizophrenia, people whom I’ve known since they were born. They were both diagnosed around 19 and are now 29. In the last ten years we’ve tried many medications, hospitalizations, with little to no avail. I never understood the word curse when I was a kid. I read about it in stories and I had seen people curse each other. Living with schizophrenia is the definition of a curse. Lives wasted in an alternate reality. The lives of the care givers and family impacted terribly.
hindsightbias 7y ago
Well, this article didn’t lead to any answers or any insight for me. The whole unexplained opening of poisoning is cryptic and unhelpful. Does this nurse see the nuclear options as poison or was this doctor trying to give Amit cyanide? Who knows. I’ve spent a month of evenings at Langley-Porter and then again at Zuckerberg, and the staff there didn’t strike me psychzombies. The last thing they wanted to do was to commit to a diagnosis of schizophrenia for my relative. I sat for an hour with the Attending on his outtake and she did everything to assure us that in her expert opinion it wasn’t black and white - drugs were part of the toolset and not The One Answer. What’s wrong isn’t that people are ignorant. They always have been and always will be. Until you’ve been there, you won’t get it. What’s wrong is we have brilliant people who are hamstrung by process. At SFGH it’s “If you aren’t a threat, you’re out” 7 days after the 72 hour lockdown. It’s a factory, because that’s all the runway WE give them. We’re lucky. We’re wealthy enough and there’s enough of us that we can probably make this work. But the other 90% in those wards? They don’t have anybody. So unless WE want to fund that level of intervention/compassion, the factory and pharmacology is the solution.
HeadsUpHigh 7y ago
DSM and other such systems(icd for example) are for CLINICAL use. I.e. they are not academic. If 2 different mechanisms create the same symptoms and are treated by the same drugs then from a clinical aide of view separating them is pointless. Academic research on the mechanics of diseases is much more nuanced than what an article on a news site can cover. Once something is clearly separated as 2 different entities in a clinically meaningful way via research then the classification system will be updated. What this means is that if e.g. we find a way to differentiate between 2 different mechanisms for schizophrenia with each of the responding better to a different drug( even if those are already existing drugs, it gives us a shortcut to choosing the right medication without trial and error) then DSM will split schizophrenia to schizo due to x and schizo due to y with further guidelines for medication. Or split them into 2 different things entirely.
tomohawk 7y ago
Schizophrenia can run in families. A family we knew was killed in the middle of the night by their step son with a hammer. Apparently, the disease can have a sudden onset. The mother and step father were teachers, and the whole community was affected. The son (teenager at the time) was diagnosed and has been held in a facility now for many years. The biological father has been in and out of institutions and homeless. Such a terrible disease.

80 points by jajag 7y ago

The diagnostic words that start with "schizo-" are a train wreck. Schizophrenia is characterized by hallucinations, delusions, thought disorder, catatonia, etc. You don't hear much about catatonia these days because it is cleared up by benzodiazepines reliably. Schizoid people have reduced emotional reactions compared to other people but they are in touch with reality. Schizoaffective disorder seems to pick a few symptoms from schizophrenia and bipolar but doesn't fit the criteria for either. You might think that sounds less severe but it can be devastating. The romanticization of schizophrenia of r.d. Liang, "one flew over the cuckoo's nest", szasz and others strikes me as particularly cruel when I see how it keeps people who are suffering from getting help.

scardine 7y ago
I don't think "one flew over the cuckoo's nest" romanticizes mental illness, for me it is about demonizing institutionalization. It pictures the time when mental illness diagnostic was an easy method to put away anyone annoying or inconvenient (the subject really having a mental illness or not made little difference). It talks about institutional cruelty like torture and lobotomy. But then I didn't read the book, just watched the movie - perhaps the "romanticization of illness" angle is more pronounced in the book but I'm pretty sure it was not the main theme and the novel did more good than bad for those diagnosed with a mental disorder or developmental disability.
- jquery 7y ago
  I mostly agree, but I think the movie romanticized the end of institutionalization, making us believe we've progressed "beyond" it, when we merely have people screaming on street corners and sleeping in the gutter. Institutionalization should've been reformed, not all but eliminated (I know it still exists, but only for the most extreme cases).
  - flensortow 7y ago
    If someone is not a threat to themselves or others, but has strange beliefs and behaviors, should we really take their freedom away just because we don’t think they are taking care of themselves adequately or we don’t like the sight/sound of them? As someone with bipolar disorder (very stable since diagnosis and medication) I’m always a bit dismayed when people call for locking ill people up “for their own good.” (Not that you’re necessarily saying that - it’s just something I do see people advocating for sometimes). I’m in SF and previously lived Tenderloin-adjacent so I’m quite familiar with the unfortunate cycle of mental illness and drug/alcohol abuse from self-medicating. It’s not a pretty sight and I do think we should do everything we can to help these most vulnerable people in society. I’m just not sure taking their liberty is necessarily the best course of action.
    - scardine 7y ago
      This. I'm fortunate enough to be considered only "eccentric" as most people are willing to forgive my weirdness in exchange for other useful personality traits. Not everybody is that lucky.
    - harimau777 7y ago
      I think that society probably has the right to enforce basic social norms so I think it is reasonable to for society to intervene if someone is being threatening or violating basic norms (e.g. by defecating in the middle of the sidewalk). Both of which are common in the Tenderloin. The problem that I see is: what options are available other than violating their freedom by forcing them to undergo treatment or locking them up? You can't, for example, fine someone who doesn't have anything. Besides, I think its unlikely that punishment would accomplish anything So I guess I'm not sure I see a good solution to the problem.
  - scardine 7y ago
    Well, the support network is far from perfect - having a 5yo son in the autistic spectrum I experience this first hand. Not too long ago my kid would be segregated to a "special" school and I'm glad he is able to attend a regular school although he still needs a dedicated tutor. Do you think weird people that do not endanger their own life or the life of others should be locked away?
- bitwize 7y ago
  > I don't think "one flew over the cuckoo's nest" romanticizes mental illness, for me it is about demonizing institutionalization. Intent is one thing, effect is another. One Flew Over the Cuckoo's Nest, the book and movie, broke ground upon its release, but one of its secondary effects was to establish the mid-20th-century mental hospital as a gothic setting, akin to the ancient stone manors of old, full of terrible secrets -- not to mention bizarre characters -- that are ripe for literary exploration. Today it's been almost completely tropified, especially since in the current era Great Literature is by definition introspectively psychological. An easy way to establish that your play or movie is "arty" is to set it in such an institution. One of the weirdest instances of this was in The Great Gatsby (2013), which wholly took place in a mental hospital (the plot of the novel being Nick's recollections to his psychiatrist) and implied that Nick admired Gatsby almost to the point of a crush and was so devastated by his death as to need psychiatric attention. I do recommend you read One Flew Over the Cuckoo's Nest, the novel. It is written from the perspective of Chief Bromden, and his mental illness helps intensify the themes of subtle control, exercised by tyrannical people and institutions, with specific delusions he has that make him sensitive to that control.
- Gibbon1 7y ago
  > It pictures the time when mental illness diagnostic was an easy method to put away anyone annoying or inconvenient One of my friends was sent to Napa State Hospital by his step dad because he had epilepsy. When he was seven. It took six years for his dad to win custody, because his dad was a Mexican. That was the world of One Flew Over the Cuckoo's Nest.

qrbLPHiKpiux 7y ago

Much, if not all, of mental health is based on theories and assumptions." "It's thought that..." when referring to how medications work. Let's just agree that we all know nothing about mental health.

vkreso 7y ago
Everything is based on theories and assumptions. Everything is a model and all models are wrong. The problem with psychology is that it is a much more disjointed science than others (and has been for a long time). You have islands of logic and some overlapping theories but all of them do not follow a unified framework. It is similar to how modern physics is trying to connect quantum theory and gravity. I'd argue that the scale of such disjointedness correlates with the power of predictability of phenomena in a certain field. It is therefore true that we know nothing and at the same time something about mental health. Connecting and integrating psychology through evolutionary psych, behavioral theories, cognitive sciences and such is an ongoing area of research and an example of an effort which reduces disjointedness of a field which may result in more succesful predictions and deeper knowledge about mental health.
PaulHoule 7y ago
We know a lot. If there is a comprehensive theory it is that mental disorders and developmental disabilities come in layers. You might have a genetic predisposition to certain problems, have that exacerbated by traumas, but learn how to compensate for them in some ways. You might do badly at certain things or certain situations but if you have support from other people, understand the difficulty, etc. you can do O.K. The big trouble I think is that mental illness and developmental disabilities interact with the expectations that people have about others. For instance much of the satisfaction parents get out of parenting is using their children as "self objects"; they want to dress them up, show them off, bask in their accomplishments, etc. An autistic child can't do that for them and they find that hard to accept. The marketing of SSRI's is also distorted. They are prescribed a lot by primary care docs who need to be on top of a wide range of medical problems and can't be experts on mental health too. That is a good thing because they help people and it can be hard to get real help from a specialist. Depression has many symptoms and for many people SSRIs help some symptoms but not others. For me, for instance, SSRIs help me control my emotions in situations where I might get overwhelmed and yell at people. I believe that they increase my self-control as opposed to suppress my emotions. I have other symptoms that SSRIs don't help with, but I do feel like they've helped me a lot at being a parent.

lisper 7y ago

About ten years ago I made a documentary film about homeless people. On my first day of shooting I had an encounter with a schizophrenic guy named Daniel, which I captured on film. I've put a clip of that encounter here: http://graceofgodmovie.com/superdanny.mp4 http://graceofgodmovie.com/superdanny.mp4 It's worth watching all the way through. The difference in his attitude when I stopped being afraid of him and started treating him like a human being instead of a threat is dramatic. I learned a lot about life that day.

dwaltrip 7y ago
This is a nice thought, and I do agree that we need more a lot more of this perspective in the world. But we need to be careful not to downplay the incredibly severe difficulties involved in helping, treating, and even simply co-existing across the months and years with those who have schizophrenia. I had a good friend stay with me for 2 months who ended up having significant schizophrenia-like symptoms (never found out the actual diagnosis). I tried my best to treat him like a human and get him the help he needed, but I was unable to. I don't want to go into details, but a lot of stuff happened. It was a very difficult time.
- lisper 7y ago
  Oh, absolutely. I'm not saying that you can just treat schizophrenics like normal people and everything will be hunky-dory. All I'm saying is that not being afraid of them (because most of them (though not all) are totally harmless) is a good first step.

coleifer 7y ago

My youngest brother has schizophrenia, which started when he was 19. He just turned 31, and were it not for his family supporting and caring for him, I'm sure he would be homeless or worse. He's one of the most sensitive, gentle people I have ever known. My wife and others who have gotten to know him would agree. Although he's "stable", thanks to an injection every 3 weeks, he's not going to ever get better. In fact he continues to retreat further and further away from the world and life. Why don't you go to the bowling group, movie night, job placement, etc, I used to ask him (events organized by a local psych facility for their patients, etc). Those people are crazy, he said. It's a baffling disease. Besides his hallucinations and delusions, the defining feature seems to be that it resists treatment of any kind that would lead to what you and I would call a normal life.

0xcde4c3db 7y ago
> Why don't you go to the bowling group, movie night, job placement, etc, I used to ask him. Those people are crazy, he said. It might be tempting to read something like this and think "of course the crazy person thinks normal people are crazy". But I'd argue that "sane" people's reactions to mentally ill people are frequently more irrational and scary than the symptoms of the illness itself.
- coleifer 7y ago
  I should have clarified, those groups are organized by a local psych facility, and are for people with mental illness.
- deleted 7y ago
  [deleted]
asveikau 7y ago
It might be he doesn't want to associate with people, groups, events that revolve around the diagnosis. Perhaps that labels him an "other" and it feels little much. Why not similar activities with the general population? That is not meant to belittle the point that delusional people will strongly deny their symptoms, of course. Being close to somebody like that gets tough, especially when the delusions have led to harm to self or others -- even after they get treatment and it works, it's easy to become paranoid of relapse and fear that every small act of legit defiance or assertion of self is a recurrence of symptoms.

DanBC 7y ago

> It was during my own nursing training that the currently favoured term of “service user” gained traction, as it was deemed more neutral. Patients overwhelmingly prefer the term patient, and this holds true every time we ask them what they want to be called. Service user is a term imposed upon them by well-intentioned mental health professionals and academics who don't recognise their own power dynamic and who do a poor job of coproduction. > while the council of the Royal College of Psychiatrists recently recommitted to “patient”. ...after they asked people what their preferred term is.

thatoneuser 7y ago
Academics can be the dumbest smart people.
- Gibbon1 7y ago
  Academia teaches you there are simple solutions to common problems. And that non-academics are stupid. Most real world solutions are shitty and incomplete.

tcj_phx 7y ago

Most of the supposed "mental-health conditions" are manifestations of stress. There are two kinds of stress: biological and emotional. Biological stress is related to things like being malnourished and/or having hormonal imbalances (thyroid, cortisol, progesterone, etc), not getting enough sunlight (no red light -> winter sickness / UV light-> Vitamin D), etc. Biological stress is worsened when a person is medicated with patent medicines that are approved for treating behavioral symptoms by implementing wrong-theory about the cause of the behavioral symptom (i.e., inadequate serotonin -> depression [0], excess dopamine -> psychosis, etc). Some scientists rediscovered a few years ago that the behavioral symptom of "psychosis" is strongly associated with an inability to make adequate amounts of the stress hormone cortisol [1]. Emotional stress has to do with people feeling trapped. From the article: "Importantly, what we call psychosis can also be a response to extreme stress or trauma." Emotional stress leads to the release of cortisol too. If a person's long-term emotional stress exceeds their ability to compensate, their "mental health" will suffer. One part of this article is about forcibly medicating people whom the professionals think don't realize they need the pills they're prescribed. IMHO, it is an act of violence to force a person to take pills that make them suicidal [2]. The legal systems generally recognize that people have a choice in medical treatments, but struggles with patients who don't even realize they have a problem [3], and/or don't like the treatments the professionals think they need. In the US the courts have decided that people can't be "helped" against their will without a court order. This is why Jared Loughner, the man who shot up Congresswoman Gifford's event, couldn't be helped, even though the people around him noticed that his behavior had changed [4]. The professionals tried to label my girlfriend as "schizophrenic". Really she was just stressed ("lonely"), and was suffering from the adverse effects of various medical interventions. Methadone causes sugar cravings; she'd taken to treating this medication-induced metabolic problem with alcohol a few days before we'd met (alcohol has 7 calories/gram, while sugar only has 4 calories/gram). In my initial assessment she also reported being injected with a prescription endocrine disruptor maybe 10 years before [5]. This prescription drug has warnings about endocrine disruption [6], but doctors don't appreciate their patients' iatrogenic deterioration when it's associated with this defective drug. My girlfriend became psychotic when she ran out of alcohol , but rather than treating her for the cause [7] they treat her for the symptom with "anti-psychotics". I consider her involuntary treatment program to be "medical assault". I found a lawyer a while back who was familiar with how the state's involuntary treatment system works, but lawyers are expensive, so I tried to go at it myself. Maybe the legal guild didn't take kindly to a legal-nobody pointing out that their system is ugly. I guess I'm going to hire the lawyer. tl/dr: The conventional practices of the mental health industry are wrong. Institutional inertia prevents the profession from fixing itself. Little bits of progress have been made in recognizing the system's contribution to the patient's problems. As I said before, the system needs a re-write: https://news.ycombinator.com/item?id=19545964 https://news.ycombinator.com/item?id=19545964 [0] What has serotonin to do with depression? - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471964/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471964/ [1] https://psychcentral.com/news/2016/06/04/low-morning-cortisol-levels-linked-to-psychosis/104266.html https://psychcentral.com/news/2016/06/04/low-morning-cortiso... [2] https://en.wikipedia.org/wiki/Akathisia#Drug-induced https://en.wikipedia.org/wiki/Akathisia#Drug-induced [3] Anosognosia - https://en.wikipedia.org/wiki/Anosognosia https://en.wikipedia.org/wiki/Anosognosia [4] Jared Loughner - https://en.wikipedia.org/wiki/Jared_Lee_Loughner#Behavior_change https://en.wikipedia.org/wiki/Jared_Lee_Loughner#Behavior_ch... "In the months leading up to the shooting, Loughner's parents became increasingly alarmed at their son's behavior, at one point resorting to disabling his car every night in order to keep him at home." [5] https://en.wikipedia.org/wiki/Depo-Provera https://en.wikipedia.org/wiki/Depo-Provera [6] "Effects on the Hypothalmic-Pituitary-Adrenal Axis: Some patients receiving medroxyprogesterone acetate may exhibit suppressed adrenal function. Medroxyprogesterone acetate may have cortisol-like glucocorticoid activity and provide negative feedback to the hypothalamus or pituitary. This may result in decreased plasma cortisol levels, decreased cortisol secretion, and low plasma ACTH levels.The use of DEPO-PROVERA Sterile Aqueous Suspension may, due to its cortisol-like glucocorticoid activity, also produce Cushingoid symptoms such as weight gain, edema/fluid retention, and facial swelling." - https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/012541s086lbl.pdf https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/01... [7] https://en.wikipedia.org/wiki/Substance-induced_psychosis#Substances https://en.wikipedia.org/wiki/Substance-induced_psychosis#Su... - "Alcohol is a common cause of psychotic disorders or episodes, which may occur through acute intoxication, chronic alcoholism, withdrawal, exacerbation of existing disorders, or acute idiosyncratic reactions. Research has shown that alcohol abuse causes an 8-fold increased risk of psychotic disorders in men and a 3 fold increased risk of psychotic disorders in women. While the vast majority of cases are acute and resolve fairly quickly upon treatment and/or abstinence, they can occasionally become chronic and persistent. Alcoholic psychosis is sometimes misdiagnosed as another mental illness such as schizophrenia." (emphasis added) (edit: added reference [7])

soup10 7y ago

Most mental health workers know that the popular conceptions about what schizophrenia is and how its managed are wrong.

pygy_ 7y ago

Treating DSM categories as if they were a single disease is completely misguided. The DSM describes syndromes, and ignores pathophysiology because we still have little to no idea of what happens in the brain (at least not enough to properly understand the relevant functional aspects). Genome-wide association studies have recently shown that schizophrenia was in fact several distinct diseases [0]. Their symptoms turn out to be mediated by the same drugs, to the extent that they makes the people who suffer from those ailments manageable. If your house suddenly becomes cold in the winter, putting on a jacket will help you feel better. You wouldn't infer from that that your furnace is down because of a clothing imbalance. [0] https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2014.14040435 https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2...

thatoneuser 7y ago
This is why I think very highly of the transition in DSM V to diagnosing on spectrums. It's not perfect but it really helps get away from putting people into buckets they don't really belong in.
- lupire 7y ago
  At the expense of putting people on spectrums where two people with the same diagnose have wildly different symptoms and effective treatments, rendering the diagnosis moot. This is a crisis in "autism", where Asperger's and autism are different on such an extreme scale, yet the language, medical literature, and treatment plans and funding are muddling it up to the detriment of all involved, creating a culture war between people who say their mild Asperger's is a personality type not a disorder, and caregivers of people who cannot speak or provide basic self-care for themselves -- because DSM dumps them in the same diagnosis and society loses the language to disambiguate the scenarios.
JamesBarney 7y ago
That paper looks interesting but also seems very preliminary.

yosys 7y ago

I dislike psychiatry grossly because the victims of the field are not compensated by how the errors destroy the victim's life. I'm a person who was medicated with the older & new generation of antipsychotics for two years of my early 20s because I was suffering religious conversion therapy "best I can describe it" from family and where I was in circumstances any other person would have great amounts of stress. The outcome of unfortunate events made me with a doctor who disliked me for desiring to be a woman (I was born a male) and attempted to convince me it's delusions & hallucinations; when I attempted to communicate I never suffered from either. The medication would result in me doubting myself but I eventually broke away from it all. It was impossible to find anyone to help sue for the tremendous pain (I still suffer to this day from it all) and it's been many years since it all happened. Anyway I deeply believe there should be a special hell for people who go into this field but I doubt anyone had any will in the outcome for me being any different because I've read philosophy on determinism since then. I think the field has done more damage than good and is a net negative with getting away with it all because of government allowing it. People prefer to believe something is good and when it really isn't.

ordu 7y ago
There is a book "A Road Back from Schizophrenia: A Memoir"[1]. Arnhild Lauveng came back from schizophrenia, got a degree in psychology and wrote the book, describing how it feels to have a schizophrenia. She describes doctors too. A bad ones and also those, who helped her to get back from schizophrenia. I believe you would like that book, her experiences are like yours. [1] https://www.amazon.com/Road-Back-Schizophrenia-Memoir/dp/1616088710 https://www.amazon.com/Road-Back-Schizophrenia-Memoir/dp/161...
- yosys 7y ago
  No, the experience was meaningless like life and nothing more than torture. I believe the field will die slowly and my life was worthless. I plan to act on suicide in the near future because of the torture.
  - ordu 7y ago

mindgam3 7y ago

> Importantly, what we call psychosis can also be a response to extreme stress or trauma. For many people it might best be understood as... a coping strategy gone awry or a form of storytelling carried out within the mind as a response to unbearable life events. This. The day that mental health professionals realize this is the day that we start improving outcomes. > there is no uncontroversial language when talking about mental illness – and that includes the phrase “mental illness” Glad the author brought up this important point. “Illness” is bogus because it implies disease/biomarkers for which there is no evidence as the article states. A more useful term would be “mental injury” as it frames the symptoms as a result of trauma. But I think the best term is simply “trauma” or “developmental trauma” when it goes back to childhood.

theArdvart45 7y ago
I cringed and abruptly stopped reading your comment at "This."

isnetea 7y ago

I’ve often wondered if it’s possible to induce psychosis and symptoms of schizophrenia in a subject via environmental conditioning. This seems practical to test these days, given the expanse of information possessed by large tech companies, and their lack of regulation. Perhaps this would be related research for a larger automated behavior control initiative. Does anyone have any pertinent references or info?

JamesBarney 7y ago
Mind elaborating on the connection between psychosis and automated behavior control.
- isnetea 7y ago
  Restated, is it possible to develop (eventually automated) ways to “drive people crazy”. Is it possible to use data and algorithms to manipulate someone into losing contact with reality, for instance, or trick them into manifesting schizophrenic symptoms
  - JamesBarney 7y ago
    I don't think so. One of the primary theories of schizophrenia is that the glial cells in the brain are doing too much synaptic pruning. It's more of an organic disorder than say depression or anxiety which is heavily affected by environment.
50656E6973 7y ago
Search "Facebook emotional contagion"

squirrel 7y ago

I find Xavier Amador very engaging and convincing on how to actually help schizophrenic people who say "I'm not sick, I don't need medicine": https://www.youtube.com/watch?v=Lstn6WNnCRc https://www.youtube.com/watch?v=Lstn6WNnCRc

raybon 7y ago

Ah, where do I start. Two of my close relatives have schizophrenia, people whom I’ve known since they were born. They were both diagnosed around 19 and are now 29. In the last ten years we’ve tried many medications, hospitalizations, with little to no avail. I never understood the word curse when I was a kid. I read about it in stories and I had seen people curse each other. Living with schizophrenia is the definition of a curse. Lives wasted in an alternate reality. The lives of the care givers and family impacted terribly.

hindsightbias 7y ago

Well, this article didn’t lead to any answers or any insight for me. The whole unexplained opening of poisoning is cryptic and unhelpful. Does this nurse see the nuclear options as poison or was this doctor trying to give Amit cyanide? Who knows. I’ve spent a month of evenings at Langley-Porter and then again at Zuckerberg, and the staff there didn’t strike me psychzombies. The last thing they wanted to do was to commit to a diagnosis of schizophrenia for my relative. I sat for an hour with the Attending on his outtake and she did everything to assure us that in her expert opinion it wasn’t black and white - drugs were part of the toolset and not The One Answer. What’s wrong isn’t that people are ignorant. They always have been and always will be. Until you’ve been there, you won’t get it. What’s wrong is we have brilliant people who are hamstrung by process. At SFGH it’s “If you aren’t a threat, you’re out” 7 days after the 72 hour lockdown. It’s a factory, because that’s all the runway WE give them. We’re lucky. We’re wealthy enough and there’s enough of us that we can probably make this work. But the other 90% in those wards? They don’t have anybody. So unless WE want to fund that level of intervention/compassion, the factory and pharmacology is the solution.

HeadsUpHigh 7y ago

DSM and other such systems(icd for example) are for CLINICAL use. I.e. they are not academic. If 2 different mechanisms create the same symptoms and are treated by the same drugs then from a clinical aide of view separating them is pointless. Academic research on the mechanics of diseases is much more nuanced than what an article on a news site can cover. Once something is clearly separated as 2 different entities in a clinically meaningful way via research then the classification system will be updated. What this means is that if e.g. we find a way to differentiate between 2 different mechanisms for schizophrenia with each of the responding better to a different drug( even if those are already existing drugs, it gives us a shortcut to choosing the right medication without trial and error) then DSM will split schizophrenia to schizo due to x and schizo due to y with further guidelines for medication. Or split them into 2 different things entirely.

tomohawk 7y ago

Schizophrenia can run in families. A family we knew was killed in the middle of the night by their step son with a hammer. Apparently, the disease can have a sudden onset. The mother and step father were teachers, and the whole community was affected. The son (teenager at the time) was diagnosed and has been held in a facility now for many years. The biological father has been in and out of institutions and homeless. Such a terrible disease.