I agree there are plenty of ridiculous manuals out there for treating a variety of both mental and physical conditions. One reason they seem so odd and stilted is it's clear that INDIVIDUALS will rarely benefit from such a flow-chart approach. At the same time, I think it's an exageration to assume that most professionals would rely heavily on such a manual. First, the term physician is used as the treating professional in this article...A person with a primarily organic/medical background is going to approach a case differently than someone with a psychology anad psychopharmacology background. A psychologist's treatment of a person with schizophrenia may be entirely different. Last, I would be interested in what the author might suggest as an appropriate treatment for someone in an active psychotic state. Many (not all!) people with schizophrenia experience mental anguish and may be a danger to themselves and others if unmedicated. The article seems weighed heavily against medication so what do you suggest for people living with this serious mental health disorder?

of course, i am not a professional but i'm just going to take a stab in the dark here and guess:
adequate and affordable medical advice?

This comment is directed primarily to Kara. The most fundamental thing to do for conditions such as schizophrenia is prevention. I lived with a paranoid schizophrenic mother and, considering the gross level of abuse that happened in our household, which every family member except myself wants to deny, I will never be convinced that abuse, especially at a young age when brains are still developing, can't CAUSE schizophrenia. So the first line of action is acknowledging that many mental illnesses are SOCIAL problems, not medical problems, and working to eliminate those social problems. Secondly, cognitive behavioral science has proven, many times over, that when a person changes their behavior, their brain chemistry changes. In fact, controlled studies comparing the brain chemistry changes of those using cognitive behavioral therapy and those using drugs to treat or correct specific 'mental illnesses', show the exact same changes with therapy as with drugs. The difference with therapy? No ugly side effects as with drugs. One very interesting outgrowth of cognitive behavioral therapy is known as "Internal Family Systems". You should check it out. Just type in "IFS therapy" on your browser.

Kara asks, what do you recommend other than medication. Recent studies of people diagnosed with schizophrenia in poorer countries (where the drugs are less available) - for example, India - found that when left alone among friends and family, most of them recovered in three to five years and became productive members of society. Those given medication simply spend the rest of their lives deteriorating. Loren Mosher (U.S. psychiatrist) in a long study funded by NIH, also found this to be the case. He used only communication, no drugs, and had a far higher recovery rate than those treated with drugs. So the answer to your question is that just about anything -- including no treatment at all -- works better than the medications.

I've collected a number of articles and resources on my blog for any who might be interested in taking a look at non-traditional approaches to psychosis/schizophrenic breaks. I'm also speaking as someone who has had a psychotic break. That was a few years ago. I've had no therapeutic medications and no formal therapy. I've been working for the past 2.5 years and my life is very stable.

Thanks for the great article. I feel enlightened. It is simply amazing to me that the public can't see exactly what is going on. It's great when you can quote straight from the manual and show how idiotic it all is. Maybe as your story gets sent around, more people will wake up to the true intentions of psychiatry and the drug companies.

Why are Doctors treating schizophrenics anyway? I guess that just shows you that we don't really need psychiatrists since apparently, anyone can diagnose and "treat" mental illness. Just look in the book and follow the symptoms, no special training needed!

So why do they get paid these exorbitant fees? And I really want to know why the insurance companies agree to pay for them and their drugs. I mean, when you look at it, who would pay for a psychiatrist or the drugs out of their own pocket. Very few I'm sure.

So, if the only reason we still have psychiatrists and drug companies is because of the insurance companies and lately the government, maybe we should go educate the insurance companies about the fraud and vested interest and lack of scientific proof of mental illness.

I'm sure they would love to cut that expense out of their budget!

Bill Simpson

As the author of this article, I'm glad to see I've generated some spirited discussion. For anyone seeking an alternative to conventional "treatment" with psychiatric drugs, there are a number of excellent places to start. I'll recommend a few:

Robert Whitaker's book, "Mad in America," which is linked in my article ("STAGE 7... if your patient lives that long");

Mich. State Univ. Professor Bertram Karon's paper, "The Tragedy of Schizophrenia Without Psychotherapy," also linked (STAGE 6... it's not very likely");

John Weir Perry's book, "Trials of the Visionary Mind," which describes a drug-free program called Diabasis (please read my review of this book at amazon.com);

The late Loren Mosher's website www.moshersoteria.com has lots of information about another drug-free program called Soteria;

"The Seduction of Madness: Revolutionary Insights into the World of Psychosis," by Edward Podvoll, contains a chapter on how to create a therapeutic home environment where true healing is possible.

Finally, I'd like to remind Ragged Edge readers that the guidelines/algorithms described in my article are only one component of an agenda proposed by the New Freedom Commission on Mental Health. Another nasty part of the plan is universal psychiatric screening of America's schoolchildren. Here's a good place to read all about it:
www.psychsearch.net/teenscreen.html

Great article! Too close to truth!!!

Some of the side effects of these drugs include brain damage, alterations in the structure of the brain, heart problems, sudden death, violence, hideous laughter, shuffling, drooling, diabetes, excessive weight gain, uncontrolable movements, disfiguring facial tics, involuntary worm-like motions of the tongue, psychotic violence, and suicide, to name a few common ones.

The other side effects are obscene profits for pharmaceutical companies for "treating" "illness" that is based on opinion, not physical tests of the person; skyrocketing health care costs for "treating" "disorders" that are completely invented to market the drugs; corruption of medicine, universities, and science reporting to inflate claims and omit data on risks; violations of the Nuremberg human rights accords by experimenting on children (including kids in foster care) without full informed consent.

Great article. It is so factual it is actually scary. Pediatrician's use this type of "delivery system" as it gets them the biggest bang for the buck in the form of huge kickbacks from the pharmaceuticals. Ethics has left the building folks and has been replaced "by see how many people I can put on Lithium today." I met a young woman in her 30's last spring who was "schizophrenic" according to her trusted doctor and she tells me he has had her on Lithium for almost 5 years and I asked her one very important question, "Are you cured yet?" And she looked at me and said "no I ain't". I said "that's because it won't cure you, it'll only make you feel better temporarily and then you will need to take more and more", and she said, "then your addicted, like me". She had a realization about this habit and this drug, and that it wasn't helping her and I hope she gets off of it and starts new.
These phony labels and phobias and drugs are all substitutes for going out and actually living and taking the risks in life and playing it to win. "I feel anxious today so let me take a pill for that." That's being a victim and that is who psychiatry is aiming for. To make them into a complete victims. They are doing this in our schools now with the TeenScreen surveys. Give the kid some ideas he may be too depressed and might commit suicide after he had a fight with his girlfriend, and he ends up on effexor because his parents may already be drug users or victims of life in their own right. So the psychs take advantage of this and get another victim as the parent signs the permission slip while they think to themselves, "maybe I'll get some new drugs out of the deal myself."
Sounds ludicrous, but real life in the trenches can be. The website the author put at the end of his own post is invaluable if you want to be armed with the truth about TeenScreen so you can use it to fight it in your community.

Dean has mentioned some interesting studies of those living with schizophrenia in poorer countries and their better functioning as it seems without medication.....While I am not a purist on either end of this spectrum..it should be noted that incidence rates for schizophrenia in general are much lower in less developed countries. So the assumption can't truly be drawn that the difference in their functioning (or the less likelihood of schizophrenia) is simply linked to medication (or not)....Rather, many suggest that the high demands of our fast-paced and rather constrictive society for many tend to in some ways heighten psychotic breaks and possibly cause more people with schizophrenia to experience episodes with enough severity to receive a diagnosis. So...it's back to the chicken/egg argument in a way....Do people with schizophrenia do better in these countries because many don't take medicine or do they do better anyways in these country-so much so that there are even fewer people with symptoms of the mental illness.
Either way-the studies in the less developed countries undoubtedly have this confounding finding to untangle.

Kara: it should be noted that incidence rates for schizophrenia in general are much lower in less developed countries.

Do you have a source for that statement Kara? My understanding was that schizophrenia plays out near an even 1% of any given population.

* Schizophrenia afflicts 45 million worldwide. Half are able to make a full social recovery. The WHO has praised India and China for programs that combine generic psychotropic drugs and human resources.
* The rate of schizophrenia is constant around the world.
* Schizophrenia develops in 1% of populations worldwide.

Source: http://www.mindful-things.com/psych_news_archive/psych_news_fastfacts.html

An additional link you (or others) may enjoy Kara.

"...85% of our clients (all diagnosed as severely schizophrenic) at the Diabasis center not only improved, with no medications, but most went on growing after leaving us."

- John Weir Perry

Source: http://spiritualemergency.blogspot.com/2006/01/mental-breakdown-as-healing.html

The WHO study that you cited has been widely criticized because while it reports results as evidence of a reflection of worldwide incidence-it only used 9 world centers. Also, if you review their definition of schizophrenia in this study it is extremely wide...After attempts to narrow it to what actually meets diagnostic criteria for schizophrenia, the statistical results of the study are no longer even valid....

The idea that the incidence is 1% across the world is what used to be accepted (and I'm sure still remains prevalent on the internet along with alot of other out-dated information)but there are even patterns noticeable within countries. People in larger cities have higher incidence than those in smaller cities..rural communities have an even smaller incidence of people with adjustment for the smaller population.
There are NO diseases that occur at the exact same incidence across all populations of the world...it's a matter of manipulating statistics that some standby the old belief that it is 1% everywhere because if you lump all forms of for example-mental disorders (MR, epilepsy, and schizophrenia, etc.) together it will look like statistically that they occur at the same right. Research shows this is not the case if you actually break it down between the specific disorders (which is what we'd really be interested in right!)there are differences (which have both genetic and environmental explanations between world population).

There are many peer-reviewed journals citing psychology's updated view of this difference across populations but I found this link to be more reader friendly if anyone's interested...I usually hate posting anything from the internet because undoubtedly I can find the opposite with google. I guess that's the beauty and the fault of the internet is that anyone can make a site..but this interview is with Dr. Robin Murray who also has published research. Also, unless you had access to a research database I don't know that you'd actually be able to read the articles references..if you are interested, feel free to email me at karasheridan@bellsouth.net

oops..I forgot the link..here you go
http://www.schizophreniaforum.org/for/int/default.asp
-Kara

I also wanted to respond to Angela's post because I'm very interested in the brain's plasticity and completely agree that we can actually change the brain's chemistry with therapy (as the research is showing more and more)...Also undoubtedly I am for this over medication each and every time the person is showing gains from the therapy and is not in danger of hurting themselves or others. I hope it wasn't confused that I was advocating that I support medication for everyone with schizophrenia. I don't at all..nor do I suggest it instead of or without at least consideration for therapy....but I also know some with severe schizophrenia don't always have the insight to participate or benefit from therapy-which is as ethically wrong to incur the cost of therapy for people that won't benefit from it (or who aren't) as it is the ridiculous cost of medication. So I am NOT saying that I agree people with schizophrenia will not benefit from therapy...I am saying that for SOME who are actively psychotic it may be very difficult. I see the biggest problem with this "manual" is the total disregard to consider each client differently instead of a factory/flow chart approach.

Also-in reference to an abusive setting "causing" schizophrenia…I just don't think that line can be drawn clearly. Especially if the abuser is a parent because there's a known genetic link to schizophrenia. So how could we determine whether it was inherited or caused in the environment? There's also the fact that not everyone in the same/similar situation develops schizophrenia…some in response to the same environment might show signs more like depression or anxiety. Also making such a conclusion would place blame on many families that were not abusive and did nothing to "cause" schizophrenia.
~I've learned a lot from this discussion and am glad that people have responded. I'm fairly new here so thank you:-)

One of the problems with polemical arguments on either side of this issue is that they usually portray all people suffering from a disorder like schizophrenia as homogenous or similar to each other when this is not the case. Schizophrenia most likely represents a "family" or continuum of similar disorders, some of which are more heavily contributed to by genetics, some which probably arise from the interaction of genetics vulnerabilities and environmental stressors (including abuse). Thus, to declare that medications should never be used with a person suffering from schizophrenia seems short-sighted. I have seen many individuals in crisis who needed support, but also benefitted from the use of medications. On the other hand, to declare that ALL schizophrenics should automatically be put on high doses of potentially dangerous medications is also probably short-sighted.

Some cases of schizophrenia seem to remit without medical intervention, some remit with the use of medication, and some never remit despite all forms of treatment attempted. In the past, the use of "moral therapy" involved no drugs (because they had not yet been developed), and emphasized social support, social involvement, and stress reduction. Many persons who were thought to be suffering from schizophrenia at that time (and our newer definitions may be different) benefitted greatly from this form of treatment, but some did not.

These are very complex conditions and we still have much to learn. To try and simplify the arguments, no matter what side you are on, does a disservice to those who are struggling to live with these conditions. Even if you have suffered from the disorder yourself does NOT mean that other people will respond or react to treatment the same way that you did.

Also, I have worked with persons suffering from schizophrenia for years -- and yes, there are some burned out physicians who follow routine patterns of prescribing, but most physicians, psychologists, etc. that I have worked with over more than 16 years truly care for their patients and want them to get better. The cynical, sarcastic viewpoint described by some in this post is just not the case of most of those practicing. I also understand that sometimes people get bitter when they disagree with the physicians who are providing their care. People can and will disagree. There are even incompetent practitioners out there -- not everyone graduates at the top of their class!

The worst problem facing those who suffering from conditions like schizophrenia is the social stigma that attaches to this label. NO ONE wants to be diagnosed with such a condition, even if it is true. It is like being told you have terminal cancer. If people find out you have that label, they treat you differently; there is widespread misunderstanding and prejudice against persons with mental illness and that *includes* from the persons who suffer the illnesses themselves. It is pervasive in our society and needs to change. Stigma often drives some of the way that staff in institutions treat patients; it drives the way that the public interacts with such patients, and it drives the way the patients often feel about themselves and their treatments.

Last, to argue that mental illnesses are only social inventions and don't really exist is an old and tired argument. It is not true. Yes, diagnoses are the result of the interaction between science, culture, and social forces, but to say that there is no biological or genetic or medical element to most forms of mental disorder is just ignorant. Anyone who has interacted or tried to help someone in the midst of a manic episode or in the throes of paranoid delusions or psychotic thought processes no longer believes in the pure "social" explanation of mental disorders.

i don't think anyone was suggesting that, but merely highlighting how little we actually know about the causes of mental illness, contrasted with the information provided in commercials as fact.
We're glad you are a really great doctor who never talks down to his patients "suffering from schizophrenia" and that you have clearly been listening to the disability community in your area enough to know that you had better throw in a paragraph about how they are really suffering from stigma, despite the former phrase being used much more heavily in your post, however, most of us do not have access to that kind of treatment. that was the point of the article.

Dr. T: Schizophrenia most likely represents a "family" or continuum of similar disorders, some of which are more heavily contributed to by genetics, some which probably arise from the interaction of genetics vulnerabilities and environmental stressors (including abuse). Thus, to declare that medications should never be used with a person suffering from schizophrenia seems short-sighted. I have seen many individuals in crisis who needed support, but also benefitted from the use of medications. On the other hand, to declare that ALL schizophrenics should automatically be put on high doses of potentially dangerous medications is also probably short-sighted.

Excellent points. I'm inclined to agree with you that the actual cause of schizophrenia is multi-faceted and varies according to each individual. In spite of that, I've also noticed that with rare exception, the first line of treatment, regardless of what form of "schizophrenia" is presenting, is always anti-psychotic medication. To illustrate that point, not long ago I had a discussion with a psychologist who had more than thirty years of clinical experience under his belt. I asked him if he had ever heard of anyone recovering from psychosis without anti-psychotics. "No," he replied, "not personally."

In this respect, I see a correlation between psychiatry and obstetrics, wherein family doctors once knew how to deliver a breech baby or twins but today's obstetricians opt for a cesarean most every time, in part because they're no longer being taught how to deliver non-routine births vaginally. To the same extent, modern psychiatry no longer knows how to deliver non-medicated care to patients in the throes of a psychotic episode. As I understand it, more than 90% of all patients who enter the psychiatric ring will end up on medication of one form or another.

My own experience was more than four years ago. I didn't go into that experience with the intent to demonstrate that individuals could move through a psychotic break without anti-psychotics -- that's simply the way my own experience unfolded. That experience lasted about six weeks during which I moved in and out of an altered state of consciousness. In the year or two after, I also went through a very pronounced form of severe depression and occasionally, wasn't entirely certain if I was dead or alive. I didn't have an actual name for that experience until more than a year had passed, which is why I didn't end up on anti-psychotics. It's possible that I could have benefitted from anti-depressants in the aftermath of that experience but I chose to shun those because I did not wish to return to the numbed state I had been in prior to my psychotic break.

Although I was not aware of their work previously I instinctively created for myself the kind of environment that clinicians such as Loren Mosher and John Weir Perry attempted to create with their projects, Soteria House and Diabasis. Since then, I've also sought to educate myself about the process I had gone through, and examined it through a number of different lenses including shamanism, mysticism, alchemy, gnosticism, Jungianism, and present day psychiatry. In this culture, the experience I went through is labelled a disorder. Not all cultures have the same derogatory label, and perhaps this too accounts for a higher recovery rate in other countries, even among settings that we might consider to be lacking or primitive.

I've found the work of clinicians such as Stanislav Grof, Carl Jung, John Weir Perry, Loren Mosher, David Lukoff, and Maureen Roberts have contained the most insights for me. Essentially, they approach psychosis as a potentially purposive transformational crisis that falls loosely under the umbrella term of "spiritual emergency". It may be that you're familiar with that approach but if you're not, my blog contains a number of articles that detail it fairly thoroughly.

Meanwhile, here I am, an individual who has gone through a full-blown state of psychosis without any form of neuroleptics, anti-depressants, mood-stablizers, or formal therapy. I do not appear as a figure in any statistical chart because the entirety of that experience occurred outside of the psychiatric arena -- I am surely only one of many. As a result, I have not been formerly labelled as having undergone a schizophrenic/psychotic break but I am certainly recognizable to those who have.

I can identify genetics (my father was in and out of mental hospitals), abuse (early childhood), stress (multiple losses over a short period of time), and trauma, along with environmental and cultural settings as factors that played a role in my psychotic break. Yet, I am well. I am working. I am not on any form of medication. My relationships and life are stable. Was I perhaps one of the few who experience one episode and never experience another? If so, does that correlate in any manner with the "treatment" I received or is it merely extremely good fortune?

For the record, the "story" of my experience has been posted on the internet for about three years. Numerous psychiatrists and psychologists have been invited to read it. This is how many have been interested enough to do so: 0. To me, that suggests that they see no need to pursue alternate methods of treatment because they're content with the model of recovery they already have, including routine medication for the majority of their "clients".

PS: Thanks for that link Kara. I've been slowly making my way through that interview.

Excellent article. With all the WELL documented facts on the fallacy of brain chemical nonsense at least our MDs can hide behind these algorithms and point out that "everyone is doing it this way" and so becomes the "standard" treatment. Not much liability there if "everyone" is doing it. Author Dr. Jonathon Leo et al have published many excellent articles on the fallacy of neuroimaging of mental health diseases and chemical imbalances for all to read and be enlightened on one of the biggest scams in history.

That's a beautiful letter, Spiritual Emergency, thanks for sharing your story with us.

I was moved by your comment that "ZERO" is the total number of psychiatrists and psychologists who have expressed an interest in reading your story.

A week ago I emailed my article "Schizophrenia Treatment in 7 Easy Steps" to over 300 mental health professionals here in Michigan, and so far I've received a grand total of ONE reply, from just one individual.

The single reply received:
"How did you obtain my email address?"

That was it!

I actually found myself chuckling as I read over the steps for treating schizophrenia. It's so ridiculous it's funny! Ben, thank you for taking the time to write this! We are such an overly- medicated society, it's sad. I hope enough people read your article and take saner approaches towards treating mental health.

Well thankyou for the laugh! It is sad to think anyone -- particularly "professionals" would even consider any one bit of this "treatment" to be valid. It is also frightening. Frightening also is the general populace and how they all buy into this "disease" and falacy of "treatment".

It is time for the intelligent sector of our country to beging promoting far and wide the truth behind all these so called diseases...for which drug companies come up with a never ending gambit of drugs to utilize -- yes, each with its own side effect(s) all needing more drugs to handle those. WhooHoo, say the stock holders...more money for us if these dopes buy the lie of chemical imbalance.

There is no "chemical imbalance". There is not one iota of proof to any chemical imbalance. Read the marketing carefully. The use nebulous phrasing to get you to assume it is true.....to assume it is valid dementia and/or disease. Wake up, folks. Get off these drugs if you are on them. Stop your friends and loved ones from getting on them. There are many other solutions to what ails you.

A group you can contact for those other options and for help with any pyschiatric mishandling you have recieved...or any misconduct by doctors that you are aware of...is a group called "Citizens Commission for Human Rights" (CCHR). Go on-line now. See the truth for what it is. Stop buying into this lie today. Go to any and all of these sites and get educated so you can protect yourself and those around you.
www.cchr.org
www.fightforkids.com
www.psychcrime.org
www.psychassault.org
:) Debi of New Hampshire

Children can feel certain their hobby horses are truly flesh and blood. I guess psychiatrists can feel certain their psychobabble is really science. Children's convictions are charming.

Ben hit the nails on their heads with this article. Real medical practitioners should be distancing themselves for the psychiatric crowd and resisting all those cool ball point pens for surely this kiddy drugging house of cards is going to fall. And when it does there will be a tally of who got how many pens and dispensed how many related prescriptions.

As a child, oftentimes when you don’t understand something, you end up breaking it. Even as adults, how often do we shake or hit an electronic device that may not be working correctly to try to fix it?

That trait reminds me of psychiatrists. Since they don’t understand the mind, they resort to breaking it any way they can. The father of psychiatry believed in quarts of blood-letting and was responsible for George Washington’s death. Then we had lobotomies, where an ice pick is slashed back and forth through your brain. That then led to electro-shock treatment which scrambles people’s minds and is still in use. And today, the best-selling psychiatric treatment is frying the brain with mind-altering drugs, even on kids younger than six.

What treatment are they going to come up with next when drugs don’t provide the miracle solutions promised?

I am enjoying the article and all the comments!

Eleanor: I understand that many people suffering from these conditions do not have the type of treatment I was describing -- and that is a shame. As human beings, they deserve it. Stigma is rampant and is often masked or not discussed even among professionals because they assume that they are free of it because they understand more about the disorder, or at least think they do. However, the stigma that the client/patient carries also makes the interaction difficult -- because of how they react to the diagnosis, to how they view themselves before or after, etc. It is a complicated situation; I do believe that part of the solution does lie in listening carefully and more fully to persons who have experienced these conditions as well as the existing treatments. How can we improve what we do if we do not listen to those who are affected by the treatments we use?

Spiritual Emergency, *I* would be interested in reading your story -- I assume it is posted on the web? However, what I know of you from what you have posted is a good illustration of some of the difficulty of working in this area. For example, you describe a lot of depression as part of your illness. This raises the question of whether or not you did experience a "schizophrenic" episode, or whether you might have been depressed to the point that you became psychotic, and then survived that to go back to depression, etc. Of course, I am operating here on limited information, but this difficulty of disentangling these various conditions, their causes, and the immense variety among patients all contributes to our difficulty in understanding what is happening. We know that a significant percentage of persons who suffer "a psychotic break" recover over time with no apparently negative long-term outcome just as we know that some persons suffer from mild depressive episodes and recover in about 6 months with no treatment at all. It is wonderful that you were one of those persons. However, that does not mean that your story is true for everyone who has a psychotic break or even for the majority of persons who suffers from such a severe condition.

However, I agree that your story raises important issues about the nature of treatment, and especially the way that patients are treated and the assumptions made by professionals. These are excellent points. I might also note that there is a growing literature about recovery from schizophrenia and psychosis. As a gross example, I ran a search on the professional literature using the terms schizophrenia + recovery. I had 899 hits. At least 80 of these references were from 2005. Some of them are by key researchers in this field (especially psychosocial rehabilitation) including Liberman. The title of the following article, for example, illustrates that progress is being made, but there is a need for more research into this area: Liberman, R.P, Kopelowiscz, A. (2005). Recovery from Schizophrenia: A concept in search of Research. Psychiatric Services, Vol.56, No.6, 735-742. More difficult, is getting this information into the hands of those providing training to physicians and other mental health professionals; even more difficult is getting it into the hands of current practitioners some of whom, of course, were trained decades ago.

Last comment for today: of course many of you are right about Big Pharma and their profit motive. They do want to sell lots of drugs and make money. But many patients benefit greatly from these medications -- in some ways, the treatment is still very crude and very invasive; there is a lot we still do not know, but personally I think we have made an improvement from the days of insulin shock, regular restraints, and frontal lobotomies. I certainly hope in the next 50 years, we'll see more improvement. Many physicians also are trained to just use the latest drugs as routine in the treatment of psychosis, but hopefully some are looking at the situation differently as new research comes out. I am a psychologist and so have a different perspective as well.

Last, I would disagree with Debi and partly agree with her as well. I agree that as the popular media or person on the street usually defines it, there is no true "chemical imbalance" explanation for mental illness. However, there is LOTS of good research that does demonstrate changes in brain chemistry (neurotransmitter production) in persons who suffer from some forms of mental disorders, especially those conditions that are more severe. There is also evidence that when those people improve, their neurotransmitter functions look more like those of a "normal" person. What is not at all clear is what the link is between the symptoms and the neurotransmitter production. For example, we do not know if the illness creates the neurotransmitter shift which then causes further symptoms, or if the illness is created by the neurotransmitter shift. The interview posted by Kara is fascinating and helps us to understand how complex the situation is. The studies clearly show there are genetic factors, for example, in schizophrenia. However, there appear to be multiple genes involved, many of which probably interact with the environment or depend upon environmental triggers to activate. Further, the fact that these drugs helps some people (in a study), does not mean that they help all people to the same degree; in fact, for some they may do more damage than good. So, to argue that the chemical imbalance explanation is totally false is incorrect; it is more truthful to say that we know that genetics are involved, we know that neurotransmitters, or brain chemicals, are involved, but we still do not fully understand the relationship between these elements and environmental factors. We have a lot to learn.

I think we can be the most helpful to persons suffering now and to future victims of these terrible disorders if we work with the truth and use that truth to educate and inform and reduce stigma.

A quick comment to Ben -- Ben, the reason I got involved with this discussion was because of the email you sent out. I am in Michigan. So, you've had a response from at least 2. However, I would suggest that most professionals do not work with patients with this severity of disorder. Most of those 300 people you sent your message to probably have some interest in the topic, but work in outpatient settings with anxiety and depression or family problems which are MUCH more common. So, don't be discouraged!

Dr. T.: *I* would be interested in reading your story -- I assume it is posted on the web?

Yes, it is. You can find a summary of that experience here: http://spiritualemergency.blogspot.com/2006/01/personal-account-spiritual-emergency.html

Meanwhile, I wanted to note that you are the first professional who has ever expressed an interest in reading that story. In spite of that, I sugggest that your time would be better spent reading through the collection of articles I've posted on my blog. My story, after all, is only one individual's perspective; within my blog however, I've tried to present the insight of clinicians who have had extensive experience working with many others who have undergone an experience that was similar to my own.

Please note, you will not find a "daily journal" at my blog site -- only article excerpts that relate to the experience I went through. For the reader's convenience all entries are titled and organized in a Table of Contents accessible on the right side of the main page. I believe that clicking my user name on this post will take you to that blog. If not, you can find it here: http://spiritualemergency.blogspot.com/

Dr. T.: However, what I know of you from what you have posted is a good illustration of some of the difficulty of working in this area. For example, you describe a lot of depression as part of your illness. This raises the question of whether or not you did experience a "schizophrenic" episode, or whether you might have been depressed to the point that you became psychotic, and then survived that to go back to depression, etc.

I've heard it said that "psychosis is the fever of mental illness". As I understand it a number of conditions can lead to the development of psychosis but the mere presence of psychosis alone is not enough to diagnose schizophrenia. Yet, what I've also found is that regardless of the known or suspected cause, nearly all forms of psychosis are approached "as if" they were or could become schizophrenia. Given that it's believed that a delay in treatment will lead to repeated episodes of psychosis, this helps explain why anti-psychotics are a standard first-line response. That said, most individuals do not have any difficulty recognizing the "psychotic" aspects of my experience. Nor do those diagnosed as "schizophrenic" have any difficulty recognizing elements in common between my experience and their own. Either way, if I am or ever was "psychotic" or "schizophrenic" I appear to be well now.

Dr. T.: However, that does not mean that your story is true for everyone who has a psychotic break or even for the majority of persons who suffers from such a severe condition.

Nowhere in my blog or my story will you find me stating that my experience is a universal one. But it is one person's experience with psychosis/schizophrenia and it is my experience of becoming well by going into that altered state of consciousness, actively engaging the emerging content, and doing so without psychiatric medication or therapy. All things considered, I suspect that makes it a rather rare form of experience, "schizophrenic" or otherwise.

Something else you will find in my experience is that in spite of the fragmented aspects, there is an underlying order and structure within it. That same imagery is consistent with the pattern uncovered in the work carried out by (for example) John Weir Perry, Carl Jung, and Stanislav Grof. This tells me that there is far more to "the schizophrenic experience" than mere neurological underpinnings, even though neurology may well play an important role for some, but not all, individuals.

For the record, it's worth noting that I would be as opposed to routine non-medication as I would be to routine medication. There are some people who feel that medication has been a blessing for them and I see no reason why they should feel guilty or ashamed for doing so. Likewise, there are others who have negotiated these experiences without medication. Since that was my experience, and since I am speaking from that experience, I've sought out the viewpoints of other clinicians who can share insights in that line.

Just wanted to add a couple things-
Ben-The few number of responses might not indicate a lack of interest as much as no real motivation to respond or debate. When I first read the article-my only real cues to your stance was the author byline and of course the forum and attitude of the magazine (and the disability community)...so had I received it in my email and didn't have that background/perspective I might not have responded either. I personally enjoyed the style in which you laid out one of many many methods of treatment but others might have even confused it as informative! Just a thought.
Also-unfortunately the support of advocates sometimes becomes clouded by overblown negative attitudes..yes, there's alot of work to do to find the best treatment for each individual but there are some truly genuine people out there learning, researching, and working with those individuals to do that..if they are not remembered at some point after all the venting and rightful complaining about bad experiences then that to me is as silly as suggesting another all-or-nothing approach. The history of any social service seems primitive from our perspective NOW...but that doesn't mean those disciplines have no place in the future because just as medicine, education, and civil rights have developed and improved with time-so has and will the field of psychology.

Last, Dr. T, thank you so much for your comments. I've learned a great deal from them. I'm a first year PhD student so this has been a really interesting discussion to hear from so many different perspectives.

Thank you for the very amusing but sadly true article. Seems like George Orwell was more a prophet than a novelist....

Ben, I might also make a few comments on your piece since others are doing so. There is much truth in your writing, but there is also some, I believe, misunderstanding. Let me draw an analogy to another field I know better than psychosis: depression. It is pretty clear that for many people, antidepressants are lifesavers. For others, they are unnecessary and probably should not be prescribed. Many of those who are prescribed antidepressants do not see an effective response and so they discontinue the medications. Here's the rub: the research studies show that physicians often do not give the first drug enough of a "test" to know whether it worked or not. They usually start the patient at the lowest possible dose because that causes less side effects. However, if that doesn't work, they may switch to another medication rather than increasing the dose. The studies indicate that in a significant number of cases, the increased dose is effective. Likewise, there are other studies suggesting that if a patient fails on an SSRI medication (after an adequate trial), that a significant number WILL achieve relief after switching to a second SSRI because they are all slightly different from one another.

So, we have a situation where, in those patients who might benefit from antidepressants, physicians often are not prescribing in a way that maximizes the potential benefit of the treatment. For patients, this often creates the sense that the doctor is making them a "guinea pig" because they are trying them on different medications all the time. Usually they resent this approach or fear it. Unfortunately, we do not, at this time, have any way to tell for sure which patients will respond to medications, which will respond better to therapy, and which will respond only with social support and exercise. So, the approach is hodgepodge and haphazard which is understandbly very frustrating to patients.

I presume that the situation is similar to the treatment of psychosis although the potential side effects are much more nasty. We do not currently have any way to predict which patients will do better on Haldol vs. Clozaril, for example. For years, the recommendation has been to start with an atypical antipsychotic because the data suggested that patients had less severe side effects and that these agents improved negative symptoms of schizophrenia much better than the older versions (which sometimes made negative symptoms worse). That is a good reason to use the newer meds even if they cost more. I worked in a state hospital for a number of years, and I remember long discussions about putting patients on atypicals and how could we help the person afford the drugs once they left the hospital. This is a very real and serious issue. However, some recent studies have suggested that the supposed benefits of atypicals vs. older agents may not be true -- that the side effect profile may be similar which would mean that it would be much better to go back to meds that cost less. If these results are replicated and supported, that may very well be the recommendation.

I hope all of you reading this can begin to see the complexity of these issues. Physicians don't make money off of the drug companies -- although they do get some rather hefty perks and this needs to be reigned waaaay back.

Treatment algorithms can be quite useful because they help to reduce the number of potential errors made by physicians with very different training and practicing in different parts of a state or the country. Every patient needs an individual and customized assessment, but algorithms often help to improve the consistency of treatment and help to reduce the common mistakes such as I was describing with antidepressants. They should not be used as "cookie cutter" approaches, but rather should be considered in the context of treatment of an individual patient. If you carefully look at the stages of the algorithm, you will also notice that they make an attempt to reduce the amount of polypharmacy by suggesting strategies that may be effective at lower doses or with single drugs before switching or trying multiple drugs. This is probably a good thing -- to help keep physicians from automatically putting people on high doses or large numbers of medications. So, the algorithm might be helpful.

I'm not saying it is a panacea. Algorithms are tricky to write and need to be constantly updated as new information comes out. We need to be especially cautious when the major information source on medications is drug-company sponsored research. There needs to be more independently conducted research to compare with drug company results. Physicians are slowly getting their act together to label some of the current practices of hefty perks to be unethical; at least I hope they are! I can see why a patient who discovers this algorithm might feel like they are being treated like a statistic or a number, that the physician is not considering their individual welfare. Instead, think of the algorithm as the physician getting a consultation from a colleague looking over their shoulder. They don't have to follow the colleague's advice, and in some cases probably shouldn't, but it might be wise to at least consider it.

I think, that only medical way of schizophrenia treatment can not always help. There is some connection between mental illness and spiritual life. Spiritual life, as many believe, is ruled by some metaphysical force (often called God, Creator).
The reason of mental illness often (maybe not always) has metaphysical origin, which is quite difficult to understand.
In some cases christianity can pull out from mental disorder and give solid ground to live as relatively healthy person.
Reading Bible and prayer can often change the inner world of mentally ill person and give him a sense of meaning and faith.
Here is one of the greatest prayers:
"Therefore, you should pray like this:

Our Father in heaven,

Your name be honored as holy.

Your kingdom come.

Your will be done

on earth as it is in heaven.

Give us today our daily bread.

And forgive us our debts,

as we also have forgiven our debtors.

And do not bring us into temptation,

but deliver us from the evil one.

For Yours is the kingdom and the power

and the glory forever. Amen.”
(Lord Jesus Christ)

Thanks for the article, Ben. You've promoted an astonishing number of comments!

Hi, Eleanor -- loved your observation about Dr. T's use of "suffering from" as paternalistic; alas, it seems he hasn't picked up on the dig, since he continues to use the phrase, almost as though he found the statement encouraging. Evidently your irony was lost on him, but I appreciate it.

Dr. T, to use "suffering from" when describing a person's condition, particularly a disability, denotes an attitude of pity and, therefore, condescension: "Sucks to be you." Thanks for your insight and for taking the time to engage in this discussion -- and of course, I acknowledge that people with mental/emotional disabilities, as do people with physical disabilities, often experience definite pain, even "suffering", but the majority of suffering is often the result of negative attitudes toward disabled folks' place in society. Until you can speak of people with disabilities as social equals and not "suffering" waifs in need of your paternalistic intervention, you can only help to contribute to "suffering".

Evonne, I'm sorry that you consider my use of the term "suffering from" to be paternalistic. Let's list the options: a person with this disorder could be called *schizophrenic* (a term that implies that this is who they are and ignores the reality that they are a person who has a condition, not a person who IS the condition), *mentally ill* (a term that perpetuates the old assumption of a difference between the 'physically ill' and the 'mentally ill' and thus I don't think is helpful), or *crazy*, *lunatic* etc. all of which I think we would all agree are more than paternalistic -- they are stigmatizing, but unfortunately are used regularly by the public still. When I am speaking to someone, I use their name, but when we are talking in the abstract we need a term. Sometimes I hear professionals talk about "consumers", but that is probably paternalistic as well and does not differentiate the condition we are talking about.

So, what is better? "person with schizophrenia?", "person diagnosed with schizophrenia"? Even you use the term "people with disabilities". I know this sounds sarcastic, but I really would like your input. I think we agree that much of the suffering that goes on with this disorder, or with any disability, is the result of negative attitudes, stigma, and discrimination -- but it is still suffering. One of the problems in suffering I also tend to see is that when a person is diagnosed, he/she applies social stigma *to themselves* because of how they were raised in a society full of discrimination and ignorance. This is a societal problem that we have made progress on, but still needs much more work. So, I am willing to change the terms I use -- suggest something positive instead of just criticizing.

Anstep, you are also right; the spiritual element of healing and recovery is often missed or ignored, but is very important. Thanks for making that point.

I agree completely.

They say there is chemical imbalance but they don't ever physically check chemical levels.

Psychiatrists only ask questions, then make a diagnosis. It's based purely on whim.

-Travis

Travis, I agree that the term "chemical imbalance" can be very confusing. It is mostly a political term -- it is used to make mental illnesses sound more like medical disorders than social or emotional disorders. On the "good" side (the side of families for example, and some persons who are diagnosed with these disorders), such a move is seen as reducing the stigma of the disorders while also possibly increasing funding for more research. On the "bad" side, it is inaccurate and seems to reduce a complex situation to a simplistic solution -- take drugs to fix the "chemical imbalance."

On the other hand, there is a lot of research evidence that suggests that there ARE differences in the levels of brain neurotransmitters (the so called "chemicals") between persons who show serious symptoms and those who do not. What we do NOT know is how those differences come about. This is even more complex for a disorder like schizophrenia because this is probably not a single condition, but a "family" of conditions that are similar to each other, but may have different causes or effects.

So, at this point, the best we can do is ask questions to confirm the presence of symptoms; enough symptoms suggests a syndrome and lead to a diagnosis which suggests treatment. It is not a perfect system and, as you suggest, there is room for mistakes and for bad judgment, but the questions are based on a lot of research, and so it is not just based on a whim. You can look up the diagnostic criteria for yourself online and probably can access much of the research that lead to the criteria. I encourage you to know what symptoms lead to whatever diagnosis you have -- at least that way you can have a good discussion with your doctor about your situation.

Hi, Dr. T --

I'm flattered at your sincere request for input on semantics; I hope that as a "word person" I do this concept justice. Again, thanks for taking the time to engage in this discussion.

Of course, when speaking in a particular forum about people who have been given a particular diagnosis, it is necessary to incorporate a term that specifies the population.

I do suggest "person" -- always "person". (I rather like "folks" as well, when speaking informally.) You are certainly correct when you say that people impose stigma on themselves; and I believe they do so because they fear others' reactions to their diagnosis. So yes, often folks who receive a diagnosis that carries such negative connotation (negative because of misconceptions or generalizations made about schizophrenia) will adopt the attitude of "I'm not one of THOSE people" -- and that, certainly, is insulting to people who have accepted schizophrenia (or, again, any disability) as part of themselves. But mind you, it's only part of a person -- just as, for example, being a woman, or being Jewish, or being black, or being homosexual, etc. is "part" of a person. It is not the definition of the person. This is why terms like "a schizophrenic" are abrasive.

So yes, I do suggest "person with schizophrenia". This shows that you have recognized that the person in question as a person first. (If you're seriously interested, a search of "people first language" on this site or on the entire 'net will give more insight. There are opponents of the method as well, and their arguments are often equally valid. But people-first language is generally accepted as the standard in "disability cool" usage.) To add "suffers from" is not necessary; it imposes your own evaluation onto what the person is experiencing -- and that is something you cannot evaluate because you don't know precisely what another person is experiencing.

As to "consumers", that's generally okay, since it applies to a population that encompasses people of all kinds. "Clients" is also fairly safe. The word "patient" has been making a steady decline, as it suggests to many people that they are "sick" and in need of "cure". "Victim", of course, is out of the question, for reasons I hope I do not have to detail here.

Such an involved argument of semantics may seem silly and overly sensitive, but the patterns one uses in language often reflect the patterns of one's thought. When the first term that comes to one's mind is a diagnosis or an evaluation rather than recognition of a fellow human being, one needs to check oneself.

If the concept of accepting (and even celebrating) a disability as part of oneself is still not sitting well, the Ragged Edge site is an excellent place to start. Joseph Shapiro's book, No Pity, is a beautifully written introduction to the concept of disability pride. I leave you with a parallel that may or may not go down easy: Consider the insult behind "people suffering from being female", "people suffering from blackness", "people suffering from Judaism", "people suffering from homosexuality", "people suffering from having brown eyes", et cetera, et cetera . . .

Yvonne, thanks for the comments. OK, so you are suggesting a slight, but important, change to my language use -- I will make adjustments. I shifted years ago to people-first language because I think it is important to recognize the person whoses illness is just a part of their life. Your last example is well taken.

I have no problem with accepting one's disablities or celebrating one's life as a whole regardless of one's situation. I encourage it in my clients and try to practice it in my own life. If I need to speak more broadly, perhaps I'll stick with "consumers" since clients, to me, refers to those persons whom I have a relationship with.

Thank you for your assistance.

Thank you, Dr. T. (And thanks, Ragged Edge, for hosting this extended discussion!) FYI, to all involved, I noticed that this discussion has been posted to other mental health forums and appear in Google searches under the headings of various "antipsychotic" drug names. I presume we can attribute that to Dr. T.'s attentiveness?

Thank you Dr T. for your many comments that have been exactly in line with our struggles, and yes, suffering. When someone who is bright, active, talented and brimming with potential is stricken with a psychotic break, it is devastating. Contrary to the comments of some, there has been no abuse in our family. Stress may have been a factor, but otherwise we cannot attribute this episode to anything external. Our confusion and pain at trying to work together as a family to understand and "bring back" our lost sister/daughter has been intense, but today seems to be headed in the right direction. I have to say that I do not honestly know if doing nothing versus the medication she has used would have been better, but I do know that we had to do something to get her to where she is today. Now I only wish we could find someone as knowledgable and willing to view each individual as Dr. T seems to be. Also, your mention of the stigma is so very much a part of what has slowed recovery. Unlike cancer patients or those with other illnesses, there is no sympathy,support, or opportunity to talk with friends. There is only negetive media, fear and misunderstanding. It is like AIDS once was, but has centuries of misconceptions behind it. We have found that the common belief is that of all the mental illnesses, people are most fearful of schizophrenia, as the media has portrayed it as a disease of crazed killers. Nothing could be further from what we know of our family member and her inner pain.

"A distinguished panel of 25 Michigan experts very carefully replaced the word "Texas" with the word "Michigan" in all appropriate spots."

Now that's funny.

I'm a psychiatrist, so let me say that the problem described here is slightly (but only slightly) more nuanced than here presented.

Yes, doctors are influenced-- but not by the pens, directly.

The way it works is that psychiatrists want to be scientists. They believe in the disease model of psychiatry, the entire field is invested in that idea. This is why we have algorithms for _disorders_ (not even diseases) which are very different from person to person, as opposed to symptom based treatment for each individual.

It's not that people aren't actually ill or suffering; it's that the model psychiatrists use to understand these sufferings is flawed.

Pharma is more than happy to go along with this banality, since they make the drugs. But make no mistake-- Pharma didn't create the culture, the doctors did.

The best analogy I can give you is politics. Senators don't get "bought." They have some core philosophy (however unreasoned or inconsistent)-- and then they get "influenced" by those lobbyists who best fit that pre-existing philosophy. But the problem in politics isn't that the lobbyists buy influence, but that the senators have ideas which are illogical or asinine.
Dick Cheney didn't go to war because of Halliburton; but Dick Cheney's worldview coincides with Halliburton's. (Or: the type of person who would go to war in Iraq is also the type of person who is suited to be CEO of an oil services company.)

Anyway, I have a blog if anyone cares to hear from the lone dissenter.

http://thelastpsychiatrist.com

So they try to rely on a science which doesn't exist-- is depression really related to serotonin? How?-- and which they don't understand (at no point in training do you learn where serotonin is made, etc).