Schizophrenia Patient Quotes

What would you call this patient – schizophrenic or schizoaffective?" He paused and stroked his chin, apparently in deep thought. "I think I'd call him Michael McIntyre," he replied.

What if the problem with schizophrenia patients wasn’t that they lacked the ability to respond to so much stimuli, but that they lacked the ability not to? What if their brains weren’t overloaded, but lacked inhibition—forced to reckon with everything that was coming their way, every second of every day?

In the spring of 2009, I was the 217th person ever to be diagnosed with anti-NMDA-receptor autoimmune encephalitis. Just a year later, that figure had doubled. Now the number is in the thousands. Yet Dr. Bailey, considered one of the best neurologists in the country, had never heard of it. When we live in a time when the rate of misdiagnoses has shown no improvement since the 1930s, the lesson here is that it’s important to always get a second opinion. While he may be an excellent doctor in many respects, Dr. Bailey is also, in some ways, a perfect example of what is wrong with medicine. I was just a number to him (and if he saw thirty-five patients a day, as he told me, that means I was one of a very large number). He is a by-product of a defective system that forces neurologists to spend five minutes with X number of patients a day to maintain their bottom line. It’s a bad system. Dr. Bailey is not the exception to the rule. He is the rule.

Eugen Bleuler (who in 1911 coined the word 'schizophrenia') once said that in the end his patients were stranger to him than the birds in his garden. But if they're strangers to us, what are we to them? (26)

And what science had revealed was this: Prior to treatment, patients diagnosed with schizophrenia, depression, and other psychiatric disorders do not suffer from any known "chemical imbalance". However, once a person is put on a psychiatric medication, which, in one manner or another, throws a wrench into the usual mechanics of a neuronal pathway, his or her brain begins to function, as Hyman observed, abnormally.

Your daughter has schizophrenia," I told the woman. "Oh, my God, anything but that," she replied. "Why couldn't she have leukemia or some other disease instead?" "But if she had leukemia she might die," I pointed out. "Schizophrenia is a much more treatable disease." The woman looked sadly at me, then down at the floor. She spoke softly. "I would still prefer that my daughter had leukemia.

When a schizophrenic patient sees things that others don’t see, he at least knows that his mind is playing with him. But your hallucinations, which you call reality. are being validated and strengthened by everything and everyone around you.

Insanity as an absence of common characteristics is also demonstrated by the Rorschach ink-blot test for schizophrenia. In this test, randomly formed ink splotches are shown to the patient and he is asked what he sees. If he says, 'I see a pretty lady with a flowering hat,' that is not a sign of schizophrenia. But if he says, 'All I see is an ink-blot,' he is showing signs of schizophrenia. The person who responds with the most elaborate lie gets the highest score for sanity. The person who tells the absolute truth does not. Sanity is not truth. Sanity is conformity to what is socially expected. Truth is sometimes in conformity, sometimes not.

Schizophrenia is a cruel disease. The lives of those affected are often chronicles of constricted experiences, muted emotions, missed opportunities, unfulfilled expectations. It leads to a twilight existence, a twentieth century underground man. The fate of these patients has been worsened by our propensity to misunderstand, our failure to provide adequate treatment and rehabilitation, our meager research efforts. A disease which should be found, in the phrase of T.S. Eliot, in the "frigid purgatorial fires" has become through our ignorance and neglect a living hell.

We call it hypocrisy, but it is schizophrenia, a modest ranch-house life with Draconian military adventures; a land of equal opportunity where a white culture sits upon a Black; a horizontal community of Christian love and a vertical hierarchy of churches--the cross was well-designed! a land of family, a land of illicit heat; a politics of principle, a politics of property; nation of mental hygiene with movies and TV reminiscent of a mental pigpen; patriots with a detestation of obscenity who pollute their rivers; citizens with a detestation of government control who cannot bear any situation not controlled. The list must be endless, the comic profits are finally small--the society was able to stagger on like a 400-lb. policeman walking uphill because living in such an unappreciated and obese state it did not at least have to explode in schizophrenia--life went on. Boys could go patiently to church at home and wait their turn to burn villages in Vietnam.

It was “mainly” this sort of mother, she wrote, who was responsible for the “severe early warp and rejection” that rendered a schizophrenia patient “painfully distrustful and resentful of other people.

By any objective measure, the modern business of “psychopharmacology”—the use of drugs to treat everything from anxiety and insomnia to schizophrenia itself—has to be judged a failure. Few patients, if any, are cured. The most violent manifestations of mental illness can be controlled, but with what long-term consequences, no one knows.

I am relatively certain that religious faith alone doesn't prevent hallucinations because many patients try to save themselves by their faith. Observation would suggest useful social acts (charity) would come closer to preventing schizophrenia.

Research has also revealed that women who have developed PTSD in relation to early childhood sexual abuse often develop borderline personality disorder. Some severe cases will result in the development of dissociative identity disorder or depersonalization disorder. Patients who have been exposed to protracted and repeated sexual abuse may also develop schizophrenia simultaneously with PTSD.

R. D. Laing, influenced heavily by Sartre and other existentialists, made the case in The Divided Self that schizophrenia was an act of self-preservation by a wounded soul [..] He believed patients retreat inside their own mind as a way of playing possum, to preserve their autonomy

One 2004 study showed that black men and women were four times more likely to receive a schizophrenia diagnosis than white patients in state hospitals.)

He had only smiled, condescendingly and therapeutically. "No, Leland, not you. You, and in fact quite a lot of your generation, have in some way been exiled from that particular sanctuary. It's become almost impossible for you to 'go mad' in the classical sense. At one time people conveniently 'went mad' and were never heard from again. Like a character in a romantic novel. But now"--And I think he even went so far as to yawn--"you are too hip to yourself on a psychological level. You are all too intimate with too many of the symptoms of insanity to be caught completely off your guard. Another thing: all of you have a talent for releasing frustration through clever fantasy. And you, you are the worst of the lot on that score. So... you may be neurotic as hell for the rest of your life, and miserable, maybe even do a short hitch at Bellvue and certainly good for another five years as a paying patient--but I'm afraid never completely out." He leaned back in his elegant Lounge-o-Chair. "Sorry to disappoint you but the best I can offer is plain old schizophrenia with delusional tendencies.

Ritual abuse diagnosis research – excerpt from a chapter in: Lacter, E. & Lehman, K. (2008).Guidelines to Differential Diagnosis between Schizophrenia and Ritual Abuse/Mind Control Traumatic Stress. In J.R. Noblitt & P. Perskin(Eds.), Ritual Abuse in the Twenty-first Century: Psychological, Forensic, Social and Political Considerations, pp. 85-154. Bandon, Oregon: Robert D. Reed Publishers. quotes: A second study revealed that these results were unrelated to patients’ degree of media and hospital milieu exposure to the subject of Satanic ritual abuse. “In fact, less media exposure was associated with production of more Satanic content in patients reporting ritual abuse, evidence that reports of ritual abuse are not primarily the product of exposure contagion.” Responses are consistent with the devastating and pervasive abuse these victims have experienced, so often including immediate family members.

Here was the real reason, he thought, why big pharma could afford to be fickle about finding new drugs for schizophrenia—why decades come and go without anyone even finding new drug targets. These patients, he realized, can’t advocate for themselves.

In 1979, [Richard] Wyatt's team published research showing that people with schizophrenia had more cerebrospinal fluid in their brain ventricles - the network of gaps in the tissue of the brain's limbic system, where the amygdala and hippocampus are located [..] The only problem was thet there was no way of telling whether enlarged ventricles were a cause or an effect - something patients were born with, or a condition they developed after they had the illness, maybe even as a side effect of their medication

For such a patient it would probably be a complete non sequitur to attempt to kill his self, by cutting his throat, since his self and his throat may be felt to bear only a tenuous and remote relationship to each other, sufficiently remote for what happens to the one to have little bearing on the other.

DID may be underdiagnosed. The image derived from classic textbooks of a florid, dramatic disorder with overt switching characterizes about 5% of the DID clinical population. The more typical presentation is of a covert disorder with dissociative symptoms embedded among affective, anxiety, pseudo-psychotic, dyscontrol, and self-destructive symptoms, and others (Loewenstein, 1991). The typical DID patient averages 6 to 12 years in the mental health system, receiving an average of 3 to 4 prior diagnoses. DID is often found in cases that were labeled as "treatment failures" because the patient did not respond to typical treatments for mood, anxiety, psychotic, somatoform, substance abuse, and eating disorders, among others. Rapid mood shifts (within minutes or hours), impulsivity, self-destructiveness, and/or apparent hallucinations lead to misdiagnosis of cyclic mood disorders (e.g., bipolar disorder) or psychotic disorders (e.g., schizophrenia).

They have been warehoused where nobody can really deal with them,” he said. Here was the real reason, he thought, why big pharma could afford to be fickle about finding new drugs for schizophrenia—why decades come and go without anyone even finding new drug targets. These patients, he realized, can’t advocate for themselves.

Our quick tour through the many dimensions of cognitive and emotional dysfunction makes it plain why the practice of psychiatry has changed so profoundly over the past thirty years. The familiar caricature of the bearded and monocled Freudian analyst probing his reclining patient for memories of toilet training gone awry and parentally directed lust is now an anachronism, as is the professional practice of that mostly empty and confabulatory art. How such an elaborate theory could have become so widely accepted—on the basis of no systematic evidence or critical experiments, and in the face of chronic failures of therapeutic intervention in all of the major classes of mental illness (schizophrenia, mania and depression)—is something that sociologists of science and popular culture have yet to fully explain.

We can pray over the cholera victim, or we can give her 500 milligrams of tetracycline every 12 hours. (There is still a religion, Christian Science, that denies the germ theory of disease; if prayer fails, the faithful would rather see their children die than give them antibiotics.) We can try nearly futile psychoanalytic talk therapy on the schizophrenic patient, or we can give him 300 to 500 milligrams a day of clozapine. The scientific treatments are hundreds or thousands of times more effective than the alternatives. (And even when the alternatives seem to work, we don’t actually know that they played any role: Spontaneous remissions, even of cholera and schizophrenia, can occur without prayer and without psychoanalysis.) Abandoning science means abandoning much more than air conditioning, CD players, hair dryers, and fast cars.

For nearly a hundred years, psychiatry has been striving to apply medical model thinking to psychiatric disorders. In this model, the symptoms besieging patients are sorted into specific disease entities and the causes then identified and removed. For doctors of internal medicine, this works. In the case of diabetes mellitus, for example, the symptoms of urinary frequency, fatigue, and confusion often lead to suspicion of the underlying cause, which is confirmed by blood sugar monitoring and then treated by insulin replacement. But psychiatric symptoms are much harder to sort into diagnoses. People with depression sometimes become paranoid. People with schizophrenia sometimes become depressed. Some people who hear voices have no other symptoms whatsoever, and others who hear voices also fall victim to terrible mood swings. Thus far, the hope that psychiatry would be able to identify homogeneous disease states, uncover the biological underpinnings, and remedy them has been largely a barren one. Kappler's symptoms, however, evolved when the hope for psychiatry's becoming a true medical specialty was bright to the point of being blinding. Over the years he would collect over a dozen diagnoses and cavalierly take a myriad of medicines, but no one would be able to bring him close to confronting the past he had disowned, to stand a chance of making peace with it and, ultimately, overcoming it. (46)

Esmé Weijun Wang writes in The Collected Schizophrenias about speaking to medical professionals about her experiences with schizophrenia. A doctor approached her to thank her afterward, but what she said shows how many able-bodied people don’t treat or see disabled people as human: She said that she was grateful for this reminder that her patients are human too. She starts out with such hope, she said, every time a new patient comes—and then they relapse and return, relapse and return. The clients, or patients, exhibit their illness in ways that prevent them from seeming like people who can dream, or like people who can have others dream for them. Disabled voices like Wang’s and others are needed to change the narratives around disability—to insist on disabled people’s humanity and complexity, to resist inspiration porn, to challenge the binary that says disabled bodies and lives are less important or tragic or that they have value only if they can be fixed or be cured or be made productive.

In subsequent experiences I frequently found the mothers of schizophrenic children to be extraordinarily narcissistic individuals like Mrs. X. This is not to say that such mothers are always narcissistic or that narcissistic mothers can’t raise non-schizophrenic children. Schizophrenia is an extremely complex disorder, with obvious genetic as well as environmental determinants. But one can imagine the depth of confusion in Susan’s childhood produced by her mother’s narcissism, and one can objectively see this confusion when actually observing narcissistic mothers interact with their children. On an afternoon when Mrs. X. was feeling sorry for herself Susan might have come home from school bringing some of her paintings the teacher had graded A. If she told her mother proudly how she was progressing in art, Mrs. X. might well respond: “Susan, go take a nap. You shouldn’t get yourself so exhausted over your work in school. The school system is no good anymore. They don’t care for children anymore.” On the other hand, on an afternoon when Mrs. X. was in a very cheerful mood Susan might have come home in tears over the fact that she had been bullied by several boys on the school bus, and Mrs. X. could say: “Isn’t it fortunate that Mr. Jones is such a good bus driver? He is so nice and patient with all you children and your roughhousing. I think you should be sure to give him a nice little present at Christmastime.” Since they do not perceive others as others but only as extensions of themselves, narcissistic

Mrs. Plotnick had learned from observing many patients over the years that the majority of patients felt well for the first month after they stopped taking their medication: The medication’s unpleasant side effects ceased, and their psychotic symptoms didn’t reappear, because there was a considerable amount of medication left in their systems. As a result, many patients thought they hadn’t needed the medication in the first place. During the second month off medication, many patients began to decompensate. By the third month, many were psychotic.

Bleuler chose this new word because its Latin root—schizo—implied a harsh, drastic splitting of mental functions. This turned out to be a tragically poor choice. Almost ever since, a vast swath of popular culture—from Psycho to Sybil to The Three Faces of Eve—has confused schizophrenia with the idea of split personality. That couldn’t be further off the mark. Bleuler was trying to describe a split between a patient’s exterior and interior lives—a divide between perception and reality. Schizophrenia is not about multiple personalities. It is about walling oneself off from consciousness, first slowly and then all at once, until you are no longer accessing anything that others accept as real.

Though diagnosis is unquestionably critical in treatment considerations for many severe conditions with a biological substrate (for example, schizophrenia, bipolar disorders, major affective disorders, temporal lobe epilepsy, drug toxicity, organic or brain disease from toxins, degenerative causes, or infectious agents), diagnosis is often counterproductive in the everyday psychotherapy of less severely impaired patients. Why? For one thing, psychotherapy consists of a gradual unfolding process wherein the therapist attempts to know the patient as fully as possible. A diagnosis limits vision; it diminishes ability to relate to the other as a person. Once we make a diagnosis, we tend to selectively inattend to aspects of the patient that do not fit into that particular diagnosis, and correspondingly overattend to subtle features that appear to confirm an initial diagnosis. What’s more, a diagnosis may act as a self-fulfilling prophecy. Relating to a patient as a “borderline” or a “hysteric” may serve to stimulate and perpetuate those very traits. Indeed, there is a long history of iatrogenic influence on the shape of clinical entities, including the current controversy about multiple-personality disorder and repressed memories of sexual abuse. And keep in mind, too, the low reliability of the DSM personality disorder category (the very patients often engaging in longer-term psychotherapy).

The α7 receptor, however, stood out from the crowd because of its special relationship with nicotine. No one experiences this more vividly than habitual smokers: Nicotine has a way of turbocharging the effects of the acetylcholine that this receptor needs in order to function, and smokers—or the α7 receptors in their brains—like it when their acetylcholine is turbocharged. This is the feeling cigarettes can give smokers—that way nicotine has of focusing their minds for short periods, or calming them. Could it just be a coincidence, Freedman wondered, that many schizophrenia patients—Peter Galvin among them—can’t get enough cigarettes? For very brief moments, nicotine may offer them at least some relief from their delusions. If Freedman could amplify that effect—mimic it in a lab, bottle it, and send it out to everyone diagnosed with schizophrenia—could it treat the symptoms of the illness more effectively and less harmfully than Thorazine? First, he needed more proof. In 1997, Freedman devised an experiment: He gave nicotine to people with schizophrenia, usually many pieces of Nicorette chewing gum, and then measured their brain waves with his double-click test. Sure enough, people with schizophrenia who chewed three pieces of Nicorette passed the test with flying colors. They responded to the first sound and didn’t respond to the second, just like people without schizophrenia. The effects didn’t last after the nicotine wore off, but Freedman still was stunned.

You and in fact quite a lot of your generation have in some way been exiled from that particular sanctuary its become almost impossible for you to go mad in the classical sense... You all are too intimate with too many of the symptoms of insanity to be caught completely off your guard. Another thing, all of you have a talent for releasing frustration through clever fantasy and you, you are the worst of the lot on that score. So you may be neurotic as hell for the rest of your life and miserable. Maybe even do a few years at Bell View and certainly good for another 5 years as a paying patient but I'm afraid never completely out. Sorry to disappoint you but the best I can offer you is plain ole schizophrenia with delusional tendencies.

In 1978, an activist named Judi Chamberlin published one of the movement's most revered manifestos called 'On Our Own: Patient-Controlled Alternatives to the Mental Health System.' Chamberlin had been diagnosed with a mental illness and found traditional psychiatric intervention unhelpful and even traumatic. She did recover, however, and she credited that recovery to an alternative mental health care facility she stayed at in Canada. Chamberlin and many other madness pride activists believe that people with 'lived experience' should not only have a proverbial seat at the table when it comes to the creation of mental health care systems, but that such people are uniquely equipped to understand what constitutes the best treatment. A slogan Chamberlin sought to make famous was 'Nothing about us without us.

Both individuals who are manic and those who are writers, when evaluated with neuropsychological tests, tend to combine ideas or images in a way that "blurs, broadens, or shifts conceptual boundaries," a type of thinking known as conceptual overinclusiveness. They vary in this from normal subjects and from patients with schizophrenia. Researchers at the University of Iowa, for example, have shown that "both writers and manics tend to sort in large groups, change dimensions while in the process of sorting, arbitrarily change starting points, or use vague distantly related concepts as categorizing principles." The writers are better able than the manics to maintain control over their patterns of thinking, however, and to use "controlled flights of fancy" rather than the more bizarre sorting systems used by the patients.

The case of a patient with dissociative identity disorder follows: Cindy, a 24-year-old woman, was transferred to the psychiatry service to facilitate community placement. Over the years, she had received many different diagnoses, including schizophrenia, borderline personality disorder, schizoaffective disorder, and bipolar disorder. Dissociative identity disorder was her current diagnosis. Cindy had been well until 3 years before admission, when she developed depression, "voices," multiple somatic complaints, periods of amnesia, and wrist cutting. Her family and friends considered her a pathological liar because she would do or say things that she would later deny. Chronic depression and recurrent suicidal behavior led to frequent hospitalizations. Cindy had trials of antipsychotics, antidepressants, mood stabilizers, and anxiolytics, all without benefit. Her condition continued to worsen. Cindy was a petite, neatly groomed woman who cooperated well with the treatment team. She reported having nine distinct alters that ranged in age from 2 to 48 years; two were masculine. Cindy’s main concern was her inability to control the switches among her alters, which made her feel out of control. She reported having been sexually abused by her father as a child and described visual hallucinations of him threatening her with a knife. We were unable to confirm the history of sexual abuse but thought it likely, based on what we knew of her chaotic early home life. Nursing staff observed several episodes in which Cindy switched to a troublesome alter. Her voice would change in inflection and tone, becoming childlike as ]oy, an 8-year-old alter, took control. Arrangements were made for individual psychotherapy and Cindy was discharged. At a follow-up 3 years later, Cindy still had many alters but was functioning better, had fewer switches, and lived independently. She continued to see a therapist weekly and hoped to one day integrate her many alters.

Abhed, my father had called heredity-"indivisible." There is an old trope in popular culture of the "crazy genius," a mind split between madness and brilliance, oscillating between the two states at the throw of a single switch. But Rajesh had no switch. There was no split or oscillation, no pendulum. The magic and the mania were perfectly contiguous-bordering kingdoms with no passports. They were part of the same whole, indivisible. "We of the craft are all crazy," Lord Byron, the high priest of crazies, wrote. "Some are affected by gaiety, others by melancholy, but all are more or less touched." Versions of this story have been tool, over and over, with bipolar disease, with some variants of schizophrenia, and with rare cases of autism; all are "more or less touched." It is tempting to romanticize psychotic illness, so let me emphasize that the men and women with these mental disorders experience paralyzing cognitive, social, and psychological disturbances that send gashes of devastation through their lives. But also indubitably, some patients with these syndromes possess exceptional and unusual abilities. The effervescence of bipolar disease has long been linked to extraordinary creativity; at times, the heightened creative impulse is manifest during the throes of mania.

This should have stopped the schizophrenogenic voodoo right in its tracks. High blood pressure can be lessened with a drug that blocks a receptor for a different type of neurotransmitter, and you conclude that a core problem was too much of that neurotransmitter. But schizophrenic symptoms can be lessened with a drug that blocks dopamine receptors, and you still conclude that the core problem is toxic mothering. Remarkably, that’s what psychiatry’s psychoanalytic ruling class concluded. After fighting the introduction of the medications tooth and nail in America and eventually losing, they came up with an accommodation: neuroleptics weren’t doing anything to the core problems of schizophrenia; they just sedated patients enough so that it is easier to psychodynamically make progress with them about the scars from how they were mothered. The psychoanalytic scumbags even developed a sneering, pejorative term for families (i.e., mothers) of schizophrenic patients who tried to dodge responsibility by believing that it was a brain disease: dissociative-organic types. The influential 1958 book Social Class and Mental Illness: A Community Study (John Wiley), by the Viennese psychiatrist Frederick Redlich, who chaired Yale’s psychiatry department for seventeen years, and the Yale sociologist August Hollingshead, explained it all. Dissociative-organic types were typically lower-class, less educated people, for whom “It’s a biochemical disorder” was akin to still believing in the evil eye, an easy, erroneous explanation for those not intelligent enough to understand Freud. Schizophrenia was still caused by lousy parenting, and nothing was to change in the mainstream for decades.

During the chaos of the Hundred Years’ War, when northern France was decimated by English troops and the French monarchy was in retreat, a young girl from Orléans claimed to have divine instructions to lead the French army to victory. With nothing to lose, Charles VII allowed her to command some of his troops. To everyone’s shock and wonder, she scored a series of triumphs over the English. News rapidly spread about this remarkable young girl. With each victory, her reputation began to grow, until she became a folk heroine, rallying the French around her. French troops, once on the verge of total collapse, scored decisive victories that paved the way for the coronation of the new king. However, she was betrayed and captured by the English. They realized what a threat she posed to them, since she was a potent symbol for the French and claimed guidance directly from God Himself, so they subjected her to a show trial. After an elaborate interrogation, she was found guilty of heresy and burned at the stake at the age of nineteen in 1431. In the centuries that followed, hundreds of attempts have been made to understand this remarkable teenager. Was she a prophet, a saint, or a madwoman? More recently, scientists have tried to use modern psychiatry and neuroscience to explain the lives of historical figures such as Joan of Arc. Few question her sincerity about claims of divine inspiration. But many scientists have written that she might have suffered from schizophrenia, since she heard voices. Others have disputed this fact, since the surviving records of her trial reveal a person of rational thought and speech. The English laid several theological traps for her. They asked, for example, if she was in God’s grace. If she answered yes, then she would be a heretic, since no one can know for certain if they are in God’s grace. If she said no, then she was confessing her guilt, and that she was a fraud. Either way, she would lose. In a response that stunned the audience, she answered, “If I am not, may God put me there; and if I am, may God so keep me.” The court notary, in the records, wrote, “Those who were interrogating her were stupefied.” In fact, the transcripts of her interrogation are so remarkable that George Bernard Shaw put literal translations of the court record in his play Saint Joan. More recently, another theory has emerged about this exceptional woman: perhaps she actually suffered from temporal lobe epilepsy. People who have this condition sometimes experience seizures, but some of them also experience a curious side effect that may shed some light on the structure of human beliefs. These patients suffer from “hyperreligiosity,” and can’t help thinking that there is a spirit or presence behind everything. Random events are never random, but have some deep religious significance. Some psychologists have speculated that a number of history’s prophets suffered from these temporal lobe epileptic lesions, since they were convinced they talked to God.

To record merely patients' symptoms without considering their subjective and cultural experiences should never be the basis for diagnosis.

The SCID-D may be used to assess the nature and severity of dissociative symptoms in a variety of Axis I and II psychiatric disorders, including the Anxiety Disorders (such as Posttraumatic Stress Disorder [PTSD] and Acute Stress Disorder), Affective Disorders, Psychotic Disorders, Eating Disorders, and Personality Disorders. The SCID-D was developed to reduce variability in clinical diagnostic procedures and was designed for use with psychiatric patients as well as with nonpatients (community subjects or research subjects in primary care).

After immobilizing his head with two white straps, the neuroanatomist moved a figure eight–shaped instrument toward the crest of his skull—a coil that delivered magnetic impulses to a very precise area of the encephalon, so that the targeted neurons, like micromagnets, would react and rearrange themselves. Transcranial magnetic stimulation allowed them to attenuate, even eradicate, the hallucinations related to schizophrenia. The main difficulty was, of course, to target the right spot, as the area in question measured only a few centimeters, and being off by even a millimeter could make the patient start meowing or reciting the alphabet backward for the rest of his life.

The goal of the research on my ward was to determine whether psychotherapy or medication was the best way to treat young people who had suffered a first mental breakdown diagnosed as schizophrenia. The talking cure, an offshoot of Freudian psychoanalysis, was still the primary treatment for mental illness at MMHC. However, in the early 1950s a group of French scientists had discovered a new compound, chlorpromazine (sold under the brand name Thorazine), that could “tranquilize” patients and make them less agitated and delusional. That inspired hope that drugs could be developed to treat serious mental problems such as depression, panic, anxiety, and mania, as well as to manage some of the most disturbing symptoms of schizophrenia.

The theories that patients with depression lack serotonin and that patients with schizophrenia have too much dopamine have long been refuted. The truth is just the opposite. There is no chemical imbalance to begin with, but when treating mental illness with drugs, we create a chemical imbalance.

A natural hierarchy arose in the hospital, guided by both our own sense of functionality and the level of functionality perceived by the doctors, nurses, and social workers who treated us. Depressives, who constituted most of the ward’s population, sat at the top of the chain, even if they were receiving electroconvulsive therapy. Because we were in the Yale Psychiatric Institute (now the Yale New Haven Psychiatric Hospital), many of those hospitalized were Yalies, and therefore considered bright people who’d simply wound up in bad situations. We had already proved ourselves capable of being high-functioning, and thus contained potential if only we could be steered onto the right track. In the middle of the hierarchy were those with anorexia and bipolar disorder. I was in this group, and was perhaps even ranked as highly as the depressives, because I came from Yale. The patients with schizophrenia landed at the bottom—excluded from group therapy, seen as lunatic and raving, and incapable of fitting into the requirements of normalcy.

Before addressing these specific problems, it should be noted that one concept underlies all rehabilitation efforts—hope. If the individual with schizophrenia has hope, then rehabilitation efforts are likely to succeed. If the person has no hope, these efforts are likely to fail. This was shown in a recent Swiss study of forty-six individuals with schizophrenia in which poor rehabilitation outcomes were predicted by “pessimistic outcome expectancies . . . and depressive-resigned coping strategies,” in short, “whether the patient has already given up or not.” Treatment and rehabilitation programs will succeed, therefore, only insofar as they also engender hope.

In schizophrenia, the most common reason for rehospitalization is stopping medications. Up to 50 percent of patients with schizophrenia relapse in the first year after remission (defined as having few or no symptoms), and more than 80 percent relapse by five years. People with schizophrenia who consistently take their medications, however, are less likely to need hospitalization.

Many DID patients have been misdiagnosed as schizophrenics and treated with neuroleptics.

Patients with DID or other dissociative disorders may be misdiagnosed as Schizophrenics on account of their auditory hallucinations, distrust, feelings of depersonalization, and on the MMPI (Kluft, 1987; Spiegel & Fink, 1979; Steingard & Frankel, 1985).

Undiagnosed DID patients received incorrect diagnoses of schizophrenia in 25% to 40% of cases in two large series (Putnam, 1989; Ross, 1989), while in one series 12% and in the other 16% had received electroconvulsive therapy.

Almost no one—not even the police officers who deal with it every day, not even most psychiatrists—publicly connects marijuana and crime. We all know alcohol causes violence, but somehow, we have grown to believe that marijuana does not, that centuries of experience were a myth. As a pediatrician wrote in a 2015 piece for the New York Times in which he argued that marijuana was safer for his teenage children than alcohol: “People who are high are not committing violence.” But they are. Almost unnoticed, the studies have piled up. On murderers in Pittsburgh, on psychiatric patients in Italy, on tourists in Spain, on emergency room patients in Michigan. Most weren’t even designed to look for a connection between marijuana and violence, because no one thought one existed. Yet they found it. In many cases, they have even found marijuana’s tendency to cause violence is greater than that of alcohol. A 2018 study of people with psychosis in Switzerland found that almost half of cannabis users became violent over a three-year period; their risk of violence was four times that of psychotic people who didn’t use. (Alcohol didn’t seem to increase violence in this group at all.) The effect is not confined to people with preexisting psychosis. A 2012 study of 12,000 high school students across the United States showed that those who used cannabis were more than three times as likely to become violent as those who didn’t, surpassing the risk of alcohol use. Even worse, studies of children who have died from abuse and neglect consistently show that the adults responsible for their deaths use marijuana far more frequently than alcohol or other drugs—and far, far more than the general population. Marijuana does not necessarily cause all those crimes, but the link is striking and large. We shouldn’t be surprised. The violence that drinking causes is largely predictable. Alcohol intoxicates. It disinhibits users. It escalates conflict. It turns arguments into fights, fights into assaults, assaults into murders. Marijuana is an intoxicant that can disinhibit users, too. And though it sends many people into a relaxed haze, it also frequently causes paranoia and psychosis. Sometimes those are short-term episodes in healthy people. Sometimes they are months-long spirals in people with schizophrenia or bipolar disorder. And paranoia and psychosis cause violence. The psychiatrists who treated Raina Thaiday spoke of the terror she suffered, and they weren’t exaggerating. Imagine voices no one else can hear screaming at you. Imagine fearing your food is poisoned or aliens have put a chip in your brain. When that terror becomes too much, some people with psychosis snap. But when they break, they don’t escalate in predictable ways. They take hammers to their families. They decide their friends are devils and shoot them. They push strangers in front of trains. The homeless man mumbling about God frightens us because we don’t have to be experts on mental illness and violence to know instinctively that untreated psychosis is dangerous. And finding violence and homicides connected to marijuana is all too easy.

How are psychiatric and neurological disorders different? At the moment, the most obvious difference is the symptoms that patients experience. Neurological disorders tend to produce unusual behavior, or fragmentation of behavior into component parts, such as unusual movements of a person’s head or arms, or loss of motor control. By contrast, the major psychiatric disorders are often characterized by exaggerations of everyday behavior. We all feel despondent occasionally, but this feeling is dramatically amplified in depression. We all experience euphoria when things go well, but that feeling goes into overdrive in the manic phase of bipolar disorder. Normal fear and pleasure seeking can spiral into severe anxiety states and addiction. Even certain hallucinations and delusions from schizophrenia bear some resemblance to events that occur in our dreams.

Their extended examinations of the prisoner led Hinsie and Glueck to the same conclusion. Irwin’s “fantastic delusional system” conformed completely to a personality pattern encountered “in patients whose diagnosis is unqualifiedly that of the schizophrenia-hebephrenia form. The murders were committed with the delusion that the accomplishment of this act would bring to the patient control of the universe which he had planned for so many years. Under the stress of these delusions and hallucinations, normal intellectual processes played no essential role. Therefore, Irwin at the time of the murders could not know the nature and quality of his act.” As the two eminent psychiatrists were now prepared to attest on the witness stand, Robert Irwin was “both medically and legally insane.”6

As many speakers noted, this tool wasn’t particularly well suited for assessing outcomes of a psychiatric drug. How could a study of a neuroleptic possibly be “double-blind”? The psychiatrist would quickly see who was on the drug and who was not, and any patient given Thorazine would know he was on a medication as well. Then there was the problem of diagnosis: How would a researcher know if the patients randomized into a trial really had “schizophrenia”? The diagnostic boundaries of mental disorders were forever changing. Equally problematic, what defined a “good outcome”? Psychiatrists and hospital staff might want to see drug-induced behavioral changes that made the patient “more socially acceptable” but weren’t to the “ultimate benefit of the patient,” said one conference speaker.11 And how could outcomes be measured? In a study of a drug for a known disease, mortality rates or laboratory results could serve as objective measures of whether a treatment worked. For instance, to test whether a drug for tuberculosis was effective, an X-ray of the lung could show whether the bacillus that caused the disease was gone. What would be the measurable endpoint in a trial of a drug for schizophrenia? The problem, said NIMH physician Edward Evarts at the conference, was that “the goals of therapy in schizophrenia, short of getting the patient ‘well,’ have not been clearly defined.

It is extremely rare for mental health workers to be killed by patients. It happens about once a year in this country. In most instances, the victims have been young female caseworkers. The homicides most frequently occurred while the victims were visiting residential treatment facilities. And the most likely perpetrators were males with schizophrenia.

The Age of Schizophrenia” (an essay bemoaning the ever-growing numbers of patients with that specific diagnosis, a widely discussed trend in the late 1930s) and “But Is the World Going Mad?” (an essay arguing that the ever-growing number of patients in mental hospitals was not cause for alarm, but rather proof of psychiatry’s progress in identifying and treating mental illness), I come away with a strong feeling that Mom’s worries about mental illness in her own family would have centered around two popular notions from that era:

He is an abnormal person and a schizophrenia patient, even a criminal and filthy-minded. I neither know his background nor he is my friend; however, I let him come since it is my nature not to humiliate and hurt; conversely, such ones caused me gravely damaged. I cannot believe if someone who claims to be the holder of a high IQ and also has a high status in society, which I always considered and thought of as one of the criminal groups. It is a surprise for me that a son of a bitch still misuses someone, telling me every time strange stories, and previously he talked about it ugly things. He also caused the worst image of Intelligence agencies, pretending as if he worked for them. I have never seen such shameless and morally dead people. I request that someone who exists as that who demonstrated for the last six years should come out to prove its reality; otherwise, disappear if it respects humanity and moral values.

Several studies report impairment in reasoning accuracy as a consequence of lesions in the left hemisphere,237 but others report impairments in reasoning following right hemisphere damage that are in reality more of a handicap. That’s because they involve not just hypothetical logical problems, but inferring complex and ambivalent or implicit meaning, inferring what is going on in another person’s mind and knowing how to understand the situation as a whole. As I have repeatedly emphasised, the old dichotomy – left hemisphere rational, right hemisphere emotional – is profoundly mistaken, on both counts; not to mention the fact that reason and emotion are never entirely separable. Knowing the limits to reason is essential to understanding. If not coupled with contextual, implicit and intuitive understanding (in none of which the left hemisphere excels), it can magnify error. As Sass and Pienkos point out: ‘The most deluded patients with schizophrenia tend to be those whose thinking is more logical.’238 This is in line with Eugène Minkowski’s insight that the problem in psychosis is not loss of reason, but its hypertrophy: ‘The mad person is much less frequently “irrational” than is believed: perhaps, indeed, he is never irrational at all.

When someone is diagnosed with depression, you won’t hear them say, “I am depression.” This is equally unlikely with a patient diagnosed with anorexia or bipolar disorder or even schizophrenia. A rare few psychiatric conditions enjoy the pleasure of being both an adjective describing one’s mood or classification of behaviors and a noun—a label—to encompass all of who one is. Alcoholics. Addicts. And borderlines. Unfortunately for me, I identify with all of these conditions.

The catastrophic outcome of deinstitutionalization, which displaced hundreds of thousands of mentally ill and disabled patients from state hospitals to the streets, nursing homes, and prisons (largely for petty, nonviolent crimes), had provoked stinging critiques of the government agencies responsible—particularly the Alcohol Drug Abuse Mental Health Administration (ADAMHA), the NIMH, and the Substance Abuse and Mental Health Services Administration (SAMHSA)—for failing to provide the community mental health care services needed to support the deinstitutionalized patients.

No.” Dr. Beck frowns. “He’s not ‘a schizophrenic.’ We don’t refer to patients that way. Miguel is a human being, and he’s more than his psychiatric diagnosis. He is not a schizophrenic—he’s a man who has schizophrenia. Do you understand that?

At autopsy, the brains of twenty schizophrenics had 70 percent more D2 receptors than normal. At first glance, it seemed that the cause of schizophrenia had been found, but Seeman cautioned that all of the patients had been on neuroleptics prior to their deaths. “Although these results are apparently compatible with the dopamine hypothesis of schizophrenia in general,” he wrote, the increase in D2 receptors might “have resulted from the long-term administration of neuroleptics.”20 A variety of studies quickly proved that the drugs were indeed the culprit. When rats were fed neuroleptics, their D2 receptors quickly increased in number.21 If rats were given a drug that blocked D1 receptors, that receptor subtype increased in density.22 In each instance, the increase was evidence of the brain trying to compensate for the drug’s blocking of its signals. Then, in 1982, Angus MacKay and his British colleagues reported that when they examined brain tissue from forty-eight deceased schizophrenics, “the increases in [D2] receptors were seen only in patients in whom neuroleptic medication had been maintained until the time of death, indicating that they were entirely iatrogenic [drug-caused].”23 A few years later, German investigators reported the same results from their autopsy studies.24 Finally, investigators in France, Sweden, and Finland used positron emission topography to study D2-receptor densities in living patients who had never been exposed to neuroleptics, and all reported “no significant differences” between the schizophrenics and “normal controls.

Prior to treatment, patients diagnosed with schizophrenia, depression, and other psychiatric disorders do not suffer from any known “chemical imbalance.” However, once a person is put on a psychiatric medication, which, in one manner or another, throws a wrench into the usual mechanics of a neuronal pathway, his or her brain begins to function, as Hyman observed, abnormally.

Over the next couple of years, Cole and the rest of psychiatry settled on a trial design for testing psychotropic drugs. Psychiatrists and nurses would use “rating scales” to measure numerically the characteristic symptoms of the disease that was to be studied. Did a drug for schizophrenia reduce the patient’s “anxiety”? His or her “grandiosity”? “Hostility”? “Suspiciousness”? “Unusual thought content”? “Uncooperativeness”? The severity of all of those symptoms would be measured on a numerical scale and a total “symptom” score tabulated, and a drug would be deemed effective if it reduced the total score significantly more than a placebo did within a six-week period. At least in theory, psychiatry now had a way to conduct trials of psychiatric drugs that would produce an “objective” result. Yet the adoption of this assessment put psychiatry on a very particular path: The field would now see short-term reduction of symptoms as evidence of a drug’s efficacy. Much as a physician in internal medicine would prescribe an antibiotic for a bacterial infection, a psychiatrist would prescribe a pill that knocked down a “target symptom” of a “discrete disease.” The six-week “clinical trial” would prove that this was the right thing to do. However, this tool wouldn’t provide any insight into how patients were faring over the long term. Were they able to work? Were they enjoying life? Did they have friends? Were they getting married? None of those questions would be answered. This was the moment that magic-bullet medicine shaped psychiatry’s future. The use of the clinical trial would cause psychiatrists to see their therapies through a very particular prism, and even at the 1956 conference, New York State Psychiatric Institute researcher Joseph Zubin warned that when it came to evaluating a therapy for a psychiatric disorder, a six-week study induced a kind of scientific myopia. “It would be foolhardy to claim a definite advantage for a specified therapy without a two- to five-year follow-up,” he said. “A two-year follow-up would seem to be the very minimum for the long-term effects.

In those early days at the VA, we labeled our veterans with all sorts of diagnoses—alcoholism, substance abuse, depression, mood disorder, even schizophrenia—and we tried every treatment in our textbooks. But for all our efforts it became clear that we were actually accomplishing very little. The powerful drugs we prescribed often left the men in such a fog that they could barely function. When we encouraged them to talk about the precise details of a traumatic event, we often inadvertently triggered a full-blown flashback, rather than helping them resolve the issue. Many of them dropped out of treatment because we were not only failing to help but also sometimes making things worse. A turning point arrived in 1980, when a group of Vietnam veterans, aided by the New York psychoanalysts Chaim Shatan and Robert J. Lifton, successfully lobbied the American Psychiatric Association to create a new diagnosis: posttraumatic stress disorder (PTSD), which described a cluster of symptoms that was common, to a greater or lesser extent, to all of our veterans. Systematically identifying the symptoms and grouping them together into a disorder finally gave a name to the suffering of people who were overwhelmed by horror and helplessness. With the conceptual framework of PTSD in place, the stage was set for a radical change in our understanding of our patients. This eventually led to an explosion of research and attempts at finding effective treatments

Carl Jung, in addition to being a practicing psychiatrist, was one of the foremost experts on the study of religious and mythological symbology. It was work in both these fields that led him to the discovery of the archetypes. In studying the myths and religions of cultures past and present Jung noticed that many of them shared similar patterns, themes, and symbols. This was interesting in its own right, but what further piqued Jung’s curiosity was that some of these same themes and symbols arose in the dreams and fantasies of patients who suffered from schizophrenia. What could account for such similarities?

All drugs have a risk-benefit profile, and the usual thought within medicine is that a drug should provide a benefit that outweighs the risks. A drug that curbs psychotic symptoms clearly provides a marked benefit, and that was why antipsychotics could be viewed as helpful even though the list of negatives with these drugs was a long one. Thorazine and other first-generation neuroleptics caused Parkinsonian symptoms and extraordinarily painful muscle spasms. Patients regularly complained that the drugs turned them into emotional “zombies.” In 1972, researchers concluded that neuroleptics “impaired learning.”30 Others reported that even if medicated patients stayed out of the hospital, they seemed totally unmotivated and socially disengaged. Many lived in “virtual solitude” in group homes, spending most of the time “staring vacantly at television,” wrote one investigator.31 None of this told of medicated schizophrenia patients faring well, and here was the quandary that psychiatry now faced: If the drugs increased relapse rates over the long term, then where was the benefit? This question was made all the more pressing by the fact that many patients maintained on the drugs were developing tardive dyskinesia (TD), a gross motor dysfunction that remained even after the drugs were withdrawn, evidence of permanent brain damage. All of this required psychiatry to recalculate the risks and benefits of antipsychotics, and in 1977 Jonathan Cole did so in an article provocatively titled “Is the Cure Worse Than the Disease?” He reviewed all of the long-term harm the drugs could cause and observed that studies had shown that at least 50 percent of all schizophrenia patients could fare well without the drugs. There was only one moral thing for psychiatry to do: “Every schizophrenic outpatient maintained on antipsychotic medication should have the benefit of an adequate trial without drugs.” This, he explained, would save many “from the dangers of tardive dyskinesia as well as the financial and social burdens of prolonged drug therapy.”32

Near-Psychotic Symptoms in Obsessive-Compulsive Disorder Despite clear-cut differences in psychopathology between schizophrenia and OCD, there is a substantial overlap, a “gray zone,” between the two disorders. Thus, unusual and “bizarre” obsessive themes exhibited by a subgroup of otherwise typical OCD patients might complicate the distinction between the obsessions and delusions. The difference between OCD-related pathologic slowness and the restrictive motor output associated with negative symptoms of schizophrenia or with catatonic motor disturbances is not straightforward. The differential diagnosis between OCD-related indecisiveness and pathologic doubt and schizophrenic ambivalence is also challenging. Patient insight into the senseless nature of OC symptoms is one of the hallmarks of the disorder. According to the DSM-5, at some point in the course of the illness, the patients must recognize that their obsessive beliefs are “definitely or probably not true.” Indeed, in typical OCD cases, patients readily acknowledge that their OC symptoms are illogical and pathologic. On the other hand, a significant majority of schizophrenia patients either do not believe that they are ill, or even if they do acknowledge symptoms, they misattribute them to other causes.6 Nevertheless, a significant subset of OCD patients can sometimes present without insight, or with conviction that their obsessions are true, thus complicating the differential diagnosis of obsessions from delusions. Overall, from the psychopathologic perspective, schizophrenia and OCD are distinct, despite their partially overlapping characteristics. Some symptoms, such as delusions and obsessions, pathologic doubt and ambivalence, rituals and motor stereotypy, may represent a continuum of OCD impairments, while others, such as negative and disorganized symptoms, are more schizophrenia-specific (Fig 3.1).

But for all of its blunt force, electroshock therapy did seem to offer relief to many patients. It appeared to alleviate intense depression and to soothe people who were experiencing psychotic episodes; it might not have been a cure for schizophrenia, but it could often mitigate the symptoms.

In the past 100 years there have been a number of different terms for autism and its manners of presentation. It was in 1908 that the word “autism” was first used by Swiss psychiatrist Eugen Bleuler to describe self-absorbed patients with schizophrenia. Dr. Leo Kanner referred to some of his patients as being “autistic” in 1943. Hans Asperger in 1944 was labeling some of his patients as autistic psychopaths. For a while, autistic patients were said to be suffering “Kanner's syndrome” and others who were affected somewhat differently were said to be afflicted with Asperger syndrome.

has been suggested that the average age at which women develop schizophrenia symptoms is later than the average age for men because the female hormone oestrogen confers protection against psychosis (apparently, oestrogen shares some of the pharmacological properties of the neuroleptics, the class of drugs most widely used in the treatment of psychotic patients).9

In 1935, Ladislas Joseph Meduna, a Hungarian researcher, invented Metrazol shock therapy. Metrazol caused seizures, and Meduna believed that seizures could treat schizophrenia. He claimed that after treating a patient with catatonic schizophrenia who had been lying in bed for four years, the man got up, dressed himself, put on his hat, and walked out of the hospital. Meduna treated ten more patients, supposedly with the same result.

This hypothesis, referred to as the monoamine hypothesis, grew primarily out of two main observations made in the 1950s and ’60s.14 One was seen in patients being treated for tuberculosis who experienced mood-related side effects from the antitubercular drug iproniazid, which can change the levels of serotonin in the brain. Another was the claim that reserpine, a medication introduced for seizures and high blood pressure, depleted these chemicals and caused depression—that is, until there was a fifty-four person study that demonstrated that it resolved depression.15 From these preliminary and largely inconsistent observations a theory was born, crystallized by the work and writings of the late Dr. Joseph Schildkraut, who threw fairy dust into the field in 1965 with his speculative manifesto “The Catecholamine Hypothesis of Affective Disorders.”16 Dr. Schildkraut was a prominent psychiatrist at Harvard who studied catecholamines, a class of naturally occurring compounds that act as chemical messengers, or neurotransmitters, within the brain. He looked at one neurochemical in particular, norepinephrine, in people before and during treatment with antidepressants and found that depression suppressed its effectiveness as a chemical messenger. Based on his findings, he theorized broadly about the biochemical underpinnings of mental illnesses. In a field struggling to establish legitimacy (beyond the therapeutic lobotomy!), psychiatry was desperate for a rebranding, and the pharmaceutical industry was all too happy to partner in the effort. This idea that these medications correct an imbalance that has something to do with a brain chemical has been so universally accepted that no one bothers to question it or even research it using modern rigors of science. According to Dr. Joanna Moncrieff, we have been led to believe that these medications have disease-based effects—that they’re actually fixing, curing, correcting a real disease in human physiology. Six decades of study, however, have revealed conflicting, confusing, and inconclusive data.17 That’s right: there has never been a human study that successfully links low serotonin levels and depression. Imaging studies, blood and urine tests, postmortem suicide assessments, and even animal research have never validated the link between neurotransmitter levels and depression.18 In other words, the serotonin theory of depression is a total myth that has been unjustly supported by the manipulation of data. Much to the contrary, high serotonin levels have been linked to a range of problems, including schizophrenia and autism.19 Paul Andrews, an assistant professor

Though nearly all the statements a psychiatric patient can make are not believed, proclamations of insanity are the exception to the rule.