Schizophrenia Symptoms Quotes

He's like several different people in one body. Isn't that a symptom of schizophrenia? I must Google that.

There's an old, frequently-used definition of insanity, which is "performing the same action over and over, expecting different results."... Now, I'm no doctor, but I am on TV. And in my professional opinion, George Bush is a paranoid schizophrenic. ... ...Other symptoms of paranoid schizophrenia are: Do you see things that aren't there? Such as a link between 9/11 and Iraq? Do you - do you feel things that you shouldn't be feeling, like a sense of accomplishment? Do you have trouble organizing words into a coherent sentence? Do you hear voices that aren't really there? Like, oh, I don't know, your imaginary friend, Jesus? Telling you to start a war in the Middle East. Well, guess what? There are a large number of people out there also suffering from the same delusions, because there are Republicans, there are conservatives, and then there are the Bushies. This is the 29 percent of Americans who still think he's doing "a heck of a job, Whitey." And I don't believe that it's coincidence that almost the same number of Americans - 25 percent - told a recent pollster that they believe that this year - this year, 2007 - would bring the Second Coming of Christ! I have a hunch these are the same people. Because, if you think that you're going to meet Jesus before they cancel "Ugly Betty," then you're used to doing things by faith. And if you have so much blind faith that you think this war is winnable, you're nuts and you shouldn't be allowed near a voting booth.

Chronic trauma (according to the meaning I propose) that occurs early in life has profound effects on personality development and can lead to the development of dissociative identity disorder (DID), other dissociative disorders, personality disorders, psychotic thinking, and a host of symptoms such as anxiety, depression, eating disorders, and substance abuse. In my view, DID is simply an extreme version of the dissociative structure of the psyche that characterizes us all.

The National Institute of Mental Health spends only $4.3 million on fetal prevention research, all of it for studies in mice, from its yearly $1.4 billion budget,” Freedman noted recently. “Yet half of young school shooters have symptoms of developing schizophrenia.

After all, it is easy to forget that psychiatric diagnoses are human constructs, and not handed down from an all-knowing God on stone tablets; to “have schizophrenia” is to fit an assemblage of symptoms, which are listed in a purple book made by humans.

Dissociative symptoms—primarily depersonalization and derealization—are elements in other DSM-IV disorders, including schizophrenia and borderline personality disorder, and in the neurologic syndrome of temporal lobe epilepsy, also called complex partial seizures. In this latter disorder, there are often florid symptoms of depersonalization and realization, but most amnesia symptoms derive from difficulties with focused attention rather than forgetting previously learned information.

Sadly, psychiatric training still includes far too little on the very serious psychiatric sequelae of childhood trauma, especially CSA [child sexual abuse]. There is inadequate recognition within mental health services of the prevalence and importance of Dissociative Disorders, sufferers of which are frequently misdiagnosed as Borderline Personality Disorder (BPD), or, in the cases of DID, schizophrenia. This is to some extent understandable as some of the features of DID appear superficially to mimic those of schizophrenia and/or Borderline Personality Disorder.

Although it is important to be able to recognise and disclose symptom of physical illnesses or injury, you need to be more careful about revealing psychiatric symptoms. Unless you know that your doctor understands trauma symptoms, including dissociation, you are wise not to reveal too much. Too many medical professionals, including psychiatrists, believe that hearing voices is a sign of schizophrenia, that mood swings mean bipolar disorder which has to be medicated, and that depression requires electro-convulsive therapy if medication does not relieve it sufficiently. The “medical model” simply does not work for dissociation, and many treatments can do more harm than good... You do not have to tell someone everything just because he is she is a doctor. However, if you have a therapist, even a psychiatrist, who does understand, you need to encourage your parts to be honest with that person. Then you can get appropriate help.

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.

He’s like several different people in one body. Isn’t that a symptom of schizophrenia?

Yet half of young school shooters have symptoms of developing schizophrenia.

psychiatrists can, given that their job is to ameliorate symptoms and the suffering that accompanies them, rather than to find, diagnose, and study spotless instances of any given disorder.

In 2010, the psychiatrist Thomas Insel, then director of NIMH, called for the research community to redefine schizophrenia as “a collection of neurodevelopmental disorders,” not one single disease. The end of schizophrenia as a monolithic diagnosis could mean the beginning of the end of the stigma surrounding the condition. What if schizophrenia wasn’t a disease at all, but a symptom? “The metaphor I use is that years ago, clinicians used to look at ‘fever’ as one disease,” said John McGrath, an epidemiologist with Australia’s Queensland Centre for Mental Health Research and one of the world’s authorities on quantifying populations of mentally ill people. “Then they split it into different types of fevers. And then they realized it’s just a nonspecific reaction to various illnesses. Psychosis is just what the brain does when it’s not working very well.

Most of the time, I could stuff down the despair far enough that I continued to—pointlessly, in my mind—brush my teeth, sometimes wash my hair in the sink, and report my symptoms to the phantom who claimed to be my doctor.

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).

As but one example, the title of this book comes from a 1968 article that appeared in the prestigious Archives of General Psychiatry, in which psychiatrists Walter Bromberg and Frank Simon described schizophrenia as a “protest psychosis” whereby black men developed “hostile and aggressive feelings” and “delusional anti-whiteness” after listening to the words of Malcolm X, joining the Black Muslims, or aligning with groups that preached militant resistance to white society. According to the authors, the men required psychiatric treatment because their symptoms threatened not only their own sanity, but the social order of white America. Bromberg and Simon argued that black men who “espoused African or Islamic” ideologies, adopted “Islamic names” that were changed in such a way so as to deny “the previous Anglicization of their names” in fact demonstrated a “delusional anti-whiteness” that manifest as “paranoid projections of the Negroes to the Caucasian group.”10

Grigorenko was deprived of his rank, his pension and his Party membership and confined for fifteen months, eight of them in psychushka where he was diagnosed as suffering from 'sluggish schizophrenia', a conceptual concoction of the Soviet psychiatrist Andrei V. Snezhnevsky, who has enlarged the definition of schizophrenia by including the mildest of neuroses. Snezhnevsky's neuroses manifested themselves in such symptoms as social withdrawal, confrontations with authorities, philosophical concerns and the desire to reform society.

Forgiveness, as it turns out, is not a linear prospect. Neither is healing; both flare up and die down. So do my symptoms of schizoaffective disorder. I have tried to control these "oscillations" as my psychiatrist calls them. But what, if anything, can truly be controlled?

Why would Westerners interpret victories of war by Sun Tzu as signs of strength and wisdom, but victories of war by Bible believers as signs of barbarism and ignorance? This cognitive dissonance is either a symptom of religious bigotry or a form of "worldview schizophrenia".

Schizophrenia and bi-polar disorder are often spoken of by laypeople – I used to do it myself – as if they were definitions as precise as those for hepatitis or appendicitis. In reality, the names are no more than those given to a collection of symptoms observable at a certain moment in time.

I walk down the aisle, keeping my head down. Sit across from a very old woman in a windbreaker who at first looks to me a little like my dead grandmother, at least in the face. I’m comforted. There is my grandmother sort of. Wearing the clothes of a slightly insane person. Tattoo on her throat of a spider in a web. Reading a ripped-up medical poster about schizophrenia aloud. SCHIZOPHRENIA: Do You Have the Symptoms?? She reads each symptom on the list, going, “Oh I have that, oh I have that.” Making sounds of delighted surprise. Like it’s a recipe she’s reading and she’s tickled to discover that— “—​she already has all the ingredients in her fridge. No need to go shopping.

For Freedman, prevention is more than just good medicine; it’s common sense. Billions of dollars are spent each year on developing drugs to treat the symptoms of mental illness after it already manifests. What if some of that money were spent on prevention, not just in the womb but in childhood? Think of all the young people who develop mental illness out of sight of anyone who can help them. What if some of those breakdowns—even suicides—could be prevented, by shoring up the mind’s vulnerability before things get worse? “The National Institute of Mental Health spends only $4.3 million on fetal prevention research, all of it for studies in mice, from its yearly $1.4 billion budget,” Freedman noted recently. “Yet half of young school shooters have symptoms of developing schizophrenia.

Medicine is an inexact science, but psychiatry is particularly so. There is no blood test, no genetic marker to determine beyond a shadow of a doubt that someone is schizophrenic, and schizophrenia itself is nothing more or less than a constellation of symptoms that have frequently been observed as occurring in tandem. Observing patterns and giving them names is helpful mostly if those patterns can speak to a common cause or, better yet, a common treatment or cure.

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)

Tranquilizers have little or no effect on the “negative” symptoms of schizophrenia—withdrawal, flattening of affect, etc.—which, in their insidious, chronic way, can be more debilitating, more undermining of life, than any positive symptoms. It is a question of not just medication but the whole business of living a meaningful and enjoyable life—with support systems, community, self-respect, and being respected by others—which has to be addressed. Michael’s problems were not purely “medical.” —

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.

Despite the growing clinical and research interest in dissociative symptoms and disorders, it is also true that the substantial prevalence rates for dissociative disorders are still disproportional to the number of studies addressing these conditions. For example, schizophrenia has a reported rate of 0.55% to 1% of the normal population (Goldner, Hus, Waraich, & Somers, more or less similar to the prevalence of DID. Yet a PubMed search generated 25,421 papers on research related to schizophrenia, whereas only 73 publications were found for DID-related research.

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.

Delusions Dissociative disorders, even those created by mind controllers, are not psychosis, but this program will create the most common symptom used to diagnose schizophrenia. The child is hurt while on a turntable, with people and television sets and cartoons and photographs all around the turntable. New alters created by the torture are instructed that they must obey their instructions and become the people around them, people on television, or other alters when they are told to. When this program is triggered, the survivor will hear “voices” of the people whom the "copy alters” are imitating, or will have many confused alters popping out who think they are actually other people or movie stars. The identities of the copy alters change when the survivor's surrounding change.

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.

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.

Specifically, damage to the left hemisphere can free up the creative capabilities of the right hemisphere. More generally, when one neural circuit in the brain is turned off, another circuit, which was inhibited by the inactivated circuit, may turn on. Scientists have also uncovered some surprising links between disorders that appear to be unrelated because they are characterized by dramatically different kinds of behavior. Several disorders of movement and of memory, such as Parkinson’s disease and Alzheimer’s disease, result from misfolded proteins. The symptoms of these disorders vary widely because the particular proteins affected and the functions for which they are responsible differ. Similarly, both autism and schizophrenia involve synaptic pruning, the removal of excess dendrites on neurons. In autism, not enough dendrites are pruned, whereas in schizophrenia too many are.

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.

If two people with no symptoms in common can both receive the same diagnosis of schizophrenia, then what is the value of that label in describing their symptoms, deciding their treatment, or predicting their outcome, and would it not be more useful simply to describe their problems as they actually are? And if schizophrenia does not exist in nature, then how can researchers possibly find its cause or correlates? If psychiatric research has made so little progress in recent decades, it is in large part because everyone has been barking up the wrong tree. It is not a question of getting a bigger and better scanner, but of going right back to the drawing board. What’s more, medical-type labels can be as harmful as they are hollow. By reducing rich, varied, and complex human experiences to nothing more than a mental disorder, they not only sideline and trivialize those experiences but also imply an underlying defect that then serves as a pseudo-explanation for the person’s disturbed behaviour. This demeans and disempowers the person, who is deterred from identifying and addressing the important life problems that underlie his distress.

We can all be "sad" or "blue" at times in our lives. We have all seen movies about the madman and his crime spree, with the underlying cause of mental illness. We sometimes even make jokes about people being crazy or nuts, even though we know that we shouldn't. We have all had some exposure to mental illness, but do we really understand it or know what it is? Many of our preconceptions are incorrect. A mental illness can be defined as a health condition that changes a person's thinking, feelings, or behavior (or all three) and that causes the person distress and difficulty in functioning. As with many diseases, mental illness is severe in some cases and mild in others. Individuals who have a mental illness don't necessarily look like they are sick, especially if their illness is mild. Other individuals may show more explicit symptoms such as confusion, agitation, or withdrawal. There are many different mental illnesses, including depression, schizophrenia, attention deficit hyperactivity disorder (ADHD), autism, and obsessive-compulsive disorder. Each illness alters a person's thoughts, feelings, and/or behaviors in distinct ways. But in all this struggles, Consummo Plus has proven to be the most effective herbal way of treating mental illness no matter the root cause. The treatment will be in three stages. First is activating detoxification, which includes flushing any insoluble toxins from the body. The medicine and the supplement then proceed to activate all cells in the body, it receives signals from the brain and goes to repair very damaged cells, tissues, or organs of the body wherever such is found. The second treatment comes in liquid form, tackles the psychological aspect including hallucination, paranoia, hearing voices, depression, fear, persecutory delusion, or religious delusion. The supplement also tackles the Behavioral, Mood, and Cognitive aspects including aggression or anger, thought disorder, self-harm, or lack of restraint, anxiety, apathy, fatigue, feeling detached, false belief of superiority or inferiority, and amnesia. The third treatment is called mental restorer, and this consists of the spiritual brain restorer, a system of healing which “assumes the presence of a supernatural power to restore the natural brain order. With this approach, you will get back your loving boyfriend and he will live a better and fulfilled life, like realize his full potential, work productively, make a meaningful contribution to his community, and handle all the stress that comes with life. It will give him a new lease of life, a new strength, and new vigor. The Healing & Recovery process is Gradual, Comprehensive, Holistic, and very Effective. www . curetoschizophrenia . blogspot . com E-mail: rodwenhill@gmail. com

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.

Whatever else it impressed on the culture, Huxley's experience left no doubt in his mind or Osmond's that the 'model psychosis' didn't begin to describe the mind on mescaline. 'It will give that elixir a bad name if it continues to be associated, in the public mind, with schizophrenia symptoms," Huxley wrote to Osmond in 1955. 'People will think they are going mad, when in fact they are beginning, when they take it, to go sane.

One of the most studied ideas as to what causes schizophrenia is the 'chemical imbalance theory,' which derives psychiatric pharmaceuticals themselves. Though the 'mechanism of action' of drugs marketed for their 'antipsychotic' properties isn't understood--plainly, drug companies believe these drugs are effective in lessening psychiatric symptoms, but they don't actually know why--what is known is that they affect chemical levels in the brain. It's therefore supposed that abnormal chemical levels might somehow be crucial to understanding what's different about the brains of people diagnosed with schizophrenia. Testing chemical levels inside brains remains impossible. Despite billions of dollars of investigation, the chemical imbalance theory has never been confirmed.

Many coders were young and coming out of the already antiauthoritarian counterculture of the ’60s. When you put these kids in charge of important machines that their managers didn’t understand, it was a recipe for insolence—or, as Brandon noted, employees who were “excessively independent.” The average programmer, Brandon continued, was “often egocentric, slightly neurotic, and he borders upon a limited schizophrenia. The incidence of beards, sandals, and other symptoms of rugged individualism or nonconformity are notably greater among this demographic group.

Those individuals who developed schizophrenia had an abnormal pattern of brain maturation that was associated with synaptic pruning, especially in the frontal lobe regions where rational, logical thoughts are controlled—the inability to do so being a major symptom of schizophrenia. In a separate series of studies, we have also observed that in young individuals who are at high risk of developing schizophrenia, and in teenagers and young adults with schizophrenia, there is a two- to threefold reduction in deep NREM sleep.

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.

Traffickers, meanwhile, had discovered a way to make methamphetamine in harrowing new amounts. While I was on the road, their meth reached all corners of the country and became the fourth stage of the drug-addiction crisis. Opiate addicts began to switch to meth, or use both together. This made no sense in the traditional drug world. One was a depressant, the other a stimulant. But it was as if their brains were primed for any drug. This stage did not involve mass deaths. Rather, the new meth gnawed at brains in frightening ways. Suddenly users displayed symptoms of schizophrenia—paranoia, hallucinations. The spread of this meth provoked homelessness across the country. Homeless encampments of meth users appeared in rural towns—“They’re almost like villages,” one Indiana counselor said. In the West, large tent encampments formed, populated by people made frantic by unseen demons in Skid Row in Los Angeles, Sunnyslope in Phoenix, the tunnels in Las Vegas. This methamphetamine, meanwhile, prompted strange obsessions—with bicycles, with flashlights, and with hoarding junk. In each of these places, it seemed mental illness was the problem. It was, but so much of it was induced by the new meth.

For several months, about all I did was talk to addicts, counselors, and cops around the country—over the phone because the pandemic restricted travel. Meth was overshadowed by the opioid epidemic. But the people I spoke to told me stories nearly identical to Eric’s. This new meth itself was quickly, intensely damaging people’s brains. The symptoms were always the same—violent paranoia, hallucinations, figures always lurking in the shadows, isolation, rotted and abscessed dental work, uncontrollable limbs, massive memory loss, jumbled speech, and, almost always, homelessness. It was creating a swath of people nationwide who, while on meth and for a good period afterward, were mentally ill and all but untreatable by usual methods of drug rehabilitation. Ephedrine-made meth wasn’t good for the brain, but it was nothing like this. Schizophrenia and bipolar disorder are afflictions that begin in the young. Now people in their thirties and forties were going mad. The new meth was also deadly in a way ephedrine meth was not. It was killing young people with congestive heart failure, a disease common to people over sixty-five.

Sarah Skoterro, in Albuquerque, a veteran of thirty years as a drug counselor, remembered the meth years ago was a party drug. Then, she said, “around 2009, 2010, there was a real shift—a new kind of product. I would do assessments with people struggling for five years with meth who would say ‘This kind of meth is a very different thing.’ ” Skoterro watched people with families, houses, and good-paying jobs quickly lose everything. “They’re out of their house, lost their relationship, their job, they’re walking around at three in the morning, at a bus stop, blisters on their feet. They are a completely different person.” As I talked with people across the country, it occurred to me that P2P meth that created delusional, paranoid, erratic people living on the street must have some effect on police shootings. Police shootings were all over the news by then and a focus of national attention. Albuquerque police, it turns out, had studied meth’s connection to officer-involved fatal shootings, in which blood samples of the deceased could be taken. For years, the city’s meth supply was locally made, in houses, in small quantities. When P2P meth began to arrive in 2009, those meth houses faded. Since 2011, Mexican crystal meth has owned the market with quantities that drove the price from $14,000 per pound down to $2,200 at its lowest. City emergency rooms and the police Crisis Intervention Team, which handles mental illness calls, have been inundated ever since with people with symptoms of schizophrenia, often meth-induced, said Lt. Matt Dietzel, a CIT supervisor. “Meth is so much more common now,” Dietzel told me. “We’re seeing the worst outcomes more often.” In

Thus did African American men at Ionia [Hospital] develop schizophrenia, not because of changes in their clinical presentations, but because of changes in the connections between their clinical presentations and larger, national conversations about race, violence, and insanity. And thus did the men develop schizophrenia not because of symptoms, but because of civil rights.

Gut dysbiosis, studies suggest, may be a possible root cause for some conditions that we label “mental illness,” including depression, autism, anxiety, ADHD, and even schizophrenia.47 Several animal studies have shown a direct link between a decline in the health of our microbiome (as a result of poor diet and environmental influences such as stress and toxic chemicals) and a sharp rise in the symptoms associated with anxiety and depression48 in humans.

schizophrenia itself is nothing more or less than a constellation of symptoms that have frequently been observed as occurring in tandem.

Ashish Bhatt answered, “Often those persons who live successfully with schizophrenia are ones who have positive prognostic factors, which include good premorbid functioning, later age of symptom onset, sudden symptom onset, higher education, good support system, early diagnosis and treatment, medication adherence, and longer periods of minimal or absent symptoms between episodes.

Changed way of speaking or using a different vocabulary, peculiar statements, extreme reactions to praise, blame and criticism.

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).

A Family Affair: Essential Fatty Acids More chemical clues to the nature of alcoholism come from research focusing on alcoholics with at least one grandparent who was Welsh, Irish, Scottish, Scandinavian, or native American. Typically, these alcoholics have a history of depression going back to childhood and close relatives who suffered from depression or schizophrenia. Some may have relatives who committed suicide. There also may be a family history of eczema, cystic fibrosis, premenstrual syndrome, diabetes, irritable bowel syndrome, or benign breast disease. The common denominator here is a genetic abnormality in the way the body handles certain essential fatty acids (EFAs) derived from foods. Normally, these EFAs are converted in the brain to various metabolites such as prostaglandin E1 (PGE1), which plays a vital role in the prevention of depression, convulsions, and hyperexcitability. When the EFA conversion process is defective, brain levels of prostaglandin E1 are lower than normal, which results in depression. In affected individuals, alcohol acts as a double-edged sword. It activates the PGE1 within the brain, which immediately lifts depression and creates feelings of well-being. Because the brain cannot make new PGE1 efficiently, its meager supply of PGE1 is gradually depleted. Over time, the ability of alcohol to lift depression slowly diminishes. Several years ago, researchers hit upon a solution to this problem. They discovered that a natural substance, oil of evening primrose, contains large amounts of gamma-linolenic acid (GLA), which can help the brain convert EFAs to PGE1. The results are quite dramatic. In a recent study in Scotland, researcher David Horrobin, M.D., matched two groups of alcoholics whose EFA levels were 50 percent below normal. The first group got EFA replacement, the second, a placebo. Marked differences between the two groups emerged in the withdrawal stage. The group that got EFA replacement had far fewer symptoms, while the placebo group displayed the full range of withdrawal symptoms associated with prostaglandin deficiency: tremors, irritability, tension, hyperexcitability, and convulsions. At the outset of the study, members of both groups had some degree of alcohol-related liver damage. Three months later, the researchers found that liver function among the EFA replacement group was almost normal. There was no significant improvement among the placebo group. A year later, the placebo group was still deficient in the natural ability to convert essential fatty acids into PGE1. What’s more, only 28 percent of this group had remained sober; the rest had resumed drinking. Results were dramatically better among the EFA replacement group: 83 percent remained sober and depression free.

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.

It is actually relatively common for someone to be diagnosed with multiple personality disorder after having visited the doctor for an eating issue. The eating issue cannot be resolved by the conventional approaches which most doctors use. Only when these approaches are all exhausted will the doctor look for alternatives and may well discover that the eating disorder is a symptom of a multiple personality disorder and not a disorder in its own right. •

The changes that occur during the prodromal phase have been broadly characterised by Hafner and colleagues (Hafner et al., 1995), though other more intensive studies are reviewed and summarised in Yung et al. (1996). These and other studies (Jones et al., 1993) showed that although diagnostic specificity and ultimately potentially effective treatment comes with the later onset of positive psychotic symptoms, most of the disabling consequences of the underlying disorder emerge and manifest well prior to this phase. In particular, deficits in social functioning occur predominantly during the prodromal phase and prior to treatment. Hafner et al. (1995) demonstrated clearly that the main factor determining social outcome two years after first admission for schizophrenia is acquired social status during the prodromal phase of the disorder. The importance of this phase was previously poorly appreciated because no conceptual

The situation changed for Michael and for millions of other schizophrenics, for better and worse, around 1953, when the first tranquilizer—a drug called Largactil in England, Thorazine in the United States—became available. The tranquilizers could damp down and perhaps prevent the hallucinations and delusions, the “positive symptoms” of schizophrenia, but this could come at great cost to the individual.

Dr Abram Hoffer from Canada has treated 5,000 people diagnosed with schizophrenia with high-dose multinutrients, especially large doses of vitamin B3 and vitamin C. His published 40-year follow-up reports reveal a 90 per cent cure rate – defined as free of symptoms, able to socialise with family and friends, and paying income tax.11 Despite this lifetime of research and results, Hoffer’s approach to schizophrenia has been largely sidelined.

Paul R. Linde in his 1994 book, Of Spirits and Madness: An American Psychiatrist in Africa. “Major mental illness cuts across all cultures,” Linde writes. “Amazingly enough, or maybe not, acutely psychotic people in Zimbabwe appear very similar to those in San Francisco. . . . They suffer from disorganized thoughts, delusions, and hallucinations. The content of the symptoms, however, is very much different . . . Zimbabweans do not report hearing auditory hallucinations of Jesus Christ, rather they report hearing those of their ancestor spirits. They are not paranoid about the FBI, rather they are paranoid about witches and sorcerers.”1

My father was also Bi-polar, but he also had symptoms of Paranoid Schizophrenia.

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

abulia (also aboulia) n. [mass noun] [PSYCHIATRY] an absence of willpower or an inability to act decisively, a symptom of schizophrenia or other mental illness. abulic adj. mid 19th century: coined from A-1 ‘without’ + Greek boulē ‘the will’.

Perhaps because of its special place in our sense of self and free will, the brain did not receive the scrutiny of microbiologists again until the final years of the twentieth century. At this point, many microbes were soon linked to mental illness, but it is the Toxoplasma parasite that has proved to be the most compelling suspect for many conditions. Occasionally, when people are first infected with the parasite they develop psychiatric symptoms, such as hallucinations and delusions, that lead to an initial misdiagnosis of schizophrenia. In fact, amongst those with schizophrenia, the presence of Toxoplasma is three times more common than in the general population – a far more telling association than any genetic connections so far revealed. Intriguingly, schizophrenics are not the only mental health patients in whom Toxoplasma infection is rife. It has also been found to be involved in obsessive–compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD) and Tourette’s syndrome, all of which have become increasingly common over the past several decades.

After all, many people with schizophrenia aren’t aware that they’re experiencing symptoms.

The second edition of the Diagnostic and Statistical Manual of Mental Disorders was published in 1968, and, unlike its 1952 predecessor, it contained not one mention of autism. As best as I can tell, the word autistic did appear twice, but again, as in the DSM-I, it was there only to describe symptoms of schizophrenia and not in connection with a diagnosis of its own. “Autistic, atypical, and withdrawn behavior,” read one reference; “autistic thinking,” read another.

Figure 2.2 Number of connections over 25 years across brain areas. This process — neural exuberance followed by pruning of connections — makes the human brain highly adaptable to any environment. Is the infant born in an urban or an agricultural society? Is it the year 2012 or 1012? It doesn’t really matter. The brain of a child born in New York City or in Nome, Alaska, is similar at birth. During the next two decades of life, the process of neural exuberance followed by pruning sculpts a brain that can meet the demands, and thrive in its environment. Brain differences at the “tails” of the distribution As with any natural process there is a range of functioning, with most individuals in the middle and a small percentage of individuals being far above and far below the mean. While the general pattern of increasing and decreasing brain connections is seen in all children, important differences are reported in children whose abilities are above or below those of the average population. To investigate children above the normal range, Shaw used Magnetic Resonance Imaging (MRI) to follow brain structure in 307 children over 17 years. Children with average IQs reached a peak of cortical thickness (and therefore number of neural connections) around age 10, and then pruning began and continued to age 18. Children with above-average IQs had a different pattern: a brief pruning period around age 7 followed by increasing connections again to age 13. Then pruning ensued more vigorously and finished around age 18. There were also differences in brain structure. At age 18, those with above-average IQs had higher levels of neural connections in the frontal areas, which are responsible for short-term memory, attention, sense of self, planning, and decision-making — the higher brain functions. At the other end of the spectrum, individuals diagnosed with schizophrenia, compared to normal children, lose 3% more connections each year from age 10 to 18. Symptoms of schizophrenia emerge in the late teens, when the cortical layer becomes too thin to support coherent functioning. A thinner cortical layer as a young adult — about 20% less than the average — could account for the fragmented mental world of people diagnosed with schizophrenia. Who is in control? Neural exuberance — increasing and decreasing connections — is genetically controlled, but the child’s experiences affect which connections are pruned and which remain. Circuits that a child uses are strengthened. So a youngster who learns to play the piano or to speak Italian is setting up brain circuits that support those activities — she will find it easier to learn another instrument or language. ​Warning to parents: This doesn’t mean you should inundate your toddler with Italian, violin, martial arts, and tennis lessons. Young children learn best when following their natural tendencies and curiosity. Children learn through play. Undue stress and pressure inhibits the brain’s natural ability to learn.

among all psychiatric conditions, OCD is one of the few that does not respond very well to so-called placebo treatment—blank pills. Even with schizophrenia and depression, when people are given blank pills—pills that they think may be helping them—a fair number of them actually improve in the short term. But with persons with OCD, generally less than 10 percent get better when they are given placebos, so if something active isn’t being done to combat their symptoms, nothing really happens—or they get worse.

Disordered thought detaches a person from reality, leading to altered perceptions and behavior, such as hallucinations and delusions. These psychotic symptoms can be terrifying, not just for people who experience them but also for people who witness them. They are also a major cause of the stigma attached to people with schizophrenia.

Only then did scientists realize the rather profound conclusions of the experiment: REM sleep is what stands between rationality and insanity. Describe these symptoms to a psychiatrist without informing them of the REM-sleep deprivation context, and the clinician will give clear diagnoses of depression, anxiety disorders, and schizophrenia. But these were all healthy young individuals just days before. They were not depressed, weren’t suffering from anxiety disorders or schizophrenia, nor did they have any history of such conditions, self or familial. Read of any attempts to break sleep-deprivation world records throughout early history, and you will discover this same universal signature of emotional instability and psychosis of one sort or another. It is the lack of REM sleep—that critical stage occurring in the final hours of sleep that we strip from our children and teenagers by way of early school start times—that creates the difference between a stable and unstable mental state.

There are worse effects than “coke bugs” for the cocaine abuser. Symptoms very similar to those of paranoid schizophrenia – almost identical with them, in fact – often appear. William S. Burroughs, for example, tells of a friend who got the copper horrors (visions of policemen) while sniffing too much coke. Just like a madman in a joke, this fellow ran into the alley and hid his head in a garbage can, evidently convinced that this made him totally invisible. (Again, the logic of amphetamine is similar. DeRopp, in Drugs and the Mind, tells of a truck driver who took so much Benzedrine that he became convinced “Benny” was driving the truck and therefore crawled into the back to have a nap. “Benny” drove him into a ditch, but he survived to tell the tale.)

I die every night and, if I’m lucky, I’m reborn in the morning. Call it karmic pot-luck, call it spiritual cleansing, call it by any other name than what it actually is: the banal symptoms of schizoaffective disorder.

During the depersonalisation or derealisation experiences, reality testing remains intact. C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, medication) or other medical condition (e.g., seizures). E. The disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder.

I once asked a schizophrenic man, "Why does the sun come up in the morning?" His reply was "Tomorrow." I looked at him blankly. When I requested explanation, he said, "Didn't you ever see Annie? The sun'll come up, tomorrow," and he burst into song. Instead of addressing the question from a factual point of view, he simply referred to an idiosyncratic association he had to my question. Adult thinking is universal and understandable by all who speak-a da language. It is a core symptom of schizophrenia, this regressive type of autistic thinking typical of children-or at least we evolutionists think so and most psychiatrists do as well.

Then came the discovery that adrenochrome, which is a product of the decomposition of adrenalin, can produce many of the symptoms observed in mescalin intoxication. But adrenochrome probably occurs spontaneously in the human body. In other words, each one of us may be capable of manufacturing a chemical, minute doses of which are known to cause profound changes in consciousness. Certain of these changes are similar to those which occur in that most characteristc plague of the twentieth century, schizophrenia. Is the mental disorder due to a chemical disorder?

Das unangenehmste aller Symptome bei Schizophrenie ist der Selbstmordtrieb. Ich führe das deswegen an, um einmal deutlich zu sagen, daß die jetzige Gesellschaftsordnung in dieser Richtung vom Psychiater eine große und ganz unangebrachte Grausamkeit verlangt. Man zwingt Leute, denen aus guten Gründen das Leben verleidet ist, weiter zu leben; das ist schon schlimm genug. Aber ganz schlimm ist es, wenn man diesen Kranken mit allen Mitteln das Leben noch unerträglicher macht, indem man sie einer peinlichen Bewachung unterwirft. Der größte Teil unserer ärgsten Zwangsmaßregeln wäre unnötig, wem wir nicht verpflichtet wären, den Kranken ein Leben zu erhalten, das für sie und andere nur negativen Wert hat. Und wenn es noch etwas nützte! Ich bin aber mit Savage überzeugt, daß bei der Schizophrenie gerade durch die Bewachung der Selbstmordtrieb geweckt, gesteigert und unterhalten wird. Nur ausnahmsweise würde sich einer unserer Kranken das Leben nehmen, wenn wir ihn gewähren ließen. Und wenn es auch ein paar mehr sein sollten, die zugrunde gehen — ist es recht, wegen dieses Resultates hunderte von Kranken zu quälen und ihre Krankheit zu verschlimmern? Vorläufig stehen wir Psychiater unter der traurigen Pflicht, grausamen Anschauungen unserer Gesellschaft zu folgen; aber wir haben auch die Pflicht, unser möglichstes zu tun, daß diese Anschauungen sich bald ändern.

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.

Fourth, along these same lines, some diagnoses remind us of a more central role of the body in a person’s struggle. Psychiatric diagnoses remind us that we are embodied souls. We know this clearly from Scripture! But functionally speaking, we sometimes over-spiritualize troubles with emotions and thoughts. When you consider the spectrum of psychiatric diagnoses, it is clear that years of research demonstrate that some diagnoses may have a stronger genetic (inherited) component of causation than others. These include schizophrenia, bipolar disorder, autistic spectrum disorder, and perhaps more severe and recalcitrant forms of depression (melancholia), anxiety, and OCD.2 Another way of saying this is that although psychiatric diagnoses are descriptions and not full-fledged explanations, it doesn’t mean that a given diagnosis or symptom holds no explanatory clues at all. Not all psychiatric diagnoses should be viewed equally. Some do indeed have long-standing recognition in medical and psychiatric history, occur transculturally, and therefore are not merely modern, Western “creations” that highlight patterns of deviant or sinful behavior, as critics would say. Observations that have held up among various

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

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.

many people falsely believe that schizophrenics are dangerous and need to be monitored at all times. This is arguably the most damaging misconception of all, and it is important to educate people that violence is not a symptom of schizophrenia – in fact, people with the illness are far more likely to be victims of violence, rather than the perpetrators.

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

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

The research on Toxoplasma gondii has thrown up some interesting findings. We know, for instance, that infections are more common amongst people with certain psychiatric disorders, such as schizophrenia and bipolar disorder. But even more disconcerting is the link to a condition called ‘intermittent explosive disorder’. Those with IED are prone to moments of uncontrolled aggression; one of the symptoms is an increased tendency to display road rage, for example

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).

Al did not have to "act crazy" to get approved for disability; he let his voluminous records do the talking. Our sessions consisted of reminiscing about his childhood, processing the racism both overt and covert that he had experienced throughout his lifetime, and discussing the news of the day. I believed that he did truly suffer mentally; he had very little contact with people other than me, didn't trust people, and seemed to hear and see things that weren't there. I used to see a lot of patients like Al. There was also Marvin, who believed he had inherited an ability to see and talk to spirits; Teddy, who claimed to be tormented by the sound of babies crying; Eric, whose outbursts of intense anger caused him shame and guilt in the aftermath. All had mental health symptoms that plagued them and shaped their interactions with others. All were also Black men. The strands of their stories were so infused with suffering that it was difficult to separate their symptoms from their history. Was Al depressed because he often self-isolated, or did he self-isolate because the only people he knew around him had chronic substance abuse issues? Was Marvin paranoid because some neurotransmitters in his brain were out of balance, or because he had been beaten by police upon multiple occasions in the past? How much of Eric's anger was due to the fact that he had very few friends left because so many of them had been murdered? All had ended up with diagnoses of severe mental illness along the schizophrenia spectrum, yet there was clearly more at work in each case.

An interest in the connection between the gut and the brain has led to some fascinating research on probiotics, which have been shown to reduce mania and some of the more robust symptoms of schizophrenia.

Anosognosia, sometimes referred to as “lack of insight,” is defined as a symptom of severe mental illness that impairs the ability of an individual to understand or even perceive their illness. It is the most common reason why patients with schizophrenia or bipolar disorder refuse medication and decline to seek treatment. Affecting roughly 40 percent of bipolar patients, it is often associated with increased danger of stroke and other neurological complications.