Schizophrenia Treatment Quotes

Psychoanalysis was from the start, still is, and perhaps always will be a well-constituted church and a form of treatment based on a set of beliefs that only the very faithful could adhere to, i.e., those who believe in a security that amounts to being lost in the herd and defined in terms of common and external goals

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.

What I rather wish to say is that the humanity we all share is more important than the mental illness we may not. With proper treatment, someone who is mentally ill can lead a full and rich life. What makes life wonderful--good friends, a satisfying job, loving relationships--is just as valuable for those of us who struggle with schizophrenia as for anyone else.

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.

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.

This is what schizophrenia is: endless despair, endless, inconclusive treatment; endless clutching at little straws of betterness; endless realisation that that is all they are, is all there is.

Death I understand. There are plenty of people willing to die to achieve ridiculous results. But I really don't think any drug could justify the possibility of anal leakage. If anything ever drips out of my ass as a result of the treatment I'm receiving, the cure is clearly not worth it. Please kill me.

[W]ay too much treatment is given to the normal "worried well" who are harmed by it; far too little help is available for those who are really ill and desperately need it. Two thirds of people with severe depression don't get treated for it, and many suffering with schizophrenia wind up in prisons. The writing is on the wall.

What would progress look like for schizophrenia? If the Galvin boys had been born a half century later or more—growing up today, let’s say, and not in the 1950s or 1960s—would their treatment be any different now? In some respects, little has changed. The market for new schizophrenia drugs remains sluggish.

suicide is a very serious problem in both depression and schizophrenia as estimates are that as many as one out of every ten persons with schizophrenia will take his life.

A diagnosis is comforting because it provides a framework—a community, a lineage—and, if luck is afoot, a treatment or cure. A diagnosis says that I am crazy, but in a particular way: one that has been experienced and recorded not just in modern times, but also by the ancient Egyptians, who described a condition similar to schizophrenia in the Book of Hearts, and attributed psychosis to the dangerous influence of poison in the heart and uterus. The ancient Egyptians understood the importance of sighting patterns of behavior. Uterus, hysteria; heart, a looseness of association. They saw the utility of giving those patterns names.

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

A diagnosis is comforting because it provides a framework—a community, a lineage—and, if luck is afoot, a treatment or cure. A diagnosis says that I am crazy, but in a particular way: one that has been experienced and recorded not just in modern times,

The test results all came back negative. People congratulated me on this news, but I sought comfort in those who understood that negative test results meant no answers—meant Dr. J’s diminished interest in my case and thus in my suffering—meant that I had no avenue of treatment to pursue and no kind of cure in my sight line.

An estimated 3.5 million people with serious mental illnesses are going without treatment (Kessler et al. 2001). That is scandalous. But mentally ill people are not the cause of the violence problem. If schizophrenia, bipolar disorder, and depression were cured, our society’s problem of violence would diminish by only about 4% (Swanson 1994).

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.

Many people still don’t understand what I have since learned: that ECT, when properly administered, is the fastest, most effective treatment for depression and bipolar disorder when medications have failed to work. Up to 90 percent of people with major depression for whom nothing else worked find relief in days or weeks, and the effects on memory are usually ( but not always) modest. It is also sometimes given soon after the onset of 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.

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 number of episodes, and it’s a very rich literature [documenting this], is associated with more cognitive deficits,” he said. “We are building more episodes, more treatment resistance, more cognitive dysfunction, and there is data showing that if you have four depressive episodes, unipolar or bipolar, it doubles your late-life risk of dementia. And guess what? That isn’t even the half of it…. In the United States, people with depression, bipolar, and schizophrenia are losing twelve to twenty years in life expectancy compared to people not in the mental health system.

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.

What, then, is the solution to this moral schizophrenia we have about animals? According to Francione, we only have two choices: we either continue to treat animals as we are now, by inflicting suf­fering even for unnecessary ends and recognizing our commitment to humane treatment as a farce, or we can recognize that animals have a morally significant interest in not being subjected to unnecessary suffering, and change how we approach conflicts of animal and hu­man interests. To do the latter, however, requires that we apply the principle of equal consideration to animals. This, Francione argues, is stunningly simple: in its most basic terms, we need to treat like cases alike. Though animals and humans are clearly different, they are alike in the sense that they both suffer and are both sentient. For this reason, we should extend the principle of equal consideration to animals.

Finally, some of the genes identified in certain variants of schizophrenia or bipolar disease actually augment certain abilities. If the most pathological variant of a mental illness can be sifted out or discriminated from the high-functioning variants by genes or gene combinations alone, then we can hope for such a test. But it is much more likely that such a test will have inherent limits: most of the genes that cause disease in one circumstance might be the very genes that cause hyperfunctional creativity in another. As Edvard Munch put it, "[My troubles] are part of me and my art. They are indistinguishable from me, and [treatment] would destroy my art. I want to keep those sufferings." These very "sufferings," we might remind ourselves, were responsible for one of the most iconic images of the twentieth century-of a man so immersed in a psychotic era that he could only scream a psychotic response to it.

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

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.

A majority of individuals with Schizophrenia have poor insight regarding the fact that they have a psychotic illness. Evidence suggests that poor insight is a manifestation of the illness itself rather than a coping strategy… comparable to the lack of awareness of neurological deficits seen in stroke, termed anosognosia.

Those who recover from their addictions no longer see homelessness the same way. “Once I started to heal myself,” said a formerly homeless man, “I knew I had to work with this so-called homelessness problem, to get some of those people suffering out there into treatment and help them turn their heads around.” “So-called?” asked Gowan. “Ain’t no homelessness problem in my opinion,” the man replied. “The problem is addiction, period. Even those people that have schizophrenia or something else like that, generally you find they have a big problem with addiction as well.

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 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.

At sixteen, Michael was admitted to a psychiatric hospital and given twelve “treatments” of insulin shock therapy; this entailed bringing his blood sugar down so low that he lost consciousness and then restoring it with a glucose drip. This was the first line of treatment for schizophrenia in 1944, to be followed, if need be, by electroconvulsive treatment or lobotomy. The discovery of tranquilizers was still eight years in the future. Whether

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

Christian psychiatrists have examined exorcism for the treatment of schizophrenia and other psychotic disorders, although they do not report good results with these conditions.

Today, as provost of Harvard University, Steve Hyman is mostly engaged in the many political and administrative tasks that come with leading a large institution. But he is a neuroscientist by training, and in 1996 to 2001, when he was the director of the NIMH, he wrote a paper, one both memorable and provocative in kind, that summed up all that had been learned about psychiatric drugs. Titled “Initiation and Adaptation: A Paradigm for Understanding Psychotropic Drug Action,” it was published in the American Journal of Psychiatry, and it told of how all psychotropic drugs could be understood to act on the brain in a common way.46 Antipsychotics, antidepressants, and other psychotropic drugs, he wrote, “create perturbations in neurotransmitter functions.” In response, the brain goes through a series of compensatory adaptations. If a drug blocks a neurotransmitter (as an antipsychotic does), the presynaptic neurons spring into hyper gear and release more of it, and the postsynaptic neurons increase the density of their receptors for that chemical messenger. Conversely, if a drug increases the synaptic levels of a neurotransmitter (as an antidepressant does), it provokes the opposite response: The presynaptic neurons decrease their firing rates and the postsynaptic neurons decrease the density of their receptors for the neurotransmitter. In each instance, the brain is trying to nullify the drug’s effects. “These adaptations,” Hyman explained, “are rooted in homeostatic mechanisms that exist, presumably, to permit cells to maintain their equilibrium in the face of alterations in the environment or changes in the internal milieu.” However, after a period of time, these compensatory mechanisms break down. The “chronic administration” of the drug then causes “substantial and long-lasting alterations in neural function,” Hyman wrote. As part of this long-term adaptation process, there are changes in intracellular signaling pathways and gene expression. After a few weeks, he concluded, the person’s brain is functioning in a manner that is “qualitatively as well as quantitatively different from the normal state.” His was an elegant paper, and it summed up what had been learned from decades of impressive scientific work. Forty years earlier, when Thorazine and the other first-generation psychiatric drugs were discovered, scientists had little understanding of how neurons communicated with one another. Now they had a remarkably detailed understanding of neurotransmitter systems in the brain and of how drugs acted on them. 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.

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.

And yet the debate over AB 1421, as I discovered in San Francisco, touched upon crucial issues of autonomy and civil liberties. The bill makes the assumption that people who display a certain level of mental disorder are no longer capable of choosing their own treatment, including medication, and therefore must be forced into doing so.

Reduced levels of ATP have been found in a wide variety of disorders, including schizophrenia, bipolar disorder, major depression, alcoholism, PTSD, autism, OCD, Alzheimer’s disease, epilepsy, cardiovascular disease, type 2 diabetes, and obesity.

are we more caring of vulnerable older adults than we are of the young? What would we think of ourselves as a society if our streets and prisons were filled with old people suffering the terrors and indignities of untreated dementia? It may be that we see it as a question of effective treatments, which is ironic, as there are no truly effective treatments for Alzheimer’s disease, but there are for schizophrenia.

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.

Depression in children, adolescents, and young adults is increasing as well. From 2006 to 2917, rates of depression the US increased by 68 percent in children ages twelve to seventeen. In people ages eighteen to twenty-five, there was an increase of 49 percent. For adults over the age of twenty-five, the rate of depression supposedly stayed stable.

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 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

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.

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

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

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).

The specific psychiatric disorders in which mitochrondrial dysfunction has been identified include the following: schizophrenia, schizoaffective disorder, bipolar disorder, major depression, autism, anxiety disorders, obsessive-compulsive disorder, posttraumatic stress disorder, attention deficit/hyperactivity disorder, anorexia nervosa, alcohol use disorder (aka alcoholism), marijuana use disorder, opioid use disorder, and borderline personality disorder. Dementia and delirium, often thought of an neurological illnesses, also included.

The last myth proved false by recent research concerns the idea that when one is seriously mentally ill, insight into illness leads to demoralization, depression, and suicidal thoughts. Having said that, suicide is clearly a very serious problem in both depression and schizophrenia, as estimates are that as many as one out of every ten persons with schizophrenia will die from suicide.

Black Americans—and Black males, in particular—are far more likely to be diagnosed with schizophrenia as compared with patients of other races, despite the fact that all ethnicities experience the disorder at the same rate. This doesn't just stop at diagnosis, though. Black people are also less likely to receive mental health services in the first place, and the care that they receive is often poorer. One study of a community mental health center's prescribing patterns found that whites were six times more likely to receive a second-generation antipsychotic medication—the contemporary treatment of choice for schizophrenia—while Black people were prescribed older drugs with riskier side effects. Black people are often subject to more coercive treatments, such as shots received on a regular basis instead of an oral medication. These depot medications can be great for people who struggle to remember to take their medicine, but they can also take away the element of choice from clients and become a tool of social coercion. Contrary to what you may think, this is, by and large, a Western problem. It is well-documented but underreported that outcomes are actually better for people with schizophrenia in less-developed countries.