Short Psychiatric Quotes

And if we do speak out, we risk rejection and ridicule. I had a best friend once, the kind that you go shopping with and watch films with, the kind you go on holiday with and rescue when her car breaks down on the A1. Shortly after my diagnosis, I told her I had DID. I haven't seen her since. The stench and rankness of a socially unacceptable mental health disorder seems to have driven her away.

That is where we stand as a nation today. Twenty years ago, our society began regularly prescribing psychiatric drugs to children and adolescents, and now one out of every fifteen Americans enters adulthood with a "serious mental illness." That is proof of the most tragic sort that our drug-based paradigm of care is doing a great deal more harm than good. The medicating of children and youth became commonplace only a short time ago, and already it has put millions onto a path of lifelong illness.

Time heals so well because many of our ills are short-term, situational, and self-limited - our bodies and our minds are programmed to be resilient without any active effort on our part.

Some judicial officials began to notice the unusual frequency of deaths among the inmates of institutions and some prosecutors even considered asking the Gestapo to investigate the killings. However, none went so far as Lothar Kreyssig, a judge in Brandenburg who specialized in matters of wardship and adoption. A war veteran and a member of the Confessing Church, Kreyssig became suspicious when psychiatric patients who were wards of the court and therefore fell within his area of responsibility began to be transferred from their institutions and were shortly afterwards reported to have died suddenly. Kreyssig wrote Justice Minister Gortner to protest against what he described as an illegal and immoral programme of mass murder. The Justice Minister's response to this and other, similar, queries from local law officers was to try once more to draft a law giving effective immunity to the murderers, only to have it vetoed by Hitler on the grounds that the publicity would give dangerous ammunition to Allied propaganda. Late in April 1941 the Justice Ministry organized a briefing of senior judges and prosecutors by Brack and Heyde, to try to set their minds at rest. In the meantime, Kreyssig was summoned to an interview with the Ministry's top official, State Secretary Roland Freisler, who informed him that the killings were being carried out on Hitler's orders. Refusing to accept this explanation, Kreyssig wrote to the directors of psychiatric hospitals in his district informing them that transfers to killing centres were illegal, and threatening legal action should they transport any of their patients who came within his jurisdiction. It was his legal duty, he proclaimed, to protect the interests and indeed the lives of his charges. A further interview with Gortner failed to persuade him that he was wrong to do this, and he was compulsorily retired in December 1941.

The issues of antidepressant-associated suicide has become front-page news, the result of an analysis suggesting a link between medication use and suicidal ideation among children, adolescents, a link between medication use and suicidal ideation among children, adolescents, and adults up to age 24 in short term (4 to 16 weeks), placebo-controlled trials of nine newer antidepressant drugs. The data from trials involving more than 4.4(K) patients suggested that the average risk of suicidal thinking or behavior (suicidality) during the first few months of treatment in those receiving antidepressants was 4 percent, twice the placebo risk of 2 percent. No suicides occured in these trials. The analysis also showed no increase in suicide risk among the 25 to 65 age group. Antidepressants reduced suicidality among those over age 65. Following public hearings on the subject, in October 2004, the FDA requested the addition of “black box” warnings—the most serious warning placed on the labeling of a prescription medication—to all antidepressant drugs, old and new.

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.

Shortly after I returned home from the Ukraine, I became severely ill with what doctors believed was a parasite. I couldn’t hold my food down and lost a lot of weight. Different doctors kept prescribing me antibiotics, but none of them seemed to help. For a couple of months, I was poked and tested in a variety of ways, only to have more questions surface than answers. Then I was sent to an ear, nose, and throat doctor for an evaluation. I was sitting in a waiting room with a bunch of toddlers, when my name was called. By the time I got into the examination room I knew I’d had enough. “Hey, I’m outta here,” I told the doctor. “I’ll take my chance with the resurrection.” Well, a couple of weeks later, my insurance agent called me. He was one of my lifelong friends and sounded concerned. “Hey, Jase,” he said. “Your insurance company wants you to see a psychiatrist.” Apparently, the ear, nose, and throat doctor recommended I undergo a full psychiatric evaluation based on my refusal to be examined, along with my speech on the resurrection! Apparently, he thought I was crazy. I convinced my buddy that I didn’t need a psychiatrist and eventually got over my illness. I would later read a passage of scripture in the Bible that caused me to smile in reflection on the entire ordeal. Second Corinthians 5:13 says: “If we are out of our mind, as some say, it is for God; if we are in our right mind, it is for you.

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

To defend ourselves from this threat, and to sustain our peace of mind, we make use of a variety of ego-defence mechanisms, particularly repression, denial, and projection. Not only do we repress the shadow in the personal unconscious, but we deny its existence in ourselves, and project it out on to others. This is done quite unconsciously: we are not aware that we do it. It is an act of ego-preservation which enables us to deny our own ‘badness’ and to attribute it to others, whom we then hold responsible for it. It explains the ubiquitous practice of scapegoating and underlies all kinds of prejudice against people belonging to identifiable groups other than our own. Shadow projection is also involved in the psychiatric symptom of paranoia, when one’s own hostile, persecutory feelings are disowned and projected on to others, who are then experienced as being hostile and persecutory towards oneself.

Kimbanguism is an extremely peace-loving religion, yet brimming with military allusions. Those symbols were not originally part of the religion, but were copied in the 1930s from the Salvation Army, a Christian denomination that, unlike theirs, was not banned at that time. The faithful believed that the S on the Christian soldiers’ uniform stood not for “Salvation” but for “Simon,” and became enamored of the army’s military liturgy. Today, green is still the color of Kimbanguism, and the hours of prayer are brightened up several times a day by military brass bands. Those bands, by the way, are truly impressive. It is a quiet Monday evening when I find myself on the square. While the martial music rolls on and on, played first by the brass section, then by flutes, the faithful shuffle forward to be blessed by the spiritual leader. In groups of four or five, they kneel before the throne. The spiritual leader himself is standing. He wears a gray, short-sleeved suit and gray socks. He is not wearing shoes. In his hand he holds a plastic bottle filled with holy water from the “Jordan,” a local stream. The believers kneel and let themselves be anointed by the Holy Spirit. Children open their mouths to catch a spurt of holy water. A young deaf man asks for water to be splashed on his ears. And old woman who can hardly see has her eyes sprinkled. The crippled display their aching ankles. Fathers come by with pieces of clothing belonging to their sick children. Mothers show pictures of their family, so the leader can brush them with his fingers. The line goes on and on. Nkamba has an average population of two to three thousand, plus a great many pilgrims and believers on retreat. People come from Kinshasa and Brazzaville, as well as from Brussels or London. Thousands of people come pouring in, each evening anew. For an outsider this may seem like a bizarre ceremony, but in essence it is no different from the long procession of believers who have been filing past a cave at Lourdes in the French Pyrenees for more than a century. There too, people come from far and near to a spot where tradition says unique events took place, there too people long for healing and for miracles, there too people place all their hope in a bottle of spring water. This is about mass devotion and that usually says more about the despair of the masses than about the mercy of the divine. After the ceremony, during a simple meal, I talk to an extremely dignified woman who once fled Congo as a refugee and has been working for years as a psychiatric nurse in Sweden. She loves Sweden, but she also loves her faith. If at all possible, she comes to Nkamba each year on retreat, especially now that she is having problems with her adolescent son. She has brought him along. “I always return to Sweden feeling renewed,” she says.

The beauty of poker is that while luck is always involved, luck doesn’t dictate the long-term results of the game. A person can get dealt terrible cards and beat someone who was dealt great cards. Sure, the person who gets dealt great cards has a higher likelihood of winning the hand, but ultimately the winner is determined by—yup, you guessed it—the choices each player makes throughout play. I see life in the same terms. We all get dealt cards. Some of us get better cards than others. And while it’s easy to get hung up on our cards, and feel we got screwed over, the real game lies in the choices we make with those cards, the risks we decide to take, and the consequences we choose to live with. People who consistently make the best choices in the situations they’re given are the ones who eventually come out ahead in poker, just as in life. And it’s not necessarily the people with the best cards. There are those who suffer psychologically and emotionally from neurological and/or genetic deficiencies. But this changes nothing. Sure, they inherited a bad hand and are not to blame. No more than the short guy wanting to get a date is to blame for being short. Or the person who got robbed is to blame for being robbed. But it’s still their responsibility. Whether they choose to seek psychiatric treatment, undergo therapy, or do nothing, the choice is ultimately theirs to make. There are those who suffer through bad childhoods. There are those who are abused and violated and screwed over, physically, emotionally, financially. They are not to blame for their problems and their hindrances, but they are still responsible—always responsible—to move on despite their problems and to make the best choices they can, given their circumstances.

Our immune system does not exist in isolation from daily experience. For example, the immune defences that normally function in healthy young people have been shown to be suppressed in medical students under the pressure of final examinations. Of even greater implication for their future health and well-being, the loneliest students suffered the greatest negative impact on their immune systems. Loneliness has been similarly associated with diminished immune activity in a group of psychiatric inpatients. Even if no further research evidence existed—though there is plenty—one would have to consider the long-term effects of chronic stress. The pressure of examinations is obvious and short term, but many people unwittingly spend their entire lives as if under the gaze of a powerful and judgmental examiner whom they must please at all costs. Many of us live, if not alone, then in emotionally inadequate relationships that do not recognize or honour our deepest needs. Isolation and stress affect many who may believe their lives are quite satisfactory. How may stress be transmuted into illness? Stress is a complicated cascade of physical and biochemical responses to powerful emotional stimuli. Physiologically, emotions are themselves electrical, chemical and hormonal discharges of the human nervous system. Emotions influence—and are influenced by—the functioning of our major organs, the integrity of our immune defences and the workings of the many circulating biological substances that help govern the body’s physical states. When emotions are repressed, this inhibition disarms the body’s defences against illness. Repression—dissociating emotions from awareness and relegating them to the unconscious realm—disorganizes and confuses our physiological defences so that in some people these defences go awry, becoming the destroyers of health rather than its protectors.

No need for psychiatric contortions; no shock waves; no need to conjure up deep-seated anxieties and conflicts. It is combat exhaustion—instead of something ominous and mysterious. It is, quite simply, just having had too much. Of course, in more technical terms, combat exhaustion can be thought of as an abnormal reaction to the stress of combat, its manifestation being unique to the person who develops it, channeled into a specific form by the person’s own individual personality and background experience. But it is only one of many abnormal reactions. A soldier who has had too much might choose to surrender or convulsively go forward. He might panic and get killed; he could get himself wounded or wound himself; he might even go to the chaplain or decide on the relative safety of a stockade. He might—if he’s so disposed—develop psychosomatic complaints, get angry, or, in some cases, become totally unreasonable. He can become neurotic, begin to shake, refuse to move, or go completely hysterical. He might even become grossly psychotic—hold imaginary rifles, hear voices, or see his grandmother in every chopper that flies by. “You will be treating these men, and the treatment is simple. For most it will just be rest. In more severe cases, those soldiers whose functioning is beginning to be impaired, who can’t rest, you will medically put to sleep. They are given enough thorazine to put them out and left alone for a day or two. They too, though, like the troopers who are merely resting, stay near the aid station. The more disturbed patients, those troopers who for the moment may be truly disoriented, who have completely stopped functioning, who for any number of reasons appear to need more than a short rest, are sent to an evacuation hospital. But they are never lost to their units. Their group identity is never tampered with, and they know they will be going back. And they do go back. And they are accepted by their units. Believe me, the casual, yet efficient way it is all handled, the official emphasis on health rather than disease, and the lack of mumbo-jumbo have taken the stigma out of having had too much. To the men, it is just something that happens; and more important, it is something they realize can happen to anyone. It is handled that way and it is presented that way. “Gentlemen, it works.

In short, no psychiatric diagnosis is, or can be, pathology-driven; instead, all such diagnoses are driven by nonmedical (economic, personal, legal, political, and social) factors or incentives. Accordingly, psychiatric diagnoses do not point to pathoanatomic or pathophysiological lesions and do not identify causative agents—but rather refer to human behaviors. Moreover, the psychiatric terms used to refer to such behaviors allude to the plight of the denominated patient, hint at the dilemmas with which patient and psychiatrist alike try to cope as well as exploit, and mirror the beliefs and values of the society that both inhabit.

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.

Diagnostic classification systems, such as the American Psychiatric Association’s Diagnostic and Statistical Manual (known as DSM-5), outline symptoms and guidance for clinical professionals who diagnose psychiatric disorders. Although the standard assessment of criminal psychopathy using the Hare criteria is as, if not more rigorous than traditional psychiatric diagnostic assessments based on classification systems such as DSM-5, psychopathy is not included as a formal diagnosis in these systems. Instead, the DSM-5 has a diagnostic category called antisocial personality disorder, which refers to individuals who violate societal norms and rights of other people.

Death is 'the ultimate loss' to the person dying, but it is inconsequential to the rest of the world. This is true of madness too. There are so many stories and films about people confined in psychiatric hospitals. Madness is often an easy solution for writers to conclude a story, especially stories with a hero or heroine in the grip of an existential crisis. And in comedy films, with some added exaggeration, it provides material to make the audience laugh. This, in short, is the world's relationship with madness. In real life, though, madness is boring. No, actually real life is boring and madness might add a bit of interest to it.

Dr. H. K. Beecher is the name of one of the first serious students of pain in the United States. In 1946, he published an article in the Annals of Surgery titled “Pain in Men Wounded in Battle” (Vol. 123, p. 96). For years it was widely quoted because of its most interesting observation. But now Dr. Beecher is passing into obscurity, for what he had to say is no longer acceptable to students of pain. Dr. Beecher questioned 215 seriously wounded soldiers at various locations in the European theater during World War II shortly after they had been wounded and found that 75 percent of them had so little pain that they had no need for morphine. Reflecting that strong emotion can block pain, Dr. Beecher went on to speculate: “In this connection it is important to consider the position of the soldier: His wound suddenly releases him from an exceedingly dangerous environment, one filled with fatigue, discomfort, anxiety, fear and real danger of death, and gives him a ticket to the safety of the hospital. His troubles are over, or he thinks they are.” This observation is reinforced by a report of the United States surgeon general during World War II, noted in Martin Gilbert’s book The Second World War: A Complete History (New York: Henry Holt, 1989), that in order to avoid psychiatric breakdown, infantrymen had to be relieved of duty every so often. The report said, “A wound or injury is regarded not as a misfortune, but a blessing.

Routinely sleeping less than six or seven hours a night demolishes your immune system, more than doubling your risk of cancer. Insufficient sleep is a key lifestyle factor determining whether or not you will develop Alzheimer’s disease. Inadequate sleep—even moderate reductions for just one week—disrupts blood sugar levels so profoundly that you would be classified as pre-diabetic. Short sleeping increases the likelihood of your coronary arteries becoming blocked and brittle, setting you on a path toward cardiovascular disease, stroke, and congestive heart failure. Fitting Charlotte Brontë’s prophetic wisdom that “a ruffled mind makes a restless pillow,” sleep disruption further contributes to all major psychiatric conditions, including depression, anxiety, and suicidality.

One study, for instance, compared written clinical observations made on patients shortly before they committed suicide with clinical observations made on patients of comparable ages and diagnoses who did not commit suicide. Counterintuitively, those who killed themselves had been assessed by their doctors as calmer and “in better spirits” than those who did not. In fact, nearly one-third of hospitalized psychiatric patients “look normal” to their doctors, family members, or friends in the minutes or hours just before suicide.

What programs would a prison need to utilize in order to maximize the likelihood that the people sent to it would renounce violence as a behavioral strategy? To begin with, it would need to be an anti-prison. Beginning with its architecture, it would need to convey an entirely different message. Current prisons are modeled architecturally after zoos — or rather, after the kinds of zoos that used to exist, but that have been replaced with zoological parks because the animals' keepers began to realize that the old zoos, with concrete floors and walls and steel bars were too inhumane for animals to survive in. Yet we still keep our human animals in zoos that no humane society would permit for animals. And the architecture itself conveys that message to the prisoners: "You are an animal, for this is a zoo, and zoos are what animals are put in." And then we act surprised when the men and women we treat that way actually behave like animals, both when they are in this human zoo and after they return to the community. So we would need to build an anti-prison that would actually look as if it had been built for human beings rather than animals, i.e. that was as home-like and pleasant and civilized and human as possible. Once we had done that, we could offer those who had been sent there the opportunity to acquire as much education and/or vocational training as they had the ability and energy and interest to obtain. We would of course need to provide treatment for whatever medical, dental, psychiatric, or substance-abuse problems they had, and would want to incorporate many of the principles of a therapeutic community into the everyday routines of this residential school, with frequent group discussions with the other residents and staff members with training in psychotherapy. The goal would be to replace the "monster factories" that most prisons now are with therapeutic communities designed to enable people who are deeply damaged, and damaging, to recover their humanity or to gain a degree of humanity they had never been able to acquire; in short, to help them heal themselves and learn, in the process, how to heal others and even repair some of the damage they have done.

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

In the short span of forty years, depression had been utterly transformed. Prior to the arrival of the drugs, it had been a fairly rare disorder, and outcomes generally were good. Patients and their families could be reassured that it was unlikely that the emotional problem would turn chronic. It just took time—six to twelve months or so—for the patient to recover. Today, the NIMH informs the public that depressive disorders afflict one in ten Americans every year, that depression is “appearing earlier in life” than it did in the past, and that the long-term outlook for those it strikes is glum.

The fading relevance of the nature–nurture argument has recently been revived by the rise of evolutionary psychology. A more sophisticated understanding of Darwinian evolution (survival of the fittest) has led to theories about the possible evolutionary value of some psychiatric disorders. A simplistic view would predict that all mental illnesses with a genetic component should lower survival and ought to die out. ‘Inclusive fitness’, however, assesses the evolutionary value of a characteristic not simply on whether it helps that individual to survive but whether it makes it more likely that their offspring will survive. Richard Dawkins’s 1976 book The Selfish Gene gives convincing explanations of the evolutionary advantages of group support and altruism when individuals sacrifice themselves for others. A range of speculative hypotheses have since been proposed for the evolutionary advantage of various behaviour differences and mental illnesses. Many of these draw on ethological games-theory (i.e. the benefits of any behaviour can only be understood in the context of the behaviour of other members of the group). So depression might be seen as a safe response to ‘defeat’ in a hierarchical group because it makes the individual withdraw from conflict while they recover. Mania, conversely, with its expansiveness and increased sexual activity, is proposed as a response to success in a hierarchical tussle promoting the propagation of that individual’s genes. Changes in behaviour that look like depression and hypomania can be clearly seen in primates as they move up and down the pecking order that dominates their lives. The habitual isolation and limited need for social contact of individuals with schizophrenia has been rather imaginatively proposed as adaptive to remote habitats with low food supplies (and also a protection against the risk of infectious diseases and epidemics). Evolutionary psychology will undoubtedly increasingly influence psychiatric thinking – many of our disorders fit poorly into a classical ‘medical model’. Already it has helped establish a less either–or approach to the discussion. It is, however, a highly controversial area – not so much around mental disorders but in relation to social behaviour and particularly to gender specific behaviour. Here it is often interpreted as excusing a very male-orientated, exploitative worldview. Luckily that is someone else’s battle.