Psychiatrist here; glad to see this near the top of HN.Schizophrenia is a serious illness, and often misunderstood as "split personality." It is a constellation of delusions, hallucinations, and scrambled thoughts that is often (though not always) pretty devastating to work, school, relationships, etc. For some reason, because we have no blood test or genetic test for it, the diagnosis is still met with skepticism from many in the public, even though everyone seems to accept the diagnosis of migraine headaches which similarly has no clear-cut lab or imaging findings.
Life expectancy as about 17 years less for those with the diagnosis, which is worse than most cancers. It's mentioned in the article, but worth repeating.
I've heard schizophrenia can be triggered by prolonged stress, e.g. a stressful work environment. (This presupposes you have susceptible genes.)
There seems to be a lot of anecdotal evidence supporting this. Do you know whether it's backed up by any research? Or more generally, does anyone know of any (successful) research about whether schizophrenia can be avoided by avoiding whatever triggers it? Or are you doomed if you have the wrong genes?
What you are describing is the "Stress-Diathesis Model." The rough explanation is that many people have vulnerabilities for mental illness (including schizophrenia, bipolar disorder, major depressive disorder, and others), and that the vulnerability is triggered by environmental stressors. It is in some ways similar to the "two-hit hypothesis" for cancer.
A search for "Stress-Diathesis Model" will yield a lot of hits in the academic literature. It's well accepted as at least part of the explanation for why some people with a genetic vulnerability develop symptoms and others do not.
My mother developed schizophrenia after a nervous breakdown. In my family circle, it is colloquially said she 'got it' from stress, because her parents constantly argued and built a stressful environment for her.
As her child, I was always scared of developing it, because there were times when I definitely had scary symptoms. I learnt about various hypothesised causes or things that could 'bring it about', so I never did drugs and practised ways to keep myself calm (I used to be extremely nervous, had sweaty hands and feet, etc.).
Now that I'm 31, I think I've done pretty well. Even with medication, my mom cannot really identify who I am, though.
I guess I just want to thank you for sharing your knowledge about schizophrenia.
Amateur here ... don't a lot of people have schizophrenic symptoms (voices), but as long as they are positive or the person can ignore them it's usually just ignored?
Like, some people might have "imaginary friends" who they chat to about the weather, quietly. Other people have "imaginary friends" who they have screaming arguments with.
In some cases, could stress either make the delusions / voices less benevolent, or send people into a cycle in which they are no longer able to manage them?
The voices with schizophrenia are outside of the head, a voice heard often clearly as though they were physically spoken. They are consistent auditory hallucinations. These can be quite nutural; one sign of paranoid schizophrenia is the voices making a running commentary of everyday actions.
If people are having chronic hallucinations, whether positive, nutural or negative, it's something to be concerned about. Usually there are symptoms outside of these hallucinations in this case where sufferers are not able to look after themselves.
In patients with bipolar during a manic/hypomanic phase, I could except hallucinations to be very positive in nature, such as supporting delusions of grandeur.
This may be much different from talking to ourselves or physically responding to dialogue WITHIN our heads, which I imagine is the source of many imaginary friends.
EDIT: I'm not qualified to speak on these subjects but I suffered from psychosis from a number of years and was misdiagnosed with schizophrenia at one stage due to the nature of my hallucinations (though still a bit over zealous on the psychiatrists part). I naturally came to learn a lot about what it is, how it's treated and spoke to many patients with psychotic illnesses in my stay in hospital (for mental disorders, a stay of 3 - 4 months is a short amount of time, many who I was in there with had been in for a year or more)
You're right, and as I read your post I wondered if you'd suffered the voices, or at least been around it enough to know.
The running commentary was the worst. For me it was 20 years ago, first year uni. Made lectures interesting but also ridiculous as your brain interprets sounds around you.
I was lucky it only affected me for a year or so then faded away after I tackled the subject and read a lot about how the mind works and other people's experiences. I had to get objective and not take shit from myself any more. I never sought professional help, but haven't had the voices since.
Even just regular noises like a car horn in the distance... your brain's imagination is secretly working overtime in the background to connect dots that aren't there. Your own mind delivers you a frank and confident explanation about the story behind the "car horn in distance". That car horn, you learn, was actually sounded by someone you know, and they're checking in as arranged, they have connections with people in this lecture hall...etc. But you never grasp exactly the explanation, or receive real proof, but there's a conspiracy nevertheless, a rambling unflattering, disapproving conspiracy - and you're at the center. That you're sure of.
It's like you're constantly on the verge of exposing the conspiracy, if only you had one more piece of evidence. But you don't need to fish for evidence, your imagination drip-feeds it all day.
That's interesting. I had assumed coming from a RF EE kind of background that it was very much like having a gain control turned way up from a noisy input resulting in peculiar signals being demodulated, but perhaps not so.
For example last night the weather was really awful and at the limit of perception almost asleep (well, I was probably actually asleep) I thought I heard a very unhappy cat meowing outside, so I actually got up and tried to find it, perhaps let it in my dry warm garage to warm up a bit. No cat existed of course.
So under my hypothesis if I had the disease I would hear phantom cats and stuff in general all the time not just once, maybe multiple ones at the same time, and specifically in that situation hear my wife (soundly sleeping like everyone else) telling me loudly and clearly to let the stray cat in to warm up, verbally and clearly and loudly.
However the alternative model, is I'd solely hear the wife telling me to let the stray cat in to warm up, maybe not even hearing the phantom meow.
An individual spurious signal model vs a generally increased noise level model.
A side orthogonal issue might be requiring it to have substantial influence on life. While almost asleep I once thought I barely heard a stray meow outside in the freezing rain so I got up and looked out the windows for a minute has no real influence on my life as an isolated although unusual incident, in comparison, constantly hearing voices loudly tell me peculiar things would have a huge influence on my daily life. So that is interesting too.
some people might have "imaginary friends" who they chat to about the weather, quietly. Other people have "imaginary friends" who they have screaming arguments with.
That's very interesting. I hadn't heard of that before. I wonder if it'd be possible to conduct an anonymous survey as to whether people have imaginary friends that they routinely chat with or get into screaming arguments with? I wish such a survey could be trusted, but it'd probably attract troll results.
You might find "the origin of consciousness in te breakdown of the bicameral mind" interesting. It references studies as such. It's from 1975, and either a stroke of genius or complete crackpot. But it is interesting, well argued, and potentially mind blowing. I have no idea if anyone studied voices among normal people since this book was published.
Julian Jaynes' book was required reading in my geeky circle of friends, and the root of many "voices of the gods" jokes. Good for endless drunken campfire discussions.
Basically, he said that before we developed language, the voices of the gods ('imaginary friends', 'voices in our heads') told us what to do when instinct didn't. The development of language pushed out the voices of the gods. I don't remember much more than that.
I heard that he had retracted the whole thing, but can't find any evidence of that retraction.
My understanding is that it's not "before we developed language" - but rather, before we developed modern culture, which silences these voices ("imaginary friends") during upbringing.
However, Jaynes argues that various conditions (schizophrenia, non-schizo "voices") are a non-silences version of that natural tendency, albeit often harmful - the revenge of the forgotten imaginary friends, if you will.
About to make the same comment. I have not had any contact with a schizophrenic sufferer. The closest I got was via the movie "a beautiful mind", which is pretty distant. In that movie, it seems to portray the life of a schizophrenic sufferer as you have described it, but I really wonder how close it is to reality.
You are not doomed if you have the wrong genes, but from what little I know it does seem like an environmental stress explanation is rather appealing for addressing why mean schizophrenic onset occurs later for those in highly structured environments, such as the armed forces.
"However, when we examined the whole data set of 298 assessments, a cross-validated probabilistic neural network model was superior and
could discriminate all cases from controls with near perfect accuracy at 98.3%."
Depending on what they're measuring, 98.3% can be pretty bad. Given that there's about a 1% portion of the population with schizophrenia, if the test is right 98% of the time (irrespectively of everything else), then it'll misdiagnose two healthy people as having schizophrenia for every correct diagnosis.
Yes, but wouldn't it be obvious (or obvious eventually) that these healthy people clearly don't exhibit other symptoms of schizophrenia? Or am I forgetting something?
What about terrifying people with the thought they have schizophrenia but just haven't demonstrated visible symptoms yet? That concern comes up a lot with genetic testing because many things aren't certain but people panic and make significant life-altering decisions after a positive test result.
EDIT: … I should also have noted that humans are notoriously suggestible – with a mental illness it's really easy to imagine people both assuming every quirk is proof of a terrible disease or even starting to demonstrate symptoms psychosomatically after being told that this will happen eventually.
… or with family histories, etc. The real challenge, though, is probably just for doctors to be very open about false positive and negative rates and explain the issue directly. I think a lot of these issues would be easier if someone was frankly told “3 times more people receive positives on this test than actually have the disease“ instead of “it came back positive for [scary]”.
Nevermind the classic problem that was addressed in One Flew Over the Cuckoo's Nest and others: how do you prove you're sane? If the machine says you're insane, what way is there to prove otherwise?
You are assuming errors would be random, which is probably false. A false positive would probably be more likely for someone with similar symptoms, than for someone without any symptoms.
Hm, that's interesting. A lot of parkinson's related disease (different than schizophrenia, but still involving dopamine a lot) have eye movement findings that are pretty recognizable.
Culturally, not sure if psychiatrists are in the habit of examining eye movements as closely as, say, a neurologist or neuro-opthalmologist, but it'd be interesting if this is replicable by other groups.
It's only another tool in the diagnostic toolkit. My presentation is, um, "non-classical" to say the least (intentional tremor being, perhaps, the weirdest part of it) and arriving at a diagnosis of Parkinson's disease pretty much involved ruling out everything else that might have been causing my symptoms (which is a rather long process, all things considered). I've met dozens of people who I could have spotted as Parkinson's sufferers two blocks away at night during a blackout, and a few who, like me, seem to have a bespoke version that "isn't the other things" and responds to treatment for Parkinsonism. Well, as well as anything does, at least - meds are always a pretty blunt weapon and can't exactly track the body's own chemistry, so there will always be good periods, and under/over-medicated periods as well. When it comes to neuropathy - or normal functioning, for that matter - we're not quite stumbling around in the dark, but there's still one hell of a long way to go before we can say that we understand much about the machine.
In the near future most laptops will have the ability to do realtime eye tracking so these kinds of tests could be administered broadly, probably even through a web page.
how close are consumer eye tracking devices? It'd be interesting to see. My group works w/ the PD side of things, and doing a desktop-based eye test might be something we'd be interested in...
So I'd say all the pieces are in place to do this. The architectural design of the tobii and the leapmotion is almost identical. High frame rate cameras over USB3 illuminated with IR.
----
Throw in an http://emotiv.com/ EEG and one could do all sorts correlations.
What I don't like about Emotiv is that external EEG is never that great - it only gets aggregate LFP's from signals from > 6 square cm of cortex at a time, and high frequency signals don't get through the bone and muscle. Still, data is data....and the sad part is neuro people have been looking at EEG for over a century and never really bothered to do real signals analysis on them...
In the mid-90s, I remember hearing that in my state, cancer research received $150/hospital bed, heart disease received $100/bed, and schizophrenia received $7/bed. My amateur theory on that was that the first two affect old, wealthy people, whereas the third affects young people with no power.
Here in Virginia, we recently had a pretty striking demonstration of what you're talking about. One of the leading politicians in the state, state senator Creigh Deeds, was attacked with a knife and nearly killed by his own son, Austin, who was 24. [1] After the attack, the son killed himself with a self-inflicted gunshot wound. Deeds was in dire condition, but survived.
It came out afterwards that Deeds' son, who had been diagnosed in the past with bipolar disorder, had undergone a psychiatric evaluation the day before the attack, and as a result of that evaluation had been placed under an emergency custody order. But Virginia law only gives mental health authorities six hours to find a bed to put the patient into in such cases; and in this case no bed could be found in that time, so Austin Deeds was sent home. [2]
This has naturally provoked a great deal of concern in these parts, both about how so little resources are available for mental health patients that a potentially violent one could be turned away for lack of an available bed, and about the ridiculously short 6-hour limit on how long such patients can be held. And rightly so -- if help had been available for Austin Deeds when he needed it, he might still be alive today, and his father might never have suffered such a horrific experience.
Deeds has recovered now, and upon his return to the legislature announced that he would be pushing hard for mental health reform in the state, garnering wide support. But it's telling that the issue had to strike at a political leader for anyone in the political class to care about it overmuch. One wonders how many other families in Virginia have suffered their own horror stories, their own tragedies, in total silence -- just because, since they weren't rich or powerful, nobody in a position to fix things could be bothered to care.
It's a complex issue. De-instiutionalization was driven both by cost concerns and advocacy for keeping the mentally ill in the community. At one time, the cops would use "searching for a bed" to detain people for excessive periods of time.
That advocacy was driven by the horrific conditions that became common. Google Willowbrook.
That sounds like a really positive result from a horrible occurrence. Mental health care is woefully underfunded in much of the US. Here in Florida they have 24 hours to place someone at a facility after they've been medically discharged, and they still have trouble. Most places that can take people have a very limited number of beds that are already filled, which in turn causes pressure to discharge people potentially prematurely to open up new beds.
The health insurance situation only exacerbates that: there might be 5 facilities in the area that can take people, but only 1 that can take the uninsured. Florida is one of the states that "wisely" chose not to do a Medicaid expansion, and so if you're poor but without a diagnosed, processed, shortlisted disability, you're uninsured. Hilariously federal subsidies for buying coverage only kick in if you're making some high percentage of the poverty line, which people with mental health issues often have trouble reaching a fraction of that.
Oh and to add to that for the one available facility they used the Room 101 description from Orwell's 1984 as inspiration. No windows. Smoothed concrete floors. Echoing cries and screams. Blood. Food barely fit for animal consumption. And of course nothing helpful like any sort of talk therapy. Psychiatrist in residence once a day for 30 minutes, allotting on average 30 seconds per patient. Sleeping in cots on the floor. Sitting against the wall for hours with nothing to do but stare. If you've never experienced it before it becomes pretty clear pretty quick how much meaningful care is provided to unprivileged people suffering from mental health issues in this country.
Also it's in part because mental illnesses still come with a huge stigmatization in this country (USA). If you're diagnosed with schizophrenia, you're not normal, and something is wrong with you. Even though mentally ill people are more likely to be taken advantage of than commit a crime because of their illness, society does not trust you if you're schizophrenic. In fact many people make fun of the mentally ill or totally ignore them. If you live in the bay area you don't have to look far for proof, just look out your window. When I visited I was surprised to see so little thought given to the countless, clearly mentally ill homeless people in almost every part of San Francisco. I can feel some of you scrambling to justify how it's somehow their fault, how it's okay to not care that they are mentally ill and homeless, that they somehow chose that life. I do it, too, because it's part of our cultural programming.
Someone fairly close to me is affected by the illness, and I've discovered it's not something you can just talk about. If someone close to you has heart disease, you'll get sympathy. If someone close to you has schizophrenia, it's almost shameful to talk about. It just doesn't get the same amount of sympathy.
What would be a good way to help a person who is mentally ill, homeless and is not fitting any structure like a hospital? I.e. if the person agrees to undergo treatment program, stay in the facility, etc. it's fine but what to do if they are not?
Homelessness is complicated, both the causes and the solutions. I am big on trying to light a single candle rather than curse the darkness. Here is my candle for homelessness:
I also speak out here and on Metafilter. My diagnosis is not a mental health issue, it is medical, but it is clear to me that it impacts my mental functioning. My answer for me is a) preserve as much agency for myself as possible and b) get my body well.
I have a cystic fibrosis. People accuse me of being mentally ill for thinking I can get well. I have been told that is not possible. It is possible. I have made ongoing forward progress for 13 years.
Unfortunately, most people do not believe me and the social fallout from that is pretty crazy-making.
Just because the answer is not easy or quick does not mean there is none. There are lots of ways to work on issues like homelessness and the mental health of other people. Each piece of the puzzle matters.
Well, if you look at cause of death, the first two are the big hitters in the US so that is part of the basis for more money. The history of funding treatment is pretty bad though.
It's not so much no power, it has been the lack of advocates because of the shame associated with all mental illnesses. A person with cancer can do the noble stand. A person with schizophrenia is much less capable of doing the needed advocacy. Things are changing as more people are pushing and not keeping quiet.
From a advocacy view, we better start putting this and brain problems in general front and center since we are living long enough that we need the understanding of treating the brain to use our longer lives well.
But we're not living long enough that we're all getting schizophrenia. We're living long enough that we're all getting cancer and heart disease. Even in the realm of mental illness, if the problem is "we're living long enough to develop new problems", wouldn't we want to focus on age-related problems?
You can still get schizophrenia in your old age. "23.5% of patients with schizophrenia developed the illness after the age of 40" Beyond that in the elderly it often get's lumped in with other form of Dementia and ignored.
IMO, finding real treatments for mental illness is probably the most important part of longevity research as a healthy body and a decayed mind is in some ways little different than a dead body.
If you could only develop schizophrenia young, it wouldn't make much sense to call it "age-unrelated". You can get chicken pox when you're old, too, and in fact it's particularly deadly to the elderly, but there's not much place in aging amelioration for anti-chicken-pox research. It's best addressed elsewhere (also, yes, basically solved already, but I'm trying to make a different point).
23.5% of schizophrenia sufferers is a minuscule quantity. What percentage of people over 40 develop schizophrenia? Over 60? What percentage of people over 60 develop one of "cancer or heart disease"?
> a healthy body and a decayed mind is in some ways little different than a dead body.
I don't disagree at all.
> finding real treatments for mental illness is probably the most important part of longevity research
No, the most important part of longevity research is getting the body to last. A dead body with a "healthy mind" (not clear what that would mean) doesn't qualify as longevous by any standard. Someone who won't go senile for 150 years is pointless if he dies at 82 like a normal person, and while that scenario is admittedly a kind of progress it (a) is undetectable, which makes research difficult, and (b) has no application at all until we can get the guy to live longer. Longer lifespans are more fundamental, are immediately visible, and have immediate application; they can take advantage of natural variation in the onset of mental failure.
Another aspect of mental illness is that it directly affects how you relate to someone as a person. It's a behavioral disorder, it affects the personality.
A person has heart disease or cancer. A person is schizophrenic, or bipolar, or manic, or psychopathic, or depressed.
It's like the aphorism "you have a body, you are a soul".
A person with cancer or heart disease may be concerned and occupied by the disease or condition, but it's not who they are.
I've had my own encounters with people suffering from various psychological conditions, and ultimately, it's simply very trying to be with them in many cases. It's worse if you're not aware of the condition at all. In several cases the information emerged later, with a very strong sense of "well, that explains a lot".
Worse is when the person turns on you, whether emotionally, physically, or by other means. And yes, I've had that happen as well.
I do have a great deal of sympathy for those suffering from such conditions, but my own self-preservation (and sanity-preservation) instincts also kick in after a time.
Much excellent discussion here, I might add, thanks all.
But are heart disease and cancer "somewhat more treatable" inherently, or because more resources have been devoted to finding and testing treatments that work for them?
Or both. Brain is arguably the most complex system in the human body, and understanding of how it works is, AFAIK (I'm not an MD or a scientist), still not very comprehensive, much less than, for example, the heart. Treating extremely complex system which we don't know how exactly it works and are very limited in experiments (pigs or mice can have hearts not unlike ours, but their brains probably differ much more and while one can observe heart disease in mice, I wonder how you could observe mental illness like schizophrenia?) would probably be not easy at all.
I think it's more that anyone can get cancer, or heart disease... But I am never going to get schizophrenia- I'm not crazy!
It's perfectly rational for a disease that can strike anyone to generate more fear (therefore funding) than one which everybody believes they're immune to.
Some people are similarly skeptical that migraines without auras are "real migraines," but once you explain that it's otherwise the same symptoms (headache, sensitivity to light/sound, nausea, vomiting) and treated by the same specialized painkillers, they'll generally take your diagnosis at face value. According to Wikipedia, a pretty sizable majority of migraine sufferers don't have auras. But it's a distinctive symptom, so it's well known.
I wonder if the reaction to schizophrenia is partly due to not having as strong an understanding of how to treat it, in addition to not knowing what it's exact causes are. Having a well proven solution to a problem seems to make it easier for people to accept that the problem really existed.
I used to get what I would very much consider "real migraines" as a child. Would lay in bed shivering with this crippling jack hammer bashing into the (always) lower left side of my skull.
Eventually the pain would get to the point where I'd get up, go to the bathroom and vomit; then within minutes the migraine would subside.
As an adult I rarely get them, but when I feel one coming I know to take a couple of Advil to head it off at the pass so to speak.
Anyway, what is a migraine with an aura? The only aura about me that I recall was my sisters telling me to shut the hell up from their bedrooms o_O
Thanks, interesting. I've never had that experience pre-migraine, although subtle scotoma is always there; i.e. transparent squiggly lines in the vision (assume everyone has this).
>Life expectancy as about 17 years less for those with the diagnosis
That's interesting. Is that due to some sort of biological action of the illness itself or is it due to behaviors that are associated with the illness?
To put it another way, is it due to illness itself shortening their life span or due to behaviors like self medicating with alcohol or a higher suicide rate?
Mix of factors. Drugs play a role (especially alcohol and cigarettes) but a surprising percentage of the deaths are non-drug cardiovascular deaths, related to poor diet (many mentally ill people are obese and diabetic by middle age) and high levels of chronic stress. Being low on the socioeconomic totem pole, even for a short time, is pretty dangerous to the heart, brain, and immune system.
Aren't there structural brain findings reported in some imaging research studies? I'd be interesting to see some of the work in MRI volumetric studies (i.e. voxel-based morphometry) or dopamine transmitter imaging, especially comparing longitudinal progression of schizophrenia patients or in cross sectional comparisons against healthy controls
My 10 year old daughter has autoimmune liver disease. It also affects her kidneys and bladder. She is being lined up for transplants. Its devastating to her, and the family. Yet, despite numerous letters and meetings with her consultants, therapists, and social services, the moronic arrogant staff at her school refuse to take it seriously and cause her and us unbelievable problems and stress. It borders abuse.
I'm very sorry to hear that. My wife has an as yet in diagnosed autoimmune issue. It's looking like either lupus or MS, but we have to wait until she's churned through the system to get a proper diagnosis. Luckily, her work place has been extremely understanding and supportive. But we've heard stories of people who see initial understanding that quickly turns sour. I hope all goes well with your daughter and that she can have a happy and healthy life.
Do you think home schooling could be an option? I've never looked in to it as we don't have children ourselves. I hated school because most of my teachers and the staff weren't qualified to teach tricks to a dog, much less teach life lessons and knowledge to children.
Schizophrenia is a serious illness, and often misunderstood as "split personality." It is a constellation of delusions, hallucinations, and scrambled thoughts that is often (though not always) pretty devastating to work, school, relationships, etc. For some reason, because we have no blood test or genetic test for it, the diagnosis is still met with skepticism from many in the public
I'm glad you posted this.
These diseases (schizophrenia, bipolar disorder, depression, PTSD) are challenging and can be horrible but I feel like the stigma makes them a lot worse. It's like many natural disasters in which the human malfeasance after the event causes more harm than the thing itself.
The way people treat people who are afflicted by these diseases is, in many cases, an aggravating factor. Instead of helping them, plenty of people (especially in the corporate world, and in society at large after 1980 or so) kick them when they're down. It's pretty disheartening.
The stigma is absolutely the biggest problem with the treatment of mental illness.
It would be as if you went to someone with cancer and said, "Well, if you really wanted to, you could just shrink that tumor right now. You just don't want to commit to changing your life. It is your fault."
I never believed this until my sister died. Now I realize just how broken the system is.
Unfortunately, that stigma exists elsewhere in medicine, too.
I'm a quadriplegic. My father has the overwhelming opinion that since my condition is 'incomplete' (meaning that I have some movement in affected regions), that it's up to me to recover, and that I can't walk because I don't put my mind to the task at hand.
A shocking thing to say to someone, but his opinion has been echoed to me by various healthcare professionals and therapists throughout the course of my care, that the mind simply will not allow the body to recover without ample hope and work towards such a recovery.
I have encountered a set of people in life that , while seemingly uninfluenced by religion or mysticism, believe that certain parts of the body (the brain, especially) work on principles and ideas that we're completely uninformed about. Consequently, those people suggest and use themselves methods derived from mysticism, without a solid scientific backing(not to say that hope and patient mental well-being aren't important for recovery, they are, but you can't 'hope' a spinal cord back together as some seem to think).
Hopefully as we document more and more quantifiable physical changes associated to disorders which we know little about this trend will slow. It's important to consider the mental aspects behind a problem, but it's a waste of time and potentially destructive to put the recovery solely in the hands of the inflicted and their mental state.
And worse yet, the cause is wildly misunderstood. One person's debilitating depressing might be resolved spectacularly via light therapy, another via a single medication, another yet only moderated by a constellation of medications, and others who have undergone a variety of treatments for a decade with little improvement.
Compare that to, say, a broken leg, which is much easier to understand.
There's a huge stigma attached to certain cancers, too, like lung cancer not caused by smoking.
You are, as I recall, too young to know about times before 1980 by personal experience. I'm not sure what you are referring to here, but if you are referring to deinstitutionalization, that happened MUCH earlier, with considerable impetus from the personal experience of President Kennedy.
In the old days of Freudianism, stigma was worse and the affliction of people with mental illness was worse. (Basis of knowledge: much specific reading on these topics, including reading about the history of diagnosis and treatment of major mental disorders, and having lived through all the years mentioned in this reply.)
Under Reagan there was a national de-institutionalization of mentally ill people, who largely ended up as the multitude of homeless vagrants who occupy urban scenes across the country.
No, no, a thousand times no. A vicious libel, connected to the "fact" that the homeless are an issue when the President is a Republican, and almost entirely disappear when he's a Democrat (I don't remember it happening to Nixon, but per the timeline below this wouldn't be contributing; the 60's judicial nullification of anti-vagrancy laws also obviously contributed: https://en.wikipedia.org/wiki/Vagrancy_(people)#United_State...).
As mentioned by tokenadult, who's an older type like myself, this really got into action with JFK's Community Mental Health Act (https://en.wikipedia.org/wiki/Community_Mental_Health_Act) and had a medical basis in effective treatments for schizophrenia and bipolar disorder that required the institutionalization of "hopeless" patients (something my mother witnessed as an RN in the 1950s; note that the study/studies behind this started in the mid-50s). It was pretty much finished by the time he became president.
There's also no way the institutions could have been closed down so fast as to create the "Reaganomics creates homelessness!" headlines et. al., which happened rather quickly.
Yes, it began with the CMHA, but it was under Reagan's presidency that the people who really should not have been de-institutionalized (ie, not the older people with dementia/etc who were returned to their homes and families during the first wave of CMHA, and instead the younger people with very serious mental illness and no support system), were. This is very well documented in the book American Psychosis by Torrey if you're interested in the facts.
As I mentioned above, between my mother and myself, we were there, we lived through the whole period in which the existing system was systematically dismantled and we know the facts from following "current events". My mom's something of a junkie for that, more than a bit of which rubbed off on me; while this was not a major focus of her's, it got her interest when a while after 3 months of residency in a psych ward, she returned to work as an RN Nurse Anesthetist and saw one of her "hopeless" cases doing janitorial or orderly work there. After thousands of years of hopelessness, this was an earthshaking thing.
Sure, some was done after Reagan became president (heck, it continues today, my Missouri Democratic governor is shutting down an institution for the mentally retarded not too far north), but you're going to have to do better than a book published in 2013 that couldn't pass the gatekeepers without blaming it on that devil Reagan.
You're really going to claim that few of the latter, the very ones with the diseases we started effectively treating in the '50s, true miracles that prompted a Federal rethinking of our approach starting in that decade, somehow continued to be warehoused until 1980???
I think this is a case where Wikipedia is not a sufficient source (wonderful though the website is). While I respect you and your mother's experiences, I prefer published evidence over anecdotal. I'll refer you to the book rather than continue this thread: http://goo.gl/yjKGxj
You're confusing two things we're providing witness of:
My mother's anecdotal experience with the revolution of treatment of schizophrenia with anti-psychotics in the '50s, which merely dovetails with the Federal government also recognizing that this deserved a serious rethink of how we treat these formerly "hopeless" cases.
Our non-anecdotal watching of current events as this good impulse was totally botched over the next N decades.
E.g. I suppose it's an "anecdote" that I read not that long ago that the state is shutting down an institution for the mentally retarded a bit to the north of me, but that's not using the word in the way you mean.
Anyway, for us, "published 'evidence'" that per your statements contradicts the facts as we contemporaneously observed them, and for obvious political motives, is less than interesting. Especially when there are so many good, honest accounts of this out there.
You will find that most if not all of the homeless became that way after they became mentally ill and there was no or very little support available for them.
If you want to end homelessness you have to bring back a mental health system that supports the mentally ill, helps them make house payments, and can train them for new jobs when they lose them.
All of these public shootings done by mentally ill people represent less than 1% of the mentally ill population, but the news media takes delight in vilifying the mentally ill as all being violent. This is, of course, not true. But news media makes popular opinion out there. If something is popular, it does not make it true.
All of these public shootings done by mentally ill people represent less than 1% of the mentally ill population, but the news media takes delight in vilifying the mentally ill as all being violent.
If you factor out drug use, the mentally ill population isn't more dangerous than anyone else.
I don't think that the media intentionally vilifies the mentally ill. Instead, I think that people in general seek mental illness as a partial explanation for extreme violent behavior. "He must be one sick fuck." It's much easier to explain human badness in terms of illness than to confront the more complex truths: (a) sometimes good or average people do bad things, and (b) some people are just horrible.
If you start concluding that all extremely violent people are mentally ill (which is probably false) and use the flawed (A -> B) -> (B -> A) thinking that passes for logic among many people, you start thinking of mentally ill people as all potentially violent.
I think that people in general seek mental illness as a partial explanation for extreme violent behavior.
Arguably: someone who's violent has a psychological disorder.
However several of the psychological disorders most associated with extreme violence or antisocial tendencies also leave the subject in a very high-functioning state. They can also be frustratingly resistant to any sort of treatment (drug, talk, or other therapies).
Lack of empathy is often not nearly as debilitating as hearing voices and seeing visions.
Lack of empathy is usually when one is a sociopath not suffering from schizophrenia or autism.
The problem is some people on the autism or schizophrenia spectrums cannot express themselves, but they have empathy and compassion, but are misunderstood by society and the news media. They just lack social skills and people skills, but can be taught them by books and therapy. Most are even nonviolent and very good people if only they were understood.
Sort of like Sherlock Holmes, only Doctor Watson seemed to be able to understand him, everyone else misunderstood him and didn't want anything to do with him because they thought he was a mean jerk with no empathy. He had empathy but got rid of distractions to focus on solving crimes to save humanity from evils like Professor Moriarty and his gangs of sociopaths.
I always see people using 'sociopath' as different from 'psycopath', and I also see people claim they mean the same thing, and I also see people say that neither are used anymore, technically speaking (as in psychiatrists). Anyone with formal training on the area would be kind to briefly (or not) clear this up?
See also https://en.wikipedia.org/wiki/Psychopathy_or_sociopathy and in general also note the WHO's International Statistical Classification of Diseases and Related Health Problems (ICD), which could be a less intensely political artifact than the US DSM.
The story that gets portrayed in the media of mentally ill people being a major danger to the general public is just that - a story. The facts don't back it up.
Even if it were the case that the violent and dangerous criminals were suffering from mental illness, wouldn't it make a lot more sense to strive to provide access to treatment for mental illness than just villify those who suffer from it?
What most people don't consider is the change in life span: http://www.ncbi.nlm.nih.gov/pubmed/21741216
Life expectancy as about 17 years less for those with the diagnosis, which is worse than most cancers. It's mentioned in the article, but worth repeating.