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Are there any circumstances where schizophrenia or bipolar disorder are not lifelong?

Are there any circumstances where schizophrenia or bipolar disorder are not lifelong?


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It is known that psychiatric disorders such as schizophrenia and bipolar I, and bipolar II are for life, and require long term treatment (lifelong).

Is this always the case?

The answer could include reference to any disorder, even those not listed in the DSM, say bipolar III, bipolar IV, bipolar V, etc. This refers to what is known as bipolar spectrum disorder.


According to this systemic review (:the most objective kind of evidence come from reviews of studies not primary sources:) 1 in 7 schizophrenia patients met criteria for recovery.

Source: http://www.medscape.com/viewarticle/814844

A Systematic Review and Meta-analysis of Recovery in Schizophrenia:

Conclusions: Based on the best available data, approximately, 1 in 7 individuals with schizophrenia met our criteria for recovery. Despite major changes in treatment options in recent decades, the proportion of recovered cases has not increased. http://www.medscape.com/viewarticle/814844


The current understanding, I believe, is that symptomatic psychiatric disorders may or may not be lifelong according to many factors, but that the susceptibility to them probably is lifelong. Some examples…

  • Substance-induced psychosis (which is pretty much what it sounds like) is often though not always temporary.

  • Certain types and locations of brain tumors may cause psychotic symptoms, which may or may not reverse on treatment. Afr Health Sci. Dec 2004; 4(3): 190-194.

  • Major depressive disorder has a highly variable course, and may reoccur or may not. N Engl J Med 2008; 358:55-68. DOI: 10.1056/NEJMra073096


Schizophrenia has no cure, which means you cannot "force" it to stop. However, not every case is lifelong by nature.

Information on schizophrenia prognosis: http://en.wikipedia.org/wiki/Prognosis_of_schizophrenia

"A clinical study using strict recovery criteria (concurrent remission of positive and negative symptoms and adequate social and vocational functioning continuously for two years) found a recovery rate of 14% within the first five years.[17] A 5-year community study found that 62% showed overall improvement on a composite measure of clinical and functional outcomes.[18]"

Some tellings from people who have come through: http://www.topix.com/forum/health/schizophrenia/TL09TM53OI68I1IVI


All Movies About Schizophrenia: An Extensive List of Films

The list below consists of movies that specifically are about cases of schizophrenia or are thought to be. They are listed in order by date of release. Many of these movies are not based on true stories, but some are. Not all of these movies portray schizophrenia or a main character with schizophrenia, but some have schizophrenic themes and/or overtones.

The Snake Pit (1948) – This movie is based on the novel “The Snake Pit” written by Mary Jane Ward in 1946. The novel tells a story about a woman who finds herself in an insane asylum and cannot recall how she ended up there. This film was considered very well done and actually won an Oscar. The story was based loosely on Mary Jane Ward’s life experiences in psychiatric care. She hears voices, feels out of touch with reality, and doesn’t remember her husband.

Through a Glass Darkly (1961) – This was a Swedish movie that is considered a three-act “chamber film.” Four family members act as mirrors for each other. The entire movie takes place while a family is on vacation on a remote island. One of the characters is released from an insane asylum where she was being treated for schizophrenia.

Images (1972) – This is a British-American movie about a wealthy housewife who experiences many delusions and hallucinations regarding her husband. She is obviously dealing with schizophrenia and has to sort out what is real from what is just in hear head. This movie is classified as a psychological thriller.

No Mercy No Future (Die Berührte) (1981) – This is a German movie about the daughter of uncaring wealthy parents who is locked up in an institution because she has schizophrenia. She experiences hallucinations and wanders the streets in search of God because she doesn’t receive proper psychiatric treatment. She ends up getting company from many strange, wandering men.

Santa Sangre (Holy Blood) (1989) – This was a Mexican-Italian movie with both flashbacks and flash-forwards in the plot. It is set in Mexico and details the crazy story of a boy named Fenix who grew up in a circus. The story involves flashbacks of religious cults, violence, and symbolism. The flash-forward involves drugs, prostitution, and murder.

Nightbreed (1990) – This was a fantasy horror movie about an unstable mental patient who is led to believe by his doctor that he is in fact a serial killer. His doctor is the actual murderer, but since he is struggling with mental illness, he is an easy victim for a set up. He eventually finds refuge in an abandoned cemetery. The main character is drugged by his doctor with LSD disguised as lithium and is ordered by his doctor to turn himself in for various murders.

Drop Dead Fred (1991) – This is a comedy fantasy style movie that includes emotional abuse, mental illness, and profanity. A young girl has an imaginary friend named “Drop Dead Fred” who causes chaos around the house and neighborhood. Nobody can see him except the young girl named Lizzie. Her mother is emotionally abusive and highly controlling. Although this isn’t completely schizophrenic behavior, some would argue that it could be classified as such.

The Fisher King (1991) – This is a comedy-drama style movie about a radio DJ who tries to help a man whose life he unintentionally ruined. He made a lot of insensitive, rude comments to a depressed individual who was a caller on his radio show. The guy who called the radio show ends up committing a mass murder at a popular Manhattan bar. The radio DJ ends up becoming suicidal for what had happened in regards to the caller into his show. He eventually attempts suicide, but instead is rescued by a homeless man suffering from catatonic schizophrenia.

Clean, Shaven (1993) – This movie is about a man who suffers from schizophrenia and is trying to get his daughter back from her adoptive parents. This movie attempts to take an objective look at the illness of schizophrenia and individuals that have it.

Benny & Joon (1993) – This was a romantic comedy movie about 2 unusual people that meet each other and fall in love. This film stars Johnny Depp and Mary Stuart Masterson as a couple. It has been noted by critics that “Joon” the character played by Masterson suffers from schizophrenia. Joon does experience auditory hallucinations and ends up doing pretty well with a stable routine and her daily medication.

Angel Baby (1995) – This is an Australian drama film about two people that meet during therapy and fall into deep love. Both of these individuals have been diagnosed with schizophrenia. They end up moving in together, getting pregnant and the wife dies during childbirth. Their daughter is given to the husband’s brother.

Conspiracy Theory (1997) – This is an American thriller movie that is about a lawyer working for the U.S. Government. A taxi driver who is a conspiracy theorist believes that most events that happen in the world are a result of government conspiracies and tells his ideas to the lawyer. The lawyer (played by Juilia Roberts) finds him funny because he saved her from a robbery, but doesn’t know that the taxi driver has been spying on her home. Some would suggest that there are overtones of schizophrenia in this movie.

Julien Donkey-Boy (1999) – This is an American drama movie about a young adult with untreated schizophrenia. He lives in a dysfunctional family with his sister who he may have gotten pregnant, and a highly athletic brother, and his authoritarian father. This film was not regarded well by critics.

The Messenger: The Story of Joan of Arc (1999) – This is a French historical drama movie that tells a story of St. Joan of Arc – the French war hero and religious martyr of the 15th century. As a young girl, Joan begins having “visions” that inspire her to lead the French battle against English forces. Her success in overcoming the English forces results in Charles VII taking the throne as ruler. Eventually Joan ends up being executed for committing heresy.

A Beautiful Mind (2001) – This is an American biographical drama movie that is based on the life experiences of John Nash (Dr. John Forbes Nash) – who struggled with schizophrenia. It features Russell Crowe playing star character John Nash and was inspired by the bestselling book with the same name written by Sylvia Nasar. The story showcases John Nash as a child prodigy and highlights the onset of paranoid schizophrenia in which he experiences delusions and believes that the F.B.I. is after him. It won four Academy Awards and was well received by critics.

Donnie Darko (2001) – This is a science fiction drama movie starring Jake Gyllenhaal, Drew Barrymore, and Patrick Swayze. It documents various adventures of the main character (played by Gyllenhaal) as he searches for meanings of visions that he experiences related to Doomsday. This movie has received pretty positive feedback and still has a large cult following.

The Caveman’s Valentine (2001) – This is an American mystery-drama style movie starring Samuel L. Jackson. It is based on the book “The Caveman’s Valentine” by Geoge Dawes Green that was released in 1994. The plot involves a former family man and pianist studying at Juilliard music school who suffers from paranoid schizophrenia and lives in a cave near Inwood Park, New York. He experiences delusions that a man is controlling the world with rays from the Chrysler Building and that his mind is being taken over.

K-PAX (2001) – This is a science fiction, mystery movie starring Kevin Spacey and Jeff Bridges about a psychiatric patient who believes he is an alien. The patient claims to be an alien from the planet “K-PAX” – hence the title of the movie. Oddly enough, his outlook on life ends up being an inspiration for other patients as well as his psychiatrist.

Igby Goes Down (2002) – This is a comedy drama style movie that follows the life of a teenager in New York City who tries to cut ties with his family. In the movie, Jason Igby’s father suffers from schizophrenia and is committed to a psychiatric institution. Igby is fearful that he will eventually develop the same mental illness as his father. He sets out on a mission to find a better life, but ends up visiting his godfather.

Spider (2002) – This is a Canadian/British psychological thriller movie about a man who is staying at a halfway house for the mentally ill. When he is released from an institution, he begins to remember a childhood trauma that occurred – his father’s murder. He also recounts other murders that happened while growing up and is taken back to an insane asylum.

Homeless to Harvard: The Liz Murray Story (2003) – This movie is adapted from the autobiography written by Liz Murray called “Breaking Night.” Liz is one of two daughters in a Bronx family and her mother has schizophrenia and is addicted to drugs. Her father is a drug addict as well, but has AIDS and lacks social skills. She ends up running away from home with another girl who is being abused. She goes on to become a star student and accomplishes a lot during her collegiate life.

Keane (2004) – This is a drama movie set in New York City that highlights a mentally ill man trying to get over the fact that his daughter was abducted several months prior. He searches for his missing daughter and the main character “Keane” confronts various ticket agents and random strangers with documentation of her disappearance, but no one says they had seen his daughter. He ends up doing drugs and becomes increasingly paranoid – he thinks he is being followed. Some of the symptoms he exhibits are schizophrenic in nature.

Spider Forest (2004) – This is a Korean psychological thriller movie about a man who awakens in the middle of a forest and finds a cabin. In the movie, the main character sees someone who has killed many people who runs through the cabin. He eventually awakens again in a local hospital and is fully bandaged. His friend questions him about the murders and he realizes that he is the main suspect in the murders due to the fact that his fingerprints have been associated with the victims. Some would argue that this movie has some schizophrenic features.

15 Park Avenue (2005) – This is an English-Indian movie about a woman in her 30’s who suffers from schizophrenia and is taken care of by her older sister and mother. The woman suffering from schizophrenia ends up creating an alternate reality in her mind in which she marries her ex-fiancé and has kids. It is discussed that she lead a pretty normal life up until her early 20’s before a traumatic experience made her withdraw from the world – this lead to the development of schizophrenia.

Shabd (2005) – This is a Bollywood drama thriller about a man living a wealthy lifestyle in India with his wife. A man achieves much fame and success with his first book, but his subsequent works are not up to par with the first. He becomes depressed and begins writing a story about a real woman who he follows. The writer experiences such guilt for pursuing this woman that he develops schizophrenia and is sent to an asylum.

Proof (2005) – This is an American drama film featuring Gwyneth Paltrow, Anthony Hopkins and Jake Gyllenhaal. It was based on the play “Proof” by David Auburn. In this film, a mathematician (Paltrow’s father) developed schizophrenia and she has to take care of him.

Stateside (2005) – This is a romantic drama movie based on a true story. The story is about an affluent guy serving in the Marine Corps to avoid being in jail who falls in love with an actress that has undiagnosed schizophrenia. The actress is living with undiagnosed schizophrenia and her concerts keep doing poorly as a result of her condition. The story is based on the life of actress Sarah Holcomb.

A Scanner Darkly (2006) – This is an animated science-fiction thriller starring Keanu Reeves, Robert Downey Jr., Woody Harrelson, and Winona Ryder. The movie is about a powerful drug called “Substance D” becoming popularized throughout the United States after the government has lost it’s “war on drugs.” This drug causes people to experience bizarre hallucinations and people to experience drug-induced schizophrenia.

Bug (2006) – This was an American film based on a play of the same name about a woman believing the delusions of a schizophrenic man that she meets in an Oklahoma motel. The woman was unable to move on from the disappearance of her son and engaged in drugs and alcohol. She meets this drifter and ends up entering a relationship with him out of loneliness. He explains his delusions to her such as that he has been victim of U.S. Government testing. She believes his delusions and they end up lighting themselves on fire.

Canvas (2006) – This is a drama movie about a Florida family dealing with a mother who is dealing with schizophrenia. This movie received pretty decent, positive reviews – but never became widely popular.

Memoirs of My Nervous Illness (2006) – This movie is based on the 1903 journal that was written by Daniel Paul Schreber. Schreber was a prominent German judge who became incarcerated in an insane asylum after a break with reality. He began experiencing delusions, believed he was communicating with God through a secret “nerve language.” He also had the desire to transform himself into a woman.

Danika (2006) – This is a horror movie about a woman suffering from very disturbing hallucinations with paranoia. Most of the hallucinations that she experiences contain threats to the safety of her family as well as media-influenced fears such as kidnappings, accidents, and terrorists. The woman ends up telling all of her thoughts to her husband and psychiatrist.

I’m a Cyborg, But That’s OK (2006) – This is a Korean romantic comedy that takes place in a mental institution. A young woman believes that she is a cyborg and is institutionalized after cutting her wrists. She experiences many delusions and utilizes electronics to attempt to fulfill her deluded thoughts that she is in fact a cyborg. Another man dealing with schizophrenia believes he can steal people’s souls.

Reprise (2006) – This is a Norwegian movie about successful writers and friends in their early 20’s. One is propelled to stardom, while the other’s work is rejected. The successful writer of the two ends up developing schizophrenia and is picked up by the other at a psychiatric hospital. Eventually the other non-schizophrenic writer finds his voice with the help of his idol.

Woh Lamhe (2006) – This is a movie based on Parveen Babi’s life including her personal struggles with schizophrenia and her relationship with Mahesh Bhatt. This was Bhatt’s tribute to Parveen for the time he was able to share with her. The title translates to “Those Moments” and is in regards to the quality moments he appreciated with her. She is documented in the list of famous people with schizophrenia that was created.

Mr. Brooks (2007) – This movie is a psychological thriller starring Kevin Costner, Demi Moore, and Dane Cook. The movie is based on a successful Portland businessman and serial killer who is forced to take on Dane Cook’s character after being blackmailed. His life gets more complicated when a police officer reopens investigation into his past murders. Some would argue that the tendencies exhibited by the main character do not fully qualify as schizophrenia.

My Name Is Alan and I Paint Pictures (2007) – This is a documentary about Alan Russell-Cowan, a renowned street painter diagnosed with schizophrenia. The movie attempts to address major issues that influence the life of Alan. It includes the treatment and diagnosis of paranoid schizophrenia and highlights the therapeutic aspects of art for people with mental illness.

Savage Grace (2007) – This was a movie based on the book with the same title written by Natalie Robins and Steven M.L. Aronson. The story is based on the relationship between a wealthy socialite and her son in which they engage in incest. The film is based on a true story of Barbara Daly Baekeland and her husband Brooks Baekeland with their only child Antony who ended up being diagnosed with schizophrenia.

Mirrors (2008) – This is a horror movie created to remake the Korean film “Into the Mirror.” The movie begins with a security officer entering a room from which he cannot escape – staring into a mirror. Another security guard attempts to figure out what is going on and during his investigation he discovers someone who suffered from schizophrenia. Most would consider this more of a horror film rather a depiction of schizophrenia.

The Soloist (2009) – This was a drama movie featuring Jamie Foxx and Robert Downey, Jr. It was based on the book “The Soloist” by Steve Lopez. It is based on the true life story of Nathaniel Ayers, a musician who developed schizophrenia and eventually became homeless as a result of his condition. Through the interaction of Foxx and Downey Jr. we find out more about Ayers’ story as a musical prodigy.

Karthik Calling Karthik (2010) – This movie is an Indian psychological thriller about an introverted guy with low self-esteem who is trapped in a job as a construction worker. He has had a troubled childhood and his brother died while trying to kill him in an unpredictable series of events. He eventually begins experiencing symptoms of paranoid schizophrenia accompanied by many delusions.

Shutter Island (2010) – Most people have seen this highly popular psychological thriller directed by Martin Scorsese. It is based on Dennis Lehane’s book “Shutter Island” which was released in 2003. It features Leonardo DiCaprio playing a psychiatric patient on “Shutter Island” (located in Boston Harbor) with an institution for the criminally insane. DiCaprio’s character experiences many of the positive symptoms of schizophrenia including the delusion that he is being psychologically manipulated.

Take Shelter (2011) – This was a drama-thriller type movie in which a new husband (and dad) experiences a series of visions related to the apocalypse. He keeps the visions from his wife and their daughter. He focuses his efforts towards building a storm shelter in the backyard – but his odd behavior puts a strain on his familial relationship. His mother suffered from paranoid schizophrenia – a condition which he eventually developed.

Sucker Punch (2011) – This is a fantasy action type movie about a young woman who attempts to escape an institution for the mentally ill before suffering a lobotomy. The storyline follows her fantasies as well as her escape plan. She was sent to the institution by an abusive step-dad and is blamed for the death of her younger sister. Basically her step-dad is setting her up and trying to make her mentally incapacitated for something she didn’t do.

Of Two Minds (2012) – This tells a story about a relationship between a girl and her younger sister who suffers from schizophrenia. After their mother dies, the older sister is responsible for taking care of the younger, mentally ill sister. After an incident happens between the younger sister and the older sister’s son, it becomes clear that she cannot handle her younger sister’s mental illness.

Do you know any other movies about schizophrenia?

Did I leave any movies off the list that may have been about schizophrenia? If you know of any other movies that could be classified as highlighting the mental illness that is schizophrenia, feel free to let me know in the comments section so I can add it to the list. Of the movies above, what are your favorites? Which ones do you think do the best job at depicting someone struggling with schizophrenia? Personally I really think the movie “A Beautiful Mind” does a fantastic job showcasing the signs and symptoms.


Are there any circumstances where schizophrenia or bipolar disorder are not lifelong? - Psychology


Update, October, 2014

I've done considerably more research into the relation between isolation and stigmatization and psychiatric disorders since first writing this piece, especially in terms of understanding isolation stress and the tangled effects of isolation in the mind. Not many researchers look into this but I am very good at connecting my own dots from studying the neuroscience of stress and case studies of those with certain forms of bipolar, schizophrenia and other mental health conditions. And everything I've found has left no doubt in my mind that not only is isolation stress a major trigger for psychiatric episodes, it is a major factor in the long term outcome for those disorders.

There is a great deal more for me to write about regarding isolation stress and emotional pain and how they're processed in the brain and how this both triggers and contributes to mental health struggles of all kinds (from depression to psychosis to manic episodes to paranoid schizophrenia and others) but I have far too much on my plate for that now. For now then, this will have to continue to serve as an introduction to the affects of isolation on mental health.

-BGE



In talking about isolation and bipolar, I will include schizophrenia as well. I've actually researched schizophrenia more than bipolar even. Indeed the two conditions can be confused for each other and can co-exist as well (well, according to the docs anyway). In discussing how psychological factors can affect the outcome and course of an mental health disorder, isolation may top the list.

One of the greatest blessings that helped me turn things around at the very end of last year was being given access to free therapy through a program sponsored by the psychology department at UBC in which psychologists in training would serve a sort of internship. My therapist, "B", turned out to be a perfect fit for me. Without getting into too much detail of our hours of sessions, feelings of loneliness and isolation was one of the things that B helped unearth for me. The more we talked about it, the more I could see this when I looked back on my own suffering the more alone I felt, the more I suffered.

As well, though B and I only touched lightly on this, among other things that I battled and was effected by, acute sensations of being rejected was one of them. (and speaking of if only, if only I'd been able to keep up the appointments with B. That would have greatly aided me in getting through some of the more recent darkness. But my free sessions ended with the end of the UBC university term. I'm able to continue them but not until a new session opens in September and then with a new therapist).

The nature of this sense of rejection is a whole other thing to explore but I believe it's something akin to Borderline Personality Disorder which, according to Psychology Today's Taming Bipolar, is often "comorbid" with bipolar disorder (and in an interview I conducted for my book with another bipolar sufferer, this came up and we both felt many of the same things, things that are described as symptoms of BPD). In any case, these acute feelings of rejection, whether or not the feeling was justified, would also greatly contribute to feelings of isolation and worsening of the condition and I could trace this back for years, even the years before the current Struggles.

So being as highly interested and motivated as I was at the time (earlier this year) to learn everything about mental health disorders, I turned more of my attention to the role of loneliness and isolation. I had a very strong feeling that I was not alone and that isolated feelings greatly contributed to negative outcomes in mental health disorders. As I read through cases of bipolar, major depressive disorder, schizophrenia and especially suicide, isolation, loneliness and worse, ostracizing from others, showed up time and time again.

Loneliness, isolation and ostracizing are three variations on a similar theme. All three set one apart from others but stem from different situations. Loneliness is the feeling of having no one in your life. Isolation is closer to a feeling of being rejected by others. Loneliness is a passive situation while isolation is an active situation, or in other words, loneliness could be a natural course of events whereas isolation is an active rejection by others. Ostracizing is of course a whole different beast. Like rejection, it's active but with strong malicious intent. I include forms of ridicule as ostracizing as well. How these are experienced very much varies with each individual and how they're feeling at any one point. One may be stronger than others in the face of these things or one may feel stronger one day and more vulnerable the next. All, I felt, would have an accumulative effect over time.

In Sylvia Nasar's superbly written and researched biography of John Nash, A Beautiful Mind (which is not to be confused with the movie of the same name. While I loved the movie, and it is based on the story of Nash as well, it bears little resemblance to the actual story), she does not specifically mention the effects of loneliness, isolation and ostracizing on Nash's illness (which was paranoid schizophrenia) but I could see these three things running like a thread through his life from his childhood to during the worst episodes of his illness. It may or not been any one instance of rejection and isolation but, based on my own feelings and intuition, I could well imagine all the loneliness, isolation and ostracizing he experienced over his life building up and both perhaps playing a role in triggering his episodes and worsening and prolonging them (this becomes a strong self re-enforcing cycle as well as we'll examine).

I really felt I was on to something so it was with some satisfaction that I ran across a piece in the online edition of The New Republic called Loneliness - how isolation can kill you. "Bam", I thought, "this is just what I was looking for".

In it we are introduced to Frieda Fromm-Reichman, a fifties era therapist made famous for her role in successfully treating a severely disturbed schizophrenic young woman named Joanne Greenberg, the subject of the well known autobiography I Never Promised You a Rose Garden (and pop song of the same name). From the article,

While this study does not tell the whole story, it does give a pretty good indication of the attitudes of the general public towards those with mental illnesses. I can tell you from my own experience and from reading dozens of case studies, that this sort of stigmatization and prejudice absolutely does exist and cannot but help contribute to the loneliness and isolation those with mental health disorders experience. I've experienced that even with people who outwardly express empathy, they'll slowly edge you out of their social circle or work opportunities thus ultimately contributing to the cycles of loneliness and isolation and their damaging affects on brain and body health and thus the course of the disorder.

New Update

This is yet another angle of understanding mental health disorders that requires much more study and outlining than I've been able to get to as yet.

At this time I can add this, however. In the four years and some months since originally writing this piece, I have had the opportunity to listen to or observe or read the stories of dozens of people with various disorders. These may be diagnosed or undiagnosed. I look into their life backgrounds and ongoing life circumstances. Meanwhile, I have done considerably more study into available literature on isolation and the brain and the effects of becoming disconnected from understanding, support and caring and loving connection. There are, I believe, very distinct effects on the mind, thinking processes and the very reality the brain creates when one prone to psychiatric disorders experiences certain types of acute or ongoing isolation (this is not to say those without risk for more severe psychiatric disorders are not affected - I think the evidence is strong that almost all humans would be affected - but the effects manifest themselves differently in those prone to psychiatric disorders such as schizophrenia, bipolar disorder, major depressive and/or anxiety disorders along with several others).

There is, I have observed, a hideous and very difficult to arrest or reverse cycle that takes place - the more one is isolated, the less able they are able to connect with and trust others. The less able they are able to connect with and trust others, the more isolated they become. The more isolated they become the more their minds turn inward giving rise to many symptoms and disordered thinking associated with psychiatric disorders. The more and stronger the symptoms and disordered thinking the less able they are to connect with and trust others and so on and so on.

Complicating this is the brain's own ability or inability to be self-aware of or understanding of any of these symptoms and resultant behaviours. Various types of delusions and/or denial will be present. Intervention is a very difficult task for family members or friends (if indeed any are present and involved at all). Society at present is not at all equipped to deal with individuals struggling with this cycle.

Clinically speaking it becomes a near impossible tangle to sort out and treat. I have to emphasize once again that while treatments with pharmaceutical drugs may appear to help in the short term, the evidence and track record for long term efficacy is weak and is complicated by potentially very serious side effects from long term use of psychotropic drugs. Helping any individual struggling with this cycle requires much, much more than a simple drug therapy routine, I'm afraid.

All of which I know sounds darkly lacking in hope. And it's true, I must say, after four and a half years of researching and study into the world of mental health and the brain, the big picture does not look at all promising. Many will be lost.

Yet I do remain brightly optimistic and hopeful on individual levels. It absolutely is possible to overcome this for many and I work daily on ways to see and work on the positive possibilities for any one individual.

So if you are reading along and all of this strikes a chord for yourself or someone you know and care for who is struggling with this, I can only leave you this - there is hope, there are positive possibilities. We just need to get you there.

BGE - September 30, 2017


All Movies About Schizophrenia: An Extensive List of Films

The list below consists of movies that specifically are about cases of schizophrenia or are thought to be. They are listed in order by date of release. Many of these movies are not based on true stories, but some are. Not all of these movies portray schizophrenia or a main character with schizophrenia, but some have schizophrenic themes and/or overtones.

The Snake Pit (1948) – This movie is based on the novel “The Snake Pit” written by Mary Jane Ward in 1946. The novel tells a story about a woman who finds herself in an insane asylum and cannot recall how she ended up there. This film was considered very well done and actually won an Oscar. The story was based loosely on Mary Jane Ward’s life experiences in psychiatric care. She hears voices, feels out of touch with reality, and doesn’t remember her husband.

Through a Glass Darkly (1961) – This was a Swedish movie that is considered a three-act “chamber film.” Four family members act as mirrors for each other. The entire movie takes place while a family is on vacation on a remote island. One of the characters is released from an insane asylum where she was being treated for schizophrenia.

Images (1972) – This is a British-American movie about a wealthy housewife who experiences many delusions and hallucinations regarding her husband. She is obviously dealing with schizophrenia and has to sort out what is real from what is just in hear head. This movie is classified as a psychological thriller.

No Mercy No Future (Die Berührte) (1981) – This is a German movie about the daughter of uncaring wealthy parents who is locked up in an institution because she has schizophrenia. She experiences hallucinations and wanders the streets in search of God because she doesn’t receive proper psychiatric treatment. She ends up getting company from many strange, wandering men.

Santa Sangre (Holy Blood) (1989) – This was a Mexican-Italian movie with both flashbacks and flash-forwards in the plot. It is set in Mexico and details the crazy story of a boy named Fenix who grew up in a circus. The story involves flashbacks of religious cults, violence, and symbolism. The flash-forward involves drugs, prostitution, and murder.

Nightbreed (1990) – This was a fantasy horror movie about an unstable mental patient who is led to believe by his doctor that he is in fact a serial killer. His doctor is the actual murderer, but since he is struggling with mental illness, he is an easy victim for a set up. He eventually finds refuge in an abandoned cemetery. The main character is drugged by his doctor with LSD disguised as lithium and is ordered by his doctor to turn himself in for various murders.

Drop Dead Fred (1991) – This is a comedy fantasy style movie that includes emotional abuse, mental illness, and profanity. A young girl has an imaginary friend named “Drop Dead Fred” who causes chaos around the house and neighborhood. Nobody can see him except the young girl named Lizzie. Her mother is emotionally abusive and highly controlling. Although this isn’t completely schizophrenic behavior, some would argue that it could be classified as such.

The Fisher King (1991) – This is a comedy-drama style movie about a radio DJ who tries to help a man whose life he unintentionally ruined. He made a lot of insensitive, rude comments to a depressed individual who was a caller on his radio show. The guy who called the radio show ends up committing a mass murder at a popular Manhattan bar. The radio DJ ends up becoming suicidal for what had happened in regards to the caller into his show. He eventually attempts suicide, but instead is rescued by a homeless man suffering from catatonic schizophrenia.

Clean, Shaven (1993) – This movie is about a man who suffers from schizophrenia and is trying to get his daughter back from her adoptive parents. This movie attempts to take an objective look at the illness of schizophrenia and individuals that have it.

Benny & Joon (1993) – This was a romantic comedy movie about 2 unusual people that meet each other and fall in love. This film stars Johnny Depp and Mary Stuart Masterson as a couple. It has been noted by critics that “Joon” the character played by Masterson suffers from schizophrenia. Joon does experience auditory hallucinations and ends up doing pretty well with a stable routine and her daily medication.

Angel Baby (1995) – This is an Australian drama film about two people that meet during therapy and fall into deep love. Both of these individuals have been diagnosed with schizophrenia. They end up moving in together, getting pregnant and the wife dies during childbirth. Their daughter is given to the husband’s brother.

Conspiracy Theory (1997) – This is an American thriller movie that is about a lawyer working for the U.S. Government. A taxi driver who is a conspiracy theorist believes that most events that happen in the world are a result of government conspiracies and tells his ideas to the lawyer. The lawyer (played by Juilia Roberts) finds him funny because he saved her from a robbery, but doesn’t know that the taxi driver has been spying on her home. Some would suggest that there are overtones of schizophrenia in this movie.

Julien Donkey-Boy (1999) – This is an American drama movie about a young adult with untreated schizophrenia. He lives in a dysfunctional family with his sister who he may have gotten pregnant, and a highly athletic brother, and his authoritarian father. This film was not regarded well by critics.

The Messenger: The Story of Joan of Arc (1999) – This is a French historical drama movie that tells a story of St. Joan of Arc – the French war hero and religious martyr of the 15th century. As a young girl, Joan begins having “visions” that inspire her to lead the French battle against English forces. Her success in overcoming the English forces results in Charles VII taking the throne as ruler. Eventually Joan ends up being executed for committing heresy.

A Beautiful Mind (2001) – This is an American biographical drama movie that is based on the life experiences of John Nash (Dr. John Forbes Nash) – who struggled with schizophrenia. It features Russell Crowe playing star character John Nash and was inspired by the bestselling book with the same name written by Sylvia Nasar. The story showcases John Nash as a child prodigy and highlights the onset of paranoid schizophrenia in which he experiences delusions and believes that the F.B.I. is after him. It won four Academy Awards and was well received by critics.

Donnie Darko (2001) – This is a science fiction drama movie starring Jake Gyllenhaal, Drew Barrymore, and Patrick Swayze. It documents various adventures of the main character (played by Gyllenhaal) as he searches for meanings of visions that he experiences related to Doomsday. This movie has received pretty positive feedback and still has a large cult following.

The Caveman’s Valentine (2001) – This is an American mystery-drama style movie starring Samuel L. Jackson. It is based on the book “The Caveman’s Valentine” by Geoge Dawes Green that was released in 1994. The plot involves a former family man and pianist studying at Juilliard music school who suffers from paranoid schizophrenia and lives in a cave near Inwood Park, New York. He experiences delusions that a man is controlling the world with rays from the Chrysler Building and that his mind is being taken over.

K-PAX (2001) – This is a science fiction, mystery movie starring Kevin Spacey and Jeff Bridges about a psychiatric patient who believes he is an alien. The patient claims to be an alien from the planet “K-PAX” – hence the title of the movie. Oddly enough, his outlook on life ends up being an inspiration for other patients as well as his psychiatrist.

Igby Goes Down (2002) – This is a comedy drama style movie that follows the life of a teenager in New York City who tries to cut ties with his family. In the movie, Jason Igby’s father suffers from schizophrenia and is committed to a psychiatric institution. Igby is fearful that he will eventually develop the same mental illness as his father. He sets out on a mission to find a better life, but ends up visiting his godfather.

Spider (2002) – This is a Canadian/British psychological thriller movie about a man who is staying at a halfway house for the mentally ill. When he is released from an institution, he begins to remember a childhood trauma that occurred – his father’s murder. He also recounts other murders that happened while growing up and is taken back to an insane asylum.

Homeless to Harvard: The Liz Murray Story (2003) – This movie is adapted from the autobiography written by Liz Murray called “Breaking Night.” Liz is one of two daughters in a Bronx family and her mother has schizophrenia and is addicted to drugs. Her father is a drug addict as well, but has AIDS and lacks social skills. She ends up running away from home with another girl who is being abused. She goes on to become a star student and accomplishes a lot during her collegiate life.

Keane (2004) – This is a drama movie set in New York City that highlights a mentally ill man trying to get over the fact that his daughter was abducted several months prior. He searches for his missing daughter and the main character “Keane” confronts various ticket agents and random strangers with documentation of her disappearance, but no one says they had seen his daughter. He ends up doing drugs and becomes increasingly paranoid – he thinks he is being followed. Some of the symptoms he exhibits are schizophrenic in nature.

Spider Forest (2004) – This is a Korean psychological thriller movie about a man who awakens in the middle of a forest and finds a cabin. In the movie, the main character sees someone who has killed many people who runs through the cabin. He eventually awakens again in a local hospital and is fully bandaged. His friend questions him about the murders and he realizes that he is the main suspect in the murders due to the fact that his fingerprints have been associated with the victims. Some would argue that this movie has some schizophrenic features.

15 Park Avenue (2005) – This is an English-Indian movie about a woman in her 30’s who suffers from schizophrenia and is taken care of by her older sister and mother. The woman suffering from schizophrenia ends up creating an alternate reality in her mind in which she marries her ex-fiancé and has kids. It is discussed that she lead a pretty normal life up until her early 20’s before a traumatic experience made her withdraw from the world – this lead to the development of schizophrenia.

Shabd (2005) – This is a Bollywood drama thriller about a man living a wealthy lifestyle in India with his wife. A man achieves much fame and success with his first book, but his subsequent works are not up to par with the first. He becomes depressed and begins writing a story about a real woman who he follows. The writer experiences such guilt for pursuing this woman that he develops schizophrenia and is sent to an asylum.

Proof (2005) – This is an American drama film featuring Gwyneth Paltrow, Anthony Hopkins and Jake Gyllenhaal. It was based on the play “Proof” by David Auburn. In this film, a mathematician (Paltrow’s father) developed schizophrenia and she has to take care of him.

Stateside (2005) – This is a romantic drama movie based on a true story. The story is about an affluent guy serving in the Marine Corps to avoid being in jail who falls in love with an actress that has undiagnosed schizophrenia. The actress is living with undiagnosed schizophrenia and her concerts keep doing poorly as a result of her condition. The story is based on the life of actress Sarah Holcomb.

A Scanner Darkly (2006) – This is an animated science-fiction thriller starring Keanu Reeves, Robert Downey Jr., Woody Harrelson, and Winona Ryder. The movie is about a powerful drug called “Substance D” becoming popularized throughout the United States after the government has lost it’s “war on drugs.” This drug causes people to experience bizarre hallucinations and people to experience drug-induced schizophrenia.

Bug (2006) – This was an American film based on a play of the same name about a woman believing the delusions of a schizophrenic man that she meets in an Oklahoma motel. The woman was unable to move on from the disappearance of her son and engaged in drugs and alcohol. She meets this drifter and ends up entering a relationship with him out of loneliness. He explains his delusions to her such as that he has been victim of U.S. Government testing. She believes his delusions and they end up lighting themselves on fire.

Canvas (2006) – This is a drama movie about a Florida family dealing with a mother who is dealing with schizophrenia. This movie received pretty decent, positive reviews – but never became widely popular.

Memoirs of My Nervous Illness (2006) – This movie is based on the 1903 journal that was written by Daniel Paul Schreber. Schreber was a prominent German judge who became incarcerated in an insane asylum after a break with reality. He began experiencing delusions, believed he was communicating with God through a secret “nerve language.” He also had the desire to transform himself into a woman.

Danika (2006) – This is a horror movie about a woman suffering from very disturbing hallucinations with paranoia. Most of the hallucinations that she experiences contain threats to the safety of her family as well as media-influenced fears such as kidnappings, accidents, and terrorists. The woman ends up telling all of her thoughts to her husband and psychiatrist.

I’m a Cyborg, But That’s OK (2006) – This is a Korean romantic comedy that takes place in a mental institution. A young woman believes that she is a cyborg and is institutionalized after cutting her wrists. She experiences many delusions and utilizes electronics to attempt to fulfill her deluded thoughts that she is in fact a cyborg. Another man dealing with schizophrenia believes he can steal people’s souls.

Reprise (2006) – This is a Norwegian movie about successful writers and friends in their early 20’s. One is propelled to stardom, while the other’s work is rejected. The successful writer of the two ends up developing schizophrenia and is picked up by the other at a psychiatric hospital. Eventually the other non-schizophrenic writer finds his voice with the help of his idol.

Woh Lamhe (2006) – This is a movie based on Parveen Babi’s life including her personal struggles with schizophrenia and her relationship with Mahesh Bhatt. This was Bhatt’s tribute to Parveen for the time he was able to share with her. The title translates to “Those Moments” and is in regards to the quality moments he appreciated with her. She is documented in the list of famous people with schizophrenia that was created.

Mr. Brooks (2007) – This movie is a psychological thriller starring Kevin Costner, Demi Moore, and Dane Cook. The movie is based on a successful Portland businessman and serial killer who is forced to take on Dane Cook’s character after being blackmailed. His life gets more complicated when a police officer reopens investigation into his past murders. Some would argue that the tendencies exhibited by the main character do not fully qualify as schizophrenia.

My Name Is Alan and I Paint Pictures (2007) – This is a documentary about Alan Russell-Cowan, a renowned street painter diagnosed with schizophrenia. The movie attempts to address major issues that influence the life of Alan. It includes the treatment and diagnosis of paranoid schizophrenia and highlights the therapeutic aspects of art for people with mental illness.

Savage Grace (2007) – This was a movie based on the book with the same title written by Natalie Robins and Steven M.L. Aronson. The story is based on the relationship between a wealthy socialite and her son in which they engage in incest. The film is based on a true story of Barbara Daly Baekeland and her husband Brooks Baekeland with their only child Antony who ended up being diagnosed with schizophrenia.

Mirrors (2008) – This is a horror movie created to remake the Korean film “Into the Mirror.” The movie begins with a security officer entering a room from which he cannot escape – staring into a mirror. Another security guard attempts to figure out what is going on and during his investigation he discovers someone who suffered from schizophrenia. Most would consider this more of a horror film rather a depiction of schizophrenia.

The Soloist (2009) – This was a drama movie featuring Jamie Foxx and Robert Downey, Jr. It was based on the book “The Soloist” by Steve Lopez. It is based on the true life story of Nathaniel Ayers, a musician who developed schizophrenia and eventually became homeless as a result of his condition. Through the interaction of Foxx and Downey Jr. we find out more about Ayers’ story as a musical prodigy.

Karthik Calling Karthik (2010) – This movie is an Indian psychological thriller about an introverted guy with low self-esteem who is trapped in a job as a construction worker. He has had a troubled childhood and his brother died while trying to kill him in an unpredictable series of events. He eventually begins experiencing symptoms of paranoid schizophrenia accompanied by many delusions.

Shutter Island (2010) – Most people have seen this highly popular psychological thriller directed by Martin Scorsese. It is based on Dennis Lehane’s book “Shutter Island” which was released in 2003. It features Leonardo DiCaprio playing a psychiatric patient on “Shutter Island” (located in Boston Harbor) with an institution for the criminally insane. DiCaprio’s character experiences many of the positive symptoms of schizophrenia including the delusion that he is being psychologically manipulated.

Take Shelter (2011) – This was a drama-thriller type movie in which a new husband (and dad) experiences a series of visions related to the apocalypse. He keeps the visions from his wife and their daughter. He focuses his efforts towards building a storm shelter in the backyard – but his odd behavior puts a strain on his familial relationship. His mother suffered from paranoid schizophrenia – a condition which he eventually developed.

Sucker Punch (2011) – This is a fantasy action type movie about a young woman who attempts to escape an institution for the mentally ill before suffering a lobotomy. The storyline follows her fantasies as well as her escape plan. She was sent to the institution by an abusive step-dad and is blamed for the death of her younger sister. Basically her step-dad is setting her up and trying to make her mentally incapacitated for something she didn’t do.

Of Two Minds (2012) – This tells a story about a relationship between a girl and her younger sister who suffers from schizophrenia. After their mother dies, the older sister is responsible for taking care of the younger, mentally ill sister. After an incident happens between the younger sister and the older sister’s son, it becomes clear that she cannot handle her younger sister’s mental illness.

Do you know any other movies about schizophrenia?

Did I leave any movies off the list that may have been about schizophrenia? If you know of any other movies that could be classified as highlighting the mental illness that is schizophrenia, feel free to let me know in the comments section so I can add it to the list. Of the movies above, what are your favorites? Which ones do you think do the best job at depicting someone struggling with schizophrenia? Personally I really think the movie “A Beautiful Mind” does a fantastic job showcasing the signs and symptoms.


Diagnosis and Tests

How is schizoaffective disorder diagnosed?

If symptoms are present, the doctor will perform a complete medical history and physical examination. Although there are no laboratory tests to specifically diagnose schizoaffective disorder, the doctor might use various diagnostic tests—such as X-rays or blood tests—to rule out physical illness as the cause of the symptoms.

If the doctor finds no physical reason for the symptoms, he or she might refer the person to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illness.

Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a psychotic disorder. The doctor or therapist bases his or her diagnosis on the person’s report of symptoms, and his or her observation of the person’s attitude and behavior.

The doctor or therapist then determines if the person’s symptoms point to a specific disorder as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is published by the American Psychiatric Association and is the standard reference book for recognized mental illnesses.

According to the DSM-5, a diagnosis of schizoaffective disorder is made if a person has periods of uninterrupted illness and has, at some point, an episode of mania, major depression, or mix of both while also having symptoms of schizophrenia. In addition, the person has a period of at least two weeks of psychotic symptoms without the mood symptoms.


Anthropologists Question the Legitimacy of Mental Disorders

Anthropologists call for a move away from biological approaches to psychiatry citing failure to deliver discoveries or improved treatments.

A recent article published in the American Journal of Physical Anthropology examines the state of the evidence for viewing mental health struggles as purely biological disorders. Biological anthropologists Edward Hagen and Kristen Syme argue that the evidence for pharmacological interventions is weak and that the prevalence of “mental disorders” has not decreased over time. Citing widespread problems with contemporary psychiatry, they propose a “re-thinking” of psychiatry grounded in biological anthropology and evolutionary theory.

“The brain is the most complex organ in the human body. Advocates contend that mental disorders should be regarded as biological diseases like any other, invoking the effectiveness of psychopharmaceutical drugs and the associations of mental disorders with hormonal, imaging, genetic, and epigenetic biomarkers, as evidence for this view,” Syme and Hagen write.
“It is inarguable that mental health phenomena have a basis in biology, and that most (but not all) should be classified as biological dysfunctions. The track record of biological psychiatry, however, a field that investigates the neurophysiological and genetic bases of mental disorders, is poor.”

Anthropology has been one of the primary academic disciplines to question the dominance of a brain-based medical model for understanding human beings. For example, anthropologists have criticized the effects of psychiatry’s ethnocentrism, as well as thrown a wrench into quick “neuro” explanations that disconnect the brain from culture.

The current article extends this critical tradition by offering a broad overview of the scientific evidence for the existence of psychiatry’s “biological disorders.” The authors look at pharmacology, genetics, neuroimaging and biomarkers, financial conflicts of interest, and psychiatry’s theoretical roots, ultimately concluding that the field has not delivered on its promise and that professionals should entertain the notion of a more anthropologically informed psychiatry.

According to Hagen and Syme, although the biomedical sciences have drastically increased life expectancy during the 20 th century, mental health has seen little progress. Between 1990 and 2010, for example, the rate of “mental, neurological, and substance abuse disorders” remained steady.

“Most studies find that the prevalence of mood and anxiety disorders have remained constant over time,” they explain. “There is little evidence that increased treatment rates reduce suicide rates, and there has been no appreciable decline in cross-national suicide rates, which vary dramatically across countries and regions.”

Critiquing biological psychiatry, the authors focus on the limited efficacy of pharmaceutical drugs, corrupt marketing practices by pharmaceutical companies, the failure to find biomarkers for mental disorders, genetic/epigenetic findings, and psychiatry’s theoretical roots.

The authors argue that the “chemical imbalance” explanation for depression was successfully disseminated through direct-to-consumer corporate marketing, despite it not being aligned with the available evidence. For example, the “chemical imbalance” hypothesis states that antidepressants work by increasing monoamines (serotonin, dopamine, noradrenaline) in the brain, but certain antidepressants like tianeptine actually decrease monoamines.

Evidence for the efficacy of commonly prescribed antidepressants has been recognized as barely superior to placebo for over two decades, while strong bias in favor of positive drug trials has been detected in the scientific literature.

“After adjusting for unreported studies, [researchers] found effect sizes Cohen’s d = .31 to .32, indicating a modest advantage of treatment over placebo. This corresponds to less than 2 points on the Hamilton Depression Scale (HAM-D), which ranges from 0 to 52.”

As the authors note, this limited efficacy is also married to common side effects such as “insomnia, sexual side effects (e.g., decreased libido, erectile dysfunction), and weight changes.”

Related to the strong bias for positive drug trials, a review of 397 clinical drug trials found that 47% of the articles reported at least one financial conflict of interest. This type of research led Marcia Angell, former editor-in-chief of The New England Journal of Medicine, to reluctantly claim:

“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines.”

Drug companies are also known to pay physicians to advocate for specific pharmaceutical treatments and to sign off on articles ghostwritten by industry insiders.

Turning to the question of neuroimaging and biomarkers, the authors acknowledge that Functional MRI and PET scans sometimes show statistically significant differences between patient and control groups, but they state that these differences are not sensitive enough to be of clinical use. There are no currently available biological tests for diagnosing mental disorders, they add.

As far as genetics and epigenetics are concerned, while acknowledging that some “mental disorders” appear to be heritable—such as schizophrenia, bipolar disorder, autism spectrum disorders, and obsessive-compulsive disorder—the exact mechanisms are far from clear.

Genetic research has primarily moved from a focus on “candidate genes” to “gene-mapping” after unsuccessful efforts at discovering candidate genes associated with particular disorders. Complicating the matter is the fact that:

“[…] the genetics of mental disorders evidences equifinality, in which different variants lead to a single disorder, and multifinality, in which a single variant or the same variants are risk factors for several different disorders.”

In other words, we still know very little about how genetic and epigenetic factors contribute to psychological suffering in concrete terms.

Regarding psychiatry’s theoretical roots, the authors explain that many professionals are questioning the validity of the DSM, which is failing to align with the forward edges of “genetics, systems neuroscience, and behavioral science.” Additionally, co-morbidity or overlap between disorders leads many to question the scientific status of the manual.

There are practical issues as well for instance, individuals may lose insurance coverage for their conditions if the DSM removes certain diagnoses.

Still, the DSM has been called an “impediment to progress” by the 2013 director of the National Institute of Mental Health, leading some critics to wonder about the scientific value of psychiatry as it is practiced clinically, even if it does provide a “common language” for clinicians.

Related to this, the authors discuss different philosophical understandings of what makes up “mental illness.” They point out that, in contrast to a “naturalistic” perspective, which assumes that mental disorders are examples of biological dysfunction, a “constructivist” perspective acknowledges that different traits and behaviors function differently in different contexts.

An obvious example here is the fact that homosexuality was considered a psychiatric mental disorder prior to changes in how it was perceived socially. Other examples of now discarded “disorders” include “moral insanity, childhood masturbation disorder, and hysteria.”

In contrast to the position of mainstream psychiatrists, the authors propose an approach to mental health grounded in biological anthropology and evolutionary biology. They believe that “mental health disorders” can be grouped into several subsets:

  • Disorders which are genetic-based developmental dysfunctions
  • Disorders associated with senescence/aging
  • Disorders caused by a mismatch between modern and ancestral environments
  • Disorders which are adaptive responses to adversity, however undesirable

Among “developmental disorders,” they list autism spectrum disorders, Tourette’s, obsessive-compulsive, schizophrenia, bipolar disorder, and eating disorders.

All of these are believed to be cross-cultural phenomena and to have significant genetic/heritability factors in their genesis.

The second group, senescence, contains disorders such as dementia, which they describe as “organism deterioration with age” associated with different possible evolutionary pressures, such as “lack of selective pressure during the post-reproductive phase” compared to the necessity of fitness during reproductive phases of life.

Disorders viewed as potentially resulting from a “mismatch” between modern and ancestral environments are, for example, ADHD. ADHD is possibly far less of a problem in “less structured environments” without the behavioral restrictions that modern society pushes on people—sitting at a desk for extended periods, for example.

Several large studies have found that younger children belonging to the same educational cohort (i.e., a year younger than their peers) are more likely to be diagnosed as ADHD because teachers’ expectations for behavior are biased toward the slightly older developmental group.

Finally, the authors believe that certain disorders are simply responses to adversity, however undesirable and unpleasant. These include depression, anxiety disorders, and post-traumatic stress disorder.

All three “disorders” may, from an evolutionary perspective, help to mitigate future adversities because of an individuals’ tendency to focus or “ruminate” on possible negative outcomes.

The authors believe that psychiatry’s resistance to viewing these conditions as adaptations to adversity may be an example of psychiatry serving “the interests of the powerful over the powerless.” Work-related depression, for example, is a significant drain to employers’ financial profits. As the authors note: “the illness label for work-related depression alleviates employers from the responsibility to improve working conditions for depressed employees.”
“Understanding the complex, multi-level mechanisms that underlie mental disorders, and cognition and behavior more generally, cannot be achieved by focusing only on the lowest mechanistic levels (e.g., molecules, neurotransmitters). Nor can we rely solely on the descriptive symptom-based approach to mental disorders epitomized by the DSM.”

Syme, K. L., & Hagen, E. H. (2019). Mental health is biological health: Why tackling “diseases of the mind” is an imperative for biological anthropology in the 21st century. American Journal of Physical Anthropology, 171, 87-117. (Link)

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20 COMMENTS

“Human suffering arises because of an embodied interaction with a world whose nature we cannot know but which we cannot escape.” I don’t know why we need to keep debating this. The DSM mindset outlived it’s usefulness long ago if it ever had anything to commend it. But it seems to proliferate like an out of control epidemic capturing more and more in its poisonous grasp – poisionous words followed by poisonous drugs. Not all are harmed or recognise the harm, maybe even some are helped to heal as they claim – who am I to argue with them. But many are left dissapointed if not destroyed by these treatments which profit the few at the expense of the many. Resting as it does on no firm intellectual basis but more so on a profound denial of the dangers inherent in life, the damage done by adverse experiences, events or circumstances how does it survive and continue to thrive?

“Among ‘developmental disorders,’ they list autism spectrum disorders, Tourette’s, obsessive-compulsive, schizophrenia, bipolar disorder, and eating disorders.

“All of these are believed to be cross-cultural phenomena and to have significant genetic/heritability factors in their genesis.”

“we still know very little about how genetic and epigenetic factors contribute to psychological suffering in concrete terms.”

In other words, it is UNTRUE that disorders like “schizophrenia” and “bipolar” “have significant genetic/heritability factors in their genesis.”

But since we know that the ADHD drugs and antidepressants can create the “bipolar” symptoms. And since we know that the antipsychotics can create both the negative and positive symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome and antipsychotic induced anticholinergic toxidrome.

It’s highly likely that the majority of “bipolar” and “schizophrenia” has an iatrogenic – not genetic – etiology/’genesis.’

But I do agree, continued reliance “on the descriptive symptom-based approach to mental disorders epitomized by the DSM” is a dumb idea. The DSM should be flushed. And the psychiatrists should stop creating the “serious mental illnesses,” in innocent humans, with their psychiatric drugs, for profit.

Psychiatry is labeled a science?

There is nothing scientific about it. Psychiatrists can’t even agree on their basic principles or methodology.

There are some poignant arguments here, but why argue the biological evidence of severe mental disorders? Have antropologists worked in psychiatric care? Have they found the evidence of white matter deterioration in MRI scans? No, says they just read some research articles.
Many psychiatrists don’t believe in the DSM either, but you cannot hit delete on a biological cause and generic etiologies of mental illness because you found that the studies you read were false. If you have seen several families with the same or similar disorders then genetic predisposition is highly likely, if you find that a man with psychosis begins to lose higher processing functions then you may realize that their neurons are on overdrive and there are functional mri scans that can show the difference.
I’m not simply glorifying psychiatry, it has become a corrupt practice because of the medical industry. To deny the existence of thousands of journal articles of evidence and medications that have worked to curb mental illnesses is simply ludicrous. Anthropologists and psychiatry/neurology needs to work together rather than attempt to disassemble each other, many mental diseases are solely human disorders and anthropological studies can help disseminate how the hominid brain evolved and formed complex pathways that could deteriorate.

Actually, it is the job of the researcher to prove that genetic/biological causes exist and are causative, not the job of detractors to disprove it. Scentifically speaking, lack of proof of genetic causation means it is assumed to be scentifically untrue, at least for the moment. And the fact that something “runs in families” is certainly no proof of a genetic origin! Speaking Chinese or using silverware to eat with both run in families, but are not in the least genetically related. Culture is passed on through families, and explains a great deal of similarity between parents’ and children’s behavior.

If we want to be scentific, we have to be VERY careful about what we assume to be true. 50+ years of research have failed to demonstrate a specific biological cause of ANY of the “mental health” diagnoses in the DSM. Scientifically speaking, this suggests that such causes are very unlikely to exist, at least in a general sense. Specific instances of these “diagnoses” may have biological origins, but unless ALL or almost all cases of “depression” are shown to be biologically caused, we can not say that “depression” is biologically-caused condition.

The problem with today thinking is that people can’t imagine talking about identity/psyche or illness, without using medical empiricism.
Medicine is not the owner of the psyche or even illness or pathology.

Depression, psychosis even headaches does not belong to medicine. This is psyche, psyche creates pathology, and psyche is not medical empiricism. Monotheistic science talks about psyche and illnesses, using medical language, and we should remember that this is a medical usurpation. The proper language of psyche/pathology was destroyed by science and its pretensions to mythical reality and also to the psychological reality of illness. Psyche was destroyed by science.Imagination was destroyed by science, the psychological meaning of illness was destroyed by materialism. Mythical reality is not science. Psyche is not medical empiricism or materialism, and never will be.

Psychological meaning of illness does not belong to medical empiricism. Every kind of pathology is an identity trait, at first. Not medicine. The nature of every illness is psychological , not medical.

We are being treated by medical empiricism like a soulless meat. We are being treated that way, because we live in barbaric reality of materialistic fascism.
People think that this is progress, to talk about psyche using medical empiricism. No, this is f. tragedy.
——————————————————————————–
James Hillman “Re-visioning psychology.”

Danzig – an earlier name for a city in Poland that the Nazis wanted to take back into Germany. WW2 started after the Nazis invaded Poland in 1939.

Yes, the psyche should not belong to medicine. They have indeed destroyed the language of the psyche, a real and actual element of human existence.

󈬢+ years of research have failed to demonstrate a specific biological cause of ANY of the ‘mental health’ diagnoses in the DSM. Scientifically speaking, this suggests that such causes are very unlikely to exist, at least in a general sense.”

“There are some poignant arguments here, but why argue the biological evidence of severe mental disorders?”

Because we’ve already medically proven the iatrogenic – not “biological” or “genetic” – etiology of the “severe mental disorders.”

Good article, but doesn’t go far enough. “Schizophrenia” and eating disorders are not genetic. The book Crazy Like Us shows how eating disorders are extremely culturally dependent, going up dramatically when the concept of “eating disorders” is introduced into a culture. They are also to some degree of product of adversity, whether that adversity is malnutrition, stress, or cultural pressure to be thin. As for “schizophrenia”, the “paranoid” part is a pretty obvious reaction to childhood trauma, for instance thinking others are talking about you behind your back because you used to be a target of racist bullying (my best friend’s issue). And the visions/voices that get diagnosed as “schizophrenia” by psychiatry are treated as signs of a spiritual path by cultures with shamanic traditions, so, like “ADHD”, it is more a problem of our restrictive environment.

“It is inarguable that mental health phenomena have a basis in biology, and that most (but not all) should be classified as biological dysfunctions.”

Why on earth is this “inarguable?” Sounds like the author assumed the conclusion without proof.

Yes, this is the primary problem with their reasoning. Bless them for noticing that “psychiatry’s resistance to viewing these conditions as adaptations to adversity may be an example of psychiatry serving ‘the interests of the powerful over the powerless.'” But this smacks, frankly, of the new “critical theory” viewpoint of life and living, which overall has proven to be quite mindless.

How much longer must we wait for broken academics to figure out a “problem” that has largely already been solved? I know that my belief that is has been solved is not widely shared, but this does remain my belief. And at the core of the academic problem is its fixation on biology and evolution. That is like giving an artist a palette with yellow and red paint on it and then asking him to make a realistic image of a tree. “Where is my blue?” he should complain. Instead he insists there must be a way to arrive at the color green starting only with the colors red and yellow. Good luck with that!

Oddly, another article posted here just a few days ago, “Do We All Need Tinfoil Hats?…” was picked up by someone in a Facebook group that I am a member of. It’s the same problem there. They are like those cave dwellers in that story by Plato, who refused to go outside to see what was there, as they had become so accustomed to living in a cave that they no longer wished for anything different.

Walk out of the cave and look around! The air is fresh! (Unless you live down wind from a forest fire). The flowers are full of bright colors! And the basic questions of the mind and spirit have been confronted and answered!

I think he means he is incapable of handling the argument.

Can you ever argue against a set of a priori assumptions?

I agree and disagree and suspend judgment on much in the article and in comments to it. I’ll just say a couple things:
To rehash what other commenters have highlighted or framed, speaking from my own experience, I find it odd they both didn’t include schizophrenia as a disorder of adversity (& iatrogenesis) and emphasized it’s genetic & developmental aspect after appearing to negate those earlier in the article. Did I misunderstand something? I tend to believe there can be aspects of all of the above & sometimes none, including schiz as a social construct and loose, if not completely misapplied, label, with its stigma, illusions, etc.
Unlike many, I am interested in the biogenesis of schizophrenia a la Hoffer & Osmond’s aminochrome hypothesis (which apparently accounts for the dopamine & trans-methylation hypotheses). Also, their urine ‘mauve’, kryptopyrrole, or pyrrole disorder test for some, but not all, people labeled with schiz. Also it’s relevance for other ailments like cancer. It was said to be a marker for oxidative stress. It is an example, and there are others in their work, that there can be biological markers for mental illness though they may not always be only specific to the diagnosis, and also may not be proven. Because we have been so over-immersed in pharmaceutics and their related research & diagnosis standards, we tend to overlook the biochemistry of nutrients and how they directly or indirectly provide insight into health & sickness. Though I’ve made many mistakes, especially doing it mostly all on my own, I‘ve noticed how nutrients—diet & supplements—can have profound effects on mental & physical status and their interrelationships.
Other commenters, please don’t make this a long debate on what I say. While I welcome comments, & will try to respond to some, I don’t want to get into the thicket and go down the rabbit hole. Of course, I’m still exploring and fleshing all this out, and I think we all know how damn complicated all this is. Thank you.

I think the first mistake of psychiatry is to assume that everyone who acts or feels a particular way should be grouped together and “treated” as if they have the same “disorder.” The evidence you report supports this. There most definitely could be biological factors that cause any sort of “psychiatric symptom.” But then we need to detect and treat the REAL problem instead of just suppressing the overt manifestations with drugs. I know I’m preaching to the choir here, but biochemistry can easily be addressed without resorting to the subjective and largely nonsensical DSM. Real science looks for causes and relationships, which I’m hearing you call for. I have no problem with that, as long as we don’t assume that “schizophrenia” is a legitimate category that groups together people who have some causal factor in common.

From my point of view, this was the first mistake of medicine. The first mistake of psychiatry was to try to convince themselves and the world that they were treating medical illnesses. And our first mistake was to believe them.

Yes. And yes, rock on. While I don’t pretend to know the ultimate answers, I would like to highlight one of Hoffer’s notions that I find appealing, even though it is materialistic etc. I should add that another favorite psychiatrist of mine, Carl Jung, also used the label schizophrenia and had an enormous amount to say about ‘it’ and had a psychogenic theory that is well worth examining. He also theorized a metabolic toxin ‘X’. He himself had ‘psychotic’-like symptoms which played a role in his self development. Hoffer considered schizophrenia a syndrome whose common final pathway is the by-products of oxidized adrenaline. He said many different causes can lead to the final pathway, but perhaps a majority had to do with chronic pellagra and vitamin b3 dependency dealing with too little NAD/NADH from normal amounts of vitamin B3 in the diet and a high turnover rate to oxidized adrenaline and it’s by products. He named a whole consortium of psychological AND physical symptoms that can come from this. Having simply summarized his hypothesis, he had a very limited perspective on the function and meaning of hallucinations (and dreams?) and tended to medicalize people who experienced these, and I completely understand if this type of thinking is a turn off I’m labeled, have used nutrients, & find it all rather maddening. It is not proven and would be hard to get the funding, consensus, etc. But I find it stimulating. His hypothesis was developed in the psychedelic pre-illegal era and before the use of vitamins, which came as a response, not a cause. It is the first oxidative stress disease theory and led to treatment with antioxidants etc. If you’ve bothered reading this, thank you for your patience. I try to make psychology & the body complimentary, and these types of ideas help me with that. Now to the….Peace.

I should also point out that many psychopaths question the legitimacy of anthropology.


A Clothing Company Labeled a Shirt 'Schizophrenic' and It's Pretty Baffling

I'm not usually outraged by things on the internet. But even I was taken aback when my sister forwarded me an email from a small online boutique called Simple Addiction, promoting a two-toned sweater the company marketed with the subject line “A schizophrenic tunic… what. ”

Get it? The tunic is called the Split Decision Tunic, like a split personality. Isn’t that hilarious?

So was my sister, Katie S. Frauenfelder, M.A., P.L.P.C. as a licensed therapist, she sees firsthand how mental illness affects her patients.

“I am not someone who seeks out things to become offended by. I am, however, passionate about mental health, as well as helping erase the stigma surrounding mental illness,” she says. “As someone who both struggles with and works in the field of mental illness, being flippant about various diseases of the mind is something I do take seriously.”

We both sent strongly-worded emails to Simple Addiction pointing out their poor choice of words and received the same canned apology from customer service. It explained that this was "an error in judgement. made in our marketing department. We have sent this note to them and will make sure that subject lines with sensitive topics will no longer be used."

But maybe it shouldn’t come as a surprise that an online clothing shop that trivializes addiction in its name decided to be flippant about one of the most severe mental illnesses.

“Schizophrenia is a mental disorder characterized by psychotic symptoms, [including] hallucinations and delusional beliefs, disorganization of thinking, and ‘negative symptoms’ which often take the form of apathy, disinterest in social engagement, or impoverished/diminished speech,” Joseph M. Pierre, M.D., professor of psychiatry at UCLA and author of the Psych Unseen blog at Psychology Today, explains to SELF via email. “Although some patients have mild symptoms and recover spontaneously, schizophrenia is often a chronic illness associated with significant functional impairment.”

This functional impairment can result in loss of touch with friends and family or unemployment, Pierre explains. In fact, an estimated 26% of homeless adults staying in shelters live with serious mental illness, according to research from the National Alliance on Mental Illness.

I couldn’t understand if the company meant to reference bipolar disorder, which can cause periods of extreme highs (mania) and extreme lows (depression), or dissociative identity disorder (DID), previously referred to as multiple personality disorder.


What Are the Types of Severe and Persistent Mental Illnesses?

When a mental health disorder becomes so serious that it causes extreme disruption in relationships, work, and daily functioning, and is not resolved through the usual levels of psychiatric care, it is termed a severe and persistent mental illness. There are several types of mental health conditions that fall under this umbrella, including:

Schizophrenia. Schizophrenia is a serious mental health disorder that features hallucinations and delusions, and a general detachment from reality.

Schizoaffective disorder. Schizoaffective disorder is a combination of schizophrenia and a mood disorder, such as depression or bipolar disorder.

Bipolar disorder. Bipolar disorder features extreme mood swings that alternate between depressive and manic episodes.

Autism. Autism spectrum disorder is a disorder of the ability to communicate or relate with others.

Obsessive-compulsive disorder. Obsessive-compulsive disorder (OCD) features obsessive fear-based thoughts coupled with compulsive behaviors that attempt to reduce the resulting anxiety.

Major depression. Severe depression features persistent feelings of despair and hopelessness, extreme fatigue, sleep disruptions, loss of interest in life, and suicidal thoughts.

Some of the symptoms of severe mental illness include:

    • Persistent feelings of being watched
    • Increasingly disorganized thinking
    • Mental confusion
    • Detached from reality
    • Extreme mood swings
    • Insomnia, nightmares
    • Auditory and visual hallucinations
    • Delusional thoughts
    • Garbled or disorganized speech or writing
    • Socially inappropriate behavior
    • Avoidance of social situations, isolation
    • Decline in academic or work performance
    • Unusual body positioning or movement
    • Unusual preoccupation and fears centered on a person or situation
    • Irrational or angry behaviors, physical assault
    • Inability to concentrate
    • Memory problems
    • Loss of interest in appearance and hygiene
    • Personality changes

    Call for a Free Confidential Assessment

    When any of these mental health disorders deteriorate to the point when the individual’s life is endangered, or they become a danger to another, it is necessary to use crisis intervention methods. This usually means that the individual is admitted to a hospital setting where they will receive acute stabilization care and intensive treatment. During this acute phase, the individual will be closely monitored, medications will be adjusted, and targeted psychotherapy will be conducted. Once the acute phase has stabilized, the individual will likely enroll in a residential program where they will receive targeted treatment for several weeks.


    Dual Diagnosis and Psychiatric Psychiatric Hospitalization

    You can use Inpatient Psychiatric Hospitalization as a first step in your recovery, or it can act as its own treatment option. The individual is constantly and consistently monitored when they are inpatients. Inpatient detoxification is often necessary because withdrawal symptoms can be particularly challenging to manage alone. An integrated treatment plan can include Psychiatric Hospitalization as a transitory phase between moving into a residential community and discharge, or it can occur at various stages of the treatment process.

    In psychiatric hospitalization, a Dual Diagnosis requires adequate and long-term care. The time it takes to achieve this ranges depending on the individual. Partially hospitalized patients can sometimes remain in the hospital for weeks or months. Although recovery may be a lifelong commitment, a few years can make a huge difference when you’re empowering yourself and bettering your health in the long run.

    Today, more patients are opting for psychiatric treatments that may include a dual diagnosis. Dual diagnosis means that a person will present to the doctor with two or more illness symptoms. These symptoms might be evident in the patient’s behavior and mental state. In some cases, the symptoms will be so severe that it will be necessary to seek other medical attention in psychiatric hospitalization.

    There are many differences between psychiatric Psychiatric Hospitalization and Dual Diagnosis. While both are highly skilled medical professionals, they are not the same. A psychiatrist can only diagnose the patient’s conditions, while a licensed therapist can treat any number of psychological disorders and still get the patient better. When a patient is given a choice between treatment options, it is much more likely that the patient will choose to go to a licensed therapist who knows how to treat multiple psychological conditions at once.

    Another difference between Psychiatric Hospitalization and Dual Diagnosis is that one is focused on one ailment, and the other is focused on multiple diseases. With Psychiatric Hospitalization, the focus is on one condition Dual Diagnosis on the other. Both can be very effective for the patient however, the focus tends to be on one ailment. When a patient has multiple diseases, they may become overwhelmed or depressed because they are trying to treat each of these conditions. However, with psychiatric Psychiatric Hospitalization and Dual Diagnosis, they can work on all of their ailments simultaneously.

    There are many benefits to both Psychiatric Hospitalizations, especially for patients suffering from mood swings, anxiety, depression, schizophrenia, bipolar disorder, or another mental illness. The main thing is to make sure that the patient is ready to accept the mental health professional’s help that will be working with them. Either way, psychiatric Psychiatric Hospitalization, and dual diagnosis can be very beneficial to the patients.


    Paranoia and schizophrenia: What you need to know

    A person with schizophrenia may experience delusional thinking, including paranoid thoughts. It may not be possible for the person to distinguish between this and regular thinking.

    Schizophrenia affects a person’s perception and can involve hallucinations and delusions. When these happen, it can be hard to know what is real and what is not.

    Paranoid delusions can cause a person to fear that others are watching them or trying to harm them. Also, a person experiencing a delusion may believe that media such as the television or the internet are sending them special messages.

    These feelings and beliefs can cause severe fear and anxiety, disrupt daily life, and limit a person’s ability to participate in work and relationships, including those with family.

    Studies suggest that nearly 50% of people with schizophrenia experience paranoia.

    Schizophrenia is a spectrum disorder, meaning that it encompasses several linked conditions, symptoms, and traits.

    Before 2013, healthcare professionals considered paranoid schizophrenia to be a distinct type of the disorder. However, the Diagnostic and Statistical Manual of Mental Disorders, which provides expert guidelines, now classifies paranoia as a symptom, rather than a subtype, of the disorder.

    Experts explained their choice to remove the subtypes from the classification, citing “limited diagnostic stability, low reliability, and poor validity.”

    Schizophrenia is a lifelong mental health condition. Symptoms often emerge when a person is in their late teens to early 30s.

    • thought processes
    • perceptions and feelings
    • sleep patterns
    • ability to communicate
    • ability to focus and complete tasks
    • ability to relate to others

    Symptoms of schizophrenia can include:

    • a lack of motivation
    • slow movement
    • changes in sleep patterns
    • low libido, or sex drive
    • a lack of self-care
    • disorganized thinking
    • changes in body language and emotions
    • withdrawing from family, friends, and activities
    • hallucinations and delusions

    A delusion is something that a person believes to be true, even when strong evidence suggests that it is false. A person may believe that someone is planning to harm them, for example.

    People with paranoia may experience a combination of the following:

    • feeling upset, anxious, angry, and confused
    • being suspicious of those around them
    • believing that someone is persecuting them
    • fearing that someone is following, chasing, poisoning, or otherwise plotting against them
    • feeling as if someone else is controlling their thoughts and actions
    • feeling as if their thoughts are disappearing or being taken away from them and behavior

    If a person experiences any of the above, they should receive immediate medical care.

    Schizophrenia is a neuropsychiatric disorder. The exact causes are unclear, but they likely involve a combination of genetic factors and environmental triggers.

    Genetic: Those with a family history may have a higher risk.

    Medical: These may include poor nutrition before birth and some viruses.

    Biological: Features of the brain’s structure or the activity of neurotransmitters, such as dopamine, may contribute.

    Environmental: Stress, past trauma, and abuse may trigger symptoms in people already at risk.

    One study suggests that people with schizophrenia and paranoia may have social cognitive impairments that make it harder for them, for example, to recognize people’s emotions or trust others. However, drawing conclusions about this will require more research.

    Use of drugs

    Some recreational drugs that affect the mental processes, such as amphetamines, cocaine, cannabis, and LSD, may trigger psychosis or schizophrenia in people with a susceptibility.

    Experts say that the use of drugs is more common among people with schizophrenia, but it is not clear whether the drugs trigger the disorder, or whether having schizophrenia increases the likelihood of using drugs to cope with symptoms.

    Various substances can also interfere with treatment. Anyone with concerns about the link between schizophrenia and substance use should speak with a doctor.

    If a person seeks help for symptoms that may indicate schizophrenia, a doctor will consider their personal and family medical histories and physical health, as well as the symptoms.

    They may also request diagnostic tests, such as blood tests, to rule out other possible causes of the symptoms.

    Diagnostic criteria

    For a doctor to diagnose schizophrenia, a person needs to exhibit signs of the disorder continuously for at least 6 months. This may involve:

    • delusions
    • hallucinations
    • disorganized speech
    • social and occupational dysfunction
    • highly disorganized or catatonic behavior
    • emotional flatness or a lack of pleasure in everyday life

    A doctor can only diagnose schizophrenia if these signs cannot be explained by any other health issue, such as drug or alcohol abuse or a mood disorder.

    Overall, it can take some time to reach a diagnosis.

    According to the National Alliance on Mental Illness (NAMI), Black and Latinx people in the United States are more likely than others to receive an incorrect diagnosis of schizophrenia. This may be due to racial bias , difficulty accessing suitable healthcare, or both.

    Schizophrenia is a lifelong condition, but treatment can help relieve the symptoms. If a person stops the treatment at any point, their symptoms may return.

    It can take time to find the best approach, which may be a combination of treatments. The right combination depends on factors such as which symptoms are present, how severe they are, and the person’s age.

    It helps if the person and their doctor are able to work together to develop and tweak the treatment plan, NAMI report.

    Medications

    Drugs called antipsychotics can reduce the occurrence of disturbing thoughts, hallucinations, and delusions.

    It can take time to find a suitable option, however. Also, around 30% of people do not have a good reaction to antipsychotic drugs. In around 7% of cases, the drugs are ineffective.

    If the person’s symptoms do not respond to at least two antipsychotics, the doctor may prescribe clozapine (Clozaril). This is not the first choice, due to the risk of adverse effects.

    Psychotherapy and social support

    Counseling and other types of therapy can help a person with schizophrenia live independently.

    • vocational training therapy
    • cognitive behavioral therapy
    • supportive psychotherapy
    • cognitive enhancement therapy

    Also, social support can help a person find work and housing and improve their communication skills and overall well-being. This may involve a peer support group.

    Caregivers and loved ones can help by learning about schizophrenia and encouraging the person to follow their treatment plan.

    One study has suggested that people with schizophrenia and paranoia benefit from support and treatment that are specifically tailored to these issues.

    Complementary medicines

    According to NAMI, the following may play a role in a wider treatment plan:

    While these may help, they cannot replace traditional treatment.

    Some researchers have suggested that cannabidiol (CBD), an ingredient in cannabis, could play a role in treating schizophrenia. However, confirming this will require more research.

    It is important that people with schizophrenia discuss any complementary treatments with their doctors.

    Is CBD legal? Hemp-derived CBD products with less than 0.3% THC are legal federally but still illegal under some state laws. Cannabis-derived CBD products, on the other hand, are illegal federally but legal under some state laws. Check local legislation, especially when traveling. Also, keep in mind that the Food and Drug Administration (FDA) have not approved nonprescription CBD products, which may be inaccurately labeled.

    Without treatment, schizophrenia can significantly disrupt a person’s life, including their ability to work, study, and care for themselves.

    • following the treatment plan carefully, including taking medications as prescribed
    • bringing up any concerns about treatment with a healthcare provider
    • making use of available support, which may involve friends, crisis services, and specialized healthcare facilities
    • making healthful choices regarding the diet, exercise, and the use of drugs, alcohol, and tobacco
    • talking about the experience of schizophrenia with friends, family members, healthcare providers, and supportive peers
    • listening to the person
    • educating themselves about schizophrenia
    • learning to spot the signs of a relapse
    • understanding what to do if a relapse happens

    Schizophrenia is a severe mental health condition that can involve delusions and paranoia.

    A person with paranoia may fear that other people are pursuing and intending to harm them. This can have a severe impact on their safety and overall well-being.

    Treatment can often help a person manage their symptoms and live a full life. It is important to receive ongoing support.


    Affective and Organic Disorders: Developing Mental Health Nursing Practice

    Schizoaffective Disorder is a mental health condition in which individuals suffer from symptoms synonymous with schizophrenia and a mood disorder or bipolar disorder. More specifically, when mood disorders are prominent, such that an individual has episodes of mania and severe depression and also struggles with the onset of psychotic symptoms, such as hallucinations and delusions, that person is likely to suffer from the disorder schizoaffective. According to Yasuhiko et al, (2018) schizoaffective disorder is thought to be between the diagnosis of schizophrenia and the diagnosis of bipolar disorder, as the symptoms of both diseases are often manifested. Despite the problem with the term Schizophrenia, we cannot deny that many are very distressed and unhappy because of the experience of hearing voices and delusionary belief (DOH, 1992). However, the presence of schizoaffective disorder may ultimately warrant an alternative diagnosis of bipolar disorder. When an individual suffers from schizoaffective disorder, this is likely to affect their academic or occupational functioning, as well as their ability to interact socially. In addition, people who suffer from this mental illness often have difficulty caring for themselves and experience problems of perception. The life expectancy of a person diagnosed with schizophrenia is reduced by 10 years compare with someone without mental health problem (Brown et al 2000, Mental Health and Disorder 2000).

    Schizoaffective disorder is a serious mental disorder characterized by loss of contact with reality (psychosis), hallucinations, delusions (false beliefs), abnormal thinking and alteration of labour and social functioning. It is a major public health problem worldwide. Its worldwide prevalence appears to be discretely less than 1%, although pockets of greater or lesser incidence have been identified (Andrew, 2015). Schizoaffective Disorder begins most frequently between the ages of 18 and 25 in men and between the ages of 26 and 45 in women. However, it is not uncommon for it to start in childhood or early in adolescence. The installation can be sudden, in the space of days or weeks, or slow and insidious, over the years. There are several disorders that share their characteristics with Schizoaffective Disorder. A schizoaffective disorder that resembles schizophrenia, but in which symptoms were present less than 6 months, are called schizophreniform disorders. Disorders in which psychotic symptoms last for at least one day but less than a month are called brief psychotic disorders. A disorder characterized by the presence of mood symptoms, such as depression or mania, along with other symptoms typical of schizophrenia, is called schizoaffective disorder. A personality disorder that may share symptomatology of schizophrenia, but in which the symptoms are not severe enough to meet the criteria of psychosis, is called a schizotypal personality disorder (Patrick, 2018).

    John, male, 23 years old, single, born in London. He was referred to the medical service of the Memory clinicon 06/01/2018, from his residence, to follow up his treatment for being presenting crisis of clinical exacerbation, with symptoms of aggression and agitation. Rio records that John was seen by liaison psychiatry in 2012 after an overdose and was referred to Alan Davis for learning Disability psychology team. He has been hospitalized on other occasions due to psychiatric problems. He lives with his mother, sister and brother in his own house. He does not have an active social life, presents difficulties in family relationships, quiet disposition and isolates himself socially. At home, John has been using medication for about 5 years. He reports that he has no personal morbid antecedents. He is totally independent in meeting the following basic needs: eating and drinking, using the toilet, moving about, dressing and undressing. It does not know exactly its weight and its height presents/displays a good state of hydration and nutrition (Fuller, 2019). He does three meals daily, without restriction of any food according to the possibilities and also does not make use of psychoactive substances (alcohol, tobacco or other drugs). In his family history, there are psychiatric antecedents (sister with mental disorders). He was calm and silent throughout the nursing interview and he has a good standard of hygiene, bathing daily. His previous pathological history is Schizophrenia.

    Mental State Examination

    The mental state assessment was performed at the time of the interview. These includes the following items: general description (appearance, psychomotor activity and behaviour, HADS, attitude towards the examiner and verbal activity), mood feeling and affection, perception, thought process (the form and content of thought), sensory and cognition (awareness, orientation, concentration, cognition, BADL, memory, information and intelligence), judgment and credibility (Larry, and Leslie, 2015).

    General Description:

    Appearance: John presents good hygiene, well kempt with no concerns regarding personal care. He is apparently calm and collaborative, with a low stare, hardly looking at the interviewer.

    Psychomotor activity and behaviour manifest calm behaviour.

    Attitude towards the examiner: presents itself as collaborative, attentive, but with sometimes reserved attitudes.

    Verbal activity: demonstrates a sometimes incoherent discourse with disorganised, spontaneous thinking on certain subjects and disorganisation of language (jumps from one subject to another and sometimes does not understand what is spoken) (Rosenberg, 2014).

    Mood, Feeling and Affection: John has a sad mood. His affection is appropriate to the situation.

    Perception: John did not present disturbances of the perception manifested by hallucinations (visual and auditory) and delusions. He displays disorganised thoughts and ideas, so in certain subjects, he/she does not have the capacity to respond.

    It has a stabilizing action on the central and peripheral nervous system and a selective depressant action, thus allowing the control of the most varied types of excitation. It is therefore of great value in the treatment of mental and emotional disorders (Lakeman, 2006).

    Nursing Care:

    Inform John of the adverse reactions most frequently related to the use of  medication and that, in the event of  side effects of any of them, especially drowsiness, torticollis, pressure drop, sedation, the doctor should be informed immediately to guide him avoid alcoholic beverages during treatment (Rosenberg, 2014).

    NMC (2007) Clearly specifies standards that registered nurses must meet when administering prescribed medicines to patients. Patients should be adequately informed, using the language they understand, the nature of their illness, medical benefit, action, duration of treatments, and the importance of medications they are taking, with potential side- effects of the medicines. (NICE 2007a). 

    The causes of Schizoaffective Disorder and Borderline Learning Difficulties are still unknown. However, there is a consensus in attributing the disorganisation of the personality, verified in Schizoaffective Disorder and Borderline Learning Difficulties patients, to the interaction of cultural, psychological and biological variables, among which the genetic ones stand out (Steven Matthysse, and Seymour, 2014). There is no single cause to explain all cases of Schizoaffective Disorder and Borderline Learning Difficulties. Contrary to popular belief, John with Schizoaffective Disorder and Borderline Learning Difficulties is not a victim of poor background or environmental factors. He is victims of genetically engineered developmental errors. More recent research has found abnormalities in the developing foetus rather than after birth. It can be said that no specific factor causing Schizoaffective Disorder and Borderline Learning Difficulties has yet been known. There is, however, evidence that it  would be due to a combination of biological, genetic and environmental factors that contributed to varying degrees for the onset and development of the disease (Daily, Ardinger, and Holmes, 2000). Another factor is almost every country where surveys have been conducted, the public believes the causes of Psychosis are more likely to be adverse Psychosocial events and circumstances (such as poverty, trauma and abuse) then biogenetic factors (Morrison et al 2005).

    Clinical Manifestations

    The severity and type of symptomatology can vary significantly between different people with Schizoaffective Disorder and Borderline Learning Difficulties. Together, symptoms are grouped into three major groups: delusions and hallucinations, abnormal thinking and behaviour, and negative symptoms (Frederic, 2014). An individual may have symptoms of one, two, or three groups. The symptoms are serious enough to interfere with the ability to work, have relationship with people and care.

    Delusions: Delusions are false beliefs which generally imply a misinterpretation of perceptions or experiences. For example, John exhibits delusions of theft or imposition of thought, believing that others can read his minds, that their thoughts and impulses are imposed upon him by external forces (Frangou, and Byrne, 2000).

    Hallucinations: Hallucinations of sounds, visions, smells, tastes, or touch may occur, although hallucinations of sounds (called auditory hallucinations) are the most frequent. John can “hear” voices that comment on his behaviour, talk to each other, or make critical and abusive comments.

    Change of Thought: It consists of unorganised thinking, which becomes patent when the expression is incoherent, changes from one theme to another and has no purpose. The expression may be slightly disorganised or be completely incoherent and incomprehensible (Frances, 2000).

    Inappropriate Behaviour: This type of behaviour can take the form of simplicity of childish character, agitation or appearance, hygiene or inappropriate behaviour. Catatonic motor behaviour is an extreme form of inappropriate behaviour in which a person can maintain a rigid posture and resist efforts to move or, on the contrary, show movement activity without prior and meaningless stimulation.

    Our nursing and healthcare experts are ready and waiting to assist with any writing project you may have, from simple essay plans, through to full nursing dissertations.

    Negative Symptoms: Negative or deficit symptoms of schizophrenia include coldness of emotions, poor expression, anecdotal, and associability. The face of John appears immobile has little eye contact and does not express emotions. There is no response to situations that would normally make him laugh or cry (Tony Thompson and Mathias, 2000).

    Risk Factors of Schizoaffective Disorder and Borderline Learning Difficulties

    Although no particular cause has been identified that is directly responsible for the development of the schizoaffective disorder, professional practitioners in this field consider that there is a combination of factors that combine to bring about their onset (Voelker, 2002). These factors are described below:

    Genetic factors: Schizoaffective disorder is similar to other health conditions in the sense that its occurrence is related to a genetic component. Individuals who have a first-degree relative with schizophrenia, bipolar disorder, or schizoaffective disorder face an increased risk of developing symptoms of the disease at some point in their lifes, unlike those who do not have a similar family history (Lakeman, 2006).

    Physical Factors: Neuroimaging studies have shown that the brain volume of people with the schizoaffective disorder is lower than that of individuals who do not suffer from this condition. In addition, it is thought that there are real structural differences in the brains of those people suffering from schizoaffective disorder.

    Environmental factors: As with the development of Schizoaffective Disorder and Borderline Learning Difficulties, researchers have discovered that exposure to toxins or viruses within the uterus can potentially lead to the onset of schizoaffective disorder later in life (Frederic, 2014). In addition, evidence has shown that when complications occur during labour, the potential damage to the brain due to such complications may lead to the eventual onset of the schizoaffective disorder.

    There is no definitive diagnostic test for Schizoaffective Disorder and Borderline Learning Difficulties. The psychiatrist establishes the diagnosis based on an overall assessment of the patient’s history and symptoms. For the diagnosis of schizophrenia to be established, the symptoms should persist for a minimum of six months and must be associated with a significant deterioration of the employment, school or social activity (Steven Matthysse, and Seymour, 2014). The information provided by the family, friends or teachers is very  important to establish when the disease started. People with a schizophrenia diagnosis are 10- 15% likely of dying from suicide (DOH, 1992) and early years of the illness may present a particular risk. (McGarry and Jackson, 1999). The physician should rule out the possibility that the patient’s psychotic symptoms are due to a mood disorder. It is common to perform laboratory tests to rule out the possibility of drug abuse or an underlying clinical, neurological or endocrine disorder that may present with psychosis characteristics, such as certain brain tumours, temporal lobe epilepsy, autoimmune diseases, immune disorders, liver diseases and adverse drug reactions. Individuals with schizophrenia have brain abnormalities that can be seen on a CT scan or MRI (Daily, Ardinger, and Holmes, 2000). However, the defects are insufficiently specific to be useful in diagnosis.

    Nursing Assessment and Evaluation of Person Centred Recovery

    Over the last decade, mental health care has become supported by service users, with recovery as an important aspect of treatment. The recovery-orientated practice has a global concentration and is incorporated into different mental health policies. Recovery concentrates on hope and on reintegrating service users back into society and their life before diagnosis (Larry, and Leslie, 2015). The general objectives of treatment are to reduce the severity of psychotic symptoms, to prevent recurrences of symptomatic episodes and to impair the functioning of the individual and to provide support so that the individual can perform as well as possible. Antipsychotic medications, rehabilitation and community support activities and psychotherapy represent the three main components of treatment. Antipsychotic medications are often effective in reducing or eliminating symptoms such as delusions, hallucinations, and disorganised thinking. After the disappearance of acute symptoms, the continued use of antipsychotic medications substantially reduce the likelihood of future episodes. Unfortunately, antipsychotic drugs produce significant adverse effects, including sedation, muscle stiffness, tremors, and weight gain (Andrew, 2015). A small number of individuals with Schizoaffective Disorder and Borderline Learning Difficulties are unable to live independently, either because they present severe symptoms and are not responsive to therapy or because they lack the skills necessary to live in the community. In such cases, continuous treatment is necessary for a safe and supportive environment. Psychotherapy is another important aspect of treatment. In general, the goal of psychotherapy is to establish a collaborative relationship between the patient, his family, and the physician. Person-centred care support practitioners to consider service users’ personal needs and to allow them to establish informed judgments about their own care and cure with support from health professionals (Yasuhiko et al, 2018).

    Role of the Mental Health Nurse

    Although Larry and Leslie, (2015)point out that nurses face difficulties to work with aspects related to mental health in basic care, the need for care of the individual with a mental disorder and his family is a reality. This creates new perspectives for the work of the nurse in the field of mental health, characterized by the transition from Memory clinic practice to treatment of the “mentally ill” to another that incorporates new principles and knowledge, based on interdisciplinarity and recognition of the other as a human being, inserted in a family and community context. People must not worry about how the nurse has acted in this process, since most of the time he/she is the care coordinator of the Memory clinic team, and one of the great challenges to mental health is to establish competence.

    Nurses play an important role in assisting people with mental disorders, such as raising the awareness to the population about the importance of their insertion in the community, including collaborating and taking responsibility for the construction of new spaces for psychosocial rehabilitation, if valued after all, the citizenship of these patients and their families are assured in the policy of deinstitutionalisation. Nurses, therefore, need to be ready to work with John with limitations and his family. The activities that the professional performs in the Memory clinic and attitudes that aim to support him and treat him in order to value not only the illness but, mainly to the person of integral form, favours the reintegration of the patient to the social life with qualified measures (Fuller, 2019).

    While the aetiology is unknown, all the therapeutic methods attempted in schizophrenia have the stamp of empiricism and groping. As a general rule, it is said that in the acute or initial periods the medications are justified (the remission or social cure of Schizoaffective Disorder and Borderline Learning Difficulties, compatible with a certain professional activity and the extra-senatorial life, is obtained in about 60% of the cases) and physical-chemical, whether to stimulate or correct the organic functions, or to imprint new rhythm to the body (shock therapy), and that in the phases of remission and chronicity fit psychotherapy and other methods such as praix-therapy are used (Yasuhiko et al, 2018). In response to major harm occurrences that have demonstrated a need for multidisciplinary teams and agencies, co- ordinated by a consistent key worker to actively involve the patient, family and carers, the Care Programs Approach (CPA) (DOH, 1990 reviews 2000a) was developed. The main purpose of nursing care is to awaken the schizophrenic’s interest in John’s life, a dignified life and participation in his family and social environment, despite the illness. It is important to value and encourage John to participate in his clinic treatment, so that the chances of adherence to treatment may be greater. Nursing care should aim to improve symptoms, prevent relapse and avoid institutionalisation.

    The patient (John) is a carrier of Schizoaffective Disorder and Borderline Learning Difficulties based on such findings: persecutory delusions, hearing unpaid voices, unreasonable ambitions, and loss of contact with reality, simulation of difficulty in walking, psychotic episodes associated with aggression, agitation the exaggerated libido and carelessness with personal hygiene (Larry, and Leslie, 2015). The great question about the patient is the continuity of treatment and their awareness of the importance of adherence to treatment. Drug therapy associated with psychosocial model is essential because it is also a reflection of the entire history of each patient. The pharmacological evolution of antipsychotics has provided a high drug potency with satisfactory results in the course of treatment. Thus, maintenance of drug treatment will lead the individual during the evolution of the disease to an improvement in symptoms. But there are undesirable side effects, such as extrapyramidal manifestations (akathisia, acute dystonia, and parkinsonian symptoms) in addition to silk, weight gain and impotence. All these effects compromise the acceptance of the drug, but with the progress of its use, the maintenance phase has a control and a decrease in these symptoms (Lakeman, 2006).

    Discontinuation of treatment may lead to further seizures, the need for higher doses of the drug, and often the need for internal doses. It is of great importance to offer patient individual therapy, support groups, occupational therapy and guidance for the family. A multidisciplinary team is essential for adherence to treatment (Patrick, 2018). However, medical staffs are confronted with patients who perform all these activities and do not evolve to improvement due to lack of psychosocial and family support, as is the case of this patient. If they ask the reason for his carelessness with treatment outside the Institution, they find that being a homeless street patient, without psychological, economic and effective support, he would end up needing internal translations, mostly for the same reason, or the medicines.

    Through this case study, it was possible to know a little more about the Schizoaffective Disorder and Borderline Learning Difficulties. Above all, this work made it possible to obtain a holistic view of nursing action and not just a technical-pharmaceutical approach. It was concluded that the systematisation of nursing care is favourable for a good prognosis. In practice, the best care is the individualized and humanized, assisting the patient as a unique being, respecting their biopsychosocial needs. It can be seen that the promotion of care is not necessarily done through technical procedures, in a hospital bed or in an outpatient clinic. Listening attentively, respect, willingness to interact, trust and bonding are elements that need to be used to provide qualified care, especially in psychic patients. Through the study carried out, we were able to value these concepts even more and realize their importance in the act of caring and, thus, lead them to apply in future practice.

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