Bipolar 2 From Inside and Out

Posts tagged ‘schizophrenia’

What’s Good About Drug Commercials?

I’ve often bitched about TV (and, I assume, magazine) ads for psychotropics. I’ve said that I despise the fact that they make the entire public their own experts on what they need and shills for “Big Pharma.” I’ve complained that they hamper doctors by encouraging consumers to “ask if drug X is right for you” and to accept no substitutes. I’ve also said that the ads present unrealistic pictures of very serious mental conditions by making depression, for example, no worse than the flu or a hangover.

Nonetheless, I’ve decided that drug commercials do have some beneficial purposes and effects. They aren’t all evil after all. They send messages to the viewing public that are actually positive. These messages contradict the prevailing public conception that people with mental illnesses are different from other people – that the entirety of their lives is taken over by their illness. People with bipolar disorder change from the depths of despair to uncontrollable, laughing lunacy within the span of hours or even minutes. People with OCD are picture-straighteners and tile-counters. People with schizophrenia are violent criminals or raving crazies, often hospitalized for life. None of these brain illnesses can be treated, according to the general wisdom.

Modern drugs have improved people’s lives and improved the general public’s conception of what mental illness is like.

First, more of the commercials now present understandable views of what some mental illnesses are like. They do this primarily when they use analogies or metaphors. Bipolar mania is like climbing a house of cards that is destined to collapse inevitably at some point. Depression is like darkness, and medications can lessen it by bringing light. They even make the symptoms and side effects more understandable: tardive dyskinesia, for example, is depicted with actual twitches, intractable movements, and mobility issues.

Also, the ads do emphasize that there are treatments, if not actual cures, for disorders that the general public views in a stereotypical way. Take schizophrenia, for example. Most people associate schizophrenia with homelessness, psychosis, and/or raving unintelligibly. Yes, those are sometimes the consequences of the disorder, but they’re far from the whole story. I’ve seen commercials for schizophrenia medications that show a man with a family playing guitar, two women with schizophrenia calmly discussing their symptoms, and a comparison of daily pills and twice-yearly injections for treatment. They humanize an illness that too many view as intractable and untreatable.

I stand by most of my criticism of ads for psych meds. They are shallow and simplistic. They do promote self-diagnosing and self-prescription and demands on doctors. They minimize the good that talk therapy can do, concentrating instead on medical and pharmaceutical interventions. At the same time, though, these ads promote more accurate, healthier views of mental illnesses, even the most severe. They portray people who have the illnesses as having alternatives, socially productive lives, and “normal” interactions with others despite their psychiatric conditions.

I have no scientific evidence to support this theory, but my guess is that after viewing these ads, often several times a day, a poll would reveal changes in attitude. That, combined with the public service announcements about depression and even ads for telemedicine therapy sessions, may indeed make it more likely that people who live with these conditions without realizing it to better understand their own possible mental problems and those of their friends and family, and to have greater empathy toward them.

And those are good things. May the trend continue.

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Mental Health

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Schizophrenia: Nature and Nurture

Think about the devastation that a case of schizophrenia can cause a family. Then multiply that times six.

If you want a book that explores such a situation, look no further than Hidden Valley Road: Inside the Mind of an American Family by Robert Kolker. It’s the true story of a middle-class family with 12 children, six of whom became schizophrenic. The children included ten boys and two girls; neither of the girls developed schizophrenia, so that’s a full 60% of the boys who did.

The story begins in the 1950s, when at least there were hospital beds as well as halfway houses for psychiatric patients. The matriarch, Mimi Glavin, however, preferred to care for her boys at home as much as she could. This was, of course, disruptive to the rest of the family. And the patterns were perhaps obscured by the fact that four of the boys and the two girls never developed the disorder. One of the girls was sent to live with a rich friend, and the other managed to be admitted to a boarding school. These were irregular family arrangements, intended to get the girls out of harm’s way, though they certainly harbored resentment at what they saw as abandonment.

The 50s and 60s were the era of what the mental health community called the “schizophrenigenic” mother. Back then, schizophrenia was thought to be caused by the mother, who was either too cold and distant or too controlling. Take your pick. It was the mother’s fault. It was also the era when Thorazine was the best (or only) treatment that could be given for the disorder.

The boys, many of whom were talented athletically or musically, presented with schizophrenia, as you would expect, during their late teen or early adult years. Chief among the delusions affecting Donald, the oldest son, were religious ones. The younger ones also heard voices. One committed a murder-suicide, and another sexually abused his younger sisters. Violence among the brothers was common. Overlooked in all this was that Don Galvin, the father, had suffered a mysterious hospitalization while on duty in the service, which was classified as depression.

Psychiatrists and other researchers were at that time conducting twin studies to examine whether twins were equally likely to develop schizophrenia or not. The Galvin family was a treasure trove.

Still, the family couldn’t resolve the nature-nurture debate. Were the six boys affected by defective genes? Or was their illness because they had all been raised in the same household? DNA study was in its infancy. Most of the family agreed to interviews and blood studies, though they proved not to be much help.

Of course, the children, when they began to have children themselves, were afraid that the family affliction would be passed down to them. One of the young women put her child in therapy at a young age, hoping to spot incipient signs of psychosis. This choice did possibly more harm than good, as the young boy never developed any symptoms and resented the unnecessary therapy.

The heroines of this story were, of course, Mimi – who cared for all her children as best she could, and her husband after he had a stroke in later life – and Lindsay, the youngest child. The care for her schizophrenic brothers was her purview – monitoring their health, their medications, their hospitalizations, and their money, as well as caring for her mother, who became incapacitated in old age. The mentally healthy brothers and the older sister largely detached from the family and went about living their own lives.

Why read this book? It delves into how schizophrenia can affect not just a person, but a whole (and large) family. It illuminates the struggles the family had to deal with in caring for the brothers who had mental illness. It records how treatments for and research about schizophrenia over the years worked and didn’t. And it’s a well-written book on top of that. I could easily have read it in a couple of days, but I stretched it out over weeks to savor and contemplate.

The book rings with authenticity, as interviews with all of the family and records of their therapy and hospitalizations were made available to the writer. It resonates with pain, frustration, pity, courage, illness, relapses, and desperation. It is truly the best chronicle of schizophrenia I have read. I can’t recommend it highly enough.

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Mental Health

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The Experiment That Changed Psychiatry

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The experiment was famous in the annals of psychiatric history. As I put it in a post in 2016:

A professor at Stanford University devised a simple experiment. He sent eight volunteers, including both women and men, to psychiatric hospitals. Each person complained of hearing a voice saying three words – and no other symptoms.

All – all – were admitted and diagnosed, most of them as schizophrenic. Afterward, the “pseudopatients”  reported to their doctors and nurses that they no longer heard the voices and were sane. They remained in the psychiatric wards for an average of 19 days. They were required to take antipsychotic drugs as a condition of their release.

Rosenhan’s report, “On being sane in insane places,” created quite a stir. Indignant hospital administrators claimed that their staff were actually quite adept at identifying fakes and challenged Rosenhan to repeat the experiment.

This time hospital personnel were on their guard. They identified over 40 people as being “pseudopatients” who were faking mental illness. Rosenhan, however, had sent no volunteer pseudopatients this time. It was a dismal showing for the psychiatric community.

Except now the wind seems to be shifting. Many psychological experiments from those long-gone days have been called into serious question, some because of reports from participants and others because of unreproducibility. The Rosenhan study, which is widely featured in psychology textbooks, is no exception.

I picked up Susannah Cahalan’s book The Great Pretender: The Undercover Mission That Changed Our Understanding of Madness, expecting to find more details of the experiment – maybe the reports written by the test subjects. Instead, I found a piece of journalistic research that attempted to track down the pseudopatients, and used Rosenhan’s notes for his unpublished, half-finished book extensively.

The author’s conclusion? That the experiment, though published in the prestigious journal Science, was at best dubious and at worse fraudulent. Rosenhan, the author says did not get volunteers from among his grad students, teach them to “cheek” pills so they wouldn’t actually be taking psychotropic meds, and turn them loose on several unsuspecting mental institutions.

Instead, the author says, Rosenhan himself was one of the pseudopatients and so were two friends of his. A sample size of eight or nine is small, but one of three is anecdotal in the extreme. Rosenhan’s write-up of the experiment used an even smaller sample – two, himself and one other. The third was relegated to a footnote as an outlier, one who found his assigned mental hospital to be a kind, helpful, and nurturing place. The sample of two related that the biggest problem on the wards was boredom, barely relieved by the occasional group session, and brief, infrequent drop-ins by a psychiatrist. Nurses remained in “cages” where they could view the floor of the dayroom and hand out meds at the assigned time.

There is doubt, too about how the three pseudopatients got out of their situations. They were all voluntarily committed, so could walk out any time they wanted, but Rosenhan’s notes say that the were released AMA (against medical advice), but with a diagnosis of “schizophrenia, in remission.” (Only one of the alleged pseudopatients had a different diagnosis of bipolar disorder.) Apparently, Rosenhan claimed to have had a lawyer draw up writs of habeus corpus, should the pseudopatients need to be “sprung,” but according to the lawyer involved, this did not happen, but was only briefly discussed.

So, after all this time, what difference does it make whether there were nine pseudopatients or only two or three; whether Science was hoodwinked into publishing a paper the author knew to be deeply flawed (to put it kindly)? We all know that such a situation could not happen today. It takes much more than a self-report of brief auditory hallucinations to get into a psych ward these days. There are extensive interviews, the MMPI test, various screeners to go through. Many of these procedures may have been put in place because of the influence of Rosenhan’s experiment.

But Calahan says that the most far-reaching effect of the experiment was that, not only did it put the entire field of psychiatry in doubt, it was cited again and again in other papers. Those papers – and thus the experiment – were influential in the massive closing of psychiatric hospitals, leading to the current situation of actual people with serious mental illness (SMI) with no place to go, a lack of psychiatric beds in hospitals, sufferers forced to live with untrained relatives, no supervision of medication, and various other breakdowns in the system.

It would be unfair to say that Rosenhan caused all that, but according to Cahalan’s reporting, his paper contributed significantly to exacerbating the problem.

 

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Mental Health

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All in Our Heads

Well, mental disorders probably are mostly in our heads, or at least our brains (and genes), but I keep seeing news features that “offer hope” for new diagnostic tools and treatments that “may someday” alleviate the suffering.

Here’s an example from the University of Pennsylvania:

Many factors, both genetic and environmental, have been blamed for increasing the risk of a diagnosis of schizophrenia. Some, such as a family history of schizophrenia, are widely accepted. Others, such as infection with Toxoplasma gondii, a parasite transmitted by soil, undercooked meat and cat feces, are still viewed with skepticism. A new study used epidemiological modeling methods to determine the proportion of schizophrenia cases that may be attributable to T. gondii infection. The work suggests that about one-fifth of cases may involve the parasite.

Great. I am sure that schizophrenics will be comforted by the thought that their problems are caused by brain parasites and cat poop.

I noticed that the study showed that only 20 percent of schizophrenia “may” involve the parasite. What about the other 80 percent? Are those cases caused by some other parasite? And how will the parasites be detected? Blood test? Brain biopsy? Could be a world of horrors there for the already mentally unstable. And, perhaps most important, will real-world results back up the computer simulations?

Schizophrenia is far from the only illness being studied. Bipolar disorder and our old pal depression come in for their share of lab work too. USA Today recently reported on a procedure that might help with depression:

The treatment — transcranial magnetic stimulation — was approved by the Food and Drug Administration in 2008 for the treatment of patients with medication-resistant depression.

Magnets generate a directed, pulsed magnetic field — similar to an MRI in strength — to the prefrontal cortex, the front part of the brain behind the forehead. The magnetic fields induce small electrical currents, which encourage a mood-lifting chemical reaction in the brain.

The treatment is daily, for four to six weeks. If the patient improves enough, the treatment is then provided as a periodic booster.

Never mind that it’s entirely subjective when a patient has improved “enough” or even shows anything other than a placebo effect. And never mind the effects of having 42 MRI-strength treatments in a row.

Apparently scientists and insurance companies are battling it out on the money front (there’s a surprise).

Plus, as always, there are nay-sayers:

The National Institute of Mental Health describes the treatment as effective for some patients, but notes that studies of its efficacy have been “mixed.” The American Psychiatric Association’s guidelines for depression treatment states the procedure conveys “relatively small to moderate benefits.”

To the desperate, any potential “cure” or even palliative treatment eventually seems worth a try. I should know. I came that close (imagine several millimeters here) to having a go at electro-convulsive therapy (ECT). Formerly know as shock treatment.

The thing is, you only hear about theories that “might” be correct and treatments that “may” help. Studies are hardly ever published that say, “You know that treatment we said was going to relieve the suffering of millions? Turns out, not so much.” If the general public even gets to see the negative results, they may still cling to the hope offered by the earlier reports.

Just look at the anti-vaxxers. It has been repeatedly proved that childhood vaccines do not cause autism. The experiment that reported that finding was a fraud and the author (Andrew Wakefield) has been discredited – investigated and found guilty of “four counts of dishonesty and 12 involving the abuse of developmentally challenged children.” Basically, he’s been kicked out of medicine altogether and given the Lifetime Achievement in Quackery award by the Good Thinking Society. (I’m not making that up.)

And yet epidemics of measles and other deadly diseases continue to rise as parents yield to fear and refuse to have their children vaccinated.

I’m not trying to say that a parasite doesn’t cause some cases of schizophrenia or that magnetic therapy will never relieve anyone’s depression.

I’m just saying that if those theories are proved false, we’ll likely never hear about it from the popular press.

 

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