Tuesday, October 25, 2011

Rethinking Schizophrenia

I has already mentioned recently my great approval of including the peer-support model in schizophrenia treatment. Of course, this presumes some acknowledgement by the sufferer of some degree of symptomatology. Those with complete lack of insight, or anosognosia, will have trouble availing themselves of this resource. But it is gratifying to see some positive press for this in popular media. The Sunday NYT has Keris Myrick's story. She has found that a full schedule and challenging herself is better life treatment than low-pressure, ease-into-it jobs. She uses other coping mechanisms as well, including peer support. The video isn't that great, but the story is good.

The Neurodevelopmental Hypothesis would seem to be an opposite at first. That approach, focusing on early detection and treatment, carries more than a whiff of "once you've got symptoms, you're already screwed and it's too late" about it. But that's an inaccurate reading, a leaping to conclusions.

Sometimes antipsychotic medications do magic, and if you are lucky, the side-effects aren't too bad. But really, they are often limited in what they can do. Hence the more recent focus on prevention and managing symptoms.

3 comments:

Retriever said...

You're the professional in the field, but Kyra sounds like a relative of mine about her age who is diagnosed bipolar but whom I consider schizoaffective. The boundaries between the two are very fuzzy, and in some sense matter less nowadays since the meds used to manage extreme symptoms are often the same. Except that the one virtue of grandstanding celebrities and the overuse of the concept of bipolar is that it carries a less "hopeless" weight as a diagnosis than schizophrenia for some...

I've been thinking a lot lately about how sometimes habits instilled by good parents, and external structures can help people in at least the initial stages of episodes. And help people control themselves long enough to get help from a trusted doctor or friends or just escape a situation that is exacerbating symptoms. "Self-awareness" isn't just a matter of navel-gazing but of managing strong emotions and fears and obsessions, and NOT acting on certain impulses until one has done the kind of thing Kyra describes (asking a coworker if they hear what she hears). Part of the trouble in helping certain patients is that they grew up in chaotic households with absent or abusive or otherwise non-functioning parents. Parents and substitute parents (healthy grandparents, ministers, etc.) MATTER.

I remember how, when our youngest was hospitalized in a teaching hospital at a very tender age, acutely ill, we were the only married parents on the wing visiting a kid. We came everyday, and sometimes brought his siblings, and his minister. The other kids got no one or a social worker or maybe a single parent completely intimidated by the place. That didn't alter the fact that my kid was sicker than most, but his prognosis was still better as he left to a safe school, regular care, parental discipline and love, good food, a calm and drug free environment, a DOG, etc.

Excuse rambling thoughts...Mental illness is a bear. On bad days I think I'd rather my kid were healthy and just a dirty thieving Wall Streeter...or even just a typical drunken undergraduate getting Cs and dissing us. But we play the cards we are dealt...

Assistant Village Idiot said...

I concur with your diagnosis. I liked the general of the article more than the specific.

Mickel Geroge said...

I am big fan of Michael Jackson and I am very upset after reading your article that he was suffering from schizophrenia problem. It’s very sad that after so much success in the life then he is also in list of celebrities with schizophrenia.