Sunday, March 08, 2020


Deevs asked for recommendations of books about paranoia.  I thought this worked better as a separate post. I used to psychblog from 2005-2009, but I haven't put in so much since then. As there as been interest in the first post on paranoia and some questions asked, I will have another go - with anecdotes.

The classic in the field is Surviving Schizophrenia, by E. Fuller Torrey. Checking up to see if it had come out in a fifth edition, I found that it is now in its seventh edition. Xavier Amador has written the very readable I'm Not Sick, I Don't Need Help, and is an engaging speaker as well.  He has a series of talks on Youtube, of which this is the best introduction.  He was studying to become a psychologist when his brother was diagnosed with schizophrenia.  The battle over medications and having to confront that "lack of insight" is a frequent symptom was very painful for him.  He eventually became his brother's guardian, agreed to forced long-acting injectable medication to keep his brother alive, and was relieved that his brother was consistently treated and nonpsychotic for decades. However, even at the end, he would ask his brother if he needed the medication.  "Nah.  I just take it to keep you happy," said his brother, with mild affection. You can see what a bind that creates. People have rights, and the idea of the government giving permission for guardianship, allowing someone to force treatment on you that you don't think you need has obvious problems. You can find complaints about this all the time on civil libertarian websites and in comment sections of both liberal and conservative sites. Horror stories are recounted, at which I nod my head and think "I'll bet I know the other side of that story."  Sometimes there are real horror stories, of people being railroaded who are not particularly ill. But in most places, psychotic folks are getting too little treatment, rather than merely annoying people getting forced treatment they don't need.  I can imagine how some trends in mental health could create a situation, decades down the road, where inconvenient beliefs are medicated against the person's will.

Yet that looked more worrisome in the 1980s when I was first working through this.  I worried such frightening things as locking up Reaganites were plausible. And as a disciple of CS Lewis, his cautionary words in God In The Dock carried great weight with me. Yet in the end, believing what I saw in front of me was the most powerful lesson. It doesn't look very probable from here.  Of course, I am writing from the Live Free Or Die state, so maybe somewhere else the danger of abuse is greater. Getting the legal structures in place to make this treatment happen is part of what I do for a living. Some of you may have what you think are strong arguments against the practice. Go right ahead, but I have probably already heard them.  From murderers.

In checking up on these, I found that friends of mine had written books for clinicians, mostly around treating those with dual diagnoses - substance and mental illness. Kim Mueser wrote The Complete Family Guide to Schizophrenia, plus a bunch of books for professionals with Doug Noordsy and/or Lindy Fox.  Bob Drake has written a passel of books on dual disorders that look like graduate texts. He is my source when people try to sell me the idea that marijuana has no negative effects on Mental health, if you want to pursue that.  They are all Dartmouth affiliated - Geisel Medical School and Dartmouth Hitchcock Medical Center - which is one of the main sources for dual-diagnosis research worldwide.  Drake may be The Guy, actually. It is weird to see guys I knew as residents noted as experts in the field.  They are all very smart guys and excellent practioners, but I have not read any of those books. As they are expensive, I doubt any of you are going to be seeking them out anyway. But just in case you need to know, these are people who are very experienced with the sickest of patients, not La-la land shrinks who sound more eccentric than their clients.

Just to throw it in, the book I recommend for dealing with Borderline Personality Disorder is Stop Walking On Eggshells. I don't have recommendations for autism, depression, mania, PTSD, or anxiety,  but I could at least give you some info to help you avoid the complete charlatans.

1 comment:

Deevs said...

This is great, and I'll be bookmarking this post. Thanks for taking the time to put this together.