Dr. Carl Pfeiffer’s 29 medical causes of schizophrenia

When people first fall into the rabbit hole of schizophrenia, the logical question to ask is “what causes schizophrenia?” A psychiatrist’s standard answer to this question is that “nobody knows” what causes it and then, rather inexplicably will hasten to add “but there are good treatments available to manage it”. Technically, the psychiatrist is correct, at least as far as the cause goes, because no medical explanation has yet evolved to apply in a general sense to all of its victims.

As a parent, I want to know what causes my child’s schizophrenia. I’m not interested in schizophrenia in a population.

A lady I am acquainted with was convinced that a particular acne medication may have triggered her sixteen year old daughter’s psychosis. The doctor told her that her daughter’s psychosis was of unknown origin. She was very, very angry because she felt the doctor patronized her by denying possible causality in the case of the acne medication. It is also patronizing of a doctor to believe that he or she knows more than the mother or father as to what makes their child tick.

It is difficult to say what causes psychosis in a particular individual because there may be multiple factors involved, but that is not to say that one shouldn’t look for cause. I am convinced that from knowing cause comes cure. Cure is a word that you are not supposed to use in the context of schizophrenia.

In his book Nutrition and Mental Illness, Dr. Carl Pfeiffer states that there are 29 medical causes of schizophrenia, ranging from pellagra to drug intoxications, to heavy metal toxicity, to wheat-gluten insensitivity, to chronic candidiasis, to a host of other rare and not so rare ailments. That does not necessarily mean that your schizophrenia can be pinned down to one of these 29 medical causes. What I find incredible is that no doctor in Chris’s hospitals bothered to ask me if there was a family history of any of these ailments or called for tests to rule them out.

It is worth noting that Dr. Pfeiffer is referring to 29 “medical” causes of schizophrenia. Half the fun of schizophrenia is figuring out the non-medical, i.e. psychological causes of schizophrenia. Understanding and treating the emotional underpinnings of schizophrenia has been pushed aside over the past few decades in favor of the biochemical model. I am getting ahead of myself here. There will be plenty of time to delve into this fascinating subject in later blogs.

Judging a book by its cover

When Chris was showed up at the hospital emergency room in December 2003, he was diagnosed simply because he appeared schizophrenic in the opinion of the doctor. Now, I ask, is this the best we can do in this day and age? If you show up in the emergency room complaining of an intense headache or a stomach ache, chances are you would be subject to a whole battery of tests until a diagnosis is made. Six years later any tests that Chris has undergone were at my insistence, never once at the instigation of his doctors. To put this another way, Chris’s medical care has amounted to over 500,000 USD, a staggering amount to bill to an insurance company without it demanding accompanying medical examinations to determine what may be causing the problem.

I insisted a week after Chris entered hospital that he undergo an Magnetic Resonance Imaging (MRI) to rule out a brain tumor. There was a reason for my concern related to a specific incident a few months earlier. The doctor never once suggested an MRI. Amazing, isn’t it? For such protracted, expensive treatment that not even the insurance company demands additional tests be done, makes one wonder.

What is truly outrageous if you think about the money aspect, is that six years on, Chris is still considered schizophrenic by his doctors (or possibly now obsessive-compulsive, judging from the pamphlets he has picked up in his current hospital stay) despite the oceans of money being spent. Mental patients are the cash cows of the mental health system.

Psychiatrists are not doing a very good job of it. If a company failed to make money for its shareholders, the president would be fired. If a Broadway show failed to attract an audience, it would close. Why does high-priced treatment for schizophrenia persist in the face of failure? Sadly, the answer is that the public has bought what author Robertson Davies calls the “higher hokum” of psychiatry (“teacup readers in an age of faith”) It hasn’t dawned on sufficiently large numbers of people that psychiatrists, researchers and academics are making money off the misery of mental illness by favoring the interests of pharmaceutical companies over the public interest.

Not a joiner by nature

During this early period, I toyed with the idea of joining the National Alliance on Mental Illness (NAMI). The website proclaimed: “Join NAMI today! When you become a member of NAMI, you become part of America’s largest grassroots organization dedicated to improving the lives of persons living with serious mental illness.” I just couldn’t join. Maybe it’s that I’m not a joiner by nature, but the message I got from NAMI’s website is that mental illness is a lifelong commitment with no escape hatch: “Individuals with schizophrenia face enormous challenges, including society’s stigmatization of people living with schizophrenia, and the discrimination that results from these prejudices.” Why, for heaven’s sake, instead of celebrating people whom they seem to regard as chronically disabled, don’t they say that they are dedicated to helping people with serious mental illness get over it and get on with their lives? Why not, indeed?

The trouble with institutions, Part II

Modern science, according to German writer Hermann Hesse, is in the Stone Age compared to the teachings of ancient Indian mythology. I’m sure he’s right.

Dr. Vandemaele, Chris’s psychiatrist at the time, felt that Chris was on the upturn and would be ready to be released from the hospital in early March, 2004. Based on Chris’s reported symptoms and the doctor’s clinical observations, Dr. Vandemaele was of the opinion that Chris had schizophrenia, with a secondary depression, the two together not uncommon in the first presentation of the illness. Dr. Vandemaele assured us that there are effective treatments for both conditions and we could expect Chris to continue to improve with the initiation of the antidepressant. I did not disagree with Dr. Vandemaele’s assessment that Chris had schizophrenia and was also depressed, but to me it was situational depression, prompted by being forced to drop out of university while residing in a mental hospital. To Dr. Vandemaele, depression was a medical thing that could be treated with drugs.

To a doctor working in a psychiatric institution effective treatments mean medication. The institutional doctor does not convincingly project to the patient or the relatives a belief that the patient will eventually be capable of functioning in normal society, probably because the doctor does not work with normal society. His belief system comes from a conservative medical training and what he sees on the psychiatric wards. He only sees the breakdown within the walls of the institution.

For decades, psychotherapy has been downgraded as an effective treatment for schizophrenia in favor of drug treatment. Many people did not benefit from this treatment because it was considered of little therapeutic value when it came to schizophrenia. Dr. Vandemaele spoke of effective medications and did not speak of psychotherapy except to turn that job over to Chris’s priest.

R.D. Laing was one psychiatrist who understood. “Madness need not be all breakdown. It may also be break-through. It is potential liberation and renewal as well as enslavement and existential death.” This sentiment may have been echoed by Dr. Vandemaele, but if it was, he never shared it with me. I could have used the encouragement and the hope in this very dark period. Instead, the language of the institution and the staff was psychosis, comorbid symptoms, prodromal symptoms, effexor, respiradone, etc. These words are terrifying.

The trouble with institutions, Part I

In late January 2004, when Chris was first hospitalized, Chris’s treating psychiatrist wrote that although Chris had a good initial response to the treatment, his condition had worsened over the past week to the point that he was in danger of harming himself. Chris had become disoriented while on a pass with a group of people and had returned to the hospital an hour later. Although no physical harm had befallen him, with the temperature outside hovering around –30ºC, he would not be going out again without one-on-one nursing support. Given the state his mind was in and the need for supervision, Chris was formally asked to withdraw from his university courses. This prompted his rapid descent into a deep depression. He stopped eating and drinking, believing that the world was going to end and resigning himself to his fate.

According to his doctor, his nihilistic beliefs had reached the point that he did not grasp that he had an illness that could be treated. The hospital made him an involuntary patient and deemed him incapable to make treatment decisions. He asked that either Ian or I be the decision-maker for treatment decisions, although Chris had a right to appeal these decisions. Chris had become preoccupied with a number of religious and existential themes and the doctor believed that he could benefit from speaking with his college priest since they had shared a strong relationship in the past. He added that Chris was challenging the finding of his incapacity to make decisions, so no new treatment could be initiated until a hearing took place, which could be as early as the following week.

Years later, reflecting on the psychiatrist’s request to bring in a priest, it occurred to me that this psychiatrist or another psychiatrist should have been the logical first person with whom Chris could discuss his religious and existential themes. What the heck was he a psychiatrist for, if not to deal with a patient’s religious and existential themes? What had become of the psychiatric couch and the empathetic psychiatrist well versed in religion, mythology and psychoanalysis? In Thomas Szasz’s view, he has become the prescription writer for the state. Unfortunately, in a psychiatric institution, the patient and his family give up freedom of choice. The institution operates on a one-size-fits-all mentality. If we wanted something tailored to our specifications, we would have to search for it outside the walls of an institution.

Existential concerns

Chris will soon be released from the hospital after three months. I am concerned that we will be right back to the situation that prompted his hospitalization in the first place. He knows that he needs to get out, he is bored out of his mind, and yet he is not looking like he can blend in with quote unquote “normal people”. He arrived home for the week-end on Saturday morning, attended to his e-mails and fixed a few computer problems. He talked to me very thoughtfully on Saturday evening. Sunday was a different story. We invited him to join us for a lecture and lunch. We went for a walk on the grounds of the lecture hall before lunch. He was in existential despair. He didn’t want to spend his day with “old people”. I can’t fault him there. He said he didn’t know what was real anymore – was I real? Was this scenery real? Was the day going to end and the sun go down? He claimed he didn’t know. I asked him if he wanted to resume his Alexander Technique lessons when he came home. “No, I have learned everything I need to know”, he answered.

The hospital fussed with his medication, introducing a second antipsychotic over my objections. I maintain that despite the elaborate, weird behavior that got Chris committed, his problem cannot be fixed with medication. It is looking likely that I am correct. The doctor is not satisfied with the addition of the second antipsychotic, noting that Chris seemed overall better just after they introduced it in a low dose. So, now they are tapering it back but not discontinuing it. Discontinuing it would be admitting they were wrong. Nobody, not my husband, not the hospital psychiatrist, not Chris’s regular psychiatrist nor anybody having seen Chris in his pre-committal state, understands my objection to the medication. It is they who just “don’t get it”. Chris has problems that persist whether he is on medication or not.

What I think has taken the edge off the situation while Chris has been hospitalized is not the medication but the fact that Chris got away from us, from living in claustrophobically close quarters every day and being treated like the two year old he was becoming. The doctors acknowledge this reality, but medicate anyway. When I object to the fact that this latest med was the fifth antipsychotic Chris has been on, and shouldn’t we conclude that antipsychotics don’t work for Chris, the clear message I receive in return in that it is foolhardy not to use antipsychotics as one treatment modality. My husband is almost threatening to divorce me if I undermine in any way Chris’s staying on medication. He reminds me of the lead-up to the hospitalization. Yes, I am painfully aware of all that but I also know that Chris has exhibited extremely weird behaviour while on medication, beginning with his first antipsychotic. His mind is more powerful than any drug or vitamin. Until he resolves his existential problems, we will continue to weather the storm.

Reparenting and Jacqui Schiff

Another proponent of the bad parenting school of thought was social worker Jacqui Schiff, who took a number of schizophrenic young people into her household in the early 1970s to “reparent” them, using Transactional Analysis techniques that she had learned from Dr Eric Berne. All My Children, published in 1970, provides a graphic account of the struggles she and her husband went through in the process of reparenting. She is scathing about the failure of parents to send the right messages to their children, which, she claims, results in their subsequent development of schizophrenia. Despite the fact she is acquainted with the parents of her charges in only the most superficial ways, she feels qualified to pass judgment on them, while making the same questionable judgments in her reparenting that parents make in parenting. She is particularly harsh on the mothers.

This harsh view of the parents, and in particular the mother, was shared by many psychiatrists at the time, notably Dr. Loren Mosher, Dr. Leo Kanner and Dr. R.D. Laing. Unfortunately, blaming the parents played right into the hands of drug companies. Why do I say this? I say this because drug companies don’t blame the parents. Drug companies claim that schizophrenia is a matter of biochemistry, by implication not by bad parenting.

By labeling schizophrenia a brain disease, not a result of bad parenting, psychiatrists and drug companies have made it easier for parents to say, “Look, it’s not my fault my child has schizophrenia; my child actually has a brain disease.” They have also ensured fat profits for pharmaceutical companies for years to come by this particular logic. What parents, feeling bad enough about the situation, would want to believe that it was their fault, especially if they had raised other well-adjusted children?

At the same time, and this is important, why would parents prefer to believe that their son or daughter has a damaged brain? Why would anyone want to believe that they were somehow “damaged”? That idea is horrible. It is a hopeless view. It is locking the young person into a lifetime of misery and dependency on drugs. There are many websites devoted to showing computer images of the damaged schizophrenic brain. One such website shows pictures of early and late gray matter deficits in schizophrenia. “But”, proclaims the website, “while there is a significant loss of brain gray matter, this is not a reason to lose all hope.” (see link below) Yes, according to the website, these deficits may be reversible and scientists are hard at work on inventing a miracle drug that could potentially reverse these cognitive declines.

I began to appreciate these out-of-favor psychiatrists (and one social worker) after I decided that there was no way I was going to believe that Chris had a damaged brain. The more I read, the more I agreed with them. They were downright interesting. They weren’t trying to toe the politically correct line. They criticized the pharmaceutical industry and psychiatrists for entering into unholy alliances. For all of the emphasis on the pharmaceutical approach, patients weren’t getting much better and of course, there were the side effects. All of this struck a chord with me.

They seemed to be in favor of schizophrenia as giving added value to the world. R. D. Laing believed that schizophrenia was a creative process leading to spiritual and emotional healing and noted that other cultures view schizophrenia as a state of trance, which could even be valued as mystical or shamanic. Isn’t finding “value” in schizophrenia more likely to lead to healing?

I looked into Dr. Leo Kanner’s work again and realized that, as with much of our sound-bite-obsessed culture, even in 1960 his remark about refrigerator mothers was probably blown out of proportion. Dr. Kanner had gone on to say something that shows an understanding that the origins (he was referring to autism) might go further back than the parents have control over. “The children’s aloneness from the beginning of life makes it difficult to attribute the whole picture exclusively to the type of early parental relations with our patients…We must, then assume that these children have come into the world with innate inability to form the usual biologically provided affective contact with people.” He then challenges the mothers to turn against the psychobabble of the contemporary psychiatrists in favor of their (the mothers’) innate common sense: “[R]egain that common sense which is yours, which has been yours before you allowed yourselves to be intimidated by would-be omniscient totalitarians.” Well said, Dr. Kanner!

http://www.schizophrenia.com/disease.htm

It’s likely I am at least part of the problem

I’m going to have to come clean early in my blog. For some time now it has been no longer permissable to blame the parents especially the “mother” for a child’s schizophrenia. But surely it would be remiss of me to attribute my son’s problems entirely to him. I am operating on the assumption that I can help his healing if I find out what it is about me that has affected him. We have heard over and over again that the parents are not to blame. Maybe so, but since schizophrenia emerges in the teenage years, parents are the people who have controlled the environment up until then.

Dr. Loren Mosher was a former chief (1969–1980) of the Center for Studies of Schizophrenia at the National Institute of Mental Health. He blamed schizophrenia on bad parenting, typically by the mother: “There are two aspects of family life that have been consistently highly associated with what’s called schizophrenia. One has been dubbed ‘communication deviance.’ It’s simple. Just means that when you sit with these parents, you can’t figure out what the hell it is they’re talking about. They can’t focus on things. You can’t visualize what they say. They go off on tangents. They are loose in the way that they think.” He stated that the other thing that was clear from studies was that “when families are very hostile to and critical of their offspring, that’s not good for them.”

Dr. Mosher’s patronizing view of the parents echoes the view of Dr. Leo Kanner, who wrote the first English language textbook on child psychiatry in 1935. In it, he adopted the term “infantile autism” to describe a set of behavioral characteristics of certain aloof children. “All too often this child is the offspring of highly organized, professional parents, cold and rational—the type that Dr. Kanner describes as “just happening to defrost enough to produce a child.” Such a mother became popularly known as a “refrigerator mother”, a term used for mothers of autistics but also of schizophrenics.

An article in the British Journal of Medical Psychology (1961) claimed: “In the interviews they manifested chaotic forms of communication while sounding superficially sensible. . . The mothers of schizophrenics did not adapt well to external reality, as shown by poor reality testing, marked denial, and projection. Disorders of thought were prominent, giving an impression of ‘diluted schizophrenia’ in these mothers.”

I am willing to entertain the thought that I may have communication deviance while sounding superficially sensible. I have always thought of myself as on track and a cut to the chase type of person. Nobody has ever accused me of not being on track. Come to think of it, my university English professor once said that I write well, but vaguely. Hmm. Since I started paying attention to this flaw, I have stopped using vague terms like “seems to” and “appears to”. I am trying hard to be more definitive, if only to avoid an impression of diluted schizophrenia. There are enough people around me at work who give off this impression.

___________________________________
1. The Child Is Father, Time (July 25, 1960), http://www.time.com/time/magazine/article/0,9171,826528,00.html
2. http://www.pep-web.org/document.php?id=paq.031.0431a