Sudden jolts

In line with a previous post on how the disorienting experience of schizophrenia can sharpen the intellect there is a recent article in the New York Times that reinforces this message.

Jack Mezirow, a professor emeritus at Columbia Teachers College, has proposed that adults learn best if presented with what he calls a “disorienting dilemma,” or something that “helps you critically reflect on the assumptions you’ve acquired.”

This article advises the aging brain to do anything from learning a foreign language to taking a different route to work.. . Continued brain development and a richer form of learning may require that you “bump up against people and ideas” that are different.

When you are confronted with what others all around you are calling a tragedy, the kind of experience that shakes up your world, rather than retreat within your normal defense mechanisms, this is the time to rise above it, to learn from it and to find something inspiring in it. By doing so, you just may be helping your brain to stay fit.

Culture and situation specific symptoms

Having said in a recent post that Africans are not overexposed to the diseased brain model of mental illness, I picked up my nightly reading, Morality for Beautiful Girls, by Scottish writer and medical doctor Alexander McCall Smith. The “mental illness is a disease like any other” viewpoint has invaded the fictional world of Precious Ramotswe, Botswana lady detective. When J.L.B. Matekoni, her garage mechanic fiancé and owner of Tlokweng Road Speedy Motors, becomes listless and secretive, she turns to Dr. Moffatt for advice. “Depression is a disease like any other,” he counsels from the perspective of Western medecine. Dr. Moffatt says he should go on medication. The fact that the forty-five year old Mr. Matekoni has just become engaged and adopted two orphans seems not to be considered as a possible reason for his depression.

Culture and context do make a difference in how your symptoms are expressed. I remember an African colleague at work got stuck in a low-rise elevator for about ten minutes. Have you ever seen someone who was catatonic? My colleague was when they took her out of the elevator. She was rigid, her eyes wide open and staring like she had just seen seen the spirit of a dead ancestor. She was whisked away to the hospital in an ambulance. It is observed that catatonic schizophrenia is more prevalent in African countries than elsewhere. Having seen what happened to my colleague with elevator trauma, I don’t need any convincing that a relatively rare form of schizophrenia in western countries is more common in Africa.

Obituary – Dr. Herbert Spiegel

From today’s New York Times
A trained Freudian analyst, Dr. Spiegel came to see traditional, open-ended psychoanalysis as too costly and meandering for many patients — and hypnosis as a way to accelerate healing, effecting change in some people even in a single session. As Dr. Spiegel’s reputation grew, performers and politicians in New York and prominent people from around the world made their way to his office in Manhattan.

Chris’s psychiatrists in his day program wouldn’t hear of hypnosis. “It’s not for schizophrenia,” they said, quickly changing the subject whenever it was raised by the parents. They left us with the impression that there was something so strange about schizophrenia that hynosis would only serve to destabilize the individual. I beg to differ. A holistic approach to healing means to employ different approaches in order to ferret out the root cause of the suffering. Hypnosis should be considered when treating schizophrenia. Deep trauma is not easy to get at through conventional therapies.

Death to the diseased brain model is a-comin’

The hypocrisy of my New Year’s resolution to write fewer, but better blogs has been pointed out to me by faithful reader Sister Jane Findlay. She has noted that I haven’t missed a day, but thankfully judges that the quality of the writing isn’t suffering. Trust a nun to know when good intentions have been cast aside. I will amend my New Year’s resolution slightly, to not necessarily posting every day.

Which brings me to the latest article from the New York Times. The Americanization of Mental Illness explains many things about mental illness and schizophrenia through the lens of culture. If you are like me, totally confused about what schizophrenia is, suspicious of the disease label that has been affixed to it and wondering why people with schizophrenia in poorer countries have better outcomes, this article is for you.

EVEN WHEN THE underlying science is sound and the intentions altruistic, the export of Western biomedical ideas can have frustrating and unexpected consequences. For the last 50-odd years, Western mental-health professionals have been pushing what they call “mental-health literacy” on the rest of the world. Cultures became more “literate” as they adopted Western biomedical conceptions of diseases like depression and schizophrenia. One study published in The International Journal of Mental Health, for instance, portrayed those who endorsed the statement that “mental illness is an illness like any other” as having a “knowledgeable, benevolent, supportive orientation toward the mentally ill.”
Mental illnesses, it was suggested, should be treated like “brain diseases” over which the patient has little choice or responsibility. This was promoted both as a scientific fact and as a social narrative that would reap great benefits. The logic seemed unassailable: Once people believed that the onset of mental illnesses did not spring from supernatural forces, character flaws, semen loss or some other prescientific notion, the sufferer would be protected from blame and stigma. This idea has been promoted by mental-health providers, drug companies and patient-advocacy groups like the National Alliance for the Mentally Ill in the United States and SANE in Britain. In a sometimes fractious field, everyone seemed to agree that this modern way of thinking about mental illness would reduce the social isolation and stigma often experienced by those with mental illness. Trampling on indigenous prescientific superstitions about the cause of mental illness seemed a small price to pay to relieve some of the social suffering of the mentally ill.

But does the “brain disease” belief actually reduce stigma?

The results of the current study suggest that we may actually treat people more harshly when their problem is described in disease terms,” Mehta wrote. “We say we are being kind, but our actions suggest otherwise.” The problem, it appears, is that the biomedical narrative about an illness like schizophrenia carries with it the subtle assumption that a brain made ill through biomedical or genetic abnormalities is more thoroughly broken and permanently abnormal than one made ill though life events. “Viewing those with mental disorders as diseased sets them apart and may lead to our perceiving them as physically distinct. Biochemical aberrations make them almost a different species.”

In other words, the belief that was assumed to decrease stigma actually increased it.

I have always wondered why on earth people are so eager to accept the diagnosis that they or their relative has a deficient brain. It’s amazing what people will allow their doctors to tell them that reflect poorly on them and give them no hope whatsoever to do anything about it. On the other hand, I have fallen into the peculiarly American trap this article explains, of high EE, or expressed emotion. I had heard about high EE families, and that people who have better outcomes with schizophrenia have low EE environments, but nobody has ever explained in a practical sense, as this article does, why being overly protective and prodding a relative to get through their problems through sheer willpower just doesn’t work very well. So, I fell into a different kind of trap. Instead of thinking that Chris had a defective brain, which I know isn’t the case, I fell into the trap of caring too much that he didn’t. This “can do” attitude doesn’t work very well as an incentive in schizophrenia.

Here’s a tip for parents. Through trial and error, I discovered that the more I pretended not to notice Chris’s, um, peculiarities, the less peculiar he became. I did read about that early on. It grates me that I had to pick it up by sniffing out and seizing on one sentence that I found in some obscure article I read. You won’t find this useful nugget in the the so-called authoritative books on schizophrenia. Some doctor noticed that patients who had better outcomes, often had parents who barely noticed there was a problem. In my defence, maybe I had to became an EE parent to counteract the medical dogma being foisted on me and Chris by the diseased brain practitioners peddling their drugs. They still are not over-exposed to that model in Africa, thank goodness, where EE is very low.

Is cognitive-behavioral therapy really all that good for schizophrenia?

I am being deliberately provocative with my title. What prompted today’s post is an article about careers for the coming decade. Cognitive-behavioral therapist is one of them, the reasons given below.

The Mental Health Parity Act requires that mental health now be covered as fully as physical health, but many insurers will cover only cognitive-behavioral therapy because it’s both shorter and, on average, more efficacious than traditional psychotherapy. Learn more: Association for Behavioral and Cognitive Therapies.

My blog is USA-centric, even though I don’t live there, for the reasons that the USA tends to drive the way the world sees things, for better or for worse. Is it throwing the baby out with the bath water by favoring CBT over other kinds of psychotherapy when it comes to schizophrenia? Schizophrenia is not garden-variety depression. It’s not about coping with a dead-end job or having your wife leave you or your dog die. Schizophrenia is the larger than life mother of all existential blow-outs. People who come under its influence deserve the best psychotherapy from the most skillful therapists, which may not be cognitive-behavioral therapy and probably isn’t in most cases. I don’t want to rain on CBTs parade. I just think that schizophrenia is more complex than what CBT can deliver.

Here’s another viewpoint about this from … there are radical approaches in psychotherapy that are especially vulnerable to state regulation, approaches that really do provide the space to speak freely. Some approaches like ‘cognitive behavioural therapy’ are unfortunately compatible with state regulation because there is an assumption in them that there is a correct and incorrect way of thinking about the world.

People experiencing a crisis of schizophrenia do not think about the world conventionally, and I wonder really how effective CBT is in helping them grapple with their myths and heroic struggles. CBT may be cost effective for governments, but will it really up to the job of helping people in severe existential angst get on in a conventional world?

What do schizophrenia and X-Ray technician schools have in common?

I am still puzzling over why a website for x-ray technician schools has information on schizophrenia, however, I’m glad it does. The information on this X-Ray Vision-aries Blog (link no longer available) is much more encouraging than what is normally found elsewhere.

Here’s a sample, below. Note that the article doesn’t push medications as a cure-all, and it acknowledges that there is no universal cure but there are individual ones.

“By learning how to take control of their illness, schizophrenics may very well end up leading happy, productive lives once the proper blend of therapy and/or medication has been established. Upon the establishment of a gratifying, personalized method of treatment, the risk of a relapse drops significantly. Roughly half to 2/3 of schizophrenics undergoing a psychotherapeutic regimen that meets their needs improve significantly – if not outright recover. The psychological community defines recovery from schizophrenia as a complete sloughing off of the disorder’s symptoms. Patients function and integrate themselves in a healthy manner without the aid of therapy and medication. While no universal cure for schizophrenia exists, individual ones do – and when they are discovered they mean bringing the victim out of their encroaching darkness and back into a satisfying and stable life.

Unfortunately, due to overarching stigmas falsely regarding psychotherapy as the exclusive realm of the crazy, the misanthropic, and the living damned, many individuals suffering from schizophrenia and other mental illnesses shy away from pursuing it.”

I See Your Dream Job

Numerology has been used by for thousands of years to tell us who we are and what our life path may look like based on the vibrational energy of the numbers 1 to 9, 11 and 22.

Sue Fredericks, career intuitive and author of I See Your Dream Job (see also The intuitive mind), makes an excellent case for why numerology does a better job of helping you to discern your true career path than any other career book I have read. This is not just another horoscope book, where the astrological descriptions often seem so generic that they can apply to just about everyone. Her added value lies in directly linking destiny path to career choice. Most of us would probably not make that link, figuring that our destiny is not necessarily our career. We should think again if we are looking for fulfillment.

We have all heard that it is better to find something you love to do as a career choice than something that you think will lead to money. The money will always follow the path you love, is the thinking. Finding something we love to do is tricky. We very often confuse what we think we like to do with what we are good at doing (skills we have learned). Another false step is to want to be like someone else, usually someone famous or fabulously rich. We are not like anybody else. We are all born with a unique molecular vibration that makes us who we are. Being who we are can earn us all the money we will ever need, Sue Frederick reassures us. Intuitively, this makes sense to me.

As a parent of a young adult in a mental health crisis, you may be doing your child a real favor by absorbing what the book has to say about possible career paths derived from being yourself. A person in a mental health crisis knows a lot about pain. This book advises you to consider your pain as your career fuel. Choose the right time to open up this career path dialogue, when your relative is well along the road to recovery. Forcing the issue too soon can provoke a crisis, as my husband and I learned the hard way last year.

For most people, getting further education or training in a field of interest is key to eventually working at a job in a field that they love. For young people who have lost precious years due to a mental health crisis, their sense of self worth needs a boost, which actually provides a wonderful window of opportunity to get started or get re-positioned in something they love while still young.

Which brings me to the numbers.

Adding up Chris’s birth day, month and year and reducing it to a prime number reveals that he is a 3. This is his birth path, his destiny number. Combining it with the astrological sign adds flavor to the life path number. Chris is a Capricorn 3. Number 3s are creative and possible career paths according to Sue Frederick are acting, music, art, fantasy or science fiction writing and teaching. So far, this doesn’t sound exceptionally insightful, but Sue Frederick adds her insight to it. Number 3s are better off teaching in none-traditional settings, she advises, as a large school system would probably feel too restrictive. The negative qualities of number 3s will surface if they are not doing what they love to do. Unlike hardworking number 4s, who often get lost in the drudgery, if number 3s are not having fun at what they do, they will quickly lose interest. She also cautions number 3s not to rely on other people for handouts. (Thank you, Sue!) They are perfectly capable of making a career that pays their way. I have been pushing Chris to think of music and fantasy writing as a career focus, so the book confirmed my hunch. Because Chris is naturally intuitive, and sees meaning and relationships where others fail to see them, numerology makes sense to him. He appreciates being a number 3. It’s becoming an easy sell.

Now, when we sit down to discuss options for taking classes at the university, the discussion go along the lines of: Don’t bother to look at this course, because it is off path for you. Consider this one instead. Using your pain as your fuel, is great advice for an aspiring writer or artist. In schizophrenia, there is plenty of pain to fuel an eventual career path. Make that pain work for you.

It’s attitude adjustment time

I recommend the following article Open Dialog — Alternative for Psychosis in Scandinavia and Finland on the bipolarblast website, You can read the article here

To quote the article’s author, madnessradio, the open dialogue approach “challenges a key problem with holistic health approaches, which, though they avoid the harm of pharmaceuticals, remain individualistic and tend to ignore social context and immediate relationships as pathways to recovery, remaining in the ’something is wrong with you” framework shared with the disease model.”

Madnessradio continues: “In the open dialog session video we watched, I was struck that they chose to show a clinical moment where a change in attitude in a therapist, not the client, was the key to improving the situation. This strikes me as revolutionary in outlook – the problem is in the network of relationships surrounding a person who is “in crisis.”

Well, perhaps easier said than done, as Barack Obama is finding out with the war on terrorism.

Yes, the shared problem, a.k.a. “blame” approach may soon be revolutionary once more, but will need sensitive handling so that parents don’t walk. Open Dialog should consider dropping the Marxist references to abusers, a.k.a. the family. Labelling the family as “abusers” will kill any dialog before it opens. How about, instead, using the language of compassion? From what I read in this article, perhaps the needed change in attitude may simply be for the family and the therapist to stop thinking the patient is whacko and instead might actually be making skewed sense. My kind of holistic schizophrenia involves attitude adjustment on the part of the family members and therapists alike. For the past several decades parents have been told that their child has a biochemical imbalance. The so-called biochemical imbalance may be a biological coping mechanism to a perception of the world that is different than the norm. And who of the rest of us is normal?