Here is a comment that I posted today to Family Dysfunction and Mental Health: Dr. Allen, like so many psychiatrists, sees schizophrenia as a special case, a “true brain disease,” that is generally unresponsive to anything but medications.

Dr. Allen: When I began writing this blog, I expected to be attacked by those folks who think that child abuse and dysfunctional family interactions are a figment of the imagination of a bunch of whining liars, and that the problem with modern psychiatry is that we are just not prescribing near enough drugs. I was waiting with baited breath to hear the phrase, “Parent Bashing.”

My response:
Hang on, hang on, here. To quote you “This blog covers mental health, drugs and psychotherapy with an emphasis on the role of family dysfunction in behavioral problems.” A lot of what you call negative comments come from people who take issue with your opinion that schizophrenia and bipolar are “true” brain diseases. The commenters I have seen who take issue with your opinion of bipolar and SZ are people who actually believe (including me) that these conditions arise from Family Dysfunction. Many people diagnosed as bipolar and schizophrenic believe that it is family dysfunction that made them what they are and you are telling them that they are wrong? Oh, no, you have a true brain disease, you say. Take this pill and go away.

How many ways do you want to have this, Dr. Allen? To replay one of your answers to an earlier comment of mine, you wrote “I certainly do not want the mothers of psychotic patients to blame themselves for their child’s illness, as such guilt generally is toxic to everyone in the family.” Hello? Your blog is about linking Family Dysfunction to Mental Health. I am linking Family Dysfunction to Schizophrenia. Your professional view of schizophrenia is a bit schizophrenic, IMO. It is weird, quite frankly, that you see schizophrenia and bipolar as a brain disease and not a mental health problem.

I can’t help but notice that you are getting most comments from people with a bipolar or schizophrenia background. Something about your blog twigs with them, but not with other people, judging from the lack of comments. But you are dismissing them as being negative and insisting that THEY’VE got it wrong. You are getting almost no comments from anybody else, I’ve noticed. Where are the personality disorder people that you treat? Can’t they come up with a comment or two? What about fellow psychiatrists. Where are they in the comments? I would appreciate it if you would look at the people who actually are caring enough to respond to you and think about perhaps opening your mind just a smidgen to the possibility that mental health and family dysfunction includes schizophrenia and bipolar.

When I read a book about schizophrenia, I am always looking to see what things that I can emulate in order to help my son get through his own particular version of schizophrenia. This kind of guidance is virtually non-existent unless you read about it from people who have been there themselves.

It is easy to dismiss Elyn Saks as an over-achieving drama queen. Many people think that hers must be a mild case of schizophrenia since she is such a high achiever. I am amazed that she racked up all the credentials that she has while clearly psychotic much of the time. However, by doing this she has also demonstrated the elasticity of this diagnosis, and she has anecdotally pointed out some valuable insights for the rest of us. Her story will be disappointing for people who see getting off medications as a pathway to recovery because she finally admitted to herself, after years of refusing to take them, that she needed the medication to function. It just goes to show that there is no one size fits all solution.

When I read these first person narratives, I always ask what information is available now that wasn’t available then or what did the person not do that might have helped? None of this guarantees, of course, that the outcome would have been any different. Elyn Saks did not explore vitamin therapy. Vitamins in large doses such as vitamin B3 (niacin) act like drugs and there are no negative side effects. Energy medicine, which has also helped my son, was not widely known back then, and so there is no mention is this book of therapies that could correct an energy imbalance

I have learned enough through my own investigations to see that certain factors were in her favor outside of just being female. One is that her family let her do her thing. It is sometimes said that the family has to be involved but not over-involved. This is what is called Expressed Emotion (EE). Patients with families exhibiting low EE are found to have better outcomes when it comes to schizophrenia. When I first was trying to find out some useful information about what to do for my son, I was intrigued to read that many doctors feel that people do best whose families don’t seem to notice that their relative is ill. Elyn Sak’s parents win top prize in that category, though it probably wasn’t a deliberate strategy on their part. Once I caught on to this simple but elegant idea, I began practicing it with my son. It seems to work because it thrusts a certain responsibility on the person while they remain clueless about how really worried you are. They are less anxious this way. You will eventually be less anxious, too, by practicing low EE.

People who get labelled schizophrenic are often overly attached to their family. They are usually the dutiful, thoughtful, “good as gold”, achieving child. This almost guarantees that their passage into adulthood will be troublesome in really weird ways. Becoming an adult and leaving the framework of the family frightens them. Rather than get angry and rebel (a time-honored method of achieving independence), many go psychotic. Highly sensitive to begin with, they simply freak when it becomes apparent that soon they will soon be venturing further into the world or that the world is putting more demands on them. They are, of course, way too “considerate” of their parents. German theologian and counsellor Bert Hellinger says that individuals with schizophrenia are particularly sensitive to (though consciously unaware of) family trauma often originating four generations in the past. They “self-sacrifice” for a parent as a way of atoning for past family trauma. In this case, Elyn Saks is no exception. Early on, she told a therapist that she no longer wanted to see her (Karen) because her parents were upset that the therapist hadn’t figured this out and come up with a plan, and that it cost them too much money to continue to see her. “It never occurred to me back then (and if it occurred to Karen, she didn’t say so) that I was taking better care of my parents than I was of myself.”

The drug rehab program that she was forced into in high school by her parents left her no time to think for herself beyond the confines of what she was told to do and how to act. This may have worked to her advantage, not because she was abusing drugs (she wasn’t) but because it gave her a framework of hard work and structure to her day that she was able to use throughout her psychosis. She always reached out for someone to hang onto, like clinging to a doorframe in a high wind, using that person as a frame of reference for her day. In her Oxford years she allowed time for herself to be clearly psycho within a framework of rigorous Kleinian psychotherapy, and then sobered up somehow during the rest of the day and went back and racked up more academic credentials. It was astonishing to me that the analysis that she underwent on a daily basis for three years in England didn’t seem to lift her psychosis. She literally clung to the analyst right up until the day she left to go back to the United States, weeping and being her usual psychotic self. She had unknowingly done what psychiatrist Thomas Szasz advises. She found herself a contractual psychiatrist unconnected to an institution. She paid out of pocket for the privilege and she got what she wanted, rather than having the State force its one size fits all approach on her.

The high school drug rehab program also gave her a lifelong aversion to taking any drugs, whether legal or illegal. If you read Robert Whitaker’s new book, Anatomy of an Epidemic, you will see that her success, messy as it is, may be in large part because she continually refused to take the antipsychotics that were offered her. Whitaker’s book extensively documents that long term use of psychiatric drugs leads to poorer outcomes. Psychiatrist Daniel Carlat says: “We often talk about neuro-transmitters like serotonin and noroepharin. But that really ends up being neurobabble. It sounds impressive to patients and it makes them think we know what we’re doing when we’re prescribing the medications. But we don’t really know how these meds work.” Side effects, said Carlat, can be serious or in some cases, unknown. “We don’t know enough about the side effects to know how many people we’re putting at risk.”

Elyn Sak’s very messy psychotic life almost tempts me to say that an antipsychotic introduced earlier would have helped get her life together, and I am someone who is not at all in favour of relying on drugs to solve personal problems in living. Reading this book I am tempted to think “oh, please, just try an antipsychotic,” but I am only too aware that psychiatric drugs can put you in a never-ending nightmare. They are major tranquillizers that set most people spinning off into long periods of relapse, weight gain, apathy, and unemployment. Should Elyn Saks have chosen the drug route, my guess is that she would not be where she is today, but there is also the possibility that had she received drugs earlier, she may have pulled herself together sooner and spared herself years of agony.

Another affirmation I got from this book is, if someone tells you that a certain therapy worked for them, then don’t wait for the latest “scientific” evidence or psychiatrists to give it their blessing as a therapy in order to try it for yourself. Everybody “knows” apparently, that psychoanalysis “doesn’t work for schizophrenics.” Elyn Saks gives Kleinian psychotherapy (think Freud) major credit in helping her cope. Freud has been routinely trashed by modern psychiatry as unhelpful for schizophrenia. However, as her therapist pointed out to her back in the early 1980s, therapists have built on Freud’s work as the basis of their work with schizophrenia. This influence doesn’t seem to be well recognized today in an age where people think Freud has no relevance. Luckily for Elyn Saks, she didn’t know what everybody else knows.

One can quibble by saying that since she still suffers from psychosis, then what good did psychotherapy do? I understand that she is now in training to be a psychoanalyst so she must believe in it strongly. People say the same things about cognitive behavioural therapy, which is finally getting a rethink after many years of being dismissed for schizophrenia. Most psychiatrists don’t want to get that involved with their psychotic patients. It’s easier and more financially rewarding to medicate them than to do the really hard work of getting to know them. I can’t believe the number of people who won’t try something because “there is no scientific evidence” that it works for schizophrenia. Well, individuals are not statistics, you are the persons most interested in your own recovery and you should do whatever it takes to get there. I have introduced to my son some truly unusual therapies, short of dancing on a toad’s grave, but if I thought that might work, I’d be game. I noticed that most of these non-sanctioned therapies moved him forward in some way. The bottom line here is think for yourself. You are you, but you are simply a statistic to the medical profession as it stands today.

To make a long story short, I think this is a great book with a lot of insight.

Here is a quote straight from the horse’s mouth of psychiatrist Daniel Carlat:

“We often talk about neuro-transmitters like serotonin and noroepharin. But that really ends up being neurobabble. It sounds impressive to patients and it makes them think we know what we’re doing when we’re prescribing the medications. But we don’t really know how these meds work.” Side effects, said Carlat, can be serious or in some cases, unknown. “We don’t know enough about the side effects to know how many people we’re putting at risk.”

It irks me that patients and relatives have been saying this for years, then suddenly young Daniel Carlat “sees the light” and is gathering great respect and a book contract with this wisdom. My eyes used to quickly glaze over with all the psychobabble trash talk that meant absolutely nothing to me and only raised my suspicions. Seemed like a lot of smoke and mirrors. Neurotransmitters? Who cares? Serotonin, neurotonin, dopamine, up, down, down, up, blah blah blah blah blah.

No doubt Daniel Carlat still sees schizophrenia as a “special case”, so I will not go out of my way to praise his latest efforts, but at least these things are starting to be said by people who supposedly count – the medical profession. Actually, as Gianna Kali points out, Carlat is still drinking the kool-aid. He’s still digging into his grab bag of labels and symptom hunting. The only difference now is that he has expanded his world vision to include the possibility that meds don’t solve everything.

“Thinking outside the box might be facilitated by having a somewhat less intact box,” says Dr Ullén about his new findings.

ScienceDaily (May 18, 2010) — New research shows a possible explanation for the link between mental health and creativity. By studying receptors in the brain, researchers at Karolinska Institute have managed to show that the dopamine system in healthy, highly creative people is similar in some respects to that seen in people with schizophrenia.

Rossa’s comment: The “schizophrenic” brain apparently looks normal enough to these researchers.

Here is a lengthy messsage from The Last Domino to me re my post on the Garden. In the shared hope of advancing the dialog, and promoting discussion, I have bolded a few key concepts.

“I must confess: I know very little about schizophrenia, although I’ve lived what may be described as a “split existence” most of my life. That split is natural for me, and is my normal. Yet I still feel a sense of Oneness with God, and with All Things.

The title of this piece, “We’ve got to get ourselves back to the Garden” is true. The split, however, occurred, not at the creation of Eve (At bottom, we’re still male and female, yin and yang.), but because of the eating of the fruit from the Tree of Knowledge of Good and Evil.

The split had more to do with the mind of humans (and their resulting expulsion from Eden), and little to do with the creative process.

On my blog, the Secret Place, I’m examining, anew, the Creation stories. There are two accounts.

I’ll try to keep this brief.

“One rabbinical commentary asserts that Adam ‘was a man on his right side, a woman on his left; but God split him into two halves.'”

It wasn’t really a split. It was more like an assignment, or an assigning, a defining of roles in a larger creative process.

What I’ve been told is this: Eve is internal; Adam is external. Eve’s role(the Mother of All Living) is to be “bone of [his] bones (Adam), and flesh of [his] flesh (Adam).”

They’re united in this process (wedded, husband and wife).

In forming the man, God instituted the first creative act. Ensuing creative acts by humans resulted as a collaboration between Adam and Eve (man and woman). The two creations reveal how God and humans create.

Because the woman was taken from man, “Therefore shall a man [MANifestation] leave his father and his mother [God], and shall cleave unto his wife [Eve, humans’ creative impetus and power]: and they shall be one flesh [seamless, an indispensable union in the creative process];” in short, manifestations would now be subject to Adam (red clay) and Eve (the Mother of All), and not directly to the creative process of “his father and his mother,” God (Spirit).

Eve (the Mother part of our being that gives birth to All) pushes out, and Adam is that which is pushed out (MANifested).

Knowing their role and their assignments, it’s not surprising that Eve ate of the fruit of The Tree of Knowledge of Good and Evil first, and then gave it to Adam.

What she tastes, he tastes. What she eats, he eats.

Another role assigned to Adam is that of “Name Giver.” Adam decides what things will be called, that is, their nature and attributes, “and whatsoever Adam called every living creature, that was the name thereof.”
Eve, too, is subject to Adam in this regard, and is not Self-Named.

The fruit is not two fruits, but one fruit. Humans get to eat the fruit (experience it), and call it whatever they choose (Good or Evil).

Every experience in our world, then, becomes the fruit–every human act, every environmental (worldly) act, or occurrence, that we bring to our intellect, and attention, to judge, becomes the fruit.

An act is not inherently good, or bad, but “thinking makes it so.” We label it either good or bad.

Adam and Eve in their pristine state, where God (in the first creation, not Lord God of the second) did the judging, and the creating, this knowledge of Good and Evil did not exist, hence judgment didn’t exist.

Neutrality prevailed. As the writer you cited observed, “The world after the Fall, outside the Garden, is essentially colorless, neutral, impersonal.” Actually, this description best describes the condition of Adam and Eve in the Garden before the Fall, not after.

Neutrality (a non-judgmental state) existed inside the Garden, and was mostly “impersonal”, in that Adam and Eve were “naked” and weren’t “ashamed”.

Once their eyes were opened (after eating the fruit), they could see their nakedness, and could now respond judgmentally to their nakedness, and, hence, concluded that they were “ashamed,” shame being a judgmental state.

This judgmental state constitutes a “splitting of the mind,” what some mystics have called an altering of the mind, a condition that creates an “altered mind”. Don’t confuse this with an “altered state of mind.” Now a thing could be seen as either sinful, or sinless.

To “regain Paradise,” once it’s lost–and most humans reside in a “split mind,” lost state–requires nothing more than living without judgment, without dividing the world into Good and Evil, Good and Bad, and seeing the world as God sees it.

The God of the First Creation made this observation of the All, after All was created: “And God saw every thing that he had made, and, behold, it was very good.”

Because “good” may be confused with “the good” identified in the Tree of Knowledge of Good and Evil, it might be better, indeed, edifying, if we move into a new understanding, one of “very good,” that is, perfection, and dwell there.

Rather than judge (and alter, and split our minds, “Judge not, that ye be not judged.”), we should declare perfection all about (“Be ye therefore perfect, even as your Father which is in heaven is perfect.”).

Granted, this is not an easy thing to do. We humans are accustom to seeing a divided world, as a result of a divided mind, where a thing is rarely seen as neutral, but on a continuum between Good and Evil, with Good on one side and Evil on the other, with degrees of Good and Evil in between.

The best way to keep the mind “The Same” is to dwell in love. “He that dwelleth in the secret place of the most High shall abide under the shadow of the Almighty.” The “secret place” is Love. Fear, or any emotion that has it’s foundation in Fear, divides the mind. We’re told: “There is no fear in love; but perfect love casteth out fear: because fear hath torment. He that feareth is not made perfect in love.”

The book finally arrived! Not a moment too soon.

A Way Out of Madness: Dealing with Your Family After You’ve Been Diagnosed with a Psychiatric Disorder [Paperback] Daniel Mackler (Author), Matthew Morrissey (Contributor)

I am hoping to be the first to review it. Maybe Chris will take a crack at it, too. It’s with him right now.

I wonder about the U.S. Military. How is it that being under psychiatric treatment means you get to STAY in the military and still perform your functions? Flat feet used to render you unfit to serve in World War II, although Donald Duck did serve in the army (KP duty I’ve heard.)

I wonder how come we are doing the legwork on Chris’s meds reduction rather than allowing the psychiatrists to manage the process?

I wonder why Daniel Carlat thinks he’s been too focused on hunting for textbook symptoms of mental disorder in his patients and then he turns around and diagnoses a patient with ADD and gives her Ritalin like he has learned nothing at all?

I wonder how Phillip Dawdy and Mike and Sam are these days.

Alice Miller, a psychoanalyst who repositioned the family as a locus of dysfunction with her theory that parental power and punishment lay at the root of nearly all human problems, died at her home in Provence on April 14. She was 87.

Dr. Mortimer Sackler. . . became a prominent psychiatrist, specializing in schizophrenia and depression, before becoming a pharmaceutical entrepreneur along with his brothers Arthur and Raymond. The brothers were convinced that pharmaceutical solutions and what they called psychobiology could replace common treatments such as electric shock or lobotomy. But it was only when Mortimer was nearly 80, 14 years ago, that the painkiller OxyContin, produced by his company Purdue Pharma, brought him a serious fortune. That drug alone brought in $2.5bn last year. He and his family were estimated a few years ago as worth £300m but he gave much, if not most, of his wealth to education, science, medicine and culture.

A sample of readers’ comments to the Carlat article in today’s New York Times:

“I’m glad that at least one psychiatrist has noticed that most psychiatrists could be replaced very effectively by an online multiple-choice questionnaire and a vending machine.”

“Your profession is not listening to your patients. Of course talk therapy should not be suspended. That seems obvious. Why is it not to you and your profession? And why has your profession accepted the “20 minutes” deemed by the insurance companies as adequate and the standard of care?”

“A psychiatrist is advocating for the importance of understanding the person for whom he/she is prescribing medication. That would be refreshing news, were it not so dismaying that we have a system of treatment where such an obvious and fundamental principle is in need of such advocacy. Part of the problem with psychiatric care is the fact that you perceive other mental health professionals as “lower in the mental-health hierarchy,” rather than as colleagues.”

“I’m glad you’ve written a book, Dr. Carlat. I could write a book–actually I have–wrote it at UCSF, too. I’ve had over 20 years of various forms of pscyotherapy,counselling, my own personal psychopharmacologist, and the one thing none of these many professionals has ever “gotten” is that I’m a human being. I keep wondering how that can be. On the other hand, back when I was married to a philosophy professor (when he was teaching at a v. small college), I met his new colleague across the hall, the psychology prof. Turned out he’d never read Freud, or so he claimed. I’m no particular fan of Freud overall, but it does seem to me that someone who has taken the trouble to earn a PhD in psychology might at least have the curiosity to find out what the man had to say. And that in an anecdotal nutshell is what is wrong with psychiatry today–most professions today–lack of curiosity about what’s outside the walls of the profession.”

“Clearly, mental illness is a brain disease..” I’m sorry, but that is not clear at all. The mind and the brain are not the same thing; they may overlap in a functional sense, but the physical organ of the brain is neither the seat of consciousness nor the locus of the sense of self. It is sad that psychology, the only discipline of modern medicine that took the mind seriously, has devolved into the simplistic materialism of its peers.”

“Am I the only reader who found it discouraging that Doctor Carlat spent a just a little more time with a patient and then congratulated himself on finding yet another drug to prescribe? He does not seem to have abandoned his deeply ingrained practice of symptom hunting at all.”

“I undoubtably have an unbalance or two but those years in therapy taught me the SKILLS I needed to face any problems I come across head on, and deal with the resulting feelings. My mother, on the otherhand, accepted the “medicate” method of treatment over the years, and continues to have years that are like train wrecks.”

“One psychiatrist attending one of my sons as an in patient even exhorted me several times in a single visit to get on anti-depressants myself, “Mr., I see it in your eyes!” My response was, “Yes, I’m depressed over my son’s situation, but no thank you, I’m going to a lap pool instead!”

See also, Brainless and Mindless my post from today.

There has been a growing tendency in the United States to push for laws in remembrance of the victim. So, we have “Kendra’s” law, New York State legislation that forces the mentally ill into treatment programs if they meet the following criteria:

•is 18 years of age or older; and
•is suffering from a mental illness; and
•is unlikely to survive safely in the community without supervision, based on a clinical determination; and
•has a history of lack of compliance with treatment for mental illness which has led to either:
◦2 hospitalizations for mental illness in the preceding 36 months, or
◦1 or more acts of serious violent behavior toward self or others or threats of, or attempts at, serious physical harm to self or others within the last 48 months; and
•is unlikely to voluntarily participate in outpatient treatment that would enable him or her to live safely in the community; and
•is in need of AOT in order to avoid a relapse or deterioration which would be likely to result in serious harm to self or others; and
•is likely to benefit from AOT.

Kendra’s law has a sunset provision for June 2010. According to a petition that is circulating: The proposed new law includes provisions such as increasing the original court order from 6 months to one year; not requiring doctor testimony, requiring fiscal management, allowing an expired order to be renewed 60 days after it expires without needing a new hearing, and viewing “non-compliance” with drugs, urine or blood tests, or drugs and alcohol use as grounds for “dangerousness”.

I can understand society’s frustration with mentally ill people who are violent and roaming the streets, but statistics show that most violent crime is committed by the “non-mentally” ill. That is no comfort to the victim or the victim’s family, so we end up with laws like Kendra’s, aimed at justice for the individual while claiming justice for society. My concern with Kendra’s law. “Assisted Outpatient Treatment” smells like meds to me. Are meds all they’re going to get? Is that it? Any real therapy going on here? It smells to me like people will be stuffed full of meds until they are so zoned out they are no longer violent, but also not employable. Kendra’s law has a whiff of buck passing. Nobody wants to be responsible here, so again, make it look responsible by passing a law, get drugs into them and you’ve done your duty. If they fail to adhere, then there is always America’s already over-crowded prison system.

One glaring absence in the reporting about Andrew Goldstein, who pushed Kendra Webdale into the path of an on-coming subway train, was Andrew’s family. Where were they? It appears he was abandoned to a group home after lurching around New York City for a number of lonely years. Not one mention of his family other than the fact that his mother refused to see him. That doesn’t cut it with me. How about an “Andrew’s law” that would force families into therapy along with their relative and would force the family to take their relative off the streets. If you don’t like Andrew’s law, there’s always “Kendra’s law”.

My “Andrew’s law” social engineering proposal at least has some merits that I think are missing in Kendra’s law. One is the acknowledgement that a supportive family is key and that families should be expected to be fully involved from the outset. Another is to give the individual and the family factual information about what is out there in terms of help that doesn’t involve medications. A third is to let the individual/the family decide what therapy is best for them and support this choice. If they want to bring in an African shaman or a Celtic priest or decide that orthomolecular therapy is also what they want, then assume that they know best. A fourth option is a personal favorite, which is “emulation.” Let people find out from other real people in real life situations what worked for them. A fifth option is to give the family some relief through short term accommodations where drugs will not be automatically administered. (The fifth option is not available in most jurisictions and is why we tried to keep Chris out of the hospital when he was relapsing.)

The “system” such as it is, discourages the family in favor of the professional and the use of medications from the start. The family is told that alternative treatments are unproven. All of this instills fear into the family, who quickly come to regard their relative as strange and hopeless.

What Andrew’s family did was to warehouse him in a group home. That is harsh judgement for me to make, not knowing much more than what I read. But it’s got to be said. Their son was their responsibility in the end, despite the problems with the way medical help was offered. The tragedy may have been prevented had the parents been given more hope from the onset and encouraged to be an integral part of their son’s recovery process. They probably weren’t told that their son could recover from schizophrenia without drugs if other interventions were in place. They were probably told instead that he had a damaged brain and that schizophrenia could only be treated using medications. If they had done more, despite the lack of help from institutions, and been encouraged with better disclosure of treatment options, perhaps there wouldn’t be a Kendra’s law. If real help was available for them perhaps this tragedy would not have happened.

The New York Times deals with the issue of the warehousing in the army’s trauma care units. It reminded me very much of the day program Chris was enrolled in for two years. Chris never wanted to go to the day program, where he felt demeaned, despite the “best of intentions.” He felt like a freak there, so he acted like one. All in all, I figured two years of “recovery” were wasted by good intentions that didn’t support the family working it out for themselves in their own way. Once you enter a program, you abide by its definition of recovery and how to go about it.

The article interviewed the mother of one young man about his experiences in the transition unit.

But things are looking up, his mother believes: he will be able to stay with her in Michigan while awaiting his discharge. His mother, Sally Darrow, has already seen one son commit suicide. She believes that Michael would become the second if he had to return to Fort Carson and the transition unit. “At home, with family and schoolmates, he’s dealing with things better,” Ms. Darrow said. “He’s not safe there.”