The Tragedy of Schizophrenia

Although schizophrenia doesn't have to be a tragedy, sometimes it really is. I thought this story was interesting because it talks about the illness in a non-western culture. Isn't it interesting that in India family support is cited so highly? I do object that medication and the "brain disease" model is pushed so heavily in this article, but the demand for psychosocial treatment helps make this less heinous.
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Schizophrenia killed Parveen Babi

Manish Chand (IANS) New Delhi, January 25, 2005

Actress Parveen Babi's lonely death in a Mumbai suburb has put the spotlight on her dark secret. She was suffering from schizophrenia - a deadly mental affliction that reportedly haunted her till her last day.

An expert here said the one-time actress may have been alive today if only those who came to her side after her death had stood by her when she was living.

"Had they shown the same kind of interest, compassion and concern, perhaps the illness could have been more effectively treated and the course of her life could have been different," Sunil Mittal of Delhi Psychiatry Centre told IANS. "For all we know, she probably would have been alive today."

Family support plays a vital role in curing schizophrenia that victimises 10 million Indians. One percent of the world population suffers from schizophrenia, according to the World Health Organisation (WHO).

"This perhaps explains why schizophrenics show a greater rate of recovery in India. Latest research shows that 70 percent schizophrenia patients in India recover after treatment whereas only 38-40 percent recover in the US," says Mittal.
...

Another pervasive myth about the disease is that patients of schizophrenia are prone to violence and, therefore, it's sensible to avoid them. Mittal finds this attitude reeking of ignorance and callousness.

"Schizophrenics seldom turn violent against others. On the contrary, they only end up directing violence against themselves..."
...
http://www.tinyurl.com/65o6s

Train Wreck

The train crash in California is an incredible disaster with eleven commuters dead and nearly 200 wounded, some very seriously. Many more people were traumatized, I'm sure.

This disaster was allegedly caused by one man who was suicidal and parked his SUV on the train tracks. Apparently the vehicle was wedged between the two rails on the track which created a barrier. This barrier effect is what turned this from a bad accident into a disaster.

The accused is a man named Juan Alvarez who the Glendale Police Chief described as, " deranged individual that was suicidal." They also said, "The state of mind of the suspect is a central issue, what led him to do whatever acts he did do."

The Mayor of Los Angeles wondered aloud, "Is there a way that we can stop one crazed individual from creating this kind of carnage?"

I smell an assault on the rights of the mentally ill brewing. After all, look at what crazy people running wild on the streets can do ... they can maim and kill hundreds. Obviously.

But wait ...

'Alvarez's estranged wife, Carmelita Alvarez, had ordered him out of her home months ago, her family said, and in November she went to court seeking a temporary restraining order keeping him away from herself, their 3-year-old son, her mother, brother and other family members.
"He is using drugs and has been in and out of rehab twice," she said in asking for the restraining order, which was granted Dec. 14. "He threatened to take our kid away and to hurt my family members," she added. "He is planning on selling his vehicle to buy a gun and threatened to use it."
Alvarez, who lived in a converted garage behind her sister's home in suburban Compton, told the court her husband had damaged her family's property and threatened to seek revenge on people he suspected of introducing her to another man. She said his drug use was triggering hallucinations. '

So he's not mentally ill in the sense that most people think of it ... he's a drug addict who couldn't live with his addiction anymore and wanted to kill himself. It's a common semantic mistake for which truly mentally ill people pay dearly. I imagine that it's because of the blurry lines between mental illness, substance dependence (which has a psychological aspect), and criminal guilt.

This afternoon the indictment will be handed down. It's expected that Alvarez will be charged with multiple counts of murder, though I expect eventually it will be reduced to manslaughter, but that he will serve substantial time in prison. The damage and pain he has caused has been immense; I hope it doesn't get even worse.

Interview with Elliot Valenstein

Okay, so this thing is old. It's still very interesting. Dr. Valenstein wrote "Great and Desperate Cures: The Rise and Fall of Psychosurgery and Other Radical Treatments for Mental Illness".
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Better Living Through Lobotomy: What can the history of psychosurgery tell us about medicine today?
An Interview with Elliot Valenstein
[ by Allison Xantha Miller ]

STAY FREE!: It seems that in the 1930s, when Egas Moniz was doing the first lobotomies on humans, treating mental illness was urgent for some reason. The new "somatic" treatments--not only lobotomy but insulin comas and electroshock treatments [see sidebar]--weren’t just a way to help individuals, they were seen as something that could help solve a great social crisis.

VALENSTEIN: Well, there was a social crisis, you’re right. Mental institutions, particularly state institutions and large governmental institutions in all countries, were becoming more and more overcrowded because there weren’t any treatments for serious mental illness. They would try anything that held out hope and wasn’t very costly. Mostly it was somatic treatments, which people grasped at as a way of getting patients to a point where they could go home. Governments were concerned about the rising costs of taking care of the mentally ill, making legislators and the superintendents of institutions very receptive to anyone who claimed that insulin treatment, electroconvulsive shock, or fever treatment would cure schizophrenia. These somatic treatments tended to be much less costly and less labor intensive [than psychoanalysis].

STAY FREE!: Why were so many people in mental hospitals?

VALENSTEIN: Lots of people were mentally ill, just as there are many today. But now they tend to be treated with drugs and outpatient care. If all of these people were institutionalized, we would have the same kind of problem. Also, there were some patients who were committed more for the convenience of the husband or the family--wives who became mentally ill and troublesome. But I think mainly it was that there’s always a baseline number of mentally ill, and they kept accumulating in institutions.

read the rest ... it's really interesting ...

January is most depressing month

From the BBC:

If you're feeling down at the moment it's not your fault because January is the most depressing month of the year.

That's according to a psychologist from Cardiff University who came up with a complicated formula to work it out. And Monday 24 January is the worst day of all because by then your Christmas holidays have worn off and you've probably broken any resolutions too.

Dr Arnalls says doing something like saving for a specific thing you really want might help beat the blues.

His formula includes things like how bad the weather is, how much you spent over Christmas and when your next lot of pocket money is coming.

Failure to quit a bad habit and not wanting to do very much at all also contribute to feeling bad at this time of year.
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I try to spend time under a very bright lamp this time of year, but it doesn't help. It's still really cold outside :)

Excuses, Excuses

Walter Freeman's son has tried to make a case for his father. Here's a quote:

Freeman's son remains steadfast in his determination to protect his father's legacy. "Today's climate is very different from the 1930s," he said. "The pioneers who faced the problems squarely and worked with what they had at hand should be honored, with due allowance for their imperfections. "Past abuses should not be repeated, but we need to know with clarity what they were, in order to avoid them, while maintaining freedom of action to deal with the unknown."

I wonder if by "imperfections" he means his father flippantly referring to his van as "a lobotomile"? I tend to call that callous and twisted. It's indicitive of his callous and twisted attitude toward his patients.

I wonder if another imperfection would be lobotomizing a 12-year-old-boy? I call that sick and criminal.

How about when he lobotomized Carol Noell's mother for headaches? Is that an imperfection? I call that a total departure from the supposed treatment guidelines that were in place which allowed operations only the "seriously mentally ill" or those with intractable pain.

It reminds me of that claim that Freeman lobotomized Rosemary Kennedy for "retardation". Freeman's son protests that Rosemary had "encephalitis" and that this is the reason that she was lobotomized. Of course, even if she did have encephalitis, why would his father lobotomize her for that? Isn't that ANOTHER departure from the supposed guidelines? Face it - there were no guidelines. He poked an icepick into the brains of anyone he could justify doing it to. Walter Freeman was a monster. He wasn't a maverick and he wasn't a genius.

Why did he take and keep photos of nearly every patient he ever had WITH the icepick still in their eyesocket? It's hard to believe he needed a photo of every single one simply for medical purposes ... I think he liked them.

Rosemary Kennedy

Here are a few articles and pics relating to Rosemary Kennedy:

Rosemary Kennedy laid to rest on Cape
http://news.bostonherald.com/localRegional/view.bg?articleid=62881

Obituaries: Rosemary Kennedy, inspired activism
http://www.iht.com/articles/2005/01/09/news/obits.html

The silent Kennedy
http://www.iht.com/articles/2005/01/11/opinion/edkennedy.html

Hidden Kennedy delivered from curse
http://www.tinyurl.com/6cqva


A Kennedy family photo taken in 1937. Rosemary Kennedy (standing on R) the mildly retarded younger sister of slain US president John F. Kennedy, has died.(AFP/File)


The Kennedy family children are seen in a boat in this undated photo. From left, are: Eunice, Jack, Joe Jr., Rosemary and Kathleen Kennedy. (AP Photo/The Kennedy Family Collection)

Doggie Therapy

According to this article, pet therapy can be a very effective and comforting therapy for people suffering from schizophrenia. The short version is that they gave regular pet therapy sessions ten schizophrenics over a ten week period and subjectively observed an improvement in their level of happiness. There something so magical about companion animals, isn't there? Of course, don't ask me to repeat that when my Golden retriever wants to go out at 10 PM on a freezing winter night ...

Pet therapy is valuable for another reason as well ... they remind everyone that we are not dealing with abstract figures - schizophrenics are comforted by a nice, well-behaved dog, just like most anyone else. It reminds everyone involved of their humanity.

Tsunami Trauma and Mental Health

The AFP released an interesting story detailing how many traumatized Thais are dealing with the horror of the Tsunami ... they are hallucinating and making-up stories about ghosts. From the article:
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Taxi drivers in Patong swear they have picked up a foreign man and his Thai girlfriend going to the airport with all their baggage, only to then look in the rear-view mirror and find an empty seat.

Guards at a beachfront plaza in Patong told AFP one of their men had quit after hearing a foreign woman cry "help me" all night long, and similar stories abound of a foreign ghost walking along the shoreline at night calling for her child.

The majority of Thais are deeply superstitious, believing ghosts reside in most large trees and keeping a spirit house in every home where daily offerings of food and drink are given to calm nearby paranormal entities.

Mental health experts warn tsunami survivors have picked up on this cultural factor as a way of expressing mass trauma after living through the deadly waves and witnessing horrific scenes in their aftermath.

"This is a type of mass hallucination that is a cue to the trauma being suffered by people who are missing so many dead people, and seeing so many dead people, and only talking about dead people," Thai psychologist and media commentator Wallop Piyamanotham told AFP.

Wallop said in time people who need counselling would be reached and assisted and the sightings would settle down, but many locals claimed they would not be swayed by such talk.

"After visiting Wat Baan Muang (a temple where hundreds of bodies are still stored) I'm very scared. I can't sleep at night and when the wind comes I'm sure it is the spirits coming," said Patong bar manager Napaporn Phroyrungthong.

"I believe in ghosts and I always will. (The tsunami) happened so quickly, the foreigners didn't know what happened and they all think they are still on the beach. They all think they are still on holiday," she said.

Rosemary Kennedy and Lobotomy

When the subject of lobotomy is raised one of the first people mentioned is Rosemary Kennedy. She has stood as proof that one did not need to be poor to be a victim of psychosurgery - any mentally disabled person was vulnerable.

According to the Associated Press,"Doctors told Joseph Kennedy that a lobotomy, a medical procedure in which the frontal lobes of a patient's brain are scraped away, would help his daughter and calm her mood swings that the family found difficult to handle at home." This story doesn't exactly match the stereotype that lobotomies were only performed in the most dire circumstances on the most seriously disturbed minds, does it?

The article goes on to say, "Psychosurgery was in its infancy at the time, and only a few hundred lobotomies had been performed. The procedure was believed to be a way to relieve serious mental disorders. Leamer wrote that Rosemary was 'probably the first person with mental retardation in America to receive a prefrontal lobotomy.' "

Sadly, she would not be the last. One man in our group was lobotomized for juvenile delinquency when he was only 13-years-old; another woman's mother was lobotomized to "cure" her of headaches. In all, over 50,000 people would be lobotomized in the United States alone.

Much of the blame lies with the Nobel Prize Committee who awarded the Nobel in Medicine to Egas Moniz for inventing the prefrontal leucotomy, a psychosurgery closely related to lobotomy. We have been fighting hard to have Moniz stripped of the Prize, but the Committee will not relent. This despite the fact that the operation is illegal in Moniz's own country, Portugal.

But damn, the doctors back then were so sure they were on the cutting edge of medicine (no pun intended). Kind of reminds you of ... right now.

By the way, you do know that still do psychosurgery, don't you? They just like to call it by a euphemistic name - "neurosurgery for mental disorder" to be exact.

Informed Choices

Good medicine is all about informed choices. Every single procedure and medication does not have to be risk-free. The risks need to be properly and completely communicated, decisions made with proper and unbiased counseling, etc.

This article talks about patients who feel strongly that Vioxx's benefits substantially outweigh the risks. They plan to keep taking these drugs and I have no problem with that. They know that there could be more problems we don't know about and that there are issues currently under scrutiny, but they choose to take them anyway.

The difference for psychiatric patients is the use of force. They are forced to take risks that others can choose to avoid.

Edited

At the request of Savgi Majevadia's family, I have removed this entry and link to the BBC.

Lobotomy Poetry

If you are interested in lobotomy and like poetry, you are in for a treat. My friend Penelope has written The Pest Maiden: A Story of Lobotomy, Poems by Penelope Scambly Schott. Her writing is so beautiful. Here is an example of her work from a different collection:
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The Millner's Dream
Imagine, you ladies whom I have made lovely, imagine this:

To stand like a fence post or a weathered snag or even a wide ceramic pot of withered marigolds, collecting the falling snow on the top of my head.

First the snow would catch in the ends of my hair and it might even melt a little from the heat of my scalp, but then there would begin to be a white blanket. It would start to mound up.

To stand abandoned like a broken garden stool. To become an old scarecrow with a crownless straw hat. To age among white furrows. To accumulate falling flakes.

To be still as a rock. To remain so absolutely still that the snow neither shifts nor blows, only compacts a little under its own flocked weight.

To wait here beyond slow dark until the snow clouds part and a shiver of moonlight casts blue shadows across the crusting field.

To hold my head straight and steady.

Now, that will be such a hat, a magnificence, to wear in the Church of Beauty Unnameable. When at last I bow down at the altar, my bared head will glitter. Ladies, it will flame.
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Good Lord, that just gives me the chills. What beauty. Here's a link to more info about The Pest Maiden and here's where you can order it.

Compassion for a Princess

New Year's Day saw Japanese Crown Princess Masako return to the public eye after thirteen months in seclusion. She had withdrawn due to the stress of palace life and the constant public scrutiny which was making the once jovial woman miserable and depressed. In a rare discussion of a private matter the palace admitted that the Princess had an "adjustment disorder caused by stress". Her husband, Crown Prince Naruhito, was upfront about her need for privacy and time to recuperate from the rigors of being a royal (apparently it's pretty sucky despite all the tiaras and scepters and stuff).

Of course it is hard to know what goes on inside a high-stakes organization like a royal dynasty, but it appears that this situation has been handled magnificently. The problem has been identified and openly discussed, helping both the Princess and members of the public who also suffer from depression to heal. It would be nice if they could actually bring themselves to use the word depression, but this is pretty damn good for such a notoriously taciturn family. link