Re: A hard, intractable situation

1

My Mom is not quite the same, but my grandfather definitely tied up as much money as he could in trust--which pissed off my aunt, because she wanted her share free and clear.

And still, I think that my grandmother's solution was to be really happy when my Dad married her and figure that we kids would deal with it when he died. But marrying him off on someone else doesn't really sound like a viable option.

(I can make more subtle, generous posts, and I bet that there is some hope. I think that these are impossibly difficult situations, but that "recovery" of a sort is possible. Right now, I'm just venting. Do you ever talk to him? I know that he's not the person you knew, but I'm sure that one of the hardest things for his mother is that people may have dropped him and her socially.)


Posted by: Bostoniangirl | Link to this comment | 08-10-09 7:42 AM
horizontal rule
2

I don't stay in touch with him independently of our parents, and I imagine you're right that the isolation does make it even harder for his mother.

Generally when I'm at home, we stop by Emily's house, and Andre is there probably half the time, but he doesn't necessarily come out - he's also got a fair amount of social anxiety. Emily has always been a very extroverted person, and she still throws big dinner parties and runs in the circles my parents do, so I don't think she has been isolated as a consequence.


Posted by: heebie-geebie | Link to this comment | 08-10-09 7:47 AM
horizontal rule
3

Hi Heebie, I don't have much time but I hope I can get back later. Just want to say I'm so sorry. I know how strange it is to try to help someone not become eventually homeless. No advice, just that I get it. I'm sorry about your friend.


Posted by: Penny | Link to this comment | 08-10-09 7:57 AM
horizontal rule
4

3: Oh, thanks. i'm used to the situation, though - he started to unravel at age 12, so I've had almost two decades to grieve and get used to current (sad) state of things.


Posted by: heebie-geebie | Link to this comment | 08-10-09 8:23 AM
horizontal rule
5

Sometimes age can attenuate the symptoms.


Posted by: bob mcmanus | Link to this comment | 08-10-09 8:28 AM
horizontal rule
6

5: Yes, that was a common finding back when I used to do research in that area. I don't recall the scope conditions and I don't believe there is any concensus on why.


Posted by: Moby Hick | Link to this comment | 08-10-09 8:33 AM
horizontal rule
7

Is stability a necessary condition for symptoms attenuating as the person ages?


Posted by: rob helpy-chalk | Link to this comment | 08-10-09 9:22 AM
horizontal rule
8

The anxiety might be treatable with medications and cognitive behavioral therapy.

Medicare recently improved the co-pay requirements for outpatient psychotherapy, so it might be more affordable.


Posted by: Bostoniangirl | Link to this comment | 08-10-09 9:26 AM
horizontal rule
9

The anxiety might be treatable with medications and cognitive behavioral therapy.

But these things require cooperation that I don't think Andre brings to the table.


Posted by: heebie-geebie | Link to this comment | 08-10-09 9:30 AM
horizontal rule
10

"But these things require cooperation"

And there's a huge issue with compelling treatment and/or medication in people where the symptoms are not bad enough to require involuntary commitment. Legally, morally, and medically, the whole area is a minefield. On the one hand, antipsychotics generally work at controlling the worst symptoms*. On the other hand, the site effects are often horrible and the potential for gross abuse with involuntary treatment is ever present.


Posted by: Moby Hick | Link to this comment | 08-10-09 9:38 AM
horizontal rule
11

7:Survival is a condition. I am not sure what you mean by stability.

I have thought the attenuation was due to biochemical brain chemistry and/or endocrinal causes. I think we all produce a little less serotinin etc as we age, and well, lose brain cells, especially frontal lobe.


Posted by: bob mcmanus | Link to this comment | 08-10-09 9:38 AM
horizontal rule
12

11: I would rather suspect nobody knows what causes the attenuation. Nobody really knows what causes the disorder (or disorders) in the first place, so.


Posted by: Sifu Tweety | Link to this comment | 08-10-09 9:39 AM
horizontal rule
13

In 10, 'site effects' s/b 'side effects'.


Posted by: Moby Hick | Link to this comment | 08-10-09 9:46 AM
horizontal rule
14

This might be a good thread to bring up Antipsychiatry. It seems hyperbolic at times, but what do you guys think?


Posted by: paranoid android | Link to this comment | 08-10-09 9:52 AM
horizontal rule
15
Increased dopamine activity in the mesolimbic pathway of the brain is consistently found in schizophrenic individuals. The mainstay of treatment is antipsychotic medication; this type of drug primarily works by suppressing dopamine activity
...Wiki

Ok, dopamine, nor serotinin, unless one's a precursor for the other. But though we may not know why there is "too much"* dopamine, we do know that reducing dopamine can often alleviate symptoms.

*scare quotes because this is complicated and controversial. And kinda profound. Yeah, I read the Szasz way back when, and went drugfree in the early eighties. Up to the professionals, I'd still be totally zoned.

Dopamine article. Couldn't find age-differentiation info.


Posted by: bob mcmanus | Link to this comment | 08-10-09 9:57 AM
horizontal rule
16

Gaaah, geez.


Posted by: Sifu Tweety | Link to this comment | 08-10-09 9:57 AM
horizontal rule
17

re: 14

It depends. I'm not familiar with authors/material on that site but I have read quite a bit of sceptical literature in that vein.

I don't think that it's at all implausible that there's something pretty messed up about the entire edifice of modern psychiatric classification as it currently stands. On the other hand, denying the existence of psychiatric illness in general just seems to be at odds with the suffering that real people have.

Richard Bentall's book is pretty interesting [and not at all 'crackpot'-y, he's a Professor of Clinical Psychology]:

http://www.amazon.co.uk/Madness-Explained-Psychosis-Human-Nature/dp/0140275401


Posted by: nattarGcM ttaM | Link to this comment | 08-10-09 9:59 AM
horizontal rule
18

15: Ok, dopamine, nor serotinin, unless one's a precursor for the other.

Dude, don't say things like that. It makes it hard to respond to the rest of your comment seriously, which I think it probably deserves.

But though we may not know why there is "too much"* dopamine, we do know that reducing dopamine can often alleviate symptoms.

We don't really know that there is too much dopamine. We don't know that reducing dopamine is actually what the drugs do. Even if that is what the drugs do, we don't know if that's why they work. What we know is that anti-psychotic drugs reduce the negative symptoms. That's about the beginning and end of it, I'm pretty sure.


Posted by: Sifu Tweety | Link to this comment | 08-10-09 10:01 AM
horizontal rule
19

18: In that vein, modern psychiatry doesn't really have much over folk medicine. Maybe a little more rigor in determining efficacy of medications. It's basically just "keep trying different chemicals until something seems to work".


Posted by: paranoid android | Link to this comment | 08-10-09 10:05 AM
horizontal rule
20

19: Modern psychiatry can, fairly reliabily, stop the negative symptoms in people with schizophrenia. That is quite a big step over folk medicine. Most of the 'trying different chemicals' stuff is because the side effects are so bad and/or because depression is also present with psychosis. Also, lots of non-psychiatric diseases are 'managed' as opposed to 'cured.'


Posted by: Moby Hick | Link to this comment | 08-10-09 10:09 AM
horizontal rule
21

I had never heard of this attenuation. I thought that many people deteriorated without treatment, particularly drugs.


Posted by: Bostoniangirl | Link to this comment | 08-10-09 10:09 AM
horizontal rule
22

18:Yeah, well, I read a ton about it, back around 1979-83 That's what I get for relying on memory. I haven't been particularly interested since.

From the article, it may be about the receptors, rather than dopamine production.

Serotonin article. I was also interested in psychedelic drugs during the 70s. Anti-depressants. You may say that serotonin and dopamine are not related, but hey...

Well, you know, if you have been reading my comments over years, I think know ecstasy can be willed, though usually with great difficulty. Umm, implications.


Posted by: bob mcmanus | Link to this comment | 08-10-09 10:13 AM
horizontal rule
23

19, 20: and, you know, maybe a lot more rigor.


Posted by: Sifu Tweety | Link to this comment | 08-10-09 10:13 AM
horizontal rule
24

and/or because depression is also present with psychosis.

You might find Bentall's book interesting, since his general claim is that the affective/psychotic split in diagnostic classification is wrong-headed.


Posted by: nattarGcM ttaM | Link to this comment | 08-10-09 10:13 AM
horizontal rule
25

17: On the other hand, denying the existence of psychiatric illness in general just seems to be at odds with the suffering that real people have.

I think the authors are really getting at the classification of the very real problems that people have (which they admit) as "illness", rather than some other sort of problem. Which is pretty weird, admittedly, but I think there's something to it.

Schizophrenia, on the other hand, seems to be a pretty clear-cut case of illness, and on that issue, the antipsychiatry site seem to use different arguments.

20: I'm mainly thinking of my experience with depression here. But even with schizophrenia, I hear there are quality of life questions on the commonly used medications. Which, given the severity of the disease, might be an overall improvement, sure.


Posted by: paranoid android | Link to this comment | 08-10-09 10:14 AM
horizontal rule
26

23: I'm really not so sure about that.


Posted by: paranoid android | Link to this comment | 08-10-09 10:16 AM
horizontal rule
27

22: I don't say they aren't related. They're both modulatory neurotransmitters, so clearly they have a lot in common functionally, if not in any other way. I'm just saying that speculating that one might be a precursor of the other is... not well supported by the literature, to put it mildly.

As far as reading a lot about this in 1979-83, well, that might be part of the problem: a huge amount has changed since then, including a great deal of questioning of what we think (thought) we know (knew) about schizophrenia. A lot of this work has been influenced by imaging techniques that didn't exist in 1983.


Posted by: Sifu Tweety | Link to this comment | 08-10-09 10:18 AM
horizontal rule
28

26: I don't really know how to help you there.


Posted by: Sifu Tweety | Link to this comment | 08-10-09 10:19 AM
horizontal rule
29

23: I wasn't arguing against you. Just pointing out that the side effects (and how much they affect quality of life) are highly variable/subjective.


Posted by: Moby Hick | Link to this comment | 08-10-09 10:20 AM
horizontal rule
30

29: I wasn't arguing against you, either. Or with you. Or in any meaningful prepositional relationship to you.

So there!


Posted by: Sifu Tweety | Link to this comment | 08-10-09 10:22 AM
horizontal rule
31

It seems hyperbolic at times, but what do you guys think?

I think R.D. Laing wants his shtick back.


Posted by: Populuxe | Link to this comment | 08-10-09 10:22 AM
horizontal rule
32

If "ecstasy" bothers you.

Meditation and Clinical Studies

...it is accompanied by a host of biochemical and physical changes in the body that alter metabolism, heart rate, respiration, blood pressure and brain chemistry

I knew a professor back when who was working on meditative techniques (Mantras vs Zen, e.g.), and brain chemistry


Posted by: bob mcmanus | Link to this comment | 08-10-09 10:23 AM
horizontal rule
33

Heebie, I'm sorry for your friend's suffering.

I know it's easy to sound doctrinaire when I say this, but I mean it in all seriousness: If society can't change people with mental illness, then maybe people with mental illness need to change society (with the assistance of those of us not so classified.) I'm not advocating some kind of Sc/ent0l0gy "all psychiatry is bad" approach. I do know people who've been helped by both talk therapy and prescription drugs, but I also know a lot of people who haven't had much luck with those approaches, despite years of trying. People like the friends I've mentioned before who have to self-medicate with cannabis every waking moment just to get through the day. And of course there's a lot of people I don't know because they've died or been institutionalized. I think our civillization could do a much, much better job of helping people who are mentally ill, or to put it another way, think and feel differently than the ostensible norm. Especially when we're talking about folx who currently inhabit that wide grey zone between "maintains pretty well" and "needs to be monitored 24/7 to keep them out of trouble". Too often, people in that part of the spectrum do wind up homeless or dead or in prison, for want, I would argue, of some basic changes in the structure of how we distribute social resources.

I dunno. Social revolution is the only thing that will help, and it's the one thing we seem unable to achieve. Depressing in micro and macro.


Posted by: minneapolitan | Link to this comment | 08-10-09 10:25 AM
horizontal rule
34

32: there is quite a bit of evidence that meditation can induce an altered state of consciousness, one with much in common with the ones induced by drugs. There's also quite a bit of evidence that meditative practice maintained over the long term has cognitive benefits. So on that tip, you're perfectly correct. I don't at all follow what implications this might have about schizophrenia or the efficacy of antipsychotic drugs.


Posted by: Sifu Tweety | Link to this comment | 08-10-09 10:27 AM
horizontal rule
35

33 gets it exactly right.


Posted by: paranoid android | Link to this comment | 08-10-09 10:27 AM
horizontal rule
36

I think R.D. Laing wants his shtick back.

That's not how you spell his name, and why the hell would Howard Stern's sidekick give a rat's ass about antipsychiatry?


Posted by: heebie-geebie | Link to this comment | 08-10-09 10:28 AM
horizontal rule
37

I had never heard of this attenuation.

There is also a fair amount of literature on how many opiate addicts (provided they survive) seemingly age out of their addiction, even without treatment. Maybe these are related phenomena (but I have almost no idea what I'm talking about now, so grains of salt all around).


Posted by: apostropher | Link to this comment | 08-10-09 10:34 AM
horizontal rule
38

Is this just a specific application of how many, many people mellow as they age? While others become all grumpy and curmudgeonly?


Posted by: heebie-geebie | Link to this comment | 08-10-09 10:36 AM
horizontal rule
39

Too often, people in that part of the spectrum do wind up homeless or dead or in prison, for want, I would argue, of some basic changes in the structure of how we distribute social resources.

Too true. Fortunately, I don't think we really need a social revolution to make progress. What's needed is for the electorate to understand that

1. These people are really a very tiny slice of of the overall population.
2. We're already spending loads of taxpayer dollars on these people. It's called, "cops and fire guys having to deal with homeless nutters on a regular basis." Assisted living facilities would in fact be both cheaper and more effective.


Posted by: gswift | Link to this comment | 08-10-09 10:40 AM
horizontal rule
40

I think our civillization could do a much, much better job of helping people who are mentally ill, or to put it another way, think and feel differently than the ostensible norm.

I imagine psychiatrists get a little weary of the conflation of the two categories.


Posted by: Flippanter | Link to this comment | 08-10-09 10:41 AM
horizontal rule
41

34:The implication is that we can alter our brain chemistry or the receptivity(?) of certain sites and pathways. In fact, there is barely any alternative explanation for the effects of meditation and other mind-altering practices.

You don't lower your heartrate at the heart.

The implications are like awesome dude.

I am still searching for good info on age and schizophrenia. Onset almost never after 65, rarely after 45, usually 15-25. I have found the question asked about declining symptoms, I see that the life studies have been done, but I can't find conclusions yet.


Posted by: bob mcmanus | Link to this comment | 08-10-09 10:42 AM
horizontal rule
42

41: but dude, everything alters your brain chemistry. Watched Caddyshack 2? Congratulations, you altered the neurochemistry of certain sites and pathways in your brain.


Posted by: Sifu Tweety | Link to this comment | 08-10-09 10:44 AM
horizontal rule
43

I never realized that movie was so powerful.


Posted by: heebie-geebie | Link to this comment | 08-10-09 10:46 AM
horizontal rule
44

Huh 41.3 may not be accurate about onset.

In the United States, Canada, and Western Europe, the sex ratio in schizophrenia is 1.2:1, with males being affected slightly more often than females. There is a significant gender difference in average age at onset, however; the average for males is between ages 18 and 25, whereas for women there are two peaks, one between ages 25 and 35, and a second rise in incidence after age 45. About 15% of all women who develop schizophrenia are diagnosed after age 35. In some women, the first symptoms of the disorder appear postpartum (after giving birth). Many women with schizophrenia are initially misdiagnosed as having depression or bipolar disorder , because women with schizophrenia are likely to have more difficulties with emotional regulation than men with the disorder. In general, however, females have higher levels of functioning prior to symptom onset than males.

Posted by: bob mcmanus | Link to this comment | 08-10-09 10:49 AM
horizontal rule
45

41:Well, I coulda been more serious about the implications, but I am being careful, and don't like want to say something really crazy you know.

1) I had at that time been reading Szasz and Laing.
2) I considered most accepted forms of normailty to be socially conditioned and largely pathological.
3) I was influenced by the psychedlic culrure and literature, and Eastern religion/Western mysticism.
4) Was aware that most explanations/etiologies of psychosis were inadequate, and was resistant to the chemical treatments. Fuck, was resistant to treatment. And many of the diagnoses, of my self and others around me. And the whole fucking edfifice. (I am not at all hostile to psychiatry. They help a ton. It's complicated.)

I mean, look at me today. I have not yet become completely sane, according to some of the small and limited minds of the interwebs. Closet republicans, everyone of them.

To say that schizophrenics take a babylook at our crazymixedupworld and choose to go crazy iwould be going way too far. But...


Posted by: bob mcmanus | Link to this comment | 08-10-09 11:00 AM
horizontal rule
46

Modern psychiatry can, fairly reliabily, stop the negative symptoms in people with schizophrenia.

This was not my understanding. I always understood that they were better at controlling positive symptoms, e.g., hallucinations and other types of psychosis. They aren't so good at improving cognitive deficits, withdrawal and disorganization.

Elyn Saks, who had primarily positive symptoms and attributes her ability to function as well as she does, says that psychosis is more like a continuum. Even with the drugs, she occasionaly has fleeting psychotic thoughts which she dismisses. At other times, she really believes them, but she knows that other people will think that those ideas are crazy, so she doesn't say anything.

(They're doing work now on starting people after screening on low doses of drugs at an earlier age in an attempt to prevent full onslaught. These pilot programs also include therapy.)


Posted by: Bostoniangirl | Link to this comment | 08-10-09 11:01 AM
horizontal rule
47

46: Yes, I had it backwards. It has been a while. Positive symptoms are what they can usually control.


Posted by: Moby Hick | Link to this comment | 08-10-09 11:03 AM
horizontal rule
48

39.2: True! And kinder to the police/firefighters. I wonder if that would work as a political lever: "Support your local police! Make sure services for the mentally ill are well funded and easily accessible!"


Posted by: LizardBreath | Link to this comment | 08-10-09 11:03 AM
horizontal rule
49

"At other times, she really believes them, but she knows that other people will think that those ideas are crazy, so she doesn't say anything."

Which puts her ahead of 95% of the people on the internet.


Posted by: Moby Hick | Link to this comment | 08-10-09 11:07 AM
horizontal rule
50

To say we can alter our brain chemistry, umm endogenouusly(?), consciously or unconsciously, seems to me to be saying a lot. Not trivial.

It was and is my nature/preference not to take it to the extremes of transcendance/Satori/singularity-unto-myself, but to take that insight into the quotidian. The hammer on the thumb does not cause the pain.

Don't enjoy Olivia Newton-John? That's my problem, not hers.


Posted by: bob mcmanus | Link to this comment | 08-10-09 11:14 AM
horizontal rule
51

re: 25

As it happens, my doctoral thesis is on this topic: definitions of disease and illness.

FWIW, I'm pretty sure that many of the putative diseases that appear in the current DSM, say, just aren't diseases/illnesses. Similarly, I'm pretty sure that the diagnositic classifications that get drawn up by some future 'perfected' science of mental health won't look much like the ones we currently employ, which are often very poorly defined and not well-grounded in empirical research. The history of psychiatry medicine's use as a tool of social control is also rather less than salubrious.

_But_ that's not the same thing as denying that there are any psychiatric illnesses at all. That's where I find much of the anti-psychiatric literature just seems wrong-headed.


Posted by: nattarGcM ttaM | Link to this comment | 08-10-09 11:15 AM
horizontal rule
52

33
Especially when we're talking about folx who currently inhabit that wide grey zone between "maintains pretty well" and "needs to be monitored 24/7 to keep them out of trouble".

Yeah, that big ol' gray area is the problem. I'm in it. I was on anti-depressants for a while, and now I'm not. It was always a mild case of depression, and when my last prescription renewal ran out about six months ago now I was getting by well enough that I weaned myself off the last refill. So what helped? I don't know. The pills? The therapy sessions? (The ones during college or the ones for a couple years following it or both or what?) Would sugar pills have worked just as well? If the pills helped, did they help so much that they were worth the $120 I paid out of pocket per month for over two years thanks to my crappy insurance coverage?For that kind of money I could have gone on vacations to exotic places or found a hooker and got laid more often; maybe those would have helped my mood and mental equilibrium more than SSRIs.

On the other hand, a distant cousin of mine was in the gray area too. He killed himself 10 days ago. (No great commiseration needed for me; I think I had only met him once. He's my dad's step-aunt's grandson or something. It's been hard on a lot of people, of course, but I'm not one of them. I only even found out about this two days ago.) He was 37 and had been battling depression since he was 12, I was told, which sounds like a long time. He was a lawyer, which I knew, an EMT according to the NYT death notice, which I didn't know, and he was apparently being maintained very well until he wasn't.

Social revolution is the only thing that will help, and it's the one thing we seem unable to achieve.

This sounds more like an article of faith than an actual testable hypothesis. Or do you want revolution against the scientific method as well?


Posted by: Cyrus | Link to this comment | 08-10-09 11:15 AM
horizontal rule
53

What Heebie's writing about is totally up there on the "parental nightmares" top-ten list, I think.


Posted by: bitchphd | Link to this comment | 08-10-09 11:27 AM
horizontal rule
54

PDF from Stanford ...on old age and schizophrenia.

Outcomes from schizophrenia vary considerably. Nearly one out of five patients experiences remission of symptoms. Another 20% experience worsening of symptoms; in the remaining 60%, the course of disease is largely unchanged over time. Some deterioration in function or increase in the number of symptoms usually occurs within the first five to 10 years after the onset of the disease, but this may be followed by stability or even improvement in symptoms as the patient ages.

This doesn't satisfy me. I want numbers. I want a table.


Posted by: bob mcmanus | Link to this comment | 08-10-09 11:28 AM
horizontal rule
55

I want numbers. I want a table.


Posted by: apostropher | Link to this comment | 08-10-09 11:32 AM
horizontal rule
56

I love love love painted tables. My co-op at CalPoly had a big table with place settings already painted on.


Posted by: Megan | Link to this comment | 08-10-09 11:35 AM
horizontal rule
57

51: That sounds like a rich field for exploration, ttaM. I've wondered for a while about how certain things were, or are, classified as diseases, and what that meant: e.g., alcoholism and other addictions. Is "disease" a stage in the evolution of scientific or popular understanding of something?


Posted by: Flippanter | Link to this comment | 08-10-09 11:36 AM
horizontal rule
58

gswift: 1. These people are really a very tiny slice of of the overall population.
2. We're already spending loads of taxpayer dollars on these people. It's called, "cops and fire guys having to deal with homeless nutters on a regular basis." Assisted living facilities would in fact be both cheaper and more effective.

However, ever since that God damned prick Reagan, it has been politically incorrect to deal with mental illness as a disease; those swine would have us think of it as a moral failing, which the sufferer can cure himself by gritting his teeth and adopting the right attitude.

And if the sufferer is not so deranged that he can keep a job, rather than getting help from public agencies, he's supposed to use his company insurance to pay for the grossly overpriced cure. Oh Hell yeah, he's supposed to go to a psychiatrist to get treatment for insanity, and then the doctor's office is supposed to forward the bills to his company's accounting department. You can see the problem there, right?

Bostoniangirl: This was not my understanding. I always understood that they were better at controlling positive symptoms, e.g., hallucinations and other types of psychosis. They aren't so good at improving cognitive deficits, withdrawal and disorganization.

Rage is a positive symptom, I swear.

The guy Heebie was talking about, my guess is that he's hearing the Voices. When I was a teenager 35 years ago, alas, I heard the Voices, but a year on phenothiazines (Stelazine) made them permanently back off to an occasional whisper where they had been yowling non-stop.

But when my uncle had the same problem they gave him phenothiazines too. Unfortunately he's one of the five or ten percent the PDR warns about, who do not get relief from phenos but instead get their symptoms intensified. When they admitted him to the psych ward he was merely cranky, but after their drug "therapy" he got radically worse to where he was totally uncontrollable, locked ward and bed restraints. You can't expect American medical personnel to actually read the PDR, can you? They're too busy counting money; their solution was to up the dosage.

Fortunately my wife, a nurse with lots of geriatric experience, got him out of that ward and off Thorazine (100 mg t.i.d.), and a month later he had regained a manageable degree of sanity. Man, that was one rough month at my house.


Posted by: j.p. | Link to this comment | 08-10-09 11:43 AM
horizontal rule
59

I have not yet become completely sane, according to some of the small and limited minds of the interwebs. Closet republicans, everyone of them.

ANOTHER EFFORT, UNFOGGERS, IF YOU WOULD BECOME REPUBLICANS!


Posted by: OPINIONATED DOLMANCE | Link to this comment | 08-10-09 11:48 AM
horizontal rule
60

57:Does this mean there is someone else here who hasn't read Foucault?


Posted by: bob mcmanus | Link to this comment | 08-10-09 11:58 AM
horizontal rule
61

However, ever since that God damned prick Reagan, it has been politically incorrect to deal with mental illness as a disease; those swine would have us think of it as a moral failing, which the sufferer can cure himself by gritting his teeth and adopting the right attitude.

There's been progress on this front. PD's are hardly a bastion of liberalism, but it's standard practice now to to have new guys get 40 hours of Crisis Intervention training in our department. Supposedly Memphis was ahead of the curve on this.

http://www.memphispolice.org/crisis%20intervention.htm


Posted by: gswift | Link to this comment | 08-10-09 11:59 AM
horizontal rule
62

52: Or do you want revolution against the scientific method as well?

I'd like a revolution that overthrows the socio-political framework in which the scientific method is quasi-deified. I know scientists have come a long way since the bad old days, but there's still far more of the "I don't drop the bomb, I just build it" ideology out there, and when you call people on it they hide behind "scientific method".

Why is it okay to spend billions of dollars designing drugs when we know that most new drugs (i.e. the ones scientists didn't steal from "folk medicine" where they'd been on 1,000-year testing schedules) are only going to help a small percentage of those they are prescribed to? Like I said, I know people who've been helped by modern psychiatric drugs, but I've also seen many people (my grandmother, several high school friends) harmed by them, sometimes irreparably. Based on what I've read about SSRIs, for instance, it's pretty scary how little we know about the mechanisms by which they function and what their long-term effects may or may not be. "Scientific method" is great and all, but aren't we mostly talking about "capitalistic method"? Do just enough testing to make sure the subjects don't turn into Swamp Thing and then throw some big parties in Palm Springs or Maui to get the doctors to start prescribing them. (Plus you have to grease enough congressmen so that when the complaints from constituents start coming in they can safely ignore them until you've made back your R&D costs and a healthy profit besides.)


Posted by: minneapolitan | Link to this comment | 08-10-09 12:05 PM
horizontal rule
63

and he was apparently being maintained very well until he wasn't

Oh yes. That was not a good week month eight years.

Heebie, I wish I had something positive to offer, but IME "hard, intractible situation" is what you have with a shitload of closely engaged family support, and even that's still dicey as hell. If Andre can get into a more stable situation while Emily's around, he's got a shot; without that, it will be tough.


Posted by: Not Prince Hamlet | Link to this comment | 08-10-09 12:06 PM
horizontal rule
64

62.2: [Spittle-flecked tirade eschewed.]


Posted by: Not Prince Hamlet | Link to this comment | 08-10-09 12:08 PM
horizontal rule
65

This situation isn't the only thing that's hard and intractable, laydeez.


Posted by: nosflow | Link to this comment | 08-10-09 12:12 PM
horizontal rule
66

The idea that mental illness=moral failing, just snap out of it predates Reagan.


Posted by: bitchphd | Link to this comment | 08-10-09 12:15 PM
horizontal rule
67

Ugh. I have an aunt who is schizophrenic and has been institutionalized since here 20s. She used to have those rage episodes when I was a kid, but I can't recall on in the last decade or so. I know public aid covers most of the institutional costs, though my mom and her sisters wind up contributing out of pocket for visits to better doctors and such.

Emily probably will have to accept at some point that she can't take care of him on her own.


Posted by: Di Kotimy | Link to this comment | 08-10-09 12:15 PM
horizontal rule
68

58

However, ever since that God damned prick Reagan, ...

Reagan had little if anything to do with deinstitutionalization . It is the ACLU types who are filing lawsuits to keep dangerous nuts on the street.


Posted by: James B. Shearer | Link to this comment | 08-10-09 12:16 PM
horizontal rule
69

66, 68: Plenty of blame to go around. The idea that the brain can just go completely haywire on you is not something people like to accept, nor is the idea of spending MY TAX DOLLARS on THOSE PEOPLE.


Posted by: Not Prince Hamlet | Link to this comment | 08-10-09 12:19 PM
horizontal rule
70

69: Plenty of blame to go around, but also credit. While the huge cracks in the current system are appalling, so was the previous willingness to institutionalize people without trying lesser restrictions.


Posted by: Moby Hick | Link to this comment | 08-10-09 12:23 PM
horizontal rule
71

Reagan had a great deal to do with deinstitutionalization. The simple summary, which I've read more than one place, holds that Reagan as Governor of California took advantage of the wide revulsion to "ACLU-types" exposing the horrid conditions of involuntary commitment to simply shut down the facilities where people were involuntarily committed, saving a cash-strapped state government a bundle of dough, getting a quick anti-government ideological fix, and demonstrating how other state govs could do the same. There was some convergence of interests there, but it played out mostly as a sick parody of the ACLU-types demands.

When Reagan was president, of course, the homeless mentally ill started to be recognized as a major urban problem, and he was typically slow or unwilling to respond.


Posted by: k-sky | Link to this comment | 08-10-09 12:25 PM
horizontal rule
72

It's not clear that he's tracking conversations if too many people are talking. .

That's me watching MSNBC politics (or unfogged live!).


Posted by: Econolicios | Link to this comment | 08-10-09 12:26 PM
horizontal rule
73

ever since that God damned prick Reagan, it has been politically incorrect to deal with mental illness as a disease; those swine would have us think of it as a moral failing, which the sufferer can cure himself by gritting his teeth and adopting the right attitude.

Huh? I've got close to nothing positive to say about Reagan, but I don't know where this accusation comes from. Indeed, one article in the Reaganite indictment of permissive liberalism was that it denied the reality of mental illness (caricatured version: insanity is a sane response to an insane world), while the common-sense conservative solution is to involuntarily commit them to an asylum and pump them full of drugs to cure the crazy. The standard conservative response to the spike in homelessness during the Reagan administration was to blame it on liberals and trial lawyers for deinstitutionalizing the mentally ill.

Now it's true that a strain of neoconservative thought developed later on that blames liberals for the alleged overuse of prescription meds to treat pseudo-illnesses, but that came about long after Reagan.


Posted by: pain perdu | Link to this comment | 08-10-09 12:27 PM
horizontal rule
74

I don't know where this accusation comes from

Well, there's this, I suppose.


Posted by: apostropher | Link to this comment | 08-10-09 12:30 PM
horizontal rule
75

71: The legal underpinnings for deinstitutionalization were laid before Reagan was governor (Community Mental Health Act of 1963).


Posted by: Moby Hick | Link to this comment | 08-10-09 12:30 PM
horizontal rule
76

Nobody really knows what causes the disorder (or disorders) in the first place, so.

IMHO, the demonic possession hypothesis has been shamefully neglected by the scientific establishment in recent centuries.


Posted by: pain perdu | Link to this comment | 08-10-09 12:31 PM
horizontal rule
77

A note of warning on anti-psychiatry websites, organizations and literature: A surprisingly large amount of anti-psychiatry effort is funded or promoted by the Church of Scientology. L. Ron Hubbard had a real bug up his ass about psychiatry, and his heirs carry on the tradition.

There are legitimate reasons to be cautious in dealing with what is a fairly new field, and one with truly horrible inability to isolate variables or perform rigorous experiments, just due to the intrinsic complexity of the psyche. Unfortunately there are also people out there pushing straight up snake oil, and they are not above lying, cheating, and otherwise manipulating people into supporting their positions.


Posted by: togolosh | Link to this comment | 08-10-09 12:31 PM
horizontal rule
78

74: The budgetary neglect of the mentally ill is an ongoing shame, and Reagan deserves criticism for that. But cutting budgets for treatment is a long way from denying that mental illness is an illness or insisting that it's a moral failing.


Posted by: pain perdu | Link to this comment | 08-10-09 12:34 PM
horizontal rule
79

||
Although not completely off-topic. We now have the single stupidest thing yet written on the health-care debate (from an Investors Business Daily editorial):

People such as scientist Stephen Hawking wouldn't have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless.
|>


Posted by: JP Stormcrow | Link to this comment | 08-10-09 12:35 PM
horizontal rule
80

76 gets it exactly right.


Posted by: Not Prince Hamlet | Link to this comment | 08-10-09 12:35 PM
horizontal rule
81

I'm not sure a scientologist would advocate for suicide as a civil right. I would, but that's just me. Not to defend the site's other contents.


Posted by: paranoid android | Link to this comment | 08-10-09 12:36 PM
horizontal rule
82

But cutting budgets for treatment is a long way from denying that mental illness is an illness or insisting that it's a moral failing.

The latter is more of a tough-on-crime thing than a budget thing, but the two tend to run in similar circles.


Posted by: Not Prince Hamlet | Link to this comment | 08-10-09 12:37 PM
horizontal rule
83

the two tend to run in similar circles

True or not, that doesn't reflect the contours of the policy debate, where the liberal viewpoint is "they're sick, so they need extensive medical and social services in a supportive community setting" and the conservative view is "they're sick, so they need to be shut away out of sight of polite society in an asylum, or, since those are expensive, maybe a jail".


Posted by: pain perdu | Link to this comment | 08-10-09 12:42 PM
horizontal rule
84

"Scientific method" is great and all, but aren't we mostly talking about "capitalistic method"? Do just enough testing to make sure the subjects don't turn into Swamp Thing and then throw some big parties in Palm Springs or Maui to get the doctors to start prescribing them.

No. Doing trials is super expensive. Isn't it better to have more drugs available than less? And that safety is the main thing which determines whether the drug can legally be sold?

As you say, each person has a different brain chemistry and for every drug, there are some patients for which taking it off the market would hurt them rather than help them.


Posted by: Cryptic ned | Link to this comment | 08-10-09 12:43 PM
horizontal rule
85

A surprisingly large amount of anti-psychiatry effort is funded or promoted by the Church of Scientology.

Storms are a-brewing with John Travolta, who is apparently furious with the church (and himself) for neglecting to treat his son's condition with any conventional western medicines. (His son died of a seizure a few months ago.)


Posted by: heebie-geebie | Link to this comment | 08-10-09 12:44 PM
horizontal rule
86

83: Either point of view tends to ignore the ultimate autonomy of the mentally ill.


Posted by: paranoid android | Link to this comment | 08-10-09 12:45 PM
horizontal rule
87

"ignore" s/b "deny"


Posted by: paranoid android | Link to this comment | 08-10-09 12:48 PM
horizontal rule
88

79: I read that this morning, and it really is almost beautiful in its unmitigated stupidity. If only Hawking had been born and raised in America, he wouldn't have been euthanized and could have played quarterback for the Redskins. Thanks a lot, socialized medicine.


Posted by: apostropher | Link to this comment | 08-10-09 12:50 PM
horizontal rule
89

It seems pretty clear from the research that there's a lot of social and environmental influence on schizophrenia, especially when it comes to management and remission of the condition. People in less developed countries consistently seem to do better than those in more developed countries, perhaps because of family supports, perhaps because such other cultures are simply more accepting of a bit of craziness in daily life.


Posted by: PGD | Link to this comment | 08-10-09 12:51 PM
horizontal rule
90

I would think any place where villages raise children would be more accepting of a bit of craziness in daily life. In our country if your crazy son goes crazy, it's your responsibility alone to quit your job, spend your life savings, etc. to save him. This makes crazy people seem to be far more of a burden, because the burden is not distributed among society, because society does not exist.


Posted by: Cryptic ned | Link to this comment | 08-10-09 12:54 PM
horizontal rule
91

83: Except that spending isn't the only issue. In mental illness, disease severity and awareness of the need for treatment tend to correlate strongly and negatively.


Posted by: Moby Hick | Link to this comment | 08-10-09 12:55 PM
horizontal rule
92

91: Wait, negatively? More severe means less aware?


Posted by: paranoid android | Link to this comment | 08-10-09 12:56 PM
horizontal rule
93

True or not, that doesn't reflect the contours of the policy debate, where the liberal viewpoint is "they're sick, so they need extensive medical and social services in a supportive community setting" and the conservative view is "they're sick, so they need to be shut away out of sight of polite society in an asylum, or, since those are expensive, maybe a jail".

Remember Andrea Yates, or any of umpity-zillion other insanity defense cases?

Either point of view tends to ignore the ultimate autonomy of the mentally ill.

The right to die muttering in the street is one that may appropriately be infringed, IMO.


Posted by: Not Prince Hamlet | Link to this comment | 08-10-09 12:57 PM
horizontal rule
94

92: Sorry for the stats-speak. Those with the most severe mental illnesses tend to not seek treatment.


Posted by: Moby Hick | Link to this comment | 08-10-09 12:59 PM
horizontal rule
95

93.last That is also my position.


Posted by: Moby Hick | Link to this comment | 08-10-09 1:00 PM
horizontal rule
96

I would think any place where villages raise children would be more accepting of a bit of craziness in daily life.

Depends on the culture. "Less developed" and "more traditional" does not automatically equate to "more accepting of the mentally ill". China, for example, stigmatizes mental illness harshly.


Posted by: pain perdu | Link to this comment | 08-10-09 1:00 PM
horizontal rule
97

93, 94: I mean the ultimate autonomy, by which I mean that a person judged to be at least minimally rational needs to have ultimate control over their treatment, or lack of such. And there needs to be considerably lower standards for judging a person to be rational. That goes along with destimatizing mental illness.


Posted by: paranoid android | Link to this comment | 08-10-09 1:03 PM
horizontal rule
98

97 further: And I realize that a bunch of progress has been made on this front in the last 50 years, and I'm hopeful that it'll get to the point I'm talking about within the next 20-30.


Posted by: paranoid android | Link to this comment | 08-10-09 1:04 PM
horizontal rule
99

84: Doing trials is super expensive. Isn't it better to have more drugs available than less? And that safety is the main thing which determines whether the drug can legally be sold?

No. The potential profit margin is what determines which drugs are investigated. The profitability of existing drugs determines which ones are produced and marketed. Safety is a minor concern in that context.


Posted by: minneapolitan | Link to this comment | 08-10-09 1:05 PM
horizontal rule
100

99: Safety and efficacy.


Posted by: paranoid android | Link to this comment | 08-10-09 1:06 PM
horizontal rule
101

I mean the ultimate autonomy, by which I mean that a person judged to be at least minimally rational needs to have ultimate control over their treatment, or lack of such.

Judged by whom? That's the kind of judgment that judges are singularly ill-qualified to render. Treating docs and family members who know the mentally ill person well and observe them closely are in a better position to judge, but if they're deciding whether the mentally person gets ultimate control over their treatment, then the mentally ill person doesn't have ultimate control.


Posted by: Not Prince Hamlet | Link to this comment | 08-10-09 1:08 PM
horizontal rule
102

101: Yes, it's quite sticky. Especially agree about the judges.


Posted by: paranoid android | Link to this comment | 08-10-09 1:09 PM
horizontal rule
103

The potential profit margin is what determines which drugs are investigated. The profitability of existing drugs determines which ones are produced and marketed. Safety is a minor concern in that context.

Right, because those evil drug company fuckers are so fucking evil that they never even think about what product liability judgments would do to their profit margins.

I'm all for demonizing predatory companies when they're being predatory, but just slapping a Snidely Whiplash mustache on everyone who makes over $75K a year and announcing that all problems arise from those folks' evil doings isn't a particularly useful way of thinking about the world.


Posted by: Not Prince Hamlet | Link to this comment | 08-10-09 1:11 PM
horizontal rule
104

I'm all for demonizing predatory companies when they're being predatory, but just slapping a Snidely Whiplash mustache on everyone who makes over $75K a year and announcing that all problems arise from those folks' evil doings isn't a particularly useful way of thinking about the world.

Fie you say!


Posted by: Sifu Tweety | Link to this comment | 08-10-09 1:12 PM
horizontal rule
105

103: I think the point is that the drug companies aren't going to fund trials of omega-3 or magnesium to treat depression.


Posted by: paranoid android | Link to this comment | 08-10-09 1:13 PM
horizontal rule
106

for instance


Posted by: paranoid android | Link to this comment | 08-10-09 1:14 PM
horizontal rule
107

And there needs to be considerably lower standards for judging a person to be rational

I don't work in mental health, and this is just one person's view in one city, but I've got the homeless shelter in my beat and there sure is a hell of a lot of "wandering around muttering in the street."


Posted by: gswift | Link to this comment | 08-10-09 1:15 PM
horizontal rule
108

105: That's the meaningful point, yes. It's the "safety is a minor concern" part that I was reacting to.


Posted by: Not Prince Hamlet | Link to this comment | 08-10-09 1:15 PM
horizontal rule
109

107: Yeah, but we already talked about the cops a few days ago.


Posted by: Not Prince Hamlet | Link to this comment | 08-10-09 1:17 PM
horizontal rule
110

And there needs to be considerably lower standards for judging a person to be rational

Just from the recent health care town halls alone, I'm going to take issue with this.


Posted by: apostropher | Link to this comment | 08-10-09 1:17 PM
horizontal rule
111

102: I haven't thought deeply about this, but isn't there a difficult issue about treatment decisions that are likely to bring the patient closer to/further from rationality? This is begging the question (or at least a question) by assuming that treatment reliably makes people more rational, but take that as a given. What do you do with a patient who, when given control of their own treatment, refuses medication and decompensates to the point where they're not minimally rational? Treat them against their will until they become minimally rational enough to refuse treatment, and then stop treatment and repeat the cycle?

That might be the answer (or the problem may be unrealistically stated) but there's a difficulty there.


Posted by: LizardBreath | Link to this comment | 08-10-09 1:18 PM
horizontal rule
112

drug companies aren't going to fund trials of omega-3 or magnesium to treat depression

Of course not. That's why we have the NIH, universities, and orphan drug legislation. And despite the GOP's best efforts, that's still a hefty chunk of the pharmaceutical R&D pie.


Posted by: apostropher | Link to this comment | 08-10-09 1:19 PM
horizontal rule
113

FWIW, I'm pretty sure that many of the putative diseases that appear in the current DSM, say, just aren't diseases/illnesses.

A friend of mine who started his psychiatry residency a few years ago is deeply troubled by questions of diagnosis and classification. He'd always had academic worries about such things, but when he started practicing, he realized just how much rides on his oftentimes tentative, best-guess diagnoses. The Diagnosis-with-a-capital-D determines not only what insurance will pay for, but also what state programs and services a person will qualify for -- or will be banned from in the future.


Posted by: Blume | Link to this comment | 08-10-09 1:21 PM
horizontal rule
114

111: I think where you're headed there is that focusing on rights doesn't take you very far with the seriously mentally ill. A rights-based model will get rid of the worst abuses, but after that you get stuck.


Posted by: Not Prince Hamlet | Link to this comment | 08-10-09 1:22 PM
horizontal rule
115

111: that has come up in a legal setting, although I'm far too lazy to google it.


Posted by: Sifu Tweety | Link to this comment | 08-10-09 1:22 PM
horizontal rule
116

111: That can certainly be a problem, but will become less of a problem when understanding of the etiology of these mental problems improves, when medications improve, and when mental problems become more destigmatized so there's less denial about having a having one. Problem problem.


Posted by: paranoid android | Link to this comment | 08-10-09 1:29 PM
horizontal rule
117

116: Also, ponies for everyone!


Posted by: Not Prince Hamlet | Link to this comment | 08-10-09 1:32 PM
horizontal rule
118

117: Like I said, I really think we're headed that direction fairly steadily.


Posted by: paranoid android | Link to this comment | 08-10-09 1:33 PM
horizontal rule
119

Though I will agree that the murky nature of many mental illnesses makes the approval/patent process for psych drugs especially ripe for abuse, like inventing new conditions in order to extend expiring patent protection.


Posted by: apostropher | Link to this comment | 08-10-09 1:33 PM
horizontal rule
120

118: On what is that opinion based?


Posted by: Not Prince Hamlet | Link to this comment | 08-10-09 1:34 PM
horizontal rule
121

Psychiatric diagnosis is indeed problematic. I just found out that my shrink gave me a diagnosis of Major Depression. This is helpful because my insurance company classifies it as a Biologically Based illness, so there's no limit to outpatient treatment like there would be with a Non-Biologically Based illness. (Why do they classify it this way? Clearly they have not run it by Sifu Tweety.) On the other hand, I'm not really sure how accurate a diagnosis it is. I mean, I've read accounts by people with real depression, and that's not how I feel. Also, I'm not sure how this diagnosis is going to affect my getting insurance in the future, although I guess that's going to be the case with basically any diagnosis at all in our current health-care system.


Posted by: B/ave | Link to this comment | 08-10-09 1:38 PM
horizontal rule
122

Why do they classify it this way? Clearly they have not run it by Sifu Tweety.

I AM INSURANCE REFORM. AOOOOO-AOOOOOGA!


Posted by: Sifu Tweety | Link to this comment | 08-10-09 1:40 PM
horizontal rule
123

115: A death-penalty case, right?

Charles Singleton.


Posted by: B/ave | Link to this comment | 08-10-09 1:44 PM
horizontal rule
124

121: If you define mental illness as applied by any random therapist, you'd get bottomless demand for treatment (or so the thinking goes). The 'Biologically Based' based distinction was pushed by NAMI and others as a way to get treatment for the worst cases without to pay for everything in the DSM-IV.


Posted by: Moby Hick | Link to this comment | 08-10-09 1:50 PM
horizontal rule
125

113: What I think happens in practice is that doctors, outside of a research setting, tend to write down the most "severe" biologically-based illnesses which will garner the most insurance coverage--based on how much the person needs treatment. So, people will get a diagnosis of major depression or bipolar disorder or schizophrenia, but not many others. People are not likely to get a diagnosis of schizoid personality disorder.

Most insurances don't provide coverage for borderline personality disorder--even though it can be quite severe. If a doctor thinks that someone is suicidal because of BPD, that's not what s/he'll write down in the chart. In the chart it will say major depression, an anxiety disorder or bipolar disorder. Some people with BPD are also bipolar, but many are probably not and carry the diagnosis anyway.

Social services in recovery try to avoid diagnosis issues and work on helping people to function better in society.

Once in therapy, outside of a few state agencies where formal protocols may be employed, e.g. DBT was designed for borderliens, good therapists will treat each patient as an individual, and will look at interpersonal patterns which many people may have trouble with, not just people with a particular diagnosis.

My psychiatrist sees me more as a person than as a diagnosis. The diagnosis helps with insurance and to some extent it informs medications (though this is blurry, and symptoms are treated more than anything else, since we don't understand the etiology of these disorders). But my shrink is a goddamn saint.


Posted by: Bostoniangirl | Link to this comment | 08-10-09 1:50 PM
horizontal rule
126

The diagnosis helps with insurance and to some extent it informs medications (though this is blurry, and symptoms are treated more than anything else, since we don't understand the etiology of these disorders).

This, I think, is reasonably common.


Posted by: Sifu Tweety | Link to this comment | 08-10-09 1:53 PM
horizontal rule
127

Also, ponies for everyone!

Yeah, that was my reaction when I read Minne's longing for revolution as the only hope for the mentally ill. I contend that, based on the empirical record, the lot of the mentally ill rarely gets better and often gets worse come the revolution. The exceptions I can think of (mainly Eastern Europe and Russia) were bourgeois revolutions that presumably fall short of the anarcho-syndicalist utopia Minne envisions.


Posted by: pain perdu | Link to this comment | 08-10-09 1:55 PM
horizontal rule
128

If anybody ever gets a grant to study the effectiveness of ponies in the treatment of schizophrenia, please contact me if you need a data analyst. Or just let me sit in on the meetings when you figure out how to blind the intervention.


Posted by: Moby Hick | Link to this comment | 08-10-09 1:59 PM
horizontal rule
129

Further, some of the diagnoses probably would benefit from treatment but may not need it as desperately. Adjustment disorder is one. Sadly, borderline personality disorder (because it's an Axis II disorder and there is no drug that has been tested for its treatment--though drugs are frequently employed) isn't treated as biologically-based, even though it is very serious and can be life threatening either through intentional suicide or self-harming behaviors.

The funny things is that a biological model without some insight from a psychosocial perspective doesn't include things like family therapy which can really help your patient.

Paul McHugh, formerly of Johns Hopkins, was a fairly controversial figure. He was very much against gender reassignment surgery (for adults, but also for kids who were intersexed) and he kind of fell in with the neocons. Plus he felt that some parents were looking for ADHD diagnoses when they were unwilling to acknowledge different temperents from their own. Success on a stimulant trial isn't really proof of disease, since most people are more focused on them.

Anyway, he criticized the biological model a bit when he said that the APA's decision not to allow for couples'/ relationship diagnoses was wrong-headed, since our relationships obviously affect our functioning and feelings. His view was that insurance ought to cover some of that.



Posted by: Bostonian/ girl | Link to this comment | 08-10-09 2:00 PM
horizontal rule
130

Bave, you might have dysthymia that's been exacerbated, but basically this is just for insurance. Come to Massachusetts for your insurance needs!


Posted by: Bostoniangirl | Link to this comment | 08-10-09 2:03 PM
horizontal rule
131

Also, ponies for everyone!

People seem to think that ponies = fun, while in reality, like most large animals, ponies = costly upkeep and manure.


Posted by: | Link to this comment | 08-10-09 2:05 PM
horizontal rule
132

Or just let me sit in on the meetings when you figure out how to blind the intervention.

The control intervention is very small horses.


Posted by: LizardBreath | Link to this comment | 08-10-09 2:05 PM
horizontal rule
133

If anybody ever gets a grant to study the effectiveness of ponies in the treatment of schizophrenia, please contact me if you need a data analyst. Or just let me sit in on the meetings when you figure out how to blind the intervention.

there's an Equus joke in there somewhere.


Posted by: pain perdu | Link to this comment | 08-10-09 2:05 PM
horizontal rule
134

133: I thought so as well.


Posted by: Sifu Tweety | Link to this comment | 08-10-09 2:07 PM
horizontal rule
135

Exacerbated or exaggerated?

My psychiatrist sees me more as a person than as a diagnosis.

Definitely true for me as well. (I've got a psychologist instead of a psychiatrist.) I just learned my diagnosis after nearly a year in therapy because I had to call my insurance company to make sure it was "biologically based" and they'd more than 30 sessions per calendar year.


Posted by: B/ave | Link to this comment | 08-10-09 2:07 PM
horizontal rule
136

"ponies = costly upkeep and manure"

Unfortunately, "costly upkeep and manure" is way too applicable to the history of non-medical mental health treatments.


Posted by: Moby Hick | Link to this comment | 08-10-09 2:07 PM
horizontal rule
137

I've got the homeless shelter in my beat and there sure is a hell of a lot of "wandering around muttering in the street."

I often think that the issue isn't so much about the "rights of crazy people" as much as it is about the illness/poverty connection.


Posted by: bitchphd | Link to this comment | 08-10-09 2:29 PM
horizontal rule
138

I haven't read much of this thread, but anybody who's been experimenting with a solution to issues of mental illness can apply for pocket change ($5,000) from the Ashoka Foundation to explore their idea.

Ashoka's Changemakers, in partnership with the Vulnerable Populations Portfolio of the Robert Wood Johnson Foundation, has announced the global launch of the Rethinking Mental Health: Improving Community Wellbeing collaborative competition.
Designed to help address the social stigmas that surround serious mental illnesses and prevent access to care, the online open-source competition invites entries featuring innovations that allow individuals, families, communities, and society to move past narrow perceptions of mental health and expand the understanding and collective involvement in finding solutions.

Although I do not think that "open-source" means what they think it means.


Posted by: Witt | Link to this comment | 08-10-09 2:48 PM
horizontal rule
139

Come to Massachusetts for your insurance needs!

Unless you fall right into that gap where you make too much to qualify for the state-subsidized plans, but still make little enough that the cheapest plan you can buy isn't deemed "affordable". No mandate for me!


Posted by: Blume | Link to this comment | 08-10-09 3:20 PM
horizontal rule
140

Similar experiences here. My health insurance has two tiers of mental health coverage ("parity" and "non-parity"), which the benefits being considerably better if your diagnosis is classified in the higher ("parity") tier. I guess the first two sessions with my psychiatrist must have been nominally devoted to diagnosing me, even though they were actually no different in structure than any of my other sessions have been—talk, talk, talk, listen, listen, insight, reflect, rinse, repeat.

At the end of the second session, she simply said that she "think[s]" that I had major depression, and "maybe some dysthymia too" (which sure doesn't sound like the language of someone who thinks the DSM-IV is some magical foolproof set of diagnostic formulae). She explained the parity vs. non-parity bit to me, and said that the self-mutilation I had done as a teenager certainly qualified me for a parity diagnosis. That was an odd moment—realizing that because I cut myself as a teenager my mental health care was going to be considerably cheaper.

So my bills have two codes on them: 1. 296.36, which means my diagnosis is "Major depressive affective disorder recurrent episode in full remission" and 2. 90807, which means I am receiving "Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient; with medical evaluation and management services". Ah, bureaucracy and systematization.

But in the end, like the B/ave and BG, my psychiatrist seems to treat me like an individual more than anything else. The goal is just to make me feel better. And especially in the beginning, I think much of the better-feeling came simply as a result of having someone who actually listened to me, of being open without being judged, of telling secrets. It's amazing how much healing can come from just thinking someone gives a shit, and from the attenuation in shame that I think comes when you simply say certain things aloud enough times to someone who seems to support you. My sense, for example, is that certain pieces of self-hatred simply went away just because I got tired of saying them.

Psychiatry is weird, yo.


Posted by: Ot/to von B. | Link to this comment | 08-10-09 3:24 PM
horizontal rule
141

"Excessive muscle pain, particularly upper back, and feet"

Weird.


Posted by: nosflow | Link to this comment | 08-10-09 3:29 PM
horizontal rule
142

too much to qualify for the state-subsidized plans, but still make little enough that the cheapest plan you can buy isn't deemed "affordable"

Yeah, this is one reason why I'm not real thrilled about reports that the public option won't be available if you "can" get private insurance. (If there is a public option at all, that is.)

Another reason is that I'm sick to death of private insurers altogether.


Posted by: bitchphd | Link to this comment | 08-10-09 4:21 PM
horizontal rule
143

One of the striking things when you look at 18th century nosologies -- before they'd started really having the slightest clue about the etiology and pathophysiology of physical diseases -- they look really like the DSM.


Posted by: nattarGcM ttaM | Link to this comment | 08-10-09 4:25 PM
horizontal rule
144

How much of that is because of the whole "modern classification" thing and how much of it is because we know jack about mental illness, do you think?


Posted by: bitchphd | Link to this comment | 08-10-09 4:49 PM
horizontal rule
145

The knowing-jack-all thing, basically. I'm not up on the very latest literature, though.


Posted by: nattarGcM ttaM | Link to this comment | 08-10-09 5:12 PM
horizontal rule
146

The very latest literature reverses everything and now we are incredibly well informed and accurate. I think that happened last month, so perhaps that's what you missed.


Posted by: Megan | Link to this comment | 08-10-09 5:14 PM
horizontal rule
147

So, speaking of ponies, the other day I saw a truck with a big ad painted on the side saying "Pony Parties: Ponies For All Occasions!", which I thought was delightful.


Posted by: essear | Link to this comment | 08-10-09 5:19 PM
horizontal rule
148

"Hello, is this Pony Parties? I'm organizing a series of lunch seminars for scientists and I was wondering what sort of ponies you recommend for such an occasion...."


Posted by: essear | Link to this comment | 08-10-09 5:23 PM
horizontal rule
149

re: 146

Heheh. I was thinking more of a few specific conditions where there might have been some recent breakthroughs, but yeah, I take your point!


Posted by: nattarGcM ttaM | Link to this comment | 08-10-09 5:26 PM
horizontal rule
150

So it turns out that intensive study of irrigation systems cures 99% of schizophrenics?


Posted by: Not Prince Hamlet | Link to this comment | 08-10-09 5:28 PM
horizontal rule
151

It is like you haven't even read the July/August edition of the Journal of Irrigation and Drainage Engineering.


Posted by: Megan | Link to this comment | 08-10-09 5:36 PM
horizontal rule
152

I'm pretty much speaking from a position of ignorance here, struggling to recall things I read when I took a psych class about the brain in college six years ago, but it always struck me that the major problem with medicating mental illness is that we can only make sort of coarse corrections to a few knobs. Modulo choices of specific agonists with different side effects, it's more or less dopamine up/down, serotonin up/down, acetylcholine up/down. Maybe to deal with some disorder you want to raise the amount of dopamine getting to the limbic system but not to the cortex, but you're stuck just sort of injecting something into the system that does something to dopamine and hoping it does what you want. There's not much fine-tuning or ability to target things. For that class I had to read through a giant stack of literature about precisely the mesolimbic dopamine system that bob mentioned somewhere up above, and it seemed like there just wasn't enough experimental control to draw good conclusions about which functions were about learning versus rewards versus motivation. The brain's a black box and you can only fiddle with it in a few ways, even when doing fancy things with knockout mice and whatnot. I came away with a lot of respect for the cleverness of experimenters, but not much confidence that anything is understood well enough now to be able to know precisely how and why drugs are working.


Posted by: essear | Link to this comment | 08-10-09 5:40 PM
horizontal rule
153

152: The brain's a black box and you can only fiddle with it in a few ways, even when doing fancy things with knockout mice and whatnot.

No one really understands brain structure, excepting you can cut pieces of brain out and voila, certain functions stop functioning. So I know where the vowels come from and where the consonants come from and .... well, that's that for language. Excepting many exciting things happy on the pretty picture box when people talk! It means something!

For that class I had to read through a giant stack of literature about precisely the mesolimbic dopamine system that bob mentioned somewhere up above, and it seemed like there just wasn't enough experimental control to draw good conclusions about which functions were about learning versus rewards versus motivation.

1) Find a depressed rat. 2) Inject the rat with an exciting new drug. 3) Kill the rat. 4) Blenderize the rat brain until it's liquid and then measure the chemical content, like dopamine. 5) If the dopamine went up, start injecting people. 6) If enough of them get better, put it on the market. 7) Profit! 8) Note interesting side effects, like if people kill themselves and shit. 9) Rinse. Repeat.

143: One of the striking things when you look at 18th century nosologies -- before they'd started really having the slightest clue about the etiology and pathophysiology of physical diseases -- they look really like the DSM.

Sure. You know what, very approximately, the external symptoms of the problem are. No clue what causes it. You could describe smallpox pretty well before anybody understood germs.

144: How much of that is because of the whole "modern classification" thing and how much of it is because we know jack about mental illness, do you think?

Don't know jack about the brain. So you can reshuffle the classification tree, and see actually see/meet people with real, genuine classic symptom clusters, but thee and me, and that doctor in the tree, have no bloody idea what causes the cluster. Still a cluster though and a whole bunch of people have the same near-identical cluster. So it's thing, but what is that thing, exactly? Meanwhile...

97: I mean the ultimate autonomy, by which I mean that a person judged to be at least minimally rational needs to have ultimate control over their treatment, or lack of such. And there needs to be considerably lower standards for judging a person to be rational. That goes along with destimatizing mental illness.

Every SOB with a problem that isn't 100% incapacitating is convinced either that 1) they aren't really mentally ill, they just have a problem - those people over there are really crazy, or 2) the rest of the world is made up of crazy people. The Voices are REALZ! REALLY! Can't you hear them? WHAT'S WRONG WITH YOU? YOU'RE IN ON IT, AREN'T YOU?

Having people run around declaring freedom from their meds is not going to result in less stigma, particularly when the freed start going after people with knives and such.

Andre is schizophrenic, full on with the hearing voices and the hey-hey, and suffers from depression, but the thing which sabotages everything is his gigantic chunk of anger.[...]The other thing is that he was a very bright, vivacious little kid, and now the light upstairs is totally off. It's not clear that he's tracking conversations if too many people are talking. This may be partly from the medications that he takes, but also: suffering from mental illness takes a toll on one's brain that's bigger than the illness itself.

All he knows is that he was enjoying being a boy, biking around, throwing rocks, chasing girls and then... the world went bad. And people talk to him funny, and it's like they don't understand. Like they can't hear it. Why do they always pretend they can't hear it? GOD! He can't stand it after awhile! Stupid people.

5: Sometimes age can attenuate the symptoms.

I think you were thinking of Bipolar/BPD/manic-depression. The symptoms do tend to decrease in severity over time on average. Schizophrenia is touch and go; sometimes you have the spontaneous remission. Frequently not. There's no rhyme or reason to it, anymore than there is to remission of cancer.

max
['Roll the dice. Hope.']


Posted by: max | Link to this comment | 08-10-09 9:34 PM
horizontal rule
154

I've sort of heard voices before. I mean, not so that I thought, shit, who said that? I was always able to recognize that the voices were internal. but they do say terrible things, 'why don't you go over to that ledge and throw yourself off'-type of thing. it was clearly internal in the sense that I knew they didn't originate outside of me, but they did seem like a hostile, non-me force in a way, and like a group of things, not just one. I was always afraid at my most crazy that I would shift into 'really' hearing voices. but then on the other side it just shades off into running internal commentary that is hostile, and I sort of think everyone has that?


Posted by: alameida | Link to this comment | 08-11-09 1:31 AM
horizontal rule
155

re: 154

A surprising number of people do hear voices. It's massively higher, as a percentage of the population, than the percentage who are plausibly mentally ill.

There's been research done on the phenomenology of 'voices'. Even in schizophrenics the phenomenology is often still quite 'internal'. Even in people who 'really' hear voices it is much as you describe.

But yeah, I think most of experience moments when the internal monologue gets a little over-powering.


Posted by: nattarGcM ttaM | Link to this comment | 08-11-09 1:40 AM
horizontal rule
156

Blume,

That situation totally sucks ass, and it can be harder for married people. My specific point to Ba/ve was that a previous diagnosis isn't going to prevent him from getting insurance in Massachusetts.


Posted by: Bostoniangirl | Link to this comment | 08-11-09 5:05 AM
horizontal rule
157

My understanding was that borderlines frequently got better with time (if they didn't kill themselves first) and that there are certain therapies which seem to be actually harmful in borderlines.

A fair number of people think that --at least for bipolar I--if not medically treated, it will only get worse over time.


Posted by: Bostoniangirl | Link to this comment | 08-11-09 5:14 AM
horizontal rule
158

157 to max's 153.last.


Posted by: Bostoniangirl | Link to this comment | 08-11-09 5:18 AM
horizontal rule
159

I don't hear voices (except every once in a while the odd one calling my name), but I do hear music and clocks and cell phone rings and the like. That's apparently rather common---particularly among people with hearing loss.


Posted by: Jackmormon | Link to this comment | 08-11-09 7:04 AM
horizontal rule
160

That doesn't sound psychiatric, to me, so much as failed interpolation from half-heard sounds. You hear background noise that sounds in some way like your name, and your brain fills in the rest. But I don't actually know what I'm talking about, and come to think of it I don't know that the distinction between 'psychiatric' and non-psychiatric I'm making makes sense.

It does really sound like it's more about hearing loss than anything else, though.


Posted by: LizardBreath | Link to this comment | 08-11-09 7:43 AM
horizontal rule
161

I've noticed that kind of sound-blurring (or whatever) often. I blame cell phones. It used to be a ringing phone sounded like a freaking phone. Now, because a phone can sound like anything, the first two tones of anything sound like a phone call to me.


Posted by: Moby Hick | Link to this comment | 08-11-09 7:50 AM
horizontal rule
162

Oh, I hear voices. They're always: "Daddy, wake up. Daddy, I'm hungry. Daddy, I have to go potty. Daddy, put on cartoons for me. Daddy, I don't like this kind of yogurt. Daddy, watch me jump. Daddy, watch me spin in a circle. Daddy, Cassidy hit me. Daddy, Noah broke my toy. Daddy, watch me spin the other way. Daddy, you're not watching. Daddy, my clothes don't fit. Daddy, I can't see out of this eye."

You say there are drugs that would make them go away?


Posted by: apostropher | Link to this comment | 08-11-09 8:08 AM
horizontal rule
163

We're in the 'Why?' phase of toddlerhood. Also, surrealism has been big lately. Last night, I spent 15 minutes playing with 'Beany,' who was originally sitting in a dish with some other beans, a touch of butter and some slivered almonds.


Posted by: Moby Hick | Link to this comment | 08-11-09 8:11 AM
horizontal rule
164

The music, however, comes out of absolutely nowhere.


Posted by: Jackmormon | Link to this comment | 08-11-09 8:16 AM
horizontal rule
165

Only my oldest went through the why stage. I would allow three whys, and then I would answer, "It's self-evident." After a couple weeks of that, any time anybody asked Keegan a why question, he would answer, "Iss seff-ebident."


Posted by: apostropher | Link to this comment | 08-11-09 8:17 AM
horizontal rule
166

I'll have to try that. Continuing to give answers just makes me want to start smoking again.


Posted by: Moby Hick | Link to this comment | 08-11-09 8:20 AM
horizontal rule
167

Why?


Posted by: apostropher | Link to this comment | 08-11-09 8:22 AM
horizontal rule
168

Because your mother and I can't start drinking until you get to sleep.


Posted by: Moby Hick | Link to this comment | 08-11-09 8:23 AM
horizontal rule
169

You say there are drugs that would make them go away?

Drugs that would prevent them, anyway.


Posted by: B/ave | Link to this comment | 08-11-09 8:28 AM
horizontal rule
170

164 to 163.
167 to 164.


Posted by: Cryptic ned | Link to this comment | 08-11-09 8:29 AM
horizontal rule
171

I've been telling the story in 165 to friends and such, since Apo last told it.


Posted by: heebie-geebie | Link to this comment | 08-11-09 8:34 AM
horizontal rule
172

The music, however, comes out of absolutely nowhere.

I used to think that, until I realised it was people's ring tones.


Posted by: OFE | Link to this comment | 08-11-09 8:41 AM
horizontal rule
173

I'd sometimes pull out, "Why do you ask?" at about repitition 3 or 4. Although I generally did not find it that bothersome of an exercise.


Posted by: JP Stormcrow | Link to this comment | 08-11-09 8:42 AM
horizontal rule
174

One child of my acquaintance used to be good at the discombobulating questions.

On seeing her grandfather for the first time aged about 6 -- they'd never met, the family aren't especially close and live a long way apart -- her question was:

"When, exactly, did you become my granddad?"

with the implicit disdain very much intended.


Posted by: nattarGcM ttaM | Link to this comment | 08-11-09 8:44 AM
horizontal rule
175

173: Between 'whys' and various additions to the list of people eaten, it can take over a half hour to tell Little Red Riding Hood. It is a delay tactic at bedtime.


Posted by: Moby Hick | Link to this comment | 08-11-09 8:44 AM
horizontal rule
176

I'd sometimes pull out

If you'd pulled out sooner, you wouldn't have to go through the why stage at all.


Posted by: apostropher | Link to this comment | 08-11-09 8:45 AM
horizontal rule
177

the discombobulating questions


Posted by: apostropher | Link to this comment | 08-11-09 8:46 AM
horizontal rule
178

160:It does really sound like it's more about hearing loss than anything else, though

One of the many things I read waybackwhen was an attempt to connect partial/total deafness to paranoia/schizophrenia.

Foucault tells us to be careful not to romanticize madness, but any occasional empirical connection between deafness and madness (or see 159) would seem to me to be based on an excess of imagination. The psychs were of course seeking clues to a broader etiology.

But whatever. When one hears the word "horse" and mindseyes an Arabian instead of a carpenter's tool, is that a surfeit or poverty of imagination?


Posted by: bob mcmanus | Link to this comment | 08-11-09 8:55 AM
horizontal rule
179

175: Yeah, I've pretty much purged the bad parts. Preparing for useless indulgent grandpahood.


Posted by: JP Stormcrow | Link to this comment | 08-11-09 8:58 AM
horizontal rule
180

176.2.1 was ill-phrased. The excess of imagination is in the deaf, not the researchers. Hearing a sound and creating a voice. Finding a fossil and creating a geological age. That sort of thing.


Posted by: bob mcmanus | Link to this comment | 08-11-09 9:00 AM
horizontal rule
181

Put me on the record as loving the "why" phase. Through this process of discovery, my adorable little tykes have stumbled upon the concepts of paradox (specifically, a version of "irresistable force versus immoveable object"), infinity, biological evolution, mind-body dichotimy, and social convention ("Why are swear words bad? They're just letters and sounds.").

I never tire of responding to the "why's", even if I can't always answer them satisfactorily. (The chain of questions often ends with "Scientists are still trying to figure that out; perhaps in your lifetime the answer will be known!")


Posted by: pain perdu | Link to this comment | 08-11-09 9:36 AM
horizontal rule
182

I saw "Why" explained somewhere as "I'm still interested in this, but I don't have enough background to ask a sensible question. Ramble on about it if you would?" This makes sense in terms of the behavior (figuring little kids aren't actually trying to drive us mad), and it's easier to deal with than answering literally.


Posted by: LizardBreath | Link to this comment | 08-11-09 9:39 AM
horizontal rule
183

My nephew had a panic attack last week because he heard voices while he was drowsily trying to fall asleep and feared that he might be schizophrenic. Blech.


Posted by: Not Prince Hamlet | Link to this comment | 08-11-09 11:55 AM
horizontal rule
184

183: That also happened to me (the voices as I fall asleep). Then I had a child and became too tired to not fall asleep instantly on hitting the pillow.


Posted by: Moby Hick | Link to this comment | 08-11-09 11:59 AM
horizontal rule
185

184: Me too. I don't think it's unusual. The problem is the panic attack, not the voices. It's one of many symptoms of the illness known as "my dad is a fuckup and I need to be in a better living situation," which modern psychiatry unfortunately can't do all that much for. Aunty and Uncle to the rescue again....


Posted by: Not Prince Hamlet | Link to this comment | 08-11-09 12:01 PM
horizontal rule
186

Every SOB with a problem that isn't 100% incapacitating is convinced either that 1) they aren't really mentally ill, they just have a problem - those people over there are really crazy, or 2) the rest of the world is made up of crazy people. The Voices are REALZ! REALLY! Can't you hear them? WHAT'S WRONG WITH YOU? YOU'RE IN ON IT, AREN'T YOU?

I'm no expert, but my impression is the opposite -- that crazy people at some level know they're crazy, and their delusions are a defense mechanism against that unbearable fact. The wrongness is so totally unbearable that the defenses have to be extremely strong. Hence the angry insistence on delusion when challenged is not because other people are wrong, but because they suspect other people might be right.


Posted by: PGD | Link to this comment | 08-11-09 12:46 PM
horizontal rule
187

186: I don't think that's the opposite.


Posted by: Not Prince Hamlet | Link to this comment | 08-11-09 12:54 PM
horizontal rule
188

I havent read the comments, but there have been several interesting articles from relatives of the physically aggressively, mental disabled (one from a brother and one from a mother).

It is so hard to maintain love for someone who hits you and makes it really hard to be around.

I'm sure that I have mentioned that I had a previously relationship end bc my daughter was going through an amazingly aggresive period of time. ouch.

I feel for your friend and his family.

Also, RIP founder of special olympics. (And her hubby started the Peace Corp?!??! Amazing.)


Posted by: Will | Link to this comment | 08-11-09 9:51 PM
horizontal rule
189

Also, I have always felt a certain kinship/affection for BG for her struggles with her mom. I appreciate BG discussing those issues.


Posted by: Will | Link to this comment | 08-11-09 9:53 PM
horizontal rule
190

The "brain chemistry" theory of Mental Illness is bullshit: what the drugs they used to call Major Tranquilizers do is sedate the bejeezus out of you. That's why they have such a had time coming up with a pill for the "negative symptoms", the lethargy, lack of sociability, inattention to hygiene, etc. because these problems can't be "solved" by sedating the bejeezus out of you. (I'm sure it's plain that giving some crazy people stimulants is not always a good idea, even though I've occasionally found stimulants helpful in motivating me to vacuum my apartment at 3 A.M., keep scrubbing with a Buff Puff until every bug is clean, or write long posts explaining exactly why the CIA hates me.)

The About.com article on antipsychotics says different, to wit: "While these medications can be sedating, these drugs are not used because of the sedation but because of their ability to diminish the hallucinations, agitation, confusion, and delusions of a psychotic episode." That's doubletalk: the reason the "hallucinations, agitation, confusion, and delusions of a psychotic episode" are dimished is because it's hard to do such things when you're sedated all nice. And it's not only "antipsychotics" that do this: I've known crazy people who sedated themselves with alcohol and/or heroin and/or "pain plls," which worked so well in a couple cases that people didn't realize how nuts the person was till s/he stopped "abusing substances." (And yes, I've seen some folks on MSM sites saying things that back this up, but no, I don't know where; I suspect I've got it bookmarked on another computer elsewhere.)

Regardless of what or whether "Mental Illness" is and how the drugs that can help do so, I can say from my personal experience with the subject that sometimes having the bejeezus sedated out of me helps me -- for one thing I've noticed that sleep-deprivation makes things worse -- and that sedating me sometimes helps whichever person has the misfortune to live with/near me at the time. As to "compliance," there are long-acting antipsychotic injections; I think there might also be "rods" to stick under the skin that release their stuff slowly over a prolonged period, but I'm not sure what to tell Google to call these things.

That said, I feel badly for anybody who angers or scares people so much that they want to have him sedated, whether to help the "patient" or just to quiet the ranter so folks nearby can sleep. I can tell you from my experience that can make a crazy peson feel pretty isolated and picked on. What ultimately makes me "compliant with a medication regimen" is the fact that because of "deinstitutionalization" I know they'd stick me in jail if they had to do something to me, so hearing "Do I have to call the cops?" is usually enough to motivate me to resort to Risperdal. Because I've been lucky enough for about a decade to have someone who'd let me know whem I was getting TOO "off-beat" I can say that sometimes "having [my] Free Will sapped" for a while hell out of the things people do to you in the prison system. Not that I'm recommending threating to sic the System on somebody however, it's just that through sheer dumb luck it's been ~20 years since I was so far gone that that threat couldn't stop me. (If I'm ever so far gone that it doesn't I hope somebody cares enough to just take me out and shoot me.)

As for the OP's friend's son's possible financial issues, is this energetically crazy guy on some kind of Social Security disability program? It sounds to me that he's eligible, if he's in the U.S.A.

SSI is for those who don't have a real work history (like me); SSDI is for those who have been able to pay enough taxes to "deserve" a bigger check. The Social Security disability thing.

And yes, all these things might have been addressed upstream in this ~190 comment thread or in a previous post; please forgive me if my personal interest in the subject of discussion here made this long thread hard to inspect more closely.


Posted by: Entity | Link to this comment | 08-15-09 3:06 AM
horizontal rule
191


As to "attentuation," consider sleep deprivation. The vicious circle of insomnia has gotten many loonies down, and people who just don't have big problems getting enough sleep don't realize what that can do. (The folks at Gitmo know though.)


Posted by: Entity | Link to this comment | 08-15-09 3:10 AM
horizontal rule