A psychologist with schizophrenia talks about what helps him function effectively

Taken from the book: “Abnormal Psychology” by David Homes.  Harpers Collins. ©1991.

Frederick J. Frese III is a psychologist who has struggled with schizophrenia for over 20 years. He described the onset of his symptoms and talked about his occasional “breakdowns”. Most of the time, however, he functions effectively, and in the following comments he describes some of the things that help. Dr. Frese believes it is important that the person whit schizophrenia be aware of the nature of the problem in order to develop effective coping strategies. He said:

Person whit schizophrenia needs to carefully study how they function. Until they can identify their deficits, it is very difficult to start building compensatory mechanisms that will enable them to function better… persons recovering from schizophrenia should be able to identify, and be on the lookout for, the sorts of persons, places, and things that can cause the type of stress that may precipitate their breakdowns. They should know to get to environments that are helpful.

Just as a diabetic must take action to control his or her blood-sugar level, persons recovering from schizophrenia must learn to monitor and take measures to counteract an imbalance in subcortical neurochemical activity. But unlike diabetes, schizophrenia seriously interferes with rational processes, and once the irrationality begins, the person may have great difficulty in acting in a rational or responsible manner.

To overcome the irrationality, Dr. Frese also emphasizes the importance of feedback from others:

Because of our disability, it is very difficult for us to know what we do that normal do not understand. Therefore, it is very helpful to have a trustworthy normal around to let us know what it is about our thoughts that perhaps it would be better not to share with everyone else. In my case, my wife constantly gives me feedback whenever I am saying or doing things that normal people may consider bizarre or offensive. Some things are rather obvious. If you are hearing voices, it is generally best not to talk back to them while normal are around. If your thoughts are dominated by the importance of the colors or similar sounds in the environment, you probably do not want to reveal too much about this to others.

Whit help, other disabled persons learn to compensate for their disabilities and frequently lead dignified, productive lives. The blind learn to use canes and seeing-eye dogs; those with limited use of their legs learn to use crutches and wheelchairs. For the mentally ill, however, the parameters of our disability are often not easily defined. We need help and feedback so we can understand exactly the nature of our disability.

Whit regard to the results of psychological testing, Dr. Frese said:

Assessment results that us we have “gross pathology”, “extreme confusion” or “diffuse brain damage” are not really helpful. We need very specific information. Perhaps new assessment instruments need to be developed, possibly with input from us, so that we can better learn how it is that we are different from others or where our psychological blind spots are.

Unfortunately, feedback is not always enough. Sometimes the symptoms overwhelm the person, who then loses the ability to function. When that occurs, some flexibility on the part of other people in the environment is necessary. Dr. Frese commented:

Schizophrenia tends to be an episodic disorder. We are going to have periodic breakdowns. This makes holding employment very difficult because the usual practice is to terminate employees who require frequent periods of leave. Work for us should be structured so that our disabilities are taken into account. Many of us are well educated and/or have useful skills when we are not having episodes. Why can´t jobs be structured for us so that our episodic breakdowns do not automatically result in our loss of employments? As with those in the general population, we like and needs to be a little more flexible in understanding that we are going to behave strangely from time and there are going to be time when we do not function well at all.

"Abnormal Psychology" by David Holmes. Part 4, p. 303. Case study 15.1.

A Psychological Analysis of Chuck Palahniuk's Fight Club

How the World of Psychology Applies to This Famous Novel.

by Bryan R. Price.

Yahoo! Contributor Network.

May, 2007.

Fight Club was originally a novel by Chuck Palahniuk, and was made into a movie a short time after the book's success. Palahniuk's contemporary and often vulgar writing style has made the author not only a good fortune, but a huge fan base of support. In all of Palahniuk's books, a great deal of psychology theory and ideas are present- and Fight Club is no different.

Fight Club's success is more than just well written content- it was a book and movie geared towards younger men. Books such as "Little Women" and other women-themed movies were plentiful- but the same could not be said for male content. The book and movie differ in many ways- so focus will be put on the movie. In the movie, the main character's name is somewhat of a mystery. Through various clues, the avid film buff will notice that small hints suggest the character's name is Jack Moore, as seen on a check.

Jack is a rather disturbed individual, who suffers from insomnia. Jack sees a doctor, who tells him to visit a support group to see what pain really was- and declined to give Jack medicine. Jack finds an ability to sleep after going to these support groups, often of which he ends up crying to relieve stress from a common office job, common apartment, and a dull, bland, life. This is where things take a turn for the worst- as Marla Singer is introduced. She makes an appearance at one of the support groups for males only- so she is clearly what Jack calls a "faker". Jack is also a "faker", of course, but he finds that he can not enjoy the support groups knowing that Marla is there faking along with him. Eventually, he confronts her and they work out a temporary solution- which ultimately ends up failing.

Meanwhile, Jack meets Tyler Durden. Tyler is a strong hater of common culture, and considered to be a nihilist. Tyler and Jack form a much more involved friendship after Jack's apartment explodes- which effectively ruins his life and everything he owned. Tyler and Jack end up fighting in a parking lot out of being curious, and end up forming a fight club when other men start to join. These applicants are usually the type that grew up without a father- a rather interesting fact to take note while watching.

Throughout the movie, Tyler and Jack start to drift apart, as Tyler forms a project to attack popular consumer culture. Eventually, Jack and Tyler find themselves at the end of their efforts, with Tyler ready to watch a few credit card buildings explode from the amount of explosives he had ordered to be planted. Jack realizes that Tyler is actually him- and nothing more than an apparition or split personality. Jack ends up putting a gun inside his mouth and pulling the trigger, only to still live and realize that Tyler is gone. Jack then wakes up in a mental hospital, with the movie ending with a scene of the fight club members planning to continue their efforts against society- and claiming Tyler will come back.

The movie and book both focus on existentialism- which is the philosophy that an individual must make meaning from a chaotic and empty universe- and this individual is often the object of suffering. Throughout the movie, there are scenes where there is clear cut evidence of this. For instance, Tyler claims, "Only after disaster can we be resurrected" [1]. Another piece of evidence of existentialism comes when Tyler states, "It's only after we've lost everything that we are free to do anything." At one point, Tyler inflicts a chemical burn onto Jack, which is a lesson that tries to explain the sole fact that you will never get anywhere in life until hitting rock bottom. Existentialism defines the need for one to make decisions to better one's life- and that a person is who they are determined to be. Clearly, the movie focuses on this philosophy throughout the entire movie- as several main themes and subtexts are based from it.

Sigmund Freud is a notable psychologist that suggested the existence of the id, ego, and superego. The id is essentially the driving force that demands pleasure constantly [2]. The ego is the checks and balances of the id, as it waits for a safe or healthy moment for pleasure to be obtained. Finally, the superego is the moral standard that suppresses the id. Jack has a very interesting system of morals in Freud's terms. Jack is first satisfied with the common, bland life of having a normal job and condo. His superego is clearly doing a great job. However, it may be functioning all to well- as the id apparently creates Tyler Durden in an attempt to overcome its suppressor. While the id is successful in achieving its purpose, the ego is still operational. While it is hard to see, as Tyler and Jack are exact opposites- the ego acts as a mediator between the two in the end of the conflict. As Jack and Tyler become equally aware of each other, the ego can claim responsibility of bringing a sense of peace to the situation.

Also, there is the matter of gender identity confusion to take into effect. Although Jack shouldn't be considered feminine, there is a definite difference between Jack and Tyler in regards to masculinity. For instance, Jack collects furniture for a hobby. This is far from masculine, and far from the gender identity of Tyler. It would seem that the gender identity confusion adds to the correct balance of id and superego [3] - and ultimately helps Jack achieve things he otherwise could not. For instance, Jack gets into his first fight, albeit with himself. He defies his boss, in an act of rebellion against conformity. He also finds an attractive woman to date off and on, depending on the state of his identity. This lack of masculinity could be attributed to Jack's lack of a father figure in early childhood- but either way, it ends up causing catastrophic consequences in his personality.

Another psychologist, Abraham Maslow, suggested the idea of self-actualization. This is the idea that all humans try to make the most of their abilities, and to strive towards success to the fullest ability [4]. Individuals who achieve such self-actualization are considered to be creative, embrace facts rather than avoid them, spontaneous, appreciate life, like to solve puzzles, and of course have morals. Essentially, this is the act of achieving the peak of one's potential. Interestingly, there is a paradox within Fight Club concerning this subject. Tyler claims that men who wish to achieve freedom from a controlling father-figure will only be self-actualized once they have children and become fathers themselves. Essentially, the only way to self-actualization in this statement is to become what you are trying to defy. However, the narrator eliminates Tyler through shooting himself- and achieves self-actualization in effect.

Obviously, following a matriarch-style of development has either directly given Jack his problems, or at least contributed to them. As with other characters in the book and movie, most notably in the fight club, the majority of men relate to Jack through not experiencing a father figure. This has led a generation of youth develop without the guidance of a father- and in essence shaped masculinity through much harsher means. Interestingly, this has made an increase in schizophrenics [5]. Poverty is usually a cause of schizophrenia, and this is very much more common among single mother families than that of couples or single father families. This makes it very possible that Jack was suffering from schizophrenia because of poverty- although other factors could have been a direct cause. Heredity is another big cause of the disorder- and Jack's father was not mentioned in this context. It would appear that the exact cause of Jack's possible schizophrenia can not be determined because of lack of evidence.

Finally, it is important to relate psychosis and sleep deprivation to the film. Jack suffers from a bad case of insomnia- which can have detrimental effects. These effects can lead to forms of psychosis [6] - which makes schizophrenia a very viable effect as a result. When Jack is denied medication, he instead finds release in another form. Because of this he experiences schizophrenia less than he was before, although he might not have known it. It would seem that everything follows a massive chain reaction- which eventually leads to schizophrenia and an eventual internal conflict.

Fight Club is incredibly accurate in terms of validity. This comes to no surprise, as the author is both very qualified and very knowledgeable. Everything that could be explained in medical terms can likewise be explained through several theories or ideas. The effects of these health afflictions are very real- such as the insomnia or schizophrenia. Interesting psychological terms such as self-actualization and gender identity come into play- and with amazing accuracy. It seems Hollywood has made a successful and fact-proven work of art. Although, it would seem the credit should likely go to Chuck Palahniuk- who sold the rights of his works to have a movie made. Overall, the movie is incredibly accurate, and is definitely worth a place in any movie collector's shelf.

Brain Abnormalities in Schizophrenia Due to Disease, Not Genetics

By TRACI PEDERSEN Associate News Editor
Reviewed by John M. Grohol, Psy.D. on August 3, 2012

The brain differences found in people with schizophrenia are mainly the result of the disease itself or its treatment, as opposed to being caused by genetic factors, according to a Dutch study.

Schizophrenia is a mental disorder that significantly affects cognition and usually contributes to chronic problems with behavior and emotion. Along with a breakdown of thought processes, the disorder is also characterized by poor emotional responsiveness, paranoia, auditory hallucinations and delusions.

People with schizophrenia are likely to have additional conditions, including major depression and anxiety.

The strong familial link of schizophrenia is thought to be as high as 81 percent, and researchers have suggested that schizophrenia-related brain abnormalities may be present in unaffected relatives, a notion that has been supported by several studies.

For the current study, Heleen Boos and a team from University Medical Center Utrecht performed structural magnetic resonance imaging (MRI) whole-brain scans on 155 patients with schizophrenia, 186 of their non-psychotic siblings, and 122 healthy controls (including 25 sibling pairs).

Researchers used the images to measure volume, cortical thickness and to map the brain anatomy in order to evaluate group differences.

Compared with healthy controls, participants with schizophrenia had strong reductions in total brain, gray matter, and white matter volumes, and significant increases in lateral and third ventricle volumes after taking into account age, gender, intracranial volume, and left or right handedness.

However, there were no significant differences in brain volume between unaffected siblings and healthy controls.

Schizophrenia patients also showed cortical thinning compared with healthy controls, and had decreased gray matter density. Again, this was not found in unaffected siblings and healthy controls.

“Our study did not find structural brain abnormalities in nonpsychotic siblings of patients with schizophrenia compared with healthy control subjects, using multiple imaging methods,” the team says.

“This suggests that the structural brain abnormalities found in patients are most likely related to the illness itself.”

Source:  University Medical Center Utrecht 

"Si oyes voces y ves visiones..., ¡no estás mal de la cabeza!" - John Read

John Read, psicólogo especialista en abusos sexuales y psicosis.

26/05/2012 por Víctor M. Amela. La Vanguardia.

¿Locura... o sentido?

John Read superó el trauma psicológico de una familia disfuncional y un abuso sexual en la infancia. Sus vivencias y su curiosidad le llevaron a investigar la psique humana y a estudiar eso que llamamos locura. Read ha concluido que lo mejor es tratar amorosamente a pacientes a los que hemos etiquetado como psicóticos y esquizofrénicos. Y lo argumenta en libros como Modelos de locura o El sentido de la locura (Herder). Read me pondera el trabajo en España del doctor Jorge Tizón y su equipo de atención precoz a pacientes en riesgo de psicosis (con el patronazgo de la Fundació Llegat Roca i Pi) y me anima a visitar InterVoiceOnline.org. Este Read me ha parecido muy cuerdo.

¿Qué es la locura?

El término para definir comportamientos inusuales en el seno de una cultura.

¿La locura... es cultural?

¡Claro! Conozco a fondo la cultura maorí, y sé que en esa cultura no es síntoma de locura oír voces.

¿No?

Aprenden desde niños que eso encaja en la normalidad..., ¡y nadie se asusta! Nadie cree que uno esté loco sólo por oír voces...

Aquí sí, aquí te llevan al médico...

Allí entienden que es un ancestro que acude a ayudarte. Lo agradeces..., ¡y a otra cosa!

Pues si yo oigo voces, ¡sí me espantaré!

Porque te han enseñado que eso es estar mal de la cabeza, enfermo, y te internarán, tratarán...: vives con ese relato miedoso.

Oír voces, entonces, ¿no es patológico?

Para la especie humana, no es nada raro oír voces y ver visiones: ¡es parte de nuestra naturaleza! El 15% de la gente oye voces.

No sabía esto, explíquemelo...

Mire, el 80% de las personas mayores de 60 años que ha perdido a su pareja o a algún ser muy querido... ¡lo oirá o lo verá en algún momento durante el primer año de duelo!

¡¿Tantas personas?!

Pero preferimos no comentarlo con nadie...

¿Le ha pasado a usted?

Un buen amigo mío se mató en accidente de coche... Lo lamenté tanto... Al día siguiente se me apareció, vino a despedirse de mí...

¿Hay explicación científica?

Lo primero es aceptar el hecho sin problematizarlo, pues lo que ayuda no es saber cómo sucede, ¡sino dilucidar qué significa!

¿Y qué significa?

¡Es un mensaje a encajar en la biografía de quien lo vive! Pero el psiquiatra, en vez de escuchar al paciente..., ¡lo dopa! Debería ver cómo encaja el mensaje en su relato vital.

¿Lo llamamos locura... y es un mensaje?

Sí. El psiquiatra debe lograr, con humildad, sensibilidad y paciencia, que el paciente se convierta en autor del relato de su vida...

¿Y no lo hacen así los psiquiatras?

En España, los profesores universitarios de psiquiatría ¡cobran de la industria farmacéutica! En estas condiciones..., me daría vergüenza ser psiquiatra en España.

¿En el resto del mundo no es así?

También en Estados Unidos... Y me abochorna que dilapidemos fortunas buscando el gen de la locura, de la esquizofrenia: ¡no existe! No hay raíz biológica de la locura.

¿Dónde debemos buscar, pues?

En el propio relato del paciente, insisto. Darle drogas antipsicóticas... ¡sí es una locura!

¿Tan contraproducentes son?

Perjudican más que benefician, por lo que deberían prohibirse. ¡Acortan diez años la vida del paciente así medicado!

¿En qué casos sí benefician?

Sólo para tranquilizar al paciente durante una crisis: eso es sólo un tercio de los casos.

¿Aconsejaría a los pacientes abandonar ahora mismo los antipsicóticos?

¡Que nadie deje a solas la medicación! Es arriesgado. Dialogad con el psiquiatra y pedidle ayuda para contactar con grupos de terapias mentales sin fármacos, que los hay.

¿Cómo trata usted a sus pacientes?

Un caso: uno llevaba treinta años medicándose porque se sentía observado y espiado y quería convertirse en mujer. Me bastaron seis meses conversando con él para entrar en su lógica y ayudarle a mejorar.

¿Conclusión?

La buena calidad de la relación terapeuta-paciente es lo más curativo que hay. ¡No existe mejor medicina!

¿Algún consejo para el terapeuta?

Escucha al paciente con paciencia, sin hacerle sentir enfermo mental y sin juzgarle.

¿Alguna otra evidencia científica sobre lo que llamamos locura y su tratamiento?

En países africanos, es la propia locura la que cura: los chamanes provocan brotes psicóticos con drogas, con fines curativos...

¿Con qué resultados?

El dato científico es que dos tercios de los psicóticos se recuperan en África. Aquí sólo recuperamos a un tercio. ¡Aprendamos!

¿Qué le llevó a aprender psicología?

La necesidad de entenderme a mí mismo.

¿Qué le pasaba?

De los 11 a los 13 años fui víctima de abusos sexuales por parte del director de mi colegio. No entendía qué estaba pasando y me vengué del mundo suspendiéndolo todo...

¿Qué efectos tiene un abuso?

Si no se repara, es un trauma psíquico que puede derivar en psicosis y esquizofrenia.

¿Es muy frecuente el abuso sexual?

En Occidente, el 20% de las niñas y el 15% de los niños padecen abusos sexuales...

¿Con efectos iguales en niños y niñas?

La niña se aislará de otros niños. El niño abusará psicológicamente de otros niños.

¿Cómo debemos actuar ante un abuso?

Hay que alejar al abusador. Y preguntar al niño y escucharle. Y hacerle entender que él no ha actuado mal. Y ayudar a los progenitores inocentes. ¡Y dar mucho cariño y amor al niño! Si se hace así, se repondrá.

¿Puede pasarle algo peor a un niño?

También es muy traumático chillarle y reñirle y abroncarle continuamente..., y tanto peor cuanto más joven, porque se dañan más los reguladores neuronales del estrés.

¿Con qué consecuencias?

Tú dile al niño continuamente que es muy malo o un desastre... y será fiel a este relato, porque los niños creen íntimamente a sus padres. Y será malo y será un desastre. Y psicótico, depresivo... y eventual suicida.

Scientists Find Truth in "Mad Scientist" Stereotype: There Is a Link between Genius and Insanity

By Christine Hsu. Medical Daylt. June 04, 2012.

Genius and insanity may actually go together, according to scientists who found that mental illnesses like schizophrenia and bipolar disorder are often found in highly creative and intelligent people.

The link is being investigated by a group of scientists who had all suffered some form of mental disorder. 

Bipolar sufferer Kay Redfield Jamison, a clinical psychologist and professor at Johns Hopkins University School of Medicine, said that findings of some 20 or 30 scientific studies confirms the idea of the "tortured genius" or "mad scientist".   

Jamison said that creativity appears to be significantly linked to mood disorders, especially bipolar disorder.  For instance, one 2010 study that tested the intelligence of 700,000 Swedish 16-year-olds found that highly intelligent adolescents were more likely to develop bipolar disorder in a decade-long follow-up.

"They found that people who excelled when they were 16 years old were four times as likely to go on to develop bipolar disorder," Jamison said Thursday night during a panel discussion at New York’s World Science Festival.

Bipolar disorder is a condition in which people have dramatic mood swings between "mania" or extreme happiness and severe depression. 

Panelist and researcher James Fallon, a neurobiologist at the University of California-Irvine said that research found that people who suffer bipolar disorder tend to be more creative when they’re coming out of deep depression. 

Fallon suggested that when a bipolar patients' mood improves, activity decreases in the lower part of a brain region called the frontal lobe and increases in a higher part of that lobe, a shift that is also seen when people have bouts of creativity.

"There [is] this nexus between these circuits that have to do with bipolar and creativity," Fallon said at the panel.

Elyn Saks, a mental health law professor at the University of Southern California who also developed schizophrenia as a young adult, said that people with psychosis do not filter stimuli as well as others without the disorder, meaning that they're able to ponder contradictory ideas simultaneously and gain insight into loose associations that the general unconscious brain wouldn't even consider worthy of sending to consciousness.

Saks said that while the invasion of nonsense into conscious thought can be overwhelming and disruptive, "it can be quite creative, too."

Studies on word associations that ask participants to list all the words that come to mind in relation to a stimulus word like "tulip" found that bipolar patients experiencing mild mania can generate three times as many word associations in the same amount of time as the general population. 

The findings suggest that mania can lead to bouts of genius because the great amount of unsuppressed ideas means a greater probability of producing something original and profound.

Many prodigies like painter Van Gogh, author Jack Kerouac and mathematician John Nash had displayed self-destructive behaviors, and it is unclear as to why humans have evolved this trait. 

"The notion of a 'tortured genius' or 'mad scientist' may be more than a romantic aberration," says the World Science Fair. "Research shows that bipolar disorder and schizophrenia correlate with high creativity and intelligence, raising tantalizing questions: What role does environment play in the path to mental illness?"

Scientists wonder whether the mental disorders are being positively selected for in the gene pool, and if there is actually a line between gift and deficit. 

Past studies have suggested that much of the link between genius and madness is produced by one particular gene called the DARPP-32, and that three out of four people inherit a version of the DARPP-32 gene, which enhances the brain's ability to think by improving information processing in the prefrontal cortex of the brain. 

However panelists noted that while society benefits from the productivity of its "tortured geniuses," people who are affected by mental disorders that often lead to bouts of creative energy don’t always consider their moment of brilliance to be worth their suffering.

"I think the creativity is just one part of something that is mostly bad," Saks said.

Published by Medicaldaily.com

Cine24.es - Alguien voló sobre el nido del cuco

(Link ver Online Español) Cine24.es - Alguien voló sobre el nido del cuco
Randle McMurphy (Jack Nicholson), un violador de espíritu libre, que vive contracorriente, es recluido en un hospital psiquiátrico. La inflexible disciplina del centro acentúa su contagiosa tendencia al desorden, que acabará desencadenando una guerra entre los pacientes y el personal de la clínica con la fría y severa enfermera Ratched (Louise Fletcher) a la cabeza. La suerte de cada paciente del pabellón está en juego. 
Título en Latinoamérica: "Atrapado sin salida". (FILMAFFINITY)

Espacio y Movimiento de la Locura: El péndulo de la Historia (Chile)

Por: Alfredo Roca.

Medico Psiquiatra, Universidad de Chile. Doctor en Medicina, Universidad Libre de Bruselas, Bélgica. Epidemiología. Universidad Católica de Lovaina, Bélgica. Profesor de la Universidad de Playa Ancha y Profesor asociado de la Universidad de Valparaíso. E-mail: aroca@upa.cl

Este artículo se referirá al espacio social de la locura y a sus movimientos, en Chile, desde la Colonia hasta el siglo XXI. Intentaremos en lo que sigue, referirnos a la psiquiatría en Chile, teniendo en cuenta el movimiento desarrollado en el tiempo largo, “la longue durée”. Esto nos permitirá observar los movimientos en la historia de la locura, en los últimos siglos. Por otra parte, abordaremos la locura desde su propio movimiento (intrínseco) en los espacios que  se le asignan. Decimos espacios, porque ellos son múltiples, pero los diferenciaremos en espacio interno, intramuros o institucional y espacio externo o extramuros.

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Open publication - Free publishing - More chile

Recovery from Schizophrenia: Psychiatry and Political Economy

Recovery from Schizophrenia: Psychiatry and Political Economy. Richard Warner.

The first edition of Recovery of Schizophrenia was acclaimed on publication as a work of major importance. It demonstrated convincingly, but controversially, how political, economic and labour market forces shape social responses to the mentally ill, mould psychiatric treatment philosophy, and influence the onset and course of one of the most common forms of mental illness. In this revised and fully updated edition, Dr Warner examines the changes in approach to schizophrenia since publication of his original book and analyses new research to answer the question: `Are they advances or not?'

Open publication - Free publishing - More economy