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  1. #1
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    Default schizophrenia and the social contract

    As I now work downtown I have become familiar with several of the schizophrenics who hang out, and it seems like I notice a new one just about every week. This morning I was walking and one was right in my path and when I tried to move out of the way he got a few inches from my face and screamed various obscenities at me. He then went into the Starbucks bathroom. I thought about it for a second and decided to go in and get in line. When he came out a few minutes later he grabbed me by the shoulders and gave me a solid push backwards, all the while continuing to yell obscenities at me. I called the police. He tried to run away from me, but I decided to follow him from about a block away. The police (4 officers total) showed up at the parking garage and he let his true colors show - the guy is completely crazy, hardly capable of forming coherent thought. She asked if I wanted to press charges. I said my only concern was finding out how I can help him take his meds. She said he has a case worker, but that there was nothing they can do. I spoke to two different officers and they made it clear that they are familiar with this guy and that there is nothing they or anyone can do for him. They spoke to him for about five more minutes until the crazy subsided and then they just left him there.

    Now consider the following response for a doctor who used to work in a psych ward:

    Quote Originally Posted by Dr. Charles Raison
    I am sorry to hear about your son. For many years I ran an inpatient team in a big psychiatric hospital, and the story you tell was the bane of my existence. A young person like your son would come in to the emergency room wildly psychotic. We would hospitalize him, give him a medicine like risperidone -- often against his will in the beginning -- and he would do remarkably better. Home he'd go, with all our follow-up plans in place, only to return a month or so later wildly psychotic all over again because he'd stopped taking his medicine.

    When we think about schizophrenia, we tend to envision the flashier symptoms and behaviors such as hearing voices, shouting at the empty sky while pushing an overflowing shopping cart or believing that one is God or the devil. I had a patient once who believed she was the Virgin Mary and Eva Braun, Hitler's lover. I had another patient who was convinced he had died years before and someone had stolen his body. Why? Because he saw his body lying in a coffin in a church once.

    In fact, while colorful, these types of symptoms are not the worst part of schizophrenia. Much worse is the fact that many people with the illness lose all insight into their situation. They believe their delusions so thoroughly, or are so thoroughly confused in general, that they can't see that something is wrong. And even when they recover, they often do not gain insight into what happened.

    This lack of insight is itself a symptom of schizophrenia, and it is one of the worst. Many studies show that, other things being equal, a patient who recognizes that he is ill and complies with treatment will do much better over the years than someone without insight, who thinks he is normal and doesn't need treatment.

    There are probably two reasons why having enough insight to comply with treatment improves outcomes. First, anti-psychotics suppress behaviors and delusional beliefs that make it impossible for a person to function in society. More importantly, over the last several years studies have shown that taking anti-psychotic medications early in the course of schizophrenia (i.e. as soon after it starts as possible) probably protects the brain from damage, with the result that treatment actually can slow the worsening of the disease.

    It is now quite clear that each bout of psychosis damages the brain and leaves a person in worse shape than before. Think of psychotic episodes like little strokes. We all know how repeated little strokes in older people eventually destroy the brain and lead to dementia. In patients with schizophrenia, repeated bouts of psychosis (usually caused by stopping medication) also damage the brain. Remember the first modern term for schizophrenia was "dementia praecox" (early dementia).

    This last point is so important that I feel the treatment of schizophrenia is one of the few places in medicine in which it can be justified to treat people against their will. Because of this belief, I always tell families that the single most important thing they can do for their sick child is to get him to take the medication on a regular basis, whatever it takes. Parents are often afraid that if they use all the leverage at their disposal to enforce medication compliance their child will come to hate them, and sadly, in my experience, this does occasionally happen. More often, though, the anger fades when the patient does better and stays as well as patients with schizophrenia can be, given our current treatment limitations.

    So specifically in your case, I would recommend you do an inventory of all the points of leverage you have over your son (house, car, food, emotional support) and make these contingent on him taking his medications. It's harsh and sometimes the patient will walk, but quite often patients will take medicine just to hold onto things they need or to get things they want. In my experience it doesn't matter how the medicine gets down the gullet -- it's just got to get there for a patient to escape the pattern of improvement and relapse that you describe and that is so destructive to a patient's brain over time.
    Schizophrenics are ticking time bombs. They may not take their meds, and by not taking their meds they cause their condition to worsen.

    I see this situation as society falling through on the social contract. We brought you into this world so you could help humanity continue, because we think life is worth living. But it didn't work out for you, and now we are going to ignore you, ostracize you and let you suffer, trying our hardest not to think about you.

    It's completely messed up.

  2. #2
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    You know there are different types of schizophrenia right?

  3. #3
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    Quote Originally Posted by Saudade View Post
    You know there are different types of schizophrenia right?
    What's the relevance of bringing up this point?

    That said, since you brought it up, I had a conversation with a schizophrenic a couple of months ago. He was good at hacky sack and quite erudite. He also believed he was part of a vast conspiracy involving the CIA, and that, for instance, they had injected him with nanobots etc. It went on and on and on, endlessly. Most of them that I've met have a hard time forming 3 sentences that cohere.

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    Senior Member prplchknz's Avatar
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    I'm schizoaffective which for me is a combination of schizophrenia and bipolar disorder. and I can tell you why I go off of meds 90% of the time. It's because I begin to feel normal and stable and think I don't need them, then eventually end up delusional and hallucinating again and really unstable.

  5. #5
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    Quote Originally Posted by mingularity View Post
    What's the relevance of bringing up this point?

    That said, since you brought it up, I had a conversation with a schizophrenic a couple of months ago. He was good at hacky sack and quite erudite. He also believed he was part of a vast conspiracy involving the CIA, and that, for instance, they had injected him with nanobots etc. It went on and on and on, endlessly. Most of them that I've met have a hard time forming 3 sentences that cohere.
    My point is there's a difference between a Syd Barrett and a Richard Chase. Not all Schizos are "Ticking time bombs".

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    Quote Originally Posted by prplchknz View Post
    I'm schizoaffective which for me is a combination of schizophrenia and bipolar disorder. and I can tell you why I go off of meds 90% of the time. It's because I begin to feel normal and stable and think I don't need them, then eventually end up delusional and hallucinating again and really unstable.
    Please keep taking your meds.

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    First of all, some of these meds have associated with them side-effects so severe that they make the original symptoms look like a walk in the park. The medication also can cause people to function at much less than a normal level. There are those that stop taking the meds because they feel better, but there are those that stop the medication because the side-effects and ill-effects are so bad that "insanity is preferred." For those in the early stages (or anyone really) I recommend adding Niacin to the list of supplements you take to help with your condition. The great thing about it is that it has very little in the way of side effects, and if there is nothing wrong with you, you have buffered yourself against any possible psychosis episodes while lowering your cholesterol.

    Anyone with Schizophrenia should try regular Niacin (not the slow release kind). 3g/day with 3g Vitamin C and 1g Vitamin B5. After a meal. You would increment the dosage 250-500mg every few days until you get to 3g. It may take a few weeks to start working, but it may help without the side effects of the other meds. It's worth a try if other things don't work that well, because you can take it while taking the other meds, and there are no real side effects. Also, this combo is good if you aren't sure you have the problem, because it's harmless if there's nothing wrong with you. That is, it won't do any damage, and as a matter of fact it will lower your cholesterol levels. If you start to even out, then a combination of diet (low carb diet), exercise (high intensity interval training), and vitamin/mineral supplementation should lessen your need for antipsychotics, etc.

    DoctorYourself.com - Niacin Therapy Details

    How do you help someone who doesn't think anything is wrong? : Schizophrenia Forum - Psych forums

    Also brainwave entrainment (Neuro-Programmer 3) may help ease some of the symptoms, again with no side effects if there is nothing wrong with you (try the Gamma session).

  8. #8
    Entertaining Cracker five sounds's Avatar
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    @mingularity, how do you know all these people you're encountering have schizophrenia?
    You hem me in -- behind and before;
    you have laid your hand upon me.
    Such knowledge is too wonderful for me,
    too lofty for me to attain.

  9. #9
    Senior Member prplchknz's Avatar
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    Quote Originally Posted by nicolita View Post
    @mingularity, how do you know all these people you're encountering have schizophrenia?
    that's what i'm curious about as well

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    I agree it would be nice if society could help people get treated, and sadly there just aren't enough resources. As for the person you describe, I would feel bad pressing charges and having him possibly end up in some prison, but if he's dangerous, that might be the best option. I'd rather send someone to prison than have them push me around. Most schizophrenics I don't think are all that dangerous though.

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