Thursday, October 9, 2014


Schizophrenia is an insidious disease that strikes about 1% of the American population. It's marked by the inability to discern between what is and isn't real, a lack of normal emotional responses, inability to think clearly, and abnormal behavior in social situations. 

Most likely it's an interaction between genes and the environment that causes schizophrenia. There's a 10% greater risk for people with first degree relatives with the disorder (e.g., parent, sibling), and a higher than normal risk if other relatives have it. 

"Psychosis", by Dave Emmet
Scientists believe that an imbalance of neurotransmitters, particularly dopamine and glutamate, may play a significant role. In addition, many people with schizophrenia have larger brain ventricles (fluid filled spaces in the brain) and less grey matter than the average person.

Schizophrenia is an equal opportunity disease. Rates among men and women and between different ethnic groups are roughly the same.

Substance use and addiction is higher for people with schizophrenia. This is particularly true for nicotine. People with schizophrenia seem to be drawn to smoking and are addicted to cigarettes at a rate three times higher than that of the general population.

  • Schizophrenics are violent and dangerous: the majority of violent crimes are not committed by people with schizophrenia, although risk of suicide is particularly high. Approximately 10% die by suicide. This is especially true for young males.
  • People with schizophrenia have more than one personality: schizophrenia is not the same as split personality or multiple personality disorders.
  • People with schizophrenia can't lead productive lives and should be hospitalized: with the proper treatment and strong social support, people with schizophrenia can and do lead very productive lives.
  • Anti-psychotic medication side effects are worse than the symptoms of the disease.
  • Hallucinations: seeing, hearing, or smelling things that are not really there;
  • Delusions: unrealistic false beliefs. For example: believing one possesses extraordinary abilities or powers (e.g., the individual believes they are God, Ghandi, the President, etc.); feelings of paranoia that others are out to get or hurt the them (e.g., the government, aliens, people around the individual); belief that a major catastrophe is imminent, etc.;
  • Disordered behavior/movement: may include agitation, inappropriate or odd posture, lack of responsiveness, behavior that is not goal-focused, etc.;
  • Disordered thinking and speech: impaired communication which may include stringing together words that are meaningless ("word salad"), providing answers to questions that are off-topic and unrelated; and,
  • "Negative symptoms": lack of emotion, not making eye contact, flat speech, being less talkative, poor hygiene, loss of interest in activities, withdrawal/isolation, and inability to experience pleasure.
Symptoms tend to start between ages 16 and 30. It's often hard to differentiate symptoms in the early stage of the disease (prodromal phase) though, as some of the symptoms may not seem all that different from what one could expect from many teens: drop in academic performance, changes in friends, sleep problems, depression, and/or irritability. Additional signs that can lead to a diagnosis at this stage include: withdrawing/isolating, bizarre thoughts, suspicions and paranoia, and family history.  

It's important to seek help from a doctor if you or your loved one experience any of the symptoms. Help is needed immediately if you or your loved one are a danger to yourself/herself/himself or to others. 

Once again, if you or anyone you know is having thoughts of suicide, it must be taken very seriously. Call the suicide hotline immediately1-800-SUICIDE (1-800-784-2433) or 1-800-273-TALK (1-800-273-8255) -- or the deaf hotline at 1-800-799-4TTY (1-800-799-4889). 

  • Anti-psychotic medication
  • Psychosocial: therapy that focuses on helping patients with everyday challenges (e.g., communication, relationships, self-care, work)
  • Illness management: learning coping skills to manage symptoms and crafting a Wellness Recovery Action Plan (WRAP) as a wellness guide for the patient, the care givers, and the treating professionals.
  • Integrated treatment for co-occurring substance use disorders: substance use and addiction are common and treatment for both is needed.
  • Cognitive Behavioral Therapy (CBT) - see yesterday's post:
  • Social and vocational rehabilitation
  • Family education and counseling
  • Self-help support groups
Treatment for schizophrenia can often be complicated by the fact that many patients have trouble taking their medication regularly. In addition, because of delusional thinking, they may be resistant to treatment in the first place. This can be exacerbated by the very laws that are in place to protect all of us and allow us to make decisions about our own treatment. Unless a person is an imminent danger to her-/himself, a patient cannot be forced into treatment unless they have given the authority to a caregiver. 


Resources Online

Mayo Clinic

National Institute of Mental Health (NIMH)

Simulated Schizophrenia - (2 films): An excellent YouTube video that simulates a psychotic episode of schizophrenia.

Thirteen Myths of Schizophrenia,



Ben Behind His Voices: One Family's Journey from the Chaos of Schizophrenia to Hope, by Randye Kaye

Me, Myself, and Them: a Firsthand Account of One Young Person's Experience with Schizophrenia, by Kurt Snyder

The Quiet Room: a Journey Out of the Torment of Madness, by Lori Schiller

Tuesday, October 7, 2014


What exactly is depression? Everyone feels down occasionally or is sad after a major loss, but what differentiates this normal range of feeling low from that of depression the illness? To answer this question, let's take a look at the myths, the symptoms, and the treatments of depression.


  • Depression is always caused by a traumatic life event;
  • Antidepressants are all one needs to feel well;
  • Antidepressants are "happy pills";
  • Depression is a character defect, not an illness;
  • Depression is the same as sadness.
  • Telling a person suffering from depression: "just snap out of it", "you can do anything if you put your mind to it", "think positively", "get a grip", etc.
The fact is, depression is an illness that cannot just be willed away with pep talks and positive thinking; and it is not caused exclusively by loss or traumatic life events. 

Medication for depression is not a cure-all, nor will it make one instantly or constantly happy. Rather it will level the psychological playing field to enable the person to feel a normal range of emotions.

  • Feelings of guilt, helplessness, hopelessness, and/or worthlessness;
  • Cognitive difficulties: difficulty concentrating, recalling details, and/or decision-making;
  • Cycling negative thoughts;
  • Decreased energy and fatigue;
  • Sleep disturbances: insomnia, waking unusually early, and/or sleeping excessively;
  • Anger and/or irritability;
  • Restlessness;
  • Loss of interest in activities that were once pleasurable (e.g., hobbies, sex, socializing);
  • Appetite loss or overeating;
  • Unexplained physical symptoms: aches and pains, cramps, digestive problems, and/or headaches that don't respond to medical treatment;
  • Persistent feelings of anxiety and/or feeling "down", sad, or empty;
  • Thoughts of or attempts at hurting oneself or of suicide.
Depression can be fatal. If you or someone you love is experiencing any of these symptoms, discuss them with your doctor or therapist immediately.

  • Anti-depressant medications
  • Cognitive Behavioral Therapy: examines the relationship between thoughts, feelings, and behaviors (e.g., the flawed patterns of thinking that lead to self-destructive behavior);
  • Electro-Convulsive Therapy (ECT): formerly known as "electroshock therapy", treats depression with currents of electricity that induce seizures in the patient. Made infamous by the movie, One Flew Over The Cuckoo's Nest, ECT now uses lower voltage doses to successfully treat depression that is resistant to conventional treatments;
  • Interpersonal Therapy (IPT): time-limited psychotherapy focusing on interpersonal issues as the source of mental stress;
  • Psychodynamic Therapy: also known as "insight-oriented therapy", focuses on the unconscious processes manifested in behavior; and
  • Psychotherapy: commonly known as "talk therapy" (e.g., talking to a counselor, therapist, psychologist, and/or psychiatrist).
According to the National Alliance on Mental Illness (NAMI), 25 million American adults will experience depression in a given year; but only half of them will receive treatment.

Depression is a very serious illness that can be fatal. If you or anyone you know is having thoughts of suicide, it must be taken very seriously. Call the suicide hotline immediately: 1-800-SUICIDE (1-800-784-2433) or 1-800-273-TALK (1-800-273-8255) -- or the deaf hotline at 1-800-799-4TTY (1-800-799-4889). 


For more information on depression, check out these resources:

"10 Depression Myths We Need to Stop Believing", by Alena Hall, Huffington Post, 9/3/14

International Society for Interpersonal Psychotherapy

Mayo Clinic


National Institute of Mental Health (NIMH)

PBS - Depression: Out of the Shadows

Psychodynamic Therapy 101, Psychology Today

Some excellent memoirs on depression:

Darkness Visible: a Memoir of Madness, by William Styron

The Noonday Demon: an Atlas of Depression, by Andrew Solomon

Night Falls Fast: Understanding Suicide, by Kay Redfield Jamison

Shoot the Damn Dog: a Memoir of Depression, by Sally Brampton

An Unquiet Mind: a Memoir of Moods and Madness, by Kay Redfield Jamison


In honor of the NAMI's "Mental Illness Awareness Week", I will be blogging about a different mental disorder each day this week.

It IS an Illness

Originally posted 3/27/13:

I still struggle at times with the notion that depression, anxiety, and chemical addiction are physical diseases, and not just character defects. Recently, I had been doubting the disease model yet again, and was beating myself up about it. I suppose, though, this is part of denial -  a normal step in the course of change {more on that in another blog}. 

Then, it hit me: I know that what I have is a physical illness and that medication does in fact work for me because of the difference in my cognition / thinking when I am taking medication. 

Here's the supporting evidence:
  1. The incessant cycling of negative thoughts has stopped. It is not that I have no negative thoughts, sadness, or anger - that would not be normal - it's just that I don't dwell on these indefinitely.
  2. like things again. No really, I'm serious. For at least two decades, not much appealed to me. I would do the things I know I should like, but everything at the banquet of life tasted like cardboard - the world was flat. I knew, for example, that horses, tennis, and time with family and friends should generate feelings of joy in me, but it was all....meh...take it or leave it...bland...grey - and at times even irritating.
  3. Color, color, C O L O R has returned to my life. Once again, I enjoy colors in objects, nature, and furnishings. My clothes, for example, have gone from neutrals to vibrant blues, purples, greens, and...P I N K. {I still adore black too!}
  4. I look forward to things. Yes, believe it or not, if nothing is scheduled on the horizon, I have actually created dates and outings in the past two months! I have reached out to female friends. This is the first time in a long is the first time that I have ever done this! 
The fact that taking a physical pill does affect change in my thoughts and subsequent behaviors, speaks of a physical, underlying disease capable of responding to medication. And lest anyone confuse psychoactive prescription medication for opiates, let me underscore: the medication does not make me feel fantastic all the time. These are not "happy pills". The meds just simply permit me to feel the normal range of feelings that the average person is capable of feeling. They free me to be Me; and for that, I am truly grateful!