I Believe People Misunderstand Mental Illness
This is about the limits of understandability where a person has schizophrenia. Some parts are context.
It is lay opinion. You are free to ignore.
If you happen to know someone with schizophrenia, think about this. How well do you know them? How many hours a day and how many days a week have you spent with them? How many years? Might you believe that particular occurrences in your friend's life may have been especially telling? But what about this: would you really know? Did you live the experiences with them?
It's possible that the quality of your 'knowing' is questionable. What you discover by talking with a person isn't guaranteed to be the reality around them as you would experience it. What is revealed to you is information that has been processed cognitively and emotionally within the person's brain. Though there are no absolutes, the picture you get from a friend with schizophrenia may not be informative in the way that you expect. It may or may not be a useful guide to your friend's past or present. Your friend's experience may not be exactly as their narrative suggests and it's also possible that, one year ago or a few years ago, you'd have been given noticeably different impressions.
Schizophrenia is characterised by distortions of perception and thinking, delusions, which can be plausible or bizarre, episodes of psychosis, and hallucinations. The distortions can be subtle, and 'plausible' delusions can easily be mistaken for fact. Schizophrenia isn't easy to relate to because we assume that everybody behaves in a way that makes sense, and that someone else's sense might be much the same as ours. It takes determined thought to start to see the full implications when that's not the case.
It's good to note that there's not absolutely always obvious disability with schizophrenia. Individuals are affected to varying extents and in some instances you may be unaware of an issue. The person may suffer mild symptoms on a very intermittent basis and in general perform much as anyone else. However, many people do suffer incapacity.
Schizophrenia isn't a clearly defined illness in the same way as something like appendicitis. It's a diagnostic label for mental illness that presents particular, similar sets of symptoms. It is considered a progressive illness because serious symptoms, meaning mental decline and psychotic crises, are preceded by a potentially extended early phase in which symptoms may be minor. 'Psychosis' means the loss of contact with reality and is seen accompanied by a patient responding to internal cues. For people still able to be in the community, psychosis tends to occur in episodes. It is dangerous because neurological damage is occurring at this time and because people are unable to care for themselves.
Do you sometimes offer friends positive feedback to their thoughts or give helpful advice? How would you do this with your schizophrenic friend? Be very careful. The feedback we give is based on our understanding, and in the case of a schizophrenic friend this is an insubstantial thing. Perhaps you feel differently but you might be wrong. Your friend has had friends before and has had feedback and advice before. Some of that was unhelpful and even damaging because it was formulated based on wrong information, much more than where schizophrenia isn't involved. A right answer to the wrong question isn't helpful. We like to help friends but this is a case for extraordinary care.
Is there anyone, for example the psychology professional, who can reliably identify the 'realities' behind the schizophrenic's concept of his/her experience and thinking? Often not. This is a hard question to even pose because there are no absolutes. Psychiatrists and psychologists bring to bear a wealth of specialised insight but the broad answer is that even they often can't correctly identify these realities. Often nobody can. On occasion the professional is worse because, with higher confidence in their own ability to extract a correct conclusion, the effects of a misinterpretation can be amplified. Professionals typically avoid the temptation to be overly drawn in by a patient's story, but, given the desire and need to help, listening and attempting to understand is inevitable.
More context. When is it schizophrenia? When it is diagnosed by a licensed psychiatrist. Anywhere. Can other people correctly identify schizophrenia in an undiagnosed person? Logically, it's not impossible, but it's a moot point. What would you do with that opinion? If you suspect schizophrenia and manage to get your friend to a psychiatrist who then promptly diagnoses; it's hats off to you, and please buy a lottery ticket. In another scenario, if you're thinking of helping a psychiatrist to identify schizophrenia in your friend, well, think again. Never mention what you think the condition might be, or even that it might be a condition. Just focus on relaying what you've observed and experienced. Be the Pygmy to the Amazon for a while. You may in fact be more coherently persuasive if you do silently bear the condition in mind, but remember that the experienced professional offers the best evaluation and outcome that is available.
Psychiatry and psychology offer the best available but we should probably also keep in mind that they have a chequered record. A present case in point is that, even though it's clear just how damaging schizophrenia is, still, in a philosophical moment, a psychiatrist will pronounce, "schizophrenia doesn't exist." One wonders whether, 60 years ago, this same psychiatrist would have been the one to destroy a life by summarily committing to an asylum the individual who had in some way displeased government or corporate bureaucracy. Both attitudes reflect dogma, and it's dogma that is most often medicine's Achilles' heel. But again, medical science offers the best that's available. There is no other, better choice.
Despite huge amounts of knowledge, science is not close to understanding how the brain and mind work in a comprehensive way, and Schizophrenia medications are still relatively primitive. However, they are a major factor in preventing the recurrence of psychosis and it's common that a patient suffers a relapse only when medication is removed or reduced. Even these medications are miraculous. At the same time, no one has fully recovered from schizophrenia as a predictable result of medication. The current drugs barely touch whatever are the underlying causes of the illness. It is not even well understood why a psychotic episode tends to have lasting, deleterious effects on the brain, but it appears it does.
Schizophrenia is not well understood and the efficacy of the drugs is the result of an oblique approach. Still, the medicines save, enhance and extend lives. They keep psychosis at bay and, in buying time, give the brain the opportunity to rewire, to grow new neurons and connections. Early, comprehensive treatment and management of first episode psychosis enhances outcome. As part of maintenance, new avenues are offered by therapies which attempt to specifically engage brain 'plasticity' through activities such as learning, exercise, music, and other mental and sensual stimulation. Social interaction is critical to building or rebuilding the self.
To end, there've been recent (2016/15), potentially major revelations in schizophrenia research. Science is gaining a foothold, but consensus and clinical impact are yet to come and the struggle may have a long way to run.
It is lay opinion. You are free to ignore.
If you happen to know someone with schizophrenia, think about this. How well do you know them? How many hours a day and how many days a week have you spent with them? How many years? Might you believe that particular occurrences in your friend's life may have been especially telling? But what about this: would you really know? Did you live the experiences with them?
It's possible that the quality of your 'knowing' is questionable. What you discover by talking with a person isn't guaranteed to be the reality around them as you would experience it. What is revealed to you is information that has been processed cognitively and emotionally within the person's brain. Though there are no absolutes, the picture you get from a friend with schizophrenia may not be informative in the way that you expect. It may or may not be a useful guide to your friend's past or present. Your friend's experience may not be exactly as their narrative suggests and it's also possible that, one year ago or a few years ago, you'd have been given noticeably different impressions.
Schizophrenia is characterised by distortions of perception and thinking, delusions, which can be plausible or bizarre, episodes of psychosis, and hallucinations. The distortions can be subtle, and 'plausible' delusions can easily be mistaken for fact. Schizophrenia isn't easy to relate to because we assume that everybody behaves in a way that makes sense, and that someone else's sense might be much the same as ours. It takes determined thought to start to see the full implications when that's not the case.
It's good to note that there's not absolutely always obvious disability with schizophrenia. Individuals are affected to varying extents and in some instances you may be unaware of an issue. The person may suffer mild symptoms on a very intermittent basis and in general perform much as anyone else. However, many people do suffer incapacity.
Schizophrenia isn't a clearly defined illness in the same way as something like appendicitis. It's a diagnostic label for mental illness that presents particular, similar sets of symptoms. It is considered a progressive illness because serious symptoms, meaning mental decline and psychotic crises, are preceded by a potentially extended early phase in which symptoms may be minor. 'Psychosis' means the loss of contact with reality and is seen accompanied by a patient responding to internal cues. For people still able to be in the community, psychosis tends to occur in episodes. It is dangerous because neurological damage is occurring at this time and because people are unable to care for themselves.
Do you sometimes offer friends positive feedback to their thoughts or give helpful advice? How would you do this with your schizophrenic friend? Be very careful. The feedback we give is based on our understanding, and in the case of a schizophrenic friend this is an insubstantial thing. Perhaps you feel differently but you might be wrong. Your friend has had friends before and has had feedback and advice before. Some of that was unhelpful and even damaging because it was formulated based on wrong information, much more than where schizophrenia isn't involved. A right answer to the wrong question isn't helpful. We like to help friends but this is a case for extraordinary care.
Is there anyone, for example the psychology professional, who can reliably identify the 'realities' behind the schizophrenic's concept of his/her experience and thinking? Often not. This is a hard question to even pose because there are no absolutes. Psychiatrists and psychologists bring to bear a wealth of specialised insight but the broad answer is that even they often can't correctly identify these realities. Often nobody can. On occasion the professional is worse because, with higher confidence in their own ability to extract a correct conclusion, the effects of a misinterpretation can be amplified. Professionals typically avoid the temptation to be overly drawn in by a patient's story, but, given the desire and need to help, listening and attempting to understand is inevitable.
More context. When is it schizophrenia? When it is diagnosed by a licensed psychiatrist. Anywhere. Can other people correctly identify schizophrenia in an undiagnosed person? Logically, it's not impossible, but it's a moot point. What would you do with that opinion? If you suspect schizophrenia and manage to get your friend to a psychiatrist who then promptly diagnoses; it's hats off to you, and please buy a lottery ticket. In another scenario, if you're thinking of helping a psychiatrist to identify schizophrenia in your friend, well, think again. Never mention what you think the condition might be, or even that it might be a condition. Just focus on relaying what you've observed and experienced. Be the Pygmy to the Amazon for a while. You may in fact be more coherently persuasive if you do silently bear the condition in mind, but remember that the experienced professional offers the best evaluation and outcome that is available.
Psychiatry and psychology offer the best available but we should probably also keep in mind that they have a chequered record. A present case in point is that, even though it's clear just how damaging schizophrenia is, still, in a philosophical moment, a psychiatrist will pronounce, "schizophrenia doesn't exist." One wonders whether, 60 years ago, this same psychiatrist would have been the one to destroy a life by summarily committing to an asylum the individual who had in some way displeased government or corporate bureaucracy. Both attitudes reflect dogma, and it's dogma that is most often medicine's Achilles' heel. But again, medical science offers the best that's available. There is no other, better choice.
Despite huge amounts of knowledge, science is not close to understanding how the brain and mind work in a comprehensive way, and Schizophrenia medications are still relatively primitive. However, they are a major factor in preventing the recurrence of psychosis and it's common that a patient suffers a relapse only when medication is removed or reduced. Even these medications are miraculous. At the same time, no one has fully recovered from schizophrenia as a predictable result of medication. The current drugs barely touch whatever are the underlying causes of the illness. It is not even well understood why a psychotic episode tends to have lasting, deleterious effects on the brain, but it appears it does.
Schizophrenia is not well understood and the efficacy of the drugs is the result of an oblique approach. Still, the medicines save, enhance and extend lives. They keep psychosis at bay and, in buying time, give the brain the opportunity to rewire, to grow new neurons and connections. Early, comprehensive treatment and management of first episode psychosis enhances outcome. As part of maintenance, new avenues are offered by therapies which attempt to specifically engage brain 'plasticity' through activities such as learning, exercise, music, and other mental and sensual stimulation. Social interaction is critical to building or rebuilding the self.
To end, there've been recent (2016/15), potentially major revelations in schizophrenia research. Science is gaining a foothold, but consensus and clinical impact are yet to come and the struggle may have a long way to run.
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