Why what we think we know about schizophrenia is wrong

80 点作者 jajag大约 6 年前

16 条评论

pygy_大约 6 年前

Treating DSM categories as if they were a single disease is completely misguided. The DSM describes syndromes, and ignores pathophysiology because we still have little to no idea of what happens in the brain (at least not enough to properly understand the relevant functional aspects).Genome-wide association studies have recently shown that schizophrenia was in fact several distinct diseases [0]. Their symptoms turn out to be mediated by the same drugs, to the extent that they makes the people who suffer from those ailments manageable.If your house suddenly becomes cold in the winter, putting on a jacket will help you feel better. You wouldn't infer from that that your furnace is down because of a clothing imbalance.[0] <a href="https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2014.14040435" rel="nofollow">https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2...</a>

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coleifer大约 6 年前

My youngest brother has schizophrenia, which started when he was 19. He just turned 31, and were it not for his family supporting and caring for him, I'm sure he would be homeless or worse. He's one of the most sensitive, gentle people I have ever known. My wife and others who have gotten to know him would agree.Although he's "stable", thanks to an injection every 3 weeks, he's not going to ever get better. In fact he continues to retreat further and further away from the world and life. Why don't you go to the bowling group, movie night, job placement, etc, I used to ask him (events organized by a local psych facility for their patients, etc). Those people are crazy, he said.It's a baffling disease. Besides his hallucinations and delusions, the defining feature seems to be that it resists treatment of any kind that would lead to what you and I would call a normal life.

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PaulHoule大约 6 年前

The diagnostic words that start with "schizo-" are a train wreck.Schizophrenia is characterized by hallucinations, delusions, thought disorder, catatonia, etc. You don't hear much about catatonia these days because it is cleared up by benzodiazepines reliably.Schizoid people have reduced emotional reactions compared to other people but they are in touch with reality.Schizoaffective disorder seems to pick a few symptoms from schizophrenia and bipolar but doesn't fit the criteria for either. You might think that sounds less severe but it can be devastating.The romanticization of schizophrenia of r.d. Liang, "one flew over the cuckoo's nest", szasz and others strikes me as particularly cruel when I see how it keeps people who are suffering from getting help.

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lisper大约 6 年前

About ten years ago I made a documentary film about homeless people. On my first day of shooting I had an encounter with a schizophrenic guy named Daniel, which I captured on film. I've put a clip of that encounter here:<a href="http://graceofgodmovie.com/superdanny.mp4" rel="nofollow">http://graceofgodmovie.com/superdanny.mp4</a>It's worth watching all the way through. The difference in his attitude when I stopped being afraid of him and started treating him like a human being instead of a threat is dramatic. I learned a lot about life that day.

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DanBC大约 6 年前

> It was during my own nursing training that the currently favoured term of “service user” gained traction, as it was deemed more neutral.Patients overwhelmingly prefer the term patient, and this holds true every time we ask them what they want to be called.Service user is a term imposed upon them by well-intentioned mental health professionals and academics who don't recognise their own power dynamic and who do a poor job of coproduction.> while the council of the Royal College of Psychiatrists recently recommitted to “patient”....after they asked people what their preferred term is.

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raybon大约 6 年前

Ah, where do I start. Two of my close relatives have schizophrenia, people whom I’ve known since they were born. They were both diagnosed around 19 and are now 29. In the last ten years we’ve tried many medications, hospitalizations, with little to no avail. I never understood the word curse when I was a kid. I read about it in stories and I had seen people curse each other. Living with schizophrenia is the definition of a curse. Lives wasted in an alternate reality. The lives of the care givers and family impacted terribly.

mindgam3大约 6 年前

> Importantly, what we call psychosis can also be a response to extreme stress or trauma. For many people it might best be understood as... a coping strategy gone awry or a form of storytelling carried out within the mind as a response to unbearable life events.This. The day that mental health professionals realize this is the day that we start improving outcomes.> there is no uncontroversial language when talking about mental illness – and that includes the phrase “mental illness”Glad the author brought up this important point. “Illness” is bogus because it implies disease/biomarkers for which there is no evidence as the article states.A more useful term would be “mental injury” as it frames the symptoms as a result of trauma. But I think the best term is simply “trauma” or “developmental trauma” when it goes back to childhood.

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hindsightbias大约 6 年前

Well, this article didn’t lead to any answers or any insight for me. The whole unexplained opening of poisoning is cryptic and unhelpful. Does this nurse see the nuclear options as poison or was this doctor trying to give Amit cyanide? Who knows.I’ve spent a month of evenings at Langley-Porter and then again at Zuckerberg, and the staff there didn’t strike me psychzombies. The last thing they wanted to do was to commit to a diagnosis of schizophrenia for my relative. I sat for an hour with the Attending on his outtake and she did everything to assure us that in her expert opinion it wasn’t black and white - drugs were part of the toolset and not The One Answer.What’s wrong isn’t that people are ignorant. They always have been and always will be. Until you’ve been there, you won’t get it.What’s wrong is we have brilliant people who are hamstrung by process. At SFGH it’s “If you aren’t a threat, you’re out” 7 days after the 72 hour lockdown. It’s a factory, because that’s all the runway WE give them.We’re lucky. We’re wealthy enough and there’s enough of us that we can probably make this work.But the other 90% in those wards? They don’t have anybody. So unless WE want to fund that level of intervention/compassion, the factory and pharmacology is the solution.

isnetea大约 6 年前

I’ve often wondered if it’s possible to induce psychosis and symptoms of schizophrenia in a subject via environmental conditioning. This seems practical to test these days, given the expanse of information possessed by large tech companies, and their lack of regulation. Perhaps this would be related research for a larger automated behavior control initiative. Does anyone have any pertinent references or info?

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squirrel大约 6 年前

I find Xavier Amador very engaging and convincing on how to actually help schizophrenic people who say "I'm not sick, I don't need medicine": <a href="https://www.youtube.com/watch?v=Lstn6WNnCRc" rel="nofollow">https://www.youtube.com/watch?v=Lstn6WNnCRc</a>

HeadsUpHigh大约 6 年前

DSM and other such systems(icd for example) are for CLINICAL use. I.e. they are not academic. If 2 different mechanisms create the same symptoms and are treated by the same drugs then from a clinical aide of view separating them is pointless. Academic research on the mechanics of diseases is much more nuanced than what an article on a news site can cover. Once something is clearly separated as 2 different entities in a clinically meaningful way via research then the classification system will be updated. What this means is that if e.g. we find a way to differentiate between 2 different mechanisms for schizophrenia with each of the responding better to a different drug( even if those are already existing drugs, it gives us a shortcut to choosing the right medication without trial and error) then DSM will split schizophrenia to schizo due to x and schizo due to y with further guidelines for medication. Or split them into 2 different things entirely.

tomohawk大约 6 年前

Schizophrenia can run in families. A family we knew was killed in the middle of the night by their step son with a hammer. Apparently, the disease can have a sudden onset. The mother and step father were teachers, and the whole community was affected. The son (teenager at the time) was diagnosed and has been held in a facility now for many years. The biological father has been in and out of institutions and homeless.Such a terrible disease.

tcj_phx大约 6 年前

Most of the supposed "mental-health conditions" are manifestations of stress. There are two kinds of stress: biological and emotional.Biological stress is related to things like being malnourished and/or having hormonal imbalances (thyroid, cortisol, progesterone, etc), not getting enough sunlight (no red light -> winter sickness / UV light-> Vitamin D), etc. Biological stress is worsened when a person is medicated with patent medicines that are approved for treating behavioral symptoms by implementing wrong-theory about the cause of the behavioral symptom (i.e., inadequate serotonin -> depression [0], excess dopamine -> psychosis, etc).Some scientists rediscovered a few years ago that the behavioral symptom of "psychosis" is strongly associated with an inability to make adequate amounts of the stress hormone cortisol [1].Emotional stress has to do with people feeling trapped. From the article: "Importantly, what we call psychosis can also be a response to extreme stress or trauma."Emotional stress leads to the release of cortisol too. If a person's long-term emotional stress exceeds their ability to compensate, their "mental health" will suffer.One part of this article is about forcibly medicating people whom the professionals think don't realize they need the pills they're prescribed. IMHO, it is an act of violence to force a person to take pills that make them suicidal [2]. The legal systems generally recognize that people have a choice in medical treatments, but struggles with patients who don't even realize they have a problem [3], and/or don't like the treatments the professionals think they need. In the US the courts have decided that people can't be "helped" against their will without a court order. This is why Jared Loughner, the man who shot up Congresswoman Gifford's event, couldn't be helped, even though the people around him noticed that his behavior had changed [4].The professionals tried to label my girlfriend as "schizophrenic". Really she was just stressed ("lonely"), and was suffering from the adverse effects of various medical interventions. Methadone causes sugar cravings; she'd taken to treating this medication-induced metabolic problem with alcohol a few days before we'd met (alcohol has 7 calories/gram, while sugar only has 4 calories/gram).In my initial assessment she also reported being injected with a prescription endocrine disruptor maybe 10 years before [5]. This prescription drug has warnings about endocrine disruption [6], but doctors don't appreciate their patients' iatrogenic deterioration when it's associated with this defective drug.My girlfriend became psychotic when she ran out of alcohol , but rather than treating her for the cause [7] they treat her for the symptom with "anti-psychotics". I consider her involuntary treatment program to be "medical assault". I found a lawyer a while back who was familiar with how the state's involuntary treatment system works, but lawyers are expensive, so I tried to go at it myself. Maybe the legal guild didn't take kindly to a legal-nobody pointing out that their system is ugly.I guess I'm going to hire the lawyer.tl/dr: The conventional practices of the mental health industry are wrong. Institutional inertia prevents the profession from fixing itself. Little bits of progress have been made in recognizing the system's contribution to the patient's problems. As I said before, the system needs a re-write: <a href="https://news.ycombinator.com/item?id=19545964" rel="nofollow">https://news.ycombinator.com/item?id=19545964</a>[0] What has serotonin to do with depression? - <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471964/" rel="nofollow">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471964/</a>[1] <a href="https://psychcentral.com/news/2016/06/04/low-morning-cortisol-levels-linked-to-psychosis/104266.html" rel="nofollow">https://psychcentral.com/news/2016/06/04/low-morning-cortiso...</a>[2] <a href="https://en.wikipedia.org/wiki/Akathisia#Drug-induced" rel="nofollow">https://en.wikipedia.org/wiki/Akathisia#Drug-induced</a>[3] Anosognosia - <a href="https://en.wikipedia.org/wiki/Anosognosia" rel="nofollow">https://en.wikipedia.org/wiki/Anosognosia</a>[4] Jared Loughner - <a href="https://en.wikipedia.org/wiki/Jared_Lee_Loughner#Behavior_change" rel="nofollow">https://en.wikipedia.org/wiki/Jared_Lee_Loughner#Behavior_ch...</a> "In the months leading up to the shooting, Loughner's parents became increasingly alarmed at their son's behavior, at one point resorting to disabling his car every night in order to keep him at home."[5] <a href="https://en.wikipedia.org/wiki/Depo-Provera" rel="nofollow">https://en.wikipedia.org/wiki/Depo-Provera</a>[6] "Effects on the Hypothalmic-Pituitary-Adrenal Axis: Some patients receiving medroxyprogesterone acetate may exhibit suppressed adrenal function. Medroxyprogesterone acetate may have cortisol-like glucocorticoid activity and provide negative feedback to the hypothalamus or pituitary. This may result in decreased plasma cortisol levels, decreased cortisol secretion, and low plasma ACTH levels.The use of DEPO-PROVERA Sterile Aqueous Suspension may, due to its cortisol-like glucocorticoid activity, also produce Cushingoid symptoms such as weight gain, edema/fluid retention, and facial swelling." - <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/012541s086lbl.pdf" rel="nofollow">https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/01...</a>[7] <a href="https://en.wikipedia.org/wiki/Substance-induced_psychosis#Substances" rel="nofollow">https://en.wikipedia.org/wiki/Substance-induced_psychosis#Su...</a> - "Alcohol is a common cause of psychotic disorders or episodes, which may occur through acute intoxication, chronic alcoholism, withdrawal, exacerbation of existing disorders, or acute idiosyncratic reactions. Research has shown that alcohol abuse causes an 8-fold increased risk of psychotic disorders in men and a 3 fold increased risk of psychotic disorders in women. While the vast majority of cases are acute and resolve fairly quickly upon treatment and/or abstinence, they can occasionally become chronic and persistent. Alcoholic psychosis is sometimes misdiagnosed as another mental illness such as schizophrenia." (emphasis added)(edit: added reference [7])

yosys大约 6 年前

I dislike psychiatry grossly because the victims of the field are not compensated by how the errors destroy the victim's life.I'm a person who was medicated with the older & new generation of antipsychotics for two years of my early 20s because I was suffering religious conversion therapy "best I can describe it" from family and where I was in circumstances any other person would have great amounts of stress. The outcome of unfortunate events made me with a doctor who disliked me for desiring to be a woman (I was born a male) and attempted to convince me it's delusions & hallucinations; when I attempted to communicate I never suffered from either. The medication would result in me doubting myself but I eventually broke away from it all. It was impossible to find anyone to help sue for the tremendous pain (I still suffer to this day from it all) and it's been many years since it all happened.Anyway I deeply believe there should be a special hell for people who go into this field but I doubt anyone had any will in the outcome for me being any different because I've read philosophy on determinism since then. I think the field has done more damage than good and is a net negative with getting away with it all because of government allowing it. People prefer to believe something is good and when it really isn't.

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soup10大约 6 年前

Most mental health workers know that the popular conceptions about what schizophrenia is and how its managed are wrong.

qrbLPHiKpiux大约 6 年前

Much, if not all, of mental health is based on theories and assumptions.""It's thought that..." when referring to how medications work.Let's just agree that we all know nothing about mental health.

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