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Insulin Shock Therapy December 3, 2012

Posted by Crazy Mermaid in Medication, Mental Hospital, Schizophrenia.
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In a desperate attempt to find a cure for mental illness in the early part of the last century, barbaric treatments were invented. Insulin shock therapy was one such treatment.

In insulin shock therapy, a patient was put into an insulin coma six days a week for months on end in an attempt to “cure” schizophrenia by “resetting” the brain. Occasionally that seventh day was filled with electro-shock therapy. Sometimes this “treatment” went on for years.

Insulin shock therapy was started by psychiatrist Manfred Sakel in 1927 when he began to use low (sub-coma) doses of insulin to treat drug addicts and psychopaths in Berlin. Interpreting his results as successful, he got the idea of “resetting” the brains of schizophrenics using the same therapy. News of his work spread, and this treatment was picked up by mental hospitals worldwide.

After being injected by insulin, patients experienced various symptoms including flushing, pallor, perspiration, salivation, drowsiness, or restlessness before falling into a coma. Each coma lasted for up to an hour and was terminated by intravenous glucose. Seizures sometimes occurred before or during the coma, and these were viewed as positive events.  Only the healthiest patients were chosen for the treatment, since it was so hard on their bodies. Broken bones were common.

For years, this “therapy” was performed on the mentally ill, including John Forbes Nash, the brilliant mathematician whose life story is told in A Beautiful Mind by Sylvia Nasar. The book goes into a little detail about his treatment.

Insulin shock therapy started to fall in disfavor when Harold Bourne, a British psychiatrist, published a paper entitled “the insulin myth” in Lancet in 1953, in which he debunked the therapy.  Then, in 1957, Lancet published the results of an experiment whereby insulin shock treatment was shown to be an ineffective treatment for schizophrenia.  Over the years, it slowly began to fall into disfavor, and is now thought of as barbaric.

It is relatively easy to see why insulin shock therapy was quickly adopted by the mental health community.  Up to that point, there was no other treatment available. Anything that had a remote possibility of working was greeted with open arms, and the “science” behind the treatment made perfect sense. “Resetting” the brain would result in curing the illness, they reasoned.

Eventually, science caught up with insulin shock therapy, and the medical community was forced to abandon this treatment, but not before much pain and suffering occurred.

In the future, it will be interesting to see which of our current therapies are viewed as barbaric as insulin shock therapy and lobotomies are viewed today.

Here We Go Again: Reducing Mental Hospital Beds August 19, 2012

Posted by Crazy Mermaid in Delusions, Mental Hospital, mental illness, Schizophrenia, Uncategorized.
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1 comment so far

Here we go again: more psychiatric hospital beds are disappearing in Washington State.  How do I know?  Not from anything in the news.  It’s because I got a phone call from a 75 year old woman whose 54 year old schizophrenic son is being released from Western State Hospital.  She called because she was desperate to find housing and help for her son before he is released, which will be soon.  She explained that she is an old lady and can barely care for herself, much less her son, who has been at Western for many years.

At Western, he has case managers and people who make sure he takes his medication as well as  living support.  He never learned how to shop or care for himself because his symptoms were so severe that they required him to be permanently hospitalized.  I’m guessing that  even with proper medication, he isn’t symptom-free or he would have been released years ago.  Even with proper medication, delusions and hearing voices is fairly common in hard-to-treat cases like his. Once out of that protective environment of the hospital, she is concerned that when he stops taking his medication, his symptoms will increase and he will become unmanageable. She is looking for housing for him that will also provide help in adjusting to life on the outside.  And she doesn’t have much time.

This situation is tragic.  They’re taking a man who has spent most of his life in an institution getting the help and support he needs in order to function, and throwing him outside to fend for himself.  Had there been any adjustment support for him, she wouldn’t be so desperate.  Programs like those he needs are overfull.  He won’t be able to get into those programs for years because they’re at or over capacity right now.  And with the State releasing more people like this man, more people will fall through the cracks.  The State hasn’t funded stop-gap programs for people like him.  There simply isn’t anywhere he can go.  Who knows what will ultimately happen to this man?

Although I understand the need to balance the State budget, balancing it on the backs of the more vulnerable population is unconscionable.

Contrary to popular opinion, 99.9 percent of people housed in institutions like this aren’t dangerous when released.  So we shouldn’t be afraid of him. In fact, statistically they are the ones who are more likely to be assaulted  and victimized  because they’re not equipped to survive outside their institution.  Turning a man out who has been taken care of most of his life will not make his quality of life improve.  In fact, the type of living situation that he was in had allowed him to have his “home base” at the hospital, able to freely come and go at will.  The point of the hospitalization was to keep him taking his medication allowing him to live with and manage his schizophrenic symptoms.  If he is left to his own devices at this late stage of his life, he will likely discontinue taking his medication, which will mean the symptoms of his illness, barely contained anyway, will return in a big way. I’m not saying he will be a danger to others.  I’m just saying that hearing voices and other negative symptoms will likely return in a big way without proper medication and supervision.  Clearly, his case must be particularly difficult because had he had an “easy” case, he would have been released years ago. He’s there because that’s where he needs to be.

His institutionalization is very different from involuntary commitment, so his release shouldn’t scare anyone from the standpoint of him being a threat.  Far from it.  He is allowed to come and go at will, but his base is always at Western State Hospital.  He goes on outings and to visit his parents, but he never stays there for any length of time.  He always has to return to Western so they can give him the care he needs.  He hasn’t gone grocery shopping or done the dishes or any number of things we are all used to doing in order to survive.  If left to his own devices without any education in performing these relatively easy tasks, he will risk his well-being to the point of being dangerous.  Just turning him loose out into the world will be a hardship.  His 75 year old mother won’t be much help, and because of his symptoms he can’t live with her- especially once he’s off his medication.

They say the mark of a civilization isn’t how they treat their rich.  It’s how they treat their poor and vulnerable population.  And from the way this gentleman is about to be treated, it’s clear that we’re not exactly the best civilization in the world.


ADHD Is A Mental Illness September 21, 2011

Posted by Crazy Mermaid in Depression, mental illness.
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It’s amazing how many people split hairs when it comes to having a mental illness.  Take the cases of Attention Deficit Hyperactivity Disorder (ADHD) and depression, for example.

Although the National Institute for Mental Health considers ADHD to be a mental illness, few parents would put it in the same category as schizophrenia or bipolar disorder- what they perceive to be “real” mental illnesses. But that’s where it belongs.

I know that when my elementary aged child received the diagnosis of ADHD a number of years ago, I didn’t put that illness in the same category as a mental illness, and neither did my son’s doctor. That thought was the furthest from my mind. Had I identified ADD as a mental illness, things would have been different.

I wouldn’t have been so forthcoming about his illness, since the shame and stigma of a mental illness would automatically follow my son’s new identity as a mentally ill child.   I would have vehemently disagreed with anyone who tried to tell me that my child’s brain chemistry problem shared many of the same characteristics as schizophrenia and bipolar disorder.  Hell, I hadn’t even heard of bipolar disorder back then, and schizophrenia to me was a scary, violent disease that people needed to be locked up for.  That was my perception of reality back then.

I have since met parents whose children have been diagnosed with schizophrenia, and I realize the fallacy of my previous assumptions.  And then there’s the new reality that bipolar disorder is in fact diagnosable in children, contrary to what people perceived even ten years ago.  In fact, scientists are now learning that many cases of  bipolar disorder have been misdiagnosed as ADHD.

Things are not so black and white any more.  There’s a lot of gray in the world of mental illnesses.

According to the National Institute for Mental Health, somewhere between 3% to 8% of children suffer from ADHD.  About 1% of the population suffers from schizophrenia. Bipolar disorder occurs in about 4% of the population.  And about 8% of people suffer from major depression in any given year.

That’s a lot of people with mental illnesses.

Splitting hairs, separating depression and ADHD from “real” mental illnesses, has done no favors to those suffering from all mental illnesses.  Were the umbrella reflective of real statistics, there would be much more money and energy available for studying more mental illnesses. It is difficult to sweep 20% of all people into the “mentally ill” category and not change people’s perception of mental illness. Let’s expand our minds to include mental illnesses like ADHD and depression in the category of “real” mental illnesses.  It would make the world a much better place.

Note: Sarah sent an interesting article regarding the over-prescription of ADHD medication at  http://www.psychiatrictimes.com/adhd

Schizophrenogenic Mothers and Mental Illness March 13, 2011

Posted by Crazy Mermaid in mental illness, Schizophrenia.
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In reading a mainstream article in a mainstream publication about Eleanor Owen, the founder of Washington State’s National Alliance on Mental Illness (NAMI), I  was shocked that mental illness, especially schizophrenia, had come out of the closet enough to warrant front page news on a Sunday morning. The article made reference to a term that I had heard once before. Schizophrenogenic mother was, according to a March 13, 2011 article in Pacific Northwest Magazine, a title that Eleanor Owen was tagged with back in the late 1960’s. What, I wondered, was a schizophrenogenic mother?

It turns out that  “schizophrenogenic mother” was the term given to the mother of a schizophrenic. It meant “a woman who was blamed by psychiatrists for her child’s schizophrenia”. Viewed as the cause of her offspring’s illness, she was blamed because of her poor parenting skills for her child’s terrible affliction. In fact, up until the late 1970’s this was mainstream thought in the world of psychiatry. How did this come to be?

In the early 1950’s, a man named Dr. Theodore Lidz wrote a book called Schizophrenia and the Family. In that book, he expounded his theory that schizophrenogenic mothers were responsible for their child’s affliction. They were, the theory went, too self-absorbed and dominating, and the result of their behavior was that their child became schizophrenic. Other psychiatrists jumped on the bandwagon, and the theory took on a life of its own.

This theory was the dominating one from the mid-1950’s through the late 1970’s. In fact, even as he lay on his deathbed in 2001, Dr. Lidz continued to maintain that psychiatry was going in the wrong direction by focusing on medication rather than psychotherapy in the treatment of this disorder.

The results this mainstream thought that the mothers were the problem was threefold.

First of all, the parents of schizophrenics had a tremendous quantity of guilt added to their already heavy burden of dealing with their child’s symptoms.  Rather than obtain the support of their friends and families as they went through the trying times of dealing with the symptoms of the illness, the parents, especially the mothers, became social pariahs.

Additionally, it goes without saying that if the child’s childhood was causing the illness, then the solution was to remove the child from the household so that he could “heal”. Instead of getting the needed psychological support of their parents, these children were taken away from them. It goes without saying that the emotional damage done to those children was enormous.

Lastly, research money for schizophrenia dried up. Why bother looking for answers that you already have?

Fortunately for the rest of us, a few of these “schizophrenogenic” parents banded together, convinced that psychiatry had it wrong. As the band of parents got larger and larger, they formed a formal group, dedicated to getting a better understanding of mental illnesses. In Washington State, Washington Advocates for the Mentally Ill was born, with the help of Eleanor Owen. Eventually this group would change its name and team up with others across the country. You might know this group as National Alliance on Mental Illness (NAMI).

Partly as a result of the efforts of this group, in the late 1970’s  it became fashionable once again to actually search for answers. What was the cause of schizophrenia? Why did it appear to run in families? What are effective treatments of the symptoms of the illness?  Can there ever be a cure for it? Money and effort was expended to help answer these questions and more.

The result is that almost everyone in the world now believes that schizophrenia is a brain chemistry disorder rather than a sign of a broken childhood. Parents are once again free to give comfort to their ill children. They’re not social pariahs any more. They aren’t blamed for their child’s illness. And drugs have been found to help relieve many if not most of the symptoms of the illness. People who were once relegated to a life of horrible symptoms are now able to live a worthwhile life.

Thank you, NAMI, and thank you, Eleanor Owen.

(Note: This story is documented in the PBS documentary When Medicine Got It Wrong)

I’m Not Crazy February 11, 2011

Posted by Crazy Mermaid in mental illness, Schizophrenia.
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Many people sing the words of songs without considering what they really mean.  Had people stopped to consider the lyrics of certain popular songs about mental illness, I doubt the songs would have made it onto the pop charts.  One such song that slipped between the cracks was by Matchbox 20, called I’m Not Crazy.  When you really listen to the words, you realize that the song is about a paranoid schizophrenic going through a psychotic episode.

While I was going through my psychotic break, I latched onto the song, singing along to it with my imaginary friends to and from work.  Although I didn’t consciously consider the possibility that I was crazy, my subconscious must have entertained that thought, because it became my favorite song.  I didn’t realize the true meaning of that song until after my psychotic break. I was stunned when I first truly listened to the lyrics.

Here, then, are the words:

I’m Not Crazy I’m Just A Little Unwell
I Know Right Know You Can’t Tell
But Stay Awhile And Maybe You’ll See
A Different Side Of Me
I’m Not Crazy I’m Just A Little Impaired
I Know Right Now You Don’t Care
But Soon Enough You’re Gonna Think Of Me
And How I Used To Be…Me

Talking To Myself In Public
And Dodging Glances On The Train
And I Know…I Know They’ve All Been Talking About Me
I Can hear Them Whisper
And It Makes Me Think There Must Be Something Wrong With Me

Out Of All The Hours Thinking
Some How I’ve Lost My Mind

I’m Not Crazy I’m Just A Little Unwell
I Know Right Now You Can’t Tell
But Stay Awhile And Maybe Then You’ll See
A Different Side Of Me

I’ve Been Talking In My Sleep
And Soon They’ll Come To Get Me
And They’re Taking Me Away

[ From: http://www.metrolyrics.com/im-not-crazy-lyrics-matchbox-20.html ]

Paranoid Schizophrenia: Worst Disease in the World October 21, 2010

Posted by Crazy Mermaid in mental illness, Psychotic, Schizophrenia.
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Paranoid schizophrenia is the absolute worst disease known to man, bar none.  It reduces its target to a mass of terror about the world around him. Loved ones become enemies. Everyone becomes enemies. And if it’s not caught in time (which is most of the time), there is nothing to be done for the person with the illness.

Combined with severe paranoia about the world around him, convinced that his delusions and hallucinations are real, the paranoid schizophrenic’s life is a living Hell.  Unable to see that he is ill because of one of the symptoms of the illness (anosognosia), he is trapped forever in that horrible world.

Yet another paranoid schizophrenic young man has committed a crime because of this illness, and nothing can be done about it.  Joshua Rockwell, a young man of 25, has been accused of armed robbery at Alderwood Mall in Lynnwood, Washington. http://www.heraldnet.com/article/20101021/NEWS01/710219819/1122. But it’s not what you think.

It is logical to assume that the young man robbed a store.  But that wasn’t the case.  He approached  a couple in their late 70’s who were celebrating their wedding anniversary. Holding a knife to the husband’s stomach, he ran away with the woman’s purse. He has spent the months since that incident in  jail, as his family hopes that he will get treatment for his illness.  No luck so far.

I’m sure his robbery was a direct result of his belief that he was being terrorized by the bad guys. I know because a similar incident happened to me as I slipped further into my psychosis.

During the tail end of my psychotic break with reality, I came to believe that there were zombies after me, ready to kill me in order to take over my body. My fear of them taking over my body eventually became so great that I decided to go to the local hospital emergency room, where I thought I would be safe from them.

Once at the hospital, I changed my mind about wanting to be there, convinced by the voices in my head that there was a conspiracy going on to imprison me there.  The fact that they refused to allow me to leave the hospital led fuel to the fire. Then, after I took off my clothes and refused to put on a blanket or robe, I was brought into a private (locked) room, where I did my best to get released by throwing furniture up against a door in an effort to break its glass window so I could leave. I threw the furniture on the advice of my attorney, one of the many voices in my head.  He told me the hospital couldn’t legally hold me, and that I needed to throw furniture in order to make them let me out.  Of course my plan didn’t work so well. At that point, I had unknowingly demonstrated that I was a danger to myself and others, and crossed that threshold into the land of involuntary commitment.

As I sat there in that locked  hospital room, waiting for God knows what to happen to me, I “realized” that I was being irradiated so that Haliburton could make a bomb out of my body. I feared for my life, sure that I was doomed,  illegally locked in a room and unable to do anything about it.  It was frustrating and horrible.

While I only experienced that paranoia for a short while, I can relate to those poor souls who experience this fear as part of their daily routine. What an awful existence, living in terror that someone is out to get you, to murder you, to steal your soul. And knowing that nobody will believe it, or, even worse, that they are part of the conspiracy, wears on you. You can’t sleep, you can’t believe what anyone says, and if you tell anyone what is going on, they accuse you of being sick. And then they want to medicate you.

You realize, only too well, that a medicated you, wrapped in a chemical straight-jacket, is an easy target for those wanting to hurt you. So you do the obvious thing:  try to avoid medication at all costs.  And those who want to medicate you have just exposed themselves as your enemy, no matter who they are or what they say to try to convince you otherwise. You’re in an unwinnable situation, about to undergo a more terrible situation that the one you’re in if you once cave in to them. So you fight with all your might.  You fight for your life. For your very soul.  And the more you fight, the more they try to put you into a straight-jacket, either physically or mentally.  It’s a fight that wears on you through the months and years, alienating you from your environment.

And you see evidence of your belief that everyone is out to get you everywhere you look.  In my case, I actually saw zombie people, including young children and babies, pass me as I walked towards my beloved swimming pool at the YMCA. Their existence was proof positive that they were the enemy, waiting to grab me and turn me into one of them at their first opportunity.

That fear and terror was a horrible thing to live through, and if it weren’t for my involuntary commitment, and subsequent mandatory medication, I would still be living in that world where everything engenders fear.  I was one of the lucky ones who was released from that world, with the help of legally mandated medication.  I lived to tell my story, in the hope that with understanding there will come treatment for what I consider to be the worst disease in the world.

Which Medical Condition Is the Worst? July 15, 2010

Posted by Crazy Mermaid in Hearing Voices, Insanity, mental illness, Psychotic, Schizophrenia.
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If you had to guess which medical condition was the worst, which one would you pick?

Most people’s thoughts would go immediately to the most widely publicized, the disease advertised as the most painful and deadliest of all diseases: cancer.  With pancreatic cancer, the victim suffers prolonged agony, relieved only by colossal injections of pain medication, until finally he expires, leaving his cancer-ridden body once and for all.  The worst possible disease, some would say.

Many would choose Alzheimer’s disease as the worst disease.  Your mind slowly loses memory, forgetting things and people and places. Eventually, your heart “forgets” to beat, and you pass on, leaving a wake of pain and suffering by your loved ones.  Because you generally become less aware of your surroundings as time goes by, and because the deterioration happens over years or even decades, the pain and suffering are felt more by your family and friends than you.

Some would say that Lou Gherig’s Disease, also known as ALS, is the worst. Like Alzheimer’s, your body slowly forgets to function, but unlike Alzheimer’s, your mind works perfectly.  The result is a little like waking up in the middle of a surgery, and being unable to communicate to the staff that you are awake. Your body is paralyzed, but your brain is wide awake. Thankfully (or not), death is generally relatively quickly.

Others would say that a stroke is the worst, for reasons similar to ALS. Your mind is generally awake, but your body is unable to communicate that awareness to the world at large. Thinking that your brain has turned to mush because you undergo the humility of wearing diapers and eating baby food,  your family may treat you like you’re a piece of furniture, or as if you’re an infant. Unable to communicate your complete awareness to them, you suffer for years or even decades in silence.

As the worst possible disease, mental illness isn’t even on most people’s radar. But consider, for a moment, the facts.

One of the problems is that unlike cancer, mental illness has a lousy public relations campaign. It doesn’t have a public personality attached to it- at least nobody positive. There’s no Lou Gherig or Lance Armstrong or Stephen Hawking to bring a sense of empathy to the masses. Unlike breast cancer, hundreds of millions of dollars aren’t spent on events to publicize mental illness- events like the Susan G. Komen Walk for the Cure – where the color pink has come to symbolize breast cancer in everything from headbands to hand mixers. Unlike Lance Armstrong’s Livestrong cancer campaign, where yellow bracelets signify triumph over cancer, there is no public campaign for the little plastic bracelet color for mental illness awareness (silver). In fact, because of its enormous stigma, you would be hard-pressed to find many victims and family members willing to take the spotlight for mental illness.

Everyone recognizes that the term “cancer” is a blanket term for a multitude of illnesses all sharing the same basic characteristic: improper cell division. Unlike cancer, the general public doesn’t perceive mental illness as a blanket name for illnesses caused by improper brain chemistry. Both are breakdowns of normal bodily functions, yet cancer doesn’t have the reputation of being a character flaw or a sign of moral bankruptcy that mental illness does.

Patients with cancer are not embarrassed to tell their friends and family their diagnosis. They aren’t afraid of being thought less of as a person for that diagnosis, that somehow they fell short. But with mental illness, the stigma is so great that the fear of rejection and isolation is a legitimate concern.  You just don’t tell anyone.

Because their loved one’s illness isn’t associated with moral bankruptcy and character flaws, friends and relatives of cancer victims don’t have the same incentives to keep anyone from knowing their loved one has cancer. Protecting themselves from the unspoken charge of moral bankruptcy by association isn’t a top concern of the families of cancer patients.

Other diseases, like cancer or ALS or a stroke, don’t cause its victims to commit heinous crimes.  You don’t see a breast cancer victim as the lead-in story on the nightly news because she murdered a bunch of school children. You don’t hear about a stroke victim trying to assassinate the President. A lung cancer victim doesn’t jump off a bridge to get away from the voices in his head. And yet the connection between these types of actions and mental illness, if the news media even bothers to make one, is voyeuristic rather than sympathetic.

People with cancer or ALS or all of the other diseases are aware that they are ill and need treatment for that illness.  In many mental illness cases, this is not true. The mentally ill patient, in many cases, has no insight into the fact that he is mentally ill and need treatment.

No legitimate insurance company would dare decline to authorize or pay  for mainstream treatment of a cancer victim, but most insurance companies have little or no such coverage for mainstream treatment of mental illness, reasoning that it isn’t, after all, a real physical illness. If they do cover it, it’s under a separate policy from “physical” health, called “Behavioral Mental Health”, and the payment for treatment and disability from the disease is very limited.  We don’t see major insurance companies splitting off cancer from a list of diseases, calling it “Cell Divisional Health”, severely restricting its access, and farming out its administration to an entirely separate company.

When it comes time for hospitalization, there isn’t a question of whether a cancer victim or stroke victim even needs to go to a hospital. If they’re seriously ill, a cancer patient doesn’t have to be at death’s door before he’s admitted to the hospital. But a mentally ill victim has to either be about to hurt or kill himself or others (as determined by a third party) or needs to have tried (and failed) to kill himself before a mental hospital will consider admitting him.

If they’re hemorrhaging, but not near death, a cancer patient isn’t turned away for lack of space. Cancer patients don’t have to wait until there’s room for them at a hospital. Unlike hospital space for the mentally ill, hospital space for cancer victims hasn’t decreased over the past 20 years.

Alzheimer’s patients aren’t routinely discharged from hospitals onto the streets, left to fend for themselves. Cancer patients aren’t routinely discharged before they are stabilized. And yet the mentally ill are routinely discharged out onto the streets while they are still unwell all of the time. Who do you think the homeless people are?

The cancer patient doesn’t have to give up his civil rights in order to be treated. He can leave the hospital whenever he wants to. But in order for a mentally ill patient to be treated, he has to give up his civil rights. Mental patients are locked in, physically unable to leave the hospital until someone else- the attending psychiatrist- says they can go- however long that takes.

Once in a hospital, a cancer patient has the option to discontinue medication at any time. Again, a cancer patient doesn’t have to give up his civil rights in order to be treated.  Mentally ill patients, on the other hand, must leave their civil rights at the door when they enter a mental hospital. Whether they want to or not, they are forced to continue medication while they are hospitalized. That is the treatment.

Comparing the physical pain of the cancer or the effects of cancer treatment with the effects of mental illness is in some ways like comparing apples to oranges.  Whereas the cancer victim fights for her life, the severely depressed victim fights to kill herself.  Is the physical pain of cancer worse than the emotional pain of continually hearing voices in your head nonstop? Is radiation sickness worse than lithium side effects?  Is prostate cancer preferable to schizophrenia?

I’m not trying in any way to minimize the pain and suffering that these diseases engender. My point is that each of these diseases –all of them- including mental illness-engenders tremendous pain and suffering. None of them- including mental illness- is any less severe than any other.

For too long, mental illness has been a quiet disease. Quietly terrible, but still quiet.  This is a disease- or a family of diseases- on par with cancer and ALS and strokes, and yet there is a huge vacuum out there. Nobody even thinks about mental illness as a true physical disease. It’s not even on the radar. This needs to change. We need to raise people’s consciousness about mental illness, and give it the parity it deserves.  We’ll know we’ve done our job when “mental illness” takes its rightful place on the list of Terrible Diseases in the public consciousness.

Anosognosia Symptom: Lack of Insight into Mental Illness June 22, 2010

Posted by Crazy Mermaid in Bipolar Disorder, Involuntary Committment, mental illness, Schizophrenia.
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It’s a crying shame that I had never even heard of the term ansognosia until I read Dr. E. Fuller Torrey’s latest book, The Insanity Offense (2008), since it’s such an integral part of understanding how the symptoms of mental illness interfere with a person’s ability to get help.

The term anosognosia is derived from the Greek words “nosos” which means disease and the word “gnosis” which means knowledge. The “an” prefix notates the negative.  A person who suffers from anosognosia is unaware of the existence of their mental illness.

This lack of insight into their illness, associated with damage to the right hemisphere of the cerebral cortex or the frontal lobe,  is a problem of major proportions because it’s the main reason why people with certain mental illnesses such as schizophrenia and bipolar disorder refuse to take their medications.   They aren’t trying to be a pain in the ass: they truly believe that they’re not ill.  And if they’re not ill, there’s no reason to take medication. Period. End of Story.

If a patient can be made to take their medication, a large percentage of them will improve their awareness of their mental illness and thus continue taking their medication on their own.  But under the current laws, forcing a patient to take necessary medication is illegal, in a large part because the law refuses to take into account anosognosia in making decisions regarding who should be forced to take medication and who should not.

It’s not easy to convey to the average person what it means to be unaware that you have an illness. How can someone who is sick not know it, especially when their symptoms are so obvious to others? Because it’s not like any other illness. It’s the brain, rather than other parts of the body, that is the problem.

In the case of the paranoid schizophrenic, there is another layer of difficulty to add to the equation. The paranoid schizophrenic lives in a world where the universe is out to get him.  So he views any attempt to get him help as simply another attempt at persecution.  He distrusts anyone who tries to get him help. It’s a magnification of anosognosia.

Unfortunately, treatment of a patient whose symptoms include anosognosia is impossible, since treatment for an illness requires admission that there is in fact an illness and cooperation by the patient in treatment of that illness. The law of the land is written around the concept that a person is capable of deciding whether or not he is ill, and therefore whether or not treatment for that illness is appropriate. The law, in other words, has never heard of the symptom called anosognosia, which makes it impossible for the patient to believe that he is mentally ill, and therefore makes it impossible for him to believe that he needs treatment. The result of this failure of the law to consider this singular symptom is that the patient goes about his business believing that he is not ill, living in his own world. How is this a problem?

Instead of being able to treat those people whose symptoms include anosognosia, families of people with mental illness live in fear of their  loved ones, aware they’re living with a ticking time bomb. They know it’s only a matter of time before their loved one hurts or kills someone, but they’re unable to prevent the atrocity from happening because the law ties their hands.

Prisons are full of people with anosognosia who commit crimes- sometimes horrendous crimes. Had they been forced to seek treatment for their mental illness, they might have lived full and productive lives. Instead, they fill our prisons, unmedicated, costing taxpayers tens of thousands of dollars a year. Or they murder police officers or random people before being apprehended and found to be not guilty by reason of insanity, then locked up in mental hospitals.

The streets of every major city in the United States are full of people with anosognosia who refuse to believe they have a mental illness. Instead of being forced to get treatment, they wander the streets, victims of crime, living off the streets, eating out of dumpsters, and living a horrible life simply because they cannot believe they are in need of medical help.

We have to change our laws, taking into consideration this terrible symptom.  We have to make it easier to involuntarily commit those with this symptom, thus improving the quality of life of those with anosognosia and making the world a much safer place for all of us.

(Note: Research for this article was done with the help of articles by the following: Dr. Kevin Thompson, PhD http://www.mentalmeds.org/articles/anosognosia.html ; Treatment Advocacy Center http://www.treatmentadvocacycenter.org/index.php?option=com_content&task=view&id=27&Itemid=56; Pages 112 and 113 of Dr. E. Fuller Torrey’s new book, The Insanity Offense (2008) among other sources)