Child abuse and schizophrenia

THERE is a good review of the claims made in the article in my previous blog entry in schizophrenia.com's Schizophrenia Daily News Blog of June 16, 2006. Because this review is of great interest to me, I have taken the liberty of copying it to my own website at childabuse.html. I have not, however, copied the four comments I have appended to the review. These comments, all of which were made on July 15, 2006, are as follows:

1. In facile analysis, the finger of blame will always be pointed at the parent. What? You didn't abuse your child? Well, you must have mystified him or her. Or you must have failed to inculcate a sufficiently optimistic attitude in your offspring... And so it goes on. As the father of a woman who slid into psychosis at university, I am familiar with all these lines. Sure, I "mystified" her. I hung a Raymond Ching portrait of Kiri Te Kanawa in my hallway. That's why Tessa (not her real name) developed the delusion she was Kiri's daughter, and was being stalked by Machiavellian martial-arts afficionados. Give me a break.

2. In 'Schizophrenia' Is Not an Illness, the first chapter of Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia, John Read, Loren R. Mosher and Richard P. Bentall write (P3) that they "have not attempted an even-handed, 'objective' approach", and claim that "What is required, after a hundred years or more of the dominance of an approach that is unsupported scientifically and unhelpful in practice, is a balancing stance rather than a balanced one". But what is a work that adopts a "balancing stance", if it is not a polemic? And what is a polemic, if it is not a work of propaganda? And what is propaganda, if it is not a product of ideology?

3. Last year, nearly 10 years after she was discharged from hospital, my daughter graduated with a BA in psychology. "What did you write in your final exam on the subject of schizophrenia?" I asked her - knowing that she had been marked incorrect when, in an assignment, she had said something in favour of compulsory treatment with anti-psychotic medication "in some cases". (It was flupenthixol, administered compulsorily, that had brought her out of psychosis.) "I told them what I knew they wanted to hear," she replied.

What does that say about our universities?

4. The problem, I think, is that the psychology departments of our universities have been "captured" by latter-day disciples of R.D. Laing, who simply do not believe there is such a phenomenon as schizophrenia (which is why they superciliously place the word in quotation marks). "The obvious fact," they say, is that "people are driven crazy by bad things happening to them" (Read, et al., in Models of Madness). So if someone like my daughter starts thinking her mother is a famous opera singer, she must have been deeply wounded by life. Yes, one psychologist, in an email to me, has presumptuously referred to Tessa's "wounds" - because psychological wounds are, according to this theory, a sine qua non of "schizophrenia". Of course, none of this would matter a great deal if the psychology departments of universities were not churning out graduates who, in some cases, go on to work in the mental health field, where they can greatly add to the difficulties one has in having a loved one committed. One can find oneself - as I found myself in late 1995 - in a truly desperate situation, only to be confronted by sugary condescension, and blithe suggestions that all could be resolved through some sort of family conference. Largely because of this attitude, I was not able to get Tessa into hospital, and ensure she stayed there, until she was at the point of total collapse. And by "collapse", I don't mean having a few funny ideas; I mean having hallucinations, seizures and blackouts.

Manchester academic to tell conferences: Child abuse can cause schizophrenia

UNIVERSITY of Manchester researcher Paul Hammersley is to tell two international conferences, in London and Madrid on 14 June 2006, that child abuse can cause schizophrenia.

The groundbreaking and highly contentious theory, co-presented by New Zealand clinical psychologist Dr John Read, has been described as "an earthquake" that will radically change the psychiatric profession.

Clinical psychologist and writer Dr Oliver James commented: "The psychiatric establishment is about to experience an earthquake that will shake its intellectual foundations [and] may trigger a landslide."

Mr Hammersley, Programme Director for the COPE (Collaboration of Psychosocial Education) Initiative at the School of Nursing Midwifery and Social Work, said: "We are not returning to the 1960s and making the mistake of blaming families, but professionals have to realize that child abuse was a reality for large numbers of adult sufferers of psychosis."

He added: "We work very closely in collaboration with the Hearing Voices Network, that is with the people who hear voices in their head. The experience of hearing voices is consistently associated with childhood trauma regardless of diagnosis or genetic pedigree."

Dr Read said: "I hope we soon see a more balanced and evidence-based approach to schizophrenia and people using mental health services being asked what has happened to them and being given help instead of stigmatizing labels and mood-altering drugs."

Hammersley and Read argue that two-thirds of people diagnosed as schizophrenic have suffered physical or sexual abuse and thus it is shown to be a major, if not the major, cause of the illness. With a proven connection between the symptoms of post-traumatic stress disorder and schizophrenia, they say, many schizophrenic symptoms are actually caused by trauma.

Their evidence includes 40 studies, which revealed childhood or adulthood sexual or physical abuse in the history of the majority of psychiatric patients and a review of 13 studies of schizophrenics found abuse rates from a low of 51% to a high of 97%. Psychiatric patients who report abuse are much more likely to experience hallucinations – flashbacks which have become part of the schizophrenic experience and hallucinations or voices that bully them as their abuser did thus causing paranoia and a mistrust of people close to them.

They admit not all schizophrenics suffered trauma and not all abused people develop the illness, but believe less traumatic childhood maltreatment, rather than actual abuse, may be an important difference. In their review of the 33,648 studies conducted into the causes of schizophrenia between 1961 and 2000, they found that less than 1% was spent on examining the impact of parental care. Still, they say, there have been enough studies to suggest negative or confusing early care may be an important addition to abuse as a cause.

Genes may still have a role to play but other evidence Hammersley and Read cite shows that genes alone do not cause the illness. A recent study compared 56 adoptees born to schizophrenic mothers with 96 adoptees whose biological parents did not have the illness. The families were observed extensively when the children were small and all the adoptees were assessed for psychiatric illness in adulthood. It was found that if there was a high genetic risk and it was combined with mystifying care during upbringing, the likelihood of developing schizophrenia was greater - genes alone did not cause the illness.

In addition a recent review revealed that, apart from for Alzheimer's, not a single gene has been shown to play a critical role in any mental illness, while sociological studies show that schizophrenia poor people are several times more likely than the rich to suffer schizophrenia and urban life increases the risk.

Finally, they argue, if patients believe their illness is an unchangeable genetic destiny and that it is a physical problem requiring a physical solution, they will readily accept a drug prescribed to them when in fact they require other therapy. Worse, those who buy the genetic fairytale are less likely to recover, and that parents who do so are less supportive of their offspring. They recommend that all patients be asked in detail about whether they have been abused, anti-psychotic drugs no longer be doled out automatically and psychological therapies offered more often.

Hammersley and Read will propose the motion 'Tears on my pillow, voices in my head: This house believes child abuse is a cause of schizophrenia' at a public debate at the Institute of Psychiatry in London on 14 June 2006. They will also be speaking at 15th ISPS Symposium for the Psychotherapy of Schizophrenia and other Psychoses in Madrid on the same day.

From University of Manchester.

---

I appended the following comment:

I REMEMBER hearing this "new theory" years ago. Anyway, Read doesn't accept that schizophrenia is an illness - and even puts the word in quotation marks in the title of Chapter 1 of Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia (2004). My daughter, who has schizophrenia, ran into people like Read while she was studying for her BA in psychology. When she wrote in an assignment that compulsory treatment with anti-psychotic medication is necessary in some cases of schizophrenia - remembering that only this had succeeded in bringing her out of psychosis - she was marked incorrect. Crazy! And no, she was not abused in any way as either a child or a young adult.

A last look at Lafayette Ron Hubbard, founder of the Church of Scientology

A PICTURE the Scientologists won't show you: The "Commodore" in sad decline, 1973.

ECT given to elderly patients without consent

UP to one in five patients given electroconvulsive therapy last year received it without their consent.

Jeremy Skipworth, Health Ministry deputy director of mental health, told Parlament's health select committee yesterday that 22 percent of patients given the controversial treatment for depression in the 2003-04 year did not agree to it.

The figure is from the first ECT annual statistics report, to be published later this month.

Dr Skipworth said that under the Mental Health Act, ECT could be given to patients incapable of giving consent if two psychiatrists decided it was in their best interests. But 22 percent was likely to be an overestimate because of inconsistencies in the way data was provided by health boards.

A leaked copy of the report shows 27 patients were given ECT in Wellington's Capital and Coast District Health Board, and five in Hutt Valley, out of a national total of 305.

ECT was administered 57 times on Wellington patients who did not give their consent.

The average number of ECT treatments overall was 10.4 per patient nationally. Most patients were elderly, with the highest number aged between 70 and 79. There were twice as many female patients as male.

Dr Skipworth was briefing MPs on a new independent review which found ECT was safe and effective for people suffering from severe depression and should not be banned. However, it recommends stricter controls on who is given the treatment. (Abridged)

Kelly Andrew in The Dominion (Wellington, New Zealand) April 7, 2005.

(Originally published at FriendCircles on April 11, 2005.)

Scientology: The verdict of Stewart Lamont

THE passage below is from the Prologue to Religion Inc: The Church of Scientology, by Stewart Lamont, which I have mentioned in the entry headlined Scientology or Bunkumology?

"Faced with friendliness and co-operation from all [my] irreconcilable sources, my task was made more difficult, not easier. I originally wanted to write a book telling the story [of Scientology] without offending anyone, but the more written material and personal evidence I gathered, the more I became convinced that, despite my good intentions and those of many Scientologists, I could not avoid the verdict that Scientology does more harm than good and that its founder Ron Hubbard was more of an evil genius than an idol with feet of clay."

(Originally published at FriendCircles on April 10, 2005.)

The appeal of Dianetics/Scientology

IF SCIENTOLOGY is bunkumology, wherein lies its appeal? I think Dr Christopher Evans hits the nail on the head in his book Cults of Unreason (1973), when he says (Page 33) that those most responsive to Hubbard's message are amateur psychologists:

"For such individuals, eager for marvels and in many cases desperately interested in abnormal psychology, yet lacking the academic training to practise it, the advent of Dianetics signalled the onset of the Golden Era. Anyone could now practise psychotherapy with a skill and facility far superior to that of the blundering psychologists who had ruled the roost in the past. Even more convenient was the fact that one didn't have to spend tedious years at university or medical school, listening to dull lectures and swotting up stuffy tomes. A few hours of Dianetics and one was a working Dianeticist who could get results!"

In other words, Scientology appeals to those who are semi-educated and who think, like criminals, that there is a short-cut to success - a viable substitute for diligent work. It thus fits in perfectly with the contemporary demand for instant results, instant gratification.

Even so, one wonders how many copies of Hubbard's book, Dianetics: The Modern Science of Mental Health, sell today. The paperback copy I have before me, which was apparently printed in 1994, claims that more than 16 million copies have been sold. But if Dianetics has, indeed, sold that many copies, how many have been sold since Hubbard's heyday in the early 1950s? When the book arrived for review at my newspaper, no one would touch it. And when I left it on my desk for a day recently, the only reaction I received from passing journalists was a laugh. By and large, educated people simply do not take it seriously.

(Originally published at FriendCircles on April 10, 2005.)

Scientology or Bunkumology?

I WAS not to escape the clutches of Scientology so easily (see previous entry). Within days of the first (and, for me, the last) of a series of five introductory lectures on L. Ron Hubbard's "science of the mind", I received some Scientology material through the mail. But fortuitously, the newspaper Truth had, in the meantime, run an exposé of Scientology under the banner headline Bunkumology. I had read the article, and had found that it confirmed all the conclusions I had reached about the jiggery-pokery with the "E-Meter" - the device with which Scientologists "audit" each other, as they seek to erase engrams and advance toward the supposedly exalted state of "clear".

Irritated by this pursuit of me, and still angry about the inane "lecture" I had attended, I clipped the Truth headline out of the newspaper, pinned it to the Scientology literature, and mailed everything back to the Scientology center. "That's that," I thought. It wasn't. Two days later, a personal letter arrived from the Scientology lecturer - he who had asked us to stare at a blank wall. "That was a strange thing to do, Alan. Why did you do that?" the letter began condescendingly. Incensed, I put the letter into another envelope and mailed it back to the center. And this time I didn't put a stamp on the envelope.

After that, there was a silence of a month or so, which was broken when yet another personal letter arrived from the Scientology center. This one was from the young woman who had audited me and produced the incredible graph of my personality. The Scientologists were holding a dance in St Kilda. She hoped she would see me there. I can't remember whether I returned that letter to the center. And as I left Australia for Japan in early 1962, I don't know whether the Scientologists made any further attempts to entice me back into the fold.

FOOTNOTE: "In the mid-sixties doors started closing in the Scientologists' faces all over the world. Whether it was from accident or design, most of the Church of Scientology target areas were in the old British Commonwealth - Australia, New Zealand, South Africa. The first door to slam was in Victoria where, in 1965, a Board of Inquiry persuaded the State legislature to pass the Psychological Practices Act which effectively outlawed Scientology in Victoria. Within half an hour, on December 7, 1965, Australian police had raided the Melbourne org and confiscated some 4000 documents, personal files and books. It was now punishable by a fine of $400 to use an E-Meter unless a trained psychologist and it became a criminal offence to receive or teach Scientology materials." - Religion Inc: The Church of Scientology (1986), by Stewart Lamont, Pages 54-55.

(Originally published at FriendCircles on March 19, 2005.)

Dianetics/Scientology (2)

       L Ron Hubbard

AT the time I was briefly involved in Scientology (see below) I was a 20-year-old tram conductor in Melbourne, and somewhat indisposed to the prospect of spending the rest of my life clipping tickets. But I didn't have any qualifications, and didn't know what sort of career I should pursue. Should I even stay in Australia? Perhaps I should go back to India, establish myself in an ashram in the foothills of the Himalayas, and spend the rest of my life contemplating the eternal. Then, one day, I saw an advertisement in my tram that offered free "IQ, personality and aptitude tests". All one had to do, the ad seemed to suggest, was go to an office in the city centre, take the tests, and be pointed in the right direction. I can't remember whether the ad mentioned the words "Dianetics" and "Scientology". If it did, the words meant nothing to me: This was 1961, and L. Ron Hubbard's perverse "science of the mind" was still in its infancy. As I said in my previous entry, it had yet to declare itself a religion.

So off I went. In those days, I was a little intimidated by offices, and a little in awe of people who wore business suits and seemed to know what they were doing. But somehow I made it through the door, and then struggled through a few pages of idiotic questions about bags of apples and oranges. I was then whisked into another room by a friendly young woman who told me to sit down in front of her desk and hold a couple of what looked like empty soup tins, one in each hand. She then proceeded to ask me personal questions like "What do you think of marriage?" while she checked and recorded electrical responses that registered, in some way, in the equipment that was mounted on the desk. As this was facing away from me, I couldn't see exactly what was happening. I guessed I was being subjected to some sort of lie detector, and felt a little hot and embarrassed.

In due course, the test was completed, and a chart or graph of my personality was produced. I think it was at this stage that the first flicker of doubt about the whole procedure crossed my mind. Firstly, it didn't tell me anything about the path I should follow in life; and secondly, it suggested I was a victim of wildly fluctuating moods. I wasn't. I didn't know what to do with myself - a fairly common predicament at the age of 20 - but I was not unhappy, and I certainly wasn't "moody". But when the woman went on to suggest I would benefit from a five-night series of free lectures, I felt I had nothing to lose and immediately signed up.

The night of the first lecture arrived and I returned to the office, this time in a new jacket and trousers I had bought specially for the occasion. As had never bought clothes before, they were not, I now know, the best fit. (In middle age, we tend to forget how difficult it can be for young people to do something as simple as go into a shop and come out half an hour later with exactly what they want or need. For me, as the shy, slightly institutionalized product of an English boarding school, this was especially difficult.) A minute or so after entering the office, I found myself in an upstairs lecture room with about 40 others, sitting in the middle of a row of chairs and facing a confident-looking male lecturer in his early 20s.

"What do you think my IQ is?" the lecturer asked, beaming at us.
There was a long silence. Naturally, no one wanted to venture a guess.
"150," he declared, almost triumphantly.
The young man to my right, who looked like a Malayan student, audibly gasped. "Ooh! A genius!" I heard him mutter.
But before anyone could congratulate him on his towering intellect, the lecturer told us all to turn to the left and face the blank wall.
"Hands up when you can see a ship sailing across the wall," he said.
Obediently, we all turned to the left and stared at the wall. And after about 30 seconds, a few timid hands rose slowly to shoulder height, where they hovered for a while as their nervous owners looked surreptitiously around for reassurance from others in the audience that they were not alone in being able to visualise a ship. Then the hands inched cautiously higher.
"Right! Hands down! Now hands up when you can tell me what color the ship is," the lecturer continued.
And so it went on. Inanity followed inanity, as the audience was subjected to what I could only see as a humiliating manipulation.

Two hours later, when I emerged into the cool evening air, I felt duped...and angry. And by that stage, I knew only too well what I had been dealing with. It was something called Scientology, which was run by an American called Hubbard, who was, to Scientologists, the closest thing to God on this side of the Pearly Gates.

(Originally published at FriendCircles on March 11, 2005.)

Dianetics/Scientology

A COUPLE of days ago, I received the following email message from an old scholar of my boarding school in England: "Have you looked into Dianetics? I have heard of some outstanding results."

At the risk of sounding cynical, I will say that this sounds suspiciously like a "sales pitch" from a Scientologist. And what are Dianetics and Scientology? In its anti-Scientology website, Operation Clambake describes Dianetics as "a form of regression therapy concocted from various sources" in the 1950s by science fiction writer L. Ron Hubbard. Scientology is an outgrowth of this, and might be described as applied Dianetics. It is also an organization, which claims to be a religion and calls itself the Church of Scientology.

This claim is interesting, as I remember being told, in the first of a series of "introductory lectures" on Scientology in Melbourne in 1961, that Scientology was definitely not a religion. I will write about my personal experience of Scientology later.

"On the surface the Church of Scientology seems reasonable," the Operation Clambake website states. "The insane content of it is only revealed to a person when the early stuff has done its work and made them more susceptible. After a short while a person 'believes' that Scientology is doing them good. They are then persuaded to help their new-found group further by donating money and/or working for the organization for almost no money. Many people do exactly that."

(Originally published at FriendCircles on March 8, 2005.)

David Stafford-Clark, psychiatrist

THE photograph above is from an obituary that appeared in Psychiatric Bulletin in 2000, after David Stafford-Clark died at the age of 83. The obituary describes him as a man who was, in his day, "one of the foremost psychiatrists in the country (Britain). He was Physician-in-Charge of the Department of Psychological Medicine and Director of the York Clinic at Guy's, as well as Consultant at the Institute of Psychiatry, University of London. But this summary sells him short: David brought to psychiatry a lively intelligence, humour, a lack of pomposity, but above all, an exemplary compassion and concern for the individual. His contribution to clinical psychiatry contrasted with the therapeutic inertia and detachment that pervaded psychiatry at that time. He was also a gifted teacher. His clinical lectures at Guy's were always packed to the doors by students who regarded most lectures as risible."

The obituary contains many other fascinating details of his career, and a number of comments I would like to include here. I will be content, however, to reproduce just one, which is particularly apposite to my criticism of Models of Madness (see below): "David encouraged students to develop a proper concern for the relief of human suffering. These concerns took precedence over lofty generalisation and speculation about the relevance of social and obscure psychological factors."

I warmed to him immediately, when I read in the blurb on the back cover of Psychiatry To-day (see below) that he had also published two books of poetry. At the time of writing, I have been unable to locate any of his poems.

(Originally published at FriendCircles on February 21, 2005.)

The psychotic delusion (2)

BEFORE I return Psychiatry To-day (see below) to the shelves of my secondhand bookshop, I would like to record a couple of passages from the chapter on Abnormal Mental Life. On Page 102, on the subject of schizophrenia, David Stafford-Clark writes:

"The disorders of thinking may be many, and may so interrupt or influence the mental life of the patient as to make contact with the examiner or with friends and relatives almost impossible. These patients can be totally inaccessible to the normal processes of inquiry or conversation, not only because they themselves are no longer interested in or able to accept the words and attitudes of others who seek to communicate with them, but also because their own mental processes have become so bizarre and extraordinary as to defy completely the normal efforts of imagination, whereby we put ourselves in the other fellow's place when holding a conversation and interpreting the replies we receive. What is fundamental in approaching the problem of schizophrenia is the necessity to appreciate that the schizophrenic patient lives in a totally different world to our own, and even those aspects of objective reality which he still perceives may have quite a different significance for him to that which they have for us, and for those whose minds and feelings we understand."

He continues, in a paragraph that runs on to Page 103:

"One example of thought disorder which will illustrate this consists in what are called ideas of reference.These are notions which, for the patient, have the certainty of complete conviction, that virtually everything that is going on relates to his own life and feelings in some special way. The smoke from the neighbouring chimneys is a signal to his friends or his enemies; a paragraph in a newspaper dealing with a cattle show is a subtle and deliberate attack on the reputation of his wife and children; the advertisements on the buses, the visits of the postman to other houses, the sound of traffic and the ringing of bicycle bells are all woven into the substance of some vast, incomprehensible cosmic plan directed entirely towards his own life and problems. Small wonder that these patients display perplexity and bewilderment as they contemplate their extraordinary fate."

THE illustration is from the ruins of Pompeii.

(Originally published at FriendCircles on February 21, 2005.)

Childhood-onset psychosis

AVID readers of this blog will recall that, in a previous entry, I questioned the assertion of Dorothy Rowe, in her Foreword to Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia, that "on a number of occasions (in Sydney in 1961) I was the first person to identify a child as being psychotic". I said that, because childhood-onset psychosis is rare, I doubted she actually did this.

But after expressing that opinion, I wondered whether psychologists in 1961 thought that childhood-onset psychosis was something one could readily find among schoolchildren.
I did not have to wonder for for long. While browsing in my own secondhand bookshop, I came across a copy of Psychiatry To-day, by David Stafford-Clark, a Pelican book first published by Penguin Books in 1952, and reprinted in 1953, 1954, 1956 and 1959. And while looking through it, I found two references to "the rare psychotic illnesses of childhood" on Page 216.

Stafford-Clark goes on to say, on Page 217, that "many of the ways of thinking and feeling which are normal in childhood, and to some degree in adolescence", including a tendency "to credit words and thoughts with magical power", can "combine to give a schizophrenic flavour to disturbances which may be far more transient and benign than schizophrenia in adult patients usually proves. For this reason the diagnosis of schizophrenia is made only with the greatest reservation during this stage of life..."

(Originally published at FriendCircles on February 19, 2005.)

The bounds of 'normality'

AS I said in my last entry, we all think we know what being "mad" means. By the same token, we all have a rough idea of what being "normal" means. So do we, when a family member 's behavior becomes "abnormal", immediately assume that the person is mentally unwell?

If you read the writings of some psychologists, you might be persuaded that the person's relatives are quick to come to this conclusion - and to drag the person off for compulsory psychiatric treatment. We live in a society that is intolerant of those who are "different", we are told. And families, we are led to believe, are particularly intolerant. Furthermore, they turn the "abnormal" son or daughter into a scapegoat for their own dysfunction. Thus, by taking him or her to the psychiatrist, and having him or her subjected to an "exorcizing" operation, they are able to absolve themselves of their sense of failure or inadequacy.

But does this actually happen? If we were living in England in the 1940s or 1950s, I would say that it sometimes does. I know, from my own experience, that English society was extraordinarily intolerant in those days, and often cruelly coercive. But does it happen today? And specifically, does it happen in New Zealand? I think it has to be pointed out that society has moved on since the 1950s. We no longer cane a boy for failing to sit up straight in class, for setting his cap at too jaunty an angle, or for allowing one sock to slip down an inch or two. Indeed, some people argue that society has gone too far in the opposite direction - and now tolerates almost any kind of unruliness.

In the early 1990s, as the father of a young woman who had graduated from university and entered the workforce, the last thing I wanted to do was interfere in her life. I thought I had done my job - and done it well. Her future was now entirely in her own hands. I was so detached, I did not realize, for a while, that her interest in the physical routine of the Fitness Foundation had become an obsession, and that everything else in her life was sliding into oblivion.

When I did realize what was happening, and also became concerned about her hypercritical manner, what did I do? Did I label her "mad", and attempt to railroad her into a psychiatrist's office. No, I extended the bounds of normality to accommodate her increasingly aberrant behavior. I made allowances for her. I rationalized. I told myself: "This is a stressful time for her. It will pass." When her criticism of me became distressingly scathing, I remembered the ease with which she had sailed through adolescence, and thought: "Oh well, I'm copping it now, rather than then."

Like her friend in Western Australia (see below), I continued to believe that she was well until I was forced, by the incontrovertible absurdity of her statements, to accept that she was not.

(Originally published at FriendCircles on February 18, 2005.)

The psychotic delusion

WE all know, or think we know, what being "mad" means. "Mad" people do "crazy" things, think crazy thoughts. But I don't think I can emphasize too strongly that the psychotic delusion, especially in the early stages of psychosis, is often plausible. When someone like Emma (see below) complains about her flatmates talking about her, or watching her, she could be right. After all, people are talked about, people are watched. She could even be right when she says that her neighbours threatened her. There are "neighbours from hell", as we all know - especially if we have watched the television program of that name. That is why it is so easy to be taken in, to accept what the person says, to go along with the psychotic delusion. If someone appears "cool. calm and collected", and tells you that he is the victim of a vendetta, why shouldn't you believe him? You might even feel sorry for him, and suggest a legal remedy for his predicament.

Sometimes a considerable length of time has to pass, before one becomes suspicious. One hears the complaint too often, in too many situations. Or the allegations become extraordinary, and start to strain credulity. Or the people they are levelled at are people you know to be fair and reasonable. When I was making my assessment of my daughter's mental condition, I did something that almost no social worker, psychologist or psychiatrist does: I tracked down as many of Tessa's former friends and associates as I could, and questioned them at length. I even traced a former friend to Western Australia, and I was impresssed by what she said. As soon as I introduced myself, she blurted out: "What on earth happened to Tessa?" She then explained that she had initially believed Tessa's stories about her victimization by the members of her sports club. Her response, she said, had been one of "Poor Tessa. How awful for her". But she said that when Tessa told her that her (Tessa's) parents had turned against her, "I knew that something was wrong, because you were always so close".

(Originally published at FriendCircles on February 15, 2005.)

The family is fair game (2)

IN this entry, I return to the Foreword by Dorothy Rowe, in Models of Madness, and specifically to the second page of it. Here, somewhat to my surprise, I found an almost word-for-word repetition of her attack on the "troubled" families of "psychotic children" (see earlier entry). But this time, there is an elaboration: "It was totally unrealistic to see the family's peculiarities (undefined) as being caused by the child's mad behaviour" (undefined).

Again, I have to say that I am puzzled by the constant references to psychotic "children", since those who become psychotic are, by and large, not children but young adults - people in their late teens or early twenties, who may, as in our daughter's case, have shown no signs of distress in their teens. Indeed, Tessa was so successful at school, and in her first three years at university, that she would, I am sure, have been judged the product of an exceptionally stable background.

I am also puzzled by the assertion it is "unrealistic" to see a "child's mad behaviour" as the cause of a family's "peculiarities". In reality, a promising young adult's inexplicable descent into psychosis can blow a family apart. For months, possibly years, one does not know what is happening. All one knows is that one's relationship with one's son or daughter is deteriorating, for no apparent reason, and that the person concerned, in all sorts of undefinable ways, is no longer the person that he or she once was. There is almost certainly obsessive behaviour, but not necessarily any behaviour one can confidently describe as "mad". All this can be extremely destructive to the relationship between the parents, as the worries increase and as the problem proves increasingly unamenable to logical analysis.

(Originally published at FriendCircles on February 14, 2005.)

A visit to Emma

THIS afternoon, we took Tessa to Palmerston North Hospital to see Emma, a friend who has been a patient in an acute mental health ward since before Christmas. Emma is a few years younger than Tessa (34), and was also treated for schizophrenia at Dunedin Hospital. LikeTessa, she also came to Palmerston North in 1996, and seemed, at that stage, to have recovered to a similar degree.

But Emma, to cut a long story short, has made no progress in the past few years, and looks like becoming a "revolving-door" patient. After staying briefly with her parents, she moved into a flat, and then into another, and then into another... She dabbled in art, signed up for occasional courses, and sometimes thought about looking for part-time work, but had little sense of direction - and minimal support. After initially living with others, and sometimes complaining that they talked about her, she favoured exclusive accommodation. This was more expensive, which meant that she invariably had little or no money. This, in turn, meant that she couldn't go out much. Often, she couldn't even afford to go to the movies. She did, however, manage to acquire an answerphone - a device that only increased her isolation. She didn't have to respond to calls; and when she did respond to them, she often insisted that no visits be made to her home without an appointment. Less and less frequently, we saw her walking along the street, wooden-faced, locked in her private world.

Late last year, Emma told Tessa this afternoon, she was threatened by her neighbours, and felt she couldn't cope with the situation she was in. She thought of calling Women's Refuge, but called the hospital instead. She didn't have to be in hospital, she said. Everyone knew that she didn't have to be there. But she wanted to live in a Christian-run place, and there were problems in finding one. She expected to be in hospital for a few more weeks.

(Originally published at FriendCircles on February 13, 2005.)

Is psychosis readily identified?

AFTER writing the last entry, I thought I would look in greater depth at the issue of identifying psychosis. In her Foreword to Models of Madness, Dorothy Rowe writes of her work in educational psychology: "Teachers who were concerned about a particular child would invite me to the school to see the child and often the child's family as well. Thus it was that on a number of occasions I was the first person to identify a child as being psychotic..."

As I said in my previous entry, I would be very surprised if all the children identified as psychotic were, in fact, suffering from psychosis. But let us assume, for the sake of argument, that they were. The question to ask now is: "Would Dorothy Rowe, in an interview, have been able to pick this up?" Remember that an interview doesn't usually last for more than an hour or so, and remember, too, that a psychotic person is often perfectly capable of presenting well for a short period of time. Finally, one must also remember that children are notorious for telling an interviewer whatever they think the interviewer wants to hear.

In the case of my daughter, Tessa, she was able to deceive the following people:

1. The Crisis Assessment Team at North Shore Hospital in Auckland in early 1995. "They were impressed by me," she said after her recovery and return home. Indeed, many people were impressed by her apparently dynamic personality when she was psychotic.

2. The executives of the chemical supplies company in central Auckland, who subjected her to a rigorous interview process before employing her in early 1995.

3. Mrs A in Sydney, with whom Tessa stayed for a while in late 1995. Although she is the daughter of a woman who suffers from schizophrenia, and is familiar with the symptoms, Mrs A did not realize, for a day or two, that Tessa was psychotic.

4. The judge of the Family Court in Wellington, who ordered her discharge from hospital after her first committal.

5. Mrs N in Dunedin, with whom Tessa stayed for a while in late 1995. Mrs N also has a good understanding of schizophrenia, having been married to a man with the illness for 20 years. But she, too, did not realize for a few days that Tessa was psychotic.

6. The "independent psychiatrist" whose opinion Tessa sought after her second committal, in Dunedin. After interviewing Tessa for about an hour, this psychiatrist "couldn't see what the problem was", her hospital psychiatrist, Chris Wisely, told me later.

So I feel strongly disinclined to believe that Dorothy Rowe could have confidently identified some Sydney schoolchildren as psychotic.

(Originally published at FriendCircles on February 7, 2005.)

The family is fair game

THIS entry continues to look at Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia. I have headed it "The family is fair game" because the writers' attitude to the members of the family of the person with schizophrenia - or the attitude of at least one of them - sometimes reminds me of the attitude of the Church of Scientology to its critics or opponents. Quite simply, almost any kind of innuendo can be levelled against them, either individually or collectively. And the attack - and that is what it is, really - is invariably couched in imprecise, sweeping, condescending terms that make a defence difficult. In layman's language, this is what is known as a smear campaign.

Thus, we read in the Foreword by Dorothy Rowe: "My contact with the psychiatric system began in 1961 when I was working in Sydney as an educational psychologist with special responsibilities for emotionally disturbed children. Teachers who were concerned about a particular child would invite me to the school to see the child and often the child's family as well. Thus it was that on a number of occasions I was the first person to identify a child as being psychotic, after which I would refer the child to a child psychiatrist. To do this I would have to talk to the parents and other family members, usually seeing them in the family home. None of the children who were psychotic came from an ordinary, loving home. Often the parents were very loving, but they were troubled people with secrets to hide, all of which pre-dated the child's breakdown." (Emphasis added.)

If you stop to think about it, this is an extraordinarily unprofessional passage - one that is so imprecise that one can hardly get to grips with it. What does Rowe mean by "child"? Is she referring to five- or fifteen-year-olds? One has to assume, from the way in which she is called to the school, that she is talking about young children. Yet childhood-onset psychosis is "exceedingly rare" (Judith Rapoport, Psychiatric News, January 17, 1997). And psychosis can be extremely difficult to identify even in an adult, who is much less likely than a child to have a view of the world that is at odds with reality. This raises another question: how often were children in the dark days of the early 1960s identified as psychotic when all they were doing was living, to some extent, in the fantasy world of the normal child? Furthermore, why doesn't one hear today, in 2005, about schoolchildren being identified as psychotic and being bundled off to see a child psychiatrist?

Finally, we read that, without exception, the "psychotic" children did not come from "ordinary" homes. What is "ordinary"? Couldn't almost any home be described as out of the ordinary, if one focused on some feature of it that in some way distinguishes it from others? And what were these "secrets", which the families were so anxious to hide - but which, for some unexplained reason, were revealed to the psychologist, a stranger, who came round for a chat? And how was it that some of these homes, although "very loving", were apparently able to drive their children into psychosis with nothing more than some troubles or secrets that lurked in the background? I thought children were more resilient than that. Why am I not psychotic, after growing up in the psychological hell of wartime and postwar England?

(Originally published at FriendCircles on February 4, 2005.)

Madness: 'the Shakespearean model'

WHEN I read about "bad things" causing schizophrenia, I sometimes remember the words of Polonius in Hamlet:

And he [Hamlet], repulsed, - a short tale to make, -
Fell into a sadness, then into a fast,
Thence to a watch, thence into a weakness,
Thence to a lightness; and by this declension
Into the madness wherein now he raves,
And all we wail for.

I call it "the Shakespearean model", and qualify the phrase with quotation marks, because I do not know whether Shakespeare really believed that people "go mad" in this sort of progressive manner. But there is no doubt that many people do hold this view of mental illness, and assume that one can trace a case of "insanity" back, through a series of events and/or episodes, to a primal, familial cause - being sexually abused as a two-year-old, or something like that.

It goes without saying that if you are sexually abused as a small child you are going to have problems in life. You may, for example, have difficulty in having a normal sexual relationship as an adult. But are you, in your late teens or early twenties, going to start thinking that car number plates encode secret messages, or that the car that stops outside your house is driven by a CIA agent who has your house under surveillance, or that the traffic congestion in the city centre, which prevents you from getting to work on time, is part of a vast conspiracy or vendetta against you? I don't think so.

And what would you say if I told you that the person concerned, as in Tessa's case, was successful at school and university, and didn't start thinking like that until after she had left home? At the time I mounted my first "rescue mission", and went to Auckland in an attempt to steer Tessa toward treatment, she was 25. She had left school more than seven years earlier, and had been living independently, away from home, for about four years. Yet to one psychologist I spoke to, her recent, dramatic decline into delusion was actually a family problem. It was something for which we were collectively responsible. And because we were collectively responsible for it, the only way to tackle it was by "working through" it collectively in sessions that would be convened by his mental health centre. I eventually left his centre with the feeling I had nearly been entrapped by another kind of madness. It was wonderful to escape: to emerge into the brilliant sunshine, and to drive with a friend to the other side of the city.

(Originally published at FriendCircles on January 31, 2005.)

Tranquillizers and sleeping pills

THE following passage is from the Alcoholism and Drug Addiction Research Foundation, Toronto, Canada*:

Tranquillizers are depressant drugs that slow down the central nervous system (CNS), and thus are similar to such other CNS depressants as alcohol and barbiturates.

The term "major tranquillizer" was formerly applied to drugs used to treat severe mental illnesses, such as schizophrenia. However, these drugs are now more commonly called neuroleptics; their action specifically relieves the symptoms of mental illness, and they are rarely misused for other purposes. This paper therefore deals with the anti-anxiety agents, or anxiolytics (formerly called "minor" tranquillizers).

Anti-anxiety agents share many similarities with barbiturates; both are classified as sedative/hypnotics. These newer agents were introduced under the term "tranquillizer" because, it was claimed, they provided a calming effect without sleepiness. Today, tranquillizers have largely replaced barbiturates in the treatment of both anxiety and insomnia because they are safer and more effective. The degree of sleepiness induced depends on the dosage. Tranquillizers are also used as sedatives before some surgical and medical procedures, and they are sometimes used medically during alcohol withdrawal.

Although tranquillizers do not exhibit the serious dependence characteristics of barbiturates, they nevertheless can produce tolerance and dependence. They may also be misused and abused.

The first drug to be labelled a tranquillizer was meprobamate - under the trade name Miltown - in 1954. Today, however, the most popular anti-anxiety agents are the benzodiazepines (e.g. Valium, Halcion, and Ativan). (NOTE that where a drug name is capitalized, it is a registered trade name of the manufacturer.) Since the early 1960s, the benzodiazepines have accounted for more than half the total world sales of tranquillizers. They are currently the most commonly prescribed class of psychotropic (mood-altering) drugs in Canada.

The first benzodiazepine developed was chlordiazepoxide, which is sold under such trade names as Librium and Novopoxide. The next was diazepam; it is marketed, among other brand names, as Valium, E-Pam, and Vivol. In the early 1970s diazepam was the most widely prescribed drug in North America. Now Halcion and Ativan - drugs from the same family as diazepam but eliminated more rapidly from the body - account for most benzodiazepine prescriptions. There are 14 different benzodiazepines currently available in Canada. Some are prescribed as anti-anxiety drugs (e.g. Valium, Librium); others are recommended as sleeping medications (e.g. Dalmane, Somnol, Novoflupam, and Halcion).

* http://www.xs4all.nl/~4david/tranquil.html

(Originally published at FriendCircles on January 29, 2005.)

Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia (2)

THIS entry is a continuation of my previous one, and examines the assertion by John Read that "people who go crazy need other people more than they need medical-sounding labels and tranquillizing drugs".

Once again, we have a colloquial reference to going "crazy", which is open to even more interpretations than the term "schizophrenia". This is followed by the implication that, even in New Zealand in the early 2000s, there are medical professionals who are content to slap the "medical-sounding" label "schizophrenia" on a person who is suffering a psychotic episode, pump the patient full of "tranquillizers", and then ignore his or her need for human contact and support. Well, if you looked hard enough, you would probably find a few psychiatrists who do this. If you looked hard enough, for long enough, you would probably find one or two who do even worse things. But by and large, is that what psychiatrists are doing today? And by "today" I mean today; I don't mean 1956 or 1974. A lot has changed in the field of psychiatry in the past few decades, and in the committal process. I have had dealings with a number of psychiatrists since 1995, and I have yet to meet one who is dismissive of the patient's need for human contact. And I have not met one, or even heard of one, who simply gives his patient tranquillizers.

Ironically, Tessa medicated herself with tranquillizers in the year before she was placed under a compulsory treatment order, in an attempt to rein in her racing mind. She reports that they did calm the mental storm, but only for a while - which is exactly what you'd expect tranquillizers to do. They did not dispel the paranoid delusions, or bring back her sense of humor, or allow her to pursue her studies and career again. The "old-generation" antipsychotic medication flupenthixol did that -together with a program of rehabilitation that included, of course, a lot of family support and encouragement.

Doesn't John Read know the difference between tranquillizers and antipsychotic or neuroleptic drugs (see the entry above)? He almost certainly does, but continues to refer to the latter as tranquillizers to insidiously call into question the aim of the psychiatrist(s) who prescribe them. The implication is that the aim is not to bring the patient out of psychosis, but simply to sedate him - and thereby make him manageable. Thus, the psychiatric patient is portrayed, albeit obliquely, as a victim. He has deviated from the norm in some way, and is drugged into a confused conformity by the man in the white coat - the modern witchdoctor - who is the agent of a society intolerant of all "difference". If we were still living in the 1950s, 1960s, or even 1970s, this argument, if it can be called that, would have merit. Today, I regard it as anachronistic in Western society.

(Originally published at FriendCircles on January 27, 2005.)

Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia

THIS is the title of a book edited by John Read, Loren R. Mosher and Richard P. Bentall, and published by Brunner-Routledge for the International Society for the Psychological Treatments of the Schizophrenias and Other Psychoses in 2004. Read is Director, Clinical Psychology, Psychology Department, The University of Auckland; Mosher is Clinical Professor of Psychiatry, University of California at San Diego; Bentall is Professor of Experimental Psychology, Manchester University.

In his Preface, Read talks about arriving in Stavanger, Norway, in June 2000, to give a "seminar about child abuse and schizophrenia". He is sitting outside his hotel when he overhears three people at a nearby table "talking about how hard it is to get psychiatrists to realize the obvious fact that people are driven crazy by bad things happening to them". One is Mosher, whose work Read has been "citing" for 20 years "as evidence that people who go crazy need other people more than they need medical-sounding labels and tranquillizing drugs".

To say that I hate this kind of loose, lazy, colloquial approach to schizophrenia would be an understatement. What does "crazy" mean? Does it mean "suffering from schizophrenia"? Presumably, it does. And presumably, the "bad things" that "drive" you into schizophrenia are the things that are collectively described as "child abuse". So child abuse causes schizophrenia, does it? Almost any reader of the first paragraph of Models would assume that it does, though this is not explicitly stated.

Some psychologists are so sure that "bad things", and only bad things, cause schizophrenia, they refer to these bad things even in the absence of evidence of anything untoward. In an email message to me some months ago, an American psychologist referred to my daughter's "wounds". What wounds? What are these wounds of which both she and I are completely unaware? No, I am not a father in denial. I am not an abuser who is unable to admit his misdeeds. Like many parents who see their child's behavior, and demeanor, change dramatically for the worse in their late teens or early twenties, I naturally assumed that something had happened. And I put some time and effort into trying to find out what had happened. Thinking that Tessa might have been raped during an overnight trip by her sports club, I called in a club official and grilled him for about an hour. I also spent about an hour on the phone with a woman from Rape Crisis, to see if I could pick up any clues there to what might have happened. It was a wild goose chase. Tessa had certainly had a few upsetting experiences - the sorts of experiences that are unavoidable in life - but nothing really serious had happened to her. In short, there was no "bad thing" in her past.

(Originally published at FriendCircles on January 26, 2005.)

Mental illness (4)

HAS any disease been served worse by the name is has been given? A person with schizophrenia is not a person with a split personality, which is something completely different - and quite rare. And he is certainly not someone who is simply inconsistent in his actions. Yet the adjective "schizophrenic" is used so often to describe someone who simultaneously follows two conflicting courses, or displays diametrically opposed character traits, that dictionaries now record that meaning. Hence the supposition of some people that the US bomber pilot mentioned in my last entry, and others like him, have schizophrenia - or are behaving in a schizophrenic way. They are not. Anyone who wants to know what schizophrenia is really like should go to my website at nzsf.com

(Originally published at FriendCircles on January 25, 2005.)

Mental illness (3)

THE following is a continuation of the previous entry:

There is more confusion on the subject of mental health than on almost any other subject. For a start, intellectual handicap, personality disorder, and mental illness are inextricably intertwined in the minds of most people. To these people, the sufferer of any of these disabilities is "crazy", "mad" or "insane". Then there are many people, even people who teach psychology in universities, who maintain that mental illness is a myth. To these people, the man who thinks the television is sending him secret messages, and/or that he is being watched by a CIA spy satellite, is actually a victim of bad parenting. Even if there is no evidence of bad parenting, it must be lurking somewhere. Treatment by antipsychotic medication is not the most appropriate treament, they maintain. In the absence of adequate time, funding and other resources, it is only the most expedient treatment. And of course, compulsory treatment of any kind is completely out of the question.

To return to the American bomber pilot: His actions might be judged insane; but the man himself almost certainly is not - if, by "insane", one means "suffering from a mental illness". It is more likely that he is suffering from a personality disorder, which is a result of his upbringing and the environment in which this occurred. But in my opinion, it is even more likely that he is simply a man who is able to dissociate himself from the consequences of his actions. In all other respects, he may be a "nice" man. He probably has a wife and kids back home. He may be a regular churchgoer and a contributor to charities. After the bombing, he may even hand out powdered milk to the survivors - and expect them to be grateful. I have known several Americans like that. And if you go to the Yahoo! discussion forums, you will find lots more of them - all brimming with vociferous virtue and malice. Yes, it's a crazy world.

(Originally published at FriendCircles on January 19, 2005.)