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Mental Illness, what is it?

  1. Oct 18, 2003 #1
    Since the suicidal death of my brother due to his state of mental health (Schizophrenia etc)

    I have been studying and researching this issue (now nearly 12 years)

    I have no formal background, no qualification except the most important one (life).

    I have interviewed and listened to many many schizpohrenic and bi polar sufferers.

    I found that the medical proffession was in a lot of ways way off the track in their approach to these and other problems.

    I wrote a simlpe but relatively complete understanding of what I knew to be clinical mental illness and If I may I would like to post it here. (it includes and example of patient responses)

    If i could get some feedback here or by e-mail it would be terrific.


    Mental Illness
    A new approach
    Scott Sieger


    When considering the nature of mental illness it is important that we define what it is we are considering.

    Mental illness is a mental condition that prevents the sufferer from participating in life in the way he or she would wish. It is a condition that places the sufferer in a state of dysfunction.

    It is a condition that society wants to protect itself from for it deems the mental state of the sufferer to be precarious, unreal and relatively unpredictable.

    Within the following example of mental aberration I will use the condition notoriously referred to as Schizophrenia.

    Schizophrenia demonstrates the greatest variety and complexities of the aberrant mental state and I intend to suggest a way that will allow us to treat and cure this condition.

    w w w w

    Schizophrenia is about ability, not ordinary ability but extraordinary ability.

    At some time in the patient’s life his brain has acquired an ability or abilities that the patient has little to no control over. The ability(s) are acquired intuitively and usually discounted as inconsequential by the patient himself and as delusion or hallucination by the medical profession when he or she is finally admitted to hospital or some form of professional therapy and care.

    The abilities I refer to are of a sensory nature: intuitive sensory abilities of an extraordinary nature. The patient immediately becomes embattled with what he senses as ordinary sensory behaviour and that which he himself would consider extraordinary sensory ability.

    Society is telling him that his ability is delusional and yet he knows that it isn’t. His imagination tries to accommodate society and his own experiences, putting himself in a state of self delusion because he is inclined to deny his ability as real because society is saying that this is the case.

    So we have at least two abilities happening. The first is his ability to know what is extraordinary (Aberrant) sensing this and the actual intuitive ability that he has acquired which is also sensed.

    A classic example would be paranoid schizophrenia where by the patient feels a strong sense of conspiracy, that the CIA or the police are watching him or his parents are threatening to kill him etc.

    A normal person is quite capable of sensing conspiracy in fact we are all part of a conspiracy. We are all part of everyone else’s plans. The wife or girlfriend is planning a special dinner. The government is planning to introduce the GST. The guy down the pub is planning to punch him in the nose etc.

    So the patient has developed an ability to sense conspiracy to a depth that would be considered extraordinary. His sense of reality is threatened and he becomes deluded trying to deal with his sensory ability and that which society would consider normal.

    For instance he senses his girlfriend’s plans for dinner and feels threatened because of his fear of his ability to sense this. He behaves badly trying to cope with all the mixed signals that his brain is trying to interpret. He behaves badly and arrives in the hospital in an extreme state of anxiety.

    The premise I am using here is that fear is always real. Not always understood for what it is but very real and valid. The ability to understand and learn from it is the ability that needs to be learned and it is only by achieving understanding and learning that the patient has any chance of recovery.

    To deny the ability is to provoke delusion. To nurture the ability is to free the patient of delusion.

    Funnily enough it is society’s state of delusion as to the nature of Schizophrenia that is actually perpetrating and enforcing a delusion upon the sufferer. Society having the delusion that extraordinary ability doesn’t exist. Which is of course not true as some of our most gifted people exhibit extraordinary ability all of which could be considered intuitive.

    I am suggesting that the patient’s sensory abilities have somehow achieved a greater depth than would be considered normal and like a person studying martial arts the patient must learn sensory discipline and nurture his ability to the level that he is comfortable with.

    I believe that our current approach to Schizophrenia is in fact quite deluded and as you would now understand the patient is also aware of this causing even more grief.

    Medication rejection, hospitalisation rejection etc are all symptoms of our “insane” approach to schizophrenia: the patient being caught between two worlds and not knowing what to believe.

    Sensory ability is essentially reflexive in that until controlled by other governing reflexes the ability continues to exist at all times in a way that is ungoverned and it is only when the ability is governed by learned reflexes that the ability is controlled and the patient’s anxiety and comfort levels return to “normal”

    w w w w


    What I propose is that the patient be treated as a person who has abilities yet to be governed and not denied.

    That the treating staff attempt to identify what abilities are in play and structure a learning and therapy program that helps the patient in the achievement of comfort by allowing him to achieve the skills and disciplines needed.

    Many programs can be developed that are able to help the patient with the above in mind.

    Open mindedness to what the patient is describing as delusion and treating the description in the light of uncontrolled intuitive ability will achieve significant results.

    A Response by M. C, California USA

    WOW. I like this. Particularly from a sufferer’s point of view..

    I can’t tell you how much comfort it gave me to hear from you that I wasn’t just stupid and/or crazy to be thinking the thoughts that I was thinking.
    In our overactive minds, we create connections and find significance in insignificant, unconnected events. And this was (sometimes is) my reality. And I found it utterly frustrating to hear from people that I should just not believe what I already believed. It was liberating, and yet scary, to think that I might be right.

    You’re right in recognizing the person’s ability to perceive as being real, because it is real, and then your next question to me was “Why?”. This caused me to look deeper into what I was experiencing. It gave me comfort and strengthened my belief in and view of God and helped me to give purpose and meaning to what I was experiencing.

    The similarity to this approach is striking to a form of therapy that exists for Borderline Personality Disorder. Are you familiar with that? It’s also called emotional intensity disorder and it affects about 1-2 million Americans. It causes the person to experience each situation to a fully charged emotional level, and they frequently are very frightened people who act in harsh, angry ways. It’s hard to treat but the recommended treatment today is called Dialectical Behaviour Therapy (DBT). It consists of accepting the patient the way they are and also accepting the need to change (thus the term Dialectical, accepting two seemingly opposite themes).

    Your idea seems revolutionary to the field of schizophrenia and also interestingly similar to this field’s approach. The thing that I like about your approach is the respect that it gives to the individual. You hit the nail on the head when you said society’s reality does not accept the other person’s. By recognizing the person’s reality as real, you’re recognizing the person as significant.

    It was an extremely exciting proposition when you said that my perception was founded. I felt like for the first time someone was saying I wasn’t stupid, or self-absorbed, or just crazy. Because according to my perceptions, the delusions I was experiencing were real.

    I think you should also recognize society’s reality as being real. You didn’t say it wasn’t, but I think to be fair you should say that both realities are real in a sense. I mean perception is relative anyway.

    Regarding the final conclusion:

    “Open mindedness to what the patient is describing as delusion and treating the description in the light of uncontrolled intuitive ability will achieve significant results.”

    I think you should go on to explain more as to why this recognition will help the patient. I have tried to give you my perception as to why it helped me, but I’m sure you have some ideas of your own that I’d love to hear.

  2. jcsd
  3. Nov 1, 2003 #2

    I have a neurological illness that 100 years ago would have been considered a mental illness. (Epilepsy). I also have in my family (both maternally and paternally) Bipolar Disorder, Autism and ADHD. I myself also have either Bipolar Disorder (Type II) or Bipolar tendencies. The medications that I take treats both seizures and mood swings (depression and hypomania). I also have had the good sense (with the prompting of a few friends) to seek therapy. Both (meds and therapy) are very helpful. They help keep me on track.

    Does this make me crazy? Ofcourse not. A person with Schizophrenia is not crazy either. If I am not on any of my medications, I will experience auditory (sound) and olfactory (smell) hallucinations during a seizure. Before surgery (done 15 years ago), I would experience extreme fear (terror even) during a complex-partial seizure. If it progressed far enough, I would scream. Was this insanity? No, it's related to the Amygdala in the Hippocampus (located in both temporal lobes of the brain) which experience the emotions of fear and anger. 100 or 150 years ago (before anticonvulsants) I would have been locked up in an insane asylum. I would have been considered crazy...phobic at best.

    The medical community is seeing Axis I disorders (such as schizophrenia, clinical depression, bipolar disorder, autism, and ADHD) with much more respect than it did a generation ago. I see society starting to follow suit-- and it's about time. There really isn't much difference between neurology and psychology. (Hence, neuropsychology). Axis II disorders are usually related to general personality (personality disorders or personality traits), and intelligence (mental retardation). Axis I disorders are usually innate and often genetic in origin. They are also often quite treatable. If you're interested in genetics, read up on chromosome bands: 10q24-26, 12q24, 15q11-14, 16p13/16p13.3, 22q11-13.

    I'm sorry about your brother. I attend a "Grief Share" group at our church because of a recent loss in my family. (My daughter). One woman who attends has a grandson who committed suicide. She had a hard time at first (spiritually) because of teachings that she has heard about hell and suicide. She, like anyone experiencing suicide in their family, struggled with this. One thing that we emphasize at "Grief Share" is that you never know what state of mind a person is in when suicide occurs and it isn't our place to judge. I don't know if you are a spiritual person, but I thought that might help.

    Last edited: Nov 30, 2003
  4. Nov 3, 2003 #3
    A Personal View

    I believe that current descriptions of any form of mental illness (as distinct from a disease such as brain cancer which can cause similar hallucinations, bizarre patterns of behaviour etc.) are woeful and lack any real insight into the phenomena.
    Mental illnesses are merely descriptions of patterns of “antisocial” or “unexplainable” behaviour. Post Traumatic Stress Disorder is a good example of a recently “manufactured” condition, as is Anxiety Disorder. These conditions are simply normal human reactions to a threat on personal safety. One must remember that psychiatrists and pharmaceutical companies make countless billions of dollars peddling drugs each year to the public (state-sponsored drug trafficking). These companies therefore have a vested interest in what drugs people are prescribed. Psychiatrists get kickbacks from companies if their particular brand of drugs are prescribed.
    Those who radiate human emotions when they feel them are not considered normal. Empathic abilities are frowned upon. I think the rise in “diagnosed” mental illness is more a reflection of the problems in our society as a whole than any personal demons. When we look at Western society with its wage-slavery, taxes to fuel the war-machine of government, mortgages, terrorism, electromagnetic pollution, media whitewashes, its surprising that all of us aren’t insane!
  5. Nov 5, 2003 #4
    Mental Illness in Young Japanese

    To illustrate my previous comments regarding society causing mental illness.
    There is a relatively new phenomena occurring in Japan where young Japanese are refusing to come out of their rooms for years. It has a hesitant diagnosis attached to it. Thousands of young people in Japan are suffering from this uniquely Japanese phenomena. The parents don't admit it, the authorities and professionals are baffled by the condition, nobody knows what to do.
    The "mental illness" did not exist before the eighties. The very severe form of agoraphobia is theorised to be a result of Japan's amazingly rigid and disciplined society, where if children do not succeed at their studies, they are considered failures.
    I wonder how long until this reaches our shores?
  6. Nov 11, 2003 #5


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    Re: A Personal View

    I just want to set the record straight. Unless a doctor owns stock in a drug company (99% don't) the only kickbacks docs get for prescribing a drug these days are free pens and an occassional lunch.

    Not much compensation for 90 hour work weeks.

    The pharmaceutical reps reap all the benefits.(The average pharmaceutical rep makes makes more than the average physician in Georgia and they don't get out of bed at 2 in the morning most nights a week.) They get a "commission" for every drug the physician writes. Most doctors try to prescribe medicines based on evidence based clincal trials and tailor it to the individual.

    Back to the issue at hand. I think bipolar disease is one of those diseases that can reap wonderful feats and accomplishments for the individual during their bouts of mania as well as a fuel for incredible creativity. Unfortunately, the natural history of untreated bipolarI (not necessarily bipolar II) disease is that 80 percent will go on to successfully commit suicide unless treated with a mood stabilizer. Many a great thinker and artists have been bipolars. I knew the chief resident at Yale University who was brilliant, dedicated and unstoppable...until he committed suicide at the tender age of 38. Of course, it was probably his mania that allowed him to thrive in an environment that already demands inhuman sleep deprivation but it eventually caused his early destruction. Some professions are naturally suited for bipolars. I know an artist who spends countless sleep deprived nights painting some of her most brilliant work and when she lapses into despondancy, has written some brilliant pieces. However, she has divorced three times, has one child in a foster home and has been kicked out of rental units due to unpaid rent. I have dragged my bipolar brother out of state hospitals many times in my life until he stayed on his medicines. (He is now a wallstreet consultant in New York City) but he has almost taken his life twice. It is a difficult problem since the disease itself can be both a blessing and a curse.
  7. Nov 29, 2003 #6
    Re: Re: A Personal View

    Where did you find this statistic?!? All the studies I've ever read put the rate of completed suicides for untreated bipolar patients (Types 1 and 2 combined) at 20%, or a 1 in 5 chance.

    You need to be very accurate with your numbers. Bloating a statistic like this one can be dangerously negatively suggestive to people who suffer from the disorder. It is needlessly discouraging and weakening to the morale.
    Last edited: Nov 29, 2003
  8. Nov 29, 2003 #7


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    Re: Re: Re: A Personal View

    You are absolutely right! The statistics apply to the general population of diagnosed bipolars in the US. It also dependent on the nosological differences between bipolar II and I and how it is defined. (Then this can flucuate from 20-50%)

    The 80 percent comes from a psychiatric epidimeologist here at the CDC (Centers for Disease Control.) who is a professor at Emory University. His statistics seem inflated because of the fact that a majority of biplors (especially bipolar IIs) are misdiagnosed with other mood disorders (in children they are diagnosed as attention deficit disorder...if you look at ADHD and Bipolar II questionaires, they are very similar), or in adults, major depressive illness, anxiety disorders or substance abuse diagnosis when many bipolars have comorbid substance abuse. He believes many of the substance abusers are comprised of a huge number of undiagnosed bipolars. Thus, his statisitcs was to incorporate undiagnosed bipolars by looking at people whose behavioral patterns coincide with bipolar I o r II but were not officially diagnosed (thus they never got the appropriate treatment.) I will try to get his work for you

    What is interesting is that Lithium is still the best treatment for suicidal prevention in this population but it has gone out of favor due to side effects and the public stigmata about it. However, due to the trend in evidence based medicine, more are starting to return to its use. The more popular alternative is valproic acid and causes liver dysfuction and massive weight gain , the latter causes many to discontinue and become non compliant.
    Last edited: Nov 29, 2003
  9. Nov 29, 2003 #8
    Re: Re: Re: Re: A Personal View

    Actually, there are many more mood stabilizers out there. Valproic Acid isn't the only AED (anticonvulsant) on the market that is also used for Bipolar Disorder. Some others that come to mind are: Tegretol (Carbamazepine), Lamictal, Topamax (Topiramate), Klonopin (Clonazepam), and Trileptal (Oxcarbazepine). Not all cause weight gain like Depakote (Valproic Acid) does and infact one of the newer ones, Topamax (Topiramate), actually brings about weight loss in most people.

    I am on both Tegretol and Topamax. They treat both the seizures and the mood swings. :smile: (Lithium is not normally recommended for people who have seizures). BTW, I've lost 10 pounds since beginning Topamax this past summer. :smile:

    There are many more meds out there for Bipolar Disorder, but because I also have Epilepsy, we have focussed on AED's (anti-epileptic drugs).
    Last edited: Nov 29, 2003
  10. Nov 29, 2003 #9


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    Re: Re: Re: Re: Re: A Personal View

    Actually, klonipin is not a mood stabilizer. It is an excellent benzodiazepene sedative for the acute mania and its accompanying anxiety . There is also neurontin. Technically, all the medicines listed except for lamotrigine and lithium are off label use for long term relapse prevention. And only olanzapine, valproic acid and lithim are technically indicated for the acute treatment of mania. http://www.medscape.com/viewarticle/458706 In addition, none of them have been shown to have the superior suicide prevention efficacy that lithium has, although all are excellent for decreasing the frequency of the cycling in and out of mania . Some are better for rapid cyclers etc. The studies are on the way, but none have shown any superiority and some (valproic acid) inferior to lithium for suicide prevention rates. http://hdlighthouse.org/treatment-care/treatment/drugs/related/updates/0060lithium.phtml

    However, you are right, topomax has great side effects profile..it also helps bipolars with migraines. Topomax has such great weight loss potential alot of docs are prescribing it off label for weight loss and it is now going up for FDA approval just for its use as a weight loss drug! The variety of medicines just show how each person has to be individually catered to.. unfortunately, due to the trend towards practicing evidence based medicines, the individual and personal touch that comes with prescribing any medicines is now in jeapordy. Some HMOS will not approve Topomax for bipolar disease until it becomes formally FDA approved for its treatment etc. How sad since so much of medicine involves using the medicines in a off label manner due to the rapidity of change in clinical medicine vs. waiting for a formal research and the bureaucratic inertia of the FDA for its approval.
    Last edited: Nov 29, 2003
  11. Nov 29, 2003 #10
    You're actually out of date about Neurontin. Sad to say, many doctors are also. This is just one of many sources about the Neurontin scam (there are many more):
    (When you get there, click on "Complete Story").

    It is still, however, an effective anticonvulsant. I infact, was on Neurontin, and after reading up on its ineffectiveness (long before "Dateline's" story this Fall-- this news has actually been out for over a year), I asked my doctor to switch me to Topamax. He hee hawed on it, but I came into his office with quite a few facts that I'd dug up. I'm sure it helps that I'm a little bit overweight and gained about 35 pounds in the 7½ years that I'd been on Neurontin. (I was not an overweight person before being on Neurontin, BTW).

    He agreed, and it's (in conjunction with Tegretol) is working very well. I have also been dx'd with ADHD, but because meds like Ritalin can (and do with me) lower the seizure threshold, I'm currently unmedicated for it. We've tried the new ADHD med (Straterra), but it seemed to make my hypomanic. This was before we switched to Topamax, however. We may give it another try at some time as I am currently unemployed and the reason why is because of my problems with concentration and following (primarily auditory) instructions.

    Keep reading. Keep learning. You sound like a person who cares about this sort of things. KUDOS for you!


    PS As for Klonopin (and one of my sources for other mood stabilizers that I listed), check this link: http://www.mercer.edu/pharmacy/faculty/holbrook/Moodst1.html
    Last edited: Nov 29, 2003
  12. Nov 29, 2003 #11


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    Thank you.

    I mentioned neurontin because some are still using it in an off label manner. Here is where those strict advocates of evidence based medicines want only medicines used in in large clinical trial to be used by all physicians. As for the list, it is not a reliable source labelling klonipin as a mood stabilizer. I have found that 20 percent of all "medical facts" on the internet are wrong. No psychiatrist would use it as a mood stabilizer....once again, only lithium and lamotrigine have consistent data on long term mood stabilization. It may listed as a mood stabilizer because of its acute anxiolytic effect during the acute manic phase but does not prevent cycling.

    here is a quote
    And a link to its usage. I like the medscape site due to its more reliable data vs. webmd that is still very commercial and has given some wrong info in the past. The link goes into all the different main uses of clonezapam. http://www.medscape.com/druginfo/Dr...=1&MenuID=USEDOS&ClassID=N&GeneralStatement=N
    A psychiatrist would be negligent if he used klonipin as a mood stabilizer.
    Last edited: Nov 29, 2003
  13. Nov 29, 2003 #12


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    As for the neurontin. After reading the Dateline article more closely, it became clear that the whistleblower in this case is not an unbiased figure. Because of national legislation regarding whistleblowers, he stands to get 30% of fines that are levied against the company if the lawsuit is successful. His allegations are substantiated with strong evidence...evidence of the company's wrong-doing.

    As to the question of Neurontin's efficacy, the water is still very muddy.

    There's apparently evidence that treatment is not an overwhelming success story... two studies showed no measurable effect. But it may be good for some people.

    Here is where psychiatry differs from most of clinical medicine.

    All double blinded, randomized placebo controlled trials tell us is whether treatment X works for the general populatin studied. It does not predict an individual's response, especially somewhere as gray as psychiatry (vs. cholesterol lowering drugs where numbers can be assessed.) There are many psychiatrists who have tried the whole gamit of antipsychotics and neuroleptics and have seen an obvious improvement in their bipolars who were finally tried on neurontin.

    The religion of double blinded placebo controlled trials as the ultimate truth of the efficacy of a drug or treatment is currently being challenged by many clinicians.

    What may not work for 51% of the study group does not mean it will not work for Joe Smith whose clinician can carefully follow his disease and monitor him well. The jury is still out and the clinical studies are ongoing.

    Remember, topomax has still yet to have large, randomized, double blinded placebo controlled trials that show its efficacy as well although many of the open labelled trials look promising.

    Psychiatrists and other clincians aren't going to wait since individual successes such as yours are enough for now. http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=11912568&dopt=Abstract

    Your obvious intelligence and capacity for research makes you a great ally along with your clincian. He/she is lucky :smile:
    Last edited: Nov 29, 2003
  14. Nov 29, 2003 #13
    Duh. I just read your profile and read that you are a physician. I feel about this tall [picture my finger and my thumb about an inch apart] trying teach you about neurology, psychology and medicine.

  15. Nov 29, 2003 #14


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    you shouldn't, more people should be as well versed and active in researching things to help their docs. We can't and will never know everything. It helps to have patients who are so intelligent and inquisitive as it directs the docs appropriatly. (remember it was a bunch of concerned, intelligent mothers who helped the physicians in lyme connecticut realize they were misdiagnosing a rash of juvenile rheumatoid arthritis instead of lyme's disease.)
  16. Nov 30, 2003 #15
    Re: Re: Re: Re: A Personal View

    Last edited: Nov 30, 2003
  17. Nov 30, 2003 #16
    Re: Re: Re: Re: A Personal View

    Ignore. Error. [b(]
    Last edited: Nov 30, 2003
  18. Nov 30, 2003 #17
    Thanks. I figure someone needs to keep my doctors on their toes.
  19. Nov 30, 2003 #18

    Is your training in this area psychiatric or neurological?

  20. Dec 1, 2003 #19


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    Internal medicine, specifically managing intensive care, critically ill patients in a large suburban hospital. However, I also hold office hours in a rural clinic (which is why my hours are insane) and see alot of everything including psychiatry. Isometimes don't come home for a couple of days, thank goodness my husband is stay at home dad. There is only one neurologist for a population over 50,000 (counting adjoining counties) so internists are expected to manage as many neurological emergencies as well as outpatient problems. There is a huge stigma about seeing psychiatrists, especially in rural Georgia where everyone knows your business! Actually, many family practitioners, genral practioners and internal medicine specialists diagnose and manage many psychiatric patients due to the stigma of seeing psychiatrists and the great role these psychiatric diseases play in regular physical illnesses. For example, after salvaging an intentional drug overdose for a suicidal patient in the ICU you screen quickly for bipolar disease, knowing the probability is great for finding one under these circumstances. An insulin dependant diabetic may be bouncing in and out of the hospital for diabetic ketoacidosis because they are paranoid schizophrenics (many are surprisingly functional at times) and just forget or have delusions about giving themselves insulin injections. The list goes on. Not to mention the personality disorders that result in just frequent office visits and contacts etc. However, if they become too difficult to manage, they are encouraged to see a psychiatrist, but it takes an act of congress to get many to accept they need specialized help! AARGH!
  21. Dec 1, 2003 #20
    I became interested in Neurology after reading some of Oliver Sack's books and have done quite a bit of follow up research, particularly on seizures.

    It is not well known to many doctors that Complex Partial and Simple Partial seizures frequently present in such a way that they are mistaken for psychosis.

    Here is a link to an introductory article on the matter:

    Psychiatric Times

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