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Medicine Needs a Reformed Attitude About Schizophrenia

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Psychosis has not come far from its historical origins in creating a host of repugnant and undesirable attitudes. In “Brain on Fire,” Susannah Cahalan goes through a tyrannous journey of madness that is throughout the book thought to be a psychotic diagnosis, but ultimately is an autoimmune disease overlooked. The stigma around having a psychotic diagnosis is strikingly evident of the deep fear of having such diagnosis attached to her name. Throughout the chapters, Susannah portrays psychotic-like symptoms, which for the most of the story go dismissed. In the emergency room, she is released for a seizure, though she is raging circular speech. In the doctor’s office, she is dismissed as an alcoholic. At a psychiatrist’s office, she is thought to have bipolar disorder. Her friends and family shy away from the psychotic spectrum, believing truly that her symptoms are a cause of physical ailment, not due to the mess of the mind. The line between mental illness (which are increasingly being shown to be biological disorders) and physical illnesses determines one’s fate. As Susannah writes after she receives her autoimmune diagnosis, “If it took so long for one of the best hospitals in the world to get to this step, how many other people were going untreated, diagnosed with a mental illness condemned to a life in a nursing home or psychiatric ward?” That is, to be condemned to a psychiatric ward is one of the worst possible cases.

There is a long history with institutional medical treatment of psychosis. In “Mad in America,” Robert Whitaker outlines the atrocious history of people with psychosis and how the medical community treated them throughout the centuries when hospitals for madness first opened up when the Puritans petitioned for the first hospital in America in 1751. “Society needed to be protected from the insane,” writes Witaker, “and it was this second function — hospital as jail — that had taken precedence when the hospital opened in 1756… in those early years, the lunatics were kept in gloomy, foul-smelling cells and were ruled over by “keepers” who used their whips freely. Unruly patients, when not being beaten, were regularly “chained to rings of iron, let into the floor or wall of the cell… restrained in hand-cuffs or ankle-irons,” and bundled into shirts that “left the patient an impotent bundle of wrath.” The images I read were so terrifying that I personally then used to hallucinate that I would be treated exactly like this if I were to turn myself into the medical community.

Such treatment of psychotic patients in contemporary psychiatric hospitals still retain the horrifying, soul-eclipsing state of housing dozens of people with mental illness together in one unit. I remember my last stay before I vowed and pleaded to my friends and family to never commit me to a hospital ever again. In my stay, I had let out my diagnosis of schizoaffective disorder, and the nurses had treated me wildly different from my last hospital visits without the psychotic diagnosis on my sheet. I was to remain in front of a camera at all times when I would be visiting different rooms. I was spoken about in the third person while I was seated two chairs away from staff. I was denied that I had any accomplishments to my name at all, an inpatient mocking my seemingly incredulous assertion that I had performed in a music video that summer, replying, “We all want to be in music videos, honey.” When I wanted to read philosophy I was denied my books. I started to rebel. I wanted to prove that I was not just a “mad” person, talking aimlessly amongst herself (which I still did), but I was more than my illness… something that a supposed healing facility would want to advocate for.

It is well-known among psychiatric patients that psychiatric hospitals are often doing minimal good to individuals with mental illness. The very act of being committed to the unit without your own clothes, hygiene supplies, comfort items, entertainment hobbies, essentially stripping you of all of the things that make you you, erodes the self-esteem of the individual. I do not doubt that we all see each other in an unusual light when we are thrown together in this single place and time. The depressed walk around more sluggish than usual, they drag their feet, their shoulders hunched. The psychotic speak in mumbles and grumbles. They slur their words in drudgery, their hair unkempt. The aggressive are the ones who are normally happier in settings like this.

The summary of the way psychosis is seen by society can be summarized by Whitaker’s statement, “Like all wild animals, lunatics needed to be dominated and broken.” It is with this control that society sees “schizophrenics” and “psychotics” that we are a problem to wield power over, instead of the other way around. We often already feel broken. Psychosis has done this to us. Restoring sanity through grounding techniques is instrumental to success, with minimal avail in actual institutions.

Ron Powers writes of schizophrenia in “No One Cares About Crazy People in our failing and stagnating mental health system. For decades, and even centuries, schizophrenia was thought to be a disorder of “oversupply of emotion,” thinking drilling holes into the brain would be the cure. This neurosurgeon, Antonio Egas Moniz, won the Nobel Prize for such treatment. How strange it is, that what was once heralded as a prestigious prize and career-making discovery could be seen in this day and age as barbaric. Such treatment of people with mental illness by locking us up in hospitals devoid of human touch or emotional intelligence under the yellow of flickering fluorescent lights, the dry, itchy cotton of the thin hospital blankets and sheets, the paper feel of our smocks, the dehumanizing effects of our guilty until hopelessly never to be found innocent may be seen one day, as barbaric too.

The line between the medical care of those with mental illness is starkly separate from the psychiatric model, but as we gain increasing evidence of psychiatric illnesses being biological disorders, why is it, then, that psychiatric patients are seen as a threat, a bug to squash, a disease to minimize instead of cure, in the medical communities all across the board? Sure, one can argue that there are still compassionate doctors and mental health social workers, case managers and staff. In the same way that men argue #NotAllMen in accusation rebuttals to the structure of male sexual oppression, the institutional structure of mental illness bears the brute force of demeaning, degrading and unenlightened treatment methods as a whole.

It is no secret that many patients with mental illness detest the hospital settings for which we are left as a last resort. John Nash in “A Beautiful Mind,” protested when his wife admitted him to the nearby inpatient facility. But like so many other family members who struggle with a severely psychotic brother, sister, spouse or friend, she was left with minimal options. She did not know what to do. It was her last resort to protect her, her baby and her sanity. While the conditions are far from perfect, these spaces are often the only place people with mental illnesses have left. And that is a problem. This society is not structured or equipped to handle people with severe debilitating mental illness. I, for one, would be homeless if it were not for my father, who has been my dedicated caretaker since I was a teen. And the fact of reality is that many people schizophrenia are homeless. Or they are incarcerated. Or they simply die.

While I was in the hospital on an emergency room visit for allergic reactions, there were other psychiatric patients waiting to be admitted in the same wing. One was wailing his head off, yelling curse words at the cop standing guard by the door. He was kicking things, crying undecipherable sentences and causing havoc just to wreak it. I offered him an origami crane. He seemed to calm down. But quickly after our hands touched, I was instructed by the guard not to interact with him. I could not even give him an act of kindness. It is understood that everyone may have mental illness where the mental illness plays out, but the able-bodied are the most protected. While the neurotypical may go home to their families and receive love and compassion for who they are, those with mental illness (especially people with schizophrenia) get minimal love from society. We are treated as a hazard, disposable things, stamped to move down the conveyor line for the others to “deal” with.

Segregating mental illness from the rest of the world is only significant of our ignorance of it. Survivors of mental health and trauma know truly that these topics are integrated into everything one does. Schizophrenia still even has a further reach to coming to understand its role and origins in society. The percentage of people who experience hallucinations, however, is actually rather high. Science Daily reports an estimate that 5% of all people have a hallucination at some point in their life. Mental health is a dynamical spectrum of symptoms, and we all exist on the same one… just some are more to the left or right than others.

No matter where we are in the medical world, whether it is in the emergency room, the clinical staff or the psychiatric hospitals themselves, people with mental illness are too often segregated from mainstream societies, even when we try to ask for help. Mental health and trauma do not get a say in the medical community, with the myth being that mental and emotional problems are seen as nonbiological. But in fact they are the most complicatedly biological. We do not know the extent to which they are biologically intrinsically woven into our lives. We do know, however, that people with schizophrenia have less gray matter than their “healthy” controls. We do know that people with schizophrenia have an enlarged choroid plexus. We know that emotions are related to our limbic system. We know that our flight or fight stress responses have to do with our amygdala. We know, from “The Body Keeps the Score” by Bessel van der Kolk, M.D., that trauma is stored in the body, with evidence that it even alters the cellular structure and memory of our flesh and blood. We know enough, that is, that psychiatric conditions should no longer be segregated from mainstream medicine. It is time we stop thinking that individuals with psychosis are not deserving of that.

Getty image via fbxx

Originally published: October 21, 2020
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