Saturday, September 6, 2014

Going Crazy: Part II

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In Part I:
I traced the pendulum swing on how ‘going crazy’ is viewed in the USA: from the 1960s when schizophrenia was viewed as a complex phenomenon with genetic, social, cultural, and spiritual components to today’s dominant view that
Since then [the 1960s], the advent of antipsychotic medication, advanced brain imaging, and molecular genetic studies has confirmed beyond any reasonable doubt that schizophrenia is a biological disease of the brain.⁠1

Part II:
 I hope to show that the pendulum has started to swing back in the other direction, based on a recent surge of dissenting voices, three of which I will discuss today.

The first is Tanya Marie Luhrman, Professor at Stanford University. In a recent journal article, she convincingly shows that schizophrenia is much more than undesirable random noise generated by a "malfunctioning (and mindless) brain."⁠2 ; instead it a complex outcome of many unrelated causes: not just the genes you inherit,but also whether your mother fell ill during her pregnancy, whether you got beaten up as a child or were stressed as an adolescent, even how much sun your skin has seen.⁠3

Luhrman reasserts the importance of social factors. If schizophrenia were solely a medical pathology, the “disease” would manifest in the same manner all over the world. But it doesn’t: her review of cross cultural research studies show the opposite:

“Schizophrenia has a more benign course and outcome in the developing world. Researchers in India found that patients scored significantly better on most outcome measures than a comparable group in the West. They had fewer symptoms, took less medication, and were more likely to be employed and married. The results were dissected, reanalyzed, then replicated—not in a tranquil Hindu village, but in the chaotic urban tangle of modern Chennai. No one really knows why Indian patients did so well, but increasingly, psychiatric scientists are willing to attribute the better outcomes to social factors.⁠4

Cultural practices affect not only the course and outcome of schizophrenia but the type of delusions the patient experiences, as Joel and Ian Gold demonstrate in their new book Suspicious Minds.

Following in the footsteps of medical historian Roy Porter, who believed “every age gets the lunatics it deserves,” the Golds poise the question:
what can we learn about ourselves and our times from examining the content of madness?

The Golds move beyond biological psychiatry to show us how the environment is a major causal factor in mental breakdown. And how our particular environment shapes the delusions our citizens have today:

“[T]hey point out, Internet-enabled cameras and cellphones, not to mention National Security Agency snooping, have turned the entire world into a single, if virtual, city and “a bizarre delusion about being watched into a sober worry…”⁠5 

 “People… for whatever reason, who are uniquely sensitive to such a loss of privacy become “the canaries in the data mines of the surveillance society.”⁠6

However, without a doubt, the biggest cultural factor predisposing madness is societal violence. This is a particular concern in the USA, which is, according to many, the most violent nation on earth.⁠7

Luhrman’s excellent piece makes this crystal clear:

“Your level of risk [for schizophrenia  also rises if you were beaten, taunted, bullied, sexually abused, or neglected when you were a child. In fact, how badly a child is treated may predict how severe the case of an adult person with schizophrenia becomes—and particularly, whether the adult hears harsh, hallucinatory voices that comment or command. The psychiatrist Jean-Paul Selten was the first to call this collection of risk factors an experience of “social defeat,” a term commonly used to describe the actual physical besting of one animal by another. Selten argued that the chronic sense of feeling beaten down by other people could activate someone’s underlying genetic vulnerability to schizophrenia.⁠8

But I want to get back to discussing the sensitivity question because I think its crucial to understanding schizophrenia. Yes, certain genes undoubtedly predispose people to what is called schizophrenia but, at root, this is best understood not as a brain pathology but a brain sensitivity, something which can be an asset, not a liability – particularly in a peaceful, spiritual society.

Dr. Some has this to say about sensitivity in a remarkable piece entitled The Shamanic View of Mental Illness:

“Those who develop so-called mental disorders are those who are sensitive, which is viewed in Western culture as oversensitivity. Indigenous cultures don’t see it that way and, as a result, sensitive people don’t experience themselves as overly sensitive. In the West, “it is the overload of the culture they’re in that is just wrecking them,” observes Dr. Somé. The frenetic pace, the bombardment of the senses, and the violent energy that characterize Western culture can overwhelm sensitive people.⁠9
To test his belief that the shamanic view of mental illness holds true in the Western world as well as in indigenous cultures, Dr. Somé took a mental patient back to Africa with him, to his village.
The patient, Alex, was an 18 year-old American who had suffered a psychotic break when he was 14. He was suicidal with hallucinations, and went through cycles of dangerously severe depression. He was institutionalized and given every type of psychotropic drugs, but nothing helped.
His parents had exhausted all treatment modalities; they didn’t know what else to do:
“With their permission, Dr. Somé took their son to Africa. “After eight months there, Alex had become quite normal, Dr. Somé reports. He was even able to participate with healers in the business of healing; sitting with them all day long and helping them, assisting them in what they were doing with their clients . . . . He spent about four years in my village.” Alex stayed by choice, not because he needed more healing. He felt, “much safer in the village than in America.”⁠10
After 4 years, Alex returned to the USA because “he discovered that all the things that he needed to do had been done, and he could then move on with his life.” The last that Dr. Some heard about Alex was that he was attending graduate school at Harvard studying psychology.
I’m delighted to be able to present these “dissenting voices,” particularly because they richly confirm my own clinical experience working with “crazy people.” 
I have had sweet, innocent patients who were connected to a higher spiritual dimension who had much to teach us but, because of their vulnerability, were cruelly preyed upon in our dog-eat-dog world. I’ve had patients who, after a sudden epiphany, confused being in the presence of the divine with being the divine. And I have also had patients with vengeful, violent command hallucinations which, I discovered – in every case – if I were able to see them long term, were always connected to early childhood trauma, usually sexual abuse.
1 A Brief History of Schizophrenia
Schizophrenia through the ages.
Published on September 8, 2012 by Neel Burton, M.D.
2 The Delusions We Serve by Gary Greenbergaug. NYT 8/28/14
3 The Social Causes of and Treatments for Schizophrenia by tanya marie luhrman
4 The Social Causes of and Treatments for Schizophrenia by tanya marie luhrman
The Wilson Quarterly: Jan/Feb 2013
5 The Delusions We Deserve by Gary Green Bergergaug: NYT 8/28/14 A Review of new book,Suspicious Minds,’ by Joel Gold and Ian Gold
6 Ibid.
8 The Social Causes of and Treatments for Schizophrenia by tanya marie luhrman
9 What a Shaman Sees in A Mental HospitalTHE MIND UNLEASHED on 25 August, 2014 at 00:48
10 Ibid.
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