
Why what we think we know about schizophrenia is wrong - jajag
https://www.theguardian.com/books/2019/may/11/nathan-filer-schizophrenia
======
pygy_
Treating DSM categories as if they were a single disease is completely
misguided. The DSM describes syndromes, and ignores pathophysiology because we
still have little to no idea of what happens in the brain (at least not enough
to properly understand the relevant functional aspects).

Genome-wide association studies have recently shown that schizophrenia was in
fact several distinct diseases [0]. Their symptoms turn out to be mediated by
the same drugs, to the extent that they makes the people who suffer from those
ailments manageable.

If your house suddenly becomes cold in the winter, putting on a jacket will
help you feel better. You wouldn't infer from that that your furnace is down
because of a clothing imbalance.

[0]
[https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2...](https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2014.14040435)

~~~
thatoneuser
This is why I think very highly of the transition in DSM V to diagnosing on
spectrums. It's not perfect but it really helps get away from putting people
into buckets they don't really belong in.

~~~
lupire
At the expense of putting people on spectrums where two people with the same
diagnose have wildly different symptoms and effective treatments, rendering
the diagnosis moot.

This is a crisis in "autism", where Asperger's and autism are different on
such an extreme scale, yet the language, medical literature, and treatment
plans and funding are muddling it up to the detriment of all involved,
creating a culture war between people who say their mild Asperger's is a
personality type not a disorder, and caregivers of people who cannot speak or
provide basic self-care for themselves -- because DSM dumps them in the same
diagnosis and society loses the language to disambiguate the scenarios.

------
coleifer
My youngest brother has schizophrenia, which started when he was 19. He just
turned 31, and were it not for his family supporting and caring for him, I'm
sure he would be homeless or worse. He's one of the most sensitive, gentle
people I have ever known. My wife and others who have gotten to know him would
agree.

Although he's "stable", thanks to an injection every 3 weeks, he's not going
to ever get better. In fact he continues to retreat further and further away
from the world and life. Why don't you go to the bowling group, movie night,
job placement, etc, I used to ask him (events organized by a local psych
facility for their patients, etc). Those people are crazy, he said.

It's a baffling disease. Besides his hallucinations and delusions, the
defining feature seems to be that it resists treatment of any kind that would
lead to what you and I would call a normal life.

~~~
asveikau
It might be he doesn't want to associate with people, groups, events that
revolve around the diagnosis. Perhaps that labels him an "other" and it feels
little much. Why not similar activities with the general population?

That is not meant to belittle the point that delusional people will strongly
deny their symptoms, of course. Being close to somebody like that gets tough,
especially when the delusions have led to harm to self or others -- even after
they get treatment and it works, it's easy to become paranoid of relapse and
fear that every small act of legit defiance or assertion of self is a
recurrence of symptoms.

~~~
coleifer
Extreme agoraphobia, social anxiety, very little to talk about... Most 31 year
olds are working, raising children, etc., and don't live in their parents
house. Don't underestimate the shame he feels when around others. Outside his
family, I think it is overwhelming for him.

~~~
Mirioron
I think this is a very important point. He doesn't fit in and humans love to
ask one another about their lives. If you give non-standard answers, then
you're seen as weird or a failure in life.

------
PaulHoule
The diagnostic words that start with "schizo-" are a train wreck.

Schizophrenia is characterized by hallucinations, delusions, thought disorder,
catatonia, etc. You don't hear much about catatonia these days because it is
cleared up by benzodiazepines reliably.

Schizoid people have reduced emotional reactions compared to other people but
they are in touch with reality.

Schizoaffective disorder seems to pick a few symptoms from schizophrenia and
bipolar but doesn't fit the criteria for either. You might think that sounds
less severe but it can be devastating.

The romanticization of schizophrenia of r.d. Liang, "one flew over the
cuckoo's nest", szasz and others strikes me as particularly cruel when I see
how it keeps people who are suffering from getting help.

~~~
scardine
I don't think "one flew over the cuckoo's nest" romanticizes mental illness,
for me it is about demonizing institutionalization.

It pictures the time when mental illness diagnostic was an easy method to put
away anyone annoying or inconvenient (the subject really having a mental
illness or not made little difference). It talks about institutional cruelty
like torture and lobotomy.

But then I didn't read the book, just watched the movie - perhaps the
"romanticization of illness" angle is more pronounced in the book but I'm
pretty sure it was not the main theme and the novel did more good than bad for
those diagnosed with a mental disorder or developmental disability.

~~~
jquery
I mostly agree, but I think the movie romanticized the end of
institutionalization, making us believe we've progressed "beyond" it, when we
merely have people screaming on street corners and sleeping in the gutter.
Institutionalization should've been reformed, not all but eliminated (I know
it still exists, but only for the most extreme cases).

~~~
flensortow
If someone is not a threat to themselves or others, but has strange beliefs
and behaviors, should we really take their freedom away just because we don’t
think they are taking care of themselves adequately or we don’t like the
sight/sound of them?

As someone with bipolar disorder (very stable since diagnosis and medication)
I’m always a bit dismayed when people call for locking ill people up “for
their own good.” (Not that you’re necessarily saying that - it’s just
something I do see people advocating for sometimes).

I’m in SF and previously lived Tenderloin-adjacent so I’m quite familiar with
the unfortunate cycle of mental illness and drug/alcohol abuse from self-
medicating. It’s not a pretty sight and I do think we should do everything we
can to help these most vulnerable people in society. I’m just not sure taking
their liberty is necessarily the best course of action.

~~~
harimau777
I think that society probably has the right to enforce basic social norms so I
think it is reasonable to for society to intervene if someone is being
threatening or violating basic norms (e.g. by defecating in the middle of the
sidewalk). Both of which are common in the Tenderloin.

The problem that I see is: what options are available other than violating
their freedom by forcing them to undergo treatment or locking them up? You
can't, for example, fine someone who doesn't have anything. Besides, I think
its unlikely that punishment would accomplish anything

So I guess I'm not sure I see a good solution to the problem.

------
lisper
About ten years ago I made a documentary film about homeless people. On my
first day of shooting I had an encounter with a schizophrenic guy named
Daniel, which I captured on film. I've put a clip of that encounter here:

[http://graceofgodmovie.com/superdanny.mp4](http://graceofgodmovie.com/superdanny.mp4)

It's worth watching all the way through. The difference in his attitude when I
stopped being afraid of him and started treating him like a human being
instead of a threat is dramatic. I learned a lot about life that day.

~~~
dwaltrip
This is a nice thought, and I do agree that we need more a lot more of this
perspective in the world.

But we need to be careful not to downplay the incredibly severe difficulties
involved in helping, treating, and even simply co-existing across the months
and years with those who have schizophrenia.

I had a good friend stay with me for 2 months who ended up having significant
schizophrenia-like symptoms (never found out the actual diagnosis). I tried my
best to treat him like a human and get him the help he needed, but I was
unable to. I don't want to go into details, but a lot of stuff happened. It
was a very difficult time.

~~~
lisper
Oh, absolutely. I'm not saying that you can just treat schizophrenics like
normal people and everything will be hunky-dory. All I'm saying is that not
being afraid of them (because most of them (though not all) are totally
harmless) is a good first step.

------
DanBC
> It was during my own nursing training that the currently favoured term of
> “service user” gained traction, as it was deemed more neutral.

Patients overwhelmingly prefer the term patient, and this holds true every
time we ask them what they want to be called.

Service user is a term imposed upon them by well-intentioned mental health
professionals and academics who don't recognise their own power dynamic and
who do a poor job of coproduction.

> while the council of the Royal College of Psychiatrists recently recommitted
> to “patient”.

...after they asked people what their preferred term is.

~~~
thatoneuser
Academics can be the dumbest smart people.

~~~
Gibbon1
Academia teaches you there are simple solutions to common problems. And that
non-academics are stupid.

Most real world solutions are shitty and incomplete.

------
raybon
Ah, where do I start. Two of my close relatives have schizophrenia, people
whom I’ve known since they were born. They were both diagnosed around 19 and
are now 29. In the last ten years we’ve tried many medications,
hospitalizations, with little to no avail. I never understood the word curse
when I was a kid. I read about it in stories and I had seen people curse each
other. Living with schizophrenia is the definition of a curse. Lives wasted in
an alternate reality. The lives of the care givers and family impacted
terribly.

------
mindgam3
> Importantly, what we call psychosis can also be a response to extreme stress
> or trauma. For many people it might best be understood as... a coping
> strategy gone awry or a form of storytelling carried out within the mind as
> a response to unbearable life events.

This. The day that mental health professionals realize this is the day that we
start improving outcomes.

> there is no uncontroversial language when talking about mental illness – and
> that includes the phrase “mental illness”

Glad the author brought up this important point. “Illness” is bogus because it
implies disease/biomarkers for which there is no evidence as the article
states.

A more useful term would be “mental injury” as it frames the symptoms as a
result of trauma. But I think the best term is simply “trauma” or
“developmental trauma” when it goes back to childhood.

------
hindsightbias
Well, this article didn’t lead to any answers or any insight for me. The whole
unexplained opening of poisoning is cryptic and unhelpful. Does this nurse see
the nuclear options as poison or was this doctor trying to give Amit cyanide?
Who knows.

I’ve spent a month of evenings at Langley-Porter and then again at Zuckerberg,
and the staff there didn’t strike me psychzombies. The last thing they wanted
to do was to commit to a diagnosis of schizophrenia for my relative. I sat for
an hour with the Attending on his outtake and she did everything to assure us
that in her expert opinion it wasn’t black and white - drugs were part of the
toolset and not The One Answer.

What’s wrong isn’t that people are ignorant. They always have been and always
will be. Until you’ve been there, you won’t get it.

What’s wrong is we have brilliant people who are hamstrung by process. At SFGH
it’s “If you aren’t a threat, you’re out” 7 days after the 72 hour lockdown.
It’s a factory, because that’s all the runway WE give them.

We’re lucky. We’re wealthy enough and there’s enough of us that we can
probably make this work.

But the other 90% in those wards? They don’t have anybody. So unless WE want
to fund that level of intervention/compassion, the factory and pharmacology is
the solution.

------
isnetea
I’ve often wondered if it’s possible to induce psychosis and symptoms of
schizophrenia in a subject via environmental conditioning. This seems
practical to test these days, given the expanse of information possessed by
large tech companies, and their lack of regulation. Perhaps this would be
related research for a larger automated behavior control initiative. Does
anyone have any pertinent references or info?

~~~
JamesBarney
Mind elaborating on the connection between psychosis and automated behavior
control.

~~~
isnetea
Restated, is it possible to develop (eventually automated) ways to “drive
people crazy”. Is it possible to use data and algorithms to manipulate someone
into losing contact with reality, for instance, or trick them into manifesting
schizophrenic symptoms

~~~
JamesBarney
I don't think so. One of the primary theories of schizophrenia is that the
glial cells in the brain are doing too much synaptic pruning. It's more of an
organic disorder than say depression or anxiety which is heavily affected by
environment.

------
squirrel
I find Xavier Amador very engaging and convincing on how to actually help
schizophrenic people who say "I'm not sick, I don't need medicine":
[https://www.youtube.com/watch?v=Lstn6WNnCRc](https://www.youtube.com/watch?v=Lstn6WNnCRc)

------
HeadsUpHigh
DSM and other such systems(icd for example) are for CLINICAL use. I.e. they
are not academic. If 2 different mechanisms create the same symptoms and are
treated by the same drugs then from a clinical aide of view separating them is
pointless. Academic research on the mechanics of diseases is much more nuanced
than what an article on a news site can cover. Once something is clearly
separated as 2 different entities in a clinically meaningful way via research
then the classification system will be updated. What this means is that if
e.g. we find a way to differentiate between 2 different mechanisms for
schizophrenia with each of the responding better to a different drug( even if
those are already existing drugs, it gives us a shortcut to choosing the right
medication without trial and error) then DSM will split schizophrenia to
schizo due to x and schizo due to y with further guidelines for medication. Or
split them into 2 different things entirely.

------
tomohawk
Schizophrenia can run in families. A family we knew was killed in the middle
of the night by their step son with a hammer. Apparently, the disease can have
a sudden onset. The mother and step father were teachers, and the whole
community was affected. The son (teenager at the time) was diagnosed and has
been held in a facility now for many years. The biological father has been in
and out of institutions and homeless.

Such a terrible disease.

------
tcj_phx
Most of the supposed "mental-health conditions" are manifestations of stress.
There are two kinds of stress: biological and emotional.

Biological stress is related to things like being malnourished and/or having
hormonal imbalances (thyroid, cortisol, progesterone, etc), not getting enough
sunlight (no red light -> winter sickness / UV light-> Vitamin D), etc.
Biological stress is worsened when a person is medicated with patent medicines
that are approved for treating behavioral symptoms by implementing wrong-
theory about the cause of the behavioral symptom (i.e., inadequate serotonin
-> depression [0], excess dopamine -> psychosis, etc).

Some scientists rediscovered a few years ago that the behavioral symptom of
"psychosis" is strongly associated with an inability to make adequate amounts
of the stress hormone cortisol [1].

Emotional stress has to do with people feeling trapped. From the article:
"Importantly, what we call psychosis can also be a response to extreme stress
or trauma."

Emotional stress leads to the release of cortisol too. If a person's long-term
emotional stress exceeds their ability to compensate, their "mental health"
will suffer.

One part of this article is about forcibly medicating people whom the
professionals think don't realize they need the pills they're prescribed.
IMHO, it is an act of violence to force a person to take pills that make them
suicidal [2]. The legal systems generally recognize that people have a choice
in medical treatments, but struggles with patients who don't even realize they
have a problem [3], and/or don't like the treatments the professionals think
they need. In the US the courts have decided that people can't be "helped"
against their will without a court order. This is why Jared Loughner, the man
who shot up Congresswoman Gifford's event, couldn't be helped, even though the
people around him noticed that his behavior had changed [4].

The professionals tried to label my girlfriend as "schizophrenic". Really she
was just stressed ("lonely"), and was suffering from the adverse effects of
various medical interventions. Methadone causes sugar cravings; she'd taken to
treating this medication-induced metabolic problem with alcohol a few days
before we'd met (alcohol has 7 calories/gram, while sugar only has 4
calories/gram).

In my initial assessment she also reported being injected with a prescription
endocrine disruptor maybe 10 years before [5]. This prescription drug has
warnings about endocrine disruption [6], but doctors don't appreciate their
patients' iatrogenic deterioration when it's associated with this defective
drug.

My girlfriend became psychotic when she ran out of alcohol , but rather than
treating her for the cause [7] they treat her for the symptom with "anti-
psychotics". I consider her involuntary treatment program to be "medical
assault". I found a lawyer a while back who was familiar with how the state's
involuntary treatment system works, but lawyers are expensive, so I tried to
go at it myself. Maybe the legal guild didn't take kindly to a legal-nobody
pointing out that their system is ugly.

I guess I'm going to hire the lawyer.

tl/dr: The conventional practices of the mental health industry are wrong.
Institutional inertia prevents the profession from fixing itself. Little bits
of progress have been made in recognizing the system's contribution to the
patient's problems. As I said before, the system needs a re-write:
[https://news.ycombinator.com/item?id=19545964](https://news.ycombinator.com/item?id=19545964)

[0] What has serotonin to do with depression? -
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471964/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471964/)

[1] [https://psychcentral.com/news/2016/06/04/low-morning-
cortiso...](https://psychcentral.com/news/2016/06/04/low-morning-cortisol-
levels-linked-to-psychosis/104266.html)

[2] [https://en.wikipedia.org/wiki/Akathisia#Drug-
induced](https://en.wikipedia.org/wiki/Akathisia#Drug-induced)

[3] Anosognosia -
[https://en.wikipedia.org/wiki/Anosognosia](https://en.wikipedia.org/wiki/Anosognosia)

[4] Jared Loughner -
[https://en.wikipedia.org/wiki/Jared_Lee_Loughner#Behavior_ch...](https://en.wikipedia.org/wiki/Jared_Lee_Loughner#Behavior_change)
"In the months leading up to the shooting, Loughner's parents became
increasingly alarmed at their son's behavior, at one point resorting to
disabling his car every night in order to keep him at home."

[5] [https://en.wikipedia.org/wiki/Depo-
Provera](https://en.wikipedia.org/wiki/Depo-Provera)

[6] "Effects on the Hypothalmic-Pituitary-Adrenal Axis: Some patients
receiving medroxyprogesterone acetate may exhibit suppressed adrenal function.
Medroxyprogesterone acetate may have cortisol-like glucocorticoid activity and
provide negative feedback to the hypothalamus or pituitary. This may result in
decreased plasma cortisol levels, decreased cortisol secretion, and low plasma
ACTH levels.The use of DEPO-PROVERA Sterile Aqueous Suspension may, due to its
cortisol-like glucocorticoid activity, also produce Cushingoid symptoms such
as weight gain, edema/fluid retention, and facial swelling." \-
[https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/01...](https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/012541s086lbl.pdf)

[7] [https://en.wikipedia.org/wiki/Substance-
induced_psychosis#Su...](https://en.wikipedia.org/wiki/Substance-
induced_psychosis#Substances) \- "Alcohol is a common cause of psychotic
disorders or episodes, which may occur through acute intoxication, chronic
alcoholism, withdrawal, exacerbation of existing disorders, or acute
idiosyncratic reactions. Research has shown that alcohol abuse causes an
8-fold increased risk of psychotic disorders in men and a 3 fold increased
risk of psychotic disorders in women. While the vast majority of cases are
acute and resolve fairly quickly upon treatment and/or abstinence, they can
occasionally become chronic and persistent. _Alcoholic psychosis is sometimes
misdiagnosed as another mental illness such as schizophrenia._ " (emphasis
added)

(edit: added reference [7])

------
yosys
I dislike psychiatry grossly because the victims of the field are not
compensated by how the errors destroy the victim's life.

I'm a person who was medicated with the older & new generation of
antipsychotics for two years of my early 20s because I was suffering religious
conversion therapy "best I can describe it" from family and where I was in
circumstances any other person would have great amounts of stress. The outcome
of unfortunate events made me with a doctor who disliked me for desiring to be
a woman (I was born a male) and attempted to convince me it's delusions &
hallucinations; when I attempted to communicate I never suffered from either.
The medication would result in me doubting myself but I eventually broke away
from it all. It was impossible to find anyone to help sue for the tremendous
pain (I still suffer to this day from it all) and it's been many years since
it all happened.

Anyway I deeply believe there should be a special hell for people who go into
this field but I doubt anyone had any will in the outcome for me being any
different because I've read philosophy on determinism since then. I think the
field has done more damage than good and is a net negative with getting away
with it all because of government allowing it. People prefer to believe
something is good and when it really isn't.

~~~
ordu
There is a book "A Road Back from Schizophrenia: A Memoir"[1]. Arnhild Lauveng
came back from schizophrenia, got a degree in psychology and wrote the book,
describing how it feels to have a schizophrenia. She describes doctors too. A
bad ones and also those, who helped her to get back from schizophrenia.

I believe you would like that book, her experiences are like yours.

[1] [https://www.amazon.com/Road-Back-Schizophrenia-
Memoir/dp/161...](https://www.amazon.com/Road-Back-Schizophrenia-
Memoir/dp/1616088710)

~~~
yosys
No, the experience was meaningless like life and nothing more than torture. I
believe the field will die slowly and my life was worthless. I plan to act on
suicide in the near future because of the torture.

~~~
ordu
The meaning of your experiences is what you make from it. It is the reason why
I suggest you reading this book. A similar experience through different eyes.
A psychologist probably might say about a therapeutic effect of this, but I'm
not a consulting psychologist, so I rather say in a technical terms: it is
hard to find meaning having just one point of data. You need at least two to
draw a line.

By the way, did he disliked you because of your desire to be a woman, or for
some other reason?

 _> I plan to act on suicide in the near future because of the torture._

It makes hard to me to speak with you. It feels like a minefield, one wrong
step, one wrong word and I became a cause of someone's death.

I'll try to ignore that. Why are you suffering now? If I understood you right,
torture ended at least a few years ago. Some kind of "flashbacks"?

------
soup10
Most mental health workers know that the popular conceptions about what
schizophrenia is and how its managed are wrong.

------
qrbLPHiKpiux
Much, if not all, of mental health is based on theories and assumptions."

"It's thought that..." when referring to how medications work.

Let's just agree that we all know nothing about mental health.

~~~
PaulHoule
We know a lot.

If there is a comprehensive theory it is that mental disorders and
developmental disabilities come in layers.

You might have a genetic predisposition to certain problems, have that
exacerbated by traumas, but learn how to compensate for them in some ways. You
might do badly at certain things or certain situations but if you have support
from other people, understand the difficulty, etc. you can do O.K.

The big trouble I think is that mental illness and developmental disabilities
interact with the expectations that people have about others.

For instance much of the satisfaction parents get out of parenting is using
their children as "self objects"; they want to dress them up, show them off,
bask in their accomplishments, etc. An autistic child can't do that for them
and they find that hard to accept.

The marketing of SSRI's is also distorted. They are prescribed a lot by
primary care docs who need to be on top of a wide range of medical problems
and can't be experts on mental health too. That is a good thing because they
help people and it can be hard to get real help from a specialist.

Depression has many symptoms and for many people SSRIs help some symptoms but
not others. For me, for instance, SSRIs help me control my emotions in
situations where I might get overwhelmed and yell at people. I believe that
they increase my self-control as opposed to suppress my emotions.

I have other symptoms that SSRIs don't help with, but I do feel like they've
helped me a lot at being a parent.

~~~
pygy_
_> We know a lot._

Yet we know very little, like, we knew how to make fire before Lavoiser
discovered the role of Oxygen in combustion.

The various paradigms we use are approximate, not unlike humor and miasma
theories were of some help before we understood physiology and discovered the
existence of germs.

The main theories of the 20th century (psychoanalysis and chemical imbalance)
have been steadily eroded by research, but are still have far too much
importance in clinic.

 _> You might have a genetic predisposition to certain problems, have that
exacerbated by traumas._

Once we understand what genes and genes circuits are involved, and how trauma
makes it worse, we'll be getting somewhere.

~~~
PaulHoule
On some level.

There is a lot of social complexity that means we may not take advantage of
those facts. For instance we might get better drugs and other treatments but
will that really help the people who are crapping on the street in San
Francisco?

Autism in particular challenges the assumptions of society. The one thing
aspies really can't do is "see the emperor's clothes". In asperger's day they
did not get along well with National Socialism, today they have problems with
neoliberalism.

You might fantasize that getting real help for aspies would increase their
productivity a lot, mean they pay more taxes and make the help profitable for
society, maybe even bend the curve of our civilization.

From another viewpoint there is more talent than there is opportunity. Maybe
Aspies are 1% of the people in the top 2% of IQ, salvaging them means a small
increase of the talent pool, and if you at the top of some insanely
competitive pyramid (etc. academia, business) why spend money to make it more
competitive for your kids...

Similarly, social structures tend to constrain the performance of science. We
create the script that there is a "depression gene" and people build a career
around that, maybe somebody wins a Nobel Prize, but really science is "what
scientists do" and is about making stories that make sense to some people at a
certain time and saying that some people are winners and others are losers. Go
look at a Cochraine report on this or that and you'll see that 5000 studies
got done, maybe 5 of those were done right, and there aren't enough samples to
really be conclusive.

Astronomy is like this. We "know a lot" but every time somebody does a new
study of Cepheid variables we find the cosmic distance scale isn't what we
thought it was, the cosmological models are broken, etc.

That is, science manufactures a certainty that isn't there. "Reason" is often
a label people use to attack other people. "Reason" magazine for instance has
that name to say that socialists, labor unions, regulators, etc. are not
"reasonable" and shouldn't be listened to.

~~~
pygy_
The social aspects are also off course crucial. I'm lucky enough to live in a
country with a social safety net that's stronger than what you have in the US
(there are still homeless folks, but psychiatric care is free in France).
Still, I'm well aware that mental care is a luxury.

Psychoanalysis is still very potent here though. The mothers of autistic and
schizophrenic people were, for decades, vilified as responsible for the
problems of their children.

A friend of mine who was anorexic for years had to endure cruel and demeaning
treatments (based on Freudian BS). As she said: "As if it were funny to lose
all those kilos :-/".

It's recently been found that, at least in some cases, anorexia is the result
of auto-antibodies that stimulate the melanocortin receptor in the brain (the
main satiety hormone). Those antibodies occur due to a cross-reaction with a
protein secreted by E. Coli (CLPB). Bulimia and binge eating can have the same
pathophysiology (where the antibodies block the receptor instead of activating
it). Yet my friend was treated as if she was making it up, "to ultimately
affirm herself".

