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The Touch of Madness (psmag.com)
69 points by fern12 8 days ago | hide | past | web | 16 comments | favorite

I was diagnosed with schizophrenia about 11 years ago.

The "double bookkeeping" mentioned in the article is a neat description of how I sometimes dealt with the hallucinations. Everything I experienced was real to me but I quickly realized that it was not "objectively real", for lack of a better term. I had the luck of having a GREAT support network, and I highly believe that its because of that I'm functioning today.

I'm currently symptom-free and have been for a few years (despite being a dumbass who cold-turkey'd my meds without my doctors knowledge). I want to try to help anyone who's feeling isolated due to "mental illness" (not a fan of that term either). Drop me an email: helpful at hax dot xyz

(apologies for rambling and/or strangely formatted text, writing this on phone whilst commuting)

I ended up stumbling on that idea of "double bookkeeping" as well, though in the context of acute drug induced hallucinations.

What made it hard for me is that both sets of ideas are correct about some aspects of my experience and wrong about some aspects. The hallucinations are mostly wrong where they deviate from "standard" reality, but they're not entirely so and seem to be capturing some patterns that my brain is picking up that I can't articulate through other mechanisms. Counter-intuitively, admitting that there were facets of the hallucinations that did make sense made it easier to deal with accepting that there were parts that didn't as well.

I view it as having two approximate models for reality which have different faults -- one model is knowingly incomplete (but scrupulously consistent); the other model is knowingly inconsistent (but has models for any experience, and serves for "experimental" ideas). The goal is to try and work both towards a shared (underlying, objective) truth trapped "between" them in some sense.

>but they're not entirely so and seem to be capturing some patterns that my brain is picking up that I can't articulate through other mechanisms.

Drugs made me more aware of how routinely our brains mildly hallucinate in ways that are designed to be imperceptible so as to 'smooth over' our perception of the world (i.e. our blind spots https://visionaryeyecare.wordpress.com/2008/08/04/eye-test-f... ).

It always seemed as if drug-induced hallucinations were less some kind of emergent or externally-imposed phenomenon and more of the drugs simply ratcheting up the misfire rate on normal systems of consciousness like face recognition, pattern recognition, piecing together incomplete information via extrapolation from memory, etc.

Learning to recognize this kind of 'misfire' and label it as distinct from objective reality was enormously helpful to me when it occurred to my emotions later, because of bipolar disorder.

The Charles Bonnet syndrome is a good example: https://en.wikipedia.org/wiki/Visual_release_hallucinations

Thank you for this comment!

My problems are different from drug-induced hallucinations or schizophrenia, but I believe they are related. You (and OP) have put into words something I've been struggling with for much of my life: the feeling that I'm engaged in "double bookkeeping", and the experience that giving both 'realities' a degree of validity leads to a much better outcome than trying to deny-all one of them. Of course that leaves 'outcome' rather fuzzy, but somehow that's easier to accept and live with.

Well put, after a bit of reflection I mostly subscribe to the concept of several "approximate models" wherein "objective" truth lies somewhere inbetween.

My own hallucinations were auditory and in the instances where they weren't random noises they only said my name, often in "plausible voices" (i.e. voices of people I had talked to recently or were nearby) and as such I don't ascribe much meaning to them. I can however see how other psychotic symptoms I've had followed the "approximation"-pattern -- had an incident where for about a day I was convinced my left arm weren't actually my arm and was most likely grafted on by aliens. In hindsight, this probably manifested this way at least partially because of fear of being different due to my diagnosis.

I find the idea that "the map is not the territory" useful in considering delusional beliefs. It keeps belief and reality separate, where "belief" could include things you know to be hallucinations etc (though I've never had those). https://wiki.lesswrong.com/wiki/The_map_is_not_the_territory

> (despite being a dumbass who cold-turkey'd my meds without my doctors knowledge)

Robert Whitaker says that the only people he's met who recover are the ones who stop taking their pills. Anatomy of An Epidemic is written around the premise that psychiatric medications take an episodic illness and make it chronic.

Avoiding polyunsaturated oil is a very important part of helping people with mental problems. These oils are "deodorized" during their production process, so that people don't realize they've already gone rancid.

random pages from Whitaker's organization:

Your Drug May Be Your Problem: How and Why To Stop Taking Psychiatric Medications - https://www.madinamerica.com/mia-manual/drug-may-problem-sto...

What Happens When You Stop Taking Psychiatric Medications - https://www.madinamerica.com/2017/09/stop-taking-psychiatric...

> When the director of the World Health Organization's mental-health unit, Shekhar Saxena, was asked last year where he'd prefer to be if he were diagnosed with schizophrenia, he said for big cities he'd prefer a city in Ethiopia or Sri Lanka, like Colombo or Addis Ababa, rather than New York or London, because in the former he could expect to be seen as a productive if eccentric citizen rather than a reject and an outcast.

I can't help feeling that this is based on some pretty skewed statistics. Someone in Colombo or Addis Ababa who's 'a bit odd might' well be seen as as 'productive if eccentric'. I don't expect a first world country would be any different. But the question is how do people further down the spectrum end up faring, and I can't imagine a raving lunatic would do better, on average, in a big city in a poor country than they would in a similarly big city in a rich country.

> I can't imagine a raving lunatic would do better, on average, in a big city in a poor country than they would in a similarly big city in a rich country

Is this anything but an argument from failure of imagination?

As a neutral observer, it seems more likely that the director of the WHO's mental health unit is informed about the experiences of the mentally ill across the globe than your hunches are. My hunch about statistics is that your feeling about statistics is rooted in unsupported beliefs about your society as opposed to facts.

I think the implication is that some places (Ethiopia or Sri Lanka) are more open in what constitutes "a bit odd" versus "deranged" than others (US or UK), and that this greatly impacts outcome once you account for general conditions of living (ie, only talking about big cities).

> I can't imagine a raving lunatic would do better

Notice how you jumped to an extreme to make your point -- raving lunatics are unlikely to do well anywhere so there is unlikely to be much variation in the outcome for them, you are correct. But what does the distribution look like? The median? The mode? etc. The vast majority of schizophrenics aren't raving lunatics -- though they are very susceptible to how they're interacted with by society.

I'm inclined to believe that when discussing the distribution of outcomes, the expected outcome on average is better where the WHO director believes it is.

>But the question is how do people further down the spectrum end up faring, and I can't imagine a raving lunatic would do better, on average, in a big city in a poor country than they would in a similarly big city in a rich country.

You'd be surprised. E.g. rural communities used to treat their "raving lunatics" much better than rich countries with their work schedules, lack of knowing each other, impersonal support networks (e.g. charities and soup kitchens), etc. Consider all the "raving lunatics" that are left to wonder and cater for themselves as homeless, and then are routinely discriminated, beaten up, thrown out of parks, etc. Heck, ordinary citizens feel out of place, get (situationally) depressed, and anxious in such big cities, much less a "lunatic" where it's either homelessness, or some atrocious asylum.

This also means that the people not that far right in the spectrum, might also be better off in those societies -- here the totally OK people already are pressured by the pace, loneliness, etc. We do have more drugs to throw at them, I'll admit to that.

I only have experience with the US. My experience has been that if people detect even a hint of eccentric or crackpot about you, they hospitalize you at worst, shun you on average, and condescend to you like an invalid at best. With the right context, you might be able to spin it into an acceptable narrative, for example if you are an artist. From what I have read, other countries offer more such narratives.

Anecdotally my experience living in a very poor country is that even the extremely schizophrenic can have a much better life than the one they'd have in my current rich, Western country (Netherlands).

However, this outcome depended on whether these individuals had a social network that could support them. The severely mentally ill (or for that matter, also the physically disabled or orphaned) without such a network fared significantly worse than they would over here in Holland.

In fact, their situation was sometimes so bad that I'd go for the 'clinical' and flawed but consistent just to avoid that. I still feel there's a middle ground to explore, though, or at least a lot of inspiration to draw from.

Very inspirational and empowering story. It goes to show that a large part of mental illness is inflamed by rejection from society, depleted self-esteem, and lack of trust. There are too many doctors that are all too willing to condemn their patients to a resigned fate of helplessness, meanwhile these people can demonstrably be healing and living with the right support systems and guidance.

Compassion, empathy, and true interest in the wellbeing of others are the keys to happier, healthier humans-- as well as a better, more peaceful world overall. This is particularly true for people we may not understand.


As an anecdote, when I had been symptom-free for a couple of years, I decided to move to a bigger city for work. Because I didn't know anyone else living there, I fell back into old habits of isolation and my hallucinations came back. I ended up explaining to my employer and we came to the conclusion that I couldn't keep working there as remote work wasn't an option. A few weeks after I had moved back home, the hallucinations stopped again. I quickly realized that my support network was the main thing keeping me "sane", and as such I started valuing them much more and ensuring they know that I'm here to support them too.

> Western cultures tend to send the afflicted into a downward spiral rarely seen in less modernized cultures

This reminds me of some of the "poet-saints" in Indian culture such as Kabir. By conventional wisdom, these men would have been deemed insane - vagrants who renounced all material possessions to walk about the earth, preaching a strange amalgamation of various religious ideas. Yet, they are a part of Hindu, Muslim and Sikh religious thought today.

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