You can blame the schools for misdiagnosing ADHD, and you can blame them for a poor IEP, but you can't blame them for a child not having a normal life due to one of the most tragic diseases known to man.
Schizophrenia is not the kind of disease you can treat with an IEP, and it sounds like the author's son fell out of the system from a very young age. Trying to blame anything but genetics and development for his son's state is disingenuous - treating schizophrenia is a complicated, involved, and ultimately very stressful process for everyone involved, and in the end it can only bring someone on the brink of homelessness or self-harm into a situation where they can be stable most of the time, but never all of the time, or even almost always.
> The word “disability,” for instance, should have covered Tim and children like him.
ADHD or blindness are not even in the same room a schizophrenia. It's like comparing having six toes on your left foot to being comatose.
> If I were a legislator today, I’d mandate — and provide funding to ensure — that every teacher receive training in recognizing symptoms of mental illnesses.
Teachers have enough on their plate, and more importantly, that's not what teachers are for. It sounds like the author took his son to plenty of mental health professionals, and he still wasn't properly diagnosed until he was nearly an adult.
> I’d see that pediatricians are trained to make screening for mental health concerns a regular part of well-child exams.
Many mental health diseases don't manifest to the levels for proper diagnosis until adulthood, and even then the process of diagnosis is not scientific.
> I’d put much more money into community mental health services...
All of that sounds great, but mental health services are one of the first things cut into in a down economy.
> Tim is where he is today because of a host of public policy decisions we’ve made in this country.
No, he isn't. The author is wrong, and I'm sorry for that, but it's very unlikely that his son would have ever been a contributing member of society. Schizophrenia is a severe mental disease that cannot be treated like a 'special need.'
This fatalistic attitude isn't wrong, but it is manifestly unhelpful and surprisingly expensive. Being homeless is not a zero-cost alternative to real treatment; in many cases, the cost of lavish treatment is far lower than the cost of ER visits and criminal proceedings that would otherwise be incurred. I believe Malcolm Gladwell wrote an article about chronic homelessness a few years ago, about Denver rolling out a program to take some number of homeless folks and set them up in an apartment free of charge with on-site nursing 24/7, and it was saving the city millions just by keeping them out of the ER. I believe the program ultimately came under fire because of how essentially un-American such a system is, even when it makes both ethical and financial sense.
The author is arguing that his son would not be homeless if institutional care had not be shut down, not that his son would be a productive member of society. It's practically tautological.
"The author is arguing that his son would not be homeless if institutional care had not be shut down"
Actually, he isn't. The only institutional care he mentions in the What I realize now section is "supportive short-term and long-term community housing and treatment", which doesn't sound like institutional care, in the sense of "When he was in jail, with its regular routines and meals, Tim usually stabilized". There was a reason why total institutions were, well, total.
In fact, his "if I were a legislator today" comments are essentially the same as the "I jumped at the opportunity to" do actions in the 1980's.
> "supportive short-term and long-term community housing and treatment", which doesn't sound like institutional care
But it is. The housing/treatment he is referring to covers a range of facilities from supported housing to crisis centers to residential and secure residential treatment facilities based in the community. The goal of these facilities is to provide the stability necessary for a person to compensate and, ideally, re-enter society.
Some folks need to enter a crisis center for a short stay during a time of instability. Some simply need a place to live (supported housing) with just a little more structure. There are also people who are chronically ill and do well (some not so well) in a residential or secure residential treatment program, but will never leave because they are unable to function without the stability of an institution.
Mental illness is a spectrum, hence the array of different support tools. The programs the OP was if'ing about exist, and are progressing. For instance, there is new legislature in my state that expands these programs to include general medical and dental care.
Part of my job includes tracking (arguably) quantifiable data on how clients respond to community-based residential treatment. I have not been in this space long, and I'm still learning about the underlying process/politics that our business model exploits. But I do have the data to show that residential treatment works, sorry I can't share.
That's a good point. The article begins with him discussing the shutdown of institutional care in favor of integrative approaches. But you're right, the solution he's promulgating at the end isn't really the same thing.
And that's what shocked me as well. He made the right diagnosis with the right title and the right observations, but jumped to the wrong conclusions :-/
He made the right conclusions and these programs have already been implemented. (at least in my state)
There are many community-based mental health providers. They are private-sector companies, usually nonprofits, that provide treatment paid for by state funding (medicaid, etc.).
No, it contradicts his own title and facts :
When he was in jail, with its regular routines and meals, Tim usually stabilized. But when he was released (...) he destabilized right away
The point I was trying to make is that these smaller community-based facilities do provide the stability that clients need to compensate. In fact they do a better job than a large impersonal institution.
I say it's a good point because it may be worth making a distinction between early-mid 20th century institutional care in an asylum and early 21st century institutional care through a variety of assistance programs. You have presented a good case that the distinction is either meaningless or that there is a direct relationship between the former and the latter, but either way, the article doesn't spell out the link between the two.
That's true, the article really didn't explain much about the programs he would like to see. I could have done a better job of explaining myself but it was late.
These residential programs are providing the type of solid routines that allows a client to stabilize and are actually doing a better job than the large institutions (according to my data). Think of the difference between how well most students do in a large impersonal lecture hall vs. 1 on 1's with teachers who take a real interest in their education.
This argument irks me. Have you been on the inside of a homeless shelter?
The constant bed bug invasions, bunking right next to a paranoid schizophrenic, living in constant fear of rape (yes, even for men)? Treated like a social pariah on a good day, non-existent the next? This isn't even the tip of the iceberg, I assure you.
Life inside the system is not nearly as rosy as you might think.
Often I feel like people should be made to work directly with the homeless before letting them spout off on this particular topic.
Your post suggested that the system wouldn't scale due to fraud - the implication being that people would take advantage of the free housing being provided.
What I said was that the conditions in these institutions is so inhumanly bad, that no one in their right mind would voluntarily do it. So what kind of fraud are you thinking of?
People running shelters taking advantage of government funding perhaps? Still seems the money is too little to make much profit through fraud, but there's no shortage of bottom-feeding hustlers and slumlords to try...
On the other hand, you have to ask whether the cost of trying to make sure not a single dollar is given to the undeserving outweighs both the monetary savings and benefits to society overall. Don't throw the baby out with the bathwater.
I envision this to be a lot like crime. You'll never get rid of it completely, so you put into place some (ostensibly) cost-effective measures to mitigate the worst of it.
> On the other hand, you have to ask whether the cost of trying to make sure not a single dollar is given to the undeserving outweighs both the monetary savings and benefits to society overall. Don't throw the baby out with the bathwater.
based on no data, what-so-ever? I believe the parent claiming that there would be no monetary savings at-scale or in the long term
And you believe that, based on no data what-so-ever? ;)
Right now, we spend a lot of money and get very little. If we chose to spend more rather than passively leak money, we'd at least be able to exercise some control over how it's spent, benefit from economies of scale, and so on.
To be explicit, I'm drawing a distinction between efficiency of dollars and raw quantity of dollars. Given the choice between spending $250 and getting nothing versus spending $500 and receiving something of substantial value, I'd opt for the latter. And that's what the qualifier about "benefits to society overall" is about; there's more value to be had from this than some dollar amount.
But if all we're thinking about is a) how many dollars it costs (and not how we're wasting money now), and b) that some small subset of people might game the system (which will always happen, regardless of counter-measures), I think that's self-defeating.
Banks combat fraud by investing in fraud prevention. They make it work because the margins are greater than the expense of the fraud prevention.
Without calculating the expense spread between the criminal justice system and the mental health system, I'd wager that the savings will be great enough that we can afford fraud prevention too.
The article I'm remembering actually addressed that. The program was limited to a very small number of people--tens, or fewer. They actually had one that wrecked his apartment every week, and still it was cheaper to fix it back up than to let this guy back on the street, where he would incur about $1M a year in ER bills. One of the big objections to this program came from the fact that the scale was so limited.
The fraud that jumps to my mind is a hypothetical person taking a free apartment, when they are perfectly capable of supporting themselves and would do so if the alternative was homelessness. That's certainly not cheaper.
I make no claims about how common this kind of fraud would actually be.
His son might not have been contributing, but having him homeless and bouncing in and out of jails is more expensive to society than appropriate institutional support.
Furthermore one of the stated issues is his unwillingness to take antipsychotic medication, and one of the characteristic traits is that in a structured jail environment, where he's presumably receiving those medications, he is able to function well. That indicates that with a proper support system that includes support to make sure that he takes the required medication, he might have a shot at being a contributing member of society.
Agreed - I cannot find any fault in any of your arguments. My brother in law has schizophrenia and takes anti-psychotics. He sleeps all the time, finds it hard to concentrate and lives in a permanent fog.
He needs these medications. But it has definitely changed him.
I am fully aware of this. My phrasing might have a shot was meant to indicate that he would face an uphill battle and success was still a somewhat unlikely proposition.
However when he's left to drift around homeless and without medication, his odds of success are currently 0. "Somewhat unlikely" is a significant improvement on that present reality.
What is your point? Schizophrenia already horribly changed the patients personality, medication just helps them deal with the symptoms. Before we had these drugs, schizophrenic patients were basically tortured (e.g. Lobotomy) because there was no way to help them.
> Before we had these drugs, schizophrenic patients were basically tortured (e.g. Lobotomy) because there was no way to help them.
The drugs are no better. I have done a couple stints in a private mental health (inpatient and outpatient) facilities when dealing with what was diagnosed as Schizo-affective disorder (which is basically the presence of schizophrenia and a mood disorder) and there was a teen there who was schizophrenic. He was a large dose of Risperdal (one of the major anti-psychotics) to treat the schizophrenia. I don't think I will ever forget the few weeks the doctor took him off his Risperdal. He was completely different. When on the drug, he was slow and almost catatonic at times. After been weened off, he actually had personality.
The point is that it's an imperfect solution, and maybe if we fund research in this area a bit more, we can find a better one.
Also, this is a bit tangential, but I don't really perceive schizophrenia as changing one's personality. I have a close friend who is schizophrenic, and when she has episodes, hardly a bit of her real self remains. It's not a personality shift, it's more like a personality stroke/seizure.
Given that those suffering from the illness so often hate the medication (I say this based on having 2 or 3 people tell me this, which is hardly data), doesn't that indicate how bad the medication is? If the disease is felt to be better (by some) than the treatment then we aren't doing very well.
MDMA is currently being tested (in sessions combined with therapy) for treating PTSD. I've heard nothing about its consideration for schizophrenia but it wouldn't be surprising.
Looked it up and this article mentions PTSD, schizophrenia, and Autism. There are some scholarly reference out there too. Seems mixed, but they want further studies.
Schizophrenia is a severe mental disease that can absolutely be treated with a comprehensive treatment plan, including medication and psychosocial interventions (including an IEP).
I didn't think the author was stating that his son wouldn't have schizophrenia if the schools had done better. I think he was saying that his son would have a better outcome with his chronic severe mental illness if various government agencies and actors were better organizing to identify and treat the illness.
Perhaps it's fair to say that Tim is where he is today because of his mental illness and a host of public policy decisions we've made in this country around how we treat mental illness.
It can be treated if you're in the lucky few who happen to have medication work for them and are able to tolerate the side effects (glad I fall into this category). Treatment's by no means guaranteed to work.
I think you've missed the point of the article. The author isn't saying that Tim would be normal but for the policy changes. He's saying Tim wouldn't be out on the street. Which is true--there has been a huge scaling back of mental health services in this country, not just in the down economy but over the past 30 years.
> The author is wrong, and I'm sorry for that, but it's very unlikely that his son would have ever been a contributing member of society. Schizophrenia is a severe mental disease that cannot be treated like a 'special need.'
I have met very many people with a diagnosis of schizophrenia. Some of those people were drug users (or had been drug users); some of those people were "forensic" patients and were being held in secure hospitals; some of those people were in the community, on medication, with full time work.
Schizophrenia is a complex illness that expresses in a wide range of behaviours, and a broad depth of severities of behaviours. One person may hear a few voices, but be able to cope well with those voices, while another people may hear more voices which are very threatening and hard to cope with.
Please, I understand what you're saying. (Some people with schizophrenia are very ill, and will need extensive support just to avoid homelessness) but I find your comment a bit stigmatising. Many people with schizophrenia do work; not all of them work full time paid employment but it's certainly possible for someone with a diagnosis of schizophrenia to lead a full and productive life.
All of what you said is true but this guy's son hsd early onset schizophrenia. The prognosis for late onset is really bad but for late onset it's terrible. Most schizophrenics are not capable of a full and productive life unless medicated and many, many people fail to keep up their treatment regimen because the drugs are hell for many too.
"The author is wrong, and I'm sorry for that, but it's very unlikely that his son would have ever been a contributing member of society."
In many less developed countries people with schizophrenia have better outcomes. It's only in the US where the condition is usually debilitating for life, because:
A) The US healthcare system relies on longterm use of anti-psychotic medication as the main form of treatment, which tends to lead to worse outcomes in the long run.
B) Family relationships in the US are generally not conducive to properly recovering from schizophrenia.
In other countries the people aren't completely normally, but they're also generally not completely unable to hold a job for their entire lives like in the US.
Can you elaborate? Are you saying in other countries the family/extended family generally care for the individual? Why are they more likely to hold down a job?
"Are you saying in other countries the family/extended family generally care for the individual?"
Schizophrenia is basically triggered & exacerbated by stress. If one becomes schizophrenic then it's possible to mostly recover from psychosis in low stress environments, but in higher stress environments it basically becomes permanent.
I think that Ethan Watters discusses why it is that people in poor countries do better due to social factors in his book Crazy Like Us, and Robert Whitaker discusses the role of anti-psychotics in Anatomy of an Epidemic.
In terms of social factors though, I vaguely remember that in poor countries families are more likely to let people with schizophrenia just hang out and work on recovering for years at a time, whereas in more developed countries this is less likely to happen. (Possibly because this isn't as possible due to the higher costs of living and the greater stresses of living in a society with a very unequal distribution of wealth, but I forget the exact mechanism.)
As for the basic data, here is one book that summarizes it:
Outcome from schizophrenia is routinely better in developing world settings, and this difference becomes apparent during the initial 2 years of illness. But even for developing world patients with a poor early course, outcome is superior to that of developed world patients with an equivalent early course. Employment rates are substantially greater for developing world subjects, and some authors have attributed this to the freedom from the economic disincentives to employment that can accompany the provision of disability benefits in the industrial world (1).
The stress trigger remains an unproved theory - there are other many potential explains (vitamin D, parasites, sociological baed on family dysfunctions...) but so far there is not a good fit.
In the UK we have something called the Sainsbury Centre for Mental Health.
They provide evidence based advice. They've provided some advice about getting people with mental health problems who are claiming incapacity benefits off benefits and back into work.
The traditional response is a long slow curve; don't rush anything; work is stressful; start with a bit of part time voluntary work; build that up; there aren't enough jobs around anyway and no-ones going to employ mentally ill people and the stress of rejection is harmful. They also used to have a stock of low grade jobs (shelf filling at supermarkets) so when people turned up they'd get kludged into whatever was available.
The evidence shows that many people actually want to be much more active. We now have strong anti-discrimination laws. And "place then train" (get someone a job that they want, then support them to keep that job) is much more effective. If someone is a good employee an employer probably wants to keep them on, and if there's funding available to make reasonable adjustments then letting them know is good.
Here's a list of the Sainsbury Centre publications
I completely agree with you. I think these demands on society are unrealistic. You can't expect that out of teachers and pediatricians.
My experience with the school system (I have a daughter with autism) has been much better then his sounds (I hope so given it's 40 years later). We have no push back in getting our developmental pediatricians' input into our daughter's IEP. Our school provides speech and occupational therapy. But as you mentioned, schizophrenia is a whole other world (even from autism in my opinion). There is no cure. There are only lesser of many evils. You can't expect society to fix that.
One thing that really bothers me are these crazy statistics - "one in every five children and one in every four adults has a diagnosable mental illness. A quarter of all mental illnesses are considered serious." One in four? Come on. If the bar is so low that one in four have a mental diagnosis it makes the term meaningless. It drives my wife and I crazy when parents claim there kid had autism but after a month on this fad diet or other they are now cured. Guess what - your kid never had autism! Don't tell that to a parent who knows their daughter will likely never leave home, never marry, and probably never hold down a meaningful job. It's just insulting.
> it's very unlikely that his son would have ever been a contributing member of society.
I'm having trouble getting past this comment. I don't wish to malign you debacle - I'm sure you're not being malicious - but it seems like a very unkind & privileged mindset. I hope this isn't representative of the community.
Paul Gionfriddo certainly doesn't consider his son to lack contribution.
My brother is mentally disabled. I love him dearly, and I've fight tooth and nail for him to have as normal a life as possible. However, I would not describe him as being a likely candidate for being a "contributing member of society." His affliction fundamentally prevents him from doing almost any job. That's just the reality of it.
I don't see any argument that his son with "no job prospects and a debilitating mental illness" is currently capable of doing work that benefits society. He's rightly only concerned with his son's survival in the crude conditions we provide, and how he might have turned out differently.
> but it seems like a very unkind & privileged mindset.
You think being of sound mental health is a privilege? In Europe we think health is a right, which is why we have public health systems. It may sound a bit strange at first, but it works quite well.
Russel Barkeley's books on ADHD. He is one of the foremost scientists who studies ADHD and has found it causes devastating problems for several percent of the population. For example, it is associated with a 10 point dificit of IQ, which is itself a major problem before you even consider poor impulse control.
I just finished my Psychiatry rotation as part of my training and there are three things, of many, that I learned: First, America has a long way to go in developing the best screening and management tools for people with mental disabilities. Second, schizophrenia is an incredibly complicated illness that can take manifest in a whole host of unsuspecting symptoms, and is not easily treatable. And third, diagnosing and treating a mental disorder in children is really hard.
The last two points, I think, are very relevant to this article. While I sympathize with you, understand that child development is a very, very complicated thing. You have naturally hyper children, naturally withdrawn children, etc, and physicians are very wary to label any child with an illness, especially schizophrenia. When we're adults and have leveled out, it's easier to discern what is "normal" from "abnormal." But children are constantly changing, being molded by their environment, and so it's much harder to outline a symptomatic threshold of what's considered normal. Additionally, children exhibit mental disorders in very different ways than adult do; there are different sets of symptoms to look out for. And these symptoms can be anything from "pressured speech" (talking too fast. some kids are just naturally fast talkers, right?) to auditory hallucinations (but the child could have a vivid imagination, right?).
The treatment for schizophrenia is an entirely different beast. The goal is usually to just suppress the symptoms and to restore the patient to a functional baseline. In many cases, the disease progresses and the prognosis worsens. In your case, your child had early-onset schizophrenia, which is associated with a worse prognosis than late-onset cases.
Although there are studies that show that early detection and treatment of schizophrenia can improve the course of the disease, chances are your kid would have still developed much of the same symptoms and issues that he has now. It really sucks, and I sympathize with you, but that's the nature of the disorder. It's terrible, difficult to manage effectively, and can ruin lives. I've seen it.
> If I were a legislator today, I’d mandate — and provide funding to ensure — that every teacher receive training in recognizing symptoms of mental illnesses.
but teachers aren't psychiatrists or clinical psychologists and can't really be expected to be.
I was recently watching a program talking about the somewhat controversial theory that schizophrenia (and other mental disorders) are either parasitic in origin or that parasites may simply contribute [1] [2].
The culprit in this case being toxoplasmosis. There's been research to show that there is correlation between the incidence of schizophrenia and the domestication of cats.
This kinda reminds me of how peptic ulcers were once thought to be caused by stress until they were found to caused by a virus [3].
At the same time the elimination of parasites is arguably related to the rise of autoimmune diseases in the developed world (the so-called "hygine hypothesis" [4]). For example, hookworms may combat asthma and other allergies [5].,
I wonder if the coming century will be a revolution in mental health as parasties, viruses and bacteria (or even the lack thereof) may be far more immportant than currently realized, possibly even causal in many cases.
Responding to your first comment about teachers not being psychiatrists, I agree with that observation but disagree that this means teachers should not be trained to recognize the signs of mental and other disabilities. The tendency today is often to ignore the problem, given there is little penalty for failing to intervene. But there are heavy costs to individuals and society.
As an example, when I was growing up I was extremely nearsighted but didn't get glasses until I was out of the home and in college. I was unable to read the chalkboard from K through 12. Yet no teacher intervened to suggest glasses to my parents, or to suggest I see an eye doctor. Only when a college prof noticed that I was squinting my eyes at the board and said "hey man, you need glasses!" did I get my eyes examined and discover what the world looked like in focus.
Along the way, everyone from the public school nurses who administered eye and hearing tests to a DMV examiner fudged my eye test results to "help" me pass those tests. And I was pretty good at doing things with limited vision. I know I'm not alone in this regard -- many children find a way to get by with a range of limitations because they don't know there is an alternative.
But we're living in the modern world, and many limitations can be controlled given early intervention. And teachers are well positioned to observe children over extended periods of time, while doctor visits are often 5 minutes ling and most children will never see a psychiatrist at all.
Schizophrenia like autism is not something to pin down to any one cause. The symptoms are like an equation and the defects are the values which cause the expression of the disease/satisfy the equation/describe the surface. There are many genes that are culprit to the disease as well a number of environmental factors, so it is possible that parasites may induce the symptoms for certain (possibly less robust) phenotypes. But it does not mean that the disease is caused by parasites any more than a plane can be a point.
One hypothesis I read recently is that schizophrenia is an emergent phenomenon of a brain trying to compensate for any number of gene induced deficiencies in wiring but instead over compensating due in part to the faulty wiring in the first place, thus creating a negative feedback loop as the brain develops and wires itself.
Again on connectivity errors, schizophrenia is also associated with a malfunction in how the default mode and task positive networks interact with each other, where in schizo, default is not properly attenuated leading to higher likelihood of dissociativity. I read recently on using ketamine to study this particular malfunction: see http://www.schizophreniaforum.org/new/detail.asp?id=1809
As for [4] it is worth reading: http://www.bmj.com/content/345/bmj.e6673. Aside from the separate dangers of overuse of antibiotics, the matter is way more subtle than being too clean. Yes we have lost contact with certain reinforcing environmental pathogens, but it is also true that the gain from cleanliness far outmatches the current risk of autoimmune disorders.
UK researchers say that they have dismantled the “myth” that allergic diseases have risen to epidemic levels because people now live in sterile homes and have become “too clean.”
....
The report says that although deficiencies in microbial exposure could be important in the rise in allergies and chronic inflammatory diseases—driven also by genetic predisposition and modern lifestyle factors such as different diets, stress, inactivity, and pollution—it is not yet clear how the trend can be reversed.
Rook said, “There are lots of ideas being explored, but relaxing hygiene regimes won’t reunite us with our old friends—just expose us to new enemies like E coli 0104.”
You wrote "This kinda reminds me of how peptic ulcers were once thought to be caused by stress until they were found to caused by a virus [3].". First of all, if you read the article you reference, you'll note that Heliobacter Pylori is a bacterium, not a virus. Second, the presence of h. pylori in the gut is not conclusively proven to be a causal relationship for ulcers. That is, in some people h. pylori is just part of the normal gut flora. Further, it HAS been shown that stress is a strong cofactor in peptic ulcers.
I heavily doubt that there we'll find a single cause for what essentially can be described as faulty wiring in the brain. Drugs, genetic predisposition and a whole lot of other causes could be the trigger just as well.
> but teachers aren't psychiatrists or clinical psychologists and can't really be expected to be.
rather to the contrary, i think. Or you haven't had occasion to attempt teaching enough?
> There's been research to show that there is correlation between the incidence of schizophrenia and the domestication of cats.
As I recall, this was more recently debunked, largely on the basis of correlation/causation confusion. ... Unfortunately, I failed in googling the counterpoint. Don't take my word for it, obviously. But consider: the popularity of cat-themes, and of mental-health quackery, especially on the internet.
OTOH, my grandmother, who was paranoid schizophrenic, refused to spay/neuter her cats because she had, to her, important conversations with them. So maybe you/they are correct.
Also note, the fluoridation of the public water supply may be sapping our precious bodily fluids[1].
> ...as parasties, viruses and bacteria (or even the lack thereof) may be far more immportant than currently realized, possibly even causal in many cases.
It is not that hard to recognize symptoms of mental illness. You certainly don't need to be a psychiatrist or a clinical psychologist. You don't even need to be a LCSW or a LPC.
It would be, at most, a single course in an undergraduate or a graduate program. It could probably be rolled in to existing curricula just as a chapter or an exam as a component of a related class.
We're not talking about diagnosis, just recognition of symptoms to the point where a referral can be made.
An interesting study highlighting some of the problems with diagnosis of schizophrenia was the Rosenhan experiment (http://en.wikipedia.org/wiki/Rosenhan_experiment) essentially it showed that doctors working in mental hospitals were unable to reliably tell the difference between those with schizophrenia, and those without it who reported a single hallucination. Albeit, the study is now close to 40 years old, and the diagnosis techniques have been improved, with for example, further editions of the DSM, major problems still exist.
In my Master's thesis I created an algorithm to diagnose schizophrenia from EEG recordings. It's obviously very preliminary research, but it would be amazing to see computers revolutionizing the way that we do neurological diagnoses.
Thanks for your article - a couple of questions. My background is that in the dim dark past I studied neuropsych and then worked as an EEG tech (mostly epilepsy screening with infrequent psych patients) for 4 years (2000-04) before going to work for the company that makes Synamps 2 :)
Now, I've only skimmed your method and results as I'm a bit flu-ridden and hence vague, but a couple of things popped out. The first is that you stated there was no control for medication. In our experience doing EEGs on folks on certain psych drugs, there was usually an increase in higher band activity (more beta, much less slow wave) - these drugs would create an unusual but not clinically abnormal EEG. It was rare to see such an EEG in someone not on those drugs.
The second is that for doing mathematical analysis on the EEG, I've had it trained out of me that resting EEG is okay to use. Some task, any task, no matter how easy, gives a more reliable baseline - since the EEG is quite dependent on arousal state, without a basic task, you don't have much control over whether the person is sitting there thinking about having a nap or highly alert and fretting over some unrelated item. For epilepsy you want them drowsy and nearly asleep as that lowers the bar for spike-and-wave activity, but unless a similar thing happens in schizophrenia and slowing, I'd think that doing a task would be superior to resting EEG.
I wonder if accounting for these issues might increase your hit rate? Like I said, I only skimmed the method and results, so I may have missed something that makes these points less relevant.
As an aside, the epileptic EEG sample looks really quaint and old-fashioned, since it has the curved needle-on-paper distortion. It doesn't need to be updated, it just looks like Ye Olde EEG to my eyes... :)
The no control for medication is primarily based on the conclusions of Boutros 2008, a summary of spectral abnormality studies of schizophrenia. I reproduced a table from the paper in the appendix. What type of psych drugs were you working with?
As an aside drugs used to treat schizophrenia have especially nasty side-effects, such as weight-gain, reduction of white blood cells, and--ironically--some of the "negative" symptoms of schizophrenia when given to healthy people. In fact the Soviets used to use antipsychotics to torture political prisoners.
I concur that active EEG could lead to a much more accurate diagnosis, however we had access to quite a bit more resting data, and it does make the math easier (stationarity for one). Standardization of other factors would also probably increase accuracy, but once again, I was limited by my data. Since I'm no longer in academia, I won't be continuing the research, but hopefully further studies address these questions in more detail.
Sorry, it's so long ago that I can't recall the drugs, only that as techs we had to report what was on the referral. We'd do our tech reports and the official report done by the neurologist would refer to the flat, beta-filled EEG as being 'normal for -foo-'. Part of me wants to say benzos, but I'm not sure if that's confabulation on my part.
I understand the limitation of the data - it's particularly hard to get access to inpatients as subjects for new studies. Thanks again for sharing your thesis - sorry I can't converse a bit more intelligently about it at the moment.
EDIT: looks like it is benzos: Some agents, particularly benzodiazepines and barbiturates, induce fast or beta (β) rhythms, and the EEG may be a useful pointer to drug intoxication when this is clinically unsuspected. from http://jnnp.bmj.com/content/76/suppl_2/ii8.full
To be clear, I was talking about recognition of symptoms and referral to experts, not diagnosis. Diagnosis is a much trickier issue. Thanks for sharing your thesis and for the interesting read about schizophrenia diagnosis.
We're so used to political debates where the Republicans say "less regulation will solve X", the Democrats say "more spending will solve X", the libertarians say "X is none of the government's business", and each suggests that things will go swimmingly under their preferred way of attacking the problem.
Some things, though, just suck.
Schizophrenia is one of those things. You can't cure it. You can't treat it very well. There's not much to be done.
Sometimes bad things happen to good people, and no amount of "training teachers" or "diagnosing diseases" or whatever will change that.
I think this is too fatalistic. This sets the bar far too low -- you could substitute poverty or crime in here without substantially altering the meaning. No, you cannot "cure" it or "fix" it, but the alternative isn't "do nothing." That's a false dichotomy.
At a minimum you can look for ways mitigate the impact it has on our society. See the pieces elsewhere in this thread which discuss the cost to our society incurred by ER visits from the mentally ill and/or homeless. That's a trivial example.
It might be worth discussing how other western industrialized nations approach this; I suspect that those countries which have some kind of socialized health infrastructure do more than the US than shrug their shoulders and avert their eyes.
That's true, but again, at least we ought to evaluate what the cost of doing nothing is. What we're doing now is pretty close to nothing, and it does have a cost, in money and in more intangible dimensions (e.g. humanitarian).
Oh, don't get me wrong--I'm very much for state-run healthcare and could be considered a proponent of socialism. I think that any civilization with as much resources as we do (we here being Americans, presumably) is criminal if it does not work to support its citizens cradle-to-grave.
I was just disagreeing with your assessment that fatalism is unwarranted--we do it (caring for mental illness) anyway, because it simply must be done, but we ought not pretend that things will get better.
Tragedy yes, though I do believe that if it was caught earlier and appropriate help was provided while the child was younger. The tragic outcome may have been avoided. There are a lot of people who live with Schizophrenia and live 'relatively' productive lives. I believe he could have been one too.
"Every year, one in every five children and one in every four adults has a diagnosable mental illness. A quarter of all mental illnesses are considered serious."
I don't really like the term 'mental illness', not so much because of the stigma attached to it, but because the term implies there is some 'normal' from which only a small subsection of the population deviates.
In reality, there is no 'normal'. There is no one person with perfect mental health; perfect clarity of thought, perception, of feeling and action. Everyone, to put things bluntly, is a little fucked up.
Thus, these figures don't really surprise me. As far as I'm concerned you can end up with any percentage of the population suffering from mental illness, it just depends where you set the thresholds.
There's a ridiculously vast difference between "a little fucked up" and serious mental illnesses such as schizophrenia, rapid cycling bipolar disorder or borderline personality disorder.
If you think serious mental illness isn't a real, debilitating reality, I encourage you to spend some time with somebody in a truly psychotic state and see how you feel afterwards. Then imagine living as that person.
There may be no absolute "normal", but there are most certainly people who live in a sad, terrible, frightening state of mental disturbance with no simple treatment.
> There may be no absolute "normal", but there are most certainly people who live in a sad, terrible, frightening state of mental disturbance with no simple treatment.
Agreed. There's a vast gulf between someone who is quirky on Tumblr and someone with a mental illness. It's simply not the same, not even close.
There's a significant difference between the casual DSM-reader's "everyone's got a diagnosis" and problems that lead to significant dysfunction. Even if you're only looking at the "entry level", there is a difference not only in magnitude but in kind between having the blues, or even having life-altering acute sadness, and being what a clinician would call depressed. Similarly, there's a huge difference between, say, believing in the lamed vavniks (that there are, at all times, 36 truly righteous people roaming the planet doing good — the idea being that you might be one of them, and breaking with that nature could have some nasty consequences in the hereafter) and believing that Murray next door is really the archangel Gabriel in human form. Or wondering if that cute barista is flirting with you and interpreting the name written on your cup as a love letter. We may all be a little fucked up, but only a little.
Then you don't like the world "illness" in general. The same holds for physiological health: none is completly bacteria-free, has perfect levels of vitamins, etc.
However, we need to operate in our judgements with ideals (healthy; sane; circle and all other mathematical entities, etc.): reaching for them, although never succeeding; that's perfectly okay.
Oh, and we do have some quite good (attempts at) theories of what "sanity" is all about.
I worked with kids at a YMCA in a wealthy area, I would say 50% of them were diagnosed ADHD. I think if it's 50%, then it's just normal. 50 years ago ADHD was normal--we hadn't set our bar there yet.
Well yes, my point is that you can draw the line in any number of places. Even if we were to agree upon your definition — and there are many different, conflicting definitions of 'mental illness' — what constitutes a significant impact on quality of life?
At some point you have to draw an arbitrary line, and even then it's frequently a guessing game working out on which side of the line someone actually lies.
My definition is from the DSM and while it is true that there's always edge cases, in practice the gray area is pretty small. Especially when we're talking about serious things like schizophrenia.
When you consider that (probably) most of the people who exhibit serious substance abuse problems are self-medicating, the numbers aren't difficult to digest. (I say this not as somebody with studies in hand, but as a person who's been clean and sober for more than a quarter-century, and who has significant experience dealing with other addicts and alcoholics. One can make pretty reliable predictions about underlying issues based entirely on the addict's "drug of choice".)
NOTE: they are not absolute (e.g IQ below average), but relative to what would make that particular individual comfortable given the life challenges he deals with at the time.
Alcohol abuse has actually been correlated with High IQ and is most commonly abused by this group because of the despair they see in the world due to their high IQ's. Essentially, because they tend to be more educated, and aware of global problems that makes them depressed.
The high IQ is a bit of a miss—it covers the spectrum, although it is certainly true that there was a tendency for high-functioning people from relatively affluent backgrounds to find their way into a recovery setting years ago. Self-selection was certainly part of it, but we have to keep in mind that more effort would generally be put into "salvaging" somebody who had displayed a lot of promise once than someone who would be a lot easier to write off.
The despair, though, isn't far off: chronic depression, or dysthymia, is common among alcohlics.
There are a lot of mental illnesses (did I spelt this right?) which aren't noticeable and even untreated let you live a "normal" life (whatever a normal life is).
I'm diagnosed with ADHD myself. I'm not on medication or treatment and while my attention span is somewhat weak I learned to live with it and find ways to accomplish things. Working in a field I find interesting, even when everything seems to be interesting for me, helps.
I think that we need a new definition of "serious" if you can live a normal life without treatment. If someone has a "serious" tumor, the assumption is they are likely to die soon without treatment.
What a timely article. Just today received a call from the school that my grade 3 son had thrown a girl to the ground threatening her. This was the second incident in a week. A team of councilors and mental health workers were called in as an emergency response team.
The similarities between the child in the article and my son are startling and scary.
Although we are still at the beginning of our story, I do believe that in my area in Canada, the system has gotten better. I can only hope that this continues and the system does not let him down like it did to the child in the article.
My son will be seeing a counselor and accessing services that were previously unavailable to us starting in 2 days. Thanks Hacker News, you are always so poignant.
I'd go easy on that counselling and do my best to figure out first what actually happened.
It would not be the first time that the visible aggressor was in fact the victim of a long drawn out teasing campaign by a group of bullies, and girls can be bullies just as easy as boys.
One of the best bits of fun seems to be to goad someone until they snap and then let them take the blame for it all.
I know the useless tunnel that counseling can be all too well. I also know my son. He is not like the rest of the kids. Exceptionally bright, exceptionally short fuse. No energy, always tired and constant sleepwalking or night terrors, and I do believe he may have already had auditory hallucinations. There is a history of mental illness in his lineage.
That being said, I have seen the kids first hand pushing his buttons on the school yard. There are so easy to push it's hard for them to resist. We are working with both the school and some mental health workers to make the situation more livable for all parties. I appreciate your concern, and I do understand that play-yard aggression is often mis-construed. That is most definitely part of this situation.
Ok, super to see you're on top of this and looking at all angles.
School can be hell if you are standing out in whatever way, and cause and effect can be hard to separate sometimes. Night terrors could be causing trouble in school, school trouble could be causing night terrors just the same.
I wish you the very best of luck with this, and I hope that it will all come to a good resolution.
One of the major problems that I've seen first hand with mental illness is that the diagnosis is so subjective and often times relies on accounts of the patient and family. If you have family who don't know what to look for or the patient doesn't know how to explain it or is under the duress of the illness at the time, you run the chance of misdiagnosis.
This happened to me. My senior year of high school I had a "breakdown" of sorts. I was suspended from school until I saw a mental health professional. After the first visit, I was diagnosed with Bipolar disorder and given meds to treat it. After awhile, the diagnosis changed to Schizo-affective disorder and more drugs were added to help. Finally, I was diagnosed with epilepsy and told that the mental health diagnosis were wrong since epilepsy can cause both depression and hallucinations if untreated.
I shared my story for a few reasons. One the brain is complex and there can be many factors that causes symptoms. If mental health professionals can't get it right, there is no way to expect teachers or school administrators to get it right. I was lucky and had phenomenal insurance at the time that I went through that ordeal. Because of that, I was able to get tests and scans that I know others wouldn't not be able to afford. I fortunate enough to have a parent who could afford for me to get a SPECT scan which is (or was) considered cutting edge and would not be covered under insurance. That was what helped the neuro-psychiatrist realize that I have epilepsy and not a mental illness. Many people can't afford these things. Had I not had that scan, I would still probably be taking 20 pills a day and having to wake up early to take Adderall so that I'm able to physically wake up in time to be functional and the worst part is, that would be all for naught. It wouldn't help me since I don't have any problems.
There is so much wrong with the mental health system (at least in the US) that it really makes me sad. You start at the education level (such as the article talks about) but then when you move to insurance, so much isn't covered that it becomes either pay out of pocket or just let the individual suffer.
My old eyes cannot handle very very long lines of very small type, and after several tries I was not able to guess the URL for the story in human friendly form.
Please submit links for humans, not machines. Add the machine link in a comment if you wish.
PS: I'm aware of Readability and the ability to increase font sizes. There are other problems in general with print links that those do not address:
• Print links generally do not include extras like comments. This particular story had a large number of comments at the original site.
• Although not applicable in this particular case, stories often include sidebar links to related stories, and these are often omitted from print links.
• The non-print link usually includes a very easy way to get to the print version. Typically, you just click a print icon and you are there. The print link, on the other hand, usually does not include any link or other mechanism to get to the non-print version (other than the "back" button if you happened to have come from the non-print version).
Taking this all into account, particularly the last part about it being very easy to get to the print link from the non-print link, and not easy to go the other way, in almost all cases the link submitted should be the non-print link.
PPS: there are some sites that offer an "all on one page" link, which is distinct from the print link. The former simply does away with splitting the article into pages, keeping the comments and sidebar links and human-friendly formatting. Submitting "all on one page" links is great.
Ctrl-+ (control-plus) on a PC or Cmd-+ on a Mac will increase the size of the type quite nicely. Ctrl-- (control-minus) will decrease the size, and Ctrl-0 (control-zero) will set it back to its original. This doesn't work well on every website, but works fairly well here.
Select a clump of 6-8 words from the first paragraph and put the in your search engine of choice. Or narrow your browser window to your preferred reading width.
I'm out of words. Here everybody seem saying smart words about being mentally disable/ill, about politics and so on but you all miss the pivot.
This (young) adult was diagnosed with schizophrenia. If the US wouldn't have the health-care system it has, this guy would receive proper treatment without hassles. Being hospitalized and so on. But he wasn't, and now he's just the last of the leasts. Why he wasn't? Because he wasn't elegible according to the insurance. Obviously he wasn't i'd say. Companies exist to make profit, this is old story, no insurance want really to treat people who are going to require life-long medications and care.
So, try to learn something from this story and realize how the US system is broken when it comes to care about people who isn't Paris Hilton.
I heard Romney saying "nobody is dying in this country because of lacks in terms of health-care, they jsut go to the first aid". He said this because he's just evil. Anyone smart realizes that being stabilized and being treated are 2 different things.
It's pretty sad that the best way to get mental health treatment is to commit a crime and go to jail. What an epic failure.
It really goes to show how our society thinks of people: if we're punishing someone for a wrong, then spend as much money as necessary. But helping someone before they do something wrong: that's socialism.
This is often discussed among homeless advocates, because such a large percentage of homeless have mental illnesses of various kinds.
I do think reform had quite a bit arguing for it: old-style "insane asylums" were really not nice places, and involuntary commitment was used fairly widely, at times even producing involuntary surgeries (like the notorious period in which involuntary lobotomies were performed), which I think are serious problems for civil liberties and easily abused. But the problem is that we just closed the asylums and didn't replace them with much of anything at all, in most states not even voluntary facilities that people can check themselves in to.
Depending on what you mean by "Mental hospitals suck" I disagree. It isn't supposed to be a place you go for happy fun time, but there are some really nice ones. The problem is, the really nice ones are out of the reach for many people who need them because they are super expensive.
I grew up around a situation similar to this. Thankfully, it hasn't turned out that badly. People with that kind and depth of mental illness have to have someone watching out for them. One little slip, one missed pill has the potential to send them down a road that they will not be able to recover from on their own. It can get bad fast and take a long time to bring back under control.
My cousin has (had?) schizophrenia. Despite the best efforts of his wealthy family and a willing mental health system in Germany he disappeared and we haven't heard anything in a very long time. He lived on the streets for a number of years but it's very hard to get schizophrenics on the needed medication and even harder to keep them on it.
This is quite a personal story and It's not near this level but I grew up with a parent with Schizophrenia and still am.
I'm 18 and currently live alone with this parent and am moving out soon as I work on my company. The situation is fine (for me) because there are few things to set them off these days and I've just had to learn how to deal with many of the disturbances. Like paranoia of me (What I talk about to others), using certain words in relation to illness like saying something is "mental" or even how are you. The illness only pops up at certain times. People wouldn't know they are ill from speaking to them, most of the time. It's 10X better than it was when I was much younger and lived with both of my parents.
I won't go into detail out of respect to my family but their illness has broke up their marriage (Although sometimes couples don't work) and now they refuse to take any medicine or see anyone. Because they aren't anymore at the level that they are forced into treatment there's nothing that can be done.
What I've learned from this is most policy on mental illness is under the assertion that if the person is at extreme harm to themselves or the public, they require treatment. If this isn't the case and the person refuses to believe they are ill or that they need treatment, little is done.
In a former job, I was confronted with a heartbreaking string of cases of individuals who are homeless, clearly suffering from mental illness, yet repeatedly breaking into local businesses, often not to steal anything of value.
The frustrating choice for those in the prosecutorial or defense systems, is how to best perform your duty to the public and these individuals.
If you simply release them, the business owners continue to face victimization. If you send them to jail, you put them in a completely inappropriate community, and damn them to poor or nonexistent care for complex problems.
It's not isolated cases, mental health issues took up a significant portion of our resources in the criminal justice system (a system that, when overburdened, suffers both Type I and Type II errors simultaneously, leading to higher rates of hasty convictions while also letting more guilty individuals walk free).
The best solution I heard, discussed only in chambers with heavy sighs as to its political infeasibility, was some sort of mental health court, analogous to a drug court.
Drug courts are designed to take a significant number of cases and prosecute them more efficiently, while focusing on what reduces recidivism most, and helps those "offenders" (treatment and monitoring is the general template, though individual cases can be highly customized, rather than one size fits all incarceration).
Drug courts don't always work, sometimes they can be systemically flawed. This American Life presented just such a case a few years ago, describing a judge who abused the process. But in most jurisdictions, drug courts lower costs to the system while putting a lot of people in a far better place.
A similar institution, a "mental health court," might feed people from courtrooms into community treatment facilities, with monitoring and care, while putting them on probation instead of placing them in jail.
This would, of course, work best with significantly increased funding for humane and competent mental treatment facilities. But at least some of those costs would be offset by lower burdens on the justice system and systems of incarceration.
Such a system would certainly help more people, and it deserves wider public discussion.
This says so much about what's broken in our legislative system:
> Six weeks into my legislative career, I was the legislature’s reluctant new expert on mental health.
After six weeks, he was not an expert. In nearly all cases, our legislators are not experts in any of the things which they are legislating, yet that never stops them from forming strong opinions and trying to "reform" or "fix" things. On HN, we see this frequently with Internet and technology legislation, but this article shows it's a problem with other areas, too.
Politicians are sometimes assigned to roles where they don't know anything on purpose - if they understand the deep issues, they'll be less willing to make funding cuts.
I did my honours year at a defense research site, and here in Australia we have two Defense Ministers - the junior is the Minister for Defense Science. While I was there, the junior minister was a total incompetant (Bishop) that knew nothing of her portfolio. When I asked the scientists why they'd give her this job, the above is what they answered with. Later on that year, there were significant funding cuts...
It's really sad that this isn't a priority in the United States. Somehow we have so little money for the government to pay for anything, that any possible solutions are either underfunded or written off completely. Overloaded case workers, run-down facilities, lack of facilities, lack of integrated programs, are just a few of the consequences.
It's an odd sort of poverty where all sorts of gadgets and innovations are commonplace, but where the marginalized in society still suffer through neglect and lack of funding for any viable solutions.
How much money would save this man? You going to build him a golden prison to live in. Schizophrenics hate being medicated. They are miserable. So they go off their medication and run away. It's not a question of money. Please stop the "we are so horrible because we don't spend enough money." That's the lazy minded answer to an extremely complex issue.
They are human beings though, so if they chose not to accept help or medication you can't force it on them. You lose a lot more taking away individual freedoms over what you deem abnormal or mentally ill than you do from the suffering making potentially poor life choices.
This raises an interesting question - what do other countries do? Have any of them achieved any significant success in managing the care of their schizophrenic citizens in particular?
This is a tough story of a state legislator who became an adoptive father finding out that policies that he thought were humane reforms didn't end up helping people in this generation like his adoptive son. Some of my perspective on these issues comes from knowing Irving Gottesman,
who was credited as the main adviser on schizophrenia relied on by the author of the book A Beautiful Mind. Gottesman has spent much of his career researching schizophrenia and debunking former theories about the origin of schizophrenia. Twin studies, especially studies of the unusual cases of monozygotic twins reared apart, and adoption studies have consistently shown that schizophrenia develops from an underlying genetic vulnerability (probably varying greatly from patient to patient, according to the best evidence from genome-wide association studies) that makes a patient all too likely to develop full psychotic symptoms over the course of childhood without careful treatment. Gottesman's research goal is to define "endophenotypes" that can be reliably measured clinically to identify patients who need one kind of preventive or supportive treatment rather than another. But we are nowhere near identifying endophenotypes for any major mental illness.
"Self-medicating with marijuana, Tim’s drug of choice for lowering the volume of the voices in his head, got him suspended from the first high school he attended — a public, vocational-technical school in Middletown, Conn. — and placed on court-ordered probation." We do know that young people whose family history suggests genetic risk for major mental illness (which might not be known for a particular adopted child) are playing with fire if they take schedule I drugs without medical supervision. Many of the worst outcomes found in families in which some relatives become mentally ill and some do not are among the persons who "self-medicate" (that is, abuse drugs) rather than reduce risk of perturbing their brain chemistry.
"If I were a legislator today, I’d mandate — and provide funding to ensure — that every teacher receive training in recognizing symptoms of mental illnesses."
Teacher who are credentialed to teach elementary school receive specific training in how to teach reading, and receive specific training in how to teach elementary mathematics, but mostly do a remarkably poor job in those important tasks anyway. There are not today any reliable lists of early symptoms of mental illnesses to guide an adult who sees young children as to who will develop severe mental illness in adulthood. Diagnostic criteria for psychology and psychiatry are not that well developed yet, and communicating criteria for best practice to future teachers in schools of education or to in-service teachers through in-service training programs is already a vexing problem in reading instruction and mathematics instruction.
"I’d see that pediatricians are trained to make screening for mental health concerns a regular part of well-child exams."
I think some of that is already done today. At least, my four children certainly seemed to be asked routine questions in well-child pediatrician visits that could raise red flags on the basis of certain answers to those questions. Again, there simply aren't that many effective early screening tools for mental illness today of any kind. One of the best tools for identifying people at highest risk for developing mental illness is to know the complete medical history of their nearest relatives--but that is the hardest tool to use for some adopted children.
"I’d require school administrators to incorporate recommendations from pediatricians and mental health professionals into students’ IEPs."
What I hear from parents whose children have IEPs (individual education plans, under federal law about special education) is that it is often annoyingly difficult to get a school to follow an IEP, even though that is mandatory by law. It is the parents's responsibility, in the first instance, to make sure that all relevant information is provided to the professionals who work with the parents in drafting the IEP. The parents have to push back if the IEP isn't drafted helpfully at first, and they have to keep an eye on whether or not the school implements the IEP.
All in all, this sad story is a good reminder that EVERY parent, and maybe especially an adoptive parent, needs to be cautious about reducing risk of future harm for all children in the parent's care. The author's description of his situation makes his situation sound very rough. He surely hoped that his son would be living independently and thriving by the son's current adult age. What I've learned about parenting after two decades is that parenting never completely ends. Launching a child into self-sufficient adulthood is wonderful. (I have done that once so far.) But there will always be scary issues for parents to watch out for that they have to take care of themselves.
AFTER EDIT: Several comments below this comment talk about the risk of drug abuse for persons who have underlying vulnerabilities to mental illness. I agree with the suggestion that alcohol (legal for all adults) is surely dangerous in such cases and perhaps tobacco (also legal for all adults) is too. But I will remind all readers here that marijuana was specifically mentioned as the now homeless person's "drug of choice" in the submitted article, and marijuana alone, plus the genetic vulnerabilities, is enough to turn some formerly productive young people out on the street unable to support themselves. (It was probably observations of situations like this decades ago that helped convince legislators to change marijuana's legal status from permitted to largely banned. The article submitted here makes the correct point that sometimes legislation has unintended consequences, and perhaps the "drug war" is ineffective policy for reducing the harm that mind-altering drugs cause individuals and society.) Richard Branson has argued that Portugal's different pattern of regulating drugs has reduced drug use and has reduced various social harms from drugs that are Schedule I drugs here in the United States.
But that said, I will stand by my statement "We do know that young people whose family history suggests genetic risk for major mental illness (which might not be known for a particular adopted child) are playing with fire if they take schedule I drugs without medical supervision. Many of the worst outcomes found in families in which some relatives become mentally ill and some do not are among the persons who "self-medicate" (that is, abuse drugs) rather than reduce risk of perturbing their brain chemistry" because it is a factually correct statement. I don't know of any physician who regularly treats psychotic patients in emergency rooms who recommends that young people with family history medical risk for psychosis use marijuana. That is a distinctly bad idea.
ONE MORE EDIT:
I shared the article submitted here among my Facebook friends, and one thoughtful friend suggested the article, from the same newspaper in 2005, "Social Network's Healing Power Is Borne Out in Poorer Nations"
as an interesting contrast to the situation described in today's article. There is some good back and forth among experts on schizophrenia in different countries in the previous article. Diseases influencing human behavior often manifest differently in different cultures.
We do know that young people whose family history suggests genetic risk for major mental illness (which might not be known for a particular adopted child) are playing with fire if they take schedule I drugs without medical supervision.
That marijuana is classified as a "schedule I drug" is, itself, obscene and a result of politics, not science.
Therefore, the rest of your suggestion regarding them "playing with fire" does not apply in this instance.
This is not the point. My point is that marijuana can speed up the onset of schizophrenia and should not be used by people that have family history of mental illness. It has nothing to do with what is legal and what isn't. Even if marijuana were legalized, my point would still stand.
I think an alternate interpretation of that study could be that if schizophrenia (considered my many to be an outdated term) runs in the family, future children will learn earlier that they need to try something to deal with the problem of schizophrenic parents being bad parents and making things worse overall.
More bluntly: because children are screwed up faster by the collective parenting habits of multiple generations of mentally ill ancestors, they turn to possible fixes outside of their screwed up families: junior high + pot is normal. Marijuana, if anything, is a minor symptom here.
Note: You're talking about why alcohol and tobacco are legal while marijuana is illegal; but hristov was talking about whether or not someone who self-medicates with marijuana is playing with fire.
In the US, it was more or less unregulated till the 50s/60s. Also, your claim does not explain European countries' stand on it or that of African nations.
I believe trade agreements with the US prevent full legalization. Portugal decriminalization act was carefully drawn not to break any of this treaties.
Correct me if I'm wrong, but this was not the case when the laws were originally passed in those countries. I.e. the original passage in decades past were not due to these trade pressures.
Even if Alcohol doesn't specifically make schizophrenia worse, alcohol abuse is the most common comorbid disorder of schizophrenics and generally exacerbates all mental health problems to some extent.
Thanks, interesting... though the opening line does seem to suggest marijuana use remains especially linked with schizophrenia -- in prevalence at least:
Alcohol use disorder, which is three times more common in patients with schizophrenia than in the general population, and cannabis use disorder, which is up to 10 times more common, both contribute to the morbidity of schizophrenia, through increased relapse, noncompliance with treatment, more hospitalizations, and poorer overall functioning.
As far as I've read, and I read whatever I can, there's still no evidence one way or another about which causes which.
Does cannabis have a causitive or trigger effect on schizophrenia? Or are schizophrenics more likely to live on the fringes of society and encounter (and like) cannabis?
Just one person's anecdote, but I am close with a person who is schizophrenic. Marijuana use significantly contributed to episode occurrence. After their psychologist told them that it can make things worse, they stopped, and it improved their situation considerably.
I think it's related to the whole paranoia side of things.
This is a valid point, and more work needs to be done in this field.
However I think a fairly safe default is to tell kids not to smoke pot until we can make a more educated decision (provided of course we don't extend that ban to adults for no reason, and provided we don't purposely ruin the lives of kids who don't listen. (You wouldn't arrest or kick a kid out of school for smoking tobacco.)).
Or even more simply: is there something in marijuana that makes schizophrenia more tolerable than with alcohol. Furthermore, mentally ill people are going to have more trouble finding a regular pot dealer, the black market being an inherently suspicious place, so as their condition worsens alcohol becomes the most-available drug.
Tobacco has anti-psychotic properties which can help to alleviate the effects of schizophrenia, which is one reason almost all schizo patients smoke. Alcohol on the other hand can make the condition worse because it has psychotic properties. Marijuana is both psychotic and anti-psychotic so how that will affect the patient is more unclear.
Yeah, the only way "playing with [legal classification of drugs] is playing with fire" makes any sense is if the fire in question is set by the legal system.
Now, if you want to say "playing with stimulants" or "playing with depressants" or some other scientific classification, then that makes sense (though I would still like to see a citation..).
Only if you believe the mood and behavior being directed towards leads to immediate sociopathic actions; otherwise, society has little to say about how an individual decides to regulate his mood and behavior.
"We do know that young people whose family history suggests genetic risk for major mental illness (which might not be known for a particular adopted child) are playing with fire if they take schedule I drugs without medical supervision."
Considering that "Schedule I" is nothing more than a legal classification, I would like to see how that works. Does it just so happen that drugs in that legal classification coincide with drugs that people at risk of mental illness should not take? That seems like quite a coincidence, if true. If he were self-medicating with tobacco or caffeine, would you express similar concern?
Marijuana is relatively harmless and should be legalized. It is also known to be useful in the treatment of a number of ailments.
However, we do know of one certain negative reaction, with a fair degree of certainty: genetically schizophrenic predispositioned people who smoke marijuana as teenagers are more likely to develop schizophrenia.
Because of this, although it should be legalized, it should not be available to teens.
Hmm, interesting stuff. It sounds like this risk doesn't really tapper off after the teenage years, but rather in the mid 20s. Makes a 21-year cut-off some states are considering (instead of the obvious 18) make a bit more sense.
The whole "Schedule I" thing is probably a bad choice of words on the authors part. Perhaps something along the lines of "mind altering substances"? Anything with the potential to significantly impact a persons impressions of the world around them is a bad idea in this situation.
There is a whole lotta things outside ingested and inhaled chemicals which can lead significantly impact a persons impressions of the world around them. I always found Julian Jaynes take on the interpretation of the schizophrenic mind as being one of degrees and perhaps just a few neuro-physical variations away from "normal" as interesting ponderage.
There are useful diagnostic criteria and well-understood risk factors for all sorts of mental illnesses. Schizophrenia is a particularly vexing case, but that does not mean that one cannot recognize that someone is at-risk for or already dealing with a mental health problem.
Author's first impulse is to look to the state for the care of his child. WRONG!!!! YOU and your family are the primary folks responsible for this kid. Your wife had about the same chance of success as any set of teachers or state gov't goons but with much more incentives. What the hell was she doing? (probably getting her 'career' on - woo hoo!)
Why are ppl so apt to think that state employees are miracle workers? Central command/control and one-size-fits-all solutions (or any approximation thereof) are bound to fail for most of us who have special needs.
I'd speculate that anyone "political" enough to be elected to the legislature at the tender age of 25 will never be able to step outside the mentally-crippling assumptions of the total-services state. Note the unrecognized contradiction between "the state should provide this service and provide it well" and "when I was in charge of things for the state, the LAST thing I or any of my colleagues cared about was providing this service".
exactly; he's just a bloke like you and I - not some super-helper-expert-because-i-work-for-the-state guy.
I'm not saying we shouldn't expect any return for our tax dollars; but certainly not as the primary source of help (read 'assistance'). also, perhaps the problem shouldn't go after our tax dollars in the first place .. it's a warm/fuzzy idea to 'help', but you're taking my dollars and supposing a solution to which you have no idea what you're doing. stop it please ;)
My state provides extensive education and training to some people, so they can become doctors.
My state provides hospitals and funding for treatment.
Imagine a person with full thickness burns to 75% of their body - "Why are ppl so apt to think that state employees are miracle workers?" - because they've been educated, trained, and provisioned to provide the help that other people need.
are you making an argument for state-employees, or just anyone that gets this type of training? you're off point - I'm saying that you can't look to the state +first+ for your family's needs - it is important to take a primary stake in your own well-being.
btw, ask the folks affected by Katrina how they would rate the training of all the emergency response state employees .. probably not so good. My point is : don't rely on these ppl.
I have a very dear loved one who suffers from schizophrenia. I've seen firsthand how useless the system is. Before a diagnosis, everybody (schools, friends, etc) are judging the parents because their child doesn't fit into "norms". After a diagnosis, they have no idea how to handle it, so things don't get better.
We pushed everybody out of state hospitals (which were horrible places) but never really answered the question of where those people need to go.
Fortunately, my loved one's disease is being well treated at the moment. I constantly fear the day that a serious psychotic event occurs, especially if it occurs after she moves out of her parents house (which, like most teenagers, she really wants to do).
As someone who was diagnosed with Schizophrenia, had several bouts of psychosis, and settled into BiPolar disorder without the psychosis, I can speak on this subject a bit. As a kid I exhibited the typical, thinking fast and trying to talk just as fast. My first major manic episode I recall was while studying for a midterm, where instead I had inspiration and handwrote a 8 page business plan. After my my first psychotic break, a year later I spent all night down the rabbit hole of importing raincoats from China. I showed no Schizophrenic symptoms until a major psychotic break that triggered my underlying proclivity towards Schizophrenia, partially by roadtripping to a new place and excessively smoking marijuana. I ended up in an out-of-state hospital for several days before transferring to a local one. My family thankfully had insurance, but the profit-driven company battled with us to deny paying for that expensive out-of-state care and treatment, thankfully they paid. I couldn't get non-group insurance until insurance companies could not as easily deny you coverage for pre-existing conditions.
Before that event I had genuinely enjoying smoking for nearly 2 years in college with no paranoia. Uncharacteristically, I got into minor legal trouble thanks to a dumb, drunken night. The day my probation ended I lit it up again, leading to a mild psychotic episode with friends who were freaked out. That was the end of marijuana for me. Never tempted to touch it again as I know that is seriously playing with fire given my tendencies. I've had one other paranoia-fueled episode where I went off my medications because I didn't like the side effects. I somehow got tangled with a local urban gang, after they broke into my house and stole my roommate's golf clubs and spotted my expensive studio equipment only to stake the place out for another burglary. I avoided hospitalization with the help of close family this time.
The biggest thing for people with BiPolar or Schizophrenics is to stay on their medication. It's a very tragic feedback loop, you feel good or normal so you go off your meds. Then you are OK for a while, then you are nearing a nervous breakdown, manic episodes (which are really fun for most people), paranoia, or deep depressive episode (which is why so very many BiPolar people commit suicide). Every time I went off my medication, a break down was near, and you had to basically hit the "reset button" on your life again. Start a new job, new location, try again. This time, you pledge to stay on your medication, your family reminds you as well. Things can stabilize when you get on the right medication with the lowest effective dosage, get regular sleep and exercise. I am stable now, with the help of family, friends, low dosage medication, and exercise. (In that order)
Title "The ‘reforms’ that I worked for have worsened his life" - That's interesting. Let's read further.
Extract : The 1980s was the decade when many of the state’s large mental hospitals were emptied (...) I jumped at the opportunity to move people out of "those places" (...) to help manage the transition of people back into the community
(...)
When he was in jail, with its regular routines and meals, Tim usually stabilized. But when he was released (...) he destabilized right away
Ok, we get your point.
But they why giving in conclusion the idea that more money thrown at a problem that seems intractable could solve it??? [Extract: I’d require school administrators (..) I’d put much more money (...) I’d get rid of laws (...) ]
This begs the question : was it considered only once that maybe "humane reforms" had been pushed too far, and that the best outcome would have been reached in a place with " regular routines and meals" where stabilization could have been provided- in other words a good old hospital.
Maybe in the past there were many people in that shouldn't have been there, and the "humane reforms" were then a good idea. But maybe we overdid them and now we make people worse, based on our own idea that people suffering from schizophrenia would be better outside the hospital.
Extract again from the post : "His only furniture was a bare mattress on the floor; a rat and flies were his companions. Sadly, he seemed content. This is the mental health delivery system that I helped build".
Yes the author did, since he considered a patient own evaluation of his situation to be perfectly valid and not in any way damaged by his disease.
It is usually better to respect a person will, self evaluation, etc. But maybe, just like for suicide, when the best judgement seems to no longer work, it is a good thing to ignore it until it can be fixed - if it can.
I don't believe that the author thought he was doing the right thing as a legislator! I think he was trying to save the state some money, without thinking carefully about how those savings would impact people's lives. As you sow...
The word "reforms" in this article, and in recent political parlance, is being used as a euphemism for "cuts."
It seems inevitable that euthanizing a long neglected mental health system could lead to further difficulty amongst the mentally ill and the people who have to live around them and/or love them. It must seem shocking that any bad outcomes could ever come out of "reforms."
As a person who was alive in the US when all of the crazies were thrown out into the street without a net in preparation for their future jail/homeless/jail/homeless/dead therapeutic cycle, I'd like to add that more than this guy's son was screwed by Reagan.
The path to hell is paged with good intentions, in this case by young, well-meaning, but unqualified and overly-ambitious people who like the sound of their own voices and think they know what is best for others, but come to realize 25 years later that they really fucked things up for a lot of people they were supposed to be helping (guys, you are supposed to be helping the 99%, not the 1%). Better late than never, but what's he going to do beyond write an article to make himself feel better. Nothing, probably (that's a challenge to the author, if he's even here).
Timothy D. Wilson's "Redirect" is relevant here and shows that a significant number of treatments for all manner of childhood and young adult issues skip one crucial yet obvious step: simple scientific testing. Instead, "common sense" often ends up the preferred approach to treating problem children, usually making the problem worse.
The problem isn't the particular reforms, it is the idea that any reform could evoke the needed individualization from centrally planned institutions.
My heart aches to think of the hell this man is in, and that his father is in watching him. I have worked with people in this condition, it is heartbreaking. I get the screaming urgency to do SOMETHING.
But if that something doesn't make sense it just isn't going to work.
Nobody brought this up (what?) but how is this relevant to.. hacker news? I get that someone on here might be schizophrenic, but is this really on topic with startups, software, etc? If I want to get sad over incurable mental illness I'll go read r/politics or atheism (oioioi).
Ideally politics of healthcare are avoided, and then people can provide information about how this stuff is handled in other countries, or discuss better systems.
You have a flow of 'patients' through a system. You also have a flow of information about those 'patients'. Some people need access to (some of) that information (doctors, the patients, their carers) but the information needs to be kept private from others.
Already there's an interesting problem that plays to the strength of many people on HN.
Given that health care spending is so large - about £120bn in the UK[1], about $800bn US[2] - it would seem that big money is available for a good solution to these problems.
There are people doing interesting things in health care IT. But I don't know what a minimum viable product looks like when you're aiming at over 60 million records (UK population) or 300 million records (US population).
Schizophrenia is not the kind of disease you can treat with an IEP, and it sounds like the author's son fell out of the system from a very young age. Trying to blame anything but genetics and development for his son's state is disingenuous - treating schizophrenia is a complicated, involved, and ultimately very stressful process for everyone involved, and in the end it can only bring someone on the brink of homelessness or self-harm into a situation where they can be stable most of the time, but never all of the time, or even almost always.
> The word “disability,” for instance, should have covered Tim and children like him.
ADHD or blindness are not even in the same room a schizophrenia. It's like comparing having six toes on your left foot to being comatose.
> If I were a legislator today, I’d mandate — and provide funding to ensure — that every teacher receive training in recognizing symptoms of mental illnesses.
Teachers have enough on their plate, and more importantly, that's not what teachers are for. It sounds like the author took his son to plenty of mental health professionals, and he still wasn't properly diagnosed until he was nearly an adult.
> I’d see that pediatricians are trained to make screening for mental health concerns a regular part of well-child exams.
Many mental health diseases don't manifest to the levels for proper diagnosis until adulthood, and even then the process of diagnosis is not scientific.
> I’d put much more money into community mental health services...
All of that sounds great, but mental health services are one of the first things cut into in a down economy.
> Tim is where he is today because of a host of public policy decisions we’ve made in this country.
No, he isn't. The author is wrong, and I'm sorry for that, but it's very unlikely that his son would have ever been a contributing member of society. Schizophrenia is a severe mental disease that cannot be treated like a 'special need.'