Schizophrenia’s Tangled Roots | Hacker News Reader

Schizophrenia’s Tangled Roots

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60 pointsantigizmo24 comments

If you're interested in this do have a look at some of the work on Psychoneuroendocrineimmunology (PNEI for short), emerging understanding of the microbiome, the gut brain axis, the role of bone-marrow in all of this, for example;

Neuropeptides and the Microbiota-Gut-Brain Axis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4359909/

or something a little more mainstream that appeared on HN, "Don’t hate your gut: It may help you lose weight, fight depression and lower blood pressure" http://www.salon.com/2017/07/14/do-not-hate-your-gut-it-may-...

Jacqui Dillon is an influential person in UK mental health care.

This submission starts with a description of her service experience 25 years ago. It's clearly an awful experience.

But it doesn't talk about the things that have changed.

People who report sexual abuse are much more likely to be believed. Things aren't good, but they're much better than they used to be.

There are early intervention in psychosis services in some parts of England. (Regional commissioning mean they don't exist everywhere). These work with people who have a first episode of psychosis.

Very recently there has been a lot of work around perinatal mental health (the Twitter user Rosey - @pndandme runs some Twitter chats and they'd have lots of info about how good / bad services are).

Importantly, mental health teams are multidisciplinary teams. That team would include social workers (who have some statutory duties), mental health nurses, occupational therapists, and a psychiatrist. They'd arrange access to other teams - psychologists, housing advice, debt and benefit advice, employment support, social activity, exercise support. (Not all of these would be "THE NHS"' see of it would be charities or community interest companies or private companies. They should all be free at the point of delivery).

MH Professionals are much more comfortable with "breakout symptoms" - they know that antipsychotic medication has pretty devastating side effects, so they want the patient to be on the minimum needed dose. This might mean that people still have auditory hallucination, but are given support to cope rather than being heavily medicated.

The article suggests that many psychiatrists are only there to prescribe meds. That is an important part of their job (they're the only ones who can prescribe meds), but there are plenty of doctors who fully accept the "bio psycho social" model, and who focus on the psychological and social factors.

The article.makes it sound like none of this is happening.

Also, go careful with Lurhman, there are several critiques of that report.

TIL https://en.wikipedia.org/wiki/Biopsychosocial_model thanks.

Why should we believe reported sexual abuse from someone experiencing a psychotic break? I have a family remember who spent two months in a psych ward last year. They had secretly stopped taking their meds and started practicing some weird form of meditation that triggered vivid recollections of childhood abuse. This culminated in accusing everyone in the family of sexual abuse and even talk about a secret pedophile society in our town. It took heavy doses of anti-psych meds and injections to get them back to reality. Now a year later they don't even mention any of the experiences.

>> Why should we believe reported sexual abuse from someone experiencing a psychotic break?

You should not take it at face value. But neither do I think you should tell them it didn't happen and it's all in their head. The later is telling them there is something wrong with their mind (to shame the patient can be extremely bad practice). Also, if you reject the notion of abuse and it turns out some of it was true, you'd be gas lighting the patient which will lead to additional distress and a distrust of the very people who are trying to help.

On a purely speculative note: Perhaps your family member had experienced some of that abuse. Perhaps the stress they were under (and that is a very broad term) lead to those thoughts mixing with all sorts of present day events and people. Whatever the cause, given what they went through to get pulled back to reality do you think they'd ever mention any of it again?

>> Also, if you reject the notion of abuse and it turns out some of it was true, you'd be gas lighting the patient which will lead to additional distress and a distrust of the very people who are trying to help.

Absolutly true.

If you deal with a psychotic it is very hard to convince them it's a delusion. People won't understand the patient and will treat them like an idiot and crazy person. Try to treat the patient and the delusions with respect and at least try to understand the situation. If you dismiss it as "crazy talk" and insult the patient's intelligence you will only make it worse.

I suffered for years and it was a neverending nightmare. Nobody will ever understand the horrible things I went through. And the worst part of it all. You get told everything is delusions. No one believes you and you doubt yourself. I will never know what experiences were real and what experiences were only in my mind. And it's really hard. I know some of it was real. But I don't know how much and what. I have the constant feeling everybody is gaslighting me and just wants me to believe I'm crazy through and trough.

These days I avoid social interactions and keep to myself. I don't trust people anymore and isolated myself. I read a lot and feeding my brain somewhat intellectual content to keep it busy. It seems to work. I haven't had a major episode in 2 years. Which further confirms my theory, that it was the environment and the people around me.

I'm happy when I'm alone and I can relax. But I have the constant feeling that I will never know the truth about my experiences and nobody will ever tell me.

My point is never, ever under no circumstances lie to a shizophrenic. Not even If you think you are doing a good thing. Tell the truth, even if it will hurt. Not knowing is really really bad for mental health. And we are not exactly good on social cues, so tell it like it is and don't be subtle.

source: I was diagnosed 8 years ago

edit: typos

Hi there,

I have been through eight years of therapy and though I have not experienced schizophrenia, I have experienced and overcome psychosis.

I am fairly sure I understand its origins through my own internal experience of it and the reading I have done on the space (Dr Winnicott is a must). This understanding helped me overcome it. I was wondering if we could perhaps have a Skype / call / go back and forth a few times via email (whatever you are most comfortable with) to see if it helps.

If you would be interested please email me at eichler(dot)summers(at)gmail(dot)com.

Josh

I'm schizotypal so I'm not as bad but I can definitely echo these sentiments, and I would also say that dismissing someone's experiences is incredibly invalidating, especially when it comes to just trying to make friends. I struggle reading human behavior over my paranoia and people can be upset and call me an abusive person for my asking their behavior or seeking their confirmation for their behavior, which often itself becomes them behaving in a gaslighting manner to me in order to prevent me from questioning them. It's really upsetting because I cannot tell if what I am understanding from people's behavior is correct and I am scared of asking.

I believe this applies to all the cluster A personality disorders. Traditional and widely taught forms of therapy can be harmful to them.

Listening and reasoning with them and not taking drastic action, such as having them committed asap was what lead to the full break from reality. For several months my family listened to stories of unjust childhood and traumas, bullying etc. We all knew about those events, but none of them were that dramatic, they were mostly minor stuff, somebody saying something bad or maybe a childhood fight. And then the icing on the cake, two or three months convincing us they were trans-gender. Which included buying new clothes, transforming their look and even talking about surgery. This experience convinces me only that if someone has these kind of issues, you should not hear them out or try to understand, but other type of help is needed. If we acted in time, a lot of of what happened afterward could have been avoided. Being soft and understanding helps no one. And I really regret that me and other family members didn't know enough about mental illness at the time.

Btw. their previous diagnosis was borderline disorder, which is why they have a skewed perception of them vs world, nobody understands, everybody is against them etc. Now it seems they are also possibly bipolar or schizoaffective. Really difficult to deal with.

>> Really difficult to deal with.

On that I can agree completely. I had a family member going off the deep end, and there was no convincing them that any of the crazy talk (and some of it really was nuts) was unreasonable. Later when they were more normal someone asked "why did you think xxxx" and the answer was "I don't know". It can be really difficult and I'm not sure there is a "right way" to handle it. I still think there are wrong ways though.

>> And I really regret that me and other family members didn't know enough about mental illness at the time.

Some things you can only learn through experience - unfortunately.

> and started practicing some weird form of meditation that triggered vivid recollections of childhood abuse.

Sure, we need to be careful to protect against false memory. We know how harmful that's been.

But we also need to remember that sexual abuse is very common, and people lying about or having delusions of being abused is somewhat less common.

But I think the problem is with people that have mental issues. There may not be a reason for it, but they want to find one anyway. They want validation, and one way is to find some external factor for why they are miserable. So they start digging in their mind for traumas, they try to reinterpret events from the past. Why someone didn't like them, why they were always sad as a child, etc. This person looked at old family photographs and saw that on all of them they look unhappy. Must be rape right? Me, afraid of sleeping in dark, wow, must be a reason for that, for sure it must be childhood abuse, rape and so on. The pseudo-scientific therapist mumbo-jumbo, repressed memories, it's all bullshit. And I understand that now, nobody can convince me otherwise anymore.

I am convinced there are times I could have been diagnosed as schizophrenic or schizoaffective. Certainly I've experienced psychosis. When I was in my early 20s, I smoked nasty weed (not enough CBD) in blunts, cause that's what my friends did and I didn't have the humility yet to accept my own limits. I gradually developed a very heightened sense of my own inner voice(s), and also became intensely paranoid of certain symbols, which I would subconsciously check for everywhere, while consciously they seemed to pop up all over the place, as if by fate or chance. I knew things were getting out of hand, as my "inner critic" would sometimes feel alien and beyond my control. It would speak loud and clear, ruthlessly. I started to feel very split. Somehow, I managed to cool it on the blunts and took a step back from my regular friends to focus on school. I'm grateful that I had this insight and was able to find the humility to let myself have moderation. That humility did not come from the inner critic. It came from a small, incredibly gentle voice that I rarely noticed at the time. It said "you don't have to smoke, don't worry, its alright not to."

Now all along I was able to recognize and hold onto the idea that these were "my voices," and I trusted in that. I'm so grateful that even in the turmoil (e.g. anxiety/panic attacks) I never fully repressed or made enemies of these experiences, I never fully dissociated. I never let myself dis-identify with even the scariest voices. I was lucky too that nobody ever brought me in for diagnosis. Looking back, I think that could have triggered a full blown break, complete with dependence on powerful psychiatric drugs.

Thankfully, I let myself stop smoking weed, other than very cautiously/irregularly, for years, and very rarely smoke to this day. One thing I've realized is that my immune system can't stand the smoke. I basically get an allergic response, throat swelling, etc. In my pride, I had ignored that.

Since then, I've also had very healing and grounding experiences with the right kind of weed. I know now that the mixtures of cannabinoids are critically important, as is dose and intake method, and last but not least the setting and company you're with. But back then, in the dark fog of prohibition, I had no idea what I was smoking, and exposed myself to energies and people I didn't "vibe with". Its frankly dangerous and absurd that weed is federally scheduled rather than regulated and understood.

And as for my mental health, it took a long time to reintegrate the sensitivities I developed in this time. More recently I finally got some good therapy to work through stuff. A rough relationship triggered the need for it. I found a gestalt therapist who specialized in working with artists and creative types. She just about refused to diagnose me with anything. Instead, she helped me affirm and recognize my own inner sensitivities, perspectives and myths as tools for self-cultivating good mental health. She carefully affirmed that my inner symbolic perspectives and experiences need not be seen as illnesses to be abolished, that I should instead retool them as indicators for self understanding and realization, and as sources to be channeled creatively. I recognized in this time things I was already doing to ground myself when life got overwhelming. For me it's piano, hiking, jogging, chamomile/lavender/holy basil tea, writing, and if I need to talk, finding someone who listens without judgement or fear.

I am so glad to have made it through to my 30s with my psychological freedom intact. Others are not so fortunate.

Anthropologists are not doctors qualified to redefine medical diseases. Autoethnography is not scientific.

I think this is the wrong place for this piece.

Can you point out a single specific piece of bullshit in the article? Otherwise your comment doesn't belong on HN.

I found the article to be interesting and well written, and I'm very much a strong supporter of actual science.

Mental illness is incredibly complex, and we have a long way to go in making significant progress.

EDIT: the parent comment has been edited to remove some aggressive language. Thanks, I appreciate that.

I'm not sure what you mean by that but HN is an emphatically pluralist place and articles of all disciplines are welcome here.

Yes, I think this piece is dangerous in some ways.

The article makes out that there has been controversy about the degree of genetic cause of schizophrenia, citing tiny effects of specific genes - but that misses the point (as the article mentions, it is a polygenic disease) - at least for the last 20-30 years we've thought that there was a roughly 30% influence of our genetic make up on acquiring the disease - the environment has long been known to have an effect on acquiring and also relapsing with the disease.

Also using an anecdote of what someone remembers of their experience being admitted to a psychiatric hospital post delivery is unlikely to be useful. If she really had a psychotic episode, her memory of the event is likely going to be very patchy, and a lack of insight is a common feature of the disease. She probably received some sort of anti-psychotic as an emergency measure - I somehow doubt she smiled and agreed with the doctors to get discharged. Post-natal psychotic episodes are seen as some of the most aggressive / dangerous forms of psychosis.

The article makes some good points that psychiatrists may find they have less and less time to spend with patients, and that medication is seen as the answer to too often.

The reason I say the article is dangerous is psychotherapy and anthropology are not sciences. I think they can be used as ideas to test, but the efficacy of anti-psychotics has been proven in trials. Not effectively treating a psychotic episode can easily result in death, and anyone experiencing psychotic symptoms do need to seek proper medical help. Just hearing voices on its own is not enough to make a diagnosis of schizophrenia, but they would at least check for the other symptoms.

Anyway, maybe a psychiatrist can chime in here, it's been a while since I've been involved with anything psychiatry-related.

Not a psychiatrist but I am schizophrenic. I agree, medication should be the first line of treatment. I developed major symptoms in my early 20s but didn't get diagnosed until I was in my early 30s. No amount of therapy would have made a difference. It fundamentally changes your perceptions. All the paranoia and delusions make perfect sense and seem completely logical when you're in that state. I never knew to seek treatment because I didn't know anything was wrong, even in spite of my life being in complete shambles. It wasn't until I got on medication for the first time and didn't experience major schizophrenic and psychotic symptoms that I finally realized the full extent of what I had been experiencing. I do agree with environmental factors being a major contributor to the severity of the symptoms but the symptoms themselves are a major contributor to the environmental factors. The symptoms prevent you from achieving or maintaining any semblance of normalcy or stability which in turn create stressors that exacerbate the symptoms. Without medication there's no way to break the cycle.

Thanks for sharing your experience. I agree that there's a sort of negative feedback loop for people who exhibit symptoms of schizophrenia. A few years ago I went to visit someone in jail whom I'd only known from an internet message board. He couldn't stop talking, and had probably been arrested for being disruptively psychotic. He's doing much better now.

> Without medication there's no way to break the cycle.

Metabolic therapies break the cycle too. The simplest form of this is Niacinamide, one of the B-vitamins. Also useful are T3 thyroid, topical progesterone USP, CO2, good nutrition, etc...

Diet and nutritional supplements do help but it really depends on the severity of the symptoms. I don't know much about T3 thyroid and topical progesterone USP, so I can't say how effective they are. I had been researching alternatives to prescription medication, mostly because of the issues I've had getting steady access to ones that don't have major side effects like Haldol and other 1st generation anti-psychotics. I found out about studies done with Tetrahydropalmatine (THP) a naturally occurring compound found in corydalis plants that target the same dopamine receptors as atypical anti-psychotics and found it to be moderately effective. I had also read studies done with L-Stepholidine a naturally occurring compound found in Stephania which is a more potent THP analog. The studies found it to be more effective but haven't been able to find a US supplier. I also came across studies successfully treating schizophrenia with the cannabinoid CBD and tried that recently which I found to be highly effective.

Wow, thank you for sharing your experience.

Doctors just don't want to admit that they don't have a clue what is causing the sickness (and not just this one). And because of that they pretend to know, inventing far fetched theories. That is a large part of their profession in health care. To make people feel they know and can help. The drugs are there to keep the cycle going. Because then patients depend on them for further medication.

Doctors "admit" this all the time. Stories in the popular media are where we get claims that doctors have the answers. As for the idea that doctors only give out psych drugs to keep patients dependent, nonsense. There is just a strong presumption for any treatment, any hope, over no treatment. On my psych rotations I never heard any attending claim anything about antipsychotics other than they helped a little, were very "dirty" and had bad side effects which made a lot of patients stop taking them...but, they're all we've got

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