Medications...Good? Bad?

Many people with serious mental illness believe that they are over-medicated. Their family members and even most people in our society at large share this perception. But it’s not true; actually, most Americans with serious mental illness are under-medicated.

Today's medications have the potential to bring great relief to almost everyone with serious mental illness. Many of these medications have unpleasant side-effects. HOWEVER, there is not a single drug or a single dose that works for everyone; often it takes months of trial and error to determine the med-regime which produces the best possible result, and some drugs make the problem worse.

They don’t “cure” mental illness like penicillin cures strep throat; they merely relieve the symptoms like aspirin relieves the pain of arthritis, and that means you have to keep taking them to achieve optimal results. Many of these medications are expensive – so drug companies, doctors and pharmacies get rich. But in spite of all these negatives, the big problem, by far, is that people aren’t taking enough of them.

One might assume that anyone in a hospital, a jail, or a licensed mental health facility is required to take whatever meds a doctor prescribes, but it isn’t true. A person perceived to be "out of control" can be given medications involuntarily, but only for a day or two. A court can order involuntary meds on a permanent basis (called a “Jarvis order” in Minnesota), but this is a complicated and expensive process. Only a tiny fraction of the people with serious mental illness are ever subject to a Jarvis. Everyone else takes meds voluntarily, which mostly means they don’t take them.

Besides the many real negatives listed above, taking pills is inconvenient. And since schizophrenia is primarily a thought disorder, which distorts one’s sense of reality, people with this illness often don’t realize that they need them.

Complicating this issue is a significant time-lag; most of the medications used in treating schizophrenia have are moderately long-acting. This is often described in terms of a half-life, which means that if you take a pill today, half of the drug is still in your body two weeks from now. So if you take 20 milligrams of some drug every day, the agent levels out at somewhere over 100 milligrams in your bloodstream. And if you stop taking it, you enjoy the effects, decreasingly, for several weeks, and don’t notice much difference.

By the time the level of the agent drops enough that you aren’t getting any benefit, you forgot you were ever taking it.

Am I Paranoid?

In the last 30 years working with people with various levels of schizophrenia, one thing that I've come to understand is paranoia. Not everyone diagnosed with schizophrenia experiences paranoia, and even those that do aren’t paranoid all the time.

Paranoia is commonly understood to mean a feeling of persecution. But the real definition is broader, more fundamental; it really means an unwarranted perception of one’s importance. What? If a person feels that Al Qaeda is following them around, the main flaw in their thinking is not so much a distorted perception of Al Qaeda as it is the perception that they are so important that Al Qaeda would be interested.

Sometimes I hear a song or an opinion on the radio and I think “that song describes an event/emotion from my life,” or “that guy just said what I’ve been thinking for years,” but I don’t dwell on such thoughts. People with schizophrenia sometimes think, “Hey, that guy must be following me around, observing my life, stealing my thoughts.”

Most of the time, people with schizophrenia realize that such thoughts are mere distractions, but they can’t quite shake them. I have often discussed people’s delusions with them and persuaded them to admit that they made no sense, but even then the delusions persist.

Once I had a long conversation with someone who wouldn’t take a shower because of a movie poster he had seen where snakes came out of the drain. He accepted the fact that big snakes like that wouldn’t fit through the tiny holes in the drain, and he even understood that we don’t have poisonous snakes living in the Mpls sewer system, but he still wouldn’t take a shower because he perceived the poster as a warning meant specifically for him. That’s paranoia.

Mythbusting - Part 5

Myth: Most mental illnesses are actually schizophrenia.

I just want to say that schizophrenia is more a category of poorly-understood conditions than it is a single disease. My hope is that within the next few years, researchers can isolate several distinct brain diseases, with distinct causes and distinct cures/treatments, all of which are currently being diagnosed as schizophrenia.

For now, let's say that schizophrenia involves a naturally-occuring checmical imbalance of the brain fluid. The embalance causes hyper-activity of the impulses we call "thoughts." This is counter-intuitive, because when you observe people with untreated schizophrenia, they frequently seem flat, lethargic, even vacant of thought. What apprently is going on here is that they have too many thoughts - so many that they can't sort out what is real and what is not.

There's lots of stuff going on in my brain as I type this: A conversation in the next room, overly-oud stereos on Nicollet Avenue, other work I need to do, the ballgame on TV tonight, food, sex, etc. But, not having this checmical imbalance called schizophrenia, I have the ability to focus enought brain power to finish this article. People with untreated chemical imbalance often find themselves unable to focus sufficiently to complete even the simplest of tasks; that's schizophrenia.