Monthly Archives: April 2010

Schizophrenia: A Change Is Gonna Come

Schizophrenia is an ugly word. It is an equally ugly disorder. To those afflicted with this disorder, the pain, both psychological and physical, is virtually unbearable, and too many times, as suicide statistics bear out, the pain is unbearable. To most on the outside looking in, it is incomprehensible, an enigmatic set of thoughts and behaviors (and if an affective component exists, moods) that stir the exaggerated fears of those who witness its effects. Ignorance, and I don’t mean that word in a derogatory manner, is the birthplace of those exaggerated fears.

This will be one of my final blog posts before I participate in a talk to be given at a nearby high school early next month. I want to thank the teachers and administrators who helped to bring this engagement to fruition. Your understanding of the importance of mental health is a testament to your foresight and courage. But, as important as teachers and administrators are, the real heroes of this talk will be the students.

During my high school years (in the late 1980s), depression was not talked about. For quite a few, this “common cold of mental disorders” was the shame of families unfortunate enough to have to deal with depression’s own devastating effects. Now, not even a quarter of a century later, a group of 200+ high school psychology students will sit in the same auditorium with a man who has paranoid schizophrenia. Now that’s pretty f-ing cool.

What has changed from my generation to this one that has created an atmosphere in which such an interaction can occur? Better medications? Sure. Better therapies? Sure. More public exposure to persons with severe mental disorders living in the community? Maybe. The change could be due to a lot of reasons. However, there is one fundamental idea that seems to have caught on in the last two decades that wasn’t around as much when I was in high school (and definitely not in my parents’ generation). That idea? That mental disorders of any severity or of any kind are not the fault of the people who are afflicted with them.  

This fundamental shift in ideology has been so subtle yet so profound that this new generation of teenagers, a growing number of whom accept this idea as a fundamental truth and who are simultaneously pushed down instead of lifted up by many in the older generations, will change the world. They will change it faster, more meaningfully, and in more dramatic ways than any generation to come before them. They will take severe mental disorders like schizophrenia out of the frontier mentality in which it has languished for centuries and provide for them the vigor and vitality of compassion, empathy, and ultimately better treatments. For this, they should be uplifted, encouraged, and lauded.

In closing, I would like to thank the students with whom I will be speaking early next month. Thank you for following my blog. Thank you for taking an interest in mental health issues. And, thank you for your willingness to sit in an auditorium for 1 1/2 to 2 hours with me, for having the courage to listen to my story and then to ask questions about my experiences, and for taking what you and I learn together and applying that to touch real people’s lives. Because there are real people (millions of them) out there who are really suffering, some of whom are ashamed of their disorders, and some who have no means to help themselves. You will be the generation to change their lives.

Thank you.

eb

A Tale of Two Vices

I drink 3 – 5 cups of regular coffee in the morning. Sometimes, I will drink a cup or two in the evening. I smoke 4 – 7 cigarettes per day (when I can afford them).

Whew! Glad I got that off my chest. Caffeine and nicotine addiction are common among people with schizophrenia, and while the magnitude of my addiction may be less than most who have this disorder, the fact is that I struggle with both of them. If I could drink coffee and smoke cigarettes all day, I probably would.

Let’s take a look at the first vice I mentioned: CAFFEINE. According to Dr. E Fuller Torrey, MD (Surviving Schizophrenia, 5th Edition, pp. 275-276, 2006), “patients have been documented as drinking thirty or more cups of coffee each day as well as drinking many colas, which also contain caffeine.” He goes on to say, “There are some individuals with schizophrenia who buy instant coffee and eat it directly from the jar with a spoon.” Dr. Torrey continues by stating that “studies of individuals with schizophrenia who ingest large amounts of caffeine have demonstrated that some patients have a worsening of their symptoms.”

A 2004 groundbreaking study by Manuel Gurpegui, MD et. al., came to this conclusion:

“…neither current caffeine intake nor the amount of caffeine intake was associated with the severity of schizophrenia symptomatology, not even after controlling for alcohol or tobacco use. However, owing to the cross-sectional nature of our data, we still cannot rule out the possibility of an association between caffeine intake and schizophrenia symptomatology. Longitudinal studies have to be carried out to address this issue.”

For a complete text of the above study, check out this link:

http://schizophreniabulletin.oxfordjournals.org/cgi/reprint/30/4/935.pdf

So, which is it? Does caffeine affect the symptoms of schizophrenia or not? As the above study indicated, it is difficult to know without taking alcohol or tobacco use into account. That said, I will speculate on what caffeine does for me:

  1. Increased anxiety
  2. Increased ability to stay awake and alert (focus and concentration go way up)
  3. Possible increase in positive symptoms (especially paranoia, though not to a substantial amount)
  4. Possible decrease in negative symptoms = more motivation, focus, and concentration = ability to get more work done

But, that is just half of our tale. Whereas the first vice is somewhat socially acceptable, the second one, NICOTINE IN THE FORM OF CIGARETTE SMOKING, is definitely not. Let’s talk about this one for a bit. To do this, we will revisit our old friend, Dr. Torrey. What does the good doctor have to say about this one? In the same book I referenced above, Dr. Torrey claims that “several studies have shown that between 80 and 90 percent of individuals with schizophrenia smoke cigarettes.”

When I read this, I was astonished. Then, I did a reality check on myself…along with a bit of research on the topic. I realized that a well-timed smoke (outside of course, even if it is -6 degrees F) can calm me and help my anxieties, thus improving my concentration. To put it plainly, smoking just feels good to me. It feels good to sit back in my “smoking recliner” that makes its home in my garage and take a long, slow drag from a Pall Mall Menthol 100. I’ve tried more than several times to quit. No luck. If you’ve never picked up a cigarette, I hope you never do. If you smoke, I wish you the best of luck in quitting. Nicotine is the most addictive drug out there…more addictive than heroin, crack cocaine and even methamphetamine. Don’t think the tobacco companies don’t know that, either. They do.

A few interesting notes on this vice:
(referenced from Surviving Schizophrenia, 5th edition, pp. 273-275, 2006):

  1. Nicotine reduces anxiety and sedation (many antipsychotics cause sedation), and improves concentration in some people.
  2. This “self-medication theory” was given support when participants [who had schizophrenia] reported that smoking improved specific brain functions that are known to be impaired in this disease.
  3. Abrupt cessation of smoking exacerbates the symptoms of schizophrenia.
  4. Nicotine decreases the blood level of most antipsychotic medications, which results in the need for higher doses of antipsychotics to relieve the symptoms of schizophrenia.
  5. Surprisingly, the lung cancer rate among schizophrenic smokers is actually less than that of the general population.

For additional resources on nicotine and schizophrenia, check out these links:

http://www.schizophrenia.com/smoke/schizophrenia.smoking.res.htm

http://www.medicalnewstoday.com/articles/26516.php

http://www.webmd.com/schizophrenia/guide/substance-abuse-schizophrenia

This last link is especially good:

http://www.sfn.org/index.cfm?pagename=brainBriefings_smoking

So, all of this begs the question: What is to be done? Torrey states: “Be aware that smoking and drinking coffee are among life’s most pleasurable activities for some individuals with schizophrenia. The fact that this is so is sad, but that does not change the reality. We should be careful about taking away such pleasures unless we are certain that the gains from doing so are worth it.” I agree.

Best wishes…

eb

The Bipolar “Bi-Cycle”

Hello again! As most of you know, I have been diagnosed with schizophrenia. What some of you may not know is that I also have bipolar disorder, the exact variation of that diagnosis being Bipolar II Disorder-rapid cycler (more on that in a minute).

I first noticed symptoms of having bipolar disorder while homeless in Boston (December 1996). However, I didn’t begin receiving treatment for it until August or September 2006. It can be a very debilitating disorder, especially when combined with schizophrenia.

What is bipolar disorder (manic-depressive disorder)? How does it affect people (including children)? Finally, what can be done about it? How does bipolar disorder affect me and why didn’t anyone (myself included) recognize for it 9 1/2 years after I first received treatment?

(1,2) Like schizophrenia, bipolar disorder is a largely genetic disorder. People with this disorder were born with the genetic predisposition to be vulnerable to getting it. Perhaps, for some it is purely genetic; for others, environmental factors trigger an episode (usually there is a genetic predisposition that rears its ugly head once certain environmental factors are experienced).

In short, bipolar = mood swings. Sometimes there is psychosis involved. More often than not, this psychosis has some sort of grandiose thinking to it, which is experienced when a person is in the manic phase (“up”). During a manic phase, a person might go on spending sprees, have a decreased need for sleep, and think that they possess the potential to be something they aren’t (a revered religious figure, President of the United States, or the ability to do things they really can’t do like single-handedly win the War on Poverty).

The euphoria of feeling powerful can be addictive, and most who have this disorder lack the capacity to realize they are sick…until of course, they fall into the seemingly bottomless pit of clinical depression. The energy and focus they had during the manic phase disappear to be replaced with a darkness that can only be appreciated by someone in its throes. The contrast between mania and depression is very striking.

For more info on bipolar disorder, check out this website:

http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml

Think children cannot be affected by bipolar disorder?  Think again:

http://www.bpkids.org/learn/library/about-pediatric-bipolar-disorder

(3) Medications are a must when treating bipolar disorder. Some of the more common mood stabilizers include Lithium, Tegretol, Depakote, and Abilify. Sometimes, an antidepressant will be used to mitigate the effects of the depressive phase, though some experts and findings have claimed that the use of antideps actually encourages and magnify the effects/symptoms of the manic phase.

Psychotherapy by a trained mental health professional is also very helpful in treating this disorder, especially in training the individual to recognize when she is about to begin a depressive slide or a manic blast-off.

(4) How does bipolar disorder affect me? My particular variety (there are two) of bipolar disorder is called Bipolar II Disorder. I experience the same depths of clinical depression as someone with Bipolar I Disorder, however, my “highs” are not quite as magnanimous as those who have Bipolar I Disorder. My “high” is called hypomania (literally, little mania).

Hypomanic episodes are fun. I have a lot of energy and focus. I can stay awake and alert for 36 to 48 hours or more. I tend to be very gregarious and accomplish a lot of work during these periods, which unfortunately only last a couple of days and are then followed by either a dive into the deep end of depression or a latent period which precedes the depression.

Where there is mania, depression is not far behind. During a depressive episode, I tend not to be very affable. I tend to isolate a bit more and my reactions to things going on around me are much less productive. I am drained of energy, focus, and interest in things that I usually find enjoyable. Whereas hypomanias are fun (and relatively benign), depressive states are just the opposite.

As I mentioned above, medicines and psychotherapy are key to coping with and partially recovering from bipolar disorder. I take an antidepressant (Wellbutrin XL) and a mood stabilizer (Depakote ER). I’ve been noticing that I still cycle somewhat. I had an appointment with my psychiatrist today; he upped my Depakote. Hopefully, the tidal flow of my moods will calm down a bit.

“Nothing is so real as a dream.”

I ran across this quote by Tom Clancy the other day while reading a book on how to get a literary agent, and I have decided to devote a post to it. Dreams come in various forms. Some people dream of riches, adventures, and fame; others dream of paying off their credit cards before they retire. I would guess that given the opportunity, many of us would strive to make our community a better place to live.

Whatever the dreams one has, they are important. Dreams give us the one thing we all need to survive: hope. What are some of your dreams? Have your dreams changed over the years? Mine have. And, I’d like to share them with you in the hopes that you will at the very least find them entertaining. Perhaps, you would like to share some of your dreams, too.

When I was a little kid, I dreamed of being two things: an astronaut and a veterinarian. Well, the first dream is floating somewhere in outer space, and allergies blocked my dream of doctoring non-human animals. So, since I wasn’t allergic to people, although I think people with schizophrenia tend to be, I decided to try to become a medical doctor. I chose this career path for several reasons, some altruistic some selfish. Here a few of the reasons that come to mind:

  1. Social prestige and power. Beginning in middle school and throughout my high school and college careers, I lacked these two things. I believed that I would gain those by working as an MD. It’s a good thing I didn’t become a doctor because this was probably the #1 reason for my choosing this profession. Pretty sure I would have had the “God Complex.”
  2. Money. Money brings a lot with it, including social prestige and power (at least in some cases). I wanted to live wealthy and enjoy the luxuries that money affords people. I neglected to take into account the pitfalls that money can bring. Again, not the best reason for wanting to become a doctor.
  3. To help people. From an early age, I felt compassion toward those creatures (human and non-human) who were hurting. Although this ranks third on my list, I think it is a close third. Social prestige and power and money would have been the driving force behind me becoming an MD; helping people may have been the factor that would have kept me going in that profession.

But, as is the case with many dreams, my dream of becoming a medical doctor changed. Why? The obvious reason is that my illness worsened. The not-so-obvious reason is that I had spent so many years studying biology and chemistry that by the time I graduated from college, I was a bit worn out with the sciences. Perhaps, regardless of my disorder, I would have chosen a different career path.

And, that leads me to the obvious question: What are my dreams now? My #1 Dream is to have a relatively happy family and to raise my daughter in the best way I know how. As for a career, I think writing and public speaking have chosen me rather than my choosing them. They are the only things I know how to do…the only things I feel comfortable doing. Will it work out long-term? Maybe. Maybe not. And, if you ask me ten years from now what my dreams are, I’ll probably have a different answer. One constant remains, however. I’d like to leave this world a better place than when I arrived.

What are some of your dreams?

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