Tag Archives: schizophrenia

schizophrenia, involuntary admission and family members

the following is a press release from vancouver’s north shore schizophrenia society.  since no-one seems to have picked it up yet, i’m publishing it here.  it addresses the important question of when involuntary admission for serious mental illness is applicable, and the involvement of family members.

vancouver coastal, in a review of the death by suicide of marek kwapiszewski, has ducked the leading question they needed to answer: why is “dangerousness” still considered a requirement for involuntary admission rather than “to prevent the person’s… substantial mental or physical deterioration,” as spelled out in the mental health act?

what was promised by CEO david ostrow to have been an “independent” review, moreover, turned out to be not so independent after all, with senior managers under question in the review taking part in drawing up its recommendations.

kwapiszewski, 54, of vancouver, who suffered from schizophrenia, jumped off the granville street bridge to his death june 29, 2008. his sister, halina haboosheh, together with her lawyer, had made 16 different attempts to get him the treatment he needed – treatment which required involuntary admission since kwapiszewski, like many suffering from schizophrenia, did not have insight into his own condition.

instead of dealing with the factors leading to kwapiszewski’s death, the review came up with three brief items in a so-called action plan, which involved no changes or improvements in practice, nor was any fault determined although it was an obvious case of clinical failure.

“the ‘action plan’ should have been called an ‘inaction plan,'” NSSS president herschel hardin commented. “it was as if a review had not taken place.”

the so-called action plan was presented to haboosheh and the north shore schizophrenia society, which made the original submission in the case, at a meeting july 26, in vancouver coastal’s boardroom.

the first item, to facilitate a discussion to consider development of an operating definition of “deterioration,” makes no commitment to ultimately do anything, and is highly questionable to begin with in any case. nor does it apply to the kwapiszewski case, where the deterioration was quite clear and substantial.

the second and third of the three items were bureaucratic filler, not representing anything new and showing no grasp of what the problem was.

the review also completely missed two other crucial factors in the case: the failure of vancouver coastal staff to involve the sister, halina haboosheh, as an integral member of the treatment team, following best practices, and the concomitant failure to share clinical information with her. if that had been done, marek kwapiszewski might well be alive today.

it was also learned that the items were not the independent work of the external lawyer and psychiatric consultant hired to undertake the review, but were a consensus arrived at with senior community mental health managers and, possibly, vancouver coastal’s risk management officer. in effect, they had a veto over what would be presented.

as well as forfeiting the review’s independence, this meant that a major shake-up of senior mental health management, called for in NSSS’s 2009 submission, could not even be addressed. instead, the primary subjects of the review, as NSSS considered them, were parties to the review’s outcome.

in response to vancouver coastal’s items, NSSS has presented four recommendations of its own to vancouver coastal and has asked ostrow and his board for leave to speak directly to the recommendations at a board meeting.

for more information, please go to the NSSS media center.

psychologists, mental illness and stigma

today please visit over at brainblogger, where i talk about research on how some psychologists view people with mental health issues, especially those with schizophrenia and borderline personality disorder.  interesting points that are being discussed in the comments are the place of diagnosis and the importance, or limits of, of objectivity.

voices – napowrimo day 24

when your voice doesn’t come out
and you hear someone else sing
and more voices run around in your mind
when you see lights left right center
when the rattling comes at you and the heat and the radiation
when you keep beating up your head
how can it work
how are you supposed to engineer a thought
or let one rise up from creation?

mental illness awareness week 2009

today marks the end of mental illness awareness week. here are some bloggers who wrote about it, and a poem

and here’s my contribution, a poem i wrote about 15, 16 years ago. you’ll be happy to hear that the suitcase has been emptied.

i’ve been carrying around with me
for all these years
a hidden suitcase of despair

once in a while
i go and open it
inspect it
gleefully
under the covers of my
sheltering bed

i am delighted at its contents:
colourful puppets and leftover trinkets
spill out
and one or two caterpillars, brillant in the half shade
of what little light pierces
the soft, warm clouds of my duvet

then, when i hear footsteps
i close it
camouflage it
so that no-one
can steal
not even with a glimpse
my precious suitcase
brimming with exquisite anguish

of schizophrenic mice and men

here is some exciting new research on schizophrenia, which i found through changeseeker. the full text is at psycport; i’ve added a few links and comments.

new research from the northwestern university feinberg school of medicine has revealed how schizophrenia works in the brain and provided a fresh opportunity for treatment. in a new, genetically engineered mouse model [which was pioneered by the good people at johns hopkins], scientists have discovered the disease symptoms are triggered by a low level of a brain protein necessary for neurons to talk to one another.

in human and mouse brains, kalirin [named after the multiple-handed hindu goddess kali for its ability to interact with numerous other proteins] is the brain protein needed to build the dense network of highways, called dendritic spines, which allow information to flow from one neuron to another. northwestern scientists have found that without adequate kalirin, the frontal cortex of the brain of a person with schizophrenia only has a few narrow roads. the information from neurons gets jammed up like rush hour traffic on an interstate highway squeezed to a single lane.

“without enough pathways, the information takes much longer to travel between neurons and much of it will never arrive,” said peter penzes, assistant professor of physiology at the feinberg school. he is senior author of a paper reporting the findings published in a recent issue of the proceedings of the national academy of science. michael cahill, a feinberg doctoral student in neuroscience, is the lead author.

“this discovery opens a new direction for treating the devastating cognitive symptoms of schizophrenia,” penzes said. “there is currently no treatment for that. it suggests that if you can stimulate and amplify the activity of the protein kalirin that remains in the brain, perhaps we can help the symptoms.”

currently the only drug treatment for schizophrenia is an antipsychotic. “the drugs address the hallucinations and calm down the patient, but they don’t improve their working memory (the ability of the brain to temporarily store and manage information required for complex mental tasks such as learning and reasoning) or their ability to think or their social behavior,” penzes said. “so you end up with patients who still can’t integrate into society. many attempt suicide.”

here is a study on the effect of the use of antipsychotics, particularly clozapine, by people with schizophrenia.

the following is an excerpt from an article which reviews the literature on suicide and suicide prevention of people with schizophrenia, where the suicide rate is anywhere from 5% to 29%:

mann et al. [250] reviewed the literature and identified a number of strategies that are effective in the prevention of suicide such as education and awareness programs for the general public, primary care providers and other gatekeepers, screening for individuals at high risk, and providing treatment using pharmacotherapy and psychotherapy. in particular, the prevention of suicide in schizophrenia should include providing proper information for the family members of the patient in the hope of reducing their hostility toward the patient. in addition, continuity of care after suicide attempts, restricting access to lethal methods and media reporting guidelines are important strategies to prevent suicide. since it is such a strong predictor of future suicide, preventing and reducing attempted suicide in schizophrenia may have a positive long-term impact.

february buddhist carnival – on mental health

a laughing buddhist nunfor this month’s buddhist carnival, i’d like to focus on buddhist approaches to mental health issues. this is partly in preparation for coping digitally, a panel discussion about mental illness and social media that i’ll be part of at this year’s northern voice blogging conference here in vancouver this coming friday and saturday (february 20 and 21). airdrie came up with this fabulous idea; the other person who will participate is tod maffin. i’ll be talking more about this conference tomorrow.

we always start this carnival with a poem. today i’ll open it with one of my haiku:

feeling rising when
i see the kitchen: messy.
oh, hello anger!

and here are the blog entries. i’ll present them in two parts; overwhelming people with information is not the buddhist way …

meditation and medication

the buddhist blog talks about the need for both meditation and medication.

as many of you know i have been living with schizoaffective disorder for most of my life and have found great refuge, relief of symptoms and calm from buddhism and meditation in particular … i notice that the more i meditate the easier it is to deal with my condition. yet meditation alone isn’t enough in my situation because despite meditating i still am debilitated by disabling symptoms such as paranoia, hallucinations, delusions (psychiatric delusions such as being convinced that you are the most horrible person on earth), mood swings and chronic depression. thus i have found medications help fill the void and basically keep me alive because my depressive episodes easily lead to suicidal thoughts.

buddhism and borderline disorder

the american buddhist muses on how buddhist approaches may be helpful for people with borderline personality disorder. he goes through the dsm-iv criteria for this condition and suggests the use of specific buddhist concepts for each of them. it’s a bit simplistic – as a counsellor, i certainly wouldn’t suggest to a person battling with a fear of abandonment to meditate on impermanence right off the bat – but the ideas are nevertheless interesting. for example

the problem of splitting, or seeing others in the extremes of idealization and devaluation (as “all-good” or “all bad”), is a matter of delusion, failing to see the enormous grey area that we all inhabit. perhaps a meditation on the qualities of a candle can help. begin by seeing the positive qualities: light, warmth, dance. but acknowledge also that it may burn us, that it will not last forever, and that it is certainly limited in its power to please us. through this we learn a gentle acceptance, even appreciation, of the candle. people are the same. they may be the light of our life, or they may badly burn us – or both at different times.

will buddhism drive you crazy?

kyle takes up the fear by some people that delving into buddhism can drive you to the brink of insanity, and right over it.

i have heard so many different misguided opinions about how buddhism is ‘dangerous’ and can cause ‘psychosis’ and even ‘permanent mental illness’. i have heard leaders and the priestly class of other religions say this, i have heard psychiatrists say this and even some historians. they claim that the kamikaze pilots in world war two shows how twisted buddhism can make one become. some psychiatrists will point to patients having psychotic breaks sometimes needing hospitalization and even having permanent mental issues caused by practicing some form of buddhist meditation.

kyle’s conclusion is that it’s important to have a teacher. generally, i’d agree with it, except that the teacher has to know what she or he is doing. i’ve had a few experiences with another approach – kundalini yoga – where the teacher actually denied that anything out of the ordinary could happen, which was contrary to my own experience. that felt pretty crazy-making for a while!

go on to part 2.

image by poorfish

blogathon: creativity and schizophrenia

(this is an entry for my participation in the 2008 blogathon, a 24-hour marathon of blogging. please support the cause and donate – however much, however little – to the canadian mental health association (vancouver/burnaby branch). to donate, use this URL: www.canadahelps.org/CharityProfilePage.aspx?CharityID=d2252. you should be able to get there by clicking the link;if not, just copy and paste the link into your browser. it will take you to the appropriate location at canada helps. thank you!
)

my stumbleupon friend andrea kuszewski has written a series of blog posts on the psychology of creativity, with a bit of an emphasis on mental health. here are a few excerpts, focusing particularly on the connection between creativity and schizophrenia:

for eons there has been dispute about the definition of creativity, but most individuals studying it today have come to agree on certain components of cognition that are present and necessary for creative thinking. these include divergent thinking, the ability to make remote associations between ideas, the ability to switch back and forth between conventional and unconventional ideation (flexibility in thinking), and perhaps most importantly, to generate original, novel ideas that are appropriate to the task at hand. other features of the creative personality include a willingness to take risks, and tendencies for deliberate, functional non-conformity …

it has been proposed in recent years that there is a strong genetic link between schizophrenia and creativity. the schizophrenic spectrum of traits includes delusional thinking (divergent, loose associations), jumping from idea to idea (flexibility), and over-inclusive thinking patterns (attention to irrelevant stimuli and detail, or lack of latent inhibition). what distinguishes these traits from creativity? to sum up a complex notion in simple terms: cognitive control.

as mentioned earlier, many famous creative individuals have had familial links to different types of psychopathology; one of the most heavily recognized in relation to creativity is schizophrenia. schizophrenia provides a good model for comparison when looking at creativity, because while the schizotypal personality embodies many of the essential elements to creative thinking, schizophrenia is lacking in one key area, which is cognitive control.

let’s have andrea’s words enter into a conversation with alex winstanley, from the summer 2008 edition of in a nutshell (i’ll tell you about that magazine in another post today), where he wrote a beautiful article entitled voices and creativity. here is an excerpt:

i use the dynamic energy of the voices to slingshot myself into poetic dimensions, as the voices are constantly breaking down the barriers between me and the imaginative world …

as i emerge from these bouts of imagination, life is so close to my confused sense i can hardly comprehend the crystalline beauty of what i am witnessing. i see the dance of the objective world with a clarity and intensity known only in the most extreme circumstances. the truth is, every day for me is an extreme circumstance, every moment a chance to renew and change my awareness.

by seeing the voices as a psychic space created to be understood, traversed, and conquered, i am evading the tendency for schizophrenics to pity themselves or play the victim.

and if we wanted to invite a third person, i think it might be jill bolte taylor and her mystical experiences after a stroke.

schizophrenia, taboos and meditation

this is a guest post by geb sheru geb. in this intriguing article, he takes up on my post about kiddie porn a while ago, and talks about how the process of obsession in a person who hunts for child pornography is similar to the process of obsessive thoughts of someone experiencing schizophrenic symptoms. walking into the “danger zone” of taboo confronts one with conflicting feelings and emotions. amplify such conflicts and you have the experience of schizophrenia.

***

“oh be careful, little eyes, what you see…”

these are some of the words to a children’s song i learned during my primary school years in sabbath school. its counsel is one of guarding the gate to the sense of sight, the sense of hearing and the sense of touch. i limit my topic to this counsel only as the chorus of the song opens up a wholly unedifying discussion.

in the discussion that follows isabella’s post kiddie porn, reference is made to a kiddie porn website and one poster remarked in apparent horror, “i can’t believe people would even want to check those kinds of sites out!”

it is here that i would like to introduce a question for discussion’s sake; why would one not want to check those kinds of sites out?

my assertion is that the most likely answer is not for some sense of right or wrong, neither commiseration or empathy for the victims, but for fear of the feelings one may experience while viewing the images or reading the words found there.

during my time in university, one of my courses was sexual perversion in history and the modern age. in that course, i was exposed to the gamut of procedures and practices, pedophilia, bestiality, necrophilia, etc., etc.; many of which, only the most deranged would find anything but revolting, however, in the “right” presentation, revulsion disappeared and in its place a low level arousal surfaced.

i don’t believe that most of us will feel a lasting aversion in this “right” and “harmless,” “friendly” presentation. for the vast majority of us, the zenith of our human experience is the sensual pleasure leading up to and including the orgasm. we call it many things; love being the most common, but when the one you love is no longer there for you, does your zenith become something else? we seek another partner and call it love all over again. we are social, sensual beings, for better and for worse.

we might sound the bell of our own voice, while viewing images of exploited children, and drown out inappropriate feelings with, “oh, my god…that’s disgusting!” but the battle has begun, between the subliminal and the expressed.

i tried this for a while, expressing my disgust when some part of me was not. as i got deeper into the course matter, i began to notice patterns in my stimulation. and as the pathways became well lit, i became lost in the internal arguments along the way. first, the case justifying prepubescent sexual autonomy; then interrupting it was the argument against; back and forth like a caged animal it went. but the undeniable fact acknowledged by only the most painfully honest remained – i felt something.

now, amplify this many, many times over; amplify the semi-conscious, low-levels of arousal to dynamic bodily phenomenon; amplify the quiet monologue of the conscience to screaming accusations against whetted and angry declinations; now multiply them and amplify them again to a frequency that prevents you from finishing a meal, from walking one minute in the same direction, that makes even the comfort of sleep far distant. make this your life for a week; no make it a month, how about a year? then you might catch a glimpse of schizophrenia.

antipsychotics? the list is long, and for many of us, they are the only option. i struggled with over-medication for two years. i struggled with proper medication for three more until after just six weeks of a meditative practice called tranquility thru concentration, i put down my medication and began clearing my mind of all thoughts at will. two years, four months and three weeks later, i am still in the meds-free mode and achieving tranquility thru concentration moment-by-moment, day by day.

my name is geb sheru geb; i’ve written a little book (23,000 words) that tells my story of overcoming schizophrenia with meditation. you can find it at meds free mode.