The Collected Schizophrenias

Diagnosis

• Craziness scares us because we are creatures who long for structure and sense; we divide the interminable days into years, months, and weeks.
• A diagnosis is comforting because it provides a framework - a community, a lineage - and, if luck is afoot, a treatment or cure. A diagnosis says that I am crazy, but in a particular way.
• Schizophrenia in the Diagnostic and Statistical Manual (DSM-5):
  • A: Two or more of the following for a significant portion of time during a 1-month period:
    • Delusions
    • Hallucinations
    • Disorganized speech
    • Grossly disorganized or catatonic behavior (which can include excessive motor activity)
    • Negative symptoms (ie diminished emotional expression or avolition)
  • B: Markedly reduced function in one or more major areas, like work, interpersonal relations, or self care.
  • C: Continuous signs of disturbance for at least 6 months.
  • D: Ruled out schizoaffective disorder and depressive or bipolar disorder with psychotic features.
  • E: Not due to drugs, medication, or another medical condition.
  • F: If there is autism spectrum disorder or a childhood onset communication disorder, then prominent delusions or hallucinations.
• Medicine is an inexact science, but psychiatry is particularly so.
• Schizoaffective Disorder, Bipolar type, involves schizophrenic symptom in addition to a major depressive or manic mood episode
• Emil Kraepelin is credited with pinpointing the disorder he called "dementia praecox" in 1893, but the Swiss psychiatrist Eugen Bleuler coined the word "schizophrenia" ("split mind", to address the loosening of associations that are common in the disorder) in 1908.
• People diagnosed with schizophrenia are more likely to be born in the winter than in the summer; perhaps due to maternal infection during pregnancy. Difficult births, obstetrical complications, and stressful events suffered by the mother, such as assault and war, are also correlated.
• Certain categories, as crude as they are, are still useful in capturing a group of individuals that probably have more in common in terms of etiology or basic mechanism than they are different. And certain disorders are better than others in that regard. So autism has proven to be a pretty useful thing. bipolar disorder has proven to be, I think, more useful then schizophrenia. Obsessive-compulsive disorder is probably one of the more specific ones. Major depression is problematic. Generalized anxiety disorder is very problematic.
• Schizophrenia's subtypes - paranoid, disorganized, catatonic, and undifferentiated - no longer exist in DSM-5, which means, among other things, that pop culture has lost "paranoid schizophrenia" as a diagnosis upon which to hang criminal acts
• One potential explanation suggests that the evolutionary development of speech, language, and creativity, while bestowing significant gifts, has "dragged" along less desirable genetic tendencies with it; from this perspective, schizophrenia is simply the price humanity pays for the ability to write hearrending operas and earthshaking speeches.

Toward a Pathology of the Possessed

• Humans might all be ciphers to one another, but people with mental illness are particularly opaque because of their broken brains. We cannot be trusted about anything, including our own experiences.

High-Functioning

• Schizophrenia and its ilk are not seen by society as conditions that coexist with the potential for being high-functioning, and are therefore terrifying. No one wants to be crazy, least of all truly crazy - as in psychotic. Schizophrenics are seen as some of the most dysfunctional members of society: we are homeless, we are inscrutable, and we are murderers.
• Among psychiatric researchers, having a job is considered one of the major characteristics of being a high-functioning person... as having a job is the most reliable sign that you can pass in the world as normal.

Yale Will Not Save You

• There might be something comforting about the notion that there is, deep down, an impeccable self without disorder, and that if I try hard enough, I can reach that unblemished self. But there may be no impeccable self to reach, and if I continue to struggle toward one, I might go mad in the pursuit.

The Choice of Children

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On the Ward

• A primary feature of the experience of staying in a psychiatric hospital is that you will not be believed about anything. A corollary to this feature: things will be believed about you that are not at all true.
• I was overwhelmed with a sense of free-floating terror that spread like blood and congealed around vulnerable targets such as my face, the patterns in the carpet and on the bedspread, the view of dry and dusty Reno from our window.
• Though nearly all the statements a psychiatric patient can make are not believed, proclamations of insanity are the exception to the rule. "I want to kill myself" generally holds water, and a therapist who hears those words is legally required to disclose them to prevent client self-harm.
• A person who is hospitalized with schizophrenia will inevitably be put on some type of second-generation antipsychotic. Zyprexa, for example, is known to put the brakes on manic activity. Hospitalization is generally reserved for times of psychiatric crisis, and so Zyprexa, or a drug like it, may shut down the most violent behaviors.
• But medication is only one part of the ideal treatment plan. According to the American Psychiatric Association's Practice Guideline for the Treatment of Patients with Schizophrenia, 2nd ed, that plan has three major components:
  • To reduce or eliminate symptoms.
  • To maximize quality of life and adaptive functioning.
  • To promote and maintain recovery from the debilitating effects of illness to the maximum extent possible
• All of this should be done swiftly: according to a 2012 study, the average stay in a psychiatric hospital is 10 days. The contemporary psychiatric hospital is intended to stabilize its patients, and then to set them up for recovery in the outside world.
• According to the Department of Justice, nearly 1.3m people with mental illness are incarcerated in state and federal jails and prisons.

The Slender Man, the Nothing, and Me

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Reality, On-Screen

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John Doe, Psychosis

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Perdition Days

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L'Appel du Vide

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Chimayo

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Beyong the Hedge

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