Stigma and Sophie’s Choice Part 2 – NABPM / NaBloPoMo Day 7

Lower Caste Party

Continuing from yesterday, I do think mental illness has a caste system.  The disorders that are seen as less scary or less threatening to anyone but the person suffering are at the top.  The farther down the scale you go, the more misunderstood the illnesses become.  They culminate at the bottom of the list with the disorders that the general public think are dangerous.  I think the list, (and granted, this isn’t all of them) looks sort of like this:

Borderline and Other Personality Disorders
Bipolar Disorder

So, Sophie’s Choice got me thinking.  Even those struggling with “higher order” mental illnesses have prejudices and pre-conceived notions about those lower down on the scale.  The thing that gets me about this is that all of the disorders above can be just as disabling as any other.  William Styron, the author of Sophie’s Choice, suffered with such immense depression that it threatened his life.  He called it, “so mysteriously painful and elusive in the way it becomes known to the self — to the mediating intellect– as to verge close to being beyond description.”  So why, in my interpretation, did he not have the same – respect? – for Schizophrenia?

Have you seen other examples of persons who are great advocates for persons with the same mental illness they suffer from, but still stigmatizes others?  I’d love to hear your thoughts.

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  • Rossa Forbes November 7, 2011 at 2:50 pm

    Sure, psychiatrists. Haven't you noticed how they always claim "schizophrenia" is a special case, almost treatment resistant? Of course, schizophrenia is their golden goose and continues to take up the most number of hospital beds. Then there are "bipolars" who should know better. Many researchers, Richard Bentall, for one, believe these conditions are one in the same. But there are many people with the diagnosis of bipolar who somehow have the impression that "schizophrenics" are the real sickos and they, the "bipolars" are the creative, annointed ones. When I deal with psychiatrists, I like to find out how "schizo-positive" they are, meaning, how much do they value what their schizophrenia patients tell them. And you know what I've found? Psychiatrists (most, not all) are about the worst. How can anybody get better if their doctor (and by default their parent) doesn't believe in them?

  • Chrisa November 7, 2011 at 3:17 pm

    Rossa, this is a prime example of what I am talking about. Take a look at children in particular. Psychiatrists are very, very reticent to diagnose children with any kind of psychotic disorder because – and I've been told this – they don't want the "label" to be stuck with them for life. How is that "label" any different than being diagnosed with epilepsy, diabetes, cancer, depression, ADHD?

  • Rossa Forbes November 7, 2011 at 4:47 pm

    Well, the problem is, in mental health, the label tends to stick way past its shelf life, particularly for schizophrenia, which people do recover from. However, it's not in psychiatry's interests to promote this (because of the golden goose). If someone with "schizohprenia" does recover, psychiatry claims he went into spontaneous remission, like some sort of act of God. A cancer patient can say, "I had cancer and tests show that I don't have it anymore." There are no medical tests for schizophrenia and nothing that can validate or negate recovery. It's all in the eye of the beholder.

  • Chrisa November 7, 2011 at 4:57 pm

    Erica, rant away. 🙂

    Rossa, the only issue with this is that the delay of treatment causes its own issues, like my son who lost more than 30 IQ points from the damage of constant psychosis. To use the cancer analogy, it would be like delaying chemo to see if the cancer is REALLY cancer, meanwhile, it spreads.

  • Rossa Forbes November 7, 2011 at 5:06 pm

    Schizophrenia, or dementia praecox, as it used to be called, is ground zero of psychiatry, along with manic depression and neurosis. Dementia praecos and manic depression were terms coined by Kraepelin in the early part of the last century. Everything else (the pathologizing of human angst) has been an add-on to the DSM. Psychiatry is vulnerable to accusations of label creep, which many psychiatrists would agree is the problem with psychiatry as it is practiced today. But they will not relinquish schizophrenia because it has a "noble" history that has been documented across cultures and time periods. It is also a scary condition, the mysteries of which psychiatry would prefer to keep to itself. Schizopyhrenia is very understandable if you take a humanistic approach.

  • Rossa Forbes November 7, 2011 at 5:23 pm

    Chrisa, my only question would be how does one distinguish loss of IQ points, from, say, the effects of the drugs or the mental turmoil that the person is going through? If someone is anxious or on a heavy dose of drugs, they can't perform. My son is about the most intelligent person I know and I delayed treatment, too. When he was floridly psychotic, he couldn't even read a book or a magazine article. He couldn't string two words together in a written list. Had he taken an IQ test, he would surely have lost points. My middle son took an IQ test when he was in second grade, and got a 40, if I remember correctly. He didn't see the point of finishing the rest. Today, he's a banker. Go figure.

  • Chrisa November 7, 2011 at 5:25 pm

    My son's IQ at age 4 was tested at 90. At 13, it was 59. That was all pre-meds.

  • Chrisa November 7, 2011 at 9:00 pm

    Erika: True about delay in diagnosing. In our case, as you know, we went through so many false diagnoses and vague diagnoses (and I didn't have the where-with-all then to research like I did later), we weren't even treating the symptoms.

  • TwisterB November 7, 2011 at 10:14 pm

    There is definitely a caste system, I would point out that as you go farther down your ladder the mental illnesses become less recognizable, and recognition is part of empathy.

    Most people can understand what an anxiety disorder would entail, since everyone has been anxious. When you get to seeing and hearing things, most people have no idea what that would be like, and unknown things are scary.

    When you talk about something like post natal depression, it can be BAD, it can even include psychosis, but most of the time it can be cured so it's easier for someone to say they HAD it.

    And to top it all off, most people might know someone with a certain mental illness but a lot of people only know about schizophrenia and bipolar disorder from TV….and you know how inaccurate that is.

  • Chrisa November 8, 2011 at 3:25 pm

    Erika – it's great, except for the fact that most insurance companies won't cover treatment without a diagnosis. Sucks, huh? I actually did another blog post about that conundrum:

  • Rossa Forbes November 8, 2011 at 8:58 pm

    Erika – If the medications work for you and others, and you feel you are fully informed, then by all means use them. What critics like me say is that many people do not want to be on the drugs in the first place, believe they are harmful, and yet are told a fable by psychiatry that they need the drugs, forever, and they are doomed if they go off them. The debate, if you can call it that, has been stacked in favor of pharmaceutical companies and psychopharmacologists in clear denial of any evidence to the contrary, and by evidence, I include patients telling their doctors that the drugs don't work for them and they want choices. At risk of prolonging this string of comments, here are some break-throughs I've seen with my own son.
    1. Assemblage point shift – within five minutes of finishing treatment got color back in his face and stopped walking hunched over.
    2. Family Constellation Therapy – as predicted by the therapy, my son broke out of the shell he had been confined to for the 3 years following his breakdown. Was able to talk to people and take an interest in life.
    3. Out-of body experiences – cutting edge therapy which can be achieved a number of ways, such as through LSD lab experiments, and light and sound therapy. Helped him to integrate his body with his mind, which is a big problem with SZ. It's like the mind has no relation to the body and the person does't know how to feel comfortable in a room, when to sit, when to stand. A few OBEs and my son was grounded, meaning he could pass for normal. There is still work to be done, but he's almost there. By "there" I am hoping that he goes back to finish his degree or do something surprising that would earn him a living. The experience of SZ takes some getting over.

  • Rossa Forbes November 14, 2011 at 12:26 pm

    I'll try to anwer your questions/comments in the order you posed them.
    1. Schizophrenia is the original basis for psychiatry. Freud seemed more concerned with neurosis, not psychosis, but generally psychiatry was put in place to deal with "mad" people – today we might call them "schizophrenics."
    3. Unfortunately, psychiatry as a profession has been perverted by greed and the promulgation of false information. This is not news. It's been the subject of media articles and Senate investigations for several years. The harm has been widespread, not just confined to a few. Read what psychiatrist Daniel Carlat wrote about drug reps in his office and how they perversely influence his treatment choices. My son has an excellent psychiatrist, but it took us a long time to find her, and the goal is one day no longer be her patient.
    4. "Schizophrenia" is hard to treat. There are no overnight cures. It's long, hard slogging. Although, I have read many times that a "schizophrenic" recovers when he finds someone who understands him. I have also seen and heard about rather quick break-throughs, but there is still work to be done after that.
    5. Medications used to be called "major tranquillizers" until they got an image change and they were called neuroleptics, or antispychotics. If they were used for what they are supposed to be used for, to calm the patient in times of great distress (used selectively), that would be one thing. They are now used for too long, in too high dosages. This leads to major health problems and brain damage. Reference: Dr. Nancy Andreasen, New York Times interview Sept. 15 2008. Dr. Andreasen reversed her previous findings on this subject. She now says: "Well, what exactly do these drugs do? They block basal ganglia activity. The prefrontal cortex doesn’t get the input it needs and is being shut down by drugs. That reduces the psychotic symptoms. It also causes the prefrontal cortex to slowly atrophy."

    So, yes, everybody should determine their own method of recovery, but first they must be given the facts as to how best to bring that about. This is not what is actually happening because of ghost written articles, drug company paying doctors to be key opinion leaders, and dangling other monetary incentives at them, and the suppression of research findings. Thank goodness for bloggers! It's getting harder and harder for companies and key opinion leaders to pretend it's business as usual.