[ExI] A Small Request

[Amara Graps]

Stathis Papaioannou stathisp at gmail.com
>The problem is, mentally ill people may
>refuse to believe that they are mentally ill no matter what evidence
>is presented to them, because lack of insight is one of the symptoms
>of the illness. Everyone else can see that they are ill, and they can
>see that they were ill in retrospect once they have recovered, but
>they can't see it whilst in the middle of it, no matter how
>intelligent and normally rational they are.

While they are in the middle of it, I would agree. There's glimpses when
they are passing in and out of mental illness, however, that something
is not quite right. I don't know how long that phase is, though, if it
is long enough to be useful to the family and friends around to do be
able to do something constructive with the ill person in that time.

BTW, we had this conversation before, but the extropy archives don't
go back to 2000. I'll paste several posts from my records.


-------------------------September 9, 2000

To: extropians at extropy.org
From: Amara Graps <amara at amara.com>
Subject: Re: Homeless


From: Barbara Lamar <shabrika at juno.com>, Fri, 8 Sep 2000

>>On Fri, 8 Sep 2000 14:40:02 EDT QueeneMUSE at aol.com writes:
>>  To be honest, these folks don't KNOW they  need it,
>>  and often they *like* themselves the way they are... so *someone*
>>  has to take them in and get them started, because they haven't the mental
>>  faculties to do
>>  it themselves!

>It makes me uncomfortable to think that if I happen to be sitting out on
>a curb looking weird and unkempt I could be forcibly picked up and
>injected with psychoactive drugs.  So there are people who like
>themselves as they are, are happy as they are, and are not hurting
>anyone.. (You know what?  This is more than I can say for a lot of  solid
>citizens. )

It makes me uncomfortable too.

Let's further this discussion because there's a lot of issues
involved. I think that this is a good arena to think creatively of
some solutions that lie between the "forcibly picked up" route, and
the "leave them alone" route.

Let's assume that that person is acting and talking in ways that are
"harmful" (huge spectrum of meaning from harrassment and verbal
abuse to others, destroying one's own life goals, etc.), and at the
same time that person: 1) is convinced that they are perfectly fine
(as Nadia says: they *like* themselves the way they are), and 2) are
good at convincing any social worker or neighborhood policeperson
that they are fine.

If you are unsuccessful at convincing them to voluntarily admit
themselves to a hospital/institution, then, today, there is very
little that one can do. You would have to petition the courts, in
order to have the person put in a hospital, and it's often a messy
and long process.  If the police stepped in and determined that the
ill person is a danger to himself/herself or others, then that person is
put in jail.  Next, a psychiatric evaluation is performed and that
person is held for a few days.  If the person is determined to be
ok, then he/she is put back on the streets.  If not, then he/she is
put in the hospital.

It might be better for the ill person and the family members/friends
if the involuntary committment process could be changed so that
friends and family members are given a larger role and the
random-ignorant-policeperson given a smaller role. That might might
make the process less vulnerable to mistakes or to overzealous
actions by single individuals. For example, if, 3 family members and
3 friends/colleagues/neighbors could give statements about the
mental state of ill person, then perhaps the committment process
would be quicker and less cumbersome. And if the forced hospital
stay was just a few days (until other tests and evaluations
determined that more time was needed), instead of weeks (with that
person being lost in the beaucratic maze), then less mistakes might
be made too. Any solution that weighs in favor of ("individually
adapted to") the ill person's local environment would be better than
all-encompassing laws and mandates.

Another issue involved here is what constitutes an "mental illness".
In the 1960s a well-known libertarian and psychoanalyst named Thomaz
Szaz held that mental ilness was a social constract rather than a
symptom of disease. (_The Myth of Mental Illness_) His view was that
the mentally ill person is expressing their difficulty with a
situation in their own life, in their "own language", which might or
might not be understandable by any other person around. His theory
was widely circulated, and is discarded now. As much as I respect
Szaz for his other opinions and ideas, and I offer that he may have
explanations for some of what he's seen in the psychiatry field,
he's wrong in big ways with some of the diagnosed mental illnesses.
For example, the evidence that schizophrenia is a brain disease is
overwhelming.

Probably most people here (including myself) would cringe at the
idea of "forced 'anything'", but in the situation of a person with
an acute mental illness (such as schizophrenia), the benefit to the
person and friend/family is overwhelmingly large. The
hospitalization accomplishes several things. It enables the health
professionals to observe the person in a controlled setting, so that
other medical illnesses, that might be causing the symptoms can be
ruled out. If medication is started, then the medical staff can
watch for side effects. Also the hospital stay offers the family and
friends a brief rest from what is often extremely stressful and
harrowing days/nights leading up to the ill person's hospital stay.

I know that it's dangerous when oppressive governments see mental
institutions as a convenient tool with which to supress
"indesirable" voices in the population. The former Soviet Union was
probably best known for using mental institutions this way. Because
the concept of forced institutionalism is such an fragile (and
emotional and dangerous) concept, it's a perfect example for
libertarians and anarchists to think about and address in order to be
prepared for the future when we have more minimal government (call
me an optimist).

To close this note, some of you may or may not know that John Forbes
Nash, Jr., the mathematical genius and winner of the Nobel Prize in
Economics (1994, for work in "Game Theory") was a paranoid
schizophrenic for about 30-40 years of his life. He received his
Nobel prize when he was approaching age 70, for work that he did in
his 20s and 30s, with long periods of his illness in-between. He
benefited from early traditional antipsychotic drugs (and he refused
any drugs after 1970), but for him, it was an episodic illness, with
periods of acute psychosis followed by periods of relative calm when
the symptoms diminished dramatically. He was involuntarily committed
several times by family members or colleagues, he never voluntarily
went to the hospital. I wonder alot what his life would have
been like if he was not been involuntarily committed to those institutions
by the people who cared about him. His years from age ~60 show his
illness in a dramatic remission and  his colleagues call him "recovered".
He is perhaps, one of the rare schizophrenic cases that goes into
remission. (The initial diagnosis by doctors of his illness can be
trusted.) He believes that he willed his own recovery: "Gradually I
began to intellectually reject some of the delusionally influenced
lines of thinking which had been characteristic of my orientation.
This began, most recognizably, with the rejection of
politically-oriented thinking as essentially a hopeless waste of
intellectual effort." The book: _A Beautiful Mind_ by Sylvia Nasar
is a really nice story about his life.

Amara

-------------------------September 12, 2000

To: extropians at extropy.org
From: Amara Graps <amara at amara.com>
Subject: Mad brain research (was: Homeless)


From: CurtAdams at aol.com, Sat, 9 Sep 2000


>That schizophrenia strikes overwhelmingly during a relatively short window in
>late teens/early twenties is interesting. 

Right. In the U.S., three-quarters of those who get schizophrenia do
so between the ages of 17 and 25. Having an initial onset before age
14, or after age 30 is unusual.

>Is there a temporally programmed
>brain change which goes to excess in such people?  Possibly the onset
>period for schizophrenia might provides clues on how and why the brain
>changes function during life.

I don't think the reasons are known yet. When the reasons are known,
then that would also be clues for the age onset of other brain
diseases such as multiple sclerosis and Alzheimer's.

There are also gender differences between men and women who get
schizophrenia. For men, the age of onset is earlier (2 to 3 years
earlier), and in men, the disease is usually more serious than for
women. The reasons for the gender differences are unknown too.

>>His years from age ~60 show his
>>illness in a dramatic remission and  his colleagues call him "recovered".
>>He is perhaps, one of the rare schizophrenic cases that goes into
>>remission.
>
>Not that rare, actually; schizophrenia often abates with age. 

Yes, that's right. I had forgotten about that.

>One theory is that schizophrenia results from hyperactivity in certain
>dopamine systems. The dopamine systems deteriorate with age, and so
>some of these patients become more normal again.

Seems reasonable. A portion of the limbic system is suspected of
being involved in schizophrenia, and I read that there is an
excessive number of dopamine receptors found in the limbic system
and basal ganglia in brains from patients with schizophrenia
compared with control brains (and this finding factored out the
antipsychotic medications the patients had been taking)

A fellow doing a lot of research with brains in order to learn of
the causes of schizophrenia is E.Fuller Torrey. He has written a
book: _Surviving Schizophrenia: A Family Manual_, that is the best
book I've yet seen on the topic.

Excerpts from _Surviving Schizophrenia_ book can be found here:
http://www.mentalhealth.com/book/p40-sc03.html

Torrey is a really interesting schizophrenia researcher, so I'll
spend a moment talking about him.

He studied medicine early in his career, but his sister's strange
behavior (who was eventually diagnosed as schizophrenic) shifted his
studies into the psychiatric field. The theories for schizophrenia
at that time made no sense to him. He fought against his psychiatric
profession, quit the American Psychiatric Association and never
rejoined. As an adminstrator at the National Institute of Mental
Health in the 1970's, he criticized his peers for flocking into
lucrative private practices to serve the "worried well, " proposing
that psychiatrists either spend two years working in underserved
areas or repay the money that the Government had invested in their
training. The advance of MRIs and a fresh generation of
neuroscientists in the 1980s supported his ideas that schizophrenia
was a brain disease, and he became an vocal advocate of the National
Alliance for the Mentally Ill. He first published _Surviving
Schizophrenia_ in 1983, and the latest (third) edition was published
in 1995. He specializes now in schizophrenia both as a
clinical and as a research psychiatrist in Washington, D.C.

He's had a varied career. He did his training in psychiatry at
Stanford University, where he also took a master's degree in
anthropology. He practiced general medicine and psychiatry; he
served as a physician with the Peace Corps in Ethiopia, spent a year
in a neighborhood clinic in the South Bronx, New York, and in Alaska
in the Indian Health Service. Included in his work in psychiatry, he
had four years as a Special Assistant to the Director of the
National Institute of Mental Health, affiliation with St.
Elizabeth's Hospital in Washington, D.C., and field research in
schizophrenia in Papua New Guinea, and in Ireland. He is the author
of nine books, over 100 lay and professional papers, and serves as
contributing editor to Psychology Today.

In 1989, a wealthy couple (the Stanleys) in Connecticut who have a
schizophrenic family member, and were impressed by his book
_Surviving Schizophrenia_, started donating money yearly to mental
illness research and to aid Torrey in his efforts. In the nice web
article that I read about Torrey,

http://www.schizophrenia.com/newsletter/398/398torrey.htm

I read that the Stanleys gave out $20 million on that year (1998).
Torrey estimates that that couple will spend more on manic
depression research than the U.S. Federal Government and about a
fifth of what the Government spends on schizophrenia research.

Torrey's most ambitious project though, now is a brain bank.

I like this quote by Torrey:

"The disease in in the brain! We need brains!"

 From the above URL:

	"We won't be getting any brains in the mail today, " the
	nation's best-known schizophrenia researcher says as he
	hurries to a meeting at his Washington laboratory. "They
	don't mail them over the weekend. We'll probably get some
	fresh brains Fed Exed tomorrow. " Dr. E. Fuller Torrey, a
	psychiatrist, has had many grand passions during his
	three-decade crusade to cure schizophrenia, but none greater
	than his new human brain bank. For years, a major obstacle
	for scientists researching the neurological roots of serious
	mental illnesses -- schizophrenia, manic depression,
	depression -- has been the lack of first-rate human brains
	to study. "The only schizophrenic brains available have been
	very old and not in very good shape, " Torrey says. They
	came from state hospitals and nursing homes, from patients
	so elderly that by the time they died the brain had
	atrophied. "We wanted to be in position to get better
	brains, brains of people younger and not dead long. " Brains
	that would be full of unaltered proteins and
	neurotransmitters, viruses and cytokines that might hold the
	answers to schizophrenia's cause.

	The brain bank is central to his grand plan. In 1994, he
	began contacting medical examiners' offices and has since
	built a national network that collects brains of mentally
	ill people who died in their 20's, 30's and 40's, from
	suicide and heart failure, in car crashes and fires. Torrey
	has employed a half-dozen pathologists around the country,
	paying them as much as $100,000 a year, to work full-time
	hunting brains. Within 48 hours of death, the brain is
	frozen at minus-70 degrees and shipped to Torrey. "We're up
	to 226 brains, " Torrey says. "We have 44 freezers here just
	full of brain. " While Torrey uses some tissue samples
	himself, most are distributed free to researchers worldwide.
	"Scientists historically have not shared their sources, "
	says Dr. Stanley J. Watson, a University of Michigan
	professor who leased a truck in December to pick up 20,000
	brain sections from Torrey's lab. "His attitude has been,
	the more horsepower, the faster we can all move ahead. "


Another interesting article on E. Fuller Torrey's research:
http://www.psychlaws.org/General%20Resources/Article5.htm

Torrey is currently working now on a viral theory to explain
schizophrenia.

There is a general consensus that genetics plays some role in the
disease (if one has a parent who is schizophrenic, then the
probability of getting the disease is ~10%, if one's grandparent is
schizophrenic, the odds are ~4%, if both parents are schizophrenic,
the statistics show about 45% probability, and the general
population has about a 1% probability of getting the disease), and
genetic theories of schizophrenia fit comfortably with the facts
known about the disease. The major criticism of genetic theories is
that schizophrenics themselves have a very low rate of
reproduction, and one would think that schizophrenia should have
died out or at least become less prevalent, if it is transmitted
from affected individuals to their offspring.

Viral theories also fit the facts known about schizophrenia. They
can explain the minor physical anomalies, the microscopic and CT-scan
changes in the brains, the seasonality of births, and the involvement
of the limbic system since several viruses have an affinity for that
part of the brain. The fact that schizophrenia runs in families can
be explained either by a genetic predisposition to the virus, by
transmission of a virus on the gene itself, or by transmission of
the virus across the placenta from the mother (or the father, via the
semen) during pregnancy. Some viruses have also been shown to cause
changes in neurotransmitters, such as dopamine in the brain.

But there are other plausible causes of schizophrenia as well
(immunological theories, developmental theories, stress theories,
nutritional theories, biochemical theories), and Torrey's book
describes these in some detail.


Amara

-------------------------  September 12, 2000

To: extropians at extropy.org
From: Amara Graps <amara at amara.com>
Subject: Re: Homeless
Cc:
Bcc:


From: Spike Jones <spike66 at ibm.net>, Sat, 09 Sep 2000

>>  To close this note, some of you may or may not know that John Forbes
>>  Nash, Jr., the mathematical genius and winner of the Nobel Prize in
>>  Economics (1994, for work in "Game Theory") was a paranoid
>>  schizophrenic
>
>Another one would be Robert Pirsig, author of Zen and the Art of
>Motorcycle Maintenance.  Dont know if it was P-S that he had, but
>he himself wrote that he was messed up psychologically, yet look
>at the product.  John Steinbeck wrote East of Eden in an alcoholic
>fog, along with who knows what psychological conditions.  Amazing
>what a partially disfunctional brain can accomplish. 


Yes.

(BTW, the first five Americans who won a Nobel Prize for literature
were alcoholics: Sinclair Lewis, O'Neill, Faulkner, Hemingway, and
Steinbeck).

Some famous creative individuals thought to have schizophrenia were
Nietsche, Nijinksy, Van Gogh, Ezra Pound, Wittgenstein, Hoelderlin,
Blake, Kafka, Joyce.

The biggest difference between a creative person and the
schizophrenic person is that the creative person has his/her thought
processes (relatively-speaking) under control, in the process of
building of something creative.

The schizophrenic person, on the other hand, does not have their
thought processes under control, and is at the mercy of
associations, disconnected thinking; they frequently have an
inability to sort, interpret and respond in ways typical to normal
brains. An inner madness. Schizophrenia is the ultimate horror in a
disease -- with this disease one cannot trust one's own brain.

Another illness- manic-depressive, is more conducive to creativity
because the thinking process isn't as impaired, and because the
manic-depressive person in their manic state has high levels of
energy. Many more famous creative people are/were manic-depressive.

One of the things I find interesting in the schizophrenic illness,
though, is that the internal world of a schizophrenic is
self-consistent and extremely logical. They start from a premise,
and then build an elaborate set of logical connections from that
premise. To anyone on the outside, though, the premise is bizarre,
crazy.

One has to be careful about the tendency to romanticize these
people's great creative works. To a schizophrenic, especially,
having this illness can be extremely unpleasant. Probably when they
are gripped at the extreme of their altered state, they can't think
of being any different, however leading into and out of that state,
they often know that something is way off with how their brains are
functioning. I suggest reading letters from schizophrenics to see
how their inner world looks to them. Quite distressing.

"As for me, you mush know that I shouldn't precisely have chosen
madness if there had been any choice." (Vincent Van Gogh, 1889)


Amara

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