Monday, April 25, 2011

Schizophrenia- a perspective.

Schizophrenia is a frightening disease for anyone, but until the recent attention on dementia, it was always the neurological disorder I feared the most.  I read about schizophrenia when I was in my early teens through the writings of RD Laing who believed the disease was a result of poor parenting. I reasoned that if it was just bad parenting, then it could be prevented and was therefore slightly less scary. However try as I might, I couldn't quite buy into his theory. While I agreed that parents could certainly drive one mad, it seemed as thought there would be a great many more schizophrenic individuals around if parenting was the cause.  I imagined back then that the brain may be lying in wait for some trigger to set it off down the schizophrenic path, which put me in a vulnerable position.  Did I have the madness in me or not? I was adopted and do not know my family history but in my teens, I didn't make the connection between genes and risk.  It was all I could bear to think my brain might be waiting to betray me at any moment.  (I had similar feelings about multiple sclerosis after I read a book on it when I was 16, but bodily dysfunction paled in comparison to mental decline in my young eyes).
If it was due to some underlying predisposition, I reasoned there would be true cause for concern.  Some rogue genetic defect that lies in wait until the bearer unwittingly triggers it, I imagined I was one such unfortunate soul and that surely, it was a matter of time.
An argument with a colleague a few years later narrowed the argument a bit- the disease was either something that could happen to anyone, or something that could only happen to certain people.  We now know that both could be true but that the latter is the more likely.

While I have always been interested in the disease, a new book reminded me of the broader ramifications of our current treatment of it.  I don't mean just the pharmacological approach- that is complex enough- but also the treatment of schizophrenic individuals.  In the early 80s many of the mental institutions that housed people afflicted with this and other diseases, were closed in favor of 'community based care' that basically never happened.  As the institutions closed, residents had nowhere to go and many schizophrenics ended up on the streets.  Once colorful character in St Louis, (where I hung my hat for a while) sat on street corners and drew what he saw.  Day after day, he created fantastically detailed pencil drawings of building, people, parks, transport.  He lived in a shelter during the night hours but had nowhere to go in the day.  He wore no shoes, even in the depths of a Missouri Winter.  One day, we heard he had been hit and killed by a car.  A tragic waste of life and a talent that would be sadly missed by all who watched him as he drew.

'Henry's Demons' by journalist Patrick Cockburn, is a remarkable account of his son's experiences with schizophrenia, and he shares the writing with his son to give the reader a first-hand view of what the disease is like.  Henry also didn't like to wear shoes, and he did not believe he was ill for much of the time.  The onset of disease was in his early 20s, which is typical, and appeared to have been triggered by marijuana use.  I was surprised to read that this is quite common with marijuana (I will post on this in more detail eventually- I am researching it now...).  Henry and his family's struggle is vividly described in the book and one wonders how many similar stories are out there. Patrick speaks about the need for institutions for those that cannot exist without such a structure, particularly when they are deep into their illness.  I wondered how people in the US coped with the costs of the treatment and care and then I remembered. Many of our schizophrenics are homeless and penniless.  I have met them while working at my local food bank.  They can appear normal for a while, but not long enough to hold down a job.  They can't just pull themselves together because they are confused about who they themselves are.  They see the world from a unique perspective and Henry and Patrick's story is a remarkable insight into that perspective.  I recommend it.
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