In my last entry, I wrote about the fascinating psilocybin research by Roland Gritffiths and his colleagues at Johns Hopkins.
They recruited people to take a dose of psilocybin, the active substance of hallucinogenic mushrooms, and then, on a different day, another substance (methylphenidate) for comparison purposes. The participants were then monitored for eight hours in a comfortable and supportive setting. Afterwards, the subjects described their experiences and completed a series of questionnaires. The results were surprising.
Among the questionnaires done seven hours after taking either substance were a hallucinogen-rating scale, a states-of-consciousness questionnaire, a mysticism scale, and the APZ. The APZ is an instrument that also measures altered states of consciousness and has categories such as "oceanic boundlessness," "dread of ego dissolution," and "visual restructuralization." The subjects rated their experiences much higher on these scales on days that they took the psilocybin.
The states-of-consciousness questionnaire included the items from the Pahnke-Richards Mystical Experience Questionnaire, a survey based on the following categories:
Internal unityExternal unityTranscendence of time and spaceIneffability and paradoxicalitySense of sacrednessNoetic qualityDeeply felt positive mood The combined scores of 22 of the 36 subjects met the criteria for a "complete mystical experience" on their psilocybin days. On days when the methylphenidate was taken, only four subjects' scores reached levels corresponding to a "complete mystical experience."
About two months following each of the sessions, the subjects were again surveyed, this time with questions that assessed possible persistent changes in attitude, mood, and behavior. They were also asked the following:
How personally meaningful was the experience?Indicate the degree to which the experience was spiritually significant to you.Do you believe that the experience and your contemplation of that experience have led to change in your current sense of well-being or life satisfaction? Here's what was surprising: One-third of the volunteers rated their psilocybin experience as being the single most spiritually significant experience of his or her life. Another 38 percent rated it as being among the top-5 most spiritually significant experiences of their lives. Longer-term follow-up assessments are now being done.
Do the results of this study suggest that people should use psilocybin frequently to gain spiritual and mystical experiences? Definitely not. The investigators are very clear in not recommending widespread use of the substance. They point out that this research was conducted in a safe and supportive environment and that the mental experiences could very well be different in other settings.
They also emphasize that some of the volunteers had negative experiences when taking the psilocybin. Almost one-third of the subjects, for example, reported experiencing "strong" or "extreme" fear at some point during their psilocybin session. During their sessions, six subjects displayed paranoid thinking or felt transient "ideas of reference" (that is, the belief that objects, events, or people are of personal significance - as when a person watching TV believes that the show is all about him).
But then, if not to encourage psilocybin use, why would researchers do these types of studies? Because such experiments may provide important information about brain chemistry, psychopharmacology, and the psychology of mental states.
They also might help lead to the development of medications for mental illnesses. Future studies could be done with people suffering with symptoms related to certain psychiatric disorders.
2007年12月14日星期五
Music on my Mind
This year, Christmas was especially musical in our home. My daughter got an electric guitar and my son an electric bass. And we all exchanged various musical CDs.
For me, though, this was an especially retro holiday season. I decided to buy myself a nice new turntable, even though new LPs are rarely produced any more. In my basement there are thousands of LPs I accumulated during the 60s, 70s, and early 80s. My children recently took an interest in the rock and roll vinyl. They still sound great. The new turntable also has given me the opportunity to listen to some obscure 20th century classical and jazz albums I had collected but not played for decades.
With music on my mind, I was interested in a New Year's Eve New York Times article about the relationship of music and the human mind. It focused on the work of Daniel Levitin, a musician, record producer, and cognitive psychologist. He directs the McGill University Laboratory of Music Perception, Cognition, and Expertise. He also is the author of a new book, titled "This Is Your Brain on Music."
The key questions on Levitin's mind are why music plays such an important role in our lives, and how our brains function to make music so memorable and emotional. He believes that by understanding music we will better appreciate essential aspects of being human. He thinks that music can reveal the "deepest mysteries of human nature."
Levitin's research has shown that music activates and coordinates many different areas of the brain involved in pleasure and emotion. Music even stimulates the more primitive structures at the base of the brain that coordinate movement and the perception of the body's position in space. Maybe that's why music and dance are almost inseparable.
It's no surprise, then, that music can be therapeutic. Many people have discovered on their own that they can feel better by playing their favorite "comfort music." Music therapy is used in many settings, from inpatient units for the criminally insane to outpatient senior programs. It has been shown to help people communicate, move, and think better. There are music therapy programs for people of all ages and abilities.
My daughter listens to music constantly. She says, "Music is amazing. I don't know why, but I just love it!" She's not alone, of course. We may not all enjoy or respond the same way to the same music, but for all of us, our deepest feelings may only be plumbed by some kind of music.
For me, though, this was an especially retro holiday season. I decided to buy myself a nice new turntable, even though new LPs are rarely produced any more. In my basement there are thousands of LPs I accumulated during the 60s, 70s, and early 80s. My children recently took an interest in the rock and roll vinyl. They still sound great. The new turntable also has given me the opportunity to listen to some obscure 20th century classical and jazz albums I had collected but not played for decades.
With music on my mind, I was interested in a New Year's Eve New York Times article about the relationship of music and the human mind. It focused on the work of Daniel Levitin, a musician, record producer, and cognitive psychologist. He directs the McGill University Laboratory of Music Perception, Cognition, and Expertise. He also is the author of a new book, titled "This Is Your Brain on Music."
The key questions on Levitin's mind are why music plays such an important role in our lives, and how our brains function to make music so memorable and emotional. He believes that by understanding music we will better appreciate essential aspects of being human. He thinks that music can reveal the "deepest mysteries of human nature."
Levitin's research has shown that music activates and coordinates many different areas of the brain involved in pleasure and emotion. Music even stimulates the more primitive structures at the base of the brain that coordinate movement and the perception of the body's position in space. Maybe that's why music and dance are almost inseparable.
It's no surprise, then, that music can be therapeutic. Many people have discovered on their own that they can feel better by playing their favorite "comfort music." Music therapy is used in many settings, from inpatient units for the criminally insane to outpatient senior programs. It has been shown to help people communicate, move, and think better. There are music therapy programs for people of all ages and abilities.
My daughter listens to music constantly. She says, "Music is amazing. I don't know why, but I just love it!" She's not alone, of course. We may not all enjoy or respond the same way to the same music, but for all of us, our deepest feelings may only be plumbed by some kind of music.
Antidepressants, Suicide, and Statistics
The link between antidepressants and suicide has been a popular topic in the news for the past few years. The obvious association is that antidepressants improve depression and therefore decrease suicidal thoughts, suicide attempts, and completed suicides.
But most of the media attention has been on whether antidepressants, especially the commonly prescribed selective serotonin reuptake inhibitors (SSRIs) might increase suicidal thinking in some people.
The news articles were prompted by statistics from research studies with these medications that suggested an increase in suicidal thinking among children. However, there were no actual suicides among the depressed children in these research studies, and the strength of the association between antidepressants and suicidal thinking was far from convincing.
Nevertheless, the FDA took the conservative and controversial step of issuing a warning that many antidepressants could possibly increase the risk of suicidal thinking. As a consequence of the warning, many medical experts worried that suicides among children might actually increase if doctors became reluctant to prescribe antidepressants.
A new, and in my opinion more accurate perspective on SSRI antidepressants and suicide appears in an article published recently in the American Journal of Psychiatry. The authors examined the suicide rate among children ages 5 to 14 years in several countries, including the U.S. They compared these suicide rates with data on the use of SSRI antidepressants.
The results showed that the suicide rate for children was lowest in those countries where the use of SSRIs was highest. The findings remained the same regardless of sex, race, income levels, and access to quality mental health care.
The United States was in this category of high SSRI use and relatively low childhood suicide rate. Overall, the U.S. childhood suicide rate was 0.7 per 100,000 suicides; however, in some countries it was as high as 1.7 per 100,000. The lowest rates of childhood suicide in the U.S. were in large cities like Chicago, New York, Boston, and Los Angeles.
The authors of the article point out that this type of research never can prove a causal relationship, but can only measure the strength of an association. However, the findings certainly are consistent with what those of us who work in the field would expect.
But most of the media attention has been on whether antidepressants, especially the commonly prescribed selective serotonin reuptake inhibitors (SSRIs) might increase suicidal thinking in some people.
The news articles were prompted by statistics from research studies with these medications that suggested an increase in suicidal thinking among children. However, there were no actual suicides among the depressed children in these research studies, and the strength of the association between antidepressants and suicidal thinking was far from convincing.
Nevertheless, the FDA took the conservative and controversial step of issuing a warning that many antidepressants could possibly increase the risk of suicidal thinking. As a consequence of the warning, many medical experts worried that suicides among children might actually increase if doctors became reluctant to prescribe antidepressants.
A new, and in my opinion more accurate perspective on SSRI antidepressants and suicide appears in an article published recently in the American Journal of Psychiatry. The authors examined the suicide rate among children ages 5 to 14 years in several countries, including the U.S. They compared these suicide rates with data on the use of SSRI antidepressants.
The results showed that the suicide rate for children was lowest in those countries where the use of SSRIs was highest. The findings remained the same regardless of sex, race, income levels, and access to quality mental health care.
The United States was in this category of high SSRI use and relatively low childhood suicide rate. Overall, the U.S. childhood suicide rate was 0.7 per 100,000 suicides; however, in some countries it was as high as 1.7 per 100,000. The lowest rates of childhood suicide in the U.S. were in large cities like Chicago, New York, Boston, and Los Angeles.
The authors of the article point out that this type of research never can prove a causal relationship, but can only measure the strength of an association. However, the findings certainly are consistent with what those of us who work in the field would expect.
When Delusions Aren't So Delusional
Occasionally, I work with our psychiatry consultation service. When physicians throughout our hospital need help evaluating and caring for patients with psychiatric symptoms, we're the team they call.
These patients may be confused, depressed, agitated, or manic. Some have longstanding psychiatric disorders and others have new, temporary symptoms. Sometimes our contribution is simply to confirm that someone does not have a psychiatric disorder.
One recent morning, I was called to see a male patient because his medical team thought he might have schizophrenia or bipolar disorder. He was an older gentleman with serious medical problems, but was quite exuberant and talkative.
He excitedly described an extraordinary and unbelievable network of international intrigue linking major historical events over the past few decades. He outlined endless details of deception, cover-ups, covert operations, and conspiracies at the highest levels. It seemed to his doctors that he must have been delusional.
Was he psychotic in firmly believing all of these outrageous and impossible claims? Not at all. A delusion is a fixed, false belief. Nothing I could say would ever dissuade him from his view of reality. To be delusional, the beliefs must be idiosyncratic - that is, unique to that person. Yet all of this gentleman's claims are shared by many like-minded people who connect through the Internet.
He's part of a subculture that thrives on distrust and conspiracy theory. Although his wild beliefs and convictions may be entirely wrong, he is neither delusional nor psychotic. There was no reason to suspect a psychiatric disorder like schizophrenia or bipolar disorder.
But did this man's unusual behavior fit the criteria for another mental disorder? As we talked, he clearly expressed paranoid thoughts. For instance, he assumed that the FBI or Secret Service had sent me to evaluate him. Did he suffer from a paranoid personality disorder?
He did meet the requirements for a diagnosis of general personality disorder; that is, he had "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture." That may include "ways of perceiving and interpreting self, other people, and events." But to have a personality disorder, the personality pattern must also lead to significant distress or impairment. That part wasn't true for this man.
It is true that this patient has a paranoid personality style, which means that he tends to view situations suspiciously and anticipates being exploited. However, these are enduring personality characteristics, not traits that developed suddenly. And they do not represent a diagnosis. In fact, many highly successful people have this type of personality style.
I concluded that this patient had no psychiatric diagnosis, although he did express unusual and seemingly unbelievable beliefs. But so do a lot of people.
These patients may be confused, depressed, agitated, or manic. Some have longstanding psychiatric disorders and others have new, temporary symptoms. Sometimes our contribution is simply to confirm that someone does not have a psychiatric disorder.
One recent morning, I was called to see a male patient because his medical team thought he might have schizophrenia or bipolar disorder. He was an older gentleman with serious medical problems, but was quite exuberant and talkative.
He excitedly described an extraordinary and unbelievable network of international intrigue linking major historical events over the past few decades. He outlined endless details of deception, cover-ups, covert operations, and conspiracies at the highest levels. It seemed to his doctors that he must have been delusional.
Was he psychotic in firmly believing all of these outrageous and impossible claims? Not at all. A delusion is a fixed, false belief. Nothing I could say would ever dissuade him from his view of reality. To be delusional, the beliefs must be idiosyncratic - that is, unique to that person. Yet all of this gentleman's claims are shared by many like-minded people who connect through the Internet.
He's part of a subculture that thrives on distrust and conspiracy theory. Although his wild beliefs and convictions may be entirely wrong, he is neither delusional nor psychotic. There was no reason to suspect a psychiatric disorder like schizophrenia or bipolar disorder.
But did this man's unusual behavior fit the criteria for another mental disorder? As we talked, he clearly expressed paranoid thoughts. For instance, he assumed that the FBI or Secret Service had sent me to evaluate him. Did he suffer from a paranoid personality disorder?
He did meet the requirements for a diagnosis of general personality disorder; that is, he had "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture." That may include "ways of perceiving and interpreting self, other people, and events." But to have a personality disorder, the personality pattern must also lead to significant distress or impairment. That part wasn't true for this man.
It is true that this patient has a paranoid personality style, which means that he tends to view situations suspiciously and anticipates being exploited. However, these are enduring personality characteristics, not traits that developed suddenly. And they do not represent a diagnosis. In fact, many highly successful people have this type of personality style.
I concluded that this patient had no psychiatric diagnosis, although he did express unusual and seemingly unbelievable beliefs. But so do a lot of people.
Mystical Mushrooms
To my mind, one of the greatest mysteries is how our mental experiences relate to the chemistry of our brains. Researchers have discovered a tremendous amount about the complexity of synapses, neural circuitry, and neuroanatomy and psychologists explore the intricacies of human behavior and mental processes.
Still, a huge gap remains in our understanding of the brain and the mind. One way of approaching this brain-mind connection is to see how certain chemicals that influence the brain affect mental experiences.
Recently, I was very pleased to attend a lecture by Roland R. Griffiths, Ph.D., a professor of Behavioral Biology and of Neuroscience who is a leading Hopkins psychopharmacology researcher and expert on the effects of abused substances.
I was looking forward to his presentation because I knew that he would be speaking on his psilocybin research, which had received considerable national attention when it was published several months ago in the journal Psychopharmacology.
Psilocybin is the naturally occurring compound that is found in certain mushroom species and is associated with altered mental states when eaten. Although psilocybin is commonly described as a hallucinogen, it is more likely to cause illusions and altered perceptions. More prominent may be the users' sense of having a mystical experience.
Although there has been a tremendous amount of research on commonly abused substances, such as heroin, cocaine, and alcohol, no serious scientific investigations have been done with psilocybin for several decades. The compound seems to have its effect through interactions with particular serotonin receptors in the brain.
Griffiths and his colleagues devised a carefully designed plan to compare the effects of psilocybin with a very different psychoactive substance, the stimulant medication methylphenidate, which was used as an active-comparison compound, or control. They specifically recruited people with a spiritual orientation who had no history of mental illness.
The announcements of the study described it as examining "states of consciousness brought about by a naturally occurring psychoactive substance used sacramentally in some cultures." As part of the study's design, each subject came in for either 2 or 3 different 8-hour sessions that were separated by about 2 months; only one of these sessions involved the ingestion of psilocybin. The participants took the compounds in a comfortable laboratory setting with specially trained monitors by their side throughout all sessions. They were encouraged to close their eyes and direct their attention inward.
As I mentioned above, each of the 36 subjects in the study was given the psilocybin just one time. As expected, during those sessions when psilocybin was ingested, the participants did experience perceptual changes, intense subjective feelings, and, occasionally, some anxiety and paranoid thoughts. Seven hours after ingesting either the psilocybin or the methylphenidate, the participants each completed various questionnaires about their mental state.
Overall, the participants regarded the psilocybin use in this comfortable and controlled research setting as a positive experience. Especially interesting were their reports of a sense that the psilocybin produced in them a mystical experience. I'll describe more of the surprising results of the psilocybin study in my next entry.
Still, a huge gap remains in our understanding of the brain and the mind. One way of approaching this brain-mind connection is to see how certain chemicals that influence the brain affect mental experiences.
Recently, I was very pleased to attend a lecture by Roland R. Griffiths, Ph.D., a professor of Behavioral Biology and of Neuroscience who is a leading Hopkins psychopharmacology researcher and expert on the effects of abused substances.
I was looking forward to his presentation because I knew that he would be speaking on his psilocybin research, which had received considerable national attention when it was published several months ago in the journal Psychopharmacology.
Psilocybin is the naturally occurring compound that is found in certain mushroom species and is associated with altered mental states when eaten. Although psilocybin is commonly described as a hallucinogen, it is more likely to cause illusions and altered perceptions. More prominent may be the users' sense of having a mystical experience.
Although there has been a tremendous amount of research on commonly abused substances, such as heroin, cocaine, and alcohol, no serious scientific investigations have been done with psilocybin for several decades. The compound seems to have its effect through interactions with particular serotonin receptors in the brain.
Griffiths and his colleagues devised a carefully designed plan to compare the effects of psilocybin with a very different psychoactive substance, the stimulant medication methylphenidate, which was used as an active-comparison compound, or control. They specifically recruited people with a spiritual orientation who had no history of mental illness.
The announcements of the study described it as examining "states of consciousness brought about by a naturally occurring psychoactive substance used sacramentally in some cultures." As part of the study's design, each subject came in for either 2 or 3 different 8-hour sessions that were separated by about 2 months; only one of these sessions involved the ingestion of psilocybin. The participants took the compounds in a comfortable laboratory setting with specially trained monitors by their side throughout all sessions. They were encouraged to close their eyes and direct their attention inward.
As I mentioned above, each of the 36 subjects in the study was given the psilocybin just one time. As expected, during those sessions when psilocybin was ingested, the participants did experience perceptual changes, intense subjective feelings, and, occasionally, some anxiety and paranoid thoughts. Seven hours after ingesting either the psilocybin or the methylphenidate, the participants each completed various questionnaires about their mental state.
Overall, the participants regarded the psilocybin use in this comfortable and controlled research setting as a positive experience. Especially interesting were their reports of a sense that the psilocybin produced in them a mystical experience. I'll describe more of the surprising results of the psilocybin study in my next entry.
Sleep, Snoring, and Psychiatry
I'm writing from Orlando, where I'm attending a medical education conference on sleep apnea and snoring, sponsored by the University of Pennsylvania. Although sleep apnea (temporary cessation of breathing during sleep) is a common problem, some patients with psychiatric disorders are at greater risk than others for this serious sleep disturbance.
By far the most common form of sleep apnea is the obstructive type, where the airway becomes temporarily blocked. The other one is central sleep apnea, which happens when there is a decreased drive to breathe resulting from a cardiovascular or neurologic disorder. With obstructive sleep apnea, the person still attempts to breathe.
Obstructive sleep apnea is sometimes thought of as a complete stopping of breathing, but it really is a decrease in airflow to the lungs due to a partial or total collapse of the airway. The extent of this collapse is influenced by a person's airway anatomy and their body weight. Skinny and normal-weight people can have severe obstructive sleep apnea, but the risk is much greater among those who are obese.
Why are people with chronic mental illnesses at greater risk for obstructive sleep apnea? One reason is that they also tend to be overweight. Lifestyle and diet are very important influences on body weight, but the problem of excess weight can be worsened by some psychiatric medications, including certain antidepressants, antipsychotics, and mood stabilizers. I've seen some patients go from skinny to obese in just a few years. Under the best conditions, losing weight usually is a struggle, and weight loss usually requires a well-organized life and a lot of motivation.
Why worry about obstructive sleep apnea? Because it leads to both short- and long-term problems. Sleep apnea often causes disrupted sleep, which makes people sleepy during the day. And this excessive daytime drowsiness can be made even worse by the sedating effects of some psychiatric medications. Daytime sleepiness not only can be a nuisance that interferes with people achieving their goals, but it can also have catastrophic effects for people who are driving or doing activities that require concentration and attentiveness.
But wouldn't someone know it if they had sleep apnea? Not necessarily. Since the apnea events occur during sleep, those affected are unaware of them. The events disrupt sleep, but not enough to wake the person up. And if people do wake up, they usually don't know what caused the awakening. Occasionally, people with sleep apnea awaken with a gasping sensation. Most simply are aware that something is wrong with their sleep, since they still feel tired and unrefreshed upon awakening.
Even if people are unaware of their own sleep apnea, their bed partners may be very aware of the problem due to the sounds of loud snoring interrupted by extended pauses and followed by deep, sometimes gasping breaths.
If you think that you or the person you sleep with may have sleep apnea, a health care professional can help determine whether a sleep study is appropriate. The benefits of treatment can be dramatic, especially in promoting increased energy and alertness. These gains can be especially meaningful for psychiatric patients who may feel sleepy and sluggish, and believe that they are drifting backwards in their lives.
By far the most common form of sleep apnea is the obstructive type, where the airway becomes temporarily blocked. The other one is central sleep apnea, which happens when there is a decreased drive to breathe resulting from a cardiovascular or neurologic disorder. With obstructive sleep apnea, the person still attempts to breathe.
Obstructive sleep apnea is sometimes thought of as a complete stopping of breathing, but it really is a decrease in airflow to the lungs due to a partial or total collapse of the airway. The extent of this collapse is influenced by a person's airway anatomy and their body weight. Skinny and normal-weight people can have severe obstructive sleep apnea, but the risk is much greater among those who are obese.
Why are people with chronic mental illnesses at greater risk for obstructive sleep apnea? One reason is that they also tend to be overweight. Lifestyle and diet are very important influences on body weight, but the problem of excess weight can be worsened by some psychiatric medications, including certain antidepressants, antipsychotics, and mood stabilizers. I've seen some patients go from skinny to obese in just a few years. Under the best conditions, losing weight usually is a struggle, and weight loss usually requires a well-organized life and a lot of motivation.
Why worry about obstructive sleep apnea? Because it leads to both short- and long-term problems. Sleep apnea often causes disrupted sleep, which makes people sleepy during the day. And this excessive daytime drowsiness can be made even worse by the sedating effects of some psychiatric medications. Daytime sleepiness not only can be a nuisance that interferes with people achieving their goals, but it can also have catastrophic effects for people who are driving or doing activities that require concentration and attentiveness.
But wouldn't someone know it if they had sleep apnea? Not necessarily. Since the apnea events occur during sleep, those affected are unaware of them. The events disrupt sleep, but not enough to wake the person up. And if people do wake up, they usually don't know what caused the awakening. Occasionally, people with sleep apnea awaken with a gasping sensation. Most simply are aware that something is wrong with their sleep, since they still feel tired and unrefreshed upon awakening.
Even if people are unaware of their own sleep apnea, their bed partners may be very aware of the problem due to the sounds of loud snoring interrupted by extended pauses and followed by deep, sometimes gasping breaths.
If you think that you or the person you sleep with may have sleep apnea, a health care professional can help determine whether a sleep study is appropriate. The benefits of treatment can be dramatic, especially in promoting increased energy and alertness. These gains can be especially meaningful for psychiatric patients who may feel sleepy and sluggish, and believe that they are drifting backwards in their lives.
Demonic Voices
I was speaking with a patient in one of our outpatient programs last week. He excitedly told me that he was on his way to a psychiatric hospital right after our meeting.
I was puzzled until he added that he was going there for a job interview. He's about to complete a mental health counseling degree at a community college. Immediately, I was struck by the extraordinary progress he has made — from being virtually overwhelmed by his schizophrenia to living very effectively with this disease.
I first met this man over 10 years ago during a series of psychiatric hospitalizations for severe psychotic symptoms associated with his schizophrenia. He was tortured by what seemed to be the voice of God saying terrible things to him.
His auditory hallucinations drowned out the daily life around him and he was overwhelmed with bizarre and frightening delusional thoughts. At times, he wanted to end his life to escape the pain of these incessant unreal experiences.
His psychotic experiences seemed so real that he could not accept the fact that he had a psychiatric disorder — and thus he saw no reason to take any medications. Usually, once in the hospital he would take medications, hoping to be discharged sooner; it often worked because his symptoms did improve. Once back home, however, he would discard his prescriptions and stop taking his medications. Before long, he'd be back in the hospital as the psychotic symptoms became more pronounced.
I'm not sure what helped him turn the corner to taking his medications regularly and staying out of the hospital for longer periods of time. It has been many years now since his last psychiatric admission. Perhaps it was a combination of maturity, faith, support from his wife, education, intensive involvement with the outpatient mental health program, and the right combination of medicines. I suspect all were important to him.
In fact, he was functioning so well that I assumed his symptoms were gone. When I asked him about auditory hallucinations, I was surprised when he responded that he continued to experience the demonic voices.
What was different now was that he had learned to differentiate what was real from what was a symptom of his illness. His schizophrenia wasn't cured, but it was under control. That's like having diabetes — the disease is never cured, but it can be managed with education, support from family and friends, effective outpatient treatment, lifestyle changes, and adherence to medications.
I was puzzled until he added that he was going there for a job interview. He's about to complete a mental health counseling degree at a community college. Immediately, I was struck by the extraordinary progress he has made — from being virtually overwhelmed by his schizophrenia to living very effectively with this disease.
I first met this man over 10 years ago during a series of psychiatric hospitalizations for severe psychotic symptoms associated with his schizophrenia. He was tortured by what seemed to be the voice of God saying terrible things to him.
His auditory hallucinations drowned out the daily life around him and he was overwhelmed with bizarre and frightening delusional thoughts. At times, he wanted to end his life to escape the pain of these incessant unreal experiences.
His psychotic experiences seemed so real that he could not accept the fact that he had a psychiatric disorder — and thus he saw no reason to take any medications. Usually, once in the hospital he would take medications, hoping to be discharged sooner; it often worked because his symptoms did improve. Once back home, however, he would discard his prescriptions and stop taking his medications. Before long, he'd be back in the hospital as the psychotic symptoms became more pronounced.
I'm not sure what helped him turn the corner to taking his medications regularly and staying out of the hospital for longer periods of time. It has been many years now since his last psychiatric admission. Perhaps it was a combination of maturity, faith, support from his wife, education, intensive involvement with the outpatient mental health program, and the right combination of medicines. I suspect all were important to him.
In fact, he was functioning so well that I assumed his symptoms were gone. When I asked him about auditory hallucinations, I was surprised when he responded that he continued to experience the demonic voices.
What was different now was that he had learned to differentiate what was real from what was a symptom of his illness. His schizophrenia wasn't cured, but it was under control. That's like having diabetes — the disease is never cured, but it can be managed with education, support from family and friends, effective outpatient treatment, lifestyle changes, and adherence to medications.
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