Q. Gary, I came across this non-academic piece...on prodrome to psychosis and trying to treat young people before they launch into full-blown schizophrenia...am struck by how similar some of the reported phenomena are to someone going through stages of awakening or specific meditation-related experiences...the pros and cons of medicalizing such phenomena (vs. getting guidance from long-term meditators and teachers)...I wonder if some people might actually get worse or start to go down a bad path if they are diagnosed and treated as if they have "pre-schizophrenia".
The "piece", "Which Way Madness Lies; Can psychosis be prevented?" by Rachel Aviv, appeared in Harpers, Dec. 2010, has gotten the interest of the cognitive neuroscientists. (BTW, Rachel won the 2010 Rona Jaffe Foundation Writers’ Award.) As similar questions continue to arise re nondual awakening and psychosis, let's look at how such psychoses are defined, especially schizophrenia, which is closest to what many folk commonly report as "mystical experiences".
Can psychiatrists accurately identify schizophrenia before it fully manifests? There are about 60 US clinics working w/folk "experiencing early psychotic symptoms" related to their grasp on reality. This period is called the "prodrome", the 2 to 3 year period preceding a "psychotic break". As it turns out, defining which "early psychotic symptoms" lead to a "psychotic break" and schizophrenia, is very difficult.
Even defining "mild hallucinations", like hearing your name in the sound of the wind is problematic. The key psychiatric element is "insight”, defined as when folk can "recognize an altered worldview as a sign of illness, not a revelation..." so that the "disease" can be stopped before it progresses further. (Defining "an altered worldview" as an "illness" is problematic, IMHO.)
A 3-year long study of 300 folk with "early psychotic symptoms", defined as "“recurring unusual thoughts,” “unusual sensory experiences,” or “increased suspiciousness”, showed that only 35% had a psychotic break. Obviously, 65% didn't have a psychotic break; they were, however, labelled as "pre-schizophrenic" by psychiatrists, psychologists, their friends and family for years, causing untold harm.
Not surprisingly, this disturbed the psychiatric community, so a Prodrome Longitudinal Study (early-psychotic-symptoms-over-time study) was conducted. A new diagnosis was generated called the "psychosis risk syndrome", proposed for inclusion in next year's "Diagnostic and Statistic Manual of Mental Disorders" (DSMMD), psychiatry's "central reference text". The new diagnosis includes:
feeling perplexed, confused, or strange, thinking that the self, the world, and time has changed (often in ways that cannot be described)...unusual ideas (about the body, guilt, nihilism), overvalued beliefs (about philosophy, religion, magic) . . .
Now, c'mon, WADR...who, exactly, hasn't felt "perflexed, confused or strange" or had "unusual ideas"????
The DSMMD was designed to give psychiatrists checklists of behaviors that require a "minimal amount of inference on the part of the observer" for arriving at a diagnosis. And what if your psychiatrist isn't certain??? Well, "the outer limits of normality are decided by committee." Now that's comforting.
A key element of schizophrenia, "delusion", is defined as a "false belief...firmly sustained despite what almost everyone else believes". The more severe "bizarre delusion" has been redefined often. When the current definition, "a phenomenon that the person’s culture would regard as totally implausible”, was developed, 10% of those previously called "schizophrenic" were not any more. Even William James, a/the 19th century pioneer of American psychology, admitted that he had a hard time telling the difference between a "mystical, metaphysical" experience and schizophrenia.
"Incomprehensibility" itself was actually used to identify schizophrenia. In the 1940s, if a psychologist felt "alienated", or got a "cold" feeling towards a patient, they were diagnosed w/"praecox feeling", or schizophrenia, which was known as "dementia praecox". Even Sigmund Freud said "Ultimately I had to confess to myself that I do not care for these patients.” Recovery was sometimes greeted with "well, you must not have been sick in the first place."
The psychiatric community recognizes the problem. The DSM task force chairman said that the new definition above had a much higher probability of "over-medication", and could cause a “public health catastrophe" with the risk of “medicalizing normality, and of trivializing the whole concept of psychiatric diagnosis.”
For admission to a prodrome clinic, folk take the "Structured Interview for Psychosis-Risk Syndromes" test, which includes, a) Do you daydream a lot...?, b) Do you think others ever say that your interests are unusual or that you are eccentric?, and c) Describe the similarities between a banana and an apple?...c'mon, you know...if you answered "both are fruit" you pass; if you answered "both have skins", you fail.
Folk interviewed in a prodrome clinic "had moved through childhood and adolescence feeling more thoughtful, intelligent, or probing than their family and peers...an existential tinge to their preoccupations". Now that's damning...
Thomas McGlashan of Yale, a pioneer in schizophrenia, and the author of "The Psychosis-Risk Syndrome", a guidebook for clinicians, said that psychiatric diagnosis is “just as completely primitive as it’s always been.”
As the current psychiatric approach focuses on behaviors rather than the causes w/in the brain, the confusion is likely to continue. As cognitive neuroscience continues to progress, terms like "self", "I", and "reality" will have a less equivocal meaning.
Cognitive neuroscience has an improving grasp on where and when the "I" manifests and how "bizarre" phenomena like a loss of a sense of "personal time" or "self and others" arise as the blogpost "Seeing everything as "One", what is "mystical"? What is really "real"? - the Science" demonstrates.
Currently, although"schizophrenia" is poorly understood, there is hope, however, as imaging improves, and more researchers and support enter cognitive neuroscience. An example is the paper "Neurodegenerative Diseases Target Large-Scale Human Brain Networks" by Seeley, et al. from Stanford which is at the cutting edge of neuroscience looking at large-scale, widely-distributed, functionally-complex neural networks. Such an approach will be required, IMHO, to address complex diseases like schizophrenia. Hopefully, that will induce the psychiatric/psychology community to move from symptoms to causes, so that confusing mystical experiences with mental disorders will not occur.
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| Rachel Aviv Winner 2010 Rona Jaffe Writers' Award |
G. An earlier post, "Big awakening, ego-death, experiences, am I OK?, withdraw? healing? a shrink?, discussed a folk who had several big "openings" and "ego-death" experiences soon after we met, and was going through much angst over whether or not she had a psychosis...
Thanks for this Gary...sharp line...created with modern medicine and psychiatry between "normal" and "abnormal"...most of the fear and anxiety I had...was due to this underlying theme of "are you crazy? is this normal? what if you lose your mind?...what is wrong with you?" This theme is so deeply ingrained that it can...seem very compelling when it flairs up."
In that blogpost, i recommended that folk see both psychologists and spiritual teachers, who were experienced in dealing with "awakening", to get both viewpoints.
Can psychiatrists accurately identify schizophrenia before it fully manifests? There are about 60 US clinics working w/folk "experiencing early psychotic symptoms" related to their grasp on reality. This period is called the "prodrome", the 2 to 3 year period preceding a "psychotic break". As it turns out, defining which "early psychotic symptoms" lead to a "psychotic break" and schizophrenia, is very difficult.
Even defining "mild hallucinations", like hearing your name in the sound of the wind is problematic. The key psychiatric element is "insight”, defined as when folk can "recognize an altered worldview as a sign of illness, not a revelation..." so that the "disease" can be stopped before it progresses further. (Defining "an altered worldview" as an "illness" is problematic, IMHO.)
A 3-year long study of 300 folk with "early psychotic symptoms", defined as "“recurring unusual thoughts,” “unusual sensory experiences,” or “increased suspiciousness”, showed that only 35% had a psychotic break. Obviously, 65% didn't have a psychotic break; they were, however, labelled as "pre-schizophrenic" by psychiatrists, psychologists, their friends and family for years, causing untold harm.
Not surprisingly, this disturbed the psychiatric community, so a Prodrome Longitudinal Study (early-psychotic-symptoms-over-time study) was conducted. A new diagnosis was generated called the "psychosis risk syndrome", proposed for inclusion in next year's "Diagnostic and Statistic Manual of Mental Disorders" (DSMMD), psychiatry's "central reference text". The new diagnosis includes:
feeling perplexed, confused, or strange, thinking that the self, the world, and time has changed (often in ways that cannot be described)...unusual ideas (about the body, guilt, nihilism), overvalued beliefs (about philosophy, religion, magic) . . .
Now, c'mon, WADR...who, exactly, hasn't felt "perflexed, confused or strange" or had "unusual ideas"????
The DSMMD was designed to give psychiatrists checklists of behaviors that require a "minimal amount of inference on the part of the observer" for arriving at a diagnosis. And what if your psychiatrist isn't certain??? Well, "the outer limits of normality are decided by committee." Now that's comforting.
 |
| William James Pioneer of American Psychology |
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| Sigmund Freud |
The psychiatric community recognizes the problem. The DSM task force chairman said that the new definition above had a much higher probability of "over-medication", and could cause a “public health catastrophe" with the risk of “medicalizing normality, and of trivializing the whole concept of psychiatric diagnosis.”
For admission to a prodrome clinic, folk take the "Structured Interview for Psychosis-Risk Syndromes" test, which includes, a) Do you daydream a lot...?, b) Do you think others ever say that your interests are unusual or that you are eccentric?, and c) Describe the similarities between a banana and an apple?...c'mon, you know...if you answered "both are fruit" you pass; if you answered "both have skins", you fail.
Folk interviewed in a prodrome clinic "had moved through childhood and adolescence feeling more thoughtful, intelligent, or probing than their family and peers...an existential tinge to their preoccupations". Now that's damning...
 |
| Thomas McGlashan Yale University |
Thomas McGlashan of Yale, a pioneer in schizophrenia, and the author of "The Psychosis-Risk Syndrome", a guidebook for clinicians, said that psychiatric diagnosis is “just as completely primitive as it’s always been.”
As the current psychiatric approach focuses on behaviors rather than the causes w/in the brain, the confusion is likely to continue. As cognitive neuroscience continues to progress, terms like "self", "I", and "reality" will have a less equivocal meaning.
Cognitive neuroscience has an improving grasp on where and when the "I" manifests and how "bizarre" phenomena like a loss of a sense of "personal time" or "self and others" arise as the blogpost "Seeing everything as "One", what is "mystical"? What is really "real"? - the Science" demonstrates.
Currently, although"schizophrenia" is poorly understood, there is hope, however, as imaging improves, and more researchers and support enter cognitive neuroscience. An example is the paper "Neurodegenerative Diseases Target Large-Scale Human Brain Networks" by Seeley, et al. from Stanford which is at the cutting edge of neuroscience looking at large-scale, widely-distributed, functionally-complex neural networks. Such an approach will be required, IMHO, to address complex diseases like schizophrenia. Hopefully, that will induce the psychiatric/psychology community to move from symptoms to causes, so that confusing mystical experiences with mental disorders will not occur.
Interesting post. A lot of good infos here. Thanks for your time!
ReplyDeleteI have been diagnosed with schizophrenia. However I don't think the current psychiatric model is very accurate. My experiences can best be described with the Transpersonal model:
ReplyDeletehttp://www.grof-holotropic-breathwork.net/profiles/blogs/socalled-schizophrenia-as?xg_source=activity
There are other people with same experiences, Paul Levy is one:
http://www.awakeninthedream.com/wordpress/
Hi, Thomas.
DeleteThanks for the sharing and links to the Transpersonal model and other folk with the same diagnosis. Agree that the current psychiatric model is outmoded, and not useful or accurate. If a model fits almost everything, then it ceases to mean anything. Trust all is well in India.
A very good blogpost. I, as you, am happy to see that cognitive neuroscience is getting more and more support. Regarding mental illnesses, it seems that the next step has to be to understand the causes for these dieases, just as you said, in order to make drugs that can target the direct causes. I hope we get brainscanners with higher resolution and also to start to collect all brain scans into a huge archive which then can be analysed and hopefully patterns will emerge.
ReplyDeleteDepersonalization disorder has been linked to most nondual definitions of "awakening," absent the anxiety. Interestingly, the Wikipedia article on "runner's high" links depersonalization with endorphins. In a 1990 article: (R. Castillo, "Depersonalization and Meditation," Psychiatry_, Vol. 53, May 1990, pages 158–167), one element of distinction is the patient's meaning assigned to the feeling of no-self. If "no-self" is seen as a positive development, the anxiety can diminish. DSM-IV-TR concludes that depersonalization disorder is not a form of psychosis.
ReplyDeleteAndy H
Hi Andy
DeleteVery useful link on endorphins to the feeling of no-self, "runner's high" and depersonalization. Particularly useful the DSM-IV-TR conclusion that depersonalization disorder is not a psychosis, and if "no-self" is seen as a positive development, rather than a pathological condition, the anxiety diminishes. All too frequently mystical experiences are pathologized by unknowing psychologists/psychiatrists resulting in great, and unnecessary, anxiety. Thanks.