NATIONAL SCHIZOPHRENIA AWARENESS DAY

Victor Bloom MD

When I was a young psychiatrist in training at Detroit's Lafayette Clinic around 1960, schizophrenia was considered to be the most dreaded disease. The diagnosis was like cancer, there was a great stigma attached to it, and a feeling of hopelessness, helplessness, doom and despair. At the time it was estimated that one out of every two hospital beds was taken for the severely mentally ill, mostly schizophrenics in custodial treatment in state hospitals. Northville and Pontiac state hospitals housed thousands of chronically ill mental patients. The asylums were sometimes called 'snake-pits' and 'loony-bins.' You had to be 'out of your mind,' 'loco,' to be there, and sometimes the 'warehousing' was lifelong. The 'inmates' were 'put away' and often they were no longer visited by family and friends. The state was attempting to do a service to the family and community by removing these 'difficult' people who were obstructing and complicating our lives. Often family members kept commitment of a member a secret lest it be known that there was 'mental illness' in the family.

The dedicated mission of the director of Detroit's Lafayette Clinic, Jacques Gottlieb, was to find the omega replica watches cure to schizophrenia. If he had succeeded in doing that, he would have earned the Nobel Prize in Medicine. He was convinced that schizophrenia was an organic brain disease, basically a neurological, rather than a psychological condition. Being that we couldn't cure it medically, psychotherapy was offered to help the sufferer 'adjust' himself to get along in the outside world or within a psychiatric ward. Families were helped to understand the condition and adjust as well, with a team of psychiatrist, psychologist and social worker. A therapeutic milieu was offered in the hospital, consisting of individual psychotherapy, group therapy, occupational and recreational therapy. Hospital stays in the Lafayette Clinic, the State of Michigan's showcase, were three to six months, sometimes longer.

With successful psychological help, emotional support and empathy, often the patients 'recovered' and the family learned how to be helpful and accepting. But Dr. Gottlieb could see that nobody with that diagnosis was completely CURED. They only got better through management and followup, which often needed to be lifelong. He was convinced that there was some error of metabolism in the chemistry of the brain, and although time has proven him right, the exact mechanism remains unknown and a 'cure' is still elusive. Research in schizophrenia is taking a back seat to medical research in heart disease, cancer, stroke and senile dementia (Alzheimer's disease), where once it was heavily funded by federal and state governments.

In the 50's psychotropic (mind influencing) medications were developed which made the patients better than anything before. Before Thorazine came on the scene, strong sedatives such as barbiturates and chloral hydrate were used to sedate the patient and to prevent destructive impulsive behavior. The new major tranquilizers, as they were called, did a better job of making the patient calm, without sedating them too much, but they were still greatly slowed. Sometimes they were reduced to a zombie-like condition, called a 'chemical strait-jacket.' What was noticed, in addition to a certain calming effect, however, was a tightening of the thinking processes, counter to the tendency of the disease to cause 'loosening of associations' or fragmented, illogical thinking. The patients became more rational in thought and adaptive in behavior, which was a major turning point.

At the same time, Freudian theory predominated in most psychiatric centers and the prevalent psychological theory was that schizophrenia was due to overwhelming childhood emotional trauma, usually from abusive parents and a chaotic home life. Some patients were treated with insight-oriented therapy for years and even decades, with many responding favorably. But for others, the effect of psychotherapy was minimal. Schizophrenia research, diagnosis and treatment was very controversial at the time, and differences of opinion still dominate the scene. Researchers and clinicians agreed that the cause and mechanism are a combination of multiple complex hereditary and environmental factors, and so psychological and pharmacological treatment were ideally combined.

The past forty years found increasing evidence that schizophrenia was indeed on a genetic and neurochemical basis, and that in many cases drugs were found to be more helpful than psychotherapy. But interestingly, patients fortunate enough to get a goodly combination of psychotherapy and medication did best. Thorazine, Stelazine and Haldol did so well, that gradually the state hospital system was abandoned, and the thought was that the newly medicated patient could be absorbed back into the community and their families. Time has shown that this has not worked--- the newspapers are full of stories of schizophrenics ending up as homeless street people or in jail, for such crimes as loitering, vagrancy, petty theft and using illicit drugs. Social scientists have found that schizophrenic persons without adequate support or aftercare tend to slide down the socio-economic scale. Correspondingly, the present situation for the severely mentally ill in this affluent country is nothing short of scandalous.

In this modern age of absorbing all sorts of 'different' people into everyday life, the deaf, blind and physically handicapped, the retarded, the grossly obese, those with severe and chronic schizophrenia can be employed in sheltered workshops, doing such things as simple assembly in a nurturing, protective and non-stressful environment. There are many simple, repetitive jobs which they can do. If the outside world is too inherently stressful, a schizophrenic person may stay close to home, reading, writing, doing chores, participating in family and group activities. Social Security disability provides federal support to disabled individuals.

On the other hand, there are many schizophrenics who are very intelligent and sufficiently intact to be highly functioning--- they may or may not be considered odd, eccentric or bizarre. As a society we are becoming increasingly tolerant of deviant behavior, so long as nobody gets hurt or terribly bothered by seemingly strange behavior. Many schizophrenic individuals, now with improved psychopharmacologic management with the newer tranquilizers, fit in to the general population more easily than before.

Therefore, now more than ever, we should work toward erasing the 'stigma' of this medical condition in our society. Just as in any other medical condition, which is diagnosable and treatable, like diabetes, arthritis and hypertension, it is amenable to lifelong management, potentially yielding optimal behavior for each person, whether the condition is serious or mild.

There are many volunteer groups now, which are alliances for the mentally ill, promoting not only research and understanding, but tolerance and acceptance. Most important on their agendas is what is called 'parity.' The principle of parity declares that in all fairness, insurers (including the federal government) should treat mental illness no differently from other physical illness, which in truth it basically is. There are no limits to coverage for treatment of a brain tumor, for example, the expenses of the doctor bill of a neurosurgeon (radiologist, anesthesiologist) and extensive hospital and rehabilitation services. In contrast, there are drastic limitations to the coverage of medical treatment of schizophrenia, for no good reason. These alliances need your support, encouragement and contribution to political action. When they reach out to you, listen and learn and give generously to their worthy cause.

Dr Bloom is Clinical Associate Professor of Psychiatry, Wayne State University School of Medicine. He is a member of the American Academy of Psychoanalysis and on the editorial board of the Wayne County Medical Society. He welcomes comments at his email address--- vbloom@comcast.net.