Differnces Between Schizophrenia and OCD

Here we discuss some differences between schizophrenia and OCD. A commenter asks if I have schizophrenia.

Isn’t blunted emotions and weird, chaotic or intrusive thoughts more on the schizophrenia side of things?

I don’t have schizophrenia. A lot of OCD’ers complain that their emotions seem dead. Anyway, I don’t have the dead emotions of a schizophrenic. I have “constricted affect.”

What you see in a schizophrenic is totally different. Also, in schizophrenia, there is a lot more going on than weird, chaotic and intrusive thoughts, and anyway, in schiz, the thoughts are willed and wanted and not intrusive in general. For instance, schiz don’t try to stop their thoughts (typical of intrusive thoughts). They just accept them all of their normal thoughts.

I actually had a type of OCD called Schiz OCD for a bit. I was convinced that I had schizophrenia. One guy I saw thought I might have it. I argued with him, and he said, “All I know is you are way too electric right now.”

I called up a bunch of therapists on the phone when I was going seriously nuts and told them exactly what was happening. They all said, “It’s not schizophrenia. It looks like OCD, but it’s gotten way, way worse.” One guy said, “Look! If you were going psychotic, you wouldn’t be calling me up right now.”

I finally went to a doc and he got together with a psychiatrist and they discussed whether or not I was psychotic. They said, “No way! Forget it! They only delusion you have is that you’re psychotic!”

Unfortunately, when OCD gets really bad, they look psychotic. I run into OCD’ers all the time who have a psychotic dx and who have even been hospitalized as a danger to themselves or others with a psychotic dx on dismissal. I argued with all of them that they are not psychotic. The problem is in figuring out the difference between the delusions of psychosis and the obsessions of OCD, which unfortunately look similar sometimes. I can always tell, but clinicians can’t.

Anyway, we had big long arguments with me and this therapists, me saying I was schizophrenic and he saying I was not.

When I got really bad, things got really really weird. I sensed a presence in the world, and evil presence, like the Devil or something, and it seemed like it wanted me to do bad things. I didn’t do any bad things.

The people in the TV seemed really real and it seemed like they could walk out of the TV into the room. The newscasters especially seemed like they were talking right to me. I knew they weren’t, but it was pretty weird.

My thoughts were coming in loudspeakers and often they came in colors too. Typically the colors were faded like faded red or faded light green. Often the thoughts repeated over and over like strobe lights. Colors in the environment got a lot brighter (I still get this one sometimes.)

All of this stuff went right away with an SSRI, which proves it wasn’t psychosis. In psychosis, you need an antipsychotic.

It’s been 21 years since that madness went on, and it hasn’t come back, but I am always afraid it will.

I don’t have schizophrenia. The therapists have already beaten that one to death.

Drugs, Mental Illness and Psychiatrists

Sutanu writes:

Hi Robert,

Your article was very interesting, I have a very personal experience with schizophrenia and I do not know the role marijuana had to play in it. I have been a pot user since I was about 22. My wife was a cigarette smoker since age 18 and alcohol user since 20.

She started smoking pot since age 24 – sometimes 3-4 times a week sometimes once daily. Around the age of 29 she started developing symptoms of schizophrenia, which was full blown by the time she was 30 (with auditory hallucinations). She has been in treatment for the last nine years.

In the opinion of her psychiatrist, it was the use of pot that triggered and maybe even possibly caused the illness. Reading your article and your responses, I am now confused whether this is possible as you have said that the safe age to start on pot is 21. Would love to hear your thoughts on this.

Statistics show that there is no increased risk of schizophrenia after age 20. Your risk is almost all used by age 19 or 20 anyway.

Anyway, the cannabis-schizophrenia link does not appear to make any sense. Of all of the recreational drugs out there, cannabis is one of the easiest of all on your brain. Schizophrenia appears to be characterized by extensive damage to the brain. Since cannabis does not cause extensive damage to the brain, there is no way that cannabis could possibly cause the sort of brain damage that is present in schizophrenia.

Since the 1960′s, rates of cannabis use have gone through the roof and the rate of schizophrenia has been completely flat. In fact it has actually declined a bit. If cannabis were causing any schizophrenia at all, much less tons of schizophrenia, we would have expected rates to have increased if not skyrocketed since the 1960′s They have not, so the notion that cannabis or illegal drugs in general cause schizophrenia is very dubious.

I have known hundreds to thousands of cannabis users in my life. Two developed schizophrenia. One had very extensive meth use for decades. They other has a mother with schizophrenia.

It’s certainly possible that cannabis can trigger schizophrenia in a vulnerable person. However, those persons were probably going to get it anyway. Cannabis may bring schizophrenia on sooner than before. This is a tragedy as each year lost to the illness is a year is a lost year for the person who has it.

Psychiatrists are assholes. They all hate illegal drugs, and they think that illegal drugs cause tons of mental disorders. If you have a drug history and you go to a psychiatrist, the asshole will automatically and immediately say that the drugs caused your disorder, no matter which disorder you have or how little you drugs used. If you smoked one joint in your whole damned life, the asshole psychs will insist that it caused whatever you might have.

Psychologists on the other hand for some reason to not seem to have these same prejudices against illegal drugs and in general to not seem to blame illegal drugs for causing tons of mental illnesses.

My observation has been that heavy drug users sometimes appear to be mentally off in some way or another, and sometimes their behavior is disordered. In general however, the off mental behavior seems to clear up when the person stops using, and they just go back to their previous psychological state. I do not believe that drug use in general causes long term psychological damage persisting after the use of drugs has ceased.

Case File: “People Are Following Me”

This was an interesting case who came to me in a roundabout way. A young man thought he had OCD with the pedophile theme, so he came to me to talk about that. I eventually got to know him pretty well.

After talking to him for a long time, I don’t think he has POCD. POCD people fear that they are pedophiles . This was not going on in this case at all. Instead, this man feared that other people thought he was a pedophile.

He would go out someplace, say to a store, and start thinking, “I bet these people think I’m a pedophile. They’re looking at me, and they think I’m a child molester.” These feelings made him anxious and afraid to go out. I eventually decided that this was more of a case of social phobia or possibly paranoia. Feeling that you are being scrutinized is either paranoia or social phobia, and it’s often hard to tell one from the other.

Upon further questioning, he said that when he went outside, people were always following him everywhere he went. Police helicopters were also following him. I asked him if he regarded these thoughts as absurd or tried to stop them, and he said no. He also said that when he was at home alone, he would get feelings like someone was going to kill him. This caused serious anxiety and made him afraid to go out. Upon questioning, he said it really did feel like people were tying to kill him or were following him.

I was surprised when he revealed to me that he heard voices sometimes, but not always. The voices tended to come when he was home alone and would tell him things along the lines that people were trying to kill him. After questioning, I determined that the voices were coming from outside, and he was hearing them with his ears. Voices in your head that you don’t hear with your ears are just thoughts.

I’ve never had paranoid feelings like this or heard voices like that in my life, so I don’t know what it feels like. The feelings of paranoia combined with hearing voices does look like some kind of a psychotic disorder, but it was confusing.

It turned out that he had OCD symptoms. While he didn’t consider himself a racist, he said that when he talked to Black people, he was bothered by the word “nigger” going in his head. He disliked having this thought and wanted to be rid of it. He also said that when he was hiking in Yosemite on the Mist Trail, he got urges to push his fellow hikers off the trail. These urges also bothered him. However, he made no attempts to resist these feelings or thoughts.

Clearly, in this case, we need to rule out schizophrenia. I did not feel that the man was schizophrenic. However, he was getting worse as far as the voices and paranoia was concerned. He had a psychiatrist who was not sure if he had schizophrenia or not. He was being treated with an atypical antipsychotic. I have had many conversations with him, and while he seems anxious, he is also quite logical and normal. Whatever is going on with him, it doesn’t look like schizophrenia at all.

Dx:

1. OCD
2. Anxiety (unable to make specific dx)
3. Social phobia?
4. Paranoid psychosis with delusions and hallucinations (unable to make specific dx)
5. Schizophrenia apparently not present.

This was a very confusing case.

Bizarre Obsessions

Repost from the old site.

OCD (Obsessive-Compulsive Disorder) is a very strange illness. Although it is lumped in with the anxiety disorders, some have observed that it has qualities about it that imply that maybe it should be moved elsewhere. On tests, OCD’ers have showed similarities with schizophrenics on certain variables. The suggestion was made by the researchers that OCD may be related to schizophrenia.

Nevertheless, OCD generally does not lead to schizophrenia, nor do anxiety disorders lead to psychosis. That is old psychoanalytic stuff. According to psychoanalysis, as the person “regressed”, they moved first into neurotic “defenses” (the anxiety disorders) and later into psychotic “defenses” as the decompensation progressed. This early thinking has been largely rejected in recent days. But some still rings true.

An old Abnormal Psych book from the 1950′s, big on the decompensation stuff above, said that when a person recovered from a mental illness, they generally went back to a the personality they had previously. That sounds about right?

Anyway, most people afflicted with an anxiety disorder would have a hard time believing that they are utilizing some sort of a defense, because they are so horribly miserable all the time. I feel the same way about a psychosis. Whatever is going on, it cannot be any kind of defense mechanism. Defenses are designed to help us cope, not to make us go nuts!

Since OCD is so terribly misunderstood and the general public has such an ignorant attitude about mental illness, I want to delve into the topic of bizarre obsessions. I will list some bizarre obsessions that I have read about and heard about from sufferers:

1. A man is afflicted with thoughts that he is a fish. He checks himself in the mirror for tiny gills and reads dictionary definitions of fish and wonders if he has gills. He feels terrified whenever he sees pictures of fish. He tries to stop the thought every time it comes into his head and describes it as crazy.

2. A man is terrified that the Night Stalker is going to kill him. No reassurance can stop these fears. The problem? The Night Stalker is safely locked away in a maximum security prison and cannot possibly get at the man.

3. A man is worried that he may possibly be the Devil. This would account for continuous thoughts of committing serial murder, torturing victims, pedophilia and cannibalizing victims.

4. A man has thoughts “Aliens are sending me messages”. The thoughts come in “red neon Technicolor like the signs in Las Vegas” in his mind. He spends all his time resisting the thought and describes it as crazy.

5. A boy has thoughts that he “has to kill his grandmother”.

6. A young woman has thoughts that “wolves follow her everywhere she goes” and that every time she walks anyway, she feels compelled to “walk north”.

7. A man has the thought that there are tiny razorblades on his fingernails, although he admits that he can’t actually see or feel them. Hence he is afraid to touch people.

8. A woman is afraid to walk past garbage of any kind, especially trash cans, because she is afraid she might “lose a little bit of her essence” every time she is goes past. So she avoids garbage cans.

9. A man fears that his overwhelming sexual guilt comes out of his fingertips and goes onto any printed paper, or any surface that can be written on. The sexual guilt will flow out of his fingertips onto newspapers, magazines, etc, and his sexual guilt will be available for everyone to see. Hence he licks his fingers all the time to prevent sexual guilt from flowing out of them.

10. A man fears that the ghost of the dead Jeffrey Dahmer is coming into his body and possessing him, and is causing him to have terrible thoughts about murder.

11. A man gets the thought, “They are poisoning me” sometimes when he sits down to eat. He goes ahead and eats the food anyway.

12. A lawyer throws away his coffee several times a day because he fears someone may have poisoned it.

13. A 29 yr old woman obsessively reads the paper to see if she has committed any murders. She constantly worries that she may have murdered someone.

14. A man worries that he may actually be a woman. Not a woman in a man’s body as in a transsexual, but that he actually is a woman. He spends hours studying his body in front of the mirror trying to figure out if he is a woman or not.

15. A man worries if his dog is really his dog. Perhaps it really belongs to someone else? As he continues these worries, he begins to worry that his dog may actually not even be a dog. Perhaps it is some other species?

16. A man constantly worries that he is hearing voices and hallucinating. Upon questioning, it seems that he is just hearing everyday noises and worrying that maybe they are voices or hallucinations.

At first glance, the overwhelming majority of people looking at these symptoms would say that these people are psychotic and that these thoughts are delusions. Unfortunately, many clinicians will also diagnose these people as psychotic and say they suffer from delusions. The problem is that not one of the people above is psychotic and there are no delusions in the series above.

It’s simply OCD and the thoughts are obsessions, not delusions. The difference between obsessions and delusions is a difference that continues to elude some clinical psychologists and psychiatrists.

The way most people immediately said Seung-Hui Cho, the VT shooter, was psychotic shows that most people associate any kind of strange thinking and behavior with “psychosis”. Most clinicians also said Cho was psychotic. I continue to argue that we lack clear evidence of psychosis in Cho’s thinking and behavior.

Psychotic people have enough problems as it is; although I’ve never experienced it, it’s clearly not adaptive, and in many cases its very painful. They don’t need to be lumped in every deranged homicidal maniac who comes along.

Likewise, folks with OCD have plenty of problems as it is without being called “psychotic”, “schizophrenic”, etc.

Sigmund Freud was wrong about OCD in some ways, but he was limited by his era. Nowadays, Freud would surely be a biological psychiatrist. He has some interesting things to say about OCD. First of all, he said: “This is certainly a crazy illness!” On the other hand, he also said, “They are not psychotic.” He also hinted that the illness may be biological in nature.

For schizophrenia, Freud felt that there was something wrong with their brains. He suggested that in the future, we might be able to find something wrong with their brains. He also said that talk therapy was of no use to schizophrenics.

As you can see, for all the derision heaped on him, Freud was right-on in some very crucial observations about common mental illnesses, observations that continue to hold up in our biological era today.

More on Schiz OCD

Repost from the old site.

This is an update to a previous post about schiz OCD, which is a particular subtype of OCD, or obsessive-compulsive disorder, an anxiety disorder which I suffer from. Fred Penzel, one of the world’s top experts on OCD, wrote to me and chided me for writing about all these different types of OCD, saying that they were all just the same thing.

Well, I will beg to differ on that. Sure, they are all just the same thing in a way, but it is important to elucidate the different types for differential diagnosis – in order to help clinicians to determine what is the proper diagnosis for individuals. I say this because people with many OCD subtypes are often misdiagnosed. The misdiagnosis is usually psychosis, schizoaffective disorder, schizophrenia or bipolar disorder.

Harm OCD is the fear that one is going to hurt or kill someone, or people in general. I spoke to one sufferer, a millionaire, who had not left the house in three years other than for short trips. After reading my articles, he was finally able to go out longer than he had in years. He’s terrified that he’s a serial killer and that he’s going to attack people or try to kill them when he goes out.

An excellent therapy for people like this is to tell them to put a knife in their pocket and walk around town with it, going in stores, sitting down to talk to people. I recommend especially going into stores where the clerk is alone so the patient could potentially “kill the person and possibly get away with it”. Remain aware of the knife in your pocket as you talk to the clerk alone in the store.

There is another therapy that one therapist is using for harm OCD. The client comes in and after he sits down the therapist pulls out a knife, holds it and says, since you’re a possible serial killer maniac, I am going to need to arm myself with a knife when I talk to you. The session is then conducted as the therapist nervously toys with the knife, watching the client’s every move.

Periodically the therapist jumps up and holds the knife defensively, yelling, “Hey, don’t move like that! I could have sworn you were making some dangerous moves in my direction. This could also be done with a close friend or a mature family member if you trust them enough.

The “therapist” makes it known that since the client is a total maniac, the therapist will need to be armed at all times when the client is around, because “you never know what a psycho will do”.

Other therapies include reading books and watching movies on serial killers, writing essays on why the thoughts are actually real killer thoughts and not just OCD, and making tapes of murderous fantasies and listening to them over and over. These have worked pretty well.

A common symptom of harm OCD is knife avoidance. I had a teenage girl come talk to me a while back who just started getting the harm symptoms. She had them all the time now and was cutting school because she could not study. She came from a traditional Hispanic family and she was afraid to tell them about the symptoms. She was terrified and secretive about the problem and had taken to avoiding knives.

She periodically opened her parents door to check and make sure they were still alive and she had not killed them (OCD makes you doubt your own memory in a very weird way). I told her she wasn’t going to get better on her own and got her to make a doctor’s appointment with a clinician.

The important thing about harm OCD is no one has ever acted on these thoughts that we know of.

It is important for clinicians to understand harm OCD because many clinicians falsely think that the person is dangerous and try to consider other dx’s such as psychopathy, sociopathy, antisocial personality disorder, etc.

I am starting to get a lot of mail from people with POCD, or the fear that one is a pedophile. I also wrote an article about that. I haven’t yet figured out any good therapies for these folks. I know that all the ones I have talked to so far just have POCD. Unfortunately, I do not think the pedophiles show up for therapy unless it is court ordered.

I just tell them if they are around, say, little girls and they get these unpleasant thoughts, to just go ahead and think them and don’t worry about it. I am convinced that the problem here is not so much the thoughts but the way that the person reacts to them. There is no harm in thinking sexual thoughts about minors as long as one will not act on them, although for most people it will be more of a passing thing.

I have talked to people who have been angrily challenged by their therapists about whether or not they are really pedophiles. One said, “Ok, look, you can’t hide behind this OCD thing. If you have these feelings you need to tell me. It’s a serious condition.” Most POCD sufferers will get totally freaked out by this. POCD is little known and I believe most clinicians are ignorant of it.

One therapy that I have heard of is to go to parks where kids hang out and just stay there until you can’t take the anxiety anymore.

The obsession that one is gay is very common. Some therapists that do not understand HOCD, or Homosexual OCD, think that the person is really gay or might be really gay. This leads to sessions about whether or not the person is really gay. As HOCD sufferers are already freaking out about whether they have HOCD or are just “coming out of the closet”, this approach is not helpful.

Which brings us to schiz OCD. Here is a 40 page thread full of people with OCD who are terrified that they have schizophrenia or are psychotic. What usually happens is that they have a fear of going insane like a lot of people do. They do research on schizophrenia and psychosis and worry they might get the symptoms. Wa-la, they get the symptoms!

They read about delusions and they get “delusions” – the same ones they are reading about. They read about hallucinations and then obsess whether or not they are hallucinating, hearing or seeing things. They are not hallucinating at all – they just think they are!

I went through that whole 40 page thread and did not see one person who was either psychotic or had schizophrenia. You can tell by the nature of the symptoms and also the way that they communicate in their posts. People with OCD are pretty sensible and rational when they speak and write. This is the paradox of the illness.

As my first therapist said to me 24 years ago at USC when I was having horrible symptoms, “You know, sitting here talking to you, you seem like a really rational, reasonable person. So how come you’re acting so crazy?” Indeed. My symptoms were largely hidden; I was getting a teaching credential at the time and doing student teaching.

I was quite busy. I also somehow had a very active social life and a beautiful girlfriend with whom I was having a very passionate relationship. At the same time, I was going out of my mind. I was pretty much terrified all the time, though I tried to cover it up. The horrible thought started about an hour after waking and went all day with no stopping it. Sleep was a blessing as it was the only thing making the thought go away.

The thought had a simple theme which I will not go into here. I remember my heart slamming away in my chest as I walked across the USC campus. This was how I spent my middle 20′s. I got high on coke, booze and pot, went to countless parties and clubs, somehow managed to date all sorts of women (How the heck did I pull that off?) and should have been having a blast. Instead, I was in my own little Hell of sorts.

Untreated schizophrenics have a way of talking that does not make sense. This is called “loosening of associations” or “thought disorder”. If you have ever had a conversation with an untreated schizophrenic, you know what I am talking about.

I recently got a mail from a woman who has been diagnosed with schizophrenia twice (once by a psychology professor) and schizoaffective disorder once. She had a prior OCD dx and a long history of depression. Social functioning is good with a circle of close friends. She is now trying to get back into school again. She was working, even at the height of “psychotic” symptoms, as a secretary.

We can see certain things here. Untreated schizophrenics typically lack good social functioning. The illness just ruins all of that. It is not possible for an untreated schizophrenic to be employed and function well at a decent occupation – schizophrenics cannot work unless they are on meds. Schizophrenics also cannot do well in college courses if they are not being treated.

Here are some of her symptoms:

Watching TV and a thought pops into her head that the people on the TV are talking directly to her.

On the computer and a word pops out on the screen and she gets the thought that it has special meaning for her.

Thought pops into her head that she is Jesus or God.

Man walking behind her – thought pops into her head that maybe he is following her or going to harm her, so she hurries away.

The next reaction after she gets the thought is confusion, and she wonders what is real anymore. There is a part of her mind telling her that the thoughts are true and another part fighting them, trying to stop them and panicking because the thoughts are crazy and insane and this means she is going insane.

Psychotic people do not operate in this dual mode of thinking while suffering delusions. The term delusional fixation was not coined casually; it has real basis in reality. To put it bluntly, if you think you are going psychotic, then you cannot possibly be going psychotic.

I have spent some time with psychotic people. I was best friends with a young Black guy who was going through the early stages of paranoid schizophrenia. I hung around with him just about every day for a year or so.

He was hearing voices a good part of the time. We would be driving in the car and he would say, “You hear that?!” and point to the radio. Voices were coming out of the radio. I said I did not hear it and he accused me of lying. After a while, I told him that my hearing was very poor and that was why I could not hear them.

I was never really afraid of the guy, but I had to quit hanging around with him because he just had too many problems. He was untreated, worsening, and still trying to manage his life, move out of his Mom’s house, go to school, pay bills, get an apartment, and get a job. He could not manage to do any of these things, and I was driving him around everywhere trying to help him get his life together.

It was definitely an interesting experience to be around this person. This guy had no idea whatsoever that he was ill and he thought the problem was all other people. He fully believed all his delusions and and to him the hallucinations were real.

People were putting transmitters in the radio, the vents and under houses to send nasty messages to him. He wasn’t hearing voices at all. Everything was fully real to him. Of course, it’s impossible to get these people into treatment as they don’t see that they are ill.

Looking back at the woman above, I do not believe she is schizophrenic at all. Further, extended courses of a variety of atypical antipsychotics have produced absolutely no benefit whatsoever. The only drug that gave her any benefits at all was a high dose – 80mg – of Prozac.

A schizophrenic with extremely mild symptoms like this would surely benefit from an atypical, not to mention numerous different ones. The fact that the “delusions” were only ameliorated by high dose Prozac gives a clue to the OCD nature of the illness.

I think the problem here is the woman’s reaction to the thoughts and not the thoughts themselves. As therapy, I would tell her to stop reacting to the thoughts and relabel them as “stupid”, “crazy”, etc. Tell yourself that OCD is trying to make you fear things that are actually harmless. Ignore the thoughts or blow them off.

If there is a guy walking behind you and you get a thought that he might harm you, just stay there with the thought and don’t run. If he seems harmless enough, stop for a bit until he catches up and ask him the time.

The truth here is that you cannot run from your fears. OCD is a process of running from one’s fears. As long as you are running, you stay ill. Your fears are like a deep, dark swimming pool. No matter how scary, you just have to go to the board, swallow hard and dive right in. Then you climb out and do it again. You do it over and over and eventually you just get used to it, because your body does not want to feel anxiety all the time.

Eventually, tolerance results via the body’s natural process of adapting to fears. If there is some thing or situation that persistently frightens you or causes you anxiety, the thing to do is to just repeatedly put yourself in that situation and then fight the urge to run away from the fear. By staying with your fears, eventually they dissipate.

What Is Schiz OCD?

Repost from the old site.

Well, to be honest, it’s nothing, officially anyway. It’s just a colloquial name given to a certain type of OCD, or obsessive-compulsive disorder, this type being a pure-O type, or obsessions without compulsions*. I have recently discovered, after hanging out on some OCD boards, that schiz OCD is actually quite common, though it is a very disturbing type of OCD and is probably also often misdiagnosed.

The person with OCD starts out worrying that they either have schizophrenia or are going to get schizophrenia. They start to read all about schizophrenia, including all of the symptoms. Then they start to misinterpret stimuli in their environment as being due to hallucinations.

They hear noises in the environment and think that they are hearing voices or hallucinating. They see things out of the corner of their eye and start worrying that they are having visual hallucinations.

Keep in mind that it is considered normal to hallucinate for brief periods on rare occasions. It is not uncommon for normals to report hearing indistinct voices for 5-10 seconds a couple of times over a 5-10 year period – a person who experiences such an experience will likely say, “My mind is playing tricks on me.” Transient hallucinations are not necessarily pathognomic of anything.

The real problem with schizophrenia is that the person is afflicted with frequent or continuous tormenting voices that the person insists are real.

Then they start worrying that they are going to get schizophrenic or psychotic delusions. Pretty soon, “delusions” or “psychotic thoughts” start popping into their minds. In more serious cases, the “delusions” or “psychotic thoughts” repeat endlessly in typical OCD style.

Some are reporting just about every schizophrenic and psychotic thought and delusion known to mankind (they are either getting them out of the books or making them up on their own). I am doing amateur therapy now with a man who has experienced hundreds of “psychotic delusions”. It is clear that, at the moment anyway, he has OCD.

Some of these folks have committed themselves to mental hospitals, often repeatedly, insisting that they must have schizophrenia. At the hospitals, the doctors are not very nice to them, and the nurses make fun of them, saying that they have “medical student syndrome”.

Some of them insist that they are delusional – their delusion being that they have schizophrenia. The “delusion that one has schizophrenia” is not an appropriate symptom for a diagnosis of a psychotic disorder.

People with schiz OCD are often in a great deal of pain, but they are not psychotic at all, and, in general, they are not dangerous in any way whatsoever. The “delusions” are simply obsessions that are often vigorously resisted. Sometimes the person spends a lot of time checking to make sure the “psychotic thoughts” are not true.

Some of the thoughts that they get are, “They are poisoning me,” when being served food, “They are against me”, about anyone, especially a loved one, “This is a message for me”, if they see a piece of paper, etc.

The thought about being poisoned proved to be quite common, with many OCDers reporting it. They all said that they went ahead and ate the food anyway. I do not think someone who really thought they were being poisoned would go ahead and eat the food.

Proper diagnosis is essential in these cases, as a number of clinicians are diagnosing these folks as psychotic. They are not psychotic; they have OCD. It is very important to distinguish between obsession and delusion. The bizarre, psychotic-like nature of the obsession does not mean it is a delusion.

An obsession is defined as the following:

Obsessions as defined by (1), (2), (3), and (4):

1. recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress

2. the thoughts, impulses, or images are not simply excessive worries about real-life problems

3. the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action

4. the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)

B. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. Note: This does not apply to children.

If the “psychotic thought” or “delusion” has the qualities above, it is an obsession. A person with a true delusion simply accepts the thoughts as absolute fact, with a conviction so deep that you cannot change their minds even if you argue with them all day and night. They believe it the same way that you believe your name is whatever your name is. Furthermore, delusions are never resisted.

I have known psychotic persons who had delusions and hallucinations; it is simply impossible to try to argue them out of their false ideas and sensory illusions. Typically, persons in the midst of a psychosis do not have the slightest clue that they are ill.

It is true that in the early stages of psychosis or even schizophrenia, the person often has some level of awareness and insight. This is especially true of more educated persons who know a lot about mental illness.

I recall a poignant case where a young man experienced the early stages of schizophrenia, went to the library and researched his symptoms and diagnosed himself with schizophrenia. However, soon afterwards, he became full-blown psychotic and all insight was lost.

The lack of awareness of being psychotic makes it difficult to get these persons to take medication. Often they have to be convinced to take medication via subterfuge.

It is also true that schizophrenics who are on anti-psychotics and are getting a good response sometimes have excellent insight.

I have lived with psychotic persons for months on end, have spent months befriending and socializing with a schizophrenic and have talked with other schizophrenics who were actively psychotic. I have never met a psychotic individual who had the slightest bit of insight into their condition.

All of my efforts to talk psychotic individuals out of their delusions or convince them of the false nature of their hallucinations have been fruitless. It is a mystery to me how anyone can claim to do psychotherapy with an actively psychotic person.

Persons with schiz OCD are being diagnosed psychotic or even schizophrenic. Let this post serve as a warning that differentiation between obsession and delusion is of profound importance, as proper diagnostics is an essential pillar of treatment. Incorrect diagnosis poses numerous risks to clients, including exposure to dangerous drugs, damage to self-esteem, confusion, etc.

Persons with schiz OCD often have a history of other forms of OCD, such as HOCD (obsession with being gay), POCD (obsession of being a pedophile), harm OCD (obsession of being a rapist or murderer), germ OCD (obsession about contamination), etc.

A man I know with schiz OCD just got back from a visit to a psychiatrist who diagnosed him as “a little bit psychotic” and tried to put him on anti-psychotics.

She gave the following reasons why he was psychotic: because harm OCD and schiz OCD were not “typical” forms of OCD, and, if he was worried about going psychotic, it must be because he is going psychotic. She also said that most psychotic people have insight into their illness – in fact, the very definition of psychosis precludes insight.

Nevertheless, although anxiety disorder does not lead to psychosis, and OCD in general does not progress to psychosis, sometimes OCD presents as the leading edge of schizophrenia, usually in a young person. In such cases, full-blown schizophrenia occurs within about two years after development of OCD. OCD and schizophrenia can also co-occur, strange as it may seem.

And some persons who seem to be suffering schiz OCD may be experiencing the onset of schizophrenia. In cases where a person with schiz OCD is regularly actually hearing things, further investigation is warranted.

However, it is likely that a person in the early stages of schizophrenia will experience their strange thoughts as ego-syntonic instead of ego-dystonic – that is, the thought will not be immediately marked as crazy and vigorously resisted, but will instead be embraced as verifiable reality.

Perspective is important. The main problem here is OCDers being diagnosed as psychotic, not the other way around.

Little has been written about the treatment of schiz OCD. A man I interviewed experienced an almost 100% loss of schiz OCD on Anafranil, one of the best anti-OCD drugs out there. He also told me that other SSRI’s have been successful in preventing relapse. When schiz OCD is very bad, medication may be necessary. A successful response to SSRI’s will typically vindicate the OCD diagnosis.

Little has been written on the cognitive-behavioral therapy (CBT) of schiz OCD. One sufferer told me that the strategy of accepting the thought and just letting it pass on through without debating it seems to be helpful. Resistance is often counterproductive, as it often just strengthens the obsession.

There is a serious dearth in the literature and understanding of schiz OCD. This post will hopefully spur more articles on this poorly-understand type of OCD.

Here and here are a couple of more articles on schiz OCD.

*Fred Penzel suggested to me that actual pure-O OCD is quite rare. He is correct. What he means is that most pure-O types engage in reassurance seeking, checking and mental compulsions. Sure they do.

On the other hand, OCD’ers seem to want to distinguish between the more ruminative types who do not have overt rituals (no one who knows me would think I have OCD because I do not wash my hands all day or turn lights off and on 20 times). Furthermore, clinicians also seem to want to make this distinction. I was told I was a “classic obsessive” – implying rumination and lack of overt rituals.

Differential Diagnosis: Schizophrenia Versus OCD

From Yahoo Answers:

I have really aggressive thoughts sometimes. I don’t even understand why I have them. Usually (not limited to) they’re about hurting people. I feel really crappy about myself after these thoughts. I won’t go into all of my thoughts because some of them are really disturbing and they come out of no where sometimes. It’s surprising and then I start feeling like maybe I’m just a really evil person although I’m considerate of other people, most of the time.

I have a heart but sometimes I feel like how can I have a heart with these thoughts in my head! They don’t pop up in my head unless I think about it.

So then I thought well these thoughts might be schizophrenia, I started looking up what schizophrenia was. Then right as I saw the symptoms and examples of the symptoms I started like displaying the symptoms in my head. It’s almost like once I absorb an idea my mind plays on it.

Like when I saw this CSI episode where this person got poisoned with Cyanide, I started worrying about cyanide poisoning. When I read the symptoms of Schizophrenia where you have like hallucinations (Like voices in your head) I started making a voice in my head. Once these ideas are in my head I can’t get them out. It’s like they become apart of me.

Like sometimes I think “what if” all the time for every symptom of schizophrenia. Like people watching you. I started thinking: WELL, WHAT IF someone was watching me. Errr! I can’t get these thoughts out of my head and I think I’m starting to convince myself that I have schizophrenia. I’m scared.

I feel like a sicko.

My mind is also very contradicting: Like if I say I’m not a bad person my mind says “yes you are” and really self-deprecating thoughts. Every time I want to feel good about myself my mind will convince me that I shouldn’t and that I’m a sick freak who thinks horrible thoughts. I’m 19 about to be 20 soon and I heard schizo starts early 20s. I just don’t know what to do…I don’t have any insurance to go see a doctor. I’ve been a worry-wart ever since I was in elementary school.

Also, like schizo, I heard you hear voices in your head and you believe what they’re telling you. Like let’s say something says, “This is God talking to you!” and I’m an agnostic and I don’t really believe in God. I like create scenarios and voices in my head ever since I heard about schizophrenia. NEVER before.

It’s like my mind is trying to give me these symptoms it’s hard to explain. It’s like I know they’re my voices but I don’t understand why my voices are saying these things. It’s like WTF? :\

A most interesting case. This is a completely clear-cut case of OCD, screaming loud and clear across the landscape. I won’t tell you how I know this, but I know this illness like the back of my hand, since I have it. Been there, done that, ok?

Not that subtypes matter, but this person has a couple of subtypes of OCD.

The first is Harm OCD.

The second may as well be called Schiz OCD. This is a person who starts to worry that they have schizophrenia. In the case above, he is starting to invent crazy voices in his head due to his fear. These voices in his head are causing him to worry that he had schizophrenia.

This person clearly does not have schizophrenia. First of all, the voices in the head. The person with schiz hears these as actual voices with his ears, the same you would hear the voices of the people around you. The voices sound just like the external voices of persons near you, so much so that it is hard to figure out who is really talking and what’s just a hallucination. So the voices are not really in the head but in the ears, so to speak. We all have internal voices in our heads that we hear all day long. Nothing to be alarmed about.

The “what if” questions are typical of OCD. A person with schizophrenia or other psychosis simply says, “People are watching me.” If you try to question them about the belief, you run into a brick wall and get a big argument. It’s a rock-solid delusion, and all delusions are hard as stone.

The person also has “contradictory thoughts.” This is unfortunately quite common with OCD. The person thinks a good thought, like “I’m a good person,” and the OCD chimes in with a contradictory thought saying, for instance, “No you aren’t. You’re evil. You’re the most evil person on Earth.” These thoughts will probably be violently resisted.

When doing differential diagnosis, look first of all at how hard the person fights or resists the thought. The more ferociously the person fights or resists the thought, the more likely you are dealing with an obsession.

A good rule of thumb is: If you try to stop the thought, it’s an obsession.

Unfortunately, clinicians understand OCD very poorly, and I doubt if this person is going to get a good diagnosis or treatment. In particular, OCD patients these days are often diagnosed as psychotic and treated with anti-psychotic drugs.

Cannabis, Teens and Schizophrenia

Repost from the old site.

I received a mail today from someone who attended an interesting conference in the Midwest.

At a Mental Illness and Criminal Justice Conference today in Omaha, Nebraska, Dr. Frederick Frese, who is the Coordinator of the Summit County Recovery Project and Assistant Prof of Psychology in Clinical Psychology at NEOUCOM and Case Western Reserve U, and on the Board of Trustees for the National Alliance for the Mentally Ill, gave a session on teenage cannabis use and schizophrenia.

He has been a diagnosed paranoid schizophrenic for 40 years.

Frese stated that use of cannabis between the ages of 15 and 18 in persons who have a variant allele of the COMT gene will lead to an almost certain psychotic break by the age of 25. He said it’s because of the formative time that the brain is in during those years, in combination with that certain allele, together with cannabis use.

He said that if you have do not have the variant allele, no problem. Frese is so concerned about this that he and his team are going to start setting up genetic testing booths for kids at rock concerts because of the very real danger that the studies show exist.

I applaud Dr. Frese for the very real efforts he is taking to try to prevent schizophrenia in vulnerable youth.

I am dubious about how many kids this will save. The rate of schizophrenia has not gone up since the cannabis era began. This suggests that use of cannabis if anything will cause schizophrenia to occur sooner than it would otherwise occur, and it would occur anyway, just later.

The number of folks with this variant allele is high in absolute numbers, and many of them use MJ and don’t get schizophrenia. But it does cause a 10 times elevated risk. I think that Frese is wrong to say that it’s almost certain that these kids will get schizophrenia by 25 after smoking one jay between ages 15-18.

As I’ve said before on this blog, I have known 1000′s of cannabis users over my lifetime, many heavy users. The number who went on develop schizophrenia? Zero. This is why this whole subject makes me yawn.

I wish Frese good luck with his experiment though. Ideally, we could construct a good experiment this way. We could follow kids with the variant allele who wait til 19 to start MJ (Is this protective?) or avoid it period, with another group who did not avoid cannabis and see how many of each develop schiz and at what ages.

Tell the truth, I am quite concerned about use of cannabis by minors. I wish they would not do it. Period. Wait til you’re an adult!

I have OCD (another, though vastly less devastating, mental illness), and I have found that cannabis is actually a superb psychiatric drug for this illness. It works better than almost any med I have ever taken for this (The drugs work great at high doses, but nuke my sex drive, so what good are they?), and I have suffered for 26 yrs.

No clinician believes me when I tell them this; all insist that pot makes you mentally ill or worsens all mental illness or caused my problem in the first place (The gall of them!?), and all try to steer me to drug treatment or drug counseling when I tell them I use. I’m really getting tired of this shit. I’m 50 years old, and I’m being treated like a child.

I have some opinions about the mental health profession, but in general they are extremely low. For such a bunch of super-smart people, there sure is a lot of bullshit groupthink, scaredy-cat thinking and just general lack of an empirical outlook.

Problems of Democracy Under Capitalism

Repost from the old site.

I’ve always been opposed to public dishonesty, which is one of my problems with Communist states. They lied about so many things that now even when they tell the truth, people figure that “All Communists lie,” so they are unlikely to be believed even when they are honest. You get a “boy who cried wolf” syndrome.

Well, capitalists are pretty much the same. Almost all capitalists will always lie to defend their own interests. That is why whenever a businessman or business interest is quoted in the paper on some controversial issue, they are almost always lying. So it seems that in order to be a businessman in capitalist society, one must lie continuously.

There are cultures, such as Arab, Japanese, Thai and Filipino culture, where lying is definitely a state of art. American society proscribes all lying as evil, and your average American will tell you that he never lies. The Japanese mindset, which I subscribe to, is, “Only an idiot never tells a lie.”

So there is a time and a place for this sort of thing.

But in the sort of issues that we read about in our daily paper – controversial issues where two sides are sparring it out – you really want to figure out what’s going on. If the business side can be counted on to lie in defense of its interests nearly 100% of the time, this is very confusing. Especially when the media is so corrupted and dishonest itself that it’s not capable of sorting things out for you.

Fox News is a more or less 24 hour lie machine, but most Americans are too stupid to figure this out. American political campaigns are all about money and never-ending lying.

I can pretty much sort out the lies from the truth after a while, but it’s quite an effort. I figure most folks either don’t have the brains to do this, or they don’t want to know the truth, or they don’t care, or they don’t have the time.

Let me give you an example.

It is very hard for schizophrenics to tell hallucinated voices from regular voices. After a while, some of them get to where they can tell the hallucinated voices from the real voices.

Well, that’s what it’s like for me to winnow out the truth from the lies in our media. The media doesn’t’ really help you too much. I can figure this stuff out after a while, but it takes a lot of time. Time I figure most folks don’t have.

At any rate, elections that are nothing but waterfalls of money and lying are hardly exercises in democracy.

Under capitalism, typically the state is simply an arm of the business community. Some more progressive capitalist states (Europe, for instance) have gotten away from that somewhat, but it’s never really easy. Furthermore, nearly the entire media is usually controlled by the top 1% of the population, who use it to push their class interests at the expense of most everyone else, and surely the bottom 60-80%.

You would think that these things would be obvious to anyone living in a capitalist society, but toss that idea out sometime in a crowd and watch the hostile responses come back. It’s painful to admit that the media one loves so much is hostile and run by one’s class enemies. That hurts, and it makes you feel stupid. You’re reading your enemies’ propaganda, you idiot! That’s the message. People get their backs up.

In recent years in the US, the state has become more and more entwined with business interests, and hence has become more and more dishonest, just like the businesses that it is now essentially a part of. That is why the Bush Administration is a never-ending Lie Machine. That is why US administrations increasingly wage war on science – because under capitalism, businesses typically despise science.

Science is out to discover the truth, come Hell or high water. To the businessman, truth is whatever helps the bottom line and falsehood is whatever hurts the bottom line. If a businessman has to lie 20,000 times about 20,000 things to protect his bottom line, he will do it and not blink an eye. Then he will get up and start it all over again.

Since business sets the dominant cultural hegemony under capitalism, most capitalist societies will tend to be hostile to science.

So, living in a capitalist society, one is really swimming in an ocean of lies. Once you enter corporate culture, you need to become a lying sociopath like the corporation itself, or you are fired. The corporation is like an ant hill. Let us call this Lying Ant Hill. If the corporation itself is a sociopathic pathological liar, so must most of its component parts, the humans who make up the corporation.

An educated and aware populace is essential for democracy. Yet how is this possible in capitalism, where the elite-controlled media lies nonstop? Where the state itself is a lie factory for wealthy interests? Where business interests can never be counted on to tell the truth? You can be like me and try to get to the bottom of things, but it’s frustrating and time-consuming. Most folks have better things to do.

Democracy in most capitalist countries has serious problems. As long as the media is completely controlled by the wealthiest capitalist interests, the truth will be difficult to discover. The state itself can no longer be counted on, as it is captured by business interests and finds itself lying constantly to defend those interests.

In short, the classic Marxist argument that capitalist democracy has serious issues has a lot of truth.

The way out of the tunnel is to get some of the money out of politics via campaign finance reform. As almost all politicians are completely bribed and corrupted (bought and paid for), this solution is generally a nonstarter.

Media democracy is another route out. But it’s difficult due to high startup costs.

One solution would be to allow access to more of the radio band to local or pirate radio stations. The ferocity with which the government has attacked pirate radio shows how terrified the US state is of media democracy.

The TV band, which is mostly cable now anyway with up to 500 channels, should be in part licensed out to local entities. There should be channels available for all sorts of folks all across the political spectrum. If you’ve got the camera and the studio, do it yourself.

But the need to sell ads makes democracy in media under capitalism very difficult. Papers, radio, TV and magazines need to sell ads to survive, and hence necessarily become the mouthpieces of the business and corporate entities that advertise in their media outlets.

Progressive presses are usually only possibly via some wealthy benefactor who is willing to eat it on advertising in order to publish a Left or pro-labor paper. This is why public access channels are the only progressive and pro-people spots on the radio band – no ads. They are listener-supported, but listening to their endless fund drives makes you realize how tenuous their existence is.

Media democracy via licensing out the cable and radio spectrum to local outfits, however, is almost impossible because the government entities that license the spectrum out are completely controlled by corporate media interests.

Hence, our public airwaves, owned by you and me, worth billions of dollars, are given away to our class enemies for pennies on the dollar. The rest of us are then locked out of the band or even arrested if we try to break into the spectrum like the pirate radio guys did.

Even if public access is granted, the fact that we have allowed horribly abusive private cable TV monopolies everywhere in the US means that these companies would probably refuse to carry any progressive stations that somehow got on the air.

The Internet offered a breath of hope to this dismal state of affairs. The cost of publishing was down to just about zero, or at least nothing but time. The Communist dream (pure Communism, after the withering of the state) where media was so democratized that neighborhood media outlets sprung up everywhere and every man could be a journalist, seemed to be happening before our eyes.

The government and the big media are really scared. Progressive voices, anti-corporate voices (like this blog, for instance), could break into the media, and the circulation was limited only by how many readers you could somehow convince to come to the website.

Hence we see desperate efforts by the cable and telephone monopolies to create fast lanes on the Internet for big-money payers and slow lanes on the Net for everyone else, like for instance this site.

There is one important lesson here: capitalism never really tolerates dissent to its essential elite structures and business interests. They will allow dissent a lot of times, but the Hell if they will give it a voice or allow it any power.

Under capitalism, the elites and business interests have to control the media space, necessary to construct the Gramscian cultural hegemony.

In the Third World, dissenters against elite and business interests are regularly arrested, beaten, jailed, tortured and murdered. And if the voices get loud enough or strong enough, the capitalists will just launch a coup, overthrow the state, then launch an Argentine or Chilean style wave of terror to permanently shut folks up. If that doesn’t work, they will make the economy scream.

That’s “democracy” under capitalism in a nutshell. To put it mildly, it’s got some serious issues.

The 50 Craziest Rock Stars Ever

Here.

This article is pretty damn funny.

A lot of rockers are or were seriously nuts!

I’m having a hard time figuring out dx’s for a lot of these people. It seems to be something towards the more extroverted end. I suspect a lot of them are acting this way on purpose, sort of like a lot of artists act “deliberately insane.”

I only see a few who were obviously psychotic: Syd Barrett, Peter Green, Roky Erikson, Brian Wilson, Jim Gordon and Skip Spence for starters. I’m familiar with all these cases. They all had schizophrenia or schizoaffective disorder. It’s commonly said that they are all drug burnouts, but I doubt it.

For one thing, LSD does not appear to cause permanent psychosis. I’ve known too many completely normal folks who have taken it 100-300 times. It’s not even proven to damage your brain. The worst that can be said about it is that very heavy users sometimes do go psychotic and have to be hospitalized. Typically, they get better, but they often go back to heavy LSD use and become mentally ill again. No one has any idea how LSD even makes you temporarily insane.

All of these people simply developed schizophrenia. LSD can trigger schizophrenia, but no one knows how that works either. LSD-induced schizophrenia looks just like the rest of schizophrenia and it responds to the same drugs too. Since acid doesn’t damage your brain, I can’t see how it could cause schizophrenia. There are good reasons not to do acid, but fear of being permanently mentally ill is not one of them.

For the rest of them, dx’s are difficult. Some seem to have issues with narcissism and borderline personality disorder. Some were just seriously whacked out on booze and dope, often cocaine and/or heroin.

Ike Turner used cocaine for some 45 years until it killed him at age 76.

Sly Stone spent years on cocaine, even living on the streets smoking a crack pipe. No one quite knows what is up with Sly these days. He shows up at occasional performance, acts very strange, walks off stage in mid-show, gets on his motorcycle and rides away.

Rick James spent a good 15 years on a crack pipe.

Whitney Houston is ruined and is heavy into cocaine.

David Bowie went nuts on coke in the 1970′s, became full-blown psychotic and embraced Nazism.

Ol’ Dirty Bastard is on crack.

John Frusciante almost killed himself on heroin and coke.

Ozzy Osborne, Jerry Lee Lewis and Liza Minnelli were alcoholics.

Keith Moon was a drunk and a pillhead who liked to blow up toilets with dynamite for fun.

Elvis was a hardcore pillhead who apparently went insane from all the tablets.

Arthur Lee of Love spent 20 years abusing drugs heavily, became homeless, set buildings on fire and shot up his neighbor’s house.

Carlos Santana used acid heavily, then 20 years ago met up with an angel named Metatron who looks like Santa Claus who has been guiding his life ever since. He communicates with Miles Davis, a dead person, on a regular basis.

Miles Davis (while he was alive and not talking to Santana) spent years shooting heroin, beating his wife and just acting weird.

Little Richard spent years binging on cocaine, having sex orgies and sucking cocks in men’s restrooms.

James Taylor was a depressive and a heroin addict.

Some were suicidal.

Wendy O Williams sawed instruments in half with a chainsaw, then retired and blew her brains out.

Ian Curtis recorded some of the most depressing music ever made, then hung himself on the night of his US tour.

Adam Ant is a depressive.

Mariah Carey assaulted staff and reporters and slit her wrists.

Some like Courtney Love and Britney Spears simply cannot seem to function as adults.

Sinéad O’Connor is just a kook.

Lou Reed’s main problem is that he’s a terminal asshole.

R. Keely is just a weirdo with a taste for underage girls.

Sid Vicious assaulted fans, carved up his chest onstage, murdered his girlfriend, then OD’d on heroin as a grand finale.

Jaz Coleman, George Clinton, Captain Beefheart and Julian Cope are unclassifiable.

No one knows what’s up with Sun Ra.

GG Allin was just nuts, dx’d as narcissistic, Borderline PD and masochistic.

Michael Jackson was one of the weirdest of all. No one seems to know what was wrong with him. He seems to have been a homosexual pedophile. I’m familiar with most of his weird antics, but I never knew that he said he had fathered 2 “Aryan” babes named Prince 1 and Prince 2. Weird!

Just because you aren’t psychotic (and most of these folks are not) doesn’t mean you’re not nuts. You can be plenty nuts without being psychotic, plenty.