Category Archives: Schizophrenia

The Nature of Denial in Various Mental Disorders

It is very hard to accept that you have a mental illness. Even a minor one. Most people who don’t have one act like they would not accept it even if they did. I have known many people in my life with untreated and even undiagnosed issues that went on for years, if not lifetimes.

Anxiety disorders are different because they are so painful and ego-dystonic but even there a lot of folks don’t want to admit it. The fact that almost everyone has low levels of anxiety on a regular basis nowadays does not help matters and it enables you to think you are just like everyone else.

Manics are notorious for not admitting they were ill. I have known a number of them in my life and probably 50% refused to admit that they had it. It is not helpful that the manic seems quite normal to many of his friends drawn in by the overblown charm of the hypomanic. I have sat in rooms with flagrant, raving, idiotic hypomanics charming the whole room with their grandiosity. I sat there shaking my head. It’s obviously an illness. Yes, it’s possible to be too damn happy. Hypomania is a case of excessive happiness. They are so happy, they’re nuts! If you do not believe that hypomanics are crazy, spend some time around one if you get a chance. This is not normal, healthy happiness, which I actually believe that there cannot be too much of, despite society saying that being too happy is “not adult” and “acting like a child.”

Schizophrenics almost all deny that they are ill. It is a hallmark feature of the disorder. Even after they have been told countless times that they have schizophrenia, even after multiple hospitalizations, even after years on antipsychotic drugs, they still insist that they don’t have schizophrenia. This is not so much a denial mechanism as a feature of the disorder. The disorder is such that it blinds you to the fact that you even have it! This disorder feels completely real, as if this is the normal way that life is.

OK, suppose you went to classes at college yesterday. The next day you tell people that you went to college yesterday, and everyone laughs at you and says no you didn’t. And to make matters worse, says you’re crazy for thinking you went to school yesterday. What would you think.? You remember full well that you went to school the other day. You remember it loud and clear. How they can they say that some obvious thing that I clearly experienced did not happen. After a while, they start thinking it’s everyone else that’s nuts and not them.

Almost all people with personality disorders deny that they are ill, as mentioned above. Everything is everyone else’s fault, and they go through their whole lives like that.

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Filed under Anxiety Disorders, Mental Illness, Personality Disorders, Psychology, Psychopathology, Psychotic Disorders, Schizophrenia

The “Crazy” Personality Disorders: Schizotypal Personality Disorder

People with Schizotypal Personality Disorder can often appear quite crazy. Schizotypals really just have a mild case of schizophrenia. They can function but often not very well, and others think they are weird, odd, strange, crazy or disturbing. They never seek help, in part because they are often quite paranoid. Many are capable of working, especially if they work alone. Some are highly intelligent. They prefer to be alone.

They often do not take care of themselves personally by not showering or shaving or wearing old clothes with holes in them. They can have poor personal hygiene because they might think hygiene is not important.

Many of their relatives have schizophrenia, and they score the same as schizophrenics on tests such as eye movement and eye tracking tests where schizophrenics score abnormally. It appears that whatever causes schizophrenia, possibly a gene, is fully expressed or fully triggered in schizophrenics. Perhaps schizophrenics get a higher genetic loading for the illness.

In Schizotypals, perhaps the gene does not fully express or maybe they get a lower genetic loading for the illness. About 15% of Schizotypals eventually develop Schizophrenia. They can have brief psychotic breaks.

James Holmes, the young man who shot up the Aurora theater, was an excellent case study for Schizotypal PD. If you want to understand this illness, study this man and his life.

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Filed under Crime, Mental Illness, Personality Disorders, Psychology, Psychopathology, Psychotic Disorders, Schizophrenia, Schizotypal

A Bit About Paranoid Schizophrenia, with a Real Life Example

If you were going psychotic and hearing voices, you would not even know they were voices. When you first heard them, if you were in your home, you would go around looking for the person hiding in your house because it would sound exactly like a person talking in your home. You would search everywhere, under the bed, behind the couch, everywhere someone could hide.

I spent a year hanging out with a paranoid schizophrenic every day. He heard voices all the time, but he was convinced they were coming form the radio or the vents or wherever. For instance, he kept demanding that we take apart the radio in my car to find the recorder in there that was putting out the recordings.

When he first came over to my house, he said he heard someone down in the cellar, so we went down there to look, and there was no one there. I thought it was pretty weird at the time, and I did not know what to think of it, as I had just met the guy, and I did not know he had schizophrenia.

After I hung around with him a while, I started to put two and two together and realized that he was slowly developing paranoid schizophrenia. I figured this out because I had been studying mental illness for 25 years. I had never dealt with a paranoid schizophrenic up close and personal like that before, but he seemed to be a textbook case based on everything that I had read.

He was 28 years old, and the symptoms seem to have started when he was about 23 and at college. There is often a long slow prodrome with paranoid schizophrenia. So while it does have a later onset often in the late 20’s and early 30’s, there has often been a long slow prodrome going on characterized by slow deterioration for even up to five or ten years.

Paranoid schizophrenics do seem to function somewhat better than the rest of schizophrenics, possibly due to this later onset. Some of them have even married, had children, started on careers or opened businesses when the disease hits, so they have had some illness-free years in which to develop their personalities. Hence the personality is more intact in paranoid schizophrenia than with the other forms.

Later I would be over at his place, and he would hear the voices coming out of the vents. He lived with his Mom, and he insisted that his Mom put a recorder in there to harass him, and he wanted me to help him take the vent apart to “look for the tape recorder.” He had a lot of arguments with his Mom about her “putting the recorder in the vent.”

It was very difficult to deal with the guy because he heard the voices, and they were so loud and clear that he would whip around and say, “You hear that?” and he would point to the car radio or the vent or wherever. I always said no, and it was making him mad because the sound to him was clear as a bell, and it was absurd that I could not hear it. So he was always accusing me of being a liar and saying I did not hear the voices when really I did.

After a while, I started making excuses and saying things like I had a problem with my hearing.

The problem is do not want to agree with the person when they say they hear voices because you are just reinforcing their craziness, and pretty soon you will be working with the person to take your car radio apart to “find the microphone.”

Furthermore, it’s best not to reinforce their delusions either because you will just strengthen the craziness.

Actually it probably would not hurt to say you hear the voices too or agree with their delusions, but I always worried that it might make them worse.

For instance, a schizophrenic says someone is persecuting them. Well, you can either agree or not agree. If you agree, you run the risk of reinforcing their belief, and they might get so reinforced, convinced and angry that they assault the person.

Another problem is that I would take him places with me sometimes, say to my doctors appointments, while we were running about trying to get him an apartment. While there, say as we were leaving, he would insist that someone in the waiting room had said some particular insult to him. Actually no one had said anything to him, much less the insult that he heard. He would want to go back in the waiting room and challenge the person over the insult, and it would be rather difficult to convince him not to do that.

He had done very well in college and was a great basketball player but not such a good student. At one point, he had moved into an apartment with other people, but that all ended when he accused them of messing with him through the walls of the apartment. He also accused people of breaking into his car. He would go out to his car, and it would seem like someone had broken into it or messed with stuff inside. He eventually had to move out due to this, and he moved back home to live with his Mom.

I kept trying to get him into an apartment down in Fresno, but things kept falling apart. He would get into the new place, and it would have the damn recorders in it too, and he would accuse the guy was rented it to him of putting the recorders in there. I met one of the men who rented to him, and he was dumbfounded, shaking his head, and could not make sense out of my friend at all. His attitude was “Good God, what the Hell is the matter with this guy!?”

My friend was a mulatto, and he had a very charming personality along with being very goodlooking. Everywhere we went, he would walk up to young White women and chat them up in his usual engaging manner, and they would usually be very interested in him. He was quite a charmer and could really talk to the girls. It was insulting as the girls would always rather talk to the insane guy than to me who was not nuts, although I was in my 40’s at the time I must admit.

If you were out in public with him, and he was chatting up women or whatever, he would typically not seem crazy at all. Instead he would seem to be a perfectly normal, charming, extroverted guy.

I was never afraid of him. Everyone kept telling me he was dangerous, and they were all trying to get me to get rid of him as a friend. He didn’t seem violent to me, and I can read people pretty well. He did yell a lot but not usually at me – more at the folks who were “persecuting him.” The whole time I was with him, I would be looking at him and trying to read his mind (I am a very good mindreader) to figure out if he was going to do something violent. I never got any vibes off of him that he was going to be dangerous, so I wasn’t really worried about him.

However, people close to me eventually convinced me to ditch him, which was not easy. I saw him a few times later around town and gave him a couple of rides. Later he had somehow gotten a job at the local supermarket, but by that time, he was deteriorating even more, and he had become very quiet and would almost ever talk.

I later heard that he was down in my city roaming around on the streets and hanging out at the mentally ill drop-in place.

My friend would never admit to being even slightly mentally ill, and after a while I stopped confronting him about it. But I did try to get him to see a psychiatrist I knew under the guise of giving him some pills for his nerves to calm him down along with some other phony excuses. She was good at dealing with psychotic people who would not admit they were ill, and she would often succeed in surreptitiously giving them some antipsychotics under the guise of calming their nerves or other phony excuses. You have to be a bit sneaky with these people when they will not admit they are ill. I have known people who had psychotic or seriously mentally ill relatives who they were considering dosing with antipsychotics in their orange juice or coffee. I actually think that would be a morally proper act.

The problem in psychosis is that the person typically has no idea that they are ill. Whether they do not want to admit for psychological reasons such as stigma or whether they can’t realize they are ill because psychosis blinds the person to the fact that they are ill, I am not sure. I suspect some of both. Some people are episodically mentally ill, and when they get better, they will often not admit that they had been ill due to stigma or ego reasons.

The problem in psychosis is that the part of the body that is needed to recognize that you are ill is itself sick. The person can’t figure that they are ill because in order to do that, you usually have to be at least somewhat sane. In fact the presence of insight is an excellent diagnostic feature in mental illness, and the greater the insight, the better the prognosis.

Insight is also a very serious problem in Bipolar Disorder, even in the milder phase known as Hypomania.

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Filed under Mental Illness, Psychology, Psychopathology, Psychotherapy, Psychotic Disorders, Schizophrenia

What Are the Definitions of Normal and Abnormal?

My concept of normal means “what most people do.” Therefore, by that definition, unfortunately heterosexuality is normal and homosexuality, no matter which way you want to look at it, is simply abnormal behavior. Now this abnormal behavior may simply be natural in the many homosexuals who simply got wired up that way as they cannot change it.

But we can say the same thing about so many other things, including many chronic illnesses like schizophrenia. Sure it is natural for schizophrenics to have schizophrenia because that’s how they got wired up. On the other hand, schizophrenic thinking and behavior is simply abnormal because 99% of the population does not think or behave like this and 97% of the population doesn’t even think or behave that way a little bit.

We can also define abnormal and not only minority behavior but also minority behavior that, if engaged in by the majority, would be a very bad thing.

If a majority of society were homosexual, that would not be a good thing at all. In fact, it would be utterly abnormal and society may well collapse. Therefore homosexual behavior is abnormally because surely you can’t have a world where everyone acts this way.

Schizophrenia is abnormal because if a majority of people were schizophrenic or even quasi-schizophrenic (Schizotypal Personality Disorder), society would not work at all, and in fact it would probably completely collapse. You can’t have a world where everyone is schizophrenic.

The problem with defining abnormal as minority behavior is that we run into problems. Being a great football player is abnormal in a sense. Only a few folks are like this. But society would not collapse if everyone were great at football. Society might be pretty weird, but it wouldn’t fall apart.

You can think of many other examples of behaviors that are objectively good or positive but are minority behaviors because the majority don’t behave that way.

In order to get out of that conundrum, we should define abnormal as:

1. Minority behavior.

2. Behavior that is either non-adaptive or would be highly destructive if a majority displayed the behavior.

 

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Filed under Heterosexuality, Homosexuality, Mental Illness, Personality Disorders, Psychology, Psychopathology, Psychotic Disorders, Schizophrenia, Schizotypal, Sex

Numbing Out As Either a Symptom-Derived or Core-Derived

Messi writes:

Schizoids are really attached to their aloofness for some reason. I don’t really get it, it just makes me feel vulnerable and trapped.

As for the neurology vs. psychology argument, I’m not sure. Some parts are unquestionably neurological – you can’t “think” your way out of flat affect. Yet at the same time, the most effective tips are usually psychological.

It seems like their 2-levels of schizoid-ness. There’s the emotional depersonalization and blunted affect, which can only be fixed through physical changes like sleep deprivation, anemia or medication, and the psychological layer beneath it with the withdrawal and vulnerability. You can’t work on the bottom layer without breaking through the top first.

It is looking like the top layer of schizoidness is the symptom cluster and it seems to be biological. In this case the numbing is core-derived in the brain. This can only be altered as Messi points out by actually changing your brain.

The commenter points out that he doubts if you can think your way out of a flat affect. I would add that I doubt if you can think your way to a true flat affect either.

What is the difference between flat, blunted and constricted affect? A therapist told me I have constricted affect but not a blunted or flat affect.

I used to be very emotional but I just deliberately and gradually numbed myself out in order to cope with a lot of ugly life stresses. At the time, I could not think of any other way to cope. Every time something awful would happen to me or around me, I would feel myself numbing out just a bit more. It seemed to be a perfectly logical thing to do. I wasn’t even thinking about it or whether or not it was a good idea, I was just doing it without questioning it as there didn’t seem to be any alternative.

I do not really mind that much but it is true that a lot of people really do not like it one bit. They think I am Spock or a robot. It’s not true as I do have emotions, but it more than they are muted in terms of showing them to the outside world. I have been trying to get my emotions back for many years now since I pretty much deliberately killed them off, but I do not seem to be able to do so. Why that is I have no idea.

I know a lot of wildly emotional people, mostly females.

Quite a few girlfriends have been like this. I remember once I was lying in bed with a girlfriend one morning and she was looking at me and suddenly she looked stunned and she said, “You don’t have any feelings. How come you don’t have any feelings?” She was a notorious emotional rollercoaster, probably a Borderline, though she was wildly, head over heels, out of her mind in love with me. I said, “I don’t want to end up like you. Look at you. That’s what happens to emotional people. Your emotions are all over the place, here, there and everywhere. I don’t want to be like that.” She seemed to think that was a pretty good answer.

Also I look around at Man World and it seems like in US Man World, a lot of men have pretty much cut off or shut down their feelings. That seems to be simply a normal way of being a mature, adult, masculine man. We use words like “businesslike, controlled and stable” to refer to these people. So I feel that by numbing out, I am just being a normal, masculine man in my society. What’s wrong with that? Men are not supposed to be all emo.

I remember when I was pretty emotional, it seemed like every time I got emo people, mostly men, would start giving me a hard time about it. They acted like I was screwing up or blowing it by showing those emotions. I guess the message really is, “You’re acting like a girl.”

The whole message I got is that in Man World they want you pretty much shut down. One thing was for sure, that’s that you can’t get sad. In and in the world of offices, you can’t get mad either. The life of many middle class men in our society seems to be, “You can’t get mad and you can’t get sad.” Of course a lot of them do anyway, so what you find is a lot of men masking rage and especially depression with drugs, alcohol, gambling, sex, workaholism, and probably numbing out.

I hear that all sorts of folks numb themselves out and you should not confuse this symptom-derived numbing with core-derived personality structure numbing, which may be biological, as in the case of schizophrenia, schizoid PD and schizotypal PD.

In the former type a formerly emotionally full person simply numbs out as a defense mechanism to cope with life. Probably emotionality is recoverable somehow and anyway, in most cases, they are probably not as numbed out as you might think. A lot of them probably have emotions that they are just hiding pretty well.

In the latter case the numbing out is a core essential part of the personality structure, possibly biologically mediated. If it is biologically derived, there was never a full emotional life to numb out in the first place. They were numbed out biologically from Day One.

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Filed under American, Biology, Culture, Gender Studies, Man World, Mental Illness, Neuroscience, Personality Disorders, Psychology, Psychopathology, Psychotic Disorders, Schizophrenia, Schizotypal, Symptoms

A Case of Schizotypal Personality Disorder

From here, an apparent case of Schizotypal Personality Disorder. I do not understand this disorder very well. It seems like they might have something wrong with their brains. It is much more common in close relatives of those with schizophrenia. It almost looks like a very mild form of schizophrenic illness. I’ve never had a client with this problem, I’ve never seen a case of it in my life, and I would have a hard time diagnosing it.

If there is something wrong with their brains, then why call it a personality disorder? Is there any evidence that this is actually a defensive structure or personality style as opposed to more of an Axis 1 type symptom-based rather than Axis 2 core-based illness?

Although I have never seen a case of it, this case history looks remarkably like what I think it looks like. Note that this man has received two diagnoses from afar, Paranoid Schizophrenia and Schizotypal Personality Disorder. Paranoid Schizophrenia is not correct. An unmedicated full blown Paranoid Schizophrenic would not have been regularly employed for long after the onset of illness. He would not have married three times and fathered a son after the onset of illness. His behavior and attire would not remarkably improve after a woman married him and could more or less take care of him. An untreated schizophrenic would not have it together no matter how much mothering his wife gave him.

This man has never been hospitalized or diagnosed, and I doubt if he has ever set foot in a clinician’s office. Part of the problem with getting types to come in is that they are so nuts and paranoid that they literally are too crazy and suspicious to come in to see a clinician. Obviously the clinician is one of the enemies who is plotting against him.

This man obviously doesn’t think there is anything wrong with him, so that’s another reason why he will never show up. I think it is quite clear that this man is not normal in any way, shape or form, and he is so ill that his behavior goes way beyond eccentricity and free-sprited Bohemian creative type all the way off into serious pathology and craziness. It looks like this illness also limits his life in some pretty important ways too. But apparently he doesn’t think he has a problem. If there’s any problem, apparently it’s with other people. Which is pretty Axis 2-like right there.

My dad is very messed up. Extremely. He was abusive and traumatized my whole family.

His appearance is pretty eccentric. His hair and beard are wild and stained from cigarettes. He wears really dirty clothes covered in industrial glue or varnish from his job…in public. This all goes away if his wife (who he’s had three of) takes care of him.

He has really intense, sometimes bizarre beliefs about politics. I remember him once calling me up to talk about how his wife was “stealing his liberty.” As in the liberty due him from the founding fathers of the US.

He’s paranoid to an extreme. He used to throw the telephone away because he thought people were listening. He thinks that people stalk him. He thinks co-workers are secretly taking nude photos of him and putting them on the internet. I can tell you he has NEVER used a computer let alone the internet…all because he’s paranoid.

He used to call me up after watching a news report about terrorism to warn me about the NYC subway I take to work everyday. I tried to reassure him by telling him my particular train is not a target because it isn’t well used. He told me that’s what, “they wanted me to think.”

He strongly dislikes most institutions: banks, universities, and governments.

He has no friends at all. Never has.

He spends his time in basements or attics.

He’s very smart, but has no interest in making money to support himself.

My mom and his former wife, an LCSW, think he’s schizophrenic. My therapist says he sounds like a schizotypal.

BUT…if you asked if he was paranoid, he’d say no. If you asked if he was eccentric, he’d say he just thinks differently from most people (with a kind of superior attitude). If you asked why he doesn’t have friends, he’d say he prefers being alone.

Regardless, anyone else can easily see that he’s really, seriously, an odd person.

Any of this make sense to people dx with schizotypal?

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Filed under Mental Illness, Personality Disorders, Psychology, Psychopathology, Psychotherapy, Psychotic Disorders, Schizophrenia, Schizotypal

The Lowdown on Psychotherapy

Juliette Kochenderfer-Moore writes:

I also question why some people want to work in therapy sometimes, and the endless job titles have my head spinning.

Is a  therapist the same as a counselor? What the hell is a psychotherapist? A psychoanalyst? Are a psychologist and psychiatrist the same thing?

Seriously. Most of them seem totally bored out of their minds at what they do for a living. Why are we paying bucket loads of money to go get labeled and undergo “treatment,” of which the success rate is dubious?

Most are not bored, most therapists enjoy what they are doing, I have liked most of my therapists, and I thought most of them were very smart.

Also it can be very good money. Licensed therapists can make a lot of money.

Anyone can be a “counselor” in California. Even you can. But hardly anyone does it because realistically, who is going to pay you good money to sit there and listen to their problems?

A psychotherapist is someone with a credential – in California, either a Clinical Psychologist, a Psychiatrist, a Masters in Social Work, or a Licensed Clinical Social Worker.

A psychoanalyst practices Freudian psychoanalysis. This seems to be going out, as a lot of it has not stood up to scientific scrutiny.

A psychologist is a Clinical Psychologist. They have a PhD. Most of them are extremely good.

A psychiatrist is an MD. They are medical doctors. I don’t like them quite as much as the Clinical Psychologists. I think Clinical Psychologists actually understand psychology and the psyche better than Psychiatrists. Nowadays Psychiatrists are mostly just drug pushers. If you want drugs, you need to go to a Psychiatrist.

Therapy is costly. I think psychotherapy is a luxury good that is available only in wealthy societies. You don’t really need it, but it can really make you feel better. I am convinced that many to even most 3rd World people could benefit from psychotherapy, but their societies are too poor, so they cannot afford these things.

Labeling is generally a good idea. Only 14% of the population has a personality disorder. That’s not a lot. Most people with a PD diagnosis definitely are very difficult people at best, I assure you. I say this because I have known a number of Personality Disordered persons for decades, and they are truly impossible and infuriating human beings. There is no way on Earth that is normal behavior. It’s not acceptable to act abrasive and annoying such that you screw up your own life and that of everyone around you. That’s not a definition of mental health.

Most people with anxiety disorders really have them. If you do diagnosis properly, and you put the person on the right drug, it is amazing what you can do.

I think it is incredible just how “syndromal” a lot of these conditions are. I work with OCD people, and this is a syndrome if I ever saw one. All of these people seem like they are reading off the same script. I know them so well that I can almost spot one half a mile away blindfolded. Also I can practically crawl up around in the brains of my clients and tell them exactly what they are thinking because I know exactly how this illness makes you think.

The Personality Disorders are also very “syndromal,” often shockingly so.

Why so many mental disorders look nearly as syndromal as physical disorders is a mystery, but I think a good answer might be that of all of the possible ways of acting crazy, humans are somehow limited to a small subset of all such craziness due to the limitations of the human brain and condition. In other words, because there are only a certain number of ways to go nuts, humans tend to go nuts in very syndromal like patterns that look a lot like physical illnesses in the way they seem to come as a “package.”

Some people are so nervous that they just do not function well. Others are going round and round about other anxiety like conditions. Panic Disorder is crippling. PTSD is a very bad illness.

Depression is real. I have known some depressives who simply cannot function at all due to extreme depression. It is almost like they have a physical condition.

Bipolar disorder is as straight up syndrome, and these people are just not well. It’s not even really ok to be hypomanic. They’re not rational, they don’t act very sensibly, and the irritable ones are insufferable jerks who quarrel and fight with everyone all the time. Full blown mania is so non-adaptive that the person almost needs to be committed so they don’t completely destroy their lives during the episode.

It’s not ok to be psychotic. Psychotic people cannot function and are often a danger to themselves or others. They desperately need to be treated.

Schizophrenia is a full-blown illness in which there is something wrong with their brains.

Many of these illnesses are highly genetic, with Manic Depression and OCD showing some of the highest loadings of all, near 85%. Obviously these people simply have something wrong with their brains.

Psychotherapy is overpriced, but we are all doing therapy with each other all the time. Anytime you talk to any of your friends or loved ones about any psychological stuff they have going and try to give them advice on how to deal with it, you are doing therapy. Anytime you try to help people to live their lives better, function better, quit making dumb mistakes and stop engaging in unhealthy behavior patterns, you are doing psychotherapy.

The problem is that most people do not want to help you get over your troubles or teach you how to function better and quit doing nonadaptive things. Also therapists have a lot of training, and they are simply better than your ordinary person off the street at such things.

But really anytime you talk to a very wise person who gives you a lot of good wisdom on how to live your life, solve your problems, function better and stop doing non-adaptive things, you are basically getting psychotherapy, as the best therapists are simply very wise people who help you by sharing some of their wisdom with you.

Psychotherapy works very well, and it certainly works as well as the competition.

What is the competition?

Get better on your own? Talk to your friends and family get them to talk you out of it? Go to church? Read some books? Get a girlfriend or boyfriend? Get a better job? Move to a new area? Join a cult? Join a self-help movement? Go to the gym? Read Manosphere Blogs and learn Game?

None of that stuff works as well as psychotherapy for helping people with diagnosed proven psychological disorders. And none of it works as well as psychotherapy for even problems in living, growth work (trying to grow as a person) or deep work (trying to delve into the depths of your psyche and figure yourself out).

The only thing that works better than psychotherapy for a lot of things is drugs. These are psychiatric drugs and they do have a lot of side effects.

Really the best treatment is psychotherapy + drugs.

I deal with OCD’ers. When OCD is very bad, I feel that psychotherapy is useless. The person’s mind is just too far gone for the therapy to do any good work. It’s like banging your head into a wall. You can do the therapy over and over, but it won’t sink in because there is something wrong with your brain. Therapy with a messed up brain is like filling up the gas tank of a car with serious mechanical problems. That gas won’t get you very well (in other words, it won’t even work well) until you fix the car so it can run well enough to even use the gas in the first place. Once you fix up the car, now you can put gas in it, change the oil, check the fluids and all of that, and that’s finally useful.

On the other hand, drugs alone don’t seem to really cut it. I have found that when you are on a really good drug, you can start using all the great stuff you learned in psychotherapy, and now the therapy really starts working. The sad thing is that psychotherapy works best on a fairly healthy brain. You have to get your brain into a fairly healthy place to where the therapy can even function at all.

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Filed under Anxiety Disorders, Depression, Health, Medicine, Mental Illness, Mood Disorders, OCD, Personality Disorders, Psychology, Psychopathology, Psychotherapy, Psychotic Disorders, Schizophrenia

OCD-Psychosis Borderline Cases

Lynn writes:

I’m really struggling with schiz-related OCD, and I know that for a fact. However, what I’m not sure about is whether I have schizophrenia (or maybe schizotypal personality) as well… or if it’s just the OCD, or if I might even also have factitious disorder imitating schizophrenia.

So, about me:

I first noticed OCD symptoms in myself when I was about 14, though it may have been subclinical then. It took the forms of “wanting to be a good person”, order/symmetry/pattern stuff, and the occasional vague “I need to do X or Y will go wrong somehow”. As I got older the order and symmetry faded somewhat and the “good person” got bad–for example, fears of violence to the point of feeling weapons in my hands and needing to rub them against surfaces to make sure nothing was actually there.

This later came to include an obsession with schizophrenia, but not of the “I’m afraid I have it” sort–rather, I wanted to prove I had it because that would provide an explanation for certain things wrong with me, taking the blame off of me, and subsequently I realised I could be (likely was) faking symptoms and started to obsessively examine if all my so-called symptoms were legitimate. I could be exaggerating, or outright fabricating.

On the other hand, I was the star pupil in my high school for the first two and a half years. All my teachers loved me. Then in the second semester of my junior year, I started skipping classes and forgetting assignments, gradually stopped bathing, started getting comments (sometimes concerned, sometimes angry) about how I never paid attention in class and my writing had gone from excellent to a mess of unnecessary words and long tangents…

Other students started to call me “weird” and avoid me, and those who were my friends either cut contact or pointed out as nicely as possible that my social and conversational skills were terrible and it made me really difficult to deal with. In response to all of this, I thought “eh, whatever, I don’t really care about school or friends anyway”, eventually dropped most of my classes, graduated early, and spent the next few years locked in my bedroom playing online games and watching anime.

I had a couple friends online, however, and the opportunity came to move out and stay with one of them when I was 21. I lived with her and her girlfriend (all three of us were bisexual) for a few weeks, but three things came up in that time.

First, my attention span and general awareness was next to none, and sometimes it was to the point that I would just stare at people really confused when they spoke to me, totally unable to make sense of their words.

Second, my roommates told me a few times that things I remembered them saying to me had never been said.

Third, I was convinced that the other girl was just trying to use me to pay the rent, had no intention of accommodating me as a proper roommate, and was taking incriminating pictures of me to show the police to kick me out. She did actually call the police, however, so I was probably right. She hated me. Bad. I did start to think I might be reaching a little when I accused her of stealing money out of my wallet, and I now think I was probably wrong on that, however.

I ended up moving back in with my family, and a couple months later the idea that I might have schizophrenia first crossed my mind. I thought about it off and on for months, but it seemed like a huge stretch, so I shelved it eventually.

Over the next year I would start seeing shadow bugs (like the typical shadow people, but the size of and moving like bugs), thinking people were breaking into my window at night… Move out again, fear that people were going to kidnap or rape me, that they were following me and planning to mug me, see whole crowds of people just coldly stare at me on the streets for several seconds…

And then over the next year after that, I’d move back with my family (evicted this time, for being a bad roommate–spending all day lying in bed and never doing chores), start noticing my hands looked strange, occasionally hear a voice repeating my thoughts aloud, and then…

And then my OCD landed on the subject of schizophrenia when researching why I was so lazy, and it was sort of like a million bells went off at once saying “YES HELLO PLEASE NOTICE ME, YOU HAVE STRUCK GOLD” …And then I shrugged it off again after a couple months of intense obsession.

And started thinking people I met online were actually people I already knew in the past, but using different names and ages and such… They acted so similar though! And then the obsession would hit again.

So basically, right now I’m sort of thinking I’m an immortal nonhuman being who reincarnated into this plane and various others of my kind are active here and occasionally contact me but usually just monitor me from a distance while doing their own things with human experiments and such.

But then there are like three voices (not actual voices lol) in my head saying “you are delusional”, “you are faking being delusional”, and “you are just being OCD, calm down” and I don’t know which to believe and the more I think and research the more distressed I get.

So, um… What do you think? (please don’t say “e-mail me”!)

This comment appeared on one of my articles, so I will publish it while keeping anything about the person’s identity confidential as is proper.

There is clearly a psychotic process going on here that looks very much like classic schizophrenia. Then we also have some very classic OCD going on at the same time. The OCD came on at age 14, and the schizophrenia came on 2.5 years later at age 16. It has long been known that OCD sometimes appears as the leading edge of schizophrenia. Schizophrenia often occurs ~2 years after the onset of the OCD, and the schizophrenia might have some of the same OCD symptoms, now magnified to psychotic level.

I am aware of several cases of OCD preceding schizophrenia. In two cases, the OCD appeared quite early around age 11-12 and was extremely severe during high school years to the point where they were nearly disabled. The schizophrenia then appeared at the classic age of 19-20.

In another case, OCD appeared at age 19 and then schizophrenia occurred at the classic age of 23.

This data has been interpreted to show that OCD is a risk factor for schizophrenia. This interpretation is false. First of all, most if not all people with schizophrenia are now known to have been ill from a very early age, possibly form birth. The schizophrenia is simply subclinical until the real hard symptoms hit often in late adolescence to early adulthood. If schizophrenics have had the illness since birth, OCD cannot possibly be a risk factor for schizophrenia as OCD appears later in life, often in late childhood to adolescence.

The question then is whether OCD is a risk factor the triggering of full schizophrenic symptoms in someone with subclinical schizophrenia since birth. This is uncertain, but it is probably not the case. Probably the stress of OCD is not a risk factor for triggering full blown schizophrenia either, as in the cases above, full blown OCD occurred for 2, 4, and 7-9 years before the onset of full schizophrenia. OCD is a very stressful illness. If the stress of OCD triggered schizophrenia, it would trigger it very soon after the OCD onset, not 2-9 years later. Stress as a trigger for schizophrenia is typically a serious stress where the schizophrenia occurs soon after the stress, not years later like some sort of time bomb.

In recent years, there has been discussion of something called schizo-obsessive disorder. These are cases of OCD and schizophrenia in the same person where the OCD is impacting the schizophrenia. Often these people retain more insight into their delusional processes than typical schizophrenics as OCD is a disorder of doubt whereby schizophrenic is a disorder of knowing. So the OCD can lead to better reality testing where the factor of doubt may be introduced into delusional material.

Schizo-obsessive disorder is probably just OCD and schizophrenia occurring in the same individual with different onsets for each illness. Each illness is discrete and neither one was causative or the other, yet both illnesses are impacting each other probably via an endless feedback loop whereby they feed into each other like a dog chasing its tail and sometimes it is difficult to tell where one illness ends and the other begins.

The above case looks like classic schizo-obsessive disorder. Schneiderian symptoms such as hearing ones thoughts spoken out loud are common as are ideas of reference and in particular paranoia. The prototypical “voice in the head” of OCD is often quite a loud voice, louder than in most OCD cases. In fact it is so loud that sufferers sometimes worry that others must be able to hear their thoughts. There is sometimes difficult diagnostics between a very loud OCD voice and and worrying that others can hear it, which has more of an OCD character to hearing one’s thoughts spoken aloud which is more schizophrenic..

Auditory hallucinations occur, but they are not common.

Functioning is often better than for schizophrenics. In the above case, you can see that this person has been able to move out of the parental home several times. They had to move back home, but most schizophrenics would probably be too ill to even survive living on their own for any length of time.

Delusions are often reported but are then denied as the person says that they do not really believe this. This is because these people often cannot accept being delusional. Probably what is happening is that delusional material is simply being hidden and then denied when a clinician confronts the person with it. Paranoid and grandiose delusions are common.

Insight wavers between complete loss to partial to even full insight on a spectrum where the symptoms move back and forth along the spectrum without any particular order or reason. These people may be more likely to recognize that they have schizophrenia than other schizophrenics because the presence of OCD enables improved insight. It is common for sufferers to waver between believing they have schizophrenia, insisting that they do not, being unsure whether they have it or not or saying that they have some illness other than schizophrenia to explain symptoms.

Thought disorder is often present but is less severe than in schizophrenia. Often written and spoken communications with schizo-obsessives can be quite clear and cogent whereas most schizophrenic communications typically have an odd to incoherent character abut them.

Mood symptoms are sometimes present and can take a bipolar character.

They are often highly intelligent, much more intelligent than schizophrenics. This is because OCD tends to strike more intelligent persons.

Treatment is often difficult as atypical antipsychotics often worsen the OCD, in many cases dramatically so.

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Filed under Anxiety Disorders, Intelligence, Mental Illness, OCD, Psychology, Psychopathology, Psychotic Disorders, Schizophrenia

“You Just Need to Learn Some Social Skills”: Stupidest Argument ever Made

Not all failure in public is due to the fact that you never learned the rules or never learned to figure people out or read social cues. I have met people who told me that they were just about the world’s greatest social actors until they got hit by a mental illness, for instance an anxiety disorder. They would go out in public with their anxiety stuff going on and they would experience near-total rejection. Why? Because people can’t stand nervous or anxious people. Now this is someone who knows the rules, what to say, when to say it, can read people perfectly, can pick up social cues… and yet he is failing socially due to something that he feels is outside of his control.

What about people with schizophrenia? Do they have “poor social skills?” Of course not, that’s not their problem. Their problem is that they are nucking futs. You go out into the world with a wild psychotic disorder and continuous auditory hallucinations and I guarantee you that you will fail. Because you can’t pick up cues? Because you are too shy? Because you don’t know the rules? Hell no. Because when you have a disorder like this, it makes you seem and behave in a completely bizarre way that turns off just about 100% of the population.

Manics can also fail socially when in the midst of a full-blown mania. Depressives probably fail socially, that is if you could somehow manage to drag out them out of the house and somehow force them to attend a social gathering. Because they are social clods? Of course not. It’s because they are profoundly depressed!

As an introvert, I resent all of these silly “social skills” arguments. They are all written by extroverts. No introvert would ever write about something so stupid.

Let’s get real here for a second. Extroverts simply do not like us. I have made friends with extroverts my whole life, but there were usually problems in the relationship.

Yet I can be extroverted. If I am with a girlfriend, I might spend the whole day with her for weeks on end, with ten of fifteen feet of each other. The only time we are apart is when we are going to the bathroom, literally. Does it make me uncomfortable? Of course not. I can be surgically attached to a hot looking babe for weeks on end. It’s not a problem!

And with some of these women, we run around doing things all day, go out to dinner every night and to bars to drink very late at night. Because I can play that game too. I don’t really prefer it, but if I have to, I can do it because that is part of my personality, especially my personality as a young man, when I was one of the wildest extroverts this side of the Rockies. That’s not a part of you that is going to go away.

Extroverts think introverts are sick, weird and mentally ill. A lot of them think we are evil. Why are we evil? Because we all have “low self-esteem.”

How do we know we have low self-esteem? Because we are shy. Because we are introverted.

How do we know we are shy or introverted or shy? Because we have low self-esteem!

And the tautalogical sphere is now complete.

Extroverts think a person who doesn’t think too highly of themselves is evil. They have extreme contempt for them.

But this is a fallacy. There are introverts who have very high self-esteem or who even have narcissistic traits – you are reading an article written by one right now. A lot of just don’t mind being alone. It drives extroverts nearly psychotic, but personally I can spend the whole day in my apartment never leaving once, never having anyone ever, and not talking to anyone on the phone. And I can be happy as a pig in shit.

Because I like myself so much that I can be all alone with myself easily. After all, if I am alone, I am hanging out with one of the greatest people on Earth, and that’s got to be a blast, right?

There are shy people who have good self-esteem. It all depends on why you are avoiding people. Did it ever occur to you that some folks might have a perfectly sensible reason for not wanting to socialize a lot? Such as that most people you meet are not only retarded, but worse than that, they are dangerously retarded?

And introverts can be very healthy. Even some extreme introverts, introverted to the point where they nearly meet criteria for Schizoid Personality Disorder, can be immaculately, even striking healthy psychologically. Just because you’re alone isn’t necessarily going to make you nuts. Some people can be shockingly healthy in their heads and still be hermits.

Extroverts have this idiot notion that if all these shy introverts would just acquire some “social skills,” all of their problems will just go away. Why will it work? Because it worked so well for them, but they were never shy in the first place so it’s a stupid comparison.

This is arrogance. Sure, extroverts have good social skills. So what? Is that going to get you into Heaven or something?

Most introverts I have met have excellent social skills also. They are not awkward, klutzy or lame socially. They know what to say and when and how to say it, they monitor their emotions and thoughts very closely – often with precision – they are masterful at reading others, they adjust their conversation and emotion throughout the conversation in response to the emotional cues and conversational style of the other. They are just a bit inhibited is all.

Being inhibited means you have “poor social skills”? Bull.

Actually, I think a lot of introverts have better “social skills” than a lot of extroverts.

Extroverts are often uninhibited, and they often do or say stupid things, but they put across a good image and people like them, so everyone just laughs when they mess up or thinks it’s an act of social mastery. If people like you, they go blind to 90% of your errors and often transform them into perfect scores.

Actually, extroverts screw up socially quite often, usually due to their lack of inhibition. Not that they care.

They blow up all the time, they make big scenes for little or no reason, and the females regularly burst into tears and plunge into depressions on emotional rollercoaster rides.

While the introvert is often quite calm and controls his emotions very well.

This is why I am dubious about this “social skills” BS. It’s just another scam by extroverts to beat up on us introverts. Most people don’t need social skills training, and those that do are often too far gone for it to do any good (Aspies) or could care less and don’t want to change (disinhibited extroverts).

I haven’t met a lot of social retards who turned into social chessmasters. When does this social alchemy ever take place?

Nor does it work the other way around. Once you get the skills, you have them for life. They are not going anywhere. Winners of social Academy Awards do not turn into stumbling dorks over time? Why would they?

The problem with shy people is usually an anxiety issue, not a problem that they don’t read social cues well or know how the play conversation tennis. How in the Hell does “social skills training” help someone with Social Phobia.

This person has an emotional dysregulation issue somewhere in their brain. Their anxiety level goes nuts when they get around people, particularly members of the opposite sex. That’s their problem, not being a social loser. They probably needs a tranquilizer or some other drug to re-regulate his emotions and reset their brains.

The same extroverts who so arrogantly beat us with rhetorical clubs over this social skills BS have now taken their supremely overbearing mindset online.

PS: What right do I have to talk about these things? Well, for one thing, I work in mental health. That’s how I earn part of my income.

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Filed under Depression, Mental Illness, Mood Disorders, Personality, Psychology, Psychopathology, Psychotic Disorders, Schizophrenia

Voices and Pseudo-Voices in Psychosis and OCD: Differential Diagnosis

One of the symptoms that is nearly pathognomic of schizophrenia is hearing voices. In particular, the voices are heard with the ears (not inside your head like the voice or voices we all hear in our heads), they go quite a bit of the time (for significant periods a day to continuously), there is often more than one of them, they often comment on the person’s behavior as it is happening, they often speak about the person in the third person, and they often say bad or insulting things about the person.

Although voices can be heard in other illnesses, especially Bipolar Disorder and Major Depression, they often take on a different quality than we see with schizophrenia. In Bipolar Disorder, the voices are more fleeting than continuous, and there is often only one voice. During Psychotic Mania, the voice may as likely tell the person how special and great they are than anything else. Voices in Psychotic Depression generally do not go on all the time, are limited to a single voice, and tend to focus around themes of guilt, fatalism, serious illness, death, suicide, homicide, nonexistence and other morbid topics.

Honestly, there is nothing strange, odd or disordered about hearing the occasional voice. Many persons will experience hearing a voice or voices at rare, once in a blue moon intervals in their lives. Clinicians properly regard this as within the normal realm of human experience. It only when voices are regular, annoying, distracting, terrifying or depressing that there is a need to intervene.

People generally do not understand what it means to hear voices. Many people think that the voice inside your head is a “voice” and they confuse this with the voices heard in a psychosis. The truth is that we all have a voice or voices inside of our heads. That is called our inner voice. Nor is there anything special about having more than one voice in your head or having two voices arguing with each other in your head. In fact, it is more common than you think.

I have met many OCD sufferers who complain of “voices,” but they are always confusing their inner voice inside their head with the auditory hallucinations of psychosis.

There is a ready way to tell the difference.

Hallucinated voices are heard with your ears. If you were to hear an auditory hallucination right now and you were alone at home, the first thing you would do would be to start searching around your place for someone hiding in your residence. You might look behind the couch, under the bed, in the closet, out the window, etc.

This is because auditory hallucinations sound exactly like the voices of the humans around you that you have been hearing all of your life. You hear with them with your ears, not your head. If you could not find anyone in your place, you might start looking around for the transmitter or loudspeaker that is somehow piping the human voices into your abode. You won’t be able to find it.

You may tell other people about the voices and enlist their help in searching for the person hiding in the house. If you are in a vehicle, you might hear voices coming out of the radio. You might try to take your radio apart to find the “transmitter” inside of it. You might try to take part of your home apart, particularly the vents, to find the “speakers” (voices in residences often come out of heating vents).

I befriended a schizophrenic man once and we become very good friends. We hung out nearly every day for a year. He was always trying to enlist my help to take apart the vents in his house. He also wanted to take apart my car radio to find the transmitter in it.

Periodically, he would look up and say, “You hear that?” That is because he heard a voice. Of course, I heard nothing and I would say I heard nothing. He never believed me and he always looked at me like I was crazy. He heard the voice as clear as a bell and it seemed ridiculous that I could somehow not hear it. After a while, I got tired of fighting with him and I started making up excuses, telling him that he had bad hearing and that was why I cold not hear the voices.

He would be incredulous that I could not hear it. I started saying, “Well, I believe that you heard something coming out of the radio, but I didn’t hear anything there.” I left it an open question whether there was really a transmitter in the radio or not. This is the best way to deal with these people because they absolutely will not accept that you do not hear the voices too and they reject the notion that they are hallucinating them. Trust me when I say that debating with a psychotic person about their delusions and hallucinations is a hopeless endeavor.

Schizophrenics also hear voices in public that are much harder to figure out. For instance they might walk by a room full of a group of people and experience an auditory hallucination coming from one of the persons in the room. The voice will seem exactly as if that person said it out loud. So this is a voice placed onto the body of an existing person.

With the schizophrenic, he went with me to my doctors’ office once and as we were walking away, he hallucinated a voice coming from a man in the waiting room. The voice made it seem as if the man was accusing him of something. “There he is. He’s the one who did it!” It went something along those lines. It was so hostile that it seemed as if the man was trying to start a fight with my friend. My friend wanted very much to go back to the waiting room and have it out with the man and demand to know why he said those things to my friend. It took quite a bit of convincing to keep him from going back and challenging the man.

When the voices start putting false voices into actually existing people, this illness can get quite bizarre and disturbing as you might imagine.

In OCD, sometimes the OCD creates an alternate voice in your head that is a different voice from the voice you are used to or your inner voice. At times, more than one voice may be created. I have met OCD’ers who had all sorts of voices going in their heads all at once. Some had whole room-fulls or even stadium-fulls. Others had the sounds of various animals going in their heads. A few have who farms or menageries of animals vocalizing away inside their heads.

These people are often terrified that they are developing schizophrenia, but I reject this. Just as OCD can create a new voice in your head or change your existing one, of course it could create more than two voices or possibly an unlimited number of voices. It cannot also create animal sounds and anything else the mind wants to conjure up. I see no grounds for referring to any of these phenomena as auditory hallucinations. With the OCD voices in the head, this is a person who is simply making up the voices or sounds their own in their heads. Or the OCD is making them up, whichever way you prefer. So this is someone who is creating a lot of mental chaos for themselves apparently for the perverse purpose of tormenting themselves or making themselves upset. These head voices are much more under voluntary control than schizophrenic voices and many OCD sufferers can shut them on or off and on proper medication, they often stop altogether. Or the person learns that they are doing this to themselves on purpose and decides to stop torturing themselves.

Unfortunately, many clinicians do not seem to be able to untangle the voices of one’s own inner thoughts and auditory hallucinations. Adding to this problem is the fact that many OCD sufferers will describe their OCD thoughts as “voices.” In these cases, careful questioning should reveal that the “voices” are actually inner thoughts and not auditory hallucinations.

It is uncertain how the notion of “voices in your head” got started. Schizophrenics are said to hear “voices in their heads.” This makes no sense as we all have voices in our heads, namely our inner voice or voices. Apparently since auditory hallucinations are the creation of a person’s mind and do not exist in the environment, it could make sense to describe auditory hallucinations as voices in your head considering that the voices are originating in the mind of the hearer and not externally. However, the very phrase “voices in the head” completely confuses the situation and I think it is best to drop this psychiatrically illiterate phrase from the discourse of educated speakers on grounds that it causes unnecessary confusion.

There may be some cases where the hallucinated voices actually seem to be originating from inside the skull of the hearer. Imagine what it sounds like when a person is talking next to you. Now examine that same experience, yet the voice is emanating directly from your skull. This would be the only case where “voices in your head” would be a logical phenomenological description.

OCD sufferers, especially those with the Schizophrenic OCD theme or what sufferers have called the “Schiz OCD” variant of the illness, often say that they hear voices.

Caution is needed here. I have heard many OCD sufferers inform me that they are actually experiencing auditory hallucinations. In these cases, careful questioning will generally reveal a person who is scanning the environment in a hypervigilant way and then misinterpreting ordinary sounds in the environment as possible “voices.”

They also often report hallucinations or quasi-hallucinations during the hypnagogic period between sleep and wakefulness. Many a bizarre thing happens to ordinary persons during the hypnagogic state, so it is best not to make too much of this. The period between sleep and wakefulness is odd and dream states may spill over into wakefulness, the mind may start to run wild and thought and dream may become confused. Once again, these are hypervigilant persons with high anxiety examining their hypnagogic states for signs of psychosis. It is a good maxim that when humans go looking for something, they often find what they are looking for in one way or another.

Once hypnagogic confusion, inner voices and misinterpretations of environmental sounds are eliminated, the clinician will find that the OCD sufferer rarely if ever experiences an actual auditory hallucination.

At times, normals may even think they hear a voice. Last winter, I pulled into a drug store parking lot at 8 PM. It was dark and raining fairly hard. The rain was creating quite a bit of environmental racket. As I opened my car door, a heard a voice off in the rainy parking lot say my name, “Bob.” I looked around a bit, saw no one there, thought for a bit about what just happened, concluded that I did not have an auditory hallucination but instead misread some odd environmental sound in the rainy racket, brushed it aside, and went into the store.

The truth is that even if it was a voice, I would not worry and neither should anyone else. Hallucinated voices are quite common. 14% of the population regularly experience them, most are not psychotic and many are probably quite normal. I have told myself that if I ever start hearing schizophrenic type voices going all the time, I am going to get concerned, but in the meantime, I am not going to worry.

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Filed under Anxiety Disorders, Depression, Mental Illness, Mood Disorders, OCD, Psychology, Psychopathology, Psychotherapy, Psychotic Disorders, Schizophrenia