Category Archives: Schizophrenia

A Few Words About Schizophrenia and Psychosis in General

I do not know much about schizophrenia. I have met two people who were schizophrenic who discussed their symptoms with me.

The young man was medicated but he was still too ill to work and lived off disability. The woman may also have been medicated and she also lived off disability. This is a typical outcome for this illness, sadly.

Her diagnosis was a true grab bag, and she had been diagnosed with everything in the book, including OCD and frequently Borderline Personality Disorder. I was not sure what her complete picture was, but in adolescence and early adulthood, she underwent what looked like a classic schizophrenic prodrome process. There’s nothing else that looks like that. Afterwards a lot of psychotic symptoms developed including visual hallucinations. Also she did not believe she was ill, which is typical of these folks.

I could not really see the Borderline PD. The problem with these schizophrenics is that the schizophrenic process is so complete and totalizing that it essentially swamps over all sorts of other or lesser symptoms.



The man also had an OCD process going on, and he denied his symptoms were caused by mental illness. He was also trying to hide symptoms from me, which they do sometimes after the illness goes on for a while. It’s not that they believe the symptoms are crazy – they think it is actually true that the man in the TV said, “It’s going to rain today” and that really is a secret message to them telling them to go to the store and buy a pack of cigarettes. Incidentally that is a common type of psychotic symptom and they are called delusions of reference and they are common in schizophrenia. I have someone close to me who had Bipolar 1 Disorder with prominent psychotic (schizophrenic-like) features who had symptoms exactly like that.

The thing is that even chronic psychotics are not stupid and are driven by the pleasure principle to avoid pain. Eventually these people often figure out that when they say certain things like that the CIA is after them, people tend to get alarmed, call the police and they get hospitalized. Being more rational than you would think, they learn to keep some of these symptoms to themselves if only to stay out of the hospital.

He had a lot more insight than a typical schizophrenic which may be due to the OCD, which would introduce a chronic doubting nature into the psychosis, which would be good for any psychosis, as they are based on hard belief. There are new theories about an illness called Schizo-obsessive Disorder which looked a lot like what this man had. Paranoia, Shneiderian symptoms, and a better prognosis are among the features. To give you an example of the Shneiderian features, for instance, this man heard his own thoughts spoken out loud in the exact same way as if you were to speak your thoughts out loud – how creepy! He was afraid to ride the buses as he feared that the others on the bus could hear his thoughts as he thought them as they sounded as loud and clear as if there were someone talking right next to you.

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

Schizophrenia “Swamps out” Any Other Disorders in the Individual

The problem with schizophrenics is that the schizophrenic process is so complete and totalizing that it essentially swamps over all sorts of other or lesser symptoms.

All you see is the schizophrenia, and its hard to see if there are anxiety, mood (Axis 1 or symptomatic) or especially personality disorders (Axis 2) underneath there. It’s like there’s a tidal wave coming in (the schizophrenia), and you are running around your house looking for roaches (other disorders).  Well, the wave is going to swamp all those roaches, and even if they are there, at some point all you will see is the wave, and the only thing that will matter is the wave, as the roaches will be swamped out so to speak.

Also schizophrenia itself can feature prominent anxiety at times (for instance that the FBI is after them), although anxiety is not typical a primary feature of schizophrenia.

Schizophrenics are often depressed, but it seems like depression is part of the schizophrenia itself. Obviously when depression is part of core schizophrenia as a symptom, it makes it hard to tell that apart from a depression arising often from the depressing effects of the illness itself.

Axis 2 (personality disorder) problems are going to get swamped out too, not to mention the fact that having schizophrenia alone has a devastating effect on personality.

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

Differential Diagnosis in Psychiatry – Separating “Symptomatic” Processes from “Core” Processes

In an anxiety disorder, the main thing you see or the “meat” of the illness is the anxiety – I call it an “anxiety process.” In this sense, even some anxiety disorders that have gone psychotic, say Psychotic OCD or Body Dysmorphic Disorder, are still basically anxiety disorders at their core and not psychotic disorders.

The primary disturbance or process if you will is anxiety and the psychosis is just growing out of that process.

What we are doing here is looking for the core essence of the problem – the Gestalt if you will. We are ignoring symptomatic features on the outside and looking underneath them to see what the core or basic process is underneath.

In the same sense, mood disorders that have gone psychotic or even resemble schizophrenia are better seen as mood processes. In Bipolar Disorder, the primary disturbance is one of mood. The psychotic features, if any, are only present during the mood disturbance – the depression or mania. The psychotic features are flowing out of the mood issue and not the other way around as in the case of some schizophrenic persons who get depressed due to the depressing nature of their illness.

If you clear up the mood process and the psychosis is still there, it tends to go over to Schizoaffective Disorder. This is a controversial category, but it is valid. No one quite knows what it is, but I believe the best explanation is that this is simply Schizophrenia and a mood disorder – Major Depression or Bipolar Disorder – occurring in the same person. Persons with Schizoaffective Disorder tend to be heavily loaded genetically for both mood disorders and schizophrenia, whereas someone with a core mood disorder will tend to have mood disorders in their family history and someone with schizophrenia will tend to have relatives with schizophrenia.

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

Chronic Mental Illness and Personality

Axis 2 disorders (personality disorders) are hard to diagnose in schizophrenia because of the swamping nature of schizophrenia and because schizophrenia itself has a devastating effect on personality.

Even mood disorders often cause serious personality changes. When they hit in adolescence, maturity is often frozen at whatever the age the illness hit. This is why you see people with chronic mental illness in their mid-50’s who still act like teenagers. They act that way because the chronic illness hit in adolescence and their maturation process for all intents and purposes froze in place.

You really need to treat the mood disorder and then see if there is anything left on Axis 2.

I don’t believe in diagnosing personality disorders that are caused by an Axis 1 symptomatic process (anxiety or mood disorder) because this violates the basic theory of Axis 2 – that these are illnesses at the very core or essence of the person, at the soul itself if you will – that usually have roots deep in childhood and adolescence and are always apparent by adolescence or early adulthood. Pathological personality change in later life violates the principles of Axis 2, but maybe we need a new DSM category for that, as it does occur sometimes.

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

Can OCD Be the Root Cause of Other Mental Disorders? If So, Can It Possibly Be the Cause of Schizophrenia in Some People?

Answered on Quora. 

There are definitely some other disorders you can get as a consequence of having OCD, such as Depression, Panic Disorder, Social Anxiety, and suicidality. However, schizophrenia and psychosis is not one of them.

But many OCD’ers worry that they may get schizophrenia or that they are in the process of getting it. Sufferers call this S-OCD, Schiz OCD or better yet OCD with the Schizophrenia or Psychosis Theme. This is simply someone with OCD who has adopted the theme of a fear of going psychotic. As with most other forms of OCD, the fear can cause symptoms that seem to mimic the fear itself. In this case, it can cause symptoms that mimic schizophrenia or other psychoses on the surface, however, careful prodding and questioning generally makes a differential diagnosis between OCD and Schizophrenia fairly straightforward.

Nevertheless, many S-OCD’ers sadly get diagnosed with schizophrenia or other psychoses by ignorant clinicians and as a result are medicated inappropriately. This subtype of OCD is very poorly known and often misdiagnosed.

I run into S-OCD’ers with incorrect diagnoses of Psychotic Depression, Schizoaffective Disorder, Schizophrenia, etc. on a fairly regular basis. The fact that when OCD is very bad, OCD’ers appear psychotic on the surface (but are not psychotic) confuses matters even more. It takes an experienced clinician to figure out what is OCD appearing psychotic and what is an actual psychosis.

At times the two illnesses are found in the same person, and sometimes in these cases it can be hard to figure out where the OCD ends and the schizophrenia begins or figuring out if a given symptom is best seen as one illness or the other. When the illnesses occur in the same person, it is sometimes called schizo-obsessive disorder. These people, who have much better insight than other schizophrenics, sometimes have a tendency to hide symptoms, which makes diagnosis even more confusing.

But having OCD is not going to give you schizophrenia. That’s not possible.


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

Do Therapists Ever Think Their Clients are Unfixable?

Question from Quora:

Some people are utterly unfixable or even improvable, but they are quite rare.

There are clients who are just too far gone, and they cannot be helped at all. It is as if the person were a ceramic bowl that was dropped on a hard floor. The bowl is now in 100 pieces, and the person who dropped it is on the ground looking at the pieces and throwing up their hands. “Where do I start?” he asks in exasperation.

All sociopaths and psychopaths are unfixable by their very nature. We can’t cure the sociopathy and psychopathy because they don’t want to get better. They enjoy being antisocial, and they do not wish to change. However, we can get them to change their behavior. For instance, a homicidal sociopath may show up in the office. A good therapist may be able to convince this sociopath that acting on their homicidal fantasies would be one of the stupidest things that they could ever do. This sociopath may then be able to go through life without killing an innocent person. So we can’t fix sociopaths, but we can change their behavior somewhat, tone it down, or reduce the amount of damage they do to society.

All paraphilias are unfixable by their very nature. The paraphilia quite literally will not and cannot go away. It’s etched in stone.

Schizophrenia is largely unfixable. They need a great deal of medication, and even then in most cases, they are repeatedly hospitalized. A few can go on to lead somewhat normal or even successful lives, but these people still need continuous medication and regular psychotherapy. In addition, they need frequent interventions to stay out of the hospital.

Many illnesses such as OCD, Bipolar Disorder and Chronic Major Depression are unfixable by psychotherapy. Most of these people will need medication for the rest of their lives. However, psychotherapy can improve their conditions a lot at least in the first and last cases.

Long-term suicidality is very hard to fix. It tends to become chronic with repeated attempts over the years. The suicidal person is typically defiant and is furious with you for challenging their suicidality. You are expected to sympathize with their condition, which is actually a very bad idea. Most suicidal people are what I would call “defiantly suicidal.”

Personality disorders are generally incurable. Theoretically, they could be fixed, but these people almost never present for therapy, and when they do, it is often at the behest of others, and they do not really wish to be there or get anything done. People with personality disorders, like sociopaths, literally do not want to get better. They like their personality disorder, and they are incredibly resistant to change. There are some case reports of cures of personality disorders, but in general the prognosis is grave.

I have never been able to fix long term low self esteem, and I have tried with a few people. There is something about that condition that hammers itself into the brain as if into concrete. I do not know why, but long-term low self-esteem seems to be one of the hardest psychological problems to fix. Why this is, I have no idea. Perhaps someone else can offer some ideas.

In many cases, long-term mental disorders simply cannot be fixed or cured. However, with psychotherapy and drugs, people can often get much better than they were before. We need to stop thinking in terms of cures and start thinking in terms of amelioration.

I realize that many clinicians insist that most people can be fixed or cured of long-term conditions, but I think they are lying. They are probably trying to drum up business. Many clinicians fear that if word got out that a lot of long-term mentally ill people cannot be fixed or cured, people would stop coming in for therapy. There goes their paycheck. Therapists are a lot more money-oriented than most people believe, and don’t let anyone tell you otherwise. I know this field very well.

Clinicians have nothing to worry about. Even if a lot of conditions could only be ameliorated and not fixed, I am sure a lot of folks would show up to try to get some improvement. Some mental disorders are so painful that any improvement feels like a miracle cure to the client. A lot of people have given up on being cured anyway, just want to at least get better and are quite happy to do so.


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

The Untreatable Borderline Personality Disorder Client: A Therapeutic Nightmare

Borderline Personality Disorder (BPD)is one of the hardest disorders of all to treat. It can be improved with some therapies, but the road is long and hard. Many seem to go on for years or decades with little or no improvement. There are reports of cures, and I am familiar with a woman whose BPD cleared up at age 55 after having come on in childhood. That’s probably a typical cure. Decades of nasty illness followed by a lifting of the illness in middle age.

Many mental disorders improve in middle age, and even many personality disorders improve during this age period.

Schizophrenia often ‘burns out” in middle age, and florid positive symptoms are replaced by more negative symptoms.

Many anxiety disorders attentuate in middle age.

Even psychopaths often get better or at least less destructive in middle age, as many of them also burn out in a similar fashion as schizophrenics. A number of highly antisocial psychopathic men get better in middle age as the antisocial behavior attentuates. It is often replaced by depression, heavy drinking and a pessimistic, cynical, imbittered and misanthropic person who nonetheless does little damage to society anymore.

It should be noted the clients with BPD vary widely in their symptom pathology.  Some are much more functional than others. Quite a few can even function well at their jobs all day, but when they come home from work, they fall apart and shift into full BPD pathology.

However, some people with BPD are so ill that they seem nearly untreatable. It is these people who will be the subject of this post, not BPD’s in general. These people seem so far gone and broken that one wonders how anyone could ever even begin to put them back together again. I suppose some progress could be made, but the damage is so severe that I have a hard time seeing how even the best therapist could possibly fix these people in any significant way.

A typical case might be a young woman who, only in her late 20’s to early 30’s, already has 8 -13 suicide attempts and many hospitalizations behind her. She goes into the hospital on a regular basis. Therapy seems to do nothing but feed her pathology as she manipulates gullible new therapists to believe her lies, nonsense, and projections as the new therapist confuses symptom pathology with the truth. Drugs do almost nothing.

Diagnosis itself is often difficult because the BPD is so severe that the person often appears psychotic/delusional. One wonders what are delusions and what are not. Even the delusions do not seem to last for long, as they are dropped, changed around, added to or substituted in a wildly chaotic fashion.

Usually there is a lot of combativeness and involvement with the court system, as the extreme rage leads a litigious person.

Splitting is severe and textbook.

Self-image is so unstable that the person almost literally adopts the full personality and even persona of whomever is on their radar at the moment. The clinician needs to be prepared that this person will so identify with the clinician that they will adopt the therapist’s image and persona as their own. Boundaries nearly do not exist for these people, and they often fall in love with their therapists, try to seduce them, or on the other hand become furious at them to where sessions became rage attacks at the therapist, and the therapists is at odds of how to respond without violating ethics.

The client can become overtly suicidal even during sessions, and infatuation with the therapist can quickly split to where the therapist is the source of all evil. Homicidal threats and homicidal-suicidal threats against the therapist may now appear. The client then hospitalizes themselves due the “horrible trauma from the evil,  incompetent therapist” and soon finds sympathetic new therapist, typically a feminist woman, to unload her story on. The new female therapist forms an alliance with the client against the “evil male” former therapist and accuses him of damaging the client.

Commonly, the therapist gets angry and tells off the client. This leads to abandonment and a vengeance agenda against the therapist, who has now “irreparably damaged” the BPD and “caused them to spiral out of control.” Be prepared to get accused of abandonment, causing severe trauma in the client and making them dramatically worse. The client may become hospitalized due to allegations of damage from an incompetent therapist.

These people are so difficult and chaotic that many clinicians refuse to see Borderline patients. Some are on the record as saying that when they say a Borderline client coming their way, they hide under their desk until they go away. For a lot of therapists, these clients are nothing but trouble, and endless parade of drama and chaos. Therapy itself is chaotic, mercurial, and wild with severe splitting and often extreme idealization of the therapist for good or ill or both, interrupted by fairly regular hospitalizations. The therapist begins to wonder what’s in it for them and thinks you could not pay them enough to suffer through such clients. These clients make an excellent argument that therapeutic abandonment is the proper choice with some clients.


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

Resolved: Transgenderism Is a Mental Illness

RL: I work in mental health, and I have to diagnose people a lot, or at least offer my opinion of a diagnosis as I cannot give out legal DSM diagnoses . I even have to do differential diagnosis constantly where I have to figure out which of two diagnoses a person has. Believe me, these cases can be very confusing.

Magneto: In your opinion, is being transgender a mental illness? I mean, I am aware of the statistics that gays/trans people have a far higher suicide rate than heterosexuals, which would seem to suggest that it is a mental disorder.

But it’s kind of hard to think trans are mentally ill when you are looking at a fucking sexy ass Asian ladyboy who is far hotter than any real woman you’ve ever been with. To be honest, I hope trans continues to become more mainstream and more men do the transition into females. Fine with me, more food to choose from, in my opinion.

Ha ha. So, more pussy, even if it’s fake pussy, eh? I’m not sure I am down with that.


Is transgenderism a mental illness. Of course it is. In most cases anyway. And the rate has gone up 600X since the 1970’s. If it is some actual biological condition in the brain like sexual orientation, one would not expect the rate to skyrocket like that.

Rates of biological conditions don’t change much. The rate of homosexuality has probably been 3% for a very long time. Homosexuality appears to be an incurable biological condition that gets wired up in their brains somehow. It is a developmental disorder like left-handedness and a number of other things. Something goes wrong hormonally in utero, and the result is male or in some cases female homosexuality. As it is a developmental disorder, would you expect the rates of left-handedness to go up 600X? Real biological conditions just don’t work like that. Why would the hormonal aberrations that cause homosexuality have gone up 600X? They wouldn’t. They would stay at some consistent rate that is close the the rate of things going wrong in utero.

Hence except in a few cases, transgenderism is not a biological disorder. I really feel for these boys who feel like girls from age 2 or whatever. I am willing to consider a biological disorder there.

Yet a biological disorder can also be a mental illness. Schizophrenia, Bipolar Disorder and even OCD look like biological disorders, and all are also mental illnesses.

These seems to be a “fad” disorder that a lot of folks are developing on their own in a similar way to how these therapists create mental illness in previously healthy girls who got molested. It’s a cool way of going crazy.

Studies in China show that ~3% of the population feels as if they are the opposite sex. So if we let this thing explode, we could end up with a 3% tranny population. In the past, these people became homosexuals (in itself a sort of transgenderism) or perhaps feminine men and masculine women.

When I was growing up in the 1970’s, we had this idea that all men and women have masculine and feminine components, even heterosexual ones. Just because a man has a feminine side or a woman a masculine one doesn’t mean he is not a man and she is not a woman, nor does it mean that either one is a homosexual.

I have a pretty strong feminine side myself, as many people used to think I was gay or bi. I’m not a Man’s Man at all. I’m not macho enough for that. I’m a Ladies’ Man who prefers the company of women. Most Ladies’ Men are not as masculine as Man’s Men.

I worry that if I were growing up today, I might have been sucked into this nonsense and decided that I was a tranny and I was really a woman or something insane like that.

If a man thinks he is a woman or a woman thinks she is a man, that is known as a delusion. It’s just not true. So they’re psychotic in a sense. And the treatment (sex change operation) doesn’t appear to make them any mentally healthier. So why do it? If the treatment doesn’t help the person, we stop doing it.

13% of people who have sex changes actually re-transition. So men who turn into women turn back into men, and women who think they are men turn back into women. If it was a real condition, one would not expect to see that. Homosexuals don’t suddenly decide to be straight. Left-handed people don’t decide to be right-handed one day. Transgenderism in childhood is highly transitory. 73% of transgender children are cured by adulthood. That is, by the time they are 18, they have abandoned the idea that they are the opposite sex. Biological conditions do not have such high spontaneous cure rates.

There have been quite a few spontaneous cures of transgenderism even in adulthood. There are a number of cases where a man was in therapy for transgenderism, and he showed up for therapy one day and announced that he’s no longer transgender. He’s really a man and realizes that and feels like one now. Then he gets up and walks out of the office. Just like that.


Filed under Anxiety Disorders, Asia, Biology, China, Gender Studies, Girls, Heterosexuality, Homosexuality, Mental Illness, Mood Disorders, OCD, Psychology, Psychopathology, Psychotherapy, Psychotic Disorders, Regional, Schizophrenia, Science, Sex, Social Problems, Sociology

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.


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.


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