There Aren't Too Many Books That I Stop Reading In Disgust

There Aren't Too Many Books That I Stop Reading In Disgust

Darby Penney and Peter Stastny, The Lives They Left Behind: Suitcases From a State Hospital Attic (New York: Bellevue Literary Press, 2008). The premise of the book is quite interesting. When Willard State Hospital, a New York State mental hospital closed some years ago, a team looking through the buildings found a number of suitcases in the attic of one building that had belonged to various patients who had died while hospitalized. For whatever reason, these suitcases were not sent to next of kin (perhaps because there were no next of kin). The authors picked several suitcases where the contents seemed quite intriguing, or where it was possible to find information in the hospital records about the owners.

There's plenty of sorrow in each story. Any time you have someone hospitalized against his or her will because of mental illness, it is a tragedy. When they are hospitalized for life, it is even more of a tragedy. If they spend their whole lives inside because they have such severe mental illness that they needed to be there, you want to cry. If they spend their whole lives inside for no good reason, you want to scream in rage.

This book tries very hard to persuade you that at least some of these people were hospitalized for life for no good reason. There have doubtless been such cases. Some persons were hospitalized for no good reason, and held against their will because the bureaucracy refused to admit that someone made a mistake. There are persons who were hospitalized with good cause, but who recovered (either because of treatment, or spontaneously), and yet someone failed to recognize that it was time for such a person to be released.

There is absolutely no question in my mind that both of these situations must have happened, simply because human beings make mistakes. They fail to recognize errors in classification; they become insistent on covering up their own mistakes (or those of predecessors); persons get lost in a large institution. Yet when I have looked into the legal cases associated with such improper commitments, and the work published by lawyers making this claim, I have been struck at how few such examples are clearly in this category. I've mentioned some of these claims made by Bruce J. Ennis, an ACLU attorney, in his book Prisoners of Psychiatry, and the reasons why his presumably strongest examples turn out not so strong upon examining other evidence. I've mentioned that as late as 1963, the ACLU's representative in Congressional hearings about mental illness commitment couldn't give a single example of improper commitment in the D.C. system. I'm sure if there were a lot of examples from outside D.C.'s system, she would have cited them as examples.

The Lives They Left Behind gives examples clearly intended to persuade that such persons were improperly hospitalized at Willard, or who were left in well past the point that they needed to be there. Yet the examples that the authors are hardly confidence inspiring. One of those hospitalized back in September 1917 was a young Filipino man they call Rodrigo Lagon (last names have been altered to protect the privacy of those long dead) who was hearing voices. While they acknowledge that hearing voices is a "first-rank symptom of the disorder called schizophrenia" (p. 52), the authors then spend several pages explaining that auditory hallucinations are actually quite common, and "not a symptom of an illness." (p. 53)

You can make a case that in the bad old days, there was perhaps a bit too much willingness to hospitalize people for odd behavior, or symptoms of mental illness, in the absence of any imminent danger to self or others. Inevitably, our legal system has to draw lines. We may have drawn them too far one direction before; we draw them too far the other direction today. But the authors' decision to imply that Rodrigo Lagon's symptoms were an inappropriate basis for hospitalization seems a bit odd.

Therese Lehner's story similarly leaves me cold. She was a Catholic nun, and at some point, started to have problems that caused her to be removed from one nunnery, and put in some poorly defined state of not being considered a nun--but not released from her vows. Her hospitalization and commitment was apparently the outgrowth of "excited, noisy and destructive" behavior and running around in the nude. She was apparently unable to provide sensible answers to questions. (p. 63) The authors, who have to this point at least acknowledged that there is such a disease as schizophrenia, now refer to it as "so-called schizophrenia," and appear to reject the biological model of schizophrenia that now has a very clear genetic basis to it. (p. 64)

Once hospitalized at Willard, Lehner's behavior conforms to the apparent schizophrenic symptoms she exhibited that led to her commitment: violence against attendants--and the authors tell us, "Such attacks are rarely unprovoked." (p. 66) Based on what? I've talked to people who work in mental hospitals, and they will tell you otherwise. Lehner also started to claim that she had children, including a dachshund. (p. 68) Yet the authors would have us believe that her odd behavior in the hospital and that led to her commitment (both consistent with schizophrenia), were really caused by being in a hospital. (p. 66) You know: sane people get sent to mental hospitals, and become crazy as a result. It isn't that people in mental hospitals end up there because they have mental illness problems.

While there is a Works Consulted section, there are no footnotes, so tracking down the origins of many of the factual claims that might be of real value to someone studying the problem of involuntary commitment is going to be a bit of work. I also notice a few obvious factual mistakes that suggest a certain lack of scholarly care. Lehner was born in Germany, and her father was still there. "In the spring of 1918, with the war over, she once again tried to get in touch with her father, but the letter was never sent." (p. 62) The war wasn't actually over until November of 1918. This is something that almost anyone familiar with the period should know--and it makes me disinclined to trust that the authors put more energy into verifying the more controversial claims.

I then looked at the author bio on the dust jacket, and I began to understand why this book has such a strong bias against the mental health system: "Darby Penney is a national leader in the human rights movement for people with psychiatric disabilities and a former state mental health official who has experienced the mental health system inside and out."

Now, just because she has been inside the system doesn't immediately discredit her opinions. But when someone discounts the biological model of schizophrenia with the quite overwhelming evidence of a biochemical origin we now have (such as I mentioned here), it is rather difficult to take a book like this seriously.

Deinstitutionalization Sure Was Peachy For This Guy, Wasn't It?

Deinstitutionalization Sure Was Peachy For This Guy, Wasn't It?

From the October 18, 2009 Syracuse Post-Standard:

Schroeppel, NY - When Deanna Candee and her son, Adam, returned from a shopping trip Saturday to their Schroeppel home, they suspected something was wrong when they saw the garage door open.
Candee’s home had been ransacked. An intruder was still inside.
As her 25-year-old son moved toward the cellar to check out a noise, Deanna, 48, started into the house, said Wilson Candee, Deanna’s father-in-law.
The intruder confronted her and grabbed her by the hair, Wilson Candee said. Adam heard his mother scream, went to her aid and pulled the intruder off. He and the stranger began to struggle.
The fight ended, Oswego County Sheriff’s officials said, when Deanna grabbed her pistol and shot the man.
Phoenix police found Timothy Hartigan, 39, dead in a bedroom when they arrived shortly after 8:30 p.m. Saturday.
Sunday, Wilson Candee provided details about the struggle based on his conversations with Candee, his grandson, and investigators.
Candee legally owned the gun with which she shot Hartigan, sheriff’s department officials said.
...
Wilson Candee said the intruder’s motive did not appear to be theft. Money left in a wallet was untouched and no articles appeared to have been gathered for removal, he said.
But he said he was told the house had been thoroughly vandalized with doors broken, glass smashed, and pictures and knick knacks knocked from the walls. Cutlery was strewn along the hallway leading to the bedroom. There also were signs that the intruder had cooked bacon and eggs, he said.
Hartigan had a history of mental illness, according to his former wife, Denise L. Cunningham, and a man answering the phone at Hartigan’s mother’s home who identified himself as Hartigan’s brother-in-law.

When Hartigan was taking his medications he was a great guy, a good father to his two children and a good friend to many, Cunningham said. He was artistic and enjoyed drawing and woodcarving, although he did less after he was diagnosed, she said.

“When he was on his medicine he was a good person,” Cunningham said. “He would never have dreamt of doing this.”

Cunningham said her former husband was diagnosed a decade or so ago and recently had been treated at University Hospital.
“His son and I had just gone to visit him ... we actually saw him a week ago today,” Cunningham said.
The hospital released Hartigan on Tuesday, she said. Hartigan’s illness could not be learned Sunday.
A spokeswoman for the hospital declined to comment, citing privacy regulations.

Hartigan was no longer living at the downtown Syracuse YMCA, where he had resided about eight years, Cunningham said, and she didn’t know where he was living after his discharge.

This is, unfortunately, a recurring situation for many of the mentally ill since deinstitutionalization: in and out, in and out, homelessness, shelter, and back again. The problem is never really solved. For those with schizophrenia, the institutional setting didn't really solve the problem, either, but at least they weren't going to be killed in a tragedy like this. Once Deanna Candee knows why this happened, it is likely that whatever trauma this incident has for her is going to be worse--once she realizes that Hartigan wasn't in his right mind, and this entire disaster could have been prevented.

There are so many of these tragedies--and yet the mainstream media choose to ignore it, because it doesn't suit their agenda.

The Tragedy of Mental Illness

The Tragedy of Mental Illness

In going through Legal Executions in New England, I have found nineteen cases where a person was executed for crimes that are clearly or likely the result of severe mental illness. There was a notion of not guilty by reason of insanity (NGRI) even at the start of the Colonial period, but just like today, the legal definition of NGRI is far narrower than the medical or conventional definition of insanity. The first NGRI verdict in Pennsylvania is in the 1740s. This being a book of executions, it doesn't include any situations (except one) where a person was found NGRI--and that one case involved a person who was NGRI, then committed another murder some years later, and this time, the jury wasn't taking any chances. That is also like today, where juries have sometimes found people sane who were clearly not (some as the cannibal serial killer Kemper)--for fear that they might be released. Still, while I haven't found a list of all NGRI verdicts, I don't get the impression that there are dozens of such cases.

Most of these are executions for murder, but in a few cases, there are people murdered for witchcraft where their confession clearly shows mental illness. There are people who confess to witchcraft in the Colonial period who genuinely believed that they were successfully casting spells to cause livestock to die and to afflict people--but I am not including those. I'm including people who have hallucinations that they were having sex with devils, for example, and confess to such crimes.

There are several murders in the list that while not clearly mental illness, don't make sense otherwise. There are some cases like that of Alice Bishop of Plymouth, who in 1648 slit her four year old daughter Martha's throat from ear to ear. She pleaded guilty, but refused at any point to explain why she did this. There are crimes that are incredibly brutal without any apparent reason, where the accused either wouldn't explain his actions, and freely admitted what he had done, with no apparent concern about the consequences. (And these are such heinous crimes that I won't even tell you about them.)

Considering the number of people in New England, and the more than 150 years covered, this is really a very low number of cases.

Still, every case is a tragedy. There is a Peter Abbott of Fairfield, Conn. who began to evince symptoms of lunacy as he grew into adulthood. “For that reason he was kept close to home, working in tandem with his father.” Schizophrenia usually shows itself in the teen or early adult years. The idea of keeping him close to home, in the hopes of preventing him from coming to harm, or harming others, was a good idea--but he married, and soon, there was no one to supervise him. Peter Abbott was executed in 1667 for murdering his wife and attempting to murder his child by slitting their throats while they slept.

Oh Joy

Oh Joy

Troubled Experiment wasn't exactly pleasant reading. They make the observation that about 1/3 of all rape charges in 1682-1800 Pennsylvania involved victims under 18--with some victims as young as 6 or 8. But now I'm about to start reading two books that are even more unrelentingly uncharming: Legal Executions in New York State and Legal Executions in New England.

Why such edifying material? It appears that there are relatively few murders in the Colonial period committed by clearly insane people--certainly not very many in Pennsylvania, a province with an enormous violence problem relative to the rest of the American colonies. My working hypothesis is that this is a combination of low insanity rates, and relatively easy commitment procedures for those who were perceived as dangerously mentally ill. Throughout the Colonial period, commitment didn't necessarily mean treatment, and certainly not effective treatment. It did not even generally mean humane custodial institutionalization.

I'm about to start reading these volumes to see if my initial impression is correct or not.

Rising Psychosis Rates

Rising Psychosis Rates

I've mentioned before a book by E. Fuller Torrey and Judy Miller. The Invisible Plague: The Rise of Mental Illness from 1750 to the Present. (New Brunswick, N.J.: Rutgers University Press, 2001) that argues (I think quite persuasively) that psychosis rates have been rising in the Western world since the 17th century. There are no specifically mental hospitals in America until 1773--unlike Britain, which had them for centuries by then. The "furiously mad" might be locked up in the poorhouse if they were considered a danger to others, and there are a very few cases where persons were confined by family members at the request of the colony. One such example was a young man who was found not guilty by reason of insanity for killing his mother. Institutions specifically for the mentally ill were extremely scarce.

I was looking through Lloyd Vernon Briggs, History of the Psychopathic Hospital, Boston, Massachusetts (Boston: Wright & Potter Printing Co., 1922), and it mentions that in 1764, Thomas Hancock left the city of Boston 600 pounds (a big chunk of money for the time) to create a public mental hospital for the inhabitants of the province. The town government declined to accept this gift, because there weren't enough insane people in Massachusetts to justify building such a facility. The population at the time would have been about 200,000 people. Today, about 1% of the total population has schizophrenia, and a somewhat smaller percentage has bipolar disorder severe enough to require hospitalization. If 1% of the population of Massachusetts back then had schizophrenia, that would be about 2000 people.

Now, it is certainly the case that only some of those would have been ill enough to justify hospitalization. Small town America was extraordinarily tolerant of mental illness, perhaps because they knew these people well enough to know who might be dangerous, and who was not. The costs meant that a person who was merely acting strangely would probably not be hospitalized. Still, if even 5% of those 2000 people were acting in a way that might cause concern about violence (to others or to themselves), that would be 100 people throughout the province. And yet the Boston government didn't believe that there was a need.

This isn't proof that Torrey and Miller's claim is correct. Perhaps Boston's selectmen had some other reason for refusing the gift, or not wanting a mental hospital in their midst. But it does certainly lend credence to the idea that the reason that there are no institutions, and surprisingly few examples of mental illness in Colonial America, has something to do with very low rates of mental illness compared to today.

The Right Search String Makes All The Difference

The Right Search String Makes All The Difference

Or maybe books.google.com just scanned in a few thousand more books since I did a search on this topic most recently. I used the search string "furiously mad" and ended up with dozens of 19th century and early 20th century books with discussions of civil commitment laws.

As usual, these are concentrated in New England, with Massachusetts and Rhode Island's legal codes overrepresented--but I also found those of Texas, Mississippi, South Carolina, Michigan, and New York, at various points through the century. A recurring pattern in many of these commitment laws is the requirement that two judges had to approve involuntary commitment.

No, It's Not Just Suburban White Kids

No, It's Not Just Suburban White Kids

This guy Van Jones is trying to make a point about the need for strong male role models in this video but he has completely destroyed it by:

1. Suggesting that there is some debate about whether young black men are animals or not. (Guess what: outside the .0001% of the population that are neo-Nazis, no one thinks anything like this.)

2. No, it isn't just "suburban white kids" who go on rampages shooting up schools. Cho Seung-Hui is one example. Another was a neo-Nazi Korean college student (and yes, that doesn't make sense) who went on a rampage at a college in western Massachusetts a few years back. And Peter Odighizuwa (an African immigrant) went on the rampage at Appalachian Law School in 2002.

3. What Van Jones has completely missed is that many (not all) of these mass murder incidents involve mental illness--not just some kid who is hurting and needs a hug.

Just About Done With My Revision of Personal Tragedies

Just About Done With My Revision of Personal Tragedies

I mentioned some weeks back that a university press had approached me about another book, and expressed a willingness to look at a scholarly history of deinstitutionalization--so I had to rip out the sections of Personal Tragedies that gave the book human interest. In the process, I have been doing a bit more research, and in some cases, significantly improving the book. In a number of cases, I was able to find primary sources where I had been relying on secondary sources before, and fixed a few errors that I would like to think were entirely in the secondary sources, but who knows? I might have contributed my own errors to the process. I also made the same changes and improvements to Personal Tragedies, in case I find a publisher that wants a mass market book instead.

I just finished reading the Joint Commission on Mental Illness and Health, Action for Mental Health (1961), the report that started Congress down the road to encouraging deinstitutionalization. I'm letting the manuscript cool for a couple of days, then I will give it one more read through before submitting it to the publisher.

UPDATE: I don't want to give the wrong impression that I have been sitting around, doing nothing (which you might think from the lack of blogging the last few days). I've also written a 9000 word introduction to machining (sort of a Machine Tools for Dummies) which I am hoping to sell; found some more eye candy for an article about the transformation of the gun industry 1790-1820; and wrote an 1800 word article about gunmaking as a family business in early America. (If I don't have a job, I can try and make up for the revenue deficit with more articles.)

While writing that last one, I was able to verify something that I have long suspected. There is a Daniel Nash who is mentioned in 1699 court records from western Massachusetts. A stolen gun was found in his blacksmithing shop; Nash was apparently asked to repair the gun, and does not appear to have been criminally involved. I have long suspected that he was probably related to Thomas Nash, the New Haven colonial armor, gunsmith, and one of my ancestors. My suspicions were based on the last name, the proximity of Daniel Nash's shop to Connecticut, and that Daniel Nash was asked to repair a gun--suggesting that Daniel had some involvement in gunsmithing as well as blacksmithing.

I was able to find confirmation that Daniel Nash was the son of Timothy Nash, youngest son of Thomas Nash. All three of Thomas Nash's sons (John, Joseph, and Timothy) were apparently trained as gunsmiths, but at least Timothy and Daniel put their primary focus on blacksmithing, with gunsmithing as more of a sideline activity. (In small towns, getting too specialized would mean that you wouldn't be employed full-time.)

Causality Direction Confusion

Causality Direction Confusion

I'm reading Robert E. Faris and H. W. Dunham's Mental Disorder in Urban Areas (1939) at the moment. This was pioneering work when it was published, demonstrating a very strong correlation between schizophrenia and poverty. The problem is: the authors didn't look at anything but the address at which the patient was living when hospitalized. They seem to have completely missed the possibility that people who are slipping into schizophrenia may lose their job, move into the cheapest housing possible, or end up on Skid Row (or hobohemia, as the book calls it). They seem to be so intent on proving that poverty and social disorganization cause mental illness of those who live in such places, that they don't even consider that the direction of causality is the other direction: that schizophrenics end up in poor sections of town because of their mental illness.

And yet, in the chapter on syphilitic insanity, they acknowledge that the distribution of home addresses of this bunch might be connected:

The possibility, however, must be considered that persons with syphilis eventually lose their earning power, find it impossible to compete successfully with other members of their respective occupational groups, and consequently tend to drift into the low-income groups. [p. 124]

Well, duh! But they seem to have completely missed this possibility involving schizophrenia and alcohol-related psychoses. (To their credit, I understand that their 1965 edition of this book reversed their position.) It does show how strongly the whole 1930s mindset prevented people from seeing anything but, "Poverty causes bad things" rather than, "Bad things cause poverty."

Another Mental Health System Failure

Another Mental Health System Failure

Seung Hui Cho's mental health records, which had gone AWOL, have finally been released. The August 20, 2009 Washington Post reports that he slipped through the cracks--and 32 people died because of it:

The records indicate that Cho sought help at the university's Cook Counseling Center three times in November and December 2005, twice on the phone and once in person. Each time, he was assessed but not treated.

On Dec. 14, 2005, the day Cho was released from a psychiatric hospital, was declared a danger for threatening to kill himself and was ordered by a judge to receive involuntary outpatient treatment at Cook, the therapist who saw him there did not evaluate his mood. Instead, she drew an "X" through the preprinted triage form.

"Did not assess," therapist Sherry Lynch Conrad wrote. "Student has 2 previous triages in past 2 weeks. Last 2 days ago."

At the psychiatric hospital, just hours before, Cho had been given Ativan for anxiety and was assessed as having a mood disorder, the newly released records show.

"Patient very non-verbal, very quiet, sits in the chair looking down at the floor, does not blink," the records say. "No smile, no laughter, no crying."

This should have immediately raised some flags. This sounds like flat affect, a common symptom of severe depression or schizophrenia.

Chop Time

Chop Time

I had a university publisher back East contact me to see if I had a book about Colonial gun manufacturing in the works; they were interested. Not written yet, but certainly researched. But would they be interested in this book, already written? Well, maybe, if I removed everything in the way of a memoir and turned it into just a scholarly history of deinstitutionalization.

My first reaction was, "But the memoir is what makes it moving, powerful, and likely to sell well." But since no one seems interested in a book like that, I'm now chopping it down to the scholarly history part.

UPDATE: Every major piece of writing needs to set and cool for a month or two. As I go through the manuscript, I find myself shaking my head at some of the scrambled sentences, and failures to properly transition between paragraphs. I also find that I have relied a bit more than I should on three secondary sources for my discussion of nineteenth century mental illness treatment, so I need to do a bit more digging.

UPDATE: As I work my way through the book, and I dig a little more for sources, I am grateful that I am doing so. It isn't just a matter of having a few more sources so that I don't appear overly dependent on Grob's work--I'm finding additional useful little aspects to this question. In one case, I discovered that either Grob misspelled the name of Manfred Sakel (the doctor who first used insulin shock therapy for psychosis), or I miscopied Sakel's name. Either way, I'm glad to find that out.

This Problem Is Everywhere

This Problem Is Everywhere

A reader just pointed me to this account by an EMT in Louisiana, about the tragedy of mentally ill people for whom there is nowhere to go:

There is nothing wrong with his body; no illness to treat, no wounds to bind. It's his mind that is broken, and there is nothing that I, or all the psychiatrists in the world, or anyone short of God himself can do to repair it.

And the futility of it makes me resent him terribly, makes me dread seeing his face. And the shame that he might see the resentment on mine burns me like a torch.

And so I say nothing, sitting silently beside him, and I bear witness to his despair.

"Why won't they take me?" he sobs plaintively, clutching desperately at my arm. "Call Zeke," he begs. "Zeke's my friend. He'll make them put me in. I can't survive out here."

How bleak must his life be, that he regards the parish coroner as his savior? People only interact with a coroner when a relative has died, or when someone thinks they're crazy. Neither is a happy occasion.

The truth is that he's not sick enough to be locked away. He doesn't hallucinate, doesn't hear voices urging him to do bad things. He doesn't contemplate killing himself. He calls for the same reason he did last week, and last month, and a dozen times before that. He is simply a man for whom living independently and wrestling his demons are two tasks he will never, ever be able to manage simultaneously.

And he knows it.

He is too honest to game the system, too naive to understand that's what it may take. Should I tell him what to say, how to act so that he'll get at least a few days in a place of comfort, where people may at least pretend to care about his welfare? I certainly know the litany well enough. I could teach him the magic words.

But then, how will I justify it to myself, knowing that he'll be taking up bed space needed by someone who is truly a danger to himself or others? In post-Katrina Louisiana, psych beds are all too precious a commodity. Mentally ill patients here move through a vicious cycle of hospitalization, medication, discharge, decompensation, hospitalization, medication, discharge...

... fragile people stuck in a meaningless revolving door of all too many psychotropic medications and all too little meaningful therapy, and altogether nonexistent followup care. They warehouse them and dope them with Haldol and Thorazine until their reimbursement capitates, and then suddenly declare that they've made significant progress and are ready to be released again into the world, with a prescription for medications everyone knows they can't afford and outpatient appointments with a psychiatrist everyone knows they won't be able to keep.

And it isn't just post-Katrina. It is the situation in most of the United States. And as I have discovered, in trying to find a publisher for my book about this problem--no one seems to care. It just isn't important.

On American Family Radio Today

On American Family Radio Today

Bryan Fischer will have me on his Focal Point program on American Family Radio today at 1:00 PM Mountain time to discuss deinstitutionalization of the mentally ill. Here's a list of stations that carry the program.

The Personal Tragedies Teaser

The Personal Tragedies Teaser

I've made some minor additions to the manuscript for my next book based on J. Allan Hobson and Jonathan A. Leonard's Out of Its Mind: Psychiatry in Crisis (2001), and updated the teaser chapters here.

Abram Hoffer Dies

Abram Hoffer Dies

In case you don't know who he is--from the obituary in the May 30, 2009 British Columbia Times-Colonist:

He challenged the then-dominant view of schizophrenia as a psychological disorder caused by poor mothering, and contributed importantly to the formation of the field of neuropsychopharmacology. He co-authored research on the genetics of schizophrenia with the renowned geneticist, Ernst Mayer. He co-discovered the first effective lipid-lowering agent, the B vitamin niacin. He developed a controversial treatment for acute schizophrenia based on the principles of respect, shelter, sound nutrition, appropriate medication and the administration of large doses of certain water-soluble vitamins, in the process carrying out among the first controlled clinical trials in psychiatry. He advanced a plausible biochemical hypothesis to explain the cause of schizophrenia and how niacin and vitamin C could eliminate its symptoms and prevent relapses. Intrigued by the concept of metabolic “models of madness,” he and his research colleagues, notably his close collaborator Humphry Osmond, studied the properties of the hallucinogens and pioneered the use of LSD, which in conjunction with skilled compassionate psychotherapy, was found to be an effective treatment for alcoholism. His work with alcoholism led to a close friendship with Bill W., the founder of Alcoholics Anonymous. He organized a self-help organization for people with schizophrenia, Schizophrenics Anonymous. Participants at SA meetings occasionally exchanged the friendly greeting, “Salutations and hallucinations!” His colleague and friend, the American chemist Linus Pauling, championed the biochemical model for treating schizophrenia that was developed in Saskatchewan and provided a conceptual underpinning for the notion that large doses of certain naturally occurring substances can favorably alter disordered brain biochemistry, coining the term “orthomolecular psychiatry.”

My brother was treated with Hoffer and Osmond's methods back in the early 1980s--and there was enormous progress, at least for several years--to the point where, had I not known of my brother's struggle with schizophrenia, I would not have realized that he was mentally ill. The improvement was that dramatic. It did not last, for a variety of reasons, but I do suspect that Hoffer and Osmond were on to something, even if the exact details of the mechanism were not completely correct.

Unfortunately at the time, the psychoanalytic model for schizophrenia was at its height, and some very positive results and intriguing theories were largely ignored by the profession. In the last twenty years, the realization that schizophrenia is biochemical or structural in nature has again taken hold. I have confidence that in another 20-30 years, we will have a good understanding--and maybe even a cure for it. For those struggling with it, either in themselves, or in loved ones--you'll just have to wait. We're not spending enough researching a disease that, until deinstitutionalization, was the single largest cause of hospital bed-days in North America. (Now it's one of the largest causes of homeless people sleeping on park benches, in homeless shelters, and on steam grates.)

UPDATE: A reader who is a professor of social work tells me that social work grad programs had largely abandoned psychoanalysis in the 1970s, and his perception is that psychoanalysis was already in decline within psychiatry by the 1970s. Hobson and Leonard's Out of Its Mind points out that experiments done in the 1960s and early 1970s were also showing that psychoanalysis did not work for psychotics. Psychoanalysis with medications was about as effective as medications alone.

He also tells me that one of the reasons that Hoffer & Osmond's work was largely ignored was:

1. They had done a lot of research about LSD--and this created a negative view of them.

2. No one was much interested in trying to replicate their results with patients. That's sort of the kiss of death for scientific research.

Tolerance? Or Indifference?

Tolerance? Or Indifference?

Theodore Dalrymple's Life at the Bottom makes the point that much of liberalism's supposed tolerance or acceptance of the underclass's degradation is really indifference to the suffering of others. By celebrating all forms of destructive behavior, liberalism is saying, "We don't care how much destruction you do to yourself and others--you aren't important enough for us to care about." The manner in which severe mental illness has been treated by liberals is in this same category. This May 30, 2009 New York Daily News article uses some harsh language to describe the subject, but still, ask yourself, why is this guy wandering the streets of Harlem? And what does it say about how liberalism regards the damage that he is doing to the community?

The escaped Wild Man of 96th St. has been caught - where else? - on 96th St.

Larry Hogue, a drug-addicted wacko who terrorized Upper West Siders in the 1990s, strolled away from the Creedmoor Psychiatric Center in Queens on Thursday.

The notorious hell-raiser was arrested "without incident" in his old stomping grounds Saturday morning after being spotted on 96th St. between Broadway and Amsterdam, cops said.

Before he was put away, Hogue, now 65, menaced the neighborhood around 96th St. He was big and he was bad, regularly mugging people to support his drug habit.

He set fires under cars, heaved rocks through stained glass church windows, masturbated in front of kids, stalked seniors and threatened children with nail-studded clubs.

Cops would arrest him and take him to the psychiatric ward, where he would be cut off from his crack supply.

After a few weeks his demons would disappear and he'd be back to his old tricks on W. 96th St.

Word that Hogue was once again on the loose on 96th St. - even for a short time - sent a chill through area residents.

"I've been a New Yorker my whole life and he's the only thing that makes me afraid," said Dorothy White, a resident of W. 96th St. for 25 years. "This man is dangerous and I'm terrified."

Michael Burns, 74, who once saw Hogue smash a car window after the driver refused to pay him for a squeegee job marveled that he wasn't better guarded.

"Whoever released him has got a screw loose," Burns said.

Hogue's reign of terror during the 90s made him a symbol of a blundering mental-health system. He was put in the slammer for a year after he slugged a 16-year-old girl and pushed her in front of a Con Ed truck.

Mental Illness & Brain Chemistry

Mental Illness & Brain Chemistry

I mentioned a couple of days ago that I am reading J. Allan Hobson and Jonathan A. Leonard, Out Of Its Mind: Psychiatry in Crisis (Cambridge, Mass.: Perseus Publishing Group, 2001) at the moment. They make an interesting point: that there are strong similarities between dreams and psychosis. This is not only in the sense that both dream state and psychosis involve irrational ideas being accepted by the brain, and seeing things that aren't there, but even at the biochemistry level.

They point out that four neurochemicals play a major part in what happens during dreaming--and in the psychotic brain: serotonin, norepinephrine, acetylcholine, and dopamine. Many of the psychiatric drugs fiddle (with varying degrees of precision) with the levels of these chemicals in the brain. Similarly, alcohol, cocaine, and amphetamines also fiddle with the levels of these chemicals in the brain (pp. 120-3). They make the case that where dreaming is driven by signals from within the brain (perhaps part of the process by which the day's inputs are processed and sorted by the hippocampus pp. 142-3), psychosis is driven by external signals.

Some years back, Drs. Hoffer & Osmond, two Canadian psychiatrists, were arguing for a model of schizophrenia in which the failure of the brain to properly convert norepinephrine played some part in the sensory confusion schizophrenics suffer. One of the doctors took norepinephrine for asthma--and a spoiled batch of it put him in his own hospital with schizophrenic like symptoms for several days, before he recovered. My research for my next book indicates that this theory is now pretty well discounted, but some of the current research is at least in the neighborhood--and fits well with Hobson and Leonard's discussion.

Latent Inhibition, Processing Power, & Schizophrenia

Latent Inhibition, Processing Power, & Schizophrenia

About a year and a half ago, I linked to an article in Science Daily about how it appears that creative people have less "latent inhibition" than the normal person. This enables creative sorts to continually re-evaluate new data for patterns and information. It also appears that schizophrenics (who are disproportionately intelligent and creative) completely lose latent inhibition as the schizophrenic breakdown happens. No surprise: the senses turn traitor for a schizophrenic.

I'm reading J. Allan Hobson and Jonathan A. Leonard, Out Of Its Mind: Psychiatry in Crisis (Cambridge, Mass.: Perseus Publishing Group, 2001) at the moment. It's a call to refound psychiatry based on the emerging biochemical brain research, away from the failure of psychoanalysis. They make an interesting point that fits into the latent inhibition issue, and that is that our senses are rather more narrow than we sometimes assume. For example, while your eyes see a very wide angle, there's really only good detail in a pretty narrow range of a few degrees. Try to read the sentences of a book anywhere but immediately where your eyes are pointed, and you will see this.

A likely reason for most of these limitations is that the brain had to evolve with its receiving capacity and processing capacity more or less in step. If the brain received more information that it could use, this would have no immediate survival value and might prove detrimental. Put it more strongly, many of the severe restrictions on what the human brain receives may well have survival value, because instead of prompting the brain treat lots of incoming information superficially, they position to perform incredibly elaborate analyses on a relatively small incoming flow of data.

If you think about this for a few seconds, you can see why a person of normal intelligence needs filters (such as latent inhibition) to keep their miserable little 386-like processors from being overwhelmed, while very intelligent people, who have brains more like an Intel Duo Core processor, can handle more data without crashing. But while there's a difference between having the equivalent of a 100 megabit Ethernet connection into your brain, and a gigabit Ethernet connection--a terabit connection might crash even the smartest of brains.

I mentioned a few weeks ago that I had visited the little coastal village where my mother and brother now live. It's a small town, and from going out walking with my brother, I think it's a good place for him, for the same reason that small towns are generally good places for those suffering from mental illness. Watching his interactions with townspeople, it was apparent that many of them could tell that something isn't quite right with Ron--but they know him well enough that they didn't seem to be afraid. I also saw a lot of kindness, of the sort that you would expect in a small town, where people can see that someone has something not quite right.

In a big city, you don't get to know someone well enough to figure this out. Once you have identified a stranger as mentally ill, you have just enough information to be concerned, but you are unlikely to have enough interactions with that person to develop confidence that you know whether this person is likely a threat or not.

At least some of the people I saw interacting with Ron, because of some of the odd things he says, acted like they were assuming that he was retarded. But he notices things that I don't. We were walking down the street, and he pointed to an oddly shaped metal plate in the sidewalk, at the corner. He asked me if I knew what they were. I wasn't sure, and guessed that they were some sort of manhole cover of an unusual design. He grinned and said they were for blind people, to tell them when they had reached the street. Sure enough: "Braille for the feet."

I've Joined The Pajamas Media Stable of Writers!

I've Joined The Pajamas Media Stable of Writers!

Here's a piece that they just published by me about mass murder, mass media, and the failure of deinstitutionalization. And they pay me, too!

Mental Illness & Violence

Mental Illness & Violence

Unlike the man being held in Pittsburgh, the person who committed suicide after murdering thirteen people in Binghamton, New York, was clearly mentally ill, probably paranoid schizophrenic. From the April 7, 2009 New York Post:

"I am Jiverly Wong shooting the people."

Those chilling words begin a disturbing, unhinged letter mailed to a Syracuse TV station -- along with Wong's driver's license, gun permit and photos of him posing with pistols -- last Friday, the day Wong massacred 13 people at a Binghamton immigrant-assistance center before killing himself.

...

The letter unleashes a slew of bizarre, paranoid accusations against police officers whom Wong, 41, believed were persecuting him, repeatedly breaking into his room, stealing from him, causing him to lose his job and trying to stage a car accident with him 32 times.

"Cop bring about this shooting. Cop must responsible. And you have a nice day," the letter ends.

The missive -- whose outlandish claims are unsupported by any publicly known facts -- suggests Wong was deranged.

His only known interaction with authorities came when he pleaded guilty to forgery in Los Angeles in 1992 and served 100 days. Police in Binghamton have also acknowledged they had received a tip that Wong had been smoking crack cocaine and was plotting to rob a bank before the shooting, although he was never arrested.

The full letter is visible here. It reminds me of some of the graffiti that used to be done by a schizophrenic that I knew slightly in West Los Angeles in the 1970s, although she was obsessed with religion.

The forgery conviction is curious, since Wong had somehow obtained handgun licenses in New York State. While not as hard as New York City, police in the rest of the state have nearly unlimited discretion as to whether to issue such a license. A friend's uncle who lived upstate attempted to get a license for a third handgun, and was told that he had enough; they weren't going to issue another such license. Now, a forgery conviction alone would not preclude Wong from obtaining a license--since forgery isn't a felony in California--but considering how tough the Sullivan Law makes getting a handgun license, it is a bit strange that Wong managed to get one.

I am a little surprised that Wong's mental problems did not come to the attention of the authorities in New York some time back. I am even a bit more surprised to see that they received reports that he was "smoking crack cocaine and was plotting to rob a bank before the shooting" and did not go out and revoke his handgun license.

I'm not a supporter of New York style gun control laws--but what is so utterly amazing is that even when police enjoy nearly unlimited authority to control guns--they so seldom use that authority against people who give reasonable people reason to be concerned. I'm thinking of Thomas Hamilton, who murdered 17 people (mostly kids) in 1996. In spite of having a long list of complaints about Hamilton's creepy interest in little boys, and that Hamilton was not a member of a gun club (a legal requirement for handgun ownership in Britain)--the local police made no effort to disarm him.

Even when their authority is limited, I am astonished at the reluctance to follow the law, such as the recent case of Jeremy Hobbs, whose Idaho concealed handgun license was not revoked after he was charged with battery (a disqualifying violent misdemeanor)--and went on to shoot someone to death in a bar fight while awaiting trial on the battery charge.

If police won't use the authority to disarm those who give indications that they are dangerous--while putting major obstacles in the way of people who aren't a problem--why bother with the whole process?