Arizona Tragedy - WWYD?

[I have WHAT in my yard?]

I shared the story of my BIL. Well he isn't the only one I know. The reason I bring up this other story is because it is so tragic that a refusal to understand can cause such heart ache. The young man I knew (schizophrenia usually begins to become obvious in the late teens early 20s) was raised in a very close loving family. His family were very religious and were completely confused and adrift at their son's strange behavior. The symptoms were subtle at first and he just seemed odd. But, slowly he got more and more strange. Eventually, he thought he heard god speaking to him. His behavior got dangerous as he tried to compel the demons out of utter strangers. His parents sought help within the church to no avail. They tried laying on of hands and prayer circles. The prayer circles actually exacerbated his symptoms.

He went into treatment time after time. By the time he was 30 he was homeless. He was delusional much of the time and could not be committed. His parents used to contact me to locate him and check on his well being. He was on medication in the early 80s and doing as well as could be expected. He started going back to church and was told he should be able to clean himself of his illness if he simply turned his soul over to god. So he went off of his meds and tried fasting and prayer.

He was delusional within a week. He called me one day and said he was done. He knew medication could only alleviate some of his symptoms and he would never be normal. He felt like he had failed god and his family. He thanked me for all of my help and hung up. I called the police and tried to find him but it was no use. He jumped off of an overpass in front of a semi. I got called to identify him and notify his parents. But, first I spent several hours consoling the driver of the truck. I am sure my friend had never thought about the driver.

His family sent a letter to me, for the driver, telling him that they knew it was not his fault.
I was very sad about my friend, but I understood his pain and why he made the choice he did.

Here is a young man who had the best of families. He had had access to good treatment for a while, but the disease was too much for him.

I will always wonder if the person at that church ever knew what they had done.

 

[nonseq]

My step-father was a paranoid schizophrenic. Your story of your friend /\\ sounds very similar to his. His family is still very religious (some live in the longest-running Christian community/commune in this country), and my step-father committed suicide when I was 5.

 

[nonseq]

"It is entirely possible, though, that in families with alcoholism and other chaotic issues in the parents, that the real reason the family member is an alcoholic, is actually an undiagnosed, untreated, mental illness. "


This is often self-medication.

 

[nonseq]

mom'sfolly :

I don't believe that the mental health issue are appearing earlier. I believe that we are getting better at identifying them earlier. JMHO. A kid who once was considered odd or a slow learner is now diagnosed with autism or dyxlexia. A lot of the symptoms of bipolar disorder and ADHD have overlap.

This isn't untainted by economic self-interest. There is often financial incentive to diagnose and treat. It's what keeps the agencies running, and it helps your stats on efficacy. Get the easy ones in and then out, and the agency looks more effective than it is.

There was an interesting bit in one of the Boston papers I think....about diagnosis and treatment of disorders in children and SSI.​

 

[welsummerchicks]

Trust me on this one: no one is overdiagnosing Schizophrenia in children. It is, in fact, rare when it emerges in early childhood. When it does, it tends to be rather severe and obvious.

Further, no one is over-treating for schizophrenia. In fact, research indicates exactly the opposite, that it is a tragically under-diagnosed and under-treated illness. Similar findings exist for bipolar disorder.

These two illnesses are quite often behind our national tragedies, these shootings and other crimes. These people - the Va. shooter, the Arizona shooter, these are deteriorated, untreated, horribly sick people. Their brains are not working normally. If they were, they would not do the things they do.

Very few mentally ill people hurt anyone. But since we are not treating so many people adequately, we're bound to ALSO not treat some people who will become violent. Doctors can show you exactly what parts of the brain are damaged to cause this extreme behavior, but they can't get out there and get people to accept help!

Schizophrenia symptoms more often appear in teens and young adults. It CAN develop at any age, but the age group most at risk for emergence is teen and young adult. As many college dormitory supervisors will tell you, the first few months of college are often chaotic ones in which young people with severe disorders break down and are hospitalized. I can't recall a single college semester in our large dorm, when we did not have at least several students become severely ill with schizophrenia or bipolar disorder, and get hospitalized.

Much of the alleged 'overdiagnosis' of children and teens consists of alleged over-prescription of stimulants and other medications, supposedly without sufficient criteria for Attention Deficit Disorder and related disorders, as well as the medicating of oppositional disorders and related disorders, without sufficient criteria being met.

These disorders are legitimate ones and do exist, and are not rare. But there are those today that believe they are being diagnosed 'too frequently'.

Keep in mind though - that they are being treated to frequently, or diagnosed too frequently, is one opinion only. Another opinion is that these diseases exist quite frequently!

I think one has to be very diligent in diagnosis, and make sure a patient meets criteria, and never prescribe for convenience sake or solely because a teacher or parent demands it. Problems need to be solved in steps, and the first step is not a pill, but some very expertly directed conversation and a lot of very careful thought.

Clearly, mild cases might be treated by change of routine or other efforts. But there is nothing, anywhere, that indicates ALL cases can be treated by stricter parenting or anything else other than medicines. There are more severe cases that simply don't respond to much of anything else.

A friend of mine's daughter had attention deficit disorder as a teen. I have never seen such a troubled, miserable kid. She felt her lack of character and effort was the cause of all her troubles. Then she was treated for ADD. While recognizing what was wrong led to some 'why me' thinking, it was far, far better to know one has a condition than that one is simply lazy, not trying hard enough, or lacks moral fiber. As often happens, the illness did not last forever. She is now an extremely happy and productive adult.

I can't say the same for the kids I knew who did not get treatment.

------------------------------

Unfortunately temporary relief from being inebriated, doesn't prevent the major psychiatric disease from progressing, like the correct treatment does.

People very often go on a low dose of medication, or the wrong medication, that does not control their disease.

As they get sicker, they tend to stop taking the medication altogether.

Again, this is more a matter of under treatment and wrong treatment. The person's medication isn't working, and he doesn't tell the doctor. He just gets sicker and sicker. Especially when his disease is first starting, it can be quite irregular, and what medication and dose worked two months ago may not be appropriate now.

Too, people quite often conceal how severe their symptoms are. The doctor prescribes based on what he observes and is told. He can only do a good job if he has accurate information.

Often, depression is a more 'socially acceptable' disease, so people with psychosis may often claim to be 'depressed', receive antidepressants, and simply get sicker and sicker.

It isn't just about 'taking medicine'. It is about getting and continuing to get, the RIGHT MEDICATION.

People very often take the medication 'only when they feel bad', or take rather a lot less than prescribed.

This will NOT keep the psychiatric diseases managed!

PLUS....adherence to any medication is very, very poor. 'Compliance' in some studies, runs lower than 50% - not psychiatric meds - their compliance actually tends to be a bit higher than the norm. The norm - the NORM of taking medication, is absolutely abysmal, across the board.

The problem is that the disease itself will over-stimulate brain cells and burn them out over time, leaving the person more and more disabled and unable to care for himself or think clearly.

The most critical aspect of treatment of these diseases is protecting brain cells. With untreated people, on autopsy the brain has actually lost up to 8-10% of its apparent volume, though the worst losses occur deeper in the brain, where they're hard to detect by measuring overall brain volume - meanin the overall loss of brain cells is probably rather more than 8-10%.

There is a reason that schizophrenia used to be called 'young dementia' ('dementia praecox). Hundreds of years ago, doctors would autopsy people in those 'asylums' after they passed away, and be utterly shocked. They could actually pick the brain up in their hand and SEE the brain tissue lost, as well as feel that the brain was lighter in their hand.

Those 'voices' start within weeks of when brain cells around the areas of the brain responsible for hearing, are decimated. And I mean decimated in the old sense - it does not take damage of many cells at all, to disrupt the fine balance in the brain. When some cells are lost or not connected up to the cells they should be, the result is that some cells get too many messages and others get none. Over-signal to some cells and under-signal others - the effects on behavior and thinking are profound.

In the long distant past, the only treatment they had was to 'close off' the brain cells from the disease process - sedatives that shut down the channels to the brain cells. Now, with better treatments available, the brain cells can be protected without sedation.

In the future, hopefully VERY near, schizophrenics will be able to receive a customized mixture of medications that adjusts as their illness changes, that both protect the brain cells and help them work more normally. And far into the future, perhaps mothers and children will get vaccines that prevent the genes crucial to these diseases from copying incorrectly, and people will be saying, instead of 'I have schizophrenia(or bipolar)', 'I HAD schizophrenia...but it didn't have me'.

 

[nonseq]

I didn't know we were only speaking of schizophrenia. My bad.

I'm not arguing with you. I agree with you. But often the criteria for diagnosing a mental disorder are very subjective. My DD went from a bi-polar diagnosis to a "possible trauma/PTSD" to a Generalized Anxiety Disorder diagnosis. I think she is an addict. But I don't know if she is an addict b/c she has a mental illness or if she has a addiction that is causing her mental illness. No one knows. Her psychiatrist is a good one. Too much overlap and gray to get a definitive diagnosis. It pretty much boiled down to trying meds until the desired level of functioning was reached. Very much trial and error.

As far as small children, in the agencies I have worked at it was common to diagnosis children with ADD/ADHD (DD has this diagnosis, too) even though they had such stressful lives or just plain bad parents that this was a more likely cause of their behaviors than ADD/ADHD.

A couple of examples: Sid whose mother was convicted of writing her own scripts to feed her addiction for prescription meds. She went to jail and Sid was sent 300 miles to live with his father. After all this upheaval, he was diagnosed with ADHD and medicated. At age 12. No prior behavioral problems.

Another one, Mary, medicated up the wazoo for intractable ADD/ADHD. For years. Finally a new clinician went and observed her and recommended a hearing test. The kid was deaf.

I had two clients who were mentally retarded due to neglect as infants. Both had multiple diagnoses and lots of meds and med switching. Both were medicated to the point of no affect. It was sad. In these cases the meds were used as chemical restraints not treatment.


Psych meds themselves can screw with brain chemistry and cause psych problems especially when they are mixed. Tranquilizers can cause a psychotic break in susceptible individuals.

And what do you do with personality disorders? No one wants to treat them. A Borderline can cause a lot of damage and is usually unhappy and suffering from other problems that impair social functioning.

Like I said, I am agreeing with you. I just don't see any of this mental health stuff as being black and white or easy to diagnosis or treat.

I think we are saying the same thing. You're just saying it better. Or wordier.

 

[welsummerchicks]

I got no problem with anything you're saying, not in the least.

I wasn't talking only about schizophrenia, but as far as the diseases most often behind these tragedies, that would be schizophrenia and bipolar disorder, and I was definitely thinking of schizophrenia as relating to the Arizona tragedy.

I think the conversation came to include attention deficit disorder, as relates to 'overdiagnosis'. And alcholism and street drugs have also been brought up. Many people see these disorders as just another part of the mental health crisis in America and they often come into conversations on this subject.

'What do you do with personality disorders?' These are also 'managed, not cured' and I have a deep sympathy for any parent who has a child with this disorder. These people need a LOT of help. Some modified forms of behavioral training seem to help. Some think the major issue with borderlines is that the way their brain is wired, they experience EVERY emotion as very, very extreme. Rather than feeling something in keeping with the situation.

In the brain, emotions are created in fundamental parts of the brain as very deep, powerful, unmodulated. They then 'travel' to another part of the brain for 'tuning', being played against experience and memory and executive functions. If that whole mechanism is less than perfect, some believe that is how borderline originates.

The training for borderlines consists almost entirely of training them to provide, throuh intense and repeated practice, all the 'tuning' and 'moderation' their brain does not provide. And there do seem to be medications that help. But they are essentially asked to do something that is superhuman - 'monitor' every single thought and make a conscious, upfront decision about what action to take, instead of just going 'click-do' like most of us.

It's fairly clear to me the Arizona shooter has schizophrenia.

While I don't think that the Sarah Palin gunsites map by itself caused this tragedy, it was a part of the partisan rhetoric that VERY OFTEN attracts people who are very disordered in their thinking. Politicians DO need to realize, that if they create a map with targets on it, it is indeed going to draw someone.

The more tempered and calm the national discussions are, the less graphic, polarized, black and white they are, the less the chance that they draw sick people.

A sick person is looking for something to 'hang his hat on', something that helps to explain the inner torture he's going through. In his irrational mind, the plan he undertakes 'makes sense', but only to him.

And perhaps even an hour later, it may not make sense to him. His behavior, even his thinking, is truly out of his control. This is something that is incomprehensible to most people, but it is rather often true. Even a few minutes after the act, these people often can't understand if they thought about it, if someone else did it, or if they read about it somewhere.

But the fact is, Sarah Palin's map and the teabagger rhetoric isn't a direct cause. It is proximal only. But while I wouldn't pin it all on them, I also don't excuse that stupid map. It was an idiotic thing to do. And the vitriol that has been on the media, is also irresponsible and useless.

BUT - a disordered sick brain leads to disordered, sick behavior that in the final estimate, 'makes no sense' and is illogical. The media, the political issues, they serve as 'materiele'.

But it is quite true that without this fixation, it might have been directed at his family members, rather than strangers.

Reading his website for about 30 seconds pretty much confirmed that he has schizophrenia. The style of writing, the phrasing, sentence structure, is very typical. The disease affects ALL areas of tbe brain - even writing, spelling and sentence structure.

Watching him in court, I no longer had any doubts. None. Zip. Zilcho. Some diagnoses are pretty easy. Whether he also has bipolar features, or other problems, what medicines would help him, how severely ill he will remain if he is (kept) on medication, meaning would he continue to be a danger, would he willingly stay on medication, that's where the experts come in.

The thing to remember is that fully half of schizophrenics can't understand that they are ill. It is not 'denial', in that 'I don't want to view myself as mentally ill', it is far more like, 'I don't see it, I can't see it'. To expect a person to change this, is literally like telling a blind man, 'see!'

With that in effect, they are very, very unlikely to stay with treatment unless they are forced, and required to comply each and every day.

How he is going to feel when he realizes what he has done...I've seen that, when they are recovered (staying on medication), how they feel, the self loathing, the horror they feel every day - no one can imagine it. It is a living hell.

As far as the trouble of the 'moving diagnosis', with the disorders you were dealing with, that isn't uncommon, especially when a young person shows symptoms of several different disorders and their illness changes over time.

The mistake often made, though, with schizophrenia is, 'oh, he's not as sick right now, so he must not have schizophrenia'.

Symptoms of schizophrenia very, very often are episodic - and can occur in waves, with sometimes as much as 10 years between crises. The trick is, whether the symptoms are obvious or not, the disease process is still chugging away.

Too, the disease can start so slowly, that people don't even notice the slide from 'peculiar' to 'dangerously ill'.

It is not that they are only dangerous to others. They hurt themselves far more often than they hurt others.

Many people with schizophrenia get into situations where their disease is less obvious. It's far less obvious when people only talk to them briefly, for example. For many, as long as they can stay on one routine, they don't get too excited or agitated, and people miss what's going on.

 

[ebwy2]

here in the uk we have the right to call the police & ambulance on anyone who we truly believe is "a danger to themselves or others" and get them taken to the mental health ward until they are well enough to be released. There are lawyers who specialise in getting those who get this done to them wrongly released.

I would like to think that if I was actively suicidal or threatening others my friends and family would take me in.

 

[mom'sfolly]

The laws here in the US were written in response to some fairly horrific situations at state hospitals and with the treatment of the mentally ill. It has possibly swung too far in terms of patient's rights. The right to refuse treatment is all powerful; and involuntary commitment is extremely difficult here in the States. A 72 hour physiciatric hold is even very difficult to get. It is almost impossible to compel treatment. To make the situation worse, most insurance companies limit coverage for mental health care. In patient treatment is costly, so most insurance companies barely cover it, limit the time allowed, with a lifetime cap, and prefer a "medical" approach to treatment. This means drug therapy, as an out patient. It means that the doctor relies on the patient's self reporting for drug function. And as WelsummerChick mention, this is notoriously bad.

 

[dewey]

Arizona employs the Baker Act -- anyone can easily be involuntarily committed by being "Baker Acted" by any individual willing to sign that they observed behavior in that person that could be a danger to themselves or others (this includes making threats), which can then result in not just a 72 hour hold but indefinite detention in a mental health facility if ordered by the court, and until determined sane or no longer a danger.

People involved in less than friendly divorces or estate splits have employed it against others to gain power and control, creating a personal and legal nightmare for the one detained. After involuntary commitment by a judge's order it's almost impossible to undo in a timely manner and without very expensive legal representation.

Using the Baker Act then hoping for judge ordered longer term committment is about the only option, although it often fails miserably in instances where it's truly needed.