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Nipping Crack-ups In The Bud

Among all the hokum on the subject you get in the news these days, here comes another one. The article is entitled Scientists try to stop schizophrenia in its tracks, out of Portland, Maine, and it’s about detecting the early signs that a psychosis may be developing so that it might be stymied.

This schizophrenia “prodrome”—the early signs—involves a troubled mental state usually found in teens and young adults. It can lead to psychosis, the loss of touch with reality that marks not only schizophrenia, but also some forms of depression or manic-depression. The prodrome can linger for weeks, or years, before it gives way to psychosis—or mysteriously disappears without a trace.

Researchers have known about this warning phase for decades, but they’re still working on how to treat it. Now they’re calling in tools like brain scans, DNA studies, and hormone research to dig into its biology. They hope that will reveal new ways to detect who’s on the road to psychosis and to stop that progression.

In the prodrome, people can see and hear imaginary things or have odd thoughts. But significantly, they understand these experiences are just illusions, or they have a reasonable explanation.

This understanding is contrasted to the state of mind in a person suffering from a full blown psychosis who lacks any such understanding.

After hearing the student’s story, Ann Lovegren Conley, the family nurse practitioner at USM, put her in touch with the Portland Identification and Early Referral program, called PIER, one of about 20 clinics in the United States that focus on treating prodrome cases. PIER has trained her and thousands of other school nurses and counselors, pediatricians and others in greater Portland in how to spot them.

PIER emphasizes non-drug therapies for its patients, ages 12 to 25, although about three-quarters of them take anti-psychotic medication.

The treatment regimen includes group meetings in which patients and families brainstorm about handling the condition’s day-to-day stresses. It also focuses on keeping patients in school and in touch with their families and social networks.

How can a program that emphasizes non-drug therapies have about ¾ of its users on psychiatric drugs? There’s a contradiction involved here when they claim they aren’t promoting drug use, they are promoting drug use. I suggest that there are probably people among those in charge of this program, as well as people in the program itself, that have concerns about the consequences of using such drugs. 75% may not be 100%, but it’s a damn shot better than even 50%. I suggest that there are probably other people in charge of this program who actively encourage the use of these drugs, together with the psychiatrists who attend the patients enrolled in the program.

Then there is ‘the treatment regimen’…of ‘keeping patients in school and in touch with their families and their social networks.’ Well, their schools, their families or their social networks could be, in large measure, the source of the problems they might be having. This ‘you are wrong’ ‘everybody else is right’ approach to treatment might not be the best one to take in the long run.

Perhaps the patient would be better off pursuing another curriculum, or out of school entirely. Miserable educations can lead to miserable people pursuing miserable careers, if not nervous breakdowns, and unemployment. Families lock up family members. Sometime extending those family relations beyond the nuclear sphere of parents and siblings is in the patient’s best interests. Social groups can bully, or otherwise mistreat members of the social group to which one is a member. I tend to think that sometimes when a person becomes accustomed to certain habitual patterns of behavior that the best and most educational course of action to take is to break out of those patterns of behavior to which one has become acclimated.

The biological psychiatry theoretical presumptions of this article aside, people can be driven crazy. Should a person be in a situation that seems to be leading inevitably towards the looney bin, perhaps that person should consider changing the situation rather than put up with it. One of the precursors to this change in situation might involve walking out on the sort of program PIER provides. Sometimes one’s better judgement actually is better.