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Why Can't Prime Time Understand Schizophrenia?

Posted: 09/08/2012 8:41 am

When I first heard that the U.S. cable channel, TNT, was producing a series about a neuroscientist with paranoid schizophrenia called Perception, I was ecstatic. Finally, we're going to see someone with schizophrenia who is not a crazed killer but is, like many with schizophrenia, doing well. Then I read the description of the show and was appalled. Last night, after watching it on the Bravo network in Canada and I was even more appalled.

The writers seemingly got halfway through "Psych 101" in college, dropped out and went on to write for television -- such is their understanding of this very serious mental illness.

Eric McCormack plays Dr. Daniel Pierce, a neuroscientist with paranoid schizophrenia, who is recruited by the FBI to help solve complex cases. As the official website says, "he struggles with hallucinations and paranoid delusions brought on by his schizophrenia. Oddly, Daniel considers some of his hallucinations to be a gift. They occasionally allow him to make connections that his conscious mind can't yet process. At other times, the hallucinations become Daniel's greatest curse, leading him to behave in irrational, potentially dangerous ways."

What we see in the first episode is that his hallucinations are actually rather benign imaginary friends who appear to the star with clues to help him solve the mystery. I'm told that nobody who actually suffers from schizophrenia ever has fully formed visual hallucinations of friendly people who counsel them wisely. In reality, hallucinations, mainly voices, tend to be negative, mean, demanding and distracting. They often tell the victim to commit suicide or to harm others. And this is only one of the symptoms of schizophrenia. There are also delusions, cognitive loss and paranoia.

As a contrast to this show, I would suggest that readers listen to an interview with a real neuroscientist with paranoid schizophrenia on National Public Radio in Athens Ohio, Erin Hawkes. Erin lives in Vancouver and is the author of When Quietness Came: A Neuroscientist's Personal Journey With Schizophrenia. She begins her book describing how the nasty voices ordered her to kill herself and were so insistent that she complied. Fortunately, she didn't succeed and was hospitalized for the first of over a dozen times until she finally found the right medication that allowed her to continue on with her life.

Erin's experiences are far more common than the benign visions of Perception's hero. But, what I found most galling about the show is that our hero does not take medication to quell his symptoms by choice and gives a lecture to his students at the end telling them that while medication will take away the symptoms we may be robbing people of what makes them unique -- their hallucinations and delusions. Reminds me of the social work professor at the University of Ottawa who thinks that "untreated schizophrenia can be a gift, and that in other cultures, hearing voices is revered as a bridge to the spirit world."

Erin has a different view. As she wrote in The Tyee:

Without medication, I fall into psychosis. My question, then, is this: are my medications changing my brain for the better or for the worse? What I care about is the quality of my life, my sanity, my self. If that takes a bit of brain renovation, so be it. I seem to function better with a (supposed, if I am a typical medicated schizophrenic) smaller brain and enlarged ventricles. Is such medication wrong? We cannot decide that these neural changes are more important than our lives at the behavioral, emotional and cognitive levels. What matters most to me is being well, without hallucinations, delusions and paranoia.

One expert told me that nobody who suffers from untreated schizophrenia has ever been known to function well in the teaching professions. He added that in 40 years of treating people who suffer from schizophrenia, he knows of no one who has stopped taking medication and was still employed or still attending college six months later.

So, while I applaud seeing someone with schizophrenia on T.V. who is likeable, attractive, not violent, successful vocationally, and very smart, it would be nice to see his illness portrayed realistically. Maybe I'm asking too much from T.V. but very often T.V. shapes people's thinking about issues.

I've seen realistic portrayals done with other illnesses on T.V. Michael J Fox struggles realistically with his guest appearances on the Good Wife because he suffers from Parkinson's disease. A number of years ago, we even saw a surgeon on one of the T.V. shows with Tourette's syndrome. He was able to keep his ticks under control while operating but his full blown illness was depicted rather realistically. Aspergers syndrome is well portrayed on Parenthood along with the impact on the young boy's parents.

Those with schizophrenia are often portrayed realistically on other cop-type shows like Law and Order but it is rare to see someone with schizophrenia on any of these shows struggling successfully and coping. Its about time that we had a realistic portrayal of schizophrenia in prime time showing the reality that many with proper treatment can and do lead reasonably normal lives.

 
 
 

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07:40 AM on 09/17/2012
2/2 He further states that only recently has some evidence been found which may support this particular hypothesis---To Insel's credit, he stops short of stating the research has found any definitive answers; but he implies that the bio-disease hypotheses are the only direction research should be focused--AND THAT is inexcusable and an entirely unscientific decision. Insel even making such statements is an abuse of his authority. It appears as if Insel is proposing that research should be directed by his personal belief in the bio-disease HYPOTHESIS. To me, that is evidence Insel's judgement is irreparably compromised by his personal biases.
07:39 AM on 09/17/2012
There is nothing wrong with believing in a bio-disease model. However Insel's statements do not scientifically support a belief in the bio-disease model since they are vague statements not conclusions drawn from research findings. Insel’s statements are his own personal BELIEF or statements of his personal opinion. The fact he is a scientist and a doctor who is the Director of a Medical Research facility, does not turn his opinion into a scientific finding or make it more meaningful---it remains simply an opinion. I believe it is irresponsible and even unethical for Insel to make a statement such as, "A starting point for mapping the pathophysiology of schizophrenia can begin with the increasing recognition that this is a neurodevelopmental disorder, or perhaps more accurately a collection of neurodevelopmental disorders that involve alterations in brain circuits." I believe this because of the tendency for the general public to reach the same flawed conclusion as dysdads did, who seems to believe that Insel’s statement is an scientific conclusion or finding; it is not. The fact is, Insel has a habit of making such statements which lead the average reader to draw inaccurate conclusions exaggerating or misconstruing what the statement actually means in ethical scientific terms. A careful reading of what he does say in this instance is that the hypothesis (that schizophrenia is a neurodevelopmental disorder) was first proposed over twenty years ago. 1/2
10:52 PM on 09/16/2012
Here is the direct quote from Thomas Insel M.D., director of the U.S. National Institute of Mental Health. "After a century of studying schizophrenia, the cause of the disorder remains unknown. Treatments, especially pharmacological treatments, have been in wide use for nearly half a century, yet there is little evidence that these treatments have substantially improved outcomes for most people with schizophrenia."

Yes, folks, Dr. Insel himself states that "Treatments, especially pharmacological treatments, have been in wide use for nearly half a century, yet there is little evidence that these treatments have substantially improved outcomes for most people with schizophrenia."

This quote appears in the VERY FIRST first paragraph (starting at the second sentence) of this article by Dr. Insel, published by the NIMH. http://www.nimh.nih.gov/about/director/publications/rethinking-schizophrenia.shtml

Thank you SO MUCH to Susan Inman and Marvin Ross for also providing links to this shocking quote in their comments below.
10:26 AM on 09/16/2012
I had decided not to respond to Ms Beachy's comments anymore but this outrageous misrepresentation of the views of Dr. Thomas Insel needs a response. Dr. Insel calls schizophrenia a brain disorder. Hopefully, readers will read Dr. Insel's article on "Rethinking Schizophrenia" for themselves and decide which representation of his ideas represent a "half truth".

http://www.nimh.nih.gov/about/director/publications/rethinking-schizophrenia.shtml

Ms. Beachy and her allies in the psychiatric survivor movement are not fans of Dr. Insel or any science based ways of responding to psychotic illnesses. They often prefer the psychoanalytically based work of his predecessor, Loren Mosher, at NIMH. The decades at NIMH under the Freudian model were a catastrophe and prevented progress in the brain based research into psychotic illnesses that NIMH now supports
11:10 PM on 09/16/2012
Correction #1: I believe ALL medical treatments should be based in science.
Correction #2: Loren Mosher was not Thomas Insel's predecessor at the NIMH. Dr. Insel is director of the NIMH. Dr. Mosher was the first Chief of NIMH’s Center for Studies of Schizophrenia. Yet he did not buy into the "brain disease" model of what is described as schizophrenia.
Correction #3: Dr. Mosher's work was not psychoanalytically based. Readers can read about him here. http://www.moshersoteria.com/bio-of-loren-mosher-soteria/

Here's a question, Susan. You reference "the decades at NIMH under the Freudian model"?!? This is news to me. Which decades were those?
11:25 AM on 09/20/2012
Hmm. Silence from Susan - undoubtedly because her untrue statements about the NIMH, Loren Mosher, and me are indefensible (along with the ever-growing pile of misinformation she spews).
06:06 PM on 09/20/2012
Ms. Inman,
You have a lot of nerve speaking so disrespectfully of those whom you disagree with. Your statements do not accurately represent my views, and unlike yourself, I won't speak for anyone else. Frankly, due to your myopic views, you have no idea what I am a "fan" of; so instead of even attempting to have an open mind, and find out; you choose to denigrate and misrepresent those whom you disagree with. FYI I respect science and I value it. That said, characterizing Insel's belief in the bio-disease HYPOTHESIS as science is laughable. He further believes that the evidence to support it will be found just around the corner if we just "stay the course." This is not science, but is a hopeful belief--for which there is not yet evidence for--making it an illusion. Before Insel's Translational Science endeavor can get off the ground, there must be actual SCIENCE to translate. In the future, if you're going to talk about history of the NIMH, at least use ACCURATE information---Your statement the NIMH was under the Fruedian model for decades is so inaccurate it is laughable. FYI because Loren Mosher's Soteria project was a success, He was FIRED because there is no $$$ to be made in non-drug treatments! BTW he head of Schizophrenia research at the NIMH, not the director of the NIMH--
08:54 PM on 09/14/2012
Marvin says people who are out of touch with reality (whatever THAT is) “deserve to have their illnesses recognized early and to receive proper treatment.” What is “proper treatment?” Surely Marvin cannot mean conventional psychiatric treatment. The director of the U.S. National Institute of Mental Health, Thomas Insel M.D. says, “Treatments, especially pharmacological treatments, have been in wide use for nearly half a century, yet there is little evidence that these treatments have substantially improved outcomes for most people with schizophrenia.”

Marvin also refers to “all the neuroscience evidence that this is a disease of the brain.” Yet Dr. Insel states that “After a century of studying schizophrenia, the cause of the disorder remains unknown.” So, we don’t even really “know” that schizophrenia symptoms are caused by “brain disease.” We simply do not know for sure the cause of these extreme mental states.

I agree with Marvin that society needs to deal with “serious mental illness” in a more rational way. Let’s start with honesty. Let’s ditch the fear-mongering and half truths which saturate the blogs of the pro-forced-drugging crowd.

One more thing, there are no diagnostic tests for schizophrenia. There is no way to prove that somebody has a case of "schizophrenia." So how can it be moral to treat a "disease" that we can merely GUESS somebody MIGHT have, with drugs that may or may not help but might do a great amount of harm?
10:20 AM on 09/16/2012
I suspect that you are taking Dr Insel's comments out of context. Later in that same article he states: "This neurochemical view of schizophrenia yielded medications that transformed the treatment of psychosis, allowing patients to be treated outside of hospitals and, in some cases, resulting in remission of the major symptoms of the illness."

He also states that "Although there can be little argument that medications have transformed the treatment of psychosis, research focusing on the drugs instead of the illness has thus far yielded too little progress on the pathophysiology of schizophrenia"

As for causation, he states "A starting point for mapping the pathophysiology of schizophrenia can begin with the increasing recognition that this is a neurodevelopmental disorder, or perhaps more accurately a collection of neurodevelopmental disorders that involve alterations in brain circuits."

The entire article can be read at http://www.nimh.nih.gov/about/director/publications/rethinking-schizophrenia.shtml

And yes, there is no diagnostic test for schizophrenia but there is also no diagnostic test for Parkinson's Disease, Alzheimer's Disease, MS, ALS and more. Does that mean that no attempts should be made to treat or to ameliorate the effects of symptoms?
01:13 PM on 09/17/2012
dysdads (a.k.a. Marvin Ross)

People should not be aggressively, forcibly, and/or thoughtlessly subjected to iffy long-term drug treatment for ANY kind of condition (physiological or psychological), especially if that treatment could be potentially harmful. That is my point, which is not hard to understand.

And no, I did not take Dr. Insel's comments out of context. It's all there in the short introductory paragraph of his article. Thanks for providing a link to that article. Readers need look no further than the first paragraph to find the statements by Insel which I mention.
03:51 PM on 09/12/2012
Mr. Ross,
Thanks for clarifying your status. BTW, How is a reader supposed to know that dysdads is you? Why not Marvin Ross? My comment about your bio pertains to the Huffpo site. It's great that you disseminate information about your status as a father on your book, but shouldn't the Huffpo site also reveal the information?
...Rossa
07:59 AM on 09/11/2012
I have a question for Marvin Ross. Have you ever been employed, directly or indirectly, by the pharmaceutical industry? Speaking engagements, honoraria? Your zealous endorsement of all things pharmaceutical and dogged determination to portray the unmedicated schizophrenic as a monster in need of the heavy hand of the state rightly raises the question. Somebody accused you in a comment in a different post of having worked for Pfizer. Another commenter said you didn't, but could you confirm or deny this in addition to answering my first question?

As you have been personally impacted by schizophrenia in a family member, why is this information not in your bio? I have been impacted by the "diagnosis" of schizophrenia in my son, and I am appalled how determined you are crush the hopes that he and others have of leading a productive life, not a lengthy half-life of chemical dependency and dependency on social services. My daily mission is to empower my son with healing words, not words that tear down an already fragile self-esteem.

You wrote:
"One expert told me that nobody who suffers from untreated schizophrenia has ever been known to function well in the teaching professions. He added that in 40 years of treating people who suffer from schizophrenia, he knows of no one who has stopped taking medication and was still employed or still attending college six months later."
10:54 AM on 09/11/2012
Ms Forbes, I am not employed by the pharmaceutical nor have I ever been employed by the pharmaceutical industry as I've said in some of my articles on Huffington Post. I do not now or in the past, get grants from them.

The description of my own book, Schizophrenia Medicine's Mystery Society's Shame, states "Written by a medical writer and family member of someone suffering from schizophrenia". This is in the description of the book on Amazon and all other sites that sell the book and on the Ingram (the distributor) description for the book.

In addition, I publish three books by people with schizophrenia and all of those books talk about their recovery and attempts at recovery. I will be bringing out a fourth book in the Spring of 2013 by a mother with schizophrenia and her daughter talking about the struggles they both had with the disease and being the child of someone with the disease.

I have also produced two documentary films on schizophrenia. See http://www.cuttingforstone.com. My goal in all this is to try to help increase the awareness of this terrible disease and the struggles that people with the disease and their families endure. I do not want to see people suffer needlessly and to be forced to live on the streets homeless or to wind up in jail because our society does not provide proper treatment and support. Part of the treatment is medication but that is not all that is needed.
09:01 PM on 09/14/2012
Marvin's "expert" must have never heard of well-known cases of recovered "schizophrenics" who don't take psych drugs like Daniel B. Fisher, Keris Myrick, David Oaks, Eleanor Longden, John Nash, Leah Harris, Will Hall, etc. The list goes on and on and on.
12:50 PM on 09/10/2012
In terms of the character in "Perception" - he seems to be more of a bipolar I (as he exhibits prominent manic symptoms - bouts of sleeplessness, heightened productivity, rapid thoughts) w/occasional hallucinations (auditory & visual, but exclusively "friendly in nature"). He does not have delusions as he is aware that the "friendly therapist" is not real. If schizophrenic, he'd probably be categorized as "undifferentiated type", but since there is presence of manic symptoms as well as high functioning, he would more closely be indicative of a bipolar I.
12:50 PM on 09/10/2012
I would like to stress that what I am about to say/write in no way minimizes nor disputes the experiences of schizophrenia, as commented by previous posters. I believe that schizophrenia itself is widely misunderstood, as well misdiagnosed. There are not only several types of schiz, but the criteria for diagnosing it are also not perfectly clear. One of the criteria demands that the person diagnosed show marked deterioration and/or inability to function in normal life (e.g. work, school, relationships) compared to functioning prior to the diagnosis. I have worked in an acute mental health facility (patients could stay up to 10 days until they were stabilized, and then would be released w/medication) where many times prominent psychiatrists misdiagnosed a patient w/schiz due to incomplete patient history - as the only apparent symptoms were psychotic in nature (hallucinations and delusions). As some patients returned to the facility several times, the complete symptomatology could be observed, and many times these patients were re-classified to bipolar I, or major depression w/psychotic features. Additional difficulty w/properly diagnosing schiz patients is in the medications used to treat the disorder; medications that are also used for treating bipolar (I & II), and major depression (w/psychotic features, as well as a recurrent or treatment resistant major depression). As with all psychiatric disorders, functioning is very different in different patients - and sometimes the only indicator of the true diagnosis.
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11:18 AM on 09/10/2012
What's really tragic is that anyone can form an opinion, however wrong, and be given a platform. Much like yourself, Mr. Ross.

You've been talking to the wrong "experts" if you think no one ever lives well with schizophrenia without medication. Long term outcomes are better in countries where medication is used less often and less aggressively.

There are those with "schizophrenia" who will need medication. But there are also those who won't need a lifetime of continuous drugging to function.

"Furthermore, anti-psychotic drug treatment is associated with the induction of irreversible brain pathology (resulting in reduced intellectual and abnormal motor functioning) and shortened life expectancy. Pre-neuroleptic drug era long-term follow-up studies indicate that recovery can not only occur, but is to be expected in the majority of cases. Ergo, so called “chronicity” in “mental illness” is likely the result of its medicalization, institutionalization with its social network disruption, marginalization, discrimination and the less specific social consequences (e.g. poverty) that accompany these processes."

http://www.moshersoteria.com/articles/biopsychiatric-model/

http://www.psychminded.co.uk/news/news2009/april09/schizophrenia-psychosis-medication003.htm
10:24 AM on 09/10/2012
There is a lot of research to show that the majority of voice hearers are not in contact with psychiatric services, and live with their voices and a well - many people regard their voices as gift.

Research shows that hearing voices is a relatively common experience, reported by 5 to 10% of the general population. Findings from international studies also demonstrated that voices could be experienced in many different ways, from positive and enriching to negative and distressing.

Hearing voices is not only related to schizophrenia, in fact it has been associated with depression, PTSD, anxiety & many other conditions and also none at all (in that you can be healthy and hear voices).

Medication is only effective for some people who hear voices, a third of people taking meds continue to hear voices at the same level - sometimes worse.

Voices act as messengers for unresolved emotions, the hearing voices approach encourages people who hear voices to understand more about their voices and to learn to live with them.

Re. academics: Eleanor is a psychologist, not so long ago she had been written off as a incurable chronic schizophrenic, her doctor told her “It would be better if you had cancer”, a young woman so overwhelmed by hearing voices she tried to drill a hole in her head to get rid of them. With help Eleanor got her life back. In this TED lecture http://talentsearch.ted.com/video/Eleanor-Longden-Learning-from-t;discussed Eleanor, explains how this can be achieved.
09:59 AM on 09/14/2012
Thank you so much for posting this short video about Eleanor Longden, who overcame a diagnosis of schizophrenia. Her story is so inspiring and so hopeful! It seems she had to ditch mainstream psychiatry and its drugs in order to find healing. Here's a print version of her story: http://www.independent.co.uk/news/people/news/a-firstclass-recovery-from-hopeless-case-to-graduate-1808991.html

Eleanor's psychiatrist, Dr. Pat Bracken, states, "As professionals we need to help people who are depressed or dominated by voices to find a path out of that state. That could be through medication, therapy, religion or creativity. It is completely wrong to try to use one template for everyone."
10:02 AM on 09/14/2012
BTW, VoicesUnLtd, thank YOU for the important work you do helping folks who hear voices. Readers could benefit from learning more about how InterVoice helps people with damaging psychiatric diagnoses. So here's a link: http://www.intervoiceonline.org/

Another helpful organization is the Hearing Voices Network: http://www.hearing-voices.org/
04:00 AM on 09/10/2012
this is absolute rubbish. I have known many people recover from schizophrenia and leave anti psychotic medication behind. My own husband is a prime example and has been teaching for 17 years since recovery. Even all the the medical research at best say that only 10-30 % of people need to stay on medication for life look at John Watkins book healing schizophrenia.Loren Moshers research on Solteria house clearly showed that people not on anti psychotic medication 6 months after the crisis were doing far better and further on there recovery journeys than those still taking medication
There are many campaigners both with in the psychiatric field & without calling for the abolition of the label schizophrenia as it is unscientific and unproven.
it is the medication which is debilitising. Psychosis is very clearly in many cases linked with chidhood trauma. Once the trauma is dealt with and the emotional aftermath people can & do get on with there lives. From every thing I have heard about this programme it is great for us to get a chance to see an un -sterotyped image and story lines long may the show continue
02:25 PM on 09/09/2012
"One expert told me that nobody who suffers from untreated schizophrenia has ever been known to function well in the teaching professions. He added that in 40 years of treating people who suffer from schizophrenia, he knows of no one who has stopped taking medication and was still employed or still attending college six months later."

wow, I know a lot of people who are thriving who had what is often labeled as schizophrenia. They hold jobs and no longer need medication. It's horrifying that someone who calls themselves an expert have never heard of such people.

I have a list of stories some of these people's stories here. Among them is a man who is Harvard educated and a practicing lawyer, another is an RN, yet another a psychotherapist...lots of other stories of folks too...I don't know all of their professions.

See: Psychosis Recovery http://beyondmeds.com/recoverypsychosis/

it includes books and websites etc that share the fact that people do recover and live med free quite often...it's tragic to disallow the possibility because it happens, but it's not likely to if one is never told it's possible.
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10:11 AM on 09/09/2012
I have been part of the "mental health community" my whole life. I have a family member with schizophrenia, I have friends with schizophrenia. No one I know with the illness has ever described to me the symptoms as a gift. Having experienced psychosis myself I can think of no greater terror. There is no joy in that. Having said that person with schizophrenia with support and proper treatment is fully capable of leading a productive life: working, leading a family, having friends, etc.
There are many "Hero's" in the mental health community who fight against terrible odds with horrible illnesses and defy the stereotypes we are fed on T.V.
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09:49 AM on 09/09/2012
Great post, and terrific comments here. My son Ben, age 30, has schizophrenia - and if his life turns out like the fictional Dr. Pierce - beautiful home, great job, management of his illness with just a "personal assistant" - well, that would be awesome.

The reality? Let's just say: not quite yet.

Living a successful life with schizophrenia is possible - I do know some older people who have somehow gotten to a place of self-management (yes, sometimes even without meds, but not without other careful safeguards, and often not without relapse). My son, however, is not yet there. For now, we remain so grateful for the small, secure steps he takes, at his own pace and definitely with the support of his meds.

to mp905: yes, with schizophrenia, in time, a job is possible. Ben has been employed for over a year, is also in school, and for the first time in about a decade, he has some realistic ideas about his future. Still - this plan is built on the treatment he must continue to receive.

Living alone? Not yet. This goal can be over-rated. Heck, even the fictional Dr. Pierce needs a house-mate.

Most frightening inaccuracy, I agree, are those helpful friendly voices. There was one recent episode of Perception that showed another young man with schizophrenia who clearly did need his meds. That was closer to life than the main character's weekly love-fests with his beautiful female invisible therapist.

Someday they'll get it right.