Psychosis is Not Normal – A Psychiatrist Responds

By Dr David Laing Dawson

This morning I witnessed a taxi pull up to a doctor’s office stopping as close to the entrance as possible. The cabby got out, went around to the passenger side and gently helped an older woman ease her way to the pavement. He then took her by the arm and slowly helped her up six stairs to the front door. He opened the door for her and only left when he was sure she was safely inside. All of this in a cold rain with remnants of snow and ice on the blacktop.

My despair for humanity is momentarily lessened.

But I must go back to a brief history of mental illness treatment as a response to Ms Nanos’ guest blog and some of the comments that it received.

When Medicine had only a few potions and surgeries that actually worked on any illnesses (let’s start somewhere in the early 1800’s) the severely and persistently mentally ill were hidden by their families, left to die in the streets, jailed, banished, punished, or they found their way to Asylums created by religious groups (Quakers, Sisters, Brothers).

Though Medicine had little to offer at the time, doctors were invited into the Asylums to help. These doctors became known as Alienists. (I’m not sure if it was a term of endearment or prejudice)

Fast forward through revolutions, civil wars, the industrial revolution, urbanization, massive population growth, the State taking over the Asylums, and the age of science. Scientific medical advances (the disease model) eventually led to the successful treatment (more importantly the prevention) of many things, of many illnesses other than mental illness, though a scientific approach did lead to a delineation of specific mental illnesses still quite valid today. And of course the Asylums grew along with the urban populations.

All that was tried to treat severe mental illness (from rotating chairs and cold baths to insulin coma and numerous varieties of work, rehab and talking) failed. Though at least through this time (about 1870 to 1950) there were some kinder periods when the Asylums lived up to the meaning of the word, and other less kind periods (wars, economic depressions) when the Asylums (evolving through titles of Asylum, Hospital for the insane, Provincial or State Hospital, to Mental Hospital and Psychiatric Hospital) at least provided three square meals and a bed to sleep in for many who would not otherwise survive.

With so many advances in scientific medical treatment developing, academic medicine (with some exceptions) lost interest in the untreatable population inhabiting the mental hospitals. Religious explanations for their existence (demonic possession for example) no longer sufficed, so it is no wonder, through the 1930’s, 40’s, 50’s, and 60’s, a plethora of psychological, sociological, familial, genetic, and conspiracy theories developed to explain psychosis, mania, depression and insanity. The new Medical specialty, Psychiatry, remained aloof. Academic and private practice psychiatry focused on the worried well, the neurotic, the anxious, the despairing and moderately depressed. They stayed clear of the mental hospitals, with a few exceptions when they brought and applied a variety of psychological and psychoanalytic theories to some wards of these Asylums and failed dismally to make a difference in actual outcome of illness, though probably bringing some improvement to many lives.

But then quite suddenly (1950’s and 1960’s), and mostly accidentally, medications were discovered that actually work: Medications that calm severe anxiety, obsessions and compulsions, that overcome severe depression, that level the profound mood swings of manic depression, that quell delusional grandiosity, and that actually work for the most puzzling and debilitating mental illness of all, schizophrenia.

The second world war was over, good economic times had arrived, our medications worked and we all looked forward to an era when mental hospitals would no longer be needed.

Paradoxically as the medications worked, and many people who otherwise would be living within the shrouds of psychotic illnesses were now functioning as independent citizens, the causality conflict between nature and nurture intensified, as did the calls to abandon the disease model.

Now I should note that Medicine (Doctors) have always over reached. When we have something that works on one problem we try it on another. At least we do this until the studies prove that it doesn’t work for the second problem.

But I think the real reason for this intense anti-psychiatry movement is two-fold: on one hand pharmaceuticals that work to change mood and thought, plus more and more sophisticated ways of watching the brain do what the brain does, undermine that last vestige of hope and desire that each of us is more than “a sloppy bag of mostly water with a limited life span”.

And professional aspirations and jealousies of status and turf.

Fast forward again (2000 to 2020) and we find our fear of psychiatry, plus the aspirations of growing numbers of psychologists, plus politicians jumping on ways to save money, (or shift costs to other jurisdictions), plus identity politics, plus changes in societal attitudes that are hard to fully understand from inside…..have left us in the disheartening position of having a mental illness treatment system worse than it was 40 years ago.

Or, as a colleague warned 30 years ago, we are heading for a time “when the good schizophrenics will get good treatment and the bad ones get none”. By that he meant, if I must translate his words into today’s reality, people with mental illnesses that respond to medication and who remain compliant with treatment and develop enough stability and insight, and have sufficient family and community support will get good treatment and helpful counseling and rehabilitation services, while those who don’t will be left to the streets and the jails.

And he wasn’t even considering the “Recovery Movement” and the plague of euphemisms that give cover for this disgrace.

The other night we had an Opening at the gallery: Live music, glasses of wine, a table of food and a growing crowd of art lovers. Then two young men wandered in. The leader was bundled in bulky parka over a hoody, drooping pants, multiple sweaters of varying length, with wild hair flailing beyond his parka. He was also carrying a very large rock partially wrapped in plastic. The second young man was gaunt, undernourished, stiff in his movements and vacant of eye.

They gravitated to a sitting area and a small bowl of chocolate bars. Others left the area and I got them sitting on a couch and I sat with them, between them. They quickly demolished the chocolate bars, dropping the wrappings on the floor. The thin young man slipped in and out of a catatonic state staring blindly and hearing nothing, unaware his nose was dripping, his face immobile, flat and blunted. He did tell me when I asked that he lived on this same street many blocks away. The other man babbled nonsense, making connections between the glass shards embedded in his rock and insects, spirits, goddesses and aliens. I offered him ten dollars for his rock but he said he wanted a quarter million. He said he has a house in Kingston, another in Mississauga, and a car somewhere in Hamilton. And his grandmother’s name is Olanzapine.

I took them to the food table but the lean one stood immobile over the cheese tray dribbling from his nose and the other bypassed the toothpicks and forks to stick his hands in the pickle bowl so I sat them down on a bench and brought them a plate of cupcakes.

And then I saw them on their way. The gaunt one headed for the door but the other held him back to choose a coat off the rack. I was satisfied the coat they chose was theirs and not that of a guest because it exuded the same odour that they did. And I wished them a good night.

But, ahh I thought, how much they would benefit from a month or two at the old Hamilton Psychiatric Hospital, or any other 1985 psychiatric hospital, with a warm bed, food, shower, activities, routine, the right medication, good counsel, and seamless follow up with regular outpatient care.

And here are two women with schizophrenia who talk about their difficult journey

And these are families asking how to help their ill relatives

7 thoughts on “Psychosis is Not Normal – A Psychiatrist Responds

  1. Sad that the two mentioned are not getting much needed help and support. WE live in dreadful times when the obvious is avoided. These people are ill and not free spirits. I am tired of the “plague of euphemisms ”

    Thank you for your article… But you may be… “a sloppy bag of mostly water with a limited life span”. I prefer to think of me without the sloppy. There but by the grace of Goddot or what go I. And who are these crack pots who talk incessantly about recovery? One does not recover from diabetes ! in the sense that one does not have it anymore. One treats and stabilizes what is otherwise a life threatening condition.

    But there you have . And the man with the “home in Kingston” ….it is likely a tumbled down shack in the bushes near the Rideau Canal And very cold and bleak it is too. And the baggy trousers ring a very definite and sad bell. I am struck always that these ill people are mostly survivors but they need a lifeline and real care. Asylums for the most part were infinitely better than what they presently endure. Sad sad sad.

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  2. “Or, as a colleague warned 30 years ago, we are heading for a time ‘when the good schizophrenics will get good treatment and the bad ones get none.'” I think we are already there. I am 100% sure that my 27-year-old son, who is compliant and stable, would be on the streets if it weren’t for my constant advocacy. Keeping him “independent” is almost a full-time job. That’s the issue – helping severely mentally ill people live meaningful lives is VERY time-intensive. I don’t know how our society can invest the time needed, realistically. 😦

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    1. Many are on the streets now because there is denial about the nature of the illness. The time that is wasted because of that denial leads to a great deal of suffering and costs in the justice system . It should be possible to address the needs in the heath care system for the most part. But society has been led astray by certain movements dating back to at least the mid last century . The irony is that we have many more tools to treat than prior to that. Also though the biology is not clear yet we certainly know far more about the human brain now. I recommend Madness in the Streets by Rael Isaac and Virginia Armat. They tell the story of being mislead by such leaders of various antipsychitry movements.They also tell of the complicity of policy makers in this story. who thought that they could do things on the cheap. NO where to go by Fuller Torrey also outlines these follies.

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  3. The author fails to mention that in developing countries, the WHO researchers concluded schizophrenia patients enjoyed ” an exceptionally good social outcome, ” whereas living in a developed country was a “strong predictor” that a person would never fully recover.

    https://www.psychologytoday.com/ca/blog/mad-in-america/201005/schizophrenia-mystery-solved

    The author fails to mention that there is already supporting evidence in America that people have made full recoveries from schizophrenia (without drugs), which includes my own case.

    The author fails to mention that many people with mental illness have been harmed by psychiatric drugs and no longer trust psychiatry. These so-called psychiatric survivors are someone’s mother, brother, doctor, friend, anyone.

    The author fails to say that the pharmaceutical companies dominate research, fund several mental health organizations, and are making billions of dollars in profits off a disease that doesn’t even exist.

    The author fails to include the thousands of mental health professionals that are working towards changing the current treatment model in hopes of providing better care for their patients.

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    1. And if you believe everything that Robert Whitaker says then you are being taken for a pretty rough ride along with many more and you may who follow fads. Many will slip through the cracks because of statements made by Whitaker and his followers.

      Yes there are faults with the Big Pharma, but if you have an illness it needs treatment. Schizophrenia is a medical condition as is Diabetes I and without proper treatment almost always the person flounders. You need to read more widely on the subject to get a more balanced view of what is needed by way of treatment.

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      1. It might be helpful for you to read more about recovery from schizophrenia without medication? As for Robert Whitaker, he is one of the many experts on mental illness who have researched psychiatric drugs and found them to be harmful.

        For starters, here is an article from Psychologist Ronald Bassman, once diagnosed and treated for schizophrenia.
        https://www.psychologytoday.com/ca/articles/200101/overcoming-the-impossible

        As I stated in my previous post, many of us have recovered from schizophrenia without medications and have gone on to have successful careers and continue to lead productive lives.

        I am not anti-medication: however, I do believe that current treatment models are woefully inadequate. Labelling mental illness a brain disease is a disservice to sufferers. What we need are more treatment centers that focus on treating the whole person rather than just the brain.

        Liked by 1 person

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