New Internationalist

The Maze Of The Mind

Issue 95

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THE DISABLING WORLD [image, unknown]

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The Maze of the Mind
IN THE United Kingdom, almost half of all hospital beds are occupied by the mentally ill and an estimated 10 per cent of the population will spend some part of their lives in a psychiatric hospital. Yet little more than 10 per cent of National Health Service spending and an even smaller percentage of medical research is devoted to those who are mentally ill.

These figures vary little across the industrialised world and they suggest that treatment for mental illness is health care's poor relation. Yet in incidence and severity, mental disorder can be as disabling as polio or blindness.

As with other disabilities, public misunderstanding of mental illness - from refusing to acknowledge its existence to telling mentally ill people to `pull themselves together' - is a barrier to both its prevention and cure. Symptomatic of that misunderstanding is the loose use of psychiatric terms such as `paranoid' `psychotic' and `schizophrenic'.

A guided tour of the main kinds, causes and symptoms of mental illness which can affect anyone - by psychiatric therapist David John.

[image, unknown] Psychoses

Depression
Everybody knows what it is to be `down or depressed. But depression becomes a mental illness when:-

There is no reason for the depression commensurate with its depth and duration. The depression continues long after the event which caused it.

The depression is the other end of a manic swing in mood.

Little is known about the causes of depression. Biochemical changes in the brain are the most likely explanation, but why these happen is still a mystery.

The main methods of treating depression are electro-convulsive therapy (ECT) and anti-depressant drugs. Sometimes the patient responds and sometimes not. Sometimes the illness clears up on its own - and sometimes it recurs.


Senile dementia
Sometimes the brain and body don't age in step with each other. If the brain grows old before the age of 60, the problem is known as pre-senile dementia - after 60 it is called senile dementia.

The patient forgets the immediate past but remembers early life. They forget people near to them, don't know what day it is, or where they are. They become confused and the intellect fails. Gradually, they go into the later stages of dementia - hoarding worthless objects like newspapers or rubbish. Aimlessness sets in - and they wander without knowing where or why they are going.

Dementia can also be caused by brain tumours, head injuries, cerebral vascular disease, Vitamin B complex dificiencies and sustained intake of drugs or poisons.

There is little chance of a cure for demented patients and treatment is usually limited to keeping them in touch with reality as much as possible, to preventing chronic physical illness, to giving the patient occupational therapy and retraining in personal habits like going to the toilet and preparing and eating food.


Schizophrenia
Schizophrenia is the most crippling and the most common of the psychoses. There are four main kinds;

Simple schizophrenia - which starts in adolescence and is characterised by lack of drive, shallowness of emotional response, and a tendency to drift. Hebephremic - which starts in early adulthood and is characterised by outbursts of continual weeping and laughter, sudden anger, and hallucinations.

Catatonic - which also starts in early adulthood but is characterised by immobility, muteness, and negative attitudes.

Paranoid - which normally starts after 35 and is characterised by delusions of persecution and vivid hallucinations.

As with all such boxes, people do not fit neatly into any one - and the picture is usually a collection of symptoms.

The causes of schizophrenia are also categorised into three main theories: Heredity -genetic disposition towards schizophrenia has been shown by identical twin studies (if an identical twin is schizophrenic then there is an 80 per cent chance of the sibling also being affected. In non-identical twins, the chance is only 14 per cent).

Environmental - family disharmony, often involving the early loss of a parent and dominance by an over-anxious mother, is though to play a role.

Bio-chemical - faulty metabolism of adrenalin plus other more complicated bio-chemical changes are also thought to be causes.

The main treatment to control this illness is drug therapy, using depot injections which last for up to a month. Usually, schizophrenics stay on drugs for the rest of their lives and are often dependent upon their families or upon institutions.

Mental subnormality is an entirely different field from mental illness. Mentally subnormal people are born subnormal - and remain so. Their greatest need is for care which allows them to reach the potential they possess and for more public understanding and acceptance.

Neuroses

The difference between neurosis and psychosis is difficult to define. In general, the neurotic is more in touch with reality and has more insight into his or her condition. The remark I most commonly hear from a neurotic is `I know it's silly but. . .'

The quick definition is that the neurotic builds castles in the sky and the psychotic lives in them. (My own tutor always added `and the psychiatrist collects the rent').

The cause of neuroses is thought to be environmental, though little is yet known about the details.

The common kinds of neuroses are:


Phobias
We all have our dislikes - of spiders, heights, crowded lifts etc. But usually these dislikes do not seriously interfere with our lives. But for someone in a phobic state, fear can wreck and rule existence. Imagine, for example, not being able to leave the house because you're frightened of being outside - or not being able to enter a room until someone checks it three times for mice.

The phobic state is usually treated by desensitisation. The patient is relaxed with a drug like Valium and is then shown or asked to re-live the fear. A person frightened of dogs, for example, would first be shown a photograph of a dog, then be shown a dog at a distance, and by the end of the treatment should be able to face an animal and even associate stroking the dog with the relaxed feeling.

The chances of cure are good, but it takes months and a good therapist.


Hysteria
Hysteria can be a physically crippling neurosis - causing blindness, deafness, fits and even paralysis. Amnesia and multiple personalties are also kinds of hysteria, and all are without any physical cause.

Usually, hysterics can be cured by relaxation therapy, psycho therapy and tranquilisers. But there is a danger that an hysteric might mimic psychotic symptoms so well that they will be treated as such.


Anxiety
Again, everyone knows what it is to feel anxious. But anxiety becomes amental illness when it begins to dominate the person's life. Tranquilisers and relaxation therapy can be of help.


Obsessional/ Compulsive states
Compulsive behaviour varies from avoiding walking on cracks in the pavement to obsessive complex rituals which can mean, for example, that the patient takes several hours to wash and dress. All of us engage in minor obsessive compulsions like doing things in a certain order. But these habits usually save time. And if the pattern is altered for some reason then it doesn't throw us completely - neither do we have to start all over again. Treatment is similar to other phobias.

Further reading:
There are many books which give a basic account of the various psychoses and neuroses. Among the most interesting is: Psychopathology and Society by Nathan & Harris (McGraw Hill 1977).

For an account of mental illness, from a non-medical standpoint, any of Erich Fromm's books can be recommended. Thomas Szasz's book `The Myth of Mental Illness' published in 1960, presents a more controversial view on the subject of mental illness.


DAVID

At the age of 45 David's life was normal. He worked as a draughtsman, enjoyed his work and was good at it. His family life was happy and stable. He liked fishing, watching TV, gardening, and having a pint once or twice a week at the local pub.

Almost imperceptibly, David began to change. He became more sociable and began inviting people home. His wife didn't mind. She too was a gregarious woman and enjoyed having the neighbours in for the occasional evening. But things did not stay at that pleasant level. Soon, she found herself coming home to a house full of people whom she had never met. Reasoning with David made no difference.

It was a long time before she realized that something was seriously wrong. The change had been so slow, taking over 3 years from the first signs of increased `sociability' to having a crowd of strangers at home. There was nothing very tangible to explain to anyone and so there had been no help or advice.

But by now she was rowing with David every night. And he seemed not to care in the slightest.

Help came in the form of the office manager who was David's boss. He arrived at the home one afternoon and found David's wife in. It was only then that she found out that he was no longer doing his work. The firm was very worried but David did not seem to be. The manager told her frankly that the sack was imminent, but that he wanted to come and talk to her first because David had been a good and conscientious worker who knew his job inside out and he couldn't understand why, nowadays, even the simplest job in the office was beyond him.

It was decided to call in a doctor who found nothing wrong with David except that he behaved in a rather silly way. At the insistence of the firm, the doctor did set up further appointments at the local psychiatric hospital where a consultant passed David on for psychological testing.

There it was found that David had gross impairment of his IQ and that his social skills were in steep decline. As the consultant had suspected, David was suffering from pre-senile dementia - the brain was entering old-age while the body was at its prime.

David is now in hospital and, unfortunately, nothing can be done for this dreadful condition. His life expectancy is less than five years. His brain is literally shrinking in size and very soon he will need constant nursing care. He will almost certainly die from a virus infection of some kind; most likely pneumonia. David's wife has had to accept that his decline can not be arrested and that she will have to start again to make a new life for herself.


KARL

When Karl's mother watched him playing cricket for the school team she was very proud of him. She did not realise that within five years lie would never play cricket again. He would suffer from schizophrenia and spend the rest of his life being cared for.

He was 18 when she first started to notice a change in his personality. It was a slow, insidious change - not alarming at first. He stopped bringing friends home. In fact he seemed not to bother with people very much at all. As she thought more about it, she realised that he no longer had any hobbies and seemed to be losing interest in almost everything -leis football team, TV programmes, the newspapers. Concentration on anything seemed impossible for him and soon she found herself having to make sure that lie got out of bed in the mornings, bothered to get washed, and went to his work.

It was not long before lie lost his job. Another job came up soon enough - but it only lasted a few weeks. At first his mother got angry with him, but lie was indifferent to her reproaches and soon became a virtual recluse, staying in his room and coming down only to eat meals.

Eventually, the doctor was called in but could make no sense of Karl and finally told him `pull yourself together and get a job'.

But that didn't help at all. And by now his mother was desperate. The doctor was again brought into the house and on this occasion Karl remained mute - refusing to answer any questions. A consultant psychiatrist was then called and schizophrenia was diagnosed.

The new depot injections have helped a little, but Karl remains withdrawn and can only work at a very unskilled level. This bright young man is now, and will probably always remain, a solitary, seemingly uncaring person who assembles ballpoint pens in a sheltered workshop.

(The names of the people have been changed, but their stories are true.)


BARBARA

Barbara, a sensible women of 25, was friendly and well liked in the little close where she and her husband lived. After four years of marriage, their first child was born - a daughter - and Barbara and her husband were over the moon.

But soon after the baby's birth, Barbara started to behave differently. Her husband soon realised that something was wrong. She became moody and morose, barely talking to him. In particular, he noticed that she was always looking at their daughter's hands. Knowing that some women do suffer from depression after giving birth, he did his best to help her in his way. But one evening Barbara turned to him and said, `Our baby is turning into a dog'. Not surprisingly, this remark threw him. He tried to discuss it with her but she was scared and insisted that the baby was growing hair and claws. Her husband showed her the perfect hands of their baby daughter, but it was no good. Her delusion was fixed

Now more than worried, her husband called out the doctor who soon realised that the problem was serious and called in a psychiatrist that same day. The consultant wasalsoworried. He recognised a severe psychotic depression which had followed the birth of the child He felt that Barbara could harm the child whilst deluded, but could not persuade her to go into hospital, so he was forced to put her on section (legally enforced removal to a hospital), and managed to get her into the mother and baby unit.

It took two weeks of medication to take effect but soon Barbara accepted the baby again and within 6 weeks she was at home and the medication was discontinued The health visitor has called every month and now - 18 months later - Barbara has not only a healthy daughter but a brand new son - and there has been no recurrence of the illness.


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