“The symptom that bothers me the most is the one I can’t even begin to describe.”

July 28, 2012 9:03 AM

Culture, delusions, and the early treatment of schizophrenia.
Greg Downey: Living in the prodrome, part 1, part 2.

Rachel Aviv's article "Which way madness lies: Can psychosis be prevented?" [pdf].

posted by nangar (19 comments total)

Wow, Ms Aviv's article was fantastic, thanks for posting it. Now I'll see the rest of the links!
posted by saucysault at 10:27 AM on July 28, 2012

I often think that what makes someone with a delusion officially psychotic is not so much the content of the delusions but the inability to understand how those around them will react to hearing them expressed. That is, it's not so much that they are at odds with the prevailing culture than that the person can't tell that those who share her culture will take these delusions to be an illness.
posted by Obscure Reference at 10:52 AM on July 28, 2012

excellent, thanks for posting!
posted by noway at 11:04 AM on July 28, 2012

Bookmarked so I can read it when I'm not at work. Thanks for posting!
posted by MexicanYenta at 11:13 AM on July 28, 2012

I agree with the above two: thanks for posting!
posted by painquale at 11:26 AM on July 28, 2012

I've half a mind to read this....
posted by gallus at 12:10 PM on July 28, 2012 [1 favorite]

Ironic that Downey wrote this piece at the time US Congresswoman Gabrielle Giffords was attack. History is truy cyclic.

From Anna's story: “The substance of my experience is thrown into doubt. I am left with this incredibly deep sense that none of these things ever happened to me.”

Living in the prodrone, indeed. I suspect that only least affected among are aware of how close we are to the edge of reality's slippery slope. We can tell that we are looking into the pit, while the others are so far entwine in their delusions that they think the world is as it appears.

Some thirty five years ago I had what I thought at the time was a peculiar form of amnesia. I was at university in Manoa. I had just served in the US Army for eight years, from 1963-1971, when I was released on a medical disability relating to a blood disease I contract while serving in Vietnam. (The symptoms of the disease are tangential to this story, but they were periodically debilitating, in that I sometimes had to lie down for several hours because of associated pain. I was retired on a small pension, at 50% disability. The condition was so rare that it didn't have either a proper name or treatment associated with it.)

Anyhow, about my third year in Hawaii, I began to realize that I didn't remember having been in the Army. I didn't think of myself as an ex-soldier, I guess is the best way I can describe this.

But, now and then some one would ask me a question in a certain way (were you ever in the Army? Well, yes. Did you go to Vietnam? Well, yes)... and memories would pour out: I would narrate scenes, while seeing them in my mind's eye, and in some cases actually experiencing odors. Some of the incidents were excessively emotional, and I found myself stumbling through them after many false starts. The scenes were vivid, but contextually isolated, like reading un-numbered pages from a book. I could talk for quite a while, describing those things I was suddenly "seeing." I wasn't hallucinating--I believed these were memories, not something that was happening at the time.

I dropped out of school during my last semester and went to live in a tree house around the corner from the North Shore, at a place called Mokuleia. I was off the grid. I fished and plucked fruit. Then I spent some time living in a hut on the side of the volcano, not too far from Hilo, on the Big Island. After that I returned to the mainland, where I lived in an isolated cabin owned by a friend of mine--an acquiantance, actually. Most of this time I lived alone. I eventually worked my way back into a "normal" reality.

I went to counseling, where I was advised that I'd had some "psychotic episodes" but there wasn't anything really wrong with me. This was not the first opinion, but it's the one I went with. A few months of group counseling with a troop of fellow combat veterans revealed to me several things, the most important of which was that I wasn't the lone fucking ranger. The other things I learned were a few coping tools, which I used to identify what I thought of as "buttons" that got pushed from time to time. I suppose "Prodrone" is an excellent term for my world.

Anyhow, to make a tedious tale shorter, I worked at the farrier's trade, and spent a lot of time in the back country of the Sierras, packing mules for various outfits, and shoeing their stock. I had a talent for recalitrant mules, it seems, and I got a lot of referrals. Mules demand honesty, so I was able to just be myself. People were more problematic.

In the late 1990's I came across the journal I kept while I was in Vietnam (I have dozens of notebooks filled with minutia). I had not looked at it since I came back from Southeast Asia. Looking through it, I discovered that some of the memories I carry are not mine. They are things my fellow grunts told me. That's a relief. Not only that, but my image of the 19 and 20 year old kid who wrote that journal has changed. He's not half the twit I thought he was.

Downy's piece mentions folks who live enmeshed in myths, for example, Revelationists, and how this is problematic only inasmuch as they are swimming against a sociological tide of something called a common reality. Common?

I am not sure that a common reality exists. But I guess that's the prodrone effect.
posted by mule98J at 12:12 PM on July 28, 2012 [16 favorites]

This is exactly the kind of thing that gives me the blithering, swiveling fantods.
posted by en forme de poire at 1:23 PM on July 28, 2012 [2 favorites]

They are excellent articles, though - thanks for posting.
posted by en forme de poire at 2:13 PM on July 28, 2012

These articles make me apprehensive about some of the thoughts that go through my head. I don't think that I'm pre- anything, I just question my reality a lot. I don't think it's a sign of oncoming psychosis, I think that it is the wandering thoughts of someone who lives in their head a lot. I hope that means that I'm in the 60%.
posted by kamikazegopher at 3:01 PM on July 28, 2012

The blog post was very interesting; especially pointing to how society's view of people with mental illness and trajectory of mental illness then affects their recovery and their role in society.
posted by saucysault at 3:22 PM on July 28, 2012

All three of these articles are among the most interesting ever linked on Metafilter, in my opinion.

My mind is reeling...

Lin and Kleinman (1988: 555), for example, reviewed discussions by mental health practitioners and suggested that,

Concurrently, a number of psychiatrists with extensive clinical experiences in various parts of Asia and Africa have reported that the majority of psychotic patients they treated in these “Third World” countries tended to suffer from a disease process that was characterized by acute onset, fulminant but typically short clinical course, and, more often than not, complete remission…

Those who believe schizophrenic individuals are more likely to fully remit in developing countries point to a number of possible reasons. ...

This, from Downey's Part 2, I see as additional reason to think, as I've been trying to work out for the last couple of years, that it might be possible to view a period of schizophrenic ideation as a normal part of development which functions in the average individual to ease acceptance of the patently absurd and irrational ideas about religion, social order, causes of disease, cosmology and etc., which form the backbone of all traditional cultures, and the greater part of our own, and that a failure to accept can cause pariah status.

In other words, we may be built to have a brief period of schizophrenic ideation in young adulthood to allow us to settle down and believe all the received nonsense everybody else does, because if we didn't, we would be outcasts.

But in some people this period is too extreme, or lasts too long-- perhaps indefinitely-- and those people we call schizophrenics, and in the contemporary developed world, this seems to be happening much more often than it did previously, for reasons that remain obscure.
posted by jamjam at 4:55 PM on July 28, 2012 [5 favorites]

As far as I am concerned these are a must read before anyone posts on MeFi about schizophrenia. persons with schizophrenia or psychosis. thanks for the work and the link
posted by rmhsinc at 6:42 PM on July 28, 2012 [1 favorite]

I came here to say much the same thing as jamjam: that Aviv article is hands-down the most fascinating thing I've ever read on MeFi. Thanks nangar!
posted by désoeuvrée at 6:51 PM on July 28, 2012

I liked reading these. Over the past couple of years I've worked with a lot of high-functioning first breaks. What I find especially interesting during the first couple of clinical interviews is sometimes convincing these profoundly frightened people to open up and tell you about the *pattern*, that is, the delusion that is forming in their minds to explain all of the increasingly unusual phenomena and coincidences that they've been seeing over the past few months-to-years. Based I guess on common neurobiology and socialisation, these tend to evolve along common paths. During these interviews, to encourage people to open up, I find sometimes I have to channel childhood fears, night terrors, mind-reading adults, true knowledge of what could indeed be lurking right there under the bed, awareness of how sometimes your shadow moves just that bit slower and differently from you in order to get through. If you listen, those things are always there, part of you waiting to jump up and overwhelm you. For most people with an adequately functioning and well-gated, properly inhibited brain, they stay as childhood terrors. Not, apparently, for schizophrenics, and the way the disease process can relapse and remit in a progressive, chaotic pattern often resembles a classic immunomodulatory process such as, say, multiple sclerosis.

Paranoid psychosis can also spring from an affective disorder, and is more likely to given early life trauma. You can take this idea an extreme that ignores several classes of divergent clinical progressions.
posted by meehawl at 8:25 PM on July 28, 2012 [4 favorites]

Thanks SO MUCH for the amazing articles! This part in Aviv's article gave me the shivers -

It wasn’t as if she had surrendered to the world of particles; she found it dismaying and unbelievable, and yet she couldn’t dismiss it as false. “There’s a sense in which the law of contradiction—that something can’t be X and not X at the same time—has ceased to matter,” she said slowly. “What I know and what I believe no longer coincide, and I can’t make them.”

posted by nemutdero at 10:54 PM on July 28, 2012

That Aviv article is indeed fascinating; thanks for linking it.
posted by LobsterMitten at 12:49 PM on July 29, 2012

Great post, and great comments too. Lots of food for thought.
posted by Acey at 9:03 AM on July 31, 2012

In other words, we may be built to have a brief period of schizophrenic ideation in young adulthood to allow us to settle down and believe all the received nonsense everybody else does, because if we didn't, we would be outcasts.

That seems too...rational....of an explanation, to me.

Once, in college, I had a suitemate who began hearing voices. She was eventually committed. I don't know what she was diagnosed with.

I do know what it was like to talk to her. I'm going to use an analogy, a dangerous thing, but: When you're having a good conversation with someone, it can be a bit like tennis, you pass the energy of the conversation back and forth between you like the ball goes over the net, you react to what I say as I'm saying it, you anticipate where the ball will land and when it gets there you respond and bounce it off in a new direction. You can feel it, sometimes, when a conversation is going well, that sense of energy building, of tension being released, a spin, a riposte.

Talking to her was like...she'd listen you and appear to be reacting to you, but it was if when the ball went over the net it went into a void. Like the energy of the conversation just was absorbed, dissolved, though sometimes the ball would come back, from a strange, impossible angle. Not an unexpected angle --- half the fun of conversation and tennis is managing to come up with a response that wrong-foots your opponent --- but an impossible one, something that had no connection to what had gone before.

It's that sense of the void that made me begin to think she was mad...even with animals, we often have that sense of connection, of a shared understanding of intent. I think that must be what she's talking about in the article that shrinks used to call "praecox feeling".

Sometimes she would say surprising things. Another way to approach it would be to say: you know that brief moment of insight you get when you recognize a metaphor? The same quality in two dissimilar things, like the way my curtains move like a wave in the wind --- there's just that second, that click, when you see it. That quintessence, the wave-ness that belongs to waves and to curtains. The reason metaphors can be so profound, the reason why they're the backbone of literature, is the way they can isolate such qualities, give us such moments or recognition, and therefore allow us to see patterns, to make us understand new things by old things. That's what I've been trying to do myself, with my tennis analogy.

Metaphors are true, in profound ways. But reality is deeper than metaphors. Reality is more complicated than metaphors. And with her....sometimes it was like she had lost that, that ability to see that reality is more, like she was stuck on that moment of truth. The curtains were the waves, not were like them. And if the curtains weren't wet that didn't matter, it just meant that waves could be dry when they were curtains. Meehawl is right, too, is close to what kids are like in some ways, because kids haven't fully formed their sense of the boundaries of the world. So I don't think it's about "received nonsense" about trying to make yourself accept arbitrary things and breaking. Unless gravity and sunlight and water are arbitrary. It's more like....you get lost in the power of the pattern, it overwhelms you. You add, you revise, keep trying to make things fit in order to tie them down into a meaning that will stay still but you can't because you can't see them anymore, things in their wholeness.
posted by Diablevert at 4:56 PM on August 2, 2012 [1 favorite]