Schizophrenia

My last column for Suite 101, an update on Dr. Long's mental health web site, which has become a significant community, and a brief discussion of community integration, the main buzzword in the mental health business these days.

What do you do with an adolescent who has a complete recovery from a first psychosis? Many psychiatrists reduce or eliminate medication after a year or two. Is it worth the risk? There are a lot of factors to be considered. Here are some of them.

Do people ever recover from being homeless or the distorted reality of their psychosis? Did anyone really survive the Great Depression or the Concentration Camps of World War Two.

Psychiatrists are taking a greater interest in the quality of life of their patients. Some atypicals have an association with diabetes. Telling somone to make lifestyle changes is a lot easier than understanding why that person isn't motivated to make them.

Suicide is a complicated outcome of mental illness. We usually explain it in terms of why someone committed suicide, as if there was a rational answer. Each year more people I know die from suicide, which is a tragedy, because suicide is a very preventable cause of death.

What happens when you don't have a reason to get up in the morning? You don't, and many people with schizophrenia don't, and for a variety of reasons. Here are some of them.

Self esteem and self confidence are critical to enjoying life and human relationships. People with schizophrenia often decline invitations to social events but it wasn't until a friend wouldn't attend my birthday celebration because of his social phobia that I began to understand how destructive "shyness" really is.

Command hallucinations are often thought to be the most serious. My friends and I "had to" do a lot of weird things, which we may laugh about now, but isn't there an implicit command in "having to do something"?

Do people in psychosis have insight to the human condition that no else can, and what good would it do them if they did? How do they feel about their experiences? I can only tell you what I think about those years I was lost in psychosis.

People in a psychotic episode sometimes do criminal things. Should they be held accountable for what they did? The answer, unfortunately, is not very clear even when you look at other medical conditions.