Voices pt2

[Gilhelmi]

snip

Ya I am still reading.

All I wanted was a nice conversation on why mental conditions/illnesses still had a stigma in this ("enlightened") day in age.

I have seen the stigma in the Army, in the Civilian workplace, and on the Internet. For the life of me, I can not understand why. I know a guy with Downs syndrome, nice person, hard worker. But I have still seen people make fun of/discriminate against him.

WHY? I am really good about seeing all sides of a debate, when I do not understand something I ask and someone explains the other sides point.

Then why can no one explain to me why the stigma is still out there.

[Gilhelmi]

While I do support the idea of people looking into things and getting the medical information that they can (whether they end up medicating or not), this is very true. I used to be very frustrated with how my brain worked. It doesn't work like a lot of other people's brains and I grew up thinking there was something wrong or broken. I've learned a lot about how I work now though and what works for me and I love how I think now. I wouldn't trade it for anything. I wouldn't even trade away the difficult parts. They are a part of the amazing parts that I love and it all fits together. Different isn't bad. And even those who have trouble functioning shouldn't be made to feel ashamed of it, they should be helped.

Thank you. I feel the same way.

[siead_lietrathua]

Then why can no one explain to me why the stigma is still out there.

i assume it's because a chunk of people are just always going to mock what they don't understand out of misplaced fear. and a second, smaller group of people are assholes who will mock what they DO understand, because trolling**. there are jerks out there that glorify in being 'better' than others. and that will probably never go away until we breed competitiveness and douchebaggery out of our species/ society.

put people that make fun of mental illness in the group with the idiots that make fun of people for their race, gender, or physical disabilities, and disregard them as useless air-sacks until they grow brains.


**I AM NOT TALKING ABOUT THIS THREAD OR THE PEOPLE IN IT. Just to clarify, since i'm sure i need to. i'm talking about douches like gilhelmi describes that would mock people with downs. i know no-one on fratch is like that.

[Andara Bledin]

Then why can no one explain to me why the stigma is still out there.

Two reasons:

Fear and Tribalism.

The weak and small-minded will always mock those things that scare them or that are Other. The problem isn't that it still happens so much as that better people don't speak up as often as they should. And this goes for a lot more than institutionalized bigotry against those with psychological conditions.

[s_stabeler]

It'd help with some conditions if people would actually believe you had it- I've had it said right to my face by a teacher that I was making it up. ( oddly enough, that teacher later became one of the better ones at dealing with it- I can only presume that someone straightened him out after he yelled at me so much it reduced me to tears.)

[Seshat]

The stigma is reducing; certainly compared to my grandparents' day, and my parents' day.

I'm cheered by the saying 'off his/her meds' instead of 'crazy': the very fact that it implies a medical condition rather than the kind of stigmatic 'weirdo'/'different'/'not like us' that existed when I was a child is very, very comforting to me.

If you weren't around before the 'off his/her meds' was the normal way to describe it; it's probably very difficult to understand how vast a change it is. But it really, really is a big change.

[Kuari]

I think it depends on where you live as well. Where I live it is still stigmatized even though there are campaigns to shed light and recognition on mental illness. I have given up counting how many people change towards me and start making themselves scarce when I mention that I'm mentally ill. It sucks, but it also weeds people out of my life that I know I would not be able to count on in an emergency.

Here, if you mention taking a trip down to the Waterford you get a side-eye - it's common nickname is 'the Mental' because it used to be a mental institution, and it is still primarily a psych hospital, but it offers blood services and x-ray. If you're in a rush in the morning and get there when the blood service clinic opens the door you can get in and out in less than a half hour, but so many people still assume you went there for mental illness treatment. My attitude is 'So what if I did? How is that YOUR business anyway?'

I lived with the stigma - you simply did not talk about mental illness in my family. Even if you were being treated for it any way. When I first was being treated for my own mental illness I was not permitted to talk about it to anybody in my family, and if I did I was told by my mother that I was only attention-seeking. The familial support was not there at all, even though I knew my mother had been institutionalized when she was in her late teens - that bit of information slipped out during one of her crazy rants at me and she confirmed it later when she was calm (though she didn't go into much detail...I got that from my grandmother later, who was pissed that my mother even told me). One would figure that a parent who'd struggled with their own mental illness would be somewhat understanding...but she wasn't. Even though there is a long family history of mental illness. Ugh.

Even now my mother cannot understand why I am so accepting of my son's mental illness. She thinks I should just tell him to grow up and stop faking. Even though he is NOT faking and has been diagnosed by a professional. Attitudes like her's make it difficult to stop the stigmatization.

[Andara Bledin]

Hey, I know it's been a few months, but an article over on Ars Technica made me think of you and your situation.

Exploratory survey digs into the lived experience of “hearing voices”

It's a fascinating read, and a promising start to really getting to the bottom of the issue.

Combine this with another recent article about synesthesia, and it makes me wonder if perhaps they aren't actually somewhat related.

[cewfa]

Count me in as someone who hears voices in a non-destructive fashion. I also talk and answer myself as well. I have autism, bipolar, and PTSD from being a victim in an armed robbery.

I would say that the OP is the only one who can decide what he needs as far as treatments go. I personally am on mild medications, and they seem to help for the most part, especially once I quit abusing them.

I wish you guys well in life.

[shadowmaster]

I highly doubt that Gilhemi would be given a diagnosis of a mental illness unless he has a LOT more going on than he's told us.

To my understanding he's said this:

1. He hears voices.
2. There are several personalities in the voices.
3. They do not encourage him to specific behaviors, but do encourage him to view the world around him in a more peaceful and accepting way.
4. They have convinced him to avoid self destructive behaviors.
5. They have never urged him to do anything harmful to himself or to others.
6. He does not see things. He is in touch with his here and now, and completely aware of his immediate surroundings and situation.

His behavior and thoughts are not disorganized. He is not delusional. He is not paranoid. He does not have a social or occupational dysfunction.

Sorry, but I don't see he meets criteria for diagnosis according to the DSM TR IV (don't have access to V).

Hi all:

Not really trying to necro an old thread here or anything; nor rehash anything that was going back and forth on semantics, ect. I've long been a CS/Fratching reader, but generally have had very little reason to post (especially on CS, though I do enjoy the stories) and generally only check in on Fratching about once a month when I have extra time during my office hours (which also leads to one of the reasons why I never have really posted before - I'd likely not remember to check back for responses because of the infrequency in which I read over this site). However, I wanted to briefly insert here as the differences between DSM IV TR and V were mentioned.

On my background briefly. I am a psychologist (although these days I'm an academic/teacher and not currently licensed to practice - though I did practice [both under supervision and then independently for a bit] in Neuropsychology for 4 years before I kind of burned out/got bored and moved more into my primary Ph.D. interests). My undergraduate background is in Social/Cognitive Psychology. My master's background is in clinical psychology - specifically Neuropsychological and Psychological Assessment and Testing, my Ph.D is in Counseling Psychology/Advanced Studies in Human Behavior (weirdly named program, I agree) specializing in human sexual behavior, sexology, gender, and relationship dynamics/counseling.

I will be speaking solely from a diagnostic perspective as that is my area of specialization and I will largely be speaking in generalizations given the basics raised above; however, I will also disclaim that since I am not currently licensed, this should be read largely as opinion and not taken as "gospel" so to speak - an informed opinion perhaps, but still an opinion. I'm speaking in generalizations because to do otherwise in this setting would be highly unethical and thus none of what I'm about to say should be tailored to any specific individual or specific circumstance.

Now that all that is out of the way. . .here's what I finally registered an account to say.

With the limited extraneous background information, under DSM IV TR, what has been discussed actually may have qualified under the diagnostic criteria for Schizophrenia, although, as Gravekeeper has mentioned that would have been a rare early onset (although onset as early as 5 or 6 is not out of the question and has been reported - it's just rare). The reason I say this is because of the exception noted in criteria A: Characteristic symptoms. Generally, two of the characteristic symptoms were required for diagnosis, the only one that has been discussed on this thread was that of hearing voices - which generally (absent attributions to a mood or schizoaffective disorder, substance or general medical condition, or to a pervasive developmental disorder) would be classified as an auditory hallucination. I will also make the distinction that has been mentioned between the "inner voice," subconscious, ect that is clearly identified as "happening internally / from oneself" since they have been identified as other voices or personalities. The exception noted for criteria A was that only 1 criteria A symptom was required if the hallucinations consisted of a voice keeping up a running commentary on the person's behavior or thoughts or consisted of two or more voices conversing with each other. In theory, if these multiple voices have different voices/personalities and converse with each other in addition to the person hearing them, that would qualify under this exempted note and would suffice as the 1 criteria A symptom noted.

That exempted note was removed from the diagnostic criteria under DSM V as it was considered too vague; now two criteria A symptoms are required for diagnosis and with the basics discussed so far, there is no clear evidence for a second criteria A symptom (delusions, disorganized speech, grossly disorganized or catatonic behavior, or negative symptoms such as affective flattening, alogia, or avolition). So with this update, criteria A would not be met and thus a diagnosis would not be made.

One other criterion that has been mentioned is that of social/occupational dysfunction and that discussion has gone back and forth in this thread quite a lot already largely over what it means to be functional. This criterion is actually somewhat open to interpretation as there is a wide range of things that could be used as evidence as an "impairment" of functioning - including those that have been discussed: in work, interpersonal relations or self-care (such as the inability to hold a job, difficulty with relationships or if one experiences difficulty with ADLs or IADLs). However, depending upon the onset of symptoms this can also include not achieving the [I]expected level[/I} of interpersonal, academic or occupational development . . .and can even include the opinion/perception of the individual as to their expectations and how they cope with general situations (all the kinds of things we'd generally code on Axis V in a global assessment of functioning) and even a mild "disturbance" (around a 70 on the GAF) could be considered under this criterion. A lot of these types of things are open to the interpretation of both the individual experiencing something and the clinical judgment of the practitioner (what I may see as a 70, another practitioner may see as a 60, or the individual experiencing may see as a 50 or a 75. . .etc).

In my general opinion, the types of things that have been discussed back and forth without more specific information (and in my case, an actual neuropsychological assessment) it may be characterized as 298.9 Psychotic Disorder Not Otherwise Specified, but I'd likely be reluctant to even go that far unless there was some reason that a diagnosis was needed (ie: access to services that require a diagnosis for insurance payment, ect.) largely due to the stigma and general attitudes associated with diagnosis, any diagnosis that you all have discussed. I'm generally of the mindset that formal diagnosis should only be made if there is a clear need for intervention.

I'll also briefly address some of the issues of faith that have been mentioned here, but only as they relate to the issues of psychological practice and diagnosis (and this is an area of some debate among practitioners depending upon their theoretical orientations and cross cultural approaches). While I am not a particularly religious or spiritual person myself, I'm generally of the mindset that is someone presents with something that is sincerely backed up by a tenant of their specific faith, I generally do not count that as part of the criteria for diagnosis (unless it stretches the boundary of what that particular faith calls for). Some examples since that sounds a bit vague, even for me:

1) My early clinical training and placement was in a psychoanalytic model - think Freud/Jung (I generally consider myself to be of a "Jungian inspired, cognitive-behavioral model with aspects of a humanistic/person-centered approach). The student practitioner I was shadowing was presenting a case to her supervisor. The client was Indian (as in from India) and Hindu and frequently discussed aspects of past lives while in session. The student practitioner characterized this as a delusion that needed to be dealt with in the therapeutic process. I strongly disagreed since past lives are an integral pillar of the Hindu faith. Now if that client had said that he and the practitioner were lovers in past lives and they had been brought together again to resolve issues from that past relationship - that would be more of a yellow/red flag to me because that starts to stretch the boundaries of what I consider part of a faith into the realm of a self-serving delusion (not the past life part, but the part about being personally connected to the practitioner).

2) One of my early clients in my first neuropsychological placement was from Haiti. While I was primarily concerned with determining if they had an issue with reading comprehension, one does tend to get into conversations in session. She mentioned that a lot of what she was attempting to achieve might actually be wasted effort because her great-grandfather "pissed off a priestess" and that priestess had cursed her family to be forever bad with money. Curses and general voodoo practices were part of her cultural and faith based heritage, so I did not consider this to be a delusion that required intervention. Instead, I worked with it in that context. Unfortunately, see did tend to make a very good point that I initially really had to think about: I said can you not counteract the curse by engaging the goodwill of the Iwa through ritual or obtaining the assistance of a priest or priestess to help you counteract the original curse? And her response: well yeah, but that requires money - how am I going to have money to do that if I cursed to forever have no money. . . . . . . .

And, I'm going to stop now, this ended up being MUCH longer that I originally intended so if you made it through all that. . I'm impressed. :-)

[Gilhelmi]

Shadowmaster, I want to thank you. You seem to be one of the good Doctors in your field.

The reason I do not trust Psychologist in general, is because of "Doctors" who see religious faith as a delusion. Others assume that because "I am a Doctor and I know whats best", and force people to take drugs for minor occurrences that in the 'old days' a person could just talk out with a trusted friend.

I actually had a nightmare a while back, about someone finding out about my "friends". In the nightmare, I was forced to take drugs that made me sick. When I sued for my freedom, the judge refused because I had been diagnosed by the person who I was suing.

The nightmare scared me because it was far too close to the truth.

[shadowmaster]

Shadowmaster, I want to thank you. You seem to be one of the good Doctors in your field.

The reason I do not trust Psychologist in general, is because of "Doctors" who see religious faith as a delusion. Others assume that because "I am a Doctor and I know whats best", and force people to take drugs for minor occurrences that in the 'old days' a person could just talk out with a trusted friend.

I actually had a nightmare a while back, about someone finding out about my "friends". In the nightmare, I was forced to take drugs that made me sick. When I sued for my freedom, the judge refused because I had been diagnosed by the person who I was suing.

The nightmare scared me because it was far too close to the truth.

(I apologize in advance if this becomes a mini-novel, because I have a tendency to be long-winded. . .what can I say, I'm a teacher ;-) )

It could partially be because of "biases" in my training (in that the school I attended was very cognitive-behavioral and "hardcore" CBT practitioners tend to eschew mediation except under dire circumstances) but I'm of the general mindset that if something can be dealt with and managed within the parameters of a therapeutic relationship then it shouldn't be managed by medication. Now, that does come with an understanding that medication is absolutely required in some circumstances so that an individual can get to the stage of being able to adequately manage a "talking setting" (organic depression for instance is not going to be helped by "talking it out" nor is an extremely hyperactive/inattentive individual going to be able to manage the focus to implement behavioral change), but in my days of practice, medication was generally my "recommendation of last resort" instead of "first resort." I saw far too many cases of people (including children) being misdiagnosed by a general practitioner (GP - a primary care physician for instance) and being overly medicated as a "band-aid" instead of actually dealing with the underlying issues that it kind of pushed me off that general medical model, unless, of course, there was a medical necessity.

Case-in-point: One of my clients during my clinical rotations in neuropsych (while I was still in training) was a 10-year-old diagnosed with ADHD. My initial interview before testing was with his adoptive mother (his biological maternal aunt) and her primary concerns were with his academics: namely he was failing because he frequently neglected to complete his homework. They had originally addressed this with his GP and the GP basically saw it as a lack of focus and inability to pay attention to tasks at hand and thus had him on Risperdal (Risperidone). I don't remember the dosage at this point since it was so long ago, but I do remember that my initial reaction was surprise that this kid was still functional at all because the dosage he was on should have been enough to "keep a horse sedated."

NOTE: Risperdal is an atypical antipsychotic that is mainly used to treat schizophrenia, but (at least in my perception at that time in my career because I saw it A LOT) seemed to be a favorite of a lot of GPs because of its sedative effect.

Anyway, I start testing this kid and I'm sort of thrown for a loop. Testing is generally not a pleasant experience for children - it's long, boring, and seems too much like school. So I try to joke around and make it entertaining. This kid was so low affect that nothing I did got a reaction. He was completely flat, monotone and I had a very hard time "getting a mental picture of his personality" - he seemed to have no personality. Seeing something like that in a general evaluation would be something that would give me pause as one expects a child to have SOME emotional reaction to SOMETHING. But no, nothing got a reaction out of this kid. It came time in the evaluation to do the computerized testing specifically for ADHD and he generated a random profile on both measures - meaning his responses didn't match a pattern for anything (not a typical ADHD profile; nor a profile that would match the general population) his responses were totally random. This is odd. So, in discussion with my supervisor, we obtained permission to see him without the medication (we were in "summer" at this point, so we didn't have to worry about disrupting his school work). And all of a sudden, my kid had a personality! He was talking with me, joking, laughing and was all around like I would expect a kid to react. Put him through the computerized testing again and he generates a "normal" profile - meaning he didn't have ADHD.

So, I then went back to my initial interview notes and reviewed all the testing I had done with him over our two month interaction. His backstory is that he was born a "crack baby" as was his little sister. He quickly became the "little man" of the house in that when he was 5 or so, he spent a lot of time "looking after" his little sister because mom was so out of it. When he was 6, little sister died from a heart condition, mom went to jail (on drug charges if I recall) and he was adopted by his mother's sister. I had noticed that when we were testing, he was a very smart kid, frequently testing out at a little past his grade level. The way a lot of these tests operate is that the questions/tasks get incrementally more difficult and we "discontinue" after several wrong answers in a row. He was testing slightly past his age level, but getting INCREDIBLY frustrated when he got wrong answers - despite my assurance that getting wrong answers at that point was fine because there was no reason for him to know 7th or 8th grade material.

So, my conceptualization of his situation was that due to his early life experiences, he never had the opportunity to form a secure attachment with any adult figure (Mom certainly did not sound like a "secure figure") and having to take on a lot of responsibility at an early age made him feel that "love" (the best word I can come up with at the moment) was conditional and depended upon his performance. This caused him to put ENORMOUS pressure on himself to achieve as exemplified by the amount of frustration I saw from him in session. I postulated that if he is the same way with school work, then any academic task sets him up to experience severe failure anxiety - which would be unpleasant. By not doing his work, he removes that unpleasant experience because now, there's no pressure. There's no "OMG, what will happen if I can't do this or if I do it wrong?" pressure, if you refuse to do the task in the first place. So my recommendations were to deal with that - his attachment and "performance" issues - in a therapeutic setting so that he could work them out.

His GP had heard "problems completing schoolwork," slapped an ADHD diagnosis on him and basically said, "We'll deal with this disruptive behavior by medicating it out of him." My response was basically "Medicating him to the point where he is barely functional might make the 'behavior' go away, but it also makes "him" go away and doesn't actually deal with what is causing the problem - you're "treating" a symptom and not the underlying issue."

It's stuff like that, that tends to make me shy away from medication unless something very serious is going on and it is required so that a person can actually engage. There is, at times, a split in the field. Neuropsychology is probably the area of psychology that is closest to being a "medical profession" but some schools that teach psychology approach it from a medical model, where the people we see are referred to as "patients" that are sick and that come to "the doctor" for a cure. The way I was trained - and the way I tended to approach people while I was practicing was more from a "helping model" - people that came to see me were experiencing some kind of issue and I had specialized training to help with that issue. Thus, these people were "clients" engaging me for a service, not patients engaging a doctor for a cure. It's a similar way that I approach teaching college. Some of my colleagues are "the authority" that wields ultimate power and control over their "vassals" - the students and they are to be respected in all matters. Um. . yeah, I'm 34 (and frequently still get mistaken for a student because I apparently look 16) . . .while many of my students are 18-24. . . quite a few are 50+ and I'm not going to approach someone twice my age as if I'm the ultimate authority and you will do as I say. I am the "subject matter expert" that just happens to have specialized knowledge that [the student] doesn't. And it's my job to impart some of that knowledge to the student. Yes, I do enforce rules (no cheating, due dates, ect.) that have to be followed, but that doesn't put me on a pedestal above them; nor does it give me power over them. Teaching, much like psychological practice, is a collaborative endeavor that requires working together toward a common goal.

And yep, I'm long-winded. . .ending it there. :-)

[Andara Bledin]

So, my conceptualization of his situation was that due to his early life experiences, he never had the opportunity to form a secure attachment with any adult figure (Mom certainly did not sound like a "secure figure") and having to take on a lot of responsibility at an early age made him feel that "love" (the best word I can come up with at the moment) was conditional and depended upon his performance. This caused him to put ENORMOUS pressure on himself to achieve as exemplified by the amount of frustration I saw from him in session. I postulated that if he is the same way with school work, then any academic task sets him up to experience severe failure anxiety - which would be unpleasant. By not doing his work, he removes that unpleasant experience because now, there's no pressure. There's no "OMG, what will happen if I can't do this or if I do it wrong?" pressure, if you refuse to do the task in the first place. So my recommendations were to deal with that - his attachment and "performance" issues - in a therapeutic setting so that he could work them out.

This kid was screwed up by praise, most likely.

This is the exact sort of situation you would expect from a kid who was too often praised for being "really smart" that it became his primary identity to be 'smart' and any perception of being 'not smart' would therefore make him lose value to those around him.

It's extremely common for kids praised for traits like this to become severely risk averse to the point where it is better to just not try anything that might be difficult as opposed to the possibility of being seen as being a fraud.

An excellent article on the risks of incorrect praise with children above toddler age:
The effects of praise: What scientific studies reveal about the right way to praise kids

[Kuari]

Shadowmaster, I wish more psychologists out there like you. I'm so used to professionals throwing pills at me and treating my symptoms instead of listening that I've pretty much given up trying to find one that will work with me. I already hate taking pills, even for massive migraines, so having doctors continually prescribe me meds instead of listening gets old really fast.

[s_stabeler]

to be honest, the way I always understood it is that mental health medication is not actually supposed to be a long-term fix on it's own. I always understood is as the medication being taken to allow the person to function enough to allow things like therapy to help bring the issues under control, and when you no longer need the medication, you are eased off it.