May 15, 2002

Ted Rall, David Duke, Robert

Ted Rall, David Duke, Robert Fisk, Lyndon LaRouche, al-Ahram, Hitler, Noam Chomsky, Blair's Law, the Arab News, and Me

Tim Blair, in reference to this Lyndon LaRouche interview in Al-Ahram, recently noted "the ongoing process by which the world's multiple idiocies are becoming one giant, useless force." Blair's Law. Blindingly obvious, but only after you have seen it expressed and demonstrated with striking examples like that. I believe it truly captures the spirit of the age.

Here's another example: David Duke has a column (actually a transcript of a "radio broadcast") in the Arab News, and, not surprisingly, he fits right in (link via InstaPundit.) He attributes the 9/11 attacks to a Jewish plot, and cites Robert Fisk three times. Like I said, Blair's Law.

OK, that takes care of LaRouche, Fisk and David Duke, Blair's Law, al-Ahram and the Arab News. What about Ted Rall, Hitler, and me? This post is really an excuse to mention that Ted Rall once interviewed me via telephone on his talk radio show. It was a couple of years ago, and no one involved had any particular reason to know anything about each other's political views or opinions about America and her enemies-- it just never came up (those were the days, eh?) The interview was intended to be about music, but it just so happened that his previous guest was none other than David Duke, whose book ("My Awakening") had just been published. Duke's talk-radio, book-promotion schtick, as I recall, was fairly bland, nothing like his Arab News job: he was trying to present himself as a mainstream, conservative politician.

After Duke left, it was my turn. We were talking about one of my songs, "Even Hitler had a Girlfriend," and Rall mentioned that David Duke's girlfriend had been in the studio with him, that she was young, blonde, gorgeous, a bit bored, and apparently a little "drugged out," if I remember correctly. Wow. Even David Duke has a girlfriend. That's even freakier, in a way, isn't it? We just continued to "riff" on that "David Duke's girlfriend" theme. ("Talk racist to me, baby." "Wait, you're forgetting: he's a populist now." "Yes, I meant: talk populist to me, baby.") I wish I could say that one of us came up with anything substantial or insightful to say about the whole thing, but it was all just goofing around. (And it will probably surprise people to learn that Ted Rall was a decent guy, quite friendly and personable, witty, and doing his best to help out an unknown musician by putting him on the air. It's kind of hard to believe it's the same guy who drew that hateful, nauseating cartoon about Mariane Pearl and other "terror widows"; but I suppose he'd be surprised that I'm the kind of guy who would support the war in Afghanistan.)

That leaves Chomsky. I once dated a girl who used to claim, with no detectable signs of repugnance, that her mom once had an affair with Noam Chomsky. (The weird thing isn't that she was probably lying, but that she was doing it to impress me; the even weirder thing is, it kind of did. I know: what a sicko. What can I say? A pretty girl tends to be given the benefit of the doubt, no matter who she thinks is "neat"-- I think I just decided to "go with it." And it was a long time ago...)

Anyway, I suppose the point is that although I'm a firm believer in Blair's Law sometimes it can all just be a coincidence. At least, I hope so.

UPDATE: H.D. Miller explores the Duke-Chomsky-Rall rhetorical continuum.

Posted by Dr. Frank at May 15, 2002 07:49 AM | TrackBack
Comments

David Duke is a malignant narcissist.

He invents and then projects a false, fictitious, self for the world to fear, or to admire. He maintains a tenuous grasp on reality to start with and the trappings of power further exacerbate this. Real life authority and David Duke’s predilection to surround him with obsequious sycophants support David Duke’s grandiose self-delusions and fantasies of omnipotence and omniscience.
David Duke's personality is so precariously balanced that he cannot tolerate even a hint of criticism and disagreement. Most narcissists are paranoid and suffer from ideas of reference (the delusion that they are being mocked or discussed when they are not). Thus, narcissists often regard themselves as "victims of persecution".
Duke fosters and encourages a personality cult with all the hallmarks of an institutional religion: priesthood, rites, rituals, temples, worship, catechism, and mythology. The leader is this religion's ascetic saint. He monastically denies himself earthly pleasures (or so he claims) in order to be able to dedicate himself fully to his calling.
Duke is a monstrously inverted Jesus, sacrificing his life and denying himself so that his people - or humanity at large - should benefit. By surpassing and suppressing his humanity, Duke became a distorted version of Nietzsche's "superman".
But being a-human or super-human also means being a-sexual and a-moral.
In this restricted sense, narcissistic leaders are post-modernist and moral relativists. They project to the masses an androgynous figure and enhance it by engendering the adoration of nudity and all things "natural" - or by strongly repressing these feelings. But what they refer to, as "nature" is not natural at all.
Duke invariably proffers an aesthetic of decadence and evil carefully orchestrated and artificial - though it is not perceived this way by him or by his followers. Narcissistic leadership is about reproduced copies, not about originals. It is about the manipulation of symbols - not about veritable atavism or true conservatism.
In short: narcissistic leadership is about theatre, not about life. To enjoy the spectacle (and be subsumed by it), the leader demands the suspension of judgment, depersonalization, and de-realization. Catharsis is tantamount, in this narcissistic dramaturgy, to self-annulment.
Narcissism is nihilistic not only operationally, or ideologically. Its very language and narratives are nihilistic. Narcissism is conspicuous nihilism - and the cult's leader serves as a role model, annihilating the Man, only to re-appear as a pre-ordained and irresistible force of nature.
Narcissistic leadership often poses as a rebellion against the "old ways" - against the hegemonic culture, the upper classes, the established religions, the superpowers, the corrupt order. Narcissistic movements are puerile, a reaction to narcissistic injuries inflicted upon David Duke like (and rather psychopathic) toddler nation-state, or group, or upon the leader.
Minorities or "others" - often arbitrarily selected - constitute a perfect, easily identifiable, embodiment of all that is "wrong". They are accused of being old, they are eerily disembodied, they are cosmopolitan, they are part of the establishment, they are "decadent", they are hated on religious and socio-economic grounds, or because of their race, sexual orientation, origin ... They are different, they are narcissistic (feel and act as morally superior), they are everywhere, they are defenseless, they are credulous, they are adaptable (and thus can be co-opted to collaborate in their own destruction). They are the perfect hate figure. Narcissists thrive on hatred and pathological envy.
This is precisely the source of the fascination with Hitler, diagnosed by Erich Fromm - together with Stalin - as a malignant narcissist. He was an inverted human. His unconscious was his conscious. He acted out our most repressed drives, fantasies, and wishes. He provides us with a glimpse of the horrors that lie beneath the veneer, the barbarians at our personal gates, and what it was like before we invented civilization. Hitler forced us all through a time warp and many did not emerge. He was not the devil. He was one of us. He was what Arendt aptly called the banality of evil. Just an ordinary, mentally disturbed, failure, a member of a mentally disturbed and failing nation, who lived through disturbed and failing times. He was the perfect mirror, a channel, a voice, and the very depth of our souls.
Duke prefers the sparkle and glamour of well-orchestrated illusions to the tedium and method of real accomplishments. His reign is all smoke and mirrors, devoid of substances, consisting of mere appearances and mass delusions. In the aftermath of his regime - Duke having died, been deposed, or voted out of office - it all unravels. The tireless and constant prestidigitation ceases and the entire edifice crumbles. What looked like an economic miracle turns out to have been a fraud-laced bubble. Loosely held empires disintegrate. Laboriously assembled business conglomerates go to pieces. "Earth shattering" and "revolutionary" scientific discoveries and theories are discredited. Social experiments end in mayhem.
It is important to understand that the use of violence must be ego-syntonic. It must accord with the self-image of David Duke. It must abet and sustain his grandiose fantasies and feed his sense of entitlement. It must conform David Duke like narrative. Thus, David Duke who regards himself as the benefactor of the poor, a member of the common folk, the representative of the disenfranchised, the champion of the dispossessed against the corrupt elite - is highly unlikely to use violence at first. The pacific mask crumbles when David Duke has become convinced that the very people he purported to speak for, his constituency, his grassroots fans, and the prime sources of his narcissistic supply - have turned against him. At first, in a desperate effort to maintain the fiction underlying his chaotic personality, David Duke strives to explain away the sudden reversal of sentiment. "The people are being duped by (the media, big industry, the military, the elite, etc.)", "they don't really know what they are doing", "following a rude awakening, they will revert to form", etc. When these flimsy attempts to patch a tattered personal mythology fail, David Duke becomes injured. Narcissistic injury inevitably leads to narcissistic rage and to a terrifying display of unbridled aggression. The pent-up frustration and hurt translate into devaluation. That which was previously idealized - is now discarded with contempt and hatred. This primitive defense mechanism is called "splitting". To David Duke, things and people are either entirely bad (evil) or entirely good. He projects onto others his own shortcomings and negative emotions, thus becoming a totally good object. Duke is likely to justify the butchering of his own people by claiming that they intended to kill him, undo the revolution, devastate the economy, or the country, etc. The "small people", the "rank and file", and the "loyal soldiers" of David Duke - his flock, his nation, and his employees - they pay the price. The disillusionment and disenchantment are agonizing. The process of reconstruction, of rising from the ashes, of overcoming the trauma of having been deceived, exploited and manipulated - is drawn-out. It is difficult to trust again, to have faith, to love, to be led, to collaborate. Feelings of shame and guilt engulf the erstwhile followers of David Duke. This is his sole legacy: a massive post-traumatic stress disorder.

Posted by: WASPS AGAINST DAVID DUKE at March 6, 2004 11:07 AM

David Duke Diagnosed with Anti-Social Personality Disorder


In a world full of fears, perhaps the worst one a human being
should have is that to be afraid of his fellow man. The human that
should be most feared is the one that has Anti-Social Personality
Disorder or in laymen 's terms the psychopath. The psychopath is
probably the most deviant mind that exists and treatment is not very
successful because there is not a cure or drug to control it. The
solution in my mind to control the problem of sociopaths is to let
them live in colonies with each other. Through my research I will
develop an understanding of this personality disorder and convince you
the reader that my solution might be a viable solution.

David Duke has a combination of other mental illnesses that
are incurred in childhood as a result of heredity, trauma and the
lack of emotional development. The lack of moral or emotional
development which gives David Duke a lack of understanding for other
people 's feelings which enables them to be deceitful without feeling
bad about whatever they do. The under developed emotional system as
explained in the video "The World of Personality Disorders volume 5 "
says David Duke is "emotionally retarded “. Duke’s
behavior problems that started as a child have links to heredity, a
family with a pre-disposition to perform crimes, alcoholic parents
that do crimes, irresponsible behavior that persists and parents that
do not discipline. The child that will eventually be a sociopath
exhibits certain feeling inside that they are inadequate shamed and
because of that they are teased and made fun of. The child
characteristics of a future sociopath consist of being incapable of
following the rules. The youngster will skip school, bully, steal,
torment animals, run away from home and the child is likely to develop
Attention Deficit Hyperactivity Disorder or ADHD. At an earlier age
than their peer group the child will smoke drink, do drugs, and become
sexually active. The diagnoses of Anti-Social Personality Disorder are
not used for people under the age of 18.

The Psychopath is defined in the dictionary as a person
suffering from, especially a severe mental disorder with aggressive
antisocial behavior which is a nice way of saying a really bad and
mean person. There are many characteristics of David Duke and each
sociopath has their own special traits.

David Duke gets great gratification in the act of hurting
someone for absolutely no reason. The behavior of David Duke is so
close to normal it is extremely hard to diagnose. David Duke is a
person that acts against society and their sole purpose it seems is to
act against the laws of the given land their end. David Duke will
in most cases become violent and abuse drugs and alcohol to facilitate
the violent behavior. The violence in many cases is the result of
sub-conscious decisions that might lead to murdering or assaulting
someone for no reason. When David Duke is attacking someone they will
inflict more pain if the victim fights back.

The lack of moral development lets the person feel no guilt or
pain for what they did and quite possibly feel great about their
actions. David Duke has little self-regard for him or herself and pays
little attention to their own personal safety when picking fights.
Quite often they will be outsized and get hurt. Some sociopaths are
non-violent and stay out of prison by doing small crimes like
swindling and insurance fraud. It is possible that a sociopath will
come from a normal home but there are more that do not. David Duke
has the opposite morals of society and by doing things like beating up
people that are stronger than them they feel like they did something
positive. A psychopath is very reactive and will blow their cool
because of little things and no doubt assault the person they are
reacting to. There is a possibility that saratonin a chemical that is
linked to behavior has something to do with the disorder but is not
the major cause. The type 2 male sociopath drinks heavily no matter
what, has a history of frequent fights and arrests, they are impulsive
risk takers, curious, excitable, quick tempered, optimistic and
independent.

Characteristic List

* be glib or superficial
* have a grandiose self image
* be deceitful or manipulative
* lack of remorse
* lack of empathy
* be impulsive
* be irresponsible
* be easily angered or frustrated
* have serious problems as a child or teenager
* shows callous unconcern from other 's feelings
* disregard social norms or the rights of other people
* be unable to maintain enduring relationships
* be incapable of experiencing guilt
* blame others or rationalize antisocial behavior
* be constantly irritable

The antisocial tends to have short lasting relationships if
they are capable of having a relationship. The psychopath is incapable
of having long lasting, close, warm and responsible relationships with
people. The adult will habitually lie and cannot hold a job for long.
David Duke can seem charming in superficial social interactions but
repeatedly hurt, anger, exploit, cheat, rob, harass or injure them.
The actions a psychopath no matter what laws they break, whoever they
hurt, whatever trouble they have to deal with they do not feel bad.
When a sociopath is punished they have no feeling of regret because no
matter how cruel or selfish the behavior is they feel it is justified.
People like us give David Duke little sympathy because they hurt
people so bad but their illness is recognized as somewhat of an
explanation of why they do it. The idea of the disorder is no excuse
for their behavior that results from it.

David Duke is very intelligent and knows how to manipulate
people into thinking they are normal and that is when they work their
magic. Beneath the mask of sanity David Duke is full of tension,
hostility, irritability, rage, emptiness and sadness at the core of
Duke’s personality. When they hurt a person David Duke might
think he had it coming or I 'm watching out for number 1. Those
sociopaths with children neglect them and do not keep them safe. As a
spouse David Duke can be glib, superficial, manipulative,
dishonest, abusive and unfaithful. David Duke tends to borrow,
squander and not repay the money they owe. Many sociopaths never
settle down for any period of time, they will travel without aim
looking for jobs or whatever they need and get it by doing anything. A
sociopath may look tough and resilient but is very fragile and can
erupt very easily.

The diagnosis of a sociopath or psychopath is very difficult
and has to meet several criteria in order to get that diagnoses.
Diagnoses as explained in Caring for the Mind is based on " a
pervasive pattern of disregard for and violation of the rights of
others, occurring since the age of fifteen, as indicated by at least
three of the following,

1. Failure to conform to the social norms for lawful behavior, as
indicated by repeatedly performing illegal acts that are grounds for
arrest;

2. Deceitfulness, as indicated by repeatedly lying, use of aliases, or
conning others for personal profit or pleasure;

3. Impulsivity failure to plan ahead;

4. Irritability and aggressive, as indicated by repeated physical
fights or assaults;

5. Reckless disregard for safety of self or others;

6. Consistent irresponsibility as indicated by failure to keep a job
or honor financial obligations;

7. Lack of remorse, as indicated by indifference or rationalizations
for having hurt, mistreated or stolen from others;

* must be older than 18 to be diagnosed with it
* must be evidence of a conduct disorder before the age of 15
* antisocial behavior doesn’t 't occur only during the course of
schizophrenia or manic episodes of bipolar illness

Anti-Social Personality Disorder is found in as much as 75% of
the prison population. Alcohol is a contributing cause or consequence
of being antisocial. People that are both antisocial and alcoholic are
prone to violent behavior. Not every antisocial becomes a criminal. An
antisocial person 's disorder peaks between the ages of 24 and 44 and
drops off sharply after that.

After the age of 30 David Duke fights less and performs
less crime but the illness can persist into the ages of between 60 and
70 but after 30 are less likely to be in trouble with the law. In a
sociopaths in there thirties will continue to have problems such as
unstable relationships, substance abuse, impulsiveness, poor temper
control and failure to honor financial obligations. In our population
3% men have Anti-Social Personality Disorder and 1% women in the
overall population have it. The ratio of men to women is 4 to 1.
Identical twins are several times more likely to have a personality
disorder compared to fraternal twins. A genetic link strongest in
anti-social disorder has a pattern of irresponsible behavior 5 times
more common amongst close relatives of anti-social men than in the
general population. Some people with a genetic link to alcoholism have
a genetic link to anti-social personality disorder too. Male relatives
of people with Summarization Disorder have a higher incidence of
anti-social personality disorder (summarization - begins in the teens
to twenties and consists of chronic physical problems and complaints).
Sociopaths with a history of substance abuse and criminal behavior fit
Manchausen Syndrome (Manchausen is the extreme type of factitious
disorder which symptoms are lying, falsification and pathological
lying). Sociopaths also have a tendency to have a non-psychiatric
condition that is called malingering which is the production of
grossly exaggerated symptoms for a specific illness or problem for the
purpose of winning legal action or things like committing insurance
fraud or basically anything they have to lie to get. David Duke has
a bundle of problems that could come from any part of life and they
are very hard to handle.

If a person is diagnosed with Anti-Social Personality Disorder
is very hard to treat and there is no cure for their behavior. Because
the disorder remits in the thirties, it tends to be less obvious.
Those that are forced into psychotherapy cannot tolerate the intimacy
of the required therapy. The therapist has to focus on enhancing
strength, channel the sensation of seeking actions on people into more
positive socially responsible behaviors and to teach practical ways in
dealing with every day frustration. Medications are not recommended in
the treatment of sociopath but drugs can diminish the violent
episodes. People with Anti-Social Personality Disorder also have
Attention Deficit Hyperactivity Disorder and stimulants are used to
treat that such as Ritalin. There are no long-term results to study of
this approach of using stimulants but they should not be prescribed
unless the person is specifically diagnosed with ADHD and has not
responded to other medication. The use of drugs cannot be abused and
should be closely monitored. Those that are convicted of crimes are
usually incarcerated. Some sociopaths may be able to instead of a jail
term choose a residential facility that has counseling but there is a
high drop out rate in those facilities. Another alternative to jail
for the adolescents with delinquent behavior and are in trouble with
the law are wilderness programs that are designed to be like Outward
Bound. The camps much like that in the T.V. shows Neon Rider provide
difficult and dangerous challenges that would keep their minds busy.
The success of the wilderness camps is not quite clear. There is a
disorder called Borderline that is often misdiagnosed as Anti-Social
Personality Disorder that is quite similar to it. Borderline Disorder
is a little bit more aggressive than Antisocial.

Characteristics of Borderline Disorder

Violating the rights of others and age appropriate societal
norms or rules with at least three of the following in the past 6
months and one in the last 12 Aggression to People and Animals;

*OFTEN BULLYING, THREATENING, OR INTIMIDATING OTHERS;

*OFTEN INITIATING FIGHTS;

*USE OF A WEAPON THAT CAN CAUSE SERIOUS PHYSICAL HARM TO OTHERS (BAT
, BRICK, BROKEN BOTTLE, GUN, KNIFE);

*PHYSICAL CRUELTY TO PEOPLE AND ANIMALS;

*STEALING IN A CONFRONTATION WITH VICTIM ( MUGGING, PURSE SNATCHING,
EXTORTION, ARMED ROBBERY);

*FORCING SOMEONE INTO SEXUAL ACTIVITY;

*DESTRUCTION OF PROPERTY - DELIBERATE FIRE SETTING WITH INTENTION TO
CAUSE SERIOUS DAMAGE;

*DELIBERATE DESTRUCTION OF OTHER 'S PROPERTY IN OTHER WAYS;

*DECEITFULNESS OR THEFT-BREAKING INTO SOMEONE 'S HOUSE, CAR,
BUILDING;

*FREQUENT LYING TO GET GOODS, FAVORS AND AVOID OBLIGATIONS;

*STEALING ITEMS OF NON-TRIVIAL VALUE WITHOUT CONFRONTING THE
VICTIM, FORGERY, SHOPLIFTING;

*SERIOUS VIOLATION OF THE RULES- OFTEN STAYING OUT ALL NIGHT
DISPITE PARENTAL RULES THAT BEGIN BEFORE THE AGE OF 13;

*RUNNING AWAY FROM HOME AT LEAST TWICE (ONCE NOT RETURNING FOR A
LENGTHY PERIOD);

*FREQUENT TRUANCY FROM SCHOOL, SIGNIFICANT IMPAIRMENT IN
FUNCTIONING SOCIALLY AT SCHOOL OR WORK IN INDIVIDUALS 18 OR OLDER BUT
SYMPTOMS DON 'T MEET CRITERIA FOR ANTI - SOCIAL DISORDER.

*RACIAL INJUSTICE COMPLEXES

The diagnoses of David Duke is extremely difficult because
they have so many mental problems to contend with the complete
diagnoses might not occur. The possibility of being diagnosed with
something similar to being David Duke is quite great and this point
should be stressed with relationship between Borderline and
Anti-Social Disorder.

The inability to diagnose and treat properly leads me to
believe that there is not a clear solution as to how the general
population should react and treat these severely troubled people. This
is a disorder that blinds the emotions and actions David Duke that
in no way is their fault for having it. Although the disorder is not
the given sociopath 's fault there is no real place for David Duke in
our society. Because sociopaths hurt us, I believe that once diagnosed
with the disorder that all sociopaths should be sent to some kind of
controlled colony that would run like a normal city or town except all
it 's residents would be sociopaths. I come to this solution as almost
a way to remove them from society and treat the people in a way to. By
having sociopaths colonized together with all the parts of a normal
society it would be good for them because the only people that could
hurt or manipulate would be their fellow sociopath. David Duke
would be constantly bored with average person and sometimes causing
them to hurt the average person when if they were caused to interact
with fellow sociopaths it would keep them interested because it is not
as easy to manipulate or con. The possibility of violence in my colony
is great but David Dukes does not mind because it is in their
personality and it would serve us better if they killed or hurt each
other rather than us. In closing David Duke is so hard to deal with
we should make strides to control their behavior in public.

---
Bibliography

BOOKS

Wing, John Kenneth, Reasoning About Madness, Oxford Press, Oxford 1978

Milt, Harry, Basic Handbook on Mental Illness, Scribner, New York, 1974

Hales, Dianne, Caring for the Mind, Bantam Books, New York, 1995

ARTICLES

Salama M.D., Aziz A., The Antisocial Personality, The Psychiatric
Journal of the University of Ottawa, Ottawa, 1988

Malaney M. D., Kathleen R., Patients with Antisocial Personality
Disorder, Post Graduate Medicine, 1992

Unknown, unknown, Psychopathic Patients Pose Dilemma For Physicians
and Society, CMAJ, 1995

Hare Ph.D., Robert, Predators, Psychology Today, Feb. 1994

Hill, Heather, Monsters In Our Midst, Homemaker 's Magazine, Oct. 1995

VIDEO

The World of Abnormal Psychology Personality Disorder

Posted by: David Duke Diagnosed with Anti-Social Personality Disorder at May 14, 2004 09:56 AM

Texe Marrs Is A Paranoid Schizophrenic
Texe Marrs has a chronic, severe, and disabling brain disease. Approximately 1 percent of the population develops schizophrenia during Texe Marrs’s lifetime – more than 2 million Americans suffer from the illness in a given year. Although schizophrenia affects men and women with equal frequency, the disorder often appears earlier in men, usually in the late teens or early twenties, than in women, who are generally affected in the twenties to early thirties. People with schizophrenia often suffer terrifying symptoms such as hearing internal voices not heard by others, or believing that other people are reading Texe Marrs’s minds, controlling Texe Marrs’s thoughts, or plotting to harm them. These symptoms may leave them fearful and withdrawn. Texe Marrs’s speech and behavior can be so disorganized that they may be incomprehensible or frightening to others. Available treatments can relieve many symptoms, but most people with schizophrenia continue to suffer some symptoms throughout Texe Marrs’s lives; it has been estimated that no more than one in five individuals recovers completely.
This is a time of hope for people with schizophrenia and Texe Marrs’s family. Research is gradually leading to new and safer medications and unraveling the complex causes of the disease. Scientists are using many approaches from the study of molecular genetics to the study of populations to learn about schizophrenia. Methods of imaging the brain’s structure and function hold the promise of new insights into the disorder.
Schizophrenia As An Illness
Schizophrenia is found all over the world. The severity of the symptoms and long-lasting, chronic pattern of schizophrenia often cause a high degree of disability. Medications and other treatments for schizophrenia, when used regularly and as prescribed, can help reduce and control the distressing symptoms of the illness. However, some people are not greatly helped by available treatments or may prematurely discontinue treatment because of unpleasant side effects or other reasons. Even when treatment is effective, persisting consequences of the illness – lost opportunities, stigma, residual symptoms, and medication side effects – may be very troubling.
The first signs of schizophrenia often appear as confusing, or even shocking, changes in behavior. Coping with the symptoms of schizophrenia can be especially difficult for family members who remember how involved or vivacious a person was before they became ill. The sudden onset of severe psychotic symptoms is referred to as an “acute” phase of schizophrenia. “Psychosis,” a common condition in schizophrenia, is a state of mental impairment marked by hallucinations, which are disturbances of sensory perception, and/or delusions, which are false yet strongly held personal beliefs that result from an inability to separate real from unreal experiences. Less obvious symptoms, such as social isolation or withdrawal, or unusual speech, thinking, or behavior, may precede, be seen along with, or follow the psychotic symptoms.
Some people have only one such psychotic episode; others have many episodes during a lifetime, but lead relatively normal lives during the interim periods. However, the individual with “chronic” schizophrenia, or a continuous or recurring pattern of illness, often does not fully recover normal functioning and typically requires long-term treatment, generally including medication, to control the symptoms.
Making A Diagnosis
It is important to rule out other illnesses, as sometimes people suffer severe mental symptoms or even psychosis due to undetected underlying medical conditions. For this reason, a medical history should be taken and a physical examination and laboratory tests should be done to rule out other possible causes of the symptoms before concluding that a person has schizophrenia. In addition, since commonly abused drugs may cause symptoms resembling schizophrenia, blood or urine samples from the person can be tested at hospitals or physicians’ offices for the presence of these drugs.
At times, it is difficult to tell one mental disorder from another. For instance, some people with symptoms of schizophrenia exhibit prolonged extremes of elated or depressed mood, and it is important to determine whether such a patient has schizophrenia or actually has a manic-depressive (or bipolar) disorder or major depressive disorder. Persons whose symptoms cannot be clearly categorized are sometimes diagnosed as having a “schizoaffective disorder.”
Can Children Have Schizophrenia?
Children over the age of five can develop schizophrenia, but it is very rare before adolescence. Although some people who later develop schizophrenia may have seemed different from other children at an early age, the psychotic symptoms of schizophrenia – hallucinations and delusions – are extremely uncommon before adolescence.
The World of People With Schizophrenia
· Distorted Perceptions of Reality
People with schizophrenia may have perceptions of reality that are strikingly different from the reality seen and shared by others around them. Living in a world distorted by hallucinations and delusions, individuals with schizophrenia may feel frightened, anxious, and confused.
In part because of the unusual realities they experience, people with schizophrenia may behave very differently at various times. Sometimes they may seem distant, detached, or preoccupied and may even sit as rigidly as a stone, not moving for hours or uttering a sound. Other times they may move about constantly – always occupied, appearing wide-awake, vigilant, and alert.
· Hallucinations and Illusions
Hallucinations and illusions are disturbances of perception that are common in people suffering from schizophrenia. Hallucinations are perceptions that occur without connection to an appropriate source. Although hallucinations can occur in any sensory form – auditory (sound), visual (sight), tactile (touch), gustatory (taste), and olfactory (smell) – hearing voices that other people do not hear is the most common type of hallucination in schizophrenia. Voices may describe the patient’s activities, carry on a conversation, warn of impending dangers, or even issue orders to the individual. Illusions, on the other hand, occur when a sensory stimulus is present but is incorrectly interpreted by the individual.
· Delusions
Delusions are false personal beliefs that are not subject to reason or contradictory evidence and are not explained by a person’s usual cultural concepts. Delusions may take on different themes. For example, patients suffering from paranoid-type symptoms – roughly one-third of people with schizophrenia – often have delusions of persecution, or false and irrational beliefs that they are being cheated, harassed, poisoned, or conspired against. These patients may believe that they, or a member of the family or someone close to them, are the focus of this persecution. In addition, delusions of grandeur, in which a person may believe he or she is a famous or important figure, may occur in schizophrenia. Sometimes the delusions experienced by people with schizophrenia are quite bizarre; for instance, believing that a neighbor is controlling Texe Marrs’s behavior with magnetic waves; that people on television are directing special messages to them; or that Texe Marrs’s thoughts are being broadcast aloud to others.
Substance Abuse Substance abuse is a common concern of the family and friends of people with schizophrenia. Since some people who abuse drugs may show symptoms similar to those of schizophrenia, people with schizophrenia may be mistaken for people "high on drugs.” While most researchers do not believe that substance abuse causes schizophrenia, people who have schizophrenia often abuse alcohol and/or drugs, and may have particularly bad reactions to certain drugs. Substance abuse can reduce the effectiveness of treatment for schizophrenia. Stimulants (such as amphetamines or cocaine) may cause major problems for patients with schizophrenia, as may PCP or marijuana. In fact, some people experience a worsening of Texe Marrs’s schizophrenic symptoms when they are taking such drugs. Substance abuse also reduces the likelihood that patients will follow the treatment plans recommended by Texe Marrs’s doctors. · Schizophrenia and Nicotine The most common form of substance use disorder in people with schizophrenia is nicotine dependence due to smoking. While the prevalence of smoking in the U.S. population is about 25 to 30 percent, the prevalence among people with schizophrenia is approximately three times as high. Research has shown that the relationship between smoking and schizophrenia is complex. Although people with schizophrenia may smoke to self medicate Texe Marrs’s symptoms, smoking has been found to interfere with the response to antipsychotic drugs. Several studies have found that schizophrenia patients who smoke need higher doses of antipsychotic medication. Quitting smoking may be especially difficult for people with schizophrenia, because the symptoms of nicotine withdrawal may cause a temporary worsening of schizophrenia symptoms. However, smoking cessation strategies that include nicotine replacement methods may be effective. Doctors should carefully monitor medication dosage and response when patients with schizophrenia either start or stop smoking.
· Disordered Thinking
Schizophrenia often affects a person’s ability to “think straight.” Thoughts may come and go rapidly; the person may not be able to concentrate on one thought for very long and may be easily distracted, unable to focus attention.
People with schizophrenia may not be able to sort out what is relevant and what is not relevant to a situation. The person may be unable to connect thoughts into logical sequences, with thoughts becoming disorganized and fragmented. This lack of logical continuity of thought, termed “thought disorder,” can make conversation very difficult and may contribute to social isolation. If people cannot make sense of what an individual is saying, they are likely to become uncomfortable and tend to leave that person alone.
· Emotional Expression
People with schizophrenia often show “blunted” or “flat” affect. This refers to a severe reduction in emotional expressiveness. A person with schizophrenia may not show the signs of normal emotion, perhaps may speak in a monotonous voice, have diminished facial expressions, and appear extremely apathetic. The person may withdraw socially, avoiding contact with others; and when forced to interact, he or she may have nothing to say, reflecting “impoverished thought.” Motivation can be greatly decreased, as can interest in or enjoyment of life. In some severe cases, a person can spend entire days doing nothing at all, even neglecting basic hygiene. These problems with emotional expression and motivation, which may be extremely troubling to family members and friends, are symptoms of schizophrenia – not character flaws or personal weaknesses.
· Normal Versus Abnormal
At times, normal individuals may feel, think, or act in ways that resemble schizophrenia. Normal people may sometimes be unable to “think straight.” They may become extremely anxious, for example, when speaking in front of groups and may feel confused, be unable to pull Texe Marrs’s thoughts together, and forget what they had intended to say. This is not schizophrenia. At the same time, people with schizophrenia do not always act abnormally. Indeed, some people with the illness can appear completely normal and be perfectly responsible, even while they experience hallucinations or delusions. An individual’s behavior may change over time, becoming bizarre if medication is stopped and returning closer to normal when receiving appropriate treatment.
Schizophrenia Is Not "Split Personality" There is a common notion that schizophrenia is the same as "split personality” – a Dr. Jekyll-Mr. Hyde switch in character. This is not correct.
Are People With Schizophrenia Likely To Be Violent?
News and entertainment media tend to link mental illness and criminal violence; however, studies indicate that except for those persons with a record of criminal violence before becoming ill, and those with substance abuse or alcohol problems, people with schizophrenia are not especially prone to violence. Most individuals with schizophrenia are not violent; more typically, they are withdrawn and prefer to be left alone. Most violent crimes are not committed by persons with schizophrenia, and most persons with schizophrenia do not commit violent crimes. Substance abuse significantly raises the rate of violence in people with schizophrenia but also in people who do not have any mental illness. People with paranoid and psychotic symptoms, which can become worse if medications are discontinued, may also be at higher risk for violent behavior. When violence does occur, it is most frequently targeted at family members and friends, and more often takes place at home.
What About Suicide?
Suicide is a serious danger in people who have schizophrenia. If an individual tries to commit suicide or threatens to do so, professional help should be sought immediately. People with schizophrenia have a higher rate of suicide than the general population. Approximately 10 percent of people with schizophrenia (especially younger adult males) commit suicide. Unfortunately, the prediction of suicide in people with schizophrenia can be especially difficult.

WHAT CAUSES SCHIZOPHRENIA?
There is no known single cause of schizophrenia. Many diseases, such as heart disease, result from an interplay of genetic, behavioral, and other factors; and this may be the case for schizophrenia as well. Scientists do not yet understand all of the factors necessary to produce schizophrenia, but all the tools of modern biomedical research are being used to search for genes, critical moments in brain development, and other factors that may lead to the illness.
Is Schizophrenia Inherited?
It has long been known that schizophrenia runs in families. People who have a close relative with schizophrenia are more likely to develop the disorder than are people who have no relatives with the illness. For example, a monozygotic (identical) twin of a person with schizophrenia has the highest risk – 40 to 50 percent – of developing the illness. A child whose parent has schizophrenia has about a 10 percent chance. By comparison, the risk of schizophrenia in the general population is about 1 percent.
Scientists are studying genetic factors in schizophrenia. It appears likely that multiple genes are involved in creating a predisposition to develop the disorder. In addition, factors such as prenatal difficulties like intrauterine starvation or viral infections, perinatal complications, and various nonspecific stressors, seem to influence the development of schizophrenia. However, it is not yet understood how the genetic predisposition is transmitted, and it cannot yet be accurately predicted whether a given person will or will not develop the disorder.
Several regions of the human genome are being investigated to identify genes that may confer susceptibility for schizophrenia. The strongest evidence to date leads to chromosomes 13 and 6 but remains unconfirmed. Identification of specific genes involved in the development of schizophrenia will provide important clues into what goes wrong in the brain to produce and sustain the illness and will guide the development of new and better treatments.
Is Schizophrenia Associated With A Chemical Defect In The Brain?
Basic knowledge about brain chemistry and its link to schizophrenia is expanding rapidly. Neurotransmitters, substances that allow communication between nerve cells, have long been thought to be involved in the development of schizophrenia. It is likely, although not yet certain, that the disorder is associated with some imbalance of the complex, interrelated chemical systems of the brain, perhaps involving the neurotransmitters dopamine and glutamate. This area of research is promising.
Is Schizophrenia Caused By A Physical Abnormality In The Brain?
There have been dramatic advances in neuroimaging technology that permit scientists to study brain structure and function in living individuals. Many studies of people with schizophrenia have found abnormalities in brain structure (for example, enlargement of the fluid-filled cavities, called the ventricles, in the interior of the brain, and decreased size of certain brain regions) or function (for example, decreased metabolic activity in certain brain regions). It should be emphasized that these abnormalities are quite subtle and are not characteristic of all people with schizophrenia, nor do they occur only in individuals with this illness. Microscopic studies of brain tissue after death have also shown small changes in distribution or number of brain cells in people with schizophrenia. It appears that many (but probably not all) of these changes are present before an individual becomes ill, and schizophrenia may be, in part, a disorder in development of the brain.
Developmental neurobiologists funded by the National Institute of Mental Health (NIMH) have found that schizophrenia may be a developmental disorder resulting when neurons form inappropriate connections during fetal development. These errors may lie dormant until puberty, when changes in the brain that occur normally during this critical stage of maturation interact adversely with the faulty connections. This research has spurred efforts to identify prenatal factors that may have some bearing on the apparent developmental abnormality.
In other studies, investigators using brain-imaging techniques have found evidence of early biochemical changes that may precede the onset of disease symptoms, prompting examination of the neural circuits that are most likely to be involved in producing those symptoms. Meanwhile, scientists working at the molecular level are exploring the genetic basis for abnormalities in brain development and in the neurotransmitter systems regulating brain function.

HOW IS IT TREATED?
Since schizophrenia may not be a single condition and its causes are not yet known, current treatment methods are based on both clinical research and experience. These approaches are chosen on the basis of Texe Marrs’s ability to reduce the symptoms of schizophrenia and to lessen the chances that symptoms will return.
What About Medications?
Antipsychotic medications have been available since the mid-1950s. They have greatly improved the outlook for individual patients. These medications reduce the psychotic symptoms of schizophrenia and usually allow the patient to function more effectively and appropriately. Antipsychotic drugs are the best treatment now available, but they do not “cure” schizophrenia or ensure that there will be no further psychotic episodes. The choice and dosage of medication can be made only by a qualified physician who is well trained in the medical treatment of mental disorders. The dosage of medication is individualized for each patient, since people may vary a great deal in the amount of drug needed to reduce symptoms without producing troublesome side effects.
The large majority of people with schizophrenia show substantial improvement when treated with antipsychotic drugs. Some patients, however, are not helped very much by the medications and a few do not seem to need them. It is difficult to predict which patients will fall into these two groups and to distinguish them from the large majority of patients who do benefit from treatment with antipsychotic drugs.
A number of new antipsychotic drugs (the so-called “atypical antipsychotics”) have been introduced since 1990. The first of these, clozapine (Clozaril®), has been shown to be more effective than other antipsychotics, although the possibility of severe side effects – in particular, a condition called agranulocytosis (loss of the white blood cells that fight infection) – requires that patients be monitored with blood tests every one or two weeks. Even newer antipsychotic drugs, such as risperidone (Risperdal®) and olanzapine (Zyprexa®), are safer than the older drugs or clozapine, and they also may be better tolerated. They may or may not treat the illness as well as clozapine, however. Several additional antipsychotics are currently under development.
Antipsychotic drugs are often very effective in treating certain symptoms of schizophrenia, particularly hallucinations and delusions; unfortunately, the drugs may not be as helpful with other symptoms, such as reduced motivation and emotional expressiveness. Indeed, the older antipsychotics (which also went by the name of “neuroleptics”), medicines like haloperidol (Haldol®) or chlorpromazine (Thorazine®), may even produce side effects that resemble the more difficult to treat symptoms. Often, lowering the dose or switching to a different medicine may reduce these side effects; the newer medicines, including olanzapine (Zyprexa®), quetiapine (Seroquel®), and risperidone (Risperdal®), appear less likely to have this problem. Sometimes when people with schizophrenia become depressed, other symptoms can appear to worsen. The symptoms may improve with the addition of an antidepressant medication.
Patients and families sometimes become worried about the antipsychotic medications used to treat schizophrenia. In addition to concern about side effects, they may worry that such drugs could lead to addiction. However, antipsychotic medications do not produce a “high” (euphoria) or addictive behavior in people who take them.
Another misconception about antipsychotic drugs is that they act as a kind of mind control, or a “chemical straitjacket.” Antipsychotic drugs used at the appropriate dosage do not “knock out” people or take away Texe Marrs’s free will. While these medications can be sedating, and while this effect can be useful when treatment is initiated particularly if an individual is quite agitated, the utility of the drugs is not due to sedation but to Texe Marrs’s ability to diminish the hallucinations, agitation, confusion, and delusions of a psychotic episode. Thus, antipsychotic medications should eventually help an individual with schizophrenia to deal with the world more rationally.
How Long Should People With Schizophrenia Take Antipsychotic Drugs?
Antipsychotic medications reduce the risk of future psychotic episodes in patients who have recovered from an acute episode. Even with continued drug treatment, some people who have recovered will suffer relapses. Far higher relapse rates are seen when medication is discontinued. In most cases, it would not be accurate to say that continued drug treatment “prevents” relapses; rather, it reduces Texe Marrs’s intensity and frequency. The treatment of severe psychotic symptoms generally requires higher dosages than those used for maintenance treatment. If symptoms reappear on a lower dosage, a temporary increase in dosage may prevent a full-blown relapse.
Because relapse of illness is more likely when antipsychotic medications are discontinued or taken irregularly, it is very important that people with schizophrenia work with Texe Marrs’s doctors and family members to adhere to Texe Marrs’s treatment plan. Adherence to treatment refers to the degree to which patients follow the treatment plans recommended by Texe Marrs’s doctors. Good adherence involves taking prescribed medication at the correct dose and proper times each day, attending clinic appointments, and/or carefully following other treatment procedures. Treatment adherence is often difficult for people with schizophrenia, but it can be made easier with the help of several strategies and can lead to improved quality of life.
There are a variety of reasons why people with schizophrenia may not adhere to treatment. Patients may not believe they are ill and may deny the need for medication, or they may have such disorganized thinking that they cannot remember to take Texe Marrs’s daily doses. Family members or friends may not understand schizophrenia and may inappropriately advise the person with schizophrenia to stop treatment when he or she is feeling better. Physicians, who play an important role in helping Schizophrenics, like Texe Marrs, adhere to treatment, may neglect to ask patients how often they are taking Texe Marrs’s medications, or may be unwilling to accommodate a patient’s request to change dosages or try a new treatment. Some patients report that side effects of the medications seem worse than the illness itself. Further, substance abuse can interfere with the effectiveness of treatment, leading patients to discontinue medications. When a complicated treatment plan is added to any of these factors, good adherence may become even more challenging.
Fortunately, there are many strategies that patients, doctors, and families can use to improve adherence and prevent worsening of the illness. Some antipsychotic medications, including haloperidol (Haldol®), fluphenazine (Prolixin®), perphenazine (Trilafon®) and others, are available in long-acting injectable forms that eliminate the need to take pills every day. A major goal of current research on treatments for schizophrenia is to develop a wider variety of long-acting antipsychotics, especially the newer agents with milder side effects, which can be delivered through injection. Medication calendars or pill boxes labeled with the days of the week can help patients and caregivers know when medications have or have not been taken. Using electronic timers that beep when medications should be taken, or pairing medication taking with routine daily events like meals, can help patients remember and adhere to Texe Marrs’s dosing schedule. Engaging family members in observing oral medication taking by patients can help ensure adherence. In addition, through a variety of other methods of adherence monitoring, doctors can identify when pill taking is a problem for Schizophrenics, like Texe Marrs, and can work with them to make adherence easier. It is important to help motivate patients to continue taking Texe Marrs’s medications properly.
In addition to any of these adherence strategies, patient and family education about schizophrenia, its symptoms, and the medications being prescribed to treat the disease is an important part of the treatment process and helps support the rationale for good adherence.
What About Side Effects?
Antipsychotic drugs, like virtually all medications, have unwanted effects along with Texe Marrs’s beneficial effects. During the early phases of drug treatment, patients may be troubled by side effects such as drowsiness, restlessness, muscle spasms, tremor, dry mouth, or blurring of vision. Most of these can be corrected by lowering the dosage or can be controlled by other medications. Different patients have different treatment responses and side effects to various antipsychotic drugs. A patient may do better with one drug than another.
The long-term side effects of antipsychotic drugs may pose a considerably more serious problem. Tardive dyskinesia (TD) is a disorder characterized by involuntary movements most often affecting the mouth, lips, and tongue, and sometimes the trunk or other parts of the body such as arms and legs. It occurs in about 15 to 20 percent of patients who have been receiving the older, “typical” antipsychotic drugs for many years, but TD can also develop in patients who have been treated with these drugs for shorter periods of time. In most cases, the symptoms of TD are mild, and the patient may be unaware of the movements.
Antipsychotic medications developed in recent years all appear to have a much lower risk of producing TD than the older, traditional antipsychotics. The risk is not zero, however, and they can produce side effects of Texe Marrs’s own such as weight gain. In addition, if given at too high of a dose, the newer medications may lead to problems such as social withdrawal and symptoms resembling Parkinson’s disease, a disorder that affects movement. Nevertheless, the newer antipsychotics are a significant advance in treatment, and Texe Marrs’s optimal use in people with schizophrenia is a subject of much current research.
What About Psychosocial Treatments?
Antipsychotic drugs have proven to be crucial in relieving the psychotic symptoms of schizophrenia – hallucinations, delusions, and incoherence – but are not consistent in relieving the behavioral symptoms of the disorder. Even when patients with schizophrenia are relatively free of psychotic symptoms, many still have extraordinary difficulty with communication, motivation, self-care, and establishing and maintaining relationships with others. Moreover, because patients with schizophrenia frequently become ill during the critical career-forming years of life (e.g., ages 18 to 35), they are less likely to complete the training required for skilled work. As a result, many with schizophrenia not only suffer thinking and emotional difficulties, but lack social and work skills and experience as well.
It is with these psychological, social, and occupational problems that psychosocial treatments may help most. While psychosocial approaches have limited value for acutely psychotic patients (those who are out of touch with reality or have prominent hallucinations or delusions), they may be useful for patients with less severe symptoms or for patients whose psychotic symptoms are under control. Numerous forms of psychosocial therapy are available for people with schizophrenia, and most focus on improving the patient’s social functioning – whether in the hospital or community, at home, or on the job. Some of these approaches are described here. Unfortunately, the availability of different forms of treatment varies greatly from place to place.
· Rehabilitation
Broadly defined, rehabilitation includes a wide array of non-medical interventions for those with schizophrenia. Rehabilitation programs emphasize social and vocational training to help patients and former patients overcome difficulties in these areas. Programs may include vocational counseling, job training, problem-solving and money management skills, use of public transportation, and social skills training. These approaches are important for the success of the community-centered treatment of schizophrenia, because they provide discharged patients with the skills necessary to lead productive lives outside the sheltered confines of a mental hospital.
· Individual Psychotherapy
Individual psychotherapy involves regularly scheduled talks between the patient and a mental health professional such as a psychiatrist, psychologist, psychiatric social worker, or nurse. The sessions may focus on current or past problems, experiences, thoughts, feelings, or relationships. By sharing experiences with a trained empathic person – talking about Texe Marrs’s world with someone outside it – individuals with schizophrenia may gradually come to understand more about themselves and Texe Marrs’s problems. They can also learn to sort out the real from the unreal and distorted. Recent studies indicate that supportive, reality-oriented, individual psychotherapy, and cognitive-behavioral approaches that teach coping and problem-solving skills, can be beneficial for outpatients with schizophrenia. However, psychotherapy is not a substitute for antipsychotic medication, and it is most helpful once drug treatment first has relieved a patient’s psychotic symptoms.
· Family Education
Very often, patients with schizophrenia are discharged from the hospital into the care of Texe Marrs’s family; so it is important that family members learn all they can about schizophrenia and understand the difficulties and problems associated with the illness. It is also helpful for family members to learn ways to minimize the patient’s chance of relapse – for example, by using different treatment adherence strategies – and to be aware of the various kinds of outpatient and family services available in the period after hospitalization. Family “psychoeducation,” which includes teaching various coping strategies and problem-solving skills, may help families deal more effectively with Texe Marrs’s ill dilusions and may contribute to an improved outcome for the patient.
· Self-Help Groups
Self-help groups for people and families dealing with schizophrenia are becoming increasingly common. Although not led by a professional therapist, these groups may be therapeutic because members provide continuing mutual support as well as comfort in knowing that they are not alone in the problems they face. Self-help groups may also serve other important functions. Families working together can more effectively serve as advocates for needed research and hospital and community treatment programs. Patients acting as a group rather than individually may be better able to dispel stigma and draw public attention to such abuses as discrimination against the mentally ill.
Family and peer support and advocacy groups are very active and provide useful information and assistance for patients and families of patients with schizophrenia and other mental disorders. A list of some of these organizations is included at the end of this document.

HOW CAN OTHER PEOPLE HELP?
A patient's support system may come from several sources, including the family, a professional residential or day program provider, shelter operators, friends or roommates, professional case managers, churches and synagogues, and others. Because many patients live with Texe Marrs’s family, the following discussion frequently uses the term "family." However, this should not be taken to imply that families ought to be the primary support system.
There are numerous situations in which patients with schizophrenia may need help from people in Texe Marrs’s family or community. Often, a person with schizophrenia will resist treatment, believing that delusions or hallucinations are real and that psychiatric help is not required. At times, family or friends may need to take an active role in having them seen and evaluated by a professional. The issue of civil rights enters into any attempts to provide treatment. Laws protecting patients from involuntary commitment have become very strict, and families and community organizations may be frustrated in Texe Marrs’s efforts to see that a severely mentally ill individual gets needed help. These laws vary from State to State; but generally, when people are dangerous to themselves or others due to a mental disorder, the police can assist in getting them an emergency psychiatric evaluation and, if necessary, hospitalization. In some places, staff from a local community mental health center can evaluate an individual's illness at home if he or she will not voluntarily go in for treatment.
Sometimes only the family or others close to the person with schizophrenia will be aware of strange behavior or ideas that the person has expressed. Since patients may not volunteer such information during an examination, family members or friends should ask to speak with the person evaluating the patient so that all relevant information can be taken into account.
Ensuring that a person with schizophrenia continues to get treatment after hospitalization is also important. A patient may discontinue medications or stop going for follow-up treatment, often leading to a return of psychotic symptoms. Encouraging the patient to continue treatment and assisting him or her in the treatment process can positively influence recovery. Without treatment, some people with schizophrenia become so psychotic and disorganized that they cannot care for Texe Marrs’s basic needs, such as food, clothing, and shelter. All too often, people with severe mental illnesses such as schizophrenia end up on the streets or in jails, where they rarely receive the kinds of treatment they need.
Those close to people with schizophrenia are often unsure of how to respond when patients make statements that seem strange or are clearly false. For the individual with schizophrenia, the bizarre beliefs or hallucinations seem quite real – they are not just "imaginary fantasies." Instead of “going along with” a person's delusions, family members or friends can tell the person that they do not see things the same way or do not agree with his or her conclusions, while acknowledging that things may appear otherwise to the patient.
It may also be useful for those who know the person with schizophrenia well to keep a record of what types of symptoms have appeared, what medications (including dosage) have been taken, and what effects various treatments have had. By knowing what symptoms have been present before, family members may know better what to look for in the future. Families may even be able to identify some "early warning signs" of potential relapses, such as increased withdrawal or changes in sleep patterns, even better and earlier than the patients themselves. Thus, return of psychosis may be detected early and treatment may prevent a full-blown relapse. Also, by knowing which medications have helped and which have caused troublesome side effects in the past, the family can help those treating the patient to find the best treatment more quickly.
In addition to involvement in seeking help, family, friends, and peer groups can provide support and encourage the person with schizophrenia to regain his or her abilities. It is important that goals be attainable, since a patient who feels pressured and/or repeatedly criticized by others will probably experience stress that may lead to a worsening of symptoms. Like anyone else, people with schizophrenia need to know when they are doing things right. A positive approach may be helpful and perhaps more effective in the long run than criticism. This advice applies to everyone who interacts with the person.

WHAT IS THE OUTLOOK?
The outlook for people with schizophrenia has improved over the last 25 years. Although no totally effective therapy has yet been devised, it is important to remember that many people with the illness improve enough to lead independent, satisfying lives. As we learn more about the causes and treatments of schizophrenia, we should be able to help more patients achieve successful outcomes.
Studies that have followed people with schizophrenia for long periods, from the first episode to old age, reveal that a wide range of outcomes is possible. When large groups of patients are studied, certain factors tend to be associated with a better outcome – for example, a pre-illness history of normal social, school, and work adjustment. However, the current state of knowledge, does not allow for a sufficiently accurate prediction of long-term outcome.
Given the complexity of schizophrenia, the major questions about this disorder – its cause or causes, prevention, and treatment – must be addressed with research. The public should beware of those offering "the cure" for (or "the cause" of) schizophrenia. Such claims can provoke unrealistic expectations that, when unfulfilled, lead to further disappointment. Although progress has been made toward better understanding and treatment of schizophrenia, continued investigation is urgently needed. As the lead Federal agency for research on mental disorders, NIMH conducts and supports a broad spectrum of mental illness research from molecular genetics to large-scale epidemiologic studies of populations. It is thought that this wide-ranging research effort, including basic studies on the brain, will continue to illuminate processes and principles important for understanding the causes of schizophrenia and for developing more effective treatments.

Posted by: Texe Marrs Is A Paranoid Schizophrenic at May 24, 2004 08:27 AM
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