Thank you for sharing, and even more for pointing out that although these people are clearly struggling (or if not struggling, at any rate unable) to communicate in a manner that is easy for 'conventional' folk to understand, they are indeed communicating thoughts, needs, fears, and hopes of a distinctly human kind. It is refreshing, to say the least, to see a doctor trying to understand patients as human, instead of just ticking the box 'disordered speech'.
This is amazing, thank you (and the patients) for sharing these.
In regards to abnormal form, I remember a psychotic patient during residency who only wrote on one corner of a page. Almost seemed like those hemineglect syndromes in neurology.
Currently I work in a high observation unit of a jail, and if I had a camera (not allowed!) I'd love to show off some of the writings made by inmates using peanut butter and/or feces.
Excellent article. Going back to peruse now. My first read through made me realize people aren’t all that different deep down. And I suspect that might scare some and intrigue others. Or both. ;-)
What is your process for reaching someone whose communication is so disordered? Wait for meds to take hold or can you provide help earlier? I wouldn't know where to begin, especially with the patient who wrote the Clanging example.
A lot of it is waiting for medications to start working. But even if someone is psychotic they are often still able to communicate meaningfully at least to some extent, eg. responding "yes" that they want medications to treat them, etc. It's highly variable from person to person. Some people are psychotic and can carry on long conversations that kinda-almost make sense, while others are mute or can barely speak coherently at all.
One of my grandmother’s favorite stories was about the time a psychotic family member silently entered her room in the middle of the night. She woke to find them standing over her in the moonlight, dressed in a full karate costume and holding a large kitchen knife. She held her breath for what felt like an eternity until, just as silently, the "ninja" drifted back out of the room.
On another occasion, they held a plastic cap gun aloft and dramatically declared, “Your father has been murdered, and this is the gun that shot him.”
One of their recurring delusions was that they were a male Vietnam War hero and a medically modified female SAS super soldier. Specifically, they believed they had been a top-gun helicopter gunner in Vietnam. After being shot up in a heroic suicide mission, they were taken to a hospital, where their male appendages were replaced with a sheep’s uterus. They were then injected with a "super soldier serum." Their depot medication, they insisted, was actually an antidote designed to suppress their "super strength", administered by undercover agents disguised as nurses—though most of the "fake nurses" were still "lovely."
Aside from that there were many capgras delusions. Their boyfriend was an imposter and conspiring with other former boyfriends who were also imposters. Other patients on the ward were familiar people from childhood but refused to admit their true identity.
A radio "poured out their ear", good giving messages from the SAS about her movements. Sometimes her brother comes on the radio to tell the SAS to leave her alone. The radio gets louder from the medication.
According to their records, they never responded to any antipsychotics across all the decades of hospitalisations. Then, after 38 years, a sharp young doctor decided to try a course of lithium. 38 years.
I have had two episodes of psychosis in my life and people often ask me what it’s like. This is very hard to explain and everyone is different (the way they experience it), but you know the way that during a dream, you totally accept the situation you are in as reality, no matter how crazy it is. So maybe psychosis involves the frontal lobes going offline and the person begins to behave like someone who is dreaming in the daytime, with the 100% believability that goes with that. When I hit my head on a water slide and developed psychosis, my husband wondered where the person he knew as his wife had gone. I was and wasn’t still there. Caused by inflammation I think. I recovered on Prozac, which was odd, but that’s another story I don’t have answers to
Fascinating. If it happened after you hit your head, perhaps the recovery was spontaneous and not due to any drug?
The Russians have something called the oneiroid state which is a dreamlike state of quite florid hallucinations. The Germans have ratlosigkeit which is a state of expansive puzzlement that has a dreamlike quality, sort of like being lost at a familiar bus stop, and not dissimilar to the Gen Z concept of a liminal space if you add in the idea that you're confused about how you ended up in a liminal space.
In WKL nosology their is systematised and unsystematised schizophrenia, the latter of which has a striking resemblance to manic depression, similar recovery rates and response to anti-manic drugs. Frank Fish did a study using the WKL system back in 1964, not long before he succumbed to his bipolar. He found the systematised group did not respond to drug treatment. Despite his book on Psychopharmacology becoming the standard textbook in universities the world over, his work on systematised and unsystematised schizophrenia has never been followed up by any other researcher.
We don’t diagnose people as psychotic simply on the basis of them not believing in, or adhering to, the dominant beliefs in their society. And no, Galileo was not psychotic.
I agree doctors/hospitals can be corrupt and misuse their power, and that’s obviously a huge problem. But that’s distinct from the question of the validity of psychiatric diagnosis itself.
Another thing that‘s been bothering me - and it seems to me this has been increasing lately - is
people throwing around the term „schizo“ at random people whose views they find unusual, even when they don‘t really know much about the person. But I guess this is a cultural issue.
It’s part of the ignorance and stigma surrounding the condition. It needs tackling head on if we are going to achieve better outcomes for psychotic individuals.
Thank you for sharing, and even more for pointing out that although these people are clearly struggling (or if not struggling, at any rate unable) to communicate in a manner that is easy for 'conventional' folk to understand, they are indeed communicating thoughts, needs, fears, and hopes of a distinctly human kind. It is refreshing, to say the least, to see a doctor trying to understand patients as human, instead of just ticking the box 'disordered speech'.
This is amazing, thank you (and the patients) for sharing these.
In regards to abnormal form, I remember a psychotic patient during residency who only wrote on one corner of a page. Almost seemed like those hemineglect syndromes in neurology.
Currently I work in a high observation unit of a jail, and if I had a camera (not allowed!) I'd love to show off some of the writings made by inmates using peanut butter and/or feces.
Excellent article. Going back to peruse now. My first read through made me realize people aren’t all that different deep down. And I suspect that might scare some and intrigue others. Or both. ;-)
What is your process for reaching someone whose communication is so disordered? Wait for meds to take hold or can you provide help earlier? I wouldn't know where to begin, especially with the patient who wrote the Clanging example.
A lot of it is waiting for medications to start working. But even if someone is psychotic they are often still able to communicate meaningfully at least to some extent, eg. responding "yes" that they want medications to treat them, etc. It's highly variable from person to person. Some people are psychotic and can carry on long conversations that kinda-almost make sense, while others are mute or can barely speak coherently at all.
Thanks!
One of my grandmother’s favorite stories was about the time a psychotic family member silently entered her room in the middle of the night. She woke to find them standing over her in the moonlight, dressed in a full karate costume and holding a large kitchen knife. She held her breath for what felt like an eternity until, just as silently, the "ninja" drifted back out of the room.
On another occasion, they held a plastic cap gun aloft and dramatically declared, “Your father has been murdered, and this is the gun that shot him.”
One of their recurring delusions was that they were a male Vietnam War hero and a medically modified female SAS super soldier. Specifically, they believed they had been a top-gun helicopter gunner in Vietnam. After being shot up in a heroic suicide mission, they were taken to a hospital, where their male appendages were replaced with a sheep’s uterus. They were then injected with a "super soldier serum." Their depot medication, they insisted, was actually an antidote designed to suppress their "super strength", administered by undercover agents disguised as nurses—though most of the "fake nurses" were still "lovely."
Aside from that there were many capgras delusions. Their boyfriend was an imposter and conspiring with other former boyfriends who were also imposters. Other patients on the ward were familiar people from childhood but refused to admit their true identity.
A radio "poured out their ear", good giving messages from the SAS about her movements. Sometimes her brother comes on the radio to tell the SAS to leave her alone. The radio gets louder from the medication.
According to their records, they never responded to any antipsychotics across all the decades of hospitalisations. Then, after 38 years, a sharp young doctor decided to try a course of lithium. 38 years.
I have had two episodes of psychosis in my life and people often ask me what it’s like. This is very hard to explain and everyone is different (the way they experience it), but you know the way that during a dream, you totally accept the situation you are in as reality, no matter how crazy it is. So maybe psychosis involves the frontal lobes going offline and the person begins to behave like someone who is dreaming in the daytime, with the 100% believability that goes with that. When I hit my head on a water slide and developed psychosis, my husband wondered where the person he knew as his wife had gone. I was and wasn’t still there. Caused by inflammation I think. I recovered on Prozac, which was odd, but that’s another story I don’t have answers to
Fascinating. If it happened after you hit your head, perhaps the recovery was spontaneous and not due to any drug?
The Russians have something called the oneiroid state which is a dreamlike state of quite florid hallucinations. The Germans have ratlosigkeit which is a state of expansive puzzlement that has a dreamlike quality, sort of like being lost at a familiar bus stop, and not dissimilar to the Gen Z concept of a liminal space if you add in the idea that you're confused about how you ended up in a liminal space.
In WKL nosology their is systematised and unsystematised schizophrenia, the latter of which has a striking resemblance to manic depression, similar recovery rates and response to anti-manic drugs. Frank Fish did a study using the WKL system back in 1964, not long before he succumbed to his bipolar. He found the systematised group did not respond to drug treatment. Despite his book on Psychopharmacology becoming the standard textbook in universities the world over, his work on systematised and unsystematised schizophrenia has never been followed up by any other researcher.
Gosh there is always so much more to learn, even though I have been reading about the condition for years. So interesting, thank you
Thats because you have to read the old stuff. Sometimes I go to PubMed and set the date range to before 1990 just to filter out the crud.
https://ghaemi.substack.com/p/keeping-up-with-the-literature-read-the-journals-and-the-old-books?utm_source=publication-search
What I‘m worried about is diagnosing a person as psychotic when they don‘t adhere to one or more of society‘s collective delusions.
Was Galileo psychotic?
We don’t diagnose people as psychotic simply on the basis of them not believing in, or adhering to, the dominant beliefs in their society. And no, Galileo was not psychotic.
That sounds like a nice guideline but how does it work out in practice? https://www.psychiatrictimes.com/view/the-horror-of-unjust-psychiatric-hospitalization
I agree doctors/hospitals can be corrupt and misuse their power, and that’s obviously a huge problem. But that’s distinct from the question of the validity of psychiatric diagnosis itself.
Another thing that‘s been bothering me - and it seems to me this has been increasing lately - is
people throwing around the term „schizo“ at random people whose views they find unusual, even when they don‘t really know much about the person. But I guess this is a cultural issue.
It’s part of the ignorance and stigma surrounding the condition. It needs tackling head on if we are going to achieve better outcomes for psychotic individuals.
You seem to be labouring under the belief that recognising psychosis is difficult. It is not. Go visit a psychiatric ward and satisfy yourself.
Well, I’ve been there more times than I care to remember, and once was involuntary. But perhaps we are talking past each other here.
What did you make of it?