Some people are afraid to ask about suicidal behavior because they fear it will put the idea into the persons head. This is not true and often the person is relieved to be able to talk about suicidal thoughts and plans
Withdrawal is often used as a means for coping with the internal chaos in the patient's brain and is an appropriate response. Family members should remind themselves not to take such withdrawal as a personal rejection, but should keep themselves available.
After noting that relapse is most often associated with not getting enough medication, Dr. Torrey writes
It should always be remembered that that the behavior of persons with schizophrenia is internally logical and rational; they do things for reasons that, given their own disordered senses and thinking make sense to them.
For this reason I give many patients an extra supply of medications and allow them to increase it on their own if they feel that they need it. Physicians do this all the time with patients with diabetes who may need more insulin on some days and less on other days, and I find the same principle useful in schizophrenia.
Surviving Schizophrenia covers everything schizophrenia, with a particular emphasis on information that can help those with it and their families:
• What it feels like to have schizophrenia, as told by people who have it.
• Theories on causes including genetics and biology.
• Likely courses and outcomes of the various types of schizophrenia.
• How to separate snake oil treatments from real treatments.
• Latest research.
• Accessing government benefits.
• Coping tips for those with schizophrenia and their families.
• How to make the mental health system stop failing those with schizophrenia.
Dr. Torrey is the world's leading expert on schizophrenia and focuses on how to reduce violence, homelessness, suicide and other problems faced by people with untreated serious mental illness. He therefore becomes highly visible on TV following headline grabbing tragedies. But in this book, you get a better understanding of his true love: researching causes and treatments of schizophrenia to try alleviate the pain and suffering of those who have it, like his own sister did. It is his intense compassion for people with schizophrenia that comes through in this extraordinary book.
The paucity of sympathy for those with schizophrenia makes it that much more of a disaster.
He devotes two chapters to symptoms. The first chapter does it through the voices of those who have it. He has people with serious mental illness talk for themselves (See videos). This should be required reading for those who work in the non-profit mental health industry, government mental health agencies and the "recovery" movement who may not understand what life is like for many of the most seriously ill.
The simple answer, then, to the question, "How should one react to someone with schizophrenia?" is, Kindly.
When most people look at a watch, they see the time. "If I look at my watch I see the watchstrap, face, hands and son on, then I have to put them together in one piece"
Quotes like that make it so much easier to understand schizophrenia, then saying 'people with schizophrenia have difficulty putting stimuli together.' After that, he goes through much of the same material from a scientific perspective and explains the neuroscience of the phenomenon being described.
I can't concentrate on television because I can't watch the screen and listen to what is being said at the same time.
He definitively answers important questions and is not reluctant to admit that there are many things we simply don't know yet.
• Can marijuana cause schizophrenia?
• Could your schizophrenia be another disorder that was not properly diagnosed and how can you find out?
• What are the predictors of good and poor outcomes?
• If medication is needed, which should you try? At what dose? For how long? And then what?
• What to do if someone with schizophrenia needs treatment and refuses it?
• What rehabilitative treatments and non medicine supports are important?
The chapters on research reveal what is known and not known, about the causes, treatments, and prognosis in fact-packed detail. New research is presented on anosognosia, having a brain so dysfunctional, it doesn't know it is not working and the role that plays in preventing access to treatment.
Dr. Torrey also uses the research chapters to debunk the pseudo-science spread by some antipsychiatrists, "survivors," and even government agencies like SAMHSA and CMHS. For example, there is no reputable evidence that medicines used to treat schizophrenia cause schizophrenia. Nor is there evidence that abandoning a medical model of care to a recovery model results in improved care. In fact, for people with schizophrenia, it often leads to no-care and more suicide, homelessness, arrest, and incarceration. Surviving Schizophrenia is proof that Robert Whitaker got it wrong in Anatomy of an Epidemic, a book Dr. Torrey lists as one of "The Worst."His chapter on treatment, is the best balanced I have seen. Dr. Torrey provides evidence that medications work and suggestions on how to go about finding the right ones, but he is no stoolie for the pharmaceutical industry and is one of their toughest critics. After describing the financial incentives they have to stretch the truth, he writes
Surviving Schizophrenia ends with chapters that describe the dimensions of the disaster caused by the federal government, state governments and the non-profit mental health industry focusing their resources on improving the mental health of everyone, rather than providing treatment to the most seriously ill, like those with schizophrenia. He quantifies and describes how this mission-creep led to unconscionable--except to those responsible-rates of suicide, homelessness, arrest, incarceration and preventable violence. This is a subject, Dr. Torrey has written about in Out of the Shadows, The Insanity Offense, and most recently American Psychosis focusing on the failed Community Mental Health Centers.
"For this reason you cannot believe much of what is written by mental health professionals about these drugs"
I read an early edition of Surviving Schizophrenia in the early 1980s, when schizophrenia touched my own family and it had the reputation as being "The Bible of Schizophrenia." And while I've used subsequent editions as reference tools, this 6th Edition is the first time I read an update cover-to-cover. It's the best think I've done. It gave me ideas to improve the quality of life for my own loved-one with schizophrenia. The number of facts and useful information per page is unequaled anywhere.
Full Disclosure: I am an admirer of Dr. Torrey, once served on a non-profit board with him, and in this latest edition, he used something I wrote, "Useful Online Resources" as Appendix B.
DJ Jaffe is Executive Director of Mental Illness Policy Org., an independent, non-partisan think-tank on serious mental illness (not mental health).