Guilt, shame, inauthenticity and mental illness

John Eagan Holmes

Mental illnesses are not per se associated with guilt. Most mentally ill individuals today know that mental illness is not their fault. Individuals who are mentally ill can feel intense guilt but that would be due to the committing of some terrible deed. The terrible deed not mental illness per se would engender the guilt. Shame is not per se associated with mental illness. Shame arises when one loses face before other individuals. All too frequently individuals with mental illness handle situations with other individuals poorly but the shame does not arise per se from being mentally ill.

A state, however, that is closely associated with mental illness is inauthenticity. Individuals with mental illnesses can hold they are not leading authentic lives. Paradoxically mental health professionals should not push individuals with mental illnesses to a point where mentally ill individuals are willing to state they are living authentically. To accept some terrible state as an authentic state is a prelude to disaster. And if one is in some terrible state one must accept that there are a ways to go, perhaps a long ways to go before one is living authentically. As treatments for mental illnesses are very frequently mediocre mental health professionals appropriately mainly provide support rather than treatment. Authenticity is a goal but holding what must be inauthentic as authentic is not even a half-way decent answer. A goal of patients/clients reaching authenticity has been a disaster in the field of mental health.

To hold that some terrible state is an authentic state for one’s self is the prelude to absolutely horrendous deeds. Before every mass shooting the shooter says ‘I hate these random individuals, I hate the world and hate who I am and that is who I am authentically. There is no downside to this act in terms of who I am authentically.’ John Egan Holmes held he was living his authentic life, Joker-like, when he killed 12 people and injured 70 others in an Aurora, Colorado theater watching a Batman movie. Individuals running the Batman franchise though not legally guilty appropriately feel some guilt.

Freud on Schreiber

What would Freud have seen? Mutter with her legs spread

Daniel Paul Schreber was a jurist living in the early 20th century who developed schizophrenia. He wrote a memoir of his illness entitled Memoirs of My Nervous Illness. The Wikipedia account of the memoir gives more coherence to the memoir than is evident on reading the memoir. Schreber was very ill but even so highly successful. He was a prominent and respected jurist when not in the asylum.

Basically when ill Schreber was disorganized, paranoid and had flat affect. What does Freud see in all this? Repressed homosexuality.Schizophrenia is horrendous blow to one’s self-esteem. Given the times Schreber felt womanly. According to Freud Schreber lusted after his father and brother rather than like normal Freudian boys lusted after mom and wanted to kill dad. Freud’s analysis of Memoirs of My Nervous Illness is a classic case of finding what one wants to find as are all Freud’s psychological analyses.

Someone might say ‘For heaven’s sake, we are not interested in the veracity of Freud’s ideas! We are interested in the rococo method by which he reaches his conclusions. And on that basis Freud’s analysis of the Memoirs is still a great text.’

Freud was very seriously mentally ill. Freud is prominently mentioned in magazines a couple of times a year and the comment is always ‘We have moved beyond Freud but Freud shaped our world.’ This could be so but not for the better.

Simple steps to stop disaster from occurring in schizophrenia

man with schizophrenia in crisis

I realize there can be crisis situations when relatives have schizophrenia. There are some very simple steps to stop disasters from occurring. The most dangerous symptoms of schizophrenia could be confusion and depression.

Cognitive symptoms is schizophrenia can be treated in schizophrenia by taking 200 micrograms of Se-methylselenocysteine once a day. There are two important considerations when taking Se-methylselenocysteine. Taking more than 200 micrograms of Se-methylselenocysteine a day is not better and there can be associated toxicities when taking more than 200 micrograms of Se-methylselenocysteine a day. Second, cognitive symptoms can be ameliorated and still one can be very ill.

Selenium-dependent enzymes are antioxidants. Zillions of bouncing around free radicals in the brain generate bouncing around thoughts. By neutralizng free radicals selenium-dependent enzymes stop thoughts from bouncing around in the brain whereby cognitive sypmtoms are ameliorated.

Of the various forms of selenium only Se-methylselenocysteine works. Selenomethionine, the food form of selenium, is metabolized via the transsulfuration pathway but the transsulfuration pathway is dysregulated in schizophrenia. See my paper Treatment resistant schizophrenia: focus on the transsulfuration pathway. Se-methylselenocysteine metabolism bypasses the transsulfuration pathway in the synthesis of selenium-dependent proteins. Taking 200 micrograms of Se-methylselenocysteine once a day is one simple thing one can do treat cognitive symptoms of schizophrenia but once again taking more than 200 micrograms of Se-methylselenocysteine a day is not better.

1500 micrograms of iodide from potassium iodide taken once a day can treat depression.No more than 1500 micrograms of iodide from potassium iodide should be taken a day. More than 1500 micrograms of iodide a day won’t be helpful. One can, of course, try lower doses of iodide. Get thyroid tests done.Iodide from potassium iodide must be taken on an empty stomach and away from coffee, tea and other antioxidants .

The SMVT transports iodide. Iodide from potassium iodine must by supplemented. With the SMVT dysregulated iodide must be transported by SLC5A5 which is strongly expressed in the stomach but not in the rest of the gut. Iodine from kelp would not be available in the stomach. Thyroid tests can be normal and still iodide from potassium iodide must still be supplemented.

1500 milligrams of L-tyrosine taken three times a day on an empty stomach is very helpful. Iodide binds to L-tyrosine in the synthesis of thyroid hormones. L-tyrosine in the context of iodide can decrease fatigue. L-tyrosine taken without iodide is not helpful.

200 micrograms of Se-methylselenocysteine taken once a day and 1500 micrograms of iodide from potassium iodide taken once a day, and L-tyrosine could make a huge difference. Neither Se-methylselenocysteine or iodide from potassium iodide will treat psychosis. The ill relative will in all likelihood like taking Se-methylselenocysteine,iodide from potassium iodide and L-tyrosine. That more is not better would have to be strongly underlined. See my page on A Treatment for Schizophrenia. Carbonyl iron treats psychosis but that would involve taking a lot of pills.

The steps suggested are not in lieu of other steps. Given relatives are a danger to themselves and others the authorities should still be called.

Adjusting antipsychotics in a short term mental hospital or at home?

Psych ward

If a seriously mentally ill relative is a danger to himself or others then the authorities must be called very hopefully a team trained to deal with mental health emergencies will answer the call.

Strange is not necessarily dangerous. Giving the seriously mentally ill individual some space can solve a whole lot of problems.

In short term mental hospitals given the diagnosis is schizophrenia and the individual is over 25 basically the only goal of the hospital is to get individuals stabilized on medications. The dosages will be high. There really are no other goals other than med stabilization.

The point is that in short term hospital meds are being adjusted and not much else. If the authorities had to be called the experience will be profoundly traumatic for the entire family including the ill relative. Despite the trauma if the seriously mentally ill relative is a danger to himself, herself or others the authorities have to be called.

That there are not more long term beds in hospitals is a good thing but even if this was a bad thing still there are no long term beds in mental hospitals available. The authorities are not coming to take the ill relative away for more than a few weeks. The ill relative is likely coming home after a very traumatic experience.

Meds can be adjusted at home. The key to an ill relative taking medications is the ill relative deciding to take medications. Giving the ill relative a lot of decision power over what meds he takes and at what dosages increases the chances he will take medications. Safe for himself or herself and others even though still strange even quite strange has to be viewed as a win when the diagnosis is schizophrenia. Low dosages are much better than no dosages. Keep the ill relative from posting on the Web.

Giving the ill relative as much decision power as feasible and giving the ill relative space in which he could be strange is the optimal strategy. Will this work every time? No.

Something for parents to consider when deciding whether on not to have guns in the house

Adam Lanza’s mom, who was a gun enthusiast who owned at least a dozen firearms, use to take Adam, of Sandy Hook infamy, to the shooting range

A child could grow up having severe psychological problems. Guns and psychological difficulties are a terrible combination. Every parent wants their child to become a well balanced young adult but that does not always occur

In 80% of school shootings, perpetrators got their weapons from family members. Parents not having guns in the house could reduce mass killings by sons. Plus their small children would not shoot themselves and other small children.

The sensible old days when there was a continuum of care for the mentally ill

Parts of the continuum of care provided to the mentally ill prior to de-institutionalization. That dastardly President Kennedy undermined the continuum of care for the mentally ill when he signed the Community Mental Health Act.



Apparently a sauna room

In 2012 the cost for short term inpatient care for 7.4 day for individuals with schizophrenia who were uninsured was $5,707 dollars. With insurance the costs were higher. Short term inpatient care hospitals are very spartan, low tech places. There is no expensive equipment. Cost of care at long term mental hospitals could be about $350,000 a year for each patient. But if we could get a continuum of care for the mentally ill the cost would be worth it!

Madness an Civilization by Michel Foucault in a nutshell

Michel Foucault

Over the last 400 hundred years the basic flaw in human in nature has been characterized in various ways and there have been different improvement regimes for the mentally ill depending on what was held to be the basic flaw in human nature.What ever was wrong with people was tripily wrong with the mentally ill. What ever improvement regimes were recommended for people were tried on the mentally ill to the point of torture Torture in one form or another has for the last four hundred years always been countenanced for the mentally ill. Madness and Civilization is shallow history given weight by an obscure writing style which is not to say that Foucault was wrong.

What did Michel Foucault do for the mentally ill? Zip as far as I can tell. He wrote Madness and Civilization, acquired a mantle of liberator and then advocated that thousands of different resistances be set up which does not work for the seriously mentally ill who require protections in the community and a letting of the mentally ill be the individuals who they are as long as they are safe for themselves and others which Michel Foucault had less than zip interest in furthering.

60’s radical liberators of the mentally ill did zip for the mentally ill. President Kennedy’s plan for the mentally ill, which was philosophically shallow, never funded properly and co-opted by various professions for the benefit of various professions was the most sensible and helpful program put forward for the mentally ill in the 60’s.

Gregory Bateson’s Double Bind Theory of schizophrenia

Gregory Bateson

In the 50’s and 60’s Gregory Bateson advanced the notion that individuals being in double binds, that is being in situations where there are conflicting messages, could lead to schizophrenia. Gregory Bateson was working at the Veterans Administration when he developed his notion of the double bind and schizophrenia. Gregory Bateson pushed that understanding the theory of types was key to understanding schizophrenia.

Situations where there are conflicting messages can be upsetting even very upsetting, however, these situations do not lead to schizophrenia. If this were so every one who was on the Internet would have schizophrenia. Now, there is evidence that every one on the Internet is upset but this does not translate to everyone on the Internet having schizophrenia.

A strange fact about Gregory Bateson is Gregory Bateson must have known the double bind theory of schizophrenia was mistaken. Gregory Bateson’s ideas had a cult following but individuals in academia were always telling Gregory Bateson he was mistaken. Gregory Bateson must have been aware that he was in the midst of a situation where there were conflicting messages but Gregory Bateson would also have known that he did not have schizophrenia.

Theory of mind in schizophrenia

Various psychologists hold that individuals with schizophrenia have difficulties with grasping mental states of other individuals which goes under the rubric of theory of mind (ToM). This is not correct.

Individuals with schizophrenia are thinking about everything all the time. For the most part other individuals do not want to talk about everything all the time.

What individuals with schizophrenia have difficulties with is grasping what is in the attentions of other individuals. By and large conversation resides around what is in attentions and this is where individuals with schizophrenia have difficulties.

There are so many difficulties in schizophrenia that separating out the difficulties presents difficulties. Disorganization can be prominent in schizophrenia and one could hold with this disorganization that individuals with schizophrenia have very rudimentary ToM, however, the disorganization can be widespread. There is zip specific to ToM to this disorganization.

Individuals with schizophrenia can hit some sore spots with other individuals when talking about everything all the time. Individuals with schizophrenia then can become paranoid about what other individuals are thinking. The fails are not fails in ToM but rather in schizophrenia conversations are warped away from useful, pleasant or routine.

If someone were to say to President Biden, who by the way I think is doing a terrific job, that ‘politicians are the problem not the solution’ then future conversations with President Biden would be warped away from conversations that went anywhere. However, over the last few decades, there has been political gridlock in the US which President Biden is certainly aware of. The problem would then not be strictly fails in ToM but rather that conversations are warped away from useful, pleasant or routine conversations. The warping away from useful, pleasant or routine conversations in schizophrenia are not fails in ToM but rather is due to the setting up of paranoid feedback loops which basically arise due to individuals with schizophrenia wanting to talk about everything all the time rather than talk on what is in attentions.