Why I am for a minimalist mental health system

NoNo No

Schizophrenia Bullentin has a paper entitled The Self in the Spectrum: A Meta-analysis of the Evidence Linking Basic Self-Disorders and Schizophrenia. The upshot of the paper is that individuals with schizoprenia spectrum disorders have disturbed senses of self. How can there not be disturbed senses of self when a marginalized individual experiences himeself or herself at the center of world events and world history?

Individuals with schizophrenia are totally aware of many data points that would suggest they are the periphery of the periphery of great events, however, that is not the lived reality. The experience of being at the center of great events is very, very difficult to shake. Individiuals with schizophrenia are not making wrong deductions and therefore therefore deduce that they are at the center of world events. Nor do individuals believe they are the center of world events as some sort of psychological compensation.The world is inside their heads. Being at the center of world events is a lived reality. Like Zeus looking into to the pool who could thereby see what was happening on Earth with the world inside their heads individuals with schizophrenia can see what is happening across the world or it seems.

Medications can help. Adopting at least partly an external point of view on one’s illness can help but explorations of the mind and self when one is already way too much in the head do not help at all.

On the other side of equation are mental health clinics that overmedicate, over promise and underdeliver. Money that should go to housing instead goes to teams at mental health clinics who from the patient’s perspective frequently are only there to harass. Housing first does not please mental health beureacracies but if there was housing first costs could be kept down and healthcare of indivduals with serious mental illnesses would improve tremendously.

Phenomenology and schizophrenia

An article is Schizophrenia Bulletin argues that a phenomenological approach has to be taken up once again in regards to schizophrenia. Phenomenology has a very humanistic ring which is basically the selling point of phenomenology in regards to schizophrenia.

In a fundamental sense psychoses of individuals cannot be be grasped by other individuals. In schizophrenia the world is grasped as totally inside one’s head and what is more with a Zeus-like overview of the world comes great wherewithal. Individuals on locked hospital wards can experience themselves as wielding great powers from perches above all events of the world.

A lot of what individuals with schizophrenia say can make sense as global judgements of individuals in any station of life can make sense. I can hold that COVID-19 is a terrible disaster that requires social distancing and a mass vaccination program and I would be right even though I am not Dr. Anthony Fauci. So global views of individuals with schizophrenia can make sense but the views are frequently not to the point in given conversations.

Though the rallying cry of phenomenology is ‘to the things themselves’ phenomenological analysis moves away from ‘the things themselves’ at light speed. In practice phenomenological analysis piles abstraction upon abstractions upon abstractions which no one needs and which individuals amidst psychoses most definitely do not need. See the philosophy of Edmund Husserl, who was the founder of phenomenology, on how phenomenology only leads to endless abstractions. Edmund was always beginning yet again in his phenomenological analyses.

Humanism definitely has a place in the treatment of schizophrenia but what humanism demands is the lowest effective dosages of medications be used so individuals with schizophrenia are safe for themselves and others, calls for allowances for neurodiversity and very importantly humanism calls for housing. Professionals to talk to who would provide provide supportive care but who would not pretend to get at the psychological bases of schizophrenia would also be nice. Office visit humanism that is only office visit humanism is not humanism.

What do the seriously mentally ill need?

First of all and most importantly the seriously mentally ill require medications where dosages are the lowest effective dosages which could leave the mentally ill still neurodifferent even very neurodifferent. On effective dosages the seriously mentally ill must be safe for themselves and others.

Second and next in importance the seriously mentally ill require housing.

Last in importance is that a warm, safe place where the seriously mentally ill could talk about the difficulties they are facing with professionals would be very nice. The goal of these talks would be support rather than treatment.

Unfortunately, mental health clinics totally fail to deliver what the seriously mentally ill need. Heads of clinics tell funding authorities that ‘our services can get individuals back to work in short time’. If there are difficulties in treatment and there are always difficulties in treatment of the seriously mentally, after all the seriously mentally ill are seriously mentally ill, higher dosages and polypharmacy are the answer and all of kinds psychological services are proffered that are totally besides the point. Funding authorities get billed for lots of hours and patients get to be zombies and are still disabled. Patients all too frequently decide not to visit mental health clinics. Patients can end up homeless and off medications. As mental health clinics are now set up mental health clinics deliver very mediocre mental health services at very high cost.

Unfortunately, the words of Mick Jagger and Keith Richards have no application in the treatment of the seriously mentally ill at mental health clinics.

No, you can’t always get what you want
You can’t always get what you want
You can’t always get what you want
But if you try sometime you find
You get what you need

Schizophrenia and COVID-19

Other than age schizophrenia is the leading risk factor for mortality in COVID-19. After adjusting for demographic and medical risk factors, a premorbid diagnosis of a schizophrenia spectrum disorder was significantly associated with mortality (odds ratio [OR], 2.67; 95% CI, 1.48-4.80). Part of the diffiulites with schizophrenia and COVID-19 could be housing conditions of the seriously menally ill and delays in getting treatment but individuals with schizophrenia could be ill in a lot of different ways. Schizophrenia is not only a mental illness.

Bleuler disease

Names of illnesses appropriately do not channel views of illnesses down preset paths whereby neutral terms are appropriately used as names for illnesses. Paul Eugen Bleuler picked the term ‘schizophrenia’ as ‘schizophrenia’ denotes ‘split mind’. Rather than the ‘mind’ being split individuals with the illness all too frequently try to say everything at once. The nonsense that has been penned about negative symptoms also stems from texts of Bleuler. Negative symptoms can be very painful. What is painful to patients is not an absence to patients. Bleuler clearly had zip grasp of the illness. ‘Bleuler disease’ is a term that is neutral in regards to ‘schizophrenia’ as zip is said about the illness by the term.

Using the term ‘Bleuler disease’ would also be cathartic in terms of the terrible mischaracterizations of ‘schizophrenia’ that have occurred over the last 100 years. Leaving ‘Bleuler’ of ‘Bleuler disease’ a non-possessive is a key to ‘Bleuler disease’ being a term is neutral and also cathartic. In a real sense individuals with schizophrenia are plagued by the mischaracterizations of ‘Bleuler disease’. Better to be open about this.

Joker

Joker, a movie starring Joaquin Phoenix, is supposedly about mental illness, at least according to this review, but Joker has zip relevance to mental illness. In Joker Joaquin Phoenix plays Arthur Fleck as a blob of discontent. Arthur Fleck is a DC Pictures/Warner Bros. Pictures construct based upon the notion that a very bleak movie derived from a comic book character could gain a big box office which was correct in 2019.

Joker is absurd. Joker shows large numbers of extras enjoying pointless mob ultra violence. Mobs enjoying pointless mob ultra violences are movie constructs not seen in 3-D. A top criticism of mob violences is that mob violences are pointless while mobs hold mob violences make points. Mob violences do have points, however, such points cannot be accepted. Being of mobs is not enjoyable rather ‘individuals’ who are of mobs are terrifically upset.

Box office totals basically state less then zip about what individuals desire in 3-D. For example, in the past movies showing near apocalypses frequently had big offices with many individuals apparently hugely applauding near apocalypses but individuals are not even slightly smiling at the COVID-19 pandemic. Basically individuals are not pro doing what is now shown in movies. Joker is a stylish piece showing ultra violence and zip else.

Words on Bathroom Walls

Words on Bathroom Walls hits a lot of right notes on schizophrenia. However, the right notes are much harder to hit on schizophrenia than the movie shows. Words on Bathroom Walls, could have done a lot more with the cooking of Adam. Cooking was Adam’s top non-human passion. The movie could have shown Adam as having some very far off the beaten road approaches to cooking that somehow worked. How Adam cooked could have been a look into how Adam viewed the World.

Mental health clinics – now a very weak link in the mental health system

Mental health clinic admistrators are pro maximizing billed hours. Lots of services are offered. Mental health clinic administrators are always telling funding authorities that the programs really do work and that individuals can go back to work with the services offered though a broad range of services are required, however, psychiatrists are not required.

Given someone has a psychotic disorder then the pyschotherapist will want to delve into that psychosis. Given the zeitgeist individuals with psychoses are expected to admit to entertaining very dark scenarios and if they don’t they are fit for work. If they talk extensively about various dark scenarios the treatment team can re-arrange the brain chemistry in all sorts of unpleasant ways. To avoid really terrible re-arrangements of brain chemistry individuals must use all the services of the mental health clinic and must see the benefit of the services with indviduals then fit to work. The threat of re-arrangemets of brain chemistry are always the sword of Damocles that hangs over the heads of individuals with psychotic disorders at mental health clinics.

What is the best kind of treatment for psychotic disorders? Not too much treatment and not too little treatment which is almost impossible to get at mental health clinics. Most individuals with schizohprenia even with the best treatment are disabled and unable to work which is not to say that treatment cannot be of terrific assistance. .

Parents could band together approach mental health clinics tell the clinics that their sons or daughters are disabled but that they do not want their children overdosed. Maybe then mental health clinics could become warms places for individuals with psychotic disorders, rather than pressure cookers, to the benefit of all.

Prescribing psychotropic medications

In terms of antipsychotics and antidepressants there should be a huge bias in favor of prescribing the antipsychotics and antidepressants that patients are willing to take. Perhaps a new antipyschotic is heralded as the best thing ever but the patient hates the new antipsychotic. The new antipsychotic could produce restlessness which the patient just can not stand and the patient is unwilling to take an anticholineric. The best antipsychotic for a patient has to be amongst those antipsychotics that the patient is willing to take so the new antipsychotic, which is the best thing ever, can not be the best antipsychotic for the patient.

Patients must be safe for themselves and others but once that is achieved dosages of antipsychotics and antidepressants should be decided by the patient though if a patient wants to take physically unsafe dosages that can not be allowed. A patient is much more likely to take an antipsychotic or antidepressant if he or she decides the dosage.

Psychotropic medications do not cure so the search for a cure via medications is worse than useless. Safe for themselves and and others though strange can count as a victory with psychotic disorders. Intutions of prescribers at the clinical level who have solved the mysteries of how prescribed psychotropic medications really work can result in disasters for patients via rococco med regimes.

Simpler med regimes are ceteris paribus better than complex med regimes though frequently medications from different psychotropic classes have to be taken. Taking a second drug from the same pysychotropic class is to be avoided. Drugs in a class are basically differentiated due to side-effects so taking a second drug in the same drug class will only add more side-effects not improve basic efficacy of med regimes. Side-effects are a huge deal with psychotropic medications and unacceptable side-effects are completly legitimate grounds for switching antipsychotics and antidepressants. There is wide variety among patients as to what side-effects are acceptable which can result in switching drugs frequently until a drug with the right side-effect profile is found.

Getting patients on board with taking medications is very important so patient decisions within limits as to antipsychotics and antidepressants taken and at what dosages count for a lot. Personal skills and willingness to work with patients on meds are as important for prescribers as a knowedege of the pharmacology of antipsychotics and antidepressants.

What is the best mental health option for someone with a psychotic disorder?

A psychiatrist in private practice by far. There are some large difficulties with this option. First of all there are not a lot of psychiatrists in private practice. If some one with a psychotic disorder is very disruptive the psychiatrist will refuse to see the patient. The treatments provided will be limited which is a feature not a bug. Both too much treatment and too little treatment can have very negative consequences. The treatment that a psychiatrist in private practice gives should involve talk and medications where the patient basically talks about anything the patient wants to talk about that relates to how the patient is doing. A psychiatrist in private practice should be willing to talk to individuals which is not a given. Some psychiatrists see themselves as pharmacologists. A psychiatrist in private practice can call things by their true name. If someone is disabled due to a psychotic disorder the psychiatrist in private practie can state flatly to any funding authorities and to the social security administration that the patient is disabled due to a psychotic disorder. At mental health clinics there is lots of pressure to say individuals can work when this is not so. The mental health clinics will get paid either way as the patient is disabled and needs medical care.

A relative with a psychotic disorder who sees a psychiatrist in private practice will appear to be just running in place and not getting anywhere but the alternative is to fall off the treadmill at a mental health clinic with very serious consequences. Family would be very important as the ill relative is going to be quite isolated.