{"id":55484,"date":"2015-03-27T19:00:33","date_gmt":"2015-03-27T23:00:33","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=55484"},"modified":"2015-03-29T22:48:00","modified_gmt":"2015-03-30T02:48:00","slug":"jettison-schizophrenia-no-thanks","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2015\/03\/27\/jettison-schizophrenia-no-thanks\/","title":{"rendered":"jettison schizophrenia? no thanks…"},"content":{"rendered":"
Picking up where I left off in jettison schizophrenia?…<\/a>, I’m talking about my objections to getting rid of the diagnostic category called Schizophrenia for the last century. First, some case examples:<\/div>\n
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  1. \n
    Recently, I mentioned the first case assigned to me as a psychiatry resident, a woman I called Gloria [back to the drawing board…<\/a>] who was hospitalized awaiting a transfer to a long term facility as a NGRI [Not Guilty by Reason of Insanity<\/font>] case after drowning her son during a psychotic episode. I came to my residency after a tour of duty in an overseas Air Force hospital where I was an Internist. When I decided to change specialties, while still there, I read everything I could get my hands on about psychiatry. There was a copy of Eugen Bleuler’s 1911 Dementia Praecox or the Group of Schizophrenias<\/font><\/em> in the hospital library, and I read it from cover to cover. Why it was in the small library of our small hospital in rural England is unknown to me. But I was taken with his description of the premorbid personality of patients who went on to develop Schizophrenic illnesses, and what he called the Primary Symptoms [the four As: loosened Association of thought, inappropriate Affect, global Ambivalence, and Autism – private logic]. I also read the Psychiatry Textbook of the day, Friedman and Kaplan, that had a detailed discussion of the "psychotic break" in the Schizophrenic patient. In back to the drawing board…<\/a>, I mentioned a conversation with Gloria’s mother, but that was only one of several. Her mother came at every visiting time, and would often catch me and talk about her daughter. It seemed to help her tell the story, and I was more than happy to listen. She described her daughter exactly as Bleuler and the text I had read – schizoid features in her persona, periodic temper outbursts, a long period of seeming confusion prior to "the break." I was amazed at the concordance of her description and Bleuler’s century-old writings.<\/div>\n<\/li>\n
  2. \n
    A few years ago, I described a case I saw not long after finishing my residency [see 1. from n equals one<\/em>…<\/a>, 2. from n equals one<\/em>…<\/a>, etc]. She was hospitalized after she had been stopped from jumping from the 14th floor of the atrium in a downtown hotel. I was the fourth psychiatrist to see her and none of us quite knew what was going on. From my previous post:<\/div>\n
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    She was confused. My friend was confused. So was I. She didn’t seem depressed and had no explanation for her behavior. At the time I saw her, she was completely focused on getting out of the hospital because she didn’t want to be a financial burden on her parents. It was over thirty years ago, but I recall  the interview clearly. She was coherent with no signs of psychosis. She was ill-suited and untrained for her job, but mainly felt she’d failed her parents who had been instrumental in getting it through a friend at the bank. She had no explanation for her behavior. What I mainly recall from the interview was that she tried very hard to answer every question I asked her, but looked at me oddly, as if to say, "Why are you asking that?" I saw her several times, still feeling somewhat lost. By this time, the pressure to leave the hospital had escalated and they set up a plan. She would go home to her parents house, take a leave from her job, and see both my friend and I as an outpatient. Once home, she refused both options, or to take any medicine, or to see anyone else. She told her parents that she would see me in the future, when she’d "sorted things out." <\/div>\n<\/blockquote>\n
    I had a hunch that this was the prodrome to a schizophrenic break based on her history, presentation [and reading Bleuler]. She had already been tried on an antipsychotic with no effect. I saw her parents as something as an advisor while she lived at home, obviously uncomfortable but steadfast in her resolve to sort things out by herself. Then one day, she asked to see me, appearing in my waiting room that afternoon in a psychotic state and was admitted for the first of several hospitalizations. I followed her at varying intervals until I retired some  twenty plus years later. <\/div>\n<\/li>\n
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    In the recent weeks, we’ve finally seen the case of Dan Markingson being definitively dealt with [from Minnesota: Dan Markingson revealed…<\/a>, ethics…<\/a>, making sense…<\/a>]. In making sense…<\/a>, I was discussing the last several moths of his life. He was apparently not overtly psychotic. There’s no mention of hallucinations or the bizarre delusions that had been apparent in the earlier period of his illness. But he was not doing well at all. There are indicators from most of the venues where he was seen and his own journal that he was decompensating without the psychotic symptoms he’d had on admission – instead he had the "Primary Symptoms" as described by Bleuler. <\/div>\n<\/li>\n<\/ol>\n
    So when Moncrieff and Middleton say [see jettison schizophrenia?…<\/a>]…<\/div>\n