Magazine Promotes Stigma Against Schizophrenia

I wanted to share this as it is simply an example of how the stigma against schizophrenia is portrayed through the media.  In the Summer 2000 issue (Vol. 10, No. 3) of City Journal, there is an article, Sanity on Mental Illness by E. Fuller Torrey, that describes the potential for violence among the seriously mentally ill.  Specifically, the potential for violence among the unmedicated, seriously mentally ill.  The article claims that “seriously mentally ill individuals who take their medicine are not more dangerous than the general population; those who don’t take it are much more dangerous.”  Such an article disgusts me because it only fuels the fear and hatred towards people with a mental illness such as schizophrenia.  It also promotes medications (anti-psychotics) that are currently under investigation by the United States of America because these medications are consistently proving that they shorten the lifespan of those who take them and can cause further medical complications such as diabetes, heart conditions, brain damage, and hormone problems (“The Myth of the Chemical Cure,” Joanna Moncrieff, 2009).  Finally, the article states that laws that require the mentally ill to comply with treatment (such as New York’s Kendra’s Law which can require compliance for up to a year before being reviewed) are a rational approach to irrational people.

There is no mention in this article of people who are diagnosed with a severe mental illness and present no danger to the general population.  However, the author of the article, Dr. E. Fuller Torrey, has stated that some schizophrenics only require medication for one to two years.  In fact, he also states that “within a few months following recovery, medication should be slowly decreased and then discontinued” (Surviving Schizophrenia, 2006).  Because schizophrenia has no cure, these people still have schizophrenia but they are not on medication because they do not need it.  But the contradiction lies in this article when Dr. Torrey states that people with severe mental illness are much more dangerous when unmedicated.  Since no distinction is made, should it be assumed that even when a schizophrenic does not need the medication they are still a danger to others?  Dr. Torrey has also stated several times that people with schizophrenia are much more likely to harm themselves than to harm another person; however that statistic is ignored when warning the general population of the dangers involved with such people (Surviving Schizophrenia, 2006).  It seems that so many contradictions in what Dr. Torrey is claiming are also irrational.  But because I don’t have any preconceived judgments against irrational people, I will not claim that Dr. Torrey should be forced to take medications.

So lets consider the reality.

First, statistics can put into perspective the reality of violence among the severely mentally ill.  A NAMI study reported that 10.6% of the seriously mentally ill people surveyed had harmed another person (“Family Perspectives on Meeting the Needs for Care of Severely Mentally Ill Relatives: A National Study,” National Alliance for the Mentally Ill, 1992).  Compare this to the Bureau of Justice Statistics reporting that 24.5% of Federal and 29% of State prison inmates reported being under the influence of drugs when committing violent offenses (Office of National Drug Control Policy, Fact Sheet, 2000). Consider instead that 40% of schizophrenics attempt to commit suicide at least once (Fenton WS, McGlashan TH, Victor BJ, et al: Am J Psychiatry 154:199-204, 1997).  Several studies also show that people with severe mental illnesses are highly likely to be the victims of crime rather than the person committing the crime.  A study of 185 individuals with schizophrenia found that 27% had been the victim of a crime (V.A Hiday, M.S Swartz, J.W Swanson, et al., Psychiatric Services 50 (1999): 555-567).

Second, the anti-psychotics prescribed to schizophrenics have never been proven through medical research or drug studies to be beneficial when taken for longer than six months.  Whether no one wants to commit the time to such a study or these medications actually hold no extended benefit, no studies have been conducted.  However, there is plenty of research that concludes that insulin is of long term benefit to insulin-dependent diabetics.  Schizophrenia is often compared to diabetes as another illness that cannot be cured and must be constantly treated with medication.  So where is the research that proves the similarities between these illnesses?

Third, there are plenty of examples of people with schizophrenia who function and even lead productive lives without medication.  These examples run the range of “average Joes” to prominent figures such as actors, lawyers, and doctors.  Of course, the example also includes myself.  I certainly am not dangerous.  I have never intentionally harmed a person or even accidentally caused a person to receive more than a stubbed toe or paper cut.  I’ve never been charged with a crime or even received a traffic ticket.  I’ve never used illegal substances or even consumed enough alcohol to be considered intoxicated.

Fourth, medication alone is largely inadequate for improving the functioning of a person with schizophrenia.  The negative symptoms of schizophrenia (lack of emotion, low energy, lack of interest in life or low motivation, affective flattening, alogia, inappropriate social skills, inability to maintain friendships, social isolation, avolition, etc) have been shown to be the most disabling or impairing of the symptoms of schizophrenia.  Anti-psychotics are usually ineffective towards treating negative symptoms; meaning some of them help some people but there is not an individual anti-psychotic that effectively treats negative symptoms in most people taking that drug.  People with schizophrenia can experience a decrease in cognitive and social functioning.  No medications are prescribed to help with these problems.  Instead, a variety of forms of psychotherapy have proven to be the most effective for treating negative symptoms and cognitive and social functioning declines.  Some types of psychotherapy have also proven to be effective in decreasing the severity of hallucinations and delusions, or at least enabling the person experiencing them to cope with or ignore them better.  No medication is going to enable a person to exert more control over their own symptoms or teach a person how to navigate the social context of society.

So, in reality, articles such as the one in City Journal are not realistic or rational.  They fuel the fear that people can develop towards the mentally ill.  They increase the discrimination against the mentally ill.  They promote black and white thinking: “a medicated schizophrenic is safe and an unmedicated schizophrenic is going to harm me.”  They give the impression that the medication for the severely mentally ill is sufficient enough to cure all their problems and make them “normal” enough to blend into the general population and cause no threat.  It would seem that these assumptions are just as delusional as thinking a government agency is conspiring against you.