Tuesday 5 October 2010

Pearls of Wisdom

Everybody gets excited about the "positive symptoms" of serious mental illness, especially those associated with schizophrenia like loss of insight, delusions, and hallucinations. The risk-managers are worried about these symptoms; the public is intrigued by them and often afraid of them; the media define mental illness by reference to them; the "comedians" make fun of them; the pharmaceutical companies strive to suppress them; the psychiatrists are most interested in them; and families, understandably, are most distressed by them.

Patients too are obviously concerned with positive symptoms which can be deeply distressing and sometimes risky. However, long acquaintance with patients experiencing the range of positive and negative symptoms suggests to me that actually most of them are more concerned with negative symptoms because they affect their lives more damagingly. It is time to put the spotlight on looking for direct therapies and daily life strategies to address them more effectively.

To remind us what "negative symptoms" are here's a short list which covers the ground...

•Slurred speech
•Low motivation
•Social withdrawal
•Emotional flattening

In practice this "passivity" can range from what a lay person might call "total shut-down" through to more familiar experiences like not being able to motivate oneself to get out of bed in the morning.

The problem is these symptoms don't excite or worry the professionals enough. Indeed it is still tacitly "acceptable" to increase passivity through use of medication if it suppresses positive symptoms. In other words it's a "result" to get the patient calmed down to the point where they don't do anything much - they can then be discharged and do nothing much in the community except grow lonely and depressed.

Little wonder that patients resist this approach. Patients tell us that much "non-compliance" with treatment regimes is not due to lack of insight but rather to rebellion against the well-meaning but unambitious goal of reducing positive symptoms at any cost.

This is definitely a case where it will fall to patients and families - not least Members of Hafal - to fight the cause for a better balance in treatment of symptoms, working with enlightened professionals who listen to what patients want and are prepared to manage risk and patient benefit in a proportionate way.

Look here for a simple explanation of the symptoms of schizophrenia; here for a treatments guide; and here for a guide to recovery.

Even if you do not share the Albanian people's reverence for Sir Norman Wisdom (who died yesterday) the opening sequence of "The Early Bird" (1965) may bring comfort in shared adversity to those who struggle to get up in the morning. See it here.