The Best of Both Worlds
schizoaffective is like having manic depression and
schizophrenia at the same time. It has a quality all its own though which is
harder to pin down.
Manic depression is characterized by a cycle of one's mood between
the opposite extremes of depression and a euphoric state called mania.
Schizophrenia is characterized by such disturbances in thought as
visual and auditory hallucinations, delusions and paranoia.
Schizoaffectives get to experience the best of both worlds, with
disturbances in both thought and mood. (Mood is referred to clinically as
"affect", the clinical name for manic depression is "bipolar affective
People who are manic tend to make a lot of bad decisions. It is
common to spend money irresponsibly, make bold sexual advances or to
have affairs, quit one's job or get fired, or drive cars recklessly.
The excitement that manic people feel can be
deceptively attractive to others who are then often conned into
the belief that one is doing just fine - in fact they are often quite
happy to see one "doing so well". Their enthusiasm
then reinforces one's
I decided that I wanted to be a scientist when I was very young,
and throughout my childhood and teenage years worked steadily towards
that goal. That sort of early ambition is what enables students to
get accepted into a competitive school like
Caltech and enables them to
survive it. I think the reason I was accepted there even though
my high school grades weren't as good as the other students
was in part because
of my hobby of grinding
telescope mirrors and in part because I studied
Calculus and Computer Programming at
Solano Community College and
U.C. Davis during the evenings
and summers since I was 16.
During my first manic episode I changed my major at
Physics to Literature. (Yes, you really can get a literature
degree from Caltech!)
The day I declared my new major
I came across the
Nobel Prize-winning Physicist
Richard Feynman walking across campus
and told him that I'd learned everything I
wanted to know about physics and had just switched to literature. He
thought this was a great idea. This after I'd spent my entire life
working towards becoming a scientist.
When Did it Happen?
I have experienced various symptoms of mental illness for most
of my life. Even as a young child I had depression. I had my
first manic episode when I was twenty, and at first thought it
was a wonderful recovery after a year of severe depression. I was diagnosed
as schizoaffective when I was 21. I'm 38 now, so I have lived with
the diagnosis for 17 years. I expect (and have been emphatically told
by my doctors) that I'm going to have to take medication for it for the
rest of my life.
I have also had disturbed sleeping
patterns as long as I can remember - one reason
I'm a software consultant is that
I can keep irregular hours. That's a primary reason why I went into
software engineering at all when I left school - I did not think my
sleeping habits would allow me to hold a real job for any length of time.
Even with the flexibility most programmers have, I don't think the hours
I keep now would be tolerated by many employers.
I left Caltech when my illness got really bad at the age of 20. I
eventually transferred to U.C. Santa Cruz
and finally managed to get my physics degree, but it took a long time and
a great deal of difficulty to graduate. I had done well in my two years
at Caltech, but to complete the last two years of classes at UCSC took me
eight years. I had very mixed results, with my grades depending on my mood
each quarter. While I did well in some classes (I successfully petitioned for
credit in Optics) I recieved many poor grades, and even failed a few classes.
A Poorly Understood Condition
I've been writing
online about my illness for a number of years.
In most of what I have written, I referred to my illness as manic
depression, also known as bipolar depression.
But that's not quite the right name for it. The reason I say I'm
manic depressive is that very few people have any idea what
schizoaffective disorder is - not even many mental health professionals.
Most people have at least heard of manic depression, and many have a
pretty good idea of what it is. Bipolar
depression is very well known to both
psychologists and psychiatrists, and can often be effectively treated.
I tried to research schizoaffective disorder
online a few years ago, and also pressed my
doctors for details so I could understand my condition better. The best
anyone could say to me is that it is "poorly understood". Schizoaffective
disorder is one of the rarer forms of mental illness, and has not been
the subject of much clinical study. To my knowledge there are no
medications that are specifically meant to treat it - instead one uses
a combination of the drugs used for manic depression and
schizophrenia. (As I will explain later, while some might disagree with me,
I feel it is also critically
important to undergo psychotherapy.)
The doctors at the hospital where I was diagnosed seemed to be quite
confused by the symptoms I was exhibiting. I had expected to stay only
a few days, but they wanted to keep me much longer because they told me
that they did not understand what was going on with me and wanted to
observe me for an extended time so they could figure it out.
schizophrenia is a very familiar illness to any psychiatrist, my
psychiatrist seemed to find it very disturbing that I was hearing voices.
If I had not been hallucinating
he would have been very comfortable diagnosing and
treating me as bipolar.
While they seemed certain of my eventual diagnosis, the impression I got
from my stay at the hospital was that none of the staff had ever seen
anyone with schizoaffective disorder before.
There is some controversy as to whether it is a real illness at all.
Is schizoaffective disorder a distinct condition, or is it the
unlucky coincidence of two different diseases? When
The Quiet Room
Schiller was diagnosed with schizoaffective disorder, her
parents protested that the doctors really didn't know what was wrong
with their daughter, saying that schizoaffective disorder
was just a catch-all diagnosis
that the doctors used because they had no real understanding of her
Probably the best argument I've heard that schizoaffective disorder is
a distinct illness is the observation that schizoaffectives tend to do
better in their lives than schizophrenics tend to do.
But that is not
a very satisfying argument. I for one would like to understand my
illness better and I would like those from whom I seek treatment to
understand it better. That can only be possible if schizoaffective
disorder were to get more attention from the clinical research
Someone You Know is Mentally Ill
One out of three people is mentally ill. Ask two friends how
they're doing. If they say they're OK, then you're it.
Mental illness is common in the entire world's population. However
people are unaware of the mentally ill who live among them
because the stigma against mental illness
forces those who suffer to keep it hidden. Many people who ought to
be aware of it prefer to pretend it doesn't exist.
The most common mental illness is depression. It is so common that
many are surprised to find out that it is considered a mental illness at
all. About 25% of women and 12% of men experience depression at some time
in their lives, and at any given moment about 5% are experiencing
(The statistics I find vary depending on the source. Typical figures are
Understanding Depression Statistics.)
Roughly 1.2% of the population is manic depressive. You probably know
more than a hundred people - the chances are great that you know
someone who is manic depressive. Or to look at it another way,
according to K5's
demographics, our community has 27,000 registered users and is
visited by 200,000 unique visitors each month. Thus we can expect that
K5 has roughly 270 manic depressive members and the site is viewed by
about 2,000 manic depressive readers each month.
A slightly smaller number of people have schizophrenia.
About one in
two hundred people get schizoaffective disorder during their lives.
More statistics can be found in
The Numbers Count.
While homelessness is a significant problem for the mentally ill,
most of us are not out sleeping on the streets or locked up in hospitals.
Instead we live and work in society just as you do. You will find
the mentally ill among your friends, neighbors, coworkers, classmates,
family. At a company where I was once employed,
when I confided that I was manic depressive to a coworker in
our small workgroup, she replied that
she was manic depressive too.
Life on a Roller Coaster
Nullum magnum ingenium sine mixtura dementiae fuit.
(There is no great genius without madness.)
When I don't feel like going to the trouble to explain what
schizoaffective disorder means, I commonly say that I'm manic depressive
rather than schizophrenic
because the manic depressive (or bipolar) symptoms are more prevalent
for me. But I experience schizoid symptoms as well.
Manic depressives experience alternating moods of depression
and euphoria. There can (blessedly) be periods of relative normalcy
in between. There is a somewhat regular time period to each
person's cycle, but this varies
dramatically from person to person, ranging from cycling every day for
the "rapid cyclers" to alternating moods about every year for me.
The symptoms tend to come and go; it is possible to live
in peace without any treatment sometimes, even for years. But the
symptoms have a way of striking again with an overwhelming
suddenness. If left untreated a phenomenon known as
in which the cycles happen more rapidly and more severely, with the
damage eventually becoming permanent.
(I had lived successfully without medication for quite some time
through my late 20's, but a devastating manic episode that struck during
graduate school at UCSC, followed by a profound depression, made me decide to
go back on medication and stay with it even when I was feeling well. I
realized that even though I might feel fine for a long time, staying on
medication was the only way to avoid being caught by surprise.)
You may find it odd that euphoria would be referred to as a symptom
of mental illness, but it is unmistakeably so. Mania is not the same
as simple happiness. It can have a pleasant feel to it, but the person
who is experiencing mania is not experiencing reality.
Mild mania is known as hypomania and usually does feel quite pleasant
and can be fairly easy to live with. One has boundless energy, feels
little need to sleep, is creatively inspired, talkative and is often
taken to be an unusually attractive person.
Manic depressives are usually intelligent and very creative people.
Many manic depressives actually lead very successful lives, if they are
able to overcome or avoid the illness' devastating effects - a nurse in
Santa Cruz' Dominican
Hospital described it to me as "a class illness".
Touched with Fire Kay Redfield Jamison explores the relationship
between creativity and manic depression, and gives biographies of many
manic depressive poets and artists throughout history. Jamison is a noted
authority on manic depression not just because of her academic studies and
clinical practice - as she explains in her autobiography
An Unquiet Mind she is manic depressive herself.
I have a bachelor's degree in Physics, and have been an avid
amateur telescope maker
for much of my life; this led to my Astronomy studies at Caltech.
I taught myself to play
piano, enjoy photography,
and am quite good at
and even do a little
painting. I have
worked as a programmer for fifteen years
(also mostly self-taught), own
my own software consulting
business, own a nice home in the Maine woods, and am
happily married to a wonderful woman who is very well aware of my
I like to write too. Other K5 articles I have written include
Is This the
America I Love?,
Code Optimization? and (under my previous username)
Good C++ Style.
You wouldn't think that I have spent so many years living in
such misery, or that it is something I still have
to deal with.
Full-blown mania is frightening and most unpleasant. It is
a psychotic state. My experience of it is that I can't hold any
particular train of thought for more than a few seconds. I can't speak
in complete sentences.
My schizoid symptoms get a lot worse when I am manic. Most notably
I get profoundly paranoid. Sometimes I hallucinate.
(At the time I was diagnosed, it was not thought that manic depressives ever
hallucinated, so my diagnosis of schizoaffective disorder was based on the
fact that I was hearing voices while I was manic. Since then it has become
accepted that mania can cause hallucinations. However I believe my
diagnosis to be correct based on the current
Diagnostic and Statistical
Manual criterion that
experience schizoid symptoms even
during times they are not experiencing bipolar symptoms. I can still
hallucinate or get paranoid when my mood is otherwise normal.)
Mania is not always accompanied by euphoria. There can also be
dysphoria, in which one feels irritable, angry and suspicious. My last
major manic episode (in the Spring of 1994) was a dysphoric one.
I go for days without sleeping when I am manic. At first I feel that
I don't need to sleep so I just stay up and enjoy the
extra time in my day. Eventually I feel
desperate to sleep but I cannot. The human brain cannot function for
any extended period of time without sleep, and sleep deprivation tends
to be stimulating to manic depressives, so going without sleep
creates a vicious cycle that might only be broken by a stay in a
Going a long time without sleeping can cause some odd mental
states. For example there have been times when I lay down to try to
rest and started dreaming, but did not fall asleep. I could see and
hear everything around me, but there was, well, extra stuff going on.
One time I got up to take a shower while dreaming, hoping that it
might relax me enough that I could fall asleep.
In general I've had the fortune to have a lot of really odd experiences.
Another thing that can happen to me is that I might be unable to
distinguish between being awake and asleep, or to be unable to
distinguish memories of dreams from memories of things that really
happened. There are several periods of my life for which my memories are
a confusing jumble.
Fortunately I have only been manic a few times, I think five or six
times. I have always found the experiences devastating.
I get hypomanic about once a year. It usually lasts for a couple of
weeks. Usually it subsides, but on rare occasions escalates into mania.
(However I have never become manic when I was taking my medication
regularly. The treatment is not so effective for everyone, but at least
that much works well for me.)
Many manic depressives long for the hypomanic states, and I would
welcome them myself, if it weren't for the fact that they are usually
followed by depression.
Depression is a more familiar state of mind to most people. Many
experience it, and almost everyone has known someone to experience
depression. Depression strikes about one quarter of the world's women
and one eighth of the world's men at
some time in their lives; at any given time five percent of the
population is experiencing major depression. Depression is the
most common mental illness.
Understanding Depression Statistics.)
However in its extremety depression can take on forms
that are much less familiar and can even be life-threatening.
Depression is the symptom that I tend to have the most trouble
with. Mania is more damaging when it happens, but it is rare for me.
Depression is all too common. If I did not take antidepressants
regularly, I would be depressed most of the time - that was my
experience for most of my life before I got diagnosed.
In its milder forms depression is characterized by sadness and a loss of
interest in the things that make life pleasant. Commonly one feels
tired and unambitious. One is often bored and at the same time unable
to think of anything interesting to do. Time passes excruciatingly
Sleep disturbances are common in depression too. Most commonly I
sleep excessively, sometimes twenty hours a day and at times round the
clock, but there have been times when I had insomnia as well. It's not
like when I'm manic - I get exhausted and wish desperately to just get
some sleep, but somehow it evades me.
At first the reason I sleep so much when depressed is not because I
am tired. It is because consciousness is too painful to face. I feel
that life would be easier to bear if I were asleep most of the time, and
so I force myself into unconsciousness.
Eventually this becomes a cycle that is difficult to break. It seems
that sleeping less is stimulating to manic depressives while sleeping
excessively is depressing. While sleeping excessively my mood gets lower
and lower, and I sleep more and more. After a while, even
during the few hours I
spend awake I feel desperately tired.
The best thing to do would be to spend more time awake. If one
is depressed it would be best to sleep very little. But then there's the
problem of conscious life being unbearable, and also finding something to
occupy oneself during the interminable hours that pass each day.
(Quite a few
psychologists and psychiatrists have also told me that what I really
need to do
when I am depressed is get vigorous exercise, which is just about the
last thing I feel like doing. One psychiatrist's response to my protest was
"do it anyway". I can say that exercise is the best natural medicine for
it may well be the hardest one to take.)
Sleep is a good indicator for mental health practitioners to study
in a patient, because it can be measured objectively. You just ask the
patient how much they've been sleeping and when.
While you can
certainly ask someone how they're feeling, some patients may be either
unable to express their feelings eloquently or may be in a state of
denial or delusion so that what they say is not truthful. But if your
patient says he's sleeping twenty hours a day (or not at all),
it is certain that
something is wrong.
(My wife read the above and asked me what she was
supposed to think about the times when I sleep twenty hours at a stretch.
Sometimes I do that and claim that I'm feeling just fine. As I said
my sleeping patterns are very disturbed, even when my mood and my thoughts
are otherwise normal. I have consulted a sleep specialist about this,
and had a couple sleep studies done in a hospital where I spent the night
hooked up to an electroencephalograph and electrocardiograph and all manner
of other detectors. The sleep specialist diagnosed me with obstructive
sleep apnea and prescribed a Continuous Positive Air Pressure mask to wear
when I sleep. It helped, but did not make me sleep like other people do.
The apnea has improved since I lost a lot of weight recently, but I still
keep very irregular hours.)
When depression becomes more severe, one becomes unable to feel anything
at all. There is just an empty flatness. One feels like one has no
personality whatsoever. During times I have been very depressed, I would
watch movies a lot so I could pretend I was the characters in them, and in
that way feel for a brief time
that I had a personality - that I had any feelings at all.
One of the unfortunate consequences of depression is that it makes it
difficult to maintain human relationships. Others find the sufferer
boring, uninteresting or even frustrating to be around. The depressed
person finds it difficult to do anything to help themselves, and this
can anger those who try at first to help them, only to give up.
While depression initially can cause a sufferer to feel
alone, often its effects on those around him can result in his actually
This leads to another vicious cycle as the loneliness makes the depression
When I started graduate school I was in a healthy state of mind at first,
but what drove me over the edge was all the time I had to spend alone
studying. It wasn't the difficulty of the work - it was the isolation.
At first my friends still wanted to spend time with me, but I had to tell
them I didn't have time because I had so much work to do. Eventually my
friends gave up and stopped calling, and that's when I got depressed.
That could happen to anyone, but in my case it led to several weeks of
acute anxiety that eventually stimulated a severe manic episode.
Perhaps you're familiar with The Doors' song People are Strange
which neatly summarizes my experience with depression:
People are strange
When you're a stranger,
Faces look ugly
When you're alone,
Women seem wicked
When you're unwanted,
Streets are uneven
When you're down.
In the deepest parts of depression the isolation becomes complete.
Even when someone makes the effort to reach out, you just cannot respond
even to let them in.
Most people don't make the effort, in fact they avoid you. It is common
for strangers to cross the street to avoid coming close to a depressed
Depression may lead to thoughts of suicide or obsessive thoughts of
death in general. I have known depressed people to tell me in all
seriousness that I would be better off if they were gone. There can be
suicide attempts. Sometimes the attempts are successful.
One in five untreated
manic depressives ends their lives at their
There is much better hope for those who seek treatment, but
unfortunately most manic depressives are never treated - it is estimated
only one third of those who are depressed ever get treatment. In all too
many cases the diagnosis of mental illness is made post-mortem based on
the memories of grieving friends and relatives.
If you come across a depressed person as you go about your day, one of
the kindest things you can do for them is to walk right up, look them
straight in the eye, and just say hello. One of the worst parts of
being depressed is the unwillingness that others have to even
acknowledge that I'm a member of the human race.
On the other hand, a manic depressive friend who reviewed my drafts
had this to say:
When I am depressed I don't want the company of strangers, and often not
even the company of many friends. I wouldn't go as far as to say I "like"
being alone, but the obligation to relate to another person in some way is
loathesome. I also become more irritable sometimes and find the usual
ritual pleasantries unbearable. I only want interaction with people with whom
I can really connect, and for the most part I don't feel like anyone can
connect with me at that point. I begin to feel like some subspecies of
humankind and as such I feel repulsive and repulsed. I feel like people
around me can literally see my depression as if it were some grotesque wart
on my face. I just want to hide and drop into the shadows. For some
reason, I find it a problem that people seem to want to talk to me wherever I
go. I must give out some kind of vibe that I am approachable. When
depressed my low profile and head-hanging demeanor is really meant to
discourage people from approaching me.
Thus it is important to respect each individual, for the depressed as
for everyone else.
The Strange Pill
This leads me to another odd experience I have had a number of times.
Depression can often be treated quite effectively by drugs called
antidepressants. What these do is increase the concentration of
neurotransmitters in one's nerve synapses, so signals flow more easily in
one's brain. There are many different antidepressants that do this via
several different mechanisms, but they all have the effect of
boosting one of the neurotransmitters, either norepinephrine or
serotonin. (Imbalances in the neurotransmitter dopamine cause the
The problem with antidepressants is that they take a long time to take
effect, sometimes as long as a couple of months. It can be hard to keep up
hope while waiting for the
antidepressant to start working. At first all one feels is
the side effects - dry mouth ("cottonmouth"), sedation, difficulty in
urinating. If you're well enough to be interested in sex, some
antidepressants have such side effects as making it impossible to have
But after a while the desired effect begins to happen. And here is
where I have the odd experiences: I don't feel anything at first, the
antidepressants don't change my feelings or perceptions. Instead, when I
take antidepressants, other people act differently towards me.
I find that people stop avoiding me, and eventually start to look
directly at me and talk
to me and want to be around me. After months with little or no human
contact, complete strangers spontaneously start conversations with me.
Women start to flirt with me where before they would have feared me.
This of course is a wonderful thing, and my experience has often been
that it is the behaviour of others rather than the medicine
that lifts my mood. But it is really
strange to have others change their behaviour because I'm taking a pill.
Of course, what really must be happening is that they are reacting to
changes in my behaviour, but these changes must be subtle indeed.
If this is
the case the behavioural changes must happen before there is any change in
my own conscious thoughts and feelings, and when it starts to happen I
cannot say that I've noticed anything different about my own behaviour.
While the clinical effect of antidepressants is to stimulate the
transmission of nerve impulses, the first outward sign of their
effectiveness is that one's behaviour changes without one having any
conscious knowledge of it.
One friend who is also a consultant who suffers
from depression had the following to say about my experiences with
I've had the almost identical experience--not just in how PEOPLE treat me,
but how the entire WORLD works. For instance, when I'm not depressed, I
start getting more work, good things come to me, events turn out more
positively. These things COULDN'T be reacting to my improved mood because my
clients, for example, may not have talked to me for months prior to calling
and offering me work! And yet, it truly does seem that when my mood looks
up, EVERYthing looks up. Very mysterious, but I do believe there's some kind
of connection. I just don't understand what it is or how it works.
Some people object to taking psychiatric medications - I did until
it became clear I would not survive without them, and even for some
years afterwards I wouldn't take them when I was feeling well.
One reason people
resist taking antidepressants is that they feel they would rather be
depressed than to experience artificial happiness from a drug. But that's
really not what's happening when you take antidepressants. Being depressed
is as much a delusional state as believing oneself to be the Emperor of
France. You may be quite surprised to hear that and I was too the first
time I read a psychologist's statement that his patient sufferred from the
delusion that life was not worth living. But depressive thought really is
It's not clear what the ultimate cause of depression is, but its
physiological effect is a shortage of neurotransmitters in the nerve
synapses. This makes it difficult for nerve signals to be transmitted and
has a dampening effect on much of your brain activity. Antidepressants
increase the concentration of neurotransmitters back up to their normal
levels so that nerve impulses can propagate successfully.
What you experience
when taking antidepressants is much closer to reality than what you
experience while depressed.
A Risky Treatment
An unfortunate problem that antidepressants have for both manic
depressives and schizoaffectives is that they can stimulate manic episodes.
This makes psychiatrists reluctant to prescribe them at all even if the
patient is sufferring terribly. My own feeling is that I would rather
risk even psychotic mania than to have to live through psychotic depression
without medication - after all, I'm not likely to kill myself while manic,
but while depressed the danger of suicide is very real and thoughts of
doing harm to myself are never far from my mind.
I had not been diagnosed when I took antidepressants for the first time
(a tricyclic called amitryptiline or Elavil)
and as a result I spent six weeks in
a psychiatric hospital. That was the summer of 1985, after a year I had
spent mostly crazy. That's when I was finally diagnosed.
(I feel that
it was irresponsible of the psychiatrist who prescribed
my first antidepressant
to not have investigated my history more thoroughly than she did, to see
if I had ever experienced a manic episode. I had my first one a little less
than a year before, but didn't know what it was. Had she
just described what mania was, and asked me if I had ever experienced it,
a lot of trouble could have been avoided.
While I think the antidepressant would still have been indicated,
she could have prescribed a mood stabilizer which might have prevented the
worst manic episode of my entire life, not to mention the ten thousand
dollars I was fortunate to have my insurance company pay for my
I find now that I can take antidepressants with little risk of getting
manic. It requires careful monitoring in a way that wouldn't be necessary
for "unipolar" depressives. I have to take mood stabilizers
(antimanic medication); presently I take Depakote (valproic acid),
which was first used to
treat epilepsy - many of the medicines used to treat manic depression
were originally used for epilepsy. I have to do the best I can to observe my mood objectively,
and see my doctor regularly. If
my mood becomes unusually elevated I have to either cut back the
antidepressant I take or increase my mood stabilizer, or
I've been taking imipramine for about five years. I think it is
one of the reasons I do so well now, and it upsets me that many
psychiatrists are unwilling to prescribe antidepressants to manic
Not all antidepressants work so well - as I said
amitryptiline made me manic. Paxil did very little to help me, and
Wellbutrin did nothing at all. There was one I took (I think it might
have been Norpramine)
that caused a severe anxiety attack - I only ever took one tablet and
wouldn't take any more after that. I did have good results from maprotiline
in my early 20's, but then decided to stop medication entirely for several
years, until I got hospitalized again in the spring of 1994. I had a
low-grade depression for several years after that (when I tried Wellbutrin
and then Paxil). I wasn't suicidal but I just lived a miserable existence.
A couple of months after I started taking imipramine in 1998, life got
You should not use my experience as a guide in choosing any
antidepressants you might take. The effectiveness of each is a
very individual matter - they are all effective for some people and
ineffective for others.
Really the best you can do is try one out to see if it works
for you, and keep trying new ones until you find the right one. Most likely
any that you try will help to some extent.
There are many antidepressants on
the market now, so if your medicine is not helping, it's very likely that
there is another that will.
What if Medicine Doesn't Help?
There are people for which it seems
no antidepressant will help, but they are rare, and for those who cannot
be treated by antidepressants, it is very likely that electric schock
treatment will help. I realize that's a very frightening prospect and
is still controversial, but ECT (or electroconvulsive therapy)
is widely regarded by psychiatrists as the
safest and most effective treatment there is for the worst depression.
Most effective because it works when antidepressants fail, and safest for
the simple reason that it works almost immediately, so the patient is
not likely to kill themselves while waiting to get better, as can happen
while waiting for an antidepressant to yield some relief.
Those who have read such books as
Zen and the Art of
Motorcycle Maintenance and
One Flew Over
the Cuckoo's Nest will understandably have a low regard for shock
treatment. In the past shock treatment was poorly understood by those
who administered it and I
have no doubt that it has been abused as depicted in
Note: While you may have seen the Cuckoo's Nest
movie, it's really worthwhile
to read the book. The inner experience of the patients comes through in
the novel in a way that I don't think is possible in a motion picture.
It has since been found that
the memory loss that Robert Pirsig describes in Zen and the Art
of Motorcycle Maintenance can be largely avoided by shocking only
one lobe of the brain at a time, rather than both simultaneously. I
understand the untreated lobe retains its memory and can help the other
one recover it.
A new procedure called
Magnetic Stimulation promises a vast improvement over traditional ECT by
using pulsed magnetic fields to induce currents inside the brain. A drawback
for ECT is that the skull is an effective insulator, so high voltages are
required to penetrate it. ECT cannot be applied with much precision.
The skull presents no barrier to magnetic fields,
so TMS can be delicately and precisely controlled.
At the hospital back in '85 I had the pleasure to meet a fellow patient
who had once worked as a staff member at another psychiatric hospital
some time before. He would give us the inside scoop on everything that
was going on during our stay. In particular he had once assisted in
giving ECT treatments, and said that at the time it was just starting to
be understood how many times you could shock someone before, as he put it,
"they wouldn't come back". He said you could safely treat someone
(It actually seems to be common for those who have mental illness to
work at psychiatric hospitals. The Quiet Room author Lori Schiller
worked at one for a while, and even now teaches a class at one. A bipolar
friend worked at Harbor Hills hospital in Santa Cruz when I knew him back
in the mid-80's. At her first job, Schiller managed to keep her illness
a secret for some time until another staffer noticed her hands shaking.
That's a common side effect of many psychiatric medications, and in fact
sometimes I take a drug called propanolol to stop the tremors I get
from Depakote, which got so bad at one point that I couldn't type on
a computer keyboard.)
You're probably wondering whether I have ever had ECT. I haven't;
antidepressants work well for me. Although I feel it is probably safe and
effective, I would be very reluctant to have it, for the simple reason that
I place such a high value on my intellect. I would have to be pretty
convinced that I would be as smart afterwards as I am now before I would
volunteer for shock treatment.
I would have to know a lot more about it than I do
I've known several other people to have ECT, and it seemed to help them.
A couple of them were fellow patients who were getting
the treatment while we were in the hospital together,
and the difference in
their whole personalities from one day to the next was profoundly positive.
Coming Up: Schizoid Symptoms
I will post Part II once discussion of this first installment
tapers off. In Part II, I will discuss the schizophrenic side of
schizoaffective disorder, something that I have not felt comfortable to
talk about much before, publicly or privately. I will cover auditory
and visual hallucinations, disassociation and paranoia.
Finally in part III I will tell you what to do about mental illness
- why it's important to seek treatment, what therapy is all about,
and how you can make a livable new world for yourself. I will conclude
with an explanation of why I write so publicly about my illness and
give a list of websites and books for further reading.
Copyright © 2003 Michael David Crawford. All