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9780060842598

Surviving Schizophrenia : A Manual for Families, Patients, and Providers

by
  • ISBN13:

    9780060842598

  • ISBN10:

    0060842598

  • Edition: 5th
  • Format: Paperback
  • Copyright: 2010-06-08
  • Publisher: HarperCollins Publications
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Summary

Since its first publication in 1983, Surviving Schizophrenia has become the standard reference book on the disease and has helped thousands of patients, their families and mental health professionals. In clear language, this muchpraised and important book describes the nature, causes, symptoms, treatment and course of schizophrenia and also explores living with it from both the patient and the family's point of view. This new, completely updated fifth edition includes the latest research findings on what causes the disease as well as information about the newest drugs for treatment and answers to the questions most often asked by families, consumers and providers.

Author Biography

E. Fuller Torrey, M.D., is currently the associate director for laboratory research of the Stanley Medical Research Institute, president of the Treatment Advocacy Center, and professor of psychiatry at the Uniformed Services University of the Health Sciences

Table of Contents

Illustrations xvii
Preface to the Fifth Edition xix
Preface to the First Edition, 1983 xxi
Acknowledgments xxiii
1. THE INNER WORLD OF MADNESS: VIEW FROM THE INSIDE
Alterations of the Senses
4(9)
Inability to Interpret and Respond
13(12)
Delusions and Hallucinations
25(12)
Altered Sense of Self
37(3)
Changes in Emotions
40(5)
Changes in Movements
45(1)
Changes in Behavior
46(4)
Decreased Awareness of Illness
50(2)
The Black-Red Disease
52(7)
Recommended Further Reading
59(3)
2. DEFINING SCHIZOPHRENIA: VIEW FROM THE OUTSIDE
Official Criteria for Diagnosis
62(4)
Subtypes of Schizophrenia
66(1)
Delusional Disorders
67(1)
Schizotypal, Schizoid, Paranoid, and Borderline Personality Disorders
68(3)
Schizoaffective Disorder and Manic-Depressive Illness
71(3)
"Manicdephrenia"
74(3)
Recommended Further Reading
77(2)
3. CONDITIONS SOMETIMES CONFUSED WITH SCHIZOPHRENIA A "Split Personality"
79(16)
Psychosis Caused by Street Drugs
80(2)
Psychosis Caused by Prescription Drugs
82(2)
Psychosis Caused by Other Diseases
84(3)
Psychosis Caused by Head Trauma
87(1)
Psychosis with Mental Retardation
88(1)
Infantile Autism
89(2)
Antisocial Personality Disorders and Sexual Predators
91(1)
Culturally Sanctioned Psychotic Behavior
92(1)
Recommended Further Reading
93(2)
4. ONSET, COURSE, AND PROGNOSIS
Childhood Precursors
95(1)
Onset and Early Symptoms
96(3)
Childhood Schizophrenia
99(1)
Postpartum Schizophrenia
100(1)
Late-Onset Schizophrenia
101(1)
Predictors of Outcome
102(2)
Male-Female Differences
104(1)
Possible Courses: Ten Years Later
105(4)
Possible Courses: Thirty Years Later
109(4)
The "Recovery Model"
113(1)
Causes of Death: Why Do People with Schizophrenia Die at a Younger Age?
114(2)
Recommended Further Reading
116(3)
5. RESEARCH FINDINGS ON THE CAUSES OF SCHIZOPHRENIA
The Normal Brain
119(2)
The Brain with Schizophrenia
121(9)
The disease is familial
121(1)
There may be neurochemical changes
122(1)
There are structural and neuropathological changes
123(1)
There are neuropsychological deficits
124(1)
There are neurological abnormalities
125(1)
There are electrical abnormalities
126(1)
There are immunological and inflammatory abnormalities
127(1)
Individuals with schizophrenia are born disproportionately in the winter and spring
127(1)
Individuals with schizophrenia are born and/or raised disproportionately in urban areas
128(1)
Other abnormalities: pregnancy and birth complications, minor physical anomalies, and an absence of rheumatoid arthritis
128(2)
What Parts of the Brain Are Affected?
130(3)
When Does the Brain Damage Begin?
133(1)
Recommended Further Reading
134(4)
6. THEORIES ABOUT THE CAUSES OF SCHIZOPHRENIA
Genetic Theories
138(2)
Neurochemical Theories
140(1)
Developmental Theories
141(1)
Infectious and Immune Theories
142(2)
Nutritional Theories
144(2)
Endocrine Theories
146(1)
Stress Theories
147(2)
Obsolete Theories
149(5)
Masturbation and Demons
149(1)
Bad Mothers
149(1)
Bad Families
150(2)
Bad Cultures
152(1)
Thomas Szasz
153(1)
Ronald Laing
153(1)
Recommended Further Reading
154(3)
7. THE TREATMENT OF SCHIZOPHRENIA: NON-MEDICATION ASPECTS
How to Find a Good Doctor
157(5)
What Is an Adequate Diagnostic Workup?
162(4)
Hospitalization: Voluntary and Involuntary
166(9)
Alternatives to Hospitalization
175(1)
Payment for Treatment and Insurance Parity
176(2)
Outpatient Treatment and Managed Care
178(3)
Services for Children
181(2)
Services in Rural Areas
183(1)
Counseling, or Supportive "Psychotherapy"
184(3)
Insight-oriented Psychotherapy
187(2)
Cognitive Behavioral Therapy
189(2)
Electroconvulsive Therapy (ECT)
191(1)
Dietary Treatments
192(1)
Herbal Treatments
193(1)
Experimental Treatments: TMS and VNS
194(1)
Recommended Further Reading
195(2)
8. THE TREATMENT OF SCHIZOPHRENIA: MEDICATIONS
First-Generation Antipsychotics
197(17)
Adverse Effects
206(8)
Second-Generation Antipsychotics
214(13)
Adverse Effects
217(10)
Clozapine (Clozaril, Leponex)
219(3)
Olanzapine (Zyprexa)
222(1)
Risperidone (Risperdal)
223(1)
Quetiapine (Seroquel)
223(1)
Ziprasidone (Geodon)
224(3)
Aripiprazole (Abilify)
227(1)
Which Antipsychotic Should You Try? The Influence of the Pharmaceutical Industry on Prescribing Patterns
227(2)
Which Antipsychotic Should You Try? The Bottom Line
229(3)
Interactions of Antipsychotics with Other Medications
232(3)
Other Drugs to Try If Antipsychotics Fail
235(4)
New Medications on the Horizon
239(3)
Drug Prices and the Use of Generics
242(3)
Medications for Early Treatment or Prevention
245(1)
The Medication-Savvy Consumer and Family
246(2)
Recommended Further Reading
248(3)
9. THE REHABILITATION OF SCHIZOPHRENIA
Money and Food
251(4)
Housing
255(4)
Employment
259(3)
Friendship and Social Skills Training
262(3)
Medical and Dental Care
265(2)
Quality of Life Measures
267(1)
The Need for Asylum
268(2)
Recommended Further Reading
270(3)
10. TEN MAJOR PROBLEMS
Cigarettes and Coffee
273(4)
Alcohol and Street Drugs
277(4)
Sex, Pregnancy, and AIDS
281(6)
Victimization
287(2)
Confidentiality
289(4)
Medication Noncompliance
293(5)
Assisted Treatment
298(8)
Assaultive and Violent Behavior
306(3)
Arrest and Jail
309(2)
Suicide
311(3)
Recommended Further Reading
314(4)
11. HOW CAN PATIENTS AND FAMILIES SURVIVE SCHIZOPHRENIA?
The Right Attitude
318(9)
The Importance of Education
327(2)
Survival Strategies for Patients
329(3)
Survival Strategies for Families
332(9)
Effects of Schizophrenia on Siblings, Children, and Spouses
341(4)
Minimizing Relapses
345(3)
Recommended Further Reading
348(7)
12. COMMONLY ASKED QUESTIONS
Does Schizophrenia Change the Underlying Personality?
355(2)
Are People with Schizophrenia Responsible for Their Behavior?
357(3)
Does Schizophrenia Affect the Person's IQ?
360(1)
Should People with Schizophrenia Drive Vehicles?
361(1)
How Do Religious Issues Affect People with Schizophrenia?
362(2)
Should You Tell People That You Have Schizophrenia?
364(1)
Genetic Counseling: What Are the Chances of Getting Schizophrenia?
365(2)
Why Do Some Adopted Children Develop Schizophrenia?
367(1)
What Will Happen When the Parents Die?
368(2)
Recommended Further Reading
370(3)
13. SCHIZOPHRENIA IN THE PUBLIC EYE
Schizophrenia in the Movies
373(9)
Schizophrenia in Literature
382(7)
Schizophrenia, Creativity, and Famous People
389(5)
The Problem of Stigma
394(3)
Recommended Further Reading
397(7)
14. DIMENSIONS OF THE DISASTER
How Many People Have Schizophrenia in the United States?
404(1)
Where Are They?
405(5)
Do Some Groups Have More Schizophrenia Than Others?
410(4)
Is Schizophrenia Increasing or Decreasing?
414(1)
Is Schizophrenia of Recent Origin?
415(2)
Deinstitutionalization: A Cradle for Catastrophe
417(7)
What Is the Cost of Schizophrenia?
424(5)
Recommended Further Reading
429(2)
15. ISSUES FOR ADVOCATES
Congress, State Government, and the Politics of Neglect
431(4)
Scientologists, Anti-Psychiatrists, and "Consumer Survivors"
435(4)
NIMH and Research Funding
439(1)
Educating the Public
440(2)
Decreasing Stigma
442(2)
Improving Services
444(6)
How to Organize for Advocacy
450(2)
Recommended Further Reading
452(1)
Appendix A: An Annotated List of the Best and the Worst Books on Schizophrenia 453(21)
Appendix B: Useful Web sites on Schizophrenia by Judy Miller 474(6)
Appendix C: Other Useful Resources on Schizophrenia 480(4)
Notes 484(37)
Index 521

Supplemental Materials

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Excerpts

Surviving Schizophrenia
A Manual for Families, Patients, and Providers

Chapter One

The Inner World of Madness:
View from the Inside

What then does schizophrenia mean to me? It means fatigue and confusion, it means trying to separate every experience into the real and the unreal and not sometimes being aware of where the edges overlap. It means trying to think straight when there is a maze of experiences getting in the way, and when thoughts are continually being sucked out of your head so that you become embarrassed to speak at meetings. It means feeling sometimes that you are inside your head and visualising yourself walking over your brain, or watching another girl wearing your clothes and carrying out actions as you think them. It means knowing that you are continually "watched," that you can never succeed in life because the laws are all against you and knowing that your ultimate destruction is never far away.

Patient with schizophrenia, quoted in Henry R. Rollin,
Coping with Schizophrenia

When tragedy strikes, one of the things that make life bearable for people is the sympathy of friends and relatives. This can be seen, for example, in a natural disaster like a flood and with a chronic disease like cancer. Those closest to the person afflicted offer help, extend their sympathy, and generally provide important solace and support in the person's time of need. "Sympathy," said Emerson, "is a supporting atmosphere, and in it we unfold easily and well." A prerequisite for sympathy is an ability to put oneself in the place of the person afflicted. One must be able to imagine oneself in a flood or getting cancer. Without this ability to put oneself in the place of the person afflicted, there can be abstract pity but not true sympathy.

Sympathy for those afflicted with schizophrenia is sparse because it is difficult to put oneself in the place of the sufferer. The whole disease process is mysterious, foreign, and frightening to most people. As noted by Roy Porter in A Social History of Madness, "strangeness has typically been the key feature in the fractured dialogues that go on, or the silences that intrude, between the ‘mad' and the ‘sane.' Madness is a foreign country."

Schizophrenia, then, is not like a flood, where one can imagine all one's possessions being washed away. Nor like a cancer, where one can imagine a slowly growing tumor, relentlessly spreading from organ to organ and squeezing life from your body. No, schizophrenia is madness. Those who are afflicted act bizarrely, say strange things, withdraw from us, and may even try to hurt us. They are no longer the same person—they are mad! We don't understand why they say what they say and do what they do. We don't understand the disease process. Rather than a steadily growing tumor, which we can understand, it is as if the person has lost control of his/her brain. How can we sympathize with a person who is possessed by unknown and unseen forces? How can we sympathize with a madman or a madwoman?

The paucity of sympathy for those with schizophrenia makes it that much more of a disaster. Being afflicted with the disease is bad enough by itself. Those of us who have not had this disease should ask ourselves, for example, how we would feel if our brain began playing tricks on us, if unseen voices shouted at us, if we lost the capacity to feel emotions, and if we lost the ability to reason logically. As one individual with schizophrenia noted: "My greatest fear is this brain of mine. . . . The worst thing imaginable is to be terrified of one's own mind, the very matter that controls all that we are and all that we do and feel." This would certainly be burden enough for any human being to have to bear. But what if, in addition to this, those closest to us began to avoid us or ignore us, to pretend that they didn't hear our comments, to pretend that they didn't notice what we did? How would we feel if those we most cared about were embarrassed by our behavior each day?

Because there is little understanding of schizophrenia, so there is little sympathy. For this reason it is the obligation of everyone with a relative or close friend with schizophrenia to learn as much as possible about what the disease is and what the afflicted person is experiencing. This is not merely an intellectual exercise or a way to satisfy one's curiosity but rather the means to make it possible to sympathize with the person. For friends and relatives who want to be helpful, probably the most important thing to do is to learn about the inner workings of the brain of a person with schizophrenia. One mother wrote me after listening to her afflicted son's descriptions of his hallucinations: "I saw into the visual hallucinations that plagued him and frankly, at times, it raised the hair on my neck. It also helped me to get outside of my tragedy and to realize how horrible it is for the person who is afflicted. I thank God for that painful wisdom. I am able to cope easier with all of this."

With sympathy, schizophrenia is a personal tragedy. Without sympathy, it becomes a family calamity, for there is nothing to knit people together, no balm for the wounds. Understanding schizophrenia also helps demystify the disease and brings it from the realm of the occult to the daylight of reason. As we come to understand it, the face of madness slowly changes before us from one of terror to one of sadness. For the sufferer, this is a significant change.

The best way to learn what a person with schizophrenia experiences is to listen to someone with the disease. For this reason I have relied heavily upon patients' own accounts in describing the signs and symptoms. There are some excellent descriptions scattered throughout English literature; the best of these are listed . . .

Surviving Schizophrenia
A Manual for Families, Patients, and Providers
. Copyright © by E. Fuller Torrey. Reprinted by permission of HarperCollins Publishers, Inc. All rights reserved. Available now wherever books are sold.

Excerpted from Surviving Schizophrenia: A Manual for Families, Patients, and Providers by E. Fuller Torrey
All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.

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