[NYAPRS Enews] NYT: Saks on 'Successful and Schizophrenic'

[Harvey Rosenthal]

Successful and Schizophrenic


By Elyn R. Saks  New York Times  January 25, 2013 


THIRTY years ago, I was given a diagnosis of schizophrenia
<http://health.nytimes.com/health/guides/disease/schizophrenia-disorgani
zed-type/overview.html?inline=nyt-classifier> . My prognosis was
"grave": I would never live independently, hold a job, find a loving
partner, get married. My home would be a board-and-care facility, my
days spent watching TV in a day room with other people debilitated by
mental illness. I would work at menial jobs when my symptoms were quiet.
Following my last psychiatric hospitalization at the age of 28, I was
encouraged by a doctor to work as a cashier making change. If I could
handle that, I was told, we would reassess my ability to hold a more
demanding position, perhaps even something full-time. 

Then I made a decision. I would write the narrative of my life. Today I
am a chaired professor at the University of Southern California
<http://topics.nytimes.com/top/reference/timestopics/organizations/u/uni
versity_of_southern_california/index.html?inline=nyt-org>  Gould School
of Law. I have an adjunct appointment in the department of psychiatry at
the medical school of the University of California, San Diego, and am on
the faculty of the New Center for Psychoanalysis. The MacArthur
Foundation gave me a genius grant <http://www.macfound.org/fellows/62/>
. 

Although I fought my diagnosis for many years, I came to accept that I
have schizophrenia and will be in treatment the rest of my life. Indeed,
excellent psychoanalytic treatment and medication have been critical to
my success. What I refused to accept was my prognosis. 

Conventional psychiatric thinking and its diagnostic categories say that
people like me don't exist. Either I don't have schizophrenia (please
tell that to the delusions crowding my mind), or I couldn't have
accomplished what I have (please tell that to U.S.C.'s committee on
faculty affairs). But I do, and I have. And I have undertaken research
with colleagues at U.S.C. and U.C.L.A. to show that I am not alone.
There are others with schizophrenia and such active symptoms as
delusions and hallucinations
<http://health.nytimes.com/health/guides/symptoms/hallucinations/overvie
w.html?inline=nyt-classifier>  who have significant academic and
professional achievements. 

Over the last few years, my colleagues, including Stephen Marder, Alison
Hamilton and Amy Cohen, and I have gathered 20 research subjects with
high-functioning schizophrenia in Los Angeles. They suffered from
symptoms like mild delusions or hallucinatory behavior. Their average
age was 40. Half were male, half female, and more than half were
minorities. All had high school diplomas, and a majority either had or
were working toward college or graduate degrees. They were graduate
students, managers, technicians and professionals, including a doctor,
lawyer, psychologist and chief executive of a nonprofit group. 

At the same time, most were unmarried and childless, which is consistent
with their diagnoses. (My colleagues and I intend to do another study on
people with schizophrenia who are high-functioning in terms of their
relationships. Marrying in my mid-40s - the best thing that ever
happened to me - was against all odds, following almost 18 years of not
dating.) More than three-quarters had been hospitalized between two and
five times because of their illness, while three had never been
admitted. 

How had these people with schizophrenia managed to succeed in their
studies and at such high-level jobs? We learned that, in addition to
medication and therapy, all the participants had developed techniques to
keep their schizophrenia at bay. For some, these techniques were
cognitive. An educator with a master's degree said he had learned to
face his hallucinations and ask, "What's the evidence for that? Or is it
just a perception problem?" Another participant said, "I hear derogatory
voices all the time. ... You just gotta blow them off." 

Part of vigilance about symptoms was "identifying triggers" to "prevent
a fuller blown experience of symptoms," said a participant who works as
a coordinator at a nonprofit group. For instance, if being with people
in close quarters for too long can set off symptoms, build in some alone
time when you travel with friends. 

Other techniques that our participants cited included controlling
sensory inputs. For some, this meant keeping their living space simple
(bare walls, no TV, only quiet music), while for others, it meant
distracting music. "I'll listen to loud music if I don't want to hear
things," said a participant who is a certified nurse's assistant. Still
others mentioned exercise, a healthy diet, avoiding alcohol and getting
enough sleep. A belief in God and prayer also played a role for some. 

One of the most frequently mentioned techniques that helped our research
participants manage their symptoms was work. "Work has been an important
part of who I am," said an educator in our group. "When you become
useful to an organization and feel respected in that organization,
there's a certain value in belonging there." This person works on the
weekends too because of "the distraction factor." In other words, by
engaging in work, the crazy stuff often recedes to the sidelines. 

Personally, I reach out to my doctors, friends and family whenever I
start slipping, and I get great support from them. I eat comfort food
(for me, cereal) and listen to quiet music. I minimize all stimulation.
Usually these techniques, combined with more medication and therapy,
will make the symptoms pass. But the work piece - using my mind - is my
best defense. It keeps me focused, it keeps the demons at bay. My mind,
I have come to say, is both my worst enemy and my best friend. 

THAT is why it is so distressing when doctors tell their patients not to
expect or pursue fulfilling careers. Far too often, the conventional
psychiatric approach to mental illness is to see clusters of symptoms
that characterize people. Accordingly, many psychiatrists hold the view
that treating symptoms with medication is treating mental illness. But
this fails to take into account individuals' strengths and capabilities,
leading mental health
<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthto
pics/mentalhealthanddisorders/index.html?inline=nyt-classifier>
professionals to underestimate what their patients can hope to achieve
in the world. 

It's not just schizophrenia: earlier this month, The Journal of Child
Psychology and Psychiatry posted a study showing that a small group of
people who were given diagnoses of autism
<http://health.nytimes.com/health/guides/disease/autism/overview.html?in
line=nyt-classifier> , a developmental disorder, later stopped
exhibiting symptoms. They seemed to have recovered
<http://www.nytimes.com/2012/12/02/magazine/the-autism-advantage.html?pa
gewanted=all>  - though after years of behavioral therapy and treatment.
A recent New York Times Magazine article described a new company that
hires high-functioning adults with autism, taking advantage of their
unusual memory skills and attention to detail. 

I don't want to sound like a Pollyanna about schizophrenia; mental
illness imposes real limitations, and it's important not to romanticize
it. We can't all be Nobel laureates like John Nash of the movie "A
Beautiful Mind." But the seeds of creative thinking may sometimes be
found in mental illness, and people underestimate the power of the human
brain to adapt and to create. 

An approach that looks for individual strengths, in addition to
considering symptoms, could help dispel the pessimism surrounding mental
illness. Finding "the wellness within the illness," as one person with
schizophrenia said, should be a therapeutic goal. Doctors should urge
their patients to develop relationships and engage in meaningful work.
They should encourage patients to find their own repertory of techniques
to manage their symptoms and aim for a quality of life as they define
it. And they should provide patients with the resources - therapy,
medication and support - to make these things happen. 

"Every person has a unique gift or unique self to bring to the world,"
said one of our study's participants. She expressed the reality that
those of us who have schizophrenia and other mental illnesses want what
everyone wants: in the words of Sigmund Freud
<http://topics.nytimes.com/top/reference/timestopics/people/f/sigmund_fr
eud/index.html?inline=nyt-per> , to work and to love. 

Elyn R. Saks is a law professor
<http://lawweb.usc.edu/contact/contactInfo.cfm?detailID=300>  at the
University of Southern California and the author of the memoir "The
Center Cannot Hold: My Journey Through Madness." 

http://www.nytimes.com/2013/01/27/opinion/sunday/schizophrenic-not-stupi
d.html?_r=0 

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