In Just One Week

I’ve written before about my ghost stories folder, the bookmark tab I keep of every local news story about a crime or a death or a disappearance related to mental illness. I get these stories from google alerts, mixed in with the front-page sensational trial coverage and the endless market-watch stories on psychiatric medication futures. I’ve been thinking lately that looking at these alerts day in and day out has given me a wildly different impression of the American mental health landscape than one gets without such a dedicated effort. For most people, “mental illness” news is associated with celebrity suicides, or mass shootings, or with bourgeois discourse about Anxiety and Depression(TM) and finding a good therapist. But most stories aren’t like that. They’re about small crimes, and small deaths, and small disappearances and difficulties and frustrations. They’re about an immense aspect of American life which is not necessarily shocking, but not necessarily harmless either, and I think that in order to understand why I’m so often frustrated with both the punitive/stigmatizing and woke/destigmatizing narratives of mental illness, it helps to see the landscape the way I see it.

Instead of writing an essay this week (or rather, instead of writing a second essay, since I’m bogged down writing a long, difficult draft of a longer piece about the non-pharmaceutical elements of mental health management), I want to recreate just one subsections of one week of the news alerts I get. I won’t quote each story in full, but I want to quote enough to give a sense, both of the scale, and the patterns, and the grinding dreary sadness of it all. I’m not including the dozens of “STOCK TIP: FUTURES ON NEW DRUG MARKET” stories, but otherwise: here is just one week’s worth—about twenty stories—of hits just on what is by far my lowest-volume alert: “schizoaffective disorder”.

Death penalty bill faces uncertain vote in House

Though the Texas House gave preliminary approval Wednesday to a bill that would deem people convicted of capital murder ineligible for the death penalty if a jury finds that they have a severe mental illness, the bill’s author expects it to fail on final passage Thursday.

The House must approve bills on two separate days, and Rep. Toni Rose, D-Dallas, says House Bill 1936 will run up against Republicans who support the death penalty in its second vote. Rose slid it by her colleagues Wednesday, she said, as the bill came to the floor as many members returned from lunch.

Under HB 1936, defendants could ask the jury during the sentencing phase to provide a separate determination on whether the defendant had schizophrenia, a schizoaffective disorder or a bipolar disorder at the time of the murder. Those who are found guilty and to have one of the illnesses to the degree that it hindered their decision-making process would be sentenced to life without parole.

The defense must provide a notice 30 days before the trial date that it intends to prove that the defendant had a severe mental illness. Additionally, either side or the judge can call an expert to examine the defendant.

Rose’s bill was grouped with other death penalty bills in the House Criminal Jurisprudence Committee, where it passed along party lines 5-3 with one Republican absent. Yet, she said her bill was about mental illness policy rather than death penalty policy.

“A person can’t control what they’re born with,” said Rose, who was a mental health professional in Dallas prior to her first House election in 2013. “If you’re born with a mental illness, how are you going to be able to control that?”

Canvassing for the bill showed Rose that Texans and members of the Legislature lack mental illness awareness, she said.

“We’re the state leaders. We’re the leaders of Texas, and if we don’t understand, how can we make laws regarding mental health?” Rose said. “If we don’t understand it, how can we make good judgment on the resources and allocating funds for Texas?”

NSB man claiming to be secret agent on trial in grandmother’s killing

DAYTONA BEACH — Did Patrick Campbell believe four years ago that he was a “United States agent” sent by the “master of ceremonies” on a “sanctioned mission” to kill his grandmother at her New Smyrna Beach home?

Or did Campbell, who has been diagnosed with schizophrenia and schizoaffective disorder, simply want the money that his grandmother was keeping in her safe, and made up the bizarre story to claim he’s not guilty by reason of insanity for the 64-year-old’s 2015 slaying.

That’s a question a jury of 13 people, nine women and four men including an alternate, will decide as Campbell goes on trial this week before Circuit Judge Matt Foxman at the S. James Foxman Justice Center in Daytona Beach.

Campbell, 31, is accused of using a rock and knife to fatally beat and stab his grandmother, Darlene Robertson, on March 17, 2015. Campbell is charged with first-degree murder, robbery and grand theft auto. If convicted on the murder count, he faces a mandatory life in prison.

There is no dispute Campbell killed his grandmother. There is no dispute he has a mental illness. The legal fight centers on whether Campbell was legally insane when he killed his grandmother. And Campbell has pleaded not guilty by reason of insanity.

The two sides have opposing experts who will testify on that point during the trial.

“Patrick Campbell the defendant in this case killed his grandmother, Darlene Robertson, in a violent and brutal encounter,” said Assistant State Attorney Ryan Will who is prosecuting the case along with Tammy Jaques. “He beat her in the face and head with a landscaping rock. He used a kitchen knife to repeatedly stab her in the chest and then he cut her throat. The killing was premeditated and the defendant is not denying his actions.”

Will said Campbell knew that killing his grandmother was wrong and went to a criminal defense lawyer after the crime.

“He was using that CIA story as another way to cover up his crime,” Will said.

Assistant Public Defender Matt Phillips said Campbell did not know the consequences of his actions and or did not know right from wrong at the time of the murder.

“You’ve already heard there is no dispute. Patrick Campbell suffers from a major mental illness,” Phillips said. “The state attorney’s office agrees Patrick Campbell was suffering from a major mental illness.”

Campbell sat stoically in a white shirt and dark coat at the defense table. Most of the time Campbell sat straight and looked ahead, showing no emotion. But he reacted as a family member described finding Campbell’s grandmother’s body.

Controversial psychologist testifies: 'Psychotic symptoms don't work like that'

John Jonchuck was lying about his symptoms according to one of the prosecution’s expert witnesses.

Dr. Emily Lazrou is now the prosecution's second expert witness to take the stand.

Whether she would testify was in question before the trial. Defense attorneys said Lazarou was biased and coercive when she questioned of Jonchuck. They wanted her off the case, but a judge disagreed and ruled a jury will decide the credibility of her testimony.

That testimony was different than a lot of what has been said on the stand, so far. Her diagnosis stands in stark contrast to the other expert witnesses.

She believes Jonchuck is faking some of his symptoms and that they don’t match what she knows as a psychiatrist.

Unlike other experts, Dr. Lazarou didn’t diagnose Jonchuck with schizophrenia or schizoaffective disorder, not even bipolar disorder.

She believes he has traits consistent with psychopathy. Basically, she thinks he’s a psychopath, which is the most severe form of anti-social personality disorder, and that was the driving force behind killing Phoebe.

“You don’t go from God to archangel to the devil to a demon to the Pope,” Lazarou said, putting her flattened hand high in the air, then back down again with each description. “In a very short period of time like that - even in a long period of time – psychotic symptoms don’t work like that. It doesn’t change like that all the time. But people that think psychotic symptoms; when you fake that’s what it looks like,” Lazarou said.

Prosecution: Do you believe the defendant was malingering mental illness on the date of offense and thereafter?

Lazarou: Yes, I do.

Prosecution: Do you believe he was insane on the date of the murder?

Lazarou: No, I don't.

The word psychopath is not something the jury will hear in the case because the judge ruled, early on, the word is too prejudicial and is not a medical diagnosis.

If she could say 'psychopath,' Dr. Lazarou has said in the past she would.

Tardive Dyskinesia Market Grows

…Tardive dyskinesia is an involuntary movement disorder that typically arises from the long-term use of antipsychotic medication in schizoaffective disorders. Tardive dyskinesia is characterized by involuntary, repetitive movements of the face, trunk, or extremities, including lip smacking, grimacing, tongue protrusion, facial movements or blinking, puckering and pursing of the lips. TDs are most common in patients with schizophrenia, schizoaffective disorder, or bipolar disorder who have been treated with antipsychotic medication for long periods, but they occasionally occur in other patients as well.

The key factors driving the growth of the Tardive dyskinesia market are rising schizophrenia patients, increasing bipolar patients, growing antipsychotic prescription, increased use of long-term neuroleptic drugs and increasing incidence of neurological disorders. However, the expansion of the market is hindered by side effects of drugs and under-diagnosed…

An Equal-Opportunity Condition

Crucial to ameliorating pharmacotherapy-associated tardive dyskinesia (TD) is recognizing the impact of TD on patients’ lives. Results from the RE-KINECT study, presented at the Congress of the Neuroscience Education Institute, which took place this past fall in Orlando, Florida, demonstrated the prevalence and disruptive impact of involuntary movement in patients with suspected TD.1 Another study, presented at the same meeting, offered a consensus approach to clinical guidelines for TD.2

Of the 204 patients, 111 (54%) had schizophrenia/schizoaffective disorder and 93 (46%) had a mood or other psychiatric disorder. Although the investigators found that patients with mood disorders were more likely to be older, female, and racially white compared with patients with schizophrenia/schizoaffective disorder, TD affected both groups of psychiatric patients equally. More than 30% of patients in each group reported that involuntary movements impacted their activities of daily living, productivity, and ability to socialize.

Another subanalysis of the same study, however, found that greater risk of TD severity may be associated with lack of a good support system.3 This RE-KINECT subanalysis focused on patients who were age 55 and older because, although TD is thought to be associated with longer exposure to antipsychotic drugs, it also manifests in older persons after shorter courses of antipsychotic therapy.

Of the 300 patients in the subgroup analysis, 114 (38%) had clinician-confirmed possible TD and 186 (62%) had no visible involuntary movements or had movements that were inconsistent with TD. The researchers found that the highest frequencies of severe abnormal movements affected the head/face (25%) and upper extremities (14%). The researchers also determined that patients in the possible TD group were less likely to be married, more likely to live in care homes, and more likely to have longer lifetime exposure to antipsychotics than the comparator group. Although further research is needed, the investigated stated that limited support systems and reduced quality of life appear to be associated with greater risk and severity of TD in this older population…

NSB grandmother killing: Jurors deadlock, mistrial declared in insanity case

DAYTONA BEACH — The murder trial of Patrick Campbell, who testified of having a “sanction” from the government to kill his grandmother, was declared a mistrial on Tuesday after jurors announced they were deadlocked.

Jurors told the judge about 2:40 p.m. that they were deadlocked with seven panelists voting that Campbell was guilty and five finding him not guilty by reason of insanity. The jury of eight women and four men began deliberations at 9:48 a.m.

Circuit Judge Matt Foxman ordered them to go back in the jury room and each one express their viewpoint on the case. If they still could not come to a unanimous verdict then Foxman said he would declare a mistrial.

At about 3:26 p.m. there was another knock on the door from jurors who said they were still deadlocked. Foxman sent them home. Jurors declined comment to The News-Journal as they filed out of the courtroom.

Campbell, who was represented by Assistant Public Defender Matt Phillips, did not appear to show any reaction or emotion as the deadlock was announced. Campbell will remain locked up in the Volusia County Branch Jail while awaiting a new trial.

Woman accused of killing mother found not guilty by insanity

PAULSBORO, N.J. (AP) — A New Jersey woman accused of stabbing her mother to death in 2017 has been found not guilty by reason of insanity.

El Jahan Gardner was charged with murder in the killing of 55-year-old Alesia Burns at the older woman's Paulsboro home. The verdict was recently handed down by a judge after a bench trial that was held late last month

A psychologist testified that Gardner wasn't taking her medication and was having a psychotic episode at the time of the killing.

He testified that Gardner had schizoaffective disorder and cannabis abuse disorder, adding that Gardner told him voices had instructed her to kill her mother.

The 31-year-old Gardner has remained psychotic despite two years of treatment while in custody. She is being treated at a state psychiatric hospital.

Closing arguments made in Davis murder case

FREEPORT — The fate of a 35-year-old Freeport man accused of killing his parents in February 2017 will be announced in court on May 29.

While the defense for Mitchell Davis does not dispute that he committed the crimes, he was in a Stephenson County courtroom Tuesday for a bench trial to determine whether he was insane at the time.

The case has been delayed multiple times because of Davis’ mental and physical fitness. He has a history of mental illness. His parents, Patrick Davis, 66, and Carlotta Davis, 59, were found stabbed to death in the early hours of Feb. 15, 2017.

Mitchell Davis faces two counts of first-degree murder in the case. If Judge Michael Bald determines that his mental illness at the time of the crimes did not rise to the level of insanity, then Davis faces life in a mental health ward in the Department of Corrections. If Bald finds that Davis committed the acts but was insane, he would spend the rest of his life in a secured facility in the Department of Human Services.

Closing arguments were made Tuesday by State’s Attorney Carl Larson and Assistant Public Defender Travis Lutz.

Larson argued that Davis was in control of his faculties to the extent that he could clean himself up after the stabbings, change clothes and call an acquaintance to arrange for a place to stay.

Larson also noted that Davis had previously threatened his parents when they mentioned putting him in a mental hospital, just as they had before they were killed.

“There’s significant evidence that the motivation was not delusion,” Larson said, “but rather his desire to avoid being hospitalized again.”

Lutz pointed to the testimony of forensic psychologist Dr. Edward Mahoney, the expert witness in the case. Mahoney said Davis has schizoaffective disorder, and that he did not understand at the time of the crime that what he was doing was illegal.

“There is one expert,” Lutz said. “And that expert has said that this individual, Mitchell Davis, has in his clinical opinion as a result of suffering from schizoaffective disorder, lacked the substantial capacity to realize his actions at the time of events and meets the Illinois state statute for insanity.”

Bald will read his ruling in court on May 29.

Trial for Tennessee church shooting suspect to start Monday

NASHVILLE, TENN. — Prosecutors are seeking life without parole for a man accused of fatally shooting a woman and wounding seven people at a Nashville church.

Local news outlets report that 27-year-old Emanuel Kidega Samson's trial will start Monday. A jury is being selected this week.

Samson faces a 43-count indictment, including a first-degree murder charge, in the September 2017 shooting at Burnette Chapel Church of Christ.

An arrest affidavit says Samson waived his rights and told police he arrived armed and fired at the church.

A psychiatrist has diagnosed Samson with "schizoaffective disorder bipolar type" and post-traumatic stress disorder after an abusive, violent upbringing.

Samson is black and the victims are white. Authorities haven't definitively said whether they believe he targeted them based on race.

Al Levin Interviews Charles Minguez | Mental Health Advocate & Aspiring Journalist

In this episode, Al interviews Charles Minguez, mental health advocate and aspiring journalist (recorded 5-16-18). Charles had his first suicide attempt at age thirteen. Before he reached his eighteenth birthday, he had been hospitalized three times. At age seventeen, Charles was diagnosed with schizoaffective disorder and major depression. Hear how Charles was originally misdiagnosed and medicated for bipolar disorder.

Mold rapper defying mental illness with first studio album

A BUDDING rapper and mental health patient is showing that disabilities do not have to be constraints in the pursuit of dreams.

Trevor Yau, who lives in Mold, lives with paranoid schizoaffective disorder.

But that has not prevented him from pursuing his passion of making music, so much that he released his debut studio album in 2016.

Trevor, who has built a strong following to his YouTube and Facebook videos, linked up with Temple Records music store in Hereford for the launch of his 'Locked in Rehab’ album, named in reference to the mental illness rehabilitation units he has stayed in…

With The Collected Schizophrenias, Esmé Weijun Wang offers a haunting personal look at mental illness 

It took eight years after she first began having hallucinations for Esmé Weijun Wang to receive her diagnosis of schizoaffective disorder. Her diagnosis, while laden with its own orbit of stigma and baggage, is a source of comfort. "I like to know that I'm not pioneering an inexplicable condition," she writes in the first essay of her new book, The Collected Schizophrenias.

Halton police locate missing 75-year-old man

Schizophrenic, Bipolar Lancaster Man Missing

Woman killed by a policeman after saying she was pregnant suffered from schizophrenia, attorney says

Patients with both schizophrenia and epilepsy die alarmingly early

The Difficulty of Loving Someone with Mental Illness

It can cause psychotic symptoms and psychosis, which can lead to hospitilastion, and is usually treated with medication. Bipolar disorder, like schizophrenia, and schizoaffective disorder, can be a very difficult condition to live with, both for the sufferer and for loved ones around them

The life and tragic death of Janice Dotson-Stephens

By the time Janice Dotson-Stephens died in the Bexar County Jail, after days had turned into weeks, and weeks into months, and meal after meal had been refused, she had lost 136 pounds.

She had been jailed in July for criminal trespass, a misdemeanor. Because of her obvious mental health issues, she was placed in the jail’s infirmary, where doctors, nurses and social workers noted her erratic and abusive behavior and her refusal to eat. She also refused treatment, even though medical staff knew of her diagnoses for schizophrenia and schizoaffective disorder, as well as hypertension.

She weighed 290 pounds at intake in July and 154 pounds at death in December. She lost almost a pound a day while waiting in jail. Staff noted meal refusals more than 100 times, medical records show.

“The stomach is empty,” her autopsy report noted, concluding she died from an enlarged heart, but “contributing to death is schizoaffective disorder.”

Dotson-Stephens’ death sparked national attention — but not because of the poor handling of her mental health. The outrage mostly centered around her low bond. For example, the bond was featured prominently in the first sentence of a CNN story: “A woman held on a $300 bond for five months died Friday in a Texas jail, and the 61-year-old’s family was unaware she had been arrested until it was time for them to collect the body.”

And it made for a provocative headline in The Root, an online magazine with a black focus: “Black Grandmother Who Could Have Been Freed for $30 Died After Spending the Last 150 Days of Her Life in Jail.”

As unjust and egregious as her incarceration and bond were, this was never a story about the inequities of cash bail. It was always a story about mental health, and our failure to treat and understand it even when it’s right before our eyes. Even in the aftermath of her death, we failed to truly see it.

Who knows? Maybe the news will be better next week.

In Fairness to Mark Fisher

If you’re the kind of oddball who fastidiously follows for-example links, you noticed that in my last entry, I used the late English essayist Mark Fisher as an example of a Marxist critic of mental-illness-as-medical-pathology who, I implied, was committed to the position that psychology, like almost everything, is a kind of superstructure: if bipolar disorder seems prevalent, then what we ought to be asking is whether or not that reflects the bipolarity of the market. As soon as I published that piece, I started to reproach myself for being unfair to Mark. His point, both in his extensive writing on mental illness, and even in the short excerpts quoted in the Jacobin review I linked, as far more complex than I made them out to be. I don’t think this was some immense smear—I wasn’t misrepresenting Fisher’s views so much as I was using one element of his take as an example of a larger tendency—but I want to give Mark his due, both because his actual point is worth considering at greater length, and because like almost every left wing writer to come of age in the last decade or so, I owe an enormous debt to Fisher, who really was and is irreplaceable, and whose work — particularly Capitalist Realism and Ghosts of My Life—changed my thinking and my life in ways very few other books have. You’ve heard this before. Mark Fisher has his detractors, but I’ve never encountered anybody who has read his work and wasn’t moved by it one way or the other.

So what was he actually saying about the relationship between capitalism and mental illness? A block quote from the Jacobin review I linked is a good start.

It would be facile to argue that every single case of depression can be attributed to economic and political causes; but it is equally facile to maintain — as the dominant approaches to depression do — that the roots of all depression must always lie either in individual brain chemistry or in early childhood experiences.

Meagan Day, the author of the review (and an excellent essayist in her own right), summarizes further:

One theme that runs through Fisher’s writing is the individualization and depoliticization of mental health. In an essay titled “October 6, 1979: Capitalism and Bipolar Disorder,” Fisher argues that the disintegration of security and solidarity under neoliberal capitalism has left people “psychologically trashed,” feeling abandoned and disoriented. Fisher, who himself struggled with depression, didn’t deny that mental illness has observable neurological manifestations. But he was aghast at the observable injunction against discussing the political and social conditions that permitted those neurological disorders to spiral out of control and destroy people’s lives.

“The current ruling ontology rules out any possibility of a socialcausation of mental illness,” he wrote. “The chemico-biologisation of mental illness is of course strictly commensurate with its de-politicisation.” If every individual’s mental illness is solely the result of anomalous brain chemistry, not induced or augmented by factors such as financial precarity or social isolation or neoliberal perfectionism, then we need not inquire whether our society itself is disordered.

Mark’s argument is—of course—correct. While some portion of mental illness can be attributed to genetic and biological factors (and this, I imagine, is particularly true in the case of more severe forms of mental illness), a good deal of it can also be explained by social and economic factors. Mainstream psychiatry even accounts for this fact: it’s one thing to be persistently depressed as a result of a chronic neurochemical abnormality; it’s another to be depressed as a result of one’s circumstances. A depressive episode in a bipolar patient and the deep depression of a person who has just lost a loved one may very well feel the same, it’s only that they don’t have the same cause. If Fisher is taking this argument further, he’s only taking it further by expanding (I think correctly) the range of circumstances which produce mental illness. You may be depressed because of a brain disorder. You may be depressed because your husband died. But you may also be depressed because the entire apparatus of western society has created the conditions for depression. A psychiatrist might not be eager to admit that final possibility, and part of that is (as Fisher says) because a good deal of mental-illness-as-individual-pathology has been weaponized to discourage us from conceiving of our unhappiness as a political problem, but part of it is also that it’s difficult to tell the difference between the two. A temporary depression with an obvious cause is easy to see. A lifelong depression brought on by economic factors and a lifelong depression brought on by a dopamine disorder are more difficult to distinguish. Both of them appear persistent, and immune to the influence of circumstances, except if you admit of everything about this life as a circumstance. Which of course it is.

The fact that identical illnesses can emerge from both idiosyncratic and environmental causes (or, obviously, a combination of the two, where the former is the risk factor, and the latter is the trigger) is clear enough when you think of physical illness. You might have a heart attack because you have a genetic heart disease. You may have a heart attack because you failed to maintain good health. You might have a heart attack because a nearby corporation has polluted your drinking water with a substance which does immense cardiac damage. You might have a heart attack because the material order you’re heir to isn’t designed to look out for your health; it’s designed to extract as much useful labor from you as possible while only paying you enough to afford shitty, addictive food, advertised to you at every opportunity. You may have a heart attack due to any combination of these factors. If the compatibility of these possibilities is more difficult to see in regard to mental illness, it’s only because we don’t understand mental illness very well. Our diagnostic and treatment protocols for depression are the equivalent of a medical universe where “coughing” was the disorder, subclassified by severity and perhaps a few proximal causes (did you just inhale a big cloud of ash?), but otherwise treated as a single unified problem. You’d have temporary coughing, major coughing disorder, maybe a relapsing and remitting cough, but we’d treat all of it with a cough drop prescription and breathing exercise. Don’t pay any mind to those smokestacks on the factory down the road.

All of this is to say that I don’t disagree with Mark at all. If there is any difference between us here, it’s only in who we imagine when we imagine our audience. This is an under-appreciated source of superficial disagreement among critics: what part of a complex issue you’re liable to emphasize depends a great deal on what you perceive as the already-accepted position you might want to complicate. Mark sees biological psychiatrist as the consensus; he wants to remind us that our environment is disordered too. I, perhaps to narrowly, see a generation of strivers eager to elevate what they already recognize as socially-induced depressions and anxieties to the level of an identity marker (the better for branding), and want to remind them that there are those of us whose illnesses are a difficult and complicated medical problem. But the underlying argument is the same: some people are more prone to psychiatric dysfunction than others, and late capitalism is not helping. It’s making the sick sicker, and infecting many of the otherwise healthy too.

Half of the Patients Diagnosed with Schizophrenia by a Baltimore Clinic Only Have Anxiety Disorders

That isn’t a joke; nor, as far as I can tell, is it because this particular clinic was particularly sloppy in a scandalous everybody-at-this-one-hospital-goes-home-with-the-wrong-leg-cut-off kind of way. As reported:

Mental health researchers discovered that at least half of people diagnosed with schizophrenia at a Baltimore clinic had been misdiagnosed and were suffering only from anxiety. A misdiagnosis can have far reaching implications for a person who could simply undergo the correct treatment for anxiety.

What this new study conducted by experts from the John Hopkins University suggests is that overdiagnosis of a serious mental illness may be a national problem that could be causing inappropriate and delayed treatment.

Central to the study was the method used by general health practitioners to make their diagnoses. According to the Schizophrenia and Related Disorders Alliance of America, there are five common symptoms that need to be present before a person can be diagnosed with schizophrenia. This includes delusions, hallucinations, disorganized speech, disorganized or "catatonic" behavior, and negative symptoms.

However, while many general practitioners were making their diagnoses according to this list, they were not necessarily seeking a second opinion from a psychiatry specialist or clinic. At issue is that, although auditory hallucinations are considered to be one of the symptoms of schizophrenia, symptoms of anxiety and hearing voices were also the most common reasons for misdiagnosis.

This is the mental health equivalent of going to the doctor for a bellyache, being diagnosed with cancer of the stomach lining, and only discovering halfway into your chemo regimen—and only due to the intervention of an independent research body—that you actually have acid reflux. I find the explanation baffling. Yes, general practitioners were making diagnoses without consulting an expert. Yes, certain “extreme symptoms”—mainly auditory hallucinations—aren’t always indicative of a severe psychiatric disorder. But half? How is that possible?

I’m not terribly interested in investigating the particular mechanisms which led to these mistakes. The study itself does a thorough job of that. But the fact that this could happen should be cause to reflect on larger issues in mental health diagnosis and treatment: how even the DSM makes its taxonomies around largely arbitrary symptom clusters, how this kind of sloppiness contributes more to general distrust of psychiatry than any political “stigma”, and how mental illness, even severe mental illness, is not so much a complete departure from ordinary human life as it is the metastatic growth of certain small glitches in ordinary human cognition into immense, life-dominating terrors.

I think of how my own diagnosis keeps shifting between “bipolar disorder type one with psychotic features” and “schizoaffective disorder of the bipolar type” because even the new, medical, and rational schools of psychiatry are clinging on to a century-old axiom that schizophrenia and bipolar disorder are distinct disorders, despite ample evidence that a family member with either is a genetic risk factor for both. I have intense mood episodes, classically bipolar in their presentation and duration, so schizophrenia is ruled out. But I also have psychotic symptoms—persistent delusions and hallucinatory episodes and catatonic lapses — which complicate matters. The difference between “with psychotic features” and “schizoaffective/bipolar type” is, according to the DSM, whether or not I have had psychotic symptoms for at least 14 days of my life in absence of a mood episode. Given that I am rarely certain whether or not I am having a mood episode, and given that a hallmark of psychosis is not knowing that you’re psychotic, and given that the “purest” sample would be from before I was on medication, and therefore from when I was even worse at knowing what kinds of symptoms I was suffering, it is essentially impossible for me to say whether I’ve met that 14 day mark. I think so, but who knows? I might’ve been more manic, or more depressed than I realized. Who cares? Do you, and does anyone really believe that 13 days of a symptom indicates one disorder, while 15 days of the same symptom indicates something else entirely? The punchline is that the medication regimen for “both” disorders, and for almost all cases of bipolar disorder, and for quite a lot of schizophrenics, is the same.

I think of how eager so many people are to believe that psychiatry—and particularly the “pathologizing” of certain abnormal mental and behavioral traits— is horeshit. You have your cranks and scientologists and Freudians, your memelords posting “this is poison” under a picture of a bottle of pills, then “this is medicine” under a picture of a forest, your contrarians yelling “show me a biological test for schizophrenia!”. All of them are delighting in this study. But so, perhaps, are your more serious critics: your rigorous materialists, asking if this isn’t all just ideology (bipolarity feels a bit like the market, after all) and your woke authors wondering if all mental illness is just an adaptation to “trauma”; surely this study lends credence to their skepticism. Throughout the second half of the 20th century, psychiatrists in the United States weaponized diagnoses — conspiracy-minded and justly paranoid Black Panthers were schizophrenics; dissatisfied housewives, oscillating between misery and acting out, were all bipolar — and it helps nobody when the damage done to psychiatry’s credibility by malicious actors is just replaced by damage done out of catastrophic incompetence.

I think of how I’ve come to answer questions about more serious symptoms. What does paranoia feel like? Well, have you ever been afraid? What is a delusion? Well, have you ever believed something that wasn’t true? Imagine that, but you can’t shake it. What is it like when Voices Tell You To Do Something? Has your boss ever told you to do something? Your mom? Sure, of course. It’s like that. I think the reason that a doctor could misdiagnose the emotional imbalance and fleeting hallucinatory quality of serious anxiety with schizophrenia is that all of us suffer emotional imbalance sometimes. Everyone has delusional thoughts. Everybody picks up white noise and over-interprets it; sees patterns where they shouldn’t be; thinks they “hear” something that isn’t there. These experiences aren’t a wholesale break with ordinary life. It’s only that when you’re very ill, you have no defense. The two second fantasy becomes a two year fantasy. The “is someone talking?” becomes “yes, someone is, and I can hear them.” The slip into an irrational mood isn’t shaken off with a cup of coffee and a run; it lasts and lasts and lasts and lasts. As disturbing as it is to think of the mentally ill as somehow alien, it may be more disturbing to see in them only our own faulty, overfiring brains, but in extremis.

Finally, I think of how excited I was to read this story. Among the mentally ill, I can’t imagine that I was alone in that reaction. It is very difficult to accept that you’re sick. More difficult, once you’ve accepted it, to accept that this will persist forever—the diagnosis is a start, not a solution. You spend so much time wondering what doctors are thinking while they examine you and build so much resentment toward friends who wonder if you’re “feeling alright”, you know, mental-illness-wise, whenever you’re frustrated or angry or sad. It is one of my secret fantasies, and I expect among the secret fantasies of many people like me, to be told one day that it was all a mistake. Yes, yes, it was very bad when that first doctor saw you, but it’s just an anxiety disorder. Don’t worry. You’re fine. If half of the people diagnosed by this clinic weren’t as sick as they were led to believe, what are the odds for the rest of us? Surely not half, but better than we thought! It’s like finding out that half the children one street over really were princes and princesses; that just last week, their real parents really did show up and take them away to live in their rightful castles. I don’t think this will happen to me, or to many of us, of course. But I’m terribly happy for the people this study saved. I’m so glad they get to live out my secret wish.