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Psychiatric Advice Please

  
 
Lilly Nowhere Late
05:36 / 21.03.05
A woman I've known for over 20 years but have only had email contact with during the past 8 years has just told me that she's been officially diagnosed as a paranoid schizophrenic. What does that mean? I feel very strange about the whole thing. Who is the doctor here and is the doctor willing to advise me? I know I can look it all up, but I'd like some generous discourse if possilbe.
 
 
Ganesh
18:02 / 21.03.05
To be frank, you'd be better putting 'paranoid schizophrenia' in a search engine and gaining a broad overview based on several online sources. Any one individual, medical or otherwise, is inevitably going to provide a single 'take' on a relatively complex phenomenon - and, ultimately, I don't think that's going to help you "work out" the diagnosis your friend's been given.

I'd be happy to help with more specific questions, but I really would suggest you do some general reading first.
 
 
Lilly Nowhere Late
18:33 / 21.03.05
Cheers Ganesh, I have actually done just that. I feel I have most of the definitions down now and a lot of the academic questions answered relatively well. I am still confused by my own reaction to this news and am not finding any search engines capable of dealing with the parade of questions contorting my sense of misunderstanding. My friend and I are having a good amount of communication to and fro via email which is helpful. She feels she's getting good care although is not keen on the meds. She is taking them I think.
Anyway, thanks for the advice. Isn't it lucky we have you around; I've missed your CV but seems often like you know your stuff. Does every board have it's own resident, um,,, advisor?
 
 
w1rebaby
22:07 / 21.03.05
Ganesh is actually, you know, a real doctor. Like Dr Fox. Only real.

I confess to knowing the first rank symptoms of schizophrenia but only because I had a girlfriend who was a medical student and got me to test her on these things.
 
 
ibis the being
23:13 / 21.03.05
I had a good friend for... uhhh (mental math...) about thirteen years - our friendship existing mostly in letters because he lived out of state, but we wrote each other often beginning at the tender age of (I think) 12 and continuing on and off until our mid-20's. In his teens his life got pretty rough, beginning with his parents getting divorced and spiraling into heavy drug use.

I saw him again when we were 19, for a couple of weeks. He had changed - had a really fierce bitter side that didn't use to be there, and he seemed to alternate between idealizing and demonizing me... he really tried to press into me how effed up his life had gotten, but my attempts at empathy were rebuffed. I felt like I didn't like him anymore. And then a little ugly romantic triangle developed wherein he got rudely jilted....

Anyway (I'm trying to make this relatively brief), everything went downhill from there in our correspondence. At first we resolved the yucky love snafu. But his personal life was ever more chaotic. His letters to me also got haphazard - I had a hard time piecing together precisely what was happening to him because of gaps in time, half-references to events I didn't recall, at times seemingly conflicting reports. There was something about jail time, being framed, various drug addictions and recoveries, house arrest, halfway houses, some doctor diagnosing him as bipolar and paranoid schizophrenic and another theorizing that he'd just "done too many drugs"... v. confusing.

Over and over I tried to reach out, asking him to help me understand what he was going through, or admitting that I couldn't but would still be his friend. Then he started telling me he was in love with me, and I had to be truthful about my lack of similar feelings. He wrote me a threatening letter warning me that if I ever published any of his letters he would sue me. A couple years of silence passed. Eventually he wrote me a letter so completely wacked out... that he was a graphic designer but also a millionaire off his "stocks" and had no friends bc everyone only wanted his money, and I would never get to be with him and his $1,000,000,000,000,000 but he always loved me and so on and so forth. I thought about it for weeks, trying to decide whether to reply at all, and finally I decided I couldn't, I just had nothing left to say to this person. I didn't even know, at that point, whether he was truly shizophrenic or if perhaps it was all some elaborate revenge campaign against me for rejecting him romantically again and again.

It was really confusing to converse with someone whose reality was apparently constantly shifting - I never had any ground to stand on. Toward the end each letter was like square one, totally disconnected from anything else he'd written, and unrelated to anything I'd written him. I still feel kind of guilty for just cutting him off like that but I didn't know how to handle him.
 
 
Lilly Nowhere Late
05:02 / 22.03.05
Thanks guys, Ibis especially for sharing. How strange that must have been(is).
I thought Ganesh was a real doctor but like I said, I've missed the cv part of the Barbelith programme.
My friend is someone I've known for 22 years. At the early point of our relationship, she was my lover and that carried on for 3-4 years through some truly amazing and bizarre circumstances. Post our relationship, we still knew one another for ages and even lived together again off and on for some amount of time although I was during all that space involved with a wholly different person. Eventually I moved to LA and then to London so for a long time we've not seen each other in person. Anyway, the gist of this story being that I feel so close, related like to this woman and also feel some responsibility to/for her. I think she's been through complete hell with this disease but is only now starting to be treated properly.
Whatever, this is a bit too much public effusion for me, and really, I think I'll need to go find my own therapist to sort out the issues it raises. But thanks again for the comments.
 
 
Ganesh
14:32 / 22.03.05
Personally, as a UK-based clinician, I'm somewhat sceptical of diagnoses made in the good ol' U S of A. US psychiatrists seem, on the whole, far quicker to diagnose and medicate than those elsewhere. If it were me or my friend, I'd be keen to know which specific diagnostic criteria were met in order to justify the label of 'paranoid schizophrenia'...
 
 
gale
16:28 / 22.03.05
I've known this guy for about 15 years who was diagnosed with schizophrenia (in the US) about 20 years ago. He doesn't work (although he probaly could) and so is supported by the government, in an apartment paid for by the state, etc.

I don't know why, but his doctors mess around with his meds a lot. Sometimes he starts having symptoms, eg, believing people he knew from 20 years ago are looking for him. However, he always knows when he's having problems and calls the police and tells them to take him to a nearby hospital that has a psychiatric dept, which they do.

He is also convinced that he is an alcoholic, so he attends lots of AA meetings. He has a tough life, and a lot of time on his hands, but is trying to make the best of it. I would say the worst part is the drugs, but he can't stop taking them.
 
 
Lilly Nowhere Late
16:43 / 22.03.05
My friend has a family history of depression and unspecified mental issues including severe substance addictions. I know she's been through quite a lot in her life including a 5year or so cocaine habit which she finally cleared and alcohol issues. I think from her description of what has occurred over the last few years, it seems the diagnosis might be correct, but who knows? Originally she was diagnosed with bipolar disorder but this is the most recent doctor's diagnosis with a firm belief that the manic depression bi-polar thing was just wrong. I understand your skepticism Ganesh, about the USA fast pay diagnosis system. You can't imagine what I've seen, including a suicide due to a person refusing to take any more of the 120mg of Prozac + 80mg of Buspar per day and so going off the rails while his doctor was on vacation. But can they all be wrong?
 
 
grant
18:53 / 22.03.05
Put "dual diagnosis" in Google, and you should come up with lots of information.

It's a newish paradigm, viewing mental illness (generally schizophrenia or similar) with substance abuse issues (usually alcoholism) as its own diagnosis, with its own treatment models and that.

Better half's getting an MSW, so I get to learn all this stuff.
 
  
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