Sage Words about Violence and Mental Illness
One of the blogs that I highlight down of the left-hand side of this one is attached to schizophrenia.com.
They have a particularly good entry for April 20th, that discusses not just the tragedy in Virginia and its possible relationship to mental illness, but also some broader social questions. Having been born and raised in the UK, and then worked there and in the United States in both medicine and psychiatry I can really relate to many of the points made in the article. It really should be disseminated as widely as possible, so I am going to do something that I usually do not, and quote the article in full:
The Loss of Life in Virginia, and How it Could Have Been Prevented
Read more… Schizophrenia, Poverty & CrimeWhenever a tragedy happens such as the recent shootings in Virginia,
the question inevitably turns to why did it happen, and how could it
have been prevented.While some reports (such as here, here and here)
have suggested the shooter in this tragedy – Cho Seung Hui – might have
suffered from psychotic depression, schizophrenia or bipolar disorder –
its impossible to know with the limited amount of evidence available,
and even after all the evidence is reviewed it will never be known for
sure.From what has been reported it does, however, seem obvious that he
was seriously depressed and socially withdrawn, and had some
significant delusions of persecution and paranoia. Whether these
symptoms add up to a serious mental illness or some type of sociopathic
disorder is unknown. Some factors don’t seem to point towards
schizophrenia – as Cho Seung Hui did not seem to suffer from the lack
of motivation (called avolition) that is so common with schizophrenia.
He was able to attend college and, from the sounds of things, was
attending classes regularly and finishing his assignments. Typically
when a person develops schizophrenia schoolwork and personal hygiene
the first thing that suffers, and an inability to complete schoolwork
is common.With regard to the question of why did it happen – it is of course
impossible to know for sure. But at the same time research into mental
illness and brain disorders does point to some possible answers.The path towards mental illness (any mental illness) is a complex
one with many different factors – from genetic predisposition and
pregnancy factors, to early life stresses and environmental factors, to
social stresses. We have more information on this in our “Preventing Schizophrenia”
– but fundamentally the factors that nudge people towards mental
illness are many and varied. The factors that have been conveyed about
the life of Cho Seung Hui suggest that early life experiences could
have been factors. Here are some of the relevant points that have been
discussed in the news:1. A Difficult Early Life – news on the family has suggested that
they had a difficult (low-income) family life in Korea which prompted
the move to the US when the parents had a young family. A low income
life that motivates a young family to leave a country – is likely to be
a high stress environment – a factor that could contribute to mental illness.2. Social stresses of immigration to the US (many studies out of the
UK have indicated that immigrants frequently face extremely difficult
social challenges in new countries due to a lack of understanding of
social norms (as well as racism) – which causes a great deal of social stress and significantly higher rates of mental illness.3. Cho Seung Hui’s Father worked in a Dry Cleaning company – and the family may have been exposed to higher levels of dry cleaning chemicals – which are linked to neurological damage.
Additionally, on a related topic, Dr. Michael Merzenich, the Neuroscientist at UCSF – comments in his blog
on the important issues related to the general social environment that
is also a factor in the extremely high levels of gun violence and
deaths in America – typically 300% to 600% higher than in other
developed countries:“Our jurisprudence is based on
the principle of “blame” for behaviors that should by hypothetically
controlled by our “free will”. Alas, human observers and psychologists
(and with increasing clarity, we brain scientists) have understood from
the beginning of time that your or my “will” is not entirely “free”.
The boundaries of “good judgment” are defined by a combination of the
inherited factors governing our brain function, by our physical brain
status (2 million head injuries/annum in the US alone!), and the
brain’s own plasticity-embedded experiences. For most of us, our
genetics combined with fortuitously not busting our skull in the wrong
place and with our particular plastic, experientially-driven brain
‘history’ adequately protects us from serious transgression. At the
same time, in our (and other) contemporary society(ies), we tolerate
conditions that result in millions of young men and women being reared
with an experiential history that is NOT adequate to keep THEM safe
from offending. THIS IS THE PART OF THE EQUATION THAT IS UNDER OUR
(SOCIETY’S) CONTROL. We’re doing a bad job with it. In fact:
1) We live in a violent society chock full of models of behavior (a
violence & fear-obsessed media, violent films, gangsta rap, et
alia) that are well outside any rational societal norms. The mass
murder of children on school campuses is one our MANY rather
spectacular modern American-violence inventions with little historical
precedent.2) We tolerate the hardening of young brains to
otherwise-not-tolerable bloody, shoot-em-/slash-em-up violence as an
acceptable source of intensive training “fun” in the heavily-rewarded
game-play of millions of our children. All that intensive training is
somehow supposed to be just fine for the child and their brain?! Those
tens or hundreds of thousands of violent repetitions in rewarded
behaviors just don’t matter a whit? Stuff and utter nonsense.3) We continue, collectively, to find innumerable ways to shame
children in their young lives as “failures”, “weaklings”, “misfits” or
“oddballs” in school and in life.4) We send juveniles and young adults off to crime school (prison) at an extraordinarily high (and growing) rate.
Sometimes I think that we could hardly be doing a better job of
training young people to misbehave. When they do, we hold them to a
universal high standard of acceptable behavior that they may actually
have had little experience with, in their own path through life, in our
very own society.”Lastly – there is the issue of easy access to guns in the US – which
when combined with all the above factors makes for an extremely toxic
mixture. Easy access to guns results in high death rates in shootings;
death rates that are typically 500% to 1,000% higher in the US than in
other civilized countries, as can be seen in the diagram below.National Comparisons for Selected Countries Homicide Rates Per 100,000 Population
Source: Corrections Service CanadaAs New Scientist Magazine notes
“Scientific studies have demonstrated over and over that owning a gun
makes it significantly more likely that you will be shot. The US has
the highest rate of firearms-related homicide in the industrialized
world – Americans are literally sacrificing hundreds of innocent
citizens each year upon the altar of the Second Amendment.”Are any of these factors preventable? Yes – of course they are – but
the actions are costly and complex. To prevent these types of tragedies
takes:1. Better education of the public about how to achieve mental health for their children,
2. Early and easy treatment for mental disorders with early testing and screening in schools,
3. Good insurance coverage
so that people can actually get their mental health problems addressed.
The US is the only developed country in the world that severely limits
coverage of mental health problems. Better and easier access to high
quality mental health treatments is a great need in the US.
4. Laws that make it possible for mentally ill people to get treatment, even though they may not understand the need.
5. A reduction in the culture of violence in the US (a movement to reduce violence in movies, on TV, and in video games). Read: In denial about on-screen violence for more information.
6. Strict gun controls
that take the millions of hand guns off US streets, and that will make
it more difficult for the people who become mentally ill or who have
psychiatric disorders – to obtain guns. Approximately 29,000 US
citizens are killed by their fellow citizens each year, by hand guns.
(see Statistics, Gun Control Issues, and Safety for more information)The answers are relatively clear – but whether we actually do anything about it is up to you.
Related Reading:
Mental Health, the Law and Predicting Violence (NPR)
America’s tragedy – Its politicians are still running away from a debate about guns (The Economist)
Mayors urge Bush to tighten gun control laws
Stricter gun control after shootings at U.S. university – not going anywhere fast
Relationship of US gun culture to violence ill-understood
Violence may be a ‘socially infectious disease’
Schizophrenia, Psychosis and Psychopathy
Ever since the tragedy in Virginia earlier this week, everyone has been trying to second guess what happened. As I said, to the trained eye there is a lot to suggest that he had a psychotic condition, but whether it was schizophrenia, bipolar disorder or psychotic depression is guess work.
One of the things that has been worrying in all the media coverage has not only been the sensationalism that we have seen in some quarters, but the mistakes that reporters – and even some of the "experts" – have made in talking about mental illness. I have heard people constantly mixing up schizophrenia and psychopathy, which is more accurately called antisocial personality disorder. I have even heard an old mistake that I had thought died years ago: that schizophrenia is a "split personality." I think that mistake probably goes back to a misunderstanding of the roots of the term "schizophrenia," and it was perpetuated by Alfred Hitchcock’s movie Psycho in 1960.
Let me just repeat: schizophrenia is NOT a split personality. Neither is it multiple personality disorder. There is even a lot of discussion whether multiple personality disorder, now known as "Dissociative identity disorder" really exists: a discussion for another day.
Because there has been so much confusion, I thought that it would be good to clarify what each of these disorders is.
You can get some of the information from Wikipedia. What has worried me a bit is that some websites have slightly questionable infrmation. Many people know that I do a great deal of advocacy work for the mentally ill, so these notes are from my own lectures.
For reliable back up information, I recommend using Healia.com to search, and you can check out at Wikipedia, Schizophrenia.com, the National Institute of Mental Health website, Medline Plus and the National Alliance for the Mentally Ill.
Psychosis
Psychosis is simply a generic term for a mental illness in which people have a "loss of contact with reality." There are often other symptoms, such as hallucinations, delusional beliefs, disorganized thinking and a lack of insight into the unusual or bizarre nature of his or her behavior. Almost anything that stresses the nervous system enough may lead to psychosis. I have often told students that it is possible to induce psychosis in just about anyone. It is a symptom and not a disease. We sometimes call it the "fever of the nervous system."
Schizophrenia
This is a group of illnesses that describe a mental disorder characterized by impairments in people’s perception or expression of reality
and by significant social or occupational dysfunction. The point is that other people don’t share their view of reality and it is causing suffering. There is always some smart Alec student who says, "But isn’t religion a delusion?" The answer is no, of course it isn’t. Millions of people share the same beliefs. The second piece is also important: is it causing suffering, distress or disability? Many people have ideas that are "different." That does not mean that they are mentally ill. Professionals should not get involved unless the beliefs are causing a problem.
A person
experiencing schizophrenia typically has disorganized thinking, and may experience delusions or hallucinations. In Western cultures these are most commonly auditory hallucinations. Simply having hallucinations does NOT mean that someone is mentally ill. I seem to be one of the few psychiatrists that supports the aims of the Hearing Voices Network. The Network tries to help people who are experiencing hallucinations and to educate the public and professionals that there are many possible reasons for hearing voices and many have nothing to do with mental illness.
One of the most disabling things about the schizophrenic group of illnesses is that they primarily affect cognition, and that is one of the things that can lead to chronic problems with behavior and emotion. For a long time there was a worry that the cognitive problems were a result of being on some of the older medications. But these cognitive problems were identified decades before the introduction of these medicines. Hence the old name of schizophreia: dementia praecox.
The diagnosis is based on self-report and observation. We do not have a laboratory test for these illnesses, but we are finding reproducible changes in the brain and in many genes. The main evidence for the illnesses is still based on their response to treatment.
There has been a lot of discussion about whether we should abandon the term "schizophrenias," since the current diagnostic approach is flawed: many people have psychotic experiences without becoming dsitressed or disabled. Neither can they – or should they – be diagnosed. This gets back to the categorical and dimensional argument that I have talked about before. The second point is that the label "schizophrenia" can be so stigmatizing.
Antisocial Personality Disorder
Antisocial personaity disorder is also referred to as psychopathy, sociopathy or dyssocial personality disorder. It is a condition characterized by lack of empathy or conscience, and poor impulse control or manipulative behaviors. The term originally came from the Greek psyche (meaning soul, breath or mind) and pathos (to suffer). At one time the term was used to describe all mental illness, and that is why there is confusion. It is quite different from psychosis. Psychosis is a chronic or intermittent symptom that comes on at some time in life. Antisocial personality disorder should have been present all the time, even though we cannot formally diagnose it until the age of eighteen. The term "psychopath" is not a good one: it has no precise equivalent in either the DSM-IV-TR or the ICD-10.
Only a minority of diagnosable psychopaths are violent offenders . There has been a lot of discussion about whether the manipulative skills of some of the non-violent psychopaths are valuable in corporate America, the military and academia, because they may bold and often charismatic leaders. The has even been a suggestion that becoming a "psychopath" may be an adaptation to working in a highly competitive
environment: it gets results for both the individual and for their
corporations or countries.
There is a recent book – Snakes in Suits – that does a good job of exploring these ideas.
In summary:
Psychosis = A symptom
Schizophrenia = A group of acute or chronic illnesses in which psychosis is a central feature
Antisocial Personality Disorder = a.k.a. "Psychopathy:" life long personality trait
The Tech Tragedy and the Mind
I have had a great many questions about the psychiatric aspects of the terrible tragedy at Virginia Tech.
Many friends and colleagues have swung into action to help with the oceans of grief and the inevitable post-traumatic stress disorder that will follow for many people.
The other questions have all been about the alleged gunman. Perhaps we can now stop saying "alleged."
I mentioned yesterday that the videos and "manifesto" might help us make some sense of the senseless.
What they show is incredible anger that had been building up and, until Monday, had no outlet. That kind of internalized anger can be very dangerous and is sometimes hard to pick up. Experts will often do some very careful "button pushing" to reveal what is going on inside. If a person is challenged, then the anger, disorganization and psychosis can all erupt. But it is a difficult technique unless you are a real expert.
A lot of what he says is disjointed and at times difficult to hear because he whispers and then becomes more and more angry. As expected there is some clear evidence of what we call "thought disorder" or "communication disorder."
You do not need to be a psychiatrist to see that the videos and the "manifesto" were the products of a very sick young person, and that the sickness lead to the tragedy.
Many commentators have asked questions along the lines of, "If he was so angry against the rich, why didn’t he attack the rich?" That would be a good question except for one thing: psychotic delusions are usually "Un-understandable."
This clumsy term was introduced by the German psychiatrist and philosopher Karl Jaspers, since he believed that they were not produced by any kind of coherent thinking. Though not everyone agrees with this idea, it captures something important: it can sometimes be exceedingly difficult to understand the thought processes of the person in the depths of a delusion. We still try to understand their thinking, but it can be tough: some of the normal rules of logic do not apply. And one of the keys to delusions is that people hold them even when presented with evidence that their beliefs are wrong. It is totally different from people who hold odd or eccentric beliefs, but are happy to modify them as more evidence some along.
I am about to give a lecture to a large group of young doctors, and I have been told to expect a lot of questions about what they should do if they ever come across someone like this young man.
Answer: with hindsight the diagnosis seems clear; nobody can diagnose everyone every time. But trust you instincts, get another professional to have a look at the person and above all a it safe.
Reconstructing a Troubled Mind After Virginia Tech
There’s going to be a lot of discussion and speculation about the tragic events at Virginia Tech.
Ten years ago I became very involved with the media after a tragic shooting at the Capitol building by a man suffering from mental illness, and so I know the questions and the second guessing that will go on.
I have, of course, not examined the alleged perpetrator of the events on Monday, but I have received a great many questions about what I think may have been wrong with him.
I did not want to answer until I had put together as much material as I could.
From the reports that I have received we can begin to construct a very plausible scenario.
The first thing to say is that it is very unusual for people with mental illness to commit major violent crimes.
Second is that many of the most horrendous serial killers have not had a psychiatric disorder at all. That may sound odd: how could someone do something awful and not be sick? Some people do bad thing because they are bad. Not because they are suffering from an illness.
Third, it is always easy to be wise after the event. Sometimes when people are mentally ill the illness itself stops them from communicating, especially to health care providers. Many people have admitted to me that they were hearing voices telling them to say nothing to me or to deny their existence. That is why we always watch to see if people may be attending to auditory hallucinations, or if they are preoccupied by internal stimuli.
Many years ago I knew a man who was obviously ill but would reveal nothing. Without tangible evidence of mental illness the courts told him to go on his way. The experience and gut instinct of one of the world’s top psychiatrists counted for little in the eyes of the court: they wanted evidence.
So the man left and immediately threw himself under a train. It was only later that his family found his writings and drawings about his fear that a demon was pursuing him. The poor man had been hallucinating and delusional all along. There are many ways of telling the difference between someone having evil experiences and someone with a mental illness: there are many people who specialize in such things.
I have been looking at the reports in the media that agree on certain points, and I am going to pick out the ones that really jump out at me as a professional.
- “He sat right beside the door, and as soon as class was over, he left."
- “On the first day, when the instructor asked students to write their names on a sheet of paper and hand it up, Cho wrote a question mark.”
- “Always wore a hat and sunglasses.”
- "He never looked up.”
- “He never looked anyone in the eye. If you even say hi, he’d keep walking straight past you."
- “He often spoke in a whisper, if at all.”
- "He would keep his headphones on a lot."
- "It was like he was carrying on a conversation with himself."
- “Nobody knows him really, he’s always quiet. When I talk to him, there’s no response."
- “The teacher had addressed a question to him and he really just stared off into space. He didn’t even recall acknowledging that she was talking to him.”
- “He disappeared from class.”
- “Taking secret pictures of his classmates.”
- “A loner.”
- “Angry, menacing, disturbed and so depressed that he seemed near tears.”
- “Rambling multi-page "manifesto" directed against the rich, the spoiled and the world in general.”
- On the day of the tragedy, “Cho’s face was blank and expressionless. There was always just one look on his face.”
- And in 2005 he was declared mentally ill and said to “present an imminent danger to himself as a result of mental illness."
We do not yet know what diagnosis and treatment were offered, but he does not seem to have followed up. As with the man who jumped in front of a train, people with persecutory delusions can be very good at concealing them.
If we look back over these items, it is likely that he sat by the door so that he could escape from some perceived threat; he probably had real questions about who he was; the hat and sunglasses are commonly worn for “protection” and the avoidance of eye contact is usually because people are preoccupied by things going on inside their heads, or because they fear that you can see through their eyes. Many people who are experiencing auditory hallucinations use portable music systems to drown out the voices: I have known more than one person who has had hearing damage from cranking up the volume. He probably was carrying on a conversation with the voices in his head. The avoidance and staring into space are usually signs of being preoccupied with internal experiences. The pictures would have been used to fuel his paranoia. The blank, expressionless face is a classic feature of one of the schizophrenic illnesses as is the social isolation. We would have to see the “rambling manifesto” to be sure, but the “rambling” could be a sign of what is known as “thought disorder” or “communication disorder.”
Several previous killers have been found to have different forms of brain disease. Taken together these clinical features are most likely the signs of a major psychiatric illness rather than something like a brain tumor.
The other thing of importance is that at least one person said that he seemed to be “mean,” so there may have been more than just a psychiatric or neurological illness going on.
Time will tell, and this is so far all informed guesswork. But at this point it makes some sense of this tragedy.
There will inevitably be a lot of speculation about what could or should have been done. But there is an extra factor that needs to be considered: the law is designed to allow people’s freedom. I have been in mental health courts on countless occasions and it is rare for a person to be committed for involuntary treatment unless there is really compelling evidence of a person being a danger to themselves or someone else.
Many people will feel that they should have noticed the signs of mental illness. Well hindsight is always 20/20 and I can tell you that the greatest experts have sometimes been fooled. If I, or one of my colleagues had, by some strange chance, run into this young man, would we have been able to diagnose him? As with my patient all those years ago, I would have been pretty sure, but I couldn’t prove it. And without that proof it is very hard to take any action.
Let me finish by saying again that the vast majority of people struggling with mental illness are not dangerous. The job of professionals is to find the ones who are, and to this day we have no reliable way of doing it.
New Causes for Hope in Psychotic Illnesses
Since many health care providers read this blog, I try to update everyone on promising new treatments that can be used to provide a comprehensive care plan for people.
I have talked before about some new medicines for the treatment of schizophrenic illnesses, and yet more are coming down the road.
There is a short article with quite a number of links here.
"I would like to quote something from the article that is very important for all of us:
It is very interesting that most experts are now focusing on medicines that will make it easier for us to undertake psychosocial rehabilitation, rather than simply relying on a medicine to "cure" the illness.The most important message from all this research is that the future looks promising for many of our sickest patients."
Medicines designed to help and support, not to sedate or damp down the mind’s activity, but to enable a person to take back control of themselves, their thinking and theior emotions.
So It Goes
Like most young people, I did a load of menial jobs to pay my way through school. For one of them I spent a summer working as a hospital porter: I was the guy who pushed the wheelchairs around. There I met an interesting man who first introduced me to the works of Kurt Vonnegut, and by the end of the summer I had read all his books.
I just heard that Kurt passed away yesterday at the age of 84. He had an interesting life. He was captured by German troops in December 1944 during the Battle of the Bulge and he spent the rest of the war imprisoned in a Dresden slaughterhouse. On the night of 13 February 1945, Allied bombing raids flattened the city, creating a firestorm that killed an estimated 35,000 civilians in two hours. Vonnegut and his fellow prisoners survived because they were being kept in a cold meat locker three stories below the ground. When they emerged, there was nothing was left of the city. Vonnegut referred to his experiences of Dresden in several of his novels, most notably Slaughterhouse-Five that came out in 1967.
He often discussed his own mood disorder and a suicide attempt in the mid 1980s. His son, Mark Vonnegut is now a pediatrician, but his book Eden Express is an amazing account of his own descent into a mental illness that was described as schizophrenia, but from his description was far more likely to have been bipolar disorder.
They both survived, and for years now I have had all psychiatric trainees read Eden Express.
Here are a few of my favorite quotes from Kurt Vonnegut.
- “1492. As children we were taught to memorize this year with pride and joy as the year people began living full and imaginative lives on the continent of North America. Actually, people had been living full and imaginative lives on the continent of North America for hundreds of years before that. 1492 was simply the year sea pirates began to rob, cheat, and kill them.”
- “A purpose of human life, no matter who is controlling it, is to love whoever is around to be loved.”
- “All of us were stuck to the surface of a ball incidentally. The planet was ball-shaped. Nobody knew why we didn’t fall off, even though everybody pretended to kind of understand it.”
- “All time is all time. It does not change. It does not lend itself to warnings or explanations. It simply is. Take it moment by moment, and you will find that we are all, as I’ve said before, bugs in amber.”
- “Another flaw in the human character is that everybody wants to build and nobody wants to do maintenance.”
- “Any reviewer who expresses rage and loathing for a novel is preposterous. He or she is like a person who has put on full armor and attacked a hot fudge sundae.”
- “Beware of the man who works hard to learn something, learns it, and finds himself no wiser than before… He is full of murderous resentment of people who are ignorant without having come by their ignorance the hard way.”
- “Charm was a scheme for making strangers like and trust a person immediately, no matter what the charmer had in mind.”
- “During my three years in Vietnam, I certainly heard plenty of last words by dying American foot soldiers. Not one of them, however, had illusions that he had somehow accomplished something worthwhile in the process of making the Supreme Sacrifice.”
- “He adapted to what there was to adapt to.”
- “(He) told us about one of Plato’s dialogues, in which an old man is asked how it felt not to be excited by sex anymore. The old man replies that it was like being allowed to dismount from a wild horse.”
- “Here is a lesson in creative writing. First rule: Do not use semicolons. They are transvestite hermaphrodites representing absolutely nothing. All they do is show you’ve been to college.”
- “Here’s what I think the truth is: We are all addicts of fossil fuels in a state of denial, about to face cold turkey.”
- “How nice–to feel nothing, and still get full credit for being alive.”
- “Humor is an almost physiological response to fear.”
- “I am eternally grateful.. for my knack of finding in great books, some of them very funny books, reason enough to feel honored to be alive, no matter what else might be going on.”
- “I can have oodles of charm when I want to.”
- “I say in speeches that a plausible mission of artists is to make people appreciate being alive at least a little bit. I am then asked if I know of any artists who pulled that off. I reply, ‘The Beatles did’.”
- “I think that novels that leave out technology misrepresent life as badly as Victorians misrepresented life by leaving out sex.”
- “I want to stay as close to the edge as I can without going over. Out on the edge you see all kinds of things you can’t see from the center.”
- “I’m suing a cigarette company because on the package they promised to kill me, and yet here I am.”
- “I’ve got at least one tiny corner of the universe I can make just the way I want it . . .”
- “If somebody says, ‘I love you,’ to me, I feel as though I had a pistol pointed at my head. What can anybody reply under such conditions but that
- which the pistol-holder requires? ‘I love you, too.’”
- “If you can do a half-assed job of anything, you’re a one-eyed man in a kingdom of the blind.”
- “It is harder to be unhappy when you are eating.”
- “Just because some of us can read and write and do a little math, that doesn’t mean we deserve to conquer the Universe.”
- “Laughter and tears are both responses to frustration and exhaustion. I myself prefer to laugh, since there is less cleaning up to do afterward.”
- “Life happens too fast for you ever to think about it. If you could just persuade people of this, but they insist on amassing information.”
- “. . . life, by definition, is never still.”
- “Like so many Americans, she was trying to construct a life that made sense from things she found in gift shops.”
- “Love is where you find it.”
- “Love may fail, but courtesy will prevail.”
- “Maturity is a bitter disappointment for which no remedy exists, unless laughter can be said to remedy anything.”
- “. . . most of the world’s ills can be traced to the fact that Man’s knowledge of himself has not kept pace with his knowledge of the physical world.”
- “Much of the conversation in the country consisted of lines from television shows, both present and past.”
- “New knowledge is the most valuable commodity on earth. The more truth we have to work with, the richer we become.”
- “One of the few good things about modern times: If you die horribly on television, you will not have died in vain. You will have entertained us.”
- “Say what you will about the sweet miracle of unquestioning faith, I consider a capacity for it terrifying and absolutely vile!”
- “Thanks to TV and for the convenience of TV, you can only be one of two kinds of human beings, either a liberal or a conservative.”
- “The chief weapon of sea pirates, however, was their capacity to astonish. Nobody else could believe, until it was too late, how heartless and greedy they were.”
- “The secret to success in any human endeavor is total concentration.”
- “There is a tragic flaw in our precious Constitution, and I don’t know what can be done to fix it. This is it: Only nut cases want to be president.”
- “. . . there is this feeling that I have a destiny far away from the shallow and preposterous posing that is our life . . .”
- “Those who believe in telekinetics, raise my hand.”
- “. . . uncritical love is the only real treasure.”
- “We all missed a lot. We’d all do well to start again, preferably with kindergarten.”
- “We are what we pretend to be, so we must be careful about what we pretend to be.”
- “We could have saved the Earth but we were too damned cheap.”
- “Well, the telling of jokes is an art of its own, and it always rises from some emotional threat. The best jokes are dangerous, and dangerous because they are in some way truthful.”
- “What had made me move through so many dead and pointless years was curiosity.”
Psychological Problems, Stigma and Success
I do a lot of work to try and de-stigmatize mental illness, and to emphasize that all of my experience and all the scientific evidence makes it very clear that most psychological and psychiatric problems lie on a spectrum. We define something as an “illness” only if it is causing suffering or distress.
Because of my work I know about the physical and psychological problems of a great many people in the public eye, but I will obviously not talk about people unless they decide to say something themselves.
When I am speaking to politicians or the media I often show them a list of some of the people with psychological problems who have gone public.
I just found this long list of Deborah Serani’s blog. There were a number of names of people whom I did not know had revealed that they had suffered from problems. I am pleased that Deborah offered some references. I have also added a few names from my own research.
If there are any mistakes, please let me know and I shall correct them.
I would like to make three points:
- Psychological problems and psychiatric illnesses are common and usually treatable
- Having been diagnosed with one of these problems does not preclude you from outstanding success
- This list does not include people with substance abuse problems, though these problems are usually as physical as any other
I do hope that you will find it helpful to see just how many terrific people have had their downs as well as their ups!
John Quincy Adams (US President)
Alvin Ailey (Choreographer)
Lionel Aldridge (Football Star)
Buzz Aldrin (Astronaut)
Adam Ant A.K.A. Stuart Goddard (Singer)
Ann-Margaret (Actor)
Louie Anderson (Comedian Actor)
Gillian Anderson (Actress)
Fiona Apple (Musician)
Diane Arbus (Photographer)
Isaac Asimov (Author)
Drew Barrymore (Actor/Producer)
Daniel Boorstin (Former Us Presidential Adviser)
Zach Braff (Actor)
Art Buchwald (Columnist)
Oksana Baiul (Skating Star)
Kim Basinger (Actress)
Ned Beatty (Actor)
Syd Barrett (Musician)
Ludwig Van Beethoven (Composer)
Maurice Bernard (Actor)
Irving Berlin (Composer)
Danny Bonaduce (Actor/Radio DJ)
Halle Berry (Actor)
Kjell Magne Bondevik (Prime Minister of Norway)
Steve Blass (Baseball Star)
Charles “Buddy” Bolden (Musician)
Robert Borrstin (Political Advisor)
David Bowie (Singer)
Marlon Brando (Actor)
Jeremy Brett (Actor)
Charlotte Bronte (Author)
Robert Burns (Poet)
Willie Burton (Athlete)
Barbara Bush (Former First Lady – U.S.)
Delta Burke (Actor)
Carol Burnett (Actress/Comedian)
Lord Byron (Poet)
Cher (Singer/Actress)
Dick Clark (Producer/Music Magnate)
John Candy (Comedian)
Ray Charles (Musician)
Deanna Carter (Singer)
Helen Caldicott (Activist/Writer)
Dean Cain (Actor)
Drew Carey (Actor/ Comedian)
Earl Campbell (Football Star)
Eric Clapton (Musician)
Jim Carrey (Actor/Comedian)
Melanie Chisholm (Singer)
Naomi Campbell (Model)
Rosemary Clooney(Singer)
Jose Canseco (Baseball Star)
Shawn Colvin (Musician)
Mary Jo Codey (First Lady Of New Jersey)
Judy Collins (Musician)
Dick Cavett (TV Host/Writer)
Courtney Cox (Actor)
Margaret Cho (Actor/Comedian)
Natalie Cole (Singer)
Michael Crichton (Writer)
Francis Ford Coppola (Director)
Sheryl Crow (Musician)
Winston Churchill (English Prime Minister)
Nicolas Cage (Actor)
Sandra Cisneros (Writer)
Patricia Cornwell (Writer)
John Cleese (Comedian/Actor)
Leonard Cohen (Musician)
Paula Cole (Actor)
Shayne Corson (Hockey Star)
Judy Collins (Musician)
Shawn Colvin (Musician)
Jeff Conaway (Actor)
Ty Cobb (Baseball Star)
Pat Conroy (Writer)
Billy Corgan (Musician)
Calvin Coolidge (US President)
Bill Dana (Comedian)
John Daly (Golf Star)
Rodney Dangerfield (Comedian/ Actor)
Charles Darwin (Scientist)
Jefferson Davis (President Of The Confederate States Of America)
Jonathan Davis (Musician)
Sandra Dee (Actor)
Gaetano Donizetti (Opera Singer)
Mike Douglas (TV Host)
Walt Disney (Entrepreneur)
John Denver (Musician)
Dame Edna Everage a.k.a. Barry Humphries (Comedian)
Ellen Degeneres (Comedian/Actor)
Richard Dreyfuss (Actor)
Johnny Depp (Actor)
Paolo Dicanio (Soccer Star)
Eric Douglas (Actor)
Charles Dickens (Author)
Patty Duke (Actress)
Scott Donie (Olympic Star)
Kitty Dukakis (Former First Lady Of Massachusetts)
Michael English (Singer)
Jim Eisenreich (Baseball Star)
Thomas Edison (Inventor)
Ralph Waldo Emerson (Writer)
Robert Evans (Film Producer)
Jules Feiffer (Cartoonist)
James Farmer (Civil Rights Leader)
Edie Falco (Actress)
Betty Ford (Former US First Lady)
Carrie Fisher (Actress)
James Forrestal (Undersecretary Of US)
Eddie Fisher (Singer)
Aretha Franklin (Singer)
Harrison Ford (Actor)
Albert French (Writer)
Sally Field (Actress)
Connie Francis (Singer)
Sarah Ferguson (Duchess Of York)
Sigmund Freud (Psychoanalyst)
Stephen Fry (Actor)
Shecky Greene (Comedian)
Barbara Gordon (Filmmaker)
Phil Graham (Washington Post)
James Gandolfini (Actor)
James Garner (Actor)
Peter Gabriel (Musician)
Kendall Gill (Basketball Star)
Ruth Graham (Writer)
John Gibson (Pianist)
Danny Glover (Actor)
Dwight Gooden (Baseball Star)
Tipper Gore (Former US First Lady)
Galileo (Scientist)
Carey Grant (Actor)
Mariette Hartley (Actor/Activist)
Tim Howard (Soccer Star)
Juliana Hatfield (Musician)
Ernest Hemingway (Writer/ Nobel Laureate)
Margaux Hemingway (Actor)
Audrey Hepburn (Actor/Activist)
Olivia Hussey (Actress)
Pete Harnisch (Baseball Star)
Linda Hamilton (Actor)
Stephen Hawking (Physicist)
Sir Anthony Hopkins (Actor)
Marty Ingels (Comedian)
Janet Jackson (Musician)
Kay Redfield Jamison (Psychologist/Author)
Richard Jeni (Comedian)
Jim Jenson (Newscaster)
Billy Joel (Musician)
Beverly Johnson (Supermodel)
Elton John (Musician)
Angelina Jolie (Actor/Activist)
Daniel Johns (Musician)
Ashley Judd (Actor)
Naomi Judd (Singer)
Al Kasha (Songwriter)
Danny Kaye (Actor)
Leila Kenzle (Actress)
John Keats (Poet)
Franz Kafka (Writer)
Gelsey Kirkland (Dancer)
Margot Kidder (Actress)
Nicole Kidman (Actress)
Joey Kramer (Musician)
Julie Krone (Star Athlete)
Pat Lafontaine (Hockey Star)
Jessica Lange (Actor)
Robert E. Lee (US General)
Jacob Lawrence (Artist)
Vivien Leigh (Actress)
Peter Nolan Lawrence (Writer)
Primo Levi (Writer)
John Lennon (Musician)
Meriwether Lewis (Explorer)
Courtney Love (Singer)
Allie Light (Director)
Abraham Lincoln (American President)
Rick London (Cartoonist)
Mary Todd Lincoln (Former US First Lady)
Salvador Luria (Scientist/Nobel Laureate)
John Madden (Football Star)
Meat Loaf (Musician/Actor)
Camryn Manheim (Actor)
Martha Manning (Psychologist)
Gustav Mahler (Composer)
Alanis Morisette (Singer)
Howie Mandel (Comic)
Bette Midler (Singer/Actress)
Dave Matthews (Musician)
Gary Mcdonald (Actor)
A.J. Mclean (Musician)
Burgess Meredith (Actor)
Sir Paul Mccartney (Musician)
Robert Mcfarlane (Security Advisor)
Sarah Mclachlan (Musician)
Rod Mckuen (Writer)
Gary Mcdonald (Actor)
Les Murray (Poet)
John Stuart Mill (Philosopher)
J.P. Morgan (Industrialist)
Edvard Munch (Artist)
John Mellencamp (Musician)
Paul Merton (Comedian)
Kate Millet (Writer/Feminist)
Carmen Miranda (Dancer)
Claude Monet (Artist)
Many Moore (Singer)
Michelangelo (Artist)
V.S. Naipaul (Writer/Nobel Laureate)
John Nash (Mathematician /Nobel Prize)
Ralph Nader (Consumer Rights Advocate)
Stevie Nicks (Musician)
Vaclav Nijinsky (Dancer)
Sir Isaac Newton (Scientist)
Deborah Norville (Journalist)
Marie Osmond (Entertainer)
Sir Laurence Olivier (Actor)
Rosie O’Donnell (Comedian/Actress)
Georgia O’Keefe (Artist)
Donny Osmond (Entertainer)
Lani O’Grady (Actress)
Eugene O’Neill (Playwright)
Dolly Parton (Musician)
Meera Popkin (Broadway Star)
Charley Pell (Football Coach)
George Patton (US General)
Jane Pauley (Journalist)
Teddy Pendergrass (Musician)
Edgar Allan Poe (Writer)
Elvis Presley (Entertainer)
Ezra Pound (Poet)
Jason Pollock (Artist)
Cole Porter (Composer)
Jimmy Piersall (Baseball Star)
Alma Powell (Wife Of General Colin Powell)
Susan Powter (Motivational Speaker)
Freddie Prinze Jr. (Actor)
Roseanne (Comedian/Actress)
Bonnie Raitt (Musician)
Burt Reynolds (Actor)
Lou Reed (Musician)
Norman Rockwell (Artist)
Theodore Roosevelt ( President Of The United States)
Joan Rivers (Comedian Actress)
Mac Rebennack A.K.A. Dr. John (Musician)
Alex Rodriguez (Baseball Star)
Alys Robi (Vocalist)
Axel Rose (Singer)
Winona Ryder (Actress)
Yves Saint Laurent (Fashion Designer)
Sam Shepard (Playwright)
Tom Snyder (TV Host)
Monica Seles (Tennis Star)
Linda Sexton (Writer)
Neil Simon (Playwright)
William T. Sherman (US General)
Marc Summers (TV Host)
Diana Spencer (Princess Of Wales)
John Steinbeck (Author)
Paul Simon (Musician)
Lauren Slater (Writer)
Willard Scott (Star Weatherman)
William Shakespeare (Writer)
Carly Simon (Singer)
Jose Solano (Actor)
Rick Springfield (Musician/Actor)
Brooke Shields (Model/Actress)
Rod Steiger (Actor)
George Stephanopoulos (Political Advisor)
Barbra Streisand (Singer/Actress)
William Styron (Writer)
Charles Schulz (Cartoonist)
Teresa Stratas (Opera Singer)
Sissy Spacek (Actress),
Dave Stewart (Singer)
Darryl Strawberry (Baseball Star)
Lori Schiller (Writer)
Francis Sherwood (Writer)
Scott Simmie (Journalist)
Earl Simmons A.K.A. DMX (Musician/Actor)
Alonzo Spellman (Football Star)
Nikola Tesla (Inventor)
Spencer Tracy (Actor)
Hunter Tylo (Actor)
Leo Tolstoy (Author)
Ted Turner (Entrepreneur)
Henri De Toulouse-Lautrec (Artist)
Mark Twain (Author)
Peter Illyich Tchaikovsky (Composer)
Anne Tyler (Author)
Tracy Ullman (Actor)
Dimitrius Underwood (Football Star)
Vivian Vance (Actor)
Kurt Vonnegut (Writer)
Tom Waits (Musician)
Mike Wallace (Journalist)
Michael Warren (Editor Canada Post)
George Washington (US President)
Evelyn Waugh (Novelist)
Damon Wayans (Comedian/Actor)
Tennessee Williams (Writer)
Dar Williams (Musician)
Robin Williams (Comedian/Actor)
Ann Wilson (Singer)
Bill Wilson (Founder Of Alcoholics Anonymous)
Brian Wilson (Musician)
Oprah Winfrey (TV Host)
Jonathan Winters (Comedian)
Ed Wood (Director)
Tom Wolfe (Writer)
Lewis Wolpert (Scientist)
Hugo Wolf (Composer)
Virginia Woolf (Novelist)
Luther Wright (Basketball Star)
W.B. Yeats (Poet)
Robert Young (Actor)
Bert Yancey (Golf Star)
William Zeckendorf (Industrialist)
Renee Zellweger (Actor)
References
Buchwald, A. (1999). Famous, important people who have suffered depression. Psychology Today.
Fonda, J. (2005). My life, so far. New York: Random House.
Jamison, K.R. (1993). Touched with fire. Manic depressive illness and artistic temperment. New York: Free Press.
Shepard, S. (1999). Mrs. gore breaks the ice on mental illness. Wahsington Bureau: The Palm Beach Post.
Shields, B. (2005). Down came the rain: My journey through post partum depression.
New York: Hyperion Books.
______(2005). Health: Celebrities who have admitted suffering from depression. England: Burmingham Post.
People with Mental Illness Enrich Our Lives
http://www.nami.org/helpline/peoplew.htm
Celebrity with Anxiety Disorders
http://www.anxietysecrets.com/celebrities.htm
Famous People Who Have Battled Depression
http://www.funkstop.com/ed/depression
Toxoplasmosis and Behavior
Last August I wrote an article about some extraordinary new evidence implicating Toxoplasma gondii in some psychological and psychiatric illnesses. Latent infection with
Toxoplasma gondii is amongst the most prevalent of human infections and it
had been generally assumed that it is asymptomatic unless there is
congenital transmission or reactivation because a person has an immune system that has become depressed or compromised. That assumption is being completely re-evaluated.
The article generated some extremely interesting correspondence and some spirited discussions.
Here is a very insightful letter from a physician:
Dear Dr. Petty,
I thought about the concept of psychological illness caused by a virus or other organism. I was wondering what would be the mode of dispersion of such a virus. Upper respiratory tract infections, skin and gastrointestinal infections spread by cough, by touch and hand to mouth respectively. How would such a brain virus or protozoal organism promote itself? Of course it could be by the above methods but it seems that there should some way that the specific disease process is connected to a behavior that helps it to spread itself.
Then I got to thinking; diseases have learned physical ways to disseminate themselves, I wonder if a disease could change behavior to promote it’s own dissemination and survival? I imagine that if that were true, people with the flu would be sociable, people with infectious diarrhea would be sociable and hungry, people with AIDS would have increased libido. I haven’t yet seen any data for this. Although I’ve always felt that there was one disease that did alter behavior in a way that is conducive to disseminating itself, and that is rabies. The host goes from being docile, to seeing all others as the enemy. He then attacks them, bites them and thus passes on the organism. A true mind altering virus, although it’s psychology works better with animals than with people. Do you think that there are other diseases that spread purely by behavior, that cause the host to seek out the next host and not just pass the disease from one to another just due to proximity?
This was my response:
What great questions!
And believe it or not, there’s quite a lot of empirical research on these very topics.
There is a whole textbook on the behavioral effects of parasites edited by Janice Moore entitled Parasites and the Behavior of Animals. Here’s an interesting one: rats and mice are hard wired to avoid cats. Millions of years of programming have ensured that Tom’s very presence would send Jerry packing. Cats carry Toxoplasma gondii and if mice or rats become infected with it, usually by eating cat poop, they lose their fear of felines. So now Tom can have lunch at his leisure.
I’ve also talked about the way in which people with creativity and schizotypal personality disorder (i.e. carriers of genetic risk) tend to be promiscuous, while people with schizophrenia have fewer children. Both groups tend to get more sexually transmitted diseases than the general population. It would be tempting to think that toxoplasmosis can be spread that way, however there’s a 32-year old study in German that showed that Toxoplasma was not transmitted by intercourse. However, cytomegalovirus, a common partner to Toxoplasma may be. And both modulate dopamine activity in the regions of the brain involved in salience.
I have done a very detailed literature search encompassing papers written in all the languages that I can read, and have not been able to find any clear evidence of behavior change induced by HIV, influenza or infectious diarrhea: what interesting and important questions to research.
We do have some more data confirming the effects of Toxoplasma infections on the behavior of rats: they become less anxious and therefore do not respond to environmental threats as quickly as uninfected rodents. An antipsychotic medication (haloperidol), a mood stabilizer (valproic acid) and two chemotherapeutic agents – pyrimethamine or Dapsone – have all been shown to prevent the development of Toxoplasma-induced behavioral change.
Another recent study from the Departments of Parasitology, Microbiology and Zoology, Charles University, the Centre of Reproductive Medicine and GynCentrum, in the Czech Republic also speaks to the significance of latent Toxoplasma infections: the presence of the parasite in the blood of pregnant women increases their chance of giving birth to boys. The increased survival of male embryos in infected women may be explained by Toxoplasmosis infections modulating and suppressing the immune system.
If Toxoplasma plays a part in the development of some psychiatric illnesses, yet a high proportion of the population carries it without any problems, one obvious question is what activates it? Environmental stress might, perhaps, cause the Toxoplasma to become reactivated and play a part in the development of specific psychiatric symptoms.
This story is continuing to develop and I am going to watch it closely. If it is confirmed, it could open up some brand new avenues for helping treat and perhaps even prevent some types of psychiatric illness.
New Medicines for Schizophrenia
Many health care providers read this blog, although most focus on non-invasive healing methods.
But it is still important to know a little about conventional medications, and one of the basic tenets of Integrated Medicine is that we use orthodox medicine together with precisely individualized treatments aimed at harmonizing the whole person.
Last night the Food and Drug Administration in the United States granted final approval for a new medicine for the treatment of schizophrenia. It is called paliperidone, and will be marketed under the name Invega.
We have also heard that three other new medicines are in the late stages of development: bifeprunox, asenapine and iloperidone.
It is a sad fact that many people with severe mental illnesses are not well served by any currently available treatments, be they medicines, psychotherapy, nutrition or anything else. So it is good news that new treatment options are emerging. The next step is to see how these new medicines work in practice and if there are any side effect issues that did not show up in the clinical trials.
Paliperidone will become available in the United States in early January. You can read something about it here.
We expect that bifeprunox will be the next one to come to market, and you can read something about it here.
We shall continue to provide up to date and independent information about all the new approaches to treating major mental illness here.
Psychiatry Below the Neck
There is more and more evidence that schizophrenia and bipolar disorder and perhaps also major depressive disorder, are illnesses affecting the whole body and not just the brain and mind.
It has been known for over a century that some physical problems, including type 2 diabetes mellitus, obesity, cardiovascular diseases and some forms of cancer appear to be more common in people with major mental illnesses. All of this was known long before the current concerns about obesity, diabetes and some antipsychotic medicines. It is also clear that the physical problems cannot just be explained away by social deprivation and poor lifestyle choices.
The new understanding of mental illness as a systemic problem, opens up some extraordinary opportunities for treatment and perhaps even for prevention. In some new research due to be published next month, investigators have identified some abnormal proteins in the liver and on red blood cells that are similar to some abnormal proteins already identified in the brain.
These proteins are primarily involved in energy metabolism in cells and in protection against oxidative stress. The implication from this is that schizophrenia and many of the associated health problems may be a consequence of impaired energy metabolism together with damage by free radicals.
You will see why this is so exciting: it looks as if we have an entirely new way of approaching, treating and perhaps preventing the most serious of mental illnesses.
