Monday, March 16, 2009

I don't *do* myths...

Dear Mythbusters,

We need you! Now! Fer realz!

Okay, we need to talk about psychosis and myths. We need to talk about those health conditions that make you lose contact with reality (psychosis as it relates to schizophrenia, severe depression, and bi-polar), and we need to talk about the myths that surround them.

Myth #1: People with psychosis are crazy axe murders.

The origins of this myth lie in two key areas: a) popular media; b) the heinously oversensationalized actions of people who are unwell.

Interestingly, the two origins of this myth conveniently play into one another. Popular media, like movies, for example, uses the medical condition of psychosis because it creates an alluring and seemingly complicated character that will do things that "normal" people would never do. And so axe murders are often described as psychotic, or insane, since it's just beyond comprehension that a person in possession of sanity would do such things.

When people with psychosis are in poor health, and are locked in the grips of a psychotic event, sometimes odd and even very unfortunate behaviour can happen... which tends to wind up in our news... over and over again, for any number of years following the event. Furthermore, since the behaviour of one in the grips of a psychotic event can be so unusual, this tends to make great fodder for semi-truthful, fictionalized tales, which supports the perpetuation of the mythology.

So, what is the truth? Are people with psychosis any more murderous or criminal than the regular population? Well, not really. The truth of the matter is that *most* crimes are committed by those who we would consider fairly sane people. However, people with psychosis still do commit crimes, at a fairly consistent rate with the rest of the population.

Can people with psychosis commit crimes that are motivated by their psychotic event? Of course. But you know how we can avoid that? By taking mental health seriously, and by ensuring that everyone has equal, compassionate, and appropriate access to preventative education and (if needed) timely treatments. (I'll discuss treatments and what I mean by this last sentence in another post, on another day.)

Just a last point about criminal behaviour and people: Crimes are more likely to be committed against us by people we know. The idea of "stranger danger" is a myth. And so the truth is that you will know, most likely, in some manner, the person who has broken into your home. Also, you are more likely to be assaulted, raped, and even murdered by someone you know and/or love than you are by a "crazed" stranger. Keep that in mind the next time you walk out your front door.

Myth #2: People with psychosis are possessed.

The origins of this myth lie in: Religion/Spirituality/Mysticism/Explaining the unexplainable by making up interesting tales that are not realistic given the information about the brain and its workings that we have today.

Okay, I'm not super religious, and I don't believe in spirits. I can understand that if you do believe in religion/spirits/ghosts/possession that this myth makes sense to you, since spirits are known to be pretty nasty, according to religious or spiritual lore.

But the truth is, psychosis is medical condition that has fairly clear symptoms, a pretty predictable progress, and a clear pattern in the activities and chemical actions in the brain. There is no definitive "test" for psychosis, but some tests will show unusual brain activity, and more refined tests (that are experimental and not used on people) will show problems with dopamine transmission. Furthermore, since medicine that deals with dopamine (and/or very good age-and-situation specific therapy) can help relieve the symptoms of psychosis, this gives us a lot of reason to think that this is a condition better treated by doctors, therapists, and loving families than preists or spiritual experts.

Consulting a doctor (or two, sometimes three) first, to rule out psychosis, would be more helpful than just attempting an exorcism or spiritual ceremony.

Myth #3: People with psychosis have access to "another dimension," "another world," "a different spiritual plane."

Origins of this myth: Religion/Animism/Shamanism/Mysticism/Delusional Thinking Itself (Yes, I said that one out loud.)

This myth is an interesting one, since it is heavily supported by some religious groups/belief systems. It is also supported by the condition itself, which can sometimes lean towards delusional thinking. (Delusions are what we call "false and fixed beliefs." They are beliefs that are not likely to be realistic, and they are beliefs that are held with a feeling of certainty, even if there is a lot of evidence to show they are wrong.) Furthermore, this myth is also supported by some older theories relating to mental health and its causes. (Perhaps I'll write more about this last point in another post as well, since I'm sure it begs for clarification!)

You know, I really wish that my psychotic event gave me visions of another world. I really wish it did. That would be a lot of fun, and it would make me a very special person who had a special view of life that others did not have access to.

But the truth is, my psychotic event really just gave me a lot of confusing and anxious feelings. What I think it did was mix up my memories and distort my concept of time, and spit it all out into the present like it was real and happening at that moment, with no order or clear logic that belonged to the context I was in. I was having thoughts and doing things that only made sense to me, and that sense of logic was next to impossible to describe to others, even though I did (and still do) understand it myself.

Confusing. Not fun. Not access to a new dimension. Definitely not "a vision." Really, I do wish it was a vision, since that would give meaning to an event that seems like it should be so meaningful.

I think my point is that the experience of psychosis can be very interesting, and can even seem insightful, but that mythologizing the "insights" or visions that come out of a condition of mental health can be very harmful. Many of us with psychosis experience painful emotions (anxiety, fear, suspicion, confusion), and feel disconnected from our loved ones when we first start to feel the symptoms of the condition. Things escalate and then our behaviour changes and people, our friends, families, and neighbours, find reasons to actively shun us for doing behaviours that none of us can predict.

Furthermore, in most cultures, a condition like psychosis has very serious social consequences. Even though a person can be revered for having visions by some groups, they are usually also feared (this is an interesting and tense paradox), and live on the fringes of society... Kind of like tigers in a zoo: fun to look at, interesting to interact with, but mostly unpredictable and fearsome, and thus always treated very, very carefully, and best if generally avoided.

In North America, we don't really think that people with psychosis have access to a special reality, and we just tend to think people with this condition are loonies or psychos or axe murderers... and so those of us with psychosis get pushed to edges of our social networks... this means, for us, fewer jobs, fewer friends, even being ostracized by our families. And really, all of that just amounts to a hell of a lot of loneliness and poverty and confusion for everyone involved.

This one is a harmful myth indeed. A soothing myth for the egos of some, maybe, but a very harmful one.

Myth #4: Psychosis is caused by a demanding and abusive world that won't accept people who deviate from what is "normal."

Origins of this myth: Early psychiatry. Reductionist environmental/social psychology.

Early psychiatry and even modern environmental psychology has invested a lot of time and energy trying to explain that psychosis is caused exclusively by the life and circumstances of the person who develops the condition. This is known as the Environmental/Social Model.

Another model is also trying to explain psychosis, this is called the Biopsychosocial Model. Before I tell you about the Biopsychosocial Model, I want to talk about one of science's Great Debates: Nature vs. Nuture. This is an important debate to talk about, since it will help us to understand why resolving this myth is important, and it will help us better understand the Biopsychosocial Model.

One of the big discussions that is happening in healthcare and mental health and psychology is what is called the nature/nurture debate. This debate is trying to pinpoint the origins of all kinds of things affecting people. On the "nature" side, we would bring up things relating to the genes (the traits that we inherit from our parents, like hair colour, skin colour, and on and on) and we discuss how a variety of things are caused by or related to our genes or our basic biology. On the "nurture" side, we talk about how our looks or behaviour or ideas are related to or caused by the places and people we grow up with.

And so if we were to take an issue like psychosis, the nature side would say: having an event of psychosis is a condition that is related more closely to the biology of the person who has it. We think this because psychosis can run in families; you are more likely to have a psychotic event if you have a family member who has lived with a condition related to psychosis (schizophrenia, severe depression, bi-polar). There is early genomic evidence that shows that psychosis (the psychosis that appears in schizophrenia) exists in a number of genes.

More support for the nature side says that psychosis happens when you change the dopamine levels; specifically, increases in dopamine amounts can increase your likelihood of having a psychotic event. And so changing the chemicals in the brain tells us that this is a condition that happens in the wiring/transmissions that happen in our heads.

For the other side, the nurture side, the debate tells us that people who grow up in certain environments or with certain life circumstances are more likely to get psychosis. In families where there is a lot of stress, there is also a tendency for more psychosis. And so psychosis can happen more often in families where a number of crises or tragedies occor, or when the family is poor and can't have the "stabilizing" effects of financial prosperity (talking about a stable supply of healthy food, a stable supply of medications for family members with health problems, access to supportive or even just higher education systems, stable access to transit to get to work or even to get to a doctor if needed!) In short, the nature debate tells us that those who are "assaulted" by life consistently, in terms of poverty, abusive or neglectful social/family conditions, food/necessity shortages, and unstable finances and housing, or just major life changes, are more likely to develop psychosis.

Well, here's the truth to this psychosis myth: In this case, both the nature and nurture debators win. Nature tells us that psychosis can be passed down through families. Nature tells us there are "genes" for psychosis, just like there are genes that mark cancer, just like there are genes that dictate eye colour. Nature tells us that we can change a person's brain chemistry to "create" or "take away" psychosis.


It gets complicated. The genes, science is thinking, become "activated" by a stressful environment. (Stress is translated by the body through a chemical called cortisol... A stressful event happens or even if you *think* a stressful event will happen, and your body makes more of this hormone, and then your body reacts to it by doing all kinds of things like having a faster heartbeat, feeling very hot or very cold, feeling nervous, and so on... more fodder for the biology discussion.) And so someone can be born with a "tendency" towards having this condition (the same way one can have a higher chance of getting a type of cancer because of their genes). But the condition may or may not come out, depending on the life circumstances/stressors/sensitivity to cortisol (stress) hormones of the person who has the genes.

And so people with a lot of stress in their lifetime would find these genes activated. And we're not just talking once in awhile work pressure stress, we're talking fairly consistent patterns of stressors. Stress that relates to uncertain living circumstances... stress that relates to being poor, like worrying all the time about food, medicine, and how to pay the next bill... stress that relates to big life changes, like going to university or even getting married... and you get the picture.

This blending of both sides, nature AND nurture, is called the biopsychosocial model of psychosis. It takes into account the traits a person is given to by their parents (bio), the environment and circumstances of the person (social), and even the person him or herself in terms of their age and experience and how they deal with life and its details (psycho).

Forever chipping away to find the truth and hoping these tidbits have helped a bit,

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