ON MENTAL ILLNESS: Proactively Treating Psychosis

Jack Bragen
Friday November 06, 2015 - 02:01:00 PM

Just as a reminder--this column is merely an opinion column and it is not a substitute for consulting with a mental health professional.  

In recent years, according to one medical doctor, the philosophy of treatment of Type 2 Diabetes has evolved. This doctor said that it is better to treat this illness more aggressively, in order to minimize damage to the body. Schizophrenia, in analogous fashion, can also be treated more aggressively--keeping symptoms at a minimum. (This is a completely different issue from the known fact that many psychiatric drugs cause obesity and Type II Diabetes.) 

If someone suffers from schizophrenia, they may benefit from getting the maximum medication they can tolerate, but not to the point of too many or too severe side effects. This increases the person's chances of developing necessary insight into their condition. It may also cause the brain to be healthier, since psychosis apparently is bad for the brain.  

I have been taking these medications for well over thirty years. Medication hasn't ruined my life.  

I can't handle as much activity as I once could. I can't handle driving in San Francisco. I can not handle a full-time job. Certain things that entail high energy, quick reflexes, multitasking, and stress, I can not deal with. I don't know how much of these limitations are caused by meds, versus how much of this impairment is either caused by my disease or perhaps by premature aging of my brain.  

However, I have reached clarity of thought. Writing for publication has helped my mental condition. Any brain-intensive activity, such as a college or adult school class, doing a lot of reading, or perhaps working at a paid or volunteer job, especially one that involves working at a computer, is probably going to be good for brain condition. I believe this increases serotonin and develops more receptors in the "good" areas of the brain. If this is so, it might help compensate for the possible brain suppressing side effects of antipsychotics. 

Paradoxically, I find that psychiatric meds create primarily a physical impairment, and they do not wipe out intellect. Other people may have other experiences. 

I have benefited from high dosages of antipsychotics. By taking a lot of meds, I have prevented myself from slipping into partial delusion. This has prevented me from losing judgment and losing the insight that I need medication. In my particular case and probably for many others, the delusions are pernicious and they are formidable. It requires a lot of vigilance, even now that I am nearly twenty years into recovery, to prevent delusions from taking hold. I can never let up on this vigilance.  

However, if you are young and not accustomed to the effects of antipsychotic medication, sometimes a lower dosage is better. Antipsychotic medication can create misery because of the side effects and the suppression of the mind. Over the years I have adapted to these meds. Being medicated to me feels normal. Yet in the first few years of taking medication, the meds made me miserable.  

I suggest working with a psychiatrist to arrive at the best solution, including finding which antipsychotic is effective and has the least side effects. Different people find different medications to be tolerable and/or effective. 

Delusions often have an emotional charge. The strong emotions they trigger are one factor that can make it more difficult to relinquish these erroneous thoughts. This is one reason why cognitive therapy and/or mindfulness can help people who suffer from psychosis.  

Delusions could promise something good, could help you deny something bad--or they could be a false threat. Whether a delusion creates pleasure or displeasure, either way this is a strategy of the disease. The delusions, by triggering strong emotions, are able to gain neurological priority.  

I recently discovered a paranoid delusional system that had been forming in my peripheral consciousness. Medication doesn't provide total assurance that a psychotic person won't be delusional. Delusions seem to find ways to slip past the barriers that we have put up.  

While medicated, the delusions that remain, one hopes, can be identified and dismantled. If medication gets too low, things may begin to deteriorate, and the ability to use the mind to fix the mind could be lost.  

I haven’t talked about therapy yet. People need meaningful interaction with others, and schizophrenic people need to talk about our symptoms to someone. We also need to get reinforcement of what we are doing right. Many of us don't need deep psychological analysis so much; actually it can be harmful.  

I have had better luck with therapists who have more life experience, compared to the inexperienced ones who sometimes believe they can cure my problems. An experienced, older therapist, or a smarter one at least, can be quite helpful. There are some who are in the wrong business. When someone in his or her twenties, fresh out of college, believes they are going to fix me, it means that I have a delusional therapist.  

Being aggressive on the medication side, and being gentle on the therapy component, can help create a good outcome. The longer a mental health consumer goes without a repeat episode and, at the same time, makes a good effort in life, the better are his or her chances at a meaningful and lasting recovery.