The nature of psychosis

http://www.nytimes.com/2011/11/26/health/man-uses-his-schizophrenia-to-gather-clues-for-daily-living.html?pagewanted=1&_r=1&ref=health

This article takes a bit of a different look at mental health, and schizophrenia specifically. The current view of mental disorders from the psychiatric establishment is that disorders are based on abnormalities in either physical architecture of the brain or in dysregulation of chemical signals. Using this basis, treatment will usually involve medication to try and correct chemical abnormalities. There is also a view that personal world views that are divergent from the rest of the populations are abnormal and should be modified to match the most popular world view as closely as possible. These standards for treatment are derived from research and data collected by scientists and mental health providers.

The article here takes a little bit of a different view. The information is told in a narrative form, focusing on the story of a patient who developed schizophrenia as an adult. He suffered from typical auditory and visual hallucinations. The hallucinations had religious content, which was odd for the patient as he was an atheist. One auditory hallucination told the patient he was damned. He also saw visions of God and Jesus. In typical fashion, these visual and auditory disturbances severely affected the patient's ability to interact with the world, and he lost his friends and his job. The patient's delusion was that he was being ordered to act to save the world.

Where the patient's story diverges from the norm is that instead of working to completely eliminate the delusional motivations, a successful treatment for this patient involved a combination of medication, psychotherapy, and an emphasis on understanding the underlying sources for the delusions and hallucinations. The theory is that instead of the hallucinations being completely made up and simply a result of abnormal chemistry, the type of resultant hallucination is based on the person's previous experiences and personal psychological makeup. This patient worked on self-analysis to understand where his hallucinations had their basis, and by understanding, it helped him to respond in a constructive and world-appropriate way to them. In addition, his social support system, which is mainly his spouse, helps him to not eliminate the delusion that he is supposed to save the world, but recognises it as an actual good thing, that it could possibly be either a divine message or simply a positive change in his thinking process. His wife helps him to pursue goals of activism that mollifies his drive to change the world for the better, while also helping him to set limits so it does not become overwhelming. He gets counseling and medication additionally to help him remain stable.

The upshot of the article is that a novel approach to schizophrenic treatment and research is to look at the patient's personal history as a way to understand why patients have certain hallucinations and get ideas on how best to control them. It also suggests that starting to collect data from the patient's perspective can be important in helping to more fully understand psychiatric diseases.