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Surviving Schizophrenia: A Manual for Families, Patients and Providers

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Since its first publication in 1983, Surviving Schizophrenia has become the standard reference book on the disease and has helped thousands of patients, their families and mental health professionals. In clear language, this much?praised and important book describes the nature, causes, symptoms, treatment and course of schizophrenia and also explores living with it from both the patient and the family's point of view. This new, completely updated fifth edition includes the latest research findings on what causes ...

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Surviving Schizophrenia, 6th Edition: A Family Manual

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Since its first publication in 1983, Surviving Schizophrenia has become the standard reference book on the disease and has helped thousands of patients, their families and mental health professionals. In clear language, this much–praised and important book describes the nature, causes, symptoms, treatment and course of schizophrenia and also explores living with it from both the patient and the family's point of view. This new, completely updated fifth edition includes the latest research findings on what causes the disease as well as information about the newest drugs for treatment and answers to the questions most often asked by families, consumers and providers.

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Editorial Reviews

NAMI Advocate
“[Torrey] is comprehensive in his coverage of topics and thorough in his discussion.”
Psychology Times
“A comprehensive, realistic, and compassionate approach...Should be of tremendous value to anyone who must confront these questions.”
Los Angeles Times
“Brilliant.... There is no one writing on psychology today whom I would rather read.”
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Product Details

  • ISBN-13: 9780060842598
  • Publisher: HarperCollins Publishers
  • Publication date: 3/28/2006
  • Edition description: Fully Revised & Completely Updated
  • Edition number: 5
  • Pages: 576
  • Sales rank: 731,396
  • Product dimensions: 5.31 (w) x 8.00 (h) x 1.29 (d)

Meet the Author

E. Fuller Torrey, M.D., is a research psychiatrist specializing in schizophrenia and bipolar disorder. He is the executive director of the Stanley Medical Research Institute, the founder of the Treatment Advocacy Center, a professor of psychiatry at the Uniformed Services University of the Health Sciences, and the author of twenty books. He lives in Bethesda, Maryland.

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Read an Excerpt

Chapter One

Dimensions Of The Disaster

Schizophrenia is to psychiatry what cancer is to medicine: a sentence as well as a diagnosis.

W. Hall, G. Andrews, and G. Goldstein,
Australian and New Zealand Journal of Psychiatry, 1995

Schizophrenia, I said. The word itself is ominous. It has been called "one of the most sinister words in the language." It has a bite to it, a harsh grating sound that evokes visions of madness and asylums. It is not fluid like démence, the word from which "dementia" comes. Nor is it a visual word like écrasé, the origin of "cracked," meaning that the person is like a cracked pot. Nor is it romantic like "lunatic;' meaning fallen under the influence of the moon (which in Latin is luna). "Schizophrenia" is a discordant and cruel term, just like the disease it signifies.

Our treatment of individuals with this disease has, all too often, also been discordant and cruel. It is, in fact, the single biggest blemish on the face of contemporary American medicine and social services; when the social history of our era is written, the plight of persons with schizophrenia will be recorded as having been a national scandal. Consider the dimensions of the disaster.

  1. There are at least as many individuals with schizophrenia homeless and living on the streets as there are in all hospitals and related facilities. Studies of homeless individuals in the United States have estimated their total number to be between 250,000 and 550,000. A median estimate of 400,000 is consistent with the data from most of the studies. Studies have also reportedthat approximately one-third of homeless individuals are seriously mentally ill, the vast majority of them with schizophrenia. It is likely, therefore, that on any given day at least 100,000 persons with schizophrenia are living in public shelters and on the streets. As will be described below, there are only approximately 100,000 people with schizophrenia in all hospitals and related facilities at any given time.
  2. There are more individuals with schizophrenia in jails and prisons than there are in all hospitals and related facilities. A recent Department of Justice survey reported that 16 percent of inmates in local jails and state prisons, or 275,900 individuals, are mentally ill. Based on data from previous jail surveys, it is reasonable to estimate that approximately half of them, or 135,000 individuals, have schizophrenia. Thus, there are more individuals with schizophrenia in jails and prisons than there are in all hospitals and related facilities. Even more shocking is the fact that 29 percent 'of jails acknowledged holding such individuals with no charges against them, often awaiting a bed in a psychiatric hospital. The vast majority of those who do have charges have been charged with misdemeanors such as trespassing. The Los Angeles County Jail is now de facto the largest mental institution in the country.
  3. There are increasing episodes of violence committed by individuals with schizophrenia who are not being treated. Individuals with schizophrenia who take medications are not more violent than the general population. However, as will be discussed in more detail in chapter 11, recent studies have shown that some individuals with schizophrenia who are not taking medication are more violent. In one study, 9 percent of individuals with schizophrenia who were living in the community had used a weapon in a fight in the preceding year. In another study, "27 percent of released male and female patients report at least one violent act within a mean of four months after [hospital] discharge." Assaults against family members by individuals with schizophrenia have also risen sharply; a 1991 survey of the members of the National Alliance for the Mentally Ill reported that 11 percent of the seriously mentally ill family members had physically harmed another person within the previous year. A Department of Justice study reported that there are almost 1,000 homicides a year committed by individuals with "a history of mental illness"; media accounts suggest that the majority of these have been diagnosed with schizophrenia. Drug and alcohol abuse and noncompliance with medications both appear to be important factors in increasing violent behavior in this population.
  4. Individuals with schizophrenia are increasingly being victimized by others. Most crimes against individuals with schizophrenia are not reported; those instances that are reported are often ignored by officials. Purse snatchings and the stealing of disability checks are common, but rapes and even murders are not rare. In Los Angeles, a study of board-and-care home residents, the majority of whom had schizophrenia, reported that one-third of them had been robbed and/or assaulted in the preceding year. In New York, a study of 20 women with schizophrenia reported that half of them had been raped at least once, and 5 had been raped more than once. In Des Moines, Van Mill, a homeless man diagnosed with schizophrenia, was beaten to death by three men, then dumped into a children's wading pool.
  5. Housing for many individuals with schizophrenia is often abysmal. Because of pressure from state departments of mental health to discharge patients from state hospitals, seriously mentally ill individuals are frequently placed into housing that would not be considered fit for anyone else. For example, in 1979 the police removed 21 "ex-mental patients' living in New York City board-and-care homes "amid broken plumbing, rotting food and roaches.... The police found the decaying corpse of a former patient lying undisturbed in one home inhabited by six other residents." Similar reports continued throughout the 1980s, and in 1990 the New York Times headlined still another report: "Mental Homes Are Wretched, A Panel Says." In Mississippi "9 ex-patients" were found in a primitive shed with "no toilet or running water" and "guarded by two vicious dogs" to insure that they did not run away.
  6. Many individuals with schizophrenia revolve between hospitals, jails, and shelters. Because of the failure of mental health professionals to...

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Table of Contents

Illustrations xvii
Preface to the Fifth Edition xix
Preface to the First Edition, 1983 xxi
Acknowledgments xxiii
1 The Inner World of Madness: View from the Inside
Alterations of the Senses 4
Inability to Interpret and Respond 13
Delusions and Hallucinations 25
Altered Sense of Self 37
Changes in Emotions 40
Changes in Movements 45
Changes in Behavior 46
Decreased Awareness of Illness 50
The Black-Red Disease 52
Recommended Further Reading 59
2 Defining Schizophrenia: View from the Outside
Official Criteria for Diagnosis 62
Subtypes of Schizophrenia 66
Delusional Disorders 67
Schizotypal, Schizoid, Paranoid, and Borderline Personality Disorders 68
Schizoaffective Disorder and Manic-Depressive Illness 71
"Manicdephrenia" 74
Recommended Further Reading 77
3 Conditions Sometimes Confused with Schizophrenia
A "Split Personality" 79
Psychosis Caused by Street Drugs 80
Psychosis Caused by Prescription Drugs 82
Psychosis Caused by Other Diseases 84
Psychosis Caused by Head Trauma 87
Psychosis with Mental Retardation 88
Infantile Autism 89
Antisocial Personality Disorders and Sexual Predators 91
Culturally Sanctioned Psychotic Behavior 92
Recommended Further Reading 93
4 Onset, Course, and Prognosis
Childhood Precursors 95
Onset and Early Symptoms 96
Childhood Schizophrenia 99
Postpartum Schizophrenia 100
Late-Onset Schizophrenia 101
Predictors of Outcome 102
Male-Female Differences 104
Possible Courses: Ten Years Later 105
Possible Courses: Thirty Years Later 109
The "Recovery Model" 113
Causes of Death: Why Do People with Schizophrenia Die at a Younger Age? 114
Recommended Further Reading 116
5 Research Findings on the Causes of Schizophrenia
The Normal Brain 119
The Brain with Schizophrenia 121
The disease is familial 121
There may be neurochemical changes 122
There are structural and neuropathological changes 123
There are neuropsychological deficits 124
There are neurological abnormalities 125
There are electrical abnormalities 126
There are immunological and inflammatory abnormalities 127
Individuals with schizophrenia are born disproportionately in the winter and spring 127
Individuals with schizophrenia are born and/or raised disproportionately in urban areas 128
Other abnormalities: pregnancy and birth complications, minor physical anomalies, and an absence of rheumatoid arthritis 128
What Parts of the Brain Are Affected? 130
When Does the Brain Damage Begin? 133
Recommended Further Reading 134
6 Theories About the Causes of Schizophrenia
Genetic Theories 138
Neurochemical Theories 140
Developmental Theories 141
Infectious and Immune Theories 142
Nutritional Theories 144
Endocrine Theories 146
Stress Theories 147
Obsolete Theories 149
Masturbation and Demons 149
Bad Mothers 149
Bad Families 150
Bad Cultures 152
Thomas Szasz 153
Ronald Laing 153
Recommended Further Reading 154
7 The Treatment of Schizophrenia: Non-Medication Aspects
How to Find a Good Doctor 157
What Is an Adequate Diagnostic Workup? 162
Hospitalization: Voluntary and Involuntary 166
Alternatives to Hospitalization 175
Payment for Treatment and Insurance Parity 176
Outpatient Treatment and Managed Care 178
Services for Children 181
Services in Rural Areas 183
Counseling, or Supportive "Psychotherapy" 184
Insight-oriented Psychotherapy 187
Cognitive Behavioral Therapy 189
Electroconvulsive Therapy (ECT) 191
Dietary Treatments 192
Herbal Treatments 193
Experimental Treatments: TMS and VNS 194
Recommended Further Reading 195
8 The Treatment of Schizophrenia: Medications
First-Generation Antipsychotics 197
Adverse Effects 206
Second-Generation Antipsychotics 214
Adverse Effects 217
Clozapine (Clozaril, Leponex) 219
Olanzapine (Zyprexa) 222
Risperidone (Risperdal) 223
Quetiapine (Seroquel) 223
Ziprasidone (Geodon) 224
Aripiprazole (Abilify) 227
Which Antipsychotic Should You Try? The Influence of the Pharmaceutical Industry on Prescribing Patterns 227
Which Antipsychotic Should You Try? The Bottom Line 229
Interactions of Antipsychotics with Other Medications 232
Other Drugs to Try If Antipsychotics Fail 235
New Medications on the Horizon 239
Drug Prices and the Use of Generics 242
Medications for Early Treatment or Prevention 245
The Medication-Savvy Consumer and Family 246
Recommended Further Reading 248
9 The Rehabilitation of Schizophrenia
Money and Food 251
Housing 255
Employment 259
Friendship and Social Skills Training 262
Medical and Dental Care 265
Quality of Life Measures 267
The Need for Asylum 268
Recommended Further Reading 270
10 Ten Major Problems
Cigarettes and Coffee 273
Alcohol and Street Drugs 277
Sex, Pregnancy, and AIDS 281
Victimization 287
Confidentiality 289
Medication Noncompliance 293
Assisted Treatment 298
Assaultive and Violent Behavior 306
Arrest and Jail 309
Suicide 311
Recommended Further Reading 314
11 How Can Patients and Families Survive Schizophrenia?
The Right Attitude 318
The Importance of Education 327
Survival Strategies for Patients 329
Survival Strategies for Families 332
Effects of Schizophrenia on Siblings, Children, and Spouses 341
Minimizing Relapses 345
Recommended Further Reading 348
12 Commonly Asked Questions
Does Schizophrenia Change the Underlying Personality? 355
Are People with Schizophrenia Responsible for Their Behavior? 357
Does Schizophrenia Affect the Person's IQ? 360
Should People with Schizophrenia Drive Vehicles? 361
How Do Religious Issues Affect People with Schizophrenia? 362
Should You Tell People That You Have Schizophrenia? 364
Genetic Counseling: What Are the Chances of Getting Schizophrenia? 365
Why Do Some Adopted Children Develop Schizophrenia? 367
What Will Happen When the Parents Die? 368
Recommended Further Reading 370
13 Schizophrenia in the Public Eye
Schizophrenia in the Movies 373
Schizophrenia in Literature 382
Schizophrenia, Creativity, and Famous People 389
The Problem of Stigma 394
Recommended Further Reading 397
14 Dimensions of the Disaster
How Many People Have Schizophrenia in the United States? 404
Where Are They? 405
Do Some Groups Have More Schizophrenia Than Others? 410
Is Schizophrenia Increasing or Decreasing? 414
Is Schizophrenia of Recent Origin? 415
Deinstitutionalization: A Cradle for Catastrophe 417
What Is the Cost of Schizophrenia? 424
Recommended Further Reading 429
15 Issues for Advocates
Congress, State Government, and the Politics of Neglect 431
Scientologists, Anti-Psychiatrists, and "Consumer Survivors" 435
NIMH and Research Funding 439
Educating the Public 440
Decreasing Stigma 442
Improving Services 444
How to Organize for Advocacy 450
Recommended Further Reading 452
Appendix A An Annotated List of the Best and the Worst Books on Schizophrenia 453
Appendix B Useful Web sites on Schizophrenia 474
Appendix C Other Useful Resources on Schizophrenia 480
Notes 484
Index 521
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Customer Reviews

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Sort by: Showing all of 5 Customer Reviews
  • Anonymous

    Posted December 29, 2013

    I read the 4th edition of this book, and it is by far the most a

    I read the 4th edition of this book, and it is by far the most amazing and informative book I have read. I highly recommend this for anyone who has a loved one with this illness. It will help you gain so much knowledge and understanding. Every page is packed with facts and useful information from an author who is very knowledgeable and passionate about the subject, has a sister who has the illness, and has done extensive research about it. I have a brother with this illness and I just got the new 6th edition for our family and am looking forward to reading it!!!

    1 out of 1 people found this review helpful.

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  • Anonymous

    Posted September 23, 2011

    Invaluble to loved ones living with schizophrenia. Very highly recommended.

    The book is written to apply to professionals, laymen and loved ones living with schizophrenia. As a layman living with a paranoid schizophrenic loved one I cannot recommend it too highly. Although some of the contents are more directed to professionals in the field, it is very easily understood and applicable to those of us living with the disease of schizophrenia.

    1 out of 1 people found this review helpful.

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  • Anonymous

    Posted February 9, 2009

    I Also Recommend:

    great book

    it is very informative and well written.

    1 out of 1 people found this review helpful.

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  • Anonymous

    Posted February 6, 2002

    An excellent book for all those coping with mental illness

    This book is an outstanding guide, not only for individuals with mental illness, but also for their family members. It is very educational, helpful, and sensitive to the subject of this devastating illness. I am glad I found this book-it helped me cope with the many struggles I have experienced living with a relative with this illness.

    1 out of 1 people found this review helpful.

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  • Anonymous

    Posted August 28, 2009

    No text was provided for this review.

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