Surviving Schizophrenia: A Manual for Families, Patients and Providers

Surviving Schizophrenia: A Manual for Families, Patients and Providers

by E. Fuller Torrey

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Surviving Schizophrenia: A Manual for Families, Patients and Providers by E. Fuller Torrey

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.

Product Details

ISBN-13: 9780060842598
Publisher: HarperCollins Publishers
Publication date: 03/28/2006
Edition description: Fully Revised & Completely Updated
Pages: 576
Product dimensions: 5.31(w) x 8.00(h) x 1.29(d)

About 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.

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...

Table of Contents

Preface to the Fifth Editionxix
Preface to the First Edition, 1983xxi
1The Inner World of Madness: View from the Inside
Alterations of the Senses4
Inability to Interpret and Respond13
Delusions and Hallucinations25
Altered Sense of Self37
Changes in Emotions40
Changes in Movements45
Changes in Behavior46
Decreased Awareness of Illness50
The Black-Red Disease52
Recommended Further Reading59
2Defining Schizophrenia: View from the Outside
Official Criteria for Diagnosis62
Subtypes of Schizophrenia66
Delusional Disorders67
Schizotypal, Schizoid, Paranoid, and Borderline Personality Disorders68
Schizoaffective Disorder and Manic-Depressive Illness71
Recommended Further Reading77
3Conditions Sometimes Confused with Schizophrenia
A "Split Personality"79
Psychosis Caused by Street Drugs80
Psychosis Caused by Prescription Drugs82
Psychosis Caused by Other Diseases84
Psychosis Caused by Head Trauma87
Psychosis with Mental Retardation88
Infantile Autism89
Antisocial Personality Disorders and Sexual Predators91
Culturally Sanctioned Psychotic Behavior92
Recommended Further Reading93
4Onset, Course, and Prognosis
Childhood Precursors95
Onset and Early Symptoms96
Childhood Schizophrenia99
Postpartum Schizophrenia100
Late-Onset Schizophrenia101
Predictors of Outcome102
Male-Female Differences104
Possible Courses: Ten Years Later105
Possible Courses: Thirty Years Later109
The "Recovery Model"113
Causes of Death: Why Do People with Schizophrenia Die at a Younger Age?114
Recommended Further Reading116
5Research Findings on the Causes of Schizophrenia
The Normal Brain119
The Brain with Schizophrenia121
The disease is familial121
There may be neurochemical changes122
There are structural and neuropathological changes123
There are neuropsychological deficits124
There are neurological abnormalities125
There are electrical abnormalities126
There are immunological and inflammatory abnormalities127
Individuals with schizophrenia are born disproportionately in the winter and spring127
Individuals with schizophrenia are born and/or raised disproportionately in urban areas128
Other abnormalities: pregnancy and birth complications, minor physical anomalies, and an absence of rheumatoid arthritis128
What Parts of the Brain Are Affected?130
When Does the Brain Damage Begin?133
Recommended Further Reading134
6Theories About the Causes of Schizophrenia
Genetic Theories138
Neurochemical Theories140
Developmental Theories141
Infectious and Immune Theories142
Nutritional Theories144
Endocrine Theories146
Stress Theories147
Obsolete Theories149
Masturbation and Demons149
Bad Mothers149
Bad Families150
Bad Cultures152
Thomas Szasz153
Ronald Laing153
Recommended Further Reading154
7The Treatment of Schizophrenia: Non-Medication Aspects
How to Find a Good Doctor157
What Is an Adequate Diagnostic Workup?162
Hospitalization: Voluntary and Involuntary166
Alternatives to Hospitalization175
Payment for Treatment and Insurance Parity176
Outpatient Treatment and Managed Care178
Services for Children181
Services in Rural Areas183
Counseling, or Supportive "Psychotherapy"184
Insight-oriented Psychotherapy187
Cognitive Behavioral Therapy189
Electroconvulsive Therapy (ECT)191
Dietary Treatments192
Herbal Treatments193
Experimental Treatments: TMS and VNS194
Recommended Further Reading195
8The Treatment of Schizophrenia: Medications
First-Generation Antipsychotics197
Adverse Effects206
Second-Generation Antipsychotics214
Adverse Effects217
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 Patterns227
Which Antipsychotic Should You Try? The Bottom Line229
Interactions of Antipsychotics with Other Medications232
Other Drugs to Try If Antipsychotics Fail235
New Medications on the Horizon239
Drug Prices and the Use of Generics242
Medications for Early Treatment or Prevention245
The Medication-Savvy Consumer and Family246
Recommended Further Reading248
9The Rehabilitation of Schizophrenia
Money and Food251
Friendship and Social Skills Training262
Medical and Dental Care265
Quality of Life Measures267
The Need for Asylum268
Recommended Further Reading270
10Ten Major Problems
Cigarettes and Coffee273
Alcohol and Street Drugs277
Sex, Pregnancy, and AIDS281
Medication Noncompliance293
Assisted Treatment298
Assaultive and Violent Behavior306
Arrest and Jail309
Recommended Further Reading314
11How Can Patients and Families Survive Schizophrenia?
The Right Attitude318
The Importance of Education327
Survival Strategies for Patients329
Survival Strategies for Families332
Effects of Schizophrenia on Siblings, Children, and Spouses341
Minimizing Relapses345
Recommended Further Reading348
12Commonly 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 Reading370
13Schizophrenia in the Public Eye
Schizophrenia in the Movies373
Schizophrenia in Literature382
Schizophrenia, Creativity, and Famous People389
The Problem of Stigma394
Recommended Further Reading397
14Dimensions 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 Catastrophe417
What Is the Cost of Schizophrenia?424
Recommended Further Reading429
15Issues for Advocates
Congress, State Government, and the Politics of Neglect431
Scientologists, Anti-Psychiatrists, and "Consumer Survivors"435
NIMH and Research Funding439
Educating the Public440
Decreasing Stigma442
Improving Services444
How to Organize for Advocacy450
Recommended Further Reading452
Appendix AAn Annotated List of the Best and the Worst Books on Schizophrenia453
Appendix BUseful Web sites on Schizophrenia474
Appendix COther Useful Resources on Schizophrenia480

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Surviving Schizophrenia: A Manual for Families, Patients and Providers 4.7 out of 5 based on 0 ratings. 3 reviews.
Anonymous More than 1 year ago
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.
Anonymous More than 1 year ago
it is very informative and well written.
Anonymous More than 1 year ago