Tuesday, April 29, 2014

Schizophrenia killed my sister

Excerpts from a very nice review of all that we don't know about schizophrenia:
Susanne Long was my sister, three years younger. She was funny and savvy. She was creative and kind and curious. ...

At the age of 32, never before, schizophrenia came to call. She began to hear nasty phrases hissed at her: We’re going to get you, etc. We may call them voices, but to her they were sentences spoken from the mouths of colleagues and passersby.

Over the next near-decade her delusional states increased from sporadic to chronic. On July 21, 1986, at the age of 40, she vanished.


What causes this devastating mental illness?

It’s related to genetics, we know that. If you have an identical twin with schizophrenia, your chances of getting it are 40 to 65 percent. If you have a parent, brother, or sister with it, your chances are 10 percent. This compares with about one percent of the world population that suffers from the illness. One percent, though, is not a small number; in the United States it amounts to about three million people. The most severely afflicted find it difficult to get up, get dressed, eat, go to work, come home. They barely function. Susanne, once intelligent and competent, graceful and well appointed, could no longer keep a job or even take a bath. So why didn’t natural selection, over thousands of years, cause the genetic propensity for this extreme disability to die out?


A recent major study confirmed a high association between people in creative professions and their first-degree relatives (parents, offspring, and siblings) who have psychopathologies such as schizophrenia. Could there be inherited brain structures that produce thought patterns such as “broad associative thinking” in which contradictory images and ideas knock about together, structures that serve an artist’s work but that in some brains go too far and become the twisted thoughts of mental illness? Does selection for a more robust imagination—so very useful to us humans—keep imagination’s more dysfunctional forms from dying out?


Susanne was never violent; neither did she ever threaten violence, nor were her actions and attitudes in any way aggressive. Most people with schizophrenia are not violent, stereotype notwithstanding. However, in his 2013 book, American Psychosis, Torrey reports that 10 percent of homicides in the United States are committed by untreated mentally ill people. Keyword untreated. And often untreated and drug addicted. That means that 90 percent of homicides are committed by the allegedly sane. But suicide is different. About one in 10 people suffering from schizophrenia commits suicide, according to the National Institute of Mental Health.


Environment is a factor. Personality is a factor. Susanne was as stubborn as a stone wall. She was also born at the wrong time. I have a twin sister and a brother 10 months older, all of us born before our parents came of drinking age. (Old fathers are likelier to produce a child who develops schizophrenia, but Susanne had a young father.) We were “the three big kids.” As children, we ignored Susie, excluded her, looked down on her. We denied her entrance to our forts, museums, and hideouts in the woods. And we lived way out in the country. We were her only playmates. Did we drive her crazy?

“I was a battered child,” she once said to me. And then I remembered. We rural children would walk home from where the school bus let us off, at the end of our mile-long dirt lane. The whole way home, our brother would verbally torment Susie. Upon arriving at the house, out in the yard, he would curl his fist and beat her repeatedly in the stomach. (No blame. He was a child, too, and our stressed-out parents with their four children were in their early 20s.) If I recall correctly these events of 60 years ago, my sister and I would stand by doing nothing, feeling nothing. We did not participate, we did not enjoy, but we felt blank. Passive. It did not cross our minds to report to our parents. I don’t think we put it through any thought process whatever. One study found that children severely traumatized in childhood are three times as likely to become psychotic in adulthood. So, stressful, traumatic childhood—check.

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