Sunday, August 07, 2011

NY Times: One Man's Battle with Schizophrenia

Benedict Carey is a New York Times mental health reporter.  In yesterday's Times, he wrote about Joe Holt, a man with a diagnosis of schizophrenia.  Mr. Holt was dealt a particularly tough deck of cards: in addition to diagnosis of schizophrenia, he had a horrible and traumatic childhood with much loss, placement in a facility where he was physically abused, and periods of homelessness as a teenager.  He now has a stable marriage, has adopted children and keeps numerous foster children, and holds two jobs, one as a computer and another as a therapist (if I read that correctly).  He struggles with his emotional life, but my take on this was that this is one extremely resilient man who has waged a successful battle against many demons and his story is inspirational.

So Benedict Carey often writes stories that are skeptical, if not outright critical, of the mental health field.  This story did not have that tone.  I found it interesting, though, that he chose a person with a diagnosis of schizophrenia who's life was not "typical."  What did I find not typical?  Well, Mr. Holt functions very well---he is personable and engaged with the world and able to function at a high level-- I'll borrow Freud's view for this, but "to work and to love" as indicative of functioning.   Certainly there are people with schizophrenia that work and marry and function well, but hallmarks of the disease often include passive symptoms of low motivation, apathy, and a lack of interest in the world.  Often the negative symptoms (which Mr. Holt is not described as having) are more disabling than the positive symptoms of hallucinations and delusions.  The second thing I found to be 'not typical" was that Mr. Holt did not recognize the voices he'd been hearing for years as 'voices.'  In general,  I've found that people who suffer from hallucinations soon figure out that they are hallucinating; the same is not true of delusions, where people often never gain the insight that their beliefs are not valid.  Finally, while Mr. Holt functions with schizophrenia, he only takes medications during acute episodes and has done well without them since 2006. 

What does this mean?  Well, I guess the choices are that either the diagnosis is wrong, or that Mr. Carey picked someone with an atypical course to feature.  There's probably more choices that I'm missing.  In one way, I liked the article because it was hopeful, positive, and mostly upbeat.  The patient featured still suffers miserably --listen to the video interview-- but he lives a full life.  On the other hand, there is a tinge of suggestion that others should be able to function as well with schizophrenia (without regular medications, no less) and I'm not sure it's always that simple.