One of my clients once told me about the first time that she was taken to a

mental hospital. She was very confused. She didn’t feel comfortable in her body. She

didn’t know how to be or what to do next. She kept on trying to run to the nurse’s

station because she was terrified of the other patients. In the end she was strapped to

her bed to keep her safe and out the way. She was diagnosed with schizophrenia. But

did that diagnosis change who she was, or is she now just labeled a schizophrenic?

There are many in the mental health profession who are very careful not to

say “schizophrenic, ” instead they may say, “X is living with schizophrenia.” What

difference does it make how you say it -- schizophrenia is schizophrenia. As one

doctor acquaintance of mine put it “How can you say that a schizophrenic has hope?

I think of schizophrenia as cancer of the mind, they get worse and worse until there

is nothing left of them.” Boruch Hashem, that doctor was not working in the mental

health field.

The concept of “mental illness” is based on the assumption that mental issues

fit into the same model as medical issues. Words like treatment, curable, incurable

diagnosis become part of the vocabulary used to discuss mental “conditions.” Yet it is

not at all clear that the mental and the physical are part of the same ball game.

While researching an article on mental illness, I asked Dr. Gerald Caplan (z”l)

former Professor at Harvard Medical School and former Head of the University Department of Child Psychiatry in

Jerusalem (1)

(Diagnostic Statistic Manuel of Mental Illness).

“Are mental illnesses real?” He took me on a guided tour of the DSM

This definitive book presents all the accepted mental illnesses. For each condition it lists potential symptoms and states how many

need to be found in order to conclude that the patient is suffering from that condition,

(e.g. 5 out of the 8). There are recommendations for the type of treatment: medication

and/or therapy.

The DSM has recently been updated. Its contents are based on the observation

of thousands of psychiatrists. The conditions listed have a statistic reality. They are

not like a broken leg where you can see what is wrong. They are not even like

influenza where you can see the virus under a microscope. Nowadays, brain imaging

is revealing patterns of similarity between those who suffer from certain conditions

and those who don’t. Yet researchers can’t be certain which came first, the illness or

the pattern. Many think, for instance, that schizophrenia describes a group of

illnesses. Is an illness defined as a common group of symptoms or a common cause?

Some categories have been dropped from the DSM because the ”symptoms”

have become socially acceptable. “Treatment,” Dr Caplan concluded, “follows the

principle that if it works, use it, given that the aim is for minimal interference.”

During a discussion about psychiatry today at a mental health clinic I was

working in, the science of psychiatry was said to be in its early stages. It could

generally describe but not yet predict.

Much of the lay population of today is very knowledgeable about mental

health. Many clients have told me exactly what damage their parents have done to

them. Some rattle off their self-diagnosed mental health condition, having come to

such conclusions by using popular ”diagnostic” scales. The client knows just how he

should be affected by whatever he has and he obligingly produces all the right

symptoms. It is ironic that the lay population seems to be much more confident in the

reality of “mental illnesses” than the profession that created them.
A diagnosis of schizophrenia, for instance, is based on observing two or three

out of nine behavior categories and their subcategories that the patient has shown over

a six-month period. The diagnosis is complex, but what does it really mean? It means

that one can expect the patient to display some of the symptoms in the DSM list some

of the time. Certain medications may help to reduce the effect of some of the

symptoms. Schizophrenia is cyclical, so the patient can be doing well for some time

and then be hit by a renewed attack. The diagnosis tells you what might happen next,

not why it happened and not how to cure it, for it is incurable.

Some time after being diagnosed with schizophrenia as a teenager, Dr. Patricia

Deegan (2) noticed that she was spending her days smoking cigarettes and waiting for

the night to arrive. She realized that, if she didn’t do something, she would waste her

entire life. She had to differentiate which actions and behaviors were due to

her ”illness,” which to the side effects of medication, and which to her reaction to her

diagnosis. She had to find out what she could and couldn’t do. Her goal was to re-

claim her life, not to be ”cured.”

Dr. Deegan is a professor of psychology and helps those suffering with mental

disorders to re-claim their lives, yet she still has to deal with the bad times when

the ”voices” deafen her despite the medications.

Not that all people living with schizophrenia could necessarily become

professors of psychology if they set their mind to it. But, as another of my clients who

lived with schizophrenia said, “Nothing stands in the way of the will.” That client was

working at building a relationship with her husband. Another client was hoping to

hold onto her job while living her shana rishona and thinking about having children.

When someone is labeled schizophrenic, the label comes with a list of

symptoms, treatments and prognoses. The person ceases to be a unique individual,

their motivations are understood in terms of their ”illness” and are often thought of as

manipulative. This mass prediction often condemns the victims of such illnesses to a

life of graded functionality: “She is a high functioning bipolar.” That’s it? That makes

her sound hardly human. Perhaps she is also a mother who is doing her best despite

her difficulties. Real people don’t “function” they “live’.

If you are living with schizophrenia, whole chunks of your character, your

values, your behaviors, might not be affected by those symptoms that comprise the

particular form of schizophrenia you live with. Schizophrenia affects you but it is not

you. There is room to maneuver. There is room to observe how your ”illness” tricks

you into restricting your life. There is even room to dream about the life you want to

lead:(3) “To me getting well means that I try to stay in the driver’s seat of my life.”

That’s one persons dream.

Dr. Patricia Deegan says that “it is possible to live a whole healthy life and

still have a psychiatric disability.” It is not enough to have a diagnosis. Treatment of

mental illness is not a matter of taking an antibiotic and you’ll get over it. The mental

illness itself has its effects, the person’s reaction to being deemed mentally ill has its

effects, the medication has its side effects and the label mental illness has its effects

on all those around the patient.

In most cases the acute symptoms can be stabilized and once that has been

achieved the goal is to find the real person again. To see what they can still do; to go

on living despite their limitations; to follow their hopes, dreams, values and

commitments and re-build their lives.

Langley, Gordon E. Meeting Gerald Caplan Psychiatric Bulletin 1997, (21)
181-183.
2.
Deegan, Patricia E. “The First International Conference in Health and Mental
Care.”Keynote Address. 1955.
3.
Roberts, Glen E. “Narrative and Severe Mental Illness: What Place
do Stories have in an Evidence-Based World?” Advances in Psychiatric
Treatment (2000)6: 432-441.