This podcast episode presents an insightful exploration of schizophrenia, a serious mental illness that significantly impacts individuals and their families. We delve into the complexities of the disorder, discussing its typical onset during late adolescence or early adulthood, and the profound effects it has on one's perception of reality. Drawing from a documentary about a family with multiple cases of schizophrenia, we highlight the genetic components associated with the disorder and the debilitating nature of its symptoms. Throughout our discussion, we emphasize the importance of understanding the lived experiences of those affected, as well as the challenges they face in seeking treatment. As we navigate these difficult topics, we aim to foster a deeper awareness of mental health issues within our community.

Website: American Psychiatric Association / What is Schizophrenia?

Website: Six Schizophrenic Brothers on IMDB

Website: Community Mental Health (CMH)

Website: National Alliance on Mental Illness (NAMI)

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Mike and Morgan welcome questions and comments Email: A PsychoDelicous Conversation

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Welcome to a Psycho delicious conversation on mental health issues and trends from two local mental health professionals in the greater Lansing area. I'm Michael Stratton, lmsw.

And I'm Morgan Bowen, dnp, pmhnp. And we're here to provide you with a deep dive into the human experience of consciousness and beyond. Our aim is to be educational and entertaining.

So just kick back and open your ears and your minds.

Hey, this is Mike Stratton and I'm.

Morgan Bowen and we are here post.

Holidays, which who knows when you're going to hear this but. But we're here in our time machine just a week after New Year's Eve.

Happy New Year.

New year.

So we were talking all things celebratory before we opened things up. However, that's not our topic today.

We'll give you the other stuff.

What are we talking about today?

Michael, I believe you made the suggestion.

I did actually, that we talk about schizophrenia. I did.

We haven't talked about it and over the break I had some time so I watched a documentary called, I think it was called Six Schizophrenic Brothers and it's on Netflix. It's a four part series of a family in Colorado with 12 children. They were an Irish Catholic family, similar to one of the speakers here.

I don't know about you.

My, my wife's family, well, she only.

Had half a dozen somewhere in the Wandering for my.

But six out of the 12 children had schizophrenia, which is a huge amount of.

That's a lot of schizophrenia. Yeah.

In the family.

Yeah.

So it got me thinking about, about schizophrenia, which we haven't talked about. So. No, figured that would be a good topic for us and it's in the realm of, you know, serious mental illness or smi.

So if you work in the field, that's. And it's, it's kind of a specific sub, you know, a sub.

I don't want to call it a subset, but typically people who work in the field, you know, who work with SMI or serious mental illness, including schizophrenia, are a bit different than, you know, what you and I do in the outpatient private practice world. Although sometimes there's some crossover.

Although, you know, both of us had experience working with a number of schizophrenics when we were working at the hospital inpatient and then also adult day treatment where I worked for a couple of years. Didn't you. I mean, you were a psych tech. What, what years were you? Do we want to say specific years?

We can. I Don't mind how many years, let's.

Put it that way.

Oh, let's see. So it was before I became a nurse. It was while I was going to nursing school. So I did it for, I think, about three years total.

Yeah. So I was like.

I was like 30 years before you, and I was there for just over two years, and then I was in day treatment for like another two and a half years. So I was over there a total of five years.

So what was the day treatment through St. Lawrence?

Yeah. Yep, yep. And it was a lot of schizophrenics who had passed through there.

When we saw them inpatient, which I'm sure you did, too, you would see people who were what they call floridly psychotic. They were having the symptoms of schizophrenia upon admission.

That is such an old phrase. I love that phrase. Floridly. Floridly, yes. When I first read that, and like a doctor's note or in charting, I just thought it was kind of a beautiful.

A beautiful way to describe.

What do they say now?

What do they say? A very ill person.

Gosh, I don't, you know, exhibiting, you know, psychotic symptoms, exhibiting severe psychosis, delusional, you know, hallucinations, hallucinating, kind of more of the specifics. I would think maybe floridly psychotic is a little too general for today's charting.

Yeah, I would think so, too.

From a layman's term, I can't actually say that I've ever met or that I knowingly met somebody with schizophrenia. So my familiarity is pretty much movies, and I was kind of looking over at, like, A Beautiful Mind. Is that like, did you see it?

He was psychotic?

Would you say that's a good portrayal, Like a. Reflective of what it's like?

Well, so. All right, so. And we should, you know, kind of define some things and talk about it. So A Beautiful Mind. And actually there is a.

Like a controversy, a discussion about what. What was his name? John Nash. Stephen Nash. It was Nash.

Russell Crowe.

Played by Russell Crowe. Very, very, very smart scientist. What was he, a physicist or. Nope. Economics. Yeah. Mathematician.

Forbes, naturally.

So a lot of people think that he was actually bipolar with psychosis because he was so high functioning at times. And a lot of times with schizophrenia, people are not so high functioning. Although that's not always true. That is not universally true.

But it is an illness that I think most people associate with psychotic phenomenon features, which are hallucinations. So seeing things that People can't see.

And more often hearing.

Yeah, hearing things. Yep.

Yeah, that's a more common hallucination, like hearing. It's like the radio's on but there's no radio in the room. Like you're hearing it and wondering why other people aren't hearing it.

When does it usually show up in somebody?

Early, well, adolescence or early adulthood. Typically is the onset late adolescence, early adulthood. And so 17 maybe starting to show some signs.

And there is a pre presentation like things that happen to somebody before the. Before the illness happens. But usually 19, 20 is kind of when it starts to become more apparent.

What would those signs be?

Well, certainly. And a lot of times a person doesn't talk about them because it's very scary. And the person doesn't know exactly what's happening.

But they're disorganized thinking, so sometimes not making sense to others, talking about things that are not happening. Maybe people are following them or they can see somebody outside or you know, something happens. There's a lot of fear.

Lots of, you know, they don't know what's going on, so they're afraid of something thing.

Paranoia sounds like the biggest sign.

Yeah, huge sign. Also there's like behavioral kind of disturbances. Maybe walking a lot, pacing, looking off into the distance.

Sometimes periods of time where they're very still and just kind of don't appear to be, you know, sort of they're there but they're not there kind of thing, things like that. Just bizarre types of things that happen that are out of character for them. That's what I would say. What about you, Mike? What do you remember?

What do you say?

Well, what I remember from the hospital when people would show up and I like that idea of the fear because I remember there was a psychiatrist who came and gave us an in service once on schizophrenia and he said it's the condition of chronic terror. Just being terrified of the world, it's not making sense to them.

So the disorganized thinking, there's input that's coming in that doesn't seem to be matching what else is going on. And so the delusional states are a way of trying to make sense of it. I'm hearing voices telling me things. No one else seems to be doing this.

So therefore there must be some kind of a conspiracy going on, probably against me. Maybe it's the government, maybe it's aliens, maybe it's monsters, maybe it's who knows what.

But the delusions, the delusional states that kind of explain to them what's Happening internally that other people don't seem to be making any sense of for themselves.

Yeah, and a delusion is a little bit different than a hallucination. A delusion is like a belief in something. It's a. It's a thought, and frequently an organized way of thinking.

So if somebody has a paranoid delusion, maybe they think that the police are out after them, or, you know, the FBI or aliens are able to, you know, read their thoughts. Those are some kind of common things that you hear with people.

There also can be, and very frequently is, a religious component to it, to either a delusion or hallucination. Lots of ideas of good and bad and evil and who's good and who's evil. It's very terrifying to the person. The person is usually incredibly scared.

And a lot of the reactive behaviors that can happen are from fear, or really the person may be thinking that you're after them, and if you're trying to help them, then it can kind of create a situation where they're afraid of their life and may react in a way that reflects that.

So one thing I'm always looking at is continuums. You know, at the far end is that kind of delusional thinking that's a result of hallucinations.

But I think to some extent, we all are trying to tell ourselves a story that makes the world make sense to us. You know, it may not be at that point of delusion, but we may be believing things that aren't real.

And as time goes on, you come to realize, like, oh, my gosh, he really was a crook the whole time, for instance. But do you think that there are different. The word that comes to mind is gradations or maybe different levels of how badly someone has schizophrenia.

Are there mild cases of schizophrenia?

Well, I think it's more. Well, how much it's going to impact quality of life and functioning.

Because the other components with schizophrenia are not a lot of interest in relationships. Not really. Sometimes not a lot of interest in bathing, showering.

There tends to be kind of a neglect of grooming that happens and just kind of not following or not keyed into social norms or societal norms. And so that can cause problems with being able to work, have a job, you know, kind of function in a way that allows them to integrate into society.

Not always. And with treatment, that can be changed. But I think that usually the severity is how much the symptoms or the illness is going to impact that.

You know, some people use the term psychotic break, so there's kind of a gradual onset, a lot of what you were describing is kind of a gradual onset, but then there's also like a real sudden break that someone might experience.

I think both of us talked about this in a prior episod episode, that some people that are prone to this, that have a family history of this, can be triggered by smoking some very strong cannabis, for instance, or some angel dust or something else that can trigger like, a psychosis. And people will describe like, they were just fine, and then all of a sudden they were. They weren't dealing with reality. They were not fine.

They were really not fine. Yeah, yeah, yeah.

So in schizophrenia, it tends to be that more gradual, you know, like, you can usually looking back, identify a. Because not all psychotic illnesses are schizophrenia. There are other versions or presentations that are not so consistent with schizophrenia.

That just tends to be the one that is most known, you know, in psychiatry, in psychology, that. That was one of the most interesting things for early psychology was to really understand the experiences of people who were psychotic.

So psychiatry has a really rich history of it or interest in it. So we're kind of talking about the presentation and then the quality of life as well.

And one thing I would say is that it's just incredibly debilitating. And it happens to somebody when they're young. And so a lot of times they're in school, they're doing really well, things are going.

Person has really a bright future, and then they begin to show signs. And that's what really came out in this documentary I was talking about.

It was very, very good representation of just how the illness impacts the person as well as like the entire family and community.

So one after the other was starting to show signs of it. They just. As they reached a certain age.

Yeah. And the thinking is that there is a strong genetic component to it with.

So they and other families where there had been multiple cases of the illness and one family have been part of a study and other. A series of studies to sort of connect the genetics with the disorder.

Have they found, like. Is there a. Like a schizophrenic gene? Have they been able to narrow that down to that point?

I don't know. Yes. Not that I know of. That's the goal. There are genes that are associated with it.

They have found genes of interest, I guess I would say, as far as I understand, I'm not an expert in this realm, but genes of interest. Genes of interest.

Because what you look for is genes that show up, especially in a family, repeated genes, where only the people with the illness have this gene mutation. And those in the family that don't have the illness, don't have that. That's kind of very confirmatory evidence.

And so that's why there's so much interest in this particular case. And at least according to the documentary, one particular researcher from Harvard, psychiatrist. I can't remember her name.

Was able to identify a gene of interest. Continue on.

I have to apologize. I've been watching Crunk.

Yes.

So she. She would say, would you find these jeans in the mall?

Right, right. D n A. No.

Crunk is the name. It's a show.

It's a. Yeah. Philomena Cronk is her name.

Yeah.

She goes.

Yeah, she's. She makes those kind of ridiculous. Very, very. Oh, that's her. That's her. You just. You just brought her up. There she is.

Is it?

Sorry. Thank goodness.

I. I thought we were getting all little John up in this.

Anyway.

Oh, so we.

I like Crunk on Earth. Sorry, go ahead.

Do people who are schizophrenic realize they're schizophrenic?

So this is another. I'm glad you brought that up, because that is hugely connected to the success of treatment.

So anosognosia is the state of not believing that you are ill. And so there is. Yes, people that do experience anosognosia. I always struggle with saying that correctly, and I'm not sure I did it.

But if they don't accept, they don't take medication, they won't. And so this happens. And that's associated with poor outcomes.

So, yes, there are people with the illness who absolutely do not believe that they do have the illness, particularly when they are, you know, psychotic or in the acute stages of the illness, which makes it very difficult to, you know, to work with and to treat.

I'm thinking about a particular individual that I was working with at one point when I was in day treatment. These were people who were generally pretty stabilized, you know, and so they were coming in two to three times a week and having programming.

And I was running a group of some kind, and this person came up to me and said, I need to talk to you right away. And I said, what is it? And they said, I have just destroyed the universe. And it was kind of shocking to hear someone say that.

And I said, you know what? I was just out in the universe and things were okay. Things were really okay. And they said, no, no, I've done that.

I said, well, wait until the group is over and we'll go check it out. And so we walked out onto the street, and I said, See, everything is here.

He said, just, just beyond this, right behind those houses, everything is gone. And so I said, well, let's go do that.

Anyway, we did that for a couple of streets or so and then I realized like this was not going to be a matter of logic, it wasn't a matter of reality testing. He was very, very sure that in fact, I mean that was his delusion was that he had destroyed the universe.

So it's like, you know, you need to get on some medication again and get stabilized and all that kind of stuff. But what a miserable thing to think that you've destroyed the universe, you know.

Yeah, it's very, very.

Again, just like there's a heavy burden, there's just a heavy mental burden that comes with, you know, believing that a lot of the common things that you will hear, especially with auditory hallucinations is, you know, people can't really make out what they're. A lot of times the voices are muted, they're not really intelligible. They can make out some words, but not a lot.

It's almost always negative and negative commentary on the person. They're ugly, they're not good enough, you know, they're never gonna do anything, they're evil, their thoughts are bad.

And the person can be very ashamed. And it's just a, it's a very torturous space to be in.

So they'd be pretty high risk for self harm.

They are absolutely, yes, yeah, those kinds of things. Much higher risk for suicide than they are for hurting other people.

And that's very consistent in the epidemiology of the illness is that there's a high rate of. Much higher rate than the tip, you know, than the non ill population for hurting themselves or killing themselves. Suicide.

Yeah.

When I worked at the hospital, when we were, when I was working on the inpatient, they had an inpatient and then they had a locked unit where people that were actively psychotic, they'd put them back there because they were more likely to be harmful to themselves or someone else. And they had more hands on supervision, you know, someone watching them all the time. It was a smaller unit.

I think there were six, six rooms maybe back there. But then they also had an isolation room where sometimes people were actually needed to be, whether they needed it or not.

Sometimes they were restrained, you know, actually used to tie to a bed that would keep them from harming themselves or harming someone else. That didn't happen very often, but it did happen occasionally.

And I always felt like, oh my God, this is cuckoo's Nest, you know, it's just, I don't know if they, I don't know to what extent that still happens.

It's much lower. And those things are tracked now.

Those are huge markers that are tracked by Medicare Services, CMS to kind of indicate the quality of treatment for somebody who's in inpatient. So it's something that the hospital's inpatient units track and it is monitored pretty. I mean, it's a heavily monitored.

And so the goal is to reduce that to, you know, as much as low as possible.

And there's benchmarks that, you know, people work with and it certainly happens, you know, in very extreme cases, but it's after a whole lot of other stuff has been tried to, you know, kind of mitigate the situation without having to do that.

Yeah, I would think that staffing, I mean, if you could put someone in a one on one situation with somebody to help them de.

Escalate and do a little reality testing or helping them just to relax, you know, just to relax and to breathe with somebody, you know, that kind of thing.

Well, and I think another important thing, you know, is this.

These are members of our families and communities and, and so people live with the illness and are, you know, in our area and we have social networks to, you know, to help and to, to attempt to, to aid those in our community. And so, you know, you and I have talked about St. Lawrence, that is, you know, historically the psychiatric hospital in Lansing area.

We're going to get sued now.

Oh, why do you say that? No, I just.

Well, no, that's.

That.

Is this, that's where we, that's where we worked.

Yes. Well, St. Lawrence was a standalone.

There's a lot of stories, like trying not to tell.

Sounds like some paranoia going on there. I'm just saying.

Yep, yep.

They've been watching me.

They have. St. Lawrence has been, you know, it was an independent hospital.

Currently it's part of Sparrow Hospital, which is now part of University of Michigan or Michigan Medicine. But St. Lawrence, up until what the 90s was, was, was their own hospital separate than Sparrow.

Right.

And it was the place for behavioral health that was like the behavioral health place for both inpatient day programs. I think they had a lot of just outpatient, you know, and they also.

Had outpatient as well.

Yeah, so they had outpatient, partial hospitalization and then the inpatient, they had a whole floor that was all psych and then the floor above was for substance use.

And when we were in day treatment, when I worked in day treatment, we had some epic Volleyball battles against the people that were in the substance abuse unit. And we would beat them. We were very proud of our status.

I thought I was good at volleyball until I went out and played with people that weren't highly medicated.

Well, and it brings up, you know, when you're in a community like ours, which is, you know, not small, but it's not humongous. It's not, you know, like a metro Chicago or whatever, so, you know, the people that work in psych kind of tend to know each other.

And then a lot of times people with serious mental illness are connected with the people that work with them. So it's kind of its own little community in a way. And so I liked that about working at the hospital is you get to know people.

You see them out of the hospital, you see them.

Yeah. And you would see people on a pretty regular, semi regular basis.

At least at one time when I was working there, it wasn't unusual for someone to check into the hospital and be there for weeks and sometimes months and the insurance would pay for it. You don't see that anymore. That's. That's pretty rare.

But you'd often see the same people coming back after a series of months or year after year to get stabilized. And that again, not something you probably see as much anymore as you used to.

No, there's a lot of different programs. And the other piece of this is community mental health. So community mental health is a huge network of programming and workers that.

That is county by county, and the money is dispersed through the federal government and then also through the state government to help and assist with the care of persons who need, you know, a lot of care, which is, you know, people who are severely mentally ill.

But they don't have anything on site. Do they have. Do they have something on site?

They do over on Jolly in Pennsylvania. Is the. Is, you know, the main, I mean.

A place where they can go in.

They have what's called a crisis stabilization unit. And so for people who are in crisis, they.

If it's something that is more acute or needs more intervention, then a lot of times they will be brought to the hospital from the stabilization unit. But they do have a place for people to present if they're having problems. And then they also.

They do have offices and programs that are there, although I'm pretty sure, yeah. But they also have other buildings throughout the community for geriatric services, like Tri County Office on Aging is through cmh.

I'm not exactly sure where that is, but that's a huge is that through cmh. It's connected with CMH for people with aging, related psychiatric issues, dementia, things like that.

Okay.

Yeah. So it's a network of services that's pretty vast. A lot of persons with serious mental illness are connected through them.

And then I guess I would also say NAMI national alliance on Mental Illness has a very strong chapter in Lansing for both persons with mental illness as well as family members. Because it really is a family illness.

Because people frequently are, you know, they remain connected with their families and ideally their families can be involved in their life and in their care. But sometimes it's not available, but just depending.

And that'll carry over into part two of this program, which will be Treatment.

A Psycho Delicious Conversation is meant for educational and entertainment purposes only. It is no substitute for therapy and should not be treated as such.

If you feel a need for real therapy, you should consult your local provider, Google Therapy, or therapists in your area. Check with Community mental Health or a suicide hotline if you are feeling suicidal.

Mike and Morgan welcome your questions, feedback or dilemmas. Feel free to send us an email@psychodelicious conversationmail.com that is a psychodelicious P S Y C H O D E L I C I o u s conversationmail.com.

The views expressed on this podcast are solely the opinions of Mike Stratton and Morgan Bowen and do not reflect the views or opinions of any site broadcasting this podcast. Replication of this podcast without rich and permission is strictly prohibited.