Category Archives: Schizophrenia & Psychotic Disorder

Mind Reading in Mental Illness

Schizophrenia & Psychotic Disorder, Treatment Approaches

During the sessions, I often can’t help wonder, how if she was right and I was wrong. How if the field of psychiatry was wrong to label that as a symptom of psychosis, calling it “delusion”, while in fact our patients were right? How if they could really read minds and it’s not coincident? How if somebody else could really read her mind but the psychiatric consultants were too quick to discard and then label that?

It turned out that I’m not the only person wondering about it and hoping to carry out some experiments with the patients in the psychiatric clinic.

About 44 years ago, Dr Bruce Greyson thought the same. And as agreed by his colleagues in the psychiatric ward, they did this experiment, investigating whether the patients who claimed that they had telepathy ability could really read minds. The senders (those minds being read by the patients) were his psychiatric trainees who volunteered to have their minds read, as they focused on an image during the experiment. After that, the patients were shown the image along with four other pictures, and the experimenter asked if the patient knew which image the sender was looking at earlier.

Unsurprisingly, none of the patient performed above chance expectations. But what was intriguing to me, is what happened later. Before the experiments, they were concerned about the consequences of such experiments, whether they would reinforce or worsen their symptoms and made the delusion worse. But, all the patients were happy to have been given this opportunity to participate, and what’s more:

  • They could trust the hospital staff more because the latter have taken their thoughts and feelings seriously.
  • As they failed to read minds in this experiment, they started to doubt their other irrational thoughts too!
  • They learnt to separate fantasy from reality after that!
  • Patients actually got better.

Obviously as a clinician, if I was too quick to disregard their delusions and beliefs, I would definitely fail to build a good therapeutic rapport, which is one of the most important predictions of therapy outcome. So often it’s a balance between building a mutual trust and strong therapeutic alliance, and challenging some of these so that they get better.

Here I’d like to share this method of experimentation, especially to many family members out there who live with someone suffering from psychosis, to be open and curious, and not too quick to disregard their beliefs, but invite them to try out their beliefs and see what happens!

Read the original paper by Dr Bruce Greyson here: Telepathy in Mental Illness: Deluge or Delusion?

Where the voices come from

Schizophrenia & Psychotic Disorder, Treatment Approaches, , , ,

Sometimes I get this question from patients’ family, asking why the patient is hearing voices, how did it happen and what else do we know about these voices.

Here I’m referring to auditory hallucination commonly seen in people suffering from schizophrenia and psychotic disorders.

Yes they hear voices in their head, usually talking to them, quite commonly saying harsh and mean things to the sufferer. Sometimes they hear a few different voices having a conversation, and it’s not difficult to guess, the conversation is about the sufferer.

“Look! She has no friend! She looks so ugly and stupid!”

“Indeed. I wouldn’t want to befriend someone like her.”

“She should just kill herself. Nobody likes her anyway. Why is she still living?”

I mean, who with a sane mind would say such things to others? Nobody. How was these produced?

In 1993, McGuire and Murray published a research article “Increased blood flow in Broca’s area during auditory hallucinations in schizophrenia“. Let me break it down a little for you… The functions of Broca’s area has a lot to do with “speech production”. As compared to another area of the brain, the Wernicke’s area, is responsible for the comprehension of speech.

Locations of Broca's Area and Wernicke's Areas. (NIDCD, 2010) | Download Scientific Diagram
Locations of Broca’s and Wernicke’s. Picture taken from researchgate.net

So what does this mean?

When the patients are hearing voices, which do not sound like their own voices, the “speech production” area of the brain has increased blood flow, less so in the “speech comprehension” area. We can’t conclude anything from here obviously, but it becomes clearer to the researchers that those voices are produced by the brain itself, almost like their own’s thought processes (which we all do: talking to ourselves or having inner talks), but “presented” as somebody else’s voice.

So it seems likely that it’s their own thoughts. At least that’s what research has found. And I believe many clinicians would agree with me — often we see those voices are actually the patients’ core beliefs, worries, and are what they were told (by their parents, significant family members, teachers etc) when they were much younger. As a therapist, when I look at it this way, it opens up a lot more possibilities to help people who are suffering from auditory hallucination. And indeed, quite a number of techniques in mindfulness-based approach and cognitive therapy have been found useful.

電視劇《我們與惡的距離》

Issues & Debates, Review - books movies series, Schizophrenia & Psychotic Disorder, ,

最近因為新冠病毒和行動管制令，終於有時間看台灣這部拍得好寫實、令人好多感悟和痛心的10集電視劇《我們與惡的距離》。

這是過程中我有的一些很深很深的感觸和領悟（劇透，想看還沒看的話不要往下讀了）：

（一）：李媽說：“全天下沒有哪個父母要花二十年養成一個殺人犯！”我哭了好久。是的，兒子是個殺人犯，大家普遍都怪到父母身上，不能教養不要生，不能照顧培育不要生… 可是也用一樣的教養方式，為什麼妹妹曉文反而堅強不屈？真的都只能怪到父母身上嗎？

我甚至在想，身為一名心理咨詢師，要是我的孩子犯了大錯（或也一樣成了殺人犯），社會會放過我嗎？社會本來就對特定職業人群有特別的要求，如老師、醫生、藝人、政治家等。這其實也沒錯，可是有時，有些父母悉心照料，有些父母工作繁忙（像Johor的蠻多孩子都是祖父母養大的，因為父母都去新加坡了），有些父母每天吵架暴力，有些父母爛賭酗酒（讓我想起有個患者的爸爸，問她為什麼還不死？她死了他也不會傷心，反而會開心再也不用給她錢了）… 可是不是每個酗酒的父母的孩子都長成一個樣，更不是每個悉心栽培的都成功養出龍鳳，不是嗎？我不是要允許父母推卸責任。可是就像在五六十年代，你的孩子要是精神分裂（思覺失調），母親肯定要被怪罪的。可是後來已經發現並不是這樣的啊… 沒有單一的原因的嘛。

（二）你或許是受害者的家屬，也就是受害者了，但那不代表你可以“替天行道”懲罰加害者和其家屬。李小明被處決後，喬安姐決定派攝影團隊跟蹤大芝，那一刻，我真的無法接受。因為我以為喬安終於可以放下了，不懷恨地諒解大芝為何辭職，甚至以為兩人可以坐下好好聊聊。她那麼做的當下，真的把我搞崩潰了。（是自己太天真，導致落差太大，抽離不出來）

當天夜裡，看完那集後，我寫下“無論你多恨一個人，你也不能傷害對方和他的家屬”。我希望自己記住這點。尤其大芝其實也是事件中的受害者之一，憑什麼她什麼也沒做錯卻被如此對待。受害者家屬或許還可以理解，更甚的是那些完全事不關己啃著瓜子的網民、媒體、大眾，人人都在補刀撒鹽………

（三）這就把我帶到第三點：加害者的家屬。我們從來沒有站在加害者的家屬的角度去看待事情對嗎？我們一直、一直都只在關注受害者和家屬的失去、悲痛。家人被殺害確實太可憐。可我認為，這部劇拍得最好的地方，就在於允許觀眾以加害者家屬的角度去體驗、承受。他們也真的很可憐。而如果像劇中最後，加害者家屬與受害者家屬能那樣坐下來面對和發洩，那其實真的很好很好（這要是真的，會讓我很羨慕台灣）。對雙方而言，那需要多大的勇氣和心胸…

（四）其實這部劇的重點，都是透過媒體傳達的。我倒沒有什麼要多說的，台灣媒體的整體型態，似乎已經是個“病態”很久很久了，久得人民也或許習慣，而也又愛又恨。媒體的責任其實真的很大，外加現在還有網民………. 人人都能當法官判罪！感覺“很棒”，不是嗎？

（五）最後來到我的重點：精神疾病。患有精神疾病的人，包括思覺失調 (Schizophrenia) 或躁鬱症 (Bipolar disorder) 的人，都不比常人更容易有暴力行為。請你把我的上一個句子，再看一遍。他們傷害他人的機率，並不比你我傷害他人的機率來得高（他們其實因為長期吃藥、患病的壓力、幻聽或抑鬱等因素，比常人更可能傷害自己）。可是過去的電影、電視劇、報章等，都愛把他們和暴力或變態行為相連…

而剛巧，我在提筆之前，看到這則台灣新聞：要求复合遭拒绝‧男子砍伤15岁少女获刑。文中提到“律师辩护曾男有强迫症、焦虑症等精神疾病，有到医院就诊纪录，但却并未按时服”。我了解在大部分國家，患有精神疾病的人如果犯了什麼，都會受到一定的保護，或許被就醫治療，或許被判處的刑法會較輕。而我不知道各位律師是不是就因為這樣，可以“總是用”（我說的誇張了哈）精神疾病來辯護。這樣呈現在媒體中，感覺上像是“患有強迫症、焦慮症的人會砍人”，不是嗎？？？………… 狗屁不通！！！是的，患有思覺失調或妄想症的人，可能出現幻覺 hallucination、妄想 delusion（像劇里的思聰，幻聽是他聽到的聲音的部分，妄想是他老懷疑別人偷拍竊聽他等），有時會分不清哪個真實哪個是幻覺，有時會自言自語，或在他人無法理解的情況下而變得很抓狂(／frustrated)。像我的一些患者，會聽見聲音叫他去死，去跳樓等。可是如果你用“強迫症”、“焦慮症”，這真的真的太離譜了。我可以建議各位律師的是：給專家評估邊沿型人格障礙… 或一些較少見的人格障礙等。也真的希望媒體努力把一些錯誤的信息糾正過來，畢竟這也是你們的責任之一。

用于精神病患的接纳与承诺疗法 (ACT)

Schizophrenia & Psychotic Disorder, Treatment Approaches, , ,

近几年在北京当助教和翻译的时候，常遇见学生问说除了药物以外，还有什么方法可以帮助精神分裂患者，尤其许多患者用药虽然很重，但还是有幻听(auditory hallucination) 和妄想(delusion) 的症状，严重困扰着生活。

其实现在有越来越多的研究表明接受和承诺疗法（ACT）对于精神病患者很有帮助。作为干预，ACT不是特别针对症状减轻，而是强调对精神病症状更灵活的反应，以鼓励价值驱动的行为（就是你的生活由你的生活意义和价值来决定，而不是完全被你的病状所控制）。许多的案例研究显示，用ACT帮助偏执狂 (Paranoia)，妄想 (Delusion) 和相关的情绪障碍，虽然症状没有完全缓解，精神病依然存在，但却相当程度的减轻了患者的痛苦，而且生活的功能性和基于价值的活动(Value-based activities) 显著增加。

所以如果你，或者身边的家人或朋友患有精神分裂症，尤其幻听和妄想的症状在用药后依然对生活造成相当的困扰，可以考虑留言或电邮联系，因为只要患者有心改变，6到10次基于 ACT 的心理治疗就可以学习新的应对方式，减轻痛苦，活得更有意义。

Support Group is running now!

Anxiety Disorder, Depression, Obsession & Compulsion, Schizophrenia & Psychotic Disorder, ,

UPDATE 13/2/2020:

Hi all, it’s unfortunate that due to current situation (Covid-19), the support groups are not running, however, please do fill in the google form to register your interest: https://goo.gl/forms/PaFNW2LBfOkOOeUv1

You will be contacted once they are running again. Thank you.

Yes, since my post written in 2017, I’ve finally managed to organise the first meet-up for Support Group for Anxiety and related problems. It went really well and we were all very pleased to meet each other and made this happened together, despite our levels of anxiety! We will continue to meet monthly and welcome new members.

Meet-ups for Depression and other problems will follow soon…

If you’re interested, please fill in the google form here:

https://goo.gl/forms/PaFNW2LBfOkOOeUv1

A few criteria to fulfill:

  • You’ve been assessed or diagnosed with the problem you specified by a mental health professional (be it a psychiatrist or psychologist or GP or…).
  • You’re attending and participating in this willingly, not being forced by others.
  • You are able to arrange your own transport and pay for your expenses.
  • You are able to pay a small fees for administrative/materials purpose.
  • You demonstrate the ability to treat others non-judgmentally and with respect, and maintain confidentiality.
  • In between our monthly meet-ups, we stay connected in Whatsapp group, however, you will only be able to join the group after first showing up in the meet-up.

To read more about it, please check out my previous post:

Support Groups in KL/Klang

Positive Symptoms of Schizophrenia: A Patient’s View

Clinical Case Studies, Schizophrenia & Psychotic Disorder

She was referred to me by a consultant psychiatrist, diagnosed as schizophrenia, and taking some medication for the past few years. She is compliant with the medication, even though the medication makes her struggle to wake up every morning. She has a job. She completed a degree few years ago, and has been able to hold her job most of the years despite her illness.

I remember during our first session we talked quite a lot about the symptoms of schizophrenia. She used to have paranoid delusion (suspecting that a fellow friend from the uni is following her and trying to do her harm etc), but now has only auditory hallucination (hearing voices of the ex-coursemate).

The consultant psychiatrist and I always thought that she had good insights into her symptoms and illness. Until it was the 4th session, she disclosed that she never thought she had any illness. Why was she taking the medicine? Because it helps her emotionally, feel calmer. I suddenly realised that it was true in her case, because her antipsychotic drugs have never reduced/ceased her voices.

Sometimes it seems that the voice is like a friend to her. We have discussed that if there is no way to remove the voices right now, how she can live with the voices, and she seems ok with it (sometimes). But after more discussion, I realised that her problems with this voice is because the voice broadcasts her thoughts. She always thinks that others can read her mind, and it’s due to this voice. She can live with this voice if there is no way to get rid of it, but she can’t live with this voice telling everyone else her thoughts…… (she gave quite some good examples of others knowing her thoughts and responding accordingly, and she thinks all these were too much a coincidence).

She believes that the voice in the mind is machinery operated, and this machine is controlled by the ex-coursemate. Once during a breakdown, she even went to confront the person, and the person denied having done that to her. Now when she’s relatively well, she thinks there is no point to confront the person, because the ex-coursemate would surely deny (and she wouldn’t believe that).

From the Psychology’s perspective, both delusion and hallucination are common positive symptoms of schizophrenia. They also tend to happen together.

From the client’s perspective, it’s more complicated than that. Because she doesn’t think they are two separate symptoms of an illness. They are one thing, the voice (hallucination) broadcast her thought (mind being read – delusion).

I surely didn’t attempt to argue with or convince her that it was just her illness. I’m not being irresponsible or denying my job and role as her therapist (I can and will still help her in many other ways), but consider this carefully, is there any point at all to do that in her case? (especially that she’s almost fully functional and is taking her medicine regularly and attending therapy session monthly). After all, who knows she might be right and I might be wrong? Who says everything I learnt in my degrees must be right when the so-call anti-psychotics are not ceasing/reducing her positive symptoms? Who is the expert in one’s illness?

 

Additional knowledge:

Positive symptoms of schizophrenia: Delusion, Hallucination, Racing thoughts

Negative symptoms of schizophrenia: apathy, lack of emotion, poor or non-existent social functioning

Cognitive symptoms of schizophrenia: disorganized thoughts, difficulty concentrating and/or following instructions, difficulty completing tasks, memory problems