Surviving Schizophrenia: A Manual for Families, Patients and Providers by E. Fuller Torrey

From the Publisher

Since its first publication in 1983, Surviving Schizophrenia has become the standard reference book on the disease and has helped thousands of patients, their families and mental health professionals. In clear language, this much–praised and important book describes the nature, causes, symptoms, treatment and course of schizophrenia and also explores living with it from both the patient and the family's point of view. This new, completely updated fifth edition includes the latest research findings on what causes the disease as well as information about the newest drugs for treatment and answers to the questions most often asked by families, consumers and providers.

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Table of Contents

Read an Excerpt

Chapter One

Dimensions Of The Disaster

Schizophrenia is to psychiatry what cancer is to medicine: a sentence as well as a diagnosis.

W. Hall, G. Andrews, and G. Goldstein,
Australian and New Zealand Journal of Psychiatry, 1995

Schizophrenia, I said. The word itself is ominous. It has been called "one of the most sinister words in the language." It has a bite to it, a harsh grating sound that evokes visions of madness and asylums. It is not fluid like démence, the word from which "dementia" comes. Nor is it a visual word like écrasé, the origin of "cracked," meaning that the person is like a cracked pot. Nor is it romantic like "lunatic;' meaning fallen under the influence of the moon (which in Latin is luna). "Schizophrenia" is a discordant and cruel term, just like the disease it signifies.

Our treatment of individuals with this disease has, all too often, also been discordant and cruel. It is, in fact, the single biggest blemish on the face of contemporary American medicine and social services; when the social history of our era is written, the plight of persons with schizophrenia will be recorded as having been a national scandal. Consider the dimensions of the disaster.

1. There are at least as many individuals with schizophrenia homeless and living on the streets as there are in all hospitals and related facilities. Studies of homeless individuals in the United States have estimated their total number to be between 250,000 and 550,000. A median estimate of 400,000 is consistent with the data from most of the studies. Studies have also reportedthat approximately one-third of homeless individuals are seriously mentally ill, the vast majority of them with schizophrenia. It is likely, therefore, that on any given day at least 100,000 persons with schizophrenia are living in public shelters and on the streets. As will be described below, there are only approximately 100,000 people with schizophrenia in all hospitals and related facilities at any given time.
2. There are more individuals with schizophrenia in jails and prisons than there are in all hospitals and related facilities. A recent Department of Justice survey reported that 16 percent of inmates in local jails and state prisons, or 275,900 individuals, are mentally ill. Based on data from previous jail surveys, it is reasonable to estimate that approximately half of them, or 135,000 individuals, have schizophrenia. Thus, there are more individuals with schizophrenia in jails and prisons than there are in all hospitals and related facilities. Even more shocking is the fact that 29 percent 'of jails acknowledged holding such individuals with no charges against them, often awaiting a bed in a psychiatric hospital. The vast majority of those who do have charges have been charged with misdemeanors such as trespassing. The Los Angeles County Jail is now de facto the largest mental institution in the country.
3. There are increasing episodes of violence committed by individuals with schizophrenia who are not being treated. Individuals with schizophrenia who take medications are not more violent than the general population. However, as will be discussed in more detail in chapter 11, recent studies have shown that some individuals with schizophrenia who are not taking medication are more violent. In one study, 9 percent of individuals with schizophrenia who were living in the community had used a weapon in a fight in the preceding year. In another study, "27 percent of released male and female patients report at least one violent act within a mean of four months after [hospital] discharge." Assaults against family members by individuals with schizophrenia have also risen sharply; a 1991 survey of the members of the National Alliance for the Mentally Ill reported that 11 percent of the seriously mentally ill family members had physically harmed another person within the previous year. A Department of Justice study reported that there are almost 1,000 homicides a year committed by individuals with "a history of mental illness"; media accounts suggest that the majority of these have been diagnosed with schizophrenia. Drug and alcohol abuse and noncompliance with medications both appear to be important factors in increasing violent behavior in this population.
4. Individuals with schizophrenia are increasingly being victimized by others. Most crimes against individuals with schizophrenia are not reported; those instances that are reported are often ignored by officials. Purse snatchings and the stealing of disability checks are common, but rapes and even murders are not rare. In Los Angeles, a study of board-and-care home residents, the majority of whom had schizophrenia, reported that one-third of them had been robbed and/or assaulted in the preceding year. In New York, a study of 20 women with schizophrenia reported that half of them had been raped at least once, and 5 had been raped more than once. In Des Moines, Van Mill, a homeless man diagnosed with schizophrenia, was beaten to death by three men, then dumped into a children's wading pool.
5. Housing for many individuals with schizophrenia is often abysmal. Because of pressure from state departments of mental health to discharge patients from state hospitals, seriously mentally ill individuals are frequently placed into housing that would not be considered fit for anyone else. For example, in 1979 the police removed 21 "ex-mental patients' living in New York City board-and-care homes "amid broken plumbing, rotting food and roaches.... The police found the decaying corpse of a former patient lying undisturbed in one home inhabited by six other residents." Similar reports continued throughout the 1980s, and in 1990 the New York Times headlined still another report: "Mental Homes Are Wretched, A Panel Says." In Mississippi "9 ex-patients" were found in a primitive shed with "no toilet or running water" and "guarded by two vicious dogs" to insure that they did not run away.
6. Many individuals with schizophrenia revolve between hospitals, jails, and shelters. Because of the failure of mental health professionals to...