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Deborah Danner and the Suffering of Schizophrenia

Deborah Danner and the Suffering of Schizophrenia

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COMMENTARY

Opponents of psychiatry use three main strategies when discussing schizophrenia and other forms of psychotic illness: deny it, romanticize it, or trivialize it. Thus, a recent “white paper” by the British Psychological Society (Psychosis and Schizophrenia) blandly declared, “Many of us hear voices occasionally, or have fears or beliefs that those around us do not share.”1

This shallow trivialization does scant justice to the nightmarish reality of psychosis, which is vividly detailed by Deborah Danner, a 66-year old woman with self-described schizophrenia, recently shot to death by a New York City policeman. The New York Times’ release of Ms. Danner’s eerily prescient 2012 essay, “Living with Schizophrenia2 gives the lie to the misleading narratives of antipsychiatry.

In her essay, Ms. Danner describes schizophrenia as “a curse,” with the only saving grace being, “. . . it’s not a fatal disease.” (That’s true, though the rate of suicide among persons with schizophrenia is about ten times that of the general population.3). For Ms. Danner, as for millions who suffer with schizophrenia and related disorders, her illness is like having “. . . the proverbial ‘Sword of Damocles’. . . ” hanging over one’s head. She recounts memories of “roaming the streets of New York in the wee hours of the morning” with the intention of finding “. . . a public place to kill myself. . .”

Ms. Danner laments the lack of mental health training among police, and the plight of both incarcerated and homeless persons with severe mental illness. And far from regarding mental illness as a “myth,” Ms. Danner rightly notes, “Mental illness is just that, an illness, a treatable illness and most of the public needs to be educated about that fact.” Instead, many in the general public (including some of Ms. Danner’s employers) regard persons with schizophrenia as terribly dangerous or violent, leading to unwarranted discrimination.

Each instance of severe mental illness is a personal, familial, and societal tragedy.

To be sure, untreated psychotic illness, especially if complicated by substance abuse, does substantially increase the risk of violence toward oneself or others.4 However, schizophrenia by itself is only weakly associated with perpetration of violence, and when adequately treated, poses a very small risk of violence toward others.4 And fortunately, suicide risk in schizophrenia can be significantly reduced with the use of antipsychotic medication.5

Unfortunately, in the public perception, “. . . there remains a focus on violence perpetration [by those with mental illness] to the neglect of victimization” within this vulnerable population.6 Yet when personality disorder and co-morbid substance abuse are taken out of the equation, persons with mental illness living in the community are more likely to be victims than perpetrators of violence, at rates of victimization several times higher than that in the general population.6

Ms. Danner observed that “. . . generally speaking, those who don’t suffer [with mental illness] believe the worst of those of us who do. We’re treated with suspicion as liars . . .” This is not surprising. The notion that people with schizophrenia are “liars” was actually propounded by one of psychiatry’s most famous critics, the late Dr. Thomas Szasz—who declared that mental illness is merely “a myth” or a “metaphorical” illness. But in his 1996 book, The Meaning of Mind, Szasz went even further, writing,

I believe viewing the schizophrenic as a liar would advance our understanding of schizophrenia. What does he lie about? Principally about his own anxieties, bewilderments, confusions, deficiencies and self-deception.7(p130)

Dr. Szasz, who was one of my professors during residency, had important things to say about protecting the civil liberties of persons with mental illness. But his view of schizophrenia as a self-inflicted form of lying has done great injury to those who suffer from this devastating illness. His position is also belied by scores of studies showing that persons diagnosed with schizophrenia show brain abnormalities at a significantly higher frequency than “normal” control subjects.8-10

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