Successful and sociopathic

I thought this NY Times op ed, "Successful and Schizophrenic," had some interesting parallels. It tells the story of a law professor who was diagnosed as schizophrenic (I hope I'm doing the math right) in her early 20s. She was basically told that she would be living in a group home for the rest of her life. And she was actually hospitalized multiple times (apparently), but after her last stint at age 28 she was told that maybe she could get a job as a cashier making change part time. Instead she became a law professor and recipient of a MacArthur Foundation genius grant. Is she still schizophrenic?


Although I fought my diagnosis for many years, I came to accept that I have schizophrenia and will be in treatment the rest of my life. Indeed, excellent psychoanalytic treatment and medication have been critical to my success. What I refused to accept was my prognosis.

Conventional psychiatric thinking and its diagnostic categories say that people like me don’t exist. Either I don’t have schizophrenia (please tell that to the delusions crowding my mind), or I couldn’t have accomplished what I have (please tell that to [University of Southern California]’s committee on faculty affairs). But I do, and I have. And I have undertaken research with colleagues at U.S.C. and U.C.L.A. to show that I am not alone. There are others with schizophrenia and such active symptoms as delusions and hallucinations who have significant academic and professional achievements.


There were also really helpful suggestions about how each person came up with coping mechanisms specific to their individual issues:


How had these people with schizophrenia managed to succeed in their studies and at such high-level jobs? We learned that, in addition to medication and therapy, all the participants had developed techniques to keep their schizophrenia at bay. For some, these techniques were cognitive. An educator with a master’s degree said he had learned to face his hallucinations and ask, “What’s the evidence for that? Or is it just a perception problem?” Another participant said, “I hear derogatory voices all the time. ... You just gotta blow them off.”

Part of vigilance about symptoms was “identifying triggers” to “prevent a fuller blown experience of symptoms,” said a participant who works as a coordinator at a nonprofit group. For instance, if being with people in close quarters for too long can set off symptoms, build in some alone time when you travel with friends.

Other techniques that our participants cited included controlling sensory inputs. For some, this meant keeping their living space simple (bare walls, no TV, only quiet music), while for others, it meant distracting music. “I’ll listen to loud music if I don’t want to hear things,” said a participant who is a certified nurse’s assistant. Still others mentioned exercise, a healthy diet, avoiding alcohol and getting enough sleep. A belief in God and prayer also played a role for some.

Sound familiar to anyone? The advice to identify and avoid triggers by explicitly structuring your life to avoid or minimize them? Exercise and diet? Sleep and sensory inputs? Religion (which always what I fall back on when my brain is sick)?

She goes on to talk about how some people pour themselves into a rewarding career. She warns about the conflation of symptoms and diagnosis:


Far too often, the conventional psychiatric approach to mental illness is to see clusters of symptoms that characterize people. Accordingly, many psychiatrists hold the view that treating symptoms with medication is treating mental illness. But this fails to take into account individuals’ strengths and capabilities, leading mental health professionals to underestimate what their patients can hope to achieve in the world.


She mentions that some people with autism managed their symptoms, sometimes to the point of eliminating them. She then closes with these thoughts that could apply equally well to sociopathy:

I don’t want to sound like a Pollyanna about schizophrenia; mental illness imposes real limitations, and it’s important not to romanticize it. We can’t all be Nobel laureates like John Nash of the movie “A Beautiful Mind.” But the seeds of creative thinking may sometimes be found in mental illness, and people underestimate the power of the human brain to adapt and to create. 

An approach that looks for individual strengths, in addition to considering symptoms, could help dispel the pessimism surrounding mental illness. Finding “the wellness within the illness,” as one person with schizophrenia said, should be a therapeutic goal. . . . They should encourage patients to find their own repertory of techniques to manage their symptoms and aim for a quality of life as they define it.