“The Inner Landscape of the Psychopath,” by Hervey Cleckley

This is one of the finest descriptions I have ever read of the psychopath. I’ve been studying them for decades now, and I still don’t understand them. They simply don’t make sense. I can’t see how they can do what they do without feeling guilt or caring what others think. With this article though, I am at least starting to get a picture of the inner dynamics of the psychopath.

The work below is a classic, of course, and it is the first major work in psychiatry that attempted to describe psychopathy. It is still just as relevant today as it was 80 years ago. This is a chapter from Cleckley’s book.

It’s intense reading. It’s not so much hard to understand as it is dense. There are some many concepts packed into even one paragraph that it gets slow-going. This is especially true for me as, with an article below, I have to form a “picture” in my mind to truly understand a lot of the prose. When I write I also think in pictures. I get a picture, try to figure out what’s in it and what it’s about, and then set about describing the picture in words the best I can. Most art forms are similar. We writers make paintings and movies in our head, the raw material of our prose.

The section below is 31 pages including my mad scribbling. If there’s anything you can’t understand or follow in this piece, feel free to bring it up in the comments and I will try to explain it as I pretty much understood everything written below. It took me a while, but I did get it.

That said, this piece is a serious “brain fry.” I call brain fries any prose that pushes your mind to its absolute limits, like going to the gym and pushing your body to its limits. You have to go slow because there are so many concepts being pushed so quickly, but if you concentrate hard enough, you can figure out most brain fry prose. A lot of people who like simplistic writing or don’t want to work their brains at Autobahn speed probably think texts like this are a nightmare or a pain in the ass. They’re not having a good time when they’re reading it. It’s one frustration after another.

And just because I understood everything below doesn’t mean everyone else can. Keep in mind I have a genius IQ of 147. So a person with a 147 IQ can muddle through everything below and figure it all out. 99.9% of the population is below 147, and I don’t have the faintest notion how well they can get through stuff like this or how much they can understand of it at different IQ levels. If you understand everything below and know your IQ, you might want to comment to tell us that you got it all, give us your number, and tell us what sort of a ride it was machete slashing through this word tangle.

The Inner Landscape of the Psychopath

From: The Mask of Sanity, by Hervey Cleckley, 1941, 5th edition

The surface of the psychopath, however, that is, all of him that can be reached by verbal exploration and direct examination, shows up as equal to or better than normal and gives no hint at all of a disorder within.

Nothing about him suggests oddness, inadequacy, or moral frailty. His mask is that of robust mental health. Yet he has a disorder that often manifests itself in conduct far more seriously abnormal than that of the schizophrenic.

Inwardly, too, there appears to be a significant difference.

Deep in the masked schizophrenic we often sense a cold, weird indifference to many of life’s most urgent issues and sometimes also bizarre, inexplicable, and unpredictable but intense emotional reactions to what seems almost irrelevant.

Behind the exquisitely deceptive mask of the psychopath the emotional alteration we feel appears to be primarily one of degree, a consistent leveling of response to petty ranges and an incapacity to react with sufficient seriousness to achieve much more than pseudoexperience or quasi-experience. Nowhere within do we find a real cause or a sincere commitment, reasonable or unreasonable. There is nowhere the loyalty to produce real and lasting allegiance even to a negative or fanatic cause.

Just as meaning and the adequate sense of things as a whole are lost with semantic aphasia in the circumscribed field of speech although the technical mimicry of language remains intact, so in most psychopaths the purposiveness and the significance of all life-striving and of all subjective experience are affected without obvious damage to the outer appearance or superficial reactions of the personality. Nor is there any loss of technical or measurable intelligence.

With such a biologic change the human being becomes more reflex, more machinelike. It has been said that a monkey endowed with sufficient longevity would, if he continuously pounded the keys of a typewriter, finally strike by pure chance the very succession of keys to reproduce all the plays of Shakespeare.

These papers so composed in the complete absence of purpose and human awareness would look just as good to any scholar as the actual works of the Bard. Yet we cannot deny that there is a difference. Meaning and life at a prodigiously high level of human values went into one and merely the rule of permutations and combinations would go into the other.

The patient semantically defective by lack of meaningful purpose and realization at deep levels does not, of course, strike sane and normal attitudes merely by chance. His rational power enables him to mimic directly the complex play of human living. Yet what looks like sane realization and normal experience remains, in a sense and to some degree, like the plays of our simian typist.

In Henry Head’s interpretation of semantic aphasia we find, however, concepts of neural function and of its integration and impairment that help to convey a hypothesis of grave personality disorder thoroughly screened by the intact peripheral operation of all ordinary abilities.

In relatively abstract or circumscribed situations, such as the psychiatric examination or the trial in court, these abilities do not show impairment but more or less automatically demonstrate an outer sanity unquestionable in all its aspects and at all levels accessible to the observer. That this technical sanity is little more than a mimicry of true sanity cannot be proved at such levels.

Only when the subject sets out to conduct his life can we get evidence of how little his good theoretical understanding means to him, of how inadequate and insubstantial are the apparently normal basic emotional reactions and motivations convincingly portrayed and enunciated but existing in little more than two dimensions.

What we take as evidence of his sanity will not significantly or consistently influence his behavior. Nor does it represent real intention within, the degree of his emotional response, or the quality of his personal experience much more reliably than some grammatically well-formed, clear, and perhaps verbally sensible statement produced vocally by the autonomous neural apparatus of a patient with semantic aphasia can be said to represent such a patient’s thought or carry a meaningful communication of it.

Let us assume tentatively that the psychopath is, in this sense, semantically disordered. We have said that his outer functional aspect masks or disguises something quite different within, concealing behind a perfect mimicry of normal emotion, fine intelligence, and social responsibility a grossly disabled and irresponsible personality. Must we conclude that this disguise is a mere pretense voluntarily assumed and that the psychopath’s essential dysfunction should be classed as mere hypocrisy instead of psychiatric defect or deformity?

Let us remember that his typical behavior defeats what appear to be his own aims.

Is it not he himself who is most deeply deceived by his apparent normality?

Although he deliberately cheats others and is quite conscious of his lies, he appears unable to distinguish adequately between his own pseudointentions, pseudoremorse, pseudolove, and the genuine responses of a normal person.

His monumental lack of insight indicates how little he appreciates the nature of his disorder.

When others fail to accept immediately his “word of honor as a gentleman,” his amazement, I believe, is often genuine. The term genuine is used here not to qualify the psychopath’s intentions but to qualify his amazement. His subjective experience is so bleached of deep emotion that he is invincibly ignorant of what life means to others.

His awareness of hypocrisy’s opposite is so insubstantially theoretical that it becomes questionable if what we chiefly mean by hypocrisy should be attributed to him.

Having no major values himself, can he be said to realize adequately the nature and quality of the outrages his conduct inflicts upon others?

A young child who has no impressive memory of severe pain may have been told by his mother it is wrong to cut off the dog’s tail. Knowing it is wrong he may proceed with the operation. We need not totally absolve him of responsibility if we say he realized less what he did than an adult who, in full appreciation of physical agony, so uses a knife.

Can a person experience the deeper levels of sorrow without considerable knowledge of happiness? Can he achieve evil intention in the full sense without real awareness of evil’s opposite? I have no final answer to these questions.

Attempts to interpret the psychopath’s disorder do not, of course, furnish evidence that he has a disorder or that it is serious. For reliable evidence of this we must examine his behavior. Only here, not in psychopathologic formulations, can we apply our judgment to what is objective and demonstrable.

Functionally and structurally all is intact on the outside. Good function (healthy reactivity) will be demonstrated in all theoretical trials. Sound judgment as well as good reasoning are likely to appear at verbal levels. Ethical as well as practical considerations will be recognized in the abstract. A brilliant mimicry of sound, social reactions will occur in every test except the test of life itself.

In the psychopath we confront a personality neither broken nor outwardly distorted but of a substance that lacks ingredients without which normal function in major life issues is impossible.

Simon, Holzberg, and Unger, impressed by the paradox of the psychopath’s poor performance despite intact reasoning, devised an objective test specifically to appraise judgment as it would function in real situations, as contrasted with theoretical judgment in abstract situations.

These workers are aware that the more complex synthesis of influences constituting what is often called judgment or understanding (as compared to a more theoretical “reasoning”) may be simulated in test situations in which emotional participation is minimal, that rational factors alone by an accurate aping or stereotyping can produce in vitro, so to speak, what they cannot produce in vivo.

Items for a multiple choice test were selected with an aim of providing maximal possibilities for emotional factors to influence decision and particularly for relatively trivial immediate gratification impulses to clash with major, long-range objectives. The same items were also utilized in the form of a completion test. The results of this test on a group of psychopaths tend to support the hypothetical interpretation attempted in this book.

If such a disorder does indeed exist in the so-called psychopath, it is not remarkable that its recognition as a major and disabling impairment has been long delayed.

Pathological changes visible on the surface of the body (laceration, compound fractures) were already being handled regularly by medical men when the exorcism of indwelling demons retained popular favor in many illnesses now treated by the internist. So, too, it has been with personality disorders. Those characterized by gross outward manifestations have been accepted as psychiatric problems long before others in which a superficial appearance of sanity is preserved.

Despite the psychopath’s lack of academic symptoms characteristic of those disorders traditionally classed as psychosis, he often seems, in some important respects, but not in all, to belong more with that group than with any other. Certainly his problems cannot be dealt with, medically or by any other means, unless similar legal instrumentalities for controlling his situation are set up and regularly applied.

I believe that if such a patient shows himself grossly incompetent in his behavior, he should be so appraised. It is necessary to change some of our legal criteria to make attempts at treatment or urgently needed supervision possible for him, the most serious objections are primarily theoretical. Perhaps our traditional definitions of psychiatric disability can stand alteration better than these grossly defective patients and those about them can stand the present farcical and sometimes tragic methods of handling their problems.

This is not to say that all people showing features of this type should be regarded as totally disabled. It is here maintained that this defect, like other psychiatric disorders, appears in every degree of severity and may constitute anything from a personality trait through handicaps of varying magnitude, including maximum disability and maximum threat to the peace and safety of the community.

In attempting to account for the abnormal behavior observed in the psychopath, we have found useful the hypothesis that he has a serious and subtle abnormality or defect at deep levels disturbing the integration and normal appreciation of experience and resulting in a pathology that might, in analogy with Henry Head’s classifications of the aphasias, be described as semantic.

Presuming that such a patient does fail to experience life adequately in its major issues, can we then better account for his clinical manifestations? The difficulties of proving, or even of demonstrating direct objective evidence, for hypotheses about psychopathology (or about ordinary subjective functioning) are too obvious to need elaborate discussion here.

If the psychopath’s life is devoid of higher order stimuli, of primary or serious goals and values, and of intense and meaningful satisfactions, it may be possible for the observer to better understand the patient who, for the trivial excitement of stealing a dollar (or a candy bar), the small gain of forging a $20.00 check, or halfhearted intercourse with an unappealing partner, sacrifices his job, the respect of his friends, or perhaps his marriage.

Behind much of the psychopath’s behavior we see evidence of relatively mild stimuli common to all mankind. In his panhandling, his pranks, his truancy, his idle boasts, his begging, and his taking another drink, he is acting on motives in themselves not unnatural. In their massive accumulation during his career, these acts are impressive chiefly because of what he sacrifices to carry them out. If, for him, the things sacrificed are also of petty value, his conduct becomes more comprehensible.

Woolley, in an interesting interpretation of these patients, compared them with an otherwise intact automobile having very defective brakes. Such an analogy suggests accurately an important pathological defect which seems to exist.

In contrast with an automobile, however, the braking functions of the human organism are built into the personality by reaction to life experience, to reward and punishment, praise and blame, shame, loss, honor, love, and so on. True as Woolley’s hypothesis may be, it seems likely that more fundamental than inadequate powers to refrain is the inadequate emotional reactivity upon which the learning to refrain must be based.

Even with good brakes on his car, the driver must have not only knowledge of but also feeling for what will happen otherwise if he is to use them correctly and adequately.

Some of the psychopath’s behavior may be fairly well accounted for if we grant a limitation of emotional capacity. Additional factors merit consideration.

The psychopath seems to go out of his way to make trouble for himself and for others.

In carelessly marrying a whore, in more or less inviting detection of a theft (or at least in ignoring the probability of detection), in attempting gross intimacies with a debutante in the poorly sheltered alcove just off a crowded ballroom, in losing his hospital parole or failing to be with his wife in labor just because he did not want to leave the crap game at midnight (or at 3 A.M.), in such actions there seems to be not only a disregard for consequences but an active impulse to show off, to be not discreet but conspicuous in making mischief.

Apparently he likes to flaunt his outlandish or antisocial acts with bravado.

When negative consequences are negligible or slight (both materially and emotionally), who does not like to cut up a little, to make a bit of inconsequential fun, or perhaps playfully take off on the more sober aspects of living? Dignity might otherwise become pompousness; learning, pedantry; goodness, self-righteousness.

The essential difference seems to lie in how much the consequences matter. It is also important to remember that inclination and taste are profoundly shaped by capacity to feel the situation adequately. A normal man’s potential inclination to give the pretty hatcheck girl $100.00 would probably not reach awareness in view of his knowledge that this would result in his three children’s not having shoes or in his having to humiliate himself by wheedling from a friend a loan he will never repay.

If, as we maintain, the big rewards of love, of the hard job well done, of faith kept despite sacrifices, do not enter significantly in the equation, it is not difficult to see that the psychopath is likely to be bored. Being bored, he will seek to cut up more than the ordinary person to relieve the tedium of his unrewarding existence.

If we think of a theater half-filled with ordinary pubertal boys who must sit through a performance of King Lear or of Beethoven’s Ninth Symphony, we need ask little of either imagination or memory to bring to mind the restless fidgeting, the noisy intercommunication of trivialities, the inappropriate guffaws or catcalls, and perhaps the spitballs or the mischievous application of a pin to the fellow in the next seat.

Apparently blocked from fulfillment at deep levels, the psychopath is not unnaturally pushed toward some sort of divertissement. Even weak impulses, petty and fleeting gratifications, are sufficient to produce in him injudicious, distasteful, and even outlandish misbehavior.

Major positive attractions are not present to compete successfully with whims, and the major negative deterrents (hot, persistent shame, profound regret) do not loom ahead to influence him. If the 12-year-old boys could enjoy King Lear or the Ninth Symphony as much as some people do, they would not be so reckless or unruly.

In a world where tedium demands that the situation be enlivened by pranks that bring censure, nagging, nights in the local jail, and irritating duns about unpaid bills, it can well be imagined that the psychopath finds cause for vexation and impulses toward reprisal. Few, if any, of the scruples that in the ordinary man might oppose and control such impulses seem to influence him. Unable to realize what it meant to his wife when he was discovered in the cellar flagrante delicto with the cook, he is likely to be put out considerably by her reactions to this.

His having used the rent money for a midnight long-distance call to an old acquaintance in California (with whom he bantered for an hour) also brings upon him censure or tearful expostulation. Considering himself harassed beyond measure, he may rise from the dining room table in a petty tantrum, curse his wife violently, slap her, even spit on her, and further annoyed by the sudden weeping of their 6-year-old daughter, throw his salad in the little girl’s face before he strides indignantly from the room.

His father, from the patient’s point of view, lacks humor and does not understand things. The old man could easily take a different attitude about having had to make good those last three little old checks written by the son. Nor was there any sense in raising so much hell because he took that dilapidated old Chevrolet for his trip to Memphis.

What if he did forget to tell the old man he was going to take it? It wouldn’t hurt him to go to the office on the bus for a few days. How was he (the patient) to know the fellows were going to clean him out at stud or that the little bitch of a waitress at the Frolic Spot would get so nasty about money? What else could he do except sell the antiquated buggy? If the old man weren’t so parsimonious he’d want to get a new car anyway!

And why did he (the father) have to act so magnanimous and hurt about settling things last Saturday night down at the barracks? You’d think from his attitude that it was the old man himself who’d had to put up with being cooped in there all those hours with louse-infested riff-raff! Well, he’d thanked his father and told him how sorry he was.

What else could a fellow do? As for that damned old Chevrolet, he was sick of hearing about it. His grudge passing with a turn of thought, he smiles with half-affectionate, playfully cordial feelings toward the old man as he concludes, “I ought to tell him to take his precious old vehicle and stick it up his _____!”

Lacking vital elements in the appreciation of what the family and various bystanders are experiencing, the psychopath finds it hard to understand why they continually criticize, reproach, quarrel with, and interfere with him. His employer, whom he has praised a few hours before, becomes a pettifogging tyrant who needs some telling off.

The policeman to whom he gave tickets for the barbecue last week (because he is such a swell guy) turns out to be a stupid oaf and a meddler who can’t mind his own business but has to go and arrest somebody just because of a little argument with Casey in the Midnight Grill about what happened to a few stinking dollar bills that were lying on the bar.

It is not necessary to assume great cruelty or conscious hatred in him commensurate with the degree of suffering he deals out to others. Not knowing how it hurts or even where it hurts, he often seems to believe that he has made a relatively mild but appropriate reprimand and that he has done it with humor.

What he believes he needs to protest against turns out to be no small group, no particular institution or set of ideologies, but human life itself. In it he seems to find nothing deeply meaningful or persistently stimulating, but only some transient and relatively petty pleasant caprices, a terribly repetitious series of minor frustrations, and ennui.

Like many teenagers, saints, history-making statesmen, and other notable leaders or geniuses, he shows unrest; he wants to do something about the situation. Unlike these others, as Lindner has so well and convincingly stressed, he is a “rebel without a cause.”

Reacting with something that seems not too much like divine discontent or noble indignation, he finds no cause in the ordinary sense to which, he can devote himself with wholeheartedness or with persistent interest. In certain aspects his essential life seems to be a peevish bickering with the inconsequential.

In other aspects he suggests a man hanging from a ledge who knows if he lets go he will fall, is likely to break a leg, may lose his job and his savings (through the disability and hospital expenses), and perhaps may injure his baby in the carriage just below. He suggests a man in this position who, furthermore, is not very tired and who knows help will arrive in a few minutes, but who, nevertheless, with a charming smile and a wisecrack, releases his hold to light a cigarette, to snatch at a butterfly, or just to thumb his nose at a fellow passing in the street below.

A world not by any means identical but with some vivid features of both these underlying situations can be found in Huysmans’ Against the Grain and in Jean-Paul Sartre’s Nausea. In the satirical novels of Evelyn Waugh, also, an atmosphere difficult to describe sometimes develops – an atmosphere that may give the reader awareness of attitudes and evaluations genuinely illustrative of deeply distorted or inadequate reactions to life.

The leading characters depicted therein show a peculiar cynicism which is more conscious and directed and purposive than the behavior of the psychopath. But none of the characters presented show even an approximate awareness of what is most valid and meaningful and natural in human beings. A negative response to life itself, an aversion at levels more basic than ordinary morals or the infraconscious foundations of taste and incentive, is conveyed subtly and impressively.

It is difficult to illustrate by incident, by the expressed attitude of the characters depicted, or by any clearly implied evaluation of the authors the specific quality of what is evoked in these novels as the essence of an unhappy, mutilated, and trivial universe in which all the characters exist. The sense of pathology pervades to levels so deep that rational scrutiny cannot reach and meet the fundamental implications; nor can inquiry satisfactorily demonstrate its precise source.

If the actual world and man’s biologic scope were only that conveyed in these interesting works, it would perhaps be less difficult to account for obsessive illness and for the psychopath’s career as reasonable reactions to a situation where no course is possible except one profoundly pathological in one way or another.

Thoughtful contemplation of what is depicted in these works of fiction suggests a world as fundamentally altered as what Straus presents as the world of the obsessive patient. In the effective and terse implication of general emotional incapacity in these characters, the authors succeed in evoking awareness of a sort of quasi-life restricted within a range of staggering superficiality.

This, rather than those aspects of the works that apparently brought them popularity, may deserve high literary appraisal as concise and valuable communications of something that is by no means easy to convey in direct language. Such a superficiality and lack of major incentive or feeling strongly suggest the apparent emotional limitations of the psychopath.

What Straus and Havelock Ellis have brought out is not discernible in the reactions of the psychopath. It is, as a matter of fact, somewhat veiled in the reactions of most obsessive patients. Observation of the psychopath makes it increasingly plain, however, that he is not reacting normally to the surroundings that are ordinarily assumed to exist. I cannot clearly define the specific milieu which such a patient encounters and to which his reactions are related.

There is much to suggest that it is a less distinctly or consistently apprehended world than what Straus describes as the inner world of the obsessive patient. It is my belief that it may be a world not less abnormal and perhaps more complexly confusing. We should remember, however, that we have no direct evidence to prove that a deficiency or distortion of this sort exists in the unconscious core of the psychopath.

We can only say that his behavior strongly and consistently suggests it. This discussion has been based, of course. on a hypothesis that the psychopath has a basic inadequacy of feeling and realization that prevents him from normally experiencing the major emotions and from reacting adequately to the chief goals of human life.

Beyond the symptomatic acts of the psychopath, we must bear in mind his reaction to his situation, his general experiencing of life. Typical of psychoneurosis are anxiety, recognition that one is in trouble, and efforts to alter the bad situation. These are natural (“normal”) whole personality reactions to localized symptoms.

In contrast, the severe psychopath, like those so long called psychotic, does not show normal responses to the situation. It is offered as an opinion that a less obvious but nonetheless real pathology is general, and that in this respect he is more closely allied with the psychotic than with the psychoneurotic patient. The pathology might be regarded not as gross fragmentation of the personality but as a more subtle alteration. Let us say that instead of macroscopic disintegration our (hypothetical) change might be conceived of as one that seriously curtails function without obliterating form.

Let us think of the personality in the psychopath as differing from the normal in some such way. The form is perfect and the outlines are undistorted. But being subtly and profoundly altered, it can successfully perform only superficial activities or pseudofunctions. It cannot maintain important or meaningful interpersonal relations. It cannot fulfill its purpose of adjusting adequately to social reality. Its performance can only mimic these genuine functions.

The persistent pattern of maladaptation at personality levels and the ostensible purposelessness of many self-damaging acts definitely suggests not only a lack of strong purpose but also a negative purpose or at least a negative drift. This sort of patient, despite all his opportunities, his intelligence, and his plain lessons of experience, seems to go out of his way to woo misfortune. The suggestion has already been made that his typical activities seem less comprehensible in terms, of life-striving or of a pursuit of joy than as an unrecognized blundering toward the negations of nonexistence.

Some of this, it has been suggested, may be interpreted as the tantrum, like reactions of an inadequate personality balked, as behavior similar to that of the spoiled child who bumps his own head against the wall or holds his breath when he is crossed. It might be thought of as not unlike a man’s cutting off his nose to spite not only his face, but also the scheme of life in general, which has turned out to be a game that he cannot play.

Such reactions are, of course, found in nearly all types of personality disorder or inadequacy. It will perhaps be readily granted that they are all regressive. Behavior against the constructive patterns through which the personality finds expression and seeks fulfillment of its destiny is regressive activity although it may not consist in a return, step by step, or in a partial return to the status of childhood and eventually of infancy. Such reactions appear to be, in a sense, against the grain of life or against the general biologic purpose.

Regressive reactions or processes may all be regarded as disintegrative, as reverse steps in the general process of biologic growth through which a living entity becomes more complex, more highly adapted and specialized, better coordinated, and more capable of dealing successfully or happily with objective or subjective experience. This scale of increasing complexity exists at points even below the level of living matter.

A group of electrons functioning together make up the atom which can indeed be split down again to its components. The atoms joining form molecules which, in turn, coming together in definite orderly arrangement, may become structurally coordinating parts of elaborate crystalline materials; or, in even more specialized and complex fashion, they may form a cell of organic matter. Cells of organic matter may unite and integrate to form the living organism we know as a jellyfish. Always the process is reversible; the organic matter can decompose back into inorganic matter.

Without laboriously following out all the steps of this scale, we might mention the increasing scope of activity, the increasing specialization, and the increasing precariousness of existence at various levels up through vertebrates and mammals to man. All along this scale it is evident that failure to function successfully at a certain level necessitates regression or decomposition to a lower or less complicated one.

If the cell membrane of one epithelial unit in a mammalian body becomes imporous and fails to obtain nutriment brought by blood and lymph, it loses its existence as an epithelial cell. If the unwary rabbit fails to perceive the danger of the snare, he soon becomes in rapid succession a dead rabbit, merely a collection of dead organs and supportive structures, protein, fat, and finally, inorganic matter. The fundamental quest for life has been interrupted, and, having been interrupted, the process goes into reverse.

So, too, the criminal discovered and imprisoned ceases to be a free man who comes and goes as he pleases. A curtailment in the scope of his functioning is suffered-a regression in one sense to simpler, more routine, and less varied and vivid activities.

The man who fails in another and more complex way to go on with life, to fulfill his personality growth and function, becomes what we call a schizophrenic. The objective curtailment of his activities by the rules of the psychiatric hospital are almost negligible in comparison with the vast simplification, the loss of self-expression, and the personal disintegration which characterize his regression from the subjective point of view. The old practice of referring to the extremely regressed schizophrenic as leading a vegetative existence implies the significance that is being stressed.

Regression, then, in a broad sense may be taken to mean movement from richer and more full life to levels of scantier or less highly developed life. In other words, it is relative death. It is the cessation of existence or maintenance of function at a given level.

The concept of an active death instinct postulated by Freud has been utilized by some to account for socially self-destructive reactions. I have never been able to discover in the writings of Freud or any of his followers real evidence to confirm this assumption.

In contrast, the familiar tendency to disintegrate, against which life evolves, may be regarded as fundamental and comparable to gravity. The climbing man or animal must use force and purpose to ascend or to maintain himself at a given height. To fall or slide downhill he need only cease his efforts and let go. Without assuming an intrinsic death instinct, it is possible to account for active withdrawal from positions at which adaptation is unsuccessful and stress too extreme.

Whether regression occurs primarily through something like gravity or through impulses more self-contained, the backward movement (or ebbing) is likely to prompt many sorts of secondary reactions, including behavior not adapted for ordinary human purposes but instead, for functioning in the other direction. The modes of such reactivity may vary, may fall into complex patterns, and may seek elaborate expression.

In a movement (or gravitational drift) from levels where life is vigorous and full to those where it is less so, the tactics of withdrawal predominate.

People with all the outer mechanisms of adaptation intact might, one would think, regress more complexly than can those who react more simply. The simplest reaction in reverse might be found in a person who straightway blows out his brains.

As a skillful general who has realized that the objective is unobtainable withdraws by feints and utilizes all sorts of delaying actions, so a patient who has much of the outer mechanisms for living may retire, not in obvious rout but skillfully and elaborately, preserving his lines.

The psychopath as we conceive of him in such an interpretation seems to justify the high estimate of his technical abilities as we see them expressed in reverse movement.

Unlike the general with the retreating army in our analogy, he seems not still devoted to the original contest but to other issues and aims that arise in withdrawal. To force the analogy further we might say that the retiring army is now concerning itself with looting the countryside, seeking mischief and light entertainment. The troops have cast off their original loyalties and given up their former aims but have found no other serious ones to replace them. But the effective organization and all of the technical skills are retained and utilized destructively.

F. L. Wells has expressed things very pertinent to the present discussion. A brief quotation will bring out useful points:

The principle of substitutive reactions, sublimative or regressive in character, has long been known, but Kurt Lewin’s (1933) experimental construction of the latter is especially apt, if not unquestionable mental hygiene. A child, for example, continually impelled to open a gate it is impossible for him to open, may blow up in a tantrum, grovel on the ground, till the emotion subsides sufficiently for him to become substitutively occupied, as with fragments of gravel and other detritus he finds there, by which he forgets his distress about the gate. […]

The human personality has the adaptive property of finding satisfactions at simpler levels when higher ones are taken away, fortunately so if this keeps him out of a psychosis, otherwise if it stabilizes him in contentment at this lower level (“going native”) or if the satisfactions cannot be found short of a psychosis (MacCurdy, 1925, p. 367). All such cases have the common regressive factor of giving up the higher-level adjustment (opening the gate) with regressive relief at a lower level (playing with the gravel).

Another illustration given by Wells emphasizes features of the concept that are valuable to us:

Consider, for example, the group of drives that center about the concept of self-maintenance, the “living standards” of civilization. This means the pursuit of the diverse means to surround oneself with the maximum of material comfort in terms of residence, food, playthings, etc., for the purchase of which one can capitalize his abilities.

That the normal individual will do this to a liberal limit is taken in the local culture as a matter of course, probably more liberally than the facts justify. For this pursuit involves a competitive struggle beset also with inner conflicts (e.g., ethical), which by no means everyone is able to set aside.

Among regressions specific to this category are those undertakings of poverty common to religious orders, but this regression is quite specific, since these orders often involve their members in other “disciplines” from which the normal individual would flee as far (Parkman, 1867, Chap. 16).

It is quite certain, though hard to demonstrate objectively, that many an individual in normal life regresses from these economic conflicts only in less degree. He does not take the vow of poverty like the monastic, nor does he dedicate himself to the simplified life of the “South Sea Island” stereotype, but he prefers salary to commission, city apartment to suburban “bungalow,” clerical work to (outside) sales.

A thought expressed by William James in 1902 and quoted by Wells deserves renewed attention:

Yonder puny fellow however, whom everyone can beat suffers no chagrin about it, for he has long ago abandoned the attempt to “carry that line,” as the merchants say, of Self at all.

With no attempt there can be no failure; with no failure no humiliation.

So our self-feeling in this world depends entirely on what we back ourselves to be and do. It is determined by the ratio of our actualities to our supposed potentialities; a fraction of which our pretentions are the denominator and the numerator our success: thus, Self-esteem = Success/Pretensions.

Such a fraction may be increased as well by diminishing the denominator as by increasing the numerator.

To give up pretensions is as blessed a relief as to get them gratified; and where disappointment is incessant and the struggle unending, this is what men will always do.

The history of evangelical theology, with its conviction of sin, its self-despair, and its abandonment of salvation by works, is the deepest of possible examples, but we meet others in every walk of life. .

How pleasant is the day when we give up striving to be young-or slender! Thank God, we say, those illusions are gone. Everything added to the self is a burden as well as a pride.

Something relevant to the points now under consideration may be found also in Sherrington’s comment on reactions (or inlaid precautions) against unbearable pain or stress in the human organism. He says:

Again in life’s final struggle the chemical delicacy of the brain-net can make distress lapse early because with the brain’s disintegration the mind fades early – a rough world’s mercy towards its dearest possession.

There are, it seems, many ways for this to occur without signs of any change which we yet have objective means to detect, chemically or microscopically. Such changes may occur under the stimulus of agents that do not have direct physical contact with the brain or with any part of the body.

Withdrawal, or limitation of one’s quest in living, appears in many forms.

The decision for taking such a step may be consciously voluntary, but it seems likely that many influences less clear and simple may also play a part. In the earliest years of human life a great deal of complicated shaping may occur, with adaptive changes to promote survival by an automatic refusal (inability) to risk one’s feelings (response) in the greatest subjective adventures. In adult life such decisions sometimes emerge in clear deliberation.

The activity of the psychopath may seem in some respects to accomplish a kind of protracted and elaborate social and spiritual suicide. Perhaps the complex, sustained, and spectacular undoing of the self may be cherished by him. He seldom allows physical suicide to interrupt it.

Be it noted that such a person retains high intelligence and nearly all the outer mechanisms for carrying on the complicated activities of positive life. It is to be expected then that his function in the opposite (regressive) emotional direction might be more subtle than those of a less highly developed biologic entity.

The average rooster proceeds at once to leap on the nearest hen and have done with his simple erotic impulse. The complex human lover may pay suit for years to his love object, approaching her through many volumes of poetry, through the building up of financial security in his business, through manifold activities and operations of his personality functions, and with aims and emotions incomparably more complicated and more profound than that of the rooster.

When complexly organized functions are devoted to aimless or inconsistent rebellion against the positive goals of life, perhaps they may enable the patient to woo failure and disintegration with similar elaborateness and subtlety. His conscious or outer functioning may at the same time maintain an imitation of life that is uniquely deceptive.

Perhaps the emptiness or superficiality of life without major goals or deep loyalties, or real love, would leave a person with high intelligence and other superior capacities so bored that he would eventually turn to hazardous, self-damaging, outlandish, antisocial, and even self-destructive exploits in order to find something fresh and stimulating in which to apply his relatively useless and unchallenged energies and talents.

The more experience I have with psychopaths over the years, the less likely it seems to me that any dynamic or psychogenic theory is likely to be established by real evidence as the cause of their grave maladaptation.

Increasingly I have come to believe that some subtle and profound defect in the human organism, probably inborn but not hereditary, plays the chief role in the psychopath’s puzzling and spectacular failure to experience life normally and to carry on a career acceptable to society. This, too, is still a speculative concept and is not supported by demonstrable evidence.

The Myth of Illegal Drugs Frying Your Brain and Permafried People

In response to Jason’s post here about drug use frying your brain, I have written this response. In general, the notion that the use of illegal drugs will fry your brain or make you permafried even after you quit is nonsense. In general, once you quit you go back to the intelligence and sanity level you were at before you started. Few people get permanently lowered intelligence or permanent mental illness from former drug use.

Most illegal drugs do not cause any permanent damage to your brain that would affect you permanently after you quit.

In all of my years using drugs, I have met 10,000’s of drug users and I never met one person who had used so much drugs that they were “fried” in the sense that they were permanently stupid or crazy after they quit using.


There may be some consequences far down the road – say, with Parkinson’s.

Jason’s article discusses an increased risk of Parkinson’s in former cocaine users. But it’s not really due to brain damages so much as changes in a certain receptor that make someone more vulnerable to a toxin. That’s not the same thing as having a fried brain.

I knew a heavy cocaine user who appeared to have neurological problems from the drug. But I am not sure if it persisted after he quit, if he ever did quit. But he’s the only person I’ve ever met like that, and even he wasn’t fried at all. He was still very intelligent and completely sane. However, he did appear to have some sort of brain damage. Whether it was permanent or not is not known.


I have known people who took LSD up to 700 times, and I know a number who took LSD 300 times. LSD doesn’t damage your brain anyway. It can cause some changes in the visual system due to permanent changes in serotonin receptors, but that just causes some perceptual problems, and this is mostly in people who have taken it 50+ times. It doesn’t change effect you in any way that changes the way you think or feel, in other words, it doesn’t make you stupid or nuts.

There are some very heavy former LSD users who seem to have permanent hallucinations, but those people took a lot of acid over a short period of time – like way, way too much acid. It’s not known what’s going on with them, but I suppose they are permafried in a sense.

LSD is a dangerous drug.


I know many people who have been smoking pot for 10, 20, or even 30 years, and there’s nothing wrong with any of them. You wouldn’t think there was anything wrong with them if you met them. They’re not damaged at all.

The pot lowering IQ discussed in Jason’s piece is only for use before you are 18. If you start using at age 18 or after, there’s no effect on IQ. People under 18 need to be very careful about pot because it can indeed lower their IQ’s a bit.

Pot doesn’t give you schizophrenia, period. The most it can do is trigger it if you are already vulnerable, but even then, most of those people would have gotten it anyway. But it can definitely bring it on sooner than it would have otherwise.

The rate of schizophrenia has been flat for 60 years, all through the 1960’s, 70’s, 80’s, 90’s, 2000’s and 2010’s, and all sorts of drug use rates for different drugs skyrocketed at various times in that period. In other words, neither cannabis nor any other drug is going to give you schizophrenia with one exception discussed below.


MDMA is a very dangerous drug and it can definitely cause physical damage to your brain. It permanently lowers scores on a few aspects of intelligence tests such as vocabulary, but you mostly can’t notice any changes and there do not appear to be any changes in mental stability. In general, it doesn’t make you stupid or nuts.

However, there are some people called e-tards out there who took a lot of MDMA very frequently over relatively short of periods of time, and these people appear to be permafried. Mostly they seem a bit stupid.

However, I have heard that even these effects of MDMA go away after ~7-8 years if you stay away from the drug.


Speed is another matter but even that tends to clear up after you quit. There are some very heavy methamphetamine users, especially people who shot the drug, who have developed an illness that looks a lot like or possibly is paranoid schizophrenia.

There are some recorded cases out of Japan, and a friend told me about another case here in California. This is not a common outcome and even with all the heavy meth abuse that is going on nowadays, you don’t hear much about people being permafried in the sense that they become permanently mentally ill with paranoid schizophrenia.

Heavy Polydrug and Alcohol Abuse for Decades (30 years)

I have heard of one person who used huge amounts of drugs and drank very heavily over many years, starting as an adolescent. They are now off of everything, and they have a rather poor short-term memory and forget stuff a lot, but other than that, they are still extremely intelligent.

They are also a bit suspicious and paranoid, but not at the level of a paranoid psychosis. I suppose this man is permafried in a sense, but if you met him, you would not appear stupid or crazy.


Bottom line is a lot of that stuff can mess you up pretty bad while you are on it so you seem stupid, crazy, or even brain damaged. But most if not all of that tends to clear up when you quit. Permafried people who are permanently stupid or nuts from heavy drug use must be awfully rare because I haven’t met one in my entire life. The fried brains and permafried nonsense is mostly mythology.

Meth-induced Voices in Your Head Start with Pareidolia

Interesting article on meth-induced voices in the head deriving from long-term use of methamphetamine.

Eventually, and note that this happened with everyday use of crystal meth for a couple of years, there didn’t have to be any white noise to trigger the voices. Eventually I heard voices all the time, and they took on a different nature. They would sound just like real voices, coming from different directions and distance, so the sensation was enough to trick my brain into believing that I really heard the voices with my ears.
They became voices that mocked me, voices that ridiculed me, voices of imaginary observers to a mind that became increasingly paranoid and deluded. So it became much like a persecution complex, or paranoid schizophrenia.
At one stage I heard people talking about me at work, saying terrible things about me. I heard them through the walls. I heard them even when I was alone.

That sounds almost exactly like paranoid schizophrenia. I have heard that long-term meth use can lead to a permanent paranoid schizophrenia-type illness. Most of this data has come out of Japan where people have been injecting shabu or meth for many years. The cases involved subjects who had been injecting shabu every day for 10+ years. The illness was incurable.

Meth-induced voices in your head take you to a bad place, a real living hell on Earth. And many who go there don’t return. They end up permanently psychotic…
…I find this very interesting, in that it could mean that hearing voices is simply an expected side-effect of prolonged drug use. Further, I noticed many meth addicts who tended to believe in black magic and possession. Even when I was in rehab years ago, some residents there became convinced that a schizophrenic resident (who talked to himself and spoke in gibberish that they thought were “demonic tongues”) was possessed. No amount of attempting to reason with them would convince them otherwise.
So beware, voices in the head and apophenia leading to an irrational belief in the paranormal (as well as possibly in God in recovery) may well just be a side-effect of the high levels of dopamine as a result of frequent prolonged drug use. And it may be permanent.

This is interesting, implying that in some cases, the delusions never really go away. 
It’s interesting how the voices start up faster the longer they have been going on. For instance, if they have been going on a long time and you quit for a while, they will start up again full-blown after only a few days of meth use. This is a kindling effect and it is well known in cocaine use and bipolar disorder, especially manic episodes.
A heavy cocaine user will quit and then smoke cocaine one time. After only using it once, they are running around shutting all the drapes and talking about how the police outside can hear everyone so people need to quiet down.
In Bipolar Disorder, the more episodes you experience, the worse the illness until you get to the point where you are a somewhat manic all the time. Episodes come more often and healthy periods between episodes shorten. The episodes themselves become worse and last longer.

Meth-induced Voices in Your Head Start with Pareidolia

By Jerome

I’ve never written about this topic on this blog, although it was a frequent subject on my old blog. Maybe it’s time…
This subject is fascinating to me now, though it wasn’t always that way. In active addiction it was scary. It was something that I lived with for a few years, but what I find most interesting is how it started.
Firstly, you need to know what pareidoloia is. It’s defined as seeing patterns where none exist, and while that explains it technically, it doesn’t really make it clear what the psychological phenomenon actually is. Visual pareidolia is when we think we see shapes like faces in inanimate objects, like Jesus on a piece of toast, or a face on Mars.
But pareidolia is also when we think we hear voices or recognizable sounds through white noise. An example of the less well known auditory pareidolia is when you’re taking a shower or hear really loud rain falling on your roof, and you think you hear voices or your phone ringing through the noise. That was how my meth voices started. At first it was just ordinary pareidolia, where there was loud rain or wind and I thought I heard voices, but would realize immediately that it was my imagination.
But then something seemed to go wrong in my brain. Fragments of sound that sounded like voices evolved into much more. As months went by, it would happen more frequently, and any background noise, even noises that were not noticeable to most people, would trigger it. So what started out sounding vaguely like voices, after a few months became voices of people that I knew speaking unintelligible words. So it was like hearing a conversation from another room, one just out of earshot and not heard clearly. Then as time went by, it became actual words and sentences that I could make out.
Eventually, and note that this happened with everyday use of crystal meth for a couple of years, there didn’t have to be any white noise to trigger the voices. Eventually I heard voices all the time, and they took on a different nature. They would sound just like real voices, coming from different directions and distance, so the sensation was enough to trick my brain into believing that I really heard the voices with my ears.
They became voices that mocked me, voices that ridiculed me, voices of imaginary observers to a mind that became increasingly paranoid and deluded. So it became much like a persecution complex, or paranoid schizophrenia.
At one stage I heard people talking about me at work, saying terrible things about me. I heard them through the walls. I heard them even when I was alone. Eventually I isolated myself from the outside world and everything in my life was affected as I retreated into my own delusional world of suffering and pain.
Meth-induced voices in your head take you to a bad place, a real living hell on Earth. And many who go there don’t return. They end up permanently psychotic. I’ll probably revisit this topic and write about how it felt to live with those voices and the inevitable delusion, but today’s post is mostly about how they start.
I find it interesting to know that those voices do start with auditory pareidolia, which is something we all experience. Of course, if you’re a meth addict and you start to experience voices, it’s probably a great time to stop using. But you won’t, I know. Yet you need to recognize that when this happens, you can no longer try to convince yourself that you aren’t an addict.
When it reaches this point, you’re a long way past crossing a line from user to addict. You need to recognize that you have a serious problem, one that is affecting not only your life but those of all involved in it. Once the voices progress to the point where you hear them all the time, they don’t stop as long as you continue using. Even if you are clean for a long time and then relapse, the voices return in a few days, and then stick around as long as you use. At least that’s how it was for me.

Update: This article about apophenia (the spontaneous perception of connections and meaningfulness of unrelated phenomena), which is of course closely related to pareidolia, lists high levels of dopamine as a possible cause. Of course drugs like meth, and to a lesser extent cocaine and crack cocaine, cause tremendously high levels of dopamine, considerably higher than the levels that occur naturally. And all of those drugs cause voices in the heads of long-term users. Apparently high levels of dopamine might also cause belief in the paranormal, and EVP, among other things. (I’d considered mentioning EVP here anyway.)
I find this very interesting, in that it could mean that hearing voices is simply an expected side-effect of prolonged drug use. Further, I noticed many meth addicts who tended to believe in black magic and possession. Even when I was in rehab years ago, some residents there became convinced that a schizophrenic resident (who talked to himself and spoke in gibberish that they thought were “demonic tongues”) was possessed. No amount of attempting to reason with them would convince them otherwise.
So beware, voices in the head and apophenia leading to an irrational belief in the paranormal (as well as possibly in God in recovery) may well just be a side-effect of the high levels of dopamine as a result of frequent prolonged drug use. And it may be permanent.
Some of my most annoying Facebook “friends” are people I became acquainted with in rehab, who share Christian nonsense followed by “type Amen” all the time. I can’t bring myself to unfriend them somehow. The most annoying proponent of the sharing Jesus movement is a girl I remember from rehab who believed that she needed to eat sand. There was even a patch of sand set aside especially for her in the garden. (My greatest challenge in rehab was to refrain from pissing in her sand patch.) So ironically, some who hang on so desperately to Jesus in recovery may in my opinion do so simply because their brains are fried from all the drugs. Fortunately I’m not one of them. I guess I’m just lucky.

A Look at Cluster A Personality Disorders

Cluster A are the odd personality disorders. They’re not so much awful people as they are simply so odd and strange that you can’t have much of a human relationship with them. Their general theme is to drive people away from them in some way or another.
Schizoids are ok, but they are very annoying. It’s generally impossible to have any decent human relationship with someone like this because…well…they don’t do human relationships. I’ve talked to Schizoids but I have never really known one in real life. You are unlikely to run across a Schizoid in life because they are such extreme loners that they simply don’t get involved with other humans at all.
Schizotypals simply have a mild form of schizophrenia and are more or less impossible to deal with in ways that are similar to how schizophrenics can’t be dealt with but on a lesser scale. They are also quite suspicious and paranoid. They have awful social skills and conversations with them degenerate and start getting tangential and strange pretty quickly. They will give off a feeling of alienation and weirdness that would probably make you want to get away from them.
I had a girlfriend who had Schizotypal traits, but she was mostly just a Borderline. When she was off into her schizotypal strangeness, it was like talking to someone from another planet. She would be saying weird and odd things that didn’t make a lot of sense and the conversation had the creepy feel of someone who is way out there and is not really with the rest of us at all. I eventually broke up with her on the grounds that she was too crazy for me. It was like dating a Martian.
I’ve never met or talked to an actual full-blown Schizotypal, so I don’t know much about them. I don’t see how you can have a decent relationship with someone like this. They’re too crazy for that. You usually won’t meet schizotypals because they are extreme loners who don’t do human relationships. They are suspicious, withdrawn and don’t talk much. They give off vibes of trying to drive you away. When at home, they often get quite shut-in and don’t want to go outside.
Paranoids I do not understand very well, but I hear they are hard to deal with too. They can also often be angry. Their constant suspicion drives you crazy and relationships with these people must be hard to deal with. You often won’t meet Paranoids either because, well, they’re too paranoid! They shy away from most relationships too and even if you work with them, they probably won’t reveal much of their disorder. They also give off serious “get away from me” vibes.
None of these people are easy to get along with. It’s going to be hard to have a decent human relationship with any of these people.
Of course Cluster B’s are awful human beings. I’ve gone into them before on this site.

Schiz OCD Versus Psychosis: Differences and Interactions

Hassan Herrera: By saying “Anxiety processes can at times escalate all the way to psychosis.” You mean, for example a OCD’er getting through the fear of going psychotic can start experiencing psychotic symptoms coming out of the anxiety process? I catch sight of a post of you setting apart core process and where the symptoms come from. I hope i got myself across.

Never seen a case of Schiz OCD going all the way to psychosis, although I know a woman with schizophrenia and Schiz OCD in which the two sort of go together but not completely. She still has delusions that she does not doubt. She also hides symptoms a lot, which is very hard to figure out, though I can sometimes do it.
I don’t think the Schiz OCD went into the Schizophrenia, but the Schizophrenia dx obviously played into the Schiz OCD. It’s an extremely complex case. Never seen a case of Schiz OCD going all the way to psychosis, although I know a woman with schizophrenia and Schiz OCD in which the two sort of went together but not completely. She still has delusions that she does not doubt. She also hides symptoms a lot, which is very hard to figure out, though I can sometimes do it. I don’t think the Schiz OCD went into the Schizophrenia, but the Schizophrenia dx obviously played into the Schiz OCD. It’s an extremely complex case.
There is a Psychotic OCD but I have never seen a single case of it, and I have seen more OCD’ers than 95% of clinicians will ever see. I have seen cases that I worried were Psychotic OCD, but when you got it all untangled, they still had reality testing intact more or less, at least in terms of overvalued ideas. There is a sub-diagnosis of OCD with Overvalued Ideas.
The OCD symptoms in this case were extremely bizarre, and phenomenologically, they looked a lot like the sort of thing you see in Psychotic OCD. His symptoms appeared so psychotic that when I mentioned them to a retired clinician, she insisted that this person was psychotic and would not accept that they were not. Unfortunately I am not allowed to share the very interesting symptoms on here.
Psychotic OCD has a sort of a “look” to it along with typical delusions that are present in a lot of cases – it is a syndrome, in other words.
A classic case of Psychotic OCD would be a case where the obsessions have escalated into delusions. The people are typically not dangerous, as fear is a freezing agent, and OCD’ers tend to be shy or very shy, passive, introverted, and remarkably nonviolent. A classic case is a man sitting in a chair all day shaking like a leaf and going on about his obsessions, which have now reached delusional intensity. The old view was that Psychotic OCD’ers never got too far gone psychosis-wise, and it was quite easy to pull them out of the psychosis. A typical case might last three weeks.
However, we now have recent cases of Psychotic OCD going on for years that did not respond to treatment. Some responded to ERP oddly enough. Some of these people are so ill that they have become the homeless mentally ill like a lot of schizophrenics, carting their belongings around in a suitcase.
The main thing to note is that Psychotic OCD is rarely seen. However, when OCD is very bad, they can appear psychotic. Hence, OCD’ers are often misdiagnosed with psychosis of one form or another and put on antipsychotic drugs, which generally do not help them. I get clients all the time coming to me with a diagnosis of some form of psychosis. Once I figure out they are not psychotic and are usually instead Schiz OCD’ers with what I call fake delusions and fake hallucinations, I tell them to fire their psychiatrist and go doctor shopping until you find an MD who understands that you have OCD and not psychosis.
A lot of psychiatrists continue to misdiagnose OCD’ers with psychosis. The phenomenology of OCD is not understood well by many clinicians, and the fact that OCD when severe looks like psychosis but is not results in  a lot of misdiagnosis.
I think a Schiz OCD’er would be the last person to go psychotic, as the condition is predicated on continuous worry and doubt that they are going psychotic. If you have spent any time around psychotic people, that’s clearly not what’s going on. In psychosis the person never worries whether they are psychotic, nor are they are aware they are psychotic.
If you are worried about or are aware of being psychotic, then you cannot possibly be psychotic. That’s a rule out for psychosis right there. This is exactly what is going on in Schiz OCD, hence Schiz OCD is never psychotic by definition.

Are Schizophrenic People Smart?

Although of course schizophrenics vary in IQ, the research shows that lower IQ is associated with schizophrenia. Typically the lower IQ was present before the schizophrenia hit. Whether these people already had pre-schizophrenia and the low IQ was a signal of that or whether lower IQ is an independent risk factor is not known. I suggest the former.
I am not sure if schizophrenia itself, once it hits, causes an IQ decline, but it would not surprise me. The process of developing schizophrenia involves considerable damage to the brain. It makes sense that this brain damage, in addition to causing the disorder, also lowered your IQ.
In summary, people with schizophrenia tend to have lower IQ’s than normals on average, but the difference may not be large. I think it was only ~3 points.

How Can I Tell If I Have Paranoid Schizophrenia or Schizotypal Personality Disorder?

Answered on Quora.
Simple. If you had either one, you would probably not be asking this question right now.
If you had paranoid schizophrenia, you would not be asking this question because people with this illness do not recognize that they are ill, typically refuse to seek help, and also refuse to take medication. If you tell them they are ill, they will not agree.
If you had Schizotypal Personality Disorder (really mild schizophrenia) you would probably not be asking this either. These people probably do not believe there is anything wrong with themselves either, and they are typically too paranoid to go in for treatment. There is a forum for Schizotypals on the Net, and many of them are on there saying that they are too paranoid and distrustful to go to therapy.

Borderlands: Obsession, Delusion and Their Differential Diagnosis

The Borderland between Obsession and Delusion

Anxiety processes can at times escalate all the way to psychosis. I have had some OCD clients who I had a very hard time figuring out if they were psychotic or not. With one, I told a retired therapist of their symptoms, and the therapist immediately said, “Well, they’re psychotic. That’s a delusion.” The things that they believed or almost believed did look like psychotic delusions. However, they did not entirely believe them. OCD with Overvalued Ideas was probably a better diagnosis. There are a few cases of Psychotic OCD. I have never seen one though, although this case was getting close.
When OCD gets very bad, they appear psychotic. However, they generally are not, and in 95% of cases, I can figure out that they are not psychotic. That is because Severe OCD That Looks Psychotic has this particular look, feel, or vibe (gestalt) about it where the cases all give off this particular vibe. It’s like they are all reading off the same script in a sense.

The Problem of Psychotic People Hiding Symptoms

You get a different look, feel, or vibe (gestalt) with an actively psychotic individual, but they can be hard to figure out too because sometimes they lie about their delusions.
I have caught them hiding symptoms from me.
Some people with psychoses learn to hide symptoms because they figure out that every time they say “The FBI is after me,” someone grabs them and hauls them off to the hospital. So they continue to believe the FBI is after them, but they learn to shut up about it.
You look at what the person is doing in reaction to the thoughts. They thought the neighbors were hacking into their computer so they disconnected their computer from the Internet? Delusion. A person who just had the fear or obsession that the neighbors were hacking in would not disconnect the computer, and their description of the fear would be full of all of these strange doubts and uncertainties.

The Difficulty of Differentiating between Thoughts and Voices

Psychotic people sometimes refer to thoughts as voices. I had one client who referred to thoughts telling him to do bad things, in this case, to kill animals. He had recently killed five puppies in response to these thoughts ordering him to kill these animals. I suspected these were more than thoughts, so I had him describe them, and he said, “It’s a thought, you know. You hear it like someone standing next to you and talking.” Ok if you hear it outside your body like that, it’s not a thought, it’s a voice.
Some people with schizophrenia hear their thoughts spoken out loud in the environment, and they fear or believe that others can hear their thoughts being broadcast out there. However, if you corner them on it, some will try to deny it by saying that they just have very loud thoughts in their heads, and the thoughts are so loud that they worry or fear that maybe others can hear them. That’s not quite precisely a delusion, and it’s not a hallucination like the thought broadcasting. It’s off into the obsession/delusion borderland.

Schiz OCD – OCD with the Fear of Psychosis Theme

There is a type of OCD where the person fears that they are going psychotic. OCD’ers have made up a term called Schiz OCD for this illness, which is really OCD with the Fear of Psychosis as the theme. Some clinicians have complained to me about these “hokey names” for the different OCD types and accused me of making them up. I didn’t make up any of them.
The sufferers make up these names for the different themes that they have. I feel that the sufferers have a right to own their symptoms and illnesses and call them whatever they want to call them. That’s their right as sufferers.
Who are we to tell them that their name for their symptoms is the wrong name? Do we have a better name? Of course not. “We” are just arrogant clinicians who think we know these illnesses better than the sufferers themselves know them. I realize Schiz OCD is a confusing name, but it’s the name they picked, and we don’t have a better one, so let’s go with it.
They develop all sorts of “psychotic” symptoms, including fake delusions, fake hallucinations, and even perceptual disturbances. Once again the Schiz OCD symptoms have a completely different quality – look, feel, vibe or gestalt – than you get with someone who has actual delusions and real hallucinations. In addition, all of the Schiz OCD symptoms have a very similar quality across many different people – once again, it’s like they are all reading off the same script.

The Problem of Misdiagnosis in Schiz OCD

I have now seen more people like this than I can count, and I’m an expert on this illness. But I still get people with this type of OCD coming to me all the time with diagnoses of various types of psychoses, schizophrenia, psychotic depression, etc. They received these diagnoses from qualified clinicians such as psychiatrists and clinical psychologists. They were misdiagnosed in 95% of cases, so you see even skilled clinicians can’t tell this OCD type from a psychosis in a lot of cases.

Are People on the Schizophrenic Spectrum Less Intelligent?

Answered on Quora: 
Indeed, repeated studies have shown that schizophrenia is associated with a somewhat lower IQ – possibly 5–10 points. These studies showed that schizophrenics had lower IQ even before the schizophrenia developed.
Why schizophrenia is associated with lower IQ is not known, but schizophrenia is a disease of the brain, and it seems that whatever is causing the schizophrenia is also lowering the IQ.

Schizophrenia and Autism: Similarities and Differences

JohnnyHG writes: There is evidence schizophrenia is developmental like Autism. I would exclude the cases of diagnosis of someone with a history of drug use or brief psychotic hallucinations from environment. The fuck up just gets delayed – it’s latent, which is why it happens in one’s teens/early 20s rather than toddlerhood. But there are signs lasting years leading up to it if I am correct, prodromal? It doesn’t happen overnight.
Experts have watched videos of children who later went on to develop the condition and could pick them out after a while. Often poorer school grades, abnormal movements, and irritable behavior could be found. Plus the negative and cognitive symptoms overlap heavily with Asperger’s/ASD or just Autism Disorder. I believe they bundled it all up because there is too much heterogeneity, hence the distinction between AS and Autism was a bit artificial.
Some things seem to be opposites: clumsiness in autism vs. stupor/stiffness in SCZ, repetitive literal speech or no speech in autism vs alogia or garbled speech in SCZ, obsessiveness with one topic in autism vs apathy in SCZ, but stereotypies are shared and so are bizarre habits. However, there is a different flavor to them, hard to describe.
Do you believe it is neurodevelopmental or stick with the old belief it’s degenerative?

Thanks for the excellent comment. I share your views. I have long believed that schizophrenia is developmental. Really they are born with it or born with the tendency. With enough stress or genetic loading, they get schizophrenia, and if they have little stress or low genetic loading, they either get schizotypal personality disorder (really just mild schizophrenia) or they may get schizophrenia with a later onset.
There really are two things they are seeing in the early symptoms.
The first are the early symptoms – clumsiness, oddness, poor grades, irritability, etc. Those are childhood symptoms.
Then there is the prodrome which hits in adolescence at some point. This causes a slow deterioration over a few years’ period leading to the classic onset from 16-24. I was best friends with a man with paranoid schizophrenia for a year. I hung out with him every day that year. It was a most interesting experience!
At the time, he was 27 years old and he was in the prodromal phase of paranoid schizophrenia. It had been going on maybe since age ~22, so five years. A long slow prodrome is common in paranoid schizophrenia. He was hearing voices the whole time, but his charming personality was quite intact. He was half-Black, very good-looking, and very charming, and he attracted White women everywhere we went together. He later got slowly worse and worse, and after a while, he was not even talking much. I haven’t heard much about him since, as my relatives are telling me to avoid him.

Do Therapists Ever Think Their Clients are Unfixable?

Question from Quora:
Some people are utterly unfixable or even improvable, but they are quite rare.
There are clients who are just too far gone, and they cannot be helped at all. It is as if the person were a ceramic bowl that was dropped on a hard floor. The bowl is now in 100 pieces, and the person who dropped it is on the ground looking at the pieces and throwing up their hands. “Where do I start?” he asks in exasperation.
All sociopaths and psychopaths are unfixable by their very nature. We can’t cure the sociopathy and psychopathy because they don’t want to get better. They enjoy being antisocial, and they do not wish to change. However, we can get them to change their behavior. For instance, a homicidal sociopath may show up in the office. A good therapist may be able to convince this sociopath that acting on their homicidal fantasies would be one of the stupidest things that they could ever do. This sociopath may then be able to go through life without killing an innocent person. So we can’t fix sociopaths, but we can change their behavior somewhat, tone it down, or reduce the amount of damage they do to society.
All paraphilias are unfixable by their very nature. The paraphilia quite literally will not and cannot go away. It’s etched in stone.
Schizophrenia is largely unfixable. They need a great deal of medication, and even then in most cases, they are repeatedly hospitalized. A few can go on to lead somewhat normal or even successful lives, but these people still need continuous medication and regular psychotherapy. In addition, they need frequent interventions to stay out of the hospital.
Many illnesses such as OCD, Bipolar Disorder and Chronic Major Depression are unfixable by psychotherapy. Most of these people will need medication for the rest of their lives. However, psychotherapy can improve their conditions a lot at least in the first and last cases.
Long-term suicidality is very hard to fix. It tends to become chronic with repeated attempts over the years. The suicidal person is typically defiant and is furious with you for challenging their suicidality. You are expected to sympathize with their condition, which is actually a very bad idea. Most suicidal people are what I would call “defiantly suicidal.”
Personality disorders are generally incurable. Theoretically, they could be fixed, but these people almost never present for therapy, and when they do, it is often at the behest of others, and they do not really wish to be there or get anything done. People with personality disorders, like sociopaths, literally do not want to get better. They like their personality disorder, and they are incredibly resistant to change. There are some case reports of cures of personality disorders, but in general the prognosis is grave.
I have never been able to fix long term low self esteem, and I have tried with a few people. There is something about that condition that hammers itself into the brain as if into concrete. I do not know why, but long-term low self-esteem seems to be one of the hardest psychological problems to fix. Why this is, I have no idea. Perhaps someone else can offer some ideas.
In many cases, long-term mental disorders simply cannot be fixed or cured. However, with psychotherapy and drugs, people can often get much better than they were before. We need to stop thinking in terms of cures and start thinking in terms of amelioration.
I realize that many clinicians insist that most people can be fixed or cured of long-term conditions, but I think they are lying. They are probably trying to drum up business. Many clinicians fear that if word got out that a lot of long-term mentally ill people cannot be fixed or cured, people would stop coming in for therapy. There goes their paycheck. Therapists are a lot more money-oriented than most people believe, and don’t let anyone tell you otherwise. I know this field very well.
Clinicians have nothing to worry about. Even if a lot of conditions could only be ameliorated and not fixed, I am sure a lot of folks would show up to try to get some improvement. Some mental disorders are so painful that any improvement feels like a miracle cure to the client. A lot of people have given up on being cured anyway, just want to at least get better and are quite happy to do so.

The Untreatable Borderline Personality Disorder Client: A Therapeutic Nightmare

Borderline Personality Disorder (BPD)is one of the hardest disorders of all to treat. It can be improved with some therapies, but the road is long and hard. Many seem to go on for years or decades with little or no improvement. There are reports of cures, and I am familiar with a woman whose BPD cleared up at age 55 after having come on in childhood. That’s probably a typical cure. Decades of nasty illness followed by a lifting of the illness in middle age.
Many mental disorders improve in middle age, and even many personality disorders improve during this age period.
Schizophrenia often ‘burns out” in middle age, and florid positive symptoms are replaced by more negative symptoms.
Many anxiety disorders attentuate in middle age.
Even psychopaths often get better or at least less destructive in middle age, as many of them also burn out in a similar fashion as schizophrenics. A number of highly antisocial psychopathic men get better in middle age as the antisocial behavior attentuates. It is often replaced by depression, heavy drinking and a pessimistic, cynical, imbittered and misanthropic person who nonetheless does little damage to society anymore.
It should be noted the clients with BPD vary widely in their symptom pathology.  Some are much more functional than others. Quite a few can even function well at their jobs all day, but when they come home from work, they fall apart and shift into full BPD pathology.
However, some people with BPD are so ill that they seem nearly untreatable. It is these people who will be the subject of this post, not BPD’s in general. These people seem so far gone and broken that one wonders how anyone could ever even begin to put them back together again. I suppose some progress could be made, but the damage is so severe that I have a hard time seeing how even the best therapist could possibly fix these people in any significant way.
A typical case might be a young woman who, only in her late 20’s to early 30’s, already has 8 -13 suicide attempts and many hospitalizations behind her. She goes into the hospital on a regular basis. Therapy seems to do nothing but feed her pathology as she manipulates gullible new therapists to believe her lies, nonsense, and projections as the new therapist confuses symptom pathology with the truth. Drugs do almost nothing.
Diagnosis itself is often difficult because the BPD is so severe that the person often appears psychotic/delusional. One wonders what are delusions and what are not. Even the delusions do not seem to last for long, as they are dropped, changed around, added to or substituted in a wildly chaotic fashion.
Usually there is a lot of combativeness and involvement with the court system, as the extreme rage leads a litigious person.
Splitting is severe and textbook.
Self-image is so unstable that the person almost literally adopts the full personality and even persona of whomever is on their radar at the moment. The clinician needs to be prepared that this person will so identify with the clinician that they will adopt the therapist’s image and persona as their own. Boundaries nearly do not exist for these people, and they often fall in love with their therapists, try to seduce them, or on the other hand become furious at them to where sessions became rage attacks at the therapist, and the therapists is at odds of how to respond without violating ethics.
The client can become overtly suicidal even during sessions, and infatuation with the therapist can quickly split to where the therapist is the source of all evil. Homicidal threats and homicidal-suicidal threats against the therapist may now appear. The client then hospitalizes themselves due the “horrible trauma from the evil,  incompetent therapist” and soon finds sympathetic new therapist, typically a feminist woman, to unload her story on. The new female therapist forms an alliance with the client against the “evil male” former therapist and accuses him of damaging the client.
Commonly, the therapist gets angry and tells off the client. This leads to abandonment and a vengeance agenda against the therapist, who has now “irreparably damaged” the BPD and “caused them to spiral out of control.” Be prepared to get accused of abandonment, causing severe trauma in the client and making them dramatically worse. The client may become hospitalized due to allegations of damage from an incompetent therapist.
These people are so difficult and chaotic that many clinicians refuse to see Borderline patients. Some are on the record as saying that when they say a Borderline client coming their way, they hide under their desk until they go away. For a lot of therapists, these clients are nothing but trouble, and endless parade of drama and chaos. Therapy itself is chaotic, mercurial, and wild with severe splitting and often extreme idealization of the therapist for good or ill or both, interrupted by fairly regular hospitalizations. The therapist begins to wonder what’s in it for them and thinks you could not pay them enough to suffer through such clients. These clients make an excellent argument that therapeutic abandonment is the proper choice with some clients.

A Bit About Paranoid Schizophrenia, with a Real Life Example

If you were going psychotic and hearing voices, you would not even know they were voices. When you first heard them, if you were in your home, you would go around looking for the person hiding in your house because it would sound exactly like a person talking in your home. You would search everywhere, under the bed, behind the couch, everywhere someone could hide.

I spent a year hanging out with a paranoid schizophrenic every day. He heard voices all the time, but he was convinced they were coming form the radio or the vents or wherever. For instance, he kept demanding that we take apart the radio in my car to find the recorder in there that was putting out the recordings.

When he first came over to my house, he said he heard someone down in the cellar, so we went down there to look, and there was no one there. I thought it was pretty weird at the time, and I did not know what to think of it, as I had just met the guy, and I did not know he had schizophrenia.

After I hung around with him a while, I started to put two and two together and realized that he was slowly developing paranoid schizophrenia. I figured this out because I had been studying mental illness for 25 years. I had never dealt with a paranoid schizophrenic up close and personal like that before, but he seemed to be a textbook case based on everything that I had read.

He was 28 years old, and the symptoms seem to have started when he was about 23 and at college. There is often a long slow prodrome with paranoid schizophrenia. So while it does have a later onset often in the late 20’s and early 30’s, there has often been a long slow prodrome going on characterized by slow deterioration for even up to five or ten years.

Paranoid schizophrenics do seem to function somewhat better than the rest of schizophrenics, possibly due to this later onset. Some of them have even married, had children, started on careers or opened businesses when the disease hits, so they have had some illness-free years in which to develop their personalities. Hence the personality is more intact in paranoid schizophrenia than with the other forms.

Later I would be over at his place, and he would hear the voices coming out of the vents. He lived with his Mom, and he insisted that his Mom put a recorder in there to harass him, and he wanted me to help him take the vent apart to “look for the tape recorder.” He had a lot of arguments with his Mom about her “putting the recorder in the vent.”

It was very difficult to deal with the guy because he heard the voices, and they were so loud and clear that he would whip around and say, “You hear that?” and he would point to the car radio or the vent or wherever. I always said no, and it was making him mad because the sound to him was clear as a bell, and it was absurd that I could not hear it. So he was always accusing me of being a liar and saying I did not hear the voices when really I did.

After a while, I started making excuses and saying things like I had a problem with my hearing.

The problem is do not want to agree with the person when they say they hear voices because you are just reinforcing their craziness, and pretty soon you will be working with the person to take your car radio apart to “find the microphone.”

Furthermore, it’s best not to reinforce their delusions either because you will just strengthen the craziness.

Actually it probably would not hurt to say you hear the voices too or agree with their delusions, but I always worried that it might make them worse.

For instance, a schizophrenic says someone is persecuting them. Well, you can either agree or not agree. If you agree, you run the risk of reinforcing their belief, and they might get so reinforced, convinced and angry that they assault the person.

Another problem is that I would take him places with me sometimes, say to my doctors appointments, while we were running about trying to get him an apartment. While there, say as we were leaving, he would insist that someone in the waiting room had said some particular insult to him. Actually no one had said anything to him, much less the insult that he heard. He would want to go back in the waiting room and challenge the person over the insult, and it would be rather difficult to convince him not to do that.

He had done very well in college and was a great basketball player but not such a good student. At one point, he had moved into an apartment with other people, but that all ended when he accused them of messing with him through the walls of the apartment. He also accused people of breaking into his car. He would go out to his car, and it would seem like someone had broken into it or messed with stuff inside. He eventually had to move out due to this, and he moved back home to live with his Mom.

I kept trying to get him into an apartment down in Fresno, but things kept falling apart. He would get into the new place, and it would have the damn recorders in it too, and he would accuse the guy was rented it to him of putting the recorders in there. I met one of the men who rented to him, and he was dumbfounded, shaking his head, and could not make sense out of my friend at all. His attitude was “Good God, what the Hell is the matter with this guy!?”

My friend was a mulatto, and he had a very charming personality along with being very goodlooking. Everywhere we went, he would walk up to young White women and chat them up in his usual engaging manner, and they would usually be very interested in him. He was quite a charmer and could really talk to the girls. It was insulting as the girls would always rather talk to the insane guy than to me who was not nuts, although I was in my 40’s at the time I must admit.

If you were out in public with him, and he was chatting up women or whatever, he would typically not seem crazy at all. Instead he would seem to be a perfectly normal, charming, extroverted guy.

I was never afraid of him. Everyone kept telling me he was dangerous, and they were all trying to get me to get rid of him as a friend. He didn’t seem violent to me, and I can read people pretty well. He did yell a lot but not usually at me – more at the folks who were “persecuting him.” The whole time I was with him, I would be looking at him and trying to read his mind (I am a very good mindreader) to figure out if he was going to do something violent. I never got any vibes off of him that he was going to be dangerous, so I wasn’t really worried about him.

However, people close to me eventually convinced me to ditch him, which was not easy. I saw him a few times later around town and gave him a couple of rides. Later he had somehow gotten a job at the local supermarket, but by that time, he was deteriorating even more, and he had become very quiet and would almost ever talk.

I later heard that he was down in my city roaming around on the streets and hanging out at the mentally ill drop-in place.

My friend would never admit to being even slightly mentally ill, and after a while I stopped confronting him about it. But I did try to get him to see a psychiatrist I knew under the guise of giving him some pills for his nerves to calm him down along with some other phony excuses. She was good at dealing with psychotic people who would not admit they were ill, and she would often succeed in surreptitiously giving them some antipsychotics under the guise of calming their nerves or other phony excuses. You have to be a bit sneaky with these people when they will not admit they are ill. I have known people who had psychotic or seriously mentally ill relatives who they were considering dosing with antipsychotics in their orange juice or coffee. I actually think that would be a morally proper act.

The problem in psychosis is that the person typically has no idea that they are ill. Whether they do not want to admit for psychological reasons such as stigma or whether they can’t realize they are ill because psychosis blinds the person to the fact that they are ill, I am not sure. I suspect some of both. Some people are episodically mentally ill, and when they get better, they will often not admit that they had been ill due to stigma or ego reasons.

The problem in psychosis is that the part of the body that is needed to recognize that you are ill is itself sick. The person can’t figure that they are ill because in order to do that, you usually have to be at least somewhat sane. In fact the presence of insight is an excellent diagnostic feature in mental illness, and the greater the insight, the better the prognosis.

Insight is also a very serious problem in Bipolar Disorder, even in the milder phase known as Hypomania.

OCD and Homicidal Thoughts

Homicidal thoughts or harming thoughts are quite common in a type of OCD called “Harm OCD.” It can get pretty bad. As a counselor and a sufferer, I have dealt with many people who had this particular type of OCD. In fact, they come to me all the time! I typically do some sort of differential diagnosis with them to make sure it’s OCD and not something more serious.
Below are some cases of obvious OCD or OCD-like thinking:

1. OK so one day me and my sister were just talking and all of a sudden I get this weird urge to choke her. I would never do that to her. I can’t even kill a bug and I’m not bi polar. This has happened again recently with my other sister, the thought just randomly occurs. If it helps I have been diagnosed with panic disorder. Please don’t be mean and say I’m a psychopath or I’m crazy. I need to know if any one else has experienced this to. Please help!
2. I do too sometimes. Sometimes while I’m driving I feel the urge to swerve into traffic. Sometimes for no reason I get the urge to choke my dog or hit her to death. (Of course I’d never do it.) It feels like you have no control over yourself. It feels like your actually about to do it but you don’t.
3. Believe it or not I’ve been through the exact same thing I had violent and sexual urges that I couldn’t control but I never hurt anyone I just always felt like I would, some specific urges I had were to drown my sister in the pool , every time I was someplace high up I would have a strong urge to jump off. I had these urges from age 10-15 and I was scared to be around people but I found out it is OCD look up OCD violent urges online.
I finally talked to somebody about it and said I was worried I would hurt somebody and they said the reason the urges don’t make me a violent dangerous person is because I’m worried about it were somebody dangerous would either not care or enjoy it.
4. i think everyone thinks these thoughts, not because you want to do them, but because your brain can think it. Its just putting yourself into a scenario, kinda like a daydream. Ive thought that way…”what if i just punched her…what if i slipped and fell and hit my head….what if i swerve into traffic??” tons of things will cross your brain…you’re human and its curiosity. I think you’re just fine. Unless you start getting the urge to actually follow through with it, or attempt it. Don’t sweat it.
5. Guys… I have that too. Sometimes ill sit and watch tv and suddenly ill have a random thought of killing my mom or hurting my dogs. Anyone in my house hold. I’m completely fine when these thoughts occur. I’m not mad, nor upset. And my family never did anything wrong to make me think such things…I would NEVER hurt anyone…
And it scared me. Sometimes i avoid certain objects i could hurt people with and i stopped watching my favorite crime shows. It all freaks me out now.. Ive asked a friend, and he has it too but not as extreme. More of a “what if” thing. He says im fine and he thinks everyone has these thoughts at one point.

Some of these folks may not even have OCD, but at any rate, all of these thoughts have an OCD-ish feel to them. It’s quite common for non-OCD’ers to get thoughts like this once in a while.
This case is more difficult:

Hello. This isn’t very easy for me to let go into the world, but I would like people’s opinions. I am on the other end of a 1.5 year bout with OCD and being terrified that I am going to indulge in homicide. Things are much better now, but yesterday at work, I got all my issues worked up in my head and at one point I genuinely wanted to indulge in homicide. I actually wanted to do it.
During that I had slight panic attacks running and of course it worries me that the curiosity of doing such an act is attractive. Now, I have read many posts here on how to self help your OCD, but this is the first time I have ever been genuinely attracted to the horrible thing I’ve been afraid of for such a long time, and that’s the difference between being afraid of intrusive thoughts and being attracted to them. Is that normal psychology for an OCD sufferer, do you think my thoughts got twisted in knots and then I deceived myself into thinking I wanted to do it, or do you think I should seek some help?

The thread goes on and on, and some folks are are telling him to go to the ER and check himself in. The guy who posted this is worried that he felt like he really wanted to do it. However, many of the OCD’ers I have dealt with have told me that they feel like they want to act on these thoughts. In every case, they were given a diagnosis of OCD by multiple clinicians. The thing is that OCD itself can make you feel like you want to do these things. It can also make you feel like you might or would enjoy them. All of this causes more panic, anxiety and attempts at thought suppression.
So if someone comes to me with classic Harm OCD stuff and then tells me that they feel like they want to act on these thoughts, I am not particularly worried. It’s probably more the OCD convincing you that you want to act on the thoughts or that you might enjoy them more than anything else.
This case is much more disturbing.

Hello, My name is Ryan. I’m 17 years old. I’m posting this here today because for quite some time i have been obsessed with murder, blood, torture, and rape. When I see someone walking down the road, my mind unconsciously comes up with random ways of torture I could try on them, I’ve been doing this since I was around 15, but now something’s changed – I feel its getting harder and harder to control, I’ve had to start journaling and drawing what I would like to do to my victims.
I feel I could take countless human lives and not stress about it. Will someone please tell me what’s wrong with the way I think? My parents told me its a stage, but I know it’s more. Just someone please try to give me insight on why this is happening.

I am honestly not sure what is going on with this guy, but one thing it is not is OCD. No way does a Harm OCD’er journal and draw pictures about torture, rape and murder. Forget that. The OCD’er would be terrified of having the thoughts in the first place, would not enjoy them at all, and would most likely viciously fight them from the first time they showed up until they went away, if they ever did.
The OCD’er doesn’t want those thoughts or feelings in his head for even one second. He would never just indulge in them for pleasure or write journals and draw pictures that delight in murder, torture and rape.
Truth is most Harm OCD’ers are so scared of their thoughts, etc. that they start avoiding all situations that might set them off, including any TV shows, movies or writing that has to do with murder, rape, torture, etc. If they watch or read something along those lines, they will feel serious anxiety and nearly have a panic attack.
In the thread, a few of them ask him questions to see if this is OCD. He says he enjoys the thoughts and feelings very much. That doesn’t sound like OCD one bit. However, he does say that he tries to resist them at times, but he can’t. Now that is very odd. But there may be occasional resistance with non-OCD stuff.
The fact that he feels like he could kill countless people without a single worry in the world is also disturbing. No way would an OCD’er feel that way.
It is interesting that a number of other commenters said that they had similar thoughts and feelings, especially when they were teenagers, and at some point, they just went away. That is very hopeful. I had assumed that once you get to the point where you are fantasizing about rape, murder and torture all the time, even to the point of doodling and journaling about your fantasies, you are pretty much gone. But apparently this is not so, and people can easily move out of this kind of thinking. That is a very good thing indeed.
The following are some cases of homicidal thinking in schizophrenia:

1. Yes but not intentional homicidal thoughts more like random ones that come in my head like if I see a bus pass by me sometimes I would have thoughts of breaking the windows with a baseball bat and screaming at the passenger or punching someone randomly passing by me but not of anger I barely get angry anymore just random thoughts.
2. Hi, I’m new here to this board. I was just curious if anyone feels these symptoms. I feel this way all the time. Whenever someone looks at me wrong. All I want to do is hurt or kill that person. I was recently hospitalized a couple months ago. I’m always scared to death. All I wanna do is crawl in to a dark room and cry. Sometimes when I’m driving I think what if I just turn the wheel and kill that jogger running.
Seriously I see a pdoc and have seen the same doc since I was a little kid. My pdoc says it’s just delusions. But it’s so real!!! I was diagnosed with paranoid sz. about 3 years ago. Does anyone feel this way? Please anyone I would love to know that I’m not alone here.
3. Hello Weenska, you most certainly are not alone. I get homicidal thoughts too. The scary thing is that they are all about killing children. You see, I work in a children’s’ hospital, and for some reason my mind is set on hurting the patients there. I get so nervous when I have to go clean a room with a patient sleeping in there.
The nurses are outside of the room sitting at the nurse’s station, and I’m alone in the room with the patient. While I’m cleaning I get evil thoughts of how I could swiftly kill the child without anyone seeing. My mind comes up with so many ways on how I could get away with it too. It’s like I’m constantly fantasizing about being a secret, mysterious child killer. Isn’t that awful?
4. I know I’m not a bad person and could never harm anyone. You’re not a bad person either. Why we get these kinds of thoughts flowing through our head is beyond me. I want you to know that whatever filthy person our minds may try and persuade us to be, that its not who we really are. 🙂
5. Princess is right, you’re definitely not alone! I have homicidal thoughts about my hubby. I don’t sleep well at night so a lot of the times I am just sitting in bed watching my hubby sleep. I would think about what it would be like to actually commit a murder. I can picture myself smashing his head in with a baseball bat, or poisoning his food, I even can see my self sneaking up on him and stabbing him in the back.
I’ve told him and at first he thought it was kinda funny, but now I can tell he’s sometimes a little edgy around me. I love him so much and I don’t want to lose him…To me, this is so much more than some kind of delusion. Its like the devil himself is tempting me. I hate feeling so sick and twisted inside. Anywho, yes I can relate. I know I’m not bad, and I will fight these thoughts off as hard as I can for as long as it takes!
6. I’ve always been a real docile person, but when I got sick I had some homicidal thoughts.
7. In 1980, I had a lot of violence in my head and I was afraid for about a week that I would get violent. It scared me and made me feel bad, but I managed to control it.
8. I get these thoughts of hurting people sometimes too. I haven’t acted on them so far.
9. I used to get terrible homicidal thoughts. There were command voices, and there were the videos/images that played in my head about terrible crimes I was committing. I have been hospitalized over 20 times, and many of these were for homicidal ideation. I would be taken to the inpatient unit and put in isolation because I could not control myself.
But after the fact when I would get re-stabilized on meds, my T told me that she did not think I had it in me to hurt another person. I have never hurt another person. I am generally very kind and calm. She wanted me in the hospital because she was afraid I would hurt myself. After I had the homicidal thoughts I would feel SO guilty about having the thoughts that I wanted to kill myself because I was such a “bad” person. But, I am not a bad person. Now I have been stable on Clozaril for 6 years, and I no longer have homicidal thoughts… ever.
10. From my perspective, It might b “normal” 2 have homicidal thoughts about some 1 I don’t like or doesn’t like me. But I have homicidal about the ppl i LUV the most! It’s like the thought pops up in my head then I got a whole bunch of cause n effect scenarios.
It could b like if i c a hammer on the table, I could bash my loved one in the head. Or it could b some insecticide, n I could add a dash of death 2 a meal. I mean yea, I been thru some bad shit, but this is just fucked up! After i realize what I just wuz thinking, then I start feeling all bad, then the potential bad endings, n it bothers me. I mean, I’m ain’t necessarily a bad dude, but damn that shit ain’t cool, feel me?
11. I get homicidal thoughts when I am deeply disturbed. I make up shit in my head on how I could kill someone and get away with it. I have really good self control, and I’m a good person, and it bothers me deeply. Most of my homicidal thoughts are about my brother though because he is clearly the Antichrist. I talked to God when I was actually planning on killing him and he stopped me. He’s a crackhead and pill popper big time and only uses my disabled mother for more crack money.
Luckily he has found a place to live so he doesn’t bang on our doors at 530 or call my phone anymore. He threatens a lot towards our family, but I can do so much more harm than he could. My father passed away in January and he was the only person who could keep him in line. The constant family feuds we’ve been having has at times caused me to the point of pure insanity. I talk about killing him openly with my family and how he just needs to die.
Of course, they’re very freaked out. I’ve always had homicidal thoughts even before schizophrenia. But they have just been getting worse about my brother. I think about killing other people sometimes, but it’s mostly my brother because he’s a piece of shit. This morning he came by again and I couldn’t sleep. I haven’t heard voices in over a week, they come and go, but this morning voices were telling me to murder someone.
12. When I read this post, I immediately remembered my early teen years, when my illness really started getting bad. I had my first hallucinations when I was about 14 or 15, and that’s when I started having thoughts of killing people. At first the thoughts were of killing people at school, like a random school shooting, and then killing myself. Then came the thoughts about killing my family members and then myself. I skipped school all the time because of it. I feel sick just typing this. I want to delete it and pretend it never happened.

This one is deeply disturbing. Some sort of homicidal thinking she had actually led to her trying to kill her brother, probably when she had schizophrenia:

I’ve had thoughts like that before too. I used to go to school with a girl who I thought was perfect. I wanted to kill her because I felt so flawed next to her. The point is, NEVER act on these impulses. Never hurt anyone or you will regret it horribly. I tried to kill my brother once and he avoided me for years (can you blame him?).

As you can see, homicidal thinking is extremely common in schizophrenia. In fact, the vast majority of schizophrenics seem to experience it at some time or other. Some of this stuff looks very OCD-ish to me. Whether it justifies an additional diagnosis of OCD or not, I have no idea. You will notice that in many cases, anti-psychotic medication specifically for schizophrenia made the thoughts go away. This implies that it was not an OCD process driving the thoughts but instead it was a schizophrenic process. If it was an OCD process, the anti-schizophrenic drugs would not have worked.
The question is how does the schizophrenic homicidal thinking above compare to the OCD-type ideation in quality? Honestly, I do not have the faintest idea.
One way it differs is that in schizophrenia it can take the form of command hallucinations ordering the person to commit violent acts. Fortunately, they do not give in to the thoughts most of the time. There is something a bit similar in OCD where the person experiences thoughts inside their head ordering them to carry out various homicidal and violent acts. The difference is that in OCD it will be a thought and in schizophrenia it will be an external voice. And in schizophrenia, there is much more likelihood that the person will act on it. The chance that a person with OCD will act on the thoughts is just about nil.
However, in schizophrenia, this thinking is much more dangerous as it regularly leads to episodes of violence. However, as you can see above, only one of the schizophrenics above ever acted on their homicidal thoughts, so in many cases, they are able to control themselves.
I have never worked with schizophrenics, and I don’t know how to deal with homicidal ideation in schizophrenia. I imagine it is a very tricky area to determine a schizophrenic with this type of thinking is dangerous or not.
People come to me after reading my articles. They are basically self-diagnosing with OCD, or they have already been diagnosed by a clinician. I have found that people are pretty good at self-diagnosis for this condition. They often write me telling me that it is as I could see inside their minds and tell them what was going on in there. All of the people who came to me with homicidal or violent thoughts had OCD so far, so I haven’t had to worry much about differential diagnosis. I did have one client who was truly homicidal, but that person was thinking in a completely different way and it wasn’t OCD driving the homicidal ideation, it was something else altogether. There wasn’t much I could do about that person either.
Unfortunately, I think most of the people who are truly dangerous are simply not going to show up for counseling or therapy. They either like to feel this way or don’t care, and they don’t see any problem with their way of thinking.

Drugs, Mental Illness and Psychiatrists

Sutanu writes:

Hi Robert,
Your article was very interesting, I have a very personal experience with schizophrenia and I do not know the role marijuana had to play in it. I have been a pot user since I was about 22. My wife was a cigarette smoker since age 18 and alcohol user since 20.
She started smoking pot since age 24 – sometimes 3-4 times a week sometimes once daily. Around the age of 29 she started developing symptoms of schizophrenia, which was full blown by the time she was 30 (with auditory hallucinations). She has been in treatment for the last nine years.
In the opinion of her psychiatrist, it was the use of pot that triggered and maybe even possibly caused the illness. Reading your article and your responses, I am now confused whether this is possible as you have said that the safe age to start on pot is 21. Would love to hear your thoughts on this.

Statistics show that there is no increased risk of schizophrenia after age 20. Your risk is almost all used by age 19 or 20 anyway.
Anyway, the cannabis-schizophrenia link does not appear to make any sense. Of all of the recreational drugs out there, cannabis is one of the easiest of all on your brain. Schizophrenia appears to be characterized by extensive damage to the brain. Since cannabis does not cause extensive damage to the brain, there is no way that cannabis could possibly cause the sort of brain damage that is present in schizophrenia.
Since the 1960’s, rates of cannabis use have gone through the roof and the rate of schizophrenia has been completely flat. In fact it has actually declined a bit. If cannabis were causing any schizophrenia at all, much less tons of schizophrenia, we would have expected rates to have increased if not skyrocketed since the 1960’s They have not, so the notion that cannabis or illegal drugs in general cause schizophrenia is very dubious.
I have known hundreds to thousands of cannabis users in my life. Two developed schizophrenia. One had very extensive meth use for decades. They other has a mother with schizophrenia.
It’s certainly possible that cannabis can trigger schizophrenia in a vulnerable person. However, those persons were probably going to get it anyway. Cannabis may bring schizophrenia on sooner than before. This is a tragedy as each year lost to the illness is a year is a lost year for the person who has it.
Psychiatrists are assholes. They all hate illegal drugs, and they think that illegal drugs cause tons of mental disorders. If you have a drug history and you go to a psychiatrist, the asshole will automatically and immediately say that the drugs caused your disorder, no matter which disorder you have or how little you drugs used. If you smoked one joint in your whole damned life, the asshole psychs will insist that it caused whatever you might have.
Psychologists on the other hand for some reason to not seem to have these same prejudices against illegal drugs and in general to not seem to blame illegal drugs for causing tons of mental illnesses.
My observation has been that heavy drug users sometimes appear to be mentally off in some way or another, and sometimes their behavior is disordered. In general however, the off mental behavior seems to clear up when the person stops using, and they just go back to their previous psychological state. I do not believe that drug use in general causes long term psychological damage persisting after the use of drugs has ceased.

Differential Diagnosis: Schizophrenia Versus OCD

From Yahoo Answers:

I have really aggressive thoughts sometimes. I don’t even understand why I have them. Usually (not limited to) they’re about hurting people. I feel really crappy about myself after these thoughts. I won’t go into all of my thoughts because some of them are really disturbing and they come out of no where sometimes. It’s surprising and then I start feeling like maybe I’m just a really evil person although I’m considerate of other people, most of the time.

I have a heart but sometimes I feel like how can I have a heart with these thoughts in my head! They don’t pop up in my head unless I think about it.

So then I thought well these thoughts might be schizophrenia, I started looking up what schizophrenia was. Then right as I saw the symptoms and examples of the symptoms I started like displaying the symptoms in my head. It’s almost like once I absorb an idea my mind plays on it.
Like when I saw this CSI episode where this person got poisoned with Cyanide, I started worrying about cyanide poisoning. When I read the symptoms of Schizophrenia where you have like hallucinations (Like voices in your head) I started making a voice in my head. Once these ideas are in my head I can’t get them out. It’s like they become apart of me.
Like sometimes I think “what if” all the time for every symptom of schizophrenia. Like people watching you. I started thinking: WELL, WHAT IF someone was watching me. Errr! I can’t get these thoughts out of my head and I think I’m starting to convince myself that I have schizophrenia. I’m scared.
I feel like a sicko.
My mind is also very contradicting: Like if I say I’m not a bad person my mind says “yes you are” and really self-deprecating thoughts. Every time I want to feel good about myself my mind will convince me that I shouldn’t and that I’m a sick freak who thinks horrible thoughts. I’m 19 about to be 20 soon and I heard schizo starts early 20s. I just don’t know what to do…I don’t have any insurance to go see a doctor. I’ve been a worry-wart ever since I was in elementary school.
Also, like schizo, I heard you hear voices in your head and you believe what they’re telling you. Like let’s say something says, “This is God talking to you!” and I’m an agnostic and I don’t really believe in God. I like create scenarios and voices in my head ever since I heard about schizophrenia. NEVER before.
It’s like my mind is trying to give me these symptoms it’s hard to explain. It’s like I know they’re my voices but I don’t understand why my voices are saying these things. It’s like WTF? :\

A most interesting case. This is a completely clear-cut case of OCD, screaming loud and clear across the landscape. I won’t tell you how I know this, but I know this illness like the back of my hand, since I have it. Been there, done that, ok?
Not that subtypes matter, but this person has a couple of subtypes of OCD.
The first is Harm OCD.
The second may as well be called Schiz OCD. This is a person who starts to worry that they have schizophrenia. In the case above, he is starting to invent crazy voices in his head due to his fear. These voices in his head are causing him to worry that he had schizophrenia.
This person clearly does not have schizophrenia. First of all, the voices in the head. The person with schiz hears these as actual voices with his ears, the same you would hear the voices of the people around you. The voices sound just like the external voices of persons near you, so much so that it is hard to figure out who is really talking and what’s just a hallucination. So the voices are not really in the head but in the ears, so to speak. We all have internal voices in our heads that we hear all day long. Nothing to be alarmed about.
The “what if” questions are typical of OCD. A person with schizophrenia or other psychosis simply says, “People are watching me.” If you try to question them about the belief, you run into a brick wall and get a big argument. It’s a rock-solid delusion, and all delusions are hard as stone.
The person also has “contradictory thoughts.” This is unfortunately quite common with OCD. The person thinks a good thought, like “I’m a good person,” and the OCD chimes in with a contradictory thought saying, for instance, “No you aren’t. You’re evil. You’re the most evil person on Earth.” These thoughts will probably be violently resisted.
When doing differential diagnosis, look first of all at how hard the person fights or resists the thought. The more ferociously the person fights or resists the thought, the more likely you are dealing with an obsession.
A good rule of thumb is: If you try to stop the thought, it’s an obsession.
Unfortunately, clinicians understand OCD very poorly, and I doubt if this person is going to get a good diagnosis or treatment. In particular, OCD patients these days are often diagnosed as psychotic and treated with anti-psychotic drugs.

Cannabis, Teens and Schizophrenia

Repost from the old site.
I received a mail today from someone who attended an interesting conference in the Midwest.
At a Mental Illness and Criminal Justice Conference today in Omaha, Nebraska, Dr. Frederick Frese, who is the Coordinator of the Summit County Recovery Project and Assistant Prof of Psychology in Clinical Psychology at NEOUCOM and Case Western Reserve U, and on the Board of Trustees for the National Alliance for the Mentally Ill, gave a session on teenage cannabis use and schizophrenia.
He has been a diagnosed paranoid schizophrenic for 40 years.
Frese stated that use of cannabis between the ages of 15 and 18 in persons who have a variant allele of the COMT gene will lead to an almost certain psychotic break by the age of 25. He said it’s because of the formative time that the brain is in during those years, in combination with that certain allele, together with cannabis use.
He said that if you have do not have the variant allele, no problem. Frese is so concerned about this that he and his team are going to start setting up genetic testing booths for kids at rock concerts because of the very real danger that the studies show exist.
I applaud Dr. Frese for the very real efforts he is taking to try to prevent schizophrenia in vulnerable youth.
I am dubious about how many kids this will save. The rate of schizophrenia has not gone up since the cannabis era began. This suggests that use of cannabis if anything will cause schizophrenia to occur sooner than it would otherwise occur, and it would occur anyway, just later.
The number of folks with this variant allele is high in absolute numbers, and many of them use MJ and don’t get schizophrenia. But it does cause a 10 times elevated risk. I think that Frese is wrong to say that it’s almost certain that these kids will get schizophrenia by 25 after smoking one jay between ages 15-18.
As I’ve said before on this blog, I have known 1000’s of cannabis users over my lifetime, many heavy users. The number who went on develop schizophrenia? Zero. This is why this whole subject makes me yawn.
I wish Frese good luck with his experiment though. Ideally, we could construct a good experiment this way. We could follow kids with the variant allele who wait til 19 to start MJ (Is this protective?) or avoid it period, with another group who did not avoid cannabis and see how many of each develop schiz and at what ages.
Tell the truth, I am quite concerned about use of cannabis by minors. I wish they would not do it. Period. Wait til you’re an adult!
I have OCD (another, though vastly less devastating, mental illness), and I have found that cannabis is actually a superb psychiatric drug for this illness. It works better than almost any med I have ever taken for this (The drugs work great at high doses, but nuke my sex drive, so what good are they?), and I have suffered for 26 yrs.
No clinician believes me when I tell them this; all insist that pot makes you mentally ill or worsens all mental illness or caused my problem in the first place (The gall of them!?), and all try to steer me to drug treatment or drug counseling when I tell them I use. I’m really getting tired of this shit. I’m 50 years old, and I’m being treated like a child.
I have some opinions about the mental health profession, but in general they are extremely low. For such a bunch of super-smart people, there sure is a lot of bullshit groupthink, scaredy-cat thinking and just general lack of an empirical outlook.

Problems of Democracy Under Capitalism

Repost from the old site.
I’ve always been opposed to public dishonesty, which is one of my problems with Communist states. They lied about so many things that now even when they tell the truth, people figure that “All Communists lie,” so they are unlikely to be believed even when they are honest. You get a “boy who cried wolf” syndrome.
Well, capitalists are pretty much the same. Almost all capitalists will always lie to defend their own interests. That is why whenever a businessman or business interest is quoted in the paper on some controversial issue, they are almost always lying. So it seems that in order to be a businessman in capitalist society, one must lie continuously.
There are cultures, such as Arab, Japanese, Thai and Filipino culture, where lying is definitely a state of art. American society proscribes all lying as evil, and your average American will tell you that he never lies. The Japanese mindset, which I subscribe to, is, “Only an idiot never tells a lie.”
So there is a time and a place for this sort of thing.
But in the sort of issues that we read about in our daily paper – controversial issues where two sides are sparring it out – you really want to figure out what’s going on. If the business side can be counted on to lie in defense of its interests nearly 100% of the time, this is very confusing. Especially when the media is so corrupted and dishonest itself that it’s not capable of sorting things out for you.
Fox News is a more or less 24 hour lie machine, but most Americans are too stupid to figure this out. American political campaigns are all about money and never-ending lying.
I can pretty much sort out the lies from the truth after a while, but it’s quite an effort. I figure most folks either don’t have the brains to do this, or they don’t want to know the truth, or they don’t care, or they don’t have the time.
Let me give you an example.
It is very hard for schizophrenics to tell hallucinated voices from regular voices. After a while, some of them get to where they can tell the hallucinated voices from the real voices.
Well, that’s what it’s like for me to winnow out the truth from the lies in our media. The media doesn’t’ really help you too much. I can figure this stuff out after a while, but it takes a lot of time. Time I figure most folks don’t have.
At any rate, elections that are nothing but waterfalls of money and lying are hardly exercises in democracy.
Under capitalism, typically the state is simply an arm of the business community. Some more progressive capitalist states (Europe, for instance) have gotten away from that somewhat, but it’s never really easy. Furthermore, nearly the entire media is usually controlled by the top 1% of the population, who use it to push their class interests at the expense of most everyone else, and surely the bottom 60-80%.
You would think that these things would be obvious to anyone living in a capitalist society, but toss that idea out sometime in a crowd and watch the hostile responses come back. It’s painful to admit that the media one loves so much is hostile and run by one’s class enemies. That hurts, and it makes you feel stupid. You’re reading your enemies’ propaganda, you idiot! That’s the message. People get their backs up.
In recent years in the US, the state has become more and more entwined with business interests, and hence has become more and more dishonest, just like the businesses that it is now essentially a part of. That is why the Bush Administration is a never-ending Lie Machine. That is why US administrations increasingly wage war on science – because under capitalism, businesses typically despise science.
Science is out to discover the truth, come Hell or high water. To the businessman, truth is whatever helps the bottom line and falsehood is whatever hurts the bottom line. If a businessman has to lie 20,000 times about 20,000 things to protect his bottom line, he will do it and not blink an eye. Then he will get up and start it all over again.
Since business sets the dominant cultural hegemony under capitalism, most capitalist societies will tend to be hostile to science.
So, living in a capitalist society, one is really swimming in an ocean of lies. Once you enter corporate culture, you need to become a lying sociopath like the corporation itself, or you are fired. The corporation is like an ant hill. Let us call this Lying Ant Hill. If the corporation itself is a sociopathic pathological liar, so must most of its component parts, the humans who make up the corporation.
An educated and aware populace is essential for democracy. Yet how is this possible in capitalism, where the elite-controlled media lies nonstop? Where the state itself is a lie factory for wealthy interests? Where business interests can never be counted on to tell the truth? You can be like me and try to get to the bottom of things, but it’s frustrating and time-consuming. Most folks have better things to do.
Democracy in most capitalist countries has serious problems. As long as the media is completely controlled by the wealthiest capitalist interests, the truth will be difficult to discover. The state itself can no longer be counted on, as it is captured by business interests and finds itself lying constantly to defend those interests.
In short, the classic Marxist argument that capitalist democracy has serious issues has a lot of truth.
The way out of the tunnel is to get some of the money out of politics via campaign finance reform. As almost all politicians are completely bribed and corrupted (bought and paid for), this solution is generally a nonstarter.
Media democracy is another route out. But it’s difficult due to high startup costs.
One solution would be to allow access to more of the radio band to local or pirate radio stations. The ferocity with which the government has attacked pirate radio shows how terrified the US state is of media democracy.
The TV band, which is mostly cable now anyway with up to 500 channels, should be in part licensed out to local entities. There should be channels available for all sorts of folks all across the political spectrum. If you’ve got the camera and the studio, do it yourself.
But the need to sell ads makes democracy in media under capitalism very difficult. Papers, radio, TV and magazines need to sell ads to survive, and hence necessarily become the mouthpieces of the business and corporate entities that advertise in their media outlets.
Progressive presses are usually only possibly via some wealthy benefactor who is willing to eat it on advertising in order to publish a Left or pro-labor paper. This is why public access channels are the only progressive and pro-people spots on the radio band – no ads. They are listener-supported, but listening to their endless fund drives makes you realize how tenuous their existence is.
Media democracy via licensing out the cable and radio spectrum to local outfits, however, is almost impossible because the government entities that license the spectrum out are completely controlled by corporate media interests.
Hence, our public airwaves, owned by you and me, worth billions of dollars, are given away to our class enemies for pennies on the dollar. The rest of us are then locked out of the band or even arrested if we try to break into the spectrum like the pirate radio guys did.
Even if public access is granted, the fact that we have allowed horribly abusive private cable TV monopolies everywhere in the US means that these companies would probably refuse to carry any progressive stations that somehow got on the air.
The Internet offered a breath of hope to this dismal state of affairs. The cost of publishing was down to just about zero, or at least nothing but time. The Communist dream (pure Communism, after the withering of the state) where media was so democratized that neighborhood media outlets sprung up everywhere and every man could be a journalist, seemed to be happening before our eyes.
The government and the big media are really scared. Progressive voices, anti-corporate voices (like this blog, for instance), could break into the media, and the circulation was limited only by how many readers you could somehow convince to come to the website.
Hence we see desperate efforts by the cable and telephone monopolies to create fast lanes on the Internet for big-money payers and slow lanes on the Net for everyone else, like for instance this site.
There is one important lesson here: capitalism never really tolerates dissent to its essential elite structures and business interests. They will allow dissent a lot of times, but the Hell if they will give it a voice or allow it any power.
Under capitalism, the elites and business interests have to control the media space, necessary to construct the Gramscian cultural hegemony.
In the Third World, dissenters against elite and business interests are regularly arrested, beaten, jailed, tortured and murdered. And if the voices get loud enough or strong enough, the capitalists will just launch a coup, overthrow the state, then launch an Argentine or Chilean style wave of terror to permanently shut folks up. If that doesn’t work, they will make the economy scream.
That’s “democracy” under capitalism in a nutshell. To put it mildly, it’s got some serious issues.

The 50 Craziest Rock Stars Ever

This article is pretty damn funny.
A lot of rockers are or were seriously nuts!
I’m having a hard time figuring out dx’s for a lot of these people. It seems to be something towards the more extroverted end. I suspect a lot of them are acting this way on purpose, sort of like a lot of artists act “deliberately insane.”
I only see a few who were obviously psychotic: Syd Barrett, Peter Green, Roky Erikson, Brian Wilson, Jim Gordon and Skip Spence for starters. I’m familiar with all these cases. They all had schizophrenia or schizoaffective disorder. It’s commonly said that they are all drug burnouts, but I doubt it.
For one thing, LSD does not appear to cause permanent psychosis. I’ve known too many completely normal folks who have taken it 100-300 times. It’s not even proven to damage your brain. The worst that can be said about it is that very heavy users sometimes do go psychotic and have to be hospitalized. Typically, they get better, but they often go back to heavy LSD use and become mentally ill again. No one has any idea how LSD even makes you temporarily insane.
All of these people simply developed schizophrenia. LSD can trigger schizophrenia, but no one knows how that works either. LSD-induced schizophrenia looks just like the rest of schizophrenia and it responds to the same drugs too. Since acid doesn’t damage your brain, I can’t see how it could cause schizophrenia. There are good reasons not to do acid, but fear of being permanently mentally ill is not one of them.
For the rest of them, dx’s are difficult. Some seem to have issues with narcissism and borderline personality disorder. Some were just seriously whacked out on booze and dope, often cocaine and/or heroin.
Ike Turner used cocaine for some 45 years until it killed him at age 76.
Sly Stone spent years on cocaine, even living on the streets smoking a crack pipe. No one quite knows what is up with Sly these days. He shows up at occasional performance, acts very strange, walks off stage in mid-show, gets on his motorcycle and rides away.
Rick James spent a good 15 years on a crack pipe.
Whitney Houston is ruined and is heavy into cocaine.
David Bowie went nuts on coke in the 1970’s, became full-blown psychotic and embraced Nazism.
Ol’ Dirty Bastard is on crack.
John Frusciante almost killed himself on heroin and coke.
Ozzy Osborne, Jerry Lee Lewis and Liza Minnelli were alcoholics.
Keith Moon was a drunk and a pillhead who liked to blow up toilets with dynamite for fun.
Elvis was a hardcore pillhead who apparently went insane from all the tablets.
Arthur Lee of Love spent 20 years abusing drugs heavily, became homeless, set buildings on fire and shot up his neighbor’s house.
Carlos Santana used acid heavily, then 20 years ago met up with an angel named Metatron who looks like Santa Claus who has been guiding his life ever since. He communicates with Miles Davis, a dead person, on a regular basis.
Miles Davis (while he was alive and not talking to Santana) spent years shooting heroin, beating his wife and just acting weird.
Little Richard spent years binging on cocaine, having sex orgies and sucking cocks in men’s restrooms.
James Taylor was a depressive and a heroin addict.
Some were suicidal.
Wendy O Williams sawed instruments in half with a chainsaw, then retired and blew her brains out.
Ian Curtis recorded some of the most depressing music ever made, then hung himself on the night of his US tour.
Adam Ant is a depressive.
Mariah Carey assaulted staff and reporters and slit her wrists.
Some like Courtney Love and Britney Spears simply cannot seem to function as adults.
Sinéad O’Connor is just a kook.
Lou Reed’s main problem is that he’s a terminal asshole.
R. Keely is just a weirdo with a taste for underage girls.
Sid Vicious assaulted fans, carved up his chest onstage, murdered his girlfriend, then OD’d on heroin as a grand finale.
Jaz Coleman, George Clinton, Captain Beefheart and Julian Cope are unclassifiable.
No one knows what’s up with Sun Ra.
GG Allin was just nuts, dx’d as narcissistic, Borderline PD and masochistic.
Michael Jackson was one of the weirdest of all. No one seems to know what was wrong with him. He seems to have been a homosexual pedophile. I’m familiar with most of his weird antics, but I never knew that he said he had fathered 2 “Aryan” babes named Prince 1 and Prince 2. Weird!
Just because you aren’t psychotic (and most of these folks are not) doesn’t mean you’re not nuts. You can be plenty nuts without being psychotic, plenty.

OCD and Social Anxiety Disorder: Differential Diagnosis

A new commenter confuses OCD with social anxiety disorder. Though I don’t know SA very well, they are clearly different illnesses. The problem is that there is overlap in all of the anxiety disorders, and in some cases, SA and OCD are both present.

You’re right about OCD including unwanted thoughts, but the shyness, nervousness, and anxiety sound more like social anxiety disorder or avoidant personality disorder.

No, nervousness and anxiety are prominent in all anxiety disorders. As far as shyness, this is just the kind of person that gets OCD. Social anxiety is a tough one, but OCDers don’t usually have this too bad. Most of the ones I deal with are more or less social on a regular basis. They’re hanging around people, but they are nervous.

It depends why they are avoiding people.

According to the DSM, if you are avoiding people due to one of the other Axis I disorders, then rule out SA. Keep in mind that people with schizophrenia and folks with some personality disorders like schizoid, schizotypal and paranoid personality disorders may also avoid people.

SA people avoid people due to massive anxiety relating to being around others. The anxiety is related to embarassment over doing something stupid or humiliating.

OCDers might avoid people due to the obsessions and the way that people react to them – heavy duty rejection. SA people are afraid they are going to be rejected in social situations, and social anxiety is pretty prominent.

Social anxiety is not necessarily so prominent in OCDers, but some have obsessions that tend to come out when they are around others. I dealt with this woman once who was afraid that when she talked to other women, she secretly made lesbian remarks to them. So she was nervous when speaking to women.

OCDers tend to be pretty nervous all the time. It’s not something that peaks when they get around others.

Harm OCD is a bad one, because they are afraid that they will hurt someone. It leads to a lot of avoidance.

If OCDers are treated well and treated as if they are normal people and not rejected or treated like shit, they will often hang around people a lot. And if you get rid of the obsessions, some will actually become social butterflies, since the obsessions might be the only reason for the introversion.

It’s true that extroverted obsessionals are quite rare, but that’s due to the nature of the illness. It only hits people with a certain personality, and that person is an introvert.

This Is Not Schizophrenia

Repost from the old site.

This is not schizophrenia. Let’s look at some symptoms here that a fellow is reporting in a weight-lifting forum. Many of the commenters are replying that the guy has “the beginnings of schizophrenia”, “mild schizophrenia” “schizophrenia”, etc, etc ad nauseum. Let’s take a look at his symptoms:

At night, no matter what I do. Not every night it always happens during the week when I have to work the next day, I cannot fall asleep. Music, TV, RX pills, Tylenol PM, melatonin. Even taken together, mixed and matched, I cant fall asleep sometimes. And my body is tired, but my brain wont shut up. And I’m not even thinking about anything important. Sometimes, just fucking music is playing.And it will keep my up, not sleeping 2-3-4 nights in a row. By the 3rd day, I feel delirious, and I didn’t want to train the other day, cause I was afraid I’d hurt myself from how slow, and tired my body felt. I’m trying not to smoke as much pot lately, cause I’m cutting, losing weight.

It’s effecting my home life, my job, my training, my relationships. Someone asked me if it was because I was depressed. I really don’t have much to be depressed about. I have a good job, I make good money, I get laid, my own place. If I’m depressed, I don’t know why.

It’s almost like I’m “tripping” is how much sense it doesn’t make -like when you’re on acid and your mind is racing and none of it applies to anything, or means anything. Random craziness.

I hear voices (not like telling me to kill or anything) but just random babbling and the voices change like they’re inhaling helium. It doesn’t make any sense. Other times, random songs play through my head and I cant shut them off. I can only control them by putting other songs in, but that causes me to strain my brain and think hard when I’m trying to relax my mind.

My head sometimes gets heavy too, like it weighs like 50 lbs, and my equilibrium gets off balance sometimes. Like a concussion.

OK, the guy is unable to control the thoughts in his head. Thoughts, crazy thoughts, random nonsense, just races through his head with little or no control over it at all. Songs, uncontrolled and unbidden, pop up in his head unbidden and play by themselves in his head.

He can’t shut any of this bullshit off, and the only way to stop the music is to substitute one stupid song for another. I am assuming the “voices” he is hearing are voices in his head, not outside of his head. Fortunately, you can hear all the voices in your head as possible without being mentally ill, though it really isn’t ideal.

It’s crucial to realize that psychotics who hear voices actually hear them with their ears, not in their minds. We all “hear voices” in our heads. Our “inner voice” is a voice inside of our heads. The idiot media and popular does not do us any good by refusing to differentiate these symptoms. Psychotic voices heard with one’s ears are transformed into “voices in his head”.

Obviously, if it’s sane to one one “inner voice”, it’s not psychotic to have more than one, or an unlimited number, though it’s not exactly ideal. You could even have animal sounds in your head.

Hang on.

OK, I just made some animal sounds in my head. There was a cow and a monkey and now there’s a lion. Does that make me schizophrenic? Come on.

If you follow the discussion, you will note that many of his friends on there tell him that he is developing schizophrenia. I do not believe he is doing any such thing, and this is not a symptom of incipient schizophrenia anyway.

I’ve been around folks in the prodrome of schizophrenia, and while their functioning was still ok enough, they were hallucinating (hearing voices) a significant part of the time. No amount of argument could convince them that the voices were not actually real, nor would they believe me when I said I didn’t hear them. This is a pretty typical picture of incipient schizophrenia.

Keep in mind that the vast majority of schizophrenics hear voices. In fact, if you don’t hear voices, I wonder if you really have schizophrenia.

What’s also interesting is that, terrifying and weird as these symptoms are, a number of the commenters admit that they have experienced them – they say they have had strange, out of control, unbidden random thoughts and music in their heads before. So, while it’s not optimal, this stuff seems to be pretty common.

What’s the diagnosis for out of control, random, unbidden thoughts and songs in your head? I say nothing. There’s no DSM dx that has a criteria like that as a sole criteria.

Just like “having a weird look in your eyes” does not give you a mental illness dx either. There are all sorts of folks walking around with all kinds of weird and crazy looks in their eyes. While it’s disconcerting, it’s not necessarily indicative of mental illness. There is no DSM dx for “has a weird or crazy look in their eyes.”

You need to be nuttier than just that. What gives people weird looks in their eyes if they aren’t nuts? Who knows? God knows what goes in people’s minds. But as long as your speech and behavior remains normal, you’re not mentally ill.

Why am I writing about this crap? I’m on a crusade to get people to quit being such morons about mental health. Even if we aren’t ill ourselves, it doesn’t help to give out false dx’s and go around accusing non mentally-ill folks of “being crazy”. It’s insulting, stupid and cruel.

Personally, I never refer to other humans with words like “weird”, “crazy”, “nuts”, etc.

Instead, I’m going to give you some specific description of their behavior, possibly with a potential dx. I can usually figure out what might be wrong with someone after spending a bit of time around them. I can almost always tell if they are psychotic or not, and usually if they are obviously dangerous or not.

Life’s tough for everyone and probably few of us make it out unscathed.

Thought Broadcasting and Thought Disorder: Pathognomic Schizophrenic Symptoms


This is a most unusual schizophrenic symptom that most folks do not know about. It’s probably quite rare to nonexistent in other disorders; in fact, I think it is pathognomic of schizophrenia or schizoaffective disorder. I doubt if you would see this symptom in a bipolar or unipolar depressed person.

As you can see if you read that post, this is a very terrifying symptom! It’s probably much misunderstood. For instance, right now, if I worked myself into an anxious enough frame of mind, I could imagine that my thoughts were being broadcast out to others. But that’s not what’s going on with these folks. Imagine of you could walking into a coffee shop full of people and suddenly all of your thoughts are being broadcast out loud to everyone in the room.

This is what you are going to experience. You will experience you own thoughts shot out into the environment, and they will sound as clear and as real as the voices of folks around you and other sounds in the environment.

In such a situation, schizophrenics often have a hard time believing that other people can’t hear their thoughts being shot out into the environment seemingly out of loudspeakers. As you can imagine, that’s quite a disturbing symptom! If I experienced a symptom like that, I’m not sure how I could go into public and try to function. It would be awfully hard.

They also often feel that they can hear other people’s thoughts.

Here is one guy’s experience:

This is a difficult concept for me in both experience and articulation to others…here is what can happen to me…I will be thinking some thoughts about something I am doing at the moment or something(s) I will do in the future…these thoughts are completely separate from my ‘voice’ hallucinations (??) ….and later in the day/week/month REAL PEOPLE (usually strangers) will come up to me & repeat these thought fragments or statements to me WORD FOR WORD!…

They aren’t generalized thoughts that most folks have in a day, but are specifically related to my own situation or something occurring in my personal realm…this has happened both in my own town and in several other locations (and other states!)…I’ve even had strangers say them from open windows of other cars at traffic lights, and even leave pieces of paper on the floor (ground) in my path with the EXACT thought or fragment on it!!…

What all this really is, I don’t know, but it seems to me to be a form of thought broadcasting (against my will)…very strange…

Whoa! I had to think about this one a bit! At first I thought the guy was psychic. Then I figured out what was going on. Those people are not really coming up to him and repeating his thoughts of earlier in the week word for word. This is a hallucination. Someone is walking up to him, and he hallucinates them saying his thoughts of earlier in the week.

Same thing with the folks at the traffic lights. They aren’t talking to him. He’s just hallucinating them talking to him.

The pieces of paper. He is just finding pieces of paper on the street and looking at them. Then he hallucinates the words of his thoughts on the paper.

Some schizophrenics experience their thoughts being broadcast out to others, sometimes insults, and then they hear the other people broadcasting angry response thoughts back to them. What a strange experience!

This case is very weird, and it was explained as so real that for a while I wondered if the guy was mentally ill. I thought he might have been psychic. He says he’s not mentally ill, just psychic, and he has not been diagnosed. All of those reactions are typical.

My own experiences began a long time ago when I noticed a conversation traveling circuits around a crowded room while remaining completely intact. It would jump from one group of people to another repeating itself, without any of those groups interacting on another dynamic. I watched this pattern loop through the room several times before I attempted to engage and alter it, rather than talking to its hosts directly.

This brought on a response I couldn’t have expected, in that suddenly a nonphysical intelligence began affecting the world around me, due to its sudden apparent sense of having been intruded upon.

Whoa! That’s really weird. Imagine being at a party. You hear a particular bit of a conversation.

“So anyway, Steve told me he really likes my hair. He was texting me but he said I didn’t answer. He doesn’t understand that it was 4:30 AM and I was out in the rain!”

Then the exact same bit of conversation, word for word, starts actually moving around the room, with different people repeating those same words above before it moves on to the next group of people. Then the conversation circles the room a few times. That would be a weird experience! I thought about this a bit and concluded that this could not possibly be actually happening. I mean, you could do it as a practical joke, but that’s not what’s happening. He is simply hallucinating this conversation going around the room.

Over years of having similar experiences of series’s of impossible coincidences, messages directed specifically to him, and the sense that this Entity was sending him missions of various sorts, he concluded that he was in touch with some psychic or mystical entity that he calls the “hivemind,” or universal consciousness. Granted, such a thing may exist, and for a while I thought the guy was psychic, but I doubt if he’s in touch with it, and I think he’s just mentally ill.

Over the years, I’ve been fascinated by the existence of this entity, and puzzled that so few (though they do exist) others are able to operate on a level where this entity has relevance. I have studied numerous metaphysical beliefs and philosophies attempting to find a corollary between it and something that was written down in history. I’m proud to say that I have found quite a few answers, but unfortunately most of them are not solid.

The entity appears to be some kind of “hivemind” entity that is in fact not conscious like we individuals are, and it seemingly does not interact with time in the same way we do. Nor does it recognize any concept of “self” due to its distributed nature. Despite all of that, it’s quite intelligent and has a decent sense of humor…For me, those moments all string together as “the entity” tries to talk to me. The message might take days to become complete and make sense, and the individuals, radio signals, television commercials, conversations on the street, cat acting funny, all of it…string together into one long coherent message…assuming I bother to listen. Furthermore, if I refuse to listen and try to block it out that’s when stuff starts going bad again.

The situation below is seriously bizarre, but I wonder what really happened.

I knew this pretty girl once who was dating a guy that represented authority to me. The guy was a lot like my father, and at the time he was being nasty to someone else so he could get what he wanted.

The girl is the focus here because of her role in that relationship. I met the guy through her in the first place, on the day I met her as well.

She was crashing his birthday party and needed a ride. Well, the message came through as the girl needing a ride again at a later time for a different scenario, but again I was the only driver available. The way she approached me about it was the message itself.

She kidnapped me and stole my car while I was sleeping in the back seat. The reason this is important about the authoritarian boyfriend is because she effectively took on his role in her own situation in order to put me in her role.

She had stolen my keys while I was asleep a few days before, and made a copy for herself. When I woke up halfway across the state from where I had parked, she explained that I could come along for the ride or wait for her to pick me up on the way back, but either way she was taking the car. I ended up driving. I would have taken her anyway had she asked, but she never asked.

This situation is so strange and is reported as if it really occurred, but I seriously doubt if it did, even though his description sounds so real.

The girl did not kidnap him and steal his car while he was sleeping in the back seat. Forget it. Simply did not happen.

Nor did she steal his car keys when he was asleep a few nights earlier and make a copy for herself. I don’t believe it. Forget it.

Nor did he wake up in the car halfway across the state from where he had parked it, with the girl driving and the girl telling him that she had stolen his car and he could either get out or go along for the drive. I simply do not believe that this occurred.

So what happened? I have no idea! But his story is so bizarre is simply strains credulity.

If you keep reading that guy’s posts (he’s not medicated), it seems like they are quite logical and make sense in a nice way, even though he is describing very strange things. But the more you read, the style of the writing itself starts seeming a little odd.

This is very typical of schizophrenic writing. At first it seems like normal speech or writing, but the more you think about it, the more there seems to be something wrong with it, though you can’t quite put your finger on it, and if someone asked you to explain why it’s strange, you could not really explain it very well in words.

This is usually called loosening of associations or formal thought disorder. Put another way, it is something like, “Talking without making sense,” but that doesn’t explain it very well.

Suppose I describe to you a series of wild and improbable adventures that I had that culminated with me going out into the woods, where bats flew out my butt and I was proclaimed King of Germany, Lord of the Jews, Prince of the Robert Lindsays and Warlord of the Race Realists at a huge feast which featured endless rounds of huge Subway sandwiches and mugs of near beer.

OK, that story is pretty weird, and no doubt it’s fiction, but it makes sense: it is intelligible and understandable. It has an intelligible story line with events described in a certain way so that everything fits together. The scenario is ridiculous, but it’s not incoherent.

Schizophrenic speech and writing is different. It is not intelligible in a very strange way. It is often almost intelligible, but not quite. For some reason, you can’t quite figure out exactly what it is the person is trying to say, and you can’t even figure out why or how it doesn’t make sense. That is thought disorder.

I believe that thought disorder is actually pathognomic of schizophrenia in a sense: that is, if you don’t have thought disorder, I don’t believe you have schizophrenia. Where there is schizophrenia, there must be thought disorder in most or possibly all cases.

This Is Not Schizophrenia

One of the many purposes of this site is to enlighten people about human psychology and in particular about abnormal psychology or mental illness. Even though most of us shout to the heavens about how sane we are, for some reason, we are terrified of discussions of mental illness. I notice that whenever I bring up the subject, it very quickly gets shut down.

There’s something strange going on. People are very afraid of mental illness, even the most minor, harmless and neurotic kinds. The psychotic stuff makes people very nervous too.

I don’t get it. People like me who are fascinated by mental illness and can talk about it all day long don’t understand. What’s the worry? Psychotics are frightening to be around, but not as much as you think. Anyway, if you’re just talking about them, it’s not like the conversation is going to jump out and kill you. Fear of discussing neurosis must be based on the idea that most of us are afraid that we might become neurotic, or more neurotic, ourselves at some point.

It never fails to bother me that most folks can’t tell the difference between neurosis and psychosis. Granted, there are some borderline folks, but generally the distinction is quite clear. If you have spent a lot of time around the two types, it’s like they are people from two different planets.

I remember 25 years ago, I was having a lot of anxiety issues. I thought I was mentally ill and recovering from a nervous breakdown, which I was more or less. So I went to this meeting of a group called Recovery.

Well, it turns out it was for schizophrenics. There were two normals running the show, there were the schizophrenics, and there was me. As nuts as they were, the schizophrenics very quickly figured out that I was not one of them, anxious as I was. The leaders figured it out too. It’s funny that people who are totally nuts can make obvious distinctions that supposedly sane folks cannot.

I do a lot of work with folks who have OCD, since I have it. It’s quite common for these people to tell me that people think they are schizophrenic, and they are often diagnosed with various forms of “psychosis,” by idiot shrinks.

People with OCD can go psychotic, but it’s rare, they are not all that nuts, there is extremely prominent anxiety, it’s pretty easy to pull them out of it – usually only after a few weeks or so – and of course they are never dangerous. It’s just some guy sitting in a chair shaking so hard he can hardly get out of the chair to go outside.

As Freud noted in his class study of the Rat Man, “They are not crazy. Nevertheless, OCD is certainly a crazy illness!” Freud was very insightful. “They are not crazy,” – in other words, they are not psychotic. “It’s a crazy illness,” – it’s very strange, and when they are very ill, they appear psychotic. The Rat Man was a wild case of OCD. The guy had an obsession that there were rats crawling into his anus. Of course that’s impossible, and most people figuring something who thinks that way is psychotic. But the Rat Man was not psychotic.

OCD one of the nuttier of the neuroses, but only on a surface level. This is because when it gets really bad, the anxiety and mental distortion are so extreme that an OCD person appears psychotic. However, a good clinician can pretty quickly figure out that they are not.

Let me give you an example.

An OCD guy I know, in a bad episode, was afraid to turn around in the shower. Why? He was worried that he was a child molester (though he wasn’t, and none of these folks ever molest anyone), and in the shower, he would get the idea in his head that there was a naked 9-year old girl in back of him. Logically, he knew that she wasn’t there, but OCD is powerful form of magic, and it almost convinces you that its bullshit is true. So he was afraid to turn around, because he was afraid that the naked 9 year old girl might be there.

To most people, that’s psychosis. Except that it’s not.

A schizophrenic person simply says matter of factly that when they take a shower, there’s a naked 9 year old girl in back of them showering with them, and this bothers them.

I knew another guy who had severe OCD that was not responding to treatment. He had harm OCD, with thoughts of attacking and killing people in general and those around him. He was also a dwarf with severe physical problems, which made his thoughts even more ludicrous. His Mom gave him a knife at one point and said, “Just do it! Stab me!” Of course he didn’t. They never do these things.

Why they never act on these horrible thoughts is an interesting subject, but it’s best for another post.

Anyway, the guy had various fears, and at one point, he got an intense worry that he was The Devil. OCD was telling him that he was The Devil. Most people will say this is psychotic, but I doubted it, though I found it disturbing. I questioned him further. “You know you’re not really The Devil, right? Or at least it’s unlikely you are?”

His response was interesting. “Logically, I know that,” he said. These people often say that, and it’s quite curious. It’s as if the mind is split between a part of the mind that knows this is all bullshit and an OCD part, terrifying and full of gale-force anxiety, that is telling you all sorts of scary crap. The OCD part has a powerful pull to it due to the psychological force of anxiety and fear, which can actually seem to bend emotions, self-image, reality and even perceptions.

At that point I knew the guy wasn’t psychotic, and I blew it off.

In contrast, a schizophrenic person simply reports that he is The Devil. Maybe it bothers him, maybe it doesn’t, but that’s just the way it goes. He’s describing obvious reality, like the sun rising in the east.

It’s hard to explain logically the difference between the two experiences, but if you’re intelligent and think about it a while, you should be able to figure out the clear-cut difference.

Here we see an example of something that looks like schizophrenia, except it ‘s not. It’s some kind of anxiety disorder. I’m not sure which, but it may be OCD:

Like I stated in my previous thread, I have not yet been diagnosed with anything because I have yet to see a doctor. I was wondering if there is any medication that one could recommend for me. This is the third week I have really been feeling strange, and I don’t know if I should start on medication yet even if a doctor recommends it.

My symptoms are:

Always hearing a different song in my head when my mind is idle (I know that it is in my head, not external).

Feeling uncomfortable talking to people or making eye contact (this comes and goes, really bad after a night of drinking, not bad after a good workout and sauna).

Depersonalized feeling, even when I am talking and joking around with friends, I feel outside of myself in a way, always worrying that I could be schizophrenic.

Less motivated.

Forgetful (always have been, recently a bit more then usual).
After a recent night of drinking, I even started to see objects sort of move or grow or something in the corner of my eye or only when I concentrate on them (this isn’t 24/7 tho).

There are a few things going on here. The person is worrying that they might have schizophrenia. A person with schizophrenia typically does not do that. Suppose your name is Jim Brown. Do you worry that your name is Jim Brown? Of course not.

Schizophrenia so contorts reality that the person does not know that they are ill. They don’t have the foggiest clue. The schizophrenic reality is simply their reality, and they don’t think it’s an illness. It’s just what’s happening.

When they get on drugs, they get much better and start figuring out that they are ill, but that’s different. Schizophrenics often have to rely on loved ones to tell them when they are going psychotic because they don’t have the foggiest clue when they are ill and when they are not. Some can sort of figure it out, but that doesn’t mean that it isn’t real.

Schizophrenic hallucinations are quite real and are not the sort of anxiety-driven nonsense that this excessively introspective individual is experiencing. If you worry that you’re hearing things or seeing things and start overemphasizing your perceptions and freaking out about them, you’re probably going to start thinking that you are seeing things and hearing things.

The visual hallucinations will often be peripheral vision things, but even normals see weird stuff out of the corners of their eyes all the time. Normals just re-analyze it, figure out what it really is, and move right along.

Sane people often think they hear things too. I’ve noticed that sometimes in the rain, I think I hear stuff. It was raining the other night in the parking lot, and I thought I heard someone yell, “Bob!” I turned around, and of course no one was there. I thought about it a little bit and then just drove away and decided not to think about it anymore. I know enough about psychotic hallucinations to know that that was not one. Once I start hearing stuff all the time, maybe I’m going to get worried, but until then, forget it.

These anxious types are overhyping their sensory organs, worrying way, way too much, and misinterpreting all sorts of normal sounds. Probably anyone can do this if you work yourself into a nutty enough frame of mind. Whatever it is, it’s not schizophrenia, nor is it psychosis.

It’s basically an anxiety issue, not a psychotic issue.

In general, these are different trajectories of craziness. One dichotomy is anxiety/psychosis. You’re either going crazy in an anxiety way, or you’re going crazy in a psychotic way. True, psychotic people can get anxious, but it’s for different reasons than the anxiety-disordered. You might get pretty anxious too if you were convinced that the Mafia had a murder contract out on you! See what I mean? The anxiety-in-psychosis and the pure anxiety disorder are coming from fundamentally different places.

Later in the thread, one fellow adds this helpful bit of diagnostics:

This doesn’t sound like schizophrenia. From what you’ve said it sounds like depersonalization disorder with comorbid social anxiety and OCD. It isn’t common, but this does occasionally occur with heavy cannabis use. It is also notoriously hard to treat. Maybe a benzodiazepine for the anxiety. Antipsychotics don’t usually work very well for depersonalization, but some individuals respond to them. I think the standard treatment is SSRI’s with a benzo. Sometimes Lamictal. Lamictal and low dose benzos would have the least side effects.

Sounds about right to me, but I’m no clinician.

Also later in thread is another guy with similar symptoms who thinks he has schizophrenia, but he doesn’t. He probably has a condition like what the fellow above has offered for a diagnosis.

Schizophrenia is a pretty clearcut illness. People who are actively ill are pretty easy to spot and typically don’t make a lot of sense when they talk. I can’t understand why someone would accuse a person with a run of the mill anxiety disorder of having something as complex and devastating as schizophrenia. The smartest people can be so damned ignorant.

Cannabis and Schizophrenia is Probably a Minimal Relationship

One thing that is interesting when you study certain issues a lot is that the more you learn about the issue, the less you understand it. In fact, most things just get more and more confusing and make less and less sense the more you study them. And this points to the limits of scientism. So many things just don’t seem to make much sense. Science claims it can discover the truth to anything and everything. In theory, it can.

But in praxis, it’s another thing altogether. So much of life remains fairly or seriously mysterious no matter how many studies and books are issued on the matters at end. Is science able to explian these things? Not at the moment anyway.

I often find that in discussions, I have to say things like, “Yes, I know it doesn’t make sense, but in this field a lot of things don’t make sense.”

So it is with cannabis and schizophrenia. Things just don’t make sense.

Those of us who went through the 1970’s watching 1000’s of people smoke cannabis heavily and never saw a single case of toxic psychosis, not to mention schizophrenia, are taken aback by the recent insistence that, say, cannabis ups the risk of schizophrenia by 38 times, or that 10% of regular adolescent cannabis users will become schizophrenic. Such theory punches right in the face of our very lived experience, so it makes no sense to us at all.

Yet the relationship keeps showing up, over and over, in study after study. It’s regular, independent of confounding factors, and even typically dose-dependent. That’s as good as it gets in science.

Nevertheless, it still doesn’t make sense.

The rate of schizophrenia collapsed while the rate of cannabis use exploded. Cause and effect indeed!

As you can see in the graph, a rate of schizophrenia of 12-13/100,000 from 1950-on collapsed starting in 1967, falling to around 3/100,000 as of 1983. It seems to have leveled off at around that rate ever since. Starting around the mid-60’s and continuing through the 1970’s at least, cannabis use in the UK went through the roof. It completely exploded. At the same time as the rate of schizophrenia collapsed by 75%. If there were indeed a relationship, the schizophrenia rate should have gone through the roof.

It doesn’t make sense.

Yet over and over, we see this relationship. The only explanation that makes sense is that something in the prodromal syndrome of schizophrenia makes pre-schizophrenics seek out cannabis in particular. The worse the prodromal symptoms, the more cannabis they use. Cannabis use clearly seems to be bringing schizophrenia on sooner in those who would develop it anyway.

This study is the best analysis yet. For every 4000 adolescents who use cannabis daily, one of them will get schizophrenia as a result. We have to prevent 4000 cases of heavy cannabis use by teens to prevent a single case of schizophrenia.

It hardly seems worth it.

How do we reconcile that cannabis is causing any psychosis at all nowadays, not to mention schizophrenia, when it never seemed to cause these reactions back in the day?

There was a young guy who was hanging out over here a lot a while back, an Hispanic gang associate type. He was a heavy user of this very strong “skunk” cannabis. When he used it, he was constantly peeking out the window, apparently looking for the cops. He also totally freaked out if I ever opened the blinds one bit. I’ve never seen anyone act so paranoid on pot before. I’ve only seen people act like that on cocaine, especially if they smoke it or shoot it.

The cannabis nowadays is much, much stronger than even the strongest pot we smoked in the 1970’s and even 1980’s. Sure, hashish and hashish oil were around back in the day, and sure we used it all right, but they were not widely used. They are breeding it for THC maximalization, and it has THC levels of up to 15-25%. It’s the THC that is psychotogenic, not the CBD. CBD acts like an antipsychotic, of all things.

Back in the day, cannabis had approximately equal levels of CBD and THC. The psychotomimetic effects of THC were counteracted by the antipsychotic effects of CBD.

I’ve smoked this new super-pot, and while I can handle it with no risk of psychosis or even serious freak-out (I doubt if any reasonable quantity of any reasonable drug would make me psychotic), it’s easy to see how it could bend someone’s head in a pretty bad way.

We are getting regular reports of people smoking this stuff and hearing voices afterwards, if only temporarily. That’s really strange; we never heard strories like that back in the day.

So the solution to the conundrum of how pot is psychosis now when it never seemed to in the past is that the pot is incredibly strong super-pot, which is almost like another drug altogether.

What Schizophrenia Feels Like

Here is a fascinating video of what it feels like to have schizophrenia. My Lord! What a terrible illness! I can’t possibly imagine feeling that way, God forbid all of the time. Of all the drugs I’ve taken in my life, including high-powered hallucinogens like LSD and PCP, I certainly never felt anything close to that. I’ve never experienced anything like those horrible voices or peoples voicing sounding like they are in an echo chamber or fading in and out.

I suppose if you felt that way, I assume you would try to get your hands on just about anything that would make you feel better or at least make those horrible voices go away. Alcohol kills the voices, but you have to be dead drunk before it works.

What’s especially creepy about those voices is that there are multiple ones all going at once and it is really hard to figure out what they are saying. They almost sound like they are talking to each other in the background.

Damn that’s frightening. I would not wish that nightmare on my worst enemy. Can you imagine being like that 24-7.

When you see those homeless people walking around with the headphones constantly in their ears playing music all the time, they are trying to drown out those continuous voices with music. Also, when you see schizophrenics standing on the sidewalk holding a conversation with the air with no other human beings around that they could possibly be communicating with, I believe that they are talking to the voices. The voices probably answer back to them and carry on conversation with them. How strange.

The nature of these voices is subject of much speculation. The latest thinking is that the voices are simply the persons internal thoughts that are somehow being distorted by the brain into seeming like they are coming from outside.

It’s often said that schizophrenics “hear voices in their head.” This is not exactly what is going on. What’s going on is more like what you see in the video. The person actually hears the voices loud and clear like you would hear someone talking to you in real life. When they first start, the person usually runs around trying to find the person who is hiding in the house somewhere. That’s how real the experience is.

As I noted before, I had a schizophrenic friend for about a year. The guy was hearing voices a good part of the time. We would go for drives in the car and the voices would come out of the car radio. When it wasn’t even on! Over at his place, the voices would come out of the vents up near the ceiling. He eventually developed some delusions about his Mom’s former boyfriend installing some tape recorder up there – he thought there was tape recorder in the ceiling. With the car radio, he kept insisting we had to take my car radio apart so find out the source of the voices. We would be driving along and he would say, “You hear that?” and point to the radio. Of course, there was no sound coming out of thing – it was turned off! They get pretty angry when you can’t hear the voices too because it’s so real to them. It would be like if you could hear people talking in a store but everyone else would insist that the people around you are silent. It would seem like they are lying!

I had to make up all kinds of stories saying that I could not hear the voices too. You could say, “Yeah, I hear them too.” But I would not recommend that. You’re just reinforcing their crazy bullshit. If I did that, then that would prove to him that he needed to take the vents apart to find the hidden tape recorders. So I had to make up all kinds of bullshit excuses why I couldn’t hear the obvious voices but he could. I eventually told him that I had serious hearing problems and could not hear very well.

One thing is that people confuse these voices the internal stuff, voices or whatever, that we have in our heads. Those are not voices; those are just thoughts. I suppose you could create multiple voices inside your head as thoughts, but that would not be the same, and I don’t see why you would want to do that anyway. Internal thoughts are experienced as “thoughts,” schizophrenic voices are actually heard out loud with your ears as in the video.

People with OCD often say that they have “voices.” That’s because the OCD thoughts can seem very loud and persistent, like “super-thoughts,” or as if “they are coming out of megaphones,” as one guy put it. But you don’t actually hear it. It’s all inside your head, so it’s just thoughts, not actual voices. Also, OCD “voices” (thoughts) often just repeat the same thought over and over and over, unlike the continuous changing stream of multiple voices you saw in the video. With careful questioning, it soon becomes clear that the OCD sufferer has “thoughts” and not “voices.”

Nevertheless, a lot of dumbfuck clinicians can’t figure that out, and a lot of  OCD people get misdiagnosed as “schizophrenia”, “mild psychosis,” “a little bit psychotic,” “atypical psychosis” and other bullshit. I’ve been dealing with them online for some time now.

An interesting condition is where the OCD sufferer worries that he is going psychotic. Some of them search the environment for every single little sound and start misinterpreting normal sounds as “voices.” Then they are convinced that they are schizophrenic.

With careful questioning, a good clinician should be able to sort this out and see it simply as anxiety that searching the environment and misinterpreting or imagining normal sounds. That’s totally different from what’s going on in the video. I’ve talked to a few people with this condition online and it’s typical that they have a “psychosis” dx by some dumbass doc and are being mistreated with an antipsychotic. I usually order them to dump the doc, quit the antipsychotics, and go get a new doc.

Note: Sorry folks, I’m sort on a mental illness kick lately. I’ve been fascinated by this stuff for decades and I know a Hell of a lot about it. I’m not frightened of writing or reading about it the way that most people are, at least not usually.

Diagnosis: Schizophrenia

This is a pretty interesting bit of writing, on the Schizophrenia.com website under “Success Stories.” I guess they don’t moderate the site since this poor woman is anything but a success story. She’s severely ill in fact, and this becomes clear. I would wager this is a case of paranoid schizophrenia again. It looks like it hit after age 27, which is pretty late. She had good function before then.

I had graduated in Business and Finance from Leicester Polytechnic and had worked in London ever since.  I joined Manpower (an employment agency) as a Sales Supervisor, the left to sell computers, then went back as a Training Manager, running 3 training centres in Central London.

As you can see, before she was ill, she was functioning quite well. Then she started using a lot of cannabis, and everything just fell apart.

I started smoking a lot of Cannabis with a friend, Jeannette. This was when the world turned on its axis. Before during meditation I had felt the presence of something. A finger manipulating my third eye, a still small voice giving me words of encouragement. Now the world spiritually was against me and the universe was trying to tell me something. It started with the world trying to teach me a lesson.

After that, the poor woman is seriously ill. The delusions have a lot to do with mediation, yoga, chakras, etc. but this is the stuff she was into before she got ill. Whatever you were into before you got ill might end up being gist for the delusional mill.

When I first started reading, I noticed that she seemed to be getting raped by men or possibly her doctors. After you read a more, it’s clear that no one is raping her at all. She’s also never been kicked in the vagina. Her delusions and hallucinations have a lot of sexual content.

I’m not sure what that means, but it’s pretty common among female schizophrenics. Promiscuous women are seen as bad women and sluts, so her hallucinations and delusions are centered around her being a “whore.” The schizophrenia will just pick up on anything around that is bad and play it up full volume.

Male schizophrenics often have delusions and hallucinations about being homosexuals, because being a gay male is seen as bad, failure, etc. in an analogous way that a promiscuous woman is seen as bad, failed, etc. The schizophrenia just picks up on whatever you fear most and then blasts that into your ear all the time.

At the time that she wrote this, she is seriously ill, and the meds do not seem to be making her any better.

Her writing is pretty chaotic, which suggests the undifferentiated type of schizophrenia, yet her premorbid functioning is more typical of the paranoid variety. Ultimately, these subtypes don’t seem to matter much.

But the next time you come across writing that looks like this, if you’ve been paying attention, you know what and only what diagnosis comes screaming off the pages.

Cannabis and Schizophrenia Redux

We have already gone over this subject at length in a previous post. However, I am starting to change my mind on the subject after a lot of reading. It is looking more and more like heavy cannabis consumption during the teenage years is somehow implicated in the development of schizophrenia later on.

How this works is not known. Cannabis is probably not causing it directly, otherwise we should see epidemics of schizophrenia. More likely it is triggering it in a person who is already vulnerable. But the evidence has been flooding from, now from 30 different studies. And the younger the person is when they start and the more they use in the teen years, the greater the risk of schizophrenia later on. Some studies are even finding a dose-response relationship.

The fatal flaw in this theory has been that the rate of schizophrenia has not risen during since the start of the cannabis epidemic. I used cannabis for many years myself, and I known thousands of users, many of them long-term and heavy users. Other than making some young people lazy and somewhat paranoid, I haven’t seen a lot of ill effects from the drug.

I knew one guy who had schizophrenia who loved pot, but it made him a lot worse, so everyone tried to keep it away from him.

I’ve known only one marijuana user out of the many thousands of drug users that I have known who developed schizophrenia, but he was a heavy speed user for 10-20 years. He developed schizophrenia around age 37 after using methamphetamine heavily for 10-20 years. I am pretty sure that over a decade of heavy speed use caused his schizophrenia since heavy meth use causes massive damage to the brain.

I’ve never known any other cases, and I never saw any cases the whole time I was growing up. I hung out with heavy users, sold the drug myself for many years, and never saw any psychosis, not even a temporary case. However, the pot around nowadays is extremely strong and the age at first use has been dropping. I tried some recently and can testify that it is extremely strong indeed. I can handle it fine as I can easily handle just about any drug out there, but I can see how it could flip someone.

Quite a few of the local young people around here smoke pot. I’ve gotten to know quite a few of them and learned of their heavy marijuana use. They ranged in age from 16-23. A couple of them were dealers in their 20’s who were using large quantities of this very strong pot.

I knew about the pot-schizophrenia link and I kept looking for it in all of these individuals. I have yet to see a case of psychosis, much less schizophrenia, among these young people. I saw one person who got paranoid on pot, and I saw other cases of the “lazy pothead” syndrome, but in general, they were quite healthy mentally and led full and enriched lives. If cannabis is implicated in schizophrenia, it sure doesn’t cause it very often, as most even heavy users seem to avoid this drastic consequence.

Many kids are using this extremely strong pot at younger and younger ages, often daily for many years in adolescence. The pot we were using was much weaker, most of us did not use it every day, and most of us didn’t start using until around age 16 or so. Heavy use started around age 20 or so.

While cannabis in general does not appear to cause significant structural damage in adults, some very ominous findings are coming out about use in adolescence.

A recent study found that adults who started using cannabis before age 17 (16 or younger) had smaller brains overall, had less grey matter (fewer brain cells) yet more white matter (connections between neurons) (Earleywine 2005). Less neurons yet more connections isn’t exactly brain damage. Instead it’s just a brain that appears to have developed in a different way.

But this is the problem. The brain is still developing during adolescence. If cannabis impairs and changes normal brain development, this could be a bad thing. As it stands, no one should use cannabis before age 17 due to the risk of permanent brain changes of unknown significance. Delaying use until after age 16 apparently results in avoidance of these changes.

Even the most pot-critical researchers are claiming that cannabis is only causing 8-13% of schizophrenia cases. However, they can’t even prove that. Those are just models, and those models are not yet backed up with statistical data, which continues to show the schizophrenia rate as flat.

This interview was quite interesting. This psychiatrist posits that cannabis is causing schizophrenia, but only in people who use it, usually on a daily basis, for years starting in adolescence. The risk is greatest the younger you start. Delaying use until 19 or 20 results in dramatically lowered risk. The risk apparently drops to zero if one waits until age 21 to start using cannabis. In other words, I, at age 52, could smoke a ton of dope between now and the time I die and it won’t give me schizophrenia no matter how much I use.

At the very least, it’s certain that early and heavy cannabis use brings schizophrenia on sooner than it would have occurred ordinarily. However, that means years of life lost to psychosis that are gone forever. Many schizophrenics who use cannabis find that they have a worse course, as the cannabis triggers new psychotic episodes.

Yet schizophrenics seem to love the stuff, paradoxically. That’s probably because at first it seems to calm them down. Schizophrenia is a horrible illness, and sufferers will take just about anything to escape from the symptoms.

One theory that keeps coming is that is quite common in the early stages of schizophrenia (the prodromal phase) for users to turn to various drugs to relieve their distress. Schizophrenics often go years before their first diagnosis.

This article by Robin Murray, a notorious proponent of the cannabis-schizophrenia link, describes a case of supposed cannabis-induced schizophrenia in a teenager. At age 15, he became a heavy cannabis user at age 17, probably to treat his symptoms. A few years later, at age 20, he was finally diagnosed. Halfway through his prodromal symptoms, he began using cannabis to treat his illness.

I had a good friend recently who was a paranoid schizophrenic. He was 28 at the time and had apparently had the illness since he was 20 or so. He had not yet been diagnosed.

Hence the cannabis-schizophrenia link is said to be merely kids in the prodromal phase seeking relief for a condition that they are going to develop soon anyway and cannabis is not implicated in the disorder. This is always possible, but new research is suggesting that this is not the case.

With the new research, it is looking more and more like teenagers need to stay away from cannabis period. If they wish to use it, they should wait until age 19-20 or even better yet, age 21 when all cannabis-schizophrenia risk is gone.


Earleywine, Mitch. 2002. Understanding Marijuana: A New Look at the Scientific Evidence (pp. 149-150). New York: Oxford University Press.

Paranoid Schizophrenia: Exhibit A

From an incoming link to a Twitter page and then to a Myspace page. I will say that he is an excellent artist. At first he seems like a very smart, sane person who is putting you on or doing some kind of a parody. Either that or he has some really fancy and elaborated thinking process going that’s well thought-out and coherent, but most of us are not onto it. The more you read, the less that seems to be the case.

Preoccupation with religion (the Bible) and especially the Devil (you can see he has shaved his head and grown a Devil goatee so he looks like The Evil One himself).

He does look like Satan, doesn't he? He also looks seriously nuts. He's got that crazy stare in his eyes. I wasn't going to divulge the guy's name, but if you try to download his photo, the paranoid motherfucker sends you a virus! So fuck you, Steven Pyle. And get help.

There’s also some complex stuff going on about Black Israelites and how Whites are evil invaders in America and need to be expelled. It’s like he’s incorporated whack Black and Brown Nationalist cant into his delusional project. LOL.

So I guess he’s a Cultural Marxist Multicultural Paranoid Schizophrenic. I figured it would come to this. Cultural Marxism and multiculturalism is so nuts on its face that you often wonder how it is that so many White people buy it. Answer I guess is hardcore brainwashing. It’s funny that Radical Multiculturalism is so nutty that even the crazies are incorporating it into their delusional systems, where it fits quite nicely.

But on the other hand, he has also seriously got into Tea Party “Obama is Evil” stuff and he parrots all the latest conspiracy theories about Obama. Once again this is risible because it just shows just how insane the Tea Partiers really are. When the schizophrenics start using your theory as material for their delusions, you’ve got to start wondering about the soundness of your theory.

I kept trying to go easy on the guy. He went to good schools, he went to art school in the US and Paris, and he’s a kickass artist, but he’s got to be out of his mind.

He’s also apparently a heavy cannabis user. As I make clear in the next post, in many cases, heavy cannabis use dramatically worsens the course of schizophrenia. I figure it’s probably making this guy a whole lot crazier.

You can also see that the personality is pretty well preserved in the paranoid subtype of schizophrenia, which tends to come on later in life, often in the late 20’s to early 30’s. But that’s just when they get dx’d. Typically, there is a 5-10 prodromal phase that precedes the dx. This guy is 31 years old, right around the age for full-blown paranoid schizophrenia to hit. You can also see that he’s got it together enough to produce a fancy webpage, along with some really cool artwork.

This is because paranoid schizophrenics, even when unmedicated, can often function at a fairly high level. The preservation of personality may be due to it hitting later in life. That is, the illness hits after the person has already developed a substantial personality. Other types that hit earlier in adolescence are worse because they hit while the personality is not yet well-formed. Many of these folks are said later to be “41 years old going on 16.” This is because the illness hit so early and their personality basically stopped developing after the illness hit.

Just the writing itself gives it away. If you study this stuff long enough, you can diagnose based on a writing sample alone. In this case there is no other possible diagnosis but Chronic Paranoid Schizophrenia. After 5 years, it goes chronic and the delusional system gets very well systematized and laid out. Yet the person has deteriorated quite a bit, and you can see the deterioration in the writing – you read it and you think it sort of makes sense, then you think again and say, “Huh?” That’s characteristic of schizophrenia.

Does Marijuana Cause Schizophrenia?

Repost from the old site.
One of the longstanding arguments against the use of marijuana is that is causes mental illness, in particular psychosis. For a long time, cannabis was said to be associated with a particular entity called “cannabis psychosis”. This entity has not been proven to exist.
Cannabis has also been said to be associated with depression and anxiety. Some people do experience anxiety when they use cannabis. In many cases, they used it for some time before an anxiety reaction started. A cannabis panic or “paranoid” reaction is quite common amongst all types of cannabis users. Generally, users who start to regularly get panic reactions tend to stop using the drug.
Anecdotally, many persons report relief from anxiety, depression, tenseness and anger from the use of marijuana. A friend of mine who was in jail for marijuana said he met many angry prisoners who used marijuana to reduce their anger. I known young males who are chronically “hyper” – tense, restless and on the verge of anger. Regular marijuana use works well to completely alleviate this condition.
In recent years, some frightening studies have come out connecting cannabis to psychosis, in particular to schizophrenia. On the surface, there would not appear to be much grounds for alarm. As you can see in my previous review on the subject of cannabis and brain damage, heavy use of cannabis, of all the intoxicating drugs, seems to be easiest on the brain.
This does not mean that it has no effects on the brain at all, but instead that heavy use of all of the other intoxicants is harder on or riskier to your brain than heavy use of cannabis.
Since heavy cannabis use is so much easier on your brain than heavy use of anything else, how is it then that cannabis should be associated with schizophrenia, while the other more harmful drugs are generally not? This is a bit of a mystery.
Promoters of the pot-schizophrenia link have suggested cannabis’ effect on the dopamine system – that is, it releases dopamine. Yet almost all drugs release dopamine, including alcohol, cocaine, methamphetamine, etc. In fact, coke and speed are far more dopaminergic than cannabis. Truth is that anything pleasurable releases dopamine – sex, chocolate, a good movie.
Animal models have not been particularly helpful in determining the relationship of cannabis to mental illness.
One recent animal model showed that not only did cannabis cause mice to actually sprout new neurons in the hippocampus, but it also reduced measures of depression and anxiety. Opiates, tobacco, alcohol and cocaine all reduce neurogenesis in the hippocampus. The reduced depression and anxiety seemed to be caused by the neurogenesis. Cannabis also protects mice against brain cell death caused by alcohol.
There is also evidence that cannabis is protective against the neurotoxic effects of stroke and head injury. Further evidence shows that cannabis is effective in slowing the progression of various neurodegenerative diseases such as Alzheimer’s, MS, Parkinson’s, and ALS (Lou Gehrig’s Disease).
Given the evidence that cannabis does not seem to do much bad to your brain, and if anything seems to be neuroprotective and even neurostimulatory, it seems odd that this drug should be connected with such a devastating brain disease as schizophrenia.
Nevertheless, the evidence seems to be there, and it is quite frightening to look it over. The initial study was an elegant analysis of Swedish military recruits in 1987.
The increased risk was on the order of 4.5 times for those using by age 15, but down to 1.6 times for those using by age 18. The increased risk was decreasing rapidly. Let’s extrapolate to ages 16 and 17: Age 15: 4.5 X. Age 16: 3.7 X Age 17: 2.65 X. Age 18: 1.6 X. At that rate, all increased risk would have evaporated for users who wait until they are age 19 until they start using.
Since the Swedish study, the evidence has piled up. Still, despite the scary and numbing evidence, there is not yet any evidence that cannabis causes schizophrenia de novo. Instead, it appears to be interacting with some already existing risk factor.
This page is a good repository for the numbing evidence on this score.
However, that site has some serious problems.
They are finding increased risk of schizophrenia from everything from “being too introverted and being alone too much”, emigrating to a new country – up to 4X increased risk, having an unpleasant and unstable home life as a child, experience – social adversity – four or more episodes of “abuse” increased risk by 2.7X, living in a city (3X increased risk), especially an inner city (as opposed to the country), or being vulnerable to depression or anxiety.
In order to avoid schizophrenia, according to the site, one would have to never go live in a new country, never spend a lot of time alone or be an introvert, never move to a city or an inner city or never grow up in one, be robust in handling stress, experience little social adversity, and somehow assure that one had a happy and stable home life as a child.
At some point, you just have to live your life and these kind of “risks” be damned. Personally, I am dubious that any of these things actually contribute to schizophrenia.
A person slowly developing schizophrenia over years tends to spend a lot of time alone, become introverted, move to a major city (often the rundown inner city part), wander around the country or parts of the globe, experience a lot of social adversity and handle stress quite poorly as the disease slowly unfolds.
Their relatives often show various degrees of the illness themselves and this probably accounts for the problems in childhood experienced by mildly effected parents. Either that, or the person at risk of schizophrenia is already odd, hostile or combative, and this causes a poor parental relationship.
Even if cannabis did increase the risk of schizophrenia, there seems may be an age effect. Robin Murray found that first use at age 15 increased the risk of schizophrenia by 4 times, while by age 18, the risk had dropped to 1.65. By this trend, one assumes that at some point after age 18, the risk would drop to zero. Assuming the risk is real, it could be substantially ameliorated by avoiding cannabis until one is 18.
In general, most studies found about a doubled risk of schizophrenia from cannabis use. It is interesting to note that chronic heavy drinking was even more of a risk to psychosis than heavy cannabis use, increasing the risk by four times.
It has become clear in recent years that schizophrenia, when occurring over a period of years, is correlated with serious damage and disruption to the brain in a wide variety of areas and manners. The notion that a meager drug like cannabis could actually cause such dramatic dysfunction and damage is ludicrous.
The only thing that could possibly be happening here is cannabis triggering, or setting off, a cascade that begins the neurodegenerative process known as schizophrenia.
The pot-schizophrenia theory was recently blown up again by a truly absurd study. An MRI study showed that subjects given THC showed reduced activity in the inferior frontal cortex. This area controls inappropriate emotional and behavioral responses to situations. The more the activity was reduced here, the more paranoia the subjects experienced.
Somewhat bizarrely, the study claimed that pot-induced “paranoia,” which most users are familiar with, is synonymous with “psychosis.” They said that 50% of the users “became psychotic” and experienced schizophrenia-like symptoms. That is obviously idiotic. If that is psychosis, then every marijuana user I have known (thousands) have been psychotic many times.
The major problem with all of the studies showing a link between pot and schizophrenia is that we should have seen an explosion of schizophrenia in the West during the 1960’s and 1970’s. Instead, the rate was flat or even declined.
Advocates of the pot-schiz link such as Murray have all sorts of reasons why either rate has actually gone up when we found it didn’t, or it’s going to go up in the future, or finally, that even heavy pot use by millions of citizens will only increase the rate of schizophrenia by 14%. This absurd and totally unproven “14%” figure is now being bandied about by the media (see below).
This study from Australia concluded that since the incidence of schizophrenia has not risen with the explosion in cannabis use, cannabis cannot be said to cause schizophrenia. Instead, the study said cannabis appears to be triggering it in people who would have ended up schizophrenic anyway. However, cannabis use may worsen the course of schizophrenia in those who already have it.
The study was unable to conclude that cannabis use brings on schizophrenia quicker in those who would develop it anyway, since they found no trend in decreasing age of diagnosis, even with the explosion in cannabis use in recent years. However, this study did find that cannabis-using schizophrenics developed symptoms sooner than those who did not use it.
On the other hand, this may be explained by the very common phenomenon of heavy use of cannabis during the prodromal phase of schizophrenia. Another study suggested that cannabis use may be causing schizophrenia in people who would not otherwise develop it, but the lack of increased diagnosis would seem to argue against that.
Yet another Australian study concluded that cannabis precipitates and worsens schizophrenia in those who would have developed it anyway.
Much of this data is from a group of psychiatrists in London (centered around Robin Murray – see above) who are convinced that marijuana is increasing the incidence of schizophrenia in the UK.
They have produced data showing that the rate of schizophrenia has gone up in their inner-city neighborhood in recent decades. However, that increase is at odds with studies done over much of the rest of the world in recent decades.
The same researchers produced another “definitive” study that “ends the debate” about whether or not marijuana causes schizophrenia. It reviews a number of studies and shows that every study does find increased psychosis with increased marijuana use. It then predicts that 14% of all cases of schizophrenia in the UK are being caused by pot use. This conclusion is unwarranted.
First of all, there is indeed an association between pot use and schizophrenia (in my opinion, especially under age 18 and particularly under age 16). However, as you can see below, the rate of schizophrenia in general has been either flat or declining all through the cannabis epidemics of the past 40 years in the West.
Therefore, it is premature of the UK researchers to claim as yet that pot is causing 14% of schizophrenia cases in the UK.
A paper out of Micronesia dated 1993 noted that schizophrenia had increased dramatically in the previous 20 years. There had been an attendant increase in the use of marijuana and other drug use.
The Australian study above, one of the best studies done to date, completely rejected the notion that cannabis causes schizophrenia in persons who would otherwise not develop it, but did suggest that cannabis use may bring on schizophrenia sooner in those who were going to develop it anyway.
Heavy cannabis use does seem to be particularly problematic in early adolescence. Kids that age should not be using cannabis anyway.
The Australian study also suggested that cannabis worsened the prognosis of schizophrenia, but that the effect was not a large one. Studying this variable is difficult since the younger one is when schizophrenia comes on, the more likely the person is to relapse, and young people are the most likely to be cannabis users.
So cannabis use and relapse to schizophrenia are going to be co-occurring due to age alone. Nevertheless, there seems to be good evidence that schizophrenics need to stay away from this drug.
The one hypothesis that shines through most clearly in all of these studies is that schizophrenics tend to be more likely to use cannabis, and more likely to use it heavily, than non-schizophrenics. In other words, simply being schizophrenic increases the likelihood of cannabis use and dependence. We can surely agree with this theory – it’s not controversial at all.
Along the lines of the Australian study, we can look at tobacco use and lung cancer. As cigarette smoking skyrocketed, lung cancer went through the roof. As smoking declined, lung cancer rates also declined.
No such picture is being seen with cannabis and schizophrenia.
Another recent study is getting a lot of media play with a totally unwarranted pot-schiz link. It found an altered development of the arcuate fasciculus, a bundle of fibers connecting the Wernicke’s and Broca’s Areas of the brain, one involved in the production of language and the other involved in the reception of language. Photo of the arcuate fasciculus is here, and a schematic is here.
Damage to the arcuate fasciculus is associated with a particular type of aphasia where language can be produced and comprehended well, but if you say something to the sufferer, they cannot repeat what you just said. The arcuate fasiculus is still developing in early adolescence, but it is not known if it continues growing in through late adolescence.
Lower volume was seen on the left side of the arcuate fasiculus in adolescent heavy marijuana users. In schizophrenia, there is reduced volume on both the left and right sides of the arcuate fasiculus. Defects in the arcuate fasiculus in schizophrenia have unknown significance, but the structure is abnormally activated, along with some other areas, during auditory hallucinations.
Excessive activation of the arcuate fasiculus associated with auditory hallucinations would not likely be caused by a reduced volume to the structure. With reduced volume, there would probably be less activation.
Damage to the brain in schizophrenia, as noted above, is quite vast and covers widely disparate areas of the brain, involving multiple structures.
Some areas are abnormally activated, while others are abnormally dormant. There are problems with various neurochemicals in the brain and receptor alterations in the cells themselves.
In short, schizophrenia is a disease caused by massive damage to the brain. One recent study likened it to a forest fire in the brain.
The problems in the arcuate fasiculus are but a tiny subset of the massive organic damage of schizophrenia. The fact that the arcuate fasiculus may be damaged by heavy cannabis use in adolescence is disturbing, but it hardly proves that such use causes schizophrenia, because schizophrenia requires much more damage than that.
Further studies using DTI found no abnormalities whatsoever in any part of the brain. In fact, if anything, adolescent cannabis users tended to have larger brains, with more cells (white matter) than the controls.
That doesn’t mean that using cannabis in adolescence makes you smart, but it surely rules out significant organic structural brain damage, and it does add interesting weight to the neuroprotective and neurostimulatory papers above.
Furthermore, many reports of “cannabis psychoses” do not appear to be psychoses at all. This preposterous report of two cannabis psychoses, published in a respected peer-reviewed journal of all things, is illustrative.
Looking over the paper, Case 1 appears to have just gotten really stoned. If that’s “cannabis psychosis”, then I’ve been “psychotic” on cannabis hundreds of times, and I must have witnessed thousands of other “cannabis psychoses”.
Case 2 is a bit more difficult, as he became suspicious of the testers at one point. It’s well known that cannabis users can feel frightened and even “paranoid.” Lord knows, I experienced it many times myself. However, the man merely felt that the testers were “concealing problems” from him. That really does not qualify as a paranoid delusion.
The world is full of suspicious people. At times, I’m pretty suspicious and wary myself, for good reason, I would say. The vast majority of people even with pathological suspicion or paranoid ideation are not suffering from paranoid delusions.
Furthermore, the questions that are asked on questionnaires of cannabis psychosis are dubious. “Most people cannot be trusted.” Well, if you live in the ghetto or the barrio, that’s a damn good attitude!
“Sometimes it seems like people are looking at me and talking about me.” Look, as you go about your business day to day, it’s quite possible people may take notice of you in one way or another.
At times people may indeed talk about you, sometimes within hearing distance. It’s hard to say whether they are talking about you in a friendly way or not. Sometimes they may seem friendly; other times not, but mostly of the time, they will probably just seem neutral.
A typical psychological questionnaire will ask you questions about many of these things. If I answer yes to any of them, it gets chalked up to “paranoia.” I know because I have taken these tests.
If you act strange in any way, people are much more likely to stare at you and even talk about you behind your back. So if everyone who acts odd enough to get stared at is hip enough to recognize the obvious, that means they have a paranoid psychosis?
There are indeed folks out there who seem to others to behave strangely. In our society, they may be called nerds, nervous, weird, or shy. Perhaps in Japan they fit right in. There are folks who live alone, never marry and even folks who never date. I’ve run across quite a few “odd” folks in my life who were not psychotic in any way. Most were not even mentally ill.
Now, I can assure you that these folks are going to get stared at from time to time, and people will even talk and whisper about them behind their back. If they happen to be self-aware enough to notice this, does this mean that they are paranoid?
In conclusion, there is some frightening stuff out there about pot and schizophrenia. At the moment, it should be read with caution. A judicious approach would be for adolescents to wait until they are at least 18 and possibly even older until they start using cannabis.
The available evidence indicates a rapidly declining risk towards the end of adolescence that presumably declines to zero increased risk at some point probably soon after age 18.
Even there, though, the Swedish study found that heavy users by age 18 were six times more likely to develop schizophrenia than non-users. So if you are going to use cannabis heavily, you should wait until you are at least 19, and possibly even older.
Prudent cannabis users will wait until they are at least 19 and then not use the drug every day. Those using or beginning to use the drug later in life, for instance me at age 50, surely must have zero increased risk of psychosis. Further research will presumably elucidate some onset age at which use of cannabis is not associated with any increased risk of schizophrenia.
I would also like to recommend a similar area of research: medical cannabis. There are many medical cannabis users now in various countries. Many of them are older people, as these are the ones who tend to be more injured or ill in life.
An interesting study would determine precisely how many of these medical cannabis users are developing schizophrenia. I have not heard of a single case so far. The number of cases must be quite small.
To add a personal link:
I used cannabis for about 22 years off and on since 1973.
All these psychiatric reports anger me because at my age and with my mental state, cannabis use dramatically improves my mental health. Many others report similar benefits. The notion that cannabis always or almost always causes deterioration of mental health is utter nonsense, and I am getting sick and tired of hearing of it.
Sure, it’s bad for some people, but look around the Net and see how many people are using it to treat anxiety disorders, eating disorders, mood disorders, etc. Does it not stretch credulity to think that all of these people are just making stuff up?
All my friends were pot smokers, and many were potheads. I also sold drugs, mostly pot, for 14 years, never got caught (neither did the vast majority of my friends) and don’t regret a thing. Actually, being a dealer was kind of fun.
Not only did I never experience any psychotic symptoms while using cannabis, I have never experienced any while off of it either. Further, I have never seen one single case of psychosis attributed to cannabis, much less schizophrenia, and that includes probably thousands of pot smokers over decades, including hundreds of heavy users, many of whom used for many years.
Based on my own experiences, any risk of schizophrenia due to cannabis is not likely to be large.
I have known a few people with schizophrenia, but not many. I was good friends for about a year with a paranoid schizophrenic who heard voices much of the time until people told me to get away from him. He had only smoked pot a couple of times and did not like the drug.
I know of one schizophrenic, ill from an early age, who loved to smoke pot. But it made him a lot worse, so everyone tried to keep him away from it. Interestingly, his brother, surely at risk of schizophrenia, was a dealer and very heavy cannabis user for many years, never developed schizophrenia and was reasonably well-adjusted.
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Richard Brautigan, (1935-1984) RIP

Have any of you ever read any of this guy’s stuff? The classic was Trout Fishing in America (1967), an absolutely bizarre yet delicious book that completely defies description. It was a classic and a best-seller.
In 1955, at age 20, he threw a rock through a police station window (!) in Oregon in an effort to get arrested so he could get something to eat (!). He was jailed but quickly transferred to a mental hospital, where he was dx’d with paranoid schizophrenia and depression and given electroshock. We never hear anything more about this dx, which seems dubious. A lot of people dx’d paranoid schizophrenia back in the 1950’s in the era of DSM-1 were actually suffering from other issues, often manic-depression or simply depression.
This list of famous schizophrenics seems weird (Joke!).
Ok, there’s the obvious: Syd Barrett (Pink Floyd), Brian Wilson (schizoaffective disorder), Skip Spence (Moby Grape), Valerie Solanas, John Nash (A Beautiful Mind is an incredible, gorgeous film – must see!), John Hinkley, Gary Heidnik, Ed Gein, Roky Erikson (13th Floor Elevators – the 1st album is out of this world, and his 1980 release The Creature With the Atom Brain is great too, especially when you realize the crazy songs were all written by a guy who was certified wacko when he was writing them), Peter Green (Fleetwood Mac), Philip K. Dick (yeah, we was definitely cookoo in his later years, Arthur Bremer, Juan Corona, John du Pont.
But Robert Pirsig (author of Zen and the Art of Motorcycle Maintenance – incredible book – read it!), Phil Spector, Cary Stayner, Nancy Spungeon, Francis Parker Yockey, Veronica Lake, Clara Bow?
Anyway, those of us who grew up as hippies in the 1970’s in the US, especially in California, sort of grew up with Richard Brautigan. He’s one of my favorite authors, but critics have sort of panned his work and they were panning it from about 1971 on. William Burroughs read with Brautigan at a reading once. Brautigan showed up, very overweight and extremely drunk and could hardly stand up at the podium. I don’t know about the schizophrenia, but he definitely had depression and alcoholism, which are epidemic among authors. Why is that anyway?
He seems to have been lonely his whole life, though he married and fathered a daughter. He never knew his father, growing up with a single Mom/waitress in Oregon. They were so poor that they often went days without eating. His stepfathers later beat him and his Mom. Around 20, he took off for San Francisco and lived most of his life there.
He is classed among the “Late Beatniks” along with Ed Sanders, Ken Kesey (although One Flew Over the Cookoo’s Nest is of course a classic movie from a Kesey novel, check out also the movie Sometimes a Great Notion, an incredible movie made from another Kesey novel; Demon Box and Kesey’s Garage Sale are also interesting), Ted Berrigan, Emmet Grogan, Bob Dylan, and Richard Fariña (check out his Been Down So Long It Looks Like Up to Me – great book!). This group was sort of a transition between beatniks and hippies.
I would like to recommend A Confederate General in Big Sur (1964). The Wiki article says it was ignored by both fans and critics both and just dismisses it. But this book is out of this world! Wow, once again, words can’t really describe it. Is it a novel? Is it a short story collection? Is it a poetry collection? No one knows. One reviewer said that his books were things called “Brautigans,” as in none of the above.
I don’t know about the schizophrenia dx, but Thomas McGuane described Brautigan as an extremely odd person. Which, again, is something we hear over and over about writers, right?
McGuane is another killer author! Check out Ninety-Two in the Shade (1973) – too much! He also wrote the screenplay for the little-known Rancho Deluxe (1974). The movie is a kick, you never really figure out what’s going on, but it’s funny to watch it when you’re stoned, because it’s obvious that everyone in the movie, from all the actors (obviously) to the probably the director and screenwriter is stoned to the gills on pot in every scene.
In the early 1980’s, he was living in a house in Bolinas, California, and drinking himself to death. In 1984, he blew his brains out. He was so lonely and isolated (A famous writer, at that), that no one even found his body until a month later. He was found in his living room, next to the window overlooking the sea. A suicide note was supposedly found that merely said, “Messy, huh?” but that has not been confirmed.
He was 49 years old.
His novels have this kind of sadness about them, but it’s a whimsical kind that is very attractive.
Other novels of his I have not read that are said to be good: In Watermelon Sugar (1968), The Abortion: An Historical Romance 1966 (1971), The Hawkline Monster: A Gothic Western (1974), Willard and His Bowling Trophies: A Perverse Mystery (1975), Sombrero Fallout: A Japanese Novel (1976) Dreaming of Babylon: A Private Eye Novel 1942 (1977) and So The Wind Won’t Blow It All Away (1982) . The last five were panned by critics. So The Wind Won’t Blow It All Away (1982) was his last book. It was ignored by both critics and readers, almost as if it did not exist. It’s said to be quite good though, although it’s also very sad.
Also, poetry that is supposed to be good: The Pill Versus the Springhill Mine Disaster (1969), Rommel Drives on Deep into Egypt (1970), June 30, June 30 (1978). June 30, June 30 was panned. It was written in Japan, where Brautigan lived for a time in the 1970’s.
Revenge of the Lawn (1971), a collection of short stories, was panned, but is said to be excellent.
Tom Robbins was obviously influenced by Brautigan. Even Cowgirls Get the Blues (1978) is fantastic! Ishmael Reed was too. I’ve never read him, but he’s supposed to be excellent. Sort of a Black counterculture novelist.
Critical anthology here.


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