Replies to post #150633 on Tornado Alley (PROG)

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A High-Profile Executive Job as Defense Against Mental Ills
October 22, 2011
http://www.nytimes.com/2011/10/23/health/23lives.html [ http://www.nytimes.com/2011/10/23/health/23lives.html?pagewanted=all ]

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Memoir About Schizophrenia Spurs Others to Come Forward
October 22, 2011
http://www.nytimes.com/2011/10/23/health/23livesside.html

[fuagf]

Beyond the Brain

by Tanya Marie Luhrmann - Summer 2012

In the 1990s, scientists declared that schizophrenia and other psychiatric illnesses were
pure brain disorders that would eventually yield to drugs. Now they are recognizing
that social factors are among the causes, and must be part of the cure.



By the time I met her, Susan was a success story. She was a student at the local community college. She had her own apartment, and she kept it in reasonable shape. She did not drink, at least not much, and she did not use drugs, if you did not count marijuana. She was a big, imposing black woman who defended herself aggressively on the street, but she had not been jailed for years. All this was striking because Susan clearly met criteria for a diagnosis of schizophrenia, the most severe and debilitating of psychiatric disorders. She thought that people listened to her through the heating pipes in her apartment. She heard them muttering mean remarks. Sometimes she thought she was part of a government experiment that was beaming rays on black people, a kind of technological Tuskegee. She felt those rays pressing down so hard on her head that it hurt. Yet she had not been hospitalized since she got her own apartment, even though she took no medication and saw no psychiatrists. That apartment was the most effective antipsychotic she had ever taken.

Twenty years ago, most psychiatrists would have agreed that Susan had a brain disorder for which the only reasonable treatment was medication. They had learned to reject the old psychoanalytic ideas about schizophrenia, and for good reasons. When psychoanalysis dominated American psychiatry, in the mid-20th century, clinicians believed that this terrible illness, with its characteristic combination of hallucinations (usually auditory), delusions, and deterioration in work and social life, arose from the patient’s own emotional conflict. Such patients were unable to reconcile their intense longing for intimacy with their fear of closeness. The science mostly blamed the mother. She was “schizophrenogenic.” She delivered conflicting messages of hope and rejection, and her ambivalence drove her child, unable to know what was real, into the paralyzed world of madness. It became standard practice in American psychiatry to regard the mother as the cause of the child’s psychosis, and standard practice to treat schizophrenia with psychoanalysis to counteract her grim influence. The standard practice often failed.

The 1980s saw a revolution in psychiatric science, and it brought enormous excitement about what the new biomedical approach to serious psychiatric illness could offer to patients like Susan. To signal how much psychiatry had changed since its tweedy psychoanalytic days, the National Institute of Mental Health designated the 1990s as the “decade of the brain.” Psychoanalysis and even psychotherapy were said to be on their way out. Psychiatry would focus on real disease, and psychiatric researchers would pinpoint the biochemical causes of illness and neatly design drugs to target them.

Schizophrenia became a poster child for the new approach, for it was the illness the psychoanalysis of the previous era had most spectacularly failed to cure. Psychiatrists came to see the assignment of blame to the schizophrenogenic mother as an unforgivable sin. Such mothers, they realized, had not only been forced to struggle with losing a child to madness, but with the self-denigration and doubt that came from being told that they had caused the misery in the first place. The pain of this mistake still reverberates through the profession. In psychiatry it is now considered not only incorrect but morally wrong to see the parents as responsible for their child’s illness. I remember talking to a young psychiatrist in the late 1990s, back when I was doing an anthropological study of psychiatric training. I asked him what he would want non-psychiatrists to know about psychiatry. “Tell them,” he said, “that schizophrenia is no one’s fault.”

It is now clear that the simple biomedical approach to serious psychiatric illnesses has failed in turn. At least, the bold dream that these maladies would be understood as brain disorders with clearly identifiable genetic causes and clear, targeted pharmacological interventions (what some researchers call the bio-bio-bio model, for brain lesion, genetic cause, and pharmacological cure) has faded into the mist. To be sure, it would be too strong to say that we should no longer think of schizophrenia as a brain disease. One often has a profound sense, when confronted with a person diagnosed with schizophrenia, that something has gone badly wrong with the brain.

Yet the outcome of two decades of serious psychiatric science is that schizophrenia now appears to be a complex outcome of many unrelated causes—the genes you inherit, but also whether your mother fell ill during her pregnancy, whether you got beaten up as a child or were stressed as an adolescent, even how much sun your skin has seen. It’s not just about the brain. It’s not just about genes. In fact, schizophrenia looks more and more like diabetes. A messy array of risk factors predisposes someone to develop diabetes: smoking, being overweight, collecting fat around the middle rather than on the hips, high blood pressure, and yes, family history. These risk factors are not intrinsically linked. Some of them have something to do with genes, but most do not. They hang together so loosely that physicians now speak of a metabolic “syndrome,” something far looser and vaguer than an “illness,” let alone a “disease.” Psychiatric researchers increasingly think about schizophrenia in similar terms.

And so the schizophrenogenic mother is back. Not in the flesh, perhaps. Few clinicians talk anymore about cold, rejecting mothers—“refrigerator” mothers, to use the old psychoanalytic tag. But they talk about stress and trauma and culture. They talk about childhood adversity—being beaten, bullied, or sexually abused, the kind of thing that the idea of the schizophrenogenic mother was meant to capture, though in the new research the assault is physical and the abuser is likely male. Clinicians recognize that having a decent place to live is sometimes more important than medication. Increasingly, the valuable research is done not only in the laboratory but in the field, by epidemiologists and even anthropologists. What happened?

The first reason the tide turned is that the newer, targeted medications did not work very well. It is true that about a third of those who take antipsychotics improve markedly. But the side effects of antipsychotics are not very pleasant. They can make your skin crawl as if ants were scuttling underneath the surface. They can make you feel dull and bloated. While they damp down the horrifying hallucinations that can make someone’s life a misery—harsh voices whispering “You’re stupid” dozens of times a day, so audible that the sufferer turns to see who spoke—it is not as if the drugs restore most people to the way they were before they fell sick. Many who are on antipsychotic medication are so sluggish that they are lucky if they can work menial jobs.

Some of the new drugs’ problems could be even more serious. For instance, when clozapine was first released in the United States in 1989, under the brand name Clozaril, headlines announced a new era in the treatment of psychiatric illness. Observers described dramatic remissions that unlocked the prison cage created by the schizophrenic mind, returning men and women to themselves. Clozaril also carried the risk of a strange side effect: In some cases, blood molecules would clump together and the patient would die. Consequently, those who took the drug had to be monitored constantly, their blood drawn weekly, their charts reviewed. Clozaril could cost $9,000 per year. But it was meant to set the mind free.

Yet Clozaril turned out not to be a miracle drug, at least for most of those who took it. Two decades after its release, a reanalysis published in The Archives of General Psychiatry found that on average, the older antipsychotics—such as Thorazine, mocked in the novel One Flew Over the Cuckoo’s Nest for the fixed, glassy stares it produced in those who took it—worked as well as the new generation, and at a fraction of the cost. Then there was more bad news, which washed like a tidal wave across the mental health world in the late 1990s, as if the facts had somehow been hidden from view. These new antipsychotics caused patients to gain tremendous amounts of weight. On average, people put on 10 pounds in their first 10 weeks on Clozaril. They could gain a hundred pounds in a year. It made them feel awful. I remember a round young woman whose eyes suddenly filled with tears as she told me she once had been slender.

The weight not only depressed people. It killed them. People with schizophrenia die at a rate far higher than that of the general population, and most of that increase is not due to suicide. In a now famous study of patients on Clozaril, more than a third developed diabetes in the first five years of use alone.

The second reason the tide turned against the simple biomedical model is that the search for a genetic explanation fell apart. Genes are clearly involved in schizophrenia. The child of someone with schizophrenia has a tenfold increase in the risk of developing the disorder; the identical twin of someone with schizophrenia has a one-in-two chance of falling ill. By contrast, the risk that a child of someone with Huntington’s chorea—a terrible convulsive disorder caused by a single inherited gene—will go on to develop the disease goes up by a factor of 10,000. If you inherit the gene, you will die of the disease.

Schizophrenia doesn’t work like that. The effort to narrow the number of genes that may play a role has been daunting. A leading researcher in the field, Ridha Joober, has argued that there are so many genes involved, and the effects of any one gene are so small, that the serious scientist working in the field should devote his or her time solely to identifying genes that can be shown not to be relevant. The number of implicated genes is so great that Schizophrenia Forum, an excellent Web site devoted to organizing the scientific research on the disorder—the subject of 50,000 published articles in the last two decades—features what Joober has called a “gene of the week” section. Another scientist, Robin Murray, one of the most prominent schizophrenia researchers in Europe, has pointed out that you can now track the scientific status of a gene the way you follow the performance of a sports team. He said he likes to go online to the Schizophrenia Forum to see how his favorite genes are faring.

The third reason for the pushback against the biomedical approach is that a cadre of psychiatric epidemiologists and anthropologists has made clear that culture really matters. In the early days of the biomedical revolution, when schizophrenia epitomized the pure brain disorder, the illness was said to appear at the same rate around the globe, as if true brain disease respected no social boundaries and was found in all nations, classes, and races in equal measure. This piece of dogma was repeated with remarkable confidence from textbook to textbook, driven by the fervent anti-psychoanalytic insistence that the mother was not to blame. No one should ever have believed it. As the epidemiologist John McGrath dryly remarked, “While the notion that schizophrenia respects human rights is vaguely ennobling, it is also frankly bizarre.” In recent years, epidemiologists have been able to demonstrate that while schizophrenia is rare everywhere, it is much more common in some settings than in others, and in some societies the disorder seems more severe and unyielding. Moreover, when you look at the differences, it is hard not to draw the conclusion that there is something deeply social at work behind them.

Schizophrenia has a more benign course and outcome in the developing world. The best data come from India. In the study that established the difference, researchers looking at people two years after they first showed up at a hospital for care found that they scored significantly better on most outcome measures than a comparable group in the West. They had fewer symptoms, took less medication, and were more likely to be employed and married. The results were dissected, reanalyzed, then replicated—not in a tranquil Hindu village, but in the chaotic urban tangle of modern Chennai. No one really knows why Indian patients did so well, but increasingly, psychiatric scientists are willing to attribute the better outcomes to social factors. For one thing, families are far more involved in the ill person’s care in India. They come to all the appointments, manage the medications, and allow the patients to live with them indefinitely. Compared to Europeans and Americans, they yell at the patients less.

Indian families also don’t treat people with schizophrenia as if they have a soul-destroying illness. As an anthropology graduate student, Amy Sousa spent more than a year in northern India, sitting with doctors as they treated patients who came with their families into a dingy hospital where overworked psychiatrists can routinely have 10 appointments an hour. Many of the doctors didn’t mention a diagnosis. Many of the families didn’t ask. There was a good deal of deception—wives grinding medication into the flour for the daily chapattis they made for their husbands, doctors explaining to patients that they were completely well but should take strengthening pills to protect themselves from the ravages of their youth. As a result, none of the patients thought of themselves as having a career-ending illness, and every one of them expected to get better. And at least compared to patients in the West, they generally did.

The most remarkable recent epidemiologic finding relates to migrants: Some fall ill with schizophrenia not only at higher rates than the compatriots they leave behind, but at higher rates than the natives of the countries to which they have come. Dark-skinned migrants to Europe, mostly from the Caribbean or sub-Saharan Africa, are at risk of developing schizophrenia at rates as much as 10 times higher than those of white Europeans. This is a dramatic increase, and it has been shown by so many studies conducted with such methodological care that it cannot be dismissed as diagnostic racism, as if white clinicians confronted with angry black men simply called them “schizophrenic” (even though this sometimes happens). Nor does it seem that biology alone can explain the increased risk, although serious research is now being done to test the hypothesis that vitamin D deficiency plays a role.

Some observers think that the epidemiologic finding is a stark story about the way racism gets under the skin and drives people mad. It is probably more complicated than that. Another young anthropologist, Johanne Eliacin, spent two years doing fieldwork among African-Caribbean migrants living in London. Eliacin saw racism, and she felt viscerally her subjects’ stinging sense of being unwanted and out of place. But she also saw a social world shot through with hostility and anger, in which people were isolated and often intensely lonely. The African-Caribbean people in Tottenham spoke of there being no community in the community. They held up schizophrenia as the symbol of what had gone wrong. Yes, racism lay at the root of the problem, but the tangible distress was the sense of being hopelessly trapped.

Epidemiologists have now homed in on a series of factors that increase the risk of developing schizophrenia, including being migrant, being male, living in an urban environment, and being born poor. One of the more disconcerting findings is that if you have dark skin, your risk of falling victim to schizophrenia increases as your neighborhood whitens. Your level of risk also rises if you were beaten, taunted, bullied, sexually abused, or neglected when you were a child. In fact, how badly a child is treated may predict how severe the case of an adult person with schizophrenia becomes—and particularly, whether the adult hears harsh, hallucinatory voices that comment or command. The psychiatrist Jean-Paul Selten was the first to call this collection of risk factors an experience of “social defeat,” a term commonly used to describe the actual physical besting of one animal by another. Selten argued that the chronic sense of feeling beaten down by other people could activate someone’s underlying genetic vulnerability to schizophrenia.

All this—the disenchantment with the new-generation antipsychotics, the failure to find a clear genetic cause, the discovery of social causation in schizophrenia, the increasing dismay at the comparatively poor outcomes from treatment in our own health care system—has produced a backlash against the simple biomedical approach. Increasingly, treatment for schizophrenia presumes that something social is involved in its cause and ought to be involved in its cure.

You can see this backlash most clearly in the United States in the Recovery Movement, which explicitly embraces the idea that the very way you imagine an illness will affect the way you experience it—an idea that seems, well, almost psychoanalytic. As the movement’s manifesto defined it, “recovery is a process, a way of life, an attitude, and a way of approaching the day’s challenges.” One of the most influential patient-driven initiatives in decades, the Recovery Movement received a federal imprimatur of sorts in 2003, when the Bush administration issued a mandate promoting “recovery-oriented services.” Treatment providers paid by Medicare and Medicaid were told that schizophrenia would no longer be understood as an illness with a chronic and debilitating course, a death sentence for the mind. Instead, patients and mental health professionals were instructed to believe that people with schizophrenia could live as effective members of a community, able to work and to be valued. The expectation of permanent impairment was to be replaced with hope.

In practice, the ascendency of the Recovery Movement has meant that many programs and day treatment centers once run by nonpatients have been turned over to clients (so as to empower them), and that the staff allows clients to make more decisions about how to spend their money and what to do with their time. These changes have not come without bumps. Clients have not always made good choices; the staff has sometimes been reluctant to allow clients a free hand. The anthropologist Neely Myers, who spent months doing ethnographic fieldwork in client-run recovery services in Chicago, points out that this very American expectation that everyone will be an independent, productive citizen sets a high bar for people struggling with serious psychosis.

But the point is that the very idea of the recovery intervention upends the bio-bio-bio vision. Clients are encouraged to take their medication, of course, but the real therapeutic change is thought to come through something social: something people learn to do, say, and believe.

That is also true for other innovative strategies to treat schizophrenia. In Europe, the Hearing Voices network teaches people who hear distressing voices to negotiate with them. They are taught to treat the voices as if they were people—to talk with them, and make deals with them, as if the voices had the ability to act and decide on their own. This runs completely counter to the simple biomedical model of psychiatric illness, which presumes that voices are meaningless symptoms, ephemeral sequelae of lesions in the brain. Standard psychiatric practice has been to discount the voices, or to ignore them, on the grounds that doing so reminds patients that they are not real and that their commands should not be followed. One might think of the standard approach as calling a spade a spade. When voices are imagined as agents, however, they are imagined as having the ability to choose to stop talking. Members of the Hearing Voices movement report that this is what they do. In 2009, at a gathering in the Dutch city of Maastricht, person after person diagnosed with schizophrenia stood up to tell the story of learning to talk with the voices—and how the voices had then agreed to stop.

This lesson—that the world as imagined can change the world as it is—lies behind the intervention that helped Susan so much. In care as usual, people diagnosed with schizophrenia are regarded as severely disabled and thus as appropriate recipients of supported housing and other benefits. People are required to get their diagnosis to justify their placements, sometimes being asked to collect an actual piece of paper from one office and turn it in at another. Many people with schizophrenia cycle through long periods of homelessness. Few of them like it. You would think that they would line up to be housed. But they dislike the diagnosis even more than they dislike being out on the street, because the idea of being “crazy” seems even more horrifying to them than it does to those of us who have roofs over our heads. For many months, I spent time with homeless women on the streets of Chicago who clearly met criteria for schizophrenia. They talked about going crazy as something the street did to people who were too weak to handle the life, and they thought of being crazy as having a broken brain that could never be fixed. They often refused to accept housing that required a psychiatric diagnosis, or they would take it for a while and then leave. They lived lives of restless nomadism, intermittently being hospitalized or jailed by the police when their behavior got out of hand, then being released to supported housing, then, in turn, finding their way back to the bleak streets.

The new kind of intervention simply gives people housing without asking them to admit to a diagnosis. Programs like the one that helped Susan are supported by federal funding set aside for people with serious mental illness, but the benefit is not described that way to clients. Though Susan knows that she has subsidized housing, she thinks she got it because she entered a program at a shelter to help her get off crack. Those who created programs like the one Susan is in believe that the social setting in which a patient lives and imagines herself have as much to do with her treatment as any medication. In general, the data prove that they are right. People are more likely to accept housing when offered it in these programs than in care-as-usual settings, and after they are housed their symptoms lessen—whether or not they are taking medications.

The pushback against purely biomedical treatment is also occurring with other psychiatric illnesses. The confident hope that new-generation antidepressants would cure depression—those new miracle drugs such as Prozac and Zoloft that made people thinner, sharper, and “better than well,” in psychiatrist Peter D. Kramer’s apt phrase—dimmed when the public learned that teenagers committed suicide more often while taking them. No simple genetic cause for depression has emerged. There is clearly social causation in the disorder, and it too looks different in different cultures, shaped by particular causes, social settings, and methods of treatment. In the standard psychiatric textbook, Harold I. Kaplan and Benjamin J. Sadock’s Comprehensive Textbook of Psychiatry, depression is now mapped out with a host of factors, some of them biological, many of them not, and the recommended treatment includes psychotherapy.

In part, this backlash against the bio-bio-bio model reflects the sophisticated insight of an emerging understanding of the body—epigenetics—in which genes themselves respond to an individual’s social context. There is even an effort within psychiatry to abandon diagnosis altogether and instead to treat dimensions of specific behaviors, such as fear or working memory. Realistically, this project—the Research Domain Criteria—won’t dismantle the diagnostic edifice. Too much of the structure of reimbursement and care depends upon the fiction of clear-cut, biologically distinct diseases. Still, the scientists are trying.

The pushback is also a return to an older, wiser understanding of mind and body. In his Second Discourse (1754), Jean Jacques Rousseau describes human beings as made up out of each other through their interactions, their shared language, their intense responsiveness. “The social man, always outside of himself, knows only how to live in the opinions of others; and it is, so to speak, from their judgment alone that he draws the sentiment of his own existence.” We are deeply social creatures. Our bodies constrain us, but our social interactions make us who we are. The new more socially complex approach to human suffering simply takes that fact seriously again.

Photo: Illustration by a schizophrenic patient, courtesy Tanya Marie Luhrmann

Full text PDF available here.
http://www.wilsonquarterly.com/ArticlePDF.cfm?sk=39E8D3C4CCC2D80C93ECD0CFF4EEB2AA10AFA92A4888EA

Tanya Marie Luhrmann is the Watkins University Professor at Stanford University. She is the author of Of Two Minds: The Growing Disorder in American Psychiatry (2000) and When God Talks Back: Understanding the American Evangelical Relationship With God (2012).

more from this author >> http://www.wilsonquarterly.com/search_result.cfm?fSearch_author=Luhrmann&bSearch=go

COMMENTS (20)

The opinions expressed here are solely those of the author and in no way represent the views or opinions of the Woodrow Wilson International Center for Scholars. This section is moderated by Wilson Quarterly staff.

continue to comments: http://www.wilsonquarterly.com/article.cfm?AID=2196

it's really interesting that social factors were not given more consideration before .. seems obvious social
environment would be, or least could be, a factor in most mental illnesses .. i have no idea, just feels common sense ..

[fuagf]

John Nash, mathematician portrayed in A Beautiful Mind, dies in taxi crash at 86

"Schizophrenia: A story of my father"

.. insert YouTube .. hopefully most saw 'A Beautiful Mind' years ago .. it is a supadupa uva movie ..

https://www.youtube.com/watch?v=ojmWRWijVfQ

* Nash and wife Alicia killed in taxi crash on New Jersey Turnpike
* Russell Crowe salutes ‘beautiful minds, beautiful hearts’


John Nash in a picture taken in 2002. Photograph: Fred Prouser/Reuters

Tom McCarthy in New York
@TeeMcSee

Sunday 24 May 2015 12.59 EDT
Last modified on Sunday 24 May 2015 18.28 EDT

Comments 288

John Nash, the Nobel prize-winning mathematician whose life story .. http://www.theguardian.com/books/2002/mar/26/biography.highereducation .. inspired the film A Beautiful Mind .. http://www.theguardian.com/film/movie/90285/beautiful.mind , was killed with his wife Alicia in taxi cab crash in New Jersey on Saturday night, police said.

Nash, 86, was a senior mathematician at Princeton University in New Jersey. He and Alicia, 82, were traveling on the New Jersey Turnpike when their driver lost control .. http://www.nj.com/middlesex/index.ssf/2015/05/famed_a_beautiful_mind_mathematician_wife_killed_in_taxi_crash_police_say.html , NJ.com quoted state police sergeant Gregory Williams as saying. The cab hit a guardrail and the couple were thrown from the vehicle.

The cab driver and a passenger in a second vehicle were treated for non-life-threatening injuries, according to reports.

Russell Crowe, who starred as Nash in the 2001 movie, which won four Academy Awards including best picture, tweeted ..

Stunned...my heart goes out to John & Alicia & family.
An amazing partnership. Beautiful minds, beautiful hearts. https://t.co/XF4V9MBwU4

— Russell Crowe (@russellcrowe) May 24, 2015

.. his condolences on Sunday morning.

“Stunned … my heart goes out to John & Alicia & family,” Crowe wrote. “An amazing partnership. Beautiful minds, beautiful hearts.”

Nash was born on 13 June 1928, in Bluefield, West Virginia, to a father who was an electrical engineer and a mother who was a schoolteacher. In an autobiographical essay .. http://www.nobelprize.org/nobel_prizes/economic-sciences/laureates/1994/nash-bio.html .. submitted to the Nobel committee, Nash described his early curiosity in mathematical problems.

--
John Nash's unique approach produced huge leaps in economics and maths
Read more
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“By the time I was a student in high school I was reading the classic Men of Mathematics by ET Bell and I remember succeeding in proving the classic Fermat theorem about an integer multiplied by itself p times where p is a prime,” Nash wrote.

Harvard invited Nash to join its mathematics department as a doctoral student, but Princeton offered superior terms, and so Nash matriculated in 1948. In just two years he had completed the work on non-cooperative games .. http://www.princeton.edu/mudd/news/faq/topics/Non-Cooperative_Games_Nash.pdf .. that would be recognized with a Nobel prize in economics 40 years later.

“This paper introduces the concept of a non-cooperative game and develops methods for the mathematical analysis of such games,” the paper begins. “The main mathematical result is the proof of the existence in any game of at least one equilibrium point.”

The promise of Nash’s immense early achievement was shattered, however, in the ensuing 10 years, when he was overcome with a mental illness that was diagnosed in 1959 as paranoid schizophrenia.

“The mental disturbances originated in the early months of 1959 at a time when Alicia happened to be pregnant,” Nash wrote in the Nobel essay. “And as a consequence I resigned my position as a faculty member at MIT and, ultimately, after spending 50 days under ‘observation’ at the McLean Hospital, travelled to Europe and attempted to gain status there as a refugee.”

In news coverage .. https://www.nytimes.com/books/98/06/14/reviews/nasar-nash.html .. of the Nobel, the journalist Sylvia Nasar, who would go on to write A Beautiful Mind, the book upon which Ron Howard’s film was based, described Nash’s struggle.

“He didn’t die, but his life, once so full of brightness and promise, became hellish,” Nasar wrote.

In the essay, Nash describes thinking himself out of his illness.

“After my return to the dream-like delusional hypotheses in the later 60s I became a person of delusionally influenced thinking but of relatively moderate behavior and thus tended to avoid hospitalization and the direct attention of psychiatrists,” Nash wrote.

“Thus further time passed. Then gradually I began to intellectually reject some of the delusionally influenced lines of thinking which had been characteristic of my orientation. This began, most recognizably, with the rejection of politically oriented thinking as essentially a hopeless waste of intellectual effort.”

Alicia Nash, an MIT physics major when the pair met, divorced the mathematician in 1963 but continued to care for him during his illness, which prevented John Nash from working for decades. He resumed professional contacts in the 1980s; the couple remarried in 2001.

Among the high-profile tributes pouring in for Nash came one from the US National Security Agency, which was recipient of unsolicited letters from Nash in the 1950s about encryption techniques. The letters have been preserved in a museum exhibit .. http://m.nsa.gov/public_info/press_room/2012/nash_exhibit.shtml .. at the NSA.

“NSA is saddened by the loss of famed mathematician John Nash,” the agency said ..

NSA is saddened by the loss of famed mathematician John Nash. #nashletters http://t.co/5WmhcLVdSq

— NSA/CSS (@NSAGov) May 24, 2015

.. on its official Twitter account.

Last week, Nash received a $500,000 Abel prize .. http://www.theguardian.com/science/alexs-adventures-in-numberland/2015/may/19/abel-prize-2015-john-nash-louis-nirenberg-and-the-maths-of-ice-cream , one of the top lifetime achievement honours in mathematics, with the New York University mathematician Louis Nirenberg. The prize was given for the two men’s work on partial differential equations, which are used to describe change, movement and velocity.

Nirenberg said Nash was a truly great mathematician and “a kind of genius”.

http://www.theguardian.com/us-news/2015/may/24/john-nash-mathematician-beautiful-mind-dies-taxi-crash

See also:

Despite evidence of a link between genius and madness, no one has proved that such a link exists. However, scientists at the University of Toronto have discovered that creative people possess little to no "latent inhibition," the unconscious ability to reject unimportant or irrelevant stimuli. As University of Toronto psychology professor Jordan Peterson puts it, "This means that creative individuals remain in­ contact with the extra information constantly streaming in from the environment. The normal person classifies an object, and then forgets about it, even though that object is much more complex and interesting than he or she thinks. The creative person, by contrast, is always open to new possibilities" [source: University of Toronto]. .. http://investorshub.advfn.com/boards/read_msg.aspx?message_id=102450856

Learning to Cope With a Mind’s Taunting Voices
http://investorshub.advfn.com/boards/read_msg.aspx?message_id=65987173

Detouring from the 'madness' above, just because i picked it up along the way and because she should not be forgotten for her seeming brilliance back when ..

Brooksley Born warned that unchecked trading in the credit market could lead to disaster, but power brokers in Washington ignored her. Now we're all
paying the price .. ouch! lol, apology for the friggin' hailstorm in this one .. http://investorshub.advfn.com/boards/read_msg.aspx?message_id=37970175

[fuagf]

A Mental Disease by Any Other Name

"Schizophrenia: A story of my father"

.. for all those who would like to see an evolutionary adjustment of the human mind toward a world of more empathy, caring and
community the story of John Nash of "A Beautiful Mind" (the one this replies to) and this story of Frank Russell are must reads ..

For Frank Russell, reinterpreting his schizophrenia as shamanism helped his symptoms.

By Susie Neilson Illustration by Richie Pope September 15, 2016

I t starts without warning—or rather, the warnings are there, but your ability to detect them exists only in hindsight. First you’re sitting in the car with your son, then he tells you: “I cannot find my old self again.” You think, well, teenagers say dramatic stuff like this all the time. Then he’s refusing to do his homework, he’s writing suicidal messages on the wall in black magic marker, he’s trying to cut himself with a razor blade. You sit down with him; you two have a long talk. A week later, he runs home from a nighttime gathering at his friend’s apartment, he’s bursting through the front door, shouting about how his friends are trying to kill him. He spends the night crouching in his mother’s old room, clutching a stuffed animal to his chest. He’s 17 years old at this point, and you are his father, Dick Russell, a traveler, a former staff reporter for Sports Illustrated, but a father first and foremost. It is the turn of the 21st century.

Up until this point, your son, Frank, has been a fully functional kid, if somewhat odd. An eccentric genius, socially inept yet insightful—perhaps an artist in the making, you thought. Now you are being told your son’s quirks stem from pathology, his mystic phrases are not indications of creative genius but of neural networks misfiring. You sit with Frank as he receives his diagnosis, schizophrenia, and immediately all sorts of associations flood into your head. In the United States, a diagnosis of schizophrenia often means homelessness, joblessness, inability to maintain close relationships, and increased susceptibility to addiction. Your son is now dangling off this cliff. So you hand him over to the doctors, who prescribe him antipsychotics, and when he balloons up to 300 pounds,1 and they tell you he’s just being piggish, you believe them.2


JUST A KID: Franklin Russell as a child, before any symptoms of schizophrenia had surfaced. Courtesy of Dick Russell

Had Frank been living someplace else, things may have turned out differently. In some countries, schizophrenics hold down jobs at five times the rates of American schizophrenics. In others, symptoms are interpreted as unusual powers.

Dick and his son tried a variety of treatments over 15 years, some more effective than others. Then, unexpectedly, the pair turned in a very different direction, beginning a journey that Dick now likens to a “torch-lit passageway through a long dark tunnel.” By sharing his story, he hopes to help others find this passageway—but he’s aware some of it sounds crazy. For instance: He now believes Frank might be a shaman.


C ertain structures and regions in the brain are thought to be particularly important in constructing our sense of self. One is the meeting place between the two middle lobes of the brain: the temporal lobe, which translates sight and hearing into language, emotion, and memory, and the parietal lobe, which integrates all five senses to locate the body in space. This region, called the temporoparietal junction, or TPJ, assembles information from these and other lobes into a mental representation of one’s physical body, and its place in space and time. It also plays a role in what’s called theory of mind, the ability to recognize your thoughts and desires as your own and to understand that other people have mental states that are separate from yours.

When the TPJ is altered or disturbed, putting oneself together becomes difficult and sometimes painful. Body Dysmorphic Disorder, characterized by extreme preoccupation with imagined physical defects, is thought to arise from faulty TPJ interplay.3 Researchers see atypical TPJ activity in Alzheimer’s patients, Parkinson’s patients, and amnesiacs.

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“Don’t take my devils away, because my angels may flee, too.”
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Schizophrenia is intimately related to TPJ messiness. It affects theory of mind; schizophrenic patients often believe that others harbor animosity toward them, and when they perform mental tasks related to theory of mind, their TPJ activity either spikes or crashes. Researchers have induced the kind of ghostly visions and out-of-body experiences that some schizophrenics experience, simply by stimulating the TPJ with electrodes. The psychiatrist Lot Postmes calls this “perceptual incoherence,” noting that the jumbled assortment of sensory information leads to an untethering of ego: “a normal sense of self, as a feeling of unitary entity, the ‘I,’ that owns and authors its thoughts, emotions, body, and actions.”4

Having a dissolved self can make it immensely hard for a schizophrenic person to present a coherent picture of themselves to the world, and to relate to other, more gelled selves. “Schizophrenia is a disease whose main manifestations are sufferers’ [diminished] abilities to engage in social interactions,” says Matcheri S. Keshavan, a psychiatrist at Harvard Medical School and an expert on schizophrenia. And yet, ironically, people with schizophrenia need others just as much as socially capable people do, if not more. “A problem with schizophrenia is however much they want [social interactions], they often lose the skills needed for navigating them,” Keshavan says.

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This craving for social connection puts schizophrenic people at stark contrast to people diagnosed with Autism Spectrum Disorder (ASD). In 2008, Bernard Crespi, a biologist at Simon Fraser University, in Canada, and Christopher Badcock, a sociologist at the London School of Economics, theorized that autism spectrum disorder (ASD) and schizophrenia were opposite sides of the same coin. “Social cognition,” they wrote, is “underdeveloped in autism, but hyper-developed to dysfunction in psychosis (schizophrenia).” In other words, where an autistic person’s sense of self is cripplingly narrow, schizophrenics’ selves are cripplingly expansive: They believe they are many people at once, and see motive and meaning everywhere.

As difficult as they may be to live with, these perceptual distortions can make schizophrenic people more creative. Schizophrenics tend to see themselves as more imaginative than others, and to embark on more artistic projects.5 Numerous people with schizophrenia have said that their creative thoughts and delusions come from the same source: Poet Rainer Maria Rilke refused treatment for his visions, saying “don’t take my devils away, because my angels may flee, too.” The author Stephen Mitchell, who translated many of Rilke’s works, put it this way: “He was dealing with an existential problem opposite from the one that most of us need to resolve: Whereas we find a thick, if translucent, barrier between self and other, he was often without even the thinnest differentiating membrane.”

Frank Russell reported feeling something similar. “He told me he feels like a mirror, reflecting what’s inside people,” his father, Dick, writes. “It was hard for him to sort out what’s him and what’s them.” And Frank, Dick reports, is highly creative. He draws, paints, and welds. He invents languages out of made-up “hieroglyphs” and archetypal symbols. He composes long poems about god and racial tension, and has won numerous awards for his poetry at school.

And yet Frank’s strange preoccupation with symbols, his belief he could become Chinese or shift into a bear, made social interaction awkward and difficult. He spent the 10 years following his initial diagnosis mostly isolated, largely incapable of forming long-lasting relationships or joining group activities. Apart from doctors, the only consistent people in Frank’s life were his parents. That was before they met Malidoma Patrice Some.


IT TAKES A VILLAGE: Malidoma Patrice Some sees himself as a titiyulo or a shaman. He believes belonging to a
community is a vital aspect of controlling symptoms commonly associated with schizophrenia. Courtesy of Dick Russell


According to the World Health Organization, schizophrenia is universal. “So far, no society or culture anywhere in the world has been found free from … this puzzling illness,” states a 1997 report. A diagnosis of schizophrenia considers the combination of five symptoms, as well as their impact and duration: 1) Delusions, 2) Hallucinations, 3) Disorganized speech, 4) Grossly disorganized or catatonic behavior, and 5) Negative symptoms like affective flattening (restricted emotional expressiveness), alogia (diminished capacity for speech), or avolition (lack of initiative). But the WHO cautions that these criteria are to be taken with a grain of salt—“current operationalized diagnostic systems, while undoubtedly very reliable, leave the question of validity unanswered in the absence of external validating criteria,” the report notes. Diagnosis “should therefore be considered a provisional tool,” set to organize treatment plans while “leav[ing] the door open to future developments.”

Terms of diagnosis are in constant flux. “It keeps changing over time,” says Keshavan. “We’re doing research to develop better biomarkers, but it’s still complicated.” Robert Rosenheck, a psychiatrist at Yale University who studies the cost efficiency of various treatment models for schizophrenia, goes even further. “Usually with medicine, the whole idea is that you have illnesses with a medical basis, a physiological basis. We don’t have that for schizophrenia.”

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If the broken-down person does not have a community around him or her, he or she may fail to heal.
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Adding to the complexity, schizophrenia looks different across cultures.6, 7 Several studies by the World Health Organization have compared outcomes of schizophrenia in the U.S. and Western Europe with outcomes in developing nations like Ghana and India. After following patients for five years, researchers found that those in developing countries fared “considerably better” than those in the developed countries.8 In one study, nearly 37 percent of patients diagnosed with schizophrenia in developing countries were asymptomatic after two years, compared to only 15.5 percent in the U.S. and Europe. In India, about half of people diagnosed with schizophrenia are able to hold down jobs, compared to only 15 percent in the U.S.9

Many researchers have theorized that these counterintuitive findings stem from a key cultural difference: developing countries tend to be collectivistic or interdependent, meaning the predominant mindset is community-oriented.10, 11 Developed countries, on the other hand, are usually individualistic—autonomy and self-motivated achievement are considered the norm. Other variables in developing countries can, at times, complicate this dichotomy—for instance, the relative scarcity of medication, and other cultural factors such as stigma. However, one study of “sociocentric” differences between ethnic minority groups within the U.S. found results suggesting that “certain protective aspects of ethnic minority culture”—namely, the prevalence of two collectivist values, empathy and social competence—“result in a more benign symptomatic expression of schizophrenia.”

“Take a young man with schizophrenia who’s socially unable to engage,” Keshavan says. “In a collectivistic culture, he’s still able to survive in a joint family with a less fortunate brother or cousin … he’ll feel supported and contained. Whereas in a more individualistic society, he’ll feel let go, and not particularly included. For that reason, schizophrenia tends to be highly disabling [in individualistic countries].” Individualist cultures also “[diminish] motivation to acknowledge illness and seek help from others, whether from therapists or in clinics or residential programs.” notes Russell Schutt, a leading expert on the sociology of schizophrenia.

Outcomes across cultures may also be affected by differences in the patients themselves. In 2012, Shihui Han, a neuroscientist at Peking University, asked volunteers from a traditionally interdependent country (China) and a more independent one (Denmark) to think about various people, all while monitoring activity in the TPJ. In both groups, the TPJ lit up when they attempted to infer other peoples’ thought processes, a theory of mind task. But in Chinese participants, the TPJ also activated when they thought about themselves. In Danish people, their medial prefrontal cortex, which the researchers used to measure the degree of self-reflection, lit up more than in the Chinese participants. In essence, Chinese subjects’ sense of self was blurrier on average, in a way that directly affected the area of the brain implicated in schizophrenic symptoms.

In Han’s study, the average TPJ activity levels of people from the traditionally interdependent country looked closer to those of schizophrenic patients. Other studies, including Chiyoko Kubayashi Frank at the School of Psychology at Fielding Graduate University in Santa Barbara, have theorized that diminished activity in the TPJ area in Japanese adults and children during theory of mind tasks “might represent the demoted sense of self-other distinction in the Japanese culture.”12 This shows up in how both populations perceive the world differently: People from collectivistic countries are more likely to believe in God,13 and to attend to context in images, while people from individualistic countries are likely to ignore context in favor of the image’s primary focus.14 This implies schizophrenics are less likely to be doubted or stigmatized for their visions in collectivistic cultures, and thus, they are less likely to feel what Schutt calls “socially-generated stress”—which, he notes, “has biological effects that can exacerbate symptoms of mental illness.”


Neilson_BR-artwork

Malidoma is from a collectivist society. Born into the Dagara tribe in Burkina Faso, he is the grandson of a renowned healer, who travels around the world but is based in the U.S. Malidoma sees himself as a bridge between his culture and the United States, existing to “bring the wisdom of our people to this part of the world.” Malidoma’s “career”—he chuckles at the term—is some combination of cultural ambassador, homeopath, and sage. He travels the country doing rituals and consultations, writing books, and giving speeches. He has three master’s degrees and two doctorates from Brandeis University. Sometimes he calls himself a “shaman,” because people know what that means (sort of) and it’s similar to his title back in Burkina Faso—a titiyulo, one who “constantly inquires with other dimensions.”

Dick first heard about Malidoma through James Hillman, a Jungian psychologist whose biography he was writing, at a time when Frank’s treatment had stagnated. For most of his 20s, Frank lived in group homes. His favorite, called Earth House, was a privately owned home, and far more structured than his other group homes. It offered classes, provided leadership opportunities, and fostered a loving, caring environment. Frank made close friends and acted in plays. Dick was elated: For the first time since Frank fell ill, his life was full of friends and purpose.

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Both shamans and schizophrenic people believe they have magical abilities, hear voices, and have out-of-body experiences.
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It’s because of reactions like this (and because communities help remind patients to take their meds) that community has emerged as a necessary dimension of schizophrenia treatment in Western medicine. In a review of 66 studies, researchers at the University of Santiago, in Chile, found that “community-based psychosocial interventions significantly reduced negative and psychotic symptoms, days of hospitalization, and substance abuse.”15 Patients were more likely to take medication regularly, hold jobs, and have friends. They were also less likely to feel ashamed of themselves. Similar results have been found in the U.S.

But for Frank and Dick, there was a problem. A spot in Earth House cost $20,000 per quarter—a price Dick, a lifelong journalist, could not afford for very long. After 16 months of Earth House subsidized by friends and family, he decided to stop “postponing the inevitable.” Dick drove Frank drove back to Boston and put him in a less structured group home, where, over time, he seemed to deteriorate.

It was around then, in 2012, that Dick decided to seek out Malidoma; first speaking with him over the telephone, and then meeting with him in Ojai, a small town outside of Los Angeles; then, a year later, meeting him in Jamaica, this time bringing Frank along.

When Malidoma first met Frank one evening over dinner in Jamaica, he recognized the man’s likeness to himself instantly. “The connection we had was immediately clear,” he says. As soon as schizophrenic met shaman, the latter shook his head and clasped Frank’s hands as if they’d known each other for years. He told Dick that Frank was “like a colleague!” Malidoma believes that Frank is a U.S. version of a titiyulo; in fact, there is a version of a titiyulo in pretty much every culture, he says. He also believes that one cannot choose to become a titiyulo: It happens to you. “Every shaman started with a crisis similar to those here who are called schizophrenic, psychotic. Shamanism or titiyulo journeys begin with a breakdown of the psyche,” he says. “One day they’re fine, normal, like everyone else. The next day they’re acting really weird and dangerously toward themselves and the village”—seeing and hearing things that aren’t there, acting paranoid, shouting.


SELF EXPRESSION: Later in life, Frank found solace by expressing himself through art. On the left,
he drums in Jamaica. On the right, one of his paintings.Courtesy of Dick Russell

When this happens, the Dagara people begin a collective effort to heal the broken-down person; one marked by loud rituals involving dancing and cheering and with an underlying current of celebration. Malidoma remembers watching his sister go through it. “My sister was screaming into the night,” he says, “but people were playing around her.” Usually, the uncontrollable breakdowns last about eight months, after which effectively new people emerge. “You have to go through this radical initiation where you can become the larger than life person the community needs for their own benefit, you know?” If the broken-down person does not have a community around him or her, Malidoma says, he or she may fail to heal. He believes this is what happened to Frank.

Had Frank been born into the Dagara tribe, and experienced the same breakdown at age 17 that led him to run from his friend’s apartment, Malidoma tells me that the community would have immediately rallied around him, performing the same rituals that his sister experienced. Following this intervention, his tribe members would begin the work of healing Frank and re-integrating him back into the community; once he was ready, he’d receive a prominent position. “He’d be known as a man of spirit, who’d be able to provide insight into the deep problems of the people around them,” he says.

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No longer simply a madman, he is a painter and a poet, a traveler and a friend.
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Malidoma is not the first person to posit a link between shamanism and schizophrenia. The psychiatrist Joseph Polimeni wrote an entire book on the subject, called Shamans Among Us. There, Polimeni noted several connections: Both shamans and schizophrenic people believe they have magical abilities, hear voices, and have out-of-body experiences. Shamans become shamans in their late teens to early 20s, about the same age range that schizophrenia is typically diagnosed (17-25) in men. Both schizophrenics and shamans are more commonly male than female. And the prevalence of shamans (say one per 60-150 people, the estimated size of most early human communities) is similar to the global prevalence of schizophrenia (around 1 percent).

This theory isn’t widely supported. Critics note that shamans appear to be able to enter and exit their shamanic states at will, while schizophrenic people have no control over their visions. But Robert Sapolsky, a neurobiologist at Stanford University, has hypothesized a similar and more widely accepted theory: Many spiritual leaders, like shamans and prophets, may have “schizotypal personality disorder.” People with this diagnosis are often relatives of schizophrenics who possess milder versions of some symptoms, such as peculiar ways of speaking or “metamagical” thinking, which is linked to creativity and high IQ. This profile sounds like it may fit Malidoma, who never experienced a “break” but whose brother and sister both did.

Whether or not Frank’s psychosis would have made him a shaman in another time or place, three central factors are present in the Dagara tribal intervention (early intervention, community, and purpose) that parallel the three factors that Keshavan, Schutt, Rosenheck, and others cite as complements to pharmaceutical drugs: early intervention,16 community support, and employment. Dick had perhaps missed the boat on the Dagara initiation ceremony, but Malidoma advised Dick to incorporate other aspects of his approach into his son’s life, including rituals and other purposeful activities.

After returning from Jamaica back home to Boston, Frank kept in touch with Malidoma by phone. He and Dick traveled to the homes and clinics of various alternative healers, who met Frank’s delusions with warmth and encouragement. Dick started to encourage his son more, too. When Frank asked Dick to include some of his thoughts in the memoir he was writing, including the idea that “one additive to beer is molten dolphin sweat,” Dick dutifully complied. Rather than provoke more delusional behavior in Frank, Dick says, these experiences have had a “grounding effect.” They show him he has friends and family who respect who he is and all that he’s capable of. “If some of [Franklin’s] dreams exist only in the imaginative realm, so be it,” Dick wrote in his memoir, My Mysterious Son: A Life-Changing Passage Between Schizophrenia and Shamanism. “I’ve learned the importance of this for him.”


FATHER AND SON: Today, Frank Russell is finding his symptoms easier to manage. He also has a deeper relationship with his
father, who says their journey into shamanism has changed the way he thinks about health and illness. Courtesy of Dick Russell

The effects have been profound. Five years ago, before meeting Malidoma, Frank was less motivated to seek social encounters. At 37 he took trips to New Mexico and Maine, and took classes in mechanical engineering. Today, he is a remarkably inventive jazz pianist. His room is filled with his paintings and metalwork, rife with archetypal imagery and hieroglyphic languages of his own creation.

He’s not cured. He still occasionally hears voices and harbors delusions. And he still lives in a group home. But he has been able to cut his medication in half again. He has lost weight, and his diabetes has become asymptomatic. He’s more courteous, alert, and engaged, his father and doctors say. He still has bad days, but they are fewer and farther between.

Perhaps the biggest factor motivating Frank’s improvement, however, has been the shift in how he views himself. No longer simply a madman, he is a painter and a poet, a traveler and a friend, an African and an American, a welder and a student.

And, most recently, a shaman. In February, Frank, Dick, and Frank’s mother visited Malidoma’s tribe in Burkina Faso, where Frank took part in healing rituals. He spent four weeks living in the village before returning home to Boston in early March. Dick and Malidoma are loath to disclose details of the ceremony, and say only that Frank’s response to the rituals gave them hope.

The experience also shifted Dick’s perception. “I never expected to be conducting spiritual water rituals at the ocean,” he said. But that’s what he did, and, in the course of helping his son recover, he found that his own views of sickness and health had shifted. “To the extent that psychosis involves the creation of an alternate reality, the goal is to enter that world. There’s also a recognition that the world we think of as real is actually infused with aspects of the Other—that there is a mysterious impenetration or even an underlying unity.”

As for traditional medicine’s take? To the best of Dick’s knowledge, scientists haven’t studied a case exactly like Frank’s.

Susie Neilson is an Editorial Fellow at Nautilus.

References

1. Berenson, A. Eli Lilly Said to Play Down Risk of Top Pill. The New York Times (2006).

2. Russell, D. The Astonoishing Zyprexa Cover-Up. www.MadinAmerica.com (2015).

3. Feusner, J.D., Yaryura-Tobias, J., & Saxena, S. The pathophysiology of body dysmorphic disorder. Body Image 5, 3-12 (2008).

4. Postmes, L., et al. Schizophrenia as a self-disorder due to perceptual incoherence. Schizophrenia Research 152, 41-50 (2014).

5. Kaufman, S.B. How Is Creativity Differentially Related to Schizophrenia and Autism? www.Blogs.ScientificAmerican.com (2015).

6. Brekke, J.S., & Barrio, C. Cross-ethnic symptom differences in schizophrenia: The influence of culture and minority status. Schizophrenia Bulletin 23, 305-316 (1997).

7. Banerjee, A. Cross-Cultural Variance of Schizophrenia in Symptoms, Diagnosis and Treatment. Georgetown University Journal of Health Sciences 6, 18-24 (2012.)

8. Foster, H. What Really Causes Schizophrenia Trafford Publishing, Bloomington, IN (2003).

9. Hengeveld, M. Job Hunting with Schizophrenia. The Atlantic (2015).

10. Bae, S. & Brekke, J.S. Characteristics of Korean-Americans with schizophrenia: A cross-ethnic comparison with African-Americans, Latinos, and Euro-Americans. Schizophrenia Bulletin 28, 703-717 (2002).

11. Parker, C.B. Hallucinatory “Voices” Shaped by Local Culture, Stanford Anthropologist Says. www.news.stanford.edu. (2014).

12. Frank, C.K. & Temple, E. Cultural effects on the neural basis of theory of mind. Progress in Brain Research 178, 213-223 (2009).

13. Cukur, C., de Guzamn, M.R., & Carlo, G. Religiosity, values, and horizontal and vertical individualism-collectivism: A study of Turkey, the United States, and the Philippines. Faculty Publications, Department of Psychology University of Nebraska, Lincoln (2004).

14. Liddell, B.J. et al. Self-orientation modulates the neural correlates of global and local processing. PLoS One 10, e0135453 (2015).

15. Armijo, J., et al. Efficacy of community treatments for schizophrenia and other psychotic disorders: A literature review. Frontiers in Psychiatry 4 (2013). Retrieved from doi:10.3389/fpsyt.2013.00116

16. Szabo, L. Early Intervention Could Change Nature of Schizophrenia. www.USAToday.com (2014).

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