Far From the Tree

by Solomon, Andrew

  821 The contribution of hormones to the development of schizophrenia is discussed in Laura W. Harris et al., “Gene expression in the prefrontal cortex during adolescence: Implications for the onset of schizophrenia,” BMC Medical Genomics 2 (May 2009); and Elaine Walker et al., “Stress and the hypothalamic pituitary adrenal axis in the developmental course of schizophrenia,” Annual Review of Clinical Psychology 4 (January 2008).

  822 For more information on white matter in schizophrenia, see G. Karoutzou et al., “The myelin-pathogenesis puzzle in schizophrenia: A literature review,” Molecular Psychiatry 13, no. 3 (March 2008); and Yaron Hakak et al., “Genome-wide expression analysis reveals dysregulation of myelination-related genes in chronic schizophrenia,” Proceedings of the National Academy of Sciences 98, no. 8 (April 2001).

  823 The synaptic-pruning hypothesis was originally proposed in I. Feinberg, “Schizophrenia: Caused by a fault in programmed synaptic elimination during adolescence?,” Journal of Psychiatric Research 17, no. 4 (1983). For a recent review article on the subject, see Gábor Faludi and Károly Mirnics, “Synaptic changes in the brain of subjects with schizophrenia,” International Journal of Developmental Neuroscience 29, no. 3 (May 2011).

  824 Statistics on response to antipsychotics over the short and long term come from Jeffrey A. Lieberman and T. Scott Stroup, “The NIMH-CATIE schizophrenia study: What did we learn?,” American Journal of Psychiatry 168, no. 8 (August 2011).

  825 This passage is based on my interview with Connie and Steve Lieber in 2008 and subsequent communications.

  826 Brain & Behavior Research Foundation (formerly NARSAD) website: http://bbrfoundation.org/.

  827 Figures on grant-making come from the Brain & Behavior Research Foundation (formerly NARSAD), “Our history” (2011), http://bbrfoundation.org/about/our-history. As of 2012, the most recent NARSAD grant statistics were: total given, $275,947,302.20; total number of grantees, 3,117; total number of grants given, 4,061; total number of institutions, 426; total number of countries (other than the United States), 30.

  828 Herbert Pardes made this remark at a NARSAD gala in 2010.

  829 The Lieber Clinic website can be found at http://columbiapsychiatry.org/clinicalservices/lieber-clinic-cognitive-remediation.

  830 Bleuler’s invention of the word schizophrenia is discussed in Paolo Fusar-Poli and Pierluigi Politi, “Paul Eugen Bleuler and the birth of schizophrenia (1908),” American Journal of Psychiatry, 165, no. 11 (2008).

  831 Frederick Plum declared that “schizophrenia is the graveyard of neuropathologists” in his paper “Prospects for research on schizophrenia. 3. Neurophysiology: Neuropathological findings,”Neurosciences Research Program Bulletin 10, no. 4 (November 1972).

  832 For more information on the genetics of schizophrenia, see Nancy C. Andreasen, Brave New Brain (2001); and Yunjung Kim et al., “Schizophrenia genetics: Where next?,” Schizophrenia Bulletin 37, no. 3 (May 2011).

  833 The most comprehensive study of schizophrenia risk in relatives is the Roscommon (Ireland) Family Study; see Kenneth S. Kendler et al., “The Roscommon Family Study. I. Methods, diagnosis of probands, and risk of schizophrenia in relatives,” Archives of General Psychiatry 50, no. 7 (July 1993); and numerous subsequent reports published by Kendler and his colleagues from 1993 to 2001. For a review and synthesis of twin studies discussing the various sorts of environmental influences that might contribute to the differential development of schizophrenia in twins, see Patrick F. Sullivan, Kenneth S. Kendler, and Michael C. Neale, “Schizophrenia as a complex trait: Evidence from a meta-analysis of twin studies,” Archives of General Psychiatry 60, no. 12 (December 2003).

  834 All quotations from Deborah Levy come from my interview with her in 2008 and subsequent communications.

  835 Studies on dopamine function in schizophrenia include Anissa Abi-Dargham et al., “Increased baseline occupancy of D2 receptors by dopamine in schizophrenia,” Proceedings of the National Academy of Sciences 97, no. 14 (July 2000); and Philip Seeman et al., “Dopamine supersensitivity correlates with D2High states, implying many paths to psychosis,” Proceedings of the National Academy of Sciences 102, no. 9 (March 2005).

  836 For more information on hippocampal function in schizophrenia, see Stephan Heckers, “Neuroimaging studies of the hippocampus in schizophrenia,” Hippocampus 11, no. 5 (2001); and J. Hall et al., “Hippocampal function in schizophrenia and bipolar disorder,” Psychological Medicine 40, no. 5 (May 2010).

  837 Epigenetics of schizophrenia is explored in Karl-Erik Wahlberg et al., “Gene-environment interaction in vulnerability to schizophrenia,” American Journal of Psychiatry 154, no. 3 (March 1997); and Paul J. Harrison and D. R. Weinberger, “Schizophrenia genes, gene expression, and neuropathology: On the matter of their convergence,” Molecular Psychiatry 10, no. 1 (January 2005).

  838 The question of parasites and schizophrenia, Jaroslav Flegr’s hypothesis that schizophrenia is exacerbated by toxoplasmosis, is described in Kathleen McAuliffe, “How your cat is making you crazy,”Atlantic, March 2012.

  839 Copy number variations in schizophrenia are the focus of Daniel F. Levinson et al., “Copy number variants in schizophrenia: Confirmation of five previous findings and new evidence for 3q29 microdeletions and VIPR2 duplications,” American Journal of Psychiatry 168, no. 3 (March 2011); Jan O. Korbel et al., “The current excitement about copy-number variation: How it relates to gene duplication and protein families,” Current Opinion in Structural Biology 18, no. 3 (June 2008); and G. Kirov et al., “Support for the involvement of large copy number variants in the pathogenesis of schizophrenia,” Human Molecular Genetics 18, no. 8 (April 2009). The contribution of paternal age to schizophrenia is discussed in E. Fuller Torrey, “Paternal age as a risk factor for schizophrenia: How important is it?,” Schizophrenia Research 114, nos. 1–3 (October 2009); and Alan S. Brown, “The environment and susceptibility to schizophrenia,” Progress in Neurobiology 93, no. 1 (January 2011).

  840 For more information on spontaneous mutations and schizophrenia, see Anna C. Need et al., “A genome-wide investigation of SNPs and CNVs in schizophrenia,” PLoS Genetics 5, no. 2 (February 2009); and Hreinn Stefansson et al., “Large recurrent microdeletions associated with schizophrenia,” Nature 455, no. 7210 (September 11, 2008).

  841 John Krystal’s comments come from my interview with him in 2012.

  842 The development of transgenic mice that display schizophrenia-associated traits was first described in Takatoshi Hikida et al., “Dominant-negative DISC1 transgenic mice display schizophrenia-associated phenotypes detected by measures translatable to humans,” Proceedings of the National Academy of Sciences of the United States of America 104, no. 36 (September 4, 2007); and Koko Ishizuka et al., “Evidence that many of the DISC1 isoforms in C57BL/6J mice are also expressed in 129S6/SvEv mice,” Molecular Psychiatry 12, no. 10 (October 2007). For a recent review article on transgenic mouse research, see P. Alexander Arguello and Joseph A. Gogos, “Cognition in mouse models of schizophrenia susceptibility genes,” Schizophrenia Bulletin 36, no. 2 (March 2010).

  843 The quotation from Eric Kandel comes from a personal communication. For a review of work by Kandel and his colleagues, see Christoph Kellendonk, Eleanor H. Simpson, and Eric R. Kandel, “Modeling cognitive endophenotypes of schizophrenia in mice,” Trends in Neurosciences 32, no. 6 (June 2009).

  844 Maryellen Walsh’s observation (“The history of schizophrenia is the history of blame”) occurs on page 154 of her book Schizophrenia: Straight Talk for Family and Friends (1985).

  845 Frieda Fromm-Reichman introduced the concept of the “schizophrenogenic mother” in her paper “Notes on the development of treatment of schizophrenics by psychoanalytic psychotherapy,” Psychiatry 11, no. 3 (August 1948); this was followed by the proliferation of the term throughout the scientific literature, e.g., Loren R. Mosher, “Schizophrenogenic communication and family therapy,” Family Processes 8 (1969).

  846 The source of the quotation characterizing t
he schizophrenic patient as an “unsuccessful mediator” between parents is Murray Bowen et al., “The role of the father in families with a schizophrenic patient,” American Journal of Psychiatry 115, no. 11 (May 1959).

  847 See Gregory Bateson et al., “Toward a theory of schizophrenia,” Behavioral Science 1, no. 4 (1956).

  848 Examples of parent-blaming in the literature of systems-oriented family therapy include Ruth Wilmanns Lidz and Theodore Lidz, “The family environment of schizophrenic patients,” American Journal of Psychiatry 106 (November 1949) (“The study of the histories of these patients impresses forcefully that one patient after another was subjected to a piling up of adverse intrafamilial forces that were major factors in moulding the misshapen personality, and which repeatedly interfered with the patients’ attempts at maturation in most discouraging fashion.”); Murray Bowen, Robert H. Dysinger, and Betty Basamania, “The role of the father in families with a schizophrenic patient,” American Journal of Psychiatry 115, no. 11 (May 1959) (“The fathers and mothers appear equally immature. The surface distance controls a deeper interdependence on each other. One parent denies the immaturity and functions with a facade of overadequacy. The other accentuates the immaturity and functions with a facade of inadequacy. The family members, particularly the father and mother, function in reciprocal relation to each other. They are separated from each other by an emotional barrier which, in some ways, has characteristics of an ‘emotional divorce.’ Either father or mother can have a close emotional relationship with the patient when the other parent permits. The patient’s function is similar to that of an unsuccessful mediator of the emotional differences between the parents. The most frequent family pattern is an intense twosome between mother and patient which excludes the father and from which he permits himself to be excluded.”); and Gregory Bateson et al., “Toward a theory of schizophrenia,” Behavioral Science 1, no. 4 (1956) (“We hypothesize that the family situation of the schizophrenic has the following general characteristics: 1. A child whose mother becomes anxious and withdraws if the child responds to her as a loving mother. That is, the child’s very existence has a special meaning to the mother which arouses her anxiety and hostility when she is in danger of intimate contact with the child. 2. A mother to whom feelings of anxiety and hostility toward the child are not acceptable, and whose way of denying them is to express overt loving behavior to persuade the child to respond to her as a loving mother and to withdraw from him if he does not. ‘Loving behavior’ does not necessarily imply ‘affection’; it can, for example, be set in a framework of doing the proper thing, instilling ‘goodness,’ and the like. 3. The absence of anyone in the family, such as a strong and insightful father, who can intervene in the relationship between the mother and child and support the child in the face of the contradictions involved.”).

  It is also worth reviewing Alfred S. Friedman et al., Psychotherapy for the Whole Family (1965), page 1: “By focusing upon the family as the unit of illness, we hoped to demonstrate not only improved health of the family member primarily ascribed the sick role, the schizophrenic, but to make a contribution towards the improved mental health of the other family members through their active engagement in the treatment process.”

  For an extended critique of parent-blame theories, see John G. Howells and Waguih R. Guirguis, The Family and Schizophrenia (1985).

  850 The quotation from Thomas Insel (“blame and shame”) comes from a personal communication in 2010.

  851 The NAMI finding that 57 percent of respondents believed that schizophrenia is caused by parental behavior is described on page 41 of Peter Wyden, Conquering Schizophrenia (1998).

  852 In the pop-psychology bestseller The Secret (2006), Rhonda Byrne declares unequivocally, “Humans have the power to intentionally think and create their entire life with their mind.”

  853 “The religion of healthy-mindedness” serves as the title of a chapter in William James, The Varieties of Religious Experience (1905). The quotation about “the conquering efficacy of courage, hope, and trust, and a correlative contempt for doubt, fear, worry” appears on page 95. The passage in full: “One of the doctrinal sources of Mind-cure is the four Gospels; another is Emersonianism or New England transcendentalism; another is Berkeleyan idealism; another is spiritism, with its messages of ‘law’ and ‘progress’ and ‘development’; another the optimistic popular science evolutionism of which I have recently spoken; and, finally, Hinduism has contributed a strain. But the most characteristic feature of the mind-cure movement is an inspiration much more direct. The leaders in this faith have had an intuitive belief in the all-saving power of healthy-minded attitudes as such, in the conquering efficacy of courage, hope, and trust, and a correlative contempt for doubt, fear, worry, and all nervously precautionary states of mind. Their belief has in a general way been corroborated by the practical experience of their disciples; and this experience forms to-day a mass imposing in amount.”

  854 The quotation from Patricia Backlar (“I sometimes felt as though I wore a scarlet letter S . . .”) occurs on pages 15–16 of her book The Family Face of Schizophrenia (1994).

  855 The quotation beginning “An entire generation of mental health professionals” occurs on pages 160–61 of Maryellen Walsh, Schizophrenia: Straight Talk for Family and Friends (1985).

  856 The quotation from E. Fuller Torrey (“Any parent who has raised a child . . .”) occurs on page 152 of his book Surviving Schizophrenia (2006).

  857 This passage is based on my interview with Paul and Freda Smithers in 2008. All names in this passage are pseudonyms.

  858 The quotation from John Bunyan (“Let them . . . recover one to his wits that was mad . . .”) comes from “The Jerusalem sinner saved, or, good news for the vilest of men,” in The Miscellaneous Works of John Bunyan, edited by Richard L. Greaves and Robert Sharrock (1979).

  859 For a layperson’s reference on the history of treatments for schizophrenia, see Robert Whitaker, Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill (2003). Henry Cotton’s theory of “focal infection” (for which tooth-pulling was supposedly a remedy) is described in Richard Noll, “The blood of the insane,” History of Psychiatry 17, no. 4 (December 2006). For more information on the history of lobotomy, see Joel T. Braslow, “History and evidence-based medicine: Lessons from the history of somatic treatments from the 1900s to the 1950s,” Mental Health Services Research 1, no. 4 (December 1999).

  860 Thorazine is a trademark for chlorpromazine. For more information, see Thomas A. Ban, “Fifty years chlorpromazine: A historical perspective,” Neuropsychiatric Disease & Treatment 3, no. 4 (August 2007).

  861 The quotation from Helen Mayberg (“It’s as though you have a house burning down . . .”) comes from personal communication in 2011.

  862 The quotation from the Russian political prisoner (“One loses his individuality, his mind is dulled . . .”) comes from the samizdat publication Chronicle of Current Events 18 (March 5, 1971), translated from Russian and cited in John D. LaMothe, Controlled Offensive Behavior: USSR, Defense Intelligence Agency Report ST-CS-01-169-72 (1972). Soviet use of psychiatric medication was described in Carl Gershman, “Psychiatric abuse in the Soviet Union,” Society 21, no. 5 (July 1984).

  863 The quotation from Janet Gotkin (“I became alienated from my self . . .”) occurs on page 17 of the Committee on the Judiciary report Drugs in Institutions (1977), which contains the transcript of hearings held on July 31 and August 18, 1975. Gotkin is also quoted on pages 176–77 of Paul Whitaker’s Mad in America (2003). With her husband, Paul Gotkin, she is author of Too Much Anger, Too Many Tears: A Personal Triumph Over Psychiatry (1992).

  864 The quotation beginning “The muscles of your jawbone go berserk” occurs on pages 35–36 of Jack Henry Abbott, In the Belly of the Beast (1981).

  865 This passage is based on interviews with Penny, Peter, Doug, and Polly Pease in 2008 and subsequent communications.

  866 The McLean schizo
phrenia genetics study is ongoing; recruitment information is available on their website, http://www.mclean.harvard.edu/research/clinical/study.php?sid=68.

  867 For more information on clozapine intoxication, see Carl R. Young, Malcolm B. Bowers Jr., and Carolyn M. Mazure, “Management of the adverse effects of clozapine,” Schizophrenia Bulletin 24, no. 3 (1998).

  868 Foucault’s treatise on mental illness is Madness and Civilization: A History of Insanity in the Age of Reason (1964).

  869 See, for example, Erving Goffman, “The insanity of place,” Psychiatry: Journal of Interpersonal Relations 32, no. 4 (November 1969).

  870 The quotations from R. D. Laing occur on pages 115, 121, and 133 of The Politics of Experience (1967). From page 121: “There is no such ‘condition’ as ‘schizophrenia,’ but the label is a social fact and the social fact a political event.” From page 115: “The experience and behavior that gets labeled schizophrenic is a special strategy that a person invents in order to live in an unlivable situation.” From page 133: “Madness need not be all breakdown. It may also be break-through. It is potential liberation and renewal as well as enslavement and existential death.”

  871 The seminal works of “antipsychiatry” include Erving Goffman’s and R. D. Laing’s works cited above, as well as Thomas Szasz’s books The Myth of Mental Illness (1974) and Insanity: The Idea and Its Consequences (1987).

  872 Figures on the reduction in institutionalized populations come from page 421 of E. Fuller Torrey, Surviving Schizophrenia (2006).

  873 E. Fuller Torrey’s statement “Freedom to be insane is an illusory freedom” occurs on page 34 of his book Nowhere to Go: The Tragic Odyssey of the Homeless Mentally Ill (1988).

  874 Judge Berel Caesar is quoted on page 160 of Rael Jean Isaac and Virginia C. Armat, Madness in the Streets: How Psychiatry and the Law Abandoned the Mentally Ill (1990).

  875 The quotations from Ann Braden Johnson (“the myth that mental illness is a myth” and “Bureaucrats who drew up programs . . .”) occur on pages 4 and xiv, respectively, of Out of Bedlam: The Truth About Deinstitutionalization (1990).