Friday, July 02, 2010

Sometimes there is no easy answer.

Riding home this afternoon, Erik & I were listening to KTSA's local afternoon show, and the host was discussing this case.

I'm not gonna go into the details of the murder here, save to say that it was among the most horrific things I ever read, and the giganto headlines detailing what happened pissed me off anew at the local Hearst rag.  I agree with the finding of not guilty by reason of insanity in this case, and I usually don't.

Seems the mother in question had a longstanding diagnosis of paranoid schizophrenia and got whacked with a heavy load of postpartum psychosis on top of it.  (This actually isn't surprising; comorbidities are as common in mental health as in physical health.)

I took Abnormal Psychology this term, and I'm not going to try hanging out my shingle tomorrow to practice--I am nothing more than an interested amateur at this point, and I realize that.  But the course was very, very eye-opening.

It is a common Leftist meme that Reagan's cutbacks in spending on mental health care back in the day resulted in mental health patients being dumped on the streets.  In reality, deinstitutionalization, or so-called community mental health care--was championed by people in the field as well as by well-meaning amateurs who didn't even bother with the bit of schooling I did.

No small part of this, of course, is due to a misunderstanding of some psychological treatments.  If I mention electroshock therapy, your hackles go up, right?  We've been taught that this is an inhumane thing, tantamount to torture.  In reality, although it is not to be used lightly, it is the quickest, most effective route out of depression.  Eighty percent of the patients treated this way DO NOT experience relapse, a better rate than anything else.  (A quick sidenote--for most mental illnesses, therapy has been shown to be as effective as drug treatment.  Sometimes it actually has a better track record when it comes to relapse.)

Locking someone away in a mental institution sounds like a horrible thing.  Back when hospitalization was much more common and of longer duration, the back wards were filled with schizophrenia patients.  Today that sounds cruel, but in studying the condition in class, I have come to the opposite conclusion--many times, fast-tracking schizophrenia patients through treatment & then returning them to "normal life" is cruel.  Even in the best cases, schizophrenia is only a somewhat-treatable disease.  Even on antipsychotic medications, many of the problems of schizophrenia can persist--including very dangerous things like auditory hallucinations.  (IE, "I hear voices.")  At best, schizophrenia patients have a diminished ability to function in normal life.

Mrs Sanchez seems to have fallen prey to something not at all uncommon for mental health patients--her medication worked well enough that she felt herself cured.  (In reality, physical health patients do the same thing.  It's just that they're more likely to hurt themselves than someone else, & of course the stigma isn't there.)  Her lawyer, who was on the show, said that her family didn't recognize the signs because they were laypeople.

Listen, it is not hard to recognize the signs of psychosis.  One of the things we learned about--which apparently doesn't happen as often as it should--in regard to schizophrenia is something called family therapy.  In this case it's not everyone sitting on a couch together so much as it is teaching the patient's family about their illness.  It's necessary for a successful reintegration into society, and I'm betting it's doubly important for paranoid schizophrenics--they're the ones likeliest to hurt themselves or someone else.

Really, if someone in your family had a potentially life-threatening illness, why the hell would you NOT learn everything you could about it?  Are there mothers out there with allergic children who don't learn how to use an Epi-pen and be vigilant for traces of the allergen?  (Or who don't learn the signs of anaphylaxis?)  Mrs. Sanchez's family chose not to learn about her disease.  And that contributed to her murder of her son, no question about it. 


On a related note: Ever see people on the street gesturing erratically or working their mouths like Mr. Ed?  They look like they're surely off their meds, eh?  Actually, they may have been on their meds religiously for a really long time.  Tardive's Dyskinesia is apparently a common side effect of long-term antipsychotic use.  Sometimes the cure is pretty horrific too.


Borepatch said...

Interesting we both posted on electroshock therapy on the same day.

JD said...

I have to agree, psych is way more complex than folk realize from watching TV. Sometimes there is no good cure for things and folks today don't seem to be able to accept that answer.

The human brain is something we don't even come close to having all the answers to yet. . .