Schizophrenia: myths and misconceptions of fiction writers

May 24 is world schizophrenia day. There are some popular misconceptions about schizophrenia that keep recurring in media and films about schizophrenia. Interestingly, in most of our films, the disorder mostly have symptoms that would help the writer to manipulate the story.

I can imagine the argument against this- ‘writing is about finding dramatic possibilities. One should not get too serious about the factual aspect of it. This is not a documentary.’ But it is a lousy argument. If a writer is writing a court drama and to heighten a plot point, if he makes up some laws which are not in Indian penal code, will we accept it?

Basically inaccurate depiction of mental illness is the product of laziness of the writer. First, the reluctance to google the particular illness and spent some time reading about it. Second, the laziness to really work around the irrevocable facts about the illness while trying to create drama. Instead they go for the easy path of molding the illness according to the needs of the story.

Now this can be really damaging from a bigger perspective. Because stigma and lack of awareness have been big problems worldwide in creating barriers in mental health care. And films and media are important determinants of public perceptions about mental illness.

Below are some common misconceptions that keep recurring-

1) ‘Schizophrenia is a behaviour or a state of mind.’

Often you read about a person who is very ‘schizophrenic’ or ‘psychotic.’  What this means is different for different writers. Some times they are referring to weird or aloof behaviour. But using name of a medical illness to denote a behaviour is in itself weird. If some one talks very sweetly, would you call him ‘diabetic?’ Continue reading

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Should cannabis be legalised?

There is a lot of confusion across the globe regarding whether to decriminalise cannabis use with or without legalisation.  Some countries like Canada, UK, France, Switzerland, Belgium have been trying to make rules more permissive. The realisation that cannabis may have therapeutic value in certain situations like cancer & HIV weight loss, nausea associated with chemotherapy etc may be partially responsible for this. But there is strong international pressure, especially from the International narcotics control bureau (INCB), to abide by the global policies framed in accordance to UN conventions.

I recently presented a seminar in regard to this reviewing the evidence for and against cannabis use decriminalisation and legalisation.

These are the bottom lines-

Hazards related to cannabis use:

It is a well accepted fact that deaths related to alcohol and tobacco (which are legally permitted substances) are more than cannabis by a ratio of at least 10:1. So question is, what is the basis of cannabis being illicit while both alcohol and tobacco are not? Is it just that the countries which are major producers of alcohol and tobacco products have more clout in the international arena? Continue reading

Alcohol, age limit and Imran Khan’s PIL: Are we overdoing ‘freedom?’

Maharashtra has raised the legal drinking age to 25. Reactions have ranged from ‘strange’ and ‘absurd’ to downright ‘challenge to individual freedom’. Are these things so black and white? Most countries have used a cut off for legal drinking at around 21. And the advantages and disadvantages of raising it from 21 to 25 needs to be studied and debated. But the current insistence of the critics to lower it to 18 does not have much basis from a public health perspective.

First of all, raising age limit to control alcohol use and the related hazards is a strategy that has strong ‘evidence basis’ to support it. I am not talking ‘what I feel strongly…’ or ‘probably we can infer’ kind of facts seen in columns but hard evidence from methodologically robust studies. What is the nature of hazards  we are talking about?

Alcohol use is the third leading risk factor for poor health globally. It has been estimated in India that while the gains in terms of revenue from alcohol sales are Rs 216 billion every year, losses from adverse effects of alcohol  are estimated to be Rs 244 billion, apart from the immeasurable losses due to multiple and rollover effects of alcohol use. Needless to say, the available estimates are merely the tip of the iceberg. Now coming to youngsters, it has been shown that some one initiating alcohol use after first two decades of life have much lesser chances of developing adverse consequences or pathological patterns of drinking than who starts before. In countries where it has been debated whether drinking age should be lowered from 21, considerable amount of evidence shows that it may not be a good idea (1,2,3,4,5,6,7,8). Continue reading

Hypomania and creativity

SylviaPlath

The link between creativity and mental illness has been well documented. It is said that Sylvia Plath, Earnest Hemingway, Vincent Vangogh and numerous others had suffered from Bipolar affective disorder (that is fluctuating episodes of (hypo)mania and depression).

Mania can be described as to be exactly opposite of what depression brings. Hypomania represents the lesser degree of mania. Hypomania is characterised by cheerfulness, increased confidence, increased goal directed activity, decreased need for sleep, overgrooming, disinhibition etc. Obviously with these features it is unlikely that a person’s family members would take him to a doctor. Because in their eyes, the person is more productive, happy and active than before.

With all the research relating mood disorders and creativity, the exact nature of the relation has remained speculative. One of these days we had a debate regarding this. The question was whether actually people with Bipolar affective disorder are (qualitatively) more creative or whether we get to see more of their works because they are (quantitatively) more productive? Continue reading

Religious experience and mental illness

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After returning from the ashram, he would always appear very silent. He would go to the terrace, and would be seen sitting there for long periods often with minimal body movements staring ahead. Some times he would be seen smiling without any apparent reason. And he refused to take food. Mother would spent hours coaxing him to eat.
He had come back after one year in the ashram. So mother naturally contacted ashram authorities regarding what to do. They advised her that currently he is a little ‘ill’ and can come back when he improves.

But if they had known what was really going on in his head, they would not have called him ill. He had started to hear the voice of God. Continue reading

Illness, crime and punishment

150px-speck1966 (Photo of Richard Speck who after killing 8 nurses on a single night in 1966 tried to defend it on base of an inherent genetic abnormality XYY)

I met a boy at the hospital. He had fever and ensuing encephalitis at the age of around 12 years. Encephalitis affected the frontal lobe of his brain.
After recovering from encephalitis his behaviour gradually started to change. He became more and more disinhibited. He would be often seen on the road side talking to girls in provocative language. He would talk with lot of sexual nuances.
He would appear cheerful all the time. He would repeatedly visit relatives who had daughters in their house. Even the ones with little girls. He would be very friendly with them and would visit the girls in schools or colleges with gifts. His sexual advances wouldnot spare even his mother and sister. Continue reading

Cosmetic psychiatry, art and humanity





Every one is unhappy at times. Some most of the times. Haven’t you seen people who never is able to set it off in a social situation or is always in ‘angst?’

Peter Kramer, a psychiatrist noticed that by prescribing flouxetine (an antidepressant) to people who doesnt have a well established depressive syndrome but nevertheless has ‘discontent’ improve drastically in their unhappiness. Kramer noted that “low self-worth, competitiveness, jealousy, poor interpersonal skills, shyness, fear of intimacy—the usual causes of social awkwardness” were transformed into “confidence, self-assurance and social comfort. ”

He proposes that why not use medications to improve the personality and well being? Why limit psychopharmacology to treat mental illness only? He argues that this ‘existential angst’, ‘melancholy,’ ‘gloominess,’ ‘pathos,’ ‘brooding;’ all of which has been associated with the transcedental nature of human beings may be due to some mild biological abnormalities in the brain. ‘Drugs, which are biological agents, appear to solve the difficulties of the discontent; therefore these difficulties must be biological in nature’.
An obivious counterargument is that most of the great contributions to humanity was by melancholic and choleric personalities. Their temperaments had produced things that are of a transcedental nature. Shubert’s brooding melancholy, Beethoven’s irascibility, Dostoevsky’s moral gravity, Lincoln’s sadness, Hopkins’ terrible pathos, Kierkegaard’s angst, or Pascal’s sense of vulnerability… If we make every one happy and in turn every one homogenous, growth of humanity would come to a standstill.
Continue reading