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

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


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

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

Delusion or Overvalued idea?

What is a delusion?
I am talking about strictly psychiatry. As a kind of thought disorder. Not in our common everyday sense of ‘ I think he has a delusion that he is very important’ and so and so.
In psychiatry delusion is defined as ‘ a firm abnormal unshakable belief held with adequate conviction which is not shared or derived from his socio cultural background’.
Someone saying that aliens inserted a machine in his head is having a delusion.(until X Files reveal with real proof that indeed its happening)
The bold texting is mine. If you remove that clause every one will be having a delusion. But even believers say ‘I believe in god’, not ‘I know there is god’. For that matter atheists also. So I guess deep down its shakable.
There is another concept called ‘overvalued idea’. Here the belief in itself is not abnormal but the behaviour related to it is abnormal. The person become so much preoccupied with his belief that it gains precedence over all his daily activities.
A person who says ‘we should plant trees for our environment’ is not talking abnormally. But when he starts spending all his time and money on this avoiding his family and business it becomes overvalued idea. It in itself is not diagnostic of any psychiatric condition.

Now tell me something about all those people who get into some train to mumbai to become a movie star but has never acted in their life except in front of their mirrors. Or actresses who live on mineral water and vegetables to reach the ‘size 0’ through out their healthy digestible adult life. Or people who spend all their hard earned bank balance and future credit on buying ‘brand’y apparels and expensive cars hoping that it will make up for the ailment of a lack of meaningful respected existence. Or someone ready to kill for money to get a decent booze even if it means that after a day what will be left is a hangover, a bloody knife and an entire life inside four walls . Or all those aspiring professionals who burn their midnight oil hoping for a secure future while world is blooming, withering and preparing for rebirth outside their life proof walls. Or all those who are wallowing in the exhilarating intoxication of hatred towards a country, caste or creed forgetting that the enemy in whose throat your knife is just an accidental, innocent product of a sperm and egg who didn’t even know that they existed let alone the fact that they are going to generate a person with greed and fear and insecurities.

Tell me something about all these people. Are they having a delusion or an overvalued idea?
At least in some cases I am not able to make up my mind.