I'm looking forward to reading the book Henry's Demons which I heard about listening to the BBC today.  Henry Cockburn and his father Patrick (a journalist), co-authored a book telling the story of Henry's experience with schizophrenia.  The writing of this book turned out to be a very therapeutic for Henry, who enjoys writing.  It was only after he began writing about his experiences that he was able to participate more fully in his treatment.

I expect this book will be a very interesting read, both because Henry and his father seem to have a gift with words, and can explain his experiences very well, but also because Henry has some insight into his condition. "Insight" is a word we use in Psychiatry to specifically refer to a persons ability to recognize the degree to which their symptoms are an illness in need of treatment.  It can vary between individuals and can wax and wane during the course of an illness.  For instance, many individuals who have been stable on treatment for many years will tell you about their illness and their need for treatment.  But that same individual, if they have an episode, can loose their insight during their episode, and claim that their psychoses are real and that they are not in need of treatment.  Many patients in treatment are somewhere in between.  It is very difficult for people to accept that hallucinations, which seem so real in every way that our world around us seems real, is in fact not real.  It's even difficult to let go of that idea after they see that these hallucinations lead to bad things in their lives (Henry almost died several times after following instructions from his psychoses) and that medications are helping them go away.  So it is very common to hear people like Henry express ambivalence.    During his interview, he expressed how privileged he feels to have had these psychotic experiences and that he does not think he has an illness.  But then he changed his tune, adding that part of him must believe it is an illness because he takes his medications.

I also hope that we get to hear his father's account of dealing with the mental health system.  During the interview he touched on a conundrum that many people face when dealing with the mental health system.  He said that the hospitals Henry was in had a lot of difficulty getting Henry to take his medications, and he thought that this was because the mental health system was afraid of overstepping the bounds toward forcing people to take medications, and are erring too far on the more gentle side these days.

I think this a very interesting thing to think about, and I certainly don't have time to discuss all my thoughts on this before it's time to go to bed tonight!  But I do think he has a point.  Psychiatry has a frightening history, and that is still what most people think of when they hear about it.  The media also just loves depicting Psychiatrists performing electro-convulsive therapy without anesthesia and forcing medications on people that take away their personality.  I think many people, including Psychiatrists have reacted against that.  In addition, many of our laws dictating mental health have also reacted against this, making it very difficult to force a patient to take psychiatric medications except in extreme situations.  This has led to a very frequent situation where the family is pleading with the Psychiatrist to treat their ill family member, and Psychiatrist is telling them that they cannot.  In fact, as a Psychiatrist, I often found myself to be the only person defending a patient's right NOT to take the medications I was prescribing!

This is a complicated issue which I hope to discuss more.  I think that greater understanding of Psychiatry and our practices will help.  How we treat mental illness is really a reflection of our cultural values, and so I think that these issues should be understood more fully by our culture as a whole.