Which way madness lies harpers

About a third of worse their long-term prognosis. Symptoms turned to her apartment that day, their eye or hear their name in the would include the electricity of her mood passed, sound of the wind—yet they doubt and she wanted nothing to do with that these sensations are real.

It they are still skeptical of their own philosophy, religion, magic. It felt disease before it has really begun. Once patients believe in their delu- like I somehow actively Three years ago, the results of a sions with full conviction, they are. P engaged in creating it. The gitudinal Study, a collaboration of the neurological mechanisms behind psychoanalyst Harry Stack Sullivan, eight prodromal outpatient clinics.

Instead, the fifty-eight- many incipient cases might be ar- enrolling at a clinic. The outer limits of normality still healthy. For patients who at which healthy thoughts become used cannabis, amphetamines, opiates, or tained despite what almost everyone insane. It is only in retrospect that hallucinogens, the risk of psychosis rose to else believes. Aviv Final2cx3. They have to identify delusions before the patient re- ally believes in them.

When does a strong idea take on a pathological flavor? How does a metaphysical crisis morph into a medical one? Anna left without a referral. The clinic accepts some pro- she said. Non-bizarre delusions chotic break. As an adolescent, she and then, moments later, scold her-. A Walk in the Park, by Sebastiaan Bremer. People with serve as a diagnostic tool. Over the past century, doc- simultaneously so that their words disintegrate—she had taken some tors have tended to grasp at anything were indecipherable.

Those patients irrevocable step toward illness. Do you ever hear voices? The cal contact. McGlashan has lived reality had become too po- plumbed their childhoods for hints compared the historical importance rous. But many of his colleagues hind them. They had their own loca- tor to open a prodromal clinic, told sis with less than 40 percent accura- tion and sentience: she could feel me. He spent fifteen years as an an- cy and there is no clearly established t hem ci rcli ng a rou nd alyst at Chestnut Lodge, a famous method for preventing conversion.

F her brain. The there and guess why someone has first place. After giving these patients tions are used. It also prompted an investigation by these patients, that they annoy me, tastes and smells—a banana no lon- the federal Office for Human Research Pro- tections, in part because McGlashan had and that I find them alien to me and ger tastes like a banana, or fresh wa- not adequately informed his patients that the to everything human.

In a letter to the board of the years ago after walking across the American Psychiatric Association George Washington Bridge with a last year, he and Robert Spitzer, the four-foot samurai sword wrapped in a architect of DSM-III, warned that if blanket.

At the time, he felt like he was izing normality, and of trivializing on the brink of tapping into his own the whole concept of psy- mystical powers. O chiatric diagnosis. Winston Churchill identifying inchoate psychotic symp- Joseph Conrad Do you daydream a lot or find yourself toms. Some patients can still hold preoccupied with stories, fantasies, Stephen A.

Douglas down jobs, excel at school, or lead or ideas? Conan Doyle full social lives, yet they complain of Do you think others ever say that transformations in their moods or George Eliot your interests are unusual or that perceptions. They often come to the you are eccentric? Thomas Hardy six-year-old clinic by referral or In- Do familiar people or surroundings William Dean Howells ternet search because other doctors ever seem strange?

Not a part of the living world? Rudyard Kipling are going through. In a paper in Psy- Alien? Sinclair Lewis chiatric Quarterly, Corcoran pub- Have you ever felt that you might not actually exist? Do you ever think Henry Cabot Lodge lished excerpts of interviews with pa- that the world might not exist? Corcoran dock overlooking the sea. Do gaging with questions of cause and black peacoat buttoned up to her you ever think it could be your imag- effect. Studies have shown that peo- chin for the length of our conversa- ination?

Other factors include poverty, moving my hand right now! Luhrmann ries he told about ghosts from the on their identity. When nia are born with a biological vul- borhood whitens. Chloe, a glamorous, well- his whole life, and played house with not as anachronistic as many have dressed twenty-four-year-old Japa- figures he had made out of sticks. Courtesy the artist. Aviv Final2. When pa- tal, but the first cab she flagged the experience.

This one had an advertisement may have invented, she put her The terror of this loss was de- for Absolut Vodka. A smaller trying to explain what a bark sounds twenty-eight-year-old named Mela- sin.

A er heard of a dog. Her symptoms began in Janu- me. Richard Dawkins! As she The God Delusion! Her pale face flushed. But she began tak- preoccupations years before their ed anything, but—for one thing, ing a low dose of antipsychotics symptoms emerged. Aaron, a patient birds. Birds had taken down the and almost immediately stopped at Aware who had been the presi- plane.

And then bush—President worrying about Hell. A few days dent of his high school class, said Bush. In The raw material of delusions crash she was dismayed to find the the past year, she has occasionally tends to evolve with the times, and God of her childhood reentering wondered whet her people a re over the past century, literature her life.

Jes- the edge of her chair. There was a part of testing missiles for the government. T atheism saved me. He reported feeling discon- much and telling me to be afraid. The chiatry becoming more of a sci- take on their own timbre. For a person who feels that her back to me as external. The symptom cal model—which treats symptoms become alarmed that she had ever is essentially the interpretation as something external and discrete, imagined she could come up with and the disorder itself.

A critique independent of the self—fails to an idea and wonder whether her in Schizophrenia Bulletin describes capture the core of the illness.

She had plastic delusion that he was attracted to young next. If there is a boundary between wrap around her hands and her shoes and large wads of cotton protruding children and would be persecuted for health and insanity, Anna felt her- from her ears.

So they keep telling you make sense. T Interpretation: Concern about plots your brain. She stopped going to class. He feels that it is important about the mixed messages they had Time no longer felt as if it passed: to write these ideas down and to en- received at home. She would lie carried the codebook with him, always rejected me. But her current con- had become less compelling. She and see notes about futuristic mind always felt that her descriptions said that her psychologist and psy- experiments involving implanted were inadequate and distorting— chiatrist strongly believed the memories and telepathy, or the phys- she was left with the feeling that change came from her taking a new ics of a new sphere of reality.

Knowing that them into being. She whom she could openly share these felt airy and insubstantial, but now struggled to create some theory that experiences, but at times she strug- she made conscious decisions every would explain why people seemed so gled to maintain belief in the reality day to rely on them just as she had phony and lifeless and small, as if of her appointments.

Rosen will before. It was a matter of ignoring they could be manipulated in her try to convince me, through Socratic swaths of her own perceptual expe- fingers. She kept her thick, cord- Along with a renewed interest in an omniscient godhead. Eventually, like hair tucked behind her ears and the mundane chores of living— she settled on paper figurines. I originally published this on 5 January Part 2 is here: Delusions, odd and common: Living in the prodrome, part 2 originally 10 January How might it feel to sense your own sanity eroding?

Would you realize it? How might you sift the phantoms from physical reality, daydream from delusion, the irrefutable from the implausible?

Or, as author Rachel Aviv puts it,. When does a strong idea take on a pathological flavor? How does a metaphysical crisis morph into a medical one? Even William James admitted that he struggled to distinguish a schizophrenic break from a mystical experience. Aviv Thanks, Deidre!

As Aviv told me in an email, the story arose, in part, out of following young patients at clinics who might be in the prodrome to psychosis, the early stages of experiencing intermittent breaks from shared reality that might lead up to schizophrenia. It is impossible to predict the precise moment when a person has embarked on a path toward madness, since there is no quantifiable point at which healthy thoughts become insane.

It is only in retrospect that the prelude to psychosis can be diagnosed with certainty. How are you being watched? What sort of ghosts or angels or aliens are following you? Patients and some clinicians alike have a vested interest in discrediting the content of delusions, dismissing the ideas as errant chemicals or glitches in brain function. But as Aviv so clearly demonstrates, the specificities of the delusions are both what the patients struggle with daily and the source of the leverage that some of them find to fight off further drift into idiosyncratic worlds.