What the...?! Man rips out own eyes in church

[Siggie]

Re: What the...?! Man rips out own eyes in church

Hmm... What if someone had auditory hallucinations then, but for religious/cultural reasons attributes it to God and sees it as a good thing. For instance, believes God is communicating through him/her. Now, if the pt is happy about it, but it causes a rift with some personal relationships (perhaps people who are alarmed and advise psychiatric intervention?), but not much beyond that, could someone successfully get someone like that admitted against their will? Arguing that they don't recognize it as illness because of the psychosis? Even that quote seems a little ambiguous. Below the level achieved before. It seems like a value judgment in some cases.

I dunno... I just find it fascinating how today we'd call someone like this mentally ill, while a few hundred years ago they may have been viewed as a prophet.

[LadyLazarus]

Re: What the...?! Man rips out own eyes in church

No, it's not too technical; I'm aware of the different types of schizophrenia and various symptoms. I think maybe it's kind of taken for granted that schizophrenia would present functional impairment. Perhaps this is why I haven't specifically read/heard about impairment being necessary in this instance. Though of course, I know this is broadly said and that's what I've been taught. No Dx without impairment. I suppose I could dig out my old copy of the DSM, but I'd much rather ask you. You don't mind, do you?

Not at all. If anything, I had answered without looking it up, but now you done did it and made me dig out my own DSM. So... the diagnostic criteria for schizophrenia include criterions A-F, of which D-F are exclusionary (and not relevant here). Criterion A includes the characteristic symptoms, which is what I had presented above (and what most people think of as schizophrenia symptoms anyway). Criterion C is duration (the 1 and 6 months I had mentioned). I hadn't overtly mentioned Criterion B--social/occupational dysfunction--because like you said, functional impairment sort of goes without saying in schizophrenia. Social/occupational dysfunction here is defined as "....for a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset" (and that's straight from the DSM-IV TR)

[Siggie]

Re: What the...?! Man rips out own eyes in church

There is an entire range of diagnosable disorders to which some form of psychosis is key. Schizophrenia and Psychotic Disorders is its own section in the diagnostic manual. Naturally, all of these disorders have their own diagnostic criteria (sometimes with minor differences). Also, all diagnosis is based on a cluster of possible symptoms, not a single symptom. For example, if someone is only hearing voices, that's not enough for any kind of a diagnosis. For a diagnosis of schizophrenia, 2 or more of the following have to be present regularly during a 1 month period (called the active phase), and the entire range of symptoms (including prodormal, non-active phase symptoms) has to be present over a 6 month period to formally qualify for a Dx of Schizophrenia: 1. delusions, 2. hallucinations, 3. disorganized speech, 4. catatonic behavior, 5. negative symptoms (My apologies if all of that is too technical). Also, there are different subtypes of schizophrenia, all with their own additional symptomalogical caveats. In short, the whole thing is entirely too complicated!

No, it's not too technical; I'm aware of the different types of schizophrenia and various symptoms. I think maybe it's kind of taken for granted that schizophrenia would present functional impairment. Perhaps this is why I haven't specifically read/heard about impairment being necessary in this instance. Though of course, I know this is broadly said and that's what I've been taught. No Dx without impairment. I suppose I could dig out my old copy of the DSM, but I'd much rather ask you. You don't mind, do you?

[LadyLazarus]

Re: What the...?! Man rips out own eyes in church

Would the destructive message with C have an effect? I don't mean for you specifically per se, but generally in your experience.

I can't (nor do I pretend to) speak for everyone in the field, but in my opinion, it wouldn't become important until that person decided they were going to act on it (intent to harm).

[LadyLazarus]

Re: What the...?! Man rips out own eyes in church

That's why I was asking the HC clinician and not you. I'm asking if a person is hearing voices, but otherwise isn't showing impairment, then do they get the diagnosis (dx) or no.

Also, the legal system would disagree with you as far as the insanity defense goes. Schizophrenics who obey a voice knowing that what their actions will cause harm and are otherwise wrong, wouldn't be able to successfully plead insanity. This much I know from mental health law, however since I'm not a clinician, I don't know what they'd require for the dx of schizophrenia.

There is an entire range of diagnosable disorders to which some form of psychosis is key. Schizophrenia and Psychotic Disorders is its own section in the diagnostic manual. Naturally, all of these disorders have their own diagnostic criteria (sometimes with minor differences). Also, all diagnosis is based on a cluster of possible symptoms, not a single symptom. For example, if someone is only hearing voices, that's not enough for any kind of a diagnosis. For a diagnosis of schizophrenia, 2 or more of the following have to be present regularly during a 1 month period (called the active phase), and the entire range of symptoms (including prodormal, non-active phase symptoms) has to be present over a 6 month period to formally qualify for a Dx of Schizophrenia: 1. delusions, 2. hallucinations, 3. disorganized speech, 4. catatonic behavior, 5. negative symptoms (My apologies if all of that is too technical). Also, there are different subtypes of schizophrenia, all with their own additional symptomalogical caveats. In short, the whole thing is entirely too complicated!

[Siggie]

Re: What the...?! Man rips out own eyes in church

Absolutely. It's one of the most difficult things about mental health diagnosis. Not only is it an issue of normal vs abnormal and functional vs impaired, but the whole thing becomes even more muddled when you take cultural considerations into account. Akin to the "cultural defense" in law, whereby one has to consider the cultural normative standards of behavior for the alleged criminal acts, in mental health as well, the cultural context bears weight. For example, if a clinician might normally consider a person who routinely causes deep cuts and lacerations on his/her own body to be exhibiting self-destructive behavior, the same clinician might reconsider their assessment if it becomes known to them that this person is a devout Catholic who believes in flogging. The cultural context is key--and in this context, religion becomes part of culture.



I think that one's assessment of these scenarios vis-a-vis their qualification as mental illness varies greatly depending upon how/where/by whom is the term being defined. Clinically speaking, I wouldn't deem anything mental illness without the functional impairment criteria being met. Someone in another discipline may have another way to define/approach this. In your scenario B, the person is bothered and distracted. The question becomes "to what extent?". As long as none of these prevent the person from adequately performing his/her ADLS (activities of daily living), none of them are relevant to MY definition of mental illness.

Also, please note: no single delusion/hallucination (read: no single symptom) is ever enough for a diagnosis. Please keep that in mind as we weigh sanity vs. mental illness.



Spoken like a true lawyer Here our professionally-mandated definitions vary; the clinical definitions for causing harm to self or others tend to be a lot more stringent (narrow) than the legal ones.

Haha. I'm not a lawyer, but I guess the legal training does come across now and again (without my awareness).
You're right. There's not enough information to really diagnose, but I was trying to illustrate the difficulty of the task.

Would the destructive message with C have an effect? I don't mean for you specifically per se, but generally in your experience.

[LadyLazarus]

Re: What the...?! Man rips out own eyes in church

I think you run into problems marking the line of abnormality or impairment.

Absolutely. It's one of the most difficult things about mental health diagnosis. Not only is it an issue of normal vs abnormal and functional vs impaired, but the whole thing becomes even more muddled when you take cultural considerations into account. Akin to the "cultural defense" in law, whereby one has to consider the cultural normative standards of behavior for the alleged criminal acts, in mental health as well, the cultural context bears weight. For example, if a clinician might normally consider a person who routinely causes deep cuts and lacerations on his/her own body to be exhibiting self-destructive behavior, the same clinician might reconsider their assessment if it becomes known to them that this person is a devout Catholic who believes in flogging. The cultural context is key--and in this context, religion becomes part of culture.

Consider these scenarios and assume that social relationships, work, etc have not really been affected and the symptoms are not interfering with functioning in any notable way other than the strangeness of the experience.

I think that one's assessment of these scenarios vis-a-vis their qualification as mental illness varies greatly depending upon how/where/by whom is the term being defined. Clinically speaking, I wouldn't deem anything mental illness without the functional impairment criteria being met. Someone in another discipline may have another way to define/approach this. In your scenario B, the person is bothered and distracted. The question becomes "to what extent?". As long as none of these prevent the person from adequately performing his/her ADLS (activities of daily living), none of them are relevant to MY definition of mental illness.

Also, please note: no single delusion/hallucination (read: no single symptom) is ever enough for a diagnosis. Please keep that in mind as we weigh sanity vs. mental illness.

Also... Are these persons really only harming themselves? No one who witnessed this guy tear out his eyes was harmed by the experience?
What about those who had to pay for the medical care immediately following or provide for long-term care for this now blind person?

Spoken like a true lawyer Here our professionally-mandated definitions vary; the clinical definitions for causing harm to self or others tend to be a lot more stringent (narrow) than the legal ones.

[Sip]

Re: What the...?! Man rips out own eyes in church

hehehe

[Eddo211]

Re: What the...?! Man rips out own eyes in church

Ashke douss ka ess gortze chaner......wait, nevermind.

[Haykakan]

Re: What the...?! Man rips out own eyes in church

Yeh there is but there is also plenty of over the hill lardass women that ware skimpy outfits to church to-i dont know wtf they are thinking.