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Health & Fitness

Redefining Crazy

Which of these people do you think is "crazy"?

Which of these people is the “crazy” one?

A. A person who reads the newspaper everyday, grocery shops, cooks healthy meals and has an immaculately clean house.

B. A person who is petting an imaginary cat and speaks in “word salad”.

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C. A person who is a talented creative visual and musical artist.

D. A person who has 12 inch paths through their house due to clutter.

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E. A person who loves to talk about cultural history, has a lovely apartment and drives every day.

F. A successful writer with multiple publications and speaking engagements.

Did you pick Person B, or maybe D? Well, Dear Readers, this was a trick question because all of these sketches are composites of people I have known, and each has a serious mental health issue.

I had always been taught that people with paranoid schizophrenia or who suffered from mania were those that society considered “crazy”.  However, in my time as a mental health professional, I have come to believe that we have to redefine what crazy is, and use better, less punitive terms. Being called “crazy” and knowing that you have something that society defines as “crazy” adds another layer to an already stigmatized illness. It’s a pretty depressing thing to endure.

Person A

Person A has paranoid schizophrenia. This is the most common kind of schizophrenia (probably 95%+ of all cases of it). A person with this has delusions (false beliefs held with conviction despite clear evidence to the contrary) and hallucinations (a perception in the absence of a stimulus, i.e. seeing or hearing something that is not physically present). The most common kind of hallucination is auditory; visual, taste and smell are more rare.

Try to imagine voices that sound real, as if they were standing next to you. Now imagine that they are making fun of you, calling you names, putting you down, telling you what an awful person you are. That is what happens with paranoid schizophrenia. This terrible illness sucks all the joy out of the person’s world view.

A person who is suffering from delusions and hallucinations is referred to as “having psychosis” or “psychotic”. The early anti-psychotic medicines that were originally discovered to treat this illness have terrible side effects and often caused a person to develop tardive dyskinesia. Tardive dyskinesia is strange movements of the extremities, or repetitive behaviors such as grimacing, sticking out the tongue, etc. Newer meds, called atypical antipsychotics (because they aren’t the “typical” earlier ones) fortunately have fewer of these side effects.

I once talked to a person with this illness who was very religious. She told me a painful story of how some people at her church said she didn’t belong there because she was harboring a demon inside her. As she spoke, several times her arm shot straight up into the air, something she could not control, a side effect of years on a first generation anti-psychotic. I felt a terrible pang in my heart thinking of how even her beloved church could no longer be a refuge.

Now perhaps you are thinking that this woman imagined the whole incident at her church. Before you dismiss this as a figment of her imagination, I suggest you reconsider. This illness leads to people treating the ill person differently, and whispering about odd behaviors behind their back which reinforces the paranoia. No matter what, she felt the pain of being rejected by her church, and still cried about it many years later.

Her house was clean and organized, and overall, she functioned extremely well. Person A did not meet the definition of “crazy” in my book.

Person B

I bet you thought Person B had schizophrenia. Wrong! It was a traumatic brain injury (TBI). Word salad is a term that means a bunch of real words strung together which make no sense. Noam Chomsky’s famous example of it is, “Colorless green ideas sleep furiously.”

As I watched Person B petting the imaginary kitten, I thought to myself that all the ideas I had been told about what defines a person as “crazy” were wrong. To me, this person who could never live safely outside a locked facility, could not communicate, and was obviously seeing things that did not exist, met my definition of “crazy”. I never before considered that a car accident could make a person crazy, but that’s exactly what happened to Person B.

Person C

Person C is a very gifted musician, songwriter and performer. After chronic use of methamphetamines over the course of two years, this person developed meth-induced psychosis which later led to a diagnosis of schizoaffective disorder. Schizoaffective disorder is essentially schizophrenia with a mood disorder heaped on top of it. In this case it was, at times, such severe depression Person C was unable to get out of bed for several days at a time. Other times Person C did things that were characteristic of mania. This included hearing voices which told Person C to run several miles without stopping right up onto a freeway ramp into traffic.

Mania is an elevated, expansive mood in which a person often sleeps very little, is very impulsive (lots of sex, spending, drugs, gambling, etc.), has racing thoughts, can be extremely jumpy, agitated, or irritable or may engage in risky behaviors. Pressured speech is a hallmark of mania and connotes speech that is rapid, frantic, difficult to interrupt, loud, and often hard for the listener to follow. Typically mania lasts for at least a week.

Once Person C got on medication everything began to normalize once again. Now here is  another person who does not meet my definition of crazy. Hmm… diagnosing crazy is harder than it seems.

Person D

Hoarding and cluttering is thought to be an anxiety disorder. I have seen houses in which only the toilet and one other key location could be accessed. Typically hoarders have very poor insight about what they are doing, and do not see their behavior as a problem, even if rats are present inside the house. While I was in one hoarder’s home, my companion had to leave because of nausea induced by the smell in the home. I thought, “If this is an anxiety disorder, we definitely need to redefine ‘crazy’!” I have even heard stories of hoarders who feed the rats as pets. 

Person E

Person E kept a nice apartment, was a charming conversationalist, drove regularly, and had . This person often commented about a fear of losing their marbles. A conversation with Person E made it clear there was no short term memory function. Questions were repeated over and over. At that point driving was still stored in long term memory, though no new learning was possible. Person E’s doctor even advocated for another year of driving with the Department of Motor Vehicles which was granted. Keep that in mind while you’re out on the road!

Person F

Person F has Bipolar II Disorder. This is the less serious form. Bipolar I is characterized by alternating periods of depression and at least one episode of mania. Bipolar II is characterized by alternating periods of depression and at least one episode of hypomania. Hypomania is not as serious as mania, and it does not last as long – usually less than a week. Bipolar disorder was formerly called manic depression. The “bi” part refers to the person have trouble on both ends of the mood scale – their sad moods (depression) and their happy moods (mania/hypomania) are both giving them trouble. Most people are just troubled by one problematic mood; for example, depression is a problem with sad, unhappy moods, and is therefore categorized as a unipolar mood disorder.

Some of the most creative, energetic people in the world have (had) bipolar disorder. Winston Churchill and Theodore Roosevelt are two famous politicians with bipolar disorder. Click here for a list of many actors, composers, writers, poets, artists and musicians who have it, or are thought to have had it.

Some of you may recall when Britney Spears made national headlines, not just for her song, “Crazy”, but because people thought she also acted that way. Britney has bipolar disorder. The chorus to her song is:

"You drive me crazy
I just can't sleep
I'm so excited, I'm in too deep
Crazy, but it feels alright
Baby thinkin’ of you keeps me up all night"

This chorus is a classic description of mania. Catherine Zeta-Jones also recently bravely announced she struggles with bipolar II disorder.

So what are the resources when someone you love has a serious mental illness?

National Alliance on Mental Illness (NAMI) is a good place to start. Mental illness actually affects one out of every four families. Their website is a wealth of information. NAMI Stigmabusters also works to address the stigma of mental illness (words like “crazy”) as they appear in popular media.

Here on the Coastside, San Mateo Medical Center offers a clinic which includes mental health services. The clinic is located in Shoreline Station at 225 S. Cabrillo Highway, Suite 205, Half Moon Bay, CA. The phone number is 650-573-3941.

If you or your loved one has private insurance, start by seeing the primary care physician and then ask for a referral to a psychiatrist, a doctor who specializes in mental illness and its treatment.

Before Britney was “Crazy” and Madonna was “Crazy For You”, Patsy Cline sang a deep rich song about feeling “Crazy”. Most people have had romantic infatuation which makes us feel a little “crazy” about another person. The word “crazy” is fine in a song title, but applying it to people? It further harms and stigmatizes our fellow brothers and sisters who are often suffering, sad and lonely. It’s crazy to do that.

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