Schizophrenia: A View Within
January 20, 2010
Maladaptive behavior comes from various biological, psychological, and environmental occurrences. The theories involved help students acquire an understanding of the deep-seated behavioral needs of prospective future clients. Mental health services, in the young deaf community, have many issues pertaining to providing adequate care. Living in profound silence, 43% of deaf youth struggle to prevail in life with mental illness. Counselors and psychiatrist are sacrificing to meet their unique needs. Prospective treatments and theory of behavioral modification can only help if one understands the causes and issues related to the illnesses. This is a look at the deaf culture, their mental health dilemma, and the sacrifice developing to accommodate the silent world.
Schizophrenia: A View Within
The human organism is susceptible from conception to death for varied alterations, which effect behavior and thought. Mal-adaptation is often a replacement behavior that occurs as a result of the alteration in thought pattern. Schizophrenia is considered to be a maladaptive behavior brought on by various causes still undergoing investigation. (NIMH, 2009)
Biological factors would include such issues as genetics, disease, alcohol use of parents or self, other substance abuse, and chemical poisoning, as well as structural brain abnormalities or injuries that effect behavioral outcomes. (Sarason, 2005) Genetic defects can include a predisposition to varied brain disturbances. (Comer, 2004) These can be passed from generation to generation and may become determinable at conception or even before. (Comer, 2004) Genetic testing for various probabilities has a long way to go. (NIMH, 2009) Present information states there is a “genome scan” for determining some of the variations of genetic predispositions for schizophrenia, but it is not completely accurate. (NIMH, 2009) The concept that it can be found is one issue and the determination of the best way to fix the occurrence is far in the future, if even in our lifetime. Genetic engineering is full of alternate ramifications and ethical considerations that will no doubt be the manifestation of a super acquisition of legal and scientific laws such as is beyond our present imagination.
Disease in infancy, childhood, or adulthood, can cause damage to the brain in various ways. Encephalitis causes inflammation to the brain usually after a viral infection or preceding a vaccination for proposed serious illness. (NINDS, 2007) Ischemic Stroke causes brain damage when the blood vessels in the brain become clotted, blocked, or plugged. The perpetual stress on blocked veins builds as the blood continuously pumps. The vessel gives way becoming a hemorrhagic stroke, which bleeds into the brain causing damage. Transient ischemic attacks (TIAs) happen, when blood supply is interrupted in brief increments. The ramifications of stroke can cause somatic conditions, yet the unseen and often less noticed effects are alterations of mood, thought, behavior, and even change in personality, thus causing mental conditions or disorders. (Satcher, 2007)
Traumatic brain injury (TBI) happens when forceful impact to the head causes damage to the brain. TBI can leave many lasting mental effects, including such behavioral/mental health challenges as depression, anxiety, personality changes, aggression, acting out, and social inappropriateness. TBI’s are on the rise with the war as are maladaptive abnormal behavioral issues, whether from the tragedy of war and survival or the injuries incurred. A soldier’s symptoms may also overlap with Posttraumatic Stress Disorder, making it more difficult for doctors to treat. (NAMI, 2009)
One considering the alcohol and substance abuse or use must consider the affect on infants and children first as the mold is made or broken in childhood, even infancy. Guided more so internally by the genetic grid, an embryo is formed. If the parent drinks while pregnant, there is an effect. The genetic makeup carries what has been the past as well as the future is embolden in every cell. Was the Grandfather predisposed to a mental illness such as schizophrenia or maybe depression? Thinking about this aspect of the human experience when considering brain function as well as the varied genetic issues of other possible configurations that make an individual what they inevitably are is amazing to say the very least.
Psychological theories include Freud’s theory of psychodynamic motivators for maladaptive abnormal behavior. This is the mental law that random thought is guided and connected by underlying motives, conscious, or unconscious that causes the behavior to be validated or rewarded. (Westen, 1998) The theory of instinctual drives such as: sex, physical urges, and aggression, manifest to mold maladaptive behavior that forms into anxiety or personality abnormalities. (Westen, 1998) The conflict between the id, the ego, and the superego, continually cause emotional friction in an already at risk individual, thus wearing down the normal ability to adjust in some circumstances and causing abnormal adjusting in some situations. (Westen, 1998)
Another factor, which should be considered, is environmental. The environment that one is constantly in affects the mental state of the individual. Chronic violence, poverty, excessive worry can cause anxiety or personality abnormalities. (NIMH, 2009) Posttraumatic Stress Disorder is a stress related illness from extreme trauma such as war, rape, or extreme violence. It is interesting that those reared and continuing life in normal, quiet, peaceful, situations have lower instances of mental illnesses. (NIMH, 2010) Racial and cultural divisions that are stressful can bring about personality and other possible sensitive counseling needs. The environmental impact of variables on mental health can be many with divided impact. The goal should be to aid the client in overcoming and integrating, thus becoming empowered in their own positive traits building the self-confidence they need to continue. (NIMH, 2010)
Struggling with Schizophrenia (295.30), PTSD (309.81), Manic Depression (296.33), as well as other numerous mental and physical challenges that at times are very crushing have taught this author about survival and the creative nature of the human spirit. The desire to do better despite the issues, to create a life from the ashes at 42, to reach out and find a way to overcome maladaptive behaviors that alienate and cause division between clients, their families and society is ever present. The blessing of therapist and psychiatrist, who have walked the roads of mental illness and social stigma, is priceless. This author has taken a 28-year span of successes and failures in a life with mental/physical illness and taken charge with the use of self-help books, research, medication, therapy, good doctors, and constant awareness of new and better medical management to find a better life. The days are scheduled like everyone’s. They are often exhausting, sometimes overwhelming. Unusual family issues and extreme stress with the muscle disease that is prevalent often overwhelms this author. Medication for pain and anxiety is limited to non-narcotic by choice, being able to think clearly is most important. The support structure present that is the best and most supportive is the doctors and therapist rather than family. This course has been very helpful in the journey to become a psychologist and better understand the behaviors of those so affected by the same issues that molded the views this author has carried for years. There are others though who struggle silently, in a world of quiet repose, where therapist and doctors have a language barrier. The deaf face amazing challenges in the mental health system.
Voices in the Silence: the Interview
“The voices tell me to cut myself. It makes me feel… feel as if I have control over just one thing in my life.” Suzan replied in sign language, when I signed to her about her schizophrenia and cutting ritual. She is 17 years young. A prominent student in high school, she also was in several extra-curricular activities. The schedule in front of me was staggering. “When I take my medication I have better days. I like to stay busy; it helps me to deal with the inner problems,” Suzan continued. “I am lucky; we have a counselor at school, which referred me for services, so many people receive no help at all.” She is not alone fighting a severe mental illness. Her plight echoes throughout the young deaf community.
Mental illness issues affect 43% of the deaf youth in America. (Eldik, 2004) The illnesses range the full gamut, from depression to schizophrenia; all of which are very hard to treat in the hearing community, under the best of circumstances. Medications and therapy treatment assigned for the group must be changed and altered to get the right balance. Communication is imperative to this process. (Carlson, 2008) Chemical consistency in the individual is remarkably different from one person to another; balance in the brain enzymes and medication application can incur many trial and error efforts to discover what works best, with the least side effects. This author’s treatment and observations through the last 28 years of mental illness still takes time and proper communication with the professionals to achieve and maintain a feasible balance. Trying and accommodating the various medications in different dosages over time to find a combination that stabilizes the illness takes patience, trust, and communication. Continuing close relationships with psychiatrist and therapist help as medications build a tolerance in the brain and must be changed to have continuing good results. This is an intricate dance between the patient and the professionals.
Communication is Vital
The young deaf community are susceptible to challenges the hearing world seem to be unable to conceive. This is manifest in the communication situation. Communication interferences in the postlingually deaf subjects determine a predisposition to mental distress. The subject observes the loss as more of a disability than prelingually deaf individuals do. De Graff (2002) found correlations in the prelingually deaf population as having a better self-image and quality of life than their postlingual counterparts. (DeGraff, 2002) Accordingly, DeGraff surmised the postlingual group felt socially isolated, less accepted by there hearing peers and more likely to have additional medical and social problems. Sign Language and speech reading in addition to written language are used to assess the deaf for mental difficulties. Various mental issues, in the hearing-impaired community, have no relative association with the level of imparity in the hearing. (Wallis, 2004) Internal and external manifestations studied in the subjects to determine the viability of treatment may gain the psychiatric personnel insight into the depth of illness. Truly, communication is imperative to the well being of the patient.
Progress serving this dynamic group of deaf marches forward as psychiatrist, counselors, therapist, and social workers are reaching out to gather and treat this vast array of people. The loving dedication of counselors and therapist learning to use American Sign Language with their deaf patients is cause for great pride. Providing translators for deaf clients is a hard job. Fifty-six percent of the deaf in one important study were unable to find accessible mental health care for lack of translators. (Steinberg, 1998) Casework and management plans effectively in place help benefit the deaf so they are able to make a fulfilling life. Positive reinforcement and patience is a virtue. Linguistic barriers often disadvantage the deaf who are able to read and write. The use of the English language for the deaf is very different from what a hearing person uses. The lack of use of conjunctions, prepositions, time continuums, and phrases cause many problems also in diagnosing adequately the specific symptoms of some forms of mental illness. Deaf think in pictorials and sign language, how does one ask, “Do you hear voices?” (a sign of schizophrenia) (Shapira, 1999) A few moments of fast signing by a patient can be seen as a manic state rather than a change in emotion. Expressions of emotions by the deaf are also a conveyance of their language; they rely on the facial expressions and body actions to understand or express the situation. This also is at times miss-read by a well-meaning clinician. The language of sign does not have adequate words for a variety of emotions; this can pose so many issues. This is why emotional behavior and facial expressions are imperative to the deaf so they gain insight. The deeper study of kinesics in the culture would help professionals diagnose illness more effectively. The ability to test by using genome will render an amazing aid for more accurate diagnosis in cases where communication is stifled. (NIMH, 2009)
The Hope for Development
Schools and mental health agencies are encouraging the deaf to become professionals in the mental health fields. The hope for the future of the deaf culture is healthy productive individuals that direct the members of their society to prosper and strive to build a well-educated peer base. The development project in place is to increase the number of signing members in the mental health and counseling community. Adapting test for mental evaluations will also help. Time and patience are encouraged by all involved. The protocol now is to have a double evaluation before commitment, this second opinion procedure is in place to secure the diagnoses and stop miss-understandings that cause wrongful commitment.
It is a personal hope that someday the mental health services for the deaf will be as easy to acquire as it is for the hearing world. I have 28 years of experience with the mental health system and 30 years working with the deaf. I intend on having many more years ahead to continue my work. Anthropology is the study of humanity and the contemporary human diversity. I am so profoundly touched by the deaf culture as a whole. The voices in the silence are many. Deaf old and young have issues. There are answers. The best of care takes time. Time takes the voices away.
Abnormal Psychology, Fifth Edition, Ronald J. Comer, (2004) Worth Publishers and W.H. Freeman and Company, New York, NY
American Annals of the Deaf 148:5, Eldik, V. (2004). . In Volume 148, (Spring Ed.), (pp.390-395 ). : .
DeGraff, (2002). . Mental Health Functioning In Deaf Children and Adolescents (Ed.), (pp. ). .
Mental Health: A Report of the Surgeon General, Satcher M.D., P.h.D., (2007) http://www.surgeongeneral.gov/library/mentalhealth/chapter1/sec1.html
NINDS Acute Disseminated Encephalomyelitis, National Institute of Neurological Disorders and Stroke, (2007) http://www.ninds.nih.gov/disorders/acute_encephalomyelitis/acute_encephalomyelitis.htm
National Institute of Mental Health: Post Traumatic Stress Disorder http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
National Institute of Mental Illness: Schizophrenia http://www.nimh.nih.gov/health/publications/schizophrenia/complete-index.shtml – pub6
Foundations of Physiological Psychology, Neil R. Carlson (2008) New York, NY: Pearson Education INC
Sarason, I.G., Sarason, B.R. (2005) Abnormal Psychology – The Problem of Maladaptive Behavior. Upper-Saddle River, NJ: Pearson Education, INC
Shapira, N. A. MD, PhD (1999) Evaluation of bipolar in inpatients with prelingual deafness. The American Journal of Psychiatry, 156(8), 1267-1269
Steinberg, A.G. MD, Eckhart, E.A.CSW (1998, July) Cultural and Linguistic Barriers to Mental Health Services From the Deaf Consumers Prospective. The American Journal of Psychiatry, 155(7), 982-984
Traumatic Brain Injury: Veterans Resource Center NAMI: http://www.nami.org/Template.cfm?Section=Traumatic_Brain_Injury&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=85&ContentID=52915
The Scientific Legacy of Sigmund Freud: Toward a Psychodynamically Informed Psychological Science, Drew Weston, (1998) Harvard Medical School and Cambridge Hospital/Cambridge Health Alliance. The American Psychological Association, Copyright, 1998
Wallis, (2004) Journal of Deaf Studies and Deaf Education 2004. . In (Ed.), (9: pp2-14 ). : . http://jdsde.oxfordjournals.org/cgi/content/abstract/9/1/2