Schizophrenia

Introduction

This assignment is a critical evaluation of the engagement and psychosocial assessment of a client living with psychosis in the community. It provides a critical and analytical account which encapsulates assessments, psycho-education, problem solving, implementation and evaluation of strategies used. I will also use Gibbs (1988) model of reflection to reflect on my assessment process and how learning can be taken forward in terms of my own practice development and that of the service setting.

My client l shall call Emily a pseudo name used to maintain confidentiality in accordance with the Nursing and Midwifery Council (NMC) 2002 Code of Professional Conduct that outlines guidelines of confidentiality. Emily was initially on the acute ward where l started the process of engagement with her before she was discharged under our team in the community to facilitate early discharge. Emily was suitable for psychosocial based interventions (PSI) and this was identified as part of her care plan in order to provide support in adapting to the demands of community living and managing her illness.

PSI should be an indispensable part of treatment and options of treatment should be made available for clients and their families in an effort to promote recovery. Those with the best evidence of effectiveness are Cognitive Behavioural Therapy (CBT) and family intervention. They should be used to prevent relapse, to reduce symptoms, increase insight and promote adherence to medication, (NICE 2005). Emily is 33 year old woman with a diagnosis of schizophrenia. She was referred to my team to facilitate early discharge from the ward as part of her discharge.

She lives in supported housing and had had several hospital admissions and some under the mental health act. Emily was being maintained in the community on medication but it was felt that there was still an amount of distress in her life and that her social functioning was suffering as a result. Emily presented with both delusional and hallucinatory symptoms and as part of her treatment cognitive approaches were considered to help alleviate the distress and modify the symptoms. Emily was brought up in a highly dysfunctional family.

Both her parents had problems with drugs and the law. Emily had been introduced to drugs at an early age but due to her illness she had stopped using them at the age of 30 when she went into supported accommodation. There was family history of schizophrenia as her grandfather had it and he had killed himself. Emily identified that her problems started in 2007 when her grandfather passed away as she was close to him and had lived most of her life with her grandparents. I completed a time line to look back at while she talked about her life history .

It is vital that the client is allowed to tell their story with the minimum intervention from the practitioner and the timeline can be used to examine if there are any links to their relapses and psychotic episodes (Grant et al 2004). In the community setting we have a variety of patients with different diagnosis of mental health problems. The rationale for choosing this patient is that she had had various interventions such as medication changes and a lot of experience with the mental health professionals including compulsory treatment under the mental health act (1983).

All these factors are likely to have an impact on the individual’s degree of willingness to engage in psychological interventions (Nathan et al, 2003). Hence initially it was a challenge to engage Emily and establish a relationship and build rapport. (Nelson 1997) states rapport is built by showing interest and concern and be particularly careful not to express any doubts about what the patient tells you. The development of a therapeutic relationship is critically important in work with persons with schizophrenia, which maybe difficult with patients struggling with mistrust, suspicion and denial (Mhyr, 2004).

Rapport took some time to develop and was established by core conditions of genuineness, respect and accurate empathy (Bradshaw 1995). I met with Emily to set the agenda and explained to her that she was free to terminate the session anytime should she feel it necessary. It was also vital to ensure that the sessions were neither confrontational and totally compliant with Emily’s view of the world ( Kingdom & Turkington, 1995) I encouraged Emily to describe her current problems and to give a detailed description of the problems and concentrate on a more recent problem.

l was directive, active, riendly and used constructive feedback, containment of feelings to develop the relationship(Tarrier et al,1998). l used her interest in Christianity to engage her and because l showed an interest this became a regular point of conversation and strengthened the connection. I also demonstrated some flexibility in response to Emily’s needs and requirements at different stages of the treatment and intervention. It is not possible to maintain a sound collaborative therapeutic relationship without constant attention to the changing situation and requirements of a patient (Gamble and Brennan, 2006).

Since the development of antipsychotic medication and dominance of biomedical models during the 1950`s mental health care has changed and evolved. The dependency on the sole use of medication was found to have left patients with residual symptoms and social disability, including difficulty with interpersonal skills and limitation with coping (Sanford&Gournay, 1986). This prompted the return of PSI to be used in conjunction with medication management.

The aim was to reduce residual disability and to include in the treatment process social skills and training rehabilitation (Wykes et al, 1998). As part of my assessment process l carried out a comprehensive assessment using CPA 1, 2, and 4 in conjunction with the Trust Policy. This was to establish what her problems were and formulate a clear plan. A process of structured, comprehensive assessment can be very useful in developing an in-depth understanding of issues surrounding resistance to services (Grant et al 2004).

I carried out a Case Formulation (CS) using the 5W`s What? , Where? , When? , With Whom and Why, and Frequency, Intensity, Duration and Onset ( FIDO) model to explore and get a detailed explanation of the problem and explore the `Five aspects of your life experiences` (Greenberger and Padesky 1995) (see Appendix 3). CS maps out the relationship on how the environment impacts on your thoughts, emotion, behaviour, physical reactions (Greenberger and Padesky,1995).

While the assessment helped to form a picture of Emily’s suitability for PSI it also provided a scope for further work on her coping skills. Given the assumption that a person may feel reluctant to give a particular way of coping as this maybe the only means of control (Gamble & Brennan, 2006), the exploration was collaborative. From the assessment and case formulation Emily’s goal was to go out more and reduce the frequency and intensity of her voices or even have them disappear. l explained to Emily that we had to be realistic about her set goals and having voices disappear was unlikely.

Kingdom (2002) states that though patients desire to make voices disappear are unlikely since voices are, as far as reasonably established, attributions of thoughts as if they were external perceptions. Goals are positive, based in the future and specific (Morrison et al 2004) and the golden rule in goal setting is to be SMART, Specific, Measurable, Achievable, Realistic and Time Limited. Emily then rephrased her goal statement to that she wanted to reduce the intensity of her voices in the next few weeks by using distraction techniques that she had not tried before.

I used the KGVM Symptom Scale version 7. 0 (Krawieka, Goldberg and Vaughn,1977) to assess Emily’s symptoms which focuses on six areas including anxiety, depression, suicidal thoughts and behaviour, elevated mood, hallucinations and delusions. A KGV assessment provides a global measure of common psychiatric symptoms (feelings and thoughts) experienced with psychosis. The framework ensures that important questions are asked and a consistent measure of symptoms is provided. The KGV is a valid tool with a considered level of high reliability (Gamble and Brennan, 2006).

Assessment is a process that elicits the presence of disease or vulnerability and a level of severity in symptoms (Birchwood & Tarrier, 1996). This gathering of information provides the bases to develop a plan of suitability of treatment, identifies problems and strengths and agree upon priorities and goals (Gamble & Brennan,2006). l also used the Social Functioning Scale (SFS appendix 6) (Birchwood et al,1990) which examined Emily’s social capability and highlighted any areas of concern.

Emily was a loner and though living in supported accommodation she was hardly involved with the other residents or joined in with community activities. She expressed that she was afraid people could hear her voices and were judging her at all times and used avoidance as a coping strategy. On using the KGV assessment and from the results (see Appendix 2) Emily scored highly in four sections hallucinations, delusions, depression and anxiety. It appeared during assessment that her affective symptoms were econdary to her delusions and hallucinations, which were initiated and exacerbated by mostly stressful events in her life. Her hallucinations were noted to be evident at certain times and were followed by sleep deprivation. Emily expressed fleeting suicidal thoughts but denied having any plans or intentions. She also experienced sporadic moments of elation which appeared to be linked to stress. It was important for Emily to understand how life events had an impact on her difficulties and the use of the Stress Vulnerability Model SVM (Zubin and Spring 1977) demonstrated this (see Appendix 4).

Practical measures arising from an assessment of stress and vulnerability factors seek to reduce individual vulnerability, decrease unnecessary life stressors and increase personal resistance to the effects of stress. One of Emily’s highlighted problems was a lack of sleep and this could be linked to the stress vulnerability and her psychotic symptoms. Normalisation was used to illustrate this to Emily. Her increase in psychotic symptoms could then be normalised through discussing about the effects of sleep deprivation on her mental state and reduction of the associated anxiety.

Emily was able to recognise how stress impacted on her psychosis. Emily identified the voices as a problem from the initial assessment. She was keen to talk about them but listened to suggestions l made to tackle the voices. The assumption of continuity between normality and psychosis has important clinical implications. It opens the way for a group of therapeutic techniques that focus on reducing the stigma and anxiety often associated with the experience of psychotic symptoms and with diagnostic labelling.

Kingdom and Turkington(2002) have described such approaches as normalising strategies, which involve explaining and demystifying the psychotic experience. They may involve suggesting to patients that their experiences are not strange and no one can understand, but are common to many people and even found amongst people who are relatively normal and healthy. Normalising strategies can help instil hope and decrease the stigma and anxiety which can be associated with the experience of psychotic symptoms.

This rationale emphasises the biological vulnerability to stress of individuals with schizophrenia and the importance of identifying stresses and improving methods of coping with stress in order to minimise disabilities associated with schizophrenia (Yusupuff & Tarrier, 1996). (Grant et al 2004). The problem l encountered when applying and using this model with Emily was that she realised and understood that she was not the only one experiencing voices but she wanted to find out why she experienced the voices.

I used the belief about voices questionnaire (BAVQ-R appendix 5) which assesses malevolent and benevolent beliefs about voices, and emotional and behavioural responses to voices such as engagement and resistance (Morrison et al 2004). We identified the common triggers of her voices such as anxiety, depression and social isolation. During my engagement with Emily l emphasized enhancing existing coping strategies (Birchwood& Tarrier, 1994); (Romme &Escher 2000). The idea was to build on Emily’s existing coping methods and introduce an alternative. We agreed upon distraction as a coping strategy.

The plan was for Emily to listen to music or carryout breathing exercises when the disturbing voices appear and to start interacting with them by telling them to go away rather than shout at them. Emily used this plan with good effect at most times as it appeared to reduce the psychological arousal and helped her gain maximum usage of these strategies in controlling the symptom (Tarrier et al, 1990). To tackle Emily’s social functioning we identified activities that she enjoyed doing and she enjoyed going to church but had stopped due to her fears that people could hear her thoughts and found her weird.

I suggested that she could start with small exposure, like sitting in the lounge with her fellow residence and going on group outings in the home as these were people she felt comfortable with as she knew them. This would then hopefully lead to Emily increasing her social functioning and enable her to attend church. Emily expressed that she felt more in control of her voices . My work with Emily was made easy as she agreed to work with me although l did face some reluctance initially. As my intervention and engagement with Emily started while she was on the ward this made it easier for me to engage her in the community.

We developed good rapport and she felt she could trust me, which made the process of engagement easier. Through my engagement and assessment process l improved on my questioning and listening skills. Emily was clearly delusional at times and working with the voices present proved a challenge at times, but l realised that l had to work collaboratively with her and gain her trust and not question her beliefs. At times though l felt l was interrogating her and did not follow a format and also because of the constraints on time l did not allow much time to recap and reflect and could never properly agree the time of next meeting.

I also worked at her existing strengths and coping strategies that she had adapted throughout her life and this empowered her and made her feel like she was contributing. At times though l felt we deviated from the set goals and l lost control of sessions. On reflection this is an area that l will need to develop and improve on and be able to deviate but bring back the focus to the agreed plan. My interventions were aimed at Emily’s voices and increasing her social functioning. This l discovered was my target areas and not necessarily Emily’s. n future l will aim at concentrating more on what the client perceives as their major problem as this will show client involvement in their care. This will also help me have a clear and rational judgement and appreciate every improvement the client makes no matter how small. I did not focus much on Emily’s family which l realised was a topic that she wanted to explore but l felt l was not equipped in exploring this part of her life in relation to her illness. The other difficulties l faced was because of my working pattern l had to cancel some of our meeting appointments.

As part of the set agenda l had to reintroduce myself and the plan and goals that we had set out in the initial stages and this always proved to bridge the gap. It was also difficult for continuity in the team that l work in as one did not carry a personal caseload so delivering interventions was not always easy and there was not always continuity as some of my colleagues were not familiar with some applications of PSI. This highlighted as a service that there was a need for us as nurses in the team to have PSI training in order to continue with the work if the main practitioner was away and also as a team we hardly ever sed assessment tools and were therefore not confident and competent in their use. l also had difficulties in completing assessment in time due to constricted time frames. l could not always spend as much time with Emily because l had other clients to see in a space of time. In future l will have to negotiate my time and improve on my time management. In this assignment l had to carry out a critical evaluation of the engagement and psychosocial assessment of a client living with psychosis and carry out a critical self reflection on the assessment process and how this could be improved on.

From my case study l deduced that use of some applications of PSI remains highly experimental and requires considerable research and more theoretical models. Furthermore discussion is also lacking on the details as to ways in which symptoms improved or social functioning enhanced in behavioural terms in relation to social context. However the interventions used in this case study highlighted considerable strength in supporting claims that PSI can work and does help reduce symptoms of psychosis.

References

1. Birchwood M and Tarrier N (eds) (1996) Psychological Management of Pschizophrenia.
2. Wiley Publishers Bradshaw T (1995) Psychological interventions with psychotic symptoms; a review. Mental Health Nursing. 15(4)
3. Birchwood, M, Smith, J, Cochrane, R, Wetton, S, Capestake, S (1990) The social functioning scale: development and validation of a scale of social adjustment for use in family interventions programmes with schizophrenia patients, British Journal of Psychiatry,157, 853-859
4. Chadwick, P, Birchwood, M, Trower ,P (1996) Cognitive Therapy for Delusions, voices and paranoia, Wiley & Sons.
5. Gamble,C, Brennan,G (2000) Working with serious mental illness:a manual for clinical practice
6. Grant, C, Mills, J, Mulhern, R, Short, N (2004) Cognitive Behavioural Therapy in Mental Health Care, Sage pub.
7. Greenberger,D, Padesky,C A(1995) Mind over mood: A Cognitive Therapy Treatment Manual for clients. Guilford Press.
8. Krawieka, M, Goldberg,D, Vughn,M (1977) A Standardised Psychiatric Assessment scale for rating chronic psychotic patients. Acta Psychiatrica Scandinavica 1977;55: 299-308.
9. Kingdom , D and Turkington,D (1994) Cognitive Behaviour Therapy of Schizophrenia.

The client is displays aggression to other people and serious violations of rules. She is also preoccupied with details and order. The most likely Psychiatric diagnosis with the given information is deferred (799. 9). Although the client displays symptoms that meet some of the criterion for obsessive compulsive disorder, as set by the DSM-IV-TR, there is insufficient information to make an appropriate diagnosis. The client also displays signs of obsessive-compulsive personality disorder, however more information is needed to make the diagnosis. The client’s behaviors are causing social and occupational impairments.

I would like to know the duration of the symptoms being displayed. I would also like to know the psychosocial history of the client, as well as the following information: developmental history, any history of trauma, and mental and medical health histories. In this case, this information is particularly significant because from the information given, one cannot determine if the aggressive behavior is associated with the preoccupation of being neat and orderly. It is possible that further information may suggest that this client may have a dual diagnosis.

Biological factors are likely to have influenced the predisposition, onset, course, and outcome of the diagnosed illness of the client. There is an interest in identifying brain areas that are involved in different disorders using imaging techniques like positron emission tomography (PET) and magnetic resonance imagery (MRI). Research also suggests that genes can play a role in the development of some disorders; specifically obsessive-compulsive disorder. Case 2 It appears that the client is experiencing non-bizarre delusions.

The most likely Psychiatric diagnosis is delusional disorder, of the unspecified type (297. 1). The symptoms do not meet the criteria for Schizophrenia. The diagnosis of the unspecified type is given because the symptoms do not meet the criterion for the other predominant delusional themes as specified by the DSM-IV-TR. The displayed behaviors of the client appear to be causing impairment in social and occupational functioning. There is also significant information that is necessary to determine if another diagnosis, such as Schizophrenia or personality disorder, is appropriate.

I would like to know the duration of the symptoms being displayed. I would also like to know the psychosocial background of the client, as well as the following information: developmental history, history of trauma, and mental and medical health histories. Specifically, has the client been previously diagnosed with Schizophrenia, and is he or has he ever suffered from a neurological disease. Biological factors are likely to have influenced the predisposition, onset, course, and outcome of the diagnosed illness of the client.

The delusions may be cause by a disease affecting the neurological system. The delusions may also be the client’s response to an experience of his environment or aspects of his nervous system. Bibliography American Psychiatric Association, Quick reference to the diagnostic criteria from DSM-IV-TR, American Psychiatric Association, Arlington, 2000. Kaplan, H. , Sadock, B. , and Sadock V. Kaplan and sadock’s synopsis of Psychiatry, 10th edn, Lippincott Williams & Wilkins, Philadelphia, 2007. Murphy, M. , Cowan, R. , Sederer, L. , Blueprints psychiatry, 3rd edn, Blackwell Publishing, Berlin, 2003.

The nine-page paper on parenting capabilities as compared among the Schizophrenic, depressed and well mothers are profoundly interesting and insightful. Central to the profession of Social work is the structural unit which essentially pertains to the family. The mother’s role is one of the most foundational ingredients that make up a home because the general expectation is that she takes on more of the nurturing role than any of the members of the family.

The article/research is said to be profoundly interesting because at the outset, despite some knowledge on depression or schizophrenia, the researches showed that there have been major areas that other studies missed especially pertaining on the parenting skills and practices when Schizophrenics or Clinically depressed mothers are the issue.

The paper opens with what has been very obvious in the study of schizophrenia; that genetics or heredity is the primary and important issue with the etiology of the disorder. However, the article is more than the previous discoveries on the influence of heredity. I wish to identify specifically what I find very important discoveries I made in the article.

A. Because the article is a comparison between Schizophrenic and depressed mothers many details about their respective kinds of personality, lifestyles or manner of living were investigated separately and comparatively. For instance, frequency of hospitalization is more noted with the Schizophrenic women than with depressed ones (p.34). This is noteworthy because this information indicates the severity (in graduated scale) of their respective disorders. Of course compared to well-mothers, depressed ones are at risk, indeed. Hospitalization frequency is indicative of mothers who may have already been in trouble in a period of time.

B. Pertaining to the depressed mothers’  “highly limited ability to demonstrate good parenting,” in that they are likely to have difficulty in providing structure and discipline to their children,  which are exactly the things necessary and essential to develop children as well-adjusted and smart members of society. For example, inside the household, how will the mother do the routines in the morning concerning food preparation, attending to basic hygiene and health of children or even, when they become rowdy and quarrelsome with one another, how will she react to these scenarios? Weisman’s study pointedly mentions the main reason: the mother does not have the energy and the ability to be involved to do even very simple routinary disciplinary actions.

C. Implications on these? It is necessary that mothers especially the Depressed for instance, must get the necessary help and that which must address the root cause or strike at the heart of their “mental/emotional” sickness. Being a social worker, I will be one of the few people who will be the first to call on these people: single parents who seemed to have no options except to prod through life and just keep on even though everything for them is hopeless and aimless. I can truly say I am thoroughly benefited by the readings. I am grateful too, because I have the opportunity to avoid the pitfalls that some of the women had gone through.

All this is insightful because I have discovered that although both types of disorders have affective deficits, the lesser affected are the depressed types because she may still be able to “connect” with her offsprings unlike the Schizophrenic when not only is the mother severely disordered, other complications like the presence of hallucinatory tendencies typical of their case cloud her relationships with her children (Goodman & Brumley, 1987). Implications for my job include:

1.  I know now how to deal with persons with various weaknesses especially those with problems as severe as Schizophrenia or even with mothers who have depressive problems; especially affective or relational deficits;
2.  I have more compassion now with mothers or single parents who are poor and especially colored because they have the least access to care and their needs are often neglected;
3.  the authors also discussed the other factors usually designated in cases of depression and schizophrenia and effectively pointed out that mother’s responsiveness account for most of the adjustment and proper functioning of children.

I cannot imagine enough those children (in the study) raised by single mothers with such a mental condition as theirs. My work’s significance has tremendously widened and deepened as I see all the individual cases and the problems that accompany them. The guidance I can afford their mothers pertaining to coping with their sicknesses and the needs of the children, and the institutional changes that can possibly help larger numbers are important outputs I gained from the informative article.

Reference

1. Goodman, Sherryl H., H. Elizabeth Brumley, 1987. “Schizophrenia and Depressed Mothers: Relational Deficits in Parenting.”

Outline and evaluate one or more biological explanations of schizophrenia (8 marks AO1/16 marks AO1) Schizophrenia is classified as a mental disorder that shows profound disruption of cognition and emotion which affects a person’s language, perception, thought and sense of self. The dopamine hypothesis states that schizophrenic’s neurones transmitting dopamine release the neurotransmitter too easily, leading to the characteristic symptoms of schizophrenia.

This hypothesis claims that schizophrenics have abnormally high amounts of D2 receptors; receptors that receive dopamine, therefore resulting in a higher amount of D2 receptors binding to the receptors causing more impulses. Dopamine neurotransmitters play a key role in guiding attention, so an imbalance of this neuron leads to problems relating to attention, perception and thought. Amphetamines are a dopamine agonist drug, which stimulates the neurons containing dopamine. According to the dopamine hypothesis, large doses of the drug lead to the characteristic schizophrenic symptoms, hallucinations and delusions.

The development and use of Antipsychotic drugs to treat schizophrenia support the dopamine hypothesis. The drugs work by blocking activity of dopamine and have been shown to alleviate symptoms of schizophrenia, such as hallucinations, delusions and thinking problems associated with the disorder. This is because by reducing dopamine activity helps to maintain a constant level in guiding attention, leading to a decrease in key schizophrenic symptoms of hallucinations and delusions because they can be caused by being overly attentive.

Statistics increase the reliability of the biological explanation of the dopamine hypothesis for explaining schizophrenia; as they show Antipsychotics have a 60% success rate. Therefore, this shows a link between high levels of dopamine activity and schizophrenia, as antipsychotics work by blocking the dopamine activity. This has led to more effective treatment, allowing those with schizophrenia to improve their quality of life, However, a meta-analysis investigation on post mortem studies on schizophrenics has produced contradicting evidence about the dopamine hypothesis.

The contradictive evidence by Haracz (1982) showed that those who died whilst on a course of the antipsychotic drugs actually had higher levels of dopamine activity than those not using the antipsychotic drugs. This occurs because the neurotransmitter builds up in the synapse of the neurone whilst the drug blocks to D2 receptors and as the drug wears off, more impulses are initiated by the neurotransmitters, causing the schizophrenic symptoms.

This means the dopamine hypothesis lack reliability in explaining schizophrenia because antipsychotics could be responsible for increasing dopamine activity and therefore actually increase the schizophrenic symptoms such as hallucinations and delusion, which decreases the schizophrenic’s quality of life as they live in a constant psychosis state where they have lost touch with reality. The development of neuroimaging techniques such as PET scans (a 3D image of the brain obtained by a nuclear machine) has led to supporting evidence for numerous explanations, yet has so far failed to provide evidence supporting the dopamine hypothesis.

This questions the reliability of the biological approaches claim that increased activity of the neurotransmitter dopamine as the neurologists have closely examined the brain and differences in dopamine activity in schizophrenics and healthy individuals. This lack of evidence means that treatments produced to help those with schizophrenia may not be successful in treating schizophrenia as there may be a possibility that the dopamine hypothesis is not accurate in explaining schizophrenia. The biological explanation of schizophrenia also claims that the disorder can be inherited.

The more common the disorder is among the biological relatives and the closer the degree of genetic relatedness increases the risk of the child developing schizophrenia. Gottesman’s research (1991) found a genetic link with schizophrenia when looking at children and their relatives. The research discovered that children with two schizophrenic parents have a concordance rate of 46% compared to children who just have one schizophrenic parent to children who have a concordance rate of 13% and siblings just 9%.

The genetic theory of schizophrenia also suggests that monozygotic twins (twins who a genetically identical) should have a higher concordance rate of schizophrenia than dizygotic twins (twins who are not genetically identical) because they have a closer degree of genetic relatedness. Adoption studies support the genetic theory that schizophrenia can be inherited as they provide evidence that the environment does not affect inheritance rate. The supporting study was carried out by Tienari in Finland. He investigated 164 adoptees that biological mothers have been diagnosed with schizophrenia and found 6. % also received a diagnosis, compared to 2% of the control group of adoptees. This means that that there is a genetic liability to schizophrenia, as more of with the biological mother having schizophrenia develop schizophrenia than the control group. As a result, this increases reliability of the biological approaches explanation to schizophrenia as it indicates genetic factors play a major role in the development of schizophrenia and environmental factors such as a different upbringing do not inhibit this.

However, Tienari’s research did not produce a statistic proving the majority of those who have biological mothers with schizophrenia developed the disorder later in life. The study showed only 6. 7% of the adopted children with a relative with schizophrenia developed the disorder, yet 93. 3% didn’t develop the disorder. This suggests that environmental factors also play a key role in causing schizophrenia – not just the genetic factors – which inclines a lack of internal validity to the biological explanation.

This means that the therapies based on the biological explanation of schizophrenia will not be effective as they do not consider all factors affecting the disorder, leading to those suffering with schizophrenia not able to improve their quality of life. Investigations on monozygotic and dizygotic twins also support the theory that genetic factors play an important role in schizophrenia. The study showed that there was a concordance rate of 40. 4% for monozygotic twins yet only 7. 4% concordance rate of dizygotic twins.

A concordance rate shows how many times both twins developed the disorder. These findings supports the genetic position because they show the monozygotic concordance rate, twin who are 100% genetic similar, to be far higher than dizygotic twins, who only have about a 50% genetic similarity. Therefore, this increases the reliability of the biological explanation of schizophrenia as it shows that the closer degree of genetic similarity there is, the increased likelihood of the relative developing the disorder. It can be argued that the biological explanation to schizophrenia is reductionist.

This is because it does not consider the environmental factors involves with developing schizophrenia, only what does on inside the brain. For example, the genetic theory states that schizophrenia is inherited, yet research only found a concordance rate of 40. 4% for monozygotic twins. If schizophrenia was caused 100% by inheritance and degree of genetic similarity, the concordance rate for monozygotic twins should be 100% as they are genetically identical. Thereby, this reduces the reliability of the biological explanation as it does not consider other factors affecting schizophrenia, such as the environmental factors.

We have no tradition of shamanism; modern day society is terrified of madness because the western mind is a house of cards, and the people who built that house of cards know that it is a house of cards. We have a great phobia about the mind and hesitate when first principles are questioned, Rarer than corpses are the untreated mad and this is because we cant come to terms with it.

As Terence McKenna says in a lecture on this subject: “a shaman is someone who swims in the same motion as a schizophrenic but the shaman has thousands and thousands of years of sanctioned technique and tradition to draw upon…” in a tribe if a child shows ‘schizophrenic’ tendencies they are immediately drawn away from society (but not rejected) and put under the care and tutelage of master shamans who will teach the child how to heal and enlighten the masses, in western society if someone is classified as a schizophrenic they are drawn out of society and told not necessarily verbally that they don’t fit in and are not of equal worth to the rest of society, they are locked up in asylums, equal to prisoners and numbed with drugs, this treatment makes schizophrenia incurable, Terence McKenna says in the same lecture “If you’ve ever bin in a mad house then you know that it is an environment calculated to make you crazy and keep you crazy…” . Culture is everywhere, it tells people what to do, what to believe and who they are. Culture embeds notions deeply inside people to the point where they are unaware of their presence these preconceived cultural notions dictate human life Culture determines who is going to be at the top of society and who is going to be at the bottom of society.

The building blocks that make up a culture in turn make up weather someone is a schizophrenic or a shaman, for instance the Yanomamo people who live in the Amazon rainforest are a shamanic community, and their cultural building blocks are vastly different to those of New York City and it is because of these cultural building blocks that there are shamans in the Yanomamo culture and no schizophrenics, just like there are schizophrenics in New York City (western culture) and no shamans. This is due to the different cultures attitudes towards god, humanity and the earth. If you took a newly born baby who had a genetic predisposition towards Schizophrenia and dropped him off in the Amazon Rainforest, he would surely become a shaman. If you took a newly born baby who is from a long line of shamans and dropped him off in New York

City, he would surely become a schizophrenic. Take away their culture and schizophrenics and shamans practically are one in the same. So far through researching the topic I have found that there is a startling resemblance between schizophrenic and shamanic tendencies. Both shamans and schizophrenics experience hallucinations and become very introverted and withdraw from ordinary realities. From the moment a person becomes schizophrenic or shamanic they are in a constant psychedelic state and perceive the world in a completely different way to normal people. What is different between schizophrenics and shamans is how that psychedelic potential manifests and conditions itself.

For a schizophrenic the conditioning takes place the moment he/she is born, the schizophrenic experiences and neutral stimulus, ordinary reality, this then elicits an unconditioned response, ordinary perception, but as the child grows up he/she is subjected to a new unconditioned stimulus, culture, when this new unconditioned stimulus is repetitively paired with the neutral stimulus, ordinary reality, Eventually the neutral stimulus, ordinary reality, becomes a conditioned stimulus and begins to elicit a conditioned response, non ordinary perception which in turn makes the schizophrenics perception psychedelic. In a sense, this psychedelic state of perception is permanent, for the schizophrenic is most likely always going to be a member of his original culture. Only through the external manipulation of the taking of antipsychotic drugs can the schizophrenic come out of the permanent psychedelic state that he/she is in. the shaman is conditioned in a similar way When a shaman is born, the Conditioning process takes place. A neutral stimulus, ordinary reality, elicits an unconditioned response, ordinary perception.

Eventually, when the shaman begins his rigorous training, he takes a powerful psychedelic, an unconditioned stimulus. This unconditioned stimulus, a powerful psychedelic, elicits an unconditioned response, non-ordinary perception. Eventually, The neutral stimulus, ordinary reality, becomes a conditioned stimulus and begins to elicit a conditioned response, non-ordinary perception . Thus, the shaman’s perception is made psychedelic. This psychedelic state is permanent, for a powerful psychological agent, such as a psychedelic substance, changes you forever. Counter-conditioning a psychedelic experience is extremely difficult. It may happen, however.

The sychedelic substance that the shaman takes reinforces his mind to perceive the Psychedelic and the culture that the schizophrenic grows up in reinforce his mind to perceive the psychedelic. If the shaman stopped taking his psychedelics, and if the schizophrenic started taking his anti-psychotics, then their state of mind would change, and this change is solely a somewhat controllable change. Therefore, the schizophrenic, like the shaman, takes a substance in order to transcend, and this substance is culture, a psychedelic. The shaman’s act of taking a psychedelic and the schizophrenic’s act of taking a psychedelic is a somewhat controllable act. Shamans and schizophrenics both experience religion .

Although schizophrenia is not seen as a religion unlike shamanism, many schizophrenics when experiencing delusions and hallucinations said is was a spiritual and religious experience which can be both positive and negative, sometimes their religious beliefs and faith can strengthen and comfort them, other schizophrenics can be rejected and contradicted by their faith because the delusions and hallucinations they have may challenge their beliefs, when this occurs schizophrenia itself sort of turns itself into a religion different from mainstream ones. Schizophrenics interpret a certain stimulus, the archetype of religion, in ways that don’t correspond with the accepted norm of their culture or rather the accepted religions of their culture. Shamans also interpret the archetype of religion but in ways that are accepted by their culture and religion. Shamans are accepted by their society where as schizophrenics are not.

A Beautiful Mind is a movie about John Forbes Nash Jr. who is notable for his contributions in Economics and Mathematics. It was evident in the film that he has an outstanding talent and showed it by performing at a remarkably high level of accomplishment. With a superior intelligence, I can say that Nash is truly a brilliant man.

Despite the fact he is a genius, everything still wasn’t perfect — he’s suffering from a mental illness called schizophrenia without his awareness. While he has a beyond average aptitude in logical and mathematical aspects, he had problems with his interpersonal relationships. This affliction slowly eats up his mind, destroying his bond with the people around him. With this illness, he wasn’t able to separate the imaginary world from the real world he is living in, with all the hallucinations and nonexistent friends he has.

I strongly believe that these delusions are from the feelings and memories he repressed in his subconscious that liberates in the form of imaginary friends and such. Lucky for him that he has understanding wife, because if it wasn’t for her love and support, he wouldn’t be able to get through one of the hardest trials in his life. Although she nearly lost her faith, Alicia didn’t give up the hope that Nash will someday overcome his disease. This quality of Alicia is something I admired: standing by and staying committed to the person she loves the most.

Granted all the struggles, Nash didn’t give up the passion to learn and share his learnings as well. He came out on top of this illness by declining therapy, living a normal life with Alicia and his child, and also by persisting in educating eager young minds.

After watching this film, I am in stack of awe with the way Nash conquered everything that stood in the way for achieving his dreams. I guess, the learning we can take from his story is that we should see our disabilities not as hindrances rather, as challenges to make us strive for more. There may be times that we trip a little, we may even fall, but we must stand up and continue walking towards fulfilling our goals.

Rosewood Movie Review

Rosewood A great story based on real example, which happened in small town of Florida. This movie was directed by John Singleton, and based from real incident, that took place in 1923 in Florida. It is a story about how middle class African-Americans were living and enjoying life, until an incident happens in town. A white female is accusing colored person in raping her. From this point main goal of three main characters is to save people from mob attack, and lynching of colored people.

This is a great example that we can relate to what he have learned in the class. As we know the main problem of this story is that a white female who had sexual intercourse with her lover, provoked him and he got in a fight with her. Leaving marks on her body and a clear mark on her face, witness of this event were colored people who were working outside and heard everything that was going on. Women was accusing that African-American men raped and beat her. She went outside screaming, and making a tragedy, hiding the truth.

This is a great example of what was happening in 19 century, where lynching escalated to a new whole level. According to Jessie Ames, lynching was happening 29% in the North and 71% in the South. And what is the worst that all this killing was happening because of the women that excuse what made in South. Even though that we are knowing according to Jessie Ames that 71% lynching in the South that was happening, this event was instigated against white male, not against female. That said that lynching were happening for no reason, and excuse for it was white women.

This move have related and showed us that no one was protected at that time. Living in this small town in Florida, having colored people everyone in middle class, leaving peacefully a knowing everyone. It still didn’t help to solve the problem. In the movie was one important scheme when sheriff of the town asked women, if she is sure that it was African-American person or not. It gives us a hint that sheriff does not belief what she is saying. Knowing that she is capable of not telling truth.

White people are getting mad and are crushing and killing African Americans, they re mad and are following each other, while sheriff was trying to make everything fair and find the one who is guilty. But everything collapsed and they started killing and hanging African Americans. The only person who tried to stop and save their lives was owner of the shop. He didn’t believed that someone couldn’t done this to her. And he was certainly sure that colored people couldn’t do that. He tried to save them from their death.

He and a new guy, who came in town, team up in order to save kids and women, which ended up being a successful plan. This movie is a great example of what and how was going during mob attacks and racist killings. It showed up that there was a fear of white people to have and realized that colored people are getting educated and are having a better life style. That they are gaining power little bit by little bit. And we could see how white people were scared when “Major” came in to town, and knowing that he is wealthy. This is a story how white folks were scared of colored people, and were doing everything they could

The Patriot Film Analysis

The Patriot is an American historical film starring Mel Gibson and directed by Roland Emmerich. It is set in South Carolina, one of the thirteen British colonies set in America. The film follows the story of a “Patriot” named Benjamin Martin. This character is a portrayal of American Revolution War hero Francis Marion. In the film Benjamin, is recognized as a war hero from the French and Indian War. However he has retired from a life of battle and is attempting to follow the virtues of pacifism, until his family becomes the target of war.

After the death of Benjamin’s son and capture of another, he is thrown back into the life he thought he has left behind. The rest of the film portrays the drama and action that leads up to the climactic battle depiction of Battle of Cowpens and the victory of South Carolina in the Siege of Yorktown. Although the story of Benjamin is compelling and inspirational, it is based off of inaccurate historical assumptions. The American Revolution portrayed in The Patriot was more about the war America wanted it be rather than what it was.

The film glorifies American victories as well as American war heroes, while portraying “the redcoats” as sadistic, brutal, and abominable creatures. A perfect example of such bias is the film’s antagonist, Colonel William Tavington, who is a fictional representation of General Sir Banastre Tarleton. The film uses misconception and inaccuracy to portray the victory of America over the British, as a representation of a sanctified glory of angels over demons.

The film starts with simple inaccuracies that can be excused, however these simple inaccuracies domino into great blunders that cannot be ignored: Some minor mistakes made by the film involve errors such as the materials used during the time period, do not actually belong to that time. For example in several action sequences of the film, weapons such as exploding projectiles or bombs are presented. Although canons were invented in this time period, none of the projectiles ever exploded (Canon link).

Another flaw involves a major societal misunderstanding, when Benjamin goes to war, he sends his children to a slave colony for shelter, for which the slaves are honoured. In the Colonial Era, slave colonies, like the ones portrayed in the film, were secluded and protective from the “White colonists”. Therefore it was highly unlikely that a character such as Benjamin would send his children to a slave colony, let alone being treated kindly for doing so. One of the major inaccuracies is the slave and owner relationship portrayed by the film.

For example during the colonists’ stand against the British Army the Continental Congress states an order. For any slave that serves “12 months” in the Colonial Army, will gain freedom and “5 schillings” per month served. When comparing this claim with other sources, it was discovered that no such claims were extended by the Continental Congress. Infact, The Patriot ignores slavery in total. Director Spike Lee was one of the many critics that were disappointed with the films inaccuracies. “For three hours The Patriot dodged around, skirted about or completely ignored slavery,” he wrote in a letter to The Hollywood Reporter. The Patriot is pure, blatant American Hollywood propaganda. A complete whitewashing of history. ”  The director of the film, Roland Emmerich, misguides his audience into thinking that the British troops are monsters sent from hell. The film portrays the character of William Tavington as a merciless villain who commits intolerable atrocities. For example, a scene in the film depicts the redcoats gathering the entire village including women, children and unarmed men.

They force all of them into a church for an interrogation about Benjamin, after which they lock the church from the outside and set the building on fire. Looking back into the American Revolution, such atrocities were never committed. Although the Sir Banastre Tarleton, portrayed by, William Tavington, is no saint, he wasn’t as evil as the film potrays him. A film critic and a historian, Stephen Hunter, told the Telegraph (magazine) that “Any image of the American Revolution which represents you Brits as Nazis and us as gentle folk is almost certainly wrong” (Cite this).

The German director relates the actions committed by the Nazis in World War II, to those of British in the film. Another major flaw of the film is the protagonist, Benjamin Martin. The movie depicts Benjamin as symbol of goodness, a beacon of hope and a human vessel for an angel. However the character Benjamin Martin tries to portray Francis “Swamp Fox” Marion, a militia leader during the Revolution, from South Carolina. According to The Guardian, there were records of Marion persecuting and killing many Cherokee Indians.

He hunted them as a source of entertainment and he raped many of his female slaves. However the movie simply depicts Benjamin Martin as the untainted hero. Finally the movie’s greatest flaw lies in its climatic battle, Battle of Cowpens. Where the tactics used by the militia were similar to that of the movie, however the results were nowhere in comparison of reality. During the Battle of Cowpens, militia was asked to play decoy. Although the film portrays General Nathanael Greene giving the orders, he was never present at this battle.

The militia charged the battle, and after firing two shots retreated back to the hill, where the British troops were overwhelmed by the American Army. However the film portrays the militia firing more than two rounds before retrieval. Lieutenant-General Charles, Lord Cornwallis, commands his men to fire at the crowd of both British and American soldiers as a last resort to defeat America. However in reality Cornwallis never took such actions against his soldiers.