The Psychotic Spectrum

“Psychotic” is a term that gets tossed around a lot in American culture.

To start, psychosis represents a spectrum of disorders with many different origins. People are most familiar with the term schizophrenia, but schizophrenia is probably going to turn out to be an umbrella diagnosis for many different conditions. People can be psychotic for all kinds of reasons, in the wake of substance abuse — with hallucinogens, for example— or because of schizophrenia. People who are bipolar can become psychotic, and so can people with various degenerative disorders. The interaction between biological and genetic vulnerabilities with family and cultural factors is known to be complex.

What are the chief symptoms?

The symptoms most people are familiar with are what we call positive symptoms: hallucinations, delusions, paranoid beliefs, unusual behavioral or mood manifestations. Those are often treated acutely with medications and patients respond well to that.

Once the positive symptoms have been treated, people can enter what’s called the negative phase of a psychotic disorder: lack of motivation, lack of direction, flatness. There’s a quality of just being slowed down, and a withdrawal or social isolation. This can be debilitating. It is also much harder to identify and treat. Everyone is familiar with the worst-case psychotic disorder, which is the disheveled person in the street who makes everyone anxious. That’s the more obvious, positive symptom.

People in the negative phase don’t look so disorganized because they’re not having hallucinations or delusions, but they can be very isolated and shut down. They often don’t really know what they want to do. They may feel lost and ashamed. They’ve gotten help from medication, but they have a whole other road ahead of them. How are they going to pick up the pieces of their lives, go on and adapt?

One feature of these disorders is tremendous denial that a person is troubled, or needs treatment. It can be very hard to treat someone who other people think is impaired when that person doesn’t think so. Typically, you see problems with family members, problems in employment. These individuals see themselves in the world quite differently, and often aren’t interested in receiving any treatment. This creates a lot of frustration in attempting to offer help.

Sources: Austen Riggs Center

Cure for Hysteria of Antiquity

In antiquity, women who had anxiety, mood swings and depression were sent by their husbands to the doctor, who diagnosed them with a disease called ′′hysteria.” Their treatment was based on a ′′pelvic massage” with the purpose of achieving hysterical paroxysm, now known as orgasm.

There were so many women who began to attend consultations to have their ′′treatment for hysteria′′ that doctors at the end of the workday were exhausted and their hands were shaky; that’s why they decided to invent a useful device that produced rhythmic vibrations and that hysterical paroxysm was achieved easier and faster in the patient without the need for the common manual massage: this is the origin of the vibrator. At that time it was seen as a healing artifact, even the wealthiest women had them in their homes for when they felt ′′bouts of hysteria.”

A Few Facts About Schizophrenia

~ It is estimated approximately 50% of patients with schizophrenia do not take their prescribed medications as directed. The most common reason is anosognosia, meaning they are unaware of their condition.

~ Lack of treatment leads to severe negative health outcomes, including a life expectancy shortened by an average of 28.5 years. 

~ Approximately half of individuals with schizophrenia have co-occurring mental or behavioral health disorders.

~ Co-occurring medical conditions such as heart disease, liver disease, and diabetes contribute to the higher premature mortality rate among individuals with schizophrenia.

~ Following illness onset, 25-50% of those living with schizophrenia attempt suicide.

~ At least 50% of people with severe psychiatric illnesses like schizophrenia smoke, compared to 23% of the general population. 

~ Smoking-related illnesses cause half of all deaths among people with psychiatric disorders. 

~ Those diagnosed with schizophrenia smoke more than half of all cigarettes produced in the United States, and they are only half as likely as other smokers to quit.

Types of Delusions

1) Collapse delusion: A transient condition that occurs frequently in acute illnesses, coinciding with the cessation of febrile states; 

2) Reference delusion: The patient attributes a special meaning to objects, events or people close to him; 

3) Touch delusion: It consists in the excessive mania of touching certain objects; 

4) Nihilistic delusion: It is found in melancholic depressions, and is made up of an incoherent mass of negative ideas; 

5) Oneiric delusion: It consists in a disturbance of the conscience that leads to emotions similar to those present in the oneiric phase (the conscience of the disturbed person enters a phase such that it is unable to distinguish reality from the oneiric profile of itself); 

6) Professional or occupational delusion: It consists in recreating, on the patient’s part, the usual conditions and places of work; 

7) Residual delusion: Represented by the persistence of delusional representations at the level of thought, even after the perturbation has ceased; 

8) Interpretative delusion: The subject interprets random facts as facts linked to him, feeling that he is the main actor or feeling indicated as a party in the case; 

9) Persecution delusion: The patient believes he is the object of persecution (a situation often identified also with the term paranoia); 

10) Bizarre delusion: The patient adheres to a system of totally implausible beliefs (in the culture of reference); 

11) Control delusion: The patient is convinced that his thoughts or emotions are under the control of some external force; 

12) Insertion delusion: Similar to the previous one; the patient is convinced that some of his thoughts are imposed on him by an external force; 

13) Erotomanic delusion: The patient is convinced that a certain person (often a celebrity) is secretly in love with him; 

14) Jealousy delusion: The patient has the unfounded and obsessive belief that he is betrayed by his partner. Among delusions, it is the most frequent; 

15) Delusion of grandeur (megalomania): The patient has the conviction that he is extremely important, for example, that he has been chosen by God to carry out a mission of fundamental importance, or that he is the only holder of extraordinary knowledge or powers; 

16) Somatic delusion: The patient is convinced that his body has something unusual, such as a rare disease, some kind of parasite or an unpleasant smell; 

17) Religious delusion: The patient is convinced that religious forces (almost always belonging to his own religion) protect him from misfortune, or from a disease (real and existing); 

18) Identity delusion: He who is affected believes he is another person, often important people such as Kings, Princes or Presidents.

Appian Way

Begun in 312 BC, the Appian Way is perhaps the most famous Roman road of all. It was wide enough for two carts to pass in opposite directions or for five soldiers to march side by side. Building the Appian Way was a massive undertaking, but the excellent craftsmanship of the road was apparent for centuries.

Ancient Rome was famous for many things, many of them big and flashy. Gladiators, triumphs, and emperors often spring to mind, but perhaps Rome’s most enduring contribution to history is more humble: their roads (which all led back to Rome), a vast, interconnected network spanning as many as 322.000 km at its maximum.

What is Dopamine?

Dopamine is a type of neurotransmitter. Neurotransmitters are brain chemical messengers that help your nerve cells communicate with one another.

Different neurotransmitters attach (bind) to different receptors on nerve cells. When a neurotransmitter binds to the right receptor on a nerve cell, it triggers that cell to take a specific action. Think of it like a key in a lock. 

Different neurotransmitters are associated with many physical and psychological processes in the body. For example, dopamine is involved in things like:

  • motivation and reward
  • movement
  • mood
  • attention, learning, and memory
  • sleep and dreaming

Neurotransmitters travel along neuronal pathways, which are basically long chains of nerve cells (neurons) that help different parts of the brain talk with one another. 

Some pathways that appear to be associated with schizophrenia symptoms have been identified. These pathways use dopamine as their primary messenger, and include the mesolimbic pathway and the mesocortical pathway.

What is Complex PTSD?

Complex post-traumatic stress disorder (sometimes called complex PTSD or c-PTSD), is an anxiety condition that involves many of the same symptoms of PTSD along with other symptoms.

First recognized as a condition that affects war veterans, post-traumatic stress disorder (PTSD) can be caused by any number of traumatic events, such as a car accident, natural disaster, near-death experience, or other isolated acts of violence or abuse. 

When the underlying trauma is repeated and ongoing, however, some mental health professionals make a distinction between PTSD and its more intense sibling, complex PTSD (C-PTSD).

Complex PTSD has gained attention in the years since it was first described in the late 1980s. However, it is important to note that it is not recognized as a distinct condition in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the tool that mental health professionals use to diagnose mental health conditions.

Both PTSD and C-PTSD result from the experience of something deeply traumatic and can cause flashbacks, nightmares, and insomnia. Both conditions can also make you feel intensely afraid and unsafe even though the danger has passed. However, despite these similarities, there are characteristics that differentiate C-PTSD from PTSD according to some experts.

The main difference between the two disorders is the frequency of the trauma. While PTSD is caused by a single traumatic event, C-PTSD is caused by long-lasting trauma that continues or repeats for months, even years (commonly referred to as “complex trauma”).

Unlike PTSD, which can develop regardless of what age you are when the trauma occurred, C-PTSD is typically the result of childhood trauma.

When it comes to Complex PTSD, the harmful effects of oppression and racism can add layers to complex trauma experienced by individuals. This is further compounded if the justice system is involved.

The psychological and developmental impacts of complex trauma early in life are often more severe than a single traumatic experience—so different, in fact, that many experts believe that the PTSD diagnostic criteria don’t adequately describe the wide-ranging, long-lasting consequences of C-PTSD.

Symptoms of Complex PTSD:

In addition to all of the core symptoms of PTSD—re-experiencing, avoidance, and hyperarousal—C-PTSD symptoms generally also include:

  • Difficulty controlling emotions. It’s common for someone suffering from C-PTSD to lose control over their emotions, which can manifest as explosive anger, persistent sadness, depression, and suicidal thoughts.4
  • Negative self-view. C-PTSD can cause a person to view themselves in a negative light. They may feel helpless, guilty, or ashamed.5They often have a sense of being completely different from other people.
  • Difficulty with relationships. Relationships may suffer due to difficulties trusting others and a negative self-view.6 A person with C-PTSD may avoid relationships or develop unhealthy relationships because that is what they knew in the past.
  • Detachment from the trauma. A person may disconnect from themselves (depersonalization) and the world around them (derealisation). Some people might even forget their trauma.
  • Loss of a system of meanings. This can include losing one’s core beliefs, values, religious faith, or hope in the world and other people.

All of these symptoms can be life-altering and cause significant impairment in personal, family, social, educational, occupational, or other important areas of life.

Einstein Lectures at Lincoln University

In 1946, the Nobel Prize-winning physicist traveled to Lincoln University in Pennsylvania, the alma mater of Langston Hughes and Thurgood Marshall and the first school in America to grant college degrees to blacks. At Lincoln, Einstein gave a speech in which he called racism “a disease of white people,” and added, “I do not intend to be quiet about it.” He also received an honorary degree and gave a lecture on relativity to Lincoln students.

The reason Einstein’s visit to Lincoln is not better known is that it was virtually ignored by the mainstream press, which regularly covered Einstein’s speeches and activities. (Only the black press gave extensive coverage to the event.) Nor is there mention of the Lincoln visit in any of the major Einstein biographies or archives.

In fact, many significant details are missing from the numerous studies of Einstein’s life and work, most of them having to do with Einstein’s opposition to racism and his relationships with African Americans.]

Atypical vs. Typical Antipsychotics

Atypical antipsychotics are also called second-generation antipsychotics (SGAs). They’re a newer class of medications that work differently in your body than previous (first-generation or typical) antipsychotics. Both help to regulate neurotransmitters, chemicals in your body that allow neurons to signal to each other.

Studies have found that the brains of people with schizophrenia are more sensitive to the neurotransmitters dopamine, serotonin, and glutamate. High or low dopamine levels can lead to hallucinations and disordered thinking.

While typical antipsychotics (FGAs) block dopamine in the brain, SGAs block both dopamine and serotonin. This results in some key differences.

The most significant difference is that SGAs are less likely to cause extrapyramidal symptoms. These are movement disorders that are common and serious side effects of FGAs. Some of these side effects can become permanent.

Both types of antipsychotics work to treat positive symptoms of schizophrenia, such as hallucinations and delusions. But SGAs may also help treat negative symptoms, like decreased pleasure or lack of motivation.

Common Atypical Antipsychotics taken:

  • Aripiprazole (Abilify) can be prescribed for adults and adolescents ages 13 and up. You can take it as an injectable solution available through a healthcare professional, or in one of four oral forms:
    • tablet
    • oral solution
    • Abilify Discmelt, an orally disintegrating tablet
    • Abilify MyCite, a tablet with a patch sensor that lets your doctor know you’ve taken the drug
  • Aripiprazole lauroxil (Aristada) is a prodrug, which means it’s inactive until a chemical reaction in your body changes it into aripiprazole. It also requires a medical professional to administer an injection.
  • Asenapine maleate (Saphris) is unique in that it’s available as both a tablet and a patch. Studies show that it’s particularly good at preventing relapse. The FDA has approved its use for children older than 10 to treat bipolar disorder, but not schizophreniaTrusted Source.
  • Brexipiprazole (Rexulti) treats schizophrenia and depression. Doctors usually prescribe it as a once-daily tablet. A generic form is not yet available.
  • Cariprazine (Vraylar) is FDA-approved to treat schizophrenia and bipolar I disorder. It can take a long time to build up in your body and to leave your system. If you stop taking it, you might still feel its effects for up to 4 weeks.
  • Clozapine (Clozaril) is the oldest SGA and remains the “gold standard” for those with treatment-resistant schizophrenia. The FDA has approved its use for reducing suicidal behavior in people with schizophrenia. It’s available as a tablet, an orally disintegrating tablet (Fazaclo), and an oral suspension (Versacloz). Clozapine is not FDA-approved to treat schizophrenia in children or adolescents, but some doctors prescribe it off-label.
  • Iloperidone (Fanapt) is a twice-daily tablet that can treat both positive and negative symptoms of schizophrenia. It can cause serious problems, such as stroke or even death, in older adults with dementia.
  • Lumateperone (Caplyta) is approved to treat schizophrenia and depressive episodes of bipolar disorder. It can increase suicidal thoughts in adults ages 18-24. The FDA has not approved it for pediatric use.
  • Lurasidone (Latuda) is a once-daily tablet that doctors can prescribe for people ages 13 and older. A 2020 study found that lurasidone continued to reduce schizophrenia symptoms in adolescents for the full 2 years of the study.
  • Olanzapine (Zyprexa) is another drug used to treat schizophrenia or bipolar I disorder. It’s available as a tablet, orally disintegrating tablet, or long-acting injectable administered by a healthcare professional. This is one of the atypical antipsychotics that the FDA has approved for adolescents. It can cause serious side effects, such as drug reaction with eosinophilia and systemic symptoms (DRESS).
  • Paliperidone (Invega) is derived from a different drug, risperidone. It comes in different forms, including extended-release tablets and long-acting injectables with different brand names. Paliperidone is approved to treat schizophrenia in children ages 12 and older, but it could have broader potential.
  • Quetiapine (Seroquel) is available in an immediate-release tablet that you take two or three times a day, or an extended-release tablet that you take once daily. It’s the least likelyTrusted Source of the SGAs to cause extrapyramidal symptoms. It’s also FDA-approved for treating schizophrenia in adolescents.
  • Risperidone (Risperdal, Perseris) is one of the earliest SGAs and is the most commonly used SGA among children. Doctors prescribe it for children as young as 5 years to treat irritability associated with autism, but it’s only approved for treating schizophrenia in children 13 years and older. It comes in four forms:
    • regular tablet
    • orally disintegrating tablet
    • oral solution
    • injectable administered by a healthcare professional
  • Ziprasidone (Geodon) is available as a twice-daily capsule, or you can have a healthcare professional give you an immediate-release injection.

Side Effects of Antipsychotics:

All atypicals carry a risk of mild to severe side effects. These side effects differ from person to person and drug to drug.

Some common side effects include:

  • sedation
  • dizziness
  • low blood pressure when standing up (orthostatic hypotension)
  • significant weight gain
  • metabolic syndrome
  • diabetes
  • hypertension
  • abnormal cholesterol
  • heart disease
  • complications in the third trimester of pregnancy
  • suicidal thoughts and behaviors

With some SGAs, extrapyramidal symptoms may still occur, especially at high doses.

It’s important that you take care of your physical health while using antipsychotics. SGAs can cause you to gain weight or worsen overweight or obesity if you already have it, leading to other chronic conditions.

You may also become resistant to your medication, so it’s important to stay in touch with your healthcare team and keep them updated if your medicine stops working.

Finally, be sure to continue your medication, even if you feel better. Suddenly stopping the medication can cause problems and may increase your risk of a relapse of symptoms.

Tributes to Thich Nhat Hanh

In his peaceful opposition to the Vietnam war, his support for Martin Luther King and most of all his dedication to sharing with others not only how mindfulness and compassion contribute to inner peace, but also how individuals cultivating peace of mind contributes to genuine world peace, the Venerable lived a truly meaningful life.

~His Holiness the 14th Dalai Lama

The government hopes that the Plum Village community will continue the Zen master’s vision and aspiration for engaged Buddhism, and so contribute to the prosperity of society, and, together with the wider Buddhist community in Vietnam and abroad, promote peace in the world.

~ President Nguyen Xuan Phuc and Prime Minister Pham Minh Chinh of Vietnam

Thich Nhat Hanh is respected by many as the most influential spiritual leader. He showed his love for humankind through his actions. His teachings on happiness touched many hearts. His footsteps and words will continue to live on through the practices of the people.

~ Moon Jae-in, President of South Korea

Thich Nhat Hanh’s legacy is one of insight, compassion, and respect for our planet and for one another. His memory and teachings will continue to inspire the next generation of environmental and social activists in the enduring struggle to protect the Earth and its people

~ Al Gore, Former Vice President of the United States

Thich Nhat Hanh influenced me and so many others by blending his unique approach to mindfulness with a fierce commitment to social justice. When I invited him to visit the World Bank, he touched the lives of hundreds of staff members and even led them on a walking meditation through the busy streets of downtown Washington, DC.  He will be deeply missed but his legacy will live on through his many disciples in all corners of the world.

~ Jim Yong Kim, Former President of the World Bank

Thich Nhat Hanh was a lifelong peace advocate who taught that polarization can be overcome as we nurture tolerance, inclusiveness, and the understanding of our deep interconnection with all human beings.

~ Antonio Guterres, Secretary General of the United Nations

Thay taught me that being a social activist is not separate from being a contemplative. Thanks to him, untold numbers of us opened our lives to the path of socially engaged Buddhism.

~ Roshi Joan Halifax, Abbot of the Upaya Institute and Zen Center

Having Thay as a brother and friend, was one of the greatest gifts in my life. At this time of grieving, I’d like to stretch out my hand to countless others who feel empty-handed at his passing and say: Let’s honor his legacy of Interbeing by joining hands worldwide, ready to carry on with renewed dedication to Thay’s work of peacemaking.

~ David Steindl-Rast, Catholic Benedictine monk, author, and lecturer

Thich Nhat Hanh… exemplified simplicity and humility.

He was one of the first people who helped me grapple with what mindfulness really meant. Many teachers try to focus on letting go of the mind. That’s such a daunting concept. But he emphasized mind-full-ness. These teachings had so many simple yet profound implications. They weren’t highly philosophical or abstract — rather grounded in reality. 

~ Father Richard Rohr – Franciscan friar, teacher, author and founder of the Center for Action and Contemplation

From Thay (“teacher,” in Vietnamese) I learned much but perhaps the most important was the skill of deep listening as an avenue to conflict resolution, helping to melt away countless political barriers in the negotiations. His insights and practices helped to open a new fertile space of collaboration through which governments were able to come to the historic agreement.

~ Christiana Figueres, former Executive Secretary of the United Nations Convention on Climate Change and a student of Thich Nhat Hanh

The most venerable Thich Nhat Hanh was one of the most respected moral and spiritual figures of our times. Not only was he one of the most articulate and inspiring proponents of Buddhist teachings and practice, but he was also a beacon of truth in his nonviolent campaigning for human rights.

~ Matthieu Ricard, Buddhist monk and author

Thich Nhat Hanh had a dramatic influence on me. He once asked me, ‘What is more important, being successful or being happy?’ I thought ‘both!’ But he said, ‘You have to choose—you can be a victim of your success but you can never be a victim of your happiness.’

~ Marc Benioff, Salesforce CEO

Thich Nhat Hanh’s teachings and practices transformed my life. Millions of people have been touched by his wisdom. Mindfulness is more powerful than nuclear energy.

~ Alejandro González Iñárritu, Academy Award-winning director

Thich Nhat Hanh was the most influential Buddhist teacher of the past fifty years. In addition to promoting mindfulness, his ability to present Buddhist insights and practices in clear, accessible, and heartfelt language greatly increased the number of people exposed to Buddhism. Thich Nhat Hanh’s legacy will continue to shape Buddhism’s present and future.

~ Jeff Wilson, Professor of Religious Studies and East Asian Studies, Renison University College, and author of Mindful America: The Mutual Transformation of Buddhist Meditation and American Culture