on the existence of madness

Naturally, as they withdraw into themselves, their families, usually befuddled, afraid they may have done "something wrong," withdraw from their side of whatever rapport had existed. This awful description could go on ad infinitum, perhaps better, ad nauseum.

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Sadly, it is still fashionable to believe that mental illness, especially its most severe form, chronic schizophrenia, does not exist. We see this antitheory espoused in numerous ways. One can read, with vicarious relief, any number of personal accounts of voyages into schizophrenia, always with the traveler's safe return. Madness as sociological voyeurism. Again, one can study the budgets of state, city, and, especially, the Federal government and see that mental illness, since public monies no longer need be spent to assuage its ravages, certainly must have been cured, disproven, or at least disavowed. Madness as political orphan. Again, one sees a strange amalgamation of intellectuals, radicals, lawyers, and, yes, Thomas Szasz, attributing schizophrenia to society's misinterpretation of its misunderstood malefactors. Madness as social deviance. The schizophrenic is thus cajoled, berated, politicized, and denied funds for research, and more importantly, care, all in the name of social sanity, openness, and civil liberty. But there is always a bottom line in life. We don't have to pay it up, however. The schizophrenic pays it every day, every minute of his often psychically intolerable life. The symptoms are real for these sufferers. They begin, usually, during late adolescence with frighteningly strange perceptions. Faces randomly become larger or smaller, noises abound where no source exists, colors and shapes shift from illusion to hallucination with disorganizing ease. Still intrapsychically, delusions may grow on the fallow ground of fear and misunderstood behavior-God tells them to do this or that, the devil threatens them externally with self-destruction, or worse, permanent torment. No longer sure of where their own being begins or ends, they appear different to us; their life's mood becomes withdrawn, without emotion. They need something, someone, and, yet, they are frozen in a terrifying fear of human contact.

VOL. 3, NO. 4,1977


they go after we admit them to the hospital?" The numbers seem overwhelming. Then one remembers, ah yes, we have buses leaving almost every day of the week taking the most severely, chronically ill to the larger state hospitals... and then they are lost to us, only to be found 6 months hence, by another emergency room doc, to whom they garble nonsense about "the voices tellin' me, doc, terrible things.. .please doc, help m e . . . I can't stand it. . . . "

William J. Annitto, M.D. Resident in Psychiatry Bellevue Psychiatric Hospital New York, N. Y.

an invitation to readers Providing a forum for a lively exchange of ideas ranks high among the Schizophrenia Bulletin's objectives. In the section, At Issue, readers are asked to comment on specific controversial subjects that merit wide discussion. But remarks need not be confined to the issues we have identified. At Issue is open to any schizophrenia-related topic that needs airing. It is a place for readers to discuss articles that appear in the Bulletin or elsewhere in the professional literature, to report informally on experiences in the clinic, laboratory, or community, and to share ideas—including those that might seem to be radical notions. We welcome all comments.—The Editors. Send your remarks to:

At Issue Center for Studies of Schizophrenia National Institute of Mental Health Alcohol, Drug Abuse, and Mental Health Administration 5600 Fishers Lane Rockville, Md. 20857

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A lucky 30 to 50 percent escape with one, two, or three attacks. The other 50 percent, who remain schizophrenic, suffer an ignoble degeneration. Often the sufferer comes into intermittent contact with different doctors, psychologists, social workers, nurses, hospitals, community mental health centers, and state hospitals. Even with the major advances in psychopharmacology of the last 25 years, many end in a debilitated, mentally deteriorated condition. Whatever the end result, the path is never pleasant. It is paved with poverty and littered with broken promises. One does not have to travel far in New York City to see this mental illness. At the admitting office of the Bellevue Psychiatric Hospital, we see it hour after hour, day after day, until, even we wonder, "but where do

On the existence of madness.

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