Save the Mind Before It Goes to Pieces : Mental health: Medicine has liberated countless people from the nightmare of schizophrenia, but being ‘crazy’ still has a public stigma.

The following is by a writer who lives in the San Diego area. He wishes to be anonymous to spare his family public attention. I’m crazy. Not just a little wild and outlandish, though I am that, too, at times. I am clinically insane, and I’m a little irritated by casual metaphors like “You’re driving me crazy,” or, “I’m crazy about you.” Insanity isn’t fun and it isn’t romantic. Insanity isn’t pretty.

In my case, it has entailed a number of psychiatric hospitalizations, a humiliating experience for me and my family. I have also been homeless and I have been arrested because of my behavior while insane. My situation isn’t much different than that of numerous other people who have psychotic disorders. In fact, I am better off than many in that I respond well to psychiatric medications and can lead a relatively normal life.

The nature of insanity seems to be poorly understood by many people. It used to be that mental disorders were lumped into two categories, the neuroses and the psychoses. Neurotic people were said to be in touch with reality but unhappy. Psychotics had lost touch with reality. The old joke had it that psychotics thought 2+2=5; neurotics knew that 2+2=4, but they weren’t too happy about it.

While still essentially true, this taxonomy has been revised. Psychoses are generally considered to be the manifestations of biological disorders and frequently respond to medications. Neuroses have been redefined as problems in adjustment to living and are probably something else altogether.

I had originally been diagnosed with schizophrenia, a disorder more common than people think. It occurs in some degree in one of every 100 individuals, an estimated 2 million in the United States alone.

In addition to the various forms of schizophrenia, there are mood disorders or disorders of affect, all generally considered to be biological, diseases of the brain. It is likely that I am schizo-affective, a category between schizophrenia and affective disorders.

We live in an exciting time as far as the understanding of these diseases go. Dr. Nancy Andreasen, author of “The Broken Brain,” writes that we may be in an era for psychiatry analogous to what general medicine went through 40 or 50 years ago when insulin, pacemakers and other discoveries were made.

This is due to a number of factors, not the least of which is the new brain imaging technology that is being developed. It used to be that the only way to see inside the brain was to open the skull, usually after death. Now CAT scans, PET scans and nuclear magnetic resonance technologies allow us to see the functioning of the living brain.

Dr. E. Fuller Torrey, a psychiatrist with the National Institute of Mental Health and the author of “Surviving Schizophrenia,” says that there is presently a good deal of interest in psychiatric research. Many students entering medical school are itching to get on the trail of these debilitating disorders. What is needed is sufficient funding to finance such research.

Apart from the humanitarian benefits, if we can figure out how to prevent and treat psychiatric disorders, we will save a tremendous amount of money on hospitalizations, welfare and disability payments, and similar public expenditures.

A major handicap is lack of public support. The common view of insanity seems to be that it is a failure of will or a clever hoax to avoid responsibility. I’ve heard lawyers argue that allowing a plea of insanity only lets criminals off the hook. My own father insisted that I “straighten out” and come out of the uncontrollable delusions I was experiencing.

It is, of course, counterproductive to expect the victims of debilitating and sometimes very frightening diseases to take responsibility for what they are experiencing. I have exerted tremendous effort to overcome my disorder. During the 1970s, when it was in vogue, I tried megavitamin therapy. The result was an acute psychotic break and 5 1/2 months in a state psychiatric hospital. In the early 1980s, I went into a radically oriented therapeutic community that didn’t believe in the use of antipsychotic medications. While in treatment there, and off medication, I became delusional; thinking I was working for the CIA, I took a BB gun into a restaurant. I was arrested, found not guilty by reason of insanity and sent to a state hospital for the criminally insane for two years.

Because of my psychiatric record and my arrest, I am not allowed to teach in a public school in the state of California, a career I had been preparing for over a number of years.

Despite all this, I know that I am lucky. I could have been less responsive to the medications I take and could have been seriously impaired for the rest of my life. And I know that I could have been killed when I took the BB gun into the restaurant.

I’m glad to live in an age when a solid understanding of insanity is being developed. It is enlightened and compassionate to treat the mentally ill as the victims of disease, which they are. It is not only enlightened and compassionate but also economical to spend money on research into mental illness. As a mentally ill person, and on behalf of other mentally ill individuals, I ask that Americans begin doing both.