Tuesday, January 19, 2016

Schizoaffective Disorder, Ethics, and Brian Wilson of the Beach Boys

Love and Mercy
We’re in Miami, FD has a cardiology conference. 
Miami Beach is nice but it's not 
Bermuda, Jamaica, gee I wanna take ya’ to Key Largo, Montego, honey why don't we go.  .   .  to the Kokomo
It gets in my head (you're it) and wanting to know where exactly Kokomo might be, a little research yields the following.  


So we’re not that far away. 

We saw the Brian Wilson- Beach Boys movie last week, Love and Mercy. If you haven't seen it, there will be spoilers. But most of today's story is from YouTube interviews and Rolling Stone.

There was a time when a certain brand of music summoned up barefoot on the beach, surfing, fast cars, and a paycheck lost to buying records at K-Mart; 45's or the long-playing 33’s. Some of us bought albums by the Beatles, but there was always a kid who loved the Beach Boys. Paul McCartney is quoted as saying that Pet Sounds, an innovative Beach Boy album, is his favorite of all time.* But the Beach Boys had so many hits.

Surfin', California Girls, Surfer Girl, Don't Worry Baby, Do You Wanna' Dance, Good Vibrations, Fun, Fun, Fun; God Only Knows, Caroline No; Help Me Rhonda, I Get Around, Wouldn't It Be Nice, Kokomo. To name a few.

Surfin' USA
And In My Room, a slow dance song that Brian Wilson, now 73, the primary writer, composer and musical director of the group, says expressed his inner feelings and thoughts. In My Room makes Brian's private world public, invites you inside, universalizes the need for safety. So many of us still do this, retreat to our rooms, or would if we had one, for personal space.

Mr. Wilson has an amazing recovery story, beginning with the decline to severe mental illness, a "nervous breakdown" in his twenties. He hears voices telling him he isn't as good as the public says he is, that he ruined the band; his orchestrations, far from brilliant. He rationalizes, in a psychotic but sensible way, that the voices aren't able to keep up with his success, that they are jealous, want him out of the way. It is likely they told him to self-harm.

After dropping out of sight in the seventies, a hermit due to mental illness and drug addiction, Mr. Wilson is in recovery by 1999, twenty years later, working again, producing records, even Smile, the long awaited unfinished album of 1965. "I'm anxious, depressed, I get scared a lot,"  he tells his fans. But he's out there, brilliant as ever.

In 2006 he tells a reporter that he still hears voices, every single day, that he has most of his life. A community of angry, critical people in his head.

His whole adult life he's been begging them to shut it up.

How does it present, an illness like this, Schizoaffective Disorder? There are two types, F25.0 bipolar, and F25.1 depressive. Voices in the head, delusions, can be features of either.

The DSM 5:
 In schizoaffective disorder, a mood episode and the active-phase symptoms of schizophrenia occur together and are preceded or are followed by at least 2 weeks of delusions or hallucinations without prominent mood symptoms.
According to Mr. Wilson the voices started soon after his first LSD trip as a very young star.

This changes everything, as far as diagnosis goes, foils schizoaffective as the obvious choice, because if you read the criterion, you find the all important D.
D. The disturbance is not attributable to the effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
Technically he couldn't have schizoaffective order because the effects of a substance triggered the illness. That being the case, the diagnosis has to be:
 Substance/Medication-Induced Psychotic Disorder (F16.959), without use
Without use means that he doesn't have to be using anymore to suffer the delusions, hear the voices of psychosis. He stops abusing drugs in treatment, but his disorder has its hold. Without use, still delusional, it is an F16.959.

Your mom was right when she said that drugs are dangerous. During the frolics of the sixties, the more anxious worried about friends who took LSD. We heard stories of people flying off rooftops. They needed designated watchers, really.

The most famous of the Beach Boys might not have suffered Schizoaffective Disorder, a combination of symptoms that present in both Major Affective Disorder and Schizophrenia. Had he not used LSD his bout with mental illness might have been much less horrific. But we really don't know.

And there is another theory, that children with a predisposition to major affective disorder or schizophrenia manifest their symptoms under stress. Brian undoubtedly had stress, beginning with a family group that depended upon him and a rabid desire to succeed, and a father who physically and mentally abused him, deliberately made him feel badly about himself, fed his self-doubt with critical, harsh words, and the fist. Wilson boxed Brian in the head, permanently knocked out the boy's hearing in one ear when Brian was little.

Murry is the voice behind the voices, cold and withholding, jealous, a spare the rod, spoil the child kind of father who strips a kid of his confidence.

The son still wants the father’s approval, plays down the abuse in interviews, although in the film it is the first thing he talks about with Melinda, the woman who tries to save him from an exploitative psychologist, Eugene Landy. He won't demonize Murry for traumatizing him, triggering his illness. He can't embarrass his father. It was the drugs, Brian insists.

He even credits his Murry with the success of the band. Murry is the one with connections, the one who arranges the initial recording contracts. When things sour financially and the band doesn't like his decisions, they fire him. Vengeful, he sells their songs for a fraction of their worth, keeps the whopping $700,000 for himself. Bermuda, Jamica, come on let me take ya'.

No picnic for our hero, the path to superstardom is disrupted, spotty, an illicit drug marathon. He hides in his room for two to three years (!), fears the shower (the shower-head is a spy), eats constantly (weighs over 300 pounds), and stays stoned 24-7. Tired of it, the family hires a psychologist to bring Brian back. 

Eugene Landy claims to have done it, but his methods? Full of textbook professional ethics violations. 

Landy marginalizes his patient, squirrels him away in a rented beach house, taking Brian’s home from him for himself, a house that is also on the beach. He renovates it on Brian’s nickel. We might call it messed up milieu therapy, Landy protecting the patient from family, denying all visitors. He snows Brian with psychotherapeutic drugs that he has no license to prescribe, and beats on him emotionally about his weight. All the while, Brian takes it on the chin, follows the doctor's orders, alternatively idolizes but fears him.

You don't have to be a professional to connect the dots when it comes to father figures.

The family has always known Brian to be fragile and afraid, but that the young man has plenty of confidence when the band is recording. He's on them for every sound, controls exactly what each musician plays, every note, each harmony. He arranges meetings in swimming pools, probably assuming that the voices can't spy on him there. Manic? Certainly, which is why the schizoaffective disorder, F25.0 bipolar is everyone’s first choice, as if it really matters, the diagnosis. 

But it does matter, at least for us mental health professionals. We have to get it right, think about what is really going on, assume nothing. If we think about the history we find that the triggers for schizoaffective disorder are rife in Brian’s world before the LSD.  
1.  He had a difficult young adulthood. Psychoses often present in the twenties or late teens
2.  He suffered extreme stress, had to produce the perfect record, face audiences of thousands.  
3. He surely suffered post traumatic stress, the negative, or “expressed emotion” inherent in child abuse. 
So maybe he had schizoaffective after all.

Looking back on how he cut off his wife Marilyn and his two daughters, Carlie and Wendy, in that stoned, depressed, psychotic two-year episode in his room, he regrets his decisions, his decent, especially listening to Eugene (Gene) Landy for prolonging the family abandonment another five years. He doesn't seem to care that Landy made millions off of him, but it infuriates the mental health community.  

See, most of us want a few well-off patients.  But we would never consider this kind of thing. 

Landy persuaded Brian (coerced, because Brian suffered a disorder) to become partners, a business collaboration, Brains and Genius (Brian and Gene). Landy takes half of Brian's earnings from investments contracts, books, and records in this great deal. If a sponsor gives Brian a sports car, Gene gets one. If Brian lands an upright piano in a deal, Gene gets a baby grand.

Sickening, taking advantage of a patient like that.

Marilyn Wilson ends the marriage, and his daughters grow up missing him, yearning for him. They team up with Chynna Phillips, daughter of John Phillips, another addicted, dysfunctional father (Mamas and the Papas). Wilson-Phillips will successfully produce and perform their own songs. You know the songs, they're that popular. Hold On, for example.

We want to give the father, the genius a big hug and say, It's not your fault.

As therapists, of course, we can’t hug him. We have our ethics and touching is touchy.  (See the new page on ethics on this blog).

Eugene Landy will lose his California license.

Later in life Brian will produce more records, and children all over the world will perform his songs in choirs. He and his wife Melinda establish a foundation for mental health awareness.

Watching the film isn't easy, but it is so well done. And hearing the rest of the story cleared my head, for I could hear Eugene Landy telling Brian Wilson, “They (his family) don't love you.  I do.“ This is what cult leaders tell their followers, young and old, who also pledge their allegiance and all of their money to an idealized father figure.

Ultimately Eugene Landy is listed as the sole beneficiary of Brian's will. You'll have to watch the movie to find out what happens with that, or read the biographies.  The Rolling Stone article is wonderful, too. 

Not surprisingly, Landy has other ethics violation accusations: one for rape, another for free-basing cocaine. We can diagnose him with an Antisocial Personality Disorder.

Because that's what he has.

therapydoc





*Brian refers to George Gershwin's Rhapsody in Blue, a masterpiece in his opinion, the great musical influence in his life. The seventeen minute composition is just shy of one side of a microgroove vinyl record album (bigger even than CD's) back in Wilson's day. Gershwin inspired Wilson, and Wilson inspired the Beatles.





 



5 comments:

Mound Builder said...

I thank you for posting this. I've only read it through once and would like to read it a couple of more times and follow some of the links, listen to the video. So far, I've only read your post. Oddly, I was talking to someone recently who wondered aloud of schizoaffective disorder was even a diagnosis anymore. Since neither of us are in the mental health field we certainly didn't know.

I can't say that I was a huge Beach Boys fan but do of course remember their music. I did not know all of that about Brian Wilson. Very interesting, and very sad.

I've always wondered about something you had touched on in what you've written and that is that yes, I do understand that people who suffer from depression or are bipolar or have schizophrenia, they have those conditions independent of how they were raised and so forth. And yet, it seems to me that there are triggering events for all of these things, events that would be difficult for anyone so that it's not as if someone has over-reacted to what's happened only that people inclined to suffer from these conditions are especially vulnerable to the events that affect them. This would imply to me that it is possible there are kinder and gentler lives intersecting with people who are vulnerable to depression, etc. but who may, possibly, be able cope a little better because the background out of which they've come was more fundamentally accepting? I'm ending that with a question mark because I don't know and am sort of asking, though you may not know, either.

The other thing it made me think about is those around someone who suffers from mental illness, of whatever sort...the children, the spouses/partners, parents, siblings, family in short... what is the proper role, (if proper is the right word to use) in terms of the family's support for a person with mental illness. On the one hand you've described how Brian Wilson abandoned his family, and on the other hand, there are family members who abandon someone like him. I don't at all mean to minimize the effect that mental illness can have and can be awfully hard to be around or to continue a relationship with someone who doesn't want it. But there are times that people have mental illnesses and try hard, work hard--medication and psychotherapy--working to overcome the things that have made it difficult to function, to have relationships, to stay in relationship... I wonder if there is a point at which not only has the patient gotten a lot healthier and stable but that the family would benefit from being compassionate, from recognizing the hard work and improvements, instead of permanently holding it agains their family member.

Sometimes it can seem, as an observer of several situations where mental illness may have had an impact on a family, that the person with the illness gets treated a bit like a prisoner who is tried and convicted, who has served a sentence, but can never be let out of jail by their own family, as if there is never a chance, even when making amends, to be allowed back into a normal life or normal relationships.

I may have other comments later, after re-reading. Thanks again for a very interesting and helpful post.

therapydoc said...

Thanks MB, Will respond next week!

Jordan said...

Thank you for sharing this. I do think it's incredibly important for successful famous people to talk about issues affecting them. It's always good to see all of the good Brian Wilson has done in the world of music even with the things he's had to struggle with.

rhysmills said...

A very interesting read. I will have to watch the film. Thanks therapydoc!

therapydoc said...

Regarding the kinder gentler families, mental illness is still an issue for the vulnerable because there is no protecting people from the stresses of life. (I think that's what you asked). But yes, it might be much less of an issue and the stigma associated would be dampened in a healthy family.

Regarding abandonment, Brian chose to cut off his family, but he also suffered mental illness, so his cut-off, abandoning his kids is more withdrawal and psychosis, not intentional. And that psychologist played a big part in the cut-off.

I've found that there's no holding adults prisoner, unless they are committed to an institution, and that's not an easy process.