Diving & Mental Illnesses

[DocVikingo]

You're a good sport, Bus.

Regards,

Doc

 

[Web Monkey]

Good point, I should have been clear as to how any feedback would be used. Currently this is only in the viability stages. So any medical clearance etc would be coming from both her Doctor and her Psychologist (or suitable local specialists etc).

I would suspect that neither of her docs has a clue how SCUBA would effect her with or without meds.

You might want to call DAN to check on the meds, and possibly get a referral to someone your friend has no history with who might be able to give a reasonable answer.

Terry

 

[mikeguerrero]

Schizophrenia,

Is a degenerative illness that seldom if never gets better with time. Meds and psychotherapy are critical for the patient to recover from psychotic espisodes. The illness manifests itself in the brain so it's creating a serious abnormality in brain activity primarily between neurons. If at the synaptic gap, a neurotransmitter doesn't make a connection with the receptor sites you have the possibility of two things happening. The neighboring neuron will either begin firing as called excititory or not fire inhibitory.

This is what can place the patient at risk of depression or mania. Now, like mentioned earlier if meds are not studied on patients at two or three atmospheres of pressure the risk is on the diver. Because the neurons are are at the molecular level at the brain this makes any slight miscalculation on the diver at a risk of dcs entering and altering drug chemistry, small possibility.

More research has to be down to allow patients a benchmark of the risks of diving with mental illness. I am not a medical doctor but I am a college instructor with an MA in Psychology. That being said, I would like to see research open up a separate dive speciality for mental patients that would first allow them to try scuba in the safety of a pool with qualified instructors with said license.

Because SSI has so many specialites they could look at fulfilling another; yes it's a high risk but just like the license that exist already the mental license could be geared to only allow divers with mental illness to dive to just above 33 feet, most corals in temperate waters are best viewed at this depth for color and acuity. This would allow your friend to appreciate the world of scuba without the ATM 2 of inherent dangers.

Remember also that someone that cares for her as much as you could be her champion dive buddy for said dives in a pool and then later open water if research gets us there. The power of therapy via friendship is equal to if not stronger than medications. She stands a strong chance of seeing the underwater world with a friend like you.

best regards,

MG

 

[DocVikingo]

Hi mikeguerrero,

As a doctor with knowledge of both diving medicine and psychiatry, some of what you have said seems problematic. For example:

1. Schizophrenia "Is a degenerative illness that seldom if never (sic; ever?) gets better with time."

It is typical for "positive" symptoms of schizophrenia (e.g., hallucinations, delusions) to somewhat subside with time, while "negative" symptoms (e.g., amotivation, social withdrawal) become more prominent. Some persons may view this as an improvement.

2. "If at the synaptic gap, a neurotransmitter doesn't make a connection with the receptor sites you have the possibility of two things happening. The neighboring neuron will either begin firing as called excitatory or not fire inhibitory (sic)."

I have little idea what this sentence is meant to convey because it is so poorly written.

However, the statement, "The neighboring neuron will either begin firing as called excitatory or not fire inhibitory," appears erroneous. Cortical neurons are either excitatory or inhibitory and each is only one or the other. Also, both "fire" to produce their intended effect.

3. "Because the neurons are are at the molecular level at the brain this makes any slight miscalculation on the diver at a risk of dcs entering and altering drug chemistry, small possibility (sic)."

I have little idea what this sentence is meant to convey because it is so poorly written.

However, the statement, "neurons are are at the molecular level," is clearly erroneous. Neurons are cells and therefore are at the anatomical, not molecular, level.

4. "The power of therapy via friendship is equal to if not stronger than medications."

There simply is no body of scientific evidence that supports such a contention. Medications consistently have been demonstrated to be far superior to psychotherapy or friendship in controlling schizophrenia.

5. "Because SSI has so many specialites they could look at fulfilling another; yes it's a high risk but just like the license that exist already the mental license could be geared to only allow divers with mental illness to dive to just above 33 feet."

What is the significance of 33' as regards diving with a mental disorder? Is there any science supporting the safety of this depth for the psychiatrically impaired diver?

Regards,

DocVikingo

 

[Mr.X]

This has been a most interesting thread. I'm learning a lot from Doc. and all the other posters.

As an instructor I have had interesting psychological and physiological cases come my way. I've had moderate to severe bipolar students (cleared by their non-diving doctors to dive) and some with clear* psychological issues also cleared to dive.

* I am not a healthcare professional, but my intuition told me they would be challenging and possibly a risk to themselves based on my gut feelings and instances of not answering direct questions, being manipulative, or undetermined behavioral changes during lecture and training sessions. Mood swings being the clearest indicator. Typically, the mood swing would exacerbate psychomotor performance UW.

From an instructional perspective I always had to keep an extra eye on these students as I could never quite gauge where they were psychologically, or physiologically at any one point. In other words, I was always in close proximity to these divers during a training dive. If anything, I found every instance to be a one-of-a-kind situation and that patience from a buddy was most helpful. Often times, they were not certified as they just weren't able to quite get over the hump of being a diver who could at any point in time be able to make decisions that would keep them out of trouble. They typically understood this when counseled.

I do hope your friend gets cleared to experience some aspect of the UW world.

Cheers,

X

 

[Y Y Y]

How do you handle it when it is the instructor with the mental disorder? Should the instructor have to disclose to potential students that they are being treated? Or that they have stopped treatment without the consent of the doctor? Does the certifying agency has a way to monitor the mental health of instructors which are being treated and if they are staying on treatment?

 

[shakeybrainsurgeon]

I doubt that diving has any direct biological effect on mental illness or the drugs used to control such illness; psychiatric drugs usually have long half-lives so they are not likely to wear off abruptly like antihistamines.

The question posed here, though, is one with broad social consequences; the answer relies so heavily on how severe the illness is, how controlled it is, what type it is, that no serious answer to it can be given in any broad terms.

One might as easily ask: would you let a schizophrenic babysit your kids? The answer could range from 'certainly' to 'are you kidding?' depending on the degree of control that has been established.

I am a little concerned that the patient here feels that interacting with the therapist is a painful experience akin to prostate exams. That is not a good sign. Such "private" patients may not like to admit that they aren't taking their meds or ar hearing the voices again, feeling such things are "private" matters. There can really be no privacy between a psychotic patient and their therapists. Unless the therapist knows exactly, and honestly, what is happening in that person's life, the degree of control cannot be established. And that control, frankly, separates a schizophrenic in a productive life from one in an institution. Cooperation fully with the therapist is not a personal option.

Remember, what we are talking about here is not a ruptured eardrum, but a psychotic disease. By it's definition, psychosis blurs the line between what is real and what is not. Some psychotic patients, like Alzheimer's patients, can only function very well so long as their environment is a very familiar one. Physicians know well the condition of "sun downing", when an elderly person with perhaps some borderline dementia is admitted to the hospital and then, in the evening (when all family goes home), suddenly decompensates and becomes flagrantly disoriented and combative. Suddenly removed from the home environment, an undetectable degree of dementia becomes fulminant.

I worry that the same thing may happen at depth, in the sensory isolation of the ocean. In this unfamilair world, alone with our thoughts and the sound of nothing but bubbles, might a well-compensated psychosis suddenly decompensate? That diving buddy means to kill them, that barracuda must be attacked, this regulator in my mouth is choking me, put there by the devil. I don't mean this in any humorous way at all. That's how a schizophrenic person can think when their control fails.

 

[mikeguerrero]

I'd like to apologize to DocVikingo for my lack of knowledge on mental disorders on divers. I clearly in no way intended to pass myself as a medical doctor or an expert on mental illness. He clearly states:

"As a doctor with knowledge of both diving medicine and psychiatry"

with that being said I believe he has the experience on advice.

I responded early in the morning before rushing to work so I didn't have time to proof read, nor did I think or suspect he would place me on blast.

I wash my hands clear off this thread; sorry I upset your expertise...

Mike G.

p.s
I also wanted to let others know that unless you are going to use the scientific method when talking about the mental illness schizophrenia on this thread, be warned that any errors you make will be noted by the Dr. himself Vikingo and you might receive hateful mail.

Here is the PM he sent me:

"Please use spell and grammar check if you're going to respond. Your last posting is nothing short of an utter embarrassment for a college instructor.

Thanks,

DocVikingo"

By the way Doc, please do not send me any more unsolicited PM's or I will take it as harrassment and notify the board.

Thanks,

MG

 

[Dr Deco]

Dear Readers:

My mother was afflicted with biolar disorder. While she was well most of the time, it was not all of the time. I would never have suggested that she take up scuba diving. People might manifest signs that confound a diagnosis of neurological DCS - or be dangerous to their dive partners. This is not medical advice, just a personal comment.

Addditonally, I would also suggest that we all use 'Spell Check.' It shows an attempt at clear thought and, it is a sign of respect to those whom you are writing.

All the best! Still in London

 

[Mr.X]

How do you handle it when it is the instructor with the mental disorder? Should the instructor have to disclose to potential students that they are being treated? Or that they have stopped treatment without the consent of the doctor? Does the certifying agency has a way to monitor the mental health of instructors which are being treated and if they are staying on treatment?

I notice that you have extra chromosomes.
I have one - X