Psych Truth Radio: Welcome Dr. Karon
Bertram Karon: It's a real pleasure to be your guest. And so, shall we talk about the important issues?
PTR: Yes. What do you think causes schziophrenia?
BK: It's really, if you look at all the data we have and all the case studies... schizophrenics are very sick human beings. What it really is, is primarily, a chronic terror syndrome. We're supposed to feel terrified for a minute, maybe for half an hour when there's a danger but if you feel you are in danger of being destroyed and you have to live that way for days, weeks, months, or years... the toll on you is terrible. All of the symptoms of schizophrenia are either aspects of the terror syndrome or defenses against it. And that includes, the catatonic state where people become rigid which we've demonstated in animals occurs when they seem they are on the verge of dying. The hallucinations and delusions which all human beings are capable of doing but most of us will never have to do...
The best evidence of this goes back to WWII. There was a situation in WWII where every solder who went through it -- and they were always sent for treatment -- looked like the sickest, most chronic schizophrenics. And the situation was very simple: people were out there shooting at you, trying to kill you. And so you dug a foxhole as quick as you could and you could barely get into it, and as soon as you could barely get into it, you got into it, so you wouldn't die. And they kept shooting at you trying to kill you, so you didn't move... when your food ran out you stopped eating... if you had to urinate or defecate you did it on yourself. And if this went on for more than three days and nights, every single soldier looked like the most chronic, sickest schizophrenic. The strange thing was however, if they were reasonably healthy people beforehand, when brought to a place of security and safety and just given rest, they got better spontaneously.
There is no such thing as a spontaneous anxiety or an endogenous depression. If a patient is anxious, there is something to be scared of. If a patient is depressed, there is something to be depressed about. If it is not in consciousness, then it is unconscious. If it is not in the present, then it is in the past and something in the present symbolizes it.
At the time, people said it couldn't be schizophrenia because we know that it doesn't get better. The long term studies however ... done in 12 different countries now indicate that irrespective of treatment, 30% of schizophrenics completely recover within 25 years. There have been studies from Switzerland, Italy, Scandinavia, the United States, Germany... they all find the same thing. Unfortunately, the best of the American studies -- that of Courtney Harding, which studied patients from Vermont -- found that the patients got better in 20 years but the patients who stayed on their medication as long as their doctors told them to, none of them ever recovered. 50% of the patients eventually stopped taking their medication against medical advise and all of the patients who had a full recovery were in that group.
PTR: So what you're saying Dr. Karon is first of all that schizophrenia is really an experience, an experience of terror ...
PTR: And secondly, if someone continues to take the medication as prescribed by psychiatrists and doctors, that the odds are that they won't improve and get better. They're better off stopping the medication.
BK: Taking the medication may make them easier to manage but it gets in the way of full recovery.
PTR: Can you tell us a little bit about your ground-breaking Michigan study which was on the treatment of schizophrenics with psychotherapy versus the usual psychiatric approach?
BK: Yes. This was a study that was done on a NIMH grant using center city Detroit patients. What we did was take clearly schizophrenic patients ... Diagnosis was made by the regular hospital staff and then reviewed by the research staff to ensure they were really schizophrenic. And if anything, they were the very sickest of the schizophrenics.
They were assigned randomly to one of three treatments: psychoanalytic therapy with no medication; psychoanalytic therapy and medication combined or, medication and support as given by a good group of psychiatrists in a good hospital. The evidence that they really were good psychiatrists is the group that did worse in our study -- the medication only group -- did as well as the medication only group in some of the studies ... which claimed to find that therapy didn't help.
The problem is that what they called therapy was done by residents who had no training in psychotherapy, supervised by supervisors who had no training in doing psychotherapy with schizophrenics. In our study, the supervisors had at least ten years experience in doing psychoanalytic therapy with schizophrenics and were considered by their colleagues to be "good therapists". Furthermore, the inexperienced therapists -- because we were interested in whether you could teach this sort of thing -- were psychiatric residents or graduate students in clinical psychology and were given training and supervision, very carefully.
Now here's what we found: the best outcome occurred in those people who got psychoanalytic therapy without medication at all. We used psychological tests, we used a clinical status interview conducted by a very experience psychiatrist who did not know what kind of treatment the patient received. The patients were examined before treatment, after six months, after 12 months and after 20 months of treatment. And then we did a follow up for medication after two years. The best results were obtained with those people who got just psychoanalytic therapy.
The next best results, which were nearly as good, was where medication was used as an adjunct but it was withdrawn as rapidly as the patient could tolerate. The experienced therapist who combined medication with therapy was honest. He told the patients, 'The medication doesn't cure anything. It makes things tolerable so we can talk. But the only thing that will cure you is your understanding.' And he withdrew the medication as quickly as the patients could tolerate and that turned out to be a good way to work.
Therapists who treated their patients with medication as well as psychotherapy but maintained the dosage level of the medication and never withdrew the patients from their medication, this was not nearly as good as just using psychoanalytic therapy or psychoanalytic therapy with medication when the medication was withdrawn as rapidly as the patients could tolerate.
The above excerpt covers the first eight minutes of the interview. You can listen to the rest of the fifteen minute interview here: Mental Health Radio [Requires Real Player]
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