Wednesday, September 26, 2007

Schizophrenia & Hope

The following is a compilation of numerous articles posted at this blog that I've shared at a number of sites around the net. It is, in my opinion, the epitome of what this blog is all about and therefore, serves as a just opener. I hope that you will read it, find meaning in it, and share it as you see fit.

Most Americans are unaware that the World Health Organization (WHO) has repeatedly found that long-term schizophrenia outcomes are much worse in the USA and other developed countries than in poor ones such as India and Nigeria, where relatively few patients are on anti-psychotic medications. In undeveloped countries, nearly two-thirds of schizophrenia patients are doing fairly well five years after initial diagnosis; about 40% have basically recovered. But in the USA and other developed countries, most patients become chronically ill. The outcome differences are so marked that WHO concluded that living in a developed country is a strong predictor that a patient will never fully recover.

Source: Mad In America

The psychotherapy of schizophrenia is, in my opinion, as much in the mind of the observers as in the mind of the patient. We must change before he can change. He has long been incurable because we have been hopeless.

-- Dr. Karl Meninger

In 1999 Ronald F. Levant told a group of fellow psychologists how recovery from a major disorder such as schizophrenia was not only possible, it was happening regularly. “Recovery from schizophrenia: a colleague snorted, “Have you lost your mind too”?

Source: Why Can't They Recover?

In the early years of the nineteenth century, when psychiatry was just beginning, a furious argument raged between people with very different opinions about the nature and course of mental disorders. On the one hand, psychiatrists like Eugene Bleuler believed that recovery was possible and indeed likely for the vast majority of people suffering from serious mental disorders like schizophrenia (then called dementia praecox).

On the other hand, psychiatrists such as Emil Kraepelin insisted that recovery was impossible and that sufferers would never recover. Indeed he believed that their condition would get worse throughout their lives. Kraepelin won the debate and the idea of permanent illness and disability formed the basis of mental health services for almost two centuries.

Source: Understanding Recovery

Psychiatrist Naren Wig crossed an open sewer, skirted a pond and, in the dusty haze of afternoon, saw something miraculous.

Krishna Devi, a woman he had treated years ago for schizophrenia, sat in a courtyard surrounded by religious pictures, exposed brick walls and drying laundry. Devi had stopped taking medication long ago, but her articulate speech and easy smile were eloquent testimony that she had recovered from the debilitating disease.

Source: Culture & Mind: Psychiatry's Missing Diagnosis

I have entitled this presentation, "Long Term Outcome for Rehabiliated Psychiatric Patients: Reasons for Optimism". The plan this morning is to look at recovery and the evidence for it among people with very serious mental illness. Let us look at some things that we've learned about rehabilitation and also a little bit about resilience. I'm going to present seven of the ten world studies this morning.

Now, when we talk about subjects who are recovered, we're talking about no medications, no symptoms, being able to work, relating to other people well, living in the community, and behaving in a way that you would never know that they had had a serious psychiatric disorder. And if you have heard of that old belief that one third get better, one third get worse, and one third stay the same, we found that it was not true. In the Vermont Longtitudinal Study, we took the bottom third of this population and found that two-thirds of them also turned around...

-- Dr. Courtenay Harding

Source: The Recovery Vision

Dr. Harding’s data are all the more powerful because she was studying the bottom 19% in the functional hierarchy in a large state hospital. Some of the people in her study had regressed to speaking in animal like sounds. Most had been in the institution for 10 or so years, many had been in and out repeatedly. The cohort is the least functional ever studied in world literature on schizophrenia. Nevertheless, of this bottom 19%, 62% to 68% fully recovered or significantly improved.

-- Dr. Edward Knight

Source: Recovery

The first study was done by [Dr.] Manfred Bleuler, whose father Eugene Bleuler renamed dementia praecox and studied schizophrenia. And his son, Manfred took over the hospital at Burgholzi in Zurich, Switzerland and he did what his father did not. He followed 208 people for 23 years and found that 53-68% of his subjects significantly improved or recovered.

"I have found the prognosis of schizophrenia to be more hopeful than it has long been considered to be."

-- Dr. Manfred Bleuler

...85% of our clients (all diagnosed as severely schizophrenic) at the Diabasis center not only improved, with no medications, but most went on growing after leaving us.

- Dr. John Weir Perry

Source: Trials of the Visionary Mind

Gerd Huber and colleagues in Germany followed 502 for 22 years after their episode of schizophrenia and found 57% significantly improved or recovered.

"Schizophrenia does not seem to be a disease of slow progressive deterioration. Even in the second and third decades of illness, there is still the potential for full or partial recovery."

-- Dr. Gerd Huber

There have now been three World Health Organisation studies showing that the outcome for schizophrenia in Developing countries is better than in the Industrialised world. This is extraordinary. How can places without psychiatrists, psychiatric nurses, psychiatric facilities, rehabilitation programs, medication and therapies come up with results considerably better than our sophisticated, scientific industrialised world? A country such as the USA spends 1% of its GNP on one illness, schizophrenia, and has results far worse than countries that don’t spend anything!

-- Dr. Simon Baker

Source: The Developing World Experience

Luc Ciompi and Christian Muller in a medium-sized city in Lausanne followed 289 people for 37 years ... they found 53% significantly improved or recovered.

"The long-term evolution of schizophrenia is much more variable and considerably better than heretofore admitted."

- Drs. Luc Ciompi and Christian Muller

The WHO Study of Schizophrenia is a long-term follow-up study of 14 culturally diverse, treated incidence cohorts and 4 prevalence cohorts comprising 1,633 persons diagnosed with schizophrenia and other psychotic illnesses. Global outcomes at 15 and 25 years were assessed to be favorable for greater than 50% of all participants. The researchers observed that 56% of the incidence cohort and 60% of the prevalence cohort were judged to be recovered. [...] The course and outcome for persons diagnosed with schizophrenia were far better in the “developing countries” than for such persons in the “developed” world of Western Europe and America.

-- Dr. Brian Koehler

Source: Long Term Follow-Up Studies

[Dr.] Ming Tsuang and the Iowa 500 study had the strictest criteria for schizophrenia but found 46% improved. Using the DSM III diagnosis, we found 62-68%. Dr. Ogawa et al. in Japan found 57% and Michael DeSisto in Maine found 49%.

Among those who went through the OPT program, incidence of schizophrenia declined substantially, with 85% of the patients returning to active employment and 80% without any psychotic symptoms after five years. All this took place in a research project wherein only about one third of clients received neuroleptic medication.

Source: Dialogue is the Change

When I was a staff psychologist at a neuropsychiatric institute in 1965, I conducted an experimental interview with an 18-year-old woman diagnosed as "acute paranoid schizophrenic." I'd been influenced by the writings of Carl Jung, Thomas Szasz, and Ayn Rand, and was puzzled about methods for training psychiatric residents that are unreported in the literature. I prepared for the interview by asking myself questions. I wondered what would happen if I listened to the woman as a friend, avoided letting my mind diagnose her, and questioned her to see if there was a link between events in her life and her feelings of self-esteem.

-- Dr. Al Seibert

Source: How Non-Diagnostic Listening Lead to Cure

A person receiving a diagnosis of schizophrenia loses hope and enters a state of anguish caused by an experience of meaninglessness, hopelessness and helplessness. Much of this hopelessness is not due to the disease but to the mental health systems designed to treat it. Mental health systems are set up for maintenance and usually communicate that life is without hope of significant accomplishment once serious mental illness has set in. Yet, experience shows that recovery from mental illness is possible.

-- Dr. Edward Knight

Source: Recovery

Hello, my name is Judi Chamberlin and unlike the two previous speakers, I am not a mental health professional. I was a person labeled with a serious mental health illness - I was diagnosed with schizophrenia when I was 21 years old, and I'm a person who's recovered. So I'm an example of what we're talking about today. And I think it's very important to recognize that recovery is not something that happens to a few exceptional, privileged or lucky people ... recovery is possible for everyone who's been diagnosed with a major mental illness.

Being told that you have schizophrenia is a devastating experience. Especially when I was told this, I was also told that I would always be ill, I was going to need treatment and it was terrifying. This happened in a time in my life when lots of things were going wrong and to be told that they weren't going to get better ... that things weren't going to come together for me, was taking away hope at a time when I needed, more than anything else, people believing in me. And I needed support, I needed someone to say that there are ways out of this morass you find yourself in and I wasn't hearing that. And what compounded it was that these people were the experts. They were the ones who were supposed to have the answers. So it was a terrible blow to be told by these experts that I was never going to get better.

-- Judi Chamberlain

Source: Confessions of a Non-Compliant Patient

We who have recovered from mental illness know from our personal experience that recovery is real. We know that recovery is more than remission with a brooding disease hidden in our hearts. We have experienced healing and we are whole where we were broken. Yet we are frequently confronted by unconvinced professionals who ask, "How can you have recovered from such a hopeless situation?" When we present them with our testimonies they say that we are exceptions. They call us pseudoconsumers. They say that our experience does not relate to that of their seriously, biologically ill, inpatients.

I recently re-experienced this negative attitude about recovery. A friend of mine, during a discussion in a psychology class, said she knew someone who had schizophrenia, recovered and became a psychiatrist. "He must have been misdiagnosed," was the professor's response. So my friend reviewed my earlier symptoms with me. I met the DSM IV criteria for schizophrenia in the interval from 1969-74. When she presented my history to her professor, he reversed his position and said that the diagnosis of schizophrenia must have been correct. He doubted I had recovered and said, "we now have a case of an impaired physician."

By having earned board certification in psychiatry, having worked as medical director of a community mental health center for 11 years and having directed the National Empowerment Center for 3 years I have proven that I am not an impaired physician. This episode reveals the depth of negative expectations which are taught to students. After all, mental illness is considered a terminal condition for which there is no cure. Therefore anyone who appears to have recovered must not have been sick. This leaves no one with first hand experience of what helps and what hurts to speak for those who currently cannot speak due to their distress.

-- Dr. Daniel Fisher

Source: Healing and Recovery are Real

They're down to 2 cases per 100,000. A 90% decline in schizophrenia! And why? Because their first-episode cases are not becoming chronic.

- Robert Whitaker, author of Anatomy of an Epidemic

"All of us could have psychotic problems. It's an answer to a very difficult life situation. It's in a way, a kind of metaphorical way to speak of things that beforehand did not have anywhere they could be spoken of."

-- Jaakko Seikkula, clinical psychologist/founder of Open Dialogue Treatment

This is the land of open dialogue where for more than twenty years, they've been documenting their results which are the best in the western world, to the extent that schizophrenia is now disappearing from their region.

There have been many studies in the USA and other countries that point out that treatment - if practiced in a way that provides patient training leads to a normal life style - that includes jobs, education, and social skills training and relieves the guilt and loneliness associated with these conditions - then even the lowest level of schizophrenia can change and be reduced or eliminated from the lives of those who suffer this condition. The tragedy is that somehow - professionals - all over with some exceptions do not believe this is a reality.

What’s wrong with them?

Source: Why Can't They Recover?

Music of the Hour: Thank You


Atlanta cosmetic surgery said...

Very nice and inspiring postings.When you are hit with a very hard and chronic illness all you need is the love and kindness of the fellow people around along with medication.

Anonymous said...

Thanks for the great work, Thanks for giving me something to do when I'm bored, Thank you for taking your time and thank you for giving me hope!

Oliver, 20 years, Schizophrenic, Denmark