Spiritual Recovery

Recovery from Psychosis and Schizophrenia

2011-12-31T06:37:00.001-08:00

It is not what you say you believe in that matters
as much as what you demonstrate you believe in.

~ Patricia Lefave ~

For insight into this blog's purpose I suggest you read How This Blog Got Started. Otherwise, feel free to read the newest article below this entry or pick and choose from any previous entries via the Table of Contents to the right.

Without an escort you are bewildered (even)
on a road you have traveled many times (before).
Do not, then, travel alone on a Way
that you have not seen at all, do not
turn your head away from the Guide."

~ Rumi (13th century Sufi poet and mystic)

Guides are those who have been to a place and come back again. In this blog, you will find the voices of many, many guides.

What's New?
Feb 12: Susan Lien Whigham: The Role of Metaphor
Feb 14: Thumbs Up: Me and Psych Drugs
Feb 26: Presumed Causes of Schizophrenia & Psychosis
Mar 07: How I Tamed the Voices in My Head
Mar 16: Dr. Bertram Karon: Schizophrenia & Therapy
Apr 15: Dr. John Breeding: Hallucinations ...
May 05: Dr. Maju Mathews: Better Outcomes ...
Aug 02: Bi-Polar or Waking Up?
Sep 26: Schizophrenia & Hope
Oct 05: An Integral Approach to Spiritual Emergency
Oct 08: Related Links (Revised)

Jan 13: schizophrenia.com

Note: I had recently opened my blog to comments as a means of soliciting some help for a mother in UK. I did pass on what I received (here and elsewhere) and at this point, am closing my blog once more to comments. I have difficulty enough keeping up with the exchanges in my mailbox. My thanks to those of you who shared information.

See also, my companion blogs: Spiritual Emergency and Voices of Recovery

Schizophrenia, Psychosis, Recovery, The Recovery Based Model, Hope for Schizophrenia Sufferers, Psyche Bloggers Carnival

crazyboards.org - "Unnecessarily hostile"

2011-04-01T09:59:00.001-07:00

If you've read the entry on schizophrenia.com, you've essentially read the entry I could flesh out in regard to crazyboards.org. They're literally identical in terms of moderator abuse, use of the community as a weapon, an attitude of "Us vs. Them", reationary, etc. One astute individual offered the observation that they were "unnecessarily hostile". That about sums it up.

http://www.crazyboards.org/forums/index.php/topic/45366-schizophrenia-pyschosis-and-recovery-psychological-approaches/page__gopid__473258

I was banned from that site after I posted this link: Schizophrenia & Hope. Apparently, I went too far with that one.

Meantime, I've seen that kind of behavior before, in other communities. I do tend to take notes on such things because, to me, the way people are treated is a very good marker for how healthy the community is. Moderators set the tone for the community standards so when you see moderators and admins resort to that kind of behavior... you know you've got a very unhealthy environment on your hands. Reactionary. Fear-based. Highly controlling. I don't function well in the vicinity of such people so it's just as well that we quickly parted company.

I did manage to make a few posts in their Book section where someone had asked about Jung's Red Book. I even quoted John Weir Perry...

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

I can only presume the moderators haven't discovered it yet. They don't seem to be very comfortable with the idea of recovery.

Also, my posts on Open Dialogue Treatment were put back in place but that was after my other posts were modified, that was after links to my personal experience were removed for "advertising, being spam and self-promotion". That was after the members and mods decided to have a go at me.

Meantime, in the "putting back" it would seem that a number of the links to studies about Open Dialogue treatment were disabled and the mod who sat on those studies, who openly praised one of the abusive members for their behavior, they followed it up with a notation that 73% of all people recover from psychosis and therefore, Open Dialogue's recovery rates of 80% to 85% of people back to work, back in school, no further episodes of psychosis, the reduction by 90% of schizophrenia in their region with only one third of them ever having made use of neuroleptics... all that was not only unremarkable, it was the equivalent of snake oil.

If I'm angry, it's not just because of their treatment of me it's because their behavior reflects the behavior of many others, a fair number of them professionals. They honestly believe that stripping people of hope is a compassionate action. They honestly believe that no one can ever recover or successfully function without medication. And they will stop at nothing to try and ensure that no one ever hears about people who do. They can't do it, of course. Not with the internet. There's too many people out there now who have.

Meantime, I do talk to an awful lot of people and I'm not shy about being honest about my experiences. I share. The good, the bad, and the ugly. I will never be referring anyone in recovery to that site or any caregiver. I don't believe people can get well in abusive environments.

In a separate discussion an observer noted: Its not like you had an agenda to get anyone to stop taking their meds.

I responded: I don't need an agenda. People take meds because they self-identify them as helpful. They stop taking meds because they don't identify them as helpful. They might be right or they might be wrong but they also tend to make their own decision. Harp on them too much and they just go away and do it in secret. Support them and not only do you help build trust, they'll be more open with what's happening for them. That means, their support people will be better able to move in fast if necessary.

There was someone who posted to that thread noting that they had given up their meds just a few days previously. My comments to her were still there last night, I don't know if they've been removed since. The link I posted however, that was removed and a moderator's comments added that implied I actively encouraged her to come off her meds. I did no such thing. She came off them four days before I arrived. What I did do was try to encourage her to make an informed decision.

The link I shared was this one: Matters to Consider When Reducing or Coming Off Medications. It opens with this argument...

To my mind, medication is a tool but it's not the only tool. The question we have to ask ourselves in regard to any form of treatment (medication or otherwise) is, "Is this helping me? Am I getting better?"

Many people identify medication as something that helps them but even those who find it helpful don't like to take it. They only do so because it makes their life better, more tolerable, more managable. This is true in spite of whatever side effects may be present. Other people do not find medication to be helpful or the burden of the side-effects outweighs the benefits. These people may find it beneficial to consider taking a different medication or to try withdrawing from that class of drugs entirely. To help you determine which avenue might be best for you, you could try asking yourself these questions...

- Do you understand why you have been prescribed your medication? (What is it supposed to do for you?)

- Does it have any positive effects for you? (Is it doing what it's supposed to do?)

- Does it have negative effects? (How is it not helping you?)

- What alternatives might be available?

Whenever people are investigating medications I like to encourage them to look at medically oriented sites and consumer based sites because this can provide a bigger and more complete picture than only one perspective. Here's two links to get you started:

- Medically Oriented Site

- Consumer Oriented Site

Exploring your answers to the questions above can help prepare you for meeting with your pdoc and discussing the issue with him/her. I suggest that for now, you continue with your medication as prescribed but start researching and exploring your alternatives. By the time you're finished doing that, you'll probably have a better idea of what treatment options might work best for you personally.

That's not quite the stirring speech to get people off their meds that the mods implied.

The truth is, people are going to experiment with their meds. In the process of doing so, they often learn some important things about them such as the degree medication might be having on their function, whether or not they truly need to be making use of them, whether they might function better with a different med in the same class, or a med from a different class entirely, and whether or not they can function well with less of them or none at all.

I encourage people to do their research so they don't set themselves up for failure. Coming off abruptly is usually a pretty good way to do that. I also believe that people benefit from support when they're attempting to make a med reduction or a withdrawal. I suspect that some folks, when they withold that information are deliberately doing so because they know a recurrence is more likely to be triggered with an abrupt withdrawal. In other words, they want the other person to fall. I want them to get safety nets in place before they even try to make the leap. This may be an indication that I am, indeed, the Anti-Christ.

About five years ago, I ran into two psychiatrists in the online environment. This was what they had to say to me...

Psychiatrist #1: On behalf of my profession, I do say that psychiatrists are the most gifted of physicians. In no other branch of medicine is the chief complaint so cryptic such that the physician has to start completely from scratch. Often, when a patient is unable to state their chief complaint and there is no one to state it for him, the patient is passed off as crazy, and sent along to psychiatry to figure him out, or he dies.

Psychiatrist #1: If the person can be cured, then it is NOT schizophrenia. Schizophrenia is a chronic mental illness that has no cure.

Psychiatrist #2: I personally think it is far more ethical and kind to allow patients to know the truth about their illness; that it is indeed incurable, but that it can be successfully managed and allow for a normal life, rather than feeding them some bullshit false hope that one day they will be cured.

What's the difference between cured and recovered? I don't know. You'd think someone would have come up with some defining criteria by now but apparently, no one can ever really be considered fully recovered.

The suicide rate from schizophrenia is highest in the year following diagnosis. Young men are more vulnerable to take their own lives. You would think that the suicide rate might actually decrease because people are finally getting treatment but instead, it spikes up. I honestly believe that this is a direct result of the attitude of those around them.

People are told, over and over and over again... You can't get well. You can't get well. You can't get well. You have a disease. There is no cure. Is it any wonder that, when faced with that kind of hopeless, dismal message, some people might choose to opt out of life entirely?

There's a lot of reasons why I do what I do. But part of putting my face out there is so that others can hear a bit of a different message for a change. Because I know that people need to feel there is a reason for hope. In the process of putting myself out there, I encounter a lot of attitudes like the one espoused by those psychiatrists, or those mods at crazyboards.

A friend sent me copies of the thread. In reviewing it, I felt I understood a little better what had happened.

It began when that moderator edited my original post to remove the links to the written accounts of my personal experience. The notation added by the mod: [Self-promotion edited out of post.]

By choosing those words, he cast the impression that my introduction to the community came in a form of advertising, that I had arrived with the intent to promote and sell a product.

The actual links I posted were to written accounts of my personal experience:
- http://thefifthbody.homestead.com/index.html
- http://community.mentalhelp.net/showthread.php?t=4937&page=5

The next link that was edited by the moderator was in regard to that other member of the community, noting that they'd come off their meds four days before. That link was removed with the added notation: [edited out instructions on how to come off of medication]

A second moderator came along at that point to note: I would like to see a reasonable amount of peer reviewed research supporting the success of these other therapies. Aside from CBT and DBT, I'm not aware or treatment programs without minimal or no meds that work for severe mental illnesses.

Now, she and I both know that the links to the studies I posted were removed by her and she had a copy in her mailbox but she didn't say that. Instead she said she wanted me to provide them, thereby implying that I hadn't made any effort to do so. When I later ask her to share them, another member attacks me for not posting them myself. He seems to have missed that I did, and they were removed.

She ended her post with this comment: If you want to generalize or claim that various programs cure or substantially help serious mental illnesses, post credible support from science or medical journals supporting your opinion, please. She's emphasizing the point because she wants the readers to gather a very distinct impression. [For the record, the list of studies I shared with her were largely drawn from this source: Finding Out More About the Open Dialogue Approach.]

At this point, the moderators have done their job of setting up the community to respond to me as an enemy in their midst, by carefully presenting me as:

- someone who arrived looking to sell a product
- someone who has encouraged others to go off their meds
- someone who has not presented any scientific evidence regarding the treatment they promote

Then, they let the rabble knock me around a bit...

- Fuck you, guy.
- No really. No one is buying your shit.
- What you're suggesting will fucking hurt people.
- THAT'S HILARIOUS.

The mods return to add more fuel...

- Your thread is up for review because of its content.

- We don't generally let users promote products and services via the website.

- The model of our community is not generally compatible with anti-med, anti-pharma, anti-psychiatry agendas.

- You have been PMed by multiple staff members explaining why your posts have been edited or made temporarily invisible while they are under review.

(It's true that I was PM'd by dianthus and Stacia but not until after those posts were removed. dianthus pm'd me to say he'd removed the links to my personal experience for violating "advertising and spam" guidelines. Stacia PM'd me to ask me to provide links on studies -- that's how she ended up with the copies in her mailbox. There was no mention of any "temporary removal". The posts were simply gone and the attacks came flying after that.)

dianthus stands back so the rabble can have another round...

- We think you're a self-important ass-wagon.
- The idea that you have a child who has to submit to your idea of treatment terrifies me.
- it's been made abundantly clear that no one wants you here...
- You asked for what you're getting.
- You came to a pro-medication, pro-treatment website and advised strongly that people should halt their medications.
- Again, fuck you, guy. No one is buying what you're selling.
- I shit on you

dianthus returns ...
- Your thread with all the posts about the treatment you're talking about was reviewed and is on the boards for open discussion, and has been for hours. I have absolutely no idea why you're saying we stifled it.

In other words, why are you making such a fuss when we have played so nicely?

I arrived there with the desire only to share some information about some of my favorite treatment programs -- all three developed by professionals, all three making use of at least some degree of medication, and all three producing recovery rates in the range of 85%.

I guess that it has to be 100% medication and no recovery or else it's anti-psychiatry, anti-medication, and anti-pharma

Sometimes it's who you know. Sometimes it's what socially acceptable medications you make use of.

In search of true healing...

2009-08-09T21:09:00.000-07:00

It's been a long while since I made a blog post. It's been a busy year. Among other things, a family member has been ill and that's required a great deal of my time and attention. I have, however, remained active in the online environment, doing what I happen to like doing -- talking with people who carry a diagnosis of schizophrenia.

As a result of one such conversation a friend brought a post at schizophrenia.com to my attention several weeks ago. The question had been posed: Can child abuse cause schizophrenia?

The poster had apparently done some research of their own and came across this article posted at Psych Central which they then linked in that thread. Among other things, the article notes: Their evidence includes 40 studies, which revealed childhood or adulthood sexual or physical abuse in the history of the majority of psychiatric patients and a review of 13 studies of schizophrenics found abuse rates from a low of 51% to a high of 97%. Psychiatric patients who report abuse are much more likely to experience hallucinations – flashbacks which have become part of the schizophrenic experience and hallucinations or voices that bully them as their abuser did thus causing paranoia and a mistrust of people close to them.

A moderator at schizophrenia.com responded to their post as follows:

The article you referenced above is not from a reliable source. Psych Central sometimes publishes articles that are antipsychiatry in nature. This is an example of one of them. The research mentioned in the paper is questionable due to the origins of the article. Note that the study was not published in one of the major peer reviewed publlications...

Source: schizophrenia.com

That statement caught my attention on three counts. The first is that Psych Central is one of the oldest and largest mental health sites on the net. Along with hosting an online community where I can be found on occasion, it also features member blogs and publishes numerous peer-reviewed articles. I'd never heard anyone refer to the site as "anti-psychiatry" previous to this.

The second was that many months ago I was briefly a member of schizophrenia.com. I lasted about 24 hours but my troubles began when I, too, made reference to John Read's work. As a result, the third detail that caught my eye was the moderator's assertion that John Read's work had not been published in a reputable journal. I knew that wasn't true.

I responded to that post at Psych Central, noting that Read's work had originally been published in "Acta Psychiatrica Scandinavica [Read, J., van Os, J., Morrison, A.P., & Ross, C.A. (2005) Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica, 112, 330-350]." I suggested that anyone who might be a member of both sites share that detail at schizophrenia.com but nothing came of it.

Weeks passed and then, about a week ago, someone pointed out a post about recovery and "true healing" that had been started at schizophrenia.com. The individual who initiated the post asserted that any talk of cure was nonsense and that the individual who suggested as much might be suffering from a "mental condition".

I've seen many of these kinds of posts go by with minimal comment before. Occasionally someone might note they heard of someone who made a full recovery and not infrequently, there will be posts from individuals lamenting the burden they've been given -- a cross to carry for the rest of their physical existence -- but rarely have I seen anyone provide any verifiable information on recovery that people can follow up on.

This is old ground and those of you who might have read this blog before know what happens when hope vanishes. Despair sets in.

Several months earlier I'd been told that I had never really been banned from schizophrenia.com. Rather, SZ Admin, the site founder and primary administrator asserted that people will sometimes try to log-in when the server is down and they'll interpret their inability to gain access as the equivalent of being banned. None of this equated with my former experience of repeatedly trying to log-in while the server was up and running and not being able to do so over a period of several days, or of attempting to log-in and being immediately transferred to an administrator's profile, incapable of going any further.

Still, I was bothered by the idea that such a dismal statement was going unchallenged. I've discussed the role of mentors and their role in the recovery process in numerous conversations over the years. A mentor is someone who inspires and encourages you; they've gone to the places you want to go, they've done the things you want to do. In the early years of my own healing, I read the recovery stories of others many, many times over. Those accounts gave me hope. They gave me motivation. I needed that. I needed to know that however messed up life might have been for awhile, things could get better for me.

So it was that with very hesitant and doubtful fingers, I entered my log-in information. Incredibly, my efforts were successful and I was transported to the thread: Kamal84 and the rest who share his/her view on how to truly heal.....

In my response to that initial post I noted that many people have made full recoveries. To demonstrate the validity of that claim, I cited the names of several professionals -- all doctors -- who had made full or partial recoveries: Daniel Fisher, Rufus May, Patricia Deegan, Christiane Northrup, Frederick Freese, Ronald Bassman, Edward Whitney, etc. I also shared a link to the blog I have where I've collected the stories of those individuals along with several others.

My words prompted Dugal, the assistant administrator to edit an earlier post of his own to add the following notation: You should also have a look at page 113 where Torrey indicates "the recovery model" has no foundation in scientific studies or data. ... Also have a look at page 435 "Scientologists, Anti-Psychiatrists, and Consumer Survivors".

I'm not sure if Dugal meant to imply that all those doctors must be scientologists, anti-psychiatrists or consumer survivors, or if I was. I didn't get the chance to ask.

When people here are being coached to refute studies from an organization as reputable as the World Health Organization, when posts are being deleted about doctors who have recovered, and when schizophrenics are being targeted and harassed by the moderators and administrators... it doesn't take a rocket scientist to figure out that something's not healthy.

The conversation continued with one member noting his doctor had told him people can be misdiagnosed. "That's not cure," the thread initiator argued, "because they were never really sick to begin with."

In response, I quoted an excerpt from an article written by Daniel Fisher: We who have recovered from mental illness know from our personal experience that recovery is real...

When asked by another member to define what I meant by full recovery, I quoted Courtenay Harding's definition and provided a link to her Vermont Study on long-term recovery: 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 ...

A member of the community posted to thank me for sharing that information. He/she shared that it's something they feel needs to be talked about but people are afraid to do so.

All those posts were rapidly deleted by the administrators. This prompted another member to ask why, to which they were informed by an administrator:

The poster you mention above has never actually been diagnosed with anything. She only believes she had schizophrenia and has recovered. The research on schizophrenia in recent years has conclusively shown that the approaches favored by her are not helpful to most schizophrenics in treating their illness. She may be a great and inspirational writer to you but to me it mostly looks like bullshit. She is well aware that she is not welcome here.

I've never been shy about my lack of diagnosis although truthfully, what did it matter? I wasn't talking about my experience -- I was talking about other people who have recovered and a study that demonstrates many people get better, even those who have been severely ill for decades. No matter. His assessment was: Bullshit.

Primary administrator SZ Admin stepped into the ring at this point to quote from one of my other blogs and express some doubts he had about my diagnosis. In the interests of full disclosure, I responded and included some personal details related to that experience which, among other things, included:

- a 10 month prodromal period [*]
- 6 weeks of active psychosis
- 14 months before I was capable of returning to work in a part-time capacity only

[* Actually, this was 14 months. I'd forgotten to include the four months I spent trying to figure out if I had died and if so, how I'd managed to keep on living.]

SZ Admin responded: Again, by your own description you have never met the criterion for a schizophrenia diagnosis - as defined in the DSM - IV. Why don't you go find a "temporary psychosis" web site to spam. ... 6 weeks of psychosis does not mean a definition of schizophrenia - irrespective of any self-diagnosed prodromal phase, or coping problems afterwards. Then he criticized me for dominating the conversation yet it was he who'd asked me for clarification and dragged in the quote from my Voices of Recovery blog.

I suppose I could have said that I'd seen a psychiatrist and had a diagnosis -- it's what everyone else says and it appears to pass muster without question. But not only is that not true, it wasn't even the issue. I shouldn't have to have a formal diagnosis in order to share information about people who have recovered, particularly when I'm linking those claims to verifiable sources.

Meantime, I found myself wondering, is it too much to ask that a primary administrator be knowledgeable of the basic criteria required for a diagnosis of schizophrenia? I reminded SZ Admin of this quote from his own site:

The diagnosis of schizophrenia, according to DSM-IV, requires at least 1-month duration of two or more positive symptoms...

Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

Source: http://www.schizophrenia.com/diag.php

Months ago, when I had my first encounter with schizophrenia.com, I'd pointed out a flaw in the quiz I'd been encouraged to take in regard to this very issue. At the same time, I'd further noted that according to the quiz writer's own account, she'd been diagnosed with schizophrenia as based on 24 hours of symptoms. It occurred to me that SZ Admin was somewhat flexible in regard to diagnostic criteria when it suited his purposes.

Shortly thereafter the original poster showed up to exclaim that "a delusional wildfire" had taken hold of the discussion and a "disaster" had occurred. I asked her what was disastrous about recovery and it was right about then that assistant administrator Dugal began to tag all my posts with the label, "Nasty Namaste". Presumably, he intended to demean me before the community. What was especially bizarre about his behavior was the signature tag that followed each jeer and jab: Please be civil and supportive. [Note: A number of the posts in this thread have since been deleted or modified, particularly those where assistant administrator Dugal repeatedly referred to me as "Nasty Namaste". Other posts of Dugal's in other threads have also been removed or had that term edited out.]

Are you all getting the full dysfunctional picture here?

- The site founder and primary administrator doesn't seem to have a firm grasp on the essential diagnostic criteria of schizophrenia, nor does he hold his administrators to any guidelines for minimal standards of behavior.

- We have a second administrator who labels people's posts regarding verifiable recovery as "bullshit" with the site founder's apparent tacit approval.

- We have a third administrator who targets and harasses members, also with the site founder's apparent approval.

You'd think that some kind of rationality might have kicked in and prompted someone, ANYONE on the administrative team to rein in their behavior if only out of embarrassment. But the show went on and then it carried over to another area of the site where the member who'd questioned why my posts were being removed was then targeted by assistant administrator Dugal.

In an effort to cast doubt and try to create suspicion about her among her peers, assistant administrator Dugal revealed to the rest of the community [... insert drum roll...] that her IP address was exactly the same as her husband's. Why would a site administrator do such a thing? The only shocking thing about this is that:

a.) there is nothing surprising about a husband and wife having the same IP address;
b.) administrators are supposed to respect the personal and confidential details of members;
c.) administrators in environments that bill themselves as supportive are supposed to actually be supportive.

Meantime, another member had also singled out and targeted that member. What occurred in that thread was something that most of us would have no difficulty recognizing as brutally unkind. At one point, that member referred to this individual -- someone who has made incredible strides in their own recovery, which includes a history of abuse in childhood and adulthood -- as an "it". An "it". It was a complete and total invalidation of her essential humanity that served to retrigger her early experiences. No moderators stepped in to stop her tormentor; they didn't seem to see anything inappropriate in his behavior.

In my recent wanderings I came across the following. It strikes me as highly applicable:

Evidence is also consistent that negative attitudes towards individuals with (or with a risk of developing) schizophrenia can have a significant adverse impact. In particular, critical comments, hostility, authoritarian and intrusive or controlling attitudes (termed 'high expressed emotion' by researchers) from family members have been found to correlate with a higher risk of relapse in schizophrenia across cultures.

Source: Environmental Factors in Schizophrenia

I don't think it's rash to suggest that if the above is true of family environments, it's also true of online environments.

Yet, that's the environment that the administrative team of schizophrenia.com creates. That's the example they set, from the site founder down of acceptable behavior for an online community that bills itself as the #1 support site for schizophrenics on the net. It is a place where people in recovery are mocked, ridiculed, silenced, slandered, targeted, set-up, verbally assaulted, demeaned, belittled, frightened and denied the opportunity to nurture hope by the community's leaders.

Given my experience of the site I can understand why they feel compelled to minimize John Read's work demonstrating the link between abuse and schizophrenic episodes; in order for them to accept that reality, they'd also have to accept that their own behavior is all too frequently, abusive. Abusive environments do not lend themselves well to recovery. More often, you must leave such environments before you can begin to get well.

I do have one heart-warming detail to report. The vast majority of participants hold themselves to a higher level of personal standard even though they are the ones who are supposed to be ill. Such is the insanity of schizophrenia.com -- the people who are most in need of healing are the administrative team.

~ Namaste

See also:
My (first) experience of schizophrenia.com

Schizophrenia Bulletin: Scientific and Consumer Models of Recovery

Update: I attempted to briefly participate at schizophrenia.com. I didn't anticipate it would go well but I was willing to give it a shot in case I'd been wrong... in case there'd been a change of heart. I did enjoy connecting with a few of the people there but ultimately, it didn't go well. Yesterday the primary administrator decided to run a "poll" to determine if my presence should be tolerated at the site: Your Thoughts On Spiritual Emergency.

In the interim, a number of the posts made by assistant administrator Dugal have since been heavily edited or deleted as if they'd never been there at all. Posts by other members who joined into his attack have also been removed. Something is wrong with the entire picture. It's not that it couldn't be good -- people will always benefit from peer support -- but the administration is not healthy.

One member has shared that schizophrenia.com is the equivalent of "an online psyche ward" where administrators are the equivalent of nurses/authoritarians and emphasis is on dominance, control, compliancy and cover-ups designed to protect the abusers, not the abused. If you think you can function well in that kind of environment -- it's the place for you. If you don't think you can, you'd best look elsewhere for your online support.

schizophrenia.com remains the only site on my list of potential support venues that comes with a heavy warning caution.

Recovery from Psychosis & Schizophrenia

2008-11-17T12:29:00.001-08:00

See also, my companion blogs: Spiritual Emergency and Voices of Recovery

Schizophrenia, Psychosis, Recovery, The Recovery Based Model, Hope for Schizophrenia Sufferers, Psyche Bloggers Carnival

UK Mum Requires Assistance

2008-11-08T07:53:00.000-08:00

I've been in contact with a mum in the UK. She has consented to allow me to share her story in this space, in her own words...

My daughter went into hospital (Section 3) after trying to commit suicide. She had borderline personality disorder and couldn't cope with things, it all became too much. She has a husband and 2 wonderful children and we think it could be postnatal depression that may have started this. The hospital she is in is not in our area and she is approximately an hours drive from us and her family. She has now been in a secure unit for over 2 years.

We have been trying to fight the system and get more help for her for 2 years. I have been writing constant letters of concern to the hospitals and even to members of parliament, but no one cares. Until meeting her solicitor 4 weeks ago I thought we were the only ones who thought it wasn't right the way she was being treated, and then an incident happened...

She was stripped naked in a search for her bra. She was covered with a sheet, in the room were 3 females and 2 males assisting with removing her clothes, all while she was being held down. She was humiliated and is frightened of what will happen next. Since the incident she has tried to overdose and is continually saying she wants to kill herself and can't cope in there. She is trying any and everything to end her life at the moment, it is becoming an everyday occurance. She is now on a one to one watch and has to have someone with her when she goes to the toilet, which I understand, but 2 weeks ago my daughter was full of life, unbelievably positive.

When we visited her she made clear that the reasons that she is willing to take her own life is the fact she is locked up. She continues to self harm (nothing too serious), because she knows she should not be in there. The hospital says she self harms because she gets upset when she sees her family. We suggested letting her see her children every week but they said this would put her at more risk to self harm. It is tearing my daughter apart to the extremes not seeing them once a week, but still the hospital denies her this. In our opinion, she self harms because she knows she has to wait 2 weeks to see her children but they cannot see this and are constantly blaming us. We are a loving family and I often wonder if they are not used to dealing with a family such as ours.

She cannot leave unless we go to court to have her released, which we are in the process of. The incident is now being investigated. We are waiting to see their reply and then will make a formal complaint and go to court if neccessary. I have considered going to the media and would have access to a journalist if necessary but I can't put my daughter through more trauma and the stigma attached to this.

We thought as many others, no doubt, that what the doctors were saying was correct, but then you begin to wonder, maybe not, and then you begin to wonder what if you are wrong? Surely they can't treat people like this! Surely she should be getting more help! But then it hits you, an overwhelming sense of failure for your child... why did we let her be taken? We thought it was right. We thought she would get help. The rest is history.

I find it hard to believe that all these people are suffering in silence, and more so their relatives. Why is it not more in the public eye? It's obviously still a taboo subject. I just hope that the people making my daughters life a misery at the moment never find themselves in the same situation. Is there any justice in the world? They will say they were stopping her from harming herself but she is not violent, she felt alone. How does she get out of this? Apart from her solicitor, no one seems to care.

That mum is currently working with a solicitor to prepare an appeal before the tribunal. What she may benefit most from at this time are the insights of others who have done the same and hopefully, been successful in presenting their case.

If you are a solicitor, advocate, parent of a child who has been sectioned, or a mental health consumer who was sectioned and released under the UK Mental Health Act, and you have some insights to share please do so in the comments section of this post. Alternatively, there is an email address listed on my profile page. I will gather up any words of wisdom and pass them on to that mum.

Thank you.

The E-Sangha Buddhist Community

2008-10-06T01:45:00.000-07:00

Once more, I have been banned from an online community:
the E-sanga Buddhist Community.

My crime? I've got a hunch I wasn't pushing the agenda someone else wanted me to push. I was banned and the posts that I'd made dissappeared from that discussion even though every single one was related to schizophrenia and recovery. An example of the type of posts that had been posted can be found here: Schizophrenia & Suicide. (The data on suicide and schizophrenia were reposted elsewhere but I've since added posts I'd put a substantial effort into at the bottom of this blog entry.)

Update 1: This morning my access was partially restored without explanation -- I can access my mailbox but can't make any posts. I'm still not certain what it was that caused the moderator to react so strongly but I think I would feel more comfortable not participating any further at the E-Sanga Buddhist Community. I did enjoy the conversations I had taken part in and I enjoyed getting to know a few other people. I was a member for approximately 72 hours.

Update 2: The message below was in my outside mailbox this morning. I logged back in long enough to respond.

Hello spiritual_emergency,
Please read the TOS about commenting in a thread about a Moderator action. You have been suspended for one day, and your Warn Level raised due to your posts about moderation in the Schizophrenia thread in the Help Forum. You are welcome back to participate in threads after that period.

cooran

When cooran initially commented in that thread it was to note: Please remember that ... the aim is to assist the Original Poster. I asked how she knew if the poster was being helped -- apparently, this is where I violated the commandment, "Thou shalt not challenge the moderator's authority".

At the time cooran made her decision, the original poster appeared to have not been back since initiating the discussion and had not commented any further in that thread. As a result, there was, in fact, no means of determining if he had found the ensuing conversation to be of personal assistance. cooran was the one who determined what would be helpful to him and then shut the conversation down by banning participants and removing posts at her discretion.

Of all the posts made in that thread since Oct 3, only one was permitted to stay; a post made last night which included this bolded statement: take your meds. What was it about that post in particular that caused cooran to feel it was the only "helpful" post that had been offered to the original poster out of the many that were made over the span of three days?

I've since been advised there is a past history between cooran and another contributor to that conversation. As a result, it's possible I was merely a pawn in the moderator's game of control. This prior conflict came to light moments later when that individual was cornered by cooran in a thread related to trauma and recovery and asked to present her certifications for speaking with authority on PTSD. The poster noted she was a victim of terrorism and that she had been speaking from the position of having PTSD -- not as a professional expert. In spite of which moderator cooran still came back to quote the medical disclaimer on the site and insist that the poster provide personally revealing information in accordance with the moderator's demand. It's not difficult to recognize the abuse of power.

My response to cooran:

I don't believe I'll be participating any further, cooran. You state that the purpose of the discussion was to help xxxxxxx and as far as I knew, I was doing precisely that.

Bear in mind that xxxxxxx had originally titled the topic "Schizophrenia, or there is more to it". This suggests to me that he was open to a conversation that demonstrated that "more". What made you so certain that xxxxxxx would not be helped by reading the conversations of two individuals who had undergone the experience of psychosis and recovered from it? Or studies related to neuroleptic medication and suicide rates?

If you were concerned that the conversation was drifing off-topic it might have been more respectful to nudge it back in place with a public reminder or private message as opposed to banning me and removing all those posts from the thread with no explanation other than that I had said something to offend you.

I have been banned from other online communities cooran. Many people are uncomfortable with the information I have to share. I've also been harassed, threatened, stalked -- I always like to point out to people that behavior never came from schizophrenics, it came from psychiatrists, psychologists, occasionally people who work in the sidelines of the mental health industry... but never from schizophrenics.

At this point in time I no longer feel comfortable participating at this community. I've made note of my experiences on my blog, shared my experience with a number of individuals in the mental health community and that will be the end of my interactions with the E-Sangha Buddhist Community.

Regards.

spiritual_emergency

Update 3: Ahhh. I've been informed that cooran works as a social worker. Perhaps that explains her actions. I've seen such tactics before. Some professionals prefer their "schizophrenics" to be humbled and compliant. If they're not, they find a way to punish them, to force them to acquiese to their control. It's disturbing behavior to witness, particularly in a professional but it happens quite routinely. In addition to being painful and damaging to the targeted individual it also casts an unsavory light upon the entire profession.

Music of the Hour: The Killers: Human

See also:
Bias & Stigma Within the Mental Health Community

schizophrenia.com

How This Blog Got Started

Voices of Recovery

Member: A lot of the meds that have come out in recent years, such as Geodon, have little or no side effects.

Please note, the second generation atypicals have different side effects. While it's true that movement disorders are less frequently attributed to them, metabolic disorders (i.e. diabetes) and pulmonary complications (i.e., sudden cardiac arrest) are linked more strongly with the newer neuroleptics.

This does not discount the reality that many people identify antipsychotic medication as personally helpful, however they are entitled to an accurate portrayal of their risks. Stating that the newer atypicals have little or no side effects is simply not accurate.

No offense intended, I just wished to clarify that statement.

Member: Spiritual Emergency, you've said nothing about the statistics of the side effects you've mentioned or compared them with the suicide rates we've seen on this thread...

...Many psychiatrists try to frighten families into keeping the person on medications by saying 10% of people with schizophrenia commit suicide. If you are told that, ask to see evidence proving that the statistic is accurate. The truth is, national statistics on suicide disprove that statement. There is no documented evidence supporting the assertion that 10% of people with schizophrenia commit suicide. If that was true, there would be over 250,000 suicides recorded in the United States every year instead of the 30,000 reported for all causes.

Source: A Special Message for Family & Friends

======================

Most Frequent Suspect Drugs in Deaths 1998 - 2005 [FDA Report]

Oxycondone (Opiate): 5,548
Fentanyl (Opiate): 3,545
Clozapine (Anti-psychotic): 3,277
Morphine (Opiate): 1,616
Acetaminophen (Analgesiac): 1,393
Methadone (Opiate): 1,258
Infliximab (Anti-rheumatism): 1,228
Interferon beta (Immunomederator): 1,178
Risperidone (Anti-psychotic): 1,093
Etanercept (Anti-rheumatism): 1,034
Paclitaxel (Atineoplastic): 1,033
Olanzapine (Anti-psychotic): 1,005]
Rofecoxib (Anti-inflammatory): 932
Paroxetine (Anti-depressant): 850

Source: Adverse Events [PDF File]

======================

... researchers in Ireland reported in 2003 that since the introduction of the atypical antipsychotics, the death rate among people with schizophrenia has doubled. They have done death rates of people treated with standard neuroleptics and then they compare that with death rates of people treated with atypical antipsychotics, and it doubles. It doubles! It didn't reduce harm. In fact, in their seven-year study, 25 of the 72 patients died.

Source: Chemical Warfare: An Interview with Robert Whitaker

======================

... There is an excess of death from natural causes among people with schizophrenia. Aims Schizophrenia and its treatment with neuroleptics were studied for their prediction of mortality in a representative population sample ... During a 17-year follow-up, 39 of the 99 people with schizophrenia died. There is an urgent need to ascertain whether the high mortality in schizophrenia is attributable to the disorder itself or the antipsychotic medication.

Source: Neuroleptic Medication & Mortality

======================

... A study in France found that excess in mortality among patients with schizophrenia was, among all variables studied, most directly correlated with the dosages of antipsychotic medication received. In the United States, high rates of death, and especially of fatal injury, have also been reported in people treated with antipsychotics. Further, a study from Finland found that the number of antipsychotic drugs used correlated with mortality...

Source: An Outcome Measure in Schizophrenia: Mortality [PDF File]

======================

Member: I would also like to say that side effects are published (and as you can see on this thread, available on the Web) and, in my experience, lists are made available every time a patient purchases a prescription drug.

In 2002, British and Japanese regulatory agencies warned that Zyprexa may be linked to diabetes, but even after the FDA issued a similar warning in 2003, Lilly’s Zyprexa train was not derailed, as Zyprexa posted a 16 percent gain over 2002. The growth of Zyprexa has become especially vital to Lilly because Prozac—Lilly’s best-known product, which once annually grossed over $2 billion—having lost its patent protection, continues its rapid decline, down to $645.1 million in 2003.

At the same time regulatory agencies were warning of Zyprexa’s possible linkage to diabetes, Lilly’s second most lucrative product line was its diabetes treatment drugs (including Actos, Humulin, and Humalog), which collectively grossed $2.51 billion in 2003. Lilly’s profits on diabetes drugs and the possible linkage between diabetes and Zyprexa is not, however, the most recent Lillygate that Gardiner Harris broke about Zyprexa in the New York Times on December 18, 2003.

Zyprexa costs approximately twice as much as similar drugs and Harris reported that state Medicaid programs—going in the red in part because of Zyprexa— are attempting to exclude it in favor of similar, less expensive drugs. Harris focused on the Kentucky Medicaid program, which had a $230 million deficit in 2002, with Zyprexa being its single largest drug expense at $36 million. When Kentucky’s Medicaid program attempted to exclude it from its list of preferred medications, the National Alliance for the Mentally Ill (NAMI) fought back. The nonprofit NAMI—ostensibly a consumer organization—bused protesters to hearings, placed full-page ads in newspapers, and sent faxes to state officials. What NAMI did not say at the time was that the buses, ads, and faxes were paid for by Eli Lilly.

Source: Eli Lilly, Zyprexa & The Bush Family

======================

... You've heard the hype: New psychiatric drugs like Zyprexa and Risperdal, called atypical antipsychotics, are a vast improvement over old drugs like Haldol. Whether or not the new drugs work any better, they make a lot of money for the drug companies. While a month's supply of an old drug like Haldol costs less than $30, a month's supply of Zyprexa can cost over $500.

To determine if these drugs are worth their outrageous price, the National Institute of Mental Health conducted one of the largest and longest independent studies ever, the Clinical Antipsychotic Trials of Intervention Effectiveness, or CATIE. Four years and $44 million later, the CATIE study, published in September 2005, reached a startling conclusion: the new drugs "have no substantial advantage" over the old ones.

Source: CATIE & You

======================

... Every psychiatric expert involved in writing the standard diagnostic criteria for disorders such as depression and schizophrenia has had financial ties to drug companies that sell medications for those illnesses, a new analysis has found.

Of the 170 experts in all who contributed to the manual that defines disorders from personality problems to drug addiction, more than half had such ties, including 100 percent of the experts who served on work groups on mood disorders and psychotic disorders.

Source: Experts Defining Mental Disorders Are Linked to Drug Firms

======================

... The big finding is that people with schizophrenia are losing brain tissue at a more rapid rate than healthy people of comparable age. Some are losing as much as 1 percent per year. That’s an awful lot over an 18-year period. And then we’re trying to figure out why. Another thing we’ve discovered is that the more drugs you’ve been given, the more brain tissue you lose.

Q. WHY DO YOU THINK THIS IS HAPPENING?

A. Well, what exactly do these drugs do? They block basal ganglia activity. The prefrontal cortex doesn’t get the input it needs and is being shut down by drugs. That reduces the psychotic symptoms. It also causes the prefrontal cortex to slowly atrophy.

Source: Using Imaging to Look at Changes in the Brain

======================

... Both typical (first generation) and atypical (second generation) antipsychotics are associated with an increased risk of stroke, Douglas said. "This risk is substantially higher in patients with dementia than those without. These findings need to be factored into prescribing decisions made by doctors caring for patients with often-distressing and difficult-to-treat psychiatric symptoms."

The risk for stroke was slightly higher for people taking the newer atypical antipsychotics, compared with people taking the older typical antipsychotics. Atypical antipsychotics include drugs such as Abilify, Clozaril and Zyprexa. Typical antipsychotics include Thorazine, Haldol and Clopixol.

Source: Antipsychotic Drugs Boost Stroke Risk

======================

... Both in vivo and post-mortem investigations have demonstrated smaller volumes of the whole brain and of certain brain regions in individuals with schizophrenia. It is unclear to what degree such smaller volumes are due to the illness or to the effects of antipsychotic medication treatment. Indeed, we recently reported that chronic exposure of macaque monkeys to haloperidol or olanzapine, at doses producing plasma levels in the therapeutic range in schizophrenia subjects, was associated with significantly smaller total brain weight and volume, including an 11.8–15.2% smaller gray matter volume in the left parietal lobe.

Source: Neuroleptics & Gray Matter

======================

... As for the abnormalities that researchers have found with brain scans, Mosher thinks the antischizophrenic medication accounts for much of this. He says, "The Germans, who invented neuropathology, looked at the brains of thousands of schizophrenics before there were any neuroleptics. And they were never able to find anything. They never reported increased ventricular volume, which at postmortem you can measure quite easily. And they also never reported any specific cellular pathology, and they studied many, many, many brains." He adds that "there are a whole lot of people who don't have schizophrenia and also have enlarged ventricles. And there are people who have other psychiatric conditions who have enlarged ventricles, and there are a number of known causes of enlarged ventricles that are not schizophrenia. So, yes, there is a statistical difference, but it is not specific."

"On the other hand," Mosher continues, "there are studies that have shown that people treated with neuroleptics have changes in brain structure that are at least associated with drug treatment, dosage, and duration -- and have been shown to increase over time as drugs are given." He cites one "horrific study" of children between the ages of 10 and 15 in which the researchers measured the volumes of the kids' cortexes. "The cortex is what you think with, the part on the outside," Mosher explains. Over time, "They watched the cortical volume of these young people decline, while the cortical volume of the nonschizophrenic controls was expanding because they were adolescents and still growing." The researcher concluded that their schizophrenia had caused the decrease in the subjects. "And yet every single one was taking neuroleptic drugs," Mosher says. ...

Today Mosher calls himself "a lapsed psychiatrist" because he thinks the biological explanations of psychotic behavior embraced by so many of his colleagues resemble a religion more than they do a body of science. From his perspective as a heretic, he reflects, "We are all afraid of going crazy. And as long as we have someone out there who can sort of do that job for us, it's not our burden." He thinks it's comforting to believe schizophrenics act the way they do because their brains are diseased. Biological differences "make them different from us fundamentally," he says. "They're sort of a slightly different race than we are." Mosher thinks it's all "a way of carefully saying, 'These people are really different. And therefore we have the right to do whatever we goddamn please with them.'"

Source: Still Crazy After All These Years

======================

In closing, while I would agree that the death rate among individuals suffering with schizophrenia should be a concern, I'm not certain that my concerns about the cause of those deaths are in alignment with your own. Nor do I feel that long-term antipsychotic medication is the best method of treatment although it may be very effective over the short-term.

None of this discounts the fact that many people identify antipsychotic medication as personally helpful to them, but many of them don't trust the industry that markets the drugs, for good reason. That industry has a history of cover-ups and deception.

Member: I’m interested in your opinion of this, “Drug Treatment of Schizophrenia,” which is provided by the Harvard Medical School Family Health Guide.

When it comes to treatment, I am always going to be biased towards successful treatments that do not include medication or that minimize the use of medication. This is because we know without a doubt that the use of neuroleptic medication comes with a significant bevy of short and long-term side effects in addition to an inflated cost that is breaking the backs of smaller healthcare networks. In addition, there is a high rate of medication non-compliance. As but one example, in the recent CATIE study, 79% of the subjects taking Geodon stopped taking it because they could not tolerate the side-effects.

Some examples of successful treatments with minimal or no medication include:

Diabasis: Diabasis was an experimental project in San Francisco. It was a residence facility that lived through three years and more of inpatient work with acute "schizophrenic" episodes in young adults without the use of medications, always as part of the county's community mental health system. Its purpose was to provide a home in which clients might have the opportunity to experience with full awareness their deepest processes during this intense turmoil. The recovery rate was 85%.

Soteria: Like Diabasis, Soteria was a home-like treatment facility that attempted to support individuals through their crisis. The Soteria paradigm was the effort of the late Loren Mosher, the first Chief of the Center for Studies of Schizophrenia at the National Institute of Mental Health. Mosher also founded the Schizophrenia Bulletin and for ten years he was its Editor-in-Chief. "At 2 years post-admission, Soteria treated subjects ... were working at significantly higher occupational levels, were significantly more often living independently or with peers, and had fewer readmissions; 571/16 had never received a single dose of neuroleptic medication during the entire 2-year study period.

Turku, Finland: A few years ago at a psychiatric clinic in Turku, Finland, it was decided to compare the outcome for first time psychotic patients if they got neuroleptics, with the outcome if they did not get the drugs. But first all the patients were granted three drug-free weeks. The plan was to have about ten patients in each of the two groups. However, the study could not be carried out. After the three weeks without neuroleptics virtually all the patients had overcome the psychosis, and the drug no longer appeared justified.

Open Dialogue Treatment: Jaakko Seikkula, Ph.D. is a professor at the Institute of Social Medicine at the University of Tromso in Norway and senior assistant at the Department of Psychology in the University of Jyvskyl in Finland. Between 1981-1998, he worked as a clinical psychologist at the Keropudas hospital in Finland where he and colleagues developed a highly successful approach for working with psychosis known as Open Dialogue Treatment (OPT). The approach de-emphasizes the use of drugs and focuses instead on developing a social network of family and helpers and involving the patient in all treatment decisions. 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. Official government statistics comparing 22 health districts in Finland found that Dr. Seikulla's district was the only one not to have any new chronic hospital patients in a two year period and led the National Research and Development Center for Welfare and Health to award a prize for "over ten years ongoing development of psychiatric care".

==========================================

If you examine those programs in more depth you're going to find that in addition to a significantly higher recovery rate, a critical difference can also be found in the attitudes that fueled the approach of the founders.

For example, both Diabasis and Soteria were treatment facilities set up in homes not institutionalized settings. One of the tenets of Open Dialogue Treatment is that the treatment team meets with the individual in crisis in their home. In all cases, hospitalization -- which weakens one's social connections, so critical to recovery -- is avoided. Individuals in crisis were also seen as partners in the process, not as inferior subjects whose behavior had to be controlled or manipulated in a certain direction. When treatment decisions were made, individuals in crisis were included in the treatment decisions. In addition, the environment was hopeful -- psychosis was viewed as a temporary crisis not a permanent condition. These points only begins to touch on some of the underlying attitudinal differences between these type of successful treatment programs and those that rely on hospitalization, stigmatization, isolation and medication.

Overall, I believe that the most successful treatment would offer care in the home or a home-like environment. It would recognize the "patient" as an expert in their own experience and work with them to understand and integrate the experience. It would also offer support to the "patient's" larger social circle, typically comprised of family, friends, and even, coworkers. Until all of those factors are in place, I don't think we should even be considering medication. In truth, I believe it should be absent or very minimal during the first weeks of crisis. If an individual understands the process they are going through; knows that others have successfully passed through the same crisis states; if they are responded to with empathy and care, these factors can reduce anxieties and fears as well as or better than sedation.

If it was determined by all team members (including the individual in crisis) that medication would be helpful, at that time, choices would be made as based on individual need and obvious indications of improvement. Any medication provided would be given for as short a term as possible. In addition, efforts would be made to ensure that social connections remained in place or were strengthened.

The above treatment principles might not make big pharma happy, but they seem to produce greater happiness in "schizophrenics".

schizophrenia.com

2008-01-13T04:28:00.000-08:00

In the links section of my blog I have an area related to discussion forums. I added that area because I recognize that many people benefit from the opportunity to talk with others who can identify with their personal experience. They can also benefit from the information sharing that can take place in such an environment.

Before I'm willing to add a link to a discussion forum however, I check it out. I'm looking for a few specific qualities:

The first quality I look for is civility. I'm not going to post a link to a forum where flaming, harassment, stalking, etc. are commonplace.

The second condition I look for is expression. Are participants allowed to express their experience in their own terms or are they constantly receiving messages that their experience and means of expression are unacceptable?

A third characteristic I look for is quality information. When information is shared I want to see good information, preferably backed up with links to reputable sources.

The fourth, and final quality I'm looking for is balanced moderation. There will be times in the best of online environments when moderators must take action. I want to see that occurring when absolutely necessary (such as the removal of spam or abusers), but I don't want to see it occurring to such a degree that it's inhibiting free discussion.

Recently, at one of the forums I do participate in sporadically, someone posted a link to the discussion forum of schizophrenia.com. I had been to the site before but wasn't aware that they offered support forums. And so it was that I decided to test the waters...

My first comment was in regard to an Australian woman who had found a treatment program that works well for her. Given the links that are being identified between various forms of trauma and schizophrenia I thought her mention of childhood trauma was interesting and shared this quote in response:

The cornerstone of Read's tectonic plate-shifting evidence is the 40 studies that reveal childhood or adulthood sexual or physical abuse in the history of the majority of psychiatric patients (see, also, Read's book, Models of Madness). A review of 13 studies of schizophrenics found rates varying from 51% at the lowest to 97% at the highest.

Source: The Guardian

A moderator, SZ Admin, responded to offer agreement that "There is definitely a strong link between high levels of stress and trauma and psychosis," however he disagreed that child abuse was a contributing factor. He suggested I read an analysis of Read's work as written by a professor in San Francisco.

I read it, but I didn't agree with it. After all, you're going to have to present a very strong rebuttal to counteract 40 different studies and I didn't feel he had done so. I shared my opinion with the moderator at which point I was chastised: Unfortunately, your comment reveals that you don't actually read or understand what the link I provided on the topic of child abuse and schizophrenia. I hope you can put more effort into understanding what we have on the site here.

Part of the problem is that Read didn't single out child abuse as the sole cause of stress or trauma and neither did I. In fact, I had specifically pointed out Read's emphasis on stress and trauma as contributing factors. The other problem is, am I not entitled to form my own opinions or must my opinion be in alignment with the moderators if I don't wish to be labeled as incapable of reading or understanding?

Meantime, I had made another post as related to the work of Jaakko Seikulla. At this point a second moderator, assistant admin, appeared and invited me to take a "quiz" to test my knowledge of schizophrenia. I was advised that I should pay particular attention to question #7. I clicked the link and was greeted with this message:

Do you have all the facts straight on schizophrenia? Test your knowledge and find out with this quiz!

http://www.healthcentral.com/schizophrenia/quizzes.html

I'm always up for learning new facts so I was down with the quiz. Here we go -- question #1...

To be diagnosed with schizophrenia, a person must:

A: Test positive on a blood test.

B: Experience psychotic, loss-of-reality symptoms for at least six months.

C: Have a "split personality."

D: Be under 30 years old.

Ummmm. Do you see a problem? The correct answer is none of the above although answer B does come close. However, the actual answer is that in order to be diagnosed with schizophrenia, positive or negative symptoms must be present for a minimum of six months. Yet according to the quiz, one must be actively psychotic for six months straight.

Let's think about that... imagine you're experiencing psychosis and are taken to the hospital. Are you placed on observation for six months without treatment? No, of course not. You're given anti-psychotic medication, almost immediately. And what do anti-psychotic medications do? They knock down the psychosis. I've never heard of anyone who has experienced six months of straight psychosis while in medical care. While it's possible that some people might have experienced the same who have never seen a psychiatrist or taken medication, those individuals wouldn't be included in the statistics because they haven't been diagnosed.

I continued with the rest of the quiz and emerged with a score of 10 out of 10 but I also shared my concern with the moderators that the quiz was presenting misinformation.

As for question #7, it stated flat out that psychotherapy is only useful for those with less severe symptoms or those whose psychotic symptoms were under control. Apparently, we are to completely dismiss the work of clinicians like Jaakko Seikulla because the quiz told us so.

Ongoing research shows that over 80% of those treated with the approach return to work and over 75% show no residual signs of psychosis. Official government statistics comparing 22 health districts in Finland found that Dr. Seikulla's district was the only one not to have any new chronic hospital patients in a two year period and led the National Research and Development Center for Welfare and Health to award a prize for "over ten years ongoing development of psychiatric care".

Meantime, I was curious about the quiz writer and since a link was offered, I clicked on that and was transported to the personal profile of Christina Bruni. Ms. Bruni is a diagnosed schizophrenic who presents herself as in remission -- good for her is all I can say. Meanwhile, one of the items I read on her profile alarmed me:

One Friday night, she became paranoid and had racing thoughts, and exhibited odd behavior all night, unable to sleep. The next morning, her mother drove Christina to the ER, where she was diagnosed with schizophrenia and placed on the psych ward.

Everyone remembers the correct answer to quiz question # 1, right? Did Ms. Bruni omit some critical details for the sake of brevity or was she really diagnosed with schizophrenia as based on a mere 24 hours of symptoms? That's a disturbing thought, isn't it?

Having been formally baptized into the wonderful world of schizophrenia.com by the quiz, I wondered, was this their idea of the epitome of knowledge and information?

[Update: This thread has since been substantially edited by SZ Admin. assistant admin's response to me has been removed, as have my responses to them. In its place stands a new response from SZ Admin that he made after he banned me with the full knowledge that I cannot possibly respond to it. Seikulla's work meantime has been called out for being "dated" in spite of the fact that it's only a few years old whereas the paradigm of non-recovery that SZ Admin clings to so ferociously has been around for more than a century.]

Moving on...

In the area of the site dedicated to book recommendations I suggested Robert Whitaker's Mad in America. The post was deleted. For the sake of politeness I suggested that I had accidentally forgotten to make the post and only previewed it instead (there is no preview option). I re-posted my recommendation. SZ Admin tagged it with a scathing rebuttal from E. Fuller Torrey.

I responded that I'd had trouble taking Torrey seriously ever since he came out of the closet with his cat-poop theory on schizophrenia, and that I was especially dismayed by the techniques of his Treatment Advocacy Center (TAC)"who may rightly attempt to address the needs of the very small proportion of schizophrenic individuals who are violent while systematically tarring the entire lot with the same brush and thus, contributing to the ongoing stigma of the vast majority of schizophrenic individuals who are not the least bit inclined to violent outbursts."

I included a lengthy quote from Dr. John Grohol who addressed those issues very well, including giving a firm reprimand to the TAC "for their fear-mongering ways and promoting the “10 times more likely” number as fact."

SZ Admin came along to trim that quote back to nothing but a link although the Fuller quote was allowed to stand in its entirety. The thread was then locked.

[Update: The posts I'd made recommending two books (Whitaker's Mad in America and John Weir Perry's Trials of the Visionary Mind) have since been removed by the administrators.]

By this time, I'd noticed that a couple of the posts I was certain I had made had disappeared so I was quite intrigued when another user by the name of lunar_wire initiated a thread titled: What They Don't Want Discussed. He noted that he'd been there a few months previously but left when the moderators began deleting his posts and insulting him. That sounded rather familiar.

Meantime, the moderators carried on gleefully: editing posts, radically modifying posts, deleting posts, locking threads. I saw more posts deleted and amended in one 24 hour period than I've seen in the entire history of other sites.

Overall, I can best sum up the moderators' behavior as disturbingly cultish.

To heighten our awareness, Them and Us identifies four basic cult behaviors that influence our thinking:

1) compliance with a group,
2) dependence on a leader,
3) avoiding dissent, and
4) devaluing the outsider.

These forces operate in all aspects of society. The core process is devaluing the outsider, resulting in Them-versus-Us behavior.

Source: Them & Us

At the end of the day, how did schizophrenia.com score?

Civility: I have to give credit where credit is due. With the exception of the moderators, the participants were kind, courteous, supportive and empathic.

Expression: Expression is only permitted within a narrow framework as defined by the site moderators. Any other personal perspective will be modified or deleted by the moderators.

Quality Information: The schizophrenia.com site is large and I'm not in any position to determine the quality of every single article there. You've already seen what I saw, so I suggest you make your own decision as to the quality of the information offered.

Balanced Moderation: It was the most controlling and heavily moderated environment I have ever witnessed in any online community.

schizophrenia.com will make it to my links section, but only in the warning section.

A very intelligent user from the schizophrenia.com site happened to pass a few details on that I thought were quite interesting. That user wished to express that they didn't agree that the mods behavior was cult-like although they thought I had some valid points. They also noted that most of the posters adhere to the genetic/biological model and E. Fuller Torrey, who advocates that schizophrenia is due solely to biological factors, has a number of supporters there including those who consider him to be "God-like". (I guess that explains why my cat-poop comment didn't go over so well.)

I felt their comments strengthened my comparison considerably.

four basic cult behaviors that influence our thinking:

1) compliance with a group: In this case, the group is composed of a dominant mindset: the genetic/biological model

2) dependence on a leader: E. Fuller Torrey seems to fit well here.

3) avoiding dissent: My experience and the experiences of others, such as the individual identified as lunar_wire, are an excellent testament to this point. The last time I looked at that discussion, the members themselves we're getting into the fray. lunar_wire was accused of being a "scientologist" who should "get off you ass" and "stop posting all your crap". I noted, with some concern, that these personal attacks were ignored by the moderators. Apparently, these same actions have been taken against lunar_wire before and he only returned because he's concerned about others not getting the opportunity to be exposed to anything other than the genetic/medical model.

4) devaluing the outsider: This was evident in the very first response SZ Admin made to me: "you don't actually read or understand. The implication is that I'm dumb; I'm stupid; I don't know how to read; I'm the new kid on the block and they're going to push me around. The problem was, within the Them & Us model, I had identified myself as a "Them" by my unwillingness to comply with their mindset. This was then confirmed by the local authority, the primary administrator. From there on in, it was open season... on me.

Within a healthy environment a range of differences are easily tolerated within a broad spectrum. Within an unhealthy environment however, the spectrum narrows considerably and any deviation must be punished. The dissenter must be brought back under the control of the prevailing mindset for the mere fact that he/she is different could lead others away from the fold and this would weaken the stability of the core group. For this reason, being different is equated with being threatening.

I highly recommend the Them & Us article to everyone for this exact same dynamic unfolds in numerous relationships within our public and personal lives; not necessarily within a cult setting. Such relationships always rely on a power imbalance as a means of either forcing compliance or punishing non-compliance. In the old days, town authorities might round up a posse while townsfolk would start to gather stones. Within the online environment, moderators-as-authorities use their tools of selective censorship, banning, and scapegoating while those within the community begin to gather into a henpeck. There is a price to be paid for being different.

Does that mean that individuals who find the "genetic/biological" model to be most relevant for them shouldn't get together to swap notes, share stories, and offer support? Not at all. The problem here is that the site presents itself as a model of inclusiveness when it isn't -- it's highly exclusive. It's quite possible that the problem is that if it advertised itself as the exclusive model it is, it might not get as many members. Not only would that reduce the potential membership, it might even go so far as to affect ad-generated revenue that the site might be dependant upon to function.

Meanwhile, how many individuals might wander in there who are a little bit different and find themselves bullied, scapegoated, hounded, silenced, and pushed around as a result? I think it's particularly reprehensible when these kind of actions take place in environments that are supposed to be "healing". Those kind of environments tend to produce a lot of scars.

What's really interesting about this particular little scenario is that right away, I picked up on the theme that "scientologists" are the bad guys, because they're a cult. What the moderators seem blithely unaware of is that they have internalized this exact same dynamic and are possessed by it; their very behavior mirrors that which is the mainstay of a cult dynamic.

Not healthy. Nope. No way.

It's interesting to note that the board moderator has since issued a blanket-wide warning in regard to Anti-Science, Anti-Progress, and Anti-Psychiatry People. My name was mentioned once or twice and just in case there was any doubt about what camp I was in, my name was specifically linked to Thomas Szasz, a confirmed enemy of the genetic/medical model. I've never read Thomas Szasz and I don't believe there is a single quote or link to him or any of his material on any of my blogs. Still, I'm starting to get the feeling that maybe I should track down some of his books.

See also:

In search of true healing (My second experience of schizophrenia.com)

Bias & Stigma Within the Medical Community?

schizophrenia.com, Schizophrenia Discussion, Schizophrenia Forums, Cult Behavior

Dr. Brant Cortright: An Integral Approach to Spiritual Emergency

2007-10-05T20:11:00.000-07:00

One of the most dramatic and fascinating ways that psychology and spirituality come together is in the phenomenon of spiritual emergency. This appendix brings the integral model to bear on the issue of spiritual emergency in the hopes of bringing some theoretical order and clarity to this puzzling experience.

Image Source

For the vast majority of people, opening to spiritual experience is a welcome and easily integrated process. However, for a small minority, spiritual experience occurs so rapidly or forcefully that it becomes destabilizing, producing a psycho-spiritual crisis. This is where spiritual emergence becomes spiritual emergency.

All the world’s spiritual traditions warn about different dangers along the way, the “perils of the path.” New and expanded states of consciousness can overwhelm the ego. An infusion of powerful spiritual energies can flood the body and mind, fragmenting the structures of the self and temporarily incapacitating the person until they can be assimilated. With kundalini awakening, for example, there is an inrush of energies along the spine and throughout the body that can overwhelm and incapacitate the ego and leave the person adrift in a sea of profound consciousness changes at every level – physical, emotional, mental. Spiritual systems have identified numerous types of spiritual crises in which the ego’s usual coping mechanisms are overcome.

Transpersonal psychology has shown how these crises are a kind of non-pathological developmental crisis that can have powerfully transformative effects on a person’s life when supported and allowed to run their course to completion (Grof & Grof, 1989; Lukoff, 1998; Cortright, 1997; Perry, 1976). The idea of spiritual emergency has gained prominence in the last decade. It includes phenomena ranging from the opening to psychic or paranormal abilities to the emergence of various kinds of altered states of consciousness.

Spiritual emergency was once dismissed by the psychiatric and psychotherapeutic establishment as merely a form of mental illness, requiring immediate medication and hospitalization in order to end it as soon as possible. This misdiagnosis and mistreatment aborted an otherwise growthful process of psycho-spiritual change. There have been numerous reported cases of individuals having their process frozen through medication and attendant psychiatric treatment. When the process becomes suspended like this, the individual is unable to complete the process and ends up feeling shamed and hurt by the misdiagnosis and mishandling, sometimes feeling doomed to having a lifelong mental illness which is actually but an artifact of this iatrogenic mistreatment.

Spiritual emergency is one area where the field of transpersonal psychology has had a significant impact on the larger field of psychology and psychiatry. The most recent edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM IV), with the guidance of several transpersonally oriented psychologists and psychiatrists, now includes spiritual emergency as a diagnostic category under the classification “Spiritual or Religious Problem”, a non-pathological V Code which may be a focus of treatment. This represents a considerable change in attitudes in the mental health community toward religion and spirituality.

However, despite this inclusion into the DSM IV, there has been little impact upon clinical practice in terms of how the mental health field as a whole treats spiritual emergency. In part this is due to the lack of training and education about this process in the mental health field, and in part this is due to confusion that exists about the phenomenon itself.

There are three major theoretical and clinical problems in this area. The first is the number and types of spiritual emergency. The current classificatory schemes are complex and cumbersome. The most widely used classification of spiritual emergency originated with the Grofs’ book Spiritual Emergency (Grof & Grof, 1989), in which 10 categories of spiritual emergency are listed including: shamanic crisis, the awakening of kundalini, episodes of unitive consciousness, psychological renewal through return to center (a particular form of psychosis), the crisis of psychic opening, past-life experiences, communications with spirit guides and “channeling”, near-death experiences, encounters with UFOs, and possession states. These categories are phenomenological descriptions based on how people undergoing a spiritual emergency describe them; no claims are made for their objective validity.

Lukoff, Lu, and Turner (1998) list 23 categories of spiritual emergency, adding such things as loss of faith, joining or leaving a New Religious Movement or cult, questioning of spiritual values, meditation-related problems, and others that are concomitant with DSM-IV mental disorders. Nelson (1990) also includes Washburn’s (1988) regression in the service of transcendence as another type, such as is often seen during the mid-life crisis. Additional categories have been reported by others in the field. The Spiritual Emergence Network has identified “guru attack”, the death and dying process, and addictions. The DSM IV scheme for identifying such problems that are concurrent with other diagnostic categories makes for over 50 possible types.

These ways of organizing the field of spiritual emergency are clinically confusing and theoretically inconsistent. As it now stands, the category of spiritual emergency is a jumble of dissimilar categories, ranging from the deepest psychotic process to the highest states of mystical realization. How can a clinically meaningful diagnostic classification emerge from such widely different levels of functioning? Is it possible to make sense of these very disparate phenomena? Is there a simpler way to organize this field that reflects a deeper order to this process? Can the whole phenomenon of spiritual emergency be organized into a coherent whole? That is the first task of this appendix.

A second problem confronting the clinician who is dealing with clients in various degrees of psycho-spiritual crisis is determining how best to intervene. What interventions can most effectively facilitate this process so it can develop optimally? For some types of spiritual emergency certain interventions are indicated, while for others the exact opposite is required. How can we best match intervention strategies with appropriate differential diagnoses? Suggesting meaningful treatment strategies is the second task.

A third problem is how to ascertain what is actually going on for a client. Depth psychology gives us a great appreciation of the psyche’s capacity for fantasy, imagination, and self-deception. For many people, the self-diagnosis of a spiritual emergency is much more appealing than that of, for example, paranoid schizophrenia. What portion of these phenomena are true spiritual infusions of higher energies and mystical states, what portion consists of images and fantasies from the collective unconscious, and what part are eruptions from the individual’s personal unconscious?

A New Way of Viewing Spiritual Emergency

Taking a simplified version of an integral schema of the psyche, various types of spiritual emergency can be viewed as being centered at a particular level of consciousness. This proves useful theoretically as a framework for organizing the entire field of spiritual emergency. It also proves clinically useful by providing a basis for assessment and devising intervention strategies to assist the process toward resolution. It is important to recognize that there are no hard and fast boundaries between these levels of consciousness. Each level includes all that is above it but not below, and each level subtly shades into the next level in a mutual interpenetration along the edges.

Level 1: Conscious - Existential level: This is the most superficial level of consciousness, our ordinary awareness of self and outer world.

Level 2: Personal Unconscious level: Following Freud, this is the plane of consciousness which western psychology has explored most thoroughly. Though psychoanalysis has made the most detailed study of this domain, the existential and humanistic psychology movements have also charted significant areas, such as the importance of the somatic domain, and have expanded our understanding of this level.

Level 3: Symbolic - Collective Unconscious level: The unearthing of the collective unconscious was Carl Jung’s great discovery. This level operates in images and symbols, and it is a dimension of consciousness that is shared by all human beings. It consists of the archetypes, universal forms or configurations of psychic potential that shape the psyche and organize psychological experience. This level is a meeting ground between the universal forces and the human psyche, a bridge which links the cosmic with the personal, a realm where universal forces take human form.

Level 4: Intermediate level: This is the realm of the inner (subtle) physical, inner vital, and inner mental planes that open to the larger, cosmic dimensions of the universe, beyond the physical creation. The philosopher Huston Smith (1976) notes in writing about the perennial philosophy that this intermediate level is a part of every major religious system in the world. It includes psychic phenomena such as ESP and clairvoyance. It is the domain of the spirit world that contains good and evil spirits (devas or angels and asuras or demons), ghosts and recently deceased souls, and fairies or nature spirits. This level encompasses different planes of nonphysical manifestation (or different bardos in Tibetan), including bissful heaven realms (or lokas in Hinduism) and painful hell realms. It includes the shamanic world, which has both higher regions and lower regions into which the shaman journeys. The intermediate level also involves the subtle body or astral body as well as the energy of kundalini and the chakras or energy centers within the human energy field (the aura.)

Level 5: Soul or Spirit level: The central being is the ground of consciousness. Above it is atman or Buddha nature, the eternal and non-evolving spirit that is one with the Divine and that part of us emphasized by the nontheistic systems such as Buddhism and kevela advaita vedanta. Below, here in the manifestation, it is the evolving soul or psychic center, our unique spiritual individuality, a spark of the Divine, which is highlighted by the theistic traditions of the world such as Christianity, Judaism, and Islam.

Levels of Consciousness and Types of Spiritual Emergency

Locating different forms of spiritual emergency within different levels of consciousness yields a framework in which to organize the various phenomena into more easily understandable categories. Further, by gearing intervention strategies to specific levels of consciousness, this gives us a key for both assessment and treatment.

For additional information, including specific suggestions for each level of consciousness one might be dealing with, read the rest of the article.

Source: An Integral Approach to Spiritual Emergency [PDF File]

See also:
Core Concepts in Transpersonal Psychology
Spiritual Emergency: A Useful Diagnostic Model?
Psychosis as an Altered State of Consciousness
Mania as Spiritual Emergency
The Far Side of Madness: Psychosis as Purposive

An Integral Approach to Psychotherapy

Music of the Hour: The Most Important Image Ever Taken

Schizophrenia & Hope

2007-09-26T23:54:00.000-07:00

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

Sean: BiPolar Crisis or Waking Up?

2007-08-02T19:47:00.000-07:00

A fascinating video series...

Part 1: The Start of the Journey

Part 2: Where Am I?

Part 3: Handcuffed

Part 4: Exit Strategy

Part 5: Are You Ready

See also: bipolar-or-wakingup.blogspot.com

Dr. Maju Mathews: Better Outcomes for Schizophrenia in Non-Westernized Countries

2007-05-05T17:39:00.000-07:00

We read with interest the article in the November issue by Srinivasan and Tirupati (1) reporting on their study of cognition and work functioning among patients with schizophrenia in India. We were fascinated by their finding that 67 percent of the 88 patients in the study were employed and that most of them were in full-time employment in mainstream jobs with minimal or no disability or support in the workplace.

These findings will seem alien to most psychiatrists in the Western world, particularly in the United States. Schizophrenia in Western societies is conceptualized as a "chronic debilitating illness" with a poor prognosis and a poor functional outcome. However, this conventional wisdom is not entirely true. At least two major international studies, the International Pilot Study of Schizophrenia (2) and the Determinants of Outcome of Severe Mental Disorders (3), have provided convincing evidence for a better outcome in India and other "less developed" countries than in the West. The multisite study of factors affecting the course and outcomes of schizophrenia in India found that 64 percent of the participants were in remission at a two-year follow-up and only 11 percent continued to be ill (4). Such numbers are likely to be reversed in the United States.

The emphasis in Western psychiatry is on symptom control or elimination and rarely on functional recovery. Patients with schizophrenia also face severe stigma, which makes it difficult for them to find mainstream jobs and very often keeps them on the fringes of society. In addition, the general public strongly associates schizophrenia with violence. Some of the stigma has been propagated by psychiatrists and other mental health professionals. The characterization of schizophrenia as a biological "disease" that needs to be managed mostly by pharmacologic means may also contribute to poor prognosis.

It is also possible that in Western societies, expectation and beliefs about mental illness and the operation of the health care system serve to alienate patients with schizophrenia from normal roles in society and to prolong illness. In contrast, beliefs and practices in non-Western societies may encourage short-term illness and a quick return to premorbid status. Thus prognosis may also be the result of culturally based self-fulfilling prophecies (4).

It is obvious that although schizophrenia may have a biological basis, good outcomes depend on a pharmaco-psycho-social approach, and the psychosocial aspect may well have the greatest impact on improved outcomes.

Maju Mathews, M.D., M.R.C.Psych., Biju Basil, M.D. and Manu Mathews, M.D.

Footnotes
Dr. Maju Mathews and Dr. Basil are affiliated with the department of psychiatry at Drexel University College of Medicine in Philadelphia. Dr. Manu Mathews is with the department of psychiatry at the Cleveland Clinic.

References
1. Srinivasan L, Tirupati S: Relationship between cognition and work functioning among patients with schizophrenia in an urban area of India. Psychiatric Services 56:1423–1428,2005[Abstract/Free Full Text]
2. World Health Organization: Schizophrenia: An International Follow-up Study. New York, Wiley, 1979
3. Sartorius N, Jablensky A, Korten A, et al: Early manifestations and first-contact incidence of schizophrenia in different cultures. Psychological Medicine 16:909–928,1986[Medline]
4. Verghese A, John JK, Rajkumar S, et al: Factors associated with the course and outcome of schizophrenia in India: results of a two-year multicentre follow-up study. British Journal of Psychiatry 154:499–503,1989[Abstract]
5. Waxler NE: Is outcome for schizophrenia better in nonindustrial societies? The case of Sri Lanka. Journal of Nervous and Mental Disease 167:144–158,1979[Medline]

Schizophrenia, Psychosis, Recovery, The Recovery Based Model, Cultural Differences in Schizophrenia, Psyche Bloggers Carnival

Dr. John Breeding: Hallucinations, Catatonia & Schizophrenia

2007-04-15T18:55:00.000-07:00

A highly informative video I found on youtube that's about 15 minutes long:

Hallucinations, Catatonia & Schizophrenia: Part 1

Hallucinations, Catatonia & Schizophrenia: Part 2

Hallucinations, Catatonia & Schizophrenia: Part 3

Dr. Breeding also has a website: wildestcolts.com

Schizophrenia, Psychosis, Recovery, Hallucinations, Catatonia, Trauma

Dr. Bertram Karon: Schizophrenia & Psychotherapy

2007-03-16T18:27:00.000-07:00

Bertram P. Karon, Ph.D., is a Professor of Clinical Psychology at Michigan State University. Dr. Karon received his A.B.from Harvard, his M.A. and Ph.D. from Princeton. He is a former President of the Division of Psychoanalysis of the American Psychological Association, and has over 150 publications. He was selected by the Washington School of Psychiatry as the 2001 Fromm-Reichmann memorial lecturer, by the US chapter of the International Society for the Psychological treatment of Schizophrenia and other psychoses as their 2002 Award for "profound contributions to our psychoanalytic understanding and humane treatment of patients with severe mental illness."

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 ...

BK: Right.

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]

See also:

The Effects of Medicating or Not Medicating on the Treatment Process

Schizophrenia, Psychosis, Recovery, Post Traumatic Stress Disorder, Hope for Schizophrenia Sufferers, Psyche Bloggers Carnival

How I Tamed the Voices in My Head

2007-03-06T16:46:00.000-08:00

Eleanor Longden, 25, started hearing voices when she was a teenager. But, contrary to the usual perception of inner voices, Longden says hers weren’t destructive: “It was rather mundane, simply giving me a narration of some of the day-to-day things I was doing. In many ways, the voice was companionate because it was reminding me that I was carrying on with my responsibilities despite feeling so sad inside. There was something constructive about it.”

People like Longden who admit to hearing inner voices can generally expect two outcomes: a diagnosis of insanity, and potent medication. But a group of psychiatrists and psychologists believe it’s time we reconsidered labels such as schizophrenia and the drugs used as treatment. In fact, they believe we should get people to listen to, and actually engage with, the voices inside their heads.

Longden believes her biggest mistake was in telling a friend she was at university with about her experiences. “I explained that the voices were actually quite positive, but she was horrified and insisted I see a psychiatrist, who ignored my unhappiness and homed in on the voice, assuming it meant I had no sense of normality. For example, I was quite involved with the university television station, and the psychiatrist stated in her notes that I had delusions of being a broadcaster. The second time I saw her, she suggested that I admit myself to hospital for three days for tests.”

Three days turned into three months, during which time Longden was told that if she left, she’d be sectioned and forced back. The drugs she was coerced into taking did little except cause weight gain, and the terrifying label of schizophrenia she was given was, Longden believes, directly responsible for the arrival of 12 very hostile inner voices.

Like most multiple-voice hearers, Longden says one voice was dominant. “He was demonic, and had a visual manifestation of a huge grotesque figure swathed in black. His threats were graphic and violent. The other voices, which were less clear, would back him up.”

Dr Rufus May, a clinical psychologist, says the aim of getting people to connect with their voices is to enable them to incorporate them into their daily lives so they are not distressing. “Voices themselves are not a problem; it’s people’s relationship with them that’s important. So, rather than voices being something that we should avoid at all costs - the traditional psychiatric view - we should be trying to get people to face them, understand them and work with them.”

As if this wasn’t enough, back at university Longden found herself the victim of a bullying campaign. “People had heard about where I’d been and within a week, my door in the halls of residence had been defaced, and I was spat at. I started to self-harm. The worst instance was in the student bar when a group of people asked me to stub a cigarette out on my forearm. When I did it, they cheered.”

Longden became suicidal and was sectioned. After seven weeks back in hospital, she went to stay with her parents in Bradford, where she continued to self-harm and her voices were louder than ever. Her psychiatrist told her it would almost have been better if she’d had cancer because it would be easier to cure.

Finally, the breakthrough came. “Everyone had treated me with this total lack of hope, and as completely passive. But then I was put in touch with a psychiatrist who asked me what I thought would help me. When I said I felt I could deal with the voices better when my mind was clear, he supported me to reduce the medication. Better still, he suggested that I engage with the voices because they probably had a symbolic meaning that might help me recover.”

Longden began to recognise her voices as a representation of unconscious feelings of self-loathing. This helped her to fear them less. “If they were metaphorical, it stood to reason they couldn’t have any control in the external world,” she says.

The psychiatrist encouraged her to talk back to them. “I began to question them, and their replies gave me great insight into my subconscious feelings - enormously helpful in my therapy - and then I started negotiating with them. Sometimes I’d say to the dominant one, ‘I’ll only talk to you after EastEnders,’ and he’d agree!”

Three years on, Longden is off medication. She says she’s happy, and is studying for a doctorate in clinical psychology. Although her voices sometimes return, she feels in complete control of them. “I see them as useful - almost like a stress barometer. My mum’s clue to feeling stressed is a migraine; mine is the voices.”

Dr Rufus May, a clinical psychologist, says the aim of getting people to connect with their voices is to enable them to incorporate them into their daily lives so they are not distressing. “Voices themselves are not a problem; it’s people’s relationship with them that’s important. So, rather than voices being something that we should avoid at all costs - the traditional psychiatric view - we should be trying to get people to face them, understand them and work with them.”

May says negative voices can be turned into a positive experience. “If a voice is telling someone to kill themselves, that could be signifying rage. So the voice-hearer could say, ‘Thanks for flagging this up. I’m not going to take you literally, but you’ve shown me there are things I need to change about me.’”

He even talks to his patients’ voices himself. “I ask the person to tell me verbatim what each voice is saying. I’ll ask questions such as, ‘How long have you been in Mary’s life?” and ‘Why did you come along?’ Sometimes, they’ll tell me something about the person they themselves are unaware of. After all, we’re dealing with the subconscious here.”

May recalls one man, Edward, whose voice told him to build a time machine. “I asked this voice - via Edward - why. It transpired that Edward felt responsible for his brother’s death and wanted to go back and change it. We were able to address that and Edward began to realise he wasn’t responsible.”

Such responses may even be life-saving opportunities. May cites the case of John Barrett who, having walked out of a secure hospital unit, stabbed a retired banker in 2004 after hearing voices in his head. “It seems to me that people didn’t work meaningfully with his voices. He’d had a violent childhood, so his voice could have represented his father.”

May is now involved in training mental health professionals in helping people who hear voices. “Conventional training goes deep, but it helps that I have a high profile,” he says. In fact, he doesn’t advocate that all voice-hearers take this route. “But if you catch people early, or other approaches haven’t worked, it can work very well.”

Some professionals - such as Richard Bentall, professor of experimental clinical psychology at Manchester University - go further, stating that medications should be avoided wherever possible. “They have high costs in terms of side-effects, some life-threatening. Antipsychotic drugs, in particular, can produce stiffness, tremors, involuntary movements, massive weight gain and increased risk of heart attacks and diabetes,” he says.

What’s more, research estimates that about half of patients given drugs don’t get an adequate therapeutic response. “Add to this the fact that they are given a label like schizophrenia - which has no scientific meaning, and is deeply stigmatising - and it’s little wonder that voice-hearers are given such little hope. The bottom line is that we need to stop trying to cure people, and liberate them instead.”

Professor Marius Romme, a psychiatrist, adds that many inner voices can be unthreatening and even positive. “They may try to comfort, congratulate, guide or reassure. It’s wrong to turn this into a shameful problem that people either feel they have to deny or to take medication to suppress.”

Romme’s work was instrumental in the formation of the Hearing Voices Network, an education and self-help registered charity for voice-hearers. Jacqui Dillon, who chairs the network, says:"We call inner voices - or indeed visions - messengers, because they give strong signals into people’s mindsets.”

The network has a growing professional following, Dillon says. “We get a lot of referrals from psychiatrists nowadays, although there’s still a long way to go.”

Talking heads

Studies have found that between four and 10 per cent of Britons hear voices.

Between 70 and 90 cent of people who hear voices do so following traumatic events.

Voices can be male, female, without gender, child, adult, human or non-human.

People may hear one voice or many. Some people report hearing hundreds, although in almost all reported cases, one dominates above the others.

Voices can be experienced in the head, in the ears, outside the head, in some other part of the body, or in the environment.

Voices often reflect important aspects of the hearer’s emotional state - emotions that are often unexpressed by the hearer.

The “hearing voices movement” has spread across the world. There are groups in countries as far afield as Australia, Finland, Japan and Palestine.

Well-known voice hearers include Plato, Sigmund Freud, Beethoven, Byron, Charles Dickens, Virginia Woolf, Sylvia Plath, Isaac Newton and Winston Churchill.

Source: How I Tamed the Voices in my Head

See also: Redefining Hearing Voices

Schizophrenia, Psychosis, Recovery, The Recovery Based Model, Hope for Schizophrenia Sufferers, Voice Hearers Network

Presumed Causes of Schizophrenia and Psychosis

2007-02-26T18:04:00.000-08:00

During the course of my wanderings over the past few years I have come across a number of presumed causes of schizophrenia and/or psychosis. I thought it would be informative to compile a list as a means of demonstrating the beliefs surrounding schizophrenia within professional fields and the lay public.

Music of the Hour:

Cause: Cat Poop

Pet Theory
"I THINK CATS ARE GREAT," says E. Fuller Torrey. His office decor would seem to confirm this statement: A cat poster hangs on one wall; a cat calendar sits on his desk; and a framed picture of a friend's cat leans against the windowsill. He even admits to having a "cat library" at home. But Torrey's interest in felines is a bit different from that of your typical cat lover. That's because Torrey, a psychiatry professor at the Uniformed Services University of Health Science and the enfant terrible of mental health research, believes that Felis domestica may carry infectious diseases that could cause schizophrenia and bipolar disorder. "My wife thinks I'm going to be assassinated by cat owners," says Torrey with a sigh. "In fact, I like cats. Unfortunately, if we are correct that they transmit infections..." Here his voice trails off, and he pensively fingers his closely cropped beard.

Torrey often speaks in a self-deprecating manner of his "delusional" notions, but he's dead serious about the cat connection. He thinks "typhoid tabbies" are passing along Toxoplasma gondii, a parasite that causes brain lesions and, if Torrey is right, schizophrenia. Torrey first made the argument nearly thirty years ago. "It was considered psychotic," he admits. But since then, his ideas, though still outside the mainstream, have attracted converts, most notably the Johns Hopkins virologist Robert Yolken, with whom he now collaborates. Together, they're trying to prove that toxoplasmosis is but one of several infectious diseases that cause most cases of schizophrenia and bipolar disorder. It helps their case that previous explanations -- bad mothering, bad genes -- have proven deficient to varying degrees. But Torrey and Yolken have also uncovered some hard evidence to support their claims, and they are about to put their theory to the test with clinical trials of drugs that are new to the psychopharmacological arsenal: antibiotics and antivirals similar to those used by AIDS patients. If the duo finds that such drugs alter the course of schizophrenia, Yolken observes, their results "would represent a major advance in the treatment of this devastating disease as well as in understanding its basic etiology."

[...]

As he tells it, the formative event for him came between his second and third years at Princeton. His sister, who was due to start college that fall, began hallucinating and yelling, "The British are coming!" The diagnosis was acute schizophrenia. "My mother was told that it was because my father had died," Torrey says with disgust. "I thought, 'This is absurd -- a lot of people's fathers die and they don't develop schizophrenia.' There was this disconnect between what I was looking at and what I was being told."

[...]

Torrey first postulated that toxoplasmosis might cause schizophrenia in the 1970s, when he read several articles attributing an outbreak of multiple sclerosis in the Faeroe Islands to the introduction of dogs there during World War II. Could indoor pets like cats, which had become widely popular only in the nineteenth century, also be reservoirs of infectious agents? Torrey, who had recently completed a book manuscript arguing that in the late nineteenth century schizophrenia and bipolar disorder went from being rare diseases to relatively common ones, became convinced that cats were central to that story. "The cat craze began with the cat shows in the late nineteenth century," he explains. "And when I went back and looked at what we know about cats as pets, it corresponded almost perfectly to what we know about the rise of psychosis."

Source: Do Cats Cause Schizophrenia?

Cause: Milk

Got Schizophrenia?
University of Florida researchers reported in the March 1999 issue of the journal Autism findings from two novel animal studies indicating autism and schizophrenia may be linked to an individual's inability to properly break down a protein found in milk.

The digestive problem might actually lead to the disorders' symptoms, whose basis has long been debated, said UF physiologist Dr. J. Robert Cade. Further research is needed before scientists have a definitive answer. When not broken down, the milk protein produces exorphins, morphine-like compounds that are then taken up by areas of the brain known to be involved in autism and schizophrenia, where they cause cells to dysfunction.

The animal findings suggest an intestinal flaw, such as a malfunctioning enzyme, is to blame, says Cade, whose team also is putting the theory to the test in humans. Preliminary findings from that study - which showed 95 percent of 81 autistic and schizophrenic children studied had 100 times the normal levels of the milk protein in their blood and urine - have been presented at two international meetings in the past year but have not yet been published.

When these children were put on a milk-free diet, at least eight out of 10 no longer had symptoms of autism or schizophrenia, says Cade, a professor of medicine and physiology at UF's College of Medicine and inventor of the Gatorade sports drink. His research team includes research scientist Dr. Zhongjie Sun and research associate R. Malcolm Privette.

"We now have proof positive that these proteins are getting into the blood and proof positive they're getting into areas of the brain involved with the symptoms of autism and schizophrenia," Cade said.

Source: Milk, Autism & Schizophrenia

Cause: Demon Possession

Can people be possessed by evil spirits?
Channel 4 seems to think so, and next week plans to broadcast "as live" the exorcism of a young man who says he is possessed by evil.

Scientists intend to monitor the man's brain with electrodes to see whether the procedure has any measurable effect.

Even within the Church of England, the idea of possession raises eyebrows. "The number of metaphysical assumptions it makes is quite incredible. It means there are such things as non-human evil spirits that can take possession of a human being and require to be told to go somewhere else by a greater power," says Canon Michael Perry, who holds a doctorate in deliverance and edits the Christian Parapsychologist.

"Some Christians believe it happens frequently - they see demons under every rug and will perform exorcisms at the drop of a hat. My view is possession is very rare."

Look back over case histories of supposed possessions and it's often easy to identify a real psychiatric condition, says Christopher French, who heads the anomalistic psychology research unit at Goldsmith's College in London.

"Epilepsy, Tourette's syndrome and some forms of schizophrenia have all been labelled as possessions in the past," he adds.

Source: The Guardian

Cause: Trauma

Schizophrenia and PTSD Connection
The psychiatric establishment is about to experience an earthquake that will shake its intellectual foundations. When it has absorbed the juddering contents of the latest edition of one of its leading journals, Acta Psychiatrica Scandinavica, it will have to rethink many of its most cherished assumptions. Not since the publication of RD Laing's book Sanity, Madness and the Family, in 1964, has there been such a significant challenge to their contention that genes are the main cause of schizophrenia and that drugs should be the automatic treatment of choice.

With his colleagues, guest editor John Read (whose name I shall use as a generic term for this body of evidence), a leading New Zealand psychologist, slays these sacred biological cows. The fact that some two-thirds of people diagnosed as schizophrenic have suffered physical or sexual abuse is shown to be a major, if not the major, cause of the illness. Proving the connection between the symptoms of post-traumatic stress disorder and schizophrenia, Read shows that many schizophrenic symptoms are directly caused by trauma.

The cornerstone of Read's tectonic plate-shifting evidence is the 40 studies that reveal childhood or adulthood sexual or physical abuse in the history of the majority of psychiatric patients (see, also, Read's book, Models of Madness). A review of 13 studies of schizophrenics found rates varying from 51% at the lowest to 97% at the highest.

Source: The Guardian

Cause: Lack of Sunlight/Vitamin D

Children born in winter/early spring have higher rates of schizophrenia.
Studies have indicated that children who born during certain times of the year (winter and early spring) have a higher than normal incidence of schizophrenia.

According to an article in the New Scientist magazine, research suggests people who develop schizophrenia in Europe and North America are more likely to be born in the winter and early spring (February and March in the Northern Hemisphere) In other words, the subjects who were born during these months had a slightly higher than average rate of schizophrenia, while subjects born in August and September had a slightly lower than average rate. There seems to be about a 10% difference in risk of schizophrenia between the high (Winter and Spring) and low risk months of birth.

One possible reason for the association between winter/spring births and schizophrenia may be related to sunlight exposure. A lack of sunlight (for example, during the shorter days of winter) can lead to vitamin D deficiency, which scientists believe could alter the development of a child's brain in the mother's womb and after birth.

Source: Low Sunlight Exposure/Vitamin D deficiency is associated with higher risk of schizophrenia

Cause: Marijuana

Reefer Madness
A pair of articles in the Canadian Journal of Psychiatry has resurrected the "reefer madness" argument about marijuana and its links to mental illness.

Cannabis use can trigger schizophrenia in people already vulnerable to the mental illness -- and this fact should shape marijuana policy, argue two psychiatric epidemiologists in this month's journal.

The link between marijuana use and schizophrenia is generally accepted in the psychiatric community. The problem is that the vulnerable population -- mostly teenagers -- generally isn't eager to absorb the message.

Australian epidemiologists Louisa Degenhardt and Wayne Hall reviewed eight international studies of teens and young adults that examined the link between marijuana use and schizophrenia. They concluded using marijuana can precipitate schizophrenia in users who have a personal or family history of schizophrenia.

Source: Journal articles link marijuana to schizophrenia

Cause: Niacin Deficiency

Megadoses of vitamin B-3 and ascorbic acid are therapeutic for schizophrenia
... We decided to tackle the most important single problem, schizophrenia. Half of our mental hospital beds were occupied by these patients, and one quarter of all hospital beds in Canada were these patients. But there were very few tangible leads. Psychoanalysis was sweeping into North American psychiatry, and the biological psychiatrists were facing imminent defeat in their views about the nature of this disease.

Dr. Osmond and Dr. J. Smythies had discovered that the mescaline experience resembled the schizophrenic experience, and he and Smythies postulated that there might be a substance in the body with the properties of mescaline and related to adrenalin. Dr. Osmond and I developed this idea, which became known as the adrenochrome hypothesis of schizophrenia.

[...]

Arising from this research are the following discoveries: (1) That adrenochrome is an hallucinogen, (2) that it could be made in the body. It is now known to be present and easily measured. (3) That megadoses of vitamin B-3 and ascorbic acid were therapeutic for schizophrenia. This was one of the roots of orthomolecular psychiatry and medicine as it is known today. (4) That niacin lowers cholesterol levels. This vitamin is now one of the world's standard materials for doing so. It also extends life and does not increase deaths from violent acts as some of the other compounds which lower cholesterol do. (5) The HOD (Hoffer-Osmond Diagnostic) and EWI tests for assisting in the diagnosis of schizophrenia. This is an excellent test, hardly known to the profession.

Source: About Abram Hoffer M.D.

Cause: Stress

Psychosis may be a natural mending effort of the psyche
Stress may cause highly activated mythic images to erupt from the psyche's deepest levels in the form of turbulent visionary experience. Depending on whether the interactions between the individual and the immediate surroundings lean toward affirmation or invalidation, comprehension of these visions can turn the visionary experience into a step in growth or into a disorder, as an acute psychosis. Based on his clinical and scholarly investigations, John Weir Perry has found and formulated a mental syndrome which, though customarily regarded as acute psychosis, is in actuality a more natural effort of the psyche to mend its imbalances. If the upset is received in the spirit of empathy and understanding, and allowed to run its course, an acute episode can be found to reveal a self-organizing process that has self-healing potential.

Source: Trials of the Visionary Mind: Spiritual Emergency & The Renewal Process

Cause: Caffeine

Java Poisoning?
Nearly 80% of the world's population uses caffeine, and 25% of the population is diagnosed with a mental disorder. Clinical studies indicate that there may be significant overlap between those figures, and that many people diagnosed as mentally ill are in fact merely suffering from caffeine poisoning. Caffeine also exacerbates the symptoms of patients suffering from organic, non-caffeine-induced mental illness.

As a small, lipid-soluble molecule (like alcohol, nicotine, and certain antidepressants), caffeine is one of the few substances capable of penetrating the blood-brain barrier, which is critical to maintaining cerebral homeostasis. Once it has penetrated this barrier, it is capable of affecting its victims' thoughts and behavior, sometimes to an alarming degree.

Because self-awareness is one of the first casualties of a toxic brain, caffeinism victims may not even suspect they are ill or (if they do) that caffeine is at the root of their symptoms.

It is the purpose of this site to alert the public to the dangers of caffeine intake, and to urge the medical community to eliminate caffeine from patients’ diets before diagnosing them with psychiatric disorders including anxiety, ADD/ADHD, mania, depression, personality disorder and schizophrenia.

Source: The Caffeine Web

Cause: Dopamine Dysfunction

Faulty Neurochemistry
Many studies have investigated the possible role of brain neurotransmitters in the development of schizophrenia. Most of these studies have focused on the neurotransmitter called dopamine. The "dopamine theory of schizophrenia" states that schizophrenia is caused by an overactive dopamine system in the brain. There is strong evidence that supports the dopamine theory, but there are also some data that do not support it:

- Evidence FOR the Dopamine Theory of Schizophrenia:

Drugs that block dopamine reduce schizophrenic symptoms.

Drugs that block dopamine have side effects similar to Parkinson's disease. Parkinson's disease is caused by a lack of dopamine in a parts of the brain called the basal ganglia.

The best drugs to treat schizophrenia resemble dopamine and completely block dopamine receptors. High doses of amphetamines cause schizophrenic-like symptoms in a disorder called "amphetamine psychosis." Amphetamine psychosis is a model for schizophrenia because drugs that block amphetamine psychosis also reduce schizophrenic symptoms. Amphetamines also make the symptoms of schizophrenia worse.

Children at risk for schizophrenia may have brain wave patterns similar to adults with schizophrenia. These abnormal brain wave patterns in children can be reduced by drugs that block dopamine receptors.

- Evidence AGAINST the Dopamine Theory of Schizophrenia:

Amphetamines do more than increase dopamine levels. They also alter other neurotransmitter levels.

Drugs that block dopamine receptors act on receptors quickly. However, these drugs sometimes take many days to change the behavior of people with schizophrenia.

The effects of dopamine blockers may be indirect. These drugs may influence other systems that have more impact on the schizophrenic symptoms.

New drugs for schizophrenia, for example, clozapine, block receptors for both serotonin and dopamine.

Source: Schizophrenia

Cause: Neuroleptics

Mad in America
In 1998 ... the University of Pennsylvania did an MRI study in which they studied people placed on neuroleptics. They found that indeed the brains of those people so treated started showing changes in brain volumes. So you start seeing a shrinkage of the frontal lobes and an enlargement of the basal ganglia.

So now we're seeing morphological changes in the brain. And here's the clincher: They found that those volume changes in the brain were associated with a worsening of the target symptoms. So the puzzle now all comes together, doesn't it? It fits with the World Health Organization's study. It tells you why people are becoming chronic -- because you're giving them an agent that causes an abnormality in brain function, that causes changes in the brain that lend themselves to greater psychosis.

Source: Interview: Robert Whitaker

Cause: Lack of Polyunsaturated fatty acid

Several studies have shown those with schizophrenia often have low levels of the particular EFAs
BACKGROUND: Limited evidence gives support to an hypothesis suggesting that the symptoms of schizophrenia may result from altered neuronal membrane structure and metabolism. The latter are dependent on blood plasma levels of certain essential fatty acids (EFAs) and their metabolites. Several studies have shown those with schizophrenia often have low levels of the particular EFAs necessary for normal nerve cell membrane metabolism.

OBJECTIVES: To review the effects of supplementing standard antipsychotic treatment with polyunsaturated fatty acids, whether essential (EFAs) or non-essential, for those with schizophrenia and, in recent updates to also evaluate the effects of EFA's as a sole antipsychotic treatment. To evaluate the relative efficacy of different types of fatty acid supplementation.

[...]

MAIN RESULTS: Four relatively small trials (total n=204) showed low levels of loss to follow up and adverse effects for those taking essential fatty acids. Early results from a few trials suggest a positive effect of eicosapentaenoic acid (EPA) over placebo for scale-derived mental state outcomes. The data, however, is limited making these results difficult to analyse and interpret with confidence. A single small study (n=30) investigated the value of using EPA as sole treatment for people hospitalised for relapse. Results suggest that EPA may help one third of people avoid instigation of standard antipsychotic drugs for 12 weeks (RR 0.6, CI 0.4-0.91). There were no clear effects of primrose oil (omega-6) EFA supplementation.

REVIEWER'S CONCLUSIONS: All data are preliminary, but results look encouraging for fish oil. EPA does not seem harmful, may be acceptable to people with schizophrenia and have moderately positive effect. A further trial is soon to be reported from the USA and more are underway or planned in the South Africa and Norway. Considering that EPA may be an acceptable intervention, large, long simple studies reporting clincially meaningful data should be anticipated.

Source: Polyunsaturated fatty acid (fish or evening primrose oil) for schizophrenia

Cause: Genetics

Heredity and the Genetics of Schizophrenia
... schizophrenia definitely has a very significant genetic component. Those who have a third degree relative with schizophrenia are twice as likely to develop schizophrenia as those in the general population. Those with a second degree relative have a several-fold higher incidence of schizophrenia than the general population, and first degree relatives have an incidence of schizophrenia an order of magnitude higher than the general populace.

It is of much interest, though, that the correlation of schizophrenia between identical twins, who have identical genomes, is less than one-half. This indicates that schizophrenia is NOT entirely a genetic disease.

The current belief is that there are a number of genes that contribute to susceptibility or pathology of schizophrenia, but none exhibit full responsibility for the disease. It is believed that schizophrenia is much like cancer, which is caused by a number of genetic and environmental factors.

Source: Heredity and the Genetics of Schizophrenia

Cause: Social Environment

Many service users, social scientists and clinicians are convinced that social factors cause schizophrenia
A familial vulnerability to schizophrenia is agreed even though the exact genes involved seem elusive. But despite epidemiological evidence showing different rates of schizophrenia in sociocultural groups that would be considered genetically similar, the causal role of the environment is still hotly contested. Many service users, social scientists and clinicians are convinced that social factors cause schizophrenia and, therefore, that behavioural or environmental change might offer a more tangible route to prevention than gene manipulation. However, a comparison of the monies given to research into the genetics and the social aetiology of schizophrenia would suggest that funders of research are not convinced. For instance, the Medical Research Council, Wellcome Trust and UK Department of Health have launched Biobank, billed as the largest ever study of nature and nurture. The aim is to investigate complex interactions between genes, lifestyle and the environment. Half a million people between the ages of 45 and 69 will be asked to take part. Unfortunately, the generally earlier onset of schizophrenia will mean that it will be difficult to research in this illness. Would we have benefited from a Biobank for 16- to 25-year-olds?

Is there evidence that social factors cause schizophrenia and, if there is, does it negate or complement the theory that schizophrenia is a genetic illness? We asked Professor Jim van Os from Maastricht University, one of Europe's top social psychiatry researchers, and Professor Peter McGuffin, a psychiatrist and geneticist who heads the Social, Genetic and Developmental Psychiatry Research Centre at the Institute of Psychiatry, London, to debate the question: Can the social environment cause schizophrenia?

Source: Can the social environment cause schizophrenia?

Cause: Shamanic Calling

Shamanism has been confused with schizophrenia
Shamanism is humanity's oldest religion and healing art, dating back to the Paleolithic era. Originally, the word shaman referred specifically to healers of the Tungus people of Siberia. In recent times, that name has been given to healers in many traditional cultures around the globe who use consciousness altering techniques in their healing work.

Historically, shamanism has been confused with schizophrenia by anthropologists because shamans often speak of altered state experiences in the spirit world as if they were "real" experiences. While the shaman and the person in a psychotic episode both have unusual access to spiritual and altered state experiences, shamans are trained to work in the spirit world, while the psychotic person is simply lost in it.

But in many traditional cultures, psychotic episodes have served as an initiatory illness that calls a person into shamanism. Mircea Eliade writes:
The future shaman sometimes takes the risk of being mistaken for a "madman". . .but his "madness" fulfills a mystic function; it reveals certain aspects of reality to him that are inaccessible to other mortals, and it is only after having experienced and entered into these hidden dimensions of reality that the "madman" becomes a shaman.

As the person accepts the calling and becomes a shaman, their illness usually disappears. The "self-cure of a psychosis" is so typical of the shaman that some anthropologists have argued that anyone without this experience should be described only as a healer. The concept of the "wounded healer" addresses the necessity of the shaman-to-be entering into extreme personal crisis in preparation of his/her role in the community as a healer (Halifax, Joan. Shamanic Voices. New York: Dutton, 1979).

Source: Shamanic Crisis

Cause: Attempt at Self-Healing

Carl Jung's view of the psyche in crisis
Over half a century ago in Küsnacht, Switzerland, the psychiatrist Carl Gustav Jung came to feel that psychological health is a dynamic, on-going process of personal development into greater maturity and spiritual awareness. This process – which he called individuation – is, he said, nourished by a continuous flow of symbolic insights transmitted from the unconscious Self to the conscious Ego, in a variety of ways including dreams, insight, and flashes of intuition. Should this inner communication flow get blocked for any reason, one may find oneself increasingly frustrated, for the simple reason that one has lost touch with the built-in guiding system of one's deeper Self.

In Jung's view, if such a blockage persists in time, one becomes alienated – in the sense that one may no longer be able to use the considerable resources of one's innate common sense to adapt effectively to one's social environment. Alienation, of course, also happens on a collective level within the family, society, and civilisation, in which case the context one may have trouble adapting to includes not only the social, but the ecological environment as well. Whether individual or collective, a chronic blockage of the psyche's inner communications process may lead beyond a mere sense of ennui, and eventually jeopardise the ability to be responsible for one's health and survival.

What really took Jung's colleagues by surprise, however, was his declaration that the so-called acute schizophrenic break phenomenon is actually no disease, but rather a natural (and temporary!) healing process – which automatically activates itself in response to the underlying blockage which I have just described. Jung maintained that the spontaneous onset of the visionary state of consciousness is nature's self-organising way for the alienated psyche to become whole again. In his view, when the Ego has become cut off from the rest of the psyche to a point of real distress, the Self "comes to the rescue" through a temporary, but complete overpowering of the conscious personality by means of a vivid upwelling of hallucinatory voices and visions from the deeper levels of the unconscious. The conscious Ego, that is, falls apart and comes back together again, renewed. If one understands the essentially life-affirming nature of the visions which occurs during this metamorphosis, appreciates their symbolic relevance to the problems at hand, and integrates their deeper meaning, the result is a healing of the alienated condition which prevailed before the onset of the so-called illness itself – and a rebirth of the personality as a more integrated, invigorated whole.

Source: The Inner Apocalypse

Cause: Cultural Memes & Mutations

Schizophrenia as meme
1. Liane Gabora's (1998) target article is a systematic attempt to draw together knowledge from different fields to answer the question of the origin of culture, offering some important suggestions. Several elements in Gabora's article draw upon the most recent discoveries in neuroscience. I will now dwell on one particular point which has especially significant implications.

2. According to Gabora, the origin of culture may be defined as "the bootstrapping of a system by which information patterns self-replicate, (leading to) the selective proliferation of some variants of these self-replicating patterns over others." In this context the term "meme" is used to refer to a unit of cultural information as represented in the brain.

3. It is evident that each meme must coincide with the set of neurons which expresses it. In Gabora's paper, the mind is described as a structure used to filter the flow of memes (i.e. of organized neuronal discharges) on the basis of internal and external cues able to activate these specific sets of neurons.

4. Gabora refers to "myths" about the origin of human culture (Donald, 1991), which hypothesize that "in the beginning" there existed a totally "episodic" mind, i.e. one able to manage only memories linked to immediate stimuli (not only environmental, but also bodily: hunger, thirst, etc.).

5. From this chaos of episodic (and therefore ephemeral) events was born a mind organized in such a manner as to allow it to evoke informational units (memes) even in the absence of external stimuli, it was able to have abstract thoughts, and therefore make associations on a second level (between actual stimuli and representations of stimuli; then between these and representations of the associations themselves, or even between these other stimuli or representations of stimuli, whether past or present).

6. The birth of this "memetic" mind is attributed to a genetic mutation, and it is hard to imagine that it could have arisen in any other way. Such a mutation would have modified the threshold of filtering of the association between information units. As a consequence, memes which would otherwise be filtered out of the operational memory (consciousness?) gain access to this sector of the mind, bringing into operation other memes in a cycle which can lead to creative (i.e. innovative) associations, but also to severe behavioural problems.

7. Gabora refers to neurobiological models of schizophrenia to illustrate the consequences of her hypothesis. Many hypotheses about schizophrenia indeed suggest that a deficit in the systems involved in information-processing could contribute to the symptomatology of the disorder (McGhie & Chapman, 1961; Hansefus & Magaro, 1976; Braff & Geyer, 1990; Cornblatt & Kellp, 1994). Such a deficit could be expressed in a severe behavioural disorder, but it could also favour creative associations between information units (Hansefus & Magaro, 1976; Preti & Miotto, 1997). Many studies have explored the propensity toward innovation and originality in people suffering from psychoses (Arieti, 1974; Preti & Miotto, 1997). This psychosis-linked creative ability is evident in the arts and in language, but is also seen in the sciences and even in extremely abstract disciplines such as mathematics (Hayes, 1998).

Source: Creativity, Genetics and Mental Illness

Cause: Double-Bind Theory & The Family

Contradictory environmental input produces schizophrenic symptoms
Bateson et al. (1956) proposed that schizophrenic symptoms are an expression of social interactions in which the individual is repeatedly exposed to conflicting injunctions, without having the opportunity to adequately respond to those injunctions, or to ignore them (i.e., to escape the field). For example, if a mother tells her son that she loves him, while at the same time turning her head away in disgust, the child receives two conflicting messages about their relationship on different communicative levels, one of affection on the verbal level, and one of animosity on the nonverbal level. It is argued that the child's ability to respond to the mother is incapacitated by such contradictions across communicative levels, because one message invalidates the other. Because of the child's vital dependence on the mother, Bateson et al. argue that the child is also not able to comment on the fact that a contradiction has occurred, i.e., the child is unable to metacommunicate (Bateson et al., 1956).

The symptomatology of schizophrenia, it is argued, reflects the accommodation of the individual to a prolonged exposure to such interactions. Once 'victims' have learned to perceive their universe in terms of contradictory environmental input, the inability to respond effectively to stimuli from the environment is no longer contingent on the extent to which stimuli from the environment are contradictory in specific interactive sequences. Instead, the individual will generally experience any input from the environment as conflicting information without being able to discriminate between different communicative levels. In the long run, this inability manifests itself as typically schizophrenic symptoms such as flattened affect, delusions and hallucinations, and incoherent thinking and speaking (Bateson et al., 1956).

It is further stipulated by Bateson et al. (1956) that double bind interactions have a pathogenic effect only if they occur in a context where the accurate discrimination of messages is of vital importance for the participants, and in a relational context which is characterized by intense levels of involvement between the participants. The interaction between parents and children within the nuclear family is a typical example of such a relational context.

Source: Schizophrenia and the Family: Double Bind Theory Revisited

Cause: Brain Trauma

Three-fold increase in head injury rates among schizophrenics
... Malaspina and her colleagues zeroed in on some 600 individuals who had at least two first-degree relatives with schizophrenia, that is, they were persons who were presumably at genetic risk of schizophrenia. In fact, some of the study subjects had schizophrenia themselves. Data about these subjects had been collected as part of the National Institute of Mental Health Genetics Initiative for Schizophrenia and Bipolar Disorders—a cooperative project involving six university sites. Malaspina and her team then used the data that had been collected to see whether they could find any link between brain injury and schizophrenia. They could, they report.

For example, when they compared the rates of brain injury for subjects who had been diagnosed with schizophrenia with those who had not, they found a threefold increase in head-injury rates among those with schizophrenia.

One might ask, of course, whether the link between head injury and schizophrenia was due to schizophrenia’s causing head injury, not the other way around. Malaspina and her colleagues do not believe, however, that this was the case.

One reason, she explained to Psychiatric News, is that whereas the analysis included head injuries both before and after schizophrenia, "if you restricted it to head injuries before illness, you saw the same thing. Head injury before illness increased the risk."

Another reason Malaspina and her coworkers believe that head injury is a risk factor for schizophrenia is that they not only analyzed data from the approximately 600 subjects who were part of the schizophrenia pedigree group, but also compared those data with data from some 1,300 persons who had at least two first-degree relatives with bipolar disorder and who were thus presumably at genetic risk for that disorder. When the researchers compared the rate of brain injury in the schizophrenia pedigree with that in the bipolar group, they found that the rate was significantly higher in the former. In the researchers’ view, this finding implies that a genetic predisposition to schizophrenia may also be capable of predisposing a person to head injury.

But how might a genetic predisposition to schizophrenia open a person to risk of head injury? Malaspina and her team offered a possible explanation: "Schizophrenia genes may increase exposure to head trauma, with head trauma further increasing the risk for schizophrenia."

And how might schizophrenia genes increase exposure to head trauma? Malaspina and her colleagues proffer a possible explanation here as well: Schizophrenia genes could code for difficulty paying attention, and inattention in turn could open a person to accidents and head injury. Indeed, difficulty paying attention has long been noted as one of the symptoms of schizophrenia. In fact, it may be not only a vulnerability factor for schizophrenia, but also one of the earliest indicators of the disease ...

Source: Head Injury May Tip Schizophrenia Scales

Cause: Cough Syrup

Mr. A, an 18-year-old high school student, came to the psychiatric emergency room after several days of consuming cough syrup (one to two 8-oz bottles per day containing dextromethorphan, 711 mg per bottle). He described experiencing dissociative phenomena involving the belief that he had died and had "become just [his] thoughts," coupled with the experience of observing himself from outside his body. He reported vivid visual hallucinations, including the ability to "see 360° in all four quadrants" and to literally "see into people." He also recounted delusions of telepathy (he could ascertain the thoughts of other students at school if he sat near them and could communicate with them without speaking) and paranoia (his employer was trying to kill him and strangers might hurt him). Mr. A had previous diagnoses of attention deficit hyperactivity disorder and social phobia. His past medical history was unremarkable. He recounted occasional marijuana use (one to two joints per week). His father had bipolar disorder.

Mr. A’s symptoms showed complete remission without neuroleptic treatment within 4 days after discontinuing the abuse of dextromethorphan, and he was discharged from the hospital with no evidence of psychosis. He was rehospitalized twice more over the next 2 months with similar symptoms. Each time, he reported consuming large doses of dextromethorphan and showed complete resolution of his psychotic symptoms with abstinence from the ingestion of cough syrup. During a subsequent sustained abstinence from dextromethorphan while participating in outpatient substance abuse treatment, Mr. A had no recurrent psychosis. He acknowledged that his previous episodes of cough syrup abuse were routinely followed by states of hallucinosis, paranoia, and dissociation.

Earlier reports of psychosis following excessive cough syrup ingestion were generally attributed to the sympathomimetic amines contained in many preparations (2, 3). However, Schadel and Sellers (4) first suggested that dextromethorphan could be the causative agent because of its metabolism to dextrorphan, a noncompetitive NMDA receptor antagonist. Individuals with the rapid metabolizer phenotype cytochrome P4502D6 can be particularly vulnerable to these psychotogenic effects (5). Since dextromethorphan is not routinely assayed in urine toxicology screenings, clinicians should be vigilant in treating cases that suggest dextromethorphan abuse.

Source: Dextromethorphan-Induced Psychosis

Cause: Ego Collapse

Q: Can you tell me what a psychotic break is? I can't seem to find any information about it.

A: There are, at least to my way of thinking, several states of mind..."normal", meaning consistent over time and situations; "disorganized", meaning a little scattered, unfocused, fragmented; "disturbed", meaning a state of mind leading to behavior that is socially unacceptable and potentially harmful to self and others; "disordered", meaning a display of clinically definable and diagnosable symptoms that are clustered under one primary heading (Depression, Borderline, Kleptomania, etc.); and "dissociated", meaning a collapse of the "ego integrity", a state of mind where the person is unsure of who they are, where they are, what they are doing and how they should be behaving - a pervasive and overall loss of "identity" and "sense-of-self".

The last, "dissociation" is generally considered a "psychotic break". In other words, a person is so overwhelmed by either internal or external turmoil that what we generally think of their "ego" just plain collapses.

Source: Ask the Therapist

Cause: Ego Death

... These issues tend to arise naturally in life, especially during transitions and intense events, but they also are brought forth intensely due to the inner work. They arise especially as the soul learns to penetrate and transcend her ego structure. To follow our example, when the soul begins to see the limitation of structure and experiences herself as presence, the structure begins to reveal its nature as a mental construct characterized by past conditioning, ideas, memories, etc. The soul begins to experience an inner emptiness, a meaninglessness, a dread of falling apart, and terror of death and annihilation. These experiences of falling apart or being annihilated actually come to pass as the structures dissolve. The soul experiences disintegration and dissolution, disorientation, and a loss of identity; she feels lost and despondent. These existential crises are actually elements of some stages of working through ego structures that then lead to deeper realizations of true nature, moving to timelessness and formlessness. (The Inner Journey Home, p 231)

Source: Ego Death

Cause: Blood Type

Schizophrenia linked to blood type
... we have isolated that schizophrenia is largely linked to Blood Type O. Genetic predisposition to alcoholism runs in Blood Type A. There is continuous on-going research, but links are being identified.

You can see manifestations of this clumping in the emotions: depression in Blood Type O, for instance. Often they are not eating enough protein, and when they start eating more protein they begin to feel much better. Most notably, mental functioning improves, whether on or off medication.

Source: Blood Types and Nutrition

Cause: Qigong

Manifestations of Psychiatric Disorders
It is quite interesting that most patients have relatively acute attacks of short duration. After the attacks, they feel relatively exhausted and many have partial or complete amnesia about their behaviour. The most common syndrome is an acute psychotic reaction, quite a significant proportion of which are similar to that of schizophreniform disorder.

These psychotic syndromes usually occur a couple of days after Qigong practice. Other presentations could mimic affective disorders, dissociative (hysteria), and other neurotic disorders. For those diagnosed with schizophreniform disorders, the clinical symptoms include delusions, hallucinations, and disorganised speech. Quite often, there is accompanying over-talkativeness and elation of mood. There can also be abnormal behaviour, especially that of 'posturing' using the various exercise postures of the Qigong practice. The first rank symptoms of schizophrenia described by Schneider such as thought control or alienation may be apparent, but are not always present.

A number of patients could be described as suffering from an affective disorder, with either depressive or manic episodes. For those diagnosed as having various forms of neurotic disorders, the clinical manifestations can be divided into physical and psychological forms. Nearly all patients have a special complaint of something like "the Qi moving within the body, and dashing or rushing into the head". Often, such `qi' becomes stagnated somewhere, leading to headache, dizziness, or strange perceptions in the lower abdomen (called the `Dan-Tian point'). Psychological symptoms include hypochondriasis, obsessive thoughts or images, phobia, suicidal ideas, and feelings of sadness, anxiety, and worries about being out of control. For those who manifest with the dissociative state (previously labelled the 'hysteric syndrome'), there are features of disturbed consciousness, disorientation of time, place, and person, and visual and auditory hallucinations. Such features usually occur after Qigong practice for 2 weeks or a month.

Source: Culture Bound Psyciatric Disorders Associated With Qigong Practice in China

Cause: Kundalini

Two patients are described who had been diagnosed as schizophrenic, but had actually instead been going through spiritual crises, which in Eastern spiritual tradition are called raising the kundalini. Perhaps this experience is not a disease, but many--especially if not understood by oneself, the nearest relations and the medical profession--cause mental illness. In WHO ICD-10 the experience could be classified as F48.8, disordines neurotici specificati alii. The process falls outside the categories of both normal and psychotic. When allowed to progress to completion this process culminates in deep psychological balance, strength, and maturity.

Source: Schizophrenia or spiritual crisis? On "raising the kundalini" and its diagnostic classification

Cause: Gluten Intolerance

Intriguing early research suggests that people with a genetic intolerance to gluten may also be at increased risk for schizophrenia. Investigators say the link, if proven, could lead to new treatment options for a small subset of schizophrenic people.

Using a Danish health registry, researchers from John's Hopkins University's Bloomberg School of Public Health found people with the genetic digestive disorder known as celiac disease to be three times as likely as the general population to develop schizophrenia. Lead researcher William W. Eaton, PhD, says the next step is to determine if following a gluten-free diet makes a difference in the symptoms of schizophrenic people with celiac disease. He estimates that 3% of schizophrenic people could potentially benefit from such a diet.

Celiac disease is a lifelong (chronic) condition in which foods that contain gluten damage the small intestine. Gluten is a form of protein found in some grains (notably wheat, barley, and rye). The damage to the intestine makes it hard for the body to absorb nutrients, especially fat, calcium, iron, and folate, from food.

"We can now screen for celiac disease, so it is at least conceivable that we can locate the folks with schizophrenia for whom gluten withdrawal might work," he tells WebMD. "But we still have to do those studies."

Source: Gluten Intolerance Linked to Schizophrenia

Cause: Repressed Bisexuality

Mankind has long searched for the cause and meaning of madness. The 639 quotations contained in this volume, each followed by explanatory comments by the author, point inexorably to the factor of unconscious bisexual conflict/gender confusion as forming the basic etiological role in all functional mental illness, including schizophrenia. Because we are all born with an innate bisexual constitution, we all have the potential to become mad when this basic bisexuality is unnaturally repressed and denied. Many examples of how this transpires are examined throughout the pages of this book, and a clear and irrefutable answer is thus provided to the age old question: What is the cause of madness?

The disease we call 'schizophrenia' is but an arbitrary name used to designate the end-stage of a process beginning with a slight neurosis. The more severe the bisexual conflict and gender confusion in the individual, the more severe the degree of the mental illness which is experienced. No other species but man is afflicted with mental illness, because no other species has either the intellectual power to repress their sexual feelings nor the motivation to do so.

Source: Schizophrenia: The Bearded Lady Disease

Cause: Subliminal Distraction

In the 1960's designers and engineers accidentally discovered a 'conflict of physiology' when it caused mental breaks for office workers. They were using prototypes of movable close-spaced workstations. The cubicle was their solution to stop the mental breaks.

They made three basic mistakes.

[*] They thought their encounter was the first time the phenomenon had appeared.

[*] They believed that it could only happen in a business office.

[*] To this day they believe it can only cause a harmless period of confusion and pseudo psychotic behavior.

This site gathers historic records to show that none of that is true. So few people are aware of it that it is never considered when there is a mass school shooting, college suicide, or strange student disappearance.

Source: Subliminal Peripheral Vision Psychosis

Cause: Parental Exposure to Dry-Cleaning Agents

A reader (who wants me to write an article on autism and paternal age-- I swear I'm getting to it) sent me a reference to a 2007 article finding an increased rate of schizophrenia in those born to parents who were dry cleaners... The authors speculate it's tetrachloroethylene exposure.

Source: The Last Psychiatrist

Cause: Lyme Disease

Lyme disease is no small health threat to persons living in the Northeast, the Mid-Atlantic states, Wisconsin, Minnesota, and northern California. True, the first signs of its onslaught are usually no more than flulike symptoms. But it is also capable, over the long haul, of inflicting a variety of other physiological insults—say, muscle pain, arthritis, heart inflammation, severe headache, stiff neck, or facial paralysis.

Now a new study adds one more malady to that list: psychiatric illness.

The study was conducted by Tomá Hájek, M.D., a psychiatry resident at the Prague Psychiatric Center in the Czech Republic, and his colleagues. It is reported in the February American Journal of Psychiatry.

Source: Psychiatry Online

Cause: Mercury Fillings

Research from more than 1,000 peer-reviewed or government studies documents the mechanism by which mercury causes or is a major factor in over 40 chronic health conditions, such as arthritis, multiple sclerosis, Lou Gehrig's Disease (ALS), Parkinson's/muscle tremor, Alzheimer's, muscular and joint pain/fibromyalgia, Chron's disease, lupus, scleroderma, Chronic Fatigue Syndrome (CFS), endometriosis, and diabetes.
...

Other neurological and mood disorders linked to mercury in amalgam include: memory disorders, depression, schizophrenia, insomnia, anger, anxiety and mental confusion, neuropathy/paresthesia, tinnitus, and dizziness/vertigo.

Source: Is there a Silent Killer Hidden in Your Metal Fillings?

Cause: Heeled Footware

These boots are made for psychosis...

Many data suggest an association between the use of heeled footwear and schizophrenia and they could probably be questioned in many instances. I have however not been able to ﬁnd any contradictory data. ... The effects of the use of heeled and ﬂat shoes during shorter or longer periods of time on cortical excitability [54], and on connectivity in cerebellar and basal ganglia loops [52,55] could be studied in patients with schizophrenia. A normalization of patterns would indicate the importance of the proposed neural pathways in the pathophysiology of schizophrenia. Patients could be recruited to clinical trials of the effects of using only ﬂat shoes as long as possible on symptoms and cognitive deﬁcits

Source: Heeled Footware and Schizophrenia Hypotheses

Susan Lien Whigham: The Role of Metaphor...

2007-02-12T12:52:00.000-08:00

Please note that references are cited in APA format. "(n.d.)" indicates that there is no date given in the source material. A list of references may be found at the end of the essay.

Abstract
Post-traumatic stress disorder (PTSD) is a psychological condition which may result from experiencing a traumatic event. Experts agree that individuals who suffer from PTSD often communicate using metaphors because it’s difficult to talk about the trauma in literal terms. Since communication about the traumatic event facilitates recovery, we can help individuals recover from trauma by learning to communicate with them using metaphorical language. This principle also applies to individuals experiencing other types of dissociative psychological conditions, such as schizophrenia.

Introduction
Chances are good that you or someone you know has experienced a traumatic event at least once in your lifetime. Many individuals who experience trauma will develop a psychological condition known as post-traumatic stress disorder (PTSD). Evidence indicates that communication plays a critical role in helping individuals recover from PTSD. Due to emotional sensitivities, traumatized individuals will often (unwittingly) choose metaphors in place of literal language to describe their traumatic experiences. We can help individuals recover from traumatic events by learning to communicate with them using metaphorical language.

The Effects of Trauma on the Human Psyche
Trauma is the word we use to describe the emotional distress which results from experiencing extreme personal injury or witnessing it. The PTSD Alliance (n.d.) estimates that 70% of adult Americans have experienced at least one traumatic event, and of these, 20% will develop PTSD. The PTSD Alliance (n.d.) goes on to estimate that 13 million Americans have PTSD at any given time. According to the National Center for Post-Traumatic Stress Disorder (NCPTSD), PTSD “can occur following the experience or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults like rape” (2006).

Metaphor helps to create a bridge between the “ordinary” world and the trauma world.

It may take days, weeks, months or years for an individual to develop symptoms of PTSD following the traumatic event (NCPTSD, 2006). PTSD manifests itself by means of a variety of symptoms, including panic attacks, nightmares, insomnia, flashbacks, hallucinations, hypervigilance, emotional numbing, avoidance and more (Jaffe & Segal, 2005). Brant (2005) makes note of the particular difficulty that many war veterans have in acknowledging their PTSD symptoms due to the stigmas attached to mental health problems and their own fears of appearing weak.

Nonetheless, communication is an important key to recovery. Butler (1997) reports that “Research suggests that trauma survivors can head off long-lasting symptoms by letting friends know what they're going through and by confronting traumatic memories early on”. “Talk to a lot of other people," says Edna Foa, a cognitive-behavioral psychologist and PTSD expert (Butler, 1997). Another trauma researcher, Rachel Yehuda, also stresses the importance of communicating to others and not withdrawing. She goes on to say that "The really devastating effect of trauma comes about when you damage your ability to relate to your social support system" (Butler, 1997).

The Role of Metaphor
What is metaphor? In simplest terms, a metaphor is a form of expression in which one thing is likened to something else with similar properties. A metaphor is one of many kinds of trope, which is a “rhetorical figure of speech that consists of a play on words, i.e. using a word in a way other than what is considered its literal or normal form” (Wikipedia, 2006). “Metaphors are common in language because they are so useful,” says Burns (2004). “Every new experience is at first understood in terms of what we already know. Metaphors can convey so much with few words, yet often are evocative and easily remembered” (Burns, 2004).

For example, in the famous play “Romeo & Juliet” by William Shakespeare, Romeo exclaims that “Juliet is the sun!” In so doing, Romeo is using a metaphor in order to liken the brightness, warmth and power of the sun to how he feels about Juliet. As the audience, we understand intuitively from this expression that Romeo does not mean to say that Juliet is literally the sun. Another example of a metaphorical expression can be found in the movie “Serenity”. When Serenity’s spaceship pilot Hoban Washburne says, “I am a leaf on the wind”, he is likening his own remarkable piloting abilities to the agile movement of a leaf on the wind. Again, it does not need to be explained to the audience that he does not believe he is an actual leaf.

Due to the highly sensitive nature of the subject matter, a traumatized individual who is using metaphors is not likely to be able to acknowledge that this is what he or she is doing. ... For the listener to insist on immediately translating the metaphors into what they may represent will likely provoke further emotional upset for the narrator, considering that the reason metaphors were chosen to begin with was that they were less emotionally threatening terms of expression. Furthermore, to automatically write off what the individual is trying to express as being false, or delusional, is counter-productive to the individual’s recovery process because it acts as an obstacle to communication.

It’s common for individuals who suffer from PTSD to use metaphors to express the experiences of traumatic events. According to Amendiola (1998), “Metaphor provides an altered frame of reference that allows the client to entertain novel experience without physiological hyperarousal and attending negative affect.” In layman’s terms, this means that speaking in metaphor allows a traumatized individual to talk about what happened without being re-traumatized by the memory of the event.

Winslow (2004) describes traumatic memory as creating a separate world which is very different from and initially irreconcilable with the ordinary world that most people know. “But,” she says, “the situation is more complicated still; changes in physical and psychological states shift the experiencer into an altered state of consciousness characterized by heightened imaging and interference with reasoning” (Winslow, 2004). Metaphor helps to create a bridge between the “ordinary” world and the trauma world.

As one might imagine, some difficulty may arise when it’s not properly understood that an individual is speaking metaphorically. Due to the highly sensitive nature of the subject matter, a traumatized individual who is using metaphors is not likely to be able to acknowledge that this is what he or she is doing. For example, imagine that a trauma victim expresses to a loved one that “Lois Lane” was in distress but that “Superman” didn’t come to save her. For the listener to insist on immediately translating the metaphors into what they may represent will likely provoke further emotional upset for the narrator, considering that the reason metaphors were chosen to begin with was that they were less emotionally threatening terms of expression. Furthermore, to automatically write off what the individual is trying to express as being false, or delusional, is counter-productive to the individual’s recovery process because it acts as an obstacle to communication.

Lawley & Tompkins (2001) point out that “Because metaphors describe one experience in terms of another, they specify and constrain our ways of thinking about the original experience. This influences the meaning and importance we attach to the original experience, the way it fits with other experiences, and the actions we take as a result”. In other words, communicating with a traumatized individual using the specific metaphors chosen by that individual can influence the future actions taken by that individual, and has the potential to empower the individual to positive action.

The question then arises of how to respond to a traumatized individual who is speaking metaphorically. David Grove, a renowned psychotherapist and PTSD expert from New Zealand, developed a special methodology which would allow therapists to communicate comfortably with their clients while preserving the metaphors chosen by their clients to represent traumatic events (Lawley & Tompkins, 2001). He calls this methodology “Clean Language”, and it is also known as “Grovian Metaphor Therapy”. The way “Clean Language” works, basically, is that the therapist responds to the metaphor with questions that continue to respect the client’s mode of expression. For example, if the client expresses that she is a bird who is trapped inside a hole, then the therapist may respond by asking questions about the nature of the bird (by saying, for instance, “And what kind of bird is it?”), or about the nature of the hole (“And what kind of hole is it?”), or about what happens next (“And then what happens?”). Note that when using “Clean Language”, each response is prefaced with the conjunction “And”. The purpose of these questions and this particular phrasing is simply to perpetuate communication. To insist that the client is not a bird or that there is no hole would prove to be counter-productive to the client’s recovery process as it would ultimately act as an obstacle to communication and thereby impede recovery.

The effort to understand metaphorical language remains a valuable opportunity to open up lines of communication and help to build the social support which is so critical to the ... recovery process.

Even though many therapists recognize and appreciate the important role that metaphor plays in trauma therapy, metaphors along with opportunities to discuss them are still often missed during the recovery process. Why? Burns (2004) gives three main reasons. One is that metaphors are so common in our every-day language. “We are so used to metaphorical language that we are like fish in an ocean of metaphors,” he says (Burns, 2004). As a result, metaphorical language may pass by unnoticed. Secondly, it may happen that the therapist assumes a universal interpretation of a metaphor and fails to recognize the more subjective meaning intended by the client. Thirdly, the therapist may be reluctant to use metaphorical language for fear of being misunderstood.

In spite of these obstacles, the effort to understand metaphorical language remains a valuable opportunity to open up lines of communication and help to build the social support which is so critical to the trauma victim’s recovery process. In reference to written trauma narratives, Winslow writes:

Shouldn’t we read the texts on – and in – their own terms [...] to learn what their authors, who know intimately the extremes of the human condition, have to say? [...] If we don’t try, I think our failure renders the writer faceless as an experiencer of trauma... (2001)

Although Winslow is speaking of being an audience to written trauma narratives, her sentiment still holds true for spoken narratives as well. As one might imagine, a little validation goes a long way.

Hallucinations and Delusions as Metaphor
While hallucinations and/or delusions may in some cases be an indicator of PTSD, they may in other cases be an indicator of schizophrenia or some form of psychosis. Regardless of which psychological condition is triggering the hallucinations, the same principle of recovery through communication applies. In his book, Phenomenology & Lacan on Schizophrenia, After the Decade of the Brain, Alphonse De Waelhens asserts that “hallucinations cannot simply be explained as nothing more than false perceptions” (Johnston, 2002). De Waelhens felt that hallucinations represented unconscious and spontaneous attempts at recovery from psychological pain by the individual who experienced them. Amendiola (1998) supports this idea when she states that individuals “are usually attempting to problem-solve, even in a dissociative date”. Bruce Fink, a scientist who continued research along the lines of De Waelhens’ school of thought, reiterated the importance of using communication via metaphor to establish what he calls a “stable delusional system” which would allow the individual experiencing hallucinations to be able to interface with society’s objective reality in spite of varying perceptions (Johnston, 2002).

The Ethics of Communicating via Metaphor
If a person says that he is a fish, it could mean many different things. It could mean that he is hallucinating. It could mean that he is delusional. It could mean that he is simply speaking poetically. Or, it could mean that he is attempting to express the nature of some trauma that he has suffered. There is a certain old-fashioned school of thought which dictates that any person expressing “false” perceptions should be “corrected” and made aware that their perception differs from the norm (Sidis, 1914). The reality is that it may be more helpful to him to attempt to understand what he is trying to communicate than it will be to insist that he is wrong.

This does not mean that one is being dishonest by electing to communicate with an individual using his choice of metaphor. It does not mean that others have to agree that they perceive him to be a fish. It only means that they are trying to understand why he perceives himself that way. Asking questions such as “What kind of fish?” will reveal more about his train of thought and thus serve to perpetuate communication along with healing.

Conclusion
Trauma makes a tremendous impact on the human psyche, the effects of which may last for years. Even though sufferers of PTSD may benefit from the assistance of a professional psychotherapist, we as friends and loved ones can also make a powerful difference in an individual’s recovery process by simply listening and making an effort to understand what the individual is trying to express. The fact that trauma victims often use metaphorical language means that sometimes we have to put in a little more effort in order to interpret what is being communicated. This effort goes a long way.

Source: The Role of Metaphor in Recovery From Trauma - Susan Lien Whigham, © 2006 All Rights Reserved

References

Amendolia, R. (1998). A Narrative Constructivist Perspective of Treatment of PTSD with Ericksonian Hypnosis and EMDR. American Academy of Experts in Traumatic Stress, Inc. Retrieved June 17, 2006 from http://www.aaets.org/article32.htm

Brant, M. (2005, September 5). The things they carry. Newsweek, 146, 36. Retrieved June 11, 2006 from EBSCO Host

Burns, P. (2004). Metaphor and trauma: Poetry from clean language questions. Fulcrum, 3, 303. Retrieved June 25, 2006, from http://www.barnhill.org.uk/Metaphor&TraumaDec04.doc

Butler, K. (1997, Oct). After shock. Health, 11, 104. Retrieved June 11, 2006, from EBSCO Host

Jaffe, J., & Segal, J. (2005, November 18). Post-traumatic stress disorder (PTSD): Symptoms, types and treatment. Helpguide Mental Health Issues. Retrieved July 16, 2006, from http://www.helpguide.org/mental/post_traumatic_stress_disorder_symptoms_treatment.htm

Johnston, A. (2002, July 24). Book review: Phenomenology & Lacan on schizophrenia, after the decade of the brain. Retrieved July 4, 2006, from http://mentalhelp.net/poc/view_doc.php?id=1270&type=book&cn=7

Lawley, J., & Tompkins, P. (2001, January 11). Learning metaphors. Retrieved June 17, 2006 from http://www.cleanlanguage.co.uk/LearningMetaphors.html

National Center for PTSD. (2006, February 22). What is Post-Traumatic Stress Disorder? Retrieved June 18, 2006, from http://www.ncptsd.va.gov/facts/general/fs_what_is_ptsd.html

PTSD Alliance. (n.d.). About PTSD: Statistics. Retrieved July 4, 2006, from http://www.ptsdalliance.org/about_what.html

Sidis, B. (1914). Symptomatology, psychognosis, and diagnosis of psychopathic diseases. Retrieved June 18, 2006, from http://www.sidis.net/spdpdchap24.htm

Wikipedia. (2006, June 26). Metaphor. Retrieved June 30, 2006, from http://en.wikipedia.org/wiki/Metaphor

Winslow, R. (2004). Troping trauma: Conceiving /of/ experiences of speechless terror. The Journal of Advanced Composition, 24.3, 607-633. Retrieved June 30, 2006 from http://www.crvp.org/seminar/05-seminar/Rosemary%20Winslow.htm

Schizophrenia, Psychosis, Recovery, Post Traumatic Stress Disorder, The Role of Metaphor in Schizophrenia

Dr. Jack Rosberg: A History of Treatment & Current Ideas

2007-02-07T19:14:00.000-08:00

I reread a book recently that was published in 1908 in German by Eugen Bleuler. The title of the book is Dementia Praecox. Bleuler coined the term schizophrenia. This book was not translated from German to English until 1950 and it was an epic volume on classifying this condition. It is as reciteful as the DSM codes.

It is important to be aware of the monumental struggles that the earlier contributors made in their efforts to understand this very difficult human process, we now call schizophrenia. I think that it is very important for us to be aware of the history of the field in order to understand why we are, where we are at, today. We should be aware that some of Freud’s earliest followers began treating schizophrenia with a more active psychotherapy. This includes Sandor Ferenczi, Gustav Bychowski, Karl Abraham, Franz Alexander and others. In those early days the work was creative and exciting. Freud himself did not like this condition we call schizophrenia and made an effort to avoid treating it even though in fact he did, but he called it another condition.

When I began my career as a trainee learning Direct Analysis under the guidance and supervision of John N. Rosen, M.D., I felt a great sense of excitement being allowed the privilege of working with patients diagnosed with schizophrenia. That was prior to the introduction of the medications. We worked without any medication and because we believed that patients could recover, we poured our energies and our hopes into the treatment process and people did make behavioral changes that allowed them to function outside of institutions. This was not far from the works of Harry Stack Sullivan and his theories of interpersonal relations. Though Rosen was theoretically much more Freudian than Sullivanian, I began to utilize some of the direct methods of psychotherapy with some of the ideas of Harry Stack Sullivan. This happened to me intuitively. It became apparent later on that there was no other direction to take for me at that time. However, even that changed over the years.

It is a fallacy to think that work of any substance only began after the introduction of the medication.

This was also around the time of Frieda Fromm Reichmann, Bertram Lewin, Carl Whittaker, Thomas Malone, Sylvano Arieti, Otto Wills Jr. and Harold Searles. All these individuals were students of Fromm Reichmann and they made significant contributions to the understanding of psychotherapy with this population we call schizophrenic. There was the Palo Alto study with the distinguished anthropologist, Gregory Batson. Don Jackson, Jay Haley and a number of other contributors who were part of this study. These individuals did much to further the understanding of treatment with schizophrenia. People did change and recover from this condition. In Europe, there was Eugen Bleuler, Paul Federn, Gertrude Schwing, Manfred Bleuler, the son of Eugene Bleuler, Gaetano Benedetti, Christian Muller, Endre Uglestad and a host of other creative individuals who pushed the frontiers of knowledge further.
It is a fallacy to think that work of any substance only began after the introduction of the medication.

There was much going on in the field but, there was the split between the biological and the psychological, that still exists today. Unfortunately, there doesn’t seem to be a significant rapprochement between the two entities. I recall vividly, my early experience working with the most regressed patients who responded to my enthusiasm and the efforts and enthusiasm of my colleagues. Certainly our work was not isolated. There was a growing trend amongst many professionals on an international level to share their experiences by their writings and also the meetings they attended. People shared there work and their ideas and there was a sense of growing hope that treatment was developing in a very positive way.

When the medications came out that did indeed turn some people away from furthering the understanding of how relationships between therapists and patients make the difference in the outcome of treatment. There was some research done by an English researcher by the name of Phillip May. His research was biased however, it pushed people away from psychotherapy with schizophrenia. I think that it’s imperative for us to understand that even though medication has a place in the treatment of this unfortunate condition, medication is developed and sold by pharmaceutical companies who gain a tremendous revenue from ‘pushing medication’. There is a place for medication, I am not opposed to it, but it is only one treatment method amongst many other important methods that should be integrated. Such as psychotherapy, and psychosocial rehabilitation.

Attitude in reference to treatment is a very important part of the treatment process. Do you really want to treat this problem? Is it important to treat this problem? Because the person you are treating who has been long abandoned by the profession, deserves the best possible help that we can give them...

Psychotherapy is and can be successful. Psychosocial rehabilitation is and can be successful. However, both methods are not widely used enough and medication can be more successful, if it is integrated in the other treatment efforts. I must tell you that it took a considerable amount of time for me to appreciate the limited value that medication has because I saw what could happen with professionals who dedicated their efforts at helping the victims of schizophrenia even without medication. However, I began to realize after some time, that it is foolish to reject any useful treatment tool. I have worked with this population for 46 years. After years of effort, I began to understand enough of the process to be able to train and teach, in countries besides the United States. I saw the devastation wrought by professionals who didn’t care enough to put their best efforts into the treatment process and also who were untrained and basically not equipped to work with these individuals.

Attitude in reference to treatment is a very important part of the treatment process. Do you really want to treat this problem? Is it important to treat this problem? Because the person you are treating who has been long abandoned by the profession, deserves the best possible help that we can give them, which I believe they are not getting. I think that we can refer to the December 1999 report by the Surgeon General of the United States, which declares with emphasis how poorly organized current methods are and how many people with schizophrenia are denied proper care. Treatment has failed to answer the needs of the serious mentally ill. Has it failed because patients who have a long history of this condition can’t be helped? Or is it because we don’t want to work with them? It is acceptable if you don’t want to treat them, but at least make that clear. Don’t say it can’t be done because you don’t want to do it or you can’t do it. That’s completely unfair.

What we do determines the future of these human beings. They are not second class citizens they are just as good as anyone else despite their illness. All the symptoms and the frightening ideas that they have, may frighten people away from treatment and persuade them to say untrue things about that person with schizophrenia. That is not right.

As far as medication is concerned, I am opposed to the over utilization of it. I am opposed to medication being the center of treatment. It has become that, in the treatment world with some exceptions. I believe that it is very important to understand that schizophrenia is not primarily a medical condition and should not be seen as that, if we are to improve the results of treatment. There are some good people in the field however, but many are overwhelmed by those people who are looking for better medications. There is much research with respect to medication however, finding one that has better therapeutic value than some of the current medications is like looking for a needle in a haystack. Even if they find it, these human beings would still need other forms of treatment such as psychotherapy to help them understand, what happened, what it means and some understanding whether or not it has to happen again.

Making contact with this patient that has some substance to it, is the first step. If you don’t make the first step, if you don’t make contact with these people for treatment, there is no second step.

When we look at how medication is utilized in many institutional settings we wonder whether or not it’s for the patient or for the staff, because you often see offerings of medication that is beyond reason. If you look at medication and you come to some conclusion as to what is it’s purpose, if it is assumed that it will overcome that condition we call schizophrenia it is a fallacy, it can not do that. When you look at patients in institutional settings you see them with the symptoms and characteristics of schizophrenia however, they are modified by medication, which very often deprives them of the energies they require to go further in other forms of treatment. There are many reports that state when you reduce medication and you include other treatment efforts, then the effects of medication are more positive. So it is quite clear that there is a place for medication but it should not be the core of treatment. What we miss sorely are training centers that will help direct interested students and professionals into the area of treatment with this population. The universities do not provide that in their curriculum.

When we think of psychotherapy, what is the first step in treatment? Contacting that individual with that condition is imperative. Even the most regressed person can be contacted in a way which leads to a treatment relationship, if you are aware of its importance. These people can be reached, they are not beyond hope, there are chances for them to recover to some degree or another, depending on the consistency and the effectiveness of treatment. There are chances for them to recover to some degree at least, if the treatment is adjusted to fit their personal needs.

In my experience in other countries, like Russia, I was able to reach patients through an interpreter because I wasn’t overly concerned about language and cultural barriers. There are barriers that are much more difficult than that, they are our own feelings and our own fears and our own unwillingness to contribute and participate and be involved in this process with the patients that we treat. To quote Freida Fromm Reichmann who many years ago said, ‘treatment with these individuals is a shared experience,’ it’s between two people, not you the therapist, just standing aside and reflecting back to the patient what you think they feel.

Making contact with this patient that has some substance to it, is the first step. If you don’t make the first step, if you don’t make contact with these people for treatment, there is no second step. The first step has to prepare the patient, whether it happens quickly or not. You just don’t sit down with an individual and expect them to be open to treatment without the necessary preparation. There isn’t any relationship in the beginning of treatment. There has to be some relatedness between you and that person because that person has been through many therapists and has been disappointed by their lack of success and they feel like failures and are ashamed of their condition. Contact necessarily must lead to a therapeutic alliance, which is the context wherein all treatment takes place.

Source: Schizophrenia-Help Treatment Center

See also: Dr. John Weir Perry: Treatment or Therapy?

Schizophrenia, Psychosis, Recovery, The Recovery Based Model, Hope for Schizophrenia Sufferers, Psyche Bloggers Carnival

Bias and Stigma Within the Mental Health Community?

2007-02-02T20:25:00.001-08:00

I have just been banned from an online discussion.

I wandered into that discussion when I came across a link to it in a blog search on "schizophrenia". A thread had been initiated there by an individual who goes by the user name of chaos.

Chaos is a diagnosed "schizophrenic" who is training to become a psychologist; he/she had posted a question to the group at large -- namely, should a diagnosed schizophrenic disclose their condition to their peers and advisors?

I happen to have a certain degree of fondness for individuals who have been diagnosed with schizophrenia and I especially like them to know that there is never cause to give up hope -- many people have recovered and some, like chaos, have gone on to become professionals within the mental health field where they often serve as a beacon of hope to others, i.e., Dr. Daniel Fisher.

Within that community, there just so happened to be another thread devoted to the subject of "Psychologists With Mental Disorders". I participated in that thread as well and thought it was very fruitful, very informative. I was thanked for my participation by at least one other participant and the moderator who banned me (psisci) also took part in that discussion, addressing me directly and engaging me in the discussion. Naturally, these behaviors did nothing to indicate to me that I was in violation of any community guidelines. Apparently however, I did violate something, perhaps when moderator psisci -- a licensed psychologist -- said this:

Schizophrenia is a very debilitating disease that is not curable, but is treatable.

Any reader of this blog would know that not only do I not agree with that statement but that numerous clinicians in the fields of psychology, psychiatry and neurology also do not agree with it. Rather than argue that point with psisci, I chose to highlight some quotes from this blog that demonstrate that statement is not a valid one -- many people have recovered from schizophrenia.

What happened next?

The thread was closed.

This comment was offered as an explanation:

psisci: I understand your points, however this board is for student doctors not patients. A forum affiliated with SDN would be perfect for your topic www.psychcentral.com.

MOD

Because I was not able to respond in that thread I initiated a new one, explaining that it had not been my intent to contravene any community standards but that nothing in my experience of that community thus far had indicated to me that I was in violation of any community norms. I pointed out that the registering software not only allows non-student-doctors to register and post, it also allows them to identify themselves as non-student doctors! Apparently, those who set up the standards for potential registrants felt that participation by those who were not doctors-in-training was quite acceptable.

I stated that it was distressing when topics were closed down as based on undisclosed expectations and then thanked the moderator for the suggestion that I investigate www.psychcentral.com. At this point, my post was deleted and I was banned from the community with no explanation.

As noted, psisci had engaged in direct dialogue with me, even after I had explicitly noted that I was not a doctor or a student-doctor. This behavior has left me puzzled as to why that moderator would feel it was necessary to silence me and remove me from the community.

This blog currently receives 600 - 1000 page views per week [Note: Actual page views this week were 1,267.] so I'm going to leave it to my readers to determine for themselves exactly what happened and what I said that was so offensive that psisci felt it was necessary to take the actions he did. Those who wish to do so can read that thread here: Psychologists With Mental Disorders. [For the record, I would advise the moderator(s) to not remove that thread. It's already been read by more than 450 people and according to my site stats, a number of them are also reading here.]

Everything is a learning opportunity, is it not? There is a lesson here in this experience of mine -- for people like chaos, for people like psisci, for those of you who read this blog on a regular basis, and for those of you who go into the mental health field as motivated by a sincere desire to help others overcome the debilitating effects of severe mental illnesses, including the bias and stigma that surrounds those who currently or ever have suffered from them.

I have just received this message in my web-based mailbox...

We are happy to have you here, but you posted as a patient who has recovered from schizophrenia, and challenged the treatment of this disease in a medical fourm. Posting with personal experiences, asking for medical feedback is a violation of the TOS for SDN.

MOD
***************

Again, please do not reply to this email. You must go to the following page to reply to this private message:
http://forums.studentdoctor.net/private.php

All the best,
SDN Volunteer Team

Readers are welcome to read that thread and identify where I "asked for medical feedback". They are also welcome to review the Terms of Service of the studentdoctor.net forums.

Naturally, when I attempted to respond to that message I recieved yet another notification that I had been banned from the community. Apparently, silence is greatly preferred to dialogue by those who are licensed psychologists and moderators of the studentdoctor forums.

A few moments ago I discovered that my access had been restored. I further discovered a duplicate of the above message in my private mailbox at that site. I let the sender (psisci) know that I appreciated their kindness in restoring my access but I also let him know that I had made the decision to move on.

These words come to mind in this moment; they were offered to me by the father of a schizophrenic son and given to that father, by his son...

Be brave and grow.

Those are wise words.

Reflections on the above:

I was thinking on this situation through the day and what I found disturbing about it. That conversation opened with a question regarding the legalities of people with "severe mental illness" practicing as clinicians.

The responses to that question were particularly insightful because the conversation unfolded primarily between students who are training to become psychologists -- issues of discrimination, fear, ethics, and the potential harm of categorizing and limiting the potential of others were raised. For a conversation, it had some good meat on its bones! At the point I entered the dialogue, I did so to challenge the premise that a mental illness -- any mental illness -- is of necessity, a permanent condition. What I found most disturbing was the way the conversation was shut down, closed, locked, when the conversation turned to cure.

I have encountered this sort of behavior before. Readers familiar with this blog will know that it was begun after encountering two psychiatrists in the online environment who insisted that schizophrenia is an incurable condition -- they further considered that telling their "patients" as much was an act of compassion. One psychiatrist went so far as to say this: "On behalf of my profession, I do say that psychiatrists are the most gifted of physicians. In no other branch of medicine is the chief complaint so cryptic such that the physician has to start completely from scratch. Often, when a patient is unable to state their chief complaint and there is no one to state it for him, the patient is passed off as crazy, and sent along to psychiatry to figure him out, or he dies."

Can you feel the love?

Meantime, I'm thinking that perhaps what offended psisci most was a comment I made in my post that was deleted -- I stated that I was not a patient; a therapeutic relationship with a psychiatrist or psychologist was not a factor in my recovery. I was not hospitalized, nor have I received any form of psychiatric medication. Maybe I was banned for not adopting the subservient role that is expected by some doctors of those they profess to serve. Maybe I was banned for challenging psisci's declaration of expertise. Regardless of the motive, the end result was the same: I was silenced, excluded, pushed out -- not even allowed the opportunity to speak on my own behalf. When I attempted to do so, that post was deleted and I was banned.

The first few times I saw this kind of behavior in professionals, it shocked me. I'm not shocked anymore. Those who can speak of recovery are those who have recovered; there are some within the medical community who would prefer that they not speak.

What I also find disturbing is that psisci was once a student-doctor, just like all the rest of the student-doctors in that community. Someone, somewhere told him that schizophrenia was incurable and that statement became sanctified as higher knowledge to the extent that speaking against it is akin to blasphemy. Meantime that statement will get passed on to the next group of student-doctors, many of whom will probably go on to silence those who can speak knowledgeably of recovery.

See also: Vincent

A clinical psychologist writes...

This is a wonderful spot. I read through your experience [at the above medical forum]. For the most part you encountered lazy jibberish.

The 'Synopsis of Psychiatry' is about the most widely used psychiatric texts by psychiatric residents in training. You can't get more mainstream or 'medical model. That said, here are excerpts from the 9th edition page 497 under 'prognosis' for schizophrenia: 'Reported remission rates range from 10-60% ....reasonable estimates that ....30% of schizophrenic patients are able to live somewhat normal lives. Another ....30% go on to experience moderate symptoms ....and 40% ....remain significantly impaired ....their entire lives.'

This simply doesn't jive with the jibberish you were hearing.

There are a fair number of luminaries in psychology and psychiatry who 'carry diagnoses' of schizophrenia and bipolar illness....more bipolar. If we looked at the lifetime prevalence of diagnosable mental disorders in the careers of mental health professionals, we will see a majority of clinicians 'qualify' ....some for GAD, Panic, OCD, Major Depression, Dysthymia, Bipolar II, and so on. Most psychologists I know are dysthymic as their baseline, with intermittent episodes of more serious depression.

We have a responsibility to manage any medical problem or cluster of serious psychosocial stressors like we would if we had diabetes, heart disease, hypertension, hypothyroidism, etc. I believe you were dealing with a very young, naive, and 'frightening' group of people in that forum. I am a clinical psychologist, age 47, and felt you were the most intelligent, well read, and sensible one of the bunch.

You have lots of people who know the intimate details of your journey. Don't pay much attention to the uptight frightened --'us-them' mental health types....

Great work you are doing.

Several months ago I had a similar discussion with Dr. Richard Petty in regard to the “schizophrenia is incurable" statement during which he also noted:

This is not true: but rather than being an indictment of psychiatry, it’s an indictment of bad psychiatry. We have a great deal of evidence that the brain is a highly plastic organ, and that many of the typical changes seen even in unmedicated people with the illness can return toward a normal pattern. This shouldn’t be a surprise: it has been known for many years that at least a third of people who carried a diagnosis of schizophrenia recover completely. To say that the recovery indicates that the original diagnosis was wrong is an extraordinary piece of circular reasoning.

Let the above serve as an example that there are good clinicians out there. If you or someone you love should end up with one of those who -- like psisci -- tells you that schizophrenia is incurable, take that as an indication that they are not up-to-date with the current research (or even the not-current research!) and that you should look elsewhere for skilled assistance.

Further reflections...

Regarding the note from the clinical psychologist who responded above...

I did very much appreciate finding that note in my mailbox. I appreciate the support and I think it's important that when one psychologist stands up to speak for their "field" that if others in the field disagree, they should stand up and voice their disagreement. If the individual above hadn't taken the time to respond, readers of this post might walk away with the impression that all psychologists were as misinformed as psisci and that would be an injustice to those in the field who are not that way at all.

The more I think about it, the more I think my "offense" was to state that I was not a patient. Earlier in that thread, psisci had already noted his discomfort with that perspective and likely did not appreciate my affirmation of his fears.

psisci: Not to hijack this thread at all, but WE are doctors, they are patients, we are not lawyers, used car salesmen or real estate agents, and they are not clients whether they pay out of pocket or not..........sigh

Aside from that, I do think the conversation was going along swimmingly; I saw a lot of intelligent responses from others that I found encouraging. The poster who goes by the name of Toby Jones for example, was clearly willing to examine and challenge the boundaries of the issue. Meanwhile, another poster there who goes by the name of Amy203 has had me chuckling all morning with her response to psisci in yet another thread titled: What is Psychology?

I would hope that any reader walks away from this post, not with the feeling that all psychiatrists or psychologists share the arrogance displayed by some, but rather, that it's vitally important to apply the tool of discernment. There are some very good clinicians out there, there are also a certain percentage who should not be permitted within ten feet of wounded human beings.

Remember the golden rule: Choose your caregivers wisely.

Interesting. Apparently, some more discussion has arisen out of the thread that was closed: Ethics Code Info: re personal problems

For those who are interested, the code of ethics of the American Psychiatry Association can be found here. The code of ethics for psychologists appear to be far more substansive, at least on first glance. They can be found here.

Elsewhere in the blogosphere...

Here's Spiritual Recoveries on being booted from a mental health bulletin board for her thoughts on schizophrenia. Glad to see that tomorrow's doctors are learning today how to kick patients out of conversations.

Regards and thanks to Furious Seasons for the plug.

Who is "John Grohol" and what does he have to do with this entry? For those not in the know, John Grohol is a clinical psychologist and also the founder of psychcentral.com. I was curious to know a bit more about him because psychcentral co-hosts the studentdoctor.forums. So I decided to check out the link psisci had recommended to me.

According to this link...

Psych Central is the oldest peer-reviewed psychology and mental health directory on the Internet. Started in 1992 as an index to mental health and support newsgroups it now indexes over 3,500 resources. It also offers hundreds of informative articles on mental health symptoms and treatments, psychology and relationship topics, as well as interactive online quizzes, and a vibrant online self-help support community.

I thought I'd take a gander at the community. What I found was a nice little forum, with an abundance of topics related to mental health issues and well-defined expectations of the participants. The emphasis appears to be on peer support although I am told that a number of students and doctors are members. John Grohol seems to take a reasonably active role in the community as well; he serves as a moderator and even hosts a Tuesday night chat with community members during which they get to ask him all kinds of questions and he does his best to provide some answers. That piqued my interest. I've heard of professionals who blog and professionals who run online communities, but I've never heard of one who chats. It just so happened that a Tuesday night chat was scheduled to begin in less than an hour...

When I logged into the chatroom, several others were already there in anticipation of the evening's event. Through the course of the scheduled one-hour chat session, a number of others popped in and out -- some to ask "Doc John" a question, others to offer up a round of "hellos" to their online friends. The entire chat had a warm free-for-all quality. Several conversations were going on at any one time, but the primary focus seems to be an informal question and answer session between the community and its founder. It was clear to me that the community members liked and respected "Doc John". It was equally clear that he liked and respected them back. As the hour wound to a close I decided to take a turn at the cyber mike...

"I have a question..."

"Sure spiritual," Doc John replied.

"If I'm here," I said, "I'm here to speak about recovery from schizophrenia. Do you anticipate any difficulties with that?"

The conversation drifted in four different directions and I had to redirect him back to my question at one point. Nonetheless, he did respond...

"No," he said. "I don't anticipate any difficulties with you speaking of your recovery ...."

And that was that.

When I logged out of chat I noticed a link down at the bottom of the forum index that linked the psychcentral community directly to the studentdoctor community along with a notation that those looking for discussions with students in psychology should try the Student Doctor Network. None of which provides me with any clearer indication as to why psisci saw fit to delete my post and ban me, but it does let me know that "Doc John" does not seem to operate from the same mindset.

Schizophrenia, Psychosis, Recovery, psychcentral.com, studentdoctor.net, Bias, Stigma,Psychology, Psychologists, Psychiatrists, Psychiatry, Professional Ethics

Dedication...

2007-02-02T18:33:00.000-08:00

There are a number of individuals I remain indebted to, each of whom have helped bring me to this place I am in today. Foremost among these are two dear friends who know who they are. I would not have made it without them and they know as much, for I've told them both many times over.

I am also indebted to a stranger who reached out to me with compassion and concern during the peak of my "psychosis". A little kindness in the right place goes far. That individual is also aware of the impact they had on my life.

I am further indebted to the internet itself and the wealth of material it delivered right to my doorstep from some of the most innovative and brilliant minds in psychology and psychiatry: Carl Jung, John Weir Perry, Marion Woodman, David Lukoff, Loren Mosher, R.D. Laing, Maureen Roberts, Clarissa Pinkola Estes, Anne Baring, Rufus May, Daniel Fisher, and numerous others.

I am especially indebted to other ordinary human beings like me who have an intimate understanding of the experience that is known as psychosis/schizophrenia in this culture. They have been some of my greatest teachers...

It was 1972 when Isaiah decided to drop a hit of acid on the beach with two fellow students in his medical program. At some point in that experience, the sun rose. As it crested the horizon, the sun blossomed into full flower and spoke to Isaiah. The sun told Isaiah that he was a child of god. Isaiah interpreted this to mean that he was Jesus Christ.

Isaiah's friends didn't know what to make of his god trip so they dropped him at the doorstep of the local psych ward. According to Isaiah, he then underwent more than 200 electroshock treatments and more than 200 hours of insulin coma therapy for the crime of believing he was god.

I always respected Isaiah for he was one tough cookie, but I also gave him a wide berth because he was rumored to have killed his psychiatrist. For all I know, Isaiah himself started that rumor. I can see where it would have had a certain degree of usefulness for him. It helped ensure that others -- like me -- kept their distance. After all, Isaiah didn't mind his time spent dancing with the gods; it was the human beings he didn't trust.

Isaiah has never recovered from the trauma of his treatments. In spite of wherever he's been, he's managed to secure a small parcel of land for himself in a beautiful setting, a wife, and children. For what it's worth, Isaiah also happens to still believe that he is Jesus Christ and I, for one, am not willing to argue the matter with him.

Hazel was a young mother when she experienced her first psychotic break. She was separated from her husband and children and placed in a lock-down ward where unusual behavior was punished by being stripped naked, hosed down, and placed in isolation. Hazel's behavior strayed into the unusual so often, she finally took to going naked.

It took Hazel eighteen years to move through her schizophrenic process. She identifies an empathic therapist as being instrumental in her recovery.

Patricia was a woman I encountered through our mutual involvement with a specific website. I'm almost ashamed to say that I don't remember much of Patricia's personal experience. What I do remember is that she was one of the few people who ever took the time to read the account of my experience, and read it with the same, painfully slow deliberation as it was written over those several weeks. She didn't judge, she didn't rush in to make my experience into something more palatable to her. She let it be...

Patricia is not only recovering; she is assisting in the recovery of others.

Michael was a graduate of John Hopkins University in their mathematics program. A clearly sensitive young man, Michael also wrote poetry, had been practicing kundalini yoga and experimenting with ethneogens when he began to experience a strange sequence of synchronicities and coincidences. What was most striking to me at that time was that he had encountered three women in swift succession, appropriately named Eve, Helen and Mary.

Michael jumped off a bridge two days before Christmas. He was the teacher who taught me why it's important to share my experience with others -- so they feel less alone in theirs. Michael was 31 years old. I will never forget the anguish of his father.

I didn't meet Benjamin. I met his mother. She was a truly beautiful person who was deeply grieving the loss of her son.

Benjamin had died due to a rare complication of anti-psychotic medication known as Neuroleptic Malignant Syndrome. The cause of death on his autopsy report was listed as, "Natural".

Benjamin's mother didn't quite know how to wrap her mind around such a word. How could the death of her beautiful son be natural? How could he die as a result of the treatment that was supposed to help him? How could those within the medical community dismiss his death so callously as being "natural"?

Benjamin was 25. His mother is currently recovering.

Marek was a diagnosed paranoid schizophrenic who spent six years in the care of psychiatrists and various medications. I ran across his blog when I followed up on a well placed link. Shortly thereafter, Marek went through another "break". He decided to go into the experience itself and in that process, made some fascinating discoveries about why he was the way he was. He no longer considers himself to be DisOrdered.

Marek is recovering.

xxxxxxxxx was in his late teens when he went through his first "break". Like Marek, I first "met" him through his blog. He could be one of the many young men out there who first encounter this experience called "schizophrenia" in this culture when they are on the verge of adulthood.

xxxxxxxxx has had great difficulty coping with what I call the encounter with the abyss -- a point of annihilation that can be part of the "schizophrenic" process, wherein one experiences oneself as nothing at all. He also has anger at having been cast into this experience that may well mean that no one will ever look at him the same way again. This part of him, angry and alone as it may be, gives me hope. Somewhere, xxxxxxxxx knows he's much more than a label -- he is a human being, having a very human experience.

Our encounters were brief, few, and in between. Still, there was an intelligent mind and a sensitive heart behind that chosen cyber name. I think of him often and hope he finds his own recovery -- in his own way and his own time.

Some of you may have noticed that there is an absence of "feminine voices" represented in the sample above. I've wondered about this myself and have considered that among the females I'm aware of who have had "psychotic" experiences, they are frequently given the label of "bi-polar". This matter remains a curiosity to me.

See also:

Tonglen

Definitions of Recovery

Music of the Hour: Vincent

Schizophrenia, Psychosis, Recovery, The Recovery Based Model, Hope for Schizophrenia Sufferers, Psyche Bloggers Carnival

Dr. Loren Mosher: Guidelines for Treatment of Psychosis

2007-01-20T19:39:00.000-08:00

Please note, Dr. Mosher passed away a few years ago. I do not know if the resources he offers at the end of his letter are still available from Soteria Associates.

Dear Sir/Madam:

Thank you for your recent inquiry about the treatment of psychosis with little or no psychiatric medication. I presume you contacted me after finding my website, on personal recommendation or having read one or another of my publications. Unfortunately, the treatment facility mentioned in many of the publications and on the website-Soteria House-is closed. There are no current American replications of its special social environment and treatment principles. Interestingly, the Soteria model (and variations on it) of care is becoming available in the Scandinavian countries, Germany and Switzerland.

The materials presented in the website (www.moshersoteria.com) make clear my views on the overuse and misuse of the psychotropic drugs, in particular the so called "neuroleptics" or "anti-psychotic" medications. These drugs, even the newer so-called "atypicals", have serious "side effects" and toxicities associated with their use. Some of their toxicities are life threatening (neuroleptic malignant syndrome), while others, like tardive dyskinesia and tardive dementia are usually cosmetically disfiguring, irreversible and result in seriously diminished overall functioning. Numerous other toxicities, both physical and cognitive, are associated with their short and long term use. Hence, if possible, it seems prudent to avoid or minimize their use.

Unfortunately, many psychiatrist’s believe the myths that these drugs are the only real treatment for "serious mental illnesses" (they may give lip service to psychosocial interventions) and that they have improved the long-term outcomes of patients receiving them. Many studies show that these two beliefs are indeed myths. In fact, long term social, vocational and symptom outcomes are probably worse now than before these drugs were introduced. However, since it does not fit the currently fashionable belief system this research is given little credence and is discouraged by funding sources and journal editors.

Moreover, it is common (but as far as I am concerned, questionable) practice these days to give many patients a "cocktail" of a combination of different types of drugs to try to treat the many different kinds of symptoms a single patient may present-independent of his/her actual problem(s). Unfortunately, both type of problem and treatment are non-specific. That is, the various "disorders" are difficult to distinguish and a given treatment may be useful for several types of problems. Hence, psychiatrist’s tend to "cover all the bases" with their medication regimes. This practice has never been subjected to clinical trials and no credible scientific evidence exists that such drug cocktails produce better results in the treatment of psychotic symptoms. Each additional drug has its own set of side effects, toxicities and interactions with other drugs that result in exposing patients to a larger number of possible medication related problems.

In addition to their short and long term unwanted effects all psychiatric drugs have withdrawal reactions because of the changes they cause in the brain. These reactions vary in time of onset, severity and type of symptoms experienced. There is also great inter-individual variability as to if, when and how withdrawal is experienced. As a rule of thumb the longer a drug has been taken and the higher the dose the more severe the withdrawal reaction will be. Do not stop your drug(s) suddenly or reduce your dose quickly, as this usually increases the chances of developing severe withdrawal reactions. Dose reduction and discontinuation should always be done slowly while in a relationship with a thoughtful and competent physician-not necessarily a psychiatrist.

You should be aware that it is generally considered to be malpractice for a physician to prescribe (including a withdrawal regime) for patients he has not seen-except in emergency situations. Hence, because I am not your doctor I am not able to give you specific advice about what to do about the drugs (if any) you are currently taking or being asked to consider. I would counsel that you find a physician you like, trust and with whom you can form a collaborative relationship to discuss your concerns and wishes. Based on my experience you are more likely to find a non-psychiatric physician who is willing to consider dose reduction and discontinuation than a psychiatrist is. Hopefully the doctor will provide you with the information you need to make an informed decision. Be very careful of information derived from pharmaceutical manufacturers, especially about their newest "breakthrough" product(s). A fairly complete list of potential withdrawal reactions from neuroleptics, as well as a prudent withdrawal program to be undertaken in conjunction with your physician, are discussed in Your Drug May Be Your Problem: How and Why to Stop Taking Psychiatric Medications by Peter Breggin & David Cohen (PerseusBooks, 2000).

My own thinking about psychiatric drugs (especially the so-called "anti-psychotic" medications) is that they should be avoided if at all possible. My approach would be first to develop relationships with the persons involved and establish a safe and protective social context-preferably at a residence. Then I would take a relationship building psychotherapeutic approach including the family if possible-based on developing an understanding of, and finding meaningfulness in, the situation presented. This is easy to say but hard to do in these days of managed care and mental health practitioners lacking training in basic listening skills. In addition, a lack of non-coercive in-residence mobile crisis teams, communities lacking safe places (like Soteria House) and viable support networks - all of which can dedramatize crises - makes the process even more difficult.

If for some reason drugs are necessary, and agreed upon by all parties, I start with the lowest dosage possible of the least toxic drug for the shortest period of time needed to address a specific behavior. The commonest reason I have found it necessary to use medications has been when it has not been possible to assemble enough caregivers to assure everyone’s safety. Unfortunately, my views are not widely shared by my fellow psychiatrists or the drug companies. There is an extensive discussion of why drugs should be avoided if possible and how they should be given when necessary in chapter 5, "Is Psychotropic Drug Dependence Really Necessary?" of Mosher and Burti’s "Community Mental Health: A Practical Guide" NY. Norton, 1994. Norton’s phone order number is 800-233-4830.

If you are in touch because of an immediate, severe personal/family emotional crisis (however defined) I cannot tell you what to do because I am neither your doctor nor do I know you or the resources and options available in your area. There are, however, several generic principles that might be useful in your decision making:

Try to remain in as normal an environment as possible - one that includes your usual relationship - at home, at a friend’s house, or at a residential setting that is home like-even if staffed by paid caregivers.

Try to use natural resources like family, friends, clerics etc. to help by providing support and common sense advice within the context of their relationships with those involved. If professional intervention is needed they should come to where you are.

Emotional/psychological crises are very frightening. Never the less try, at all costs, to avoid medicalization of whatever the "problem" is. Also, even though you may not know exactly what to do - do not let mental health professionals take away your power to control your own life by the use of coercion. The use of coercion means that because the professionals don’t want to take the time to understand the problem and its context they provide a pseudo solution with the use of force. The problem with the power and authority of psychiatrization is that it comes with the nearly inevitable consequences of labeling, stigmatization, discrimination and marginalization. Once you have been diagnosed, it will be impossible to remove a diagnosis from your medical records, regardless of the haste with which it was applied, or regardless of whether the diagnosis may be even remotely considered "correct." What I am saying - try to stay away from emergency rooms and hospitals unless it is clear to someone that the problem probably has a physical origin. This should be determinable by a call to your primary care doctor.

Most crises arise in a family and its historical context. Hence, the focus of the relationally oriented intervention usually should be the family. Given this conceptualization it becomes very difficult to decide whom, if anyone, should be medicated. I would not object personally to a sedative medication being given to all those who have been sleep deprived as a result of the crisis. The drug of choice for such situations is Benadryl, available without a prescription. Other sedatives would need to be prescribed by your physician. Sedatives have been shown to be as helpful as the anti-psychotic drugs in the de-escalation of severe ("psychotic") crises.

Within the context of a relationship, interventions should focus on the life events that are temporally related to the beginning of the crisis - e.g. loss of a job, breakup of a relationship, a death, failure at school, leaving home etc., etc. Each situation is unique so there is no one answer to what went wrong and how it might be best dealt with.

It is good to remember that the more normally people are treated the more normally they will behave. In addition, crises offer opportunities for growth and change in a positive direction and are usually self-limited if not dealt with in a way that prevents their resolution. One of my major objections to the use of the anti-psychotic drugs in acute crisis situations is that because they are such powerful central nervous system suppressants they may well have the effect of preventing crisis resolution.

It may not be easy to follow the generic principles I outlined above. They should be regarded as guidelines that will likely have to be compromised. There are only a handful of crisis teams or programs (in the U.S.) of which I am aware that operate more or less in accordance with them. Basically, the use of psychotropic drugs is required by most residential treatment programs - thus immediately excluding them from the list. Crisis teams are usually coercive and medication oriented.

A list of programs not requiring the use of psychotropic drugs will be sent if it was requested in your communication to me. If you requested written materials about my work they will be sent so long as a snail mail address was included.

Should you, your family and/or social network or program wish to schedule a face to face consultation around the questions you have raised you may contact me at the above address, email, phone or fax.

Sincerely,

Loren R. Mosher M.D.

Source: Soteria Associates

Schizophrenia, Psychosis, Recovery, Treatment, Loren Mosher, Soteria House

John O'Donohue: November Questions

2007-01-18T22:27:00.002-08:00

November Questions

Where did you go
when your eyes closed
and you were cloaked
in the ancient cold?

How did we seem,
huddled around
the hospital bed?
Did we loom as
figures do in dream?

As your skin drained,
became vellum,
a splinter of whitethorn
from your battle with the bush
in the Seangharraí
stood out in your thumb.

Did your new feet
take you beyond,
to fields of Elysia,
or did you come back
along Caherbeanna mountain
where every rock
knows your step?

Did you have to go
to a place unknown?
Were there friendly faces
to welcome you, help you settle in?

Did you recognize anyone?
Did it take long
to lose
the web of scent,
the honey smell of old hay,
the whiff of wild mint
and the wet odour of the earth
you turned every spring?

Did sounds become
unlinked,
the bellow of cows
let into fresh winterage,
the purr of a stray breeze
over the Coillín,
the ring of the galvanized bucket
that fed the hens,
the clink of limestone
loose over a scailp
in the Ciorcán?

Did you miss
the delight of your gaze
at the end of a day's work
over a black garden,
a new wall
or a field cleared of rock?

Have you someone there
that you can talk to,
someone who is drawn
to the life you carry?

With your new eyes
can you see from within?

Is it we who seem
outside?

© John O'Donohue

Dr. Brian Koehler: Long-Term Follow Up Studies

2007-01-17T18:29:00.000-08:00

I thought it would be helpful to summarize the actual data on long-term follow-up studies in schizophrenia since there are still so many myths surrounding this area. I am still amazed to hear graduate students in various mental health disciplines speak of the “incurability” of severe mental illness. I derived the following information primarily from “Beyond dementia praecox: findings from long-term follow-up studies of schizophrenia” by Joseph Calabrese and Patrick Corrigan, published in Recovery in Mental Illness: Broadening Our Understanding of Wellness edited by Ruth O. Ralph and Patrick W. Corrigan in 2005 for the American Psychological Association.

The Burghölzli Hospital Study ( Switzerland)
Manfred Bleuler, son of Eugen Bleuler who was director of the Burghölzli clinic in Zurich and gave us the name schizophrenia, followed a cohort of 208 patients for an average of 23 years. This cohort included both first admissions and readmissions to the hospital during 1942 and 1943. The diagnostic criteria emphasized psychotic symptomatology. The results indicated that 53% of the group participants overall and 66% of the first admission participants were judged to have recovered or be significantly improved. Fully recovered participants comprised 23% of the first-admission group and 20% of all research participants.

The Iowa 500 Study ( United States)
In the Iowa 500 study, 186 persons with schizophrenia were followed for an average of 35 years. The researchers also included a group with affective disorder and a control group of 160 surgical patients. Compared to people from the other psychiatric groups (i.e., with a diagnosis of affective or schizoaffective disorder), 46% of those people with schizophrenia had improved or recovered.

The Bonn Hospital Study ( Germany)
This study followed 502 persons with schizophrenia for an average of 22.4 years. The results were that 22% of the research participants had complete remission of symptoms, 43% had non-characteristic types of remission (defined as involving non-psychotic symptomatology, such as cognitive disturbances, lack of energy, sleep disturbances, hypersensitivity; in regard to the latter, some patients have described this state as a type of “skinlessness”), and 35% experienced characteristic schizophrenia residual syndromes. Therefore, 65% had a more favorable outcome than would have been expected from clinical experience. In regard to social functioning, 56% of all participants were judged to be “fully recovered,” which was defined in this study as full-time employment. At the last follow-up, 13.3% were permanently hospitalized.

The Lausanne Study ( Switzerland)
This study reported the longest term follow-up of the major long-term studies. The researchers, who included Luc Ciompi, followed 289 participants for an average of 37 years and up to a total of 64 years. The results indicated that 27% reached a stabilized 5-year end state of recovery, 22% reached an end state described as “mild,” 24% were described as “moderately severe,” and 18% were judged to have a “severe” end state. There was a 14% rate of continuous hospitalization.

The Chestnut Lodge Hospital (United States)
In this study, 446 (72%) of the persons treated between 1950 and 1975 at Chestnut Lodge psychiatric hospital in Rockville, Maryland, were followed for an average of 15 years. This site specialized in psychoanalytically-oriented long-term residential treatment. The research population consisted of persons with chronic and treatment-resistant mental illness. The researchers used a highly restrictive definition of recovery: full time employment, absence of symptomatology and need for treatment, meaningful engagement in family and social activities. The results were that two thirds (64%) of the persons with schizophrenia were judged to be chronically ill or marginally functional. One third (36%) were recovered or functioning adequately. The investigators reported that there were recoveries that included persons who had been viewed as hopeless chronic cases.

The Japanese Long-Term Study ( Japan)
This study took place at Gumma University Hospital in Japan. One hundred and five persons with schizophrenia discharged between 1958 and 1962 were followed for a period of 21 to 27 years. Thirty one percent of the participants were judged to be recovered, 46% improved, and 23% unimproved. Results on social outcome indicated that 47% were fully or partially self-supportive and 31% were hospitalized.

The Vermont Longitudinal Research Project ( United States)
This study, conducted by ISPS member Courtney Harding and colleagues, followed 269 persons for an average of 32 years. The participants had been ill for an average of 16 years and were hospitalized on the back wards of Vermont State Hospital for 6 years. This study is unique in that the participants were involved in an innovative rehabilitation program and were released with community supports already in place. DSM-III criteria were used. At follow-up, one half to two thirds of all participants were considered to have improved or recovered. Of the living participants with schizophrenia, 68% did not display further symptoms or signs of schizophrenia at follow-up. Almost half (45%) of the participants displayed no psychiatric symptoms at all. More than two thirds (68%) of the participants were assessed as having good functioning on the Global Assessment Scale, which provides a global measure of social and psychological functioning.

The Main-Vermont Comparison Study ( United States)
This study compared the outcomes of 269 persons with schizophrenia in Maine with the outcomes of the 269 persons in the Vermont Longitudinal Study. The average follow-up period for the Maine participants was 36 years and 32 years for the Vermont participants. The persons in the Vermont study were exposed to a model rehabilitative program organized around the goal of self-sufficiency, immediate residential and vocational placements in the community, and long-term continuity of care. The Maine participants received standard psychiatric care. Results of this study showed that the Vermont participants at follow-up were more productive, had fewer symptoms, better community adjustment, and global functioning than the Maine participants. Approximately one half (49%) of the Maine participants were rated as having good functioning on the Global Assessment Scale, the primary global measure used for both the Maine and Vermont participants. The authors suggested that it was the provision of the model rehabilitative program.

The Cologne Long-Term Study ( Germany)
This study followed 148 persons with a DSM-III diagnosis of schizophrenia and 101 persons with schizoaffective disorder for an average of 25 years. The results showed that 6.8% of persons with schizophrenia had full psychopathological remission and 51.4% had noncharacteristic residua. Therefore, 58.2% had a more favorable outcome than would have been expected with schizophrenia.

The World Health Organization International Study of Schizophrenia
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. Those participants with a specific diagnosis of schizophrenia had a recovery rate which was close to 50%. Geographic factors were significant in terms of both symptoms and social disability. Certain research locations were associated with greater chance of recovery even in those participants with unfavorable early-onset illness courses. 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.

The first of the WHO studies, the International Pilot Study of Schizophrenia (IPSS), assessed 1,202 persons diagnosed with schizophrenia in nine countries. The results showed that persons with schizophrenia in the “developing” world (e.g., Columbia, India, Nigeria) had better outcomes than persons in the “developed” countries (e.g., Moscow, London, Washington, Prague, Aarhus, Denmark). Overall, 52% of persons in the developing countries were assessed to be in the “best” category of outcome (defined in this study as an initial episode only, followed by full or partial recovery) compared with 39% in the developed countries. This finding was also reported in a 5-year follow-up research study. In this study, 73% of those participants from the developing world were in the best outcome group compared with 52% in the developed world. A second study called the Determinants of Outcome of Severe Mental Disorder (DOSMD) used more rigorous criteria and followed more than 1,300 patients in 10 countries and, similar to the IPSS, discovered that the highest rates of recovery occurred in the developing world. At a 2-year follow-up, 56% of those in the developing world were in the best outcome group compared to 39% of the participants from the developed countries. The finding of better outcome for persons in the developing countries applied whether the illness was either acute or gradual in onset.

These findings by the WHO have been critiqued on the basis of differences in follow-up, arbitrary grouping of centers into developed or developing, diagnostic ambiguities (e.g., narrow versus broad definition of schizophrenia), selective outcome measures, gender-related factors, as well as age. However, a recent reanalysis of the data by Kim Hopper and Wanderling (2000) convincingly demonstrates that not a single one of these criticisms is sufficient to explain away the findings of differential course and outcome in schizophrenia favoring persons in the developing countries. These are surprisingly robust findings.

The findings of the WHO studies demonstrating better courses and outcomes for people in the developing world have been attributed to the following factors: family environment and expressed emotion; social role expectations; stigma and discrimination, etc.

Harding, Zubin and Strauss (1987) noted that the development of chronic illness in persons with schizophrenia “may be viewed as having less to do with any inherent natural outcome of the disorder and more to do with a myriad of environmental and other psychosocial factors interacting with the person and the illness” (p. 483).

In regard to all of the follow-up studies, Calabrese and Corrigan (2005) concluded:

“Each of these studies found that, rather than having a progressively deteriorating course, schizophrenia has a heterogeneous range of courses from severe cases requiring repeated or continuous hospitalization to cases in which a single illness episode is followed by complete remission of symptoms. The findings reported in these studies as a whole indicate that roughly half of the participants recovered or significantly improved over the long-term, suggesting that remission or recovery is much more common than originally thought” (p.71).

Source: Long Term Follow Up Studies

Schizophrenia, Psychosis, Recovery, The Recovery Based Model, Hope for Schizophrenia Sufferers, Psyche Bloggers Carnival

Dr. Daniel Fisher: Learning from Northern Europe

2007-01-17T17:09:00.000-08:00

In April-May, 2006, I gave a series of talks in Sweden, Netherlands, and Denmark. I talked but I also entered into dialogue with “users” (their name for consumer/survivors), families, and providers. This tour filled me with new understanding, which I want to share with you all. We entered into dialogues of mutuality across cultures and languages. My symbol for this sharing is found in the drawing of two hearts by a user from Denmark:

I now feel the core of recovery is as follows. Throughout our life we each pursue our development to become the unique person we deeply are. We develop this sense of ourselves through deepening emotional connections with important persons in our life. These connections provide us the light to see and feel our values and emotions. The better we know ourselves, the better we can self-direct our life based on our dreams and goals.

When we experience various traumas causing us loss of control over our lives, we suffer extremes of emotional distress. If we are unable to share these emotions with others, we develop distortions in our thinking and feeling which interfere with our expected life role. We are then at risk of being labeled mentally ill, unless we can share these extremes of anger and sadness and transform them into passion. This passion can empower us to continue our journey of self-discovery.

Through this process we learn to believe in ourselves and to accept our deepest self. To transform disturbing emotions into passion, we need to share with authentic, genuine people. These genuine people are capable of connecting with us at our heart level. Heart-felt conversations with genuine people are based on caring, trust, respect, hope, and love. These conversations empower us because they help us to believe in ourselves. In these conversations we are able to be fully present in the moment with each other enabling us both to more deeply be. The “Heart is a lonely hunter” forever seeking nourishment through love.

People in Europe resonated with this message, just as they had in Japan. The hunger seems to be universal. The need to hear a hopeful message is widespread. They resonated when I told them of the young man in Canada who shared with me that he heard voices when his heart no longer spoke to him. In a similar vane, members of the Voice Hearers Network in the Netherlands reported that telling your life story in your words to others is crucial step in relieving the distressing aspects of hearing voices.

Users in Denmark told with great enthusiasm of a Finnish model for preventing first episodes of psychosis from leading to mental illness. In remote, rural areas of Finland, far from hospitals and academic psychiatry, professionals have empirically learned how to prevent schizophrenia from developing. When a member of the community (usually a young adult) goes into a state of severe emotional distress and their reality becomes distorted, a team of professionals convene several meetings with the significant members of the person’s social network. The person in distress is always present at such meetings. Open dialogue, in down to earth language, is used to frame each person’s understanding of what has been happening within the network to lead the person in distress to respond in such a fashion. They use some of the ideas for a reflecting team developed by Tom Anderson in Norway.

Such meetings allow the person in distress to remain in his or her home without hospitalization, and to require little medication. Apparently, the break in the conversations, which had caused acute distress, is repaired. This allows the young person to resume connection with the people and conversations necessary to orient him/her to reality. The recurrence rate is very low, most likely because such an approach strengthens the person’s connections with their network, rather than rupturing such connections as frequently happens in hospitalization. This approach is similar to the community healing ceremonies utilized in developing countries. The recovery rate in developing countries is much higher than in industrialized countries.

Source: Learning from Northern Europe

Schizophrenia, Psychosis, Recovery, The Recovery Based Model, Hope for Schizophrenia Sufferers, Psyche Bloggers Carnival

The Hidden Side of Happiness

2007-01-14T17:43:00.000-08:00

Pleasure only gets you so far. A rich, rewarding life often requires a messy battle with adversity.

Hurricanes, house fires, cancer, white-water rafting accidents, plane crashes, vicious attacks in dark alleyways. Nobody asks for any of it. But to their surprise, many people find that enduring such a harrowing ordeal ultimately changes them for the better. Their refrain might go something like this: "I wish it hadn't happened, but I'm a better person for it."

We love to hear the stories of people who have been transformed by their tribulations, perhaps because they testify to a bona fide psychological truth, one that sometimes gets lost amid endless reports of disaster: There is a built-in human capacity to flourish under the most difficult circumstances. Positive reactions to profoundly disturbing experiences are not limited to the toughest or the bravest. In fact, roughly half the people who struggle with adversity say that their lives have in some ways improved.

This and other promising findings about the life-changing effects of crises are the province of the new science of post-traumatic growth. This fledgling field has already proved the truth of what once passed as bromide: What doesn't kill you can actually make you stronger. Post-traumatic stress is far from the only possible outcome. In the wake of even the most terrifying experiences, only a small proportion of adults become chronically troubled. More commonly, people rebound—or even eventually thrive.

Those who weather adversity well are living proof of one of the paradoxes of happiness: We need more than pleasure to live the best possible life. Our contemporary quest for happiness has shriveled to a hunt for bliss—a life protected from bad feelings, free from pain and confusion.

This anodyne definition of well-being leaves out the better half of the story, the rich, full joy that comes from a meaningful life. It is the dark matter of happiness, the ineffable quality we admire in wise men and women and aspire to cultivate in our own lives. It turns out that some of the people who have suffered the most, who have been forced to contend with shocks they never anticipated and to rethink the meaning of their lives, may have the most to tell us about that profound and intensely fulfilling journey that philosophers used to call the search for "the good life."

This broader definition of good living blends deep satisfaction and a profound connection to others through empathy. It is dominated by happy feelings but seasoned also with nostalgia and regret. "Happiness is only one among many values in human life," contends Laura King, a psychologist at the University of Missouri in Columbia. Compassion, wisdom, altruism, insight, creativity—sometimes only the trials of adversity can foster these qualities, because sometimes only drastic situations can force us to take on the painful process of change. To live a full human life, a tranquil, carefree existence is not enough. We also need to grow—and sometimes growing hurts.

In that moment, our sense of invulnerability is pierced, and the self-protective mental armor that normally stands between us and our perceptions of the world is torn away. Our everyday life scripts—our habits, self-perceptions and assumptions—go out the window, and we're left with a raw experience of the world.

The phenomenon is akin to what Zen Buddhists strive to attain in meditation or what people report about religious rapture. Colors become more vivid; ordinary objects seem suddenly beautiful. It's an experience of sublime bewilderment tinged with fear—the old-fashioned meaning of awe. "When you take the self out of the picture, sometimes the world emerges as more powerful, as wondrous," he says. "It's this opening experience: 'Oh my god, look at this world.'"

In a dark room in Queens, New York, 31-year-old fashion designer Tracy Cyr believed she was dying. A few months before, she had stopped taking the powerful immune-suppressing drugs that kept her arthritis in check. She never anticipated what would happen: a withdrawal reaction that eventually left her in total body agony and neurological meltdown. The slightest movement—trying to swallow, for example—was excruciating. Even the pressure of her cheek on the pillow was almost unbearable.

Cyr is no wimp—diagnosed with juvenile rheumatoid arthritis at the age of 2, she'd endured the symptoms and the treatments (drugs, surgery) her whole life. But this time, she was way past her limits, and nothing her doctors did seemed to help. Either the disease was going to kill her or, pretty soon, she'd have to kill herself.

As her sleepless nights wore on, though, her suicidal thoughts began to be interrupted by new feelings of gratitude. She was still in agony, but a new consciousness grew stronger each night: an awesome sense of liberation, combined with an all-encompassing feeling of sympathy and compassion. "I felt stripped of everything I'd ever identified myself with," she said six months later. "Everything I thought I'd known or believed in was useless—time, money, self-image, perceptions. Recognizing that was so freeing."

Within a few months, she began to be able to move more freely, thanks to a cocktail of steroids and other drugs. But as her physical strength came back, she did not return to her old way of being as a feisty, demanding, "Sex-in-the-City, three-inch-stilettos-and-fishnets" girl. Now quieter and more tolerant, she makes a point of being submissive in a turn-the-other-cheek kind of way. Cyr still takes a pharmacopoeia of drugs every day, but she says there's no question that her life is better now. "I felt I had been shown the secret of life and why we're here: to be happy and to nurture other life. It's that simple."

Her mind-blowing experience came as a total surprise. But that feeling of transformation is in some ways typical, says Rich Tedeschi, a professor of psychology at the University of North Carolina in Charlotte who coined the term "post-traumatic growth." His studies of people who have endured extreme events like combat, violent crime or sudden serious illness show that most feel dazed and anxious in the immediate aftermath. They are preoccupied with the idea that their lives have been shattered. A few are haunted long afterward by memory problems, sleep trouble and similar symptoms of post-traumatic stress disorder. But Tedeschi and others have found that for many people—perhaps even the majority—life ultimately becomes richer and more gratifying.

Sometimes, as with Cyr, the change hits like a bolt of lightning. W. Keith Campbell, a professor of social psychology at the University of Georgia in Athens whose research focuses on the self, calls this phenomenon "ego shock." He has found that a serious blow to self-esteem can temporarily freeze normal psychological protective mechanisms. The way we react to a sudden ego threat (a public rejection, a professional failure) is often to go numb: Just for an instant, time stops, the mind goes blank and the world suddenly seems unfamiliar.

Campbell believes something similar happens to many people who experience a terrifying physical threat. In that moment, our sense of invulnerability is pierced, and the self-protective mental armor that normally stands between us and our perceptions of the world is torn away. Our everyday life scripts—our habits, self-perceptions and assumptions—go out the window, and we're left with a raw experience of the world.

The phenomenon is akin to what Zen Buddhists strive to attain in meditation or what people report about religious rapture. Colors become more vivid; ordinary objects seem suddenly beautiful. It's an experience of sublime bewilderment tinged with fear—the old-fashioned meaning of awe. "When you take the self out of the picture, sometimes the world emerges as more powerful, as wondrous," he says. "It's this opening experience: 'Oh my god, look at this world.'"

In her moment of desperation, Tracy Cyr was struck by this feeling of euphoria. "You see the truth of things, and you can't help but be in wonder, in glorious wonder," she says. "Everything is OK. Everything is perfect and good. There's absolutely nothing to fear."

After such a shock, people often say that their lives are transformed involuntarily and that their old values or habits evaporate in an instant. Campbell found that more than half of the people in his studies who had experienced an ego shock said that it ultimately had positive long-term effects upon their lives. "Really negative events have the ability to shake up the status quo in your life, which opens the door for change," says Campbell. "You could become a depressed, despairing drunk—or you could become a much better person."

Still, actually implementing these changes, as well as fully coming to terms with the new reality, usually takes conscious effort. Being willing and able to take on this process is one of the major differences between those who grow through adversity and those who are destroyed by it.

Crises challenge our deepest beliefs: that bad things don't happen to good people, that life makes sense, that we have control over what happens. Tedeschi describes them as seismic, because they overturn basic assumptions upon which life is built. Afterward, a new framework must be constructed. "That's no small thing," he observes. "It requires some people to make big changes not only in how they think but in what they do and in how they choose to live." Brooding over what happened—in other circumstances a dangerous warning sign of depression—may actually be essential to the process of growth.

Notably, the people who find value in adversity aren't the toughest or the most rational. Instead, they tend to be ordinary—neither the best- nor the worst-adjusted. What makes them different is that they are able to incorporate what happened into the story of their own life. They are willing to undertake the painful process of rethinking who they are and giving up an old script that no longer applies. "Maybe one of the keys [to growth] is the capacity to admit that you've been changed by experience," says King. "Which means admitting that you're vulnerable, and admitting that there would have been good things about your life if you hadn't had to go through those negative events."

Eventually, they may find themselves freed in ways they never imagined. Survivors often say they become more tolerant and forgiving of others, capable of bringing peace to formerly troubled relationships. They say that material ambitions suddenly seem silly and the pleasures of friends and family paramount—and that the crisis allowed them to reorganize life in line with the new priorities.

People who have grown from adversity often feel much less fear, despite the frightening things they've been through. They are surprised by their own strength, confident that they can handle whatever else life throws at them. Like Tracy Cyr, many also feel transformed by a sense of deep compassion for and connection to others that is intensely rewarding on its own.

"People don't say that what they went through was wonderful," says Tedeschi. "They weren't meaning to grow from it. They were just trying to survive. But in retrospect, what they gained was more than they ever anticipated."

Source: Psychology Today

See also:
Psychosis & Ego Collapse
Spirituality & Trauma

How To Produce An Acute Schizophrenic Break

Schizophrenia, Psychosis, Recovery, The Recovery Based Model, Hope for Schizophrenia Sufferers

Music May Help Schizophrenia

2007-01-14T12:23:00.000-08:00

Music therapy may help to ease the symptoms of depression, anxiety and emotional withdrawal that many sufferers of schizophrenia experience, according to Dr Mike Crawford and researchers at Imperial College London.

In their new study involving four hospitals, the team found that encouraging patients to express themselves through music seemed to improve their symptoms.

This type of treatment has only been attempted before with patients who are already fairly stable.

“This study shows that music therapy provides a way of working with people when they are acutely unwell,” Dr. Crawford said.

Music therapy is a type of psychotherapy in which the patient is encouraged to utilize music to improve interpersonal and communication skills in ways that regular dialogue is limited. Forms of music therapy generally are based around cognitive/behavioral, humanistic or psychoanalytic frameworks or a mixture of approaches. There are usually both active and receptive parts of the therapy, meaning that at times music is listened to and at other times there is the use of musical improvisation or creation.

Source: Psych Central

See also: The Coded Messages of the "Schizophrenic"

Schizophrenia, Psychosis, Recovery, The Recovery Based Model, Music Therapy

Alix Spiegel: The Dictionary of Disorder

2007-01-14T10:30:00.000-08:00

How one man revolutionized psychiatry.

In the mid-nineteen-forties, Robert Spitzer, a mathematically minded boy of fifteen, began weekly sessions of Reichian psychotherapy. Wilhelm Reich was an Austrian psychoanalyst and a student of Sigmund Freud who, among other things, had marketed a device that he called the orgone accumulator—an iron appliance, the size of a telephone booth, that he claimed could both enhance sexual powers and cure cancer. Spitzer had asked his parents for permission to try Reichian analysis, but his parents had refused—they thought it was a sham—and so he decided to go to the sessions in secret. He paid five dollars a week to a therapist on the Lower East Side of Manhattan, a young man willing to talk frankly about the single most compelling issue Spitzer had yet encountered: women. Spitzer found this methodical approach to the enigma of attraction both soothing and invigorating. The real draw of the therapy, however, was that it greatly reduced Spitzer’s anxieties about his troubled family life: his mother was a “professional patient” who cried continuously, and his father was cold and remote. Spitzer, unfortunately, had inherited his mother’s unruly inner life and his father’s repressed affect; though he often found himself overpowered by emotion, he was somehow unable to express his feelings. The sessions helped him, as he says, “become alive,” and he always looked back on them with fondness. It was this experience that confirmed what would become his guiding principle: the best way to master the wilderness of emotion was through systematic study and analysis.

Robert Spitzer isn’t widely known outside the field of mental health, but he is, without question, one of the most influential psychiatrists of the twentieth century. It was Spitzer who took the Diagnostic and Statistical Manual of Mental Disorders—the official listing of all mental diseases recognized by the American Psychiatric Association (A.P.A.)—and established it as a scientific instrument of enormous power. Because insurance companies now require a DSM diagnosis for reimbursement, the manual is mandatory for any mental-health professional seeking compensation. It’s also used by the court system to help determine insanity, by social-services agencies, schools, prisons, governments, and, occasionally, as a plot device on “The Sopranos.” This magnitude of cultural authority, however, is a relatively recent phenomenon. Although the DSM was first published in 1952 and a second edition (DSM-II) came out in 1968, early versions of the document were largely ignored. Spitzer began work on the third version (DSM-III) in 1974, when the manual was a spiral-bound paperback of a hundred and fifty pages. It provided cursory descriptions of about a hundred mental disorders, and was sold primarily to large state mental institutions, for three dollars and fifty cents. Under Spitzer’s direction—which lasted through the DSM-III, published in 1980, and the DSM-IIIR (“R” for “revision”), published in 1987—both the girth of the DSM and its stature substantially increased. It is now nine hundred pages, defines close to three hundred mental illnesses, and sells hundreds of thousands of copies, at eighty-three dollars each. But a mere description of the physical evolution of the DSM doesn’t fully capture what Spitzer was able to accomplish. In the course of defining more than a hundred mental diseases, he not only revolutionized the practice of psychiatry but also gave people all over the United States a new language with which to interpret their daily experiences and tame the anarchy of their emotional lives.

“The DSM revolution in reliability is a revolution in rhetoric, not in reality,” Kutchins and Kirk write. Kirk told me, “No one really scrutinized the science very carefully.” This was owing, in part, to the manual’s imposing physical appearance. “One of the objections was that it appeared to be more authoritative than it was. The way it was laid out made it seem like a textbook, as if it was a depository of all known facts,” David Shaffer says. “The average reader would feel that it carried great authority and weight, which was not necessarily merited.”

The Biometrics Department of the New York State Psychiatric Institute at Columbia Presbyterian Medical Center is situated in an imposing neo-Gothic building on West 168th Street. I met Spitzer in the lobby, a sparsely decorated and strangely silent place that doesn’t seem to get much use. Spitzer, a tall, thin man with well-cut clothes and a light step, was brought up on the Upper West Side. He is in his seventies but seems much younger; his graying hair is dyed a deep shade of brown. He has worked at Columbia for more than forty years, and his office is filled with the debris of decades. Calligraphed certificates with seals of red and gold cover the walls, and his desk is overwhelmed by paper.

Spitzer first came to the university as a resident and student at the Columbia Center for Psychoanalytic Training and Research, after graduating from N.Y.U. School of Medicine in 1957. He had had a brilliant medical-school career, publishing in professional journals a series of well-received papers about childhood schizophrenia and reading disabilities. He had also established himself outside the academy, by helping to discredit his erstwhile hero Reich. In addition to his weekly sessions on the Lower East Side, the teen-age Spitzer had persuaded another Reichian doctor to give him free access to an orgone accumulator, and he spent many hours sitting hopefully on the booth’s tiny stool, absorbing healing orgone energy, to no obvious avail. In time, he became disillusioned, and in college he wrote a paper critical of the therapy, which was consulted by the Food and Drug Administration when they later prosecuted Reich for fraud.

At Columbia Psychoanalytic, however, Spitzer’s career faltered. Psychoanalysis was too abstract, too theoretical, and somehow his patients rarely seemed to improve. “I was always unsure that I was being helpful, and I was uncomfortable with not knowing what to do with their messiness,” he told me. “I don’t think I was uncomfortable listening and empathizing—I just didn’t know what the hell to do.” Spitzer managed to graduate, and secured a position as an instructor in the psychiatry department (he has held some version of the job ever since), but he is a man of tremendous drive and ambition—also a devoted contrarian—and he found teaching intellectually limiting. For satisfaction, he turned to research. He worked on depression and on diagnostic interview techniques, but neither line of inquiry produced the radical innovation or epic discovery that he would need to make his name.

As Spitzer struggled to find his professional footing in the nineteen-sixties, the still young field of psychiatry was also in crisis. The central issue involved the problem of diagnosis: psychiatrists couldn’t seem to agree on who was sick and what ailed them. A patient identified as a textbook hysteric by one psychiatrist might easily be classified as a hypochondriac depressive by another. Blame for this discrepancy was assigned to the DSM. Critics claimed that the manual lacked what in the world of science is known as “reliability”—the ability to produce a consistent, replicable result—and therefore also lacked scientific validity. In order for any diagnostic instrument to be considered useful, it must have both. The S.A.T., for example, is viewed as reliable because a person who takes the test on a Tuesday and gets a score of 1200 will get a similar score if he takes the test on a Thursday. It is considered valid because scores are believed to correlate with an external reality—“scholastic aptitude”—and the test is seen as predictive of success in an academic setting. Though validity is the more important measure, it is impossible to achieve validity without reliability: if you take the S.A.T. on a Tuesday and get a 1200 and repeat it on a Thursday and get a 600, the test is clearly not able to gauge academic performance. Reliability, therefore, is the threshold standard.

In 1949, the psychologist Philip Ash published a study showing that three psychiatrists faced with a single patient, and given identical information at the same moment, were able to reach the same diagnostic conclusion only twenty per cent of the time. Aaron T. Beck, one of the founders of cognitive behavioral therapy, published a similar paper on reliability in 1962. His review of nine different studies found rates of agreement between thirty-two and forty-two per cent. These were not encouraging numbers, given that diagnostic reliability isn’t merely an academic issue: if psychiatrists can’t agree on a patient’s condition, then they can’t agree on the treatment of that condition, and, essentially, there’s no relationship between diagnosis and cure.

Problems with the reliability of psychiatric diagnosis became evident during the Second World War, when the military noticed that medical boards in different parts of the country had dramatically different rejection rates for men attempting to enlist. A draft board in Wichita, say, might have a twenty-per-cent exclusion rate, while Baltimore might find sixty per cent of its applicants unfit for service. Much of the disparity was on psychiatric grounds, and this was puzzling. It seemed implausible that the mental stability of potential recruits would vary so greatly from one area to another. A close study of the boards eventually determined that the psychiatrists responsible for making the decisions had widely divergent criteria. So a hypothesis emerged: perhaps it was not the young men but the doctors who were the problem.

In 1949, the psychologist Philip Ash published a study showing that three psychiatrists faced with a single patient, and given identical information at the same moment, were able to reach the same diagnostic conclusion only twenty per cent of the time. Aaron T. Beck, one of the founders of cognitive behavioral therapy, published a similar paper on reliability in 1962. His review of nine different studies found rates of agreement between thirty-two and forty-two per cent. These were not encouraging numbers, given that diagnostic reliability isn’t merely an academic issue: if psychiatrists can’t agree on a patient’s condition, then they can’t agree on the treatment of that condition, and, essentially, there’s no relationship between diagnosis and cure. In addition, research depends on doctors’ ability to form homogeneous subject groups. How can you test the effectiveness of a new drug to treat depression if you can’t be sure that the person you’re testing is suffering from that disorder? Allen Frances, who worked under Spitzer on the DSM-III and who, in 1987, was appointed the director of the DSM-IV, says, “Without reliability the system is completely random, and the diagnoses mean almost nothing—maybe worse than nothing, because they’re falsely labelling. You’re better off not having a diagnostic system.”

Spitzer had no particular interest in psychiatric diagnosis, but in 1966 he happened to share a lunch table in the Columbia cafeteria with the chairman of the DSM-II task force. The two struck up a conversation, got along well, and by the end of the meal Spitzer had been offered the job of note-taker on the DSM-II committee. He accepted it, and served ably. He was soon promoted, and when gay activists began to protest the designation of homosexuality as a pathology Spitzer brokered a compromise that eventually resulted in the removal of homosexuality from the DSM. Given the acrimony surrounding the subject, this was an impressive feat of nosological diplomacy, and in the early seventies, when another revision of the DSM came due, Spitzer was asked to be the chairman of the task force.

Today, the chair of the DSM task force is a coveted post—people work for years to position themselves as candidates—but in the early nineteen-seventies descriptive psychiatry was a backwater. Donald Klein, a panic expert at Columbia, who contributed to the DSM-III, says, “When Bob was appointed to the DSM-III, the job was of no consequence. In fact, one of the reasons Bob got the job was that it wasn’t considered that important. The vast majority of psychiatrists, or for that matter the A.P.A., didn’t expect anything to come from it.” This attitude was particularly prevalent among Freudian psychoanalysts, who were the voice of the mental-health profession for much of the twentieth century. They saw descriptive psychiatry as narrow, bloodless, and without real significance. “Psychoanalysts dismiss symptoms as being unimportant, and they say that the real thing is the internal conflicts,” Klein says. “So to be interested in descriptive diagnosis was to be superficial and a little bit stupid.”

Spitzer, however, managed to turn this obscurity to his advantage. Given unlimited administrative control, he established twenty-five committees whose task it would be to come up with detailed descriptions of mental disorders, and selected a group of psychiatrists who saw themselves primarily as scientists to sit on those committees. These men and women came to be known in the halls of Columbia as dops, for “data-oriented people.” They were deeply skeptical of psychiatry’s unquestioning embrace of Freud. “Rather than just appealing to authority, the authority of Freud, the appeal was: Are there studies? What evidence is there?” Spitzer says. “The people I appointed had all made a commitment to be guided by data.” Like Spitzer, Jean Endicott, one of the original members of the DSM-III task force, felt frustrated with the rigid dogmatism of psychoanalysis. She says, “For us dops, it was like, Come on—let’s get out of the nineteenth century! Let’s move into the twentieth, maybe the twenty-first, and apply what we’ve learned.”

“There are lots of studies which show that clinicians diagnose most of their patients with one particular disorder and really don’t systematically assess for other disorders. They have a bias in reference to the disorder that they are especially interested in treating and believe that most of their patients have.” Unfortunately, because psychiatry and its sister disciplines stand under the authoritative banner of science, consumers are often reluctant to challenge the labels they are given. Diagnoses are frequently liberating, helping a person to understand that what he views as a personal failing is actually a medical problem, but they can in certain cases become self-fulfilling prophecies.

There was just one problem with this utopian vision of better psychiatry through science: the “science” hadn’t yet been done. “There was very little systematic research, and much of the research that existed was really a hodgepodge—scattered, inconsistent, and ambiguous,” Theodore Millon, one of the members of the DSM-III task force, says. “I think the majority of us recognized that the amount of good, solid science upon which we were making our decisions was pretty modest.” Members of the various committees would regularly meet and attempt to come up with more specific and comprehensive descriptions of mental disorders. David Shaffer, a British psychiatrist who worked on the DSM-III and the DSM-IIIR, told me that the sessions were often chaotic. “There would be these meetings of the so-called experts or advisers, and people would be standing and sitting and moving around,” he said. “People would talk on top of each other. But Bob would be too busy typing notes to chair the meeting in an orderly way.” One participant said that the haphazardness of the meetings he attended could be “disquieting.” He went on, “Suddenly, these things would happen and there didn’t seem to be much basis for it except that someone just decided all of a sudden to run with it.” Allen Frances agrees that the loudest voices usually won out. Both he and Shaffer say, however, that the process designed by Spitzer was generally sound. “There was not another way of doing it, no extensive literature that one could turn to,” Frances says. According to him, after the meetings Spitzer would retreat to his office to make sense of the information he’d collected. “The way it worked was that after a period of erosion, with different opinions being condensed in his mind, a list of criteria would come up,” Frances says. “It would usually be some combination of the accepted wisdom of the group, as interpreted by Bob, with a little added weight to the people he respected most, and a little bit to whoever got there last.”

Because there are very few records of the process, it’s hard to pin down exactly how Spitzer and his staff determined which mental disorders to include in the new manual and which to reject. Spitzer seems to have made many of the final decisions with minimal consultation. “He must have had some internal criteria,” Shaffer says. “But I don’t always know what they were.” One afternoon in his office at Columbia, I asked Spitzer what factors would lead him to add a new disease. “How logical it was,” he said, vaguely. “Whether it fit in. The main thing was that it had to make sense. It had to be logical.” He went on, “For most of the categories, it was just the best thinking of people who seemed to have expertise in the area.”

Not every mental disorder made the final cut. For instance, a group of child psychiatrists aspired to introduce a category they called “atypical child”—an idea that, according to Spitzer, didn’t survive the first meeting. “I kept saying, ‘O.K., how would you define “atypical child”?’ And the answer was ‘Well, it’s very difficult to define, because these kids are all very different.’ ” As a general rule, though, Spitzer was more interested in including mental disorders than in excluding them. “Bob never met a new diagnosis that he didn’t at least get interested in,” Frances says. “Anything, however against his own leanings that might be, was a new thing to play with, a new toy.” In 1974, Roger Peele and Paul Luisada, psychiatrists at St. Elizabeths Hospital, in Washington, D.C., wrote a paper in which they used the term “hysterical psychoses” to describe the behavior of two kinds of patients they had observed: those who suffered from extremely short episodes of delusion and hallucination after a major traumatic event, and those who felt compelled to show up in an emergency room even though they had no genuine physical or psychological problems. Spitzer read the paper and asked Peele and Luisada if he could come to Washington to meet them. During a forty-minute conversation, the three decided that “hysterical psychoses” should really be divided into two disorders. Short episodes of delusion and hallucination would be labelled “brief reactive psychosis,” and the tendency to show up in an emergency room without authentic cause would be called “factitious disorder.” “Then Bob asked for a typewriter,” Peele says. To Peele’s surprise, Spitzer drafted the definitions on the spot. “He banged out criteria sets for factitious disorder and for brief reactive psychosis, and it struck me that this was a productive fellow! He comes in to talk about an issue and walks away with diagnostic criteria for two different mental disorders!” Both factitious disorder and brief reactive psychosis were included in the DSM-III with only minor adjustments.

The process of identifying new disorders wasn’t usually so improvisatory, though, and it is certain that psychiatric treatment was significantly improved by the designation of many of the new syndromes. Attention-deficit disorder, autism, anorexia nervosa, bulimia, panic disorder, and post-traumatic stress disorder are all examples of diseases added during Spitzer’s tenure which now receive specialized treatment. But by far the most radical innovation in the new DSM—and certainly the one that got the most attention in the psychiatric community—was that, alongside the greatly expanded prose descriptions for each disorder, Spitzer added a checklist of symptoms that should be present in order to justify a diagnosis. For example, the current DSM describes a person with obsessive-compulsive personality disorder as someone who:

is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost. . . .

is unable to discard worn-out or worthless objects even when they have no sentimental value. . . .

adopts a miserly spending style towards both self and others.

Five other criteria are listed in a box beneath the description of the disorder, and clinicians are cautioned that at least four of the eight must be present in order for the label to be applied.

Finally, Spitzer and the dops argued, here was the answer to the problem of reliability, the issue that had bedevilled psychiatry for years. As they understood it, there were two reasons that doctors couldn’t agree on a diagnosis. The first was informational variance: because of rapport or interview style, different doctors get different information from the same patient. The second was interpretive variance: each doctor carries in his mind his own definition of what a specific disease looks like. One goal of the DSM-III was to reduce interpretive variance by standardizing definitions. Spitzer’s team reasoned that if a clear set of criteria were provided, diagnostic reliability would inevitably improve. They also argued that the criteria would enable mental-health professionals to communicate, and greatly facilitate psychiatric research. But the real victory was that each mental disorder could now be identified by a foolproof little recipe.

Spitzer labored over the DSM-III for six years, often working seventy or eighty hours a week. “He’s kind of an idiot savant of diagnosis—in a good sense, in the sense that he never tires of it,” Allen Frances says. John Talbott, a former president of the American Psychiatric Association, who has been friends with Spitzer for years, says, “I remember the first time I saw him walk into a breakfast at an A.P.A. meeting in a jogging suit, sweating, and having exercised. I was taken aback. The idea that I saw Bob Spitzer away from his suit and computer was mind-shattering.” But Spitzer’s dedication didn’t always endear him to the people he worked with. “He was famous for walking down a crowded hallway and not looking left or right or saying anything to anyone,” one colleague recalled. “He would never say hello. You could stand right next to him and be talking to him and he wouldn’t even hear you. He didn’t seem to recognize that anyone was there.”

Despite Spitzer’s genius at describing the particulars of emotional behavior, he didn’t seem to grasp other people very well. Jean Endicott, his collaborator of many years, says, “He got very involved with issues, with ideas, and with questions. At times he was unaware of how people were responding to him or to the issue. He was surprised when he learned that someone was annoyed. He’d say, ‘Why was he annoyed? What’d I do?’ ” After years of confrontations, Spitzer is now aware of this shortcoming, and says that he struggles with it in his everyday life. “I find it very hard to give presents,” he says. “I never know what to give. A lot of people, they can see something and say, ‘Oh, that person would like that.’ But that just doesn’t happen to me. It’s not that I’m stingy. I’m just not able to project what they would like.” Frances argues that Spitzer’s emotional myopia has benefitted him in his chosen career: “He doesn’t understand people’s emotions. He knows he doesn’t. But that’s actually helpful in labelling symptoms. It provides less noise.”

What may have been a professional strength had disruptive consequences in Spitzer’s personal life. In 1958, he married a doctor, and they had two children. As the demands of his project mounted, he spent less and less time with his family, and eventually fell in love with Janet Williams, an attractive, outspoken social worker he had hired to help edit the manual. In 1979, he and his wife separated, and several years later Spitzer and Williams were married. Williams became a professor at Columbia, and she and Spitzer went on to have three children. Spitzer remained close to his oldest son, but his relationship with his daughter from his first marriage was initially strained by the divorce.

The DSM was scheduled to be published in 1980, which meant that Spitzer had to have a draft prepared in the spring of 1979. Like any major American Psychiatric Association initiative, the DSM had to be ratified by the assembly of the A.P.A., a decision-making body composed of elected officials from all over the country. Spitzer’s anti-Freudian ideas had caused resentment throughout the production process, and, as the date of the assembly approached, the opposition gathered strength and narrowed its focus to a single, crucial word—“neurosis”—which Spitzer wanted stricken from the DSM.

The term “neurosis” has a very long history, but over the course of the twentieth century it became inseparable from Freudian psychoanalytic philosophy. A neurosis, Freud believed, emerged from unconscious conflict. This was the bedrock psychoanalytic concept at the height of the psychoanalytic era, and both the DSM-I and the DSM-II made frequent use of the term. Spitzer and the dops,however, reasoned that, because a wide range of mental-health professionals were going to use the manual in everyday practice, the DSM could not be aligned with any single theory. They decided to restrict themselves simply to describing behaviors that were visible to the human eye: they couldn’t tell you why someone developed obsessive-compulsive personality disorder, but they were happy to observe that such a person is often “over-conscientious, scrupulous, and inflexible about matters of morality.”

When word of Spitzer’s intention to eliminate “neurosis” from the DSM got out, Donald Klein says, “people were aghast. ‘Neurosis’ was the bread-and-butter term of psychiatry, and people thought that we were calling into question their livelihood.” Roger Peele, of St. Elizabeths, was sympathetic to Spitzer’s work, but, as a representative of the Washington, D.C., branch of the A.P.A., he felt a need to challenge Spitzer on behalf of his constituency. “The most common diagnosis in private practices in Washington, D.C., in the nineteen-seventies was something called depressive neurosis,” Peele says. “That was what they were doing day after day.” Psychoanalysts bitterly denounced the early drafts. One psychiatrist, Howard Berk, wrote a letter to Spitzer saying that “the DSM-III gets rid of the castle of neurosis and replaces it with a diagnostic Levittown.”

Without the support of the psychoanalysts, it was possible that the DSM-III wouldn’t pass the assembly and the entire project would come to nothing. The A.P.A. leadership got involved, instructing Spitzer and the dops to include psychoanalysts in their deliberations. After months of acrimonious debate, Spitzer and the psychoanalysts were able to reach a compromise: the word “neurosis” was retained in discreet parentheses in three or four key categories.

With this issue resolved, Spitzer presented the final draft of the DSM-III to the A.P.A. assembly in May of 1979. Roughly three hundred and fifty psychiatrists gathered in a large auditorium in Chicago. Spitzer got up onstage and reviewed the DSM process and what they were trying to accomplish, and there was a motion to pass it. “Then a rather remarkable thing happened,” Peele says. “Something that you don’t see in the assembly very often. People stood up and applauded.” Peele remembers watching shock break over Spitzer’s face. “Bob’s eyes got watery. Here was a group that he was afraid would torpedo all his efforts, and instead he gets a standing ovation.”

The DSM-III and the DSM-IIIR together sold more than a million copies. Sales of the DSM-IV (1994) also exceeded a million, and the DSM-IV TR (for “text revision”), the most recent iteration of the DSM, has sold four hundred and twenty thousand copies since its publication, in 2000. Its success continues to grow. Today, there are forty DSM-related products available on the Web site of the American Psychiatric Association. Stuart Kirk, a professor of public policy at U.C.L.A., and Herb Kutchins, a professor emeritus of social work at California State University, Sacramento, have studied the creation of the modern DSM for more than seventeen years, and they argue that its financial and academic success can be attributed to Spitzer’s skillful salesmanship. According to Kirk and Kutchins, immediately after the publication of the DSM-III Spitzer embarked on a P.R. campaign, touting its reliability as “far greater” and “higher than previously achieved” and “extremely good.” “For the first time . . . claims were made that the new manual was scientifically sound,” they write in “Making Us Crazy: DSM—The Psychiatric Bible and the Creation of Mental Disorders” (1997). Gerald Klerman, a prominent psychiatrist, published an influential book in 1986 that flatly announced, “The reliability problem has been solved.”

It was largely on the basis of statements like these that the new DSM was embraced by psychiatrists and psychiatric institutions all over the globe. “The DSM revolution in reliability is a revolution in rhetoric, not in reality,” Kutchins and Kirk write. Kirk told me, “No one really scrutinized the science very carefully.” This was owing, in part, to the manual’s imposing physical appearance. “One of the objections was that it appeared to be more authoritative than it was. The way it was laid out made it seem like a textbook, as if it was a depository of all known facts,” David Shaffer says. “The average reader would feel that it carried great authority and weight, which was not necessarily merited.”

Another study, whose primary author was Spitzer’s wife, Janet Williams, took place at six sites in the United States and one in Germany. Supervised by Williams and some of the most experienced diagnostic professionals in the world, the participating clinicians were given extensive special training before being split into pairs and asked to interview nearly six hundred prospective patients. The idea was to determine whether clinicians faced with the same client could agree on a diagnosis using the DSM. Although Williams claims that the study supported the reliability of the DSM, when the investigators wrote up their results they admitted that they “had expected higher reliability values.” In fact, Kutchins and Kirk point out, the results were “not that different from those statistics achieved in the 1950s and 1960s—and in some cases were worse.”

Almost immediately, the book started to turn up everywhere. It was translated into thirteen languages. Insurance companies, which expanded their coverage as psychotherapy became more widespread in the nineteen-seventies, welcomed the DSM-III as a standard. But it was more than that: the DSM had become a cultural phenomenon. There were splashy stories in the press, and TV news magazines showcased several of the newly identified disorders. “It was a runaway success in terms of publicity,” Allen Frances says. Spitzer, Williams, and the rest of the dops were surprised and pleased by the reception. “For us it was kind of like being rock stars,” Williams says. “Because everyone saw that it was the next big thing, everyone knew us and wanted to talk to us. It was like suddenly being the most popular kid on the block.”

A year and a half after the publication of the DSM-III, Spitzer began work on its revision. Emboldened by his success, he became still more adamant about his opinions, and made enemies of a variety of groups. “I love controversy,” Spitzer admits, “so if there was something that I thought needed to be added that was controversial, so much the better.” He enraged feminists when he tried to include a diagnosis termed “masochistic personality disorder,” a nonsexual form of masochism which critics claimed implied that some abused wives might be responsible for their own mistreatment. He angered women’s groups again when he attempted to designate PMS as a mental disorder (“pre-menstrual dysphoric disorder”). “A lot of what’s in the DSM represents what Bob thinks is right,” Michael First, a psychiatrist at Columbia who worked on both the DSM-IIIR and DSM-IV, says. “He really saw this as his book, and if he thought it was right he would push very hard to get it in that way.” Thus, despite the success of Spitzer’s two editions, and despite extensive lobbying on his part, the American Psychiatric Association gave the chairmanship of the DSM-IV task force to Allen Frances. “The American Psychiatric Association decided that they had had enough of Spitzer, and I can understand that,” Spitzer says with a note of regret in his voice. “I think that there was a feeling that if the DSM was going to represent the entire profession—which obviously it has to—it would be good to have someone else.” This certainly was part of the reason. But Spitzer’s colleagues believe that the single-mindedness with which he transformed the DSM also contributed to his eclipse. “I think that Spitzer looked better in III than he did in IIIR,” Peele says. “IIIR, for one reason or another, came across as more heavy-handed—‘Spitzer wants it this way!’ ”

As chair of the DSM-IV, Frances quickly set about constructing a more transparent process. Power was decentralized, there were systematic literature reviews, and the committees were put on notice that, as Frances says, “the wild growth and casual addition” of new mental disorders were to be avoided. Spitzer was made special adviser to the DSM-IV task force, but his power was dramatically reduced. He found the whole experience profoundly distressing. “I had the feeling that this wonderful thing that I created was going to be destroyed,” he says.

The official position of the American Psychiatric Association is that the reliability of the DSM is sound. Darrel Regier, the director of research at the A.P.A., says, “Reliability is, of course, improved. Because you have the criteria, you’re not depending on untestable theories of the cause of a diagnosis.” He says that psychiatric practice was so radically changed by Spitzer’s DSM—it was, for the first time, at least nominally evidence-based—that it’s impossible to compare reliability before and after. One consequence of the addition of diagnostic criteria was the creation of long, structured interviews, which have allowed psychiatrists successfully to assemble homogeneous research populations for clinical trials. In this context, the DSM diagnoses have been found to be reliable.

But structured interviews don’t always have much in common with the conversations that take place in therapists’ offices, and since the publication of the DSM-III, in 1980, no major study has been able to demonstrate a substantive improvement in reliability in those less formal settings. During the production of the DSM-IV, the American Psychiatric Association received funding from the MacArthur Foundation to undertake a broad reliability study, and although the research phase of the project was completed, the findings were never published. The director of the project, Jim Thompson, says that the A.P.A. ran out of money. Another study, whose primary author was Spitzer’s wife, Janet Williams, took place at six sites in the United States and one in Germany. Supervised by Williams and some of the most experienced diagnostic professionals in the world, the participating clinicians were given extensive special training before being split into pairs and asked to interview nearly six hundred prospective patients. The idea was to determine whether clinicians faced with the same client could agree on a diagnosis using the DSM. Although Williams claims that the study supported the reliability of the DSM, when the investigators wrote up their results they admitted that they “had expected higher reliability values.” In fact, Kutchins and Kirk point out, the results were “not that different from those statistics achieved in the 1950s and 1960s—and in some cases were worse.”

Reliability is probably lowest in the place where the most diagnoses are made: the therapist’s office. As Tom Widiger, who served as head of research for the DSM-IV, points out, “There are lots of studies which show that clinicians diagnose most of their patients with one particular disorder and really don’t systematically assess for other disorders. They have a bias in reference to the disorder that they are especially interested in treating and believe that most of their patients have.” Unfortunately, because psychiatry and its sister disciplines stand under the authoritative banner of science, consumers are often reluctant to challenge the labels they are given. Diagnoses are frequently liberating, helping a person to understand that what he views as a personal failing is actually a medical problem, but they can in certain cases become self-fulfilling prophecies. A child inappropriately given the label of attention-deficit/hyperactivity disorder can come to see himself as broken or limited, and act accordingly. And there are other problems with the DSM. Critics complain that it often characterizes everyday behaviors as abnormal, and that it continues to lack validity, whether or not the issue of reliability has been definitely resolved.

Even some of the manual’s early advocates now think that the broad claims of reliability were exaggerated. “To my way of thinking, the reliability of the DSM—although improved—has been oversold by some people,” Allen Frances says. “From a cultural standpoint, reliability was a way of authenticating the DSM as a radical innovation.” He adds, “In a vacuum, to create criteria that were based on accepted wisdom as a first stab was fine, as long as you didn’t take it too seriously. The processes that happened were very limited, but they were valuable in their context.” And Frances believes that both psychiatry and the public have benefitted in a less tangible way from the collective fantasy that the DSM was a genuine scientific tool. “In my view, if I had been doing the DSM-III it would never have been as famous a document, because I’m a skeptic,” he says. “But it was good for the world at large. Good for psychiatry, good for patients. Good for everyone at that point in time to have someone whose view may have been more simpleminded than the world really is. A more complex view of life at that point would have resulted in a ho-hum ‘We have this book and maybe it will be useful in our field.’ The revolution came not just from the material itself, from the substance of it, but from the passion with which it was introduced.”

Spitzer, too, has grown more circumspect. “To say that we’ve solved the reliability problem is just not true,” he told me one afternoon in his office at Columbia. “It’s been improved. But if you’re in a situation with a general clinician it’s certainly not very good. There’s still a real problem, and it’s not clear how to solve the problem.” His personal investment in the DSM remains intense. During one of our conversations, I asked Spitzer if he ever feels a sense of ownership when troubled friends speak to him of their new diagnoses, or perhaps when he comes across a newspaper account that features one of the disorders to which he gave so much of his life. He admitted that he does on occasion feel a small surge of pride. “My fingers were on the typewriter that typed those. They might have been changed somewhat, but they all went through my fingers,” he said. “Every word.”

Source: The New Yorker

See also: Diagnostic and Statistical Manual of Mental Disorders

Schizophrenia, Psychosis, Disorders, DSM: The Bible of Psychiatry

Dr. R.D. Laing: The Experience of Schizophrenia

2007-01-13T19:48:00.001-08:00

... We start again from the split of our experience into what seems to be two worlds, inner and outer.

The normal state of affairs is that we know little of either and are alienated from both, but that we know perhaps a little more of the outer than the inner.

We need not be unaware of the "inner" world. We do not realize its existence most of the time. But many people encounter it -- unfortunately, without guides, confusing outer with inner realities, and inner with outer -- and generally lose their capacity to function competantly in ordinary relations.

This need not be so. The process of entering into the other world from this world, and returning to this world from the other world, is as natural as death and giving birth or being born. But in our present world, which is both so terrified and so unconscious of the other world, it is not surprising that when "reality," the fabric of this world bursts, and a person enters the other world, he is completely lost and terrified and meets only incomprehension in others.

Sometimes, having gone through the looking glass, through the eye of the needle, the territory is now recognized as one's lost home, but most people now in inner space and time are, to begin with, in unfamiliar territory and are frightened and confused. They are lost. They have forgotten that they have been there before. They clutch at chimeras. They try to retain their bearings by compounding their confusion, by projection, (putting the inner on the outer), and introjection (importing outer categories into the inner). They do not know what is happening, and no one is likely to enlighten them.

The person who has entered this inner realm (if only he is allowed to experience this) will find himself going, or being conducted -- one cannot clearly distinguish active from passive here -- on a journey.

This journey is experienced as going further "in" as going back through one's personal life, in and back and through and beyond into the experience of all mankind, of the primal man, of Adam and perhaps even further into the beings of animals, vegetables, and minerals.

In this journey there are many occasions to lose one's way, for confusion, partial failure, even final shipwreck, many terrors, spirits, demons to be encountered that may or may not be overcome.

We do not regard it as pathologically deviant to explore a jungle or climb Mount Everest. We feel that Columbus was entitled to be mistaken in his construction of what he discovered when he came to the New World. We respect the voyager, the explorer, the climber, the space man. It makes far more sense to me as a valid project -- indeed, as a desperately and urgently required project for our time -- to explore the inner space and time of consciousness.

No age in the history of humanity has perhaps so lost touch with this natural healing process that implicates some of the people whom we label as schizophrenic. No age has so devalued it, no age has imposed such prohibitions and deterrences against it, as our own. Instead of the mental hospital, a sort of reservicing factory for human breakdowns, we need a place where people who have travelled further and, consequently, may be more lost than psychiatrists and other sane people, can find their way further into inner space and time, and back again. Instead of the degradation ceremonial of psychiatric examination, diagnosis and prognostication, we need, for those who are ready for it, (in psychiatric terminology, often those who are about to go into a schizophrenic breakdown) an initiation ceremonial, through which the person will be guided with full social encouragement and sanction into inner space and time, by people who have been there and back again.

What is entailed then is:
(i) a voyage from outer to inner,
(ii) from life to a kind of death,
(iii) from going forward to going back,
(iv) From temporal movement to temporal standstill,
(v) from mundane time to eonic time,
(vi) from the ego to the self,
(vii) from outside (post-birth) back into the womb of all things (pre-birth),

and then subsequently a return voyage from
(1) inner to outer,
(2) from death to life,
(3) from the movement back to a movement forward once more,
(4) from immortality back to mortality,
(5) from eternity back to time,
(6) from self to a new ego,
(7) from a cosmic fetalization to an existential rebirth.

[...]

One would hope that society would set up places whose express purpose would be to help people through the stormy passages of such a voyage. A considerable part of this book has been devoted to showing why that is unlikely.

In this particular type of journey, the direction we have to take is back and in, because it was way back that we started to go down and out. They will say we are regressed and withdrawn and out of contact with them. True enough, we have a long way to go back to contact the reality we have all lost contact with.

Source: The Politics of Experience - R.D. Laing

See also:
In The Beginning
Transcendental Experience: In Relation to Religion and Psychosis
Mental Breakdown as Healing
Schizophrenia & The Hero's Journey
Tips for "Dark Night" Journeyers

May it Be

R.D. Laing, The Politics of Experience, Schizophrenia, Psychosis, Recovery, The Recovery Based Model, Hope for Schizophrenia Sufferers, Psyche Bloggers Carnival

Pema Chödrön: Tonglen

2007-01-13T19:45:00.000-08:00

During this session I'm going to teach tonglen practice. And I'd like to talk first about different styles of tonglen.

The very simplest style... which I think would be helpful for every single one of us, and something well worth cultivating in one's life, is taking a tonglen attitude towards pleasure and pain whenever it arises in your life.

I've gotten into the habit of doing this, and I don't always remember to do it. But more and more, it becomes spontaneous and natural. When things are painful -- in any form -- when things are difficult, usually that in itself will remind me, just the quality of difficulty, the quality of struggle, or pain, or dissatisfaction, or unpleasantness. That itself will remind me to just have the simple thought: "Other people feel this."

Now that sounds so simplistic, maybe not all that important. But, believe me, it makes a big difference because what happens with pain is the sense of isolation get so strong, and the sense of our particular personal burden, and the loneliness of that, and the desperation of that. So this simple thought, which sometimes is quite challenging to people -- you say it but you don't quite believe it -- you think ... you're the only one. And I've had people, many times, say to me, "This pain that I feel, I think no one else in the world feels this." And then I can say to them with tremendous confidence: "Wrong."

But what is not wrong is that we do have that feeling often, that I am the only one that has this particular pain. So maybe it will be quite a challenge to you to say this and it might not seem genuine. But even that is beginning to shake up your complacency about pain being just your individual burden. It somehow shakes it up just to even contemplate that other people feel this.

And in many cases my own experience is just that, that which could become so introverted, a downward spiral of depression and isolation -- just the thought that other people feel this opens it up. It's what Trungpa Rinpoche used to call, "Thinking Bigger".

And I think I've said this before, I'll say it again, that compassion or the sense of shared humanity, of our kinship with each other, this is what heals. This is what heals the desperation we can feel, the darkness we can feel and the chain reaction of aggression, or chain reaction of misery that gets triggered off by just sometimes a slight shift in the energy and we feel uneasy, or agitated, or unhappy in some way, and then that spirals into a chain reaction of ... pain. One thing leading to another, a sort of struggle to try and get away from that uneasy, uncomfortable feeling.

So this is a basic tonglen logic: When you feel the discomfort, just have the thought: "Other people feel this." And then if you want to take it a rather dramatic step further, you can say, "May we all be free of this." But it's enough just to acknowledge that other people feel this. And then the most dramatic and probably the most difficult, taking it even a step further would be to say: "Since I'm feeling this anyway, may I be feeling it so all others could be free of it."

So it's kind of three levels of courage. The least courage is just to say, "Other people feel this," and that is enough. But if -- in that particular moment of time -- it feels genuine, say, "May this become a path for awakening the heart for all of us." And then the one that sometimes you might feel really genuinely able to say just because of how you're feeling in that moment of time, to take it the deepest level of courage, is to say, "Since I'm feeling this anyway, may I feel it so that others could be free of it."

This is the tonglen attitude towards pain. It doesn't involve the breathing in and breathing out, but it's the spirit of tonglen.

Source: The Spirit of Tonglen

See also: The Practice of Tonglen

Myth Busting: Schizophrenia is Incurable

2007-01-12T17:04:00.000-08:00

The Recovery Vision: New paradigm, new questions, new answers.

Presenters:
Dr. Courtenay Harding, Ph.D.
Director
Institute for the Study of Human Resilience

Dr. William Anthony, Ph.D.
Executive Director
Center for Psychiatric Rehabiliation

Judi Chamberlain
Senior Consultant on Survivor Perspectives
Center for Psychiatric Rehabilitation
Senior Association, National Empowerment Center

Dr. Marianne Farkas, Sc.D.
Director
World Health Organization Collaborating Center

Hello. 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. So that our old views of schizophrenia are considerably different than they have been for the last hundred years. What I'd like to do is go through this table a little bit and talk about these studies and then tell you what exactly these investigators had to say when they got through.

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.

The first study was done by 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.

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

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.

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%.

Let me tell you what these gentlemen had to say about the long-term course of schizophrenia.

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

Luc Ciompi and Christian Muller: "The long-term evolution of schizophrenia is much more variable and considerably better than heretofore admitted."

Courtenay Harding and John Strauss: "We have gathered some evidence that the course of schizophrenia is a more complex dynamic and heterogeneous process than has heretofore been appreciated or predicted by diagnostic specificity."

Gerd Huber: "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."

So that, ladies and gentlemen, is substantial evidence for recovery. There are also many myths about schizophrenia, which have been challenged by all of these studies. "Once a schizophrenic, always a schizophrenic," has been significantly challenged now. The reality is improvement and recovery for most patients.

"The same treatment for all" is a myth. We've found that individualized treatment is much more successful because there's wide heterogeneity of function, interest, and capacities within each person.

There's a myth that says, "You only do rehab afterwards..." after the symptoms settle down. It turns out you need to do rehab starting on day one. Rehab is actually treatment. Rehab can reduce symptoms. Getting someone a job can reduce symptoms. Getting them stable housing can reduce symptoms. So why wait until the symptoms subside with medications when we have strategies to do something about it?

There's a myth that says, "No psychotherapy for these patients". But our patients tell us they need supportive psychotherapy and they need somebody to talk with about the process that they're going through.

There's another myth that says, "We need to be on medications all our life." There's absolutely no evidence in the world literature that says that's true. There may be a few people who need it all their lives, but certainly most people do not. Over time, most patients begin to titrate off their medication.

There's a myth that "people can only do low levels of work" and in reality, people can do all levels of work. It depends on their education. I got telephone calls from all over the country when I was on National Public Radio a while ago. People who were physicians, professors, high school teachers, nurses, engineers who called called to say thank you for telling our story because we don't tell anyone because of the stigma.

And the last myth, and one of the most insidious, is that "families are the cause of it all". When you work with families, they can be collaborators and very helpful.

Source: The Recovery Vision [PDF file]

[Ed. Note: After reviewing the data offered by Dr. Harding, psychiatrist #1 had this to offer: "... she is a psychologist with a vested interest in seeing recovery. Just check out her “Center for Rehabilitation and Recovery” website." [Source]

Since when are physicians not supposed to have "a vested interest in recovery"?]

See also:

The Recovery Model

Examples of Human Resiliance

A conversation with a "psychiatrist"

Unlike The Murphy's

Misrepresentations of Schizophrenia

Schizophrenia, Psychosis, Recovery, The Recovery Based Model, Hope for Schizophrenia Sufferers

Dr. Edward Knight: Recovery

2007-01-12T17:02:00.001-08:00

According to Pat Deegan, a psychologist with schizophrenia, recovery from serious mental illness is defined as “Rediscovering meaning and purpose after a series of catastrophic events which mental illness is.” When someone becomes mentally ill, he loses not only sanity (albeit temporarily for most people), but also position in society, income, friends and, in many cases, family and possessions.

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. Experience teaches that with expectations of recovery and proper support, people can regain their lives and their independence.

Recovery theories are grounded in longitudinal studies of schizophrenia. According to Nancy Andreasen, MD, schizophrenia is probably the cruelest and most devastating of all the persistent mental illnesses. It, therefore, serves as a touchstone for recovery based models of treatment.

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.

Two of the studies on which the recovery model is based were done by Courtney Harding, PhD. Dr. Harding’s definition of recovery has four criteria:

having a social life indistinguishable from your neighbor

holding a job for pay or volunteering

being symptom free, and

being off medication.

Dr. Harding’s data in a recovery oriented system in Vermont point to recovery or significant improvement in 62% to 68% of people studied. 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. Half of the cohort of 62% fully recovered meeting all four of Dr. Harding’s recovery criteria and half met three out of four criteria, usually continuing to take medications while meeting the other criteria.

In a companion study to her Vermont study, Dr. Harding studied a system in Maine oriented to maintenance instead of recovery . Patients were considered incapable of accomplishing anything like holding jobs or volunteering. They were expected to be in and out of the hospital for the rest of their lives and basically live as totally disabled. In this system, in spite of the adverse expectations, people recovered or significantly improved at a rate of 47%. Vermont’s 62% to 68% recovery rate was significantly better. Those who had been studied in Vermont were significantly more likely to have lower symptoms and to work or volunteer. This points to the healing effects of meaningful activity, which the individual chooses to pursue.

[...]

One site in particular has pushed the recovery model further than others. This site is Southeast Mental Health Services located in LaJunta, Colorado. Until mid-2000, this community mental health center operated on the traditional model, which included group residences, day treatment of six hours a day five days a week, Assertive Community Treatment (ACT) teams and once a week counseling. It was a model strongly held within the milieu. In mid-year 2000, the center switched from a traditional model to a recovery model.

When the decision was made by the executive management to train the staff in psychiatric rehabilitation, the treatment staff moved to individualized goal setting and skills teaching. The group homes were shut down and replaced by individual housing. Five or six consumers were placed intentionally in the same normal apartment complexes, which allowed them to form informal support groups. The ACT teams withered because people were doing so well that the teams were no longer needed. Outpatient commitment orders were successfully dropped on all consumers except those with criminal holds. After outpatient commitment orders were dropped, staff observed a spontaneous maturation process in consumers as consumers shed the infantile expectations that someone will be taking care of them full-time.

[...]

This is the potential of the recovery model. We believe that this model can be replicated elsewhere, as long as funding is provided to train professionals in working in the new model and to continue appropriate therapeutic and social supports.

Source: Recovery

Schizophrenia, Psychosis, Recovery, The Recovery Based Model of Schizophrenia, Hope for Schizophrenia Sufferers

Marek: A Story About Schizophrenia

2007-01-11T14:23:00.000-08:00

I thought I would pass on the story of a very human being who was diagnosed with schizophrenia. I wandered into this individual's blog in mid-January, 2006. I thought he was very funny. As I read more, I thought he was a talented poet and writer -- somewhat jaded and cynical -- yet also compassionate, kind, empathic, and very wounded. Where others saw "a schizoprenic" I saw "a mystic".

He has been willing to share his story for the sake of other people out there who have been diagnosed with a form of "mental illness" and has consented to allow me to respectfully share his story with others too. I trust that anyone who reads his story here will extend that same respect to him. [Those who won't will have to deal with his webmistress, who seems to be very fond of, and protective of him.]

Marek...

I wanted to share a story with all of you about the day I first recognized that having a “mental illness” meant that I would not be accepted as an intelligent human being capable of contributing to this world and worthy of the basic respect that any person should be afforded.

I went to my first psychiatric consultation six years ago. I, of course, should have been in therapy much sooner but did not realize the extent of my illness or the fact that I was even ill at all until that time.

I had to first consult with a primary caregiver due to the regulations dictated by my insurance plan. This meant that I had to first see my general practitioner and he would then send me to a specialist if required.

I recall making a list of things that had been disturbing me. Things that I did not necessarily feel were unusual but felt they were causing me great distress nonetheless. Things such as hearing voices. At the time, I didn’t realize that hearing voices was unusual. I thought everyone heard them. I just felt distressed by the things that they were saying and by the number of voices there were altogether. At its worst, it was like being in a crowded room where everyone was talking to each other and I would think I would hear my name being called but could not make out any of the other words. It became noise. Overwhelming noise.

I also had begun to take an enormous amount of over-the-counter antihistamines that seemed to help reduce some of my anxiety but they did cause my heart to race.

I mailed my list to my doctor prior to my visit. I knew that, by the time my visit would finally take place, I may not have the desire or ability to speak candidly with him.

When I arrived in his office, he asked me what had been bothering me. I mentioned the letter that I had mailed to his office and much to my disappointment, he had not read it. He quickly left the room and retrieved the letter from the front desk, where it had apparently been for several weeks.

I watched as he read quickly through the letter and he was obviously disturbed by what he had read. He wasted no time in telling me that he would refer me to a psychiatrist as the whole “antihistamine” thing bothered him.

I did later see the psychiatrist and that will no doubt be the subject of many upcoming blogs. But what I found distressing was how my relationship with this doctor had been irreparably changed.

I saw him many months later, as I was visiting someone in hospital. I approached him and said hello as I was genuinely pleased to see him. My pleasure soon faded as I realized that he was very uncomfortable in my presence. It was at that moment, I realized he would have rathered I had been a drug addict or a wife beater than the person who was standing before him.

That day, I went home and cried.

© Marek

Source: General Practice

That entry was made in September, 2005. In March of 2006, Marek made a new entry in which he stated: I am no longer disOrdered. What occurred between September 2005 and March 2006 is a story unto itself.

Schizophrenia, Mysticism, Recovery, Human Dignity, Rights of the "Mentally Ill"

Dr. Loren Mosher: Still Crazy After All These Years

2007-01-11T14:18:00.000-08:00

For over a decade Loren R Mosher, MD, held a central position in American psychiatric research.

He was the first Chief of the Center for Studies of Schizophrenia at the National Institute of Mental Health, 1969-1980. He founded the Schizophrenia Bulletin and for ten years he was its Editor-in-Chief. He led the Soteria Project.

The Soteria research demonstrated that there is a better way: A better way to treat schizophrenia and other psychoses that destroy the lives of so many young people. The Soteria research showed that the prevalent excessive destructive psychiatric drugging of all these young people is a huge and tragic mistake. The psychiatric establishment was offended. Prestige and Money won. Truth and Love lost.

The success of Soteria was the reason that Dr Mosher was forced to leave his key position in American psychiatry.

When Dr. Mosher died he was Director of Soteria Associates, San Diego, and Clinical Professor of Psychiatry, School of Medicine, University of California, San Diego.

The following excerpt is linked via the entry: Dr. Loren Mosher & Soteria House

Still Crazy After All These Years

Sometime in the next few months, the Journal of Nervous and Mental Diseases will publish an article that describes an unusual experiment with newly diagnosed schizophrenics. This experiment randomly assigned young people with that diagnosis to one of two different forms of treatment. Some entered a psychiatric hospital where they received drugs to quell their psychotic ravings. The others went to a place known as Soteria House. They lived there for several months with a small group of other schizophrenics and a team of empathetic men and women (not medical doctors) who gave the disturbed individuals round-the-clock emotional support. The study tracked the research subjects for two years. According to the new report, the schizophrenics who lived in the therapeutic home and received no drugs fared better than the ones who received medication in the hospital. Furthermore, "The ones who did the best are those who would have been predicted to have the worst outcomes," Loren Mosher says.

Mosher, a San Diego psychiatrist, was the principal architect of the Soteria experiment. What unfolded during the years it operated (1971 through 1983) shaped his ideas about schizophrenia, a condition estimated to afflict 1 to 2 out of every 100 Americans. Unlike the majority of his professional colleagues, Mosher was never persuaded that psychotic behavior is caused by brain abnormalities. He moreover came to believe that if schizophrenia is not an organic disease, then it's wrong to force schizophrenics to take drugs that change their brains. He acknowledges that the powerful antipsychotic medications prescribed for schizophrenia nowadays often do suppress the symptoms of lunacy and make disturbed individuals easier to control. But Mosher argues that there are better ways to help most schizophrenics recover their sanity - cheaper, more humane and libertarian, less devastating to the human body and soul.

Because he holds these beliefs, the 69-year-old doctor claims, "I am completely marginalized in American psychiatry. I am never invited to give grand rounds. I am never invited to give presentations. I am never invited to meetings as a keynote speaker in the United States." Yet from 1968 to 1980, the period when many of his unorthodox beliefs came into focus, Mosher occupied a prominent position in the American psychiatric research community. He was the first chief of the Center for Studies of Schizophrenia at the National Institute of Mental Health in Washington, D.C. He founded the Schizophrenia Bulletin, and he served as its editor in chief for ten years. The story of how and why he became an outcast in his profession reveals much about the profound ways in which the concept of madness has changed in America over the past 40 years.

[...]

He says in 1968 he wasn't convinced schizophrenia was an organic illness. "In my mind, it was sort of an open question. There were so many differences among people who had the same label that it made me pause." Schizophrenia was then, as it is now, considered to encompass a long list of potential symptoms (see box above). "And you can get that label without sharing a single characteristic with some other person with the same label," Mosher points out. No blood test or brain scan or other external validating criterion for schizophrenia has ever been established. Instead, a diagnosis "boils down to the subjective impression of the interviewer." The question of whether a person receives the label is "just my call, as the diagnostician."

Mosher leaned toward the view that schizophrenic behavior resulted from psychosocial experiences. But today he insists that as chief of the center, "I had no objection to people approaching it from a disease standpoint.… I just thought that both [disease and social models] ought to get equal time and an equal amount of money." Mosher says his attitude toward biologically oriented research proposals was " 'Fine. If you obey the canons of science and produce an answer, that's great. And the same with the social side.' But of course, it was always the biological types and the drug types, the interventionists, who announced the causes and the cures."

[...]

Mosher was making his way through medical school and beginning his early psychiatric training just as the neuroleptic bandwagon began rolling. He prescribed drugs during his residency training; none of his mentors had denigrated them. Even the experience at Kingsley Hall had been ambivalent. Although the overall gestalt of the experimental London facility looked down on drug therapy, Mosher says a number of the residents took neuroleptics prescribed by doctors unaffiliated with the Philadelphia Association.

Only at Yale did alarms begin to sound, he recalls, as residents and medical students confided to him their belief that drugs were the only useful treatment in psychiatry. That seemed extreme, Mosher thought, and he says his first few years as the chief of the Center for Studies of Schizophrenia did nothing to allay his concern about the growing influence of the pharmacological industry within American psychiatry. He thought the National Institute of Mental Health was doling out an "inordinate" amount of its funding for studies that the drug companies themselves could well afford. (Smith Kline's annual revenues, for example, soared from $53 million in 1953 to $347 million in 1979.) The drug research that the institute was funding, though sophisticated, seemed to him repetitive "especially in view of the fact that the neuroleptics developed early on were as good as those being endlessly and expensively tested with federal money." It made more sense to Mosher to spend taxpayer dollars on evaluating psychosocial therapies, since they lacked commercial patrons with deep pockets.

So he perked up at the grant proposal that came across his desk one day in 1969. A couple of psychiatric researchers in Northern California were asking the National Institute of Mental Health for money to compare two wards in a state mental hospital: a traditional one that employed neuroleptics, and a drug-free ward that offered a special psychosocial milieu. To Mosher, this sounded like a perfect opportunity to assess scientifically how a place like Kingsley Hall stacked up against one that used drugs as the mainstay of treatment. Unfortunately, the hospital administrator balked at the proposal, and the two psychiatric researchers lost interest in pursuing it.

The idea continued to intrigue Mosher, however, so he refined it, coming up with a plan that proposed randomly assigning newly diagnosed schizophrenic patients to one of three treatment venues: a general hospital ward that relied on drug therapy, a community treatment center that used drugs, and a community center where drugs were avoided if possible.

Although he was a high-ranking insider, Mosher couldn't just wave his hand and conjure up the money for his own study. Instead, the project had to go before the institute's Clinical Project Research Review Committee. And in 1970, when Mosher first appeared before the top academic psychiatrists who were its members, he got a lukewarm reception. According to Whitaker, who reviewed the minutes of the committee's review sessions while researching Mad in America, the resistance was understandable. Mosher's proposal "didn't just question the merits of neuroleptics," Whitaker writes. "It raised the question of whether ordinary people could do more to help crazy people than highly educated psychiatrists. The very hypothesis was offensive."

On the other hand, turning down the chief of the Center for Studies of Schizophrenia would have flouted bureaucratic niceties. So the committee compromised by giving Mosher less than he had requested. It slashed one community treatment center from the study design and offered only enough money to run the second (drug-free) center for 18 months (instead of five years). This was supposed to be a kiss of death, Mosher claims. But he immediately started working to get the funding extended. As he toiled on that, the project that came to be known as Soteria (a Greek word meaning "deliverance") got underway.

In April of 1971, it was ready for business. The facility was to operate out of a rambling two-story, 1912-vintage wooden house that sat between a nursing home and a two-family dwelling on a busy street in a poverty-stricken section of San Jose. The building's 12 rooms were designed to accommodate a maximum of six schizophrenics. Two full-time staff members, plus various volunteers and part-time assistants, would live with them; a house director and psychiatrist would contribute advice.

Staff and residents shared the cooking and other household chores, and the staff "aimed to provide a simple, home-like, safe, warm, supportive, unhurried, tolerant, and nonintrusive environment," Mosher has written in a detailed description of the project. Most "worked 36- to 48-hour shifts to provide an extended opportunity to relate to 'spaced-out' (their terms) residents continuously over a relatively long period of time.… [They] were explorers in an uncharted frontier; they were in a place where few people without preconceived notions had ventured before, and they were there without the usual trappings of power to control madness." They didn't carry "the highly symbolic keys to freedom: There were no locks on the doors. There were no syringes and few medications; and there were no wet packs, restraints, or seclusion rooms."

[...]

Mosher points out that the kind of therapy dispensed at Soteria House differed profoundly from the work that went on at the famous Chestnut Lodge psychiatric hospital in the '50s and '60s. There psychiatrists had tried to cure patients with traditional Freudian-style psychotherapy. "I'm fond of saying psychosis does not fit the 50-minute hour -- because it goes on 24 hours," Mosher says. "So you ought to conform your treatment to fit the problem." Rather than scheduling specific sessions with their charges, the Soteria staff members made a commitment to be available every moment of the schizophrenic residents' waking hours. Mosher says the overall feeling had much in common with the "moral treatment" asylums that appeared in America in the first half of the 1800s. Small, humane, and pleasant environments, these institutions promoted the concept that many lunatics could recover their sanity if treated with decency, gentility, and respect. As peculiar as that notion might appear today, Whitaker in Mad in America writes that "Moral treatment appeared to produce remarkably good results." He cites records from five moral-treatment asylums showing that between 50 to 91 percent of their patients were able to return to normal lives in their communities. Such outcomes led one asylum superintendent to declare in 1843 that insanity "is more curable than any other disease of equal severity.…"

Like this man, the staff at Soteria embraced the notion that "recovery from psychosis was not only possible but probable and to be expected," Mosher asserts, adding, "You start there, and you're way ahead of the game right away." And Mosher went further. By the time the Soteria project got rolling, he had come to believe that rather than being an unfathomable mystery, psychosis was an understandable coping mechanism.

He claims that in this way it resembles shell shock. "Men would be in combat and their entire platoons would be killed, and they would survive and be covered with blood and guts. And they would go out of their minds." What such individuals look like as they're ranting and raving "is really no different than what acute psychosis is like," Mosher says. "Except that the [shell-shock victim's] trauma -- the overwhelming experience -- is very readily identifiable. It's right there, easy to see."

In contrast, he says the trauma that drives schizophrenics over the edge "is not often so readily identifiable, and it is more often cumulative, rather than a single event." Mosher claims that a number of well-done scientific studies over the years have implicated various psychosocial factors. "Something on the order of 60 percent of adult admissions to psychiatric hospital wards have histories of sexual and/or physical abuse," he says. "This has only been studied in the last 20 years." Furthermore, "There are two aspects of family life that have been consistently highly associated with what's called schizophrenia. One has been dubbed 'communication deviance.' It's simple. Just means that when you sit with these parents, you can't figure out what the hell it is they're talking about. They can't focus on things. You can't visualize what they say. They go off on tangents. They are loose in the way that they think." He says the other thing that's pretty clear from studies is that "when families are very hostile to and critical of their offspring, that's not good for them."

Mosher acknowledges that no single one of these factors can be said to be the sole cause of schizophrenia. "Not every person who's been sexually or physically abused becomes psychotic. Some do. But often there's a lot of things going on, and usually there's also a trigger event" -- a romantic rejection, the death of a parent, an excessive involvement with recreational drugs. "So if you add sexual or physical trauma to having a hostile, critical, fuzzy family -- and then somebody breaks your heart -- your chances of going to pieces are pretty good."

Mosher insists that almost no one is so crazy that it's impossible to talk with them. "If you believe that the person is in there and you can really speak to them, there are very few instances when you can't. It's really a matter of attitude." His eyes sparkle when he thinks about experiences he's had while doing grand rounds at hospitals. "They would always bring me the person who was the very craziest. I would sit down with this very, very crazy person, and he or she and I would have a conversation that -- after the first five minutes or so -- could be understood by all the members of the audience. And the people in the audience would say afterward, 'Well, [the patient] must have been having a good day today.' " That was never it, Mosher retorts. "It's just a matter of how you approach people. If you treat them with dignity and respect and want to understand what's going on, want to really get yourself inside their shoes, you can do it."

These days, he says, "If you say 'psychosis,' people step back and say, 'Well, I'll talk to them after you give them drugs.' But that's hardly any fun at all! Truly. The most fun that I have had in my life was just sitting, talking for hours to people who were out of their minds. And it doesn't take very special training. What it takes is just attitude and interest and intensity and willingness to sort of suspend your own reality and not worry about it."

The staff members at Soteria House cultivated all those things, and Mosher says they saw a pattern. First one person would work to establish a bond with the newcomer, something that might take anywhere from two hours to three weeks. In the weeks that followed, the newcomer would gradually develop relationships with others in the house, creating a role for him- or herself in the extended family of the community. These relationships stimulated the schizophrenic residents to change, Mosher believes. "As you have a relationship with another person, you can come to recognize that they're thinking and behaving in quite a different way than you are. And if you come to have a sort of affection for that person, then it can become safe to think and act more like they do" -- i.e., less crazy and more sane. He says in a third and final stage, the Soteria residents would become increasingly competent at directing their own activities as they prepared to create lives for themselves outside the house.

[...]

Today Mosher says more than 40 publications have described the study. Mosher thinks the "cleanest, most important" finding was the outcomes for the hospital and Soteria patients after six weeks (the point at which neuroleptic drugs are known to be most effective at reducing psychotic symptoms). Comparing the outcomes at that point showed that the Soteria subjects experienced as great a reduction of their psychotic symptoms as did the hospital patients, Mosher says. Whereas all of the hospital patients received neuroleptic drugs, only 24 percent of the Soteria patients did during that interval, "and really only 16 percent had enough to be said to have had a possibly therapeutic course -- two weeks or more." Mosher adds that the 76 percent of Soteria patients who got no drugs at all did better than those who took some form of medication. To Mosher, that means "If you can construct the right kind of social environment for newly diagnosed people who have schizophrenia, 76 percent will respond in that environment as well as or better than they do to drugs."

In part because of that exposure, Mosher estimates he gets an average of three requests a day from people seeking help. Most have been diagnosed with schizophrenia or have children with that diagnosis, and they're looking for non-pharmaceutical forms of treatment. Some think Soteria is still operating, but most just want to find someone using similar methods, "And I always have not much good information to give them," Mosher laments. "There just isn't much out there." Although he thinks many psychiatrists "really don't believe the mainstream," Mosher says the price of defying it is very, very costly. "These days if you don't treat somebody who's truly psychotic with neuroleptic drugs, you can be sued for malpractice. It's that bad."

He [Mosher] receives invitations to give presentations in Europe quite often. The first true replication of Soteria opened in Bern, Switzerland, in 1984, according to Mosher, and it's still operating today. He describes at least ten Swedish facilities as being "Soteria-like," as are a couple of others in Germany. "The whole concept is extremely popular there," Mosher says. "They think it's wonderful." He speculates this may be because "there's less homogeneity" in Europe. There's also "less drug-company pressure," he asserts. "They all have national health care. And they have more of a culture of not always going with fashion. I don't know."

In the United States, however, Mosher confesses to feeling hopeless about the future of anyone misfortunate enough to receive the label he so hates. When asked what words he prefers instead of "schizophrenic" or "mentally ill," Mosher responds, "Why not call it a severe personal emotional crisis? Or a severe psychological crisis? Why not call it disturbed and disturbing behavior -- a pretty good description, since that's how it looks from the outside. There are lots of ways of recognizing that these folks are acting in ways which are unconventional -- and that still recognize they're in severe psychological pain."

[...]

He adds that "These days, for the very first time, schizophrenia has become a source of enormous corporate profits. Schizophrenics were somewhat profitable ever since the mid-'50s, though nothing like today. The sales of the antipsychotic drugs were running about $600 million a year for years until the '90s, when the new atypical drugs arrived. Since then, the bill for antipsychotics has grown to more than $4 billion a year. That's a lot of money."

Today Mosher calls himself "a lapsed psychiatrist" because he thinks the biological explanations of psychotic behavior embraced by so many of his colleagues resemble a religion more than they do a body of science. From his perspective as a heretic, he reflects, "We are all afraid of going crazy. And as long as we have someone out there who can sort of do that job for us, it's not our burden." He thinks it's comforting to believe schizophrenics act the way they do because their brains are diseased. Biological differences "make them different from us fundamentally," he says. "They're sort of a slightly different race than we are." Mosher thinks it's all "a way of carefully saying, 'These people are really different. And therefore we have the right to do whatever we goddamn please with them.' "

Source: Still Crazy After All These Years

See also:
Soteria - Bern, Switzerland
Mosher's Letter of Resignation From The APA

CATIE & You

Schizophrenia, Psychosis, Recovery, The Recovery Based Model, Hope for Schizophrenia Sufferers

Dr. June Singer: Boundaries of the Soul

2007-01-09T10:45:00.001-08:00

... I had to recall what I had learned in my own analysis when I had been training, shortly after I had begun to work with my first cases under supervision. I was, like all neophytes, exceedingly eager to achieve a successful outcome and I tended to become quite active in leading, rather than gently guiding the process. My training analyst had gently tried to restrain me, but when that failed she shocked me one day by saying, "You are not supposed to want the patient to get well!"

At first, I could not quite believe this, for I surely did not understand her meaning. But gradually as it sank in I was able to see that if I acted out of my desire to heal the patient, I was setting myself up as the miracle worker. I would be doing it for my own satisfaction, for the joy of success, and possibly, for the approval of my training analyst. My own needs would be in the foreground then, and the patient's needs would revert to the secondary position. Besides, the possibility for healing lies in the psyche of the patient, the place where the disunion or split exists.

The possibility for healing lies in the psyche of the patient, the place where the disunion or split exists.

The psyche, as Jung has taught, is a self-regulating system, containing within it all the elements which are necessary both to produce a neurosis and to transform the neurosis into a constructively functioning attitude. If I, as analyst, impose my concepts of the direction into which the outcome should be, I am doing violence to the potential unity of the patient's psyche. My task is to use myself as a vehicle for clarifying the patient's dilemmas and for helping her learn to interpret her unconscious production. My task is not to contaminate the analysis with my own problems. And it is for this reason that I constantly need to be aware of my own needs and my own biases.

Source: Boundaries of the Soul: The Practice of Jung's Psychology

Dr. Daniel Fisher: Evidence Based Practices & Recovery

2007-01-09T07:18:00.000-08:00

When people are in the greatest distress, they experience despair, isolation, hopelessness, and a lack of control. It is at those trying times that they need hope, social connection, and a belief that they can regain control of their life, which are the principles of the evidence-based recovery model. Use of approaches based on the recovery model is crucial at the beginning of the recovery process and throughout it. We know—we recovered from schizophrenia. We were able to begin recovery only when we felt we could connect and borrow someone else's hope until ours returned. Indeed, this is why people move on in their recovery. To wait and apply these principles only later in people's treatment may rob them of their chance to recover.

When people are told they suffer from a permanent biological brain disorder, they feel they will never recover or regain control over their lives. This treatment approach has ensured that people remain hopeless, helpless patients and has made them indefinitely dependent on the mental health system.

Research has shown that the principles underlying the recovery model are evidenced based. An epidemiological study of a group of seriously disabled persons who were consumers of mental health services in Vermont showed that practices based on the principles of hope, social connection, and self-determination—those of the recovery model—were essential ingredients in the high rate of recovery in this group. A much lower rate of recovery was found in Maine, where treatment was based on maintenance and medication compliance, the essence of the medical model.

Another study of the conditions best suited for recovery, the Soteria House study, found that persons experiencing their first episode of schizophrenia achieved more significant recovery when their treatment was provided in the context of relationships characterized by hope, trust, and self-determination rather than in accordance with the principles of the medical model. In Falum, Sweden, persons experiencing psychosis who were treated according to the principles of the recovery model had better outcomes than those whose treatment followed the medical model.

Currently, the benchmark for evidence-based practice is maintenance: symptom reduction and medication compliance. However, when community integration is used as the outcome measure, the recovery model is clearly more evidence-based than the medical model.

The medical model, which is the underpinning of evidence-based practices, is described in the article by Dr. Frese and coauthors as being "highly paternalistic, emphasizing illness, weakness, and limitations rather than potential for growth." The authors state that people who are in the greatest distress should be treated by a "paternalistic, externally reasoned approach." This is the primary approach used in the mental health system today. When people are told they suffer from a permanent biological brain disorder, they feel they will never recover or regain control over their lives. This treatment approach has ensured that people remain hopeless, helpless patients and has made them indefinitely dependent on the mental health system.

Source: Evidence Based Practices & Recovery

Schizophrenia, Psychosis, Recovery, The Recovery Based Model of Schizophrenia, Hope for Schizophrenia Sufferers

The Only Way Out Is Through

2007-01-08T21:14:00.001-08:00

In the early winter of 2002 I had a psychotic break which was preceded by a period of multiple losses in a matter of months as accompanied by trauma. My psychotic break lasted about six weeks, during which I moved in and out of an altered state of consciousness that was entirely real to me. Within that space, guides and helpers appeared; primary among these was a mentor figure who filled a therapeutic role and was my constant companion throughout. A summary of that experience can be found here.

Because I did not know that what I was experiencing was called a psychotic/schizophrenic break in this culture, I did not seek medical care. I approached the experience as I had any other difficult experience in life, with the attitude that the only way out is through. I placed my faith in my mentor, committed myself to the experience, and fully engaged the arising content. At first, the content was fragmented and skipped around a great deal. As I moved through the process a clear pattern emerged.

That was four years ago. I have been working for the past three years (just a few days a month to start). My relationships are all stable. I have not been on any form of therapeutic medication (neuroleptics, anti-depressants, or mood stabilizers). Nor have I had any formal therapy (which I couldn't possibly have afforded). However, I have had a great deal of informal therapy via the support of some very dear friends and some help from the internet.

I spent three years actively researching what it was that had happened to me and why. I've since created a blog that contains numerous articles and books that best helped me interpret, integrate, and move beyond that experience. I consider myself to be recovered although there's much I continue to learn about my experience. I also feel fortunate to have had it -- painful as it was. Tremendous insights and spiritual growth arose as a result and continue to do so. To a certain extent, that process is still in play, albeit, much more slowly.

The most difficult part of recovery for me has been acknowledging that healing must occur on multiple levels of experience: physical, mental, emotional, and spiritual. It takes a long time and it has to unfold in an environment that is not receptive to the visionary experience and the healing thereof. It's worth noting, I don't self-identity my own experience as one of "schizophrenia" -- I consider it to have been a form of spiritual awakening -- yet there is no getting away from this culture's label. If you try to tell people in this culture what happened to you, the culture itself has already slotted you and your experience into a cubby hole labelled "psychotic". This culture tends to think that visionary experiences, mystical experiences, shamanistic experiences, are no longer happening. They are -- it's just that the people who have such experiences are being marginalized, medicalized, medicated, shamed, stigmatized, and silenced.

The spontaneous onset of visionary experience affects from .5 to 2% of the global population. Other cultures not only apply different labels, they often have higher recovery rates. In this culture, the vast majority of individuals going through an experience of psychological upheaval will typically end up in a psych ward and be given neuroleptic medication to suppress the content that bubbles up from the unconscious of a fragmented or collapsed ego structure. That was not my experience.

BEYOND ALL THE MADNESS
BEYOND ALL THE TRUTH
IN THE EYE OF THE NEEDLE
IN THE EYE OF THE SOOTH
LAY A GLISTENING TELLING
ALL CRYSTALINE BLUE
OF JUST WHO I AM
AND JUST ...
WHO
ARE
YOU
©spiritual_emergency

Spiritual Emergency, Shamanism, Mysticism, Gnosticism, Alchemy, Schizophrenia, Psychosis, PTSD, The Hero's Journey, Spiritual Awakening, Ego Death, The Dark Night of the Soul, Kundalini Awakening, Carl Jung, John Weir Perry, Stanislav Grof, Christina Grof, R.D. Laing, Loren Mosher, Maureen Roberts, David Lukoff, Recovery from Schizophrenia