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Over
the years victims of schizophrenia have been
considered by many mental health professionals as
being chronic with no hope for recovery. I believe
chronic is an anchronism. There is a great deal of
research that points out that individuals with
schizophrenia can make good social recoveries.
However, psychiatrists, psychologists alike have
abandoned these individuals and have relied
primarily on the physical methods of treatment.
Indeed, the old treatment models viewed patients as
hopeless cases who needed to be stabilized with
hospitalization, and then maintained with
medications. The heavy tranquilizing effects of
these drugs made management of patients easier,
although they only masked the condition. The newer
generation of medications do the same with less side
effects even though those claims are disputed.
We know that denial is one of the major defense
mechanisms of these patients. But this is also true
of the professionals, i.e. psychiatrists and
psychologists etc., who laugh at and deny the claims
of those who have recovered from this dreadful
disorder.
In 1957 Karl Menninger wrote “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.”
Psychotherapy is one treatment tool. I have
practiced it for 48 years with success. Not all the
patients I treated have recovered, however, many
have and I believe many more could have if the
atmosphere was more hopeful and there were better
community resources.
Between 1913 and 1923 and 1943 through 1952
significant changes in patients with different
levels of schizophrenia were made in some American
hospitals leading to discharge - some 55 to 71% of
patients recovered well enough to be discharged back
into their communities. I believe this was due to
better patient care. After the medications became
the primary treatment effort - the human part of
treatment - the hope and optimism diminished. It was
widely reported that by 1970 there would be no more
schizophrenia because of the medications and
psychiatriatric hospitals would not longer be needed
for that perpose, i.e., to house schizophrenic
patients.
I am not opposed to the use of medication as one
treatment tool however, what we are doing is
abnormalizing the patient by using the traditional
forms of treatment and over using medication. What
we need to do is normalize treatment by dealing with
reality issues and determining when and how much
medication is therapeutic. Research points out that
reducing medication by two thirds in many patients
combined with other treatment methods is successful
in the recovery process, and contrary to popular
belief individuals with schizophrenia have, do and
will recover providing that there is a hopeful
attitude in the treatment milieu.
Freda Fromm Reichman who was one of the three
earlier contributors to the psychotherapy of
schizophrenia, said years ago - “What is effective
in therapy is patients experiences of therapy as a
helpful and constructive human relationship that
reinforces their efforts to come to terms with a
troubled past, not an explanation of how and why
they became the kind of people they are”.
The term treatment resistance by definition means
that there are patients who do not respond to some
treatment methods, it does not suggest and it should
not be understood as saying that those individuals
cannot make changes with changing treatment
approaches. Yet the term treatment resistance is
used commonly amongst professionals in the field,
suggesting that individuals with schizophrenia
cannot change. In 1990, I wrote a paper with a
colleague entitled, The Use of Direct Confrontation
in the Treatment Resistant Schizophrenic Patient, it
was published in the Journal Acta Psychiatric
Scandinavca, 1990: 81;352-358. What it stated with
emphasis was that we felt that treatment resistant
applied more to the professional that it did to the
patient. As a psychotherapist, I cannot think of
such a term as being relevant if I intend to work
with the long term schizophrenic. If I need some
reason to avoid the treatment of the individual who
has this very difficult condition called
schizophrenia - then of course this term is a very
convenient retreat route for me.
What I set forth in this Newsletter, is not only
true in the USA, I have visited and worked in 16
countries frequently and with some exceptions the
same is true throughout the world. The failure, of
treatment is international. Not because of the
severity of the conditions of the serious mentally
ill individuals but because of the failures in the
professional world. The pessimistic outlook
regarding treatment for schizophrenia has influenced
the professional world to retreat from developing
training centers - for students and professionals to
acquire treatment skills for the person with
schizophrenia and other serious mentally ill
patients. Stigma is not only part of the lay public
but also is rampant amongst psychiatrists,
psychologists and other mental health personnel.
This is also a treatment tragedy. The ignorance of
the field in such areas as psychosocial
rehabilitation and psychotherapy is epidemic.
It has been some years past that the principles and
or ideas of psychosocial rehabilitation have been
introduced. Even though there is some recognition of
its value - on an international scale - there are
not enough treatment centers established to meet the
needs of the millions of individuals world wide. Is
it the money? Isn’t it true that not affording
proper care costs much more not to ignore the cost
in human suffering.
There is no doubt that this treatment effort is a
critical part of the overall approach to the serious
mentally ill. We hear much about biopsychosocial
treatment and its value - but how much of it is
being done? Also, I have emphatically stated that
this approach will be more successful with an active
psychotherapy to support its gains. But how do we
press home the importance of training medical and
psychology students in these areas. Certainly
psychologists and students of psychology should be
introduced to the fact that people with these
disorders can recover given the “right” kind of
treatment. To quote William Anthony Ph.D. at Boston
University, a distinguished contributor in
psychosocial rehabilitation “Psychology as a field
has not focused its training in the area of serious
mental illness. This is a message that consumers
have been bringing to us but we haven’t been
listening. Too many psychologists remain unaware of
the new hope and have shown little interest in
working in schizophrenia”.
In 1999 Ronald F. Levant EdD 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”?
Those of us who have spent years working with
schizophrenia and know those who have recovered -
have heard so many times - “that person must have
been misdiagnosed”. What a terrible declaration.
Those who think this way and convey this as
professionals - whatever their discipline - do
indeed created a self - fulfilling prophecy!
Courtney M. Harding Ph.D. - University of Colorado
did a research study of a group of patients released
from Vermont State Hospital between 1955 and 1960 in
a state funded, early model bio-psycho-social
rehabilitation program. The 269 patients chosen for
the Vermont model study, were classic back ward
cases - those diagnosed with chronic schizophrenia
and deemed unable to survive outside of a hospital.
In the 1980’s when Harding and her colleagues
tracked down and interviewed all but 7 of the
original 269 patients - 32 years in most cases,
after their first admission to the hospital.
Hardings study in The American Journal of Psychiatry
(Vol. 144, No.6 p.718-735) showed that 62% to 68% of
those former back ward patients showed no signs at
all of schizophrenia. 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?
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