Recovery from "schizophrenia" and other "psychotic disorders"

My county, Lane County, Oregon, is one of a number of places around the country just starting to participate in a new “early intervention” program sponsored by NIMH, called RAISE, that says it aims to help people soon after they begin experiencing their first psychotic episode.  While there are some good reasons to offer help to young people as soon as they start having problems that might be labeled psychosis, I have serious doubts about the program here being offered.

For one thing, the very name of the program (RAISE stands for “Recovery After an Initial Schizophrenic Episode”) suggests the program will be reckless in applying labels and stigma.  Even the DSM cautions against calling a psychotic episode “schizophrenia” unless the mental health condition has lasted at least 6 months, but people will be recruited into the RAISE program as soon as possible after their problems with psychosis begin, a much shorter time period.  Nevertheless, just due to the name of the program, they will feel defined  as having had a “schizophrenic” episode. 

Second, the NIMH website advertises that the program involves “intense and sustained pharmacological intervention.”  This implies a reckless use of medication as well as of labeling.  (Of course, the two go together – the sooner a person is labeled with “schizophrenia” the more justification can be made for “intense and sustained” drugging.) 

Early intervention programs that really aim to help are very cautious about the use of both labels and drugs.  The lack of caution in the design of this program suggests that the true purpose of the program is the early recruitment of young people into a life as labeled consumers of psychiatric medication.  Tobacco companies have to recruit their own customers, but pharmaceutical companies have government assistance in capturing their market.

It’s interesting that an old friend of mine, John Bola, did a review of all the studies that ever compared programs that started people out on drugs immediately, with programs that didn’t, and where the comparison period was at least a year.  You can read his paper here.  What he found was that in each case, the program that didn’t rush people into drugs did better – and that was before taking into account the fact that the people not on drugs didn’t have to deal with drug side effects.  And of course the best effects reported for an early intervention program are those of the Open Dialogue program, which also avoids using drugs wherever possible.

I wait for the day when we will treat young people with “psychosis” based on the evidence, and not based on the wishes of those more interested in profit.

In an article titled “ Effects of Culture on Recovery From Transient Psychosis” the author asks why premodern cultures studied by the World Health Organization had 10 times the rate of acute onset psychosis followed by full recovery as that found in more modern cultures.

The author contends that “Traditional treatment in a premodern society usually consists of a prescribed period of rest; sympathy; heightened social support; alleviation of underlying social stresses; exploration of alternative coping
strategies; and various types of traditional healing rituals, sometimes lasting days or weeks, and frequently resulting in the full recovery of the patient.”  

While “modern medical experts” make fun of “primitive” perspectives about spirits and the use of “witch doctors” to address them, it seems that any truly “evidence based” approach to understanding psychosis would be more interested in figuring out how and why they were so effective.

Contrast the “primitive” approach with the relative isolation and drugging imposed on the newly diagnosed psychotic person in in a modern culture.  The person is identified as “biochemically imbalanced” rather than overcome by stressful life events, no attempts are made to really understand him or her, the experience is identified as an illness with no spiritual consequences, and no coping tools are suggested beyond taking pills as prescribed.

I am reminded of an early drug trial on antipsychotics.  They had 4 groups, three groups were each on a different antipsychotic, while the fourth group was a placebo.  After about 6 weeks, each of the drug groups was doing better than the placebo group. But when they came back and checked on how everybody was doing after a year, they found that the group that had been started on placebo was doing better than any of the three groups started on drugs.  Instead of concluding that there was something wrong with rushing people into drugs however, the experimenters hypothesized that the group initially started on placebo was only doing better because they had been noticed by others to be doing worse because of not being on drugs, and this had elicited sympathy and concern from the people who noticed, and it was the extra care that they received that resulted in them doing better when measured a year later.  Of course, it never occurred to the experimenters that giving a drug to people that made them seem like they didn’t need extra support, resulting in them not getting the support they really needed, so that they would be doing worse later, may not have been a good idea.  (Not to mention that more drugs meant more risk of nasty side effects as well.)  And so the modern era of drugging and lack of empathy was begun. More »