Recovery from "schizophrenia" and other "psychotic disorders"

 Many of you have probably been aware of two prior World Health Organization (WHO) studies that showed almost twice the recovery rates from “schizophrenia” in developing countries as in developed countries.  While critics of current psychiatric practice attributed the better outcome in developing countries to the fact that most were not on medication, others suggested that cultural factors were mostly responsible for the better outcomes.

A new study though, that looked only at people on medication in a wide variety of countries, found little difference in outcome between developing and developed countries.  While not noted in the article, this apparently provides new backing for those who would maintain that it was the greater use of antipsychotic medication in developed countries that resulted in the greatly reduced recovery rates in those first two studies. 

For those who want to know more about the assertion that long term use of antipsychotics is highly detrimental to real recovery and contributes to long term disability, this issue is covered in depth in Robert Whitaker’s new book, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America

Richard Bentall, in his book Doctoring the Mind: Is our current treatment of mental illness really any good? describes how researchers first noticed and tested the properties of the medications that later became known as “antipsychotic.”  The procedure was fairly simple.  They first exposed rats to an electric shock applied to the floor of their cage, accompanied by a sound.  The rats quickly learned to climb a rope to get away from the floor of the cage whenever they heard the sound:  this is what is called “conditioned avoidance.”  Then they gave the rats the new medications, and noticed that the medicated rats no longer showed the conditioned avoidance – that is, they no longer climbed the rope in response to the sound.

That this effect exists is not surprising given what we now know about the function of dopamine in the brain, and the role of antipsychotic medication in blocking dopamine.  Dopamine nerve cells are involved in anticipating threats, and that animals that have been repeatedly exposed to threats show increased sensitization of their dopamine system (in other words, their dopamine system is more reactive).  And since antipsychotic medications block dopamine, it follows that they reduce threat anticipation.

People who are diagnosed with psychosis are often misperceiving people or events as threatening when they are not.  Often, such misperceptions cause chaos in a person’s life (especially if the person takes action to fight off threats that are unreal, actions which may create real threats.)  So, medications that reduce “conditioned avoidance” reduce reactivity to perceived threats, and this is helpful at least some of the time.  But isn’t it also possible that such reduced anticipation of threat can go too far, and result in people on medication being less likely to protect themselves from many real threats that may exist? More »

[Note:  The document below is just a part of the proposed consumer empowerment guidelines for Lane County.  I'm posting this separately here, because it is the part of the document that would be of most general interest.]

Recovery from many kinds of problems is affected by beliefs about the possibility of recovery.  Consider a hypothetical example of a person who has received an injury which affects the person’s ability to walk, but which is not necessarily permanently disabling if strong efforts are made to recover.  If the person is led by medical authorities to believe that the disability is permanent, efforts at rehabilitation will probably not be made, and the prediction may become a self fulfilling prophecy.  Since the disability at that point is a result of the inaccurate prediction rather than the injury itself, the disability becomes a medical system induced condition.

The mental health system faces the same kinds of issues.  In fact, none of the major mental health disorders have been shown to be reliably permanent, and no studies have shown mental health professionals being able to determine who will definitely have the disorder for the rest of their lives.[i]  For each disorder, at least a sizable minority are found to fully recover, without need of further medication or other mental health treatment.[ii]  Consumers who do recover typically credit others who helped them believe they could recover, and their own efforts at recovery, as essential parts of that recovery.[iii]

And yet, many consumers have been led to believe by the mental health system that they will always be “mentally ill” and that their need for treatment, in particular treatment by medication, will inevitably be lifelong as well.[iv]  More »

A lot of efforts to transform an often oppressive mental health have focused on “recovery” and making the mental health system more “recovery focused.” Many agencies have integrated the notion of recovery into their practice, and if the use of this word were a measure of progress, we would be well on our way to system transformation! Unfortunately, what seems to be happening is that as the word “recovery” is used more and more, it seems to mean less and less. I know someone for example who is on heavy doses of an antipsychotic as well as other medications, lives in a foster care home, and spends most of his daytime hours in a mental health day treatment program, yet is assured by his case managers that he is “recovered.”

More at this recovery page.