Recovery from "schizophrenia" and other "psychotic disorders"

[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 »

In the mental health field currently, when people experience intense anxiety and depression, and when they experience mania and/or psychosis, the experience is understood to be a “disorder” or a “biological dysfunction” that is of no use and should “corrected” by any means that might be effective in doing so.  The most straightforward way of doing this is conceived to be a drug that might directly reverse the theorized “biochemical imbalance” though other methods are tried, particularly when drugs don’t work.

The primary opposition to this point of view in our culture comes from those who deny the existence of mental disorders at all:  they see “diagnosis” in the mental health field as being an illegitimate enterprise, and the DSM as a work of quackery designed to make money for drug companies and for “mental health professionals.”  It is noted that there is no physical test for any sort of “mental disorder” and no objective way of determining what should be called a disorder.  It is then imagined that people would do fine if saved from those in the mental health field who attempt to diagnose and then “help” them.

A middle ground between these two extreme views is however emerging.  In this view, the mental states that get diagnosed as “disorders” tend to be specialized states of mind which do tend to cause trouble for people, but which can also be seen as part of an evolved, problem solving strategy used by the mind.  That is, while these mental states may not be consciously chosen by the person and may cause problems, they also may solve important problems, and so in any given case it may be unclear whether they are doing more harm than good.

An example of a “biological” evolved problem solving strategy that both causes problems but also potentially solves problems is that of a fever.  Fevers cause many problems, and if quite high may cause brain damage or even death, yet we have evolved to have fevers because they often help solve the problem of infections. More »

In the attempt to convince people to take medications, the hazards of such medications are often minimized or overlooked. While many people may truly be better off taking some medications, at least for awhile, the danger in hiding the hazards of the drugs is that rational decisions about how long to stay on medications, at what dosage, and how hard to try to find alternatives, become impossible. Instead, an illusion is created that the only rational approach is to stay on medications indefinitely, because only an irrational person would risk the return of a destructive psychosis.

If we really allowed ourselves to face all the facts however, we would see that these decisions are much more complex. For example, while the effects of being caught up in psychosis can be terrible, the effects of the antipsychotic medications can be terrible as well. These medications significantly increase the risk of death, due to causing things like heart problems, metabolic syndrome, obesity, diabetes etc. And, while most of psychiatry is still in denial about it, it appears that antipsychotic medications have a tendency to shrink brains. (For those of you unfamiliar with the evidence for this effect, I include some references and other information at the end of this post.)

Some people might think that if antipsychotic medications will shrink the consumer’s brain and then possibly kill them, then the obvious decision is to just get off the medications as quickly as possible. However, the problem is that it appears that uncontrolled psychosis, and its associated distress, will also shrink a person’s brain and very possibly kill them (besides making a total mess of their life in other ways.) 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.

(Note, this is a very old post, and at least many of the problems reported with the EAST program no longer exist, as they have been open to making some changes.  This post however does still describe problems that exist with many suppposedly “progressive” programs which really still follow an excessively narrow and inaccurate “medical model.”)

The following exerpt is part of an email I wrote to Kathy Savicki, the director of an early intervention in psychosis program in Oregon called EAST.  (You can find out more about EAST by checking out www.eastcommunity.org.)  While this program can be praised for at least bringing up the issue of recovery, it also apparently suffers from very serious flaws due to the way it pushed a biological explanation for psychosis – both common sense and research tell us that when people believe their mental problems are biological, they feel less able to do anything about them.  Since empowerment is a key factor in recovery, and since biological theories are highly speculative, then biological theories should never be presented as fact.  ”I found some things about your program that I liked very much, but also some apparent problems which I would like to discuss with you.  Since you have taken a forward looking approach in being involved in new programs, I am hoping you are open to hearing different and probably controversial ideas, even if critical of some aspects of your program!