schizophrenia recovery - whay can't they recover?

WHY CAN’T THEY RECOVER?

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?

Now for many success stories, 60 minutes profiled the Anne Sippi clinic in California, schizophreniatherapy.com and schizophrenia-help.com. The founder Jack Rosberg is truly one of the few who has had success treating people suffering from schizophrenia combining therapy with medication. I can tell you it works because my brother Dan has benefitted from it. the journey has been long, the steps are short, but in the right direction. My brother Dan is treatment resistant, yet he has been able to claim some of his life back thanks to the Anne Sippi Clinic.