I wish I had been taught to ignore delusions and paranoid feelings as a concrete strategy. Once I had sufficient insight into the truth that they were internal manifestations, I could spend a lot of time in talk therapy about how it felt to have these frightening ideas. It took me a long time to give up trying to make sense of them, and my "illness/symptoms" took up most sessions with my psychiatrist. Once I had gotten some traction on my problem and felt healthier, the thoughts got cut down to size, until they were much less significant.As they were less overwhelming, I began to ignore the intrusive ideas, and accept that they might always arise, but they didn't have to be attended to. It was a big deal to harness this management skill, one I found myself through trial and error as I improved. I still use it as a coping technique, every single day. BTW, I was on low dose risperdal(no longer) and talk therapy, and credit both with helping, but my ongoing relationship with my therapist has made vastly more of an impact on my wellness and functioning. Life saving, life changing.
9
This study is gratifying in that it is on point with our institiutonal philosophy. Our training of clinicians has at its core a combination of the current medical model and the fundamentals of talk therapy.
We believe in the value of talk therapy, but understand that, without an understanding of neuroscience, neurotransmitters, brain biochemistry and other pathological agents, our practitioners will be unable to communicate with the medical profession in our efforts to deal with the whole human condition—the entirety of the human body at all levels, physical, behavioural, and spiritual.
Medication alone risks numbing the human spirit rather than liberating it.
Keith Pagan
British Psychoanalytic Institute
www.british-psychoanalytic-institute.com
We believe in the value of talk therapy, but understand that, without an understanding of neuroscience, neurotransmitters, brain biochemistry and other pathological agents, our practitioners will be unable to communicate with the medical profession in our efforts to deal with the whole human condition—the entirety of the human body at all levels, physical, behavioural, and spiritual.
Medication alone risks numbing the human spirit rather than liberating it.
Keith Pagan
British Psychoanalytic Institute
www.british-psychoanalytic-institute.com
3
Now if we can just find a way to treat schizophrenics so that they aren't housed in jails and prisons or unhoused altogether.
4
My first Abnormal Psychology course was in 1971, where the Professor, Rachel Gittleman-Klein, whom I still adore, spent the first lectures making the point that psychoses were caused, and only partially alleviated, by brain bio-chemestry. She started the course by surveying the students about on the etiology of schizophrenia, where the vast majority, including me, believed it was caused by external stress, such as "double bind" parenting. After hours spent in Queen's college library trying to find research proving her wrong, I couldn't.
Perhaps the pendulum has swung too far. Now we do know that severe psychosis does have a genetic component, but we may have given up on, not only "talk therapies," but more salubrious environments as part of any long term public health approach.
We need to go beyond formal mental health facilities, to recognize serendipitous settings, such as public tennis courts, that convey a mentality of support, limit-setting but in the context of acceptance. The sports activity becomes a setting that shifts the focus from the individuals psychiatric deficiencies to enjoying a cooperative sporting activity. Emotional connections become a by-product of the activity rather than its focus. This can release natural desires for human affinity.
One problem is there is no professional organization to promote and monetize this very inexpensive but effective approach to providing succor to large numbers of those in distress.
AlRodbell.com
Perhaps the pendulum has swung too far. Now we do know that severe psychosis does have a genetic component, but we may have given up on, not only "talk therapies," but more salubrious environments as part of any long term public health approach.
We need to go beyond formal mental health facilities, to recognize serendipitous settings, such as public tennis courts, that convey a mentality of support, limit-setting but in the context of acceptance. The sports activity becomes a setting that shifts the focus from the individuals psychiatric deficiencies to enjoying a cooperative sporting activity. Emotional connections become a by-product of the activity rather than its focus. This can release natural desires for human affinity.
One problem is there is no professional organization to promote and monetize this very inexpensive but effective approach to providing succor to large numbers of those in distress.
AlRodbell.com
5
It's good to see the psychiatry field has made strides from and era of chaining people up, removing their teeth and drilling holes in their brains!
For those of you out there who are just starting to deal with a loved one's psychosis diagnosis, it will be a long road and there will be many ups and downs and setbacks and breakthroughs. The first thing I had to learn, and it took few years since I was in deep denial, was to fundamentally change my idea of success. In the case of a psychosis diagnosis (psychosis is the term used by medical professionals) it is highly unlikely that things will ever be the same again - but they can be much, much better.
My son was in hospital or a care setting for about a year in total time. His illness started when he was about 18 years old and then, over about 10 years, he slowly stabilized to a place where he could function well in social settings. He is now almost 35 years old and has attended several employment training programs and now works steady as a carpenter's helper. One of the turning points for him and for us was the assignment of a social therapist (my term) with whom he went out for 'coffee' every two weeks or so for about 2 years. This was a critical piece of his recovery because it brought into play the crucial social piece that had been destroyed when he became ill. ALL his friends disappeared and he had no one to hang out with. With his social therapist he could relearn the intricacies of chit-chat and of just hanging out at the mall or the pool hall and was able to reform himself to a level of normality that allowed him to rejoin society on sustainable terms.
My son was in hospital or a care setting for about a year in total time. His illness started when he was about 18 years old and then, over about 10 years, he slowly stabilized to a place where he could function well in social settings. He is now almost 35 years old and has attended several employment training programs and now works steady as a carpenter's helper. One of the turning points for him and for us was the assignment of a social therapist (my term) with whom he went out for 'coffee' every two weeks or so for about 2 years. This was a critical piece of his recovery because it brought into play the crucial social piece that had been destroyed when he became ill. ALL his friends disappeared and he had no one to hang out with. With his social therapist he could relearn the intricacies of chit-chat and of just hanging out at the mall or the pool hall and was able to reform himself to a level of normality that allowed him to rejoin society on sustainable terms.
10
The results of this study may also be applicable to long-time sufferers of schizophrenia. My mother, after years of ECT treatment and high doses of medication (with which she was never compliant because of the horrible side effects), responded to a low dose of medication and supportive psychotherapy, as well as some life changes. She was able to live independently and do meaningful volunteer work. There were still difficult times, but she was remarkably resilient.
4
We need to start treating mental illness holistically- looking for physical medical causes, nutritional, spiritual, social, psychological supports. We need more research and early intervention. I feel like the mental health care system in this country is broken. There is a lot of evidence that some mental illness is caused by infection and inflammation of the brain. Children with PANDAS Pediatric Autoimmune Neuropsychiatric Disorder Asssociated with Step) are being confined to institutions when all the need is an antibiotic or IVIG. Yet most mental health care providers refuse to consider that a medical physical cause is the culprit. Why has psychiatry been divorced from the rest of medicine? Aren't psychiatrist MDs? Yet they never check for physical causes, nutritional status, or diseases that cause mental health symptoms. Our whole bodies and lives effect our brains health and well being.
8
The published results of the study cited in the article does not say what the article claims. There is nothing in the published results about lowered doses and nothing about doses at all in the listed findings. THE TIMES JUST GOT THIS PLAIN WRONG. THEY SHOULD RETRACT THIS ARTICLE. What the report did assert was that that medication plus therapy is better than medication alone. However, there is nothing new or ground-breaking about this outcome. Medication plus therapy has long been acknowledged as the gold standard in treating serious mental illnesses. What is new is the size and the scope of the study. This is important because it gives added credence to continuing the best standard of care. What was also new was the way the study was conducted. The online version of this article links to the original report of the study in the American Journal of Psychiatry. People should read the study itself. My mom taught me not to believe everything I read. Sometimes Mom got it right.
5
The NYT believes that drug companies are pushing drugs for profit at the expense of patients. This is why they distorted this story to say what the study did not. Most people will take the article as gospel, but they should read the study.?
I know by watching a family member struggle with schizophrenia that drugs and talk therapy together are much more effective. Schizophrenics often have deep psychological issues that create the mental pressure that leads to a schizophrenic breakdown. To prevent further episodes, it's important for the patient to deal with those issues. To do so, the patient needs the relief from symptoms that the meds give. That said, the meds have side effects. There is no way around that.
I know by watching a family member struggle with schizophrenia that drugs and talk therapy together are much more effective. Schizophrenics often have deep psychological issues that create the mental pressure that leads to a schizophrenic breakdown. To prevent further episodes, it's important for the patient to deal with those issues. To do so, the patient needs the relief from symptoms that the meds give. That said, the meds have side effects. There is no way around that.
2
Thank you.
The fallacies here are being repeated all over the Internet: if you have talk therapy, you can lower your meds!!
The fallacies here are being repeated all over the Internet: if you have talk therapy, you can lower your meds!!
It's too bad that there's only one small reference to Open Dialogue, a nearly medication free talking therapy system which has successfully treated even schizophrenia in Finland for more than 20 years. Here in the US, we watched our son's paranoia dissipate in Open Dialogue sessions, even while he was heavily symptomatic. Open Dialogue, a program which includes family members and requires multiple therapists may be expensive to contemplate, but what is the value of a human life? Do we just throw people away because they've been struck by mental illness? Another Open Dialogue in Finland is that many patients have re-entered the work world, and gotten off of their version of SSI. Which is more expensive, effective treatment or a lifetime of dependency?
7
This is news?
Bruno Bettelheim said this in 1950 again and again.
Worse, third party pay destroys the ethic and effect of therapy, most especially traditional psychoanalysis.
If the patient dies not pay, the patient does not work.
And the therapist knows this and takes the money.
Bruno Bettelheim said this in 1950 again and again.
Worse, third party pay destroys the ethic and effect of therapy, most especially traditional psychoanalysis.
If the patient dies not pay, the patient does not work.
And the therapist knows this and takes the money.
3
Proponents of the "drugs are all powerful" treatment of schizophrenia usually totally disparage the concept that patients' reports of unusual voices and visionary experiences may be potentially meaningful.
I recommend -
- Article - Psychosis As Purposive: Jungian Treatment of Schizophrenia - "The Far Side Of Madness" by John Weir Perry - Book Review by Rob Couteau - tygersoftwrath.com
Dr. Perry treated his patients with empathy and openness regarding their inner experiences. He discovered ten sets of visionary motifs which may emerge, especially during initial acute episodes of schizophrenia.
- "symbols of the center, death, return to beginning, cosmic conflict, threat of the opposite sex, apotheosis (identifying with divinity), sacred marriage, new birth, new society, and the quadrated world."
This spontaneous process is aimed at re-organizing and healing the emotionally impoverished pre-psychotic self.
- YouTube - "Eleanor Longden - The Voices In My Head" -TED Talks
Eleanor's initial reports of fairly mild experiences with inner voices were met with a medical establishment diagnosis of impending insanity needing heavy drugs. Eleanor's fearful response precipitated her into a "psychic civil war". After many tormented years, she finally met therapists who "helped me to understand that .. my voices were a meaningful response to traumatic life experiences."
- "Intervoice/ A Practical Guide To Coping With Voices" - intervoiceonline.org
I recommend -
- Article - Psychosis As Purposive: Jungian Treatment of Schizophrenia - "The Far Side Of Madness" by John Weir Perry - Book Review by Rob Couteau - tygersoftwrath.com
Dr. Perry treated his patients with empathy and openness regarding their inner experiences. He discovered ten sets of visionary motifs which may emerge, especially during initial acute episodes of schizophrenia.
- "symbols of the center, death, return to beginning, cosmic conflict, threat of the opposite sex, apotheosis (identifying with divinity), sacred marriage, new birth, new society, and the quadrated world."
This spontaneous process is aimed at re-organizing and healing the emotionally impoverished pre-psychotic self.
- YouTube - "Eleanor Longden - The Voices In My Head" -TED Talks
Eleanor's initial reports of fairly mild experiences with inner voices were met with a medical establishment diagnosis of impending insanity needing heavy drugs. Eleanor's fearful response precipitated her into a "psychic civil war". After many tormented years, she finally met therapists who "helped me to understand that .. my voices were a meaningful response to traumatic life experiences."
- "Intervoice/ A Practical Guide To Coping With Voices" - intervoiceonline.org
3
This certainly sounds great, but my son has been diagnosed for 6 years now with paranoid schizophrenia. Everyone knows it but he still does not accept the diagnosis as fact. That means talk therapy was never helpful for him with his deep paranoia. He has tremendous family support which is good because all of his friends went away with his multiple drops from society and into hospitals. Without the acceptance that he has the disorder he always stopped the medications and became very psychotic.
I am pleased that there are new therapies coming into use, but the disorders as far as I have seen in my network are more like cancers. There is not one cure or one treatment for all.
I am pleased that there are new therapies coming into use, but the disorders as far as I have seen in my network are more like cancers. There is not one cure or one treatment for all.
4
Thanks for writing this article about a federally funded study.
Now, would you please write an article about the abuses of the psychiatry field by the various authorities and the endemic lack of freedom and the stigma that that society inflicts on the patients, always assuming they are guilty of a crime without committing one?
Now, would you please write an article about the abuses of the psychiatry field by the various authorities and the endemic lack of freedom and the stigma that that society inflicts on the patients, always assuming they are guilty of a crime without committing one?
7
You could use a good therapist.
The psychiatry field is a tool of the authorities. I know.
3
Well. More pablum for the just say no crowd.
And how many of them actually have to contend with a seriously mentally ill loved one?
Get back to me in ten years. Let me know how more therapy, less druuugggs worked out.
In real life - not a study.
And how many of them actually have to contend with a seriously mentally ill loved one?
Get back to me in ten years. Let me know how more therapy, less druuugggs worked out.
In real life - not a study.
4
I'm the conservator of a parent who was diagnosed with PTSD and schizophrenia 20 years ago, when I was in my teens. Drugs have worked to dampen - not eliminate - the most dramatic of symptoms and, yes, things are much better when my parent's medication is stable. However, I feel -- as does nearly everyone in my family -- that the overzealous reliance on drugs and little other intervention early on contributed significantly to both the physical damage and the poor outcomes that we've dealt with. When we - family, worked much harder on social support, talk, and made efforts to create "combined" approaches on our own, things have been much better and more optimistic. The fact is --- for those dealing in "real life" the damage of medications is readily apparent. The idea that people who content with the mentally ill would not support these ideas or agree with them is nonsense.
6
What do we do about mass murderers and people who carry guns ready to kill.....................you know, like soldiers and cops?
Talk Therapy?
Trouble is, nobody talks anymore. They just watch Television
The real dysfunction is in the family that does not communicate and instead shuffles off their problem children to the authorities.
Now you want to involve the family in care? How about thinking about that.
Talk Therapy?
Trouble is, nobody talks anymore. They just watch Television
The real dysfunction is in the family that does not communicate and instead shuffles off their problem children to the authorities.
Now you want to involve the family in care? How about thinking about that.
4
What does this article have to do with family care? My parent has schizophrenia...none of us caused it because we were sitting around watching TV. In fact, she was a high functioning, employed member of the community and an excellent and invested parent before she had a trauma induced psychotic break, from which she never recovered. What do you know about dealing with a mentally ill family member? Talk therapy can be powerful. Pharmaceutical treatment can be powerful. Simplistic reactive suggestions like, "Why don't you just sit down and communicate with your kids," is not exactly sage or useful advice for those of us who actually have to deal with schizophrenia -- which is an actually *illness.*
6
As a licensed Ph.D. psychotherapist who has done research and specialized in the treatment of psychosis for 35 years, this new research looks promising on the face of it, but it overlooks research that preceded it on first episode psychosis where no antipsychotic medications were used. The Agnews Project, gold standard randomly assigned National Institute of Mental Health research compared two groups of young people in first episode psychosis. The group that got no meds had a 75 percent lower re-hospitalization rate at three-year follow up than the group that got meds. Both groups were given client-centered milieu therapy.
But the current research medicated everyone even though the harmful effects of antipsychotics are well documented.
The Agnews Research was used to develop two San Francisco Bay Area publically-funded, med-free first episode psychosis programs – I-Ward and Diabasis. Both programs replicated the Agnews results.
I-Ward, where I worked, was a med-free, 20-bed unlocked program that was open for eight years. We provided a therapeutic approach that diverted hundreds of young people from being trapped in the mental health system indefinitely, and they weren't subjected to antipsychotics.
But the current research medicated everyone even though the harmful effects of antipsychotics are well documented.
The Agnews Research was used to develop two San Francisco Bay Area publically-funded, med-free first episode psychosis programs – I-Ward and Diabasis. Both programs replicated the Agnews results.
I-Ward, where I worked, was a med-free, 20-bed unlocked program that was open for eight years. We provided a therapeutic approach that diverted hundreds of young people from being trapped in the mental health system indefinitely, and they weren't subjected to antipsychotics.
11
All you need to know is that the study is Federally funded.
I am elated to find this gracing the pages of the Times; but as many have noted in the comments, this is nothing new. I speak of this from experience. I am diagnosed as Schizoaffective. Although I had been suffering for years before my diagnosis, once diagnosed, I reluctantly started medication and found a private practice Psychologist. Through her support and the support of my family, I learned to self advocate. I researched everything I could. Everything I found suggested that patients who use smaller doses and eventually taper off the medication HAD FAR BETTER OUTCOMES. I stayed on the medication for a year and half. I only got better because I believed I could. I would not accept the psychiatric narrative that was given to me. This was in part possible because I had a sympathetic M.D. (Note - NOT a Psychiatrist), who understood despite my troubles, I was reasonable, well informed, and patient. I've now been off all medication for 3 years (I still see a psychologist) and find myself relatively happy and stable. I live alone, I am on the honor roll at my university, I have a nice girl friend and two cats. I struggle from time to time (who doesn't?), but I've learned how to manage. There is a better life out there for people like me. There is a better life possible than a life time of chemical shackles and side effects. Educate and advocate, you can make it.
29
Involving the family in the schizophrenics treatment destroys the patients family relationships and is against all principals of medical privacy for that patient. It only serves to assure a persistent presence in all forms of therapy as the family will readily call the police on their family member at any hint of illness. This assures a constant stream of money for the profession and an unconstitutional home incarceration by the authorities.
Paranoia is a very normal human emotion until the cops or the doctors see it.
Anger is a normal human emotion until the cops or the doctors see it.
Consider how man people in jail are deemed mentally ill.
Schizophrenia is grossly and many times incorrectly diagnosed.
Paranoia is a very normal human emotion until the cops or the doctors see it.
Anger is a normal human emotion until the cops or the doctors see it.
Consider how man people in jail are deemed mentally ill.
Schizophrenia is grossly and many times incorrectly diagnosed.
2
In 1992 I was diagnosed with schizophrenia. In 1995 the diagnosis was amended to schizoaffective disorder. I am basically okay with my current regimen of anti-psychotic and antidepressant medications. Over the period of several years I became very disenchanted with therapy. In a nutshell: my psychotic episodes were preceded by episodes of severe depression. The point of entry for my depressive episodes: Love Addiction. As I understand it, Love addiction is a layman's diagnosis that helps the afflicted person understand what's causing the problem. I first encountered the idea of Love Addiction as an explanation fro my problems in Dr. David Burns self-help book, "Feeling Good." Not one therapist, not one single therapist, whether provided by the county or in private practice, offered Love Addiction as a possible diagnosis. A book that costs less than ten dollars helped me escape the endless rounds of talk-therapy that went nowhere and serve to underscore the incompetence of the therapy community in nearly every aspect of my relationship with women. I've had to do with trial and error until today, at fifty-one, I feel confident that I will never consult a therapist for this issue if I can help it.
Talk therapy with a schizophrenic?
Good luck with that.
Good luck with that.
1
It's exactly that kind of flippant, uneducated and thoughtless remark that perpetuates what's called stigma.
12
It is disheartening but not surprising that the psychiatrists interviewed for the most part emphasized that "catching them early" leads to better results (which is NOT what the study showed) and de-emphasized that less use of drugs and more use of psychosocial interventions was the huge difference in this approach. Combining this finding with the Harrow and Wunderlink studies showing that recovery is MORE likely with lower doses of antipsychotics for shorter times, psychiatrist should be talking about a new paradigm. But so far, they appear to be more interested in protecting their professional interests than making sure patients get the best care.
5
I wish that this had been available 40 years ago when a friend had a psychotic break. She never recovered from it and it's sad. She's spent most of her life, post psychotic break, taking meds, functioning poorly, unable to hold down a decent job, and very unhappy. We truly need to do a better job caring for our mentally ill citizens. This woman needed and still needs a highly structured living situation where support is available to her when she needs it, not when someone has time for her. The meds were not enough. She needed human contact. I haven't seen her for months and each time I do I wonder which one of her I'm meeting. Am I seeing the paranoid, suspicious, unhappy person or the one with some hope? She may not be helped but I hope some other, younger people are.
4
Sure this is a good finding -- talking eases stress, alienation, confusion, confabulation and a whole host of "what ails 'ya". I'm not sure public dollars need to validate this scientifically. It falls under the auspices of common sense. Will we need studies to confirm that talk therapy helps elders, individuals with intellectual disabilities, individuals experiencing the condition of homelessness, individuals with bipolar disorder? criminals? terminally ill folk? A better question might be to ask psychologists and psychiatrists who they think is "unreachable"? Who do we have bias against? Who doesn't get invited to treatment? We can then heroically overturn the bias, a research finding no less and act surprised that talking to people, including them and considering them worthy of whatever everyone else gets is actually effective.
Social inclusion is a human need for all of humanity. The United Declaration of Human Rights, penned almost 70 years ago does a fine job of mapping out full rights and full participation for everyone.
Social inclusion is a human need for all of humanity. The United Declaration of Human Rights, penned almost 70 years ago does a fine job of mapping out full rights and full participation for everyone.
2
So this patient said "and my insurance company will pay for that!" with a big grin and the doctor wrote down "still delusional" and kept moving because, you know, she was working a 13 hour day and she still had a lot of paperwork to finish and they all lived happily ever after. Now go to sleep, kid, your mom will be home by tomorrow we hope.
3
It's sad that there is a focus on treating mental illness now only because of recent mass shootings.
Mentally ill people are no more likely to kill than people with no mental illness. It's just that these killings are more "newsworthy." Mentally ill people suffer horribly, a lot of times alone, and our health insurance companies have contributed to their suffering by consistently denying them treatment. Luckily health care reform under Obama has begun to address the issue.
Mentally ill people are no more likely to kill than people with no mental illness. It's just that these killings are more "newsworthy." Mentally ill people suffer horribly, a lot of times alone, and our health insurance companies have contributed to their suffering by consistently denying them treatment. Luckily health care reform under Obama has begun to address the issue.
5
Of course talk therapy works, sometimes, as do medications. But what is rarely mentioned in such studies is that many of those with severe mental disorders are not particularly amenable to reasonable support from others, whether offering talk or meds. As a practitioner and family member of folks with schizophrenia, I would venture to say that leading the horse to water is much harder than making it drink. Helping someone who might have mood challenges and psychotic symptoms who actually wants something to change and improve is very different from the usual experience, which might include the family and friends being accused of hostile intent, or ignored, while the client sinks further into despair and goes to one appointment out of every ten scheduled. Not to bum everyone out, because I do believe there's hope; it's just that in my view the so-called scientific studies tend to miss the obvious, because they are measuring outcomes where there is data relating to participants, not folks hostile to participation.
3
Block grants? Watch that money be funneled into everything but mental health treatment in the more conservative states, or funneled into religious organizations as "mental health" centers.
3
So what about the people who have had psychosis for over 10 years , does this study work for them also? I'd like to ask the researchers and Dr's this question , U understand about prevention but there are people out there who need a better treatment plan than just drugs.
More than 6 years after his first hospitalization, our son was not considered new enough in the system to be included in early action programs. But Open Dialogue began working for him almost immediately. Now, a year and some months later, session observers cannot believe that he had been totally delusional and incapable of communication. But it's true. And he is emerging from years of illness.
2
The most important findings of this study promise were unfortunately lost in the article. This study was in FIRST EPISODE psychosis and the really exciting findings are that the multi pronged approach of combining cognitive behavior therapy, family education, peer support and education employment/vocational services with low dose medication, if needed, produces a superior outcome to treatment as usual. Those of us who have family members who live with schizophrenia know all too well how difficult it is to get a young person experiencing early symptoms of mental illness to get help. The approach used in this study encourages self empowerment by the ill person and their family and it appears is more successful at helping them get their lives back on track instead of preparing them for a lifetime of disability. This alone makes it a "landmark" study. People who don't get this "early intervention" are often the ones that require chronic and larger doses of anti-psychotics to control the symptoms, which in turn makes patients balk because of side effects. So this isn't about meds or no meds, it's about the value of early intervention using measures commonly available across the country.
9
However, there is also evidence emerging that long-term treatment with antipsychotics has a point of diminishing returns, apparently somewhere around two years out. The Wunderlink and Harrow studies have clearly shown that even people with a worse initial prognosis on the average are more likely to recover a functional life with less medication use over time. Which makes this study all the more important, as brief, low-dose use (or complete avoidance) of antipsychotics appears most likely to lead to recovery.
3
This research is really exciting and may lead to more effective and humane treatment. But why on earth did the article mention in the middle of nowhere the political "debate over the possible role of mental illness in mass shootings." Schizophrenia is NOT commonly associated with mass shootings; to imply so is wrong, and terribly cruel.
3
From personal experience I have found that medication eases the symptoms of an SMI while talking provides short term comfort. Moreover, supportive talking with a non-professional seems to be as helpful as formal therapy. If a dangerous schizophrenic were to undergo a severe onslaught of symptoms, the right medication coursing through his blood would help him deal. What he and his psychiatrist talked about a month ago would be drowned in a tidal wave of confusion. I do not believe that this study stands up to real life.
1
This study appears to strongly substantiate the NIMH funded Soteria Program research studies of 1970-1978. And it is about time. Eight years of contemporaneous and follow up research showed that minimum or no medication for young people diagnosed with schizophrenia suffering their 1st psychotic break randomly assigned to a residential house in San Jose, CA. did significantly better that the control group that was hospitalized and medicated. A replication study,(Emanon House) also funded by NIMH, in neighboring San Mateo County demonstrated that the statistically significant positive results were not unique to a particular program or staff. Unfortunately, the results were attacked and belittled by the pharmaceutical interests and an entrenched Psychiatric establishment. (see Loren Mosher, Alma Menn et.alia)
As I was intimately involved in both Soteria and Emanon Programs, I take heart that even now, after more than forty years the gods of the copybook headings have returned to confront us with a truth that has long been known but seldom acknowledged. Let us hope that this new study can withstand the assault from the pharmaceutical profiteers that will assuredly be launched in the coming months. It is way past time to redeem and stop wasting the lives of so many who are now being condemned to a lifetime of chemically induced stupor in the name of fear and profit.
As I was intimately involved in both Soteria and Emanon Programs, I take heart that even now, after more than forty years the gods of the copybook headings have returned to confront us with a truth that has long been known but seldom acknowledged. Let us hope that this new study can withstand the assault from the pharmaceutical profiteers that will assuredly be launched in the coming months. It is way past time to redeem and stop wasting the lives of so many who are now being condemned to a lifetime of chemically induced stupor in the name of fear and profit.
6
Is there a "cure" for schizophrenia? I don't know. They (the talking doctors) don't know. And the pill pushers have no idea. Most likely, there is no "cure" for this terrible condition. We are probably wasting our time and billions of dollars trying to find out.
Having some knowledge of the issue I'm not currently interested in a "cure". I'm looking to make the patient's life as pleasant and productive as possible.
3
That's about all that there is: palliation and, hopefully, survival. After six years of head shrinking, oodles of different kinds of pills and multiple hospitalizations, it all ended for my wife with an overdose of nembutal. A forseeable outcome, I think.
2
If you really are interested in making a patient's life as pleasant and productive as possible, Google "Open Dialogue" videos by Daniel Mackler, a psychologist turned film maker. He filmed in Finland, where they had had the highest rates of diagnosed mental illness--and they now have lots of healthy, functioning people. Why? Because they re-thought the model and broke through stigma and convention. Open Dialogue can work wonders.
3
I really have a very strong interest in the successful application of this combined approach to mental health treatment, particularly as there has historically been a concrete wall of insufficient resources for needy patients to receive one-to-one psychotherapy. So as another commenter said in other words this is not a "new" concept nor anything that could not have been implemented on a community treatment model with interested and committed psychiatrists participating at a hands-on level...ground level. As for families participating, this has been the backbone of care. The relatives willing to "hug" needy relatives should have some backing. Best wishes for an Eden on earth for psychotics, rather than the fantasy created through their minds by a benevolent caring power.
2
This guy is completely full of it. Is he even aware that Schizophrenia is caused by a parasite? Yes, google: T. Gondii parasite. These quacks need to stop using the media to promote their agendas. I am now hearing this prasite also may be responsible for bi-polar disorder. More to come on that.
1
Dunno that I agree with your conclusion, but the reading was fascinating and the subject of great interest. Thanks.
Meds only = driven by capitalism and big pharma. So glad this sort of study came out and hoping we can find a more humane way to deal with pain and suffering in our society.
4
Anti-psychotics turned our son from weird to wonderful. He stopped them after five years and became a monster. His bi-weekly talk therapy sessions did not help. A tragic housefire had him hospitalized and convinced to return to taking medication. Another miracle of transformation. . A very bright and feeling person is now on the road to vocational rehabilitation. Please, please do not run down the benefits of modern anti-psychotic medication.
12
It is interesting, as well as very revealing that it takes such a study to determine the universal need for a kind ear..It is not just a mentally ill individual that benefits from such 'therapy', but the vast population in general..If folks just had someone to talk to, all of these mass killings just might have been prevented..
6
Agreed. If people would start talking to each other again--Real facebook---face to face communication, genuine empathy, less competition and more caring.
3
Sadly, the psychiatric profession needs to progress beyond both "talk therapy" and anti-psych drugs and look into nutritional deficiencies and food intolerances. These have been studied and links found. Maybe a person with schizophrenia needs a certain type of diet to help with the condition. If successful, drugs may be unnecessary. Big Pharma won't be happy though!
4
I am so happy and a bit relieved to hear the results of this study. I am a new Psychiatric Nurse Practitioner and this is the model we are taught. Medication along with therapy always increases the outcome. Sounds simple, right? The issue with it is that we cannot be paid for both services at the same time. So the reality is in outpatient clinic we are forced to do only medication management in a 20 minute timeslot in order to get reimbursed. This is not enough time to do a therapy session as well. I am wondering whether the reimbursement amount will change for therapy? Good study though.
4
I have two thoughts.
There was a study at the Karolinska Institute in Sweden about 15 years ago showing that much lower doses of anti-psychotic medications were as effective for treatment of psychotic episodes than were at that time currently being used. They showed that the target receptors got saturated at a much lower dose than was prescribed and that the higher doses just increased sedation and negative side effects. The US still routinely uses higher doses of various anti-psychotic medications than is probably necessary.
A good friend of mine is a psychiatrist in Stockholm who predominantly treats psychotic patients using a combined approach of talk therapy and medication. She said it is also extremely important to get to know each patient individually over a long period for the most effective treatment, since it will vary considerably from patient to patient. Schizophrenia is a highly heterogeneous disease, which some experts think is probably several different diseases that we can't differentiate yet because there aren't molecular markers available.
There was a study at the Karolinska Institute in Sweden about 15 years ago showing that much lower doses of anti-psychotic medications were as effective for treatment of psychotic episodes than were at that time currently being used. They showed that the target receptors got saturated at a much lower dose than was prescribed and that the higher doses just increased sedation and negative side effects. The US still routinely uses higher doses of various anti-psychotic medications than is probably necessary.
A good friend of mine is a psychiatrist in Stockholm who predominantly treats psychotic patients using a combined approach of talk therapy and medication. She said it is also extremely important to get to know each patient individually over a long period for the most effective treatment, since it will vary considerably from patient to patient. Schizophrenia is a highly heterogeneous disease, which some experts think is probably several different diseases that we can't differentiate yet because there aren't molecular markers available.
3
Many people (patients included) believe that these problems in living originate in the mind. The mind cannot be diseased, except metaphorically. So far, the so called "disease" does not show up on the autopsy table, except when neuroleptic medication has damaged the brain.
2
The prevailing attitudes toward schizophrenia in our society and within mainstream psychology reflect our collective lack of awareness and denial of the unconscious. Depth psychologists who know and honor the unconscious as a source of healing and sound mental health recognize schizophrenia for what it generally is: a healing process. Unfortunately, our society tends to treat it as just the opposite, something dangerous to be fought and suppressed. One of the most important depth psychologists working to care for people with schizophrenia was Dr. John Weir Perry of San Francisco. Dr. Perry created a living environment for young schizophrenics which enabled them to live through their acute schizophrenic breaks without drugs or locked doors and move on to healthy lives. Dr. Perry wrote several excellent books about schizophrenia, but if his name is new for you, this interview is well worth reading: http://www.global-vision.org/papers/JWP.pdf The way our society looks at schizophrenia mirrors the way we tend to look at many of the collective societal and world social issues facing us today.
9
The one sterling benefit of medication for any psychiatric illness--on the spectrum from depression to schizophrenia--is that it can give the patient a benchmark for "well" vs. "not well." If you've forgotten--or never known--what "normal" feels like, you can't possibly develop the tools that can help you manage your symptoms, learn to resist suicidal or violent ideation, or know when it's time to seek outside help.
The problem is in seeing medication as the only viable and a lifelong treatment.
We always try to do things on the cheap in this country, though the real costs are always appallingly high by every measure.
The problem is in seeing medication as the only viable and a lifelong treatment.
We always try to do things on the cheap in this country, though the real costs are always appallingly high by every measure.
5
Honestly, it doesn’t really take a seventeen year study to know that talking to a patient is a revolutionary idea. Of course, we need psychotherapy; of course we need input from the community; medications may be relevant, but antipsychotics are not the treatment, but an aid to help diminish the terror. Schizophrenia is a human problem. People with schizophrenia are people. We need to make a relationship and deal with the psychotic character in psychotherapy. We need to treat the whole person. We have lost our way in believing that schizophrenia is some bio-neurological disorder.
12
Thank you!
Good. Now if only we can have mental health screenings for this deadly disease as a routine part of the annual pediatric physical exam of young males in America -- before they hit puberty and become violent towards others, mostly vulnerable females.
3
Mary, you must have schizophrenia confused with another illness. It is not common for young men so afflicted to be violent toward others. Further, with schizophrenia the first psychotic break usually occurs in the late teens years.
2
Sorry, but you start your comment with the idea that all schyzophrenics are a danger to others, which is short sighted and totally incorrect. Most of them are a danger to themselves.
Screening is not only an irrellevant idea, it is impossible. Editor’s note: This comment has been anonymized in accordance with applicable law(s).
Screening is not only an irrellevant idea, it is impossible. Editor’s note: This comment has been anonymized in accordance with applicable law(s).
Though, I don't know anyone in my family that suffers from schizophrenia, it is wonderful to know that the U.S. is working on helping those people. In my opinion, drugging people with pills and other medicines, is not helping, it's just dulling the condition for a while. If I had some sort of mental illness, I would rather be cured than drugged into false health. I could be wrong on this, but this is what I'm pulling from what schizophrenic people were being treated with, against what they are now, which is obviously much better.
2
Sadly, you cannot conclude that treatment HAS changed. The idea put forward in the study just supports it.
The power of the pharma world is immense, not only with regards to schyzophrenia, but just as well in cases like AIDS, cancer and Ebola. Medication is like a religion: better not combined with power (read capitalist power) Editor’s note: This comment has been anonymized in accordance with applicable law(s).
The power of the pharma world is immense, not only with regards to schyzophrenia, but just as well in cases like AIDS, cancer and Ebola. Medication is like a religion: better not combined with power (read capitalist power) Editor’s note: This comment has been anonymized in accordance with applicable law(s).
There is an entire site devoted to activism regarding this topic: madinamerica.com. What you're reading today is old news to that community.
10
It's so true. Whitaker's book (Anatomy of an Epidemic) literally saved my life. The most disheartening thing I've had to deal with so far in Psych Academia is that NONE of the Professors (or even my current Primary Care Physician for that matter) I've encountered have any idea about MIA. When I tell them my experiences and how MIA has been so informative (while fair), I get eye rolls and out and out denial of my recovery thus far. While I'm happy to see this on the NYT, I find it terrifying that it has taken this long considering that the work and info is already out there.
This is very encouraging news and also highlights the benefit of early diagnosis on positive outcomes.
An important issue is how for-profit or non-profit health insurers will respond. Although schizophrenia (and bi-polar disorder) cause individuals enormous suffering, they also have enormous costs to society in lost productivity, plus the long term costs of mental health care, emergency hospitalizations and unfortunately, prison stays for the mentally ill who often have no private insurance and end up homeless. The cost to society overall would be greatly reduced by providing this dual talk-therapy and medication approach to people with psychosis, the first episode or otherwise. However, insurance companies are not bearing these greater costs to society and so, are most interested in covering the cheapest, effective treatment.
This is yet another important argument for having a single payer system, as in the Scandinavian countries, which balance the best treatment options while taking into consideration the cost to society as a whole and to the suffering individual.
An important issue is how for-profit or non-profit health insurers will respond. Although schizophrenia (and bi-polar disorder) cause individuals enormous suffering, they also have enormous costs to society in lost productivity, plus the long term costs of mental health care, emergency hospitalizations and unfortunately, prison stays for the mentally ill who often have no private insurance and end up homeless. The cost to society overall would be greatly reduced by providing this dual talk-therapy and medication approach to people with psychosis, the first episode or otherwise. However, insurance companies are not bearing these greater costs to society and so, are most interested in covering the cheapest, effective treatment.
This is yet another important argument for having a single payer system, as in the Scandinavian countries, which balance the best treatment options while taking into consideration the cost to society as a whole and to the suffering individual.
4
Hi, I wonder if that Scandinavian model is commonly applied. I grew up in Belgium, had my mother in psychiatry for the first 20 years of my life, and I am off course interested in the topic at hand.
However, in general, the Belgian health care model appears not only better in quality than in Sweden, it is much more democratic. It could be - and I sense- that mental illnesses are however better treated in Sweden, regardless of the overal sloppiness of the health care here (much due to neo liberalism).
I will question the matter, thanks for the hint! Editor’s note: This comment has been anonymized in accordance with applicable law(s).
However, in general, the Belgian health care model appears not only better in quality than in Sweden, it is much more democratic. It could be - and I sense- that mental illnesses are however better treated in Sweden, regardless of the overal sloppiness of the health care here (much due to neo liberalism).
I will question the matter, thanks for the hint! Editor’s note: This comment has been anonymized in accordance with applicable law(s).
This approach seems disingenuous. Schizophrenia is a medical and chemical problem, and in my opinion the best use of professionals is in monitoring the effectiveness of the medication dosages, the indignity of the side effects, and treating the patient as a human being who needs health and, often, social services support. They need continuity with the patient to do this, and that rarely exists in the revolving door that is our psychiatric social worker system. Anyone who has lived with a schizophrenic can, in my experience, identify immediately when the medication is not effective or when they have abandoned it - either because they feel better and "no longer need it", are paranoid about taking anything, or run out of meds before they can organize themselves to get to the doctor again. In my opinion, the best use of "therapy" is to compassionately observe progress, discuss their challenges and fears, but with a strong social work component to make sure the patient has housing, food, disability income (if needed), and the ability to refill their medications. Most psych. patients are lucky if they can spent more than a week, if not only days, in a hospital to make sure their medication is correct before they are thrown back into the world, where they may no longer have a home or any kind of support system. It is cruel and ineffective.
3
Sorry, but we are talking about a talkative approach by psychiatrics, not fellow family members or such.
To call it disingenuous is an easy way of setting aside your own comprehensive abilities. This is not a fluffy topic, it is a serious matter. Editor’s note: This comment has been anonymized in accordance with applicable law(s).
To call it disingenuous is an easy way of setting aside your own comprehensive abilities. This is not a fluffy topic, it is a serious matter. Editor’s note: This comment has been anonymized in accordance with applicable law(s).
Schizophrenia is not necessarily a medical or chemical problem, despite what you may have heard repeatedly in the media. No one really understands what schizophrenia is, or whether it's even a "thing" in itself, or a combination of other "things" that are incorrectly grouped together. The idea that excess dopamine is the cause of schizophrenia was discarded by most researchers back in the 1980s, though pharmaceutical companies have done their best to keep it alive. That being said, your description of the current system as "cruel and ineffective" is absolutely correct. I am hoping that this study's publicity finally leads the mental health and insurance authorities to start moving in a more practically effective and humane direction.
1
How exactly do you know that schizophrenia is a medical and chemical problem?
The notion that a schizophrenic benefits from talking to a psychiatrist is offensive nonsense. Emotional disabilities are diseases with physiological origins. Medication has proved effective. You wouldn't expect to treat the physically disabled through idle talk with a physical therapist. You wouldn't expect to convert a gay person to straight through idle talk with a sex counselor. Why would you expect to make inroads into mental illness by talking with the mentally ill?
1
Uh, because they are social beings and it's important to know that someone cares enough to speak their language. You surely do not know the territory.
10
It all depends what type of patients we are talking about, when it comes to physiological effectiveness of drugs. It is not related to a physiological incapability that is supposedly uncurable. Fortunately, you cannot state that schizophrenia is a physiological 'handicap'. The state of a patient can however be reminiscent of it, but that is exactly the point here: apply drugs, combine with therapy, and gradually decrease dependency of the drugs.
Offensive nonsense is your post: don't comment on stuff you have no competent view on. Elsewhere it is called trolling. Sad but true. Editor’s note: This comment has been anonymized in accordance with applicable law(s).
Offensive nonsense is your post: don't comment on stuff you have no competent view on. Elsewhere it is called trolling. Sad but true. Editor’s note: This comment has been anonymized in accordance with applicable law(s).
Ah, but HAS medication proved effective? Maybe in the short term, but we're now seeing that long-term treatment with antipsychotics is actually associated with a more chronic "disease" process. Read the Wunderlink and Harrow studies for more on that, or see the WHO intercultural schizophrenia studies, showing that recovery is much more likely in developing countries who use LESS medication and MORE psychosocial interventions. All of which supports the outlined approach. And yes, there is good evidence that focused psychotherapy from someone with the proper skills DOES decrease the likelihood of a relapse and increase the likelihood of a social recovery.
As in most conditions, medication is most effective when used in short-term crisis situations, and loses effectiveness over time. There are other things that can be done, but we have to get over believing it's "all about brain chemistry," because really, it isn't.
As in most conditions, medication is most effective when used in short-term crisis situations, and loses effectiveness over time. There are other things that can be done, but we have to get over believing it's "all about brain chemistry," because really, it isn't.
This is excellent news!
As someone who carefully read the excellent book , "Anatomy of An Epidemic", by Robert Whitaker, I was well aware that long-term use of psychiatric drugs can actually cause relapse and chronicity of mental health conditions in individuals. Such information is suppressed by the pharmaceutical industry and physician "thought leaders" who put out the opposite information.
Here's hoping that such groups as the American Psychiatric Association, long-time supporters of the prescription drug approach to "care", get on board and retrain those who have invested their careers in this. As for new physicians just coming into the field, they will do society as a whole, and individuals who have such difficulties, a giant favor - and a reduction in suffering - by taking a humane, compassionate, family-centered approach to helping. It is also good news to see Dr. Duckworth of NAMI calling this study a "game changer", as NAMI takes the majority of its funding from the pharmaceutical industry. The insurance industry now has to come on board as well, and cover real talk therapy, as opposed to the bogus, fifteeen minute "med checks" that exist now.
As I think of all those who have suffered (and died) by the side effects of prescriptigon drugs, such a shift in care would be a real memorial to them.
As someone who carefully read the excellent book , "Anatomy of An Epidemic", by Robert Whitaker, I was well aware that long-term use of psychiatric drugs can actually cause relapse and chronicity of mental health conditions in individuals. Such information is suppressed by the pharmaceutical industry and physician "thought leaders" who put out the opposite information.
Here's hoping that such groups as the American Psychiatric Association, long-time supporters of the prescription drug approach to "care", get on board and retrain those who have invested their careers in this. As for new physicians just coming into the field, they will do society as a whole, and individuals who have such difficulties, a giant favor - and a reduction in suffering - by taking a humane, compassionate, family-centered approach to helping. It is also good news to see Dr. Duckworth of NAMI calling this study a "game changer", as NAMI takes the majority of its funding from the pharmaceutical industry. The insurance industry now has to come on board as well, and cover real talk therapy, as opposed to the bogus, fifteeen minute "med checks" that exist now.
As I think of all those who have suffered (and died) by the side effects of prescriptigon drugs, such a shift in care would be a real memorial to them.
7
I am glad that in our society, we are finally trying a more holistic approach to treating mental illness, based on programs that have been successful in Australia and Scandinavia for decades, as this piece points out. I cannot help but wonder how long it will take us to follow their lead in the area of gun control.
4
What happens if the medication dosage starts out higher, the other treatment modalities are begun, and drug dosages are tapered down over time? Would you get the best of both approaches, or something much worse than either by itself?
You could end up with a withdrawal syndrome owing to the individual's habituation to the drug. The withdrawal symptoms will almost always be taken as proof that the person needs the drug in unreduced doses for an underlying condition.. That is not necessarily so; withdrawal psychosis often reflects dysregulation of the nervous system in response to prolonged use of the drug. No one points to an underlying condition when people are withdrawing from illegal or street drugs. Such withdrawals are carefully managed and when something goes awry with the tapering program, no one ever says "you really need the heroin."
It's not just talk therapy (with a therapist) that helps people process and cope with symptoms. There's a whole PEER-based movement that is based on empowerment. Check out the Hearing Voices Network at hearingvoicesusa.org.
2
This article reveals what so many clinicians already know-talking to, being understood and connecting with another person is vital to well-being. Just read Christopher Bollas's exquisite essay on doing psychoanalysis with a woman with schizophrenia from this Sunday's week in review: A Conversation on the Edge of Human Perception.
1
It was only about a week ago that a major paper was released saying that talk therapy is over rated because the negative studies are not reported in the literature. We still seem to be in the dark ages for mental health treatment. Drug companies and practitioners are mostly concerned with keeping their piece of the pie and the studies just reflect these two groups desire to maximize their income.
6
This study does not break new ground. Rather, it shows how treatment as usual short-changes patients by neglecting psychosocial support.
11
Supportive housing and wraparound services until these folks heal have got to be part of the treatment. Mental illness (behavioral illness?) isn't an infection that can be cured by an antibiotic as one lives one's normal life. It's more like cancer, with rounds of intensive care interspersed with recuperating and, hopefully, recovery. And it isn't a crime. Linking it to gun violence provokes discussion -- that's good -- but ultimately an irrelevant distraction. We know what works. We've known for years. We'd just rather spend our taxpayers' money in other ways.
2
Of course the collapse of sound care for severely disturbed patients occurred under pressure from insurers and pharmaceutical marketeers.
Now - the problem is reconstructing psychiatric training. It is much much more difficult to become competent treating patients in a relational therapy than to prescribe medication by checklist in 15 minute monthly visits.
Very few psychologically-minded clinicans remain in residency programs; those remaining must restore the deep and complex tradition that Bollas alluded to in his Sunday Couch account of an eccentric treatment.
Yes- cost and oversight may concern insurers, but readmissions to acute hospitalization is thousands per day.
Now - the problem is reconstructing psychiatric training. It is much much more difficult to become competent treating patients in a relational therapy than to prescribe medication by checklist in 15 minute monthly visits.
Very few psychologically-minded clinicans remain in residency programs; those remaining must restore the deep and complex tradition that Bollas alluded to in his Sunday Couch account of an eccentric treatment.
Yes- cost and oversight may concern insurers, but readmissions to acute hospitalization is thousands per day.
13
If only we could remove the fraudulent inflation of what things cost across our economy we could easily afford this via insurance.
It is also sick and intentionally false ideas like "rate suckers" that prevents the re-regulation of things like pricing and insurance payouts.
There are no "rate suckers". The model on which all insurance is based requires that all of society be considered by the algorithm. If they don't do this they cannot account for the expected unexpected expenses. Even if you are the best or healthiest you can and many will have an incident which requires massive payout. Thus you may think your rate is "better" but it isn't. You are still paying according to the model and now they have a tracker on your car or are tracking your health the insurer will be better able to find ways to blame you for the event that requires them to pay and lower or even deny payment.
It is also sick and intentionally false ideas like "rate suckers" that prevents the re-regulation of things like pricing and insurance payouts.
There are no "rate suckers". The model on which all insurance is based requires that all of society be considered by the algorithm. If they don't do this they cannot account for the expected unexpected expenses. Even if you are the best or healthiest you can and many will have an incident which requires massive payout. Thus you may think your rate is "better" but it isn't. You are still paying according to the model and now they have a tracker on your car or are tracking your health the insurer will be better able to find ways to blame you for the event that requires them to pay and lower or even deny payment.
1
Oh geez really? They do do it better in, you know, Denmark and other places that we are, you know, not?
And meanwhile, back in the great old USA, many decades of ruined lives litter society because we needed our own special study and imprimatur for what much of the advanced world has already proven works.
I mean, imagine. Fragile people struggling with a first psychotic episode at a particularly turbulent time of life benefit from strong family support, guidance through the challenges of college, and techniques to help them manage frightening symptoms.
As we have seen in news story after news story, our psychotic mass murderers almost always come from strained or broken families; the parent with custody seems often to have serious mental health issues that make her--mostly--custodial care of a vulnerable child not a very good idea; these young people become more and more isolated, with no professional legally able to intervene; and then we all wring our hands.
And for the less-spectacularly ill--those for whom the only shattered lives are their own--well, we all pay the tab eventually, as they get arrested over and over, or go on permanent disability payments, etc. etc. And all the while, lives that could have been salvaged are not.
I just love how exceptional we always seem to be...
And meanwhile, back in the great old USA, many decades of ruined lives litter society because we needed our own special study and imprimatur for what much of the advanced world has already proven works.
I mean, imagine. Fragile people struggling with a first psychotic episode at a particularly turbulent time of life benefit from strong family support, guidance through the challenges of college, and techniques to help them manage frightening symptoms.
As we have seen in news story after news story, our psychotic mass murderers almost always come from strained or broken families; the parent with custody seems often to have serious mental health issues that make her--mostly--custodial care of a vulnerable child not a very good idea; these young people become more and more isolated, with no professional legally able to intervene; and then we all wring our hands.
And for the less-spectacularly ill--those for whom the only shattered lives are their own--well, we all pay the tab eventually, as they get arrested over and over, or go on permanent disability payments, etc. etc. And all the while, lives that could have been salvaged are not.
I just love how exceptional we always seem to be...
4
Actually, they do best in places like Nigeria and Columbia and India. The less Western medicine is practiced, the more likely a "schizophrenic" is to recover. Interesting, isn't it?
I am beyond thankful for this newly released research result, having witnessed in my years of being an in patient mental health therapist, what seemed like the unavoidable pain of the old recommendations. This signals revolutionary change in the field where this dose of hope is sorely needed.
5
Schizophrenia, as we understand, is characterized by a "breakdown of social communication" and a profound sense of "self-isolation," as such, any variant of "talk therapy," promoting social connectedness and positive self-image in the context of social reality is going to have a significant positive effect, specifically when provided in a therapeutic social milieu (e.g., engaging significant people in person's other life), above or beyond what medication treatment that primarily promotes "agitation control," with all the "side effect profile" issue, can provide. Hopefully this kind of reporting will promote a greater public awareness and balance the research funding, which is new skewed in favor of biological treatment over psycho-social interventions, and a greater appreciation for "talk therapy."
1
Schizophrenia, as we understand, is characterized by a "breakdown of social communication" and a profound sense of "self-isolation," as such, any variant of "talk therapy," promoting social connectedness and positive self-image in the context of social reality is going to have a significant positive effect, specifically when provided in a therapeutic social milieu (e.g., engaging significant people in person's other life), above or beyond what medication treatment that primarily promotes "agitation control," with all the "side effect profile" issue, can provide. Hopefully this kind of reporting will promote a greater public awareness and balance the research funding, which is now skewed in favor of biological treatment over psycho-social interventions, and a greater appreciation for "talk therapy."
3
No surprise here. In fact, Empathic therapy, even when treated by an non-professional therapist, has been successful treating ALL mental illnesses. The only one thing necessary for a treating therapist is that they need to be loving and nonjudgmental. The problem is, pharmaceutical companies can't get rich off that. The costs associated with psychotropics medications far outweighs the cost of even expensive therapy. Psychotropics place a heavy burden on our health care system. Medications cause obesity, diabetes, cardiac problems, you name it. Those pills aren't cheap in the long run. There is no easy way to fix a mental health problem. We have enough proof that all humans need are love and understanding in order to prosper.
7
@Jim Tankersly
"The only one thing necessary for a treating therapist is that they need to be loving and nonjudgmental."
This is an ABSOLUTE Fallacy. That may be a quality which a person needs if they choose to be a therapist but to actually do it and be helpful one must have maturity, and worldliness, and actual knowledge that pertains to the topics being discussed. I've dealt with therapists who think as you state and they did me more harm than I was enduring when I came to them. Inevitably they tell the patient they have to "let go" or other ridiculous platitudes which if they were true would have precluded therapy coming into existence.
Fallacy two, cost of medicine, It is cheaper than therapy which is why we are having this discussion.
"The only one thing necessary for a treating therapist is that they need to be loving and nonjudgmental."
This is an ABSOLUTE Fallacy. That may be a quality which a person needs if they choose to be a therapist but to actually do it and be helpful one must have maturity, and worldliness, and actual knowledge that pertains to the topics being discussed. I've dealt with therapists who think as you state and they did me more harm than I was enduring when I came to them. Inevitably they tell the patient they have to "let go" or other ridiculous platitudes which if they were true would have precluded therapy coming into existence.
Fallacy two, cost of medicine, It is cheaper than therapy which is why we are having this discussion.
3
Please cease and desist from spreading the notion that "love and understanding" will cure schizophrenia. If you care about people with schizophrenia, spreading misinformation about the treatment and the prognosis is really unconscionable.
Talk therapy = often a very good thing. A cure for schizophrenia, a replacement for medications, for most schizophrenia patients, no it is not and the study does not suggest any such thing.
Talk therapy = often a very good thing. A cure for schizophrenia, a replacement for medications, for most schizophrenia patients, no it is not and the study does not suggest any such thing.
4
Congratulations on a great article - sensitively told!! As a psychiatrist, over the years I've often thought that my patients taught me more than I ever taught them. The point is we are all human, we all go through periods of struggling and suffering, and life is not easy. We all need strategies for coping and we can all learn from each other. We are truly all in this together and the more we realize that, the better it is for us all.
11
This is a wonderful outcome from a rigorous study. Use of anti-psychotic
drugs has a place, but these side- effects can be disastrous, especially with the development of Diabetes 2. Rates of obesity and diabetes in African-American communities from these drugs are at epidemic levels.
More talking to patients is a more humane approach.
drugs has a place, but these side- effects can be disastrous, especially with the development of Diabetes 2. Rates of obesity and diabetes in African-American communities from these drugs are at epidemic levels.
More talking to patients is a more humane approach.
7
I am not a mental health practitioner. I do not know a lot about mental illness.
With that being said.
I do think that many people do not have ties and positive interactions with society. They are isolated. They have no one to talk to.
Many of these people could possible benefit from talking to someone on a very regular basis. Maybe 2 to 3 times a week. This person would have mental health training and operate at the convergence of a good school teacher and grandmother. This person would not have an agenda other than trying to improve interaction between the person seeking help and society at large.
Lets say this person gets paid a good teachers salary, so that he or she can prosper, while allowing the cost for the talks to be very reasonable.
For more serious situations the suffering person can be referred to professionals with greater qualifications.
With that being said.
I do think that many people do not have ties and positive interactions with society. They are isolated. They have no one to talk to.
Many of these people could possible benefit from talking to someone on a very regular basis. Maybe 2 to 3 times a week. This person would have mental health training and operate at the convergence of a good school teacher and grandmother. This person would not have an agenda other than trying to improve interaction between the person seeking help and society at large.
Lets say this person gets paid a good teachers salary, so that he or she can prosper, while allowing the cost for the talks to be very reasonable.
For more serious situations the suffering person can be referred to professionals with greater qualifications.
9
I agree with you, however, one of the most difficult challenges of this disease is that the ill person often has no interest in talking with people and cannot be forced to do so (this often just backfires). My mother has a diagnosis of schizophrenia or schizoaffective disorder (depending on which clinician or bout of hospitalization we are dealing with) and, for 20 years, has connected and then rejected clinician after clinician, friend after friend, case manager after case manager, ad naseum. The fact is, part of her illness and/or psychological make up is an extreme distrust and fear of others and other people's control -- therefore, when someone hints at lack of safety, they get woven into a paranoid framework and case to be a part of her life. This is very, very common among people with these illnesses, so while it is a great idea to encourage socialization in the way you've described, such folks who might offer these communications would likely be banging on the doors of folks who won't answer. I've observed this time and time again.
Tremendous news that should give real hope to the families of the newly diagnosed. I urge you not to wait for new programs to develop. Instead call your local NAMI affiliate and sign up the next Family to Family education series. You have a vital role to play in helping your loved one live a better life in the community, and NAMI will support you in learning it.
3
This is only partially right. The big hope is for a sick child to make money, earn honestly, and succeed getting praise for his work. This can only be done when the family gets heavily involved. But it really works wonders.
1
I totally agree about the role of the family. Invaluable. But families are usually clueless about how to help. They have not been trained. (Breaking news: Family intervention a threat to psychiatry.) Krista MacKinnon runs an excellent online training course called Recovery Our Families.
http://familieshealingtogether.com/focus/recovering-our-families/
http://familieshealingtogether.com/focus/recovering-our-families/
I could not agree more with this study. Our son showed signs of psychosis in his teens and we instantly sought medical help. He was diagnosed with schizophrenia, quickly put on antipsychotic medication, given talk therapy, and had the support of family. I do not want to glamorize this. It was a long, long haul of many terrifying years for our son and our family. But today he is in his thirties, no longer has a diagnosis of any mental illness and with his doctor's approval is no longer on any medication. He leads a productive, giving life.
I am convinced that the earlier a person is treated to relieve the psychosis the better the outcome for that person and all of society. It is absolutely necessary to educate the public in understanding the importance of early treatment.
I am convinced that the earlier a person is treated to relieve the psychosis the better the outcome for that person and all of society. It is absolutely necessary to educate the public in understanding the importance of early treatment.
22
I generally agree, but caution that people can and do recover even after years of being labelled and discarded as "chronic." It may be as long as ten or twenty years, but people can, and do, recover. Ron and Karen Coleman are an inspiration in this regard.
http://www.workingtorecovery.co.uk/home.aspx
http://www.workingtorecovery.co.uk/home.aspx
My brother is a clinical psychologist. Years ago he told me that schizophrenics often knew that their impulses were inappropriate but acted on them anyway because they didn't care about being inappropriate or because they were seeking attention. These folks would clearly profit from talk therapy and a network of support from family and friends.
While I'm sure the medications have their merit as well, dosing is a problem. Another brother is diagnosed bipolar--not schizophrenic--and the medications he has taken for decades have led to serious weight gain with diabetes (which does not run in our family) and tremors.
To put the U.S. Congress' 2014 block grants into perspective, they amount to $12.50 per American with schizophrenia. You decide if that sounds like a serious commitment by our representatives.
While I'm sure the medications have their merit as well, dosing is a problem. Another brother is diagnosed bipolar--not schizophrenic--and the medications he has taken for decades have led to serious weight gain with diabetes (which does not run in our family) and tremors.
To put the U.S. Congress' 2014 block grants into perspective, they amount to $12.50 per American with schizophrenia. You decide if that sounds like a serious commitment by our representatives.
11
Modern Psychiatry, as well as our immoral blood-money health care system is engaged in collusion. The insurance & drug companies promote and sell medication, 15 minute 'med checks' (what a joke), and a revolving door of renewed prescriptions at the expense of talk therapy and most Psychiatrists are all too willing to play that game. And it is a game because we know talk therapy is effective but there's no mechanism to monetize it so we avoid it. And in this country all that matters is making money - profitizing off of the sick. That's why the hypocrisy of many (not all) Psychiatrists who applaud these findings without criticizing the system they promote are hypocrites in every sense of the word.
Sadly, this is great news born of unnecessary suffering because those with Mental Illness are considered even less relevant in our society than the poor. I can tell you anecdotal story after story of people who have realized benefits from "talk therapy" - not just those suffering from Schizophrenia and this comes as no surprise.
Nor is it surprising for the insurance and the drug companies who wish to strangle, to death, talk therapy. They are people who care nothing about suffering and everything about profit. And we're a sick nation for letting them do it via the lie single-payer health care is 'Socialism' and their demonizing of talk therapy. Until Americans end their ignorance of how bad our health care is than nothing will change. Suffering is a multi-billion dollar industry.
Sadly, this is great news born of unnecessary suffering because those with Mental Illness are considered even less relevant in our society than the poor. I can tell you anecdotal story after story of people who have realized benefits from "talk therapy" - not just those suffering from Schizophrenia and this comes as no surprise.
Nor is it surprising for the insurance and the drug companies who wish to strangle, to death, talk therapy. They are people who care nothing about suffering and everything about profit. And we're a sick nation for letting them do it via the lie single-payer health care is 'Socialism' and their demonizing of talk therapy. Until Americans end their ignorance of how bad our health care is than nothing will change. Suffering is a multi-billion dollar industry.
14
and anti-depressants are no more effective than placebos for mild to mid leveldepression
but they sure do cost a lot more
but they sure do cost a lot more
"Until Americans end their ignorance of how bad our health care is than nothing will change. Suffering is a multi-billion dollar industry."
Amen.
There is nothing "best" about America any longer except that we are the best place to exploit people without fear of being held to account for it or even having the victims notice it is happening.
Amen.
There is nothing "best" about America any longer except that we are the best place to exploit people without fear of being held to account for it or even having the victims notice it is happening.
6
I have bipolar disorder. I've been hospitalized over 25 times in 7 years, had over 50 ECT treatments, and have been on, and have experienced the side effects of most of the drugs used to treat bipolar disorder. I've also spent over $50,000 on therapy. None of those things helped me and I do none of those things now but I've been healthy for over 3 years. The only thing that helped me was writing down all of my thoughts and learning over the years to see the signs of the mania and finding out for myself the things I need to do to stop the mania from accelerating. It's different for everyone.
13
hemingway, when asked who his therapist was, used to quip, smith-corona
1
I would suggest to you that any problems you currently have are mainly caused by the ECT which is a form of lobotomy with far less precision than poking in an ice pick above the eye socket and wiggling it about.
3
Hey..ACW....."thank...Gods..for those pills"..? What?
I am a schizophrenic. Diagnosed over ten years ago now and been through half a dozen doctors who did little more than throw pills at me to the point where my pharmacist said to me one day, "What are the doing to you...they are going to kill you". WAY over medicated because I was suicidal every day of my life...for years. Gained over 40 pounds, in and out of psyche wards, screaming, violence, blood,....three weeks of ECT, .... ...violence on the street by me for some of the meds made me extremely aggressive and constantly looking to.....? attack someone verbally..out of nowhere, just to provoke a fight so I could kill or be killed. I'm not kidding. Amazing I am still alive. Amazing I am not in prison.
risperidone
lithium
lorazepam
geodon
clonazepam
every SSRI invented
many more that I can not even remember
combinations/ cocktails....to the point I was so toxic I was smelled bad and was having certain organ failures.
at least 40 mil diazepam a day
None of this was pretty. It was horrible and ugly and NOT effective!
I am a schizophrenic. Diagnosed over ten years ago now and been through half a dozen doctors who did little more than throw pills at me to the point where my pharmacist said to me one day, "What are the doing to you...they are going to kill you". WAY over medicated because I was suicidal every day of my life...for years. Gained over 40 pounds, in and out of psyche wards, screaming, violence, blood,....three weeks of ECT, .... ...violence on the street by me for some of the meds made me extremely aggressive and constantly looking to.....? attack someone verbally..out of nowhere, just to provoke a fight so I could kill or be killed. I'm not kidding. Amazing I am still alive. Amazing I am not in prison.
risperidone
lithium
lorazepam
geodon
clonazepam
every SSRI invented
many more that I can not even remember
combinations/ cocktails....to the point I was so toxic I was smelled bad and was having certain organ failures.
at least 40 mil diazepam a day
None of this was pretty. It was horrible and ugly and NOT effective!
10
Seems only logical. If the two sides of one can learn how to resolve their differences through constructive internal dialogue, what need is there for some chemical inducement to only cloud and confuse matters for someone.
1
Big Pharma must be in shock.
But they will soon launch a new crusade for drugs, just as Coca Cola has launched a campaign to make sugary soft drinks part of a healthy diet.
But they will soon launch a new crusade for drugs, just as Coca Cola has launched a campaign to make sugary soft drinks part of a healthy diet.
9
Exactly Jon. As a schizophrenic and a.." past"... victim of "Big Pharma", "some" drugs help "some" of us anywhere from a little to a lot. But we are just "freaks" for the doctors to play with......and the doctors are the middle men of the greedy pharmaceutical companies. Sure, I bet they like it when their drugs can actually help us...... but it's really just about the money.
3
Clinical trials and statistical analyses are positive indicators. Nevertheless, they are not the scientific equivalent of a genetic marker, blood test, or brain scan that identifies the cause of schizophrenia or indicates specific interventions that actually cure this terrible disease. Furthermore, this article seems to conceptualize effective treatment of schizophrenia as identifying the afflicted individual as quickly as possible following the initial psychotic break. What if schizophrenia was actually a longer term developmental process? What if some method could be developed to detect it in its earliest developmental stages? The tiny step forward achieved by this particular study may excite some readers but for those struggling with the disease its findings will likely be far less than restorative; the true criterion for success.
12
It is called "baby steps", sir...
What we are currently experiencing, is the result of what is called "Giant LEAPS" in the treatment of mental illness.
...The almost EXCLUSIVE use of medication to "tone down" the affect of mental illness... Rather than moving carefully and cautiously...
Pharmaceutical Corporations making money hand over fist at the cost of MILLIONS OF PEOPLES LIVES!
And, not just people with schizophrenia are treated with anti psychotic medications.
The pharmaceutical corporations are renaming these medications and using them for smoking cessation and Rheumatoid Arthritis.
25 million is just the tip of the iceberg.
At the very least this tiny step is encouraging those who need help NOW...
The 25 million Americans that already suffer, may well benefit from this confirmation... May well benefit from the expansion of this idea to those who have suffered for decades.
Perhaps prevent anti psychotic medications from expanding even further...
And, I would hope that further "baby steps" will help to find these individuals at an earlier age.
I appreciate the step, no matter how small.
What we are currently experiencing, is the result of what is called "Giant LEAPS" in the treatment of mental illness.
...The almost EXCLUSIVE use of medication to "tone down" the affect of mental illness... Rather than moving carefully and cautiously...
Pharmaceutical Corporations making money hand over fist at the cost of MILLIONS OF PEOPLES LIVES!
And, not just people with schizophrenia are treated with anti psychotic medications.
The pharmaceutical corporations are renaming these medications and using them for smoking cessation and Rheumatoid Arthritis.
25 million is just the tip of the iceberg.
At the very least this tiny step is encouraging those who need help NOW...
The 25 million Americans that already suffer, may well benefit from this confirmation... May well benefit from the expansion of this idea to those who have suffered for decades.
Perhaps prevent anti psychotic medications from expanding even further...
And, I would hope that further "baby steps" will help to find these individuals at an earlier age.
I appreciate the step, no matter how small.
1
There is no single cause for schizophrenia or any other mental illness, no absolute biomarkers, and thousands of mutations across a wide range of genes that increase risk. The science has moved past the "nature vs. nurture" debate, our most exciting work shows how nature influences nurture and vice versa. Similarly, although I agree that the goal should be restoration, I'm doubtful there will ever be a "cure" for this or any other psychiatric illness. If we are able to achieve this it will certainly not be within my lifetime and will require an incredible amount of new knowledge on how the brain works and how it generates the mind - we will probably be able to cure this illness around the time we can upload our mind into computers.
The most important part is the admission that this combined treatment is having an effect on the patients noticed by their friends and family. This is, unfortunately, news in-and-of itself. Not to say that previous treatments haven't improved quality of life (and there's the strange case of later-life remission for schizophrenia in particular) but the gains are often closer to stabilization than remission. If friends of patients are noticing an improvement that's the kind of behavioral results we should encourage and investigate further. If we only paid attention to mental illnesses when they were cured we would never fund mental health research, since for the foreseeable future they effectively cannot be cured.
The most important part is the admission that this combined treatment is having an effect on the patients noticed by their friends and family. This is, unfortunately, news in-and-of itself. Not to say that previous treatments haven't improved quality of life (and there's the strange case of later-life remission for schizophrenia in particular) but the gains are often closer to stabilization than remission. If friends of patients are noticing an improvement that's the kind of behavioral results we should encourage and investigate further. If we only paid attention to mental illnesses when they were cured we would never fund mental health research, since for the foreseeable future they effectively cannot be cured.
1
It's not a disease if it can't be detected on the autopsy table.
I applaud the results of this study. As a psychiatrist, I've been watching the steady move away from everything psychodynamic and the narrowed focus on the biological, aka pharmacological, at most psychiatry residency programs. Most younger psychiatrists barely have any experience or education in therapeutic modalities. This shift is fairly recent, too, within the last couple of decades.
Now let's get the big HMOs to start paying for regular therapy visits and not just cover the medications. In my program, it was always taught that the best treatment for psychiatric illnesses was a combination of pharmacology and therapy. I continue to abide by this rule in my private practice but the HMOs were becoming such a hurdle, I stopped taking insurance all together, and now I'm able to practice how I feel psychiatry should be practiced.
Now let's get the big HMOs to start paying for regular therapy visits and not just cover the medications. In my program, it was always taught that the best treatment for psychiatric illnesses was a combination of pharmacology and therapy. I continue to abide by this rule in my private practice but the HMOs were becoming such a hurdle, I stopped taking insurance all together, and now I'm able to practice how I feel psychiatry should be practiced.
45
in most areas of life, talk is cheap and drugs expensive
but not in psychiatry
but not in psychiatry
But unfortunately only people who. are wealthy can afford to pay to see a psychiatrist, psychologist, social worker . Many people with insurance pay a lot to have insurance even with employer assistance. Insurance plans have such awful mental health coverage that people such as yourself don't accept insurance. So it is an elitist system with the very wealthy being the only ones to afford decent mental health services.
1
I'm sure you do. But now only the wealthy can afford you.
2
Wow, psychiatrists favor talking therapy! Is it not ironic that psychiatrists want to add their well paid voices to the schizophrenic cacophony? So why isn't there a schizophrenia talk app, say $4.99 on ios and free on android? Still one wonders about the natural course of the disease prior to all the dubious therapies and meta-analyses. One used to hear of the law of thirds, one third recover, one third don't, and one third fall somewhere in the middle. Is that the proper model for comparison? It seems the voices are silent or off-line to inquiry unless one is willing and able to pay handsomely.
3
Bathe brain develops thru complex experience, mostly in relation to a full human interaction. Texting cannot facilitate growth in an impaired mind.
Cyber life is probably constricting everything from peripheral vision to emotional resilience.
Cyber life is probably constricting everything from peripheral vision to emotional resilience.
1
An important finding; however, the NYT article title and front page summary are misleading, in that they leave out such wording as "in combination with" and instead seem to emphasize the superiority of talk therapy over medications. Having been in the mental health field for over 20 years as a so-called talk therapist, I have seen the great importance each of these treatments can have on a person's life, and how quickly someone living with schizophrenia can become too paranoid to even engage in psychotherapy if they stop taking their medications. At the same time, the principle of including a human connections--including cognitive behavioral components that have shown promise in research, as well as supportive and socially based interventions, cannot be overstated.
27
If one reads the article, you can see that the authors and the research clearly discuss the need for both .
Clearly you are correct. As I said in my comment, I was referring to the article *title* and *front page summary* and not the article as a whole. For better or worse, most of us are prone to not always reading the content underlying every article title and summary.
Now that we have the data showing that the holistic combination of therapies, education and family inclusion works best for patients, we need to pass legislation that will give responsible family members an accessible process to compel schizophrenic relatives who have become detached from reality to enter treatment and stay with it
17
Mr Cahill we used to have that option in society and it was abused often enough and did so much harm to perfectly normal and OK people we stopped allowing it. Francis Farmer is a famous case and the man Howard Dully "My Lobotomy" is another case of a person subjected to this abuse. I was also subject to this sort of abuse of family "right" as a child.
While I do not disagree we need to be able to compel people who are not in their right minds to be treated, we still need to develop ways and means for protecting against the inevitable abuses of people who cannot stand up for themselves by "responsible" parties who probably need psychiatric intervention themselves.
While I do not disagree we need to be able to compel people who are not in their right minds to be treated, we still need to develop ways and means for protecting against the inevitable abuses of people who cannot stand up for themselves by "responsible" parties who probably need psychiatric intervention themselves.
2
Thank you "magicisnotreal" for your thoughtful, experience-based reply to my comment, and for expanding upon it to describe the harmful downside that can occur when family right is abused. Getting the balance right is the great challenge here, but it's a challenge we all must accept in order to relieve the pain and despair of the disconnected tens of thousands of people suffering from untreated schizophrenia. And we need experienced, perceptive people like yourself to lead the way in achieving that difficult balance.
1
To John Cahill 10/20/15 10:31am - Any medical "treatments" that were forced or surveilled would have prevented the participants in this study from enjoying the positive outcomes these treatments gave them. Not only that, but the dehumanizing delivery of health care services to the participants in this study would have been a confounding factor that would easily have been confused by these researchers with the effects of the services themselves. Instead of identifying involuntary and inescapable conditions of this "treatment" to be the culprit for its suboptimal outcomes, the treatment would likely be viewed as the culprit for the patient's stagnant or deteriorating health and quality of life.
This is encouraging, but I hope it won't encourage "medication deniers" because most schizophrenics are lost souls without medication. A lot of the talk therapy described here has to do with coaching, helping the person to maintain or rebuild contacts with others, and to live in some peace with the world at large. It requires professionals because many with schizophrenia have over time exhausted or alienated even the most dedicated family members. The promise of earlier intervention may mean those ties are not broken in the first place. It also offers the patient more personal control over his/her situation, a gratifying result.
The problem - this is long term, which doesn't fit int the fix-it-in-5 sessions model which has taken hold. It is people intensive; it will require funding. It requires earlier recognition, outreach and intervention.
I think that very few people in mental health ever believed that meds without person to person therapy would work, and most came to beleive that talk therapy absent meds for many conditions was also in effective: It's good to see a study that supports the opinions of "middle road" approach professionals dedicated to their patients.
Now to press for change in coverage and delivery.
The problem - this is long term, which doesn't fit int the fix-it-in-5 sessions model which has taken hold. It is people intensive; it will require funding. It requires earlier recognition, outreach and intervention.
I think that very few people in mental health ever believed that meds without person to person therapy would work, and most came to beleive that talk therapy absent meds for many conditions was also in effective: It's good to see a study that supports the opinions of "middle road" approach professionals dedicated to their patients.
Now to press for change in coverage and delivery.
9
So it's the Mad person's fault that their family abandoned them? I don't think so. Many of the families who produce Mad people have a pathological deficit in their capacity for pro social behaviors and patterns of behavior. Commitment, responsibility for their actions on the lives of others, selflessness, flexibility, and unconditional love are all noticeably and measurably absent in these families. It is in this toxic environment that one becomes Mad and talk therapy is so hotly contested by the "families of the mentally ill" because it often addresses and repairs the damage they do to the "patient" they created.
1
Wow, who'da thunk it? Talking to people with problems is more helpful than drugging them into zombies. The underlying problem is that the pharmaceutical industry can't patent talking. If they could it would be an FDA-approved "medication".
10
Courtenay Harding (formerly of Boston University) and others have been saying this kind of things for years now....as Shakespeare said, there's method in madness (the political question is how to create financial incentives to treat people along these lines).
2
I have been on these medications before, in an attempt to control my PTSD.
They system had me going to group only sessions, and they just pumped me full of unnecessary pills.
I put on about 60 pounds, and felt no better, if not worse.
I guess the question then becomes which is worse, the ill feeling... or the PILL feeling!
I gave up on the Psychiatric care, and weaned myself off of every one of the pills, INCLUDING the Beta blocker that was disguising my triggers. I cannot TELL you how difficult this was... How ADDICTING these medications are... Especially because I did it on my own.
THEN I found a one on one therapist (not a psychiatrist) that does EMDR therapy and that uses a sliding fee scale, so I only have to pay $50 per session... Of course Medicare does not cover her therapy...
My therapist saved my life!
THIS is what I had to do... Take my life back into my own hands and refuse to let the legal drug dealers keep me addicted and a basket case.
I cannot imagine how much MORE difficult it would be for someone with Schizophrenia to try to fight against established practice!
They system had me going to group only sessions, and they just pumped me full of unnecessary pills.
I put on about 60 pounds, and felt no better, if not worse.
I guess the question then becomes which is worse, the ill feeling... or the PILL feeling!
I gave up on the Psychiatric care, and weaned myself off of every one of the pills, INCLUDING the Beta blocker that was disguising my triggers. I cannot TELL you how difficult this was... How ADDICTING these medications are... Especially because I did it on my own.
THEN I found a one on one therapist (not a psychiatrist) that does EMDR therapy and that uses a sliding fee scale, so I only have to pay $50 per session... Of course Medicare does not cover her therapy...
My therapist saved my life!
THIS is what I had to do... Take my life back into my own hands and refuse to let the legal drug dealers keep me addicted and a basket case.
I cannot imagine how much MORE difficult it would be for someone with Schizophrenia to try to fight against established practice!
15
I'm so glad you found a therapist that was affordable and helpful.
Mental illness can be debilitating and leave one feeling vulnerable and weakened. Unfortunately, the current systems for mental health add to feelings of vulnerability and weakness. I can't help but wonder if the mere act of taking over your own care is a big part of your current success. When we are ill we look to health professionals to lend a hand to keep us afloat. Sadly, I believe most mental health "help" comes with so much discouraging (dehumanizing and often harmful) baggage that only the very strong (or very wealthy) survive it. Despite the feelings of vulnerability and weakness I do hope more people fight for themselves.
I looked to the mental health system when I suffered a severe mental health crisis and it made things worse. I thought I had to take whatever they offered since I felt so weak even tho it felt wrong. When I swore off their help I began to improve and continue to improve. I do think a good affordable therapist could be really helpful but I never found one in my area so I have to go it alone for now but I know how strong I am now and won't accept help that feels harmful again.
Mental illness can be debilitating and leave one feeling vulnerable and weakened. Unfortunately, the current systems for mental health add to feelings of vulnerability and weakness. I can't help but wonder if the mere act of taking over your own care is a big part of your current success. When we are ill we look to health professionals to lend a hand to keep us afloat. Sadly, I believe most mental health "help" comes with so much discouraging (dehumanizing and often harmful) baggage that only the very strong (or very wealthy) survive it. Despite the feelings of vulnerability and weakness I do hope more people fight for themselves.
I looked to the mental health system when I suffered a severe mental health crisis and it made things worse. I thought I had to take whatever they offered since I felt so weak even tho it felt wrong. When I swore off their help I began to improve and continue to improve. I do think a good affordable therapist could be really helpful but I never found one in my area so I have to go it alone for now but I know how strong I am now and won't accept help that feels harmful again.
2
Even though this article enlightens us in the U.S., it seems that this model has already proven to be workable in other countries, most of whom have some form of universal health care. When there are still many in Congress trying to dismantle ACA , one wonders how we can expect to proceed successfully. Though it seems more logical and humane to treat patients with both medication and talk therapy, where are the therapists going to come from ? Who can afford this approach? Most insurance companies will cover medications but offer limited money for talk therapy.Most of us who have lived in big cities have seen so many lost souls, sick with mental illness living on the streets. We,as a country can't even help these sick people find a safe and decent place to live or food to eat, never mind find them medical treatment that works. Until the big pharmaceuticals aren't allowed to buy off doctors and Congress with trips,gifts and bribery,we aren't going to go much further. At the very least, we as fellow human beings, need to learn compassion and understanding of mentally ill people. We wouldn't demonize people with cancer and neither should we those who suffer from diseases of the mind. I'd much rather my taxes were being used to help fund free or low cost clinics for the mentally ill in our country, than for ongoing wars that cost trillions of dollars and never end.
6
I am very sure psychotherapy can be helpful but anyone who has direct contact with those suffering from schizophrenia know that someone in a more extreme delusional state cannot be "talked back" from that state sitting while in an office chair. There's something a bit la-la-la about this article.
3
You're absolutely correct but there is a notion that schizophrenics only need meds and that they don't need or won't benefit from talk therapy. Most people feel safer if the patient is 'zonked' out and essentially over medicated. The best treatment for schizophrenia is a combination of medication and talk therapy.
1
The very nature of a delusion is that you are not going to talk the person out of it.
1
"There's something a bit la-la-la about this article. "
I am not sure I understand what you mean by la la la...
From what I gather, from reading this article, they are talking about the very beginning of the schizophrenic break...
That if they can catch this problem at its' onset, and give talk therapy and social support, as well as much less medication, that the people with this problem will not get out of hand... That they can have a LIFE rather than being consigned to the fringes of society.
So, what do you mean by "la la la"?
I am not sure I understand what you mean by la la la...
From what I gather, from reading this article, they are talking about the very beginning of the schizophrenic break...
That if they can catch this problem at its' onset, and give talk therapy and social support, as well as much less medication, that the people with this problem will not get out of hand... That they can have a LIFE rather than being consigned to the fringes of society.
So, what do you mean by "la la la"?
1
So, finally something may be decided to go back to the same cure mentioned by Freud and practiced by Jung, before these crazy pills were invented that have severe side effects.
4
I don't think we want to go back quite that far.
2
I admit to being a bit confused here. For years, we have been being told that schizophrenia is not character based, but is a chemical imbalance. It would seem to me that if this is true, then the proper medications should be able to rebalance whatever imbalance exists and cure the disease. One on one talk therapy, however, would seem to indicate that it is a character issue, as talking reaches the rational part of the brain, that which influences character and personality.
I'm sure that someone with psychiatric training can clear this confusion up for me.
I'm sure that someone with psychiatric training can clear this confusion up for me.
Hopefully, these findings will change medical education and thereby medical practice. I was appalled when a young person I know came for a visit during her psychiatric rotation. She told me that she finally had time because psychiatry was a breeze -- you just had to write a prescription and that was it, a few minutes per patient. When I asked her about talk therapy and mentioned Harry Stack Sullivan and methods a psychiatrist friend who trained in Israel with European educated psychiatrists use, she was surprised because she had not heard of, much less received any training, about any alternatives to medication. She also received no training on listening to or hearing patients presenting with somatic complaints that might have psychiatric origin.
9
Of course people receiving a lot of attention will improve, but they also quickly regress once the study ends and the support vanishes. We will never be willing or able to spend what is necessary to properly care for such severely chronically ill people. A kinder approach in the long run might be to increase funding for genetic research to find markers for these diseases, so those from families with a history of them can be tested in their late teens and given help in making knowledgeable, humane, and well-considered decisions about their reproductive plans and be given all the help they need in not passing on these horrific diseases to yet another generation.
1
You say that "Of course people receiving a lot of attention will improve, but they also quickly regress once the study ends and the support vanishes..."
You DO realize that the patients in the study have the opportunity to continue treatment outside of the study, right? They don't just walk out the door and fall off the face of the earth...
So, what I hear you saying is that we should just throw those that already HAVE schizophrenia away... Because they need continuing attention. And, instead, spend money on research into possible genetic prevention/treatment...
That ongoing support is out of the question?
I have a therapist... I did not just receive 2 years of therapy and quit...
I continue to see her on a monthly, or bi monthly basis...
She helped me learn to understand my problem, and work with it, or around it.
I am very thankful NOT to be sitting in some institution, drooling into my lap!
You DO realize that the patients in the study have the opportunity to continue treatment outside of the study, right? They don't just walk out the door and fall off the face of the earth...
So, what I hear you saying is that we should just throw those that already HAVE schizophrenia away... Because they need continuing attention. And, instead, spend money on research into possible genetic prevention/treatment...
That ongoing support is out of the question?
I have a therapist... I did not just receive 2 years of therapy and quit...
I continue to see her on a monthly, or bi monthly basis...
She helped me learn to understand my problem, and work with it, or around it.
I am very thankful NOT to be sitting in some institution, drooling into my lap!
Good research, but the title of the article implies that talk therapy is all that is needed. This is a grave problem. Antipsychotics are very, very useful and for some people are a matter of life and death. The take home result will be that patients will be given less meds AND that insurance will never fund the other parts of the complete treatment plan. Sick people will say "Look! Here in the NYT it says I don't need meds any more!" And will never show up to clinic for the therapy, etc. You won't hear from that individual again until he shows up in the hospital or jail. :(
4
I think people could be trained to talk to people with Schizophrenia without being a psychiatrist or a psychologist. An empathetic person that knows how to listen and watch for signs that symptoms are getting out of control. Creating and maintaining trust with the person is by far the most important skill.
45
Eric do you have any experience with folks with Schizophrenia? If patiently listening and empathy was a cure, then there wouldn't be many afflicted.
2
The article nor myself is suggesting a cure. We are just talking about better outcomes.
1
Eric, patiently listening and offering empathy wont help a person with moderate to severe Schizophrenia. It is a nice thing to say of course but this particular disease can involve delusion and altered realities of different sorts. You really need someone trained to handle that.
1
This subject have been kown for years now. the problemas it Always, is money but not money alone, it important to consider the biases and prejudice, thar afect effective care and support. In fact this IS the very first and more important problem. Once you overcome it then you can commit Enough Money to support the dialog solution as the main course of action
Let's not forget the revolutionary brain research being done now that holds the potential for vast improvements in pharmacological treatment. I don't think long-term improvements in treatment will come simply from less medication, but from better medication that is managed by skillful doctors who have the time and economic incentive to invest in their patients. Many people are alive today thanks to good medication. Instead of demonizing chemistry, let's improve the system that is incapable of effectively wielding this important tool.
Seriously, this disease may be secondary to a biochemical abnormality or imbalance in neurotransmitters. When was the last time "talk" could totally correct a biochemical abnormality? No one would be absurd enough to suggest treating sickle cell, thalassemia, or any other inborn error of metabolism with "talk therapy".
Could there be an iota of motivation by therapists to prove this, thus putting pressure on insurance companies to PAY for said therapy? Just consider that for a second. It seems that a majority of radiology research goes to justify a new (more complicated more expensive) way to diagnose an old disease. It's called "self-serving".
The phrases "have utility" or "ease" are most interesting. At the bottom line, the patients STILL required meds. And the "control group" was "standard therapy". To prove a superior outcome, would it not have been better to have a control group on that same "reduced" dosage of medication WITHOUT talk therapy? Only that would show superiority, and only with that could one judge the incremental gain vs. cost of that gain.
That being said, cost was the primary factor that brought us "mainstreaming"; how's that going?
Could there be an iota of motivation by therapists to prove this, thus putting pressure on insurance companies to PAY for said therapy? Just consider that for a second. It seems that a majority of radiology research goes to justify a new (more complicated more expensive) way to diagnose an old disease. It's called "self-serving".
The phrases "have utility" or "ease" are most interesting. At the bottom line, the patients STILL required meds. And the "control group" was "standard therapy". To prove a superior outcome, would it not have been better to have a control group on that same "reduced" dosage of medication WITHOUT talk therapy? Only that would show superiority, and only with that could one judge the incremental gain vs. cost of that gain.
That being said, cost was the primary factor that brought us "mainstreaming"; how's that going?
2
Studies by Baxter at UCLA showed brain changes after psychotherapy. You are naive if you do not understand that experience changes brain, that everything is not hard wired, and that plasticity is a crucial feature of our Mind/Brain.
1
Interesting how medical research conclusions are constantly in 180 degree opposite directions of previous research findings. Being in good health is the most important thing in life but doctor's treatment is still based on trial and error rather than real professional knowledge and experience. I trust my car repair shop but I never ever trust a doctor.
1
No surprise in the results, minimizing medications and providing supportive or cognitive behavioral therapy has been the wise approach for a long time. However in our area the community mental health center, tasked with caring for the medicaid population, makes every effort to dis-enroll the chronically mentally in and send them out to their primary care provider, and NO talk therapy, often with an extremely complex list of medications and ongoing poorly managed psychosis. They follow the mandate of state requirements to the letter as they are hamstrung by inadequate financing. The treatment approach of this "landmark" study has been known for years, there's just has never been the will to initiate such a program. My prediction: this will never become standard practice.
17
My 22 year old son has schizophrenia. Thank God he does well on Risperdone with little side effects. He also has a twice-monthly session with a talk therapist which he loves. My son is not "normal" but thanks to medication and therapy he's able to pursue his dream which is becoming a cook. My advice is to find what works and stick with it. Also keep the stress down as much as possible.
38
Laurie-I believe we have a lot in common. Feel free to contact me at [email protected]
Wonderful news!
The late mathematician John Nash conquered his own paranoid schizophrenia with logic.
Psychiatry does not know which comes first, thought or brain chemistry, in the feedback loop that starts running at birth and ends at death.
Psychiatry does not know which comes first, thought or brain chemistry, in the feedback loop that starts running at birth and ends at death.
It may be a "game changer" if people - not just professionals, but patients and their families - really take on board what this is saying and also what it is NOT saying. The news is not really "new" or astounding. It just says that talk therapy is often beneficial. And the sun usually comes up in the east and sets in the west. Of course, talk therapy "in which the person ... learns tools to build social relationships, reduce substance use and help manage the symptoms, which include mood problems as well as hallucinations and delusions" is a very good idea! Please note carefully it. does. not. say. this will cure schizophrenia, or lessen hallucinations, delusions, or paranoia. Read it over carefully! It says the therapy will help the patient build social relationships and "manage" the symptoms.
Please please please take on board that this does NOT say stop your medications, or cut your dose in half, or just find a therapist willing to talk about demons or dragons. And - since I'm sure many are also reading the "Opinionator" column describing a fairly ludicrous psychoanalysis-by-phone-for-several-years-from-Norway-paid-for-by-trust-fund - it DOES. NOT. SAY. try psychoanalysis.
Please please please take on board that this does NOT say stop your medications, or cut your dose in half, or just find a therapist willing to talk about demons or dragons. And - since I'm sure many are also reading the "Opinionator" column describing a fairly ludicrous psychoanalysis-by-phone-for-several-years-from-Norway-paid-for-by-trust-fund - it DOES. NOT. SAY. try psychoanalysis.
1
This is great news!
Hope the epidemic of diagnosing drugs for everything comes to an end.
Hope the epidemic of diagnosing drugs for everything comes to an end.
2
Don't confuse this with Open Dialogue. They do not use anti-psychotic medication at all with patients in Open Dialogue. They use benzos short-term, but anti-psychotics are prohibited because they so drastically inhibit functioning for the vast majority who take them. They are, after all, nothing more or less than reward hormone (dopamine) blockers. Most of us need that reward hormone just to get out of bed every morning.
2
In US studies 89% of patients with Schizophrenia also have antibodies present for Toxoplasmosis. In other countries medical researchers have found Toxoplasmosis in as many as 94% of Schizophrenia patients.
In the US psychiatry is based on politics and voodoo...
In the US psychiatry is based on politics and voodoo...
1
Anything in the states is based upon politics. It surprises me how we ever had a revolution or even a war between states when most people are just docile punching bags, while politicians line their pockets with bribes from drug companies and etc.
1
Causation and correllation are two very different things. This is the same nonsense that started the vaccination-autism non-connection.
Nonsense, this level of infection and correlation is unique to Schizophrenics. No other US group tests above 51% for presence of Toxoplasmosis.
That's indicative of causation and should be the primary avenue of research until conclusively disproved.
That's indicative of causation and should be the primary avenue of research until conclusively disproved.
It took this long to study and find this out? That's amazing.
Is this because big pharma had a stranglehold on research dollars?
Big pharma's interests are not those of the American people. They need expensive medicine, we need affordable, safe medicine. Big pharma needs non-profit competition.
Is this because big pharma had a stranglehold on research dollars?
Big pharma's interests are not those of the American people. They need expensive medicine, we need affordable, safe medicine. Big pharma needs non-profit competition.
1
In fact community mental health clinics in New York continue to treat people with schizophrenia with a combination of talk therapy and medication. They never stopped doing this. However, these clinics are often staffed by students or part-time staff who are people in transition who leave after two years. The end result is the vulnerable patient who needs ongoing treatment suffers the loss of his or her therapist every two years and after 10 years has had five therapists. This creates a different type of damage.
42
From Anne:
"In fact community mental health clinics in New York continue to treat people with schizophrenia with a combination of talk therapy and medication. They never stopped doing this. However, these clinics are often staffed by students or part-time staff who are people in transition who leave after two years. The end result is the vulnerable patient who needs ongoing treatment suffers the loss of his or her therapist every two years and after 10 years has had five therapists. This creates a different type of damage."
This is an excellent point. The patients in this trial were not being treated by students or part-time staff or even average therapists, The one advantage of drugs is that they can be administered equally by all. Not to say that this trial is wrong... indeed it seems very likely, almost obvious, that such combined therapy, with excellent therapists, will be superior. But it may be difficult to replicate in your (or my) home town. And 50% reduction in drug dose is not that big a reduction... 20% is probably within the margin of error.
"In fact community mental health clinics in New York continue to treat people with schizophrenia with a combination of talk therapy and medication. They never stopped doing this. However, these clinics are often staffed by students or part-time staff who are people in transition who leave after two years. The end result is the vulnerable patient who needs ongoing treatment suffers the loss of his or her therapist every two years and after 10 years has had five therapists. This creates a different type of damage."
This is an excellent point. The patients in this trial were not being treated by students or part-time staff or even average therapists, The one advantage of drugs is that they can be administered equally by all. Not to say that this trial is wrong... indeed it seems very likely, almost obvious, that such combined therapy, with excellent therapists, will be superior. But it may be difficult to replicate in your (or my) home town. And 50% reduction in drug dose is not that big a reduction... 20% is probably within the margin of error.
Note that the study doesn't posit either/or. There is a place for medications, but they are not a panacea. Neither are they anathema.
I fear this study will be seized upon by the crowd that wants to turn the clock back to the days before antipsychotics, and to lay the dead hand of Freud over the treatment field. (For some kinds of mental illness, such as autism, talk therapy actually makes things worse.)
The trick of mental illness is that unlike physical illness, it is diagnosed by symptom, rather than cause. There is a specific cause and cure for, say, syphilis or malaria; there is no known 'schizophrenia bacillus' or 'bipolar virus'. 'Schizophrenia' is a constellation of symptoms, and a symptom, say, 'fever' or 'headache', may have varying causes, and one patient's cure is another's placebo and a third's poison.
I'm old enough to remember what life was like for schizophrenics, and their families and friends, before the advent of those drugs. I've seen the dubious joy of unmedicated schizophrenia. And there are some of us who get down on our knees every day and thank whatever gods there may be for those pills.
I fear this study will be seized upon by the crowd that wants to turn the clock back to the days before antipsychotics, and to lay the dead hand of Freud over the treatment field. (For some kinds of mental illness, such as autism, talk therapy actually makes things worse.)
The trick of mental illness is that unlike physical illness, it is diagnosed by symptom, rather than cause. There is a specific cause and cure for, say, syphilis or malaria; there is no known 'schizophrenia bacillus' or 'bipolar virus'. 'Schizophrenia' is a constellation of symptoms, and a symptom, say, 'fever' or 'headache', may have varying causes, and one patient's cure is another's placebo and a third's poison.
I'm old enough to remember what life was like for schizophrenics, and their families and friends, before the advent of those drugs. I've seen the dubious joy of unmedicated schizophrenia. And there are some of us who get down on our knees every day and thank whatever gods there may be for those pills.
23
No one least of all mental health practitioners (except for a tiny handful of fanatics) want to resurrect Freud...his ideas have been out of vogue for decades.
Autism is not a mental illness, it is a developmental disability.
1
Freud's theory & technique- from 100 years ago - has contributed very little to modern psychotherapy with psychotic patients. It is silly to use such an ill-informed critique - you would not judge any other medical treatment by it's 1920's originator!!
“…using standardized checklists that rate symptom severity and quality of life, like whether a person is working, and how well he or she is getting along with family members. The group that started on the combined treatment scored, on average, more poorly on both measures at the beginning of the trial. Over two years, both groups showed steady improvement. But by the end, those who had been in the combined program had more symptom relief, and were functioning better as well. They had also been on drug doses that were 20 percent to 50 percent lower, Dr. Kane said.”
There is something in this article that doesn’t add up. The two groups must be as similar as possible at the start, in order to compare degree of improvement. Why were they different? This article says that the test group was sicker at the start, and also had “more symptom relief.” Think logically – if the control group had not been as sick, they would have had less range available for “symptom relief,” Think of this as if you gave an anti-fever medication to two groups (101 and 100 average fevers). The group with a higher fever could readily show more relief of fever symptoms than the group that started with a lower fever.
There is something in this article that doesn’t add up. The two groups must be as similar as possible at the start, in order to compare degree of improvement. Why were they different? This article says that the test group was sicker at the start, and also had “more symptom relief.” Think logically – if the control group had not been as sick, they would have had less range available for “symptom relief,” Think of this as if you gave an anti-fever medication to two groups (101 and 100 average fevers). The group with a higher fever could readily show more relief of fever symptoms than the group that started with a lower fever.
I believe headline is somewhat misleading. Study was on 'first episode psychosis', not well-developed schizophrenia. And it has long been known that talk helps. That was not a novel finding. The important finding is what many suspected, but no study confirmed: don't make seriously mentally ill wait for treatment. The secondary finding is to supplement meds with talk. NY Times story will be widely spun to suggest talk replace meds.
DJ Jaffe
Executive Director
Mental Illness Policy Org
http://mentalillnesspolicy.org
DJ Jaffe
Executive Director
Mental Illness Policy Org
http://mentalillnesspolicy.org
4
Exactly what I found when i went through a number of brain drugs to fight ADD and depression. Less is definitely more. More almost caused me to have a psychotic split. And I have been off narcotic type drugs for many years. A minimal dose of Cymbalta ultimately did the trick for me. I now continue to take it only for neuropathy pain in my feet.
2
"...it included three elements in addition to the medication. First, help with work or school such as assistance in deciding which classes or opportunities are most appropriate, given a person’s symptoms. Second, education for family members to increase their understanding of the disorder. And finally, one-on-one talk therapy in which the person with the diagnosis learns tools to build social relationships, reduce substance use and help manage the symptoms..."
The first two are generally called "case management," which in the US is often handled via an "assertive community treatment" program. Note that the third is not psychoanalysis, as described in this week's Couch essay.
The first two are generally called "case management," which in the US is often handled via an "assertive community treatment" program. Note that the third is not psychoanalysis, as described in this week's Couch essay.
2
Another helpful article on mental health care by Benedict Carey. May he never leave the NY Times. This finding does not surprise me, however. I once worked at Fountain House in NYC: a psychosocial rehabilitation center on West 47th Street that operates, in many ways, like a co-op. Staff and "members" of Fountain House (which does not consider its users to be "patients") work together on all of the functions and activities of the center, and the typical hierarchies found in many so-called treatment settings are absent. Members are also assisted in finding work placements and encouraged to participate in the community, not retreat from it. Medication compliance is encouraged at Fountain House, but it is the idea that quality of life for people with severe and persistent mental illness requires much more than medication that makes the model so valuable. In short, the idea is that if you provide a healthy social, psychological, and vocational environment for people, with or without a history of mental illness, they will optimize their quality of life and develop towards their best self. If only other work settings would realize this same need in the rest of us.
37
This is a fascinating, and hopefully helpful, study. However, infrared his information will be misinterpreted by those who read the headline and not the content - and then become the fiasco of 2015 that closing down inpatient facilities became decades ago, when they were not replaced by the community services designed to make the transition work. Note that the study calls for many services, including family education, that must be in place for lowered medication dosages to have a chance to succeed.
26
Thank God for the beginning of common sense in finding ways to effectively treat mental illness. For decades the approach and consensus has mainly been more drugs and even more drugs. This strategy that hasn't worked was fueled by the money and power of the billion dollar (big-pharma) industrial complex. I believe less is best when it comes to prescribing these powerful chemical, mind altering substances. This successful strategy has promise in treating other conditions such as Bi-polar disorder and addiction, which often like schizophrenia, go hand in hand... Bravo!
1
It's 2015 and we still can't figure out how to Really treat schizophrenia. And yet another landmark study. How many other landmark studies have been done which have shown medication has been the correct treatment? There have been reports that many homeless suffer from schizophrenia. Talk therapy? Really? Where is that supposed to take place?
This country is inept with offering mental health insurance benefits. How dare these reports keep changing correct treatment methods. And we blame those afflicted with schizophrenia for not getting proper "treatment". The wrong people are being blamed, obviously.
This country is inept with offering mental health insurance benefits. How dare these reports keep changing correct treatment methods. And we blame those afflicted with schizophrenia for not getting proper "treatment". The wrong people are being blamed, obviously.
22
Medication is often successful at combatting so-called "positive" symptoms but has never been shown to transform the underlying disorder...talk therapy with people diagnosed with schizophrenia can happen in the same places it happens with people with other diagnoses.
Val in NY to MIMA in heartsny
I'm hard pressed to disagree with you. My beautiful, popular late sister spent almost half of the rest of her life in England, after my family moved there for two years. (She had developed cancer, but we lost her to aspiration, this year. She was 49.) Her psychiatrist disapproved of the way schizophrenia was treated in the U.S. and didn't want her to return stateside when we left. That was in the early '90's.
This country is inept and behind in everything--especially mental health treatment. And, the "experts" make it seem that talk therapy is some amazing innovation, when it should be part of the basis of treatment, anyway. Doesn't inspire confidence at all.
Skeptical and heart broken.
Submitted 10-21-15@3:47 a.m. EST
I'm hard pressed to disagree with you. My beautiful, popular late sister spent almost half of the rest of her life in England, after my family moved there for two years. (She had developed cancer, but we lost her to aspiration, this year. She was 49.) Her psychiatrist disapproved of the way schizophrenia was treated in the U.S. and didn't want her to return stateside when we left. That was in the early '90's.
This country is inept and behind in everything--especially mental health treatment. And, the "experts" make it seem that talk therapy is some amazing innovation, when it should be part of the basis of treatment, anyway. Doesn't inspire confidence at all.
Skeptical and heart broken.
Submitted 10-21-15@3:47 a.m. EST
My friend's brother had therapy from the time of his first psychotic break, and continued weekly therapy for over 40 years with the same psychiatrist - he was one of his first patients. He was given meds but often did not take them - we found hundreds when cleaning out his apartment after his death. His psychiatrist spoke at the funeral and said that only in the past 2-3 years was he able to make any connection with this tragic man. The man had brought in a book of city landmarks and started talking about them. He also wanted his doctor to see if the books he had written were still in print and being used in graduate programs. They were and that pleased him. But this was after nearly 40 years of therapy, in which he rarely would talk to his therapist at all.
Family support? Many schizophrenics want little if any contact with anyone, family or otherwise. My friend's brother had some relationship with his mother, but the strain of caring for him caused her to slip into schizophrenia herself - family history of the disease. His sister tried everything to no avail. It's a tragic disease as drugs only treat a few symptoms which are traded for other ones. Talk therapy? Getting schizophrenics to talk is not always possible.
Family support? Many schizophrenics want little if any contact with anyone, family or otherwise. My friend's brother had some relationship with his mother, but the strain of caring for him caused her to slip into schizophrenia herself - family history of the disease. His sister tried everything to no avail. It's a tragic disease as drugs only treat a few symptoms which are traded for other ones. Talk therapy? Getting schizophrenics to talk is not always possible.
13
Unfortunately, the "experts" (people whose incomes depend on a continuously ill patient) have neglected to clue families in to what family support should look like. Why would experts want to power share? Families have been left high and dry and haven't a clue about how to establish good communication with their relatives. There are some excellent survivor led courses these days about how to communicate with your relative.
A coordinated and effective, caring approach by nurses, nursing assistants, and psychiatrist back-up in a small Massachusetts city was quite successful for the period of time it was funded (1973-1980). It included talk therapy, based on dialogue, medications on a regular basis and some home visits and involvement of other people in the community who collaborated with us. Hours of talk therapy each week was not on the menu of services. Compassion and trying to understand the person's world framed everything. Best work I ever did.
1
Let me just guess. The study was conducted by talk therapists.
1
And three weeks ago the NYT ran an article about a study that showed talk therapy was about 25% less effective in treating depression than previously thought. The point is, pharmaceuticals are an important tool in modern treatment protocols of mental illness. Talk therapy, and, perhaps more importantly, the socialization of individuals who suffer from mental illness is equally important. There has to be both. If the American epidemic of mass slayings has a common thread, it is the social isolation these mostly young men endure. It is an unrelentingly pernicious condition not unlike solitary confinement. Without the drugs and the compassion of a society that is willing to empathize with those suffering from psychosis the way we do cancer victims we will continue to see some of our mentally ill reaching out to the internet for companionship and for guns and ammo as an expression of their relationship to the rest of us.
1
It's too bad this article didn't include more from Mary Olson. She could have told us about Open Dialogue, the approach developed in northern Finland, where people in first episodes are given no antipsychotics at all to start with, with talk used instead. It's been really successful, 2/3 or so make good recoveries without using antipsychotics, while the drugs are still available of course to those who seem to need them. They see psychotic experiences, when properly addressed, as very possibly just a temporary thing, not an indication of a "lifelong illness."
It's also worth noting that a randomized study by Wunderink et al found that people doing well on antipsychotics were twice as likely to make a functional recovery over a 7 year period if they were guided in attempting to get off or at least reduce use of drugs, compared to those who stayed on standard amounts of the drugs. It's clear we should be doing more to help those who can to minimize drug usage.
It's also worth noting that a randomized study by Wunderink et al found that people doing well on antipsychotics were twice as likely to make a functional recovery over a 7 year period if they were guided in attempting to get off or at least reduce use of drugs, compared to those who stayed on standard amounts of the drugs. It's clear we should be doing more to help those who can to minimize drug usage.
17
Good news - but it will not work. Doctors do not get paid for the time it takes for talk therapy. The drug companies will oppose this treatment because they are making a fortune. And, statistics show that our family structure has fallen apart.
I am the sister of a paranoid schizophrenic. I make sure my brother is not on the streets or in jail. In court, the judge commented several times about how unusual it is for a relative to even show up.
I am the sister of a paranoid schizophrenic. I make sure my brother is not on the streets or in jail. In court, the judge commented several times about how unusual it is for a relative to even show up.
12
So scarey to think that, I think we've all gone to doctors that are on pharma payrolls.
The best defense is to get this info out there so that it becomes common knowledge.
The best defense is to get this info out there so that it becomes common knowledge.
I know what the "Liberty Caucus" will say: "We can't afford it!!!"
These schizophrenic people are FELLOW AMERICANS. To condemn schizophrenics to drugs-only and disability is on a slippery slope of evil downwards towards killing off mentally ill people, as our World War II enemy did.
These schizophrenic people are FELLOW AMERICANS. To condemn schizophrenics to drugs-only and disability is on a slippery slope of evil downwards towards killing off mentally ill people, as our World War II enemy did.
13
Schizophrenia is a spectrum of illness - not a single entity like appendicitis. Some respond to the medications we have now; some don't - some lucky individuals have a single psychotic episode and then recover with no further treatment. Both of these facts make statistical evaluation of any treatment very difficult.
9
Antipsychotic medications and alcohol don't mix. People stop taking their medications so they can party at the local bars.
Who exactly thought in the first place that talk therapy didn't have utility in treating patients with schizophrenia?
It's been obvious forever that it does.
The real problem is that the insurance companies don't want to pay for regular and frequent psychotherapy, but instead want to limit mental health treatment to a handful of medication management visits.
It's been obvious forever that it does.
The real problem is that the insurance companies don't want to pay for regular and frequent psychotherapy, but instead want to limit mental health treatment to a handful of medication management visits.
30
You are absolutely right that this is something known about for years. And although it appears many comments seem to interpret this study as indicating that medications are unnecessary if therapy is provided, it in fact shows that the combination is best.
As a psychologist who has worked for 10 years with people diagnosed with schizophrenia, my experience has been that when people build long-term, trusting relationships with empathic care givers, quality of life is much improved. Should this be so surprising? Why should people with schizophrenia be different from anyone else? I hope this research begins a sea change away from the over-reliance on the next over-hyped, over-marketed miracle drug, and towards compassionate, humanistic, family-involving care.
15
This is news and it is not news. This is how I was trained. I did my residency in Psychiatry at the Massachusetts Mental Health Center in the 1980's where every patient got talk therapy, no matter how psychotic they were. We understood then, and we were far from the first, that people could heal by telling their stories, by being accepted and understood. We worked together to discover the meaning of the symptoms, to try to figure out what would happen if those symptoms weren't there, and so on. In the context of the trusting therapeutic relationship, patients sometimes dared to doubt their perceptions, to accept that they were products of their own minds, and then to challenge them. The medications really do help, but they are not a panacea. The challenge now is to be able to afford to provide the RIGHT treatment to people with schizophrenia. Too often, psychiatrists have been limited by funding sources to providing only medications when we really want and our patients really want so much more. Prescriber? Nope. I'm a psychiatrist with a prescription pad that I'd rather use less. Will America and the insurance companies allow us to truly treat our patients? I hope so.
32
I practice psychiatry. I wasn't part of this study, but I'm not surprised by the findings. With insurance reimbursement pressuring those of us who prescribe to "see" patients for as little as 15 minutes, precious little conversation can take place. And while some patients are fortunate enough to have therapists, in my experience most people with schizophrenia do not. Some cannot afford it, some communities lack these mental health professionals, and some patients lack transportation and support to remember and attend appointments. For these reasons and more, I do my best to provide both expert medication management and counseling. My "med check" appointments are 30 minutes. This means my clinic takes in significantly less money than it would if I saw 3 or 4 patients per hour. But years ago I worked at a clinic where 3 to 4 patients per hour was the expectation, and I struggled to maintain strong and therapeutic relationships with many of my sickest patients. I was constantly rushed, forced to focus almost entirely on medication, leaving little time for anything else. No wonder patients frequently stopped taking their medication, stopped coming to appointments, and had more trouble avoiding hospitalization, jail and homelessness. Perhaps other, smarter psychiatric specialists get better results in very brief appointments than I did, but for me I know there is no substitute for time. If only I could continue this style of practice without going into the poor house!
24
Harry Stack Sullivan is back, finally.
7
This combination of drugs and psychoanalytically informed talk therapy worked well back in the 1960's when I was a psychiatry resident at Jacobi hospital. Then psychopharmacology took over departments of psychiatry, training deemphasized talk therapy and the culture ridiculed (think Woody Allen) psychoanalytic therapy. Now, hopefully, it's back to the future.
I have a "schizophrenia-spectrum" disorder. I've been doing meds and therapy (mostly) both together for 20 years. My primary meds have been Risperidone and Lithium since 1996, though i've tried a lot of others i always come back to these. (Great part is, they're generic/cheap). While risperidone has been as high as 6-8mg now it's closer to 2-3mg (figure half or third). I seem to be able to work with my team to adjust meds as necessary, if side effects are bad, or symptoms doing well for a long time, i might tell them i want to reduce meds and they usually are OK with that. If i'm having symptoms making me uncomfortable, as long as i'm not too high they let me increase. In fact my doctor prescribed me a "range" (size=1.5mg) of risperidone and anywhere in that range i can change on my own (such as by pill cutting or removing a pill or adding even) which i'm convinced my doc allows just so i don't bug him so much asking every time i want to change something.
9
This is some seriously irresponsible reporting. I read through the study at AJP: medication doses in the NAVIGATE arm are not mentioned even once. The similarities to "Open Dialogue" , are made by an uninvolved participant who writes for an anti-psychiatry blog. It is great news indeed that comprehensive treatment allows lowering of medication doses (if it in fact does) and is no surprise as well, but objective reporting should come before hype.
1
Speaking from experience, people with psychotic disorders are in dire need of love and acceptance. Mental illness is a very isolating and lonely journey. The paradox is that their behavior, many times, drives people away at the very moment when they are in the most need of human contact and support.
Kudos to the folks that did this study. Social connectedness and love are vital for all humans, especially those suffering from this horrible illness.
My mother suffered greatly, she even was homeless for a period of time. Thanks to low dose Haldol and social support, she was able to have ten good years. She was even able to travel to Italy to see the Vatican and other sights. She died there from a heart attack, but not until she had seen everything that she went there for. We all felt a sense of peace about that. Mom, indeed you " did do very well under the circumstances"!
Kudos to the folks that did this study. Social connectedness and love are vital for all humans, especially those suffering from this horrible illness.
My mother suffered greatly, she even was homeless for a period of time. Thanks to low dose Haldol and social support, she was able to have ten good years. She was even able to travel to Italy to see the Vatican and other sights. She died there from a heart attack, but not until she had seen everything that she went there for. We all felt a sense of peace about that. Mom, indeed you " did do very well under the circumstances"!
8
This is great news. The even larger hurdle now will be finding the resources to implement this approach on a wider scale given the direction mental health service delivery has been going for the past 20 years. In North Carolina there are fewer and fewer public dollars going into providing necessary treatments for this population. Unfortunately, given the current political climate in our state I do not see that changing anytime soon.
1
Working as a nurse in acute care psychiatry in a general hospital, including some years in the Psychiatric ER , I know full well that psychotropic medications are essential. Once the patient is out of imminent danger and in better self control, talking, teaching and re teaching is very important. Teaching the family is equally important. I always reminded patients when they were being discharged to think about how they were feeling when they were admitted. It frequently helped with medication compliance and curbed
recidivism. Talking is supportive and builds trust. It always helps the patient to feel valued. Who doesn't want that?
recidivism. Talking is supportive and builds trust. It always helps the patient to feel valued. Who doesn't want that?
3
I'm thrilled to be reading about advances in the care of this ghastly disease. My cousin struggled with this disease all of her adult life. Enduring the side effects of a myriad of drugs, a broad continuum of competent and incompetent therapists, and an endless array of sometimes ignorant, sometimes hostile people, she valiantly navigated her tragically circumscribed life for almost three decades before she succumbed and took her own life. As treatments improve for this sometimes intractable disease, we must also stress education, public awareness, and an end to the stigma that only impedes progress for those suffering from mental disease.
4
I worked in the field of mental health and know that stigma and isolation conspire to condemn people with schizophrenia to worsening mental health outcomes. Add high dose medication and you add difficult to manage and difficult to socialize with outcomes. I am happy to hear the good news of your article. Now, let's focus on schizophrenia with those living in poverty, an all too common fact. Therapists are in short order, given too little time with clients, ancillary staff have less time and groups are often run by unqualified leaders. Is there a way to apply learnings like these across the economic spectrum? Let's keep educating the general society that people with mental health are people first, are often eager for social interaction and who have a great deal to contribute once stigma and judgement are laid aside.
6
And so we find that the lazy, but nicely reimbursed, approach of using chemo-surgery to assign bothersome and complicated patients to a frustrating chemical twilight, complemented by a fragmented web of social services and the lack of a secure safety net, is inferior to working proactively toward a cure. In retrospect, is anyone surprised? Did we really think that drugs and a social service shuffle would do it? The probability of such a solution was so small but it relieved us of so much responsibility that the temptation of embracing it simply overwhelmed good sense.
8
Well, just more evidence that we need to communicate more, and in person. How about opening up shops where people can come to talk? Talk Shops. And ban laptops and cellphone use.
1
There's nothing new about this approach. The need for help in organizing one's life and developing meaningful rela relationships has been known for decades and various clinicians have developed variations on this approach. The willingness of NAMI to get behind this is significant because they have fought family-focused intervention in the past because of concerns with blaming parents for psychosis. The real issue here will be adequate funding--schizophrenia is a long-term proposition with frequent relapse, particularly in in its early years. The history of mental health in the US is one of recurring scandals related to the neglect and inadequate care of patients.
3
Most people with mental illness get better results with less medication and more human interaction with a counselor?? Is this really a new concept? Many of us health care providers have been saying this for years. Most people I see in the ER report their interaction with their psychiatrist as follows: He asked me how the medicine was working for me. I told him I couldn't tell much difference so he increased the dose, added another medicine or switched to a new medicine and told me to come back in a month. Perhaps there are psychiatrists who spend time talking with patients about their mental illnesses, but I haven't heard of one doing so in 20 years.
13
My son who will be 45 next month was diagnosed with schizophrenia in 1990. As a result of a combination of drugs and regular sessions with a skilled psychotherapist, he has not been hospitalized in years and lives independently here in Maine. Fortunately, the City of Portland has the psychosocial support services he needs, and together with the local 12 Step Program, he has remained drug and alcohol free as well. While he remains unemployable, he none-the-less, has managed to create a life for himself despite his illness and the suicide of his father which occurred over 15 years ago. He calls the local warm line late at night if he becomes overly anxious and has learned to make use of the various programs available to those with mental illness. Therapy has been vital to his recovery and I am deeply pleased by the good news in this article. However, I would never advise him to stop taking his meds as, despite the side effects, they have also played a major role in keeping him out of the hospital. Hopefully, one day, meds will not be needed for those who suffer from schizophrenia and other forms of mental illness. However, if used properly, I continue to believe that they are a vital part of the recovery process.
13
This will come as no surprise to many. Good therapy creates new neural pathways, and those changes have lasting impact. Drugs alter brain chemistry - stop the drug and go back to ground zero, only perhaps worse off for the side effects and dependency. Personally, I hope the pharmaceutical industry digs its own grave by continuing to make medication too expensive so the general public can learn just how many effective holistic treatments exist. Start by changing diet to eliminate manufactured foods.
8
Dr. Hyman Spotnitz: Modern Psychoanalytic Analysis of the Schizophrenic Patient, published 1969. Dr. Spotnitz' research notes that schizophrenia can be cured with talk therapy if used by a properly trained analyst who is being properly supervised. This NYT article reifies the both research and practice Spotnitz and his analysts have been developing at The Center for Modern Psychoanalytic Studies in Manhattan.
4
Talk therapy alone can not cure schizophrenia. That was debunked a long time ago.
How heartbreaking to again be told that treatment helps. So what? In Wyoming the governor first and now the legislature refuse medicaid expansion which at least gives some kind of health care to severely mentally ill like schizophrenia sufferers. Of course the protocol mentioned in the study helps, but does that help those in jails and prison and on the streets and in the gutters? Politicians would rather build more jails and arm police to the teeth so that those persons not shot by the police can go to prison if they are not left unnoticed and perpetuate the horrible public crimes we read about all the time.
Of course it would be cost effective and humane to offer treatment but don't hold your breath.
Of course it would be cost effective and humane to offer treatment but don't hold your breath.
10
We have known for a long time that high doses of medications like these are more expensive and more dangerous than the cheaper and safer talk therapies and lower dose therapies, and now we find that they are less effective too. Something similar was found for treating depression also. I predict we will see more examples of this in the coming years, with alternatives to intensive drug-based therapies being the better choice in many cases, not only for psychotic disorders but also for pain, anxiety, depression and other forms of brain and mental illness.
There are other alternatives to drug treatments aside from talk therapy. For instance, we and other medical research groups are finding benefits of very low-dose electrical current (applied to specific brain regions for short durations, don't try this at home) for treating auditory hallucinations in schizophrenia. Its in its early stages, but my hope is that we will find safer, cheaper and more effective options for treating brain and mental illness.
There are other alternatives to drug treatments aside from talk therapy. For instance, we and other medical research groups are finding benefits of very low-dose electrical current (applied to specific brain regions for short durations, don't try this at home) for treating auditory hallucinations in schizophrenia. Its in its early stages, but my hope is that we will find safer, cheaper and more effective options for treating brain and mental illness.
1
We already have an herb that is so effective for pain management that it's legalization is associated with a very significant reduction in prescription opiate overdose deaths. It's defective medicine to prescribe opiates for pain without first evaluating whether and to what extent cannabis can be substituted.
Great study, not at all surprising to those of us who do the clinical work. As Harry Stack Sullivan said, we are all more simply human than otherwise, and treating people with schizophrenia as people to be helped instead of as potential monsters to be chemically restrained is very important. Meds are often an important part of therapy, but should not replace actually helping people.
The problem, of course, is that the insurance companies don't want to pay for talk therapy -- often, the mental health benefits are carved out to a separate company, so the company paying for talk therapy isn't the same company saving money by using less medication and less other services. And no insurance company is realizing the savings to society in the reduced need for public supports, prisons, etc -- this is yet another form of corporations publicizing risk while privatizing profit. NYT has published extensively about how the for-profit prison system, in particular, becomes a de facto mental hospital. We are all going to pay regardless -- it would help if we paid for the services that actually helped.
Yes, talk therapy is expensive... But it's extremely cheap compared to hospitalizations, prison, welfare, and the knock-on costs associated with substance abuse as people try to self-medicate.
We as a society can do better. People with schizophrenia are people, and they are often very interesting and cool people. But the longer they go untreated, the worse the outcomes are.
The problem, of course, is that the insurance companies don't want to pay for talk therapy -- often, the mental health benefits are carved out to a separate company, so the company paying for talk therapy isn't the same company saving money by using less medication and less other services. And no insurance company is realizing the savings to society in the reduced need for public supports, prisons, etc -- this is yet another form of corporations publicizing risk while privatizing profit. NYT has published extensively about how the for-profit prison system, in particular, becomes a de facto mental hospital. We are all going to pay regardless -- it would help if we paid for the services that actually helped.
Yes, talk therapy is expensive... But it's extremely cheap compared to hospitalizations, prison, welfare, and the knock-on costs associated with substance abuse as people try to self-medicate.
We as a society can do better. People with schizophrenia are people, and they are often very interesting and cool people. But the longer they go untreated, the worse the outcomes are.
174
It's finding those who will take the time to follow-through with these outcomes. Our HIPPA laws need to change to help our children who experience the first episode of delusions to obtain the help they need. Simple changes to our mental health system can be made to support this model of support. Family is very important in the recovery of the patient.
Some of my clients have been lucky enough to live in MA, where there is a provision in state law to require mental health insurance/coverage. That doesn't stop the insurers from trying to deny coverage for talk therapy-- until they're reminded of the patient's have the right to the coverage, and that the insurer's "utilization review" is practicing medicine and undercutting the state requirements. Most patients, however, aren't aware of their rights, and coverage shenanigans continue for those patients who don't know the law, or don't have the energy (because of the mental illness the insurers are trying to avoid paying for) to self-advocate. And god forbid that the prescribing doctor write a letter about the necessity of adjunct talk therapy-- insurers clearly know the patients better than their treating providers.
Legislating minimum mental health standards for various conditions through the ACA (or imposing them through Medicare/Medicaid so that it's a contracted-for threshold) may be the only way to force insurers nationally to provide the needed medication + therapy that will help patients succeed. Not that Republicans would vote for it, gun violence crisis and all. Prevention is not their interest; punishment and control are their only ideas.
Legislating minimum mental health standards for various conditions through the ACA (or imposing them through Medicare/Medicaid so that it's a contracted-for threshold) may be the only way to force insurers nationally to provide the needed medication + therapy that will help patients succeed. Not that Republicans would vote for it, gun violence crisis and all. Prevention is not their interest; punishment and control are their only ideas.
This is my experience, too, as a counseling clinician. If one is not trapped behind the biopsychiatric lens that warps schizophrenics into brain-damaged outcasts, it is intuitive and obvious that they are people who have escaped sanity because of harrowing influences, and who speak personal truths in very lost, covert ways. Of course they are people -- "cool" and often astonishingly acute.
1
And will this therapy be covered by insurance? I have heard of people who pay as much as $300/session with their therapist. Unless you are very rich, I don't know how anyone can afford this. I realize that not everyone charges that much but I do know that it's not cheap.
59
That's very true in nearly all of health care - and particularly talk therapy. By and large, however, early psychosis clinics are largely government funded, so in fact, it can actually be easier in most cases to access care at a public clinic than a private one. There are some notable exceptions to this, and either way, access for EVERYONE should definitely be the goal. You can find more about the 70 clinics in the US at psychosisprevention.org
Harriet, Obamacare now requires that mental health issues be treated as any other illness, without separate deductibles or limitations.
I believe the Affordable Care Act obliges health insurance companies to cover at least some mental health treatment (with a diagnosis you get even more treatment). I pay $25/hr session with a really wonderful therapist, who I would never be able to afford without insurance. So, things have changed! Of course sometimes you don't know what you'll get going off a list of in-network doctors. But it's worth the work to investigate.
The brain is the last frontier and we know probably 1% of what there is to know about it. We know more about Mars and neanderthals.
I'm sorry but only 25 million dollars granted from Congress? The Department of Defence sneezes 25 million dollars and doesn't even notice.
The consequences of mental illness on individuals, families and society at large are substantial. Unlocking the mystery of mental illness requires a far larger financial commitment from the federal government.
I'm sorry but only 25 million dollars granted from Congress? The Department of Defence sneezes 25 million dollars and doesn't even notice.
The consequences of mental illness on individuals, families and society at large are substantial. Unlocking the mystery of mental illness requires a far larger financial commitment from the federal government.
13
SCHIZOPHRENIA IS A CONSTUCT OF DISORDERS . . .
...which are defined by the DSM as having a selection of many "symptoms." It has the potential to destroy patients' lives and those of family members.
Of course the results of this study have to be followed and repeated with careful methodological scrutiny.
If further studies validate the conclusion as stated ... this will constitute a quite important finding.
...which are defined by the DSM as having a selection of many "symptoms." It has the potential to destroy patients' lives and those of family members.
Of course the results of this study have to be followed and repeated with careful methodological scrutiny.
If further studies validate the conclusion as stated ... this will constitute a quite important finding.
1
I think this is a good approach. I have two me members of my family who suffer from bi-polar and schizophrenia. My brother in Fl just gets drugs and is not doing all that well. My younger sister receives medication and support from her family and church friends and is doing very well.
4
I dont want to generalize about people with schizophrenia, but some who have taken prescription drugs for a years have side effects and appear slowed in their responses and movements. I endorse those comments which ask how can talk therapy compete against Big Pharma?
2
The rationale for pushing drugs is that they can be administered in some objective, qualitative way, so the insurance companies trust that "their" money is being well spent. But, the subjective recommendations for talk therapy from a licensed psychiatrist? Well, why would we trust such individuals? They might be abusing the system with their notion that treating human suffering takes time.
The notion that giant pharmaceutical companies are more trustworthy than physicians determines treatment for us all: therein one of the great delusions of our time. Show me the money.
The notion that giant pharmaceutical companies are more trustworthy than physicians determines treatment for us all: therein one of the great delusions of our time. Show me the money.
3
The article fails to mention the history of what it calls the standard approach.
Twenty or thirty years ago, possibly more, the conventional wisdom was that "schizophrenia doesn't respond to therapy."
Tempting to wonder, from this perspective, where those studies originated, and how the timeline for development and marking of antipsychotic drugs lines up with that of the decline - might say neglect - of therapy.
Twenty or thirty years ago, possibly more, the conventional wisdom was that "schizophrenia doesn't respond to therapy."
Tempting to wonder, from this perspective, where those studies originated, and how the timeline for development and marking of antipsychotic drugs lines up with that of the decline - might say neglect - of therapy.
2
For many patients with schizophrenia, the problem with taking medication is that they do not believe that they have an illness requiring medication. This is why the same patients continue to be readmitted to the hospital.
This study should not be interpreted as an either or. The patients in this study were adherent with their medication, just at lower doses. The vast majority of patients with schizophrenia need to be on medication ongoing. The problem with providing psychotherapy has been non-adherence to treatment and adequate reimbursement for therapy.
This study should not be interpreted as an either or. The patients in this study were adherent with their medication, just at lower doses. The vast majority of patients with schizophrenia need to be on medication ongoing. The problem with providing psychotherapy has been non-adherence to treatment and adequate reimbursement for therapy.
4
This study appears to vindicate the successful non-drug treatments of schizophrenia that formed the core of the Soteria Projects and the work of Loren Mosher, former NIMH Director in the 1970's.
I know this subject well. My late father was a paranoid schizophrenic. He'd been committed to King's County Hospital a few times but eventually ended up twice at Pilgrim State Hospital on Long Island.
He'd had all the popular treatments, shock, freezing and insulin but none
worked. The medications made him sleep all the time.
By the time I was in my teens he had improved some what. We worked together fabricating and installing commercial kitchens. He still has some paranoia. We'd go to a restaurant and he would tell me that people were talking about him. Talking to him was usually effective. Making him observe the people talking among themselves and only looking at each other would usually move him back into reality.
It takes a great deal of patience. My mother ran out of it and treated him meanly until she divorced him. She really was not the type to have patience. I believe she was going to divorce him years earlier but found herself pregnant and used him to support her.
My sisters and I took care of him as best we could. He'd always held a job and was well paid for it. He was in demand in his trade and people were always calling asking him to come work for them.
He remarried and the woman was everything my mother wasn't, patient and understanding. We talked on the telephone and for the most part he seemed normal (what ever that is) but much much better after my mother was out of the picture. I think marriage to a different person would have made his life better.
He'd had all the popular treatments, shock, freezing and insulin but none
worked. The medications made him sleep all the time.
By the time I was in my teens he had improved some what. We worked together fabricating and installing commercial kitchens. He still has some paranoia. We'd go to a restaurant and he would tell me that people were talking about him. Talking to him was usually effective. Making him observe the people talking among themselves and only looking at each other would usually move him back into reality.
It takes a great deal of patience. My mother ran out of it and treated him meanly until she divorced him. She really was not the type to have patience. I believe she was going to divorce him years earlier but found herself pregnant and used him to support her.
My sisters and I took care of him as best we could. He'd always held a job and was well paid for it. He was in demand in his trade and people were always calling asking him to come work for them.
He remarried and the woman was everything my mother wasn't, patient and understanding. We talked on the telephone and for the most part he seemed normal (what ever that is) but much much better after my mother was out of the picture. I think marriage to a different person would have made his life better.
21
You judge your mother severely. She has a story, too, of which "wife of a paranoid schizophrenic" and "mother of you" are just two parts. She stayed with him for his money, really? While he was in and out of the hospital? And never heard of child support? Is it possible that she loved him, and did the best she could?
2
This is good news for those with schizophrenia, but I would urge caution about these findings. Schizophrenia, like all illnesses, affects different people in various ways. Bright, reasonably high-functioning people with this illness may benefit from this approach, but many will struggle with finding mental health clinics which will accommodate their needs, and will struggle in making regular appointments to clinics far from their places of residence.
Similar findings about those with depression were made a number of years ago, but it isn't like America has turned a new corner in its fear of mental illness, or its lack of comprehensive treatment for it. Most of us would be lost in the abyss of despair without the few life-saving medications we have for these dreadful diseases. Everybody should see their local doctors about what is available in their area before breaking out the champagne.
11
This good news should be no surprise to any familiar with the science of psychiatric rehabilitation and the peer-led wellness movement, as well to any paying attention to the Open Dialogue movement in Scandinavia.
That only now does such news arrive to Page One suggests the impetuosity of expectations of our American mental health care system lusting for quick and impersonal magic pill fixes of complex neurological and psychological problems.
It also shows the inordinate power of Big Pharma's influence in 3 ways: its undue influence on the clinical trials system, its heavy handed marketing to prescribers, and its strong if subtle influence on media consciousness.
More power to holistic mental heath care, especially to talk therapy and peer self-help. Now let's get Medicaid to pay proper rates for them.
That only now does such news arrive to Page One suggests the impetuosity of expectations of our American mental health care system lusting for quick and impersonal magic pill fixes of complex neurological and psychological problems.
It also shows the inordinate power of Big Pharma's influence in 3 ways: its undue influence on the clinical trials system, its heavy handed marketing to prescribers, and its strong if subtle influence on media consciousness.
More power to holistic mental heath care, especially to talk therapy and peer self-help. Now let's get Medicaid to pay proper rates for them.
11
Of course there is no mention in the article of using the gluten-free diet (and probably also dairy-free) to control. There never is. There is no money in using a diet to control medical problems. As pointed out in another comment, medicine is a business, and the question is who gets paid for treating schizophrenia -- drug companies or talk therapists.
There have been reports going back 50-60 years on the connection between gluten and mental problems, like schizophrenia. Just do a search on schizophrenia and gluten-free.
There have been reports going back 50-60 years on the connection between gluten and mental problems, like schizophrenia. Just do a search on schizophrenia and gluten-free.
2
A few years ago I worked as a student intern at a hospital behavioral health unit, and on several occasions I conducted group therapy sessions that included persons diagnosed with schizophrenia. To my surprise, and contrary to conventional wisdom, several patients with schizophrenia functioned better during group therapy and seemed to experience benefits thereafter as well. When I shared my observations with experienced professionals, their responses alternated between disinterest and amusement. This recent study is consistent with my admittedly unscientific observations.
29
Love heals all.
It is true. "Talk Therapy" or whatever one wants to call it in whatever country is all premised on human love, agape. There is no doubt that this medicine, love, is more potent than any pharmaceuticals out there. If a palpable medicine is needed for any health issue, the first step is to create a healing love relationship and then to use that relationship to hear from the person being healed, what it is that they need to fix their mind or body. And to follow that directive.
It is true. "Talk Therapy" or whatever one wants to call it in whatever country is all premised on human love, agape. There is no doubt that this medicine, love, is more potent than any pharmaceuticals out there. If a palpable medicine is needed for any health issue, the first step is to create a healing love relationship and then to use that relationship to hear from the person being healed, what it is that they need to fix their mind or body. And to follow that directive.
7
Americans talking to psychotics? Good luck with that. We won't even talk to each other anymore, we just Facebook all of our so called friends. Humans are highly social animals and this study proves that we mostly just need to be human with each other. We all crave a good conversation, don't we? Maybe if we invent a therapy robot for schizophrenics, that way we can go on with our normal lives pursuing perceived happiness.
5
When are these “geniuses” going to start institutionalizing the dangerously insane again instead of forcing the rest of us to live and work with them? Pharmaceutical suppression of their symptoms and counseling to act like they “fit in” is not working in too many cases. If all HR, police, and medical records were scanned the ratio of seriously troubled people to those in the headlines is probably 100:1. Instead of warehousing the insane in asylums they have elected to warehouse them within plain site right next to the rest of us. Warehousing is not fixing what is wrong.
2
Where in this article did you see any mention of "dangerously insane" people?
1
This recognition has been a long time coming. Just for perspective’s sake: In 1977, two psychologists, Bertram Karon and Gary Vandenbos published a very readable, lucidly persuasive book titled, Psychotherapy of Schizophrenia: The Treatment of Choice. We could go back further. If you want a taste of how straightforwardly reasonable and humane this approach can be, Google an article (it’s in PDF form) called, The Tragedy of Schizophrenia Without Psychotherapy. You’ll see how we are all more similar than different.
18
I used to work in a chronic long term hospital that treated chronic schizophrenic clients. (They no longer exist). I singled out a few of these patients and spent hours each week in talk therapy with these clients. It did not work for those particular clients
3
not reimbursed by insurance, or at a rate so low no counselor will accept payment.
15
In Berkeley there is a block or two where the schizophrenics hang out. One was a chess master. They let their psychosis reign. I believe they are fed and clothed nearby - sometimes. So perhaps if only the paranoia could be treated and the euphoria or mania not. At minimum these folks need a bed and food - and at present they dont get it
2
I know that research in this area moves at a glacial pace, but the revelations about memory issues being at the root of much of it frustrate me. Fortunately, this study hopefully will open up more interest in the area of failed or broken memory as a direct cause of the illness. At least the study suggest we can't simply medicate this illness away. My layman instincts keep taking me back to failed memory at the root of much of it, and I hope this study will open more research doors to looking at memory issues when treating this at a practical level. http://ajp.psychiatryonline.org/doi/full/10.1176/ajp.156.9.1358
These treatments work, especially those based on Need Adapted Treatment and Open Dialogue, which have some of the highest recovery rates in the world for first episode psychosis. Wunderink published a 2013 article in JAMA showing that people had a much higher functional recovery rate from psychosis when their medications were gradually reduced or discontinued when possible than those on maintenance protocols. We need to rethink how we treat psychosis so we don't overuse the medications which come with very difficult and cumulative side effects. Instead therapies like Open Dialogue, a family based dialogic therapy can really help young people work through their psychoses, re-connect with their families and stay in their lives.
1
Whose involved in talk therapy? It used to be a trained psychiatrist. Today, i'm under the impression-that essentially they are drug managers. What's the likelihood that cuts in budgets-would implement & support this study's findings?
This should be great news but i'm afraid this new method won't be common place anytime soon. First of all, it calls for the reduction of anti-psychotics, something the Big Pharma will lobby the States not to do, not to rewrite the protocols, they'll lose tons of money from Medicaid that pays for the poor schizophrenics including those in our jails. Next, is the "Talk therapy", which means going to a psychiatrist or psychotherapist, again it will cost money and time, along with the chronic shortage of these same professionals in the country, those available don't take Medicaid. Lastly, "Family support", that's a laugh! Now from what i know, many if not most homeless in this country are mentally ill and many suffer from schizophrenia- What "Family Support"? Nice ideas but in our selfish and self centered country , all for not. Money and patience, regarding Money- our society wants more of it, as for Patience, we've got none.
5
Am I wrong to find it depressing that other countries figured this out DECADES ago and it's just now front page news here? I feel sad for all the people who needed this treatment in the US and didn't get it. RIP Kimmy.
3
Decades ago a program called Diabasis in San Francisco used intensive inpatient talk therapy, working with the symbolism experienced in a first psychotic break. The author of the book was John Weir Perry, a Jungian analyst, who reported success with that approach. No medications were given. It has been a long time since I read that book, and I am not claiming that the cases were studied in a statistically rigorous way. But the approach of engaging a person to interact with the content of their mind seems far more promising and respectful and less scary than having to smother that content in an excess of numbing medication. Offering effective therapy in an underfunded community psychotherapy environment is a challenge. That system needs more funding. The article mentions fear of young people who have a psychotic break and may turn violent. Not all of those who do so are schizophrenic. However, if we're serious about limiting mass killings by people who are out of touch with reality or social context, we'd better control access to guns through a fully enforced, national system of background checks for firearms without loopholes.
2
It's nice to see that the United States is hoping to catch up with the rest of western Europe when it comes to these programs, but even these 'early intervention' programs are by no means as good as they say they are, with the possible exception of the Open Dialogue program in Finland. Open Dialogue actively works to try to not put young people on medications and works with the family dynamic by visiting families right in their own homes. The early intervention program I am most familiar with insisted on neuroleptic medications as a condition of staying in the program, and its idea of helping the families was really just a way of getting families on board with the medications and to defer to the authority of the medical staff. The program said it believed in a low drug approach and minimal use of medications, but even what was considered a low dose was way too high for my son. Any attempts by his family to try something new were rebuffed.
In a parallel study, it was found that cancer patients often could not tolerate chemotherapy and discontinued treatment. So doctors halved the dosages and talked to their patients. The patients reported feeling much better during the 2 year study. They would have continued the study for another year, but all the patients were dead. That's what this study is like for schizophrenics. Sheer quackery.
1
I don't think their is anything new in this approach. The therapy as described in the article constitutes a psycho educational model that teaches family members and the afflicted individual strategies to minimize the debilitating effects of the disease with constant monitoring of medication levels to ensure the minimum dosage necessary to help the individual be asymptomatic. I studied this approach in grad school in the 80's and saw it in practice throughout my professional career. The psycho educational model was developed to counteract the zeitgeist of misguided analytic approaches that were applied in the 50,s through the 70;s when schizophrenia was erroneously viewed from the perspective of family dysfunction or a reaction to trauma. Perhaps the above strategy wasnt universally applied but it certainly is not a major innovation.
1
Without talk therapy, I wouldn't be alive today.
Diagnosed with schizophrenia at age 30, I fell into a world of psychosis, paranoia and intermittent catatonia. My first psychiatric hospitalization lasted 8 months and introduced me to the cruelty of seclusion rooms, "five-point" restraints and the "angry hands" of some psychiatric technicians of the Nurse Ratchet variety. The meds of that day -- Haldol, thorazine, prolixin -- made me a more compliant patient but did nothing to silence my screaming thoughts and distorted thinking.
Violent, suicidal, anhedonic, I was hospitalized in Phoenix, Tucson and San Francisco. Despite being advised by more than one psychiatrist to " ... get out (of the marriage)," and "... don't go down with a sinking ship... we've lost her," my husband never gave up seeking appropriate care for me.
His search led us to a San Diego area psychiatrist who described himself as "... an old timey doctor..." a man who used his own unique mix of psychoanalytic training, experience treating prison populations and sense of caring to reach me deep within my crazy world. In fits and starts over several years, using talk therapy, this psychiatrist restored my sanity and salvaged me from the scrap heap.
Even now, almost 40 years later, my husband and I feel truly blessed. And as for that remarkable psychiatrist? Still caring and brilliant, he recently celebrated his 99th birthday.
Diagnosed with schizophrenia at age 30, I fell into a world of psychosis, paranoia and intermittent catatonia. My first psychiatric hospitalization lasted 8 months and introduced me to the cruelty of seclusion rooms, "five-point" restraints and the "angry hands" of some psychiatric technicians of the Nurse Ratchet variety. The meds of that day -- Haldol, thorazine, prolixin -- made me a more compliant patient but did nothing to silence my screaming thoughts and distorted thinking.
Violent, suicidal, anhedonic, I was hospitalized in Phoenix, Tucson and San Francisco. Despite being advised by more than one psychiatrist to " ... get out (of the marriage)," and "... don't go down with a sinking ship... we've lost her," my husband never gave up seeking appropriate care for me.
His search led us to a San Diego area psychiatrist who described himself as "... an old timey doctor..." a man who used his own unique mix of psychoanalytic training, experience treating prison populations and sense of caring to reach me deep within my crazy world. In fits and starts over several years, using talk therapy, this psychiatrist restored my sanity and salvaged me from the scrap heap.
Even now, almost 40 years later, my husband and I feel truly blessed. And as for that remarkable psychiatrist? Still caring and brilliant, he recently celebrated his 99th birthday.
98
When I first read the governmental dollar amount of 25 million, I actually painfully chuckled in disbelief, as we Americans need to totally rebuild our mental health care system in America and in order to do that we need to fully and completely rebuild our full health care system ( not likely ) as it would take billions and not just millions to start to even turn this around. I suspect that none of this will really occur until we transform America nationally in a very comprehensive way and possibly do it outside of government at present possibly to guide the way. This money is also not money held hostage or frozen in offshore bank accounts, however it's money that 'stays in motion' inside and within the economy and recirculates. Maybe 'common sense' might actually be a central component of healing America's severe social and economic disturbance itself. It would seem so.
This is very exciting: less is more. I am waiting by the mailbox to read my copy of the AJP. Since my days of training, megadoses of meds have been used. Most recently this is combined with poly pharmacy of megadoses, for example the rapid increase of dosing of olanzapine to 40 mg, the adding of quetiapine 600 mg and then risperdone 6 mg. Patients got obese, tremulous and zombies. We were taught "rapid haldolization" by our gurus. The new recommendations are revolutionary. Talk to the patient and have patience!
3
Look up the work of Revella Levin. She pioneered this approach decades ago. Unfortunately, the establishment was invested in the pharmacologic approach. Dr. Heinssen is absolutely wrong. Dr. Levin's work was published much more than 7 years ago showing that a well designed one on one approach can cure, yes cure schizophrenia. Again, look up her work-
http://www.ncbi.nlm.nih.gov/pubmed/9220382
J Am Acad Psychoanal. 1996 Winter;24(4):709-36.
Communicating with the schizophrenic superego.
Levin R.
Abstract
The procedure reported here, which I have called "conversations with superegos," raises a number of important questions, both about ordinary versus psychopathological psychic structure, and about technique. There is no space to enter into a lengthy discussion, but a few brief points may be in order. First, let us consider the issue of psychic structure. I have argued that the superego is a hostile agency within the mind whose operations are essentially inimical to the patient's growth and well-being. (As an element of psychic structure, the superego can be distinguished from the ego ideal on the basis of the associated affect, that is, guilt rather than shame. Similarly, it is possible that the superego may be constructed on the basis of identifications that are different than those that may form the basis of the ego ideal). (Abstract Truncated)
http://www.ncbi.nlm.nih.gov/pubmed/9220382
J Am Acad Psychoanal. 1996 Winter;24(4):709-36.
Communicating with the schizophrenic superego.
Levin R.
Abstract
The procedure reported here, which I have called "conversations with superegos," raises a number of important questions, both about ordinary versus psychopathological psychic structure, and about technique. There is no space to enter into a lengthy discussion, but a few brief points may be in order. First, let us consider the issue of psychic structure. I have argued that the superego is a hostile agency within the mind whose operations are essentially inimical to the patient's growth and well-being. (As an element of psychic structure, the superego can be distinguished from the ego ideal on the basis of the associated affect, that is, guilt rather than shame. Similarly, it is possible that the superego may be constructed on the basis of identifications that are different than those that may form the basis of the ego ideal). (Abstract Truncated)
1
My son has schizophrenia.
We have been living with it since an early age for him.
Getting the diagnosis took a long time. I believe he was hallucinating since he was 2. He was under the observation of 2 psychotherapist, but the diagnosis did not happen until he was about 12.
The first psychiatrist, diagnosed him, but really did little to help him. He had a headache, mis diagnosed as migraine. I went a long time trying to help him with it, only to see a general practionier who correctly diagnosed the head ache as Headache, no migraine.
A neurologist was involved, he was treating him for migraine, and when presented with hallucinations, really did nothing.
My son saw demons who were red in color walking up walls, along the ceiling, and in all sizes. They were speaking to him, telling him to kill himself. He was in a classroom, and saw his teachers head come off and fly to the desk top next to him and it spoke to him.
I finally met a psychiatrist through the Kaiser system, and we were able to dry the hallucinations and the voices up.
It has taken a long time to finally get to a therapist who is having the one on one sessions with him. My son I a wonderful person, who is kind and gentle, very intelligent. He now just wants to have a job. He wants to help with things around the house. He is smart as a whip, reads at the college level.
I still struggle to find resources for him.
We have been living with it since an early age for him.
Getting the diagnosis took a long time. I believe he was hallucinating since he was 2. He was under the observation of 2 psychotherapist, but the diagnosis did not happen until he was about 12.
The first psychiatrist, diagnosed him, but really did little to help him. He had a headache, mis diagnosed as migraine. I went a long time trying to help him with it, only to see a general practionier who correctly diagnosed the head ache as Headache, no migraine.
A neurologist was involved, he was treating him for migraine, and when presented with hallucinations, really did nothing.
My son saw demons who were red in color walking up walls, along the ceiling, and in all sizes. They were speaking to him, telling him to kill himself. He was in a classroom, and saw his teachers head come off and fly to the desk top next to him and it spoke to him.
I finally met a psychiatrist through the Kaiser system, and we were able to dry the hallucinations and the voices up.
It has taken a long time to finally get to a therapist who is having the one on one sessions with him. My son I a wonderful person, who is kind and gentle, very intelligent. He now just wants to have a job. He wants to help with things around the house. He is smart as a whip, reads at the college level.
I still struggle to find resources for him.
62
You are an outstanding father, which also informs me about why your son is so kind and outstanding. Keep telling the story about your son's struggle and your loving dedication to his cause to become a happy and productive individual. Please know you are not alone. You show us all the best side of our humanity.
2
While this study is certainly welcome and overdue, as someone with decades of experience within my family of the short and long term damages that can come from the use of anti-psychotic and other psychiatric drugs, with or without talk or other therapies, it continues to sadden me--or worse--that the remarkably effective methodologies and technologies of Dianetics and Scientology are so widely ignored or maligned in the mainstream media and the mental health community and professions.
Talk? Where's the Big Pharma margin in talk? Take your anti-shyness pill & speak up for greater profits, that's the only talk Big Pharma's snake oil salesmen want to hear.
9
Anybody who has visited a Canadian hospital psych ward will know that the crying need is for a human being to talk to. Fellow patients are distrustful of one another and there are few visitors who are not distraught family members. On occasion, as a chaplain, I have visited psych wards to visit family members of my residents and inevitably, when other patients see that I am sitting and talking with a patient, will come over, line up, and request a talk session after I have finished with the one I have come to visit.
Yes, it is productive and doesn't see chemical/drug management as the one and only route to offering care. There is no quick fix however and it takes great patience. One must also be willing to work through the layers of protection that have been built up to compensate especially in cases involving abuse and trauma.
Yes, it is productive and doesn't see chemical/drug management as the one and only route to offering care. There is no quick fix however and it takes great patience. One must also be willing to work through the layers of protection that have been built up to compensate especially in cases involving abuse and trauma.
18
Thanks so much for your comment. My son's college chaplain visited him at CAMH in Toronto and prayed with him. This was a turning point for my son, who had stopped eating. resigned himself to death, and was just about to be given electroshock. Were it not for the chaplain . . .
Does "drug-related" substances include such as LSD, magic mushrooms, and peyote? Or is it still a sin, a crime to suggest such? We need to get beyond our fear of what is already available from Mother Nature and avoid drugs.
3
They tried LSD in the psych hospitals in the 60s i believe, and the results were the patients jumped out of the windows (thinking they could fly) - killing themselves.
You got it brother.
I am very sympathetic to those who suffer mental disorders. However, there are some professions that should be off limits to individuals with severe issues like schizophrenia, even if the disease is treated and the person is functional. Nursing is one of those. Flying planes another. While I admire the courage of the young woman who enrolled in nursing school, this is not the wisest profession for those with mental disorders. We need to be compassionate and not stigmatize people with mental (or physical) illnesses. But there should be some boundaries around certain professions.
12
If we want to restrict the professions associated with mental health, we should NOT limit the disability payment (i.e. SSDI) options available as alternative income sources. We should also be careful about like this year where those payments are significantly reduced because medicare may jump $100+ while income does not go up resulting in an unstable/unreliable income for those with mental illnesses.
1
Wow. What an incredibly disheartening comment.
This study confirms what mental health advocacy groups have been saying for years. Medication alone is insufficient. Give people pills and send them into the community without support is not the solution. Unfortunately the pharmaceutical companies and the medical world are proposing crisis control treatments that although they do help do not give the mentally ill the care needed to deal with the disease. It's basically a question of money. Pills cost less than trained personnel.
80
The article suggests that all those patients who stop taking antipsychotics do so because of side effects. This is untrue. Because of the nature of their illness many patients do not comply with the medications, forget to take them, or once their symptoms decrease as result of the medications decide they no longer need them and stop taking them. In fact, compliance significantly increases when patients are given injections of antipsychotics that last 2-4 weeks.
And the study is fine but I'd like to know where they are going to find therapists who can provide psychotherapy to patients with schizophrenia. We have a severe shortage of psychiatrists in this country and most psychologists and social workers are not trained to deal with patients with active schizophrenia. And family support is fine for those who have intact families but many of those with this disease do not have this.
And yes catching patients during the first psychotic break markedly improves outcome but again most of these patients need to be diagnosed by primary care physicians, most of whom have little training in the diagnosis of mental illness.
And the study is fine but I'd like to know where they are going to find therapists who can provide psychotherapy to patients with schizophrenia. We have a severe shortage of psychiatrists in this country and most psychologists and social workers are not trained to deal with patients with active schizophrenia. And family support is fine for those who have intact families but many of those with this disease do not have this.
And yes catching patients during the first psychotic break markedly improves outcome but again most of these patients need to be diagnosed by primary care physicians, most of whom have little training in the diagnosis of mental illness.
1
It's not clear to me how studies about mental illness can allow for all the variables of being human. How do you control for drug use, family relationships, and the million and one other bits and pieces that affect whether talk therapy is effective? I would like to believe anything hopeful, but I am skeptical about the effectiveness of talk therapy for those whose lives are chaotic and whose mental states are precarious.
1
I think it's just really important to read what the findings from talk therapy were and be very careful about reading too much into it. The talk therapy is purported to do the following:
"... the person with the diagnosis learns tools to build social relationships, reduce substance use and help manage the symptoms, which include mood problems as well as hallucinations and delusions."
And the claim is that success was measured "using standardized checklists that rate symptom severity and quality of life, like whether a person is working, and how well he or she is getting along with family members."
Those are very modest goals and the possible outcomes in turn are very modest. And they absolutely do not suggest stopping meds. They do suggest considering experimenting with reducing dosages.
"... the person with the diagnosis learns tools to build social relationships, reduce substance use and help manage the symptoms, which include mood problems as well as hallucinations and delusions."
And the claim is that success was measured "using standardized checklists that rate symptom severity and quality of life, like whether a person is working, and how well he or she is getting along with family members."
Those are very modest goals and the possible outcomes in turn are very modest. And they absolutely do not suggest stopping meds. They do suggest considering experimenting with reducing dosages.
This is a no brainer. "Buckets of pills," is what one psychiatrist in a large state institution answered, when I asked what therapy patients received. Pills are a lot easier, and cheaper too. Except for the side effects. Half the folks I know who aren't "psychotic" are still on antidepressant and anti-anxiety meds. I see the effects over the years, and I think we are an over-medicated society.
http://www.thecriticalmom.blogspot.com
http://www.thecriticalmom.blogspot.com
1
Antidepressants and anti-anxiety medications are not indicated for the treatment of psychosis. Those folks you know must be being treated by doctors who have no idea what they are doing. I don't know about Germany but there are many excellent academic departments of psychiatry in NYC where practitioners would certainly know this.
Baloney!, I know first hand that involving the family is degrading to the soul and personality and destroys the family relationships, for many years.
I know for a fact, that cops who have cold robot personalities routinely judge people they encounter of any degree of anger as mentally unfit and they take them to hospitals ( that make money ) to be evaluated and ultimately judged mentally unfit and relegated to a lifetime of soul destroying stigma.
Long Island, where this study originated, is a capitol of this kidnapping and I'll bet the incidence of mental diagnosis is highest here.
I know. I'm a victim of the system. I'll be leaving the evil empire state in the future.
I know for a fact, that cops who have cold robot personalities routinely judge people they encounter of any degree of anger as mentally unfit and they take them to hospitals ( that make money ) to be evaluated and ultimately judged mentally unfit and relegated to a lifetime of soul destroying stigma.
Long Island, where this study originated, is a capitol of this kidnapping and I'll bet the incidence of mental diagnosis is highest here.
I know. I'm a victim of the system. I'll be leaving the evil empire state in the future.
I don't understand why so many people, including researchers and clinician, don't understand the value of treatment which utilizes both meds and talk therapy.....this just seems like common sense to me. Yes, I understand that scientist and researchers are always looking for data, but come on folks, medicine alone or talk-therapy alone is intuitively NOT better than a rational combination of both. It's about balance, like most aspects of living.
2
Well, the drug companies won't be happy with this, but the medications given for psychotic disorders all have terrible side effects. The less of these the better. A structured day, physical activity, healthy diet, creative outlets, loving family support, skills-based therapy, and staying substance - free, along with the minimum dose of medication needed. This is a recipe for success and for hope.
But it will take more resources and funding than we as a society are currently willing to give. Let's hope for the best, and for more, in the future.
But it will take more resources and funding than we as a society are currently willing to give. Let's hope for the best, and for more, in the future.
1
Could you tell me of any drug for any disease that doesn't cause major side-effects. There are 16,000 deaths in the U.S. per year related to the use of the nonsteroidal anti-inflammatory drugs such as ibuprofen and thousands more related to the use of Tylenol.
The idea that it is only psychiatric drugs that can have bad side-effects is ludicrous and only demonstrates an anti-psychiatry bias by those who perpetuate it.
The idea that it is only psychiatric drugs that can have bad side-effects is ludicrous and only demonstrates an anti-psychiatry bias by those who perpetuate it.
1
It's a wonderful coincidence that in the Times "couch" blog, Christopher Bollas, a psychoanalyst, just a few days ago published an account of treating a patient with schizophrenia using talk therapy. The early comments to his article suggested that such treatment was irrational and irresponsible. This study shows how mired in conventional thinking such views are. I have found in my own work as a clinical psychologist that listening and thinking together with a schizophrenic about the difficult and painful situation they find themselves in is healing. Just helping them grasp that their minds are worthy of being understood is often a huge step.
4
Community mental health centers are woefully understaffed and underfunded now. Social workers and psychologists have huge caseloads; their current clients can go for very long periods without so much as seeing their assigned counselors. Under our current mental health system, there just aren't sufficient therapists to provide the additional one-on-one talk therapy that this research shows can be valuable. And don't expect to see a crush of students studying social work should there be, increased demand for their services semikolon
1
between schizophrenia, bipolar, severe depression and many other mental illnesses there are a lot more people than you can imagine. look around, folks who you think are normal like you and me and struggling. reach out, give them a hand, help your fellow man/ woman.
1
Good luck trying to find therapists for early intervention. In this country, it is nearly impossible for the uninsured to find low-cost or free therapy, unless you have proven to be a threat to yourself or others.
If it wasn't for non-profit mental health centers, even those who try to seek help would be completely helpless.
If it wasn't for non-profit mental health centers, even those who try to seek help would be completely helpless.
2
If you disagree - and once the trembling subsides - we'll both kill you! Just more too-late pharmacological claptrap. Shame on all of you for treating humans like lab rats.
I hope this starts a trend. I'm all for meds that work but many meds in America are too high a dosage--it's as if the objective is to just make the patient pliable and then just make them behave with no further understanding of their condition. And a result is that a lot of people will "go off" the med because it makes them uncomfortable. Another drug whose dose is way too big is the med they give to opiate addicts called Suboxone. It's 200 times the potency of morphine and it's prescribed in 8 mg pills or sub-lingual film. It doesn't get addicts "bombed"because of an ingredient in it but it makes it so hard to get free of the drug. A person can't cut pills into micrograms accurately. In Europe they make dosages in micrograms so that a person can taper down. But in America they are hammering people into a new addiction and billing for it big time.
2
The American community mental health system is woefully understaffed and underfunded. Social workers and counselors have huge caseloads; their clients can go very long periods of time without even seeing therapists. There simply won't be enough therapists to timely provide the one-on-one talk therapy that this study shows to be helpful, without radical change to our mental health system.
1
What you fail to mention is that very few of those social workers and therapists are trained to treat patients with schizophrenia.
1
What better way to destroy a witness and their credibility?
Russia has the Gulag.
America has the Mental health profession.
I'm with the Tea Party now. Take no prisoners.
Russia has the Gulag.
America has the Mental health profession.
I'm with the Tea Party now. Take no prisoners.
The author needs to remove the reference to mass shootings. There is absolutely no connection in the substance of the article between schizophrenia and mass killings. The suggestion makes it sound as if anyone with a schizophrenic diagnosis is a mass killer, which only stigmatizes mental illness further and is irresponsible journalism I'd expect from FOX but not the NYTimes. Please retract. Otherwise, great article.
2
If this combined therapy is ever studied in the rest of the population that suffers from schizophrenia (i.e.: non first break patients), they surely would thrive significantly better also. The question is where will the money come from to pay for clinicians to provide the extra time? Common sense dictates that the bond that forms from spending more time with these lost souls is always stronger therapeutically. Staffing numbers must be adequate or better to allow this combination therapy. People often confuse taking less time as having efficiency. It's certainly less expensive to just have medication management in the short run but while restoring the person's humanity requires more resources and perhaps more time, it would prove less expensive in the long run. And it's the right thing to do.
5
The problem is that psychotherapy is very expensive, and pills are comparatively cheap. That is why the vast majority of people receive medication that often doesn't work, and rarely get any really effective treatment. This is true not just for psychosis, but also for anxiety and depression. SSRI's are notoriously ineffective. Anxiolytics work fairly well but are also quite addictive. What it boils down to is the unwillingness of health insurance companies to pay for treatment that actually works, and the profound financial interest that pharmaceutical companies have in promoting the use of psychiatric drugs.
2
Actually, the mental health process makes you worse. It reinforces the idea that you are sick and degrades your self esteem. The stigma destroys your soul. Talk therapy makes you worse.
I'll bet it's been a long time since the Doctor talked to patients.
How about a study comprised of the opinions of patients?
I ask........if a patient takes their medicine regularly and it is supposed to be a cure, why do patients have to see the professionals for years? Why are people still considered sick?
The mental health field is highly profitable with very low overhead. That's why patients are kept on drugs and in talk therapy.
The mental health field is already a government scam to destroy lives and make money in many instances.
I'll bet it's been a long time since the Doctor talked to patients.
How about a study comprised of the opinions of patients?
I ask........if a patient takes their medicine regularly and it is supposed to be a cure, why do patients have to see the professionals for years? Why are people still considered sick?
The mental health field is highly profitable with very low overhead. That's why patients are kept on drugs and in talk therapy.
The mental health field is already a government scam to destroy lives and make money in many instances.
I have always thought that drugs were more effective than talking therapy but that psychiatrists like to think that talking to them is a great benefit. Tell me this. They manipulated 2 controls -- the dosage of drugs and the amount of talk therapy. How do they know that cutting the dosages in half wasn't the sole cause of the improved treatment and that the talking therapy was more helpful to the shrinks than it was to the patients?
This is wonderful and welcome news. In addition to providing adequate resources to the drastically under-funded and under-staffed community mental health centers for needed therapy for those with mental illness, there is another necessary piece to this puzzle.
All communities should be required to have police officers receive certified "Crisis Intervention Training" which educates on the general, unmistakable signs and symptoms of various faces of serious mental illness, whether psychosis, bipolar, schizophrenia, and how to respond. Working hand in hand with officers, an on-call Mobile Crisis Unit of professionals, ideally from the mental health department, can be called onsite or in-home to assess whether psychiatric evaluation is needed and obtain a court order to transport the person to a hospital with a psychiatric unit. Parents, families or friends can also contact the Mobile Crisis Unit directly for assessment.
Here in Charleston a special mental health court is available 24/7 for Mobile Crisis teams to obtain immediate orders from a judge. If hospitalization is deemed necessary, the mental health court follows up on the judge's order for mandatory treatment and compliance with medications for periods up to three years.
After much research, I have learned that few cities, other than Charleston and Nashville, have a seamless, fully implemented program like ours to ensure that a person is not a danger to himself or others. Cities need these resources NOW!!!
All communities should be required to have police officers receive certified "Crisis Intervention Training" which educates on the general, unmistakable signs and symptoms of various faces of serious mental illness, whether psychosis, bipolar, schizophrenia, and how to respond. Working hand in hand with officers, an on-call Mobile Crisis Unit of professionals, ideally from the mental health department, can be called onsite or in-home to assess whether psychiatric evaluation is needed and obtain a court order to transport the person to a hospital with a psychiatric unit. Parents, families or friends can also contact the Mobile Crisis Unit directly for assessment.
Here in Charleston a special mental health court is available 24/7 for Mobile Crisis teams to obtain immediate orders from a judge. If hospitalization is deemed necessary, the mental health court follows up on the judge's order for mandatory treatment and compliance with medications for periods up to three years.
After much research, I have learned that few cities, other than Charleston and Nashville, have a seamless, fully implemented program like ours to ensure that a person is not a danger to himself or others. Cities need these resources NOW!!!
8
As a long time advocate for people using the public mental health system, I applaud the results of the study if it reduces the long term use of dangerous anti-psychotic drugs which I, myself have taken. It is far past time to explore many non-drug alternatives since the effects of the drug often can be devastating. I have personally experienced many of them including tremors, sedation, numbing of emotions, and significant weight gain which then resulted in sleep apnea, metabolic syndrome, and disabling arthritic knee pain.
Others experience worse problems from taking these medications from the time they were promoted as a second-generation miracle drugs with few side-effects. They were not but were about the same as the drugs for schizophrenia used in the 1950s. The profit driven drug companies have continued benefitting from questionable marketing promises and fraud at the expense of desperate patients.
Additionally zealous advocates for these drugs have changed the laws in nearly every state to make it much easier to force people to take these drugs no matter what the negative side-effects are. Complaints about the drugs are ignored by court order and helpless patients suffer and remain disabled.
Now, bills in Congress by Rep. Murphy are trying to make forced treatment with the drugs a federal mandate and prevent patients from using lawyers to help them obtain safer treatments they want and need.
Hopefully, this study will put an end to those bills.
Others experience worse problems from taking these medications from the time they were promoted as a second-generation miracle drugs with few side-effects. They were not but were about the same as the drugs for schizophrenia used in the 1950s. The profit driven drug companies have continued benefitting from questionable marketing promises and fraud at the expense of desperate patients.
Additionally zealous advocates for these drugs have changed the laws in nearly every state to make it much easier to force people to take these drugs no matter what the negative side-effects are. Complaints about the drugs are ignored by court order and helpless patients suffer and remain disabled.
Now, bills in Congress by Rep. Murphy are trying to make forced treatment with the drugs a federal mandate and prevent patients from using lawyers to help them obtain safer treatments they want and need.
Hopefully, this study will put an end to those bills.
3
“The more holistic approach that the study tested is based in part on programs in Australia, Scandinavia and elsewhere that have improved patients’ lives in those countries for decades.”
Ask yourselves why this study was the first test of its kind in the U.S. even though the results of an emphasis on ‘talk therapy’ were widely known. Answering that question provides a window into mental & physical health care in this country.
For-profit corporations, to include health Insurance companies and pharmaceutical drug-makers, dictate levels of reimbursement, what procedures & treatment plans are approved, and what is adopted as ‘standard of care’. They fund research, via grants and other quid pro quo mechanisms, if they think it will result in ‘greater efficiencies’ (i.e. greater profit). This research then takes on a life of its own as it is disseminated, published, taught in training programs, then offered to patients. There is something sinister when the underlying manifestation derives from the pursuit of profit not the desire for better care. I think that is a distinction with a meaningful difference. One that is relevant when considering why we are, with greater frequency, falling behind the rest of the developed world. The AMA shares culpability here.
Will providers now reimburse for extended tx. needs given they resist long-term talk therapy that has also been shown to be effective irrespective of what the ‘time limited’ cabal preach? Not while profit trumps care.
Ask yourselves why this study was the first test of its kind in the U.S. even though the results of an emphasis on ‘talk therapy’ were widely known. Answering that question provides a window into mental & physical health care in this country.
For-profit corporations, to include health Insurance companies and pharmaceutical drug-makers, dictate levels of reimbursement, what procedures & treatment plans are approved, and what is adopted as ‘standard of care’. They fund research, via grants and other quid pro quo mechanisms, if they think it will result in ‘greater efficiencies’ (i.e. greater profit). This research then takes on a life of its own as it is disseminated, published, taught in training programs, then offered to patients. There is something sinister when the underlying manifestation derives from the pursuit of profit not the desire for better care. I think that is a distinction with a meaningful difference. One that is relevant when considering why we are, with greater frequency, falling behind the rest of the developed world. The AMA shares culpability here.
Will providers now reimburse for extended tx. needs given they resist long-term talk therapy that has also been shown to be effective irrespective of what the ‘time limited’ cabal preach? Not while profit trumps care.
14
There are those of us in the mental health field who have long despaired over the trend to only administer drugs to the mentally ill, while ignoring the benefits of talk therapy. There are those of us who have also known for a long time that drugs were never meant to be a replacement for talk therapy, but only a supplement. When one schedules patients for fifteen minute appointments, writes a scrip, conducts a five minute verbal check-in, billing hours increase exponentially. (I have witnessed this first hand.) Bona fide, effective therapy takes time!
If Medicare and Medicaid will attach some teeth to their recommendation to implement combination therapy for schizophrenics, the outcome promises to be significant. I can only hope that those psychiatrists and M.D.'s, who practice drugs only treatment, take this study seriously, and will do the right thing even if it means losing easy Medicare/ Medicaid income in the process.
If Medicare and Medicaid will attach some teeth to their recommendation to implement combination therapy for schizophrenics, the outcome promises to be significant. I can only hope that those psychiatrists and M.D.'s, who practice drugs only treatment, take this study seriously, and will do the right thing even if it means losing easy Medicare/ Medicaid income in the process.
4
This study is huge and representative of the types of treatments which are proving most effective for all variety of severe mental illnesses. It amounts to a use of Recovery Mode, harm reduction l & rehabilitative techniques which research-clinicians who recognize the severely mentally ill are as capable of functioning, working & thriving - just as any other "different," minority group in this nation - have been advocating for for years. I've written about how such techniques need to be applied to people battling long-term eating disorders as well. There was a landmark study in Australia which showed astounding success with individuals with long-term anorexia, using very similar approaches. The time has come to stop trying to make the severely mentally ill invisible by medicating us into zombies. Recognize that just because our minds are different, and that we don't conform to subjective, cultural and consumeristic norms - doesn't mean we aren't capable of being productive, contributing members of society. We would much rather be functioning members of society than sit around subsisting off of handouts from the government. Why is it only nations such as Australia, Sweden & Finland recognize our full humanness?! I'm grateful to the Times for covering this very important research. The United States' prejudicial view of the "mentally ill" (who in actuality simply have psyches whose colors vary from the dominant classes) must stop. Studies continue to show drugging doesn't work.
2
It's a known fact that the federal government uses the mental health profession and "Talk Therapy" to interrogate unwitting people. I read about it 20 or 30 years ago.
The study was federally financed. Further reporting is necessary.
You are guilty before you prove your innocence.
The study was federally financed. Further reporting is necessary.
You are guilty before you prove your innocence.
Great news! The adverse effects of anti-psychotic medications have long made life more difficult for schizophrenics. The hope of being able to get good results with lower doses is a real step in the right direction. Like many illnesses, schizophrenia can vary in severity. Some folks do very well after a single psychotic break; others are severely disabled by the disease. Treatment is not, therefore, one size fits all. It is great to have studies backing up the possibility that less may be more and affirming the value of psychotherapy at least for some patients.
5
Wonderful news.
2
How many hours per week was 'talk' therapy given?
1
This is great news. I did not know anyone was doing this sort of work here in the U.S. and I am so happy to learn of this and their success. My great uncle had schizophrenia and was committed to various mental institutions beginning in the 1940s when he was in his early 20s. The illness robbed him of his life and to say that he suffered is an understatement. So it is wonderful to know that young people now may not have to go through what he did. And that's what progress is all about. Hats off and all my gratitude to the many people who worked on this project.
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As the first antipsychotics didn't become available until the mid 1950s. it would have been impossible for you uncle to be treated with them in the 1940s. He couldn't have responded to drugs that weren't available.
I second that! My brother has lived with schizophrenia for 16 years -- without the benefit of services like this, it's been a tough road to say the least. I've since launched a nonprofit effort aimed at raising public awareness about early intervention for psychosis - check it out psychosisprevention.org.
Human interaction is found to be more effective than drugging them numb? What a concept!
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The absurdity of this wretched country is beyond parody. Maybe we should have just threw them all in jail for $31k per year per 'patient' because employing prison guards is more effective than hiring a counselor for $2k/patient. Anyone ready to stand up for the defenseless or are you still too busy blowing up whole countries for having different social norms than you?
Google the Soteria Project, created by Dr. Loren Mosher in the 1960's - 1980ss. This successful program of therapy was shut down presumably due to the influence of the drug companies.
This research is a replication of what he found more than 40 years ago.
Dr. Mosher quit the American Psychiatric Association because it was heavily influenced by the drug companies.
I expect that there will be attempts by Big Pharma to discredit this finding as well.
This research is a replication of what he found more than 40 years ago.
Dr. Mosher quit the American Psychiatric Association because it was heavily influenced by the drug companies.
I expect that there will be attempts by Big Pharma to discredit this finding as well.
45
Most of the investigators for this trial have received money from drug companies. Perhaps it's not as corrupt as you think it is?
"expect that there will be attempts by Big Pharma to discredit this finding as well."
I don't see why "Big Pharma" would be motivated to do that, as the study casts no doubt on the usefulness of medication in schizophrenia. That is not in doubt. Questioning it is pretty much like questioning evolution, or suggesting the moon landing was a hoax. Are there controversies about medications - which is better, how they work, finessing dosages, side effects, and a million other questions - yes absolutely there are many questions, but there are no psychiatrists and no studies anywhere suggesting that antipsychotic medications are not often very effective in alleviating the symptoms of schizophrenia.
I don't see why "Big Pharma" would be motivated to do that, as the study casts no doubt on the usefulness of medication in schizophrenia. That is not in doubt. Questioning it is pretty much like questioning evolution, or suggesting the moon landing was a hoax. Are there controversies about medications - which is better, how they work, finessing dosages, side effects, and a million other questions - yes absolutely there are many questions, but there are no psychiatrists and no studies anywhere suggesting that antipsychotic medications are not often very effective in alleviating the symptoms of schizophrenia.
This is a very dangerous issue. My stepdaughter was schizophrenic for over 30 years and if she was not treated with medication, she would be in great danger and danger to others.
By the way, she was in talk therapy the entire 30 years and medicated so what does that tell you? Please do not believe talk therapy is the answer alone. Please!
By the way, she was in talk therapy the entire 30 years and medicated so what does that tell you? Please do not believe talk therapy is the answer alone. Please!
13
No one said that psychotherapy was "the answer along." The article speaks of reducing the amount of meds needed and improving quality of life. The quality of psychotherapy also matters. For some it has often been nothing more than a brief med 'check-in' before the prescription is written. The study is advocating actual therapy, which focuses on life issues.
That said, there will always be subgroups for whom more meds may be necessary.
That said, there will always be subgroups for whom more meds may be necessary.
15
That is not what the study showed, patient we on drugs and had talk therapy/community support.
1
My stepdaughter was not over medicated and had both a social worker and a therapist that she saw 3 times a week. I also provided her with a lawyer that she could call if she had any problems with the home she stayed it. I was in touch on a daily basis with all of them. Lucky that I had the money to provide all this. My point is that she was a severe case - a woman who was the first woman at Dartmouth and a civil engineer. I had to chase her all over the states and Europe when she became so paranoid that she would stalk high level politicians she thought could save her.
It has been a few years since she passed away - a fluke within the medical community and I still feel the pain from this loss as I loved her so very much.
Again, my point is that you can have all bases covered but some people just are not capable of not being medicated.
It has been a few years since she passed away - a fluke within the medical community and I still feel the pain from this loss as I loved her so very much.
Again, my point is that you can have all bases covered but some people just are not capable of not being medicated.
My guess is there will be a lot of resistance to these published findings from drug companies, insurance companies, and all the MD's whose lives depend on being able to prescribe and administer these agents.
8
If you are going to be cynical, you might note that this was published in the American Journal of Psychiatry and what it is arguing for is more work for psychiatrists and how the government should spend more Medicaid money on psychiatrists. This study lays the groundwork for more government money for the people who published the study.
FYI, most psychotherapists are *not* skilled in working with people who have paranoid schizophrenia! It's different. You have to deal with memory problems, executive skills dysfunction, and other symptoms of psychosis not found in most therapy patients to this degree.
My disabled daughter's first therapist refused even to listen to voicemail messages from me (perfectly legal under HIPAA--it's giving info that's forbidden). And I am my daughter's legal guardian! Lacking crucial info about her specific disorder, the therapist fired her for not following through on things she'd agreed to do (but had not registered due to attention problems, forgotten due to memory problems, or could not do secondary to paranoia).
Many therapists refuse to treat people with psychotic disorders. Some are aware that they lack needed skills. Others share the public's paranoia about people with mental illness (especially psychotic disorders). Many covertly stigmatize them. Proper training is vital!
My disabled daughter's first therapist refused even to listen to voicemail messages from me (perfectly legal under HIPAA--it's giving info that's forbidden). And I am my daughter's legal guardian! Lacking crucial info about her specific disorder, the therapist fired her for not following through on things she'd agreed to do (but had not registered due to attention problems, forgotten due to memory problems, or could not do secondary to paranoia).
Many therapists refuse to treat people with psychotic disorders. Some are aware that they lack needed skills. Others share the public's paranoia about people with mental illness (especially psychotic disorders). Many covertly stigmatize them. Proper training is vital!
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daughter desperately needed--and received--antipsychotic medication when she developed a psychotic break during her attempt at college.
As she stabilized, talk therapy was increasingly helpful but medication was still vital. She was enduring emotional torment minute-by-minute, and could not have survived the agonizing days between therapy appointments, even if they'd occurred twice weekly (insurance restricted them to monthly). (An ACT team was not in the cards, since she'd only been hospitalized twice.)
That said, I think once she was stable her medications should have been gradually reduced, since they caused a quick 100-pound weight gain. She was ravenous 24 hours a day. This was a health hazard, damaged her morale, and put her into another category of people despised by the community (especially when she would use food stamps to buy a treat).
However, she was very aware of her painful symptoms and participated eagerly in her medication treatment since it did reduce the symptoms to a level she could tolerate.
Now, 15 years later, she's employed part-time, married, and stable. The medications are being titrated downward, and she's lost nearly 50 pounds so far. She's been using me, her father, and her mother-in-law for informal talk therapy for years, but we're getting old and she's agreed to try again to find a good therapist. They're rare...
As she stabilized, talk therapy was increasingly helpful but medication was still vital. She was enduring emotional torment minute-by-minute, and could not have survived the agonizing days between therapy appointments, even if they'd occurred twice weekly (insurance restricted them to monthly). (An ACT team was not in the cards, since she'd only been hospitalized twice.)
That said, I think once she was stable her medications should have been gradually reduced, since they caused a quick 100-pound weight gain. She was ravenous 24 hours a day. This was a health hazard, damaged her morale, and put her into another category of people despised by the community (especially when she would use food stamps to buy a treat).
However, she was very aware of her painful symptoms and participated eagerly in her medication treatment since it did reduce the symptoms to a level she could tolerate.
Now, 15 years later, she's employed part-time, married, and stable. The medications are being titrated downward, and she's lost nearly 50 pounds so far. She's been using me, her father, and her mother-in-law for informal talk therapy for years, but we're getting old and she's agreed to try again to find a good therapist. They're rare...
68
Not exactly sure how a weight gain caused her to be on food stamps. Would guess the illness caused her to be on food stamps. Glad they were able to help her.
2
The anti psychotic medication altered her appetite which made her hungry all the time for sweets which led to her being in a check out line with sweets that she paid for with food stamps.
Unfortunately, there are people that think if someone is on food stamps they have a right to judge their food purchases which leads to someone with very difficult to control cravings from a medication to be further stigmatized as a result of their illness.
Unless you've taken anti psychotic meds and experienced the cravings first hand (I have) you really can't imagine them. It's hard to explain how strong the urge to eat fattening sweets is, it's an insatiable hunger and the weirdest most intense med side effects I encountered. We stigmatize people with mental illness, fat people, poor people that buy food we think they should avoid with food stamps... I think you misunderstood the original comment.
Unfortunately, there are people that think if someone is on food stamps they have a right to judge their food purchases which leads to someone with very difficult to control cravings from a medication to be further stigmatized as a result of their illness.
Unless you've taken anti psychotic meds and experienced the cravings first hand (I have) you really can't imagine them. It's hard to explain how strong the urge to eat fattening sweets is, it's an insatiable hunger and the weirdest most intense med side effects I encountered. We stigmatize people with mental illness, fat people, poor people that buy food we think they should avoid with food stamps... I think you misunderstood the original comment.
For those who think of or treat medicine as a business, the question is who gets paid for treating schizophrenia -- drug companies or talk therapists. Drug companies are organized and lobby as a group, and many of them are huge. Talk therapy is provided by individuals, and whether they are individual entrepreneurs or work for a larger hospital, clinic, or group practice, most of the money winds up with them (since they are highly paid) and not the business owners or stockholders. In the case of drugs, those who prescribe and administer the drugs are not paid very much in comparison to the total cost of the therapy.
So pharmaceutical companies and the financial community of stockholders and brokers and investment advisors will get more business and more money if schizophrenia is treated by drugs. In pursuit of their own self-interest, they will try, have tried, and have succeeded in advancing such treatment. Studies recommending other forms of treatment are swimming against the tide, and are unlikely to be funded by drug companies or by any entity where drug companies or the financial community have clout.
This is how free enterprise works, and why medicine is and should be, at its heart and essence, not a business, but rather something where business plays an essential but subordinate role. Any arrangements to that effect will be steadily eroded by a free enterprise economy and must be constantly guarded and defended. We dont do that very much these days.
So pharmaceutical companies and the financial community of stockholders and brokers and investment advisors will get more business and more money if schizophrenia is treated by drugs. In pursuit of their own self-interest, they will try, have tried, and have succeeded in advancing such treatment. Studies recommending other forms of treatment are swimming against the tide, and are unlikely to be funded by drug companies or by any entity where drug companies or the financial community have clout.
This is how free enterprise works, and why medicine is and should be, at its heart and essence, not a business, but rather something where business plays an essential but subordinate role. Any arrangements to that effect will be steadily eroded by a free enterprise economy and must be constantly guarded and defended. We dont do that very much these days.
125
There is some validity to what you say but there is also a downside of a healthcare system with no profit motive. Over her in the UK the latest headlines are that a recent exhaustive study deemed nearly 3 in 4 NHS hospitals unsafe. When you register with your local GP you must register with the one in your 'catchment' -- like a school district in America. While US doctors order more X-Rays and MRI's and blood tests than are needed (profit motive) the NHS doctors order to few (rationing). Wait times can also be frustratingly long. You can buy private insurance in the UK but they will not cover ANY pre-existing conditions.
It's easy to bemoan the profit system in America but once you experience the opposite you are far more likely to see the upside.
It's easy to bemoan the profit system in America but once you experience the opposite you are far more likely to see the upside.
Yes indeed. Your comment should be engraved in every wall of every medical/psychiatric institution, and it should be the epigraph for this article. Those needing the treatment described herein could have been spared muc pain and misery if these **common sense ** treatments had been administered for years.
Much better approach than playing a kind of drug roulette that has strong side effects and has to be changed up or adjusted from time to time.
17
This makes a lot of sense. The problem is funding and availability of therapists wherever they are needed, in the numbers needed, in populations that are naturally difficult to get to treatment and in healthcare systems that are setup to keep offering the least expensive option.
This is both great and bad news for as long as we mete out care as oppose to offer it. Psychotherapy is one of the most difficult services to get funded even with the best insurance plans. Even then, the cost to patients in CoPays is prohibitive. The hoops through managed care are discouraging and this adds an extra layer of difficulty in an already complex situation. I hope special measures are in place to make it a lot easier for these patients. They deserve better care and this seems a lot better than what is currently in place.
This is both great and bad news for as long as we mete out care as oppose to offer it. Psychotherapy is one of the most difficult services to get funded even with the best insurance plans. Even then, the cost to patients in CoPays is prohibitive. The hoops through managed care are discouraging and this adds an extra layer of difficulty in an already complex situation. I hope special measures are in place to make it a lot easier for these patients. They deserve better care and this seems a lot better than what is currently in place.
104
This may turn things around a bit. First off, it's a prestigious poject like the Rand Studies that showed that abstention was not the most effective model for alcohol dependency,, so hard for denial of claims, and secondly, we are dealing with a so-called parity diagnosis, so harder to deny medical necessity. The model also does not necessitate the increase of the woefully underfunded community mental health ssytem, as it has a chance to work on a outpatient basis involving treatment support for family involvement, an essential component, I believe.
1
I could not agree more. Finding qualified in-network therapists for treating serious mental illness can be very difficult. Network rolls are often populated with people who are willing to receive low reimbursement rates, which keeps the best people out-of-network. We spent years dealing with this issue in the case of a daughter with an eating disorder. Over time we ended up building her entire treatment team using out-of-network providers, putting pressure on the insurer through an employer to cover the costs. Low budget ACA plans have made this particular issue worse.
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