This new Times article on the hearing voices approach didn't reference the Times' earlier account of new NIMH-sponsored approach of family and social supports combined with low-dose medications for relatively short term use for people experiencing first-break psychosis that was compared to Open Dialogue in the Times earlier article: http://www.nytimes.com/2015/10/20/health/talk-therapy-found-to-ease-schi... It's a false choice that it's either crude overmedication vs. hearing voices/Open Dialogue with no meds at all. Even Open Dialogue as practiced in Finland has about 30 percent of its patients using antipsychotics: https://dawsonross.wordpress.com/2015/08/10/a-psychiatrist-critiques-ope...
12
Nobody has discussed that schizophrenia's origins is in the physiological rather than the mind. Neuroimmunology has proven this and the psychiatric community simply yawns at it. http://www.psychiatry.cam.ac.uk/blog/2015/03/20/the-role-of-the-immune-s...
Dr. Carl Pfieffer researched the physiological origins as well.
http://orthomolecular.org/hof/2004/cpfeiffer.html
Dr. Carl Pfieffer researched the physiological origins as well.
http://orthomolecular.org/hof/2004/cpfeiffer.html
11
I don't need "proof this works". I am a psychiatrist who depends on the medical model for his income, and if people with emotional distress can find comfort in non-medical interventions, without pills, doctor visits or hospitals, I'm in favor! Life is a struggle, experience and the empirical method are perfectly adequate, the scientific method isn't appropriate to everything. Doctors use plenty of unproven interventions, as well.
What I would appreciate, however, from the NYTimes and people generally, is that narratives of dissatisfied patients be used to suggest ways in which we can improve, rather than as evidence of the evil of the psychiatric mechanism. When we investigate car accidents no one proposes walking to work, we make safer cars, for example. I hear the narratives and complaints and I always use them to improve my psychiatric practice. Lots of my patients benefit from my care but that doesn't mean my care is the right solution for everyone.
What I would appreciate, however, from the NYTimes and people generally, is that narratives of dissatisfied patients be used to suggest ways in which we can improve, rather than as evidence of the evil of the psychiatric mechanism. When we investigate car accidents no one proposes walking to work, we make safer cars, for example. I hear the narratives and complaints and I always use them to improve my psychiatric practice. Lots of my patients benefit from my care but that doesn't mean my care is the right solution for everyone.
119
May be helpful to clarify the kind of "voices" that may warrant a professional consultation:
The kind that are loud, clear, clearly Not Yours and are absolutely indistinguishable from what you'd hear if a real person was talking to you, right here, right now, right with you.
Most definitely not a memory. Nothing "kinda like" about it.
Scary real.
If the voice you hear is clearly not your own, especially if it is persistently directive, derogatory or abusive in tone or content, consider consulting with informed, competent, caring, licensed professionals at the time of your choosing.
(If the person you meet with at first flunks with respect to any of the above selection criteria, then consider a second opinion from a fresh source.)
In the end, no matter what they say, it will always be your call, as it should and must be.!
Disclosure: I had the privilege of serving members of the public in that professional advisory capacity for over 2 decades. A true and lasting lesson in humility for a wet-behind-the-ears, gung-ho young professional.
Respects to all those struggling with this challenge.
The kind that are loud, clear, clearly Not Yours and are absolutely indistinguishable from what you'd hear if a real person was talking to you, right here, right now, right with you.
Most definitely not a memory. Nothing "kinda like" about it.
Scary real.
If the voice you hear is clearly not your own, especially if it is persistently directive, derogatory or abusive in tone or content, consider consulting with informed, competent, caring, licensed professionals at the time of your choosing.
(If the person you meet with at first flunks with respect to any of the above selection criteria, then consider a second opinion from a fresh source.)
In the end, no matter what they say, it will always be your call, as it should and must be.!
Disclosure: I had the privilege of serving members of the public in that professional advisory capacity for over 2 decades. A true and lasting lesson in humility for a wet-behind-the-ears, gung-ho young professional.
Respects to all those struggling with this challenge.
20
An important article, not because it's necessarily "right", but because it highlights a potential avenue of treatment in an area where the "established" treatments have been lacking. Thanks.
19
Did I miss something in this article? Psychologists? Psychotherapy? (Not Behavior Modification or the evidence-based types.) Gestalt Therapy? I and my students and supervisees spent much time in conducting therapy listening to and talking to voices, including the ones of "normal" people. That's what therapy tried to do then - clear out one's head and the disturbances from the past. Well, I'm glad to have it reclaimed and am not surprised that it isn't being done by the psychiatrists but by the people with the most to gain.
14
Given that care is pyramidal with the Dr. at the top, and earning the most, they do not have time, for these programs which are time intensive and unfunded. American medicine is still your money or your life, with top down treatment. How do these groups do an assessment, what outside the meeting support is available, how can a " bad trip " be kept from becoming a tragic event.
4
What if "hearing voices" is a type of dream - an auditory dream rather than a visual one?
5
It is sad that psychiatric treatment has become equivalent to medication treatment in the minds of consumers of these services, as well as policy-makers and others. There are many psychiatrists who do not practice in a meds-only model of care, and in fact have psychotherapy training that works well with the strengths-based and non-pathololgizing mode of care described in this article. For many years, and getting increasingly worse even with, or perhaps even because of, Obamacare, these psychiatrists have been all but squeezed out of public care settings because they are only paid to prescribe medications, which is not the care they want to perform, nor the best care for people in need of these services, by insurance companies, third party payers, mental health care organizations (government funded and otherwise) and hospitals. Very sad that some of the most highly trained mental health care specialists cannot take care of the people most in need of their wide-ranging expertise.
12
Unfortunately, as so many often find, their expertise isn't all that wide-ranging. It's a shame.
3
Although I take medications for depression, I went to a therapist who did something similar with me. She had me sit in a chair and talk to an empty chair across from me. In the empty chair I was to imagine my heart. I would voice a complaint or ask a question. Then I moved to the other chair and spoke for my heart, gave voice to my heart. It said things I never imagined. One question I asked was “Why can’t I _______?” When I moved to the heart chair it said, to my amazement, “You won’t let me!” Before I started I thought it was the corniest thing in the world, but I don’t think that now. My advice is not to shut out any source of treatment until you try it. I have friends who won’t go get the anti-depressants they need. They spend every day very unhappy. It’s the same bias in reverse.
30
Reminds me of George Constanza of Seinfeld going for holistic over traditional treatment :-)
1
Another thought---
Maybe those voices can be good too.
We always view somebody who "hears voices" as being "crazy"
but I think that is a grade school type put down.
Even perfectly sane people have internal discussions with themselves
and often I talk to myself which if somebody asks I say is "thinking out loud".
The voices aren't necessarily bad and are a problem only if they harass you
or encourage you to do bad stuff. There are many examples of
intelligent and creative people "hearing voices" telling them new ideas
or solving a problem. Maybe sometimes we should listen to those voices.
They are really only a problem if they tell you to do bad things
and you go out and follow their suggestions.
Maybe those voices can be good too.
We always view somebody who "hears voices" as being "crazy"
but I think that is a grade school type put down.
Even perfectly sane people have internal discussions with themselves
and often I talk to myself which if somebody asks I say is "thinking out loud".
The voices aren't necessarily bad and are a problem only if they harass you
or encourage you to do bad stuff. There are many examples of
intelligent and creative people "hearing voices" telling them new ideas
or solving a problem. Maybe sometimes we should listen to those voices.
They are really only a problem if they tell you to do bad things
and you go out and follow their suggestions.
15
There is no one size fits all approach to anything involving people. I am grateful for the many tools in the toolbox, for myself and for my own clients. It's easy to view everything as a nail if you only allow yourself a hammer--thankfully we are always learning and growing in our struggles with mental health. We are able to patch our own unique quilt of treatment together--therapy, medication, support groups, herbs, exercise, food, lifestyle, etc.
10
This is fantastic that people are seeking therapies which do not follow the mainstream pharmaceutical solution. For the most part people are too lazy or scared to try to understand anything different from what "experts" to tell us to be true.
Consider for a moment the possibility that people who hear voices really do hear voices; perhaps the voices are real and not just some hallucination generated by the brain. Medical industry is so very quick to dismiss anything which cannot be explained according to western scientific rules and methodology and for the most part the rest of society just accepts this as fact without developing its own truth. It is something which has been drilled into us in school. In western society we are conditioned to believe all thought is generated by the brain, there is nothing more. There is a plethora of evidence that we are much more than just physical bodies (eben alexander, anita moorjani, etc); unfortunately when following western scientific standards this only qualifies as "anecdotal" evidence. Many traditional medicine treatments have known this for thousands of years. What does Acupuncture, chiropractic, massage therapy, yoga, reiki, hypnosis have in common?
Wake up people, we are spiritual beings having a physical experience not the other way around.
Consider for a moment the possibility that people who hear voices really do hear voices; perhaps the voices are real and not just some hallucination generated by the brain. Medical industry is so very quick to dismiss anything which cannot be explained according to western scientific rules and methodology and for the most part the rest of society just accepts this as fact without developing its own truth. It is something which has been drilled into us in school. In western society we are conditioned to believe all thought is generated by the brain, there is nothing more. There is a plethora of evidence that we are much more than just physical bodies (eben alexander, anita moorjani, etc); unfortunately when following western scientific standards this only qualifies as "anecdotal" evidence. Many traditional medicine treatments have known this for thousands of years. What does Acupuncture, chiropractic, massage therapy, yoga, reiki, hypnosis have in common?
Wake up people, we are spiritual beings having a physical experience not the other way around.
7
It's odd. I talk to my sister who has schizophrenia. And she says she hears voices to. I think it's a variant of people who don't recognize their hand as their own or think their relative has been replaced. Everyone has heard voices. Can you replay a song in your head. Can you hear your father's voice telling you something from a remembered incident? Have you ever ruminated over some remembered trauma? Can you read a recipe and almost taste what the dish will be like? You have heard hundreds of thousands of voices. Your brain can, with suitable incentive, replay many of them. People speak languages they never studied. They see images of things they have seen and things they haven't seen. My sister has taken medicine and dinnertime doesn't. But no one seems to be trying to track her how to live with her symptoms. To me the symptoms sound like how I feel after two or three days without sleep. So I have wondered if it is a hormone failure, an autoimmune disease. Nowadays, with discussion of DNA activation occurring only if a segment is on the outside of the DNA bundle it might be that something inactivates some set of of DNA, in some cells. Just as we have common mutations with cancer it could be we have common mutations that inactivate certain cells.
9
To me the symptoms sound like how I feel after two or three days without sleep.
No disrespect intended but if you believe the symptoms of schizophrenia sound like missing a couple of days sleep, then I suspect you have never been exposed to a person truly suffering the agonies of this illness.
No disrespect intended but if you believe the symptoms of schizophrenia sound like missing a couple of days sleep, then I suspect you have never been exposed to a person truly suffering the agonies of this illness.
7
With over 600,000,000 prescriptions a year, psychiatry is one of the world’s most lucrative businesses with an increase occurrence of infants being put on psych meds. But what about the more than 470,000 adverse reactions each year? Or the 90,000 emergency room visits?
Citizens Commission on Human Rights is a beneficial organization with helpful information on safer treatment options.
Citizens Commission on Human Rights is a beneficial organization with helpful information on safer treatment options.
14
RE:
“I would advise anyone to be carefully evaluated by a psychiatrist with expertise in treating psychotic disorders before embarking on any such alternative programs,” said Dr. Ronald Pies
Dr. Pies is correct; Open Dialog (OD) is hardly a cure- all and appropriate therapy for everyone. In fact, persons who automatically prescribe it, and those persons with a vested interest in OD are potentially dangerous to the patient. And enough with the P. C. descriptions. Persons with mental illness NEED to be recognized as patients, despite the feel good bromides for O. D. practitioners.
“I would advise anyone to be carefully evaluated by a psychiatrist with expertise in treating psychotic disorders before embarking on any such alternative programs,” said Dr. Ronald Pies
Dr. Pies is correct; Open Dialog (OD) is hardly a cure- all and appropriate therapy for everyone. In fact, persons who automatically prescribe it, and those persons with a vested interest in OD are potentially dangerous to the patient. And enough with the P. C. descriptions. Persons with mental illness NEED to be recognized as patients, despite the feel good bromides for O. D. practitioners.
10
One of the biggest challenges to approaches such as Hearing Voices Networks, Open Dialogue, and peer services is research. While there is some limited research that has shown efficacy, it is of course, challenging and competitive to get research projects funding. In the current environment, those supporting the more "medical model" approach also control who gets to do research and about what, and then claim there is insufficient research to support scaling these innovative approaches. Additionally, there is considerable disagreement on what can be defined as treatment as well as what can be defined as recovery. Those who support the "medical model", believe that hospitalization and forced medication can be considered "treatment", while those in the "recovery model" approach would argue that this approach is simply symptom abatement. Often, the measures for success in traditional treatment modalities are "compliance" (are you taking your medication, listening to what your clinician tells you to do, going to doctor's appointments) or whether or not the person being treated has caused inconvenience or affront to others. By their measure, a person who is able to care for themselves but also often wanders around talking to themselves has not achieved successful recovery. This approach, though well meaning, is paternalistic and is the reason that those who support the "recovery model" are wary of the "medical model" community.
5
I do hope that any possible treatment with promised is studied and, if truly useful, becomes part of the treatment offerings for people suffering with mental illness. On the other hand, medication saved my life, and saved my daughter's life. In both cases we went through the litany of talk therapy available to us at the time because our psychologists did not recognize the depth of our suffering. Finally my family doctor started me on meds I became so much better and continue on them to this day. It took my daughter's attempted suicide in her teens to wake up her psychologist to recognized that more was necessary. It was hard to find the right meds for her but eventually they did, then with a doctor who worked with her using cognitive behavioral therapy, she was eventually able to stop using medication, but without the medication I don't think she would have been able to respond to the therapy. She still has struggles and has returned to medication at times but she is holding her own.
There are a lot of bad psychologists out there-many have their own crazy mix of therapies, with you as the guinea pig and seem to have little understanding of how to use the therapies that have actually been shown to work, even as they claim they are using them. There are also a few really great ones, I've had one, they are the ones who are caring, smart and use science supported therapies, and most important, are willing to recognize when a patient needs medication to progress.
There are a lot of bad psychologists out there-many have their own crazy mix of therapies, with you as the guinea pig and seem to have little understanding of how to use the therapies that have actually been shown to work, even as they claim they are using them. There are also a few really great ones, I've had one, they are the ones who are caring, smart and use science supported therapies, and most important, are willing to recognize when a patient needs medication to progress.
11
This philosophy of getting well is reminiscent of R.D. Laing's approach to psychiatry, whereby he validated the person suffering from hallucinations and where he viewed schizophrenia as just an other way of looking at things.
We all need validation. AA works becasue alcoholics work with other alcoholics to get sober. The program called Recovery works for certain People with anxiety disorders, and the like. And there are many other group oriented self-help programs. They are based on the same principle: people with similar disorders working with each other without professional intervention. This program appears to work on the same principle.
But for some people reading this article, this treatment may make them feel that the treatment they are receiving is inadequate, and while it well may be, it may also be that it is working just fine.
We are all very different with very different bio-chemistries, and we do not all respond the same way to any of a variety of treatment options. While this article does mention that some people are too ill to attempt this approach, I think it would have been useful had it also mentioned that some people are doing just fine with the approach they are using, which may or may not rely on medication.
We all need validation. AA works becasue alcoholics work with other alcoholics to get sober. The program called Recovery works for certain People with anxiety disorders, and the like. And there are many other group oriented self-help programs. They are based on the same principle: people with similar disorders working with each other without professional intervention. This program appears to work on the same principle.
But for some people reading this article, this treatment may make them feel that the treatment they are receiving is inadequate, and while it well may be, it may also be that it is working just fine.
We are all very different with very different bio-chemistries, and we do not all respond the same way to any of a variety of treatment options. While this article does mention that some people are too ill to attempt this approach, I think it would have been useful had it also mentioned that some people are doing just fine with the approach they are using, which may or may not rely on medication.
3
----For the first time in this country, experts say, psychiatry’s critics are mounting a sustained, broadly based effort to provide people with practical options, rather than solely alleging abuses like overmedication and involuntary restraint.
Such campaigns have repeatedly been mounted. Like those mounted against segregation, all were put down.
Your statement puts down all of us, from whatever generation past or present, who have mounted those campaigns.
Harold A. Maio, retired mental health editor
Such campaigns have repeatedly been mounted. Like those mounted against segregation, all were put down.
Your statement puts down all of us, from whatever generation past or present, who have mounted those campaigns.
Harold A. Maio, retired mental health editor
6
The Foundation for Excellence in Mental Health Care is a wonderful organization, with such basic tenets as respect for every individual with mental health needs. It expects recovery and in the programs it funds, that is always the bottom line. The individuals who started it were influenced by Robert Whitaker's excellent book "Anatomy of an Epidemic", which showed that the "normal" way of treating people with mental health crises was creating a culture of chronicity as well as early death. Robert Whitaker also started a progressive and exciting blog, "Mad in America". Such innovative approaches are desperately needed in an era in which psychiatry has turned into a pill pusher model of care with 15 minute "med checks". The health insurance "industry" should take heed of new and humane approaches to care, and pay for them.
9
The idea that any element of the human psyche, including hearing voices, has no function is contrary to what we know about the entire natural world. How could the psyche be any different? If we haven't yet fully discovered this function, we should at least proceed with caution. That said, my experience in working with patients--for more than 30 years--is that the person's "equipment" for encountering such voices usually needs to be strengthened, i.e. their consciousness needs to develop more capacity for registering the meaning that the voices convey. Dialogue often helps but only when it can reveal that meaning. We need specialists in the meaning of the voices--which takes training and discipline and clarity of mind.
4
My experience with support groups modeled after AA is that most people in recovery are very skeptical of the "helping" professions, and even more skeptical of psychiatric medications. Informal group pressure could result in individuals who are severely depressed unwisely going off their meds with severe consequences.
An individual who is suffering can greatly benefit from having a sponsor and from having a support group. That individual can also be harmed by the support group by having some maladptive behaviors reinforced while reducing or eliminating an addiction.
An individual who is suffering can greatly benefit from having a sponsor and from having a support group. That individual can also be harmed by the support group by having some maladptive behaviors reinforced while reducing or eliminating an addiction.
1
The British Psychological Society published a very scientific and enlightened review titled Understanding Psychosis and Schizophrenia in 2015. It outlines alternative perspectives and treatment approaches to the highly "medicalized" US model. It's available free on-line. I'd highly recommend it to readers interested in a a more in-depth discussion of these issues.
5
This is a wonderful and hopeful step towards an integrative model for treating psychiatric disorders in ways that are humane and effective. I worked at Taunton Psychiatric Center before there were psychotropic medications widely available, and at Manhattan Psychiatric Center and outpatient clinics during the initial exodus of inpatients out.
The willowy catatonics have always stayed in my mind very vividly, their symptoms were so clearly symbolic as acting out of psychological duress within. I witnessed also the tremendous potential for health that most people have, which had been largely ignored as our pop-a-pill society decided not to pay the costs of inpatient treatment or necessary outpatient support.
This new model seems to me to hold promise well beyond the dreadful short and long term side effects of most pharmaceuticals.
It would be such a magnificent thing to have options for people to check into a hospital when they need more intensive interludes of care, to benefit from actual therapy sessions at mental health centers that provide, as well as these peer groups that have structured empathic communication and insight from others, good quality therapists for people who are seeking to gain self knowledge and healing, or even crisis counseling, not to mention facilitated trauma groups which are also often majorly beneficial to prevent people from falling apart under the duress of symptoms.
This is a humane and vital emerging therapy. Thank you for sharing the news.
The willowy catatonics have always stayed in my mind very vividly, their symptoms were so clearly symbolic as acting out of psychological duress within. I witnessed also the tremendous potential for health that most people have, which had been largely ignored as our pop-a-pill society decided not to pay the costs of inpatient treatment or necessary outpatient support.
This new model seems to me to hold promise well beyond the dreadful short and long term side effects of most pharmaceuticals.
It would be such a magnificent thing to have options for people to check into a hospital when they need more intensive interludes of care, to benefit from actual therapy sessions at mental health centers that provide, as well as these peer groups that have structured empathic communication and insight from others, good quality therapists for people who are seeking to gain self knowledge and healing, or even crisis counseling, not to mention facilitated trauma groups which are also often majorly beneficial to prevent people from falling apart under the duress of symptoms.
This is a humane and vital emerging therapy. Thank you for sharing the news.
9
the only voices that are not being heard are the ones receiving treatment. the money, the doctors, the therapist, drugs companies are to loud talking over the ones that are suffering. good luck bumping these players out of the ring they play for keeps and have the govt on their side.
sorry for the negativity
sorry for the negativity
13
Right on! Nothing about us without us! When our daughter experienced her first psychotic 'break' our family had to do some serious soul searching (it was embarrassing and painful but rewarding). In the process we found out who was doing the loudest talking in our family (it was me and her dad fighting like children) and in the midst of this chaos whose voice needed to be heard the most? As you can guess, it was our daughter's voice who had been repressed for years and years and her psychosis turned out not to be some kind of genetic flaw or chemical imbalance but rather, a cry to be heard!! Shame on we families who are quick to diagnose a single member of the family who refuses to hold up the mythology and the narrative that the dominant members of the family cling to so they can appear to be 'successful' I would bet my bottom dollar that most psychosis stems from trauma,: it can range from a death in the family, loss of employment, bullying at school, incest, physical or mental or sexual abuse, poverty, racism, fear of failure, emotional bullying at home, marital fighting, the list goes on. National Alliance of Mental Illness (NAMI) is composed mostly of parents and good luck getting the majority of parents with children with a psychaitric diagnosis that their children are trauma survivors and that medicalizing trauma has been a big disaster by stigmatizing and blaming their children
14
I have suffered from severe mental distress and I want to say I am sick and tired of slip shod psychiatry, along with irresponsible bio psychiatry. I too tried alternative options and was subjected to bad psychiatrists. So hear me out.....for far too long psychoanalysis has been getting short shrift and subjected to ridiculous labeling. The only thing that has really helped me is the COMBINATION of medication and lots of talking it all out. I had to try SEVERAL meds. before finding a good fit. My psychoanalyst (and there are plenty of good therapists and psychiatrists) has helped me get to the root of the problems, and has done so with incredible compassion and patience. It has required dedication from him and from me, and the pay off is that I am better! I never thought it would happen. But it was done in a contained environment with a well trained and board certified practitioner. Anything less is a rip off and frankly, irresponsible. Discussing the meanings behind behavior, voices, thoughts, feelings is something that psychoanalysis has been doing for eons. I'd be dead if I hadn't received proper care.
13
I pressed 'like' because you feel better. I am happy for your success. One question: did your prescriber fully inform you of the potential side effects and discuss with you the difficulty of tapering off a medication even if it made you ill?
3
Thank goodness there's some TRUTH about psychiatry in a major newspaper. The so-called "anti-psychiatry" path is the one I've chosen, and I plan on not EVER returning to the mainstream mental health system. That system is dishonest, costly, dangerous, stigmatizing, and deadly.
12
I am very sorry that your experience has been so detrimental. However, painting the mainstream mental healthy system with the same paintbrush of "dishonest, costly, dangerous, stigmatizing, and deadly" is dangerous in itself (and reminds me of Scientologists' views on it, to be quite honest). There has been a lot of progress in destigmatizing mental health care in recent years, as many people are still ashamed to seek it. Programs like HVN are definitely worth exploring further, as is a more holistic approach to mental healthcare, but most people suffering from severe mental illness do need pharmacological intervention to correct a chemical imbalance. I am willingly medication free after years on a prescribed stimulant for ADHD, but my condition is not severe enough to put my life or the lives of others at risk.
6
Our beautiful adult daughter was deeply traumatized by her psychiatric care. Her labeling and forced medication made her much, much worse. I agree wholeheartedly with 'J' that psychiatry is deadly and stigmatizing. It has been corrupted by a greed mongering industry (big Pharma) and is built on JUNK SCIENCE: ghost written articles, thought leaders who receive junkets to Hawaii like Ronald Pies who are treated like rock stars for doubling the rate of bi-polar diagnosis of children, suppressed trials, publication bias, etc. I am personally offended that you inferred that anyone who rightly criticizes the profession of psychiatry (which has far more in common with a cult religion than any science I know of) is somehow similar to Scientology. Hasn't that become passe, accusing all critics of psychiatry of having ties to Scientology??
15
This sounds interesting, and I hope there will be more study of this therapy's potential benefit for these patients. Why is medication always the only answer?
While this post focuses on patients with serious mental illnesses, I do believe that holistic, talk-based therapy can be helpful for individuals with mild anxiety or depression -- yet often, one is encouraged to take medications. At my last workplace, I realized that most of the women I worked with were taking antidepressants, anti-anxiety medications or some combo. They called these "happy drugs." I don't think this is the answer.
While this post focuses on patients with serious mental illnesses, I do believe that holistic, talk-based therapy can be helpful for individuals with mild anxiety or depression -- yet often, one is encouraged to take medications. At my last workplace, I realized that most of the women I worked with were taking antidepressants, anti-anxiety medications or some combo. They called these "happy drugs." I don't think this is the answer.
27
Interestingly, the Open Dialogue approach seems to be behind the treatment of the fictional protagonist on the counter-culture hit TV show "Mr. Robot." Elliot, the lead character, hears and sees his dead father (aka Mr. Robot). He tried self-medicating him out of existence with Adderall for a while, while seeing a psychologist (who cannot prescribe medications) but normally such a person is given anti-psychotic medication. Instead his therapist tells him that Mr. Robot is a part of him and should be interacted with, not pushed aside, in hopes of integrating him into Elliot in the future.
Of course, it is a bit convenient in a TV show that is centered on the main characters delusions - and his genius hacking abilities. Any "cure" would mean the end of the show. But it does seem like the show is breaking ground in more ways than one.
Of course, it is a bit convenient in a TV show that is centered on the main characters delusions - and his genius hacking abilities. Any "cure" would mean the end of the show. But it does seem like the show is breaking ground in more ways than one.
6
I was under the impression that modern mental health practices assumed that plans that involved both medication and therapy were best- and any plan that pushes JUST MEDICATION or JUST THERAPY was not recommended. A plan that pushes JUST THERAPY assumes that you can overcome all of your ailments through stronger will power and I feel that disregards that these are actual illnesses- if someone told me to get over pneumonia through mindfulness I would not be happy. At the same time Therapy is important because it teaches you strategies cope with stress and calm down- as well as an outlet for processing things that could be making your condition worse- but in the end- while it may give you stronger legs to stand on- without medication more than likely you'll be back in therapy pretty quick.
After a breakdown last year and dealing with a lot of undiagnosed problems for years I ended up in some intensive outpatient programs. Sadly after experimenting nearly a dozen different medications it was found I'm extremely allergic to most of them- so after a point therapy was the only outlet I had. Medication would have made the process to recovery so much easier though. Two of the medications actually worked to alleviate my symptoms!!!!... but one made me blind and another more than doubled my blood pressure.
I don't know how I feel about this article... its like its trying to make medication seem bad... but in reality it seems like these people had some really bad uninformed doctors.
After a breakdown last year and dealing with a lot of undiagnosed problems for years I ended up in some intensive outpatient programs. Sadly after experimenting nearly a dozen different medications it was found I'm extremely allergic to most of them- so after a point therapy was the only outlet I had. Medication would have made the process to recovery so much easier though. Two of the medications actually worked to alleviate my symptoms!!!!... but one made me blind and another more than doubled my blood pressure.
I don't know how I feel about this article... its like its trying to make medication seem bad... but in reality it seems like these people had some really bad uninformed doctors.
7
Any person who feels that therapy is built on the assumption that you can change through "stronger will power" does not know anything about therapy. Therapy is not about increasing will power - it is about examining your decisions from an outside perspective and working to see the needs that your behavior is meeting, and to increase your range of options to meet those needs. It's about getting away from knee-jerk reactions and starting to realize that other choices are available to you. Good therapy is very empowering - far from blaming a victim, it both validates the challenges that a person may have faced and the LOGIC behind their seemingly 'illogical' choices, while helping create hope that the client is not bound to make those choices forever. While will power enters into the equation at some point, it does for medication as well - a person needs to decide to seek help and to evaluate the effectiveness of the intervention and to persist in taking the medication if it's working or change it if it's not. But therapy's not about will power. It's about re-assuming control of your emotions and behavior through increased perspective and through the practice of new and more effective alternative thinking and actions.
6
I think therapy by itself is enough for some situations, like mild anxiety or for some types of depression. Especially if it's related to a specific event such as parents divorcing or a loved one dying, many people might benefit from talk therapy while they grieve and then be ok once they've processed things.
But I do agree that most people with long-term mental illness seem to do best with a combination of medication and some kind of talk therapy, whether it's one-on-one meetings with a psychologist or a support group of some kind. What worries me most is the number of, I'm assuming self-diagnosed, people with mental illness who seem to have no treatment plan at all even when they have insurance and access to providers. At least I hope they're misdiagnosing themselves and not storming out of doctors' offices after being officially diagnosed.
But I do agree that most people with long-term mental illness seem to do best with a combination of medication and some kind of talk therapy, whether it's one-on-one meetings with a psychologist or a support group of some kind. What worries me most is the number of, I'm assuming self-diagnosed, people with mental illness who seem to have no treatment plan at all even when they have insurance and access to providers. At least I hope they're misdiagnosing themselves and not storming out of doctors' offices after being officially diagnosed.
1
I'm only slightly surprised that no mention has been made of EEG biofeedback training for treating psychiatric illness. Data supporting its efficacy is in the peer-reviewed literature for a wide range of conditions including psychotic disorders. Our work has focused on neurodegenerative conditions like Alzheimer's and Parkinson's and are finding that interventions using infrared light stimulation along with brainwave biofeedback have helped stop the progression of the disease and reversed symptoms both cognitive and behavioral. Funding for these types of approaches has been almost nonexistent and is hopefully starting to shift.
Community support of the kind described in the article is potentially extremely therapeutic, especially to people who are without financial resources to pay for psychotherapy, deeply fearful, alienated and ashamed for not being 'like everyone else'. There are options that can help and the challenge of having a system where the patient is required to be the 'clinical quarterback' is very much part of the problem. www.quietmindfdn.org
Community support of the kind described in the article is potentially extremely therapeutic, especially to people who are without financial resources to pay for psychotherapy, deeply fearful, alienated and ashamed for not being 'like everyone else'. There are options that can help and the challenge of having a system where the patient is required to be the 'clinical quarterback' is very much part of the problem. www.quietmindfdn.org
6
This article reminds me of the true story movie "A Beautiful Mind", about math genius John Nash, who was hallucinating, but the drugs to suppress the hallucinations made a zombie out of him and were destroying his career, marriage, and family. So he simply went off the drugs, taught himself to distinguish hallucinations from reality, and lived a normal life. The real Nash died in a taxi car crash only last year at age 86.
Applause are in order for the people in this article who are helping other people cope with life without dangerous permanent psychiatric drugs.
But we should also be discussing the research going on in the last 5 years revealing how many schizophrenia cases turn out to actually be just brain infections (namely toxoplasmosis), which existing anti-biotics can cure!
Just google "schizophrenia anti-biotics".
Applause are in order for the people in this article who are helping other people cope with life without dangerous permanent psychiatric drugs.
But we should also be discussing the research going on in the last 5 years revealing how many schizophrenia cases turn out to actually be just brain infections (namely toxoplasmosis), which existing anti-biotics can cure!
Just google "schizophrenia anti-biotics".
9
In my clinical experience of over 40 years there are often voices or inner experiences that are related to past traumas. Often these inner experiences are trying to help the person as if they were still a child or vulnerable to a past situation. Dialoguing with these voices respects their perspective, then allows them to be helpful in a present tense situation, not guarding from no-longer threatening past experiences. This is a mainstay of the perspectives developed in working with people suffering from dissociation disorders, but many of us have this phenomena to some degree or another. It is a matter of degree, of not assuming it is something wrong, but inquiring "what is right" about this response.
What a great article!
What a great article!
35
I totally agree. I am a psychotherapist, retired after over thirty years. It is always a matter of degree. Inner voices have to do with the person's experiences and groups like the ones described in the article, can be tremendously helpful. It's never "either or".
4
This is an interesting article that presents an additional aspect of care for severe mental illness. I am frustrated, however, by the author's implications that (1) there are clear delineations between psychological and psychiatric interventions for mental illness, (2) illnesses are homogenous (both between and within diagnoses), (3) that there is a standard response to treatments, and (4) that treatment success is determined by the absolute removal of presenting symptoms.
It is great to know that there are many forms of treatment possible and that some will work better for certain conditions/individuals than others. This fact is not evidence, however, against the usefulness of psychotropics, but an acknowledgement that there is no 'one size fits all' approach. I think it's important to note that many aspects of the HVN mentioned are similar to existing treatment approaches, including the group modality, emphasis on building functional relationships, and engagement with others.
Clark Kopelman, PhD
It is great to know that there are many forms of treatment possible and that some will work better for certain conditions/individuals than others. This fact is not evidence, however, against the usefulness of psychotropics, but an acknowledgement that there is no 'one size fits all' approach. I think it's important to note that many aspects of the HVN mentioned are similar to existing treatment approaches, including the group modality, emphasis on building functional relationships, and engagement with others.
Clark Kopelman, PhD
19
Reading the reader’s comments is like listening to the family members of someone with a mental illness: a variety of perspectives that are insightful and irreconcilable from each other. The Open Dialogue method described in the article is effective because it values everyone’s perspective, and is about listening but not persuading.
The 15-minute medication visit is not effective because it is so inadequate. I am the psychiatrist at Gould Farm (www.gouldfarm.org), a residential treatment for people with major mental illness in Monterey, Massachusetts. “Guests” live there, join the community, work on the farm to bake bread, grow kale, milk cows, and then work in the kitchen to prepare the food they have grown for the entire community. Medication is a part of recovery, with the goal of finding the least amount of medication that helps someone function at their best. With some symptoms at bay, people can resume their development in a caring and supportive community in which they live and work in a social context.
Insurance routinely denies covering this treatment as not medically necessary. However, the outpatient model is not adequate for many people struggling with mental illness.
The 15-minute medication visit is not effective because it is so inadequate. I am the psychiatrist at Gould Farm (www.gouldfarm.org), a residential treatment for people with major mental illness in Monterey, Massachusetts. “Guests” live there, join the community, work on the farm to bake bread, grow kale, milk cows, and then work in the kitchen to prepare the food they have grown for the entire community. Medication is a part of recovery, with the goal of finding the least amount of medication that helps someone function at their best. With some symptoms at bay, people can resume their development in a caring and supportive community in which they live and work in a social context.
Insurance routinely denies covering this treatment as not medically necessary. However, the outpatient model is not adequate for many people struggling with mental illness.
51
Perhaps you should amend this to people with major mental illness and a lot of money.
And I assume you have studies demonstrating that what your "guests" are doing actually make them better.
And, by the way, do you also consider people in state mental hospitals to be "guests"?
And I assume you have studies demonstrating that what your "guests" are doing actually make them better.
And, by the way, do you also consider people in state mental hospitals to be "guests"?
4
Steve, you're right, residential treatment programs can be prohibitively expensive for many families. I live and work at Gould Farm and I wish there was some way to open our program up to everyone for free. Unfortunately, insurance rarely covers residential treatment programs for adults with mental illness and until that changes, non-profit organizations are left scrambling to make ends meet and still offer the highest quality services to some of our most vulnerable community members. Programs that include access to Open Dialogue and the Hearing Voices Network mentioned in the article.
Gould Farm charges the least and offers the most services compared to our sister therapeutic communities. One reason we are able to do this is that all our staff and their families live at the Farm and work alongside our residents, sharing our lives in partnership. We also give out over $1 million in financial aid to families every year. It is important to us to have a diverse community of residents and to make it possible for people from all walks of life to have access to treatment.
This is a really important and complicated discussion for everyone affected by a serious mental health challenge: how to get top-notch, evidence-based treatment that leads to lifelong recovery, while keeping these services accessible to everyone. Over the past eight years I have seen the impact Gould Farm has had on saving people's lives and am grateful to be part of this healing community.
Gould Farm charges the least and offers the most services compared to our sister therapeutic communities. One reason we are able to do this is that all our staff and their families live at the Farm and work alongside our residents, sharing our lives in partnership. We also give out over $1 million in financial aid to families every year. It is important to us to have a diverse community of residents and to make it possible for people from all walks of life to have access to treatment.
This is a really important and complicated discussion for everyone affected by a serious mental health challenge: how to get top-notch, evidence-based treatment that leads to lifelong recovery, while keeping these services accessible to everyone. Over the past eight years I have seen the impact Gould Farm has had on saving people's lives and am grateful to be part of this healing community.
5
Serious, long term research is needed into the possible long term effects of all psychotropic medications, even those used on and off label for "diseases" such as headaches, seizures and pain. A "yin/yang" situation, many drugs have side effects that mimic the "disease", and could occur at any time. No wonder patients seek alternatives! When someone abruptly stops medication, are symptoms are from the original disease, or side effects of the medication? After all, they do affect brain physiology. These questions need answers, patients are owed answers, and research is needed. The FDA "Serious Adverse Effect" registry is inadequate because it is not ongoing. Physicians must conduct ongoing research into the true efficacy of what is prescribed. Computerization and electronic medical records should be helpful if used without fear of the malpractice lawyers. These patients are opening a critical dialogue which could help many people with challenges, and should be thanked.
11
"Some psychiatrists are wary, they say, given that medication can be life-changing for many people with mental problems, and rigorous research on these alternatives is scarce."
What "rigorous research" is the basis for psychotropics? The research run by Big Pharm?
Who life is change by medication? Big Pharm's?
What "rigorous research" is the basis for psychotropics? The research run by Big Pharm?
Who life is change by medication? Big Pharm's?
9
Fred,
Since you believe any studies that were funded by pharmaceutical companies is invalid I assume that you also consider there is no evidence that hypertension medications, antibiotics, or diabetes medications work as the studies on these were also sponsored by the pharmaceutical companies that make them and virtually all studies on medical devices have been sponsored by their manufacturers.
Based on your criteria, you essentially consider all of modern medicine to be invalid.
Since you believe any studies that were funded by pharmaceutical companies is invalid I assume that you also consider there is no evidence that hypertension medications, antibiotics, or diabetes medications work as the studies on these were also sponsored by the pharmaceutical companies that make them and virtually all studies on medical devices have been sponsored by their manufacturers.
Based on your criteria, you essentially consider all of modern medicine to be invalid.
1
A single "psychotic" symptom does not a psychosis make. Based on information submitted here, most of these people would not qualify for diagnoses in the psychotic range,
1
While I'm very pleased to see the Times cover this subject, it would be nice if the story also informed readers that a wide range of "alternative" approaches and paradigms are being applied to all varieties of mental health challenges - not just "schizophrenia" or psychosis. The story also seems to neglect a central tenet running through all the non-medical-model approaches - that "mental illness" is a social construct, just as "physical disability" is defined a social construction in the Americans with Disabilities Act. The reason why new approaches to "mental illness" have gained more attention is more and more people are finally recognizing the reality of neurodiversity - and the fallacy of any "normal" mind (i.e. Sanism). That, and the significant harm and suffering mainstream psychiatry & mental health has caused people unfortunate enough to be branded with DSM labels. It would also have been nice for the story to point readers to one of the primary news outlets/online forums for our movement - Mad in America, founded by author and journalist Robert Whitaker. That said thank you for exposing readers to a small slice of a very large movement that is rightfully acknowledged far more in progressive countries like Australia and New Zealand. It is remarkable how antiquated the U.S. approach to "mental illness" is -but that's largely because it comes down to money - not only "big pharma." It's also the professionals who don't want their Ivy League careers threatened, either.
15
Amen. I agree. Although the problem is larger than some psychiatrists and their Ivy League careers. Many psychiatrists are good and want to do good (like cops, I suppose). But the larger system, i.e.. the APA and thus psychiatric training programs rely exclusively on the medical model, even in the face of mounting evidence based theories that would post to a stronger psycho-social approach. Their hands are tired. Until we get Big Pharma money out of mental health care, we're stuck with this antiquated, damaging system.
10
For moderate to mild mental health cases, this approach may be all that is needed. For the severely mentally ill, especially those who are poor, without family support and in danger of hurting themselves and others, it will never do. Go on some psych wards and see what you are up against. I have.
4
Open Dialog and the HVN have both been tried and been successful with people from all socioeconomic strata and all levels of severity. I challenge YOU to attend a HVN meeting and see how rich all of the people there are, or how mild their initial presentation was. Many people find HVN meetings after YEARS of trying standard psychiatric approaches with repeated failures. The idea that psych meds automatically for everyone with severe symptoms, or that these approaches are only for "mild to moderate" symptoms, is something made up with no evidence to support it.
5
Hearing voices could be a preliminary sign of schizophrenia or some other psychiatric disorder but this could also project an underlying emotional trauma which keeps haunting our sub conscious minds. Like an auto pilot it triggers a heightened state of some auditory nerve functioning, which can lead to this disorder. Deep research in neurosciences have revealed such cases, who may be treated through non-psychiatric non-medication treatments, using alternate therapies like mindful meditation exercises, chigong energy healing and zen mind-less thinking. These alternate healing techniques helps in releasing neuro-chemicals like dopamine and serotonin which relaxes our nerves, changes our mind waves from high beta-state to alpha and theta state. Such non-psychiatric treatments have minimal side effects and are often able to hit the root cause of the problem than treating its symptoms on peripheral levels. we need to come out of the clutches of some patented drug companies and their OTC products which are often prescribed & sold as confetti tablets by medical practitioners.
4
I was diagnosed bipolar with psychotic features last year. I thought I was the messiah, heard voices... The whole nine. The improvement I experienced after being put on antipsychotics (invega) and Mood stabilizers (speak ore) was immediate. In that regard, I consider myself lucky. Not everyone is as med-responsive as I have been.
Though the invega makes me sleepy, it keeps me sane. Fortunately, I was given a second mood stabilizer (lamictal), which has efficacy in treating the depressed phase of bipolar I. Even more fortunately, I am on a timetable to be off antipsychotics in a year or so.
While I appreciate the benefits of such holistic approaches, the professionals who practice it need not be so anti-medication, as meds have done a lot of good for a lot of people. It's the first generation antipsychotics that are the real brain killers. Atypical (second generation) antipsychotics are a miracle of modern medicine. The old standbys--Thorazine, Haldol and the like-- are debilitating. Trust me, I know.
What it comes down to is: if meds don't work for you, or if the side-effects are too much, this sounds like it's worth a shot.
Though the invega makes me sleepy, it keeps me sane. Fortunately, I was given a second mood stabilizer (lamictal), which has efficacy in treating the depressed phase of bipolar I. Even more fortunately, I am on a timetable to be off antipsychotics in a year or so.
While I appreciate the benefits of such holistic approaches, the professionals who practice it need not be so anti-medication, as meds have done a lot of good for a lot of people. It's the first generation antipsychotics that are the real brain killers. Atypical (second generation) antipsychotics are a miracle of modern medicine. The old standbys--Thorazine, Haldol and the like-- are debilitating. Trust me, I know.
What it comes down to is: if meds don't work for you, or if the side-effects are too much, this sounds like it's worth a shot.
14
I think that the issue many people have, myself included, is the "meds first, meds foremost" approach taken by the clinical community. I am a proponent of medication where the person treated chooses to take it, but I am also someone who is very concerned about the long-term effects of such medications, which have proven to be severe and in many cases shorten life expectancy. Additionally, the measure of success in pharmacological treatment is somewhat lacking, in that it rationalizes away side effects such as lethargy, drooling, diskensia, weight gain, sleep loss, and profuse sweating. It can be very difficult to live a productive and fulfilling life with the side effects of psychotropic medications, however, clinicians too often dismiss these concerns as the price of reduced psychiatric symptoms. I am also concerned about the trend towards medicating at younger and younger ages, as we are now seeing even pre-school aged children being medicated as a first intervention. I am not against medication, but I think it has become a crutch for a system that does not wish to invest the time and resources to really help people recover, and instead would prefer to simply suppress psychiatric symptoms insofar as they might be bothersome to others.
6
Open Dialogue isn't rejecting mainstream psychiatry for everyone; it is offering options. I suspect that most people, if they think about it, know at least one person with debilitating mental illness who has not been helped by standard psychiatric interventions (including medication). I know two. One is now dead. The other, my mother, has been on at least a dozen different medications over the past twenty years and has gotten worse, not better. When she pleads for help, she's given a different diagnosis and a new prescription. Mainstream psychiatry appears to have no answer for these people. But its practitioners, in my experience, have been shockingly reluctant to admit the limits of their knowledge and abilities.
36
It is wonderful to hear about alternative mental health care! My experience with American psychiatrists was simply awful: their interest was to have ongoing clients, not to cure patients. Heavy medication was handed out to fellow sufferers like candy and it was obvious doctors had no intention of helping anyone other than pharmaceutical companies.
Sure there are cases where medication is necessary and that's just it: medication should only be used when necessary.
Sure there are cases where medication is necessary and that's just it: medication should only be used when necessary.
13
Thanks for publishing. Finally! Although I don't hear voices, I've been involved with the mental health community for many years and know that peer supported programs for those who do really HELP. Now it's time to apply pressure to get the mainstream psychiatric community to RESEARCH this, and form a coalition with the alternative communities. It's not enough for them to continue to say: Oh, we can't support it because there's not enough research. There's not enough research BECAUSE they don't support it. Psychiatrist need to stop being pill pushers and start being healers. People suffering from mental illness depend on it.
12
This does not appear to be a brand new therapy---
It seems to be another form of "talk therapy" which
has been around for quite a while. In fact talk therapy is the basis
of traditional psychoanalytic treatment.
The major difference is that modern psychiatry is so obsessed
with and even addicted to the use of powerful drugs that the
value of non-drug options like this are largely ignored.
This therapy with proper direction by a trained professional
could have very promising results without all the negatives
connected with the use of excessive drug therapy.
I say let's hear what the voices have to say
and start from there.
It seems to be another form of "talk therapy" which
has been around for quite a while. In fact talk therapy is the basis
of traditional psychoanalytic treatment.
The major difference is that modern psychiatry is so obsessed
with and even addicted to the use of powerful drugs that the
value of non-drug options like this are largely ignored.
This therapy with proper direction by a trained professional
could have very promising results without all the negatives
connected with the use of excessive drug therapy.
I say let's hear what the voices have to say
and start from there.
5
When I became the communications director for a statewide mental health foundation in Texas, I sought to learn as much as I could about mental health and mental illness.
I attended two Alternatives conferences, which are funded by SAMHSA, and was amazed by what I saw and learned about successful recovery through effective alternative therapies, treatments and community supports.
I encourage consumers of mental health services who are in the process of recovery to attend an Alternatives conference. The next one is in San Diego on September 19-23. Sometimes financial assistance is available to people who can't come otherwise.
I attended two Alternatives conferences, which are funded by SAMHSA, and was amazed by what I saw and learned about successful recovery through effective alternative therapies, treatments and community supports.
I encourage consumers of mental health services who are in the process of recovery to attend an Alternatives conference. The next one is in San Diego on September 19-23. Sometimes financial assistance is available to people who can't come otherwise.
4
As a psychiatrist I truly hope the approach described here works. It could be a break-through. However we won't know if it works well, or if it works at all, until it has been studied in the kind of rigorous research that is the gold standard for all treatments. History is filled with apparent miracle cures that weren't and that, sometimes, turned out to make the people who received them worse. There is always a risk that premature optimism for new and non-validated treatments will turn people away from established treatments for psychosis that, while they may not help some, do help a majority of the people receiving them.
12
There is a premature optimism because pharmaceutical therapies are so resoundingly and across-the-board intolerably awful for the individual who actually has to ingest these poisons. While these drugs may make life easier for those around a person with psychosis, the best they can do for the 'patient' is make them miserable in a less violent and risky way.
After destroying so many for so long, your profession has little credibility left to add to this discussion.
After destroying so many for so long, your profession has little credibility left to add to this discussion.
6
There actually is significant research on Open Dialogue, not so much Hearing Voices Networks. Open Dialogue is the primary mode of treatment in Finland. One challenge for scaling it in the US is that it depends on committed participation of close friends and family members. Those "most severely ill" that we are trying to reach here in the US often have long since disconnected from family and friends and thus are largely alone in the world. There are approaches to helping those individuals build "recovery communities" so that they have a similar network of support, but again, funding. Additionally, since the clinical profession controls the research dollars, it is very challenging to fund rigorous, gold standard research for this approach, especially when combined with the challenge that often not just the research, but the approach itself is not funded to a scale that results in a statistically viable sample. The lack of research lies firmly at the feet of the clinical community.
5
Yes, its a breakthrough because regular people, despite years and years of slick marketing by big Pharma are coming to realize that your profession doesn't have very good solutions and that the one-size-fits-all medical model of mental illness has been a disaster. Common sense approaches that emphasize relationship building, which your profession has very little to offer, enjoys better outcomes. You don't need a weatherman to know which way the wind blows. Your profession is based on research that is nearly 100% funded by the industry that profits from the outcomes and you want to pontificate on rigorous research. Really? The short term drug trials that your profession uses to justify your laughably simple prescribing algorithms and your trial and error approach of subjectively observing people's behavior before and after tranquilizing them, in order to diagnose them using the most flawed document in the world, the DSM IV, this is an example of practices based on rigorous research? This is the height of hypocricy!
Your practice and medical training are based on junk science. Your profession rejects rigorous science and data. Your profession is based on cherry picked studies, ghost-written articles, and thought 'leaders' who enjoy junkets and gifts from big Pharma. Thousands of flawed, short-term trials paid for by big Pharma that don't outperform placebos are hidden from public view. Entire medical schools and endowed chairs are paid in full by big Pharma.
Your practice and medical training are based on junk science. Your profession rejects rigorous science and data. Your profession is based on cherry picked studies, ghost-written articles, and thought 'leaders' who enjoy junkets and gifts from big Pharma. Thousands of flawed, short-term trials paid for by big Pharma that don't outperform placebos are hidden from public view. Entire medical schools and endowed chairs are paid in full by big Pharma.
4
It seems to me that it's quite possible that the voices are just subconscious thoughts that for whatever reason are breaking through to the conscious mind and manifested as voices.
2
"On 28 February 1998, a paper written by Wakefield and twelve other authors about twelve children with autism was published in The Lancet."
From today's NYTimes anti - med blurb -
" Nine of 14 young men and women enrolled in the program,,,"
“It’s tiny, just a pilot study,” Dr. Gordon said. “But it’s a start.”
Damn right it's tiny.
Get back to me without the anecdotes and a WAY bigger sample.
From today's NYTimes anti - med blurb -
" Nine of 14 young men and women enrolled in the program,,,"
“It’s tiny, just a pilot study,” Dr. Gordon said. “But it’s a start.”
Damn right it's tiny.
Get back to me without the anecdotes and a WAY bigger sample.
6
Believe me, we would love to see this funded as a large scale research project. Would you be willing to help make that happen?
Brian K. Hollander
Incoming Co-President
New York Association of Psychiatric Rehabilitation Services
Brian K. Hollander
Incoming Co-President
New York Association of Psychiatric Rehabilitation Services
1
I will be happy to help when the NYTimes runs a lenthy article, complete with anecdotes, about the many people whose lives have been dramatically improved by the judicious use of medication for neurological disabilities, including children of all ages.
Which means i won't be helping any time soon.
Which means i won't be helping any time soon.
iHow can you be diagnosed by a Psychiatrist when HMOS only allow them to RX Meds than you are Evaluated by an MSW Social Worker who gives the Shrink feedback RE how the Med He or She started you on.
Been with my HMO since 64 and when in treatment for anxiety disorder only seen by DR to RX Meds when I ask her why doesn't she talk to me and treat me she said because of the Money Drs earn more than MSWS so Drs time more valuable..it certainly is not like in the movie Analyze this with Robert Dinero and Billy Cystal as the shrink.
one patient from my HMO Committed suicide because she could not get and Appointment with a shrink jumped off HMOS Parking lot roof in Los Angeles.
Been with my HMO since 64 and when in treatment for anxiety disorder only seen by DR to RX Meds when I ask her why doesn't she talk to me and treat me she said because of the Money Drs earn more than MSWS so Drs time more valuable..it certainly is not like in the movie Analyze this with Robert Dinero and Billy Cystal as the shrink.
one patient from my HMO Committed suicide because she could not get and Appointment with a shrink jumped off HMOS Parking lot roof in Los Angeles.
3
Hearing voices could be a preliminary sign of schizophrenia or some other psychiatric disorder but this could also project an underlying emotional trauma or imbalance of neuro-chemicals which keeps haunting our sub conscious minds. Like an auto pilot it triggers a heightened state of some auditory nerve functioning, which can lead to this disorder. Deep research in neurosciences have revealed such cases, who may be treated through non-psychiatric non-medication treatments, using alternate therapies like mindful meditation exercises, chigong energy healing and zen mind-less thinking. These alternate healing techniques helps in releasing neuro-chemicals like dopamine and serotonin which relaxes our nerves, changes our mind waves from high beta-state to alpha and theta state. Such non-psychiatric treatments have minimal side effects and are often able to hit the root cause of the problem than treating its symptoms on peripheral levels.. Another technique which is in vogue is NLP- Neuro linguistic programing, which provides an insight into the mind process, it helps in having thought observation from the first state-to the third level as an neutral observer . There after getting anchored through visualization and guided imaging into that altered state, NLP technique promotes auto suggestion by sending sub-liminal messages into our sub conscious mind. This helps in soothing our freckled nerves and bring us into the state of deep relaxation. I have been practicing NLP for years.
3
The Hearing Voices Network "gained a foothold" decades ago. The doctors quoted in this article are very late in incorporating (while possibly watering down with professionalism) the effective methods and support shared freely among people in the network who hear voices. I recommend the TED talk by Eleanor Longden, who found her way back from nearly fatal suffering. Re medication, a position paper on the HNV website does not disdain medication; it states "Medication is just one way, amongst many, that people may choose."
7
We live in a society that stigmatizes people with mental illness. I get that. But wouldn't it be a step in the right direction for people living with mental illness to start using their last names? It's not productive for us to accept; "protecting privacy" as a given.
www.HereSheIsBoys.com
www.HereSheIsBoys.com
Brenda - Why is it not productive "for us to accept protecting privacy as a given?" What would you have gained by knowing that young woman's last name? And given today's media possibilities, she could have lost a great deal.
3
Outing people was barbaric for homosexuals, and it's barbaric for Mad people. Openly Mad people DO suffer consequences, and often quite stiff ones. And we're already suffering with poverty, domestic violence, police harassment, and our incompetent, greedy, sanist psychiatrists. Anonymity is just about the ONLY free resource at our disposal. Don't pressure Mad people into surrendering it in the name of "destigmatization".
2
That there is the possibility of ameliorating the effects of heard voices, particularly with reduced or no medication, is surely the essential -- if not necessarily new -- message here: some voice hearers will benefit. There would be a lot right in funding research studies that investigate this phenomenon, though many might be untrusting of the research and researchers (with some justification; e.g., http://www.nytimes.com/2016/08/07/magazine/the-brain-that-couldnt-rememb....
It was fascinating to read Sarah story: the voice of the crying child connected to a frightening childhood experience, and after positively engaging it it now sings! This makes powerfully tangible the idea of reclaiming, as an adult, one's wounded inner child, regardless of whether one hears voices. There's something good here for all of us.
It was fascinating to read Sarah story: the voice of the crying child connected to a frightening childhood experience, and after positively engaging it it now sings! This makes powerfully tangible the idea of reclaiming, as an adult, one's wounded inner child, regardless of whether one hears voices. There's something good here for all of us.
21
Some people hear voices because of a mental disorder that may possibly be helped by medication. Some other people hear voices because the voices are really there. Our physical reality is not the only reality. There are personalities all around us that have no physical presence but would like to communicate with someone that is attuned to them. That is why some people can communicate with so-called "dead" people. These alternative approaches may certainly be more helpful to such sensitive people than conventional medicine. How to tell the difference is not something I'm qualified to say.
27
Totally agree !
1
To diagnose a mental disorder based on hearing those voices they would have to markedly interfere with a person's ability to function.
If you hear voices but function without problem, you don't have a mental disorder.
If you hear voices but function without problem, you don't have a mental disorder.
3
"Our physical reality is not the only reality. There are personalities all around us that have no physical presence but would like to communicate with someone that is attuned to them."
All around us: If I am reading you correctly, you are describing incorporeal personalities that exist independent of whoever hears them, like sprites in The Tempest.
Sensitive people: those gifted with the ability to hear the sprites?
This is helpful only in that it might be palliative to those who are, for whatever reason, already inveterately invested in needing a supernatural "connection". I don't think it is particularly counter-productive, because Open Dialogue and HVN, for example, are not about that.
All around us: If I am reading you correctly, you are describing incorporeal personalities that exist independent of whoever hears them, like sprites in The Tempest.
Sensitive people: those gifted with the ability to hear the sprites?
This is helpful only in that it might be palliative to those who are, for whatever reason, already inveterately invested in needing a supernatural "connection". I don't think it is particularly counter-productive, because Open Dialogue and HVN, for example, are not about that.
So according to this article, all treatment with psychiatric medications is "overmedication."
And I'll be convinced that these alternative modalities are worthy alternatives to psychiatry when they are willing to do take the homeless or violent mentally ill brought to emergency rooms acutely into their groups. If they are as good or better than psychiatry than they should be willing to treat the same patients. Otherwise all they are saying is once people are stabilized or you weed out those whose hallucinations would make them disruptive or their depression would make them too incapacitated to participate, we can take over. It's like saying that after a surgeon completes the heart transplant we can sew up the skin and that's the same as doing the transplant.
And I'll be convinced that these alternative modalities are worthy alternatives to psychiatry when they are willing to do take the homeless or violent mentally ill brought to emergency rooms acutely into their groups. If they are as good or better than psychiatry than they should be willing to treat the same patients. Otherwise all they are saying is once people are stabilized or you weed out those whose hallucinations would make them disruptive or their depression would make them too incapacitated to participate, we can take over. It's like saying that after a surgeon completes the heart transplant we can sew up the skin and that's the same as doing the transplant.
19
I'm not sure you read the article.
No, it doesn't say all medication is "overmedication", in fact it talks about the members of the described group who continue to take medication.
Also, I'm not sure where it says that they don't take anyone who is homeless, or has a history with violence - although, to be fair, violence in people with mental illnesses is more often than not associated with substance use, so I can't see why someone would be disqualified once they are sober.
Most non-crisis programs take people once they are stabilized. In the same way that cardiac rehab programs take people once the heart attack is over, or the transplant is done, once the acute crisis has passed in someone with mental health issues, the real challenge is keeping the person healthy, so that they can continue with their lives.
No, it doesn't say all medication is "overmedication", in fact it talks about the members of the described group who continue to take medication.
Also, I'm not sure where it says that they don't take anyone who is homeless, or has a history with violence - although, to be fair, violence in people with mental illnesses is more often than not associated with substance use, so I can't see why someone would be disqualified once they are sober.
Most non-crisis programs take people once they are stabilized. In the same way that cardiac rehab programs take people once the heart attack is over, or the transplant is done, once the acute crisis has passed in someone with mental health issues, the real challenge is keeping the person healthy, so that they can continue with their lives.
This article made it clear, I thought, that the alternative modalities aren't for everyone. @Steve, I think your simile is faulty.
This article explicitly does NOT say that all treatment with psychiatric medication is "overmedication". It explicitly reports that many people using this approach do it in conjunction with medication, at lower doses. Psychiatric medications have side effects that include drastically increasing the risk of diabetes, weight gain, kidney failure, decrease in sex drive, and a numbing of all emotions. You may think this is a good trade-off for not hearing voices, but the kick is, medications don't even take away all the voices in many cases. And while this article doesn't go into it, the Hearing Voices movement does work with people in crisis, especially in Denmark and Britain, where there are more resources. Using medication and other treatment to stabilize a person and then working to help a person live with voices in a practical every day way with less or no medication is in no way a comparison to sewing up skin after a heart transplant.
It is worrisome that severely psychotic people might forgo needed medical treatment for a holistic program, but on the other hand, using these programs with medication could likely allow patients to function on smaller doses and have fewer side effects. Any treatment which allows patients to decrease their dosage of meds is welcome, since the side effects can be overwhelming and lead to non-compliance.
9
Indeed, that is true. And the snowball effect of meds - more and more of them to help with side effects, is just a horrible trap to fall into. Also, the fact that talk therapy has practically been eliminated from psychiatric treatment is very scary. Doctors just throw meds at you and really don't follow up at all. This sounds like a pathway for which there was a real need. I hope it proves fruitful for these people.
1
Psychological imbalance is not the same thing as diabetes or pneumonia. To describe something as a disease, you need a standard of health. We know what a healthy kidney is because it has a single physiological function. But what is the function of a psyche? Social integration? Then let's lock up all rebels, inventors, scientists and entrepreneurs. Happiness? Let's put Van Gogh and Shakespeare on Thorazine. Aggression, violence and ruthlessness are highly valued in certain cultures and often for good reasons. Hearing voices are a common trait of shamans, prophets and holy men in indigenous societies. This does not mean that psychotic symptoms are to be embraced but individuals should be encouraged to make sense of their lives in a way that is meaningful to them. It is better than deadening themselves with drugs, whether legal or illegal.
77
To begin with, mental health clinicians do not see psychotic symptoms as problems needing to be treated except insofar as they are barriers to functionality, be it social, vocational, educational or recreational functioning. Millions of Americans have delusional beliefs. It is of no concern to mental health professionals if these individuals are able to function and be safe in their communities. Millions report instances of hallucinations; this does not concern us if the person is not receiving command auditory hallucinations to kill him or herself or others, nor if, again, the hallucinations are not impairing the person's every day functioning. These criteria are built in to diagnoses of these illnesses.
In addition, it is worth noting that we don't "lock up" people anymore, much to the chagrin of the families of the mentally ill, who often want just that done to their family members. National and state mental hygiene laws now mandate the least restrictive settings possible. People can be hospitalized against their will in acute inpatient units if they are judged to be imminent dangers to self or others, but legally must be discharged once their acute symptoms subside, (usually in 7-10 days, often less.)
In addition, it is worth noting that we don't "lock up" people anymore, much to the chagrin of the families of the mentally ill, who often want just that done to their family members. National and state mental hygiene laws now mandate the least restrictive settings possible. People can be hospitalized against their will in acute inpatient units if they are judged to be imminent dangers to self or others, but legally must be discharged once their acute symptoms subside, (usually in 7-10 days, often less.)
1
I am diagnosed with depression and suffer with negative, hateful voices in my head everyday. I disagree with the anti-medical, miracle cure tone of the article. I know with certainty that my negative voices do not want to help me in any way.
Their goal is to rob me of all joy and happiness. They are symptoms of a serious mental illness and need to be treated with medication. I have dialoged with them in Therapy for years and it did not help at all.
Their goal is to rob me of all joy and happiness. They are symptoms of a serious mental illness and need to be treated with medication. I have dialoged with them in Therapy for years and it did not help at all.
26
But you are on medication and you still hear the voices ... so that doesn't seem to be effective either !
Andrew, I am not in your shoes and I'm sure you know from experience. I speak negatively to myself as well, but I know it's me, talking to me. I wonder, "What part of me is talking so incessantly?" It's like an insane roommate that will not leave. Meditation helps. Remembering not to believe all my thoughts helps. Disconnecting from "the world" helps. The truth is (at least for me) that this world is insane. Its values so often are not in support of life. I go inside, move the inner roommate over, and find a space to connect with something that is both inside of me and outside of me. I know this is possible because we are all connected. I wish you peace and send you lovingkindess.
2
It's so interesting that anything that suggests a different approach is heard as 'anti' or proporting a miracle cure.
Alternative approaches are often much more reasonable, nuance, and science-based then the fevered, biomedical, pharma-driven ones we here every day.
I wonder what it might take for people to recognize that fact.
Alternative approaches are often much more reasonable, nuance, and science-based then the fevered, biomedical, pharma-driven ones we here every day.
I wonder what it might take for people to recognize that fact.
1
I am a firm believer in using medications to treat what we call "mental" illness. True illness is biological/chemical in nature and cannot merely be talked away. The talking phase of full recovery ensures a change in lifestyle, but the medication ensures that the scary/manic/disorganized thoughts are redirected through the brain functions that channel them properly. If an illness can be controlled solely with talk therapy, there was no illness to begin with, and no illness to control for the rest of one's life. The individual may have merely been living through a series of life crises; sorting out the reasons/suppression/action plan for alleviating the pain is, yes, supported by talk therapy.
Real mental illness, where mis-firings and confusions in the brain waves/synapses, and over- or under- production of brain chemical cause erratic behaviors, can only be controlled with medication. Schizophrenia is, actually, more similar to epilepsy than it is to what we call "seasonal affective disorder." Autism and Alzheimer's are more similar to clinical depression than is grief at the death of a loved one. (Grief is not depression.)
The saddest thing in life is to be mentally ill and have someone yell at you to "snap out of it." Would we say that to someone having a grand mal seizure?
Living well; medicated for life. Life's wonderful, thanks to effective drugs. But why are they so expensive?
Real mental illness, where mis-firings and confusions in the brain waves/synapses, and over- or under- production of brain chemical cause erratic behaviors, can only be controlled with medication. Schizophrenia is, actually, more similar to epilepsy than it is to what we call "seasonal affective disorder." Autism and Alzheimer's are more similar to clinical depression than is grief at the death of a loved one. (Grief is not depression.)
The saddest thing in life is to be mentally ill and have someone yell at you to "snap out of it." Would we say that to someone having a grand mal seizure?
Living well; medicated for life. Life's wonderful, thanks to effective drugs. But why are they so expensive?
18
How do you know that 'true illness' is biologic or chemical in nature? (Particularly since the theory of 'chemical imbalance' has been so thoroughly debunked at this point...) Citations?
1
holistic is the new gluten free.
4
We have a mental health crisis in our country which has been going on for over thirty years.
Our nation has an abysmal and shameful record of neglect when it comes to mental health, and we have to applaud and encourage any efforts to find alternative treatments that are effective. It is clear that a 'one size fits all' treatment regimen does not apply to mental health treatment.
Congress passed the 'Mental Health Parity And Addiction Equity Act' in 2008, and it took the Obama Administration almost six years to issue guidelines to implement the law.
There is a severe shortage of psychiatrists, and our society continues to stigmatize mental health issues. We frequently criminalize and incarcerate people with anti-social behaviors and addiction, when they are public health issues.
Congress needs to reorder their priorities to devote whatever it takes to stem this epidemic. We must encourage public debates and discussions of mental health, which should lead to reexamining the inadequate resources devoted to diagnosing and treating the mentally ill.
We have to do better.
Roy Steele
San Francisco, California
Our nation has an abysmal and shameful record of neglect when it comes to mental health, and we have to applaud and encourage any efforts to find alternative treatments that are effective. It is clear that a 'one size fits all' treatment regimen does not apply to mental health treatment.
Congress passed the 'Mental Health Parity And Addiction Equity Act' in 2008, and it took the Obama Administration almost six years to issue guidelines to implement the law.
There is a severe shortage of psychiatrists, and our society continues to stigmatize mental health issues. We frequently criminalize and incarcerate people with anti-social behaviors and addiction, when they are public health issues.
Congress needs to reorder their priorities to devote whatever it takes to stem this epidemic. We must encourage public debates and discussions of mental health, which should lead to reexamining the inadequate resources devoted to diagnosing and treating the mentally ill.
We have to do better.
Roy Steele
San Francisco, California
9
Right !
What is being described is essentially getting in contact with parts of oneself that are dissociated from conscious awareness and that somehow (with perhaps genetic roots) break through into voices heard as alien, coming from outside the self. Conceptually, this is not that different than most of contemporary psychoanalysis, a cluster of views called relational, that attempts to connect a person with those disowned parts in the context of a therapeutic relationship. Given the low level of most psychiatric treatment, these groups look promising.
While it may be walking a risky road for those hearing voices, once one begins to make friends with alien parts of oneself, they can lose some of their toxicity. So it takes a skilled and supportive therapist- or perhaps the support of the group described hear- to provide what the analysts call a holding environment.
As an analytically oriented therapist I never understood why what I do is called a medical procedure, other than that meant that patients I see can get some insurance coverage. So we play the game. And also because the drug companies needed discrete medical entities to market their many products.
This has taken us away from looking at the meanings of a symptom- why is this happening, what function does it serve, how do the voices protect you, what are you scared of, are you scared of me?- and how this plays out in relationships. Some people may need medication; some may not. It is not an either/or.
While it may be walking a risky road for those hearing voices, once one begins to make friends with alien parts of oneself, they can lose some of their toxicity. So it takes a skilled and supportive therapist- or perhaps the support of the group described hear- to provide what the analysts call a holding environment.
As an analytically oriented therapist I never understood why what I do is called a medical procedure, other than that meant that patients I see can get some insurance coverage. So we play the game. And also because the drug companies needed discrete medical entities to market their many products.
This has taken us away from looking at the meanings of a symptom- why is this happening, what function does it serve, how do the voices protect you, what are you scared of, are you scared of me?- and how this plays out in relationships. Some people may need medication; some may not. It is not an either/or.
11
It's called medical because it relates to health and illness, as in mental.
Most everything relates in a broad way to health and illness. For example, my tennis sneakers contribute to both physical and mental well-being, but my health plan doesn't pay for it. Also, my guitar, which improves my mood when I play it, needs some repairs. Why not cover that as medical?
1
I am a psychoanalyst with wide experience treating individuals suffering from mental illness. It is sometimes possible to get to the root of the meaning of psychotic process, enabling sufferers to move forward and lead richer and more fulfilling lives. This takes a lot of work on the part of both patient and analyst and takes time. Email is not a sufficient venue for discussing this process more deeply or in more detail, but I can offer hope in that, I and others have been helpful to many.
4
I think it sounds fine and very humane and promising to suggest that someone who hears voices question the voices, asking "What do you want?" and trying to get to a metaphoric understanding of what the voice may be saying, how it relates to their lives, their emotions, etc.
But nothing like that is going to work - in fact it could be incredibly destructive - if the person doesn't FIRST fully understand that the voice is not real, i.e., if the person can't distinguish the contents of their own head from external reality.
In short, it sounds like it could be helpful for some people who are already on antipsychotic medication, and perhaps for selected others. But if it encourages some to go OFF those medications or not start taking them when they are needed, then, well, this is dreadful.
But nothing like that is going to work - in fact it could be incredibly destructive - if the person doesn't FIRST fully understand that the voice is not real, i.e., if the person can't distinguish the contents of their own head from external reality.
In short, it sounds like it could be helpful for some people who are already on antipsychotic medication, and perhaps for selected others. But if it encourages some to go OFF those medications or not start taking them when they are needed, then, well, this is dreadful.
9
Did you even read the article?
First off, voices like these are real - in that they are an actual phenomenon that the person experiences, so whether or not other people can hear them, they are real to the person experiencing them, and are a real symptom. You cannot reason away, or talk someone out of, auditory hallucinations.
Second, hearing voices does not mean you can't distinguish the contents of your head from external reality. It means you hear voices, and it doesn't always impact or influence how you see the rest of your environment. Obviously, in a crisis, when a person is very ill and can no longer distinguish between what is safe and what is not, there needs to be more intervention, but that is not what this article is talking about. Not everyone who hears voices is in crisis.
The whole purpose of groups like this one, and some others that I have heard of, or known people to be involved in, is to take something that is frightening, or distressing, and understand what part of your self it comes from, or what part of your psyche is generating it, so that you can either live with it, or have it be altered to make it less disruptive. The whole point is to avoid crisis, and allow people to do well without the side effects of high doses of medication - which very often render a person non-functional.
First off, voices like these are real - in that they are an actual phenomenon that the person experiences, so whether or not other people can hear them, they are real to the person experiencing them, and are a real symptom. You cannot reason away, or talk someone out of, auditory hallucinations.
Second, hearing voices does not mean you can't distinguish the contents of your head from external reality. It means you hear voices, and it doesn't always impact or influence how you see the rest of your environment. Obviously, in a crisis, when a person is very ill and can no longer distinguish between what is safe and what is not, there needs to be more intervention, but that is not what this article is talking about. Not everyone who hears voices is in crisis.
The whole purpose of groups like this one, and some others that I have heard of, or known people to be involved in, is to take something that is frightening, or distressing, and understand what part of your self it comes from, or what part of your psyche is generating it, so that you can either live with it, or have it be altered to make it less disruptive. The whole point is to avoid crisis, and allow people to do well without the side effects of high doses of medication - which very often render a person non-functional.
18
Totally talking past each other, Ephena. Yes, I read the article. I didn't suggest anyone try to talk someone out of hallucinations. I suggested pretty much what you're suggesting: that this is good stuff IF the person understands that the voice they're hearing is inside their head, not external reality.
What deeply intrigues me about this discussion, and I do not mention this lightly, is that the vast majority of such internal voices are always "fearful" and hypercritical" and "toxic" as well as "Shaming" and "Blaming" e.g. "Your worthless!" and then much worse. With 96% of all family structures being fully dysfunctional and abusive, it makes pathological sense that it would all turn in this direction. That is to say, I wonder if anyone has gone to any psychiatrist or simply wake up one morning and hears an inner voice saying "You're a beautiful, wonderful, caring and loved woman or man" and "We need more people like you on this planet as you shine with intelligence, compassion and warmth" and "There are so few like you!"
Healthy, loving and 'authentically caring parents' would go a very long way to healing as well as preventing mental disorders. About time *all* of us woke up to this reality, fact and 'common sense' conclusion. In the meantime we all struggle or pay a price one way or another.
Healthy, loving and 'authentically caring parents' would go a very long way to healing as well as preventing mental disorders. About time *all* of us woke up to this reality, fact and 'common sense' conclusion. In the meantime we all struggle or pay a price one way or another.
20
I'm certain that your intentions were good when you suggested that "Healthy, loving and 'authentically caring parents' would go a long way to healing as well as preventing mental disorders"...but in reality those words do an incredible disservice to both those suffering from mental illness and their deeply loving and caring families that are more often then not doing everything in their power to help their loved ones find peace of mind. Mental Illness is just that...an illness. This article is not referring to people who are mentally unstable as the result of emotional abuse. This article addresses illnesses of the brain that are the result of a chemical imbalance...one that steals the victim's life as they knew it away from them. Please don't recklessly hypothesis about a matter that is so critical for our society to truly understand. The shame that a victim of mental illness feel is often part of the disease...the toxic behavior the result of the anger that this pain creates in their souls. What our society needs is more compassion for those suffering from mental illness and a lot less judgment of them and of their loved ones.
I heartily agree.
1
I used to be normal and have self-doubts and negative talks but then I started to observe, challenge and accept. Then, the strangest thing happened, I started to like them and humor them and find them full of fake observations. Now after a good internal beating, which is very rare, I may ask, really? Like you do not mean that do you sort of way.
When I look in the mirror, I do hear I am a good person in the back of my mind and it is automatic and I do believe that is my core…everything else is just a symptom of something else.
It is possible. It takes time but it is possible.
When I look in the mirror, I do hear I am a good person in the back of my mind and it is automatic and I do believe that is my core…everything else is just a symptom of something else.
It is possible. It takes time but it is possible.
Not all auditory hallucinations come from schizophrenia or other psychosis. People with dissociative identity disorder also hear voices which are often conversational and sometimes child like. Unfortunately this diagnosis is out of favor with mainstream psychiatry and goes unrecognized and misdiagnosed. The treatment for those voices is not medication, but psychotherapy, and would respond positively to the supportive group environment described in the article. I agree with other comments that this is not an either or situation. Some conditions respond well to medication, some to therapy, some to a support group, and some to a combination of them all.
23
As a psychiatrist treating many adults with serious mental health disorders, I would note how important is the partnership a doctor has with the client. I always ask about medication side effects so as not to create a bigger problem and emphasize the issue of healthy choices like exercise, having a routine, and having a social life, the latter all being things that make up the good life we all want. No one should hear that he or she is unable to work or have a life because of mental illness and I regret that some may have heard that from their doctors. Getting better is always an option.
18
Alternative therapies have been around for many, many years and have been successful in helping those with mental health problems. Part of the overall problem is that psychiatrists in general are only trained in the medical model, that is find out what the symptoms are and give the person medication. Big pharma has driven this model and courts psychiatrists usually explaining how the new meds work and for what symptoms the medication should be prescribed. However, most medications have potential side effects ranging from tardive dyskinesia, a permanent syndrome characterized by involuntary repetitive movements that had no purpose to suicidal ideation and suicide.
38
Home remedies for psychiatric disorders sounds like a bad idea. We have mentally disturbed people killing others when they stop taking their meds. Presumably we will be able to sue the holistic groups when something bad happens....
12
Perhaps you should read the article. These are not "home remedies", they have studied outcomes which are positive, and there are more studies being done.
Also, people with mental health issues killing other people when they stop taking their meds really does not happen all that often. That's a pretty damaging myth. When people with mental health issues commit violent acts, it is usually due to the use of substances, and people with mental health issues are much more often the victims of violence than perpetrators.
Also, people with mental health issues killing other people when they stop taking their meds really does not happen all that often. That's a pretty damaging myth. When people with mental health issues commit violent acts, it is usually due to the use of substances, and people with mental health issues are much more often the victims of violence than perpetrators.
We have mentally disturbed people killing others when they stop taking their meds. --your conclusion--though common-- is not a causal connection. Most of the time going off your meds causes severe withdrawal symptoms of psychosis. it's the withdrawal from these meds that are often the cause of abberant behavior--and not the underlying brain disorder.
To Bill:
Most of those "psycho killers" have ONLY nuked the family members who neglected and abused them. And psychiatry's body count is WAAAY higher than the body count of all those "psycho killers". Also, 'sunmuse' is right about the Mad people who get reprogrammed for violence when their quacks start jacking them up on those poisonous psychiatric narcotics. It's hard not to strike back at a world that condones a "health care" system in which doctors make millions by torturing their patients.
Most of those "psycho killers" have ONLY nuked the family members who neglected and abused them. And psychiatry's body count is WAAAY higher than the body count of all those "psycho killers". Also, 'sunmuse' is right about the Mad people who get reprogrammed for violence when their quacks start jacking them up on those poisonous psychiatric narcotics. It's hard not to strike back at a world that condones a "health care" system in which doctors make millions by torturing their patients.
1
Where can I begin. While I appreciate the New York Times for giving a voice to those who have rejected psychiatry's poisonous treatments, it is a bit disheartening that Mr Pies and Allen Frances are mentioned without highlighting the ongoing controversy between them and Mad In America founder Bob Whitaker.
Speaking of, Mr Whitaker should have been interviewed for this article. He has done more than any psychiatrist I know to create a safe space for those of us who have been maligned by institutional psychiatry to share our stories and to recover from their damaging so called "treatments".
A few years back I stumbled upon Mad In America. With the information I got from the site, I decided to stop all my meds. That triggered a process that ended up with me regaining the life that institutional psychiatry stole from me. I am a happy and productive member of society now. None of that would have happened if Mr Pies and, less so, Allen Frances had gotten their way.
The so called "mentally ill" remain the group of people society thinks it has a right to malign and make fun of. Institutional psychiatry is a pseudo science that should have been barred from any role in determining behavioral normality long time ago.
PS: No, I am not Scientologist, neither is the average Mad In America reader. I am just a human being who sees institutional psychiatry for what it is: the last form of legalized civil rights abusing institution that remains in the books in the US and abroad.
Speaking of, Mr Whitaker should have been interviewed for this article. He has done more than any psychiatrist I know to create a safe space for those of us who have been maligned by institutional psychiatry to share our stories and to recover from their damaging so called "treatments".
A few years back I stumbled upon Mad In America. With the information I got from the site, I decided to stop all my meds. That triggered a process that ended up with me regaining the life that institutional psychiatry stole from me. I am a happy and productive member of society now. None of that would have happened if Mr Pies and, less so, Allen Frances had gotten their way.
The so called "mentally ill" remain the group of people society thinks it has a right to malign and make fun of. Institutional psychiatry is a pseudo science that should have been barred from any role in determining behavioral normality long time ago.
PS: No, I am not Scientologist, neither is the average Mad In America reader. I am just a human being who sees institutional psychiatry for what it is: the last form of legalized civil rights abusing institution that remains in the books in the US and abroad.
24
Considering that there are more and better studies supporting psychiatric treatments than for 80% of the medical and surgical treatments provided patients, I assume you must consider all of modern medicine pseudoscience.
Perhaps you're not a scientologist but you must be a Christian Scientist.
Perhaps you're not a scientologist but you must be a Christian Scientist.
5
There is no way to recommend Robert Whitaker's work highly enough. The books Mad In America and Anatomy of an Epidemic, along with the Mad In America web site and project, should be read by anyone interested in the subject.
6
Steve,
Repeating a falsehood many times doesn't make the falsehood true. During the DSM-5 controversy not only Allen Frances, who served as chief editor of DSM-IV, came strongly against it for "making up" diseases, but the former director of the NIHM, Tom Insel, wrote a blog in his public blog saying in plain terms what everybody already knew https://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml
To get an HIV diagnosis, you get an HIV test that checks the presence of HIV antibodies in your blood system. To get a cancer diagnosis you get a combination of imaging and biological tests to check the presence of cancerous cells in your body. To get labelled "mentally ill", you get a psychiatrist to decide based on his/her own opinion whether your pattern of behavior matches any of the diseases made up by vote at any of the DSM committees.
I am not a "Christian Scientist", just a "scientist". Psychiatry has no objective reality to study, only labels made up by vote. If you happened to live in the 1950s, being gay got you labelled "mentally ill". If you happened to be a black living in a non free state in the XIX-th century, seeking freedom got you labelled with "drapetomania". The way psychiatry invents its diseases today is no different from when they invented "drapetomania" or "homosexuality" as mental illnesses.
Repeating a falsehood many times doesn't make the falsehood true. During the DSM-5 controversy not only Allen Frances, who served as chief editor of DSM-IV, came strongly against it for "making up" diseases, but the former director of the NIHM, Tom Insel, wrote a blog in his public blog saying in plain terms what everybody already knew https://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml
To get an HIV diagnosis, you get an HIV test that checks the presence of HIV antibodies in your blood system. To get a cancer diagnosis you get a combination of imaging and biological tests to check the presence of cancerous cells in your body. To get labelled "mentally ill", you get a psychiatrist to decide based on his/her own opinion whether your pattern of behavior matches any of the diseases made up by vote at any of the DSM committees.
I am not a "Christian Scientist", just a "scientist". Psychiatry has no objective reality to study, only labels made up by vote. If you happened to live in the 1950s, being gay got you labelled "mentally ill". If you happened to be a black living in a non free state in the XIX-th century, seeking freedom got you labelled with "drapetomania". The way psychiatry invents its diseases today is no different from when they invented "drapetomania" or "homosexuality" as mental illnesses.
5
I am a psychiatrist and psychoanalyst and have read your article of August 8 about alternative form of treatment for people who are "hearing voices" with great interest and some frustration. It seem to have been forgotten by practicioners of contemporary "biological psychiatry" as well as the writer of the article that psychotherapeutic methods to help patients dealing with their voices have been around for decades. To name some of the most influential, the late Harold Searles gave us an in depth understanding of delusions and hallucinations, Andrew Lotterman and Eric Marcus of Columbia University have written volumes about psychodynamic psychotherapy of psychotic patients. There is effective, manualized cognitive-behavioral therapy for psychosis. Unfortunately many in the mainstream psychiatry dismiss the meaning of psychotic symptoms. 15 minute "medication checks" are a shame on the health care system of the most powerful country. Psychiatry has lost its mind....
97
Thanks, your comment captured my initial reaction. I worked with psychotic clients for a number of years and I think it is very sad that very few clients ever get the chance to work with a therapist or psychiatrist trained to help them explore the meaning of delusions and hallucinations. I had some basic training in this and found it helped a number of clients. Unfortunately, the insurance system is increasingly moving away from psychodynamic treatment, for a number of reasons too complex to get into here. Very few training programs even train graduate student clinicians in the work of Searles, Bion, etc. I hope some of the folks in the hearing voices network investigate the work of pioneers like Searles and Bion.
11
Will someone please read and study the work of Dr Abram Hoffer, he was certainly a pioneer in alternative treatments for mental illness, basically using B-3 he reversed acute schizophrenia episodes. His primary focus was molecular psychiatry.
His work is well documented and covered over 50 years, he lived in Canada which may explain a lot.
Time to be brave.
His work is well documented and covered over 50 years, he lived in Canada which may explain a lot.
Time to be brave.
1
As an American with Schizo-Affective Disorder with Paranoid-Schizophrenic tendencies this is so fascinating to me. As the Jungian analyst who I saw for ten years tried in vain to get me to start dialoging with my voices in order to find out what they wanted. Of course he was also the therapist who gave me the ultimatum to go on medication in the first place, or else he would refuse to see me, and he once got very annoyed when he realized by my behavior that I had gone off my medication without telling him. It seems to me that we have been unrealistically glorifying the medical model of Psychiatry of late. It is hardly the silver bullet it is marketed to be. Then there is the dehumanization Psychiatry is so famous for. Perhaps in the future Depth-Psychology and even Jungian- Analytical-Psychology will be making a comeback. Especially since the retrospective view of Psychiatry is always pretty poor. And we know that Psychiatry without Psychology is never as helpful as it is when combined with Psychological treatment. My experience over the last 3O years tells me that this idea that all you need is a pill is extremely premature if not simply bogus. Although I do take my pills because... well... they do help me. But I also see my new Jungian therapist once a week. I suppose a large part of the problem is simply that the mystery of what we refer to as mental-illness is just so far from solved. Therefore it is probably a mistake to put all of our eggs in one basket.
22
Anyone who has lived through a loved one afflicted with schizophrenia knows that medication can be a life saver. If alternative treatments can help that is wonderful. But to dismiss meds is to show a complete lack of understanding how horrible and debilitating schizophrenia is. An incompetent Doctor took my relatively high functioning brother off meds because he decided he didn't have schizophrenia. In the two years since my brother has deteriorated and is probably unreachable at this point.
48
Like other medical diseases neurological illnesses need scientific research to eradicate them. We have romanced mental illnesses out of reality. And so we have left them open to every social concept and magical thinking that comes along each year.
Let's publicize the scientific findings we already have to give people a fighting chance against the flights of fancy, hunches, misconceptions, myths and assumptions of those that eschew scientific research to find the cure.
Let's publicize the scientific findings we already have to give people a fighting chance against the flights of fancy, hunches, misconceptions, myths and assumptions of those that eschew scientific research to find the cure.
1
Seriously? Engaging voices is what happens during the times certain individuals decide they don't need medication anymore. This concept is already present --and engaged.
1
I'm generally pretty skeptical about CAM, but if Thorazine is still a mainline treatment for psychoses, clearly there is room for improvement
16
As someone who suffered through 25 years of "alternative AKA holistic" treatment, my advice, don't do it. Good meds, like the Zyprexa I've taken for almost 30 years, and good doctors who are rational, sensible, and know what they're talking about will be all anyone needs. Those who would have hysterical reactions, as in trying to take away meds that work wonderfully for wonder drugs or treatments are quacks to be avoided at all costs. I've had doctors who are quacks. The doctors who I have now have been true life savers.
29
As a legal advocate for people who suffer from mental illness, this article and the non-medical intervention it describes, is hopeful. Almost all of my clients hate the way their medication makes them feel. Further, all of my clients are under involuntary court orders to take the medications, another pernicious aspect to mainstream psychiatry.
42
I am a bit puzzled by this article, since it seems to have an agenda, but I am not sure what it is. Many of the comments are of the form, "big pharma makes lots of money and the courts require medications, thus medication free approaches are worth checking out". Many comments pointed out that Dr. Pies has received money from big pharma, making his testimony suspect. On the other hand, Debra Kornbluh provides legal representation to those who want to avoid court ordered medications, also making me suspicious. I have heard that families and friends of hallucinating patients fear them going off medication. Maybe some of that is self interest, but I have also heard that medications can help them in parenting, job performance and social interactions. That may not be a permanent cure, but it does sound better than the alternative.
2
If all of your clients are "under involuntary court orders to take the medications," you are a legal advocate for only a small, select group who have been found to be a danger to self or others under the criteria specified in the Mental Health Act. I'm sure you realize that your clients don't represent the majority of people who live with mental illness, many of whom take medications voluntarily because they find them helpful. Some people don't experience side effects while others chose to manage the side effects rather than suffer through repeated psychotic episodes.
4
Gee, psychiatry is more powerful than I thought. Who knew it controlled the legal system.
2
Every time I read an article in the Times about psychiatry, I am reminded of an article on Medscape I read that asks "what does the New York Times have against psychiatry?" And points out for an article called "redefining mental illness", but it could also be appropriate for this article, that: "The article about mental illness was an incredibly unscholarly, misinformed, confused—at worst, unhelpful, and at best, destructive—commentary that will add to the confusion about the diagnosis of mental illness, enhance the stigma, and may lead some patients to doubt the veracity of the diagnoses that they have been given and the treatments that they are receiving."
It is absurd and dangerous to think that bipolar disorder, something I have, could be managed without medication. How often do you call into question oncology and advise cancer patients to skip medication and try a support group?
It is absurd and dangerous to think that bipolar disorder, something I have, could be managed without medication. How often do you call into question oncology and advise cancer patients to skip medication and try a support group?
73
Funny you should compare psychiatric diagnosis to cancer... Incidentally, outcomes for cancer treatments have improved over the decades, and outcomes for psychiatric diagnosis have not.
Perhaps they shouldn't be compared... And perhaps you should speak for yourself and your own experiences with psychiatric diagnosis (to which you are certainly entitled), and not attempt to speak so much for others. It seems quite an extreme and all-encompassing statement to say, "It is absurd and dangerous to think that bipolar disorder... could be managed without medication."
This is one of those situations where all 'opinions' are not created equal... Because there are *many* people who've been so diagnosed who are living very well without psychiatric drugs. No one wants to take psychiatric drugs away from you, but perhaps you might leave a little bit of space for those who want and benefit from other alternatives?
Perhaps they shouldn't be compared... And perhaps you should speak for yourself and your own experiences with psychiatric diagnosis (to which you are certainly entitled), and not attempt to speak so much for others. It seems quite an extreme and all-encompassing statement to say, "It is absurd and dangerous to think that bipolar disorder... could be managed without medication."
This is one of those situations where all 'opinions' are not created equal... Because there are *many* people who've been so diagnosed who are living very well without psychiatric drugs. No one wants to take psychiatric drugs away from you, but perhaps you might leave a little bit of space for those who want and benefit from other alternatives?
18
@Sera: You said "... outcomes for cancer treatments have improved over the decades, and outcomes for psychiatric diagnosis have not." Outcomes for schizophrenia have indeed improved and outcomes for depression and bipolar disorder have improved even more. The research actually supports the notion that bipolar disorder is rarely successfully treated by any modality that does not include medication. Which is not to say that non-pharmacological treatments are unimportant. Let's not throw the baby out with the bathwater. All modalities should be used wherever they show promise. And each person is different in what they need for successful treatment.
As one of the nurse practitioners on the psychopharm mailing list used to say, "It's important to keep an open mind, but not so open that your brain falls out."
As one of the nurse practitioners on the psychopharm mailing list used to say, "It's important to keep an open mind, but not so open that your brain falls out."
10
Given the rate of medical error, and the less-than-stellar rate of diagnosis accuracy, I think it is wise to "doubt the veracity of the diagnoses" as the article you quote states. Medicine is an art -- and a diagnosis can depend much more on *who* you see than one would like to think. Second opinions, or searching out someone who has significant experience in your condition, can make all the difference.
1
Transforming "bad" voices into "good" voices could be considered Mission Accomplished with respect to creating a positive self-image and the ability to see oneself as a valuable member of society. How that happens is not as important as the fact that it can happen over time with the right combination of support and ongoing research into the nature of mental illness.
8
My close friend was diagnosed bipolar II and put on lithium and seroquel for several years. Initially the drugs were miraculous, but after 2 years the drugs began to cause augmentation of the symptoms rather than amelioration. There were substance abuse problems, as well, and he began attending 3-4 Twelve Step meetings a day, some that dealt with both alcohol and mental illness, as well as others for people who were on meds. Over a period of 5 years, he discontinued his meds and shows no signs of relapse for 7 years. Of course, the doctors now say it was a "misdiagnosis". Right.
17
Hey, 'misdiagnosis' is a very common scenario. I've had no fewer than 5 separate labels over 40 years...all of which seemed descriptive of my symptoms at the time of diagnosis. Patients change, labels change, criteria change, consulting doctors change, and successful treatments change, too.
3
I've been in therapy and on medication for bipolar disorder for almost 15 years. I've also spent a significant amount of time studying psychology academically. Therapy and medication worked wonders for me. They took me from totally non-functional to pursuing my dream in grad school. I'm the last person who is going to say that medication is bad.
What I will say, from experience, is that not all therapies work for all patients. Medication isn't for everyone. Some people need it. They may not like it, but some people have no chance at functioning without it. I'm one of those people. But that's not for everyone. The truth is that psychologists and psychopharmacologists know a lot less than they'd like about how and why therapy and medications work. Which means that alternate therapies such as the ones in the article are perfectly viable.
Here's the important bit. The supporters of these therapies are being REALISTIC. They know it's not for everyone. And it sounds like if the people that come to them aren't getting better, they are referred elsewhere. In addition, as long as they don't prevent others from getting therapy that's needed (for example, saying that medication is poison and that no one should be on it when that is obviously not the case), then IMO they are doing fine. In the end, we all just want to get better, and to help others get better. That's what it's all about, right?
What I will say, from experience, is that not all therapies work for all patients. Medication isn't for everyone. Some people need it. They may not like it, but some people have no chance at functioning without it. I'm one of those people. But that's not for everyone. The truth is that psychologists and psychopharmacologists know a lot less than they'd like about how and why therapy and medications work. Which means that alternate therapies such as the ones in the article are perfectly viable.
Here's the important bit. The supporters of these therapies are being REALISTIC. They know it's not for everyone. And it sounds like if the people that come to them aren't getting better, they are referred elsewhere. In addition, as long as they don't prevent others from getting therapy that's needed (for example, saying that medication is poison and that no one should be on it when that is obviously not the case), then IMO they are doing fine. In the end, we all just want to get better, and to help others get better. That's what it's all about, right?
72
Without mentioning a name, because I have no right to do so, there is a highly regarded psychiatrist, affiliated with a top medical school, who advocates what this Voices group is doing. He says getting rid of the voices is impossible, but it is possible to train people to hear them yet ignore harmful, distracting messages. And he claims to have success with his patients. Alternative programs, that work either with those taking medications successfully, or for those whom medicine is harmful, are a boon and blessing. And because these programs are run by trained specialists, they will probably yield good results. It's also about time all of us realize that many so-called "crazy" people are simply those unfortunate enough to have genes that make them vulnerable; that is what separates them from us "normal" folks. Often a very thin line, so let us be more compassionate.
17
"“The reason these programs are proliferating now is society’s shameful neglect of the severely ill, which creates a vacuum of great need,” said Dr. Allen Frances, a professor emeritus of psychiatry at Duke University."
This I find quite disingenuous. The reason these programs are proliferating now is psychiatry's neglect of the needs of its own patients, and its rigid overreliance on drugs and neglect of the psychosocial needs of those using its services. Note that a number, if not all, of the group participants have received plenty of "mental health care" from the standard psychiatric system. They weren't neglected - the problem is, the treatment they received either didn't work, or the cure was worse than the disease.
A little humility might be helpful if Francis and his ilk want to find out what this phenomenon is really about.
And BTW, there are PLENTY of studies on the Open Dialog model, which has been around in Finland for decades. They have the very best outcomes for schizophrenia-diagnosed patients of any approach in the world. Claiming that psychiatrists are skeptical because of lack of evidence is disingenuous in the extreme!
This I find quite disingenuous. The reason these programs are proliferating now is psychiatry's neglect of the needs of its own patients, and its rigid overreliance on drugs and neglect of the psychosocial needs of those using its services. Note that a number, if not all, of the group participants have received plenty of "mental health care" from the standard psychiatric system. They weren't neglected - the problem is, the treatment they received either didn't work, or the cure was worse than the disease.
A little humility might be helpful if Francis and his ilk want to find out what this phenomenon is really about.
And BTW, there are PLENTY of studies on the Open Dialog model, which has been around in Finland for decades. They have the very best outcomes for schizophrenia-diagnosed patients of any approach in the world. Claiming that psychiatrists are skeptical because of lack of evidence is disingenuous in the extreme!
35
And I assume you also blame doctors for providing inadequate care when patients died of cancer, heart disease, or diabetes. Or is it only psychiatrists who are to blame if their patients don't get better?
3
No, but cancer treatment has REDUCED the death rate due to cancer. Psychiatry is perhaps the only medical sub-specialty where treatment INCREASES the rate of death. Surely you are rational enough to distinguish between a person dying as the result of a disease and a person dying from the treatment of the disease who would otherwise have lived a longer life?
There are increasing numbers of studies on long-term outcomes for those diagnoses mentally ill that are showing long-term use of medication to have either no positive effect or negative effects on the very symptoms they are meant to treat. Look at the work by Wunderlink or Harrow (among others) on the long-term comparison of those taking vs. those not taking medication.
Harrow's data (25 years' worth) are particularly enlightening. It takes a couple of years before the divergence becomes apparent, but once past the two-three year mark, even those with better prognoses in the beginning do worse than those with more severe diagnoses (aka schizophrenia) who used the medication short-term or not at all.
I'm a scientist by training and I look at DATA. The data say that 1) not everyone is helped by psych drugs, 2) those who are helped fare better IN GENERAL when doses are low and courses of treatment are shorter (allowing that there are exceptions where long-term use is indicated), and 3) there ARE alternative approaches that appear to work quite well for a good hunk of this population.
There are increasing numbers of studies on long-term outcomes for those diagnoses mentally ill that are showing long-term use of medication to have either no positive effect or negative effects on the very symptoms they are meant to treat. Look at the work by Wunderlink or Harrow (among others) on the long-term comparison of those taking vs. those not taking medication.
Harrow's data (25 years' worth) are particularly enlightening. It takes a couple of years before the divergence becomes apparent, but once past the two-three year mark, even those with better prognoses in the beginning do worse than those with more severe diagnoses (aka schizophrenia) who used the medication short-term or not at all.
I'm a scientist by training and I look at DATA. The data say that 1) not everyone is helped by psych drugs, 2) those who are helped fare better IN GENERAL when doses are low and courses of treatment are shorter (allowing that there are exceptions where long-term use is indicated), and 3) there ARE alternative approaches that appear to work quite well for a good hunk of this population.
1
You should read Dr. Francis' book, "Saving Normal." He is incredibly critical of the over use of medications, the DSM-V, and the runaway train we call "big pharma." We need more of "his ilk."
“I was told I was a ticking time bomb, that I’d never finish college, never have a job, never have kids, and always be on psychiatric medication." A doctor that says these words to a patient, especially one that is extremely fragile, is sadistic. It's one thing to strongly encourage that a patient stay on medication but quite another to degrade them and make them feel even worse.
58
I agree - if that's really what the doc said and not taken a bit out of context. Could he/she have been trying to tell the patient that if she rejected treatment, that might be her fate? i.e., without medication she would likely not finish college etc. In other words, it may have been an attempt to save her, by getting her to see that the alternative to rejecting treatment was pretty terrible. It may not have been handled very well, but it may not be as inhumane or sadistic as you're suggesting. For some with severe psychosis, the doctor's predictions of how their life would proceed - without medication - were pretty accurate.
1
The thing is that The Times didn't bother to ask the psychiatrist whether he or her said this nor did it risk being sued for libel by not asking the person to name the doctor.
The Times has a history of publishing charges of mismanagement of patients by psychiatrists based solely on the claims of patients without ever bothering to get the psychiatrists' side of the story or to demonstrate that it believes them by publishing the names of the doctors.
And for those who say that would be libel, remember that the truth is a 100% foolproof defense against this.
The Times has a history of publishing charges of mismanagement of patients by psychiatrists based solely on the claims of patients without ever bothering to get the psychiatrists' side of the story or to demonstrate that it believes them by publishing the names of the doctors.
And for those who say that would be libel, remember that the truth is a 100% foolproof defense against this.
6
It's delightful to read about this work in The Times, and further evidence of the rapidly expanding roles which peers can play in helping each other deal with what gets named many ways, ranging from serious mental illness to mental health issues, to emotional disturbances, etc., depending on the "namer's" psycho-political perspective. The key is that people with lived experience have a *very* important role to play, often along side of (hopefully) enlightened and non-arrogant mental health professionals, in helping people advance their recovery and have fuller participation in life and communities of their choice.
10
As is common, this kind of treatment is framed as being in opposition to standard psychiatric treatment, when it should be welcomed as part of an array of treatments all of which should be available to many. When someone has heart disease and high cholesterol, it's sometimes enough to change your diet, start exercising, lose weight, maybe start meditation or yoga, etc. In other cases, you can do everything under the sun to change your lifestyle but you still need medication, or even a stent placed surgically to take care of the problem. Most of the time, both kinds of intervention will be useful and necessary
Similarly, programs like the Recovery Learning Community can be an invaluable part of helping people ameliorate symptoms and live with their condition. In some cases it may be sufficient, in other cases it may make some difference but some medication may be necessary as well.
We should not be casting this as two treatments systems in opposition. They are not — they can complement each other.
Similarly, programs like the Recovery Learning Community can be an invaluable part of helping people ameliorate symptoms and live with their condition. In some cases it may be sufficient, in other cases it may make some difference but some medication may be necessary as well.
We should not be casting this as two treatments systems in opposition. They are not — they can complement each other.
79
As I read the description of HVN I couldn't help but consider its similarities to the 12-steps of AA which has been widely used in the United States to help people to help themselves cope with the illness of addiction. Although helpful to many, we know now that some forms of medicine and psychotherapeutic treatment in addition to or in lieu of AA meetings can help too. By the same token, it seems highly unlikely that sufferers of schizophrenia will benefit solely from an approach that completely denies the medical community access. As the mother of a son with schizophrenia I have walked the walk and talked the talk. I cannot be more grateful to his psychiatrist (which we have had to pay for out of pocket) and both my husband, his brothers, and I have provided as much loving support as we can muster on any given day. In return he goes out and fights the good fight, playing music because, like many other sufferers he is so terribly creative and talented. My point is that it takes a holistic approach and to me that means that all of what we have to offer as a society is made available to the sufferer.
16
It's a bit misleading to call understanding and interpreting voices (auditory hallucinations) an "alternative" form of mental health care. In the 20th century, psychoanalysis viewed such voices as symbolic messages from the unconscious. Only in the recent age of biomedical psychiatry are such voices dismissed as meaningless.
Of course, psychoanalysis didn't, and doesn't, cure many psychoses. Fortunately, the Hearing Voices Network isn't opposed to medication, just its reflexive use. (It is thus "complementary" medicine, not "alternative.") It's hard to argue against the best of both worlds: symptomatic treatment with medication when needed, and the kind of understanding, human support, and self-acceptance we all want for ourselves.
Of course, psychoanalysis didn't, and doesn't, cure many psychoses. Fortunately, the Hearing Voices Network isn't opposed to medication, just its reflexive use. (It is thus "complementary" medicine, not "alternative.") It's hard to argue against the best of both worlds: symptomatic treatment with medication when needed, and the kind of understanding, human support, and self-acceptance we all want for ourselves.
124
I agree with Dr Reidborg that it is the best of both worlds when a person has human support and guidance with radical self-acceptance as well as someone with experience in using medication for symptomatic treatment and the wisdom to know when to try, when to back off. I am a primary care doctor and find it challenging to find psychiatrists that have the time and are paid adequately through insurance to do this. I once went to a Mind-Body training that taught me to ask 5 questions for any recurring symptom: When were you born? (the symptom), What is your name? When do you come? What do you need? What are you trying to teach? This article reminded me of the potential in exploring that for many symptoms, not just voices in your head. Thank you!
I also find the "alternative" treatment given to the girl who heard the crying child really disturbing. They asked her questions to help her "recollection of a frightening experience in childhood." Let us not forget that well meaning, trained professionals have helped patients "remember" with perfect clarity traumas and horrifying abuse that never happened. And those "recollections" are not harmless, they can cause actual trauma when "remembered" and can result in strained relationships with people they come to imagine harmed them.
As the distinguished psychiatrist and educator, Dr. Allen Frances, said "The reason these programs are proliferating now is society's shameful neglect of the severely ill.." Psychiatrists are one of the lowest paid specialties of the medical profession, along with primary-care physicians and obstetricians. Also, insurance companies are only beginning to reimburse patients for psychiatric treatment.
Support groups, such as AA, are fine but they have limits in mitigating the symptoms of serious mental illness, including depression (which can lead to suicide and murder), anxiety, psychoses, and severe personality disorders.
The next congress and president should make an effort to expand community mental health centers, training fellowships for psychiatry and clinical psychology, and more adequate insurance reimbursement.
Support groups, such as AA, are fine but they have limits in mitigating the symptoms of serious mental illness, including depression (which can lead to suicide and murder), anxiety, psychoses, and severe personality disorders.
The next congress and president should make an effort to expand community mental health centers, training fellowships for psychiatry and clinical psychology, and more adequate insurance reimbursement.
18
Psychiatrists and all American physicians are overpaid compared to all other American workers whose output is not filtered through the insurance industry.
Having medical delivery depend on the 'third' rail of the health care system guarantees excessive costs, sets up questionable incentives, and deprives millions of people access to service...service of any kind.
Having medical delivery depend on the 'third' rail of the health care system guarantees excessive costs, sets up questionable incentives, and deprives millions of people access to service...service of any kind.
1
Comparing physicians' pay to "all other American workers" doesn't tell you much, CC. In the first place, physicians undergo a long and arduous training, including four years of college, four years of medical school, a year of internship, and, for specialists, several years of a medical residency. That is a huge investment, which few would make unless it is reasonably compensated.
Second, because of those educational requirements, there is a scarcity of trained physicians compared with the demand, and this drives the cost of their services up.
It seems that your preference is for a government-run, single-payer medical system, but that has its problems, too. The American medical system, including the insurance industry, is the source of most of the new technological innovation in medicine, such as micro-surgery, new drugs, new and expensive diagnostic equipment, that we share with the rest of the world
Second, because of those educational requirements, there is a scarcity of trained physicians compared with the demand, and this drives the cost of their services up.
It seems that your preference is for a government-run, single-payer medical system, but that has its problems, too. The American medical system, including the insurance industry, is the source of most of the new technological innovation in medicine, such as micro-surgery, new drugs, new and expensive diagnostic equipment, that we share with the rest of the world
Look at the many years people who've undergone psychiatric treatment have put in... Certainly often longer and more arduous than any doctor...
It is a serious problem in our culture that we elevate physicians to such all-knowing status.
The power imbalance is a substantial part of the problem with the system...
It is a serious problem in our culture that we elevate physicians to such all-knowing status.
The power imbalance is a substantial part of the problem with the system...
This makes me think about how dreams never include information you don't already know. In dreams, other people always act according to your perception of them.
In my completely uneducated opinion, problems either stem from trauma or a biological problem. The key is to sort them out and treat them accordingly.
In my completely uneducated opinion, problems either stem from trauma or a biological problem. The key is to sort them out and treat them accordingly.
5
Women with Bipolar Disorder have a significantly lower average life span, 63 yrs. Perhaps modifying med use combined with alternative modes of treatment will lead to more fulfilling, extended life.
10
One of the reasons for this shorter life span is that the drugs induce metabolic problems, sometimes diabetes, and also heart problems, as well as enormous weight gain in many people. Also, I have heard from many users that smoking is a partial solution to the side effects, so smoking is very, very common among antipsychotic drug users. The drugs are most definitely NOT panaceas!
9
Women with bipolar disorder commit suicide at a rate of 15-50%, depending on which study you look at.
That will skew an average.
That will skew an average.
4
Steve,
You want to present the studies that you apparently know of that show that patients with untreated schizophrenia and bipolar disorder live longer than those who are treated.
All the studies I've heard of say the opposite but apparently you have access to studies of which I am unaware.
You want to present the studies that you apparently know of that show that patients with untreated schizophrenia and bipolar disorder live longer than those who are treated.
All the studies I've heard of say the opposite but apparently you have access to studies of which I am unaware.
1
"By definition Alternative Medicine
Has either not been proved to work,
Or been proved not to work.
Do you know what they call alternative medicine
That's been proved to work?
Medicine!"
-- Tim Minchin, "Storm"
Has either not been proved to work,
Or been proved not to work.
Do you know what they call alternative medicine
That's been proved to work?
Medicine!"
-- Tim Minchin, "Storm"
11
Not necessarily true. You need to account for politics. Remember that medicine has officially supported in the past: that the use of thalidomide was safe, that formula feeding was better for your baby than nursing, that we shouldn't pick up our crying babies because it would spoil them, that babies should only be fed every four hours, that Benzedrine and Valium were not addictive, that X-ray mamograms prevented cancer (they actually cause MORE cancer!), that Hormone Replacement Therapy was safe and effective, and the list goes on and on. Sometimes a particular treatment or therapy challenges the authority or undermines the profitability of the mainstream medical practitioners, which makes it an "alternative" therapy really fast. Additionally, some therapies that are not very effective or are too dangerous are promoted because they are profitable (remember Viiox?)
Just as an example - acupuncture is considered "alternative medicine," despite its ongoing use in China for over 5000 years. People are able to do conscious operations on patients using acupuncture - that sound like pretty good proof that it works, at least for temporary pain relief! So why is it "alternative?" Can't be patented, undermines the authority of the Western doctors, gives credit to a non-European/American treatment modality, etc. It's often about trade protectionism, not what actually works.
Just as an example - acupuncture is considered "alternative medicine," despite its ongoing use in China for over 5000 years. People are able to do conscious operations on patients using acupuncture - that sound like pretty good proof that it works, at least for temporary pain relief! So why is it "alternative?" Can't be patented, undermines the authority of the Western doctors, gives credit to a non-European/American treatment modality, etc. It's often about trade protectionism, not what actually works.
22
Thanks Rick. I had never heard quite such a concise definition of alternative medicine. Sobering.
1
Funny... Because there's TONS of research speaking to the very broad and pervasive *FAILURES* of what gets called 'medicine' where psychiatric diagnosis is concerned. In fact, outcomes for psychiatric diagnoses haven't improved for decades, and people who enter the mainstream system are shown to be dying, on average, 25 years younger. Is this the 'medicine' you speak of? Perhaps... just perhaps... there are other forces (like special interests, marketing, etc.) at work, too...
8
There's an even bigger problem when the person suffering from psychosis fears medication and any other intervention. That's our situation with a niece who is pretty much homeless, can't work, etc., and refuses all treatment since she has a number of imaginary fears/disorders, including the fear of taking any medication for anything.
25
First of all--I think this is a viable approach. Relationships are curative, medication at best--palliative. My concern is that nothing was mentioned of the problems of hoping to engage the psychotics who suffer not only from hearing voices but poverty of expression, those for whom even saying, "yes, no, I don't know," is a struggle. Medication doesn't help them, of course. But how can one even persuade them to come to a place for alternative treatment.
Secondly--there is a subset of those who use Marijuana or alcohol and it exacerbates or even brings on psychosis. What is the role of the mentor to this population of individuals?
Everyone wants a purpose in life. This sort of program seems to offer for a subset of the population a chance to fulfill their purpose.
Secondly--there is a subset of those who use Marijuana or alcohol and it exacerbates or even brings on psychosis. What is the role of the mentor to this population of individuals?
Everyone wants a purpose in life. This sort of program seems to offer for a subset of the population a chance to fulfill their purpose.
2
Intensive psychotherapy of schizophrenia, once declared dead, is again alive. It has a long history of serious study, exploring the process in depth. In the 60s, with the advent of medications, big pharma united with state legislatures wanting to lower the cost of mental hospitalization. State hospitals were emptied; the streets were filled with the homeless. Eventually, even the very best of private centers studying the psychotherapeutic intervention in psychotic process, like Chestnut Lodge and the Menninger Clinic, were forced into closure.
Serious study has demonstrated the real and at times life saving benefit of appropriate medication for psychosis. To oppose such proper use would be to return to the needless destruction of lives. Experience has also shown that the romanticization of schizophrenia, fashionable for a while, was equally destructive.
This is not a religious battle of faith; it is a struggle to integrate broad and deep studies, to try to define what combination of disciplined interpersonal engagement and of medication works best for each individual.
In the process, one should not make matters worse by privileging a single approach. Also, there is a vast literature of studies in depth on the subject. Perhaps what is most important is that physicians and medical schools resist the bias that can come from the luxury of drug company funding and that the government respect serious studies of all types. - a psychiatrist with 55 years in practice.
Serious study has demonstrated the real and at times life saving benefit of appropriate medication for psychosis. To oppose such proper use would be to return to the needless destruction of lives. Experience has also shown that the romanticization of schizophrenia, fashionable for a while, was equally destructive.
This is not a religious battle of faith; it is a struggle to integrate broad and deep studies, to try to define what combination of disciplined interpersonal engagement and of medication works best for each individual.
In the process, one should not make matters worse by privileging a single approach. Also, there is a vast literature of studies in depth on the subject. Perhaps what is most important is that physicians and medical schools resist the bias that can come from the luxury of drug company funding and that the government respect serious studies of all types. - a psychiatrist with 55 years in practice.
27
When i was in college, i went to a tarot card reader/ pyschic. He told me my pyschic gift was hearing. At the time i had never heard voices. Many years later, under alot of stress, I DID hear a voice, of my sister, giving me directions and pointers as to how to proceed.....schizophrenia or pyschic ability? I think our culture is not spiritual enough to understand, yet. KUDOS to the NYT's for opening the dialogue!
5
Probably neither. Some people hear voices without schizophrenia. The notion of some kind of psychic phenomenon is intellectually puerile and absurd.
4
In my experience I have found it interesting that the tradition of Western Psychiatry and the Esoteric tradition often overlap in their observations. But use different terms and come to different conclusions. For instance Psychiatry calls "telepathy," which by definition has no audio component, "thought-insertion." But it seems to me that Western science is ridiculously biased against the Esoteric tradition which seems to be such a totally unscientific stance. Since human beings have found the Esoteric tradition to be enormously helpful for many thousands of years (in fact I know of no pre-modern human culture which was able to survive without it), it seems to me that this is an area of human experience which is ripe for brain research. I hear that our government thinks so also. Yes...I would put one of my eggs in this basket... but not all.
Dr. Pies is right. Initial examination by a psychiatrist is a wise move before embarking on unproven treatments for "voices". A psychiatrist can distinguish between true auditory hallucinations and vivid thoughts -the latter of which the examples in this column seem to have.
Psychiatry is no more "controversial" than is Cardiology or Urology.
I'm always fascinated how most people have an "opinion" of Psychiatry but not of "Urology" or other medical specialties. Kind of reminds me of the "opinions" that chlldren should not be vaccinated. The old sayiing applies: a little bit of knowledge is a dangerous thing.
Psychiatry is no more "controversial" than is Cardiology or Urology.
I'm always fascinated how most people have an "opinion" of Psychiatry but not of "Urology" or other medical specialties. Kind of reminds me of the "opinions" that chlldren should not be vaccinated. The old sayiing applies: a little bit of knowledge is a dangerous thing.
5
A study with 14 participants? Not statistically valid. I will hold off recommending this until a study with a much larger patient population comparing medication vs these various non medication treatments is carried out. Until then, it is merely anecdotal information, and the practice of any branch of medicine should not be based in anecdotes.
9
Typically, "alternative" means unqualified. There's a reason why most alternative "practicioners" did not go to medical school: They didn't want to do the work it genuinely takes to understand (as best we can) the human brain and body. Buyer beware. If you don't see an M.D. after the name or a med school diploma on the wall, head for the door.
11
And maybe even when you do see an MD on the wall, beware! Along with the MD often comes arrogance.
While I appreciate the Times' efforts to bring awareness about alternative solutions for complex medical problems, I am wary of articles that tout alternative solutions for mental health issues without caveat:
~The neuroscience offering insight into mental illness is still VERY new; the science of human sexuality rivals its nascence. Lithium is one of the oldest (if not THE oldest) effective drugs for bipolar illness; it was identified as a treatment in 1948, 25 years after insulin.
~Most of these articles do not acknowledge how little we actually know about the mechanisms of mental illness, or even acknowledge what we DO know about it, that it is an illness that is bio-psycho-social in nature, with many factors at interplay. Accurate diagnosis can be difficult.
~The failure to identify the above two points means that many uninitiated people believe that mental illness is a one-size-fits-all experience with diagnoses that fit neatly into categorical boxes (as other illnesses like diabetes might) and that treatments are similarly effective in most people.
~People with mental health issues are often all too willing to take their treatment into their own hands - both because a feeling of knowing better than all the experts can be a major symptom (grandiosity) of bipolar mania, and because of the point above - not all treatments are similarly effective in all people and there is often a great deal of trial and error finding an accurate diagnosis and effective med.
~The neuroscience offering insight into mental illness is still VERY new; the science of human sexuality rivals its nascence. Lithium is one of the oldest (if not THE oldest) effective drugs for bipolar illness; it was identified as a treatment in 1948, 25 years after insulin.
~Most of these articles do not acknowledge how little we actually know about the mechanisms of mental illness, or even acknowledge what we DO know about it, that it is an illness that is bio-psycho-social in nature, with many factors at interplay. Accurate diagnosis can be difficult.
~The failure to identify the above two points means that many uninitiated people believe that mental illness is a one-size-fits-all experience with diagnoses that fit neatly into categorical boxes (as other illnesses like diabetes might) and that treatments are similarly effective in most people.
~People with mental health issues are often all too willing to take their treatment into their own hands - both because a feeling of knowing better than all the experts can be a major symptom (grandiosity) of bipolar mania, and because of the point above - not all treatments are similarly effective in all people and there is often a great deal of trial and error finding an accurate diagnosis and effective med.
9
Of course you're right that psychiatry is far behind the other branches of medicine. It's why we know the cause of every case of hypertension and back pain. but not mental disorders
4
Sounds to this retired psychiatrist like the person reporting hearing voices here is not schizophrenic but, rather, has a dissociative identity disorder. These conditions are actually quite common and often misdiagnosed by psychiatrists. Dissociative disorders are the result of life-threatening traumatic experiences, usually in childhood, and often the result of sexual abuse by an adult. The treatment of these disorders is very different than that for schizophrenia. The lack of basic knowledge of mental disorders on the part of practicing psychiatrists is propagated by drug companies and ignorant administrators in so-called mental health facilities. Modern psychiatrists have allowed themselves to become glorified drug vending machines. If you are a person who is hearing voices, check out dissociative disorders on the net and diagnose yourself!
109
Whew ... an interesting insight, but you really jump the rails when you then suggest people go on the Internet and diagnose themselves! Seriously what kind of doctor tells people to go on the Internet and diagnose themselves - I'm amazed.
Yes!! I have DID and am grateful that I was diagnosed correctly .
It is however very difficult to find qualified therapists for treatment. And there is a special stigma for those with DID-many therapists believe it's rare, non existent or made up from the " sexual abuse hysteria/false memories" from the 70's and 80's.
However it's quite real and I thought the exact same thing reading her story of a child crying within .
With DID the voices respond to you.
It is however very difficult to find qualified therapists for treatment. And there is a special stigma for those with DID-many therapists believe it's rare, non existent or made up from the " sexual abuse hysteria/false memories" from the 70's and 80's.
However it's quite real and I thought the exact same thing reading her story of a child crying within .
With DID the voices respond to you.
1
Apparently your knowledge of psychiatry comes from movies and TV where multiple personality disorder is a common disorder and schizophrenia virtually nonexistent, the very opposite of the real world
1
Would you let your children drive a car that was designed and built by an alternative engineer?
7
Would I let my children (I have two of them) drive acar that was designed and built by an alternative engineer?
I don't know. Do the 'mainstream' cars made by the 'mainstream' engineers keep crashing other people's children into walls? (As the mainstream psychiatric system seems to be doing...)
If yes, then, for sure... bring on the alternative engineers...
I don't know. Do the 'mainstream' cars made by the 'mainstream' engineers keep crashing other people's children into walls? (As the mainstream psychiatric system seems to be doing...)
If yes, then, for sure... bring on the alternative engineers...
5
Mainstream cars have air bags and carefully tested frames. Ditto, metaphorically, for modern medicine. Experiment on yourself. Take your children to a fully educated, fully licensed psychiatrist or neurologist, if needed, God forbid. They deserve it. Don't be the alternative to a good parent.
1
Chris, Have you looked at the death rates for people receiving services in the mainstream system? Where are the air bags? Why are they dying 25 years younger and, so often, without even the benefit of a full and happy life?
2
European countries have alliances between traditional psychiatry and alternative treatments. Just one more way they are ahead of us.
40
It will be fascinating to see how this develops in the U.S. I would have been skeptical about this too, but I just went to a seminar last month on the growing research indicating that these new treatment modalities actually can work better than what we've been doing here. So many patients are on a merry-go-round of medications with side-effects, intervals of non-adherence to the meds, and multiple hospitalizations.
Amazingly, research has shown since the 1970's (and continuing today) that in "undeveloped" countries - that have less access to medications and hospitalizations - people with psychotic mental illness function much better over time than people do in the U.S.
Why?
More family support? Different social standards? Less emphasis on independent living? Less exposure to medications that themselves harm brains over time? We don't know. But there are people who - despite multiple remissions in the years after diagnosis - eventually recover higher functioning.
Here's the thing - we don't understand everything. In Finland and other countries, these treatment programs have had very good results.
Our mental health system is failing an awful lot of people. If something else can add to our treatment arsenal, I for one welcome it.
Amazingly, research has shown since the 1970's (and continuing today) that in "undeveloped" countries - that have less access to medications and hospitalizations - people with psychotic mental illness function much better over time than people do in the U.S.
Why?
More family support? Different social standards? Less emphasis on independent living? Less exposure to medications that themselves harm brains over time? We don't know. But there are people who - despite multiple remissions in the years after diagnosis - eventually recover higher functioning.
Here's the thing - we don't understand everything. In Finland and other countries, these treatment programs have had very good results.
Our mental health system is failing an awful lot of people. If something else can add to our treatment arsenal, I for one welcome it.
153
I have several loved ones who have mental illness disabilities. If I had to guess the biggest contributor to better outcomes, I'd say it was the decreased emphasis on individualism and independent living.
Each time my loved ones have had relapses, there is often some issue related to their inability to be independent- either inability to manage some aspect of their own care such as getting meds refilled- or the need to be financially self-sufficient and hold a job despite the stress of the job making ones illness worse. Stress aggravates symptoms. It is also incredibly stressful to be dirt poor because disability payments are paltry while copays and deductibles for psychiatric meds are high even with Medicare.
Other countries don't make their disabled pay market rent but we do- other countries support group homes or increased housing subsidy.
Social supports for our most vulnerable brethren with mental illness would go a long way toward their wellness.
Each time my loved ones have had relapses, there is often some issue related to their inability to be independent- either inability to manage some aspect of their own care such as getting meds refilled- or the need to be financially self-sufficient and hold a job despite the stress of the job making ones illness worse. Stress aggravates symptoms. It is also incredibly stressful to be dirt poor because disability payments are paltry while copays and deductibles for psychiatric meds are high even with Medicare.
Other countries don't make their disabled pay market rent but we do- other countries support group homes or increased housing subsidy.
Social supports for our most vulnerable brethren with mental illness would go a long way toward their wellness.
5
I'm not sure what studies you're reading but everything i've read says that mental illness is a world wide problem and that in countries without access to modern treatments, it's an even greater problem.
Of course killing people with mental disorders as still occurs in some societies is a 100% cure.
Of course killing people with mental disorders as still occurs in some societies is a 100% cure.
3
Kestril1 - Great response. Check out the excellent book "Anatomy of an Epidemic", by noted science writer Robert Whitaker, to see how ongoing prescription drug treatment can cause both a chronic mental illness "state" as well as early death. In countries such as Finland, which use minimal-to-no medications for mental health conditions, outcomes (as measured by whether the person is working or not) are way better than here in the U.S., where the psychiatric model is about medications as the prime approach.
1
Perhaps with newer laws making research into alternative drug therapies will provide another option. LSD, MDMA (ecstasy), even marijuana may help those with psychiatric illnesses. We don't really know but there could be uses. Ayahuasca, psilocybin mushrooms and other organic compounds may have answers for some as well.
We haven't discovered all of the cures available in nature's medicine chest yet.
We haven't discovered all of the cures available in nature's medicine chest yet.
9
It might surprise you to know that in fact most of the things you mention including LSD have been studied for the treatment of mental disorders. Not only were they ineffective, they tended to exacerbate the mental disorders.
7
Schizophrenia is a genetically based biologic mind disorder as well established half a century ago by the Scandanavian homozygotic twin studies. Nobody enjoys using antipsychotic drugs but the alternative is unchecked illness. There have been many serious non-drug interventions tried and they have not worked. Occasionally very ill people have run away (psychotically) from such programs and turned up hundreds of miles away (I am not making this up) injured or dead. The NYT is not doing anyone any favors by publishing what amounts to an uncritical endorsement of such measures. While it is true that about a third of schizophrenia cases spontaneously remit, a third more recur episodically and a third become chronic, untreated. And in the meantime, some very bad things indeed can happen.
86
Much truth to your comments, especially the 1/3, 1/3, 1/3 conundrum. This is true for many medical issues. The problem that I found in working in the mental health field for over thirty years is the psychiatrists, though cognizant of this phenomena, are really not "aware" of it. They routinely blast away with medications and restraints without any really feeling for the "patient." This is because they are in the business of Managing patients, rather than truly helping them. As a LCSW, I didn't hesitate to advise my clients to stop taking the medication when they were having significant side effects after a few days. On the proper dosage of the proper medication, the "patient" experiences minimal side effects. To medical doctors, patients are cases, things, and they therefore seldom establish a necessary therapeutic alliance with their patient.
6
@ AS: I did not see any reference to schizophrenia in the article.
4
Schizophrenia has an inherited vulnerability aspect, but if it were entirely genetically based there would not be such variability in the "twin studies," nor among urban vs. rural incidences of illness (such studies are controlled for migrations that occur), nor among first generation immigrants in comparison with family members who still reside in their countries of origin, nor among birth months, etc. Psychotropic medication can be a life saver for people living with more severe, debilitating symptoms, but it is increasingly accepted that for actual improvement in quality of life and community enfranchisement, medications are insufficient in many instances. Readers can find excellent information on a range of services helpful to people living with mental illness through the Substance Abuse and Mental Health Services Administration website http://www.samhsa.gov
4
"Alternative" mental health care? Seriously? From psychoanalysis and Analytic Psychology to drug therapy, lobotomies, exorcism, and electroshock, has there ever been any other kind?
34
Actually, yes. Every neuron is an electrochemical system and therefore you can change chemical activity in the brain by altering brain electrical activity. This has been shown to be effective with major psychiatric disorders as well as neuropsychiatric conditions and neurodegeneration which is the area our group focuses on now. I'd strongly suggest looking into neurofeedback training and specifically z-score LORETA approach as this utilizes a normative database to compare an individual's brain activity to norms for their age, gender and handedness. We've seen Alzheimer's and Parkinson's disease symptoms arrested and in some cases reversed with this treatment in combination with near infrared light stimulation. I also suggest that psychotherapy is also extremely helpful in treating psychosis especially when it focuses on emotional experience and expression.
More information at www.quietmindfdn.org
More information at www.quietmindfdn.org
I have no personal experience with schizophrenia, but the treatment described makes total sense to me. Is it really that novel to consider the voices experienced as residue of past trauma that needs to be healed? I mean, we know that trauma is at the root of many less stigmatized forms of mental illness - anxiety, depression, and the like. Is it really only know that psychiatrists are regarding schizophrenia in that light? I hope not.
17
Are you also familiar with epigenetic changes? Some studies indicate that trauma can be passed down genetically, through generations. In that case, considering voices as trauma that needs to be healed might be counterproductive to the person experiencing the voices, as they have no way to 'work through' an experience they didn't endure.
Additionally, this theory brings me to a point of chicken-and-egg reasoning...
people whose brain is wired to see threat in everything often experience the world in its entirety as traumatizing:
My ex suffered trauma because his mom tried to kill him when he was a little boy. He believes he was left in her hot car to die because she thought him to be a defective child (either consciously or subconsciously, doesn't matter to him.)
She believes he was about 11 years old when she started leaving him in the car because he caused trouble every time she took him into a store - and she believes he should have known how to open the door or window to cool off.
Additionally, this theory brings me to a point of chicken-and-egg reasoning...
people whose brain is wired to see threat in everything often experience the world in its entirety as traumatizing:
My ex suffered trauma because his mom tried to kill him when he was a little boy. He believes he was left in her hot car to die because she thought him to be a defective child (either consciously or subconsciously, doesn't matter to him.)
She believes he was about 11 years old when she started leaving him in the car because he caused trouble every time she took him into a store - and she believes he should have known how to open the door or window to cool off.
1
Trauma is not the primary cause of schizophrenia, which is an organic illness. That much is known.
7
Josh Hill,
Uh, citations, please? Why are you so confident in the organic origins of 'schizophrenia'? Science certainly is NOT as confident as you seem to be...
Uh, citations, please? Why are you so confident in the organic origins of 'schizophrenia'? Science certainly is NOT as confident as you seem to be...
I strongly encourage the movement to avoid insurance eligibility. Once you have it your freedom is gone and half your time will be taken up with filling out forms or appealing cases. I've seen the insurance dole destroy more than one promising, vital movement.
29
Maybe it takes experiencing voices to solve the problem. When I was a teen a friend of mine had a nervous breakdown. What it was finally diagnosed as was schizophrenia. I know that she was on and off her meds because of the side effects. Those side effects were almost worse than the disease. She would gain weight, feel far away from the world, feel nauseous, etc. She'd stop taking them and the schizophrenia would "return" in full force. The doctors characterized her as uncooperative and noncompliant. Guess what, when we're told that something that keeps on making us sick is good for us and that we have to take it for the rest of our lives it's very disheartening. Who wants to be sick from side effects for the rest of their life?
If we treated mental illness with the gravity that we treat cardiac problems or cancer perhaps we'd have more success in helping patients cope. It's easy to give up on a very mentally ill person. It's all in their head. But that's where their personality is, their essence as a person is. And when that gets distorted by illness and then their body and intellect gets distorted by medications it's hard to see the point of taking the meds. When we start to truly see mentally ill individuals as medically ill and in need of human care and compassion as well as medications/therapy that do more than blunt the voices or their personalities maybe then patients will be willing to swallow the pills or cooperate in treatment.
If we treated mental illness with the gravity that we treat cardiac problems or cancer perhaps we'd have more success in helping patients cope. It's easy to give up on a very mentally ill person. It's all in their head. But that's where their personality is, their essence as a person is. And when that gets distorted by illness and then their body and intellect gets distorted by medications it's hard to see the point of taking the meds. When we start to truly see mentally ill individuals as medically ill and in need of human care and compassion as well as medications/therapy that do more than blunt the voices or their personalities maybe then patients will be willing to swallow the pills or cooperate in treatment.
143
"If we treated mental illness with the gravity that we treat cardiac problems or cancer perhaps we'd have more success in helping patients cope..."
EXACTLY!! Mental illness is a social AND medical issue, and that idea will spread with adequate funding for brain research with active promotion of Brain Banks, so that we can learn more and educate people about the mechanisms of illness instead of allowing them to believe it was simply poor parenting or childhood trauma.
If we did, then we'd also acknowledge that our system is not designed to serve people with mental health issues. My ex is on Social Security Disability for schizoaffective disorder. One of the reasons he is eligible is his inability to manage personal affairs; any paperwork is confusing and overwhelming regardless of the financial incentive to complete it.
When his SSDI claim was accepted, he was sent a stack of paperwork to enroll into Medicare and choose a Part D plan. He spent a month in a mental hospital because he was uninsured and ran out of meds - despite Medicare being "available" to him - because he did not complete the forms to enroll (or ask for help because it's embarrassing.)
At the Area Agency on Aging and Disabilities, I asked about getting a caseworker to help him with this. I was told that their services are limited to elders and people with physical disabilities. A home health nurse can help you figure out med refills and food stamp application, but not if you are "only" mentally disabled.
EXACTLY!! Mental illness is a social AND medical issue, and that idea will spread with adequate funding for brain research with active promotion of Brain Banks, so that we can learn more and educate people about the mechanisms of illness instead of allowing them to believe it was simply poor parenting or childhood trauma.
If we did, then we'd also acknowledge that our system is not designed to serve people with mental health issues. My ex is on Social Security Disability for schizoaffective disorder. One of the reasons he is eligible is his inability to manage personal affairs; any paperwork is confusing and overwhelming regardless of the financial incentive to complete it.
When his SSDI claim was accepted, he was sent a stack of paperwork to enroll into Medicare and choose a Part D plan. He spent a month in a mental hospital because he was uninsured and ran out of meds - despite Medicare being "available" to him - because he did not complete the forms to enroll (or ask for help because it's embarrassing.)
At the Area Agency on Aging and Disabilities, I asked about getting a caseworker to help him with this. I was told that their services are limited to elders and people with physical disabilities. A home health nurse can help you figure out med refills and food stamp application, but not if you are "only" mentally disabled.
17
I met Dr. Frances when he was on his anti-DSM V tour. I briefly told him the story of my son who was diagnosed with "schizophrenia" and was ill for 6 years. He heard voices and did very little other than sleep all day, watch TV and eat at night. He came off his meds 6 years ago--- very, very slowly- and is well now. Dr. Frances told me that it wasn't possible that my son ever had schizophrenia !!! I disagreed with him---telling him he did and he recovered.
The core problem with psychiatrists is their belief that people cannot recover from psychotic illness. This belief keeps people ill and over-medicated.
The core problem with psychiatrists is their belief that people cannot recover from psychotic illness. This belief keeps people ill and over-medicated.
79
With all due respect, it is not the belief of most U.S. psychiatrists that "people cannot recover from psychotic illness." First of all, "psychotic illness" is an umbrella term--a bit like "engine trouble"--that defines nothing in particular. Psychosis is essentially a symptom in search of a diagnosis. It can occur in the context of an acute stressor; as a result of street drug intoxication; or, as is often the case in chronic psychosis, as a result of schizophrenia. Many persons with a first-episode of psychosis in the context of an acute trauma or stressor will recover with supportive psychotherapy and "tincture of time". If they require antipsychotic medication initially, it is often possible to taper and discontinue it after a few months. The situation is different for most patients with schizophrenia (which actually describes a "final common pathway" for a number of underlying disturbances of brain function). Most--though not all--persons with chronic schizophrenia will continue to require antipsychotic treatment, in order to avoid relapse and deterioration in their activities of daily living.
For more on these issues, please see:
http://pro.psychcentral.com/long-term-antipsychotic-treatment-effective-...
and
http://pro.psychcentral.com/how-antipsychotic-medication-may-save-lives/...
Ronald W. Pies MD
SUNY Upstate Medical U.
and Tufts USM
For more on these issues, please see:
http://pro.psychcentral.com/long-term-antipsychotic-treatment-effective-...
and
http://pro.psychcentral.com/how-antipsychotic-medication-may-save-lives/...
Ronald W. Pies MD
SUNY Upstate Medical U.
and Tufts USM
9
I worked in community mental health for 20 years. It was my experience that a dogmatic approach from any point on the treatment continuum was unhelpful. Neither paternalistic providers nor adamantine anti psychiatry activists are ideal. Informed consent however, of the very common and often devastating metabolic effects (most perniciously onset of diabetes), of antipsychotic medications, is absolutely necessary, even if it frightens some individuals away from potential benefits.
Bearing witness to people's experiences, suffering and otherwise, with humility and care, funding resources known to provide stability and greatly increase odds for improvement---such as affordable housing and social supports--willingness to fund alternatives, go a long way towards offering a life of dignity and purpose to people with severe psychological distress
Bearing witness to people's experiences, suffering and otherwise, with humility and care, funding resources known to provide stability and greatly increase odds for improvement---such as affordable housing and social supports--willingness to fund alternatives, go a long way towards offering a life of dignity and purpose to people with severe psychological distress
34
I too am the mother of a son with schizophrenia. He still takes his medication (8 years now) but is completely self-directed on this front. He has decided that the benefits outweigh the side effects which are many. I recall asking his psychiatrist if he would ever be able to overcome this illness and come off the meds. The doctor said it was possible but they were not able to predict which patients would be able to successfully wean off. But he offered hope. Like any other specialist we have to shop around for the right provider but that is unfortunately not always available for sufferers of psychosis because treatment is often started when the patient is in the throes of psychosis.
8