Tuesday, 25 September 2012

Full Recovery from Schizophrenia?

Full Recovery from Schizophrenia?

Full moon dark sky
This is the first of a series of blog postings related to my own series of research studies (my doctoral research at Saybrook University) of people who have made full and lasting medication-free recoveries after being diagnosed with schizophrenia and other psychotic disorders. This is very exciting research because it is one of the few areas within psychological research that remains almost completely wide open.

One reason it is so wide open is that most Westerners don’t believe that genuine recovery from schizophrenia and other related psychotic disorders is possible, in spite of significant evidence to the contrary. Since there are some very hopeful findings that have emerged within this research, I want to begin this series of postings by summing up one particularly hopeful aspect of my own research, which is a group of five factors that emerged which are considered to have been the most important factors in my participants’ recovery process. But before looking closer at these factors, we should back up for a minute…

Upon reading the statement in the preceding paragraph, “…people who have made full and lasting medication-free recoveries from schizophrenia…,” it’s likely that many readers did a double-take. Yes, you read this correctly. Contrary to this widespread myth about schizophrenia, the research is quite robust in showing us that not only is full medication-free recovery from schizophrenia possible, it’s surprisingly common, and is actually the most common outcome in many situations—such as in many of the poorest countries of the world, such as India, Columbia, and Nigeria, and as the result of certain psychosocial interventions, such as the Open Dialogue Approach used in Lapland, Finland.

This is likely to come as a surprise to many because we simply don’t hear much about this in the mainstream media. In fact, we generally hear quite the opposite message repeated again and again in various forms — something to the effect of, “Schizophrenia is a degenerative brain disease from which full recovery is not possible.” Considering how robust the evidence is that full recovery is possible and actually quite common, coming from sources no less prestigious than the World Health Organization and the National Institute of Mental Health, it is really quite tragic that the myth of no recovery continues essentially unimpeded. But for now, rather than going further into the details of this recovery research (which is well documented in my book, Rethinking Madness), let’s return to the topic at hand — the factors that appear to be particularly important for those who have experienced such full and lasting recoveries:

Factor #1: Hope in the possibility of real recovery. All participants in all three of my research studies expressed that in order to even begin the journey towards real recovery, they first had to believe that such recovery is actually possible. And in order to do this, virtually all of them had to extract themselves from the intense hopelessness generated by the toxic (and untrue) belief that such recover is not possible — a belief that they all reported was forced upon them (quite heavily handed in most cases) within the mental health treatment that they had received.

This takes us to Factor #2: Arriving at an understanding of their psychosis alternative to the brain disease theory. Every participant went through a process of developing a more hopeful understanding of their psychotic experiences, generally coming to see their psychosis as a natural though very risky and haphazard process initiated by their psyche in an attempt to cope and/or heal from a way of being in the world that was simply no longer sustainable for them.

Factor #3: Finding meaning. All participants expressed how important it was for them to connect with meaningful goals/activities that made their life worth living—that provided them with some motivation to greet each new day with open arms and to channel their energy productively. And they all expressed having to overcome significant inhibition to this factor coming from the mainstream treatment they had received, which typically included strong motivation-inhibiting drugs (antipsychotics in particular) and the advice to generally lay low and avoid stress at all costs.

Factor #4: Connecting with their aliveness. All participants reported how important it was for them to connect more deeply with themselves—particularly with their feelings, needs, and sense of self agency. And again, they all reported finding significant hindrance to this factor coming from the mainstream treatment they had received—both from the inner conflicts arising from the belief of having a diseased brain as well as from the serious aliveness-dampening psychiatric drugs they were on.

Factor #5: Dealing with their relationships. All participants expressed the importance of healing and/or distancing themselves from unhealthy relationships and cultivating healthy ones. They all felt that unhealthy relationships played a significant role in their vulnerability to developing psychosis in the first place, and so this kind of work was extremely important. A number of them expressed gratitude to a therapist or friend who facilitated this work.

So, as we look at the sum total of these recovery factors, what we find is the rather disturbing idea that the mainstream paradigm of care for psychosis/schizophrenia may often cause more of a hindrance than a benefit in one’s recovery. In particular, there are two generally unquestioned aspects of the mainstream paradigm of care that should probably be seriously reconsidered:

(1) In spite of the widespread belief that one must remain on antipsychotics or similarly powerful psychiatric drugs for the duration of one’s life, the emerging recovery research reveals a very different picture. Not only have we discovered this in my own research, but the most recent longitudinal research conducted by the National Institute of Mental Health (no less) paints a very similar picture. This study essentially consisted of following a number of people diagnosed with schizophrenia in a non-interfering manner, simply allowing them to go about their lives in their own way, and allowing them to choose what kind of treatment they wanted. At the 15 year mark, it was found that of those who chose to stop taking their psychiatric drugs, 44% were considered “recovered,” compared to only 5% of those who have remained compliant with these prescriptions.

This is a difference of nearly nine-fold in favor of those who stopped taking their prescribed psychiatric drugs. The World Health Organization studies have also shown in the so called “developing” countries in which psychiatric drug use is quite rare, well over half of those diagnosed with schizophrenia have gone on to make full recoveries, compared to only about a third of those in the U.S. and other so called “developed” countries, where psychiatric drug use is much more common.

So we find ourselves in quite a predicament. On one hand, it’s considered extremely dangerous to suggest that those diagnosed with schizophrenia should consider coming off these drugs, and even the mention of this possibility is considered one of the worst forms of taboo within the mental health field; but on the other hand, the research suggests that for many people, this is exactly what is called for. Of course, the research also shows that coming off these powerful drugs is very risky and should be done very slowly and under the careful guidance of a professional.

(2) Another major aspect of the mainstream treatment model that we find particularly problematic is the practice of trying to convince someone that they have a brain disease from which they will likely never recover. But the reality is that the brain-disease hypothesis remains unsubstantiated (see Rethinking Madness for a thorough discussion of this), and that full and lasting recovery is quite common. We also find that the hopelessness so often generated by this belief often leads to a self fulfilling prophecy — it appears to be very difficult to experience real recovery when you don’t believe it’s possible. Considering these points, then, it’s clear that we need to seriously reconsider the harm/benefit ratio of pushing these beliefs onto people and even the ethical implications of continuing to do so.

So we find ourselves at a crucial juncture in our treatment of people diagnosed with schizophrenia and other related psychotic disorders. We can take the path of least resistance, ignoring the results of the emerging recovery research, and carry on with treatment as usual, continuing to pay the ever increasing costs of this treatment model to society, the diagnosed individuals, and their families. Or we can take up the challenge of really embracing the emerging recovery research and its implications. This path will surely require a major overhaul of our mental health care system, but it offers the potential of significantly more hopeful outcomes for those so diagnosed as well as the greatly reduced burden on our increasingly struggling society as a greater percentage of people recover and regain the ability to take care of themselves. The choice is ours.

For a much more thorough discussion of these and closely related topics, as well as a detailed discussion of the finding of Dr. Williams’ own recovery research, you can find Dr. Williams’ book, Rethinking Madness (Sky’s Edge Publishing), on Amazon and other major retailers. More information is available at www.RethinkingMadness.com

References
Harrow M, & Jobe TH (2007). Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medications: a 15-year multifollow-up study. The Journal of nervous and mental disease, 195 (5), 406-14 PMID: 17502806
Harrow, M., Jobe, T., & Faull, R. (2012). Do all schizophrenia patients need antipsychotic treatment continuously throughout their lifetime? A 20-year longitudinal study Psychological Medicine, 1-11 DOI: 10.1017/S0033291712000220
Hopper, K., Harrison, G., Janca, A., & Sartorius, N. (2007). Recovery from schizophrenia: An international perspective: A report from the WHO Collaborative Project, The International Study of schizophrenia. New York, NY: Oxford University Press
Seikkula, J., Aaltonen, J., Alakare, B., Haarakangas, K., Keränen, J., & Lehtinen, K. (2006). Five-year experience of first-episode nonaffective psychosis in open-dialogue approach: Treatment principles, follow-up outcomes, and two case studies Psychotherapy Research, 16 (2), 214-228 DOI: 10.1080/10503300500268490
Williams, P. (2011). A multiple-case study exploring personal paradigm shifts throughout the psychotic process from onset to full recovery. (Doctoral dissertation, Saybrook Graduate School and Research Center).
Image via Zacarias Pereira da Mata / Shutterstock.
Paris Williams, PhD, works as a psychologist in the San Francisco Bay Area. He holds a PhD in Clinical Psychology from Saybrook University. He offers the rare perspective of someone who has experienced psychosis from both sides -- as a researcher and psychologist, and as someone who has himself fully recovered after struggling with psychotic experiences. In his book "Rethinking Madness," Dr. Williams takes the reader step by step on a highly engaging journey of discovery, exploring how the mainstream understanding of schizophrenia has become so profoundly misguided, while crafting a much more accurate and hopeful vision of madness.

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