I was on a radio show two years ago, talking about “TREATING the ‘UNTREATABLE, Healing in the Realms of Madness”. Before the show began, the staff gave me an email. They had apparently read the content of the email, for they presented it to me in a hushed and nearly reverential way. It was a lovely email from a former patient, telling me how much I had helped her more than three decades earlier. I pondered and tried to get a fix on who it was.
Suddenly, it became clear to me. It was “Lois” , the protagonist of “Two Rats and the Extraterrestrial” in TREATING. I hadn’t heard from her for more than 25 years. After the show, I contacted her. We talked and traded emails on a number of occasions over the intervening time.
Life was good for her. Sure, there had been difficulties, but she had negotiated them. She had reestablished contact with her children, had remarried, worked, lived happily with her new husband and even dealt with his death. She was involved in life and activities and the lives of her children and grandchildren. Most importantly, she had done this on the basis of the Intensive Psychotherapy we engaged in, vividly described in TREATING the ‘UNTREATABLE’. This previously often hospitalized woman, who was a “burnt out case”, loaded up on all kinds of antipsychotic medications by a number of psychiatrists, hospitals, half way houses and day care settings for seven years prior to seeing me, hadn’t taken any antipsychotics for over thirty years. Her antipsychotic medications were gradually titrated down as her delusions and hallucinations were understood and worked through. She had had none of the hallucinations and delusions she had before she came to see me, hallucinations and delusions that were readily comprehensible during the uncovering, exploratory work that we did.
It was a great pleasure for me to know that Lois had weathered the storms of her psychosis and her previously inept and stultifying treatment with the usual evidenced based therapies available at that time. It was an even greater pleasure to realize that the gains of our two and a half years of Intensive Psychotherapy had lasted over the intervening decades and that Lois had built a life for herself. Most importantly, it remains a deep pleasure to know that our Intensive Psychodynamic Psychotherapy led Lois out of the morass of psychosis and the oft repeated diagnosis of Paranoid Schizophrenia into a world where she leads a full life as a functioning person. For Lois and her Intensive Psychotherapy, the word CURE seems appropriate.
But how can schizophrenia be cured? Isn’t it a brain disease? How can talking change the brain?
Intensive Psychotherapy can be transformative. It was for Lois and it has been for others. How does it transform? By talking about and working through the patient’s own metaphor, concretized into hallucinations and delusions. My fingers typing are the result of brain reactions and chemicals. When a person is beset by his own thought productions and doesn’t recognize that they come from within, it is a small step to become either terrified or enraged or dissociated; or some combination of each. All of these reactions have a chemical substrate.
As issues are worked through, as hallucinations and delusions are metabolized psychologically, a person begins to calm. Brain chemistry, as Susan Vaughan describes in The Talking Cure, changes in the neurotic person as issues get worked through. In the psychotic person, sometimes one gets lucky and understands the origin of psychotic thought, as was the case with Lois and others in TREATING the ‘UNTREATABLE”. When this happens, there is calming and the ability to give up hallucinations, delusions and other forms of psychotic thinking. Often, antipsychotic medications can be titrated down and sometimes stopped as comprehension replaces terror.And of course, brain chemistry changes when someone is not constantly in a state of excitement and on alert.
So Lois got cured and Paranoid Schizophrenia was cured and Brain Chemistry Changed as Lois understood her issues and realized that what seemed to come from the outside, really came from within. And this has lasted over thirty years, with no antipsychotic medication.
Not bad for Intensive Talk Therapy of Psychosis
Subject: Healing vs Cure
Ira:
You presented a wonderful story of the recovery process but I would be very
hesitant to say that you cured her. Instead you seem to have provided an
atmosphere or environment which allowed her brain and other biological systems
as well as her psychological state to settle down so she could put herself back
together. That is called a healing process. You were but one aspect, albeit it
sounds like an important one, of her journey. She did a load of work herself.
Only a few surgeries and some antibiotics can claim cure in the medical sense.
Courtenay
Hi Courtenay.
I understand what you say, but would hold out for cure, for the following reasons.
The case, presented in TREATING, describes a floridly psychotic woman who had been viewed as a chronic paranoid schizophrenic for 7 years. Within a year, I had gotten her to look at the underpinnings of her beliefs, with the result that she was able to heal and give up delusional beliefs. I and Lois are convinced that the Intensive Psychotherapy led to her understanding her psychotic thinking; we both view her psychotherapy as the quintessential fact in her transformation.
As she understood and gave up her delusions–of first seven and then 20 years duration–she cleared and returned to the world–off meds.
TREATING the ‘UNTREATABLE’: Healing in the Realms of Madness was originally going to be subtitled Recovery, Healing, Cure. In the process of an uncovering exploratory psychotherapy, as she understood and calmed, she recovered and healed. The fact that she has maintained these gains, without any additional psychotherapy or antipsychotic medication, for more than 30 years shouts out CURE to me.
Perhaps, you are saying that schizophrenia is not a disease process, merely a way of thinking with resultant sequellae, hence can’t be cured. I’d settle for Intensive Psychotherapy being the main factor in transforming a person’s world view. I’ll look at this issue in a future post.
In the actual case you can see how instrumental Intensive Psychotherapy was in the rapid change of her condition from crazed heavily medicated psychotic to functioning person in the world.
All the best,
Ira
I was diagnosed and treated for schizophrenia at the age of 18 (back in 1968 in the UK). By the time I reached 21 I was ‘written off’ as suffering from chronic schizophrenia. For five years I was reduced to a zombie with antipsychotic drugs, and ECT. I came to realize that psychiatry was doing me far more harm than good. In 1974, against medical advice, I withdrew from the debilitating medication, jumped out of the net, and built up a life for myself. Now, over forty years on, I can honestly say I have been fine since then without any meds. So where did my chronic schizophrenia go?
After leaving the psychiatric system I found accommodation, a job and, later, became happily married (as I am still), returned to study and obtained a first-class degree. Did I have a brain disease? I think not. There were aspects of my social situation, not my brain, that needed changing (such as moving out of the house where I lived with my dysfunctional family).
In my case, I would dispute the diagnosis. It was based only on so-called ‘negative’ symptoms – lethargy, apathy, lack of affect, social withdrawal – without looking for other possible reasons of these so-called symptoms. I never had the floridly psychotic symptoms which often lead to a schizophrenia diagnosis.
None the less I was diagnosed with, and treated for, chronic schizophrenia., which apparently disappeared completely in 1974 when I came off the medication and sorted my life out. I’m sure what happened to me is by no means unique. I dread to think of what my life would have been like if I had continued with the psychiatric treatment. I am not saying that meds are wrong for everyone, but one size does not fit all. I think some serious questioning needs to be done about the validity of the diagnostic process.
This is a courageous tale, Jean; I’m glad it worked out so well.
Unfortunately you had to do it by yourself. It would have been preferable had you been able to find a psychiatrist who would look at your symptoms and gradually try to titrate down medicines, all the while seeing how you handled the reductions and talking with you about the issues that brought up symptoms.
Your post raises the issue of misdiagnosis and the all too easy diagnosis of schizophrenia, coupled with the overuse of antipsychotic medication to the exclusion of trying to understand what is actually going on in the person called schizophrenic.
It would be of great interest if others who have gone cold turkey off of antipsychotic meds or gradually withdrawn from meds could share their stories. Perhaps we can do a retrospective study.
Yes, you’re right. I think if I ‘d had a psychiatrist who would have helped me come off medication by gradual reduction, it would have been much easier and safer than doing it alone. The first time I tried to come off, I naively went cold turkey, and this was at the stressful time of leaving home. It was awful! I became anxious and distressed to the point I feared I was going mad.
By the time I felt ready to try again, I’d figured out that I should gradually withdraw. My psychiatrist didn’t agree to my cutting down at all, so I still had to do it secretly, without support. I’d no idea how many milligrams to reduce at a time, which tablets to cut down on in what order or at what pace. Withdrawal was, therefore, more scary (and I suppose more dangerous) than it should have been, but fortunately things worked out well for me. It was wonderful to feel awake and alive again once I became safely drugs-free.
I’ve written in detail about my withdrawal from meds in my memoir ‘The Dark Threads’.
Thank you Ira,
I have found this writing of yours to be uplifting and grounded. And am inspired by how much sense it makes. –
My experience is of the same diagnosis, and I am in the process of coming off of psychiatric medicines after ten years or more of medication treatment, and therapies. I do not have a clinician who is encouraging this directly. Though I am working with a psychiatrist and therapist. I am interested in radicalized mental health alternatives such as The Icarus Project, and have organized a local chapter in my town.
I am nearly off of the medicine Abilify which is thought to be a key medicine in treating schizophrenia. Instead, I have set out through immense anguish and worked closely for four years with a Zen monk. My trainings in Zen and my involvement in community building movements have brought me closer to wholeness. I find that as my thresholds of mental pain expand I can integrate and process threatening elements of the mind and world through a perspective of wisdom.
My hope is treatments such as yours can be celebrated instead of marginalized. Thanks.
This may be a difficult process, Colin. Often symptoms recur as medication is diminished. If not, so much the better. If symptoms return, it’s important to try to make sense of the meaning of the delusions and hallucinations, and work with a psychiatrist who will use medications in conjunction with an attempt to understand these phenomena. Zen, with its deep breathing, calming and relaxation may give you a central point from which to view everything which arises and realize that it all comes from you. Good luck with this.