"Many of us robotically prescribe serial medication trials in the face of unrelenting depression, even when we ourselves have no real expectation of seeing significant clinical improvement. We participate in this fruitless ritual rather than adequately considering and/or confronting the non-biological factors that are often contributing to these medication-resistant cases. And we justify our own circumscribed mindset with faith-based statements like “You have a chemical imbalance”, or “You will have to take this medication for the rest of your life.” We have fallen into an intellectual rut in our conception of depression, having ourselves become dependent on the idea of medications as a convenient, if somewhat unreliable, therapeutic mainstay."
ITA with this statement. It's the over-emphasis on the biological that has worried me. Depression is also an emotional and spiritual malaise and humans are complicated beings with multifacted lives.
But the biological model has demonstrated particular weakness when applied to the disorder known as depression.
Not to mention, schizophrenia and psychosis. Personally, I prefer the Jungian approach.
"...85% of our clients (all diagnosed as severely schizophrenic) at the Diabasis center not only improved, with no medications, but most went on growing after leaving us."
- John Weir Perry
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The Facility: Diabasis was an experimental project in San Francisco. It was a residence facility that lived through three years and more of inpatient work with acute "schizophrenic" episodes in young adults without the use of medications, always as part of the county's community mental health system.
Staffing: The facility was staffed by twenty paraprofessionals who served not only the ordinary functions of attendants, but also provided psychotherapy as counselors. Some of these held fractions of our seven paid positions, while others were volunteers.
Theory and Method: The orientation ultimately derived out of a Jungian approach although not all staff were specifically given to that theory and method; instead, several modalities were drawn upon. There was a consensus on the basic viewpoint that the acute "psychotic" episode under discussion typically contains elements of a spontaneous reorganization of the self and that therefore, if handled well, may result in self-healing.
Progress of Therapy: Our most surprising finding in the case of early acute episode was that grossly "psychotic" clients have usually come into a coherent and reality-oriented state spontaneously within two to six days, without need for medications.
Conclusions: Returning to the question of what alternative programs can be, we arrived at certain conclusions. It is possible to do effective psychotherapy in the acute episode, since the client's talk is clear and the material of dynamics active and ready to hand. The use of medications can be reserved for backup alone. Therapy is best conducted in the spirit of nondoctrinaire openess and thus to be of help in facilitating its own aims toward reorganizing the self. When allowed to proceed, we find that a growth process is often underway that can be sustained, with consequent developments in one's system of meanings, value, beliefs and lifestyle. This treatment mode may then help avoid the devastating picture of incapacitation and recidivism that now prevails, and then becomes a burden to mental health systems.
Source: Trials of the Visionary Mind
I am familiar with Perry's writing but I think it must be said that he wrote more than 30 years ago and I would have reservations following him now. It remains to be seen what the best treatment for schizophrenia and other major mental illness will be but it seems inhumane to me not to include symptom relief within whatever treatment is offered. I think the best case for a biological basis for mental illness can be made for these major disorders.
I am familiar with Perry's writing but I think it must be said that he wrote more than 30 years ago and I would have reservations following him now.
Jung wrote more than 30 years ago, and you are a follower and practioner of Jungian methodology.
Perry produced an astonishing rate of recovery in an era when we lacked the "technological advances" we have today. Jaakko Seikkula (non-Jungian) is another clinician who produces similiar rates of recovery using a process he refers to as open dialogue treatment.
With a success rate in the range of 80-85 percent in a culture that seems to produce long term dependancy and chronicity, both men are worthy of studying and listening to because they are producing cure (or did) by talking to those in their care. So did Jung, but Jung was also reputed to be a schizophrenic who had healed himself.
Some final food for thought...
Most Americans are unaware that the World Health Organization (WHO) has repeatedly found that long-term schizophrenia outcomes are much worse in the USA and other developed countries than in poor ones such as India and Nigeria, where relatively few patients are on anti-psychotic medications. In undeveloped countries, nearly two-thirds of schizophrenia patients are doing fairly well five years after initial diagnosis; about 40% have basically recovered. But in the USA and other developed countries, most patients become chronically ill. The outcome differences are so marked that WHO concluded that living in a developed country is a strong predictor that a patient will never fully recover.
My thanks for your link to the Candid Psychiatrist. I've responded in some depth to the forums there. This topic may be of interest to those who are of a Jungian inclination: Schizophrenia: A Jungian Approach
Regards.
>Jung wrote more than 30 years ago, and you are a >follower and practioner of Jungian methodology.
Indeed, Jung died 44 years ago. But I am not a classical Jungian -- I see myself as a Developmental Jungian (from Andrew Sullivan's Jung and the Post Jungians) which means I also draw on object relations and self psychology in my thinking about my work. Then it is also worth noting that my original training was in social learning theory and I am not averse to using behavioral techniques when they seem indicated.
But more importantly I do not work with people with psychoses. Of all the various and sundry problems human beings can have, it seems to me that major mental illnesses like schizophrenia, delusional disorder, and clear bi-polar disorder are more likely to have a biological basis than the problems of the people in my practice. And psychosis is not a walk in the park.
This does not mean that I believe that people with major mental illness cannot benefit from psychotherapy. Quite the contrary and I have long felt that excluding them from therapy is a mistake. That said, it helps both therapist and patient to work together when the most disruptive symptoms are not intruding.
But as I said, this area is not one in which I feel comfortable working so I do not.
But more importantly I do not work with people with psychoses. Of all the various and sundry problems human beings can have, it seems to me that major mental illnesses like schizophrenia, delusional disorder, and clear bi-polar disorder are more likely to have a biological basis than the problems of the people in my practice. And psychosis is not a walk in the park.
My own thoughts run to the line that psychosis is a result of a collapsed or fragmented ego -- note that by "ego" I am referring to one's conscious personality structure. There are numerous ways in which to remove the ego -- hallucinogens, for example -- but spiritual practices, trauma, loss, extreme personal crisis... these will also do it. There appears to be an increased vulnerability during transitional life stages, e.g. adolescence, adulthood, midlife.
When the ego collapses/fragments, unconscious contents well forth from both the personal and collective unconscious, including archetypal material. It's these factors, as combined with fragments of the collapsed ego structure, that produce the experience we call psychosis in this culture. Jungians and transpersonal therapists seem best equipped to understand the depth of these processess.
I have no doubt that there is a neurological component. After all, I'm having a neurological response right now, therefore, why wouldn't I have one to a crisis that was extreme enough to produce ego collapse? Unfortunately, as with depression, the biological model has taken firm hold as if it's the only possible explanation. And yet, science still cannot produce a test that can determine who has schizophrenia or why some people recover from it, even without treatment.
There's no point in debating the matter, of course -- you don't work with those in psychoses. I, on the other hand, have a vested interest in the subject. I had a psychotic break approximately five years ago. I've made a full recovery without hospitals, medication, or formal therapy. I've also talked to a lot of schizophrenics many of whom are not finding the help they need. This culture seems to produce chronicity; other cultures do not.
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