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Psychotherapy more effective than drugs for “Schizophrenia”

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Apotheosis

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http://bipolarblast.wordpress.com/2009/10/26/psychotherapy-more-effective/#more-7931

Psychotherapy more effective than drugs for “Schizophrenia”

Bertram P. Karon, Ph.D., is a Professor of Clinical Psychology at Michigan State University. Dr. Karon received his A.B.from Harvard, his M.A. and Ph.D. from Princeton. He is a former President of the Division of Psychoanalysis of the American Psychological Association, and has over 150 publications. He was selected by the Washington School of Psychiatry as the 2001 Fromm-Reichmann memorial lecturer, by the US chapter of the International Society for the Psychological treatment of Schizophrenia and other psychoses as their 2002 Award for “profound contributions to our psychoanalytic understanding and humane treatment of patients with severe mental illness.”

Psych Truth Radio: Welcome Dr. Karon

Bertram Karon: It’s a real pleasure to be your guest. And so, shall we talk about the important issues?

PTR: Yes. What do you think causes schziophrenia?

BK: It’s really, if you look at all the data we have and all the case studies… schizophrenics are very sick human beings. What it really is, is primarily, a chronic terror syndrome. We’re supposed to feel terrified for a minute, maybe for half an hour when there’s a danger but if you feel you are in danger of being destroyed and you have to live that way for days, weeks, months, or years… the toll on you is terrible. All of the symptoms of schizophrenia are either aspects of the terror syndrome or defenses against it. And that includes, the catatonic state where people become rigid which we’ve demonstated in animals occurs when they seem they are on the verge of dying. The hallucinations and delusions which all human beings are capable of doing but most of us will never have to do…

The best evidence of this goes back to WWII. There was a situation in WWII where every solder who went through it — and they were always sent for treatment — looked like the sickest, most chronic schizophrenics. And the situation was very simple: people were out there shooting at you, trying to kill you. And so you dug a foxhole as quick as you could and you could barely get into it, and as soon as you could barely get into it, you got into it, so you wouldn’t die. And they kept shooting at you trying to kill you, so you didn’t move… when your food ran out you stopped eating… if you had to urinate or defecate you did it on yourself. And if this went on for more than three days and nights, every single soldier looked like the most chronic, sickest schizophrenic. The strange thing was however, if they were reasonably healthy people beforehand, when brought to a place of security and safety and just given rest, they got better spontaneously.

There is no such thing as a spontaneous anxiety or an endogenous depression. If a patient is anxious, there is something to be scared of. If a patient is depressed, there is something to be depressed about. If it is not in consciousness, then it is unconscious. If it is not in the present, then it is in the past and something in the present symbolizes it.

At the time, people said it couldn’t be schizophrenia because we know that it doesn’t get better. The long term studies however … done in 12 different countries now indicate that irrespective of treatment, 30% of schizophrenics completely recover within 25 years. There have been studies from Switzerland, Italy, Scandinavia, the United States, Germany… they all find the same thing. Unfortunately, the best of the American studies — that of Courtney Harding, which studied patients from Vermont — found that the patients got better in 20 years but the patients who stayed on their medication as long as their doctors told them to, none of them ever recovered. 50% of the patients eventually stopped taking their medication against medical advise and all of the patients who had a full recovery were in that group. (The WHO studies found that in developing countries where drugs are not used at all recovery rates are much higher!)

PTR: So what you’re saying Dr. Karon is first of all that schizophrenia is really an experience, an experience of terror …

BK: Right.

PTR: And secondly, if someone continues to take the medication as prescribed by psychiatrists and doctors, that the odds are that they won’t improve and get better. They’re better off stopping the medication.

BK: Taking the medication may make them easier to manage but it gets in the way of full recovery.

PTR: Can you tell us a little bit about your ground-breaking Michigan study which was on the treatment of schizophrenics with psychotherapy versus the usual psychiatric approach?

BK: Yes. This was a study that was done on a NIMH grant using center city Detroit patients. What we did was take clearly schizophrenic patients … Diagnosis was made by the regular hospital staff and then reviewed by the research staff to ensure they were really schizophrenic. And if anything, they were the very sickest of the schizophrenics.

They were assigned randomly to one of three treatments: psychoanalytic therapy with no medication; psychoanalytic therapy and medication combined or, medication and support as given by a good group of psychiatrists in a good hospital. The evidence that they really were good psychiatrists is the group that did worse in our study — the medication only group — did as well as the medication only group in some of the studies … which claimed to find that therapy didn’t help.

The problem is that what they called therapy was done by residents who had no training in psychotherapy, supervised by supervisors who had no training in doing psychotherapy with schizophrenics. In our study, the supervisors had at least ten years experience in doing psychoanalytic therapy with schizophrenics and were considered by their colleagues to be “good therapists”. Furthermore, the inexperienced therapists — because we were interested in whether you could teach this sort of thing — were psychiatric residents or graduate students in clinical psychology and were given training and supervision, very carefully.

Now here’s what we found: the best outcome occurred in those people who got psychoanalytic therapy without medication at all. We used psychological tests, we used a clinical status interview conducted by a very experience psychiatrist who did not know what kind of treatment the patient received. The patients were examined before treatment, after six months, after 12 months and after 20 months of treatment. And then we did a follow up for medication after two years. The best results were obtained with those people who got just psychoanalytic therapy.

The next best results, which were nearly as good, was where medication was used as an adjunct but it was withdrawn as rapidly as the patient could tolerate. The experienced therapist who combined medication with therapy was honest. He told the patients, ‘The medication doesn’t cure anything. It makes things tolerable so we can talk. But the only thing that will cure you is your understanding.’ And he withdrew the medication as quickly as the patients could tolerate and that turned out to be a good way to work.

Therapists who treated their patients with medication as well as psychotherapy but maintained the dosage level of the medication and never withdrew the patients from their medication, this was not nearly as good as just using psychoanalytic therapy or psychoanalytic therapy with medication when the medication was withdrawn as rapidly as the patients could tolerate.
 
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Op.cit

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Apotheosis

To be honest I find the author of the above just a touch to willing to use distorting language to create supporting arguements for their own beliefs. Its a pity because I think they are on the right track and the sophistry is just not needed. I think its a really counter productive tactic that can put people off otherwise good ideas. Just my opinion.

However, more to my personal taste is this meta-analysis of the effectiveness of long-term psychodynamic psychotherapy. It passes my own test for rigor and objectivity and does conclude that LTPP is effective. No one could accuse Pub Med of being cranky or not part of the mainstream.

Worth a look.

http://www.ncbi.nlm.nih.gov/pubmed/18827212

Regards,
Op.cit
 
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Apotheosis

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No one could accuse Pub Med of being cranky or not part of the mainstream.
What is so great about the mainstream?

I respect your perspective on this. But to my mind; what is so admirable, truly rational, verifiable, & 'truthful' about the general orthodox views & commonly held assumptions on madness? You can just as easily level at the established psychiatric perspectives that it is just as much 'willing to use distorting language to create supporting arguments for their own beliefs', & are just as guilty as sophism themselves.

Interesting link - personally I have never doubted the efficacy of depth psychology, & the failings of the Bio-Medical model in relation to MH.
 
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Op.cit

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Thanks, I always read your posts with interest.

Regarding sophistry, you are right, every one with a point of view does it sometimes.

I accept their is nothing morally, ethically, or any other way you care to name a sense in which being part of the mainstream is superior to being outside it. If you are right, you are right, it does not matter where you sit.

However getting your ideas accepted by the mainstream does have advantages. In this case it would mean that more resources, cash in the form of taxpayers money being allocated to these sorts of therapies. I think that is what we both want.

To be fair,the reverse is true also true. Their is no real glory in splendid isolation outside the mainstream.

Regards,
Op.cit
 
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Apotheosis

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To be fair,the reverse is true also true. Their is no real glory in splendid isolation outside the mainstream.
Thanks, & yes I agree. But here is where we come to some fundamental schisms; & opposites of paradigm, that are so fundamentally different, as to be irreconcilable. You know what I'm talking about. & this has been the case for a very long time.

To use very broad & general categorisations ~ If the generally accepted consensus of the mainstream & establishment is that of biological reality, scientific reductionism, materialism, etc etc etc; then would such a system ever genuinely acknowledge the trans-personal, the extent of depth psychology & it's methods, & the spiritual aspects of alternative & far more holistic systems? How can it?

There has been a nod in the direction, & a slight acknowledgement of some alternative perspectives to things; but that is all it is; a slight appeasing of many that hold different views.

I can't see that any of this will be reconciled in my lifetime, & quite possibly not for hundreds, if not thousands of years.

& what do I & others do, when we have a fundamental disagreement with the core basis to the mainstream paradigm; & consensus view of reality? & the ideas on which it is based.
 
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Apotheosis

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breaksandflows

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In tune with the approach taken by most cognitive scientists, often mental operations are described on the model of the computer, as self-contained modules, distinct subsystems that cannot be penetrated by consciousness.

Like computer hardware, the minds modules have separated out from language (conscious awareness), so as to function smoothly and automatically as a self-reproducing circularity (autopoiesis) untroubled by thoughts tendency to go outside the circle and think back on itself.

As Friedrich Kittler put it in Cartesian terms: "Phonographs do not think therefore they are possible".

Joseph Tabbi - "A Media Theory of the Unconscious"
 
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Apotheosis

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breaksandflows

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"...the Dutch Company which is ev'rywhere, and Ev'rything".

To which, Dixon replied: "Somewhat like the Deists' God, do tha mean?"

"Late Blow, late Blow,-"

"Mason, of Mathematickal Necessity there do remain, beyond the Reach of the V.O.C., routes of Escape, pockets of Safety,- Markets that never answer to the Company, gatherings that remain forever unknown, even down in Butter-Bag Castle. I'd be much oblig'd if we might roam 'round together, some Evening, and happen we'll see. Mind I'm seldom all the way outside their Perimeter,- yet do I make an effort to keep to the Margins close as I may"

Thomas Pynchon - "Mason & Dixon"
 
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Op.cit

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Apotheosis

& what do I & others do, when we have a fundamental disagreement with the core basis to the mainstream paradigm; & consensus view of reality? & the ideas on which it is based.

I think that I understand you point of view. The question above is the really important one to individuals I imagine. My answer and I apologise if it sounds trite is to try and have a happy life. The answer to how one does that, regardless of opinions about the correct paradigm for mental health, is not to be found I would suggest in mental health services anyway.

Returning to the paradigm. NICE has published new guidance this morning (well I got it today).

Schizophrenia Core interventions in the treatment and management of schizophrenia in primary and secondary care

http://www.nice.org.uk/nicemedia/pdf/CG82FullGuideline.pdf

Section 8 may be of particular interest.

Apologies for the late response I have been away.

Regards,
Op.cit
 
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Apotheosis

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& what do I & others do, when we have a fundamental disagreement with the core basis to the mainstream paradigm; & consensus view of reality? & the ideas on which it is based.

I think that I understand you point of view.
Yes, I think that you do. Thank you. I feel very alone in my views sometimes.

The question above is the really important one to individuals I imagine. My answer and I apologise if it sounds trite is to try and have a happy life. The answer to how one does that, regardless of opinions about the correct paradigm for mental health, is not to be found I would suggest in mental health services anyway.
It's not trite - it's true.

Thanks for the link to the document - Interesting. I'll give things a few hundred to a couple of thousand years, & see how things stand then. Maybe things will be more humane by then.

Don't apologise for the late reply - the appeal of the internet & forums, is that we can revive things at any time, & make a reply days, weeks, months, & sometimes years later. It's good to have some time to digest & think about things as well, before making a reply. I have recently had a thread replied to on another forum - that was replied to over 2 years after I started the thread. Maybe some questions need a few years, or a decade or 2 to think about them, & of a suitable answer? :)
 
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Apotheosis

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