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Treating schizophrenia without drugs?

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firemonkee57

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Treating schizophrenia without drugs? There's good evidence for it.
April 24, 2009

Award-winning researcher and psychiatrist Tim Calton examines studies demonstrating how psychosis can be managed without medication. Such non-drug approaches shoud no longer be ignored, he argues.

......

Over two hundred years ago medical psychiatry planted its standard within the realm of the human experience of 'madness', quickly becoming the dominant paradigm. Other ways of understanding and tending to mental distress were suffocated or retreated to the margins. Psychiatry's success in creating and disseminating knowledge about those forms of life which get described as 'madness', 'psychosis', or 'schizophrenia', quickly becomes apparent when surveying the first National Institute for Clinical Excellence (NICE) guidelines for the treatment of people diagnosed with schizophrenia.

This document, a synopsis of so-called 'best practice' in the clinical treatment of 'schizophrenia' within the NHS, clearly states that antipsychotic drugs are necessary in the treatment of an acute episode (National Institute for Clinical Excellence, 2002), a mandate not extended to psychosocial interventions.

Last month we had the updated guidelines (National Institute for Clinical Excellence, 2009). They do appear somewhat more balanced (stating that cognitive-behavioural psychotherapy should be offered alongside medication), although important semantic emphases remain (such as the fact that clinicians need only 'discuss' alternative therapies, not necessarily offer them). The importance granted medication, at the expense of other ways of understanding and helping with mental distress, reflects the tendency for medical psychiatry to see aspects of the vast and complex realm of human experience as mere disease.

Although the NICE guidelines carry a powerful political imprimatur they reflect the deep but extremely narrow tradition of biomedical research into madness; research which would have us believe that the only way to 'get better' and 'stay well' are to take antipsychotic medication, for life if necessary.

The question remains, however, as to whether it is possible to help people experiencing 'psychosis' without recourse to antipsychotic medication? Such a question might provoke a range of immediate and urgent responses depending on your sociopolitical context, life history and experience. One way of mediating this array of responses would be to scrutinise 'the evidence' supporting the use of no or minimal medication approaches to the treatment of 'psychosis'/'schizophrenia'.

There is certainly a wealth of historical evidence supporting a non-medical approach to madness ranging from Geel, the city in Belgium where the 'mad' lived with local families, receiving support and care that allowed them to function in the 'normal' social world despite the emotional distress some experienced (Goldstein, 2003), to the so-called Moral Treatment developed at the York Retreat by William Tuke towards the end of the eighteenth century (Digby, 1985), which advocated peace, respect, and dignity in all relationships, and emphasised the importance of maintaining usual social activities, work and exercise. These approaches, predicated as they were on a gentle and humane engagement with the vagaries of human experience at the limits, and invoking respect, dignity, collective responsibility, and an emphasis on interpersonal relationships as guiding principles, have much to tell contemporary biomedical psychiatry.

In the modern era, non-medical attempts to understand and tend to 'psychosis' have coalesced into a tradition counterposed to the biomedical orthodoxy. The richest seam of evidence within this tradition is that relating to Soteria House , the project developed by Loren Mosher and colleagues in San Francisco during the early 1970s (www.moshersoteria.com). Here, people diagnosed with schizophrenia could live in a suburban house staffed with non-professionals who would spend time 'being' with them in an attempt to try and secure shared meanings and understandings of their subjective experience.

Antipsychotic medication was marginalised, being considered a barrier to the project of understanding the other, and was only ever taken from a position of informed and voluntary choice. Arguably the most radical aspect of the Soteria project was the emphasis given to building a case across many different rhetorical levels, including the scientific/evidential. Subjected to a randomised controlled trial in comparison to 'treatment as usual' (TAU - hospitalisation and medication), with follow-up assessments at six weeks and two years, it proved at least as effective as TAU with some specific advantages in terms of significantly greater improvements in global psychopathology and composite outcome, significantly more participants living independently, and significantly fewer readmissions (Bola, 2003). A Swiss iteration of Soteria reported similar results and suggested these could be achieved at no greater fiscal cost than TAU (Ciompi, 1992), whilst a recent systematic review of all the evidence pertaining to Soteria confirmed both claims (Calton, 2008).

More evidence supporting the use of non-medical approaches to helping people diagnosed with 'psychosis' / 'schizophrenia' has emerged from Scandinavia and the USA (Calton, 2009). In the former, so-called 'Need Adapted' treatment, an approach which places great emphasis on interpersonal relationships and striving after meaning, whilst decentring medication, treating it as merely one of a plurality of interventions, is associated with people spending less time in hospital, experiencing fewer 'psychotic' symptoms, being more likely to hold down a job, and taking much less antipsychotic medication. In the latter, evidence from an innovative series of research projects conducted in the 1970s suggests not only that people diagnosed with 'schizophrenia' can recover without the use of antipsychotic medication when exposed to a nurturing and tolerant therapeutic environment, but also that antipsychotic medication may not be the treatment of choice, at least for certain people, if the goal is long-term improvement.

To conclude then, it seems appropriate, given the evidence, to claim that the human experience of 'psychosis' can be helped without recourse to the use of antipsychotic medication. The research cited above does not appear to have been considered in the current NICE guidelines (presumably because of the small number of studies undertaken using minimal or no medication approaches), though may well be incorporated into the next iteration. This should happen because the lack of any meaningful idea of choice with regard to treatment for people diagnosed with 'psychosis' / 'schizophrenia' in the UK is abundantly apparent; a state of affairs that may not be sustainable given recent pronouncements on patient choice (DoH, 2008).

We must remember, honour and reiterate these alternative traditions of thought and practice if we are to overcome the extant biomedical hegemony.
* Tim Calton is a psychiatrist and winner of the 2005 Royal College of Psychiatrists Research Prize and Bronze Medal. He is a research fellow at the Institute of Mental Health in Nottingham and special lecturer in the department of health psychology at the University of Nottingham.


http://psychminded.co.uk/news/news2009/april09/schizophrenia-psychosis-medication003.htm





I am not a zealot when it comes to the use of medicine for psychiatric illnesses . I am wary of it's potential use as a means of social control ,
My own position is that the smallest amount of medication should be used and that if a person is coping ok with their symptoms and is not a danger to themselves or others then they should not be browbeaten into taking medication to conform to societies ideal of a 'normal' person.
However if a person is suffering distress,danger,and dysfunction, from which the use of medication brings a measure of relief ,then i can not see the inherent evil some claim there is in persuading that person to take medication for his or her problems .

My own position is that for most people the best potential for the use of therapy is as adjunct treatment that hopefully reduces the amount of medication needed and that there should be more therapy available as a potentially beneficial adjunct treatment.


Despite being cautiously pro med i think it is right to post stuff that is both pro a medical approach and pro a non medical/therapeutic approach .
Others, such as Apotheosis, will necessarily find more points of agreement with the author of the article than i.
 
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Apotheosis

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My own position is that for most people the best potential for the use of therapy is as adjunct treatment that hopefully reduces the amount of medication needed and that there should be more therapy available as a potentially beneficial adjunct treatment.

Despite being cautiously pro med i think it is right to post stuff that is both pro a medical approach and pro a non medical/therapeutic approach .
Others, such as Apotheosis, will necessarily find more points of agreement with the author of the article than i.
Thank you for the link. I do agree with your comments. The problem that I see is that there are not many alternatives available. Not to say that they don't exist; as indeed they do. I agree that there should "be more therapy available as a potentially beneficial adjunct treatment". Given the lack of comprehensive alternative care; or means/opportunity of med free recovery; then often meds is the lesser of Evils. I can't very well say to people that they shouldn't take meds; when I do take them (a low dose of one). I would have loved, & still would; the opportunity for a med free recovery. I don't presently have the level of support necessary to try. & I was never given such an opportunity. I think people should have that potential choice; (within guidelines as part of a duty of care).

I am careful to not give any specific advice to individuals. I wouldn't tell anyone to not take, nor to take something; beyond general opinion. I think it should be personal choice as largely as possible. But I agree that both sides of this 'debate' should be openly discussed. These things should I feel be openly looked into; with as much impartiality as possible. Mental illness is still largely a Taboo subject. This is however something I enjoy chatting about & exploring.

There are indeed those - "suffering distress, danger, & dysfunction" - I was one of them. There is also that minority who are violent. More specialist care should be available across the board.

If it was a case of meds or 'nothing' - then I'd choose meds. If it was however a choice of meds, or comprehensive psychological help in therapeutic, trustful, & open accommodation - then I would choose the later.

You know me well - I'm in general agreement to the article. :)

http://www.mentalhealthforum.net/forum/showthread.php?t=3909

There is an ongoing discussion on another forum; about anti/pro psychiatry; although I do not like the term 'anti-psychiatry'. Carl Jung & John Weir Perry are two of my favourite practitioners in mental health, I don't think either could be referred to as anti psychiatry; although their ideas were not in line with the general Orthodox Bio-Medical model.

A lot of the differences in perspectives, does appear to come down to theorised or assumed causes & prognosis. Simplistically - Are these conditions almost wholly biological; or rather tied more into psycho/social & 'other' elements? i.e. - predominantly psychogenic in nature & largely influenced by environmental factors (inter-personal relationships, society ect ect). If the truth is more in line with the latter; then the primary assistance should, IMO, reflect this. If what I am experiencing has a primary psychogenic cause - then give me a psychological treatment.

IMO, Treatment should reflect the multi faceted nature of MH conditions. & meds be but one part of a multi disciplined approach. Such a change does seem to be slowly taking place. I don't think anyone would deny - that proper social support, secure accommodation, & addressing the wider issues in the life of the sufferer - has a potentially beneficial effect.

http://thehealthyskeptic.org/the-chemical-imbalance-myth/

Here are the articles which were being discussed -

http://psychology.hypnoticworld.com/issue/anti-psychiatry.php

http://en.wikipedia.org/wiki/Anti-psychiatry

A fellow poster friend replied to the other discussion with this; it seemed thoughtful & balanced. I don't think they would mind if I posted it here -

Ghost said:
Personally I think it too broad a subject to jump one way or the other. As the article states some parts of psychology are not considered to be science. Very few scientists believe it to be so, I've read books on that particular subject on the difference between empirical science and the lack of such objectivity in psychology. The history is clearly quite questionable as is the unproven claim it is genetic, what the cause is no one knows.

As for it not existing at all, I wouldn't say that either but I imagine the causes are varied and individual. When I did my counselling course the tutor compared my thoughts to those of Karl Popper. Sometimes its to simplistic to be pro this or against that.
http://www.rethink.org/applications/discussion/view.rm?skip=0&post_id=18442&id=0

It is indeed a complex & multi faceted subject; with no easy answers.
 
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firemonkee57

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I think one of the difficulties is in working out those most likely to be helped by a stand alone therapy approach and/or those most likely to incur negative effects if being tried on such an approach proves futile .
It would be great if some people could manage without meds but there is a potential for disaster in misjudging who might be helped by such an approach.

Possibly the diathesis-stress model could be used a starting point for making such a decision .

In the diathesis–stress model, a biological or genetic vulnerability or predisposition (diathesis) interacts with the environment and life events (stressors) to trigger behaviors or psychological disorders. The greater the underlying vulnerability, the less stress is needed to trigger the behavior or disorder. Conversely, where there is a smaller genetic contribution greater life stress is required to produce the particular result. Even so, someone with a diathesis towards a disorder does not necessarily mean they will ever develop the disorder. Both the diathesis and the stress are required for this to happen.

http://en.wikipedia.org/wiki/Diathesis-stress_model

Those with less of a familial occurrence of schizophrenia ie where a greater degree of life stress is needed to bring about the illness might be a good starting point for trying a therapeutic approach .

Aside from deciding who would most likely benefit from a non medical approach there is the pragmatic question of providing the resources to allow for the necessary intensive interactions that would be needed especially in the earlier stages of using such an approach.
You and i both know how much of a Cinderella mental health care is in terms of funding .
Basically not only does there need to be a careful evaluation of those most likely to benefit from such an approach but also the required resources,both financially and otherwise, to allow a realistic chance of such an approach being successful.
That is not said to poo hooh the use of such an approach but to point out that it is one thing to advocate such an approach in theory but another to put it into real life practice.
 
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Apotheosis

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Possibly the diathesis-stress model could be used a starting point for making such a decision.
Yes, that is reasonable.

My condition is very much linked to stress. But ways can be learned of better dealing with 'life'.

Aside from deciding who would most likely benefit from a non medical approach there is the pragmatic question of providing the resources to allow for the necessary intensive interactions that would be needed especially in the earlier stages of using such an approach.
You and i both know how much of a Cinderella mental health care is in terms of funding .
Basically not only does there need to be a careful evaluation of those most likely to benefit from such an approach but also the required resources,both financially and otherwise, to allow a realistic chance of such an approach being successful.
That is not said to poo hooh the use of such an approach but to point out that it is one thing to advocate such an approach in theory but another to put it into real life practice.
Yes indeed. I agree with all your points. The socio/political climate disallows to a large degree these 'other' approaches. It is a complex subject again as to why.

If comprehensive therapeutic help & support were made available as the norm; then there is no reason why people could not try med free alternatives - meds & more 'traditional' methods could always be used as 'backup'.

It appears that practically such approaches need not be any more expensive or resource intensive. Indeed; if a certain proportion could be helped to a med free recovery - the long term costs would be cheaper.

http://www.moshersoteria.com/soteri.htm#OAH
 
Rambuie Perspecador

Rambuie Perspecador

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I am careful to not give any specific advice to individuals. I wouldn't tell anyone to not take, nor to take something; beyond general opinion. I think it should be personal choice as largely as possible. But I agree that both sides of this 'debate' should be openly discussed. These things should I feel be openly looked into; with as much impartiality as possible. Mental illness is still largely a Taboo subject. This is however something I enjoy chatting about & exploring.

Now THERE is someone who has changed his tune. I see no problem with people taking cannabis being more careful, and not taking cannabis in the future, or ceasing to take cannabis if it removes their symptoms of schizophrenia.

I DO have a problem with idly chatting about the life-and-death situations of people unavoidably stricken by schizophrenia in their make-up, being trivialised under labels of 'Orthodoxy', or indeed 'anti-psychiatry', as was the case with the theosising on this site.

As for Taboo, it became Taboo to voice any other perspectives that went against an hysterical attachment to the nonsensical position taken up by CASL, against the use of the word schizophrenia!

A change indeed - or is it? :confused:
 
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Apotheosis

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A change indeed - or is it? :confused:
If you read my posts on this site (or any other forum I go on) you will find consistency in my views & opinions going back years. If you don't like freedom of speech or people openly discussing subjects on an open forum then I suggest you don't post here.
 
Rambuie Perspecador

Rambuie Perspecador

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You don't get rid of people That easy, Apo. You wring Apo. logies out of everyone else for Existing, but I note your inconsistencies and tell you them when I've a mind to, not when it suits you. As for freedom of speech, you constrain me at every turn. I have told you before that your liberties are someone else's constraints. Well take a few liberties, but I am counting and so will everyone else be, whose hands are tied by you. Anyway, if you induced your schizophrenia through substance-abuse I don't think it qualifies you to be laying down what's what for the rest of us. Do you? What was it you said? 'Get over it'. Go on then. :evil:
 
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Apotheosis

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You don't get rid of people That easy, Apo. You wring Apo. logies out of everyone else for Existing, but I note your inconsistencies and tell you them when I've a mind to, not when it suits you. As for freedom of speech, you constrain me at every turn. I have told you before that your liberties are someone else's constraints. Well take a few liberties, but I am counting and so will everyone else be, whose hands are tied by you. Anyway, if you induced your schizophrenia through substance-abuse I don't think it qualifies you to be laying down what's what for the rest of us. Do you? What was it you said? 'Get over it'. Go on then. :evil:
Be aware of the forum rules -

http://www.mentalhealthforum.net/forum/showthread.php?t=1567
 
Rambuie Perspecador

Rambuie Perspecador

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Theos, I am aware of the rule book which you are slinging in my direction. I just wonder if you are, or were when you were causing great offence, consternation and heart-ache to people with schizophrenia with your insistence on a posting of the CASL petition site! It may be news to you, but I do not have schizophrenia by leave of you and you will be glad it stays that way. You over-stepped your limits by making that posting and I think by now you realize that. Making people Angry and then not removing the source of their Anger is not the hall-mark of a balanced perspective from someone moderating a site with any distinction. Just be aware in future - and yes, some deference also for my 34 + years of this interminable condition. :mad:
 
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Apotheosis

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I'll post what I like; about whatever subject I like; I am not the one with a propensity to break forum rules. I neither have to ask your permission to do so, nor feel bad in any way for doing so. You may not like free speech; but on an open forum it is allowed.

CASL is alive & well. It is long overdue that we scrapped this unhelpful & defunct term. - Hopefully soon.

http://www.asylumonline.net/

Many do support CASL - on this site & in society. :)
 
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Apotheosis

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http://www.asylumonline.net/

A Carer's View of Schizophrenia

Some people like the term ‘schizophrenia'. The diagnosis does enable some service users to access benefits they might otherwise not, so they may find it useful. Some psychiatrists like to have a simple label they can use to describe people who otherwise have a confusing and diverse range of inconsistent symptoms; it suggests that they recognise these behaviours. In so doing, it enables them to ignore and discount the history and traumas of the service user, and all aspects of his or her life since everything is dismissed as ‘psychosis' and ‘fantasy'. Some families think initially but mistakenly that if there's a ‘diagnosis', it represents a well-defined situation for which a genuine treatment and route to recovery is known, as happens with other health problems. So, initially, there may be brief relief with the diagnosis. However, this does not last. All affected families are horrified when the label ‘schizophrenia' is soon attended by another damning label, that of ‘severe and enduring mental health problem', yet despite this devastating prospect, they are urged NOT to give up hope as this is important to their relative's recovery.

In practice, most families continue to hold the hope of recovery, and to work unstintingly for their family member's support with absolute dedication sometimes for decades and often despite the unsupportive disinterest, and sometimes outright hostility and inhumanity, of many staff. The family often hold the flame which helps and inspires the service user throughout his illness. This is called LOVE, and it is discounted and dismissed by the services and the NHS obsessed as it is with regulations and procedures.

The government has ‘recovery' as its goal though how to reconcile ‘recovery' with the ‘severe and enduring' label is a contradiction neither explored nor explained, and the treatment offered continues to be the same drugs.

As carers begin to search for information, they meet other carers and families; they come to know service users also diagnosed with ‘schizophrenia' who have been maintained on drugs for decades and whose lives, along with those of their families, are slipping by in poor or no quality, stigmatised, rejected, isolated and dumped by mainstream society.

Soon, the vast range of symptoms and histories included in the umbrella diagnosis ‘schizophrenia' is apparent and it is inconceivable to everyone except the psychiatrist that all these people could, or should, have the same diagnosis or the same treatment. By relying almost entirely on drugs, other therapies of proven value are ignored, often not even mentioned. When carers / families want to discuss other options with the psychiatrist, their request is usually refused or ignored. So, if you're in the right place with more forward thinking and humane approaches available, your service user family member can access empathic therapies, taking into consideration his/her specific history and experiences with understanding and allowing him/her to process them then move on with improved chance of recovery. But, if you are not in an enlightened area, you are supposed to accept the total devastation of your family meekly and without question.

‘Schizophrenia' was coined nearly a century ago. No other branch of medicine continues to rely on the faltering first footsteps taken so long ago. It is time it was abandoned so that service users can be treated individually, have their symptoms and histories properly addressed so they can recover proper control of their lives. Once schizophrenia has been abandoned as a concept, the medicalisation of mental illness and the domination of the drug companies is no longer acceptable. This is not recovery; it is sedation and containment using a chemical cosh lobotomy. Service users need appropriate individualised support, so that the 80% recovery rates achieved in the developing World can be seen here instead of the 20% we have currently. A recent comment by an enlightened psychiatrist was to the effect that the service user was in charge of his own recovery, but the psychiatrist supported his/her journey properly so that it was ordered and (s)he was not overwhelmed in the process.
 
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Apotheosis

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Thanks for the link Firemonkee; an interesting article. I don't think that there are any easy or simple answers.
 
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