Recovery from “schizophrenia” and other “psychotic disorders”

Recently I came across the following story of a woman who recovered from “schizophrenia” with the help of a therapist who used a method called the “Emotional Freedom Technique” or EFT. At the core of this method, it seems to me, is learning to calmly face difficult thoughts or emotions, while not buying into them more than necessary. My belief is that whether you learn to do this through EFT “tapping” or some other method, it is essential for good emotional health to find some way of doing it. (You can find out more about EFT at lots of websites, including http://123eft.com/ )

One thing easily seen in stories like this is the importance of focusing on a person’s story and that person’s reactions to their story, rather than mystifying everything by calling it a “biological illness.” There is certainly a biological aspect to our reactions, but so much more than that is involved.

Here’s the story, originally from Gary Gregg’s emofree.com web site.

Inside a successful schizophrenia case
Hi Everyone,
For a year, Sonia Novinsky (from Sao Paulo, Brazil) worked with her
schizophrenic client, “Jacqueline”, on an almost daily basis.
The result has been a first class success for this serious mental
disorder…AND…it was done without the use of drugs or conventional
means. As you will see, Jacqueline, now lives a normal life….free of
her hallucinations, anorexia and other symptoms. As you will also see,
EFT didn’t do this alone…although it was a critical tool. It was
EFT…PLUS…Sonia’s skill, caring and rapport building that brought
this welcome relief.
This article will be of high interest to the professionals on this list
so Sonia has described the case in detail.
Please note that English is not Sonia’s first language and thus
providing this article for our readership took an extra level of
commitment and caring. For your convenience, I edited it slightly for
readability.
Hugs, Gary
________________________________________
By Sonia Novinsky
Jacqueline came to me about one year ago. She was a beautiful woman, in
her forties and had been diagnosed as a schizophrenic with auditory
hallucinations, depression and an inability to operate in social
environments. Now, after a year, the hallucinations are gone and she is
well adapted to society. Along the way many other benefits
occurred…including relief from anorexia and the cessation of smoking.
Here’s the story.
She arrived in a very depressive state, saying to me: “This is my last
chance. And all I can pay is 10 dollars per session.” It was impossible
to refuse her desperate appeal for help. She said…
“For 9 years now, since my daughter was born, I am taking Haldol, Prozac
and other medications because Psychiatrists considered me an incurable
schizophrenic patient. I’ve been sleeping most of my daytime during all
these years.
After a traumatic event when my daughter was born I fell into a
depression. I started listening to Mary’s voice (Jesus’s mother)
GC COMMENT: her former psychiatrist diagnosed this an auditory
hallucination.
and I had some inappropriate behaviors, including a kind of anorexia,
with hospitalization. I heard about your work with Energy and I want to
try it. I believe that this could help me to get rid of medication and
my disease. The only reason I don’t kill myself today is because my
religion forbids me to do it.”
My first thought was: should I do EFT for a psychotic client? But the
despair I saw in her eyes touched me and I decided to try. She said she
would do anything to be free from Haldol. In fact, she threw away her
drugs and cut off communications with her psychiatrist. She refused to
take drugs because of the negative effects on her and made it a
requirement that I work with her on that condition.
At the first moment she told me that she had a supportive husband and
parents, and also wonderful children and that made her feel more guilty
for being a mentally ill person. She complained of smoking too much, of
having difficulties to rest and sleep. She said she was also 30 kg more
than her ideal weight, partly because of the antipsychotic medication.
During the last 9 years she was afraid to drive a car, which was normal
to her before her crisis.
The last psychiatrist she saw was very oppressive, telling her she had
an incurable mental illness and was obliged to take Haldol for the rest
of her life. When she arrived at my office she was very angry with all
psychiatrists and therapists who took care of her during all these
years. They gave her no hope: just labels and drugs.
Before investigating core issues, I worked for some weeks on our
rapport, trying to help her on her self esteem and trying to develop
some trust in our connection. She was very upset with the kind of
relationship she had with her psychiatrists and therapists. A hierarchy
was always present, and she was the inferior part of it, all the time.
Her objections about the treatment were never validated by them.
I agreed to try to work with her without medication (her choice) only if
we could see each other almost everyday and talk on the phone whenever
necessary. She agreed to tap with me on the phone whenever I asked her.
In this case it is very important to stress how strong was her intention
to get rid of any medication because they condemned her to be out of a
normal life.
In this case, besides EFT, praying was used almost everyday. She bought
“A Course in Miracles” and did her lessons everyday. The first result,
from the combination these items, was that hallucinations started fading
down and disappeared completely.
I will make a summary of the main topics we worked with EFT. We did EFT
hundreds of times. I learned a lot with Gary, so I do a free talk while
tapping, in a way that I can’t reproduce here, introducing humor and
installing new meanings and possibilities. She was entirely open to work
with EFT.
We started working with the most apparent sensation she was having at
the moment she arrived. In my experience you can start with this state,
even if it is not a core issue. When this layer is reached, even if you
don’t clear it completely, it gives room for the traumatic memories to
show up. Meanwhile you get the basic trust needed to work deeply.
Defenses hold back slowly while the person calms down. At the same time
inner positive resources become more available for working with more
delicate issues. So we started working on her self image and self
esteem, while tapping:
Even though I was shocked by the label of “incurable schizophrenic” Dr.
X put on me, at his office, that makes me feel completely hopeless, I am
not this label, I am more than what people think about me and I deeply
and completely love and accept myself.
While we were tapping I installed some reframing about how I was one
with her, no hierarchy between us, how we were together and no label
separating us.
The result was important for the rest of the treatment: she trusted that
she was not alone and that I was assuming a strong, deep, and personal
commitment with her. Differently from other professionals she had seen
before, I was not just using a technique or medications or my
professional skills. Sometimes when there is a lack of this commitment,
then technique, titles or medications become tools that are responsible
for the client’s feelings of isolation, inferiority and separation. When
this happens, these tools become inefficient.
She disclosed that when her daughter was born she was very upset with
some events and we tapped on them. The worst one (which launched her
first psychotic episode) was her husband’s imposition that his mother
should be the godmother of her daughter. Since they started dating, his
mother and his sisters disapproved of Jacqueline and were mean to her.
Jacqueline’s husband, Leo, didn’t allow any choice to Jacqueline. He
almost begged for this, crying and screaming. When Jacqueline went to
see her mother in law to invite her, her reaction was very negative. She
said: “I accept to be the godmother but I will not receive your family
in my house.” This was a traumatic event for Jacqueline.
She felt very unhappy, with no way out, and thus she had her first
psychotic attack. She undressed completely at a soccer stadium full of
people.
We tapped for this event, and many aspects showed up. We tapped for the
shame and guilt of not having control of her behavior. While she was
narrating the event I tapped on her. This is my preferred way of tapping
specific events. This one was a very traumatic event but finally her
husband agreed on her demand that his mother would not do the baptism of
their daughter.
Thus she was victorious in some way, but she paid a high price for this
“victory”: from this day on she carried the label of a sick person.
After two months her mother in law died suddenly and that gave
Jacqueline the illusion of having a mean power inside her, and that made
her still more guilty. In some way Jacqueline felt she had no control
over herself but from another point of view she was afraid of having
some extraordinary power.
While doing EFT….
Even though I lost control about my behavior that day in the stadium and
I am ashamed about it, I completely forgive myself. This was they way I
found at that time to validate my protest against my mother in law and
my husband demands.
Even though I did what I did at the stadium and she died two months
later, it is only a belief that I can control someone else’s time to
die. This is God’s power, not mine so I can be free of any
responsibility for other people’s life or death.
Jacqueline wanted to drive a car again. She felt ready to try it, after
clearing her psychotic attack and its consequences. So we tapped for the
fear of driving, first at my office, then in her car.
Even if I have fear of driving a car because I went out of control that
day at the stadium, and my mother in law died just after it, and my
husband said that I was not trustable anymore, I deeply and completely
accept myself.
Some aspects of her fear were: fear of losing control, fear of hitting
the car, fear of hitting some one on the streets, fear of hurting her
children if she hits the car, fear of killing someone.
We made a test. We went inside her car and tapped in the car for any
aspect, like “heart jumping too fast”, “I am not able to drive anymore”,
etc With me at her side, in the car, she drove the car by herself. After
a couple of minutes she was very calm, driving the car. Since that day
she is driving the car with no problem, with her children. Sco Paulo (my
home) has very dangerous and wild traffic. Many normal people don’t
drive cars here. But she does it now.
Schizophrenia is caused sometimes by double messages received mainly
during childhood. Since her birth we could find many situations where
double messages were received. Clearing all these double messages along
Jacqueline’s life, since her birth until now, it was essential to allow
her to see everything in a different way and to create a more integrated
identity.
Jacqueline was the first child. Her father (Italian origin) wanted only
a male child. When Jacqueline was born her mother felt in some way not
comfortable with the fact that she couldn’t give her husband a boy. At
the beginning of her life Jacqueline felt no holding, no sensation of
being desired. Eleven months after her birth her mother gave birth to a
boy who received all the attention of the parents. Jacqueline was most
of the time with a single aunt that had a strong passion for a catholic
priest at that time.
We tapped for all events and sensations Jacqueline could remember that
were related to this belief of not being wanted, of not deserving love,
of being guilty for not being the boy her parents were waiting for. The
strategy Jacqueline found was trying to persuade her father that she was
good enough like a boy would be, and to do so she became too close to
him and that made her mother very jealous and ambivalent towards her.
Even though I felt the cold eyes of my cold and felt alone in my little
bed, feeling I didn’t deserve love for not being a boy,….
Even if I still feel guilty for not filling my parents expectations,
when they said to me how important it was for them to have a boy as
their first child…
Even if I felt an ambivalence in my mother’s way of looking at me
because she wanted a boy instead of me and she was jealous of my love
for my father…
Investigating it more, I discovered that when Jacqueline had her crisis,
after the birth of her daughter, she was feeling guilty and not
deserving to have two healthy children, a boy and a girl. This was
connected with a specific and important event that we addressed in each
detail.
When she was 18 years old she was dating her future husband and she got
pregnant. As she was very religious and she wanted to become a mother
she didn’t want to make an abortion. But her husband, Leo, said that he
would stay with her only if she made the abortion.
She postponed it as much as she could. She felt under a big pressure.
She didn’t want to lose Leo and didn’t want to lose her child. She
talked with her parents and they agreed with the abortion. So she did
it. It was a very traumatic event for her. She felt guilty for the
abortion, felt enraged with Leo, who didn’t go with her to the clinic,
and felt very uncomfortable with her father. After the abortion he was
very critical to her. Their parents were supportive on one side, but on
the other they were very severe and full of deception.
We tapped for each aspect of this event: the blood she saw, the place
where she laid down, the light of the room, the questions the doctor
asked her, the ambivalent sight of her mother, the feeling of
abandonment because Leo was not there, the guilt of killing a 4 months
old fetus.
We discovered that her anorexia was connected with the blood she saw at
the abortion.
Even if the medication had controlled the anorexia, it was a good
release to understand and clear this event and the compulsion that it
triggered. From that day she started feeding herself on a more balanced
way and started losing the extra weight she had at the beginning of the
treatment.
She cried a lot when we were tapping for this event. Anger at herself,
anger at Leo, anger at her parents that could have said to her: “You may
have the child and we will help you”, anger at her father, who called
Leo to drink a whisky to calm down, sensation of having committed a
murder, etc
After some sessions working on this issue we tapped for forgiveness,
reframing that she was not alone on what she had done, she was just a
girl in love with Leo and in some way she did the abortion to save her
relationship with him.
Sometimes Jacqueline called me during the evening, crying, hopeless,
feeling that something was wrong with her, feeling that her husband
didn’t love her, although he always said the opposite. She never had an
abreaction, we just tapped on the phone and she calmed down.
We could see at that moment how the mother in law event triggered the
abortion trauma, guilt and anger. When her husband made this second
imposition to her: “My mother will baptise my daughter”, she fell apart
and collapsed. Since that day she started hallucinating and having
inappropriate behaviors. One manifestation of this behavior was a
passion for a catholic priest (like her dear aunt in the past), who held
her in a compassioned way at the church.
In my point of view, the main issue for Jacqueline was not being held
since the beginning of her life, and this fact was repeated many times,
maybe because the writings on her walls were like these: “I don’t worth
to be loved, I don’t deserve to be hold, there is something wrong with
me, I should be different to be accepted, I am inappropriate, I have
some strange powers that can harm people, etc”
I was suspecting, from some facts Jacqueline told me about, that her
husband was also sending double messages to her. On one side he said he
loved her, on the other side he was indifferent, quiet, isolated,
absent.
I worked with the couple for three sessions and my impression was
confirmed. Leo was very polite but was always concerned with Jacqueline
in a very distant and professional way, asking me if she shouldn’t start
with the medication again.
During the year we worked together Jacqueline had some more depressive
moments. Sometimes she was very accelerated, talking and talking,
reading the Bible compulsively, going to the church and speaking in a
non-spontaneous and hearty way. I supported her not taking the
medication in all these moments.
Beyond EFT we did some yoga therapy, grounding and breathing exercises
to calm her and connected with the here and now, feeling her body
sensations and trusting them. Being touched by me in a very tender way
very important for her to feel grounded and accepted, bringing hope back
to her life. These procedures were enough to stop any process of losing
control or wish to die.
What was interesting is that when we cleared all aspects of the guilt of
the abortion, including the guilt of having healthy children and the
guilt of being alive (she used to talk of suicide as a self punishment),
on the same week her anxiety stopped and her voice became more calm and
she stopped smoking.
As she was more awake and present to her family she started trying to be
closer to her husband but he was always very distant, even repeating
mechanically that he loved her.
We tapped: “Even though I feel like I am crazy with the double messages
he sent to me yesterday, and maybe since I was 18 years old, I hold
myself, I deeply accept myself, and I choose not to believe that I am
crazy. Maybe there is something wrong with him..”
She asked him to go to therapy but he didn’t go.
After some time, as she was more centered and not feeling crazy, she
started realizing how strange was her husband’s behavior. It was not
difficult for her to find out that he was having an affair. Coldly, he
agreed and told her he didn’t love her anymore.
Now they are in a divorce process. As a catholic this is very
complicated to her. But she has the serenity to face this fate. She
brought her children to therapy, she went to a lawyer and asked for the
rights of her children. Leo came to me and confessed that since she was
18 he didn’t love her. He only married her because she made the abortion
and he felt committed with her and grateful to her. So maybe he has been
sending double messages for twenty years.
Jacqueline became very angry with him and with herself. We are now
tapping for her to accept reality as it showed up and finally be free of
these double messages that made her schizophrenic for 20 years. The good
part of it is the two wonderful children who are really special and are
doing the best they can to facilitate this difficult moment for
Jacqueline and Leo.
We have more work to do. The important thing is that Jacqueline is
working again in her profession. She could finally see that her husband
was away for many years, although physically present.
I think the most important piece of this therapy was the possibility she
opened for me to have a deep rapport with her, while tapping. She
started believing that she was a person, not a sickness, and as far as
this occurred, her own family started to legitimate her like a mother, a
professional and a complete human being. She felt self confidence to
re-start her professional life again. For 10 years her family and Leo’s
family considered Leo like the best husband, almost an angel, and
Jacqueline was the crazy one, the problem.
The whole system around her changed when she changed. The truth showed
up and she could see how she felt crazy also because her husband was
sending double messages since a long time, maybe during all their
marriage.
She is now living alone with her children. Leo left the house, and
Jacqueline is very grounded, determined, not even feeling a victim. She
said to me, “It’s time to turn the page: the page of my marriage, of my
labels, of my poor self esteem. I am ready to take care of me and my
children, and all I want is Leo to be happy, as far from me as
possible.”
Some months ago she gave me a long written testimony ( in Portuguese),
about her issues and her treatment, confirming some results I wrote
above. Her intention was to help other people who could profit from her
experience. One of these last days she completed the testimony verbally.
I quote this her words :
“For the first time in my life I feel peace in my heart. I have
difficulties with my son and with my husband but they don’t disturb my
peace. I want to live like a normal woman and like a helper, for this I
am praying and serving as a volunteer in a hospital.

For the first time people trust me again. I was elected for the
directory board of my club, and possibly I will be a candidate for a
public position in the near future. I am free from the obsession toward
the priest, I know it because I went to see him in the church and could
see him only like the priest he is. I don’t need smoking nor the voices
I used to listen to. I can remember the abortion without guilt. I
couldn’t have a child for myself at that moment. I feel free from the
double messages my husband used to send to me all the time, saying he
loved me but excluding me from his life and problems and pleasures. I
feel ready to take care of myself, and to take care of my children. I am
living each day, not anticipating the worse like I used to. The pressure
I felt in my heart is gone. I think I tried to protecte my husband by
accepting the double message without any protest, putting the guilt on
myself. I feel healthy as anyone in this life even if I need therapy for
some more time.”

I wrote in the computer while she was speaking. Her voice was soft.
During her worse days her voice was too acute and full of irony and
arrogance. This day her eyes were tender, her voice was tender, her
posture was elegant, her energy was kind and balanced.

Concluding I think that what was decisive was EFT plus the holding she
felt because I could accept, without any judgment, her passion and
fantasies toward the priest, her wish to die, and her fear of getting
crazy, and her deep pain, out of any category or classification that
could separate us.
Sonia Novinsky

An interview with me on “Madness Radio” can be found at
http://freedom-center.org/madness-radio-cognitive-therapy-ron-unger I talk about why I got interested in psychosis, mainly because of my own experiences as a young man that it seemed to me were understandable yet not likely to be understood by our current mental health system. Then I talk about cognitive therapy for psychosis and why I think it is a helpful and needed addition to the mental health field.

Download episode file directly:
http://freedom-center.org/audio/download/384/MadnessRadio-2008-07CognitiveTherapyRonUnger.mp3

Hugh Massengil videod part of a seminar I did, and posted it to YouTube. I’m discussing the relationship between cognitive therapy for psychosis and medications, and then talking a little about “what is psychosis” and the continuum between everyday errors and “psychosis.” If you want to check it out, it’s available at http://www.youtube.com/watch?v=TFjBnScM2Bk

Recently a couple people I know have put their recovery stories on the web. One is my friend Hugh Massengil, who got his story put on an official state website, even though his story suggests mental health treatment is almost completely off track, at least in its standard form. He is on a committee about increasing wellness among those with mental health diagnoses (very important given data that such people typically die 25 years earlier than average, often due to conditions that are aggravated by medication.) His story illustrates that wellness often is a result of successfully breaking away from traditional “treatment.” You can access his story at http://www.oregon.gov/DHS/mentalhealth/wellness/success.shtml

Another is the story of Oryx Cohen, who is one of the leaders at the Freedom Center http://www.freedom-center.org/ You can access Oryx’s story at http://www.familymentalhealthrecovery.org/2008TorontoRecoveryConf/TorontoRecovery08-OCohenCrashCourseWithPsychiatry.doc It’s a great read, going from his attempt to get his car to fly on the freeway (not very successful) to his attempt to get off psychiatric medications and have a good life (much more successful, though not without difficulty and one big slipup.)

Finally, I’d suggest checking out the video at http://bipolarblast.wordpress.com/2008/06/28/acute-psychosis-in-mania-and-schizophrenia/ It’s an overview of the perspective of psychosis as all about reorganizing the mind, as a positive process if the person gets supported in working through it in a good way. The video is well done and worth the time you will take watching it!

A consumer advisory council in our county has asked our local mental health managed care company to create a policy against having professionals give consumers disempowering misinformation, and asking prescibers to let consumers know that help is available in getting off medications as safely as possible, should the consumer request this. This has stirred up some debate, and the managed care company has attempted to “punt” by deciding to do a survey instead, to see how much of a problem there may be with the issues the consumer advisory council brought up. Below is my argument as to why “just doing a survey” at this point is not an adequate response. I”m seeking to publicize what we are doing in this county because I hope to see other people in other parts of the country also demand change from the mental health system, and I think if we share language and ideas about doing this, we may be able to find the best ways of leveraging some changes.

A survey, if done well, might be a helpful thing. However, the current situation appears somewhat analogous to one where a mental health system had no policy against clients being sexually harassed, then when some clients complained of being harassed, the system responded by planning a survey to see how common sexual harassment was (a survey that might take a year to complete) while still having no policy in place saying that sexual harassment was wrong.

The consumer council has raised some issues which are no less critical than an issue like sexual harassment.
- When consumers are misinformed about the nature of mental and emotional problems, in ways that reduce realistic hopes, the result is increased disability. When hope is removed, people don’t try, and not trying is disabling. (As some consumer organizations have put it, an untrue disempowering belief can “ruin a life as surely as any bullet.”)
- Long term outcome studies show that many consumers are able to do well once they get off psychiatric medications. But when consumers don’t know that help is available in getting off psychiatric medications, or when professionals refuse to offer such help, consumers may needlessly stay on medications, suffering dangerous “side” effects and possibly early death. (While it is possible that some other consumers may do better if they stay on medications, the mental health system does not have the right to trap a group of consumers on medications just because some members of that group may be better off if they stay on medications. This should be a personal choice.)

Matters involving mental health system imposed disability and possibly death are much too critical to wait for survey results before taking a stand.

A survey could be helpful in deciding what needs to be done to implement a policy or guideline, but really has no bearing on whether or not there should be a policy or guideline. Arguments against forming a policy or guidelines now have suggested either that no such policy is necessary, and/or that professionals would be insulted by such a policy. I don’t believe either of these arguments stand. We have policies against sexual harassment even when we believe our coworkers would not do such a thing: stating the obvious does no harm, and it formalizes our ethical standards. If it turns out that people are in opposition to something like a policy against sexual harassment, and if people oppose efforts to limit sexual behavior, that suggests the policy is even more important. It can’t be both ways: the policy can’t be both unnecessary, and something that will stir up real opposition.

I believe professionals have no more right to put someone on medication and then not offer to help them get off when requested, than does a physician have the right to install a shunt in someone and then refuse to remove it if the person changes his/her mind about its desirability. And it is obvious that professionals have no right to provide disempowering misinformation. We have not heard any good arguments against the policies or guidelines that have been proposed, and the need to avoid mental health system imposed disability and/or death is a very strong argument for the proposed changes. Please take action now to address this issue. Thank you.

OK, some input into what might be good survey questions:

Has any mental health professional ever told you that you were definitely going to be mentally ill for the rest of your life, or that your illness was definitely the result of a genetic predisposition or definitely the result of a chemical imbalance or brain disease? (This question could also be put in the form of a checklist, where the consumer could check each item he/she had been told by a professional. One other statements that might be included in such a checklist is “you will definitely relapse if you discontinue your medication.”)

Do you believe that the person who prescribes your psychiatric medication(s) would be willing to assist you in reducing or getting off those medications in the safest way possible, even if he or she thought your request to reduce or get off the medication was not a good idea?

Have you ever experienced a medication “side effect” about which you had not been warned? What was the medication, and what was the “side effect”.

Have you ever been told that medication was the only possible effective treatment for your diagnosis? If so, what was the diagnosis?

Below is a letter I wrote to Daniel Fisher, director of the National Empowerment Center (NEC). NEC has done a lot of good work, but I believe they are allowing a lot of their effectiveness to be compromised by allowing excessively watered down definitions of mental health “recovery” to be considered acceptable.

From the letter:

> One thing I am troubled by is defining “recovery” as possibly still requiring medications and/or therapy. I see this as radically diminishing expectations for recovery. For example, at our county mental health department, clinicians are talking about people being “recovered” when they no longer need case managers to survive in the community and when they are still on multiple kinds of heavy duty and quite dangerous medications, as long as they can go get those medications from their primary care doctors in the community. Of course, they still need their mental health diagnosis to qualify for their prescriptions, yet the system can wash its hands and say the people are “recovered.”

> I get your point that many people in the community use medications and/or therapy yet don’t see themselves as “mentally ill.” Of course, you and I don’t think anyone should see themselves as “mentally ill” so I certainly am not advocating that everyone taking medications see themselves as mentally ill! However, these people are distressed enough to see a need for mental health system support, and I think we should define full recovery as meaning no longer needing such support, period. (One still might need such support at some point in the future, but that is true for any human being.) This would be more consistent with a common sense definition of full recovery, as we might use that term for any other condition or problem.
>
> It would make sense to talk about degrees of recovery, and to talk about what part of recovery it makes sense to focus on first. Certainly the overall focus should be on quality of life and getting a meaningful life. If a person has a massive physical injury that impairs ability to walk, the most important thing is to become mobile again in the community in some form or another. But a medical system that told a person they were “fully recovered” after they were getting around town in a wheelchair, even while the possibility existed that the person would become able to walk again if given competent assistance, would rightfully be called deceitful and incompetent. I’m afraid that when we allow “full recovery” to be defined as attained while the person still is seen as requiring dangerous medications, we become accomplices in just such a deceit.
>
> In your “three circles” diagram, there is some implication of degrees of recovery. All the way over to the left is where people are seriously impaired, in the middle lesser impairment, on the right, not impaired. When people move from the left to the middle, they may still require some kind of treatment, but they have much less impairment. While that is a degree of recovery, it is not full recovery: people should be aware there are further degrees of recovery that are possible, or in your diagram, getting all the way over to the right.
>
> I know there is pressure from people who still rely on medications to have the definition of full recovery include them. And some people who are much more deeply dependent on the mental health system also want to see themselves as recovered - for example I have a brother who still takes large doses of Clozaril, lives in a foster home, and spends most of his days in a mental health “clubhouse” and likes to see himself as “recovered.” (The mental health professionals who deal with him are happy to collaborate in this definition of “recovery”, as it means they don’t have to do anything different or provide any additional kinds of assistance.) I don’t slight the progress my brother has made, but I also don’t want him to think he has recovered as far as he can go. (With my encouragement, he has been working with his prescriber to gradually lessen the dose of Clozaril, so he is still moving forward.) We can really honor the degrees of recovery people have made, while still noticing that further recovery is possible for them. We can honor people’s progress toward recovery, without dumbing down our definition of “full recovery” to mean less than recovering to the extent that one has a full life without further need for treatment.
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> I know it would be a major move for the National Empowerment Center to modify its definition of full recovery to mean being able to live a full life in the community with no ongoing mental health system support, but I think it is a move that is critically necessary. Dan, you have made just this kind of recovery, and I think, especially with the data out there about how medications are shortening the life span of so many people, we need to be offering hope that this full recovery is possible. That message will be clearly conveyed only when we make sure the words “full recovery” are taken to mean having a full life while no longer needing ongoing treatment. Thanks for your consideration of this critical topic!
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> Ron Unger LCSW

While “talking with voices in your head” is many people’s idea of insanity, a different perspective is that mental problems come more from either fighting too much with the voices or from giving in to them too easily.  From this other perspective, the ideal is to actually be curious about the voices and talk to them in ways that get to the bottom of what is going on.  You can read more about this kind of approach at

http://www.intervoiceonline.org/2006/12/6/talking-with-voices-by-dirk-corstens-and-rufus-may and at

http://www.en.transformationalpsychology.com/index.php?cmd=page&id=2676

In an earlier post, I mentioned my friend Chuck Areford wrote a column in our local paper severely criticizing our reliance on the long-term use of antipsychotics, which appears to be dramatically worsening death rates among those treated for “serious mental disorders.”  After a psychiatrist wrote a contrary column in which he tried to discredit Chuck as a well meaning but misinformed “nonmedical” person, I and a few others were motivated to write a response defending Chuck and his assertions.  As part of this effort, we posted a lot of background information backing up our assertions to the web.  You can read everything we got in the newspaper, and the references for it, at http://www.mindfreedom.org/rg

This is an outline I recently sketched out, see if it makes sense to you.  I do think we need a way to fit all these pieces together….. 

In a traumatic situation, life or death may depend on one thing, and focus on doing that thing right becomes intense. Trauma makes people “care too much” for regular life, where no one thing matters so much. Through exposure to trauma, people may learn to draw hard, absolute lines, or to actively shut out part of their psyche which seems too dangerous to acknowledge during the traumatic events (such as a part that acknowledges softness.)

Spirituality is often associated with healing and with wholeness, but it is also associated with the journey toward healing and wholeness. Mistakes on this journey can happen to anyone, but in particular for a person who has been traumatized, aspects of a positive breakthrough toward healing and wholeness can become overly valued, resulting in actually going further out of balance. A positive breakthrough experience can, like trauma on the other end, make certain things be valued too much for regular life, and can get a person to draw hard, absolute lines, or shut out parts of the psyche which appear contrary to the spiritual breakthrough.

Psychosis typically emerges out of a pattern of self-preoccupation with inner divisions, where a person cares too much about feelings, thoughts, and perceptions, which then take on a semblance of troubling “otherness” and of “reality” rather than just mental events. “Intrusions” from parts of the psyche which have been rejected, or which violate the “hard lines” one has drawn about acceptable mental content, are experienced as uncontrollable, at the same time they “must” be controlled. Since the source of them cannot be the self, bizarre explanations of their origins start to seem acceptable. (The resulting “hallucinations” and “delusions” are termed “positive symptoms.”) Typically, the harder a person tries to control such things, the more out of control they become. This can result in demoralization and an across the board giving up, usually seen as “negative symptoms.”

Neuroleptics can be described as “indifference in a pill” as inducing indifference appears to be their positive function. Since positive symptoms result from “caring too much” the neuroleptics are often effective in reducing them at least somewhat. They can also have some effect on negative symptoms, since a person no longer so demoralized by the vicious circles of “caring too much” may find it possible to start caring about things again, in a more balance way, with whatever capacity to care they have remaining after the drug effects. However, for many people there will be either no effect on the overall level of “negative symptoms” or they will actually get worse due to drug induced indifference.

A more targeted intervention would focus primarily on teaching a person to learn targeted indifference, teaching a person to shift focus away from controlling thoughts, feelings, and perceptions, and increased focus on and caring about acting based on one’s values. (This is the essence of Acceptance and Commitment Therapy, an approach found effective with psychosis. Other kinds of psychotherapy also include this focus in less explicit ways.) Neuroleptics would be seen as a backup intervention, useful only when other interventions could not be effective quickly enough, and then with a plan to phase them out as soon as the person themselves learns to avoid “caring too much” about mental events etc.

Today, the Register Guard newspaper in Eugene Oregon published the following editorial, which calls for radical change in the long term treatment of mental problems such as those labeled “schizophrenia”.  Chuck Areford, the mental health worker who wrote it, makes some good points.  You can access it at http://www.registerguard.com/csp/cms/sites/dt.cms.support.viewStory.cls?cid=78024&sid=5&fid=1