Recently, results from several studies have suggested that these medications may be less effective for the outcomes that matter most to people with serious mental illness: a full return to well-being and a productive place in society. Read the full post here.
It was only a short while ago that the National Institute of Mental Health Director was singing a different tune, that schizophrenia and other mental health disorders were developmental brain disorders that needed better drugs to target underlying causes. He was describing the problem from a purely scientific perspective:
We must address mental illnesses, from autism to schizophrenia, as developmental brain disorders with genetic and environmental factors leading to altered circuits and altered behavior. Today’s state-of-the-art biology, neuroscience, imaging, and genomics are yielding new approaches to understanding mental illnesses, supplementing our psychological explanations. Understanding the causes and nature of malfunctioning brain circuits in mental disorders may make earlier diagnosis possible. Interventions could then be tailored to address the underlying causes directly and quickly, changing the trajectory of these illnesses, as we have done in ischemic heart disease and some forms of cancer. For serious mental illness, this is a new vision for prevention, based on understanding individual risk and developing innovative treatments to preempt disability.
So, his latest post shows an important shift in thinking in its questioning long term use of the drugs and acknowledging the neglected importance of what is needed to help people to achieve better outcomes – family engagement and education, employment, and therapy.
Neither first nor second generation antipsychotic medications do much to help with the so-called negative symptoms (lack of feeling, lack of motivation) or the problems with attention and judgment that may be major barriers to leading a productive, healthy life. Family education, supported employment, and cognitive behavioral therapy have all demonstrated efficacy in reducing the likelihood of relapse events, increasing the ability to function in daily life, and improving problem-solving and interpersonal skills.
He ends on a humble note.
These new data on the long-term outcomes for people with “schizophrenia” remind us that 100 years after defining this disorder and 50 years after “breakthrough” medications, we still have much to learn.
My next post will highlight the” Recovering our families” on-line course that I find, from my own experience, to be the best and the most innovative guidance one can find for helping family members transform and heal from the emotional distress associated with trauma and challenges surrounding mental health diagnoses.
Last Friday I spent a lovely day in Vancouver with my old friend from university who I haven’t seen for many years. We talked and talked and talked. Ann, at least as far back as I can remember, has been interested in social justice issues, art and creativity, and obviously, found the right home for herself when she moved to Vancouver in the 1970s. As we sat in a coffee bar, she talked about ayuahuasca healing (there are practitioners in Vancouver) and said that renowned Vancouver psychiatrist and addiction expert Dr. Gabor Mate, is very interested in exploring its potential in healing a wide variety of human suffering that manifests as illness. So much so, apparently, that he is doing a lot of his work in Mexico, having found that his belief is increasingly in conflict with the mainstream. My curiosity was immediately piqued. I haven’t had time to explore this topic further, but I found a fascinating interview
with Mate on Ayahuasca. There also a Youtube question and answer session
Please note that I am not advocating that we throw caution to the wind and unquestioningly embark on this potentially healing but also potentially dangerous path. Anyone on antipsychotics, anti-depressants, or anti-anxiety medication is at particular risk. Cold turkeying off these medications in order to avoid adverse side effects of the tea should not be done. For most things in life, especially things we ingest, we need to do our homework.
excerpt from interview with Gabor Mate:
What if we actually got that human beings are bio-psycho-social creatures by nature, and actually bio-psycho-spiritual creatures by nature—which is to say that our biology is inseparable from our psychological emotional and spiritual existence—and therefore what manifests in the body is not some isolated and unique event or misfortune, but a manifestation of what my life has been in interaction with my psychological and social and spiritual environment?
Well, if we had that kind of understanding then we would approach illness and health in a completely different fashion.
What if, furthermore, we understood something in the West which has been the underlying core insight of Eastern spiritual pathways and aboriginal shamanic pathways around the world, which is that human beings are not their personalities, we’re not our thoughts, we’re not our emotions, we are not our dysfunctional or functional dynamics, but that at the core there is a true self that is somehow connected to—in fact not connected to but part of—nature and creation.
Gabor Mate is a Canadian physician, speaker and author of four books. He teaches and leads seminars internationally. He has worked in family practice and palliative care and for 12 years worked on Vancouver’s downtown eastside, notorious as North America’s most concentrated area of drug use. For more information visitDrGaborMate.com.
I was not aware of this Hawaiian inspired message until today. The ho’oponopono message has been translated in many languages and is practiced world-wide.
How Dr. Hew Len healed a ward of mentally ill criminals with Ho’oponopono
Ho’oponopono, the Hawaiian system that heals oneself … and the world, too
More than thirty years ago, in Hawaii, at the Hawaii State Hospital, there was a special ward, a clinic for the mentally ill criminals. People who had committed extremely serious crimes were assignated there either because they had a very deep mental disorder or because they needed to be checked to see if they were sane enough to stand trial. They had committed murder, rape, kidnapping or other such crimes. According to a nurse that worked there in those years, the place was so bleak that not even the paint could stick to the walls, everything was decaying, terrifying, repulsive. No day would pass without a patient-inmate attacking another inmate or a member of the staff.
Read how Dr. Len accomplished this amazing transformation.
So, here I am in the neurology unit of our local teaching hospital, where I have been since Saturday. No flowers or cards, please! I’ll be out in a few days. There is no need for surgery. I’ll be on medication. For life. I’m fine with this because the tests have determined where the problem lies and what remedial action will prevent the problem from happening again in future.
There are no psychiatrists attached to the neurology unit. Imagine that! If mental illnesses are really brain disorders, why aren’t psychiatric patients treated by the hospital’s neurologists? Well, we all know that psychiatric patients never see a neurologist, and most don’t undergo medical testing to determine the cause of their symptoms.
I wandered down to another floor of the hospital and found the hospital’s glossy magazine on a display rack. This month it features its department of psychiatry and an interview with the head doctor of the day program that Chris attended for two years. The program, as it did when Chris was there, emphasizes early intervention, which seems to be the premise for the interview. The program still focuses on the importance of structure in the patient’s day, the value of integration back into the community, the art and music therapy, etc. Interestingly, the doctor did not mention medications. Perhaps he wanted to avoid an overt conflict of interest since the magazine had a number of pharmaceutical sponsors’ logos on the back page. Medications are a mainstay of the program. The program staff taught my son that medications, for him, are for life. Early intervention, a good idea, depending on how it is done, I strongly believe is also a way for the program to extend pharma’s revenue stream.
Unsurprisingly, a critical omission in the interview was discussion of importance of the role of the family. It was all about how doctors and therapists help the patient recover and resume his or her role in the community. The critical influence of the family was totally ignored. The family, I know from my experience, being merely passive bystanders who attend the program for 90 minutes every two weeks to listen to the “experts” talk about the program and the medications. It was four years after leaving the program that Chris was finally able to begin integrating into the community. My husband and I had to educate ourselves during that period on how to bring out Chris’s potential; Chris left the program still very much in his shell, and unable to undertake further work or training. He was not its star pupil. The day program did not clue us in how we could help Chris better at home, the environment he was born into and where he spends most of his time.
How much trust should we place in mental health experts to bring out relatives to a state of wellness? How much work should we be willing to do ourselves? Could efforts be better directed by working with self-help and recovery programs that teach families and friends how to help someone in distress from a non-disease perspective?