Holistic Recovery from Schizophrenia

Is getting a second opinion (or a third or a fourth) when handed a diagnosis of schizophrenia an idea whose time has come?

There are now many more doctors who consider themselves holistic practitioners, and some of them, I hope, are doctors who don’t agree with the label of schizophrenia. If they truly are holistic, they should distrust the rush to label someone and should be willing to disagree with that practice. There are registries of such doctors on the Internet under the labels “holistic” and “alternative.”

This will only work if you find yourself a doctor who is “schizopositive,” meaning a doctor who subscribes to the idea that schizophrenia is not a disease, it can be the beginning of a spiritual journey. Schizophrenia is still the line where even supposedly open-minded doctors often have minds that swing shut when the “S” word is mentioned. This plan may work best if you are not already on meds. The presence of meds usually scares physicians into agreeing with their peers.

People seek second opinions in every other area of medicine. Why not a second opinion in mental health?

I’m not at all a fan of Glenn Close’s campaign to reduce stigma for the “mentally ill.” I especially hated the tee shirts (see above) that she and her sister wore for the Bring Change 2 Mind campaign.  Putting that aside, the Ottawa Citizen has an interview today with Glenn and her sister Jessie Close, which is cringeworthy.

Perhaps you can spot what I’m talking about.  Hint: I’m really only referring to one sentence out of the whole interview. The basis of my objection concerns the study that Sheila Mehta conducted in 1997 at Auburn University. To quote from the New York Times article on The Americanization of Mental Illness:

The results of the current study suggest that we may actually treat people more harshly when their problem is described in disease terms,” Mehta wrote. “We say we are being kind, but our actions suggest otherwise.”
 
Can anyone spot the harsh treatment in the Ottawa Citizen?

No prizes will be awarded for the right answer.

I have cut and pasted below an introduction from the results of a study published April 2012 in Acta Neuropsychiatrica. I’m posting this as sort of a placeholder on my blog, so that I can refer back to it for a good description of what yoga does to improve cognition. (Thanks to MIA for alerting me to this study.)

Adjunctive cognitive remediation for schizophrenia using yoga: an open, non-randomised trial
Bhatia, T., Agarwal, A., Shah, G., Wood, J., Richard, J., Gur, R. E., Gur, R. C., Nimgaonkar, V. L., Mazumdar, S. and Deshpande, S. N. (2012), Adjunctive cognitive remediation for schizophrenia using yoga: an open, non-randomised trial. Acta Neuropsychiatrica, 24: 91–100. doi: 10.1111/j.1601-5215.2011.00587.x

Introduction
Cognitive impairment represents a prominent feature of several psychiatric illnesses, including schizophrenia (SZ), major depressive disorder (MDD) and bipolar disorder (1–3). Deficits in long-term memory, working verbal memory, executive functioning and vigilance have been consistently associated with poor functional outcome in persons with SZ (4–8). As pharmacological treatment is not routinely efficacious (9), there is ongoing interest in adjunctive non-pharmacological interventions for ameliorating cognitive deficits (10–12).

In comparison with conventional therapies, yoga represents a different approach. It is a set of mental and physical practices that have been evolving in India for several millennia. Yoga is viewed by many practitioners as a systematic process designed to purify the body and the mind from toxins accumulated due to improper lifestyle choices and negative thinking patterns. Yoga includes components centred on meditation, breathing and activity or postures designed to balance the body’s ‘energy centres’ (13). Intensive yoga exercises may improve the cognitive function among psychiatrically ill and healthy adults (14–20). There are several mechanisms by which the practice of yoga may improve the cognitive function. Yoga emphasises body awareness and involves focusing one’s attention on breathing or specific muscles or parts of body, so yoga may improve more general as well as focused attention. Yoga practice also influences perception by increasing perceptual sensitivity, by selectively ‘shutting out’ undesirable stimuli and by changing distorted perception. Practising yoga improved auditory and visual perception, by increasing sensitivity to various characteristics of the stimuli (e.g. intensity and frequency) (21). A recent study (20) observed that memory functions of male volunteers improved after yoga. In an open trial of yoga (n = 21) versus physical therapy (n = 20) among patients with SZ in India, greater improvement in psychopathology BP1 was reported with yoga therapy (YT) compared with physical therapy. Improvement in clinical severity was noted following 3 weeks of YT, but cognitive function was not evaluated (22). In another study (23), yoga was found to improve facial emotion recognition deficits. The precise physiological basis for the beneficial effects of yoga is unknown and continues to be investigated. Selvamurthy et al. (24) have found that yoga helps achieve a stable autonomic balance. Others have reported that the practice of yoga reduces autonomic arousal (25,26). Because increased physical activity reduces autonomic reactivity to mental stressors (27), it is possible that some of the beneficial effects of yoga are related to stabilisation/normalisation of autonomic function.

The studies reviewed above were conducted by highly trained therapists or clinicians in structured academic centres. Their utility in routine clinical practice is uncertain. Moreover, YT has typically not been used as a cognitive remediation strategy for individuals with impaired cognition. In the present pilot study, we evaluated the impact of YT among individuals with severe psychiatric illnesses. Cognitive domains known to be impaired in these disorders were assessed.

A few weeks ago Chris stopped by a display in a hotel lobby and purchased a copy of the following DVD entitled “Un Documentaire: Manuel Diagnostique et Statistique. Le coup de poker le plus funeste de la psychiatrie.” (The Diagnostic and Statistical Manual: Psychiatry’s biggest gamble).

You may have seen clips of this DVD posted on YouTube. As it happens, the Citizen’s Commission on Human Rights (CCHR) owns the video rights. The English title of the DVD is The Diagnostic and Statistical Manual: Psychiatry’s Deadliest Scam. The CCHR was founded in 1969 by the Church of Scientology and Dr. Thomas Szasz. The extent of the financial relationship now between Scientology and CCHR is unclear from the CCHR website.

I don’t really care about the relationship between these two organizations. Whatever CCHR is, it one one of only about two organizations critical of psychiatry and pharma (the other being the Church of Scientology) that has deep enough pockets to get the message out to the greatest number of people. Disclaimer: I am not a member of, nor have I ever been a member of, or contributor to, the Church of Scientology or CCHR, nor do I intend to be.

Here’s the take home message from the DVD, as you would expect

• mental illness has no diagnostic test
• psychiatry can’t agree on what defines mental illness
• DSM needs a diagnosis in order to bill insurance

There are some clever illustrations of how there is little agreement on what mental illness is. In one scene, a fictitious group of psychiatrists are the celebrity guests in an updated version of the 1950s television game show, “What’s My Line?”  The psychiatrists try to guess what diagnosis the contestants were previously given, and they all get it wrong, all the time.  In another, patients brought hidden cameras into their therapy sessions and tried to get the psychiatrists to explain what their diagnosis really meant. The wobbly and convoluted answers were hilarious.

There is an expensive French language voice-over that adds a bit of unnecessary, but comic Gallic emphasis  to what is already explained. “Non, c’est ridicule!” says a male voice in response to something the female French voice is explaining. He also responds with “C’est tellement incroyable!” (That’s truly unbelievable!)

A problem with the DVD is that it hardly mentions schizophrenia. I ‘m pretty sure I understand why. It’s because the public still believes that there is this horrible mental illness called schizophrenia that is a “true” mental illness. Schizophrenia still persists in being the one diagnosis where psychiatry and pharma hasn’t inflated the numbers by widening the catchment area, as it has done with bipolar, ADD, autism, and depression. There has been no Joe Biederman popularizing the schizophrenic child – the bipolar child is as close as psychiatry has gone so far.  Let’s assume CCHR, in the DVD at least, doesn’t mention that schizophrenia is manageable without drugs and not a real illness to begin with, because if it did, the public wouldn’t buy the rest of what it is saying. CCHR would prefer to work with the diagnoses that are becoming heavily criticized as being over-diagnosed. A rising tide lifts all boats, so any challenging of the the current treatment paradigm for depression and bipolar, with carry schizophrenia with it. There is a slight problem with my logic of a happy ending for all, and that is that psychiatry won’t give up schizophrenia without a fight.

Dear Rossa and Ian,

Just to let you know that Chris and I have had four lessons in May and will then have 3 in June. I will then be away for a few weeks and back in mid-July. I have been very worried about him for the past few weeks. He seems to be drifting again, and in lessons I’m not able to get through to him and to communicate in the way we were able at the start of the year.

To me it feels very like the last time his condition deteriorated, and I’m concerned that he might not be taking his medication or that the balance isn’t right.

I’m sure you are aware of this as well, but I wanted to pass on my concerns. Please don’t hesitate to ring.

Yours sincerely,

Chris’s voice teacher
 
……
This well-meaning message that I received yesterday is a prime example of a good reason not to divulge your relative’s diagnosis to other people almost EVER, and a reminder of how the public has internalized pharma’s message. I think I know what’s going on, and I’m doubtful that it’s relapse (although, once again, it has all the hallmarks), but I certainly can see where his teacher is coming from. I phoned her immediately and explained the way I see it. Chris is tired of voice lessons, doesn’t feel like he’s progressing, and has found musical theatre and a small job to be a welcome change of pace. But Chris doesn’t yet have a firm foundation of self, and allows his conflicted self to act like he’s splitting apart. “Normal” people expect a person to show a consistent face across different spheres of activity. Chris hasn’t mastered this technique.

In March, he took a month off from voice lessons and I encouraged him not to go back for a while because, from what he was telling me, he needed a break Apparently, he resumed his lessons in May, probably out of some misguided sense of selflessness and fear of disappointing his teacher. CHRIS – THIS DOESN’T WORK! You are either there and fully participating or you are physcially not there. But take a stand! Don’t be there but be mentally vacant! Stop being all over the map!

(N.B. Chris’s psychiatrist tells me she’s pleased with his recent progress. Go figure.)

Today’s New York Times Opiniator was written by a man who suffered extensive maternal deprivation at a very early age. Read the entire piece here.

May 31, 2012, 12:00 pm

Fortunate Son

By EMILLIO MESA

But after I was attacked, when she fought for me in the emergency room and then nursed me back to health in her home, that finally changed. Psychologists typically believed that the most important bond between a mother and child occurred during the first three years of life. If a child suffered maternal deprivation, he would be emotionally damaged for life. I don’t think that’s true. Getting mugged was a blessing in disguise. It let my mom and me make up for the time we’d lost. It took 14 months of living with her, but I’d finally come home.

Outdoor and indoor voice is a phrase I learned from Chris’s nursery school teacher many, many moons ago. As I entered the school I witnessed a little tyke running around screaming his cheery morning hello at about a thousand decibels. “That’s an outdoor voice, Kyle,” said the ever patient Karen. “We use our nice, soft indoor voices when we are inside the school.”

Well, I learned this week-end that Chris has an outdoor voice and an indoor voice. His indoor voice around our apartment is sometimes hard to hear, and his indoor persona is kind of glum and rarely smiles. Not so, the outdoor Chris. As an official greeter at church, the outdoor Chris warmly greeted people in a hail and hearty way, smiling broadly while firmly grasping and pumping hands. He was the man.

The indoor Chris, I deduce, is a product of the monotony of living at home with his parents and having no regular social interactions through job or school. Judging from the performance I saw this week-end, this indoor personal will eventually change as Chris’s life gathers momentum.

Last week I read a fantastic article on Lisbeth Riis Cooper’s blog at the Mad in America site. Her guest post is written by a mother who figured out how to help her son, and she mirrors my own thoughts about how to help an adult child recover.

Four years ago my husband accepted a job managing an American manufacturing facility in Shanghai. For one fun, adventurous year, I lived with my husband. For the past three years, my husband and I have lived separately because our youngest adult child has needed a family touchstone in the States.

I am writing this entry while sitting in my husband’s flat in Shanghai. This is my first vacation away from my son in nearly three years. My husband and I have been able to visit Singapore and the ancient and awe-inspiring temples of Cambodia. I was a little nervous about taking this trip, but all is perfectly calm on the home front.

I feel so blessed to share our family’s healing and recovery. Understand we’re still very much in recovery, but healing is coming as swiftly as the onset of our son’s distress.

The author writes that healing can start happening rapidly once a parent or relative grasps what it takes on their part to help recovery. Read the rest of her post here. Don’t miss it. Skyblue, a frequent commenter on my blog, has added some excellent commentary to her post.