Holistic Recovery from Schizophrenia

Going where nobody else is headed has its drawbacks

Yesterday evening, Ian and I had our quarterly meeting with Dr. Stern, Chris’s psychiatrist. We hadn’t had a chance to meet since Chris was released from the hospital in May. We spoke about his overall good progress, how Ian and I were pleased to have him home with us and how we are content to let things unfold at the pace Chris was setting. Then Dr. Stern dropped the bombshell. She leaned forward, and in a clearly worried voice, said “what’s this about Chris having an out-of-body experience? Chris’s occupational therapist told me about this and she also told me about a lucid dream.”

It has been my policy all along not to tell Chris’s psychiatrists about what outwardly kooky looking things he is undertaking in the world of holistic healing. I have learned, as this experience shows, that it only worries them and they want to put a stop to it.

Most, if not all, psychiatrists would not want their schizophrenia patients having an OBE, because to them, it is exactly what you don’t want them to have. Dr. Stern said she wanted Chris “in” his body and grounded, not out-of-his body and floating in space looking down at himself. It is exactly the sensible sort of thing a cautious psychiatrist should say, except that what has changed is that energy medicine has opened up a whole other realm of healing possibilities. I tried to handle this as best I could, knowing that Chris and I were headed to the sound shaman the next day for another go at it.

I tried to reassure Dr. Stern that actually, the meditative state that he achieved was a grounding state, not an excitatory state. I told her that an OBE for someone with a history of psychosis was actually a good thing, but it was counter-intuitive, because most people would think an out-of-body experience can lead to the person becoming destabilized and this was not in fact what was happening. Please note that this way of thinking is not only not widely shared, but not widely known. There’s me, and there’s the sound shaman, and beyond the two of us, who else knows about this counter-intuitive way of looking at schizophrenia? There must be a secret society somewhere, or maybe this is well-known in Eastern mysticism, but with Chris’s Western diagnosis of schizophrenia I was treading on very thin ice with Dr. Stern. Come to think of it, Western medical diagnoses are not included in Eastern mysticism texts.

Do you do yoga, Dr. Stern? I enquired brightly. “Keep in mind that yoga is used in many programs for schizophrenia patients.” Dr. Stern was more inclined to feel that yoga was more of a physical workout than a mental one, and that deep meditation is not something recommended for someone like Chris. Dr. Stern is a good psychiatrist and an excellent Family Constellation psychiatrist, but she is not a yoga person, nor all that familiar with energy medicine. Dr. Stern doesn’t “do” energy medicine, and this is where it gets tricky with a psychiatrist. What I am doing with Chris is clearly out of most traditional psychiatrists’ comfort zones. I only later thought about Chris’s former holistic psychiatrist, who taught us about energy medicine and got Chris to practice visualizations. Where is the line drawn between lucid dreaming and say, visualizing you are a shining ball of light in space with giant meteorites bouncing off you?

The out-of-body experience and the lucid dreaming were all news to Ian, who thankfully didn’t jump in and punch the air with “let’s put a stop to all this nonsense now!” I told Dr. Stern that lucid dreaming was something Chris does and it didn’t start recently. I was praying hard that the session would soon be over. I needed more information from the shaman to bolster my weak case in Dr. Stern’s eyes. “I understand your concerns, Dr. Stern, and if I were you I would feel the same way. I will look into this some more and share further information with you.” Inside me, I am really just hoping that all this will not be raised again.

When it was time to leave, I excused myself to make a phone call from Dr. Stern’s inner office. As I entered, I noticed a large jagged quartz crystal on top of the table near the door. Now, what was that there for if she is not a proponent of energy medicine and the healing power of gemstones and vibrations? Is this just a decoration that psychiatrists put in their offices now to show solidarity with the holistic crowd in the same way all companies claim they are eco-friendly? Or, is it just a nice decoration with no other meaning? All of this I ponder.

How do you feel about this?

According to yesterday’s New York Times,* Aspergers syndrome is proposed to be struck from the next edition of the DSM, due out in 2012, in favor of the term “autism spectrum disorder.” I suggest that the DSM editorial board hit the delete button and do the same thing for schizophrenia, in favor of a more nuanced perspective, as appears to be the case with the jettisoning of the Aspergers’ label. The DSM proposed change recognizes that there are different levels of functioning within autism, and that there are often other accompanying health problems that need to be treated.

This is a step forward, at least. Why not extend the same courtesy to schizophrenia, which seems to be on the bipolar, depression, mania, OCD spectrum? Although I am most definitely not in favor of saddling anyone with a psychiatric diagnosis, taking on the likes of the American Psychiatric Association, publisher of the DSM, will have to be chipped away at over time. What exactly is the difference between Aspergers, which can be terribly taxing on the individual and the family, especially when the child is young, and schizophrenia, which often allows a trouble free childhood and academic success, often brilliance, but provokes a major crisis in the adolescent years and early twenties? Well, for one, Aspergers is a recent addition to the DSM (1994) and it is easy to give up something you haven’t become entrenched in. (I had actually never even heard of it until my son was diagnosed with schizophrenia.) Schizophrenia, in contrast, functions as both the the holy grail and cash cow of the mental health industry. Wait, no, I take that back about the holy grail part. The APA and pharmacology aren’t interested in curing schizophrenia. It’s too much of a cash cow. They just pretend they are interested.

“Asperger’s means a lot of different things to different people,” Dr. Catherine Lord is quoted as saying. “It’s confusing and not terribly useful.” (I say the same goes for schizophrenia.)

The New York Times article quotes the efforts of the Aspergers’ lobby to widen the understanding of Aspergers to include health issues that accompany this diagnosis. The autism lobby has done an excellent job of bringing the message to the psychiatric community that there are underlying health issues that can be addressed, very often successfully. Many people say exactly the same thing about schizophrenia. I won’t quibble about deleting one more meaningless diagnosis in the DSM, but while they are at it, they should treat schizophrenia in the same way.

Unfortunately, the diagnosis of schizophrenia is too big a diagnosis for the APA to relinquish. That they will hit the delete button for schizophrenia is unlikely, given that the latest APA news to be posted on its site is “Brain MRI May Pinpoint High Psychosis Risk.” Nonetheless, let’s keep in mind that the gay rights lobby forced it to delete homosexuality from the DSM in the early 1970s. It can be done.

It can be done, were it not for the fact that the public seems to have bought the APA’s and NAMI’s negative view of schizophrenia. There is no powerful lobby for schizophrenia taking the same position that the autism lobby has succeeded in doing. This means that the battle to normalize schizophrenia on the spectrum of human conditions and delete it from the 2012 DSM is lost before it has begun due to a lack of organized opposition to the prevailing viewpoint.

“All interested parties will have an opportunity to weigh in on the proposed changes. The American Psychiatric Association is expected to post the working group’s final proposal on autism diagnostic criteria on the diagnostic manual’s Web site in January and invite comment from the public.”

Mark your calendar for January 2010 and let them know that Aspergers isn’t the only meaningless label. Here’s the APA’s website address. http://www.psych.org/

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http://www.nytimes.com/2009/11/03/health/03asperger.html?hpw

Chris’s second visit to the sound shaman

“I was in a good mood that day and was happy to head out into the country. I was well rested and alert, but was slightly irritable, perhaps at the memory of our first trip out where we were delayed and nearly had to turn back. Having already undergone the therapy once before, I knew how it mattered that I be attentive but relaxed, to keep my body open, because this time around I had the tendency to become somewhat passive, which spoils the therapy as it works on the mind especially, and I think partly through the mind then the body.

The therapy lasted less than one hour, but I felt many changes. I tried to dissociate better my feelings about a color, red or green say, and allow the color to dominate my perception with as little judgment as possible. There were flies in the room, which at first I found irritating but later I found this a silly reaction to have, after I became more present in the room. The “sound/colors” themselves aren’t like anything else you’re likely to hear, because they’re pure sounds, they’re as natural as breathing. Once you hear them they take up the room. Listening to a color is much different from listening to Mozart; it’s the difference that having an author makes to the sound, as you follow music in Mozart but hearing the color red for example is like a mosquito bite and not “interesting” per se.

However, I began to fall into a sort of trance, which wasn’t quite sleep, or it was rather an aware sort of sleep that instead of relaxing into my body and dreaming I left my body and begun to experience the room while my body “powered down.” First I began to say to myself, this is just a sound, a basic unrefined sound but just a noise really and then my head refused to make any noise, any comment or utter any “thoughts” as I was released into the space or “aura” around me. I could see my body lying down from four feet away in any direction, and it was the best impression or image of myself that I’ve found in a long time, better than any mirror image can give. Those flies which I found irritating I realized were in harmony with my feelings of irritability which I had carried in with me, and I could fly around the room as if the flies were part of me. The only pain I felt was at the head level, when I could see that a big dark block at my head masked or obstructed this free flow of energy I experienced. To stand up in that state would have been impossible. Just as I was about to fall asleep the music stopped and it was time to go.

The sound technician explained that adepts at yoga, monks or shaman masters train for years to enter such a state, and that I was very lucky to enjoy it so early. That night I slept soundly and experienced a lucid dream in the morning, but this one was much clearer and longer than any I had previously experienced. The dream was pure fantasy or very close; actually it took the form of an episode of The Simpsons! I had been thinking about skiing the night before, and in this dream the Simpson family went skiing high up in the mountains, and Bart and Lisa got involved in the dangers and thrills of racing and jumping. When I felt scared at the outcome, and the dangers posed to the characters was too great, the story changed, based on my emotions. I suddenly had the power to create a dream and change it based on my emotions. The next day as I was reading on my bed in the afternoon I saw a woman wearing white enter the room and tap me on the shoulder, I could feel the touch but the woman I didn’t know, it was still a dream. My head was telling me to get off the bed and do something else, and here was this woman who appeared also compelling me to get up.

However, I don’t believe that this “awareness” the therapy opens within me should be relied on as a permanent change. There are many habits built into me that must be recognized first if I want to avoid becoming a “ghost” that just reacts to every little breeze or stimulus. From a personal point of view, emotion is more important or as important for a person, but mind can increase awareness and therefore enrich the emotional experience. The therapy has made me more aware of the physical manifestations of mental blocks: My head was quite unwilling to leave this form and it stayed there, while my body which has been through countless ordeals was more flexible. It’s interesting to know just how much my body has priority over my head, the sounds reaching all my cells without interference from my mind. The next step would be to train my mind to listen to my body first before the noise of the outside world, and to calm the tensions existing in the body which cause the mind to have fear and to shut down.”

Phonons

“Phonons are the tiniest particles of sound. Phonons are to sound as photons are to light. It takes billions of phonons to make up a sound. Phonons oscillate, echo, reverberate etc. at the sub atomic level in the quantum soup.” -Pauline Oliveros*

It takes Pauline Oliveros, a musician, to explain a complex subject (phonons) in a simple, straightforward manner. I am not allowing my complete ignorance of physics and phonons to deter me from feeling that the sub-atomic level of sound is where schizophrenia can be healed. Browsing the web has turned up an article from the European Society for Pigment Cell Research, of all places, linking schizophrenia to phonon activity. http://www.espcr.org/espcr/b_iss/Dis-8a.htm

According to our shaman of sound, phonons are a relatively recent discovery and the Big Bang actually lasted, best scientific guess at the moment, 300,000 years. That’s pretty darn close to a hundred thousand times pi. (Martin A. Armstrong take note!)

I don’t plan to wait for the phonon-related blockbuster drug that might emerge in twenty years or so. (A new drug “Fanapt” that works on a “more relevant set of neurotransmitter receptors” as the company describes it, will be on the market in 2010.**) Chris and I are getting to work now in the relaxed offices of shamanic healers and therapists who understand that to be of “sound mind and body” means paying attention to the vibrations of sound and emotions.

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*Pauline Oliveros is a musician who has developed a theory called “sonic” awareness, which is a focused musical and environmental consciousness.
**http://www.washingtonpost.com/wp-dyn/content/article/2009/11/01/AR2009110101846.html?hpid=moreheadlines
***See also http://www.answers.com/topic/phonon

Emotional Freedom Technique

The Emotional Freedom Technique newsletter always provides some interesting insights into how we can use our body’s electrical system to heal our minds and bodies. In today’s newsletter an EFT practitioner/therapist has written about his recent experience with a 16 year old client who was on the verge of being committed to the psych ward after breaking up with his girlfriend. The full story can be found at: http://www.emofree.com/Articles2/relationship-breakukp-desanto.htm

I have reprinted Steve DeSanto’s observations about the outcome of the treatment below. First I would like to say that I wish I had known that there were other possible ways of dealing with the crisis when Chris was beginning to come unravelled while in his teens. I am not saying that Chris wouldn’t have ended up in the hospital anyway, but access to another way might have saved Chris from becoming a psychiatric patient and the agony of all that goes with it.

Steve DeSanto: “I’d like to point out some important things relating to the above session. First, we have a single mom already stressed out because she’s single and raising 3 kids. Michelle’s a spunky woman and certainly no shrinking violet. But her son’s emotional condition caused her to seriously consider checking him in to the psych ward. If Nadine had not answered the phone, she probably would have done just that.

Unfortunately, far too many parents do. They trust the mental health system out of ignorance. They wrongly assume psychiatrists have the inside scoop on matters of the mind and can somehow work magic. (But they can’t … unless they know EFT–grin).”

NAMI again

There is something about NAMI’s patronizing view of the mentally ill that really irks me. For a bit of fun, I took a Q and A from its Ask the Psychiatric Pharmacist section and thought, what if this were an obese person they are talking about? Everybody knows that you can’t make another person lose weight. They have to do it themselves, for their own personal reasons. It’s the patronizing attitude that bothers me more than the good intentions. This approach may work with your friends, but it still presumptously assumes that the patient is incapable of making his own decisions for his own reasons. (NAMI does assume the person is incapable of making their own decisions because NAMI believes in agnosognosia, the inabilty to recognize that you are mentally ill!)

So, below is Q and A #14, to which I have copied almost verbatim, but substituted fat/obese for mental illness, diet for medications, FATSO for NAMI. I left in the special case they plead for bipolar and schizophrenia.

As yourself as you are reading this, if this approach will really work if you try it on your friend. I’d say, you’ve just lost a friend.

Original question: Someone I really care about has mental illness but repeatedly stops taking his medication and his symptoms come back. Sometimes my friend has to be hospitalized. How can I help him? (My thought: Why is this question being directed to a pharmacist in the first place?)

Rephrased question:
Someone I really care about is immensely obese but repeatedly stops dieting and he gains it all back. How can I help him?

PHARMACIST’S response: One answer is to let the fat person know that he can always count on your love and friendship, but his best chances of losing weight will occur when he accepts that proper diet is crucial to his recovery. Sometimes one can help persons struggling with fat (especially those with bipolar or schizophrenia) decide for themselves which is worse – the short periods of time without the donut and the side effects, followed by the inevitable re-emergence of the fat (often piling on more fat than before)….. or, the steadier, prolonged times of skinny living (or at least more manageable fat) while staying with the diet and coping with the hunger. In a recent study, a researcher and colleagues have shown that higher rates of non-compliance with diets were associated with relapse between 6 and 18 months following a previous binge.

Simply relapsing can help some of those suffering with obesity to be more compliant with their diet. To them, relapsing means “hitting rock bottom”, and they will be more motivated to change whatever they can to ensure a better recovery. Others may not be prepared, and will be more difficult to reach. For these people, consistent support and patience are important to maintain.

Another valuable action you can take is to tell your friend about FATSO. There may be a FATSO group in the community in which he lives. You could take him to a FATSO meeting. Show him how to get on the FATSO website and navigate to the different sections available (“Inform Yourself,” “Find Support,” and “Take Action”). Being an informed consumer will help him understand not only more about his illness but also about the important role dieting can have in controlling his symptoms (in his case, obesity).

It’s very important that your friend knows you will be there to help him when his over-eating gets troublesome. Your support in helping him stay on his diet will benefit him greatly.

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http://www.nami.org/Template.cfm?Section=Ask_the_Pharmacist&template=/ContentManagement/ContentDisplay.cfm&ContentID=85046

Alarming weight gain seen in kids on psych drugs

CHICAGO — Children on widely used psychiatric drugs can quickly gain an alarming amount of weight; many pack on nearly 20 pounds and become obese within just 11 weeks, a study found.

“Sometimes this stuff just happens like an explosion. You can actually see them grow between appointments,” said Dr. Christopher Varley, a psychiatrist with Seattle Children’s Hospital who called the study “sobering.”

You can find the article at: http://www.washingtonpost.com/wp-dyn/content/article/2009/10/27/AR2009102702316.html?hpid=sec-health

My response to this shocking relevation is – oh for heaven’s sake. Like this is a big surprise? Alarming weight gain has been observed in adults for years. Is it only when we see it in children that alarm bells goes off?

Eugene, Oregon takes a giant step forward

Hot off the press! The city of Eugene, Oregon passed this resolution last night. Please circulate. Your local paper should know about this.

The original post is from Ron Unger’s blog. http://recoveryfromschizophrenia.org/2009/10/city-affirms-choice-in-mental-health-treatment-including-choice-of-non-drug-alternatives-as-a-human-right/

RESOLUTION NO. __________

A RESOLUTION AFFIRMING THE CITY’S COMMITMENT TO HUMAN RIGHTS AND MENTAL HEALTH CARE.
The City Council of the City of Eugene finds that:

A. The City Council of the City of Eugene recognizes that the diversity of our population is vital to our community’s character, and that we have a long tradition of protecting and expanding human rights and civil liberties protections for all of our residents, including persons with all types of disabilities.

B. U.S. Courts have affirmed a number of rights for people diagnosed with mental disabilities. At the national level, the right to choose to live in the least restrictive environment that is reasonably available has been affirmed. At the state level, a number of courts have affirmed a person’s right to refuse psychotropic medications, even when the state has a “compelling interest” in providing treatment, if less intrusive, effective treatment alternatives exist. These decisions are consistent with the principle that all people have the right to lives free of unnecessary restrictions and intrusions.

C. Many people determine that psychiatric medications are quite helpful for their mental and emotional conditions, and are grateful to have the opportunity to take them. Others find medications to be harmful to their health, unhelpful and/or excessively intrusive and problematic. When people seek treatment and are offered medication as the only treatment option, they may feel coerced into choosing that option. Many of the medications currently provided are typically associated with significant medical risk, are often experienced as subjectively harmful, and their long-term effectiveness remains controversial. Furthermore, there are widely researched psychosocial alternative treatments likely to be at least as effective for many, with fewer harmful effects.

D. Many mental health problems are caused by trauma and human rights violations, such as child abuse, war, racism, lack of housing and economic opportunities, domestic violence, and others. A key element in any kind of trauma is the denial of choice. When people who have been traumatized are denied choices in recovery, an effect may be retraumatization.

E. Serious psychiatric disorder is often thought of as inevitably a permanent condition requiring a lifetime of medication, however research shows that a substantial fraction of those with even the most serious diagnoses do fully recover, eventually not requiring treatment. Treatment choices, designed to foster rehabilitation and recovery, which include working, living, and participating in the life of the community, have been shown to increase such recovery.

NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF EUGENE, a Municipal Corporation of the State of Oregon, as follows:

Section 1. All mental health service providers within the City of Eugene are encouraged to incorporate self determination and consumer choice as much as possible, with accurate information provided to consumers and to families about those choices. Special emphasis should be placed on providing diverse alternatives in treatments, including non-drug alternatives, whenever possible.

Section 2. All mental health service providers within the City of Eugene are urged to offer a full range of choices designed to assist in complete recovery. Section 3. This Resolution shall become effective immediately upon its adoption.

The foregoing Resolution adopted the ____ day of October, 2009.

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Acting City Recorder

Martin Armstrong’s cycle theory becoming less of a secret

“We seek and see patterns in things. It is the way our minds work, presumably for the purpose of survival.”*

What I love about schizophrenia is how relevant it is to the life forces of our universe. There is almost nothing that I encounter on a daily basis that doesn’t relate in some way to schizophrenia as I have come to understand it. The latest is an article in the New Yorker magazine about market cycle guru Martin Armstrong, whose ability to predict market cycles based on the mathematical ratio pi, earned him billions and, unfortunately, since 1999, jail time. For obvious reasons I wish I understood as much about the cycles of the market as I think I do about how energy vibrations relate to schizophrenia. On the other hand, Mr. Armstrong has been at his obsession since the 1970s and I only relatively recently started to grasp that there is a link between energy vibrations and schizophrenia.

Losing one’s mind is treated by Western medicine from a biochemical perspective, but is seen by ancient and indigenous cultures in a completely different and more positive way. Ancient and indigenous peoples and religions use vibration as a pathway to the power that shapes the universe. These can range from ceremonially inducing a trance-like and/or hallucinatory state through yoga, music, or plant stimulants that shift the center of energy.

Martin Armstrong began to sense a pattern to the rise and fall of markets when he realized that on average there was a financial panic every 8.6 years between 1683 and 1907. He realized that there was a natural rhythm to the economy and world affairs that followed 8.6 year cycles. Later, he realized that the number 8.6 was 3,141 days, or 1000 times pi (3.141) Pi is an irrational number that governs the physical universe (pyramids, the swing of a pendulum, etc.) If it governs the physical universe, Armstrong reasoned, why could it not govern the financial markets and human behavior?

As technical analysts do for markets, people with schizophrenia see patterns where other people fail to see them. It looks like chaos to us, but as I have said many times, if you pay close enough attention to what is said, there is more than a thread of logic and ultimate truth tying it all together. Technical analysis of market forces say that the market fundamentals like balance sheets and price/earnings ratios are less important than emotions and the so far unexplainable forces that produce quantum changes in markets. “The idea that there may be celestial influences on the spontaneous desire to invest or not is an old one,” a trader is quoted as saying in the article, “but it’s too embarrassing to explore in modern economics. These topics are not fit for polite conversation in most circles.” To which I can add, “or even when healing schizophrenia using energy therapies.” I don’t bother talking to people about this anymore. They begin to nervously back away from me, as if I, too, have caught the so-called disease of schizophrenia.

Martin Armstrong believes that cycles in life (and the markets) started with the Big Bang. Very early on I began to entertain the idea that schizophrenia is also related to the Big Bang, but I couldn’t and still cannot explain it. I do think that schizophrenia is possibly related to sub-particle behavior, which is less predictable than the mass behavior Mr. Armstrong has observed that comes in waves. Perhaps people with schizophrenia are closer to the “God particle” than the rest of us. Many are obsessed with religion and see themselves as God or a God like figure, which to me is an enormous clue that science, so far, has failed to link to physics. I am being perfectly serious here, by the way.

The therapies that most correlate with the cycle theory that Chris and I have undertaken are sound therapy, which replicates the spiraling sound waves following the Big Bang, the Tomatis Method, which recognizes that our behavior is governed by what we hear, and the assemblage point shift. Cathartic psychotherapies also correlate because they are often ceremonial in nature and stimulate cellular changes through a release of emotion. What I am trying to do in having Chris undergo these therapies, is to put his emotions and actions more in sync with the natural world and to not be overwhelmed by it.

On reading the New Yorker article, I found another fellow traveler in Edward R. Dewey, the chief economic analyst at the Department of Commerce in the early 1930s. Like my experience in asking psychiatrists what causes schizophrenia, Mr. Dewey asked a number of economists about what caused the Great Depression, and he found that everybody had a different explanation, which to him meant that nobody had a clue. This has a familiar ring to me. At this point you either accept the wisdom (?) of the crowd, or you continue to look for meaning in what otherwise looks like chaos. Mr. Dewey found his answer in the view of a particular economist that business behaviors have a tendency to repeat themselves.

I am not writing this to boast that I have unlocked the key to healing schizophrenia, because clearly I haven’t. To me, though, there is growing compelling evidence, such as demonstrated by Martin Armstrong, that we are all sensitive to universal forces that began with the Big Bang. Observing the phenomenon of schizophrenia gives you a ring side seat in the quantum universe. This information, even if barely understood, can still be used to heal.

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*The Secret Cycle: Is the Financier Martin Armstrong a con man, a crank, or a genius?, Nick Paumgarten, The New Yorker, October 12, 2009

Click to access NewYorker1012091.pdf

Consumer empowerment

Ron Unger has written a superb piece on consumer empowerment which I think is a must read.

“Recovery from many kinds of problems is affected by beliefs about the possibility of recovery. Consider a hypothetical example of a person who has received an injury which affects the person’s ability to walk, but which is not necessarily permanently disabling if strong efforts are made to recover. If the person is led by medical authorities to believe that the disability is permanent, efforts at rehabilitation will probably not be made, and the prediction may become a self fulfilling prophecy. Since the disability at that point is a result of the inaccurate prediction rather than the injury itself, the disability becomes a medical system induced condition.

You can find the rest of his article at http://recoveryfromschizophrenia.org/2009/10/the-role-of-consumer-empowerment-in-mental-health-recovery/

I know a woman whose husband died within this last year, and his doctor was completely shocked that he had died, because his condition wasn’t life-threatening. Nevertheless the man in his late 70s went further and further downhill, until he ended up in a nursing home, all the time treated by the same doctor. The doctor said to the wife after the fact, “maybe I was too pessimistic when I spoke with him.”