Holistic Recovery from Schizophrenia

Documentation of Tomatis results

A Swedish center, Tomatis Nordiska AB, has extensively documented the results of its work with clients since 1998, using a self-rating questionnaire which was developed by other Tomatis centers. These results are published at http://tomatisassociation.org/Content/Documents/Document.ashx?DocId=60422

Of the children with one or more medical diagnoses, the majority had either very serious conditions, such as autism or Aspergers syndrome, or disorders such as ADHD. In spite of these diagnoses, the results indicated that the children demonstrated substantial progress as a result of the training.

One conclusion that the Swedish center drew, is that the training appears to have beneficial effects on concentration and attention difficulties, as well as on social adaptation and behavior, in both adults and children, even in severe cases.

In my son Chris’s case, I am extremely encouraged by the subtle, but profound changes I see happening. Chris is a different person today than he was when he began the therapy in May. As an outsider looking in, it is hard to put a finger on it. Chris’s voice has changed. He just sounds more “normal” somehow. He speaks in a normal voice about normal things with his brothers. Not that he had what I ever considered an abnormal voice, but something has changed. It’s lower, for one thing. His body movements are more fluid. He seems sincere in a manner that I cannot explain. He is calm but more determined. He says his dreams are more vivid and continuous. All of the above must be when people say that someone is becoming more “grounded.” He complains of being more tired than usual, which may be an indication that his medication needs lowering.

As long as we stay the course, I feel that Chris’s difficulties over the past six years will soon be behind him. Tomorrow’s blog will give Chris’s impressions of what Tomatis has done for him. I’ve had a sneak preview. What Chris is articulating about the changes he has noticed, I can reduce to “living less in his mind and more in his senses.”

Dr. Tomatis asks the right questions

Something I have not been able to comprehend throughout this whole journey, is what little interest Chris’s doctors have shown in the circumstances surrounding his birth and his time in utero. Chris’s doctors have treated his condition as if it mysteriously appeared in his late teens. I realize now that the gestation period is highly important and provides the first clues to the condition called schizophrenia.

I finally found in Dr. Tomatis a doctor who understands the link, which is really quite amusing because he’s been dead since 2001.

When I filled out the client information form at the Tomatis Center I was given a platform to tell all in response to questions such as:

How long was your pregnancy?
Was there anything unusual about it?
Did you have any worries at the time?
Did you and your partner get along at this time?
How long had you been together at the time?
How many pregnancies have you had?
How long was your labor?
Was there anything unusual about your child’s development?

The Tomatis questionnaire is directed at detecting trauma to the fetus. Trauma can be a subtle as everyday maternal worry and anxiety or it can be something as seemingly innocuous as listening to Black Sabbath or other heavy metal music, listening all day to the constant whirring of propellers or jackhammers or sleeping with the television on. Loud noises are traumatizing to the fetus.

The questionnaire is no place to be coy. I wrote entire pages and then some. I finally got to tell someone about my forty-four week pregnancy, the fact that Chris barely moved in utero, the twenty-four hour labor, my husband’s and my arguments during our first year and a half of marriage, the financial insecurity, Chris seeing space aliens in the park at the age of ten, and so on. Filling out the questionnaire only confirmed the sinking feeling in my heart that the fetal ear hears all and knows all, and some ears are more sensitive than others.

Sound therapy – the Tomatis Method

“Mozart,” I thought, and with the word conjured up the most beloved and the most exalted picture that my inner life contained.

In May this year, immediately after his three month stay in hospital, Chris began the Tomatis Method, an auditory training method developed by a Frenchman, Dr. Alfred Tomatis (1920-2001), who theorized that voice and behavior problems are hearing problems. According to him, the voice only reproduces what the ear can hear.

The human ear, which resembles in shape a fetus, begins to develop a few days after conception and is fully formed by the fourth month of pregnancy. The ear doesn’t sleep. It is the only one of our sensory organs that is alert twenty-four hours a day. Tomatis theorized that the problems of autism, schizophrenia and other disorders stem from the fetus not fully hearing the mother’s voice. If a child is not integrated properly into the early environment, he or she will begin to listen more to certain frequencies than to others, will lose the desire to communicate and will turn inward by listening to her/himself. If you change the way the ear hears, he reasoned, language and behavior change, too.

Each of us has a unique auditory curve, which responds to certain sound frequencies and not to others. To achieve optimal hearing (and therefore understanding) Tomatis invented the electronic ear, a device that filters out certain sound frequencies using the music of Mozart and Gregorian chants. Why Mozart? According to Tomatis, among other things, the music of Mozart encompasses childhood auditory frequencies of 120 beats per minute. The electronic ear filters the music of Mozart to represent the sound environment before birth.
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Hesse, Hermann, Steppenwolf, Bantam Books, 1974, pg. 233

The Alcoholism and Addiction Cure

On the surface, schizophrenia seems to have nothing in common with alcoholism and addiction, however I highly recommend reading the book The Alcoholism and Addiction Cure: A Holistic Approach to Total Recovery, by Chris Prentiss. For starters, the author doesn’t shy away from using the word “cure”. He doesn’t consider alcoholism or addiction either “incurable” or a “disease”. These are symptoms that are coping mechanisms that one has chosen in response to life’s pain. Medical professionals who refuse to use the word “cure” in the context of certain mental health problems deprive people of hope and virtually guarantee that their problems are forever managed, never cured.

Mental health professionals are being disingenuous when they say that the cause of schizophrenia or alcoholism or addiction is unknown. Some people will stop right there and think to themselves, “well, if a doctor says this, there’s not point in my looking any further.” It is true that there is no one neat scientific explanation that can explain away the cause, but that doesn’t mean that a cause or causes cannot be found. Chris Prentiss makes a clear cut case for finding the cause of the pain by looking at the problem through the prism of the family story. Through my own research and willingness to undertake psychotherapy, I now have some insight into the cause(s) of my son’s problems. The causes are both psychological and physiological. I have developed a working theory that makes sense to me. I may be entirely wrong about what the real causes are, but it doesn’t really matter because I have noticed whatever we are doing seems to be working. I can empower healing in my son by changing the way I relate with him, by showing conviction that he will recover, and by understanding that his problems have a context.

Chris Prentiss eventually came to realize that his son’s descent into alcoholism and addiction was due to the son’s deep rooted anger with his father. The family background that he describes in his book provides a plausible explanation for this outcome. Many people will protest that everybody is angry with their father (or their mother) and that most people who are angry with a parent don’t descend into drug addiction. Well, actions do make sense if you care enough to pay attention. There is a logic to life.

Why schizophrenia is not a disease

The mistaken and unhappy notion that a man is an enduring unity is known to you. It is also known to you that man consists of a multitude of souls, of numerous selves. The separation of the unity of the personality into these numerous pieces passes for madness. Science has invented the name schizomania for it.

I do not believe there a pathological disease called schizophrenia. If people labelled schizophrenic really have a disease, it begs the question, why aren’t neurologists overseeing their care? The state called schizophrenia often strikes the gifted, the sensitive, the creative – people struggling to express something about their world that others fail to see. I began to understand and appreciate the journey my son was going through when I turned to literature for the answers that Western science seemed unable to provide.

Well, okay, I turned to Hermann Hesse and Google for many of the answers. For Hesse, schizophrenia can be a transformative process.

Demian is about a very specific task or crisis in one’s youth, which continues beyond that stage, but mostly affects (sic) young people: the struggle to forge an identity and develop a personality of one’s own.

Not everyone is allotted the chance to become a personality; most remain types, and never experience the rigor of becoming an individual. But those who do so inevitably discover that these struggles bring them into conflict with the normal life of average people and the traditional values and bourgeois conventions that they uphold. A personality is the product of a clash between two opposing forces: the urge to create a life of one’s own and the insistence by the world around us that we conform. Nobody can develop a personality unless he undergoes revolutionary experiences. The extent of those experiences differs, of course, from person to person, as does the capacity to lead a life that is truly personal and unique.

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1. Hesse, Hermann, Steppenwolf, Bantam Books, 1974
2. Hesse, Hermann, Soul of the Age: Selected Letters of Hermann Hesse, 1891-1962

The Diagnostic and Statistical Manual of Mental Disorders

A friend handed me an article by Alex Beam, “Who’s Crazy Now?”, that appeared in the Boston Globe (Tuesday, July 28, 2009). It is a criticism of the making of the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), and relates the usual criticism about the proliferation of medical diagnoses for normal human emotions, habits and bodily functions (e.g. nicotine dependence and premenstrual syndrome, to name two). It makes the very good point that the losers in this trivialization of mental disorders are the truly mentally ill, who would probably love to exchange places with the merely jet lagged or those undergoing nicotine withdrawal.

The article, while criticizing the marginalization of psychiatry as a profession, has inadvertently shown where exactly psychiatry should be headed if it wants to grow in stature with the public. Well, let me amend that. It shows how psychiatry could reposition itself to feel good about itself. Modern psychiatry appears to be largely about status and not about the people truly in need of its services.

The writer says that adding new so-called mental illnesses is “a naked land grab by a profession threatened with marginalization by biochemical research”. Wrong. Biochemical research has not made mentally ill people suddenly well. There is no threat that I can see from biochemical research.

In referring to the last edition of the DSM, published in 1994, blogging psychiatrist Dr. Daniel Carlat has this to say: “The idea was that in 20 years the science would have progressed to where it had hard scientific and biological markers for diagnoses, it just hasn’t happened. … The lack of biological markers to help us diagnose has made us feel in some way inferior to other medical professionals, as if we were not real doctors, because we don’t base our decisions on hard science.”

Modern psychiatry, feel inferior no more. There are no biological markers and there never will be. Mental illness is largely
p-s-y-c-h-o-l-o-g-i-c-a-l. Modern psychiatry has somehow missed this fundamental point. Take some motherly advice: Hold your head up high and as a profession, get back to doing what you should have been doing all along, which is treating people with serious mental disorders, and gasp, even empowering cure in them. Psychiatry is an art, not a science. Enjoy it for what it is and rid yourself of those who are unskilled in the art of understanding human beings. Let them be brain surgeons or neurologists. Psychiatry is needed, but has turned its back on the seriously mentally ill and their families, whose lives are in turmoil.

I briefly followed a blog by a psychiatrist, and stopped, because all he could write about was insurance and billing. I just bet his waiting room is filled with seasonal affective disorder (SAD) patients. If he has time to blog, which many psychiatrists seem to be doing, he is overachieving and hasn’t got time for the people who really need him.

The shopping cart

The left coast is chock-a-block full of peculiar people. My word! A supposedly HIV infected guy approached me on the street in Vancouver. Uh, oh, I thought, here comes the pitch. And what a pitch it was.

“Excuse me,” he began, “Thank you for at least speaking with me. Most people would not. Do you know that you look like the ex-wife of that billionaire whose last name is – I can’t think of it but it begins with a ‘T’.”

“You mean, Ivana Trump?” I gushed. I looked over at Ian, who is definitely not The Donald. “Ian, give this good man five dollars.”

Watching The Soloist on the plane to Vancouver was a great opening act for what was to come. The running theme of the Vancouver and Victoria leg of our August vacation was the shopping cart. At one point in the movie, Nathaniel Ayers refuses to leave his shopping cart behind when he is invited to give a solo concert.

The shopping cart would be an excellent place to begin to learn to treat schizophrenia holistically by understanding what is essential for the individual’s sense of survival, which surely must have something to do with his or her past. To me, the shopping cart represents life’s laundry. Everything that is important to the person is found within. The cart is wheeled everywhere, often with a plastic bag attached to pick up bottles, which presumably are redeemed for money.

Vancouver, being a laid back west coast city with good weather, has lots of street people driving life’s laundry around. I wonder if social service workers have bothered to ask them, piece by piece, what their life is about?

In Victoria, Ian and I were given an interesting perspective on street life by an old friend of Ian’s who has had a reversal of fortune. Jim is now out there with the best of them, “binning” as he calls it. He is in hot competition with Victoria’s street people for bottle collection and redemption. He waits until after dark, when no one from his previous life will see him, and then heads to the neighborhoods where he knows he can get the most bang for the buck. As we drove around Victoria’s streets in broad daylight, Jim gave a thumbs up to a few guys and gals pushing shopping carts, and occasionally pointed out that so and so over there was his main competition for that tax free income.

I know a lady from work who, judging from her appearance and quirks, has extreme mental health issues, but she plays the game of life, none-the-less. She walks to and from work dragging a shopping trolley, but is also occasionally seen trundling a piece of luggage to and fro. She sports bright red earmuffs when it’s not even cold outside. To talk to her, she seems normal enough, but her appearance and that trolley set her apart. I wonder what is so important to her that she takes it with her on a daily basis.

I know nothing about her, whether or not she has received treatment for mental health in the form of psychotherapy and/or medication. I suspect, because of her age, that she had not spent a lot of time in psychotherapy. It has only been relatively recently that psychotherapy for schizophrenia is promoted as a treatment that can work for schizophrenia. Since the advent of the typical (first generation) antipsychotics in the 1950s, the benefits of psychotherapy have been downplayed in the rush to pharmaceuticalize treatment. Four years ago when I began my search for other options beyond simply medications, the standard view put out by pharmaceutical companies and the big mental health organizations was that psychotherapy was not considered helpful for schizophrenia.

I am still unclear, from watching The Soloist, how that hospital/shelter, whatever it was that the patients milled outside of, was helping the street people it was supposed to be helping. How about starting with some individual psychotherapy? How about talking with them about what the contents of their shopping carts mean to them?

The Soloist

I watched the movie The Soloist recently on the small screen while on a plane to Vancouver. The movie is based on the real life story of Nathaniel Ayers, a schizophrenic street musician in Los Angeles. In the 1970s, Mr. Ayers was forced to drop out of the prestigious Julliard School in NYC because of his schizophrenia. A journalist from The Los Angeles Times, Steve Lopez, noticed him one day and took an interest in his case.

Movies are always better viewed large, not on a small screen and not on a plane. It was hard to see what was going on. The scenes from the movie were pretty murky, the mentally ill shuffling past the viewer in an endless night of rotting humanity.

Two things from the movie struck me about the treatment of the mentally ill. It was clear to me that the clues were right there in the open about how to help someone, yet nobody was following through.

Clue number one. The doctor, at least I think he was a doctor, named David, at whatever that building was where the mentally ill were milling around, said to the journalist, “just be his friend.” Then he said something about friendship changing the brain chemistry. Key concept. Not practiced apparently in or near David’s building.

An institution is no substitute for friendship. Where was Ayers to get that kind of friend? It appears that Nathaniel Ayer’s family was not in contact with him while he was on the streets, so they were not there to provide this needed friendship. And, hanging around other mentally ill patients for long stretches doesn’t help people get better, it only reinforces their isolation. You need to hang around with people you care about and who care about you. An institution could, in theory, design a more caring program, by emphasizing more one-on-one interaction between patient and staff. All treatment programs should recognize the importance of a caring family. But families need help to continue to be caring in very trying circumstances.

Clue number 2. This is so obvious you would wonder why it isn’t being done on a large scale. Nathaniel Ayers was, once upon a time, a promising musician. He does well when he is playing his instrument or listening to music. Music also changes brain biochemistry, but why isn’t this rather obvious thing being factored into a treatment program? In one scene Ayers plays his instrument to an assorted throng of the mentally ill and they are enraptured by it, proving that everybody benefits from music, not just the musically gifted. I am more than just a little put out to read that the foundation started in Nathaniel Ayers’s name discriminates between the “artistically gifted” schizophrenic and those who are not. Let’s hope a client doesn’t get dropped from getting further help if it is learned that he or she is merely creatively average.

The idea to encourage Mr. Ayers’ skill appeared to come from the journalist and not from the insitution. Whatever that institution was doing, it sure wasn’t doing it for its clients. They continued, en masse, to be mentally ill.

Play the ball as it lies

This is my last post before taking the month of August off. I am at a crossroads as to the direction of my blog. I hope that my time away will provide fresh insight or else help me to realize that my blog has served its purpose and it’s time to close. Comments and suggestions are most welcome. I read and answer every e-mail.

A reader has asked me what I think the cause is of Chris’s problems. I answered “me”! I am only being partly facetious when I say this. While there are probably many reasons for why Chris is the way he is, I do think that mental illnesses (in fact other illnesses, too) grow out of the family story. As painful as it is, I feel that self-examination is important to appreciate larger truths. Another way of looking at is that “the apple doesn’t fall far from the tree”. This to me is a comforting thought. It says that Chris’s problems are not insurmountable, in fact, they are understandable in the family context.

Too many of us turn our problems over to institutions and seek medical answers when we could put more of the onus on ourselves to seek answers and to provide solutions. Nobody will ever care about your relative the way you do, or the way you should. Many readers will object to this last statement, citing personal circumstances, dual diagnoses and the impossibility of living with someone with a mental illness.

What I have noticed, is that Chris wants to be with his family. His behavior at home has, on occasion, tested our patience beyond all belief, but sending him away is only a temporary solution. While he is away is a chance for us to get our own house in order. The street is not an option for us, no matter how tempting it is in our worst moments. The loneliness of those diagnosed with a mental illness only intensifies when separated from the family. Sure, I can visit Chris every day in the hospital, but it’s not the same.

What is missing in the mental health system, no matter where you live, is empowerment, helping patients and families to help themselves get better. If the customer is always right, then why isn’t the patient, or the involved family member, by extension, always right? If, for example, a person does not want to take medications, then shouldn’t this be an indication that some other solution should be sought? When families can’t cope with the patient at home, then why aren’t there affordable, short term, drug free treatment options to allow a needed time-out? Mainstream medicine is not very consumer oriented when it comes to allowing people to choose.

We do not play the ball as it lies when it comes to treating mental illness. Many people who have been labelled mentally ill are creative. They are inclined to art and music. Yet, the solutions we impose on them are scientific. We give them meds and talk about their biochemical imbalances, as if they are laboratory animals. Could they be telling us that the solutions to their problems (our problems) lie in the realm of art and music if we would only speak their language?

Recovery: not what you were thinking

Chris and I have come full circle. He has been out of the hospital since May and doing well at home. By doing well I do not mean he is free of delusional thinking. It is there, running beneath the surface like a low grade fever. This may come as a surprise to anyone who labors under the false impression that being on meds takes care of all that. It doesn’t. Chris, for the time being, is sociable, humorous, helpful, and a regular guy in many respects. May it ever be so. He is once again considering enrolling in a university course this fall, if only to stem the loneliness. I have faith that Chris will continue to recover in surprising ways.

I am pleasantly surprised to discover that Chris has recovered rather quickly this time around. This is not what I have been led to believe. I have read countless articles that claim that it takes much longer to recover with each relapse. I don’t know where this claim comes from, but naturally my suspicion falls on the pharmaceutical companies. Even so, real people (as opposed to just pharmaceutical companies) also report that it takes longer for the medications to be effective a second or even third time around. The issue is whether you consider the medications effective in the first place, which I do not. I feel that the medications have only been helpful for Chris as a sedative, not as a symptom reliever.

Chris was a more evolved person in any case before his recent slide. I credit this to the fact that my husband and I cared enough to keep at it and to try new ways of thinking and new interventions. I consider it less a relapse on Chris’s part than a necessary breakthrough. R.D. Laing says it best: “Madness need not be all breakdown. It may also be break-through. It is potential liberation and renewal as well as enslavement and existential death.”

I hope that I have painted a realistic portrait of what recovery can look like. It is not as straight up as many would have you believe. I do believe, however, that focusing on the individual and not giving up, goes a long way towards helping your relative regain a normal life.