The tragedy of schizophrenia without psychotherapy

Al Gorman was looking for help for his son, having experienced first hand how poorly conventional medicine and psychotherapy understands and treats schizophrenia. He located a paper by Bertram P. Karon titled “The Tragedy of Schizophrenia without Psychotherapy” (2001) and was awakened to the possibility that recovery from the condition was possible employing psychotherapy and without an ongoing dependence on antipsychotic medication.

He writes:

When an individual possesses a rigid delusional belief that he is overtaken by some daemonic force, although perhaps unconventional, the obvious thing to do is to aid that person in exorcising the daemonic force through a symbolic ritual of catharsis. With this interference out of the way more conventional approaches to psychotherapy can be undertaken.

Today’s post is taken almost verbatim from Guiding Recovery from Schizophrenia Employing a Model of Direct Confrontation Psychotherapy, by Al Gorman and there is a further progress report on his son.

Mr. Gorman continues:

“Jack Rosberg has illustrated a Direct Confrontation model for psychotherapy with a schizophrenically diagnosed patient. He has summarized five significant steps to the systematic treatment of schizophrenia as follows:

1. Establishing relationship and trust with the patient,
2. Facilitating an experience of catharsis,
3. Employing more conventional methods aiding the patient in his or her psychosocial interferences,
4. Remobilization into society,
5. Aiding in the process of the patient discovering vocational meaning and purpose in his or her life.”

“It is obviously significant enough to establish rapport and trust with a psychotic patient however as Rosberg suggests the catharsis is fundamental in resolving a meaningful path forward. Unless the therapist is willing to enter the delusional system with the patient, with sincerity and care, he or she will have little effect. The therapist cannot hope to have any success in bringing the patient into a state of normalcy unless he or she is willing to entertain entering the delusional system as a full partner with the patient. The therapist’s ability to meet the patient’s level of madness with one of his or her own making that is, in the eyes of the patient, equally or more absurdly mad than the patient’s own state is helpful in creating a meaningful background of relatedness and establishing trust that will allow for catharsis and the subsequent psychosocial healing of the patient.”

While the article and the follow up progress report on his son are too lengthy for me to reprint in its entirety, I fully subscribe to the principles behind Direct Confrontation Therapy which Mr. Gorman enthusiastically endorses. When my own son was recently psychotic, I felt it was a golden opportunity to make a significant breakthrough with him. Unfortunately, I did not have the knowledge at my disposal to do so and was unaware of anyone else who could help him on this path. I have said many times that the right psychotherapy is crucial. The right psychotherapy, the one that can produce profound changes rather quickly, lies in entering into the delusional belief system, by putting yourself into the other person’s shoes, or as Loren Mosher famously put it, by “acting like an LSD trip guide.”

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