Can you recover from schizophrenia: Schizophrenia Treatment and Self-Help – HelpGuide.org
Schizophrenia Treatment and Self-Help – HelpGuide.org
Schizophrenia recovery is possible. These treatment and self-help tips can help you to manage symptoms, live and work independently, build satisfying relationships, and enjoy a rewarding life.
Schizophrenia: Recovery is possible
Getting a diagnosis of schizophrenia can be devastating. You may be struggling to think clearly, manage your emotions, relate to other people, or even function normally. But having schizophrenia doesn’t mean you can’t live a full and meaningful life. Despite the widespread misconception that people with schizophrenia have no chance of recovery or improvement, the reality is much more hopeful. Although currently there is no cure for schizophrenia, you can treat and manage it with medication, self-help strategies, and supportive therapies.
Since schizophrenia is often episodic, periods of remission from the severest symptoms often provide a good opportunity to start employing self-help strategies that may help to limit the length and frequency of future episodes. A diagnosis of schizophrenia is not a life-sentence of ever-worsening symptoms and hospitalizations. In fact, you have more control over your recovery than you probably realize.
The majority of people with schizophrenia get better over time, not worse. For every five people who develop schizophrenia:
- One will get better within five years of experiencing their first symptoms.
- Three will get better, but will still have times when their symptoms get worse.
- One will continue to have troublesome symptoms.
What does schizophrenia recovery mean?
Coping with schizophrenia is a lifelong process. Recovery doesn’t mean you won’t experience any more challenges from the illness or that you’ll always be symptom-free. What it does mean is that you are learning to manage your symptoms, developing the support you need, and creating a satisfying, purpose-driven life.
A treatment plan that combines medication with schizophrenia self-help, supportive services, and therapy is the most effective approach.
Encouraging facts about schizophrenia
- Schizophrenia is treatable. Currently, there is no cure for schizophrenia, but the illness can be successfully treated and managed. The key is to have a strong support system in place and get the right treatment and self-help for your needs.
- You can enjoy a fulfilling, meaningful life. With the right treatment, most people with schizophrenia are able to have satisfying relationships, work or pursue other meaningful activities, be part of their community, and enjoy life.
- Just because you have schizophrenia doesn’t mean you’ll have to be hospitalized. If you’re getting the right treatment and sticking to it, you are much less likely to experience a crisis situation that requires hospitalization.
- Most people with schizophrenia improve. Many people with schizophrenia regain normal functioning and even become symptom-free. No matter what challenges you presently face, there is always hope.
Tip 1: Get involved in treatment and self-help
The earlier you catch schizophrenia and begin treatment with an experienced mental health professional, the better your chances of getting and staying well. So, if you suspect you or a loved one is exhibiting schizophrenia symptoms, seek help right away.
Successful schizophrenia treatment depends on a combination of factors. Medication alone is not enough. It’s important to also educate yourself about the illness, communicate with your doctors and therapists, build a strong support system, take self-help measures, and stick to your treatment plan. Pursuing self-help strategies such as changing your diet, relieving stress, and seeking social support may not seem like effective tools to manage such a challenging disorder as schizophrenia, but they can have a profound effect on the frequency and severity of symptoms, improve the way you feel, and increase your self-esteem. And the more you help yourself, the less hopeless and helpless you’ll feel, and the more likely your doctor will be able to reduce your medication.
While schizophrenia treatment should be individualized to your specific needs, you should always have a voice in the treatment process and your needs and concerns should be respected. Treatment works best when you, your family, and your medical team all work together.
Your attitude towards schizophrenia treatment matters
Accept your diagnosis. As upsetting as a diagnosis of schizophrenia can be, resolving to take a proactive role in treatment and self-help is crucial to your recovery. That means making healthy lifestyle changes, taking prescribed medications, and attending medical and therapy appointments.
Don’t buy into the stigma of schizophrenia. Many fears about schizophrenia are not based on reality. Take your illness seriously but don’t buy into the myth that you can’t improve. Associate with people who see beyond your diagnosis, to the person you really are.
Communicate with your doctor. Help your doctor ensure you’re getting the right type and dose of medication. Be honest and upfront about side effects, concerns, and other treatment issues.
Pursue self-help and therapy that helps you manage symptoms. Don’t rely on medication alone. Self-help strategies can help you to manage symptoms and regain a sense of control over your health and well-being. Supportive therapy can teach you how to challenge delusional beliefs, ignore voices in your head, protect against relapse, and motivate yourself to persevere with treatment and self-help.
Set and work toward life goals. Having schizophrenia doesn’t mean you can’t work, have relationships, or experience a fulfilling life. Set meaningful life goals for yourself beyond your illness.
Getting a diagnosis
The first step to schizophrenia treatment is getting a correct diagnosis. This isn’t always easy, since the symptoms of schizophrenia can resemble those caused by other mental and physical health problems. Furthermore, people with schizophrenia may believe nothing is wrong and resist going to the doctor.
Because of these issues, it is best to see a psychiatrist with experience identifying and treating schizophrenia, rather than a family doctor.
Tip 2: Get active
As well as providing all the emotional and physical benefits, regular exercise can even help to manage symptoms of schizophrenia. Unless you’re experiencing a psychotic episode, getting physically active is something you can do right now to improve your focus, relieve stress, give you more energy, help you sleep, and make you feel calmer.
You don’t have to become a fitness fanatic or join a gym, but rather, find a physical activity you enjoy and aim for 30 minutes of movement on most days. If it’s easier, three 10-minute sessions can be just as effective. Rhythmic exercise that engages both your arms and legs, such as walking, running, swimming, or dancing, can be especially effective at calming your nervous system. Instead of focusing on your thoughts, try to focus on how your body feels as you move—how your feet hit the ground, for example, the rhythm of your breathing, or the feeling of the wind on your skin.
Tip 3: Seek face-to-face support
Connecting face-to-face with others is the most effective way to calm your nervous system and relieve stress. Since stress can trigger psychosis and make the symptoms of schizophrenia worse, keeping it under control is extremely important. Find someone you can connect with face to face on a regular basis—someone you can talk to for an uninterrupted period of time who will listen to you without judging, criticizing, or continually becoming distracted.
As well as helping to relieve stress, having the support of others can make a huge difference in the outlook for schizophrenia. When people who care about you are involved in your treatment, you’re more likely to achieve independence and avoid relapse.
Ways to find support
Turn to trusted friends and family members. Your loved ones can help you get the right treatment, keep your symptoms under control, and function well in your community. Ask loved ones if you can call on them in times of need. Most people will be flattered by your request for support.
Stay involved with others. If you’re able to continue work or education, do so. Otherwise, pursue a passion, cultivate a new hobby, or volunteer to help other people, animals, or causes important to you. As well as keeping you connected, helping others can give you a sense of purpose and boost your self-esteem.
Meet new people. Joining a schizophrenia support group can help you meet other people dealing with the same challenges and learn important coping tips. Or get involved with a local church, club, or other organization.
Find a supportive living environment. People with schizophrenia often function best when they’re able to remain at home, surrounded by supportive family members. If that’s not a viable option for you, many communities offer residential and treatment facilities. Look for a living environment that is stable, makes you feel safe, and will enable you to follow your treatment and self-help plans.
Take advantage of support services in your area. Ask your doctor or therapist about services available in your area or contact hospitals and mental health clinics, or see the hotlines and support section below for links to support services.
Tip 4: Manage stress
The day-to-day stress of living with a challenging emotional disorder such as schizophrenia can be draining. High levels of stress also increase the body’s production of the hormone cortisol, which may trigger psychotic episodes. As well as exercising and staying socially connected, there are plenty of steps you can take to reduce your stress levels:
Know your limits, both at home and at work or school. Don’t take on more than you can handle and take time for yourself if you feel overwhelmed.
Use relaxation techniques to relieve stress. Techniques such as mindfulness meditation, deep breathing, or progressive muscle relaxation can put the brakes on stress and bring your mind and body back into a state of balance.
Manage your emotions. Understanding and accepting emotions—especially those unpleasant ones most of us try to ignore—can make a huge difference in your ability to manage stress, balance your moods, and maintain control of your life. See HelpGuide’s Emotional Intelligence Toolkit.
Tip 5: Take care of yourself
Making simple lifestyle changes can have a huge impact on the way you feel as well as your symptoms.
Try to get plenty of sleep. When you’re on medication, you most likely need even more sleep than the standard 8 hours. Many people with schizophrenia have trouble with sleep, but getting regular exercise, reducing sugar in your diet, and avoiding caffeine can help.
Avoid alcohol and drugs. It can be tempting to try to self-medicate the symptoms of schizophrenia with drugs and alcohol. But substance abuse complicates schizophrenia treatment and only worsens symptoms. If you have a substance abuse problem, seek help.
Eat a healthy, balanced diet. Eating regular, nutritious meals can help avoid psychosis and other schizophrenia symptoms brought on by substantial changes in blood sugar levels. Minimize sugar and refined carbs, foods that quickly lead to a crash in mood and energy. Boost your intake of omega-3 fatty acids from fatty fish, fish oil, walnuts, and flaxseeds to help improve focus, banish fatigue, and balance your moods.
Tip 6: Understand the role of medication
If you’ve been diagnosed with schizophrenia, you will almost certainly be offered antipsychotic medication. The two main groups of medications used for the treatment of schizophrenia are the older or “typical” antipsychotic medications and the newer “atypical” antipsychotic medications. It’s important to understand that medication is just one component of schizophrenia treatment.
Medication is not a cure for schizophrenia and only treats some of the symptoms. Antipsychotic medication reduces psychotic symptoms such as hallucinations, delusions, paranoia, and disordered thinking. But is much less helpful for treating symptoms of schizophrenia such as social withdrawal, lack of motivation, and lack of emotional expressiveness.
You should not have to put up with disabling side effects. Schizophrenia medication can have very unpleasant—even disabling—side effects such as drowsiness, lack of energy, uncontrollable movements, weight gain, and sexual dysfunction. Your quality of life is important, so talk to your doctor if you’re bothered by side effects.
Never reduce or stop medication on your own.
Sudden or unsupervised dosage changes are dangerous, and can trigger a schizophrenia relapse or other complications. If you’re having trouble with your medication or feel like you don’t need to take it, talk to your doctor or someone else that you trust.
Authors: Melinda Smith, M.A., Lawrence Robinson, and Jeanne Segal, Ph.D.
Schizophrenia Prognosis, Outlook, and Chances of Recovery
This is a time of hope for people with schizophrenia. New antipsychotic drugs are being studied, and brain research is headed toward understanding the molecular and neuronal roots of the illness.
Is There a Cure?
There is no known cure for schizophrenia, but the outlook for people who have this illness is improving. There are many ways to treat schizophrenia, ideally in a team approach. These include medication, psychotherapy, behavioral therapy, and social services, as well as employment and educational interventions. Psychiatrists, primary care doctors, psychologists, social workers, and other mental health professionals are crucial in helping people with schizophrenia and their families explore sources of treatment. The earlier treatment is sought, the better the outcome. With treatment, many people with schizophrenia can recover to the point of living functional, rewarding lives in their communities.
How Long Does Schizophrenia Last?
Ten years after diagnosis:
- 50% of people with schizophrenia are either recovered or improved to the point that they can work and live on their own.
- 25% are better but need help from a strong support network to get by.
- 15% are not better. Most of these are in the hospital.
Long-term numbers for 30 years after diagnosis are similar to those at the decade mark, except that more people get better and can live on their own. The lifetime risk of suicide for people with schizophrenia is about 5%, but getting treatment and taking medication seems to lower that risk.
Women seem to be better than men at staying in recovery long term.
What Affects the Outcome?
If you or a loved one has schizophrenia, here are a couple of things that may show how well you’ll do long-term:
- How well you did in society and at work before your schizophrenia began
- The amount of time from the start of symptoms to diagnosis and treatment. The sooner you’re treated for schizophrenia once symptoms begin, the more likely you are to improve and recover. But prodrome — the time between when symptoms begin and full psychosis starts — can be days, weeks, or even years. The average length of time between the start of psychosis and first treatment is 6 to 7 years.
Half of young people recover from schizophrenia
Until recently, medical professionals believed that only a minority of patients could recover from schizophrenia. But now, new Norwegian research suggests that more than half of the study participants are doing well.
After four years of treatment, 55 per cent of the young people were partially or fully recovered, and fully ten per cent of those who are fully recovered no longer use medication.
“Having such a high proportion be well-functioning shows that schizophrenic patients have a greater potential to get well than previous research has shown,” says Professor Anne-Kari Torgalsbøen at the University of Oslo’s Department of Psychology.
She believes too much pessimism has been associated with this diagnosis.
“The results of this study give hope not only to patients and their relatives, but also provide inspiration for everyone who treats young people with psychotic disorders,” she says.
Hallucinations and delusions
Torgalsbøen specializes in clinical psychology and is following close to 30 young adults for ten years. This study shows how the participants are doing after four years, and was recently published in the European Psychiatry journal.
All the study participants were recruited within five months of being hospitalized or starting outpatient treatment for first-episode mental disorders.
The study required the first episode of psychosis to be on the schizophrenia spectrum, she says.
“Schizophrenia means that the patient has had serious delusions or hallucinations, and a big drop in their ability to function,” says Torgalsbøen.
For example, some patients thought that a monitor had been implanted in their back or that their parents planned to poison them.
Others thought they were in Dante’s inferno, and physically felt like their arms were being chopped off and their eyes torn out.
Prejudices are an additional burden
“These symptoms create a lot of anxiety and create a huge emotional strain,” says Torgalsbøen.
The worst thing about having a psychosis for most patients is that they can’t tell anyone because they worry about the reactions they’ll get. They’re afraid of being seen as a loser and deviant.
Societal prejudices still add a significant burden. As one participant expressed it:
“How well you do as a person has a lot to do with how you’re treated as a person.”
Close follow-up using several treatment methods
All patients received several forms of treatment as recommended in the Norwegian Directorate of Health’s national professional guidelines.
An important part of the treatment is for patients to receive information about the diagnosis and what they themselves and the family can do to manage the mental disorder.
“This is called psychoeducational treatment, which according to the research yields the best results,” says Torgalsbøen.
Patients have also participated in group discussions, and some received cognitive therapy. Cognitive therapy involves patients working to change their delusions as well as how they think about their own experiences and psychosis.
“They get training in thinking critically about how realistic their thoughts are,” says Torgalsbøen.
Rebuilding resilience – and themselves
The majority of participants have received regular, systematic treatment over several years. Most have taken antipsychotic medication during the follow-up period.
They also received help with finding a vocation, at first through supported work and then regular employment.
One participant who was asked what she had found effective about the treatment, responded: “I got help building myself up again.”
Torgalsbøen says the research focus has been to study the segment of participants who have fully or partially recovered. One of the criteria for full recovery is that the participants have regular employment.
In addition, she has explored what traits characterize those who have become healthy despite the upsetting and traumatic experiences that the psychosis poses.
“The participants who recover show greater resilience than those who are still struggling with their challenging symptoms and ability to function,” says Torgalsbøen.
Resilience is a psychological trait that deals with a person’s ability to adapt positively despite adversity – such as getting a serious mental illness.
People with good resilience can handle crises and stresses in a positive way.
Insight into psychological processes
To measure their resilience, participants responded in a questionnaire to what extent they agreed with statements such as:
• “I’m not easily discouraged by defeat.”
• “I’m working to reach my goals, regardless of the obstacles I meet on the road.”
“We gained insight into the psychological processes that affect mental health in this group, which is at high risk of sustained loss of function,” says Torgalsbøen.
She believes the study shows that individuals who manage to put the disease behind them and look ahead have more success in regaining their health.
May point to new future treatment
This study may point to a new approach in the treatment of schizophrenia, says Professor Kenneth Hugdahl at the University of Bergen.
“Torgalsbøen has turned the problem on its head and asked questions that haven’t been asked before, like what helps someone get healthy,” says Hugdal, who is a professor of biological psychology.
While previous research has focused on why some patients don’t get better and why treatment doesn’t work, it may be more fruitful to focus on those who do get better, Hugdahl points out.
“We can imagine that future treatment would try to strengthen the resilience of people with low levels of resilience,” he says. “And in any event, showing that schizophrenia is not a hopeless disease is a very important message.”
Early treatment important
Why is it that more than half of these study participants have managed to become well functioning, as opposed to what previous research has shown?
“It’s important to emphasize that these patients received early treatment. For example, we know that cognitive therapy works better when the patient gets help early so that the irrational thoughts don’t get a foothold,” says Torgalsbøen.
She stresses that we shouldn’t compare these young patients with older schizophrenic patients who have not received the same early, research-based treatment that psychotic patients receive today.
Lower dropout rate
Another important factor is the low dropout rate.
Torgalsbøen notes that the close follow-up of participants explains why recovered patients have remained in the study.
“We’ve been conducting follow-ups once a year for ten years and have a low dropout rate of only 21 per cent,” she says.
“Other studies have lost contact with these people, which has probably led to the number of completely healthy participants being underreported in the past.”
This could indicate that previous research methods might have contributed more to the impression of a poor prognosis, rather than the symptomatic behaviours of the schizophrenic patients.
“This and other new international studies show that schizophrenic patients have far greater potential for improvement than expected,” says Torgalsbøen.
Read the Norwegian version of this article at forskning.no.
Breakthrough for depression, schizophrenia, and high blood pressure
Scientists have mapped the enzyme that transforms dopamine into noradrenaline. The discovery may lead to better treatment options for diseases such as depression, schizophrenia, and high blood pressure.
Can sleep prevent schizophrenia, Alzheimer’s and ADHD?
Better sleeping habits could prevent a number of neurodegenerative illnesses.
With Views of Psychiatrists, Psychologists, and Others Diagnosed With This Disorder
Schizophr Bull. 2009 Mar; 35(2): 370–380.
Frederick J. Frese, III
2Department of Psychiatry, Northeast Ohio Universities College of Medicine, Rootstown, OH 44272
Edward L. Knight
3Value Options, Colorado Springs, CO 80920
4University of Southern California Gould School of Law, Los Angeles, CA 90089
5Department of Psychiatry University of California, San Diego, School of Medicine, La Jolla, CA 92093
2Department of Psychiatry, Northeast Ohio Universities College of Medicine, Rootstown, OH 44272
3Value Options, Colorado Springs, CO 80920
4University of Southern California Gould School of Law, Los Angeles, CA 90089
5Department of Psychiatry University of California, San Diego, School of Medicine, La Jolla, CA 92093
1To whom correspondence should be addressed; tel: 330-762-3500, fax: 330-252-3024, e-mail: [email protected] Copyright © The Author 2009. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: [email protected] article has been cited by other articles in PMC.
As the concept of schizophrenia began to develop over a century ago, it was accompanied by little hope of recovery. As the second half of the 20th century began, new treatments and changing social conditions resulted in most long-term patients being discharged into the community. Many of these expatients showed more improvement than had been expected. Treatment approaches evolved to help these persons live better lives in the community. In the recent past, psychosocial and psychiatric rehabilitation approaches to treatment have increasingly incorporated perspectives of persons in recovery. These perspectives are explored with emphasis on how they have helped drive federal government and other perspectives on recovery. Particular attention is given to the varying views of psychiatrists, psychologists, and other highly trained persons who have themselves been diagnosed and treated for schizophrenia.
Keywords: recovery, rehabilitation, consumer, survivor
Recovery from schizophrenia is a concept that has evolved considerably since the early identification of this psychiatric condition. Emil Kraepelin,1 who is generally given credit as being the first to describe the condition we now call schizophrenia, characterized the disease as one of inevitable deterioration. Kraepelin saw this disease as one that resulted in “profound” and “terminal” dementia. Indeed, his term for the condition was dementia praecox. Eugen Bleuler,2 the individual said to first to have used the term, schizophrenia, also emphasized this disease’s downward course. These early pioneers did allow for the possibility of some improvement for those with the condition, but Kraepelin tended to see any such improvements as temporary remissions. Bleuler had a similarly pessimistic view of the possibility of recovery, using the terms, “recovery with defect”2(p186) and “healing with scarring,”2(p263) to describe the occasional patients who were seen to be returning toward normal functioning.
Despite allowing for the possibility of some degree of recovery, these, and other early writers, overwhelmingly emphasized the high likelihood of deterioration for persons with schizophrenia. As a result, this pessimistic view of the condition has dominated the psychiatric profession’s attitude toward this disease until fairly recently.
The pessimistic Kraepelin/Bleuler perspective concerning the prospect of recovery from schizophrenia that prevailed during the early 20th century began to change with the discovery and introduction of antipsychotic medications in the 1950s. One result of this nascent optimism was the discharge to the community of the vast majority of those who were institutionalized because of their disorders. Indeed, as the 21st century began, over 95% of those who were or would have been in government psychiatric hospitals were then “living in the community.”
The early pessimistic view is also not reflected in the current “Diagnostic and Statistical Manual of Mental Disorders IV-TR,” which lists “course” indicators of the disorder that contemplate complete recovery or interepisode remissions. Still, many mental health professionals remain pessimistic.
From the Medical (Disease) Model to the Rehabilitation Models
The increasing presence of seriously mentally ill persons in the community gave rise to the recognition that although some persons with schizophrenia and similar disorders could function, to varying degrees, in society despite their conditions, it quickly became clear that there were difficulties reintegrating serious mentally ill persons into society. Initially, this problem was addressed by caretakers focusing on social as opposed to medical aspects of the disorder. The primary goal of care became to increase former patients’ ability to “function” in society, as opposed to the traditional focus on attempting to diminish or eliminate the symptoms of the disorder. Interestingly, the term, function, began to include the resources, as well as the skills needed, to succeed in an environment. The term “psychosocial rehabilitation (PSR)” started to be used to describe this approach, which stressed the “rehabilitation” of those with the disability, as opposed to medical “treatment” of the disease. Importantly, stated principles of PSR included emphasis on “client choice,” “strengths,” and “empowerment of consumers.”
Before long, it became apparent to many that “psychosocial” aspects of these disorders could not be divorced from medical considerations. Increasingly, the importance of wellness and a “holistic approach” became to be recognized, and aspects of medical management were enveloped into the PSR concept. As attention to both medical and social factors began to merge, the term “psychiatric rehabilitation” was coined to reflect this integration of social and medical perspectives.
It is important to recognize that this psychiatric rehabilitation approach included attention to psychiatric symptoms, as well as attention to such skills as self-maintenance activities, vocational skills, using public transportation, social interaction skills, and similar variables.3–5 Also, the concepts of consumer choice and empowerment began to be seen as important aspects of one’s ability to function. Overall, the psychiatric rehabilitation approach seemed to allow for more optimism that persons with psychiatric disabilities could improve and increasingly integrate into society, even if they continued to exhibit some of the symptoms of their disorders.
From the Rehabilitation to the Recovery Approach
As the focus of care was expanding to include input from those with the psychiatric conditions, some of the persons who had been diagnosed and treated for these conditions began to organize. Local groups were put together with such names as the Insane Liberation Front, established in Portland, Oregon, in 1970. New York City’s Mental Patients’ Liberation Project and Boston’s Mental Patients’ Liberation Front were both founded the following year. In 1973, the first national meeting of such rights groups was held in Detroit. This gathering was referred to as the Conference on Human Rights and Psychiatric Oppression that met every year through 1985. At these sessions, the participants strategized, focusing primarily on how to gain more dignity and freedom for persons who had experienced what they saw as cruel and demeaning treatment from those in control of the mental health system that had afforded them few rights and subjected them to what they saw as bizarre and often cruel mistreatments.6,7 Not long after the first organizational meeting, some of the more educated or articulate of these “persons in recovery” began to produce reports about their own personal experiences, perceptions, and opinions concerning their experiences of recovery. These perceptions and opinions came from collective as well as individual perspectives and were frequently quite different from those of the professionals who had been managing and delivering mental health services. Increasingly, the voices of recovering persons began to demand that their own perspectives and their developing goals should take on more importance than just being additional elements of recovery. Indeed, many of the more strident voices of these recovering persons characterized the treatment they had experienced as oppression, often viewing professionals as part of the oppressive mental health system. Increasingly, these voices began to demand that their views become a stronger force in the determination of their journeys to recovery.
Judi Chamberlin,8,9 Sally Zinman,10 and their associates11 were some of the early, articulate, “persons in recovery” to begin to produce published materials concerning consumer perspectives of their psychiatric conditions. As time went by, numerous additional consumer voices began to be heard, and a virtual national consumer movement began to develop.12 Often, these consumer perspectives focused on demanding changes in how they were cared for and in how they were perceived by society in general. Increasingly, consumer voices began to incorporate a call for political, as well as mental health-care, changes.
Jacobson,13 in an overview where she purports to reflect these consumer perspectives, has argued that from a policy perspective there is an aspect of recovery in addition to the medical and rehabilitation approaches. Jacobson sees 2 ideologically driven, polarized views of recovery, differing primarily in the extent to which they emphasize individual or social transformation. She refers to viewing recovery as a process of symptom reduction (medical model), and/or of functional improvement and normalization (psychosocial or rehabilitation model), as being “mainstream” views. She sees these views as being primarily those of individual change, which she contrasts with a more radical perspective that she sees as almost entirely a matter of social change. Jacobson sees the focus on clinical improvement and functional normalization as being of primary concern to the psychiatric profession and other “elite” professionals along with their allies, the pharmaceutical manufacturers. 13(p164) She contrasts this with seeing recovery as primarily being a matter of social transformation, a view she sees as being linked closely with that of the disability rights movement.
Others also see “recovery” as having both radical and more mainstream interpretations. The psychiatrist Anthony Lehman14 describes this dichotomy a little more ominously. He refers to recovery not only as being a loaded word conveying an optimistic message leading to healthy fulfilling lives but also a word that can be interpreted as signaling that patients are victims of an oppressive mental health establishment from which they should be freed.
As the advocacy voices of consumers were beginning to emerge in the early 1990s, William Anthony,15 who had been championing a psychiatric rehabilitation model approach to addressing the needs of persons with psychiatric disorders, expanded his view of the concept of psychiatric rehabilitation. Anthony’s expanded view paid much more attention to concerns being articulated by recovering persons. He issued a call for recovery to become the “guiding vision” as to how we go about structuring our approach to caring for those with psychiatric disabilities. This vision has evolved into what many observers characterize as the recovery model. It is important to realize that by emphasizing the importance of consumer views, which often strongly emphasized the call for societal changes including a transformation of the mental health care delivery system, the emerging recovery movement necessarily embodied calls for the societal (political) changes mentioned by Jacobson, as well as calls for improved medical and rehabilitative care.
Impact of the Recovery Perspective on the Mental Health Delivery System
During the past half century, we as a society have clearly evolved from a position where recovery for persons with schizophrenia was not seen as a reasonable expectation to one where some form of recovery is not only seen as possible but, indeed, is expected. One very significant indication of the impact of this new view occurred with the report of the President’s New Freedom Commission (NFC) in 2003. 16 This report designated recovery as the single most important goal in its call for the transformation of the American mental health service delivery system. This was a remarkable development.
Although the NFC emphatically states that recovery was to be the major goal of the transformed system, not surprisingly, there appeared to be various perspectives as to the meaning of the term, recovery. A major attempt at forging a working definition of recovery was addressed on December 16 and 17, 2004, at a consensus conference held by the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration (SAMHSA), a division of the US Department of Health and Human Services. Participants at this conference included a large proportion of persons in recovery from schizophrenia and other serious mental illnesses including Patricia Deegan, Daniel Fisher, and Fred Frese, all mentioned below. Additionally, family members, administrators and professionals from various mental health entities, and other interested parties attended. The following “national consensus statement on mental health recovery” emerged from the deliberations that transpired at the conference.
“Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.”17
Additionally, emerging from the consensus conference was a statement of “The 10 Fundamental Components of Recovery.” These components were identified and explicitly described in the document produced by SAMHSA in the following manner:
Self-direction. Consumers lead, control, exercise choice over, and determine their own path of recovery by optimizing autonomy, independence, and control of resources to achieve a self-determined life. By definition, the recovery process must be self-directed by the individual, who defines his or her own life goals and designs a unique path toward those goals.
Individualized and person centered. There are multiple pathways to recovery based on an individual’s unique strengths and resiliencies as well as his or her needs, preferences, experiences (including past trauma), and cultural background in all its diverse representations. Individuals also identify recovery as being an ongoing journey and an end result as well as an overall paradigm for achieving wellness and optimal mental health.
Empowerment. Consumers have the authority to choose from a range of options and to participate in all decisions—including the allocation of resources—that will affect their lives and are educated and supported in so doing. They have the ability to join with other consumers to collectively and effectively speak for themselves about their needs, wants, desires, and aspirations. Through empowerment, an individual gains control of his or her own destiny and influences the organizational and societal structures in his or her life.
Holistic. Recovery encompasses an individual’s whole life, including mind, body, spirit, and community. Recovery embraces all aspects of life, including housing, employment, education, mental health and health-care treatment and services, complementary and naturalistic services, addictions treatment, spirituality, creativity, social networks, community participation, and family supports as determined by the person. Families, providers, organizations, systems, communities, and society play crucial roles in creating and maintaining meaningful opportunities for consumer access to these supports.
Nonlinear. Recovery is not a step-by-step process but one based on continual growth, occasional setbacks, and learning from experience. Recovery begins with an initial stage of awareness in which a person recognizes that positive change is possible. This awareness enables the consumer to move on to fully engage in the work of recovery.
Strengths based. Recovery focuses on valuing and building on the multiple capacities, resiliencies, talents, coping abilities, and inherent worth of individuals. By building on these strengths, consumers leave stymied life roles behind and engage in new life roles (eg, partner, caregiver, friend, student, employee). The process of recovery moves forward through interaction with others in supportive, trust-based relationships.
Peer support. Mutual support—including the sharing of experiential knowledge and skills and social learning—plays an invaluable role in recovery. Consumers encourage and engage other consumers in recovery and provide each other with a sense of belonging, supportive relationships, valued roles, and community.
Respect. Community, systems, and societal acceptance and appreciation of consumers—including protecting their rights and eliminating discrimination and stigma—are crucial in achieving recovery. Self-acceptance and regaining belief in one’s self are particularly vital. Respect ensures the inclusion and full participation of consumers in all aspects of their lives.
Responsibility. Consumers have a personal responsibility for their own self-care and journeys of recovery. Taking steps toward their goals may require great courage. Consumers must strive to understand and give meaning to their experiences and identify coping strategies and healing processes to promote their own wellness.
Hope. Recovery provides the essential and motivating message of a better future—that people can and do overcome the barriers and obstacles that confront them. Hope is internalized but can be fostered by peers, families, friends, providers, and others. Hope is the catalyst of the recovery process. Mental health recovery not only benefits individuals with mental health disabilities by focusing on their abilities to live, work, learn, and fully participate in our society but also enriches the texture of American community life. America reaps the benefits of the contributions individuals with mental disabilities can make, ultimately becoming a stronger and healthier nation.
Although SAMHSA has been designated as the lead federal agency in implementing the recovery approaches to mental health treatment, the federal agency that has probably been most aggressive in shifting its resources toward a recovery approach has been the Veterans Healthcare Administration (VHA) of the Department of Veterans Affairs (VA). Shortly after the President’s NFC’s recommendations were issued, the Serious Mentally Ill Committee of the VHA began to develop a Mental Health Strategic Plan incorporating the recovery vision. This plan developed over an extended period was signed by the undersecretary in 2004 and has been in the process of being implemented by the vast mental health delivery system of the VHA. Recently, this recovery oriented; Mental Health Strategic Plan of the VHA has been modified and updated with an eye toward streamlining implementation in VA Medical Centers and Clinics with the issuance of a VHA Handbook for Uniform Mental Health Services.18 Interestingly, this most recent VHA document stresses the importance of the definition of recovery, and its 10 components articulated in the report of the SAMHSA consensus conference.
Clearly, the view of recovery articulated by these federal agencies is highly reflective of the views articulated by those who have had personal experience recovering from these disorders. Indeed, the SAMHSA document is so focused on the perspective of the recovering person that, to some, there seems to be relatively little attention to the nature of the condition from which the person is recovering. An examination of the how the recovery concept is being articulated in the definition and components being proffered by federal government agencies reveals that there is particular importance given to the subjective views of the persons in recovery. The terms, “self-direction”, “person-centered”, and “hope”, strongly suggest that the final arbiter of whether recovery is occurring is the person who is experiencing the process of recovery.
A fairly strong secondary focus in the federal agencies’ characterization of recovery is the inclusion of what appear to be societal or political considerations. The descriptions of peer support, empowerment, and respect all relate to the individual’s interactions with others, including cooperation with other consumers as well as calling for a significant change in how consumers are perceived by clinicians, providers, and others in the broader society.
It is important to recognize that this federal accentuation of the subjective and societal factors relevant to recovery is a substantial broadening and alteration of both the medical and the rehabilitation approaches to treatment. Diminishing symptoms and increasing an individual’s ability to function both lend themselves to objective, scientific measurement of observable processes and factors that are presumably changing for the individual. The federal focus on the subjective and societal factors involved in recovery significantly overshadows the attention traditionally afforded the medical and functional limitations of psychiatric disabilities.
Implications for and Involvement of Schizophrenia Professionals
Reflecting on the impact of the recovery concept, and considering how important the consumer perspective has been in its development, what are some major messages for those referred to by Jacobson as the “elite professionals,” working in the area of schizophrenia? How does one accommodate the predominantly subjective and politically oriented recovery model into the objective, scientific approach of professionals working in the field of schizophrenia? One avenue to explore in answering this question could be the realization that some of these so-called professional elites are themselves persons who have been diagnosed with and treated for schizophrenia. Because of the obvious downside consequences of revealing that one has a personal history with schizophrenia, it is likely that most professionals in this category are unlikely to publicly identify themselves, particularly those younger professionals, for whom such revelations could be career damaging. However, during the past few decades, there have been a number of highly trained professionals who, for various reasons, have been willing to be open and even publish materials related to their conditions and the process of their recoveries.
Indeed, it turns out that many of those who were lending their voices to those of the rising consumer advocacy movement were persons who, despite having been diagnosed with, and undergone treatment for, schizophrenia or schizoaffective disorder, eventually were able to attain sufficient appropriate education to become certified in the mental health field and work as professionals. Many of these persons in recovery became nurses, social workers, occupational therapists, and other mental health professionals. Some had even been able to complete doctoral level training and function as psychiatrists, psychologists, or other professionals in the field. This latter category includes the following.
Carol North, MD, was one of the earlier psychiatrists to self-identify as having been diagnosed with and treated for schizophrenia. Her book, Welcome Silence: My Triumph over Schizophrenia,19 details her experiences as a young person diagnosed with schizophrenia and having the delusions and other symptoms associated with the condition. In her book, North relates her experience of recovery, but she attributes her recovery primarily to dialysis. However, she goes on to explain that research has failed to show that dialysis is a remedy for schizophrenia despite her experience with this procedure. North is particularly sensitive to the stigma accompanying serious mental illness.
Dan Fisher, PhD, MD, was another early voice of a person who had been diagnosed with schizophrenia and began to stress the fact that recovery from schizophrenia was possible, if not likely. Fisher20–23 had been initially diagnosed with schizophrenia while working as a research scientist in the 1960s. Despite this diagnosis and multiple hospitalizations for this condition, Dan was able to earn a second doctorate, this one in medicine, and went on to complete a psychiatric residency at Harvard University. Although Fisher only gradually disclosed his history of being treated and diagnosed with schizophrenia,21 he later became one of the appointed commissioners on the President’s NFC on Mental Health, where his voice was influential in forging the major recommendation of the Commission. That recommendation was that the mental health system in the Untied States be transformed in such a manner that the major goal for the transformed system would become “recovery” for persons with serious mental illnesses. Further details concerning Fisher’s advocacy activities can be found at www.power2u.org.
Elizabeth Baxter, MD, is a psychiatrist who identifies herself as being diagnosed with schizoaffective disorder. Baxter24 relates that she has been hospitalized several times for her psychiatric condition, twice toward the end of her psychiatric residency training. She relates that at one time her doctors indicated that the most she “would ever recover would be the ability to put objects into boxes on an assembly line.”24(p32) She25(p1298) refers to “my recovery” and “bright recovery” and attributes her recovery to her persistence, the encouragement of friends, family and caregivers, and spiritual growth.
Although Baxter has published and given numerous presentations discussing her personal experiences with psychosis, in consumer circles she is well known as the cocreator, with Sita Diehl,26,27 of BRIDGES: A Peer Education Program. BRIDGES, an acronym for, Building Recovery of Individual Dreams and Goals through Education and Support, is a structured peer education program based on the belief that those with mental illness “can and do recover a new and valued sense of self and purpose.” BRIDGES was designed with input from over 100 persons in recovery and is facilitated by and offered to persons recovering from mental illness throughout the country. BRIDGES draws heavily both from Diagnostic and Statistical Manual of Mental Disorders and other scientifically oriented descriptions of serious mental disorders and from writings of other persons in recovery. The program not only focuses on identifying traditional and other symptoms of mental illness but also embodies personal and advocacy perspectives.
Patricia Deegan, PhD, a psychologist, is another of the early voices to describe her experiences in overcoming schizophrenia. Deegan28–32 had been diagnosed with schizophrenia as a teenager, spent considerable time hospitalized in a state psychiatric facility, but was nevertheless able to continue her education, eventually earning a doctorate in psychology from Duquesne University. Of all the persons in recovery who have gone on to become fairly highly educated mental health providers, Patricia Deegan was one of the most effectively articulate. Deegan stressed that those of us in recovery faced a society in which discrimination, stigma, and disrespect were far too common. In a series of published articles, Deegan began to call for a very different focus regarding the concept of recovery from serious mental illness.
Deegan’s writings stressed that persons in recovery are not passive recipients of rehabilitation services and in her words that recovery refers to a “self pole” as opposed to the “world pole” of traditional rehabilitation approaches. She describes her experience of psychiatric treatment as one of dehumanization and depersonalization, spirit breaking, learned helplessness, and of having to overcome humiliating experiences. Deegan stresses the importance of reclaiming and recovering a sense of self after being devalued, dehumanized, and degraded. She emphasizes that every journey is unique and that the task is not to become normal but to become who you are and who you are called to be.29(p11) She also repeatedly calls for social justice and civil rights for persons with psychiatric disabilities.29(p9) Recently, Deegan has begun calling for more of a partnership model in the delivery of mental health treatment, with the partners being the practitioner and the client. She refers to this approach as a “shared decision making” process.30 For further information concerning the development of Deegan’s views and activities, see www.patdeegan.com.
F.J.F., PhD, the current senior author, is a psychologist who has been open and public about his being hospitalized numerous times for schizophrenia, since making a presentation about his condition at the Annual Convention of the American Psychological Association.33 Since becoming open about his condition, he has published works on schizophrenia advocacy, coping skills, recovery, and treatment.34–39 F.J.F.34 argues that recovering persons should work cooperatively with providers so that the mental health delivery system treats the mentally ill more effectively but with increased dignity and respect. In the early 1990s F.J.F. served as president of the National Mental Health Consumers’ Association. Also in the capacity of an advocate, F.J.F. has served on the boards of several national professional and advocacy organizations, including the National Alliance on Mental Illness (NAMI), the National Industries for the Severely Handicapped (NISH), the Treatment Advocacy Center, and the American Occupational Therapy Association, as well as serving on national committees for both the American Psychiatric Association and the American Psychology Association. During the past few years, he has been serving as a contributor to the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative.40 For more information about activities of F.J.F., see www.fredfrese.com.
Ron Bassman, PhD,41 was initially diagnosed with schizophrenia at age 22. He spent 2 extended periods, of 6 and 7 months, in private and public psychiatric hospitals, respectively, as an inpatient being treated for his condition. Nevertheless, Bassman went on to earn a doctorate in clinical psychology and later obtained a position with the New York State Office of Mental Health, where he participated in the development and implementation of a training module for psychiatric staff that emphasized key recovery themes such as hope, self-help, empowerment, mutual support, and respectful communication. Bassman also served a term as president of the National Association for Rights Protection and Advocacy.
In his writings, Bassman consistently refers to the iatrogenic effects of hospital treatment, the damage of having a psychiatric label, and the crushed dreams and stigma as being possibly more difficult to overcome than the original condition, itself.42(p137) He lists hope, safe niches, natural supports, reconciliation with family, absence of damaging treatment, belief in himself, successful experiences, meaningful work, psychotherapy, intimate relationships, and the passage of time as significant factors moving one toward recovery.42(p150–151) For additional information concerning Bassman’s views and activities, see www.ronaldbassman.com.
Al Siebert, PhD,(43–45) indicates that he was the first clinical psychology doctoral graduate from the University of Michigan to be selected for a postdoctoral fellowship at the Menninger Clinic, then located in Topeka, Kansas. Not long after arriving there, however, he was hospitalized in the nearby VA hospital and given the diagnosis “schizophrenic reaction, paranoid type, acute.” He relates how he was kept in a back ward for about 4 weeks, after which he left “against medical advice.” Interestingly, Siebert characterizes this experience as a months-long transformational experience that was the best thing that ever happened to him. In Siebert’s view, “from 20 percent to 30 percent of the people who go through a ‘schizophrenic’ period fully and completely recover from the condition and can do so with no medications.”44(p111) More information about Siebert’s views and advocacy activities can be found at www.successfulschizophrenia.org.
Other Professional Voices
In addition to the psychologists and psychiatrists who have been open and active in helping in the development of the recovery approach to treating their conditions, 3 other doctoral level professionals, who are not specifically certified as psychiatrists or psychologists, but who themselves have schizophrenia, have been active in the mental illness/schizophrenia arena, advocating for recovering persons by publishing and making presentations about their conditions.
E.L.K., PhD (sociology), the current second author, indicates that he was first diagnosed with schizophrenia in 1969. Since then, he has been hospitalized at least 14 or 15 times, in addition to having spent some time being homeless. E.L.K.46 readily acknowledges that he takes medication for his condition. Indeed, he states that without the combination of meditation and medication he would be in and out of the hospital very frequently. E.L.K. believes medications need to be separated from other aspects of the medical model that create helplessness. He believes symptoms are not written in stone, but the individual can learn to work with them and alter them in positive directions. Anxiety, eg, can be, as Kierkegaard pointed out, a spiritual teacher of letting go of concepts and notions that limit the openness of the present. He says that it has now been over 25 years since the pivotal point that started his recovery by introducing him to a spiritual practice that empowers him to face his difficulties. He has taken medications for schizophrenia for 27 years without interruption. He has also been diagnosed with depression, anxiety disorders, and mania but currently manages these conditions successfully without meds. Meditation helps him maintain balance and lower stress levels in his busy schedule. He practices zazen and centering prayer. Without meditation and prayer regularly, he may get overstressed and develop prodromal symptoms. He keeps them from returning by focusing and letting go of thoughts, ideas, concepts, and images. For “religiosity” or anxiety, eg, he focuses on the breath and as Dogen, the founder of Japanese Soto Zen, says “Thinks not thinking.” That is, he lets go of thoughts. This is similar to the recent development of Acceptance and Commitment Therapy of letting go of “mental boxes.” When he experiences the prodromal symptoms of mania, such as talking fast or racing thoughts, he mindfully walks slowly and deliberately while letting go of thoughts. As with everything, these states of prodromal symptoms pass. They do not worsen or return unless ignored.
He has not been hospitalized in 25 years. Doctor E.L.K. is currently vice president for Recovery, Rehabilitation and Mutual Support for Value Options, the second largest behavioral managed care company in the United States. He is also involved in research, having worked with several research centers: University of California, Los Angeles; Boston University; Nathan Kline Institute in upstate New York; and National Research and Development Institutes in New York City. His areas of research interest are mutual support, recovery, rehabilitation, and co-occurring substance abuse and mental illness. For further information about mental health activities of E.L.K., go to www.professored.com.
E.S., JD47–51, the current third author, is associate dean and chaired professor of law, psychology, and psychiatry and the behavioral sciences at the University of Southern California Gould School of Law; Adjunct Professor of Psychiatry at the University of California, San Diego, School of Medicine; and Assistant Faculty, the New Center for Psychoanalysis. E.S. has written several books on mental illness and the law.49–51 Several years after attaining tenure, E.S. produced a volume where she relates that she openly accepts that she has schizophrenia, from which she feels she will never fully recover and for which she willingly takes medication.47(p334) (This was after many years of resisting the diagnosis and need for medication.) Reflecting on some of the difficulties of her recovery experience, E.S. states that “Early on after being diagnosed as schizophrenic, I was given the prognosis: grave – the psychiatric equivalent of a death sentence, the assumption that I’d never live or work on my own.”48(pA5) However, she feels that the humanity and dignity of clients should be at the center of the mental health system and stresses that stigma is a major barrier for persons in recovery, seeing stigma against schizophrenia as perhaps the most profound of all stigmas.
E.S. and her colleagues are engaged in studying high-functioning people with schizophrenia to see if it is possible to identify strategies they have developed to manage their symptoms, hoping such strategies might be both teachable and effective for others.
Professor E.S. serves as a member of the Task Force on Serious Mental Illness and Serious Emotional Disturbance of the American Psychological Association and as a member of the Board for Mental Health Advocacy Services and the Bazelon Center for Mental Health Law.
Robert Miller in 1961 started as a medical student at Oxford University. However, in 1967, he experienced a serious psychotic breakdown that put him out of action as far as developing any other career was concerned, for about 3 years. However, in 1973, he obtained his doctorate from Glasgow. After several periods of postdoctoral study at British universities, he emigrated to New Zealand in 1977 and obtained employment as a lecturer in the Department of Anatomy and Structural Biology, University of Otago. Robert Miller has for many years tried to use his theoretical ideas about normal forebrain mechanisms to shed light on psychosis and the complex disorder called schizophrenia. As a result, he has written many articles on the theory of dopamine-mediated psychosis. He is currently working on an overall theory of schizophrenia, entitled “A neurodynamic theory of schizophrenia and related disorders,” which he introduced at a recent scientific conference.52 Since emigrating to New Zealand, Miller has worked in collaboration with the Schizophrenia Fellowship of New Zealand. He has written autobiographical accounts of his own illness, when he was a young man and also has produced an educational booklet on schizophrenia. He frequently participates in international conferences on schizophrenia research, and in 2007, he was given the “Officer of the New Zealand Order of Merit” award “for services to schizophrenia research.”
This article of course could neither begin to examine the entire spectrum of consumer perspectives on recovery from schizophrenia nor does it purport to adequately portray the views of each of the professionals mentioned above. However, a cursory look at the selected published comments of these professionals does allow one to draw certain inferences about the impact of these public disclosures as well as about the perspectives of these professionals concerning their own recoveries from schizophrenia.
Unfortunately, there still continues to exist in professional circles questions concerning the possibility of recovery from schizophrenia53 and particularly pessimism as to the possibility of persons with schizophrenia successfully completing academic work at the doctoral level.54 So, the fact that these professionals have publicly identified themselves as having been diagnosed and in treatment for schizophrenia, but have nevertheless obtained doctorates and are performing as professionals in the mental health field, in and of itself, sends a strong message. By being open about their psychiatric conditions, they are implicitly demonstrating that the diagnosis of schizophrenia no longer means that one will necessarily experience the lifetime cataclysmic consequences once assumed to accompany the disorder. Without necessarily being explicit about the issue, these professionals are establishing a significant functional measure of recovery. And clearly, the greater the number of persons, especially those in the mental health professions, who are willing to be open, and even public, about their conditions, the more normalized schizophrenia becomes. Such increasing numbers could be viewed as positive functional measure of increasing hope for others and for diminishing stigma.
Second, examination of the writings of these professionals reveals a rather wide divergence concerning their perspectives on their recoveries and on recovery in general. For example, Miller and F.J.F. see the biological correlates of schizophrenia as being important. Fisher, Bassman, and Siebert play down or even deny the importance of any biological considerations. E.S., Baxter, F.J.F., E.L.K., and Deegan clearly acknowledge that they have had to struggle with, and continue to experience, at least some of the classic symptoms of schizophrenia. Such symptoms include sometimes experiencing delusions and hallucinations, as well as apathy, avolution, and/or other negative symptoms. Others, such as North, Siebert, Fisher, and Bassman downplay or deny that they currently experience any symptomatology. The latter 3 of these advocates tend to see the need to substantively change health-care and societal conditions, in general, as their primary concern. Indeed, Fisher and Siebert contend that persons diagnosed with schizophrenia can “completely recover” often without the use of psychotropic medications. Views also vary widely concerning such topics as dangerousness, homelessness, cooperation with family members, and the use of coercive treatments. Contrary to the view often articulated by consumer advocates,55 among these consumer/professionals at least, there is no monolithic “consumer perspective” on many aspects of recovery.
Nevertheless, virtually all these persons stress the difficulty of overcoming pervasive stigma, hostile attitudes, and other societal barriers to their recovery. One strong message that is voiced by these professionals is that they see a major barrier to their recovery as being how persons with schizophrenia have been, and continue to be, treated by society, including treatment by those entrusted with their care. Many do not see that their degree of recovery is primarily a function of how disabled they are but feel that traditional cultural, attitudinal, and linguistic barriers to their recovery are important factors that must be considered and measured as we address the issue of recovery. Again, Bassman and Fisher see oppression by the mental health system and by society in general as a primary target for change in order for recovery to occur. Siebert, who on occasion has denied the existence of schizophrenia in himself or in anyone else, sees the hostility of the mental health profession as the major impediment to recovery for those labeled with this condition.
Weighing of the Value of Medical, Functional, Subjective, and Societal Factors
Concerning the broad range of views of even the most educated of persons in recovery from schizophrenia, it is not surprising that there exists considerable variation concerning the question of relative weighting of the several approaches to recovery addressed in this article. Medical/biological approaches to psychiatric disabilities include the traditional focus on symptom reducing but increasingly are encompassing other, related health issues, such as obesity, cardiovascular illness, hyperlipidemia, diabetes, and other conditions that may be associated with medication side effects, and other issues affecting morbidity and mortality that may accompany serious mental illnesses.56,57
The measurable functional, psychosocial factors, ie, the degree to which individuals can care for themselves and can find a satisfactory role and quality of life in society, continue to be vitally important, but questions concerning the degree these matters as viewed by professionals are weighted, as opposed to the more subjective and societal factors embodied in the recovery model, is a matter that can be approached in a variety of ways by different consumer/survivor advocates. For example, the 3 authors of this article address this question very differently.
E.L.K. addresses the question concerning the weighing of these various factors with comments from a global perspective as well as from his personal experience. He comments:
In a recent international study of schizophrenia, 60% of those with this disorder were working for pay or doing significant household labor, 40% were working for pay, and 20% with moderate to severe disability on Global Assessment of Functioning Scale were working for pay. This latter is called “mixed recovery” by Kim Hopper.58 Poverty and unemployment are at least as much a function of stereotyping and discrimination of what we label “bizarre” behavior and fear as a society as a medical complication of an illness. Neither does most of India isolate people who exhibit such behavior nor do some other countries, and this is not just rural areas. As American styled culture grows in these areas, it will be interesting to see if this continues. The constant barrage of fearful images in the media has a lot to do with this.
E.L.K. indicates that for him, personally, symptom reduction is about 95% or better from when he was very ill. But this is due as much to his zazen practice as medication. This practice allows him to carefully observe under what conditions prodromal symptoms arise, what sustains them, and when they pass away. Due to this, he is able to immediately recognize any precursors to delusions or hallucinations such as thought patterns that tend to paranoia (thinking he knows others’ intentions), racing thoughts, or high anxiety and take appropriate measures.
His social functioning is better actually than preillness (He was painfully shy and withdrawn.) or during illness. He serves as a vice president of a large corporation, a fact that he feels speaks for itself.
Side effects. E.L.K. indicates that he had to get off typical medication and go to an atypical because of significant dystonia, akathisia, and oculogyric crises. On one atypical, he gained a lot of weight and had to switch to another. He has lost 50 pounds since then with the help of careful diet and exercise. His goal is to lose 15 more pounds, and he is on course to do that. At that point, he will be at 180 pounds, his preillness weight. This has helped tremendously with fatigue and depression and with having energy to do his daily career activities.
Subjective weighing. Symptom reductions and learning how to “fit in” so as to have “acceptable” behavior by current American standards has been crucial to recovery of E.L.K. He is able to monitor what people’s expectations are and express himself appropriately. He has social intelligence to a fairly high degree in his estimation while he maintains personal autonomy and does not introject others’ opinions by trying overly to please and thus create resentment in himself. E.L.K. feels he learns very quickly from the consequences of his behavior and adjusts quickly.
One the other hand, F.J.F. takes a very different approach to the question of weighing the various factors involved in recovery. F.J.F. relates that he and 3 other doctoral level consumer/survivors (the others having been diagnosed with conditions other than schizophrenia) have suggested that relative weighing of scientific vs subjective factors should perhaps be a function of the degree of disability experienced by the individual with the serious mental illness.59 These authors suggest that for very disabled persons, more weight should be afforded to evidence-based, scientifically oriented factors, but as the person experiences increasing recovery, more autonomy (empowerment) should be afforded to the person in recovery to make their own decisions as to how they might best determine the nature of their recovery journey. Not surprisingly, some professionals who have been diagnosed and treated for serious mental illness, including Daniel Fisher,60,61 mentioned above, have taken issue with this approach to the weighting of subjective perspectives of those with serious mental illnesses. Once again, while the recovery movement stresses the importance of empowerment and related subjective factors, there is clearly wide divergence in the “educated consumer” community as to the weight to be given to these subjective factors, particularly for the homeless, the imprisoned, and the very disabled in general. This also holds true for the societal/political factors embodied in the recovery concept, as well.
E.S. is somewhere in the middle. As a result of some very degrading and painful treatment, E.S. has described herself as very “pro psychiatry but very anti-force.” Like “medical model” people, E.S. believes that mental illness is a medical disease that is often helped by both medication and therapy. Like more radical consumers, she believes that force is almost always a bad solution. Yet, she takes these positions for pragmatic reasons, not because she (or anyone else) has a slam dunk argument about the philosophical issues involved: these views work for her—help her live a good life. E.S. allows that others may be better served by thinking, eg, that the entire problem is social and devising social solutions for themselves.
As for her location on the question of whom the recovery model should be directed toward, she is somewhere between E.L.K. and F.J.F. E.S. believes that the appropriate question is one of capacity, where capacity requires a low level of ability. If someone lacks that low level of ability, we do not and should not respect their self-determining choices a la the recovery model; a benign other should decide for them. (If you think taking medication will cause a nuclear explosion, someone else should decide whether the medicine is right for you.) But if the person has that low level of capacity, their determination of what is best for them should be decisive, even if the medical profession sees that choice as irrational or otherwise substandard. E.S. has devoted a large part of her career to trying to understand and measure capacity.
It is also apparent that some, if not most, of these professionally trained individuals give much more consideration to the symptoms and functional difficulties that have traditionally been seen to accompany schizophrenia than the emphasis these are afforded by the official (SAMHSA) definition of recovery and the listing of components thereof. Baxter, Miller, F.J.F., and E.S. particularly stress the importance of the biological determinants and concomitants of schizophrenia and other serious mental illnesses.
An important point remains, reflected in comments of E.S.—the recovery model’s focus on self-determination may be somewhat at odds with its listing of 9 other features of the model. An individual consumer may want to be allowed the agency of making his own choice. But his choice may be to adopt the medical model and ask the doctor paternalistically to decide for him. His autonomous choice may be to be nonautonomous. Or he may want to make his own choice but reject that adopting a “holistic” approach is a good idea or that “peer support” is an admirable goal. In other words, the focus of the recovery model on the individual’s perception of what is good for him may pull against some of the other features of the model.
Expectation of recovery from schizophrenia is a concept that has evolved to a remarkable degree during the past century or so, since the disorder’s initial identification and nosological recognition. Beginning with an extremely pessimistic view, indeed one that emphasized the likelihood of continuous deterioration for those diagnosed with this disorder, we have arrived at a point where at least some degree of recovery is increasingly the expectation for persons with this widely misunderstood condition. Although there would appear to be varying opinions concerning how this term, recovery, should be defined, it is apparent that adoption of the concept by the federal government and other organizational entities is generating considerable interest and even optimism among many consumers, advocates, providers, payers, and others who influence the delivery of mental health services.
Also, there are increasing numbers of mental health professionals, including psychiatrists, psychologists, and other doctoral level practitioners, who are willing to become open about their personal experiences with this condition. Many of these professionals have been dedicating their time and talents in efforts to merge their academic and professional training with their personal experiences. Although there is a wide range of views and opinions as to how these professionals characterize their recoveries, thus far they, along with other advocates, have been able to participate in very substantive changes in our approach to schizophrenia. While many professionals still remain relatively pessimistic about recovery from schizophrenia, emphasizing deficits, impairments, and dangerousness, recovering persons clearly are increasingly being brought into the greater society and increasingly being afforded more dignity and more respectful roles in society, including roles at the professional level.
Thus, our focus on some highly functioning consumers with schizophrenia has allowed 2 points to be brought forward: that the pessimistic view of schizophrenia is belied by their existence and that these consumers have views about recovery somewhat at odds with each other. Another important tack will be to look at consumers with schizophrenia who are not necessarily high functioning according to some external ranking of jobs but who are high functioning in the sense of living up to their premorbid potential. E.S. and her colleagues plan to study this population in a follow-up study to their “high-functioning” study being conducted now. Judging living up to one’s premorbid potential may be difficult, but perhaps one could look at different things—the person’s ability on psychological testing, how high a level they functioned at before becoming ill (Were they a good student?), and perhaps the occupational functioning of family members. None of these is foolproof but may be useful indicators. Studying the views of recovery in this group, too, could shed further light on what the concept means and whether it is a useful concept.
1. Kraepelin E. In: Dementia Praecox and Paraphrenia. Barclay RM, translator. Edinburgh, UK: E and S Livingstone; 1919. [Google Scholar]2. Bleuler E. In: Dementia Praecox or the Group of Schizophrenias. Joseph Zinkin., translator. New York, NY: International Universities Press; 1950. [Google Scholar]3. Anthony W, Cohen M, Farkas M. Psychiatric Rehabilitation. Boston, Mass: Center for Psychiatric Rehabilitation; 1990. [Google Scholar]4. Cook JA, Hoffschmidt SJ. Comprehensive models of psychosocial intervention. In: Flexer RW, Solomon PL, editors. Psychiatric Rehabilitation in Practice. Stoneham, Mass: Butterworth-Heinemann; 1993. pp. 81–97. [Google Scholar]5. Liberman RP. Recovery From Disability: Manual of Psychiatric Rehabilitation. Washington, DC: American Psychiatric Publishing; 2008. [Google Scholar]6. Valenstein ES. Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Radical Treatments for Mental Illness. New York, NY: Basic Books; 1986. [Google Scholar]7. Deutch A. The Shame of the States. New York, NY: Harcourt, Brace and Company; 1948. [Google Scholar]8. Chamberlin J. On Our Own: Patient-Controlled Alternatives to the Mental Health System. New York, NY: Hawthorn Books; 1978. [Google Scholar]9. Chamberlin J. Speaking for ourselves. An overview of the ex-psychiatric inmates movement. Psychosoc Rehabil J. 1984;8:56–63. [Google Scholar]10. Zinman S. A patient-run residence. Psychosoc Rehabil J. 1982;6:3–11. [Google Scholar]11. Zinman S, Harp HT, Budd S. Reaching Across: Mental Health Clients Helping Each Other. Riverside, Calif: California Network of Mental Health Clients; 1987. [Google Scholar]12. Frese FJ. Advocacy, recovery, and the challenges of consumerism for schizophrenia. In: Buckley P, editor. Psychiatric Clinics of North America. Philadelphia, Pa: W.B. Saunders; 1998. pp. 233–249. [PubMed] [Google Scholar]13. Jacobson N. In Recovery: The Making of Mental Health Policy. Nashville, Tenn: Vanderbilt University Press; 2004. p. 164. [Google Scholar]14. Lehman AF. Putting recovery into practice: a commentary on “What recovery means to us. Commun Ment Health J. 2000;36:329–331. [PubMed] [Google Scholar]15. Anthony WA. Recovery from mental illness: the guiding vision of the mental health service system in the 1990’s. Psychosoc Rehabil J. 1993;16:11–23. [Google Scholar]19. North C. Welcome Silence: My Triumph Over Schizophrenia. New York, NY: Simon & Schuster; 1987. [Google Scholar]20. Fisher D. The empowerment model of recovery: finding our voice and having our say. www.power2u.org. Accessed September 3, 2008. [Google Scholar]21. Fisher DB. One view: a psychiatrist’s gradual disclosure. OMH News. November 1994:16. [Google Scholar]22. Fisher DB. Hope, humanity, and voice in recovery from psychiatric disability. J Calif Alliance Ment Ill. 1994;5:7–11. [Google Scholar]23. Fisher D. Health care reform based on an empowerment model of recovery by people with psychiatric disabilities. Hosp Community Psychiatry. 1994;45:913–915. [PubMed] [Google Scholar]24. Baxter B. Person first: my journey of recovery. NAMI Advocate. 2006;32:31–32. [Google Scholar]26. Baxter EA, Diehl S. Emotional stages: consumer and family members recovering from the trauma of mental illness. Psychiatr Rehabil J. 1998;21:349–355. [Google Scholar]27. Diehl S, Baxter E. Nashville, Tenn: Tennessee Department of Mental Health and Developmental Disabilities; 2001. Back from where I’ve been: stories from the BRIDGES program of recovery from mental illness. [Google Scholar]28. Deegan PE. Recovery: the lived experience of rehabilitation. Psychosoc Rehabil J. 1988;11:11–19. [Google Scholar]29. Deegan PE. Recovering our sense of value after being labeled. J Psychosoc Nurs Ment Health Serv. 1993;31:7–11. [PubMed] [Google Scholar]30. Deegan PE, Drake RE. Shared-decision-making and medication management in the recovery process. Psychiatr Serv. 2006;57:1636–1639. [PubMed] [Google Scholar]31. Deegan PE. Spirit breaking: when the helping professionals hurt. Human Psychol. 1990;18:301–313. [Google Scholar]32. Deegan PE. The independent living movement and people with psychiatric disabilities: taking back control over our own lives. Psychosoc Rehabil J. 1992;15:3–19. [Google Scholar]33. Buie J. Psychologist prevails despite schizophrenia. APA Monitor. 1989;20:23. [Google Scholar]34. Frese FJ. The role of psychologists in serving the seriously mentally ill: a call for partnership between the served and the servers. In: Johnson DL, editor. Service Needs of the Seriously Mentally Ill: Training Implications for Psychology. Washington, DC: American Psychological Association; 1990. pp. 33–36. [Google Scholar]35. Feiner J, Frese F. Recovery in schizophrenia. In: Saddock BJ, Saddock VA, Ruiz P, editors. Comprehensive Textbook of Psychiatry. 9th ed. Baltimore, Md: Wolters Kluwer; 2009. [Google Scholar]36. Frese FJ. Cruising the cosmos—part three. Psychosis and hospitalization: a consumer’s recollection. In: Hatfield AB, Lefley H, editors. Surviving Mental Illness: Stress, Coping and Adaptation. New York, NY: Guilford Press; 1993. pp. 67–76. [Google Scholar]37. Frese FJ. A Calling. Second Opinion. 1994;19:11–25. [Google Scholar]38. Frese F. Self-help activities (of persons in recovery from serious mental illness) In: Mueser KT, Jeste DV, editors. The Clinical Handbook of Schizophrenia. New York, NY: Guilford Press; 2008. pp. 298–305. [Google Scholar]39. Frese FJ. The mental health consumer’s perspective on mandatory treatment. In: Munetz MR, editor. Can Mandatory Treatment Be Therapeutic? New Directions for Mental Health Services, 75. San Francisco, Calif: Jossey-Bass; 1997. pp. 17–26. [PubMed] [Google Scholar]40. Nuechterlein KH, Green MF, Kern RS, et al. The MATRICS consensus cognitive battery: part 1. Test selection, reliability, and validity. Am J Psychiatry. 2008;165:203–213. [PubMed] [Google Scholar]41. Bassman R. Consumers/survivors/ex-patients as change facilitators. In: Frese FJ, Lamb HR, editors. The Role of Organized Psychology in Treatment of the Seriously Mentally Ill. New Directions for Mental Health Services, No. 88. San Francisco, Calif: Jossey-Bass; 2000. pp. 93–102. series-ed. [Google Scholar]42. Bassman R. A Flight to Be: A Psychologist’s Experience From Both Sides of the Locked Door. Albany, NY: Tantamount Press; 2007. [Google Scholar]43. Siebert A. My transforming peak experience was diagnosed as paranoid schizophrenia. In: Frese FJ, Lamb HR, editors. The Role of Organized Psychology in Treatment of the Seriously Mentally Ill. New Directions for Mental Health Services, #88. San Francisco, Calif: Jossey-Bass; 2000. pp. 103–111. series-ed. [PubMed] [Google Scholar]44. Siebert A. Peaking Out: How My Mind Broke Free From the Delusions in Psychiatry. Portland, Ore: Practical Psychology Press; 1995. [Google Scholar]45. Siebert A, April 1987 . Presentation at: Annual Meeting of the Western Psychology Association. San Jose, Calif: 1987. Should some cases of schizophrenia be facilitated instead of treated? [Google Scholar]47. Saks ER. The Center Cannot Hold: My Journey Through Madness. New York, NY: Hyperion Books; 2007. [Google Scholar]48. Saks E. A professor’s story: going public after tenure. The American Prospect. 2008:A4–A5. [Google Scholar]49. Saks ER. Refusing Care: Forced Treatment and the Rights of the Mentally Ill. Chicago, IL: University of Chicago Press; 2002. [Google Scholar]50. Saks ER. Interpreting Interpretation: The Limits of Hermeneutic Psychoanalysis. New Haven, CT: Yale University Press; 1999. [Google Scholar]51. Saks ER, Behnke SH. Jekyll on Trial: Multiple Personality Disorder and Criminal Law. New York, NY: New York University Press; 1997. [Google Scholar]52. Miller R. Presentation at the Winter Workshop on Schizophrenia and Bipolar Disorders. “A neurodynamic theory of schizophrenia”: introduction. February 5, 2008; Montreux, Switzerland. [Google Scholar]53. Weiden PJ. Symposium presentation at: Annual Meeting of the American Psychiatric Association. Is recovery attainable in schizophrenia?: biologic, pharmacologic, and psychologic perspectives. May 5, 2008; Washington, DC. [Google Scholar]54. Hu R. Symposium presentation at the 57th Institute on Psychiatric Services. Cognitive dysfunction in schizophrenia. October 5, 2005; San Diego, Calif. [Google Scholar]55. Satel S. How Political Correctness Is Corrupting Medicine. New York, NY: Basic Books; 2000. p. 50. [Google Scholar]56. Hopper K, Harrison G, Janca A, Sartorius N. A Report from the WHO Collaborative Project, The International Study of Schizophrenia. New York, NY: Oxford University Press; 2007. Recovery from schizophrenia: an international perspective. [Google Scholar]57. Meyer JM, Nasrallah HA. Medical Illness in Schizophrenia. Washington, DC: American Psychiatric Publishing; 2003. [Google Scholar]58. Manderscheid R, Druss B, Freeman E. Data to manage the mortality crisis. Int J Ment Health. 2008;37:49–68. [Google Scholar]59. Frese FJ, Stanley J, Kress K, Vogel-Scibilia S. Integrating evidence-based practices and the recovery model. Psychiatr Serv. 2001;52:1462–1468. [PubMed] [Google Scholar]60. Fisher DB, Ahern L. To the editor concerning “evidence based practices and recovery” Psychiatr Serv. 2002;53:633. [PubMed] [Google Scholar]61. Frese FJ, Stanley J, Kress K, Vogel-Scibilia S. In reply (to letter To the Editor concerning “Evidence-Based Practices and Recovery” by Fisher, D.B. & Ahern, L) Psychiatr Serv. 2002;53:633–634. [Google Scholar]
Full Recovery from Schizophrenia – PCH Treatment Center
At PCH, we know recovery is possible because we’ve witnessed it personally. Even for a diagnosis as challenging as schizophrenia, there’s always hope. Here’s a firsthand account written by Tracey Higgins, reflecting on her full recovery from schizophrenia. Sharing our experiences and finding common ground are critical steps on the road to recovery, so we’re sharing Tracey’s story hoping it will help someone else out there.
My full recovery from schizophrenia happened more than 20 years ago. I remember it like it was only yesterday. I was in my early 20s and had been experiencing flashbacks from my childhood while bathing my son. At first, I was startled by them and had no idea what they meant. I could only see glimpses into the incident that caused me to enter the world of schizophrenia.
During that time, the voices in my head were getting louder and yelling at me to kill myself. Instead of exploring the incident, I gave in to the voices and ignored the flashback. But the flashback kept on resurfacing, so I made an appointment to see a therapist. I chose to see a therapist rather than a psychiatrist because past experiences with psychiatry had taught me not to trust psychiatrists. Most psychiatrists don’t provide talk therapy. And I needed to talk.
As soon as I got in to see a therapist and brought up my schizophrenia, I watched her squirm in her chair. I was devastated by her reaction. It took so much courage to get there and now she was afraid of me. I attended eight sessions with the therapist, however; she didn’t know how to do therapy with me, so it was counterproductive. The best she could do for me was to suggest some books to read on abuse. One of those books was, “The Courage to Heal: A Guide for Women Survivors of Child Sexual Abuse” by Laura Davis. Later that book would become essential to my recovery from schizophrenia. Until then, I stuffed it into my dresser drawer, where it remained untouched for some time.
The strangest thing about buying that book was that I had no conscious awareness that I had even been sexually abused in the first place.
Schizophrenia had been protecting me from that truth.
I began to ignore the flashback and the continuing ones that kept popping up out of nowhere in my mind. They were presenting some very disturbing scenes that I was too scared to confront or unable to cope with. So, I focused on the threatening voices in my head and the persistent symptoms of schizophrenia. I wasn’t about to let go of schizophrenia just yet. I carried on as best I could. I continued to speak in riddles and share my ideas with others that had no basis in reality. I was the laughingstock of my family. I was living in this brilliant yet terrifying world called schizophrenia, where nobody could find me.
One weekend I had a male friend and his daughter over for a sleepover. While checking in on my friend’s daughter, I found her lying naked on a bed with her father. He was touching her inappropriately. As a result of witnessing that, an explicit, more severe flashback raced across my mind like an army of soldiers. I didn’t know how to respond, so I went to bed and lay there wide awake while feeling terrified.
The next morning, I asked my friend to leave my house. Afterward, I called my friend’s sister-in-law and told her about the incident. She said, “We suspected something like that.”
Next, I called someone to come get my son and take him for a couple of weeks. For that entire time my son was gone, I called him every day to tell him how much I loved him. I had to protect him from seeing me come undone. He was 4 years old.
Then, I went and got the book, “The Courage to Heal: A Guide for Women Survivors of Child Sexual Abuse”, out of the dresser drawer. Page after page, I scoured through its contents to find tips and tools to help me. The book suggested that I write things down and use a bat to siphon off my anger, so I went and bought a typewriter and a jumbo plastic bat from a Toys “R” Us store.
The following morning, I sat at my typewriter and pounded away at the keys. To the reader, my writings looked like some kind of secret code or some newly discovered language. But within that text, fragments of forgotten memories from my childhood were beginning to emerge. The one incident of the sexual assault in my mother’s bedroom was now present.
The shock of realizing what had happened to me brought me to my knees. I sobbed uncontrollably while lying on the floor curled up in a ball. I took that plastic bat and pounded it on my mattress until I fell into exhaustion. I lay there so quietly for what seemed like hours. Then I’d go another round of crying and release the pent up emotions that had me stuck inside the world of schizophrenia for many years. Back and forth I’d go from crying to expressing my anger. My body was taking a beating. At one time, I thought I was going to have a heart attack, so I made an appointment with my family physician. When I got in to see her, I was a mess. I actually collapsed on the floor. I told her what was happening and she wrote out a prescription for me. I believe what she gave me was Ativan.
When I got back home, I threw out the pills and decided to go through recovery drug-free. I only had a short time to deal with my schizophrenia, so I figured the pills would prolong my recovery. I made that decision based on my gut feeling. And I believe at the time it was a good choice; however, if I had the opportunity to redo my recovery, I would have used medications to take the edge off the powerful feelings that were emerging.
The more I released the emotions surrounding the trauma, the more the symptoms of schizophrenia were losing their power over me. What looked like a mental breakdown was actually a breakthrough from schizophrenia.
After a while, I was able to line up and match the incident of abuse with the symptoms. Things were starting to make sense to me. The more I understood my schizophrenia, the more confident I became in my recovery. The pain of it was all-consuming but I was making progress. Things were becoming a little easier, yet the pain was all too real and raw.
After some time of going back and forth from dealing with the trauma, I went out on my front step to get some fresh air. I was just sitting there quietly, reflecting on my childhood, and all of sudden I heard some birds chirping. I looked up and admired them. Then, I discovered the voices were gone. The worst was over. I was going to be OK. From that point on, I never looked back.
Recovery from schizophrenia wasn’t easy. After my initial recovery, I had to learn to live and find my place in the world. Today, I have found my place. And by telling my story, I hope to influence many people to understand that no one is beyond hope. That there is hope for this condition we call schizophrenia.
Overview – Schizophrenia – NHS
Schizophrenia is a severe long-term mental health condition. It causes a range of different psychological symptoms.
Doctors often describe schizophrenia as a type of psychosis. This means the person may not always be able to distinguish their own thoughts and ideas from reality.
Symptoms of schizophrenia include:
- hallucinations – hearing or seeing things that do not exist outside of the mind
- delusions – unusual beliefs not based on reality
- muddled thoughts based on hallucinations or delusions
- losing interest in everyday activities
- not caring about your personal hygiene
- wanting to avoid people, including friends
Schizophrenia does not cause someone to be violent and people with schizophrenia do not have a split personality.
When to seek medical advice
If you’re experiencing symptoms of schizophrenia, see a GP as soon as possible. The earlier schizophrenia is treated, the better.
There’s no single test for schizophrenia. It’s usually diagnosed after an assessment by a mental health care professional, such as a psychiatrist.
Causes of schizophrenia
The exact cause of schizophrenia is unknown. But most experts believe the condition is caused by a combination of genetic and environmental factors.
It’s thought that some people are more vulnerable to developing schizophrenia, and certain situations can trigger the condition such as a stressful life event or drug misuse.
Schizophrenia is usually treated with a combination of medicine and therapy tailored to each individual.
In most cases, this will be antipsychotic medicines and cognitive behavioural therapy (CBT).
People with schizophrenia usually receive help from a community mental health team, which offers day-to-day support and treatment.
Many people recover from schizophrenia, although they may have periods when symptoms return (relapses).
Support and treatment can help reduce the impact the condition has on daily life.
Living with schizophrenia
If schizophrenia is well managed, it’s possible to reduce the chance of severe relapses.
This can include:
- recognising the signs of an acute episode
- taking medicine as prescribed
- talking to others about the condition
There are many charities and support groups offering help and advice on living with schizophrenia.
Most people find it comforting talking to others with a similar condition.
Page last reviewed: 11 November 2019
Next review due: 11 November 2022
Recovering from Schizophrenia | NAMI: National Alliance on Mental Illness
Recovering from Schizophrenia
I started to hear voices. The voices were degrading. The radio started talking to me. I thought that people were conspiring against me.
I was perplexed and disturbed. I was isolated and unable to function. I experienced a nervous breakdown and was hospitalized.
The hospital was an unfamiliar, restricted environment. My symptoms persisted and my anxiety sparked. Treatment included medications with adverse side effects.
I was discharged with a diagnosis of schizophrenia. It seemed that my goals and dreams were shattered. I didn’t want to admit that I had schizophrenia.
I was involuntarily committed to outpatient treatment. I had no control over my choices or my illness.
I was discouraged and I felt isolated.
Trying to run away from Schizophrenia was futile.
Outpatient treatment educated me about schizophrenia and helped me accept what I could and couldn’t change.
Acceptance came easier when I learned that recovery is possible.
NAMI, The National Alliance on Mental Illness, offered support groups where I knew I was not alone. I learned that mental illness is nothing to be ashamed of, which was essential for my accepting it.
I had a stellar support system, which also included my mother and friends.
Treatment required a trusting relationship between me and the therapists, as it was a collaboration and teamwork. Treatment also required patience and stamina. Medications had negative side effects and the process for finding the one that was therapeutic was arduous. Cognitive therapy, such as counseling, entailed much practice and it was very trying.
Eventually, I found a medication that alleviated my symptoms. Coping skills learned from cognitive therapy helped manage symptoms, such as voices, radio signals and people conspiring against me. With cognitive therapy, I became accustomed to recognizing and dismissing the symptoms, and I later experienced a reduction in paranoia.
Treatment also included goal planning and community integration. Goal planning was person centered, in that it was based on my unique strengths and will. Goal planning helped me achieve a quality life. Community integration helped me integrate into society after isolation.
Support groups have been essential in my treatment. They have provided social integration and I have also learned a treasure trove of coping skills from other members of the group.
In addition to my treatment, I have found that a positive attitude makes the difference between discouragement and perseverance. I have been blessed with a great support system and I have found that exercise is important. Humor is great medicine and spirituality has given me much peace and strength as well.
I later graduated from high school. Another milestone was completing a college education, where I majored in communications.
Being a support group facilitator has been rewarding. In addition, I write to educate people about mental illness and to serve as an advocate for others with disabilities. I am a speaker about mental illness and I am on committees that advocate for ethical treatment and rights for people with disabilities.
People with mental illness and their therapists work incredibly hard to recover. One must persevere and never give up. Success is possible.
90,000 News: 10 Years of Schizophrenia – Expert
Arnhild Lauweng. Her name is similar to the name of the heroine of a Scandinavian fairy tale. In fact, it is – the story of Arnhild fully corresponds to the canons of classical fairy-tale drama: a tragic event at the beginning, long trials in the middle, despair, struggle, a miracle. Fairy tales are usually not told about what follows after a miracle. In reality, ordinary life begins: dissertation, two dogs, friends, travel, work.
Lauweng – psychologist. Preparing a doctoral dissertation. She has small hands and a childish expression on her face. She sits in the front row in a large hall at a conference of psychoanalysts organized by the Moscow Association for Analytical Psychology, and listens to Allan Guggenbühl’s talk on how psychotic children in Georgia were treated with the help of myth-drama.
– Before I became a psychologist, I was sick with schizophrenia. Ten years, says Arnhild. – I saw wolves and cut myself severely. I remember how it was, but now it’s a completely different matter.
Wolves appeared everywhere – in the class where Arnhild studied, on the street, in the hospital. They huddled together and attacked her. She heard their growls and fetid breath and fled from them as best she could. There were also rats and crocodiles. And the mysterious birds of prey “vilvet”, which strove to tear it to shreds. But she inflicted real injuries on herself – she cut herself into blood, banged her head against the wall so that she had to be tied up.
Schizophrenia is a serious illness associated with the breakdown of thinking processes and emotional reactions.Auditory and visual hallucinations, paranoid, fantastic delusions, disorganized speech and thinking against the background of significant social dysfunction. “Glass and wood”, psychiatrists say about schizophrenia: fragility, on the one hand, flattening of reactions, on the other. Splitting of the psyche. Loss of connection with reality. And, as a rule, all this progresses over time.
“Now I’m healthy and no longer afraid of getting sick,” says Arnhild. – I remember what the world around me looked like then. And I’ve had “temporary improvements.”I remember how I perceived them. This is not the case now. And I must admit that this is also possible.
– This cannot be! – colleagues whisper, trying to keep politically correct smiles.
Indeed, to go crazy and come back is like dying and resurrecting. Arnhild, when she was resurrected, wrote the book “Tomorrow I was always a lion.”
“Leo is power,” she explains. “This is what I’ve always been. “Tomorrow I will be a lion” is like playing with the future, past and present, because I am me all the time.
This book is a document that describes the history of an incurable illness and recovery, a book that healthy people read avidly, and patients cite on specialized forums, because she told about the disease that they could not formulate.
After the lecture, I sit opposite Arnhild, we drink coffee, and I look at her children, all in white thread scars, their hands cut.
“What do you think,” I ask, “can a healthy person understand a sick person? You were there and now you are here.Can these two worlds touch?
“Probably not,” Arnhild says and looks me in the eye. I, embarrassed, look away from her hands. – We can understand each other. Sometimes. You are reading my stories. Perhaps you have never been to Norway. Perhaps you have never gone crazy. But you can understand my feelings and emotions, thanks to this we can hear each other. But even if we are both absolutely normal … and I am telling you something now, and we think that we understood each other, in fact I said one thing, but you heard something completely different.Communication is a very complex thing. So yes and no.
I am trying very hard to understand, I am trying to imagine what it is like to see wolves, crocodiles, half-meter rats in the same way as I see people around me now. How does it feel – when a wolf gnaws your legs to the bone, and they tell you: “Don’t pay attention, it’s all because you are sick with schizophrenia.”
“This is a vicious circle,” Lauweng’s voice pulls me out of my reverie. – Wolves – because schizophrenia, and schizophrenia – because there are wolves.
– But healthy people really don’t fight wolves …
– Yes. But does the diagnosis explain why wolves appeared? This is a symptom. Just imagine, a person says to a doctor: “I have a headache.” Does the doctor say, “He has a headache because he is sick?” Not. The doctor will begin to find out: maybe it’s pressure, or maybe an infection, or maybe a migraine. A symptom can reflect dozens of different problems. And only in the case of mental illness, we hear: “Well, he is a schizophrenic, and that explains everything, you should not pay attention.”I told the nurses, “I’m dead. I don’t feel life inside me. ” And they answered: “No, this is not so, you are talking to us – it means that you are alive. And all your experiences are not real, they are the result of illness, stupidity, nonsense. ” And then I actually died: I stopped talking about it, and the body became silent, as if dead. And we do this all the time in clinics: we do not hear the experiences of patients, we invite them to shut up, explaining that their pain is delirium, an illness, and therefore does not exist. But in fact, because I was diagnosed with schizophrenia, the voices did not stop yelling in my head and tormenting me.And what exactly are they yelling and why is this happening – these questions are no longer of interest to anyone from the moment the diagnosis was made.
We are silent for almost a minute, and Arnhild adds:
– Symptoms are actually symptoms of something more, that which is life itself. Symptoms are a kind of message. Encrypted. They are not just “because of the disease”, they are saying something.
It all started, as usual, in early childhood. Arnhild was three years old when her father, a priest, contracted cancer.When she was five, he died.
“His bed was in the room, and when I came in, I didn’t know if he was still alive or not,” recalls Arnhild. “He didn’t think of anything better than explaining to me:“ I am going to heaven and will be there with the angels. ” But I didn’t want him to play with the angels. I wanted him to play with me. And I thought that if I behaved well, he would stay with me. Children, you know, have very developed magical thinking … And adults too, ”grins Arnhild.“For example, adults say,“ If I go to the gym and eat one carrot, I’ll live to be 90 ”. But my father still died. And for me it meant that I failed. And if I don’t try hard now, then – who knows? – maybe mom will die.
It seems too obvious to adults that the child is innocent. Nobody would even think to talk about it. But in fact, children often take the blame for events that are beyond their control. Otherwise, the world is too big, uncontrollable and dangerous.
“And then there’s too much emotion,” says Arnhild. – Anger, guilt, despair … They don’t fit. I want to get rid of them. But it is impossible to selectively banish “bad” feelings and leave the “good” ones behind. They are like a flock of sheep: first one runs away, then another, and then all the others. And after a while you feel completely empty. You remember everything, but you don’t feel anything. After a few years of this existence, I told the nurses that I was dead.
At school, Arnhild did not have a good relationship with classmates.A common story. She was not hounded, but she was not noticed either. She tried to be perfect. Don’t create problems. Nobody. But the feelings have not gone anywhere. And over time, the classic symptoms of schizophrenia began to appear – in the form of voices. Suspecting something was wrong, she turned to the school nurse.
– The nurse asked if I was afraid to get fat and if I was afraid to ride the bus. But I did not suffer from such fears. Another thing scared me: do I really exist and do my thoughts belong to me? And she didn’t ask me about that.
In his book Tomorrow I Was Always a Lion, Lauweng writes: “I continued to keep a diary and write about myself in the third person -“ she ”. This confused me. If “she” is me, then who writes about “her”? Is “she” me? If “she” is me, then who then talks about all these “I” and “she”? ”
Then the Captain appeared. He began to finish writing phrases in the diary for Arnhild. And when she wrote: “Who is this?” – answered: “I”. And since then he took over the leadership of her life: at first he gave cruel and merciless orders in his head, and then materialized in the form of a hallucination.
The Ice Princess and the Fire Dragon
– The world has turned gray. I lost myself and drew dragons. Golden ones flying across the night sky. The individual paintings were combined into a single whole, says Arnhild.
Imagine an ice princess in a purple dress walking through a winter forest with bare, dead trees. The forest is full of wild beasts and monsters, but none of them pays attention to the lonely princess. The next picture is a golden dragon devouring an ice princess.And then a large white egg is incubated. From which – in the next picture – a living fiery red princess will emerge. And now this renewed princess is walking through the same forest again – in the next picture. But now the situation has changed radically: all wild beasts and monsters are attacking her.
“She no longer has ice protection, she has become alive and vulnerable, so she is in great danger, she can be devoured,” explains Arnhild in his book. And he continues: “My consciousness was completely darkened, I did not understand anything in my mind and could not explain what was happening to me.But the neatly dated drawings, from first to last, tell the whole story. And they testify: not realizing anything by reason, I at the same time understood everything. ”
One day she came home and told her mother that she had put on a red dress and was ready to go into the forest, that the Captain and others would soon come for her and take her with them from the forest, where there were iron trees with leaves scarlet as blood.
The doctors and the police really came for her. And they took me to a hospital, to a closed ward – this was the first hospitalization.There will be dozens of them, voluntary and forced, with handcuffs, with the use of force, with isolation wards and walking on a dog leash – for the sake of her own safety, so that she does not run away.
“True, they were a little late,” she will write later. – I have already disappeared into the woods. And I found myself in a dense thicket, and it took many years before I was able to get out of it. ”
– If you could now turn to yourself during the period when all this was happening, what would you say to yourself? – I ask Arnhild.
– If I had the opportunity to talk to myself as a child, then I would say: “This is not your fault.” Because I seriously thought I was to blame for my father’s death. “It’s not your fault and you have to tell your mom how you feel because she can’t know it.” If I were talking to myself as a teenager who was already sick at that time, I would say: “Yes, now you are sick, but everything will be much better. And now you can’t even imagine how great everything will be. You will have so much joy, just wait a couple of years, don’t kill yourself, everything will be fine. “
When words expire
Who would listen to a schizophrenic? Even if he says ordinary, completely normal things? If he wants or does not want something, it is interpreted as a manifestation of the disease. If he is angry, the card will be marked “aggressive” and the dose of medication will be increased. If he shows any activity, the journal will write: “trying to attract attention to himself.” As if a healthy person is not trying to draw attention to himself! A mentally ill person loses the right to his own speech and desires, often they simply do not see a meaningful creature in him, and if he tries to prove the opposite, all his evidence turns against him and is perceived by the staff as an aggravation.
“There were two of us: she, the nurse, and I, the patient,” recalls Arnhild. – And we argued: whether a citrus fruit is an orange. I argued that yes, but she believed that citrus fruits are only lemons. Announcing that I wanted to take the dictionary and check it, I went to the shelf. I don’t know what scared the nurse so much, but she pressed the panic button, and reinforcements rushed in. I tried to explain that I only wanted to take the book, but she stated that I wanted to get to the light bulb to break it and cut myself. They did not listen to me and dragged me out of the room.Then I got angry, and my behavior became “ugly and demonstrative”, which did not lead to anything – there were a lot of orderlies, and I was taken to the isolation ward. Mattress, four white walls, green concrete floor. And I am an orange martyr who suffered for the right to be called a citrus orange.
Irony hides bitterness. “My words do not have any meaning now, for everyone I am, first of all, a sick schizophrenic. When words lose their meaning and turn into symptoms, you feel completely alone and helpless, ”Lauweng wrote later.
Even before her illness, Arnhild dreamed of becoming a psychologist. She studied well, and no one would have doubted her choice. But when, already ill, in moments of remission, she started talking about her dream, they also saw this as a symptom, and the doctors explained this by the fact that she identifies with her own psychotherapist and just wants to “become one”.
Man-symptom. A person who is always expected to smash dishes, light bulbs and cut himself with shards. Inside of which dreams, pains, hopes, resentments, despair are not assumed.Who is denied everything human, as if the disease once and for all corroded everything that is characteristic of ordinary people. He, of course, was “the first to begin”, but from now on society recognizes only one role for him – the role of a madman, each inhalation and exhalation of which automatically becomes a confirmation of his abnormality.
“At that time, there was so little left in me of the healthy, normal Arnhild, of what was myself, and not a disease, that every little thing acquired tremendous importance,” she says.
To return to life, she had to find, assemble herself piece by piece. As it should be in fairy tales, on her way she met different characters – kind ones who “allowed to be not only a patient, but also a person”, and evil ones who tormented her morally and physically, believing that it was impossible to harm a mad person anyway. so much he is already damaged by the disease.
There was an orderly who discussed the news with her and never used more force than necessary. And another – an athlete who allowed Arnhild to walk without a leash: he simply caught up with her whenever she decided to run, and, as if nothing had happened, continued the conversation.There were psychotherapists who knew how to wait until Arnhild herself matured and found the right words. And there was a mother who did not turn off the heating of the water mattress in her daughter’s room, although she had been in the hospital for a year with no hope of being discharged. Once, when Arnhild was let go home for only a few hours and advised his mother to remove all the breakable objects for this time, his mother put the family service on the table. The most beautiful, fine china. But she has seen more than once how her daughter breaks dishes and cuts her hands with lightning speed.The cups on the table spoke of trust. They said: “Here, at home, you are not a patient with a diagnosis of schizophrenia, here you are Arnhild.”
– Does this mean that it is good enough to treat a psychiatric patient for him to be healed? Is it possible to say that in many ways the disease is a consequence of the label that the patient receives? – I ask Arnhild.
– Of course not, but an attitude that allows the patient to retain residual self-esteem gives hope. The disease is real – I pulled out my hair, I tried to kill myself, and it was all for real.But at the same time, a diagnosis is only a way to explain, to name what goes beyond the concept of a social norm. This is not a given, but, on the contrary, a convention that people invented, and it can be a temporary phenomenon or generally erroneous.
Cup can be glued
Once, in an art therapy class, Arnhild was painting a cup she made with her own hands – it was a Christmas present. Suddenly the cup slipped out of her hands and shattered. The patient froze with the splinters in her hands, but this time she did not cut herself, but asked to take the splinters from her, because she needed to think.The cup was glued together, and in order to avoid noticeable seams, Arnhild fashioned two cats around the cup.
– It did not become the same as I intended it. It was already a completely different cup. But she was no worse. And to this day she stands with pencils on my table.
Most often, Arnhild is asked: how did she manage to get well? What did you do? How exactly was it treated?
Reading her books, I understand that one cannot count on a monosyllabic answer. She experienced all possible methods and techniques on herself, but what exactly helped and what prevented is unclear.But the answer is still there, albeit not in the form of a recipe, but in the form of a direction, a glimpse. The path seems almost impassable, most often a person falls into a funnel – the more society expels the patient, securing him the role of a madman, the more he is doomed to play this role. The meaning of the symptom goes further and further, the content of mental life melts away, and a sign of insanity remains from the person. You can only catch on to incredible, stubborn hope. Hope to return to yourself and to those who still believe in you.
“When I last got into a closed ward, I had no idea that he would be the last,” recalls Arnhild.- I thought: this is the end. Before that, everything was going well for me: I went to work part-time, stopped taking medications. And now she was again tied to the bed with straps. Then I wanted to drop everything and die: no matter what I did, nothing helped, the voices returned, and only belts could handle the chaos. But that was the last time.
It is very difficult to hope in a hopeless situation. It is much easier to accept everything as it is, to stop wanting the impossible, so as not to face excruciating disappointment.
“No hope is required for a realistic plan,” Arnhild explains. – It is needed when there is no possibility. They told me: your illness is forever, you will never become a psychologist, your task is just to learn to live with your symptoms, to serve yourself on your own. But such a life did not inspire me. Constantly focusing on the hopelessness of my situation only did harm. Therefore, I so want to give hope to others.
– Your story really inspires hope.But does this mean that schizophrenia can really be cured?
– Someone is recovering from cancer, someone can live with this disease for a long time. And someone dies quickly. It is the same with schizophrenia. But everyone who wants to hope has a right to do so, no matter how realistic their hope is. Today it is easy to say: “I carried the opportunity to recover”. But after all, very few people believed in this when I sat in the isolation ward and ate the wallpaper from the walls.
– What did you gain from the disease?
– I think I have become more humble, calm.I am very much not sure. If there were no illness and my life would have been like everyone else’s – university, specialization as a psychologist, career … I think I could become arrogant. But now I am very humble, because I know that life can be very, very difficult. I’m also very curious right now. I am always interested in what the story of a person is and what makes him come to a psychologist. Yes, I can react to what you say, but I’m interested in something else – why are you saying this? What’s your story? What is your life?
Prince, two dogs and a black square
Returning to normal life Arnhild compares to trying to jump on the bus.Getting off the bus is much easier. Even in Norway, where a patient with a psychiatric diagnosis has more opportunities to recover than in Russia, there is discrimination. It is difficult to get a job. It’s hard to believe in yourself. Too much of a life has been lost. The patient has learned to be ill well, but almost completely does not know how to live.
– One of my therapists told me that with my diagnosis and my medical history as thick as an Oslo phone book, it will take time for people to believe that I have recovered.
I think that this is also a fairy tale scenario: the sleeping princess wakes up after ten years of deep sleep, and life begins anew. From scratch.
“No, I don’t have a blank slate,” says Arnhild. – Once in the isolation ward they wrapped my hands with bandages so that I would not hurt myself. One of the orderlies violated the ban – it was impossible to talk to me – and put a white sheet in front of me, in the middle of which he drew a black square. At first I didn’t want to paint, but nevertheless I took paints.It was difficult, but my hands were bandaged. Clutching a brush with my palms, I painted the leaf with colored circles and triangles. When I finished, the entire sheet was covered in colored shapes. “Look, I ruined your sheet with this square,” said the orderly. “It’s still there, but you drew a pattern and this square became part of the pattern. He has ceased to be ugly and does not destroy anything else. Nothing prevents you from doing the same with your life. ”
– What does your typical day look like today? – I ask Arnhild.
– Oh, I don’t have ordinary days now. Because I travel a lot, write my doctoral dissertation – it’s a matter of a year or two. I work a lot. But, of course, I know what an ordinary, quieter life looks like when you walk your dogs, spend time with your family, cook food. And I, of course, try to do all this too. But I have to hurry, because I missed a lot. They will ask me where I was during the funeral of King Ulaf – and at that time I was in the isolation ward. And I have not seen a war in the gulf.And she missed the Olympics. The list can be long. And I will not stop because I love everything that I do. But sometimes I need rest. Just being at home, doing my research, reading a book, walking the dogs … I need to be alone. And after that I can go around the whole world.
– You are talking about solitude, and as for loneliness – how do you manage to cope with it?
– I used to be a very lonely person. Being mentally ill means being lonely.There is only personal experience, and as such there is no connection with the world, there is no opportunity to participate in the life of society. The system is closed. And my world was completely lonely. Of course, I had no friends, I was alone all the time. And at first it was a difficult task to “build bridges”, make friends. Because I thought of myself as a bad person to whom no one wants to be a friend. But as soon as I stopped thinking bad about myself, I met incredible people. Therefore, I cannot now say about myself that I am lonely.
– Psychologists helped you quite a lot and were in a sense close people. And if you imagine that you could get an appointment with any psychologist of all time, who would you choose?
– Oh, I don’t want therapy at all now! Of course, I would like to get to Jung, Freud or someone of the same kind. But it doesn’t really matter how famous your therapist is, relationships are more important. It’s all about the individual approach and communication.
And this seems to be one of the key path markers.Archild all the time recalls not formal techniques, but the moments when communication happened – a cup, a drawing, a mother.
– When you were sick, you had a dream to get well. She was fulfilled. What are you dreaming about now?
– There is an idea for a school for people with mental disorders. And my Ph.D. is about this project. I would really like to have such a school in Norway. And, of course, I want psychology to be better in many countries. This is my first time in Russia, but I have been in Poland for a long time, and I saw that in many countries there is no normal psychological assistance.Even in Norway, behavioral therapy and medication are used extensively. And there are many more ways to help. And also in Norway we are very subjective: “You are good, and you are not good enough.” And we should just be a little kinder to each other.
– Do you have any rule in life that you follow?
– Now I will try to formulate … Probably like this: “Go if you really want to, even if you are not sure. Just think about it later. ”
– You have two dogs … Would you like to have a family, children?
– Yes, I have two lovely dogs, Rocky and Foxy.And, of course, I would like to have children. But first I need to meet my prince. This may sound naive, but from the age of 16 to 26 I was very sick and had no idea what flirting was. I should have taken a flirting course, Arnhild laughs. – So yes, I’m still waiting for the prince on a white horse.
Arnhild has long brown hair. But in the previous pictures, which were taken after the illness and posted on social networks, her hair is fiery red. Like that princess in her children’s drawings, fiery red.Who came out alive from the golden dragon.
Treatment of schizophrenia in Moscow ★★★ New Life Clinic
Paranoid is one of the most common forms of the disease. It usually occurs in people over 35 and is characterized by the following symptoms:
- Auditory hallucinations.
- Sounding your own thoughts in your head.
- Lack of thoughts in the head (“empty head”)
- Uncontrolled flow of thoughts.
- Crazy ideas.
- Persecution mania, etc.
A person can hear non-existent voices that enter into dialogue with him, warn of an imaginary danger, or, conversely, encourage him to take certain actions. However, hallucinations are not always purely auditory in nature; they can be visual or tactile.For example, the patient can see golden threads descending from the sky, make contact with aliens, or imagine himself to be a god.
Paranoid schizophrenia, unlike other forms of the disease, is accompanied by the appearance of predominantly positive (productive) symptoms. In this case, negative signs of schizophrenia are quite rare.
Sluggish schizophrenia is characterized by a slow progression of the disease and the similarity of symptoms with other neurotic disorders, at least in the initial stage of the disease.
A person becomes withdrawn, begins to relate to others with alienation, even to those who were quite close to him, acquires the status of an “eccentric”, neglects the rules of personal hygiene. His speech can become rather pompous, but at the same time, intonation disappears from it. The world around him loses its colors for the patient, former interests lose their significance, the person loses the ability to feel pleasure or displeasure from the phenomena occurring around him.
- Asthenic form – the patient has mental exhaustion, he quickly gets tired of even the most simple things, is unable to do anything for a long time. May start collecting rather strange items.
- Obsessive form – characterized by the presence of obsessive actions in the patient’s behavior, for example, the performance of certain rituals before any actions.
- Hysterical form – characterized by the occurrence of attacks of the so-called “cold” hysteria – a condition in which the patient deliberately over-emotionally reacts to quite ordinary phenomena.It manifests itself most often in women.
Schizophrenia occurs at two rates – attacks and continuously. In the first case, the symptoms appear in the form of seizures, after which remission occurs. In the second, the stability of the state is observed, which gradually worsens. Doctors at Dr. Buchatsky’s clinic treat schizophrenics of any stage. All that is needed is to contact the specialists of the medical center in time.
In our clinic you can undergo diagnostics and treatment of schizophrenia.Diagnosis begins with a consultation with a psychiatrist. In most cases, the situation is complicated by the fact that the patient denies the existence of the disease. Nevertheless, you should try to convince him of the need for consultation, explaining that without medical assistance, his condition is doomed to constant deterioration.
In diagnostics, MRI or computed tomography of the brain is used. A blood test will make it possible to draw a conclusion about the functionality of the thyroid gland, as well as exclude possible liver or kidney diseases.A conversation with the patient and his loved ones will make it possible to assess the symptoms of schizophrenia, to identify possible cases of the disease in the family.
Psychological tests (among which there will be a special test for schizophrenia) will help assess the state of the patient’s psyche, confirm or refute the suspicions that have arisen.
Diagnosis of schizophrenia is not a matter of one day. Only a comprehensive assessment of the patient’s condition will make it possible to draw the necessary conclusion.
And you should always remember that schizophrenia is treatable.Timely appeal to a psychiatrist and the beginning of treatment will allow the patient to return to himself, and his loved ones to a normal life.
In the clinic of Dr. Buchatsky, you can undergo treatment for schizophrenia on an outpatient basis or in a hospital. Our doctors use the most effective and newest methods in treatment – classical, author’s, alternative.
Call us at +7 (495) 1813303 and make an appointment for a consultation or appointment.
You can get detailed advice
+7 (495) 181 33 03
90,000 The brain of a person suffering from schizophrenia: how the disease manifests itself and how scientists fight it
Even if there are no people with schizophrenia among your friends, most likely you have an idea of its symptoms.
The disease can manifest itself in the form of hallucinations, delusions and paranoia, as well as difficulty concentrating, organizing thoughts and performing basic daily tasks.
For many years, doctors knew little about the disease, except for symptoms reported by the patients themselves. The causes of schizophrenia and how it affects the brain have largely remained a mystery due to the exceptional difficulties scientists faced in trying to understand the most complex – and least accessible – organ in the human body.
But today, thanks to new technologies, the veil of secrecy begins to hide behind.
“Over the past few years, we have seen tremendous advances in understanding and treating schizophrenia,” says Physician Husseini Manji, MD, Global Leader of Neurology Therapy at Janssen. “This area of medicine is going through an interesting period.”
The ability to create new treatments for people with schizophrenia was one of the reasons that attracted Dr. Manji to the company.Then, in 2008, he was director of the National Institute of Mental Health and director of the Mood and Anxiety Disorders Program.
“Several pharmaceutical companies tried to convince me to join them, but Johnson & Johnson was focusing on neurology just as many were moving away from the field,” he explains. “The science of mental illness has matured to the point where existing knowledge could be translated into advanced treatments for diseases like schizophrenia.”
Nearly 2.5 million people with schizophrenia – one percent of the US adult population – are eagerly awaiting progress in understanding and treating this complex disease.
Physician Husseini Manji,
Head of Global Therapeutic Area Neurology at Janssen
Schizophrenia is one of the most severe mental illnesses. It usually manifests itself in late adolescence or after 20 years. The consequences can be disastrous: people with schizophrenia are at increased risk of becoming unemployed, homeless, and imprisoned.About a third of patients try to commit suicide, and about one in ten eventually succeeds.
Researchers know that schizophrenia is largely inherited, but they know less about the biological basis of the disease. However, thanks to advanced brain imaging technologies, scientists such as Dr. Manji are beginning to gain a clearer understanding of the changes taking place in the brain of a person with schizophrenia. It turns out that these changes occur even before the onset of clinical symptoms.
Study of the brain of a patient with schizophrenia
Several brain imaging studies have been conducted over the past decade to provide evidence of structural abnormalities in the brains of schizophrenic patients. This gave scientists clues to the biological causes of the disease and how it progresses.
One 15-year study, funded in part by Janssen and described in the American Journal of Psychiatry ( American Journal of Psychiatry ), found that patients had less brain tissue during their first episode of psychosis. of people.Although losses stabilized over time, long-term relapses of psychosis were associated with additional volume reductions.
“From earlier postmortem studies of the brains of people with schizophrenia, we knew that they had fewer synapses and neuronal branches that allow neurons to communicate,” explains Dr. Scott W. Woods, professor of psychiatry and director of the Prodromal Research Clinic. period of psychosis PRIME at Yale University.”We think this explains the decrease in brain tissue volume seen in the images.”
In adolescence, everyone experiences the normal loss of a certain amount of gray matter, which contains neurons and their short processes, but experts believe that in people at high risk of developing schizophrenia, this process may proceed too quickly or actively, causing psychosis.
Imaging studies indicate a lack of gray and white matter in the brains of people with schizophrenia.In adolescence, everyone experiences the normal loss of a certain amount of gray matter, which contains neurons and their short processes, but experts believe that in people at high risk of developing schizophrenia, this process may proceed too quickly or actively, causing psychosis.
The abnormal development of the white matter, which contains long, myelin-coated nerve fibers that connect the four lobes of the brain, can also be a watershed for some people predisposed to the condition.The authors of the study, published in the journal Clinical Neuroimage ( NeuroImage: Clinical ), suggest that this may be associated with cognitive symptoms in schizophrenic patients, including cognitive and memory impairments, apathy and low motivation.
What causes these losses is still unknown, however, according to a widespread theory, inflammation contributes to the progression of many diseases. Two years ago, British researchers discovered increased activity of immune cells in the brains of schizophrenic patients and people at risk.It is unclear what exactly might trigger the inflammatory process, but prior research has been able to establish a link between early infections and cases of schizophrenia.
“Inflammation is one of the mechanisms leading to the destruction of synapses and neural branches in the brain, so severe inflammation could explain the loss,” says Dr. Woods.
Advanced Brain Protection Techniques
By learning about these brain abnormalities, Janssen scientists understand the importance of treating people in the earliest stages of schizophrenia and identifying new ways to minimize the damage caused by multiple relapses.
One of the important areas of research at Janssen is finding ways to increase adherence to treatment. This problem is faced by any physician who treats chronic diseases, but special difficulties arise when working with patients with schizophrenia. Only about half of patients are taking their prescription medications. Failure to adhere to regimen triggers a cycle of relapse and recurrence of symptoms that is difficult to interrupt – and diminishes the response to treatment.
“Unfortunately, the nature of schizophrenia limits patients’ understanding of the disease,” says Dr. Manji.- In many cases, after feeling a little better, they stop taking the medication. At the same time, unlike, for example, patients with diabetes who feel the effects of skipping a dose of insulin after only a few hours, patients with schizophrenia who stop taking antipsychotic drugs may not experience symptoms of relapse for several weeks.
Janssen scientists have attempted to help address this difficult recurrence cycle by developing long-acting injectable antipsychotic drugs that are given to patients less frequently than other drugs.
To further protect patients from the ravages of multiple relapses, Janssen is investigating ways to identify patients at high risk of relapse using data collected from smartphones, medical trackers and body sensors.
Long-acting injectable drugs are administered by doctors, so if a patient misses a dose, the attending physician will know about it and can take action.
To further protect patients from the ravages of multiple relapses, Janssen is investigating ways to identify patients at high risk of relapse using data collected from smartphones, medical trackers and body sensors.
“We want to know if monitoring factors such as sleep, activity level, interactions with other people and other biomarkers can provide doctors with information about an impending relapse in advance,” explains Dr. Manji. “This would enable them to identify and contact patients who are worsening, instead of waiting for them to come to the appointment at the appointed time.”
Among other things, the inclusion of medical technology in a patient’s treatment plan would help doctors obtain more objective data on how a person really feels.Practice shows that when patients are asked about their health for several weeks, they remember only the last day or two. With more long-term, measurable data, clinicians could not only have a relatively clear picture of how the patient is feeling, but also be more constructive in admission.
“If patients are stable and you don’t need to spend so much time just treating psychotic symptoms, you can focus on finding constructive ways to help them get back to normal,” says Dr. Manji.
Not just elimination of symptoms, but complex treatment
To truly improve the lives of people with schizophrenia, scientists are not only developing new drugs, but also promoting the principles of integrative care. Manji said he was attracted to Johnson & Johnson because the company shares his conviction that medicine must go beyond pill therapy to ensure optimal outcomes for patients with schizophrenia.
“We want to convey to people that, in the long term, the best way to treat schizophrenia is to use a more holistic, integrated model of care,” he explains.- Mental illness has a great impact on every aspect of a person’s life: his physical health, behavior and relationships. Patients need several types of correction, not just medication. ”
One of Janssen’s research focuses on the vital role of caregivers and the challenges they face in treating and caring for people with schizophrenia. Patients are currently being recruited for a one-year clinical trial called Family Intervention in Recent Onset Schizophrenia Treatment (FIRST).The researchers plan to assess the overall impact that caregivers can have on patients by participating in a psychological education and training program for caregivers. It is possible that such programs can help reduce the number of treatment failures, such as hospitalization in a psychiatric hospital and suicide or attempted suicide.
The company’s sincere commitment to improving the lives of patients is reflected in its projects with academia, government and the biotech industry.“This disease is so complex that we need to unite to make progress in research,” said Dr. Manji.
In 2015, Janssen Research & Development launched the Open Translational Science in Schizophrenia (OPTICS) project, a forum for collaborative analysis of Janssen clinical trial data and publicly available information on schizophrenia provided by the National Institutes of Health.
In addition, the company acts as an industry partner in a newly formed consortium led by the Johns Hopkins University School of Medicine and the Salk Institute for Biological Research.The consortium aims to improve the quality of induced pluripotent stem cell technology – a tool that allows scientists to harvest skin cells from patients with mental disorders and convert them into neurons. By creating a neural model of schizophrenia using patient cells, scientists hope to gain a qualitatively new understanding of the underlying mechanisms of the disease in order to develop more targeted therapies.
Dr Manji believes that such innovative projects will lead to not only new treatments for schizophrenia, but also approaches that can delay and possibly even prevent the disease.
“We now know that schizophrenia, like many other illnesses, does not strike people overnight,” he explains. “It matures before a person develops full-blown psychosis, and the sooner treatment is started, the better the long-term prognosis.
If we learn to identify people at high risk of developing schizophrenia and find out what happens to them at the earliest stages, then in the future we can change the entire trajectory of the disease. ”
This article, by Jessica Brown, originally appeared at www.jnj.com in May 2017
Is there life when you have schizophrenia
If a more humane attitude towards patients in Russia has become widespread in recent decades, then in Great Britain the first attempts were made back in the middle of the twentieth century.
One of the most prominent figures here is the Scottish psychiatrist Ronald Laing. In his youth, he worked in the Glasgow City Hospital – and saw that many patients in the psychiatric ward were given the popular lobotomy at that time, but this did not bring any benefit.Shock therapy and insulin comas did not help either. In the fifties, Laing began to struggle to improve conditions for the sick and conducted the first experiment. At his suggestion, eleven patients with severe forms of schizophrenia were spent every day from Monday to Friday in the company of nurses in a bright, comfortable and fully furnished room. Here they could communicate, cook, knit, paint, and sew. Although some patients retained symptoms of schizophrenia, their general condition improved: they could dress up and paint, go for a walk, shop, help staff, and many developed close relationships with nurses.Laing then became convinced that people with schizophrenia benefit from a more human attitude.
Some time later, after an internship with the famous child psychoanalyst Donald Winnicott, Laing came to a new understanding of the essence of schizophrenia in adults.
In a certain sense, as Laing believed, schizophrenia is the degradation of the human “I” to an infantile state of splitting and disintegration. A healthy person has to spend a certain amount of effort to keep his “I” whole.However, he does not notice this: he has enough strength. In schizophrenics, the psychological strength, according to Laing, was reduced. He called this “ontological uncertainty.” Any action that would be simple for a healthy person requires effort for them. Laing wrote about this in his first book, The Divided Self.
By the sixties, in society in general and among psychiatrists in particular, indignation was ripe with the practices that were then adopted in medicine: lobotomy, antipsychotics, treating patients as inferior people.During this time, Laing practiced as a psychoanalyst in London, studied families of people with schizophrenia and continued to write about it. His books have gained popularity among fellow psychiatrists and a wider range of progressive intellectuals. He began televising mental health, traveling to the United States to lecture, and participating in major conferences. Ronald Laing became the star and founder of the antipsychiatry movement. Her supporters viewed the current medical system as a massive form of violence.
Laing not only published scientific papers and educated the masses, but also established an antipsychiatric commune – Kingsley Hall – in London’s working class district. Doctors and patients in the commune had equal rights. People with schizophrenia could “get through” their psychosis without suppressing their symptoms with drugs. There were no strict rules, except for one thing: it was obligatory to get together for dinner every evening. There, the members of the commune gave lectures, talked about their illnesses, just chatted with each other. The commune lasted five years and was also home to artists, actors, poets and leftist activists who interacted with patients.Kingsley Hall received about a hundred visitors a week.
Three years later, the commune building was pretty dilapidated – no one followed it. Local residents regularly complained about the participants. They were irritated by loud music, disorder, behavior of patients – so, one of the girls was caught dancing naked on the roof. Locals threw dog excrement into the windows, smashed milk bottles on the doorstep, and called the police. The Kingsley Hall Board of Supervisors requested Laing to vacate the premises.
Laing was disappointed with the result of the experiment.In the seventies, he went on a journey, first to Sri Lanka, then to India – he meditated, studied Sanskrit and philosophy. Tired of his fame, he began to take LSD and drink. In the eighties, he received a suspended sentence for possession of hashish and was accused of assaulting a client who was grabbed by the elbow during an argument. Laing died of a heart attack two years later. Many of his ideas have remained underappreciated for decades. In addition, individual antipsychiatric proponents began to offer ideas that were far from what he advocated.
Hungarian-American psychiatrist Thomas Szas, for example, was sure: schizophrenia does not exist, it is a social construct. Psychiatric patients, in his opinion, were not sick. So society only reacted to their out-of-the-box thinking – they called them sick. In 1969, Szasz formed the Citizens Commission on Human Rights with the Church of Scientology to investigate human rights abuses in psychiatry. The very nature of psychiatric diagnoses was called fraudulent by the supporters of this organization.
In the sixties and seventies, antipsychiatry was a fashionable trend that was widely discussed, but in the eighties, world medicine again returned to the treatment of disease with drugs. Today, doctors consider refusal to use medications dangerous and harmful, and they do not see a complete cure for the disease as possible: “If a person recovered from schizophrenia, then most likely he did not have schizophrenia.”
“Schizophrenia flows like a process,” says Gennady Averyanov. – It is impossible to recover with the help of psychotherapy.You know, in Germany there is a whole clinic where schizophrenia is treated with group psychoanalysis. They came to us in the nineties, to the Bekhterev Institute, talked about their methods – everyone laughed. The very idea that schizophrenia can be treated without drugs is extremely harmful. It’s like saying to a cancer patient “you, my friend, don’t heal, meditate”. A very bad idea. ”
Is it possible to cure schizophrenia, how to treat schizophrenia
Schizophrenia is one of the most common and, at the same time, one of the most mysterious mental diseases.It is associated with a splitting of consciousness, can be accompanied by hallucinations and delusions.
Scientists have not yet been able to fully figure out the causes of this disease. It is currently unknown how to recover from schizophrenia and completely defeat the disease.
However, there are methods of therapy that make it possible to achieve long-term remission and reduce the intensity of seizures.
Therefore, despite the fact that doctors do not yet know how to cure schizophrenia and get rid of it forever, patients can count on effective help in matters of life with schizophrenia, rehabilitation after seizures, social adaptation, etc.
Where and how to treat schizophrenia and can it be cured
In case of initial or repeated seizures, accompanied by hallucinations or delusions, treatment in a hospital is necessary. Modern drugs used to treat schizophrenia effectively stop the manifestations of the disease and help achieve remission. However, a person diagnosed with schizophrenia needs to be prepared for constant medication and regular supervision of the attending physician. In addition, at the end of treatment, it is highly desirable for the patient to undergo a course of psychotherapeutic rehabilitation, which will help him quickly return to normal life.
Medicine still gives a negative answer to the question “is it possible to recover from schizophrenia.” However, people with this diagnosis can often lead a normal life (of course, if all the doctor’s recommendations are followed).
How a psychotherapist can help
It is impossible to completely cure schizophrenia, but it is possible to achieve long-term remission and ensure the stability of the patient’s condition. And in solving this problem, professional psychotherapeutic support plays a huge role.
The psychotherapist explains to patients what the essence of the disease is, tells what factors can trigger new attacks and how to behave in order to reduce the risk of relapse.
The specialist also works with relatives, because in order to adapt to new living conditions and successful integration into society, patients need the support and understanding of loved ones. And if it is impossible to recover from schizophrenia, this does not mean at all that a person should lead an isolated lifestyle, deprive himself of work, study and the joy of communication.On the contrary, the faster and more successful its adaptation is, the more favorable the prognosis and the lower the risk of exacerbations.
Very often, within the framework of psychotherapy, group sessions are held, where people talk about how they learn to live with their illness, share their victories and provide each other with mutual support. This practice helps patients, if not completely recover from schizophrenia, then at least not be afraid of their illness, do not feel guilty about their illness and isolated from other people.
Despite the fact that at the moment schizophrenia is incurable and it cannot be cured, that is, it is not yet possible to completely eliminate the risk of relapse, modern medications and high-quality psychotherapeutic support help patients to live a full life.
Supplement – Kommersant Healthcare (119579)
In 2013, there were 559,420 people diagnosed with schizophrenia in Russia, in 2017 – 488,500. It has decreased, but this is also a lot. Representatives of the Russian society of psychiatrists are sounding the alarm: in Russia, there is an overdiagnosis of schizophrenia.
Introduction to psychiatry
Over 15 years, the number of patients with schizophrenia in the world has increased by 30% and today is 45 million people, or 0.8%. By 2020, mental disorders will be among the top five diseases that will lead in the number of human labor losses associated with these diseases. These are the forecasts of the World Health Organization. Public opinion in our country is such that patients with schizophrenia are considered dangerous to society.
Mental disorders will soon overtake cardiovascular diseases, which are still traditionally leading in the morbidity structure of the world’s population.Schizophrenia leads to disability more often than the onset of blindness, and only dementia and paralysis are ahead of it.
There are three main symptoms of schizophrenia: psychotic, they are productive, or positive, negative, and cognitive. Psychotic symptoms are vivid, dramatic, widely described in culture. For example, hallucinations (visual, auditory, bodily) and delusions. Although there are “true” hallucinations and pseudo-hallucinations. In the first case, a person hears a voice calling him from the kitchen, or sees a heron standing on his bed.This form almost never occurs in schizophrenia, although most people are sure of the opposite, but it indicates the presence of pathology – intoxication, trauma, tumors, epilepsy. Pseudo-hallucinations are when the patient sees everything through the “receiver”, these are the very “voices” that comment on something, call for action, order and even threaten. In this case, the voices can become a spiritual guide, or, conversely, they will drive you crazy.
Delirium is a disorder of thinking, in which a person’s thoughts, his conclusions, conclusions are built on illogical judgments, it is impossible to argue with such a patient and it is impossible to dissuade him from what he claims.This is also a psychotic symptom. Primary delirium develops for a long time, consistently, for example, a neighbor is poisoning me, so I will defend myself. And the secondary one arises against the background of altered mood, hallucinations, when it is necessary to interpret what surrounds the patient. There are also environmental delusions, such as induced delusions, which often occur among cult founders; delirium of pardon, when a prisoner thinks that he will be shot in any case, railway paranoia, when it seems that everyone is whispering, watching, discussing, wanting to harm.The main problem is that absolutely any person can have delusions and hallucinations, for example, in case of poisoning or blood loss, high temperature, infectious diseases. And it is impossible to diagnose “schizophrenia” in such a state.
However, according to the results of a survey of the Russian Society of Psychiatrists, in which 807 psychiatrists with about 17 years of experience took part, only 14% diagnose schizophrenia in full accordance with the ICD (International Classification of Diseases), while the rest are not guided by all the principles of the ICD, or not all symptoms are remembered.And 3% believe that it is necessary to completely remove from the ICD-10 the main signs of schizophrenia – negative symptoms and cognitive impairments.
Negative symptoms are a decrease in energy in a person, apathy, lack of will. Cognitive impairment is a disorder of thinking, perception, attention. The patient may experience disorganization of thinking, speech, he can isolate himself socially, which is often accompanied by silence, remain in a frozen position for a long time, or, conversely, fall into aimless excitement, which is expressed in pretentiousness, mannerism, unnatural plasticity, endless walking and wringing of hands …Moreover, none of the signs is sufficient to diagnose schizophrenia; it can be any other disease. But the presence of all three at the same time – positive, negative and cognitive symptoms lasting at least six months – can really be a sign of schizophrenia.
This disease often begins in adolescence or even childhood, sometimes later. According to statistics, only 50% of patients have frequent or prolonged hallucinations. According to a large study (Epidemiological Catchment Area Project, USA), 11-13% of people have hallucinations at least once in their life.Another study, conducted in Holland, showed that “truly pathological” hallucinations were observed in 1.7% of the population, but another 1.7% experienced hallucinations that were not recognized as clinically significant.
Consequences of overdiagnosis
In 2013, there were 559 420 people diagnosed with schizophrenia in Russia, in 2017 – 488 500. These data indicate not that there are fewer schizophrenic patients, but that the diagnosis has become more accurate. And yet, representatives of the Russian society of psychiatrists are sounding the alarm: in Russia, this diagnosis is made unreasonably often.For example, the frequency of the discrepancy between the number of patients with bipolar personality disorder (BAD), which resembles some of the manifestations of schizophrenia, in the world and in Russia differs 150 times! And the frequency of discrepancy between depressive and anxiety disorders, which can also be accompanied by a single psychosis, is 60 times! At the same time, world medicine indicates that the prevalence of schizophrenia is the smallest among other mental disorders. This means that people with bipolar disorder and disorders are often treated in our country as people with schizophrenia.
This situation can be changed by treating patients with schizophrenia and similar psychiatric diseases selectively, giving people a chance for rehabilitation, and not giving them up. Indeed, most often they are not dangerous, no matter how hard those who stigmatize these diseases try to prove it.
Stories and photographs of people who live with schizophrenia
Schizophrenia occurs in 0.3–0.7% of the population. According to a VTsIOM poll, 38% of Russians believe that people with schizophrenia should “stay away from others.”Arden Arkman, a journalist, photographer and author of the public “You are not a stranger here,” made a project about those who live with schizophrenia: he filmed characters in important places for them and learned what it is like to have schizophrenia in Russia.
“Hello, I am Sasha, a very dangerous animal”
Sasha, 20 years old
Minsk – St. Petersburg. Blogger. Photo taken at Sasha’s house
As a child, I had a tendency to pathological fantasies, but this did not particularly interfere with my life and did not distinguish [me] from other children.At the age of 11, there were mild auditory hallucinations – it seemed that my mother was calling me. The most striking manifestations began at the age of 15, after the return of repressed memories of violence.
In the [Minsk] hospital, nurses beat patients, especially very young children from the orphanage. In general, there was a lot of violence in the department – psychological, physical and sexual. There is an ongoing investigation into this, but the police are not entirely on my side. Because of the diagnosis, instead of the victims, they believe the rapists (rapists are doctors), falsify the data on medical records and say that these are just “visions”.
In words, I was diagnosed with dissociative identity disorder, but officially it was not brought anywhere, referring to the fact that in the CIS this diagnosis is treated with doubt. Then they diagnosed schizophrenia. Everyone knows about the diagnosis, I blog on this topic and have never hidden it. What for? The stigmatization of the mentally ill needs to be fought; silence only exacerbates the problem.
I do not take pills: they have changed my drugs many times, nothing suits, they only make things worse and give strong side effects.In Russia, I have not yet applied for psychiatric help, but in Belarus everything is very bad.
The hardest part is the attitude of society and the need to constantly prove that I am not a dangerous inadequate maniac. Because of the diagnosis, my word is lower than the word of the person who committed an unlawful act on me, because “she might have thought”.
In social networks, every now and then they compare me with a dangerous, rabid beast that needs to be isolated, in PND doctors see me not as a person, but as a time bomb, and this is depressing. Hello, I am Sasha, a very dangerous animal 157 centimeters tall and weighing 43 kilograms , who loves pugs, cannot open a can without someone else’s help and often helps people. Nice to meet you, I am more dangerous than a bear because I have schizophrenia.
“Isn’t it time for you to knit?”
Ekaterina, 19 years old
St. Petersburg. Photographer. The picture was taken in the courtyard of the psychiatric hospital
From the age of four I had suicidal thoughts.Each awakening, if there was no adult nearby, caused wild fear and panic, as if I had been left forever. My father died when I was three years old. From four to 14 years old, I did not believe in it and occasionally saw him in the crowd. I quietly hurt myself: tore off the skin, did not allow the wounds to heal, tore out strands of hair.
Was hospitalized at the age of 18 due to voices, unreasonable psychosis and obsessive thoughts. There laughter or tears were fraught with droppers and increased dosages . They could tie [to the bed] for a day or a week – it all depended on the mood of the nurses.A grandmother in dementia was tied to a chair in the hallway so that she was always in sight, even being tied to food. The dressing question was solved with ducks and diapers. One woman was admitted pregnant, she was taken away by ambulance to give birth, and a few days later she was returned to the closed ward. Forced to abandon the child. None of the staff supported her, although due to the birth itself and the refusal, she suffered greatly physically and mentally.
In general, if the hospital treatment came up – it’s luck, if not – you may think that it should be so.Sometimes doctors only drown out acute symptoms, do not understand the root of the problem and do not say how to continue to live with this. This is partly because of the complexity of psychiatry as a science, and partly because of the moral principles in our country.
Relatives accepted the diagnosis calmly, although one of my relatives is now afraid of me. Some friends began to be a little wary, the usual display of emotions became [for them] a wake-up call: “Isn’t it time for you to knit?”
I have a feeling that I have no right to exist, which is why sometimes [I can] not ask for help, not do something on my own initiative, sometimes not take what is supposed to be done.
People think that “psychos” are certainly dangerous for society, that it is better to avoid them altogether and not be allowed to any positions. During the treatment, I had to take an academic leave from studies, and when I decided to return, I needed a certificate that I could continue my studies. There was not a word in them that I was being treated in a psychiatric hospital – apparently, so that this would not cause problems.
The disease definitely hurt me a lot, slowed down my progress, almost killed me many times, forever affected my way of thinking, made life difficult.On the other hand, after so many years of blind war, I found myself in better conditions and now stronger than many. Schizophrenia is still with me and always will be, sometimes it reminds me of itself, but it gives a contrast to appreciate life.
Psychoactivist Sasha Starost – about public self-flagellation, performances and schizophrenia
Psychoactivist Sasha Starost – on public self-flagellation, performances and schizophrenia
“I was discriminated against only by employees of state psychiatry”
Andrey, 26 years old
St. Petersburg.She is studying to be a landscape architect. Photo taken at Andrey’s house
From childhood there were hysterics and tearfulness, but real problems appeared at the age of 15-16. Strong feelings arose for no reason, and the picture of the world became more complicated – signs, symbols, in the center [of which] was me, a fighter against cosmic forces. I thought that I needed to commit self-immolation in order to become like the Sun. The quality of life worsened, relations with the mother deteriorated, and social phobia grew.
One day my mother called a psychiatrist who came to my house, discussed the problems and offered hospitalization. I agreed, but expectations did not coincide with reality. The orderlies who came to me were rude, put on a heavy straitjacket: “You are crazy, so you don’t jump out of the window.” And they took me straight from home.
At the II Skvortsov-Stepanov hospital, they gave me leaky pants and a shirt, taking my clothes away. It felt like a prison: almost everything was banned except for personal hygiene items and books .The staff also looked like jailers, calling the chroniclers “meat”. One of the nurses took the boy under the “protection” and daily injected him with extraordinary injections of a neuroleptic for minor violations of the daily routine. When the boy complained to the manager, it stopped, but the nurse was not fired.
The diagnosis was revealed to me only a year after being discharged under the pretext: “For many patients, the announcement of the diagnosis has a shocking effect, some commit suicide.” Because of the pills, my personality has changed a lot, and the feeling of loss and trauma remains.Then I lived quietly for several years without medication, until depression began, and then I was admitted to a day hospital.
Delirium gave me an understanding of how fragile there can be a basis for confidence in any idea.
I have become more careful and methodical because of my understanding of the destructive power of irrationality. The perception of others has changed – I learned to accept a much larger number of people.
At first, my mother did not accept the diagnosis and believed that everything was fine with me.Friends found in him an explanation of my peculiarities – occasionally I met sympathy, once – romanticization. I was discriminated against only by employees of state psychiatry. Psychotherapists showed blatant unprofessionalism, one of them said: “Homosexuality is a disease.” Only one physician was good, helped in prescribing appropriate medications and understanding mental status. In general, there is no need to talk about comfort, trust and the subjective, that is, human attitude in psychiatry, there [the patient] is treated like a thing.I always felt like I was floating freely, occasionally receiving handouts of pills.
“If schizophrenia disappeared, I would not know what to do”
Nadezhda, 18 years old
Kostroma. Studying at a medical college. Photo taken in Hope’s room
Hallucinations began at the age of 12, one of them still exists today: it is a choir without words, like the sound of a flute without turning over notes. Then there was the sound of pouring water at night, voices and apathy.Parents did not believe, they called her a dreamer using drugs.
Both hospitalizations are the most difficult time in my life due to the inability to escape from myself. The first doctor accused me of simulating symptoms, but prescribed treatment. In the children’s wards, you can only be in the wards during lights out, rounds or quiet hours, [the rest of the time] we sat on the chairs at the nurse’s station. For noise, they were punished with knitting (tied with ropes to a bed. – Approx. Ed. ) – they should last no more than an hour and a half, but children were knitted for a day or night.
The adult department had two doctors for 50 people. One woman had bruises and pain from the ropes, but they did not untie her for a long time. An elderly patient was punched in the face by a nurse for calling her mother in the hallway. The saddest thing was occupational therapy – we cut and stitched strips of fabric, making a carpet, then unbuttoned and sewn again.
Father considers the diagnosis a fantasy even now. She says that I have broken my whole life: I will get a job as a cleaner and die of hunger. His mother supports him.
My nine-year-old brother says there is no schizophrenia because I don’t run after people with an ax. It’s awful that children are also brainwashed.
At school I was bullied not only because of my diagnosis, but also because of my sexual orientation. And when new people came to the 10th grade, the attitude improved, they read my diary on social networks.
The ex-girlfriend said that she also had hallucinations, but then admitted that she had invented everything.Such attempts to imitate are offensive. Now we only communicate as acquaintances.
Illness made me strong and patient. If schizophrenia disappeared, I would not know what to do. It gives the syndrome of the search for deep meaning – something that wildly likes, but also frightens . These are both signs and influxes of thoughts like “does God believe in himself”.
In our psychiatry, there is a severe shortage of people. The district psychiatrist is the decoration of the office. He threatened my mother that they would pick me up with the police right from the school.He complained that the patient himself was due to fired vodka, but he had not yet drank himself to hallucinations. In hospitals, patients are not informed about what is happening to them, and there is no psychotherapy in closed wards. Personally, the hospital did not help me, and the restriction of freedom and communication only did harm.
“I will say – they will immediately be fired”: what is it like to hide a mental disorder from colleagues
“I will say – they will immediately be fired”: what is it like to hide a mental disorder from colleagues
“I take 11 tablets a day”
Alexandra, 20 years old
Zhukovsky.Works in anti-cafe, future psychologist. Photo taken in the courtyard of Alexandra’s house
It all started at the age of 15 with depression. Parents took [her] negatively, especially dad with his “you invented everything.” Soon, voices began, male and female, and hallucinations in the form of ciphers, which I wrote down on paper. Voices ordered me to pass these codes to people I knew. From hallucinations now there are layers that move and cross all space.Previously, because of them, it was scary to leave the house: I thought there was a conspiracy against me. I also see the eye – this is a kind of entity that appears on different surfaces and communicates with me. Usually all this happens in autumn and winter, and dies down in spring and summer. When the eye leaves, I am even sad without it, I managed to love it as a friend .
The head physician at the PND [neuropsychiatric dispensary] persuaded my parents to send me to the hospital by force – they did not agree, and she began to threaten that she would deprive them of parental rights.I myself now have a negative attitude towards involuntary hospitalization.
I believe that help through violence is not help.
I went to the Mental Health Research Center for a month and a half – there are good conditions and doctors, only they lied all the time that I had depression, but were discharged with a diagnosis of schizophrenia. I believe that the patient should know the truth about his condition. I was lucky that the hospital did not practice punishment and gave only modern drugs – the treatment regimen was changed more than 10 times when side effects arose. Now I drink three antipsychotics, a corrector and a normotimic – only 11 tablets per day . This is much more than is usually prescribed for schizophrenia, but I feel good.
Mom takes the diagnosis calmly, but dad is still unhappy, believes that he is mistaken and that it is better not to take antipsychotics. Only the former best friend turned away from the entourage, the rest communicate well, including colleagues at work and guests of our cafe, who are also in the know.
Thanks to my illness, I began to better understand people who are faced with mental problems.Earlier it seemed that this would never happen to me, but when it happened, I realized that no one was immune from this disease. ”
“I lived on the street for a month and a half as a homeless person”
Denis, 40 years old
Zelenograd. Literary and translator, member of the Writers’ Union. The photo was taken in the area where Denis was when he lived on the street
The first attack occurred at the age of 23. It seemed that passers-by were giving me signs, and the colors of the cars were associated with the order that the “higher government” was giving me.Later, all types of hallucinations began, which were felt as a result of external influences. A physicist friend said: “Well, let’s say the brain can be used as a receiver. But it doesn’t have a transmitter! ” And then I thought that perhaps this is really a disease, because such a phenomenon as a conversation with voices in the head is limited to the limits of the patient’s nervous system. Purely theoretically, even if the brain could receive signals from the outside in the form of voices, it would not be able to communicate with them. Often, misunderstanding of this leads the patient into a delusion, as if he is communicating with someone, although this is just a malfunction in the brain.
Once I lived on the street for a month and a half as a homeless person: my wife was taking me to hospital, but I got scared and ran away from her. I drank water from the river, ate what I find.
When the residents paid attention [to me], I had to leave that area – I walked for a long time and found an abandoned dacha near the airport [Sheremetyevo], from which they took me away with the police three days later. About seizures and relationships with loved ones wrote the story “Gardens where rivers flow”, published in the samizdat “Organon”. I have had eight hospitalizations during the whole time. All forced .
Friends did not turn away, but some spoke disparagingly – and I parted with them. A friend came to visit during my seizure. After our conversation, he told his wife: “This is not Denis! Denis went out to smoke somewhere. This is another person whom I do not know. ” This dichotomy – this or the wrong person – became the defining principle by which friends began to build relationships with me.
I got a disability when I was dismissed from my job.It was a difficult step, like putting an end to yourself. But there was no other way out, we had to survive on something. Because of this status, it is impossible to obtain a driver’s license; when employed in a budgetary or state institution (research institute, public school and many other institutions), a certificate from a psychiatrist is required. A certificate from the PND and drug dispensary was required even when applying for a job as a forest park cleaner at the State Budgetary Institution “Automobile Roads”. When my mother was selling an apartment, they demanded a certificate stating that she was not observed in the PND – this was submitted as a mandatory procedure, which means that such difficulties could arise for me when solving issues with real estate.
I treat my illness as a cross, religion helps to reconcile with it. I like to quote the prayer of St. Demetrius of Rostov – its meaning is that a person completely surrenders himself to God’s will, without which even a hair from his head will not fall. Schizophrenia shows how fragile a person and his life are . A person [with schizophrenia] is forced to take medications, he is more vulnerable to the “world open wide to the fury of the winds” than healthy people. We must hurry to do good deeds and stand guard over the positive values that are given to us in life.I have a family, a daughter is growing up, this gives a certain value horizon to my life.
How to communicate with a loved one who has a mental disorder: 9 simple rules
How to communicate with a loved one who has a mental disorder: 9 simple rules
“The strangeness began as a result of violence”
Irina, 22 years old
Moscow. The photo was taken in the place where Irina’s first suicide attempt took place
At the age of 14, I began my first romantic relationship with a boy who was 22.One day he came, grabbed my hands, threw me on the sofa and raped me. When trying to resist, he hit me in the face. He said that if I told about it, my loved ones would feel bad, and I was silent. For the next two years, he kept me under total control, humiliated me, forced me to cook food, clean the apartment and satisfy me. Weirdness appeared as a result of the violence: it was very disturbing, before the panic attacks . It seemed that I was fat, ugly, superfluous in this world.
A voice appeared that yelled at me, called me names, said that without me everyone would be better and that I was a burden for my mother.And I decided to leave. She took a camping knife, burned the diary and went to the garages.
I remember how I lost consciousness and woke up in the hospital. Mom that day signed a consent for a psychiatric hospitalization, [in the hospital] I was four months. I remember feeling like I was betrayed.
It was not allowed to smoke in the hospital, but it was possible to earn money for a pack: to stand at the distributor during meals or to wash the toilet and shower. In the evening, the remaining cigarettes were taken away and punished, so before the lights out I went outside and smoked the whole pack at once.Then on the commission I diligently played “a normal person”, and I was even removed from the register in the PND.
A working treatment regimen was selected only in a paid clinic, and in the state one psychiatrist wrote a paper on the effects of azaleptin, and therefore his entire department took only this drug.
Outside of aggravation, nothing but too quick thoughts prevents me from functioning in the world. In an exacerbation, it can be difficult to leave the house, eat food, travel by public transport .Symptoms are at first difficult to separate from your thoughts and desires, but over time, the realization came that it was alien.
With angina, a person does not perceive pus on the tonsils as part of himself – this is a manifestation of the disease, they get rid of it, use drugs. It’s the same with mental disorders.
Many acquaintances, having learned about my diagnosis not from me, limited our communication, and then completely disappeared from my life, but I do not regret it.The media often show schizophrenics, “schizos” as unbalanced psychos, who, as soon as they turn away, will be hacked to death with an ax and smeared with guts. Therefore, society shuns people with mental disabilities.
“Why aren’t you being shut down? Why are you walking the streets? ”
Sonya, 20 years old
Moscow. Courier studying to be a hairdresser. The photo was taken in the park where Sonya
likes to walk
I got sick at the age of 14, I have senestopathic schizophrenia – this is when it seems as if someone is crawling on you.There were four hospitalizations in total, in one of the hospitals the staff forbade us to enter the doorsteps of their offices: they were afraid that we would attack. Sometimes the nurses scolded us for [we] pissed them off, said we weren’t sick and were playing the fool.
At school, a social worker told everyone about the diagnosis. Classmates began to mock me, and almost all the teachers refused to teach me.
I went to individual training, studied only with two teachers – English and mathematics.The knowledge remained at the level of the eighth grade.
Mother thinks that I can pounce on her, and says: “Do not come, I’m afraid of you.” The father denies everything, prohibits taking medications and threatens to stop sponsoring if taken . My grandmother also has schizophrenia, a paranoid type, but even she attributes some of my symptoms to upbringing. Only friends treat her well, do not think she looks like a maniac. The parents of some of them at first considered me dangerous and changed their minds when they met.The former guys did not believe in the diagnosis, they were forbidden to take pills, although many of my reactions were attributed to the fact that I was hysterical, playing a fool, or that I had forgotten to take my medications.
I decided to forget about my personal life, because with such a diagnosis it does not shine.
There are other restrictions: I would like to drive a motorcycle, work as a nurse, but this is not possible. It is also difficult in life when, due to a disorder of thinking, it is difficult to explain something to people. Schizophrenia is a punishment that will make my dreams most likely never come true .
Our psychiatry lacks normal human doctors and modern original medicines. Now I take a generic for two thousand, but the original costs seven, and the difference in terms of effectiveness and portability is huge.
When I worked as a cashier at Pyaterochka and combined two jobs, I became nervous, forgetful and inattentive from lack of sleep. They called the manager, she said that I looked like a person from a mental hospital, I replied that this is partly true, which was followed by indignation: “Why are you not being shut down? Why are you walking the streets? ” In general, people with mental disorders are sometimes kinder and more sincere than healthy people.
Brilliant bipolar: is the “fashion” for mental disorders dangerous?
The ingenious bipolar: is the “fashion” for mental disorders dangerous?
“My father yelled that I need to hit in the face, and the voices will pass”
Julia, 32 years old
Moscow. Programmer. Photo taken at Julia’s house
From adolescence, she was cleanliness: she washed things if someone touched them, and washed her hands if she touched the floor.One day before the New Year, I ripped out the entire apartment with bleach, including the cupboards. This has become an annual ritual. When I left at the age of 21 for the USA on Work and Travel, this symptom disappeared at one point and never returned, probably because I was far from my family.
In America, after a few years I developed paranoia and voices. I thought I needed to do something wrong in order to understand how the voices would react, if they were real. And I broke the windows in the room. The neighbors called the police, they took him to the hospital.The ward was for two, we were fed with dishes from the cuisines of the world, there we played board games, a console, went in for sports. Do not compare with Russian hospitals , where dirt, terrible food, rudeness, mating and injections for educational purposes, and cigarettes act as currency, like in prison. In the USA, I was diagnosed with depression with psychosis, and in Russia it was already schizophrenia.
I don’t communicate with my parents. They laugh at me, refuse to go to family therapy with the words: “You are crazy here.”
My father, drunk, yelled that I needed to be punched in the face and the voices would pass, showing films about possessed people. Parents were forbidden to talk about the diagnosis, but I posted information about it on social networks. This did not affect the attitude of friends and colleagues.
The diagnosis barely bothers me: thanks to antipsychotics, only the voices before bedtime remained from the symptoms, you can live with them. But when it takes a day to sleep out due to stress, you have to ask for leave retroactively.Isn’t my illness a good reason? A psychiatrist can only give a referral to a hospital, but not an ordinary hospital one. In general, due to illness, I have lost several years of my life, and there is always a risk that the condition will become unstable.
In America, people get to psychiatric hospitals when not everything is bad, but in our country – when a person has already lost his job, became homeless or has gone into defect . Patients need to be socialized on time, brought back to life, to work. I go to a psychotherapist who left state psychiatry because she only had Soviet medicines in her arsenal, and all the patients returned to the hospital over and over again.
I like Buddhism, its texts have therapeutic benefits – for example, the “Tibetan Book of the Dead”, which influenced Carl Gustav Jung, but I do not set the goal of enlightenment for myself and I treat life and religion rationally thanks to my experience.