A psycho-social treatment model for mental 'illness'
Polar sets of assumptions about severe mental 'illnesses':
1. Psychological phenomena, including voice-hearing, 'delusions', and self-destructive behaviors are meaningful, make sense in the context of life history, & are best resolved through psychosocial means.
2. Mental disorders have genetic, viral, neurochemical, &/or structural etiologies. They can be altered significantly only through use of biological treatments in which the treatment partner has little input, except to decide whether to comply or not. The treatments usually have temporary effects, so they must be continued or repeated throughout life.
Looking at 'schizophrenia' as presumably one of the most biologically-determined kinds of psychological difficulties that humans experience:
Harrow, 2012: naturalistic, long term outcome study of people diagnosed with DSM-III schizophrenia; 'recovery' defined as working, not disabled, with relationships in the community. At 20 years post, 5% of those who took neuroleptics continuously during the study period were recovered. 40% of those who stopped meds early on were recovered. No differences in initial symptom severity. Those who stopped using meds "have better prognostic factors, better pre-morbid developmental achievements, less vulnerability to anxiety, better neurocognitive skills, less vulnerability to psychosis and experience more periods of recovery."
Wunderink, 2013 (pdf): no difference in outcome at 7 years post between med-compliant & med-refusing groups diagnosed with schizophrenia.
Compulsory community treatment (coerced medication for 'schizophrenia') have been found to have no impact on outcome in the UK & Australia.
Seikkula, 2011: sustained 85% reduction in population prevalence of schizophrenia over 20+ years, with use of family therapy as primary mode of intervention. 2/3 of treatment partners are medication-naive, less than 1/5 used antipsychotic meds for more than a few weeks. Hospitalization & ECT not used.
World Health Organization: Rate of recovery from schizophrenia in developing countries: over half within 5 years, 60% at 15 year follow-up. In developed countries: 30% historically, perhaps less than that now.
Harding, 1987: replicated WHO findings in the US
Torrey 2010: 30 years after WWII, incidence rates of schizophrenia were up to twice as high in Germany than in surrounding countries, though Germany had exterminated >= 73% of people with schizophrenia diagnosis in the preceding generation.
Hundreds of anecdotal accounts of recovery have been published or documented in which people describe in detail their own sustained recovery from psychosis via psychosocial means.
1. Psychological phenomena, including voice-hearing, 'delusions', and self-destructive behaviors are meaningful, make sense in the context of life history, & are best resolved through psychosocial means.
2. Mental disorders have genetic, viral, neurochemical, &/or structural etiologies. They can be altered significantly only through use of biological treatments in which the treatment partner has little input, except to decide whether to comply or not. The treatments usually have temporary effects, so they must be continued or repeated throughout life.
Looking at 'schizophrenia' as presumably one of the most biologically-determined kinds of psychological difficulties that humans experience:
Harrow, 2012: naturalistic, long term outcome study of people diagnosed with DSM-III schizophrenia; 'recovery' defined as working, not disabled, with relationships in the community. At 20 years post, 5% of those who took neuroleptics continuously during the study period were recovered. 40% of those who stopped meds early on were recovered. No differences in initial symptom severity. Those who stopped using meds "have better prognostic factors, better pre-morbid developmental achievements, less vulnerability to anxiety, better neurocognitive skills, less vulnerability to psychosis and experience more periods of recovery."
Wunderink, 2013 (pdf): no difference in outcome at 7 years post between med-compliant & med-refusing groups diagnosed with schizophrenia.
Compulsory community treatment (coerced medication for 'schizophrenia') have been found to have no impact on outcome in the UK & Australia.
Seikkula, 2011: sustained 85% reduction in population prevalence of schizophrenia over 20+ years, with use of family therapy as primary mode of intervention. 2/3 of treatment partners are medication-naive, less than 1/5 used antipsychotic meds for more than a few weeks. Hospitalization & ECT not used.
World Health Organization: Rate of recovery from schizophrenia in developing countries: over half within 5 years, 60% at 15 year follow-up. In developed countries: 30% historically, perhaps less than that now.
Harding, 1987: replicated WHO findings in the US
Torrey 2010: 30 years after WWII, incidence rates of schizophrenia were up to twice as high in Germany than in surrounding countries, though Germany had exterminated >= 73% of people with schizophrenia diagnosis in the preceding generation.
Hundreds of anecdotal accounts of recovery have been published or documented in which people describe in detail their own sustained recovery from psychosis via psychosocial means.