Interview with psychologist Lloyd Ross on treating schizophrophrenia

Lloyd Ross is speaking BULLS**T. My schizophrenia is the same as having a biological disorder like diabetes. I would walk to the ends of the earth to prove it. Once the brain stops producing the chemicals needed properly or overproduce, it needs medication to stem the flow or encourage it. Like a diabetic need insulin because his body won't produce enough or too much, plus he has to watch what he eats. SAME as schizophrenia. Medication plus lifestyle - manage stress, avoid marijuana, cocaine etc., therapy, walks, diet and so on.
The medication blocks the receptors that overproduce dopamine, medical science proves this. Other drugs help with serotonin.
Your going back to when Freud was born thinking talking could cure what we now call schizophrenia. That's over 100 years ago fool.

Im open to the possibility that some people could crawl out of mental illness on their own. But also they should not persuade others to do so. Its irritating. We are not all the same.

I said that as well as medication, therapy and changes to life are often needed. Without a support network many people relapse I do realise this.

No man is an island.

I think that intensive therapy can sometimes be counterproductive - we cannot open the flood gates too soon. I think mindfulness is a brilliant concept.

Nothing of course can replace genuine connections to people. god I certainly didn't get well on my own. I had a doctor, nurse and people gave me advice and stuck up for me when I wasn't able to work.

Is there really such a thing as a doctor in" good will hunting" someone dedicated to getting you better? Who will turn you inside out to find out the exact memory (ies) that have made you unwell . in my experience my doctor is more interested in getting home for tea at 5 o'clock

Laurie is bang on the money.

Sure, because the majority can get better without doing anything (most depressions, acute psychosis without negative symptoms...).
But if you increase the stress of a chronic person by 'pushing' him with an aggressive psychotherapy, he will only get worse.

Van Gore,

Regarding this "My schizophrenia is the same as having a biological disorder like diabetes"... for this to be true, there could have to be clear evidence that changes in levels of neurotransmitters such as dopamine cause experiences like social withdrawal, delusions, and hallucinations. So where is that evidence?

We have such evidence for diabetes, but to my knowledge the dopamine hypothesis of schizophrenia has never been proven. If you have studies that prove it, please share. You can believe faulty brain chemistry causes your distress as much as you want, but that doesn't make your view true or scientific.

Besides, schizophrenia - severe psychosis / extreme states - can be cured at least in many cases, using both intensive psychosocial help and the lifestyle adjustments you mentioned Van Gore, which I thought were very good.

I may have listed these books earlier, but here are about 30 case studies of people fitting the diagnostic criteria at one time who were cured or improved dramatically:

Treating the Untreatable by Steinman - https://www.amazon.com/Treating-Untr...dp/1855756099/

Rethinking Madness by Williams - http://www.rethinkingmadness.com/dow...s_complete.pdf

Weathering the Storms by Jackson - https://www.amazon.com/Weathering-St...dp/B005WH0PZQ/

When the Sun Bursts by Bollas - https://www.amazon.com/When-Sun-Burs...dp/030022365X/

Psychotherapy of Schizophrenia by Benedetti / Furlan - https://www.amazon.com/Psychotherapy...dp/088937077X/

These are five out of about 40 books on this theme which tell the stories of people who were once schizophrenic but recovered. I can list more if people want... to those who think cure of schizophrenia is impossible, I challenge you to read the 30-plus stories of the people in the books above with an open mind.

I am always surprised when people hold the belief that schizophrenia is an incurable disease. There are so many accounts telling otherwise. That doesn't mean everyone gets cured, but it is possible.

And lastly, what Laurie says is correct - we are not all the same. I actually do not believe trauma is "the cause" of schizophrenia - it is a significant cause in some, not all people. That is my position. You might consider that my and Lloyd's positions differ somewhat.

However, thinking of John Read's research in Models of Madness, I think there's a lot of evidence showing that traumatic experiences contribute to going mad at least in many people. And yes there are other causes too.

Some of you may be interested to see the data linking trauma and (some cases of) schizophrenia here - "Who is Right, Psychiatrists or their Patients?" - https://www.youtube.com/watch?v=e-u_CGtUUZk

Can you explain why I get better while I enhance dopamine instead or reducing it?

I am tired, I won't discuss the diabetes vs mental disorder because what you said about diabetes shows a lack of medical knowledge, there are many types of diabetes, most of them are not treated with insulin and they are diagnosed with physical tests, not like mental disorders which change with years because they are 'made' by humans, new ones are added, old ones are eliminated, some criteria are changed... It doesn't mean psychological pain doesn't exist, but the diagnosis and treatment it's not like diabetes, and what you said about receptors is false too, they don't produce dopamine, they release it. Oh, and insulin is an hormone, not a med like haloperidol. Probably there is a biological cause of psychological and psychiatric alterations, but they are not like diabetes, and it doesn't mean psychotherapy is useless, because what changes how we act and feels change our brains too, as well as what changes our brain can change what we feel or do. The last and most important thing it's if dopamine hypothesis were right, most of people would be cured when they are given antipsychotic, but only around one in three people with schizophrenia are symptoms free with antipsychotic, the other one in three have symptoms even with antipsychotics and the last one in three don't respond to medication -like me-. Most of people with diabetes mellitus type 1 are ''cured'' when they are given insulin, if not all.

You can have and give an opinion without being a medical professional or a medical professional student -like me-, but please, investigate better, not reading blogs. If you read any psychopharmacology book you won't find anything comparing mental disorders with diabetes, even those that highly agree with biological psychiatry, if you read the DSM you will find they are mental disorders and not illnes when it's discussed about disorder vs illness, because there is not enough evidence to consider mental alteration as illness. Some books that don't discuss disorder vs illness use the term mental illness, but because the illness vs disorder issue it's not the point.

You could begin learning a bit of neuroanatomoy, then neurophisiology, then neuropathology, the basics of pharmacology and then some psychopharmacology. If you could learn the general idea of anatomy, phisiology and pathology it would be still better, before focusing on the ''neuro'' part. If you have a good library near you live you should be able to find them. They cost more than 80€, so I wouldn't buy them lol.

If you want to learn some about non biological psychiatry you could read what bpdtransformation said, but I guess you will understand by your own why purely biological psychiatry doesn't make fully sense after learning about neuroanatomy and neurophisiology, and then if you are interested on why medications work in some cases you will read about psychopharmacology. Pubmed is really good for new interesting information.

You could find this interesting and easy to understand, it explains why using the lowest possible antipsychotic dose it's importand and explain some about receptors supersensitivity due to antipsychotic medications and upregulation. You have to click on the picture to download it.
http://www.mentalhealthexcellence.or...s-why-and-how/

Crazy, inside and aside

"Outwardly: dumbly, I shamble about, a thing that could never have been known as human, a
thing whose shape is so alien a travesty that humanity becomes more obscene for the vague resemblance."
I have no mouth and I must scream -Harlan Ellison-

I got better by only staying far from stress, I wasn't completely symptoms free but I was functioning, I made it without medication or psychotherapy, and relapsed when I lost the friends I was making and found myself completely alone, it was because my stress increased.

Crazy, inside and aside

"Outwardly: dumbly, I shamble about, a thing that could never have been known as human, a
thing whose shape is so alien a travesty that humanity becomes more obscene for the vague resemblance."
I have no mouth and I must scream -Harlan Ellison-

I was not being scientifically specific in relation to if it releases or produces etc.

and I did say the brain can over produce too, as well as under. Both ways.

My main argument is that many forms of schizophrenia are biological in origin so medication is a huge part of "treatment". The psychological therapy is often to figure how relationships were affected by your condition and how to move forward.

Insulin doesn't cure that would mean the body would be able to regulate insulin without medication but it can't.

I won't give up without a fight lol

VanGore,

You aren't really fighting if you don't provide evidence: Again, where are studies showing that changes in biological factors are the cause of schizophrenia? You haven't cited anything. It's fine to have an opinion, but an opinion is just that.

Also, consider this: What is the appropriate, or "correct" level of dopamine for a brain to have? Who decides that? And, are varying levels of dopamine perhaps appropriate responses to whatever varied experiences a person has had in their life?

Difficult questions...

And in my view of therapy for severe psychosis, the relationship can modify the distressed psychobiological state so that the person can ultimately become non-scizophrenic and well. It's not "managing an illness", it's truly getting well - becoming non-mentally ill - and living as good a life as most functional non-mentally ill people live. There's a big difference. The books I provided with the 30 cases give many examples of this type of recovery.

... a recovery that is possible only for a minority.

Why? In other countries recovery it's not the minority (see finland and open dialogue), it depends o the treatment and community support.

Maybe I have a too positive point of view...

Crazy, inside and aside

"Outwardly: dumbly, I shamble about, a thing that could never have been known as human, a
thing whose shape is so alien a travesty that humanity becomes more obscene for the vague resemblance."
I have no mouth and I must scream -Harlan Ellison-

[...] I decided to ask a Finnish expert about the program. I contacted Kristian Wahlbeck who is a Research Professor at the National Institute for Health and Welfare, Mental Health and Substance Abuse Services, in Helsinki.

His comment in an e-mail to me was "I am familiar with the Open Dialogue programme. It is an attractive approach, but regrettably there has been virtually no high-quality evaluation of the programme. Figures like "80 per cent do well without antipsychotics" are derived from studies which lack control group, blinding and independent assessment of outcomes."

He went on to say that "most mental health professionals in Finland would agree with your view that Open Dialogue has not been proven to be better than standard treatment for schizophrenia. However, it is also a widespread view that the programme is attractive due to its client-centredness and empowerment of the service user, and that good studies are urgently needed to establish the effectiveness of the programme. Before it has been established to be effective, it should be seen as an experimental treatment that should not (yet?) be clinical practise."

Don't Be Too Quick to Praise This New Treatment | Marvin Ross

__________________________________

How can we have faith after thousands of years of non-pharmacological treatment of 'madness' with unsatisfactory result?

Eeyore,

There can't be a precise control group for "schizophrenia", because the label lacks validity and has poor reliability. Psychology is not a hard science like physics or chemistry; we are dealing with human beings and thus the studies are quasi-experimental. What we need to look for are the pattern across multiple studies, not any one study. Each individual study might be biased, because schizophrenia is a subjective label given to a person based on judgment, not an illness with reliable biomarkers... Interestingly, the Open Dialogue approach does have 3 separate cohort studies over different time periods; they all did similarly well, in the early '90s, late 90s, and early 2000s.

Also, how do you accomplish "blinding" when you are giving psychological and social support to live human beings for periods of years? You're going to find out how what type of treatment you're giving them. Interacting with real people isn't like giving some people a pill and others a cube of sugar. For the critic to make this comment, you have to wonder what is going through his mind and how well he understands the level of engagement in terms of providing long-term help to people over years. Again, it's a lot more than just giving someone a pill.

Still, you might be interested to know that new studies into Open Dialogue in different settings are being started:

https://www.madinamerica.com/2016/03...-and-training/

So in the next few years, more data is coming! :-)

Also Eeyore, "recovery" is another subjective term: People improve and recover to different degrees, over different time periods, in different settings. It's not all or nothing. And results like the Open Dialogue approach suggest clearly that with sufficient support, most psychotic people can have relatively good outcomes. As do the results of long-term psychotherapy carried out by the 388 Project in Quebec, and Benedetti and Furlan in their study of 5-year psychotherapy for severe psychosis reported in the book Psychotherapy of Schizophrenia, and Roberta Siani's outcomes for psychotic patients reported in Psychosis: Psychological Approaches and their Effectiveness.

I'm sad to hear you've been do discouraged! That's a shame. Consider that things might have a chance of being better than you think.

You should have a 5 minutes conversation with my schizophrenic mother (not that she would allow you to open your mounth or that she would accept to speak with you...).

I am proof that medication works god damn!!
Without medication I can barely concentrate long enough to watch a music video. I was taken off meds that work and experienced the full brunt of my condition.

The hunger games - I volunteer !!!

Van Gore, I do think drugs can help people; I have not said that it cannot or does not help some people.

On the other hand, drugs helping one person is not proof that the drugs are generally effective in a particular way. It's an anecdote, although valid for the person telling the story.

Eeyore, sorry to hear about your mom. I had a very difficult and violent father, although he was fortunately not overtly psychotic. When someone has been delusional and/or hallucinatory for a long time, as in an older adult, it can be harder to help them because it is more ingrained. But it's still possible for them to change a lot. Unfortunately, many people do not have access to good social support... and furthermore, they have defenses against asking for help and/or don't know they need help. And that is a very difficult situation.

With my dad, I had to get away from the family house and live apart from the family for quite a while. Fortunately I had enough help to do that, but I know some people do not.

bpdtransformation, do you know any book that talks specificly about treating negative symptoms? I have checked the ones you linked here, but I am poor and before buying anything I would like to have the opinion of someone who has read them.

I was thinking on buying making sense of madness from the same book serie than models of madness.

Which one would you recomend to read first for someone who has a traumatic childhood, a lot of negative symptoms, existencial problems and doesn't find a meaning in life?

Crazy, inside and aside

"Outwardly: dumbly, I shamble about, a thing that could never have been known as human, a
thing whose shape is so alien a travesty that humanity becomes more obscene for the vague resemblance."
I have no mouth and I must scream -Harlan Ellison-

My understanding is that drugs completely cure around 25% of people while they substaially help another third or so......there is another 25% that don't respond to meds and the remaining ten percent commit suicide.....this is from e fuller Torrey's surviving schizophrenia which cites another source I'm too lazy to look up. So it's far from an n of one. Still some people can be helped by therapy...I had cbt for psychosis along with my meds..I would say the meds helped 90% and the therapy 10%. I know Elyn saks was helped so much by therapy she became a therapist......

Hi Oliver,
I once spoke (via phone) to one of the authors of that book series Making Sense of Madness... Jim Geekie, a very compassionate man.

I don't use the term "negative symptoms"... because I don't view emotional withdrawal, lack of affect, low motivation, etc as symptoms of an illness. I view these experiences as understandable responses to things going wrong in one's life... the causes of these experiences could be partly internal, but are most often experiential and due to lack of social support in some form.

To me what are called negative symptoms are the prototype of what Harold Searles wrote about when he discussed the "out of contact phase" of severe schizophrenia in his work at The Chestnut Lodge. They describe the understandable feelings of someone who is very estranged from his fellow human beings emotionally, and thus understandably unmotivated and apathetic. Psychodynamically, negative symptoms express a deficit of all-good self/other images, and a predominance of all-bad internalized representations. This is a bit technical, but it basically means that the defense of splitting is constantly in operation.... the person has either had too many negative experiences in life (or alternately, too few positive ones). I wrote about the reasoning behind this here - https://bpdtransformation.wordpress....proach-to-bpd/ - and a more severe version of this description would apply to schizohprenia. The following article #10, on the four phases, also describes how to exit the negative-symptom phase (for BPD or schizophrenia) via developing positive relationships and trust.

So I would reframe negative symptoms as the "out of contact phase" and look at how to get someone from that place of (non)relating and (a)motivation toward a position of being more related and attached emotionally. Some books that discuss this for borderline states include Jeffrey Seinfeld's The Bad Object and David Celani's Treatment of the Borderline Patient... and for schizophrenic states, Arctic Spring by Laura Tremelloni, Treating the Untreatable by Ira Steinman, Weathering the Storms by Murray Jackson, and Collected Papers on Schizophrenia by Searles... all of these books have at least some case studies with people starting out with severe negative symptoms, or what I'd call withdrawal/apathy. And these people can get better and become more related and motivated. It just tends to take more time and resource, because the negative-symptom picture is a developmentally earlier position (in a non-pejorative sense, a less emotionally developed position).

I am not sure what these books are selling for used online but some of them may still be cheap. However, I don't think reading these cases is absolutely necessary... the most important thing is supportive real people, and figuring out how to access and relate to them better.

Sometimes Psychotic, the connection between drugs and improvement for psychosis is an inference on the part of Torrey, not a known causal link. He notes that some quasi-experimental studies have suggested that 25% of people "fully recover", however recovery is defined... and then he makes the questionable assertion that this is due to drugs. However, there is the equal possibility that many of these people were mostly or primarily helped by other external factors in their lives.

It is very difficult to prove cause and effect in these quasi-experimental studies of human beings... where people are, of course, subject to so many possibly confounding factors that cannot be controlled for, as in a truly scientific experiment in physics or chemistry.