Interview with psychologist Lloyd Ross on treating schizophrophrenia

New Jersey-based psychologist Lloyd Ross and I just put together this interview:

https://www.madinamerica.com/2017/02...es-lloyd-ross/

Lloyd has a particular approach which he described in this way:

Quote: "Over the last 40 years I saw approximately 150 people who could be considered schizophrenic because they were having delusions and hallucinations, i.e. they had a serious break with reality. Some of these therapies were very brief because they didn’t accept that I don’t use medication, which I always explained in the first session...

Now out of these 150 people whom I saw over 40 years, probably about 100 of them accepted my non-medication approach. The large majority of these stayed in treatment for at least one year, and many stayed for between three to five years or more...Most of the people I consulted with chose to try working without medication, which was often because they or their parents didn’t like what the medications were doing to them...

With somebody who was experiencing symptoms that the profession labels schizophrenic, such as having hallucinations, delusions, or being very paranoid, I would usually see them 3-5 times per week over a period of at least two years. Many of these schizophrenic clients were young people undergoing life transitions — these life transitions, like leaving home and going to college, often cause a stress that brings up earlier trauma and can cause a break with reality in a vulnerable person. But I also saw some older clients whose life stresses had precipitated a break. I worked intensively with them because psychotic conditions are very serious and require intensive help. "

We also discussed his success with the group that stayed over the longer term:

Quote: "The large majority of them get much better. I’d say 85-90% of the schizophrenic men and women who stayed in therapy at least two years got well to the point of being able to go to school, to work, to function in a meaningful, personally satisfying way, and to be involved in relationships. Probably a majority of these got married and had families. Sometimes their functioning was a bit awkward but they still functioned.

For example, a young man who had been psychotic might date or marry the quiet, shy girl rather than the girl who was the life of the party. But they could still have a meaningful intimate relationship and become good parents.
So yes, for most people diagnosed with schizophrenia, if they get effective help they get better. They go out into the world and function, and most often they don’t become severely psychotic again.

In the early part of the work, what happens a lot of times is that as a psychotic person starts to function better, the voices reoccur; but they’re not as disturbing anymore, they’re okay. Later on, if the person more fully works through their issues, these symptoms can completely or mostly go away. Or they still occur but don’t bother the person much at all, because they’re much stronger emotionally."

And then we discussed many other issues like the biogenetic model, how to understand hallucinations as meaningful phenomena, some trauma in Lloyd's own history, Lloyd's views on NAMI and the business of psychiatry (may be controversial). etc. I hope you will check it out.

I like this

"We're all born to broken people on their most honest day of living"

The Dopamine Flux
www.thedopamineflux.com

Youtube channel
https://www.youtube.com/user/MozePrayIII

This article confirms my strong bias against psychologists and their mostly trivial
(and expensive) talks.
Sure, 90% of success rate of his magic psychotherapy.

In a perfect world, which this one is not.

Aw man. I thought this was real too. I had so much hope. Forreal i did.

"We're all born to broken people on their most honest day of living"

The Dopamine Flux
www.thedopamineflux.com

Youtube channel
https://www.youtube.com/user/MozePrayIII

I wish I could recover without meds but I need them and will until I pass away. It's often a biological reason to schizophrenia because its passed down through your genes its been proven. Its not hard to believe that its the chemicals in the brain that are out of whack.
Therapy is often needed to come to terms with bizarre thoughts, or intrusive thoughts too. I realise this also .
Unfortunately this doctor is misguided

Oh ye of little faith :-)

What makes you think that intensive therapy cannot work for many people? Perhaps people really can become quite well, be fully free of schizophrenia, have normal lives with fulfilling careers and loving relationships.

One thing you are correct about - some family support, money, and safe living situation is needed. The lack of these things can ruin an effort to help someone.

This particular interview with Lloyd is of course anecdotal. But stronger evidence is provided by meta-analyses such as this:

TABLE OF CONTENTS

In which over 2600 psychotic people from 37 studies were greatly helped by therapy.

There are also larger scale studies in Gaetano Benedetti (Psychotherapy of Schizophrenia), Roberta Siani (in Martindale's Psychosis - Psychological Approaches and their Effectiveness), and the CBT therapists in Britain such as Morrison and Bateman. Many people are unaware of this work.

Lastly, if you doubt the type of accounts Lloyd shares, let me recommend the books Rethinking Madness (Williams), Treating the Untreatable (Steinman), Weathering the Storms (Steinman), The Infantile Psychotic Self (Volkan), and the Regressed Patient (Boyer). They are all on Amazon used. In these books are about 50 further cases detailing the process by which schizophrenic people can fully recover or significantly improve.

Van Gore, what makes you think schizophrenia is primarily biological? I know of no evidence supporting this idea.

What I have read in John Read's work (Models of Madness), in Jonathan Leo's writing on recent studies of schizophrenia and genes, and in Jay Joseph's books (such as The Gene Illusion) show pretty convincingly that genes are not causal to psychosis in any meaningful sense of the word. They simply convey a varying vulnerability to stress under different circumstances. And, genes change throughout one's life including (obviously) after birth, via epigenetic interactions with the environment. So, things are hardly set or fixed in the way the false biological model of schizophrenia teaches. Things are much more hopeful than you think.

If you want to be more hopeful, you might study exactly how Jay Joseph picked apart the notion that twin studies prove a primarily biogenetic basis for schizophrenia. That was part of what helped me dismiss this myth and get to where I am now, where I work full-time, have no remaining symptoms, have good relationships, and am quite well most of the time.

Even these inconclusive studies are distant to the raves of Lloyd, I still don't understand how can they persuade these people without insight of their illness to join their therapy.

About the biological causes of schizophrenia, you already mentioned the confirmed biological vulnerability and I would like to add that the effectiveness of antipsychotic medications is a proof that many symptoms occur because of some chemical imbalances in our brain.

Eeeyore, I mentioned a varying level of vulnerability to stress, not a vulnerability toward schizophrenia as a specific disease. We all have different levels of resilience.

The effectiveness of tranquilizing agents in making people feel less - which often doesn't go very far in the long run in restoring psychotic people to a meaningful, fulfilling life - is in no way a proof that distress occurs because of chemical imbalances. No chemical imbalance causing the symptoms of supposed schizophrenia has ever been discovered. Even leading psychiatrists like Ronald Pies have admitted the chemical imbalance idea was a myth. I'm not sure why you would think otherwise.

Lloyd doesn't persuade anyone to join therapy or not. People who wanted to work with him did so.

You didn't mention what you felt was inconclusive about the studies I cited - I have to wonder if you read them...

See what Ron Pies says here:

"In truth, the “chemical imbalance” notion was always a kind of urban legend- - never a theory seriously propounded by well-informed psychiatrists."

Psychiatry?s New Brain-Mind and the Legend of the ?Chemical Imbalance? | Psychiatric Times

So Eeyore, why do you believe in this idea, when even psychiatrists do not?

So why more than 40% of monozygotic twins of those with schizophrenia are also affected by it?

Proof may be a too strong word, but surely it is a hint of the role that these neurotransmitters play. If by which often doesn't go very far in the long run in restoring psychotic people to a meaningful, fulfilling life you mean that they should be discontinued, you should read this article from your dear Dr. Pies:

Long-term Antipsychotic Treatment: Effective and Often Necessary, with Caveats

(While Lloyd suggested that long term antipsychotic treatment is deadly...)

Persuade anyone? He just tells them that antipsychotic treatment is deadly and that it messes up his magic psychotherapy with 85%-90% of very positive results.

I'll quote several phrases from the link you posted before:

For nearly 100 years, individual psychotherapy has been used in the treatment of schizophrenia, but its efficacy remains one of the most hotly debated subjects in the history of psychiatry.
[...]
These findings are not an aberration. They are consistent with those of the clinical literature, the findings of Smith et al. (1980) and of Mojtabai et al. (1998), and the practice guidelines of the APA (1997). The findings of our review, however, contradict those of Malmberg and Fenton (2001) and Cormac et al. (2002), of most previous qualitative reviews of the literature, and the PORT guidelines (Lehman & Steinwachs, 1998). The findings are especially contrary to suggestions that individual psychodynamic psychotherapy is contraindicated for people diagnosed with schizophrenia.
[...]
Although this meta-analytic review is the broadest one conducted to date, it has certain limitations, which need to be addressed by future meta-analyses. First, there were a small number of studies to review...A larger sample of studies will enable more accurate estimates of effect sizes, and analysis of more potentially important moderator variables, such as estimation of changes in effect sizes over time during treatment and through several follow-up periods. The small number of extant studies also limited the amount of information available to conduct analyses of potential clinically important moderator variables such as therapist experience or training.
Second, about half of the studies we reviewed did not assign participants randomly. The purpose of random assignment is to minimize potential threats to a study's internal validity (Kazdin, 1998). Random assignment specifically reduces selection biases, which are
systematic differences in groups on the basis of the selection or assignment of subjects.
A third limitation to this meta-analysis is that we did not attempt to retrieve unpublished data.
Fourth, we did not report outcome variables, the effect sizes for each outcome variable, nor did we report effect sizes separately for dichotomous and continuous data.
[...]
Sixth, we were unable to conduct time-series analysis and estimate how much change occurred over time at different time periods, such as at six months or two years.
Seventh, we were unable to use the Jacobson-Truax statistic (Jacobson & Truax, 1991) to determine how close toward being in a non-clinical population patients were at the end of their treatments.
Eighth, our inclusion of within-group, pretest-posttest effect sizes from change scores can face interpretative problems, given that change scores have the potential to be influenced strongly by regression to the mean (Campbell & Kenny, 1999).
[...]
a more fine-grained understanding of the role of individual psychotherapy for the treatment of schizophrenia remains to be elucidated by future primary research and by future meta-analyses. It is clear that much remains to be learned about the utility of individual psychotherapy for the treatment of schizophrenia, and we have mentioned some of the important topics that need further exploration.

Wow. Nothing like a good dose of ignorance to take mental illness treatment back a century

Hi Eeyore,

Studies of twins are a big interest for me. The basic answer to your question in my view is that a large part of the greater concordance between identical twins is due to the problematic equal environment assumption in twin research - i.e. that twin researchers assume that the fact that identical twins are treated much more similarly than non-identical twins or siblings is not a confounding factor when studying what to attribute to genes and what to environment. In other words, they attribute to genetics what could be largely environmental (or more properly environmental-epigenetic). They also make many other problematic assumptions related to methodology, which subjects to include or exclude, and sample size. Jay Joseph reviews this area extensively in his book The Gene Illusion, and here - Jay Joseph, Psy.D. Licensed Psychologist - Publications . Another good writer in this area is Jonathan Leo.

We should also remember that schizophrenia remains a label without validity and with frequently poor reliability. So one has to wonder about the influence of these problems on studies of twins. I guess one could assume that rates of "misdiagnosis" occur about equally frequently within different groups, but who knows.

Regarding the monozygotic twins issue, Brian Koehler of NYU, and of our ISPS group has also done some good research into this issue. He states:

"In our field, there is a significant “missing heritability” between rates of “schizophrenia” in monozygotic twins and the combined reduced influence of genetic variants identified in genome-wide association studies (GWAS). The 80% figure often given as a heritability factor is somewhat misleading for students in our field who do not know how the H2 statistic is derived and various ways of deriving it. Through extensive molecular biological research of the most recent studies on monozygotic twins I have derived a theory which will make a much stronger case for socioenvironmental influences on what was previously though of in classically genetic terms."

More here - https://www.madinamerica.com/2015/12...d-epigenomics/

Yes, I have read this article by Ron Pies and have actually spoken to him in the past. He is a well-meaning man, although I disagree with his views on antipsychotics, which I view as selective use of biased studies where success is defined as a person being quieter and less disturbing to others over the shorter-term, rather than functioning and relating better over a long time-frame. Pies admits, however, that the evidence for antipsychotics having a strong efficacy beyond one year is relatively weak and mixed, as Sohler's recent study asserted too. Ron has his own opinion based on his own clinical experience, but that is different from data based on a range of well-run studies. And again, how efficacy or success is defined is important. It can be different for different people.

What I mean to say with Lloyd is that he tells them what he offers and how he works, and then they have the choice to work with him or not. This should be contrasted with some psychiatric treatments such as depot injections or ECT which are forced on unwilling recipients.

And yes, there are limitations to that Gottdiener study - just as there are a number of limitations to any individual quasi-experimental study of humans. However, the trend or pattern - across studies - which is what we need to look for with quasi-experimental studies - is consistently in the direction that psychotherapy and psychosocial support in general are supportive for people diagnosed with schizophrenia (again, a rather vague label). Despite the caveats, the data in this collection of 37 studies consistently supported therapy as helping psychotic people to function and feel better. This is not surprising, since empathy, support, and human contact tend, other factors being equal, to be supportive and helpful for most, not all people. It's not rocket science.

Laurie,
Perhaps you are not aware that functional outcomes for people diagnosed with schizophrenia now, in 2017, are not significantly better than they were in the early-to-mid 20th century. So ironically, going back a century in time to before would not mean that outcomes for psychotic people changed much! Of course, there is the issue of correlation versus causation and what to attribute to drugs or to other factors. These are uncertain.

I am getting this data from Jaaskelainen's recent meta-analysis, which shows that functional and symptomatic outcomes for schizophrenia have not improved for several decades, and have been declining in the last 15-20 years:

https://www.yellowbrickprogram.com/A...eview-Bull.pdf

Quote: "Consistent with the previous systematic reviews,
we found no evidence to suggest that recovery outcomes
have improved over time. There appear to be numerical
differences over time in outcome in schizophrenia, but
our sample size lacked sufficient power to demonstrate
statistical significance. Indeed, recent decades had lower
numerical proportions of subjects who met our recovery
criteria. This is a sobering finding—despite major
changes in the delivery of care to people with schizophrenia
(eg, deinstitutionalization, antipsychotic medications,
psychosocial interventions, and early psychosis services),
the proportion of those who met recovery criteria have
not improved over time. "

I'm not advocating that today's treatments for mental illness are perfect, but today's treatments are a vast improvement. The biggest problem with contemporary treatment is medication compliance.

The problem with this non-mainstream view is that there are many other studies that show the correlations between the various family relationships (even 'remote' ones!) and the chances of 'inherit' sz.

Yes, we are still in the darkness for the negative symptoms, but you ignore that many times it is precisely the effect of the new antipsychotics on the positive symptoms that gives the opportunity to the schizophrenic to, at least partly, return functioning.

Why should a schizophrenic person, that doesn't see it's problems, decides to work with Lloyd?

There are some serious limitations specific to that study, namely, the small number of studies that it reviewed and the contradictions with the results of similar studies.
In addition, the various psychotherapies are not simply reducible to 'empathy, support, and human contact', especially since sometimes they are not so empathic.

Laurie,
This is what I was saying the meta-analysis did not show - that today's treatments are not a big improvement in terms of outcomes. If they were, we should expect functional and symptomatic outcomes today to be much better than in the mid 20th century, but this is precisely what the Jaaskelainen meta-analysis shows has not been happening.

Eeyore,

Perhaps you can provide some citations or authors for your statements about other family relationships. It's understandable that people more frequently get diagnosed with this label within a particular family, nor is this unique to that diagnosis. Conditions such as poverty, discrimination, neglect, abuse, isolation, and so on tend to run in the same families from generation to generation, just as genes do, and thus it's difficult to disentangle or quantify the contribution of each. That is what Jay Joseph talks about, when he reviews the whole range of studies - on identical twins, fraternal twins, siblings, adoption studies, broader family studies, etc.

Yes, I agree, dulling down distress at least for a while can be useful, so someone can talk about their feelings. Didn't say that's not possible with drugs. In limited doses, can definitely be useful for some people at some times. At the same time, the drugs exert a generalized effect on thinking / feeling, rather than treating a specific illness or illness process. They are not like insulin for diabetes...

Exactly, people in most situations should have informed consent and choice about what treatments the are involved in.

My statement about psychotherapies was general; you are right, they are more complicated than simply empathy. The study I cited was a meta-analysis of 37 studies, which to me is a reasonable starting number. I'd be interested what number of studies you would want in a meta-analysis.

Thanks for engaging with me on these issues.

This is an interesting discussion. I didn't like taking antipsychotics, but I can concede that there were times in the past when I did need to take them. In J. Michael Mahoney's book one of the doctors that he quotes stated that before these antipsychotic tranquillizers were available that some patients would just expire after being in a prolong manic / psychotic episode. I think the term for this unfortunate condition was exhaust status. I put a link to Mahoney's book at Amazon where those that are interested can click on look inside and read a little of the beginning. He states that antipsychotics can be useful in stabilizing the patient so psychotherapy can begin.

https://www.amazon.com/SCHIZOPHRENIA...d+lady+disease

Also here is a link Kempf's paper that I posted in the psychotherapy forum.

https://forums.psychcentral.com/psyc...ticles-15.html

Schizophrenia.. it's not a disorder... but many disorders!

In the begining, when antipsychotic were discovered, the idea was giving them to people while treating them with psychotherapy in a communitary environmnet... and then release them! (most of them where in psychiatrist hospitals...living there)

Unfortunately, the pure biologist psychiatrist basically "killed" the psychotherapy part...

There could be a ton of causes for psychosis/schizophrenia...

And that identical twins are more likely to develop schizophrenia could mean two things: it has a genetical component or it has an environmental component. Why? Because identical twins are more likely to experience and live the same experiences in they first years of life than non identical twins.

Of course, there is a predisposition of some kind, a gentical base that could explain why in certain environments or after stressfull experiences some people develop psychosis while others depression. Anyway, that it has a genetical component doesn't mean it's all "inside" (biological). People with schizophrenia has lived much more traumatic experiences than people without it before the illness onset, stress has been a huge schizophrenia risk, stress is a huge risk for all mental health disorders. People under extreme stress tends to get either dissociation or psychosis.

This doesn't mean it's all biological, the dopamine theory it's absurd... It was someone who wasn't a doctor that observed people who consumed amphetamine and got psychosis from it, improved after they were given a certain med that was the first antipsychotic. From this it was assumed psychosis was always caused by too much dopamine, but it's like saying dyziness it's always caused by low sugar because some people stop being dizzy after they eat something.

Probably there are some brain annomalies... and what antipsychotics do it's slow the brain, so the psychosis is reduced as well as any brain activity. It has been found antipsychotics are as helpful as lorazepam to treat acute psychosis...

Antipsychotic=sedation=less brain activity=less psychosis (it's a brain activity).

Antipsychotic because of their profile could be better to manage psychosis long term on people who are in a great life risk because their insight it's always too low, they have cognitive impariments (not due to psychosis) or any other condition. But long term antipsychotics lead to hypersensibility of dopamine receptors, in the end they make the situation worse and recover less likely. This is why if recover it's likely it's better to use a low dose of an antipsychotic or none at all! And if it is used a normal dose, it's better to use it during the acute phase, and once it ends to reduce it slowly, as slow as the patient needs.

Anyway, there still could be people who need them lifelong because of their particular situation they are not able to live without having their brain a bit sedated. Or people who has been on antipsychotics that much time they receptors are too hypersesitive to completely stop the meds. It shouldn't be the norm.

People shouldn't be given and stay on moderate dosage of an antipsychotic after a first break for too much time, the dosage should be reduce slowly (to avoid rebound effect and psychosis appearing again) once the lower possible dosage is reach or it's off of med at all. More time one is on an antipsychotic after a break, less likely the recover is.

I can say by my own experience... not by medical reasearch... I have found myself as psychotic when I was a teen taking a normal dose of an antipsychotic than when I had my psychotic break almost a year ago. Right now I am mild psychotic on a diarly base, and somtimes moderately. I take a low dose of an antipsychotic that first blocks presynaptic autoreceptors (this receptors tells the cell it has released enough dopamine, so if they are blocked the cell release more dopamine) and then postsynaptic ones (this make the next cell unable to cach dopamine, and here it's the sedative effect or antipsychotic effect), so at low dose this med is actually stimulant and it's used to treat negative symptoms. Basically, I am not taking anything that lows my dopamine, I am actually taking something that enhances it. Also, I take Concerta which is an stimulant that makes the brain releases more dopamine.... so more and more dopamine and I don't get psychotic (When I say getting psychotic I mean being dysfunctional, severe psychosis) unless I take a lot of coffee along with my morning Concerta.

I am not missdiangosed with a psychotic disorder, my main symptoms are psychosis, dissociation and low mood (post psychosis depression). But first of all psychosis, when there is severe psychosis there is not dissociation or low mood, I am just with a psychotic break.

I still hear voices on diarly basis, and feel paranoid... but I gained insight... and slowly learn to manage it... I couldn't learn to manage it while I was on a dose of an antipsychotic that works causing sedation (antipsychotic effect). I couldn't control myself that much, I didn't have that much insight. I have more insight now with my psychotic symptoms than when I was on Seroquel 400mg, or Ziprasidone 80mg or abilify 30mg, ... because secundary cognitive symptoms from antipsychotic didn't alow me to learn about my own psychosis.

So yeah... it's possible to treat psychosis and schizophrenia, even early onset like mine and without family/social support like my case, even if I have a dissociative disorder and trauma related issue too....

Probably this psychologist got people who were able to manage psychosis and schizophrenia or learn to without antipsychotics and that's whhy his rate of success, I doubt he would be able to treat without medication someone who has 0 insight and a mild cognitive delay.

*Just* to remember, in a far far far country there is something called open dialogue that is able to treat 70% of schizophrenic people without medication (diarly, long term, ...). It's not a psychologist, but a whole place.

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-