I’m sorry to hear you guys are going though such a difficult time. Yes, you can lead a horse to water, but… It may help to simply let him know you’re concerned about him holding all of this himself and wondering if he’d like to find someone who can help him make some sense out of what’s going on. Probably counterproductive to try to convince him there’s anything wrong with him, but just acknowledging that he looks like he could really use some support.

HERE is a fairly extensive list of resources on my own website. In particular, I would take a look at the MindFreedom International therapist directory and see if you can find anyone near where you live, and I’d also look at some of the peer support services.

Regarding data with regard to recovery rates via non-medication approaches, I go over all of this research in Part One of my book, Rethinking Madness, which you can download for free by clicking “View Excerpt” on THIS PAGE.

Sending my best wishes,
Paris

I understand your resistance to these ideas, and I appreciate your desire to support those struggling with extreme states (btw, I have always been very clear that I do not “romanticize” these kinds of experiences nor do I invalidate how very distressing and disabling such experiences can be). As a clinical psychologist, as someone who’s personally experienced such extreme states, and as a friend and family member of others going through such experiences, I really get this.

When holding the stance that you’re holding here, which is generally held within the mainstream, and especially by those trained in the medical model understanding of “mental illness,” I want to encourage you to consider several logical fallacies in this reasoning:

(1) Distressing, powerful, and/or confusing experiences and behaviors do not automatically imply brain disease, just because the cause of such experience or behavior is not immediately apparent; and (2) correlation is not causation. Consider the intense grief someone may have upon losing a loved one. If we submitted them to an fMRI scan or other such neurological assessment, of course we would expect to find anomalous activity within the brain and other aspects of one’s physiology. I agree with you—mind and body are two perspectives (subjective and objective, respectively) of the very same process—any event within the mind will certainly have a physiological correlate, and vice versa, and the more extreme the event in one, the more extreme the event is likely to be in the other. Yes, mental and physiological events are highly correlated because they can be seen as simply two different perspectives of one holistic organism. However, the existence of such extreme states does not automatically imply physiological disease. Returning to the example of the grief stricken person, most people would recognize the absurdity of suggesting that the grief is caused by some disease process occurring within the brain, while recognizing that of course we would naturally expect to see some extraordinary biological activities corresponding with such an extraordinary subjective experience. In the case of the so called “mental illnesses,” however, because the cause is often not immediately apparent, or because the response strikes us as being unusually strong, we assume there must be some physiological disease process occurring–interesting hypothesis, but entirely unsubstantiated.

Also I would really appreciate it if you don’t continue to spread the myth that biomarkers have been well established for schizophrenia (or any of the other so called mental illnesses)—I consider this highly unethical and even harmful, especially coming from someone credentialed as a physician, though I’m sure you don’t intend any malice but are simply misinformed. Just several months ago, the Director of the National Institute of Mental Health officially declared that DSM diagnoses (which of course includes the diagnosis of Schizophrenia) lack validity, and the President of the American Psychiatric Association begrudgingly responded by acknowledging that it is in fact true that no such biomarkers have yet been found.

Finally, the evidence continues to roll in lending to ever increasing robustness with regard to the conclusion that the use of antipsychotics most likely interferes with long-term recovery (though may be of benefit in the short term), and that the majority of people who satisfy the criteria for a schizophrenia diagnosis would probably be far better off if they receive psychosocial support with minimal to no antipsychic use (and responding to your comment of homeless individuals struggling with psychosis, leaving people to languish away on the streets certainly doesn’t count as adequate psychosocial support). Here is a recent article summarizing the findings of these major research studies.

Thanks for engaging with this important and challenging topic,
Paris

This statement is a trivialization of the suffering people (and their loved ones) with schizophrenia endure. I am a medical doctor who has personal experience with mental illness. I am not a psychiatrist before you get your dukes up and accuse me of being in bed with big pharma. Recovery from psychosis is not a romantic process of self discovery where a little art therapy and talking about feelings will make all well.

A few clarifications: this mind/brain binary that you dance around is astounding. Brain is mind and mind is brain. And I think you are using illness and disease interchangeably. There are abnormalities in brains of people with schizophrenia (and thus disease) but what concerns treatment is illness. As a doctor if someone has a “disease”, let’s say a mild skin condition, that doesn’t bother them I am not concerned. Illness is the lived experience of the abnormality. And it is this suffering in schizophrenia that physicians, with the help of allied health, treat. Just because we can’t identify the abnormality doesn’t mean it doesn’t exist. This supposes that we have the tools to look at, simultaneously, all higher cortical functions and connectivity (we don’t) and there is a large body of convincing evidence that supports the “brain” basis of schizophrenia. Now schizophrenia is likely a heteregeneous condition in terms of pathophysiology but so are other syndromes such as epilepsy. You are wrong that when psychosis is due to a clear medical condition it’s no longer a mental illness; it would be diagnosed as a psychotic illness due to e general medical condition in the DSM and psychiatrists would often contribute to treatment (look up neuropyschiatry as a sub-speciality). There are literally hundreds of papers done by physicians trained in such investigations that show a range of differences in brain imaging in patients with schizophrenia, from structural changes most grossly to differences in activation on MRI and functional imaging. No gold standard “brain scan or blood test” is the case in a number of “neurological disorders”. There is no brain test or blood test for the primary headache disorders? For that matter other neurological disorders like the dystonias or most cases of myoclonus? Or restless leg syndrome? Does this mean to they too are a “construct”? Are they not illnesses because they too are diagnosed based on symptoms? What divides mental illness and neurological illness is based more on tradition. Schizophrenia, untreated, often presents with “neuro” symptoms as well such as movement disorders, eye movement abnormalities and frontal lobe dysfunction that a first year intern could pick up on neurological exam.

Granted the idea of self and personal history are important in understanding schizophrenia and definite risk factors for development of psychotic and other neurobehavioral illnesses but this again is rooted in biology – look up the fascinating research on epigenetics and impact of stress and related hormones on gene expression.

Psycho-social rehabilitation and adjuvant psychotherapy is important to ensure best outcomes. This is not dissimilar to most other chronic medical conditions where lifestyle and stress control are important for wellness, from conditions like headache, pain, hypertension, inflammatory bowel disease…etc. However, medications (while far from perfect) play a crucial role in severe psychotic illness as they do in many disorders; people in florid states of psychosis – the patient who wants to dig the colony of lobsters out of their stomach with an exacto knife, or the person eating their own faeces or the person dying of dehydration in a catatonic stupor – needs medical stabilization which includes antipsychotics. It’s actually laughable to think that these types of patients described (which are not uncommon in the emergency psychiatry department) should “integrate” their illnesses. Want to see how well people “integrate” illness, go to any North American downtown core and see the homeless folks talking to themselves in rags who will all die likely before they reach their fifties. That’s the face of untreated mental illness and it’s not pretty.

I’ll pick up your book when I can. I too think that domination of the medical approach needs to be challenged with something else.

Regards.

I appreciate your willingness to really engage in these ideas and your interest in my own thinking and conclusions. I address essentially every point you mention here in Part One of my book, Rethinking Madness, where I go over a thorough review of the recovery research. Keep in mind that this literature review comes directly from my doctoral dissertation and so had to pass through a dissertation committee comprised of highly experienced professors of psychology with an expertise in psychosis. In other words, this review is about as peer-reviewed as reviews come. You can download this review for free by clicking on “View Excerpt” on this page. You can also download the dissertation itself for free HERE, though I think you’ll find book version more reader-friendly.

I’m going to give you my opinion on this. There are many reasons that could explain this. Here’s a few I can think of , I’m sure I could get you sources of critical analysis of these figures and this phenomenon , but for what its worth, having the illness myself , here’s my opinion

Citizens of poorer countries tend to be more servile and task oriented. It means there is less opinion , contradictory and oppositional language are reduced , eccentricity and egoistic language not used as much. In the west we communicate in a more spontaneous and erratic fashion. This is especially problematic for a schizophrenic.

Citizens of poorer countries tend to be less sophisticated from a technology usage point of view. Technology can pose a problem to a schizophrenic in that it is prevalent , always on , and can flood the senses with mixed , irrelevant messages.

Culturally poorer countries have a more social mindset , the west is far more individualistic and more concerned about their own personal lives rather than the collective.

Individualistic Success is engrained in western culture and it’s stereotypes are forced upon us everyday through the media. This can lead to a malformed opinion of self and what it is to be human.

Illicit drugs and vice are less accessible in these countries.

Many poorer civilisations are more family oriented and support is more readily available.

Poorer societies are judged more by what they do than what they say. Task orientation is driven by physical labour rather than complex verbal communication.

Statistics can he hard to accurately collate due to lack of money and distrust of authority. Also there is a general distrust in scientific enquiry which could skew these success figures.

Here are just a few I can think of.

Regards.

It’s not perfect , but the outcomes for serious mental disorders is much better. It was only a century ago that the seriously mentally ill were locked up in inhumane conditions , subjected to physical abuse , restrained 24 hours a day , there were no medical interventions. A century or 2 before that , they were probably judged as evil , many of them lynched. So their is improvement , steady improvement , the need for long term and life long hospitalisation or incarceration has being addressed with psychiatric medication. Most people hospitalised now are for short periods of time. That’s an improvement. So the path has not being without merit , so their is benefit in the path. Its not ideal , we all know the side effects, etc and the long terms health concerns are a big problem , very big problem but things are better.

As a schizophrenic why should we persist with medical research
1) The effects of the illness are devastating

I also believe that if we can stop spontaneous, random and compulsive thought processes without side effects. That would be fantastic. How could you be opposed to this. This would greatly improve the lives of schizophrenics the world over.

Saying its not possible from the outset. I don’t agree with.

I recall you yourself saying in a comment, maybe not on this discussion, that schizophrenics should normalise their symptoms , integrate them into their lives , adapt , etc. How long will it take for a schizophrenic to come into this frame of mind , in reality your talking years and years. And what do we do with all the acute cases in the interim.

The above paragraph is set against the context of your perspective. My position is that the illness lies on a spectrum of severity. Some maybe able to normalise their symptoms and function , however for others the symptoms maybe too severe.

Regards.

I address most of your questions in another article on this website: HERE

Generally speaking, those approaches that emphasized psychosocial support while minimizing or even completely avoiding neurological enterventions (i.e., typically psychiatric drugs) have demonstrated far better outcomes than the mainstream medical model treatment–we’ve seen well documented rates of full and lasting medication-free recovery as high as 82% in some cases. And those countries (typically the poorest) who use the least western psychiatric treatment have shown far higher rates of recovery. So you tell me which tree is likely to bear the most fruit? Supporting individuals in meeting their needs (cultivating healthy relationships with self and other, meaningful activity, connecting to their dreams and values, financial security, basic physical health, etc.), or continuing to seek for that “magic bullet” drug or some other miraculous psychosurgical intervention. At the moment, the vast majority of our resources in this regard continues to go to studying the brain, while these psychosocial alternatives that are well established to be extremely helpful are essentially neglected. Do you really think we should continue along this so far unfruitful path? And if so, why?

Why is that Paris? Schizophrenia at it’s core causes stress in the body due to obsessive and compulsive thought processes. This stress becomes so toxic that it causes other distressing phenomenon. Why do you think that these thought processes should be accepted as ‘normal’? Normal if they didn’t cause any dysfunction maybe , but definetly not normal when we see the illness develop; spreading through the brain like a wildfire.

I can only assume that you believe that schizophrenia is a transitionary mechanisim facilitating enlightenment and knowledge. That is why I originally posed the question to you ‘are you spiritual in nature’. This is not to deride you.
Seriously what else are we to do if we dont look at the brain. You yourself have said that we are barking up the wrong tree. Sorry, but plain and simple that is not rational.

I have said this here before, have you looked at the outcomes for schizophrenia and the people that develop it. Google famous schizophrenics and you will see to what level schizophrenics operate in society and the tangible results of their illness. The truth is some go around in an agitated and confused manner , some commit heinous crimes , many die too early in life , the list goes on Paris.

Schizophrenics have a lot to offer , I encourage them to become rational in their thought processes.

Also with respect to anyone that tells me that schizophrenia and its outcome can’t be quantified and measured by a Google search. That is where we differ in terms of our view of the world.