Saturday, March 12, 2011

Parents of Patients With Schizophrenia Can Stop Feeling Guilty Now

Schizophrenia is not something I really wanted to focus on much in this blog.  Certainly, family dysfunction (and a variety of other stresses including someone just leaving home for the first time to go to college or join the military - an extremely common scenario) may trigger or exacerbate a first psychotic episode in a vulnerable patient, leading to the hallmark delusions and hallucinations. 

However, the vast majority of neuroscientists, physicians, and psychologists no longer believe schizophrenia to be primarily a "functional" (psychological or behavioral) disorder.

As I have mentioned several times, given the current state of our knowledge about neural networks in the brain (100 billion nerve cells with over a thousand separate connections each), the idea that schizophrenia is a brain disease is extremely difficult to "prove" beyond a shadow of a doubt, as some mental illness deniers insist we must. 

It would be hard to believe that the brain is the only organ in the body that is immune from any chronic developmental disease that would cause microscopic deterioration to its parts - in this case its neural network connections.

The fact that our current treatments for psychosis suck big time, while an important issue in itself, is not really relevant to the argument about the nature of the illness. 

Still, because some of my readers keep bringing schizophrenia up, I would like to describe a new study that I think should finally lay at least one argument to rest.  The study is brilliantly designed and the results very clear.

In my post Antipsychotics Are for Psychosis, Not Insomnia, I discussed an earlier study that looked at the role of antipsychotic medications in the development of severe brain shrinkage (cerebral atrophy) that is seen in many severe cases of chronic schizophrenia.  That study concluded that both the underlying disease and the medication both contributed to this phenomenon.  The study was not conclusive, however, because there was no actual control group.

At last, we now have the very first prospective study about this issue by Andrew M. McIntosh, David C. Owens, William J. Moorhead, Heather C. Whalley, Andrew C. Stanfield, Jeremy Hall, Eve C. Johnstone, and Stephen M. Lawrie.  It has been published on line in the journal Biological Psychiatry. 

A prospective study is one that follows over time a group of similar individuals (cohort) who differ with respect to certain factors under study, in order to determine how these factors affect rates of a certain outcome.  In this case, 162 individuals at high genetic risk of schizophrenia and 36 healthy control subjects were followed over 10 years. 

The high risk subjects had at least two first- or second degree relatives affected with schizophrenia.  None of the subjects in the study had any psychotic symptoms or other evidence of schizophrenia at the beginning of the study.

Participants received detailed clinical and up to five MRI scan assessements at 2-year intervals. The results?  17 of the 146 high-risk subjects who were scanned developed schizophrenia over the 8 years of the study. People at high genetic risk of schizophrenia had significantly greater reductions over time than the control group for whole brain volume and left and right prefrontal and temporal lobes.

Greater prefrontal reductions were shown in high-risk subjects who subsequently became unwell compared with those who did not. These changes were significantly associated with increasing severity of psychotic symptoms.

In other words, cerebral atrophy was developing in these patients before they had been treated with any antipsychotic medication.  In fact, it started to develop before they even had any symptoms!  So the atrophy is clearly present in the absense of any treatment at all.

Oh, and guess what?  The study was not funded by the drug companies, nor do any of the authors declare any drug company connections.

So, if you are the unfortunate parent of a person with schizophrenia who is dead set on blaming yourself for the condition of your child, I would ask two questions.  These are rhetorical questions, since I have no way of evaluating the accuracy of your anwers:

First, were you an abusive or neglectful parent or the spouse of an abusive or neglectful parent?  If not, what on earth are you feeling so guilty about?


  1. 1.
    This is long and may post truncated: The full text is here:

    I don't think you are wasting your time here, I think the human universe is nagging at you to develop a more comprehensive psychological foundation and you have erected a defensive wall.

    SZ , the DSM-V illnesses, neuroses and "non problematic" people all have the same fundamental human experience and operate under the same functional laws in my view. Everything that happens in all kinds of psychosis is part of a universal human consciousness and can be experienced by anyone and is experienced to some degree. There is no need to postulate or care about "Brain Disease" (except as a minor research and to develop drugs) when theories of functional psychology can account for all known mental illnesses, to my view. Furthermore there are not just applicable functional models, I am very sure there is a wealth of untried and unused psycho-social approaches that are simply not used because of and entrenched anti-growth attitude in society and in the psychiatric industry.

    Biology and consciousness are interactive, in the individual and in social groups and over time. My own biochemistry has changed with cure. ..

    In your "logic" here for every one of your arguments there is an valid counter-argument. I can do each one, but I would like to address some other things in this post before that, because that line is not really of prime importance. Counter arguments can expose this line as affected propaganda but they do not address the root for as in all things the intention of the propaganda is what counts.
    Arguing for a "brain disease model" is essentially arguing why you can't do something instead of just doing it because in fact in fact simply changing some social practices and attitudes is most likely to effect cure or recovery and render the biologic factors to second rate curiosity.

    Why do you need so much to argue this "brain disease" model for one category of mental illness? Specially, yourself,as we know Pharma's reasons. Your purpose seems to be to fit your reconciliation model and deal with the politics of guilt. To me, it's basically because SZ doesn't fit in with your idea of "reconciliation " as therapy. In anther model of therapy IE one of emotional transformation, SZ and other DSM-V type diagnoses fit in quite well in a functional model. I'm speaking from my own experience of having made a successful transformation from or through various schizophrenic stages to full emotional health IE being cured.

    I was cured of SZ over 30 years ago. It was recorded and forgotten - (here's a link if it works if anyone wants to read how that worked) medicine it appears, doesn't remember what it knows. studies stating that I (as a class of SZ) am/was incurable are absurd to me - something of a waste of time and an inculcated ignorance and/or social deceit. Whatever truth that may be in those studies is misused.

  2. 2. First, before extending that, you are a psychiatrist acting as a psychotherapist in private practice in the USA, Is that right? I am unfamiliar with the USA and their "insurance" health uncaring system. LOL

    I think it means you cannot receive remuneration from giving SZs psychotherapy, the DSM -V standards are used to deny this form of treatment as coverable. Is that true? I don't know, I'm asking. I have a net friend, fellow SZ-cured person, who says this is true in Australia.

    Also I would gather you have never attempted to treat a SZ person, isn't that right? You have no record of failure? Techniques tried? Therapies tried ? Gestalt? Group? Confrontation? etc? I've read most of your your book, it seems you never tried and also I have a suspicion that things that I know work for emotional transformation are missing from your repertoire which means there are things you will refuse to do by not "believing " in them. If I'm right that would mean your social culture is counterproductive to your result.

    However..the significant question .... how can you deny a functional connection if you have never tried to Analise and find the function?

    It seems you took the brain model as Gospel from the beginning, and never experimented, Your "scientific attitude " is not one of practical experimentation but one of deferring to authority. You actually needed to be convinced by authority to even reconsider psychotherapy. Possibly, the hospital environment where you first learned therapy would extremely discourage you from the direction of experimentation with SZ. In which case it simply is "you", your culture, the structure of your mentality which prevents you from finding techniques to communicate with and transform SZ.

    I represent the SZ type that was abused and neglected rather that the type that has normal, or loving parents. I might add yet another type - vapid parents which would be another point on a gradient scale. However, I am exploring this now (the relevance of my experience to other types of SZ) and I tend to think that I was operating under universal human functional principles. In other words certain basic functional humans laws of psychological operation that I have experienced may be applicable to all types of people.

    So the good news! ..Is that if a SZ has had abusive and neglectful parents I can say from my experience that they could possibly be a great deal of hope for them. The ones with loving parents don't fit my direct model but I have a very strong suspicion they experience the same things I d d and for the same reasons and that elements of my curative experience just might be applicable to them.

  3. 3. I think you are quite right that for the loving and caring parents they have no salient reason to punish themselves with guilt. However for one thing it is natural to examine one's behavior and self-criticize for the reasons of possible growth. This is healthy growth behaviour.

    If however parents of SZ surrender to popular models of SZ treatment from the biomedical community swallowing the propaganda that SZ is a brain disease - they will probably have a lot to feel guilty about. There are several stages at which they can be misguided and might have extreme regrets if they ever discover the truth, or reflect on the end result they have achieved.

    Now please, a psychiatrist may tell themselves that they were doing the patient a favour eliminating the "annoying troublesome symptoms", but those symptoms and suffering are not disposable - they are the life of the person. I am the corpse that arises from the coroner's table - I was there - I have had every bit of the SZ experience. The annoying troublesome symptoms" the anxiety and fear was all that I was. As a SZ I was like a transient ghost but as drug lobotomized I was dead. SZ are people functioning as people, SZ is and emotional dysfunction, not a collection of strange anomalies, the symptoms are all understandable through understanding the dynamic transformations of fear and anxiety. SZ need their suffering to transform.

    There is no class of person with mental illness that does not have "work points" and to which psycho-social exercises cannot be applied to those work points. That is from my own long personal observation of many types of people for thirty years post cure. If SZ have had abusive experience then it is to doubly ignore the potential benefits benefits of personal growth techniques. There are people with brain problems and brain dysfunctions, but SZ and many of the other extreme "categories" are understandable human experience from my POV because not only do I have the inner experience, I observed the universal functioning of others in groups as my own emotional growth was facilitated.
    My POV is not about SZ, is is about human growth models.
    ---end ---

  4. You have missed the mark.

    A better question would be, why on earth more psychiatrists don't feel guilty for perpetrating such massive fraud? Or about how they have harmed hundreds of thousands with "off-label" i.e. "experimental" drug use?

    The only thing I feel guilty about is allowing my son to be drugged at all, when he was young. The deleterious effects of the DRUGS were attributed to his "condition." The denial on the part of mental health professionals that experience(being traumatized)had anything to do with my son's difficulties--

    I am outraged at the unethical psychiatric profession. NO accountability, no ethical integrity and it is NOT medicine--psychiatry's "treatment" record speaks for itself.

  5. Skyblue,

    To answer your questions: Yes, one can get reimbursed for doing psychotherapy with patients with schizophrenia in the US.

    When I trained back in the Dark Ages, psychoanalysts were in control of psychiatry and a lot of my training, and they very much believed that you could treat schizophrenia with psychotherapy alone. Not that they ever had any success that I could see.

    When I later became turned on to family systems ideas, they also believed schizophrenia was functional. My hero Murray Bowen developed his theories with the families of patients with schizophrenia.

    And yes, I tried a variety of techniques from a wide variety of psychotherapy schools and very much wanted them to work. Instead, I found that delusions and hallucinations were completely impervious to any intervention I tried.

  6. Yobluemama,

    You said, "A better question would be, why on earth more psychiatrists don't feel guilty for perpetrating such massive fraud? Or about how they have harmed hundreds of thousands with "off-label" i.e. "experimental" drug use?"

    I hope by now you know I am incomplete agreement with you about the validity of that question. It just was not the question addressed in this post.

  7. I agree 100% with yobluemama!

    I, too, am of the group of parents who feels guilty about ever introducing my son to the psychiatric system as well. I should have taken him fishing instead of taking him to the hospital. Had I been a better parent would his experiences have been different? I believe with certainty that they would.

    It has taken several years to facilitate his drug free recovery. Although there have been a few bumps along the way he is fully functional and symptom free. His last psychotic break was experienced without any drugs and it passed. On the other side of it he has grown significantly. Perhaps we need to stop thinking that psychosis needs to be interrupted and we need to help individuals manage through it so they can experience personal growth.

    Your conclusion that delusions and hallucinations were completely impervious to any intervention you tried is a common one. I appreciate it is difficult to acknowledge the ineffectiveness of the psychotherapist. I think it would be better to acknowledge that one is not effective in providing treatment, is not interested in treating this group, or cannot employ methods that work than to generalize the collective ineffectiveness of the psychotherapists to the conclusion that psychotherapy is ineffective in treating individuals who have been provided a schizophrenic label.

  8. "Yes, one can get reimbursed for doing psychotherapy with patients with schizophrenia in the US."

    A little vague , sounds conditional, perhaps exceptional circumstances.
    I'm researching to see if the basic person with any serious mental illness who has nothing, i.e. no money, no ability to work, no liaison with parents, can get be funded for anything other than lobotomized Biomed death in North America.
    If anyone knows anything on about the situation on health insurance and health services in the USA regarding this, please leave some information for me on my Blog.

    The same goes for Canada- I don't even know the situation in Canada anymore. Maybe the new DSM standards since 1980 now prevent coverage for psychotherapy for the major clssifications. I'd like to know if anyone besides myself has had success with the system since 1980?

    The only reason I was able to get psychotherapy and be cured of Schizophrenia pre-1980 was because the psychotherapist (also a psychiatrist and therefore an M.D. but only in a role to me as psychotherapist) was able to get reimbursed through the Government for basic charges and he waived the additional fees (that actually went to other senior psychotherapists in the Holocaust Org) for about three three years. That was often two groups a week plus the occasional weekend potboiler.

    So that was a lot for free and which was otherwise obtainable and absolutely essential for anyone who would have been like myself. I had nothing , I lived in a rathole on social assistance, ate poorly and my life as victim of circumstances and the Government Mental Health System would have remained the same without the generosity of the Holocaust Psychotherapy.

    So both effective psychotherapy methods and availability to the masses are needed to provide cures, health, teach the population a growth-oriented way of life and oppose emotionally dysfunctional ways of living. I am not sure if either exists anymore anywhere in North America. For all those that ask me for recommendations I still have no existing effective therapy verifiable that I can recommend and not a clue if anything can be funded.

  9. Skyblue - I just said a psychiatrist in the US CAN get reimbursed. I should have added that the psychiatrist would have to be in private practice. If employed by someone else, fagettabout it.

    Also, I didn't mean to say anything about the availability of this service, nor about how many doctors actually provide it. Psychiatrists get paid a LOT more by Managed Care Insurance Companies for just prescribing meds, so that's what most of them are doing. Even though we're a shortage specialty, most docs are simply too wimpy to fight this.

    As for poor people with no insurance in the US, they're completely screwed. Community mental health centers are so underfunded that they won't let their employed psychiatrists do anything BUT write scripts, and patients are lucky to be seen more than once or twice a year.

    The first thing politicians cut during recessions, particularly those from one party, is services for the mentally ill.

  10. Yes, I got it was conditional. Your additional information tells more of what I thought the situation in the USA must be like.

    So the ruling class protects themselves by being pharmaceutically "non-compliant". A drugged population makes a politically compliant population and an obedient workforce - an integrated system of interlocked business interests.

  11. I made a full post on the theme presented by your statement that you had complete failure in treating SZ with psychotherapy. It's been over a year but this is something that needs to be addressed to the survivor community. I'm sure your statement is representative of the psychiatric profession, so its quite useful.

    You don't work with SZ any more I think, though that doesn't matter to the thesis.

    1. Skyblue - you quoted me correctly on your blog but incorrectly here. What I said was that it is the delusions and hallucinations, or what you referred to as positive symptoms, that do not respond to psychotherapy. And I stand by that statement.

      Correct me if I misunderstand you, but you also seem to be equating treating psychotic symptoms with anti-psychotic meds with dehumanizing people and not caring about the rest of their lives. Not the same thing at all. A lot of psychiatrists are in fact doing nothing but medicating, but not me. Believe it or don't.

      I agree that much of what you recommend for treatment of patients with schizophrenia can be very helpful in many (but not all) cases, and that it's a scandal how society won't pay for it but would rather put people in jail, where thousands of people with the disorder are now languishing in part because of the anti-psychiatry movement. And getting involuntarily medicated while there!

      Is control sometimes necessary? Damn right! Maybe you would prefer to let a person being terrorized by things that aren't real to continue to freely run nude on the freeway, but I would commit that person in a heartbeat. It would be the height of immorality NOT to do it. And if you think I'm exaggerating, then you've never stayed a shift in a psychiatric emergency room.


  12. Rebecca Petheram rpetheram@comcast.netMay 26, 2012 at 4:22 PM

    My son is schizophrenic and was hospitalized two weeks ago after being found nude after midnight. He doesn't want to take meds. I don't know what to do for him/to him/around him. Who would be willing to work with him? He so desperately needs help. He's on medicaid/medicare. SSD/SSI. Thirty on on April 16, an Aries. :)