[spiritual_emergency]

A good article I came across today...

Treating schizophrenia without drugs? There's good evidence for it.
April 24, 2009

Award-winning researcher and psychiatrist Tim Calton examines studies demonstrating how psychosis can be managed without medication. Such non-drug approaches shoud no longer be ignored, he argues.
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Over two hundred years ago medical psychiatry planted its standard within the realm of the human experience of 'madness', quickly becoming the dominant paradigm. Other ways of understanding and tending to mental distress were suffocated or retreated to the margins. Psychiatry's success in creating and disseminating knowledge about those forms of life which get described as 'madness', 'psychosis', or 'schizophrenia', quickly becomes apparent when surveying the first National Institute for Clinical Excellence (NICE) guidelines for the treatment of people diagnosed with schizophrenia.

This document, a synopsis of so-called 'best practice' in the clinical treatment of 'schizophrenia' within the NHS, clearly states that antipsychotic drugs are necessary in the treatment of an acute episode (National Institute for Clinical Excellence, 2002), a mandate not extended to psychosocial interventions.

Last month we had the updated guidelines (National Institute for Clinical Excellence, 2009). They do appear somewhat more balanced (stating that cognitive-behavioural psychotherapy should be offered alongside medication), although important semantic emphases remain (such as the fact that clinicians need only 'discuss' alternative therapies, not necessarily offer them). The importance granted medication, at the expense of other ways of understanding and helping with mental distress, reflects the tendency for medical psychiatry to see aspects of the vast and complex realm of human experience as mere disease.

Although the NICE guidelines carry a powerful political imprimatur they reflect the deep but extremely narrow tradition of biomedical research into madness; research which would have us believe that the only way to 'get better' and 'stay well' are to take antipsychotic medication, for life if necessary.

The question remains, however, as to whether it is possible to help people experiencing 'psychosis' without recourse to antipsychotic medication? Such a question might provoke a range of immediate and urgent responses depending on your sociopolitical context, life history and experience. One way of mediating this array of responses would be to scrutinise 'the evidence' supporting the use of no or minimal medication approaches to the treatment of 'psychosis'/'schizophrenia'.

There is certainly a wealth of historical evidence supporting a non-medical approach to madness ranging from Geel, the city in Belgium where the 'mad' lived with local families, receiving support and care that allowed them to function in the 'normal' social world despite the emotional distress some experienced (Goldstein, 2003), to the so-called Moral Treatment developed at the York Retreat by William Tuke towards the end of the eighteenth century (Digby, 1985), which advocated peace, respect, and dignity in all relationships, and emphasised the importance of maintaining usual social activities, work and exercise. These approaches, predicated as they were on a gentle and humane engagement with the vagaries of human experience at the limits, and invoking respect, dignity, collective responsibility, and an emphasis on interpersonal relationships as guiding principles, have much to tell contemporary biomedical psychiatry.

In the modern era, non-medical attempts to understand and tend to 'psychosis' have coalesced into a tradition counterposed to the biomedical orthodoxy. The richest seam of evidence within this tradition is that relating to Soteria House , the project developed by Loren Mosher and colleagues in San Francisco during the early 1970s (www.moshersoteria.com). Here, people diagnosed with schizophrenia could live in a suburban house staffed with non-professionals who would spend time 'being' with them in an attempt to try and secure shared meanings and understandings of their subjective experience.

Antipsychotic medication was marginalised, being considered a barrier to the project of understanding the other, and was only ever taken from a position of informed and voluntary choice. Arguably the most radical aspect of the Soteria project was the emphasis given to building a case across many different rhetorical levels, including the scientific/evidential. Subjected to a randomised controlled trial in comparison to 'treatment as usual' (TAU - hospitalisation and medication), with follow-up assessments at six weeks and two years, it proved at least as effective as TAU with some specific advantages in terms of significantly greater improvements in global psychopathology and composite outcome, significantly more participants living independently, and significantly fewer readmissions (Bola, 2003). A Swiss iteration of Soteria reported similar results and suggested these could be achieved at no greater fiscal cost than TAU (Ciompi, 1992), whilst a recent systematic review of all the evidence pertaining to Soteria confirmed both claims (Calton, 2008).

More evidence supporting the use of non-medical approaches to helping people diagnosed with 'psychosis' / 'schizophrenia' has emerged from Scandinavia and the USA (Calton, 2009). In the former, so-called 'Need Adapted' treatment, an approach which places great emphasis on interpersonal relationships and striving after meaning, whilst decentring medication, treating it as merely one of a plurality of interventions, is associated with people spending less time in hospital, experiencing fewer 'psychotic' symptoms, being more likely to hold down a job, and taking much less antipsychotic medication. In the latter, evidence from an innovative series of research projects conducted in the 1970s suggests not only that people diagnosed with 'schizophrenia' can recover without the use of antipsychotic medication when exposed to a nurturing and tolerant therapeutic environment, but also that antipsychotic medication may not be the treatment of choice, at least for certain people, if the goal is long-term improvement.

To conclude then, it seems appropriate, given the evidence, to claim that the human experience of 'psychosis' can be helped without recourse to the use of antipsychotic medication. The research cited above does not appear to have been considered in the current NICE guidelines (presumably because of the small number of studies undertaken using minimal or no medication approaches), though may well be incorporated into the next iteration. This should happen because the lack of any meaningful idea of choice with regard to treatment for people diagnosed with 'psychosis' / 'schizophrenia' in the UK is abundantly apparent; a state of affairs that may not be sustainable given recent pronouncements on patient choice (DoH, 2008).
We must remember, honour and reiterate these alternative traditions of thought and practice if we are to overcome the extant biomedical hegemony.

* Tim Calton is a psychiatrist and winner of the 2005 Royal College of Psychiatrists Research Prize and Bronze Medal. He is a research fellow at the Institute of Mental Health in Nottingham and special lecturer in the department of health psychology at the University of Nottingham.

Source: Treating Schizophrenia Without Drugs

[spiritual_emergency]

Hello Fred,
Elsewhere you had noted: I am reading Anatomy of the Psyche by Edward F Edinger. It is an analysis of the Rosary of the Philosophers, an alchemy text, as a symbolic representation of psychological transformation and becoming who you should be.

Edinger tends to be fairly heavy reading. Are you using Jungian insights as a means of interpreting and working through your own experience? If you click on my name you'll be transferred to my profile. I have a photo album there of books I've found helpful, a number of which are by Jungian authors. The one author I would recommend most highly for those who have experienced psychotic states of consciousness would be John Weir Perry -- have you read any of his work?

If you've not yet read it, this post also has some information related to medication, including information on some treatment programs with very good outcomes that use minimal or no medication.

Naturally, if people find medication to be helpful for them and they feel comfortable pursuing that path, they should continue to do so. However, those who would prefer to avoid medication or find the side-effects to be too debiliating are often eager for alternate methods of treatment.

~ Namaste

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[spiritual_emergency]

Re: The Rosarium Philosophorum

I haven't read Edinger's book but I have read The Mystery of the Coniuncto: Alchemical Image of Individuation. It might be interesting to compare notes.

Meantime, those who might think schizophrenia has nothing to do with The Rosary of the Philosophers probably haven't read this page nor had that experience...

7. Ascent of the soul. The soul departs from the spirit and body of king and queen in great distress. Unlike the usual idea of conception, it does not come from "above" to animate the body, but it leaves the body to mount heavenwards; later it will descend as a healing force and saviour, a parallel to XXXXX's 'second coming'. This is the soul-less stage in analysis when the patient has no sense of direction, as in schizophrenia. The decomposition of the elements, the four functions, has led to dissociation and collapse of the existing ego consciousness. The analyst, like the alchemist, must work ceaselessly at this stage to assist the royal couple's "resurrection".

Source: Temple of the Sacred Spiral

See also: I am dispirited...

Music of the Hour: Delerium ~ Flowers Become Screens

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[spiritual_emergency]

From Edinger's Mystery of the Coniuncto...

Picture 7: Separation of Soul and Body

Now things have become a little more complex again. More elements enter the picture. We have the same slab tomb with the united body lying on it, but in addition a tiny little figure is ascending from the body into a cloud that has appeared above the tomb.

This is a representation of the age-old ritual of the soul separating from the body at the moment of death. ...

Psychologically, it corresponds, in smaller ways anyway, to what happens when any sizable identification or projection breaks down. A piece of the psyche separates from the concrete, corporeal container. You know, as long as we have pieces of our psyche deposited, like bank deposits actually, in various objects or activities or people in our outside environment -- as long as that's the case, then there's a free-flow of life, a kind of breathing between ourselves and those parts of our exteriorized psyche. Life goes on; one is interested and alive and things flow.

Now if any of those containers of one's psyche dies, one goes through a grief reaction because a piece of one's self dies at the same time. ...

The same thing can happen when a person or object dies for us psychologically -- it doesn't have to be a literal death...

Source: The Mystery of the Coniunctio: Alchemical Image of Individuation

See also:

• How to Produce an Acute Schizophrenic Break
• Shamanism: Soul Loss & Soul Retrieval
• Ego Death

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[spiritual_emergency]

I have been working with a Jungian analyst and we use whatever my fertile imagination cooks up (or takes a shine to) as part of the process.

It's been my own experience that most everything that comes up, comes up for a reason. Meantime, I'm the one who dragged your post about Edinger in here so I'm not certain -- has psychosis been part of your personal experience? John Weir Perry was an Jungian analyst who worked with schizophrenics (usually, first episode) who were in active states of psychosis. Perry's experimental project in Diabasis had an 85% recovery rate, without medication.

At least some of the individuals who participate or read here find Jungian applications to be useful but either can't find an analyst to work with or can't afford one. If you have any insights to share from your own experience, (nothing you don't feel comfortable sharing, of course), others, myself included, might benefit from it.

I am hoping to pursue analytic training myself one day.

It's my understanding it's a long road; first a degree in psychology (a Master's seems to be the preferred route these days) as followed by an additional four years of training in depth psychology. I wish you luck with it.

Medical treatment can be part of the answer for some people, yes. It is not, however, the whole answer. I may seem to be referring to psychological disorders.

I couldn't speak to all disorders but it certainly seems to be helpful for some people who have experienced psychosis. I tend to recommend it to those whose (psychotic) content contains archetypal elements.

Much thanks for the book recommendation. I've only read a bit of Hillman thus far and liked what he had to offer. I'll add Suicide and the Soul to my ever-growing wish list.

For any other readers who are new here and don't know how I've harped on about Jungian applications, I think this link will lead to a discussion that covers that in more detail: An Introduction to a Jungian Approach to Psychosis. Additional information can be found via my blog of the same name, visible in my signature.

~ Namaste

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[spiritual_emergency]

Fred: I have never experienced a state of psychosis. The work with my analyst is my first foray into psychotherapy so I do not have anything to compare it to. I went into analysis thinking I was self aware and knew things and now I realize I do not know anything at all.

Psychosis -- what I prefer to refer to as a "fragmentation crisis" or "altered state of consciousness" -- was my introduction to the collective unconscious. Of course, Jung himself was rumored to have had a breakdown of schizophrenic proportions and much of what he learned is thanks to the schizophrenics he worked with in his career, as filtered through his own mind, life and education. It would probably be difficult to arrange for a classroom setting but as a life-experience, it was a powerful introduction and one that I'm still learning from.

See also: The Mandala Experience: Schizophrenia & Self-Disintegration

~ Namaste

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