[spiritual_emergency]

Bertram P. Karon, Ph.D., is a Professor of Clinical Psychology at Michigan State University. Dr. Karon received his A.B.from Harvard, his M.A. and Ph.D. from Princeton. He is a former President of the Division of Psychoanalysis of the American Psychological Association, and has over 150 publications. He was selected by the Washington School of Psychiatry as the 2001 Fromm-Reichmann memorial lecturer, by the US chapter of the International Society for the Psychological treatment of Schizophrenia and other psychoses as their 2002 Award for "profound contributions to our psychoanalytic understanding and humane treatment of patients with severe mental illness."

Psych Truth Radio: Welcome Dr. Karon

Bertram Karon: It's a real pleasure to be your guest. And so, shall we talk about the important issues?

PTR: Yes. What do you think causes schziophrenia?

BK: It's really, if you look at all the data we have and all the case studies... schizophrenics are very sick human beings. What it really is, is primarily, a chronic terror syndrome. We're supposed to feel terrified for a minute, maybe for half an hour when there's a danger but if you feel you are in danger of being destroyed and you have to live that way for days, weeks, months, or years... the toll on you is terrible. All of the symptoms of schizophrenia are either aspects of the terror syndrome or defenses against it. And that includes the catatonic state where people become rigid, which we've demonstated in animals occurs when they seem they are on the verge of dying. The hallucinations and delusions which all human beings are capable of doing but most of us will never have to do.

The best evidence of this goes back to WWII. There was a situation in WWII where every solder who went through it -- and they were always sent for treatment -- looked like the sickest, most chronic schizophrenics. And the situation was very simple: people were out there shooting at you, trying to kill you. And so you dug a foxhole as quick as you could and you could barely get into it , and as soon as you could barely get into it, you got into it, so you wouldn't die. And they kept shooting at you trying to kill you, so you didn't move... when your food ran out you stopped eating... if you had to urinate or defecate, you did it on yourself. And if this went on for more than three days and nights, every single soldier looked like the most chronic, sickest schizophrenic. The strange thing was however, if they were reasonably healthy people beforehand, when brought to a place of security and safety and just given rest, they got better spontaneously.

At the time, people said it couldn't be schizophrenia because we know that it doesn't get better. The long term studies however ... done in 12 different countries now indicate that irrespective of treatment, 30% of schizophrenics completely recover within 25 years. There have been studies from Switzerland, Italy, Scandinavia, the United States, Germany -- they all find the same thing. Unfortunately, the best of the American studies -- that of Courtney Harding, which studied patients from Vermont found that the patients got better in 20 years but the patients who stayed on their medication as long as their doctors told them to, none of them ever recovered. 50% of the patients eventually stopped taking their medication against medical advise and all of the patients who had a full recovery were in that group.

PTR: So what you're saying Dr. Karon is first of all that schizophrenia is really an experience, an experience of terror ...

BK: Right

PTR: And secondly, if someone continues to take the medication as prescribed by psychiatrists and doctors, that the odds are that they won't improve and get better. They're better off stopping the medication.

BK: Taking the medication may make them easier to manage but it gets in the way of full recovery.

<hr width=100% size=2>

The above excerpt covers the first four minutes of the interview -- Dr. Karon also has a number of fascinating things to say in regard to the success of psychotherapy and schizophrenics. You can listen to the rest of the fifteen minute interview here: Mental Health Radio [Requires Real Player]

See also: [*] PTSD: Fight, Flight or Freeze[*] Spirituality &amp; Trauma

[spiritual_emergency]

<blockquote>
Most of Bertram Karon's articles are only available via paid subscriptions to various journals however I did find one that had a few interesting tidbits...<blockquote>

There is no such thing as a spontaneous anxiety or an endogenous depression. If a patient is anxious, there is something to be scared of. If a patient is depressed, there is something to be depressed about. If it is not in consciousness, then it is unconscious. If it is not in the present, then it is in the past and something in the present symbolizes it.

The defense mechanism of isolation is typical of severely depressed patients. They typically make no connection between their feelings and obvious experiences that would depress anyone. It is always important to ask what happened before they started feeling depressed and keep asking when they say "Nothing" or "Nothing important." The "unimportant" will turn out to make good sense of their symptoms.

Hallucinations are simply waking dreams. Get associations if you can, and use them in the therapeutic process.

If you think the patient is delusional, ask him or her to tell you about it in as great detail as possible. Do not attack or humiliate the patient or call it delusional. You never know that something is delusional just because it is improbable. If you investigate a delusion from the patient's point of view, he or she will discover its inconsistencies or even that it is delusional. Then your interpretations solve a problem for the patient.

All that we have to offer our patients is understanding, but that is far more powerful than any medication.

Source: The Effects of Medicating or Not Medicating on the Treatment Process - Dr. Bertram Karon

[spiritual_emergency]

<blockquote><blockquote>
If you think the patient is delusional, ask him or her to tell you about it in as great detail as possible. Do not attack or humiliate the patient or call it delusional. You never know that something is delusional just because it is improbable. If you investigate a delusion from the patient's point of view, he or she will discover its inconsistencies or even that it is delusional. Then your interpretations solve a problem for the patient.

-- Dr. Bertram Karon</blockquote>

Imagine that I was to travel to a foreign country that was very different from my birthplace. I would be surrounded by new sights, smells, tastes, feelings and people speaking a foreign language. Would I be correct in assessing those events as delusional or would the real problem be that I don't speak the language and I don't understand the culture? I think this is the real problem. The people around an individual going through an experience of psychosis have never been to that "country" and they do not speak the language. The "country" of psychosis does not adhere to a linear framework; the language of schizophrenia is metaphor.

I wanted to come back to this because it's really central to the experience of psychosis. It's said that people going through psychosis have lost touch with reality; they see, hear, taste, smell, and feel things that those around them do not see; these things are therefore classed as "delusional" and "not real". The primary purpose of treatment in this culture is to bring an end to the delusions and thus, restore the individual to the reality that others see, hear, taste, smell and feel. If an individual has been restored to this state of "normality" they can be considered to be "responding successfully to treatment" although not "cured". I think this is the equivalent of dragging a blanket over a mess and declaring that the mess is now magically "gone!" It's not gone. It's still right there -- it's only hidden by the blanket. To me, this is not recovery. To me, recovery is taking care of the mess to the extent that you no longer require a blanket to cover it up.<blockquote>Perry’s work in traditional psychiatric settings led him to conclude that those in the thrall of an acute psychotic episode are rarely listened to or met on the level of their visionary state of consciousness. Instead, every imaginable way to silence the patients – to ignore and to disapprove of their nonrational language and experience – was called into play, thereby increasing their sense of isolation, alienation, and so-called madness. (Although the book was first published in 1974, things have not substantially changed in state mental hospitals or in community residence settings. To explore the strange imagery of psychosis with a client in a counseling session is viewed as “feeding into their delusional system,” and it is sternly discouraged by psychiatrists and social workers.) Perry’s work with those in acute stages of psychosis revealed that their pre-psychotic personalities were the true source of the “sickness.” Forced to live an emotionally impoverished life, the psyche had reacted by forcing a transformation in the form of a “compensating” psychosis, during which a drama in depth was enacted, forcing the initiate to undergo certain developmental processes.

Such psychic processes, which are accompanied by rich, emotional imagery, yield amazing parallels to classical myths and to obscure rituals of antiquity:<blockquote>The individual finds himself living in a psychic modality quite different from his surroundings. He is immersed in a myth world ... His emotions no longer connect with ordinary things, but drop into concerns and titanic involvements with an entire inner world of myth and image.</blockquote>
Although the imagery is of a general, archetypal nature (“imagery that pertains to all men and all times”), it also portrays the key issues of the individual undergoing the crisis. Therefore, once lived through on this mythic plane, and once the process of withdrawal nears its end, the images must be linked to specific problems of daily life. Thus, the archetypal affect images await a reconnection to their natural context: to the personal psychological complexes (which are externally projected).

Source: Psychosis as Purposive</blockquote>

It was no mere coincidence that Kali came into that space with me. Nor is it coincidence that Sarah has an "imaginary friend" named Hannah or Merlin; that Phil hears an Otis or Plabius; that BeautifulPain is shadowed and frightened by a menacing demon-like figure; that Daniel feels stuck in the lion's den.<blockquote>They are messengers and they have a message. They are related to sincere problems that occurred in the person’s life and they tell us about those problems. Therefore it is not wise to kill the messenger. Instead of not-listening to the message we should look how to help and sustain the person in solving their problems.

-- Dr. Marius Romme

If the therapeutic factors in the psychotherapy of the neuroses are puzzling, those in the psychoses are utterly mysterious. So much is this the case that in the average psychiatric opinion, it is generally held that, as a matter of fact, there is no healing for the psychoses, that there can be allviation of symptoms but not cure. I have always been reluctant to accept this closing of the door upon the possibility of healing, and this is because I find, as Jung has found, that the psyche knows better than we do what it is up to in its deep turmoils.

Since the psyche had its own intentions in a psychosis, when the unconsciousness is activated to this extreme degree, a welter of emotions wants to come into play, accompanied by images of a mythological cast that belong to these emotions. Most of these elements of the psyche are very necessary to the further growth and development of the personality. It becomes a very painful experience when they meet a wall of prohibition that dams up their flow and prevents their movement.

-- Dr. John Weir Perry</blockquote>

In my experience, there are three critical factors that have to happen in order to facilitate recovery...

1: The experience must be expressed. Often, this happens quite naturally during the experience of psychosis -- everything comes up. It doesn't come up in a rational order anymore than the burritos you ate that made you sick come back up tidily wrapped in their floury skins -- it's a mess, but it's a mess that's now in the open.

2: The content must be explored in order to be understood: An exercise that can be helpful is that of amplification:<blockquote> Amplification is the process of gathering all available knowledge on a particular dream symbol from personal and impersonal associations. Knowledge may be gleaned from associations to folklore, historical references, literature, art, and mythology. The object of amplification is to understand the significance of a particular symbol or expression.

The universality of the dream symbol is expressed by the collective unconscious.

Amplification is a Jungian technique which attempts to expand the individual's associations and understanding of a dream image. An image is chosen from the dream and the individual asks questions of the image. What is the shape of the image? What is the function of the image? What alterations does the image go through? What does the image do? What do you like and dislike about the image? What does the image remind you of? The individual writes down all of the associations that he can think of concerning the image.

Source: Dream Function According to Jung</blockquote>
3: The images must be linked to specific problems of daily life: Every significant image/character or event within my experience was relevant to significant people or events that had occurred in my "real" life. Part of my task in recovery was to understand where and why. It was for this reason that I found a timeline to be a useful tool. Placing events on the timeline that had occurred within my "real" life and those that had occurred with my "experience" helped me see how those events related to one another. It brought that experience down from the "non-linear" to the "linear" and this, in turn, helped those around me to understand what my experience had been all about -- it restored our common language.

If you are working with a therapist, exploring the imagery and linking them to your specific problems can take place within that relationship. If you are not working with a therapist, you can explore the imagery on your own (a journal can be helpful), with a close friend/support person, or a network such as a support group. Should you determine that a therapeutic relationship will be to your advantage, go back and listen to that interview with Dr. Karon during which it is emphasized that the best outcomes are achieved with therapists who know what they're doing -- in other words, don't expect a marriage counselor to help you work through an experience of psychosis. Seek out someone who has experience doing psychotherapy with individuals who have gone through extreme states of altered consciousness such as psychosis.

At some point during that process of exploration and re-connection, order should begin to arise. It would not be enough for me to say, "Kali -- The Divine Mother -- showed up in my experience because Tuesday is red." No. Kali showed up in my experience because a.) I had a friend named Kali, b.) my own mother had died, and c.) I felt an integral part of who I was had also died. It's all very rational when it's understood. One thing that experience told me was that my friend Kali was someone who was good for me, someone I could trust at a point when I didn't even know if I could trust myself. The archetypal image of Kali also told me that there was more to me than what I thought there was and I needed to reconnect with that larger Self of who I am in order to heal. It's worth mentioning that for the first year or so I projected the archetype of Kali onto my friend Kali. Gradually, I came to see that the two were not the same and now enjoy a very rich relationship with the human Kali as well as the archetypal Kali. A similar process occurred with other key "characters" of my experience.

The work that has to unfold does not end with exploring and identifying where those images pertain to your personal situation, but you now know where your efforts have to be applied. In my own case, I had to deal with grief, loss, trauma -- all of these take time but I was able to move through the bulk of that work over the space of three years as opposed to 20-25. In my own case I did that without medication but I'm certainly not opposed to others using medication as they determine is personally helpful. Ideally, it is short term use and allows you to still "think clearly". It can be painful and it can be frightening however you are under no obligation to go to places you don't want to go, to see things you don't wish to see, or to feel things you don't wish to feel. The individual going through the process must set their own pace.

See also:[*] Therapy for Schizophrenia -- NOT an Oxymoron
[*] Dr. Rufus May: Understanding Psychotic Experience and Working Toward Recovery

this makes complete sense to me:

Take, for example, the research of Courtenay Harding, Ph.D. This researcher followed "back ward schizophrenics" (those deemed unable to live outside of the hospital) for some 30 years following their discharge from state hospitals in Vermont in the late 1950's and early 60's. In contrast to the accepted rate of 10% "recovery rate" generally reported by the psychiatric profession, Dr. Harding found that 2/3's (66%) of these people, "showed no signs of at all of schizophrenia" (p. 27). What accounted for this success? To find out, Dr. Harding studied a similar group released from state hospitals in Maine. In contrast to the state of Vermont where emphasis was on integration into the community, skill building, and social support, treatment of those people released in Maine focused on education and medication. In the latter state, 48% of those followed over 30 years showed no signs of the diagnosis–an astounding figure still when compared to the recovery rates touted by the medical profession.

i don't do group therapy anymore, but when i did i saw great strides in that with psychotic and schizophrenics.......interaction and being heard and learning how to deal with that was the key. isolating and shoving meds down one's throat is not the answer.

</font><blockquote><div id="quote"><font class="small">Quote:</font>
interaction and being heard and learning how to deal with that was the key. isolating and shoving meds down one's throat is not the answer.


</div></font></blockquote><font class="post"> Oh I totally agree!

You know, I tried to say similar over a year ago on here-- but I didn't get much reception to the idea.

I sure am pleased that- you-- spiritual emergency, are here, as you're so efficient at getting the point across of there being many alternatives in coping and helping those with "mental struggles"-- not just drugs.

mandy

[spiritual_emergency]

<blockquote>
Dr. Courtenay's study is an exceptionally hopeful one. Those who haven't read it can find it here: The Recovery Vision: New paradigm, new questions, new answers.

I'm a great believer in therapy for schizophrenia, but my personal beliefs are that different forms of therapy are most appropriate during different stages of the process.

During the experience itself, the best kind of therapy is 24 hours around the clock. My therapist was one who "fell into my head". He served as my constant companion during the entirety of those six weeks. He wasn't a "professional" but because he was a character modelled on a warm and empathic friendship I'd had, he could be a friend. He was available to talk with me, to hold my hand if I was frightened. I didn't feel judged by him and therefore I didn't feel shamed. That meant that I could allow what was happening, to simply happen. Note that this isn't the stage for analyzing the content -- it's simply the stage where you bring it all up. About 14 months after my breakdown I stumbled across the work of John Weir Perry and was astonished to read that what my psyche had created for myself was precisely the type of setting he used with his clients. Perry had an 85% recovery rate so his words are worth paying attention to...<blockquote>O'C: In your book The Far Side of Madness, you describe how at Diabasis - the home for "schizophrenic" individuals which you set up in Berkeley iin the 1960's - they could comfortably get into their visionary process in a totally supportive atmosphere. What are the necessary conditions to enable a person to go through the experience of madness and be renewed by it when they come through, as you put it, on the far side?

PERRY: That's a question with many facets! The first one, which we touched on briefly toward the beginning of this conversation, was about the conditions that are set up around such an individual. What we did at Diabasis was specifically to set up what we hoped would be the most ideal, least toxic (smile), least damaging environment for a person in the visionary state.

First off, this means a home. You need a place with friendly, sympathetic individuals who live there. These people have to be companions, have to be willing to listen and not be frightened and not be judgmental about it, and not try to do anything to anybody.

One has to let the visionary process unfold itself spontaneously. Under such conditions, to our surprise, we found that our clients got into a clear space very quickly! We had started out with the notion that we would surely be in for alot of bedlam with all this "madness" going on, but actually the opposite was true! People would come in just a crazy as could be on the first day or two, but they'd settle down very soon into a state of coherency and clarity. Often, when I would come in for a consultation at the end of the week, I would see someone who had been admitted in a completely freaked-out state just a few days before, sitting at the dinner-table indistinguishable from anybody else; sometimes I couldn't tell if this was a new member of the staff, or one of our clients. The calming effect of a supportive environment is truly amazing!

It's a well-known fact that people can and do clear up in a benign setting. Actually, they can come down very quickly. But if some of our cases had gone to the mental hospital, they would have been given a very dire message: "You've had a mental breakdown. You're sick. You're into this for decades, maybe for the rest of your life!" and told "You need this medication to keep it all together." I am quite certain that if some of our clients had been sent to the mental hospital, they would have had a long, long fight with it. The outcome of their stay at Diabasis, however, was that their life after the episode was substantially more satisfying and fulfilling to them than it had been before!

Source: Mental Breakdown as Healing</blockquote>
The next stage in the recovery/therapeutic process is interpreting the content -- this is when you do the analyzing, the piecing back together, the understanding, the integration. I had my (human) friend Kali to serve as a companion through that stage, as well as the wonders of the internet. I did a lot of surfing at that time, a lot of reading. Mostly, I explored stuff on my own, but if something struck me as particularly interesting or insightful, I'd share it with Kali.

That was also the time when I was processing a lot of emotional content: grief, rage, despair... it had to be worked through. Mostly, I did that alone but I could talk to Kali about those things as well. If I'd been in a traditional therapeutic relationship this would have been the time to work one-on-one with someone, but not with the same intensity as during the process itself: once or twice a week probably would have been sufficient.

Somewhere in there I began to find other people who had been through similar experiences. If they were schizophrenics who had been through a traditional experience in this culture, I couldn't connect with them. Their conversation was constructed primarily around their dysfunction, their medication, their doctors and the hospitals they had been in -- they perceived their psychosis to be an illness, something very negative. I hadn't been to the doctor, I hadn't been on meds, I hadn't been hospitalized. While I recognized a number of "negative" elements in my own experience, there had been a great deal of "positives" in my experience too. I couldn't relate to their experiences of mainstream treatment. Nonetheless, the mere fact that I was moving outward was an indication that I was capable of dealing with group settings. I would not have been capable of doing so during my experience nor in the months immediately after. I had to live life very, very quietly for many months after.

Now, I continue to learn but I'm also at the point where I can assist others too. Mostly I do that via educating others as to what the psychotic process can be about and ideally, instilling in others a sense of hope that they too can recover. Occasionally, I'll make a connection with a fellow schizophrenic. This happened between myself and a fellow about a year ago who went by the name of Marek. Marek was not in very good space in those days. He's in much better space now. Should you wish to, you can read a bit more about him here: Marek: A Story About Schizophrenia

So, therapy? Absolutely. The most positive recovery rates are being seen among those who do therapy with their clients, but it also has to be the right kind of therapist, the right kind of therapy, and the right time to apply that particular kind of therapy.

[spiritual_emergency]

<blockquote>
mandyfins: I sure am pleased that- you-- spiritual emergency, are here, as you're so efficient at getting the point across of there being many alternatives in coping and helping those with "mental struggles"-- not just drugs.

lol. I wasn't good at it before but one day I had not one, but two psychiatrists tell me that schizophrenia was incurable. I knew what kind of hopelessness that message was sending to people who carried that diagnosis and I got angry. Really angry!

But rather than direct my anger at them, I channelled it into creating my Spiritual Recovery blog. I gathered up all those articles and accounts I'd read of people who recover from schizophrenia -- what kind of treatments work best for them, what kind of doctors they work with, what helps, what doesn't help, etc. All of which has meant that I can present a fairly convincing argument when people try to tell me that "schizophrenia is incurable". Usually what they mean is they don't have a clue how to assist someone to full recovery... but some people do.