Interview with psychologist Lloyd Ross on treating schizophrophrenia

Can you explain why I get better while I enhance dopamine instead or reducing it?

I am tired, I won't discuss the diabetes vs mental disorder because what you said about diabetes shows a lack of medical knowledge, there are many types of diabetes, most of them are not treated with insulin and they are diagnosed with physical tests, not like mental disorders which change with years because they are 'made' by humans, new ones are added, old ones are eliminated, some criteria are changed... It doesn't mean psychological pain doesn't exist, but the diagnosis and treatment it's not like diabetes, and what you said about receptors is false too, they don't produce dopamine, they release it. Oh, and insulin is an hormone, not a med like haloperidol. Probably there is a biological cause of psychological and psychiatric alterations, but they are not like diabetes, and it doesn't mean psychotherapy is useless, because what changes how we act and feels change our brains too, as well as what changes our brain can change what we feel or do. The last and most important thing it's if dopamine hypothesis were right, most of people would be cured when they are given antipsychotic, but only around one in three people with schizophrenia are symptoms free with antipsychotic, the other one in three have symptoms even with antipsychotics and the last one in three don't respond to medication -like me-. Most of people with diabetes mellitus type 1 are ''cured'' when they are given insulin, if not all.

You can have and give an opinion without being a medical professional or a medical professional student -like me-, but please, investigate better, not reading blogs. If you read any psychopharmacology book you won't find anything comparing mental disorders with diabetes, even those that highly agree with biological psychiatry, if you read the DSM you will find they are mental disorders and not illnes when it's discussed about disorder vs illness, because there is not enough evidence to consider mental alteration as illness. Some books that don't discuss disorder vs illness use the term mental illness, but because the illness vs disorder issue it's not the point.

You could begin learning a bit of neuroanatomoy, then neurophisiology, then neuropathology, the basics of pharmacology and then some psychopharmacology. If you could learn the general idea of anatomy, phisiology and pathology it would be still better, before focusing on the ''neuro'' part. If you have a good library near you live you should be able to find them. They cost more than 80€, so I wouldn't buy them lol.

If you want to learn some about non biological psychiatry you could read what bpdtransformation said, but I guess you will understand by your own why purely biological psychiatry doesn't make fully sense after learning about neuroanatomy and neurophisiology, and then if you are interested on why medications work in some cases you will read about psychopharmacology. Pubmed is really good for new interesting information.

You could find this interesting and easy to understand, it explains why using the lowest possible antipsychotic dose it's importand and explain some about receptors supersensitivity due to antipsychotic medications and upregulation. You have to click on the picture to download it.
http://www.mentalhealthexcellence.or...s-why-and-how/

I got better by only staying far from stress, I wasn't completely symptoms free but I was functioning, I made it without medication or psychotherapy, and relapsed when I lost the friends I was making and found myself completely alone, it was because my stress increased.

I was not being scientifically specific in relation to if it releases or produces etc.

and I did say the brain can over produce too, as well as under. Both ways.

My main argument is that many forms of schizophrenia are biological in origin so medication is a huge part of "treatment". The psychological therapy is often to figure how relationships were affected by your condition and how to move forward.

Insulin doesn't cure that would mean the body would be able to regulate insulin without medication but it can't.

I won't give up without a fight lol

VanGore,

You aren't really fighting if you don't provide evidence: Again, where are studies showing that changes in biological factors are the cause of schizophrenia? You haven't cited anything. It's fine to have an opinion, but an opinion is just that.

Also, consider this: What is the appropriate, or "correct" level of dopamine for a brain to have? Who decides that? And, are varying levels of dopamine perhaps appropriate responses to whatever varied experiences a person has had in their life?

Difficult questions...

And in my view of therapy for severe psychosis, the relationship can modify the distressed psychobiological state so that the person can ultimately become non-scizophrenic and well. It's not "managing an illness", it's truly getting well - becoming non-mentally ill - and living as good a life as most functional non-mentally ill people live. There's a big difference. The books I provided with the 30 cases give many examples of this type of recovery.

... a recovery that is possible only for a minority.

Why? In other countries recovery it's not the minority (see finland and open dialogue), it depends o the treatment and community support.

Maybe I have a too positive point of view...

[...] I decided to ask a Finnish expert about the program. I contacted Kristian Wahlbeck who is a Research Professor at the National Institute for Health and Welfare, Mental Health and Substance Abuse Services, in Helsinki.

His comment in an e-mail to me was "I am familiar with the Open Dialogue programme. It is an attractive approach, but regrettably there has been virtually no high-quality evaluation of the programme. Figures like "80 per cent do well without antipsychotics" are derived from studies which lack control group, blinding and independent assessment of outcomes."

He went on to say that "most mental health professionals in Finland would agree with your view that Open Dialogue has not been proven to be better than standard treatment for schizophrenia. However, it is also a widespread view that the programme is attractive due to its client-centredness and empowerment of the service user, and that good studies are urgently needed to establish the effectiveness of the programme. Before it has been established to be effective, it should be seen as an experimental treatment that should not (yet?) be clinical practise."

Don't Be Too Quick to Praise This New Treatment | Marvin Ross

__________________________________

How can we have faith after thousands of years of non-pharmacological treatment of 'madness' with unsatisfactory result?

Eeyore,

There can't be a precise control group for "schizophrenia", because the label lacks validity and has poor reliability. Psychology is not a hard science like physics or chemistry; we are dealing with human beings and thus the studies are quasi-experimental. What we need to look for are the pattern across multiple studies, not any one study. Each individual study might be biased, because schizophrenia is a subjective label given to a person based on judgment, not an illness with reliable biomarkers... Interestingly, the Open Dialogue approach does have 3 separate cohort studies over different time periods; they all did similarly well, in the early '90s, late 90s, and early 2000s.

Also, how do you accomplish "blinding" when you are giving psychological and social support to live human beings for periods of years? You're going to find out how what type of treatment you're giving them. Interacting with real people isn't like giving some people a pill and others a cube of sugar. For the critic to make this comment, you have to wonder what is going through his mind and how well he understands the level of engagement in terms of providing long-term help to people over years. Again, it's a lot more than just giving someone a pill.

Still, you might be interested to know that new studies into Open Dialogue in different settings are being started:

https://www.madinamerica.com/2016/03...-and-training/

So in the next few years, more data is coming! :-)

Also Eeyore, "recovery" is another subjective term: People improve and recover to different degrees, over different time periods, in different settings. It's not all or nothing. And results like the Open Dialogue approach suggest clearly that with sufficient support, most psychotic people can have relatively good outcomes. As do the results of long-term psychotherapy carried out by the 388 Project in Quebec, and Benedetti and Furlan in their study of 5-year psychotherapy for severe psychosis reported in the book Psychotherapy of Schizophrenia, and Roberta Siani's outcomes for psychotic patients reported in Psychosis: Psychological Approaches and their Effectiveness.

I'm sad to hear you've been do discouraged! That's a shame. Consider that things might have a chance of being better than you think.

You should have a 5 minutes conversation with my schizophrenic mother (not that she would allow you to open your mounth or that she would accept to speak with you...).

I am proof that medication works god damn!!
Without medication I can barely concentrate long enough to watch a music video. I was taken off meds that work and experienced the full brunt of my condition.

The hunger games - I volunteer !!!

Van Gore, I do think drugs can help people; I have not said that it cannot or does not help some people.

On the other hand, drugs helping one person is not proof that the drugs are generally effective in a particular way. It's an anecdote, although valid for the person telling the story.

Eeyore, sorry to hear about your mom. I had a very difficult and violent father, although he was fortunately not overtly psychotic. When someone has been delusional and/or hallucinatory for a long time, as in an older adult, it can be harder to help them because it is more ingrained. But it's still possible for them to change a lot. Unfortunately, many people do not have access to good social support... and furthermore, they have defenses against asking for help and/or don't know they need help. And that is a very difficult situation.

With my dad, I had to get away from the family house and live apart from the family for quite a while. Fortunately I had enough help to do that, but I know some people do not.

bpdtransformation, do you know any book that talks specificly about treating negative symptoms? I have checked the ones you linked here, but I am poor and before buying anything I would like to have the opinion of someone who has read them.

I was thinking on buying making sense of madness from the same book serie than models of madness.

Which one would you recomend to read first for someone who has a traumatic childhood, a lot of negative symptoms, existencial problems and doesn't find a meaning in life?

My understanding is that drugs completely cure around 25% of people while they substaially help another third or so......there is another 25% that don't respond to meds and the remaining ten percent commit suicide.....this is from e fuller Torrey's surviving schizophrenia which cites another source I'm too lazy to look up. So it's far from an n of one. Still some people can be helped by therapy...I had cbt for psychosis along with my meds..I would say the meds helped 90% and the therapy 10%. I know Elyn saks was helped so much by therapy she became a therapist......

Hi Oliver,
I once spoke (via phone) to one of the authors of that book series Making Sense of Madness... Jim Geekie, a very compassionate man.

I don't use the term "negative symptoms"... because I don't view emotional withdrawal, lack of affect, low motivation, etc as symptoms of an illness. I view these experiences as understandable responses to things going wrong in one's life... the causes of these experiences could be partly internal, but are most often experiential and due to lack of social support in some form.

To me what are called negative symptoms are the prototype of what Harold Searles wrote about when he discussed the "out of contact phase" of severe schizophrenia in his work at The Chestnut Lodge. They describe the understandable feelings of someone who is very estranged from his fellow human beings emotionally, and thus understandably unmotivated and apathetic. Psychodynamically, negative symptoms express a deficit of all-good self/other images, and a predominance of all-bad internalized representations. This is a bit technical, but it basically means that the defense of splitting is constantly in operation.... the person has either had too many negative experiences in life (or alternately, too few positive ones). I wrote about the reasoning behind this here - https://bpdtransformation.wordpress....proach-to-bpd/ - and a more severe version of this description would apply to schizohprenia. The following article #10, on the four phases, also describes how to exit the negative-symptom phase (for BPD or schizophrenia) via developing positive relationships and trust.

So I would reframe negative symptoms as the "out of contact phase" and look at how to get someone from that place of (non)relating and (a)motivation toward a position of being more related and attached emotionally. Some books that discuss this for borderline states include Jeffrey Seinfeld's The Bad Object and David Celani's Treatment of the Borderline Patient... and for schizophrenic states, Arctic Spring by Laura Tremelloni, Treating the Untreatable by Ira Steinman, Weathering the Storms by Murray Jackson, and Collected Papers on Schizophrenia by Searles... all of these books have at least some case studies with people starting out with severe negative symptoms, or what I'd call withdrawal/apathy. And these people can get better and become more related and motivated. It just tends to take more time and resource, because the negative-symptom picture is a developmentally earlier position (in a non-pejorative sense, a less emotionally developed position).

I am not sure what these books are selling for used online but some of them may still be cheap. However, I don't think reading these cases is absolutely necessary... the most important thing is supportive real people, and figuring out how to access and relate to them better.

Sometimes Psychotic, the connection between drugs and improvement for psychosis is an inference on the part of Torrey, not a known causal link. He notes that some quasi-experimental studies have suggested that 25% of people "fully recover", however recovery is defined... and then he makes the questionable assertion that this is due to drugs. However, there is the equal possibility that many of these people were mostly or primarily helped by other external factors in their lives.

It is very difficult to prove cause and effect in these quasi-experimental studies of human beings... where people are, of course, subject to so many possibly confounding factors that cannot be controlled for, as in a truly scientific experiment in physics or chemistry.

These positions sound very sectarian...

Eeyore,
How so - and what are your views on these issues?

If you want some data on the link between "things going wrong in life" and schizophrenia, here's some:

"In a very different tone than that of “schizophrenia is a destructive, inherited brain disease,” Anjnakina et al. state at the top of their article “The relationship between childhood adversity and psychotic disorder is well documented.” Indeed, this is true. There is not enough room here to begin to do the vast amount of literature justice, but I will provide just a few key resources. Read et al.17 concluded in 2005 that child abuse is a causal factor in “schizophrenia.” Read et al.18, after identifying similarities in the brains of traumatized children and adults who were diagnosed with schizophrenia, demonstrated the neurodevelopmental pathways through which childhood adversity may cause psychosis. In 2004, Janssen et al.19 established a strong dose-response relationship between childhood abuse and psychosis after following 4045 individuals from the general population for two years. Bentall et al.15 also found a dose-response relationship between childhood abuse and psychosis (meaning that the greater number of adverse experiences and/or the higher the severity, the greater the risk), wherein those who had a high-severity of childhood abuse were 48.4 times more likely to develop psychosis as an adult. When specificity and dose-response relationships are demonstrated, a causal relationship is strongly probable. In fact, Bentall et al.15 stated that “experiencing multiple childhood traumas appears to give approximately the same risk of developing psychosis as smoking does for developing lung cancer.” And, lastly, in the same month as the Sekar study was released (January 2016), so too was a nationwide cohort study out of Denmark and Sweden20 which found that experiencing the death of a first-degree relative before 18 years of age, especially from suicide or accident, resulted in a 39% increased risk of being diagnosed with schizophrenia."

Citations -

15. Bentall, R., Wickham, S., Shevlin, M., & Varese, F. (2012). Do specific early-life adversities lead to specific symptoms of psychosis? A study. Schizophrenia Bulletin, 38, 734-740.

16. Cohen, P., Brown, J., & Smaile, E. (2001). Child abuse and neglect and the development of mental disorders in the general population. Development and Psychopathology, 13, 981-999.

17. Read, J., van Os, J., Morrison, A. P., & Ross, C. A. (2005). Childhood trauma, psychosis, and schizophrenia: A literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica, 112, 330-350.

18. Read, J., Fosse, R., Moskowitz, A., & Perry, B. (2014). The traumagenic neurodevelopmental model of psychosis revisited. Neuropsychiatry, 4(1), 65-79.

19. Janssen, I., Krabbendam, L., Bak, M., Hanssen, M., Vollebergh, W., de Graaf, R., & van Os, J. (2004). Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatrica Scandinavica, 109, 38-45.

20. Liang, H., Olsen, J., Yuan, W., Cnattingus, S., Vestergaard, M., Obel, C., Gissler, M., & Li, J. (2016). Early life bereavement and schizophrenia: A nationwide cohort study in Denmark and Sweden. Medicine, 3. Doi: 10.1097/MD. 0000000000002434.

Source: https://www.madinamerica.com/2016/02...ly-discovered/

Over in Europe they've done a lot of research into the links between adverse life events and risk of getting a schizophrenia diagnosis. It's a pretty strong link, not really a sectarian position to take...

And yeah, I agree drugs can reduce severe distress in the short term - although reducing distress is different from "treating a brain disease", given our lack of knowledge about whether or not there is one unitary brain disease called schizophrenia, and the problem with identifying the entity's biomarkers. However, the Sohler data I was referencing earlier showed that we lack good evidence that antipsychotic drugs have a beneficial effect for most people beyond one year:

http://psycnet.apa.org/?&fa=main.doi...037/ort0000106

So, there is a contrast between the presence of many long-term longitudinal studies of adverse life experiences correlated to chances of receiving the schizophrenia diagnosis on the one hand... and the mostly short term nature of drug trials on the other.

All of these studies based on correlations and assumptions to varying degrees, thus should be interpreted cautiously across a range of settings. I've read some books on the science of brain differences and gender... what they taught me is that no one study of humans really says anything close to definitive, and these studies must be interpreted much more cautiously than with hard sciences. I can't remember the titles now.

Thank you bpdtransformation, I am going to check them.

Even though i argue for the biological team, i think this thread has inadvertantly inspired me to go back to my psychologist and see it through to the end. But i do agree with an earlier post saying meds was 90% and therapy 10% . I didnt realise that risperidone helped intrusive thoughts i did think it was me doing sumthing wrong but i think a bit of hypomania triggers it.
I also looked up books on negative symptoms its so so hard to find books that you can understand on schizoaffective

That it is wiser for the non-specialists to follow the academic consensus (the DSM worshipers).

Your are not defending the position of your previous post:

"I view these experiences (negative symptoms of EVERY schizophrenic) as understandable responses to things going wrong in one's life"

but a different position:

"the survivors of SERIOUS AND RARE childhood traumas are more likely to develop psychosis, but they are a minority of the people with schizophrenia"

I'll cite again the article of Pies:
most psychiatrists who have treated severely impaired patients with schizophrenia have little doubt that long-term antipsychotic treatment is both effective and necessary to avoid relapse of psychotic illness.

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

This seems to be the academic consensus that the non-specialists should follow.

Eeyore,

Then let me ask you this: has following the academic consensus resulted in you reclaiming a "good" life, i.e. being able to have a meaningful career, have good friendships and romantic relationships, feel fulfilled and alive... or whatever it is you want to do?

To the degree that mainstream treatment promotes desired outcomes, I would support them. I just don't think that they do nearly often enough... the long-term functional outcomes of mainstream treatment are pretty abysmal - for most, not all. Approaches that I cited earlier, like Benedetti, Siani, Martindale, Open Dialogue, Gottdiener, etc... show a lot better functional outcomes for a bigger proportion of people, if you develop a really in-depth relationship with a person, something that is rarely done in mainstream treatment of schizophrenia.

Also Eeyore, I have to wonder if you have not read the research I linked carefully.

The whole point of that research is that these traumas are not rare in those diagnosed with schizophrenia. They are common - and much more common than anything abnormal found genetically or biologically.

Here's a talk with more detail about how common adverse experiences are for those diagnosed with schizophrenia, Trauma and Psychosis: From Heresy to Certainty:



If you have research saying that people with serious adverse experiences are only a small minority of those labeled schizophrenic, please post it here.

Pies' statement is an appeal to opinion, not to actual scientific studies. He doesn't even cite any data supporting the idea that most psychiatrists (where?) believe what he says. Although I think it is very probably true that most of them believe this. But then again, when your only tool is a hammer... And again, I think these drugs do quiet people down pretty effectively. But the question is, what are they effective at, and how effective are they? That could be a whole other discussion...

But, I am in favor of choice. If people want these drugs they should be free to take them. I do not think, however, that professionals should impose antipsychotics onto every person so-labeled. Many can get better without. From my earlier citations, the majority of formerly schizophrenic people in the Benedetti study, from the 388 Quebec program, from Sandin's work in Sweden, and from Open Dialogue came off or were never on antipsychotics. This suggests that they may not be necessary for a large group of people labeled schizophrenic, with sufficient support. I met many psychiatrists in ISPS (like Ira Steinman and Bert Karon) who do not use drugs heavily or for long periods, and talked with them about how and why they do or do not use the drugs. I really recommend to you Ira's book, Treating the Untreatable - he is not against all drugs, and he is very hopeful about people recovering with or without drugs.

Here is his bio - Ira Steinman

Hi Van Gore,

I'm glad to hear some things in here were a bit encouraging, whether from me or others. I think even if talking and relationships are only a small bit of what helps someone that is good. Again I am for whatever works for a particular individual, and if that includes drugs then good for them!

You might be interested to see how early psychiatrists (60s/70s) defined schizoaffective disorder along a continuum:

https://bpdtransformation.files.word...157update2.png

It actually overlaps into schizophrenia and is not clearly separable from schizophrenia on the severe end, or from less severe conditions on the lower end. So I think a lot of what is said about schizophrenia or borderline states would also apply to schizoaffective. And in my view, any of these conditions can be moved through or out of with enough help, i.e. they are not incurable lifelong illnesses.

There are a couple of good books about severe schizoid states and how to work with them psychologically: Schizoid Phenomena, Object Relations, and the Self, by Guntrip, and The Empty Core by Seinfeld. These should be available used online. Also, Disorders of the Self by Masterson... Ralph Klein writes about severe schizoid conditions in there. To me the distinctions between these similar labels are somewhat arbitrary and unreliable. The more important thing is to understand what is going on in an individual's life, what they want and how to get there.

I'm not psychotic but only depressed and no, I hadn't a good life with or without the consensus; but the only little improvements were from the tablets.

My mother is a schizophrenic with no insight and my father always opposed the standard psychiatric treatment in favor of "social and familial support". She only got worse until she was hospitalized after that she kidnapped me when I was a child and escaped in another country. Finally she was put on invega that stopped her delirious behavior, but my father interrupted shortly after her treatment and so she came back to her delusional ravings.

Yes, but the mainstream treatment has been the most effective one and led to the closure of most asylums.

Sure thing that it is rarely done, it is impossible in many cases!

I read your quote, 40%-50%. It is not "much more common than anything abnormal found genetically or biologically", those under the Ultra High Risk Criteria and those genetically close to the schizophrenic (twins, sons of two schizophrenic parents) have a similar risk.

I don't have any research about the % of those that had a child abuse among the schizophrenics and I have not the mental energy to listen to the 60 minutes talk. Does he give us some numbers?

Even if you accept the consensus that Sometimes psychotic cited, there is still big room for improvement.

How can you know in which group they are if they don't try them?

Could you quote some passage about some highly delirious and delusional case like my mother? Thanks.

Eeyore,

Here is one case study from psychiatrist Ira Steinman about intensive psychodynamic psychotherapy of delusions: Three Rats and the Extraterrestrial -

Curing Schizophrenia Via an Intensive Psychotherapy « IRA STEINMAN M.D.

And in this free book, Rethinking Madness, are six long case studies of a variety of social / psychological supports leading to recovery:

http://www.rethinkingmadness.com/dow...s_complete.pdf

I don't know if these are like your mother, because I don't know her. The most severe cases of delusions and withdrawal and paranoia that recovered are in the books Treating the Untreatable by Steinman, and Weathering the Storms by Murray Jackson... especially Weathering the Storms. If you want something hopeful try to find that used.

Where do you get the idea that mainstream treatment has been the most effective? Again please provide some studies with data, not just professionals' opinions. And again the question is effective at what... making people silent , numb or compliant, or making them truly alive, functional, and engaged in fulfilling relationships?

Earlier I cited the Jaaskelainen meta-analysis, which shows that throughout the time in the mid-to-late 20th century when antipsychotic drugs became available, outcomes for people labeled schizophrenia did not improve and have gradually been worsening:

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

Closing the asylums has led to loads of people in prison and on the streets. That's not a great achievement.

Talking to delusional people and understanding them is not impossible, although it is rarely attempted due to lack of money and lack of understanding of how to do this type of work.

Where is the data for your comments about abnormal genes being commonly found in people with a given label (and again, that label is arbitrary because there are no reliable biomarkes for schizophrenia)?

Read does give numbers, yes – here's some - http://www.integration.samhsa.gov/pb..._Psychosis.pdf

You can see adverse social experiences like poverty and trauma are very common in people receiving severe psychiatric diagnose. But looking at these things is not profitable and is disturbing to profesionals.

My point with drugs is that some people don't want them, so given the uncertainty around the schizophrenia diagnosis ab initio and the fact that drugs don't cure, why force them on people... let them pursue other avenues of help, as Open Dialogue does. There's no one-size fits all treatment. But if people want drugs let them take them... if it improves their condition, all the better. That is Ira Steinman's position with his cases like the one given above.

The twin research inflates the proportion of risk attributable to genes; for more detail see here from Brian Koehler of NYU -

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

I see we could keep going back and forth on this stuff. But thanks for your interest in discussing.

Just wanted to comment on abnormal genes....they actually have found some trends but feel everyone has different mutations....in my case I have two mutant copies of the metabotropic glutamate receptor called grm3. It's a splice variant thing...sometimes during some conditions the cytoplasmic tail is cut off...so it can't signal. So in my case glutamate sensing is disrupted part of the time. The meds work for me because dopamine feeds back Into glutamate signaling....not because there are changes in neurotransmitter levels. so at least in some cases there is a clear genetic component but that doesn't mean that therapy doesn't help anyway....I like to think it's a mix....meds plus therapy just like how there is a social and genetic component to psychosis.

Thank you for the material.

Thank you for the material but unfortunately my mother has also some severe thought disorders and some strong negative symptoms that would made a psychotherapy like these very hard. Her hallucinations and delusions are also so realistic and 'plausible' that the approach of Dr. Ira with the patient of the rats wouldn't help.

Where do you get the idea that there is a more effective treatment?

Here is a study that compares many antipsychotic medications with placebo:
[...] We identified 212 suitable trials, with data for 43 049 participants. All drugs were significantly more effective than placebo. [...]
https://www.ncbi.nlm.nih.gov/pubmed/23810019

Another study:

[...] We identified 116 suitable reports from 65 trials, with data for 6493 patients. Antipsychotic drugs significantly reduced relapse rates at 1 year (drugs 27% vs placebo 64%; risk ratio [RR] 0·40, 95% CI 0·33–0·49; number needed to treat to benefit [NNTB] 3, 95% CI 2–3). Fewer patients given antipsychotic drugs than placebo were readmitted (10% vs 26%; RR 0·38, 95% CI 0·27–0·55; NNTB 5, 4–9), but less than a third of relapsed patients had to be admitted. Limited evidence suggested better quality of life (standardised mean difference −0·62, 95% CI −1·15 to −0·09) and fewer aggressive acts (2% vs 12%; RR 0·27, 95% CI 0·15–0·52; NNTB 11, 6–100) with antipsychotic drugs than with placebo. [...]
http://www.thelancet.com/journals/la...239-6/fulltext

Another study concludes:
"[...] Although pharmacological treatment has indicated various kinds and levels of adverse effects, most currently used psychosocial interventions cannot demonstrate wide-ranging or long-term (ie, >18 months) effects on patients’ psychosocial and functional outcomes and quality of life. In addition, there are wide variations in the treatment responses among these patients, resulting in an inability to accurately predict the treatment efficacy to a particular patient, and in turn making the optimal patient-focused treatment difficult. In addition, little is known about the therapeutic components or mechanisms of most of the current psychosocial interventions, through which they can produce their effects. With continuous increased understanding about the etiology, psychopathology, and clinical manifestations of schizophrenia, more effective methods and personalized treatment plans are developing or emerging to allow mental health professionals to better define and manage the course of and patient recovery from the illness. [...] "
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3792827/

Lead researcher, Professor Anthony Morrison from the University of Manchester, said: “Antipsychotic drugs are the mainstay of treatment for schizophrenia, but as many as half of all individuals with schizophrenia choose not to take drugs because of common, potentially severe side-effects, because the treatment is not felt to be effective, or because they do not perceive that they have an illness. Currently no evidence-based safe and effective treatment alternative exists.”
https://www.dur.ac.uk/news/newsitem/?itemno=20017

Effective on easing their psychotic symptoms and their suffering.

I don't know what did happen in the USA but here in EU with the reduction of their psychotic symptoms many people were able to live with their family or in a non-restrictive institutional environment.

These positions are sectarian :

[...] The overall impression created by the review of Read et al is that there is a wealth of evidence suggestive of a causal relationship between childhood trauma and psychosis. For example, Read et al produce weighted averages for females and males of reported child sexual abuse (48% females, 28% males), incest (29% females, 7% males), and child physical abuse (48% females, 50% males) from 51 studies of psychiatric inpatients and of outpatients when half or more were diagnosed with a psychotic illness. In terms of understanding the relationship between childhood trauma and psychosis, however, these estimates are misleading.

And after having reviewed the major recent population-based Studies of Childhood Trauma and Psychosis, this meta-study concludes:

The evidence that childhood trauma causes psychosis is controversial and contestable. Child abuse certainly causes prolonged suffering, and it may increase the distress experienced by those who develop a psychotic mental illness in adulthood and lead to worse outcomes. The implications of this for clinical practice require careful consideration. There is not, in our view, a large body of research supporting a causal connection, contrary to the impression gained from the review of Read et al.

https://academic.oup.com/schizophren...-Environmental

Another study states:

[...] There have been suggestions of a link between child sexual abuse and schizophrenia, a hypothesis that has claimed considerable public, if not professional, attention (Sansonnet-Hayden et al, 1987; Briere et al, 1997; Read & Argyle, 1999). The differences between cases and controls for schizophrenic disorders did not reach significance in this analysis and a discussion of trends is unlikely to be contributory. The findings to date do not support an association between child sexual abuse and schizophrenia. [...]
Impact of child sexual abuse on mental health | The British Journal of Psychiatry

Other studies give much more small numbers:

[...] An association between childhood abuse and psychotic symptoms was consistently reported by large cross sectional surveys with an effect ranging from 1.7 to 15. However, we cannot conclude that the relationship is causal as lack of longitudinal studies prevent us from fully excluding alternative explanations such as reverse causality. [...] However, specificity of childhood abuse in psychotic disorders and, particularly, in schizophrenia has not been demonstrated. [...] So far none of the studies reported support the hypothesis that childhood abuse is either sufficient or necessary to develop a psychotic disorder. It seems likely that any effect of childhood abuse on schizophrenia needs to be understood in terms of genetic susceptibility and interaction with other environmental risk factors. [...]
https://synapse.koreamed.org/DOIx.ph...pi.2012.9.2.87

[...] Rates were significantly higher among child sexual abuse subjects compared with controls for psychosis in general (2.8% vs 1.4%; odds ratio, 2.1; 95% confidence interval, 1.4-3.1; P < .001) and schizophrenic disorders in particular (1.9% vs 0.7%; odds ratio, 2.6; 95% confidence interval, 1.6-4.4; P < .001). Those exposed to penetrative abuse had even higher rates of psychosis (3.4%) and schizophrenia (2.4%). Abuse without penetration was not associated with significant increases in psychosis or schizophrenia. [...]
Schizophrenia and Other Psychotic Disorders in a Cohort of Sexually Abused Children | Child Abuse | JAMA Psychiatry | The JAMA Network

Another article concludes that Mainstream psychiatrists are not impressed. “There are no methodologically robust studies showing that schizophrenia is caused by childhood abuse,” says Robin Murray of the Institute of Psychiatry. “The strongest predictor of schizophrenia is a family history of the disorder.”

Peter McGuffin, also at the institute, warns that refocusing on abuse risks a return to the 1960s “when it was fashionable to blame the parents for ‘causing’ schizophrenia”. “A hazard is that it demonises the family,” he says.
https://www.newscientist.com/article...hrenia-linked/

Thank you too.