Interview with psychologist Lloyd Ross on treating schizophrophrenia

Eeyore,

In Steinman's book, Treating the Untreatable, there is one case of a man, George, with much more severe delusions than the rat case. This man had been in and out of psych hospitals and halfway houses for 20 years and never able to function, and he had all manner of plausible delusions. You should check out that case. It's a 20 page case so I cannot type it up here, plus I lack a copyright.

In Murray Jackson's Weathering the Storms, there is the case of Conrad, which was extremely severe – a young man who became delusional in his early teens and remained that way for many years into adulthood.

These cases are very detailed and with enough time and patient support, they both got much better.

I get that idea (that there is something more effective, for many, in the long term) from sources like the Gottdiener meta-analysis, Siani's work, Sandin's work, Benedetti's work, from Karon's Michigan Psychotherapy Project, from the 388 project, Soteria, the NIPS Study, Open Dialogue, the World Health Organization studies of recovery in settings where drugs were not available but a lot of social support was, from talking to about 30 individual therapists within the ISPS group about their work, and so on. Taking these studies as a group, long-term recovery seems to be impacted most by psychological / social support, i.e. getting insight into delusions and being able to internalize love and support. Of course, that cannot be proven – just like we can't prove that drugs are the most effective treatment. It's also what worked in my individual case; of course that is not evidence generally.

Regarding the study of drugs you cite, these are mostly short term studies of a few weeks or months. They basically give the person a numbing agent / tranquilizer for a short period, and the person is understandably quieter and less distressed than those who get a placebo. Tranquilizers work. That is what “efficacy” means in these studies primarily. It doesn't refer to following a person for years and seeing them improve the quality of their relationship, being able to develop rewarding careers, developing a personal identity. To me it's pretty hollow and meaningless to define efficacy as “removing symptoms”. Still could be useful in the short term. As I said before, people should do whatever works for them.

Regarding the criticism of psychosocial treatments, I'm not sure why these researchers would criticize psychological interventions for lacking evidence of long-term efficacy... when the evidence for long-term effectiveness of drugs is equally lacking. That is what the Sohler meta-analysis I cited earlier concluded about drugs. One could also say that little is known about precisely how the drugs affect different neurotransmitter systems.

And as for how psychosocial interventions produce their effects, it's about understanding the causes of your problems, developing trusting and loving relationships, and getting insight into the functions of phenomena like delusions and hallucinations. These experiential processes are not easy to reduce into numbers or quantitative studies. You have to do them to understand them, and most of these researchers probably have very little experience being with psychotic people and developing a healing relationship with them, plus the fact that they are commonly funded by drug companies biases them against investigating therapy seriously.... lastly, a lot is known about the therapeutic mechanisms of psychotherapy in general. Check out Barry Duncan's compendium of research into what makes psychotherapy work, The Heart and Soul of Change. The most crucial thing is the quality of the therapeutic relationship as perceived by both sides, but especially by the client.

Well, Anthony Morrison is quite mistaken about the idea that there are no viable alternatives beyond drug treatment – how sad for him to think that... the Gottdiener meta-analysis I posted earlier showed that psychotherapy for psychosis produces similar rates of short-term improvement to drugs, but without the side effects. Just because some professor says something doesn't make it true. I'm glad I never believed stuff like that, otherwise I might not have a job and be in good relationships today.

If people can live with their family that's great, if it's a generally positive environment. Europe is way better than the USA absolutely. Conditions in the US for psychotic people are terrible. No one gives a f--- about them, generally speaking.

Of course, no one factor is the cause of severe psychosis. Various types of stress are involved and it depends on the individual case.

I do not think the family should be blamed at all. In some cases, abuse might be involved and that is one factor of many causing more distress leading to a psychotic breakdown. In many other cases, abuse is not involved. We should look at people as individuals. Even if parents do abuse their children; they're not evil parents... they are usually very troubled and stressed people themselves.

I saw what your research said about child abuse and psychosis. I would say the researchers are motivated to deny Read's claims because to see links between psychosocial trauma and psychosis threatens the biological model which support drug sales, and threatens these researchers' funding indirectly.

Robin Murray actually just admitted that he has given far too little attention to psychosocial factors and he regrets this:

https://academic.oup.com/schizophren...dFrom=fulltext

Sorry, I may not have a very coherent answer this time. I just played tennis for five hours and I'm pretty tired. But I'm still interested to see how someone with a mind very different than mine thinks about things.

Your move

I just found out that Mike Mahoney's website got up and running again so I thought that I would add it to this post. You can download both volumes of his book in pdf format for free at his site in case anyone is interested.

Schizophrenia - The Bearded Lady Disease