This is the third in a series of posts on psychosis. Last week, I reported on the experiences of Carl Jung and John Nash. Both managed to recover from psychotic breaks without meds, but their stories are very different:
Jung suffered his mental breakdown in his late thirties, following his bitter split with Freud. In a restful country setting, over six or so years, Jung engaged in his own personal journey, experienced a deep healing, and went on to lead a celebrated life as the founder of his own brand of psychology.
John Nash went through two or three years of increasingly bizarre behavior prior to his his first psychotic break in his early thirties. Although he experienced some intermittent periods of remission, Nash lost at least a quarter-century of his life to his illness. The Nobel Prize he would later receive was for his work prior to his psychotic break.
Responding to my post, Cretin observed:
As far as if people with psychosis can recover, I think the answer is "it depends". Referring to Harrow and Jobe, some patients do recover, but others never do. It all depends on the course of the illness.
The Harrow and Jobe study Cretin is referring to is prominently featured in Robert Whitaker’s 2010 "Anatomy of an Epidemic." Whitaker cites the study in support of the proposition that over the long term, patients with psychosis actually do better off their antipsychotics than on them. This is a reasonable conclusion to draw from the study, but this is not what the study concluded.
What the researchers were looking for (and this jibes with Cretin’s response) were types of patients who were likely to do better off an antipsychotic. Thus, imagine two individuals entering a facility together, both evidencing signs of psychosis. Is it possible at this stage to distinguish the “good prognosis” patient from the “bad prognosis” patient, to predict who is more likely to recover quickly with the least amount of intervention?
In effect, to separate out Carl Jung from John Nash?
Yes, sort of, conclude Harrow and Jobe. Their study found “significantly better functioning for the patients not on antipsychotic medications," but these were a different group of individuals than those who remained on their meds over 15 years. Nearly half those not on antipsychotics at the end of the study had "favorable prognostic indices" when hospitalized 15 years earlier.
By contrast, little better than one in ten patients still on antipsychotics met the favorable prognosis criteria at the beginning of the study.
Thus, according to Harrow and Jobe in so many words, a patient with a prior work history who is not inclined to attribute his or her circumstances to bad luck, who is showing signs of improvement on their antipsychotic, is a possible candidate for weaning off his or her antipsychotic.
Psychiatry has a dangerous tendency to over-generalize - to treat all depressions as the same, all manias as the same, all psychoses as the same. Likewise, psychiatry tends to lump all patients together, with little or no regard to factors that can promote or obstruct an individual’s recovery.
