Rethinking Schizophrenia Treatment

  • I want to spark a debate about schizophrenia treatment and get your feedback about your experiences. A number of people at the Mental Health Networking LinkedIn group have offered insight on the topic "To DSM or not DSM?"

     

    This psychiatric bible is a tool for getting the right treatment when used accurately and wisely. The comments posted on LinkedIn spurred me to want to talk about schizophrenia treatment: the good and not-so-good and the attitudes of providers.


    I was diagnosed in 1987 when I was 22. I returned home after a hospital stay of three weeks, where I was given Stelazine to halt the positive symptoms.

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    From the fall 1987 to fall 1988, I attended a day program, Rise. From fall 1988 to summer 1989, I attended a second day program. This is where people with mental health conditions meet five days a week for group therapy, health workshops, art therapy and individual sessions with a counselor.


    I do not recommend a long-term tour of duty in a day program for any young person. A better option would be an IPRT, or Intensive Psychiatric Rehabilitation Treatment program, where you set a goal like going to school or finding a job.


    It was my experience in the second day program that I had to pull out the punches to be taken seriously in my goal of getting a full-time job. Miraculously, my counselor consented to sending in the application for OVR-the Office of Vocational Rehabilitation in New York State that sent people with disabilities to school or training so they could get a job.


    OVR sent me to ICD-the International Center for the Disabled-in December 1989 to its clerical program. In August 1990, I obtained my first job as the administrative assistant to the director at an insurance firm. After that, I cycled in and out of jobs in the gray flannel insurance field until I went back to school in 1997. In June 2000, I obtained my library science degree and have worked 12 years in a professional job.


    From fall 1988 to January 1991, I lived in a halfway house and then in an apartment program. In February 1991, I found a studio near the beach and have been living independently since then.


    I tell you all this because I'm interested in hearing other people's experiences in the mental health system. I was able to obtain employment three years after I was diagnosed, yet it was a struggle to be taken seriously at the second day program.


    The wind-up is that, from my experience, and hearing other people's stories, the staff in the mental health system could either set the bar low for their clients, or worse yet, fail to set it at all.


    True cases in point:


    A friend, Robin, who was the ex-blogger here, wrote how he needed to find a new doctor so met with a psychiatrist and told him: "I have an MBA. I was the CEO of corporations and recently retired from working in business."


    The doctor told him: "You shouldn't make up a story to feel better about having schizophrenia." (Circa 2002.)


    I showed up to a new therapist's office in a designer suit in 1992. At the intake, he told me, "You don't have schizophrenia, and don't need medication. You were bullied as a kid, so started to think other people were persecuting you as an adult. You can join my group therapy but don't tell the other members you just got out of a hospital."


  • Lastly, a psychiatrist told another friend he wouldn't ever be able to work. Today this friend also has an MBA and works at an investment firm.

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    Those are the not-so good experiences with schizophrenia treatment.


    Two hopeful stories will remind us of the need to think outside the four walls and to not be afraid to be a little different in how we brainstorm solutions to our problems.


    In 1996, my insurance company denied me treatment because I had a pre-existing condition. The therapist could only give me five sessions. I told him I was in danger of losing my job the first Saturday I met him. He told me he was a career coach by day advising $100K executives how to find work, and that he would give me the Myers-Briggs Type Indicator and a battery of vocational tests.


    It turned out I was an INTJ, a personality type, and would make a good librarian, so I applied to the three library schools in New York City and was accepted.


    My life changed forever for the better because of that fortuitous meeting with the therapist. If it wasn't for him, I don't know where I'd be today.


    The Lives Restored column in the New York Times in December featured Keris Myrick, a woman with a high-profile job and schizoaffective.


    She calls her psychiatrist when she's depressed and tells him that instead of going to a hospital, she's about to check herself into a hotel with a spa, with luxurious bed sheets. That is how she treats herself when she's feeling blue.


    People should not have to languish in the mental health system for years and years, if not decades. We need to give young people diagnosed with schizophrenia real-life skills and tools, and I didn't get that at the second day program I attended.


    The idea of viewing a client through the lens of his symptoms ticks me off. I prefer to use the asset model in how I interact with others. This turns the focus away from deficits and limitations, to a person's strengths, talents and experience.


    I survived my time in the day programs and in the residences, and I got out because of my own hard work and persistence. As I look back on that time, I'm not upset because I realize my early experiences led me to become a mental health activist. You don't come to the table swinging when your life is good. It's less likely a person will challenge the status quo when things are going well.


    I submit that business as usual is not working and the mental health system could benefit from true innovation.

     

    What if more therapists could do career counseling?


    What if the focus were on mental health and wellness, not illness as a chronic, debilitating hallmark of who a person is?


    What if hospitals were more like hotels?


    What if mental health staff truly believed recovery was possible for most people, and actively coveted helping their clients lead full, satisfying, happy lives?


    Comments?


    I'd love to hear your impressions on this.

Published On: January 05, 2012