Optimism and Hope for Successful Treatment Outcomes

  • At the NAMI 2006 convention in June, Ronald Diamond, MD, a psychiatrist affiliated with the University of Wisconsin at Madison, led a poster session titled “Striving Toward Recovery: Setting New Expectations in Schizophrenia.”

    It gave an unapologetically rosy view that raises the bar for psychiatrists everywhere, who will have to work if we are indeed to get better.

    As its number one learning objective, the poster presentation discussed the idea that the concept of recovery suggests a collaborative approach between client and clinician; one that is focused on engendering hope, improving quality of life, and supporting personal empowerment.
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    With these dynamics in place, remission is possible, as is recovery. By definition, “Remission and recovery are two different ways to evaluate improvements in schizophrenia. Remission is a medical model view focusing on symptom improvements, while recovery is a social rehabilitation model which focuses on the consumer’s social role and his or her own view of what is most important in life.”

    Table 1, on the oversized flier Diamond gave me, lists “Criteria for Achieving Remission,” from the Remission in Schizophrenia Working Group of the American Psychiatric Association. Criteria include a score of 3 (mild), 2 (minimal), or 1 (absent) for at least six months for all of the following items on the Positive and Negative Syndrome Scale (PANSS):

    1. Delusions
    2. Conceptual disorganization
    3. Hallucinatory behavior
    4. Unusual thought content
    5. Mannerisms and posturing
    6. Blunted affect
    7. Passive/apathetic social withdrawal
    8. Lack of spontaneity and flow of conversation

    A score of less than three suggests a level at which symptomatology does not have appreciable effects on daily functions.

    If this sounds like you, you’re well on your way, and even if it doesn’t, talk to your psychiatrist. Ask him if he feels this is a goal you can work on. Recovery is possible even if you don’t fit this category. And remission could happen long before you recover.

    The stages of remission start with the acute phase, then the stabilization phase, and after that, the stable phase, which leads to the endpoint, remission. In my story, it took a good 10 years to get to my recovery. Self-healing and self-help were ongoing modes in my life, and serve me well to this day.

    Recovery is hard work, and worth the effort. As stated on the flier: “The journey to recovery can start at any time point throughout the stages of illness to achieving remission.”

    After the poster session, I greedily lapped up the information on the flier. One section, “The Consumer’s Own Voice on Recovery,” identified factors that 57 survey participants felt were the most important to their recovery, including:

    • The role of an active sense of self
    • Determination to get better
    • Understanding the illness
    • Undertaking responsibilities
    • Managing their illness
    • Accepting the disorder
    • Accepting the need for medication

    As I read and re-read the flier, musing on this encouraging “news,” I knew it was time for everyone to expect more from her psychiatrist, and better treatment. For five years I continued to see a doctor - I’ll call him Dr. Tarnoff - who belittled me and discouraged me even though I had no symptoms for ten years, I had a master’s degree, and I worked full-time.

  • He repeatedly asked me to switch from the drug that worked to give me this life, to an atypical, because “everybody’s doing it.” I felt like a science experiment, and I feared experiencing breakthrough symptoms. So I nixed him at every opportunity, and finally left him for a psychiatrist who treats me like a human being. The poster session I attended left no doubt in my mind that patients are in the driver’s seat when it comes to individualized treatment plans focused on their own goals and hopes for living their lives.
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    That’s the ideal. It doesn’t often work like that in real life, though. Too many patients languish for years if not decades, at the hands of psychiatrists whose ex cathedra attitudes foster alienation and despair. A true professional is someone who knows that his patients deserve equal footing, and who is not afraid to be humble.

    It’s time to take back our lives, and tell our treatment team that only the best will do. By writing this, I hope to give you insight to share with your doctor. Take this article with you to your next session, and question him about whether he’s willing to work with you to set goals and monitor your progress.

    If, like mine, your sessions last only 20 minutes, you deserve more than a prescription. You deserve to speak your mind, not just medicate it.

    Share your thoughts about schizophrenia treatment in the message boards.

Published On: January 11, 2007