Meanderings

Though I am turning away in radical fashion from psychiatry, I cannot pretend to know what to do in all instances of supposed mental illness, most particularly how does one treat, if not through psychiatry, the acutely psychotic individual.

The only instances in which I became psychotic, as I’ve said many times now, was when I took hallucinogens. I was never violent and it’s questionable whether I was actually a danger to myself, but nonetheless I was forcibly hospitalized and medicated with first generation neuroleptics because I was not acting within the norms of society. People are afraid of psychosis so they lock us up if we become psychotic, regardless of whether we are actually a danger or not. (When someone is an outright danger to themselves or others it’s clear that this is an acute emergency and needs to be looked at in a different way than the typical non-violent psychosis–however, I also think that if people were properly trained in de-escalation, a lot of potentially violent people could be managed without drugs as well) In any case the question is what should be done if someone is simply psychotic and not a danger? I think the example of Soteria House and the programs it inspired are key here. Soteria House was a project that ran from 1971-1983. It “treated” people who were diagnosed schizophrenic and compared outcomes with the local psychiatric hospital. It was a drug free rehabilitation. (drugs were used in just 3% of cases and only very temporarily)

My neuropsychologist, who knows a hell of a lot more about the brain and mental health than any psychiatrist I’ve ever met, once told me while I was having a manic episode that in his experience manic episodes run their course. Whether you suppress with medication or just let it work itself out the time involved for it to come to resolution is the same. Testing this opinion, I did let a manic episode run it’s course without additional medication. I was none the worse for it and I’m sure better off since I did not get stuck on even higher doses of neuroleptics.

With this in mind I propose that had I had a place like Soteria House to recover when I first got psychotic, I would have never entered the psychiatric system and I would now be fully recovered and not have lived a blunted, numbed-out, cognitively impaired life for the past 15 years. Soteria house was created for those diagnosed as schizophrenic, but it’s progenies worked with all sort of people labeled “seriously mentally ill,” with similar startling results:

ABSTRACT: The author reviews the clinical and special social environmental data from the Soteria Project and its direct successors. Two random assignment studies of the Soteria model and its modification for long-term system clients reveal that roughly 85% to 90% of acute. and long-term clients deemed in need of acute hospitalization can be returned to the community without use of conventional hospital treatment. Soteria, designed as a drug free treatment environment, was as successful as anti-psychotic drug treatment in reducing psychotic symptoms in 6 weeks. In its modified form, in facilities called Crossing Place and McAuliffe House where so-called long-term “frequent flyers” were treated, alternative-treated subjects were found to be as clinically improved as hospital-treated patients, at considerably lower cost. Taken as a body of scientific evidence, it is clear that alternatives to acute psychiatric hospitalization are as, or more, effective than traditional hospital care in short-term reduction of psychopathology and longer- social adjustment. Data from the original drug-free, home-like, nonprofessionally staffed Soteria Project and its Bern, Switzerland, replication indicate that persons without extensive hospitalizations (less than 30 days)are especially responsive to the positive therapeutic effects of the well-defined, replicable Soteria-type special social environments. Reviews of other studies of diversion of persons deemed in need of hospitalization to “alternative” programs have consistently shown equivalent or better program clinical results, at lower cost, from alternatives. Despite these clinical and cost data, alternatives to psychiatric hospitalization have not been widely implemented, indicative of a remarkable gap between available evidence and clinical practice. J Nerv Ment Dis 187:142-149, 1999

More from the Soteria website:

Basically, the Soteria method can be characterized as the 24 hour a day application of interpersonal phenomenologic interventions by a nonprofessional staff, usually without neuroleptic drug treatment, in the context of a small, homelike, quiet, supportive, protective, and tolerant social environment. The core practice of interpersonal phenomenology focuses on the development of a nonintrusive, noncontrolling but actively empathetic relationship with the psychotic person without having to do anything explicitly therapeutic or controlling. In shorthand, it can be characterized as “being with,” “standing by attentively,” “trying to put your feet into the other person’s shoes,” or “being an LSD trip guide” (remember, this was the early 1970s in California). The aim is to develop, over time, a shared experience of the meaningfulness of the client’s individual social context-current and historical. Note, there were no therapeutic “sessions” at Soteria. However, a great deal of “therapy” took place there as staff worked gently to build bridges, over time, between individuals’ emotionally disorganized states to the life events that seemed to have precipitated their psychological disintegration. The context within the house was one of positive expectations that reorganization and reintegration would occur as a result of these seemingly minimalist interventions.

What is most remarkable about this is that the staff were not afraid of psychosis. Psychiatry is fraught with fear. Fear of that which is not understood, and so, psychosis must be suppressed and in so doing so begins the oppression of those labeled with mental illness. It’s all a slippery slope from there.

Not just psychosis, but every less than pleasant feeling ends up medicated. We are all afraid of feeling. We are not taught to cope and we have the expectation that we should be “happy.” Normal causes of pain and suffering like grief and trauma are medicated instead of worked through. And natural alternatives are not even considered. This is in the truest sense inhumane. It is human to feel and yet we are more and more often told that “negative” emotions are a disease.

I wish to feel! Since coming off of meds I’ve slowly started to feel again. Often the feelings are unpleasant. Or because I’ve been blunted for a decade and a half, I get overstimulated sometimes. I feel too much. I need to remove myself from overstimulating situations sometimes. But this is common of everyone in withdrawal and it is also common to welcome feelings coming back with mixed emotions. Once the withdrawals are over we live fuller lives. Not perfect lives and not lives without difficult moments but we experience the full array of human emotions and celebrate them.

I don’t always feel good these days. Sometimes I feel downright shitty. But boy do I sure as hell feel empowered. I can’t begin to describe how wondrous of a feeling it is to take my mind and body back from psychiatry and to own them. To be responsible for them and to treat them with respect and wholesomeness. It is purely a joy. Even when I am feeling desperately awful I feel a sense of power I never have before. Everything is opening up ahead of me and for the first time in 15 years I feel the sense of possibility. No one should ever have that taken from them. And it’s stripped from millions of people with mental illness routinely on a daily basis. I, like many people diagnosed with “severe mental illness,” have been told, we will never function normally again, that we will be sick for the rest of our lives and that we will need to poison are bodies with toxic drugs for the rest of our lives. Well, I’ve now seen evidence of thousands of people who were told that and it was simply not true. How can psychiatrists be so damn cocky? How did we get here?

There are so many societal factors at play. Frankly I think capitalism is one of the roots of it, but I probably shouldn’t get that political on you and it certainly is not as simple as just that. But clearly the pharmaceutical companies have much to do with the agenda of pushing drugs at everything one feels as unpleasant or is perceived as abnormal by others, all in order to turn a profit.

Of course, the “abnormal” have been victims of human rights abuses for hundreds of years. So it’s a question of oppression by the “normal” as well–giant societal factors at play.

More on these tangents later.