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Rethinking Schizophrenia in the Light of New Evidence: Thirty Years After the Vermont Longitudinal Study of Persons with Severe Mental Illness

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Rethinking Schizophrenia in the Light of New Evidence: Thirty Years After the Vermont Longitudinal Study of Persons with Severe Mental Illness Rethinking Schizophrenia in the Light of New Evidence: Thirty Years after the Vermont Longitudinal Study of Persons with Severe Mental Illness Alberto Fergusson*, Miguel Gutiérrez-Peláez** Despite new evidence, procedures, client testi- 5. Patients must be on medication for the rest of mony, and movements around the world, old myths their lives. Reality: Only a small percentage regarding schizophrenia still prevail among both need permanent medication; the public and mental health professionals. Thirty 6. People with schizophrenia cannot perform any years have passed since the mind-blowing publi- jobs except low-level ones. Reality: People cation in 1987 of the Vermont Longitudinal Study with schizophrenia can and do perform well of Persons with Severe Mental Illness (Harding, at every level of work; Brooks, Ashikaga, Straus, & Breier), which led to 7. Families are etiological agents. Reality: Fa- Harding and Zahniser’s 1994 article, Empirical Co- milies can provide critical information and rrection of Seven Myths about Schizophrenia with provide environments to lower a relative’s Implications for Treatment. Harding and Zahniser vulnerability to psychotic episodes (Harding presented empirical evidence sufficient to dismant- & Zahniser, 1994). le seven common myths regarding schizophrenia: Other studies that followed provided additio- 1. Once a schizophrenic always a schizophrenic. nal evidence for these findings (DeSisto, Har- Reality: Ever widening heterogeneity of out- ding, McCormick, Ashikaga & Brooks, 1995; comes across time; Ascher-Svanum, Russo, Shumway & Harding, 2. A schizophrenic is a schizophrenic is a schi- 2003; Isaac, Chand & Murthy, 2007; Cohen, Pa- zophrenic. Reality: Wide heterogeneity within tel, Thara & Gureje, 2008; Lieberman, Drake, the diagnostic category; Sederer, Belger, Keefe, Perkins & Stroup, 2008; 3. Rehabilitation can be provided only after sta- Jääskeläinen, Juola, Hirvonen, McGrath, Saha, bilization. Reality: Rehabilitation should begin Isohanni, et al., 2013). on day one; Despite these findings, we continue to hear the 4. Psychotherapy is pointless for schizophrenia. same myths and prejudices expressed by practi- Reality: Supportive psychotherapy is crucial tioners, health professionals, families, and people to integrating experience and enhancing con- diagnosed with schizophrenia. We must once more tinued adult development; review all available studies and empirical evidence * Universidad del Rosario, Director of the Center for Psychosocial Studies (CEPSO/CEPSS), School of Medicine and Health Sciences. Vice-president of the World Association for Psychosocial Rehabilitation (WAPR). E-mail: [email protected] ** Universidad del Rosario, Director of the Psychology Program, School of Medicine and Health Sciences. People, Family, and Society Research Group, Bogotá, Colombia. E-mail: [email protected] Avances en Psicología Latinoamericana / Bogotá (Colombia) / Vol. 35(2) / pp. 199-204 / 2017 / ISSNe2145-4515 199 Alberto Fergusson, Miguel Gutiérrez-Peláez in order to rethink schizophrenia, to take a close Grandin (2006), Higashida (2013), Sellin (1994), look at what we know and what we don’t know, Tammet (2006), and Williams (1994 & 1999). and review the impact of this distinction on the Despite evidence of its efficacy for recovery treatments we offer and those that we could offer. (Gutiérrez-Peláez & Villamil-Díaz, 2015), psy- Throughout the past century and this one, chotherapy is prescribed only occasionally and many scientific, social, and political movements medication is still the number one treatment for have presented a variety of alternatives for the most cases of psychosis. Despite new evidence, treatment of psychosis. These movements have treatments for schizophrenia have not been broadly included the anti-psychiatric movement and the changed for decades. New forms of treatment have influential works of Franco Basaglia (1976); Ba- been introduced and evidence of their effectiveness saglia, Scheper-Hughes, Lovell & Shtob (1987); and efficacy have been presented, but they continue Basaglia & Basaglia Ontaro (1975; 1981 & 2005), to be applied only marginally. In Colombia, for David Cooper (1967; 1968; 1971), Maxwell Jones example, Fergusson has treated homeless people (1952; 1962; 1968; 1976; 1979a; 1979b; 1980; diagnosed with psychosis for over thirty years 1982; & 1984), Ronald Laing (1960; 1967; 1976, through the method of accompanied selfrehabilita- & 1985); Laing & Esterson (1964), and Thomas tion or self-analysis, a method that he created and Zsasz (1976; 1977; 1986; 2001 & 2002), as well as systematized (Diaz, Fergusson & Strauss 2004; Accompanied Autoanalysis (self-rehabilitation or Gutiérrez 2013; Fergusson 2014; Gutiérrez-Peláez self-recovery) in Colombia and the United States 2015; Harding 2015). At his institute for accompa- (Fergusson, 2014). nied self-rehabilitation, 77 % of participants have The voices of persons with psychotic illness and been treated without medication. This method has functioning had been silenced and discredited for recently been replicated in Washington D.C. and centuries, but some began to listen to them at the Vermont in the United States, and in Scandinavian beginning of the twentieth century. Psychiatrists countries, where practitioners have developed the such as Lombroso (2009), Prinzhorn (1922/2012), Open Dialogue model (Seikkula & Arnkil, 2014). and Morgenthaler (1921/1985) began to identify In other countries such as France and Belgium, theretofore unrecognized talent among their most institutions like Le Courtil and Antenne 110 offer disturbed patients. In subsequent instances, people treatments based on Lacanian psychoanalysis, and suffering from mental illness described their own their interventions for mentally disturbed children mental functioning and their experiences with psy- have been shown to be effective (Coccoz, 2014). chiatric and psychological treatments. Two exam- Other programs have successfully introduced and ples were Schreber’s Memoirs (1955) and Clifford implemented peer support groups for psychosis, Beers’ paradigm-breaking autobiography (1922). It which have proven to be beneficial in certain ca- was out of Schreber’s autobiographical book that ses (Castelein, Bruggeman, van Busschbach, van Freud (1911) derived his theory that delusions are der Gaag, Stant, Knegtering, & Wiersma, 2008). a way of seeking recovery, an intent to cure that is Several movements around the globe take diffe- coherent with the psychoanalytic goal of unveiling rent approaches and have different ways of unders- the subject hidden behind his or her symptoms. tanding psychosis. They include the Hearing Voices From 1980 on, biographies of people with autism Network, Mind Freedom (directed by David Oaks), have contested the rigid and naïve conceptions of the International Center for the Study of Psychia- their mental functioning (Gutiérrez-Peláez 2014; try and Psychology (ICSPP), and the International Maleval 2011 & 2012). Outstanding examples Society for Ethical Psychology and Psychiatry of this valuable literature include the works of (ISEPP), among others. The recovery model in the 200 Avances en Psicología Latinoamericana / Bogotá (Colombia) / Vol. 35(2) / pp. 199-204/ 2017 / ISSNe2145-4515 Rethinking Schizophrenia in the Light of New Evidence US is stronger every day and voices such as that of There is a need for professionals trained es- psychologist Pat Deegan, formerly diagnosed with pecially for the treatment of this population, severe mental illness, are trending in both mental specialists who can overcome their prejudices health and medical attention in general. Many of against both ex-combatants and people suffering these groups have strongly criticized the use of from psychosis (Letovancová, Kovalčíková, & the term schizophrenia, which has appeared in the Dobríková, 2017; Magliano, Strino, Punzo, Aco- literature for more than a century since Bleuler in- ne, Affuso, & Read, 2017; Verhaeghe, Bracke, & troduced it in 1907. The International Society for Bruynooghe; 2008; Slobodin & De Jong, 2015). the Psychological Treatments of Psychosis (ISPS), Academic research plays a key role in this matter. for example, has criticized the term, arguing that Researchers conducting epidemiological studies the concept itself has no real scientific foundation, should be alerted of the possible false unification while it does have great power to stigmatize people of research samples (Gutiérrez-Peláez, 2017), not so diagnosed. This criticism has been echoed by letting these overshadow the value of testimony detractors from diverse sectors, including radical by subjects who experience or have experienced voices that object to pharmaceutical practices and the effects and consequences of psychosis, of well treatments, such as Peter Breggin and Peter C. documented clinical cases, and the voices of diffe- Gotzsche, or Allen Frances and others who have rent movements and thinkers who have gradually strongly opposed the approach of the DSM-V. There been increasing their visibility. is also a growing concern regarding the early mor- Psychiatry has always been interested in finding tality rates in people with schizophrenia (Laursen, the physical substrate of mental disorders ran- Nordentoft & Mortensen, 2014). ging from theses of organicity, brain dysfunction, neurotransmitter imbalances, and genetic predis- A Word on Mental Health positions, extending even to environmental and in Post-Conflict Colombia dietary hypotheses. Psychological
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