Do Psychological Therapies for Schizophrenia and Psychosis Work? – A Debate

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The journal Progress in Neurology and Psychiatry hosts a debate between Peter Kinderman, one of the co-authors of the British Psychological Society’s recent Understanding Psychosis and Schizophrenia report, and two authors whose meta-analysis of cognitive behavioral therapy was cited in that report.

“The British Psychological Society’s report has been widely welcomed as helpful and possibly even revolutionary,” writes Kinderman. “It contains much more than just a statement of the benefits of psychological therapies – although those benefits are clear.”

“Overall, the picture that emerges from (Understanding Psychosis and Schizophrenia) is of claims that are either not supported by the studies the authors themselves cite, or are just plain wrong, or are interpretations that require the kind of mental gymnastics that would make a contortionist wince,” write Peter McKenna and Keith Laws.

Kinderman, Peter, Peter McKenna, and Keith R Laws. “Are Psychological Therapies Effective in Treating Schizophrenia and Psychosis?” Progress in Neurology and Psychiatry 19, no. 1 (January 1, 2015): 17–20. doi:10.1002/pnp.365. (Abstract and full text)

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6 COMMENTS

  1. So what are we to make of this? Are they both right? Both wrong? One right one wrong? Some other variant? If seems to me that there’s no “bullet proof” study. There’s always someone, usually someone who has a different opinion, who presents arguments of why the study or study conclusions are flawed in some way. It leaves us scratching our heads saying, “what can we believe?”

    • Hi David,

      Coming from a lived-experience and Buddhist perspective, I would suggest that we can “trust” our actual experience, once we learn to let-go of our self-protective attachment to a conceptual sense of reality. Which in experience involves questioning the “paradox” within my taken for granted, habitual behaviours, including NOT noticing how my body creates my mind.

      A difficult reorganization of my sense of self, immersed as I am, in a cultural climate that pressures me daily, to assume I am my mind. Yet, having won my struggle with what prescriptive modern medicine believes was a serious mental illness, produced by a disease process. I now understand belief-systems, as largely a rationalization of behaviour.

      While, in terms of moving towards understanding Schizophrenia and Psychosis, as a Continuum of Human Experience. Dr John Weir Perry’s observation that we need to understand our subconscious “systems of projection,” brings our common humanity, into “conceptual” debates about what works for the “other.”

      With a turn inwards, towards one own experience of sensation and how our body creates our mind, bringing the “avoidance” motivation of an intervention/treatment attitude towards other people, into conscious awareness. A process of gaining improved self-awareness, which R.D. Laing pointed out, as beginning to notice how we habitually fail to notice, the subconscious roots of our taken for granted behaviours, including our modes of thinking.

      Best wishes,

      Batesy.

      • Yes, I have seen firsthand what you refer to…What gets labelled psychosis and becomes a disease is a human experience that means many things but is often part of person’s journey…the medical model locks people into labels and diagnoses when they are most vulnerable….this is wrong and often has tragic consequences…We need to rethink psychosis…and at least be honest with what we do and do not know….the human experience is complex and extreme experiences are to be expected especially in light of today’s world…

        • Hi TIP,

          I agree with every word you wrote. While you mention, perhaps the most important single word term in the whole mental health debate.

          HONESTY. Of which Billy Joel has a great and insightful song, that mentions those pretty faces, all to willing to tell pretty lies. Although psychologist’s prefer to rationalize this self-protective feature of our normal behaviour, as an expression of “healthy boundaries.”

          While in great talk between Will Hall & Mary Olsen on Madness Radio. When asked whether she thought the “open-dialogue” approach to first episode psychosis, can become acceptable to mainstream America. She uses the word “honesty” in an important cultural context. Noting that in Finland, people seemed to able to be more emotionally honest in the circular questioning of family members.

          While in my own self-healing of decades of spontaneous psychoses, (psychosis being an image label of the surface impression of a human experience) being immersed within a different culture, was vital to my capacity to tolerate the mind annihilating sensations of “terror” which lay at the root of my “prepsychotic personality.” -John Weir Perry

          Spending three years in the largest Buddhist society in the world, was crucial to my desire to understand my experience from the inside-out, because I found myself in a culture with more “embodied” sense of self. A culture, that does not have the “automatic” good/bad axis of subconscious judgement, that I experience within my native Caucasian culture.

          While in terms of honesty, I spent two days last week, in the company of mental health professionals, with no life experience capacity, to acknowledge “how” they were rationalizing the behavioural needs of a vocation stuck in the “time” limited paradigm of prescriptive medicine.

    • I’d start with asking if any of these people has a conflict of interest. As to clinical studies for psych disorders I don’t believe any of them. If I had to choose I would err on the side of psychotherapy because I’d not put Hitler on these drugs – they are hell – but I don’t think that there is much evidence for psychotherapy in general (which does not mean it’s not helping – simply you can’t have a placebo controlled study for it, not really).