In this interview, Lloyd Ross of ISEPP and I discuss how to help people experiencing delusions, hallucinations, paranoia, and other problems commonly associated with a diagnosis of “schizophrenia.” We discuss the problems with the biological model of “mental illness” as contrasted with a more psychosocial, contextual model of distress.
As Lloyd says, “What kind of hope do you have if someone tells you you have a brain disease called schizophrenia, and we can only give you this drug that can hold it down but can’t cure it? What kind of hope is that?”
There are better, more hopeful ideas available for supporting people experiencing extreme states, and in this interview we go in search of them.
Matt: Hi Lloyd, thanks for speaking to me today. As a therapist with 40 years’ experience working in intensive psychotherapy with people who would be, and often were, labeled schizophrenic at psychiatric hospitals, your viewpoints may be a real eye-opener for those who only know the popular view of so-called “severe mental illness.”
I am going to ask you questions about your work aimed at an audience of people who are mostly unfamiliar with depth approaches to extreme states, who generally believe that there is a brain disease called schizophrenia requiring lifelong drugging. You’ll note that sometimes I ask the questions using language I don’t believe in myself. You’re free to challenge and reframe anything.
First, can you tell me a little bit about your background and training? Where did you go to school, what sort of therapist are you, and what sort of setting do you work in?
Lloyd: Well, I’ve had a 40-year career as a psychologist in New Jersey. As a young man, I got a Master’s degree in psychology, and then before starting my Ph.D in psychology decided to take a full year off. This was a big mistake because I wound up getting drafted, spent two years with the army in Vietnam, and went through a lot of trauma. But I survived the war, came back and completed my doctorate, and did postdoctoral training.
As a postdoc I was supervised by a number of people, including Margaret Mahler for one year. Next to Freud, Mahler is the most significant person in ego developmental psychology, which is a common form of psychoanalytic theory. She pushed the bar to the next level in terms of understanding our early emotional development.
As an early-career psychologist, I did some work for the Mount Carmel Guild, a public social services agency, where I wound up supervising the first comprehensive community mental health center in the country in Newark, New Jersey. I also spent a few years as a school psychologist working with young kids.
After I got my doctorate and completed supervision I immediately opened up a private practice, and I ran my practice in Ridgewood, New Jersey for 40 years. I did a few other things as well. I consulted for the Newark police department; evaluating police officers who were in disciplinary trouble and addressing whether or not they should stay on the force. I also consulted for a children’s orphanage called St Peter’s Village and did therapy with its kids. But the main thing was my private practice. I was doing 70 hours a week of private practice therapy sessions for close to 40 years. I don’t think I could do it now, but for the first 30 years I wasn’t tired at all doing 70 hours of therapy a week. I did this work six days a week, and sometimes even a little bit on Sundays.
Matt: Wow, 70 hours a week of being emotionally available to people is a lot! I can’t imagine doing that. I’m very impressed.
Now let’s turn to the subject of this interview. How much experience do you have working with clients who may have been diagnosed “schizophrenic” in psychiatric institutions, who are variously delusional, paranoid hallucinating, unable to function? Specifically, how many such people have you worked with in therapy lasting at least one year? And how many times per week do you typically work with them?
Lloyd: Over the last 40 years I saw approximately 150 people who could be considered schizophrenic because they were having delusions and hallucinations, i.e. they had a serious break with reality. Some of these therapies were very brief because they didn’t accept that I don’t use medication, which I always explained in the first session.
Let me explain that point. The fact is that I don’t use medication to treat people diagnosed with schizophrenia. If somebody wants to work with me and they’re on antipsychotic medication, one of the goals is to come off the medication because medication interferes with the work of psychotherapy in terms of working through feelings. It causes people to avoid emotionally important issues and to be unmotivated. You can’t really do psychotherapy with somebody in this condition, because they can’t process the events that happened to them. What we need to do in psychotherapy is go back and process difficult events, to see what factors in our present and past life are causing us trouble and get them under our control.
Now out of these 150 people whom I saw over 40 years, probably about 100 of them accepted my non-medication approach. The large majority of these stayed in treatment for at least one year, and many stayed for between three to five years or more. I’d say it was about evenly split between men and women, so about 50 people of each gender that I did serious work with. Most of the people I consulted with chose to try working without medication, which was often because they or their parents didn’t like what the medications were doing to them.
What was interesting was I saw a number of psychiatrists’ kids who were seriously troubled — it wasn’t always psychosis, also other diagnoses — because I was the only one in the area who didn’t use medication and the psychiatrists didn’t want their kids on medication. This included the children of a psychiatrist who treated kids and used medication for all the kids in his practice, but he didn’t want his own children on anything. So that was interesting.
Matt: Interesting indeed! About working with delusional or paranoid people in psychotherapy, I think a lot of therapists are intimated by or simply ignorant about how to work with people in these overwhelming states because it is not taught. But you clearly have a lot more experience doing psychotherapy with people diagnosed “schizophrenic” than most people. I imagine the Mahler developmental theory of autism and symbiosis was helpful in understanding their problems.
So with the people you worked with, what about the frequency of treatment?
Lloyd: With somebody who was experiencing symptoms that the profession labels schizophrenic, such as having hallucinations, delusions, or being very paranoid, I would usually see them 3-5 times per week over a period of at least two years. Many of these schizophrenic clients were young people undergoing life transitions — these life transitions, like leaving home and going to college, often cause a stress that brings up earlier trauma and can cause a break with reality in a vulnerable person. But I also saw some older clients whose life stresses had precipitated a break.
I worked intensively with them because psychotic conditions are very serious and require intensive help. After an intensive early period of work, I cut down the sessions gradually, over periods of years, letting the client taper down the frequency of our meetings at their own pace. With most psychotic clients we wouldn’t set a formal discontinuation date. Instead we would stay in touch as long as they needed or wanted. With former psychotic clients, I’ve been to their college graduations, weddings, to when their kids get married, to all these events of my clients — and these were people who were delusional and couldn’t function when they started working with me.
There’s one patient I started seeing in 1978 who was labeled delusional and couldn’t function in the beginning, who I’m still working with. He’s now running a very successful business and has two kids, one in high school and one who just graduated college; the kids are doing great and he and his wife are doing great. The reason I’m still seeing him after all this time is he still has some issues around mother and father; his mother was “schizophrenic” (in quotes). His mother did some pretty horrible things to him and he wants to continue talking about it. He functions fine and won’t fall apart without therapy but he still wants to be seen. So I still see him. Every mother’s day I still get a mother’s day card from him. This shows you a little bit of what is going on in the transference between us.
With psychotic clients I often work with them for three, four, five years. Because it takes a long time to work with really serious problems. Keep in mind schizophrenia is not a disease; you don’t get cured, you learn to truly experience your pain in a direct way. You often do a lot of crying, you come to truly understand what happened to you; you have to keep looking at what happened that caused your breakdown, so that symptoms won’t come back.
I’ll give you an example that’s not about psychosis but about trauma that happened to me and my friends. I had a lot of friends who died in Vietnam; it was very traumatizing to me. Every year at least once or twice I go down to the Vietnam Memorial wall in Washington DC, and I stand there and cry remembering my friends who died in the war. This is how I deal with my own trauma. And I know guys who were in Vietnam who don’t do that, and they have all kinds of problems that developed from the repressed trauma. It comes back to haunt them. I have one friend who denied what happened when we were in Vietnam, and his life fell apart, he lost his wife, kids, friends, everything. So facing your pain is crucial, not just after you’ve had a psychotic break but for anyone who’s been through significant trauma.
Matt: Okay, thanks Lloyd for the detail on your caseload over all these years. I personally think this frequency of work, multiple times a week, can be crucial if you want to establish a strong enough trusting relationship to get a handle on overwhelming confusion, terror, and fear. It’s sad that relatively little of this work is being done right now.
Now let me ask you about what you would say to a layperson or a beginning therapist who wanted to understand the primary causes of severe states of delusion, paranoia, and hallucination: problems that in the popular discourse get labeled “schizophrenia.” Leading psychiatrists have asserted that there is a lifelong disease called schizophrenia caused by faulty genes or misfiring brain chemistry. But the evidence for that hypothesis — and a hypothesis it is — continues to be missing.
So thinking about a person who is new to this area, where would you recommend they start in learning more?
Lloyd: If I was trying to teach someone how to take a look at the issue of very serious emotional problems, I’d first suggest that they read the book Broken Brains, Wounded Hearts by Ty Colbert, a friend of mine. This was the first book I read after school that had any meaning. What we’re dealing with with a schizophrenia diagnosis and other serious problems is wounded hearts, not broken brains.
I would then take a look at one of two books by Grace Jackson, an American psychiatrist. One of them is Rethinking Psychiatric Drugs, and the second one is Drug-Induced Dementia. In both of these books she describes why psychiatric drugs are absolutely deadly when used over the long term. The second one is extremely detailed and you can read it twenty times and still not get everything. The first one, Rethinking Psychiatric Drugs, is the easier read for a layperson.
Then I would go to Margaret Mahler; her book is The Psychological Birth of the Human Infant. She’s easy to read even though her background is German. She describes ego-developmental theory; in fact, she founded it. She videotaped mothers and infants for weeks and months at a time, and her theory came from what she observed. And what she’s saying is that we go through stages of emotional development in relation to other people, and when we suffer any kind of trauma at a particular stage it has ramifications for later on. And sometimes we go through half our lives without ever having a past trauma come back; and then something happens that brings it up and all of a sudden we can’t function.
Most of the people that we see who would be called schizophrenic in a psychiatric hospital setting experienced some kind of trauma at a very young age… if it happens a bit later, it tends to get called Borderline Personality Disorder. But it’s not a disease — it’s bad shit that happens to us.
There are three more books that I think are crucial; one of them is Bert Karon’s Psychotherapy of Schizophrenia: The Treatment of Choice. Everything Bert says I’m spot on with. I think he’s just great. And he’s been working with people who were diagnosed schizophrenic all his life. He’s mainly worked with really severe psychotic patients. He uses the old jargon but he has the same views as me. I would strongly suggest that book.
The other two, one of them is a little difficult; it’s by Hyman Spotnitz, the title is Psychotherapy of Preoedipal Conditions. Spotnitz was an analyst from the New York area. It’s a technical book, but for a therapist it’s a really valuable guide of how to relate to psychotic people preverbally and at their level. If you follow him you’re going to be able to wade right in and be there with a person when they’re having delusions and hallucinations. He talks about those issues really directly.
And the last book is by a guy named Clancy McKenzie; it’s called Delayed Post Traumatic Stress Disorder from Infancy. He’s a psychiatrist from Pennsylvania. He’s a bit of a strange guy, but he says it like it is in terms of schizophrenia and borderline states and their causes. He discusses early trauma in detail and how it can cause later suffering that gets labeled as schizophrenic and borderline conditions. Any young person, or young therapist, who wants to take a serious look at issues around helping people with so-called “schizophrenia” should read these books.
Matt: Okay, thanks for these suggestions. From my own reading of these books, I agree these are some great resources with which to start. So what specifically causes the kind of experiences like delusions, hallucinations, and withdrawal or apathy that get labeled schizophrenia?
Lloyd: It’s complicated. It’s usually “bad shit” happening in some form over long time periods. It can be mostly the relationship to parents going wrong in some way. But sometimes it’s not the mother-child relationship; sometimes it’s very subtle things.
Being abused physically or sexually, being homeless, being poor, neglect from parents, having a parent die… all of these things in childhood or early adulthood can be involved in leading someone to have a psychotic breakdown at a later age and getting labeled schizophrenic. It’s never one thing; there are always multiple causes going into it when someone has these severe problems. It may take years to figure out the causes, and you may never figure out all the causes. And you don’t have to — you can still get better and make significant changes.
Matt: This makes me think of John Read’s research; he has dozens of studies which strongly link trauma of all kinds with an increased probability of receiving a schizophrenia or bipolar diagnosis. There’s also the Adverse Childhood Experiences Study which says much the same thing.
Lloyd: Yes, and I have an example from my own life of how early trauma can come back at a later time. As a child myself, when I was very young, I went through a trauma with my grandmother. Because my parents were out working until late, I had to take care of her in the afternoons as a five year old, helping her to the bathroom and to the sink, giving her a drink. I was told “if anything happens to her it’s your fault” — that was a big burden for a little kid. Our house was very dark in the evening time, and I would be scared when I was alone with my grandmother in the dark; scared that something might happen to her and I would be blamed.
Much later on, after the war and after I’d started my career, I found that when I came home at night to my wife, if it was nighttime and the lights were dark, I would go into a rage. I talked about this in my analysis that was going on at the time. It turned out that it came from when I was five years old and I had to sit with my grandmother in the dark and caretake her, and I hated it. Once I got that connection I didn’t go into a rage anymore with my wife. It didn’t go away, I just felt very uncomfortable. From then on my wife made sure the light was on when I came home.
Matt: That is a good example of “transference” of difficult feelings from an earlier setting to a later one. Okay, now let’s go back to the topic of people having a breakdown and getting labeled schizophrenic. This often happens to young people in their late teens or twenties, right? Why would that be?
Lloyd: Yes, a lot of people become “schizophrenic” during adolescence… the majority, that’s when it usually occurs. It’s not like magic, it’s not a coincidence; it’s usually a reawakening of whatever trauma occurred earlier on, which can get triggered by the stresses people often face as young adults — stresses like having to leave home, start college, start a job, start dating and being intimate with the opposite sex, and so on. As an example, imagine if a kid was abused sexually at age four or five, and then as an adolescent they begin to have sexual experiences, but it’s extremely uncomfortable and traumatic because it brings up the past traumatic experience.
What triggers psychosis or so-called “schizophrenia” is usually something, or some combination of things, that is so traumatic that you can’t get your mind to wrap around it; you can’t accept it or process it, it’s terrifying. That’s what hallucinations are: you push an unbearable experience out of your mind, and you see it outside of you. Hallucinations are not meaningless, and they are not evidence of any disease.
As an example, I worked with a woman who was coming off psychiatric drugs but was having hallucinations and hearing voices and couldn’t work. One day she came in and told me she wanted me to see her mother, of whom she was afraid. So we talked a little bit and I said, “Look, how about if you bring your mother in to the next session?” And this lady, the mother, came in and she was the most aggressive woman I ever met. She let me get a quarter of a sentence out before she let out that she wanted her daughter back on psychiatric drugs because it was easier on her.
I let the mother speak, then escorted her out to the waiting room. Then I sat down again with the young woman, my patient. I said to her, “I’ve got to tell you, there were at least three times when I felt like strangling your mother and squeezing her until her eyeballs popped.” And then she said, “Oh my god, that voice in my head, I realize it’s my own voice telling me to kill my mother.”
What I did is I inadvertently gave her permission to be angry at her mother. Then her hallucinations went away, and she started to feel and function better in her outside life. This type of thing rarely happens this quickly. But if it can happen, like it did in this case, then it’s clear that with hallucinations or voices related to so-called schizophrenia we’re talking about a defense or an adaptation, not a disease.
As another example, there was a young man who was showing psychotic symptoms, including mild delusions and transient hallucinations which scared him; eventually he wound up functioning well. Near the end of therapy he told me how his mother in his adolescence was attempting to seduce him by coming into the shower with him. We started with his sharing his experience in a very difficult, halting way; from starting with bits and pieces to getting to the point where he shared it completely.
Then we moved on to talking about how crazy his mother was, and then to why she was like that, to what happened to her to make her like that. Eventually he left home; after graduating high school he went to college, we had phone sessions or he’d come home overnight just for a session; and now he’s studying to be a psychologist and functioning well in a doctoral program. He doesn’t have hallucinations or delusions anymore.
Matt: Okay, it’s good to hear these individual examples. Now with delusional or hallucinating people whom you’ve worked with long term, have you had many good outcomes more generally? Do you often see people return to work or school, make careers, develop better relationships with family or friends? Is there much hope for people labeled schizophrenic if they get effective therapy?
Lloyd: One of the things you have to remember is that the problems that get labeled schizophrenia are not a disease. Therefore one doesn’t “get cured” — there is no “it” that goes away.
For example, take one formerly psychotic patient who still keeps in touch with me. He came in and I’ve never met anybody more paranoid and suspicious. We worked and we worked and we got through the paranoid issues. Later on in our therapy, something bad would happen with his school or work, and he’d start to think there was a conspiracy of people plotting against him. But then he’d catch himself and he’d say “Does that sound paranoid?” I’d look at him and say, jokingly, “Paranoid, what, you paranoid?” And we’d both laugh, and he’d be less afraid.
What I’m saying is that a psychotic tendency — a tendency to become suspicious of others for example — often remains, but the more conscious you are of it the better off you are. Let me give another example. Another formerly psychotic guy that I still work with is successfully in business. His mother died just before Christmas, and Christmas was always a horror show for him. Just before Christmas he usually visited his mother’s grave, so from Thanksgiving to Christmas he started feeling crazy. We finally worked that out; what he had to do is visit the grave and talk to his mother, tell her how good things are now, how nice his kids are in spite of her. And he would do that. He didn’t look forward to it, a couple of times he avoided it, but when he did avoid it the psychotic symptoms came back. When he did face the bad experiences with her, things were usually better.
Matt: I like these detailed examples where you see that people given psychiatric labels are actually just people. There’s very little of this detail in psychiatric reports about people labeled with “schizophrenia” — to the point that the person seems to recede into the label, rather than presenting as a real human being.
Okay Lloyd, let me take you back again to the several dozen severely disturbed people you worked with long-term. I want to ask for more detail on how effective you felt intensive psychotherapy was in their cases. How many of them got “well,” i.e., returned to work, functioned, felt much better? I’m hoping to get something positive for young people who need hope for “schizophrenia recovery.” And I want you to tell me the truth of your experience, not sugarcoat anything.
Lloyd: The large majority of them get much better. I’d say 85-90% of the schizophrenic men and women who stayed in therapy at least two years got well to the point of being able to go to school, to work, to function in a meaningful, personally satisfying way, and to be involved in relationships. Probably a majority of these got married and had families. Sometimes their functioning was a bit awkward but they still functioned. For example, a young man who had been psychotic might date or marry the quiet, shy girl rather than the girl who was the life of the party. But they could still have a meaningful intimate relationship and become good parents.
So yes, for most people diagnosed with schizophrenia, if they get effective help they get better. They go out into the world and function, and most often they don’t become severely psychotic again.
In the early part of the work, what happens a lot of times is that as a psychotic person starts to function better, the voices reoccur; but they’re not as disturbing anymore, they’re okay. Later on, if the person more fully works through their issues, these symptoms can completely or mostly go away. Or they still occur but don’t bother the person much at all, because they’re much stronger emotionally.
Matt: Yes, I remember Eleanor Longden and Rai Waddingham of ISPS (the International Society for Psychological and Social Approaches to Psychosis) talking about how their voices might reoccur but they weren’t as bothersome when they had become emotionally stronger.
And about the frequent successes; it’s encouraging to hear about that. Hope is so important. I remember when I first read cases by authors like Bryce Boyer, Harold Searles, Vamik Volkan, Murray Jackson, and Ira Steinman, and I was amazed because the stories of schizophrenic people working out their problems and becoming very lucid and clear-thinking were so counter to the medical model picture of hopelessly brain-diseased people who would never get truly well. It was so encouraging and motivating to read these cases.
So Lloyd, speaking about these relatively good outcomes, let me play the devil’s advocate with you — why should a reader believe this? Saying most people diagnosed “schizophrenic” can get well and function is so counter to what one reads in psychiatry journals which say, “schizophrenics have low fertility and rarely marry” or “schizophrenia is a chronic, severe, incurable brain disease” or “people with schizophrenia are likely to need psychiatric care including medication indefinitely.”
Lloyd: This bad outlook can be true if you only give a psychotic person drugs and don’t really try to understand or talk to them. But with the intensive psychotherapy that I did with many people who had been diagnosed schizophrenic in the beginning, after several years of work many of them really were able to work, date, marry, have a family. With some of them, many years down the line not only did I meet their husbands and wives but I met their kids.
What I found interesting is that with my formerly psychotic patients who have kids, their kids are really solid — those kids have got their heads on straight. So as parents these people that had severe breakdowns and recovered from them do a really good job. For one of my patients who was like this at the beginning of our work but got better, his daughter is in advertising, she’s in New York working, and his son just graduated from a really good prep school in Jersey and is in Rutgers doing well in the pharmacy program.
Matt: That’s great. But again Lloyd, when I’m hearing this, I’m imagining what many people might think: “How can this be true, given that so many people, and most psychiatrists, think schizophrenia is incurable and that we shouldn’t expect too much of people with this diagnosis? Are you just telling me what I want to hear?”
Lloyd: I’m a very direct and blunt person. I’m from New Jersey. I tell people the truth, not what they want to hear. So no, I’m telling you my real experience with these people who were “schizophrenic” in the beginning of our work. Most of them did really well.
Matt: Okay, I’ll take you at your word. And I think that when two people do work together, what the therapist believes or expects is possible is important in determining the range of outcomes that are in fact possible. In fact I would say that with extreme states, having an ironclad belief that getting well is possible is even more important.
Let’s talk now about American psychiatrists who believe that schizophrenia is an incurable brain disease. Why do they get such poor results with many clients?
Lloyd: Poor results for an incurable brain disease — yeah, these results make sense for them because you’re not going to get anybody who’s lastingly better using that type of approach. Because delusions and hallucinations are not caused by a brain disease, and the medication doesn’t treat the real problems! The medication usually stops you from facing the real issues.
In order to deal with the things that happened to someone, in the case of someone who is labeled schizophrenic, it usually means they went through horrible, horrible trauma. To get better and to get control over your terror and rage you’ve got to understand what you went through that traumatized you; when you take medication you aren’t able or motivated to deal with those things.
Matt: Okay, how do parents factor into all of this? When a young person gets diagnosed schizophrenic in America today, the family will typically be told that their child has a brain disease and that the parents are in no way responsible for contributing to their breakdown. Can you comment on that?
Lloyd: In this case the family is basically saying, or being told to say, “It’s not our fault, not our responsibility,” and they’re willing to sacrifice the kids at all costs, even if it means a lifetime on drugs and not being able to work or have relationships. That little old lady I wanted to strangle, the mother of my young woman patient, what she was telling me is: “I want to put my daughter back on meds so her problems won’t be upsetting to me anymore.”
In a lot of situations with an adult psychotic child, they’re better off away from the parent, because the parent is capable of destroying any progress they make. This is not all parents, but a significant number of parents. So in these cases, at least in some of them, does the psychotic breakdown partly go back to the parent’s behavior and attitude? Damn right it does, at least for some of them. It may not be intentional, it doesn’t make the parent “evil,” but what happened to the patient as a child is at least partly the parents’ responsibility.
The NAMI people, they’ll tell you, “It’s not our fault that our kid is psychotic, and they need these drugs for the illness.” But they’re often sacrificing their kid’s chance to get really well.
Matt: That is very controversial, but I basically agree with what you are saying. I think it’s important however not to make parents feel blamed. Any parent can do a less than perfect job with their child for a variety of reasons, like being poor, having to take care of the parents’ own parents, not knowing how to parent, fear of intimacy, etc. We know this is a hot-button issue. My position is that facing how one may have contributed to another person’s distress in the past can give you insight and make you more powerful, because it means you can change the relationship going forward.
Okay Lloyd, how do you talk to clients and families who have heard of the idea that schizophrenia is an incurable brain disease and are worried by this pessimistic idea? If schizophrenia is not a brain disease, how can people think about psychotic experience?
Lloyd: One of the first things I do with people diagnosed with schizophrenia and their families is I tell them about some of the research that’s been done in terms of the professional reputation of psychiatrists. A number of studies have been done by physicians about physicians. It turns out there’s a hierarchy about how physicians regard physicians. Psychiatrist fall at the bottom of the list. There’s a reason for that, which is that other physicians tend to see them as not being real physicians. When medication came along, psychiatrists who felt the heat of being considered quacks said, “Now we’re real physicians,” and they just jumped on that; it made them feel better.
Almost all of the research that’s been done — other than by pharmaceutical companies — shows that psychiatric medications, whether they’re antipsychotics, antidepressants, or stimulants, do basically nothing other than have an immediate brain-dampening effect that disappears very quickly, and what you’re left with are the side effects. The side effects are the real effects of the drug, but they’re very painful, dangerous, and toxic.
So the studies show that if you’re diagnosed schizophrenic and you take a drug and continue taking it, you will probably remain delusional and nonfunctional all your life; chances are you’re gonna be on welfare, you’re not gonna work, you’re not gonna do anything. But most of the people who are diagnosed schizophrenic, and if they don’t stay on a drug too long and they get some decent level of social support… most of them eventually get better and move their way into society and function.
So yes, I directly tell clients that schizophrenia is not a brain disease, or more properly: there is no brain disease called schizophrenia. Also, what kind of hope do you have if someone tells you you have a brain disease called schizophrenia and we can only give you this drug that can hold it down, but can’t cure it? What kind of hope is that?
And I tell people these diagnoses haven’t been developed by a real scientific process; they’ve been developed arbitrarily by committees of white-haired white men. They were created for insurance reasons so medication could be sold. They don’t cure anything, many of them are addictive, and a lot have other effects that are worse than the real distress that you have. And the drug companies are very powerful.
If you look at the guy from Princeton, John Nash, the one who recovered from a schizophrenia diagnosis, he said the movie A Beautiful Mind is relatively accurate except for that part where he gave the speech at the end thanking medication for his recovery. They fabricated that part because the drug companies contributed funding to the movie. In reality, he went off medication and that’s when he started to get better. Even when he went off the medication, he was left with tardive dyskinesia which in itself is debilitating. I also have a friend, David Oaks of Mindfreedom; he’s a bright guy but he walks with a limp because of the tardive dyskinesia, and his body is dysmorphic because of the antipsychotics. They can really ruin your body.
Matt: That was a great movie, even if what helped Nash was misrepresented. Moving on: do many of the therapists you know also believe that schizophrenia is not an incurable brain disease, or as you reframed it, that there does not exist an incurable brain disease called schizophrenia? I’ve noticed there seems to be a big gap between how private practice non-medical-model therapists think and practice, and how research psychiatrists and academic psychiatrists think and write.
Lloyd: Unfortunately, quite a few therapists I know do think schizophrenia is a brain disease; they just take the company line, meaning: “Schizophrenia is a disease, worship the DSM, if a patient threatens suicide, get a psychiatric consult right away.” They all freak out about that. Most of these therapists have never had the chance to work with psychotic people intensively on low or no drugs; they don’t know what they’re missing.
In Northern New Jersey I work with a group of therapists including Burton Seitler and Robert Sliclen. One of them, Burton, is starting a journal. It’s called JASPER, the Journal of Psychoanalytic Research. Both Burton and Robert think about schizophrenia as not being an illness and consider psychotic people as being able to get well without medication like I do. A few others in New Jersey think this way too, a couple of social workers.
Matt: It’s a shame that more therapists don’t get the chance to work with psychotic clients off drugs, or really to work intensively in a relational way with psychotic people at all, on or off drugs. Because as long as these people are mainly drugged up, sitting at home, not working, not functioning, and they aren’t being given effective help, it’s easy to maintain the myth that they have a disease and need to keep taking loads of drugs indefinitely.
When you are working with very difficult material in a therapy session, how can you work with and understand delusions and hallucinations — how do you engage with these difficult experiences in a way that helps the client get a handle on them?
Lloyd: Well, the first issue is to recognize and realize that delusions and hallucinations are not totally irrational craziness, let alone evidence of disease. What they are is a way for a person to defend themselves against psychic conflict. Once you recognize that, the issue becomes how to delve into the underlying issues and memories that are creating the need for the symptoms. Hallucinations and delusions and paranoia are basically defenses against horrible things, or against an overwhelming or badly neglectful environment that severely affected a person and that a person’s mind cannot cope with.
It’s like in the army when a young soldier in the trenches would see their friend shot dead, and his fellow soldiers would shake him and say, “It don’t mean nothing!” so that he could keep functioning. What you’re doing in this wartime example is putting somebody into a delusional state, a state of total denial, so they can still function. I treated many Vietnam veterans who were falling apart until they faced what had actually happened. After we worked on the war traumas in therapy, I would get a call later from the wife saying, “My husband is here with me again.”
This example relates to defenses like hallucinations and delusions, which can be necessary for psychic survival. This is what delusions and hallucinations in schizophrenia have to do with: something unbearable.
Another common example of how difficult life experiences get turned into “symptoms of an illness” is when women have postpartum depression. It’s not a disease. What happens is, you have a baby and all of a sudden your life totally changes. For the next year you have this appendage that sucks up all the energy you have; it doesn’t even let you sleep. Everything centers around that baby. And after a short time many people have thoughts, “Why did I have this damned kid? I’d like to get rid of it.” Some people are taught “You cannot have bad thoughts like that,” so they push them away, perceive themselves as bad, feel guilty and overwhelmed, and in extreme cases wind up making a suicide attempt. But it doesn’t have to be that way. The person who can accept these disturbing thoughts is able to handle those feelings.
So to restate this whole discussion, a hallucination is often build out of unacceptable thoughts or feelings that have to be projected outside of you. It’s a defense and nothing more than a defense. It’s perfectly logical; nothing bizarre about it.
In therapy a lot of people grind away at these hallucinations and delusions with me and they soften and stop being a central part of their lives. Like I said before, it’s not guaranteed to never come back, but it’s not there in a big way anymore.
Matt: I agree with this concept of hallucinations and delusions as defenses or adaptations to overwhelming experiences. I’ve always thought the disease theory of schizophrenia was extremely vulnerable because it couldn’t explain why many hallucinations appeared to have meaning or context in a particular environment or culture. If it’s only a meaningless brain disease, why do hallucinations often tend to focus on particular fears based on the person’s relationships and past experiences? Why wouldn’t hallucinations simply be random sounds or colors, rather than words and images related to the person’s environment?
I wanted to ask you more about the role of the family with psychotic young people. You’ve already noted families could often be difficult and hold the young person back. Can you say anything else, like what hurt or helped in terms of how families got involved in treatment?
Lloyd: Families were usually suspicious — they sometimes had a right to be, because in many cases they had contributed to the child’s distress. When the family did contribute to the kid’s breakdown, it didn’t just happen. Some of it was totally inadvertent; they didn’t start out wanting to hurt their kid, but their own problems created problems in their children.
Way down deep, these parents knew that. That’s a big reason why NAMI exists. They’re mostly a bunch of parents who want kids on drugs; you dope them up and they never take a look at anything underneath. They say, “It’s the fault of the kids’ brain chemicals, it’s nothing wrong with the parents.” But that idea’s a myth.
Only a few parents came in and said, “Look, I know we’re involved in some way in contributing to our kid’s problems, so you gotta see us too so that our kid can get better.” They wound up in therapy alongside their kid and it was a pleasure.
These few healthy parents were looking for their young adult child to go into the next phase of development, which is oppositional defiance and being more separate and independent from the family. When I see a young person going through that phase I think that it’s fantastic. I help them to be successful in that endeavor in every way I can, because that’s a movement toward health. This process of opposing the other and developing your own identity can be worked through at any age — it’s about emotional development and not chronological age. I have grandchildren and whenever I’m involved with them I make trouble; I set them off against their parents, so they can develop their identity.
Matt: I like that idea of encouraging a person to be oppositional and defiant! So Lloyd, if as we’ve been discussing there’s little evidence that extreme psychotic experiences are caused primarily by genes or brain chemistry, and much evidence that being diagnosed with schizophrenia relates to adverse life experiences, why do psychiatrists keep believing what they do?
Lloyd: Psychiatrists do this for several reasons. One reason, and I’m being sympathetic here, is that they’re really not trained to do anything else; they don’t know what else to do. When you go to any school of psychiatry in this country, you get trained to medicate, and that requires saying that problems are medical conditions. There is no course whatsoever in psychotherapy or human development; they don’t teach it anymore, so these psychiatrists don’t have a clue. They see themselves as white coat doctors, treating a disease not a person. Some of them may have a little more sense and try to talk to their patients and be benevolent, but they’re not trained in it. In the old days they studied Carl Rogers, Alfred Adler, Carl Jung, Margaret Mahler. Now they don’t do any of that.
The other reasons have to do with them making a lot of money pushing drugs. There’s a psychiatrist in Ridgewood, New Jersey, who just as I was opening my practice was consulting at one of the clinics near where I worked, and he had started seeing kids there. This psychiatrist said, “Would you teach me how to work with kids in psychotherapy?” So I supervised him for two years, and he was getting really good at it. He eventually left and went into practice privately.
I found out later he stopped doing psychotherapy and was only prescribing drugs. I ran into him at a restaurant one day and asked him why he stopped doing therapy with patients. He said, “As a psychiatrist doing psychotherapy I can charge about $200 for a one hour session… if I medicate, I can see four people for 15 minutes each in the same amount of time, for $800 per hour. And if I shock people, I can charge $1500 a pop and it only takes 15 minutes. Do the math, do the math.” And he walked away while I just stood there. That’s the name of the game for most psychiatrists and most pediatricians.
I once argued with a pediatrician; I said, “Why are you giving these kids drugs for ADHD? You know that’s bullshit.” And he agreed with me! But he said,“About two thirds of the patients are being pushed by the school to get drugs to get their behavior under control. If I don’t drug the kids, I’ll lose two thirds of my practice because they’ll go to another pediatrician who will drug them”.
It’s sad, but that’s what it’s about when it comes to psychiatrists and schizophrenia. They’re in business. When you’re in business doing something and you don’t know how to do anything else, you don’t have an alternative. Those are the nice guys. The not-so-nice guys, even if they do have an alternative, they prefer to profit.
Matt: Yes, the ability to earn so much more money by prescribing drugs in short time periods (relative to actually getting to know people in depth and working through their issues) is a huge problem. Like you said, ignorance is a huge part of it, and the drug companies have contributed a huge amount to that by making psychiatrist training into a mostly biological endeavor, as well as by creating the illusion that there is a brain disease called schizophrenia that has to be drugged indefinitely.
Anyway, thanks a lot for your time Lloyd. I think your direct, passionate thoughts will be very interesting to readers. Even if people don’t agree with everything you say, they have to respect that you’ve spent 40 years trying to help seriously troubled people by talking to them, and have been successful in many cases.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.