Danish psychologist Olga Runciman’s webinar on July 7, 2017 was one of the most helpful presentations I have ever attended. Her remarks on the origin and treatment of psychosis had the ring of an experienced practitioner whose insights were honed by years of experience. Some of her ideas on treating psychosis without drugs were new to me and some of them validated thoughts I have already incorporated into my clinical work. Perhaps her points hit home with me so strongly because I am currently seeing several young adults who want to come off, or have taken themselves off, antipsychotic medications.
First, a brief preface for those who did not attend the webinar. Olga is a survivor of schizophrenia and of antipsychotic drugs. She is also the first psychologist in Denmark to specialize in psychotic disorders. She is a pioneer in helping people get off antipsychotics which is quite difficult since, as she pointed out, there is very little written on this topic.
Olga quit her drug cocktail cold turkey, although she recognizes that this method might not work for everyone. In her practice, she typically prefers to take people off one drug at a time. In terms of getting off psychiatric meds, her view is nuanced. She is quite clear that quitting antipsychotics is not for everyone. Some people need to keep taking them. It’s not a black or white thing, but rather varies with the individual.
One strong motivation for getting off antipsychotics is the shorter life expectancy for those who take them. People with a schizophrenia diagnosis who take antipsychotics live 25 years less than people in the general population.
On the origin of psychosis Olga was again right on the mark. Trauma in all its forms—abuse, molestation, neglect, bullying—is irrefutably linked to psychosis. The statistics are compelling. People who had experienced three types of trauma were 18 times more likely to be psychotic than non-abused people. People who had experienced five types of trauma were 193 times more likely to be psychotic.
Trauma comes in many shapes. It is not only sexual and physical abuse, but also includes bullying and inappropriate parenting. In my clinical experience, even having a therapist steeped in the model of biological psychiatry can, over time, be traumatic. Trauma alienates our selves from ourselves so that our behaviors and thoughts seem like that of a stranger. It also distances a person from the world, such that the traumatized person lives in a private world of fear, paranoia and negative voices. And psychiatric drugs, as Peter Kramer pointed out about Prozac, change our personalities. So with psychosis there is a double alienation from the self: one from trauma, the other from psychiatric medication.
For Olga, what worked to bring her back to herself and to the world was not psychiatric drugs but therapy. Her remarks about therapy for people diagnosed with psychosis echo Foucault’s view that recovery from madness comes about mainly through a healing relationship with a benevolent wise therapist. Foucault applauded the aspect of Freud’s theory that included a therapeutic relationship.
However, Freud famously believed that psychotic people could not be helped by therapy because they could not form a transference. Freud’s idea that psychosis was not treatable by therapy lingers to the present day and has created a space for psychiatric drugs to take the place of therapy. Fortunately we live in the era of Foucault not Freud, an era in which pioneers like Olga are staking out a new frontier in the treatment of psychosis. With massive worldwide opposition to the biological model of psychiatry, a new frontier is desperately needed.
The essence of this new frontier is considering a person in their social context. As Gregory Bateson, the founding father of family therapy, said half a century ago, we must take an ecological view of the person. Psyche and psychology always includes the person’s social environment.
So how does Olga help people come off their medications? She uses a four step plan. First, involve others: family, friends, community, therapist. Second, make a plan to leave psychiatry. Decide how to taper and get off medications, whether all at once or one drug at a time. It is helpful to get advice from a pharmacist or doctor to facilitate this step. Third, re-engage with society by getting a job, volunteering, or studies. Fourth, be prepared for the fact that the issues for which one entered psychiatry in the first place will re-emerge. Make a plan to deal with these issues (support group, therapist, helpful books like Anatomy of an Epidemic, etc.). The goal of the plan is to break out of the isolation and private world that trauma has created and re-engage with a public world.
Olga’s metaphor for the process is that of puncturing a hole in the wall that emotionally separates the psychotic person from the community so that one becomes emotionally connected with others—culturally, emotionally and in a way that has personal meaning. If therapy is to help in this process, the therapist must create a good relationship with the client. It doesn’t matter what model of therapy is used—it is the connection that is the most important. A good relationship can begin to puncture a hole through the wall of disconnection.
From my own practice, I have little to add to Olga’s model of helping a person emerge from psychosis and psychiatric drugs. I know how difficult it is to help a person re-engage with the world by getting a job, volunteering, and reconnecting with family and friends. The outside world can be a discouraging place. But I know that the model works if the therapist is patient and persistent, finds unique strategies for connection, and has the courage to break away from mainstream psychiatry.