Danish psychologist Olga Runcimanâs 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. Itâs 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 formsâabuse, molestation, neglect, bullyingâis 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 Foucaultâs view that recovery from madness comes about mainly through a healing relationship with a benevolent wise therapist. Foucault applauded the aspect of Freudâs 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. Freudâs 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 personâs 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.
Olgaâs 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 othersâculturally, 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 doesnât matter what model of therapy is usedâit 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 Olgaâs 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.
Thank you for this. I mean that. I’m beginning the process of genuine, bona fide recovery. Once the psychosocial stuff was taken care of, I made the decision to drop the tranquilizer . I find that I’m doing better, physically, and being transformed into a new human being, one who isn’t “sick” 24/7. Perhaps not at all surprisingly, I find that much of my “progress” has occurred and is happening –despite– Mental Health, Inc. I am blessed, though. Because of social class issues, etc., I get a little more “breathing room” than many of the “patients” I see at the clinic. In fact, my (obviously…) trauam-induced madness isn’t even offically called “Schizophrenia,” because people from “good families” aren’t “Schizophrenic;” we’re “Bipolar I.”
Thanks again. I don’t think I’ll ever find a “professional” in the land of Mental Health, Inc. who will do a whole lot to help me on my journey , but God has put a genuine, caring, older, wiser, friend+mentor in my life. She helps tremendously. The people of Mental Health, Inc. definitely did not help, don’t help much now, but at least with a “good family” behind me, they seem to mostly stay out of my way.
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For my wife’s d.i.d. it’s mostly about attachment theory! Her attachment to me and our son gives her the feeling of safety that she needs to deal with the trauma, heal the attachment issues, tear down the dissociative walls, connect the various girls in the system. Glad to see that Olga believes family, friends and community along with a good therapist to help facilitate the attachment relationships is the #1 issue to address. Wish we had had a good therapist that understood what was needed. Thanks for the article: it’s spot on.
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Very interesting. I was bullied relentlessly as a kid and way into high school, too. That was my main trauma.
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I think what Olga is doing is wonderful, especially in light of the evidence suggesting antipsychotic drugs can actually hinder recovery and often steal years of life from those taking them, while reducing that quality of life.
I do, however, wonder how someone in a psychotic state, who may be hearing things, seeing things, feeling paranoid or tormented is going to actually function in a job or as a volunteer. These symptoms are different from having “issues” one can just work on. They are truly horrifying and debilitating, which is why many psychotic people crave isolation.
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You bring up an important point. Clearly, the step of re-engaging with society comes later in the process, when the person is stabilized and no longer hearing voices or feeling paranoid.
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I was an active volunteer, co-chairing an organization with over 250 volunteers, and overseeing the redesign of private school, in addition to many other volunteer positions, while I was being made “psychotic,” via antipsychotic induced anticholinergic toxidrome.
Keeping very busy and active with others was the only way I could keep the “voices” at bay. So I disagree you need to wait until the person is no longer hearing “voices.”
Although, I will say I was not personally afraid of the “voices,” since they claimed to be people I knew in real life who I knew were stupid and unethical. And I was eventually handed over the medical evidence they were, in fact, child rapists.
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Hi,
Surely we’re talking about people with problems and not “psychotic” people. I benefited from psychotherapy and there was no suggestion on the therapists part that I was mad or that I would not ‘recover’.
A person can have strange problems – but everyone’s problems are strange.
Supposing a person thinks they might have cancer or that they might be made redundant – this is an anxiety problem. Also if a person thinks that another person might kill them – this is also an anxiety problem (as in some environments people do resort to violence and the fear of being attacked is realistic).
If a person’s worries get completely out of hand I imagine they could have a breakdown – but if a person has an accommodation on problems I’d imagine they would be unlikely to breakdown.
My solution to anxiety was not to think about worrying prospects from a worried frame of mind – but to look at them later when I felt calm – and then they didn’t seem very frightening and I knew what to do about them. My “anxiety” stemmed from neuroleptic drug withdrawal and it was too much for me – so I needed tactics to get around it.
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I also wonder about people who do not become psychotic bc of a history of trauma. We have heard of people with no trauma or abuse history who were given SSRIs or smoked “skunk” PCP laced marijuana and experienced psychosis. In this case are we looking at a biological/chemical reaction in the brain causing the problem? If this is a FEP it could be handled without drugs, but might not respond to psychotherapy? Or am I wrong?
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What I’ve heard is that when someone stops smoking skunk they often recover by themselves.
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Hi truth,
Psychotherapy might show people how to negotiate symptoms like ” High Anxiety”. I benefited from a CBT/Buddhist Meditation Mindfulness approach.
I’d imagine most recovering “schizophrenics” would suffer from neuroleptic drug induced withdrawal syndrome.
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The skunk smokers are biological, but they can likely be treated with 1g+ doses of the amino acid L-glutamine, in an effort to restore the nervous system’s glutamate (a neurotransmitter) levels and hopefully, the individual’s awareness. You can’t do much psychotherapy with the delirious, but it’s dangerous to use drugs on someone under the influence of PCP, although old-time megavitamin therapy (1g of B3 TID+ 1g of C TID) might help. You’d likely also continue the glutamine as needed (1g+?)
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I think the fly in the ointment is the use of terms like “schizophrenia” and “psychosis” – t terms that suggest impossible situations.
I’ve never suffered from “voices” but I believe people can find ways of coping with them. To me paranoia is the same as anxiety the solution being to “stop worrying” very gradually and when this happens things seem very different.
My psychiatric difficulty in engaging with life stemmed from neuroleptics. I was neurologically disabled while I consumed them but I was able to engage straight away when I stopped (I withdrew carefully).
I think any decent therapist should be able to work with a “schizophrenic” and show them how to deal with their situations so that they don’t break down again (in the same way as they might work with anyone else).
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Freud = FRAUD. I’m surprised and disappointed that he was given even the few lines in the article, above.
Freud has been 100% deconstructed by numerous writers, and PhD theses.
If you think about it, you’ll realize that there are NO such things as “id”, “ego”, and “super-ego”. These are all imaginary CONCEPTS. They have no objective reality. They (MIGHT!) have **SOME** utility as ideas in a “History of Psychology” course, but that’s about all the value they have. Can we **PLEASE** leave Freud and the other **TRASH** on the scrap heap of history….????….
Freud was a misogynistic, hashish smoking, cocaine-snorting FREAK. Have you read his book about cocaine?
Can we **PLEASE** leave Freud on the scrap heap of history, where he belongs….????….
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Let us remember that Freud dared to say to the medical community that sexual abuse (trauma) was the origin of mental disorders. History has proved him correct.
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….”the origin”???? As if so-called “mental disorders” have *no*other* origin? As if so-called “mental disorders” are in fact valid diagnostic categories? As is if “sexual abuse (trauma)” *always*, and necessarily creates so-called “mental disorders”?
Isn’t it also true that among the first groups of women Freud worked with, one group ALL reported childhood sexual abuse / molestation / rape, and Freud DIS-believed them, and used them to form his bogus “”oedipal” & “electra” “complex”” nonsense? To the extent that “Freud spoke to the medical community”, may we also blame him for the gross over-medicalizing and over-drugging of human problems of living? That Freud was “correct” on one, or even two minor points, does not change my disgust with him. Why do *YOU* rise to defend him? I still maintain, that except as a historical footnote, we’d all be better off leaving Freud on the scrap heap of history….. And, in conclusion, *IF* “trauma is the origin of mental disorders”, then *WHAT* is the origin of trauma?…. We have so much trauma, largely because we refuse to acknowledge it, and prevent it before it happens…. So tell us about Freud’s “primal horde” theory….????….etc.,….-
*rotflmfao*
(c)2017, Tom Clancy, Jr., *NON-fiction
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And for doing this he brought down on himself the anger and disapproval of all of Viennese Victorian society! How dare anyone suggest that the wonderful Victorians sexually abused their children!!!!! His paper on hysteria is still a very good understanding of how trauma can affect people in very bad ways. He ended up having to take back much of what he said about the abuse of children.
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It is true that Freud originally believed his patients and attributed their difficulties to having been abused as children. It was only after the Viennese aristocracy excoriated him for saying such horrible things about them that he developed his “drive theory” to explain away his observations. He chickened out, for which I can’t forgive him, but we do need to give him credit where credit is due.
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I respect Olga’s work and other. Clearly individuals can withdrawal from psychotropics and some can live with psychosis and even go on to embrace the gifts they have. Nonetheless, it seems evident from comments like fiachra that general public doesn’t understand schizophrenia. And the author seems to agree with commenters as well. The commenter truth had a helpful comment.
It’s thought that anatomy of epidemic focused primarily on topic of schizophrenia and didn’t go into detail on the diagnosis of depression. I think it’s even more the case that general public doesn’t understand challenges of depression because they make so many comments like fiachara concerning depression.
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Olga is conducting pioneering work in the sense that she is opening the door to non drug workable solutions for “Schizophrenia”.
But so many more psychologists need to join the process using the skills they already have. All they have to do is to listen to the person express their ambitions and help them with the process.
A lot of anxiety is to do with “transference” (i.e. the anxiety is in the person and not in proportion to outside events). Fear is very persuasive though, and can only be let go of very slowly.
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