[NOTE: As part of our own continuing journey, PsychOdyssey’s team reads hundreds of articles about various aspects of mental illness and psychiatric rehabilitation. When we see one which we think particularly relevant for family members, we post it here. How is our selection? Please let us know in our Comment section below. Ed.]
Special Series: In 2011, The New York Times ran a front-page series of articles, called Lives Restored: Living with Schizophrenia, about successful individual struggles with severe mental illness. See more about this interesting series here.
Anonymous (2007). Why Having a Mental Illness Is Not Like Having Diabetes. Schizophrenia Bulletin 33(4), 856-847, doi:10.1093/schbul/sbj080.
“I reject the analogy of schizoaffective disorder as being like diabetes. If I could choose a replacement analogy, I would say schizoaffective disorder is like a whirlwind: it comes out of nowhere, strips you naked and sucks you dry, and swiftly vanishes, leaving you empty and shaken but alive, wondering if it really did happen and whether, and how soon, it will come back again.”
Behavioral Healthcare [Magazine] (2011). Up to one in four incarcerations should be prevented.
The scandal of preventable incarceration of individuals with psychiatric disabilities continues to careen of out of control. The American Psychiatric Association estimates that 20% of all prisoners, about 550,000 individuals suffer from a severe mental illness. With the number of inpatient hospital psychiatric beds nationally now down to about 40,000 (from over half a million in the 1950s), prisons and jails have become a de facto–and wholly inadequate and inappropriate–long-term institutional care solution.Behavioral Healthcare takes on this important issue in this fulsome article.
Belluck, P. (2010). Giving Alzheimers Patients Their Way, Even Chocolate. New York Times, December 31, 2010.
“Margaret Nance was, to put it mildly, a difficult case. Agitated, combative, often reluctant to eat, she would hit staff members and fellow residents at nursing homes, several of which kicked her out. But when Beatitudes nursing home agreed to an urgent plea to accept her, all that changed. Disregarding typical nursing-home rules, Beatitudes allowed Ms. Nance, 96 and afflicted with Alzheimer’s, to sleep, be bathed and dine whenever she wanted, even at 2 a.m. She could eat anything, too, no matter how unhealthy, including unlimited chocolate.” This story about Alzheimers has important parallels for families of loved ones in psychiatric hospitals.
Bloch, S. & Green, S. A. (2006). An Ethical Framework for Psychiatry. British Journal of Psychiatry, 188(1), 7-12.
Of all the medical disciplines, perhaps the most enmeshed in medical bioethics is psychiatry. This is particularly true around the thorny subject of compulsory treatment, which brings into view the philosophical framework of psychiatry. Bloch and Green find a middle ground between Kantian duty-driven, rules-based absolutism and Millsean outcome-based utilitarianism. That middle ground is a combination of a pragmatic Jamesean “principlism” and a Humesean-influenced “ethics of care”. While the subject seems esoteric, families in the maelstrom may find this analysis useful as a philosophical framework for interpreting their own families experiences within The System, especially when faced with the possibility of compulsory treatment.
Copeland, M. (2002). Wellness Action Recovery Plan (WRAP) (template).
Mary Copeland is the developer of the Wellness Action Recovery Plan model, now accepted worldwide as a highly useful means of psychiatric rehabilitation for structuring and sustaining recovery. Although not identified as such from Copeland, here is a more detailed WRAP Plan which presents more specifically what Copeland’s wonderful work is about.
Deegan, P. (2005). The importance of personal medicine–A qualitative study of resilience in people with psychiatric disabilities. Scandinavian Journal of Public Health 33, p. 1-7.
From a pioneer of the self-help consumer wellness and recovery movement. “Personal medicine… self-initiated, non-pharmaceutical self-care activities…” “…[r]ecovery is about changing their lives, not their biochemistry.”
DeSisto, M.J., Harding, C.M., McCormick, R.V., Ashikaga, T. & Brooks, G.W. (1995). The Maine and Vermont Three-Decade Studies of Serious Mental Illness. British Journal of Psychiatry, 167, 331-342.
Psychiatric rehabilitation is the new frontier in mental health. Based on holistc, humane, self-help, partnership, and evidence-based principles, psychiatric rehabilitation offers more recovery promise for individuals with serious mental illness. In this oft-cited article, outcomes in two states, Maine (using traditional treatment modalities) and Vermont (engaging psychiatric rehabilitation principles), are compared. Based on solid evidence, “Vermont subjects were more productive, had fewer symptoms, and displayed better overall functioning and community adjustment.”
New research suggests that the cause of schizophrenia may be a retrovirus transmitted 60 million ago that became entwined in human DNA, a dormant virus which may be set off by events like infections, pollution, smoking, and infections around the time of birth, such as influenza (The influenza trigger may help explain the “winter birth” correlation, since influenza tends to occur at that time of year).
Glynn, S.M., Cohen, A.N., Dixon, L.B., and Niv, N. (2006). The potential impact of the recovery movement on family interventions for schizophrenia–opportunities and outcomes. Schizophrenia Bulletin 32(3), pp. 451-463, doi:10.1093/schbul/sbj066.
The field of psychiatric rehabilitation is moving the world of mental health care from the so-called “medical model” of treatment of cases and illnesses to a recovery model focused on the empowerment of the individual to live a full life with and in spite of illness. One of the keys to successful recovery is family involvement. Glynn, et al., explore what this means for individuals with schizophrenia and their families.
Harding, Courtenay M., & Zahniser, James M. (1994). Empirical correction of seven myths about schizophrenia with implications for treatment. Acta Psychiatrica Scandinavica, 90(suppl. 384), 140-146.
The legendary Courtenay M. Harding (of the “Vermont Study”) and her colleague, James H. Zahniser, present empirical evidence accumulated for two decades before the article’s publication to challenge seven long-held myths in psychiatry about schizophrenia.
Harris, Gardiner (2011).Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy. The New York Times, March 5, 2011. Retrieved from http://www.nytimes.com/2011/03/06/health/policy/06doctors.html?pagewanted=all.
Harrow, M., & Hobe, T. H. (2007). Factors involved in Outcome and Recovery in Outcome and Recovery in Schizophrenia Patients Not on Antipsychotic Medications: A 15-Year Multifollow-up Study. The Journal of Nervous and Mental Disorders, 195(5), 406-414.
Recent research supported by the National Institute of Mental Health suggests that over the long term more a far greater number of those with SZ in recovery are not taking antipsychotic medications. opposite. In a 15-year longitudinal follow-up study, Martin Harrow and Thomas H. Jobe researched whether unmedicated individuals with schizophrenia can function as well as those on medication. Their study included 64 individuals with SZ who were were initially assessed upon hospitalization, and then followed up 5 times over 15 years. At each follow-up, the individuals were compared on symptoms and global outcome. What did Harrow and Jobe discover? “A larger percent of schizophrenia patients not on antipsychotics showed periods of recovery and better global functioning.”
Hutchinson, D.S., Gagne, C., Bowers, S., Russinova, Z., Skrinar, G., Anthony, W.A. (2006). A framework for health promotion services for people with psychiatric disabilities. Psychiatric Rehabilitation Journal 29(4), 241-250.
Hutchinson et al. advocate promoting wellness for those with psychiatric disabilities in a manner consistent with a public health approach. The researchers are team members of Boston University’s Center for Psychiatric Rehabilitation.
Kleinman, A. (2010). On Caregiving–a scholar experiences the moral acts that come before–and go beyond–modern medicine. Harvard Magazine, July-August 2010, pp.25-29.
Any loved one tending to another with a psychiatric disability knows the often relentlessly heavy burden of caregiving. Yet, in time, it can also be a blessing. Arthur Kleinman, an anthropologist teaching at Harvard Medical School, discovered this paradox in caring for his ailing wife. “Caregiving is also a defining moral practice. It is a practice of empathic imagination, responsibility, witnessing, and solidarity with those in great need. It is a moral practice that makes caregivers, and at times even the care-receivers, more present and thereby fully human.”
NSW Consumer Advisory Group–Mental Health Inc. and Mental Health Coordinating Council (2009). Literature Review on Recovery–Developing a Recovery Oriented Service Provider Resource for Community Health Organizations.
From New South Wales in Australia comes this excellent (and long… 72 pages) resource on the philosophy, principles, and practice of recovery. It includes a 10 page bibliography of articles on all aspects of the subject.
Osborn, Lawrence A. (2009). From Beauty to Despair–The Rise and Fall of the American State Mental Hospital. Psychiatric Quarterly, 80. 219-231.
The American State Hospital has survived over 200 years. Society once viewed state hospitals as an absolute necessity and each state constructed numerous hospitals. Over time, the image of the state hospital as a means to cure the mentally ill changed drastically. The public perceived state hospitals as snake pits that warehoused the mentally ill and the state hospital was nearly destroyed. Nevertheless, the state hospital remains today with purposes similar to its ancestors and some that are very different. This paper examines the many influences that created the state hospital. Additionally, this paper addresses the Kirkbride Model, treatment methods and practices over time, and how the state hospital fell into disfavor as a means to treat the mentally ill. The paper concludes with comments on the mental health system today, in relation to the state hospital’s role in treatment.
Rossler, Wulf (2006). Psychiatric rehabilitation today; an overview. World Psychiatry 5(3), 151-157.
For families in the maelstrom of mental illness, an ultimate goal is to help their loved ones recovery. The best modality for recovery is psychiatric rehabilitation. But many even in the mental health sector still don’t know what psychiatric rehabilitation is. While many experts have written volumes on the subject, the pithiest description we have seen appears in a 2006 piece by Professor Wulf Rossler of University of Zurich for World Psychiatry. In a sentence, psychiatric rehabilitation is a treatment modality that helps people with severe and persistent mental illness develop emotional, social, and intellectual skills to live, learn, and work in the community with the least amount of professional support. Rossler goes on to explain the modality’s concepts and methods in plain English (even though a Swiss!) that families and other non-technical people can easily understand.
Scaglione, F. (2009). The OMIG Who Stole Xmas, New York Nonprofit Press, 8(10). Chatham, NY: New York Nonprofit Press.
OMIG is not the internet acronym for the exasperatory “Oh My God!” But for many New York behavioral health agencies, it might as well be. OMIG stands for Office of the Medicaid Inspector General. It is headed by James G. Sheehan. Mr. Sheehan is striking terror into the hearts of providers. As the State of New York struggles with its budget crisis, suddenly it is becoming The Auditor from Hell in the pursuit of ”waste, fraud, and abuse”. What now constitutes “abuse”? Even the most persnikity detail on a submitted form. If you don’t have all your t’s crossed and i’s dotted, forget about getting Medicaid reimbursement. And if previously accepted paperwork is now found deficient, your agency might be found to owe reimbursements worth hundreds of thousands of dollars. This new witch hunt by government apparatchiks may be the sad harbinger of things to come under ObamaCare and cash-strapped state Medicaid programs. The implications for many of the agencies serving disabled loved ones in The System and their family members are chilling.
Spaniol, L., & Zipple, A. M. (1994). The Family Recovery Process. Journal of California Alliance for the Mentally Ill, 5(2), 57-59.
When mental illness strikes, the result can be devastating not only for the loved one but also the family. Just as the loved one must engage in a process of recovery, so also must family members. In 1994, two leaders of psychiatric rehabilitation addressed this important subject in a timeless article entitled “The Family Recovery Process” in the now discontinued Journal of the California Alliance of the Mentally Ill. The article describes six general characteristics of family recovery and suggests four stages of the family recovery experience. All families in the maelstrom of mental illness can benefit from this helpful analysis. Excerpt:
Recovery is a process of self discovery, self renewal, and transformation. All people experience recovery at various times in their lives. The more threatening the particular event, the more it shakes the foundation of who we are and how we experience our lives. These powerful events break personal connections we took for granted and shatter the expectations, dreams and fantasies for which we had hoped. Clearly these are processes which involve profound adjustments in our lives and more intensive periods of recovery. Recovery is painful and difficult for all family members. Yet the outcome of recovery can be the emergence of a new sense of self which is more vital and connected to who we really are, to others, and to a greater sense of meaning and purpose in life.
Szalavitz, M. (2011). Marijuana Linked with Earlier Onset of Schizophrenia in Research Review. Time, February 7, 2011. Retrieved from http://healthland.time.com/2011/02/07/marijuana-linked-with-earlier-onset-of-schizophrenia-in-research-review/#ixzz1DJTuQJgP
Time magazine reports on a meta-survey done by Australian researchers that concludes that heavy marijuana use can lead to earlier onset of psychosis. See the researchers’ article here.
“Schizophrenia is still one of the most mysterious and costliest disorders in terms of human suffering and societal expenditure.” Mysterious indeed! So write Jim van Os and Shitij Kapur, to begin their helpful account about the etiology of schizophrenia, which touches all the bases: genetics, biology, chemistry, natology, environmental factors, societal factors.
Vogel-Scibilla, S.E., McNulty, K.C., Baxter, B., Miller, S., Dine, M. & Frese. F.J. (2009). The Recovery Process Utilizing Erikson’s Stages of Human Development. Community Mental Health Journal 45, 405-414. doi þ10.1007/s10597-009-9189-4.
An interesting article by six authors all with psychiatric disabilities which frames recovery in terms of Erik Erikson’s famed eight stages of human development–with, unlike Erikson’s straight-line model, appropriate accommodations for the distinctively “non-linear” aspects of recovery.
Wiens, S.E. and Daniluk, J.C. (2009). Love, Loss, and Learning–The Experiences of Fathers Who Have Childrren Diagnosed with Schizoprenia. Journal of Counseling & Development, 87, pp. 339-348.
An outstanding article that gives voice to fathers of young adult children diagnosed with schizophrenia. “A qualitative, phenomenological method was used to explore and describe the fathering experiences of 6 volunteer participants. The findings suggest that mental health professionals should recognize the needs and important role of fathers in the lives of their children who have schizophrenia.”