New PsychOdyssey OpEd: Response to “Definition of Insanity”

Wall Street JournalOn Tuesday, April 1, The Wall Street Journal published an editorial criticizing the Substance Abuse and Mental Health Services Administration. (To view a copy of the editorial, click here.) PsychoOdyssey’s Tom Pyle wrote the following letter in response:

As father of a son with schizophrenia, I found the Journal’s editorial about SAMHSA partly right. Yes, SAMHSA is a bloated bureaucracy not primarily addressing serious mental illness. Yes, SAMHSA supports some aspects of the consumer/survivor movement. Yes, SAMHSA sometimes seems hostile to traditional psychiatrists like Dr. Torrey who espouse medications first and foremost.

But, no, not all roads to recovery run exclusively through heavy anti-psychotic medication and hospitalization. Solid science increasingly shows that heavy anti-psychotic use over long periods may retard recovery 1, cause extreme weight gain2, induce metabolic syndrome 3-5, or cause brain shrinkage 6. No wonder ex-patients like Dr. Fisher, himself a psychiatrist with schizophrenia, feel like “survivors”. consistent with the federal government’s 2003 National Consensus Statement on Recovery7, several non-medical therapies like the Hearing Voices Network are worthy psychosocial adjuncts to medication (or even no medication).8-13

Recovery is a mental health concept without a consensus.7,14-21 Depending on one’s view, it can be an outcome, a process, or an ideal—or, optimally, all three. Sadly, paradigm partisans too often hijack the term for their own narrow purposes. In fact, recovery has three components. The medical component (Dr. Torrey) is about hospitals, doctors, and medications for short term and enduring symptom stabilization as governed by the science of psychiatry. The empowerment component (Dr. Fisher) is about self-help, individual choice, peer support, and hope as governed by science of psychology. The third component, rehabilitation, is about providing skills and supports to advance community integration and reduce stigma as governed by the science of psychiatric rehabilitation22-28. No one component is sufficient. All are needed for integrated, holistic treatment. Thus recovery discussions must be pluralistic. All voices should be represented, especially those with psychiatric disabilities of whatever ilk or ideology who  personally must endure the mental illness maelstrom.

Thomas H. Pyle, MBA, MS (PsyR), CPRP

Princeton, NJ

Mr. Pyle is an appointed family representative member of the New Jersey Mental Health Planning Council

References

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2.         Parsons B, Allison DB, Loebel A, et al. Weight effects associated with antipsychotics: A comprehensive database analysis. Schizophrenia Research. 5// 2009;110(1–3):103-110.

3.         McEvoy JP, Meyer JM, Goff DC, et al. Prevalence of the metabolic syndrome in patients with schizophrenia: Baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schizophrenia research. 2005;80(1):19-32.

4.         Meyer J, Davis VG, Goff DC, et al. Change in metabolic syndrome parameters with antipsychotic treatment in the CATIE Schizophrenia Trial: Prospective data from phase 1 Schizophrenia Research. 2008;101(1-3):273-286.

5.         De Hert MA, van Winkel R, Van Eyck D, et al. Prevalence of the metabolic syndrome in patients with schizophrenia treated with antipsychotic medication. Schizophrenia Research. 2006;83(87-93).

6.         Ho B, Andreasen NC, Ziebell S, Pierson R, Magnotta V. Long-term antipsychotic treatment and brain volumes: A longitudinal study of first-episode schizophrenia. Archives of General Psychiatry. 2011;68(2):128-137.

7.         Substance Abuse and Mental Health Services Administration. National consensus statement on mental health recovery. In: Substance Abuse and Mental Health Services Administration, ed. Washington, DC. : U. S. Department of Health and Human Services. Retrieved from http://store.samhsa.gov/shin/content//SMA05-4129/SMA05-4129.pdf.; 2004.

8.         Romme MA, Honig A, Noorthoorn EO, Escher AD. Coping with hearing voices: an emancipatory approach. The British Journal of Psychiatry. July 1, 1992 1992;161(1):99-103.

9.         Ruddle A, Mason O, Wykes T. A review of hearing voices groups: Evidence and mechanisms of change. Clinical Psychology Review. 7// 2011;31(5):757-766.

10.       Kreinin A. “Hearing voices” in schizophrenia: Who’s voices are they? Medical Hypotheses. 4// 2013;80(4):352-356.

11.       Martin PJ. Hearing voices and listening to those that hear them. Journal of Psychiatric and Mental Health Nursing. 2000;7(2):135-141.

12.       Weddings S, Walley L, Collings T, Tullett F, McEwan B, Owen K. Are hearing voices groups effective? Intervoice Online 2006; http://www.intervoiceonline.org/wp-content/uploads/2011/03/Voiceseval.pdf.

13.       Bentall RP. The illusion of reality: A review and integration of psychological research on hallucinations. Psychological Bulletin. 1990;107(1):82-95.

14.       Craig TKJ. Recovery: Say what you mean and mean what you say. Journal of Mental Health. 2008;17(2):125-128.

15.       Davidson L, O’Connell MJ, Tondora J, Staeheli M, Evans AC. Recovery in serious mental illness: Paradigm shift or shibboleth? In: Davidson L, Harding C, Spaniol L, eds. Recovery from severe mental illness: Research evidence and implications for practice. Boston, MA: Center for Pyschiatric Rehabilitation, Boston University; 2005.

16.       Deegan P. Recovery as a journey of the heart. In: Davidson L, Harding C, Spaniol L, eds. Recovery from severe mental illnesses: Research evidence and implications for practice. Boston: Center for Psychiatric Rehabiltiation; 2005:57-68.

17.       Frese FJ, Knight EL, Saks E. Recovery From schizophrenia: With views of psychiatrists, psychologists, and others diagnosed with this disorder. Schizophrenia bulletin. March 1, 2009 2009;35(2):370-380.

18.       Harding CM, Brooks GW, Ashikaga T, Strauss JS, Breier A. The Vermont longitudinal study of persons with severe mental illness, II: Long-term outcome of subjects who retropsectively met DSM-III criteria for schizophrenia. American Journal of Psychiatry. 1987;144:727-735.

19.       Onken SJ, Craig CM, Ridgway P, Ralph RO, Cook JA. An analysis of the definitions and elements of recovery: A review of the literature. Psychiatric Rehabilitation Journal. Summer2007 2007;31(1):9-22.

20.       Spaniol L, Gagne C, Koehler M. Recovery from serious mental illness: What it is and how to support people in their recovery. In: Marinelli RP, Dell Orto AE, eds. The psychological and social impact of disability, 4th ed. New York, NY: Springer Publishing Company; 1999:409-422.

21.       Treatment Advocacy Center. Sometimes needed: A path to a recovery path. 2011.

22.       Anthony WA, Cohen M, Farkas MS, Gagne C. Psychiatric rehabilitation. Boston, MA: Center for Psychiatric Rehabilitation; 2002.

23.       Atyeo H, Forchuk C. Psychiatric/psychosocial rehabilitation (PSR) in relation to residential environments: Housing and homelessness. Current Psychiatry Reviews. 2013;9:188-194.

24.       Ellison ML, Anthony WA, Sheets JL, et al. The Integration of Psychiatric Rehabilitation Services in Behavioral Health Care Structures: A State Example. Journal of Behavioral Health Services & Research. 2002;29(4):381.

25.       Gill KJ, Barrett NM. Psychiatric rehabilitation: An emerging academic discipline. Israeli Journal of Psychiatry and Related Science. 2009;46(2):94-102.

26.       Pratt CW, Gill KJ, Barrett NM, Roberts MM. Psychiatric rehabilitation. 2nd ed. New York: Elsevier; 2007.

27.       Rossler W. Psychiatric rehabilitation today: An overview. World Psychiatry. 2006;5(3).

28.       United States Psychiatric Rehabilitation Association. What is psychiatric rehabilitation. 2011; https://netforum.avectra.com/eweb/DynamicPage.aspx?Site=USPRA&WebCode=IAPSRS.

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