A new approach to treating mental illness?

When people exhibit signs of psychosis – they hear voices, they think someone is out to get them – more often than not, they are referred to psychiatrists who immediately put them on powerful drugs like Haldol, Depakote, Abilify or Seroquel. These drugs sometimes tamp down the voices and other psychotic symptoms (and sometimes they don’t). Such medications also make many people feel like zombies and carry a plethora of severe side effects such as excessive weight gain and an increased risk of diabetes and heart problems. Too often, their benefits are short-lived, and many people experiencing psychosis end up in a vicious cycle of hospitalization and isolation – unable to hold down a productive job and stigmatized by the world at large.

In her new book, Agnes’s Jacket, Gail Hornstein, a professor of psychology at Mount Holyoke College, offers an intriguing alternative to dealing with psychosis: support groups that allow people to discuss and deal with the voices they are hearing without medication, in a caring and empathetic environment. She explores this “psychiatric survivor movement” in great depth in her book, chronicling the Hearing Voices network and other support groups that have made this movement possible. She presents vivid examples of people who were previously labeled psychotic and slapped on drugs, but who, with the help of support groups, have learned how to live with and control the voices they hear inside their heads. Some of these people have gone on to live rich, productive lives without the need for medication or hospitalization. As Hornstein writes in her book, “Sharing experiences in peer support groups has led them to a whole different way of understanding their distress…Psychiatric survivor groups teach patients that emotional difficulties, no matter how severe, can coped with."

Hornstein makes a persuasive case for the power of peer support and the importance of understanding psychotic symptoms in the context of the trauma that many people with such symptoms have experienced in their lives. And she rightly points out that psychiatrists -- under the sway of the pharmaceutical industry and managed care – have been much too quick to put their patients on powerful drugs instead of exploring other therapeutic alternatives first.

Just one quibble. In her book, Hornstein seems to sweep all American psychiatrists into the same boat, ignoring those who remain committed to psychotherapy (despite inadequate reimbursement from insurers) and to developing the kind of positive, trusting relationships that put patients on the road to recovery.

Last year, for example, I had the opportunity to attend a meeting of the International Society for the Psychological Treatments of the Schizophrenias and other Psychoses (ISPS), where I heard a previously psychotic patient talk about how his relationship with his psychiatrist enabled him to recover from years of mental illness. As a young man, Mark had been labeled schizophrenic because he heard voices all the time. He was repeatedly hospitalized, put on Haldol and Clozaril, powerful anti-psychotics that made it difficult for him to function. For years, Mark couldn’t hold down a job or live on his own.

Over the past 10 years, however, Mark has been in therapy with the same psychiatrist, and they have developed such a strong relationship, one based on mutual respect and trust, that Mark is no longer psychotic. He now has a job, lives by himself and, judging by what he had to say at the ISPS meeting, is a thoughtful, articulate man. He credits the relationship he has developed with this particular psychiatrist for his recovery, noting: “When you feel good about the people you’re working with, you generally want to stay healthy.”

And that, of course, is precisely what makes the support groups that Hornstein extols so effective as well. Regardless of what experiences people are sharing and who they share it with, they are much more likely to recover from mental illness when they are surrounded by understanding, empathy and respect. And that’s not something you can get from a pill.