TRANSCRIPT
When you hear the word schizophrenia, what is the first thing that comes to your mind? People talking to themselves. People with multiple problems. People wandering in the street. People who are afraid. People who are, you know, psycho.
I started to hear voices when I was 17 years old. Somebody with emotional problems. Somebody who’s having a pretty rough time in life. I couldn’t really understand what they were saying. I think it’s split personality, but I remember that it’s more like hearing voices. It was like wind, whooshing of wind. Voices in the head. Hearing voices. If you had to hear voices all the time, I could see how that could drive you nuts.
I used to think I had tuberculosis of the brain. A problem in the brain. It’s something bad, I knew that. A mental disease. I couldn’t even go to a phone book to find a phone number. Disorientation. Sort of out of touch with reality. I was sure that people knew what I was thinking… Paranoia. …knew what I was hearing… Having irregular thought patterns. …I was hearing full-fledged voices. Flipping out. “Kill yourself! Kill your mother! Kill your sister!” Imagine if you heard a counterfactual voice in your head telling you horrible things about yourself!
I totally believed — — “Kill your mother! Kill your sister!” — — that the devil had taken me over. Psychopath. I don’t know much about schizophrenia…and neither do I. Could you give me some examples of hallucinations you had? Faucets running blood. To be honest, the word “crazy” would come to mind. My gut reaction is crazy. The whole thing smells like feces anyway…
One second they’ll be someone, the next second they’ll be crazy. Crazy. Crazy. Crazy. People used to run maggots — they would have maggots all over them. People who are crazy. Probably “crazy.” Kind of crazy. Crazy. There’s no other way to describe it but terror. Crazy people locked up in small rooms. You find yourself crowded up against a wall… Crazy people. Crazy people. …in a purely defensive posture. Absolutely insane.
I’ve never said any of this before. It’s very, very difficult. Crazy. I would spend most of my classes in the women’s bathroom. Madness. I was building a fort. Straightjackets and asylums and all of my worst fears realized. I was going to drive off of Irvine Park — there was a cliff there. Unstable. “One Flew Over the Cuckoo’s Nest.” I was admitted to the Neuropsychiatric Unit. Psychiatry, medication. I was started on Thorazine… Pills. …Stelazine… Drugs. …and Cogentin… Scary. They made me so extremely sedated. A life of confusion. I could barely walk. Makes it hard to have a life. Dystonic reactions. Uncontrolled behavior. Something wrong with the person. I had no hope. Sadness.
They told my mother… Mental illness. …she needed to realize… Mental illness. …I had an illness… Mental illness. …that nobody gets well from… Mental illness. …nobody recovers from… Mental illness. …and she needed to take care of her other children. Severe mental illness. My diagnosis was schizophrenia. I have never met a schizophrenic whose life wouldn’t have driven me crazy if I had lived it. Not their life as described in the hospital record by people who don’t want to hear what it was like, but their life as they have experienced it… Then there’s no question that I would be just as sick and in just the same way this patient is.
And in fact I have never worked with a schizophrenic where I have not walked away from some session with the feeling, “My God, a human being has lived this way.” My father was killed in Korea when I was 10 months old. My mom at that time was pregnant with my sister Cindy. What I remember from a very early age is my mom’s depression, and feeling it was my fault. And I feel that left a lasting impression in me. I had to be extra good or my mom might not be with me, or might want to leave me, or… I felt it was up to me to keep her love.
Her mother was not a person who understood separate identity. Her mother regarded Catherine as the reincarnation of Catherine’s dead father. So Catherine was this “un-person.” When I was six years old my mom remarried another Marine. And at the time she remarried it wasn’t really apparent that he had a problem with alcohol. But as time went on it became more and more apparent. When he drank he became more and more verbally…mean. He was usually drunk in the late afternoon and evening, all the way up until 9:00pm when he went to bed.
I always had this fear that he would become physically violent, because at times he would go right up to her and say, “You bitch!” And as a small kid seeing that it just terrifies you. If you’re dealing with someone who is schizophrenic you have to assume their life has been god-awful. You also have to assume they’re terrified. And of course if you are terrified and have a life that has terrified you then why should you trust someone?
What do you have to transfer that would make you trust somebody who says, “I’m here to help you…”? Well, lots of people have said that who aren’t the least bit helpful, of course, starting with their parents, and going on to other authority figures who aren’t helpful, including mental health professionals who said, “I’m here to help you,” and have done things that have been very hurtful.
I remember it all starting when I was 6 years old and I was coming home from the hospital from having had all that surgery. What surgery did you have? I had four kidneys and four ureters. So I was wetting myself all over the place and getting hit for it and getting…stuff…for it. And there was no way I could have controlled any of it.
Well they finally discovered the problem and did the surgery on it, but the thing was that they… …they said things like, “We’re going to operate on your doll.” And they did all kinds of cystoscopy, which were excruciatingly painful, or were in those days. They’ve done all kinds of better stuff now, although I’m scared as hell of it when I have it now… …I hear it’s still pretty bad. It’s not good, but it’s not…a “screamer.” It used to be a “screamer”…because the materials were bigger and they’d force you open and do all that stuff.
And then they’d say it wouldn’t hurt, and they’d say that again, and you’d have another one, and another one. And you don’t know the difference between urethra and vagina when you’re young…before all that fun stuff happens. So it all seemed like the “down there” part, and leaking and bleeding and all of that stuff.
When I was coming home from the hospital it was raining and the tears were running down the window of the car, and a voice said, “This is going to be your life.” All the symptoms that are used to diagnose mental disorders are functional for people in some way.
– They help them? – They help them. They’re somehow helpful. They enable people to avoid pain, to protect themselves, to feel better about themselves, to feel exalted, to retreat… So essentially the psychosis is a way to distance themselves from something too overwhelming to deal with.
I was 8 years old when I first had suicidal thoughts. And they were scary. It’s not that I wanted to feel suicidal. My thoughts were, “Whew…I want out of here.” This poured into my school too. I began feeling really different, really strange. I got teased a lot. I got called “Bulgy Eyeballs,” “Witchy” — all these names!
And yet I couldn’t come home and tell my mom or my dad how bad I felt, how strange I felt, that nobody liked me, because if I did I would upset them! Right. So from an early age I started developing an alternate way to deal with all the pain, because it was extremely painful. There was a separation between me and people… until they all got to be generic.
I was 10 when “others” came to me and said, “You’re not of them — there’s another place where you belong.” “You’re not of them…” People came to you? Not people… …some “things.” For people who become psychotic, or whatever word we use… …the reality they’ve lost touch with is other people. They no longer feel a sufficient connection to other human beings to feel like a human being.
I don’t know what it was that I was projecting that made people hate me, or dislike me, or become angry. But I know it must have been something because it was almost universal. When my father was drinking he would call me “Fatty Cathy.” He’d ask, “Did…
You take an Ugly Pill today?” And he would always say, “Why are you making your mother unhappy?” when he was actually causing it. Later, when I was a teenager, he’d say, “Why are you wearing your dress so short? Do you want to be a whore, a bitch?” He was a misogynist. He would practice that, as it were, when he was drunk. He would go after the girls in the family. He’d say, “Make-up… Why are you wearing that make-up?” And then, “That dress is so short you can see your…” And he would actually say it. So she had no ally.
One thing that schizophrenia does is it saves you from real-world traumas. I witnessed a murder.
– How old were you?
– Twelve. I think that would have been traumatic in somebody’s life, but it wasn’t really in mine, because by that time I was so far gone it didn’t matter to me.
I was in the sixth grade, and in the seventh was a girl named Kathy, and she came with two teenage boys, and they attacked a kid who was carrying home some laundry in a bag, and they knifed him. They were playing around with him first… They would have hit him, and probably cut open his laundry or something, but she said, “Are you men or what?” So they knifed him. And he was lying there, bleeding. There was blood pouring out. There was a lot of it.
Did you talk about it with your parents back then?
Never.
– With anybody?
– No. So you witnessed a murder and you just lived with it all alone?
Yes.
What would have happened had you told your parents?
I don’t know. I was in an anti-Semitic camp for 3 years and I didn’t tell them. I really started becoming very religious. I would say my rosary on stone.
On stone… what does that mean?
Well, there are stones in gardens… pebbles…
So you’d sit on the stones?
No, I wouldn’t — I would kneel!
– That must have hurt!
– It did. My knees were pretty scraped…
I had read stories of the saints, where they would make themselves pleasing to God by inflicting self-harm because then God really knew they loved Him and wanted to live for Him. So I felt that if no one else wanted me, God would want me!
You try desperately, you try so hard, and you look at other people, and you try to act like them, it doesn’t work, so you try something else, and that doesn’t work. Nothing helps. Human beings get to feel helpless. And that’s the fundamental problem that human beings have. We are born very helpless. And when life becomes overwhelming, we fall back into the helplessness. Parents try to dress it up, people try to dress it up. They say, “She’s creative, she’s sensitive, she’s this and that…” “If only you would do something with your hair, dress a little better, get out a little more.” But “out” is not where I want to be. And dressing better is putting a dress on a warthog.
What do you think causes schizophrenia?
Chemical imbalances. Some sort of neurological process that went haywire. Something went wrong in the brain. My abnormal psychology textbook said something about nature and nurture, that certain things like having abusive parents or being sexually abused as a child increase the chances that you’ll be schizophrenic, but it’s also a chemical imbalance in the brain.
Okay, let’s go to the broken brain theory, because it is important that we address it. This theory is the crux of the fraud being told to people. Maybe a chemical imbalance, I think it could be… Something is depleted in your brain… like there’s too much of some chemical or not enough of it… You go to Washington Square Park and ask people, “What is schizophrenia?” A chemical imbalance, I guess. I’m pretty sure it’s a neurological disorder. Overload of brain activity. They have broken brains, the drugs help fix it. People with schizophrenia’s symptoms are often helped by medication that act on the brain, so that makes me think it’s a brain disorder.
When I was a newspaper reporter, I used to write that stuff… Alterations in the chemicals of the brain. Biological factors. Chemical imbalance… Because that’s what people told me… It’s an imbalance. DNA. It’s a neurological disease. But it is intellectual fraud. Chemical imbalance. I’m sure the condition has always been there. It’s part of the human genome and memenome [sic]. It’s easy to prove that it’s fraud. A guy named Kenneth Kendler, who’s an editor of one of the journals… I forget exactly which one… In 2005 he said, “We have looked for these chemical imbalances and we have not found them.” Most likely chemical imbalances in the brain. Arvid Carlsson was one of the initial promoters of this hypothesis. In 1992 he said, “It didn’t pan out.” It’s just a brain disorder that develops. Hormonal, mental imbalance. Chemical imbalance.
John Kane said in 1993 or 1994… these are big psychiatric researchers: “The dopaminergic hypothesis is no longer credible.” I have a neuro degree so I know it’s an imbalance of dopamine receptors. It didn’t pan out. Something that is just not firing right in your brain. It didn’t happen. It could be an organic thing in the brain. If you want I’ll get you a book by Steve Hyman, a former director of the National Institute of Mental Health, and he said, in 2002, “There is no evidence of a lesion in the dopaminergic system in schizophrenia.” Some sort of chemical imbalance.
So why does the public believe something differently?
I would assume a chemical imbalance.
Because they lied to us! Chemical imbalance in the brain. It’s sort of a combination of drug companies… Chemical imbalances… groups that they fund or provide money to… Some sort of chemical imbalance. Like the National Alliance on Mental Illness. Chemical imbalance in the brain. The psychiatric researchers, when talking to reporters, they’ll say… and I remember when I first reported on this, they would say, “These drugs are like insulin for diabetes.” Maybe it needs to be drugs, in the same way a diabetic needs them… And I’d ask, “How so?” And they’d say, “Well, it’s correcting this chemical problem.” Chemical imbalance in the brain.
Okay… so I’d write that. Physiological or chemical. Then later, once I did my own research, and they’d say, “It’s like insulin for diabetes,” I’d reply, “No it’s not! That’s not what you found!” And they’d say, “Oh, you’re right.” Every time… “Oh, you’re right.” And I’d say, “Why do you tell people that then?” Chemical imbalance in the brain. And they’d say, “Because it gets people to take their drugs.” I don’t know too much about it, but I know that you need medication. It’s a convenient slogan. Chemical imbalance. Chemical imbalance. Chemical imbalance.
I’d say, “But you’re lying.” And they’d say, “But we know the drugs are good for them…” You have to take your pills. So why don’t you just tell them we think your drugs are good for you but we don’t know what’s wrong with your brain? Probably a chemical imbalance. Isn’t it wrong to tell somebody they have something wrong with their brain when you don’t know that?
Could you tell me what a mental health professional might best say to not help someone with schizophrenia recover?
Well, the usual thing: “You have this genetic, physiological disorder, which is incurable, but with the best of modern treatment, by which I mean medication, you can be marginally acceptable to most people most of the time.”
What do you think is the best treatment for schizophrenia?
Medicine. Medication. Medication. Medication. Well, if I were a doctor I would probably say “drugs.” What’s happened now in the psychiatric residencies is that psychiatrists have been trained to “treat” psychotic individuals, and the word “treat” has come to mean “medicate.” They’ve been told that talking with these people can be very dangerous to them, so don’t try doing uncovering work with them. They really aren’t well-trained to do psychotherapy with anybody.
I once asked a therapist if there were any brain disorders that were beyond traditional treatment, and he replied, “The only one that’s not really treatable is schizophrenia.” But I know there are medications that help. Virtually all post-graduate education in psychiatry nowadays is paid for by drug companies. Psychopharmaceuticals. Some type of pharmaceutical. The drugs — I think there are more and more new drugs. Probably medication. Medicine. Mental hospitals… I don’t know. You have to see a psychiatrist, you know, get some drugs.
The key to helping people, the most fundamental thing, is to help them get over feeling helpless. To help them understand that they can actually figure things out and make decisions, make choices. And you can’t do that if you’re giving medication, because you’re saying to them, “You can’t do it — you
Need a drug. Medication. Medication. Medication. Medication. Medication. Chemical stabilization. First of all, you’ve got to stabilize this person.
When I met Catherine, I was a first-year medical resident at UCLA [University of California at Los Angeles]. She and her mother sat in the little room where I interviewed her, and she sat with her head down, with her hair over the front of her face so you couldn’t see her face, just the top of her head. The only words she said during the interview were, “I need to be in a hospital.” So I admitted her up onto the ward at UCLA, and I intended to treat her with psychotherapy only.
The evidence is that most people who get real therapy do get better. It may take a lot of work or it may take a little work… Well, usually it takes a lot of work if they’re schizophrenic because people who are schizophrenic have very serious problems. The research that says it’s not effective is often done with therapists who don’t know how to do the therapy — maybe don’t even want to do this kind of treatment. It’s hard work. It’s gut-wrenching, grueling work. Working with schizophrenics challenges our own sense of ourselves, and our own beings in many, many ways. Sometimes that can be exciting, and sometimes that can be pretty threatening. Sometimes you feel you’re going out of your mind.
Dr. Dorman saw me for 50 minutes, 5 to 6 days a week. For the first 3 to 6 months, I didn’t speak; I just rocked back and forth. She was right out of an old textbook, the old Kraepelin description of a catatonic schizophrenic. I was sitting like this, in a fetal position on the chair, and I wouldn’t look up, and he would sit there the entire 50 minutes with me not saying a word, rocking back and forth. Sometimes she would sit catatonically still, with just a slight rock, and she was so shut down she didn’t even swallow her own saliva. She actually left her mouth a little open, and her saliva would drool down the front of her dress and drip in a string into a puddle on the floor.
And people would talk about how I looked.
– Right in front of you?
– Right in front of me. What kind of things would they say?
There were two volunteers on my unit, both older ladies, and one said, “Look at her, poor dear. Some of them just never make it — isn’t it a shame?”
They presumed you couldn’t understand it?
Well, they thought I couldn’t hear it, but I could! Yes, I was psychotic, yes, I was hearing voices, but I could hear that too! Isn’t it much easier to give someone a pill and get rid of them?
When I worked in a hospital that gave shock therapy, if the psychiatric resident was angry at a patient and had no insight into it, within two weeks the patient was being given electroshock treatment. If there’s one fact that you can glean from the history of psychiatry, it’s the power of psychiatrists to be deluded about the merits of their therapies. And there are various reasons for that, but history tells us that very clearly.
The way history tells us is that we see so many discarded therapies that were initially seen as miracle therapies, that were initially seen as cures.
– For schizophrenia?
– Well, for insanity or schizophrenia… I mean, if you go back far enough, bleeding people was a cure, spinning people around was a cure, electroshock was a cure, metrazol convulsive therapy was a cure, scrambling the frontal lobes was a cure.
– Through lobotomy.
– Yes, yes, lobotomy. So the frontal lobes are the frontal part of our brain… When lobotomy was introduced in the 1940s, it was seen as a miracle therapy. And when psychiatrists initially did research to evaluate the patients who had had their frontal lobes scrambled or cut off, they concluded it couldn’t make patients with schizophrenia worse: it could only help them.
When you look back at these things, you think, “My God, how barbaric could we be?” My sense is that somewhere down the road we will look back at these medications we use now and say, “How barbaric…”
She would sit and rock, and knead her fingers, in this kind of declaration of agony. And grit her teeth, like this. Finally, I’d say, about 4 or 5 months into seeing him, he made a comment. He said, “Reality can be pretty scary, can’t it?” And for me, “Wham!” — an antenna went up. Nobody had ever told me that. Nobody. Here was I, just doing my own internal world thing, and it hit a chord. And I thought, “How did he know? How does he know?” And that was the beginning…the start of having trust. That was when her antenna went up. I didn’t know that, because she didn’t tell me until… eight years later.
In time, during our sessions, little by little, I started to open up. And I didn’t open up all at once. It was a process… because to me, trusting someone was like a death sentence, because my experience was that trusting, especially trusting people close to you, meant that you’d be hurt, or even abandoned.
You sit, you point out what a safe room they’re in, and you remind them that you won’t force them to take drugs no matter what they say or do, that you won’t lock them up no matter what they say or do, that you’re just here to be there and talk with them about who they are and what’s going on. And you see people begin to regain their trust in another human being.
Could you describe the best, most helpful qualities your therapist had?
Courage… humor… the whole thing that set up the rest of my life. We were miners. I had the map… she had the light. Many times we therapists have to carry that hope for our patients because they don’t have it. And so we have to carry that light and eventually they can take it. So we were miners together, and she was saying, “Take me along, take me along.”
She had a really strong teamwork with her doctor, with Frieda Fromm-Reichmann. They both liked each other very much. They both had a “family feeling” toward each other. There was a kind of psychological adoption that happened. And she said, more than once, “I’m not mentally ill, and I never have been. I don’t know what it’s like. Your job is to tell me that.”
The therapist can act as a reliable guide, a guide into the mind — into the horrors, and a guide with regard to the realities of the world. I see everybody as like a new world, a new culture, and each one has their language, and each one has their experience. And I find it very exciting to enter this new world, and learn a new language with this person, rather than make them learn my language.
You go to most hospitals, and in the emergency room they’ll say, “He’s talking gibberish, he doesn’t make sense.”
And you created an alternate language?
Oh yes. What did you call it?
Irian.
– Irian?
– Yes.
– Can you still speak it?
– I know words of it.
Did anyone there believe in you, did any of your co-workers, or did they all think you were crazy?
Mostly they thought I was crazy. No, no one there really believed in it. They thought it was just “Dr. Dorman’s Experiment.” Most mental health professionals have never seen a seriously disturbed person get better. The treatments they give are to make people into less disturbing sick people.
I wasn’t following the rulebook about it, so it clearly was an experiment. Everybody thought I was crazy. Even other medical residents said, “He thinks he can talk to schizophrenics — so that makes him schizophrenic.”
You can learn and study about schizophrenia. There are theories and there are approaches. But when you are in a room with somebody, they never quite fit the formulas or the book, the textbook descriptions. And so you have to be willing to tolerate a certain ambiguity, and also to rely on your own creativity, because everyone is different, and even one person might be different from day to day, from hour to hour.
Why did you stick by her? What gave you faith in her?
You know… she never missed an appointment. And she had choice in coming?
Sure! She didn’t have to come. Six days a week… I would get to the office, and she would be leaning up against the wall, eyes closed… After about a year of seeing her, she closed her eyes and shuffled around the ward, with two little slits, bumping into things, bumping into tables. But
When sitting and quiet, she would have her eyes closed. There she was, up against the wall, in this peculiar tilt. She would kind of tilt up against the wall. I kept my eyes closed for two of those years…
Wait a minute! You kept your eyes closed, literally?
Literally, my eyes were closed. And I must specify, I wasn’t thinking, “Oh, I’m going to close my eyes!” It had nothing to do with that. Literally, they closed and I simply could not open them. But the point is, she never missed an appointment and she was always on time. Always on time.
I made those sessions with Dr. Dorman because he had planted a seed, and as we progressed, that seed was watered. And he would always address what was underneath the delusion, underneath the appearance. He would always appeal to that part of me that was healthy. And you know what? There is always a healthy part within a person, no matter how small. And he told me that! He said, “Cathy, I knew you had a well piece. It might not have been that big, but it was there.”
Do you feel your therapist loved you?
She loved… aah… she loved the health in me, she loved the strength in me. Those are the weapons. Those are the weapons.
At the beginning, I kind of saw him as Jesus, because he was present and he was kind and he listened. But as I developed more of a connection with Dr. Dorman, my psychotic process got worse. I started hearing voices to kill Dr. Dorman. Schizophrenics take life to the edge in some way. They live on the edge in many ways. And many of us are frightened of that, but others of us get excited by that, by that edge, and being right there on that edge… And there’s something about that that attracts a certain type of therapist to work with schizophrenics.
How was it for you when she wanted to kill you?
I remember when we first talked about it. I said, “Well Catherine, maybe you hear voices against me for the same reason you hear voices against your mother. For you, closeness and tenderness can be a horror, because it puts you in a terrible position of smallness and dependency. Maybe you’re hearing voices against me because of the development of something tender.”
You know what happened? She never said a word, but afterward the nurses heard her just crying deeply in her room, after I said that. And I didn’t say any more than that. What was happening was my internal psychotic world was being slowly cut away.
– He was challenging it, I guess.
– He was challenging it. And this was all on an unconscious, subconscious level. Also, I had suicide attempts…
– In the hospital?
– In the hospital. What variety of suicide attempts?
I tried hanging myself when Dr. Dorman was on vacation. I literally had the sash around my neck and I was on the suitcase… I was in my closet. My roommate darted by the door and she saw me and she shouted for a nurse. And I was already up there, I was ready…
So you were going to kick it out and hang?
Yes. And when he got back from his vacation, he came up on a weekend to have a therapy session with me on the suicide ward, to process all these things.
What if she had killed herself when you’d been away?
Well, that would have been a horror. I assume that she was making, among other things, a statement both of despair and about the fact that I was away.
She must have felt rejected by you, too. Or abandoned?
Probably. Probably both. But you know, that was part of her learning curve. Part of her learning curve was that I had to go away, that she had to exist separately from me.
So she had to learn to live without you?
That is correct.
So it was actually good for her that you went away?
That is right. See, there’s a danger, though, when people feel despairing in the moment. They don’t have a full commitment to kill themselves, but they can end up… she could have ended up killing herself by accident.
– And your suicide attempts?
– The usual… cutting your wrists with razor blades. Apparently, they were not the usual one or two… not little cuts, they were… deep and I kept going at it, but I never did find anything that was good enough, and I’d just kind of get tired of doing it.
I had to face these inner demons. I couldn’t go around them, I couldn’t go above them, and I couldn’t go under them. They tried to alleviate my symptoms with the Stelazine and the Thorazine. That did not work.
Did you ever take any psychiatric medication when you were hospitalized at Chestnut Lodge?
Well, if chloral hydrate, Seconal, Nembutal, and all the “tal-tals” are psychiatric medication, yes, bung full of them.
Did they help you?
What you get is a night’s sleep. Somebody comes along and clubs you.
Were you on medication the whole time you were hospitalized?
No. Dr. Dorman told my parents in a consultation with them that he “did not want Cathy to have another crutch.” He said, “I want her to know that when she gets well, she did it herself.”
The difference between the pre-medication era and the medication era was that when patients were able to think clearly, to be stronger, to be trustful in the pre-medication era, they could know that they were doing it, not that a drug was doing it to them.
I prefer to work with people without medication because at least then I know what I’m dealing with. The medication also blurs and covers up certain things and then I don’t know exactly what I’m dealing with and neither do they.
He thought I really hated my mother. And I told him, “You’re wrong! I love my mother! Probably I love my mom too much. I always felt overprotective.”
You don’t have to be right all the time. That’s one of the most crippling ideas a therapist could have.
A therapist working with people with schizophrenia?
A therapist of any kind, actually! People don’t need perfect therapists. If we had to be correct all the time, nobody could do therapy. But if we have to do our damnedest to try to understand, that we can do. And that’s all it takes. And that’s a great deal.
When in life do you have a bright, kind person doing their damnedest to try to understand you?
And how did he respond when you disagreed?
He listened! He said, “Okay, I want to hear about it. Let’s talk about it.”
– So he was very respectful.
– Yes! And you know, just the very act that he did that… It started to make me feel like I was… somebody.
She never stripped me, without my consent.
– So she was very respectful.
– Yes! She knew the difference between problems and symptoms. She knew the difference between being creative and being crazy, and being religious and being crazy, and that was delicate stuff for me.
We had an “I-Thou” relationship.
With the previous psychiatrist… Can you explain that to the audience?
It was an “I-Thou” relationship, I was a human being.
– Versus?
– Versus an “I-It.”
Do you believe someone could recover fully from schizophrenia and live a life without medication?
Without medication… no, I do not. I don’t think so. Medication seems like it’s pretty necessary.
In the area of neuroleptics, we’ve had two good long-term outcome studies. The first was done by Courtenay Harding, who’s now at Boston University. Not without medication. I don’t believe it’s possible.
She followed the long-term outcomes of people who, in the 1950s, diagnosed with schizophrenia, on the back wards of a Vermont state hospital, had been given up for lost… I don’t know if they could recover, but maybe somehow adapt and be able to cope with it.
Now it so happened that in the 1960s, Vermont had a socially progressive model for rehabilitating these people. So she followed up with them in the 1980s. It’s maybe, slightly possible, but probably not. And here’s what she found.
I don’t think so. They could recover, but not fully. She found that one-third were completely recovered: asymptomatic, out in the world, you wouldn’t know they’d ever been schizophrenic. I don’t recall that I’ve seen those cases. Another 34% were doing pretty well. Pretty good social functioning. I don’t think so. 32% were pretty chronically ill. I don’t think that they could recover fully, because I believe there’s something so strongly embedded in your brain.
But there’s something really key here. Of those who had recovered completely, they all shared one trait. And that trait was: every one had quit taking…
His or her medication. No. No. Not without medication. No recoveries in those who followed the paradigm of care where you stayed on drugs for life. I don’t really think so. No, I think you need to take your medication, yes.
The second one was just released… I think you could live without medication. I don’t know if you’d recover. Following people diagnosed with schizophrenia in Chicago for 15 years. And they found, and this was just reported in May, 2007, that 40% of all people diagnosed with schizophrenia who got off their medications eventually recovered: asymptomatic, doing well. Not fully, but I think they could live a pretty normal life. Now only 5% of those who stayed on their medications recovered. I don’t think so. So that’s the best long-term study we have in modern times, and it shows quite clearly that if you want people to recover from schizophrenia, if you want to give them the best chance possible, you get them off the drugs. Fully… no.
So that study is done. It’s funded by you and me, the taxpayer. Now you go and find one newspaper that reported on that study! I wouldn’t think so. I don’t know why I wouldn’t think so. Why not? Because the NIMH didn’t promote it, psychiatry didn’t promote it, and they didn’t promote it because it didn’t tell the story they wanted!
From what I’ve heard, no. If the reverse were true: if 40% of those on drugs recovered, versus 5% of those off drugs, that story would have been plastered all over the news. From what I’ve heard it’s fairly permanent, unless there’s medication involved. That’s dishonest science, that’s from a discipline that’s dishonest, because when they get results they don’t want, they don’t broadcast them to the public. I don’t know. The doctors don’t know and I don’t know either.
Is Harding’s story well-known? Do you think young psychiatrists are being told, “You know, we followed schizophrenia patients for 30 years, and we found, believe it or not, that we don’t have to be so despairing. One-third are completely recovered. Now they all happened to be off their drugs so what we should do is help them get off their drugs.” Right!
I started getting despairing at the end of my residency. She’d been in the hospital for close to three years and she clearly looked worse than when she came in. My inner thought was that she would end up in the state hospital, that I had failed. Her mother said this: “I’ll just take her home. All she needs is love.” I turned to Catherine and I said, “Catherine, you know you can’t go home. You’ll either kill your mother, or you’ll kill yourself. There’s no way to get better there.” But since I was leaving residency I transferred her to a small, private psychiatric hospital so I could continue to see her.
The first visit there she was still mostly catatonic. She also had a high-pitched, squeaky voice in those days, and the first thing she said when I sat down was: “Thank you, Dr. Dorman, for not letting me go home.” I found it so disruptive at first because I was put in a room with four other girls, a dormitory room, and at UCLA I had just one roommate. So here I was, lying in bed, trying to stop the voices, to concentrate and “go down.” – Basically to zone out. – Yeah, zone out!
And my roommates were talking about the psych techs. They’d say, “Did you see John? What a bod!” And, “He would make a good lay!” And it was driving me even more crazy… So I had that happening, and I’d meet with Dr. Dorman, and say, “I need to be in my own private room! It’s too painful in there! I can’t concentrate!” And he said, “Cathy, you can handle it. You don’t need to be isolated anymore.” And it was like… ah! But you know what, that was the best thing he ever did!
I came out from the disturbed ward, after almost 3 years. And that’s long after they give up. In most state hospitals it’s 2 years, and I don’t mean 2 years and a day: I mean 2 years. And then what do they do? Then you’re “chronic,” you’re “back ward.” Oh, I see. And they give you a chance, they try, but you’re not going to make it, and we have others to help. And I was there almost 3 years, and… and… heavy.
As I stayed in that room, I became diverted from all the other stuff in my head. Not only was I diverted, but I started becoming interested and wanting to know: “What’s ‘lay’?” And, “What psych tech is that?” Convalescence takes a hell of a long time. For one thing you have to learn the difference between problems and symptoms. You have to learn how to act… All of a sudden I began feeling wonder. I began feeling curiosity. And we talked about it. And our sessions evolved so that soon I did all the talking. I talked about wanting to have a boyfriend one day, things like that… things I would never have spoken of before. And I really had to process my new feelings. I was developing feelings again. I had split off my feelings a long time ago.
One day in occupational therapy I was able to open my eyes all the way, and everyone in occupational therapy came over and hugged me. I started drawing! I drew pictures of a mermaid, of a beautiful mermaid. I used colors. The day after that happened, I went for my session. She said, “My eyes are fluttering. I can’t stop them.” I said, “Oh?” She replied, “Yes,” and she did this… First time in 2 years, big wide eyes. Like this… she looked around. I was stunned! I didn’t know what to say. But I saw everything upside-down. Also the day before. Like, you would be upside-down, and you would be in slow motion, and I would see you through my mouth. In other words, my eyes would be where my mouth is, so I would be looking… And I remember telling Dr. Dorman this, and he said, “Cathy, you’ve had sensory deprivation for quite a few years. This is normal… It will start… coming back.”
So I asked her, later, “What event triggered that?” She replied, “There was no event.” It was an accumulation of personal experience. The personal experience of the horror of her madness. The personal experience of who she had become as a person. And most importantly, she said, that experience, quote, “Became boring.” And then came the real work.
I found myself spontaneously crying when I went on outings with other clients to the movie theatre. And there would be nothing sad on the movie, but suddenly something would get triggered and I would cry. All these feelings that I held in and repressed… for decades… were coming out, just like a dam had been punctured. They came out in all kinds of places. The schizophrenia had been a part of my identity, and in a way I had to grieve for it.
Catherine would sit in the patio and just stare at a green tree, and she’d say, “It’s just so beautiful, that tree, to see again.” So I knew she was re-entering the world. Everything looked new to me. The flowers looked new. The sun had a new meaning to me… the moon had a new meaning. It was like everything was from a fairytale, yet I knew it wasn’t a fairytale. She said, “I’m ready to see the world,” and she grinned, because of the double entendre. She always had a little sense of humor, from that point on. Even before she had sometimes used irony… See, under all that schizophrenia, she was there. All schizophrenics are. All humans are.
When I was discharged in January of 1973, I went for day treatment for another 4 months. But I saw Dr. Dorman every day, Monday through Friday. I took the bus to his office, and I saw him for 50 or 55 minutes. When I got out of the hospital, I was living on my own. I was still an outpatient, and I was singing in the church choir. I went back to school. I took summer courses. And I got my GED and I went to classes. I took psychology, philosophy, and I think sociology. And I tried with everything I had. I did my utter best to be present, there. To be there. And I got straight F’s. And somebody said to me, “You’re a very odd person… You’re a strange person. You seem to be not here.” I remember going to him, telling him, “What’s the purpose of me getting better like this when my brain is damaged?” I thought, “The world is full of titans. These people are titanic.” “I can’t study!” “I can’t…
Never do what they do.
“What good is it if I can’t go to school?”
“How am I ever going to do that?”
He told me, he said, “Cathy, every faculty you had before you got ill will come back. Give yourself time.” I held onto that like a life raft, because at that point I started to feel suicidal. It happened when I was in my second year in college. I was losing my schizophrenic identity. I looked in the mirror and I didn’t recognize anything I saw. It was awesome and wonderful and terrifying at the same time. And I didn’t recognize the life I was living. I was starting to develop a new identity. And I went bonkers. If I hadn’t had Dr. Dorman to help me process all those new experiences and feelings… And I ended up back upstairs… it would have been so easy… the disturbed ward… to allow myself to slip back. I felt so… desperate.
That next semester I skipped… A guy came in to do something in the cabinets and I said, “Is this going to be my life?” And then I took classes in the fall… “Am I going to spend my time going out, getting socked in the kisser, and coming back here?” And I got straight B’s in all those classes. And he shrugged and said, “It’s worth a try, ain’t it?” And from then on I was doing well with school and studying. “Pick yourself up off the floor, spit out the carpet, and get on with it, again.”
Do you believe someone could recover fully from schizophrenia and live without medication? Probably not. You know the data from cross-cultural studies: that in countries where they can’t afford to medicate, the long-term recovery rate is twice as good as it is in countries where nearly everyone is medicated. My instinct is probably “no.” And the chronic disability rate is twice as high in the USA and other countries where almost everybody is medicated as it is in countries where they can’t medicate. These are the World Health Organization studies. I think it would be really difficult. So it was the USA and 6 other European or rich countries. And initially the poor countries were India, Colombia, and Nigeria. I don’t know, I don’t know.
I really… Do you know where the best outcomes were? In rural India, where only 2%, no, 4% of patients were kept on anti-psychotic medications. If there was an absolute recovery that would be great, but it might also just be learning to live with it. Now if I were a doctor, and I looked at those outcomes, and I hypothesized that medication use is a variable that changes long-term outcomes, and I found that outcomes are better in countries where they don’t maintain patients on the drugs long-term, what would I decide?
As I understand it, most psychological disorders are lifelong diseases, and I think you can recover in the sense that you can have a happy, balanced life if you’re on your medication. I don’t know that it can be cured at the moment. If there is a psychological imbalance and there was some way they could go in your brain and change your brain chemistry permanently, then sure, but I don’t think that’s available at the moment. I’d say, “Oh, Christ, we should be doing something differently. We should not be keeping people on meds all their lives, we should be trying to minimize use.” Without medicine I think it’s impossible.
But was there any discussion of that? No… The way things work now, no, I don’t think it’s possible. Was there any acknowledgement of that by Western doctors? No… I sincerely doubt it. They seem to get worse. Most mental health professionals have never heard of those studies, even though they were done by one of the most reputable research groups in the world. I think that you cannot recover from schizophrenia, but you can keep it under control. Reputable and non-radical, too. That’s right, they’re not the least bit radical! In fact, they did the studies to show how good the new medications were!
No, probably not. But they were honest: when they found the opposite they didn’t believe it at first, they thought it must be that in countries where they don’t medicate, they use different diagnostic criteria, but they published their findings saying, “We don’t believe it.” No, I don’t think so. Then, because they’re good researchers, they repeated it very carefully, using the same diagnostic criteria in all 6 countries, and found exactly the same thing. Probably not. You see, if they worked for a drug company they’d have said, “This explains it,” but they’d do no research to show it. The important thing would be to make sure that drugs kept selling.
No, I’d say that you’d need medication. And in fact, the World Health Organization investigators concluded that living in a developed country is, quote, “A strong predictor that you’ll never fully recover.” I think you would be hard pressed to find someone who wouldn’t continue their hallucinations or delusions just through counseling, so I’m not so sure that something other than medication would be able to fully alleviate all the symptoms.
I was in New York, sitting on a bus, and… there it was again, the whole business, right down. I was schizophrenic. And I said to myself, “Wait a minute!” By this time your therapist had already died, right? Oh yes. So I said, “Hey! What’s this all about?”
Well, schizophrenics don’t do that. You mean they don’t look at themselves from the outside and say, “Hey, what’s going on here?” Don’t have a very sane and rational conversation with themselves? Yes. And I said to myself, “Oh, mother’s little sweetheart! Let’s figure this out. Aha! You’ve forgotten what it was like. You had the desire to escape somewhere, had you? Is mother’s little sweetheart wanting to go someplace else?”
Did your therapist talk that way to you? No!! She was much gentler! I said to myself, “Suffer a little smarter, will you?” So we suffered a little smarter. Me and my brains.
And you didn’t end up back in the hospital? No.
How long have you been married to Joanne? 51 years.
– 51 years? – Yes.
In the whole time you’ve been married to her, have you seen any symptoms of schizophrenia? No. Not in her… Were you ever worried that you might see any? No, frankly no. No, I was never really worried. What led you to have such confidence in her? We were together for a while before we were married. I just felt she was free of all symptoms.
Do you feel that you are at any risk of becoming schizophrenic again? Never. I have no fear of that whatsoever. She was given an MMPI when she was admitted, and the schizophrenic spike and the paranoid spike were extraordinarily high. It was clearly an MMPI that would be interpreted by an objective observer as: “This person suffers from schizophrenia.” And then, 10 years later, I asked her to complete another MMPI, in 1979, 2 years post-treatment, and it was within the normal range. There are no spikes. The schizophrenia is gone.
Have you taken any psychiatric medication since then? I have not taken any psychiatric medication since November of 1969, when I entered UCLA.
Do you ever dream that you’ve returned to being psychotic? I used to, the first 4 or 5 years…
– The first 4 or 5 years of what? – Of my recovery. This was from 1973 to about 1977 or 1978. Periodically I had dreams in which I was back where I’d been, hearing voices… “Kill yourself! Kill your mother!” …and with disorganized thoughts. But I was still seeing Dr. Dorman, so we discussed that in session, and he said, “See how healthy you’re getting: it’s coming out in your dreams now. It’s no longer a part of your conscious reality.” And again he said, “And in time you won’t even have it in your dreams.” And he was right on!
Do you ever dream that you’ve returned to being psychotic or schizophrenic? All the time. All the time. I mean, not every night, no. But every so often. Is it a fair question to ask for a type of dream, a specific dream that encapsulates that? Well, I’m in a hospital somewhere… in restraints… and I’m back again, only I’m older and I don’t have the necessary… vim and vigor to do much about it.
It must be a relief to wake up… Yes…
– Quickest recovery ever! – Yeah, quickest recovery ever!
Do you feel you’re all well? I feel I’m a very well-balanced person. Do I at times get anxious and get stressed out? Yes. Do I at times get depressed? Yes. But the difference is, I know I have within me the tools and ability not to let that overcome.
Me and become my life. What are the tools you use now? If you feel bad, I get one of the tapes of stuff I’ve sung and bay and howl against the music. I journal. Sing alto parts. I will play music. I’ve sung a whole lot of wonderful stuff. Go do it again. I will dance. Dance has always been a very cathartic experience, a very therapeutic experience in my life.
Work. I write poetry, a lot of poetry. Sickle off a rocky acre. Meditation. Flick the sickle. Making sure I have quiet time, staying in the present moment, appreciating the present moment. Call somebody up. It’s such a gift, because there was a part of my life, almost seven years, when I had no quiet in my mind… All the noise! Only chatter! Chatter, chatter! Have a chat. The greatest gift is wanting to be with people. Go skiing with friends. Doing the opposite of isolating, but really loving the contact with people. And seeing that humanness in people. The sacred. The sacred in each one of us.
Do you believe someone might be able to recover fully from schizophrenia and live a life without medication? I think anything’s possible. Yeah, I believe anything’s possible. It’s possible, certainly it’s possible. I do not know—but I hope so!
Let’s say you were a young person now… let’s say you were 14, 15, 16, and… God help me! …and you had schizophrenia now… I think so. Well… you know what, I think it depends on the degree and the level of schizophrenia. I think it’s possible. It must be possible. I think it could be possible.
What would happen to me today… would be so much less good. I’d be put on an adolescent unit somewhere, and then I’d die. You never know, but maybe. It might take years and years, a lot of time, but you never know. I think if you had the right kind of doctors and the right kind of therapists involved, it’s possible. It’s true. Yes. I would like to think so. I think there’s always hope. I don’t see why not. If it’s a psychological condition… and everyone’s walking around crazy! Some people can just hide it better than others.
I wonder, if your parents had taken a slightly different turn, a left turn instead of a right turn, left you at one place instead of another. Well, I would not be alive, because I had suicide as my ticket out.
So you think you would have killed yourself? Most probably. I don’t know whether it’s possible, frankly. The schizophrenics I’ve known haven’t done well. One jumped off a building. There are people who wake up from a coma after 18 years, so yes, I do believe it.
Before you met Cathy and heard her story, did you know that people could recover from schizophrenia and live lives without medication? No, I did not. I thought it was like a one-way street. I think it can be possible. Yeah, I think it seems feasible, especially if they have a good support group, a good group of friends.
Did you make friends in the hospital? Yes.
– Good friends? – Yes. We still are. I believe it’s possible, sure, sure. I believe so. I certainly don’t believe that it’s impossible. We had a reunion, four of us.
– Really? – Yes. All diagnosed with schizophrenia? Yes. All recovered? Three-and-a-half.
– Three-and-a-half. – Three-and-a-half… I think if they wanted to, if they 100%, passionately, with all their being wanted to, I think they could. She died, by the way.
Which one? The one who “half” made it. Yes, I do. If they have the proper treatment and also… the willingness to change their life. I would hope so. But the other two are fine. Hard lives, hard work.
Taking psychiatric medications? Certainly not. Well, since I don’t believe that medication is necessarily necessary… sure. I think it is possible, but I think it really depends on the individual. I care about people who are going through what I went through because I have been there. Probably. I think the mind is capable of enormous change, so probably.
They are some of the most beautiful, courageous people I’ve ever met. If they really wanted to and really understood their disease, then yes, they could probably do it. I’d like to think so since I don’t believe in medication. And it saddens me when I see society and the media portraying them as buffoons, as these psychotic knife-wielding…
Yes, I’d hope so, I’d hope so, although the cases I’ve heard that come into the newspaper seem to be… people who came off their medication and had a bit of trouble. Sure, that happens, but that is not the majority of people who have a mental disorder. Yes, and sometimes I think medication can be adverse.
One of the things I really hope for in this work is that someday all people who struggle with psychosis have the option of having meaningful therapy, if they choose. I’d like to think they could. I would hope that would be the goal. I hope so. I hope that somebody cares enough to try to help.
To have somebody come to you and be more open with you than your best friend will ever be… and talk with you about their lives, and what they’re going through… and their hopes and desires and fears… It’s such a privilege to be allowed to get to know people like that. There’s no other way to do it other than being a therapist.
You keep learning how to do therapy as long as you’re alive and doing therapy. That’s what makes it absolutely fascinating to be a therapist. Possibly, possibly. I would hope so, I would hope so. Definitely, definitely.
Every day I wake up and go to work and I don’t know what the day is going to be like. And I love that. Some people would hate that because it would make them anxious. I love that. I love that I can’t predict how I’m going to be surprised, and I always retain a sense of wonder about what a person will bring to me. I do believe there’s a possibility for that. I think they could.
Yes, why not? I mean, anything’s possible, right? Telling that story was the best thing I ever did. The most rewarding thing I ever did. And the reason it was the most rewarding was because so many patients, so many people who had been there, including many recovered patients who had experienced neuroleptics, who found them horrible, said, “Thank you for telling our story.” I believe they could. Yes, I do. I think anything’s possible.
It comes back to what Harry Stack Sullivan said, and that was based on the teachings of his teachers, that, “We’re all more simply human than otherwise.” That every one of us has the potential for breakdown, and that everyone who’s had a breakdown has the potential for recovery. Yes, I believe in everybody’s possibility for change at any given moment. Absolutely. I think that people can recover from anything.
At the end of Catherine’s treatment she said that she thought it was time for her to leave… because she needed to gain experience away from me. And I agreed. And she said she would miss me. And at that moment, I thought, “My God, I’m going to miss her too!” When I look back, this journey was one of the greatest journeys of my life. I would not change what I went through. I would not change it one bit.
Are you ever surprised your life turned out the way it has? Not surprised… Dumbfounded. Shocked. Amazed. I got to use my experience of having been sick in a lot of positive ways. And that’s a great blessing. I can talk to you. For a purpose. That’s it? That’s all. Thank you very much.
Anything else you want to add? No, that’s about it.
– Thank you very much. – Thank you, sir. – That’s all, thank you. – You’re welcome. – Thanks a lot. – No worries, mate. – Thank you very much. – Hope I helped you…