TRANSCRIPT
One thing that I’ve seen is a general rule, and this basically contradicts how the mental health system works, is that putting people on antipsychotics when they are psychotic is not very helpful in the long run. In the short run, yeah, it might damp down some psychotic symptoms. It might make people appear a bit more normal, but does that really help them? And also, who does that serve?
A lot of times what I’ve seen is the mental health field, with their attitudes toward treating psychosis, actually often are trying to serve society. They’re trying, also trying to serve the mental health professionals. They try to make the mental health professionals more comfortable because when someone is really psychotic, really out, they’re really saying really wild or crazy things. It can be very threatening to mental health professionals. They don’t know what to do. They don’t know how to help people, and they do often really want to help people, but they have no clue how to do it.
So when you put people on medication and they start behaving more normal, the mental health professionals say, “Oh, they’re more rational, therefore I can interact with them better.” The problem is those medications, in the long run—and there’s lots and lots of actually very good scientific evidence to back this up—the long-term outcomes are much worse for people who take the medications, especially the people who stay on the medications for a long time. And then let’s add to it, these medications have horrible side effects. One of the basic ones being that people who take long-term antipsychotics have a 25-year less life span than people with the exact same problems who didn’t take the medications. These medications are very dangerous. They’re very deadly in the long term. All sorts of physical problems they cause: heart disease, diabetes, blahdy blahdy blah. The list could really go on.
So what do we do if people are not going to be taking medication? What is helpful? Well, this idea really motivated me to make films. When I first started putting up a camera and filming, I wasn’t filming myself. I was filming other people. I was specifically making films on recovery from schizophrenia, recovery from psychosis. My second and third films were both about excellent treatment programs that got really good results. One was in Finland and one was in Sweden, and they’re both on the internet. They’re both free. One is called Open Dialogue; that’s the Finnish program for helping people in first episode psychosis. And Healing Homes is my film about healing from schizophrenia without medication, with a Swedish program using farm families.
Well, both of these films show different aspects of helping people in psychosis. So one of the main things that may not be so apparent in these films also, but it is the backdrop of what I consider to be reality and a very broad reality for people with mental health problems, people with extreme mental health problems. So when people are going through psychosis, in general, I put them into two categories.
The first category is people who have already been receiving services from the mental health field. They’ve already been hospitalized. They’ve already been put on psychiatric medications. Perhaps they’ve been on psychiatric medications for years already, or maybe even a short while. But those people are no longer treatment naive. They’re one category. They’re people who have already received treatment.
The other category is people who are in what’s called a first episode psychotic break. It’s the first time they’ve ever experienced psychosis. They haven’t received treatment. They’re not medicated. They haven’t been to mental hospitals. They maybe have never had any interaction with the mental health field at all. Well, these two categories of people, in general—now there are always exceptions, again—but in general, to me, are very different.
Now, the Finnish program that I talked about, they work with people in first episode psychosis. And the takeaway message from that is if you treat people very, very soon into their psychotic episode, very quickly, before they’ve had it for a long, long time, and you don’t give them a lot of medication, you really try very hard to not put them in the hospital, you don’t even necessarily have to talk about diagnosis at all, and you really do a lot of helping them to work out whatever it is that they’re going through, a very, very high percentage of people will come through it. They come out the other side of psychosis, and they’ll move on with their life. They’ll be able to work. They’ll be able to go back to school. They’ll be able to have normal functioning lives, and their statistics prove it.
Over 80% of the people who go through their program, people who came in in a first psychotic episode that if it went on for a little bit longer would have been able to be diagnosed with schizophrenia, over 80% of those people are able to come out the other side and not be psychotic anymore. And also, it’s very important to know more than 90% of those people did it without any antipsychotic medication at all.
Now that’s one category. The other category is people who have already been in the mental health system, who have already been hospitalized, who have already been treated by conventional means, meaning antipsychotic medication, and sometimes lots of antipsychotic medication, sometimes mood stabilizers, sometimes other medications on top of it, sometimes medications to treat the side effects for the antipsychotics if they’re on.
Well, what I’ve seen, and what I’ve seen in lots of different programs, what I’ve seen as a therapist, is when people have already been in the mental health system, it’s actually, in general—not always, but in general—it’s a lot, lot harder to get well. It’s a lot harder to come out the other side. And the main indicator that I’ve seen is all the stuff that the mental health system has done to them, in many ways, makes it much harder for them to get better.
Part of it is the mental health system uses a lot of force. It can force people to do a lot of things they don’t want to do, and for a lot of people, that can be very traumatizing. So if we consider that trauma, in a large sense, puts people in the position, in the vulnerable position, to end up losing their minds, the mental health system traumatizes them more, makes it harder to come out the other side.
Also, the medications that they put people on really mess with people’s motivation. It really takes away something, in many cases, that allows them the force, the personal force, the passion to be able to find their way out of it, to fight their way out of it, to make sense of what they’re going through, to put meaning on their experience. Instead, so many people on antipsychotics are zombified by it, are sort of exhausted by it. They’re not so motivated. A lot of times they don’t have much motivation to do anything. They do a lot more sleeping, and sometimes their psychotic symptoms are still there, but they just become listless. They become apathetic. They become lethargic. They can maybe still be hearing the voices that they were hearing before. The difference is now they just don’t care anymore.
The Swedish film that I made was a really good encapsulation of a program, a good example of a program that shows how much extra work you need to put in to help people once they’ve been in the mental health system, especially if they’ve been in the mental health system for a while with problems of psychosis. With the Finnish program, a lot of people were getting well within a couple of months. Sometimes they were getting well within a couple of weeks. Sometimes they were even getting well in a couple of days.
Now, the interesting thing is their statistics show that over 80% of the people who came through their program, who were in the first psychotic episode, were getting better, were coming out and being all well. Well, the interesting thing is I can’t remember the exact numbers, but I think you had to have been in their program and receiving treatment for something like two or three weeks before you could be counted as part of their statistics. Or what they told me when I was there is actually there are quite a few people who came through their program who, with just a few sessions of therapy, often family therapy, were able to sort out whatever it is they were going through and actually pull out of their psychosis, bounce out of their psychosis, emerge from their psychotic break. And those people, they couldn’t even count them because they weren’t in.
Treatment long enough to justify being counted as part of their statistics. So, their numbers would have been even higher. Now, the program in Sweden is much more intensive—much, much more intensive. Sometimes one, two, three, four years of helping people. Lots and lots and lots of therapy, multiple different forms of therapy. And also, people were living embedded in family homes, almost like foster care for adults with serious mental health problems. But they chose very, very healthy families for people to live with.
These families basically were a very nurturing, healing environment that also put a certain pressure on people to move forward in their lives, to participate, to get better. It’s like the opposite of a mental hospital, where it’s a depressing, miserable, unhappy, unmotivated environment. These families in the Family Care Foundation in Sweden were lovely people. I’ve actually met tons of them. I’ve lived with the family; it’s like I tried it out. I have one family especially that I’ve gone back to many times and lived with them.
It’s like it’s a very positive environment. It’s a very healing environment. Even for me, when I was going through just the loneliness of traveling, just the loneliness of being far from home, I thought, “My God, if I ever have serious problems, I’d certainly want to go live with one of these families.” And then on top of it, imagine not only being able to live with one of these families full-time, permanently, for free because of Swedish socialized health care, but also getting lots of really good therapy. And the family was getting their own support from therapists, so it was a very strong, nurturing, healing environment. Most mental health programs offer nothing resembling that.
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