Column on Schizophrenia
Edith Cook
Edith Cook
Is mental illness contagious? Is it inheritable? Was my youngest brother, who was diagnosed with schizophrenia at fourteen and remanded to an institution, affected by our mother? I knew nothing about mental health and neither did anyone else in my family of origin; still, it was obvious, Mother acted irrationally. We children who grew up on her watch would have been influenced by her mood swings. We may have imitated them.
Memories lead to questions. Decades later I read about Lapland, a western region of Finland, where, during the 1970s and early 1980s, its 70,000 inhabitants experienced schizophrenia that was double, sometimes triple, the norm for other parts of Finland and the rest of Europe. Twenty-five or so new cases of schizophrenia appeared every year; typically, these patients became chronically ill.
Yet today, the long-term outcomes of psychotic patients in western Lapland are the best in the Western world; not only that, the region now sees very few cases of schizophrenia. Remarkably, the illness is disappearing from the region.
The medical success, which has been decades in the making, is largely due to a Finnish psychiatrist with psychoanalytic training who arrived at the psychiatric hospital in Turko in 1969. Yrjo Alanen decided on a novel approach to his patients. At a time when few psychiatrists believed psychotherapy could help schizophrenics, Alanen was convinced that their hallucinations and paranoid utterances, when carefully parsed, revealed meaningful stories. He trained colleagues, nurses, and staff to take time to listen to the patients. He also understood, to help change patients’ lives, he needed the collaboration of family and friends—in later stages, even their former teachers and potential employees. He emphasized that psychosis originates in severely frayed social relationships. “Psychosis does not live in the head; it lives in the ‘in-between’ of family relationships,” he said.
Alanen devised a “need-adapted” treatment plan that assigned each patient a “membership” in a psychosis team that included the patient’s family, plus two or more professionals trained in group family therapy. Patients met regularly with the team. Treatment decisions were made jointly in these meetings.
“It’s almost impossible for anyone meeting with the patients’ families to not understand they have difficulties in life,” said Alanen. They are “not ready” to become adults, “and we can help them with that.”
In the sessions, the therapists directed the conversation toward the patient’s past successes. Focusing thus would help strengthen the patient’s “grip on life.” The hope was that “they haven’t lost the idea that they can be like others.” Eventually the patient would be encouraged to construct a new self-narrative for going forward, to see himself or herself as integrated into society instead of isolated from it.
In any first meetings, Alanen avoided even the suggestion of antipsychotic drugs. Some first-episode patients would need to be hospitalized but others would not. Some would benefit from low doses of benzos, others would not. During the first three weeks, Alanen did not mention drug therapy. Only if a patient showed no improvement, did he resort to short-term drug treatment, and then only in specific cases.
Alanen was confident that, once a physician realized that many people who experience a bout of psychosis or a deep depression can recover with minimal drug treatment—or without any medication whatsoever—they’d try his approach.
The transformation of care, from a system in which patients are regularly hospitalized and medicated, to one in which patients are infrequently hospitalized and only occasionally medicated, has shown spectacular results. Alanen’s success stories have captured worldwide attention. Indeed, we can read about it on the internet.
Within the "Finnish National Schizophrenia Project" and the principles of the Need-Adapted Treatment, Laplanders, and Finnish residents generally, gained access to crisis intervention teams within the "Acute PsychosisIntegrated Treatment Project" (1992-1993) which, in Western Lapland, proceeded into "Open Dialogue in Acute Psychosis Project" (ODAP) (1994-1997).
I found these details in Robert Whitaker’s “Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America.” As his title suggests, the author focuses on the abuses of psychiatric drug treatments in chapters with titles like “The Bipolar Boom” and “The Money Tree.” The long-term use of psychotropics does more harm than good, he argues.
Whitaker included the Lapland treatment for schizophrenia under his descriptions of success stories, “Blueprints for Reform.” He traveled to the region to see for himself. These stories may be read online about the disappearing cases of schizophrenia in Lapland, where people live under severe Arctic weather conditions which, I imagine, includes Seasonal Affective Disorder.
The Laplanders, most of whom are Sami, once a nomadic people, are scattered across Lapland (Sapmi), which spans the far north of Sweden, Norway and Finland and the northwestern corner of Russia. When they settled, they began herding reindeer, but today only ten percent follow the tradition. The Sami are considered one of Europe's oldest ethnic groups. Today they have their own flag and national anthem, both created in 1986.
Previously known as Lapps, the Sami have preserved their language and traditions despite efforts by the Nordic nations to assimilate them. The 80,000 Sami, most of whom live in Norway and Sweden, claim the mountains, lakes and forests they inhabited long before the Nordic kingdoms emerged in the Viking era, and so, disputes over land ownership and hunting and fishing rights try Sami relations with the descendants of Norse and Finnish settlers. The indigenous Sami were pushed off their lands by European settlers like the American Indians. They also suffered from the Soviet invasion of Finland early in the Second World War.
That war, of course, wreaked havoc on my family also. My youngest brother knew his mother only as an ailing woman. She died when he was four. At eighteen, temporarily released from the mental institution, he took his life by jumping in front of an oncoming train.
I was raising my family in California when the news arrived of his self-imposed death. It overwhelmed me with grief and guilt. Only years later did I realize, if faced with the prospect of being locked away for life as my brother was, I might have decided as he did.
Today other options are available—if you know about them and have access to them, which is by no means a given. We can read Whitaker, but where would we find the solutions he offers? Even in trend-setting California, when Darold and I tried counseling, it was scarcely any better than what my brother likely endured at the institution. More on that in another essay.
Susie
On Dec 1, 2023, at 1:05 PM, Edith Cook <e104...@gmail.com> wrote:
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