Mental Health Round-up

Unlike the Pendleton Roundup there will be no bull(s).

We’ve known this for a while- the evidence simply piles up:

Lilly, J&J Antipsychotics Don’t Top Old Drugs in Kids (Update1)

By Rob Waters and Tom Randall

Sept. 15 (Bloomberg) — Best-selling antipsychotic medicines by Eli Lilly & Co. and Johnson & Johnson caused more side effects and were less effective for children with schizophrenia than a little-used 30-year-old generic drug costing one-fourth as much.

For the study, published today in the American Journal of Psychiatry, 116 children ages 8 to 19 were given molindone, an older drug available as a generic, or a newer antipsychotic, either Lilly’s Zyprexa, which generated $4.8 billion in sales in 2007, or J&J’s Risperdal, with $4.7 billion in revenue.

Most children failed to improve on any of the drugs, and side effects were more common in those taking the newer ones. Zyprexa, in particular, caused weight gain and unwanted boosts in insulin, blood fat and signs of liver damage. The trial is the latest in a series of studies finding that the newer, pricier medicines don’t improve treatment for mentally ill patients, researchers said.

“This is yet one more study which has failed to find any significant area of advance or superiority of the second- generation medicines,” said Jeffrey Lieberman, senior author and a professor of psychiatry at Columbia University in New York, in a Sept. 12 telephone interview. The drugs sell because of “very aggressive marketing campaigns and a wish among patients there was something better out there,” he said.

Lilly, based in Indianapolis, fell 28 cents, or less than one percent, to $46.32 at 10:51 a.m. in New York Stock Exchange composite trading. Johnson & Johnson, of New Brunswick, N.J., dropped 1 cent to $70.58.

Pending Application

J&J’s Risperdal was cleared by U.S. regulators last year for treating adolescents with schizophrenia and bipolar disorder. Lilly has a pending application with the U.S. Food and Drug Administration to market Zyprexa to adolescents ages 13 and older, spokesman Jamaison Schuler said in a telephone interview.

The study wasn’t long enough to compare side effects that have been associated with extended use in the older medicines, Schuler said. Those side effects include tardive dyskinesia, or involuntary muscle movements such as repetitive grimacing, blinking and movements of the arms and legs.

“It’s difficult to understand whether or not the findings of this study add any meaningful information based on the authors’ acknowledgement of the limitations of the study,” said Srikant Ramaswami, a spokesman for J&J, in an e-mailed statement today.

(Go here for the full article)

Who knew it could be worse than in Oregon??

N.C.’s mental health disgrace: Nowhere to go but up

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• published September 14, 2008 12:15 am

There’s no way to comprehend how a patient in a psychiatric hospital that’s been warned for months about unsafe conditions could have been allowed to sit in a chair for 22 hours without food or help while staff members in the room played cards and watched television.

The patient’s experiences sound like something out of a horror movie. Doctors weren’t notified that he had fallen and hit his head while choking on medicine, nursing staff members failed to follow doctor’s orders to check his vital signs and give him fluid and hospital workers were caught falsifying his medical records, a report in the Raleigh News & Observer.

Steven Sabock, 50, died of a heart problem about 22 hours after being left in a chair in the dayroom at Cherry Hospital.

(Go here for the full article)

Of course, we already know what works

For many years, it has been assumed that people who experience severe and persistent mental health difficulties do not recover, leading to low expectations that have been seen to wear away hope and support chronicity (Harrison & Mason, 1993). In the introduction to Mental Illness and Recovery, Ralph and Corrigan (2005) stated that:

Prior to 1990, students of major mental health disciplines learned that the serious mental illnesses were defined as having poor prognoses with progressively downhill courses. Treatment was limited to custodial options. People with these diagnoses had to foster ideas of hope and recovery in a mental health system that viewed serious psychiatric disorders as harbingers of doom. According to the old school, people with serious mental illness needed to accept that normal life was impossible, that dreams of independence were unattainable, and that long-term institutionalization was inescapable. Recovery signaled a monumental revolution in the mental health paradigm. (p. 4)

Recovery is a common term that is generally equated with getting well or getting back to normal (Roberts & Wolfson, 2004). However, when this term is used with respect to mental illness, most people agree that it refers to a process rather than a steady state. Although a clear definition of recovery is elusive and seems to mean different things to different people, most people agree that a person “in recovery” is working to take back control of his or her life and is working toward achieving her or his own goals and dreams. It does not necessarily mean an absence of what might be considered “psychiatric symptoms”.  It does mean learning to relieve difficult feelings and behaviors, and to live well in spite of these difficulties (Ralph & Corrigan, 2005; Roberts & Wolfson, 2004). As people who have a lived experience of mental health difficulties have attempted to define recovery, various themes have emerged (Ralph & Corrigan, 2005). These themes include:

* Recovery is defined in terms of continual growth, increased control over one’s life, and either a redefining or reestablishing of a sense of self in the recovery process.
* Recovery is a highly individualized process rather than a universally defined end state, and requires methods of research than can capture or at least more accurately assess the dynamic and varied nature of the phenomenon.
* Recovery is a nonlinear, ongoing process—people do not move through the recovery process in a predetermined, orderly manner.
* People play an active role in their own recovery process.
* People are the experts on the topic of their own experiences, needs, and their own recovery.
* Hope is an essential ingredient.
* Meaning and purpose in life are necessary to recovery.
* Relapse is part of a process and not a failure. (Davidson & Strauss, 1992; Loveland, Randall, & Corrigan, 2005; Morse, 1997; Ralph, 2000; Strauss & Carpenter, 1981; Young & Ensing, 1999)

Ralph and Corrigan (2005) contend that recovery is concerned with a sense of meaning in life and personal comfort, and is focused on validation of personhood, recognition of common humanity, and tolerance for individual differences. Allott, Loganathan, and Fulford (2003) and (Ralph, Lambert, and Kidder, 2002, June)consider that the turning point in a person’s life, when they begin to focus away from illness and toward recovery, is marked by the individual’s active and responsible engagement with his or her distress and difficulties. Recovery is often described as having a defining moment or a turning point (Allott et al., 2003). Sometimes it is a low turning point before which the person had a hard time moving forward, feeling that they would never be well, and dealing with the grief and anxiety that is commonly associated with loss of health and hope for the future. It is sometimes claimed that recovery is often further delayed by a state of learned helplessness encouraged by the low expectations of mental health professionals. Several authors suggested that a beginning of working toward recovery can often be attributed to talking to peers about mutual experiences and self-help strategies. People begin to regain their sense of self, taking back control and responsibility for their lives (Faulkner & Layzell, 2000; Leibrich, 2001).

Coleman (1999), who has a lived experience of mental distress including institutionalization and who is an advocate for recovery, emphasized that recovery depends far more on self-help and collaboration than on being treated.

Recovery is not a gift from doctors but the responsibility of us all. …. We must become confident in our own abilities to change our lives, we must give up being reliant on others doing everything for us. We need to start doing these things for ourselves. We must have the confidence to give up being ill so that we can start becoming recovered. (Coleman, 1999, p. 7)

(See this for source)

The notion that recovery from severe psychiatric disorder is impossible is now contradicted by impressive and well-known longitudinal studies and the anecdotal experience of many, many people.

In the Japanese Long Term Study (Ralph & Corrigan, 2005), follow-up evaluations were conducted for 105 people with the diagnosis of schizophrenia who had been discharged from mental institutions between 1958 and 1962. Follow-up periods were from 21 to 27 years. Results indicated that 31% were recovered, 46% improved, and 23% were unimproved. Forty-seven percent were fully or partially self-supporting and 31% were again hospitalized. Early stages of the illness course were typically found to fluctuate with regard to social functioning, whereas later stages stabilized to either a stable self-supporting state or a chronic institutionalized state.

Roberts and Wolfson (2004) considered the International Study of Schizophrenia (Harrison et al., 2001) to be the most comprehensive long-term follow-up study of recovery. It included 1633 participants from 14 culturally diverse areas who were studied at 15 years and again at 25 years after diagnosis. The results were in line with previous studies. Outcomes at 15 years and 25 years were favorable for over half of the participants. However, the researchers in this study admit that their studies, like other similar studies, rely heavily on the presence or absence of symptoms and social disabilities, and on resource indicators as outcome indicators rather than indicators that might be defined by the study participants.

Of most relevance to this project is the Vermont Longitudinal Research study (Harding, Brooks, Ashikaga, Strauss, & Brier, 1987).  In this study, 269 people were followed for about 32 years. On average, the people in this study had been ill 16 years, totally disabled for 10 years, and hospitalized in the back wards of the Vermont State Hospital for 6 years. Patients participated in a model rehabilitation program organized around the goal of self-sufficiency, residential and vocational placements in the community, and long term continuity of care. They had been released from the hospital with community supports already in place. At follow up one-half to two-thirds were considered to have improved or recovered, depending on the criteria used. Sixty-eight percent did not display signs or symptoms of schizophrenia. Forty-five percent displayed no psychiatric symptoms at all. More than two-thirds were rated as having good functioning on tests that included both psychological and social criteria. This landmark study was hailed across the country and around the world as evidence that, given intensive education and support initiatives along with medical treatment, recovery from severe mental illness is possible. This finding had a great impact on the mental health field because it was in contrast to the longstanding view that people with mental health symptoms could not get better.

These findings were further supported by the Maine–Vermont Comparison Study (Desisto, Harding, McCormick, Ashikaga, & Brooks, 1995), which used a group-matching design. This study compared the outcomes of 269 people in Maine in similar circumstances with the 269 people in the Vermont Longitudinal Study. However, the Maine patients received standard inpatient treatment and aftercare. Vermont participants were found to be more productive and had fewer symptoms, better community adjustment, and better global functioning than Maine participants. Roughly one half of the Maine participants were rated as having good functioning. The researchers in these studies suggest that the model rehabilitation program utilized in the Vermont study (which will be discussed in the history section of this literature review) gave Vermont participants an earlier opportunity to adapt to life in the community and may explain the better outcomes for these participants.

Anecdotal evidence of recovery from severe mental health difficulties is growing at a rapid pace. Ralph and Corrigan (2005) state that as people have gained more voice around issues that impact their lives, a new understanding of recovery has emerged based on their lived experience (Deegan, 1988). This understanding of recovery was introduced in the 1970s with the rise of the consumer/survivor/expatient movement (Chamberlin, 2002) and is not based on a disease model framework. This view has emanated from individuals who were living with and trying to recover from mental illness and the effects of institutional and other medically based treatment interventions (Chamberlin, 2002). Walsh (1996) suggest that mental illness changes lives irrevocably. She says, “We can never go back to our ‘premorbid’ selves. The experience of disability and stigma attached to it changes us forever. People would not want to go back. Recovery involves growth and an expansion of capacities.” (p.  87) For many people who write about this process, recovery is a personally meaningful goal rather than an abstract construct that is studied academically.

Although Roberts and Wolfson (2004) feel that there is a need to gather and strengthen the evidence base for recovery, they suggest that this can and needs to be a major area for collaboration between people who experience mental health difficulties and care providers. They contend that meta-analyses or randomized, controlled trials provide little guidance on what might make a difference to a person who is working on their recovery.

How does the medical model fit into all of this? Roberts and Wolfson (2004), well-known British psychiatrists, claimed that the medical model is narrowly focused on disease, treatment, and biological reductionism, and contrast this with the broader person-centered focus of recovery models. Ralph et al. (2002), asserted the validity of an evidence base largely composed of personal narrative, and the views of “experts by experience.” At present there is significant tension between the medical model and recovery initiatives. Often their values and language stand in significant disjunction with one another. However, in this research project and in mental health recovery work around this country and around the world, this researcher has found that the medical community, while often unwilling to give up the notion that medical treatment is essential, is discovering that by supporting recovery initiatives and peer support, they experience more successful outcomes (Copeland, 2004c).

From:

Steven J. Onken, Ph.D., Jeanne M. Dumont, Ph.D.; Co-Principal Investigators
Priscilla Ridgway, M.S.W., A.B.D., Douglas H. Dornan, M.S.,
Ruth O. Ralph, Ph.D.; Co-Investigators
Prepared for:
National Technical Assistance Center for State Mental Health Planning,
National Association of State Mental Health Program Directors

Recovery is the reawakening of hope after despair.
Recovery is breaking through denial and achieving understanding and acceptance.
Recovery is moving from withdrawal to engagement and active participation in life.
Recovery is active coping rather than passive adjustment.
Recovery means no longer viewing oneself primarily as a mental patient and reclaiming a
positive sense of self.
Recovery is a journey from alienation to purpose.
Recovery is a complex journey.
Recovery is not accomplished alone—it involves support and partnership.

And we know about the horrible, advancing death rate of people with a mental health diagnosis:

In October 2006, the National Association of State Mental Health Program Directors (NASMHPD) released a report entitled Morbidity and Mortality in People with Serious Mental Illness[i]. Among the report’s findings were the following devastating outcomes for the population with serious mental illnesses:

* Persons with serious mental illnesses are now dying 25 years earlier than the general population.
* Sixty percent of premature deaths in persons with schizophrenia are due to medical conditions such as cardiovascular, pulmonary and infectious diseases.
* Increased morbidity and mortality are largely due to treatable medical conditions that are caused by modifiable risk factors such as smoking, obesity, substance abuse, and inadequate access to medical care.
* Antipsychotic medications have become more highly associated with weight gain, diabetes, dyslipidemia, insulin resistance and the metabolic syndrome.
* Access to adequate healthcare for individuals with serious mental illnesses is greatly impaired by numerous factors.

So- we know that the mental health treatment system/ public mental health system does not work, does not lead to recovery; we know that it in fact is part of the increasing death rate among persons who are “mentally divergent”. What is worth doing?

SAMHSA- Consensus Statement:
The 10 Fundamental Components of Recovery include:

• Self-Direction: Consumers lead, control, exercise choice over, and determine their own path of recovery by optimizing autonomy, independence, and control of resources to achieve a self-determined life. By definition, the recovery process must be self-directed by the individual, who defines his or her own life goals and designs a unique path towards those goals.

• Individualized and Person-Centered: There are multiple pathways to recovery based on an individual’s unique strengths and resiliencies as well as his or her needs, preferences, experiences (including past trauma), and cultural background in all of its diverse representations. Individuals also identify recovery as being an ongoing journey and an end result as well as an overall paradigm for achieving wellness and optimal mental health.

• Empowerment: Consumers have the authority to choose from a range of options and to participate in all decisions—including the allocation of resources—that will affect their lives, and are educated and supported in so doing. They have the ability to join with other consumers to collectively and effectively speak for themselves about their needs, wants, desires, and aspirations. Through empowerment, an individual gains control of his or her own destiny and influences the organizational and societal structures in his or her life.

• Holistic: Recovery encompasses an individual’s whole life, including mind, body, spirit, and community. Recovery embraces all aspects of life, including housing, employment, education, mental health and healthcare treatment and services, complementary and naturalistic services (such as recreational services, libraries, museums, etc.), addictions treatment, spirituality, creativity, social networks, community participation, and family supports as determined by the person. Families, providers, organizations, systems, communities, and society play crucial roles in creating and maintaining meaningful opportunities for consumer access to these supports.

• Non-Linear: Recovery is not a step-by step process but one based on continual growth, occasional setbacks, and learning from experience. Recovery begins with an initial stage of awareness in which a person recognizes that positive change is possible. This awareness enables the consumer to move on to fully engage in the work of recovery.

• Strengths-Based: Recovery focuses on valuing and building on the multiple capacities, resiliencies, talents, coping abilities, and inherent worth of individuals. By building on these strengths, consumers leave stymied life roles behind and engage in new life roles (e.g., partner, caregiver, friend, student, employee). The process of recovery moves forward through interaction with others in supportive, trust-based relationships.

• Peer Support: Mutual support—including the sharing of experiential knowledge and skills and social learning—plays an invaluable role in recovery. Consumers encourage and engage other consumers in recovery and provide each other with a sense of belonging, supportive relationships, valued roles, and community.

• Respect: Community, systems, and societal acceptance and appreciation of consumers —including protecting their rights and eliminating discrimination and stigma—are crucial in achieving recovery. Self-acceptance and regaining belief in one’s self are particularly vital. Respect ensures the inclusion and full participation of consumers in all aspects of their lives.

• Responsibility: Consumers have a personal responsibility for their own self-care and journeys of recovery. Taking steps towards their goals may require great courage. Consumers must strive to understand and give meaning to their experiences and identify coping strategies and healing processes to promote their own wellness.

• Hope: Recovery provides the essential and motivating message of a better future— that people can and do overcome the barriers and obstacles that confront them. Hope is internalized; but can be fostered by peers, families, friends, providers, and others. Hope is the catalyst of the recovery process.

But the absence of these principles in practice is only a small part of the problem.

Other issues are directly in the way of an effective mental health supports system:

from:
http://mhtransformation.wa.gov/MHTG/articles/20080709.shtml

Trauma is among the most significant factors involved in mental illness, and it must be taken into account by caregivers and providers, four prominent speakers told the Trauma-Informed Care Symposium in Yakima on June 11.

The purpose of the symposium was to present information about the impact of trauma, take stock of trauma-related activities and programs already occurring in Washington, and develop priorities for promoting trauma-informed care in Washington.

Tonier Cain, a survivor of trauma, shared her story as one of the speakers. It begins with a severely neglectful mother, a long history of childhood and adult sexual abuse, alcohol addiction from age nine, marriage at age 14, and a drug addiction that led to 66 drug-related convictions.

After being incarcerated numerous times and losing several of her children to the foster-care system, Cain became pregnant again and found a program that helped drug-addicted pregnant women become drug-free and keep their children.

This was the turning point for Cain as for the first time, instead of asking, “What is wrong with you?” one trauma-informed clinician asked, “What happened to you?”

After entering the program, she began working on her trauma issues. In the four years since she completed the program, she has been drug- and alcohol-free, has become a national speaker on trauma issues, has become a board member on several boards of directors, and has become a homeowner and a nurturing mother to her young daughter.

“We would do well to assume that every person who comes to us seeking services is a trauma survivor,” said Dr. Roger Fallot, who opened the symposium with an overview of trauma-informed services.

Dr. Fallot discussed the difference between trauma-informed systems and trauma-specific services. As he explained, human service systems become trauma-informed by thoroughly incorporating an understanding of the prevalence and impact of trauma and the complex paths to healing and recovery into every component of service delivery. Trauma-specific services, on the other hand, refer to specific interventions that directly address trauma and its impact and help individuals heal and move forward in their recovery.

Local trauma champion Laura Merchant gave an overview of a trauma initiative currently taking place in Washington State. Merchant is the Assistant Director at the Harborview Center for Sexual Assault and Traumatic Stress and is involved in a collaborative project with the Mental Health Division that trains clinicians throughout the state in trauma-focused cognitive behavioral therapy (TF-CBT), a psychotherapeutic intervention designed to help children, youth, and their parents overcome the negative effects of traumatic life events.

Merchant discussed the difference between regular cognitive behavior therapy and TF-CBT. TF-CBT emphasizes routine trauma screening for all new clients instead of assuming that, if a client has a trauma background, the client will raise the issue.

Finally, Dr. Brian Sims discussed how to create trauma-informed systems of care. Dr. Sims explained that it makes sense to ask people who have serious mental illness about a trauma history; up to 98% of people who have serious mental illness have a trauma history. Dr. Sims also discussed strategies that mental-health providers can use to facilitate trauma-informed treatment, such as giving consumers choices and treating consumers with respect.

At the end, participants filled out a worksheet in which they identified the three items that they felt were most important in implementing trauma-informed care in Washington State. On the same worksheet, participants could sign up to become “Trauma Champions,” therefore becoming members of the newly-formed Trauma Advisory Group.

The Mental Health Transformation Project (MHTP) sponsored this event, and Jill SanJule, Consumer Liaison for the MHTP, organized the symposium with assistance from Mary Blake, the SAMHSA Project Officer for the Washington State Mental Health Transformation Grant, Susan Salasin, the Project Officer for the National Center for Trauma-Informed Care, and Joan Gillece of the National Association of State Mental Health Program Directors.

SanJule also received input and assistance from a statewide taskforce consisting of Tom Schumacher of the Department of Veterans Affairs, Cheryl Sullivan-Colglazier of the Juvenile Rehabilitation Administration, Ann Christian of the Washington Community Mental Health Council, Peg Evans-Brown of the Department of Vocational Rehabilitation, and Robin McIlvaine of the Mental Health Division. In addition to assisting with planning the event, the taskforce members have also committed to assisting with the next steps in implementing trauma-informed care in Washington.

I would say these things must be a first step to systems change:

  • There should be immediate action to train current professionals and peer providers in mental health / trauma treatment strategies (e.g. EFT or EMDR or other evidence based therapies);
  • The principles of self-determination must be assertively promoted throughout the provider community, adopted as “best practice” and made part of both administrative rules and contracting for mental health services and supports;
  • The “brain disease/ chemical/ medical model of mental health must be discarded and debunked using the existing mountain of research that contradicts this approach (the pharmaceutical industry, while it has a place in treatment for some people, must be taken out of the driver’s seat of medical/ psychiatric education);
  • The training for mental health professionals from the doctorate level to the bachelor’s level must include significant education regarding the fact and circumstances of mental health recovery and the importance of addressing trauma and incorporating self-direction in services.

With these actions, we can begin to implement the recovery principles and National Consensus Statement. Without these fundamental and vital steps, systems change will be a joke at the expense of both the tax payers and the people who are trapped in the Public Mental Hell System.

I will leave you with this story I found on Ron Unger’s blog:

By Sonia Novinsky
Jacqueline came to me about one year ago. She was a beautiful woman, in
her forties and had been diagnosed as a schizophrenic with auditory
hallucinations, depression and an inability to operate in social
environments. Now, after a year, the hallucinations are gone and she is
well adapted to society. Along the way many other benefits
occurred…including relief from anorexia and the cessation of smoking.
Here’s the story.
She arrived in a very depressive state, saying to me: “This is my last
chance. And all I can pay is 10 dollars per session.” It was impossible
to refuse her desperate appeal for help. She said…
“For 9 years now, since my daughter was born, I am taking Haldol, Prozac
and other medications because Psychiatrists considered me an incurable
schizophrenic patient. I’ve been sleeping most of my daytime during all
these years.
After a traumatic event when my daughter was born I fell into a
depression. I started listening to Mary’s voice (Jesus’s mother)
GC COMMENT: her former psychiatrist diagnosed this an auditory
hallucination.
and I had some inappropriate behaviors, including a kind of anorexia,
with hospitalization. I heard about your work with Energy and I want to
try it. I believe that this could help me to get rid of medication and
my disease. The only reason I don’t kill myself today is because my
religion forbids me to do it.”
My first thought was: should I do EFT for a psychotic client? But the
despair I saw in her eyes touched me and I decided to try. She said she
would do anything to be free from Haldol. In fact, she threw away her
drugs and cut off communications with her psychiatrist. She refused to
take drugs because of the negative effects on her and made it a
requirement that I work with her on that condition.
At the first moment she told me that she had a supportive husband and
parents, and also wonderful children and that made her feel more guilty
for being a mentally ill person. She complained of smoking too much, of
having difficulties to rest and sleep. She said she was also 30 kg more
than her ideal weight, partly because of the antipsychotic medication.
During the last 9 years she was afraid to drive a car, which was normal
to her before her crisis.
The last psychiatrist she saw was very oppressive, telling her she had
an incurable mental illness and was obliged to take Haldol for the rest
of her life. When she arrived at my office she was very angry with all
psychiatrists and therapists who took care of her during all these
years. They gave her no hope: just labels and drugs.
Before investigating core issues, I worked for some weeks on our
rapport, trying to help her on her self esteem and trying to develop
some trust in our connection. She was very upset with the kind of
relationship she had with her psychiatrists and therapists. A hierarchy
was always present, and she was the inferior part of it, all the time.
Her objections about the treatment were never validated by them.
I agreed to try to work with her without medication (her choice) only if
we could see each other almost everyday and talk on the phone whenever
necessary. She agreed to tap with me on the phone whenever I asked her.
In this case it is very important to stress how strong was her intention
to get rid of any medication because they condemned her to be out of a
normal life.
In this case, besides EFT, praying was used almost everyday. She bought
“A Course in Miracles” and did her lessons everyday. The first result,
from the combination these items, was that hallucinations started fading
down and disappeared completely.
I will make a summary of the main topics we worked with EFT. We did EFT
hundreds of times. I learned a lot with Gary, so I do a free talk while
tapping, in a way that I can’t reproduce here, introducing humor and
installing new meanings and possibilities. She was entirely open to work
with EFT.
We started working with the most apparent sensation she was having at
the moment she arrived. In my experience you can start with this state,
even if it is not a core issue. When this layer is reached, even if you
don’t clear it completely, it gives room for the traumatic memories to
show up. Meanwhile you get the basic trust needed to work deeply.
Defenses hold back slowly while the person calms down. At the same time
inner positive resources become more available for working with more
delicate issues. So we started working on her self image and self
esteem, while tapping:
Even though I was shocked by the label of “incurable schizophrenic” Dr.
X put on me, at his office, that makes me feel completely hopeless, I am
not this label, I am more than what people think about me and I deeply
and completely love and accept myself.
While we were tapping I installed some reframing about how I was one
with her, no hierarchy between us, how we were together and no label
separating us.
The result was important for the rest of the treatment: she trusted that
she was not alone and that I was assuming a strong, deep, and personal
commitment with her. Differently from other professionals she had seen
before, I was not just using a technique or medications or my
professional skills. Sometimes when there is a lack of this commitment,
then technique, titles or medications become tools that are responsible
for the client’s feelings of isolation, inferiority and separation. When
this happens, these tools become inefficient.
She disclosed that when her daughter was born she was very upset with
some events and we tapped on them. The worst one (which launched her
first psychotic episode) was her husband’s imposition that his mother
should be the godmother of her daughter. Since they started dating, his
mother and his sisters disapproved of Jacqueline and were mean to her.
Jacqueline’s husband, Leo, didn’t allow any choice to Jacqueline. He
almost begged for this, crying and screaming. When Jacqueline went to
see her mother in law to invite her, her reaction was very negative. She
said: “I accept to be the godmother but I will not receive your family
in my house.” This was a traumatic event for Jacqueline.
She felt very unhappy, with no way out, and thus she had her first
psychotic attack. She undressed completely at a soccer stadium full of
people.
We tapped for this event, and many aspects showed up. We tapped for the
shame and guilt of not having control of her behavior. While she was
narrating the event I tapped on her. This is my preferred way of tapping
specific events. This one was a very traumatic event but finally her
husband agreed on her demand that his mother would not do the baptism of
their daughter.
Thus she was victorious in some way, but she paid a high price for this
“victory”: from this day on she carried the label of a sick person.
After two months her mother in law died suddenly and that gave
Jacqueline the illusion of having a mean power inside her, and that made
her still more guilty. In some way Jacqueline felt she had no control
over herself but from another point of view she was afraid of having
some extraordinary power.
While doing EFT….
Even though I lost control about my behavior that day in the stadium and
I am ashamed about it, I completely forgive myself. This was they way I
found at that time to validate my protest against my mother in law and
my husband demands.
Even though I did what I did at the stadium and she died two months
later, it is only a belief that I can control someone else’s time to
die. This is God’s power, not mine so I can be free of any
responsibility for other people’s life or death.
Jacqueline wanted to drive a car again. She felt ready to try it, after
clearing her psychotic attack and its consequences. So we tapped for the
fear of driving, first at my office, then in her car.
Even if I have fear of driving a car because I went out of control that
day at the stadium, and my mother in law died just after it, and my
husband said that I was not trustable anymore, I deeply and completely
accept myself.
Some aspects of her fear were: fear of losing control, fear of hitting
the car, fear of hitting some one on the streets, fear of hurting her
children if she hits the car, fear of killing someone.
We made a test. We went inside her car and tapped in the car for any
aspect, like “heart jumping too fast”, “I am not able to drive anymore”,
etc With me at her side, in the car, she drove the car by herself. After
a couple of minutes she was very calm, driving the car. Since that day
she is driving the car with no problem, with her children. Sco Paulo (my
home) has very dangerous and wild traffic. Many normal people don’t
drive cars here. But she does it now.
Schizophrenia is caused sometimes by double messages received mainly
during childhood. Since her birth we could find many situations where
double messages were received. Clearing all these double messages along
Jacqueline’s life, since her birth until now, it was essential to allow
her to see everything in a different way and to create a more integrated
identity.
Jacqueline was the first child. Her father (Italian origin) wanted only
a male child. When Jacqueline was born her mother felt in some way not
comfortable with the fact that she couldn’t give her husband a boy. At
the beginning of her life Jacqueline felt no holding, no sensation of
being desired. Eleven months after her birth her mother gave birth to a
boy who received all the attention of the parents. Jacqueline was most
of the time with a single aunt that had a strong passion for a catholic
priest at that time.
We tapped for all events and sensations Jacqueline could remember that
were related to this belief of not being wanted, of not deserving love,
of being guilty for not being the boy her parents were waiting for. The
strategy Jacqueline found was trying to persuade her father that she was
good enough like a boy would be, and to do so she became too close to
him and that made her mother very jealous and ambivalent towards her.
Even though I felt the cold eyes of my cold and felt alone in my little
bed, feeling I didn’t deserve love for not being a boy,….
Even if I still feel guilty for not filling my parents expectations,
when they said to me how important it was for them to have a boy as
their first child…
Even if I felt an ambivalence in my mother’s way of looking at me
because she wanted a boy instead of me and she was jealous of my love
for my father…
Investigating it more, I discovered that when Jacqueline had her crisis,
after the birth of her daughter, she was feeling guilty and not
deserving to have two healthy children, a boy and a girl. This was
connected with a specific and important event that we addressed in each
detail.
When she was 18 years old she was dating her future husband and she got
pregnant. As she was very religious and she wanted to become a mother
she didn’t want to make an abortion. But her husband, Leo, said that he
would stay with her only if she made the abortion.
She postponed it as much as she could. She felt under a big pressure.
She didn’t want to lose Leo and didn’t want to lose her child. She
talked with her parents and they agreed with the abortion. So she did
it. It was a very traumatic event for her. She felt guilty for the
abortion, felt enraged with Leo, who didn’t go with her to the clinic,
and felt very uncomfortable with her father. After the abortion he was
very critical to her. Their parents were supportive on one side, but on
the other they were very severe and full of deception.
We tapped for each aspect of this event: the blood she saw, the place
where she laid down, the light of the room, the questions the doctor
asked her, the ambivalent sight of her mother, the feeling of
abandonment because Leo was not there, the guilt of killing a 4 months
old fetus.
We discovered that her anorexia was connected with the blood she saw at
the abortion.
Even if the medication had controlled the anorexia, it was a good
release to understand and clear this event and the compulsion that it
triggered. From that day she started feeding herself on a more balanced
way and started losing the extra weight she had at the beginning of the
treatment.
She cried a lot when we were tapping for this event. Anger at herself,
anger at Leo, anger at her parents that could have said to her: “You may
have the child and we will help you”, anger at her father, who called
Leo to drink a whisky to calm down, sensation of having committed a
murder, etc
After some sessions working on this issue we tapped for forgiveness,
reframing that she was not alone on what she had done, she was just a
girl in love with Leo and in some way she did the abortion to save her
relationship with him.
Sometimes Jacqueline called me during the evening, crying, hopeless,
feeling that something was wrong with her, feeling that her husband
didn’t love her, although he always said the opposite. She never had an
abreaction, we just tapped on the phone and she calmed down.
We could see at that moment how the mother in law event triggered the
abortion trauma, guilt and anger. When her husband made this second
imposition to her: “My mother will baptise my daughter”, she fell apart
and collapsed. Since that day she started hallucinating and having
inappropriate behaviors. One manifestation of this behavior was a
passion for a catholic priest (like her dear aunt in the past), who held
her in a compassioned way at the church.
In my point of view, the main issue for Jacqueline was not being held
since the beginning of her life, and this fact was repeated many times,
maybe because the writings on her walls were like these: “I don’t worth
to be loved, I don’t deserve to be hold, there is something wrong with
me, I should be different to be accepted, I am inappropriate, I have
some strange powers that can harm people, etc”
I was suspecting, from some facts Jacqueline told me about, that her
husband was also sending double messages to her. On one side he said he
loved her, on the other side he was indifferent, quiet, isolated,
absent.
I worked with the couple for three sessions and my impression was
confirmed. Leo was very polite but was always concerned with Jacqueline
in a very distant and professional way, asking me if she shouldn’t start
with the medication again.
During the year we worked together Jacqueline had some more depressive
moments. Sometimes she was very accelerated, talking and talking,
reading the Bible compulsively, going to the church and speaking in a
non-spontaneous and hearty way. I supported her not taking the
medication in all these moments.
Beyond EFT we did some yoga therapy, grounding and breathing exercises
to calm her and connected with the here and now, feeling her body
sensations and trusting them. Being touched by me in a very tender way
very important for her to feel grounded and accepted, bringing hope back
to her life. These procedures were enough to stop any process of losing
control or wish to die.
What was interesting is that when we cleared all aspects of the guilt of
the abortion, including the guilt of having healthy children and the
guilt of being alive (she used to talk of suicide as a self punishment),
on the same week her anxiety stopped and her voice became more calm and
she stopped smoking.
As she was more awake and present to her family she started trying to be
closer to her husband but he was always very distant, even repeating
mechanically that he loved her.
We tapped: “Even though I feel like I am crazy with the double messages
he sent to me yesterday, and maybe since I was 18 years old, I hold
myself, I deeply accept myself, and I choose not to believe that I am
crazy. Maybe there is something wrong with him..”
She asked him to go to therapy but he didn’t go.
After some time, as she was more centered and not feeling crazy, she
started realizing how strange was her husband’s behavior. It was not
difficult for her to find out that he was having an affair. Coldly, he
agreed and told her he didn’t love her anymore.
Now they are in a divorce process. As a catholic this is very
complicated to her. But she has the serenity to face this fate. She
brought her children to therapy, she went to a lawyer and asked for the
rights of her children. Leo came to me and confessed that since she was
18 he didn’t love her. He only married her because she made the abortion
and he felt committed with her and grateful to her. So maybe he has been
sending double messages for twenty years.
Jacqueline became very angry with him and with herself. We are now
tapping for her to accept reality as it showed up and finally be free of
these double messages that made her schizophrenic for 20 years. The good
part of it is the two wonderful children who are really special and are
doing the best they can to facilitate this difficult moment for
Jacqueline and Leo.
We have more work to do. The important thing is that Jacqueline is
working again in her profession. She could finally see that her husband
was away for many years, although physically present.
I think the most important piece of this therapy was the possibility she
opened for me to have a deep rapport with her, while tapping. She
started believing that she was a person, not a sickness, and as far as
this occurred, her own family started to legitimate her like a mother, a
professional and a complete human being. She felt self confidence to
re-start her professional life again. For 10 years her family and Leo’s
family considered Leo like the best husband, almost an angel, and
Jacqueline was the crazy one, the problem.
The whole system around her changed when she changed. The truth showed
up and she could see how she felt crazy also because her husband was
sending double messages since a long time, maybe during all their
marriage.
She is now living alone with her children. Leo left the house, and
Jacqueline is very grounded, determined, not even feeling a victim. She
said to me, “It’s time to turn the page: the page of my marriage, of my
labels, of my poor self esteem. I am ready to take care of me and my
children, and all I want is Leo to be happy, as far from me as
possible.”
Some months ago she gave me a long written testimony ( in Portuguese),
about her issues and her treatment, confirming some results I wrote
above. Her intention was to help other people who could profit from her
experience. One of these last days she completed the testimony verbally.
I quote this her words :
“For the first time in my life I feel peace in my heart. I have
difficulties with my son and with my husband but they don’t disturb my
peace. I want to live like a normal woman and like a helper, for this I
am praying and serving as a volunteer in a hospital.

For the first time people trust me again. I was elected for the
directory board of my club, and possibly I will be a candidate for a
public position in the near future. I am free from the obsession toward
the priest, I know it because I went to see him in the church and could
see him only like the priest he is. I don’t need smoking nor the voices
I used to listen to. I can remember the abortion without guilt. I
couldn’t have a child for myself at that moment. I feel free from the
double messages my husband used to send to me all the time, saying he
loved me but excluding me from his life and problems and pleasures. I
feel ready to take care of myself, and to take care of my children. I am
living each day, not anticipating the worse like I used to. The pressure
I felt in my heart is gone. I think I tried to protecte my husband by
accepting the double message without any protest, putting the guilt on
myself. I feel healthy as anyone in this life even if I need therapy for
some more time.”

I wrote in the computer while she was speaking. Her voice was soft.
During her worse days her voice was too acute and full of irony and
arrogance. This day her eyes were tender, her voice was tender, her
posture was elegant, her energy was kind and balanced.

Concluding I think that what was decisive was EFT plus the holding she
felt because I could accept, without any judgment, her passion and
fantasies toward the priest, her wish to die, and her fear of getting
crazy, and her deep pain, out of any category or classification that
could separate us.
Sonia Novinsky

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Filed under CS/X movement, Links: Recovery, Mental health recovery, personal story, pictures, wellness and systems change

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