The Course of a Psychotic Illness – In Response to Psychiatry and the Business of Madness

By David Laing Dawson MD

In the late 1960’s and early 70’s when a young man or woman in a psychotic state was brought to the hospital by family, by ambulance, by friends or police, we would admit him and keep him safe. He would have a physical examination, some blood tests, and be fed, if he was willing to eat. If she was delusional, hallucinating, talking in an incomprehensible manner, we would optimistically hope that the cause of this was the ingestion of illegal substances, perhaps LSD, Mescaline, mushrooms.  We would wait a few days before concluding otherwise. In fact, we sometimes waited one or two weeks, even three weeks, before concluding that this was a psychotic illness not induced by drugs. Drug induced psychosis actually clears quickly; it doesn’t take weeks, but we might indulge in wishful thinking along with the boy or girl’s family.

The history, the symptoms, the family history might clearly point to one of the psychotic illnesses studied and delineated over the previous hundred years (schizophrenia or manic-depressive illness), or not clearly one or the other, perhaps both. Nonetheless we now had effective treatment, drugs that actually work. These would be prescribed. And over the next few weeks to perhaps 8 weeks, our young man or young woman almost always got substantially better. The few that did not progress that quickly had been quietly ill for years before the admission. Average length of stay in the hospital grew shorter and shorter, at that time somewhere between 20 and 60 days.

But the other bit of folk wisdom with the backing of experience was that it usually took at least three admissions to hospital before such a patient achieved long-term stability. And this happened for four main reasons: we prematurely stopped the medication, severe side effects forced us to stop the medication, the patient stopped taking his medication, or the patient, stable within a quiet, supportive environment, entered a new, complex, chaotic and demanding environment that provoked relapse (a relationship, university, a job, travel, even a poorly considered therapeutic program.)

And throughout this process, the family, the patient, and the caregivers all struggled to find a way of understanding, talking about the illness, and finding a balance between cold truth and hope.

It often took three or four admissions before the patient and his family could come to terms with having a mental illness that required medication for a long time. This was not aided by our own optimism, our hope that a six or twelve month course of these very new medications would be sufficient to keep psychosis at bay for years to come.

What actually happened, inevitably, after stopping the medication, was a three or four or even six month period of wellness sans drugs, giving unfortunate support to the conviction of not needing them, followed by relapse of illness, of psychosis.

So these admissions and recoveries and relapses and re-admissions often spanned 5 to 10 years before stabilization was achieved. And, for those who eventually stayed on their medications, another 5 to 10 years of recovering the lost skills, the lost time, of learning what to avoid, of finding a way to live a full life with a chronic illness. Not least of those adaptations is finding a way of thinking about, accepting, as part of one’s past and present, several periods of psychosis, of misreading the world, of damaging relationships and sense of self, of being delusional.

I have been living in and around the same city now for 45 years. And from that period in the 1970’s I have known a few people who gradually made complete recoveries while consistently taking their medication, adjusted over time. And while they have recovered and lead full lives they know they are vulnerable; they know what to avoid; they know they must stick to some routines. I know others who take their medication and have achieved stability if by no means full recovery. And I know of others who have not, who have never been willing to take this medication over a long period of time. Some have died. A few others I see around town occasionally, one in a torn raincoat, walking down the center of the street gesticulating madly and talking to the clouds, another, a woman, standing outside a variety store haranguing exiting customers about incomprehensible injustices, and another plodding along the sidewalk, his head bent in unusual fashion, talking to himself.

But never, in those 45 years, have I seen someone who suffered from this kind of severe psychotic illness, recover fully without consistently taking his or her medication. You’d think by now, if it were possible, I would have seen it.

See Psychiatry and the Business of Madness in Mad in America

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10 thoughts on “The Course of a Psychotic Illness – In Response to Psychiatry and the Business of Madness

  1. Thanks for your straight talk. Many professionals out of kindness don’t tell families just how desperate schizophrenia is. I knew enough to realize that it was incurable and how resistant patients can be to believe they are sick, not to mention the delusions that imprison them from understanding reality.

    When I first visited my son Matthew at Whitby Psychiatric Hospital, as I was leaving I said to a nurse that I hoped he didn’t have schizophrenia (though he had every symptom which I recognized as schizophrenia.)

    The nurse assured me that schizophrenia wasn’t “so bad” and that people could live “normal lives” I knew better and thought the staff were not well trained in recognizing serious mental illnesses. My first thought was that my son was in a place where no one understood his disease.

    It took awhile to realize that the nurse meant to allay my fears for my son. But he did the opposite .I preferred that he be straight-forward with me instead of giving me watered down information, which lowered my confidence in that hospital.

    Matthew killed himself not long after that. He could no longer handle the cruel voices that tortured him.

    Professionals should not hold out even faint hopes for families. The truth is mental illness systems have few resources for the most ill. The news is full of failure to properly treat this group. Until governments recognize the need for scientific research to find the cure for neurological diseases, like schizophrenia more families will face a brick wall with no hope for improved treatments and the blessings of a cure. .

    .

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  2. Well said June..the only hope, in my opinion, for this horrible illness is brain research and the development of better medication. My son is on medication, Invega and it by no means keeps his delusional thinking at bay..he is almost daily very disturbed by his thoughts and the voices that he says allows him to read people’s minds. He tries so hard to work his way through these thoughts …as a mother this is extremely hard to watch him endure. Vivian

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    1. What a sad trial for you and your son. Schizophrenia must be one of the cruelest diseases. It attacks youth just as they are becoming into adulthood and leaves them bereft of comfort.

      Governments are not even interested enough to fund the necessary scientific research to free them from this terrible life sentence of schizophrenia.

      I embrace you. June

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  3. I have personally seen one full recovery from schizophrenia without medication which has lasted for over five years. Others I have read (e.g., Paris Williams) claim to have seen much longer full recoveries. Are you simply presuming that when someone does recover without meds, then it couldn’t have been schizophrenia in the first place?

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    1. All studies of this have to rely on clinical records and varying diagnostic criteria and definitions of recovery. I can’t say fullrecovery can not happen without medication. My observations are only of those many patients I have seen since the late sixties with severe psychotic illness.

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  4. Keeping an eye on patients, specifically with drug induced psychosis is extremely important.

    Too many times psychiatrists or doctors assume the patient has a mental illness when in fact it is not latent paranoia, but a side effect from a drug induced psychosis. The waiting time in the 70’s was key and we are losing that waiting time and patience more and more.

    I think checking for a drug addiction is a key first step in those cases, using positive resources like addiction recovery quotes or photos of outdoors or nature and other reinforcing topics, along with making sure the patient is making recovery, staying away from the suspected drugs.

    After that, CBT along with medication is an option for those who experience continued distress. I believe that moderation is key.

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    1. If you would like to know more about the relationship between psychosis and marijuana, please register to attend Dr. Amir Barsoum’s lecture on this topic. Please register early to ensure enrollment at kathleen.mochnacki@gmail.com

      This lecture will be held at St. Mary’s Anglican Church in Richmond Hill at 7pm, Wed, Sept 16. Dr. Barsoum will describe the symptoms and signs of psychosis, and the current understanding of the biology of psychosis. He will also talk about the effects of marijuana in the brain, and explain the biological rationale as to how marijuana use may trigger psychosis. In addition, Dr. Barsoum has invited a patient to talk about his experience of having suffered from marijuana addiction and marijuana-induced psychosis.

      Dr. Barsoum has been a practicing psychiatrist for 15 years. He is currently on staff at Markham Stouffville Hospital, where he practices general psychiatry. He is also on staff at Bellwood Health Services, an addictions facility in Toronto, where he provides consultation for patients with concurrent mental disorders and addictions. In the early part of his career, Dr. Barsoum worked at CAMH, (Queen Street Site), where he cared for patients with severe and persistent mental illness.

      This event has been generously funded by our partner, Canadian Mental Health Association of York Region and Simcoe County. All members of our Home on the Hill community are most cordially invited to attend this presentation. Please register early to ensure enrollment. Participants may register at kathleen.mochnacki@gmail.com

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  5. Well said, indeed. I sometimes wonder if the antianything folks actually believe what they say or decided to take the extreme position in hopes the opposing view may be impacted somewhat. When I recently attended a seminar by a Szaz true believer (I don’t even remember his name), I described some of the severely mentally ill patients I had worked with and asked the presenter what he would do to help them. He quickly answered, “I trust the law.” When I explained that I was talking about patients in a prison acute care mental health unit, he shrugged his shoulders.
    I don’t think anyone should talk about serious mental illness until they have worked on a hospital or prison ward for serious mental illness patients.

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