Psychpolitics

He is not here; he has risen! Luke 24:6-7

The general approach to psychosis in general hospitals and psychiatric hospitals is built on the biocentricism. The approach in practice is that the person living with psychosis is first assessed by a psychiatrist/ physician. Preceding such assessment, neuroleptic drugs are usually administered. The rationale of such an approach is that the patient/sufferer is in an acute phase and nothing can be done via psychotherapy or psychological counselling. Whilst such reasoning pervades general psychiatric, medical and psychological teaching and training, it negates the efficacy of psychotherapy which has been there before the advent of psychiatric drugs. The biocentricism approach also ignores the true working of the psychiatric drugs as reviewed by French psychiatrists in the mid twentieth century. For instance, Jean Delay and Deniker stated that the drugs work by damaging certain parts of the brain (Moncrieff, Cohen, Porter 2013). The work in Finland by Jaakko Seikkula revealed that psychotherapy is the first line of treatment and has proven efficacy over the currently held belief in the approach held by biocentricism (Seikkula, Alakare, Aaltonen, 2001b). It is the argument of this paper that if we are to follow clinical evidence then psychotherapy should be our first line of treatment.

Science means taking reality into account and articulating the lessons it teaches thus attending to evidence (Smail, 2005). Our current approaches in our Zimbabwean context in psychological conditions have not taken reality into account and neither have they even articulated the lessons that shows they are attending to evidence. The historical works by Bertam Karon, Austin Riggs and Chestnut Lodge cited in (Levin 2018) present the clinical evidence that work with persons living with psychosis is very possible without drugs. Research findings by Martin Harrow present the most compelling longitudinal studies carried which showed that persons on long-term treatment on drugs tend to have the worst functional outcomes over a long period of time especially those diagnosed as having the schizophrenia construct (Harrow and Jobe 2018). With this evidence being presented in clinical work and research it is expedient in our context in Zimbabwe that we invest more in making psychotherapy the first line of treatment.

Psychiatric drugs might prove helpful to some persons especially in managing distress that usually accompany psychosis, however their use as first line treatment or as mono treatment of psychological distress present huge problems than they intend to solve. The one apparent problem is that it dampens the person in whom it seeks to treat living them in a numbed state what commonly referred to a “zombie” with long-term effects the drugs can result in having neurological disabilities such as Tardive Dyskinesia which can be observed as involuntary awkward movements, face grimacing among other signs. The fact that the paper suggests psychotherapy as the first line of treatment can be based on the fact that risks such as of neurological damage are eliminated. Secondly the paper understands that the chemical imbalance theory which has been used as the basis to administer psychotropic medication has been debunked and administration of psychotropic drugs cannot be sustained on the basis of correcting a chemical imbalance.

Joanna Moncrief in her book “bitterest pills” suggests psychiatric drugs have a drug effect rather than a disease effect (Moncrieff, 2013). This can be also be understood by the fact that the mechanism of action of these drugs remains unknown. By stating that the psychotropic drugs have a drug effect entails that it does not sort of target a specific disease but rather has similar effects to anyone despite having a disorder or not. Gird with this knowledge it is expedient to make psychotherapy the first line of treatment during admission and if and when necessary to help the patient psychiatric drugs can be administered for a short term using very low doses as prescribed by Glen Gabbard’s treatments of psychiatric disorders (2014).

The method of using Psychotherapy as the first line of treatment has been used from 1992 in Finland as proposed by Jaakko Seikkula in Open Dialogical therapy. It has over the years shown greater efficacy over medical treatment regiments in ameliorating psychological disorders and has resulted in high discharge rates among hospitalised persons. The approach of psychotherapy as the first line of treatment will ensure that we move from an objective approach on how the patient appears to the treater, how he is different to others to one which then is of a subjective view which focuses on how the patient feels (Levin 2018). The return to the subjective view which will be led by a psychotherapist will allow practitioners especially in our context to retain their role as practitioners in madness as they will enter in the chaotic spaces of the individual in the acute phase only with words to abate the madness. In Aeschalus words “soft speech is to distempered wrath, medicinal (Levin 2018).

In conclusion no practitioner can cure the patient without first curing the soul.

Prosper K Mushauri

Counselling Psychologist

Reference

Gabbard G O. (2014), M.D Gabbard’s treatments of psychiatric disorders Fifth edition American Psychiatric Publishing

Harrow M, Jobe TH. Long-term antipsychotic treatment of schizophrenia: does it help or hurt over a 20-year period? World Psychiatry. 2018 Jun;17(2):162-163. doi: 10.1002/wps.20518. PMID: 29856562; PMCID: PMC5980604.

Levin R (2018) Successful drug-free psychotherapy for schizophrenia New York, NY : Routledge.

Moncrieff J, Cohen D, Porter S. The psychoactive effects of psychiatric medication: the elephant in the room. J Psychoactive Drugs. 2013 Nov-Dec;45(5):409-15. doi: 10.1080/02791072.2013.845328. PMID: 24592667; PMCID: PMC4118946.

Moncrieff, J. (2013). The bitterest pills: The troubling story of antipsychotic drugs. Springer.

Seikkula, J.. Alakare, B., & Aaltonen, J. (2001a). Open dialogue in psychosis I: An introduction and case illustration. Journal of Constructivist Psychology, 14, 247-266.

Seikkula, J.. Alakare, B., L Aaltonen, J. (2001b). Open dialogue in first-episode psychosis 11: A comparison of good and poor outcome cases. Journal of Constructivist

Seikkula, J., Alakare, B., Aaltonen, J., Holma, J., Rasinkangas, A, & Lehtinen V. (in press). Open dialogue approach: Treatment principles and preliminary results of a two year Follow up on first-episode schizophrenia. Ethical and Human Sciences and Services

Smail D (2005) Power, Responsibility and Freedom An Internet Publication