Saturday, 17 October 2009

Beyond redemption? - Critique of an article by Peter Stastny on treatment for first "psychotic episodes".

Via Gianna's blog, Beyond Meds, I just came across an interesting article by Peter Stastny on Although I widely agree to Peter Stastny's observations, two things bother me about his article. One of them is the misconception I see also Peter Stastny obviously holds, that Scandinavia must be paradise when it comes to services offered by the mh system. This is not so! I left the following comment at the post:

Peter Stastny here makes it sound like living in Scandinavia almost is a guarantee for more humane and recovery-oriented care to be provided when a person goes through a "psychotic" crisis. Nothing could be more wrong. "Need adapted treatment", also called the "Vestlapland's model", is, as the name suggests, restricted to a region in Finland, namely Vestlapland. There have been other recovery-oriented treatment approaches that were inspired by the Vestlapland's model, respectively by Soteria and similar projects. For instance the Swedish Parachute Project. All of them have been geographically restricted to more or less minor areas, and many of them are not employed anymore today.

It is true, that community care widely has replaced especially long-term hospitalizations. However, a closer look at how this community care does - NOT - work, shows that it is in fact nothing but what you might call "hospitalization in the community", or, more precisely, on the margins of community. Today, the biological model and thus the almost exclusive reliance on psychotropic drugs as "treatment" dominates psychiatric "care" in Denmark and Norway entirely. In hospital as well as in the community. People aren't warehoused behind the brick walls of a locked ward. They are chemically restrained warehoused in halfway houses respectively in an assisted living facility - more often than not of poor quality; there have been numerous scandals about gross overmedication as well as intolerably filthy and run-down environments here in Denmark over the past years - or, if they're lucky, in their own apartment and at the nearest drop-in center.

About 90 per cent of those who enter the system and receive a "psychosis" or "schizophrenia" label end up as revolving door patients, and on disability.

De-institutionalization has widely failed in Denmark, because it was (mis-)used in order to save the state money, not in order to provide more recovery-oriented services to people in crisis. In the meantime, the overall failure of community mental health care has Danish politicians ask for the re-establishment of hospital beds on locked and secured wards, for the implementation of AOT-laws, as well as for several other initiatives, such as the re-establishment of seclusion rooms, that inevitably will bomb mental health services in this country back to the good old asylum-days. It doesn't occur to anyone that the problem may not be the form - community instead of hospitalization - but the contents - recovery-oriented services instead of drugs, drugs, and even more drugs.

The situation in Norway, Sweden, and as far as I am informed also in Iceland is that AOT-laws already do exist, and are excessively used, and that at least the mh system in Norway has hospitalization facilities at its disposal so as to be able to incarcerate a vast number of people long-term. Norway also is the European country with most incidents of involuntary hospitalization and "treatment", as far as I know, Denmark holds a sad third or fourth position on this list.

By and large, also the psychiatric establishment in Scandinavia has been successful defending a purely biological, and in addition widely on coercion based, "treatment" model, and preventing alternatives from as much as being publicly discussed, or even becoming known to a broader public. IMHO, our system is anything but a model system. And it looks like it will be even less so in the future.

The other disagreement I have concerning Peter Stastny's article is that also he, as most professionals, seems to believe that when people first had their second, third, or umpteenth "psychotic break" they're beyond redemption. Why his article entirely focusses on alternative treatment options for first "psychotic episodes". I can't tell you exactly how many times I had a "psychotic break" before I eventually received the guidance that made it possible for me to, I dare say once and for all, resolve crisis, but this last of my crises certainly wasn't my first one.

I have no doubt that crisis is "addictive", and habit-forming. The longer and more often someone employs a certain pattern of behavior, certain coping strategies, the more ingrained, probably also neurologically, it becomes. On the other hand, my compared to a teen or twenty-tear-old relatively more extensive life experience also was a huge advantage to me throughout the process of working things out. I'd say, all in all, my chances to recover were maybe different in kind but no smaller than any "first psychotic break" individual's.

No one should ever be regarded "beyond redemption". Recovery is possible and should be aimed at, no matter how many "psychotic breaks" someone has experienced. The services Peter Stastny, and others, are so eager to make available to people who experience their first crisis ought to be available to everyone, disregarded whether they're going through their first, second, or umpteenth crisis.

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