Monday, 2 March 2009

Merete Nordentoft, the OPUS-project, and The International Society for the Psychological Treatments of the Schizophrenias and other Psychoses, ISPS

The following is a rather nasty slamming of the Danish branch of The International Society for the Psychological Treatments of the Schizophrenias and other Psychoses, ISPS. So, don't get me wrong, it is not a critique of the international organization, or of any other countries' groups! - With the exception of the Swedish ISPS-group, that is.*)

I must admit, that it was a somewhat pleasant surprise when I learned, that The International Society for the Psychological Treatments of the Schizophrenias and other Psychoses, ISPS, also has a Danish branch. "They hide efficiently," I wrote in an e-mail to Daniel Mackler, since I usually don't miss important things going on in this country's mh system.

Well, apart from the fact, that even an organization, that gives high priority to psychological treatment options as help for people in extreme states of mind, does have its problems with avoiding to pathologize the individual, I thought, naive as I at times can be, that there maybe really was not just a very few helpers, that can be counted on the fingers of one hand, but maybe even a whole organization of helpers, who do take people who experience extreme states of mind seriously, and really make an effort to offer these people the kind of help they want. And well, the pathologizing we can thank Freud for. Just as we can thank him for psychoanalysis. So...

I guess, I'll have to reconsider.

For a moment, I thought I'd add a link to the ISPS to my sidebar. And yes, the American branch of the organization does actually have some very interesting articles on its site, and on the home page it says: "We promote the humane, comprehensive, and in-depth treatment of psychotic disorders." Very nice, indeed! So, maybe this really was something, I should add to my collection of recommended Danish sites?

Now, I don't just link to something without first investigating a little further what I am possibly going to recommend. - Which doesn't mean that I would be looking for 100% conformity with my own views, only. But well, one has to draw the line somewhere, right?

The first name I came across was Bent Rosenbaum, a Danish psychiatrist. This reverberated mixed emotions. The next name did no longer reverberate mixed emotions, but red alert: Merete Nordentoft.

Why red alert? Well, Merete Nordentoft, psychiatrist and one of the Danish mainstream medias' pets on the subject of "mental illness", also is the initiator of the so-called OPUS-project **). The acronym stands for "tidlig opsporing og behandling af unge psykotiske", meaning "early detection and treatment of young psychotics", which already tells me a whole lot. Alone the choice of words: them (the "psychotics") - and us. (And "opsporing" may as well be translated as "tracking down", giving the concept a whole new - somehow slightly TAC-like - dimension...)

But let's have a look at what this, allegedly so revolutionary, project actually is all about. According to the report, I link to above, treatment consists of five different initiatives: Individual dialogues, medical treatment (here we go!), psycho-education (Honi soit qui mal y pense!), social skills training, and family work (of course meaning work with your biological family, your relatives. Certainly not the "family" of your own choice, your friends. As we all know, care providers are much more fond of relatives than of friends. And they have their reasons, yahahhh!).

'Well,' you may think, ' individual dialogues does sound promising, doesn't it?' Let me tell you right away: I'll have to disappoint you. In another report on the project, that in the meantime has disappeared from the net, it was stated that the individual counselling a person is entitled to during the two-year-period she is assigned to the project, is limited to 12 - TWELVE! - in certain cases up to 24 - TWENTY FOUR! - sessions with a therapist, and that the subject of the sessions would have to be agreed upon beforehand. Yep. Unfortunately, this is not a joke. While the counselling itself definitely turns into a joke, under these circumstances.

My own course included 45 sessions, spread over the period of three and a half years. A (-n absolute) minimum, when it comes to "psychosis". And only possible because I a) wasn't twenty years old - or young - anymore, but more like two times twenty, with the according life-experience and a certain background knowledge in relevant areas (such as philosophy, literature, and, yeah, psychology/-analysis).

Because I b) was as motivated and determined as you possibly could be - not to learn how to live with a chronic, limiting illness, but to become aware of, understand, and resolve my existential problems.

Because I c) wrote - 24/7 ("I'm fond of saying psychosis does not fit the 50-minute hour -- because it goes on 24 hours." -Loren Mosher), and not for the drawer, but for my therapist to read. Which means, that, anytime, I could have a certainly imaginary but nevertheless somewhat concrete conversation with my therapist, on paper. Also at 3 a.m. in the morning, if necessary.

Because I d) wasn't additionally traumatized by a stay at a locked ward, respectively by the betrayal of my trust it would have been to arrange for such a stay against my explicit will. Something that inevitably hadn't only meant a remarkable setback in my recovery, but that under all circumstances also had ruined any trust in my therapist for good. And that in any other professional in addition. While I, at the same time, was pretty clear about what to do in case it should turn out, that there, obviously, was no trusting in humanity at all. "Suicide was my ticket out," Catherine Penney says in Take These Broken Wings, asked about what she thinks would have happened had she not met Daniel Dorman. It also was my ticket out.

Because I e) wasn't at any time drugged,

because f) nothing ever was agreed upon beforehand but date and time for the next appointment,

and last but certainly not least because I g) didn't raise to the biological bait, other than for a, luckily very short, period where I had some doubt, caused by the massive propaganda everywhere. By the way the only period of time in my entire life where I seriously contemplated suicide - the real deal, not the "I want/have to go somewhere else"-thing the voices tried to convince me of. You don't change your genes, or a chronic chemical imbalance in your neurotransmitters just like that. You can only, passively, hope, that the "medication" works its magic. But you can always become active, and change learned behavior - and recover fully.

Which brings us back to the OPUS-project. According to the report I link to above, the weekly dialogue sessions are sessions with what is called a contact-person. The term "therapist" thus has disappeared entirely from this, obviously newer report. So what. Eventually, it anyway was just a joke, wasn't it?

Well, and in this, newer, report it says under "individual dialogue":

"The dialogue treatment can include many elements: counselling, guidance, crisis intervention, psycho education, relaps prevention, psychological support of insight and actual cognitive therapy. [Ah, so there they maybe were anyway, those 12, maximum 24 sessions with a therapist??? Absolutely out of this world fantastic!]

In general, the dialogues can be scheduled according to the phase, the patient is in, like this:
Acute phase:
Contact and treatment compliance are established. The dialogues are primarily of supporting and psycho-educating character, (...)
Stabilizing phase:
The patient is supported in him continuing to follow the treatment, although he has improved. Psychological support is given for insight and acceptance, (...)
Maintenance phase:
Support is given to continue the treatment, (...)"

Under "medical treatment" you can read in detail about what exactly is supported with such a great effort and persistence:

"For most of the patients antipsychotic medical treatment has been indicated."

Really cosy it gets a little further down in the document, where it is stated, that many people in crisis experience periods of "depression" - strange, very strange indeed, that they feel down after they were made believe, they suffer from a chronic biological brain disease - which then of course preferably are treated with antidepressants, SSRIs, according to the report. Since the "depression" is to be regarded part of the biological disease, and certainly not a result of humiliating and disillusioning messages from the "helpers", that render the individual in crisis completely disempowered and helpless, no no! And since, as we all know, they've shown to be so effective, the SSRIs, yes! And by the way, no no, it is neither the so-called "antipsychotic medication", that can cause depression as a side effect!

Yah, and since both "psychotic and depressed states can cause a lot of anxiety" - no no, this is certainly not a side effect of the recommended SSRIs! - we can easily add one or the other benzo to the cocktail, that in case of a diagnozed substance abuse (and we will have to term the consumption of three different psychoactive substances on a daily basis for an indefinite period of time - it's chronic, remember?! - a substance abuse, although it hardly will be diagnozed) can get spiced up with some methadone or the like. Cheers! Or: Your health!...

If you're lucky, you then end up like Gianna, who, after almost twenty years in a medical daze, saw through the charade, and now in her fifth year, physically seriously damaged by the drugs, struggles to free herself from the prescribed psych drug hell. If you're not so lucky, you end up more or less a vegetable at some supported housing program - or like Luise.

And, in case you should be the owner of a healthy amount of scepticism, OPUS also has a solution for this:

"It often happens, that the patient doesn't wish to take medication, especially the antipsychotic medication. (...) At OPUS our philosophy has been, that, if the patient didn't want the medicine, that was found necessary for him, the patient had his reasons, and it was the task of the staff to investigate the background, educate about what the medication could be used for, and which side effects could be expected, and to try continuously to motivate acceptance of the relevant treatment." Yep. And then you end up like Gianna, or Luise, anyway. When you, because you already are in a somewhat vulnerable state of mind, can't stand the psycho-terror (being "motivated") anymore. With or without healthy scepticism.

Note that "treatment" in the above quotation equals to drugs. So, don't count on other kinds of treatment to be offered. Obviously, the weekly dialogues are not so much meant as treatment in a therapeutic fashion, as they are meant to be indoctrination. While, in a way, indoctrination is the exact opposite of therapy.

OPUS finally died as a "masterpiece", in my opinion, with the following quotation, that, characteristically, is found under "Familywork", which according to the report includes "individual meetings at the start of treatment" with the relatives, "without the patient but with the patients acceptance" - What is attempted to be saved here, by the bell? The "Nothing about us without us"-concept? Nice try. Try again! Cf. above: psycho-terror of people in extremely vulnerable states of mind - :

" - psycho education with weight on a biological model (guilt-reducing)"

How did Loren Mosher put it? " 'Biologically based brain diseases' are certainly convenient for families and practitioners alike. It is no-fault insurance against personal responsibility." And: "Biological differences 'make them different from us fundamentally,' he says. 'They're sort of a slightly different race than we are.' Mosher thinks it's all 'a way of carefully saying, 'These people are really different. And therefore we have the right to do whatever we goddamn please with them,' ' " he is quoted in this article.

Or, to put it in a slightly different way: Whether or not it costs "the schizophrenics" their lives - due to the drugs, or because suicide, quite logically and not the least sick, becomes the ticket out of an existence with a chronic brain disease - most important is, that doctors and relatives can wash their hands.

More fitting than one immediately should think, that Merete Nordentoft was awarded Den Gyldne Skalpel (The Golden Scalpel) for the OPUS-project. Reminds me of a certain Nobel Prize laureate...

And with this quite clearly stated disdain for people in crisis, the Danish branch of the ISPS, which Merete Nordentoft is a member of, and at whose International Symposium at Copenhagen in June 2009 she is going to participate as a member of the local scientific committee, died too in its shape of a pleasant surprise, and a potential link in my sidebar.

Concerning other than the "insight" and "treatment alliance" promoting "support" offered by OPUS: I had a friend who was assigned to OPUS. "A place to stay? Sorry, we can't help you with that. A job? Sorry, we can't help you with that." But the pills he got. Straight out. And all for free. He didn't even need to ask for them. Oh, and along with the pills came the message: "It's a lifelong burden." I wouldn't be surprised if he killed himself. He chose to believe in their message - and was devastated by it - although I did my very best. But it was my word against the "experts"...

This really must be termed excellent support of people in crisis.

And no, I was wrong. They don't hide. Not at all. They're right there. Having a biobiobiopsychiatrically splendid time right in the middle of Danish biobiobiopsychiatry. The members of the Danish branch of the ISPS. Obviously, promoting the "psychological treatments" in their interpretation means nothing much else than promoting "the slightly more sophisticated" version of pitch-black, poisonous pedagogy. Sad but true. But not that surprising anyway, in the country of the Jante Law.

By the way, also Lene Falgaard Eplov, who is convinced that recovery can't be anything else than learning to live with a chronic brain disease, and biopsychologist Torben Schjødt are members of the Danish ISPS group. Uhm, yah, R.I.P. ISPS Denmark.

If you should read the report on the OPUS project, note that the possibility to receive trauma related therapy isn't mentioned once throughout the entire report. Not even a superficial look at the individual in crisis' life story is mentioned. Thus it is denied in advance, that traumatic experiences can cause emotional suffering. Apropos of the persecutor at any given time doing whatever is in his power to prevent the victim - and the surroundings - from becoming aware of the abuse/mistreatment.

The report is an evaluation from the years 1998 to 2002. The OPUS-project still operates, by and large in the same way as described in the report. It's outcomes: no change in the number of people who become chronically ill and go on disability - roughly 90% of those labelled with "schizophrenia" or other "psychotic disorders" in this country. Indeed, what a masterpiece!

*) While I'm at it: A quote from the "Guidelines for practice" published by the Swedish ISPS-group: "Antipsychotics are a corner stone in the treatment of patients with psychosis. During the acute phase benzodiazepines are to be offered to treat sleepnessness and anxiety."

**) Originally, I here had a link to a paper on the OPUS-project published on Århus Universitetshospital Risskov's - Danish biopsychiatry's stronghold, setting the fashion for the psychiatric system all over the country, and the location for OPUS to, initially, be established - website. Unfortunately, the paper has disappeared from the website. Several other publications about OPUS can be found here though.


Moss said...

Excellent article. Keep up the good work. We are not labels, we are not consumers, we are people.

Mark p.s.2 said...

I have an OPUS card. (This is a joke on the OPUS acronym). The card is used to get on public transport here.

Daniel Mackler said...

Thanks for sharing this---I didn't know about it. More to learn every day!! Much appreciated. (I wish I could read your Danish writing too.)
-Daniel Mackler