November, 2003, speaker meeting of NAMI PA, Main Line,
available at www.NAMIpaMainLine.org/info-resources/
Our speaker, Dr. William Packard, presented a very informative and helpful talk entitled “Caring for the Whole Person: a Psychiatrist’s Perspective“. The goals of his approach are to minimize the impact of mental illness and maximize recovery and growth of the person who has the illness. He concentrated on approaches to treatment of a person who has recently had a first psychosis and been diagnosed, but many of the same principles apply in treating a person with chronic mental illness.
Medication is a necessary foundation for psychological treatment and recovery, but therapy is also important to restore the personality and maximize recovery. For effective therapy, it is important for the doctor and patient to establish mutuality, in which they trust and respect each other, work as a team, and actively cooperate in the treatment process. To achieve mutuality, it is important for the therapist to genuinely listen to the patient and understand the patient’s point of view and what is important to the patient. The psychiatrist who has understood the patient’s concerns and the patient who has been heard can work together more effectively, so the patient can accept the diagnosis and the need for medication and move forward in subsequent steps of recovery.
A first psychosis often occurs in the late teenage or young adult years and is an extremely difficult experience for many reasons. A psychotic episode undermines the sense of self the young person has been developing, results in a loss of control and independence, disrupts career plans and also often results in the loss of friendships. Thus, it is understandable if a person who has recently developed a major mental illness is hurt, angry and afraid. The patient needs help to emerge from the overwhelming emotions and begin to use logic as a basis for problem-solving to cope with the multiple problems of having a major mental illness. To counter the many negative feelings, it is helpful to take positive approaches such as:
— fostering the mentally ill person’s pride in their ability to cope with the very difficult experience of psychosis and their progress toward recovery (an important step in restoring the person’s sense of competence),
— emphasizing positive goals, such as wanting to feel good again and get back to the person’s “old self”,
— distinguishing between the illness which is the problem, and the person, who is more than just the illness.
To minimize the impact of illness, Dr. Packard helps the patient regain their identity and distinguish themselves from their illness, while nevertheless accepting that they do have an illness which requires treatment. As the patient moves from the acute phase to the chronic phase, Dr. Packard helps the patient to repair self-esteem and restore self-confidence and ambition.
Once Dr. Packard and the patient have established cooperation, he recommends several steps the patient should take to enhance recovery, including:
— take prescribed medications, and discuss any doubts and questions with the doctor
— educate oneself about one’s illness
— avoid drugs and alcohol
— get enough sleep, since it restores the mind.
Recovery is a slow process, and it is not surprising that patients may be impatient with the difficulty and slowness of recovery. However, we have good grounds for hopefulness, since a high rate of functional recovery can be achieved by the combination of medication and weekly therapy over several years. For example, studies by Lili Kopala and others have shown that the combination of second generation antipsychotic medications (the atypicals) and weekly therapy for 2-5 years can dramatically diminish hospitalization and suicide rates and improve neurocognitive function and social and occupational functioning.
The family of a young person who has developed a major mental illness also has a very difficult task and many difficult emotions, including grief, fear of the unknown, an overwhelming sense of responsibility, and often shame and embarrassment. Often family members may experience a depression after their loved one develops a psychosis. Useful strategies include:
— learning about the illness, e.g. from books and NAMI
— talking about the experience, e.g. in support groups, with friends, and with the mentally ill family member
— taking an active approach to help the recovery of the mentally ill family member, as well as to care for one’s own health.
In summary, Dr. Packard emphasized the following strategies for effective treatment:
— the importance of medication as a foundation for treatment
— the need for the patient to feel heard, to accept that he or she has an illness, and to collaborate with the doctor in working toward recovery
— getting the patient and family to work together as a team
— the importance of the distinction between the illness and the individual who is more than his or her illness
— treating the illness as a problem (or series of problems) to be solved
— allowing time (several years) for the personality to restore itself and grow.