Kim Hopper Center to Study Recovery in Social Contexts October 2009 A note on the project: This paper will attempt to lay out a usable version of the capabilities approach and explore how its conceptual toolkit might aid us in thinking about “first breaks” and early crises. As will quickly be evident, this is very provisional work. Applied work in capabilities that deals with physical and mental states of distinction, limitation and exclusion – difference, “impairment,” and “disability” – is still in its formative stages and has yet to get its linguistic house in order. So, a forewarning: In making the argument, this paper will necessarily raid and pillage a number of literatures for concepts, distinctions and applications that will then be put to provisional use, found wanting or misleading, and revised accordingly or thrown out. Initial or trial adoption of terms should not be mistaken for final endorsement – and, indeed, one of this paper’s major points will be the need to interrogate the conceptual frameworks we routinely take for granted in discussing public mental health, to question our well-worn equipment of everyday thinking To date, some preliminary efforts have been made to use the capabilities approach to rethink recovery and social integration as “outcomes,” to support self-determination, and to make a case for peer participation in research.1 Fueled by pilot funding from the Center to Study Recovery in Social Contexts, additional work is under way to examine decision-making, citizenship, parenting, community participation, complex poverty, and user views of freedom. This joint project with INTAR on “first breaks” opens fresh ground the charge is twofold: re-think and re-ground, framework and fieldwork – theory to direct the inquiry, practice that will need to be interpreted as evidence. Prologue: Transcript excerpt, BBC “Yesteryear” 2030 BBC Interviewer: “So, let me see if I have this right. Continue Reading…
Share“Reframing First Breaks and Early Crisis: A Capabilities-Informed Approach” — Kim Hopper
“Alternative approaches to first break situations: Key practice models and their operant values” –by Stastny, Chaudhary, Hagmann
I. Introduction: The purpose of this working paper is to identify and describe key alternatives to mainstream psychiatric intervention — designed to benefit individuals experiencing a first break or early crisis episode (see definition below) — that are either currently available or have been in operation since the mid 1970s. We focus on the three programs/practice models that are most prominently represented in the literature and that stood the best chance of falling within a set of guiding principles that are based on discussions held by members of the INTAR network during its four preceding meetings (see below). We examine these alternatives in terms of their operating principles, engagement of affected persons and interested others, outcomes, and consumer satisfaction, relying on published data, with the ultimate goal of determining to what extent these programs preserve and enhance existing capabilities, offer means of operationalizing “hope,” and assist participants in early recovery and a return to a viable developmental trajectory. We see this paper as a contribution towards developing a framework to systematically examine current and newly developed alternative modalities with respect to their potential for averting capability deprivation, enhancing recovery processes, fostering individual agency, and safeguarding the dignity and human rights of people experiencing serious mental health crises. We also hope this paper advances the discussion of just what constitutes a viable and acceptable response to a person experiencing a serious, and potentially debilitating break-down for the first time in their life. (download paper Continue Reading…
ShareFactors Involved in Outcome and Recovery in Schizophrenia Patients Not on Antipsychotic Medications: A 15-Year Multifollow-Up Study – Harrow & Jobe
This prospective longitudinal 15-year multifollow-up research studied whether unmedicated patients with schizophrenia can function as well as schizophrenia patients on antipsychotic medications. If so, can differences in premorbid characteristics and personality factors account for this? One hundred and forty-five patients, including 64 with schizophrenia, were evaluated on premorbid variables, assessed prospectively at index hospitalization, and then followed up 5 times over 15 years. At each follow-up, patients were compared on symptoms and global outcome. A larger percent of schizophrenia patients not on antipsychotics showed periods of recovery and better global functioning (p .001). The longitudinal data identify a subgroup of schizophrenia patients who do not immediately relapse while off antipsychotics and experience intervals of recovery. Their more favorable outcome is associated with internal characteristics of the patients, including better premorbid developmental achievements, favorable personality and attitudinal approaches, less vulnerability, greater resilience, and favorable prognostic factors. The current longitudinal data suggest not all schizophrenia patients need to use antipsychotic medications continuously throughout their lives. Read More Here: Continue Reading…
ShareTreating schizophrenia without drugs? There’s good evidence for it – Tim Calton
There is certainly a wealth of historical evidence supporting a non-medical approach to madness ranging from Geel, the city in Belgium where the ‘mad’ lived with local families, receiving support and care that allowed them to function in the ‘normal’ social world despite the emotional distress some experienced (Goldstein, 2003), to the so-called Moral Treatment developed at the York Retreat by William Tuke towards the end of the eighteenth century (Digby, 1985), which advocated peace, respect, and dignity in all relationships, and emphasised the importance of maintaining usual social activities, work and exercise. These approaches, predicated as they were on a gentle and humane engagement with the vagaries of human experience at the limits, and invoking respect, dignity, collective responsibility, and an emphasis on interpersonal relationships as guiding principles, have much to tell contemporary biomedical psychiatry. In the modern era, non-medical attempts to understand and tend to ‘psychosis’ have coalesced into a tradition counterposed to the biomedical orthodoxy. The richest seam of evidence within this tradition is that relating to Soteria House , the project developed by Loren Mosher and colleagues in San Francisco during the early 1970s (www.moshersoteria.com). Here, people diagnosed with schizophrenia could live in a suburban house staffed with non-professionals who would spend time ‘being’ with them in an attempt to try and secure shared meanings and understandings of their subjective experience. Comment: PsychMinded, by Tim Carlton, April 24, 2009 Read More Here: Continue Reading…
ShareAntipsychotic medication, mortality and neurodegeneration: The need for more selective use and lower doses – Weinmann & Aderhold
Abstract Introduction: Although a range of adverse effects of antipsychotic medication are well documented, less attention has been paid to the issue of reduced life expectancy. Method: The medical literature was searched to identify studies assessing severe somatic side-effects of long-term antipsychotic treatment with a possible impact on mortality, and studies evaluating antipsychotic-associated brain structure changes. Conclusion: Antipsychotics should be used more selectively, for shorter durations and with lowest possible effective dose. Greater use of psychosocial interventions that have been proven effective should be an integral part of facilitating reductions in frequency, dosage and duration of antipsychotics. Psychosis, Volume 2, Issue 1 February 2010 , pages 50 – 69 Read More Here: Continue Reading…
ShareReversal of Schizophrenia Without Neuroleptics – Irwin
It is commonly believed tha t reversal of schizophrenia is accomplished primarily through neuroleptic drug treatment, but this belief can only be maintained by ignoring a great deal of material published in the scientific literature. Randomized studies comparing psvchosocial treatment programs without neuroleptics to drug-based programs were sought out for review, and six were found. Long-term out comes were statistically equivalent or superior in the nondrug group in all six studies, even those where the quality of the psvchosocial treattment was questionable. In studies with psychosocial interventions that appeared to have higher quality, both short- and long-term results were equivalent or superior without neuroleptics. These findings suggest that neuroleptics interfere with long- term recovery and, if appropriate psychosocial interventions are available, are not even necessary for short-term behavior control. Matt Irwin, Ethical Human Psychology and Psychiatry, Vol. 6, No. 2, Summer 2004 Read More Here: Continue Reading…
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