Psychologists with Mental Disorders?

[psycholytic]

I would like to ask all of you who know their state's law: Are people with a mental disorder, such as bipolar disorder, allowed to practice clinical psychotherapy?

[Therapist4Chnge]

Yes. Consider the prevelance rates for various disorders, it will happen. Also, you wouldn't be able to legally restrict a person from working in the profession.

-t

[toby jones]

I would have thought that it would have been discrimination to prevent people from practicing on the basis of their mental illness.

I would have thought that if someone is competent and professional then there shouldn't be a problem (regardless of diagnostic history) whereas if someone is not competent and professional then they should not be allowed to practice (regardless of diagnostic history).

But I have no idea of the law.

What I do have an idea of, however, is people being told they can't do this and they can't do that on the basis of their diagnostic history. Categorisation often causes more harm than help IMHO...

[psycholytic]

Originally Posted by Therapist4Chnge

Yes. Consider the prevelance rates for various disorders, it will happen. Also, you wouldn't be able to legally restrict a person from working in the profession.

-t

I can't help it, that's a scary thought to me.

[psychanon]

Originally Posted by psycholytic

I can't help it, that's a scary thought to me.

Why?

[psycholytic]

Originally Posted by psychanon

Why?

I would assume that serious disorders are more likely to interfere with therapy and reactions of such a clinician, than not enduring those type of disorders, which in return could potentially be not in the best interest of a client being on the receiving side.

That's the best explanation I can offer.

[Psyclops]

Read: "An Unquiet Mind" By Kay Redfield Jameson.

[Paranormal]

I'm really glad that someone brought this up, because i've been thinking about it myself.

but I do have to say that it is a little dissapointing to know that a psych student, planning to be a psychologist, says that she/he is fearful of the fact that individuals with mental disorders can make a living out of this profession.

you need to remember that with ANY professional in this field, he/she always has a supervisor. no matter what, if the person is unfit for the job, he/she will NOT do the job--period. i can understand where your fear comes from, and it's mostly from ignorance, but that's not your fault.

There are laws, and strict rules to follow while practicing psychotherapy. you should only be afraid of the fact that mentally ill people practice psychotherapy if issues/problems occured from them in the past. for all i know, there hasn't been any. i havn't heard of one at all.

i think if anything, it can even make the counselling relationship better (without the patient knowing of the counsellors illness) since the counsellor would easily feel empathetic towards clinical cases. though no experience of a serious condition is necessary for this to happen--counsellors should be empathetic anyhow. but there are quite a few cases of prominent people in the field that have contributed so greatlly to psychology due, mostly, to their own experience with disorders.

and by the way, someone with bipolar disorder who is having a hard time with their depressive/manic bouts would NOT want to be counselling anyway. they'd be getting the counselling before they give it.

[toby jones]

> I would assume that serious disorders are more likely to interfere with therapy and reactions of such a clinician, than not enduring those type of disorders, which in return could potentially be not in the best interest of a client being on the receiving side.

I disagree with the assumption. Even if the assumption is true in 99.999% of cases the assumption could prevent the 00.001% of the population who could go on to do good work. I like to think that ability to be a competent clinician would be something that would be assessed on an individual, case by case basis, rather than something that is assumed on the basis of diagnostic history.

The 'serious disorders' that you speak of are probably the ones that are controlled fairly well with medication? Or perhaps you think that bi-polar and the like are due to psychodynamic factors so that even if the medication is controlling the symptoms well enough for the person to complete their training to the satisfaction of their supervisors their psychodynamic conflicts are likely to hurt their patients somehow?

I do think that you might want to think a bit more on the utility of your assumption. Especially if you are going to be working with clients who have disorders that you consider to be 'severe'. If you tell people that they can't do certain things because their diagnostic history means they are likely to harm others then do you think that makes it more likely that they will harm others or less? The expectations that we have of people can have a fairly significant causal impact on their behaviour...

Just a thought.

[WaitingKills]

I can only state what I know from doing my masters in clinical psych in australia that the registration boards ask about mental illness and addictions in order to cover their ass.

When registering in Queensland, I was asked if I had a mental illness, addiction or other ailment that I thought would interfere with my professional duties and ethics.

I have heard from other people, that if you have an illness like bipolar, schizophrenia etc, that you can have practicing requirements such as being under regular care of a medical professional, taking medications, required to take time off if you are having a 'relapse'.

These issues won't preclude you from registering, but these boards have to know, not only to cover their ass, but yours if you get into problems.

I'm sure this would be the same in Canada or the States.

[psycholytic]

Originally Posted by WaitingKills

I can only state what I know from doing my masters in clinical psych in australia that the registration boards ask about mental illness and addictions in order to cover their ass.

When registering in Queensland, I was asked if I had a mental illness, addiction or other ailment that I thought would interfere with my professional duties and ethics.

I have heard from other people, that if you have an illness like bipolar, schizophrenia etc, that you can have practicing requirements such as being under regular care of a medical professional, taking medications, required to take time off if you are having a 'relapse'.

These issues won't preclude you from registering, but these boards have to know, not only to cover their ass, but yours if you get into problems.

I'm sure this would be the same in Canada or the States.

Thanks for the response

Same in Germany! I don't know though if it is to cover their ass, since it would not make sense to let someone practice, and if anything goes wrong related to their illness, how would their ass be covered ?

[WaitingKills]

Originally Posted by psycholytic

Thanks for the response

Same in Germany! I don't know though if it is to cover their ass, since it would not make sense to let someone practice, and if anything goes wrong related to their illness, how would their ass be covered ?

Ok, say I have long-term depression and I'm a psychologist.

I have a client come in who's also depressed and we talk about the benefits of suicide and how much life suck and that there is nothing really to live for blah blah blah.

So client makes a miraculous recovery (was a 'reserve' listed applicant for her psych degree, and found out that she made it in the second offers) and is now feeling better. Reflecting on the situation in counselling, she decided that my interventions were inappropriate and damaging. She sues both me and the registration board for allowing an 'unfit' psychologist to practice.

If I have been honest with my application to the relevant registration board, they can buffer this by saying either A. she didn't admit that she had depression therefore we are not responsible and turn around and sue me themselves, or B. we did know that she had depression however she is not following our requirements (take time off if relapsing etc) therefore we did the best we could to care for this situation...

This is a vague, and probably ****ty example, but you can get my point.

[psycholytic]

Originally Posted by WaitingKills

Ok, say I have long-term depression and I'm a psychologist.

I have a client come in who's also depressed and we talk about the benefits of suicide and how much life suck and that there is nothing really to live for blah blah blah.

So client makes a miraculous recovery (was a 'reserve' listed applicant for her psych degree, and found out that she made it in the second offers) and is now feeling better. Reflecting on the situation in counselling, she decided that my interventions were inappropriate and damaging. She sues both me and the registration board for allowing an 'unfit' psychologist to practice.

If I have been honest with my application to the relevant registration board, they can buffer this by saying either A. she didn't admit that she had depression therefore we are not responsible and turn around and sue me themselves, or B. we did know that she had depression however she is not following our requirements (take time off if relapsing etc) therefore we did the best we could to care for this situation...

This is a vague, and probably ****ty example, but you can get my point.

Yeah, I guess you have a point there

[50960]

Not to hijack this thread at all, but WE are doctors, they are patients, we are not lawyers, used car salesmen or real estate agents, and they are not clients whether they pay out of pocket or not..........sigh

[toby jones]

> I was asked if I had a mental illness, addiction or other ailment that I thought would interfere with my professional duties and ethics.

My reading of that is that if you feel you are likely to be unprofessional enough to get sucked into a discussion on the virtues of suicide DESPITE your patients best interest then you would be wise to speak up.

If, on the other hand, you don't see your history of mental illness or addiction or whatever to be something that is likely to interfere then you don't need to mention it.

My understanding of the statement is that they are indeed trying to screen people who are seriously concerned that they won't be able to practice competently (if you believe it then that goes some way towards making it so).

My understanding is that discriminating against people on the basis of their diagnostic history is a breech of human rights. Discriminating against people on the basis of their inability to perform their job adequately, on the other hand...

[50960]

Toby, as a licensed psychologist, you will asked this ? a million times, by medical staffs, by credentialling agencies, by the board of psych, by insurance companies, by anyone who can. YES they can use it against you, life is not fair. YES you do have recourse if they do, but it is likely more of a pain in the ***** than most people wish to be involved with. It is mid-level harassemt, but if you are not ill you are safe, and if you are ill they probably have a good reason to try and find that out. Not everyone can be a psychologist.

[psycholytic]

Originally Posted by psisci

Not to hijack this thread at all, but WE are doctors, they are patients, we are not lawyers, used car salesmen or real estate agents, and they are not clients whether they pay out of pocket or not..........sigh

Sorry, which post are you referring to?

[psycholytic]

and by the way, someone with bipolar disorder who is having a hard time with their depressive/manic bouts would NOT want to be counselling anyway. they'd be getting the counselling before they give it.[/QUOTE]


Response to paranormal
And why do you think that is the case?

[psycholytic]

I do think that you might want to think a bit more on the utility of your assumption. Especially if you are going to be working with clients who have disorders that you consider to be 'severe'. If you tell people that they can't do certain things because their diagnostic history means they are likely to harm others then do you think that makes it more likely that they will harm others or less? The expectations that we have of people can have a fairly significant causal impact on their behaviour...

Just a thought.[/QUOTE]


Response
I do not understand what your standards are? Would you have a person who shoots heroine give you an injection or one that does not?

I am not implying that the heroine addict couldn't do it well 95% of the time; I would be concerned about the rest.

But, hey, you can choose your game, I can choose mine.

I must also tell you, that it should be okay if I have a different opinion than yours on that topic, and know that this has zero to do with how one treats clients. I was talking about the clinician, did you confuse that?

[toby jones]

> as a licensed psychologist, you will asked this ? a million times, by medical staffs, by credentialling agencies, by the board of psych, by insurance companies, by anyone who can.

And everytime they ask you can say 'I don't know of anything' honestly if you truely believe that your past diagnostic history is not relevant. Of course it can take a bit to get to that point especially in light of other people saying that past diagnostic history is ineed likely to make you incompetent.

IMHO this is an example of how clinicians (who jolly well should know better) condone and encourage people to see themselves as being persistently limited and defective in virtue of their diagnostic history. It doesn't do anything to counter stigma in fact it goes quite a long way towards promoting it.

Another poster posted some names of people who are practicing psychiatrists who have received a diagnosis of schiozphrenia in their history. They must have been remarkable people to have been able to succeed in that DESPITE other people thinking that they shouldn't have been allowed to do that. Just think how many more people could go on to achieve great things if only we believed in them and encouraged their strengths instead of repeatedly focusing on their past histories.

They can't use it against you if they don't know about it. I don't see that diagnostic history is relevant therefore I don't see why I couldn't honestly answer 'I don't know of anything that is likely to interfeare with my ability to give competent therapy'. What more do they need to know? Are they allowed to ask you about your sexual preference or marital status? You are supposed to inform them about disabilities (insofar as they are likely to impact on your ability to offer competent services) and I don't see how it is different in the case of mental illness.

I think people get carried away with making future predictions about people on the basis of their diagnostic category. I think that the generalisations about future behaviour (when they do hold) quite often hold as a matter of self (or clinician) fulfilled prophecy.

[psycholytic]

Originally Posted by toby jones

> as a licensed psychologist, you will asked this ? a million times, by medical staffs, by credentialling agencies, by the board of psych, by insurance companies, by anyone who can.

And everytime they ask you can say 'I don't know of anything' honestly if you truely believe that your past diagnostic history is not relevant. Of course it can take a bit to get to that point especially in light of other people saying that past diagnostic history is ineed likely to make you incompetent.

IMHO this is an example of how clinicians (who jolly well should know better) condone and encourage people to see themselves as being persistently limited and defective in virtue of their diagnostic history. It doesn't do anything to counter stigma in fact it goes quite a long way towards promoting it.

Another poster posted some names of people who are practicing psychiatrists who have received a diagnosis of schiozphrenia in their history. They must have been remarkable people to have been able to succeed in that DESPITE other people thinking that they shouldn't have been allowed to do that. Just think how many more people could go on to achieve great things if only we believed in them and encouraged their strengths instead of repeatedly focusing on their past histories.

They can't use it against you if they don't know about it. I don't see that diagnostic history is relevant therefore I don't see why I couldn't honestly answer 'I don't know of anything that is likely to interfeare with my ability to give competent therapy'. What more do they need to know? Are they allowed to ask you about your sexual preference or marital status? You are supposed to inform them about disabilities (insofar as they are likely to impact on your ability to offer competent services) and I don't see how it is different in the case of mental illness.

I think people get carried away with making future predictions about people on the basis of their diagnostic category. I think that the generalisations about future behaviour (when they do hold) quite often hold as a matter of self (or clinician) fulfilled prophecy.

We are talking current, not past histories.

[psycholytic]

Originally Posted by toby jones

> as a licensed psychologist, you will asked this ? a million times, by medical staffs, by credentialling agencies, by the board of psych, by insurance companies, by anyone who can.

And everytime they ask you can say 'I don't know of anything' honestly if you truely believe that your past diagnostic history is not relevant. Of course it can take a bit to get to that point especially in light of other people saying that past diagnostic history is ineed likely to make you incompetent.

IMHO this is an example of how clinicians (who jolly well should know better) condone and encourage people to see themselves as being persistently limited and defective in virtue of their diagnostic history. It doesn't do anything to counter stigma in fact it goes quite a long way towards promoting it.

Another poster posted some names of people who are practicing psychiatrists who have received a diagnosis of schiozphrenia in their history. They must have been remarkable people to have been able to succeed in that DESPITE other people thinking that they shouldn't have been allowed to do that. Just think how many more people could go on to achieve great things if only we believed in them and encouraged their strengths instead of repeatedly focusing on their past histories.

They can't use it against you if they don't know about it. I don't see that diagnostic history is relevant therefore I don't see why I couldn't honestly answer 'I don't know of anything that is likely to interfeare with my ability to give competent therapy'. What more do they need to know? Are they allowed to ask you about your sexual preference or marital status? You are supposed to inform them about disabilities (insofar as they are likely to impact on your ability to offer competent services) and I don't see how it is different in the case of mental illness.
I think people get carried away with making future predictions about people on the basis of their diagnostic category. I think that the generalisations about future behaviour (when they do hold) quite often hold as a matter of self (or clinician) fulfilled prophecy.

Response
If it is highly related to your work and possible negative outcomes it could have on people involved, why not?
They will ask your religion if you try to become a priest (they wouldn't let me in for sure). On the other hand , I wouldn't want a religiously devoted person preach their stuff to me all the time at the university, and guess what, that crap happens all the time. I guess, life is not fair

[50960]

You are confusing how things should be with how they are. If you have bipolar disorder you can get all sorts of perks, and rightly so from the ADA, from others involved in your care who understand, and maybe your job. However, if you are a person wishing to go into the upper 99.99 percentile of people who get a doctoral degree intending to license them to provide care for others, you may get help in school, residency etc..., but after that you are alone. Sure you can say no to all those questions, and I advise you to do just that, but they are out there looking to sniff you out. I knew a guy who got an Rx from his doc for vicodin to help with severe knee pain post ACL surgery 2-3 months. He worked at a hospital, and some nurses knew, told their friends..... Dr. Shrink got vicodin, one of the nurses knew a borderline PATIENT of his, and she reported him. After 6 years, and over 100k he kept his license...lost his wife, and became a serious gambling addict. This guy was 33 and on top of the world when I met him. When you actually get a license and are practicing write me back, there is no utopia here, only business and politics. You need to have a clue, not a soft heart to survive. This is a true story from ca.....

[toby jones]

I think people might be missing what I'm saying here. I agree that if there are current things that are likely to impact on ones ability to be professional then the profession may not be for you. That being said everybody has things they need to work on, eh? I guess it is a matter of assessing whether one can be a competent professional or not.

What I'm speaking out about is people thinking that PAST diagnostic history automatically rules out certain professions.

I would think that in the individuals case they have the application procedure and interview process. Then they have however many years of graduate school where performance over time can be assessed. They also have clinical supervision where performance over time can be assessed. If they are unable to do it then I guess that will become apparant at some point. I think it is unfair to rule people out on the basis of their diagnostic history without actually ASSESSING application, interview, grad school, and practical performance, however.

Surely it is possible for clinicians to see other clinicians for medication or even therapy. As such it is surely possible for support to continue well after graduate school.

> they are out there looking to sniff you out. I knew a guy who got an Rx from his doc for vicodin to help with severe knee pain post ACL surgery 2-3 months. He worked at a hospital, and some nurses knew, told their friends..... Dr. Shrink got vicodin, one of the nurses knew a borderline PATIENT of his, and she reported him... This guy was 33 and on top of the world when I met him. When you actually get a license and are practicing write me back, there is no utopia here, only business and politics. You need to have a clue, not a soft heart to survive. This is a true story from ca...

Was there more to this?

She reported him for what, exactly?

Given that there are some lisenced clinical psychologists and psychiatrists practicing who are indeed open about their diagnostic history I'm going to retain my faith in the profession. I'm not talking about lying about current abilities I'm just talking about being able to say 'sure, I was diagnosed with that in my past but you know what? I'm doing alright now and so no I don't see anything that is likely to impact on my ability to do this'. Not anymore so than the worries that other people have.

It is interesting to me that full recovery rates for schizophrenia are around two thirds in developing nations (that have less access to psychological / psychiatric services) and around one third in developed nations (that have much better access to psychological / psychiatric services). This gets me wondering about the causal impact of being told that one has a severe illness that is likely to impact on ones life into the future.

FYI no, I don't have a dx of scizhoprenia or bi-polar or anything like that. I am, however, genuinely interested in being able to help people. I'm not sure how much it helps them to pat myself on the back for being the epitome of psychological health or to run their future down in order to make mine look brighter.

[psycholytic]

Originally Posted by toby jones

I think people might be missing what I'm saying here. I agree that if there are current things that are likely to impact on ones ability to be professional then the profession may not be for you. That being said everybody has things they need to work on, eh? I guess it is a matter of assessing whether one can be a competent professional or not.

What I'm speaking out about is people thinking that PAST diagnostic history automatically rules out certain professions.

I would think that in the individuals case they have the application procedure and interview process. Then they have however many years of graduate school where performance over time can be assessed. They also have clinical supervision where performance over time can be assessed. If they are unable to do it then I guess that will become apparant at some point. I think it is unfair to rule people out on the basis of their diagnostic history without actually ASSESSING application, interview, grad school, and practical performance, however.

Surely it is possible for clinicians to see other clinicians for medication or even therapy. As such it is surely possible for support to continue well after graduate school.

> they are out there looking to sniff you out. I knew a guy who got an Rx from his doc for vicodin to help with severe knee pain post ACL surgery 2-3 months. He worked at a hospital, and some nurses knew, told their friends..... Dr. Shrink got vicodin, one of the nurses knew a borderline PATIENT of his, and she reported him... This guy was 33 and on top of the world when I met him. When you actually get a license and are practicing write me back, there is no utopia here, only business and politics. You need to have a clue, not a soft heart to survive. This is a true story from ca...

Was there more to this?

She reported him for what, exactly?

Given that there are some lisenced clinical psychologists and psychiatrists practicing who are indeed open about their diagnostic history I'm going to retain my faith in the profession. I'm not talking about lying about current abilities I'm just talking about being able to say 'sure, I was diagnosed with that in my past but you know what? I'm doing alright now and so no I don't see anything that is likely to impact on my ability to do this'. Not anymore so than the worries that other people have.

It is interesting to me that full recovery rates for schizophrenia are around two thirds in developing nations (that have less access to psychological / psychiatric services) and around one third in developed nations (that have much better access to psychological / psychiatric services). This gets me wondering about the causal impact of being told that one has a severe illness that is likely to impact on ones life into the future.

FYI no, I don't have a dx of scizhoprenia or bi-polar or anything like that. I am, however, genuinely interested in being able to help people. I'm not sure how much it helps them to pat myself on the back for being the epitome of psychological health or to run their future down in order to make mine look brighter.

Do you really not understand this or are you pretending? I can't believe this, did you ever look into the ethical standards of the profession. I admit that it is a complex topic, but if you just snip your sniff (vicodin, cocaine, whatever) from staff, you pretty much behaved unethically, and who knows what else you would do. Beyond that I have no more motivation to get deeper into this one.

[psycholytic]

Originally Posted by toby jones

> I was asked if I had a mental illness, addiction or other ailment that I thought would interfere with my professional duties and ethics.

My reading of that is that if you feel you are likely to be unprofessional enough to get sucked into a discussion on the virtues of suicide DESPITE your patients best interest then you would be wise to speak up.

If, on the other hand, you don't see your history of mental illness or addiction or whatever to be something that is likely to interfere then you don't need to mention it.

My understanding of the statement is that they are indeed trying to screen people who are seriously concerned that they won't be able to practice competently (if you believe it then that goes some way towards making it so).

My understanding is that discriminating against people on the basis of their diagnostic history is a breech of human rights. Discriminating against people on the basis of their inability to perform their job adequately, on the other hand...

Sorry, but you are not making any sense here? What are you trying to say? Maybe in 2 sentences , please.

[Manning]

I don't mind wading in. Please note that I'm not a doctor or training to be one. What I am, is an individual who has had a schizophrenic break [Ref.] and made a full recovery without hospitals, psychiatrists, medication, or formal therapy. I'm also someone who has spent the past few years extensively studying what it was that had happened to me and why. In the course of doing so I've stumbled across some of the most brilliant and innovative minds in psychology and psychiatry. I've also spoken intimately with a number of individuals who have gone through the experience known as psychosis / schizophrenia in this culture. I wandered in here the other day when the post chaos had made in regard to disclosure showed up in a blog search.

Having made my introduction, I'd now like to pass out a few bonus points...

toby jones: It is interesting to me that full recovery rates for schizophrenia are around two thirds in developing nations (that have less access to psychological / psychiatric services) and around one third in developed nations (that have much better access to psychological / psychiatric services).

The gist of this discussion seems to be founded on the assumption that a mental illness, even a severe one such as schizophrenia, is a permanent condition. I have had the unfortunate experience of encountering individuals on the other side of the fence you are all approaching, namely full-fledged doctors who have insisted that schizophrenia is incurable. I'm happy to tell you, they lost that argument.

As toby jones notes, the recovery rate from schizophrenia varies dramatically by culture; there have now been no less than three studies from the World Health Organization verifying that fact. How dramatic is the variance? According to the WHO, "The outcome differences are so marked that WHO concluded that living in a developed country is a strong predictor that a patient will never fully recover." India, on the other hand, has rates of recovery as high as 90%.


paranormal: but I do have to say that it is a little dissapointing to know that a psych student, planning to be a psychologist, says that she/he is fearful of the fact that individuals with mental disorders can make a living out of this profession.

Yes, it does seem to imply that the practicing clinician lacks faith that healing and recovery is a real possibility. Of course there is also tremendous stigma and fear regarding some mental disorders and schizophrenia in particular. I would suggest that this could be overcome by setting aside the stereotype that Hollywood has created of the schizophrenic lunatic -- the vast majority of schizophrenics I've spoken with are not violent but are highly empathic; a number of them are especially creative and sensitive. Are some violent? Yes, but they are not the majority.


paranormal: i think if anything, it can even make the counselling relationship better (without the patient knowing of the counsellors illness) since the counsellor would easily feel empathetic towards clinical cases. though no experience of a serious condition is necessary for this to happen--counsellors should be empathetic anyhow. but there are quite a few cases of prominent people in the field that have contributed so greatlly to psychology due, mostly, to their own experience with disorders.

To which I offer this quote by Carl Jung: "A schizophrenic is no longer schizophrenic when he feels understood by someone else."

The trouble is, most people do not know how to speak his or her language. A fellow sufferer however, knows the language. This is not to say that someone with first hand experience will automatically be capable of offering an empathic connection to the client -- it may well depend on which model they subscribe too. I have found tremendous insights from sufferers and non-sufferers alike. For example, Daniel Fisher is a practicing psychiatrist who was diagnosed with schizophrenia. The mere fact that he has recovered so fully serves as a beacon of hope to numerous others. I found the work of John Weir Perry however to contain far more personal insights for me. Perry has never undergone the experience of psychosis, but he did work with schizophrenics for 40 years.


toby jones: The 'serious disorders' that you speak of are probably the ones that are controlled fairly well with medication?

I find it regretable that so many people, clinicians included, invest their faith in medication. Often, this sets up a belief system wherein, if the individual does not seem to be getting better, their medication is changed and that's all that is changed. To be sure, I've spoken with numerous individuals who identified medication as personally helpful in their recovery. I've also spoken with a number of individuals who have not. Neuroleptics pack quite the whallop when it comes to side effects so I remain of the opinion that if one can get by without them, it's very much to their benefit to do so.

There are also valuable lessons to be learned from cultures and settings in which medication is not prescribed as the first line of defence. Psychiatry nearly always reaches for the prescription pad when dealing with schizophrenia, psychologists typically don't have that right and it's here that I see some very promising work in the field. For example....

Jaakko Seikkula, Ph.D. is a professor at the Institute of Social Medicine at the University of Tromso in Norway and senior assistant at the Department of Psychology in the University of Jyvskyl in Finland. Between 1981-1998, he worked as a clinical psychologist at the Keropudas hospital in Finland where he and colleagues developed a highly successful approach for working with psychosis known as Open Dialogue Treatment (OPT). The approach de-emphasizes the use of drugs and focuses instead on developing a social network of family and helpers and involving the patient in all treatment decisions. Ongoing research shows that over 80% of those treated with the approach return to work and over 75% show no residual signs of psychosis. Official government statistics comparing 22 health districts in Finland found that Dr. Seikulla's district was the only one not to have any new chronic hospital patients in a two year period and led the National Research and Development Center for Welfare and Health to award a prize for "over ten years ongoing development of psychiatric care".

Source: Open Dialogue Treatment

In closing this post, I'd like to recount a brief discussion I once had with a psychologist who had thirty years of clinical experience under his belt. I asked that individual, "Have you ever known anyone to recover from psychosis without anti-psychotic medication?"

"No," he said. "Not personally."

Thirty years of experience and he couldn't recall a single case.

I talk to psychologists and psychiatrists all the time. Most of them remain of the opinion that schizophrenia is incurable, that schizophrenia is frightening, that schizophrenia can only be tamed (but not cured) with a pill. Most of them believe that because that's what they were taught.

I'm here to tell you that "schizophrenics" and those who wish to assist them deserve better textbooks.

[Psych_Ho]

1) In applying for licensure, one is required to disclose past/current conditions, including psychiatric. Lying or not divulging this info is not only unethical but you can lose your license if your deception is uncovered. If you are under the care of a psychiatrist and are given the all clear, you are in the clear.
2) As a psychologist, you are ethically obligated to refrain from seeing patients if you have a situation or condition that is impairing your ability to provide services to them- when in doubt, consult with a colleague. It is totally fine to take a hiatus from seeing pts., get your own situation under control (even just stress from a divorce, or a physical illness, for example) and then return to practice. The problem is when you continue seeing pts. in the presence of a situation that is affecting your abilities.
3) Assuming the prevalence disorders characterized as "severe" is the same among the small % of the population that goes on to get a Ph.D. is illogical for a number of reasons. Yes, there will be disorders among psychologists. However, the fact is that chronic/severe illnesses DO affect one's occupational functioning and achievements (of course, not in ALL cases) and Ph.D. holders are not a representative sample of the population given their level of occupational achievment.
4). Yes, pts may file complaints with licensing boards and that is an unavoidable fact. The best way a licensed psychologist can protect themselves is to 1) document, document, document 2) consult with a colleague and document it 3) refrain from lying or deception 4) Have malpractice of your own, which you can get thru APA at very little cost and 5) document, document.
5) Re: virtues of suicide: check out Marsha Linehan's suicide assessment/ DBT stuff. It's ok to engage in a discussion about suicide with a pt. if you are prepared, know how to manage the discussion, and what is actually going on in the conversation- the message you need to convey to the pt. when they are saying suicide has "merit" - the question behind the question. The standard you wil be held to is what another reasonable/comptent professional in the field would do - the standard of care.

[psycholytic]

Originally Posted by Psych_Ho

1) In applying for licensure, one is required to disclose past/current conditions, including psychiatric. Lying or not divulging this info is not only unethical but you can lose your license if your deception is uncovered. If you are under the care of a psychiatrist and are given the all clear, you are in the clear.
2) As a psychologist, you are ethically obligated to refrain from seeing patients if you have a situation or condition that is impairing your ability to provide services to them- when in doubt, consult with a colleague. It is totally fine to take a hiatus from seeing pts., get your own situation under control (even just stress from a divorce, or a physical illness, for example) and then return to practice. The problem is when you continue seeing pts. in the presence of a situation that is affecting your abilities.
3) Assuming the prevalence disorders characterized as "severe" is the same among the small % of the population that goes on to get a Ph.D. is illogical for a number of reasons. Yes, there will be disorders among psychologists. However, the fact is that chronic/severe illnesses DO affect one's occupational functioning and achievements (of course, not in ALL cases) and Ph.D. holders are not a representative sample of the population given their level of occupational achievment.
4). Yes, pts may file complaints with licensing boards and that is an unavoidable fact. The best way a licensed psychologist can protect themselves is to 1) document, document, document 2) consult with a colleague and document it 3) refrain from lying or deception 4) Have malpractice of your own, which you can get thru APA at very little cost and 5) document, document.
5) Re: virtues of suicide: check out Marsha Linehan's suicide assessment/ DBT stuff. It's ok to engage in a discussion about suicide with a pt. if you are prepared, know how to manage the discussion, and what is actually going on in the conversation- the message you need to convey to the pt. when they are saying suicide has "merit" - the question behind the question. The standard you wil be held to is what another reasonable/comptent professional in the field would do - the standard of care.

Thanks for enhancing the thread. This is a good post. Could you maybe refer to a site (ehtical standards for clinician's , or such) so people can look it up and then know what the standards are? That would be great, thanks

[Squarepants]

Originally Posted by Manning

I'm here to tell you that "schizophrenics" and those who wish to assist them deserve better textbooks.

A very interesting (and informative) post, Manning. Congratulations on your recovery!

[50960]

Manning, although I appreciate your post, and the fact that you recovered, I feel one anecdotal story does not equal the conclusion that the whole field is wrong in its views of schizophrenia. This is similar to the people in the NE who were having a warm winter blaming it on global warming. Schizophrenia is a very debilitating disease that is not curable, but is treatable. There are many disorders that involve paranoia, hallucinations, thought disorders etc.. that are not schizophrenia, and some can be eliminated if the cause is found.

[Manning]

Squarepants: A very interesting (and informative) post, Manning. Congratulations on your recovery!

Thank you, Squarepants.

psisci: Schizophrenia is a very debilitating disease that is not curable, but is treatable.

Rather than argue the point with you, I believe it would be most beneficial to allow others to speak for me...

The psychotherapy of schizophrenia is, in my opinion, as much in the mind of the observers as in the mind of the patient. We must change before he can change. He has long been incurable because we have been hopeless.

-- Dr. Karl Meninger

In 1999 Ronald F. Levant EdD told a group of fellow psychologists how recovery from a major disorder such as schizophrenia was not only possible, it was happening regularly. “Recovery from schizophrenia: a colleague snorted, “Have you lost your mind too”?

Source: Why Can't They Recover?

In the early years of the nineteenth century, when psychiatry was just beginning, a furious argument raged between people with very different opinions about the nature and course of mental disorders. On the one hand, psychiatrists like Eugene Bleuler believed that recovery was possible and indeed likely for the vast majority of people suffering from serious mental disorders like schizophrenia (then called dementia praecox).

On the other hand, psychiatrists such as Emil Kraepelin insisted that recovery was impossible and that sufferers would never recover. Indeed he believed that their condition would get worse throughout their lives. Kraepelin won the debate and the idea of permanent illness and disability formed the basis of mental health services for almost two centuries.

Source: Understanding Recovery

Psychiatrist Naren Wig crossed an open sewer, skirted a pond and, in the dusty haze of afternoon, saw something miraculous.

Krishna Devi, a woman he had treated years ago for schizophrenia, sat in a courtyard surrounded by religious pictures, exposed brick walls and drying laundry. Devi had stopped taking medication long ago, but her articulate speech and easy smile were eloquent testimony that she had recovered from the debilitating disease.

Source: Culture & Mind: Psychiatry's Missing Diagnosis

I have entitled this presentation, "Long Term Outcome for Rehabiliated Psychiatric Patients: Reasons for Optimism". The plan this morning is to look at recovery and the evidence for it among people with very serious mental illness. Let us look at some things that we've learned about rehabilitation and also a little bit about resilience. I'm going to present seven of the ten world studies this morning.

Now, when we talk about subjects who are recovered, we're talking about no medications, no symptoms, being able to work, relating to other people well, living in the community, and behaving in a way that you would never know that they had had a serious psychiatric disorder. And if you have heard of that old belief that one third get better, one third get worse, and one third stay the same, we found that it was not true. In the Vermont Longtitudinal Study, we took the bottom third of this population and found that two-thirds of them also turned around. So that our old views of schizophrenia are considerably different than they have been for the last hundred years.

-- Dr. Courtenay Harding

Source: The Recovery Vision

Dr. Harding’s data are all the more powerful because she was studying the bottom 19% in the functional hierarchy in a large state hospital. Some of the people in her study had regressed to speaking in animal like sounds. Most had been in the institution for 10 or so years, many had been in and out repeatedly. The cohort is the least functional ever studied in world literature on schizophrenia. Nevertheless, of this bottom 19%, 62% to 68% fully recovered or significantly improved.


-- Dr. Edward Knight

Source: Recovery

The first study was done by [Dr.] Manfred Bleuler, whose father Eugene Bleuler renamed dementia praecox and studied schizophrenia. And his son,Manfred took over the hospital at Burgholzi in Zurich, Switzerland and he did what his father did not. He followed 208 people for 23 years and found that 53-68% of his subjects significantly improved or recovered.

"I have found the prognosis of schizophrenia to be more hopeful than it has long considered to be."

-- Manfred Bleuler

...85% of our clients (all diagnosed as severely schizophrenic) at the Diabasis center not only improved, with no medications, but most went on growing after leaving us.

- Dr. John Weir Perry

Source: Trials of the Visionary Mind

Gerd Huber and colleagues in Germany followed 502 for 22 years after their episode of schizophrenia and found 57% significantly improved or recovered.

"Schizophrenia does not seem to be a disease of slow progressive deterioration. Even in the second and third decades of illness, there is still the potential for full or partial recovery."

-- Dr. Gerd Huber

There have now been three World Health Organisation studies showing that the outcome for schizophrenia in Developing countries is better than in the Industrialised world. This is extraordinary. How can places without psychiatrists, psychiatric nurses, psychiatric facilities, rehabilitation programs, medication and therapies come up with results considerably better than our sophisticated, scientific industrialised world? A country such as the USA spends 1% of its GNP on one illness, schizophrenia, and has results far worse than countries that don’t spend anything!

-- Dr. Simon Baker

Source: The Developing World Experience

Luc Ciompi and Christian Muller in a medium-sized city in Lausanne followed 289 people for 37 years ... they found 53% significantly improved or recovered.

"The long-term evolution of schizophrenia is much more variable and considerably better than heretofore admitted."

- Drs. Luc Ciompi and Christian Muller

The WHO Study of Schizophrenia is a long-term follow-up study of 14 culturally diverse, treated incidence cohorts and 4 prevalence cohorts comprising 1,633 persons diagnosed with schizophrenia and other psychotic illnesses. Global outcomes at 15 and 25 years were assessed to be favorable for greater than 50% of all participants. The researchers observed that 56% of the incidence cohort and 60% of the prevalence cohort were judged to be recovered. Those participants with a specific diagnosis of schizophrenia had a recovery rate which was close to 50%. [...] The course and outcome for persons diagnosed with schizophrenia were far better in the “developing countries” than for such persons in the “developed” world of Western Europe and America.

-- Dr. Brian Koehler

Source: Long Term Follow-Up Studies

[Dr.] Ming Tsuang and the Iowa 500 study had the strictest criteria for schizophrenia but found 46% improved. Using the DSM III diagnosis, we found 62-68%. Dr. Ogawa et al. in Japan found 57% and Michael DeSisto in Maine found 49%.

Among those who went through the OPT program, incidence of schizophrenia declined substantially, with 85% of the patients returning to active employment and 80% without any psychotic symptoms after five years. All this took place in a research project wherein only about one third of clients received neuroleptic medication.

Source: Dialogue is the Change

When I was a staff psychologist at a neuropsychiatric institute in 1965, I conducted an experimental interview with an 18-year-old woman diagnosed as "acute paranoid schizophrenic." I'd been influenced by the writings of Carl Jung, Thomas Szasz, and Ayn Rand, and was puzzled about methods for training psychiatric residents that are unreported in the literature. I prepared for the interview by asking myself questions. I wondered what would happen if I listened to the woman as a friend, avoided letting my mind diagnose her, and questioned her to see if there was a link between events in her life and her feelings of self-esteem.

-- Dr. Al Seibert

Source: How Non-Diagnostic Listening Lead to Cure

A person receiving a diagnosis of schizophrenia loses hope and enters a state of anguish caused by an experience of meaninglessness, hopelessness and helplessness. Much of this hopelessness is not due to the disease but to the mental health systems designed to treat it. Mental health systems are set up for maintenance and usually communicate that life is without hope of significant accomplishment once serious mental illness has set in. Yet, experience shows that recovery from mental illness is possible.

-- Dr. Edward Knight

Source: Recovery

Hello, my name is Judi Chamberlin and unlike the two previous speakers, I am not a mental health professional. I was a person labeled with a serious mental health illness - I was diagnosed with schizophrenia when I was 21 years old, and I'm a person who's recovered. So I'm an example of what we're talking about today. And I think it's very important to recognize that recovery is not something that happens to a few exceptional, privileged or lucky people ... recovery is possible for everyone who's been diagnosed with a major mental illness.

Being told that you have schizophrenia is a devastating experience. Especially when I was told this, I was also told that I would always be ill, I was going to need treatment and it was terrifying. This happened in a time in my life when lots of things were going wrong and to be told that they weren't going to get better ... that things weren't going to come together for me, was taking away hope at a time when I needed, more than anything else, people believing in me. And I needed support, I needed someone to say that there are ways out of this morass you find yourself in and I wasn't hearing that. And what compounded it was that these people were the experts. They were the ones who were supposed to have the answers. So it was a terrible blow to be told by these experts that I was never going to get better.

Source: Confessions of a Non-Compliant Patient

We who have recovered from mental illness know from our personal experience that recovery is real. We know that recovery is more than remission with a brooding disease hidden in our hearts. We have experienced healing and we are whole where we were broken. Yet we are frequently confronted by unconvinced professionals who ask, "How can you have recovered from such a hopeless situation?" When we present them with our testimonies they say that we are exceptions. They call us pseudoconsumers. They say that our experience does not relate to that of their seriously, biologically ill, inpatients.


I recently re-experienced this negative attitude about recovery. A friend of mine, during a discussion in a psychology class, said she knew someone who had schizophrenia, recovered and became a psychiatrist. "He must have been misdiagnosed," was the professor's response. So my friend reviewed my earlier symptoms with me. I met the DSM IV criteria for schizophrenia in the interval from 1969-74. When she presented my history to her professor, he reversed his position and said that the diagnosis of schizophrenia must have been correct. He doubted I had recovered and said, "we now have a case of an impaired physician."

By having earned board certification in psychiatry, having worked as medical director of a community mental health center for 11 years and having directed the National Empowerment Center for 3 years I have proven that I am not an impaired physician. This episode reveals the depth of negative expectations which are taught to students. After all, mental illness is considered a terminal condition for which there is no cure. Therefore anyone who appears to have recovered must not have been sick. [*] This leaves no one with first hand experience of what helps and what hurts to speak for those who currently cannot speak due to their distress.

-- Dr. Daniel Fisher

Source: Healing and Recovery are Real

There have been many studies in the USA and other countries that point out that treatment - if practiced in a way that provides patient training leads to a normal life style - that includes jobs, education, and social skills training and relieves the guilt and loneliness associated with these conditions - then even the lowest level of schizophrenia can change and be reduced or eliminated from the lives of those who suffer this condition. The tragedy is that somehow - professionals - all over with some exceptions do not believe this is a reality.

What’s wrong with them?

Source: Why Can't They Recover?

Thank-You

.

[50960]

I understand your points, however this board is for student doctors not patients. A forum affiliated with SDN would be perfect for your topic www.psychcentral.com.

MOD