Medicine and Madness

What heals the patient with mental illness: psychotherapy, the doctor-patient relationship, daily exposure to a therapeutic community, or psychotropic medication?

In his book The Soloist, LA Times columnist Steve Lopez explores these options in his efforts to help a homeless black schizophrenic musician, Nathaniel Ayers. Mr. Lopez quotes Dr. Mark Ragins on the treatment of mental illness as outlined in Ragins’ book A Road to Recovery: “Making a diagnosis isn’t as important as making a connection. We’re not even sure what labels like schizophrenia and bipolar disorder mean, nor do we have very strong evidence that medication is the best response.”

According to Dr. Ragins, the history of mental health treatment—diagnosis, prescription—has been a colossal failure. While there is no cure for mental illness, Ragins believes that patients can rebuild their lives in the setting of therapeutic communities—places where they can develop a sense of belonging and learn how to manage their disease.

Ragins’ approach is refuted by a psychiatrist from the Los Angeles County Mental Health Department, who plays down the notion that doctors should focus on patients’ lives rather than just treating their symptoms. “A ‘warm and fuzzy’ embrace won’t get the job done,” she argues. “Chronically mentally ill patients are sick, sometimes dangerously so. They need psychiatric counseling and medication, not sunshine and hugs.”

Traditional allopathic medicine relies on pharmaceuticals to treat illness and disease. The humane medicine movement seeks to create awareness in the power to heal through attentive listening, empathetic understanding and therapeutic touch. Many patients still look to their doctor to prescribe the appropriate drug for their illness. Where do patients place their faith: in the expertise of the physician or in the curative power of the drug?

Many psychiatrists now recognize that patients’ candid discussions of their experiences can help their recoveries. In a recent New York Times article, ‘Mad Pride’ Fights a Stigma, Dr. Robert W. Buchanan, the chief of the Outpatient Research Program at the Maryland Psychiatric Research Center, notes that it’s critical for patients to have open dialogue. “Problems are created when people don’t talk to each other,” he says.

In family-focused therapy, relatives are being enlisted to help manage the patient’s illness. “If you combine medication and family-focused therapy, you get quicker recoveries from episodes and longer intervals of wellness,” said David J. Miklowitz, a professor of psychology and psychiatry at the University of Colorado. “Relapses are less common, and functioning improves, including relationship and family functioning.”

Some people need medication to survive. But no two cases are alike; there is no right and wrong way to treat such patients, no universal therapeutic model.

Mr. Lopez concludes that in the treatment of the mentally ill “there are no magic pills, and thousands have gotten better only to chuck the meds and sink back into the grips of incurable disease.” In the end, Mr. Lopez learns to accept Mr. Ayers as he is, “to expect constant backsliding, to prepare for the possibility that he could be homeless again or worse, and to see hope in small steps.”

And finally, in striving to help another individual, Mr. Lopez learns a valuable lesson himself: “I’ve never had a friend who lives in so spiritual a realm as Mr. Ayers, and I know that through his courage and humility and faith in the power of art—through his very ability to find happiness and purpose—he has awakened something in me.…He has wiped away my professional malaise and shown me the dignity in being loyal to something you believe in, and it’s not a stretch to say that this man I hoped to save has done as much for me as I have for him.”

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