Monday, December 19, 2011

Early psychosis intervention programs pay mere lip service to spiritual beliefs

Is schizophrenia a spiritual illness, as patients often maintain, or is it a brain disease, as the medical profession claims? The OASIS program at the University of North Carolina, like many psychosis programs affiliated with university medical programs, strikes a hypocritical note.

Gianna Kali at Beyond Meds alerted me to a recent newspaper article about the program. (Thank you, Gianna!) I have noticed that the medical profession is now starting to pay at least lip service to the idea that schizophrenia, in the patient's view, is a psycho/spiritual quest. But as you read further into this article it becomes apparent that the staff at the OASIS program completely reneges on the promise to the patient - that they believe him when he maintains that schizophrenia is a spiritual quest. It almost seems like they "tricked" him, because, to the program, it was all about the meds all along.

What is actually happening is that outpatient programs for identifying and treating early psychosis (like the OASIS program) are getting the idea that they should appear sensitive to the client's "delusional" beliefs. This looks innovative and "client centered." So, journalists are fed the following story about hope and recovery, and the staff "accepting" (humoring) the young man (Binanay) in his spiritual delusions, and how outraged the medical director is that the parents of a different boy are given no hope, and we the readers are emotionally sucked into this outrageous idea that there is no hope! We are also being sucked into thinking that the only hope to manage psychosis is through meds.

Binanay was also lucky to be diagnosed soon after the onset of his illness, and to be referred to the Outreach and Support Intervention Services (OASIS) program – administered by UNC’s Center for Excellence in Community Mental Health – in Carrboro’s Carr Mill Mall.

Binanay needed direction; he needed acknowledgement of his perception that what was going on was as much in his heart as his head. It was a profound spiritual experience.

The staff at OASIS was willing to accept that. The importance of mapping an exit strategy of the client’s own design is a cornerstone of the OASIS philosophy. The conviction that there’s hope is another.

Diana Perkins, OASIS’ medical director, describes a recent meeting she had with the parents of an 18-year-old boy in rural North Carolina who had been diagnosed with schizophrenia. They had taken him to a local hospital, and were told by a psychiatrist that their son would never recover – no hope; get used to it. “And it was just devastating,” Perkins says. “Here they had this 18-year-old boy, off in college, and now they’re being given this message. This was a psychiatric hospital; this was a trained psychiatrist.”

The problem, Perkins says, is that psychiatrists often don’t see schizophrenia patients until their illness is advanced. But a commitment to the meds was part of the plan, and that involved a tradeoff – the euphoria for a shot at stability – he wasn’t quite ready to make.

“Clinicians have this bias,” Perkins says, “and they really need to understand that this is not inevitably a chronic, disabling illness, that people can learn to manage it.

Later in the article, OASIS staff seem to have reneged on their promise to Binanany, to respect his belief in the spiritual origins of his so-called schizophrenia.

“His illness took a severe course,” Saade says of Binanay’s struggle with recovery.
“I think David had a hard time coming to terms with the role that medication would play in his life,” Perkins says, “what he needed to do to maintain a sustained recovery, how he was going to manage.”

Maybe Binanay's "illness" took a severe course because he had a hard time adjusting to the diminished expectations that this program offered him and to the side effect of the meds. Maybe Binanay felt tricked. Instead, we have a spokesman for, in essence, a drug rehab program defining Binanay for us in disease terms. Who was on hand to help him with his spiritual issues and to build resiliency without resorting to drugs? As for the OASIS program -- been there, seen it, done it with my own son in a different "innovative" program. The goals and treatment methods were the same -- to keep people on their meds. The results were that my son was on meds, and no alternative treatment that would have worked with his beliefs was offered.

What is OASIS?

OASIS, which stands for Outreach And Support Intervention Services, is an award-winning program dedicated to providing services to adolescents and young adults who are experiencing early psychosis, or who are at risk for developing psychosis. (Ed. note - Psychosis risk syndrome is criticized as being a way to get people on meds early, many of whom might otherwise never go on to develop psychosis.) 


The mission of OASIS is to foster successful recovery from early psychosis and to increase public understanding of psychotic disorders. The program aims to:

•Provide early identification and treatment (Ed. note - This means meds.)

•Prevent relapse (Ed. note - This means meds.)

•Prevent hospitalization (Ed. note  - This means meds.)

•Minimize disruption in people's lives

•Support people in the workplace, school, and relationships

•Educate the community and other providers to recognize early psychosis and the importance of early treatment (Ed. note - Maintain and increase the public's belief in meds.)

•Provide educational opportunities for mental health professionals (Ed. note - This means jobs.)

•Provide access to state of the art clinical research programs (Ed. Note - This means you may become a guinea pig for drug trials. You will certainly be fodder for the university medical program with which this program is affiliated. You will be considered a laboratory animal for the scientific interest of the medical students and faculty. How many medical staff offer spiritual guidance?)


  1. Enjoyed the 'Ed. Notes'.
    Keep up the great work!


  2. Yes, this worries me, that the "industry" of mental health treatment is pretending to honor patients' needs, while giving us the same old same old.

    I consider new drugs to be part of the same old as well. Because same old is always going to be new drugs that somehow are better than the old. And the tragedy of "faith big pharma way" is if we patients don't have faith in new drugs, they might decide there is something the matter with us spiritually!

  3. Hmm, I should correct my post in one respect, but I'll leave it. The article says the staff was willing to "accept that." What is "that"? His need for direction, no doubt. LOL. Whatever it "that" is, it appears that the staff merely accepted but did not work with his spiritual beliefs. My son's "illness" also took a "severe course" as they describe it here. Same type of program. They certainly wouldn't want to patch them up too quickly, would they?
    Good comment: "And the tragedy of "faith big pharma way" is if we patients don't have faith in new drugs, they might decide there is something the matter with us spiritually!"

  4. We've been there and done that too. I went to a parent support group with OASIS, as my son was in the program. The subject of the movie, A Beautiful Mind came up. I remarked that John Nash spoke about medication and that it was not how he got better. The leader of the group meeting asked me not to mention this again. She told me it would be a bad influence on "consumers" because it might make them think they could get well without meds. I was reminded (in front of the other parents) that they (OASIS) use "evidence-based treatment," which includes taking antipsychotics. A little later, we attended a group outing with "consumers" and parents. My son made mention that he was not taking medication, which was true. Shortly afterward, my son was discharged from the program.

    In my personal experience, OASIS, The STEP Clinic and the ACT teams in the area are like lovers. The so called progressive community of mental healthcare providers will not offer a person care who is not compliant. Even the local clubhouse is part of the romance.

    So, rumor has it that my son is not compliant. No clubhouse membership, no invites to the group outings, and then, when we asked if he could participate in some of the psycho-social programs, well, they say, "We are full." (this means "we know he isn't taking his meds").

    The newspapers and NAMI folks say the OASIS, the STEP program and now, XDS ACT team services are the best in the state and maybe some of the best psychiatric providers in the country.

    "Sometimes the best isn't good enough." (same newspaper)

  5. For a long time my mother has Paranoid Schizophrenia, do you think it is even possible to have a full recovery?
    I whant to know if it's possible and whant drugs can help her with this?
    I apologize for grammar mistakes, but English is not my native language

  6. Yes, I believe full recovery is possible, even for people like your mother who have been suffering for quite a while. Unfortunately, I do not think that drugs are very helpful in treating schizophrenia. I don't know anything about your mother's situation, but do people around her believe that recovery for her is possible? The belief of others in her recovery is very helpful. Take a positive view of her of her ability to recover and treat her with kindness and respect. Read what others have to say about recovery. Here is a quote from a review of John Weir Perry's book that could be a starting point:

    The notion of a “reorganization of the Self” is central to Perry’s approach to the psychotic journey. Extreme damage to the self-image (usually, through a mother’s withholding of love) was a typical problem in the cases he studied. The injury to the self-image is so severe that, during a crisis, psychic energy leaves the higher levels of consciousness and is attracted to the psychic depths, where an archetypal process of renewal commences. The goal is not only to restore self-esteem but also to engender a “capacity to love and be loved.”

    For this to occur, there must be a connecting link with another human being (and not necessarily a link with a “professional”): one that instills warmth and trust. This encourages a forward progression of the inner-imagery (reminiscent of Jung’s statement that a schizophrenic is no longer schizophrenic when he feels understood by someone else). Therefore, at this stage, “analysis” seems secondary to basic human kindness. In place of an omniscient psychotherapist, Perry posits the autonomous psychic process as a crucial factor.


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