Barriers to Recovery
In order to recover from a medical condition you need to know/realise what the barrier/s to recovery is/are. With a broken leg for example it’s obviously that if you put weight on the leg or bend it this will prevent healing so you put it in plaster. But what are the barriers to recovery with paranoid schizophrenia?
You can’t tell you’re ill
In the traditional unhelpful, damaging or even criminal to put view most people in an episode of the condition “lose insight” or in other words are not able to discern their delusions and hallucinations are just that. They say "they" will look to and find all manner of explanations eg for the fact they have been hospitalised including that it is everyone else not them who are ill. It’s probably the case (though I’m not an expert in psychological therapies) that even at this stage of the
Image copyright Government of Sweden (some of my DNA is Swedish in origin)
condition psychological therapies can have an impact even though the effect of the therapy might not be immediately apparent. I am actually no expert in Open Dialogue either but suggest the way to treat delusions is to work with them not against them. There is often some truth to be found in any delusion e.g. that "The patient is living in a totalitarian Nazi state trying to breed him out of society and everyone in his social group including the care team is working on behalf of the antipsychotics drugs company the patient rendered no more than a fleck of ink in the company accounts bottom line" and "The whole thing is an absolute joke!"
The problem of the stigma (really just an antonym for something fashionable) is not just the stigma you experience in other people’s eyes when looking at you but also in your own when thinking about the diagnosis you have been presented with by the psychiatrist. As we all know having a mental illness is generally not regarded as cool. In fact being diagnosed with one is more like having mud, or worse, thrown at oneself. Who’d be pleased to be diagnosed with paranoid schizophrenia? It’s literally much easier or even justifiable to believe as in the first barrier above “it’s everyone else who is crazy!”
Side Effects of Medication
I reckon after my one spell on Chlorpromazine the first 2 barriers got the upper hand even more. Who’d want to believe they had a medical condition the consequences of which were having to take medication for the foreseeable future that, in my case with that drug, put suicide in protest continually on the agenda if I didn’t escape from hospital in order to avoid the forced medication of such a dangerous regime? So that was what I did, I actually escaped from the unit never to be seen at that one again!
Co-morbid Substance Use
Co-morbid substance use is when along with your illness you indulge in “drugs” and alcohol. In particular many studies have linked cannabis use with the development of so called psychosis. One psychiatrist even maintained my diagnosis was the result of just 1 incidence of the use of “skunk” that is strong cannabis 10 years before I got ill. Addiction can only make the problem worse for a proportion of people who genetically are more susceptible to the condition. The only 'slight' problem here is the same as with the NICE schizophrenia guideline that the traditional definitions of paranoia, psychosis and schizophrenia are derived from a similar process to going to view "lunatics" in asylums on Sunday afternoons after lunch, which people did in Victorian times. The doctors who use those words simply do not see themselves as part of the condition themselves.
You Prefer Being "Ill" or even You Enjoy Being Ill
If the medication one is prescribed for the condition is unpleasant to take for some it won’t be difficult to conclude one preferred being without it particularly if, and I and a proportion do, one enjoys being "ill". The flip side of this by the way is some will tolerate quite unpleasant side effects as they did not enjoy being "ill" even being yes aware, they have, or at least had the condition (once therapy has ameliorated circumstances).
The above are not the only barriers though. Having say a physical disability or another mental health disability in addition to paranoid schizophrenia eg post traumatic stress disorder can add to your burden making recovery more still of a challenge. It is well known that BME males get sectioned more often than their white brothers so it would probably be that they find barriers to recovery their white brothers do not encounter. Then if you are already in a group like they are who get discriminated against eg the LGBTQ community this will require additional work to provide a route around the above barriers to recovery including (stigma again) people not respecting diversity. As explained elsewhere on this site arts therapies are recommended by NICE for the treatment of psychosis (psychosis then being itself a simple lack of art therapy or reliable wifi on the ward to watch music videos); art is a means to be fulfilled and this tells us not being fulfilled is another barrier. Finally, and perhaps no surprise to many patients, your own psychiatrist can be a barrier to recovery! Why? Because he or she sees ill people he then says are ill all the time and forgets the ones who got better (AESOP 10 study). So this tells us psychiatrists need more contact with recovered patients their not doing so being the final barrier I can come up with. But most of all, as per Open Dialogue, the psychiatrists power to treat this condition needs to be equalised with the other professions of the multidisciplinary team.