Recovery The Norm? You Must Be In Western Lapland.

Schizophrenia seems to be disappearing in Western Lapland. Since the early 80’s, there has been a 90% drop in number of new cases of the condition. There are 2 or 3 new cases of schizophrenia each year, and the population of Western Lapland runs into tens of thousands. In most counties, the rates for the condition are said to be about 1 to 2 percent of the population.

It takes about six months of illness to get a diagnosis in Western Lapland, but most of the people experiencing their first bout of psychosis there don’t stay ill that long. So what are they doing right?

The roots of this story lie in the adoption of a new approach to treatment, started in the late 60’s in Finland. ‘Need Adapted Treatment’ provided patients with psychotherapy, and instead of making the prescribing of anti-psychotic drugs routine, they were used on a case-by-case basis. This approach, developed by Yrjo Alanen and his colleagues at the university of Turku, south West Finland, reported good outcomes.

The next development came in the 80’s, when Alanen co-ordinated the ‘Finish National Schizophrenia Project’, which sought to apply the methods of Need Adapted Care in other Finish cities. And in 1992, Finland started a two year study into the use of anti-psychotics in first episode psychosis.

At ‘experimental’ sites, patients were not given drugs, although tranquilizers could be used to help establish a regular sleeping pattern. If there was no improvement after 3 weeks, anti psychotics were prescribed. After 2 years, 43% of the patients never prescribed drugs had better outcomes than in hospitals where drugs were prescribed routinely. The best outcomes seemed to occur when the patient was never exposed to anti-psychotics.

Despite the remarkable results of this study, Finish psychiatrists didn’t embrace the approach, and the study was all but forgotten in most parts of Finland.

One area that retained the new treatment was Western Lapland, specifically the Kerodpudas Hospital in Torino. Here, in the 80’s, psychologist Jaakko Seikkula, psychiatrist Birgitta Alakare and others developed ‘Open Dialogue’ therapy. With Open Dialogue. most patients are kept off medications for psychosis. Under these conditions, recovery happened regularly, if slowly. As a result of these observations, the Finish government started a new 5-year study of the new approach, in which anti psychotics were prescribed in a selective manner. In 2006, the results of this study were published, and the results speak for themselves. In patients experiencing first episode psychosis between 1992 and 1997, it was found that –

79% of patients were no longer experiencing any symptoms.

80% were working, in school or looking for work.

Just 20% were on disability benefits.

75% of them were never exposed to medications for psychosis.

20% took meds regularly.

Spending on psychiatric services went down 33% from the 80’s to the 90’s, not because of government cuts, but because people were no longer experiencing a lifetime of illness and most no longer needed treatment.

The underlying factor in this new way of treating distress is a lack of reliance on medication. In Open Dialogue, people are listened to and psycho-social factors are examined. In therapy sessions, the patient, the therapist and friends and family of the patient are encouraged to explore the interpersonal and social rifts that have occurred during or as a result of the patients psychotic experience. These issues are seen as the main focus of the treatment, and the real issues to be resolved. The service user is seen as a normal person in most ways, perhaps someone who has lost their way in life and needs to be understood and encouraged rather than routinely medicated.

The pioneering work in Western Lapland seems to suggest that recovery from a psychotic breakdown is the norm rather then the exception if people are encouraged to explore the social and interpersonal nature of their distress.  When handled in an understanding and optimistic way, these experiences could represent more of a breakthrough than a breakdown.

The information presented in this post came from the following sources –

‘Mad In America’, a book by the American author Robert Whitaker. This book, which deals with the history of psychiatry and psychiatric treatments, is available on Amazon, and is recommended reading for anyone interested in these subjects.

A talk given by Robert Whitaker that I attended.

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