Hope for recovery from suicidal and self destructive phenomena in treatment resistant mental illness

In 1992, the Austen Riggs Center began to follow 226 admitted patients in a longitudinal, multidimensional follow-along study that asked, among others, a most basic question: Can our patients recover? The first thing we learned was how impaired our patients are. They are generally previously treatment resistant patients who typically meet criteria for five or six disorders, including mood disorders, schizophrenia, PTSD, personality, substance use, and eating disorders. Now, with data published in the January 2009 issue of the Journal of Nervous & Mental Disease, comes the heartening news that for a wide majority of the sample the answer is a resounding yes.

The first main paper released from the study, “Improvement and Recovery From Suicidal and Self-Destructive Phenomena in Treatment-Refractory Disorders,” shows that, over time, 73 percent of previously suicidal and self-destructive subjects ceased to injure themselves and 77 percent were free of suicide as a clinical issue. Even suicidal ideation disappeared in more than half of the sample. Recovery from such depths is not only possible, but, given time, very likely - offering an empirical foundation for hope. While the study is not a controlled sample, it does offer hope to clinicians who struggle mightily to treat these patients. And it strongly suggests that Riggs treatment helped these previously treatment resistant patients stop their downhill trajectories and begin to move toward recovery.

Indeed, this study adds powerful new testimony to the mounting case that even the most desperate people with multiple diagnoses can be treated. In 2005, a McLean Hospital study found that, among patients diagnosed with borderline personality disorder, an astonishing 74 percent had no active symptoms after six years. Only six percent had relapsed into the full-blown disorder. At the Personality Disorders Institute at Cornell’s Weill Medical College, randomized controlled trials have shown that borderline patients make lasting improvements with a psychodynamic treatment called “transference focused psychotherapy.”

What’s all the more striking is that impressive outcomes in previously “treatment resistant” patients can be produced by long-term psychodynamic psychotherapy. In an age of drug treatments and managed care, the “talking cure” practically disappeared from mainstream medical practice. Whereas psychiatric residents once devoted half their training hours to long-term psychotherapy, it’s now shrunk to a puny 2.5 percent. But in a landmark meta-analysis of 23 studies involving more than a thousand patients, researchers found the method demonstrably effective, with long-lasting benefits. The study published in the October, 2008 issue of the Journal of the American Medical Association, marked what one academic described to The New York Times as a “turning point” for the psychodynamic approach.

In short, there is hope for those complex patients who don’t respond to psychiatry’s usual treatments. They may actually not be “treatment-resistant” but actually can respond when given the space and time to take charge of their lives with the help of a psychotherapist.