Psychotic Spectrum Disorders: A Conversation with Jane G. Tillman, PhD, ABPP
What other activities have you seen help people with this condition?
Keeping patients engaged is really key—for example, learning to paint, or working in the greenhouse. Exercise is particularly important if you’re going to be on antipsychotic medications because they cause weight gain. Also, informal activities with peers, such as going to the movies and going to dinner together are extremely important. The benefit of the open setting at Riggs is that people can be out in the world, not cloistered and locked up in a hospital. For schizophrenic people who are often so socially isolated, to be out in the world can be quite beneficial.
What positive outcomes have you seen from sufferers of this condition after treatment at Riggs?
There’s a wide spectrum of outcome. These are often notoriously difficult conditions to treat. I have seen people do extremely well, and I’ve seen people get worse and deteriorate, so the outcome possibilities are hugely different. I’ve seen people go to school, work in a part-time job, and live independently in a community. I’ve also seen people who really couldn’t manage in the open setting, and have left treatment here in a terrible way, sometimes going to locked settings. A major part of recovery is some supportive, social relationships. And if you can tap into people’s creative potential, that’s a huge boost to their self esteem and ability to express themselves. Certainly engaging the creative side of any person in this situation is very important. For our patients, to go the shop and take instruction from another person is a really big deal. Some people have a hard time allowing themselves to try something new and fail -- and then to try something else, which is what the creative process demands.
What do people who recover have in common?
A lot of our patients are very bright to start with, and they have good family support, so they can take their time and find their way. Many people who recover find a creative pursuit, something that engages them, or a kind of work they can tolerate that gives them a place in the world of dignity and self-respect.
One of the things that is astonishing to me is that the recovery rate for people with schizophrenia in third world countries is reported to be higher than in the U.S.--often these countries have no access to medication. This points to ‘village mentality’, where there is more social support, a place for people with psychosis in the community. They don’t get shipped off or hidden from the to-and-fro of community life. The social environment may support persons with psychosis better in different cultures. In a fast-paced, so called “advanced” country, mentally ill people may become dehumanized problems to be managed rather than people to be understood. Our prisons are perhaps the largest mental health system in the country, full of people with psychotic disorders. And, of course, many sick people are living on the streets.
What books, or other resources, would you recommend for lay people who want to learn more about psychosis?
For an academic treatment of the history of psychotic disorders, I’d send people to Andrew Scull’s book Mad House: A Tragic Tale of Megalomania and Modern Medicine. It’s a historical account of what went on in the Trenton state hospital in the early 1900s. I’d recommend The Center Cannot Hold: My Journey Through Madness, by Elyn Saks, a professor, attorney, and MacArthur Grant recipient who has suffered from remitting and relapsing schizophrenia for a number of years. She recounts the experience of her symptoms, her various treatments including psychoanalysis and the important role of medication for helping her maintain her mental health. She does not romanticize schizophrenia and speaks to the profound effects of the course of her illness on her life and work.
In this five-part series exploring psychotic spectrum disorders, we will present excerpts from a longer interview with Jane G. Tillman, PhD, ABPP, Evelyn Stefansson Nef Director of the Erikson Institute for Education, Research, and Advocacy of the Austen Riggs Center, a member of the Riggs clinical staff and an authority on psychotic spectrum disorders.