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Raising the Bar and Offering Hope

Sean Kidd

For Psychology Month, Dr. Sean Kidd, Scientist and Head of Psychology Service, Schizophrenia Division, blogs about the power of higher expectations.

As a psychologist, I spend a lot of my time trying to help people understand that while illnesses such as schizophrenia are major challenges in the lives of our clients and their families, the picture is not a hopeless one. Often depicted in mainstream media as intractable, we need to be reminded that mental illness can also include recovery and a full and rewarding life.

The general tendency is to fear things we can’t understand or what makes us uncomfortable. An illness like schizophrenia does not necessarily mean lifelong impairment. As an individual with psychosis recently shared with me, the message given to her during her first hospitalization was that just like a diabetic who can’t eat a cake, she could never have the life she once hoped she might. She was devastated by those comments which diminished her sense of identity and hope.

Not to minimize the very real impacts of illnesses like schizophrenia, the reality is many of the patients I see can successfully engage in recovery. It may take several years, but some experience a total remission of symptoms and many more are able to have rich lives despite some aspects of the illness persisting. But the first step is to have higher expectations for those with schizophrenia and know that will lead to better outcomes.

And it was this desire to raise the bar that led myself and a team of clinicians and researchers to CAT – cognitive adaption training. This therapy puts in place environmental supports to encourage routines that help people take those initial steps towards a life outside of mental illness. Often these are steps out the front door. The focus in mental health can sometimes be assessment, diagnosis and prescription, but psychologists bring our background in interventions like psychotherapy and intensive training research to every challenge and every patient.

Over dumplings at my favourite restaurant in Chinatown, Dawn Velligan, a prominent researcher and fellow psychologist from the University of Texas at San Antonio, who developed this intervention, helped me hatch a plan to bring CAT to CAMH. The results? After two years of working with clients struggling with the most difficult form of schizophrenia – those with intense negative symptoms and cognitive impacts – something remarkable happened. We saw people tackle their challenges in new ways and make gains those around them previously thought impossible.

People became much more active, were living healthier, had more confidence, and were getting out in their communities. Our clinicians did not make this happen. Rather, they worked together with clients to move some of the major barriers out of the way. Our research showed strong effects in community functioning after treatment, and offered new hope for patients who might have not been expected to do that well in life simply based on their diagnosis. And working as part of a multidisciplinary team with nurses, occupational therapists and social workers, we are finding unique ways to meet the needs of our patients.

With new interventions, the true potential of people can be revealed, even those who are considered hardest to meet their needs and treat. Our research shows that with the right type of support, clients can get a lot further in their recovery than people had believed possible. Nothing can top that – everyone, from family, to clinicians, to the person themselves — making real changes in their lives. I think this goes to show people should re-adjust their expectations about the potential of those with mental illness and realize that raising the bar is going to lead to better outcomes.

6 Comments Post a comment
  1. annick #

    Yes and the bar can be raised at any stage of the illness.
    Looking for new achievements instead of fearing possible failures is a good way to start

    February 5, 2014
  2. hczzz #

    I find this article very poignant in light of CAMH’s recent Understanding Campaign which states stereotypes, and stigmatizing labels of schizophrenics. I think the most important part of this post is the where Dr. Kidd stated the following:

    “As an individual with psychosis recently shared with me, the message given to her during her first hospitalization was that just like a diabetic who can’t eat a cake, she could never have the life she once hoped she might. She was devastated by those comments which diminished her sense of identity and hope.”

    Please imagine how hopeless this person would feel after seeing a giant poster on a bus shelter that states schizophrenia leads to #a wasted life, #restraining orders, #scared neighbours, #ashamed relatives, #public fear, #alienated friends, #panhandling, #living on a park bench and that schizophrenics are a burden; #overburdened ERs, #Overburdened Courts, #Crowded Jails or if a television commercial by CAMH comes into her own home and tells her that #Her life is officially over.

    This type of demeaning campaign doesn’t only diminish a person’s sense of identity and hope, it crushes it into little pieces. CAMH was made aware that this campaign was triggering people into mental health episodes as early as November but the campaign was never amended or discontinued.

    Perhaps people like Dr. Kidd who seem to understand the difficulties of mental illness should have been consulted regarding the conception of this campaign. CAMH obviously has people who are educated about mental illness at their disposal. Such a shame these people were not utilized.

    I am not at all skeptical that 6 days after the end of this damaging, hurtful campaign CAMH is all of a sudden concerned about and sensitive to the feelings of schizophrenic people.

    February 6, 2014
    • Hi Heather – we appreciate and acknowledge your concerns about the recent campaign and look forward to discussing with you in more detail.

      February 6, 2014
    • Patricia Jane #

      I understand your concerns about the campaign, but there is another concern about your letter, and I hope it is okay to mention it. An important part of ending stigma and encouraging hope and recovery is to avoid calling a person “a schizophrenic” as if this illness were the individuals’s identity. Schizophrenia is a brain disorder,not a person. We would not think of reducing a person fighting cancer to “a cancer”. Research has shown for many years that a person who can envision him or herself as a whole person — much more than the illness he or she has — is more likely to get overcome the illness. So we need to separate the illness from the person and use language that puts the person first and the illness second. For example, instead of “a schizophrenic” or “schizophrenics” or “schizophrenic people” we need to say “a person with schizophrenia” or “individuals living with schizophrenia” or “people who have schizophrenia.”

      February 6, 2014
  3. Patricia Jane #

    Regarding the woman who felt that she was given the message in hospital that she could never have the life she once hoped she might. Mental health professionals need to be taught explicitly not to give this message. They need to be taught examples of how to support and encourage a person with a serious mental illness. One such example; A young man in his early 20s has had to drop out of university because of bothersome psychotic symptoms and is in hospital. His doctor tells him his symptoms look like schizophrenia, and then asks him, “What do you want to do with your life?” The young man answers that he wants to go back to university and finish his degree program. The doctor says, “I would like to help you do that.” This is a true story and happened in 1996. So there are doctors and other mental health professionals who have been practicing this kind of support and encouragement for a long time. They should be enlisted to educated the ones who are not.

    February 7, 2014
  4. Hi Patricia
    I understand the point you are trying to make. I have schizophrenia and I am not particularly bothered by the term schizophrenic.It is not so much the terms used that bother me so much as the stereotypes and labels I receive due to my illness. I will always have schizophrenia. I don’t believe in recovery, just learning to live with my illness every day. I don’t know if people with other chronic illnesses like diabetes mind the term diabetic or if those with asthma are offended by the term asthmatic. I do think you have a valid point however. Words are powerful and can be used to remove a person’s identity. I have been called schizophrenic and I have also told people I am schizophrenic. I will challenge my own use of language. Thank you for pointing that out.

    February 7, 2014

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