A Recovery Blog

This blog is about my continuing recovery from severe mental illness. I celebrate this recovery by continuing to write, by sharing my music and artwork and by exploring Buddhist ideas and concepts. I claim that the yin/yang symbol is representative of all of us because I have found that even in the midst of acute psychosis there is still sense, method and even a kind of balance. We are more resilient than we think. We can cross beyond the edge of the sane world and return to tell the tale. A deeper kind of balance takes hold when we get honest, when we reach out for help, when we tell our stories.

Saturday, February 20, 2010

E. Fuller Torrey, M.D. -- A Wounded Zealot

I bought the book Surviving Schizophrenia: A Manual For Families, Consumers, And Providers by E. Fuller Torrey, M.D. (4th edition) sometime after the year 2001. In the fall of 2001 I had returned to art school, but was not taking any anti-psychotic medications. At first I was doing quite well, but by the end of the semester I had crashed into my last psychotic break. By the beginning of 2002, I was committed to taking the medications. I bought the book at a Border's bookstore in Rochester. I was drawn to the title because that's what I wanted, to survive the illness. I opened to the first chapter; it was called Dimensions Of The Disaster, not Dimensions of the Illness, or Problem or Puzzle, but Dimensions of DISASTER. Disaster conjures up visions of tornadoes, tsunamis, earthquakes and in it's wake destruction and death. And at that point in my life, I could accept that pronouncement because I had just survived for the third time in three years, something disastrous--a psychotic break with reality. As I skimmed through the book, it seemed to be one that would answers many, many questions. And later, on the NAMI message boards for schizophrenia, I would see it referred to as the "Bible" on schizophrenia. But too many times as I read through some chapters, I kept getting tripped up by the negative and dogmatic attitude interspersed throughout it. So I put the book down and forgot about it.

A little over a week ago I picked it up seeking to once again expand my knowledge of my illness so that I could write an informed essay on some aspect of schizophrenia or of my personal experience with it. I remembered that I had been skeptical about it in the past, but thought I would give it another chance. I skipped the first chapter and went directly to the second entitled The Inner World Of Madness: View From The Inside. My first thought was that Mr. Torrey was being a bit presumptuous. He did not suffer from schizophrenia and he could not know about it from the inside. As I read I saw that he did include the perspective of some people who did suffer from schizophrenia and some of that was interesting, but still I thought the tone was off. I had the thought that I might write an article that challenged some of Torrey's perspectives, but first I wanted to get the newest edition, after all he might have changed his position in the intervening years. The newest 5th edition dates from 2006. I ordered the book and got it today.

Right away I compared the two editions to see what had changed and what had remained the same. I felt like a detective...or a journalist. On the cover I noticed that the word "Consumers" in the title had been changed to "Patients". The next thing I noticed was that the first "Disaster" chapter had been moved almost all the way to the back of the book and the second insider view of "madness" had been pushed up to the opening spot. I'm not going to review all the changes, just one that particularly drew my attention. In the 4th chapter, Onset, Course, And Prognosis, towards the end of it the author fit in amongst the sections something titled The "Recovery Model". I thought, yes, now maybe we're getting somewhere good. I believe in the "recovery model" and was hoping that he was starting to, too. No such luck. Mr. Torrey writes: "The 'recovery model' has no foundation in scientific studies or data. It has its roots in mid-twentieth-century exhortations about 'the power of positive thinking' and similar self-help movements....The problem with the 'recovery model' is that it places unrealistic expectations on individuals who suffer from schizophrenia and their families. If the person does not recover, then it must be because they are not trying hard enough. This is like telling individuals with acute polio that they can walk if they just try hard enough; the reality is otherwise."

Here is a little bit of background on Mr. Torrey: He was born in Utica, New York in 1936 and got his bachelor's degree magna cum laude from Princeton, his medical degree from the McGill University School of Medicine, a master's degree in anthropology from Stanford University and also trained in psychiatry there as well. His sister Rhoda was diagnosed as having schizophrenia in 1957. In the 1940s and 50s there was a strong tendency, due in part to Freudian psychoanalysis, to place blame for schizophrenia on poor parenting, especially poor mothering. Mr. Torrey has said that this had a strong and negative effect on his mother and obviously on him too, to some extent. Meanwhile, his sister has never recovered and has mostly lived in psychiatric hospitals.

Personal experience tends to color everything and create certain preferences, beliefs and even prejudices. Mr. Torrey seems to have dedicated his life to helping those who suffer from mental illness, and their loved ones, learn to cope better through education. The problem is that his education has serious flaws, particularly since he is in a position of influence, a position he has been known to use to his advantage on occasion. What's tricky in his book is that his obvious negative prejudice is interwoven with elements that are also accurate or at least sensible. I certainly wouldn't say--throw the book away, nor would I say that Mr. Torrey's life is so misguided as to be wasted. But I do say, that he is too quick to throw out the idea that schizophrenia goes beyond the biological and into the psychosocial and even spiritual realms. His view is dry. It doesn't lack heart, it lacks insight, the insight of precisely those he is trying to help.

Of the "recovery model" he writes that it "has been widely extolled by a few individuals who had an episode of schizophrenia, or some related illness, from which they recovered. As such, these individuals fall into the category of the 25 percent of patients who completely recover. What these individuals are saying is: 'If I did it, so can you!'" I don't believe that those of us who do move in the direction of recovery are as few as Mr. Torrey seems to think. In fact, I think as society gradually begins to change its views on mental illness, deflating the stigma attached to it, more and more people will venture out to new territory and start to spread their wings.

I did not have one "episode" of schizophrenia and I am not fully recovered, but I am proud of how far I have come, proud that I survived the acute stage of my illness. I was acutely ill for years and then for years depressed. This recovery of mine has been hard won and is precious to me. Mr. Torrey thinks he is a realist, but I think he is more of a fatalist, which is odd for a doctor. A good attitude and positive feedback, a creative approach and natural intelligence along with yes, medicine and a great deal of patience is what I call living in recovery and it is good enough. Low expectations create a low level of living. I know you should dare to dream, if only just a little at a time. If you take away the dream, you not only lessen the quality of life, you shorten life itself. There may be no scientific data on that, but that doesn't detract from its veracity. The science of the body is not all there is, though it is important and before we return to dust let us embrace our spirit which is so much greater than just "the power of positive thinking".

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