The experience of self and the treatment of psychosis
More than 50 psychiatrists, psychologists and other mental health workers assembled at a symposium on March 9th and 10th at the Copenhagen Harbour Front. The two-day symposium became a very successful rite-de-passage, and it created a lot of energy and enthusiasm concerning the psychological and psychosocial treatment of psychosis. In Denmark, as in other places of the world, this is very much needed in order to supplement and counterweight a dominance of biological, and especially psychopharmacological, viewpoints on treatment.
Professor of philosophy, Dan Zahavi (Centre for studies of subjectivity in Copenhagen) opened the symposium with a lecture on “Phenomenology and Intersubjectivity”. His theoretical exposition started with Jaspers notion of Schizophrenia as a disturbance of the ego with difficulties of separating the self from others, and with changed subjective feelings of 'here and now' existence, “Dasein erlebnis”. He then went through some arguments and counter-arguments in the Theory-of-Mind debate, and he concluded that "in most normal intersubjective situations we have a direct and immediate understanding of the other person’s intentions, since these intentions are manifested in the person’s behaviour and embedded in a shared social context."
Professor Courtenay Harding (Institute for the Study of Human Resilience, Boston University) talked of “Recovery in a new light” and “Issues for the future”. From her long-term follow-up studies of chronic patients in Vermont and Maine she pointed out the paradox between mental workers wishes to treat patients with schizophrenia and the general pessimistic attitude towards the outcome of schizophrenia prevailing in psychiatry (DSM-IV). She pointed out that the long-term outcome showed another reality: 45-65 % of each cohort significantly improved - i.e. improved in all areas but one - and/or recovered. Courtenay Harding advocated that neuroplasticity and resilience is taken into consideration, and that hope is given to patients which will help them reclaim a life during and after the schizophrenic episodes.
Tor Kjetil Larsen (Rogaland Psychiatric Hospital, Norway) reflected on the theme of “Hypopsychosis – can we prevent schizophrenia?” with results from the TIPS (early psychosis) and TOPP (prodromal symptoms) projects in Norway. He concluded that "Hypopsychosis should be defined and understood as a clinical syndrome that needs to be treated in itself. Whether or not hypopsychosis develops into a psychosis is and interesting and important question but not a necessary condition for the validity of the concept of hypopsychosis." Later he presented a lecture on “Schizoanalysis – the importance of Deleuzes and Guattaris work for modern psychiatry”. Especially the concept of the 'psychosis as a rhizom' characterized by diversity at the root of the categorization (and not only at the top as indicated in a tree-structure), multiplicity in meaning, and productivity.
David Kennard (England) recapitulated history with ”Therapeutic communities in the treatment of schizophrenia". He described them in their historical and social context, and emphasized benefits and pitfalls in the contemporary TC approach to care in the community.
Bent Rosenbaum (Unit for Psychotherapy Education and Research, Glostrup University Hospital, Denmark) talked to the title: ”Treatment of people with a schizophrenia diagnosis. A psychodynamic perspective”. He distinguished what was dynamic and what was supportive in the supportive psychodynamic psychotherapy. He went through different theories on the topic: Freud, Bion, Ogden and further on to Meltzer, Daniel Stern and Lacan.
Finally Professor Johan Cullberg (Sweden) gave, from a very personal perspective, an insight into: “Art and Psychosis” - thus closing the circle of the theme: self and subjectivity.