Whatever works!

 “Perhaps the only thing that can be confidently said about treating psychosis is that there has to be a fit between the patient’s metaphor for the illness and the method used. For Frieda and Joanne, the treatment was a quest, a search for the answer to a tangled problem that could be revealed only by collaborative work. For Mary Barnes, who regressed almost to the point of infancy because she was convinced she had to “go down and come back up again,” living in Kingsley Hall, a Laingian therapeutic community, was the only way to get better. As Greenberg once remarked, “Her metaphor was not mine. But it worked for her. For other people, the metaphor is that it’s chemical, and therefore you’re absolved… You don’t have to have any part in the process. … Some people say, ‘I don’t want to weave my own rope, I want it done for me. I want doctors to do it for me the way they did my appendix and my hernia.’ “

For Carol North, kidney dialysis “removed some unidentified substance from the blood, presumably a chemical responsible for producing schizofrenic symptoms.” North and her physician had a very specific image of what this toxic substance was and used a filter with tiny pores “because the molecules that are thought to cause schizophrenia are much smaller than those in kidney failure.” Psychologist Norman Endler, whose psychotic depression felt unconnected to any life event, insisted that ECT was the only effective method. For Marie Cardinal, whose uncontrollable menstrual bleeding and hallucinations reflected a desperate struggle for “the words to say it,” classical psychoanalysis was what worked. Paula Perlstein repeatedly sought psychosurgery because “cutting the medial tracts between the portions of the frontal lobe and the thalamus” was the “miracle” that relieved her suffering.

It may well be, as has long been suggested, that there are many different kinds of schizophrenia or manic depression, each with a different cause, and differences in patient response reflect this variability. But since no one has ever come up with a reliable way of telling which patient is likely to respond to which treatment, such a claim has no practical import. Thousands of research studies and decades of work can still be summarized in one phrase: no treatment works for everybody, and every treatment works for some.”

Gail A. Hornstein, To Redeem One Person is to Redeem the World [pags 389/390]