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By Bower, Bruce | Science News, April 28, 2001 | Go to article overview

Back from the Brink


Bower, Bruce, Science News


Psychological treatments for schizophrenia attract renewed interest

Leslie Greenblat learned she had schizophrenia long after she had begun to hear, in her words, "thought-voices." She heard them all the time, whether she was driving, reading, shopping, or talking with friends. The disembodied remarks seemed to come from someone whose intimidating and demoralizing pronouncements couldn't be ignored.

Greenblat's condition first landed her in a psychiatric hospital in 1990. Over the next 3 years, the young woman was briefly hospitalized another dozen times. After each discharge, she took antipsychotic medications for a few months until the thought-voices receded. Invariably, however, they returned.

Then Greenblat began psychotherapy with psychiatrist Ann Alaoglu at Chestnut Lodge, a private psychiatric hospital in Rockville, Md. Although trained as a psychoanalyst, Alaoglu didn't have Greenblat lie on a couch and dissect her childhood. Instead, Alaoglu provided a relaxed environment and gentle, straightforward questioning to convince Greenblat that she finally had found a partner in healing. In that atmosphere, the cacophony of thought-voices started to ease.

"Before I met her, I didn't trust doctors," Greenblat wrote in an article last year for SCHIZOPHRENIA BULLETIN (Vol. 26, No.1). "Doctors doped me up, locked me in, and were generally distant. Dr. Alaoglu ... was willing to put herself on the line, sharing with me her sense of my progress and lapses."

Alaoglu's methods hardly represent the norm for schizophrenia treatment. But her success with Greenblat and other patients helps explain why the search for effective treatments has expanded beyond medication in the past decade. Researchers are increasingly exploring ways to combine psychological and social approaches with antipsychotic drugs, especially in the early stages of the disorder. Techniques in the spotlight include family-education sessions, job training, social rehabilitation, and several forms of one-on-one psychotherapy.

Consider Alaoglu's approach. She regards hallucinated voices as having meaning for the person who hears them. Unlike Greenblat's previous doctors, Alaoglu offered Greenblat ways to make sense of the voices.

Before a flight home, for instance, Greenblat once told Alaoglu that the trees were warning her not to go. "You seem a bit nervous about your trip," the therapist responded.

Such observations "gave me a sense of how I was communicating," Greenblat says. She was often conveying her feelings indirectly, through personally significant symbols that seemed bizarre to others. Such realizations, Greenblat says, also helped her develop intimate and safe contact with Alaoglu, easing schizophrenia's terrifying isolation and stigma.

"Psychotherapy doesn't fix schizophrenia," Alaoglu says. "But it can help to improve a person's functioning."

As Greenblat's condition improved over the next few years, she collaborated with her psychiatrist in adjusting her doses of antipsychotic medication. She also participated in a vocational rehabilitation program.

Greenblat, now in her 30s, is studying for a master's in health science. The rigors of school sometimes cajole her thought-voices out of hiding, but she pulls through these rough times with the help of family members, friends, and Alaoglu.

Greenblat's ongoing struggle illustrates a bitter truth: There are no quick fixes for schizophrenia. It's a severe mental disorder that draws most of its public attention in rare cases when a sufferer commits an act of violence.

Over the past century, schizophrenia treatments have included isolation in pastoral settings or hospital wards, intensive psychotherapy, brain surgery, dialysis, and a growing number of medications. The fiercest theoretical battle has pitted psychoanalysts--some of whom have regarded schizophrenia as a product of emotionally callous parents--against biological psychiatrists--who view schizophrenia as a brain disease. …

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