A whole person approach to psychosis and schizophrenia

Twenty years ago I found myself in a hospital and told that I was dealing with something called ‘ psychosis. I didn’t understand what that meant. When I was thirteen, I was much more concerned about the classes I was missing at school, a band concert I had been looking forward to, and the stamp of mental illness I felt squarely on my forehead. When I was discharged from the hospital, I felt free – until my next hospital admission, just a few months later. My hope slipped away. It took years for me to fully accept my condition and discover what a good life with it could look like – far beyond just taking medication and go to therapy– a return to life and a license to pursue my life dreams.

This week I had the privilege of interviewing Ray Kotwicki, a psychiatrist with a holistic view of mental health and recovery. He is the lead physician for Intensive Outpatient Services at Hightop Health. Kotwicki says, “We cannot separate a person’s head from the rest of their body,” highlighting the complicated relationship between physical and mental health. He believes mental health recovery is multi-dimensional, with “physical, psychological, social and existential components.”

What are psychosis and schizophrenia?

Psychosis is an umbrella term for a variety of experiences that change our perception of the world, including things like visions, hearing voices, disorganized thoughts, and fixed, unusual beliefs. In addition to the traditional symptoms of psychosis, many with schizophrenia live with negative symptoms, a manifestation that can in a sense take away some of the color from life through blunted emotional expression, social withdrawal, loss of interest in activities and a disappearance of emotions. motivation.

Kotwicki acknowledges that while these “negative” symptoms have a greater impact on a person’s recovery, they are easier for doctors to ignore than the more esoteric symptoms. He shares that families may mistake this as a lack of “personal responsibility,” when these elements are just as much part of the condition.

A final aspect of schizophrenia that Kotwicki discusses is anosognosia, which he describes as a phenomenon in which a person “fails to notice that their perceptions are distorted in some way.” Anosognosia, or the inability to recognize one’s illness, is common in many neurological conditions such as brain injury (Steward and Kretzmer, 2022) and dementia (Hallam et al., 2020).

Options for recovery

Kotwicki emphasizes the individual nature of mental health recovery. After a psychosis or a diagnosis of schizophrenia, many people begin to let go of their ambitions for the future. Expectations can be blunted. Yet many return to their hopes and dreams.

Seeking mental health support can be part of recovery, but Dr. Kotwicki discusses others, such as “college support” and “relationship building.” He says recovery consists of “doing the best we can with the circumstances.” He says, “I want everyone to know that there is hope and recovery, and there are options for people with schizophrenia.”

Treatment options

There has never been a time when so many options for treating schizophrenia have been available. Antipsychotic medications provide relief from psychosis symptoms for many. These are available in oral and injectable forms that can last from a few weeks to a few months. Kotwicki shares that an advantage of long-acting injectable medications is that “you don’t get a reminder every time you take a dose of your disease.” For someone who has difficulty accepting their condition, this can be huge.

More recently, interventions to address negative symptoms have also become available, including a class of medications that Kotwicki describes as “looking at a different system when working on the muscarinic system, as opposed to dopamineThis new mechanism could alleviate both the psychosis and negative symptoms of schizophrenia.

Psychological and social interventions, including psychotherapies such as cognitive behavioral psychosis therapy and recovery-oriented cognitive therapy are also often part of the treatment.

Whole health

Kotwicki also emphasizes the importance of recognizing the interdependent relationship between one’s mental health symptoms and physical health. He shares that historically, the medical system may have overlooked the physical health of people with schizophrenia by focusing primarily on their mental health. Kotwicki argues that the two are linked, stating, “Physical and mental health are inextricably linked.”

With effective support, many can live well with schizophrenia and related conditions. And because knowledge about psychosis and what can lead to recovery increases every day, there is every reason to do so optimistic.