Recovery From Schizophrenia: Psychiatry And Political Economy

TREATMENT 271the office work and the purchasing of household supplies. The treatment settingcalls for staff who are tolerant and empathic and it brings out their capacityindependently to find inventive solutions to difficult problems.There is no commonly used form of psychiatric treatment (except for electroconvulsivetherapy) and no diagnostic measure that cannot be provided forresidents of this treatment facility. Patients with acute or chronic organic braindisorders, for example, can be evaluated using the laboratories and diagnosticequipment of local hospitals. Consulting physicians provide treatment for medicalproblems.An essential step in the treatment of people entering Cedar House is theevaluation of the patient’s social system. What has happened to bring the patientin for treatment at this particular time? What are his or her financialcircumstances, living arrangements and work situation? Have there been recentchanges? Are there family tensions? From the answers to such questions as these, aplan may be made that will hopefully diminish the chances of relapse after thepatient leaves residential treatment.In some cases the solution may be straightforward. The patient has been livingon the street, sleeping in doorways on cold nights and eating out of garbage cans.Floridly psychotic at the time of admission, he (or, more rarely, she) may showfew positive features of illness after a day or two of warmth and good food. Thisperson needs help in applying for welfare entitlements, finding a place to live and,probably, a lot of supervision while settling into a new pattern of living. Anotherpatient may relapse into acute psychosis after starting a job or losing one. He orshe needs to be referred to a supported employment program for on-the-jobcounselingOther situations can be more difficult to ameliorate. A patient and his or herfamily members may be at loggerheads, periodically inflaming the patient topsychotic outbursts, or the family members to angry rejection; yet none of theparties wishes to separate. Although the patient is calm and well while inresidential treatment, careful family negotiations may be necessary before thepatient can be discharged.Most people suffering from a psychosis will benefit from some form ofmedication. The period of residential treatment allows the opportunity to spendtime observing the patient’s illness and selecting the most suitable drug (anantipsychotic may not be the best choice), monitoring and adjusting the dosage tominimize side effects and evaluating the benefits. An added advantage of the moreleisurely pace of residential treatment (compared with brief hospitalization), asdiscussed in Chapter 10, is that it allows an opportunity to see if low doses ofmedication, or none at all, will be effective. 6The Cedar House model has been replicated in other parts of Colorado, andthere are a growing number of similar domestic-style, non-alienating alternativesto hospital for acute psychiatric treatment around North America and elsewhere.Well-established examples include Venture in Vancouver, British Columbia; 7Crossing Place in Washington, DC; 8 and the Progress Foundation in San