10 - Treatments: What is Working and What is not Working

Two major perspectives exist about abnormal behaviour. The main premise of the medical model is that mental disorders are diseases or illnesses arising from a malfunction inside the person. The treatment prescribed, which could be psychotherapy or drugs, is aimed at changing the patient’s behaviour and attitudes. The psychosocial model focuses on the interaction between the individual and the social environment. The self-concept is given careful consideration. Mending relationships within the patient’s social environment is the main target for treatment suggested by the psychosocial model.

Most therapists prefer the eclectic approach. It is a very open-minded and flexible approach, surveying a wide range of theories and choosing the best ideas from here and there along a broad radius of ideas. The result is an integrated type of therapy where various techniques are adapted to suit each individual case, but a large range of possible theories are explored in the process. For example, the psychobiological approach incorporates information from the biological, psychological, and social aspects that may have contributed to the behavioural disorder. It covers a range of possibilities.

chart

Drugs are another type of physical intervention used to correct underlying chemical abnormalities. Ataractics is the term for drugs used in the treatment of mental and emotional disorders. Drug treatments seem to alleviate some of the guilt felt by both the patients and their families. The notion is that if the patient is being treated for a chemical imbalance, then no one is really responsible for “driving the person crazy”. Thus the illness is no more shameful than diabetes, epilepsy, or high blood pressure. The chemical composition of the mentally ill person’s brain does differ significantly from a normal person. Missing chemicals may be identified and, therefore, can be replaced. For example, one of the chemicals lacking in the brain of the mentally ill is adenine. An injection of malononitrile stimulates the production of adenine.

pills

Antipsychotics are a major treatment for the nonagitated, psychotic patients. Another class of drugs widely used is benzodiazepines. The immediate goal of treatment of the acutely agitated psychotic individual is to reduce the agitation, irritability, and/or hostility to where the patient is not a physical danger to himself or herself or to others. The alleviation of hallucinations and/or delusions causing agitated behaviour is the ultimate goal. If the psychotic person is too upset to take oral medication, drugs may be administered by intramuscular injection.

Presently, the importance of nutrition in maintaining or restoring mental health is receiving wide attention. For example, megavitamin therapy has yielded some positive results. A low carbohydrate, high protein diet is supplemented by large doses of vitamins. It is not yet precisely understood how this therapy works, but findings have been very encouraging.

All of the physical treatments mentioned treat the symptoms of mental illness; they do not attempt to alter the causes except in the case of a chemical imbalance. If the treatment reduces or eliminates the symptoms, the patient can return to a more or less normal life.

Psychological Treatment of Behavioural Disorders

Psychotherapy simply means treatment for behavioural disorders through psychological means.

Group therapy offers opportunity for persons with behavioural problems to use the empathy and support of a small group to resolve their conflicts. The group leader may either provide direct guidelines or be nondirective during therapy. Thus, one therapist can give support to several people at once. The group provides a setting for people to explore their common problems in an open, uninhibited way with the realization that others have experienced a similar hardship. For group therapy to be valuable, participants must be capable of forming relationships with others and must be willing to express their feelings to the group.

poepl in a meeting setting

When other therapies seem to fail, hypnotherapy may be used. In this approach, hypnosis is teamed with other therapeutic procedures. One common use of hypnotherapy is age regression that examines events of early childhood.

Psychoanalysis was a therapy used by Sigmund Freud to bring repressed memories and hidden conflicts into conscious awareness (Lesson 1). It is still a popular method used by a number of therapists. One of the merits of psychoanalytic therapy is abreaction or the expression of a repressed emotion. Another name for this is catharsis or the discharge of emotional tensions by verbalizing one’s feelings. For example, Sally always believed her older sister was favoured by her parents, which caused her to be bitter. Many years later she was able to talk about the pain she felt when she was ignored by her parents.

The psychoanalytic technique is best suited to a certain type of individual. Characteristics important in a patient considering psychoanalysis are above average intelligence, introspective attitude, good verbal expression, not seriously disturbed, and between 18 and 40 years of age. Patients must have fairly healthy personalities so they can understand what is going on and help with their own cure. Often psychoanalytic treatment extends over a period of several years.

Sleep deprivation has been studied for many years as a possible treatment for depression. It involves keeping people up for nearly a day or longer than normal. Sleep deprivation accelerates the response to antidepressant medication. Sleep deprivation benefits may have something to do with body rhythms. It is not a helpful therapy for people with milder forms of depression or those who are manic-depressive.

Play therapy for young children serves several purposes. It is designed to help them become aware of valid reasons for their feelings and behaviours. For children who have been emotionally abused or neglected, another purpose is to provide them with an opportunity to interact with caring, sensitive adults. Free play is often used, which means various toys are provided and the children are given the opportunity to play with them in any way they choose. Doing art work and then explaining what they have drawn and why is another way to gain valuable information from young children. Through play therapy, children may reveal information about themselves that they cannot talk about such as sexual abuse, sibling rivalry, dysfunctional family lifestyles, and damaging discipline practices.

Treatment or Abandonment?

Sometimes therapy alone is not adequate for seriously ill mental patients. Institutionalized care may be prescribed for those who present a threat to themselves or to those around them. Families of these patients may not be able to provide the indepth care and supervision they require. There are critical shortages of acute-care beds in psychiatric units of hospitals to provide care for patients with severe problems.

In recent years the philosophy relating to mentally ill people has changed. At one time these people were institutionalized indefinitely. The new change took the focus away from institutions and emphasized having these patients released to the community to continue their recovery and rehabilitation in a more “normal” situation surrounded by friends and family. However, many of these people have been abandoned by friends and family because these care-givers have found the amount of support and supervision required for the mentally ill is too demanding in addition to their own commitments. Without follow-up support such as community clinics to monitor ongoing treatment and medication, many former mental patients neglect to take their medication and to check-in for necessary medical appointments. After that happens, they usually begin experiencing the same symptoms that sent them to a mental institution in the first place. As their mental illness becomes more pronounced, these people often find themselves wandering the streets and seeking shelter whereever they can as homeless people. Others end up in the criminal justice system for crimes that have been committed when what they really need is psychiatric care. Institutional care can be reduced, but before that happens, the money must be spent to make the patients ready for the community and the community ready for the patients.