Narratives of Recovery from Serious Mental Illness

172 Pages·2016·1.566 MB·English

by  William Tucker (auth.)

William Tucker
Narratives
of Recovery
from Serious
Mental Illness
Narratives of Recovery from Serious Mental Illness
William Tucker
Narratives of Recovery
from Serious Mental Illness
123
William Tucker
ColumbiaCollegeofPhysiciansandSurgeons
NewYork,NY
USA
ISBN978-3-319-33725-8 ISBN978-3-319-33727-2 (eBook)
DOI 10.1007/978-3-319-33727-2
LibraryofCongressControlNumber:2016938657
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To Sheila, my anchor and my sail
Foreword
When a resident in psychiatry in the early 1970s, I was cautioned against working
inastatementalhospitalorclinic.Theriskofdoingso,Iwastold,wasthatIwould
becomediscouraged(andpossiblyleavethefield)sincenoneofmypatientswould
get better. The prevailing view within my field and among the general public was
that a serious mental illness, especially schizophrenia, ushers in a lifetime of dis-
ability and despair.
So while I took call at a state hospital I did not start working in public mental
health until 2007 when I became chief medical officer of the largest state mental
hospitalsysteminthiscountry.Bythen,notonlyhadthebleakprospectsforpeople
with mental disorders come under great challenge I could dedicate myself to a
growing ethos and clinical practice of recovery for those with persistent mental
disorders, and their families.
Dr. Bill Tucker, who served in the same position I now do but for him some
yearsago,givesusabookmeanttoillustratebycaseexample,byindividualstories,
howliveswithrelationships,contribution,work,school,purposeanddignitycanbe
restored to people with serious mental illnesses. He shows us and thereby fosters
hope, by giving us the stories of twelve patients he personally treated, as part of a
psychiatricoutreachteaminthecommunity,inNewYorkCity.Afterworkingasa
state official, Dr. Tucker literally rolled up his sleeves and took care of very ill
patients under challenging and at times daunting circumstances. He hopes that his
work will encourage others to put skepticism and stigma aside and discover the
rewards of patient care outside the office and beyond the “worried well.”
Recovery from serious mental illness is not a singular or monochromatic pro-
cess.Inanefforttodefinerecovery,andtherebybetterrefineanunderstandingofits
approaches, colleagues and I described some of its dimensions, which are inter-
locking and certainly not mutually exclusive (Lieberman et al. 2008).
Recovery in patients with serious mental illness can and does occur in the
biological substrates of the brain: growth of neural and glial (connective) cells is
possible, cell loss (evidenced by brain grey matter reductions) can be attenuated;
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viii Foreword
neural connectivity and brain flow can be improved. Sensory gating can be
improved. We are still learning more—especially about neurogenesis.
Recovery from acute psychosis is well known, especially for the so-called
positive symptoms like hallucinations and delusions. Negative symptom recovery
remains on the list of what our field needs to do more for.
Recovery of cognitive functions impacted by mental illness, especially
schizophrenia, has advanced substantially in the past decade. These capabilities
includeattention,focus,memoryanddecision-making.Improvementintheseareas
is essential for people to function in their own self-care, autonomy, and capacities
for school and work.
Recovery too of social functions is possible and our techniques to assist are
continually improving. Social-skills training has become an integral part of psy-
chiatric rehabilitation and re-opens the doors of human connection and relatedness
that were too often lost with chronic mental illness.
With recovery, as well, the quality of a person’s life improves, as does their
ability to be a responsible agent, a decision-maker, in their own life. With these
strengths comes the spirit of hope that recovery breeds and sustains.
Dr.Tuckerdoesnotoversellrecovery.Hedoesnotunderstatethedemandsupon
patient, family and clinician that the path of recovery requires: He is too good a
doctor and he is an honest broker of the kind of effort needed to achieve success.
Buthiswork,hisinsights,hisexample,andhishopearewelcomebeaconsoflight
in my field—which too often still lives in the shadows or does not get its message
out as clearly as needed to overcome the doubters.
Recovery is possible for people with serious mental illness. You don’t have to
believe me. You just need to read this book.
New York City Lloyd I. Sederer
December 2015 MD
Reference
Lieberman JA, Drake RE, Sederer LI et al (2008) Science and recovery in Schizophrenia.
PsychiatrServ59(5)
Preface
I write this book to commemorate all my patients at Pathways to Housing from
2005 to 2011—not only those who recovered, because they all welcomed me into
their lives and invited me to share in their efforts toward recovery. Its purpose is
threefold:(1)toillustratemyviewofthesuccessofsomeofthemwiththoseefforts;
(2)tosuggesttopolicy-makershowoutreachpsychiatrycanbridgethegapbetween
institutional treatment or homelessness and stability in the community; and (3) to
invite fellow psychiatrists at any stage of their careers to enter this work and
improve on it.
ix
Acknowledgements
I could not have begun without the guidance and encouragement over many years
of Christian Beels and Marianne Eckardt. Kim Hopper and John Tepper-Marlin
reviewed the manuscript and did their best to improve its accuracy and clarity.
Janice Stern, my editor, is truly the midwife who brought it into the world.
xi
Contents
1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
What Is Recovery, and How Does It Relate to Stability?. . . . . . . . . . 1
What Is Serious Mental Illness?. . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Why We Need Expanded Outreach Services . . . . . . . . . . . . . . . . . . 4
My PersonalCareer Trajectory,Leading up to Outreach Psychiatry. . . 6
The Pathways Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
My View of How These Patients Change . . . . . . . . . . . . . . . . . . . . 21
How These Narratives Emerged. . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Confidentiality and Consent Issues. . . . . . . . . . . . . . . . . . . . . . . . . 27
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
2 Gary N. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Personal and Psychiatric History . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Treatment Begins. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Course of Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Improvement Begins. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Consolidation of Gains; New Capacities . . . . . . . . . . . . . . . . . . . . . 41
Post-script. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
3 Pamela P.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Personal and Psychiatric History . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Treatment Begins. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
New Issue; Course of Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Improvement in Both Systemic and Psychological Health . . . . . . . . . 53
Post-script. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
4 Bernardo H.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Personal and Psychiatric History . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Treatment Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Obstacles to Improvement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
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