Gracefully Insane by Alex Beam

Author:Alex Beam
Language: eng
Format: epub
Publisher: PublicAffairs
Published: 2011-02-15T05:00:00+00:00

Alfred Stanton’s career was to have one more interesting twist. He surrendered the title of psychiatrist-in-chief in 1967 and devoted the next fifteen years to research. During that time, he raised money, recruited doctors, and oversaw one of the most ambitious psychiatric research projects ever undertaken, a project that would scuttle one of his own most cherished beliefs: that intensive psychotherapy could help deeply disturbed, schizophrenic patients.

When Effects of Psychotherapy in Schizophrenia, I and II was finally published in 1984, the book-length work claimed nine authors, and the research had engaged eighty-one therapists and 164 patients from five major teaching hospitals, including McLean. Stanton played the role of honcho-godfather-coordinator for the study, which took over a decade to design and implement. He left the heavy lifting to Dr. John Gunderson, an ambitious and intelligent young psychoanalyst just beginning a research career in the field of borderline personality disorders. The timing of the schizophrenia study was crucial. The psychopharmaceutical revolution had just begun. For the first time, doctors realized that comparatively cheap drug regimens might hold out more promise for treating, or at least stabilizing, disturbed patients than psychoanalysis. “This was at the beginning of the rift within psychiatry between the psychodynamic and the biological people,” Gunderson explained to me in his office at Bowditch Hall. “Before we started there had already been three studies that failed to show much benefit from psychotherapy, but they were flawed. What was needed was a really definitive study—enter us.”

Although the logistics of quantifying the purported progress of an unstable sample of 164 schizophrenic patients were daunting—sixty-nine subjects dropped out within six months—the research design was relatively simple. Two groups of schizophrenic patients would be assigned different kinds of therapy: One was the Sullivan /Fromm-Reichmann type of intensive psychotherapy, called EIO, or exploratory, insight-oriented therapy, administered three times a week. The other patients received a more modern treatment called RAS, or reality-adaptive supportive psychotherapy, offered once a week or less. The aim of the insight therapy, the study explained, was “to explore the patient’s inner life,” often using the traditional Freudian tools such as discussions of family history, childhood traumas, and so on. RAS was something else. It was deemed to be more “present-oriented” and more practical, “intended to identify problems that could be solved or that could be expected to recur in the future.... Another major feature of the RAS therapy was its focus on the patient’s behavior itself rather than the potential covert meanings behind the behavior.” Perhaps most importantly, it “provided patients with a coherent theory about their illness which emphasized its biological origins and the need for long-term, largely pharmacologic treatment.”

The authors buried their conclusions beneath the usual mound of academic qualifiers, for example: “There is no easy way to reduce the results into a single statement that one form of therapy is preferential to another.” But the message came through loud and clear. “Obviously the results failed to confirm either the strength or breadth of favorable effects that we hypothesized would be associated with the EIO as opposed to the RAS treatment,” they wrote.

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