The average person with a psychiatric disability can achieve most of their desired life goals. The problem is the focus of treatment hasn't been one of rehab. The focus of treatment in the US and around the world is one of crisis intervention only.
I think one of the greatest problems that we face and that patients face is the stigma that society puts on them with labels. If you're called a schizophrenic, then there's an identity that goes with that that takes away your personality and puts you in terms of your symptoms. One of the first things we do when individuals come to us for treatment is ask them to tell us about themselves. "Well I'm bipolar, or I'm a schizophrenic." And I'll go, "no, your name is Susan, you are from Spokane and you have schizophrenia."
Medications are critical to stabilize as much as possible the biological problem that's creating the symptoms. OK. That's a given. So what happens once that biological problem is stabilized? The person's brain is working. And they start to realize, "oh my gosh! I've lost ten years to being in an out of the mental hospital. I don't have any friends left. I haven't finished high school. I'm taking this pill but my life is still really messed up.
I've worked with so many patients who were allowed to stay psychotic via the legal system because they had a right to refuse medications. And I've known people who died with these rights on.
We have promoted the concept of violence. An individual is no longer allowed to get treatment unless they can say, unless someone can say that they are a danger to self or danger to others. So you have an individual that reports symptoms. They're told they're not sick enough yet. The psychosis emerges; now you're going to have forced treatment. The individual refuses treatment for an illness they no longer believe they have, that two weeks earlier they reported was getting worse. Now who has the thought disorder?
I've often fantasized about the ideal treatment center and my thoughts continue to go back to the concept of asylums, as asylums were originally developed as a safe place, as a haven for the individual who is not able to cope with all the input in society and needs quiet, that needs space, that needs light.
The secret to understanding violence in the mentally ill is to understand what is the trigger. People become violent when they're frightened, so by gaining understanding of individuals, gaining their trust you don't have to worry about violence.
People often ask what is the most challenging of the psychiatric diagnoses to treat or work with and I find that the most challenging problem to work with is stigma.