- John Weir Perry
The Facility: Diabasis was an experimental project in San Francisco. It was a residence facility that lived through three years and more of inpatient work with acute "schizophrenic" episodes in young adults without the use of medications, always as part of the county's community mental health system. Its purpose was to provide a home in which clients might have the opportunity to experience with full awareness their deepest processes during this intense turmoil.
Staffing: The facility was staffed by twenty paraprofessionals who served not only the ordinary functions of attendants, but also provided psychotherapy as counselors. Some of these held fractions of our seven paid positions, while others were volunteers. Although this arrangement brought the secondary benefit of lower cost, it's primary purpose lay in selecting individuals by disposition rather than by professional category; we picked ones who by qualities of empathy and ease with psychic depth were particularly suited to this work, whom we could then educate and train on the job.
Theory and Method: The orientation ultimately derived out of a Jungian approach although not all staff were specifically given to that theory and method; instead, several modalities were drawn upon. There was a consensus on the basic viewpoint that the acute "psychotic" episode under discussion typically contains elements of a spontaneous reorganization of the self and that therefore, if handled well, may result in self-healing. The therapeutic aim was to avoid the damage of labeling and disqualifying attitudes and instead, to respond to all that happens intrapsychically with honest feeling; also it was to validate the efforts the psyche makes spontaneously to effect a transition from a poor state of organization of the self to one that is more suited to the nature of the particular individual's disposition. The processes expressed in the imagery and emotion frequently lead to profound changes in one's outlook and lifestyle, specifically in one's cognitive structures, value system and belief system.
Progress of Therapy: Our most surprising finding in the case of early acute episode was that grossly "psychotic" clients have usually come into a coherent and reality-oriented state spontaneously within two to six days, without need for medications. We have found that our work was most effective with those acute early episodes that were productive of imageful content. With clients who came to us in their third or fourth episode, we often found that their experience was beneficial but the outcome less striking. Chronicity was another matter and the chances of fruitful experiences more uncertain. A history of heavy medication usually made it difficult to do effective psychotherapeutic work.
Conclusions: Returning to the question of what alternative programs can be, we arrived at certain conclusions. Such a program can be much more than benign mileau therapy. It is possible to do effective psychotherapy in the acute episode, since the client's talk is clear and the material of dynamics active and ready to hand. The use of medications can be reserved for backup alone, for the rare times when behavior becomes too hard to handle and after other psychological means have been attempted. Therapy is best conducted in the spirit of nondoctrinaire openess to learn from the clients what the experience of their altered states is, and what it feels like to go through this process, and thus to be of help in facilitating its own aims toward reorganizing the self. When allowed to proceed, we find that a growth process is often underway that can be sustained, with consequent developments in one's system of meanings, value, beliefs and lifestyle. This treatment mode may then help avoid the devastating picture of incapacitation and recidivism that now prevails, and then becomes a burden to mental health systems. The cost-effectiveness of such a program depends entirely upon its use by the community to handle acute and early, if not first, episodes, with the prospect that these clients might be benefited in such a way that they would no longer remain indigents, dependant upon the county for aftercare.
Source: Trials of the Visionary Mind / http://spiritualrecoveries.blogspot.be/2006/05/dr-john-weir-perry-diabasis.html