From "Incurable" Schizophrenic to Person in Recovery: A Not So Uncommon Story

Abstract

In this commentary on Bertram Karon’s (2008) case study of Mr. X, I present my perspective from today’s clinical, empirical, political, and sociological perspectives, 40 years after Karon began seeing Mr. X. Within this context, I agree with Karon that he most likely “saved” Mr. X’s life, keeping him from quite probably destructive electro-convulsive treatment (ECT) and possible suicide, and facilitating Mr. X’s return to a full and gratifying social and professional life. In my analysis of Karon’s case study, I identify those elements in his treatment that, from today’s clinical and empirical evidence, seem to have been effective. A number of these can be seen as consistent with today’s model of “assertive community treatment” (ACT), including Karon’s daily engagement with Mr. X in natural, “in vivo” settings (like a diner and Mr. X’s work setting); Karon’s attention to Mr. X’s basic needs (like food and employment); and Karon’s continuing to supportively spend time with Mr. X over quite a while, even when Mr. X did not immediately appear responsive to this. All of these effective ingredients of the treatment do not require psychoanalytic theory for their explanation. Overall, I am led to conclude that Karon’s theoretical, psychoanalytic account of the successful treatment of Mr. X goes beyond the available data, at least the data available to the reader. Much of what Karon describes as effective would also be considered helpful by people with psychotic disorders who have neither been offered nor benefited from psychodynamic insights, and can be accounted for by alternative conceptual frameworks which make fewer theoretical assumptions. I end my commentary with a plea for humility in our attempts to understand the daunting challenge of helping a person “create a livable world” in the face of a condition as complex, dynamic, and seemingly mysterious as schizophrenia.