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Psychiatrist To Discuss Recovery

Published April 6, 2005 in the Hartford Courant, By Garret Condon, Courant Staff Writer,

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When Dr. Daniel Fisher was a neurochemist working for the National Institute of Mental Health in the late 1960s, he was convinced that the key to mental illness was somewhere in the brain's messenger chemicals, which he was studying. But that was before he was hospitalized with schizophrenia and got a first-person perspective.

"I found that thinking that everything was determined by chemistry was very disempowering and very dehumanizing," he said. Fisher, 61, who turned from neuroscience to psychiatry after his own battle with mental illness, is now one of the leading proponents of a view that is about as far from the lab bench as one can get. He believes that with enough of a support system, people can recover fully from mental illness, even from disorders such as schizophrenia that are widely believed to be chronic, long-term illnesses for most people.

Fisher, who will speak tonight at the University of Hartford, avoids the term "mental illness." He prefers to speak of times of "severe emotional distress and loss of social role."

"Sometimes it all just goes so far you can't stand or tolerate it anymore and you go into this state," he explained, saying that it could be triggered by fear or extreme sadness. "Some emotion gets the best of you so that you can't, yourself, get out of it."

Fisher founded the National Empowerment Center in Lawrence, Mass., in 1992 to promote the philosophy of full recovery. Today, he practices psychiatry one day a week and devotes most of his professional life to consulting, writing and teaching.

He said social and cultural factors contribute heavily to the burden of mental illness in the developed world. "In developing countries, there is much lower incidence of what we call long-term mental illness," he said. He noted that the World Health Organization did two studies in 1979 and in 1992 that found much lower rates of mental illness in the developing world and a much lower use of psychiatric drugs. "These studies should make us stand up and take notice."

In these countries, he said: "You can just feel the [personal] connections are valued more highly." He said that in interviews, people who have recovered from mental illnesses say the most important factor was the support they received from the people around them.

Fisher said that he doesn't oppose the use of psychiatric drugs, but thinks they should be used as a last resort. The kind of recovery he believes is possible would allow patients to go off such pharmaceuticals, assisted by a mental health system that provides encouragement and a sense of community.

Such a system "cannot directly provide the friends or jobs that people need," he said, "but it can give them more hope and more courage. A good mental health worker is a coach in a way, to help [individuals] build their strength and build their capacity to relate and to envision the future again."

Dr. John Goethe, director of the Burlingame Center for Psychiatric Research and Education at Hartford Hospital's Institute of Living, said most mental health experts would not call even long-term illnesses incurable. He said that many people with such diagnoses as schizophrenia, bipolar disorder and major depressive disorder can lead normal lives while managing their illness with medication and other forms of psychiatric care, much as a diabetic can live normally with insulin. Fisher says drug-free recovery could become the rule. He acknowledged that his views are not shared by all, but said that the notion of full recovery is becoming more mainstream. Fisher was a member of the White House New Freedom Mental Health Commission, which delivered its final report in 2003. Fisher said he lobbied hard to get the commission to include the language of recovery in its report. The report's "vision statement" begins: "We envision a future when everyone with a mental illness will recover, a future when mental illnesses can be prevented or cured."

Fisher's lecture is at 7 p.m. tonight in the North Cafe of the Gengras Student Union of the University of Hartford. It is co-sponsored by Volunteers in Psychotherapy of West Hartford and the university's psychology department. VIP provides psychotherapy in exchange for volunteer work done elsewhere by clients. For further information call 860-233-5115.