Some of the voices inside Caroline White's head have been a lifelong comfort, as protective as a favourite aunt. It was the others - "you're nothing, they're out to get you, to kill you" - that led her down a rabbit hole of failed treatments and over a decade of hospitalisations, therapy and medications, all aimed at silencing those internal threats.
At a support group here for so-called voice-hearers, however, she tried something radically different. She allowed other members of the group to address the voice, directly: What is it you want?
"After I thought about it, I realised that the voice valued my safety, wanted me to be respected and better supported by others," said White, 34, who, since that session in late 2014, has become a leader in a growing alliance of such groups, called the Hearing Voices Network, or HVN.
At a time when Congress is debating measures to extend the reach of mainstream psychiatry - particularly to the severely psychotic, who often end up in prison or homeless - an alternative kind of mental health care is taking root that is very much anti-mainstream. It is largely non-medical, focussed on holistic recovery rather than symptom treatment, and increasingly accessible through an assortment of in-home services, residential centres and groups like the voices network White turned to, in which members help one another understand each voice, as a metaphor, rather than try to extinguish it.
For the first time in this country, experts say, psychiatry's critics are mounting a sustained, broad-based effort to provide people with practical options, rather than solely alleging abuses like overmedication and involuntary restraint.
"The reason these programmes are proliferating now is society's shameful neglect of the severely ill, which creates a vacuum of great need," said Allen Frances, a professor emeritus of psychiatry at Duke University. Chris Gordon, who directs a programme with an approach to treating psychosis called Open Dialogue at Advocates in Framingham, Massachusetts, calls the alternative approaches a "collaborative pathway to recovery and a paradigm shift in care." The Open Dialogue approach involves a team of mental health specialists who visit homes and discuss the crisis with the affected person - without resorting to diagnostic labels or medication, at least in the beginning.
Some psychiatrists are wary, they say, given that medication can be life-changing for many people with mental problems, and rigorous research on these alternatives is scarce.
"I would advise anyone to be carefully evaluated by a psychiatrist with expertise in treating psychotic disorders before embarking on any such alternative programs," said Ronald Pies, a professor of psychiatry at SUNY Upstate University, in Syracuse. "Many, though not all, patients with acute psychotic symptoms are too seriously ill to do without immediate medication, and lack the family support" that those programs generally rely on.
Alternative care appears to be here to stay, however. Private donations for such programmes have topped $5 million, according to Virgil Stucker, the executive director of CooperRiis, a residential treatment community in North Carolina. A recently formed nonprofit organisation, the Foundation for Excellence in Mental Health Care, has made several grants, including $160,000 to start an open dialogue programme at Emory University and $250,000 to study the effect of HVN groups on attendees, according to Gina Nikkel, the president and chief executive officer of the foundation. Both programmes have a long track record in Europe.
©2016 The New York Times News Service
