WEBVTT 00:00:24.000 --> 00:00:28.000 I'm going to talk to you about treating psychosis with psychoanalysis. 00:00:28.000 --> 00:00:37.000 In 1982, we opened the Center for psychoanalytic treatment of young adult psychotics in Quebec, 00:00:37.000 --> 00:00:45.000 which is referred to by its street address, "388", to keep the anonymity of the Center. 00:00:45.000 --> 00:00:50.000 What is psychosis? 00:00:50.000 --> 00:00:55.000 Also known as schizophrenia, psychosis is a severe mental illness 00:00:55.000 --> 00:00:58.000 that can have devastating effects. 00:00:58.000 --> 00:01:05.000 Symptoms include delusions, hearing voices, unbearable anguish; 00:01:05.000 --> 00:01:11.000 Patients will also be mistrusting, or closed off in an imaginary world. 00:01:11.000 --> 00:01:16.000 They will suffer from severe, sometimes extreme psychological distress, 00:01:16.000 --> 00:01:24.000 will cut themselves off from other people, and live in solitude. 00:01:24.000 --> 00:01:30.000 In the early 1980s, psychiatric science was at an impasse with treating psychotics. 00:01:30.000 --> 00:01:36.000 Treatment at the time consisted of medication and hospitalization. 00:01:36.000 --> 00:01:40.000 But medication couldn't prevent relapses; 00:01:40.000 --> 00:01:49.000 so patients would be re-hospitalized more frequently and for longer periods of time. 00:01:49.000 --> 00:01:53.000 As result, symptoms became chronic. 00:01:53.000 --> 00:01:57.000 This was known as the "Revolving door syndrome", 00:01:57.000 --> 00:02:01.000 whereby patients spent more and more time at the hospital, 00:02:01.000 --> 00:02:05.000 were increasingly marginalized, 00:02:05.000 --> 00:02:11.000 and placed in health care facilities, often for life. 00:02:11.000 --> 00:02:18.000 Today, in 2012, not much has changed. 00:02:18.000 --> 00:02:20.000 Nevertheless, there has been an important one: 00:02:20.000 --> 00:02:24.000 the chemical dimension of treatment has been strengthened. 00:02:24.000 --> 00:02:32.000 According to psychiatric biology, psychosis is a brain illness 00:02:32.000 --> 00:02:38.000 So the psychiatrist, who is also a doctor, 00:02:38.000 --> 00:02:46.000 will treat the sick brain before taking care of the person in distress. 00:02:46.000 --> 00:02:53.000 Thoguh it is well known that medication today can alleviate symptoms, 00:02:53.000 --> 00:03:00.000 they still can cannot prevent relapses from happening. 00:03:00.000 --> 00:03:04.000 In 1980, when the 388 was first opened, 00:03:04.000 --> 00:03:11.000 psychotic patients were also at an impasse with traditional psychiatric medicine. 00:03:11.000 --> 00:03:13.000 They felt ignored, 00:03:13.000 --> 00:03:15.000 they were afraid of speaking up, 00:03:15.000 --> 00:03:20.000 afraid of talking about what they were going through. 00:03:20.000 --> 00:03:25.000 When they did talk, they were told they were insane, delirious 00:03:25.000 --> 00:03:30.000 that what they said wasn't real and they should forget the imaginary voices. 00:03:30.000 --> 00:03:32.000 "Ignore the voices". 00:03:32.000 --> 00:03:36.000 Then patients were given more medication and kept at the hospital for longer 00:03:36.000 --> 00:03:43.000 until they eventually became quiet, and removed from others. 00:03:43.000 --> 00:03:46.000 One of the patients talks about this impasse. 00:03:46.000 --> 00:03:52.000 "I lost my friends... I wasn't feeling well. 00:03:52.000 --> 00:03:56.000 I was going crazy, I could hear voices, 00:03:56.000 --> 00:04:01.000 and I always carried a knife with me. 00:04:01.000 --> 00:04:05.000 I couldn't take it anymore... I wanted to end my own life. 00:04:05.000 --> 00:04:07.000 I went to see a psychiatrist 00:04:07.000 --> 00:04:10.000 but he didn't ask me what was wrong-- I didn't get a chance to talk. 00:04:10.000 --> 00:04:14.000 I asked for some psychotherapy, but he said it really wasn't for me. 00:04:14.000 --> 00:04:20.000 I started taking pills, and then the medication stopped having an effect on me 00:04:20.000 --> 00:04:26.000 or on the voices; and on top of that, I was gaining weight. 00:04:26.000 --> 00:04:31.000 It went on like this for years, until the doctors found a miracle medicine. 00:04:31.000 --> 00:04:36.000 I felt better for 6 months, even got a job... 00:04:36.000 --> 00:04:40.000 ...and then I had a major psychotic attack at work 00:04:40.000 --> 00:04:44.000 -- even though I had been taking my medication. 00:04:44.000 --> 00:04:47.000 I called my psychiatrist and told him that my medication wasn't working; 00:04:47.000 --> 00:04:50.000 all he did was increase my dosage. 00:04:50.000 --> 00:04:54.000 I felt like my life was over. 00:04:54.000 --> 00:04:58.000 I had no purpose, I fell into a deep depression, 00:04:58.000 --> 00:05:02.000 I wasn't doing anything anymore, not even speaking." 00:05:02.000 --> 00:05:10.000 Another patient, Mr. F, talks about his isolation: 00:05:10.000 --> 00:05:12.000 "I feel gentleness, 00:05:12.000 --> 00:05:14.000 I feel sadness, 00:05:14.000 --> 00:05:16.000 and I am alone. 00:05:16.000 --> 00:05:21.000 Life is like a hard lump stuck in my throat." 00:05:21.000 --> 00:05:27.000 30 years ago, GIFRIC psychoanalysts and psychiatrists 00:05:27.000 --> 00:05:33.000 were already trying to find alternative ways of treating psychotics. 00:05:33.000 --> 00:05:39.000 They wanted to give a future to those psychiatry had left out in the cold 00:05:39.000 --> 00:05:43.000 by offering them a real and dynamic treatment 00:05:43.000 --> 00:05:46.000 in which they would no longer be passive spectators of their own treatment, 00:05:46.000 --> 00:05:52.000 as they had been in traditional psychiatry. 00:05:52.000 --> 00:06:00.000 GIFRIC psychoanalysts wanted to offer an alternative to treatment and hospitalization, 00:06:00.000 --> 00:06:03.000 to offer a choice of treatment. 00:06:03.000 --> 00:06:06.000 The alternative was founded on 3 A's: 00:06:06.000 --> 00:06:09.000 (A)nother place, (A)nother way, (A)longside 00:06:09.000 --> 00:06:11.000 I'll explain: 00:06:11.000 --> 00:06:14.000 1. To find another place in the city, other than psychiatric hospitals, 00:06:14.000 --> 00:06:17.000 and bring psychotics together in their own space 00:06:17.000 --> 00:06:21.000 as a way of countering their marginalization in society. 00:06:21.000 --> 00:06:25.000 2. To find a different kind of treatment, using psychoanalysis: 00:06:25.000 --> 00:06:30.000 allowing us to hear and understand what psychotic patients have to say, 00:06:30.000 --> 00:06:35.000 and encourage patients to speak about that lump in their throat 00:06:35.000 --> 00:06:39.000 so that they can get things off their chest. 00:06:39.000 --> 00:06:42.000 3. To treat alongside psychotic patients, 00:06:42.000 --> 00:06:47.000 as a partner and main actor of their treatment in their treatment team; 00:06:47.000 --> 00:06:53.000 to help patients fulfill their dream of being in control of their future, 00:06:53.000 --> 00:06:55.000 of changing their own lives, 00:06:55.000 --> 00:07:01.000 and to claim the spot in society that is rightfully theirs. 00:07:01.000 --> 00:07:10.000 It was a challenge to do all of this in 1982-- and it is still a challenge today. 00:07:10.000 --> 00:07:15.000 Opening the 388 center was an innovation in psychosis treatment. 00:07:15.000 --> 00:07:22.000 Let me go back to Mr.D, the first patient, who said "I wasn't even speaking" 00:07:22.000 --> 00:07:28.000 "I saw an article on the 388 center and figured, why not? 00:07:28.000 --> 00:07:33.000 I started my analytic treatment. It was not easy and took a lot of hard work. 00:07:33.000 --> 00:07:40.000 But now, I'm back in school, I talk, and I've got a new lease on life." 00:07:40.000 --> 00:07:47.000 At the center for psychoanalytic treatment, psychoanalysis is defined as 00:07:47.000 --> 00:07:56.000 "a set of ethical practices that will promote a space in social relationships 00:07:56.000 --> 00:07:59.000 for unconscious desires." 00:07:59.000 --> 00:08:04.000 This new type of psychoanalysis is open to the problems faced by psychotics, 00:08:04.000 --> 00:08:12.000 and was made possible by the work of Willy Apollon, a psychoanalyst. 00:08:12.000 --> 00:08:19.000 The center is located in a beautiful house in a bustling neighbourhood 00:08:19.000 --> 00:08:25.000 in the heart of the of Quebec city. 00:08:25.000 --> 00:08:32.000 The facilities are open 24 hours a day, all year round 00:08:32.000 --> 00:08:34.000 There is no medication on the premises, 00:08:34.000 --> 00:08:38.000 there are no isolation rooms or restraints; 00:08:38.000 --> 00:08:44.000 The center runs on verbal agreements. 00:08:44.000 --> 00:08:50.000 Elise says: "What I like about the 388 is that the house promotes social living, 00:08:50.000 --> 00:08:53.000 that does not marginalize us." 00:08:53.000 --> 00:09:00.000 The Center was born out of a partnership between an NPO, the GIFRIC, 00:09:00.000 --> 00:09:06.000 and a public care institution-- currently, the CSSS Vieille Capitale. 00:09:06.000 --> 00:09:11.000 The budget for the Center was made available by the 00:09:11.000 --> 00:09:15.000 Ministère de la sante des services sociaux. 00:09:15.000 --> 00:09:20.000 A complete psychiatric treatment is the first of the treatments offered at the Center, 00:09:20.000 --> 00:09:25.000 performed by an interdisciplinary team trained in the psychoanalytical treatment. 00:09:25.000 --> 00:09:34.000 This team, that is ready for anything, is headed by a psychiatrist-psychanalyst. 00:09:34.000 --> 00:09:42.000 There are beds for treating those crises that used to send patients to the hospital. 00:09:42.000 --> 00:09:45.000 Having these beds on-site avoids hospitalization. 00:09:45.000 --> 00:09:48.000 There are also art workshops-- not art-therapy, 00:09:48.000 --> 00:09:55.000 but workshops with real artists, musicians, ceramists, stage actors, 00:09:55.000 --> 00:09:57.000 and painters 00:09:57.000 --> 00:10:06.000 -- to allow psychotics to invent adequate means of expressing what words can't. 00:10:06.000 --> 00:10:10.000 There are always things that cannot be expressed in words. 00:10:10.000 --> 00:10:14.000 The Center also houses sociocultural activities: 00:10:14.000 --> 00:10:17.000 these are group activities that break isolation 00:10:17.000 --> 00:10:24.000 and favour the creation of strong relationships with others 00:10:24.000 --> 00:10:27.000 through work and study projects. 00:10:27.000 --> 00:10:35.000 At the heart of all this are regular, personal sessions with a psychoanalyst. 00:10:35.000 --> 00:10:41.000 Through psychoanalysis, psychotic patients work on "the thing inside them" 00:10:41.000 --> 00:10:46.000 -- or "the monster", in their words-- that makes their life unbearable. 00:10:46.000 --> 00:10:50.000 Patients are guided through their suffering, 00:10:50.000 --> 00:10:57.000 and go through why their life is insane in their eyes, and in other's eyes. 00:10:57.000 --> 00:11:01.000 Patients talk about anything with their psychoanalysts; 00:11:01.000 --> 00:11:08.000 but they talk about their crises in particular: the voices, the delusions, the dreams, 00:11:08.000 --> 00:11:11.000 the inner demons... 00:11:11.000 --> 00:11:14.000 They talk about the traumatic experiences in their life 00:11:14.000 --> 00:11:17.000 and will try to make sense of all of it. 00:11:17.000 --> 00:11:24.000 Then, patients try to find another way of living with others 00:11:24.000 --> 00:11:28.000 so that they can give new meaning to their life. 00:11:28.000 --> 00:11:35.000 The goal is to understand what happened to them, 00:11:35.000 --> 00:11:40.000 to profoundly change their life. 00:11:40.000 --> 00:11:42.000 One patient explains: 00:11:42.000 --> 00:11:46.000 "I understood that psychosis is a language; 00:11:46.000 --> 00:11:51.000 one that I would be the one to decode, 00:11:51.000 --> 00:11:59.000 so that I would be able to never use it again." 00:11:59.000 --> 00:12:06.000 Another patient shares his experience with psychoanalysis: 00:12:06.000 --> 00:12:11.000 "In my treatment, the long process of de-possession was difficult: 00:12:11.000 --> 00:12:17.000 breaking free of the psychological jail that confined me to exclusion. 00:12:17.000 --> 00:12:25.000 Today, I no longer carry the weight of the voices of others like me. 00:12:25.000 --> 00:12:32.000 In order to do that, I had to find the root of a fissure in my childhood; 00:12:32.000 --> 00:12:40.000 and when I found that fissure, I could not just plug it up. 00:12:40.000 --> 00:12:47.000 Now, my work requires that I do something that was completely unknown to me before: 00:12:47.000 --> 00:12:49.000 Negotiating. 00:12:49.000 --> 00:12:56.000 You cannot imagine how much human wealth negotiation represents." 00:12:56.000 --> 00:13:00.000 At the 388, we have results 00:13:00.000 --> 00:13:05.000 Here is some objective data from the GIFRIC clinical observatory 00:13:05.000 --> 00:13:11.000 First, we have a significant decline in the number of hospitalizations 00:13:11.000 --> 00:13:17.000 90% less hospitalization days for a group of patients 00:13:17.000 --> 00:13:21.000 that had been in treatment for at least 3 years in January 2012. 00:13:21.000 --> 00:13:26.000 This represents a substantial amount of cost savings. 00:13:26.000 --> 00:13:29.000 The amount of medication was also reduced, 00:13:29.000 --> 00:13:32.000 and the quality of life was also improved: 00:13:32.000 --> 00:13:36.000 life in an apartment room, studies, work, friends 00:13:36.000 --> 00:13:38.000 an independant lifestyle... 00:13:38.000 --> 00:13:45.000 and being able to laugh again. 00:13:45.000 --> 00:13:52.000 Psychotics go from being socially excluded to being full-fledged citizens. 00:13:52.000 --> 00:13:56.000 They, like you and I, even pay taxes 00:13:56.000 --> 00:14:00.000 There are 2 types of subjective data for the results 00:14:00.000 --> 00:14:07.000 (1) Those taken from evaluations conducted in 2002 by Ministry of Health experts 00:14:07.000 --> 00:14:11.000 In their report, they took an interest in parents 00:14:11.000 --> 00:14:18.000 who saw their children become more open and express their personality. 00:14:18.000 --> 00:14:25.000 They did this by progressively going through the stages of social reintegration. 00:14:25.000 --> 00:14:29.000 The experts also noted that parents particularly appreciated how 00:14:29.000 --> 00:14:37.000 treatment at the 388 allowed patients to optimize their abilities 00:14:37.000 --> 00:14:43.000 and reach a state of recovery their families had stopped hoping for. 00:14:43.000 --> 00:14:50.000 The second type of results are more important to us. 00:14:50.000 --> 00:14:54.000 (Here's a picture of the green staircase) 00:14:54.000 --> 00:15:05.000 What we care most about, is when the psychotics are discharged 00:15:05.000 --> 00:15:11.000 Its who we care about most-- those whose lives were saved by psychoanalysis. 00:15:11.000 --> 00:15:13.000 One such patient says: 00:15:13.000 --> 00:15:17.000 "I used to deal to the difficulties I faced in life 00:15:17.000 --> 00:15:22.000 by locking myself up in my imagination. 00:15:22.000 --> 00:15:26.000 Sometimes it became nightmarish: 00:15:26.000 --> 00:15:29.000 nobody wanted to hear about what I had in my soul. 00:15:29.000 --> 00:15:32.000 My analytical treatment saved me. 00:15:32.000 --> 00:15:36.000 The analyst accompanied me, without judgement, 00:15:36.000 --> 00:15:38.000 through the meanders of my thoughts. 00:15:38.000 --> 00:15:43.000 Now, I can face the challenges life throws at me 00:15:43.000 --> 00:15:51.000 with the experience I amassed during my treatment." 00:15:51.000 --> 00:15:53.000 Now I will conclude. 00:15:53.000 --> 00:15:57.000 A couple years ago, after a visit at the 388, 00:15:57.000 --> 00:16:04.000 a fellow psychiatrist-- a former director of a psychiatrist hospital in Montreal 00:16:04.000 --> 00:16:10.000 as well as Canadian representative to the WHO at the time-- 00:16:10.000 --> 00:16:13.000 wrote the following: 00:16:13.000 --> 00:16:17.000 "If the 388 did not exist, 00:16:17.000 --> 00:16:21.000 it would need to be invented." 00:16:21.000 --> 99:59:59.999 Thank you for your attention.