New Zealand, 2002:  A Case History
By Ann Rosberg


It was at least a year ago that we began corresponding with the mother of a young woman who was diagnosed as having schizophrenia.  The family lived in New Zealand and the mother had researched the Internet to see if she could get some information related to the treatment of that condition.  According to her, after a great deal of searching, treatment in Auckland, New Zealand was focused on medication and hospitalizations.  There was no substantive treatment, not only in the public sector but also in the private sector.  She was despondent and desperately searching for some relief for her daughter, who at the age of 22 had a history of at least 8years of this unfortunate condition.  We corresponded with her for quite awhile and felt strongly that we wanted to do something more than sending
e mail letters.  We suggested to the family that we would go to New Zealand and work with this young woman for at least several months.  We had talked to the mother and A. the young woman on the phone and felt that this was a unique opportunity to share our experience with them.  We offered our help and it was happily accepted by family and A. and we left for New Zealand in June of 2002.

We stopped in Auckland for two days to recover from the long journey and then drove to a suburb of New Zealand on 15 June.  We arrived in this lovely suburb of New Zealand and were looking forward to meeting with A. and her family who had been so desperate to find someone who could help her young daughter who as I said, had been diagnosed as having schizophrenia.  They had searched for help and could find no one to offer A. the help that she needed and deserved. 

As unreal as this may seem, this young woman was yet another ‘hopeless case’ according to the 20 or more professionals she had seen over the past eight years.  The parents and she were told that she must ‘wait for a miracle’, which meant that there was nothing available to help her with her schizophrenia. The word ‘hopeless’ we believe is a product of the professional world, rather than the condition of the person with schizophrenia.  It is quite clear, in our estimation, that too many professionals and the uneducated public see those individuals with schizophrenia as being untreatable because of the stigma and the lack of understanding of this process.  Clearly the unwillingness of the professionals to involve themselves in the world of schizophrenia with some hope and the freedom to see the human qualities that these people possess.  It is not easy but it is critical, in treatment, to see the world through their eyes and understand their needs and have the willingness to participate in their lives. 

In the waiting part of the airport we saw a sign with the name Rosberg on it and felt welcomed.  A. her mother and father were there.  We were happy to see them.   I gave her mother a hug, shook hands with the father and felt immediate warmth for A. and gave A. a big hug which she returned.  I can only imagine what she was thinking and that is, who in the world are these strange people coming all the way from America to help me and can they really help me?  In view of the past, can I believe them and maybe do I really want to change?  Do I really want help?  Maybe it’s easier and less disappointing to stay the way I am. 
The mother had told us that A. really wanted to get well, in our correspondence with her, was tired of her life as a sick person.  We didn’t know whether this was her mother’s wish and whether A. felt the same way.  We had a brief telephone conversation with A. and her mother in the past and they both were warm and friendly. 

We talked briefly at the airport then went to a restaurant for lunch.  During lunch, we noticed that A. had a large appetite and also drank too much wine.  However, it was interesting to observe the interaction between the family members.  It was obvious that her parents did not approve of her eating and drinking habits.  We could see the underlying conflict between her parents and her even though it was suppressed.  After lunch, they took us to our apartment and we sat with A. and family.  We felt comfortable with her and the parents.  Her communication was pretty much limited to saying ‘yes’ many times to whatever we and/or her mother and father would say to her.  In our initial contact with her there we did not observe any symptoms of schizophrenia.  We spent the rest of the afternoon with her and her family getting to know each other.  She was coherent, appropriate, and easy to like.  After some time, the mother and father decided it was time to leave and A. left with them.  But before she left she mentioned that she would like to get together with us the next day, which was Sunday, and we were very happy to agree with her decision.

The next day, we needed to get the fundamental groceries at a local store and in doing so had A. help us get something for dinner.  We began immediately working with her, getting to know her and of course, her getting to know us.  That is the first step in treatment, making a meaningful contact.  We did not ask her too many questions and she seemed reluctant to offer any information about herself.  One must bear in mind, that this was our first contact alone with her.  Her answer to some of the normal questions we would ask, would simply be ‘yes’. She spent the rest of the afternoon with us and also had dinner with us.  She was extremely polite and courteous.  The time went by very fast and she left in time to catch her train to go back to her apartment.  We were impressed by her knowledge of the exact time which she needed to make the train back to her apartment and how long it would take for her to leave our apartment to get to the train station.  She was a very precise in that respect. 

As she showed us the ‘her’ city by train and bus we began to know each other.  She is very intelligent and clever.  In the beginning, we let her decide what to do during the day.  She would tell us what time she wanted to come over to our apartment in order for us to begin the day.  She usually came at noon.  She was always prompt.  She would be with us at our apartment after being out for the day and would have dinner with us.

We were there to help her develop a program that was healthy for her and for her to get out of bed at a reasonable time and change her lifestyle.   She showed us where she spent a great deal of time. It was an undesirable area, populated by people who were drug addicts and those who sold drugs, alcoholics and explicit sex shops.  She visited there frequently with her boy friend to play pool and drink wine in a very disreputable place.  Also in that area she had to see her case manager every fortnight and her psychiatrist, whom she saw every month.  They were part of the public system, which is a treatment design that doesn’t offer any help beyond the overuse of medication.  In that public clinic one could see people who were destined to spend their life being mentally ill without any hope offered to them by that institution. 

She had been diagnosed at that public institution by psychiatrists.  There were different diagnosis, schizophrenia, schizo affective disorder, borderline personality disorder and other forms of psychosis, severe depression and obsessive compulsive disorder.  One by one we looked at these diagnosis and began to discount them as we grew to know her.  She was not schizophrenic, she didn’t have a schizo affective disorder or a borderline personality disorder, but we could tell that she was quite depressed and suffered from an obsessive compulsive disorder.  There were times when anxiety and stress produced psychotic like symptoms but we were convinced that this was more of a hysterical nature than psychosis. 

On one occasion, we asked to see her apartment.  We wanted to have some better idea of how she expressed her obsessive compulsive disorder.  Jack instructed her to show us what she would go through before she was able to leave the apartment.  She went through her obsessive checking to make sure in her mind, that there were no dangers remaining.  Methodically and painfully she went through her ritual making sure that the gas burners were off, no escaping gas and that the windows were locked. 

She was interested in sports mainly in biking and running.  She had won a competition in long distance running which was really amazing in view of the fact that she was a smoker!  We thought, in view of her interest in sports and the fact that she was overweight, that perhaps going to the gym on a regular basis would be a good idea.  A good deal of the weight gain had to do with clozapine, a medication she was taking.  She was in agreement and luckily there was a gym close to her apartment and her parents agreed to fund it.   

After the initial phase of treatment, Jack started working with her intensively.  It was an informal therapy because it took place on the train, on a bus, in a restaurant, walking down a street, sitting waiting for a train.  He would cajole her, make jokes and she seemed to be responding.  We knew after a while that she would be resistant to change because she had this condition for so many years.  We were not sure that she trusted us.  We were not sure that we had established a treatment alliance.  She had known over the years many psychotherapists/psychiatrists who were indifferent and disappointed her, so why should she trust us so soon?  We confronted her repeatedly with the fact that she had to make lifestyle changes in order to live a more productive life, but we understood that even though she needed to trust someone, she was not yet ready to trust us that much. 

When Jack was pressing harder, I would adjust my stance and be softer with her.  By that I mean that I would support Jack’s work, which helped her understand the sick life she was leading and hoped to help her understand that if she didn’t change some of her habits, it could lead to a lifetime of sickness.  I found it important to focus on issues more than is typical in treatment.  I saw many healthy parts to her that I thought needed to be reinforced.  There was a strength to her that at first sight was not visible, but it became apparent afterwards and I felt that if I could help bring it out in a meaningful way, she would be able to use it productively.  She was as I said intelligent and sensitive and when she wasn’t threatened, there was openness and a sweetness and warmth expressed by her.  It was a good balance between the three of us.  We were in the process of pressing her to make behavioral changes that would benefit her.  She agreed that this had to happen, but she expressed some fears in reference to making changes.  However, the relationship was growing stronger and we felt that there was a therapeutic alliance and even a sense of affection between us. 

We spent hours a day with her, usually around 6 hours a day, depending on what we were doing and where we were.  As the relationship grew stronger, we demanded more of her.  Her parents were very supportive and that helped us in establishing a program for her that met her specific needs.  We thought that she needed both physical and mental activities that were stimulating and also physically activating.  Besides the gym, she wanted to resume playing the piano.  Her parents brought her piano to our apartment, so that she could practice.  Part of the structure also was that she should clean her flat on a daily basis.  She was not too happy about that, but she agreed. 

In order to go to the gym, it takes a little more than getting up at noon.  That meant that A. had to get up at least three times a week earlier.  We agreed on a time that she should be awakened.  In view of the fact that she was taking medication and also that she had lived a life of sleeping long hours, we all felt that it was appropriate for us to wake A. up earlier by phone.  Another issue with A. was that it was difficult to engage her in any meaningful discussion, she would usually be agreeable, at least on the surface, by saying ‘yes’ to most requests.  Even though it became apparent that she didn’t always agree.  We asked her why she would say ‘yes’ and she stated that she felt it would help to quote her ‘to keep the peace’.  So both Jack and I had to do a lot of the talking about what we thought she was going through and how she felt and though we weren’t always right, our intuition did indeed serve us well a good deal of the time. 

She was interested in computers as well, so we went to a computer school in her area and A. and I registered together.  I thought it would be helpful to her if we did this together.  She already had some command of the computer and I was impressed with how quickly she was able to deal with its intricacies. The computer course completed the week.  So, the plan would be to meet her at the gym, Monday, Wednesday and Friday and then to computer school on Tuesdays and Thursdays, plus piano practice, constituted a full working week for her.  That meant that she had to get up earlier.  Jack and I mentioned once again, that she should clean her apartment and she finally found that gratifying.  But bear in mind that this was not without a struggle and attempts on her part to undo the structure of the week, which at times, she succeeded in doing.  We persisted and she began getting up quite early for her, she had something to keep her occupied in a useful way.
 
She seemed over medicated.  She complained about this and told us it really made her feel unwell and tired all the time, the medication made her ‘feel zombie like’.  In view of the fact that we are not psychiatrists we did not encourage her to do anything about it.  Our efforts were designed to help her make behavioral changes in order for her life to be more rewarding.  The medication was left in her hands and she independently began to reduce the amount prescribed.  There didn’t seem to be any negative affects initially. 

Just to show you how intelligent and clever she is, one day she asked Jack if he really treated ‘crazy’ people.  Jack’s reply was ‘of course I do’.  Jack mentioned that he had brought some video tapes with him and asked if she wanted to see some of his tapes of actual treatment sessions.  She was intrigued.  As she watched a tape, she wanted to see more of them.  They are actual video tapes of severely regressed individuals diagnosed as having schizophrenia.  She saw someone who really cares about others and gets angry at their craziness, while respecting them as worthwhile human beings.  I think that perhaps she thought that for once, here is a man who understands me and that he really does treat people in a humane and sensitive way. 

Just as Jack was active with her, I was as well.  I expressed a woman’s point of view, perhaps a maternal point of view without being over bearing or demanding.  I never told her what to do, I was respectful of her.  She began to ask me my opinions about different things in her life.  I thought it would be good to disclose something personal about myself I shared my life with her and she began to share hers with me as well.  We were equal, after all.  I was real with her and I think that she was sensitive to this.  I really cared for her a great deal and showed my affection towards her, which she began to reciprocate. 

We worked in the kitchen together.  Not in the beginning, but after some time.  She actually wanted to make a dinner for us one night, which I thought was a lovely thing to do for us.  We had a typical New Zealand dish.  She surprised us with her efficiency but then knowing her, we both knew that she had many talents that were not on the surface, but deep down.  It was up to us to find them and to make the healthy parts flourish. 

We all decided that it would be a good idea to see more of New Zealand, within her budget and ours as well.  We decided to go north which is much warmer and went to another area for a vacation, a lovely spot.   We made arrangements with her parents and once again, her parents were cooperative and generous with her.  She had a room to herself and she thought it was a wonderful room.  We decided to see some of the culture, which we found very interesting.  She was easy to be with most of the time.  We also went to the Great Barrier Reef and she did some swimming there and seemed to be having a good time as we were.  She went biking by herself on a motor bike and came back to report that she had a wonderful time, ‘exciting’ was the word she used. 

After this, there seemed to be a greater bond between us.  We had enjoyed her company and I think that perhaps she was happy to get away for a mini vacation and enjoyed her time with us as well.  She, I think really began to trust us more and to talk more about herself and some of her problems.  Jack and I were able to help her understand more and more about her life.

Upon our return we resumed our lives in much the same manner, her going to the gym three days a week and some of the computer classes.  Jack kept the pressure on and reminded her of her need to change and to lead a more normal life.  She seemed to want to do that.

However, she began having trouble sleeping.  Believe me, I know what it’s like when you are under a great deal of pressure and you can’t sleep and I told her this.  I also told her that sometimes I would be so tired, that I didn’t want to continue working, but I would awake the next morning, after a restless night’s sleep and continue to do my work, which I loved.  I never once told her that she should in any way continue her efforts at trying to change. 

At one point, she stopped medicating herself, without telling us.  She had suddenly stopped taking one of her medications, one of the so called anti psychotic medications.  She felt better during the day, but was having trouble sleeping at night.  She wanted to do the right things, but was naïve about stopping medications.  Usually, one does not just stop taking medication all at once, but she did.  She did not become psychotic!  Therefore, she definitely was not schizophrenic as she was told by her doctors.  You really have to be experienced to understand the process of schizophrenia in order to make an accurate diagnosis.  I failed to mention that Jack had told her and her family that she did not have schizophrenia. 

A. told Jack that she had some medication for anxiety which she was taking at bedtime.  That she said seemed to help her.  Jack was not the prescribing doctor and was not about to prescribe anything for her because he is not a physician.  She took matters into her own hands as far as her medications were concerned.

She seemed to be progressing and enjoying herself.  Interestingly, at moments when she was under a lot of pressure, she would just go and play the piano.  This seemed to reduce the anxiety. 

She started to look in the papers for a job.  As a matter of fact, she had two or three job interviews that she wanted to go to.  She wanted something simple and also something near her apartment.  She did this without us prompting her nor did we tell her that this was part of her rehabilitation.  She actually started this search while we were on vacation by looking at the want ads in the paper.  She renewed her resume from something that she had before.  I was amazed at her competence on the computer.  She was fantastic, I helped her a little, but for the most part, she did all the work.  This was very tedious for her and almost overwhelming.  It did in fact create a good deal of anxiety.

When the day came for her to go to her interview, she came over to our apartment and we saw her for the first time in clothes other than her regular jeans and sweatshirt.  She looked absolutely lovely.  I would have hired her on the spot with her qualifications in hand and her ability to articulate her needs.  She was nervous as it was pouring rain outside and didn’t want to get wet.  I loaned her my umbrella and off she went.  She returned only to tell us that it was a telemarketing job.  Jack told her that she was not the kind of person that was hardened to this kind of approach and suggested that she not take the job.  She was relieved.  However, it became apparent to us that this young woman was looking for some way of becoming independent and not feel, obligated to the system or to her parents. 

For a few days, she took off from looking for a job.  After all, she had come a very long way in such a short time.  We were approximately six weeks into our stay in New Zealand. 

She really loved bicycles and told us many times how she would go down a flight of stairs in the city and also on dirt paths; where she could jump over small cliffs.  She loved challenges that she could meet. 

One of the times, I remember, she was at the club with her personal trainer and he told us that he was going to take A. for a run around the park.  It was A. who took him for a run around the park.  When they returned, he was amazed at how fast and how athletic she was and that she had out run him by far.

One day, she was to come over to our apartment and told us that she wanted to come by bicycle.  She started to ride her bicycle once again, wonderful.  She started from her apartment which was approximately 30 miles away and rode to our apartment.  We were careful not to discourage her, because it’s important not to prevent people who have emotional problems from making these kinds of efforts.  When she arrived at out back door with her bicycle, she was all red in the face and had nicked her chin and leg.  We were amazed at her strength and endurance.  We really felt that she was struggling for her recovery.  She took the train home, after all this was her first time on the bicycle for some time.

And so the treatment went.  She was a little difficult at times and rightfully so.  After all, she had changed her lifestyle a great deal.  From staying in bed most of the time and seeing her doctor and then going to the pub to play pool and drink wine, to becoming a more  responsible person, going to the gym, playing the piano, computer, cleaning her flat, which she now seemed to enjoy.  This was a good beginning for her and she really was beginning to feel good about herself. 

However, treatment is not always positive.  There was a day that she was really angry there was so much anger inside her and no way to express it. 

One day her parents were at our apartment, she came over with a sullen and angry expression and not wanting to see her parents.  As we were sitting on the veranda talking, trying to deal with some of her angry feelings, her mother came out from the apartment.  A. got up suddenly and brushed her mother aside angrily and yelled something at her.  A. went inside, for awhile then came out again.  She felt guilty for yelling at her mother, but didn’t know what to say because she was still consumed with anger.  Her mother was irate but didn’t express her apparent anger towards A. for being so rudely treated.  When her parents went to leave, A. ran after them.  We thought she felt guilty and wanted to apologize but it turned out that what she wanted to do was get a CD from her father’s car. 

When she came back, she seemed agitated and quite irrational.  There were a number of ideas that she stated, one was to thumb a ride up north to a beach and spend some days sleeping on a beach.  We were concerned about her doing something that might be harmful to her and tried to work through some of the irrational ideas.  Then she wanted to go to see her case manager.  This concerned us a great deal because we were worried that our treatment alliance was ruptured and that she was choosing her case manager because of her anger towards us because she felt, this was our guess that we were in league with her parents. 

She said she felt like going there because she ‘felt sick’.  But we were concerned.  We tried to persuade her to stay and talk this through; there was no moving her in our direction.  Realizing that we could not change her mind we decided to go with her so that we could make an effort to reestablish the alliance with her.  We took a train with her to the clinic where her case manager worked.  It seemed on the way that we were resolving her feelings of suspicion about us.  We went into the clinic and sat with her and it took some time, she changed her mind and tried to leave several times.  But the staff persuaded her to stay.  Finally she was escorted into the case manager’s office and before long he came out and told us that A. wanted us to leave.  Jack told him that we would respect her wishes but he wanted her to tell us to leave.  She did come out and told us that she was just going around the corner to see her psychiatrist.  A woman raced to the door and brought a car around the front and it became obvious what was going on.  She was ushered into the car and she waved goodbye to us as we stood at the entrance to the clinic. She assumed that she was going to see a psychiatrist, we both looked at each other in disbelief; they are going to take her to the hospital. It was a gross breach of ethics that they lied to her and took her without her knowledge or consent, we assumed, to the hospital.  It seems like the dark shadow of the past creeps up into the present. 

In New Zealand, they have a system called ‘regulation’ wherein a person can be admitted to a hospital.  If a psychiatrist believes they need to be there, i.e. in the hospital, it has been our experience that many psychiatrists are too quick to hospitalize people and by doing so, rob them of their dignity.  They do not have the chance to deal with their problems because in the public system, it appears there is no one equipped to help them deal with their problems.  Not only do they not have the ability but they don’t have the time and it seems they don’t have the interest.  As a matter of fact, if you do not make your appointments eventually they will send the police and take you to the hospital.  A. knew this and was terrified at the thought of them coming to her door even if she was not regulated.  They had done that in the past.  How does one get well and how does a person get away from that dictatorial system!  How can one get well if they are so afraid that if they don’t obey the dictums then they will be hospitalized.  If you don’t do what they say, you are back in a hospital against your will without the freedom of learning to cope with your problems and not only do you become a prisoner of this system, but you give up hope.  We assumed that A. was in the hospital, but we did not know for sure, until at that night a call came from her.  She was in the hospital as we suspected.  She was desperate!  She told us that she was not crazy and wanted out and they wouldn’t let her.  We told her to be calm, if possible and just obey the rules.  They kept her three days, just enough time to medicate her to the fullest.  However, she was caught spitting out the medication and put on watch, so she had to take the medication or she would ‘be in serious trouble’.  We were in constant contact with her.  We told her that she could call us when she wanted and we would do whatever we could to help her.  What they did to her was certainly destructive to their system and helpful to our position.  Because she saw the difference between ignorance and dogma and the warmth, hope and determination we had in relationship to her.   

After she came out of the hospital, she came to our apartment.  She was put on medication in the hospital, not just a helpful dose, but a great deal of neuroleptic medication that was designed to destroy her sense of freedom and independence.  Medication can be useful but some people do not respond favorably to it.  She was resistant to the dictatorial attitude of the public psychiatrist and she stopped taking the medication because she didn’t want to be a zombie anymore. 

Let me tell you what I think about the system in New Zealand as I know it.  Medication is the primary treatment method.  According to the many people we talked to and psychiatrists and other mental health professionals, there is nothing else besides the use of medication.   It can harmful and destructive and when given by itself, makes the patient chronic sooner. The public health system doesn’t really help.  It appears to me that the method of treatment there is regulated inappropriately by the government, professional apathy, stigma and the pharmaceutical industry.

People are caught in a web of chemical straight jackets and it perpetuates their illness.  The public system in New Zealand is very poor and we couldn’t find anyone who was experienced in the treatment of schizophrenia with anything besides medication. Psychiatrists, many of them do not understand the psychology of schizophrenia and A.  was misdiagnosed.  It was obvious to Jack, that she was basically a severe depressive reaction with some of the symptoms related to depression.

She was more open with us this time, after having been in the hospital.  A. told Jack during a conversation with him about the profession that she ‘learned how to lie to the professionals’.  This was one of her defense mechanisms that she had to learn in order to protect herself.  We all have coping devices in the real world we live in, lying to the professionals was A. way of coping.  This was the first time she had ever said anything negative about the New Zealand’s way of dealing with patients

We did meet some interesting psychiatrists and psychologists.  There was one psychiatrist in particular, the head of a public clinic, who was sympathetic to treatments other than the use of medication but whose hands were tied by the system in place.  He was a participant in a research study that focused on the consumer, their version of treatment and what they felt helped and what they believed hurt them.  Many of them recovered partially or fully without any professional help because they were determined to overcome their conditions.  That in contrast to the stigma that exists in the public and professional world, which states without equivocation that people with schizophrenia cannot recover. 

Her mother was good enough to contact the news media ABC New Zealand because she felt that this was an important story that needed to be told. Obviously they wanted an interview with Jack and also A.  They wanted to know about Jack’s method of treating people and also his views of New Zealand’s treatment of this condition called schizophrenia and other related disorders. They interviewed A. as well.  The interview went very well, Jack did indeed tell them about the terrible treatment of the severely mentally ill in Australia which is not uncommon in other countries as well, including the US.  They interviewed A. also and she told them many things, which I will quote below.

This will give you an idea of how the interview went.  

Jack:  How are you today?

A.:  Good, thank you.

Jack:  Good to see you today.

A.:  Yes, good to see you too Jack.

Jack:  Is there anything you want to talk about? 

A.:  I’m feeling pretty good today.

Jack:  I’m glad to hear that.  Let’s see, let me think for a moment.  You have a history of severe depression for about 8 years, is that right?

A.:  Yes.

Jack:  You’ve been hospitalized a number of times with that condition.

A.:  Yes.

Jack:  You have been diagnosed as what?

A.:  Schizophrenic.

Jack:  Is there any indication that that’s an accurate diagnosis?

A.:  In some ways yes, in some ways no.

Jack:  Do you want my opinion?

A.:  Yes.

Jack:  There is no reason to believe that you are schizophrenic and I think that’s a terrible misdiagnosis.

A.:  Yes.

Jack:  You suffer from depression and some of your fantasies did resemble schizophrenia, but you don’t have the characteristics of schizophrenia.

A.:  Yes.

Jack:  Depression is bad enough and you’ve had some unhappy experiences. Is that correct?

A.:  Yes.

Jack:  Can you tell me something about what happened when you were in the hospital?

A.:  Yes, when I was in hospital I wasn’t very happy at all to be there.  I don’t think it helped me a lot.  It’s a negative place to be.  I don’t like medications.  I try to avoid medications.  Yes, I just don’t think hospitals help very much.

Jack:  Do you think it did you some harm?

A.:  Not harm, no, but I think it was a waste of time and money and the government’s money.

Jack:  What could have been a better way to go with you?

A..  I just needed some time out to figure out what I was going to do with my life; I’m still sort of frustrated at the moment.

Jack:  Is that true?

A.:  Yes, that’s right.

Jack:  I’m not going to mention it unless you want to.

A.:  That’s alright.

Jack:  The condition which is called OCD can you tell me what that meant?

A.:  It meant I felt I always had to keep checking things all the time.  At the moment, I’ve pulled through that, I don’t have that condition anymore.

Jack:  You overcame that just recently?

A.:  Yes, just recently.

Jack:  What else did you do?

A.:  I broke up with my boyfriend.

Jack:  Why did you do that?

A.:  Because I thought he wasn’t good for me and I wasn’t good for him, he has a history of mental illness too and I don’t think we are a good combination.

Jack:  Isn’t it true that you began activating yourself?

A..: Yes.  Yes, I’ve decided I don’t want to be on the pension anymore and I have to start looking for a part time job.  I do work at the moment but just as a clean up person. 

Jack:  So you became increasingly active, right?

A.:  Yes.

Jack:  Made changes, significant changes made.

A.:  Yes.

Jack:  You got out of bed.

A.:  Yes, I stopped taking my medications which was clozapine and that enabled me to have less sleep at night, I wasn’t so sedated and that’s another big change in my life because I took that medication every night for 4 years pretty much, without missing a night.  I think that created some stress.

Jack:  Reducing the medications, you did it yourself?

A.:  Yes, I totally stopped it.

Jack:  Activating yourself, breaking up with your boyfriend, looking for work, doing physical things, like going to the gym – three times a week.

A.:  Yes.

Jack:  It created some anxiety in you didn’t it?

A.:  Yes.

Jack:  And when you went to the doctor, didn’t he think that that was, a reflection maybe of regression on your part and you were getting sicker?

A.:  Yes, well the doctors interpreted my recent unwellness as a result of not taking my medications.  But to me personally, I don’t think it had anything to do with taking my medications.

Jack:  What do you think it has to do with?

A.:  Just the changes in my life.

Jack:  Well, making changes and the changes created anxieties.  It was mistaken as being a result of not taking your medications and then what happened?

A.:  I was quite unwell and I had to go back to hospital.

Jack:  Were you unwell?

A.:  Yes,

Jack:  Is that what you consider being unwell?

A.:  Yes.

Jack:  Being anxious?

A.:  Anxious, having psychotic like symptoms.

Jack:  Yeah, well if you change your lifestyle and become more active, and that creates anxiety, which is not an abnormal condition.  Would you consider that to be a sickness?

A.:  No, It just depends how you respond to those changes.

Jack:  Yeah, well do you want to know my opinion?

A.:  Yes.

Jack:  You were not psychotic, you were just anxious, and it’s ok to be depressed and anxious, especially when you make changes in your life and the changes you made after many years were very very significant, one would expect that.  Remember in our process of our working together, especially in the beginning, I told you as you made the changes you would feel some anxiety?

A.:  Yes.

Jack:  And increased depression, because as the medications goes out of your system there is more increasingly difficult for you to sleep, but you slept enough.

A.:  Yes.

Jack:  You did a lot of things.

A.:  Yes.

Jack:  A lot of things that were strange to you.

A.:  Yes.

Jack:  That you hadn’t experienced for many years.  I think it’s a tribute to you.  That you had the strength the determination and the courage to face a different lifestyle, which was confused and you were considered to be a psychotic and I don’t see anything that resembles that at all.

A.:  Yes.

Jack:  I don’t know if you’ll agree with me or not, you don’t have to – I think you’re a winner.

A.:  Thanks Jack.

Jack:  What is your position now?

A.:  I don’t know at the moment.  I, well…

Jack:  What did you tell me yesterday?  Can I remind you what you said to me yesterday?

A.:  Yes.

Jack:  You were determined.  Am I using the correct term?

A.:  Yes.

Jack:  You were determined to recover, you were determined to go to work and you were
determined to stay out of the hospital.

A.:  Yes.

Jack:  Aren’t those the factors that make a person get better?

A.:  Yes.

Jack:  And I’ve always had faith in your capacity to recover.

A.:  Yes.

Jack.  I think I’ve made this quite clear to you and it grows more and more as time goes on because I see how much courage you have.  Even though your faith waivers back and forth which is only a natural thing.  You are making progress and in my opinion.  There is every reason to believe that you can recover fully and you can live a better life than you have ever lived in your life and you can succeed professionally in your life, if you like.

A.:  Yes.

Jack:  Or whatever you want to do.

A.:  Yes.

Jack:  OK?

A.:  Yes

A. was interviewed by the ABC New Zealand News as well and this is quoted from the video tape we have in our possession.

Interviewer:  When did things go bad for you?

A.:  Just at 15 when I was working for a bakery, split shift, and going to school full time and they put a lot of pressure on us to do well in order to get into University.  I started to get depressed quite run down and then things progressed as I got older.  I had strange thoughts at 18 and I was diagnosed as schizophrenic.  I’ve never really been well since I was about 14.

Interviewer:  How did you cope with that knowledge that you had schizophrenia?

A.:  Not very well, I was pretty upset about it I felt that there was no hope for me I thought I would never be able to live a normal life, that there was nothing anyone could do.  I was told by a psychologist quite recently that I would have to wait for a miracle to come until I could live a normal life.

Interviewer:  So at the age of 14 you were basically told that you would not lead a normal life?

A.:  Yes, pretty much.

Interviewer:  What were your experiences with doctors and professionals before you met
Jack.

A.:  I found they just didn’t care.  You would go see a psychiatrist for about half an hour at the most, usually 15 minutes, they write a script for you, every fortnight.  You are supposed to take it, you come back and report in or however long that they say and if you’re unwell you go to hospital, which really doesn’t help at all and just keep moving along and it’s just terrible the medication.  Sometimes I even think the medication side effects are worse than the illness.

Interviewer:  Did you feel understood?

A.:  No, I think I was misdiagnosed.  I think that they didn’t understand what was
happening to me so they diagnosed me as having schizophrenia.

Interviewer:  In terms of symptoms that you suffered and it probably was not schizophrenia but there are probably things that are shared in common.  How do you try to explain to someone who has never lived that?

A.:  What biggest thing that sticks out in my mind is what’s different between me and someone who is happy and healthy is the fear factor.  I’m frightened all of the time.  I just don’t feel normal, which is a sad thing.  But Jack has helped me come out of that and try to recreate a life and a lot of things are starting to happen for me now.  I’m trying to get a job, well I have a job, but not a well paying job, just try and be normal like anyone else.

Interviewer:  Was there anything in the system of having control in over the situation?

A.:  No.  No, they are totally in control and they - - you’re allowed to put your input in but they really don’t consider it very much.

Interviewer:  Did you ever feel that you had control over the illness or did the illness control you?

A.:  The illness had control over me, but that’s where Jack has helped me.  I’m learning how to control it.  I was in hospital recently of a different circumstance, the reason I was put in hospital was because I gave up fighting and too exhausted to keep going, which to me indicates that I do have some control over it.  Before I’d get sick and couldn’t do anything about it.

Interviewer:  How has your life changed since you met Jack?  What tools do you have now?

A.:  Strength, mainly and Jack’s the first person who’s given me hope, that you’re going to live a normal life, you’re not going to be on medications and I think I’ve done it quite successfully.  There’s been a big difference in my life, because I didn’t have to sleep as much and I’m not constipated and I put on a lot of weight because of the medications and like I say, Jack has helped me do all that.

Interviewer:  What other tools or techniques have you been able to use in order for other people to help themselves?

A.:  I believe that we can all be our own therapist if you can truly understand if you have the insight, which a lot of mentally ill people lack.  But when they get better to try and look deeply internally and try and recognize their problems and understand them so they can deal and manage them, I think it’s possible for anyone.

Interviewer:  Just in terms of what you feel the New Zealand system as it exists, how can that be improved to meet the needs of people?

A.:  I think the professionals need to spend more time with their patients to fully understand what the diagnosis is and I think it’s very important to treat the person and not the diagnosis, because I think that’s where a lot of people have gone wrong.

Interviewer:  What sort of extra support does a person need?

A.:  I think it’s a good idea to have a case manager.  Learning how to live life again, learning how to look after yourself, manage money and help pay your bills.  If you’re looking after yourself, that’s very satisfying and I think it’s a good opportunity to do that and keep going.

Interviewer:  So those sort of life experiences, when you have schizophrenia or something else people are unable to do these sort of things?

A.:  Oh yes, definitely.  It’s very debilitating.  It’ not physically, obviously, but to live a life and look after yourself and be independent of your parents and to pay your own bills, it’s very hard to do when you have schizophrenia.

Interviewer:  How has the case manager helped you, in what way?

A.:  Just someone to help you and just being there and just by listening and they helped me find some accommodations when I didn’t have any.  Help show you how to clean up and cook for yourself and basic life skills that they help you with.

Interviewer:  So what are your dreams now?

A.:  I want to become a psychologist because I think I’m well on the road to full recovery and I think now that I’ve had this experience, I can really help other people to get through what I have.  I’d eventually like to open up my own clinic and follow pretty much in Jack’s footsteps because I believe in what Jack’s done and many other people.

Interviewer:  Could you have ever imagined you saying that a year ago?

A.:  No.  After that person told me I had to pretty much wait for a ‘miracle to happen’, it hit me pretty hard, because I thought there’s no hope for me and I wouldn’t be able to get married and have kids and now I have dreams.  I think they are achievable dreams I can do a lot, I have a lot to give.

Interviewer:  Wonderful.  You’ve almost got me in tears!

In conclusion:
You might be interested in hearing that A.’s father wrote us an e mail dated
October 29, 2002, quote:
“A. had an interview for a job as an assistant at an Industrial Snack Bar which is on a train line, not too far from where she lives.  She then had a trial on the following Monday and rang us that night all excited that she had gotten the job, but at that stage she was still on trial.  She has been working there for almost two weeks”.

We received an e mail from A. dated November 2, 2002 and I quote: 
“I got that job and have been working there for three weeks.  It is a sandwich shop, they sell just about every fast food item that you can think of, so I am still just learning everything.  My hours are 9-2:30 Monday – Friday so I am up at 6:30 every weekday morning.  My duties include serving, cleaning and food preparation.  It is hard work but I like it”.  There were other things that she said, but this was the most important issue.
 
Another e mail from A.’s father dated November 25, 2002:
“I spent a couple of hours yesterday evening with A. and I must admit to being almost shocked with the changes in her.  She has decided in her own mind to stop seeing  George however, it hasn’t been finalized yet.  George’s mother is trying desperately to keep them together and is putting pressure on A. to go on a vacation with them for Christmas.  She has even bought a plane ticket for A. but A. doesn’t want to go.  She has to make a stand here and finish it for good.  In her own words last night, George has never given her anything only taken.  She had a big night out on Saturday with her friend Shirley and met lots of interesting people and did normal things (not playing pool at the dive The Irish Pub).  They have agreed to spend a lot more time together which can only be a good thing.  Shirley has no time for George.  A. was also telling me about all the young men she is meeting through being at work.  It seems that this whole new world is opening up for her that she wasn’t part of before.  She is also continuing to lose weight and at this rate she will be back to her slim old self before too long.  All in all, everything is positive at the moment and as long as she drops George and keeps her job, I am confident things will get better and better.  I am going to the city next weekend and hope to spend some time with her so I should be in touch early next week.”  End.

I must remind you, this is a woman that was given no hope they told her that she would have to wait for a miracle to happen.  We give her all the credit for working so hard on her life and being so determined to overcome her problems.  She obviously was able to incorporate some of the things we said and experience with her.

So, as you can see, this is a very interesting woman who now has some insight into her condition and has overcome her depression and related symptoms and seems to be well on her way to recovery.  She is making her own decisions now and probably will take some time for her to process all that happened.  But she is doing well and Jack and I are very happy that we had the opportunity of working with this young woman to give her some degree of hope and to her parents as well.  Her parents have and continue to be supportive of her in every possible way.