July 7, 2004
Position Statement – ISPS-INT@yahoogroups.com

Tullio: Thank you for your reply to my comments on neuroscience/neuroimaging results in psychotherapeutic interventions.  I am also not surprised by the American cognitive therapists.  Most have not really worked with persons diagnosed with schizophrenia, nor are they aware of the neuroscience literature on the massive effects of psychogenic and social stress on CNS development, structure and function, even at the level of having genotoxic and chromosomal damage.  If my theory is correct, and I believe with each passing year the neuroscinece evidence becomes more confirmatory that it holds a great deal of accuracy, that the neuroscience of schizophrenia largely overlaps with the neuroscience of profound anxiety/stress, social isolation, neglect, hopelessness, etc, then psychotherapy and social inclusion can be crucial for assisting recoveries.  I believe that these clinicians who espouse popular media portrayals of schizophrenia as a primarily neurobiological brain disease with polygenic etiology, do not really understand the depth of human feelings/affects, the depth of identity/self formation and the importance of the relationship (psychotherapy is not just 'talk therapy') and deep emotional processes which take place in good long-term psychotherapy, which some theorists (eg, Jeremy Holmes & Peter Fonagy) have likened to developing secure attachments and greater affect regulation).  I have had the good fortune to see very ill patients get significantly better in long-term psychotherapy (I have been working with 10-18 or 20 persons with schizophrenia in my hospital and/or private practice at any one time for many years, it has been very difficult but also very enriching and gratifying, humanizing as well), some without medications or sporadic use of the latter.

Brian Koehler PhD - New York University