In the past week, two different but related news items have focussed on the appropriate treatment of schizophrenia.
The first was the New South Wales State Coroner’s findings into the fatal stabbings at Westfield Bondi Junction in 2024 by Joel Cauchi who lived with schizophrenia but had been unmedicated for years. The coroner reportedly said, ““It was, ultimately, a major failing that Doctor Boros-Lavack revised her view with respect to Mr Cauchi’s early warning signs and did not do more to proactively urge Mr Cauchi to resume his medication.”
Juxtaposed to this is American Health Secretary Robert F. Kennedy Jr.’s assertion that the keto diet could cure schizophrenia, citing research from Stanford University. The psychiatrist, Dr. Christopher M. Palmer was quick to respond, saying “I have never claimed to have cured schizophrenia or any other mental disorder, and I certainly never use the word ‘cure’ in my work.” However, in 2019 he had reported on two patients who embraced a keto diet and had experienced remission of symptoms to the point where they were able to cease anti-psychotic medications, and he had cited it as a ‘promising therapeutic approach for schizophrenia.’
Schizophrenia – Past and Present
Schizophrenia has been recognised for centuries and has variously been understood as a divine or demonic possession, an imbalance of the four bodily humours and currently as an illness; an interaction of genetic, neurobiological, and environmental factors.
Early treatments included trepanation, drilling holes in the skull to release spirits, and exorcism. More recently lobotomy, ECT, and insulin coma therapy were practiced, but from 1952 the discovery of chlorpromazine was the beginning of effective medications.
Managing Schizophrenia
The hallucinations and delusions of schizophrenia are most effectively managed with medication. However, preventing relapse, and increasing adaptive functioning to support the person’s integration into family and community is through non-pharmacological approaches including cognitive behaviour therapy, psychoeducation to teach communication and social skills and family therapy to support and educate family members. Lifestyle factors including diet, avoidance of drugs and alcohol and remaining fit are also recommended.
One crucial element is a cohesive, caring and vigilant group around a person to monitor and support effective and appropriate medication. Given the often-distressing side effects that have accompanied medication, especially early treatments, it is little wonder people want to stop taking them. While it is every person’s right to make this request, close assessment and management are essential.
In Summary
Together, the two news items reinforce the need to provide careful, ongoing, and effective treatment for people who suffer schizophrenia. Kennedy’s pronouncements are incorrect, dangerous, and cruel to sufferers of the illness, their families, and carers. He offers premature hope and risks fuelling already fragile alliances between a patient who is eager to cease medication and their family and treating professionals who fear the consequences if they do. The terrible events of Westfield Bondi Junction are a warning of the consequences for an individual, their family, victims and their families and treating professional when the fracture inside a person’s mind is not effectively countered by coherence from those on the outside.
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