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Psychology Practitioners and Schizophrenia:A View from Both Sides

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Frederick J. Frese III

In recent years some few psychologists, psychiatrists, and other mentalhealth professionals have begun to reveal their own experiences as per-sons who have been diagnosed with various forms of serious mental ill-nesses. This article gives a brief background of one such person, a practicingpsychologist who was diagnosed early in his adult life with schizophrenia.Despite numerous breakdowns and hospitalizations he was able to estab-lish a career as a practitioner and as an advocate. The article also offers anumber of recommendations for professionals in this field based on theauthor’s experiences as both a recipient and a provider of psychologicalservices to persons with schizophrenia and other serious mental ill-nesses. © 2000 John Wiley & Sons, Inc. J Clin Psychol/In Session 56:1413–1426, 2000.

Keywords: schizophrenia; mental illness; psychiatric hospitals

Articles and book chapters have been produced previously about my personal experi-ences with schizophrenia. These have been published in the popular (Anstett, 1996; Spitz& Witek, 1994) as well as in the professional literature (Buie, 1989; Frese, 1994a, 1994b;Schwartz, Wiggins, & Spitzer, 1997). Generally, the purpose of these efforts has been topresent a picture of what it is like to live with this condition, with an eye toward demys-tifying the disorder, thereby hopefully having the effect of destigmatizing this long mis-understood condition.

From the feedback that I have received during the past decade or so, I know thatsome psychologists have read some of these materials, but until this time I have not hadthe opportunity to produce a fairly lengthy document concerning my interactions withpsychologists during what has now been some 33 years since first being diagnosed withparanoid schizophrenia.

Therefore, I dedicate this undertaking to my fellow psychologists and will attempt toinclude in this document information concerning my interactions with psychologists andexperiences that I have had that may be of particular interest to them.

Correspondence concerning this article should be sent to: Frederick J. Frese III, 283 Hartford Drive, Hudson,OH 44236.

JCLP/In Session: Psychotherapy in Practice, Vol. 56(11), 1413–1426 (2000)© 2000 John Wiley & Sons, Inc.

Family Background

On my mother’s side, as well as on my father’s maternal side, my lineage is primary Irish,with family names like Sullivan, Brennan, Murray, and Sweeney. In that rates of schizo-phrenia have been reported to be high among the Irish, my vulnerability for this disordermay be a function of this aspect of my biological heritage. My family name, Frese, ofcourse, comes from paternal lineage. As best I can trace the etymology of the name, itderives from the name of the peoples who have been the inhabitants of a slice of Europe’snorth coastal lands for eons. A quick glance at a world map reveals that these lands stillcarry variations on our family name. Friesland is a coastal province in the northern Neth-erlands, extending a considerable distance inland from the Zuiderzee and the North Sea.Additionally, the Frisian islands extend in an arc from their western terminus in the Dutchprovince of Friesland, east along the coasts of East Friesland and North Friesland inNorthwestern Germany and along the Jutland peninsula coast of southwestern Denmark.The name occurs in our English linguistic culture through Frisian carvings, Friesian-Holstein Cattle, Frisian horses, and, of course, freesia, a genus of plants of the iris family.

The most important contribution of the Frisians to our culture comes from the Frisianlanguage. Although it is now spoken in three small areas located in The Netherlands andin two small areas near Oldenburg in Germany, each with its own dialect, the language isin fact probably the closest living language to English. Even a cursory look a the OxfordEnglish Dictionary reveals that the origin of a very large percentage of common words is“Old Frisian.” Indeed it would not be too much a stretch to refer to modern English, thelanguage in which this document is written, as a form of neo-Frisian.

Be this as it may, I think the reader may be finding it curious that this writer goes tosuch length to describe the very language we are communicating in as emanating fromhis paternal family lineage. Such solipsism, if not downright outrageous grandiosity, Iwould suggest, is not unusual for someone with schizophrenia (see Sass, 1994), evenwhen “in remission.”

But let this be enough of my dwelling on my heritage. Suffice it to say that in mypaternal lineage, I am the first grandchild of the son of German immigrants. He, Freder-ick Joseph Frese (senior), was born in Baltimore just after his family arrived from Europe.The family moved quickly and as a result my grandfather grew up in the town of SanAntonio, in Pasco County, Florida, a town his parents helped found in the early 1880s. Inhis early teens my grandfather left home to find employment in Savannah, Georgia. Afterworking in a bank for several years, he married an Irish American, named Helen Brennan,established a partnership with gentleman named Traub, and went on to become co-ownerof a small chain of grocery stores.

Although the rest of my grandfather’s life was spent in the food industry, both hissons entered the professions. The family moved to New York City in the mid 1920s. Myfather, Frederick Joseph, Jr., and his younger brother, now my Uncle Joe, both were thebeneficiaries of Jesuit education, beginning in high school. My father attended FordhamUniversity and St. Louis Medical School. My uncle went on to become a Jesuit priest. Healso obtained a doctorate in American history, under Samuel Eliot Morison, at Harvard.He spent virtually his entire career at Fordham University, serving as that institution’sacademic vice president for a quarter century and briefly as its acting president in themid-1960s.

My father went on to join the military and spent over three decades with the ArmyAir Corps/U.S. Air Force. From 1944 until his retirement in 1970, he held the rank ofcolonel, and the designation of flight surgeon. Most of his career was spent as a physician/administrator in what was to become aeronautical/space medicine, or bioastronautics.

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Personal Experiences

Because the development of the space-medicine field occurred at Air Force bases in theSan Antonio area, I spent most of my formative years (ages 7 to 17) growing up in the hotTexas sun. The culture was of course heavily influenced by Hispanic language, food, andcustoms, but my father’s circle of associates were in large part German scientists who hadbeen brought to the area after the war to help develop the American space effort. Thesewere medical and biological scientists for the most part, the rocket scientists having beensent to Huntsville, Alabama, to work with Wernher von Braun.

Because I was reared across the street from a major scientific research center, Iundoubtedly was influenced by that social and cultural ambiance. Many well-knownscientists, including psychologists, worked at the research center and would often visitour family home. One of the more notable of such visitors was Saul Sells, who was tobecome a long-tenured psychology professor at Texas Christian University. Dr. Sells washighly respected by my father and became a good friend of the family. In retrospect, thishappenstance may have become important in my own development.

By the time I was in my junior year of high school, I had attended seven elementaryschools and three high schools. I found myself in the all-male Central Catholic High School,reluctantly wearing an ROTC military uniform twice a week. My grades were good, but oneday I shaved my head totally bald, an action that was unheard of among Texas high schoolstudents in the late 1950s.This move on my part precipitated a lot of attention. Most observ-ers, including my parents, were curious why anyone would take such an action, breaking thesocial customs of the time for young men. My father arranged for me to be thoroughly ex-amined over a three-day period by his friend, Dr. Sells, and his psychology associates.

Dr. Sells’ group administered what were the common psychological tests used at thetime. As I remember, these included the Rorschach, the Thematic Apperception Test(TAT), an IQ test, and a few other personality tests. They reported back to my familywhat I was told were very positive findings. The only negative conclusion was that mypersonality was such that I might have difficulty in supervising people when I maturedbecause I was essentially too polite to become demanding of others.

Aside from my encounters with Dr. Sells, who I remember also came to my highschool’s career day to talk to us about psychology, I had no other serious interfaces withpsychologists until my sophomore year at Tulane University. I had won a generous schol-arship to college, courtesy of the U.S. Navy. In return, the Navy had several require-ments, one of which was that I was required to take at least one semester of psychology,which the Navy viewed as a form of leadership training. I liked psychology and went onto make that my major. Tulane was heavily oriented toward experimental psychology atthe time. I particularly remember the work that was then being done on transfer of train-ing and occupational selection.

After graduating from Tulane, I went on to spend four years as an officer in theMarine Corps, spending more than half that time in Japan, predominantly at Iwa Kuni AirStation, which is located in western Honshu, not far from Hiroshima. I had scored fairlywell on the military’s equivalent of IQ and achievement tests, and did likewise on mea-sures of physical ability, the latter being mostly due to my having kept in shape as a polevaulter while in college. But in the appearance, demeanor, and “command presence”categories, I was perhaps not the ideal “poster role model” for a Marine. While in Japan,I spent most of my spare time trying to learn the Japanese language, taking three Univer-sity of Maryland Far East Extension Japanese-language courses, then being tutored by aJapanese Junior High School teacher, and teaching English to executives and other employ-ees of Mitsui Polychemical Corporation.

Psychology Practitioners and Schizophrenia 1415

When I returned from Japan, I was given the duty of assistant guard officer at theMarine Corps Barracks at the Naval Air Station (N.A.S.) in Jacksonville, Florida. I wasto find this job extremely stressful. The commanding officer was a hyperactive Brook-lynite. He appeared to be very dedicated to the Marine Corps. When I revealed that I didnot intend to make the Marine Corps my career, he seemed to make it a personal crusadeto try to change my mind in this regard. Frequently I felt I was being deemed “unworthy.”I undoubtedly deserved such treatment, because, while I would try to dutifully performthe tasks I was assigned, I clearly did not put my heart into the work that I felt was onlyto be a final, fairly temporary assignment.

While in Japan, I had been able to escape psychologically from the demands of my mil-itary duties by taking up study of the Japanese language. There the language was all aroundme, both vocally and in written form. I was constantly stimulated by it. But in Jacksonville,Florida, in the mid 1960s there was little opportunity to study Japanese, so I took up an-other hobby to get my mind off my assigned duties.This was to be mathematics. I had a strongminor in mathematics (19 semester hours) while at Tulane. I enrolled in graduate school inthe Masters ofArts in Teaching (Mathematics) at the local University of Jacksonville. ThenI studied for several months preparing for the Graduate Record Examinations (GREs). I trav-eled to Gainsville to sit for these tests at the University of Florida. Even though I had stud-ied much more for the verbal section, I found this part to be by far the greater challenge. Onthe second section, the quantitative or mathematical part, I actually finished well ahead oftime and had time to review my answers. Since it appeared that everyone else in the testingroom was still working on their answers when I finished, I was sure I must have done well.In fact, several weeks later, when my scores arrived, I found I had scored an 810 on the quan-titative section. Since the 99th percentile started at 740, and most people, myself included,thought the scores, like the SATs, only went up to 800, I became quite excited about whatI viewed as a superior accomplishment.

In addition to taking the GREs, I also decided to take the test to become a Mensa mem-ber. Mensa purports to be an organization which restricts membership to persons with highscores on IQ tests. In the mid 1960s Mensa administered a Cattell IQ test. The primary en-try requirement to the organization was attaining an IQ score at least two standard devia-tions above the mean. In that the Cattell had a standard deviation of 25, this meant havinga numerical score somewhere above 150. My score on the test managed to reach that level.

The reports of the GRE and the Mensa examinations, along with my taking partialdifferential equations and number theory in graduate school and being reasonably con-versant in the Japanese language, helped my ego counteract the barrage of criticism thatI was receiving at work. These accomplishments became a form of evidence for me thatthere was more to me than just being the bungling Marine officer I felt like while at work.Indeed I began to see myself as somehow being relatively intelligent.

But this developing change in my self-image began to create a bit of a conundrum. IfI were indeed an intelligent person, why was it that I was not able to perform in a satisfactorymanner in my Marine Corps duties? I found the question increasingly perplexing.

In addition to being responsible for working at the front gate to the Naval Air Station,the duties of the 144 men and officers at Marine Barracks, N.A.S. Jacksonville, werethreefold. We were to provide security for the station’s brig ( jail), for the Fleet Intelli-gence Center Europe (FICEUR), and for the nearby large arsenal of atomic weapons.

The Start of a Schizophrenic Break

In early 1966, shortly after I had received my GRE and Mensa scores, two events tran-spired, which in retrospect probably contributed to my initial breakdown. We had two


men at all times guarding the nuclear weapons. One afternoon, one of the young menperforming this duty was killed with his own shotgun. It was most likely an accident, butthis event started me thinking very intently. Shortly after the death of this Marine, still inhis teens, a strong rumor began to circulate that one of the nuclear weapons had beenaccidentally dropped while being loaded onto a plane. Indeed, I had seen the Army offi-cers from the special nuclear weapon disarming team talking in an animated fashion atthe Officer’s Club.

Not long after these events I made what for me was a great discovery. I becameconvinced that my “immediate superior” and certain other high-ranking officers and offi-cials had somehow become hypnotized when they had been young men fighting in theKorean War. This “discovery” of mine was not particularly original. Indeed it was themajor theme of a movie that I had seen a few years before, calledThe ManchurianCandidate.I became absolutely sure that I had uncovered a plot to destroy America andour way of life. In my own mind this knowledge of the existence of what were de factoenemy agents gave me a sense of renewed strength. I was not being criticized because Iwas doing anything improper, but because “the enemy” controlled my superior officer,and many others. I now saw criticism in a very different light. I also became much moreconfident regarding my activities while at work. Criticism of me was seen as an attack bya hypnotized “human tool” of the enemy. As such, critical remarks no longer had the stingthey had before. They only revealed to me those men who were under the influence of ourCommunist enemies.

I now was sure that I had uncovered important information about a secret psycho-logical weapon of the enemy. For the first time since arriving in Florida, I was beginningto become very confident that whatever I did was correct. One day I ordered the Marineguards at FICEUR to enforce recently rewritten regulations concerning the mandatedchange from winter to summer uniforms for all personnel. The dates for changing to thesummer uniforms in the regulations were in fact incorrect, but I demanded that they beenforced, in spite of grave reservations by the guards on duty. As a result of my orderalmost no one was permitted to enter or leave this highly sensitive intelligence center fora considerable period of time. Needless to say, my insistence that orders be carried outexactly as written quickly came to the attention of higher authorities.

When you are going into a schizophrenic break, in your mind you are behaving in aproper manner, but generally you also pick up from others that they are having problemswith the way in which you are acting. I could tell others thought my behavior to bestrange, but I also knew that I knew of the enemy’s hypnotic control of our high officials.Others, of course, were unaware of this. It seemed only natural to me that they wouldthink I was behaving oddly.

At some point, shortly after the difficulty at FICEUR, I decided that it would be wiseto share “my discovery” with the person who I felt would know most about hypnotism.Therefore, I made an appointment to see the psychiatrist at the station hospital. Mycommanding officer seemed rather pleased that I was going to see a psychiatrist. He didnot realize I was going in order to warn the government about his and other high officials’untoward activities.

The hospital’s psychiatrist listened rather intently when I told him about the use ofhypnosis by the enemy. But after about 30 minutes when I got up to leave, I found therewere two rather large attendants in white coats who had arrived in order to escort me toa single padded room in the hospital’s fairly small psychiatric ward. I almost immediatelyrealized that the psychiatrist had to be one of those under the control of the enemy. I alsorealized that the enemy knew that I was on to them and that in all probability they wouldhave to eliminate me.


I had to minimize their opportunity to kill me by hunkering down in the corner ofmy padded room. I also checked out all visitors to my room to see if they had been inthe Korean War or were somehow otherwise under the control of the enemy. Because Iwas fairly certain that I was going to be killed, I demanded that I be given the lastrights, or Extreme Unction, as it was called in the Catholic Church. Reluctantly a priestcame and administered the sacrament. I also found out, somewhat by accident, that Iwas diagnosed as being a paranoid schizophrenic. This latter finding initially stunnedme greatly. To me it meant I was to be considered insane or crazy. My career was over,not only with the Marine Corps, but also any hopes I may have had to take up anycareer were now dashed.

It was arranged that I be transferred fairly quickly to the officers’ psychiatric ward atthe Naval Hospital in Bethesda, Maryland. This was not only the Navy’s finest hospital,but it had an added advantage for me. My father was then stationed at the Pentagon andliving in the Washington, DC, area. Therefore, I was able to see my family fairly oftenduring the almost six months I was a psychiatric patient in Bethesda.

The officers’ psychiatric ward had about 20 beds, most of them filled during the timeI was there. The other patients, many of them older and retired, tended to stay for fairlybrief periods of time. By the time two months had elapsed, virtually none of the patientswho had been there when I arrived were still there. Even though others had attemptedsuicide, or engaged in some rather strange activities, I came to understand that my con-dition was considered more serious than those of the others.

At Bethesda, the medications that I was given were trifluoperaziine (Stelazine) andchlorpromazine (Thorazine). The side effects, particularly the akathisia, were terrible. Iwas able to avoid taking the medications for a while by “cheeking” them, but the stafffound out about it and switched me to the liquid forms of these medicines.

It was also at Bethesda that I, as a patient, ran into a psychologist for the first time.He was fairly young, had a Master’s degree, and he administered psychological tests tome. To the TAT, I made up what I thought were some fairly clever stories. I was expectingsome sort of encouragement or pleasant comment concerning my clever responses. Ireceived no show of emotion at all. I became very distrustful of psychologists from thatpoint on.

During my six month stay in Bethesda my extreme paranoia did diminish. In my ownmind I was a hero. I had saved this country by exposing the enemy’s scheme. Somehowmy government must have taken the information they had gotten from me and used it tocounter the enemy’s activities, because I sensed that the threat to the country had dimin-ished. I had done my part. I was now leaving the hospital and the Marine Corps. Havingbeen kept as a psychiatric patient had been an effective cover. I had eluded the enemyduring the crisis.

Somehow I managed to get accepted to the American Graduate School of Inter-national Management in Phoenix. I, of course, told no one about my recent experience asa psychiatric patient. I was a graduate of Tulane and former captain in the Marines, whowas passably conversant in both Japanese and Spanish. My grades in school kept me inthe upper one fifth of the class. I turned out to be a “hot ticket” on the job market forprospective managers in the international business field. I received eight tentative offersof employment from large respected players in the international field. These includedHallmark Cards, American Express, and Jacuzzi Pumps. I decided to take the offer fromthe Koehring Corporation, a widely spread-out manufacturer of capital goods headquar-tered in Milwaukee. I took the job with Koehring because the starting salary was good, Ireally liked the company, and it was the only one that did not require me to fill out ahealth questionnaire prior to being hired.


After about three months of my working for Koehring in Mt. Gilead, Ohio, all of thecompany’s new management recruits were called to the company headquarters in Mil-waukee for training. It was during this time that I had my second breakdown. A phenom-enological description of this break is detailed elsewhere (Frese, 1994a). Indeed thatdescription has been analyzed elsewhere (Schwartz, Wiggins, & Spitzer, 1997). Suffice itto say that in my own mind I went through the process of breaking the code of theuniverse, by focusing on the transcending qualities of the Divine Trinity. While experi-encing this activity, I was taken to the local public psychiatric hospital, where I spent afew weeks, and to the best of my memory received no psychological services at all.

When I was released from the Milwaukee County Hospital, I was still actively psy-chotic. After driving to Peoria, Illinois, to see some graduate school classmates, I droveback to Ohio, where, after a few days I was behaving so bizarrely that my parents sent mybrother-in-law up from Texas to take me back with him where I was next hospitalized.This time I found myself in the psychiatric ward at the Air Force’s primary hospitalcomplex, Wilford Hall, at Lackland Air Force Base in San Antonio. My stay there was ofseveral weeks duration. I do not remember encountering any psychologists during mytime there. After my release, I was flown to an Air Force Hospital in Alabama en route tomy parents’ home in Florida.

Before long, in late December, I returned to Ohio to make my home off a hallway ina house occupied by some 18 veterans and graduate students at Ohio State University.The house was owned by a friend of mine from the Marine Corps. There I was to spendthe next six months in a fruitless search for a paying job. Eventually I was hospitalized,then committed to the Columbus State Hospital, the circumstances of which I have detailedelsewhere (Frese, 1993). I encountered no psychologists in the state hospital, but afterbeing transferred from there to the Veterans Hospital in Chillicothe, I did have an expe-rience with a psychology intern from Ohio State University.

After I had been in the Chillicothe hospital for a few weeks, the intern, a tall, blondyoung man, came by to give me some psychological tests. I remember that the Differen-tial Aptitude Test (DAT) was one of these instruments, and I believe there was some formof IQ test as well. A few days later the intern returned with a rather forlorn look on hisface. I asked him if I had done poorly on his tests. He assured me that, to the contrary, Ihad done very well indeed. In fact, he said, were it not for my disorder, “I might evenhave become a professional.” His words stuck with me. I took them as a challenge. Andalthough I think it unlikely, I do acknowledge that it is just possible that he may havemeant them as such.

A couple of months after I was released from the Veterans’ hospital, I was able tosecure employment as a “psychologist” working in the state prison, which happened to belocated just across the highway from the Veterans’ facility. In those days there was nopsychology licensing law in Ohio and the only requirement for the job was a bachelor’sdegree and scoring fairly well on a test. In that I was given a 10% boost in my test scorefor being a veteran, I managed to get the job in spite of my having recently been committed.

During the three years I worked in the prison, my immediate superior was Russell G.Leiter, Ph.D., author of the Leiter International Performance Scale, and various otherpsychological tests of intelligence and ability. There were six other B.A.-level “psychol-ogists” working in the prison. The others all said they wanted to go to graduate school.Primarily in order to help them in their efforts in this regard, I arranged for two graduatecourses in psychology to be taught at the prison by professors from Ohio University. I, ofcourse, also took these courses. I did well enough in the courses that I was offered a fulltuition assistantship in the Psychology Department at Ohio University. I performed fairlywell at the university during my first two years. But during the summer after my third


year, I returned to work for the Department of Mental Health and suffered another psy-chotic breakdown. As a result of this break I was hospitalized initially in a private psy-chiatric hospital in Cleveland. After a stay of several weeks, I was released while stillquite delusional. After a few weeks, my mother came to Ohio and brought me back toFlorida, where I was rehospitalized in another private hospital.

At this Florida hospital I did see a psychologist. Initially he conversed with me asthough I was a fellow professional. This posture quickly deteriorated into a “do as I say”posture. What he was saying was that I should chart the times of day when I felt well, orat least when I felt best. I considered this advice to chart my behaviors and feelingsessentially of little value. I was very depressed as a side effect of the powerful medica-tions that I was taking. I had a very difficult time just getting out of bed, much lessspending time charting my moods. I never returned to the psychologist for further assis-tance after my first posthospitalization visit.

The Road Back

Despite my breakdowns and spending almost a year (1974–75) so depressed from themedications that I could not write a complete sentence of the dissertation proposal I hadbegun, my professors decided to let me remain in the program. In the fall of 1976 I leftschool to take a job as an administrator and psychology assistant in Ohio’s largest psy-chiatric facility, Western Reserve Psychiatric Hospital. Eventually I completed my dis-sertation. I was awarded the Ph.D. in psychology in the fall of 1978. A year later I becamelicensed as a psychologist in the state of Ohio.

When I arrived at Western Reserve Psychiatric Hospital, I apprised my superiorabout my having schizophrenia. Somewhat to my surprise, I was told that there was atleast one other staff member with such a condition and that I appeared to be in compar-atively pretty good shape. At any rate I was strongly advised not to tell anyone else aboutmy disorder.

Upon my arrival at Western Reserve, most of the other psychology staff memberswere Masters-level persons. They had fairly large caseloads and it was the custom forthem to write, “No psychology services needed” in the charts of many of the patients. Iconsidered this practice unfortunate, in that I did not think that there could be manypsychiatric patients who could not benefit from some sort of psychology service.

I also noticed that most of the patients were diagnosed as having “schizophrenia,chronic undifferentiated type.” This was almost always abbreviated as “S.C.U.T.” Unfor-tunately these patients were also referred to in conversation as “scuts.” In that one dic-tionary definition of a scut is “a contemptible fellow,” I began to become upset about thedemeaning manner in which patients were referred to. At one point I became so enragedas to write and deliver letters to all the top administrators demanding that this despicableuse of the termscutbe stopped. I won the argument, which had become quite heated, butthe price of my victory was for me to be labeled by many of my coworkers as being“propatient,” a term that most definitely did not carry a positive connotation.

Despite difficulties such as these, within three years of my arrival at Western ReserveI was promoted to the position of psychology director. I was to hold this job for some15 years, until my retirement in the fall of 1995. During those years the hospital sawmany changes. When I retired, most of the psychologists had doctorates and were mem-bers of the medical staff. All patients were receiving some sort of regular psychologicaltreatment services, as well as regular, periodic psychological evaluations. Both the patientpopulation and the psychology staff were less than half the size they had been at theirpeaks during the previous 12 years. Clozapine (Clozeril) and other atypical medications


had started to be used in the early 1990s, and many patients who had been sick for a longperiod of time were beginning to show improvement.

Significant for me personally was my concern in the early 1980s when I discoveredthat Division 18 Public Service Psychologists, of the American Psychological Associa-tion (APA), had no section for psychologists serving the serious mentally ill outside theVeterans’Administration. This concern caused me to request that a section be establishedfor such psychologists. With the help of Pat DeLeon and the officers of Division 18, I wasable to establish the desired section by writing the bylaws and collecting over 70 signa-tures from psychologists willing to support such an effort. Today, Community and StateHospital Psychologists, Section V of the APA’s Division 18, now is the Division’s third-largest section and is rapidly closing the gap in this regard with Section III, that of theVeterans’ Administration Psychologists.

Even more significant for me, however, was my decision to no longer remain silentabout my having been diagnosed with schizophrenia. In 1986, Pamela Hyde, J.D., thenthe director of the Ohio Department of Mental Health, put out the word that she waslooking for consumers to serve on the local mental health boards. I decided to apply forsuch a position on the board of Summit County (greater Akron), in which I resided. Aftera few months I was appointed, but the board members and staff were very discrete. Noone seemed to know that I was the consumer on the board.

After a year or so of my serving incognito on the board, I happened to be giving aspeech as part of a panel presentation to a graduate school class in psychiatric rehabili-tation at nearby Kent State University. Much to my surprise I found myself starting thespeech by asking how many persons in the audience had ever been psychotic. Morespecifically, I asked for all those who had been committed and locked up in a seclusionroom in the back wards of a state hospital to stand up and identify themselves. Whennobody stood up, I said, “Well, I guess I’m the only one standing.” I then went on toreveal many of the details of my experiences.

Since that time in early 1987, my life has changed remarkably. I began attending thenational convention (Alternatives) for persons in recovery from serious mental illness. Ihave attended every annual convention since the initial one held in Baltimore. A fewyears after I began associating with other persons in recovery, I was elected to be presi-dent of the National Mental Health Consumers’ Association. I also became active withthe National Alliance for the Mentally Ill (NAMI). Indeed I currently serve as First VicePresident of that organization. Due primarily to these activities, I have been invited togive numerous speeches about how I go about coping when I have been diagnosed withschizophrenia. During the past 12 years I have given over 300 speeches in some 40 states.Most of these speeches have been to statewide gatherings of consumers or NAMI groups,but I have also spoken at graduate and medical schools, and at national conventions ofoccupational therapists, psychologists, and psychiatrists. I have also made numerous localand national television appearances.

Since I have become open about my schizophrenia, other psychologists and psychi-atrists have also begun to be open about their having mental illnesses. Ron Bassman(1997); Wendy Walker Davis (Frese & Davis, 1997); Kay Jamison (1995); Al Siebert(1994); Pat Deegan (1993); and Lauren Slater (1996) are all doctoral-level psychologistswho have written or given presentations about their personal experiences with mentalillness. Carol North (1987); Dan Fisher (1994); Suzanne Vogel-Scibilia and Beth Baxter(Baxter, Vogel-Scibilia, & Johnson, 1997) are psychiatrists who have done the same.Virtually all of the mental health professionals that I know who are open about havingthese disorders feel that the stigma that accompanies these disorders is a very seriousmatter. Indeed some feel that the stigma can be worse than the disorder itself.


What Was Helpful and What Was Harmful

I have previously published a list of 12 aspects of coping for persons with schizophreniaand similar disorders (Frese, 1997). A synopsis of them follows:

1. Denial, acceptance, and one’s belief structure.Delusions, by definition, are (false)beliefs. The person who has them cannot tell they are false. Coming to under-stand what you are experiencing in psychosis is a major task. But coming to suchan understanding is a great help in enabling you to cope with this condition.

2. Knowledge about the disorder.Once a person realizes that he or she has such adisorder, information about how best to live with the condition is most helpful.

3. Antipsychotic medications, and other chemicals.I cannot stress enough howvitally important appropriate medication is. I also stress how deleterious streetdrugs are, such as amphetamines, PCP, LSD, etc.

4. Delusional thinking.It is helpful to realize that the development and exacerba-tion of delusions often tend to be a function of excitement and other forms ofstress.

5. Social interaction mechanisms.Persons with serious mental illnesses communi-cate differently. We do not pick up on social cues as readily as normal people do.Our timing and rhythms are often different from those of normal individuals aswell.

6. Replaying/rehearsing.We frequently find ourselves talking to ourselves, oftenin our thoughts and sometimes with our voices. Often we are preparing forfuture encounters with trying situations.

7. Expressed emotion.Like many persons with schizophrenia, I tend to be verysensitive to hostile criticism, authoritative overcontrol, insults, threats, and thelike. Too much exposure to these factors can lead to relapse.

8. Stress and excitement,such as can occur at parties, conventions, in shoppingmalls, etc., can increase the probability of relapse for us.

9. Being involved with music and hobbiescan be very helpful. I sometimes findlong periods of dancing alone to be helpful when I am becoming symptomatic.

10. Fighting stigmais another activity that I and many other consumer/survivorsfind valuable. Many subscribe to the “advocacy is the best therapy” approach.

11. Revealingto others that you have a mental illness can be very helpful undercertain circumstances. Many persons in recovery from mental illness choose notto do this due to the stigma they then must face.

12. Networkingwith other consumers can be exceedingly helpful. It is most grati-fying to be able to share with and learn from others who have had similar expe-riences to your own.

Hints to the Practitioner

I have previously presented (Frese, 1989) and published (Frese, 1994b) recommenda-tions concerning how psychologists might possibly improve their services to personswith schizophrenia and other forms of serious mental illness. But these have pertained tothe entire field of psychology, including research, education, public policy initiatives, etc.In this article I will limit my comments to areas of interest of the practitioner.


Recently I finished serving a three-year term as the Public/Consumer member of theBoard of Trustees of theAmerican Occupational TherapyAssociation.As I was leaving thatposition I was invited to write an article making recommendations to occupational therapypractitioners about serving persons with serious mental illness (Frese, 1998). It occurs tome that many of the thoughts I shared concerning occupational therapy practitioners maybe of value to psychology practitioners as well. These thoughts were as follows.

Probably the biggest change that has occurred in the latter half of the twentiethcentury is realization that the functional psychoses and other forms of serious “psycho-logical” illnesses have specific biological bases (Preskorn, 1993). With the advances inneuroimaging and molecular biology we now have confidence that these disorders areaccompanied by irregularities in neurotransmission at the level of the synapse. Increas-ingly serious mental illnesses are coming to be seen as having concomitant overactiva-tion or underactivation of synaptic neural receptors.

Along with these findings has come the development of an array of medications tohelp remediate these irregularities. Particularly of note during the past decade or so hasbeen the advent of the selective serotonin reuptake inhibitor (SSRI) class of antidepres-sants such as fluoxitine (Prozac) and sertraline (Zoloft) and the atypical antipsychoticssuch as clozapine (Clozeril), risperidone (Risperdal), and olanzapine (Zyprexa).

During the recent decades while these biological breakthroughs have been forthcom-ing, we have also been experiencing remarkable changes in the manner in which wedeliver care to seriously mentally ill persons. Back in 1955 there were some 558,239patients in our publicly operated psychiatric hospitals. The community mental healthmovement, and its accompanying “deinstitutionalization,” closed or substantively down-sized virtually all these facilities. By 1994 the number of patients in such places wasdown to 71,619 and still dropping (Torrey, 1997, pp. 8–9).

Accompanying this population decline in our public hospitals has been a concomi-tant increase in the numbers of those who are mentally ill in our jails, prisons, and nursinghomes, and of those who are homeless in our streets and missions. Also additional hun-dreds of thousands of mentally ill persons are living isolated and too often under-stimulated lives in apartments, halfway houses, and group homes.

This change in locus of mentally ill persons necessitates a major rethinking of howwe deliver services to these folks. Forty years ago mental illnesses were seen as being sodevastating as to necessitate long, often lifetime, stays in public institutions. Today thesepeople are to be found overwhelmingly in jails, substandard housing, and in the streets.While it is true that some, like perhaps myself, have been restored to functioning atnear-normal levels, many others continue to be more seriously disabled. And many are attimes so incapacitated that they have difficulty caring for themselves. For these folks,treating personnel must frequently come to them, wherever they may be found. Thenature of these disorders is that the victims often cannot appreciate what is happening tothem. They are often not able to organize themselves so as to be able to take advantage ofthe traditional hospital- or office-based treatments that are usually offered to them. Inresponse to this need we have seen the development and tremendous expansion of casemanagement services during the recent past. Even more recently we are realizing thatmany of the most seriously mentally ill persons need to be helped more regularly thanwas initially recognized. Caretakers need to visit those in their care to ensure that they aretaking their medications properly, so that their clothes and living spaces are adequatelyclean, and so that these folks have an opportunity to socialize and begin to acquire somesort of occupational skills.

In this rapidly changing world of delivering mental health services, psychologistsunfortunately are not as involved as they could be. In recent years hundreds of assertive


community treatment (ACT) teams have been established, including dozens instituted bythe Veterans’ Administration. These teams usually consist of a nurse, a psychiatrist, asocial worker, and a group of case managers. Staff-patient ratios are generally better than1:12. Unfortunately, few psychologists are making the transition from hospital-basedtreatment to these ACTs.

Therefore, my first hint to practitioners of psychology is that they consider leavingtheir offices and getting out to where the clients are. This means essentially not onlyreviving the “house call” approach to treatment, but also being willing to make such callswhen the clients are not in houses. Psychologists need to experience the environmentstheir clients inhabit, so that they can more effectively be of assistance. All psychologistsare well trained in principles of learning. As such they are well prepared to help personsin recovery from serious mental illnesses learn to navigate their new environments. Butthey have not been as proactive in making their services available as they perhaps could be.

Another opportunity for possible improvement in the way in which psychologicalservices are delivered involves the area of stigma and discrimination. As mentioned above,from the perspective of the patient or consumer, we often see the stigma we find insociety as one of our biggest problems. For much of history, being labeled “insane” or“crazy” was for most people equivalent to receiving a life sentence in an asylum. Untilfairly recently, mental disorders were so devastating and so misunderstood that the morenormal members of society had very little contact with the mentally ill, or at least littlecontact with people that they knew to be mentally ill. Mental illness, or insanity, wasclouded in mystery, shame, and frequently fear. Persons with mental illness were system-atically precluded from many of the forms of employment and educational opportunitiesopen to other citizens. Until fairly recently persons with mental illness were often deniedrights to drive automobiles and to enter into contracts. In many ways we were treated asoutcasts by the society from which we had come.

Today as many persons are experiencing recovery, we too often face the prejudicesthat have been held over from the past. Too often the words that are used in everydayparlance to automatically reject concepts, proposals, and even other people are the samewords that are used to describe the mentally ill. Words like “crazy,” “nuts,” “psycho,” anddozens of similar pejorative and derogatory terms are constantly used in the vernacular.Too often one sees cartoons depicting typical stereotypes of the mentally ill as ax mur-derers, Napoleon impersonators, or similarly bizarre characterizations. Such unfortunateportrayals can be seen frequently every day in the popular media. This must end. We, asa nation, must begin to realize that mentally ill persons are human beings and should begiven the dignity of being recognized as such.

We need help in changing society’s discriminatory view of us. We seek clinicianswho will not only work to analyze and treat us, we are also looking for partners in ourefforts to have society change its view. The traditional posture of psychologists as thescientist-practitioners may no longer be totally satisfactory. We consumers must havepartners in recovery who are willing to work with us in our advocacy efforts. The mind-sets of the folks in the normal community must be changed. Laws and policies must bechanged. The behaviors of others toward us must be changed. Consumer and familyadvocates are working hard to effect these changes, but more professionals, includingpsychologists, need to make efforts to partner with us in these advocacy activities.

Also, psychologists should perhaps consider re-examining the way they have tradi-tionally been taught to view our conditions. From the consumer’s perspective psycholo-gists tend to be a little too quick to pathologize our mental states. Often psychologists,like other mental health professionals, readily buy into the disease model of mental ill-ness. They tend to hold up an intelligent, articulate, attractive, successful, ideal model of


what is normal. Then they frequently conclude that persons who are not close to thatmodel are somehow defective and need to be corrected or cured. Differences from thenorm become deviance. Diagnoses focus on “defects.”

From our perspective, just because we are different does not make us automaticallydefective. The work of Jamison (1993), Spitzer (1997), and others is increasingly dem-onstrating that persons with mental illness often have considerable talent. Increasingly,psychologists and psychiatrists, like those pioneers mentioned above who have beendiagnosed with serious mental illness themselves, are beginning to be more open abouttheir experiences. The time has arrived for our more normal practitioner friends to join usin these efforts. Help us to celebrate our recoveries and those of our brothers and sisterswith these conditions. Help us find a place, a dignified place in everyday society, wherewe can work and contribute just like other members of the human family.

In conclusion, psychologists and other professionals who would like to help us workour way back into society are most welcome to join us in our efforts. Those who areuncomfortable with our activities are free to object or ignore us, but for those of us withserious mental illnesses, we will increasingly intensify our often-stated position: Regard-ing decisions made concerning us, there shall be “nothing about us without us.”

Select References/Recommended Readings

Anstett, P. (1996, June 18). Living with schizophrenia. Detroit Free Press, pp. 8F–10F.

Bassman, R. (1997). The mental health system: Experiences from both sides of the locked doors.Professional Psychology: Research and Practice. 28(3): 238–242.

Baxter, B., Vogel-Scibilia, S., & Johnson, J.R. (1997). Living with brain disorders: Strategies forrecovery. Paper session presented at the National Alliance for the Mentally Ill Annual Con-vention, Albuquerque, NM.

Buie, J. (1989). Psychologist prevails despite schizophrenia. APA Monitor, 20(5), 23.

Deegan, P. (1993). Recovering our sense of value after being labeled mentally ill. Journal of Psy-chosocial Nursing and Mental Health Services, 31(4), 7–11.

Fisher, D.B. (1994). Hope, humanity and voice in recovery from psychiatric disability. The Journalof the California Alliance for the Mentally Ill, 5(3), 7–11.

Frese III, F.J. (1989). A consumer/psychologist’s view of psychology. Paper presented at the annualmeeting of the American Psychological Association, New Orleans, LA.

Frese III, F.J. (1993). Cruising the cosmos—part three. Psychosis and hospitalization: A con-sumer’s recollection. In A.B. Hatfield & H. Lefley (Eds.), Surviving mental illness: Stress,coping and adaptation (pp. 67–76). New York: Guilford Press.

Frese III, F.J. (1994a). A calling. Second Opinion, 19(3), 11–25.

Frese III, F.J. (1994b). Psychology’s role in a consumer driven system. In D.T. Marsh (Ed.), Newdirections in the treatment of serious mental illness (pp. 79–98). Westport, CT: Praeger.

Frese III, F.J. (1997). Twelve aspects of coping for persons with serious mental illness. In L.Spaniel, C. Gagne, & M. Koehler (Eds.), Psychological and social aspects of psychiatricdisability (pp. 145–155). Boston: Center for Psychiatric Rehabilitation.

Frese III, F.J. (1998). Occupational therapy and mental illness: A personal view. Mental HealthSpecial Interest Section Quarterly, 21(3), 1–3.

Frese III, F.J., & Davis, W.W. (1997). The consumer/survivor movement, recovery, and consumerprofessionals. Professional Psychology: Research and Practice. 28: 243–245.

Jamison, K.R. (1993). Touched with fire: Manic-depressive illness and the artistic temperament.New York: The Free Press.

Jamison. K.R. (1995). An unquiet mind: A memoir of moods and madness. New York: Alfred A.Knopf.


North, C.S. (1987). Welcome silence: My triumph over schizophrenia. New York: Simon & Schuster.

Preskorn, S. H. (1993, winter). The revolution in psychiatry. National Forum (Honor Society of PhiKappa Phi), 22–25.

Sass, L.A. (1994). The paradoxes of delusion. Ithaca, NY: Cornell University Press.

Schwartz, M.A., Wiggins, O.P., & Spitzer, M. (1997). Psychotic experience and disordered think-ing: A reappraisal from new perspectives. The Journal of Nervous and Mental Disease, 185(3),176–187.

Siebert, A. (1994). The survivor personality. Portland, OR: Practical Psychology Press.

Slater, L. (1996). Welcome to my county. New York: Random House.

Spitz, K., & Witek, R. (1994, March 6). The odyssey of Fred Frese. Beacon Magazine, 1–13.

Spitzer, M. (1997). A cognitive neuroscience view of schizophrenic thought disorder. Schizophre-nia Bulletin, 23(1), 29–50.

Torrey, E.F. (1997). Out of the shadows: Confronting America’s mental illness crisis. New York:John Wiley & Sons.


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