Home' Trinidad and Tobago Guardian : June 19th 2013 Contents B6
Guardian www.guardian.co.tt Wednesday, June 19, 2013
During a chance meeting five years
ago at Boston s airport, Cheryl Gagne
mentioned to a former psychiatrist of
hers that she was bound for an Aus-
tralian conference to deliver a keynote
speech on mental illness recovery.
Confounded, the physician merely
stared at Gagne. Probably, said Gagne,
the doctor was recalling her former
patient s years of being psychologically
crippled by alternate diagnoses of bor-
derline personality disorder and bipolar
disorder, and a succession of hospital-
"Oh, the look on her face. I was poised
and well put together. She couldn t figure
out whether I was having an episode or
telling the truth," Gagne recalled.
Bucking widely held expectations that
the mentally ill are destined to lifelong
dysfunction, Gagne, 52, has been thriving
for many years. Her path to what she
and others call recovery has relied on
cognitive remediation, a roughly 20-year-
old therapy that, its adherents say, is
gaining wider acceptance.
Premised on the notion that routines
help many with mental illness develop
order in their everyday lives and succeed
in their pursuits, cognitive remediation
grooms the brain in the steps needed to
meet such goals.
Boston University neuropsychologist
Susan McGurk gives an example of how
it works: A severely mentally ill person
undertakes three to four months of thrice-
weekly sessions using special software
with repetitive exercises.
Those exercises may be aimed at help-
ing him or her develop productive day-
to-day routines; be better organised; pay
better attention to directions; problem-
solve with greater speed, accuracy and
regularity; and so forth.
"Maybe they start out learning a shop-
ping list of six items," McGurk said. "And
if they cannot remember all six items at
first, we evaluate how they encode that
list of things. What can they remember
and not remember?"
Cognitive skills, she added, are not a
gauge of a mentally ill person s intellectual
ability. When memorisation isn t suffi-
cient, a mentally ill client is coached on
writing down information he or she does-
n t readily retain.
"Trying to remember some instruction
your boss gives by repeating it over and
over again on your way back to your desk
is not an effective tool in the workplace,"
McGurk said. "We re teaching people
how to recognise what they should do
before they re in over their heads."
In 2010, The Bridge New York, which
provides mental health rehabilitation
services, converted its outpatient pro-
gramme to a cognitive remediation model.
That s partly because the New York
State Office of Mental Health, a main
funder for The Bridge, began demanding
that such programs seek to move many
mental health clients into the social and
economic mainstream, agency social
worker Daniella Labate said.
"The aim is not to have people sitting
around in a room doing nothing for the
rest of their lives," said Labate, who coor-
dinates the agency s cognitive remediation
Cognitive remediation---not to be con-
fused with cognitive behavioural therapy
---first helped to treat schizophrenia and
schizoaffective disorder. Increasingly, it s
being tested on those with depression,
autism, anorexia nervosa, attention-
deficit hyperactivity disorder and other
conditions, said Alice Medalia, director
of psychiatric rehabilitation at Columbia
University Medical Center.
Nevertheless, even as some with men-
tal illness who ve benefited from cognitive
remediation consider themselves recov-
ered, experts add that recovery is a fluid
notion. Also, cognitive remediation is
not a guaranteed fix for everyone.
"Some would say recovery means you
don t have an illness at all anymore,"
Medalia said. "Others will say it means
managing your illness so that you live
a gratifying life. ... Recovery means
people are able to negotiate functional
everyday tasks that are meaningful to
them after their cognitive functioning
has gotten better."
Michele Ponist, 57, diagnosed with
bipolar disorder and a client at The Bridge
New York since 2007, has been doing
cognitive remediation since 2011.
In one of two computer labs in the
agency s offices on Manhattan s Upper
West Side, Ponist recently showed her
skill at computerised cognitive remedi-
ation drills with names such as "Brain
Bender," "Fripple House" and "Factory
The drills approximate scavenger
hunts and puzzles. They involve precise
grouping of identical items such as
"Fripple House s" animated characters
and graphics outlining work flow. The
drills level of difficulty increases as
clients get more and more correct
Ponsit credits those drills and other
cognitive remediation strategies for help-
ing turn her life around. After more than
a decade of not being employed, she
spent a year in a $9-an-hour state-
funded position as a peer counsellor to
clients in a separate residential pro-
gramme run by The Bridge.
Last month, funding for the pro-
gramme ran out. But Ponist is on target,
social worker Labate said, to land her
dream job of working in a corporate
mailroom. Ponist has done similar work
for The Bridge, which partners with
companies willing to employ people
with mental illness.
"I m running into the higher-ups. I m
hobnobbing with them, giving them the
mail and loving it," Ponist said. "I accom-
plished that here at The Bridge. I know
I can do that outside The Bridge."
She added, "We discuss during group
session what we re learning through cog-
nitive remediation and how what we re
learning applies to all areas of our daily
For a population angling to be per-
ceived as normal as possible, given what
they struggle with mentally, hope is key,
"The no-hope message is the old par-
adigm, " said Harvard s Dr Dost Ongur,
a psychiatrist and clinical director of the
schizophrenia and bipolar disorder pro-
grammes at McLean Hospital in Boston.
"... There s a growing recognition of all
the dynamic changes that take place in
the brain, which shrinks in the early
years of a psychotic disorder. What s also
being discovered is that positive inter-
ventions reverse that brain shrinkage."
A new (old) way to treat mental illness
Indeed, cognitive remediation has
been shown to reshape the brains
of some mentally ill people posi-
tively, said Medalia, lead organiser
of an annual conference on cognitive
remediation in psychiatry in New
York, hosted this month.
In 1998, many of her colleagues
dismissed the merits of her first
randomised controlled trial on the
subject, said Medalia, who is also
director of Columbia s Lieber Recov-
ery and Rehabilitation Clinic for
"The prevailing attitude was that
people with schizophrenia couldn t
change ... (or) anyone with brain
disease," she said. (cnn.com)
They may look like computer
games, but Michele Ponist
credits these drills for helping
her turn her life around.
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