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New York Times. Letters.

Finding Purpose After Living With Delusion” (“Lives Restored” series, front page, Nov. 26) addresses something many psychiatrists, including me, who trained years ago know: psychotic symptoms are not just “biological,” and there is meaning behind them.

Today, there are pressures to see far greater numbers of patients for shorter periods of time, and the predominant focus is on medications that often reduce the psychosis to prevent hospitalizations. For people with other psychiatric conditions, it is generally those who can pay out of pocket who use talk therapy.

The symptoms of paranoia and hallucinations make it difficult for most people with schizophrenia to hold the types of jobs that would generate the income to pay for a more comprehensive therapy. With luck, the excellent treatment portrayed in your “Lives Restored” series will contribute to a rethinking about how we care for our most severely mentally ill.

JEFFREY B. FREEDMAN
New York, Nov. 26, 2011

The writer is a former president of the New York County branch of the American Psychiatric Association.

To the Editor:

In the late 1980s, I was privileged to organize one of the first “Clozaril clinics” in Massachusetts. Back then, the drug (clozapine) seemed to produce almost miraculous recoveries in some patients who had been suffering for decades with schizophrenia.

But our state-financed center was able to provide more than medication: patients also had access to supportive counseling, social services and personalized case management. (In today’s spartan economy, money for such services is often nonexistent.)

Your article about Milt Greek once again demonstrates the benefits of a holistic approach to severe psychiatric illness — one that is broad enough to incorporate treatments ranging from medication to meditation.

As for helping the patient understand his delusions and place them in the larger context of his life, the psychiatrist Silvano Arieti was writing about this back in the 1970s. Today, we also use cognitive behavioral strategies in dealing with the delusions of schizophrenia. Milt Greek’s story should remind us that psychiatry needs to be as comfortable with meanings as with molecules.

RONALD PIES
Lexington, Mass., Nov. 26, 2011

The writer is a psychiatrist on the faculty of SUNY Upstate Medical University, Syracuse, and Tufts University School of Medicine, Boston.

To the Editor:

Milt Greek, in your wonderful article about his recovery from schizophrenia, describes being traumatized in an early encounter with a psychiatrist. As you reported it, “The doctor never asked what he thought his hallucinations meant, or whether strange thoughts were linked to experiences in his life.” In all likelihood, his psychiatrist responded in this way because he or she was trained that showing interest in the psychotic symptoms would be “collusion” and make matters worse.

Mr. Greek’s experience is not uncommon. We find that rejection of the personal meaning of symptoms often backfires, and has the unintended consequence of driving patients away from accepting effective treatments.

In Britain, there is a growing awareness of how important it is for mental health clinicians to remain interested in the personal meaning of psychotic experiences, and of the fact that fears of “collusion” are unfounded. We believe that it is possible to help someone navigate through his psychotic experience without alienating him from effective treatments. We are working to bring these techniques to American psychiatry.

PETER J. WEIDEN
DOUGLAS TURKINGTON
Chicago, Nov. 27, 2011

The writers are professors of psychiatry at the University of Illinois at Chicago Medical Center and the University of Newcastle-upon-Tyne, England.

A version of this letter appeared in print on November 30, 2011, on page A34 of the New York edition with the headline: Treating People With Schizophrenia.