A Whole-Person Approach to Psychosis and Schizophrenia

Pychiatrist Ray Kotwicki discusses holistic psychosis therapy.

Reviewed by Michelle Quirk

Key points

• Psychosis affects one's physical, psychological, social, and existential health.
• Mental health recovery often involves a whole health approach.
• Living well with schizophrenia and related conditions is a reality for many.

Twenty years ago, I found myself in a hospital, told I was dealing with something called psychosis. I didn't understand what that meant. At age 13, I was far more concerned with the classes I was missing at school, a band concert I'd been looking forward to, and the stamp of mental illness that I felt square on my forehead. Upon release from the hospital, I felt free—until my next hospitalization just a few months later. My hope slipped. It took years for me to fully accept my condition as well as to discover what living well with it could look like—far beyond just taking medication and going to therapy—a return to life and a license to chase my dreams.

This week, I interviewed Ray Kotwicki, a psychiatrist with a holistic view of mental health and recovery. He is the chief medical officer of Intensive Outpatient Services at Hightop Health. Kotwicki says, "We can't separate somebody's head from the rest of their body," emphasizing the intricate relationship between physical and mental health. He believes that mental health recovery is multidimensional with "physical, psychological, social, and existential components."

What Are Psychosis and Schizophrenia?

Psychosis is an overarching term for a diversity of experiences that alter our perceptions of the world, including things like visions, hearing voices, disorganized thoughts, and fixed, unusual beliefs. In addition to traditional symptoms of psychosis, many with schizophrenia live with negative symptoms, a manifestation that can, in ways, take some of the color out of life through blunted emotional expression, social withdrawal, loss of interest in activities, and a dissipation in motivation.

Kotwicki acknowledges that while these "negative" symptoms have a greater impact on a person's recovery, they are easier for clinicians to ignore than the more esoteric ones. He shares that families might mistake this as a lack of "personal responsibility," whereas these elements are just as much a part of the condition.

A final aspect of schizophrenia is anosognosia, which Kotwicki describes as a phenomenon in which a person "doesn't notice that their perceptions are skewed in some way." Anosognosia, or the inability to recognize one's illness, is common in many neurological conditions like brain injury (Steward and Kretzmer, 2022) and dementia (Hallam et al., 2020).

Possibilities for Recovery

Kotwicki emphasizes the individual nature of mental health recovery. After an experience of psychosis or diagnosis of schizophrenia, many begin to let go of their aspirations for the future. Expectations can be dulled. Yet, many do return to their hopes and dreams. Seeking support for mental health can be one component of recovery, but Dr. Kotwicki discusses others, such as "support in college" and "building relationships." He describes recovery as "doing the best we can with one's circumstances." He says, "I want everyone to know that [there are] hope and recovery, and imminent possibilities for people with schizophrenia."

Treatment Options

There has never been a time when so many options for schizophrenia treatment have been available. Antipsychotic medications provide relief to many from psychosis symptoms. These are available in oral and injectable forms that can last a few weeks to a few months. Kotwicki shares that one benefit of long-acting injectable medication is that "you don't have the reminder every time you take a dose of your illness." For someone who is struggling to accept their condition, this can be huge.

More recently, interventions have also become available to target negative symptoms, including a medication class that Kotwicki describes as "looking at a different system in working on the muscarinic system as opposed to dopamine." This novel mechanism might alleviate both psychosis and the negative symptoms of schizophrenia.

Psychological and social interventions, including psychotherapies like cognitive behavioral therapy for psychosis and recovery-oriented cognitive therapy, are also often elements of treatment.

Whole Health

Kotwicki also expresses the importance of recognizing the interdependent relationship between one's mental health symptoms and physical health. He shares that, historically, the medical system may have overlooked the physical health of individuals with schizophrenia, by focusing primarily on their mental health. "Physical and mental health are inextricably related," he says.

With effective support, many live well with schizophrenia and associated conditions. Further, as knowledge of psychosis and what can lead to recovery expands each day, there is every reason to be optimistic.

To find a therapist, visit the Psychology Today Therapy Directory.