Many people with Type 2 Psychosis often continue to be serviced through a variety of long-term facilities, such as psychiatric inpatients and outpatients, community residency programs of community mental health centers (CMHCs Community Support Program), supported living, nursing homes, etc.  Some of them may also have criminal justice system involvements for which they may be incarcerated in prison systems. Many may be living independently with family or other kinds of supports, and receiving varying degrees of psychiatric supportive interventions through outpatient care facilities, and some may not be receiving any services at all, and some are even “homeless.” Type 2 Psychosis may also coexist with other psychiatric diagnoses, such as developmental disability condition or "substance abuse." So the incidence rate of people associated with Type 2 Psychosis could be much larger in this sense.

The unifying feature for Type 2 Psychosis condition, besides some shared characteristics, is the demonstration of some levels of "compromised functioning" in specific domains of "personal independence" and in social communication, as defined by the existing social norms, not just by the presence of some elements of "atypical" thinking, feeling, and behavior syndromes, often traditionally defined as "hallucinations" or "delusions," as elements of “atypical thinking” is also shared with some “creative people.” The presence of these symptoms may or may not always affect personal independence or "wellbeing," or necessarily associated with "at risk behavior criteria."  There is an increased reports in the mental health community media of many  such people living “adaptively,’ and functioning well with having a history of such “atypical experiences” or even having continued experience of such “atypical experiences,” and able to positively redirect to productive living, with or without any continued psychiatric supportive interventions. Some  people also report of “creative productivity” from having such experiences.

There is also increased awareness of “iatrogenic effects” on some of these people, compromising further their functioning that may include some adverse biological effects such as metabolic functioning from long-term anti-psychotics use, or psychological dependency affecting their sense of “wellbeing” and personal sense of independence from any long-term biological and or psycho-social interventions.

 The continued presence of Type 2 Psychosis, over many years does not necessarily imply any biological or psycho-social based determinism, or specified prognosis,  as dynamics for this condition are yet to be fully known. Neither it implies any limitation for potential for “improvement” in functioning, as interventions geared to specific individual cases with defined functional outcome become more identified, and their positive benefits are yet to know. The emerging human technology potentially has infinite ways to compensate for varied forms of “disabilities,” be it physical or psychological. So any “negative stigma’ associated with any of this so-called “long-term syndrome” hopefully will lose significance. The presence of this syndrome, therefore, requires more active exploration and investigation for developing innovative or more effective ways for interventions by the mental health community, and there is a need for advocacy for ongoing support for all such efforts from the public and the social media at large. A realistic acknowledgement of "deficits" in the mental health and societal service systems may help to stimulate this positive outcome, and generate interests in young clinicians and mental health researchers in working with this challenging population with an "open mind."   

Addendum:

Crow proposed some years ago (1980) in the British Medical Journal, (see JT Crow, Molecular pathology of schizophrenia, more than one disease process, pp 66-68), a “two process approach” to psychosis (schizophrenia), based on his hypothesis of a bio-genetic causality for the two differential categories of psychosis. Crow’s Type 2 was more akin to the idea of Dementia Praecox à la Kraepelin (often classified as Disorganized [Hebephrenic] Schizophrenia), where loss of cognitive functioning supposed involve progressive irreversibility.

The Type 2 Psychosis that is proposed here does not contain any implication for non-irreversibility or deteriorating condition. Rather it is assumed that with “proper therapeutic management” an optimal functioning to one’s specific individual situation can be accomplished within or without any “residual” disability framework of functioning, with the belief that evolving human knowledge and “technology’ can also increasingly promote compensatory techniques to “mask’ all different kinds of “disabilities,” and making most of what is currently available.

Also to be noted that "management' concept used here does not imply any external control or direction to one’s life, as it may be assumed by some, but rather promoting “self-management” in collaboration with the support from one’s current “therapeutic milieu,” (e.g., psychiatric support service provers, and “significant-others in one’s life) to improve one's functioning, which in some ways is implied in all kinds of psychiatry and psycho-social therapeutic services. “Management’ may include prompts or suggestions initiated by self or others tor adherence to the suggested therapeutic follow-ups or a routine as well as for increased practice of positive “redirection” to productive activities in one’s daily life.  So target psychiatric interventions may not necessarily focus on elimination or reduction of  long-standing "atypical experiences"  such as "hearing voice syndrome" or entrenched personal delusional beliefs, rather focus on "distress" reduction, personal and or social “risk’ related behaviors, and strategies for support for active redirection to a variety "positive activities," and on the improvement of functional outcome: in terms of normalization of one's life to promote wellbeing to his or her "potential functioning." This views is consistent with the current emerging trend in mental health field.

References;

·       Mohiuddin Ahmed, Ph.D., Harold J. Bursztajn, MD, Ronald Abramson,MD. Back to the Future. Psychiatric Services Vol.67(5)2016. See also Google+ comment and video on this article in YouTube.  

·       Mohiuddin Ahmed, Ph.D., Harold J. Bursztajn, MD, Ronald Abramson, MD, Steven Nisenbaum, Ph.D. An alternative name for schizophrenia. The Lancet Psychiatry,Vol 1, Issue 4, 2014.

·       Mohiuddin Ahmed, Ph.D.,& Charles N. Boisvert, Ph.D. (2013): Mind Stimulation Therapy: Cognitive Intervention for Persons with Schizophrenia , Routledge, NY.

·       Mohiuddin Ahmed, Ph.D, David N Osser, MD, Charles M Boisvert, Ph.D., Lawrence Albert, MD, & Masood Aslam, MD.(2007): Rationale for Emphasis on Management over Treatment of Schizophrenia in Clinical Practice, Annals of Pharmacotherapy, Apri4,1:693-95.

·       Mohiuddin Ahmed, Ph.D. & Charles M Boisvert, Ph.D. (2006): Using Positive Psychology with Special Mental Health Populations, American Psychologist May-June 2006, 333-5.

·       Mohiuddin Ahmed, Ph.D. & Charles M Boisvert, Ph.D. (2003): Multimodal Integrative Cognitive Stimulating Therapy (MICST): Moving beyond the reduction of psychopathology in Schizophrenia, Professional Psychology: Research and Practice, December 2003, 34(6):644-51.

·       Mohiuddin Ahmed, Ph.D.(2002) Computer-facilitated therapy dialogue with persons with schizophrenia, Psychiatric Services, 53(1): 99-100.

·       Mohiuddin Ahmed, Ph.D. (1999): Computer-facilitated therapy: Reality-based dialogue with people with schizophrenia, Journal of Contemporary Psychotherapy, 28(4): 397-403.

·       Mohiuddin Ahmed, Ph.D., Franz Bayog, B.A., and Charles M Boisvert, Ph.D. (1997): Computer-facilitated therapy with inpatients with schizophrenia, Psychiatric Services, 48(10): 13354-5.

·       Crow, Timothy J. (1980): "Molecular pathology of schizophrenia: more than one disease process?" British Medical Journal, 280.6207 (1980): 66.

·       Jay D. Paul.(2014): The Vacuum of the Mind: A Self-Report on the Phenomenology of Autistic, Obsessive-Compulsive, and Depressive Comorbidity," (2014): Schizophrenia Bulletin, 41 (6): 1207-1210.

(This article reflects this individual writer’s perspectives, and does not claim to  present a consensus validated opinion for the mental health community at large. This opinion is being presented primarily to generate discussions, reflections, and sharing of ideas  on this complex and challenging mental health condition!  The references cited reflect also this writer’s own and collaborative writings that relate to views expressed in this opinion piece.)

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