Camila Knudsen (not her real name) doesn’t like to recall how her world began changing when she was 14. Background sounds in her suburban neighborhood—lawn mowers, planes, barking dogs—intermingled in a deafening buzz. The cacophony made it hard for her to hear what people were saying or to respond sensibly. “My mind was a blank,” she recalls. “Sometimes I felt like I couldn’t see or hear anything. I’d walk past someone and if they were laughing, I felt like they were laughing at me.” Exhausted, Camila holed up in her room at home and avoided her friends. She wouldn’t shower, and she spent much of her time staring into space. Her father remembers how on 9/11 he and Camila watched television together as a plane flew into the second tower of the World Trade Center. Camila didn’t so much as bat an eye when the building burst into flames. “It was as if she hadn’t seen it,” he says. “She had such a hard time speaking; it was almost to the point that she was catatonic.”
Alarmed by their daughter’s behavior, Camila’s parents began looking for help. But local psychiatrists were booked solid, some of them for the next six months. Meanwhile, her downward spiral accelerated. Then a pediatrician referred the Knudsens to William McFarlane, a psychiatrist in Portland, Maine, who had recently launched an experimental treatment program for early-stage mental illness. McFarlane championed a radical view that psychotic illnesses, including schizophrenia, can be prevented by treatment if caught early enough. His program, Portland Identification and Early Referral, or PIER, was a groundbreaking effort to find and treat patients showing early warning signs of psychosis.
Camila was accepted in September 2001 on the day she was assessed. The PIER staff believed that her symptoms, coupled with a history of schizophrenia on both sides of the family, put her at high risk for a full-blown psychotic break with reality. Quick intervention was crucial, McFarlane and his staff stressed, to prevent the onset of major hallucinations, delusions, and paranoia. Should Camila become psychotic even once, the lingering effects on her brain could diminish chances for recovery. One of the most crippling features of schizophrenia is that if delusional thinking is left unchecked, it takes over, robbing patients of the ability to recognize—and seek treatment for—their illness. Losing touch with reality puts schizophrenic patients at high risk of job loss, illness, homelessness, and suicide.
The Knudsens began PIER’s recommended treatment, a novel mix of psychotherapy and medication. Camila stuck with the program for four years and her symptoms subsided, slowly at first, but steadily. “You couldn’t tell she has a mental illness now if you tried,” her father says. “She’s going to be a productive member of society.”
By taking schizophrenia prevention to the community, McFarlane is charting a bold new course. With nearly $15 million in new funding from the Robert Wood Johnson Foundation—a longtime PIER supporter—his program has been broadened from Portland to four additional sites nationwide (Sacramento, California; Ypsilanti, Michigan; Salem, Oregon; and Glen Oaks, New York), embracing a combined population of more than 1 million people. Similar programs are ongoing in other countries, notably Australia, Denmark, Canada, England, and Germany. McFarlane’s program is by far the largest effort in the United States to prevent psychosis.
