Madness and the Family: What Helps, and What Makes Things Worse?

Families are often very important for people encountering severe mental and emotional difficulties. But how can family members really know what is helpful, and what is likely to make things worse for the person having problems? Similarly, for those who want to help families, how can they know what will really be helpful for those families, and what will make things worse?
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Different Forms of Childhood Adversity Related to Specific Psychosis Symptoms

In this month’s issue of Psychological Medicine, researchers from King’s College London found evidence for associations between different types of childhood adversity and specific symptoms associated with psychosis. As current categorical approaches to psychosis and schizophrenia diagnoses come under increasing scrutiny, this study adds support to sociological and psychological theories and treatments.

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“David Bowie, Psychosis and Positive Nonconformity”

For MinnPost, Susan Perry discusses the late singer-songwriter and actor David Bowie and his experiences with psychosis. She highlights the work of psychologist Vaughan Bell, who details how Bowie’s family history of psychosis is reflected in his work, and Stephanie Pappas, explaining “why Bowie’s positive expression of nonconformity has helped so many people who feel like misfits.”

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Letters to the Editor: “The Treatment of Choice”

Readers respond to the New York Times article, “The Treatment of Choice,” about innovative programs for psychosis and schizophrenia that involve patients and their families in treatment decisions. “Narratives of success counter a drumbeat of faulty links of mental illness and violence, inaccuracies which serve only to further stigmatize and isolate individuals with psychiatric illness.”

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Is an Ominous New Era of Diagnosing Psychosis by Biotype on the Horizon?

When former NIMH chief Dr. Thomas Insel speaks, people listen. Dr. Insel famously criticized the DSM a couple of years ago for its lack of reliability. He notably broke ranks with the APA by saying there were no bio-markers, blood tests, genetic tests or imaging tests that could verify or establish a DSM diagnosis of schizophrenia, bipolar or schizoaffective disorder. However in a new article he announces research that claims to have found bona-fide physiological markers that identify specific “biotypes” of psychosis. This system could, purportedly, identify a person as possessing a specific biotype of psychosis, instead of a DSM-category diagnosis.
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Madness and the Family, Part III: Practical Methods for Transforming Troubled Family Systems

We are profoundly social beings living not as isolated individuals but as integral members of interdependent social systems—our nuclear family system, and the broader social systems of extended family, peers, our community and the broader society. Therefore, psychosis and other forms of human distress often deemed “mental illness” are best seen not so much as something intrinsically “wrong” or “diseased” within the particular individual who is most exhibiting that distress, but rather as systemic problems that are merely being channeled through this individual.
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Madness and the Family (Part Two): Towards a Unified Theory of Family Dynamics and Psychosis

In Part One of this article series, we reviewed the contemporary research into the links between psychosis, problematic family dynamics, and other forms of childhood trauma. After reviewing this research, we find that a very interesting and important question emerges: What do all of these have in common? In other words, is there some common denominator that all of these types of trauma and patterns of problematic family dynamics share, a single underlying factor that makes someone particularly vulnerable to experiencing a psychotic crisis? Indeed, I believe that there is.
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Disease Theory of ‘Mental Illness’ Tied To Pessimism About Recovery

Researchers recently completed a first of its kind, large-scale international survey of attitudes about mental health and they were surprised by the results. According to their analysis published in this month’s issue of the Journal of Affective Disorders, people in developed countries, like the United States, are more likely to assume that ‘mental illnesses’ are similar to physical illnesses and biological or genetic in origin, but they are also much less likely to think that individuals can overcome these challenges and make a full recovery.

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The Recovery After an Initial Schizophrenia Episode (RAISE) Study: Notes from the Trenches

I was a psychiatrist who participated in the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE ETP). Although I welcomed the positive headlines that heralded the study’s results, the reports left me with mixed feelings. What happened to render the notion that talking to people about their experiences and helping them find jobs or go back to school is something novel?
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Why Mainstream Psychiatry Fears a Balanced Understanding of Psychosis

Many people are now familiar with the BPS report, Understanding Psychosis and Schizophrenia, and they have appreciated how it integrates both science and a humanistic understanding to convey a fresh and progressive approach to difficult and extreme experiences. But it has come under attack by psychiatrists, using arguments that are often quite slick, and sound reasonable to the uninformed. But they are wrong, and the better we can articulate how and why they are wrong, the better we can advocate for a more humane and skillful response to people having the experiences that are called “psychosis.”
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Landmark Schizophrenia Study Recommends More Therapy

Results of a large government-funded study call into question current drug-only approaches to treating people diagnosed with schizophrenia.  The study, which the New York Times called “by far the most rigorous trial to date conducted in the United States,” found that patients who received increased drug counseling along with individual talk therapy, family training, and support for employment and education experienced a greater reduction in symptoms, were more likely to resume work and school, and reported a higher quality of life than those receiving current standard treatments.

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“My Ego Strength is Too Developed for Me to Ever Become Psychotic!”

That was the emphatic response from my grad school psychopathology professor 35 years ago, after I’d stated in her class that anyone could become psychotic given sufficient life stressors, losses and trauma. How many current mental health professionals, especially psychiatrists, also believe they have such strong egos that they never could experience extreme states?
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Prescription Stimulant Use is Associated with Earlier Onset of Psychosis

Individuals diagnosed with psychotic disorders have an earlier onset of psychosis if they have previously been exposed to prescription stimulants, according to new research currently in press in the Journal of Psychiatric Research.

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Long-Term Social Supports Needed After Onset of Psychosis

New data on the effects of social support after the onset of psychosis suggests that patients with intense social support function better than those without such help, but than once supports are removed the effects eventually diminish.

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A Network Meeting in North America

On a beautiful Vermont summer week-end, about 40 people – social workers, psychologists, psychiatrists, administrators, and people with lived experience among us – gathered together. Our purpose: To come together and model what many of us had experienced in Europe at the International Meetings for the Treatment of Psychosis.
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Therapeutic Alliance can be Helpful or Harmful in Early Psychosis, Depending…

Research lead by Richard Bentall of the University of Liverpool finds that the quality of the therapeutic alliance (TA) in treating early psychosis, long known to be instrumental in achieving positive outcomes, can also lead to poorer outcomes when the quality is negative. "This is the first ever demonstration that TA has a causal effect on symptomatic outcome of a psychological treatment, and that poor TA is actively detrimental, these effects may extend to other therapeutic modalities and disorders," the authors conclude.

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The Sweet Spot Between Ignorance and Certainty: A Place Where Dialogue and Healing Can Happen

It’s now widely known that a good relationship between helper and person to be helped is one of the very most important factors determining the outcome from many different types of mental health treatment. But when people are in an extreme state such as the kind we call “psychosis,” forming a good relationship is not an easy thing to do. And unfortunately, the typical interaction between professionals and clients seen as psychotic in our current mental health system has characteristics which make a positive human relationship almost impossible.
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CBT: Part of the Solution, Part of the Problem, an Illusion, or All of the Above?

Cognitive behavioral therapy or CBT has been pretty heavily criticized by a number of Mad in America (MIA) bloggers and commenters in the past few years. In a way that isn’t surprising, because most MIA bloggers are looking for radical change, and CBT often appears to be part of the establishment, especially within the therapy world. But while I’m all for criticizing what’s wrong with CBT, especially with bad CBT, I think there’s also a danger in getting so caught up in pointing out real or imagined flaws that we fail to notice where CBT can be part of the solution, helping us move toward more humanistic and effective methods of helping.
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Is My Therapist Good or Not?

I frequently get asked by people on the internet whether or not I think their therapist is good. For a variety of reasons, I usually do not feel comfortable answering them directly. However, I do feel comfortable writing about the subject here, as a sort of amalgamated response. As such, here are some questions I might ask such people, and here is how I might respond to their answers.
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More Reflections on Compassion and Uncertainty at ISPS 2015

In the blog posts by Noel Hunter and by Sandy Steingard, there have already been great reports on ISPS 2015, but I would like to share my own thoughts about what was most significant, and directions for the future.
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Developing a Compassionate Voice as a Step Toward Living With Voices

I’ve previously written about the possible role of compassion focused therapy in helping people relate better to problematic voices, in my posts Could compassionate self talk replace hostile voices?Feed Your Demons!, and A Paradox: Is Our System for Responding to Threats Itself a Threat? I’m happy to see more interest being taken in this kind of approach, and a video has just become available which, in 5 minutes, very coherently explains how a compassion focused approach can completely transform a person’s relationship with their voices and so transform the person’s life!
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Listening for the Person within “Madness”

As we struggle to invent a humane approach to the extreme states that get called “psychosis” or “madness” or “schizophrenia,” it may be helpful to investigate some of the better approaches developed in the past. While these approaches are not without their flaws, they are often surprisingly insightful. (It can also of course be depressing to notice how truths once more widely known were so easily “forgotten” as compassionate approaches got ditched in favor of the latest coercive innovations.)
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Is This Depression? Or Melancholy? Or…

We live in a culture bombarded by media and sped up by rapid-fire social interactions. It’s definitely useful to grab hold of a simple, short, sound-bite term, to quickly describe what we are feeling or suffering. “Depression” is such a word – it evokes and encapsulates, conjures the images of that ugly pit of despair that can drive so many to madness and suicide. Yet at the same time the words we use, strangely, become like those pens deposited in medical offices and waiting rooms around the world: ready at hand, easily found, familiar — and tied to associations, marketing and meanings we were only dimly aware were shaping how we think.
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Finding the Gifts Within Madness

When people are seeing the world really different than we do, it’s often reassuring to think that there must be something wrong with them – because if they are completely wrong, or ill, then we don’t have to rethink our own sense of reality, we can instead be confident about that own understandings encompass all that we need to know. But it can be disorienting and damaging to others to have their experiences defined as “completely wrong” or “ill.” And we ourselves become more ignorant when we are too sure that there is no value in other ways of looking or experiencing.
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Understanding Psychosis and Schizophrenia? What About Black People?

In many respects it is difficult to fault the report Understanding Psychosis and Schizophrenia, recently published by the British Psychological Society (BPS) and the Division of Clinical Psychology (DCP)[i]; indeed, as recent posts on Mad in America have observed, there is much to admire in it. Whilst not overtly attacking biomedical interpretations of psychosis, it rightly draws attention to the limitations and problems of this model, and points instead to the importance of contexts of adversity, oppression and abuse in understanding psychosis. But the report makes only scant, fleeting references to the role of cultural differences and the complex relationships that are apparent between such differences and individual experiences of psychosis.
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