Many families trying to support someone in psychosis fall into the same trap professionals find themselves caught in: power struggles: “How can I make my relative change? What should I do to get them to see they are sick?” While it’s hard to argue with wanting someone to get better, control and conformity are at the heart of everything wrong with the standard psychiatric approach. The deeper families dig themselves into forcing change on their relative, the more they flounder.
Madness has a way of presenting us with paradoxes. Trying to get someone to change more often than not just leads to failure and desperation — and drives them into isolation. Gentle encouragement becomes pleading and pressure, and then coercion, and soon family members have formed alliances with professionals and are entrenched in medications, forced treatments, and disease explanations. Exerting control might lead to apparent momentary gains, but it is more likely to obscure deeper reactions that show up later: throwing meds away, apathy, self-destructive behavior, or even violent outbursts. Add the dimension of young people testing independence from their parents, and the age-old drama of adolescent rebellion is played out on the stage of mental health.
While all families are different, one way out of this impasse is to let go of changing the relative. Easier said than done, of course, when it’s your child in crisis, but in family after family, recovery for a person struggling with psychosis means a shift from controlling the other to controlling yourself. Â It means looking at how you relate to your relative, rather than what’s wrong with them. And it means getting support to make change.
I learned a lot about putting this perspective into practice from Krista Mackinnon and the Family Outreach and Response Program (FOR) of Toronto Canada. (I should say that Krista is my friend, and a colleague on a number of mental health projects.) When I discovered FOR’s work seven years ago it was a revelation — a pro-survivor, anti-oppression, and recovery based family support organization, publicly funded with a solid track record of success. I wrote about it for my Icarus Project blog at the time, and have been learning from FOR ever since.
Now Krista — who began work as a counselor after surviving her own psychotic crisis as a teen — has done an extraordinary service to families and everyone supporting people in psychosis. With the encouragement of FOR and director Karyn Baker – who is herself a family member – Krista expanded the curriculum she taught Toronto families into a training class and support group that everyone can take. Don and Lisbeth Cooper also deserve praise for the farsightedness of investing in Krista’s work via Mother Bear, taking the risk of partnering with psychiatric survivor-led teaching. The new class, offered online, has been a resounding success for the more than 200 family members, professionals, survivors, and recovery researchers who have taken it so far. Krista has gained wide acclaim for the clarity of her teaching and the practical usefulness of the skills she offers.
Krista designed the class to be affordable — 8 weeks of training and support for less than the cost of two therapy sessions — and completely flexible, fitting anyone’s schedule and requiring only a limited time commitment. Drawing on her years of work as a family counselor and her personal insights into recovery from madness, training topics include the limitations of a disease model approach, working with boundaries, how to communicate with someone in psychosis, rekindling hope, untangling power struggles, understanding medications, and wellness strategies for the whole family. I recommend the course to virtually every family I meet, as well as professionals, survivors, and anyone interested in psychosis recovery.  The positive response has been tremendous, and I see firsthand how the skills learned can make a real difference for family support. Kristaâs partners Family Outreach and Response and Mother Bear are now working on an outcome study with University of Northern Colorado researchers, in order to document the training’s effectiveness and demonstrate it as an evidence-based practice.
I was able to finally get Krista, a mother of three with a busy professional schedule, back on Madness Radio as a guest after our previous interview in 2007. Our new interview focuses on the common dilemmas families face and the skills Krista teaches in her course and  counseling practice. In less than an hour interview Krista casts bright illumination on practical ways families can move forward.
Madness Radio: Effective Family Support With Krista Mackinnon.
Download audio file directly here.
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“While all families are different, one way out of this impasse is to let go of changing the relative. Easier said than done, of course, when itâs your child in crisis, but in family after family, recovery for a person struggling with psychosis means a shift from controlling the other to controlling yourself. It means looking at how you relate to your relative, rather than whatâs wrong with them. And it means getting support to make change.”
What I’ve often found to be the case is that there is a family dynamic in place which does not accommodate the needs or process of one of the individuals. When they express their individuality and independent thinking, they are judged, shamed, guilted, or ostracized, perpetually, as a way of trying to control them into conformity (much like the society, at large, with which we’re dealing, supported by psychiatry).
There is nothing ‘wrong’ with the individual, but these dynamics can exist daily in a family, which can be crazy-making to a person–and often leads to what we call ‘mental illness,’ ‘psychosis,’ etc. I think it’s more hurt and feelings of betrayal which are plaguing that person’s heart, and causing chaos in their mind. From awareness of these issues, these internalized dynamics and the false beliefs that are created from them can certainly heal with the right support.
Family abuse takes many forms, and is a chronic and debilitating nightmare for a kid. As an adult, this can linger as post traumatic stress, but at least we have more options and freedom about how to get away and heal from what gets internalized from all of this. It’s a complex network of neuro-confusion that begs for clarity, so the mind can relax, and the heart can heal.
Aside from a blatant abuser, there are enablers, and they can be more insidiously abusive and double-binding than the actual primary abuser. Often, it is the most sane-acting and successful person in the group who is the most clever and manipulative, what I’d call ‘the gaslighter’ of the group. It’s a sinister role to play, but some choose to play it. They are usually most challenged to own their part in how this toxic dynamic, holding on fiercely to their power-struggling reality.
So much to explore and learn about how families operate, and how to make them safer and geared toward producing a community of health, alignment, well-being, and emotional freedom.
I appreciate all the work being done in this area. Thank you for this information!
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Great post Will. FOR sounds like a fantastic resource for family members of folks experiencing severe emotional distress. I think a lot of parents of kids going through “first-breaks” are understandably scared and are looking to fix the problem. They are left with limited options and a societal push to medicate the psychosis away. Parents without any experience in this area are likely to trust the opinions of doctors and medical professionals.
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Te thing is is the person takes genuine psychotherapy they will probably be changed or get cured and the family won’t like it , in fact they will resist it. Usually the family has to change to learn a new way of being and existing according to growth principles.
A lot of people when they learn what they have to do and accept and change in themselves they prefer eh other person to remain sick.
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” but in family after family, recovery for a person struggling with psychosis means a shift from controlling the other to controlling yourself. It means looking at how you relate to your relative, rather than whatâs wrong with them. And it means getting support to make change.”
Yep that’s it support for change is kind of an oxymoron because promoting change usually means kicking out the support.
And within the above paradigm the afflicted person can get genuine personality change psychotherapy but the others are outside of that process.
Some social manipulators such as Dr. Allen which some here are familiar don’t like that, they want to manipulate the family to “remain together ” like they were puppets in some kind of dysfunctional confluence.
More often than not, the cured will go their own way and with a better standard of health and others will have to learn to follow them or be discarded.
It’s better that society and families learn a new standard of mental health and take their lumps. The entire civilization needs a new way of being, accommodation is not going to work.
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What will be, will be, Cera sera.
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Psychiatrist â I am trying to stop you from killing yourself.â
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Patient â I am trying to kill myself because you have named and made me diseased. Thanks to you Doctor I am spiritually diseased, physically diseased, occupationally diseased, socially diseased, emotionally diseased, and intellectually diseased.â
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Yes, yes, yes. Well said, markps2. Just today I came across a quote by Dr. Thomas Szasz who says that psychiatric diagnoses are often “swung as semantic blackjacks: cracking the subject’s dignity and respectability destroys him just as effectively as cracking his skull. The difference is that the man who wields a blackjack is recognized by everyone as a thug, but one who wields a psychiatric diagnosis is not.”
Thugs wielding semantic blackjacks. Surely, this was the role of the experts who “treated” my (late) son.
I am so grateful to people like Krista MacKinnon and Will Hall for showing families a more truthful and more hopeful way to address the challenges of mental/emotional turbulence.
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I’ve taken two of Krista’s online courses and highly recommend them. I think it is important to stress that the courses don’t begin or end with the premise that families, and parents in particular, are abusive and the cause of the original psychosis. The course helps individual families learn how to help foster recovery in others and in themselves. (Hint, it’s all about keeping hope alive in yourself in order to keep it alive in others.) It doesn’t teach better parenting skills. It teaches the skills that are needed to navigate an intense period of turmoil in the lives of families. It teaches participants how to talk to someone in extreme states, how to empathize with what they are going through, how to set boundaries and how to HOPE. This is a revolutionary approach because it’s a direct challenge to the authority of the medical profession that up until now has controlled the framework of discussion, casting everything as a “disease” model. Many thanks to Krista, The Family Outreach and Response Network, and Mother Bear for helping people to practice building an environment conducive to recovery.
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It’s missing something essential because they are worried about this abuse and blaming thing. Abuse doesn’t matter, it’s emotional development and /or the blocking of it internally or externally for whatever reason…
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Supportiveness can be just as damaging as abuse. Work is tough and teaching work is better than hope.
But halfway there isn’t that bad I suppose.
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Oh. “Mother Bear” – I think this is the person who has an issue about “blaming the patents”?
So the “families” don’t critically introspect – this is a danger – I always evaluate on this.
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Listening to the radio talk — on and on about the symptoms totally irrelevant to my perspective wish they’d get on to the curative process – 30 minutes in and still nothing – very annoying – ok that’s it getting to the real story now – just went off meds slowly but nothing about emotional transformations.
So the story is she just went off the meds and life was ok as something had changed or energy released (for later yoga and writing) so the psychosis was the pain for the transformation I suppose but not self-examined though i guess it worked – basically says she doesn’t understand what happened. Not much self-examination here transformation maybe because of not wanting to “blame”anyone. Sort of laissez faire. It is more like recovery rather than psychodynamic change.
They are discussing abuse – A blase or even nice family that simply avoids strong emotions can be just as toxic as abusive families – that’s something that is not well understood.
Too much lightfoot dancing around here on this subject.
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Overall a very very soft approach far too worried about saving egos for my taste. Just not my style – IMO, the more egos you crack the stronger the results – after all egos were meant to be broken, why waste all that madness?
To each their own taste, good if it gets some results, so long as it’s not NAMI.
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“Not much self-examination here transformation maybe because of not wanting to âblameâ anyone…It is more like recovery rather than psychodynamic change…Too much lightfoot dancing around here on this subject.”
I agree. There is a difference between ‘blame’ and the lack of ownership that goes with this, and cause and effect, where everyone takes responsibility for their role in the family system, including the initial client. For the family member that was the catalyst for bringing attention to the family, the challenge would be to speak their truth. For the family, the challenge would be to hear it, respect it, and then each person can speak their truth. Then, you see what you have to work with.
This is where true change is found, in the awareness of cause and effect. It’s hard for me to imagine how a family environment (or lack of one) cannot drastically influence the stress level of a child, which later becomes post traumatic stress in many forms. I agree, there are many forms of abuse, neglect, emotional abandonment, not respecting boundaries–all sorts of insidious ways we drive each other crazy, and all sorts of ways we dodge this issue.
“IMO, the more egos you crack the stronger the results â after all egos were meant to be broken, why waste all the madness?”
Well said. In my opinion, as well. When egos are challenged, we grow and evolve in awareness, and we learn our innate strength and power.
What I find interesting is that for those of us who have gone through all of this mental health crap, our egos have been slashed, which is why we roar. What we’re doing now, is cashing in on this and finding our voice, strength, and power, which would be the natural next step, as we heal from our wounds over time.
I don’t believe the madness is wasted. It’s a tool for healing, justice, and truth, and for creating healthy communities.
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It’s all about shattering illusions…
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Thanks Alex, I’m glad someone is hip to what personal growth is.
Protecting the egos of people who are “afraid to be blamed” is repressive.
Here what is being sacrificed is individuals and they seem to be sacrificed to something that is not alive the concept of “family”. This sounds like a social-political agenda.
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Get down. Be blamed.
Don’t do the crime , if you can’t do the time.”
If you are not guilty you got nothing to worry about.
If you are then fix it, if you can’t fix it then go through the guilt about it and fix yourself.
The blame stops here, I take the blame, Why not?
Do it for love.
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Well OK maybe you have to do magical intervention with some kinds of people. A little legerdemain, a sleight of hand.. nobody is to blame but how about changing this thing here…
But overall you can’t build on lies or repression and that has to be dealt with sooner or later.
If you try to save the family regardless, that also is abusive and repressive.- some parents are loveless or frozen in some kind of neurosis in that case all the work or the main work is done with the afflicted person and they will decide their own future regardless.
Unfortunately the parents usually pay the bills, so taking money from violent or sexually abusive or controlling parents to help them do their thing is not necessarily a good thing. So I suppose it’s best to play a game with these people ..like “gee no one is to blame but…etc”. I suppose at least it’s a hook.
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Usually anyone at all makes any significant personality changes , everyone they know , especially the parents will be in resistance to this change.
In other words they want change, but they usually won’t like the change they get. Unless of course they have concurrent guidance or therapy.
People have “levels” of emotional health, a person free of neurosis or who becomes free will be unhooked from those in lower levels or those still caught up in neurosis. Being unhooked they will be emotionally unhooked or disengaged from anything or anyone or any family member that can damage them and those in lower levels will have nothing emotionally to offer such a person. Although one could still relate to them out of compassion or obligation there is simply no emotional reciprocation that can occur.
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So you have to acknowledge this and let the ball goes where it bounces, trying to enforce relationships on other is social control and if you wish to replace the decision making mechanisms of others you might as well use drugs.
Some “helpers” (eg Dr. David Allen – actually he goes further having an elaborate agenda of social engineering) is ) cannot accept that a family member upon getting healthy will want to break from an abusive or simply dead relationship and they try to force said sad thing upon them. They and probably most people do not realize that the only real bonds we have with others are in the mind , not in the blood. Blood is really an conception we have, it’s not a genetic control and if the conception is altered the bond is altered).
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It’s not necessarily trauma that causes problems but inner repression. Inner repression doesn’t even need much trauma. Some people were just very sensitive in their development. Some people can suffer oodles of trauma and just become extremely resilient because they are not engaged in inner emotional repression.
To see if this group understands the idea of real change I look to see if they understand the idea of inner transformations. Most of these families have no idea of the inner life – that is a result of the culture they live in this is how the larger civilization is dysfunctional. So these type of people are easily fooled by the Med Shrinks. A lot of what this group does seems to be work on the outer – to provide a respite or peaceful secure environment for adaptation. This can result in what they call ‘recovery’ which to my view is not enough because there can be actual cure which is beyond recovery. It’s not certain but I suspect there can be more than what has been achieved.
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In the second tape Krista seems to have changed, I think she is no longer in doubt as to what caused her “episodes” and also she has advanced her understanding of the whole process in many ways.
They are teaching the families (parents) about the inner life as opposed to the repressive forces of the “great culture” which dissuades them from knowing and practicing inner changes.
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Many, many thanks Will for writing this article. I listened to the audio interview with Krista MacKinnon and replayed so many parts of it it took me 3 hrs to finish the 47 min interview. “IF ONLY” resignates repeatedly in my head coming up on the 2nd anniv of my 25 y/o son’s horrific suicide, after two psych breakdowns which were 18 months apart. Thank you to Krista who acknowledges each time she went into psychosis was triggered by cannabis and/or other hallucinogens. But as Krista says the underlying traumas that people face is part of the catalyst into altered mental states. I get this now, but I want to ask why, why, why, why did the MH industry not acknowledge this to my son? Why didn’t this knowledge reach my son after a ” sea of stressors” ( two of the biggest stressors was a physical recovery for a severe knee injury on top of just marrying his longtime girlfriend who became less than interested when her “Prince Charming” wasn’t able to live up to this image) while indulging in too much cannabis, idled and on disability from his successful career in the trades. Why did none of the MH “experts ” help my son, or his family, as we were desperately trying to seek compassionate support. Just box into that MI label like Krista was, massively over-drug, warehouse with no education he could recover. Anything but hope was forecast yet my son, who intuitively realized the psychotropics were so damaging to him so did wean himself from them. We took my son to a psychologist who was a decent, caring man who also doubted the dx of ” bipolar” was factual but admits he wasn’t aware as much as he could have been how psychoactive drugs, like cannabis, can trigger “episodes”. And proud, independent young men don’t like to bear their psyches for introspective, soul- searching. I wish I had offered to join my son to improve our relationship, every parent-child can grow spiritually and emotionally, but I was counseled by another ” expert” to stay in the background, that it was up to my son to break away from the source of his conflicts. My son weaned himself off the toxic meds, yet, sadly, returned to cannabis (remaining with the woman he believed was his soulmate but slowly realizing she was undermining him as she was fully caught up the stigma of his MI label ) for reasons I assume now, to escape. A 2nd break, with my family’s well-meaning attempts to seek drug rehab help for my son, proved catastrophic as he was coerced instead into the locked psych unit and kept against his will for 13 days total, then ” dumped” by the system. So more trauma, on top of unresolved trauma, and 7 months later despite weaning off those toxic agents again, my son alone and isolated where he insisted he moved to and could heal around nature – took his life. And his family remains devastated. So, I ask how could this program you and Krista have developed not be in every community? I absolutely will sign up for the 8 week online courses. Please know every resource we tried to help our son failed, ultimately. My son was a macho, young man. The thought that was brainwashed into him of being ” bipolar for life” though we believed he was overcoming the stigma, and healing. We supported his cessation of meds, as I never saw any benefit while he took them, just the opposite. But he never met a Krista who could have explained, she, too, experienced similar parallels. God, I wish there were do-overs, Will. I want to shout from the mountaintops my son should be alive. The TRUTH was denied him. And it didn’t and shouldn’t have ended with the absolute tragedy of his suicide. Thank you to MIA for all this website has given me. So profoundly sad, however, I found it too late to help save my beautiful first-born son. But absolutely, Open Dialogue, and practicerecover.com can save countless lives in the future.
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When it comes to families, *listening* is the key…
âBeing listened to is so close to being loved that most people cannot tell the difference.â David Augsberg
Duane
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This is an excellent article and I plan to save it. I, too, have learned a huge amount from Family Outreach. Everything that Will and many commentators have pointed out about how families try to intervene to force their hurt one to conform is right on. It is true that families have dynamics and roles and that these are not always constructive.
At the same time it is important not to blame families, for many reasons. The main one is that, when professionals blame families, they reinforce the biggest road block to recognizing the important insights that Krista and the FOR team offer. I am sure that most parents desperately want to find a way to prevent their beloved child from suffering any more. They are frightened because they know that unless their young one can get back to thinking in a way that the world will accept, they are doomed to exclusion, labeling, ridicule and worse. It is all very complicated. Thank goodness for Will,and Karyn and Krista and the Coopers.
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I had the same reaction as Alex here.This is an abhorrent attitude- the parents want to suffocate or control the child because they might be caused some social embarrassment. It’s also abhorrent to prevent anyone from suffering – that is the snuffing out of life.
The choice of language here tells a tale of acceptance of repression.
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If families or a family member is to blame for anything, they need to take the blame for whatever it is and change it. There can be no useful insights that come from repression or avoidance.
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“most parents desperately want to find a way to prevent their beloved child from suffering any more. They are frightened because they know that unless their young one can get back to thinking in a way that the world will accept, they are doomed to exclusion, labeling, ridicule and worse. It is all very complicated.”
This speaks of conforming for the purpose of being ‘accepted.’ Accepted by whom, a degenerating society? I don’t think it’s so complicated.
Another choice a parent would have is to celebrate their child’s independent and novel, creative thinking, if that’s what the case is, and to encourage the kid to follow their mind and heart, without caring AT ALL what others think. If the parents are frightened for the child, then it is their fear which would cause the kid problems. That’s THEIR fear they are passing along to the child, rather than confidence.
Those who think in ways that are challenging to society are the movers and shakers of the world. They are the ones poised to create a new and better society, celebrating diversity, as opposed to fearing others’ reaction to their lack of conformity.
Suffering is caused when we judge and shame ourselves for being who we are. We learn that as children from those around us. As adults, we can clean this up and re-write these debilitating messages, and encourage people to think on their own, trust their own hearts, and honor what they feel, without question.
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“Your children are not your children. They are the sons and daughters of Life’s longing for itself. They come through you, but not from you. And though they are with you, they belong not to you.
“You may give them your love but not your thoughts. You may house their bodies but not their souls. For their souls dwell in the house of tomorrow, which you cannot visit, not even in your dreams.”
Kahlil Gibran,
The Prophet
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