Changing Society’s Whole Approach to ‘Psychosis’

We’re excited and a little apprehensive.  Fifteen years ago this month we were sitting together in the basement of Peter’s house.   We were writing (or to be more precise, editing) a document which went by the snappy, and now rather quaint sounding title of ‘Recent Advances in Understanding Mental Illness and Psychotic Experiences.’

We had felt a sense of despair at the widespread misinformation and atrocious stereotypes that were dominating media coverage of mental health at the time. We felt that our profession had a responsibility to challenge these stereotypes, and that as psychologists we had something unique to contribute. That was the time when research into the psychology of psychosis was beginning to burgeon, and many of our findings challenged not only the stereotypes but – perhaps more significantly – much ‘accepted wisdom’ within mental health services as well.

For example, we were finding that ‘psychotic’ experiences are actually very common.  Thousands of people have unusual beliefs or hear voices, but live successful lives and never come into contact with mental health services. Evidence was also emerging that rather than being some scary mystery brain disease, psychosis can often be a reaction to the things that happen to us – for example abuse and trauma – and the way we make sense of those events.

We summarised the latest research into one easy-to-read document aimed at service users, journalists, policy makers and the public.  We hoped not only to challenge the myths, but also to provide a resource for people who might not have come across all these ideas or research studies before. In particular, believing that ‘information is power’, we hoped that a summary of the various debates and evidence with regard to ‘psychotic’ experiences would be useful to service users. We wanted it to be a resource that people could draw on in their negotiations with professionals who issue advice and sometimes even use coercion on the basis of their claimed expertise.  Twenty of the leading clinical psychologists in the field contributed, and in the summer of 2000 our professional body, the British Psychological Society Division of Clinical Psychology, published the ‘Recent Advances’ report.   Later we turned it into a set of training materials, ‘Psychosis Revisited’ – which became a bestseller.  In 2010 the Division published a second public information report, this time about the tendency to experience extreme moods that can lead to a ‘bipolar’ diagnosis.  Anne was one of the editors together with Steven Jones and Fiona Lobban.

In 2012 the Division asked Anne to lead a project to produce a new, updated report on psychosis, summarising the huge progress that has been made since the first one in consolidating a consistently psychological approach to experiences that have traditionally been seen as part of an essentially biological problem.  24 contributors have been involved this time round.   Most of those who contributed the first time were keen to be part of this project too.  There are also new contributors, many of them younger researchers who have come to prominence since the first report, for example Tony Morrison and Daniel Freeman.  Significantly, about a quarter of the contributors have themselves experienced psychosis.

The report is entitled ‘Understanding psychosis and schizophrenia: why people sometimes hear voices, believe things that others find strange, or appear out of touch with reality, and what can help’.  It provides an accessible overview of the current state of knowledge and its conclusions have profound implications both for the way we understand ‘mental illness’ and for the future of mental health services.

Our primary target audience is the public and those who help shape public opinion, such as journalists, as well as service users and their families.   We hope that mental health staff will find it useful too.  It’s written in everyday English rather than professional language, and we’ve included an extensive list of further resources, with web links.

Its main messages are:

• The problems we think of as ‘psychosis’ – hearing voices, believing things that others find strange, or appearing out of touch with reality – can be understood in the same way as other psychological problems such as anxiety or shyness.
• They are often a reaction to trauma or adversity of some kind which impacts on the way we experience and interpret the world.
• They rarely lead to violence.
• No-one can tell for sure what has caused a particular person’s problems. The only way is to sit down with them and try and work it out. The opportunity to talk things through in this way is vital, but surprisingly rare.
• Services should not insist that people see themselves as ill.  Some prefer to think of their problems as, for example, an aspect of their personality which sometimes gets them into trouble but which they would not want to be without.
• We need to invest much more in prevention by attending to inequality and child maltreatment.  Concentrating resources only on treating existing problems is like mopping the floor while the tap is still running.

We think that the radical idea that ‘psychosis’ can be understood and treated in the same way as other psychological problems has the potential to revolutionise our mental health services.  In the past we have often seen drugs as the most important form of treatment.  Whilst they have a place, we now need to concentrate on helping each person to make sense of their experiences and find the support that works for them. Perhaps one day, too, the default approach in psychosis services will be a psychological one, with a psychological formulation driving every decision and the content of every conversation. We hope  that our document will also contribute to a sea change in attitudes so that rather than being seen as somehow alien and stigmatised, people who experience psychosis will find those around them accepting, open-minded and willing to help.

Understanding Psychosis is available to download free from www.understandingpsychosis.net.  Copies are also available from http://shop.bps.org.uk/understanding-psychosis-and-schizophrenia.html