Causing a Stir: Launching “Understanding Psychosis and Schizophrenia” in New York City

Anne CookePeter Kinderman
19
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As the British Psychological Society prepares to launch its report in the USA, two of its authors reflect on the widespread debate it is provoking. 

Those of you who read the New York Times may have seen its coverage of the British Psychological Society’s recent report, ‘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.’  The report has been widely welcomed and many have seen it as a marker of how our understanding of these experiences is changing.  It was written by a group of eminent clinical psychologists drawn from eight UK universities and the UK National Health Service, together with people who have themselves experienced psychosis.  It provides an accessible overview of the implications of psychological research for the way in which we understand these experiences.

Many have suggested that its conclusions have profound implications both for the way we understand ‘mental illness’ and for the future of mental health services.  Those welcoming the report from the London launch platform included the President of the UK Royal College of General Practitioners, a senior representative of the Royal College of Psychiatrists, and the National Clinical Director for Mental Health Services (the UK Government’s Chief Psychiatrist) together with the Shadow Government Minister for Mental Health. Its publication received widespread coverage in the UK media, including on the main national news program.

The report has received an overwhelmingly positive response from people who have themselves experienced psychosis or used mental health services: see, for instance, journalist Clare Allan’s piece in the national Guardian newspaper or Nicky Hayward’s in-depth review on the UK Royal College of Psychiatrists’ website.  These responses have been profoundly moving for those of us who have spent the last two years working all hours to try and produce a document that would be truly helpful.

The report has not been without its critics. Some of you may have seen the somewhat intense response by Dr Jeffrey Lieberman, complete with white coat, who accused the report authors of ‘challenging the veracity of diagnoses and giving people … license to doubt that they may have an illness.’  Some commentators have seen such responses as a sign that the report’s normalizing message might be a threat to those whose work has been based on the idea of brain diseases requiring aggressive pharmacological treatment.  In a similar vein, some other US psychiatrists, for example Allen Frances, have suggested that the report does not address ‘real’ schizophrenia.

Some criticisms are well taken.  For example, people have pointed out, and we have acknowledged, that the report paid insufficient attention to the specific issues faced by people from black and minority ethnic groups.  People from these groups experience discrimination not only within society but within services, and are overrepresented at the ‘sharp end’ of psychiatry: more likely to be diagnosed with schizophrenia, more likely to experience compulsion and forced medication, less likely to be offered talking therapy. As we move forward, it is vital that these issues are acknowledged and addressed.

Others have suggested that the report ‘ignores a hundred years of psychoanalytic thought.’ Some criticisms have been more technical, for example those of our handling of the issue of comparisons between psychological therapies on the one hand and medication on the other. These have been addressed in traditional academic outlets.  Some have painted the report as an attempt by psychologists to ‘sell their wares.’  Whilst of course every statement by a professional body contributes to public awareness of what the profession has to offer, our primary motivation was very different, as we have explained elsewhere.  The report is at pains to acknowledge that ‘often the most important source of help and support is our network of relationships: friends, family and community.’  Indeed, self-help and community based approaches are covered first, psychological therapy only later.  And far from claiming that psychologists – or indeed any ‘experts’ – have all the answers or know what is best for people, the report suggests that ‘people themselves are the best judges of whether a particular therapy or therapist is helping them.’  It advocates humility on the part of professionals, suggesting that the common idea that our job is to tell people what they need should be replaced with a different ‘guiding idea’:

Mental health is a contested area. The experiences that are sometimes called mental illness, schizophrenia or psychosis are very real. They can cause extreme distress and offering help and support is a vital public service. We know something about the kinds of things that can contribute to these experiences or cause them to be distressing. However, the causes of a particular individual’s difficulties are always complex. Our knowledge of what might have contributed, and what might help, is always tentative. Professionals need to respect and work with people’s own ideas about what has contributed to their problems. Some people find it helpful to think of their problems as an illness but others do not. Professionals should not promote any one view, or suggest that any one form of help such as medication or psychological therapy is useful for everyone. Instead we need to support people in whatever way they personally find most helpful, and to acknowledge that some people will receive support partly or wholly from outside the mental health system (p.103).

So there’s ongoing debate. And, to carry that debate forwards, we (Editor Anne Cooke and co-author Peter Kinderman) are coming to New York this month to launch the report in America.  The official launch is at 9am on Saturday 21st March as part of the ISPS conference being held at the Cooper Union in Manhattan.  Three other report authors will also be present: Caroline Cupitt, Tony Morrison and John Read.  We are also discussing the report at a public meeting organized by the Icarus Project on Monday 23rd.

New York City is famously not only the city that never sleeps, but also a furnace for debate and radical thinking.  Our report has certainly stimulated debate, and we hope to continue the conversation with as many people as possible during our four days in the Big Apple.

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19 COMMENTS

  1. I believe the call for humility is the most likely cause for much of the uproar. All sorts of theorizing is allowable, as long as you don’t start suggesting that the patients/clients/survivors may have some knowledge that the “professionals” may lack. Suggest that, and the gloves are off!

    —- Steve

  2. Thanks for your article Peter and Anne, and the links to other critiques and comments, some of which I had not read and were fascinating. Really this feels like a watershed moment where psychologists and therapists, at least in Europe, are finally saying no more. No more to reductionist ways of perceiving psychosis that elicit labels and prescriptions far too readily. This is a very positive statement that posits that we must perceive extreme states as complex and highly individuated narratives that are often rooted in trauma.

    My quibble is this, and it looks like it has already been somewhat addressed. I come from the perspective as a therapist but I see this statement as having the implicit suggestion that many of these folks would be far better served working with a therapist, and esepcially one steeped in CBT.

    I see you address this by saying that in fact many people would be helped by a wide variety of support…friends, family and community. But the suggestion is still there to visit a therapist…”later.”

    In the wider world, many people experiencing profound distress go to traditional healers, herbalists, spiritual ministers, etc. The thought of sitting down in an office for 50 minutes to talk about problems, esepcially by a practitioner using a particular “evidence based” treatment style, does not fit global pan-cultural needs. I think its key to note that there have been an enormous number of ways of approaching “psychosis” that do not fit into the mold of therapy or psychiatry.

    I applaud this statement heartily for expanding our understanding of extreme states as quite common and certainly not requiring medicalization and patholigization…but I worry that it is not expansive enough to be open to the complex unique worldviews and systems of healing found throughout the world.

    In any event, thanks so much for your hard work. I am very interested to see how the ongoing debate unfolds.

  3. Thank you so much for the work you are doing, and best of luck in NY. I hope you may help bring some sanity into our “mental health” industry, an industry that has run amok in the US.

    I also hope you might help educate the psychological and psychiatric communities to the reality that the antipsychotics / neuroleptics, themselves, do cause schizophrenia symptoms in at least a percentage of people.

    From drugs.com: “… neuroleptics … may result in … the anticholinergic intoxication syndrome … Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures.”

    This description of neuroleptic induced anticholinergic intoxication syndrome is almost identical to today’s definition of schizophrenia.

    And as a grown adult, I was made “psychotic” on a child’s dose of Risperdal, .5 mg, within two weeks. This implies this is not a safe dose of Risperdal for any child, and it’s not a safe dose for an adult who presented with concerns of child abuse, rather than a brain disease, either.

    And it’s probable that the etiology of most “‘real’ schizophrenia” is actually the result of the central symptoms of neuroleptic induced anticholinergic intoxication syndrome being misdiagnosed as schizophrenia by doctors – especially since the psychiatrists are currently still claiming to be unaware of the fact the neuroleptics can cause the symptoms of schizophrenia.

    Best of luck in the big Apple, and thank you again for the work you are doing. I hope you will consider passing this information on in your work in the future.

  4. Interesting that authors call for “humility” while pointing out, how the report is formulated by “a group of eminent clinical psychologists.” My point here, being that in an era of self-preservation, gained through the use of cognitive function, clinical psychologists may suffer form what McGorry et al, in their psychiatric formulations on the experience we label psychosis, call “the clinicians illusions.”Which Allen Francis formulates more concisely as: Psychiatric diagnosis is seeing something that exists, but with a pattern shaped by what we expect to see.

    My point here being: cognitive capacity is an experience-dependant evolution of being, which suffers from the dichotomy of taking immediate experience for granted. More specifically, in context of our PARADOX OF MODERNITY, we mature towards an adult consensus reality, having long forgotten HOW life begins, not with cognitive capacity, but motion & e-motion, to secure our survival.While in New York later this month, the IPSP conference will swamped by horde of emotional adolescents, demonstrating no capacity to FEEL how their body creates their experience of mind.

    They will do so, because, as a current aspirant for the top political job, here in Australia, so frankly pointed out, “in great race of life, you can always bet on self-interest.” While I make no apologies for labelling people emotionally adolescent, and ask readers to contemplate Billy Joel’s poetic description of our apparently “healthy psychological boundaries,” as little more than pretty faces, so willing and able to tell pretty lies. I ask middle class academics to consider that their well formulated “affect-regulating” responses to any sense of otherness, is based on the need to dampen the vitality affects of our primary process, e-motivation. With our common-sense psychological functionality, more of dissociation from the reality of being, than an embrace of it.

    While in terms of betting on self-interest, academic turf-wars, are the business as usual name of the game, in our 21st century urban landscapes of an economy masquerading as society. A masquerade which is based on our Western cultural history of viewing the body as a House of Sin. With the industrial revolution and rise of a “subject – object” attitude of mind, responsible for our current era of Material Wealth & Poverty of Self-Awareness. While in New York, the emotional system of a self-interested gathering, will feel much excitement and that something is really happening man!

    Yet” as we wind on down the road, our shadows taller than our souls,” somehow, some way, the things “appear” to change the more they ………. For as Joseph Campbell points out in his book “The Inner Reaches of Outer Space,” our human anatomy has not changed in the last 40,000 years, let alone the last 4000. And in New York, ISPS professionals will continue to utter the psychological delusion, that we are all different, with nothing more than “subjective” evidence, to affirm their affect-regulating needs.

    I urge ordinary members of the survivor community to go beyond the “appearance” of this rank & status eminence, and involve themselves in a self-education effort, made possible by our age of technology, which will take society beyond taken a for granted sense of worship, (the reverence of our parental, emotional systems of society) towards a sense of individual self-worthship. While the self-interest of professional groups can be clearly seen in their tendency for “self-citing” behaviour. With this report being no different form research behaviours in the early intervention for psychosis, approach to anomalous experiences. While another eminent psychologist, explains how the rise of neo-Kraepelian psychiatry, was based on the self-interest of any groups natural survival instinct & how a group consensus is reached:

    ” The Kraepelinian dichotomy: Emil Kraepelin’s view that psychotic disorders could be conceptualized as naturally-occurring disease entities which could largely be differentiated into dementia praecox and manic-depressive psychosis, has had a huge impact on twentieth-century psychiatry. The rise of neo-Kraepelinian psychiatry in the 1960s and 1970s contributed to the construction of DSM-III, in which the Kraepelinian dichotomy between schizophrenia and psychotic affective disorders became embedded in psychiatric classification. (Greene, 2007) An essay which points out how the attachment driven urge of group behaviour tends to be self-citing: The neo-Kraeplinians, although not connected in any official way, worked together to promote their approach. Blashfield (1982) described this informal network with their common beliefs, methodologies and research interests as an ‘invisible college’: there was a tendency among this group to produce papers which actively reinforced one another’s findings. (Greene, 2007)”

    While my comment is written in the spirit of Willelm Reich’s important insight that: “everyone is right in some way,” it is merely a matter of knowing “how.” (Reich, 1973) A view which understands all words as nothing more than labels, and would see the “chemical imbalance” metaphor as semi-accurate description of how our body creates our mind. With the great existential challenge of our age, being, imo, the need to resurrect the body, from the nightmare of history, which weighs so heavily on our Western educated souls. To which end I include an excerpt from my own existential journey, to understand my psychoses, from the inside-out:

    “With my existential challenge exploring the paradox of a taken for granted sense-of-self lacking knowledge of internal structure and brain-nervous system function. Lacking knowledge of the thermodynamic nature of organism organization, and the level of dissociation involved in a mind-body split in functional awareness. With an experiential focus on how: The attempt to regulate affect – to minimize unpleasant feelings and to maximize pleasant ones – is the driving force in human motivation. (Schore, 2003) A self-exploration of my affective states of consciousness creating a “sensate” (Levine, 2010) awareness of the “thermodynamic,” (Schore, 2003) “primary process” (Panksepp, 2004) nature of dissociation, compared to secondary process conceptualizations stating: Dissociation can be understood as a psychological survival strategy that enables us to endure overwhelming pain and fear. (Longden, 2013)”

    My 30,000 word formulation on the lived-experience of psychoses, can be read here:
    https://www.academia.edu/8013843/Psychosis_Affective_States_of_Consciousness_and_Nervous_System_Dysregulation

    While my experiential understanding of just how much, my mind fears the sensations of my body, and how my mind is fundamentally, a dissociation from the nature of being alive. Seeks to cause a stir in the taken for granted ego-functioning of middle class intellectualism. Asking the owner of this webzine to consider how his need for civil discourse, on a subject that so e-motive in nature, has created little more than a window for intellectual masturbation?

    Intellectual masturbation, which is in deep denial of our common need to self-regulate the subconscious processes of our common “primary-process affective consciousness.” (Panksepp, 2004)

    Sincere regards to all,

    David Bates.

    • David, I love how you see past the illusions! I agree with you, here, about the mind-body split, and dissociating from reality over embracing it, feeling it, and how middle class academic standards are a textbook example of this.

      Motion and emotion–what I would call ‘energy’–indeed, precede intellect and cognition, manifestations of the mind, which are influenced by the heart. I perceive that, as well. To me, this speaks of our spirit nature, by way of emotional expression, our authentic voice and means of communication. We are simply incurring more splitting, rather than integration. That’s how I’m interpreting the meaning of your post.

      “I urge ordinary members of the survivor community to go beyond the “appearance” of this rank & status eminence, and involve themselves in a self-education effort, made possible by our age of technology, which will take society beyond taken a for granted sense of worship, (the reverence of our parental, emotional systems of society) towards a sense of individual self-worthship.”

      Beautifully said, thank you!

      • Thank you Alex,

        Its not easy to stand outside the attachment driven illusions of a consensus reality, within any group of like-minded individuals. Particularly when the subject of the consensus is mental health, which as you rightly point out, is about energy.

        It is staggering, the extent to which both psychology & psychiatry ignore the burgeoning new science disciplines, which are exploring the bio-energetic nature of our internal structure & function. While it is this internal reality of being, which can make sense of why Dr John Weir Perry suggested psychosis is natures way of setting things right. And how R.D. Laing’s comment on our post infancy trance like illusions, is fundamentally correct.

        As Allan Schore points out: Bioenergetic conceptualisations thus need to be implanted into the central core of psychoanalytic and psychological theory, a position they now occupy in physics, chemistry, and biology. Thermodynamics are not only the essence of biodynamic, they are also the essence of neurodynamics, and therefore of psychodynamics.

        Which is why I try to point others in our community, towards the developmental science, that will answer Dr Michael Cornwall’s potent question, in terms of our global mental health debate, “if mental illness is not what psychiatry says it is, then what is it.” An adaptive process, involving the bio-energetic nature of the relationship between our heads & our hearts. An adaptive process expressed far more poetically by a famous writer and victim of our confusion about the nature of being human:

        I took a deep breath and listened to the old brag of my heart. I am, I am, I am. ―Sylvia Plath, The Bell Jar

        Warm regards,

        David.

        • “Its not easy to stand outside the attachment driven illusions of a consensus reality, within any group of like-minded individuals. Particularly when the subject of the consensus is mental health…”

          You said a mouthful here, that is so very true. It wears me down but I have a stubborn streak in me about this. Speaking of energy, I always have to take care that I don’t drain mine in this process. Going up against resistance can be very draining, and not terribly advisable, but we do seem to be getting close, here, so it’s hard to give up just yet.

          I’ve not studied the science of bio-energetics, but the work I’ve done as an energy healer and in my spiritual studies speak precisely to the energies of our biology, so it seems we’re talking about the same thing.

          From Chinese Medicine, I learned about the body heating up and cooling, and how this affects our health and well-being on all levels, mind, body and spirit. Seems to speak of the thermo-dynamics to which you refer.

          Also, in my spiritual work, we talk about aligning the heart and mind, and when we talk about higher states of consciousness, we talk about aligning the heart and mind with the heart and mind of God, as this is how we access our inner being/highest consciousness.

          I think one of the misconceptions of this alignment (what is commonly referred to as a state of ‘enlightenment’) is that once we achieve it, it’s some kind of permanent state of being in which we always exist; whereas I always try to point out that it is only a reference point, and that we are, indeed, human, so we go in and out of this state of heart/mind alignment, that’s natural, and it’s how we walk a path of creativity and manifestation.

          Still, once we know all of this, we have a goal toward which to focus–that is, in order to find my clarity and balance, I look for my heart/mind alignment with that of God, Source, Spirit, Inner being–whatever anyone wants to call it, that which is greater than ourselves. Then, I get my information, learn what I need to learn, then move along my path in a more integrated state. To me, this is the exact same thing as ‘soul retrieval.’

          You and I are coming from two different areas of study, yet I see how our perspectives perfectly coincide, and deliver the same conclusion.

          You’ve done remarkable work. I’ve always felt that you knew the truth about these issues. How are we going to get the point across? Or is that the point, no need to get anything across, just live our truth, and revel in our alignment with it, as examples? Who knows? Either way, I’m so glad we had this conversation!

          I’ve always appreciated your perspective and heart, David. Thanks for your diligence in all this, that’s what it takes. You’re a brilliant example of heart/mind alignment.

          • David, if you don’t mind, could you drop me a line at your convenience, at email below? I have some questions I’d like to ask you regarding all that you’ve been studying around this. I have a feeling you could bring me some clarity that I have yet to be able to find elsewhere, including within myself. Thanks in advance!
            [email protected]

  5. The cover of this report is a breath of fresh air. How unlike the awful, scary stuff that I encountered when my son was first hospitalized. CAMH’s booklet featured black line drawings of people writing in anguish (no doubt from their diagnosis.) How does scaring people aid in recovery?

  6. …….together with the people that have themselves experienced “psychosis”……..I’m confident that Anne and Peter will see to it , if they have not already done so that the experiencers will receive just financial compensation at least equal to what the outside observers have received or will receive along with equal accolades and respect . All in the spirit of the times they are a changing ? Are they not ?

  7. I am surprised that the while the Division of Clinical Psychology of UK intends to launch this report in the US in its present form. The editor is about to re-write the report – or at least this is what she has told black and ethnic minority people in UK who have objected to some of the content of the report, the way it excluded black voices from contributing to it, and how the report has drawn only on ‘white knowledge’ in its writing. The editor of the report has issued an apology (http://www.sumanfernando.com/Apology%20by%20Anne%20Cooke.pdf) and (a) offered to work with black and minority ethnic people in UK in deleting parts of the report that are offensive to black British people seen in the report as ‘the other’ whose ‘home countries’ are elsewhere than in UK etc. , and to correct inaccurate information (for example that black British are excessively diagnosed as ‘schizophrenic’ in their ‘home countries’) and (b) offered to redress the fact that black British psychologists and service users and others were excluded from contributing to the report. In fact black and minority ethnic people, including members of the DCP, wee not even told about the report and not invited to its launch in UK.

    Black people in UK have been struggling for many years to deal with the oppressive diagnosis ‘schizophrenia’ which, as in the USA (see Jonathan Metzl’s The Protest Psychosis; how schizophrenia became a black disease), is given predominantly to black people. The DCP seems to have ignored this fact and more seriously, excluded the voices of black and minority ethnic people in UK from being heard in this report. I see that Toni Morrison is listed as having been a ‘report author’. It would be interesting to know whether she was appraised of the way ‘schizophrenia’ is used as weapon of oppression of black people in the UK and what her contributions was in discussions. Has she been told of the objections to the report by black people in the UK?

    • Although it’s worse than unfortunate that the voices of People of Color were not included, or included minimally, and I am a person of color myself here in the United States, I still believe that this is an important step forward in dealing the with system that refuses to listen to ANYONE with lived experience. I certainly understand being upset about the exclusion of such important voices, the American government in the 1800’s tried to commit genocide against my people, but I still welcome any step forward in the attempt to make the system listen to all of us who’ve been harmed by its so-called “treatment”. We keep working to create a better world for all people.