Towards a New Understanding of Psychosis – ISPS 2015

Sometimes I read things on various websites or hear speakers from abroad make statements to the effect of “Change has become apparent.” There is, evidently, some indication that society, families, and even mental health professionals are beginning to understand that people suffer in unique and varied ways, and they suffer for a reason. Purportedly, more people are beginning to question the pedestal upon which the pharmaceutical industry and psychiatry stand, and they see how trauma, poverty, racism, oppression, family dynamics, and a diet based on chemically manufactured foods contribute to this thing called “mental illness.”

But, every time I see this stated somewhere or hear someone utter some such words, I can’t help but wonder if they are delusional (pun intended). I live in the United States, where every time I turn on the television I am assaulted with another ridiculous pharmaceutical ad for some “disease” that has been invented to sell this very drug (I mean, seriously, do I really need to “ask my doctor” about dry eyes when the humidity outside is about 0%???). I work in a system that shuns me for uttering the idea of true recovery (without meds!) and for suggesting the role of trauma in individuals’ apparent “bizarre” and “disruptive” behaviors. The word” recovery,” the Hearing Voices movement, “person-centered” approaches, CBT for psychosis, and other consumer-driven and non-medical model ideas have been usurped by mainstream professionals jumping on the latest fad. These same “recovery-oriented” professionals, in essence, turn these approaches into manipulative ways to get people to “comply” and just take their meds already while completely ignoring the principles upon which these approaches originated. While so many tout the great improvements being made and the alleged sea of change, I continue to find myself increasingly disheartened and hopeless.

Well, just recently I started to see a bit of what others have been reporting, and realized that perhaps there is some reality to this idea of a shift of thinking within the mental health profession. The International Society for Psychological and Social Approaches to Psychosis (ISPS) held its international conference in New York City at the end of March, and over 700 people from around the world came together to discuss psychosocial approaches to “psychosis” and extreme states. The idea was for people of all professional decrees, family members, students, individuals with lived experience, and/or anybody else with an interest in the topic to come together and have a dialogue about ways to change services and provide the greatest opportunities for healing to those who suffer.

This seemingly open-minded, progressive, all-about-paradigm-change conference disappointingly began with a plenary speaker whose research was an expansion on the “known” genetic etiology of “schizophrenia” and how “schizophrenics” can be recognized by some kind of eye-twitch recognition (for those who believe in such fantastical ideas, check out this recent article showing how the length of one’s fingers can predict schizophrenia!). But, then came the “launch” of  the British Psychological Society’s “Understanding Psychosis and Schizophrenia,” where Drs. Kinderman and Cooke spoke about their controversial report that has ruffled the feathers of many whose feathers need to be ruffled.

Understanding Psychosis Launch from ISPS 2015

Anne Cook & Peter Kinderman at ISPS 2015

And it ended with a line-up that inspired me to continue trudging through my professional training in an effort to humbly follow in their footsteps.

The vision behind this gathering of quite disparate minds was an honorable one. How do we forge change and bring about awareness that, just maybe, extreme mental states are understandable reactions to life events? How do we convince others that “treatment” can possibly rely upon standard psychotherapeutic principles utilized with individuals who suffer in ways that are perhaps more recognizable to others and need not be infantilizing, medical, or coercive? The notion was that we needed to welcome a wide variety of viewpoints and create in-person dialogue to promote change. Yet, there were many times that I wondered if this was not instead another instance of paying lip-service to politically correct ideas while engaging in practices that actually serve to further oppress and undermine the very ideas claiming to be made. But, as a wise man recently said to me, perhaps lip-service is where we need to begin in order to get our foot in the door and start that change happening; I believe this to be true.

I was excited to see how many people were active participants in panel discussions on the Hearing Voices Network, peer-run programs, and first-person stories from those with lived experience. During those panels that I was fortunate enough to be a part of, people were actually interested in hearing about some of the harm that comes from diagnoses and coerced treatment. They were open to discussing alternative approaches (I continue to ask, why are they ALTERNATIVE???) to working with individuals in distress. And, amazingly, many of these people were psychiatrists.

There was the phenomenal work of Anthony Morrison, who is the first researcher to empirically show that psychotherapy can be effective with individuals diagnosed with schizophrenia, even when they choose to not take psychotropics. Although many know this intuitively, the scientific community is not really interested in intuition; for him to show this repeatedly through empirical data is profound. His discussion was followed by Mary Olsen, who is working tirelessly to bring Open Dialogue to the United States. Dr. Olsen further promoted the controversial (!) idea that “treatment” should be based on the simple principle of “being with” rather than “doing to.” She further emphasized that effective therapists are those who are able to tolerate the autonomy of the client, take pleasure in the client’s growth, and do not rely on the dependency of the client to serve his or her own needs for attachment. And then there was John Read, who has changed the lives of many (including my own) with his ground-breaking research on trauma and psychosis. Some highlighted points he made were:

• “Mental illness” is significantly more prevalent in countries with greater income inequality (Wilkinson & Pickett, 2009)
• Approximately 69% of female and 60% of male inpatients had experienced either sexual or physical abuse as children (From: Models of Madness, 2nd Edition; If you have not read this book, I highly recommend it!)
• In addition to physical and sexual abuse, of those who are diagnosed “schizophrenic,” on average, 47% experienced emotional abuse, 51% experienced emotional neglect, and 41% experienced physical neglect (Read et al., 2008)
• Individuals who had experienced three types of trauma were 18 times more likely to experience psychosis than those who had not experienced abuse; Those who had experienced 5 types of trauma were 193 times more likely to experience psychosis than those not experiencing trauma (Shevlin et al., 2007)

I like to believe that the plan was to save the best for last, but sadly the last tends to be the least attended. Nonetheless, to have so many contrasting and powerful minds together in one place was a pretty radical experience.

There were intense discussions about oppressive attitudes and practices, what recovery means to different people, how “symptoms” are not the problem nor should they necessarily be the primary focus, the almost universal ignorance of trauma in adolescent and adult inpatients’ lives, and the role of clinicians in alternative approaches like HVN. Difficult topics were explored, like the powerful assertion that family dynamics of double-binds, gas-lighting, denial, dissociation, manipulation, confusion, and invalidation of the child’s experience are far more damaging than overt abuse. I think, for me, the most jaw-dropping, but completely unsurprising statistic shown was from Dr. Dangerfield, a psychologist working in a day hospital in Spain. He showed that: of adolescents admitted to a day hospital in Spain, 95% had experienced childhood adversity, including abuse, neglect, and bullying; Of those diagnosed with a psychotic disorder, only 2% were reported as having no adversity. Sadly, only 22% of these individuals had this abuse detected prior to the study. In this same analysis, it was found that 47% of those individuals whose abuse was not detected had attempted to end their lives; NONE of those whose abuse was acknowledged made a suicide attempt (Tizon, Read, & Dangerfield, 2015). The message was pretty clear: “treatment” should consist first and foremost in recognizing and acknowledging the role that trauma, society, and family dynamics play in the development of extreme states of distress, and ignoring these factors can, quite literally, be fatal.

Although there were certainly some frustrations along the way, this conference left me feeling hopeful that we just might be slowly headed in a positive direction. I do not know of a single other event where psychiatrists and other professionals would gather to discuss the “promising advances” in genetic research of “mental illness,” and people like me (and some other writers at MIA) would walk out feeling inspired and thankful to be a part of it. Of course, egalitarianism between alternative thinkers and the mainstream is far from having been realized, I do see this as a step forward. It is comfortable and validating to be in a group of homogenous thinkers and people who “get it” (whatever “it” may be to that particular individual), but tolerating the frustration and dissonance that comes from being in a group of very un-like-minded folks with a shared goal can lead to growth and creativity. Personally, I think it is important to recognize when people are actually starting to listen to the loud cries so many have been putting out there for so many years. People from all around the world gathered together, most of whom had their ears open, in one place where no one was censored, disagreement was (mostly) tolerated, and difficult dialogue did actually take place.

Of course many are stuck in their ways, and will never break out of their rigid thinking; but, one thing that became very apparent to me was that there are peers and advocates who are extremely egotistical and oppressive and there are psychiatrists who are genuinely compassionate, humble, and open-minded.  Nobody has a monopoly on doing everything right. We must not generalize and ignore those who are our allies. It seems many more people are listening than I ever would have guessed. And I am beyond excited by the prospects this fact makes possible.

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References:

Read, J., & Dillon, J. [Eds.] (2013) Models of Madness: Psychological, Social and Biological Approaches to Psychosis, Second edition. East Sussex: Routledge

Read, J., Fink, P. J., Rudegeair, T., Felitti, V., & Whitfield, C. L. (2008). Child Maltreatment and Psychosis: A Return to a Genuinely Integrated Bio-psycho-social Model. Clinical Schizophrenia & Related Psychoses, 2, 235-254.

Shevlin, M., Houston, J. E., Dorahy, M. J., & Adamson, G. (2007). Cumulative Traumas and Psychosis: An Analysis of the National Comorbidity Survey and the British Psychiatric Morbidity Survey. Schizophrenia Bulletin, doi: 10.1093/schbul/sbm069

Tizon, J. L., Read, J., & Dangerfield. (March, 2015). Childhood Neglect, Physical and Sexual Abuse, Perversion … Antecedents of Psychosis? Workshop presented at the ISPS international conference, New York.

Wilkinson, R., & Pickett, K. (2009). The Spirit Level: Why More Equal Societies Almost Always Do Better. Leadership and Policy in Schools, 11, 129-134