Metacognitive Training (MCT): A New Treatment Approach for Delusions

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I am a professor and head of the clinical neuropsychology working group in the Department of Psychiatry and Psychotherapy at the University Medical Center in Hamburg, Germany. In 2002, our group developed a metacognitive training program (meta = Greek for above/beyond, cognition = derived from Latin for thinking; thinking about thinking). The training can be downloaded at no cost via www.uke.de/mct and is available in 33 languages (for a review see Moritz et al., 20141). For me it is very important that as researchers we serve the public and should not take money for our “inventions.”

MCT is based on the theoretical foundations of the cognitive-behavioral model of psychosis, but it employs a somewhat different therapeutic approach. The program is comprised of eight modules targeting common cognitive biases (i.e., distortions in the processing of information) in psychosis/schizophrenia. These errors and biases, on their own or in combination, may culminate in the formation of false beliefs to the point of delusions (i.e., fixed false beliefs; Garety & Freeman, 20132; Savulich, Shergill, & Yiend, 20123). The sessions aim to raise participants’ awareness of these distortions and to prompt them to critically reflect on, expand upon, and change their current repertoire of problem solving. Since psychosis does not occur instantaneously and suddenly, but is often preceded by a gradual change in the appraisal of one’s cognitions and social environment (e.g., Klosterkötter, 19924), empowering metacognitive competence may act prophylactically to prevent or hinder a psychotic breakdown.

Each module starts with psychoeducational elements and “normalizing” of symptoms. Through presentation of many examples and exercises, each respective MCT topic is introduced (e.g., jumping to conclusions) and the fallibility of human cognition in general is discussed and illustrated. With regard to “normalizing,” we stress that cognitive biases and errors are normal to some degree. To illustrate, according to a study, many Americans believe that they saw Bugs Bunny while visiting Disney Land. This is extremely unlikely, however, as it is a Warner Brothers character and anyone with such a costume would likely be asked to leave by guards within minutes.

In a second step, the pathological extremes for each cognitive bias are highlighted. The participants are introduced to how exaggerations of (normal) thinking biases lead to problems in daily life and sometimes may culminate in delusions. This is illustrated by case examples of people with psychosis, and group participants are given the opportunity to share their own experiences if they feel so inclined. In this way, patients learn to detect and defuse cognitive traps. Dysfunctional coping strategies (e.g., avoidance, thought suppression) are also highlighted in this context, along with ways to replace them with more helpful strategies. In short, the training aims to provide a psychological understanding of psychosis in contrast to the still commonly held view that psychosis is a severe brain disorder, which is not amenable to psychological understanding. While we do not dispute that some patients may have brain deficits, we think that these impairments are often exaggerated5.

Among the problematic thinking styles recognized as potential contributors to the development of delusions are attributional distortions (especially one-sided attributions; module 1), a jumping to conclusions bias (modules 2 and 7), a bias against disconfirmatory evidence (module 3), problems in theory of mind (modules 4 and 6), overconfidence in memory errors (module 5), and depressive cognitive patterns (module 8).

In the last year, we added two modules on self-esteem and dealing with stigma, as a number of studies found that these are the symptoms patients suffer from the most6. Given that patients may experience shame regarding their diagnosis, among many other exercises, we discuss which individuals (e.g. family members, doctors) patients could talk with about the disorder (and which may be less recommended). The labels schizophrenia/psychosis evoke false associations in many people. We therefore provide examples of how to convey information about the disorder in a way that is understandable to people without psychosis. Again, we emphasize that the feelings and ideas of schizophrenia patients are sometimes viewed as extreme, but are often psychologically accessible and understandable. The disorder is neither trivialized nor demonized.

The modules are designed to be administered within the framework of a group intervention program. The main purpose of metacognitive training is to change the “cognitive infrastructure” of delusional ideation. In addition to the module slides, homework is given to participants at the end of each session to encourage engagement in MCT materials outside of sessions. We have now also developed an individualized treatment called MCT+, which can also be downloaded at no cost via www.uke.de/mct_plus.

With regard to research support, in the last two years, two meta-analyses about MCT have been published that show that metacognitive training decreases symptoms and delusions significantly relative to control interventions (Eichner & Berna, 20167; Liu, Tang, Hung, Tsai, & Lin, 20178). As a result, the intervention will be recommended as an evidence-based treatment in the next version of the treatment guidelines for schizophrenia in Germany. The program is not commercially funded by any pharmaceutical company or other enterprise. Rather, we depend fully on federal grants and donations for the development and dissemination of MCT materials. The concept has been adapted for other disorders, including geriatric depression (by the second author), borderline personality disorder, obsessive-compulsive disorder and bipolar disorder. Most of these versions are available at no cost in many languages here

In the course of time, MCT has been shaped by discussion with clinicians, but feedback from patients and their relatives have also had a large influence on MCT. We would be very interested in your feedback — positive and negative feedback alike is appreciated!

Show 8 footnotes

  1. Moritz, S., Andreou, C., Schneider, B. C., Wittekind, C. E., Menon, M., Balzan, R. P., & Woodward, T. S. (2014). Sowing the seeds of doubt: A narrative review on metacognitive training in schizophrenia. Clinical Psychology Review, 34(4). http://doi.org/10.1016/j.cpr.2014.04.004
  2. Garety, P. A., & Freeman, D. (2013). The past and future of delusions research: From the inexplicable to the treatable. British Journal of Psychiatry, 203(5), 327–333. http://doi.org/10.1192/bjp.bp.113.126953
  3. Savulich, G., Shergill, S., & Yiend, J. (2012). Biased cognition in psychosis. Journal of Experimental Psychopathology, 3(4), 514–536. http://doi.org/10.5127/jep.016711
  4. Klosterkötter, J. (1992). The meaning of basic symptoms for the genesis of the schizophrenic nuclear syndrome. Japanese Journal of Psychiatry and Neurology, 46(3), 609–630. http://doi.org/10.1111/j.1440-1819.1992.tb00535.x
  5. Moritz, S., Klein, J. P., Desler, T., Lill, H., Gallinat, J., & Schneider, B. C. (2017). Neurocognitive deficits in schizophrenia. Are we making mountains out of molehills? Psychological Medicine, 47(15), 2602–2612. http://doi.org/10.1017/S0033291717000939
  6. Moritz, S., Berna, F., Jaeger, S., Westermann, S., & Nagel, M. (2016). The customer is always right? Subjective target symptoms and treatment preferences in patients with psychosis. European Archives of Psychiatry and Clinical Neuroscience, pp. 1–5. http://doi.org/10.1007/s00406-016-0694-5
  7. Eichner, C., & Berna, F. (2016). Acceptance and efficacy of metacognitive training (mct) on positive symptoms and delusions in patients with schizophrenia: A meta-analysis taking into account important moderators. Schizophrenia Bulletin, 42(4), 952–962. http://doi.org/10.1093/schbul/sbv225
  8. Liu, Y.-C., Tang, C.-C., Hung, T.-T., Tsai, P.-C., & Lin, M.-F. (2017). The efficacy of metacognitive training for delusions in patients with schizophrenia: a meta-analysis of randomized controlled trials informs evidence-based practice. Worldviews on Evidence-Based Nursing.

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Steffen Moritz, PhD
Steffen Moritz is professor of clinical psychology and head of the Clinical Neuropsychology Unit at the University Medical Center Hamburg-Eppendorf (Germany). He has developed a number of self-help interventions and treatment programs for psychosis, obsessive-compulsive disorder and depression that are available at no cost via www.clinical-neuropsychology.de. He is author of over 200 research articles.

112 COMMENTS

  1. A quick yet important question, Steffen: “false beliefs” do not just mean “unusual” (read: unpopular, heterodox, heretical, non-mainstream, fringe…) beliefs for you, don’t they? I’m asking that, since I’m a bit wary of CBT-type therapies (potential) usage to enforce conformity and “respectability”, and to supress alternative and contrarian notions.

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    • Dear Vortex,
      Good question. Delusional ideas are often defined as (fixed) false beliefs but some of them are not really false (as they cannot be falsified) but indeed unusual. Thinking about it I agree that we should have written unusual beliefs (which are quite common in general population). Yours, Steffen

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  2. “Rather, we depend fully on federal grants and donations for the development and dissemination of MCT materials.”

    This article is helpful, in a sense, because it provides more evidence for the myriad ways in which tax dollars may be wasted. Psychiatry itself is a colossal delusion. It is the epitome of error, bias, false beliefs, delusions, and fixed false beliefs. Any thinking person understands that psychiatry is, as Szasz rightly understood, the science of lies. Psychiatry is a pseudo-scientific system of slavery, and no amount of fictional “therapy” can justify the atrocities that are carried out under its supposed authority.

    Unlike Bugs Bunny, the myth of mental illness leaves nothing but destruction in its wake. Fictional “diseases” such as those listed in this article (i.e. geriatric depression, borderline personality disorder, obsessive-compulsive disorder, bipolar disorder, and schizophrenia) do more harm than any fictional “cure” could ever resolve. This is not thinking about thinking. That’s what philosophy is for. This is just one more manifestation of the delusional thinking that is characteristic of psychiatry.

    Rather than attempt to treat such psychiatric delusions, I would simply recommend that people read more, and better books.

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      • Nothing against you personally Steffen. I’m sure that you’re a decent person. I’m merely pointing out that this “program” is an offense to thinking individuals. Please familiarize yourself with the history of psychiatry, including the writings of Karl Kraus and Thomas Szasz. The notion of “psychosis” is part of psychiatric myth making. “Psychosis,” like mental illness, is a myth. Danke schoen.

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        • I do not agree. Psychosis is not a myth, neither is OCD. We can debate about diagnostic labels (e.g., schizophrenia etc.) and pathologization human experiences as well as treatments but there *are* people that need help and more importantly want help and we have been able to show in a lot of well controlled empirical studies that we are able to provide this help with MCT. This has been confirmed with meta-analyses.

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          • Steffen:

            We all have beliefs not based in reality. It is purely subjective to say that some are “psychotic” and thus need “treatment/help”, while others are not. One could say that believing in “mental illnesses” is “delusional”. And how can any studies done about purely arbitrary, abstract concepts that are nothing more than value judgments with no basis in reality, be taken seriously?

            Lawrence

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          • Dear Lawrence,
            Thanks a lot.
            “We all have beliefs not based in reality.” – This is what I have already written, we all have distortions. Bad example – I know but look at my picture – I am balding but I often like to think it’s a whirl 😉 Biases/distortions are not “sick” per se and sometimes even promote mental health (large literature on unrealistic optimism etc.). However, *escalations* of certain biases (e.g., overconfidence, jumping to conclusions) can *under stress* trigger severe symptoms that may cause subjective suffering (e.g., anxiety, feelings of persecution). This is well replicated.
            It is now text book knowledge in psychiatry that most symptoms are dimensional. The healthy are not as healthy and the “psychotic” is not as non-comprehensible as our older colleagues thought. This is why Jaspers’ fourth delusion criterion was skipped!

            “some are “psychotic” and thus need “treatment/help”, while others are not”
            People do not need help because they are psychotic. I would never say that. They only need help if they suffer (many) or in the rare cases that they bring suffering to others. Seeing the ghost or hearing the voice of a beloved one who has passed away is a form of reality distortion which may even bring comfort to some.
            Ambiguity is hard to tolerate but: it all depends.

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          • Anxiety and obsessional thinking are very real. They can be very distressful as well. But “OCD” is a horribly damaging and truth obfuscating tautology to label individuals with, especially when they are already suffering and trying to understand the nature of their suffering.

            Underneath (sometimes) irrational obsessional thinking (which could superficially be a myriad of things), there is always something like a fear of losing control, or a fear of something bad happening etc., which is the primary schematic beneath such superficial thoughts.

            When those are the fundamental ideas (which even occur in varying degrees in people with no dysfunctional lives), it makes sense to simply say that, in ordinary human language, than to teach people that their “‘OCD’ is causing so-and-so behaviour”, which is the equivalent of HD (Headache Disorder) causing a headache. Yet, this is repeatedly done by mental health professionals (and even their clients), both in real-life and online.

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      • re: Slaying_the_Dragon_of_Psychiatry: “Text book knowledge in psychiatry = canonized fiction and delusion.”

        What I wanted to say is that even the (obviously at least in your opinion) “Necronomicon” (H. P. Lovecraft) of modern psychiatry acknowledges that mental health and mental illness are not dichotomous. Most problems exist on a dimension and some symptoms that decades ago had been regarded as clear signs of mental illness like voice hearing (prevalence 15-20% in the general population) or false beliefs are very common in the population. The line between need/no need for (voluntary) treatment is thin but often visible in my opinion: At some point quantity *can* lead to a new quality and that is when symptoms result in harm to oneself (e.g., suicidal thoughts, severe rumination) or other people (e.g. violent acts against relatives etc.).
        I would like to add that psychiatry/clinical psychology is less and less fixated on contents – suffering is a far more important criterion. Believing the CIA is behind you is not more or less “mad” or “sane” than believing that Jesus sits next to God or that he was born by a virgin. However, we usually treat the former because such beliefs (often – not always) come with a lot of fear and despair. Yet, also deep religious beliefs which according to public opinion are somehow “OK” *can* lead to psychiatric problems (I remember the mother of a class mate who was deeply religious and was unsure about a stomach operation; after a lot of prayers she finally chose to undergo the surgery but it failed and her somatic condition worsened which she viewed as a sign of divine punishment and was deeply depressed for some time).
        Yours, Steffen

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  3. “…attributional distortions (especially one-sided attributions; module 1), a jumping to conclusions bias (modules 2 and 7), a bias against disconfirmatory evidence (module 3), problems in theory of mind (modules 4 and 6), overconfidence in memory errors (module 5), and depressive cognitive patterns (module 8).”

    Well, this looks like it might be an EXCELLENT therapy for the PROVIDERS of “mental health care,” especially the psychiatric community. All of these except perhaps Module 8 are regularly evidenced by mainstream practitioners. “Attributional distortions” are, of course, built into the DSM diagnostic system, including the infamous “chemical imbalance” trope. “Jumping to conclusions” is facilitated by the DSM, as fitting the checklist allows one the luxury of pretending you know what’s happening in the absence of evidence. “Bias against disconfirmatory evidence” – well, that one’s kind of obvious. “Problems in theory of the mind” – again, completely obvious. “Overconfidence in memory errors” – such as Dr. Ron Pies’ confident statement that no well-informed psychiatrist would ever put the “chemical imbalance theory” forward, despite evidence he’d done so himself in the past. As for “depressive cognitive patterns,” if you changed that to “depressing cognitive patterns,” psychiatry would be 100%!

    Let’s require them to go through this before they’re allowed to talk to a client. I bet 80% would drop out of psychiatry rather than face up to the delusion on which their profession is built.

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    • Dear Mr McCrea,
      Good point. Cognitive biases are not confined to people with psychosis. We always stress this in our papers and talks. Virtually everyone has such distortions and some of these (e.g., Pollyanna effect (bias of “normal people” to remember pleasant items more accurately than unpleasant ones, unrealistic optimism and others) even seem to promote mental health.
      Jumping to conclusions and overconfidence is indeed a problem in medicine and also at times in psychology. Some of my colleagues do not take sufficient time to collect and weigh information properly. Our approach is “normalizing” – people with psychosis are not treated as aliens with weird thoughts and malfunctioning minds.

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      • Thanks for your reply. I was not referring to individuals who have distortions, but somewhat sardonically referring to the DSM diagnostic system and the mainstream’s religious adherence to it in contradiction to actual data. The idea that all or most “mental illness” is due to physiological malfunctions of the brain is completely unsupported by the data (the “low serotonin” theory of depression was debunked back in the 1980s, before Prozac even came to market), and yet is still held to be undeniably true by many in the field. It is a shared delusion, given more power by the agreement of powerful people, despite a complete lack of evidence that this belief has any connection to reality.

        So my post was intended as dark humor, as in my view, the entire psychiatric worldview is based on a mass delusion, namely that the DSM diagnostic categories represent some as yet undefined physiological malfunction, despite years of research failing to find any such malfunction for any such diagnosis. In fact, the very idea that all people meet the criteria for a particular disorder have the same problem, or even have anything wrong with them at all, is another shared delusion. Unfortunately, those who have power can safely maintain their delusions, while persecuting those whose beliefs don’t comport with the official version of what people are supposed to believe.

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        • Sorry, humor is not a great German virtue, I fear. Like you, I am also quite skeptical about biological models of mental illness (-> Neurocognitive deficits in schizophrenia. Are we making mountains out of molehills?; https://www.ncbi.nlm.nih.gov/pubmed/28485257) and some years ago we investigated the question how neuroleptics actually work, which led to the effect by defect hypothesis:
          https://www.ncbi.nlm.nih.gov/pubmed/23643756
          Yet, some patients seem to benefit from medication. Unfortunately, at least for psychosis, psychological programs are yet not sufficiently effective to provide full recovery. We still have a long way to go; funding of psychological research is a serious issue.
          Yours, Steffen

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          • Yeah, some people benefit from Jack Daniels, too. Alcohol is a great anti-anxiety agent. Doesn’t mean getting drunk is “treating” a “mental illness.”

            What do you think about the DSM/ICD classification of “mental illnesses” based on behavioral checklists?

            Ich habe einmal in Deutschland gewohnt (Freiberg i. Br.) und verstehe die Einschrankungen des Deutschen Sinn fuer Humor! (Ungluecklicherweise habe ich kein Umlaut auf mein Computer!)

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          • Your German is very good.
            checklists: not good at all. Proper assessment needs time as symptoms are often fluctuating. Especially in the first minutes many patients are extremely tense and seem more severely ill than they are. We had a case where a patient was to referred to my unit for suspected mental retardation. It turned out the poor guy had above average IQ but was so intimidated by all the staff suddenly surrounding his bed and asking him short questions and requesting even shorter answers. Also, sometimes patients do not answer honestly in such contexts for understandable reasons, they underreport symptoms for fear to be wrongly classified (e.g., an OCD patient with full insight who has the obsessive thought to stab his children might not report this because he worries that an antisocial personality is suspected, or a voice hearer does not speak about the voice for fear to be „punished“ with more medication) or else they over-report because they want to be taken seriously and get the possible treatment. So, it needs time to build a good relationship and to come to reliable assessments… I always tell our students (and future doctors) to assess and treat a patient as if it was a relative.

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          • Danke!

            Personally, I find the very process of “diagnosing” people with these largely arbitrary labels like “OCD” and “mental retardation” and “schizophrenia” to be problematic in itself. I have rarely used them except as a means of getting insurance companies to pay for their client’s needs. I find them dehumanizing.

            I agree about assessing each individual as an individual, but even the term “assessing” suggests that I’m somehow above them and able to tell the client “what is wrong” or “what to do.” My approach is more humble: I try to help the client clarify what s/he needs and what is happening to him/her without me trying to evaluate or direct them beyond simply helping them gain some perspective on what is happening. I figure that the only one who knows what’s really going on is the client. It seems your approach supports that idea, but still uses diagnostic labels. I wonder, is it possible to accomplish the same or better results with no labels or “assessment” whatsoever?

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          • Hey Steve,
            Thanks, that is why we encourage trainers to skip exercises, delete slides or insert new ones. for exmaple, some do not like the part where we explain what cognitive biases have to do with psychosis as they – like you – reject the label. That’s fine – this is not carved in Stone. MCT is not a cook book. Most trainers show this slide and then discuss with patients. Most agree, others don’t. that’s fine too. The idea is to exchange view and to validate different opinions. Agree to disagree is also Ok.
            “I figure that the only one who knows what’s really going on is the client” – I do not agree but I think that the ‘”customer is always right” (I like the German equivalent better: the customer is king). So, if a patient wants to work on self-esteem rather than on voice-hearing we should consider this preference.

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          • This is a reply to Steve McCrea – that the only one who knows what’s going on with a person is the person himself.
            You could possibly make a case for this always being true by defining “knowing” in very broad terms, but the “knowing” of a psychotic person is not the “knowing” most of us are familiar with.
            For instance, when my husband was psychotic (and please don’t shoot me down for using that word – it happens to be rather useful if not 100% accurate) he “knew” all kinds of things that may have been true in a sense if he truly was accessing the other person’s subconscious and “knew” things that they didn’t consciously know themselves. He “knew” that a whole list of people were conspiring to kill him, for instance. He “knew” that people were watching him on CCTV.
            Attempts to rationalize were hopeless, as you will know yourself if you ever interacted with someone in such a mindset. As a person on the outside looking in, it was far more easy for me to understand the roots of his fears, paranoia, beliefs etc. than it was for him – and in fact, it remains so.

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  4. Whenever I see articles mentioning CBT, I think of what psychologist, Oliver James, said in an article in the Daily Mail: “However filthy the kitchen floor of your mind, CBT soon covers it with a thin veneer of ‘positive polish’. Unfortunately, shiny services tend not to last. CBT fails to address the root cause of many people’s problems, which often stem from traumatic experiences during their childhood.”

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    • Hello Gerard,
      Thanks a lot. Early behavior therapy was indeed a bit like that. However, evidence-based CBT (so if it is conducted properly by a therapist) will address trauma, here is just one quick example that I found: https://recoveryfromschizophrenia.org/cbt-for-psychosis-trauma-psychosis-handouts/
      Our program also targets deeper emotional problems and self-esteem, especially the individualized format: http://www.uke.de/mct_plus
      yours, Steffen

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      • Hello Steffen
        Thank you for your reply. “Evidence-based CBT” has to assume that those “mental illnesses” it treats are actual disease entities (as opposed to reifications) and that is where it all falls flat for me. CBT is an extension of medical model (let’s locate the problem in the individual) thinking and therefore cannot be taken too seriously as an approach that accurately and thoroughly explains (and by implication effectively addresses) people’s distress

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        • Hello Gerard,
          Thanks. Under a certain amount of stress we all fall apart mentally. CBT – if practiced correctly – does not treat people with mental problems like a broken radio but as humans with vulnerabilities (that we all have!) and certain experiences that impact our psychological well-being. The blame is not necessarily put on the individual. But it is a big difference what developers of CBT had in mind and what is actually done by some therapists (I think it is a minority). This is also a problem with the MCT – we provide the training at no cost via the internet. Every therapist can download and I had comments of patients complaining that they had to go through a 3 hour module with their therapist!!! It is like with IKEA furniture. People just do read the manuals (where we make clear that each session should not be longer than 45-60 minutes, that humor and empathy is important and that it is not a lecture), that is why we started to provide workshops to raise compliance of therapists with the rationale of MCT, yours, Steffen

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          • I find concepts like “CBT” for children who are already going through abuse at the hands of another person to be ridiculous. It’s like teaching a child forced into prostitution how to better handle being a child prostitute than to remove him/her from that situation and doing something about the perpetrator.

            Unfortunately for children or youth in such situations, falling into the hands of the mental health professional is just as dangerous, because once the kid is labelled, the perpetrator will use the labels and also the fact that the victim is taking “psychiatric help” as an excuse to gaslight him/her further making the victim’s outwardly behaviour progressively more aberrant and seemingly “sick” which is again used as a point for even more gaslighting.

            This is one area where most of you people fail, and actually become a part of the problem and not a solution. Most mental health professionals are well intentioned and quick to want to help out the person with their whole gamut of psychological therapies or prescription drugs. They just lack insight (much like some of their patients), that they are actually a danger to such clients.

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  5. Hey all,
    First of all, I am new to this great forum. Hello everybody. Second, please excuse my writing. I am from Germany and – to quote Marc Anthony – “my English is not very good-looking” 😉 Third, I am on vacation starting Saturday. So, I won’t be able to reply posts following Friday (until May 7th) but you can reach me via email ([email protected])
    Kind regards, Steffen

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  6. Thank you very much for the modules, it was exactly what I was looking for in a psychological intervention. I did Compassion Therapy in the past but I only found it useful for a better self-esteem and dealing with others. Those modules are very useful for deconstructing delusional thoughts.
    I’m considering convincing my parents to make a small donation for your programme.

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    • Scroll down to the bottom of this page https://clinical-neuropsychology.de/metacognitive-therapy-psychosis-english/

      and you’ll find details of how you can make a donation to the programme

      ——————

      I’ve downloaded the modules to have a look. I think that the majority of people would benefit from thinking about their thinking. It is, for instance, useful to become acquainted with one’s style of thinking, and one’s biases.

      Common sense is a funny term because it is not what it says it is. Common sense is uncommon.

      The majority of people would also benefit from learning how to communicate their message briefly and succinctly. To cut to the chase. If only out of simple respect for others.

      Not having looked yet I can’t add much more. Other than anything involved in improving peoples’ ability to think and rationalise is probably for the better.

      And thanks to Mr Moritz et al for offering these resources gratis. It’s heartening to see academics and the institution put learning and self-improvement above greed and profit.

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  7. Wow -free resources that are easily accessible, easy to download, in different languages etc. Thank you for this!! I skimmed the first module and liked it very much: clear, straight forward, pragmatic presentation of information and practical homework.

    – I will try to come back with more comments after looking at it more deeply etc.

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  8. Thanks, Sa.
    We aim to provide therapists some degrees of freedom. If they do not like a particular exercise: no problem. They can just skip it because we have more material than can done in 45 minutes. We also provide a template to create new exercises. It is important that we have open and fair discussions (it is OK if patients disagree with some contents) and to share experiences.

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    • Yes the open and fair discussions seem very important …..as well as skipping if necessary. For example many people have such terrible experiences in the hospital (forced treatment etc.) that that particular example could really be a trigger and not appropriate for discussing types of factors that may or may not have influenced recovery. (e.g. wouldn’t want people to blame themselves at all for the ‘terror’ or despair in such a setting if that were the case.

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  9. Regarding “Delusions”, I know who the delusional people are. The delusional are those that call a prison a hospital. The delusional think they are helping the “ill” who are being continually drugged (medicated).
    No government or society should put people in prison BEFORE a crime has occurred.

    That psychiatry has gotten away with, and continues to get away with calling drugs “medicine” is criminal.

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      • Steffen,
        I can see that you mean well and I applaud you rolling with the many punches you’re receiving here in the comments.

        In a way, as you might tell, you’ve really poked the hornets nest with the well-meaning delivery of this study here. At the core of MIA is a wounding by authority: somebody who isn’t me says that I’m wrong to think what I’m thinking and feel what I’m feeling. That authority wields the power of the mainstream, and in some cases brings with it forced restraint, forced drugging, forced ECT, many times for the “patient” simply being in disagreement with those in authority around them (family, government, etc.). Perhaps your treatment could be of help, but I (and others here) have a hard time getting past the resistance against being told that I’m “delusional.”

        You do not like being spoken to as a “naive lackey of some kind of nazi organization.” I’m only using the comparison here because you summoned the imagery. Yes, you are naive, to not understand the history of this forum and community and to not address the issues that to me seem obvious with offering an authority-based, “correct your bad thinking” approach to treating psychosis here. And in some ways, you are a lackey, because you’re serving as an extension of an “organization” that has harmed many of us in the name of “helping.” This doesn’t make you bad, it just makes you human. Remember that you are a representative of medical authority, with your PhD and your research support and university sponsorship, and this negative feeling you’re experiencing here is an important lesson for you as you live within this role. If you want to deepen your ability to help those who have legitimate issues with the way they’ve been treated by mainstream medicine, you should sit with these feelings of pain, and reflect on what trauma would lead someone to inflict it on you. On one hand you are another human, and you must take care of yourself and your emotions and have a right to react to attack. On the other, you are the voice of power in our world, and to do right you must humble yourself and sit with the pain shared by those of us responding to you here.

        To understand and fit your work in the context of those who need it most, you must learn. Read Will Hall’s Outside Mental Health. Read Anatomy of an Epidemic by Whithaker (founder of MIA). Read some Laing, perhaps Politics of Experience. Take some other recommendations from these forum members. You’re being given an amazing Continuing Education opportunity by these commenters here- your impact in the communities you seek to help most will massively multiply if you choose to accept this course of study!

        Good luck to you and may your work help heal many.

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        • Well written knaps. Mr. Moritz, like many people in his profession, seems to be a decent person. However, while it is important to have people with good intentions work with you, those good intentions don’t remove the associated dangers.

          Going through bits of this article reminds me of the dangers of scientistic behavioural jargon, and why getting trapped in a system of well-intentioned human beings who think and operate in these ways, and label people, and the modalities of their own thinking completely removes any normalcy from an individual’s life. While they have their reasons for doing it, the public also has good reasons for wanting to avoid it. This is not just true within the institutions but also among public domains like books, the internet, published literature etc.

          In common society, we talk about love, joy, hope, success, failure, strength, weakness, comfort, adversity etc. We don’t talk about behavioural criteria, cognitive biases, mood congruence and incongruence etc. That very language, whilst being useful in some moments for some people, after a while, becomes toxic, nauseating and prevents people from turning into psychologically healthy adults who are in tandem with ordinary society.

          Mr. Moritz is probably a good human, and I applaud him for posting on here and taking some heat which may make him feel agitated. I do not want to slander him in any way. Many people from the mental health fields feel very victimised by the MIA crowd, as I see posts from them (on various mediums like blogs and comment sections), the contents of which range from absolute anger at the MIA crowd (which includes labelling the commenters here with “personality disorders”) to fear. The kind of stuff presented in the article, while it is obvious Mr. Moritz has exerted a lot of physical and mental work in creating, and it is great that he genuinely wants to help people, is not stuff that is very new to me. I have seen modules of this nature before.

          That being said, I am also terrified of anyone in any country like Mr. Moritz or his colleagues, and they have to live with the fact that there is absolutely nothing they can do, no matter how well-intentioned or noble their cause may be, to make some of us feel comfortable with them, EVER. It isn’t because they are bad or flawed. My experiences are probably nowhere near as bad as some of the posters here, but it has been enough to keep away. It is just the imbalance of power that exists, added with all the other facets of the professions.

          One being the observer, the other being the lab-rat. One being able to label, and the other on the receiving end. One who will form “well-intentioned therapeutic alliances with family members” regarding the “condition of their relative” (which from what I have seen can be a fair bit of “well-intentioned indoctrination”), which is compassionate infantilisation that will impede the person playing the role of patient from ever reaching his fullest potential. Once this happens, the person playing the role of patient can never fully trust his family again either. One who has the backing of the state, the power of the pen, the paper and the syringe, and the other who doesn’t.

          The “I do not like to be spoken to as if the naive lackey of some kind of nazi organization” line made me chuckle. However, visiting the website just shows that this organisation is just like every other well-intentioned organisation of psychiatry out there in every country. There is no initiative to stop labelling individuals. The same truth-obfuscating, scientistic behavioural jargon permeates their modality of help. It is still ripe with “personality disorders” (aka state-sanctioned medicalised defamation irrespective of the behaviour of the labelled). I also expect diagnoses of “bipolar disorder” due to mania caused by prescription drugs like stimulants and antidepressants are also made at his workplace.

          The article mentions that there are people with this thing called “schizophrenia”. I am well aware of the behaviours that are subsumed under the tautological rubric of that label.

          Now, I have met many people labelled with that label. Several of the individuals I met were people who were engineers, business graduates, had Ph.Ds etc. They were smart, rational, funny and on the whole pretty normal. Unless they would have told me about their label, I would never even have known. On, the other hand, there is the other version that most people are familiar with. The person with the dirty matted hair, speaking to things in the air etc.

          More than their problems, I applaud their resiliency in living in society playing the role of a “schizophrenic” with all the stereotypes that come with it. Mr. Moritz mentions that “the disorder is neither demonised or trivialised”. Well. You have demonised these individuals the day you labelled them as “schizophrenics”. Their suffering is enough without mental health professionals butchering them even more by labelling them in such a manner.

          Life is full of contradictions, and we are all hypocrites every now and then. They are not “bad”, and we are not “good”. I suppose if I had the circumstances where I was in a position of medical power and the head of a department of some behavioural field, I would be out there labelling individuals, putting them into categories and doing everything else that these people do. But I am where I am, and they are where they are. Snakes and mongooses. We must be vigilant of the other, and we will fight, because we must, in order to preserve our own well-being.

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          • Hi ‘wing-man’ knaps, I call you that because I sort of thought about getting a link to that specific article on this thread but hestitated because I also start to feel sort of “I hope Steffen will not be overwhelmed by all that strong headwind”.

            Steffen, we need you keep on your feet because “Last man standing” is no fun if there is a severe power imbalance, ok? Thus I think it’s good that you are on holiday and hopefully come back in real good shape, ready to take it on with this insubordinate MIA crowd…

            About that article about authority, having seen the current dynamics in Academia where everyone fights for research money and publishing papers is a constant must, I can understand why there are so little challenging new thoughts coming through. Especially in psychology, I get the feeling that psychologists are so very much afraid to do some straight talking and therefore they hide behind these annoying phrases that registeredforthissite described. They are afraid of raw emotions and so very much try to stay objective and neutral, but hey, this is simply impossible because what more subjective thing is there than human perception? To me it feels like psychologists sort of try to stay out of the dirty waters while trying to analyse them, but you can never understand what you haven’t grasp fully yourself. There needs to be a re-strengthening of “experimental psychology” where scientists go and immerse themselves in certain experiments and then record their SUBJECTIVE reaction. I find it so very funny that especially scientists from the so-called “soft” sciences interpret statistics the way like it would somehow translate to “normal” and further to “real”… In most hard sciences outliers are the most interesting thing to receive an understanding because in the extremes you can see the process behind because of its nature of being an extreme version. See, when there is no contrast nothing can be observed (Have you ever looked at white circles painted on a white sheet of paper? Must have been an interesting experience full of new insights I reckon.). By only ever trying to define the ‘normal’ thing you destroy contrast and you end up with white noise where everything evens out to a constant signal and nothing can be distinguished anymore.

            In my opinion, Psychology so much needs the courage to allow for subjectiveness and see itself not as a judging authority, not even a sort of referee, but merely as a consultant, something like a technical advisor who points out the functioning and the consequences that each possible behaviour or cognitive STRATEGY (nb: not fallacy) has. Thus I think, to be utterly politically uncorrect, Psychology is in deep need of masculine rational and technical thinking combined with a masculine way of emphathy which in my experience is so very refreshing. To explain what I mean I again have to tell a personal story and I hope I do not annoy too many people who are reading this. I never planned to be that open on this board but well, maybe it is of some help, I go by my gut feeling. My father had dementia and died two years ago in a retirement home because we couldn’t keep caring for him on our home. Before, he also came into contact with psychiatry because that’s how they assess his mental abilities. I found it extremely cruel how they made him aware of his fallacies like the test where they ask him to name the date and read the time on a clock. Things he couldn’t do any longer and you see, my father was an exceptional analytical thinker, a chess player and strategist, and for him to experience not being able to read the clock correctly was unbelievable distressing. I will never forget the look in his eyes because he still did understand what was happening, he did consciously experience his slow declining mental abilities and how it is to become weaker and weaker and less able to defend himself. And the treatment that many well-meaning nurses subjected him to, sadly, often felt like they were assessing a child. But interestingly the male nurses in most cases had a different approach. They still treated him along the lines of a silverback gorilla (he actually had a lot of grey hair on his back) who just simply needed help in certain aspects of his daily life. And that was so soothing for him…

            So I would be very interested in the new modern male viewpoint of Psychology, how would you guys assess it without being like the patriarchal fathers of this field but also not just replicating the female views that probably your mothers implanted in your heads (they did so for a good reason, because you were young and still boys and please don’t forget, no mother is responsible for her son to become an adult male, she only needs to let go but he has to find his place in this world, as I reckon that is a very masculine thing to do… but I could be wrong, I don’t know)?

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  10. Hi Steffen,

    My wife has d.i.d. I’ve been walking thru the healing journey with her using a lot of attachment theory concepts to help her work thru the trauma and undo the dissociation. So that is the lens I see things thru.

    I know you briefly addressed another person’s question about trauma. How does your group understand the practical effects of dissociation? If I wanted, I could try to list the 8 ‘alters’ in my wife’s system, and explain how each girl’s cognitive biases, distortions, delusions, etc are a direct result of dissociation and the resultant fact that each only controls a portion of the mental faculties of a non-dissociated person. It wasn’t until I helped heal the underlying trauma which then gave me access to connect the girls internally that those distortions, bias and delusions were foundationally altered.

    There are still 3 holdouts in my wife’s system, and so those 3 girls (alters) tend to default to their unique distortions even though I have them superficially connected to the others in the system…but until I can remove the internal barriers via a restructuring of their internal working model, I understand that any progress they make externally is limited though moving toward permanency.

    I know that’s an extremely simple explanation of what has occurred over the last 10 years that she and I have walked this journey together…so I will just summarize saying, unless you address the underlying dissociation that is likely at the base of much of what you are seeing in the distortions, delusions, etc, I’m afraid your therapy ‘may’ be temporary.
    I wish you well,
    Sam

    Note: maybe I should add that some people like to differentiate d.i.d. from schizophrenia by saying the voices are internal versus external, but I have to wonder about that arbitrary delineation. When my wife first started hearing the ‘voices’ she thought they were external, too. She called them aliens. But I redirected her by gently insisting they HAD to be internal and thus part of her ‘system’. It took her a few years to fully embrace the other girls, alters if you prefer, but now she recognizes them as part of her internal mental system.

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  11. Welcome to MiA, Steffen. Absolutely I believe it’s important to end the mass drugging of people with the psychiatric drugs, since the antidepressants and ADHD drugs can create the “bipolar” symptoms, and millions of Americans, including many children, have had the common adverse effects of these drug classes misdiagnosed as “bipolar.” And the “bipolar” and “schizophrenia” drugs, including the antidepressants and/or antipsychotics, can create both the negative and positive symptoms of “schizophrenia,” via NIDS and antidepressant and/or antipsychotic induced anticholinergic toxidrome.

    https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome
    https://en.wikipedia.org/wiki/Toxidrome

    But the American “mental health workers” do not know their drugs actually cause the symptoms of their theorized DSM disorders, including antidepressant and/or antipsychotic induced “psychosis,” because the above listed, medically known, syndromes are not billable DSM disorders.

    Plus, the American “mental health workers” only label people with disorders that allow them to bill insurance companies, so they may be paid. And since child abuse is classified in the DSM as a “V Code,” and the “V Codes” are not billable disorders, millions of child abuse victims have been mislabeled with the other, billable DSM disorders.

    https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

    Over 80% of Americans labeled as “depressed,” “anxious,” “bipolar,” or “schizophrenic” in the US today are actually child abuse victims. Over 90% of those labeled as “borderline” today are child abuse victims.

    https://www.madinamerica.com/2016/04/heal-for-life/

    The problem with this is that the psychiatric drugs do not cure crime victims of their legitimate distress. And the American “mental health professionals” have been utilizing the psychiatric drugs to silence child abuse victims on a massive scale, as well as silence their legitimately concerned parents. Today’s American “mental health industry” is actually a multibillion dollar, primarily child abuse covering up, industry – according to their own medical literature.

    I was just listening to this, which implied talk therapy may not be a viable solution for the vast majority of DSM labeled child abuse victims.

    https://www.madinamerica.com/2018/03/trauma-memory-mental-health/

    Although, absolutely, talk therapy would be infinitely better for the millions of child abuse victims who were mislabeled with the billable DSM disorders, than what is currently going on. Which is that the American psychiatrists are turning millions of child abuse victims into the “mentally ill” with the psychiatric drugs.

    Rumor on the internet is America, and all of Western civilization, was taken over by “satanic pedophiles” long ago. Those of us whose children were harmed by such satanists, know this problem is real.

    http://www.social-consciousness.com/2017/07/putin-west-controlled-by-satanic-pedophiles.html

    I’m quite certain America needs to start arresting the “satanic pedophiles” some day, if our society is to survive and thrive. Rumor is Trump is aware of these problems, plus apparently related worse problems, like child and human trafficking. When countries have multibillion dollar, primarily pedophilia covering up industries, these industries, of course, are also functioning to aid, abet, and empower the pedophiles.

    Today’s psychiatric and psychological industries need to change the DSM billing code “bible,” so that your industries may be able to bill insurance companies for actually helping child abuse victims, rather than continuing to just misdiagnose and poison child abuse victims en mass. And the psychological and psychiatric industries need to come up with ways to actually help child abuse victims. Justice and arresting the pedophiles would, of course, be the best solution. But that’s not happening in our current world yet.

    I found love, empathy, truth, and self esteem building (plus, of course, keeping the “mental health professionals” away from my child) worked to help my abused child go from remedial reading in first grade (after the abuse) to graduating Phi Beta Kappa (with highest honors), including also winning a psychology award, from university. DSM stigmatizing and psychiatric drugging child abuse victims, as today’s “mental health professionals” are doing, will never result in helping child abuse victims. It harms them. If we don’t discuss our society’s systemic societal problems, we can’t fix them.

    I will mention one more thing, anticholinergic toxidrome induced “psychosis” does not tend to be “delusional.” To the contrary, when I was being poisoned with the psych drugs, resulting in anticholinergic toxidrome induced “psychosis.” I heard the “voices” of the molesters of my child in my head, bragging about abusing my child. I was told to ignore the “voices,” so I did.

    But once I’d been weaned off the psych drugs, and the medical evidence of the abuse of my child was handed over by some decent and disgusted nurses, I was almost relieved to learn that I had been right to have concern of the abuse of my child after all. Despite that reality being a disgusting reality (my son was doing much better at this point, thankfully). And we quickly ran away from one of the abusers, who I had not realized was likely one of the abusers, because he was a pastor. At that time I had no clue child molesters run in rings, share their victims, and all sorts of even more disgusting stuff.

    People can’t heal from trauma, without truthfully addressing reality. Forcing people to live in denial or make believing trauma induced distress or concerns are some sort of made up “life long, incurable, genetic” DSM disorder, which is what today’s “mental health professionals” are expecting people to do, will never cure a trauma survivor.

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    • …oops, I only read half your post, sorry. I work in Germany in a psychiatric hospital and we strictly adhere to treatment guidelines but the hospital has a troubled past. We looked at old medical records and found that until the 1970s many patients received “insulin coma therapy”. It is sad and almost unbelievable because safer treatments were already available.
      But: Psychiatrists have become more and more critical about medication and are aware of their side-effects. We had some “sputnik shocks” – just to name a few: the meta-analysis by Leucht showing that antipsychotics only have medium effect size, data by Andreasen (then Editor of American Journal of Psychiatry) that antipsychotics can harm brain metabolism, Kirsch’s meta-analysis on antidpressants etc. Please read Moncrieff’s blog, she has done great work.
      If a patient chooses not to take drugs this is usually tolerated and for some disorders like OCD and depression they are often the only treatment. Medication are only given in rare incidences against the will of a patient if his or her life is in danger (acute suicidality). No one is drugged anymore to silence him/her – I can say that at least for my hospital.
      In Germany psychotherapy is the first-line treatment. I will be part of the expert group working on the renewal of the German treatment guidelines for OCD (this diagnosis exists; OCD symptoms are extremely common, see http://www.uke.de/myMCT, but when they rise to a certain degree they can become a huge and disabling problem that needs treatment) and I am pretty sure that the old text will be essentially confirmed stating that cognitive behavioral therapy with response prevention should be sought first. Antidepressants might be considered but only when psychotherapy is not effective. Antipsychotics agents should not be given at all if OCD is mono-symptomatic.

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  12. “When my wife first started hearing the ‘voices’ she thought they were external, too. She called them aliens. But I redirected her by gently insisting they HAD to be internal and thus part of her ‘system’. It took her a few years to fully embrace the other girls, alters if you prefer, but now she recognizes them as part of her internal mental system.”
    Thanks for sharing. This is wonderful. In the MCT+, in one of the modules we convey techniques of compassionate mind (our approach is eclectic, we combine a lot of techniques from different therapeutic “schools” because there is no one route to recovery) and try to gently connect the “voices” to prior experiences with personal demons etc. In many voice hearers the voices are quite congruent with/or exaggerations of what significant others once said to them. In fact, we published three papers were we found that depressed patients and those with OCD to some degree also have vivid and acoustic ruminations and obsessive thoughts. Voice-like thoughts are quite common

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    • Steffen,
      I do appreciate your kind reply, but I would love to hear your understanding, if any, of how dissociation effects and complicates the healing process. For my wife, the dissociation has been much harder for us to undo than the actual trauma.
      Yours,
      Sam

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  13. I looked through some of your modules and I believe the program is suffering from the same problem as many others cognitive therapies (CBT, ACT, DBT) – the text is always something like a workbook with assumption of targeting retarded people. It’s difficult to read. For me it’s incredibly difficult to stay focused on such material.

    I’d like to compare it to Daniel Kahnemann’s work Thinking Fast and Slow, this book is CBT-like, it touches the subject of cognitive biases, but it is also an interesting book and an interesting experience, you could immerse in it. And it is highly therapeutic too. I would put ‘Narrative CBT for Psychosis’ somewhere in between your work and Kahnemann.

    I hope someone in the future would write a CBT-book with central idea and a lot of anecdotes and vignettes illustrating the point so you would be basically reading something resembling good fiction.

    So to summarize: my major criticism is in the are of digesting this kind of information. If it sound too critical – please also note that I’m Russian and it may come from my lack of knowledge of the language.

    As someone who have suffered from psychosis (I’d be among the continuum of psychotic bipolar – schizoaffective) I would confirm your idea that delusional beliefs come from snowballing of cognitive errors (partly reinforced by the speedup of thinking and affect). And a typical paranoid is definitely jumping to conclusions all the time.

    Nevertheless, I really like what you and your team doing. CBT is the only thing that you can sell to mainstream mental health now and it is working so more CBT means not only better overall mental health and higher life satisfaction, but also less medications. Less medications means less diabetes and heart disease.

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  14. Dear Igor,
    Thanks for your comment; I will discuss the recommendations with my team. The MCT is a low-threshold approach necessitating little therapeutic skills so it can also be administered by nurses, psychological students etc. with little training. Why? Too complicated training approaches (or those that require expensive and long curricula) often do not make it into the psychiatric “DNA”/infrastructure. They die in beauty (expression? – again, I am not drunk, stupid or anything – English is just not my native tongue). The modules are quite structured and I agree there is a lot of text but trainers are advised not to read the text but to use these as notes and to find their own language. Humor and empathy is key. It is like a discovery. There have been quite a lot of studies from my group and others on effectiveness (delusions, positve symptoms) but also acceptance/appraisal and around 80-85% of participants say they like the training and have fun (we always make an anonymous poll at the end where patients assess us and give marks on how they liked the particular module and the performance of the trainer, just like in a regular hotel) because we try to explain (well we struggle) how positive symptoms come about and that the cognitive apparatus from people with psychosis is not that different from “normal” people. It is about escalations of regular biases that under stress and with some past trouble can create the storms of psychosis (again, not all psychotic symptoms need to be treated, in some cases a reality distortion can be functional). However, I am not a fan of “Kumpel Psychiatrie” (the term buddy psychiatry comes perhaps closest) that claims that all people are psychotic, psychiatry is psychotic etc.
    Russia: We have a Russian translation, not sure how good it is.
    Thanks, Igor, really appreciate your tone. I have learnt a lot by patients and some of the contents of MCT where directly inspired by what patients said or suggested for improvement.

    Yours, Steffen

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  15. Dear Dr Steffen,

    In the “Power of the Now” Eckhart Tolle says that spirituality can be developed organically.

    A German psychologist assured me in the 1980s that all “patients” could make full recovery with the help of “psychotherapy”. I am very happy to hear about your own developments.

    I have to admit that I didn’t study your papers. But I can refer to my own experience of “psychotherapy” in dealing with the problems I experienced when I withdrew from my longterm neuroleptic injection.

    I suffered with what Robert Whitaker describes as Neuroleptic Withdrawal “High Anxiety”. If I hadn’t found a (“CBT”) way of coping with this, I would have gone Mad.

    Eckhart Tolle wasn’t around at that time but I did find it possible to recover organically in the longterm.

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    • Thank you Dr Stefan,

      I made Full Longterm Recovery through “psychotherapeutic” means, which could equally be described as “Buddhist Practice”.

      (I never cost anything again, and I was non the worse for this).

      “Handwerker hatte golden boden”

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  16. To all of you
    It has been wonderful to exchange views with you in the last days, although it sometimes felt like in the last minutes of the movie “Last man standing”. Again, sorry for the English. I will be on vacation for the next two weeks and while my wife’s “security system” is not perfect (I will be able to respond emails) she will definitely not let me access the computer. Happy to talk to you after May 7th.
    I just would like to assure you that there are a lot of good, warm-hearted and dedicated people working in psychiatry and we need your support and encouragement to grow and to “hold the fort”. A lot of you have experienced bad things in “my institution” but don’t generalize and please do not blame the researchers/clinicians like me who talk to you and are open to change (again, the MCT was developed in close exchange with “you” – there is so much wisdom in many patients and their relatives and we can only improve tratments if the “experts by profession” and the “experts by experience” collaborate). No need to feel compassionate with me or others but sometimes it feels like a two-front war as a psychologist – you have *some* (not all, not even most!) biological researchers and the ”big industry” against you and then you have the antipsychiatric movement that at times (again not all!) treats you like the lackey of a post-nazi organization (already said that before). As I said, in my hospital and many others “we are proud to serve” so to speak and if a patient does not want medication that is fine and in many cases medication is not even offered because guidelines endorse psychotherapy.
    I have re-read this twice and I regrret that I may sound like a false priest (e.g., Robert Mitchum in The Night of the Hunter, my favorite Scene: https://www.bing.com/videos/search?q=love+hate+rovert+mitchum+night+of+the+hiunter&view=detail&mid=1C3A5342E2E145AD72EB1C3A5342E2E145AD72EB&FORM=VIRE). Sorry for that…
    Alle Gute für Euch, Gruß, Euer Steffen
    (translate with deepl.com of you want)

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  17. “We all have beliefs not based in reality.”

    I would revise this to

    “we all frame our experience in our core definitions and beliefs many of which are acquired by reaction as if something is true of us (in relation to any given situation) – that is not true.”

    This then operates dissociation because a relational communication operates through the filters of self-reinforcing or self-protective belief that are invisible to the perceiver. And in any mutuality of ‘reality reinforcement’ a socially conforming narrative reality operates as if consensually self evident, and as a suppressive defence against other perspectives that are felt dissonant to the self-inflation or power of protection. I often use this for illuminating the directed narrative of social reality:
    “No one understood better than Stalin that the true object of propaganda is neither to convince nor even to persuade, but to produce a uniform pattern of public utterance in which the first trace of unorthodox thought immediately reveals itself as a jarring dissonance.” ~ Alan Bullock, in Hitler and Stalin: Parallel Lives
    But this political manipulation is only a derivative of intrapersonal ‘narrative control.
    Adaptation to, and participation in a (human) world based on dissociative subjection is both an incredible learning feat and a terribly displaced or denied sense of being. The consensus reality is that the world is ‘real’ and we are a product of it, subject to it and die in it. But these conditionings are the result of both personal and collective separation trauma… denied, dissociated from and normalised.I might add that the psychic defence of a split off sense of self, inhibits both the fearful and the awe inspiring – as both are threatening to the ‘control’ that is central to the survival sense of a cut off, frail, isolated self in need of the power and shield of defences against ‘chaos’.

    This ‘wrote itself’ through me in response to the first quoted sentence.

    As for your article – I found it framed in technical speak – which may be appropriate to the rules and permissions of your working environment – but feel completely dissociated to me – though I have no doubt there is a relationship of shared purpose with those who come to you for help, that is the condition in which reintegrative perspectives find recognition and acceptance.
    Re-cognition is a matching resonance of felt knowing – and so-called knowledge is generally as dissociated from being as financial currency instruments are dissociated from true commonwealth – and ‘ruled’ by a similar priesthood of definition, prediction and control.
    About four decades ago – or many lifetimes – my ‘world’ was undone to psychotic experience. I chose to accept I had awoken prematurely and without inner preparation to a ‘crash course’ in learning to live a different self-world. Terrifying and disabling – yet alive in a way that was true prior to belief and in which belief had to become conscious – along with the trauma or denials associated with its protective gesture.
    True knowing cannot be formulated, systemized or defined – and so some choose to assert there is no truth – and develop systems of control around conflicted ‘truths’ that actually embody the chaos they presume to control because the shadow is dis-owned and projected. But in a truly felt and honoured relationship, any modality or system may either serve a genuine mutual need, or be suspended for the acceptance of the law of the heart’s recognition and alignment in true need.
    If you read me, thankyou for your attention. I was not seeking responses so much as extending a witness into a shared consideration. Having shared somethiing of myself with you – I open a relational channel – in which I may reread your article with more of a sense of your movement of desire in healing purpose.
    Being with what is, allows movement and change. And a true acceptance of being with our own thought and emotional results, likewise allows movement and change. I see I am emphasising ‘being with’ as both an inner self-honesty as extension of worth. We may only ‘stand at the door and knock’ if we would meet in freedom. Different roles do not define being – unless losing identity to them.

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  18. Okay so last night I had a read-through of the slides and, all in all, I expect some people would find them very helpful or at the very least, thought-provoking.

    For someone like me they wouldn’t be of any use. I already know how to think. I am already a rational person. I know about attributional biases and expectancy effects and the many ways the mind can play its tricks. I know about the value of not jumping the gun and so on. I know that feelings are not always facts. I know that suspecting something isn’t always knowing something.

    Many of these techniques might well help people to navigate psychosis without recourse to drugging.

    But often, people with psychosis, particularly those labelled schizophrenic, are unbudgeable magical thinkers. I’ve tried a few times in life to try and help magical thinkers move away from their childish thinking styles, but to no avail. In many ways it’s cruel to keep pushing them. To keep telling them they are getting it all wrong. It’s like dressing a small child in business attire and expecting them to become successful CEOs.

    And what I have also learnt is that while it is no doubt a good thing to be a rational sceptic it does not prevent one lapsing into psychotic experiences. What it does, it would seem, is prevent one from becoming totally overtaken by them.

    In recent times I used some quite nifty and cunning techniques to make real the fact that I had been under surveillance by the mental health services under new UK surveillance laws. One aspect of these laws is that it is now unlawful for anyone to confirm or deny to someone else that they have been, are being, or are going to be, put under intrusive covert or overt surveillance.

    So I figured out a number of ways to get people to tell me without explicitly telling me.

    And one by one they betrayed themselves.

    While this was going on a few attempts were made to CBT my mind out of the (correct) suspicion that I was under intrusive surveillance. In other words, the CBT techniques were weaponised. Suffice to say I had wised up on these techniques too and was able to counter them.

    Interestingly it was recently announced that much of the intrusive surveillance that has been going on rampantly in this country by various agencies has been predominantly unlawful.

    All correspondence relating to the unlawful intrusive surveillance of me has so far been ignored.

    As a european survivor of cage-beds said: You become the animal they see.

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    • Rasselas,

      I think the UK Mental Health System operates at a level of criminality rather than unlawfully.

      But if they wanted to put the “loony on to you” they would then have to pay “loony money to you at a high rate” and since the system is falling apart anyway it wouldn’t make goid sense.

      My feeling is that most “violence” committed by “mentally ill” people in the UK is motivated by psychiatric drug treatments. Other than this the “mentally ill” are very very peaceful.

      At the moment the UK is more or less admitting that they’ve long term disabled about 1% of the population with the SSRIs and driven them into Severe Mental Illness.

      So, “Mental Illness” in the UK is a bit of a misnomer.

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      • Make no bones about it, I’m a bone fide looney. My very own version of it, of course. A class above the average lunatic (same as everyone else thinks). But utterly barmpot all the same.

        To paraphrase Charles Bukowski, it’s not that I don’t like people — I really do like people — it’s just that more often than not I find them disgusting, am disgusted by them, and so, for the most part, give them a wide berth. Add in an often intense self-disgust and what you end up with is a discontented hermit that prefers the company of the wind, and the sagacity of ants and other insects. And yet yearns deeply for connection.

        I am nearly at the age I never expected to reach. The age in which I long-imagined I could finally be myself and not have to put on any futile or disgusting act or pretension. And get away with it.

        But that’s all much of a muchness again.

        Some people characterise this age as the Age of Surveillance Capitalism. Less loftily, I prefer my own coinage: it’s The Age of the Creep.

        As soon as I leave home I am being recorded. In my home I am being recorded. Every micro-move is recorded.

        If ever I dreamed of overcoming selfconsciousness, it’s never going to happen in this life. The best solution I have found is the mountain-top. But there are limitations, obvious natural limitations. And it’s never too long until some vacuous git with a cameraphone appears…

        The mental health system in my area have embraced their new powers of surveillance with relish. It’s taken me a number of years to get to grips with the fullness of what is going on.

        I’m not sure if I was discharged because I finally called foul on all this, and it was making things awkward, or if, instead, it is simpler to just use all the powers of surveillance to keep tabs. Most likely the latter. So-called severely mentally ill people do not get discharged. All that paperwork is smoke and mirrors. If you are discharged with that SMI status rest assured that you have been successfully incorporated into a sophisticated surevillance apparatus. Which is also not passive. What I mean by that is, as the years go by, the surveillance system is taking on a life of its own, and moving into the area of behavioural control and influence. You might think you are living your own life. It takes some time to work out that you aren’t, and never will.

        And on that dubious-sounding note, I’ll bow out.

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        • I’m glad you have only suffered the one catastrophe. I think, in all fairness (in a universe that doesn’t give a flying ‘ow’s-yer-father for fairness) that’s more than enough for one life. I’ve tried counting my own catastrophes — I don’t know why I subject myself to this armchair interrogation, as it ends up excruciating — and the count just won’t happen. They blur into one another, overlap. A bundle of old wires, all tangled up and knotted, and no way of knowing which ends combine. Each and every time I think I’ve unknotted myself and am running now on a nice, contented, thread, it’s only a matter of time until I come to see that I had it all wrong, and it’s just as tangled up and messy as it ever was.

          I don’t know why people detest the modern therapies. I appreciate some people need to get a lot off their chest about their past. There is definitely a human need for the confessional. But once you’ve spilt the beans it’s a matter of now what? And I think it brings people to the same place as those who cannot attest to significant trauma in their life. And that is a place of, how has the past affected my ability to rationalise, to be healthily sceptical, and to balance out how I see the world with how I see myself.

          We all have at least a little bit of magical thinking in us. If we didn’t I doubt we’d ever fall in love or be moved by the poetry of nature. It becomes a problem when the magical thinking goes too far. I won’t burden you with where I personally draw the line. And most people draw the line somewhere or other. In short, people prone to excessive magical thinking are pretty much refusing to draw any line at all. And until they do, they are truly up the old creek in some way or other. Unless they join or form some kind of cult. In which case, their toxic refusal of rationality will follow its course. Which, if history teaches us anything, leads a whole bunch of halfwits into deplorable decadence of one kind of another.

          Still, there’s a lot of fun to be had down at the bingo hall. Don’t forget the lucky pen and lucky mascot…

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    • rasselus redux: “But often, people with psychosis, particularly those labelled schizophrenic, are unbudgeable magical thinkers. ”

      Story time.

      Once, she came to believe she was pregnant. Less than a week later, she came to believe that she had miscarried. There was no proof of either. When confronted with the possibility that this was symbolic, she insisted that she had lost a baby and now she must grieve. It may be possible that the belief helped her grieve whatever it was representing – the loss of innocence, trust, fear of betrayal – whatever it was. But there was no way she was going to see that pregnancy as a symbol of anything other than a literal lost baby.

      Once, he was told that he needed to strip naked and swim in the ocean. When I suggested that this might be a symbol for being vulnerable in relationships and exploring his emotions – nope. It was a literal command. He got arrested for stripping naked at a public place and swimming in the ocean. (He was on a “Community Treatment Order” at the time, so this didn’t go well.)

      There are example after example of these sorts of beliefs – many of which are not harmful until you get “caught.” My goal with my friends is to help them to “not get caught.” Waving a giant flag in a public place, standing on a box and preaching, stripping naked in a shopping mall, or hiding in the shelves of the grocery – are ways to “get caught.”

      Once you are caught you surrender all control of your life. The police come, the ambulance comes, you are shot up with something and taken away in a very involuntary fashion.

      As for surveillance, I am stunned at how readily people under age 30 just forfeit their privacy, and – as a 50-something, how challenging it is to maintain my privacy while trying to function in the world. Apps & devices know everything about the users, more and more all the time.

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  19. Steffen, to me it seems like you are operating in a kind of ‘dogooder’s bubble’. I get that you genuinely try to help people who experience(d) psychosis but I see a lot of subtle problems with your so very ‘kind’ approach. You fully target the reasoning power of the mind by attempting to support people in handling day-by-day situations with common sense. Indeed, the level is very basic, at times it feels very much like being back in kindergarden. It’s the very structuring that gives a feeling of being taught instead of being understood and assisted in finding an individual coping strategy. You show pictures and use them to point out cognitive bias. This is fine for everyday situations but how does it help with severe issues or traumatic experiences?

    See, as I understand it, you still adhere to the illness model. You see it as a sort of ‘vulnerability’ that some people carry which is triggered by certain life stressors and so on. Irrespective of whether that is true or not and despite you, being the kind and jolly good person as you prefer to come across, stressing that this shouldn’t be seen as a weakness at all – hey, even great artists and other famous (often very creative) people have/had ‘it’ – the way you interpret mental illness is not so much different to the bio-bio-bio worldview alltogether. You believe in different sets of people which are determined by their genetics, their temper, and their childhood upbringing – by reaching adulthood their brain has formed and certain behavioural and cognitive patterns have been developed. One set of people are prone to develop psychiatric disorders when facing difficult but nevertheless everyday life situations like broken hearts, job loss, failed exams, death of a loved one, etc. The second set of people do suffer facing such situations but because they do not carry this alluded vulnerability they can mostly cope without help or self-assess when they need help and arrange for it accordingly and soon are able to carry on with their life.

    As your group designed the material such that it addresses certain cognitive biases that have been observed being exaggerated in people who ‘have’ psychosis or schizowhatever, I believe you somehow concluded that people of category ‘vulnerable’ have a certain wiring in their brain that makes them vulnerable to interpret many day-to-day situations dangerably wrong which is giving them so much stress that finally they overreact and freak out or draw back and lie in bed all day or go looking for the final relief of all. But because modern-day science has already advanced so far that it acknowledges that the brain does have the lifelong ability to learn and adapt, you do not fully support the bio-bio-bio chronical disease bit but heroically offer psychoeducation to help set ‘vulnerable’ to understand their vulnerable cognitive patterns and learn new strategies, ‘normal’ strategies, to correct their thinking and avoid further mental illness.

    Of course at the same time you argue that in theory ‘everyone’ can develop a mental illness. Maybe you see it the way that there can be a kind of temporal vulnerability (??) maybe related to having slept little or malnutrition that messes with cognitive brain patterns by temporally disrupting certain pathways but I rather think you mean it the way that a more robust person would need to face larger amounts of stressors to develop symptoms of mental illness and maybe they would more easily recover because of their inherent more robust nature.

    Could you see yourself becoming mentally ill? Severely depressed maybe, suicidal? Or, god behold, straight out manic, jumping out of your bathtube in excitement and running through the rain to the bar full of happiness but stark naked. You seem to be quite a reasonable person thus mania would probably free all your deep cravings to finally just let it all hang out for one day.

    I ask you these questions because to me it seems that you try to be nice to patients – or, to be polite and respectfull, lets call them clients – but you still draw a visible line between yourself and ‘them’… also because you don’t like ‘buddy psychiatry’ and I reckon you fear that if psychosis or mental illness symptoms in general are seen as something ‘normal’ clients would be left alone and deteriorate and senselessly suffer run-down and unkempt in some street’s corner and finally die tragically, having been a burden to their family and to society while alive and still giving them a bad feeling of not quite fathomable guilt posthumously. Instead if clients would just understand their natural vulnerability to certain cognitive biases, they could address this condition and maybe with the right cognitive strategies to interpret social situations ‘correctly’, avoiding stressors, adhering to a healthy lifestyle, not too much aspirations in life (getting to know their ‘healthy’ boundaries and limitations because of their ‘vulnerability’) and in some cases a little bit of drugging to restrict the most rebellious ones by inhibiting their pathways to their bothersome wild emotions and higher brain-personal weirdness (i. e. making them just a little impaired), these clients could lead a near-to-normal ‘functioning’ life due to the right management of their condition.

    Steffen, like someone said above I also think you are a decent guy and it’s great that you have made it to this website and are interested in alternative views and the opinion of your patients. I believe everything you claimed in your blog, your whole intention of helping people. That’s why I would very much love to open your eyes to some subtle but very important things that people labeled as mentally ill or even only having a disorder of some sort face. One of these things is severe devaluation and degradation and this is also felt when being confronted with your approach. From your comments I got the feeling that you cannot quite understand why (former) patients speak of being in ‘prison’ or having been ‘tortured’ or their lives have been destroyed and they got further traumatized. You even tackle this views in some of your material, where you address ‘perceived threats or insults’ due to the cognitive bias of the patient where they assess certain behaviour and certain comments from the medical personnel wrongly or exaggerated’. You also state that the situation in German hospitals is certainly different and there is rarely any forced medication there. I think you must be very blind. And being blind to injustice and outright abuse especially if it is done in the name of righteousness is very dangerous as you should know from history. I am not so far away from Germany and I know about the situation. Yes, psychotherapy is on the rise as is mindfullness techniques and awareness of medication side-effects. But as I tried to outline above, it is still the same line of thinking, just hidden under more socially accepted methods and a softer, reasoning shell. People rarely ‘heal’, instead they get by as second class citizens with an ‘ok’ life – if they are lucky. I will address this issue in my second post following below.

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  20. Following my comment above, I first want to tell you that I can see why patients do respond positively to your approach.

    From my own stays in hospitals I know that many patients come from a background where they have never been taught certain coping streategies to handle their emotions or more difficult social situations like human dispute. First, there is just way more opportunity to accumulate pain (trauma) when you are born into less favourable conditions meaning that it is more likely to experience stressors and therefore end up with some sort of disorder or mental illness symptoms, second, if you have been identified as mentally ill from a young age, in many cases you were not expected to be able to acquire such skills or you simply could not do it because you were zombified by drugs. Therefore, of course you feel some sort of validation of your experience and you are given an explanation and some power and hope for a better future. Additionally, most people will benefit being educated about ‘the fallibility of human cognition in general’ and will feel some sort of release if they are told that everybody experiences these biases. That’s all fine and that’s certainly not what I am criticising.

    Steffen, I would like to open your eyes to ‘learned helplessness’ and the very root of many of these issues you are trying to address through adjustment of the reasoning
    mind. You seem to be fully convinced that the exaggerated biases are an intrinsic part of the patient’s cognition. After all, that is the reason why they are your patients and why they have been given their respective disorder or mentall illness label, right? And exactly there lies your bias from my point of view. I know about the condition of mental illness from my own experience. I have lived experience of mania, full-blown psychosis and medication-induced anxiety as well as medication-induced depression including suicidal thoughts. I have experienced how medication changed my inner state and my thought patterns within days and how it feels to loose your usual pattern of thinking and your very feeling ofwhat it means being yourself.

    Some of this I told about in comments to a blog of Lawrence K. who commented to your blog above. I find his train of thought regarding learned helplessness and impact of psychiatric treatment and administration of neuroleptics quite intriguing.

    Anyways, what I would very much like to convey to you is my observation of how my cognitive experience very quickly and very situation-related changed. It is true, that in psychosis all these cognitive fallacies in their exaggerated form were present, like jumping to conclusions and attributation and so on, but not the whole time, it was switching back and forth. Also, when regaining my ‘normal’ balanced state, I am as ‘normal’ maybe even more rational and less jumping into conclusions than most others. Even more interestingly, when I was heavily drugged with a combination of three to four medications, I developed completely foreign ways of thinking, extremely self-critical thoughts, highly fearfull thoughts, expecting negative outcomes, etc., very similar to what is typical for people prone to develop depression. And I watched in horror and awe how this could be even possible. I am a very self-confident and optimistic person with high self-worth. In the beginning I was completely aware, that this catastrophic and disempowering thinking was very unusual for me. It felt totally alien but I sort of got accustomed to it more and more and soon it felt like I had been this way all my life. I started to reinterpret my memories according to the new thinking and I forgot how it felt being me. And I tried hard to get back to my former self, but it was not quite possible until I got off this horrible drugs.

    I am not an all-out oponent of drugs, but they should be used with extreme caution. Initially, they where fine to calm me down from my psychosis but they did not – and I feel the need to stress that – change the crazy content of my thoughts! They completely knocked me out, which at least gave me some rest. I came to terms afterwards because I slowly understood (with horror and lots of shame) that I am in psychiatry and not just minutes away from the fullfillment of all my deepest desires and wildest dreams provided that I just figure out this damn so very complex but divinely inspired mysterious puzzle where I have to dare to do unusual things for accomplishing certain secret tasks that unfortunately by the time being only I could truly fathom but soon I would not only get all this rewards but also quietly had saved the world and ensured the emergence of a new cosmic time of peace and happiness.. You sort of get the grand scheme of my exciting first psychosis I reckon. It is very true that apart from serious traumatic happenings with my boyfriend which caused me to flee reality, I was also bored with my life at that time because he also isolated me from friends and the ongoing trouble and violence were incredibly tiring which made me refraining from my usually very active life. As is stated somewhere in the material you offer, I was quite susceptible to psychosis (such an adventurous cosmic story taking place with myself as the key actor in it). Therefore, all the strategies you are mentioning in your therapy approach are valuable to a certain degree and have their place, but they can never cure anybody. You hold people in a category of being a ‘vulnerably’ person and in that way you take away their capability to grow out of their issues and overcome their ‘disorder’ or ‘illness’.

    From my experience all the patients I got to know are avoiding some sort of pain. They carry around some thing, or some things, that hurt them so much that they would do anything to never have to feel it again. Psychosis has a lot to do with survival mode, you know. Probably you would give the argument that not every of your patients has experienced truly traumatic events. Well, who can claim the right to put a scale measurement on the degree of pain felt in a certain situation? And who would distinguish people along their ability to endure a certain degree of pain? As with physical pain, your endurance can vary from day to day and is dependent on many factors. It is the same with your ability to cope with psychological pain. Thus, as I currently understand it, psychiatric disorders and mental illnesses are nothing more than certain inner states that are accessed e.g. as a reaction to a painful experience (to avoid some sort of painful realization or having no other (perceived) choice to distance oneself from a painful reality) or for other reasons, that are accompanied by a certain way of thinking (a certain vulnerability to specific exaggerated cognitive biases). Temper and social background account for a certain variety. People get used to this states and spiral down through the mechanisms you address. It is subsequently useful to train them to get out of this cognitive patterns or be e. g. critical when they catch themselves figuring out highly implausible explanations for certain situations they experience. But in the end your approach still teaches your patients to see themselves as faulty and as having to be on the watch all life long.

    I know from my own experience that the latter generates much stress in oneself and this stress is added with the need of having to deal with ‘well-meaning’, ‘helpful’ family members and friends that readily try to assist you in reminding of your ‘vulnerability’ as soon as you start having some fun or just want to stay home and sleep a whole day or just f** do something a little weird or unexpected. You get treated like a child and at the same time everybody wants to cheer you up and assure you that you are still a worthy and capable person, just uhm.. ‘vulnerable’ – ‘but that doesn’t imply weakness or impairment’ – ‘you could even be a genius, just, uhm, without a meaningful employment and, uhm, yeah, just take it easy, everything is good… Still taking your meds?’. See next post below for more.

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  21. To summarize my two comments above, I think your approach has value but you are still ‘only’ teaching coping strategies for symptoms which is a little more empowering than administering sedating drugs, but also ‘just’ that. You do not dare to assess the simple truth: that most if not all of your patients are some sort of victim in the sense that something uncomftable or outright horrible has happened to them what very often they cannot consciously access or describe in a sensible way. It could very well be some perceived injustice or something that you would see as something completely trivial. But as I said before, probably, if you dig deeper, you’ll find some sort of severe and REAL! pain.

    I would ask you to sincerely consider to view your patients truly as much as a capable person as yourself. Capable in the sense of awareness and being a fully sentient being. You may be surprised why I feel the need to say that but as a patient it was always the feeling I got from the well-meaning medical personnel like you present yourself. They just didn’t get how patronizing and disempowering they felt to me through their kindness and ‘thoughtfulness’ for my ‘vulnerability’. I am lacking the words to fully describe what I mean…. uhm… To help you understand I will give a final shot in trying to explain, and sorry to those who consider it bragging, but I consider it usefull here and now:

    I never ever had had anything to do with psychiatric disorders or mental illnesses until I was 31. I was considered a high achiever because everything in life came easy to me. My childhood had the usual troubles, my parents had some issues in their relationship and money was always short, but all in all it was good. School was easy, university was easy, I did my master in earthsciences and was on my way to a phd. I always worked (so much stress for somebody so vulnerable?!) to have some additional money and I travelled the world twice for 8 month with a backpack as a woman on my own. I was only barely 20 the first time and I got raped but coped well with that ‘difficult life stressor’ despite being somewhere in Indonesia without much help. I love hiking in high altitude including some climbing, due to my studies I had to crawl through narrow caves, I am a scuba diver as well with training for high risk cave diving and I always have been known for my calm behaviour and keeping a clear head in difficult situations. I have guided diving teams. I am also a very optimistic and sociable person who takes things rather easy. I rarely had any troubles with people and could de-escalate any situation quickly mainly because of my charming personality. Now, I fell in love with a guy with a very difficult background, a violent upbringing. I thought I could handle the situation but I was wrong. At some point I got psychosis and foolishly decided to go to hospital for help. It took me five years and many relapses to fully recover from the brainwashing i received. And I had to work through my and my boyfriend’s psychological wounds and troubles mostly by myself with the help of many good reads (many inspired by this website). I am finally through this crisis, still together with my boyfriend, back in a well-paid job and challenging activities.

    I tell you this personal information about myself because I’d like you to imagine how your material would feel to someone like me? Thats why I called it kindergarden level. Most of the things that are mentioned I knew by intuition because I had to assess people and their behaviour correctly in risky situations. But I have to admit, being trapped and heavily drugged and intimidated back in hospital, I would be glad for something that easy with some jolly phrases and funny pictures that I am still capable to comprehend at that low point in my life. I was mostly like all the other patients, docile and happy about every bit of kindness and positive attention and distraction from the fact that I am in psychiatry that I could get.

    Steffen, you cannot trust whatsoever positive feedback your patients give you. As a mental illness patient you get trained to give the right answer and you are pressured into the feeling of being intrinsically inferior. Everything you do, the way you feel and think, is permanently critizised allthough you are simultaneously told its not really your fault. Your subjective experience is downplayed and given little value. You get so hungry for human appreciation that you end up behaving like a dog to those who give you a litlle bit of warmth. Being labeled something that implicates psychosis is the worst stigma there is. It doesn’t really help that you state that a certain amount of cognitive bias or delusions is considered ‘normal’. What helps is to clearly address the pain that has driven one crazy and that made you exhibit such crazy behaviour and unusual thoughtpaths. That helped me. And that helped my boyfriend overcome his ‘domestic violence disorder’.

    A psychologist would have given us cognitive strategies that stay on the surface only, like somebody above stated about the polished floor that soon gets dirty again. It’s NOT thought patterns that make you crazy or depressed, its real situations that make you feel a certain uncomfable way and that you don’t deal with appropiately. Thought patterns can be artificially changed quite quickly. If you don’t believe it just give it a try and take some antipsychotics mixed with two or three other mood stabilizer for about four weeks while being admitted to a closed ward somewhere where nobody knows you and with fake medical files that give you a schizophrenic label. Well, but as long as you yourself know that this is just a fake situation and you can still redeem yourself its not the same really because that knowledge protects you. It must crash your self-concept completely to be viable.

    So, again, I appreciate your approach in a certain way but I think you still would have to travel a long way to reach the ability to really ‘help’ people by allowing for a chance to completely heal. And for that you would have to understand the real cause for the troubled behaviour that your patients show. And truly grasp the truth that lies in your own statement that EVERY human being has this cognitive biases because it is a normal feature of human cognition. Therefore everybody has the capability to develop signs of anxiety or psychosis or depression or suicide. But psychological trauma has much to do with individual assessment of a situation. Therefore, the surer you are of yourself for whatsoever reason there is the more stressors you can handle. Another way for you to practically understand could be to bring yourself in a situation where you are completely out of control for a while. I am sure you would be astonished how your thought patterns change and you suddenly exhibit many exaggerated biases.

    That’s why I think the first approach for troubled people should be a calming and soothing, safe environment and as much help as possible with practial issues (social workers with concrete solutions for whatever bothers you instead of lengthy talk therapy, the latter can be done as soon as your immediate circumstances are safe and you feel at peace again.) Thus they get the chance to calm down and become their normal balanced self again. And then it can be assessed if this person needs any coping strategies or it he or she has just been out of their mind a little. Do you understand? Your approach as well is a one category fits all aporoach. In the studies you cite it is stated, ‘schizophrenics tend to know where the coloured ball is from after only one guess’ – see, I am trained in probability theory but in hospital or while I was completely crashed by the diagnosis and still taking drugs the chances would have been very high I would have reacted exactly the same. You are behaving according to diagnosis after diagnosis and that works in a very subtle way as you as apsychologist should know best. Don’t you know about studies e.g. regarding Maths tests where people had to state in the beginning of being male or female which subsequently influenced their capabilities? Think about it, my friend.

    English is also not my first language and therefore I hope my ideas came across more or less comprehensible. Gruesse nach Deutschland, lieber Steffen!

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  22. One last comment, Steffen, and Fiachra, I would not be so quickly to buy into the seemingly empowering approach of this ‘thinking about one’ s thinking’ approach.

    I read through one of your case studies about the unlucky 44 year old IT phd guy. First of all, my full respect goes to him regarding being able to complete his phd and work in IT despite his schizophrenia diagnosis. But hold on, its not with regards to his proclaimed ‘severe mental illness’ but the fact that he managed to do this while receiving risperidone injections twice a month for five years. I still cannot understand how people are able to perform well while being on antipsychotics. The only explanation I have is that he got a lot of support from his surroundings, so that he could fully focus on studying and working, without having to deal much with household chores or administrative tasks or other day-by-day requirements.

    But well, here we have a high functional ‘schizophrenic’ that unfortunately relapses from time to time. Described as a sad feature of his mental condition. Now he receives MCT+ which after having read the description for this case sounds more like brainwashing to me. I give you some examples:

    This patient is described as having the feeling of being a disappointment to others, particularly to his father in the first psychotic episodes but for the current one it targeted his workplace, collegues and boss. He feared loosing his job and developed ‘delusions’ of his colleagues sort of mobbing him to make him ill again and to ultimately get rid of him. Therapy tried to slowly get him to understand that he might exaggerate the situation by showing him examples of biased thinking.

    “Again, the aim was rather to sow doubt, while working on cognitive
    biases rather than confront the patient with the fallibility of his personal beliefs.” – But see, rather than taking his core perception serious and trying to find out what prompted him to see himself as a disappointment and help him finding the root to his slightly paranoid thinking, there was no validation but only the focus of making him adhere what your team decided to be the true situation. You believe that you know what the situation is in reality but you only rely on the assessment of his family members presumably. Thats the difference to the Open Dialogue approach where they try to bring all involved people together and discuss the situation on an equal footing.

    Maybe his colleagues were talking about him, have you ever thought about that possibility, Steffen? Maybe his family was disappointed and he could feel that even if they tried hard not to show him because they learned it is not his fault as he has an illness that makes him behave a certain way. I am only guessing here, but being on antipsychotics slows you down, make you less socially capable and maybe he got a bit overweighted or his colleagues knew about his diagnosis and, hey, of course as the kind person you are, Steffen, you assume that they will deal with it in a nice way as long as the patient demonstrates self-confidence and acceptance about his illness, but in reality this rarely takes place. People are people and they will ‘talk’ about any unusual thing they encounter, especially if they again read in the newspaper about some violent deed of somebody with alleged mental illness. Therefore, it is very possible that there was some sort of truth to his feelings. Also the disappointment bit is understandable because having been labeled ‘schizophrenic’ takes its toll and fearing loosing his job is also not something weird taking into account how difficult everything feels while being sedated, having your Dopamine system and other neurotransmitters disrupted severely (i am talking about antipsychotics). Especially in IT, where you need to constantly stay educated on the last developments, having to solve complex tasks. Of course he exaggerated everything but what else do you do if nobody takes your feelings seriously and you are seen as some kind of poor weirdo??

    “With the help of different exercises the message is conveyed
    that hasty decisions often lead to errors.” – Must have been a tremendous insight for someone who has acchieved a phd in a (presumably) technical subject working in IT.

    “Several studies show that patients with schizophrenia tend to stick to their conviction even
    when confronted with strong counter-arguments” – Thats because the core nature of psychosis is a symbolic representation of some REAL issue and its the task of the therapist to help the patient figuring out his way to leave this complex maze. Think about it, here you have a highly intelligent person with a phd and still he does not accept strong arguments that any child would understand… uhm… what a mysterious illness indeed. I can tell you from my own experience that the patient has a very good reason for holding onto his ‘delusions’ – its because you FEEL that there is some important message in your psychotic symptoms but its so very basic that it feels near to impossible to explain other than by attributation or jumping to associations and so on. It is symbolic for gods sake and you haven’t figured out the message yet, otherwise you wouldn’t be psychotic. Delusions can die within a minute if you figure them out. Interestingly, thats the goal of your MCT intervention…. Oh my, I hope your so very rational mind can comprehend its fallacy…

    “Patients are taught to collect information from different sources (e.g.
    contextual information, prior knowledge) and to decrease their level of confidence in case
    information is incomplete or ambiguous.” – Again, we are talking about someone who has a phd and had to write scientific papers. Fair enough, it’s about “identify facial expressions and underlying emotional
    states” but in my opinion this patient most likely didn’t have much difficulties with those things as long as he wasn’t taken over by psychosis which happened because of some underlying unsolved deep and painful issue.

    I give you an easy to understand example, Steffen. Just imagine I take you on a high line (I sincerely hope you are like most people not used to be in great heights and therefore a bit afraid of standing on a wobbly line above a 200 m abyss). Calm down, I put you into safe gear and nothing will happen when you slip. I take you to the middle of the line (there is one line where you walk on and one for your hands to balance yourself). Then I jump a little to make it more exciting. At that point most untrained people would be in an extreme state and feeling quite desperate and anxious. Then I would do these exercises with you. Assessing facial expressions and talk about your delusions. You seriously think that you are about to die? Are you joking? I told you you are completely safe, don’t you see your safety gear? What? I am a sadistic bitch because I tried to scared the hell out of you by making the rope wobble even more by jumping up an down? Come on, you are jumping to conclusions and your information is incomplete… I am used to heights for me it is great fun, I just wanted to give you the feeling of great excitement. My intention was completely benevolent. So you should really think about your way of thinking right now! It needs to be corrected, my dear friend. Don’t you see how you have a tendency to blame others for
    up to 100% for your negative experience?

    Do you now understand how patronizing and degrading your approach is? I gave you the analogy with being on a rope high above the ground to give you an impression of how psychosis feels. It is an extreme state and that is as little or as much a delusion as is your panicking on the rope while being completely safe in reality because of all the safety equipment. Do you finally get it?? Its a highly SUBJECTIVE experience and it’s most likely only true for your patient but what you do when you belittle his experience and try to make him become rational and get back to calm reasoning is in fact violent behaviour. You force him away from his current reality. And I tell you from my own experience that this very simply feels like torture to the patient.

    Somewhere in a comment above you say that you tell staff to treat the patients like they would treat a relative. But I disagree. It is a seemingly well-intended and kind idea but it is as superficial and sadly hypocritical as your whole approach. Again you distance yourself and your staff from the patient because if you really follow through a thoroughly well-intended approach you have to treat them as you would like be treated yourself if you were in their position. For that to be viable you would need to truly empathise with your patient what is only possible when you try to understand and gather unbiased insight into their state without declaring it a disorder or ‘abnormal’. There are more cognitive fallacies in your answers. One was pointed out by knaps2 where you kind of overreacted and described your delusional perception of being addressed like some minion of a nazi organisation…uhm… I wouldn’t dare to use such a ‘funny’ analogy while being in hospital. I know, its all about context but just saying. The other is you proudly talking about your decent manners in dealing with patients, stating that the client is always king… Well, as long as they follow your rules that is. They are allowed to choose a little bit which of your modules they like best. They are even allowed to disagree a little but if you decide their disagreement makes no sense or that they are outright refusing your treatment I am sure you write things like ‘no signs of compliance’, ‘poor insight to his illness’ and so on. So you are giving him a ‘bad rating’ which will result in more pressure on your patient. I cannot see a true ‘client is king’ attitude which is further outlined in your good cop bad cop left/right hand video. You try to be on the patient’s side but still feel the need to patronize him. Congratulations to your dissociate behaviour. Could you please make up your mind?

    Back to the case study, where it even gets worse.
    “The patient reported memory problems but did not agree that there would be a connection
    between the psychotic symptoms and his increased forgetfulness. He would rather ascribe
    those problems to the increased dosage of antipsychotics he was receiving.” – No comment on that… but nice wording, indeed. Very ‘neutral’.

    I think there is no point discussing this case study any further. Maybe you understand by now or maybe you do not. And again: yes, your approach has value it just needs to be presented in a different view and psychiatric personnel should get these lessons too with examples how they constantly misinterpret patient behaviour and statements. Are you ready to part from the disease model and respect the patient’s root causes of some form of abuse? If real or only perceived isn’t the important thing because it was real for them and they first abd foremost need understanding and empathy.

    As I hope you understood from my example of walking on the high line, perception is highly subjective and in essence it is true that only the patient knows even if you didn’t get the meaning of it. He and his delusions are the key to some unprocessed pain. I think with depression its very often some kind of surpressed aggression and so on. But that can be totally wrong as well. I just wanted to convey why a psychotic exhibits a certain behaviour. This goes to the lady with the psychotic husband as well as for all who cannot understand their beloved psychotic.

    Of course a psychotic person is highly uncomftable to have around. But put yourself into his shoes, in his reality he IS watched and put under surveilance and threatened and whatsoever. It feels very real to him like with the example of being on a high line most people would perceive themselves of being in a highly dangerous situation regardless of how often their mountaneer guide would assure them that nothing can happen because they are wearing safety equipment. Just ask yourself how you would behave if for some reason you get convinced that you are about to get murdered or contacted by aliens. Don’t be so arrogant to think it could never happen to you. Just read Eric Coates recent blog post. After psychosis we ‘schizosomething’ or bipolar people ask ourselves with astonishment how it could have been possible for us to have such a convincing experience of something utterly illogical…It is truly fascinating but it also makes one a little bit more humble and cracks the ego. I always thought I am invincible and with my highly analytical and rational mind I smiled about emotional colored assessments of others. Nobody would have ever thought that I could develop delusions but it happened. Therefore, Steffen, I would be happy if I have broadened your understanding a little bit.

    And please accept my apologies if sometimes I crossed the lines of politeness a little bit because for me it is still difficult to join into a discussion with psychiatric personnel because it triggers so much pain that I experienced from their hands. And this is not some wrongfull identification of facial expressions but comes from the very fact that I understood very early that these people truly think they would help me by exhibiting all sorts of hurtful behaviour and I could simply not make them understan because of their stubborn view and closed minds.

    “Force is needed to make you accept your illness” , and that ‘force’ came explicitely with forceful injections and restrains as well as more subtle like your “back-door” approach (like you ironically call it yourself in that paper) of brainwashing.

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    • As “the woman with the psychotic husband” you mention – not all people who go through psychosis come to an understanding of what happened and why. My husband still clings to aspects of his unusual beliefs as literally true although others he realizes were rather strange. I think this is because it’s more comfortable than thinking “I was crazy then.” But of course I can’t be sure. Yes, I’m sure he subjectively felt what he did, and I can see why in many cases. His family of origin is so typically schizophrenogenic. His father even told me, “We [i.e. he and his wife] know exactly what goes on in all of our [married] children’s lives,” and thinks that is a) normal and b) something to be proud of.

      Thank you so much for your amazing posts. I don’t think I’ve ever read anything before that made things so clear. You do write that the drugs slowed you down enough to give you rest and the opportunity to slow your thinking. I also saw with my husband that they don’t stop the psychosis. Are there any non-drug options you know of that could do the same – better?

      You also mention that your life was boring before psychosis. Dr. Rufus May writes similarly of his own experience, and I think my husband would agree re: his own life.

      By the way, it’s not just highly uncomfortable to be around someone psychotic. It is absolutely terrifying, especially if it is someone you love and can no longer access because of this “something” that seems to have possessed them.

      What helped you most in your own life? Can you recommend anything specific such as books or healing modalities?

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      • Hi gabi, I thought I’d chime in and offer a couple ideas. We keep talking about trauma for good reason. Even trauma that occurred before we could speak words or develop memories has a lasting impact, actually developmentally probably a bigger impact, and I believe “complex PTSD” or similar is at the core of my struggles with psychosis. So some of the modalities that focus on surfacing and resolving trauma could be a help to your husband, as they were for me. In particular, I had some breakthroughs with Brainspotting (similar to EMDR), although the practitioner didn’t do a good job supporting me with grounding skills. Without the grounding, I was unearthing old trauma and not being able to hold it and take care of myself, which kind of launched me into more semi-psychotic experiences. I learned more about some of these skills (body awareness, emotional state awareness, combining those into my mindfulness/meditation practice, self care routines, spiritual techniques from Buddhism and New Age practices and similar). After a lot of healing, I’ve found myself drawn to Jungian analysis and working with dreams.

        For trauma treatment, I found an interesting overview called The Trauma Treatment Handbook by Robin Shapiro. It’s written for practitioners but was easily understood. Also another overview book, The Body Keeps the Score by van der Kolk.

        Finally, your own awareness practices and self-development could be a huge aid to recovery of your husband. We choose our partners for a reason; based on my own experiences, I found that patterns played out with my partner reflected unresolved family/childhood conflict. Being more aware of yourself and your relationships, and responding to triggers with more intentionality, could only help.

        Good luck!

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      • Hi Gabi, my apologies for the phrasing ‘woman with psychotic husband” which may sound rude in English I guess although it was just the easiest description that came to my mind. I couldn’t remember your name and didn’t find your post and was already a bit tired.

        Well, yes it can be sort of “more comfortable” to hold on to beliefs instead of confronting them, especially if there is some pain covered underneath them. Thats where MCT comes into play and can be very helpful because it is a technique that doesn’t confront openly but through ‘the backdoor’ which can be a good thing because you don’t feel attacked right away but are able to follow the explanations of cognitive bias and discover them for yourself in your own thinking. Thus probably the material provided by Steffen could be of help in your case but I reckon your husband won’t accept them through you. Not because he is suffering from his condition but rather because its always difficult to accept help from your partner. Maybe it helps you to consider the large amount of shame and guilt that awaits him as soon as he leaves his delusions and explanations behind? I can tell you from my own experience that disillusionment felt crashing. And its a very personal thing because psychosis confronts you with your innermost desires and weaknesses. Thats very likely hidden under his strange beliefs, they are protecting something vulnerable that he feels like he cannot face. At least that was it in my case.

        I totally understand your frustration with your husband’s condition and that it is frightening from time to time. And I think it’s great how you try to get a broader understanding by reading on this website. It shows your commitment and your love!

        Non-drug options, oh my, it’s very difficult in my experience to be reached while psychotic because you just don’t trust and the delusions feel so very real. I can only opt for a safe and non-intrusive environment with neutral people that do not judge… Something like soteria or Open Dialogue. For me it would have been a lot about being able to fully trust somebody, to calm me down and make me sleep and regain sanity, but nobody around me could offer that. All were confused because of the medical babble they were given and I could feel their fear and confusion and helplessness and sadness even when they tried to be there for me and to feel that from loved ones upset and burdened me even more and reinforced my psychosis. You have to understand that a psychotic person feels an tremendous amount about the people around them. It appears to be distorted when they try to talk about it but it’s really not. While being “out of your mind” (whatever caused it, I tried to give an example with the panickingg on the high line above an abyss before to make it understandable how it feels if the mind is in an extreme state) funnily the perception of basic things is very present and accurate. You get raw impressions of the other person, their movements, their facial expression, the tone of their voice, it’s a bit like a young child experiences the world. Basic information but no access to higher forms of reasoning. So if your doctor has had a quarrel with his wife at home and is tense, you immediatly get this but most likely you attribute it to something related to yourself or integrate it into your psychotic storyline.

        What helps is for the non-psychotic people to be extremely honest and tell straight about their feelings of fear, of confusion, of aversion and annoyance because of lack of understanding and having to cope with a freaked out person that embarrasses them. Do not try to follow general adult behaviour codex and hide your personal emotional state. That makes everything worse. Tell the patient everything that you feel in plain honesty. That’s a very interesting thing, I reckon, because in the current system, people try to be polite and forgiving, because they assume the psychotic person to be somehow impaired like “he doesn’t know what he is doing, poor fellow, he is controlled by a mysterious illness”. I am with Szazs on this, mental illness is a myth in that you do know on a very basic level what you are doing and there are motives and so on (you do understand when you are hurting someone or behave stubborn or rebellious) but of course you might think you have a very good (delusional) reason for that and you get totally mixed up and project old emotional distress and traumatic feelings onto the wrong situation or the wrong person. You are re-living some emotional scheme that gets projected onto the current real situation happening around you and your helpless brain just trys to do it’s job in making sense of it all.

        The reasoning mind is a translator, a story-teller. It gets the input of your old emotional scheme and tries to somehow connect it to the current reality and because there are little matches it comes up with fantastic storylines because otherwise the strong emotions that you genuinely feel would have no basis. But the raw mind cannot fathom time, it’s not capable to make higher assessments like “oh, this strong emotions originate in my childhood trauma or in my boyfriend’s attacking me ten months ago” but it only feels the rage or anger or feeling of being watched and ordered around by parents or bullied by someone that happened someday in the past and finds a storyline that makes it possible for this feelings to have emerged in the current situation. And there you have the bizarre realities and distorted perception of real events that the psychotic person experiences.

        I think there is some evidence that people experiencing psychosis (and sorry, I use all that wording because it would be quite difficult for me to find synonyms) process things in a more “bottom-up” way, meaning that their perception is raw and gets interpreted afterwards instead of the usual way where the brain makes use of your previous experience and interpret the perception before jumping to conclusions. See the hollow-mask-illusion. And for me it’s quite fascinating that everyone experiences psychotic symptoms when sleep-deprivated etc. Your perception gets switched and you no longer use certain (costly?) higher functions. You are sort of in survival mode.

        Now in psychosis it’s a perceived threat, a past traumatic situation that emerges. Maybe thats why before psychosis many experience overwhelming feelings, almost spiritual, where you are connected to everything and it feels so magical. Probably higher rational brain functions get disrupted and your perception switches from top-down to bottom-up. Of course you withdraw because it’s so fantastic, well, if you ever tried some weed you probably understand.

        If it is true that for some reason (maybe because the trauma pushes through with utter urgency to finally be recognized and processed) your higher brain functions get sort of reduced (I mean the rational part, the top-down approach), then there you have the explanation for the mysterious change in personality before visible onset of psychosis.

        And to explain it more technically again how psychosis feels for the one experiencing it: It’s like a photo with many filters and layers above, a distorted reality indeed, but you cannot see it because that is impossible for anyone if you only have this photo and none without the filters and layers. That would be needed from the therapist, to help you identify the filters and layers, something that Steffen tries to do with much passion, but unfortunately still under the premise that the filters and layers are meaningless and some kind of illness. What may help at the moment, when the patient get rid of filter and layers (maybe only to a certain degree like with Gabis husband) and can see the real undistorted photo that all others see too. But the problem is, filter and layers (trauma) still exist in the patient’s subconscious and will come through again to color the next actual photo and again the patient develops ‘delusions’ meaning his story-telling brain (see studies of Damasio) tries to connect emotional scheme with current surroundings. That’s why the content of psychosis can change but the emotional theme might stay quite the same and involve some kibd of perceived threat because again, the root of psychosis seems to be some form of abuse.

        What it is that troubles and bothers your husband subconsciously I am sorry I cannot tell you. It may be related to childhood upbringing. And you must understand that it is still his decision if he feels the urge to confront it and start the most likely difficult and hard way of healing or if he prefers to stay with his symptoms and just focus on dealing with them in the best way possible, accepting himself as mentally ill. And now I may say something unpopular, but please don’t fall in the trap to make yourself a victim because you so much wish to be a good person or stand to your values or hope that love will conquere everything. I did make myself a victim because of thinking along these lines. My boyfriend was very abusive and I did go through hell with him. It did work out in the end but it took it’s heavy toll on me. Please care for yourself and don’t risk becoming burned out and bitter because you give too much and receive little back. A ‘mentally ill’ person can only heal if he or she decides to do the work. This is again a difficult thing to grasp because its always some form of abuse or negative experience that causes symptoms of mental illness, but its like when you slip on a banana, shit happens, and yes the banana being there on your way is damn unfair especially if someone put it there to make you slip, but you need to want to get back on your feet to solve the whole situation and hold to account the banana offender. Of course, it could be that you got your leg broken while slipping and you need support in healing and getting up, but what I want to convey is that it’s the same with mental illness as with any other obstacle, the patient has to want to change the situation.

        But please on the other hand never forget how immensely difficult it is for people labeled mentally ill to free themselves from all the brain-washing and oppression and outright force to have ‘insight into their chronic illness’ and accept their condition the way the psychiatric establishment decided it has to be. So you see it’s a very tricky and entrenched situation that we are all in that had been in contact with psychiatry and clinical psychology.

        What helped me most in my life and my recovery? Well, it is difficult to explain because it’s a combination of many things. But lately it was a therapist who rarely used cognitive methods but fully concentrated on feeling certain emotions inside my body and made me describe them. And then he wouldn’t allow me to rationalize and also he wouldn’t try to put it into context or find some meaning. Instead he would sit with me and share the feeling. He would ask and ask for detailed description until he understood the feeling for himself and then we would both be there and feel my feelings, my pain, my fear, my panicking, my humilation, my desperation. Without any judgement. That was something so very empathetic of him, because all time long through this so very difficult years being threatened by my boyfriend so often and simultaneousley threatened by psychiaty who wouldn’t take my accounts of domestic abuse serious even when my boyfriend finally started to come out of the closet and admit it I was so lonely with my experience and I so much needed human empathy. But how should you receive that in a therapeutic setting without loosing that healthy distance? And there he surprised me with a great thing… We were feeling some of my very dark and sad emotions and I was so in need of an embrace although I wouldn’t show because I hate showing neediness. And suddenly he took a blanket and gave it to me and told me to put it around my body tightly because as he feels the same what I feel he can readily understand that I needed to feel being supported and warmth. So I did that and I cried and he just was there with me enduring my pain together for about ten to fifteen minutes. Then everything lifted and we drank some tea and changed subject. To me this felt tremedously respectful. It never crossed the line to be too emotionally, I was allowed to keep my dignity while opening up so much. But still he didn’t leave me alone but tried hard to grasp what I was going through to feel and share it with me, validating it.

        Greetings Gabi and much strength and good luck on your way! Take care of yourself and thank you for being open to listen to others and dare to start a debate.

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    • phoenix, I’d like to thank you for the extremely detailed, lucid posts, that reflect a lot of my own experiences and conclusions as well (but put it much clearer than I’d be able to). Like you I’m a high-functioning, very analytical person, with one major destructive psychosis and a couple more manageable others; found a relationship with a very troubled person and walked through Hell with her for both of us to transform (including a much deeper understanding of our family systems, and other social systems); a risk taker. My relationship with my family, including my father who is a hospital president, is likely forever wounded because of the lack of proper treatment and healing during the psychosis (medication + CBT). I too look to Open Dialog as the best chance of healing for those undergoing psychosis, as it’s a model that addresses the entire system surrounding the Identified Patient at once, rather than treating the symptoms as an individual brain anomaly.

      I can hear the emotion behind your words and hope that the message comes through to Steffen and others who read this – not that they should abandon their work, but that they should attempt to reorient their understanding of the fundamental causes of psychosis, and their relationship to their clients. It feels to me a little like this thread is symbolically much bigger than one clinician interacting with a couple mental health consumers… I feel some hope and suspense that this could be a transformative and healing moment. At this point in my life I still harbor some anger, but much more than retribution, I want change.

      Finally- not bad for English as a second language 😉 Thanks again for all your writing.

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      • Knaps, we seem to have had a quiet similar experience. I am with you in seeing it as a transformative quest where I as well gained a “much deeper understanding of our family systems, and other social systems” and I can relate to much of what Eric Coates writes about. I am just very happy that I am not subject to any AOT and managed to escape psychiatry and also got my family to mostly understand my point of view and refrain from forcing me to accept the mainstream interpretation and treatment methods of my condition. If you read my answer to Gabi above I tell a bit more about what insights and treatment helped me.

        I also sincerely hope that Steffen and others without lived experience get the point what I so much try to get across, that we patients are not somehow intrinsically impaired but that there is deep meaning and transformative power involved for family systems and social systems as a whole. I am very impressed with the Open Dialgue analogy of an electrical switch falling or a burnt fuse in a house where there is some electrical stuff going wrong. If you focus only on the broken fuse, nothing will be truly solved. It was just the weakest part that broke but in reality there is something wrong in the house’s overall electrical wiring which needs to be addressed.

        Being a high risk taker like you as well describe yourself you certainly know how humiliating it feels when the ‘well-meaning ones” come along and start talking about that vulnerability model. It put me off totally and made me very much want to kick them into their testicals to educate them about their own intrinsic vulnerability. One so very helpful clinical psychologist started to explain to me that we are all boats floating on water and that some boats just aren’t build so well and therefore cannot tolerate a storm so well. I watched in awe as he felt himself to be so very empathetic and sensitive while essentially telling me that he is a better build boat than I am but if I accept some fixing I would eventually match his superior built and be as capable as him. And you see, I have experienced people so sure of themselves tremble on steep mountain ridges and outright refuse in childish manner to go any step further or panick in two meters depth while diving down because they got some salty water into their nose. But I would have been an extremely poor guide if I had started to educate these people along the lines that they are faulty mountaineers or faulty divers. It never ocurred to me to put measurements on their ability to tolerate heights or whatever because I simply know that often the most frightened ones in the beginning exceeded all others later because their fear made them extremely cautious but also alert and they learned better and faster – if they didn’t loose motivation and quitt early.

        For me personally I remember how empowering it felt once I left these damn labels and psychiatric descriptions behind that in such a dismissive way described my apparent (cognitive and affective) shortcomings. When I went on via ferrata, fixed-rope routes, again after two years of psychosis treatment, I was shaking and full of anxiety and I just had little confidence to cross even a quiet simple route. I stood there and cried and my boyfriend helplessly tried to comfort me. You know it was me who once showed him this sport and built his confidence. But with the psychiatric label and psychiatric treatment having crushed my self-confidence I had a blockage in my mind and so much fear. After a while I put myself together and trembling and sweating and shaking (making the rope wobble and wobble) I somehow managed to cross and then I had to laugh still in tears because my former self came back and was so very amused how intimidated the once so self-assured risk-enjoying me was at that point. I discovered a very new bit of myself, a soft and very feminine quality and it was tremendously healthy for my relationship to finally experience my boyfriend being the guide who cares for me, secures my steps, is patient and motivates me. Therefore, he discovered his healthy male energy which was wounded because of his childhood experience with an at times drunken and violent father.

        You see, there is beauty in challenging situations and I think you experienced the same with your partner. It can be a deep and very meaningful thing but it is extremely demanding and sadly mainstream psychiatric and clinical psycholigical thinking can severely slow down or even inhibit this transformation because they hold you back with their closed mind interpretation and ‘conservativeness’. No risks. Niente. Nada. None of that. Behave! And think of your vulnerable filthy build boat! Stay at shallow waters and close to the shore. No sailing for you, I am sorry.

        Nice that we found each other on this board and thumps up to your path and keep on climbing, it is worth to get to the peak. But also remember: “There are many ways to the top, but the beautiful view is the same for all.” With this I mean that its also ok to sometimes just take the cableway up, especially after having dealt with so much adversity and having had to fight so much.

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        • I’m amazed by your writing, so open, funny, expressive! Yes, I think I can take your last bit of advice to heart. What a beautiful analogy. I’m a rock climber, but in recent years as I’ve faced a lot of the roots of my psychological issues, have naturally been doing less roped climbing, certainly less risky alpine/adventure climbing. Funny how for me, the symbolic life expresses itself in my interests and desires in the physical world. Not so different from psychosis, yet much less intensity. I’m enjoying the scrambling and cable routes much more these days 🙂
          Your description of your trembling traverse and the growth for you and your boyfriend is amazing to me, and I’m happy for you to have made it through so much of these struggles to the other end of the tunnel.

          Thank you for the encouragement! And same to you: congrats on your journey so far and may it continue taking you higher and higher.

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          • And yes, I definitely agree about reaction to the vulnerability model. Authority and the presumed superiority, even if subtle, has been a huge continual wounding for me throughout this process. Originally from hospital staff – doctors and psychiatrists in particular – and in an ongoing basis from family, particularly relevant with my father who is a medical authority. I still feel pain and resentment towards the psychiatrist who worked with me at that time back in 2007, a well-published research psychiatrist and head of the department for a large medical group in the US. He’s a friend of my family, and lives in my parents’ neighborhood, so it made the pain hit even more “close to home” figuratively and literally. It’s a terrible thing and as you go into detail about, can have an enormous lasting impairment on functioning. It did for me. I feel like I’m only in the past couple years finally getting on with my life, in a self-led way.

            I won’t argue that temperament plays a role: making one more susceptible to trauma, more susceptible to expressing that trauma as psychosis. Yet I view those temperamental traits as neutral, not negative. The same trait that causes these negative outcomes in the contexts like my life can also cause positive outcomes, and in fact I’m sure they have (sensitivity and intellect -> reading complex situations better -> more power and potential impact in the world)

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          • Very true everything that you expressed, especially the last paragraph of your second response.

            Congrats to that highly complex climbing route (= life quest) with having a medical authority as a father and struggling with mental illness. If you manage to get to the top of that route, chapeau! Its an ABO route I reckon, see the following definition:

            TD (tres difficile): Very hard. Years of training technically and physically, but you could do it if you dedicated yourself to your goal.
            ED (extremement difficile): Extremely hard. Requires lots of dedication and long periods of climbing (i.e no job).
            ABO (abominable-abominable): No job or family or very very disciplined over many years.

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          • Oh, and knaps, about that that feeling of continual wounding… When I was hospitalized the last time, with still having to deal with that seemingly endless fight to get my view across to these well-meaning so self-assured offenders, I was (in tears on the inside but with the need to appear ‘normal’ and agreeing and stable on the outside to get away from their need to make me comply) watching this video all the time. It is an analogy how it felt to me, having to calmly navigate through a perceived battlefield always watching my back and being highly focussed and concentrate on how I react to their attempts to ‘normalize’ me and adhere to their thinking while still holding on to my truth and my knowledge of who and what I truly am.

            https://youtu.be/7OEleTHiMtk

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          • Thanks phoenix… I do appreciate the validation around it being a tough struggle. Lucky for me I have a very hefty amount of privilege. Without that, I would never have had the foundation to bring myself to healing; I’d be like many people without social support and means to sustain themselves, facing this medical system without any resources to advocate for myself. Those people are the true ABO climbers 🙂 I see them on the streets and do not envy their difficult journeys.

            I very much enjoyed the video, thank you for sharing! I can see how it would resonate with you during that time… and I will be bookmarking it for the future.

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          • Knaps, yes, of course there are much worse and much more challenging experiences where material issues and/or extremely harsh or abusive relationships or circumstances like war come into play. But I wasn’t assessing that but… hm… emotional challenge (which can drive one crazy as well as ‘true’ ‘diehard’ trauma, you know, like poison versus a sledge hammer)…

            It sort of felt in your words that you very much appreciate your father. And being on opposite sides of a worldview while deep down loving and respecting each other (subconsciously) – that can be tough, regardless of privilege. But tough like in mastering climbing routes, not like in surviving extreme traumatic situations.

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          • thanks phoenix, yes I think you see what’s going on inside me pretty well (especially for someone across an ocean and communicating by writing!)

            Thank you, I have a hard time taking compliments sometimes 🙂

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          • To very freely quote Jung’s approach of interconnectedness, probably one of my sewage pipes is somehow going across the ocean and connects to your system [you would have to read some of my other comments somewhere on this website to get this joke]. It’s just a familiarity to your view on the world that enables me to sort of ‘get’ what you mean. Nothing extraordinary really, if you break it down to basic thinking.

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          • “Nothing extraordinary really, if you break it down to basic thinking.” – I see I’m not alone in my troubles accepting compliments!

            I do appreciate the reflection regardless. It has been a pleasure exchanging words with you here.

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    • Hey phoenix, watched another Robot movie last night (he even looked a bit like Wall-e, but predated him) from the 1980’s called “Short Circuit” – where Number Five’s “malfunction” was that he was ALIVE. This made the military and his creators extremely upset…and they tried to destroy and repair him “accordingly.” It wasn’t until you just made this Wall-e comment that I linked it to spiritual emergence…which is frequently perceived as “malfunction” by society in general, and psychiatry specifically.

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  23. If synchronicity has any relevance, and resonance – then
    http://www.miraclesinactionpress.com/dthomp74/2009/HTML%20Versions/2%20Urtext/PSY/UR%20Psychotherapy%20load.htm
    this short (channelled) treatise ‘Psychotherapy: Purpose, Process and Practice’ (ACIM) may be interesting – as a perspective neither of the ‘patient’ or the ‘therapist’ – yet addressing both.
    The terms may be offputting or trigger old reaction – but they are used in very specific meanings, quite distinct from their usual context.

    But I don’t want to go among mad people,” Alice remarked.
    “Oh, you can’t help that,” said the Cat: “we’re all mad here. I’m mad. You’re mad.”
    “How do you know I’m mad?” said Alice.
    “You must be,” said the Cat, “or you wouldn’t have come here.
    ~ Lewis Carroll, Alice in Wonderland

    The recognition of insanity – including my own – rather than projecting or out-sourcing it onto Life or Being Itself, was part of a basis for choices that grew my capacity to make choices. For paradoxically that which opens as a simple honesty to a present state is an ‘upstream’ awakening from a prior perspective.

    Psychiatry – in my mind – is associated more with the power and mandate of the State and less with a true therapeutic relationship. Psychotherapy may be sometimes available under State services but is associated more – in my mind – with voluntary seeking out of help or support.

    As the link explains, the therapist and patient have conflicting goals – and yet the true nature of a relationship – or indeed the nature of true relationship is the key or context for all or any modalities or approaches of exploring issues.

    Family Constellation work and approaches such as Open Dialog hold an honouring of the individual within a larger relational being.

    I personally managed to avoid collapsing or crashing into the realm of psychiatrists, psycho-pharma and etc – perhaps because when opening into Life from a mere dream of a life, I was more terrified of being regressed than of the the visceral terrors of an unskinned mind – and an un-manned sense of self-capacity.
    Later in my development I was also shocked to discover that fear of love was being kept hidden by fears of evil intents, conflict and terror symbols. Once I started to be able to read my own mind of conditioned reaction, rather than live the world it dictated, I was significantly unburdened of inner conflict (fear).

    I appreciate feeling the inputs in such a forum as this though I always feel for a reintegrative rather than combative outcome. However, voices that need to be heard, have to assert across the niceties of social conventions that otherwise implicitly deny them – or indeed deny us all wholeness.

    Words have been used to weave spells of a mind entranced to its own image. I feel to redeem words by using them to release rather than possess or dominate. Release and be released is a conscious use of the law of mind. However, no one can release a choice of which they are unaware of making, and no one challenges the basis of where they believe their safety lies.

    One of the things I liked in the A Course in Miracles work – is that it is natural to be the ‘Son of God’ albeit under the beliefs and experience of unnatural thinking – that is the thinking of the ‘world’ by and large.
    Transition from fear or lack-defined search to love-embodying extension of wholeness is all about getting out of our own way – but at a deeper level than the world we think or thought we know.

    Regardless whether this finds anyone, it embodies and extension of worth in which I am restored to Sanity.
    Even a trace of anxiety – alerts me to not being in my ‘right mind’ – NOT for feeding the blame identity – but to orient towards finding and living a willingness for fresh perspective rather than attempts to change others – or collapse into a changed (denied and split) sense of self.

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    • Binra, for me personally it’s quite difficult to reach an understanding of what it is excatly that youwish to get accross especially because English is not my native language. I get, that it is some spiritual concept and I can tell you, I see some value in that kind of approach to the world, as very often it feels to me like scouting the still unknown and unexplored fields of knowledge and expressing the first blueprints of whats out there.

      Still, I am favoring the scientific approach because in my opinion science is something open to all people, not only to some enlightened special ones that are exclusively able to channel or float out of their body into parallel or ‘higher’ dimensions of more delicate and probably advanced spheres. Do you understand a little what I mean? Channeled material can be an interesting read but I treat it like scouted information, it’s coming from one or two or three individuals that are giving their impression of what they have seen. The way it is currently done in many New Age schools is more like treating this information as some exquisite material for some selected higher evolved beings that are kind of worshipped for their exceptional nature. Now, scouting is a very applaudably activity that needs a lot of special abilities but its nothing really sacred or something that makes you god-like. And I think thats even often stated by channlers or mediums themselves.

      Regarding my preference to the scientific approach: it can be taught and comprended in a straight forward way so that everybody can fathom it, even if there still are levels. But even with ‘lower IQ’ (again, I am just lazy to find more appropriate words) you could train yourself and it needs much more effort but it is manageable to reach some form of understanding. Therefore, the knowledge accumulated can be discussed and evaluated by a huge group of people and thus there is way more opportunity to distinguish between fact and fiction so to say.

      But thank you, I do like the concept of synchronicity (see Jung) but I think we will still have to get a way better understanding of physics to truly make sense out of it and in particular understand why its sometimes showing itself and sometimes its not,if you sort of understand what I mean.

      The course of miracles I haven’t done or read but I think it is something like law of attraction and as much as I would enjoy my universal order of a profound lottery win being soon delievered, with a background degree and exclusive initiation in psychosis I have lived experience of the pitfalls of magical thinking 🙂 hope you get my friendly meant bitter irony. I am not making fun out of you as I hope I could get accross, I just like to also put spiritual knowledge into context and try to grasp its natural place.

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      • All true communication is a ‘synchronicity’ – otherwise robots-programs interact as codes to merely code for ‘meaning’.Nothing is then shared – except the nothing is coded to SEEM real.

        I see communication in terms of resonance – for a shared resonance is like a shared ‘wave’ within felt presence.
        Any version of un-sanity can be seen as dissonance within ourself that reflects (tunes into and receives) conflicted reality-experience.
        Any true relationship serves to tune us to coherent giving and receiving. Likewise the sense of the loss or violation of connectedness and belonging, can split or fragment a sense of struggling to survive under a sense of denial, deprivation and inadequacy – all of which apply intelligence to defences that may not be socially or culturally recognized as an attempt of self-protection – but as carrying a version of the dissonance that carries on unaddressed and unhealed – not least because it is demonised in blame or shame, weaponised by social manipulators, and marketised by corporate mind and revenue capture.

        I look to uncover my own part in such patterns of victim/victimizing so as to starve them of support, and release them for a better way of being. That this often makes me out of range to ‘normal thinking’ is a measure of just how guilt-manipulative ‘normal thinking’ is. So much so that I see ‘society’ is built upon blame and shame excepting where the love leaks through or is held true – despite persecution.

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        • Hi again binra, see, I feel that there is much wisdom and thinking and feeling in your writing, but at the same time to me it feels like so very difficult to ‘get’ what is your message. The most difficult thing in science is to break down one’s own reasoning into basic words and concepts that can be understood by all. Thats what Steffen did with this MTC treatment, he broke down complicated things into material that can be used by anyone and convey the most important concepts. I would love to start resonating with you but I am still not I am afraid… There are so many highly complex words, you know, and I need to read it slowly and slowly again and still not really grasp it. Best wishes!

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          • Yes – I write to an intuitive feeling and not to the defined, predictive control mind. I write to spark NOT KNOWING within a movement that I call innocent curiosity. There are many who deal in the ‘known’ but which is really ‘thinking’ that is invested in. Steffen’s ‘thinking about thinking’ is interesting IF it translates to awareness of patterns of thought – and their corresponding outcomes in personal and relational experience.
            I hold that the linked booklet I included above is extremely simple in its message but embodies a different foundation as to who you are are and what the world – or anything – is. It is the different foundation that holds a different purpose and so – in a sense – is like a different operating system. The ‘world’ in human terms operates an insane ‘operating system’ that is held together by narrative continuity and control – we can call this social conditioning and it is a vital aspect to our adaptation and participation in the shared human construct of self and world – yet this construct is generally taken as Reality at expense of the realty of our feeling being – which is not at all the same as emotional fragmentation and reactivity.

            My point – if there is A point is the foundation from which all else follows. A false or distorted sense of self/reality can only propagate error – and does – with tragic consequence. The protection of such ‘self’ becomes the protection of the error, and this pattern is pervasive to a world that hides its ‘sins’ in fake narratives that mask in moral justifications. And I don’t say that to judge against anyone but rather to point to the pattern that we think from.

            In Steffen’s work – what i most notice is a relationship of mutual respect and willingness to learn from and work with the ‘patient’ in discovering help that is sought and accepted. Therapists are subject to all manner of errors – particularly if they are an ‘unhealed healer’.
            I feel that that is the nature of those who try to resolve their own psychic-emotional conflicts by using others to play out their unconscious scripts. Of course we all do this apart from noticing we do it and changing our mind about our mind. But we tend to believe it is reality rather than something we made up.
            We may say that we can ONLY experience an interpreted ‘reality’ – but I hold that that applies to the mind as judgemental filtering and not to cognition or knowing itself. Of course to ‘talk about’ or make definition of reality is to separate from it to do so – in subjective sense – because we never ‘really separate’ from what Is – and that is a key realisation from which an innocent curiosity can stir in place of conditioned reaction. In simple terms this was called ‘ask and your shall be answered’. Current science posits a thing-world of determined ‘relationships’ because it is an evasion OF Relationship.
            Intimacy – in true sense – is knowing or one with. The loss of Self to ‘fragmented mind of personality conflict’ is a traumatic experience upon which we ‘think’. Or more accurately, we think we think!
            The ability to notice, question and challenge our ‘thinking’ is effectively awakening as a quality of life that our mind was blind to until something stirred or moved within us beneath the surface thinking. While I am making sense in terms of what I hold worthy – the underlying ‘point’ is more like someone calling “Over here!” to those who take their dreams to be real – and of course seek to ‘make sense’ of this in terms of their narrative continuity.
            I don’t mind at all that you or anyone else does or doesn’t ‘get’ it. For that is your freedom. I am mindful of sharing from a sense of worthiness to the worthiness in others – as a fundamental of mental health. What you give our DOES set the measure of what you receive. You extension of ‘best wishes’ to me regardless of not finding concept-resonance, is also a similar shared blessing – and I hold that point of shared resonance as a generosity of spirit.
            To those who have, more shall be given.
            “To those who have not, more shall be taken – even the little that they have”. This is not about ‘stuff’ – or about anyone ELSE doing anything to us – but addressing our self. If we live from a sense of lack – we go forth and multiply it. And so we have co-created a world of abundance of debt – and that term also applies to unpaid debts to ourselves and each other.
            May here have woken from accepting labels, identities and diagnosis that deny them wholeness and true individuality. But identity politic works through oppositional polarities as a way to bolster a sense of self-lack rather than truly move from wholeness of being – because of course that is more fearful to our sense of needing to control life.
            Those who seek to control life are subject to their own judgement as a sense of being ‘controlled’. While that is simple – the way it is set up may be insanely complex. However one does not need to understand HOW extending a blessing or alighting in a true appreciation WORKS – to experience gratitude and affection in place of addictive affliction. Finding the willingness for a changed perception begins with honest owning of the thinking that makes them. Now that a habit is brought to awareness, you are in the realm of choice. But no one can change a choice they disown by projecting it to the fault and power of ‘others’.

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          • Thankyou. I feel that like with making music together, a ‘chemistry’ of relational ease (freedom to be ourselves) provides a context in which ‘life happens’.
            I can only live this freedom by extending it (to you and others), and if (as) you feel this you (may) release me of what I am not fulfilling for your expectation, while in some sense appreciating that I am extending something I at least value to a sense of valued and accepted company.
            You are correct that my growing an articulation for what I might call ‘heart-nowing’ is like a foreign language – but anyone who is socially assigned ‘madness’ or ’not one of us’, is ‘misunderstood’ or held apart from and judged. It goes with the territory.
            Of course I appreciate any moment in a shared understanding and look to grow in the joy of that rather than be driven by a sense of needing to overcome what is “wrong with me”. If I have MY OWN acceptance for myself in lack of self-judgement and conflict – then I have a sense of this in others even where they may not yet. A healer who abides with – and lets healing be – is not a ‘heroic intervention’ so much as a temporary sharing of light into the mind of the belief in lack and separation. The gift shares on.

            That is perhaps a simple summary: the appreciation of the gift of life naturally extends or shares or shines into others unless blocked by refusal to accept or inhibition and suppression of extending as the natural and true presence that (beneath all else) we are. The nature of the blocks to love’s awareness begins perhaps with that they are hidden, denied, kept secret, operating undercover as self-protective defences to past experience of changes or ‘separation trauma’.

            It seems to me that waking to life rather than running a programmed set of strategies and responses – means using the pallet of such abilities or li-abilities as the material through which to re-cognize and align in true desire. This is easy to say – but of course perhaps the most fearful to approach – because it re-opens all the beliefs that we cant have, are deprived, denied, rejected and blah blah. But working consciously and cooperatively with life rather than asserting demand or reacting from the place of fear of failure – is like ‘feeling my way’ in the flow of the moment, rather than setting myself up to fail – perhaps unwitting – and perhaps because ‘failure’ is safer at this moment in time than exposure in self-pain. Whatever ‘society does’ to us, it is what we ‘do’ to ourself that has the power to most hurt and deny. And for me that was the realisation that set me on a course of growing in responsibility AS myself – rather than blame for an impossible situation.
            An impossible situation MAY turn out to be a faulty interpretation. In which case trying to escape or overcome it is in fact compounding the error.
            So as you say, the willingness to think around and feel into what SEEMS real opens to new perspective – freely and naturally and not under coercion, though when I cannot afford to engage old thought habits, it might seem that a sword is over my head – but I see this is because what I need is finding a way to align me on purpose, and as I align in purpose, the drama-conflict falls away. Innate teaching-learning in life can be supported by relationships as it can also attract and align them in new purpose. Healing is a decision.

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  24. Science for me is a facet of love of truth.
    If insanity – under any name is split or conflicting ‘truths’ then science in my terms is a unified uncovering of the truth – which is recognized by its fruits – ie you Know by them. But science in the world has very strong identifications (ie: insanity) in definition, prediction and control.
    How we define ourselves in relation to our world IS our experience of it. If ‘therapists’ define themselves as the fixing or managing of broken or inadequate people then that IS how they experience AND what they ‘teach’ by demonstration. However, what anyone chooses to ‘learn’ or accept true for them is their own core freedom – subject ONLY to being awake and aware of such freedom. This is the nature of spiritual awareness and not the lure of gaining power or possessions in the ‘world’.
    The well adjusted insane have NO idea that there is a transcendent perspective that their own thinking excludes, and those whose mask or armour breaks down have glimpses that often lead to ego-inflation and ego-alien encounters in terror – because we (generally) lack a culture of initiation and support for what would only be natural ongoing human flowering or development – if not for the normalising of insanity in forms of dissociation and denials as our ‘social masking’.

    Physics has application in consciousness in terms of what you put in is what you get out. Because we are ingenious in the way we structure our minds, we have subconscious levels of active choice operating beneath a waking surface of narrative continuity – as the story of ‘me’.

    I appreciate and enjoy a sense of willingness to dialog without locking each other into rigid definitions. This is a willingness to honour relationship without a frame of only using each other to get from.

    Talking about spiritual knowing is only useful if it enables releasing talk or thinking about reality so as to be it. The essence of knowing, is that it cannot be defined – and put into predictive control thinking. In scientific terms this is always being the willingness to challenge the thinking by which we believe we know. Believing we know generally means we are blind and therefore treat others and ourselves in terms of beliefs instead of looking, listening and receiving of them.

    A central facet of A Course in Miracles is that it regards Creation or indeed our filtered distortion of Creation, as Mental or within Mind. I could list many other approaches that say the same in other facets and slices – but to A Course in Miracles (as opposed to the normalised learning of a course in grievances), all sickness stems from unforgiveness that may manifest in many forms – or over many generations – and serve many purposes. The only meaning I see in the word ‘spiritual’ is self-honesty. Without that, nothing else can align true – and with it all else can follow. People can and will use anything and everything to deceive themselves with, while other goals are more compelling or attractive to them than self-honesty. That is also their right and their freedom as an unfolding experience of self-recognition.
    Self-honesty is not framing oneself in a diagnosis or negative definition – even if there are negative results as a result of conflicts that have come up to be addressed in forms of deeply challenging experience or relations.
    (I am not anti science – but all of what folks here have understood regarding corruption in ‘psycho medical’ applies across the board. Corporate science is part of a system management replacing human relationships.
    Science needs to be significance within Meaning – and splitting life apart to get different meanings is a split mind and an insane world – in which “everything is backwards”. Science has to be a willingness and curiosity for truth – not a determiner or tool for the narrative dictate of corporate (social) engineering.
    Whatever “THEY” are seeking to achieve by ‘control’ is at expense of true relational communication. So I don’t step into or invest in ‘THEIR’ framework but grow in true appreciation. (They only have access to who I am through my own thinking and so my sense of active ‘spritual’ practice is to become aware of my own thinking – which mean awake to it rather than simply run by it. Doesn’t matter that I ‘forget’ because when I notice I forgot I am back in willingness. Everything has to shift to support the desire for a sanity of a peace of being instead of running from fear or being consumed by grievance. It is always a step at a time and only this step now. Not a load of ‘spiritual concept baggage’.

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  25. [sorry, was written in a hurry, please excuse grammar and errors]

    Hey guys,
    Welcome back to the forum or… well…perhaps I should say Coliseum 😉 The blog has taken a very different turn since I left and I am not so sure if anyone is still here. I guess, you might be around, Phoenix, and there might be still some bullets left for me in your gun, “Slaying_the_Dragon_of_Psychiatry”.
    For lack of space my responses will be mainly directed to you, Phoenix, as you have written by far the most. Still, I would like to thank all of you for your comments and replies. While I do not agree with all of what has been written, I respect the different opinions expressed and is has urged me to make some significant changes pertaining to the MCT. Most importantly, we will create a developer version of MCT which will allow clinicians to re-write text on the slides. Some translations need to be improved and I also agree that some formulations can be viewed as stigmatizing although this was never intended. I would now prefer to speak of individuals with psychotic symptoms rather than equating people with their diagnoses. However, please look at the additional module on dealing with stigma where we make very clear that psychological problems are ubiquitious and that even psychotic symptoms are known to many many people.
    I have read the manymanymany replies (thanks) during my vacation but felt unable to answer, mainly because it takes a lot of time to enter text in a mobile phone plus it has a German auto-correction function (do not know how to disable it). It would have made my grammar even worse. I remember from one German forum that a member even doubted I was a professor because I did not set commas properly ;-)). So, please excuse my absence,
    I am still on vacation but home now and can type from my computer. I will make my reply as short as possible. I must say that I was not very happy about the language, especially by you, Phoenix: “do-gooder-bubble”, “kindergarten level”, ” being the kind and jolly good person as you prefer to come across”, “You believe in different sets of people which are determined by their genetics, their temper, and their childhood upbringing” – you are quite eloquent and you have complained about abusive language and patronizing behavior. Why not be nice yourself to a person who you do not know
    Try walking in my shoes. You are anonymous; many of you have fancy nicknames while I am here with my full name, email etc. I do not expect a lot of respect and it is good to be critical but you might have found some expressions insulting, too, if you were me.

    From the dozens of sentences that have been written since my last post I will first address the below ones because I thought about these the most:
    “Could you see yourself becoming mentally ill? Severely depressed maybe, suicidal? Or, god behold, straight out manic, jumping out of your bathtube in excitement and running through the rain to the bar full of happiness but stark naked. You seem to be quite a reasonable person thus mania would probably free all your deep cravings to finally just let it all hang out for one day.”

    I have picked the quote (A related quote from phoenix starts ” I also sincerely hope that Steffen and others without lived experience…”) because I have heard this many times before. Many individuals with mental problems seem to think that their clinicians are perhaps ignorant and cold but (or perhaps because of this) super-resilient and never experienced *severe* mental problems themselves. This is not true. Freud was one of the first to disclose mental problems in his “Psychopthologie des Alltageslebens” (Psychopathology of everyday life) where he reported experiences of auditory hallucinations. Marsha Linehan, the founder of dialectical behavioral therapy (DBT), an accepted and evidence based treatment for personality disorders, was diagnosed among other labels with schizophrenia in her early life: https://www.nytimes.com/2011/06/23/health/23lives.html
    Being a psychologist/psychiatrist or patient is not mutually exclusive at all and I have struggled with mental health problems myself. Not happy to talk about this but this seems to best way to gain some creditability.
    When I was 18-20 I met FULL criteria for anorexia (my mother had it too). I somehow made it without treatment. So according to the bio-bio-bio model that some of you suppose I am clinging to I would be more vulnerable than phoenix and others as I got a mental illness a lot earlier and with far less stressors (father died when I was four, that’s almost all – just a difficult and sensitive child, I guess etc.). For some, I might look now like Anakin Skywalker turning into Darth Vader. I still consider myself vulnerable in a sense of being unstable under stress and sensitive. This is also a point I want to bring across in the MCT. Cognitive biases are normal and must not be understand solely as weaknesses. Biases (e.g. inflated responsibility and perfectionism in OCD) can also be virtues. It all depends. Biases are not biological flaws and can sometimes be induced by context. For example, if you experinentally induce a dilemma or severe doubt most people will react subsequently with compensatory overcertainty (a student of mine just completed a thesis on this).

    I have been in psychological treatment later for tinnitus (I am a great fan of Heavy Metal and have a Judas Priest tattoo; did not carry ear plugs during an extremely loud “Annihilator” concert because in former times this was considered against the rules of RocknRoll – this was when the tinnitus started ;-)) and I never regretted it and I am not ashamed. The therapist and I are not talking much about the tinnitus any more (I have accepted it and I sometimes do not hear the noise for days although it is there) but with other problems, some of which can be labeled mental health issues. We all struggle!
    I was never the brightest kid in the yard (I like the German equivalent better which goes like “no the brightest candle on the cake”, not sure if that exists in the English language, too) but I think I am a good psychologist because I have made my own experiences with mental problems and tried to amalgamate personal experience and the urge to help myself and others with psychological methods. This has led to several self-help manuals that my unit provides at no cost in many languages for, just to name a few, auto-aggressive behavior (www.uke.de/impulskontrolle – click on English page) and obsessive thoughts (www.uke.de/assoziationsspaltung). These have been validated by independent groups. I am not self-complacent and think I am healer or so. What might have worked for me, might not work for others, so everything needs to be evaluated and thrown in the dustbin if results are not good. For MCT meta-analyses show that it has an impact on people’s symptoms and I am disappointed that this is not really acknowledged by anyone here.

    The other quote I would like to pick is this:
    “Steffen, you cannot trust whatsoever positive feedback your patients give you. As a mental illness patient you get trained to give the right answer and you are pressured into the feeling of being intrinsically inferior. Everything you do, the way you feel and think, is permanently critizised allthough you are simultaneously told its not really your fault. Your subjective experience is downplayed and given little value”

    I understand your point, Phoenix, but why not ask how we measured acceptance? Why making such bold conclusions? I know many patients hide their opinions for fear of rejection or other negative consequences so we ask all patients in Hamburg to “vote” and throw their score sheets in a box with no name on it but just a symbol (this symbol allows us to analyze personal developments even though we do not know who the person is). If a patient refuses, which happens sometimes but not often this is totally OK. Most of the time, patients like that we ask them for their judgments and to assess how we did ad how we can improve!

    I would like to end with the final words poor Barbara Graham uttered before her execution: “Good people are always so sure they’re right.” This is directed to both many of my colleagues but also a lot of people in the antipsychiatric movement. You seem to know it all! Why not discuss and see if we can learn from each other, why shouting (or writing?) the opponents down. Psychologists in psychiatric institutions are sometimes seen as the naive “Uncle Toms” of psychiatry who stand in the way of an epic battle between good and evil. This is wrong in my opinion. Psychotherapy can help a lot of people, even with severe mental problems. However, funding is poor and we need more financial support but perhaps more importantly more encouragement. Of course I would be happy for donations for the MCT but I am equally happy for donations to other psychotherapeutic treatments or organizations like MIA who try to bring together patients, relatives and clinicians.

    Yours, Steffen

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    • Steffen, I haven’t read through your whole response yet but I already feel its going in the right direction. Please excuse my use of language and expressions that might sound very rude and emotional coloured to you at times.

      Wir können auch in Deutsch diesen Teil ‘ausfechten’, ich stamme aus Österreich und Herr Moritz, Sie sind sich den gewissen kulturellen Differenzen zwischen unseren Ländern sicher bewusst. Ich kann Ihnen sehr wohl auch mit der Ihnen gebührenden Höflichkeit begegnen, aber die Feinheiten würden sowohl Sie als auch ich nur in unserer gemeinsamen Muttersprache verstehen. Ich würde Sie auf Deutsch niemals in einer wichtigen Konversation mit Dialektbegriffen und österreichischem Schmäh konfrontieren, sondern sehr wohl gewisse gesellschaftliche Regeln beachten. Ich verstehe auch die unserer Kultur gemeinsamen Formen des Umgangs zwischen unterschiedlichen Positionen zB den Unterschied zwischen Patient und Arzt oder Patient und klinischem Psychologen. Sie sind hier in diesem Forum in der schwierigen Lage, dass Sie beruflich agieren, während ich auf der Seite der (ehemaligen) Patienten stehe. Mir sind diese Verhältnisse sehr wohl bewusst. Ich hoffe, Sie haben von mir nun genügend Rahmenbedingungen bekommen, um meine eigentliche Intention und auch die Art meines Humors korrekt deuten zu können.

      I would love to add more profile information on my part like a photo but I would hestitate to openly state my full name because of the stigma attached to being a former patient. It could severely damage my career especially because I am also a woman in her thirties which is difficult enough. Steffen, i think you can grasp the difficulties one has with being taken serious after having lost the mind especially in German speaking countries where rationalityn and being in firm control of ones emotions is valued so very high.

      This I felt like was needed to be stated rather quickly. Now I will enjoy reading through your comment with more focus. And by the way, I am very happy and relieved by your reply. Something I would never tell you in a coversation in German interestingly.

      Yours, phoenix

      bzw. ich danke Ihnen sehr für Ihre Rückmeldung und Ihre Bemühungen, meine Sichtweise gewisser Sachverhalte zumindest in Betracht zu ziehen, sprich darüber nachzudenken, ob ich in manchen Belangen einen wichtigen Punkt gefunden habe, der Ihnen bei der Verbesserung Ihres Ansatzes hilfreich sein könnte. Ich verbleibe neugierig mit den besten Grüßen aus Ihrem Nachbarland.

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    • Just to keep English speaking followers of this conversation an update on artificial intelligence and the kind of humour it is capable of already displaying:

      This is the google translation of the German part of my talk with Mr. Moritz:

      Zu Deutsch wechseln
      We can also ‘fight’ this part in German, I come from Austria and Mr Moritz, you are certainly aware of certain cultural differences between our countries. I may well meet you with due courtesy, but the subtleties of both you and I would only be understood in our common mother tongue. I would never confront you in German in an important conversation with dialect terms and Austrian nonsense, but I would certainly observe certain social rules. I also understand the forms of dealing with different positions common to our culture, eg the difference between patient and doctor or patient and clinical psychologist. In this forum you are in the difficult position of being a professional, while I am on the side of (former) patients. I am well aware of these conditions. I hope you have now received sufficient framework from me to correctly interpret my actual intention and the nature of my humor.

      […]

      or thank you very much for your feedback and your efforts to at least consider my point of view of certain facts, that is, to think about whether I have found an important point in some matters that could help you to improve your approach. I remain curious with the best regards from your neighboring country.

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  26. Hey phoenix,
    Thanks for your 2 latest posts but I must admit that I a bit disappointed that you did not read mine to the end. It took me quite some time to think about how to respond and I might deserve to be heard, too. Ok, there is clearly some redundancy in my blog but you won’t find out until you read it to the end. MCT is about attenuating overconfidence and delaying momentous decisions – this is nothing that at least I have learnt in kindergarten and I continue to think MCT is a new approach (especially as we have created a lot of seeing-is-believing hands-on exercises, see especially module 4, where people are demonstrated that jumping to conclusions and overconfidence foster incorrect decisions in an entertaining and non-insulting way). For both people with and without mental problems but especially for the latter because they are easily taken away by emotions (not all, but many!) it is often a good idea to hear each other out and perhaps sleep over something before we jump to our guns/to conclusions.
    respect because I am doctor/patient-doctor relationship?: This is not my attitude at all. I come from a working class family and I do not think I am superior to a non-doctor. No joke: I had a little speech impediment when I was awarded professorship because I tried to come across very intellectual and started fuzzy sentences I was not able to finish 😉 We should respect everybody regardless of education, gender etc. My former boss and head of the clinic was always making fun about himself for his bad marks in school. In Hamburg, my hometown, we have a saying that fits quite well: the boy is no good for business, he has to go to university ;-)) All I wanted to express is that saying that someone is creating kindergarten stuff, is living in a do-gooder-bubble or has developed a dehumanizing approach (many other *expressions* [again, the content is debatable] that would have insulted you or others perhaps too) as some bloggers put it is neither polite in Vienna nor in Valdiwostok and is undeserved in this harsh tone in my opinion!
    I would be happy to hear from you sometime but perhaps not today!

    Yours, Steffen

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    • Steffen, I just do not have so much spare time, I am working full-time and studying and have a family life. I know it may appear that I am bored and thats why engaged so much on this board over the last week, but thats not the case. I am in desperate need to leave MIA again for some while and turn to my own business. Enough debate on a subject that I already left behind, I am no longer suffering from mental illness and I have no business with psychiatrists or psychologists anymore. I now understand why everything hapoened the way it happened in my life and this massive opening up on my part and these many posts of mine actually make me ashamed a lot. But it felt necessary to me, I wanted to be of service. To all people who felt annoyed by my many comments I sincerely want to appologize. I am now leaving and might just come back from time to time like others do. Thank you all for reading and letting me talk freely about my various opinions on various subjects.

      And Steffen, I wrote you an email on your public email (the @uke.de one) for you to ensure my identity and alliw for any more private questions you might have.

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      • I think Steffen you are missing a core point. You can humanize yourself all you possibly can and yet you are in a position of mainstream authority and these commenters here are not.

        Sadly you are repeating the trauma of our experience with the mental health authority, whose own still unresolved ‘stuff’ gets in the way of being able to hold the emotional pain of the client. Underneath the anger stemming from this oppression there is real feedback about your approach here.

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  27. Dear phoenix,
    Thanks for your kind and funny emails, I hope we stay in contact. No need to apologize!
    By the way, my favorite Austrian words are “Pfiat Di Lackerl” (especailly in Kärnten) or “Fluchtachterl” (last 1/8l wine before you leave the bar) and “Stiegenhaus” (staircase).
    “Phoenix”: funny, we have just developed an imagery rescripting self-help manual for people with depressive symptoms called “Like a Phoenix from the Ashes”: https://clinical-neuropsychology.de/imagery-rescripting/
    @knaps: As I said. If you and others like to view me as an Anankin Skywalker on his way becoming Darth Vader, that’s OK. Time wlll tell whether my colleagues and I will succeed to change the system for the better or become part of it.
    All the best, yours, Steffen

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    • Dear Mr. Moritz, I am charmed that you felt the need to publicly announce our ‘Waffenstillstand’ – and sorry for that term of war but it ‘feels’ just right at the very moment – but please be so kind and let me make you understand some slight cognitive fallacies regarding my cultural background which does indeed possess some common shared principles but quite stern differences as well:

      (i) I am from a catholic country where the weekend still is ‘holy’ and you are very lucky indeed that its not Sunday yet
      (ii) you are for my feeling dangerably close to make us both loose or undermine credibility with your exposure of your interpretation of the kind of Email exchange we had… for spectators: Mr Moritz and I discussed an issue between our respective countries that happened took place in Cordoba, Argentina in the year 1978 in a soccer area. This exchange helped him to understand my way of sarcasm and humour. For the interested ones, I will provide a link, but please leave both of us, Mr Moritz and myself alone with history, because this Website here is about much different topics.

      https://youtu.be/koD8ARIWgUg

      This video helped Mr. Moritz to understand that we are in different teams but are still playing for the same goal – getting united to be able to have (sport) events together where we still wear national colours but where we do not start a war again like the last time an Austrian unsuccessfull painter went to Germany where he started something really cruel that quickly took over whole Europe. By the way, Alice Millers analysis of that painter guy is incredibly sharp sighted.

      (iii) I will not comment on your nice approaches to communicate in my language but will be so polite to explain to you that where I live every valley has its own dialect which might get you lost in interpretation rather quickly…

      (iv) I can now announce with absolute certainty that Mr Moritz is indeed the decent guy he presents himself, a great being even by German strict standards, “TÜV geprüft”, (oh, I found the “ä, ö, ü”s on my keyboard that I somehow missed in my first German approaches to greet Steffen and come to an understanding despite sharing a language that divides us)

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  28. I felt the need to clarify one thing, maybe ‘mental illnesses’ do also apply to certain countries because of historic reasons. In Austria there is still much debate wether this country was the main reason for both World Wars to have started or especially in case of WWII if this country was the first victim invaded by Germans (in case of WWI it was the Austrian Archsomething that got murdered I think in Serbia or somewhere). To make you all understand my beef with Mr. Moritz more clearly, the German are finding it amusing that Austrians cling to Cordoba 78 in a ‘childish’ way as they interpret it. To use and quite freely quote Hans Krankl, who shot the goal, he answered “you say you can’t hear us talking and mentioning about it, but we won’t stop, you will hear it always and ever aand for good again, because to us it just was something beautifull, if you can understand it or you won’t, that doesn’t is much of a concern to us, really”. It might help some of you understand that there can arise trauma from being the perpetuator as well. Thank you, Küss die Hand!

    https://youtu.be/5wOSL6ySDkU

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  29. Hello,
    Based on the above discussion in Mad in America in May, MCT is open source now: https://clinical-neuropsychology.de/mct-os/ This took a while, sorry for the delay.
    This means that you can edit/alter the MCT as you like. I agree that some phrases/terms appear stigmatizing (clearly, this was never our intention!). So, we are fine if existing slides are deleted, new ones are edited etc. All the best and thanks for all the input. You can register at no cost regardless whether you are a clinician, patient or a relative.
    I learnt a lot, yours, Steffen

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