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

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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“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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Ok good, but these techniques are not actually new.

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“…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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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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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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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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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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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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fully agree!

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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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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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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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“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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Dear samruck2,
I am really sorry to disappoint you as you have invested a lot of time in your post but I have no simple answer to that. Dissociation itself is a heterogeneous phenomenon as you know and clearly multi-causal. Yours, Steffen

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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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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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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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Hey Flachra,
Thanks a lot. Yes, I know his work. Really happy that your condition has improved and that psychotherapy has been helpful.

Yours, Steffen

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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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“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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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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interesting post and informative blog. thanks for this post

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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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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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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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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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And Steffen, because you like videos…I love the scene in the Wall-e movie with the repair ward where these ‘malfunctioning’ machines later get freed and help wall-e and Eva in their quest – as they are without having been ‘restored’ to function ‘normal’ again.

https://youtu.be/iigKPkLB5IQ

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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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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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[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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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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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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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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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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