Seven Strategies to Avoid Retraumatization While Working with Psychosis

Tim Dreby, MFT
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Stories related to psychosis can be intense, and can lead to traumatic recall when a sufferer retells them and does not feel contained or believed within the relationship. Perhaps this is the reason many therapists, family members, and psychiatric wards learn to shut down the telling of the story.

Shutting down stories can be seen as protecting the psychosis survivor from unnecessarily reliving the experience and going through the distress again. Perhaps this is done to avoid a fight or yet another power struggle over reality. Activating trauma that you cannot stand to consider is a bad idea, right?

Imagine being a person who has experienced psychosis and having the entire mental health system agree not to let you tell your story as a boundary. This strategy is employed over and over again despite the fact that recipients of this kind of care often become progressively more isolated and distressed over time.

Perhaps no one in the system can imagine what it is like to experience systemic indifference to traumatic material. Indeed, is it really so impossible to believe that these experiences are real and there for a purpose? Is it really so hard to believe that the person in psychosis may have some perceptions that are spot-on accurate? Not acknowledging them can be cause for further social withdrawal, instill a sense of hopelessness, and do further damage to an already ailing self-esteem.

Trying to stay on the same page as everybody else may teach a person to suppress their experiences. While symptom suppression may decrease social attacks and ridicule, I also believe it is the wrong tact for many. Too many people suppress, isolate and withdraw from social functioning. Is it not possible to create spaces and relationships in which experiences of psychosis can be dealt with in mindful manners? If survivors can be believed by supporters, if their experiences can be credited with having profound meaning, then perhaps outcomes could be better.

A New Strategy with Survivor-Led Groups

I have come to strongly believe that shutting down stories related to psychosis is the wrong thing to do. I believe this so strongly that I have come out as a therapist with lived experience with madness. I regularly share my experiences in group therapy to facilitate group reflection and the telling of stories.

I credit the Hearing Voices Network for prompting me to take this plunge. Word of survivor-led groups achieving remarkably different results prompted me to start a curriculum for professional groups. In the curriculum, which I have turned into a training and a group therapy guide, I deconstruct what psychosis is into solvable components.

It’s true that there are times when I wonder if coming out mad was the best career decision. I have had to bravely admit my vulnerabilities, which sometimes seems to hurt my credibility. And yet I find that being an artfully unreliable narrator helps guide people to their own truth more effectively. I feel I get better results having taken the plunge.

Being out has helped me exponentially in creating specialized care for psychosis survivors. As a result, I have a number of suggestions for how to encourage the telling of stories without retraumatizing survivors in group settings and in individual encounters. Many of these suggestions are based on replicating realities that happen in survivor-led groups.

1. Eradicating Stigma and Grounding Participants

Many supporters actually believe that people who experience psychosis are fragile. It is one of the three most dominant stigmas about mental health challenges, according to Patrick Corrigan’s research.1 As a professional, I have heard this said so many times and I am convinced that my colleagues say this because they don’t know what “psychosis” feels like. At times, simply reversing this stigma can help ground someone who is in psychosis and remind them about how tough they are to be handling such real trauma.

There are other grounding techniques that I have utilized when I sense the group is starting to feel traumatized. Often, acknowledging the trauma in the room and allowing the groups to socialize and focus on related movies, music, or art can help. If group members initiate this process, it is good to compliment and acknowledge what they are doing as being helpful. Instead of controlling the group and staying on course, collaborating and enhancing these efforts is advisable.

2. Believing that Psychosis is Happening for a Reason and Holds Truths

I already said this, but it stands to be further emphasized.

I believe that if classifying experiences that trigger psychosis as an ‘illness’ can retraumatize many, finding value in those experiences will help ground many psychosis survivors who are in distress. In other words, when the helper meets the content of the survivor’s experience with curiosity and interest, the psychosis survivor is less likely to be traumatized. In contrast, if the supporter exudes the belief that the psychosis survivor will be traumatized, this outcome will be more likely to come true.

Often the survivor leader is excited to learn that others relate to them, and has a high level of hope that others can achieve wellness in spite of disturbing material. Thus, getting naturally excited when a person is sharing details and having strong beliefs about recovery being possible helps deepen the threshold for what others can bear.

Additionally, studying different causation frameworks that psychosis survivors hold gives participants a basis for understanding how experiences that trigger psychosis are possible.

In therapy groups I have often suggested there are six styles of causation frameworks that operate in different ways at different times. Sometimes the experiences may be caused by or related to political, psychological, traumatic, scientific, spiritual or artistic factors.

Knowing which framework explains a given trigger is often impossible! However, I believe that the more types of frameworks the psychosis survivor uses to explain the triggers, the more likely that they will be able to navigate the trigger in a functional manner. Positive knowledge about all explanations helps one find the value of each experience.

The more explanations the supporter learns, the better they can help make valuable meaning of these disturbing experiences. Giving up and calling the experiences meaningless does not help.

When there is a purpose for suffering, it is far more helpful.

3. Sharing Your Own Experiences with Psychosis

One of the huge benefits of survivor-led groups is that the leader also shares their own experience with psychosis. This opens people up to telling their story because it defies the dysfunctional boundary that exists between clinicians and patients—the presumption that the clinician is ‘well’ and the patient needs to learn wellness from them because they know better.

Additionally, when a survivor leads the group and discloses their own experience it sets the stage for more sharing.

One reason I believe this works is that if group members are free to judge the leader as being delusional, they get the chance to do some projective identification testing. If they do judge the leader as being delusional and see that it doesn’t bother the leader, they will become more emboldened to take the same risks and withstand others who may try to reality-check them.

Another reason self-disclosure in survivor-led groups works is because many in the group will believe the leader’s story and support them, as that is the way they want to be treated if they tell of their own experiences. Therefore, a leader who is prepared to believe some pretty outrageous stuff in a reciprocal manner is generally appreciated by many in the group.

Whatever place the group participant may be in, the tendency is to become compelled to share. I believe that sharing breaks down defenses and helps the participant let go of the traumatically reinforced material.

4. Spotting and Sharing Related Experiences to Achieve Cultural Competence

Many workers in the mental health system might say they can’t share their experiences with psychosis because they haven’t had them. Though I agree that it can be harder to relate to psychosis material if you haven’t had those experiences of being in a crisis, I think most workers likely have had some related experiences; if they learned to identify these and articulate them it would be helpful for psychosis survivors.

If a mental health worker sits in group and understands the experiences that trigger psychosis, they will probably learn to be able to relate. Additionally, being able to relate normalizes psychosis experiences and makes it safer to disclose without feeling like others don’t believe you and don’t care. In the definition of psychosis that I have created, things like dreams, interpersonal interactions, and intuitions can trigger alternative realities. I think workers can learn to relate using those common experiences and learn to join the conversation.

I think this is a measure of cultural competence. If you can see serendipitous events and imagine thoughts that may come up from them, why not share those with the psychosis survivor? Why not think about how you might explain those experiences in creative manners? Doing so isn’t going to hurt you. It is a sign of wellness and empathy.

5. Knowing When the Story Is Really There to Test You

It is important to know when a psychosis survivor is simply trying to establish her or his right to tell the story. In the past, survivors may have been interrupted or challenged when they tried to tell their story. Some will tell fragmented stories to see if they can get away with it and keep your interest and concern. I have been known to get in there and fish for special message experiences to demonstrate that I am there with them. However, it can be important to notice when this isn’t wanted and just let the person tell their story without being judged for doing so.

In many cases, the traumatic response may happen when the test has failed yet again. Indeed, I think it is important not to be concerned about whether the psychosis survivor’s comments are accurate or fit into your reality. Perhaps it is possible for the leader to make a few inaccurate-sounding comments themselves. This helps normalize and permit those experiences and paradoxically challenges the psychosis survivor to question themselves.

This is not to say that there is not a time to challenge an inaccurate comment that is made about you; there is a point where this can be effective. But first you have to repeatedly pass the tests. And acknowledging that you don’t understand everything about yourself and that they may be seeing something you are not aware of can help put off the challenge until the test is passed.

6. Bringing Other People or Situations Into the Discussion

If I am afraid that a person is going to get triggered by sharing their psychosis story because the group is inattentive or emotionally absent, I may try interrupting and identifying a triggering experience the participant has referenced and ask other group members if they can relate to the experience. If I am not in group, I may think of a similar experience I have heard before and share that experience to prove that the person is not alone. Usually, at least, I can relate to the triggering experience and share a story. This not only prevents the participant from feeling quite so alienated, it reminds them that others can relate and deepens the support in the room.

Likewise, if I am able to listen and discern some conspiracy ideas that might explain some of the triggering experiences and I fear retraumatization, I may propose that the group talk about that particular brand of conspiracy and how it really is possible. Again, this may help the participant feel like they are not alone. Group conspiracy talk is another way to deepen the threshold of what the group can tolerate and invite stories.

With other people relating and participating, the person telling the story is less likely to be retraumatized and may feel more supported. Then, it is a great idea to return to the story and hear it out intensely without having need for reality tests.

7. Addressing the Fact That You May Be Recording What Is Said

In many countries where the Hearing Voices Network has flourished, such as England, the Netherlands, and New Zealand, socialized medicine enables support groups to be funded outside the system where there is no need for clinical notes. This also helps create a sense of safety that invites disclosure.

Indeed, if group records are going to be taken by the facilitator for reimbursement purposes, that needs to be addressed in the room, identifying the potential for conspiracy.

Letting the participants know what I believe about the notes and the potential for them to be used in an abusive manner without my knowledge is a strategy I often employ. I point to computer screens and light fixtures and suggest that if they can put cameras down peoples’ colons, they can certainly bug the room without my ability to protect the group participants. I believe it is a disservice to promise a psychosis survivor that their material is safe. We are not in control of their ideas of reference that may be confirming unsafe realities. At least when the helper acknowledges the limits of their power it validates the concern.

When I document what takes place in a group, I also note that I have used my own lived experience to crack open stories. I tell participants that I do that. I think doing so demonstrates integrity and clarifies that the note is not written with the intent to do them harm. I also think doing so reduces stigma of the chart reviewers and takes away the perception that the helper will turn on the group participant and abuse power.

It is ideal when these issues can be avoided, but I also think it is possible to address them if you have to take notes in order to bill in the health care system.

Specialized Care Is Necessary

I believe that utilizing these strategies and other well-documented efforts of the hearing voices movement can help clinicians grow and come to a point where they can listen to stories of psychosis and contain them just like survivors can. I think that people who choose to specialize in this type of care need opportunities to grow and learn to contain such stories, and that survivors need opportunities to become specialists and lead groups themselves. Specialized care is most certainly needed.

Show 1 footnote

  1. Corrigan, P, Watson, A, “Understanding the impact of stigma on people with mental illness,” World Psychiatry. 2002 Feb; 1(1): 16–20.

18 COMMENTS

  1. Excellent post!

    I was not aware that it was a formalized tactic to encourage psychosis survivors to suppress their stories! I have wrestled with a push and pull approach to telling my story or hiding it from everyone.

    Starting as a personal catharsis, I tried to blog about what it was like to live with psychosis. But the effort became a severe stressor for me as I relived the fear and confusion, post by post. Finally, I deleted the blog and gave up on the effort.

    Several months later, I became involved with a therapist that often issued writing assignments as part of my recovery. She loved my writing and enthusiastically encouraged that I begin a blog, writing under a pseudonym, as part of my therapy.

    Now, when I write about my experiences, it enters into the dialogue of my therapy as she subscribes and reads each post.
    I have since expanded my content to include news and information about mental illness.

    Coming out with my story publically has been extremely helpful for me. I have yet to reveal my real name, but I intend to do that soon.

    If you’re curious, you can read my stories of psychosis at breathingwithanoose.com

    Thanks for a great post!

    • Oh, yes, it is a very common “formalized tactic to encourage psychosis survivors to suppress their stories.” I had to stop trying to discuss my “psychosis” with my psychiatrist, because he constantly claimed it had nothing to do with reality. I did end up painting the whole story, in the privacy of my home, and writing about it, too, since I’m an artist.

      My Jewish psychiatrist did finally look at my work, and concluded it to be the “work of smart female” and “insightful.” So my psychiatrist overcame his delusions I was “w/o work, content, and talent,” and weaned me off his neurotoxins. But I am a big Chagall fan, and Chagall was a Jew who survived the Nazi psychiatric holocaust of the Jews. So some of my work pays homage to Chagall’s wisdom and insights.

      But my psychiatrist was mighty embarrassed, to the point of being downright paranoid, once my family’s medical records were finally handed over. Because it turned out I had medical evidence of the abuse of my child in those medical records, and my entire anticholinergic toxidrome induced “psychosis” had been about having the “voices” of those child rapists in my head, bragging about their crimes.

      Not to mention, since that psychiatrist had gotten all his misinformation about me initially from a psychologist who was good friends with the pedophiles and their pastor, and none of those people actually knew me. And my psychiatrist had never bothered to actually listen to or believe me, his medical records were filled with tons of provable lies and gossip about me. Which made him look like a delusional schmuck.

      And since my artwork is now so damning, or “too truthful,” regarding my childhood religion’s, and their “mental health” workers’, systemic child abuse covering up practices. A psychologist from my childhood religion recently attempted to take control of all profits from my work, all my original work, my story, my accountants and lawyers, eventually steal all my family’s money, all under the guise of a BS “art manager” contract. Of course I didn’t sign that contract.

      But make no mistake, our “mental health” workers, and the religions who own the hospitals, are terrified that their multi billion dollar, scientific fraud based, primarily child abuse covering up, iatrogenic illness creating “mental health” and social worker system will be exposed for what it actually is.

      No, no, no, the last thing they want is for the truth to come to light. The last thing they want the masses to know is that all the anticholinergic drugs, which I think is most the psych drugs, can create “psychosis,” via anticholinergic toxidrome. Which is none of their BS DSM disorders, it’s merely a medically known way to poison a person, and make them “mad as a hatter.”

      But what our “mental health” workers need to learn, is it will also make the person hyperactive, not always “inactive,” as would be the case if the person were suffering from neuroleptic induced deficit syndrome. So those poisoned via anticholinergic toxidrome will go ahead and hyperactively paint and/or write about all the scientific fraud based “mental health” and religions’ systemic child abuse covering up crimes.

  2. “Is it really so hard to believe that the person in psychosis may have some perceptions that are spot-on accurate?” No, but automatically disbelieving all people who come to you for help is insane behavior. “Trying to stay on the same page as everybody else may teach a person to suppress their experiences.” Absolutely true, if you automatically disbelieve or dismiss everything a person says to you, they will absolutely stop sharing most relevant information with you. “If survivors can be believed by [‘mental health workers,’] if their experiences can be credited with having profound meaning, then perhaps outcomes could be better.” Yes, absolutely.

    1. “Many [“mental health” workers] actually believe that people who experience psychosis are fragile.” I agree this is BS, thus “reversing this stigma” is imperative. “As a professional, I have heard this said so many times and I am convinced that my colleagues say this because they don’t know what “psychosis” feels like.” Just an FYI, if the “mental health” workers would like to know “what ‘psychosis’ feels like,” so they may properly help those who deal with it. I do recommend they briefly take a taste of their own “medicine.” Since, particularly the antipsychotics, but also many of the other psych drugs, the anticholinergic drugs, do create “psychosis,” via anticholinergic toxidrome.

    https://en.wikipedia.org/wiki/Toxidrome

    2. I agree, “when the [“mental health” worker] meets the content of the survivor’s experience with curiosity and interest, the psychosis survivor is less likely to be traumatized. In contrast, if the” “mental health” worker ignores and denies their client’s real life concerns, a bad “outcome will be more likely to come true.”

    And this would be particularly true when the “psychosis” is created with the anticholinergic drugs. As well as when the goal of the “mental health” workers is participating in and covering up the abuse of a person, or their child. And profiteering off of covering up child abuse and rape has been, and still is, the primary actual function of all DSM believers for, apparently, over a century. Because none of the DSM believers can EVER bill ANY insurance company for EVER helping ANY child abuse survivor EVER, without first misdiagnosing them.

    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo

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

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

    Based upon my experience “the experiences [of “psychosis” were] caused by or related to political [abuse of psychiatry], [political abuse of psychology], [a cover up of] traumatic [events], scientific [fraud], spiritual” emergency turned to a spiritual awakening, and a desire on the part of the scientific fraud based “mental health” workers to silence all truth seeking and visually truth telling artists.

    I agree, “calling the experiences meaningless does not help.” For goodness sakes, my anticholinergic toxidrome induced “psychosis” was all about the “voices” of the people who raped my child harassing me, and then my psychiatrist was stymied once the medical evidence of the abuse of my child was finally handed over.

    3. I agree survivor-led groups are wiser than the ignorance led “mental health” workers’ groups, for all the reasons you listed in #3.

    4. I agree, the current definition of psychosis includes “things like dreams, interpersonal interactions, and intuitions.” Which means the current definition of “psychosis” is meaningless, and we’re all “psychotic.” And I agree, all these things, which are not “psychosis,” “can trigger alternative realities.” For example, all Americans who’ve stood against the never ending wars since late 2001, have an alternative reality to the “mental health” workers’ desire to support the never ending banksters’ war reality. But us anti-war activists’ reality is not a bad reality, it’s a reality based upon common sense. The “mental health” workers’ reality is a theology based upon your scientific fraud based “bible,” and your worship of a fraud based monetary system, run by the globalist banksters’ that our founding fathers’ forewarned us against.

    5. “In the past, survivors may have been interrupted or challenged when they tried to tell their story.” This is not something in the past, this is exactly what’s going on today by our “mental health” workers. My entire life was actually declared a “credible fictional story” in the end, by my insanely delusional psychiatrist. I hope you will be helping people in a more sane manner in the future, “mental health” workers. But you need to give up your “invalid” DSM “bible,” and actually start to believe your clients’ concerns are legitimate.

    6. “if I am able to listen and discern some conspiracy ideas that might explain some of the triggering experiences and I fear retraumatization, I may propose that the group talk about that particular brand of conspiracy and how it really is possible.” Let’s be honest, all DSM believers conspire against all non-“professionals.” And all the globalist banksters, lawyers, judges, pastors, doctors, educational officials, fake news media, and government officials are “conspiring” to steal from the masses of America, and have been doing so for decades.

    As the liberal intellectual Chris Hedges stated, “We now live in a nation where doctors destroy health, lawyers destroy justice, universities destroy knowledge, governments destroy freedom, the press destroys information, religion destroys morals, and our banks destroy the economy.”

    And most the Trump supporters agree, we live in a lawless society. The Clinton crimes, and the desire to have most these “conspirators” fired, is what resulted in Trump being elected. We have globalist fraud based banksters, who want to cover up the fraud of their Federal Reserve banking system, in charge of our society. Usually they cover up their crimes with world wars, but this does seem to be what the wars since 9/11/2001 have been, or actually are.

    https://www.youtube.com/watch?v=5hfEBupAeo4

    But some people are finally waking up, and all need to wake up. We need truth, not merely mainstream media propaganda.

    7. I agree, the “mental health” workers can offer no promises of privacy to any of their clients. I have proof in my medical records of doctors gossiping with others, as well as other doctors, and doctors do break the HIPPA laws. Today’s medical community, in general, has nothing to do with behaving in a manner commensurate with common decency. It’s all about worshipping the almighty dollar, which is already worthless, doctors. Wake up.

    • Someone Else. Doctors gossip like little girls. LOL we still live in the 1800’s. We are now caught in a storm of deception. That deception is “research”. Research into “quality in healthcare”. The research into that looks like this. “we propose that if we cut off a persons leg without giving them opioids, it might reduce their quality of life”………”we propose” and “the study in quality of healthcare will conclude in 10 years”, “whereupon we will commence the second study”……..”{researchers in critical psychiatry ‘proposed’ that some patients might not get the intended effect from their psych drugs”. I get upset at even thinking what society I live in….. OHHH I should not say that, it’s negative thinking, I better do some mindfulness training or some pills that dull my “hyperawareness”

  3. This is the way with not just ‘psychosis’. I do get traumatized at trying to get my truth across, but the trauma is because of the intense emotions in trying to get heard. My trauma happens in just thinking that once more I need to retell and once more they throw it into the trash, and on top of it tell me what my story really is. Then you suffer from repression, oppression, but it only festers. I will NEVER EVER believe in such a cruel system. I cannot support, nor be part of systems that try to control, distort, invalidate, and ultimately try to kill people. They really just want people to go away, yet not knowing they only exist because of their sham. What other field do you suppose a shrink could work in? I fear none. He is not over educated, he is educated in the field because he is lacking and is simply projecting onto others. It is this projecting that he is not aware of, yet teaches it. He is obviously a non believer in evolution since then he might entertain the fact that the way people are, might be related to that and since within evolution we do not know what is right and what is wrong, we are unable to identify it. We have certain laws within society, the only time you are free to intervene in my life is if I cause harm to you. Other than that, I remain not definable, or confinable. And if I hurt someone, you have one option and that is to prosecute me, but you have no right to label except for the deed I did.

    • Sam plover – thank you greatly for your comments! That are your comments that I can relate most as “psychosis” survivor and “schizophrenic”. Participating in Open Dialogue 4 days introductory training last 2 days it was interesting to watch how most of participants with special education diplomas (soc.workers, psychologists, psychiatrists) were not able to understand “basic human” relationship with those “other” they were trying to help. I must say I was the only one “other” among them. It was ok for me as I have already walked all that injustice that author beautifully described in his article. And during those 4 days I have realised how lucky I am not being the part of the system! I was risking my own wellbeing going to that training but having some knowledge of OD and being passionate for OD to come to my country I decided to go. And must say I had won a victory over myself in learning hard and being challengingly active. And even adressing the issue of perticipants’ trying to avoid sensitive issues as choosing conversations/reflections “about weather” instead. But all experience has left me hopeful that OD has start in my country. I realise that no model is “perfect” but to my humble knowledge and personal experience the OD approach is the best to challenge status quo.

  4. Thanks for your writing, and thanks for the work you are doing in the system! I am in a very similar situation and while I’ve always shared bits of my experience, I’ve found after the discovery of HVN I too have had far greater confidence, and willingness to share my own experience. It is a powerful aid to the people who still turn to the expert, and it is even more powerful to influence the self proclaimed experts around where they need to change their ways!

    I have faced some infuriating screwtney from my peers and my managers, but so far I still have my job. 🙂 I am a big believer in mutual disclosure and seek to find greater ways to integrate this into what is known as practice. I really identify with your statement…”It’s true that there are times when I wonder if coming out mad was the best career decision. I have had to bravely admit my vulnerabilities, which sometimes seems to hurt my credibility.” Being vulnerable and forthright with self disclosure lead to an increase in struggle that set me back for awhile, and I continue to struggle with it to some degree, but overall I do feel stronger, and my workplace is a better place to be because of it.

    Most grateful for your work with the so called experts to create an evolution of perspective!

  5. Tim thanks for a VERY enlightening article and for the wonderful work you do by truly listening and validating people and their experiences! I am sorry to hear you were harmed by psychiatry. Until I was sent to a psychiatrist while in cancer treatment (told it was for “help with sleep meds” because chemo and steroids caused insomnia) I didn’t know psychiatry is ALL about suppressing a person’s experiences and reality. (not every psychiatrist, but clearly the majority). In their minds nothing that happened to a person, or is happening to them, matters at all. The power shrinks wield is very scary. The shrink I saw in cancer treatment tried to get me put on the psych ward but I refused. Since she had no grounds whatsoever she could not force me but my refusal made her very angry and she retaliated and did a ton of harm by plastering labels and false, denigrating statements all over my electronic records for all other healthcare workers to read. These false records have brought great harm whenever I need medical services (other than what my family doctor can provide) and after providing overwhelming evidence from my long time doctors (and legal evidence) proving her statements and labels are absurd I discovered a psychiatrist answers to no one. Psychiatrists are simply allowed to publish blatant, utterly false character assassinations of innocent people with impunity. The harm they do is endless.

    Thank you for speaking out Tim and I wish you all the best in your job hunt as people like you are desperately needed in the system!

    • Thank you for sharing your experience. I don’t talk to my psychiatrist. I am always fine and just throw her an innocuous bone so she’ll trust me. There is no hope that I will change her mind in my eyes. Yes she makes money off me, but not much, that is the freedom I have. : )

    • Hi Rosalee, you picked a real winner, the newby shrink who wanted to make an impression and started the psych conveyer belt. The more she diagnoses, the more popular she is with her colleagues and Pharma.
      Imagine how many people have dragged these labels around their whole lives, from childhood on. The crosses to bear.
      My daughter was in an advanced class, a learner and remember lol, so in her class, many went off to become doctors etc. We live in a blue collar neighbourhood, with me being a stay at home mom. Ours was the party house. All her friends lived in the “rich” area. All professional parents, who never allowed a big group of kids into their houses. When they were teens I saw their behaviour and could see who would be a medical person. They were generally uptight and coached from home. I cringed to think of them as looking after people. They had no clue about living with alcoholism, yelling parents, food fights. There was no disfunction in their homes, until the point that it actually becomes a disfunction, in that they have an inability to see or feel or understand, identify with an array of differences within people. This leads them to see everything else as disordered and they gain no insight. They THINK they understand, but they can never really feel it or put themselves in someone elses shoes. It is I think a very lonesome and alien world to them.
      Their idea of being crazy as kids or teenagers was having a drink or smoke a joint away from their houses. This made them feel that they accomplished something radical, yet they missed the boat.