From Aeon: “If the scientific credibility of the medical vision is waning, its political justification has also eroded. Over the past decade, a new generation of psychologists have been studying the nature of mental health stigma: what it is, how it’s created, how to solve it. The consensus of this research is that psychiatry’s medical vision – and its language of ‘chemical imbalances’, ‘brain circuit defects’, ‘genetic abnormalities’ and so on – merely replaces one kind of stigma for another.
In particular, medical narratives tend to trigger three negative outcomes. They make other people want to distance themselves from the patient. They make patients pessimistic about their own recovery. And they evoke, in the patient’s mind, the idea that drugs are the optimal course of treatment. Perhaps the most troubling finding of the new research is that stigma toward schizophrenia – measured as a desire for social distance – has actually increased over the past 30 years, plausibly due to the greater acceptance of the medical narrative.
Academic psychiatrists today often claim that psychiatry has already moved away from the narrow biomedical vision of the 1980s. They say that psychiatry has instead embraced a more holistic, ‘biopsychosocial’ vision that respects all of the different factors – brain imbalances, childhood trauma, social injustice – that make us unwell. Aren’t psychiatry’s critics just beating a dead horse?
But these reassurances ring hollow to me. Despite the calls for a more holistic model, in practice, interventions for people like Luca have changed very little since the 1990s, with its short cycles of hospitalisation, diagnosis, drugs and monitoring. Psychiatry journals are increasingly dominated by biological perspectives, to the exclusion of psychological and social ones. And the fact that about one-fifth of US college students are on antidepressant drugs – and about a third of Scottish adults are on some form of psychiatric medication – suggests that, if anything, psychiatry’s medical vision is actually more entrenched now than it was in the 1990s.
But if psychiatry’s medical vision is failing TIs like Luca, what should we replace it with? How can we break out of this bind?
Despite the entrenchment of the medical vision, my recent explorations of psychological, social and spiritual approaches to psychosis have made me optimistic about the future. I think we’re at the beginning of a renaissance of alternative approaches that loosely resembles the plurality of paradigms in the 1960s. The ultimate goal of these movements is to create safe, non-coercive, therapeutic communities that give people space to explore alternative, meaning-making frameworks – an ethos embodied in Soteria Houses, the Open Dialogue framework, and Inner Fire, among others. One of the leading organisations in this context is the global Hearing Voices Network, which encourages people to understand their voices and other unusual experiences not as symptoms of a disease, but a source of creativity, inspiration and insight.
One avenue of intensive exploration is that experiences such as threatening voices, unusual beliefs and dissociative episodes are protective responses to traumatic experiences. Although popular books like Bessel van der Kolk’s The Body Keeps the Score (2014) remain controversial, what’s no longer controversial is the link between childhood abuse and neglect, and adult experiences of psychosis. Hence the popular slogan that we should no longer ask patients ‘What’s wrong with you?’ but ‘What happened to you?’ The idea that terrifying experiences like Luca’s can be a coherent response to abuse or neglect has been developed by organisations such as the Hearing Voices Network, the National Paranoia Network, and the Power Threat Meaning Framework.
A second approach sees psychosis as a ‘spiritual emergency’. This view is advanced today by organisations like Safely Held Spaces and the International Spiritual Emergence Network. While some of a materialist mindset scoff at the idea that psychosis has a spiritual dimension, these framings have powerful practical benefits. Cross-cultural research on schizophrenia has shown that the way culture makes sense of voice-hearing impacts both the content and the emotional tone of the voices. In the US, where voice-hearing in the context of schizophrenia is framed as a symptom of a disease, voices are experienced as more invasive, hostile and distressing. In parts of India, Ghana and China, where voices tend to be understood as belonging to deceased ancestors or other spirits, voices are experienced as more benevolent and less scary. Some voice-hearers have found that, simply by adopting a curious and compassionate attitude to what the voices are trying to say, they become less threatening and more supportive.
There are yet other approaches. Some within the voice-hearing community contend that hearing voices is merely a different way of processing information about the world – a form of neurodiversity with its own strengths and limits. Some groups, such as the Plural Movement and, to a lesser extent, proponents of Internal Family Systems, hold that voice-hearing is a natural sign of the multiplicity of the soul. Perhaps all of us are more or less ‘multiple’, and voice-hearing is simply one way that different parts of the mind talk to each other.
The problem is this: unless people like Luca have access to this whole range of meaning-making frameworks, they’ll either understand their voices in terms of a hypothetical brain disease, or in terms of hostile intruders running an experiment on them. We urgently need to expand the range of scientifically plausible alternatives.
. . . I recently reconnected with Luca. His own journey, which began so abruptly in November 2020, has now taken on new contours. He still hears the voices, and he holds the belief that he’s the subject of a cruel experiment. He explicitly identifies as a TI. But he’s also placing those horrific experiences into a broader spiritual perspective, much like that advanced by the International Spiritual Emergence Network.
Luca now sees himself as intensely receptive to spiritual influences. The same psychic openness that allowed The Team to gain a foothold into his mind is also a fountain of powerful revelations – massive ‘information downloads’ from the cosmic mind. These revelations centre around the broken state of humanity, the interweaving of the spiritual and material worlds, and the need for love – insights he’s compiling into a book. He is no longer preoccupied with victimhood, but with survivorship, and with his greater mission to promote ‘unprecedented change, healing and love’.
The real tragedy here is not that psychiatrists failed to stamp out Luca’s voices and strange beliefs. The tragedy is that he had to discover this spiritual path on his own.”
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