Saturday, December 14, 2019

Comments by Greg Shankland

Showing 24 of 24 comments.

  • As someone who has studied and practiced Neuro Linguistic Programming (NLP = how language programs the mind) the idea that we create our own mental wellbeing is well established. NLP provides techniques for doing so based on the principles of neuroplasticity. We can understand how the brain perceives and codes information and we can learn to manage that practically with specific outcomes in mind.

    The core techniques are really simple – in essence, by asking yourself different questions you prompt the brain to create new pathways. Doing so deliberately quickly becomes a habit. By focusing on what you can change or engineer/create, you can easily change your relationship with self to create better experiences and with the world to create better outcomes. And vice versa – achieving better outcomes reinforces a better relationship with the world through our social reward systems.

    You will notice I didn’t mention illness once – NLP is a wellness model that works for everybody.

    To create new experiences, you simply find a point in an unhealthy routine, program or experience that you can easily spot to create a point at which you interrupt it – a point from which you ask yourself “How can I change my response? What is it that I am trying to achieve?” This brings a ‘program’ or habitual response into the mind in an aware way to prompt you to replace it with a more deliberate choice. Interrupt/replace is a very simple and powerful technique for creating new experiences.

    Similarly, in thinking about what we are trying to achieve (which usually is something we do with others), it helps to spend a little time defining what it is we are trying to achieve by asking the basic sensory questions – “What will it look, feel and sound like?” And the reward or appreciation questions – “What will it do for me and others?” This clarifies what it is that we are trying to achieve, IN THE BRAIN, placing information that becomes a part of positive pathways. Then ask “What do I need to have in place?” to clarify the conditions for success and “What do I need to do to…?” to get the brain working on identifying actions to get there.

    There is your short course in NLP – those two techniques can make a huge difference. Doing so quite literally creates pathways in the brain that shape and create the futures and experiences that you desire.

    We are of course social mammals and we crave social reward or appreciation. We create more interesting experiences and outcomes with others and rewards are therefore most powerful when the appreciation is from and with others (shared appreciation) – which is where social therapy obviously has a great strength in connecting healing and reward/appreciation systems in the brain.

    Hope you are well Ann and Hugh, I am missing our interactions on the wellness scene in NYC.

  • Not only might two people with the same diagnosis not have much in common… an individual easily lands up with more than one diagnosis. Who exactly is responsible for agreeing diagnostic criteria? If governments are dismissing the DSM as irrelevant or flawed, what is keeping them in place? Or – what has to happen for them to be banned from use?

    Do we know? Is activism our most effective approach?

  • It seems to me that the basic function of the brain is to model the world(s) in which we live with the purpose of finding predictable ‘happiness’, where happiness is however we each define thriving in a social context – we thrive as a group because we can achieve more as a group.

    Anxiety, depression, paranoia, mania are all the result of unusual models of self to world – they are information and actionability issues that can be remedied via a combination of education and mind/life strategies. A life coach may be your best guide.

    I studied Neuro Linguistic Programming (NLP) in the business world forty years ago. NLP offers a workable model of the functional mind that helps one create better experiences and achieve desirable outcomes in a systematic and practical way that anyone can learn.

    I began to hear voices out of the blue at age fifty five and soon found myself instinctively applying my practice of NLP to own my reaction and response to voices, eventually managing to routinely prevent the recurrence of psychosis without medication, in spite of particularly aggressive and cruel voices. I have remade this practice into a suite of six simple mind strategies in tool format that anyone can apply.

    NLP works from the concept of the well mind. Instead of focusing on some ‘illness’ (poorly defined in DSM language) it simply asks ‘What can I do to achieve this particular desirable outcome?’ and makes that a habit.

    Mental issues are primarily information issues in the brain – our experiences are encoded in ways that they predict our ability to thrive in the world as we see it. We can deliberately improve our confidence in self and reshape the ‘as we see it’ element to create ‘happiness’ as we each define it. Habitually.

    Prescription drugs are more likely to get in the way than help because they alter our emotional responses. Emotions regulate the flow of information in brain processing. When I took anti-psychotics I got fat and became emotionally “dulled” – and that dullness projected onto everything in life. Pointless really, since the drug made no difference to voices and my quality of life was made worse, not better. If we aren’t looking at whole life quality as a desirable outcome, how can we even take drug efficacy seriously?

  • I grew up in South Africa and many studies and articles that tout the idea that voice hearers are shamans and ‘mental illness’ does not exist do not examine the full context.

    It MAY SOMETIMES be true that IF your tribe feels you are communicating with spirits, your experience of hearing voices is made less traumatic because the community around you “believes” that a connection with ancestors has value. (That is an absurdly narrow view that ignores the bigger context in which it takes place.

    It is based on a rose colored view of a belief IN something (for which there is ZERO evidence of benefit beyond the rose colored view). The problem is…
    – Almost all ‘traditional’ (the term used here in S Africa) belief systems worldwide include a belief in BOTH good and evil ‘spirits’
    – And have rituals for APPEASING the good spirits and WARDING OFF the evil characters
    —- YES, in many traditions ‘good’ spirits need work, to keep them on your side, ‘favors’ which often involve HARMFUL (especially to animals) and cruel rituals. The belief requires that ancestors be considered in decision making, a drag on the rate of social change or improvement. When things go wrong in the family, it may be that the ancestors are upset (a belief, entirely devoid of real evidence) and effort and resources are expended to solve a problem in the spirit world in the hope that it bounces back into the real world.
    (Good luck putting the evidence together for that – people will see what they believe and simply keep reinforcing the belief system).
    – The poor voice hearer now shaman has a new role and responsibility – voices have determined his/her future. Yes, the experience (of voices) MIGHT be less traumatic because it is without stigma, even valued, but what happened to the right to craft a life of choice? The experience of life, with implications for a whole tribe, has been dramatically altered and GIVES voices power IN THE COMMUNITY.
    Without any PROVENANCE whatsoever!!

    WORSE…
    Pick up any newspaper aimed at an audience with tribal roots here in SA and you will find a page or two in the classifieds section, where so called ‘traditional healers’ offer services, achieved by engaging the help of the spirit world, for a fee, usually with a ritual… that include:
    – finding the love of your life
    – enlarging your penis or improving the sexual satisfaction of your partner
    – becoming rich (overnight usually)
    – making your traffic fines disappear
    – winning that upcoming court case (favors that spirits supposedly can endow)
    OR…
    – PLACE A CURSE ON YOUR ENEMY! Yes, the evil spirits can be coaxed into harming someone you don’t like, presumably because that is what they like to do.

    Imagine the poor man or woman who believes that a curse has been placed on them by an enemy unknown and who hears voices that are the evidence of that curse.
    – the ‘WITCH’ who has placed the curse is at risk in the community
    – and a few (or their homes) are burned or stoned to death in SA every year (WITHOUT evidence, only the say so of someone in a community, gang justice by violent means, because the solution to spirit problems must be pretty radical, for certainty)

    The benefits of a subset (some are KNOWN to be harmful) of herbal remedies passed along with the tradition pale into insignificance when the belief system creates a culture in which harmful practices are ignored for fear of criticizing a belief system because we assign a higher power to it.
    Says who? Show me how!

    It is also NOT TRUE that tribal cultures do not see some voice hearers as ill, or ‘cursed’ (they usually have an equivalent term)… they DO generally have a much more supportive and community based response.
    – Open Dialogue works from the same principle – ensure that reliable, empathetic, support is in place, no matter what – without the problems associated with beliefs in spirits, where ANY belief can take root and gather steam in a crowd or perpetuate itself by declaring itself to be above common sense and/or scientific evaluation. HUMAN rights come first.

    Every SYSTEM of beliefs that GIVES provenance to spiritual powers is HARMFUL
    – we have loads of evidence of the HARM voices have caused, of how ‘spirits’ have INTERVENED in our lives through history, causing lasting conflict
    – we have zero evidence of the ‘good’ in the spirit world
    —- other than the BELIEF IN a greater good that we have come to associate with a ‘spirit world’

    The belief itself may have some value, but belief in a greater good does not require a belief in a spirit world, in fact, a belief in each other would be more reliable and tangible.

    That became a little bit of a rant… studies that ignore the bigger picture of belief systems are poorly designed and of doubtful value.

  • Hi Fiachra, yes they would. The mind has automated much of its functionality and the mind strategies are designed to help create better experiences by managing the flow of information more deliberately.

    Past trauma is just one source of sensitivities. We develop new sensitivities in the experience because voices present new problems that are very difficult to resolve.

    One of the tools is designed to help people map out themes to which we have become sensitive or more sensitive:
    – I have not had past trauma, but the experience of hearing voices has been like living in an intimate and abusive relationship with three psychopaths. Hearing voices IS the trauma (I can’t think of anything worse) from which I DEVELOPED sensitivities to particular themes in which voices were very busy. Because voices engaged me in stories of conspiracy and religion (or, a hereafter, in which religion is a deciding factor), the threats and ‘busy’ themes were mostly FUTURE related. Once I mapped voice activity against my goals a clear picture of how voice activity was getting in the way fell into place and I was able to dismiss sensitivities that were simply not important and then systematically address the others in my own time when I felt comfortable doing so. Analyzing my past was a total waste of time.
    – Anyone with past trauma likely has a sensitivity that has carried forward and been AGGRAVATED by voices hammering away at that theme (and connected ideas).
    – We also easily develop sensitivity to themes in the world around us, which can also be mapped against a few simple life themes.

    Once you have identified your sensitivities and which of them are worth working on, they are addressed in the interaction with voices in a deliberate form of exposure therapy, when you are feeling strong enough to do so. Knowing what to look for helps one see progress and gain confidence. Exposure therapy works, because most ‘problems’ that voices ‘set’ (deliberately) are FAKE – they only SEEM real in our sensitivity to the topic – and facing them makes them dissolve away. This research (discussed somewhere here in Mad In America) applies similar principles: https://tidsskriftet.no/en/2018/03/originalartikkel/drug-free-after-basal-exposure-therapy

    The mind strategies help people reduce the intensity of our automatic, emotional reaction to voice provocation (i.e to reduce sensitivity), which means they absorb less mindshare.

    I consider this mapping exercise to be an ‘advanced’ tool, that not everyone will need to apply. Because the other tools dramatically change the relationship with voices and the hearer’s sense of control of their experience, the need to delve into this level of analysis is less than we might surmise. If our reward systems are properly engaged (which brings optimism about the future), we are better able to deal with the past (it falls to lower in our significance hierarchy).

    Also, if we diminish the effect of the ‘busy’ provocation by voices of past trauma and the implications thereof, then more traditional therapeutic methodologies have a better chance of success, if someone needs extra help.

  • RR, I relate to your comment ” i dont seem to have a problem that can be addressed”, at least in terms of my history (no trauma, or drama, or bullying…).

    The ‘problem’ for me was that I suddenly started hearing voices that are unbelievably cruel (Voices have no meaning, or provenance, a pre-requisite for meaning in my book). I didn’t need psycho-analysis, I needed tactics to survive the onslaught and defend myself. I needed to get ahead of it (pre-empt it) to get back to being in control of my experience and my life.

    In time I decided that I could own my reaction and response to voices and learned to do it both systematically and habitually. Over time I heard fewer voices – from many, to three that stayed a very long while, to one that is still a pain the ass (with her audience in the background). I prevent the recurrence of psychosis with little effort required. I still get irritated relatively often (every week or two I will find a space where I can yell out loud at voices to dissipate the irritation), but that’s it.

    At some point after a period of active engagement with the hearing voices community I formulated my systematic response as a suite of simple tools that anyone can learn to apply.
    I talk about the six tools in this video on my YouTube channel MAD-Sense. https://youtu.be/GHXbduh9RRQ
    – The use of caricatures is akin to Avatar Therapy at KCL
    – The interrupt/replace technique from Neuro Linguistic Programming is akin to SloMo at KCL
    – the other techniques create the conditions for success
    There are about 20 hours of video on the YouTube channel that show how phenomenology creates experience and support an understanding of the experience and how and why the tools work.

    Be well.

  • I agree with you RR – there is a group that is difficult to reach, once they are experiencing the problem and have not yet moved through enough of it to either know that it is a problem or sense that they can improve their experiences.

    Part of the solution lies in educating a much wider group – ‘the public’, where stigma resides, at an early age, in school. If I had known what “hearing voices” was, when I first heard voices, I or someone around me would have recognized it sooner and it would have been a lot less distressful (which is what leads to stigma – people can’t relate to the experience and fear our distress). If I had prior knowledge that “it” (it does need SOME term) existed it would have been much simpler for someone to say to me “Do you think it could be X?”, from where I am more likely to explore the possibility.

    I also think that such education could be handled in a positive way. I happen to have studied Neuro Linguistic Programming (how language programs the mind) in a business context. NLP offers a functional model of the mind – and techniques for creating better experiences and being more deliberate about working towards outcomes we desire. I use adaptations of NLP thinking and techniques to model the hearing voices experience and to manage my experience and prevent the recurrence of psychosis. The techniques are simple enough for anyone to learn (and have parallels in research at King’s College, London).

    I used the base techniques before hearing voices – i.e. they have value in the everyday world…. and they help me explain (i.e. educate) the experience as the functional mind responding to unusual stimuli. Understanding more about how the mind functions is something we would all benefit from and education could be located in this context -‘ know your mind’.
    – In this context, ‘voices’ and other unusual stimuli are just that, ‘unusual stimuli’ that follow an identifiable and largely predictable path in how our predictive brain tries to process them, a process we can learn to control
    – only those who experience the unusual stimuli need to go the extra yard and learn how to handle them

    There are complicated versions of NLP. The basics though, are pretty straight forward and non contentious. Our brain IS neuroplastic – learning how to harness that deliberately and of our own volition from a young age is something that will come in time anyway, which is an opportunity change

  • I can own my reaction and response to ‘voices’ without normalizing them. I see no value at all in declaring them to be normal. They are quite obviously unusual – and to try and convince myself (or worse, others) that they are ‘normal’ is a waste of time and contrary to the evidence we have.

    Moreover their unusualness has specific characteristics that provoke the brain (automatically) and mind (cognitively, once you become aware of it) in particular ways. If I am to own my reaction/response to them, it is the difference (compared to ordinary stimuli) that I need to focus on to do so.

    I fail to see how normalizing them has any direct merit. Indirectly it may lead me to abandon the search for what causes them, which can be useful in that it shuts down all the hypothesizing that becomes the experience.

    I do this directly – simply by acknowledging that they exist and that I am not in control of their origin. No need for distortion.

    The point at which I can act is when I become aware of them (not that that is a problem). The way to spot them instantly is to notice their difference – and then to train my reaction/response to be more useful.

    Some seem to think that ‘normalizing’ them may reduce stigma. I prefer to simply say I cannot manage the perception of others, nor do I need to. It is my own reaction / response that I choose to manage; and if I do that others will be responding to me ‘normally’ anyway.

  • Thanks Someone Else,
    I also hope the article shows how phenomenology creates experience and that the experience can be described as a natural response to unusual stimuli.

    Psychiatry ignores the phenomenology, without seeing how it causes other so called symptoms.
    Psychology is inclined to psycho analyze me, also without seeing the relationship between phenomenology and experience.

    I have no idea what “causes” ‘voices’ – I do know that by seeing how these weird stimuli provoke the mind, I can learn to manage my reaction/response and prevent the recurrence of psychosis or extreme states.

  • I have never been a fan of the term “hearing voices” because it does a poor job of describing the characteristics of the stimuli. Whatever it is (we do not know), the most common experience of it and one that makes it distressing is that we CANNOT walk away from it, nor do we have any sense of it’s origin.

    You see this in the nature of the beliefs that we form:
    – in accounting for the presence (the what/who answer) it is something external that has it’s own volition and is present/absent by it’s own choice. i.e. we experience it as having agency
    – descriptions of how ‘voices’ behave mostly assign bad intent, in part because of the above (making it unwelcome and intrusive) and because of it’s behavior (commanding, cruel, making assertions of influence, claiming to intervene)
    – even amongst those who describe some voices as friendly, by far the majority add a “but” that qualifies that statement. You see this in the descriptions of the relationship – it’s like living with a psychopath – sometimes loving (manipulatively, sometimes cruel. It is a fairly typical abusive relationship.
    – some who cast the voices as a spirit entity, BELIEVE that ‘spirits’ are helpful (because this is more closely associated with our belief IN a greater good, questionably, in my opinion) and they RATIONALIZE bad behavior as having some unknown, hidden, even unknowable “meaning”. This is finding a rationale that fits a belief – a poor process for evidence seeking or evaluation.

    For a thorough discussion of the hypotheses that look for a physical (brain form or function, chemistry, genetics) read Simon McCarthy’s “Can’t You Hear Them?”. He discusses over 50 hypotheses, none of which does a good job of describing the phenomenon, let alone how it arises.
    https://www.amazon.com/Cant-You-Hear-Them-Significance/dp/1785922564

  • To add – there are more forms of help than going to the doctor – since you are in here, you know that.

    What I got from the docs “auditory hallucinations” description is that there is such a thing that is known about, that others experience it.

    What I did not get is sensible help. Anti psychotics did nothing for the weird stimuli, made me dull (which projected onto life in general) and I gained huge amounts of weight.

    Hearing Voices groups helped in that people there “got” what was happening and were more supportive and importantly, listened. They are inclined to fuel more unusual beliefs unless you guard against it.

    Early intervention programs offer good support if acessible to the person.

    I apply techniques from neuro linguistic programming to own my reaction/response and control the experience. They help people be more objective instead of being stuck in the subjective experience of it.
    Available on my YouTube Channel https://youtu.be/GHXbduh9RRQ

  • Thanks Someone Else – I will check out that link.

    To be clear, I do not believe that Voice2Skull technology has anything to do with it. Humans have heard voices for millennia, V2K is recent.

    The point I am making is that a belief about what voices are gains credence when we can hypothesize a ‘how?’ answer that is itself credible.
    – when I thought I heard the neighbors, the ‘how’ that gave it credibility was “from the fire escape”, which was the only place from which I could be observed
    – when voices created the experience of following me using non verbal cues, in the form of bringing my focus to where I could hear them as a progression from at my door, to outside my door, to on the stair case, to at the door to the street, to on the street… I needed a NEW explanation for ‘how’ this could happen, and I changed my belief about what/who voices were accordingly. We might believe that V2K is a PLAUSIBLE ‘how’ answer, which could make us belief that some government or secret agency is doing this – but as I say above, this is simply not a logical answer.
    – similarly, when voices began to claim to be spirit beings, the phenomenology was now a telepathic like interaction at the level of thought, that made the idea of interacting with a spirit entity SEEM more plausible, BECAUSE it offers a (supernatural) explanation for how.

    I had to account for ALL THESE…
    – the neighbors ‘from the fire escape’, then
    – the neighbors, using cameras to spy on me in my bed/bathrooms, then
    – who knows who, following me on the street (voices were encouraging me to think conspiracy theory and the CIA) and then..
    – spirit beings, CAPABLE of interacting telepathically at the level of thought

    The point I am making is that there are characteristics in the phenomenology (the ‘how?’ “evidence” we try and account for) that shapes how we characterize the ‘what/who?’ answer… and that we form a belief system that connects these answers and locates the villain/voice in a particular way.

    I am not saying there isn’t a phenomenon…. I am simply saying that we DO NOT KNOW what it is, we experience as external because it behaves sentiently…. and in attempting to explain it we are asking questions that shape a belief system that connects how, what/who, why and why me answers together that SEEMS reasonable (at the time)…. only because we struggle to find better answers. The belief I accept is based on
    – the phenomenology I experience
    – the HYPOTHESIS that seems to provide a good answer to one of the basic questions in the logic chain
    – the ‘how’ answer is closest to the phenomenon and is a key factor in making the belief ‘unusual’ to others, because it accounts for the ‘unusual’ evidence the hearer has and others do not

    I had many beliefs – each de-stabilized by a shift in one answer in the what/who, how, why, why me logic chain.

    My first belief, “It’s the neighbors was a very logical inference, strongly held as a result. The distress arose from the fact that neighbors should not behave that way.

    My second belief was an “I don’t know who/what this is, but any answer must account for the fact that ‘they’ (there were now many voices) can follow me”. At the time, I had not seen that the experience of ‘following’ was a trick, created by non verbal cues. And that by WITHHOLDING answers to who they were, voices were LEADING me to self populate my answer with one that gave them the ability to follow and anticipate me.

    My third belief was “auditory hallucinations”, which to me meant my brain misfiring. This didn’t hold as ‘true’ for long, because it did not explain how well voices were deceiving me, or why they were so cruel and aggressive.

    My fourth ‘belief’ was in fact DOUBT about what voices were, because they made a string of ASSERTIONS about who they were, OBVIOUSLY designed to create confusion and doubt about who/what they were, becvause that gave them a greater hold on my mind. This is in part a result of my response, which was to reject their assertions. Either way, my brain tested every assertion as an hypothesis and created the extreme experiences associated with each assertion of power as people who had died, then minions, to god, then god, then the devil, then an evil god, then aliens.

    Since their strategy was to scare, deceive, confuse and make complex, the assertion that “made sense of” all that awful behavior was the assertion that one was the devil – from whom that kind of behavior was to be expected.

    This does not mean that the voices is the devil or that there is a god or even a life herafter…
    it simply means that there is a strange phenomenon that sets out to deceive us into believing (or having doubts about) ‘something’ about them that GIVES them power, until you learn to rject it all.

    Apologies for the length of this answer – it hopefully gives another slant with more emphasis on the experience of it, which includes my response.

  • Thanks Cat and Fiachra, glad you gained some understanding from it.

    We are reluctant to admit to hearing voices for several reasons:
    – we quite literally may not have a clue what it is. I was quite convinced my neighbors had taken to spying on me, until I went to the doctor who described it as “auditory hallucinations” and I discovered that it was a known ‘phenomenon’. At first, I was relieved that my doc had heard of it, that it happened to others and that there may be a solution (turns out later that the drugs did nothing for me)
    – we are afraid of the implications, both in terms of how we see ourselves (my brain / mind has always been my greatest strength, the idea of being ‘mentally ill’ made no sense) AND how others (friends and family) will react, or more importantly, how it might change those important relationships that we rely on.

    It was a close friend that got me to go to the doctor – by BEING that close friend. He made it easier by saying – “get some professional advice, you have nothing to lose” (appealing to my logic) and by saying “I am here for you and will help in any way you need” (the emotional appeal).

    You help someone by being their friend and making it as non threatening as possible – ONLY a good friend can have that conversation without it being a major problem, so don’t be afraid to address it gently in a helpful rather than challenging way.

  • Thanks out. Whilst I agree that we all define ourselves I also know that we can learn from the experiences of others. I have found that there are many similarities in experiences that arise from characteristics of the phenomenology.

    So, when the characteristics of the voices I heard were:
    – a male and female voice speaking nearby, as if they did not want to be overheard (the ‘evidence’ voices presented),… it was inevitable that I would make the logical inference that the voices belonged to the couple upstairs, since at that stage I had no idea what ‘hearing voices’ even was
    – when voices feigned a new capability of following me, an experience created by a progressive shift (over a few days) in where I could hear them (non verbal cues), at my door, then just outside my door, on the stairs, at the door to the street, then on the street… AND deliberately WITHHELD responding to my questions about what they were, it was inevitable that I would form a belief about what/who they were that accounted for i) their ability to follow me and ii) other malign behavior… a believe that GAVE them power commensurate to their observed behavior… AND later
    – when they began to ASSERT that they were spirit entities, supported by a now telepathic like interaction with my thoughts (as opposed to voices I could hear at a distance), regardless of whether or not I accepted those assertions (I didn’t, mostly), my brain still TESTED those hypotheses to create experiences that were pretty extreme.

    It was voice behavior that shunted my frames of reference to each of the three worlds, populating each with new villains, by sharing, withholding and asserting information that LED my belief formation in predictable ways, based on how the brain functions. Function we all share.

    It was clinical professionals that led me to test the idea that voices were somehow generated by my brain, an idea that for me was not consistent with the strategic sharing, withholding and asserting evident in voice behavior.

    My responses to the unusual information presented was quite natural – in fact the formation of these unusual beliefs RELIES on my brain to function as one would expect it to respond to weird info presented in an inexplicable way.

    I am hoping that others will recognize some of these characteristics of the phenomenology in their own experience of it and see that their response is often just their predictive brain doing it’s natural thing.

  • The fundamental assumption that depression is a brain state independent of our relationship to the world we live in is problematic.

    If one is in a position or enduring circumstance in which we cannot see an optimistic future for ourselves, then becoming depressed about that long term picture of the future seems likely. It follows that it can be changed by acting (to induce the experience of influence or control) to change one’s view of available opportunities in the world. If action achieves good rewards (both social and self actualizing) then the brain will be transactionally rewarded, changing the brain state in response to our view of the world.

    I studied neuro linguistic programming. A simple technique for changing how we relate to the world we live in is to respond by asking ourselves outcome based questions – “What outcome am i trying to achieve? What do I need to have in place, what actions do I need to take to achieve it?”. Simply by asking ourselves these kinds of questions we engage the brain in finding ways to achieve desirable outcomes and in recognizing progress towards them – engaging a proper reward progression.

    Any drug for which the “therapeutic effect” is to dull emotions (neuroleptics have the same problem), will systematically dull our view of the world and our ability to enjoy it.

    Emotions are a product of information processing. We can easily learn simple techniques that give us greater control of our “flow”, which shapes our relationship to the world we live in and the story we are creating.

    No drugs required.

  • Sometimes it is clear that a belief is indeed false – which is a key criterion for ‘delusional’.
    That does not mean that it has been derived without evidence. An example illustrates the point:

    When I first “heard voices”, I had little to no information about what that meant.
    I was home alone and heard two people talking to each other about what I was doing – making a meal.
    “He seems to be OK” a feminine voice said. “Hmph”, from a disinterested male voice.
    “He eats better than we do” followed by another “Hmph”, they said.
    That was the evidence I worked from. I figured out that logically it had to be my upstairs neighbors because:
    1. They had to be able to see into my apartment
    2. That could only be done from the external fire escape
    3. The only other people with access were the upstairs neighbors
    Conclusion = “It’s the neighbors!”, a ‘belief’ ‘fixed’ by the evidence through a rational process of elimination.

    Weeks later after things got out of hand I saw my doctor who described what I was experiencing as “auditory hallucinations”. He might have called the belief delusional, from that frame of reference (he didn’t, but I get the basis of the definition, in spite of it being poorly understood).
    – It was real problem because I ACTED on it, I moved out

    The fact is it WAS NOT the neighbors. The problem is that the stimuli that ‘voices’ presented sounded like people speaking softly or at a distance. What they said only made sense as the neighbors peeking in on me. I had hurt myself that afternoon and made a lot of noise and rationalized that at least one of them thought it a good idea to check up on me. We didn’t know each other, hence ‘peeking in’ seemed reasonable (literally, supported by a plausible reason).

    There is no point in defending beliefs as true or not true – that is not how beliefs work.
    We form beliefs in spaces where we LACK good evidence – beliefs are more hypothesis than fact.
    We often use beliefs in a different form – what we believe IN – the ideas we hold as true and navigate towards, in an attempt to create A world in which they HOLD as true (we DISMISS contradictory evidence).

    Beliefs are by definition not truths. Unless they occasionally happen to be true.

    In spaces where we do not know, we can believe anything – based on partial evidence, or by sucking something out of the air. The fact that these ideas cannot be disproved does not make them true.

    What makes a belief delusional is clear in the example above. The problem is the medical definition: “a fixed belief resistant to contrary evidence”. Until I knew to dismiss voices ‘they’ were evidence that my neighbors were commenting on my activity. A new frame of reference helped me see the problem differently.

    It helps to pick a simple example like the above – which is not confused by the idea of ‘meaning’, a burden that ‘belief in’ carries.

    Believing THAT ‘voices’ ARE aliens, or energy parasites, or god, or a demon… are trickier to pin down one way or the other. The point is we DO NOT KNOW – and these are hypotheses… that we are calling beliefs, and sometimes defend as if we believed IN them. I think we can see how that can be problematic, whatever we call it, if it makes an experience more intense (paranoid for example) or if we act on it. This is where the rubber hits the road, less so in the debate about what to call it.

  • “everyone is talking about something that has the same basic structure underlying it, which could most easily be outlined in four points.
    1) something out there has some special kind of power and control in the world (God, the NSA, aliens, etc.);
    2) either you have discovered it yourself or this something has revealed itself to you in some special and probably secret way that others may not have access to or insight about;
    3) this something has some specific use or purpose for you, possibly as a victim of exploitation or punishment or experimentation, or possibly in some special mission or magnified role in the universe;
    4) this power infiltrates your world, although there may be other powers out there as well.
    Once you realize that this structure is there, underlying what just about every “psychotic” is talking about, it becomes very easy to decode what “psychotics” are saying almost all of the time.”

    This structure of the stories in which voices engage us is supported/created by characteristics of the phenomenology.
    1) I am experiencing unusual stimuli of UNKNOWN origin in an unusual way. I experience it as “supernatural” precisely because it is unusual and as having intent and agency that is very definitely not me… therefore something must be producing it and I form a BELIEF (not fact) about what that something is. We account for the PRESENCE in a belief system that connects how (supernatural) and what/who (an entity that might explain the how. It might be the neighbor (if the stimuli seem like voices nearby); god (if say the stimuli are ‘a soft still voice’ ‘in the mind’, or the voice claims to be god, as one of mine has) or an alien (my voices claimed this too). When you reject this as simply a belief, voices might PERSIST in trying to create new beliefs: :: The voices I hear worked to escalate their power by claiming to be people who had died (connecting to a common belief); people that I knew who had died (making it personal); family who had died (personal and more significant); god, the devil and then an evil god (in an attempt to assert greater power and influence)… and aliens and multiples… The point is voices drag us into a space where we have no evidence – and beliefs flourish. Whilst you may say we have no evidence for OR against any particular what/who belief, ‘voices’ cannot be all those things and none seems more likely than the other.
    We are unlikely to agree at the level of belief, an expression of the experience – and conflict is the result.
    2) I hear them (or experience intrusive thoughts, or…) and you don’t – therefore the information that ‘voices’ have shared with ME is “privileged”, or unique or special… and specifically NOT shared or transparent to others… and potentially has value or threat potential, depending on how ‘voices’ choose to present it, or how I interpret it. We need to remember that it has NO PROVENANCE whatsoever, cannot be tested, verified, validated or be subjected to any kind of check for coherence or even relevance, let alone significance. We are inclined to give it significance because it is unusual, special or secret or… :: The voices I hear have thrown so much horseshit at me it is simpler to reject it all than to bother to assess it.
    3) Now that I have been ‘chosen’ as a victim or the second coming (or both, more likely), I am engaged in a conspiracy with ‘voices’ or ‘god’. Either I am a victim, ‘voices’ torture me and “don’t care” as mine say; or ‘voices’ may impose a special responsibility on me – mine chose to say I am “the perfect man for the job” which morphed into being the second coming in an escalation of role (imposed) in much the same way that they escalated their own assertions of power via what they claimed to be. The basic tactic is to encourage, or so it seems (and cause mania) and discourage (causing fear and paranoia)
    4) These come together in a story, a narrative of the experience as ‘voices’ persist and use these phenomenological characteristics to create scenarios usually with: a conflict = the problem that gets a reaction and engages; a role that encourages one to act, so that ‘voices’ get to interfere ; and consequences in the outcomes, or more accurately, the perceived implications.

    Experience is shaped by phenomenology in very specific ways.
    1) We form a belief system around our answers to to the basic how (the phenomenology experienced), what/who (a belief) and why/why me (a personal narrative) QUESTIONS. Where/when become a self evident pattern that we learn to anticipate. Our answers vary widely, our questions are the same.
    2) ‘Voices’ engage us in stories that leverage these beliefs, creating scenarios that connect to events in our lives (to maintain apparent relevance), encouraging and discouraging us to create extreme states
    3) By dragging us into spaces where we lack verifiable evidence… voices are able to create and sustain conflict by suggestion, assertion, deception… the conflict is unresolvable (because the problem ‘voices’ set is fake)… and we are more easily set against each other because we hold beliefs strongly (based on MY evidence, which YOU don’t have)
    4) The stories can be reduced to the simplest of all – the battle between good and evil…

    If you want to see more on the structure of the stories voices engage us in, I talk about it in this video. I talk about three common narratives based on where we locate voices (the villain), a soap opera (my world), conspiracy (the world) and cosmic opera (other world). The structure is the same, the heroes/villains are of each world, their ‘powers’ become progressively more grand 🙂
    https://youtu.be/lpAthnONQ54

  • The end goal is a better form of help. Psychiatry may or may not be part of it.

    In the “hearing voices and extreme states” field for example, there are several non drug approaches that are making progress through the research process:

    From King’s College London are:
    – The Avatar Study – which helps people face persistent and bullying voices to change the relationship with the voices they hear.
    https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(17)30427-3/fulltext
    – SloMo – an approach to help people slow their thinking down to find alternative interpretations of voices that are less distressing. When it works well the NHS will make it available via an App for free.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5667466/

    From Vestre Viken Hospital Trust in Norway, is a form of exposure therapy used to help people better control their experiences and avoid the need for drugs, applied across several ‘conditions’ including psychosis:
    https://tidsskriftet.no/en/2018/03/originalartikkel/drug-free-after-basal-exposure-therapy

    I myself apply variations of these three to prevent the recurrence of psychosis, to create good experiences in the mind (instead of defending the subjectivity of extreme states as ‘normal’) and achieve good outcomes in life. I have knocked off the extremes. Being in control of your experiences is easily more rewarding (literally) than mania and/or paranoia.

    btw, Mania is a problem in how it distorts our sense of priorities. It may feel good in the experience, but does not translates to a sense of achievement in expressing ourselves with others. Viewed in the longer term it is a distraction from creating a story that brings appreciation, respect, progress, independence. I prefer to assess the effect on my story rather than to defend mania as a good experience (nobody cares).

    I developed my variations on these three ideas independently based on my practice of Neuro Linguistic Programming:
    – I made caricatures of the voices I hear to exaggerate their worst characteristics and gave them childish names to minimize their claims to power. I name them, define them, own the relationship and shut down the formation of unhelpful beliefs about them.
    – I use a simple interrupt/replace technique from NLP to own the interaction with voices which is the experience in the moment. I create good experiences by dismissing voice stimuli and bringing my attention to real world stimuli, mindfully, to proactively stimulate a good reward progression. I choose which stimuli to give significance to.
    – I mapped themes I had become sensitive to. You find them in the topics in which voices are busy, where the reaction/response is paranoia, mania or reticence. I mapped them against my goals to eliminate those that do not matter in my story, then addressed the remainder in my interrupt/replace as a form of exposure therapy until my sensitivity to them faded to nothing.

    I have three other simple tools that I apply to help create the conditions for success. These are self help tools that anyone can learn to apply. I prevent psychosis and have no need for a psychiatrist or medication in spite of voices that have been particularly cruel.

    In simplest terms I formulate my understanding of the ‘hearing voices’ experience as a natural response to weird stimuli. I simply had to work harder at filtering that information to reestablish emotional equilibrium. Once done, the maintenance effort is low.

    The same ideas are applicable to some other states such as anxiety, depression and OCD. It helps to think of of them as “states” we can change, given the know how in practical tool format. Using simple mind strategies we can use information to create better experiences and to feel more in control of them.

    Whilst I have made psychiatry irrelevant to me, I don’t go so far as to dismiss the idea that there is possibly a place for prescription drugs, bio feedback mechanisms, imaging or some novel technique in offering point solutions or in helping create the conditions for success, in some future version of psychiatry.

    There is little doubt to me that a form of best practice will emerge because it helps us learn from others and shortens the lead time to success, however we choose to define it. Some group will be the curators of that best practice and work to keep it current and available.

    Will it be Psychiatry? The question is at what point does new evidence overtake the current model and is the new evidence psychiatry, or psychology, or NLP for that matter?

  • Managing the perceptions and language of Joe Public seems like a rather tall order. I wonder if something can be achieved by trying to define what we expect of the major stakeholders – a big picture framing of ideas that people might be able to unite around? Rights would seem like a good starting point.

    There are several big stakeholder groups:
    1. People seeking help (what to do, how to do it) and support (encouragement and TLC) – a group with diverse needs and perceptions, all of whom want to be treated with respect and expect the professionals who serve them to be well informed and trained (rights)
    2. Professionals who offer “services” – are they clear on who they are serving? We (society) have installed a conflict, charging some of them with protecting society “from” individuals they deem to pose a risk. How do we know they are up to date on best practice or progress in their field?
    3. The associations that represent and speak on behalf of their professional members – I recall a Bob Whitaker article on this site that pointed out that the APA mission is to serve the interests of the profession, rather than the customer. That is a high value target we can petition – who should they serve?
    4. Family and friends – it seems to me we could do much better at educating this group and coaching them to provide helpful support, instead of leaving them to “cope” in the hope that a tablet will make the problem more manageable
    5. Government – have we done enough to engage policy makers? Surely we can expect our government to make sure that psychiatrists are properly detailed (what a pharmaceutical rep is tasked to do when marketing to a doctor) in how to help a service seeker make an informed decision. Surely we can demand that every psychiatrist has a leaflet that points people to alternatives. My doctor asks me a few questions once a year about my state of mental health – a form has to be filled in. Surely we can demand that psychiatrists certify at each new prescription cycle that they have taken proper steps to inform the service seeker of the options/alternatives, benefits (and explain them), the cons – those side effects are real, not just statistics that the psych accepts as a good trade off. Since we know that the “evidence” in this field is stuck in the past, can we not lobby a group of respected professionals from say ISPS to draft “best practice” … instead of relying on the idea that an individual psych will be informed and up to date. If drug companies can “fast track” development cycles on drugs with promise, then how can we leverage that to fast track new evidence into best practice and task the government with ensuring that the gatekeepers, those ‘diagnosing’ are in fact working from best practice. Surely we have that right. (I realize some will say that government are part of the problem – they are also potentially the best point of leverage)
    6. Joe Public – let us campaign for education at schools. Catch em early I say.

    It seems to me that Joe Public is the most difficult group to influence – and they are not participating in Mad In America discussions. We are a diverse a group – it would be good to chunk the debate up to a point where we do have a shared need (respect, rights, realistic expectations of professionals and a way to ensure them).

    Here is a straw man that says let us find a few initiatives ( < 5) that target high value levers in the system, framed at the level of rights, of what we can expect from our institutionalized organizations:
    1. A bill of customer rights in plain english – I should find one in every practice waiting room (there are several out there from other countries). There are people that seek help, denying that there is a problem seems unhelpful. http://www.cchr.org/about-us/mental-health-declaration-of-human-rights.html
    2. Let's get a band of INFORMED professionals and service seekers in the system (preferably global with UK, EU nouse) to develop best practice guidelines that a service user can reference in a discussion about choice and consent, instead of leaving it to the professional. When the Mayo Clinic website still says " Schizophrenia requires lifelong treatment, even when symptoms have subsided. Treatment with medications and psychosocial therapy can help manage the condition. In some cases, hospitalization may be needed" we KNOW this is not best practice. Frankly, I think that puts them and others in the same boat at risk, legally.
    3. The "fast track" idea appeals to me. How can we get a trio of universities to champion recent research and learnings into best practice policy at government level? Government should be higher than psychiatric associations in the power hierarchy.

    Is there a news organization that we can get onside? We need a Rachel Maddow or Anderson Cooper to take an interest to raise our visibility. Or Change.org … how do we tie in to an existing platform that is more public? On here, even if we disagree, we are preaching to the converted. And arguing about political correctness is a dead end in my opinion.

    We need a few ideas that unite us around a cause (something simple and actionable) instead of defending our experiences as 'normal' – when people can't even relate to it.

    I am not suggesting any of this is easy and I cannot claim to be much of an organizer – I am simply suggesting that we might be better served if we focus on a few things, phrased positively in language that Joe Public can relate to.

    I am hoping someone will see something, say something that sparks an idea…

  • Thanks Fiachra, that’s it – state of mind affects what we “see”, which is our perception in the moment.

    We can help PREVENT extreme states by helping people understand how they happen, to catch the build up early and disrupt it.

    The mere presence of voices leads us to form beliefs about them because we do not know what they are and we try to account for them. If they behave badly we form beliefs that give them power.

    Their persistence creates the conditions in which distress escalates. Voices drag us (the mind) into these spaces where :
    – we can neither prove nor disprove anything, where they distort our representation of the world (not the world itself) via a de facto relationship in which they assert power/influence. From this position:
    – they insert conflict that makes us focus on the threat, THEM and
    – the “evidence” they present, which IS frightening
    – which “holds” our attention and
    – the brain sends blood to the body to fight or flee, NOW, neither of which is an option
    – in the moment of need, they offer a way out, “do this”

    We have to help people recognize the staging… the setting of the scene in which we lack the evidence to prove/disprove anything so that we dismiss the conflict and threats before voices are able to escalate the distress to extreme states that shut down rational thought. We can disrupt the build up to prevent ever getting into the extreme state.

    And if we can routinely help people do that, “schizophrenics” will no longer be dangerous because they will have control of their experience. We have to give people the tools to address the problem if we want to address stigma.

    For those who want to see more, in this 40 min video I isolate five phenomenological characteristics in my first few weeks to show how this staging happens. Note how:
    – Just two comments from the voices I heard established a perfectly rational ‘delusion’ that inserted conflict
    – My distress escalated in line with changes in the location of where I heard voices… the gradual ‘staging’ that made the perceived problem worse and kept sensible action out of reach, eventually causing panic at being unable to escape.

    We have to spot this six week build up to disrupt it – had I known at the time that I was caught in a fake problem the distress would have been minimal.
    https://youtu.be/7s–ldk-5bw (Mapping early episodes)

  • The one article referenced by redux shows some insight into the phenomenology, the structure of which is quite common: “was suffering from paranoid schizophrenia at the time and had been hearing voices telling him to “free” children or risk harm to his own family”.

    This is a good example of voices making threats to the hearer that are experienced as real enough to create fear that demands action.

    The voices have threatened the hearer’s family – and have suggested an action to avoid the threat. In a state of fear :
    – the chemistry of fear has the effect of a temporary frontal lobotomy that precludes clear thinking because
    – the body is primed to act … and it is action that will resolve the fear
    – the hearer cannot flee the threat
    – voices are suggesting, putting the idea in the mind in this state of searching for an out… and
    – declaring that this is the ONLY action that will resolve the problem… and
    – creating a sense of urgency, to get the person to act in the moment of greatest fear

    If the hearer believes that the voices can carry out the threat, and a record of ‘paranoia’ suggests s/he gives it significant credibility, then the compunction to act as suggested is strong, absent a clear alternative.

    By helping the hearer understand how these conditions of distress create the paranoia, we can help people recognize that the problem (threat = conflict + consequences) are not real. Education rather than medication and confinement can help prevent the extremes.

    The majority of people who hear voices do not act on threats that go against their basic respect for safety – instead we panic, a state of uncertainty about a course of action…. which eventually subsides when the person is able to disconnect from the voice stimuli (the threat, that holds attention) and reconnect to ordinary stimuli around them that are not threatening.

    Which means that voice behavior: creating conflict, the power of suggestion, inserting a specific action in the moment… plus voices “style”… aggression in the moment, a “do it or else” theme to exaggerate urgency… is a significant factor.

    I am not offering a moral perspective, simply a technical one that aids in understanding how phenomenology contributes to experience… and sometimes action when extreme states spill over.

    We are not serving people well if we are not helping them understand the experience and and to anticipate it to reduce the paranoia and fear that drive the need for care.

    We can reduce the number of potentially dangerous situations with education. If we can help people feel more in control of their experiences we will in time stop tagging them as dangerous.