Thursday, October 29, 2020

Comments by Ron Unger, LCSW

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  • Steve, I don’t know about you, but I don’t usually put a lot of effort into changing something I’m doing unless I think there may be something “wrong” with it, something that is leading to less than an ideal result.

    I certainly do agree though that the goal should not be some presumed “normality” especially since, as David Oaks likes to point out, normal people are destroying the planet.

    So if we don’t want to tell people that they are wrong and should think like others do and value what others do, what should we tell them?

    Should we tell them that however they think, and whatever they are valuing, is completely right?

    That has its own problems, because the way the person is thinking or processing or valuing may be setting the person up for difficulties and distress down the line, or may be heading them towards harming their loved ones, etc.

    I think the best therapy approaches this as a kind of inquiry or dialogue, exploring possibilities, it does accept that people will have to decide for themselves but doesn’t presume that those decisions will always be for the best – instead it is constantly questioning.

  • It seems like most of those who have commented on my comment emphasize how people should be able to work out for themselves what is “disorder” or not. I would agree with that – I would also point out that “post traumatic stress disorder” is generally not a label that people have forced on them, it’s usually a case where someone knows they have a problem and the PTSD label connects the problem with the trauma that happened earlier.

    I agree with Steve that it is important that people get the message that any disorder may be temporary, rather than some “judgement of insufficiency” that is not expected to change. And there is a problem where some people (professionals or not) just expect PTSD to last forever. But that isn’t inherent in simply saying that the person has troubles or a disorder that are a reaction to bad things that happened to them.

    I didn’t see anyone respond to what I think is a more crucial part of my comment, where I pointed out that if we get too caught up in denying that there may be anything “wrong” or “disordered” in someone’s reactions, we may actually be harming them by making them more helpless, by convincing them that their troubles are just an inevitable result of what happened to them, and there is no possibility of them changing their reaction to something else and so getting more control over their lives.

    I would argue that we have to watch out for people doing things they think will be helpful, but that backfire, at each stage of the process of reaction to trauma. For example, when people experience trauma, they might feel threatened by thoughts about what happened and try to push them out of their mind, but this may backfire when the thoughts pop back in later in the form of flashbacks and they get caught up in an endless war of trying to suppress thoughts and memories. Professionals may then try to help, but at times their drugs or other approaches will backfire and make things worse. Then those critical of professionals may jump in and try to make things better – but there can also be problems with how they put things, especially if, as I have pointed out, they make people feel their reactions to the trauma are the only reactions that are possible for them.

    This may seem a little complex and tricky, but I believe (as a trauma survivor who had to work through my own disorder, as a therapist, and as a critic of our mental health system) that this is just the nature of the territory.

  • I think we can go too far in trying to emphasize how reactions to trauma are normal, and trying to deny that there is anything problematic about them. The problem that is caused by doing this is that people might start thinking that their reactions are inevitable, and there is nothing they can do to change them – which means they are stuck with them. We’ve just induced helplessness.

    If a hurricane hits my house, it throws stuff around, stuff isn’t where it would have been. So it’s a normal reaction. But it’s also fine to call it disorder. Calling it disorder reminds me that it doesn’t have to be that way, it can be rearranged into order again, I don’t have to leave things the way the hurricane left it. Trauma can be that way too – it throws everything around, or we throw ourselves around in trying to cope with it, that’s normal, but they way it leaves things is a disorder when it comes to trying to go one with life, so there’s some need to reorganize.

    I agree with Paula though that huge problems come when we assume that disorder means illness means the person needs drugs or some simplistic one size fits all “treatments” that don’t address the full spectrum of people’s humanity.

  • I appreciate this article, and all of Joanna’s work. But I’m bothered by one sentence: “Further follow-up studies show that people who take long-term antipsychotic treatment for psychotic episodes have worse outcomes than those who do not (e.g. Moilanen et al 2016; Wils et al, 2017).” The problem is that the Moilanen citation doesn’t seem to support that assertion: instead, that article suggested a mixed result, and reported that people who stayed on antipsychotics with no drug-free periods were the ones with the best scores on the Social and Occupational Functioning Assessment Scale [SOFAS].

    Anyway, if the data really is more nuanced, I think we would do well to reflect that in our statements, so we can so to speak take the “scientific high ground.” Any thoughts about that? Am I misreading anything?

  • We definitely need to abandon simplistic models of “mental health” I have often stated that “stability is a false god of the mental health system.” When we are facing a big threat, like climate change, the last thing we want to be is stable overall, and just keep on with business as usual. But we do need to be stable in some ways, so we don’t fall apart and can take wise action.

  • I like the observation that some of these statements, like the “it’s not about you” may be helpful if they are said by someone with less power than a therapist.

    I am a therapist, and I’m aware that it’s important to be careful about what I say! One thing that helps when one is in a professional role is to say things more tentatively, as in “I wonder if it may help to think that it isn’t about you, or that at least much of it is not about you.”

    This makes it easy for the person to reject the idea if it doesn’t fit. Also it helps if the therapist asks if anything they are saying doesn’t seem quite right, and acknowledges they may say things that don’t fit for the person and asks to be informed when that happens.

    Regarding moderation, I much like the Oscar Wilde version: “everything in moderation, including moderation!”

    And there is the tricky matter of the sense in which any statement is understood. I like the Discordian saying that “all statements are true in some sense, false in some sense, and meaningless in some sense…..” We don’t always know how our statements will come across, so we have to be aware they might come across quite contrary to what we intended.

  • Climate change is certainly one big reason to question the idea that “positive emotions” are necessarily good! I think of the Katrin Meissner quote: “It scares me more than anything else. I see a group of people sitting in a boat, happily waving, taking pictures on the way, not knowing that this boat is floating right into a powerful and deadly waterfall.”

    Still, there are lots of “mentally unhealthy” responses to climate change. One is just denial – refusing to know, even when we have reason to know. Or people are aware it’s happening and are traumatized, and they respond by trying to avoid reminders of it, watch the news less, etc. Or they despair and use drugs or other distraction.

    Whether it’s mutual aid, professionals working with individuals, or public health efforts, we need to be aware it’s a tricky balance to find a constructive approach to big challenges. It’s not about trying to just be happy, or squashing the “upsetting” emotions, but it is about finding a way to not be demoralized and shut down by the threat and finding some kind of positive path.

  • Hmmm, I think this is a complex topic. I would agree that I wouldn’t want mental health professionals doing things like deciding who can run for political office, but I do think they may have opinions worth considering (to the extent that mental health professionals know anything at all – many of them seem to know less than the average citizen!) I would rather hear the opinions of people like Bandy Lee rather than have them shut up by the Goldwater Rule – though they are just a perspective. Regarding mass delusions, I think they are a kind of public mental/social health issue – I’m not sure what the best treatment is, but I sure hope we come up with something good before we exterminate ourselves!

  • I’m not sure where you are getting this idea that counselors can’t bill to help child abuse survivors. They definitely can, whether they call the resulting problems “PTSD” or some other diagnostic category.

    And while some counselors cover up abuse (and some are even abusers), many others are very active in increasing awareness of the dangers of child abuse and of the needs of survivors.

    In fact, some counselors have been too willing to believe that their clients were abused. They have asked leading questions, been too sure that even dreams of abuse were the beginnings of recovered memories of abuse, or they’ve been willing to completely believe even fantastical tales of abuse (where supernatural things happened, for example.)

    I work as a counselor, and I know that these issues are not always black and white. Sometimes people do not have clear memories, and it is necessary to just hang out with the uncertainty. I have seen things like someone over the course of weeks start to remember that a certain family member abused them, then get uncertain about that, then recall it as a different family member (all without pressure from any other family members, who were not told about the memories.)

    False memories are not impossible, but it is also terrible to just assume that something is a false memory when it may be quite accurate. Counselors may not be able to know for sure what happened in particular cases, but they can be trained in ways to interact with people about their stories and their memories in ways that are sensitive and respectful, and help people on their own search for what is true.

  • You make some good points. Here’s a little of my thinking:

    Having everyone believe the same thing can create social cohesion within a group: “we all think Trump is going to save us from an elite group of pedophiles and cannibals!” So why do some people come up with their own unique beliefs? I think it’s also for the purpose of cohesion, but that of cohesion within the person. When people are confused and distressed, they may organize internally around some weird belief, and having that internal coherence may seem more important than whether or not they match up with anyone else.

  • While judging only some beliefs as “rational” is indeed problematic, failing to do so also causes problems, often ones that are more severe.

    By “rational” I mean “in proportion to.” So a “rational” fear would be in proportion to a threat, while an “irrational” one would be out of proportion to the threat. We can also have “irrational” lack of fear, as when people aren’t bothered at all by the threat of climate change, etc.

    People do indeed have “different realities” in the sense of different perceptions and different maps of what is going on. But these perceptions and maps apparently exist inside a world that has effects on us whether or not we believe in those things to start out with: so people who think Covid is a hoax can still die of it.

    This especially becomes a problem when we need people to take collective action, for example, to stop systemic racism, Covid, or climate change. We need some way to respect the fact that no one has an absolutely correct perspective, and everyone needs some slack to make sense of things for themselves, while also pushing people to “face facts” that may be essential to survival and to social justice.

  • In this article they talk about people’s “mental disorders” but it might make more sense if they just talked about people’s mental and emotional troubles. Because Steve is right, if you are going to take a “transdiagnostic” approach, you don’t really need the idea of diagnosis. I think it makes more sense to try to understand the complex factors that might have pushed someone into some kind of trouble or other, and then also look at what might be changed to help them reverse some of the trouble and become less distressed. The diagnostic categories don’t much help with that, and often just confuse people or lead to discrimination.

  • Well, if the article only said what you are saying, I wouldn’t have any problem with it. I definitely agree that if the therapist comes off as insensitive, as unwilling to listen to what the person is dealing with and suffering from, and if the therapist makes it sound like all of the problem can magically be solved, it won’t go well!

    Situations where we have to let go of controlling some things and focus on what we can still control are often situations of loss – like when we have to let go of trying to put out the fire and just control what we can, which might be getting out of the house before we burn up too. In such situations, there is real loss, but focusing on what one can control is still an important way to reduce losses.

    What bothered me in the article was when it made much stronger statements than you made, such as when it was asserted that “Telling individuals to stop focusing on “what they can’t control” is not only gaslighting, it’s inaccurate.” I get it that Megan wanted to critique therapists who might be suggesting that their clients pay no attention to broader social factors that cause oppression, but I think trying to figure out what you actually can control is also important for social activists – we are always trying to figure out where it is we might actually be able to make changes, and to avoid beating our heads against walls and getting nowhere!

  • It seems to me that being either positive or negative can get overblown, or “toxic.” The tricky thing is to be just as positive, or negative, as what fits the situation! And we are always trying to figure out exactly what we are up against, especially when the threat is something new, like Covid 19.

    As for trying to focus on what one can control – it seems to me that is basic to any kind of problem solving, it’s not part of “toxic positivity.” It makes sense even in very “negative” situations – so for example one might be dying, but decide to focus on what one can control, like sending a kind message to loved ones. I do get that it may be annoying or wildly inaccurate when someone else is telling you what you should think you can control, but that’s another issue.

  • Hi Steven,

    It’s great to hear about your continued work! There is so much that needs to be changed, but community organizing like what you are doing does open up cracks, through which some people will escape from oppression, and through which some light will get in.

    And thanks again for having me speak in your church, on the topic of When Minds Crack, the Light Might Get In: A Spiritual Perspective on Mental and Emotional Breakdown – https://recoveryfromschizophrenia.org/2017/12/minds-crack-light-might-get-spiritual-perspective-mental-emotional-breakdown/ (The whole talk is available at that link.)

  • Hi Fiachra, thanks for posting the link to the video! And thanks for joining us for the webinar itself. I hope lots of people do check out the video and then try practicing what Rufus talks about. You are right in a sense that there is nothing too mysterious about how to help people with troublesome beliefs – but we do have to unlearn a lot of what is conventionally taught about them, as well as to overcome what are pretty natural impulses to just get more rigid in response to encountering beliefs that seem to us seriously wrong.

  • Yes, I think that’s why it’s so important that we start training professionals differently! People should be able to turn to “the system” and find that it is helpful. I’m reminded of someone Daniel Mackler interviewed who lived in the area where Open Dialogue is practiced – this person compared the mental health system with the system which delivers water to each house: reliable, of good quality, and available when needed!

  • Yes, I think that move from less helpful “delusions” to a more resourceful creativity is something I experienced in my own life and that of close friends, which I wrote about in https://recoveryfromschizophrenia.org/2013/06/madness-and-play-exploring-the-boundary/ and in https://recoveryfromschizophrenia.org/2016/09/how-psychiatry-almost-stopped-burning-man-a-story-of-hell-and-liberation/

  • I agree with you that a psychotic break is a natural reaction, though it may have very unhelpful aspects. In that way it is like other natural reactions: for example, I might see a spider, jerk my head back to get pull away from it, and in doing so bash my head into something behind me. Quite natural, but also painful! Regarding antipsychotics and psychiatry: my sense is that not all use of antipsychotics, and not all psychiatrists, are the same. For example in the article I talked about one person’s interaction with a psychiatrist, where at first the person felt just like a target for the psychiatrist’s drugs, but when the psychiatrist talked respectfully they were able to form a collaborative relationship. I suspect there may be times when antipsychotics may be helpful to a person, at least for a bit, to help the person avoid over-reacting when they don’t have a better way to do that. Though I believe in always looking for a way to do it without the drugs wherever we can.

  • Hi Fiachra, I think you make some good points.

    Regarding the “two types of delusions” thing: I’ve noticed something along the same lines, that some express fears, while others are more an attempt to counter fears and make things seem OK or even great. Though it is also true that the emotional meaning often gets mixed. For example I asked one guy who was constantly bothered by and scared of people who seemed to be constantly monitoring him, how he would feel if that stopped or if he found out it wasn’t happening, and when he really thought about it he noticed he would feel unimportant and alone. So the belief in being monitored was both organized around fear and his hope of being important enough for someone to pay attention to.

  • Thanks for this great article on a difficult topic! A few thoughts of mine about that:

    I think there is a danger, not just of psychedelics being framed and used in a narrow way that just reinforces a dominant and too-narrow culture, but also in them being used in a way that is too open, or open to the wrong kind of dynamic.

    That perspective fits with that of many traditional understandings of Spirit generally – that when we open up to Spirit, things can go in a good way or a bad way, which is why it is good to have helpers nearby, a positive connection with community, that helps sort out which way to go.

    There are people right now using psychedelics in ways that totally fit with capitalism – as documented in articles like https://www.ft.com/content/0a5a4404-7c8e-11e7-ab01-a13271d1ee9c . There are people using them in some very dark ways – as Charlie Manson used to – some of that is documented in this article https://www.psymposia.com/magazine/lucy-in-the-sky-with-nazis-psychedelics-and-the-right-wing/ And there are people who are using them skillfully to promote healing, and to look outside of cultural forms which are clearly too narrow.

    Anyway, I think we need to be aware that the outcome from increased use of psychedelics is very much dependent on how we go about using them and integrating that use.

  • Great article! Some thoughts:

    Carl Jung was aware that there really isn’t any limit to what we might find in as we go deeper beneath consciousness. (First there might be our subconscious, then our personal unconscious, which is understood to be deeper, then Jung thought we could encounter the collective unconscious, which includes all of the mental forms which are possible for us, and contact with all sorts of characters who are “not us” but part of what we can access in our minds.)

    Of course, that relates to the idea that “mind” is not really something that has clear boundaries – in some sense there is just one mind.

    And any kind of creativity requires stretching in some sense beyond what we previously have know as our selves – because what we previously thought of as our self hadn’t done or said what we are now creating.

    I think many writers find the process is often more like being dictated to, at least at times. Your process seems more so than most, but not an entirely different kind of thing.

    Lots of us in dreams find there is something very creative in us that is very different from our conscious mind. For example, I know nothing about making music, yet in my dreams I have sometimes heard very impressive music that did not seem to be anything I had heard anywhere: it seems that my mind had composed it. Too bad I could not recreate it while awake!

    Leonard Cohen has written about the sense of not being the writer, for example as in the following lyrics from “Going Home”:

    “I love to speak with Leonard
    He’s a sportsman and a shepherd
    He’s a lazy bastard
    Living in a suit
    But he does say what I tell him
    Even though it isn’t welcome
    He just doesn’t have the freedom
    To refuse
    He will speak these words of wisdom
    Like a sage, a man of vision
    Though he knows he’s really nothing
    But the brief elaboration of a tube”

    Anyway, I really agree with Russel Razzique when he says the function of the mental health system should be to help people with any distress they may be having without dismissing the spiritual or creative value of what they may be experiencing – the point should be to help them find ways to hold on to what is valuable in their experience while reducing the trouble it is causing them. If they find a way to do this, then it no longer makes sense to consider them as a person with a mental health problem.

    Last year I put together an online course “Addressing Spiritual Issues within Treatment for Psychosis and Bipolar” https://www.udemy.com/course/spiritual-issues-psychosis-and-bipolar/ which is my attempt to convey this message to the mental health field….

  • Hi Sam,

    I certainly appreciate your not wanting a therapist to decide how you should be organized or exactly what you are supposed to be, or making you be something without your consent. And I know that different words resonate differently for different people, so I appreciate that “fragment” doesn’t resonate well for you. I’m not sure there are any perfect words: but I do know many people did things to cope when they faced trauma that are no longer working for them months or years afterward, and the idea that change is possible, especially change toward what feels to themselves like being more “whole,” can be liberating. I know that was true for me

  • A few years ago the local Christian college was trying to both have a counseling program and refuse to respect the rights of LGBT students. But lots of the local agencies decided they would not accept interns from that college till the policy changed. It did. But it does take people standing up and refusing to go along with stuff.

    I have also heard of really dysfunctional psychology or counseling education programs. I went to social work school, it was mediocre but was at least mostly friendly and relatively reasonable.

  • Thanks for this article, connecting the DSM fiasco to some deeper realities that are hard to write about!

    I think the notion of “dialogue” is so important in mental health, because it allows for multiple viewpoints, which are necessary to address complex and contradictory realities.

    One tricky thing is that we do sometimes need to go from dialogue to action, and as you also point out, “Complex, contradictory things or identities do not have impetus and are more conducive to stasis than progress.” Especially when we feel threatened, we feel like we need to decide what is right, and it needs to be something simple we can act on!

    The way this is dealt with in Open Dialogue is to let ideas for action emerge out of the dialogue, and to avoid coming up with big plans – instead, just decide what to do till the next meeting. And to deliberately hold back on drastic actions, like taking so-called “antipsychotic” drugs.

    In Zen they talk about “not one, not two.” There is always a dialogue between our complex/contradictory totality, and our ability to stand up for an be something specific, this and not that. It would be nice to see that more appreciated in the mental health field.

  • Hi Oldhead, like you do I imagine, I find the way that word “appropriate” is used is mostly very obnoxious, where someone is claiming the right to tell someone else what they should be doing and what is OK or not!

    What I was referring to, and what Aristotle was referring to I think, is more about what works to accomplish goals. As an example, let’s say I love someone, but they do something to offend me. If I just tell myself “anger is good, let them see my anger!” I may show anger in a way that makes my partner feel unloved and even decide to break up. Which was not what I wanted! But anger expressed more skillfully and artfully may leave my partner still feeling loved, but also understanding what the offense was and how it upset me. Does that make sense?

  • I agree with the criticism of the “anger is a secondary emotion” claim. I agree that anger is as valid as any other emotion. However, I also think that for any emotion, it can help to get in touch with the wants and needs that are behind it, and it can also help to review the evidence for whether it is really justified, etc.

    I like Aristotle’s saying on this: “Anybody can become angry – that is easy, but to be angry with the right person and to the right degree and at the right time and for the right purpose, and in the right way – that is not within everybody’s power and is not easy.”

  • Hi Derek, I appreciated the nuances you were able to articulate as you told your story!

    As an active member of ISPS though, I was disappointed to hear about the negative side of the experience you had with that therapist.

    I wonder if you would generally agree with the following: that the good side of many schools of psychoanalysis is their interest in deeper meanings and relationships, while the problematic side is the way they typically gives way too much power to the professional?

    I am told that there are branches of psychoanalysis which attempt a kind of shared exploration and consciously try to avoid this “power over” kind of dynamic, but I am less familiar with those.

  • Steve, I think you are jumping to a conclusion that this study doesn’t support, when you say the study suggests the treatment has no positive effect. The study’s outcome could also be a result of the treatment having positive effect, but insufficient positive effect to prevent all of the suicides that might otherwise result.

    It’s very hard to convince people that forced hospitalization never has a positive effect, when there are so many stories of people who were about to kill themselves, but got hospitalized and in the hospital quit being suicidal and then got out and weren’t suicidal anymore.

    what many of us wonder about though is the bigger picture. Is it possible that the dragnet of forced treatment pulls in many more people who wouldn’t have committed suicide if they hadn’t been hospitalized, but who as a result of the trauma of forced treatment, do end up committing suicide? I think we can agree that we need an answer to this question, but I don’t think we yet have data that can answer it.

  • While this is interesting, I don’t see it as convincing evidence that forced hospitalization leads to more deaths (or even as proof that forced hospitalization doesn’t save lives.)

    The problem is, this study doesn’t seem to have a way to rule out the possibility that those who were forcibly hospitalized were a group that had gotten to a place, pre-hospitalization, where they were way more likely to kill themselves, and so hospitalization may have reduced the suicide rates but wasn’t effective enough to prevent all of the suicides.

    A more effective study would randomize acutely suicidal people to either get forced hospitalization, or simply be offered treatment on a voluntary basis. Then we could compare outcomes between the two groups. This would be a difficult group to get approval for (since those who believe in forced hospitalization would see it as unethical to not forcibly hospitalize people who seemed to be at high risk of suicide, while those who are opposed to it would see it as unethical to do even as part of a study like this.)

    Anyway, I just want to see all of us on MIA being careful about our logic, and to avoid convincing ourselves we have proof of something when we aren’t quite there yet.

  • Thanks Anita – you tell your story very well, and I’m happy to hear of your work to bring more understanding to others!

    My only reservation about the way you frame your story is that by saying you were “misdiagnosed” with schizophrenia, this suggests that there are others who fully deserve this diagnosis! And it’s also true that, according to the DSM, if you did have enough of certain “symptoms” to match the checklist, then you did qualify for the diagnosis – the DSM doesn’t actually say it’s a misdiagnosis if the cause is trauma.

    I think it’s better to bring attention to how labeling something “schizophrenia” is just a way of not trying to understand what is really going on. Not everyone who gets this label is responding to a distinct trauma, but they still have a story and deserve to have people try to understand it rather than just have it all attributed to an imagined “psychiatric illness.”

  • Lewis Mehl Madronna is a Native American doctor who has thought a lot about how to bring indigenous wisdom into healing practices. One interview with him is at https://www.stillharbor.org/anchormagazine/2016/11/11/the-healing-of-narrative-an-interview-with-lewis-mehl-madrona . Or you could check out this talk, which includes a lot about using traditional stories to assist mental health recovery https://www.youtube.com/watch?v=qS-km545WbM

  • Steve, thanks for your comment about the diversity of what therapists do. That matches what I’ve seen.

    A couple comments though. You said the goal of being “normal” is abhorrent. I would agree with you if we were talking about trying to be “normal” overall, because that is both usually undesirable and impossible, but I do see some value in helping people figure out how to regain “normal” abilities they may have lost, or never had to start out with. So somebody might not know how to engage with random people in a friendly way, or how to experience “normal” physical affection without feeling freaked out, and they want to be able to do that. It makes sense that a therapist might join with them in working toward such a goal.

    I know when I had some really different mental experiences, I often had to struggle a bit to regain “normal” kinds of things I used to be able to do. But I definitely never had the goal to overall become normal…far from it!

    Also, I think it is possible to work as a therapist and still piss off psychiatrists. I’ve done quite a bit of that, and I only got fired once from a minor job. But most therapists don’t do that openly, for example lots of therapists used to tell David Oaks they agreed with his criticisms of psychiatry and would talk to their clients about the problems with drugs, but they wouldn’t speak in public. Maybe some avoid it because they are intimidated, but it seemed some were just too shy about speaking up in public in general….maybe they needed therapy for that?

  • There is a middle ground between solving a problem for someone and leaving them to solve it for themselves, and that is to collaborate with them in solving the problem, but encourage them to do the part of the problem solving that they are able to do, and teach them the rest as you go. So instead of rushing in with the solution, you ask them to get going on solving it, then only when they get stuck you maybe help out a bit, but also with an eye to helping them learn how to get to their own solution next time.

    I would definitely agree with those who would say the more we can get people solving their own problems without the help of therapists, the better! But I would still suggest having therapists available for when that isn’t happening.

  • Hi Steve, I’m not clear on how what you are trying to say is different from what I said. I certainly never said people can’t be or shouldn’t be proud of surviving adversity of various kinds! But pride is still something to be used with caution – for example I may have survived an adverse situation by learning to be very distrustful, but if I’m too proud of my habit of distrusting people, I might never work on “recovering” from that, and starting to notice more when some people might be worthy of trusting. That’s where discernment comes in, in my opinion.

  • My point was not that people with mad pride never want to change their lives or themselves, but rather that people don’t want to change what they have pride in. So if a person is always proud of how they do things, they won’t acknowledge (and recover from) mistakes that they make, they will be proud of them instead.

    I think what people need instead is discernment, sometimes being proud of their actions and reactions even when society might call them mad, and sometimes working on recovery instead. I know that’s a little tricky to explain, it’s not a fixed answer, but it is what I think works best.

  • Thanks Annette, I appreciated hearing about the complexity of the experience of you and your family, and how participating in Open Dialogue was helpful.

    As you might have noticed if you read my recent blog post, I’m trying to re-educate professionals to be willing to talk in an open minded way about experiences that are seen as spiritual – and not to assume that all experiences that are off the beaten path are detrimental.

  • Larry, I’m having a hard time following what you are saying.

    Are you trying to say for example that you think I’m wrong to propose that feeling fear, or being organized by the emotion of fear, can sometimes be helpful?

    And then, whether or not we agree that fear can sometimes be helpful or not, it seems you are asserting that people can just freely choose what to feel by altering their beliefs? While I would agree that beliefs do influence emotion, the process of changing beliefs is not so straightforward. For example I might know that I could feel more content if I could believe that our society is headed toward a completely wonderful future, but then find I have a hard time believing that is true.

    I think a lot of people feel fear for example, and would like to choose not to feel it, or not to feel so much, and have no idea of how to go about making such a change. Or they try, and what they try actually makes it worse. So it often isn’t simple.

  • Hi Julie, I think Oregon, maybe especially Eugene, may be a better place to be poor and looking for a therapist. I for example work mostly in a non-profit agency that sees mostly people on Medicaid, some on Medicare. People on Medicaid don’t have to pay anything themselves. We do have to diagnose people with something, but we try not to diagnose people with anything they find unacceptable, and most of us at least don’t believe that diagnosis is useful beyond putting people in a category so the insurance company can make sense of it (one of the cofounders of the agency has openly compared the DSM with the Malleus Maleficarum, the book that was used to determine who was a witch.)

    One other thing: as a therapist I try not to tell people what their problem is – the idea instead is to explore what’s going on together, and see what the possible avenues for change might be. But if people don’t have the ability to change their external situation (however problematic), then we usually do end up exploring what they might change about themselves, either how they see things or how they behave or both. Because I think as humans few of our problems are “all external” – we have to decide how to respond to our situation, and we seldom find the perfect response right off the bat. It takes experimentation, and what is needed changes over time. People come to therapy usually because they want to find better ways of responding to their situation. And one possible response of course is working to get into a better situation, where that is possible!

  • I certainly agree that it’s bad for society when the idea is spread that only professionals can be helpful – really, effective interpersonal support is something that should be woven throughout the fabric of society. I do think though that it makes sense to have people who study how to be helpful in situations where everyday supports or unpaid supports are not working.

    As for Soteria, it was a collaboration between people who did have some professional training and people who did not, professionals like Loren Mosher and Voyce Hendrix did a lot to set the frame for what was done there. Open Dialogue uses people with a high degree of training (training that is different of course from what is mostly offered in the US).

    Professions can be a source of both good and bad. Professions can get corrupt, and it’s really important that they get criticized and this corruption is brought to light. I still see value in them however. They are like governments, they sometimes need to be overthrown, but then you find yourself still needing a government.

  • I certainly agree that often people do find effective ways to help themselves all by themselves. It’s just when they can’t find a way to do that, or even more when they stumble into ways of trying to help themselves that inadvertently makes things worse, that they may need external help.

    I don’t agree that everyone who turns to external help will lose trust in themselves and their own ability to solve problems. Often, when we watch someone help us, we figure out what they are doing and realize we could do it next time for ourselves. I know some people do become dependent and some people especially some professionals encourage dependency, I don’t agree with that, but it is not inevitable.

  • Yes, it is very unfortunate that healing has to occur regarding what was offered as “help.”

    I do think it is interesting though that the way people try to help themselves can also turn out to be unhelpful. For example someone betrayed by important people in their lives might withdraw from society in an attempt to protect themselves, but as a result their life might fall apart and they end up not having any social support etc. It can be overprotection that causes damage, which in some ways parallels the way the mental health system can think it is protecting people but do way more damage than help.

  • Hi manymore, I’m glad you are finding your voice, and you are speaking up!

    It is certainly worth questioning what “being lost” as an individual means, especially when we live in a society that has overall lost its way and seems bent on destroying its own future.

    But it does seem to me that some people do get lost in ways that can even be life threatening, even before any bad treatment becomes part of the picture.

    Regarding “first episode psychosis” treatment, I’m not opposed to it, if it’s done well. Open Dialogue is for example an approach designed to make early intervention, they try to respond within 24 hours of an initial report. Of course, a very important part of what they do is try to hold off on using “antipsychotic” drugs. I don’t know of any early intervention programs in the US that make that attempt to hold off on using “antipsychotics” but there are some that do attempt to keep the doses low and at least some of the time will suggest that people try reducing or coming off the drugs after they have been stable for a while (this sometimes happens in Oregon for example.)

  • I think my comment might have disappeared for a moment, but it’s up there now right below your original comment.

    I agree with you that mental and emotional problems often get exaggerated by the mental health system, but I think that if we had no mental health system that there would still be some mental and emotional problems, some of which would be extremely serious or disabling all by themselves. Certainly we are all entitled to our humanity, but part of being human means we have tricky brains and live in a tricky & often traumatizing world, and we sometimes need help, and sometimes from helpers who have to know more than the average person.

  • I agree with you that there are no “bad emotions” in the sense of emotions we should never have, but I don’t agree that people have trouble with emotions only because therapists see a problem! It’s so much more complex than that.

    Take fear for example. In many ways it’s a great emotion to have, it can save our lives, push us to avoid danger. But people can get in huge trouble with it, when fear is overgrown people can become afraid to leave their home, afraid to interact with other people, their lives can be ruined. All that can happen without ever going to a mental health professional or taking a psych drug – that’s why I think people are really dreaming when they imagine there would be no “mental health” problems if there were no mental health system.

    At the same time, it is an unfortunate truth that for many people, their problems were not so big before they turned to the mental health system and got “help” that made things way worse.

    I would like to imagine a society where, when people have been traumatized or when they run into other sorts of mental or emotional problems, they can turn somewhere and get help from other people that is really helpful. It’s in some ways a simple dream, but I don’t think we can ever get there if we keep imagining that bad “help” is the only kind of problem out there.

  • As I read the comments it seems that some may be getting distracted from my main points because of not relating to the term “mad” which to some might mean believing in “mental illness” which you don’t.

    I think it might then be helpful instead to think simply of being different, or especially extremely different, perhaps in ways that seem to cause problems.

    When we find ourselves being different, we have to decide, do we want to try to recover from these differences, to try to be more like others so as to avoid any problems or disruption that seem associated with those differences, or do we want to accept and even be proud of our differences, and ask others to accept us as we are and to adjust to accommodate the way we are different?

    To use a simple example, let’s say I am being way more fearful about an upcoming event than is most everyone else. If I think my fear is reasonable, and I think everyone else is just being overly bold, I might accept or even be proud that I am perceptive enough to have that fear, and I would want others to also accept and accommodate my fearfulness. If on the other hand I think my fearfulness is going overboard, I might try to recover from it, or to overcome it.

    The key thing I am proposing is that we really need both strategies, sometimes working to change ourselves, sometimes rejecting the idea of changing, being happy with ourselves as we are. Trying to rely exclusively on just one of these strategies, and always rejecting the other, is unlikely to lead to a successful life.

  • Someone Else, I think you bring up some important concerns, though I’d encourage you to also consider that others may have other experiences.

    So it is really important that mental health professionals acknowledge that “antipsychotics” can for some people actually cause them to hear voices etc. At the same time, the much more usual pattern is for these drugs to quiet voices at least somewhat. Of course, this quieting is itself not necessarily a good thing…..

    One way of making sense of that is to think of the voices as messengers, that let you know something is going on that needs to be dealt with. So for you, the voices functioned as messengers that you were reacting badly to the drugs, and needed to get off them. For others, the voices may be messengers about underlying distress for example about past traumas, and the drugs create indifference around that past trauma, which quiets the voices – but only as long as the drug is taken, and it keeps the person from engaging with the parts of themselves that have continued to be distressed by the trauma. So it may both de-escalate a crisis and also prevent healing.

    I don’t agree with the assertion that the mental health system needs to be completely overthrown in order to address child abuse. Rather, I would say there are parts of it that need to be overthrown, while in other parts of it, there is really a lot of knowledge and expertise about how to help people recover from abuse. I’d hate to throw all that out.

    I do think we would do well to throw out the DSM. A lot of people would say, well, then you have to throw out modern mental health care, because it is “based on” the DSM. But I think a lot of it is based on something much more simple, which is simply that a lot of people are feeling stuck in states of distress and would like some kind of help getting out of it. To many professionals, the DSM is just a way of putting the distress into a category so the insurance company will be happy – then the real work of figuring out what is going on with the person, and how to work toward change, begins.

  • The idea that emotionally traumatized people “don’t have anything wrong with them” and that the focus should all be on social issues, social justice, is an interesting one.

    It’s the exact opposite of the psychiatric idea that the problem is all inside people, with no social justice issues at all!

    I am proposing that the truth, as with physical trauma, is somewhere in between.

    In the case of physical trauma, it would be quite weird if someone claimed to have had serious physical trauma, but then not to have had, even for a while, (before it healed) something wrong with them or with their body.

    I think it is also true of emotional trauma that an event that doesn’t create something bad or wrong within a person is not much of a trauma! That doesn’t mean the injury is necessarily permanent, and some injuries are healed without special assistance, but as with physical problems, some may stay unhealed till the right assistance is received.

    Of course, there is no guarantee that what people offer as “help” will truly be helpful – sometimes what is offered makes things worse. Figuring out what is truly likely to be helpful is an important goal.

    I really get how rotten a thing it is to tell an emotionally traumatized person that the problem is all inside them, and that there was no problem with what happened to them or with whoever caused it!

    But I also think it can be disabling to emotionally traumatized people to tell them that the problem is now all outside of them, even while they continue to be miserable. And what if their abusers are now dead, and if there is now no way to seek justice? At this point, something inside may need to change to relieve the misery, and it’s the idea that people can do internal work toward healing, and get help doing that work if they need it, that provides hope.

    That’s not to say that there isn’t also something to be accomplished by helping people get in touch with the sense in which they have always been completely OK, the sense in which the trauma didn’t affect them. In IFS, mentioned elsewhere in these comments, there is the idea that we all have an undamaged “Self” that, if we learn how to bring it forward, can help us heal or unburden the parts of us that have been messed up by trauma. So it’s complex, but I’m hoping we can talk about the complexities so we might have a chance of actually helping people who are caught up in stuff that often isn’t real simple.

  • Hi dfk, I agree with you that the internal family systems approach is a very similar approach to the one described in these videos.

    And PacificDawn, it sounds like you are saying no one should offer therapy, because that makes it sound like there is something wrong with the person who was hurt, while all the attention should go to social justice issues etc. I see that as wrong – like saying that no doctor should sew up wounds or set broken bones of those who have been beaten up, because the real problem is with the assailants. It seems more reasonable to both help people who have been hurt AND to attend to the social justice issues, prevention of more harm, etc.

  • While I think it is true that a lot of psychiatrists base their practice on the idea of “real mental illnesses” as described in the DSM, I don’t think they all do. Some see the causes of mental and emotional suffering as often much more complex, usually involving social causes, etc. They don’t want to try to solve everything with drugs, but they do seek to offer a drug, or medical, intervention that might in some cases be helpful for at least a limited period of time. Do I have to be against their work, just so I can say I am truly anti-psychiatry? Or can I say that maybe there would be a small role for a medical specialty helping out in mental health, even after all the lies and corruption gets scraped away?

    I know the latter is heresy to many of you, but I would propose that the reason psychiatrists love to paint all their critics as “antipsychiatry” is that being antipsychiatry is actually a much weaker position than being focused on what is wrong or corrupt within psychiatry. They love to face the weaker argument, because it does come across as extremist, and it’s kind of sad to see so many on MIA rush to paint this weaker position as being the stronger one.

    Anyway, I’m afraid if I keep responding to comments I may just repeat myself, so I don’t think I’ll respond more unless I think of something really new to say…..

  • I understand the need for decisive action! But I really contest the notion that “being more extreme” is always helpful in getting there. I think instead it very often backfires.

    For example, let’s say I know someone, “X,” who often does very dangerous things. If I tell others “I am against everything X does!” it is certainly more emphatic than just being against the dangerous things X does, but it is also more likely to come across as me just having a grudge against X. It backfires, makes me look bad instead. I’m much better off just focusing on being against the dangerous stuff X does.

  • Rachel, I think you and Kindredspirit make good points about how projecting, or mischaracterizing the opposition, plays a big role in our polarized society. For one thing, if our opposition is some irrational extreme, then that’s the only reason they don’t like us, it couldn’t be anything wrong with us! Paranoia in this sense can make us feel better about ourselves (and I agree that psychiatrists often do that.)

    One reason I prefer the critical psychiatry stance to the anti psychiatry one, is that it’s harder for psychiatrists to demonize. “I’m not against anything a psychiatrist might do or so, I’m only against the harmful things they might do or say.” This “middle ground” stance brings focus to what’s important, which is what is or isn’t harmful.

  • I’d like to offer some defense of “middle ground” kind of thinking! Though I agree very much, it’s a terrible idea to look for the middle ground say between MLK and the KKK. That’s because MLK himself was a middle ground kind of person. The true “middle ground” might better be seen between white supremacy and a (hypothetical) black supremacy. Curiously, when current white supremacists talk about “white genocide” they speak their fears about how if white supremacy no longer prevails, that white people then will be oppressed. We need to articulate how there is a possible middle ground, where skin color doesn’t make people better or worse, it’s still hard for many people to believe that is possible.

    We live in an increasingly polarized world, that is tearing itself apart and neglecting the future. I think the way forward is to get better at identifying and moving toward something like what I am calling the “true middle ground” or point of balance. That’s what we need for mental health, ecological health, political health etc.

  • Hi Eric, thanks for this article, I think it makes a lot of sense! I think this role of “investigator” is already being taken on by those who are shifting to developing a formulation rather than a diagnosis: a formulation is a map of what’s going on and of possible routes to something different. Therapists can collaborate with people in developing such maps and in going through the process of change. But “investigating” sounds more understandable, less like jargon, than “developing a formulation.”

  • Thanks Will. This is a very deep and thoughtful essay! I really appreciate the way you addressed your own mistakes, and the way fear of facing our own mistakes can then make us more fearful of calling out something that is wrong in others.

    And it’s also important that we find measured ways of calling out the failings not just of our enemies but also of our close allies. This requires something other than black and white thinking – we don’t want to trash people who are otherwise doing good work, but we also don’t want to just get silent when real damage is being done by people who otherwise are doing good things.

  • Hi Peter, thanks for writing up this summary of your impressions from the ISPS-US conference. I was also there, and I do agree with you that it was an interesting intersection of professionals with people sharing and drawing from their own experiences.

    One difference in my reaction: I didn’t see as much conflict as you did between the views of the professionals and the people with lived experience.

    For example, you defined Beck’s approach as seeing problems that need to be fixed, rather than seeing persons with whom we need to connect. But what I saw was that Beck’s approach was all about connection. They talked about how they had been working to come up with an approach that would work for the most aliented people – as they put it, to help the person in the corner who won’t communicate with anyone, and who has been disconnected for a long time. Their approach was all about trying to build connection with that person, and then supporting that person in connecting with others, and Beck specifically said he believes in being person centered, not symptom (or problem) centered.

    Of course, Beck’s approach didn’t come out of thin air: he and his team admit it came about largely by listening to people with lived experience in the “recovery movement.”

  • Well, if you are talking about trying to get all of the mental health system to repurpose or reframe words, that indeed is a daunting task! But what I was referring to was just that it is easy for someone like me to use the word “recovery” in a way that makes clear I don’t assume it is an illness that someone is recovering from, or that they will always need to be “recovering,” etc. I guess what I am saying is that I don’t want to see us make “recovery” a bad word just because the system has figured out how to misuse it. I see it as a word that can still be helpful, and I believe our energy would be better spent insisting the word be used in its more helpful sense, rather than opposing its use at all.

  • Yes, that really is one of the worst problems of mainstream psychiatry – robbing people of their story, diverting attention from criminals and social dysfunction and instead directing the attention toward imagined brain defects which psychiatry then pretends to treat!

    By the way, one really cool poster that people can print out to paint a more accurate picture about trauma and “psychosis” is at https://psychosis2.files.wordpress.com/2018/10/ten-ideas-think-differently-about-psychosis-1.pdf

  • I’m sure you are right that most are currently thinking of it as “recovery from an illness” but it’s pretty easy in conversations to make clear that one is thinking in broader terms. I think it’s important to remember the ways the word “recovery” can be used constructively, while also of course balancing that with awareness of its limitations.

  • I’m glad you acknowledged that perceiving “recovery” can be a step forward for people told they will always be “sick.” I think it’s crucial that we don’t reject a word that is often so useful in helping people take that crucial step, even as we also explore its limitations and traps.

    And I would disagree with one thing you said about the term recovery – that it implies we must have been “sick” in the first place. It doesn’t. “Recover” is a broad word in the English language. We recover our balance, we recover from a shocking event, we recover from all kinds of things.

    We can even “recover” from something that is overall good – like I might recover from the chaos caused by doing a home remodel. I think “madness” can often be like the remodel – we lose functionality for a while, but we also might go into some kind of transformation that makes things better in the long run. An exclusive focus on “recovery” suggests that getting back to some status quo is the only objective, but refusing to talk about recovery can leave people feeling like it is understood they can never get back things they once had that they really would like to return to.

    I like the notion of the hero’s journey – it includes the idea that we have to leave “normality” to do some crucial things, but then there is a return stage, or a “recovery” stage as well.

  • Yes, the idea that one approach will help everyone should be declared quite dead! But I think there is value in having a diversity of approaches, then people can find something that fits for them at a given time and place.
    Steve, I wonder if you watched any of the video? If you did, can you see how someone like John might be more ready to help someone after learning something like Process Work?

  • Hi BigPicture, sorry if you were waiting for a response, I didn’t think of anything to add to what you already said, at least nothing without making a longer post than I might be ready to do! I think you make some good points, many of them along the lines of what Alan Watts used to talk about when he said that sometimes you have to go out of your mind, to get back to your senses.

    And I agree about the post hypnotic trance thing. Going into at least a different kind of trance gives you at least the awareness that some other kind of processing is possible, even though it doesn’t tell you what “being truly awake” might be…..

  • Hi Steve, I agree with you that much of what is taught in standard approaches is either not helpful or is actually detrimental, but I don’t think that all attempts to educate people in how to help is useless – a good example is the Open Dialogue program, which relies a lot on education, though part of what they educate is also humility and staying uncertain! I think we need to work on sorting out what is helpful and what isn’t.

  • Lots of professionals were trained to think that talking with people about their “psychotic” experiences would just make them worse, so if they believed that, it’s not surprising that they would think that people who hear voices shouldn’t go to a hearing voices group. But it’s also so ridiculous – it shows the impact of bad ideas, that can make the whole mental health system quite mad, and not in a good way.

  • I’m glad you found the article liberating! I hope you watch the video too, I think you will find it much more helpful. And I know it is hard to get practitioners to change, but I think it is worthwhile to keep chipping away at it, just getting a few to change can make a big difference to the people those practitioners work with. And once enough change, the balance may shift and the current model of mostly mistreatment may come to be seen as the monstrosity that it is.

  • Wow, I really like your phrase, about how spirituality is looked at as a “decorative garnish on a plate of pharmaceuticals.” I may quote you on it. It really captures the way I’ve seen spirituality be approached by the mainstream, when it even approaches it at all! It’s like a frill people might be allowed to have as long as it doesn’t interfere with them properly attending to the main course, the drugs and suppression.

  • Thanks for your story. It’s curious the bit about realizing you (and others) were God and then trying to talk about it – this was easier for me as a young man when I started thinking the same way, because that perspective was more talked about at least in the “hippy” subculture. Writers who were popular at the time, Alan Watts and Baba Ram Dass, for example, had some good ways of talking about it.

    In the hearing voices movement they say hearing voices is only a problem if you don’t know how to handle it. I would also say that thinking you are God is only a problem if you don’t know how to handle it and relate to others from that perspective. If mental health professionals understood this, they would be better at really helping people instead of just trying to squish perspectives they can’t understand.

  • Thanks Sarah! One thing I really liked about the article is your analysis of how the special confidential relationship of therapy actually backfired for you and left you feeling worse about yourself.

    I think ideally, any therapist, or even anyone who is going to have some kind of confidential helping relationship, would be trained to recognize the possibility of this kind of dynamic and ways to overcome it.

    I do think there is a time and place where people want or need a space to talk confidentially about things they can’t bring up elsewhere, but ideally they get help finding ways to then get support elsewhere – either because they learn how to frame their issues in ways they can share with the others already in their lives, or they learn how to find people they can share with (if the current people in their lives are too judgmental.)

  • I also don’t find value in distinguishing “healthy depression” from “clinical depression.” “Clinical depression” too often just means a depression that the clinician is unable to, or too lazy to, understand the cause for!

    But I do think depression is kind of like fear: sometimes it is really helping us, and other times it is more based on misunderstanding, exaggeration, etc. So I might be depressed about my relationship or job or even my whole way of being in the world, and that might be helpful and realistic, because there might be something terribly wrong with my relationship or job or way of being in the world, and I need to slow down and face that and let it sink in so maybe I can find some other path. Or maybe I feel everything is depressing, but it really is just an irrationally dark view, and what I need to do is to question my dark thoughts and see the value of jumping back into life without making any big changes.

    A key thing here is that it shouldn’t be clinicians deciding which is which: people have to make these decisions for themselves, though clinicians can collaborate with them in doing that, or facilitate thoughtfulness about it. It helps to have a clinician who isn’t too sure that the only thing needed in each case is rosier colored glasses to look at the world through……

  • Thanks Annette for sharing your experience, and I hope you do write more as a blog post! I had something similar happen – experiences and time spent exploring perspectives that psychiatry sees as psychotic, but making sense of it as a process of healing and transformation. I think there can be real dangers in going through this kind of process, and it isn’t the same for everyone – some people go to deeper and more intense places than I did and need much more support to navigate it safely – but many more would get through it successfully if we aimed more at exploration and working through, not suppression.

  • Hi LavenderSage, it’s true I wrote this blog without addressing any possible spiritual perspectives. But I didn’t mean to rule them out. There is for example the view that the self is an illusion – so it doesn’t really make sense to say something is part of something that doesn’t exist! Or there is the view that we are all one – so anything or any being we encounter is really part of us, equally so whether it seems to be “in” us or “outside” of us. What is key I think is not quibbling over different ways of conceptualizing our own identity or that which seems to be outside of us, but rather of seeing the possibility of establishing relationships that respect both what might seem like our “self” and what seems like “other,” whether or not that seems to “others” to be inside or outside what we “should” – according to them – be seeing as our “self.”

  • Hi Bradford, I think I see it as a bit more complex than what you are suggesting. I think there are a range of possible ways humans can get into troubles or confusion, that they are on a continuum with extremes possible, that is we can have a panic attack and be sure we are about to die, be so depressed we can’t get out of bed for days, or be so “psychotic” that we believe and experience outlandish things (as when my friend David Oaks thought the CIA was making his teeth grow.) These sorts of problematic mental states existed before the DSM came along, but what professionals did was to make committees to divide it all up into neat categories, and then they started talking in weird ways, like saying that the person’s “schizophrenia” made them believe or do certain things, which then took them off the hook from having to try to actually understand what might have happened to the person and what they might be going through to get them to think or act that way.

  • One way of thinking about it is that voices and thoughts exist on a spectrum. At one end we have stuff that is distinctly a “thought” – there doesn’t seem to be any hearing component to it, and it seems consciously willed. At the other end are experiences that are distinctly “voices” – one may hear them so distinctly that one has to look to see if anyone is there, and they are definitely not consciously willed. Then there are various kind of in between experiences – which some people might call thoughts, and some might call voices, with no clear distinguishing line.

  • Thanks for the comment, and for the perspective on the Metamorphosis story – there really are so many different ways of interpreting things, and so often reality is too complex to be captured in any one of them. Which is why, in Open Dialogue, they are so dissatisfied when only one perspective on things is on the table! They always want to bring in more, since dialogue is impossible if only one view is present.

  • I agree that the “psychosis” does communicate, usually in a disguised way, what the problem is, and taking drugs to suppress what is happening often gets in the way of sorting out what it’s all about. That why I think it makes sense to only use drugs when people can’t find any other way to head off some immediate disaster, drugs should not be the cornerstone of treatment.

  • I agree, when people do manage to get “less psychotic” and the problem seems to be just dissociative, then they are often told that they never had a psychotic disorder or “schizophrenia” to begin with. But somehow the fact that a mistake was obviously made in that case never gets them thinking that maybe the whole conceptual scheme, with its clear diagnostic separations, could be a mistake……

  • I would agree with you that the goal of identifying people with specific categorically distinct disorders is a fantasy! But the notion that people can have serious mental and emotional problems with which they can use help is not a fantasy. Rather than diagnosis, I much prefer trying to map out what might be going on for a particular person, or making a “formulation” of the problem. This can be individualized, but also draw on general knowledge of the kinds of problems that people often experience with different kinds of mental phenomena.

  • Hi Someone, I didn’t mean to suggest that I was assuming that “psychosis” is always something organic that can’t be approached with understanding and therapy, I just meant that this is a common assumption in the mental health field! What I was trying to suggest is that it often reflects just a further degree of alienation from one’s own experience, an alienation that often begins, as you suggest, with childhood trauma.

  • The recording of the webinar on this topic is now available, for free, at https://youtu.be/MO3_Odqq-7k I think Sean and his team are really on to something – for lots of people at least, I think turning toward the intense inner experiences they need to have and process, in a setting and at the time they choose, will be really effective in getting them to a place where they are no longer haunted by “disorders” that need suppression, by drugs or otherwise!

  • Hi JanCarol, I agree that this kind of work goes by different names and descriptions, including what we now call shamanic practice. I also agree with you that it offers a chance of true healing and entrance into the states of wellbeing you describe! So much different than spending the rest of one’s life trying to run away from certain experiences…..

  • Groups within society, or sometimes pretty much a whole society, can also be “out of touch with reality” and this is actually more dangerous than just an individual being out of touch, that’s something important to think about. Psychiatry is out of touch with reality when it ignores the down side of its treatment approaches. And critics of psychiatry are out of touch with reality when they exaggerate the down side of those treatments to make the issue seem more black and white than it is – for example by claiming that it’s a fact that the drugs are making people die 25 years earlier than average, when the science actually indicates the drugs as being one of a number of factors that are leading to early deaths – even if a very important factor.

    In my seminars on CBT for psychosis, I talk about how psychosis involves being disorganized and/or out of touch with reality, then I ask the students if any of them are perfectly organized or completely in touch with reality. If any answer “yes” I suggest they may be suffering from a grandiose delusion! I then introduce the dilemma, how can any of us decide for sure who is truly out of touch with reality if we are only partly in touch with reality ourselves? Then I suggest that what we really need to do is to dialogue about and investigate together different views about what reality might be, and that better approaches to “psychosis” work on that basis.

  • What most people mean by “psychosis” is being out of touch with important aspects of reality and/or being severely disorganized. Of course everyone is at least somewhat out of touch with reality, and somewhat disorganized, but it’s when it gets to seem extreme that people use the word “psychotic.”

    It’s kind of hard to argue that states of being extremely disorganized and out of touch with reality do not exist. I understand that some might like to use a different term for those states – some like the term “extreme states” – but it seems clear to most that these states of being do exist, and are worth talking about as something different than everyday states of mind.

    Some see “psychosis” as a medical problem that always implies a particular underlying medical condition. This theorized medical condition of course may not and probably does not exist – that is, some kinds of medical conditions can make people psychotic, but the fact that someone is psychotic is not good evidence that they have any particular underlying medical condition.