As we struggle to invent a humane approach to the extreme states that get called “psychosis” or “madness” or “schizophrenia,” it may be helpful to investigate some of the better approaches developed in the past. While these approaches are not without their flaws, they are often surprisingly insightful. (It can also of course be depressing to notice how truths once more widely known were so easily “forgotten” as compassionate approaches got ditched in favor of the latest coercive innovations.)
We live in a culture bombarded by media and sped up by rapid-fire social interactions. It's definitely useful to grab hold of a simple, short, sound-bite term, to quickly describe what we are feeling or suffering. "Depression" is such a word - it evokes and encapsulates, conjures the images of that ugly pit of despair that can drive so many to madness and suicide. Yet at the same time the words we use, strangely, become like those pens deposited in medical offices and waiting rooms around the world: ready at hand, easily found, familiar -- and tied to associations, marketing and meanings we were only dimly aware were shaping how we think.
When people are seeing the world really different than we do, it’s often reassuring to think that there must be something wrong with them – because if they are completely wrong, or ill, then we don’t have to rethink our own sense of reality, we can instead be confident about that own understandings encompass all that we need to know. But it can be disorienting and damaging to others to have their experiences defined as “completely wrong” or “ill.” And we ourselves become more ignorant when we are too sure that there is no value in other ways of looking or experiencing.
In many respects it is difficult to fault the report Understanding Psychosis and Schizophrenia, recently published by the British Psychological Society (BPS) and the Division of Clinical Psychology (DCP)[i]; indeed, as recent posts on Mad in America have observed, there is much to admire in it. Whilst not overtly attacking biomedical interpretations of psychosis, it rightly draws attention to the limitations and problems of this model, and points instead to the importance of contexts of adversity, oppression and abuse in understanding psychosis. But the report makes only scant, fleeting references to the role of cultural differences and the complex relationships that are apparent between such differences and individual experiences of psychosis.
With a diagnosis of schizophrenia, if internalized, comes the erosion of personhood, lowered self-esteem, shattered dreams, and a sense of disenchantment. The psychiatrist Richard Warner has even suggested that those who reject the diagnosis of severe mental illness may have better outcomes as they retain the right to construct their own narrative of personhood and define what really matters for them. Despite public education campaigns (or perhaps because of them), the stigma of mental illness is as enduring as it was 50 years ago.
As awareness spreads about there being something wrong with existing approaches to “psychosis” aka “madness.” Interest grows in exploring what to do instead. One meeting place for exploring this question of “what to do” will be the ISPS conference in NYC in March 2015, which is titled “An International Dialogue on Relationship and Experience in Psychosis.” This conference promises to stand out in terms of the variety of voices, perspectives, approaches and traditions that it will bring together to focus on the deeper issue of how helpers can best understand and interact with those experiencing what is called psychosis.
If human beings were meant to be entirely stable entities, then “stabilizing” them would be an entirely good thing; a target for mental health treatment that all could agree on. But it’s way more complex than that: healthy humans are constantly moving and changing. They have a complex mix of stability and instability that is hard to pin down. All this relates to one of my favorite subjects, the intersection of creativity and madness.
The kinds of experiences we call psychotic are often incredibly scary: people feel they are being persecuted by strange forces, or that their brains have been invaded by demons or riddled with implants from the CIA . . . the list of possible fears is endless, and often horrifying. While standard mental health approaches counter many of these fears, they often create new fears of a different variety. Wouldn’t it be helpful if professionals were trained in an approach that could help people shift away from both dangerous psychotic ways of thinking and also away from the sometimes equally terrifying explanations which emphasize pathology?
When Doug Turkington, a UK psychiatrist, first announced to his colleagues that he wanted to help people with psychotic experiences by talking to them, he was told by some that this would just make them worse, and by others that this would be a risk to his own mental health, and would probably cause him to become psychotic! Fortunately, he didn’t believe either group, and in the following decades he went on to be a leading researcher and educator about talking to people within the method called CBT for psychosis.
As we develop critical awareness about the mental health “treatments” that don’t work and that often make things much worse, the question inevitably comes up, what can those who want to be helpful be doing instead?
In 2004, a patient was given an experimental antipsychotic called bifeprunox and died of hepatorenal failure nine days later. But the sponsor apparently did not investigate the death for three years. In late 2007 the sponsor issued a safety alert and suspended all bifeprunox studies. This is where things get interesting.
The core of Acceptance and Commitment Therapy, or ACT, is the idea of simply accepting, rather than trying to get rid of, disturbing or unwanted inner experiences like anxiety or voices, and then refocusing on a commitment to take action toward personally chosen values regardless of whether that seems to make the unwanted experiences increase or decrease. This idea is consistent with the emphasis in the recovery movement of finding a way to live a valued life despite any ongoing problems, but ACT has value because of the unique and effective strategies it offers to help people make this shift.
What would happen if professionals opened their minds about the nature of madness? What new possibilities might be created if they questioned labels such...
While a 2-year outcome study by Wunderink, et al. has been cited as evidence that guided discontinuation of antipsychotics for people whose psychosis has remitted results in twice as much “relapse,” a not-yet-published followup of that study, extending it to 7 years using a naturalistic followup, finds that the guided discontinuation group had twice the recovery rates, and no greater overall relapse rate (with a trend toward the medication group having more relapse.)
When children do things like recoil in fear from monsters and ghosts in their darkened bedroom at night, it’s easy to see the “out of touch with reality” aspect of their experience as being closely related to the faculty that gives them their ability to play – their imagination. We help children through such challenging experiences by being with them, and by playing together, doing things like creating scary images together and then figuring out how to cope with them or laugh at them. In the process we help them explore how to create a world view that works to at least some extent and has room for joy and originality - when their imagination helps them (and maybe others) see the world in new ways.
While some people find their lives ruined by belief in imagined conspiracies that affect them personally - they may isolate from, or even attack, friends and family, and get diagnosed with psychosis - many other people believe in conspiracies on the basis of little evidence, yet have prominent places in society or even bodies like the US Senate. Yet it seems clear to me that the same dynamics are often involved in both.
When people call someone in their family “mentally ill,” what does it mean? The term mental illness has gotten out of control vague. There is no way to prove someone does or doesn't have a mental illness in the way it is referred to, so why don't we hear people say, “There's someone in my family who's extremely challenging for me (and others perhaps)”? Why don't we hear descriptions of the behavior, how people feel in response to it, and what concerns it brings up in an honest way where the speaker owns their own experience?
Earth Day 2013 is a good time to reflect on how problems in our mental health system reflect deep flaws in “normal” conceptions of what it means to be a human being. These flawed conceptions then contribute in a critical way to the climate crisis that threatens us all.
The United States desperately needs good programs to help people withdraw from neuroleptic drugs. From all I have seen and heard, there aren’t any - none at least that can reputably claim to get good results on a fairly consistent basis. Again and again I find myself challenged to envision such a program, and in reply to the challenge I have broken down this hypothetical program into various components.
The more we worry about the separation from reality, the more scared we get and the more separated we get. This month I found out about another trap. When you can see the beauty and spirituality and mystery and magic of what is going on, it's tempting to do things to make it last longer and help yourself get further into it, like skip sleep or skip meals or use drugs. I had to fight those temptations often through this month, and still am, to be honest, because there is so much of this process that was not just scary, but glorious and giganticly interdimensional and impactful.
A recent article, "Screw Positive Thinking! Why Our Quest for Happiness Is Making Us Miserable" provides humorous perspective on the ways seeking too hard after happiness can make us unhappy - and, it seems, stupid as well! I'm going to argue that the same paradox also applies to other aspects of mental health, and that some of the major problems in current mental health treatment result from failing to take this into account.
The recent research scandals out of the University of Minnesota’s Department of Psychiatry may be alarming, but they are not new. Back in the 1990s, when the university was working its way towards a crippling probation by the National Institutes of Health (for yet another episode of misconduct (this time in the Department of Surgery), the Department of Psychiatry hosted two spectacular cases of research wrongdoing, both of which resulted in faculty members being disqualified from conducting research by the FDA.
In the "agreement for corrective action" against CAFE study coordinator Jean Kenney last week, the Board of Social Work cited Kenney's failure to respond to "alarming voicemail messages" from family members of Dan Markingson. Presumably, the Board is referring to a message left by his mother, Mary Weiss, which warned, "Do we have to wait until he kills himself or someone else before anyone else does anything?" The failure of Kenney and Stephen Olson to take the warnings of Mary Weiss seriously has been one of the most disturbing aspects of this case. In a deposition for the lawsuit filed by Weiss, Kenney was questioned about her response. Here is an excerpt. (The initial questions come from Gale Pearson, an attorney for Mary Weiss.)
It looks like a great event: The Hearing Voices Network 25 Years On: Learning from the PAST, Practicing in the PRESENT, Visioning the FUTURE. ...