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Can Completing a Workbook Aid Recovery from Psychosis?

Biological psychiatry would have us believe that the state of mind called psychosis always results from something gone wrong with the brain, and that a drug intervention is the only way to have a substantial impact on that defect. 

But the reality is much more complex.  Research in past decades has shown that psychosis is often a reaction to adverse life events, to trauma, experiences of oppression, and other stressors.  And if it is a reaction, then the possibility exists that people can learn to react differently, and that this difference in reaction can play a major role in overcoming the problem.

That’s why I was interested when earlier this year I heard that a colleague was co-authoring a workbook designed to help people understand their state of mind in a more psychological way and to take an active role in their recovery.  I was asked to write a foreword for it (which you can read below) and the book is now published:

Here’s my foreword for the book:

Rufus May currently works as a psychologist helping people with psychosis, but when he was 18 it was he who became paranoid and was diagnosed with schizophrenia.  Professionals at the time explained what they thought had gone wrong with his mind, but he noticed the way they framed things made him feel like the passive victim of an active illness, with no room for hope that his own efforts could lead to recovery.

Fortunately, Rufus later met others who were more encouraging, and he found ways to regain control of his life and to move toward a meaningful future. 

People shouldn’t have to be lucky, however, to hear about active approaches to recovery from psychosis:  such ideas should be available to everyone!  This workbook is a great step in that direction.

I first met one of the authors, Jessica Murakami-Brundage, when she was an intern assisting me in facilitating a hearing voices group.  I’ve taught a multitude of students, but Jessica stands out as someone who was subsequently inspired to learn and work with leaders in the field and who is now, with this publication coauthored by her own former student Laura Dewhirst, stepping into leadership herself. 

When a path is well laid out, it seems simple and easy to follow.  So it is with the exercises in this workbook.  But those familiar with the variety of often conflicting therapy approaches for psychosis will recognize that impressive work was done to boil down the wisdom of those various modalities into this very user-friendly format.

Better yet, the authors have done so in a way that is not superficial.  They offer creative approaches even for some of the deeper and trickier issues, such as exercises exploring the possible meaning behind what a voice is saying and guidance in how to respond to a voice in a way that balances assertiveness with compassion toward both the voice hearer and the voice.

Still though you may be asking, how much can a workbook do to help someone escape from something as daunting as psychosis? 

One way of understanding psychosis is as something that results when our minds experiment with seeing things differently, and then get lost somewhere, or tangled up.  Once this occurs, it’s easy for us to lose confidence in ourselves.   How can we possibly use that same mind to get us out of a trap that it has created?

We might recall though the wise saying that “if you are going through hell, keep going!”  Our minds may have gotten into a confused or hellish place, but stopping mental experimentation can be an unhelpful solution, sort of like stopping in hell.  A better approach might be to recognize that while we’ve wandered into making sense of things in a way that doesn’t work very well, we can keep experimenting with other ways of making sense till we find something that works better. 

That’s what this workbook is about:  experimenting with possibly better ways of making sense.  The authors provide some ways of understanding psychotic experiences, but they also acknowledge that the perspectives they offer are not the only possibilities.  That’s important since there are many unresolved questions not only about psychosis but also about the nature of reality itself. What people need is not a one-size-fits-all view but help in finding a perspective that fits them personally and facilitates forming good relationships with others and creating a meaningful life.

Another barrier to recovery can be the exaggerated negative views of people with psychosis held by many professionals and members of the public.  Such “stigma” can then be internalized by the person with psychosis, causing huge problems.  Oryx Cohen has stated that after he first became psychotic, the way psychosis and its implications were explained to him made him feel he was being kicked out of the human race!  Fortunately, he later found better ways to understand what was happening, and he now helps others recover through his work as chief executive officer of the National Empowerment Center.  Escaping from stigma is not easy and some have reported it can be more difficult than dealing with psychosis itself, but the exercises in this workbook on resisting stigma and discrimination can help people begin to break free.

The journey of a thousand miles truly does begin with a single step.  I’m hoping that many of you reading this workbook will find that it facilitates some very significant early steps in your journey toward recovery and toward fashioning the life you want.

Compared to some of the (relatively few) other workbooks or general self-help books devoted to psychosis, this book is notable for drawing on a number of different therapy approaches, including cognitive behavioral therapy for psychosis (CBTp), Acceptance and Commitment Therapy (ACT), Dialectical Behavioral Therapy (DBT) and Compassion Focused Therapy (CFT). 

If you like the idea of self-help books though, here’s a few others you might also want to check out:

Think You’re Crazy? Think Again

Relating to Voices using Compassion Focused Therapy: A Self-help Companion

The Dialectical Behavior Therapy Skills Workbook for Psychosis: Manage Your Emotions, Reduce Symptoms, and Get Back to Your Life

Overcoming Paranoid and Suspicious Thoughts, 2nd Edition: A Self-Help Guide Using Cognitive Behavioural Techniques

Overcoming Distressing Voices

Our minds are tricky, and the world is confusing, and it can be difficult trying to figure everything out. Well, we never figure everything out, but with some help, we can often get to a place where it doesn’t seem quite so hard.

Please do comment if you have any thoughts about this post!

2 comments… add one
  • i think that there are individual & highly complex interrelated biological, psychological & emotional, social & environmental, & soul / spiritual / transpersonal factors involved in psychosis / schizophrenia. i don’t think that there is any either / or & that we should fully integrate all areas of clinical / biomedical psychiatry with all areas of psychology, sociology & spirituality.

    Reply

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