Recent research showed again that people diagnosed with “schizophrenia” tend to “jump to conclusions” sooner than do most people, and this causes them to do poorly on many tasks. 

A psychiatrist I know pointed out that research like this tends to be interpreted as illustrating some “neural” defect in the brains of those diagnosed, and wondered if the dominance of this sort of interpretation might be a demonstration of  a “research prejudice” for seeing the problems of “schizophrenia” as lying in neurons alone, rather than in mental processes.

My response to him was as follows:

This emphasis [on “neurons” rather than mental process] enhances the prestige of medical and biological researchers, while it disempowers those diagnosed with “schizophrenia” since they learn to see themselves, as Rufus May put it, as the “passive victim of an active illness.”

This also directs our attention away from how the neural difference may result from an understandable story:  by failing to look for a possible story, our chances for actually helping people are diminished.

One possible story about how the “jumping to conclusions” effect occurs, has to do with divergent thinking and its role in psychosis.  It’s well known that people who tend toward psychosis (both those diagnosed schizotypal and schizophrenic) show increases in divergent thinking,  which is kind of the opposite of jumping to conclusions about something:  instead it involves having a mind that is more open than usual, so that more ideas and associations come in.  This is related to what is often seen in people diagnosed with “schizophrenia” where stimuli is overwhelming, because it is not easily categorized and made sense of.  [continue reading…]

Daniel Mackler just released his newest film, “Open Dialogue” — on the Finnish Open Dialogue Project

A trailer for the film is on YouTube,  http://www.youtube.com/watch?v=aBjIvnRFja4

Also, there’s more info about the film (and a place to buy it, if you’re interested), at http://www.iraresoul.com/dvd3.html

And a guide to finding various articles and interviews about Open Dialogue on the web is available here.

A couple other things: 

Daniel Mackler, the filmmaker for the Open Dialogue documentary, also has a new film out called “Healing Homes” about another alternative for people with psychosis and other serious mental health issues.  See http://www.iraresoul.com/dvd2.html

Finally – and this barely relates to all of the above, but I met Ed Knight at a 3 day seminar in Open Dialogue so it kind of fits – Ed has a website with some interesting thoughts about psychotic experience, as well as bipolar, you can start here.

While I have done some introductory seminars in CBT for psychosis, there is now on the East Coast a new factility that goes well beyond that:

“The Institute of Cognitive Therapy for Psychosis (ICTP) is proud to announce its presence on the web! You may visit our official page at: http://www.sites.google.com/site/ictpsychosis. Information on the ICTP as well as training offerings and updates will be listed on the site.

“Additionally, the ICTP invites you to attend a CBT for psychosis (CBTp) training in Manhattan, which consists of 4 consecutive days of didactic training from April 27th to April 30th at the Kimmel Center, part of the New York University campus. This is also supplemented with 30 hours of weekly phone supervision. The trainers are Michael Garrett (SUNY Downstate), Page Burkholder (Kings County Hospital), David Kimhy (Columbia) and Yulia Landa (Cornell). The training is offered in collaboration with the International Society for the Psychological Treatments of Schizophrenia and Other Psychoses (ISPS). You may find more information about this training here (https://sites.google.com/site/ictpsychosis/training)”

The training comes with 30 hours of consultation over the phone, so it’s meant to be a package that really gets people going as therapists using this practice.  It is pretty expensive though, $3500, with a bit of a discount if peeople join ISPS (which is a good idea anyway for anyone interested in networking with others who provide psychosocial help for people with the difficulties that get called psychosis.

The article “Living in a Dream World: The Role of Daydreaming in Problem-Solving and Creativity” recently published in Scientific American Mind, explores both the positive functions of daydreams, as well as the hazards of getting too deeply immersed.  A related article looks a great scientific achievments made while daydreaming, “Delivered in a Daydream: 7 Great Achievements That Arose from a Wandering Mind [Slide Show]”  Finally, the first article mentions a website devoted to those with “maladaptive daydreaming” – Wild Minds – it has lots of ideas and discussion.

What is the difference between daydreaming and psychosis?  Not too much it turns out – just mainly that the daydreamer keeps track of the fact that all the content is produced by one’s own mind, while the person likely to get diagnosed with psychosis usually has lost track of that at some point, or doesn’t want to believe that the content is from one’s own mind.  Why might a person not want to think that a daydream is produced by one’s own mind?  There are two likely reasons.

One is that the person may find that by imagining that the daydream is not a daydream, but is real, the person can get more deeply into it.  Given that we are talking about people with a tendency to dream too intensely, this is just another way to up the intensity.  Of course it also has real hazards!

Another reason is that the person may be having negative daydreams, and want to avoid or disown them in some way.  When they intrude anyway, they seem to be coming from somewhere other than the “self.”

Of course, many people labeled “psychotic” do believe, or at least do believe a lot of the time, that the mental content they experience, be it voices or whatever, is coming from their own mind.  So at that point, it really is just an intense involvement in daydreaming. 

Just in my brief look at the Wild Minds website, it seems that a lot of the coping ideas also apply to working with voices and such.  So it would be good to explore more the continuum between daydreaming and experience that gets called psychosis – this could help us learn how to moderate the experience so people can learn to take advantage of the positive aspects of it while minimizing the hazards.

Not too long ago I finished reading Making Sense of Madness by Jim Geekie and John Read.  A central idea in the book was that “madness,” or “schizophrenia” are “essentially contested concepts” which means that like other terms such as “beauty” we can expect that there will always be controversy about their meaning, that different groups will see the meaning differently, etc.

This led me to think about how when a person is in the states we call madness, just about everything can become an “essentially contested concept” – the nature of self, of the world, of good and evil, of the meaning of words or a glance or anything at all.  Or at other times, a person will accept the most incredible ideas without contesting them in the least.  What’s that about?  I thought I would share my thoughts.

I have heard more than one person say that they traced to origins of their psychosis to a time period when they were “asking too many questions at the same time.”  And yet, we also know from research that a common behavior in psychosis is asking too few questions, of jumping to conclusions off very little evidence, and then holding onto those conclusions without allowing them to be questioned.  How could “asking too many questions” and “questioning too little” both be a part of what we call psychosis, or madness? [continue reading…]

In a recent blog entry Robert Whitaker draws the connection between the recent publication of evidence that antipsychotics shrink the brain and evidence published previously that shows that such brain shrinkage is associated with an increase in negative symptoms, functional impairment, and cognitive decline.   All of these problems have previously been attributed to “schizophrenia.”

Robert Whitaker has previously pointed out evidence showing that those treated long term with antipsychotics on average are doing worse than those not treated.  We are now starting to get more familiar with the mechanisms that lead to this worsening of outcomes.  What remains to be seen is what the public and the mental health system will make of this information.

Lots of “mad” people do things that they believe will solve a problem, but which actually make the problem much worse.  But we are all human, and it turns out that the mental health system is prone to making the same kind of errors.  What we don’t know is whether, or how long, it might take for the mental health system to work toward “recovery.”

According to a news article today, it’s going to be a lot harder for anyone to deny what some of us have been saying for quite a while:  that antipsychotic medications frequently result in shrinkage of the brain.  The study, in the Archives of General Psychiatry, found that over seven years ” More antipsychotic drug treatment, including duration and intensity, was linked to greater declines in brain volume. Severity of disease, alcohol and illegal drug use had no effect.”

Despite this seeming damming evidence, the lead researcher didn’t want to come off as critical of the medications, no doubt because he knows where most of the research money comes from, so he was careful to caution everyone not to “jump to the conclusion” that this was “bad.” 

Well, when they find evidence that suggests that “schizophrenia” makes a brain shrink, they somehow never imagine that it might NOT be bad.  But here they found that severity of “disease” seemed to cause no shrinkage, and the medications did, and yet we shouldn’t “jump to the conclusion” that it is bad.  I can almost see the spin the drug salespeople will be putting on this a few weeks from now “Well actually you see we are now thinking that the drugs only shrink the unbalanced part of the brain, so the overall result is good!”

I hope this leads to a lot more pressure for non-drug alternative approaches.  And for programs to help people who have been dependent on these drugs to try carefully phasing them out in safe ways, with good support.

In modern religions, people are taught to hope for some spiritual experiences in the future (heaven) and to fear other sorts of spiritual experiences (hell.)  But if you actually have a spiritual experience in the present, they call a psychiatrist and determine that it is all a biochemical imbalance……

Recent research shows that people in the psychiatric system often strongly prefer to have professionals talk about spiritual concerns:

Huguelet, P., Mohr, S., Betrisey, C., Borras, L., Gillieron, C., Marie, A. M., et al. (2011). A Randomized Trial of Spiritual Assessment of Outpatients With Schizophrenia: Patients’ and Clinicians’ Experience. Psychiatric Services, 62(1), 79-86.
doi: 10.1176/appi.ps.62.1.79
   
Abstract
Objective: Recovery-oriented care for patients with schizophrenia involves consideration of cultural issues, such as religion and spirituality. However, there is evidence that psychiatrists rarely address such topics. This study examined acceptance of a spiritual assessment by patients and clinicians, suggestions for treatment that arose from the assessment, and patient outcomes–in terms of treatment compliance and satisfaction with care (as measured by treatment alliance).
Methods: Outpatients with psychosis were randomly assigned to two groups: an intervention group that received traditional treatment and a religious and spiritual assessment (N=40) and a control group that received only traditional treatment (N=38). Eight psychiatrists were trained to administer the assessment to their established and stable patients. After each administration, the psychiatrist attended a supervision session with a psychiatrist and a psychologist of religion. Baseline and three-month data were collected.
Results: The spiritual assessment was well accepted by patients. During supervision, psychiatrists reported potential clinical uses for the assessment information for 67% of patients. No between-group differences in medication adherence and satisfaction with care were found at three months, although patients in the intervention group had significantly better appointment attendance during the follow-up period. Their interest in discussing religion and spirituality with their psychiatrists remained high. The process was not as well accepted by psychiatrists.
Conclusions: Spiritual assessment can raise important clinical issues in the treatment of patients with chronic schizophrenia. Cultural factors, such as religion and spirituality, should be considered early in clinical training, because many clinicians are not at ease addressing such topics with patients.

There is a perennial question directed toward those of us who see madness as having a spiritual dimension, and it goes something like this:  “How can “psychotic” experiences that are both terrifying and debilitating be seen as at all spiritual?  Isn’t it true that looking for spirituality within psychosis is just a case of “romanticizing madness?”

One way to answer this question is just to turn it around, and to point out how the usual psychiatric approach of seeing nothing at all positive in “psychotic” states acts to increase fear of madness, which in turn increases distress and disability.  In other words, the usual approach goes to an extreme opposite of “romanticizing” madness, and instead “awfulizes” it.  We can then explain that what we advocate for is simply a balanced view, or being open to noticing both what is negative and positive in experiences that go outside of usual cultural boundaries and are seen as “psychotic.”

But to fully address the question, I think we need to go deeper – very much deeper!  What follows will be my take on how to make sense of some of the deepest issues of our existence which I believe play a pivotal role in key experiences such as those of trauma, psychosis (or madness), and spirituality.

In the conventional view, it is believed possible to make a clear distinction between bad or sick experiences, which might be labeled “psychosis,” and positive or growth oriented experiences that we might call spiritual.  But the more we look for some clear “dividing line” between the two, the more it seems to be missing.

Instead it seems there is a realm of experience that is outside of our cultural norm, that we might call mystery, where people have experiences that are challenging, with a possibility of these experiences being seen as either bad or good, and of having results in terms of life outcomes that may be either bad or good in the conventional sense.

Mystery itself can be seen as both absence and presence.  When we focus on its dark side, it is absolutely terrifying.  But it does have another side, that can be seen as offering absolute security, and as having everything that we actually need.  [continue reading…]