I found a link to a very interesting article on the Beyond Meds site.  The article is called The Creativity Crisis and it documents how creativity is key to a society’s success, and yet it has been in a decline in the US since about 1990.  The article finds various reasons for this, but one reason it doesn’t mention is the dramatic escalation of use of psychiatric drugs for kids since that time.  Even Ritalin and other stimulants used for “ADHD” is known to reduce creativity, but the antipsychotics, also increasingly used for kids, are even more dramatic in their ability to inhibit original thinking.

It’s interesting that our society tends to view “living in your own world” or even “attending to internal stimuli” as the hallmark of mental illness, yet as this article points out, it is also key to creative development.  There’s even a word for the “imaginary worlds” that creative people often develop in childhood and then take with them into adulthood:  they are called  “paracosms.”  Really creative kids can see and hear stuff they make up.  But what happens to kids like these when they annoy someone and come to the attention of a psychiatrist?

This article actually downplays the connection between creativity and mental and emotional problems – calling it a myth, for example, that creative people tend to be anxious or depressed, and stating that such traits tend to shut down creativity.  But when researchers have actually look at people who have had creative achievment as a group, they do find higher than average levels of “mental disorders.”  It may be true that anxiety and depression get in the way of creativity, but it also seems true that creative people are prone to struggling with such things. 

At one point in the article, it is suggested that people get suicidal because they aren’t creative enough, and points to people who think of all the ways things can go wrong, but not to possible solutions, as being the one’s prone to depression and suicide.  But this could also be seen as misguided creativity – the creativity is all going into seeing how things could go wrong, and not into possible solutions.  So I think it makes more sense to see mental and emotional problems as often related to misguided creativity, and to see the solution as helping people learn to use their creativity in more constructive ways.

One interesting part of the article is the distinction made between divergent and convergent thinking, and how both play a key role in successful creativity.  In psychiatry, both these forms of thinking are well known – but there they get labels like “positive symptoms” for thinking that diverges from “normal,” and “negative symptoms” for thinking that seems too convergent, when too many possibilities have been eliminated and the person seems to be missing something normally present.  I think it is true that many people get carried away by both divergent and convergent thinking in ways that are not helpful to them, but I think it is also helpful to know that these forms of thinking have important uses, and that if they are better directed, they can be part of a healthy creative life. 

Our society tends to want to produce kids as a sort of standardized product:  they should succeed in some simple linear way, shouldn’t cause trouble, shouldn’t do anything freaky, etc.  But that isn’t how kids work.  We as a society need to be less controlling, and re-envision childhood as a time to explore imaginary worlds.  And when young people get lost in their imagination, we need to see that as a sign of potential talent as well as trouble, and help these people learn to put it to constructive use.

A week ago or so I posted a review of Robert Whitaker’s book Anatomy of an Epidemic on Amazon.com.  The purpose of doing so was to address what some have seen as a problem of Whitaker relying too much on “naturalistic” studies in coming to his conclusion that psychiatric medications are doing more harm than good on average.

What I said in response to that contention was that 

I think not.  What Whitaker perhaps assumes everyone knows, but doesn’t discuss, is the fact that it is really impossible to perform tightly designed scientific studies about long term outcomes.  People will not stay in a double blind randomized study over the course of years, so such studies just don’t and can’t happen.  Because of this, we are left in a bind, with two choices:

• 1.  We can base our decisions on the more “scientific” studies, that have tight designs but look only at short term outcomes, usually just weeks or months, or
• 2.  we can base our decisions more on naturalistic studies, which are somewhat less scientifically convincing but at least are studies of what we really care about, the actual long term outcomes, what happens over years or even decades.

If we choose option 1, we fall victim to something called the “Streetlight Effect” which is described by Louis F. Markert as follows:  “The Streetlight Effect is the fundamental error of searching for something where the light is best, but not where it actually may lie. It is described in a favorite old joke among scientists–a fact which alone should raise our eyebrows! Late one night a policeman finds a drunk crawling around on his hands and knees under a streetlight. The drunk tells the officer he’s looking for his wallet. When the officer asks if he’s sure this is where he dropped his wallet, the man replies that he thinks he actually dropped it across the street. “Then why are you looking over here?” the officer asks. “Because the light’s better here,” explains the drunk!”

When a person has a psychotic episode for the first time, or when a person is already taking antipsychotics and is wondering whether or not to continue, the most important consideration is most likely to contribute to a positive long term outcome for the person.  But we have no way to study that with randomized double blind studies.  The streetlight of randomized double blind studies does not shine on the long term.  It shines only on the short term, and shows us that in that short term, people are better off getting on or staying on the drugs.  As far as psychiatry has been concerned, that should be the end of the story, and everyone with psychosis should stay on the medications for life.

What Whitaker has done has been to systematically look at the studies that go beyond the short term, to see what they indicate.  These studies are a bit murkier, like views away from the streetlight, and their interpretation is more problematic.  In any one study, it is always possible that some factor or other contaminated the result, making the study appear to show one thing when really something else was happening.  But these are the studies that at least actually look at the outcome we really care about, so they are the best evidence we have to determine what is happening.  And when they all say essentially the same thing – that long term outcomes for people who take the medications are worse on average than for those who do not take them – then that is strong evidence we need a radical change in direction in mental health treatment.

It would be much simpler and easy for all of us if what reduced psychosis most in the short term was also what best supported long term recovery and mental and physical health.  But it’s time for the entire mental health system to take note that this doesn’t seem to be the case, and so we need to be looking for ways to help those who want to attempt safe tranistions to less or no medications, and we need to work on really understanding people rather than assuming we can forever use medications to “make people normal.”

 A lot of the hopelessness around “schizophrenia” has to do with beliefs that it is rooted in brain differences and so cannot be “talked away.” One way of fighting this notion is to talk about neuroplasticity, or how the brain changes itself with experience. As you change how you think and act, your brain changes, and if the changes are positive, the brain changes can be too.  One of the studies to illustrate this most clearly is just now being released: it happened right here in my hometown of Eugene Oregon. See below. Note that one of the brain areas positively affected was one that has been identified as playing a role in “schizophrenia.”

http://www.sciencedaily.com/releases/2010/08/100816155000.htm

Quite awhile ago I received, via Twitter, a link to an article that purports to distinguish between mysticism and psychosis, written by a psychiatrist.  I started to write a blog post in response, then I got sidetracked, but the recent discussion on this blog has inspired me to come back to it.

The article asks some very legitimate questions, such as, would the well known mystics of the past have been treated for psychosis if they showed up in the present?  And the article has a very good description of some of the common factors in psychosis and in mystical experience.  Despite that however, I think the article is really flawed in its attempt to make a definite distinction between mysticism and psychosis, when in reality people’s experience is on a continuum, and people usually experience a mix of “spiritual truth” and delusion.

For example, anyone familiar with the story of the prophet Ezekiel knows that people could be both mystical and way over the top as far as exhibiting behavior that psychiatrists would lable psychotic.  (Rossa Forbes recently touched on  this in one of her comments.

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I just ran across an interesting article on psychosis and spirituality.  It starts off by pointing out that

“Psychotic and religious experiences have been associated since the earliest recorded history (Lukoff & Lu, 2005). The Old Testament uses the same term to refer to madness sent by God as a punishment for the disobedient, and to describe the behavior of prophets (Rosen, 1968). Socrates declared, “Our greatest blessings come to us by way of madness, provided the madness is given us by divine gift” (Dodds, 1951, p. 61). In more recent years, religious institutions and the mental health field-especially in the West- have taken a more dichotomous view of spirituality and psychosis. When spirituality and psychosis overlap, the experience has usually been viewed as pathological.”

I think it would be fair to call this a “dissociation” between spirituality and psychosis, a sign of something truly wrong with both our mental health system and with our culture generally.  There is no recognition that spiritual experiences come in any sort of raw or disorderly form.  Consequently, when people do have confusing experiences, it is labeled as illness, and no one helps the person sort out what might be valuable in the experience.  I believe this is a sad thing.

The article, INTEGRATING THE SPIRIT WITHIN PSYCHOSIS: ALTERNATIVE CONCEPTUALIZATIONS OF PSYCHOTIC DISORDERS, does have a bit too much of the “some people have real biological mental illness and some people have spiritual emergencies” rhetoric for my taste at points, but it is a good article overall.  (Certainly, some people may be more understandable to themselves and others in spiritual terms, but I don’t think there is any dividing line that allows us to “really” categorize people as one or the other, no reason to shrink some people to being viewed as biologically defective while others are allowed to be seen as having valid spiritual journeys.) 

I think to really reach out to people in crisis with a spiritual perspective takes an ability to be pretty free of dogma – and that means being free of the kind of dogma that dismisses all spiritual experiences as meaningless, as well as free of dogma that says it can have only one kind of meaning.  Not something easy to find in either the mental health system or the wider culture.

The latest way to sell antipsychotic drugs appears to be to tell people that psychosis will damage your brain, and so people need antipsychotic medications to protect those brains.  This claim was recently made by Jeffrey Lieberman on a PBS television show.  Fortunately, Robert Whitaker took some time to analyze the science behind these claims, and you can read his column on that here.

What follows is a handout I designed to give to people to help them think through whether they really want to try psychiatric medications.  Imagine how mental health treatment might be different if these questions were routinely considered by everyone before psychiatric drugs were prescribed!

Questions you might want to consider before relying (or continuing to rely) on any psychiatric medication

As with any potentially life-altering choice, it is important that decisions about psychiatric medications be made in a thoughtful manner, which requires looking at all sides of the issue.  But because billions of dollars are spent to promote psychiatric medications, because the time available to medical providers who meet with you is often limited, and because the possible advantages of medications are often easier to understand than the disadvantages, there is a risk that people may end up on medications without a full understanding of possible hazards associated with taking medication.  This handout assumes you have already heard about the possible benefits of using medication, and it focuses on addressing the “other side,” or some of the possible reasons you might want to decline to use medication.

I am not a doctor, so I am not providing medical advice in this handout.  But I am passing along to you concerns I have heard about medications, so that you can, if you choose, decide to seek out more information and make up your own mind about what to believe. 

Have you considered the possibility that even if the medication is effective in helping reduce your mental or emotional problem in the short term, that it may cause this problem to become worse in the long term?  There exists quite a bit of evidence for example suggesting that anti-anxiety, antidepressant, mood stabilizing, and antipsychotic medications, despite seeming to help in the beginning, are likely to make problems worse in the long term.[i]

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I spent some time down by the river today, alternating between reading and swimming, and learned a new concept (and a term to go with it) that I thought I would share with you.  I was reading “Cognitive perspectives on dissociation and psychosis: Differences in the processing of threat?”  by Dorahy & Green, from the book Psychosis, Trauma & Dissociation.

This chapter discusses an odd finding where people who tend to be paranoid were found to spend less time than normal looking at threatening stimuli, but then when they looked away at relatively non-threatening stimuli, they tended to see more threat in that non-threatening stimuli.  This pattern was called a “vigilance-avoidance” method of threat processing, and it was hypothesized that the paranoid people were attempting to avoid the unpleasant feelings resulting from observing the threatening stimuli by looking away, but then since their more automatic perception of threat had been “set off” they then tended to see more threat in the non-threatening stimuli.

In cognitive therapy we call this sort of thing a dysfunctional experience control strategy.  The person is trying to perceive less threat, but ends up feeling threatened by stuff that really is relatively safe, which of course makes everyone else think the person is crazy, and of course one can do oneself much good by taking action to protect against threats that aren’t there.

In its more extreme forms, a person may withdraw attention from most of the external world which seems threatening, but then since the automatic aspects of threat perception have already been activated, even the formerly safe internal world begins to be perceived as threatening, and there is no escape.

Lots of fictional tales start with the hero being threatened in some way in a real-world kind of way, then the person journeys into a kind of fantastic land where threat follows them, though in a new and more fantastic form.  In stories, the hero often first learns to do something to handle the threat in the fantastic world, then emerges with a new strength that allows him or her to handle the real-world kind of threat. 

The key thing is that the person needs to learn how to take a stand and start looking at threats in the eye, not turning away to try to feel better.  Unfortunately, most mental health treatment currently is based on helping people avoid having the experience of facing their demons, using everything from drugs to distraction.  So it is hard for heroes to emerge from that.

“Schizophrenia” can be seen as revolving around having difficulty in containing opposites, such as love and aggression.  In normal everyday culture, opposites are often contained simply by pretending they aren’t there and aren’t supposed to be there, while “under the table” they are allowed to coexist.  In other words, hypocrisy is the rule.  Those who end up defined as “schizophrenic” are often those who actually attempt to do what the culture says it does, which is to get rid of one opposite in favor of another.  This sets off an internal war, as other parts of the self rise up to prevent any such elimination, since in reality both opposites are necessary to life.

At the same time, when people who are caught up in “schizophrenia” manage to recover, they do a huge service for the culture, because they find ways to accomplish the reconciliation of opposites in new ways, and often ways that are much less hypocritical than those common in the culture beforehand.

Of course, problems with opposites manifest as other disorders as well.  [continue reading…]