In an article titled ” Effects of Culture on Recovery From Transient Psychosis” the author asks why premodern cultures studied by the World Health Organization had 10 times the rate of acute onset psychosis followed by full recovery as that found in more modern cultures.

The author contends that “Traditional treatment in a premodern society usually consists of a prescribed period of rest; sympathy; heightened social support; alleviation of underlying social stresses; exploration of alternative coping
strategies; and various types of traditional healing rituals, sometimes lasting days or weeks, and frequently resulting in the full recovery of the patient.”  

While “modern medical experts” make fun of “primitive” perspectives about spirits and the use of “witch doctors” to address them, it seems that any truly “evidence based” approach to understanding psychosis would be more interested in figuring out how and why they were so effective.

Contrast the “primitive” approach with the relative isolation and drugging imposed on the newly diagnosed psychotic person in in a modern culture.  The person is identified as “biochemically imbalanced” rather than overcome by stressful life events, no attempts are made to really understand him or her, the experience is identified as an illness with no spiritual consequences, and no coping tools are suggested beyond taking pills as prescribed.

I am reminded of an early drug trial on antipsychotics.  They had 4 groups, three groups were each on a different antipsychotic, while the fourth group was a placebo.  After about 6 weeks, each of the drug groups was doing better than the placebo group. But when they came back and checked on how everybody was doing after a year, they found that the group that had been started on placebo was doing better than any of the three groups started on drugs.  Instead of concluding that there was something wrong with rushing people into drugs however, the experimenters hypothesized that the group initially started on placebo was only doing better because they had been noticed by others to be doing worse because of not being on drugs, and this had elicited sympathy and concern from the people who noticed, and it was the extra care that they received that resulted in them doing better when measured a year later.  Of course, it never occurred to the experimenters that giving a drug to people that made them seem like they didn’t need extra support, resulting in them not getting the support they really needed, so that they would be doing worse later, may not have been a good idea.  (Not to mention that more drugs meant more risk of nasty side effects as well.)  And so the modern era of drugging and lack of empathy was begun. [continue reading…]

People often become psychotic because they face a problem or set of problems that appears overwhelming to them.  Then what happens is they get tricked into thinking that the “psychosis” is their primary problem, when really the primary problem is their difficulty in facing their original problems in a direct way. 

So for example, people will start seeing their problem as a need to “stop the voices” or to quit seeing images, or quit having violent impulses, or whatever.  (Trying to hard to “get rid of” such mental experiences often just amplifies them, as I’ve written about elsewhere.)  The mental health system tends to jump in and agree that “psychosis” is the real problem, and prescribes drugs to stop it, often failing to notice when the drugs themselves become disabling or ruinous to a person’s health.  All of this ignores the fact that “psychosis” never was the primary problem, but rather, it was the need to face problems in living more directly.

I just read an article about a therapist who was good at just this common sense approach of helping people face their problems directly.  He wasn’t opposed to all use of medication, but thought it was a horrible substitute for real assistance, which he saw as joining with people in helping them face issues that they weren’t ready to deal with alone.  See this article about the work of Dr Elvin Semrad.

I have written elsewhere about links between creativity and psychosis.  In a recent blog entry, Gianna Kali of “BeyondMeds” links to an article describing how teachers in schools all say they seek to encourage creativity, yet their favorite students all tend to be those who show traits incompatible with creativity – those who are good at agreeing, following rules, etc.  Why the discrepancy?  And what does it mean for mental health?

Creativity is extremely valuable, but it can also have high costs.  One of the costs is that people who are attempting to be creative will sometimes make errors, and their attempted improvements will sometimes make things worse.  But if we are to become a society that truly values creativity, we need to recognize that we benefit from those who live more “on the edge” and who sometimes fall off the edge:  instead of stigmatizing them or labeling them as forever ill, we might better collaborate with them in helping them figure out where they might have gone wrong while also staying open to the possibility they have a lot to teach us.

I really wonder how much creative talent is currently buried under high doses of antipsychotic medications……

Martin Luther King often made the point that it is better NOT to be “adjusted” to injustice, and that psychologists often over-emphasize the value of “adjustment.”  He even called for the establishment of a group to champion “creative maladjustment.”  In a talk later broadcast on public radio in Eugene Oregon, three activists including myself talk about what often goes wrong in mental health care currently, and how it might be different if the system really respected the human rights of the people it tried to help and if it acknowledged that being “adjusted” is not the only way to be healthy – and that at times being “maladjusted” is actually more important!

Hear David Oaks, TC Dumas, and myself  at http://www.klcc.org/audio/cityclub2010_01_15.mp3

I’ve had a collection of handouts I’ve given out at seminars I give on CBT for Psychosis and Trauma and Psychosis.  Just today I put these all on the web – well some are just web links anyway, others are stuff I’ve written.  You can access them all here.

A double bind was originally thought of as something that happens in communication, especially parent-child communication, where a person gets two contradictory messages, and is also prevented from commenting on the contradiction.  As described in the double bind entry in Wikipedia, “this creates a situation in which a successful response to one message implicates a failed response to the other, so that the person will be automatically wrong regardless of response. The person can neither comment on the conflict, nor resolve it, nor opt out of the situation.” 

Double binds, when one doesn’t fully realize they exist, naturally lead to feeling and acting “crazy.”  They were theorized by Gregory Bateson and others to be the way parents for example might cause their children to become “schizophrenic.”  The theory lost credibility however when research failed to find a significant difference in the amount of double bind type communication in families in which one person was diagnosed with schizophrenia compared to other families.

But it may be that Bateson and others were right about the key role played by double binds, they just weren’t right in blaming family communication patterns as being the primary source of double binds.  Looked at more carefully, it becomes apparent that all sorts of traumatic situations create double binds for the person encountering them. [continue reading…]

I’ve recently been corresponding with a woman, let’s call her Alice, who is concerned about the part of the Eleanor Longden story where Eleanor states that “Hearing voices is like left-handedness; it’s a human variation, not open to cure, just coping.”  Alice pointed out that since some people do find a way to a place where they no longer hear voices, it is misleading to state that there is “no cure.”  She went further to say that she considers complete recovery, from psychosis or trauma, to have happened only when a person no longer experiences any kind of disadvantage due to the psychosis or trauma.  Since hearing voices has some disadvantages, this means she believes it isn’t appropriate to call it complete recovery if the person still hears voices.

My reply to her was as follows: [continue reading…]

I was curious about the story linked to below, which talks about how to join a child’s imaginary world in order to relieve their distress.  This approach matches my own sense of how to work with young kids – but also, I think, is a good way of working with adults who, when they are overwhelmed, regress toward more childlike ways of relating to their imagination.  I especially like the stuff about how kids may know the monsters are not real but still need help organizing their imagination to empower themselves against the monsters.  Because the imagination is a world of its own, which we ignore at our peril.

In “rescripting” therapy, and in helping people rewrite their nightmares, I help people activate their imagination to deal with their negative imagination, memories (flashbacks), and dreams.  And I try to help people make friends with their voices, though I’m not that good at it yet.  (Making friends with voices is an important thing to attempt, since so many people who really recover have managed to do this.)

http://psychcentral.com/news/2009/11/13/coping-with-childrens-worries/9565.html

The City of Eugene, Oregon just this evening passed an official resolution affirming that it is a human right for people to have choice in mental health treatment, including choice of non-drug alternatives.  It also affirmed the right to treatment oriented toward complete recovery.

I have special reason to be proud of this resolution, as I initiated work on it and my friends and colleagues in Eugene helped get it passed!  Now I hope some of you out there ask your own city councils & other bodies to pass your own resolutions, affirming these same rights.  You can read the text of this resolution here.  You can also find some background and references for some of the claims made in the resolution here.

I also want to describe the process we went through to get this resolution passed, for those who might be curious.   [continue reading…]