Since the beginning of recorded history, humans have reported having
experiences in their minds (not tied to sensory perception of what others see
as physical reality) that seem to be coming from somewhere other than their own
mind.
How people conceptualize these experiences has varied over time. Such “visitors” within one’s own mind or
personal sense of reality might be understood as spirits, ancestors, gods,
demons, or in more modern times, the government intruding via technology.
Psychiatrists of course are not fond of any of these explanations. They insist that people interpret everything they experience in their mind that is not based on physical sensation as being their own mind, as being sourced in themselves. When people report experiencing things otherwise, they are routinely diagnosed with a psychotic disorder. As psychiatric critic Thomas Szaz pointed out, what is asserted by psychiatry seems to be that “If you talk to God, you are praying; If God talks to you, you have schizophrenia.”
I recently started reflecting more on this subject when I encountered a recent article by Eric Coates, The Day I Became Schizophrenic. In the article, Eric explains that he understands the word “schizophrenia” to indicate that one has ”a mind that you share with some sort of outside presence.” He relates many of his experiences he has with such presences, such as voices that dictate to him poems and a novel that, it seems to him, he has no role in composing. He also reports finding a lot of value in this experience.
Anyway, that got me thinking. For example, I reflected that we tend to recognize what is our own mind or our “self” by noticing the familiar patterns of thinking and feeling that we identify as ourselves.
But this creates an interesting situation. If we do suddenly find a new way of thinking or feeling, some really new perspective, it is not going to feel like “us.” In fact this new way of thinking or feeling may feel alien to us, or even, perhaps, actively opposed to the patterns that we have identified with.
But any kind of creativity requires stretching in some sense beyond what we previously have known as our self – because what we previously thought of as our self hadn’t previously done or said what is now being created.
That’s why I think many writers find the process of writing is often more
like being dictated to, by some kind of awareness or entity that is other than
their self, at least at times. Eric’s process seems especially that way, but creativity
in general seems to have this aspect.
My favorite songwriter, the late Leonard Cohen, has written about the sense of not being the writer of his own work, for example as in the following lyrics from “Going Home”:
“I love to speak with Leonard
He’s a sportsman and a shepherd
He’s a lazy bastard
Living in a suit
“But he does say what I tell him Even though it isn’t welcome He just doesn’t have the freedom To refuse
“He will speak these words of wisdom Like a sage, a man of vision Though he knows he’s really nothing But the brief elaboration of a tube”
We often think of creativity as a conscious achievement, but really much
creativity comes from “somewhere else.” For
example, I know nothing about making music, yet in my dreams I have sometimes
heard very impressive music that did not seem to be anything I have heard while
awake. Something or someone composed
this music, but it certainly wasn’t anything in my mind of which I am
consciously aware!
Getting back to Eric’s assertion that schizophrenia means having a mind that one shares with others: I don’t quite agree. Instead, I agree with psychiatrist Russel Razzique when he says the function of the mental health system should be to help people with any distress they may be having while also recognizing and helping them make use of anything that might be of spiritual or creative value in that experience. If they find a way to do this, then it no longer makes sense to consider them as a person with a mental health problem.
That is, our job should be helping people navigate the rocky parts of experiences
of outside presences in our mind, without framing everything about those
experiences as pathology.
When a young person or the family of a young person just
diagnosed with psychosis is considering whether or not to try antipsychotic
drugs, it makes sense they might want to know the results of randomized
controlled trials of these drugs compared to placebo in people who have never
taken the drugs.
It would be important to see this comparison with placebo in people who have never taken the drugs, since placebo could be expected to work more poorly in people undergoing drug withdrawal.
So what can we tell people about such trials?
According to a recent systematic review, what we can say is
that…..well, that we don’t actually have any good studies of this nature!
The reviewers found just one study that met this criteria, but it was a flawed
study done in China, with ambiguous results.
This means that the push to get young people diagnosed with psychosis on antipsychotic drugs has no basis in science.
That is, there are lots of studies with no placebo comparison at all, and there are lots of studies of people already on antipsychotics that compare something like taking a new antipsychotic with getting placebo while withdrawing from previously taken drugs, but no good studies comparing drugs to placebo for people diagnosed with psychosis who have never before taken antipsychotics.
If we take the concept of “informed consent” seriously, then it seems this is something we have to disclose.
And if we disclose this, then we might find ourselves also pushed to offer treatment alternatives, since many people will not choose a drug known to have substantial risks when that drug has never been shown to outperform placebo for people with their condition.
When we relate with each other, a key thing we long for is to have the other see meaning in our experience, while we notice and reflect on the meaning in theirs.
But when people are seen to be “mad” or “psychotic” or “crazy,” they are typically told that their experience makes no sense, and their best option is to take pills in an attempt to make that experience stop.
When people’s experience seems extreme, it may be difficult to find meaning in it even when people around the person do make an effort. One reason for that may be the shallowness of our culture, which has difficulty connecting to anything too far from the “norm.”
Spiritual traditions, though, do contain clues about how to understand extreme experiences and extreme states of consciousness.
That’s a subject Caroline Maze-Carlton explores in a recorded webinar “Messages, Meaning and Ancestral Maps: Spiritual Frameworks for Extreme States.” See the link below!
Assimilation, genocide, and systems of oppression such as anti-Semitism and Islamophobia have left many disconnected from ancestral traditions, spiritual tools and texts. When encountering extreme states of being such as Voices and Visions, the pharmaceutical model of chemical imbalance often steps into claim space in this cultural vacuum. However, for many, Western medicalized approaches are neither sufficient nor culturally competent. This Webinar will explore ways in which we can re-claim spiritual tools and wisdom traditions and be in open dialogue with our ancestors as we navigate extreme states of being. Caroline will draw on over a decade of direct experience supporting others with altered states of consciousness in diverse settings from peer respites to forensic psychiatric units, as well as her personal lived experience as both psychiatric patient and student of Abrahamic traditions and Buddhist sutras.
About the presenter:
Caroline Mazel-Carlton is a ritual-weaver and sacred space holder in the Jewish Renewal lineage of Rabbi Zalman Schachter-Shalomi. She is a student of the ALEPH Jewish seminary and recently completed the Yad B’Yad program in Muslim-Jewish collaboration and leadership. She has traveled the globe in her role of Director of Training for the Wildflower Alliance (home of the Western Mass Recovery Learning Community) supporting systems change and alternatives to the conventional mental health system. Her passion for re-claiming Jewish identity and tradition through a feminist lens extends to the roller derby community where she is known as Mazel Tov Cocktail (#18).
When people are fully informed about a proposed mental health treatment, they should be familiar with three things:
What are the likely benefits of the treatment
What are the risks, and how likely are they to be a problem
What are the possible alternative treatments, and what are the benefits and risks of those
As part of a Mad in America continuing education course, I recently moderated a panel discussion about informed consent (and too often the lack of) informed consent in mental health care.
Those on the panel had lots of “expertise by experience” as
well as experience working within different facets of the mental health
system. We were also reflecting on a number of presentations on informed
consent that had preceded within the course. It made for some good
discussion!
Bob Nikkel, chair of the MIA continuing education
project, said “I think it was one of our most powerful presentations.”
The course as a whole does cost a little, but you can watch this panel discussion for free, at this link:
“Don’t React – Choose How to Relate to Distressing Voices!” is the subject of a webinar that was presented by Dr. Mark Hayward on 6/20/19. (See the link to the complete recording below.)
This webinar presents a very practical way to help people start experimenting with different ways of relating to voices they might be having trouble with. I encourage people to check it out!
“There has recently been a shift from conceptualizing a voice as a sensory stimulus that the hearer holds beliefs about, to a voice as a person-like stimulus which the hearer has a relationship with. Understanding voice hearing experiences within relational frameworks has resulted in the development of psychological therapies that focus upon the experience of relating to and with distressing voices. This webinar explores lessons learnt from the development, experience and evaluation of one of these therapies – Relating Therapy. These lessons are located within the broader context of other relationally-based therapies that seek to support recovery through the use of digital enhancement (Avatar Therapy) and dynamic interaction with voices (Talking With Voices).”
About the presenter: Mark Hayward has worked
as a Clinical Psychologist within NHS mental health services for the past 20
years. His roles combine clinical (Lead for the Sussex Voices
Clinic), research (Director of Research for Sussex Partnership NHS
Foundation Trust) and teaching (Honorary Senior Research Fellow at the
University of Sussex).
His
research activities have focused primarily on the exploration of voice hearing
within relational frameworks – acknowledging the voice as an interpersonal
‘other’ and researching differing aspects of the relationships that people can
develop with their voices. These relationships have been central to the
development and evaluation of new forms of individual and group therapy that
can facilitate acceptance of self and voices through the use of assertiveness
and mindfulness training. His books include the CBT self-help book ‘Overcoming
Distressing Voices’, and the research monograph ‘Psychological Approaches to
Understanding and Treating Auditory Hallucinations’.
Mark
is committed to increasing access to effective psychological therapies for
people distressed by hearing voices.
I’ve been intrigued by the way the battle against mental health system oppression has drawn on two important and powerful ideas – which happen to contradict each other!
One is the idea that people can “recover” from mental health problems. Asserting the possibility of recovery has been key to fighting back against the oppressive belief that certain people will always be “mentally ill” and will need to resign themselves to a limited life as a mental patient, etc.
The second idea is that people may not have to change to be OK and valuable – that people can even be proud of what has been called madness! Mad pride helps people fight back against the oppressive notion that one has to be “normal” to be acceptable, and that mental diversity means illness.
But, if one is perfectly OK as one is, then there is no need for recovery. In fact, if one is already quite OK, then the suggestion that one should work on recovery can itself be oppressive – like offering “reparative therapy” for gay people.
On the other hand, if one’s mental state and current beliefs are causing lots of problems that are keeping one stuck, then being encouraged to be proud of that mental state can become a barrier to changing or recovering and so can deepen or prolong problems and oppression.
Contradictions like those outlined above can lead to battles between activists about how to move forward. They can also lead to battles, and confusion, within people who are trying to find the best way to deal with their own “mad” states.
What I want to show is that it’s possible to embrace both “recovery” and “mad pride” despite the contradictions. But to do so, we need to be aware of both the advantages, and of the “down” or “shadow” side of each of these notions.
Compared to mad pride, recovery has been much more widely embraced. It has even been embraced by much or most of the mental health system – though often what is embraced is just the word itself, and not the possible reality! But because of its popularity, it has also been more widely critiqued, and some have even advocated that we stop using the word altogether.
One common critique is that the word “recovery” implies that one must have been ill in the first place, and so this word should not be used when the problem never was an “illness.” However, people do “recover” from many things that aren’t an illness: we recover our balance, we recover from injuries, we even recover from the down side of events that were overall positive, as in “I’ve finally recovered from that wild party I attended last night!” Krista Mackinnon, in her “Recovering Our Families” course, emphasizes that all humans are constantly recovering from all sorts of things, and so “recovery” is not something unique to those who have been psychiatrically labeled.
A stronger critique of the notion of recovery points out that recovery involves going back to something, while many prefer to see their life as going forward. John Herold for example talks about wanting to move toward “discovery” and not “recovery.” I agree with that up to a point, but I also notice that we often have to go back to something we had possessed previously in order to move forward overall. For example, if I used to know how to face people and maintain friendships, but then I seemed to have lost that ability during an emotional crisis, I may want to recover the skills and habits I had before so that I can then get on with my life and move into that wider process of discovery.
Then there’s the problem of the word being co-opted to mean something much less than real recovery. Lots of mental health programs use the recovery word, but their practices remain targeted towards lifelong drugging and containment of the person, with “recovery” apparently meaning only getting to where the person won’t be in crisis so much. I understand why that sort of use of the word “recovery” makes people want to vomit, but I would rather work on reclaiming the word, rather than giving it up. The US government can call a nuclear missile a “Peacekeeper” but that doesn’t mean we need to quit using the word “peace.” I think our best strategy is to continue to emphasize the true meaning of recovery and to contrast truly recovery-oriented treatment with that which is not.
Adding complexity to discussions of recovery is the distinction between “clinical recovery,” or no longer experiencing “symptoms,” versus “personal recovery” which has been defined as “recovering a life worth living.”
Interestingly, within standard care, “personal recovery” is often framed as the proper goal because of a belief that “clinical recovery” is not possible. In other words, it is believed that the person will always have symptoms and will always be less than healthy than others because of that, but they may still learn to “recover a life worth living” despite continuing to be ill. (Of course, this notion that they are still ill can be used to convince people to stay on their drugs, which makes this interpretation popular amongst those who embrace the medical model but who still want to offer some appearance of hope.)
But there is a deeper and more valid reason to focus on personal recovery rather than clinical. That’s because the experiences that the mental health system called “symptoms” may not be a problem at all once the person learns to live with them. Hearing voices for example may be benign or even helpful once the person learns to relate to them differently. And once experiences no longer cause problems, there is no longer a need for drugs or any kind of treatment to manage them.
Of course, it’s the idea that people don’t need to change, and that their differences may be OK or even something quite valuable, that is basic to that idea that sometimes seems in opposition to recovery: mad pride.
“You are only given a little spark of madness. You mustn’t lose it.” Robin Williams
From a radical mad pride perspective, there is only mental diversity, and not any mental problems, disorders, or illnesses. People do best when they accept and become proud of themselves as they are rather than try to change. If people have problems, or seem to be disabled in some way, it’s just because society has failed to accommodate their differences, and so it’s society that needs to change.
But what are the problems with this kind of radical mad pride perspective?
One issue is that if I am suffering in some way, while believing that there is nothing wrong with me but only problems with others, and if it’s also true that I don’t have the power to make others change, then I am stuck with my suffering. Working on recovery from a problem may not require accepting that one is ill, but it at least requires accepting that something needs to be changed; but pride is the opposite of believing in a need for change.
Another problem is the adversarial relationships that a radical mad pride perspective can create with others. If I for example demand that others change their attitudes and start accepting me just as I am and if I demand that they change in other ways to accommodate my differentness, while I insist that I am perfectly fine as I am and don’t need to change anything, I may just piss people off. I’m certainly not likely to be effective at winning friends and forming peaceful relationships, since good relationships tend to be built when people are willing to change at least some to accommodate each other, at least when they are able to do so.
On the other hand, the notion of radically accepting ourselves just as we are can often seem to be the very core of peace of mind and mental healing. So it can all seem quite complex.
How can all this be best resolved? Or, how can we take what is best about mad pride, and what is best about recovery, without getting caught up in the shadow side of each?
I think it may help to take a step back, and look in more general terms at how we can resolve other kinds of contradictions.
It’s not uncommon that things are opposites, but we find ourselves needing both. Breathing in for example is a good thing, but so is breathing out, even though that’s the opposite. Our ability to open up to people and trust is a good thing, but so at certain times is our ability to close up and distrust.
Mental health issues can be notoriously complex. People can go through terrifying, bewildering experiences that may also have a very important positive side. Or, experiences may seem to be quite positive, but then lead to something very detrimental.
It’s also possible that an experience we want to recover from at one point may be something that later we wish to regain. In my own life I can identify times I have worked to recover from “madness” and to regain my ability to integrate with normality, and then also times when it seemed more important to turn around and work to recover from that normality trance, so I could reclaim what I had discovered when I first went “out of my mind.”
One metaphor for madness is that of revolution. Revolution overthrows the existing order – then anything is possible, which is both great, and terrible. Revolution is both something to be proud of, when it is necessary and when it works out well, and it is something to recover from, so that order can be restored.
When we over-value sanity, we stick with an existing order in rigid ways that can be oppressive. When we over-value madness, or revolts against sanity, we can get lost in disorder. Life though works best at the edge of chaos and order, so it may require both rebellion against order and efforts to recover order.
One way to map relations between polarities, where neither polar opposite provides a full answer, is to use what is called a polarity management map. These maps make overt what is positive and negative about each polarity, and suggest that each polarity is the solution for the problems caused by the other.
Below is a polarity management map about recovery versus mad pride. It suggests that there is no final answer to resolving the tensions between mad pride and recovery, or between madness and sanity generally. Rather, whenever we emphasize the positive of one side, we will also sooner or later encounter its negative, and then may have to shift to the opposite side.
If we follow this line of thinking, it follows that there are no final answers as to when a focus on change and recovery is best, versus when it might be better to instead be proud of one’s current state and perspective, even if it is somewhat “mad.” Instead, we will be more open to exploring what might fit or seem healthy, or not, in any given situation. And we will be open to the possibility that whatever we choose now, we will later be called upon to choose the opposite.
When we are too sure that our side is right, that “God is on our side,” we end up at war with our opposite. People who are too sure that their current mental view or version of sanity is correct will go to war against that which opposes it, be they voices or other people who are seen mentally wrong But going to war just makes everything more extreme, and prevents the “peaceful revolutions” that are possible when people realize that their current polarity is just one side of a more complex picture.
Modern humans are not, of course, the first to struggle with these issues. Spiritual traditions going back to ancient times wrestle with how to relate to the limits of any existing order, and how to find value in what is outside of that order, or “outside of our minds.” While these traditions are not perfect, and have too many times been bent to completely corrupt and oppressive purposes, they also contain reminders that we humans do our best not when we stay confined within a mundane “sanity” but rather when we allow ourselves, at least at times, to open up to what goes beyond.
What would mental health treatment look like if it balanced an awareness of the need for “recovery” with an awareness that people also sometimes need to go “out of their minds” to resolve problems that they haven’t been able to solve otherwise, or maybe that their entire culture has not been able to face and resolve?
To explore some possible answers to that question, I recently put together a new online course, “Addressing Spiritual Issues Within Treatment for Psychosis and Bipolar.” This course outlines some radically different ways of conceptualizing the mental states that get called “psychosis” and “bipolar” and reviews ways professionals can shift from pretending to “know it all” to being helpful to people as they face some of the bigger mysteries together. In the course, I try to strike a balanced position that avoids both “romanticizing” extreme states and the more common mistake of “awfulizing” or “pathologizing” them.
This course comes with 6 CE for most US professionals. Use this link to get more information, or to register.
A few more thoughts:
One other possibly helpful metaphor for madness is that of wilderness.
It can be disturbing when young people wander off into the wilderness. What if they become lost, and need to be rescued? Sometimes people do need to be rescued. But a society too sure that the wilderness is nothing but bad will seek to prevent young people from ever wandering off, won’t recognize when people are doing OK in their explorations and don’t need to be rescued, and/or will even seek to destroy the wilderness so that everything can be “civilized” – aka, sane.
But any society cuts itself off from the wilderness, and/or declares war on what is wild, only at its own peril. Certainly, modern civilization or “normality” has declared war on the wild, and it does often seem that it is winning. But that “winning” is a most terrible thing, and puts us all in danger!
Rather than winning, we need to focus more on finding a dynamic balance, or peaceful coexistence. The peaceful coexistence between recovery and mad pride that I have proposed is just one example of that.
Emerson said that “People wish to be settled; only as far as they are unsettled is there any hope for them.” It’s time that we define mental health not as some settled “sanity” but as the unsettled and possibly playful dialogue that results when we value both madness and sanity, and when we explore together with those whom we wish to help rather than impose our own version of some settled, and dead, “correct answer.”
When people have problems with voices, the most common recommendation they are given is to try to avoid them – to take drugs to make them stop, to simply ignore them, to use distraction, or similar approaches.
But these strategies often don’t work. Or even if they do seem to work, they may themselves cause other kinds of problems that may not be acceptable. So what else can people try?
One possibility is to try the opposite of avoidance: to deliberately engage with the voices!
But this sounds scary or wrong to some people. Won’t engaging with the voices make people take them too seriously or see them as more real than they are? Might that lead to people getting even more lost in the world of voices, and so more distressed?
While the mind is tricky and things can always go wrong, we now know that it is possible for people to engage with voices in ways that make things better. Specifically, when the engagement is done with creativity and compassion, the result can be a positive change in the relationship with voices, leading to much greater peace of mind.
But how can people learn how to facilitate this sort of constructive engagement?
Fortunately, Charlie Heriot-Maitland (known for producing the Compassion for Voices video), Rufus May, and Elisabeth Svanholmer have just made available a free series of videos, in which they offer practical ideas about how to do just that. These videos cover topics such as how to:
Prepare to engage with voices
Identify and nurture the compassionate self and engage with voices from that perspective
Change the power balance with voices
Identify the function of voices
Work with voices that don’t seem to want to engage
Map out voices
Engage constructively with voices that sound like an abusive person from the past
Marital arts exercises that can help in work with voices
I spoke to Rufus May, one of those involved in making these videos, and asked him what inspired he and his colleagues to do this. He answered that:
“We know there is a growing interest in this approach and we wanted to make some accessible resources. In the Bradford Hearing Voices group I volunteer with, I might facilitate a dialogue with a group member’s voice and then encourage them to regularly engage with their voice or voices. In this way group members have found they have been able to improve the relationship they have with their voices.
“People ask me, how can you talk with someone’s voice? I sometimes joke ‘I‘ve got a special microphone!’ But the truth is we ask someone to ask their voice questions and then report the answers the voice is giving them. We have found if we use good communication skills such as empathy and non-judgemental questions the voice sometimes begins to respond in a different way.”
I asked Rufus for an example of this:
“Through a facilitated dialogue with a person’s voice that was being quite harsh and critical towards the person, we established the voice wanted the person to be more assertive with people in their social network. The person went on to consult with the voice on who to be more assertive with and when she became more assertive the voice seemed to relax and become more constructive.
“We have also found if people compromise with their voices the voices often behave in a less controlling way. So finding out if the voices like certain types of music or food or drink and listening to the music the voice likes or consuming the food the voice likes can role model to the voices a more respectful collaborative relationship.”
I asked Rufus where these engaging approaches have come from:
“In many traditional cultures consulting with voices is something that has been done for 100s of years. The original Hearing Voices research carried out by Romme and Escher in the 80s in Holland found many voice hearers who had never used mental health services negotiated and engaged with their voices.
“The challenge is how to talk with voices that are hostile and controlling. This means we as communities need to support voice hearers to become more confident in being assertive with their voices and then learning how to engage in a power with style of relationship, rather than power over.
“Hearing Voices groups can be good spaces to learn this ‘living with voices’ approach. We have also found tools like Nonviolent communication and mindfulness and compassionate mind exercises helpful in supporting this process.
We have tried to make short films that demonstrate how you can engage voices and find ways to learn from them. The three of us myself, Elisabeth and Charlie have used both role-play and some demonstrations of mapping out and talking with Elisabeth’s voices.
“We don’t want engaging with voices to become a therapy that only highly trained professionals can used. While we welcome therapists using these approaches, we also want people who hear voices, and their friends and family to know about dialoguing and creative ways to understand and engage with voices.”
I think that last point Rufus makes is really important! It’s helpful when mental health professionals can offer certain kinds of assistance, but it can be even better when people learn how to help themselves and each other. That’s what really creates a healthy society. So I hope lots of you take an interest in this approach and do check out the video series, which again is available at https://openmindedonline.com/portfolio/engaging-with-voices-videos/
” The approach is not so much trans-diagnostic as dismantling of diagnosis, and includes a perspective on psychosis that sees it as part of a wider potential of human experiencing that includes valued aspects such as spirituality and creativity.”
What would it look like if mental health providers were
trained to be both deeply humanistic, AND very efficient at helping people
identify and cope with the issues at the core of whatever their difficulties
might be, including psychosis?
It might look like the approach developed by Isabel Clarke and Hazel Nicholls, which they call “Comprehend, Cope and Connect (CCC).” CCC starts from the perspective of the immediate experience of the individual -‘what it feels like to be me, now’. This approach to mental health difficulties brings together the impact of past trauma and adversity on present coping (comprehend), and utilizes the latest in mindfulness and compassion-focused approaches to manage change (cope and connect).
In the presentation linked to below, Isabel Clarke focuses on using this approach with people whose experiences might be described as “psychosis.” Isabel brings a uniquely deep and yet practical understanding to this topic. On the one hand, she has thought deeply about the nature of psychosis, and she has written several inspiring and insightful books and articles on the intersection of spirituality and psychosis. On the other hand, she has extensive experience working in acute care settings where making a direct an immediate impact is essential, and this has pushed her to develop an approach capable of accomplishing that objective.
“Simple and yet powerful, this impressive body of work has
transformed practice wherever it has been introduced. Mental health practitioners
should all be aware of it.” said Dr Lucy Johnstone, consultant clinical
psychologist and author of ‘Formulation in psychology and psychotherapy’.
Comprehend, Cope, Connect: An Experience Based Approach to Psychosis & Other Mental Health Challenges
About the presenter:
Isabel Clarke’s work spans two areas: psychosis and
spirituality, and clinical psychology. Both draw on the research based Interacting
Cognitive Subsystems model of cognition, and both seek to bring spirituality
into center stage, founding it in cognitive and other research and theory, and
regarding it as a central part of what it means to be human.
Recently Isabel has been developing Comprehend, Cope and
Connect (CCC – previously known as Emotion Focused Formulation Approach,
EFFA) in the diverse contexts of Acute, Primary Care and Culture Free
Adaptation. See “ICS Underpinning 3rd Wave CBT” and
the following book for more details:
Clarke, I. & Nicholls, H. (2018) Third Wave CBT
Integration for Individuals and Teams: Comprehend, Cope and Connect.
London & NY: Routledge.
Other books by Isabel Clarke:
Clarke, I. (2013) Spirituality: a new way into understanding
psychosis. In E.M.J. Morris, L.C.Johns & J.E.Oliver Eds. Acceptance and
Commitment Therapy and Mindfulness for Psychosis. Chichester:
Wiley-Blackwell.P.160-171.
Clarke, I. ( 2008) Madness, Mystery and the Survival of God.
Winchester:’O’Books.
Clarke, I. (Ed.) (2010) Psychosis and
Spirituality: consolidating the new paradigm. Chichester: Wiley
When someone is “mad” or “psychotic,” should the people around them try to make sense of their experience and of what they are saying? Or should the person be taken to professionals who will listen only in order to diagnose and then prescribe treatments aimed at suppressing or eliminating experiences that are understood to be meaningless?
In the mainstream of mental health treatment in the US, the latter approach is dominant. But what does it mean to be “treated” by people who won’t try to understand you?
When I was a young man having experiences that were “extreme” and arguably quite “mad” or “psychotic,” one of my worst fears was that the people around me would give up on the idea of finding any significance in what I was communicating, and that they would decide to see it as something that simply couldn’t, or even shouldn’t, be understood.
Fortunately I always seemed to keep some contact with at least one person who saw some significance or meaning in what I had to share, and after awhile, I made more sense of it myself and had a better time communicating with others. Now I work as a therapist, helping others explore the significance of their own “mad” experiences.
I was recently interviewed on the topic of “Finding Meaning in Psychosis.” You can check out that interview here:
Thanks to Stacy Duffy for being the interviewer! Also thanks to everyone at Psychosis Summit who contributed to making this happen. (There are 20 additional interviews with a wide variety of perspectives and innovative approaches to psychosis at the Psychosis Summit website, https://www.psychosissummit.com/ )
Cognitive therapy is probably still understood by most to be about trying to reduce or dispute “thinking errors” or such. But last week, at the ISPS-US conference, I had a chance to hear from Aaron Beck and his team (Beck is still quite active at 97 years old!) and it was interesting to see just how much they have moved toward evoking something positive as their first priority.
Aaron Beck at 97 years old, presenting at the 2018 ISPS-US conference, alongside his colleague Ellen Inverso
Beck’s current work is recovery oriented cognitive therapy for psychosis. They see the core of the work as being finding ways for people to have experiences that give them or help them find a sense of meaning, connection, and purpose. Their overall aim is still to change beliefs, especially the “self defeating beliefs” that lead to “negative symptoms” but they see those beliefs as often falling away as people have access to the positive stuff.
Beck overtly stated that therapy should be person centered, not symptom centered (even though so much CBT is the latter.)
I really liked lots of the examples given about how to be person centered even when faced with challenging stuff. For example, one person in the audience asked how to talk with a guy who claimed to have been roasted in an oven. Beck said first he would acknowledge the story, then he would be curious about what that was like, how he felt etc., then he would ask about other times in the person’s life when he may have felt that way, or does anything currently make him feel that way. It seemed he was describing a process of following the vein of emotional content to where it would connect with more realistic biographical facts or current issues.
Beck stated that helping the person get going with something positive, something that has meaning and purpose for the person and gives them a sense of connection, tends to “suck the juice out of” any delusion.
He was also very much into discovering the wants and needs behind even very challenging behaviors. One story was about a doctor trained in recovery oriented cognitive therapy, who had a patient who was saying he wanted to shoot him. So instead of treating it as a symptom, he asked the patient, “why do you want to shoot me?” The patient responded, “because you are planning to shoot me.” “But,” the doctor explained, “I don’t even own a gun!” “Well,” said the patient, “you use your drugs like a gun.” The doctor thought about it and said, “I wonder if you are feeling you have very little control? That must be frustrating. But I know you must have lots you want to do outside of here and I want to help you get out so you can do that!” This made sense to the person and they started to work together.
One good introduction to recovery oriented cognitive therapy for psychosis is the following recorded webinar:
In addition, SAMSHA now has available a series of webinars that goes into more detail about this approach, at this link.
This 6 hour course presents evidence based, practical and humanistic ways to help people recover. For more information or to register, go to this link.
Working with Trauma, Dissociation, and Psychosis: CBT and Other Approaches to Understanding and Recovery - An Online Course
Free Offer: Presentation on “Understanding Psychosis as an Attempt to Solve Problems: Integrating Perspectives on Trauma, Spirituality and Creativity”
Click the link below to access this recording that explores some of the trickiest aspects of "psychosis," and also to receive notices periodically about online courses and webinars that may become available.
http://eepurl.com/cMAgI
Places are still available for the next
ISPS International webinar!
“Decoding Delusions: Making Sense of Different Types of Troublesome Beliefs”
with Dr. Douglas Turkington
20th February 2025
To register, go to https://DecodingDelusions.eventbrite.com
Announcing the next ISPS International webinar: “Decoding Delusions: Making Sense of Different Types of Troublesome Beliefs” with Dr. Douglas Turkington
Thursday 20 February 2025
17:00-18:30 London Time
To register, go to https://DecodingDelusions.eventbrite.com
How can professionals or other helpers best understand and respond to extremely troublesome or "delusional" beliefs? Explore options in a webinar by CBT for psychosis expert Doug Turkington on 2/20/25, 9 AM PST,
Explore how trauma can lead to psychosis, and then what kind of treatment is likely to facilitate recovery, in an on-demand 6 CE course, “Trauma, Dissociation, and Psychosis: Approaches to Understanding and Recovery.” Only $29 -a 67% discount-till 1/24/25!