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Understanding Psychosis and Schizophrenia – A Valuable, and Free, Online Report

What would happen if a team of highly qualified psychologists joined up with a team of people who knew psychosis from the inside, from their own journey into madness and then recovery – and if they collaborated in writing a guide to understanding the difficult states that get names like “psychosis” and schizophrenia”?

Well, you don’t have to wonder anymore, because the result was just published a couple of days ago in the form of a report that is free to download at Understanding Psychosis and Schizophrenia

A fundamental point made by the report is that “‘psychotic’ experiences are understandable in the same ways as ‘normal’ experiences, and can be approached in the same way.”

I believe this report will be useful to a great many people, because of the way it combines a thorough knowledge of the science with common sense and perspectives drawn from actually listening to people who have had these experiences and then have made sense of them for themselves.  The knowledge in this report will likely both change the perspective of many professionals, as well as be of assistance to many individuals and families who want a deep understanding of the subject that is also  very accessible and easy to read.

It includes  a list of resources at the end which many people may also find helpful.

Jacqui Dillon, Chair of the UK Hearing Voices Network, was quoted as saying:

This report is an example of the amazing things that are possible when professionals and people with personal experience work together. Both the report’s content and the collaborative process by which it has been written are wonderful examples of the importance and power of moving beyond ‘them and us’ thinking in mental health.

I fully agree.

Going Deeper Into “Madness” with ISPS: Anticipating the International Dialogue in NYC 2015

As awareness spreads about there being something wrong with existing approaches to “psychosis” aka “madness,” interest grows in exploring what to do instead.

One interesting meeting place for exploring “what to do” will be the ISPS conference in NYC in March 2015, which is titled “An International Dialogue on Relationship and Experience in Psychosis.”

This conference promises to stand out in terms of the variety of voices,  perspectives, approaches and traditions that it will bring together to focus on the deeper issue of how helpers can best understand and interact with those experiencing what is called psychosis.

I’ve been a member of ISPS (The International Society for Psychological and Social Approaches for Psychosis) for many years now; I currently serve as chair of the education committee for the US branch of ISPS and I’m the lead moderator for its US list serve.  What keeps me interested in this group and its discussions is the focus on understanding psychosis in depth, the willingness to look at it from a lot of angles, and the interest in service models that address the true complexity of the issues people face while maintaining hope for understanding and integration, not just the suppression of unwanted experiences.

In some important ways, the subject of how to make sense of psychosis cannot be separated from the subject of how we make sense of our own existence at its deepest levels.  Often it seems there are a wide variety of possible ways to make sense of things, but then there is the challenge of how to make sense of all these possible explanations and perspectives, and how to talk to each other so that we can share our experience and work together in various ways.  This problem can exist at various levels:  within and between the “parts” of an individual mind, between an individual in crisis and someone trying to help that individual, and between and amongst all those who together form a mental health system or even a culture, etc.

The best approach to these potentially bewildering and overwhelming issues seems to be dialogue, a dialogue which doesn’t determine any final answers, but does improve relationships at various levels, and encourages multiple approaches to understanding.

I value the dialogues I have found within ISPS:  these dialogues have allowed me to improve my understanding of madness and to increase my ability to communicate what I understand to diverse individuals and audiences.  I think if we are ever going to shift society and the mental health system into a wiser approach to extreme experiences, we all need to find such opportunities for dialogue so we can hone our ability to connect with people coming from a variety of different backgrounds and levels of understanding.

The international conference in NYC aims to compress a lot of such dialogues into just a few days!  This conference will bring together not just people from all over the world but also people holding a wide variety of perspectives:  psychiatrists, other mental health professionals, people with lived experience,  family members; and people from schools of thought as varied as psychodynamic, CBT, Open Dialogue, Art Therapy, the Hearing Voices Movement, and biomedical perspectives.

[click to continue…]

Why “Stabilizing” People is Entirely the Wrong Idea

If human beings were meant to be entirely stable entities, then “stabilizing” them would be an entirely good thing, a target for mental health treatment that all could agree on.  But it’s way more complex than that:  healthy humans are constantly moving and changing, they have a complex mix of stability and instability that is hard to pin down.

All this relates to one of my favorite subjects, the intersection of creativity and madness.

It is a curious fact that people seen as “psychotic” or “schizophrenic” may show sometimes more creativity, and sometimes less creativity, than “normals.”

A good example of this was a test done to see how

people “guess” which of two alternatives (e.g., “left” or “right”) will occur next, when in fact the order of outcomes is random. We can analyze the sequence of guesses and quantify their entropy (unpredictability). Healthy people tend to have a Gaussian distribution of sequential guesses, with most responses at intermediate levels of entropy, and fewer very redundant or very entropic responses. In contrast, people with schizophrenia tended to show both more redundant (predictable) and more entropic (unpredictable) responses; longer periods of predictable behavior were interrupted by very unpredictable behavior.

That comes from an interesting little article, Creative cognition and systems biology on the edge of chaos .

What the guessing game test, and other research tends to show, is that people diagnosed with psychosis are often both too “unstable” at times, but also overly stable at other times (actually more of the time.)  This corresponds to the way people experiencing “psychosis” can be both very flexible and innovative in the way they understand things, and also often very rigid and uncreative in other ways or at other times.

When I was a young guy going through a somewhat “mad” period, I identified as being very creative, while I saw “normals” as being more like robots or insects or something.  The truth at the time was that I myself was often too much like the robot or whatever – I would fall into ruts or various sorts of “false selves” that weren’t very connected with anything alive within me, and then here and there I would be very weird or random in efforts to break free of those ruts.  [click to continue…]

Does Long Term Use of “Antipsychotic” Drugs Result in More Disability, and More Psychosis?

This sounds like a weird question – everyone knows that psychosis is often very disabling, and antipsychotic drugs are widely recognized for their effects in reducing psychosis in at least most people, and most often taking effect in just a few days.  And when people become psychotic again, it’s often understood that it’s because they “weren’t taking their meds.”

But what if it’s trickier than that?  What if “antipsychotic” drugs make things better in the short term, but make long term problems worse?  How would we even know?

In a recent letter to the Psychiatric Times, psychiatrist Sandy Steingard outlined some of the ways we can know that there definitely is a problem with the long term use of antipsychotics.  (Note that while she addressed a limited number of studies, that’s just because there actually are very few studies which look at really long term outcomes.)

She started her letter by writing about the Wunderink study, which found dramatically higher rates of recovery among the group that had been randomly selected 7 years earlier to receive a trial in getting off antipsychotic drugs, compared to those maintained on the drugs as usual.

It should be stated that the results of the Wunderink study are not perfectly clear in all respects.  For example, of the members of the group that guided discontinuation of the drugs, most had resumed taking at least some drugs over time, though the dosages on average were much smaller than those of the “treatment as usual” group.  So some have argued that the positive effects might have come from lower than average doses, and they argue that the study should not be taken to indicate that any use of drugs is detrimental long term.

But Sandy brought up more evidence, and the case against long term use of antipsychotics became more convincing as she continued. [click to continue…]

How Can Professionals Learn to Reduce Fears of Psychotic Experiences Rather Than Emphasize Pathology?

The kinds of experience we call psychotic are often incredibly scary: people feel they are being persecuted by strange forces, or that their brains have been invaded by demons or riddled with implants from the CIA….. the list of possible fears is endless, and often horrifying.

While standard mental health approaches counter many of these fears, they often create new fears of a different variety.   People diagnosed with schizophrenia for example may be led to believe that they will definitely be mentally ill for life, that this illness controls what happens in their brain and not themselves, and that there are few or even no alternatives if drugs don’t work for them.

This can be extremely demoralizing.  Oryx Cohen graphically described his own reaction to the standard mental health psychoeducation he received after his first psychotic experience:  he reported it made him feel he had lost his membership in the human race!  As a result of it, he felt caught up in a pathologized understanding of himself, he lost his expectation of being capable of learning from experience and shaping his future, and he now felt defined by his abnormality rather than by his humanity.

Despite rather than because of what the mental health system taught him to believe, Oryx later discovered other ways of understanding his experience, and he made a full recovery.  But wouldn’t it be better if people like Oryx were helped to find a more humanistic understanding of themselves within the mental health system and from the very beginning of treatment?

Wouldn’t it be helpful if professionals were trained in an approach that could help people shift away from both dangerous psychotic ways of thinking and also away from the sometimes equally terrifying explanations which emphasize pathology?

Further, what if such an approach could also build a foundation for learning effective coping skills, and also help a person build hope and a road map toward a possible full recovery?

And wouldn’t it be nice if this approach was already proven to be “evidence based” so that both people learning the methods and their supervisors and colleagues could have confidence in its effectiveness and safety?

Fortunately, at least one such an approach exists, and it is called CBT for psychosis.  This method allows professionals to collaborate with people in developing understandings of their psychotic experiences that neither minimize problems nor emphasize pathology, but instead help make sense of extreme human experiences in a way that is grounded in more everyday human experience and issues.

And better yet, those of you who are interested don’t need to go out and buy something, or travel to a seminar somewhere, in order to learn this method:  instead, an online training module on normalizing is now being made available, for free!*

To access this training, I’m asking that you first register with my email list at this link, then you will be instructed how to sign up for the training module itself.

Here’s an outline of what you can learn from participating in this training module: [click to continue…]

CBT for Psychosis, and the Hearing Voices Movement – Can They Be Friends?

Doug Turkington

Doug Turkington

When Doug Turkington, a UK psychiatrist, first announced to his colleagues that he wanted to help people with psychotic experiences by talking to them, he was told by some that this would just make them worse, and by others that this would be a risk to his own mental health, and would probably cause him to become psychotic!  Fortunately, he didn’t believe either group, and in the following decades he went on to be a leading researcher and educator about talking to people within the method called CBT for psychosis.

I’m writing about Turkington because I just spent a week learning more about CBT from him at a training in California.  This training was part of a bigger effort to bring this psychological approach into wider use in the western US.  Attending this training and seeing the interest and passion in those who attended got me reflecting on what the role of CBT might be in changing our mental health system overall.  A key question related to that, it seems to me, is the question of how CBT can improve its relationship to another key change effort in the field of psychosis, that of the Hearing Voices Movement (HVN).

I have a lot of interest in the possible improvement in that relationship between CBT and HVN, because for quite a while I have had my “feet in both worlds.”  My first involvement with the mental health system was as an activist for change and increased choice, then I became a mental health professional so I could work to provide some of the alternatives I believed should exist.  The first alternative approach to voices I heard about was the CBT approach of Paul Chadwick, so I started with that, and went on to become a CBT practitioner and educator.  Then, when I heard about the HVN, I adopted many of its ideas as well, arranged for Ron Coleman to come to my town of Eugene Oregon to do some trainings, and got an HVN group going here.

While I have always interpreted CBT for psychosis in a flexible way, integrating it with HVN ideas, I have sometimes been unsure how well that would fit with the approach of the CBT for psychosis establishment.  So it was really interesting to spend a week with Turkington, and to have a chance to explore his views in depth.

According to Turkington, the very most important part of cognitive therapy for psychosis is “normalizing” which means framing psychotic experiences as understandable and as just a fairly common variation of normal human experience and issues.  This includes talking with people about how to get past fearing or “catastrophizing” such experiences, and even how to see them as possibly valuable, for example by seeing how such experiences can be part of a creative process or of a shamanic journey, etc.  I have always been open to talking about this positive, somewhat shamanic side of psychotic experiences, and discussion of such views is common within HVN, but it was nice to see Turkington teaching this approach as part of standard CBT for psychosis! [click to continue…]

From Protest to Taking Over: Using Education to Change Mental Health Care

As we develop critical awareness about the mental health “treatments” that don’t work and that often make things much worse, the question inevitably comes up, what can those who want to be helpful be doing instead?

I believe that one key to successful change is going to be making effective training in alternatives widely available, so that those working in the field who hear our protests and criticisms with an open mind will be able to get support in then transitioning to doing things differently.

One example of an initial effort in that direction is an “online conference” I’ve help produce titled “Therapy on the Wild Side – Depathologizing and Working with “Psychosis” and Extreme States of Consciousness“ I wrote about that some in an earlier blog post.

I’m hoping that in a few years, it will be possible for people all over the US to easily learn ways of helping that are both respectful and likely to lead to long term improvement.  Such forms of helping may include everything from setting up peer self help such as that provided by hearing voices groups, to one on one support such as the better forms of therapy, to more systematic/team approaches like Open Dialogue and Soteria houses.  Only when we have lots of people thoroughly educated in what to do differently will we be able to “take over” the mental health system and then more consistently provide real help instead of oppression to those who are distressed! [click to continue…]

Therapy on the Wild Side – Depathologizing and Working with “Psychosis” and Extreme States of Consciousness

Thanks to the work of those who have recovered and of those who have helped them, there now exists an ever growing resource of humane and humanizing strategies that can allow us to help those struggling with difficult experiences in ways that bring all of their uniqueness and personhood into the world – without “stigma” or pathologizing.

But it can often be difficult to make it to seminars where such strategies are taught.  To get over that hurdle, we’ve made available an “online conference,”  “Therapy on the Wild Side – Depathologizing and Working with “Psychosis” and Extreme States of Consciousness”  where you can pay one low fee, and access a variety of practical and amazing presentations from around the world.

For example, hearing voices can seem bizarre and disorienting, and the conventional approaches of trying to suppress or distract from them commonly fail, so it can help to have available the alternative of helping people to calmly explore the experience and its possible meaning.  In two different presentations, you can learn how to do a voice profile to understand the voice better, and how to carry on a dialogue with individual voices, in a way that increases coping and integration.  The presenters for this are Ron Coleman, Karen Taylor, and Rufus May, all of whom are leaders in the international Hearing Voices Movement.

Have you ever wondered what the relationship might be between the deliberately induced altered states and dissociation induced by hypnosis, and the more chaotic states called “psychotic”?  Gabrielle Peacock, MD from Australia is trained in Ericksonian hypnosis, but you don’t have to be a hypnotist to learn and benefit from the approaches she teaches, approaches that  honor these individuals abilities in ways that shamans or witch doctors do in other cultures, approaches that can “bring clarity, enlightenment and peace to an individual who feels lost in our western world devoid of such useful cultural guides.

I’ve got a presentation in the conference, it’s called “Understanding Extreme States and “Psychosis” as Attempts to Solve Problems:Integrating Perspectives on Trauma, Spirituality and Creativity.”

There are other presentations as well.  You can learn from Brad and Hilary Keeney about how to “minimize the handling of narrative, causal understanding, explanation, and sideline commentary in favor of plunging directly into the live, unfolding interactive stream of therapeutic interaction,”   Dr. Jeffrey Zeig offers ideas about how to work with the person and not the label, and Bill McLeod, MD shares advice about what does and doesn’t help derived from 50 years experience working inside mental hospitals.

Psychologists, social workers and professional counselors in the US can earn up to 6 CE credits for no additional fee!

There is a lot  more information about the conference and the speakers, as well as some previews of what is offered, on the conference website, where of course you can also register.  Once you register, you can access the presentations whenever you want, or download them to your computer.

I hope you check it out!  Let me know about any questions you have.  And don’t procrastinate:  registration for this conference is likely to be available for only a few weeks.

Helping Children and Adolescents Deal with Voices

Rachael WaddinghamRachael (Rai) Waddingham has made available a presentation by herself with lots of good ideas for anyone trying to help a child or adolescent do better with the experience of hearing voices, here’s the link for that:

http://panopto.ucc.ie/Panopto/Pages/Viewer.aspx?id=273f2a59-b6e2-4a68-bbe3-a8adc7262956

If you like what Rai has to say, and if you live in one of the Northeastern states of the US, you might want to check out information about her tour this May, at http://isps-us.org/blog/?p=675

Also, you might want to check out my earlier blog post on this topic, What to do when children hear voices

Daniel Mackler’s Films are Now Free on YouTube

My friend Daniel Mackler has made films recognized around the world, covering a variety of psychological and social approaches to psychosis.  They are available in a number of languages, and now, thanks to his generosity, they can all be watched for free on YouTube!

They are as follows:

Take These Broken Wings centers on the lives of two women who both recovered from severe schizophrenia.  The film traces the roots of their schizophrenia to childhood trauma and details their successful psychotherapy with gifted clinicians.

Open Dialogue documents the  methodology of the world’s most successful approach to helping people with psychosis, and interviews many  of the clinicians involved.

Healing Homes chronicles the work of the Family Care Foundation in Gothenburg, Sweden  This organization, backed by over twenty years of experience, places people who have been failed by traditional psychiatry in host families — predominately farm families in the Swedish countryside — as a start for a whole new life journey, with intensive therapy, help for the families, and help for the person in getting off medication as part of the process.

Coming Off Psych Drugs offers a rare glimpse into the world of coming off psych drugs through the eyes of those who have done it.

Daniel explains his rationale for giving away these great films at http://wildtruth.net/my-films-are-now-free-on-youtube/

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