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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:

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

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

Madness as an Attempt to Heal from Dissociation?

One idea I’ve been intrigued by for awhile is the notion that psychosis can arise from attempts to heal dissociation.

Dissociation is all very ordered and structured.  But it doesn’t allow a person to function as a whole.  Trying to go from a really dissociated place, to putting things back together, can involve a loss of structure, which is “mad” or “psychotic” though also a step toward healing, if one can get through it successfully.

I read a blog post recently at by Carolyn Spring on the “Positive Outcomes for Dissociative Survivors” website, here’s an excerpt from it that I think describes this step pretty clearly: [click to continue…]

Uses and Abuses of “Recovery” – A Review

The World Psychiatric Journal just published an interesting article, Uses and abuses of recovery: implementing recovery-oriented practices in mental health systems .  It is available in full at that link.

One of the things it does is to outline “7 abuses of the concept of “recovery”.”  I think this effort to identify problems in the use of the term “recovery” is important, even though I believe their list of abuses is much too short, and some of their reasoning about those abuses, and what should be done instead, is flawed or incomplete.

One interesting issue they define as a problem is thinking that “RECOVERY IS ABOUT MAKING PEOPLE INDEPENDENT AND NORMAL”  They state that

But recovery is not about “getting better” or ceasing to need support – it is about “recovering a life”, the right to participate in all facets of civic and economic life as an equal citizen (33). This requires a framework predicated on a human rights and a social model of exclusion: “It is society that disables people. It is attitudes, actions, assumptions – social, cultural and physical structures which disable by erecting barriers and imposing restrictions and options” (34).

It is true that all humans need support, and the exact kinds of support vary by individual, and sometimes people’s problem can be simply that the society fails to provide the kind of support they need, or they haven’t yet been able to find it, even though such support exists here and there.  The understanding that people have different abilities, and that a healthy society should include more people by removing barriers, comes out of the physical disability movement, where people often have physical differences which will last a lifetime and cannot change.  So for example a person requiring a wheelchair to get around may recover an active life when the society removes barriers to access, and provides supports like ramps and elevators.  An example in the mental health world may be where a sensitive person fails to thrive or breaks down in an ultra-competitive culture, but then is able to recover when helped to link up with a subculture that provides necessary supports needed by that person due to their sensitivity.

But it’s also true I think that for many, mental health recovery is very much about “getting better” and ceasing to need various forms of special support.   Mental health crisis, even of the most serious variety, is often temporary, and with the right kind of assistance at the time, people can often get back to being as independent as anyone else (though not “normal” as we all know by now that this only exists as a setting on a washing machine.)  I think we would do best to see that recovery comes in different varieties or flavors, sometimes it seems more about learning to live better with a particular disability, and sometimes learning how to no longer have that disability.  So I think for example counseling approaches which offer strategies aimed at helping people overcome, and not just learn to live with, specific mental health disabilities should remain a part of any recovery oriented system, even though these approaches should never be offered as the only possible route forward. [click to continue…]

Finding the Inner Wild

Modern “civilized” cultures do not have a good relationship with the wild.  It seems we are always doing everything possible to shut it out of our lives, or to kill or tame it to the point where it is unrecognizable.  Yet that which is wild is always still lurking, somewhere over the edge of our boundaries and frontiers, and also inside people, both inside the “others” we might approach warily on the street, and even inside our family members and ourselves.

Another name for the Wild is Mystery, or the Unknown.  We like to pretend that the Unknown is just a small affair of no great importance, but we are shadowed by a sense that the Unknown or Mystery totally dwarfs and makes a mockery of everything we think we know.  So we commonly act as quickly as we can to suppress that sense, to find whatever allows us to go back to thinking we know what we are doing.

And yet, as much as we try to suppress the Wild, we totally need it.  Sometimes we need it just as a location where we might find some missing ingredient that our tame world needs to function, and sometimes we need it when the contradictions in our “normal” world become too oppressive and we need to immerse ourselves, at least for a while, in something much vaster.

into the thicket

I am intrigued by the relationship between the experiences we call psychosis and wildness in general.  That’s why I especially enjoyed recently reading a book titled “Into the Thicket” by William Brundage, which tells his story of getting lost simultaneously in the wilder areas that existed near his home in Eugene Oregon, and getting lost in the wilds of his own mind.

“Madness” is often associated with one’s mind falling apart, but Will’s story is unique in that he recalls a specific time and place where he had an experience of his mind shattering.  It might be best to let him tell the story himself: [click to continue…]

An Opportunity for “Mad Caring”: David Oaks Needs Our Help

For decades, one of the most prominent voices for radical change, or  “non-violent revolution” in mental health care has been David Oaks, former director of MindFreedom International.  Many activists today were drawn into their work due to David’s influence.  Robert Whitaker for example has credited an interview he did with David in 1998 for propelling him into noticing and writing about the way psychiatric drugs were harming more than helping.   My own journey in becoming outspoken on these issues has also been massively influenced by David’s activism and ideas, which is one reason I care strongly about the issue I am bringing up here.

While David has been helpful, directly or indirectly, to so many of us, he now needs our help.  In December 2012, while attempting to retrieve his cat “Bongo” from a loft, he slipped and fell, breaking his neck (which was already very vulnerable due to a previously existing bone condition.)  He then teetered on the edge of survival for some months, setting the record at the local hospital for longest stay in the ICU.  An infection he suffered during this time resulted in a high fever which caused additional difficulties, partially impairing his ability to speak.  David has worked hard since in rehab to regain some use of his arms, but lacks control of his hands and legs.

Since David’s accident, he and Debra have exhausted their savings paying for bills not covered by insurance.  Friends and local agencies have donated some of the labor toward the remodel of their house to fit David’s wheelchair, but usually not the cost of materials. The cost of daily life has increased tremendously. And to continue working and to move freely about in the community, David will need technological help with the internet, a computer and a specially-equipped van. [click to continue…]

Acceptance and Commitment Therapy for Psychosis: A Highly Valuable Contribution despite Major Flaws

The core of Acceptance and Commitment Therapy, or ACT, is the idea of simply accepting, rather than trying to get rid of, disturbing or unwanted inner experiences like anxiety or voices, and then refocusing on a commitment to take action toward personally chosen values regardless of whether that seems to make the unwanted experiences increase or decrease.

The process of applying ACT to “psychotic” experiences is well described in the book Acceptance and Commitment Therapy and Mindfulness for Psychosis, which I recently finished reading.  I found a lot to like in the book and generally in the concept of applying ACT to psychotic experiences, but I also noticed some major limitations, which I will get to below.

There is, I think, great value in the notion of shifting attention away from attempts to eliminate experiences that might be labeled “psychotic” and focusing instead on increasing a person’s ability and willingness to move toward his or her values.  This idea is consistent with the emphasis in the recovery movement of finding a way to live a valued life despite any ongoing problems, but ACT has value because of the unique and effective strategies it offers to help people make this shift.

It is also a virtue of ACT that it is “transdiagnostic,” that is, it is not an approach designed for specific “mental disorders” but rather an approach designed to address problems in living which are understood to be universal for human beings, including for the professionals themselves.  ACT appreciates that life is tricky and that we can get caught up in strategies that are unhelpful to us, like focusing too much on trying to get rid of unwanted experiences and/or getting too taken over by, or “fused,” with them, but it also appreciates that we all retain the ability to turn toward more constructive, value-driven approaches. [click to continue…]

Creating Dialog on Approaches for “Psychosis” in New Jersey

What would happen if professionals opened their minds about the nature of madness?  What new possibilities might be created if they questioned labels such as “schizophrenia” and if they instead showed curiosity about the person underneath the label, and interest in the way “psychosis” might be an understandable response to the person’s life?  How would it work if such professionals gathered for a conference, if they invited service users and survivors to help lead it, and then if they worked together to find a path forward? [click to continue…]

Madness, Revolution, and Making Peace

While some will frame Eleanor’s story, told in her awesome TED video, as the triumph of an individual struggling against “mental illness,” I believe the story might better be seen as a refutation of the whole “illness of the mind” metaphor, and as an indication of a desperate need for a new paradigm.

When human experiences like hearing voices are framed as “illness,” the strategy of attempting to eradicate them naturally follows.  When Eleanor was first hospitalized, she was trained in this model, which directly led to what she describes as her engagement in a “psychic civil war,” where the voices multiplied and became overwhelmingly nasty.  Unfortunately, this is not unusual:  research shows that fearing experiences, and attempting to avoid and/or suppressing them, often predicts the escalation of difficulties.

All humans experience inner conflict at times.  Consciously, we may want our mind to behave in a particular way; but we have impulses, emotions, thoughts, and sometimes voices that have other ideas.  Problems with this sort of inner rebellion can range from trivial to life threatening, from the seemingly everyday to disruptions that seem bizarre and overwhelming, such as some kinds of voice hearing that are common after experiences like severe trauma.

Most current mental health treatment is based on labeling those disruptive parts as being “symptoms” of a disorder or illness, and then attempting to suppress them by any means possible, especially with drugs.  Unfortunately, this can backfire in a number of ways:  the drugs and other means employed may suppress many kinds of functioning and not just the disturbance, the attempts at suppression can stir up more conflict, and finally, the person fails to notice that the disturbing experiences may have had something positive to offer if understood correctly.

Eleanor very definitely did not recover by “battling her mental illness.”  She recovered by considering the radical notion that the disturbing experiences and voices were not aspects of an illness or of something to be eliminated, but rather were signals from the parts of herself that had been most disturbed by events which had happened to her, parts of her that carried valuable messages if only she could learn to listen in the right way.

It is very difficult to heal when one is identifying parts of oneself as an illness or as symptoms of an illness.  It becomes possible to heal when one appreciates all the parts of oneself as having something to contribute, even if those same parts may be confused in some way, or in some way need to be subjected to limits.  Voices or impulses demanding self harm for example may seem to be entirely negative, but they can also be used as helpful indicators of underlying issues that need to be addressed.  Understood this way, both conflict with the voices or impulses, and instances of acting on them in destructive ways, can be reduced, while appropriate action to address the deeper issues can be facilitated.

Wise leaders learn how to find something of value in rebellion or dissent, and are always learning from that which resists them.  I believe that a wiser mental health system would aid people in being curious about and even learning from that which disturbs them, creating dialogue and negotiation rather than attempts at suppression.  Shifting to such an approach would require that professionals drop the pretense of being “experts” in understanding mental disorders, but it would allow them to actually practice expertise in helping people like Eleanor find their own version of peaceful coexistence within their complex inner selves.  It’s time to stop the suppression, and to begin creating the conditions for healing and peace making.

Tapering Off Medications When “Symptoms Have Remitted”: Does That Make Sense?

While a 2 year outcome study by Wunderink et al has been cited as evidence that guided discontinuation of antipsychotics for people whose psychosis has remitted results in twice as much “relapse,” a followup of that study, extending it to 7 years using a naturalistic followup, finds that the guided discontinuation group had twice the recovery rates, and no greater overall relapse rate (with a trend toward the medication group having more relapse.)

A video of a presentation on this 7 year outcome study is at

Of course this study doesn’t prove that everyone will do better off medication.  In the study, they only tried to help people off medication if people seemed to be doing well on medication for 6 months, and they felt they couldn’t tolerate people experiencing “florid psychosis” while off medication.  But I think it does really support the contention that outcomes for long term use of antipsychotics varies from short term outcome, and that we should be trying to give more people a chance to experience the possible benefits of either never starting, or getting off, antipsychotics.

Nancy Andreason and colleagues recently released a study that indicated that both taking antipsychotic drugs, and having relapses into psychosis, cause a loss of brain tissue, but in different areas of the brain.  In their conclusions they stated their belief that the cautious use of antipsychotics is justified despite the damage they cause to the brain, because such use is in their opinion the best way to prevent relapse which would also result in brain damage.  But if, as the 7 year study above indicates, antipsychotics are not reducing relapse risk in the long term, it becomes more obvious that we should be looking hard for alternatives to antipsychotic use so we can help people find ways to avoid both the problems associated with relapse and the problems associated with antipsychotics themselves.

(And it may be that almost all the brain tissue loss is really due to the antipsychotics, see this critical analysis of the Andreason study, by psychiatrist Joanna Moncrieff.)

Robert Whitaker wrote a good summary of how the Wunderink study should be taken as a decisive piece of evidence indicating the need for a new standard of care.