Recovery from "schizophrenia" and other "psychotic disorders"

Too often, our mental health systems are more oriented toward “drug and keep out of trouble” than they are toward recovery (even when they say they are about recovery!)

It could be different. In Lane County Oregon, activists, especially consumers, have organized to propose guidelines directing the mental health system to practice with recovery in mind from the beginning. This would mean professionals would have to avoid presenting biological speculations which are likely to make a consumer feel they have a difference which is beyond their control (such as, “you have an illness of the brain” or “you have a biochemilcal imbalance.”) Medications would be seen as only one tool among many, accurate information about benefits and risks would be available, and help would be available in getting off medications as well as getting onto them. The consumer voice and consumer choice would be considered at each level of mental health treatment, to reduce trauma and increase the chances that treatment offered would match individual needs.

You can take a look at the guidelines we have drafted, at lane-guidelines-revised If you like these guidelines, feel free to modify them and propose them to your local mental health system!

When people dream, they are “completely out of touch with reality” and they take totally seriously the most fantastic and improbable perceptions. When people are psychotic, they do pretty much the same thing. Could there be a connection? Actually there seem to be many connections, some of which are discussed at http://www.hgi.org.uk/archive/psychosis.htm.

Dreaming and creativity are highly associated. I know some people who have questioned the notion that psychosis (considered an illness) could be linked to creativity (considered one of the highest human functions) but the evidence just keeps getting stronger. Just this morning, I was reading in one book that in testing brain differences, physiological differences, and cognitive differences, the very strongest predictor of a schizophrenia diagnosis was being low in a thing called “latent inhibition” which is the ability to screen things out of awareness that were previously tagged as irrelevant. Most of the places I have seen this discussed, it is looked at as nothing but a “brain defect” that predisposes a person to psychosis. But is being low in latent inhibition always a bad thing? It turns out not: highly creative people are also low in latent inhibition! Of course, those who are successfully creative have learned how to handle this difference.

More on this at http://blogs.psychologytoday.com/blog/beautiful-minds/200903/schizophrenic-thought-madness-or-potential-genius or in more detail at http://pantheon.yale.edu/~sbk22/Scott_Barry_Kaufman/Publications_files/Kaufman%20%282009%29.pdf

Before most of my blog vanished into cyberspace, I had posted a link to a MindFreedom document that compares the myths that people are told about “mental illness” with what people would hear if they were told the truth. You can access this document at http://www.mindfreedom.org/truth/mental-health-myths

Will Hall was recently interviewed about Mad Pride in Newsweek, see http://www.newsweek.com/id/195694

In response to this article, a mental health worker I know questioned how people could say that madness is just a “difference” and not an illness, and yet also claim that people who are mad deserve disability payments. In response, I wrote the following, which attempts to sort out the connections between mad pride and gay pride, and how both might relate to the topic of “disability.”

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I agree that the issue of what is just a difference, that one can realistically be proud of, and what is a disability, is an interesting one.

One may be blind, and be to some extent disabled by that, and yet feel that one’s life has been enriched and not deprived overall as a result of the experience. One might need help from others at various times due to being blind, yet also have unique gifts and perspectives to offer to others as a result of one’s blindness.

Mental differences are even more complex.

Years ago, if a young man came into a psychiatrist’s office, reporting that he could not work because he was distracted by overwhelming anxiety and suicidal thoughts prompted by strong feelings of attraction to other men, his affliction would be considered to be his homosexuality and efforts would be made to turn him straight so he could be happy and not disabled. These efforts would likely have just made things worse. The same young man, coming into a psychiatrist’s office now, would hopefully be told he could learn to accept himself as different than others, that this difference was not itself an illness, and that once he did accept it and learn to live successfully with it he would not be ill at all. The young guy might even be referred to people who will teach him to take pride in his differences, and to find others who will appreciate him just for those differences. (He will still make a lousy husband for your daughter, and to that extent will be disabled, but on the other hand he may make a great boyfriend for your gay nephew, so overall there is no disability.)

These days, if a person comes into a psychiatrist’s office and reports that he or she is distressed due to hearing voices and having various kinds of strange experiences and perspectives, he or she is likely to be told that all of this is due to the person’s mental illness, and the psychiatrist will attempt to change it all as much as possible, to make the person “normal.” Yet, research on the general population shows that many people are living fine out in the world who regularly hear voices and have strange beliefs and experiences. Somehow, they manage all this without a lot of distress or disability. What “mad pride” is about is helping people with strange experiences and perspectives to make the shift from being distressed and disabled by their differences, to learning how to accept and enjoy them, and even see them as having value.

The Icarus Project, in which Will Hall is active, speaks of “negotiating the space between brilliance and madness.” So there is an implication that the person has to learn how to manage his or her “dangerous gifts.” With appropriate management skills, there is no longer disability.

What we really have to learn from the mad pride movement is similar to what we had to learn from gay pride: that it is to a great extent the person’s and society’s ignorance of what to do with differences, and not the differences themselves, that are the problem. People can still be disabled when they haven’t found out how to manage their differences, and so they really do deserve disability at that point, but they can also potentially learn how to navigate out of the disability and perhaps become something amazing. Or at least have an enjoyable life, while still being “different.” This is most likely to happen when both the person and the helpers see the possibility of it happening and have some kind of roadmap of how to get there.

So there’s a beginning of an answer. I know it’s hard for those who see “schizophrenia” as nothing but a “biological illness” to consider some of these possibilities, but I think if we really keep studying all the links between creativity and madness, and listen to people who have been there like Will, we will start to get it.

I was recently reviewing an article, (Nettle 2006) (see the abstract below) that makes some really interesting observations that pertain to the relationship between psychosis and creativity.

The author explores how “divergent thinking” (which I believe might also be characterized as a loosening of associations) is commonly experienced by poets and artists, while “convergent thinking” is more seen in mathematical types, (which I believe could also be seen as a tightening of associations.) Divergent thinking leads to having more unusual experiences such as are seen among both artistic types and those diagnosed as psychotic, while convergent thinking is associated with experiences on the negative symptom dimension, which are more seen amongst both mathematicians and those with autism.
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I think the author misses a point though when he associates convergent thinking with autism but not “schizophrenia.” Overly convergent thinking is definitely seen in people diagnosed with schizophrenia, it is often observed in autistic type reactions, and certainly fits with the negative symptom dimension commonly seen in people given this diagnosis.

One way the interplay of excessively divergent and then excessively convergent thinking is seen in people diagnosed with “schizophrenia” is in the way a person makes associations in response to a stimulus. The tendency is to have a much greater than average initial associations, which then are overwhelming, lead to a kind of “collapse” into having a smaller than average number of associations.

Another way this interplay is observed has to do with metaphor. People who tend to get diagnosed with schizophrenia use metaphor wildly, just as the mind does in dreams, but then also typically are not very good at understanding metaphors, much as people with autism fail to get them (this is the excessively convergent thinking.)

I believe this all has to do with a sort of underlying “bipolarity” to the processes common to psychosis. It’s kind of a chicken and egg thing. It could start with a person being in a mental rut, leading to divergent thinking in an attempt to get out of it, that then leads to some kind of trouble followed by an over-correction to overly convergent thinking, which deepens the rut, etc. Or it could start at the other end, with something inspiring the person into overly divergent thinking, which leads to trouble and etc.

At any rate, I think if we get better at understanding the parallels between human creative process, both divergent and convergent, we will be much better at helping people tease out the possible meaning in their psychotic experiences, both on the positive and negative dimension, while also helping them avoid the kind of over-corrections that keeps them cycling through “bipolar” extremes rather than finding a balance.

If someone wants a copy of this article, I can email it to you.

Ron Unger

Nettle, D. (2006). “Schizotypy and mental health amongst poets, visual artists, and mathematicians.” Journal of Research in Personality 40(6): 876-890.
Many researchers have found evidence of an association between creativity and the predisposition to mental illness. However, a number of questions remain unanswered. First, it is not clear whether healthy creatives have a milder loading on schizotypal traits than people who suffer serious psychopathology, or whether they have an equal loading, but other mediating characteristics. Second, most of the existing research has concentrated on artistic creativity, and the position of other creative domains is not yet clear. The present study compares schizotypy profiles using the O-LIFE inventory in a large sample of poets, artists, mathematicians, the general population, and psychiatric patients. Poets and
artists have levels of unusual experiences that are higher than controls, and as high as schizophrenia
patients. However, they are relatively low on the dimension of introvertive anhedonia. Mathematicians
are lower than controls on unusual experiences. The results suggest that artistic creatives and psychiatric
patients share a tendency to unusual ideas and experiences, but creative groups are distinguished
by the absence of anhedonia and avolition. Moreover, different domains of creativity require different
cognitive profiles, with poetry and art associated with divergent thinking, schizophrenia and affective
disorder, and mathematics associated with convergent thinking and autism.