Nathaniel Lehrman, M.D. recently posted his story of how he became psychotic, how he was treated, and then how he recovered despite the fact that much of his treatment was misguided. This story provides some good insight into some of the dynamics that are common in the way our mental health system, which is supposed to help people find their balance, often just gets caught up in an imbalance opposite to the imbalance the consumer is experiencing.
What happened to Nathaniel was that in the middle period of his life he got into a political battle, which resulted in a number of people turning against him and causing him trouble. His distress about this situation caused him to become hypervigilant for threat or “paranoid” which caused him to see more threat and threatening behavior than actually existed, and this resulted in his hospitalization. Once in the hospital, he was treated as though all of his perception of threat was delusional, even though he had solid evidence that much of it was real.
In other words, while Nathaniel had become unbalanced in the sense of seeing more threat than actually existed, the hospital clearly took up the opposite sort of imbalance, seeing less threat than actually existed. This is a very common dynamic when mental health professionals refuse to listen in detail to what consumers have to say, and refuse to acknowledge that real life situations may be quite complex, with real perceptions mixing in with mistaken ones.
In the better psychological approaches, like CBT for psychosis, or Open Dialogue, professionals take an interest in what consumers say, and they don’t assume they know for sure what is real and what is not. Instead, they encourage looking at the subject from multiple points of view, in a thoughtful, reflective way. This allows truths to emerge, and imbalances on both sides, within the consumer or the mental health system, are gradually reduced.
Nathaniel was lucky enough to have his psychotic episode when he was already middle aged and a successful psychiatrist, so he was not overwhelmed by those who didn’t take him seriously, and he managed to find his own pathway toward recovery. But many of those who enter the mental health system don’t have these kinds of strengths, and they are likely to get caught up in a vicious circle, in which they respond to the mental health system minimization of their beliefs by emphasizing their own beliefs more strongly, which causes the mental health system to see them as even more crazy and becomes even less willing to listen for any truth in what they might be saying, etc. This is one way what might be a temporary imbalance becomes a “chronic disorder” due to poor treatment.
In some other cases, a delusional belief may be literally impossible, but still has a bit of truth in the sense that it is a metaphor for something that is really going on. A competent mental health system would be curious about this kind of truth as well, rather than just completely dismissing the belief as delusion.