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“Psychosis” is more like a revolution than it is an “illness.”

Someone I know recently challenged me when I asserted that people could oppress themselves, and said he believed that oppression required someone outside the person doing the oppressing.  I didn’t agree, but in explaining my disagreement, I came up with some thoughts relevant to psychosis which I decided to share here.

One thing that my colleague had also suggested was that the oppressiveness of our current mental health system could be relieved by switching to a peer run system.  While I think peer run systems have some advantages, most notably that they usually at least believe in listening to the people they are supposed to be helping, I don’t believe that this move alone would make the system completely non-oppressive.  We had a peer run agency in our county for a number of years, and it did some good things, but I knew a number of “peers” who found it oppressive and who wouldn’t go there, for various reasons.  The problems were often those one might call “political” – arguably, dysfunctional internal politics.  So peers being oppressive to other peers is also possible.

At one point in our discussion I pointed out that I see people as a “complex process emerging out of an interaction of subsystems, some of which can be oppressive to others or to the person as a whole.”  By this I meant that people have their own internal politics, their own organization, which can be oppressive in much the same way that the government of a country can be oppressive.

The notion that all personal oppression comes from outside the person seems to me as flawed as the notion someone might have that all oppression of nations comes from other nations.  True, there are forms of oppression where one nation oppresses another, such as in colonial domination, but nations are also commonly oppressed by their own governments.  And I think there is an interaction between oppression by another nation and the tendency to form an oppressive self-government:  nations that have had their autonomy damaged through domination by outsiders seem more likely to form autocratic governments.

I think this is mirrored in a tendency for people who have been dominated or abused by others to form rigid forms of “self government” and then to experience “revolutions” that create chaos.  The resulting mess we call “psychosis.”  I think psychosis has a lot more similarities with  revolution than it does with “illness.”  That’s why psychosis often feels good when it first starts:  like with revolutions, there is often the sense of lots of great new potential, with no sense of the enormous possible costs.  That’s also why psychosis is not infrequently “successful” and leaves the person with a better sense of self organization than before – as documented on the late Al Seibert’s website, successful schizophrenia.  Though the outcome can also be something like a “failed state” with armed groups terrorizing each other for decades:  this outcome is more likely when outside intervention is unhelpful, such as when outside forces try to prop up authoritarian systems that are themselves oppressive.

Unfortunately, most of our current mental health system does try to prop up forms of self organization within the patient that are inherently oppressive.  For example, consider the whole effort to “get rid of voices.”  There is nothing that authoritarian governments like to do more than to suppress dissenting voices.  Non-oppressive systems tend to listen to them, not necessarily listen in the sense of believe them or do what they say, but at least to hear them out and consider what of value they might have.  Our current mental health system tends to side with the factions within a person that want to control thinking and suppress disturbing voices, even if that results in widespread oppression within the person.  More progressive mental health approaches, such as Open Dialogue, or the Voice Dialogue approach advocated by many within the hearing voices movement, help the person develop a more democratic, less oppressive way of being organized where all voices can be heard.  (The Open Dialogue approach also supports this in the person’s social network as a whole.)

So what I think is most important in reforming the mental health system is that we work at making it non-oppressive at all levels.  It should be a system that does encourage all voices to be heard.  Of course, not all voices can get exactly what they want, but in a process where all voices can be heard, it is more likely that each voice, whether it is a person or a part of a person, will get what he, she, or “it” needs.

9 comments… add one
  • good piece! I agree that human beings of all stripes can be oppressive and that ultimately, in the end, it IS our own oppressive natures we must free ourselves from.

    your site looks great…I had a hard time with the black background…had to lift the articles and read them elsewhere… 🙂

  • I second Gianna’s comment. Great piece, and yes, I too, had trouble with the black background, particularly when viewing it through my Blackberry. The new site is much clearer.

  • I’m glad the two of you above liked the piece. I’m thinking now maybe I should have made reference to Eleanor Longden’s characterization of psychosis, a “psychic civil war.” I think lots of people have had thoughts along these lines.

  • Hi Ron,

    Thanks for this piece, and for noting that the idea of intra revolution has been out there. I have written on issues close to this so I feel like I should comment. I feel that the reification of psychosis as the category we use to describe devalued experiences is damaging to the sense of change that would be possible if we weren’t calling it psychosis in the first place. The term is a short form that is acceptable to most of us because it would take a lot of time to simply recount concrete mental or personal events, but it subsumes them into the logic of therapeutics as a word, which is at worst the oppressive business of quelling dissent as you say in your blog. So I would consider both the questionable category we use to describe these conscious events of apparent discord, and its narration of probable outcomes as naive euphoria at the beginning and ugly hangover at the end. These events are not simply charted, though stories have a way of making it seem so, and though the narratives we are told sometimes happen that way, they are in the least attributable to social conditions as well as any perceived ‘state’ or ‘condition’ (or defined process) of being (‘psychotic’, ‘delusional’, and so on). Moving beyond therapeutics in our definitions and description of events can also help us not oppress people who are trying to describe their experiences to themselves, hearing their own self-‘organizing’ (though many of us will derive from therapeutics to do so– to good and bad effect).

    Thanks again for your attention to the possibility that ‘madness’ is political!

    Cheers,
    Erick Fabris,
    author of Tranquil Prisons (see my website for details)

    • Hi Eric,

      It was good to see your comment, thanks.

      I agree with you that “psychosis” is a term that comes with a lot of baggage and misleading associations, but I still use it because its use is so widespread, and it often helps to at least start with terminology people are familiar with.

      “Extreme states” is popular with many who champion alternative perspectives, but it really is more vague than psychosis, as one can be extremely depressed, or anxious, etc. without being “psychotic.” “Psychosis” tends to mean some mixture of being “disorganized” (or experimenting with alternate forms of organization) and being out of touch with important aspects of reality (while possibly being in touch with other aspects that may usually be missed.) I’m not aware of a good alternative word for that.

      Revolutions, civil wars, etc. can have good or bad outcomes, and those of us who try to influence their outcomes might best be aware of how the bad outcomes we see might be a result of the way our intervention is being unhelpful, and not simply due to the nature of the revolution itself. We need to develop wiser ways of interacting with people in these states than most of what is traditionally done.

  • I can certainly see psychosis as a revolution- it seems that in some people their brain (or part of it) goes off on a whole new track, leaving the original personality bewildered, dominated, liberated or nearly destroying it. Like a revolution that happens around you and you don’t realise it’s happening until too late. With voices, I like the philosophy of allowing the voice-hearing person chat with the voices and the therapist to find anything of value that might guide control or emergence from a psychotic “domination”. Although I haven’t been a therapist I have talked with and interviewed many people with psychoses and always took the tack that they should let their voices or “apparitions” into the conversation, eg. the woman who said there was an old nun sitting on the footstool near my legs and telling her to go and shout at the neighbours etc. Mind you, the transcription clerk who listened to the tapes had to ask me many questions about who she should record was saying some of the sentences!
    In Australia with the current trend towards reforming the mental health system, I think that peer-led organisations for therapeutic benefit would be a bad idea. Some version of shared decision-making seems OK to me [I’m also on the other side of the couch with major depression], but allowing patients/clients to totally govern is quite frightening when I listen to the loudest voices in the debate! We would have individuals who “hate doctors, psychiatrists, hospitals, social workers, police and drugs” and with major personality disorders calling the shots! No thank you very much! These people want a revolution and they truly WANT to become the oppressors! Meanwhile I might read some more of your posts.

    • Hi Murfomurf,

      It’s interesting what you say about your experience talking to people’s voices, as a non-therapist. Actually the Voice Dialogue work I referenced is being pioneered by people who aren’t therapists, especially by people who are part of the Hearing Voices movement. When I’ve gone to train therapists in how to do this some of them worry it might cause scary voices to emerge that they won’t know how to handle, but I think the voice hearers themselves are much less frightened of other people’s voices, because they’ve had to deal with voices of their own.

  • Great alternative approach to current yet ancient psychological thinking. Todays definitions totaly miss any incorporation of so-called “illnesses” in a greater context – such as recovery itself (yeah, yeah, it is only one of many possible cases, but come one…without excitement I wouldn’t get up in the morning..). Unfortunately it is easier, cheaper, and less time-consuming for both helper and helped to accept a definition that requires you to fight symptoms rather than making an in-depth functional analysis and evaluating all aspects relatively to each other (in other words, getting to know a person). What is being done today is stereotyping on a “high” level where few people who are personally concernced ask questions because, well, it is easier, cheaper, and less time-consuming while the promises are big! Then, quite funny, in the long-term, some problems dissolve into thin air simply because of necessities (which create structure – or they don’t – OR because psychosis can be defined as a functional piece of mindwork in some cases – maybe radical and risky, but usually the more close to the ground the more effort has to be made to stand up – more steps to perform – more opportunities to shoot yourself in the leg). At least, psychological work creates some excitement – if only there were more people able to introduce their ideas.

    Returning to the origins…from recent personal experience I have found that some delusions can be quite fun if you just let them happen – if you have the time – if nobody disturbs you. Lying in bed and experiencing the “head-cinema”, so to say. Only when it comes to being an irritating asshole I try to be less excited about my state ;).
    Cheers + keep it up!
    One of the new hippie-psycho-communiy – without drugs I have hallucinations! A bit more Frank Zappa is needed here 😉

    • Hi Zappalicious,

      Thanks for your comment. I think you touch on two important themes – both the way psychotic experiences can be positive, entertaining, fun, and liberating if taken in the right way, and also the need to take responsibility for one’s state especially in terms of one’s impact on others.

      A lot of research implicates a fear of madness as playing a key role in amplifying madness. Noticing how madness can be fun, the Frank Zappa part in your summary, tends to counter that fear, and can work out well if accompanied by that sense of knowing when enough is enough.

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