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pachyderm: You may gather from other topics here that we feel that mistrust of mental health professionals is not always misplaced.

Yes, I think this is my hesitation about even trying to come up with ways of coaxing someone into treatment.

Those who are around an individual who is going through a process of psychosis, one of the very first things that happens is they get concerned and they get frightened. They think to themselves, 'Something's not right," and the next thought is, 'This person needs some help'. That's often entirely correct -- something is not right and the person often does need some help. Linked to those initial thoughts is another one that says, "The psychiatrist or hospital or medicine is the help they need."

In many instances, that's true. People do identify psychiatrists, hospitals and medications as being helpful to them. But in many other instances, it's not true at all. Some people identify the same as being unhelpful, even damaging. However, the initial perception is that this is what will help everyone and because that's the prevailing perception, friends and family members may feel quite justified in coaxing, insisting, even forcing people into treatment that is, at best, a hit and miss proposition. None of this changes the fact that something is wrong, that this person may require some help, and that it's usually those who are closest to that person who first recognize this.

It's a difficult position that floss is in. I'm sure she wants to help and us suggesting that "help" may not be helpful likely isn't reassuring her fears any. She still has to do something and that something is not likely to be nothing at all.

floss, I suspect that if your boyfriend's behavior continues you will take or arrange for him to be taken to the hospital. You will do that because you're concerned about him, you don't know what else to do, and there doesn't seem to be anywhere else to go. Even if you're aware that there's a risk that treatment may not help him or may make things worse, you're probably willing to take the risk that he'll end up in the group that later says, "That was horribly unpleasant for everyone but it was just what I needed at that time. Thank you." Once he's taken to the hospital you'll probably feel an enormous sense of relief that other people -- experts -- are now taking over his care, even if you have mixed feelings about actually taking him or having him brought in. You will likely feel this is the best that you can do and given the limited options available, you may well be right. After all, you likely have no understanding of psychosis yourself and can't be expected to flourish in a situation that may feel overwhelming.

I recognize that you're not in an easy position and I can also see why you are concerned with your boyfriend's behavior. You've made your post in a schizophrenia and psychosis forum so it seems safe to assume that you're concerned that this is what he is experiencing. You also noted that in your tenative explorations of this topic with your boyfriend, he didn't seem very open to your interpretations. A less threatening and possibly more apt term you could use is personal or transpersonal crisis. Part of the reason this term is less threatening is because a crisis is recognized as difficult, but temporary. Schizophrenia on the other hand, is often presented as equally or more difficult, but permanent. The stigma attached to that word is substantial enough that when applied as a label to another human being, it nearly always induces shame and a sense of being devalued. In turn, this triggers a defensive posture.

Bear in mind, that none of us here are doctors. But we are people who have gone through the experience known as psychosis or schizophrenia in this culture and for this reason, we may be able to provide you with some insights into what your boyfriend is going through and what you can do to help him.

With that thought in mind, I'm going to suggest that you resist going the involuntary sectioning route unless it becomes absolutely necessary. The reason I say that is because my experience of psychosis is that it is a fragmentation of the personality/ego structure. Imagine that you live in a home with walls. One day, the walls come down and now, all the rest of the world can see in and come in. You no longer feel safe in your own body. You no longer have ego boundaries to protect you. Those boundaries have been breached. Therefore, when the people around you who care about you and want to help you begin pushing you to accept certain labels, to do certain things, to behave in a specific way, this too is experienced as a boundary violation that one will try to protect themself from.

The sense of violation may become so extreme as to become traumatizing (i.e., being restrained, being injected with medication against your will, being kept separate from your friends and family members during a time of crisis.) This is why I suggest you go the sectioning route only if absolutely necessary. I can't define for you what "absolutely necessary" means but I would suggest that if there is a significant risk of personal or interpersonal violence, it may be necessary. I don't necessarily consider resistance to hospitalization or medication to be an indication that a person is a "danger to themselves" because that resistance may be an attempt to shore up fragmented ego boundaries -- what may actually be a healthy response, not a pathological one.

In my experience, a triggering factor always plays a role in the collapse or fragmentation of the personality structure. Sometimes this trigger is easily seen and understood (which is why I asked what else has been going on in your boyfriend's life). Other times, it's deeply buried and the sometimes seemingly small incident that serves as the trigger on the surface only symbolizes the deeper anxiety. To a large extent, psychosis is a crisis of identity.

There is a very strong link between stress, trauma and psychosis. If your boyfriend has recently experienced a loss, a trauma, a death it may be helpful for him to begin treatment for that. Typically, that kind of treatment will revolve around forms of psychotherapy. It may involve medication but it likely will not include voluntary or involuntary hospitalization.

The language that we use, the expectations that we have, the fears we contain within ourselves, the behaviors that we express... all of these can impact in a negative or positive fashion upon the human being undergoing this experience. Some individuals are especially skilled in this area. One such individual was John Weir Perry; a Jungian trained psychiatrist who worked with people diagnosed as schizophrenic for over 40 years. At his Diabasis project in the US, 85% of the individuals he worked with recovered from their experience of schizophrenia -- most of them, without medication. Loren Mosher and R.D. Laing were two other individuals who also had good rates of recovery. Yet another individual is Jaakko Seikulla from Finland who also has a recovery rate in the range of 85%. You will probably not be able to find any treatment programs that are modelled upon the success of physicians like Perry, Mosher, Laing or Seikulla because the biological model of psychosis and schizophrenia is the current darling of the generation. However, that doesn't mean you can't learn from their success and attempt to create a treatment program that implements some of their insights.

In seeking out the most effective forms of care for your boyfriend, I suggest you ask any professionals you encounter to share their definition of recovery and to disclose the percentage of patients in their care who actually meet or exceed those expectations. Personally, I would not be willing to work with any professional whose recovery rate was not at least 65% and when I say recovery I mean, full recovery -- no medications, no disturbing symptoms, working, having healthy relationships, re-integrated back into society. The best physicians are the ones who are producing recovery in their patients, but the vast majority fall far below that 65% marker. Only the exceedingly gifted are producing recovery above it.

I'm closing this exceptionally lenghty post with a few links that may be insightful for you. Meanwhile, I urge you to take from this post what has been most helpful to you and to set aside the rest. Best of luck to you and your boyfriend.

[*] Dr. Rufus May: Understanding Psychotic Experiences &amp; Working Toward Recovery

[*] Understanding Psychotic Experiences [Note that this article states that newer atypical medications produce fewer side effects than older ones. It's now understood that this is not true -- they produce different side effects. Whether or not those side effects are better or worse than those that come with older neuroleptic medication is largely a personal view.]

[*] The Role of Metaphor

[*]Dr. Loren Mosher: Guidelines for Treatment of Psychosis

[*] Mental Health Act: UK