This week, the British Psychological Society publishes its 180 page report Understanding Psychosis. Like it's 2000 predecessor, it is a polemic game changer, guaranteed to challenge dogma, wobble professional pride and provoke debate on what we can and can't claim about psychosis. Psychotic experiences, like voice hearing and experiencing persistent, unusual beliefs, are framed here as part of a continuum of experience, a normal variation rather than as radically other. Most importantly, it is a report that gives hope - an emphasis that recovery from distressing psychosis is not only possible, but probable. This hope is crucial, for schizophrenia as an idea still sits in the collective conscious as the archetypal terrifying, irrational, out of control mental condition. This potent notion of schizophrenia is one that trumps any other diagnosis, and colonises the heads of those suffering and their relatives. As psychiatric survivor Sally Edwards writes, "I was labelled with all sorts; eating disorders not otherwise specified, major depressive disorder, borderline personality disorder, schizoaffective disorder and eventually schizophrenia... that was the one that knocked the stuffing out of me completely". We read Sally's hopelessness in what this might mean as she continues, "What was the point in fighting if I was going to be suffering from a lifelong brain disease forever?"

Rest in Link -

Making Space for the Meaning in Madness*|*Dr Jay Watts

Although it is a waste of time to argue with a paranoid patient about his delusions, he may still be persuaded to keep them to himself, to repress them as far as possible and to forgo the aggressive action they might suggest, in general to conduct his life as if they did not exist.”

This quote from Clinical Psychiatry, a hugely influential textbook in the 1950s and 1960s, epitomises the way in which unusual mental states were generally understood for much of the 20th century. Delusions (such as paranoid thoughts) and hallucinations (hearing voices, for example) were of interest purely as symptoms of psychosis, or what used to be called madness.


Apart from their utility in diagnosis, they were deemed to be meaningless: the incomprehensible effusions of a diseased brain. Or in the jargon: “empty speech acts, whose informational content refers to neither world nor self”. There’s a certain irony here, of course, in experts supposedly dedicated to understanding the way the mind works dismissing certain thoughts as unworthy of attention or explanation.

The medical response to these phenomena, which were considered to be an essentially biological problem, was to eradicate them with powerful antipsychotic drugs. This is not to say that other strategies weren’t attempted: in one revealing experiment in the 1970s, patients in a ward for “paranoid schizophrenics” in Vermont, US, were rewarded with tokens for avoiding “delusional talk”. These tokens could be exchanged for items including “meals, extra dessert, visits to the canteen, cigarettes, time off the ward, time in the TV and game room, time in bedroom between 8am and 9pm, visitors, books and magazines, recreation, dances on other wards.” (It didn’t work: most patients modified their behaviour temporarily, but “changes in a patient’s delusional system and general mental status could not be detected by a psychiatrist”.)

How far we’ve come since those days may be gauged by the arrival on Thursday of Understanding Psychosis and Schizophrenia, a report published by the British Psychological Society. Written by a group of senior clinical psychologists (including one of the authors of this blog), together with people who have themselves heard voices, experienced paranoia or received diagnoses such as psychosis or schizophrenia, the report argues that these sorts of problems can be understood in the same way as other psychological conditions such as anxiety or depression.


“Psychotic” experiences are much more common than used to be believed. Until the 1990s, if you had asked a mental health expert what proportion of the population had paranoid thoughts, for example, they would have answered around 1% – that is, the 1% of the population diagnosed with psychosis. But we now know that around a quarter of people experience regular paranoid thoughts. Just like anxiety and depression, psychotic symptoms exist on a spectrum: many people experience them occasionally and without causing distress; a few people are affected regularly and severely.


What this means is that we need a treatment model for psychosis that doesn’t consist solely of medication. This isn’t to say that the drugs don’t work: for many people they make a positive difference. But for many others the side effects are so unwelcome that they refuse to take the pills.


Moreover, though the precise biological mechanisms are uncertain, we do know that environmental factors – particularly trauma, abuse or deprivation – often play a significant role in psychotic experiences. Research has also found a strong link between psychological processes – the way a person thinks, feels and behaves – and whether they experience delusions and hallucinations. In other words, what happens to people in their lives, and the way they respond, can determine whether or not they experience delusions and hallucinations.


As such, clinicians cannot simply dismiss psychotic experiences as the deranged ramblings (“empty speech acts”) of mentally ill people, but instead must sit down with the individual and try to work out what lies behind their problems.
Research has suggested that cognitive behavioural therapy (CBT) and other psychological therapies – so-called “talking treatments” – can often be beneficial. Indeed the National Institute for Health and Care Excellence (Nice) recommends that they should be made available to everyone diagnosed with psychosis or schizophrenia.


The reality, however, is very different. In a 2012 report – pointedly entitled The Abandoned Illness – the Schizophrenia Commission noted: “We were particularly concerned about the lack of access to CBT and other psychological therapies which are recommended in the Nice guidelines and can be very valuable in helping people deal with the impact of symptoms and in keeping them out of hospital … Only 1 in 10 of those who could benefit get access to true CBT (Cognitive Behavioural Therapy) despite it being recommended by Nice”. NHS figures suggest that in only 3.4% of care spells for psychosis is the patient even given an appointment with a psychologist, let alone a course of treatment.

People with these problems also tend to suffer from severe anxiety, depression and sleep problems, all of which often fuel their psychosis. CBT has a proven track record with these relatively common problems, but again the therapy is rarely used to treat patients experiencing psychosis. (Ironically, in 1952 the first published paper by Aaron Beck – the “father of CBT” – applied a cognitive approach to delusional belief.

For all that, these are relatively early days for CBT as a treatment for psychosis. This kind of therapy isn’t right for everyone. But as we deepen our understanding of the psychological processes involved in these experiences, the treatment we can offer will become much more powerful. The development of CBT for anxiety disorders provides a model: initial efforts produced moderate benefits, but when subsequent theoretical advances were translated into treatment, huge steps forward resulted.


We need to follow a similar process for the treatment of delusions and hallucinations. There’s a lot of work going on right now, including two pilot schemes under the NHS Improving Access to Psychological Therapies scheme, but much more research is needed. Evidence-based talking treatments need to be urgently and thoroughly embedded in the mental health system.

In Understanding Psychosis and Schizophrenia, a patient called David Strange reveals just how much of a difference psychological treatments can make: “In February last year, 10 years since being diagnosed, I finally started psychological therapy treatment … The difference CBT has made is amazing – it has really transformed my life … The only thing I regret is that I didn’t have access to it sooner – it could have prevented a lot of suicide attempts and I wouldn’t have felt so awful for so long.”

Delusions and hallucinations may be the keys that unlock psychosis | Daniel and Jason Freeman | Science | The Guardian

Full BPS Report Here -

https://www.bps.org.uk/system/files/...h_nov_2014.pdf

& a critique -

https://theconversation.com/is-schiz...-illness-31818

[SmileHere]

Interesting! I'm glad they seem to be looking at it in more holistic ways!

And I'm glad they recognize some people do not want to take meds forever... I wonder how much Rufus May and the others had to do with this?

[likewater]

Wow. It's like they recognize people with schizophrenia are people that can benefit from being treated like people. what a concept. How many years did this take?

Originally Posted by likewater

Wow. It's like they recognize people with schizophrenia are people that can benefit from being treated like people. what a concept. How many years did this take?

Well, there has always been those people who have - From Tuke to Jung to many others. For as long as there has been barbaric treatment, there has been those trying to introduce a humane system of treatment.

Personally i think it's going to take another 200 years still before there is a genuinely humane system/treatment of the 'mad'.

This article/report is something - But there is the usual reams of articles & people contesting it.

https://altmentalities.wordpress.com...rry-psychosis/

When the Dream becomes Real -

www.global-vision.org/papers/JWP.pdf

John Weir Perry & Diabasis -

spiritualrecoveries.blogspot.co.uk/2006/05/dr-john-weir-perry-diabasis.html

The Far Side of Madness, by John Weir Perry.

Book review by Rob Couteau -

www.tygersofwrath.com/psychosis.htm

Book List -

The Far Side Of Madness
Trials of the Visionary Mind: Spiritual Emergency and the Renewal Process
Roots of Renewal: Meaning of Psychotic Episodes
Lord of the Four Quarters: Mythology of Kingship (Jung & Spirituality)
Self in Psychotic Process, The: Its Symbolization in Schizophrenia (Jungian Classics Series)
Heart of History: Individuality in Evolution (Suny Series in Transpersonal and Humanistic Psychology)

Read more: John Weir Perry | Healing Sanctuary

[Axiom]

I think I've read somewhere that 80% of all the cases of schizophrenia can be accounted for by genes, which makes the progression of schizophrenia almost unavoidable (at least with current treatment options). At any rate I don't think you can understand schizophrenia well if you say it's a mainly psychological disorder like most cases of anxiety and depression, so I think they're over-emphasizing the psychological part here. But apart from that this was a good read, and I completely agree with what they're saying about therapy. Thanks!

PS: I have no doubts that what I have is more of a brain disease than a psychological disorder. Not saying it's like that for everyone though.

Originally Posted by Axiom

I think I've read somewhere that 80% of all the cases of schizophrenia can be accounted for by genes, which makes the progression of schizophrenia almost unavoidable (at least with current treatment options). At any rate I don't think you can understand schizophrenia well if you say it's a mainly psychological disorder like most cases of anxiety and depression, so I think they're over-emphasizing the psychological part here. But apart from that this was a good read, and I completely agree with what they're saying about therapy. Thanks!

PS: I have no doubts that what I have is more of a brain disease than a psychological disorder. Not saying it's like that for everyone though.

Personally i don't see an either/or - physiology & psychology (mind/brain) are interrelated/interdependent. So too imo is environment.

So much i think depends upon what models & understandings of reality & the self we're using.

The materialist model is currently very popular, especially with the mainstream.

i wouldn't deny that all kinds of stuff can go on at a brain level - some psychotic states i would see as regressive & primarily concerning brain function. But to me it isn't the full picture - especially regarding the areas of consciousness.

[Axiom]

Originally Posted by Apotheosis

Personally i don't see an either/or - physiology & psychology (mind/brain) are interrelated/interdependent. So too imo is environment.

So much i think depends upon what models & understandings of reality & the self we're using.

The materialist model is currently very popular, especially with the mainstream.

i wouldn't deny that all kinds of stuff can go on at a brain level - some psychotic states i would see as regressive & primarily concerning brain function. But to me it isn't the full picture - especially regarding the areas of consciousness.

I think we pretty much agree on this.
I am aware that psychological and biological are not opposites. I studied psychology in university. I see that I wasn't very clear in my post though.
My mind is slow this morning, so please excuse my shortness. Was going to write more but can't find the right words.

Originally Posted by Axiom

I think we pretty much agree on this.
I am aware that psychological and biological are not opposites. I studied psychology in university. I see that I wasn't very clear in my post though.
My mind is slow this morning, so please excuse my shortness. Was going to write more but can't find the right words.

i think the thing is that no one fully knows? It's all theories & conjecture. There is evidence for an aspect of genetic/development causes in the psychoses - we also have epigenetic & brain plasticity phenomena, as well as all the current theories on brain/mind & the different understandings on the nature & workings of the brain. i think the current knowledge within the entire field of genetics is just scratching the surface - related to how genes effect the brain & in relation to consciousness, & we get into some very complex areas.

i'd like to see a genuine integration between different understandings & models of reality. i don't see the contradiction in seeing the psychoses as integral/multifaceted conditions, involving a spectrum of areas, across biological, psychological/emotional, social/environmental & spiritual/transpersonal ranges.

i think we need a far broader, integral & comprehensive model around it all.

The various polemics around it all from different groups gets tiresome.

Originally Posted by Axiom

I think I've read somewhere that 80% of all the cases of schizophrenia can be accounted for by genes

i'm currently reading a book by a well respected psychiatrist/neurologist - who cites 10% of cases of schizophrenia in which he considers the primary aetiology is genetic/brain developmental - not negating physiological aspects within other cases.

He also takes a more integral view - But is also very much coming at things from the orthodox as well.

The book is from 1994 - so may well be dated - i'm not up or well read on current neurological/genetic theory/research, concerning psychosis/schizophrenia - other than the general press release articles. & i take serious issue with primary 'materialist'/biomedical (brain is mind) assumptions.

[Axiom]

Originally Posted by Apotheosis

i'm currently reading a book by a well respected psychiatrist/neurologist - who cites 10% of cases of schizophrenia in which he considers the primary aetiology is genetic/brain developmental - not negating physiological aspects within other cases.

He also takes a more integral view - But is also very much coming at things from the orthodox as well.

The book is from 1994 - so may well be dated - i'm not up or well read on current neurological/genetic theory/research, concerning psychosis/schizophrenia - other than the general press release articles. & i take serious issue with primary 'materialist'/biomedical (brain is mind) assumptions.

That's really interesting!
However, as I said about my mind - not top notch today, I think what I said was incorrect. I don't think the 80% I read about and this are necessarily contradictory. Please forgive crappiness of the following sentences:

What I read about was an answer to the question "how much can you explain with genes", i.e. not 80% of cases are explained completely by genes, but genes account for 80% of the variation. It's what's called heritability in psychology. Most or all cases are best explained by a combination of genetic and environmental factors. And also, even though 80% of the variation (hope I got it correct this time) could possibly, assuming that number is correct, be explained by genes, that doesn't mean that environmental factors aren't more important. It could be that all cases of schizophrenia could be prevented by changing the environment for those who are at risk. So it's not a static number. Heritability is a difficult concept and I doubt I did it justice in this paragraph so feel free to correct me. It's been a while since I read about heritability so I reckon some of what I've written here might be incorrect.

I hope this is more correct than what you quoted from my first post here. Because that was obviously incorrect. Sorry if I have confused anyone with my contradictory statements.

For those who are interested, this is just a google search I did but the top results seem like good sources. I see It's also mentioned on Wikipedia:
Click for Google

[Sometimes psychotic]

I've seen numbers from 30-80% for the genetic basis but it's a lot more complicated than that. The most recent studies that see sz as between 8 and 40 different illnesses and not one thing suggest that with some gene combinations you have nearly 100% chance of developing sz. That really suggests that there is a very strong genetic basis for some people as opposed to environmental factors but accounts for the fact that everyone has a different experience.

[Sometimes psychotic]

http://ajp.psychiatryonline.org/doi/....2014.14040435

This is the paper if you have access to it...

Originally Posted by Axiom

What I read about was an answer to the question "how much can you explain with genes", i.e. not 80% of cases are explained completely by genes, but genes account for 80% of the variation. It's what's called heritability in psychology. Most or all cases are best explained by a combination of genetic and environmental factors. And also, even though 80% of the variation (hope I got it correct this time) could possibly, assuming that number is correct, be explained by genes, that doesn't mean that environmental factors aren't more important. It could be that all cases of schizophrenia could be prevented by changing the environment for those who are at risk. So it's not a static number. Heritability is a difficult concept and I doubt I did it justice in this paragraph so feel free to correct me. It's been a while since I read about heritability so I reckon some of what I've written here might be incorrect.

i'm not saying there isn't a physiology/biology to these experiences/conditions, but i think it can be very over egged, especially concerning genetics & brain theory.

Something just doesn't gel with me concerning biomedical psychiatry, & it's explanations, & never has. Possibly because i feel it doesn't really explain/fit very well with how i perceive my own experiences, i'm not exactly sure? Some people seem to find a lot comfort & satisfaction within the current orthodox/mainstream paradigms - i don't.

http://www.nytimes.com/2010/01/10/ma...anted=all&_r=0

[Axiom]

Originally Posted by Apotheosis

i'm not saying there isn't a physiology/biology to these experiences/conditions, but i think it can be very over egged, especially concerning genetics & brain theory.

Something just doesn't gel with me concerning biomedical psychiatry, & it's explanations, & never has. Possibly because i feel it doesn't really explain/fit very well with how i perceive my own experiences, i'm not exactly sure? Some people seem to find a lot comfort & satisfaction within the current orthodox/mainstream paradigms - i don't.

http://www.nytimes.com/2010/01/10/ma...anted=all&_r=0

Just want to say that I wasn't trying to argue with you. Hope my post didn't read like I was disagreeing with you.

I do believe my illness is mainly due to genes and other physiological factors like head injuries, not my social/psychological environment. My environment has been pretty good my whole life, and I have had plenty of protective factors. But the schizophrenia didn't care about that. Also, I find it very difficult to believe that many of the things I struggle with are more psychological than biological in nature. Like the fact that I can't feel joy when thinking about future or past, which I was perfectly able to do before I got ill. Or the fact that every time I quit my medicines I lose myself completely in a cycle of very predictable mood swings and delusional behavior. This happens with or without the presence of external or internal triggers, and it never stops, even if am completely without meds for many months. And before I suddenly got ill, my life was really good. I was happy and functioning well psychologically. Those are some of the reasons why I do not believe that my schizophrenia was caused by psychological issues, but there are more.

I think this is very individual. For some it is more biological in nature, for others more psychological. But there's no shame or comfort for me in either of the explanations.

Originally Posted by Axiom

I think this is very individual. For some it is more biological in nature, for others more psychological. But there's no shame or comfort for me in either of the explanations.

i feel you need to go with whatever explanations you are drawn to & that make sense to you. Nothing makes full sense to me in relation to it all, i can see some truth in all the different perspectives, & yet i don't have categorical answers. i see a mystery in madness.

For various reason i think the primary aetiology in the majority of cases is psychogenic, but that is my personal opinion.

Hope you don't mind a bit of debate - i think it's healthy.