Rethinking Madness - MENTAL HEALTH reset

This incredible book written by my good friend and psychologist Paris Williams (Phd) totally changes the current thinking about mental health, psychosis, and the way the west could view it, and treat the individual struggling with it. As the sub title states Rethinking Madness moves the reader "towards a paradigm shift in our understanding and treatment of psychosis". I wanted to give an overview of some of the research and psychological models that allowed Paris to come up with his model then reinforce that none of us can escape struggle in our life's. Embracing it, working through it with understanding, and not trying to mask it with quick fixes may be what our society needs to fully heal then live in more harmony. 

Over the last century and billions of dollars later the research still can not show any substantial evidence that many of the psychiatric disorders are actually caused by brain disease. No biological markers or physiological tests that can be used to diagnose schizophrenia have been found.  Through the weaving of six case studies throughout the book Paris shows that FULL recovery is not only possible but surprisingly common when other treatment methods are put in place outside the traditional western medical model. The information that I found most disturbing was that patients diagnosed with a psychiatric disorder and told they had a brain disorder (requiring life long medication) were much less likely to recover than those in some of the poorest nations on earth. In these places they were treated with a far more holistic model of care. One of the most damaging consequences of the West's medical model is the dehumanisation, stigma, and general hopelessness when people are labelled with a "mental illness".  Long term use of antipsychotic medication within the current medical model has been shown to cause more harm than benefit in many cases. The stories woven within this show that people who recover from psychotic episodes undergo a "profound positive transformation".

It has been written that sometimes people going through a supported psychotic episode may be helpful in reordering the way the world works, not only re framing how the individual functions. An example of some well known people throughout history that have contributed in this way is Sir Isaac Newton, Joan of Arc, Vincent van Gogh, and Black Elk of the Sioux (he had a shamanic illness in his youth helping his people intergrate with the Europeans), Virginia Woolf, Carl Jung, and John Nash (winner of the 1994 Nobel Memorial Prize in economic science). If you get a chance check out the movie "Beautiful Mind". 

"The goal of the recovery process is not to become normal. The goal is to embrace our human vocation of becoming more deeply, more fully human...to become unique, AWESOME, never to be repeated human being that we are called to be." Patricia Deegan

The Agnews Hospital Study

All participants were in the hospital for an average of 6 weeks and were checked on at regular intervals over the 3 years. Rappaport (head of the research group) found that over the first 6 weeks the members of the group on the medication did significantly better (this has been replicated in numerous other studies). However within a short time the participants not taking the medication fared significantly better. After 3 years the group on the placebo and no medication after were doing by far the best (only 2 out of 24 rehospitilisations) and the two groups still taking the meds were quite clearly the worst (16 out of 24 readmission for the group on the meds during and after the initial hospital stay). Rappaport concluded that those that never received the medication "showed greater clinical improvement and less pathology at follow up, fewer re-admissions, and less overall functional disturbance in the community than other groups of patients."

WHO studies

These studies including a 15 and 25 year longitudinal study have shown that people suffering from schizophrenia in developed countries have far worse outcomes than those who live in "so called" developing countries such as India, Nigeria, and Colombia. It makes interesting reading that the use of antipsychotic medication is inversely correlated with good recovery outcomes. The patients in rural Chandigarh, India showed the highest rate of complete remission (71% shown no psychotic symptoms within 2 years of the final follow-up, and 79% assessed with good to very good overall functioning).

The open dialogue approach that takes place in Finland doesn't involve residential space but incorporates freedom of patients with an expectation of full recovery within an environment that creates safety, empathy, and authentic interpersonal interaction. 5 years following initial diagnosis 86% of members of the programme had returned to work or education, and 82% were assessed as fully recovered (didn't have any residual psychotic symptoms, and were not on any psychiatric drugs). 

One conclusion that could be made of the current medical model in treating schizophrenia and psychosis is that it contributes further to brain malfunctioning and very likely reduces the rates of recovery. The research also shows that when people are supported in a compassionate and empathetic environment psychosis often resolves automatically. 

John Weir Perry (A Carl Jung orientated psychiatrist) has more than 40 years of experience of working with psychiatric patients. He referred to a theoretical framework of a psychotic episode as "the renewal process" made up of the same stuff that seers, visionaries, cultural reformers, and prophets go through. Perry theorised that conclusion is not the result of damage or impairment but is "actually initiated intentionally by the unconscious psyche (although not wanted or invited!)". He stated "when a person finds themselves in a state of acute distress, in circumstances that have assailed their most sensitive  vulnerabilities the psyche may be stirred into an imperative need to re-organise the self." In other words I take this as when too much is going on to handle within your capabilities your system shuts down to allow a defrag. Much like an overloaded computer. This can happen with a sharp sudden trauma or chronic long term stress.

Perry discussed an aspect of the renewal process that was more expansive with the health of society as a whole - once an individual has gone through a profound reorganisation of their inner culture they sometimes emerge with a vision of how our culture should be organised in order to continue it's existence. In Western society we try and STOP this process to return them to normal as quickly as possible, compared to more "spirituality aware" societies in which people are met with more respect and validation. 

Arnold Mindell has developed a framework he named the Process Paradigm (Process Orientated Psychology). The main points are that we all have both PRIMARY and SECONDARY processes operating within us at all times. The primary process is what we most presently identify with and the secondary processes are background processes which we identify the least, some of which we are not even fully conscious (Carl Jung names this as the shadow). The feedback loop is how we process information from our environment so we can modify our own behaviour and beliefs to "fit in". Mindell suggests we all have filters modulating our individual feedback loops, and we all have blind spots that often self serve us in minimising information that might be uncomfortable/painful or difficult to integrate into our worldview. The "metacommunicator" (observing ego) is that part of us that is detached from the experience and gives us more pro-activity than reactivity to situations. This access is hampered by intense fear, or anger. Meditation helps give us more space around making better reactions to situations. Allowing more reasoned and thought through pro-action compared to poor reaction with no space or time to think rationally. Mindell talks about the "flipping" our primary and secondary processes (the metacommunicator usually stops this from happening) This flipping could help explain dramatic personality changes when the metacommunicator is weak (intoxicated with alcohol, drugs, overwhelmed by strong emotions)

Isabel Clarke (researcher and a clinical psychologist) has created a cognitively (Cognition is the mental processes involved in making sense of the world via perception, thinking, interpreting, and reasoning) orientated model of psychosis that is a result of an imbalance in our view of the world. Clarke talks about psychosis, spiritual experiences, and even large social movements like revolutions come about from a shift or discontinuity of consciousness. John Teasdale and Phillip Barnard put forward the Interacting Cognitive Subsystem (ICS) model. This is the different modes of information processing (sight, hearing etc) are managed by 2 overarching "meaning" making systems 

1) Propositional subsystem (logical mind, concerned with external world, language/words/symbols - correlated with neocortex) 2) Implicational subsystem (emotional meaning and holistic perception, more the inner world, concerned with worth of self and threat to our position or survival - sees the world as more interconnected. Thought to be linked to older and deeper regions of the brain). 

Clarke talked about our establishment of our sense of self will protect against transliminal (mystical or psychotic) experiences (a temporary life enhancing, spiritual event or a damaging psychotic breakdown). She suggested the role of religion (which can be described as a cultures way of putting spiritual matters into an understanding framework) is to keep us connected with this holistic mysterious, interconnected realm. However by concentrating on the fate of the individual soul rather than on our interconnection with a greater whole our modern religions are letting us down, letting the technology born of our "ferocious power to discriminate and to bend the material world" to our will, taking us to the point where the sustainability of our species is on the brink.

Existential - fundamental dilemmas which we all face as living conscious beings - finding meaning, joy, purpose, minimising suffering. 

Otto Rank (1884-1939) was a student of Sigmund Freud for 30 years before forming his own ideas in the late 1920's. In 1936 he published an essay "Will Therapy" where he first floated his idea that the core of all fear is a dynamic dialectical (tension existing between two opposing forces) system between 2 poles, one LIFE FEAR (fear of living as an isolated individual - autonomy), and the other DEATH FEAR (fear of loss of individuality - fusion) which is when you lose your sense of self by being engulfed my too much merger and connection. Rank suggested that we find ourselves bouncing between the two poles seeking middle ground that we can tolerate at any one moment in time. Rollo May (1909-1994) used Ranks work an a foundation for his own formulatioin of psychosis. He talked about the dialectecal relation of the individual and their community. On one hand people want to find their own uniqueness, authenticity, or sence of agency. On the other the individual wants to experience love and belonging. If either state is hampered then it can lead to psychological conflict and neurotic anxiety results.

Ernest Becker (1924-1974) wrote the Pulitzer Prize winning book The Denial of Death. "Our deepest need is to be free of the anxiety of death....but it is life itself which awakens it, and so we must shrink from being fully alive." We then find ourselves being afraid to die, but also fearful of really living. According to Becker this is the price we pay for being human.  In 1999 Kirk Schneider created another version of the 2 pole theme - defining the 2 poles as "constriction" or "expansion" and talking about our fears coming from the "dread of ultimate constriction" (isolation/alone/no purpose) and the "dread of ultimate expansion" (losing your self, chaos, lost in the world with no grounding). 

Paris Williams (the author and good friend of mine) has developed an integrative and comprehensive model for psychosis - it's a Duality/Unity Integrative model (DUI model for short). Some of the other models that have been developed have the "2 pole" theory. Basically one pole of individually or autonomy and the other community or greater connection with others and the natural world. Having a "healthy" sense of self and your purpose allows a "healthy" interaction with others/community/the world. Moving too far in one direction (either getting isolated OR losing yourself in others or the world) creates an imbalance that can lead to dis-ease and ultimately a break down of some sort. Existentially orientated thinkers in the East have been looking at different ways of explaining this 2 pole system for over 2500 years. Practitioners of Hinduism, Taoism, and Buddhism have discussed the "principle of fundamental interconnection". The DUI model unpacks the constant "dance" of experiencing life, experiencing duality - that is SELF (separate from the world), and UNITY (interconnected with the rest of the world). This "dance" between the 2 poles is dynamic - affected by ever changing conditions within us or the external environment. If we move to far towards SELF we can feel isolation, and if we move to far towards connection we may feel engulfed. As other psychologists have stated "we spend our lives in a tug of war between these two states trying to find our "window of tolerance" (WOT).

I have heard many people describe life as a dance. I tell all my physiotherapy and coaching clients that motion is lotion, especially moving in nature - and what is good for the body is good for the mind and soul. Our bodies, minds, and soul exist meshed together. I have written about how getting to know yourself as the awesome one and only NEVER to be repeated YOU (ignoring the trappings of a materialistic, consumeristic, label giving, box fitting society), then coming to understand that we are all connected - not only with each other, but with the millions of other ecosystems within our home (with a life giving force flowing through it all - name this what you want, God, the force, Universe etc)  that we all share - the beautiful planet Earth. Growing to know this is completing the circle of understanding. Not acting in accordance with protecting our life support system while allowing each other to thrive within our windows of tolerance is a dilemma creating an environment for dis-ease and dysfunction. The many constructed systems that we operate under are completely broken. It's like everyone is looking for the answer to a question and finding out the question is not relevant. We need a completely different question - and completely different systems.  Treating others and everything empathically (understanding that they are here with us and ultimately for us) who are struggling with coming to terms how they might fit back in with a system that is not working could be the answer to not only saving them, but allowing them to defrag then reconfigure helping find the right questions to ask to change our systems to save our world. 

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