Monday, July 21, 2014

Free Online Training Module Using Normalizing Within CBT for Psychosis


Ron Unger is a licensed cognitive behavioral therapist whose understanding of psychosis I greatly appreciate and admire. His writing has helped me enormously in "normalizing" the way I think about my own relative, calming ME down, and increasing MY hope for my son's recovery. Ron has recently created an online course in "how to talk to people with psychotic experience in a way that allows them to calm down, feel more grounded, access coping skills, and increase hope for recovery." His course was designed with professionals in mind, but it is also open to service users, ex service users or survivors, and family members.

  • Free Online Training Module Using Normalizing Within CBT for Psychosis

  • Use the link above to signup to get access to a free online training in how to talk to people with psychotic experience in a way that allows them to calm down, feel more grounded, access coping skills, and increase hope for recovery. By signing up here, you will also be added to an email list to be notified about upcoming events like the release of the complete online training in CBT for Psychosis, which will include CE credits for US professionals. You can unsubscribe from this list at any time.


Please read more about the background for this course. I have reprinted an excerpt from Ron's Mad in America post below. (If the link above doesn't work, there is further information in the comments section of Ron's post.)

How Can Professionals Learn to Reduce Fears of Psychotic Experiences Rather Than Emphasize Pathology?

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July 19, 2014

The kinds of experiences we call psychotic are often incredibly scary: people feel they are being persecuted by strange forces, or that their brains have been invaded by demons or riddled with implants from the CIA . . . the list of possible fears is endless, and often horrifying.
While standard mental health approaches counter many of these fears, they often create new fears of a different variety.   People diagnosed with schizophrenia for example may be led to believe that they will definitely be mentally ill for life, that this illness controls what happens in their brain and not themselves, and that there are few or even no alternatives if drugs don’t work for them.
This can be extremely demoralizing.  Oryx Cohen graphically described his own reaction to the standard mental health psychoeducation he received after his first psychotic experience:  he reported it made him feel he had lost his membership in the human race!  As a result of it, he felt caught up in a pathologized understanding of himself, he lost his expectation of being capable of learning from experience and shaping his future, and he now felt defined by his abnormality rather than by his humanity.
Despite − rather than because − of what the mental health system taught him to believe, Oryx later discovered other ways of understanding his experience, and he made a full recovery.  But wouldn’t it be better if people like Oryx were helped to find a more humanistic understanding of themselves within the mental health system and from the very beginning of treatment?
Wouldn’t it be helpful if professionals were trained in an approach that could help people shift away from both dangerous psychotic ways of thinking and also away from the sometimes equally terrifying explanations which emphasize pathology?
Further, what if such an approach could also build a foundation for learning effective coping skills, and also help a person build hope and a road map toward a possible full recovery?
And wouldn’t it be nice if this approach was already proven to be “evidence based,” so that both people learning the methods, and their supervisors and colleagues could have confidence in its effectiveness and safety?
Fortunately, at least one such approach exists, and it is called CBT for psychosis.  This method allows professionals to collaborate with people in developing understandings of their psychotic experiences that neither minimize problems nor emphasize pathology, but instead help make sense of extreme human experiences in a way that is grounded in more everyday human experience and issues.
Read the rest here.

Monday, July 7, 2014

People never change because they are happy

Torn from easyJet's latest in-flight magazine issue, an interview with Serbian performance artist Marina Abramovic:

You're known for doing crazy stuff, but your latest piece is just you in a room for eight hours a day, six days a week. What's happening?

"After 40 years of being an artist, I really want to see if I can work with just energy. It could fail, so I guess that's why it's worth doing. I've never been in a space where there is nothing."

What do you hope to achieve?

"People are so lost these days, there's a need for this transmission of energy at the moment. They are full of so much pain and direct contact with an artist is not there. Artists become celebrities and are untouchable."

How can you do this by saying and doing nothing?

"We can alert our powers of telepathy. For the past year, Russian and American scientists have measured my brain waves. They have proved that when you're looking at a total stranger, without saying one word, you're sending subconscious information to each other. So you can actually know more about somebody without saying one word than while having a conversation. It's cheaper than a telephone."

In past performances, you've cut yourself, taken drugs and allowed strangers to hurt you. Why?

"Terrible events can make tremendous change, like terminal disease, an accident, someone from your family dying. People never change from happiness. I'm not waiting for this kind of event. I'm staging difficult situation in the form of the performance."

Louise Gillett

Louise Gillett is a writer and creative talent behind the blog Schizophrenia at the School Gate. No, wait, she's not just a writer, she's an excellent writer and she's got a wonderful way of explaining "schizophrenia" from the point of view of her older and wiser self. She writes about her insecurities in a way that I find delightful and insightful.  I got Louise's permission to reprint her latest musings on social anxiety because I think what she's saying can give parents hope in recovery.

Here's just a snippet:

"About me.  Well, I am normal (we have established that.  Or haven't we?!) but I was diagnosed with schizophrenia as a young person and that still affects my perception of myself.  I feel quite strongly that this label is wrong - not for me in particular, but for everyone who is afflicted with it.  Because anyone can suffer emotional distress for a variety of reasons (there always are reasons) and anyone can break down - and anyone can also recover.  But the label of schizophrenia doesn't allow for recovery - even if, like me, you haven't had to take medication for twelve years and you have no symptoms of mental ill-health (social anxiety is not schizophrenia). 

Which means that those people who do recover - which is more than you would think - stay very quiet about the fact that they were ever diagnosed.  Which gives the others with the same label - and people are still being given this label today - very little hope for their own futures. " 

Read the rest of Louise's post here

Monday, June 23, 2014

Next Recovering Our Families course starts in August

Recovering Our Families

“Recovering our Families” introduces families to key recovery principles, leaders, research and resources that are person- and family-centered, trauma-informed and strengths based. This interactive, facilitated online class combines emailed lessons with recovery exercises, videos, online resources and a password-protected website with private facilitated group discussions and peer support. The “Recovering Our Families” course was written by and is facilitated by Krista MacKinnon with the help and support of Family Outreach and Response Program in Toronto Canada, and The Foundation For Excellence in Mental Health in Oregon, USA. If you’re not registered in the class, learn more about it hereNext class begins August 29th, registration will be open soon.

A list of warmlines by state

Warmline logo
A warmline is a peer-run listening line staffed by people in recovery themselves.
Scroll down to see a directory of known warmlines around the US.

Information on peer-run respite nationwide.
Other peer-run respite programs to go to:
Another directory of warmlines:
http://www.mhselfhelp.org/warmlines-index/

Metro Boston Recovery Learning Community (MBRLC) recent Peer Warmline feature in the SAMHSA Recovery to Practice weekly newsletter 11/12/10.
Warm line featured in the Boston Globe on February 5, 2009! (Article written before our collaboration with NERLC and the expansion from three to six days a week.)

Article about the Metro Boston Recovery Learning Community warmline by Carey Goldberg

The Warmline Guide is now live at:
http://www.power2u.org/peer-run-warmlines.html

To search for Warmlines by state, click on a state in the list below.

(Note: Warmlines listed in red are nationally accessible and welcome calls from anywhere)

Thursday, June 19, 2014

The Secrets They Kept: The True Story of a Mercy Killing that Shocked a Town and Shamed a Family



An intriguing quote in this book puts the secrets of the Levin family tragedy in perspective:

"Secrets are like stars. They blaze inside the heart and ultimately could be explosive. But there are two types of secrets. Small secrets, like small stars, will eventually burn out. With time and space they lose their importance and simply vanish. No harm done. But big secrets, like massive stars, with time and constant fear grow stronger, creating a gravitational pull that eventually . . . When they get so big, they become a black hole." (Jennifer Jabalay).

A true story, The Secrets They Kept reminds me very much of the family secrets that author Robertson Davies so brilliantly exploited in his novels like Fifth Business and What's Bred in the Bone.

The central question in this book is what could possibly motivate a man to kill his own daughter? Sixteen year old Sally Levin had recently been diagnosed as schizophrenic, and about to be institutionalized. Sam, her father, told the court that he wanted to relieve her suffering and she had begged him to do it. Sam's granddaughter, Suzanne Handler, leaves no stone unturned considering plausible answers where very little family history is available. Her aim in writing the book is to give Sally her rightful place in the family and to expose the consequences of the stigma surrounding mental illness. What I see when I read this book is all that and more. This is a family psychodrama acted out over multiple generations. At the end of the book, the author writes about how hidden secrets estranged her from her mother (Sam's daughter), reminding me of Swiss psychiatrist Carl Jung's observation, "Nothing has a stronger influence psychologically on their environment and especially on their children than the unlived life of the parent."

My review of this book draws on shamanistic beliefs that form the basis of Family Constellation Therapy popularized by ex-Jesuit priest Bert Hellinger. My family participated in Family Constellation Therapy that was precipitated by a diagnosis of schizophrenia in my son.

The Hellinger Institute of Northern California website explains that "A Family Constellation is a three-dimensional group process that has the power to shift generations of suffering and unhappiness. Bert Hellinger, the founder of this work, who studied and treated families for more than 50 years, observed that many of us unconsciously "take on" destructive familial patterns of anxiety, depression, anger, guilt, aloneness, alcoholism and even illness as a way of "belonging" in our families. Bonded by a deep love, a child will often sacrifice his own best interests in a vain attempt to ease the suffering of a parent or other family member. Family Constellations allow us to break these patterns so that we can live healthier, happier, more fulfilled lives. In a moment of insight, a new life course can be set in motion. The results can be life-changing." 
(http://www.hellingerpa.com/constellation.shtml)

From a Family Constellation Therapy perspective, there are probably two or more tragedies in the Levin family history, one buried in the history before the family immigrated to America, and the one at hand. We suspect this because of Sally's status as a black sheep and her diagnosis of schizophrenia. Sally embodied something about the Levins that they feared about themselves. She was their mirror.

Author Suzanne Handler has stunned me by fearlessly and compassionately shining a light on her own grandfather and his immediate family in order to bring respect and honor to her long dead and forgotten aunt Sally. She leads the way in showing others how compassion and forgiveness are important in even the most awful circumstances. She's done what Family Constellation Therapy would advise her to do for the sake of her own healing and for those of her children and her children's children. She brings Sally to life through this book, she erects a new gravestone bearing the proper spelling of Sally's name, and she forgives her grandfather.

Amongst other things, this book is a truelife crime story so I'll put my own thoughts on the table as to what may have motivated Sam Levin to kill his daughter on August 16, 1937.

It is not axiomatic that all parents love their children equally or at all. Some parents have favorites and some have scapegoats. From what little we know about Sally, it appears that Sally was the one who never quite fit in with the family of seven who lived a cramped existence in a two bedroom house. Her break with reality may have been the final straw for an already stressed family. Anyone who has lived with a family member who is actively psychotic knows how high tensions can run. The psychotic person is alternately feared, criticized and ridiculed by other family members who haven't a clue how to help their relative. Or, in trying to be compassionate, families often project worry and instill learned helplessness in their loved one. (There are books and courses available today that teach people how to diffuse the stress and uplift the person, but this kind of knowledge was little known then and only somewhat better known today.)

This (purely speculative) abuse may also have been a longstanding pattern in the Levin household when it came to Sally who was strikingly different from the others, being two shades darker in complexion. Her family called her "Blackie," underscoring her noticeable difference. Was she the family black sheep or the family "scapegoat"? Shouldn't at least her mother (Sam's wife) have protected her? Surely she must have known something of Sam's plans that day, or at least have had some sort of inkling. Protection is often too big a burden to ask of siblings, who are rivals for their parents' affections. When the deed was done, the family members rallied round their father and perhaps took a vow of silence to not divulge to anyone that Sally was anything other than a beloved sibling. Their shame would have been too great.

Regarding Sam's wife, I thought immediately of the Mrs. Dempster character in Davie's book, Fifth Business. Both were alike in that the townsfolk said they were never right in the head. Mrs. Dempster wandered off one day and took a tumble with a tramp down by the river, to the lasting shame and horror of her pastor husband. Perhaps Sally Levin's complexion gave rise to suspicions on Sam's part that she was not his biological daughter and he treated her accordingly, despite his professed love for her.

What is a scapegoat? In Family Constellation Therapy a scapegoat is someone on the receiving end of a subconscious family process spanning multiple generations. Like the Biblical animal scapegoat, one family member, as a form of atonement, takes the brunt of the collective sins of the community/family and then is forcefully driven away from them. The family honor is thereby restored and the family can point to the scapegoat as the strange one who is not like them.

If one believes that there is some truth to the intergenerational scapegoat theory, then Sam was sacrificing one child for the good of the many. He was unconsciously carrying out his duty to his ancestors, while problematically creating a new burden for future generations of the family.

Did Sam Levin really intend to kill himself along with Sally? I doubt it. It was Sally's idea for him to join her in death, not his. He needed to live to support the rest of his family. He was a dutiful husband, son, and father. His suicide note cleverly introduced the idea that he was insane himself, and destined to go the local insane asylum if he didn't kill himself first. His suicide note says nothing about loving his daughter, nor anything about his daughter, for that matter, other than signing her name at the bottom. He was sane when he killed her. Not even temporarily insane. And yet, I can also imagine him fearing he was becoming temporarily insane because of stress. I've almost been there myself. The label of schizophrenia was enough to push me into a spiraling psychedelic anxiety that if not checked, could have made me temporarily insane. There is nothing I can tell from the story that leads me to believe that Sam loved his daughter, although the investigators came to the conclusion by interviewing relatives and church leaders (all people who would want to protect Sam) that "the defendant was so obsessed with the love for his child that he himself would lay down his life with her." Except . . . he didn't lay down his life for her. This is a psychic anomaly. It seems that he visited her grave many years later, and that shows a certain amount of contrition and respect for her, but love for Sally may not have been the case while she was alive. 

There is another interpretation of Sally's outcast status that comes from Family Constellation Therapy which shows how Sally herself was perhaps sacrificing herself for someone in a previous generation of the Levin family who was denied their right to belong to the family, through an untimely death, a murder, prison or some other form of estrangement. The Levin parents were immigrants from the pogroms of the Ukraine whose known family history was lost along the way. Sally chose to offer herself in atonement for some long forgotten exclusion. She was intuitive to the suffering in the Levin household. She was their mirror.

According to Dr. Dietrich Klinghardt, schizophrenia often has its roots at the fourth (intuitive) level of healing because schizophrenics are particularly sensitive to these familial exclusions or injustices and will act out the role of victim. Dr. Klinghardt maintains that if schizophrenia is not cured at the physical level (level 1), it is usually because the issues lie in the realm of intuition (level 4). According to the Family Constellation theory, the root of schizophrenia is almost always found three or four generations removed from the present. The current family environment isn't directly responsible for the origins of the schizophrenia, but the family is implicated because of the way its members might unconsciously deal in the present with the aftermath of the family event from the past.

On a non-Family Constellation note, I'm of the opinion that it is the original diagnosis of schizophrenia that is a recipe for disaster because it causes people to lose all hope. Sally might well have lived had her doctors not painted such a bleak scenario of her future. This non-medical diagnosis of schizophrenia (there are no biomarkers) and similar mental illness labels should be dropped in favor of empathic treatment of people, not treatment of labels masquerading as diseases.

I highly recommend this book because it shows us how the author explores and attempts to resolve the ominous burdens of her family history.

Sunday, April 27, 2014

Justin Bieber: The new face of positive psychiatric labelling

I went for a walk today with my youngest son Taylor around our neighborhood. We looked at the Nantucket style houses that were recently built and we agreed that, while charming, the blue shingles didn't quite fit in with the rest of the houses on the street, and we mulled over  that was a good thing since they did liven the neighborhood up a bit.

Taylor spotted a kid buzzing around the street on a bike with a Justin Bieber style hair cut, and we both laughed and agreed how much we like Justin Bieber, hair poof and all, because he is clueless and fun (remember his happy mug shot -Yo, check it out - I can't believe I've been arrested!), he acts like many other clueless twenty-year olds despite his fame and fortune, and he's generally nice to people.

We eventually got around to to talking about benzos, celebrity deaths, doctors with boring jobs, and psychiatry. "It seems to me that all psychiatrists do is tell people what's wrong with them," said Taylor. "Why don't they instead start describing people by what's right with them?" Taylor began to warm up to his idea. "Take Justin Bieber. Why not call him "wonderfully expressive and enthusiastic (mug shot)? Or, a true risk taker who likes to test his own limits (excessive drunken speeding in a residential neighborhood). How about just plain "boyish"? (Egging of neighbor's house.) This is a whole paradigm shift. I can't even think of what we would call the Bieb's diagnosis because we are so used to negatives."