Thursday, October 21, 2010

How to stop psychosis

I got permission from Gianna Kali at Beyond Meds, to reprint her post in its entirety. This is a must read for anyone who has just been told they are certifiably crazy, and for those who are there to remind them that they are. (Please send this to a medical student you may know.)

Listening to Psychosis (or other forms of mental anguish)

April 6, 2007

by giannakali

Knowing what I know now about outcomes for schizophrenics, or people experiencing delusions, who are listened to, who are not told their delusions are crazy or wrong–that many of these people who are taken seriously recover, I often wonder what would have happened had someone listened to my (drug-induced) delusions. If it had not been assumed I was crazy–if I had not been coerced into believing I was crazy. What would have happened if I was taken seriously? I will never know, but there is plenty of evidence that had I been listened to and had my psychotic thinking been explored with respect I may have never entered the world of psychiatric care as we now know it. I again remind you of Soteria House.

I might add, that I finally, took myself seriously. Stopped dismissing the “crazy” for meaningless. That was when my healing began.

Below is a story of a woman, not terribly different than me. In fact we shared a common delusion. We were both to be the mother of the second coming of Christ. She was 18, I was 19. She was listened to by a kind clinician and released from the hospital vastly improved. I was belittled, and humiliated and drugged into a stupor. The rest is history.

Here is an account of the story as told by Al Seibert, Ph.D:

When I was a staff psychologist at a neuropsychiatric institute in 1965, I conducted an experimental interview with an 18-year-old woman diagnosed as “acute paranoid schizophrenic.” I’d been influenced by the writings of Carl Jung, Thomas Szasz, and Ayn Rand, and was puzzled about methods for training psychiatric residents that are unreported in the literature. I prepared for the interview by asking myself questions. I wondered what would happen if I listened to the woman as a friend, avoided letting my mind diagnose her, and questioned her to see if there was a link between events in her life and her feelings of self-esteem. My interview with her was followed by her quick remission.This account raises important questions about:

1. the powerful influence of the interviewer’s mind set and way of relating to patients perceived as “schizophrenic,”
2. aspects of psychiatric training and practices that have never been researched,
3. why psychiatrists misrepresent what is scientifically known about “schizophrenia,” and
4. why the psychiatric literature is silent about the personality characteristics of people who fully recover from their so-called “schizophrenia” and the processes by which they recover.

One morning the head nurse of the locked ward reported the admission of an 18-year-old woman. The psychiatric resident who admitted her the previous evening said “Molly’s parents brought her in. They told us Molly claims God talked to her. My provisional diagnosis is that she is a paranoid schizophrenic. She is very withdrawn. She won’t talk to me or the nurses.”

For several weeks the morning reports about Molly were the same. She would not participate in any ward activities. She would not talk to the nurses, her case worker, or her doctor. The nurses couldn’t get her to comb her hair or put on make-up.

Because of her withdrawal and lack of response to staff efforts, the supervising psychiatrist, David Bostian, told the resident in charge of Molly to begin plans to commit her to Ypsilanti State Hospital. Bostian said the university hospital was a teaching facility, not one that could hold patients who need long-term treatment. The staff consensus was that she was so severely paranoid schizophrenic she would probably spend the rest of her life in the back ward.

I decided that since she was headed for the “snake pit,” this was an opportunity to interview a psychiatric patient in a way very different from how I’d been trained in my clinical psychology program. I asked Molly’s doctor, a third-year resident, for permission to administer some psychological tests and interview her before she was transferred to the state hospital. The resident said I could try, although she expected nothing to come of my efforts.

I contacted the head nurse and arranged to meet with Molly the next morning in the ward dining room. At home that evening I prepared myself for the interview with Molly by reflecting on a cluster of the following four issues and concerns:

1. After reading The Myth of Mental Illness by Thomas Szasz (1961), I began to notice that the only time I saw “mental illness” in anyone was when I was at the hospital wearing my long white coat, working as a psychologist. When I was outside the hospital I never thought of anything people said as “sick,” no matter how outrageous their words or actions. I found it interesting that my perception of “mental illness” in people was so situationally influenced.

2. I’d been puzzled about an unresearched, unreported aspect of the way psychiatric residents talked to newly admitted mental patients. At our institute the psychiatric residents were required to convince each of their patients that they were “mentally ill.” I was present in the office of a resident, for example, during a shouting match with a patient….

….As I prepared myself for my interview with Molly the next day, I developed four questions for myself:
1. What would happen if I just listen to her and don’t allow my mind to put any psychiatric labels on her?

2. What would happen if I talk to her believing that she could turn out to be my best friend?

3. What would happen if I accept everything she reports about herself as being the truth?

4. What would happen if I question her to find out if there’s a link between her self-esteem, the workings of her mind, and the way that others have been treating her?…..

….I felt a rapport with her and felt that I could start a conversation. It went like this:

A.S.: “Molly?…(she looks up at me)…I am curious about something. Why are you here in a psychiatric hospital?”

Molly: “God spoke to me and said I was going to give birth to the second Savior.”

A.S.: “That may be, but why are you here in this hospital.?”

Molly: (startled, puzzled) “Well, that’s crazy talk.”

A.S.: “According to whom?”

Molly: “What?”

A.S.: “Did you decide when God spoke to you that you were crazy?”

Molly: “Oh. No. They told me I was crazy.”

A.S.: “Do you believe you are crazy?”

Molly: “No, but I am, aren’t I.” (dejected)

A.S.: “If you will put that in the form of a question, I’ll answer you.”

Molly: (slightly puzzled, pauses to think) “Do you think I am crazy?”

A.S.: “No.”

Molly: “But that couldn’t have happened, could it?”

A.S.: “As far as I am concerned, you are the only person who knows what happens in your mind. Did it seem real at the time?”

Molly: “Oh yes!”
A.S.: “Tell me what you did after God spoke to you.”

Molly: “What do you mean?”
A.S.: “Did you start knitting booties and sweaters and things?”

Molly: (laughs) “No, but I did pack my clothes and wait by the door several times.”

A.S.: “Why?”

Molly: “I felt like I would be taken someplace.”

A.S.: “It wasn’t where you expected, was it!”

Molly: (laughing) “No!”

A.S.: “One thing I’m curious about.”
Molly: “What?”
A.S.: “Why is it that of all women in the world, God chose you to be the mother of the second Savior?”

Molly: (breaks into a big grin) “You know, I’ve been trying to figure that out myself!”

A.S.: “I’m curious. What things happened in your life before God spoke to you?”

It took about 30 minutes to draw out her story. Molly was an only child who had tried unsuccessfully to earn love and praise from her parents. They only gave her a little love once in a while, just enough to give her hope she could get more. She voluntarily did many things around the house such as cooking and cleaning. Her father had been a musician so she joined the school orchestra. She thought this would please him. She practiced hard and the day she was promoted to first chair in the clarinet section, she ran home from school to tell her father. She expected him to be very proud of her, but his reaction was to smash her clarinet across the kitchen table and tell her, “You’ll never amount to anything.”

After graduation from high school, Molly entered nursing school. She chose nursing because she believed that in the hospital the patients would appreciate the nice things she would do for them. She was eager and excited about her first clinical assignment, but it turned into a shattering experience. The two women patients she was assigned to criticized her. She couldn’t do anything right for them. She felt “like the world fell in.” She ran away from school and took a bus to the town where her high school boyfriend was in college. She went to see him, but he told her to go home and write to him. He said they could still be friends, but he wanted to date other girls.

A.S.: “How did you feel after that?”
Molly: “Awful lonely.”
A.S.: “So your dad and mom didn’t love you, the patients were critical and didn’t like you, and your boyfriend just wanted to be friends. That made you feel very sad and lonely.”
Molly: (head down, dejected) “Yes, there didn’t seem to be anyone in the whole world who cared for me at all.”
A.S.: “And then God spoke to you.”
Molly: “Yes.” (quietly)

A.S.: “How did you feel after God gave you the good news?”

Molly: (looks up, smiles warmly at me) “I felt like the most special person in the whole world.”

A.S.: “That’s a nice feeling, isn’t it?”

Molly: “Yes, it is.”

(The kitchen crew came into the dining room to set up for lunch.)

A.S.: “I must go now.”

Molly: “Please don’t tell them what we’ve been talking about. No one seems to understand.”

A.S.: “I know what you mean. I promise not to tell if you won’t.”

Molly: “I promise.”

Two days later I was walking through the locked ward to see another patient. When Molly saw me she walked over and stopped me by putting her hand on my arm. “I’ve been thinking about what we talked about,” she said. “I’ve been wondering. Do you think I imagined God’s voice to make myself feel better?”

She surprised me. I didn’t intend to do therapy, but she seemed to see the connection. I paused. I thought to myself “maybe so, but if there is an old-fashioned God who does things like this, then He is watching! I didn’t care what the other doctors and nurses do, I am not going to give her a rough time. I am going to be her friend!” I shrugged my shoulders. I said, “perhaps” and smiled at her. She smiled back with good eye contact, then turned and walked away.

At staff rounds the head nurse reported a dramatic improvement in Molly. She was now a cheerful, talkative teen-ager. She spoke easily with her doctor, the nurses, and other patients. She started participating in patient activities. She brushed and combed her hair, put on make-up, and asked for nicer looking dresses.

At rounds a week later Dr. Bostian described her amazing recovery as “a case of spontaneous remission.” The plans to commit her were dropped. A few days later she was transferred to the open ward and she did so well the doctors and nurses expected her to be discharged soon. I left the hospital soon after, so I was not able to follow-up. What would have happened to her if I had not taken time to listen to her with an open mind and affirm her reality? The psychiatric staff’s prediction that she was destined to spend many years in the back ward of the state hospital would, most likely, have been validated.

Gianna again:
I don’t know exactly what was going on with me at the time of my psychosis. The circumstances leading to my disturbed thinking may have been very different than Molly’s, but I know that how I was treated in the hospital was incredibly disrespectful and humiliating, much like she was being treated before Seibert interviewed her. One psychiatrist scoffed at me when I told him God had spoken to me. I, too, was threatened with state institutionalization if I didn’t admit I was permanently damaged and didn’t agree to a life-time on meds. I remember the impact it had on me. I felt scalded and deeply ashamed. I exited that hospital with my spirit shattered. I had been an outgoing, confident socializer. I left emotionally immobilized and so insecure that I had difficulty conversing with anyone for a long time after that. A painful insecurity left me stumbling over words and feeling hideously on display for all to see how sick I was. I felt marked, branded for the severely fundamentally flawed person that I was. That mark has stayed with me for two decades. It was not apparent to anyone else for much of those years that anything was wrong with me. I had a full career as a social worker. But I never again felt whole. I never again felt unbranded, normal or healthy. I can’t say I’ve completely recovered from it. I am, just now, beginning to recover as I take my life back from psychiatry. My self-esteem has reached heights I never thought it could in just the last ten months since I began to question psychiatry and how I was treated.

We don’t know what happened to Molly. She may have gone back into an oppressive situation and relapsed. She may not have had another clinician who treated her respectfully. That is what happened to me. I was continually told I was sick by everyone who had any influence on me–family and doctors–and needed to comply with oppressive and disrespectful treatment. My prognosis as told to me was poor. And so I remained in the psychiatric system. But as Soteria House shows people who are encouraged to heal and believe they are not crazy do heal and move on to have successful lives. The tragedy is that the vast majority of people who have a psychosis or anguishing mental event are not given the opportunity to work through it. Drugs halt any natural process of recovery and freeze people in a static hell from which few are lucky enough to extract themselves. Emotional, psychological, and spiritual growth is slowed to a snails pace. Clearly some people do extract themselves sometimes and it is because of the incredible flexible nature of our psyches and spirits that some people are able to do this. But too many are not. I do not know what graced me to be able to extract myself from the lies I was fed. I feel lucky, but otherwise no different from the millions of people who are not able to do so. I did in the end have friends and family who supported me and believed in me but not until I had proved that I could function to some extent through the drug haze–many people cannot function through the drug haze. Somehow, I achieved some credibility and now no one is telling me I can’t do it. My current psychiatrist, my therapist, my neuropsychologist, my husband, family and friends all believe I can live without drugs.

How did I get here? I never gave up and I’m blessed with a fighting spirit. I never did completely accept my pronounced fate. I always doubted in some deep recess of my mind that I was incurable and fundamentally impaired. I did not completely, without a doubt, accept my diagnosis and I did not accept that the quality of life I led on drugs was all I would ever have. I continued to dream of a better life. And now I am beginning to live it. Many people’s dreams are permanently squashed and they die never experiencing a sense of well-being. This is an outrage. This is why I harbor anger and resentment. I see my fellow sufferers trapped with no one to help them. At this point my anger is slowly changing to a passion that propels me forward. I don’t actually believe that every bit of anger must be extinguished. It must just be transformed to compassion and love. And then I hope it will be a furious power for change. Perhaps it already is.

10 comments:

  1. Thank you for republishing this piece. It is so full of hope.
    I remember the feeling of engaging with my daughter for the first time in years without the labels and fears we had been conditioned by the psychiatric industry to carry. We were told for so long that we couldn't handle our daughter, that we'd always need outside help and that she would be "sick" for life. I was sitting across the dinner table from her and suddenly my daughter seemed like a new person. As I considered possibilities, the future (!), I still become overwhelmed with emotion.
    We are still scared sometimes by the depth of her sadness and her explosive anger but without looking at her behavior through the lens of "mental illness", it is just that - profound grief and unbridled fury. And, it passes. Without the drugs fueling it, it passes quickly. Last night, an episode passed in matter of a couple of hours! Compared to days, weeks, months. The exact same kind of episode a couple of years ago would have sent her to her Seroquel, Zyprexa, Hadol, etc. Ensuring that the pain of the moment would be deadened and paralysis would set in.
    I have often thought how my daughter's life might have been different if I had trusted my instincts. I used to look at her and see the confusion written on her face. I felt very protective but also felt so useless, so ineffective in helping her to clear her mind. So, I got swayed by the "professionals" who told me they knew how to deal with people like my daughter but none of them were very good or compassionate.
    Ha. Now I am angry, impulsive and prone to sadness as I try to battle the mental healthcare world. To make any significant changes seems so daunting a task and feel so puny. I get frustrated and scream at my computer. Crazy behavior!
    I want to stop this story from playing out over and over again in millions of households across the world. So, maybe I make a spectacle of myself and see what they do with me!

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  2. Accepting the responsibility which noturally comes to those who have found something of real value in their lives which is to share it and finding myself inevitabely in the way things work when you reveal the truth put on the spot to exemplify in my world what I have come to know, I without arragance commit here and to all in my sphere of function to live up to my understanding without wavering no matter what.
    This is why I am alive and I know it with a degree of certainty that goes beyond all the likely obstacles which confront a person with my background.
    So I have told the people in the Grow 12step group that I would provide a living example of what is possible in terms of life accomplishements in the most meaningful sense for them.
    For some years now I have been experiencing the state of conciousness which some top athletes have known and called "the Zone" from time to time.Until now I have not been sufficiently grounded in rock solid reality to safely live constantly in that most empowered wonderful mode of function however now it has come down to the wire and integrity insists that I commit totally now and follow through on the implications of what do know to be true. This full on mode of living is in fact the realuized state to which the Master Jesus made referance when he plainly said that The kingdom of heaven is at hand. My experience proves that it was then true and in fact always has been for anyone who woulde prove willing to fulfill the requirements necessary to its realization in their own lives
    So the first thing I recognise that I need to do is to in a sensible and controlled way come off the 300mg of serequel which I Have been taking for the last while and prove to myself that the true nature of any man is well able to overcome any and all obstacles to it own revelation of perfect and true function in living here on earth. I have mentioned in a previous comment that the conviction of faith in life has been firmly estabelished in my daily victorious living experience and so this final step beyond belief has naturally emerged as the right way for this one to go foreward.
    What a privilege it is to bear this responsibility and to know that it shall be done of a certainty. So Rossa if you will permit me this luxery here on your blog I undertake gladly to keep you and those reading here informed of my èxperience as it is made real in living
    Thankyou for the oportunity to let my light shine so far here.

    Much love

    Noel Gaughan

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  3. Kristin - It is so exciting to see the progress that you write about. Of course, there are days when it may seem like it's one step forward, two steps back, but then, but we weather them and move forward.
    Noel - Yes, please keep us posted on your progress with the medication lowering. Slowly and sensibly, as you say. Please make sure you have back up support.

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  4. It's amazing what we can do for one another as people, and what we can do to ourselves.

    This is great reprint. It's awesome you've opened up and brought this to light. There should be more doctors like Al Seibert and a re-modeling of mental health care institutions.

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  5. Thank you, this helped me figure out how to overcome the voice in my head telling me everything positive is a lie. Its terrifying getting stuck fighting it to have it say "gotcha, you're thinkin about it." Just a test of my willpower. Kindof like my dad. He'd say something demeaning to see if I would ignore it, defend myself and get absorbed in it, or accept it and let it damage me. I got stuck and thought I was losing my mind. Thankyouthankyouthankyou.

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    Replies
    1. Thank you for thanking me. Are you aware of the Hearing Voices Network or Eleanor Longden? Check out these two links. (I posted the HVN USA but there are many other groups around the world.)

      http://talentsearch.ted.com/video/Eleanor-Longden-Learning-from-t

      http://www.hearingvoicesusa.org/

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  6. This is such a useful post, thank you. I suffered / am suffering from a mild psychosis & I know it didn't happen out if the blue, If I can make sense of it I am sure I will go back to usual.

    It's SO encouraging to hear info like this, cos it makes sense.

    When I was in hospital I knew that a lot of the other patients were just out of balance in their understandings. Unfortunately I was too self involved to assist as much as I could, but the patients were helping each other too.

    I was lucky that the staff were helpful also, so things Are changing & it's articles like this that Help! - Thank U

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  7. This is an interesting site. I"m trying to help my son, who has been through a lot for 6 or 7 years. In that time, he has experienced no real improvement when there has been contact with the psychiatric community; they have only forced and provided drugs - which doesn't seem to alleviate the voices (his main symptom). How do I help him get through those very difficult days / weeks when the voices seem to be relentless, 24/7? Sometimes he appears to be slowly improving with good eating and supplements, but then he's hit with a bout where the voices overwhelm and it cripples him. At these times, I feel it's damaging him to let this continue and I feel I should be seeking medical attention -- which just takes us back into the same cycle of him being "formed," put on medication (but no other support beyond the doctors inquiring about how the drugs make him feel....note-not how he feels...but they say, "how do you feel with the xxx"), and then him wanting to be off them...and slowly, properly (following the road back, etc.), trying to move towards that. But, he never can get past the relentless voices. I have read of the hearing voices network but there are no hands-on groups / resources for that in our area...and, on a daily basis I feel I'm not getting him to the support he needs. Suggestions? What has been most helpful to your recovery?

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    Replies
    1. Anonymous,
      Your description of your son not being able to get past the voices sounds a lot like my son. He has tried slowly and responsibly to get off the meds at different times, and then, boom! Anxiety and hallucinations. It's possible your son and mine will always have the hallucinations so here's what I would do and what I am trying to do with my son. My son takes 1 medication only at the lowest recommended dose. For him this actually stops most of the hallucinations. I am encouraging him to get involved in the Hearing Voices Network, which I believe does a lot of work on-line, so having a group where you live isn't so important. I am also encouraging him to read more about how to change the relationship with the voices. Here is Rufus May's advice: http://rufusmay.com/index.php?option=com_content&task=view&id=98&Itemid=33
      Pat Deegan has made a DVD that both you and your son might want to investigate together. https://www.patdeegan.com/store/products/understanding-person-who-hears-distressing-voices-course-first-responders
      I actually do feel that a medication at the lowest possible dose often allows people breathing room. Medications don't preclude using other means to overcome the voices. For my son, the visual hallucinations are a challenge. Another recommendation I have is the online course called Recovering Our Families. It has helped me a lot with understanding my own reaction to my son's challenges. http://practicerecovery.com/ My son has tried to manage his symptoms without meds, but he's still not able to, and perhaps never will be, but I have said that the thing that he hasn't really tried is learning how to change the relationship with his voices so that he doesn't get so distressed and unable to function. I hope some of these suggestions are useful to you.

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  8. Does anyone know of any supplements that can help to heal the brain of a first episode psychosis?

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