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Psychosis, PTSD and Story as a Vehicle of Healing



Contrary to popular misunderstanding the term "schizophrenia" does not refer to multiple personality syndrome. The Greek etymology of the word actually means "broken soul" or "broken heart".

-- Michael O'Callaghan

This paper will describe the process of making sense of psychotic experiences and promoting recovery for people who are receiving psychiatric treatment. It will focus on some of the concepts, therapeutic strategies and actions that are likely to help the recovery process. I am a clinical psychologist who has spent the last nine years working psychosocially with people whose problems have been diagnosed as psychotic. I have also had the experience as an 18-year old of receiving psychiatric treatment for psychosis and being diagnosed with schizophrenia. I will consider some of the basic principles we can learn from the growing recovery literature in order to better promote self help and recovery for the person who has psychotic experiences. I will envisage the different ways that we as professionals and patients might understand psychotic experiences as meaningful events in the context of people’s social lives. I will argue that rather than attempting to reduce psychotic experience the focus of our work should be on reducing the debilitating nature of the experience so that people can freely get on with their lives. I aim in this chapter to reflect on practical considerations for working with psychosis that derive from both subjective wisdoms as well as the usual professional sources.

My Experience of Psychosis
From September 1986 to November 1987, I was treated for psychosis. This included several involuntary hospital admissions. Initially, I had experienced sleep deprivation and was very confused holding some grandiose and paranoid beliefs involving espionage and science fiction theories. I perceived the television and radio as having interactive messages for me. I also entertained spiritual beliefs focussing on battles between good and evil and having special powers of communication. My concentration was extremely poor. I was in a high state of vigilance, fear and tension, leading to chest pains. Perhaps due to having a family history of problems diagnosed as schizophrenia, clinicians quickly made a diagnosis of schizophrenia. My parents were informed and told I would need to take medication for the rest of my life. However, 14 months after my initial psychiatric admission I stopped taking my depot injection of medication and disengaged with psychiatric services. I have not since received or used psychiatric services.

As a patient, I did not receive any specialist psychological interventions. The main interventions I received were pharmacological, ideological (‘you must accept you have a serious mental illness’) and eventually occupational therapy. I believe that I came very close to developing a long-term sick role as a ‘schizophrenic’ because the expectation all around me was that I would not be able to rebuild my life. Rather, I was encouraged to passively adjust to a serious ‘mental illness’ with a maintenance style medication regime. The belief held by hospital staff was that I would be powerless to influence the return of psychotic symptoms that could at any moment strike again. For me to escape this prophecy it felt like wading through miles and miles of swamp. This was an incredibly lonely journey. I had no guides, no specialist support, and no stories of success. With hindsight, my own understanding of my initial psychotic reaction is that my drift into a psychotic world was the result of dissociative psychological strategies that allowed me to escape from a social reality I felt alienated from. Motivated by the poor care I received and witnessed, I decided to train as a psychologist so that I might influence change in therapeutic approaches in the mental health system.

I now work in Bradford mental health services in England as a Clinical Psychologist. My aim in this chapter is to reflect on how recovery from psychotic experience, can be best promoted given the evidence from personal accounts and clinical research. In another publication I have reflected on what was and what was not helpful to my recovery process (May, 2000). In retracing my route to recovery I highlighted enabling personal narratives (stories of success and possibility), meaningful activities, and social inclusion opportunities (housing, work and educational opportunities) as being important turning points. I would like here to reflect on four areas which are important for practitioners to address if they are to be helpful in enabling people’s recoveries. These areas are clinical language, the recovery process, medication and a whole-person approach.
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Trauma & Spiritual Emergencies

Will all spiritual emergencies contain a traumatic element? Inasmuch as the loss of ego barriers can be a traumatic experience even for those who have long been following a spiritual path -- yes. Inasmuch as the spiritual emergency was caused by some buried wound in your past -- not necessarily. I think it's more accurate to say that when one's ego barriers are displaced, shattered or dissolved and unconscious content wells forth, that process is going to bring up whatever is buried.

Not everyone who goes through a spiritual emergency has some form of personal trauma in their background. However, it is true that individuals suffering with PTSD have been misdiagnosed as psychotic or schizophrenic.

Misdiagnosis and incorrect or inadequate treatment is not unusual for adults and children with PTSD. For example, refractory depression, substance abuse, and eating disorders, among others, often mask underlying but undiagnosed PTSD. Flashbacks and other dissociative episodes can frequently be mistaken for psychosis (especially schizophrenia), and unnecessary anti-psychotic medication can undermine treatment progress.

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