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Recent Advances in Understanding Mental Illness and Psychotic Experiences:



Recent Advances in Understanding Mental Illness and Psychotic Experiences:

A document which is well worth reading -

Recent Advances in Understanding Mental Illness and Psychotic Experiences:
A report by The British Psychological Society Division of Clinical Psychology.

The full document can be read here -


This report describes recent advances in understanding
psychotic experiences. It is written for mental health
service users,mental health professionals,and interested
members of the public. The report is divided into three
parts, covering understanding of mental illness, causes and
help and treatment.

Part 1: Understanding mental illness

Section 1:What this report is about –


This report presents psychological perspectives on
serious mental illness.It refers to psychiatric diagnoses
of ‘schizophrenia’,‘paranoid schizophrenia’,‘psychosis’,
‘manic depression’ and ‘bipolar affective disorder’.

These problems include hearing voices (hallucinations),
holding unusual beliefs (delusions) and experiencing
strong fluctuations in mood.

Each individual’s experiences are unique. Many people
who have these kinds of experiences do not come into
contact with clinical psychologists or psychiatrists
because they do not find their experiences distressing.
Some people, however, are so distressed by them that
they seek professional help or others seek help on
their behalf.

Section 2: How common are these

About one person in a hundred is likely to receive a
diagnosis of schizophrenia in their lifetime, and similarly
about one person in a hundred is likely to receive a
diagnosis of bipolar disorder (manic depression).

100,000 to 500,000 people in the UK today are likely
to have been given the diagnosis of schizophrenia,and
about 500,000 are likely to have received a diagnosis of
bipolar disorder (manic depression).

Social circumstances are very important. People from
disadvantaged backgrounds, especially young men,seem
at greatest risk of receiving a diagnosis of
schizophrenia.However, although the risks might vary,
almost anyone could have psychotic experiences in
circumstances of extreme stress.

Section 3: Prognosis – course and outcome

The course and outcome of psychotic experiences are
very different for different people. Less than a quarter
of people who have distressing psychotic experiences
at some time in their lives remain permanently affected
by them.

People have poorer outcomes if their spouses or
family members are highly critical or overprotective.

Section 4: Problems with ‘diagnosis’ in mental

Psychiatric diagnoses are labels that describe certain
types of behaviour. They do not indicate anything
about the nature or causes of the experiences.

Section 5:A continuum between mental
health and mental illness

Mental health and ‘mental illness’ (and different types
of mental ‘illness’) shade into each other and are not
separate categories.

Ten to 15 per cent of the population have heard voices
or experienced hallucinations at some point in their
life. These are frequently triggered by extreme
experiences such as sleep deprivation.

It may be appropriate to think in terms of ‘stress vulnerability’
when explaining psychotic experiences.
People may have greater or lesser levels of
vulnerability to this type of experience, which are
triggered by greater or fewer numbers of stressful
events experienced.

In some cultures hearing voices and seeing visions is
seen as a spiritual gift rather than as a symptom of
mental illness.

Part 2: Causes

Section 6:The complexity of psychotic

Social,biological and psychological causes of psychotic
experiences are all important,and interact with one

Because there is a very close relationship between
‘mind’ and ‘brain’,it is very difficult to draw clear lines
between biological and psychological factors.The
causes of psychotic experiences are complex and one
single ‘cause’ will not be found.

Sometimes psychotic experiences can be triggered by
something relatively minor, but become a problem as a
result of some kind of vicious circle, involving the
person’s situation or their reaction to the experience .

Section 7: Biological factors in psychotic

In the main, research into genetics, brain chemistry, the
physical environment and brain structure has not led
to clear conclusions about physical causes.

It is likely that genetics,brain chemistry, brain structure
and the environment are all associated with
vulnerabilities to a variety of general traits,which may
in turn be related to psychotic experiences.

It is clear that psychotic experiences involve brain
events,and can be influenced by biological processes.It
is important to remember, however, that every single
thought we have involves chemical changes in the
brain,and this is as true for ‘normal’ as well as
‘psychotic’ experience.

Section 8: Life circumstances and psychotic

Psychotic experiences can sometimes follow major
events in someone’s life, either negative (for example
bereavement) or positive (for example winning the

Many people who have psychotic experiences have
experienced abuse or trauma at some point in their

If people who have had mental health problems live in
a calm and relaxed home atmosphere, their problems
are less likely to return.

Section 9: Psychological factors in psychotic

Psychological models of psychotic experiences focus
on patterns of thought associated with these
phenomena and on their meaning for the individual.

These include: difficulties with attention,difficulties in
understanding what other people are thinking, jumping
to conclusions and the tendency to believe that the
bad things that happen are the fault of other people.

Hearing voices often appears to be the result of
difficulty in distinguishing one’s own,normal, inner
speech from the words of other people.

Psychotic experiences often have an important
subjective meaning or significance for the individual.

Part 3: Help and treatment

Section 10:Assessment

Clinical psychologists use a wide variety of information
to reach a psychological ‘formulation’,an account of a
person’s problems developed in collaboration,that
describes and accounts for the problems and offers a
plan for help.

Section 11:Medication for psychotic experiences

Traditional psychiatric drugs are by far the most
common form of help offered to people with psychotic

They are not a ‘cure’ but can alleviate ‘symptoms’. They
can be used for acute psychotic experiences and/or
used long-term to try to prevent future problems.

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.....They do not help everyone. Two-thirds of people who
take medication regularly are likely to experience a
recurrence of their psychotic experiences within two

They can have serious unwanted effects (‘side effects’)
which for some people can be worse than the original

Newer drugs (‘atypical antipsychotics’ such as
clozapine) are not necessarily any more effective, but
can cause fewer adverse effects. Each individual should
be able to make informed choices about which,if any,
drug works best for them.

Many people are on doses above recommended levels.
The British Psychological Society has stated ‘It is unsafe
for people to be forced to use medication with
potentially lethal side-effects against their wishes and
without in-patient supervision’.

Section 12: Psychological interventions for
psychotic experiences

The most common form of psychological therapy for
psychotic experiences is Cognitive Behaviour Therapy
– CBT. This is a tried and tested intervention that
examines patterns of thinking associated with a range
of emotional and behavioural problems.

There is convincing evidence that psychological
interventions are effective for many people in reducing
psychotic experiences and the distress and disability
they cause.

Despite the effectiveness of psychological interventions,
and the fact that they appear to be cost-effective, more
resources are needed, especially for training.

Section 13: Risk and psychotic experiences

Most people who have psychotic experiences are not
dangerous.The increase in risk associated with a diagnosis
of schizophrenia is minimal.

The proportion of homicides committed by people
with psychiatric diagnoses has fallen since the
introduction of community care and is still falling.

People who use mental health services are themselves
at risk of becoming victims of violence. They are also
at risk of self-neglect,suicide, abuse of human rights
and the damaging consequences of treatments.

There is an increase in risk associated with the
diagnosis of Antisocial Personality Disorder. This is,
however, a different type of problem from those
described in this report. The term ‘antisocial
personality disorder’ is used to describe someone
whose behaviour is considered antisocial or dangerous
and tells us little more than that.Such a description
does not indicate that a person has psychotic

Section 14: Social exclusion

People with psychiatric diagnoses are arguably one of
the most socially excluded groups in society.

Media accounts give a very biased picture and help to
maintain public prejudices.

The policy of community care has not failed. Most
people who used to live in psychiatric hospitals have
been successfully resettled and are well supported.

There is a growing ‘User/Survivor Movement’ in which
former and current mental health service users are
campaigning for better services, for the acceptance of
frameworks of understanding other than the ‘medical
model’ and against stigma and discrimination.

Section 15: Implications of this report for
mental health services

Services need to adopt an individual and holistic

Services must respect each individual’s understanding
of their own experiences.

Service users should be acknowledged as experts on
their own experiences.

The use of coercive powers (for instance detention
under ‘Section’ and forcible treatment) should not be
further extended.

Psychological therapies should be readily accessible to
people who have psychotic experiences.

All mental health workers should be aware of and use
a psychological understanding of psychotic

Training is needed nationally to educate all mental
health staff about the information contained in this
report. It should also be part of the basic training of all
the mental health professions.

Prejudice and discrimination against people with
mental health problems should become as
unacceptable as racism or sexism......
Read the full Report On-line.