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Understanding Psychotic Experience And Working Towards Recovery

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Apotheosis

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http://rufusmay.com/index.php?option=com_content&task=blogcategory&id=18&Itemid=33

Understanding Psychotic Experience And Working Towards Recovery

Rufus May, Centre for Citizenship and Community Mental Health, Bradford

This paper will describe the process of making sense of psychotic experiences and promoting recovery for people who are recieving 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 9 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 labelled with the diagnosis of '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 invisage 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.

1. Clinical Language

Being given a diagnosis of schizophrenia was not helpful for me. It created a learned hopelessness in me and my family who resigned themselves to the established belief I would always be ill, unable to work and always need antipsychotic medication. There is a deeply held assumption that schizophrenia is a disease-like degenerative process. Thus the category of schizophrenia is associated with a failure to recover and a gradual deterioration in social functioning (Blackman, 2001; McGorry, 1991; White, 1987) It is more helpful to see each individual’s mental health as a unique and evolving story, which is importantly influenced by social and relational experiences.

Compared with traditional diagnostic categories, a focus on individual experiences provides a better framework for understanding psychosis on both empirical and practical grounds (Bentall, 1990). The British Psychological Society Report Recent Advances in Understanding Mental Illness and Psychotic Experiences, suggested individual formulations may be more useful than diagnostic categories (BPS, 2000). Moreover there is generally a practical benefit to moving away from clinical language and the concept of mental illness to a more holistic flexible language about ‘mad’ experience. Traditionally clinical language has risked colonizing people’s experiences and beliefs (Dillon & May, 2002). The danger of clinical language is that it objectifies the individual concerned, presenting them as a passive victim of an active pathology. Therefore, the use of traditional clinical language risks compounding the sense of anxiety and powerlessness that the patient will experience. Consequently, there are strong arguments for an increased emphasis on valuing the subjective experience of psychosis and the meanings people attach to their experiences. I find it helpful to use terms such as voices and disturbing or alternative beliefs, rather than the terms hallucinations and delusions. This more inclusive language helps to increase understanding of client’s perspectives of their experiences and ways they might best enhance their coping abilities. This demedicalizing of the experience also highlights the fact that it is not the voices or unusual beliefs that are the problem, rather the person’s relationship with these experiences that will determine how distressing they are (Morrison, 1998; Romme & Escher, 2000).

2. Recovery Processes

The concept of schizophrenia was unhelpful to me. A more helpful concept would have been recovery, but unfortunately this was never discussed. In discussing recovery I am not implying the medical concept of ‘cure’. Rather I am using the definition made by Anthony (1993) who suggests that recovery from serious mental health problems is a multi-dimensional concept: social and psychological recovery processes are seen as being as important as clinical recovery (Coleman, 1999). Clinical recovery is defined by reduction in ‘symptoms’ (e.g. voices and unusual beliefs). Social recovery describes the development of meaningful social relationships and roles, vocational activities and access to decent housing. Psychological recovery describes the process of developing ways to understand and manage psychotic experiences and regain some sense of structure in one’s life. These distinctions are important as currently services and research focus too heavily on clinical recovery. However, if someone can recover socially and psychologically, clinical recovery may be irrelevant to the quality of their life. For example, there are many people who live successful lives who hear voices. They have ways of managing their voices so that their experiences do not hold them back from getting on with their lives. Anthony’s (1993) definition of recovery includes dimensions of self-esteem, adjustment to disability, empowerment and self-determination.
Read the rest & full article here -

http://rufusmay.com/index.php?option=com_content&task=view&id=30&Itemid=33
 
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Whitecrow

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Like IT!

Hi there, after reading most of this thread i found myself being very fond of the language used and of story of this person. I too have been diagnosed with paranoid schizophrenia and am very aware of the problems this can bring.

I am new to this site and would love to say a BIG shout out to all people reading this for being as beautiful as they are. I am not talking of a mere physical beauty, but a real deep inner beauty that comes with being part of existance and life on this planet. What many of my friends quite often have trouble with is after experiencing mental and emotional distress, distinguishing between what is a 'human' experience, and what is 'mental'? Like what is 'normal' for them to experience or if they are having that experience because of their 'mental illlness'?

Anyway, back to the board of subject. My memory is soooo bad after being on risperidone, experiencing schizophrenia and trauma that i can't seem to remember that much of what i just read, but i do know that when i read it, i felt a great sense of being understood, which is one reason why i came onto this site. Soz for waffelling everyone, bit tierd. Love, Light and liberty to you ALL! Peace.:clap::clap:
 
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Whitecrow

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Great stuff!

I have read it over again and would like to say that this Rufus May fellow is a bloody hero!!! I saw him once at a conference in birmingham with a fellow called sky, teaching grounding techniques! If i could use my brain better and had more intelligence i would do the same as him! Did anyone see that programme on Rufus May? They were trying to make him out to be a really dangerous therapist, he is not by any means, he is a revolutionary of the mental health system, and he obviously has first hand experience of the services and mental/emotional distress which makes him so good. - Unlike some CPN's and MH workers who are sometimes so patronising, but it's not an easy job at times i can imagine. But generally they all have a great heart and the social worker and CPN i have had in recent years have been really good.

I suppose i have taken that role in life abit after having a spiritual breakdown and entering the mental health system. The role of victim and helpless, 'ill' 'mentalist' and mad person of the area. But i am proud of being mad! At least that i am different from most of the shallow people out there, seemingly only interested in their self, money, possessions, physicality and the capitalistic system of GREED!!! Soz, just abit peeded off with people at the mo. Anyway. PEACE TO ALL!:)
 
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schizolanza

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Welcome to the forum Whitecrow.
 
keepsafe

keepsafe

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Hello Whitecrow :welcome:
Hope you find it helpful here
 
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Danage

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Welcome

Welcome Whitecrow.

I was on Risperidone but it didn't work for me. It switched off my (although small) sex drive which I found odd (I was OK with it though, as I said my sex drive is small). It's something to do with a build up of prolactin. I asked my CPN if it had something to do with lactation (judging by the name of the chemical) and she said 'yes', but that it can cause sexual dysfunction as well (which is what I was experiencing). Have you ever had that problem with Risperidone?

I have a bad memory because of my psychosis, and it is not inhibited particaly by medication.
 
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Whitecrow

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Welcome Whitecrow.

I was on Risperidone but it didn't work for me. It switched off my (although small) sex drive which I found odd (I was OK with it though, as I said my sex drive is small). It's something to do with a build up of prolactin. I asked my CPN if it had something to do with lactation (judging by the name of the chemical) and she said 'yes', but that it can cause sexual dysfunction as well (which is what I was experiencing). Have you ever had that problem with Risperidone?

I have a bad memory because of my psychosis, and it is not inhibited particaly by medication.
I think that my problems with risperidone could well be the opposite! My girlfriend often complains about my high sex drive! Before being 'ill' i had naturally a very low sex drive, but with the schizophrenia it kind of triggered off a higher sex drive in me and at the time i acted very inappropriatly with it. Now being on risperidone it seems stronger still, (very frustrating). I want to try to rise my kundalini because i am led to believe that can help, focus my energy on spiritual matters and stop being so sexual. But it is hard to know what the risperidone causes in me as i have been on it for seven years now and it has become part of my personality. If you don't mind me asking? What are you on now then? (if any) DEEP INNER PEACE, Whitecrow.
 
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Whitecrow

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Reply

I think that my problems with risperidone could well be the opposite! My girlfriend often complains about my high sex drive! Before being 'ill' i had naturally a very low sex drive, but with the schizophrenia it kind of triggered off a higher sex drive in me and at the time i acted very inappropriatly with it. Now being on risperidone it seems stronger still, (very frustrating). I want to try to rise my kundalini because i am led to believe that can help, focus my energy on spiritual matters and stop being so sexual. But it is hard to know what the risperidone causes in me as i have been on it for seven years now and it has become part of my personality. If you don't mind me asking? What are you on now then? (if any) DEEP INNER PEACE, Whitecrow.
I am not a sex maniac or anything, but think about it alot. I never wanted to be a 'sex man', but sex:redface: is something i enjoy a hell of alot, but haven't had it for over a year now! That is probably why i keep thinking about it!

Anyway, yeah i think my psychosis has also contributed to my memory loss, though at times it is hard to tell whether it is the meds or the condition, or maybe a mixture of the two! PEACE
 
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Danage

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I think that my problems with risperidone could well be the opposite! My girlfriend often complains about my high sex drive! Before being 'ill' i had naturally a very low sex drive, but with the schizophrenia it kind of triggered off a higher sex drive in me and at the time i acted very inappropriatly with it. Now being on risperidone it seems stronger still, (very frustrating). I want to try to rise my kundalini because i am led to believe that can help, focus my energy on spiritual matters and stop being so sexual. But it is hard to know what the risperidone causes in me as i have been on it for seven years now and it has become part of my personality. If you don't mind me asking? What are you on now then? (if any) DEEP INNER PEACE, Whitecrow.
That is odd.

I am back on Olanzapine.

Shalom.
 
lost

lost

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"being ill I had a low sex drive"

Not sure being ill necessarily lowers your sex drive. The word "erotomaniac" covers a lot of embarrassing details from when I was ill.

But amisulpride seems to have sorted that out. Anecdotally, it's always seemed to me that anti-psychotics lower sex drive - it's one of the most complained about side-effects, no?
 
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Apotheosis

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But amisulpride seems to have sorted that out. Anecdotally, it's always seemed to me that anti-psychotics lower sex drive - it's one of the most complained about side-effects, no?
Amisulpride has just about destroyed my sex drive. Proven by the fact that my Prolactin levels are over 3 times higher than what they should be. Raised prolactin is the main side effect (one of many) from this drug. Raised prolactin over the long term leads to Osteoporosis. In women it causes loss of menstrual cycle.
 
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Danage

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Amisulpride has just about destroyed my sex drive. Proven by the fact that my Prolactin levels are over 3 times higher than what they should be. Raised prolactin is the main side effect (one of many) from this drug. Raised prolactin over the long term leads to Osteoporosis. In women it causes loss of menstrual cycle.
Osteoporosis - I thought women could only get get (Osteoporosis is what my great-grandmother died from, and that seems to run in the family, at least, down the female side). I assume men getting it has something to do with the prolactin. I had increased prolactin levels from what I can tell because the medication Risperidone, shut off my sex drive. It was like someone had flipped a switch and switched it off. It was weird.
 
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Whitecrow

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"being ill I had a low sex drive"

Not sure being ill necessarily lowers your sex drive. The word "erotomaniac" covers a lot of embarrassing details from when I was ill.

But amisulpride seems to have sorted that out. Anecdotally, it's always seemed to me that anti-psychotics lower sex drive - it's one of the most complained about side-effects, no?
Yeah, i was well messed up when i was suffering with pschosis, went on for about two years before i was sectioned (the first episode). Complete hell alot of it, but now am really well and taking 1.5mg of risperidone morning and 2mg evening. This is working for me at the moment and trying to into work. Gonna start just a few hours a week first to see how i start and how i get on, then i will increase if i can handle it. When i was experiencing pschosis i would go through phases of high sex drive then months and months of none at all, but now have quite a strong one, but i would prefer not to have.

Anyway enough about sex drive, i am really, completly into the meaning and spiritual side of pschosis. Can anyone reading this share their experiences of such things? I share the view Rufus May has that all we experience during pschosis has a deeper meaning and that at present modern pychaitry fails to recognise this side to the pschotic patient. I want to look further into the various meanings of experiences and come to a better understanding of what i went through. Can anyone share?
 
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Apotheosis

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i am really, completly into the meaning and spiritual side of pschosis. Can anyone reading this share their experiences of such things? I share the view Rufus May has that all we experience during pschosis has a deeper meaning and that at present modern pychaitry fails to recognise this side to the pschotic patient. I want to look further into the various meanings of experiences and come to a better understanding of what i went through. Can anyone share?
Hi WhiteCrow. I share an interest into the spiritual aspects of psychosis. Running Google searches on "schizophrenia & shamanism" & "schizophrenia & spirituality" brings up interesting results to start a search; if you have not done so already. I am very much into the works of Carl Jung & John Weir Perry; among others.

I have found this Blog to be very good; & full of very interesting information -
http://www.blogger.com/profile/16283478682307609903

(Click on the four Blogs at the Bottom of this profile page)

I have shared some views & experiences on this site. Some are here -

http://www.mentalhealthforum.net/forum/showthread.php?t=2183

If you go to - Support > Mental Health Issues and Experiences > Schizophrenia - there are most of the threads on these subjects which people have raised. But do start a thread of your own on this subject, if you like.

I can look at things simply; & as a complete explanation; to say that I experienced certain trauma, which lead to certain mental & emotional pain, which lead to drug & alcohol abuse; which triggered & exasperated psychosis.

I can also view things from more esoteric perspectives - that I came into this life with many things to deal with; with much "stuff" form previous lives. That I became unbalanced, (a falling out), with the spiritual side to myself, not wanting to "do the work", & attracted a dark energy into my being. I experienced a lot of negativity; this in turn was part of a deeper process of learning - to ground me in the physical; & re-address the spiritual/physical imbalance. Since working with certain healers & following certain recovery techniques; I am now in far more balance; & processing the things I came here to deal with & release. A journey of discovery & growth continues.

I could of course say that I'm genetically flawed & the chemicals in my mind are awry - But I'd be lying if I said I believed such pony.
 
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