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Apotheosis
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Understanding Psychotic Experience And Working Towards Recovery
Rufus May, Centre for Citizenship and Community Mental Health, Bradford
http://rufusmay.com/index.php?option=com_content&task=view&id=30&Itemid=33
Understanding Psychotic Experience And Working Towards Recovery
Rufus May, Centre for Citizenship and Community Mental Health, Bradford
Read the rest & full article here -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.
http://rufusmay.com/index.php?option=com_content&task=view&id=30&Itemid=33
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! 
