It’s now widely recognized that therapy can be helpful for psychosis. But there is still a lot of confusion around what type of therapy approach is helpful, and especially about how professionals can find training by experts in how to work with these experiences.
One thing I’ve done to remedy this is to put together a list of mostly online places that offer training in various approaches to psychosis. You canaccess that list here. I hope you get some use out of it, and pass this information on to others who may be interested!
People experiencing psychosis are often feeling stuck in bewildering mental states, and it’s easy for professionals to get lost when they attempt to help. This may explain why for many decades, the consensus among professionals was that therapy could not be effective for those with psychosis! Fortunately, research has emerged showing that cognitive behavioral therapy (CBT) as well as many related therapies can be modified to work reasonably well for people with various kinds of psychotic experiences.
This webinar will provide an overview of the research behind CBT for psychosis, and of the style and strategies used. There will then be discussion of approaches that can easily be integrated with CBT such as compassion focused therapy, acceptance and commitment therapy, psychodynamic therapy, mindfulness, family systems and dialogical approaches, and approaches developed within the hearing voices network. Resources for getting training in CBT for psychosis and related approaches will also be described.
This webinar was co-sponsored by Mad in America Continuing Education and by ISPS-US. You can find the recording of the webinar at this link (note you have to scroll to the bottom of the page to find it.)
When we go into severe mental health crisis, it can feel like a civil war inside, with various voices, demons, or other entities engaged in battle with each other. When the chaos is great, the idea that we might ever come back together might seem unbelievable.
One thing that can help though is recognizing that even when things are going smoothly, we still have different parts inside. And even when things are at their worst, we still have the ability to access something inside us that can guide us toward healing.
This is a subject that was explored in a webinar titled “Internal Family Systems (IFS) and the Inner World in Non-Ordinary States” that took place on Friday, Aug 6, 2021.
This webinar explored how IFS understands and works with people experiencing voices, visions, paranoia, and other non-ordinary states.
IFS posits that there is no such thing as a ‘Unitary mind’, indeed the mind is made up of multiple ‘parts’ who interact internally in the same way that we interact in external relationships. These parts can become wounded by life’s adversities, and take on extreme roles in order to protect the person from further wounding. Each of these inner parts holds its own unique feelings, thoughts, experiences and core beliefs.
A core tenet of IFS is that every part has a positive intent no matter how extreme their actions to protect the person.
IFS believes that under all these parts is a person’s ‘core Self’ and this Self cannot be damaged by life’s adversities and contains qualities of compassion and wisdom. Self is the natural leader of the system once parts are unburdened and trust Self’s leadership.
The IFS method promotes internal harmony by befriending parts and bringing healing to the parts who have been wounded.
About the presenter:
Stephanie Mitchell is a Level 3 trained IFS practitioner, psychotherapist, trainer and supervisor in private practice in Adelaide Australia. She specialises in working with complex trauma and experiences which often get labelled as ‘mental illness’. She is interested in how healing and change occur in the human to human relationship, within spaces of safety and acceptance and outside the constructs of diagnostic labels. Stephanie has almost a decade working in Mental Health settings including 3 years co-facilitating a Hearing Voices group.
Have you ever met people who reported that “asking too many questions” was what seemed to have led them into madness?
Or maybe you noticed yourself that the more you looked into the deeper aspects of existence, the more paradoxical, and maddening, reality seemed to become?
If these sorts of issues interest you, and if you think understanding them may help us provide better help to people who are struggling, then you may benefit from watching the recording of the webinar “How Can the Uncontainable Be Contained? Paradoxes of Madness & Philosophy.” The link to the recording is below:
About the presenter: Wouter Kusters (1966) obtained a Ph.D. in linguistics and earned an MA on the philosophy of psychosis. In the Netherlands, he is known for his books on the experience of psychosis and its relation to philosophy. For his Pure Madness (2004), and A Philosophy of Madness (2014), he won the Dutch Socrates Award for the best philosophy book of the year in Dutch. The latter has recently been translated into English (2020, MIT Press). Wouter Kusters works as an independent writer, researcher and teacher in the Netherlands, see: https://kusterstekst.nl/.
“…madness is less about living in another private bizarre reality and more about living in our ordinary reality but then stumbling on problems that are hidden in (or ‘under’ the pavement of) ‘realism,’ and being haunted by them, which grow the more attention you pay to them.”
“Now, an important difference for many ‘madmen’ is that they just find themselves in these abysses, without preparation, with no language or tools to navigate there, with no others, and without any sense of freedom within the fall. The seduction to reduce it to a psychological crisis, or even a neurobiological crisis is then overwhelming — and from a practical point of view it is quite prudent to do so. Nevertheless, many of the questions and problems that continue to haunt those deemed mad or psychotic have nothing to do with a personal or neurological problem, but all with the greater questions. Being in a condition of madness means you are trying to resolve the most fundamental questions of existence, but in an uncontrolled, wildly associative way. You want to know what it’s all about, what good and evil are, what is at the very heart of existence: you want to know the meaning of life and the cosmos. “
This pandemic seems like such an obvious opening for western industrialized cultures to wake up and recognize the impact of structural inequalities and traumatic experiences on our individual and collective well-being. Yet our mainstream media and professional journals, fed by guild and corporate priorities, continue to emphasize the risk of mental illnesses that inherently exist within individuals, or are just waiting to emerge. A large focus of their narrative centers around risk assessment. I see risk assessment, used to net and guide us into the treatment streams most valued by those invested in separating us, a dangerous toxin clothed in care. Even authentic compassionate caring that is nourished by fearful assumptions is transmuted into othering, such as calls for “saving” the most “vulnerable,” whilst the most “vulnerable” have been excluded from contributing.
As Victor Hugo wrote in Les Miserables, “not being heard is no reason for silence.” If the voices of the majority are muted or silenced, that heightens the message of domination. We don’t need a war on mental illness, we need collective peacemaking that centers on the experiences of those who have been most harmed by systemic devaluation and “othering.” This includes our natural environment.
Our scarcity driven systems invest in separating and dividing us. We don’t need guild-driven narrators to distribute more tools for assessing individual pathology. This is a moment when collective fear can drive us into more binary narratives that sacrifice lives and futures. It is also a moment that human and environmental justice can pull us together to co-construct new narratives. We can form a movement around the common ground of being human in our surviving planet. Our biggest risk is allowing this existential crisis to melt away.
Turning towards one another gives us a chance to listen and connect, to restore basic justice that has been so obscured by dominance narratives. We must begin to listen to voices that are gasping to breathe. I naively thought that our global interconnection was now undeniable. But, more and more I see those invested in anachronistic narratives storm the media in a “scientific” blitz spinning messages which reassure some and profit only the few. We are provided campaigns to prevent suicide instead of calls for collective action to address the very conditions that lead people to see no other alternative. It’s time that we unite to co-construct alternatives to the current corrupt and barren narratives. For this we need to uproot racism, classism, sexism, heterosexism, ableism, and all the other strains of separation and systemic dominance.
Those who envision enhancing our current “safety nets” often have not seen themselves in those whom they seek to “protect.” To do that we all must move into changing our relationships with our fears. Holding ever more tightly to familiar narratives that separate, label, detain, and “treat,” will reinforce the nooses choking us all. Truly sustainable nets are co-created when those voices we haven’t heard, those bodies we have feared and used, are centered and finally fully participate in weaving our futures.
Let’s tune in, listen, participate!
On May 7th there was an international conversation with a select panel on a Mad in America, An Urgent Conversation: “Mental Health is Our Common Wealth. Fear and Grief are not mental illnesses and they never were.” If you missed it, you can still listen to the recording:
Join us as we read books about psychosis and extreme states. What can we learn from each other?
Each month we will read a different book and discuss it over a special Book Club listserv. At the end of the month, we will have a Zoom Q & A with the Author. Books can be purchased in the ISPS-US bookstore to help ISPS-US financially (a portion of your Amazon.com purchase goes to ISPS-US without additional cost to you).
This month (May) we are reading Hearing Voices, Living Fully: Living with the Voices in my Head by Claire Bien:
When Claire Bien first began hearing voices, they were infrequent, benign and seemingly just curious about her life and the world around her. But the more attention Claire paid, the more frequently they began to speak, and the darker their intentions became…
Despite escalating paranoia, an initial diagnosis of Schizophreniform Disorder and taking medication with debilitating side effects, Claire learned to face her demons and manage her condition without the need for long-term medication. In this gripping memoir, Claire recounts with eloquence her most troubled times. She explains how she managed to regain control over her mind and her life even while intermittently hearing voices, through self-guided and professional therapy and with the support of family and friends. Challenging a purely medical understanding of hearing voices, Claire advocates for an end to the stigma of those who experience auditory verbal hallucinations, and a change of thinking from the professionals who treat the condition.
When you purchase a ticket, you will be added to the listserv and given the Zoom link to the Q & A which will happen on Sunday May 31st at 7pm EST.
Upon request, copies of the chapter of the book are available while people are waiting for their book to arrive. Discussion starts May 1st, and continues throughout the month.
A donation of $10-40 is suggested, and your donation supports ISPS-US. Sign up on Eventbrite.
While the experience of psychosis can be highly distressing, many who recover report that the treatment was often worse than the psychosis itself. What is it that goes so wrong with treatment, and what could we do to improve efforts aimed at helping?
In a webinar titled “What Hurts & What Helps in Treatment for Psychosis: Insider Perspectives” (see below for the recording) two “experts by experience” reflected on their own experiences of treatment and on what eventually worked better. They also discuss attempts to get professionals to be more open to learning from the experience of those who have undergone treatment.
About the presenters:
Brenda Froyen is a motivated teacher/educator in language didactics and children’s literature. Besides her passion for education she is active in the field of mental health care, organizing conferences and giving lectures and workshops based on her own experience as a patient. Her writing skills have resulted in several books including Psychotic mum: an inside story, editorials in newspapers, and in the website www.psychosenet.be, one of the pioneer projects concerning E-health care in Belgium. For three years she was part of the Belgian Superior Health Council who formulated advice on the DSM5. Brenda is constantly looking for new ways and initiatives to improve the quality of mental health care and education: two fields that have a lot more in common than one might think.
Dmitriy Gutkovich is an activist for those with hearing voices lived experience. In addition to facilitating weekly groups for those with lived experience, Dmitriy sits on the boards of HVN NYC, HVN USA, and the NYC Peer Workforce Coalition, and is chair of the ISPS-US Experts-by-Experience Committee. His main projects include celebrating the stories of those with lived experience, and creating a forum where those with lived experience can share their tools and strategies for improving quality-of-life. He is also a loving husband and hard-working professional.
“hallucinations,” defined as sensations that don’t seem to have any physical cause, and
“delusions,” defined as beliefs that don’t agree with others in one’s culture and/or with physical reality.
Thanks to the revolutionary impact of the Hearing Voices Movement, many people around the world are now able to think of the experience of the first phenomena, “hallucinations,” as something much broader than just as part of a “psychosis.” In fact, even the term “hallucination” has been questioned, with less medicalized terms like “hearing voices” and “seeing visions” proposed instead. And it has been asserted that hearing voices itself should never be defined as an illness. Instead, hearing voices is conceptualized as a human variation, like being left handed or gay. It is understood that people may have problems with the voices and may need help figuring out how to relate to them, but once the relationship has been improved, the experience may change to something that is overall benign or even beneficial to the person.
Unfortunately, less attention has been brought to that other key component of psychosis, the “delusions.” And yet, the need for a revolution in how they are approached may be just as intense.
Sometimes, revolutions start with changes in understanding. One area to begin with might be the notion of a firm distinction between hallucinations and delusions. Hallucinations are understood as disorders of perception, while delusions are understood as disorders of conception: but in practice conception plays a big role in perception, and vice versa. For example, consider the difference between thinking that an external force is controlling one’s thoughts (classified as a delusion) and “hearing” thoughts that seem to be coming from outside one’s mind (classified as a hallucination.) Are these two really that different? Or are they better thought of as on a continuum, with some experiences in the middle and not easily classified as one or the other?
In hearing voices groups, the lack of a clear distinction between perceiving a different reality, and conceptualizing or believing in a different reality, is often understood, and so alternative ways of relating to “unshared beliefs” have been developed alongside alternative ways of relating to voices. But these alternative approaches to working with troublesome beliefs have not received as much publicity as have approaches to hearing voices.
One example of a person working to change that is Rufus May. At age 18, Rufus became convinced that he was a spy and that a device had been planted in his chest. His beliefs were treated in the conventional way by the mental health system: he was diagnosed with “schizophrenia,” hospitalized, and drugged. But Rufus decided not to believe in the diagnosis and the drugs, and he eventually found his own way to regain control of his life. Then, using undercover skills which he had previously just fantasized, he infiltrated the mental health system, keeping his psychiatric history secret as he completed his training as a psychologist.
With his training complete, Rufus shifted to being open about his history, and became an effective advocate and educator for alternative approaches. And while some of his efforts have been around alternative approaches to hearing voices, he has also written very coherently about alternative approaches to working with difficult beliefs. for example in his article Accepting Alternative Realities. He also explored that topic in a recent webinar, Believe It or Not! Ways of Working with “Delusions” or “Unusual Beliefs” (See the link at the end of this post.)
One reason I believe Rufus is a great teacher on this topic is due to the degree of flexibility, creativity, and respect for people that he brings to the work.
A key issue with “delusions” is that people are often holding beliefs in a rigid manner: this tends to prompt those around the person to become unhelpfully rigid in return. In conventional mental health treatment, this rigidity involves insisting that the person “get insight” into the “fact” that their belief is a delusion and is a sign of the presence of a “mental illness” like “schizophrenia.” This rigidity is maintained despite evidence that many ideas about “schizophrenia” may be as untrue as any “delusion,” and despite extensive evidence that confronting any strongly held belief in a rigid way tends to make the person holding the belief dig in and defend it more.
I’ve been practicing CBT for psychosis for many years, and CBT does have some ways to approach “unshared beliefs” in a less rigid way. But there is still a tendency in much CBT literature to emphasize attempting to change the belief seen as troublesome. That is sometimes possible, and work around reconsidering beliefs can be important, but it is also sometimes not possible or not the most helpful approach.
In many cases, it can be more helpful to work on things like understanding the life experience that led to the belief, exploring the possibility of living successfully even while continuing to have the belief, and/or looking at the belief as a possibly metaphorical message about something that needs attention, and then shifting the focus to that area.
A couple years ago I had a chance to hear Aaron Beck, a key founder of CBT, speak about his understanding of how to approach apparent “delusions.” It may be common for older people to be rigid in their views, but I was pleased to find that Beck, then age 97, was advocating for a more creative direction. He was asked for example how he might respond to a man who was claiming to have been roasted in an oven. Beck said first he would acknowledge the man’s story, and be curious about what that experience was like, how it felt etc. Then he would ask about other times in the man’s life when he may have felt that way, and then inquire about whether anything currently was making him feel something similar. In other words, he was saying it might make more sense to follow the vein of emotional content to where it might connect with the man’s past or current issues and distress, which then could be addressed directly. That could be way more effective than simply trying to change beliefs.
Too often in conventional mental health treatment, once people express a belief that seems “insane,” there is just an effort to suppress the belief, rather than to really understand where the person might be coming from, and what their most important concerns might be.
Another example Beck gave involved a man who told hospital staff that his psychiatrist was a threat, and revealed that he wanted to shoot the psychiatrist. In a conventional setting, this would be seen as a sign of the worsening of a dangerous psychosis, and an increase in antipsychotic drugs, by force if necessary, would have been seen as the solution. But in this case, the psychiatrist had been trained to proceed with more sensitivity and flexibility, so instead of treating it as a symptom, he asked the patient, “why do you want to shoot me?” The patient responded, “because you are planning to shoot me!” “But,” the doctor explained, “I don’t even own a gun!” “Well,” said the patient, “you use your drugs like a gun.” The doctor thought about it and said, “I wonder if you are feeling you have very little control? That must be frustrating. But I know you must have lots you want to do outside of here and I want to help you get out so you can do that!” This made sense to the person and they started to work together.
In the hearing voices movement, it is often pointed out that the voices may be “poor communicators” and that working things out with them may require considering alternative interpretations of what they are saying, until a more constructive meaning emerges. For example, a voice that tells someone “you need to die” may be better understood as a part of the person saying that “something is wrong, you need to change something” or “you need to let something about you die.” Once the message is properly understood, it becomes something helpful rather than destructive. The voice hearer can learn to be like the parent who hears the child say “I hate you” but is able to infer that the child needs some love and a nap, rather than taking the statement literally.
One interesting thing about “delusions” is that people can be disturbed by their own beliefs: that is, they can find themselves falling into a belief, but sense there is something wrong with the it at the same time. At that point, they are like the voice hearer who hears a message that seems disturbing, but which they are also starting to believe.
A key skill people need to learn is discernment: sorting out what might be a valid message in the belief or in what the voice is saying, while dismissing what might be exaggeration or a too literal interpretation. This allows them to resolve the situation by believing the helpful part of the message, while disregarding the rest.
At other times people are not at all disturbed by their belief, but their having the belief does become disturbing to others. At that point, the person with the belief is, in relation to us, like the voice is in relation to the voice hearer. The person is saying something, and we must decide how to respond to it. Do we see them as the enemy, and someone whose views simply need to be suppressed? Or do we consider the possibility that while the person may be a poor communicator, there may be some valid message in what they are trying to communicate, even if we can’t agree with all of it?
To develop an adequate approach to difficult beliefs, it is also important to think more broadly about the nature and function of beliefs in general, and to understand how all humans tend to “behave irrationally” around their beliefs when those beliefs become important to their world view and their identity.
Beliefs are often a tribal kind of thing: people may believe something to fit in with others, not because of logic. Having a tendency to do so may benefit individuals in an evolutionary sense, because it makes the individual more likely to get along with others in their social group. (This works, of course, only when the belief is not so destructive as to lead to the extinction of the entire group: it remains to be seen for example how the “tribal belief” in the non-existence of the climate crisis, popular in many quarters, will affect the evolutionary viability of humanity.)
Curiously, psychiatry identifies only untrue beliefs held by one or at most a few people who are at odds with their culture as having mental health problems, and doesn’t consider the possibility that beliefs held by larger groups or even entire cultures may be even more of a problem – even though the dangerousness of a belief tends to increase the more people endorse it!
(If psychiatry were more able to recognize the “pathology” of widely held beliefs, it might for example be more able to reflect on the damage done by beliefs it has itself promoted, such as the one about how “mental disorders” are caused by “biochemical imbalances.”)
But, one might ask, if people often hold beliefs just to fit in with their group or tribe, why do some individuals seem to go their own way and choose beliefs that put them at odds with their community?
One answer may be that when a person’s life does not seem to them to be working out, they may be motivated to try on different beliefs, sometimes desperately grabbing on to whatever seems to offer some chance at inner coherence amid chaos and disruption. Once a belief that seem to help restore internal order is found, the person may be reluctant to let go of it, even when that puts them at odds with their culture and gets them labeled “psychotic.”
It is also true that evolution would never work if there were not genetic variations, and cultural beliefs can never evolve unless we have people trying on different perspectives. Much variation in belief may be just a part of human diversity, and not a problem that needs to be solved. A skilled approach to working with beliefs involves both toleration of differences in perspective, with an awareness of a variety of possible things that can be tried when a belief is causing problems that do not seem to be tolerable, either to the person or to others with whom they must interact.
There’s a lot more that could be said about this topic: this post just scratches the surface. To go a little deeper into it, consider viewing the “Believe It or Not” webinar:
Topics covered include
understanding the protective function of beliefs,
understanding how they may be linked to past life events,
ways to be with someone with different beliefs, and
if someone is motivated to hold their beliefs more lightly how we might help them with this.
When we relate with each other, a key thing we long for is to have the other see meaning in our experience, while we notice and reflect on the meaning in theirs.
But when people are seen to be “mad” or “psychotic” or “crazy,” they are typically told that their experience makes no sense, and their best option is to take pills in an attempt to make that experience stop.
When people’s experience seems extreme, it may be difficult to find meaning in it even when people around the person do make an effort. One reason for that may be the shallowness of our culture, which has difficulty connecting to anything too far from the “norm.”
Spiritual traditions, though, do contain clues about how to understand extreme experiences and extreme states of consciousness.
That’s a subject Caroline Maze-Carlton explored in a webinar “Messages, Meaning and Ancestral Maps: Spiritual Frameworks for Extreme States.” A link to a recording of that talk is below.
Assimilation, genocide, and systems of oppression such as anti-Semitism and Islamophobia have left many disconnected from ancestral traditions, spiritual tools and texts. When encountering extreme states of being such as Voices and Visions, the pharmaceutical model of chemical imbalance often steps into claim space in this cultural vacuum. However, for many, Western medicalized approaches are neither sufficient nor culturally competent. This Webinar will explore ways in which we can re-claim spiritual tools and wisdom traditions and be in open dialogue with our ancestors as we navigate extreme states of being. Caroline will draw on over a decade of direct experience supporting others with altered states of consciousness in diverse settings from peer respites to forensic psychiatric units, as well as her personal lived experience as both psychiatric patient and student of Abrahamic traditions and Buddhist sutras.
About the presenter:
Caroline Mazel-Carlton is a ritual-weaver and sacred space holder in the Jewish Renewal lineage of Rabbi Zalman Schachter-Shalomi. She is a student of the ALEPH Jewish seminary and recently completed the Yad B’Yad program in Muslim-Jewish collaboration and leadership. She has traveled the globe in her role of Director of Training for the Wildflower Alliance (home of the Western Mass Recovery Learning Community) supporting systems change and alternatives to the conventional mental health system. Her passion for re-claiming Jewish identity and tradition through a feminist lens extends to the roller derby community where she is known as Mazel Tov Cocktail (#18).
“Don’t React – Choose How to Relate to Distressing Voices!” is the subject of a webinar that was presented by Dr. Mark Hayward on 6/20/19. (See the link to the complete recording below.)
This webinar presents a very practical way to help people start experimenting with different ways of relating to voices they might be having trouble with. I encourage people to check it out!
“There has recently been a shift from conceptualizing a voice as a sensory stimulus that the hearer holds beliefs about, to a voice as a person-like stimulus which the hearer has a relationship with. Understanding voice hearing experiences within relational frameworks has resulted in the development of psychological therapies that focus upon the experience of relating to and with distressing voices. This webinar explores lessons learnt from the development, experience and evaluation of one of these therapies – Relating Therapy. These lessons are located within the broader context of other relationally-based therapies that seek to support recovery through the use of digital enhancement (Avatar Therapy) and dynamic interaction with voices (Talking With Voices).”
About the presenter: Mark Hayward has worked
as a Clinical Psychologist within NHS mental health services for the past 20
years. His roles combine clinical (Lead for the Sussex Voices
Clinic), research (Director of Research for Sussex Partnership NHS
Foundation Trust) and teaching (Honorary Senior Research Fellow at the
University of Sussex).
research activities have focused primarily on the exploration of voice hearing
within relational frameworks – acknowledging the voice as an interpersonal
‘other’ and researching differing aspects of the relationships that people can
develop with their voices. These relationships have been central to the
development and evaluation of new forms of individual and group therapy that
can facilitate acceptance of self and voices through the use of assertiveness
and mindfulness training. His books include the CBT self-help book ‘Overcoming
Distressing Voices’, and the research monograph ‘Psychological Approaches to
Understanding and Treating Auditory Hallucinations’.
is committed to increasing access to effective psychological therapies for
people distressed by hearing voices.
I’ve been intrigued by the way the battle against mental health system oppression has drawn on two important and powerful ideas – which happen to contradict each other!
One is the idea that people can “recover” from mental health problems. Asserting the possibility of recovery has been key to fighting back against the oppressive belief that certain people will always be “mentally ill” and will need to resign themselves to a limited life as a mental patient, etc.
The second idea is that people may not have to change to be OK and valuable – that people can even be proud of what has been called madness! Mad pride helps people fight back against the oppressive notion that one has to be “normal” to be acceptable, and that mental diversity means illness.
But, if one is perfectly OK as one is, then there is no need for recovery. In fact, if one is already quite OK, then the suggestion that one should work on recovery can itself be oppressive – like offering “reparative therapy” for gay people.
On the other hand, if one’s mental state and current beliefs are causing lots of problems that are keeping one stuck, then being encouraged to be proud of that mental state can become a barrier to changing or recovering and so can deepen or prolong problems and oppression.
Contradictions like those outlined above can lead to battles between activists about how to move forward. They can also lead to battles, and confusion, within people who are trying to find the best way to deal with their own “mad” states.
What I want to show is that it’s possible to embrace both “recovery” and “mad pride” despite the contradictions. But to do so, we need to be aware of both the advantages, and of the “down” or “shadow” side of each of these notions.
Let’s start by looking at the concept of recovery.
Compared to mad pride, recovery has been much more widely embraced. It has even been embraced by much or most of the mental health system – though often what is embraced is just the word itself, and not the possible reality! But because of its popularity, it has also been more widely critiqued, and some have even advocated that we stop using the word altogether.
One common critique is that the word “recovery” implies that one must have been ill in the first place, and so this word should not be used when the problem never was an “illness.” However, people do “recover” from many things that aren’t an illness: we recover our balance, we recover from injuries, we even recover from the down side of events that were overall positive, as in “I’ve finally recovered from that wild party I attended last night!” Krista Mackinnon, in her “Recovering Our Families” course, emphasizes that all humans are constantly recovering from all sorts of things, and so “recovery” is not something unique to those who have been psychiatrically labeled.
A stronger critique of the notion of recovery points out that recovery involves going back to something, while many prefer to see their life as going forward. John Herold for example talks about wanting to move toward “discovery” and not “recovery.” I agree with that up to a point, but I also notice that we often have to go back to something we had possessed previously in order to move forward overall. For example, if I used to know how to face people and maintain friendships, but then I seemed to have lost that ability during an emotional crisis, I may want to recover the skills and habits I had before so that I can then get on with my life and move into that wider process of discovery.
Then there’s the problem of the word being co-opted to mean something much less than real recovery. Lots of mental health programs use the recovery word, but their practices remain targeted towards lifelong drugging and containment of the person, with “recovery” apparently meaning only getting to where the person won’t be in crisis so much. I understand why that sort of use of the word “recovery” makes people want to vomit, but I would rather work on reclaiming the word, rather than giving it up. The US government can call a nuclear missile a “Peacekeeper” but that doesn’t mean we need to quit using the word “peace.” I think our best strategy is to continue to emphasize the true meaning of recovery and to contrast truly recovery-oriented treatment with that which is not.
Adding complexity to discussions of recovery is the distinction between “clinical recovery,” or no longer experiencing “symptoms,” versus “personal recovery” which has been defined as “recovering a life worth living.”
Interestingly, within standard care, “personal recovery” is often framed as the proper goal because of a belief that “clinical recovery” is not possible. In other words, it is believed that the person will always have symptoms and will always be less than healthy than others because of that, but they may still learn to “recover a life worth living” despite continuing to be ill. (Of course, this notion that they are still ill can be used to convince people to stay on their drugs, which makes this interpretation popular amongst those who embrace the medical model but who still want to offer some appearance of hope.)
But there is a deeper and more valid reason to focus on personal recovery rather than clinical. That’s because the experiences that the mental health system called “symptoms” may not be a problem at all once the person learns to live with them. Hearing voices for example may be benign or even helpful once the person learns to relate to them differently. And once experiences no longer cause problems, there is no longer a need for drugs or any kind of treatment to manage them.
Of course, it’s the idea that people don’t need to change, and that their differences may be OK or even something quite valuable, that is basic to that idea that sometimes seems in opposition to recovery: mad pride.
“You are only given a little spark of madness. You mustn’t lose it.” Robin Williams
From a radical mad pride perspective, there is only mental diversity, and not any mental problems, disorders, or illnesses. People do best when they accept and become proud of themselves as they are rather than try to change. If people have problems, or seem to be disabled in some way, it’s just because society has failed to accommodate their differences, and so it’s society that needs to change.
But what are the problems with this kind of radical mad pride perspective?
One issue is that if I am suffering in some way, while believing that there is nothing wrong with me but only problems with others, and if it’s also true that I don’t have the power to make others change, then I am stuck with my suffering. Working on recovery from a problem may not require accepting that one is ill, but it at least requires accepting that something needs to be changed; but pride is the opposite of believing in a need for change.
Another problem is the adversarial relationships that a radical mad pride perspective can create with others. If I for example demand that others change their attitudes and start accepting me just as I am and if I demand that they change in other ways to accommodate my differentness, while I insist that I am perfectly fine as I am and don’t need to change anything, I may just piss people off. I’m certainly not likely to be effective at winning friends and forming peaceful relationships, since good relationships tend to be built when people are willing to change at least some to accommodate each other, at least when they are able to do so.
On the other hand, the notion of radically accepting ourselves just as we are can often seem to be the very core of peace of mind and mental healing. So it can all seem quite complex.
How can all this be best resolved? Or, how can we take what is best about mad pride, and what is best about recovery, without getting caught up in the shadow side of each?
I think it may help to take a step back, and look in more general terms at how we can resolve other kinds of contradictions.
It’s not uncommon that things are opposites, but we find ourselves needing both. Breathing in for example is a good thing, but so is breathing out, even though that’s the opposite. Our ability to open up to people and trust is a good thing, but so at certain times is our ability to close up and distrust.
Mental health issues can be notoriously complex. People can go through terrifying, bewildering experiences that may also have a very important positive side. Or, experiences may seem to be quite positive, but then lead to something very detrimental.
It’s also possible that an experience we want to recover from at one point may be something that later we wish to regain. In my own life I can identify times I have worked to recover from “madness” and to regain my ability to integrate with normality, and then also times when it seemed more important to turn around and work to recover from that normality trance, so I could reclaim what I had discovered when I first went “out of my mind.”
One metaphor for madness is that of revolution. Revolution overthrows the existing order – then anything is possible, which is both great, and terrible. Revolution is both something to be proud of, when it is necessary and when it works out well, and it is something to recover from, so that order can be restored.
When we over-value sanity, we stick with an existing order in rigid ways that can be oppressive. When we over-value madness, or revolts against sanity, we can get lost in disorder. Life though works best at the edge of chaos and order, so it may require both rebellion against order and efforts to recover order.
One way to map relations between polarities, where neither polar opposite provides a full answer, is to use what is called a polarity management map. These maps make overt what is positive and negative about each polarity, and suggest that each polarity is the solution for the problems caused by the other.
Below is a polarity management map about recovery versus mad pride. It suggests that there is no final answer to resolving the tensions between mad pride and recovery, or between madness and sanity generally. Rather, whenever we emphasize the positive of one side, we will also sooner or later encounter its negative, and then may have to shift to the opposite side.
If we follow this line of thinking, it follows that there are no final answers as to when a focus on change and recovery is best, versus when it might be better to instead be proud of one’s current state and perspective, even if it is somewhat “mad.” Instead, we will be more open to exploring what might fit or seem healthy, or not, in any given situation. And we will be open to the possibility that whatever we choose now, we will later be called upon to choose the opposite.
When we are too sure that our side is right, that “God is on our side,” we end up at war with our opposite. People who are too sure that their current mental view or version of sanity is correct will go to war against that which opposes it, be they voices or other people who are seen mentally wrong But going to war just makes everything more extreme, and prevents the “peaceful revolutions” that are possible when people realize that their current polarity is just one side of a more complex picture.
Modern humans are not, of course, the first to struggle with these issues. Spiritual traditions going back to ancient times wrestle with how to relate to the limits of any existing order, and how to find value in what is outside of that order, or “outside of our minds.” While these traditions are not perfect, and have too many times been bent to completely corrupt and oppressive purposes, they also contain reminders that we humans do our best not when we stay confined within a mundane “sanity” but rather when we allow ourselves, at least at times, to open up to what goes beyond.
What would mental health treatment look like if it balanced an awareness of the need for “recovery” with an awareness that people also sometimes need to go “out of their minds” to resolve problems that they haven’t been able to solve otherwise, or maybe that their entire culture has not been able to face and resolve?
To explore some possible answers to that question, I recently put together a new online course, “Addressing Spiritual Issues Within Treatment for Psychosis and Bipolar.” This course outlines some radically different ways of conceptualizing the mental states that get called “psychosis” and “bipolar” and reviews ways professionals can shift from pretending to “know it all” to being helpful to people as they face some of the bigger mysteries together. In the course, I try to strike a balanced position that avoids both “romanticizing” extreme states and the more common mistake of “awfulizing” or “pathologizing” them.
This course comes with 6 CE for most US professionals. Through this link, it is available for $49.99 (an 68% discount.) Use the link to get more information, or to register. Note that if you do pay, 50% of the proceeds goes directly to ISPS-US to help fund its activities.
A few more thoughts:
One other possibly helpful metaphor for madness is that of wilderness.
It can be disturbing when young people wander off into the wilderness. What if they become lost, and need to be rescued? Sometimes people do need to be rescued. But a society too sure that the wilderness is nothing but bad will seek to prevent young people from ever wandering off, won’t recognize when people are doing OK in their explorations and don’t need to be rescued, and/or will even seek to destroy the wilderness so that everything can be “civilized” – aka, sane.
But any society cuts itself off from the wilderness, and/or declares war on what is wild, only at its own peril. Certainly, modern civilization or “normality” has declared war on the wild, and it does often seem that it is winning. But that “winning” is a most terrible thing, and puts us all in danger!
Rather than winning, we need to focus more on finding a dynamic balance, or peaceful coexistence. The peaceful coexistence between recovery and mad pride that I have proposed is just one example of that.
Emerson said that “People wish to be settled; only as far as they are unsettled is there any hope for them.” It’s time that we define mental health not as some settled “sanity” but as the unsettled and possibly playful dialogue that results when we value both madness and sanity, and when we explore together with those whom we wish to help rather than impose our own version of some settled, and dead, “correct answer.”
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