Healing Journey

An Open Dialogue around ‘Psychosis’

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“The deepest hunger of the human heart is to be understood” Stephen Covey

Cabiria, 1914 (from a silent movie by Giovanni Pastroni). Trying to capture how terrifying Psychosis sometimes feels like, which is difficult and the clip that goes with this photo reminded me of the experience.

In November 2014 I went to the launch of the lengthy report “Understanding Psychosis and Schizophrenia” by the British Psychological Society (BPS) in London. There I got to meet and hear from some of the top experts and clinical Psychologists in the UK. A revised version was published in 2017 [1].

‘Psychosis’ is a loss of touch with reality, which is usually temporary. Because the general population don’t understand it, they can overreact. The person themselves may feel quite confused & scared. Especially if it’s their 1st experience. It can involve unusual perceptions e.g. the person feels they are under attack from evil and the need to protect themselves. In my experience, how I protected myself was influenced by religious upbringing. I even started to go to Latin mass to try and calm my brain down ! While some would have frowned upon that at the time, for me it was a coping mechanism. I only occasionally go to church these days, usually to light a candle and to sit in silence for a while.

As an example of one of my “psychotic breaks”, in my last experience I decided that the town I live in, which is prone to flooding as it is built on a river, was going to become immersed in water. I checked into a hotel that was a few stories high & took a bus to a ‘safer’, inland county. At the time I was frightened. It wasn’t based on reality but could have been based on news reports and worries about climate change. Stress and lack of sleep would have been a trigger, plus the fact that I was still going through drug withdrawal. It took at least two years to get the main effects of long term use of prescribed psychotropic drugs out of my system and I was left with long term sleep issues, the effects of which I still feel to this day.

Psychosis can be triggered by anti-depressant use and severe lack of sleep / stress [2]. I had been on anti-depressants for anxiety / panic attacks for 3 years when I had a ‘psychotic break’ in August 2008. Other illicit drugs can also trigger psychosis e.g. skunk cannabis [3].

Trying to make sense of the symptoms can help. In the context of the person’s life. As through making sense of experiences or learning to process them, a person is more likely to recover.

Usually the people around you will not understand and may be unsupportive. I went through my last ‘psychotic break’ alone (2012). I would not recommend that but maybe getting through it alone is why I no longer fear it. There was also a Spiritual aspect to the experience and I wish I kept notes at the time to give me more insight into what I was going through. In my terrified state, particularly at night time, with no support around me, I used the online work of Sean Blackwell to help me through. “Bipolar or Waking up?” [4, 5, 6]. I do believe this was more of an awakening and a spiritual journey. A part of my own evolution as a soul on this planet.

A significant percentage of people hear voices and for many this is not a problem. If the person has voices that are distressing or ask them to harm themselves or others and the person finds this overwhelming, they would need help and support in coping with the voices. There are people who have managed to integrate their voices into their lives, without been affected negatively by them e.g. Eleanor Longden [7] , Jacqui Dillon [8] and Rai Waddingham [9]. Dutch Psychiatrist Dr Marius Romme has also done a lot of great work in the Hearing Voices Movement [10]. Some children also hear voices and may need support.

Others experience hallucinations. If the hallucinations affect a persons quality of life, including ability to work, sleep and relate with others, the person may need help in dealing with their experiences.

Open Dialogue

I’m a believer in the Open Dialogue approach, where the person should be involved as much as feasibly possible in decision making about their care or treatment plan [11, 12].

Open Dialogue includes the gathering of clinicians, family members, friends and other relevant persons for a joint discussion. It was started in Lapland by Jaakko Seikkula et al. It is also used in other countries eg the Parachute project in New York [13]. In West Cork a successful pilot project was implemented [14, 15]. It would be great to see widespread use of this approach. If a more traditional, backward approach is used it can lead to more dysfunction within a family and the fracturing of relationships, sometimes long term, in my experience. It is important to get the approach right at the start. Not everyone will want family involved in their care.

I write more about the trauma of what happened me in 2008 in the blog Anti-depressants are great, until you have an Adverse Drug Reaction, where I outline some of the things that would have helped at that crucial time. Because of the way people in ‘psychosis’ are treated, I ended up with Post Traumatic stress for the past 9 years. It has improved via therapy and hard work on my self, but it is something that will probably always be there are a protective force in my life. A hyper vigilance and a lack of trust in others.

Hence I have learned as much as I can about what is helpful when a person is in distress. I’ve dedicated several years to learning via reading, listening to audio/visual presentations (of experts I respect), courses, conferences and various short training sessions. A summary version of what happened to me can be found under Other Relevant Resources at the end of this blog.

During my first ‘psychotic break’ (where I had not harmed myself or others) I needed:

In places like Finland, where they employ the Open Dialogue approach and where prescribed psychoactive drugs are not the main form of treatment, they have proven that recovery is possible. They use early intervention and involve the person in decision making. In general, instead of the person ending up on disability they end up back as productive members of society.

Below is now 88 yr old Prof Ivor Browne giving a talk in the National College of Ireland in 2015. As opposed to being “anti-drug”, Prof Ivor Browne believes in using the lowest dosage of tranquilizing drugs possible for as short a time as possible. Ivor explained that people need help in understanding the psychotic process. He also recognises the importance of therapeutic relationships, personal friendships and loving relationships, when it comes to healing from trauma and distress. What are referred to as “Anti-psychotics” e.g. Olanzapine, as mainly major tranquilizers.

For people to have “Recovery spaces”, they need to be with supportive people who can tolerate, be patient and interact with the person in ‘Psychosis’. Soteria is a network of people in the UK promoting the development of drug-free and minimum medication therapeutic environments for people experiencing ‘psychosis’ or extreme states [16].

If a person is a carer for someone in emotional distress e.g. A family member, the long term goal should be to enable the person they are caring for. It is important to keep the person as independent as possible, so that they do not become too reliant on someone else e.g. doing their own laundry, some cooking, housework / cleaning and having a diary to organise their week. The carer also needs to take good care of themselves.

The public have learned to associate the word ‘psychosis’ with violence and there is not necessarily a link, unless drugs or alcohol are involved [17, 18]. That can include prescribed psychotropic substances or withdrawal from these drugs [19]. People in distress need hope that they can recover and heal. Education from reliable, unbiased sources is an important part of that healing journey. As are supportive and understanding people who can hold space for the person in distress. These support networks also need education around Psychosis, what is helpful and what is not. Being judgemental, getting into arguments with the person, being critical and dismissive of their experience is usually unhelpful. Trying to stay calm and creating a calm space for the person, where they are not over stimulated, might be helpful. Everyone is an individual and has their own unique journey and experience.

Note: This blog is not medical advice and is mainly based on my own experience. But also on my extensive interest and learning in the whole area. Do not stop or change prescribed psychotropic drugs without advice, due to the dangers of withdrawal. Any changes need to be made slowly, under the supervision of an expert in this field. At the start of my journey I was never given that advice from the ‘experts’ I was dealing with and this delayed my healing journey.

Minor and major tranquilizers did help me at times e.g. with sleep, which can help restore some normality. But overall, in hindsight, I found that the large cocktail of drugs I was on (over a 3 year period) fueled symptoms, as opposed to ‘curing’ them. “The ethical use of psychotropic drugs is perhaps the single most important aspect of Psychiatric care that requires urgent attention” Dr Phil Thomas [20, 21].

* waiting on approval to include extra tips on how to help people who are in psychosis and what doesn’t help. Also advice for carers on self-care.


References

[1] Understanding Psychosis and Schizophrenia, revised version 2017 ~

https://www.bps.org.uk/system/files/user-files/Division%20of%20Clinical%20Psychology/public/CAT-1657.pdf (Edited by Anne Cooke)

[2] Antidepressant-associated mania and psychosis resulting in psychiatric admissions. Yale study (2001) ~ www.ncbi.nlm.nih.gov/pubmed/11235925

[3] Smoking skunk cannabis triples risk of serious psychotic episode, says research

https://www.theguardian.com/society/2015/feb/16/skunk-cannabis-triples-risk-psychotic-episodes-study

[4] Am I Bipolar or Waking Up? Sean Blackwell, 2011

http://www.amazon.com/Am-I-Bipolar-Waking-Up/dp/1461178258

[5] Sean Blackwell’s work ~ www.youtube.com/user/bipolarorwakingup

[6] Corrina Rachel speaking to Sean Blackwell about Bipolar ~

~ www.youtube.com/watch?v=WLIeS6idzD4

[7] TED video by Eleanor Longden (Voice Hearing) ~

www.ted.com/talks/eleanor_longden_the_voices_in_my_head?language=en

[8] Jacqui Dillon (Voice Hearing) ~

www.rte.ie/radio1/doconone/radio-documentary-sounds-mad-hearing-voices-psychology.html

[9] Rai Waddingham ~ http://www.behindthelabel.co.uk/

[10] Hearing Voices Network ~ www.hearing-voices.org

[11] OPEN DIALOGUE: an alternative Finnish approach to healing psychosis (by Daniel Mackler) ~

https://www.youtube.com/watch?v=HDVhZHJagfQ

[12] A collection of resources on Open Dialogue and Open Dialogue practices ~

http://willhall.net/opendialogue/

[13] New York ‘Parachute’ programme for people with acute mental distress lands in the UK ~

https://www.theguardian.com/society/2015/oct/20/parachute-therapy-psychosis-new-york-uk

[14] Mental health pilot focus of Finnish film ‘Open Dialogue’ ~

http://www.irishexaminer.com/ireland/mental-health-pilot-focus-of-finnish-film-open-dialogue-393492.html

[15] A fresh approach to mental health ~
http://www.irishexaminer.com/lifestyle/features/a-fresh-approach-to-mental-health-396031.html

[16] Soteria ~ www.soterianetwork.org.uk

[17] ‘Mental disorders’ are neither necessary nor sufficient causes of violence ~ 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525086/

[18] Dispelling the Myth of Violence and Mental Illness ~

https://psychcentral.com/archives/violence.htm

[19] Prescription Drugs Associated with Reports of Violence Towards Others

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0015337

[20] Psychiatry in Context : Experience, Meaning & Communities by Dr Philip Thomas

https://www.amazon.com/Psychiatry-Context-Experience-Meaning-Communities/dp/1906254729

Dr Philip Thomas highlights the limitations of neuroscience in explaining Psychosis or distress. He also explores how Racism plays a key role in many black people’s experience of Psychosis.

[21] My review of this book ~ www.goodreads.com/user/show/46943899-anne

This review was published in the Journal of Critical Psychology, Counselling and Psychotherapy (Volume 16, Number 1, March 2016)

Other relevant Resources

* ‘I was unaware of potential adverse effects to my prescribed antidepressants’

https://www.independent.ie/life/health-wellbeing/mental-health/aines-story-i-was-unaware-of-potential-adverse-effects-to-my-prescribed-antidepressants-31218347.html

* One woman’s account of suffering from psychosis ~

www.todayfm.com/One-womans-account-of-sufferinbg-from-psychosis

* Course ~ Caring for People with Psychosis and Schizophrenia (pharma funded which influences the advice given) ~

https://www.futurelearn.com/courses/caring-psychosis-schizophrenia

* Intervoice (International Hearing Voices Projects) ~ www.intervoiceonline.org

* Hearing Voices Network Ireland ~
http://hearingvoicesnetworkireland.ie/

* The Icarus Project ~ http://theicarusproject.net/

* CRAZYWISE – Official Extended Trailer ~

https://www.youtube.com/watch?v=iKfQd0bk214

* Peter Lehmann “Recovery from Psychosis and Depression by Taking Psychiatric Drugs versus Recovery by Coming off Psychiatric Drugs”

www.peter-lehmann-publishing.com/articles/lehmann/pdf/recovery-from.pdf

* 8 Tips to Help Stop Ruminating ~
www.psychcentral.com/blog/archives/2014/02/16/8-tips-to-help-stop-ruminating

 * Adverse effects of Prescribed Psychotropic substances (e.g. the anti-psychotic Olanzapine) may be found in my initial blog “Some of the many useful links…”

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