Understanding Psychosis and Schizophrenia

understanding“An individual having unusual difficulties in coping with his environment struggles and kicks up the dust, as it were. I have used the figure of a fish caught on a hook: his gyrations must look peculiar to other fish that don’t understand the circumstances; but his splashes are not his affliction, they are his effort to get rid of his affliction and as every fisherman knows these efforts may succeed.” Karl Menninger

What would happen if a team of highly qualified psychologists joined up with a team of people who knew psychosis from the inside, from their own journey into madness and then recovery – and if they collaborated in writing a guide to understanding the difficult states that get names like “psychosis” and schizophrenia”?

Well, you don’t have to wonder anymore, because the result was published a couple of days ago in the form of a report (180 pages) that is free to download. This report is well worth reading. Here’s a summary:

‘Executive Summary
This report describes a psychological approach to experiences that are commonly thought of as psychosis, or sometimes schizophrenia. It complements parallel reports on the experiences commonly thought of as bipolar disorder and depression.

Hearing voices or feeling paranoid are common experiences which can often be a reaction to trauma, abuse or deprivation. Calling them symptoms of mental illness, psychosis or schizophrenia is only one way of thinking about them, with advantages and disadvantages.

There is no clear dividing line between ‘psychosis’ and other thoughts, feelings and beliefs: psychosis can be understood and treated in the same way as other psychological problems such as anxiety or shyness. Significant progress has been made over the last twenty years both in understanding the psychology of these experiences and in finding ways to help.

Some people find it useful to think of themselves as having an illness. Others prefer to think of their problems as, for example, an aspect of their personality which sometimes gets them into trouble but which they would not want to be without.

In some cultures, experiences such as hearing voices are highly valued.

Each individual’s experiences are unique – no one person’s problems, or ways of coping with them, are exactly the same as anyone else’s.

For many people, though not all, experiences such as hearing voices or feeling paranoid are short-lived. Even people who continue to experience them nevertheless often lead happy and successful lives.

It is a myth that people who have these experiences are likely to be violent.

Psychological therapies  – talking treatments – are very helpful for many people. The National Institute for Health and Care Excellence recommends that everyone with a diagnosis of psychosis or schizophrenia should be offered talking therapy. However, currently most people are unable to access it.

More generally, it is vital that services offer people the chance to talk in detail about their experiences and to make sense of what has happened to them. Surprisingly few currently do. Professionals should not insist that people accept any one particular framework of understanding, for example that their experiences are symptoms of an illness.

Many people find that ‘antipsychotic’ medication helps to make the experiences less frequent, intense or distressing. However, there is no evidence that it corrects an underlying biological abnormality. Recent evidence also suggests that it carries significant risks, particularly if taken long term.

Services need to change radically, and that we need to invest in prevention by taking measures to reduce abuse, deprivation and inequality.’

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