Last month the British Psychological Society’s Division of Clinical Psychology published a very important document. It’s called Understanding Psychosis and Schizophrenia, and was edited by Anne Cooke, Principal Lecturer in the Department of Applied Psychology, Canterbury Christ Church University.
Here are some quotes:
“It is often assumed that there is a straightforward dividing line between ‘mental health’ and ‘mental illness’ (normality and abnormality) and that discrete, identified disease processes (for example ‘schizophrenia’) are responsible for experiences such as hearing voices. However, recent research suggests that this is not the case.”
“At points we probably all also have beliefs that some others would find odd. Stressful life events are likely to have a significant impact on how we think and feel…”
“People who continue to have severe and distressing experiences may lead happy and successful lives in all other respects, such as work and relationships. Many people find that the hardest part of recovery is overcoming prejudice, discrimination, lowered expectations and the pressure to subscribe to a ‘sick role’.”
“An enormous range of things have been proposed as possible causes of psychotic experiences. As every thought is both a brain-based event and a human experience, it can be impossible to separate out different types of causes. It can be helpful to think in terms of ‘levels of explanation’ rather than causes. For example, a thought can be explained in terms of its brain chemistry (which chemicals are involved?), its psychology (e.g. do people have different ‘thinking styles’ in different moods?) or its social context (e.g. what has happened to which the thought is a reaction?). An explanation might link these levels but one does not ‘cause’ the other any more than, say, the wiring of a television ‘causes’ the plot of EastEnders.”
“Over the last 15 years or so, we have discovered much more about the role that life events can play for many people, particularly deprivation and trauma. It seems that, as with other problems such as anxiety and depression, a major cause of many psychotic experiences lies in things that have happened in people’s lives, and how these have affected them.”
“However, the widespread acceptance of the idea that diagnoses such as schizophrenia refer to biological illnesses has led to a situation where people often assume that experiences such as hearing voices always arise from a problem within the brain. As a result workers have often not tried to understand the experiences in the context of the person’s life, or prioritised talking to the person about their experiences. The ‘brain disease’ idea has also contributed to a climate in which the main, or only, treatment tends to be medication. This in turn has meant that other approaches to helping, such as talking treatments, have often been unavailable. It has also diverted resources away from the circumstances of people’s lives, not only in the way that we try to help people in distress, but also in research and in efforts at prevention.”
“At least in the UK, most mental health services are currently based on the ‘medical model’ – the assumption that experiences such as hearing voices indicate illness and result from some sort of problem with the brain. This idea is also enshrined in mental health law and is the basis for compulsion. In the past many professionals have also believed that people experiencing distressing voices or paranoia are unlikely to recover without treatment (usually medication). This belief has led to a perceived ‘duty of care’ to provide treatment, and a tendency to view someone who does not want the treatment being offered as lacking in insight. As this report has shown, both of these assumptions are unfounded.”
The fact that Britain’s principle association of clinical psychologists has published a paper of this kind represents a major breakthrough, and can legitimately, I think, be called a milestone.
The central theme of the paper is that psychosis is understandable, not in psychiatry’s sense, as an indication of broken neural machinery, but rather as one of the highly individualized ways that people cope with their experiences.
The paper runs to 180 pages, which includes about 40 pages of very useful references.
Incidentally, there’s an excellent article on the paper – Making Space for the Meaning in Madness – by Jay Watts, DClinPsy, on the Huffington Post (November 26). Dr. Watts is a British clinical psychologist and psychotherapist, Honorary Senior Research Fellow at Queen Mary University of London and an Associate Fellow of the British Psychological Society.