Are you Prepared to Address Psychosis in Your Practice? (Feature-Length Version)

In Madness and Civilization, philosopher Michel Foucault has predicted a proliferation of madness as disparities increase and modern society advances. Indeed, with psychopharmacology industry booming, rates of addiction, fueled by the opioid epidemic, skyrocketing, terrorism wars raging abroad, ongoing drug wars afflicting low income neighborhoods, escalation in homeless encampments in major cities, and a rise in bullying in schools, and even cyberbullying, it really does seem like higher percentage of people have been forced to explore their mental health struggles. While mass shootings have kept danger stigma in the media high and the media response continues to reinforce silence about mental struggles, the field of psychotherapy does have a lot more trends to address.

When I look through my state’s psychotherapy association’s annual conference, I see many of these trends getting addressed in workshops. But ever invisible is the issue of psychosis. Is it possible that the issue of psychosis functions as a significant part of the madness narrative? Is it possible that psychosis too is affecting more and more Americans as Foucault inferred?

 

 

What the Statistic Say: Continue reading “Are you Prepared to Address Psychosis in Your Practice? (Feature-Length Version)”

A New Definition of Psychosis

Psychosis is an antiquated word that leads to huge misunderstandings that play a large role oppressing a larger and larger portion of the population. For the past nine years I have run professional focus groups, going through the process of listening, exploring, reflecting, writing, seeking feedback and rewriting to get a better definition of psychosis.

 

Defining Psychosis, the Mainstream Way:

I remember using the mainstream definition as a young professional during the job I used to get me through my Master’s Program. Wondering how I was to connect with people who had delusions and voices that I clearly didn’t experience with my neurotic, highly-medicated self, I filled the white board with a list of labels and complicated words I was proud to be able to define. It was my college education that got me the job, and this was one way I could use it to be useful.

positive symptoms

Hallucinations:           reports of sounds (voices,) visuals, tactile sensations, tastes, and olfactory sensations that others do not experience

Delusions:                   “an idiosyncratic belief or impression that is firmly maintained despite being contradicted by what is generally accepted as reality or rational . . .” In spite of the “preponderance of the evidence”

Disorganized Speech: Frequent derailment or incoherence): Word salad, tangential, or circumspect speech

negative symptoms

  1. Andhedonia
  2. Avolition
  3. Amotivation
  4. Alogia
  5. Attention Problems
  6. Catatonia
  7. Posturing
  8. Lethargy
  9. Flat affect
  10. Social Withdrawal
  11. Sexual Problems

 

The Errors of These Ways:

Life has taught me that the mainstream definition, as such, does little to depict what it feels like to have a break from reality. Indeed, not understanding this can cause a supporter to make things worse even when they have the best of intentions. Indeed, miscommunication, pain, and strained relationships often result once a sufferer has a break.

Continue reading “A New Definition of Psychosis”

Another Anything for a Little Attention Man

It’s true that a plastic rimmed hat

That cost me ten cents at a thrift store

Is sitting on my head;

And it’s true that they gave me

A free plastic trash bag

To covers some  of my

Old five and dime store clothing display;

And it’s true I might have taken the bus;

When it didn’t look like rain this morning;

And it’s true that it would have been

Ten miles home, or four miles to the mall

By the time the skies opened

And dogs and cats nailed down upon my face;

It’s true that already have an interview suit

In another state

That my father wouldn’t send to me

When we fought on the phone earlier today;

And it’s true I have an interview on Friday

And it’s true that I have the money

On my card to pay;

And it’s true that I don’t have enough money

To pay four more months’ rent stay;

Continue reading “Another Anything for a Little Attention Man”

The Need to Dismantle Industry Constructs (Part Three)

When I think back to my twenty-two-year career working with other providers, my mid-career first-break, and the things that helped me recover, like my dog, I know for sure that the standard of care needs is a disservice to those who experience madness.

Many people who have breaks from reality get that permanent housing trajectory in their heads and rant and rail against it. They may still believe that there is such a thing as schizophrenia and be disinterested in the lives of their peers who are clearly schizophrenics. Those who have breaks, like me, are extremely diverse with distinctive cultural backgrounds, different access to resources and differing levels of buy into to the concept that they are permanently ill with something that will never go away. Those without a history of privilege become very susceptible for decline into permanent warehousing conditions that make healing very challenging.

Clearly, dismantling industry constructs for things like schizophrenia and poor prognosis is an important component of recovery. I have a hunch that to plan for generativity, schizophrenic constructs, other disorder constructs that block the formation of counterculture, and constructs from developmental psychology need to be challenged.

 

 

***

Continue reading “The Need to Dismantle Industry Constructs (Part Three)”

The Need to Plan for Your Loved Ones Recovery (Part One)

 

In the United States, when a person has what is often referred to as a first break, the courses of action that get taken against them may end up being a crime against their humanity.

While there can be very diverse responses from family and friends, there is the unfortunate tendency to turn to the mental health industry for support and direction. Many providers in the industry only know the standard of care which is to refer the person to a hospital and psychiatric medications.

Few providers take an interest in understanding and exploring the important experiences that lead to the break. I call these experiences special messages. Finding a provider who is curious about these experiences, skilled at understanding them, and who knows better than to try to suppress them can be rare.

Many providers fail to acknowledge the trauma involved in the lives of the people who have first breaks and that the trauma that gets worsened as the standard of care—forced medication, social security, revolving hospital doors, and warehousing—get implemented. Many presume this is a necessary process.

Continue reading “The Need to Plan for Your Loved Ones Recovery (Part One)”

Learning Disabilities and Psychosis

Never saw my hometown until I stayed away too long

I never heard the melody until I needed the song . . .

. . . I never I spoke “I love you” till I cursed you in vain

Never felt my heart strings until I nearly went insane

                                                           

–Tom Waites, San Diego Serenade

 

It is funny how sometimes one cannot really see themselves until they get a glimpse of a harsh paradoxical reality. Perhaps doing so gives one that alternate perspective that is so necessary to really see oneself and gain wisdom. I think that’s what Tom Waites is getting at in the excerpts of his song I posted above. That is why the ability to relate to others is such a powerful teacher and healer that is so needed in a therapeutic endeavor. Other people’s struggles help us stop and see ourselves better. Even if it is painful, growth is likely.

And, just as the song goes, I never really saw myself as a learning-disabled person until I just recently had the opportunity to sit with an individual while she was receiving a mid-life diagnosis. It was a diagnosis that I thought might be helpful. Little did I know that before this sitting, I rarely considered the full effect of how a learning disorder affects me as a writer, therapist and mental health consumer.

 

***

Continue reading “Learning Disabilities and Psychosis”

A Need for Providers who Specialize in “Psychosis.”

I was hired straight out of college into work in the counseling field. I started to work with an adult mental health population at my second professional job at the age of twenty-three. Since that time I have been increasingly focused on how to make therapeutic engagement meaningful when working with people in “psychosis.” In the field there are many who will say or imply this is not possible. They may argue that the mental health system is the best we can do. This story is for the providers who think more can be done to help individuals who have anomalous experiences.

***

Working my way through graduate school, I can still remember struggling to get my dumb-ass footings as a professional counselor. I remember thinking about how ironic it is that they start you out with the most sophisticated of problems.

“Oh, you’re good,” said this vagabond homeless man who sticks out in my memory.

“What do you mean?” I asked perplexed by how he could affirm me with such confidence.

“Well, I can tell because you just asked me what was going on with my schizophrenia, like you really wanted to understand it.” Continue reading “A Need for Providers who Specialize in “Psychosis.””

Writing for Mental Health: Six Basic Considerations

I like to think that I could recommend writing to some other people who have been subjected to a diagnostic labeling process that diminishes their hopes and potential. Indeed as emotional tension pulses through my back and appendages, I have found few other outlets that are there for me like the mixing and mastering letters.

Sure, I have been sent to a shrink for being who I am. Sure, I have been buried in institutions at different points of my life. Indeed life on that trajectory has filled me with loss and lack. But when I’ve found myself incarcerated immobile, I’ve been blessed to find value in defining it. Initially as a teen, I found  appreciating expressive words through music got me started. The more I switched from song to verse to story, I found the problem-solving that takes place in the editing process satisfying. Indeed for me there are few other outlets that rival writing in terms of learning about life and wellness.

Continue reading “Writing for Mental Health: Six Basic Considerations”

A Vacation Day for a Schizophrenic:

Fifteen years ago, I remember hearing a psychiatrist who had just been away for two weeks say, “There is no such thing as a vacation when you are schizophrenic!” As an unlicensed professional vying to get a staff position on the unit, I had carefully avoided rolling my eyes. I had politely nodded my head as though it had been a thoughtful thing to say.

***

This year’s weekend of April 1st, my wife supports me in insisting that we take a vacation day. She packs up her hybrid SUV with camping materials and when I finish my Friday commute, we hit the interstate headed north. We plan to camp and hike at the Kings Range on the Lost Coast in Humboldt County, but we know even before we sift through the remains of the Bay Area traffic, there’s no way we are going to make it the whole way.

We make it to the city of Ukiah and drive until we find a Safeway. I am about ready to drop as we load our shit into the front of the car and depart to hit the restroom. We pass the panhandlers and the no camping sign and I start to stress about the possibility that the security will force us to move on in the middle of the night.

“Don’t worry about it my boobie,” says my wife.

I look into the eyes of a particular panhandler and hate our privilege. There sure are a significant amount of late night shoppers who are finishing their long weeks. I ponder the meaning of it all over the urinal. After we regroup, we steal into the back of the SUV.

Continue reading “A Vacation Day for a Schizophrenic:”