Psychosis is a broad term for a range of ways in which we might experience a different reality from most other people. It is a more formal name for what we mean by madness or craziness. The most commonly discussed examples are hearing voices that others cannot hear (‘hallucinations’) and holding unusual, idiosyncratic beliefs that seem strange or frightening to others (‘delusions’). These beliefs are often about fearing that others are out to harm us (‘paranoid delusions’) and sometimes about unusual powers or responsibilities we feel we have (’grandiose delusions’).
Understandings of these experiences has varied throughout history, with religious explanations dominating until the last two centuries. Today, understandings greatly between cultures. Many ‘developing’/’third world countries’ continue to make sense of hearing voices and so on from a social and spiritual context which provides a shared meaning to the experiences.
In ‘developed’/’first world’ countries, meanwhile, the official view of madness is dominated by a biological/medical framework. This ideology dictates that hearing voices is a symptom of an illness, invented at the end of the 19th century in Germany. This supposed brain disease, called ‘schizophrenia’, is said to have a biological and genetic basis. In fact the construct itself is meaningless. There are five types of symptoms of this invented illness: (hallucinations, delusions, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms’ (e.g. having no feelings). We only need two of these five to get the diagnosis. So I can have the first two and nothing else, and you might have the last two and nothing else. We have no symptoms in common, but we get the same diagnosis. In scientific circles this is called a ‘dysjunctive’ category and is immediately discarded.
Both the label ‘schizophrenia’ and belief in bio-genetic causal beliefs have been shown in study after study to increase stigma, fear and prejudice. Many people given the diagnosis report that the reaction of other people when told of the diagnosis is worse than the problems that earned them the diagnosis in the first place. And yet ‘destigmatisation’ programmes, often funded by drug companies, promote the false notions that ‘mental illness is an illness like any other’ and that ‘schizophrenia’ is a debilitating, permanent condition involving inferior genes and a dysfunctional brain. Unsurprisingly this attitude leads to pessimism about recovery, among the public, professionals and ‘patients’.
However, in all but one (the U.S.A.) of the 23 countries (‘developed’ and ‘developing’) where surveys have been conducted the public believes that mental health problems, including madness/psychosis/’schizophrenia’, are cause primarily by life events (stress, unemployment, violence, child abuse/neglect., war trauma, rape, etc) rather than by biological or genetic factors.
It seems the public may be right. The evidence linking adversities, in childhood and thereafter, to psychosis is overwhelming. The evidence put forward in support of bio-genetic causal notions is flawed and unconvincing. Nevertheless the ‘medical model’ has a powerful ally. The pharmaceutical industry exerts its enormous financial might to influence research funding and journals, professional training, prescribing practices, the media and social, professional organisations, and drug regulation bodies (such as the FDA in the USA).
Anti-psychotic medication is currently the first line of treatment (often forcibly) despite their being only marginally more effective than placebo and having a range of severe adverse effects which shorten life span by 5 to 10 years. Evidence based non-medical approaches, including CBT for psychosis (CBTp) and Open Dialogue remain inaccessible for most people who would benefit. Meanwhile the Hearing Voices Network has established self-help groups in over 20 countries, where people can support and learn from one another without being labelled, stigmatised or drugged.
Bentall, R. P. et al. (2014). From adversity to psychosis: Pathways and mechanisms from specific adversities to specific symptoms. Social Psychiatry and Psychiatric Epidemiology, 49(7), 1011–1022.
Although there is considerable evidence that adversities in childhood such as social deprivation, sexual abuse, separation from parents, neglect and exposure to deviant parental communication are associated with psychosis in later life, most studies have considered broad diagnoses as outcomes. In this review we consider evidence for pathways between specific types of adversity and specific symptoms of psychosis. 引文
Longden, E. & Read, J. (2016). Social adversity in the etiology of psychosis: A review of the evidence. American Journal of Psychotherapy, 70(1), 5–33.
Longden, E. et al. (2018). Assessing the impact and effectiveness of hearing voices network self-help groups. Community Mental Health Journal, 54(2), 184–188.
The Hearing Voices Network (HVN) is an influential service-user led organisation that promotes self-help as an important aspect of recovery. This study presents the first systematic assessment of the impact and effectiveness of HVN self-help groups. A customized 45-item questionnaire, the Hearing Voices Groups Survey, was sent to 62 groups affiliated with the English HVN. 101 responses were received. Group attendance was credited with a range of positive emotional, social and clinical outcomes. Aspects that were particularly valued included: opportunities to meet other voice hearers, provision of support that was unavailable elsewhere, and the group being a safe and confidential place to discuss difficult issues. Participants perceived HVN groups to facilitate recovery processes and to be an important resource for helping them cope with their experiences. Mental health professionals can use their expertise to support the successful running of these groups. 引文
Longdon, E. & Read, J. (2017). “People with problems, not patients with illnesses”: Using psychosocial frameworks to reduce the stigma of psychosis. The Israel Journal of Psychiatry and Related Sciences, 54(1), 24–28.
Read, J. (n.d.). Making sense of, and responding sensibly to, psychosis. Journal of Humanistic Psychology, 0022167818761918.
This article argues that words like “psychosis” and “schizophrenia” create the illusion of an explanation for certain behaviors and thoughts but actually explain nothing. Hearing distressing voices and feeling very paranoid do not occur because someone has something called “schizophrenia” that causes them to act in certain ways, although many psychiatrists still cling to this delusion. The behaviors and thoughts that experts in some cultures label psychotic or schizophrenic are usually understandable reactions to our life events and circumstances. So rather than ask, “What is wrong with you?” and “What shall we call it?” It is more sensible, and useful, to ask, “What happened to you?” and “What do you need?” 引文
Read, J. et al. (2014). The traumagenic neurodevelopmental model of psychosis revisited. Neuropsychiatry, 4(1), 65.
Read, J. & Williams, J. (2019). Positive and negative effects of antipsychotic medication: an international online survey of 832 recipients. Current Drug Safety.
This article aimed to ascertain the experiences and opinions of users of an international sample of antipsychotic drugs regarding positive and negative effects. 引文
Taitimu, M. et al. (2018). Ngā Whakāwhitinga (standing at the crossroads): How Māori understand what Western psychiatry calls “schizophrenia.” Transcultural Psychiatry, 55(2), 153–177.
This project explored how Maori understand experiences commonly labelled 'schizophrenic' or 'psychotic'. 引文
Geekie, J. et al. (2013). Experiencing psychosis: Personal and professional perspectives. Routledge.
In this book, first-person accounts are brought centre stage and examined alongside current research to suggest how service user experience can contribute to professional understanding and therefore the treatment of psychosis.
引文
Read, J. & Dillon, J. (2013). Models of madness : Psychological, social and biological approaches to psychosis. London
New York: Routledge.
Are hallucinations and delusions really symptoms of an illness called 'schizophrenia'? Are mental health problems really caused by chemical imbalances and genetic predispositions? Are psychiatric drugs as effective and safe as the drug companies claim? Is madness preventable? This second edition of Models of Madness challenges those who hold to simplistic, pessimistic and often damaging theories and treatments of madness. In particular it challenges beliefs that madness can be explained without reference to social causes and challenges the excessive preoccupation with chemical imbalances and genetic predispositions as causes of human misery, including the conditions that are given the name 'schizophrenia'. This edition updates the now extensive body of research showing that hallucinations, delusions etc. are best understood as reactions to adverse life events and that psychological and social approaches to helping are more effective and far safer than psychiatric drugs and electroshock treatment. A new final chapter discusses why such a damaging ideology has come to dominate mental health and, most importantly, how to change that. 引文
.