Schizophrenia and Psychosis – Brain Disease or Existential Crisis?




Burning blurred lights

With the most recent schizophrenia/psychosis recovery research, we discover increasing evidence that psychosis is not caused by a disease of the brain, but is perhaps best described as being a last ditch strategy of a desperate psyche to transcend an intolerable situation or dilemma. To better understand how this conclusion which is so contrary to the widespread understanding of psychosis has come about, it will help if we break down this discussion into a short series of questions and answers.

What? Schizophrenia may not be caused by a brain disease?

The emerging recovery research and continuous lack of substantiation of any of the various brain disease hypotheses have cast serious doubts about the validity of the brain disease theory (as discussed in more detail in my book Rethinking Madness and my previous posts (Full Recovery from Schizophrenia? and Is Schizophrenia Really a Brain Disease?): 1) regarding the anomalous brain structures or brain chemistry that is sometimes found in people diagnosed with schizophrenia, these are only found in a small minority of cases, and even in these cases, there is no significant evidence that these are caused by anything other than unusual life circumstances (e.g., trauma, nutritional deficiencies, and substance abuse) or by the use of psychiatric drugs themselves; 2) the research is clear that, in stark contrast to well established diseases of the brain (such as Alzheimer’s, Parkinson’s, Huntington’s, and multiple sclerosis), many people diagnosed with schizophrenia/psychosis make full and lasting medication-free recoveries; and 3) that many of those who experience full recoveries do not just return to their pre-psychotic condition, but experience profound healing and positive growth beyond the condition that existed prior to their psychosis, again in stark contrast to well established diseases of the brain.

So, if schizophrenia/psychosis is not caused by a disease of the brain, then what does cause it?

This is not a simple question, and it’s further compounded by the fact that there continues to be widespread controversy over whether or not “schizophrenia” is even a valid construct. While there is not the room to go into the details of this issue here, the essence of this controversy is that while it is clear that many people experience anomalous beliefs and perceptions (so called delusions and hallucinations), we still don’t have clear evidence that it’s appropriate to lump the vast range of such experiences under a single label. All that we can really say for sure is that people do experience distressing anomalous experiences (so called delusions and hallucinations), and that such experiences cause varying degrees of distress and limitation, last for varying lengths of time, and sometimes arise with varying degrees of strong emotions and/or altered states of consciousness. Therefore, for the sake of this discussion, I find it more helpful to just use the term “psychosis,” acknowledging that what we call “schizophrenia” is essentially just long-term psychosis.

Returning, then, to the question of what causes schizophrenia/psychosis, I’ve devoted an entire book, Rethinking Madness, to a thorough exploration of this question, and unfortunately, it’s just not possible to adequately summarize the thorough answer that this question deserves within such a brief article. What I will attempt to do here, however, is to put forth the most essential concepts of this alternative understanding and encourage others to engage in a fruitful dialogue about this important topic.

What I believe is the most relevant implication of the emerging recovery research (of others’ research as well as my own) with regard to the cause of psychosis can be put like this: The individual we deem “schizophrenic” or “psychotic” is merely caught in a profound wrestling match with the very same core existential dilemmas with which we all must struggle. In other words, it appears likely that schizophrenia/psychosis is not caused by a disease of the brain but is rather the manifestation of a mind deeply entangled within the fundamental dilemmas of existence.

So what exactly are these existential dilemmas?

The term “existential dilemma” essentially refers to the dilemmas inherent in finding ourselves in a state of existence — “Here I am, alive, conscious, and feeling. Now what?” These dilemmas, at their core, relate to our need to maintain our existence, and perhaps even more importantly, our need to create a life that is worth living — where the joys and rewards of living are strong enough to overcome the inherent pain and suffering of life and provide us with the will to go on living. Some of the most important such dilemmas that have been named by various existential thinkers are: finding a balance between autonomy/authenticity and love/belonging; finding a balance between freedom and security; coming to terms with the fact that all of our decisions and actions come at some cost; coming to terms with our own impending death; and cultivating enough meaning in our lives so that we are able to rise out of bed every morning and greet each new day.

In virtually all of the research and case studies I have come across that have looked closely at the actual subjective experiences of those who have fallen into a psychotic process, we see evidence that, prior to the onset of psychosis, these individuals had found themselves in overwhelming existential dilemmas similar to those mentioned above, but to a far greater degree than that which the average person ordinarily experiences. In one of the most well-known such studies, R. D. Laing, a Scottish psychiatrist renowned for his pioneering research on schizophrenia and his clinical work with those so diagnosed, closely studied the social circumstances surrounding over 100 cases of individuals diagnosed with schizophrenia, and he concluded that “without exception the experience and behavior that gets labeled schizophrenic is a special strategy that a person invents in order to live in an unlivable situation”. Bertram Karon, one of the world’s most renowned clinicians specializing in psychotherapy for those diagnosed with psychotic disorders, stated his belief that any one of us would also likely experience psychosis if we were to have to live through the same set of circumstances as those of his psychotic clients. We see other evidence of this again and again in the plethora of biographical and autobiographical accounts that have been written and filmed.

The original focus of my own research was to explore the change within my participants’ experience and understanding of the world and themselves (their personal paradigm) that took place throughout their entire psychotic process, from onset to full recovery. The findings that emerged with regard to the onset of psychosis were very much in alignment with the findings of the other research mentioned above — there is clear evidence that every participant in all three of my own studies had also experienced such an overwhelming dilemma prior to the onset of psychosis. After thorough analysis of the data in the final and most comprehensive of the three studies, I arrived at the conclusion that there are essentially two fundamental dilemmas that appeared to lie at the crux of both the onset and resolution of these participants’ psychotic process:

1) The need to achieve a sustainable balance between autonomy (personal choice/personal freedom/authenticity) and connection (love/belonging/acceptance).

2) The need to maintain a relatively secure and stable sense of self when the very fabric of our being and indeed of the entire universe is profoundly groundless, impermanent, and interconnected.

What is particularly interesting about these dilemmas that seem to play such an important role in psychosis is that they may be the very same dilemmas that lie at the core of all human experience, regardless of one’s degree of sanity or lack thereof. It’s likely that most of us can easily relate to the first dilemma — we only need to think of the various challenges we’ve had in our relationships with family members, partners, and other loved ones. We can easily witness this dilemma occurring within toddlers as they struggle to find a balance between the drive to explore the world and assert their autonomy while still wanting to be unconditionally loved and accepted by their caretakers. And of course this dilemma never fully goes away for most of us. The second dilemma mentioned above is probably a little more difficult for some of us to relate to, especially for us Westerners (many practitioners of some of the Eastern traditions such as Buddhism, Taoism, and Advaita Vedanta have thoroughly explored this dilemma). This dilemma generally lies a little more deeply beneath our conscious awareness than the first dilemma, though it often becomes conscious in unusual circumstances, such as during contemplative practice (such as mindfulness meditation), psychological/emotional crisis, and hallucinogenic drug use.

So, if these existential dilemmas are universal, then why do some individuals become more overwhelmed by them than others, and go on to develop psychosis?

The research suggests that there are two main factors that may make someone vulnerable to experiencing one or both of these dilemmas to a very high degree:

With regard to the first dilemma (autonomy vs. relationship), it has long been established in the field of developmental psychology that healthy childhood development requires that we find a healthy balance between our sense of autonomy and our trust that we are loved and accepted by others. Attachment research has been exploring and validating this idea for decades. Childhood abuse (physical, sexual, and/or emotional), trauma, neglect, and a poor fit between the temperament of a child and her/his caretaker(s) all clearly interfere with establishing a healthy balance in this regard, and all of these are well established in predisposing someone to developing serious emotional and psychological problems, and in more extreme cases, psychosis.

Regarding the second dilemma, recall that this dilemma refers to our need to maintain the sense that we are a relatively secure and stable self living in a relatively secure and stable world, when the reality of our situation is very different than this. To better understand how someone can be overwhelmed by this dilemma, it will help to first touch on the concept of cognitive constructs. The term cognitive constructs refers to the belief systems and interpretations that each of us has constructed throughout our lives which allow us to make sense of the world. They can act somewhat like a double edged sword for us. On one hand, they provide us with the means to distinguish one object or being from another, and they give us the general sense that we “kinda know what’s going on” so that we can meet our needs and navigate our way through life. They also give us a sense that there is some solid ground beneath our experience — in other words, that we are a secure and stable self living in a relatively secure and stable world. But on the other hand, our cognitive constructs can close our minds to other perspectives, and they create the illusion that the world and our self are much more stable and secure than they actually are.

For most of us, our cognitive constructs are fairly solid, changing only slowly over time. However, in certain cases, such as during acute crisis or trauma, or with the use of certain psychoactive drugs, one’s cognitive constructs can become very unstable. On one hand, this can lead to the potential benefit of having a more open mind (less rigid belief systems) and a greater sense of interconnectedness and “oneness” with all; but on the other hand, the loosening of our cognitive constructs can also lead to the potential terror of experiencing just how precarious and ungrounded our existence and self really are, which can lead to profound shifts within our personal paradigm as we attempt desperately to find some “solid ground” to cling onto once again. Such radical personal paradigm shifting is closely associated with so called delusions and hallucinations — experiences that are generally equated with psychosis.

Why some people are more prone to the loosening of one’s cognitive constructs is still somewhat mysterious — it appears that certain drugs and psychological or physiological distress may play a significant role, and there may even be some genetic or developmental predisposition. However, even though some people may be more prone to the destabilization of their cognitive constructs, it seems likely that virtually anyone has the potential to experience this if exposed to an overwhelming dilemma, situation, or trauma. It’s all too easy to find cases of extreme neglect, abuse, torture, or other trauma that have profoundly shaken up one’s experience of one’s self and the world and led to psychosis or at least psychotic-type experiences.

The research suggests, then, that both of these factors play an important role in the development of psychosis — an overwhelming existential dilemma and unstable cognitive constructs. The research also suggests that these two factors are very closely related, in that the experience of such an overwhelming dilemma makes one more susceptible to experiencing unstable cognitive constructs, and vice versa. It’s also important to emphasize that it is the individual’s own subjective experience of their situation that is most relevant. Sometimes, it’s easily evident to an observer that an individual is experiencing such an overwhelming dilemma (again, think of overt trauma, abuse, torture, etc.); but at other times, the individual’s crisis is not so apparent to an onlooker, though it is often all too apparent to the individual her/himself.

So we finally arrive at the final and perhaps most important question in this discussion: “Why would an individual’s psyche intentionally initiate psychosis?”

In other words, how can something as chaotic and as potentially harmful as psychosis act as a strategy to aid someone in transcending an otherwise irresolvable dilemma? To understand this, it helps to use as a metaphor the process of metamorphosis that takes place within the development of a butterfly. In order for a poorly resourced larva to transform into the much more highly resourced butterfly, it must first disintegrate at a very profound level, its entire physical structure becoming little more than amorphous fluid, before it can reintegrate into the fully developed and much more resourced form of a butterfly. In a similar way, when someone enters a state of psychosis, we can say that prior to the onset of psychosis, for whatever reason, they have arrived at a way of being in the world and experiencing of the world that is no longer sustainable (i.e., is poorly resourced), and it seems that their predicament cannot be resolved using more ordinary strategies. As a desperate last-resort strategy, then, one’s own psyche initiates a psychotic process. As the individual enters into a psychotic process, we can say that their very self, right down to the most fundamental levels of their being, undergoes a process of profound disintegration; and as we have seen in the recovery research, with the proper conditions and support, there is every possibility of their continuing on to profound reintegration and eventual reemergence as a renewed self in a significantly changed and more resourced state than that which existed prior to the psychosis.

This is why the intentional destabilization of one’s cognitive constructs may be so beneficial, although of course very risky. It is this very loosening of one’s personal paradigm — of one’s experience and understanding of one’s self and of the world — that allows an individual to undergo such a profound transformation at such a deep level of their being. When such a process resolves successfully, the potential amount of growth and/or healing that this allows is enormous; but of course, when such a process does not resolve successfully, an individual’s personal paradigm may remain unstable and chaotic indefinitely (think florid psychosis).

This idea is well supported in the recovery research in the findings that many people who make full recoveries from psychosis often experience a degree of wellbeing and ability to meet their needs that far exceeds that which existed prior to their psychosis. It’s important to keep in mind, of course, that such resolution is not always successful, and that an individual may remain in a psychotic condition indefinitely. But we must also not lose sight of the very hopeful findings from the recovery research that suggest that such a successful resolution from a psychotic process is surprisingly common, and may even be the most common outcome given the proper conditions and support (see “Full Recovery from Schizophrenia?” ).

References

Arieti, S. (1978). On schizophrenia, phobias, depression, psychotherapy, and the farther shores of psychiatry. New York, NY: Brunner/Mazel.

Bassman, R. (2007). A fight to be: A psychologist’s experience from both sides of the locked door. New York, NY: Tantamount Press.

Beers, C. W. (1981). A mind that found itself. Pittsburgh, PA: University of Pittsburgh Press.

Dorman, D. (2003). Dante’s cure. New York, NY: Other Press.

Greenberg, J. (1964). I never promised you a rose garden. Chicago: Signet.

Hagen, B. F., Nixon, G., & Peters, T. (2010). The greater of two evils? How people with transformative psychotic experiences view psychotropic medications. Ethical Human Psychology and Psychiatry: An International Journal of Critical Inquiry, 12(1), 44-59.

House, R. (2001). Psychopathology, psychosis and the kundalini: Postmodern perspectives on unusual subjective experience. In I. Clarke (Ed.), Psychosis and spirituality: Exploring the new frontier (pp. 75-89). London: Whurr Publishers.

Karen, R. K. (1994). Becoming attached: First relationships and how they shape our capacity to love. Oxford, UK: Oxford University Press.

Karon, B. P., & VandenBos, G. (1996). Psychotherapy of schizophrenia: The treatment of choice. Lanham, MD: Rowman & Littlefield Publishing, Inc.

Laing, R.D. (1967). The politics of experience. New York: Pantheon Books.

Mahler, M. S., Pine, F., & Bergman, A. (1973). The Psychological Birth of the Human Infant, New York: Basic Books.

May, R. (1977). The meaning of anxiety. New York: W. W. Norton & Company.

Mindell. A. (2008). City shadows: Psychological interventions in psychiatry. New York, NY: Routledge.

Modrow, J. (2003). How to become a schizophrenic: The case against biological psychiatry. Lincoln, NE: Writers Club Press.

Mosher. L. R., & Hendrix, V. (with Fort, D. C.) (2004). Soteria: Through madness to deliverance. USA: Authors.

Nixon, G., Hagen, B. F., & Peters, T. (2009). Psychosis and transformation: A phenomenological inquiry. International Journal of Mental Health and Addiction. doi: 10.1007/s11469-009-9231-3

Nixon, G., Hagen, B. F., & Peters, T. (2010). Recovery from psychosis: A phenomenological inquiry. International Journal of Mental Health and Addiction. doi: 10.1007/s11469-010-9271-8

Perry, J. W. (1999). Trials of the visionary mind. State University of New York Press.

Rathus, S. A. (2006). Childhood and adolescence: Voyages in development. Belmont, Canada: Thompson Wadsworth.

Schore, A. N. (2002). Advances in neuropsychoanalysis, attachment theory, and trauma research: Implications for self psychology. Psychoanalytic Inquiry, 22, 433-484.

Slade, A. (1999). Attachment theory and research: Implications for the theory and practice of individual psychotherapy with adults. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (pp. 575-594). New York: Guilford press.

Wallin, D. J. (2007). Attachment in psychotherapy. New York: The Guilford Press.

Williams, P. (2011). A multiple-case study exploring personal paradigm shifts throughout the psychotic process from onset to full recovery. (Doctoral dissertation, Saybrook Graduate School and Research Center, 2011). Retrieved from http://gradworks.umi.com/34/54/3454336.html

Williams, P. (2012). Rethinking madness: Towards a paradigm shift in our understanding and treatment of psychosis. San Francisco: Sky’s Edge Publishing.

Image via E. Petersen / Shutterstock.

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  • Renee’

    Thank you so much for posting this. I have been struggling and searching to find the true answer to my 5yr+ diagnosis of schizophrenia/psychosis. I wad never able to accept it just being a brain disease and now I know why. I am completley greatful to have found this article
    I know realiillness my childhood belief system is at the root cause of my illness.

    • http://www.rethinkingmadness.com Paris Williams, PhD

      Hi Renee, I am really glad you found this article helpful and that you managed to avoid being inculcated into the idea that there is something wrong with your brain. My own research has shown that the belief that one has a diseased brain is one of the most inhibiting factors in one’s recovery (Click HERE and HERE for my other articles related to this idea.) On the other hand, it is helpful to recognize when one’s own experiences are not in line with consensus reality, in order to best meet one’s needs, relate to others, and recognize when to seek support. If you want to look further into finding some alternative kinds of support, including peer support groups and mental health practitioners and clinics who don’t push the brain disease model, go to my own Resources page HERE.

      Paris Williams

  • Renee’

    Now realize * sorry typo

  • Anonymous

    Beautiful article. Everything that you’ve written also seems reminiscent of the transformative process that many shamans throughout various cultures go through. While a Western interpretation would view the behavior of these individuals as symptoms of psychosis, to the culture in question they are signs of shamanic potential and interpreted as the individual having the ability to come into contact with other realities. It is precisely this upheaval and unravelling of the persons sense of self and reality that leads to a recovery process and adoption of the “healer” role. Reading about such processes, which seem to occur with shamans all over the world, and reading your article, seems to point to psychosis not being a “sickness”, but actually a healing mechanism. RD Laing eloquently reffered to it as the “ancient voyage”.

    • http://www.rethinkingmadness.com Paris Williams, PhD

      Thanks for bringing up this important idea. Yes! I believe that this is exactly what the recovery research is showing–that the psychotic process may well be to cope/heal/transcend dilemmas/situations that otherwise appear to be irresolvable. Also, it is ironic that in many ways we’ve come full circle, finally coming to recognize what many indigenous societies have known for tens of thousands of years–that individuals who have gone through such a process successfully play a very important role in the health of a society (for example, by having stepped outside of the box of a given society’s paradigm and helping minimize the risk that a rigid, dogmatic social paradigm will prevent that society’s ability to grow and adapt). On the other hand, it’s important not to “romanticize” these experiences, recognizing that they often wreak serious havoc in people’s lives until and unless the individual is able to integrate these experiences successfully into their lives.

      You may also be aware of another comment by R.D. Laing (I’m pretty sure it was him)–something to the effect of “The mad person is drowning in the same ocean in which the mystic is swimming.”

      Paris Williams

      • smart alex

        Dear Paris,

        the quote you mentioned is from Joseph Campbell. At least that’s what Stan Grof was writing in ‘Psychology of the Future’ on p. 136.

        As much as I am sympathizing with this metaphor, I am still wondering how the psychotic came into the water in the first place (considered that entering a psychotic state is, to my knowledge, always involuntary)…

        Secondly, it would be interesting to know if there are (former) psychotics who had later in their life a mystical experience, i.e. those ‘who learned to swim’?

        Best wishes

        ——————
        “The psychotic drowns in the same waters in which the mystic swims with delight.“

        Joseph Campbell

      • JDF

        ”In other words, it appears likely that schizophrenia/psychosis is not caused by a disease of the brain but is rather the manifestation of a mind deeply entangled within the fundamental dilemmas of existence”

        This statement is a trivialization of the suffering people (and their loved ones) with schizophrenia endure. I am a medical doctor who has personal experience with mental illness. I am not a psychiatrist before you get your dukes up and accuse me of being in bed with big pharma. Recovery from psychosis is not a romantic process of self discovery where a little art therapy and talking about feelings will make all well.

        A few clarifications: this mind/brain binary that you dance around is astounding. Brain is mind and mind is brain. And I think you are using illness and disease interchangeably. There are abnormalities in brains of people with schizophrenia (and thus disease) but what concerns treatment is illness. As a doctor if someone has a “disease”, let’s say a mild skin condition, that doesn’t bother them I am not concerned. Illness is the lived experience of the abnormality. And it is this suffering in schizophrenia that physicians, with the help of allied health, treat. Just because we can’t identify the abnormality doesn’t mean it doesn’t exist. This supposes that we have the tools to look at, simultaneously, all higher cortical functions and connectivity (we don’t) and there is a large body of convincing evidence that supports the “brain” basis of schizophrenia. Now schizophrenia is likely a heteregeneous condition in terms of pathophysiology but so are other syndromes such as epilepsy. You are wrong that when psychosis is due to a clear medical condition it’s no longer a mental illness; it would be diagnosed as a psychotic illness due to e general medical condition in the DSM and psychiatrists would often contribute to treatment (look up neuropyschiatry as a sub-speciality). There are literally hundreds of papers done by physicians trained in such investigations that show a range of differences in brain imaging in patients with schizophrenia, from structural changes most grossly to differences in activation on MRI and functional imaging. No gold standard “brain scan or blood test” is the case in a number of “neurological disorders”. There is no brain test or blood test for the primary headache disorders? For that matter other neurological disorders like the dystonias or most cases of myoclonus? Or restless leg syndrome? Does this mean to they too are a “construct”? Are they not illnesses because they too are diagnosed based on symptoms? What divides mental illness and neurological illness is based more on tradition. Schizophrenia, untreated, often presents with “neuro” symptoms as well such as movement disorders, eye movement abnormalities and frontal lobe dysfunction that a first year intern could pick up on neurological exam.

        Granted the idea of self and personal history are important in understanding schizophrenia and definite risk factors for development of psychotic and other neurobehavioral illnesses but this again is rooted in biology – look up the fascinating research on epigenetics and impact of stress and related hormones on gene expression.

        Psycho-social rehabilitation and adjuvant psychotherapy is important to ensure best outcomes. This is not dissimilar to most other chronic medical conditions where lifestyle and stress control are important for wellness, from conditions like headache, pain, hypertension, inflammatory bowel disease…etc. However, medications (while far from perfect) play a crucial role in severe psychotic illness as they do in many disorders; people in florid states of psychosis – the patient who wants to dig the colony of lobsters out of their stomach with an exacto knife, or the person eating their own faeces or the person dying of dehydration in a catatonic stupor – needs medical stabilization which includes antipsychotics. It’s actually laughable to think that these types of patients described (which are not uncommon in the emergency psychiatry department) should “integrate” their illnesses. Want to see how well people “integrate” illness, go to any North American downtown core and see the homeless folks talking to themselves in rags who will all die likely before they reach their fifties. That’s the face of untreated mental illness and it’s not pretty.

      • http://www.rethinkingmadness.com Paris Williams, PhD

        To JDF,

        I understand your resistance to these ideas, and I appreciate your desire to support those struggling with extreme states (btw, I have always been very clear that I do not “romanticize” these kinds of experiences nor do I invalidate how very distressing and disabling such experiences can be). As a clinical psychologist, as someone who’s personally experienced such extreme states, and as a friend and family member of others going through such experiences, I really get this.

        When holding the stance that you’re holding here, which is generally held within the mainstream, and especially by those trained in the medical model understanding of “mental illness,” I want to encourage you to consider several logical fallacies in this reasoning:

        (1) Distressing, powerful, and/or confusing experiences and behaviors do not automatically imply brain disease, just because the cause of such experience or behavior is not immediately apparent; and (2) correlation is not causation. Consider the intense grief someone may have upon losing a loved one. If we submitted them to an fMRI scan or other such neurological assessment, of course we would expect to find anomalous activity within the brain and other aspects of one’s physiology. I agree with you—mind and body are two perspectives (subjective and objective, respectively) of the very same process—any event within the mind will certainly have a physiological correlate, and vice versa, and the more extreme the event in one, the more extreme the event is likely to be in the other. Yes, mental and physiological events are highly correlated because they can be seen as simply two different perspectives of one holistic organism. However, the existence of such extreme states does not automatically imply physiological disease. Returning to the example of the grief stricken person, most people would recognize the absurdity of suggesting that the grief is caused by some disease process occurring within the brain, while recognizing that of course we would naturally expect to see some extraordinary biological activities corresponding with such an extraordinary subjective experience. In the case of the so called “mental illnesses,” however, because the cause is often not immediately apparent, or because the response strikes us as being unusually strong, we assume there must be some physiological disease process occurring–interesting hypothesis, but entirely unsubstantiated.

        Also I would really appreciate it if you don’t continue to spread the myth that biomarkers have been well established for schizophrenia (or any of the other so called mental illnesses)—I consider this highly unethical and even harmful, especially coming from someone credentialed as a physician, though I’m sure you don’t intend any malice but are simply misinformed. Just several months ago, the Director of the National Institute of Mental Health officially declared that DSM diagnoses (which of course includes the diagnosis of Schizophrenia) lack validity, and the President of the American Psychiatric Association begrudgingly responded by acknowledging that it is in fact true that no such biomarkers have yet been found.

        Finally, the evidence continues to roll in lending to ever increasing robustness with regard to the conclusion that the use of antipsychotics most likely interferes with long-term recovery (though may be of benefit in the short term), and that the majority of people who satisfy the criteria for a schizophrenia diagnosis would probably be far better off if they receive psychosocial support with minimal to no antipsychic use (and responding to your comment of homeless individuals struggling with psychosis, leaving people to languish away on the streets certainly doesn’t count as adequate psychosocial support). Here is a recent article summarizing the findings of these major research studies.

        Thanks for engaging with this important and challenging topic,
        Paris

  • Paul

    Is it possible that once the mind reaches a certain threshold of acceptable stress levels that psychosis is triggered. Absolutely yes , its probably the most likely. I think some people are more predisposed to it than others though. In my own circumstances I kept pushing the boundaries on these stress levels and I unfortunately became psychotic. The biggest problem is that the mind has clearly fractured, part of it no longer supports myself and my decisions. In fact it seeks to act in a manner contrary to its best interests. In psychological terms the concept of theory of mind is hit the hardest. The mind can no longer act independently and it can not act in a strategic manner to further its goals , part of it overwhelms it with guilt and shame. So where does this leave us; to pursue the medical model or a holistic model. The medical model try as it may to understand the problem of psychosis has not being able to crack the proplem and the holistic approach seems to carry an ideological emphasis that is almost philosophical. The holistic approach is carried out in a manner that is unscientific at least there are too many variables in its delivery. In any social model the people that are most confident with their views seek subservience to those same views and the vulnerable are overwhelmed with these ‘ideals’ which snowball into group ideals. The scientific approach represented by psychiatry offers more hope , sure there can be a perceived brutality in it but to my mind it is consistent with evolutionary principles. If a person acts in an eratic fashion that makes them likely to harm themselves or others then then can be forcibly treated in a manner that is scientifically consistent. For me the goal of the sufferer should be to seek out and map a path that is most conducive to his/her best interests. I saw a few psychistrists in my time and I remember I had a severe criticism of them at the time , they dont say much , they act and behave in a clinical manner devoid of any real emotion or empathy. If I felt bad the solution was to increase the medication or indeed try new medication. This did irk me but now I understand it. I’ll be honest there was no sence of entrapment I was not being asked to divulge the nature of these halucinations , in fact it felt that I should say as little as possible about these experiences. There was no ideology adanced even with regard that I would need to take medication for the rest of my life. I was not patranised at all. The fact is if a person stays out in a storm and does not seek shelter and if the storm prolongs then the person will die. Is the persons faith brutal absolutely yes it is but its no good to blame the weather.

    • http://www.rethinkingmadness.com Paris Williams, PhD

      Thanks for sharing your story, and I’m glad that you’ve had relatively positive dealings with the mainstream psychiatric profession. There are others who have been less fortunate.

      I appreciate your thoughts about this topic and resonate with many of them. I do, however, want to challenge your use of the term “scientific.” There are two aspects in particular to this challenge I want to mention here:

      Genuine science holds hypotheses and theories as just that–hypotheses and theories. Unfortunately, unsubstantiated hypotheses often move to the category of “fact,” especially when powerful entities benefit from this move–e.g., the “brain disease” hypothesis of schizophrenia and other psychiatric diagnoses. This is certainly a valid hypothesis, but if we are to remain true to the principles of science, then we need to acknowledge that this remains nothing more than a hypothesis.

      Second, an unfounded assumption has arisen within the field of science that if it cannot be observed, then it must not exist. This is an assumption from a philosophical paradigm known as “positivism,” a paradigm that emphasizes “objectivism” and “materialism” (that all aspects of the universe and of human experience can be reduced ultimtaely to matter). This paradigm arose from the ideas of Isaac Newton and his peers who perceived the universe as essentially a giant machine that can be broken down into a set of completely isolated and discrete entities knocking into each other like so many billiard balls on a pool table. This paradigm has since been profoundly discredited by Einstein’s work on relativity and further discredited by the discoveries of the field of Quantum Mechanics. So, even what we often think of as “objective science” operates under a set of unfounded and even discredited assumptions about the world.

      Third, the continuing influence of positivism plays a strong role in trying to locate qualities of subjective experience (such as “mind,” “mental contents,” and “consciousness”) within the brain, rather than working directly with those subjective experiences on their own merit. The sad tragedy of this is that, regardless of whether or not we can find correlations of mental experiences within the brain, the reality is that people still continue to have subjective mental experiences, many of which are very distressing. So, in order to support people having these experiences and to increase our understanding of them, it makes sense to actually explore such subjective experiences by working with them directly. In fact, there is a perfectly valid method of scientific inquiry that does exactly this (explores subjective experiences directly), known as qualititive inquiry.

      So, in short, I just want to emphasize that there is no “purely objective science” devoid of philosophical assumptions, and to not acknowledge this keeps us blind to our own biases and assumptions. This can then lead to devastating results. One such result, in my opinion, is what has been exposed by the recovery research conducted by both the National Institute of Mental Health and the World Health Organization: That those who live in the poorest countries of the world with virtually no access to Western psychiatric treatment have far higher recovery rates than those in the wealthy West with very high access to this treatment (WHO); and that those in the West who decided to terminate their psychiatric treatment have done far better (in general) than those who continued diligently to receive their treatment (NIMH).

      Food for thought…

      Paris Williams

      • Paul

        I understand you when you talk about how hypothesis turning to fact without any clear substantiation. I myself will only use medication in crisis situations because I feel that long term treatment as a means for solving this problem does not work at least it did not work for me. The side effects of the medication are too distressing over the long term and also I am not convinced that the medication as is currently constituted is good enough or niche enough to solve this problem. So the truth is that I am in search of another way at least until I feel the medication is safe and right. I am interested only living in this world within the reality that it has bestowed upon us. Do I believe reality is malible , No, it only moves in a manner dictated by its constituent parts. Spirituality to my mind does not figure in reality. There is no external input , reality quite simply drives itself. If a person has a subjective experience of reality it does not change the objective experience. If a schizophrenic accepts the idea that there reality can be changed by paranormal activity, what is there hope. They have no control over their life and never will. If a person cannot exert control and think for themselves they will be a slave to psychiatry , spirituality and society. The problem of course is this condition because of its nature makes it very hard to either think independently or take control. This is the problem. I await new medication or indeed if I could offer some hope, another way.

      • Paul

        If anyone should doubt that reality is somehow malible by external forces , you should study statistical information on any subject you wish and if you have the time and expertise to look at the data draw your own conclusions. If you do not have the expertise read some objective analysis or commentary on the data. I suggest that you will eventually see a blueprint of how reality works and you dont have to look past Charles Darwin for its origins

        • http://www.rethinkingmadness.com Paris Williams, PhD

          Paul, I admire your ability to find your own way towards health and a workable life in the midst of all the mixed messages that are found in the mental health field. Thanks for sharing some of this story with us.

          I want to clarify something that I think you misinterpreted from me. I never suggested that “reality is malleable,” or at least not the way you seem to be using this term. It seems clear to me that there are certain laws, principles, drives, or whatever you want to call them that are fundamental to the nature of our universe, and I haven’t seen any evidence suggesting that these are malleable. What is malleable is our individual construct, or interpretation of the raw sensory input that we continuously take in from the world. We each have a construct of our self and of the world that has been shaped by our society, our family, or own experiences, and perhaps our innate temperament; and this construct may deviate more or less from that of that which is generally agreed to be the most legitimate one in society (i.e., “consensus reality); and one’s construct may range from being relatively stable over time or shift radically (i.e., what occurs in periods of “florid psychosis,” psychoactive drug use, etc.). Where I think we can get in trouble is when we think that our own personal construct, or that of our society, is a purely objective view of “reality.” I believe that by the simple nature of what is involved in making sense of the world so that we can navigate through it, we are essentially forced to distort it and be blind to the most fundamental aspects of it–especially the profound impermanence,interconnectedness, groundlessness, and self-lessness. I believe that if we were to really be exposed to reality in its most raw form, we would find ourselves being thrashed around by an impermanent, interconnected “sea,” with all manifestations (including our very “self”) arising and passing away not unlike the passages of waves across the ocean. Who could tolerate such clear exposure to these deeper truths? How could one maintain security in the existence of one’s self and meet the needs of that self? There is a reason for our delusions.

          So I believe that in many ways we’re on a similar page. Your own comments also make me think of the “free will/determinism” paradox, though that’s another rabbit hole topic. We may not want to venture down that too far.

          Thanks for sharing your thoughts and experiences.

          Paris Williams

          • Paul

            Thanks for the reply. One thing, What about if the universe is not their to satisfy our needs , that we look for meaning where their is no meaning at all. That determinisim at least faith based is just coincidence. As a philosophy I ask myself why its there at all. That we just construct all this stuff to satisfy our needs. Anyway thats all I got. Good luck

      • Paul

        I feel I should qualify a remark in an earlier post. I think that the goal of anyone suffering from this condition should integrate themselves fully into society and not become sceptical of society. Society can be understood from a psychological point of view and a person should never get caught in the feutility that it is somehow unjust. It is what it is. The goal must be to live and thrive in its midst and I do agree with the sentiment about a person being able to remove themselves from any given social paradigm and being able to think for themselves.

        • John

          I disagree. Concerns about justice should trump concerns about functionality, and it needs to be recognised that attempting to pragmatically succeed within an unjust system will itself serve to perpetuate injustice. When people simply pursue their own interests, and are unwilling to make sacrifices in order to do what is right, human society degrades itself.

          • Paul

            Ideally , you’d be right. But unfortunately with schizophrenia , stress is a big problem. Showing over concern about the ills of the world can cause unnecessary stress. I find that it’s important to reserve my strength to tangibly improving my own life. And of course if I have anything left in reserve I like to engage in a bit of social commentary. The illness is difficult and requires alot of trade offs.

  • Kevin Keough

    Nice to come across your research and sensible ways to (honestly) examine the prevailing position that simply will not permit a different model the light of day. Dr. Williams demonstrates a solid sense of self by virtue of daring to present his and related research that has accumulated over 50 years.

    Like you I gave Laing a fair shake re his research and approach to psychotherapy. Very few mental health professionals know that the dominant approach to treating schizophrenics included the notion that staff members were not to talk with, chat, say hello–how goes it, etc or otherwise communicate with schizophrenics because it would fuel their psychoses. No talking—no communication—definitely no expression of ordinary human kindness. That is what passed as a “therapeutic milieu” during the 1950′s into the 1960′s.

    It isn’t hard to conceive that a patient confined to a psychiatric hospital not feeling very safe or secure might find deliberate efforts to eliminate communication between patient and staff-to ban expressions of ordinary human kindness might be construed as deeply disturbing. “Yeah, this is the place they say I get help……little confused because they can’t even bring themselves to look at me…..actually….no more doubts…..I am sure this is hell”.

    Thank you for such a solid and refreshing post.

    • http://www.RethinkingMadness.com Dr. Paris Williams

      Thanks for your support, Kevin. I appreciate your pointing to the very important factor for recovery of simple kind and healthy human contact. I also want to add some other important factors: hope, including a hopeful and meaningful understanding of one’s anomalous experiences; self connection, self connection, and self worth/dignity; and the pursuit of a rich and a meaningful life, and support in doing so.

      For more discussion of these, see one of my other articles on this website HERE.

      Paris Williams

      • http://www.rethinkingmadness.com Paris Williams, PhD

        …small typo above. I meant, “…self connection, self acceptance, and self worth/dignity…”

  • ashrak

    Beautiful article. Everything that you’ve written also seems reminiscent of the transformative process that many shamans throughout various cultures go through. While a Western interpretation would view the behavior of these individuals as symptoms of psychosis, to the culture in question they are signs of shamanic potential and interpreted as the individual having the ability to come into contact with other realities. It is precisely this upheaval and unravelling of the persons sense of self and reality that leads to a recovery process and adoption of the “healer” role. Reading about such processes, which seem to occur with shamans all over the world, and reading your article, seems to point to psychosis not being a “sickness”, but actually a healing mechanism. RD Laing eloquently reffered to it as the “ancient voyage”.

    http://www.mediafire.com/?50cdjly22skb5hc

  • Jen

    Hi Dr Paris,

    I was diagnosed with schizoaffective disorder 17 years ago. I saw a psychiatrist, listened to what she said and took the pills she prescribed and I got well (depending on how you define that). According to my doctor, I’ve basically recovered, although I still take medication. I don’t have psychotic symptoms or depression. But I’ve been on a 17 year long existential crisis that has never been resolved. In particular, my spiritual beliefs, life philosophy etc fluctuate wildly and rapidly. I can’t hold on to any one set of beliefs, because I feel that everything can be true!! Everything exists, everything has a life inside my head.

    What are the practical implications of your work; ie What can I do about it??!!

    Thanks.

    • Cate

      Jen
      I loved – ‘Everything has a life inside my head’ . Some of the life inside my head is bad and some is good and I have never known what to believe. People like us are looking for the truth and losing reality in order to find it.

  • Paul

    I have tried reading about existentialism I really have and theirs alot of higher thought stuff their , philosophically complex stuff. When I got sick I was stressed out unbelievably , I was not asking myself ‘Who am I?’ ‘Whats my place in life?’ I was just stressed. I did however afterwards go on my ‘learning’ and my quest for knowledge phase and the only thing that process blessed me with is the realisation thst it was all bolox. Selfhelp groups and spirituality groups talk about joined up thinking and that soul destroying word ‘listening’. If you listen the more chance that your ears will be filled with garbage. Dont get me wrong you have to listen when someone is feeling down ( someone close to you ) its the humane thing to do but to hold this up as a tennant of life ahead of self expression is foolish. People are not seers(spelling) they are not gods , they are flawed , some are distubed and if your willing to listen to all that sh*t and expect to ‘learn’ then you are mistaken.

  • Zander

    This article is completely false, ridiculous and misleading. People please beware of quack “psychologists” giving extremely wrong and damaging information. Just because they have a PhD after there name doesn’t mean anything.

    According one of best hospitals in world in psychiatry:

    “researchers believe that a combination of genetics and environment contributes to development of the disease.

    Problems with certain naturally occurring brain chemicals, including the neurotransmitters dopamine and glutamate, also may contribute to schizophrenia. Neuroimaging studies show differences in the brain structure and central nervous system of people with schizophrenia. While researchers aren’t certain about the significance of these changes, they support evidence that schizophrenia is a brain disease.

  • Zander

    Sorry I have few typos in the last comment and couldn’t edit it, so i’m reposting.

    This article is completely false, ridiculous, and misleading. People please beware of quack “psychologists” giving extremely wrong and damaging information. Just because they have a PhD after their name doesn’t mean anything.

    According to one of best hospitals in world in psychiatry, the Mayo Clinic:

    “researchers believe that a combination of genetics and environment contributes to development of the disease.

    Problems with certain naturally occurring brain chemicals, including the neurotransmitters dopamine and glutamate, also may contribute to schizophrenia. Neuroimaging studies show differences in the brain structure and central nervous system of people with schizophrenia. While researchers aren’t certain about the significance of these changes, they support evidence that schizophrenia is a brain disease.

    To imply that it is caused by existential thinking is completely retarded.

    • Mitchell

      “Neuroimaging studies show differences in the brain structure and central nervous system of people with schizophrenia.”

      These differences are caused by the psychiatric drugs they are given.

  • Max

    This article makes alot of sense to me. When I was 17 I had a manic episode with psychotic symptoms and made a full recovery. I was stuck in a rut at the time after months of problems building up and my relationships with my parents and friends breaking down, I had increasingly been losing my sense of purpose and self and falling deeper into indifference and drug use. The episode was horrific and overwhelming but made me change and become a totally different person and find direction. My own experiences fit very clearly with what this theory describes, luckily my psychotic phase didn’t last very long. I did take a small level of antipsychotics as part of the recovery.

  • http://www.schizlife.com SchizLife

    I definitely feel like schizophrenia is the dismantling of an unhealthy cognitive framework, and possibly even the foundation, to further the metaphor. That is the purpose of psychosis… to unlearn some negative beliefs and behaviors, cultural or imprinted, and then to build from the ground up. Great post, great ideas, great research!

    • Anonymous

      So schizophrenia is a motivating force? What about a predisposition to schizophrenia. Do you believe that exists> The truth of the matter is for me personally I heard voices from the age of five. As a five year old do you think I had to unlearn all my ‘negative’ traits build up in my relatively short lifespan. Do you really believe that schizophrenia is some kind of imposed morality. I think you should get real and have a look at the medical basis for the condition.

  • Dr. Ann Reitan

    Your article is incredibly insightful. I agree that psychosis can represent an existential crisis, the experience of the psychotic individual does not conform to consensual reality, and these facts can leave the individual who experiences psychosis in a fearful, traumatizing and perhaps deadly-slippery situation.

    The self-expression in your article is somewhat curative for psychosis, if only in that it normalizes what psychotic individuals experience.

    This is a great article.

  • Mike

    I enjoyed the article and its perspective. I don’t have a primary belief about the source or primary causative factors for schizophrenia as there are so many variables at play. I’m actually writing a play dealing with the subject and have been doing quite a bit of reading on the subject. One of the comments mentioned we cannot ignore research that indicates such important factors as structural brain changes, and differences in levels of certain neurotransmitors. This is true, and also I wonder percentages of persons diagnosed with schizophrenia who don’t have indicators of a structural brain difference. What about individuals with major neurotransmitor chemical imbalances [normally associated with schizophrenia] who do not have it. Even writing the words ‘have it’ feels somewhat limiting to its complex existence. That complex existence may indeed involve physiological aspects to consider such as genetic proclivities, developmental trauma, severe nutritional deficiency or imbalance. The brain chemistry imbalance theory does not really hold solid ground for me. It’s like asking what came first the chicken or the egg. Just because brain chemistry is [often?] part of the person’s experience with schizophrenia does not mean THAT is the primary causative factor.

    I’m also intrigued with the ‘spiritual crisis’ model. Stanislav Groff [sp] has writeen about this. For those who have an anathama to the word spiritual I substitute ‘crisis of the psyche’. There are all kinds of reasons why this might be possible and valid. Certainly shamanic initiation stories within indigenous cultures suggests ‘psychosis symptoms’ from our western symptomology perspective. There is speculation about certain prophets and sages having schizophrenia or aspects of it, as well as certain eccentric, creative artists.

    What is sad and disturbing is how the medical model has primarily thought of and worked with schizophrenia from brain chemistry and focusing on medication to shift symptoms. And because symptoms are shifted and in many cases individuals are able to life ‘functional’ lives again, then that is interpreted as successful treatment. As holistic perspectives pertaining to physical illness have shown the mainstream medical model over the past few decades, it’s not just about allieviating symptoms; there is often more going on.

  • Paul

    Paris,

    I looked at your suggested reading material on your website and their is a lot of talk about spirituality , with special mention of angels and the likes.

    One question for you , Do you believe that recovery from schizophrenia is possible without buying into the supernatural?

    It’s an important question. Are you religeous? Do you consider yourself a spirtualist?

  • Paul

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    Paris,

    I looked at your suggested reading material on your website and there is a lot of talk about spirituality , with special mention of angels and the likes.

    One question for you , Do you believe that recovery from schizophrenia is possible without buying into the supernatural?

    It’s an important question. Are you religious? Do you consider yourself a spiritualist?

    • http://rethinkingmadness.com Paris Williams

      Paul,

      A number of the suggested books on my website’s reading list are phenomenological case studies of people with psychotic experiences, and such experiences very commonly include spiritual themes. Also, people having such experiences often find themselves overwhelmed with experiences of self dissolution and self transcendence (perceiving oneself as more than just their limited egoic and/or physical self). While this concept is what is often pointed to when the term “spiritual” is used, there is nothing “airy fairy” about this concept at all, since profound interconnectedness/impermanence and the fact that the boundaries between self and other is more or less arbitrary is a well established concept within any of the major sciences that explore this (i.e., physics, ecology, biology, anthropology, etc.)

      Regarding my own personal beliefs, I consider myself strongly phenomenological, putting most faith into direct subjective experience. I personally have a difficult time accepting any kind of blind faith, but I don’t judge people who prefer to go this route as a way to find guidance in their life,

      Paris

  • Paul

    “boundaries between self and other is more or less arbitrary”

    This is presupposed on something you take as fact. If there is a level of truth in this , it rests completely on the subjective experience and projections of the physical matter of the brain. I don’t see it as arbitrary though. Physics is the study of physical matter , how it interacts with itself and the laws that govern this interaction and has absolutely nothing to do with anything else. Biology is the study of living matter and the interaction of its constituent parts. Ecology is the study of a system of living matter and inanimate matter and how they interact with each other. Dependency and interaction are governed and driven by constituent parts obeying local rules and a willingness to maintain themselves in the face of indifference and ruthless opposition.

  • http://www.attitudeshifting.com Gib from attitudeshifting

    It seems as if a lot of the ‘Ills” of the world could be lessened by ordinary people taking a little more iniative and tryin to communicate with others around them. It seems to me that we come up with answers and then create questions to satisfy the answers.

  • Anonymous

    please, can anyone give me any psychologist phone number

  • Paul

    Paris,

    I though some more about the brain disease ‘hypothesis’. I accept that the pathology has not being fully identified. However , as a person with this diagnosis , I also accept that this condition has being identified in numerous individuals as we all know , the mode of experience is generally similar , the cognitive processes that create and enforce delusions are generally similar. We are all biological flesh. If the problem is not biological , then what?
    Can we seriously ignore family history of schizophrenia , peoples predisposition to it and genetic heritability. When the evidence is incontrovertibly pointing to abnormal biological expression.

    People so readily accept that a heart , a kidney , a liver can falter. Why is so hard to believe that the most complex system of matter known in this universe can also falter?

    • http://www.rethinkingmadness.com Paris Williams, PhD

      Good points, Paul. I address these in much more detail in one of my other articles HERE

      Of particular relevance to this topic is that recently, the National Institute of Mental Health has made a formal statement regarding the lack of validity for the DSM, which is the “bible” of diagnostic categories of mental disorders voted in every decade or so by the APA (i.e., the categories that we generally think of as “mental illnesses”). The President of the American Psychiatric Association responded by openly acknowledging it’s true that we still have found no biomarkers for schizophrenia or any of the so called “mental illnesses.” If/when we do find a strong causal link between a particular psychological condition and a neurological condition, then the condition is no longer considered a “psychiatric disorder,” but then becomes considered a “neurological disorder,” such as is the case with Alzheimer’s, Huntington’s, Multiple Sclerosis, etc.

      By challenging the label of “schizophrenia” and the other psychiatric “mental illnesses,” I’m certainly not denying that people experience painful and confusing thoughts, feelings, impulses, beliefs, perceptions, etc, and that there are certain patterns of such types of distress. However, to leap from the recognition of such distressing conditions to the assumption that these must imply some pathological disease process occurring within the brain is where I believe we create some serious problems and confusion. Certainly, all experiences occurring within the mind have physiological correlates, and as would be expected, the more powerful the mental/emotional experiences, the more powerful the physiological correlates; but this is not the same thing as disease.

      For example, most of us would experience tremendous distress at the loss of a deeply loved one, and any neurological or biological assessment of the individual in such a conditionis likely to also reveal unusual and intense experiences occurring within the body; and yet most of us recognize by simple common sense that grief is not a physiological disease. However, when the cause of such anomalous experiences is less clear, we tend to be very quick to jump to the conclusion that there must be some kind of disease occurring within the brain/body, and hence we call it a “mental illness.”

      While I’m not a big fan of comparing the human nervous system/body to a computer (complexity and systems theories have shown that this metaphor is deeply flawed), there is one metaphor that I find helpful in this case. And that is recognizing a distinction between software and hardware. Fundamentally, they’re both the same process—software determines the particular manipulation of the billions of little switches called bits and other hardware, so as changes occur within a program, corresponding changes also occur within the hardware. But we recognize that a particular program may be personally offensive or even have “bugs” in it, while this does not imply that anything is at all wrong with the hardware. Imagine trying to correct a bug in a software program by physically trying to manipulate the billions of tiny bits within the memory boards—absurd, right? Well, this is very similar to the idea of dumping chemicals onto a brain that we assume to be diseased when the root of the problem is that certain needs are simply not being met for this person within their life. It’s generally much more effective to support the person in meeting these needs.

      Thanks for your willingness to contemplate this very important and complex topic. You can click HERE for another article of mine where I go deeper into these ideas.

      Paris Williams

      • Paul

        Paris

        Regarding the hypothesis for pathology of schizophrenia , I know , and you should know I suspect, that this hypothesis is not without merit. Blockading dopamine has being proven to slow down and stop spontaneous thought processes. This is independent of sedation , I can personally atest to this. Unfortunately the dopamine system is linked to movement ,spontaneity, mood and a whole host of experiences and functions and we all know blockade of dopamine leads to other medically significant phenomenon. But the hypothesis has a basis.

        In terms of biochemical markers I suspect we could arrange a double blind test for identifying acutely psychotic persons. I do not think that such a process could identify grief as a set of emotions. But I am willing to stand corrected of course. However I don’t see grief and intense stress as an appropriate comparison.

        The reason of course is, the social and medical significance that serious mental illness has and the level of dysfunction it introduces into persons lives. Unfortunately the illness can lead to the sufferer becoming so completely detached from reality that they pose a risk to themselves and the public. It’s also a major form of disability and puts pressure on everyone , from government budgets in the form of health care and loss of earnings revenue , and of course to the friends and families , ravaging relationships in its wake.

        But there is cause to be hopeful , I would hope that government sponsored organisations can now take the lead in brain research. We spend billions on investigating our universe , yet don’t do the same with mapping the human brain. Seriously forget about the billions on space exploration and put this money into the BIGGEST challenge effecting Human civilisation.

        Of course the reason we don’t see the brain as such an area of exploration is that traditionally that has being seeing as Gods zone. But with the continued emergence of secularism and humanism this is gradually changing and for the better. Procrastinating on this subject should no longer be accepted , this issue is as serious and more serious than all the other scientific hot topics.
        Obama’s recent announcement on research was heartening.

        Lets pry control away from the hands of private companies , who are wedded to dopamine blockade and lets invest heavily in other perspectives. Gene therapy for example. Another heartening report this week was a set of scientist readdressed a faulty protein producing gene to eradicate schizophrenia like symptoms in a mouse. Wow! can you imagine this , No side effects interms of treatment if they can get the treatment delivery right. That’s real hope.

        Regards

      • Paul

        You also did not address the whole area(posted in my original comment) of genetic heritability of schizophrenia and its prevalence in closely related individuals. This is impossible to ignore and is an established fact and if one wants to be objective, highly relevant. But of course I am glad of your reply.

        The reason I like these types of sites is that they are clinical in some respects. At least compared to what you would find in a standard schizophrenia forum. I do respect you do have clinical and scientific training and as such, can communicate with you.

        Appreciate your replies

        • http://www.rethinkingmadness.com Paris Williams, PhD

          These are all great points; however, I believe we’re barking up the wrong tree looking for something wrong with the brain. We have very clear evidence of very strong psychosocial correlates and psychosis (especially childhood abuse/neglect, trauma, and substance use); and we know of psychosocial support systems that are very effective (giving as high as 82% rates of full and lasting medication-free recovery)–but of course these would involve Big Pharma and the psychiatric industry losing billions of dollars per year.

          I discuss the Dopamine (and other neurotransmitter) hypothesis, genetics and heredity, recovery rates, alternative and highly successful treatment models, and the research showing the pros and cons of psychiatric drugging all within Part One of my book, Rethinking Madness, which you can download for free HERE. Please feel free to share this link. This is very important information that all too often gets swept under the carpet, presumably because it is a serious threat to the most powerful players within the mental health industry. This review of the research comes directly from my own doctoral dissertation, and therefore had to pass through a panel of university professors whose titles and jobs are all on the line whenever they approve such work. In other words, the review of the research presented in this document is highly credible.

          Thanks again for grappling with this important topic,
          Paris

          • Mike

            I’ve read Paul’s book and cannot recommend it enough. If you’ve bothered to read this article and the comments then you’re obviously interested in the importance of the subject and I hope you will avail yourself of what seems to me the vitally important information he has put together. And by the way I do not know him, I’m doing research on the subject. I’ve read quite a lot of books and articles over the past year and a half, some of them rather clinical in nature. I also highly recommend ‘Mad In America’ and ‘Angela’s Ashes’ as particulaly well written, intelligent, and empathiclly significant contributions to the ‘mental illness’ issue.

            Regarding a section of a previous comment above “Neuroimaging studies show differences in the brain structure and central nervous system of people with schizophrenia. While researchers aren’t certain about the significance of these changes, they support evidence that schizophrenia is a brain disease.“ From my research their has been seen differences in brain structure with persons with diagnosed schizophrenia. HOWEVER, (1) Quite a number of individuals with diagnosed schizophrenai do NOT show these differences and (2) I most or [possibly all?] these situations there is no way to be certain if neuroleptic drugs have not contributed to these differences. The above quote admits ‘researchers aren’t certain about the significance of these changes.’ This is a very important statement not to be glossed over lightly. Nonetheless they ‘assume’ it to be supportive evidence of schizophrenia being a brain disease.

            I am NOT anti brain research. However the assumptions and interpretations that can easily be touted as ‘fact’ is disturbing, and thus the implied possibilities of potential future engagement with and treatment for individuals with ‘diagnosed’ mental illness. I do not have a Ph.D. but common sense informs me from the research I have done that there is a BIG DIFFERENCE between causation and correlation. Especially when correlation [physiological, bio-chemical brain factors] are not indicated or present 100% of the time. If the ‘scientific community’ is still at odds in it’s understanding and interpretation of what the mind [consciousness] actually is in relation to the brain, how can we expect any clarity on the complex phenomenia that is labeled ‘mental illness.’

            I would also encourage others who read this article and the posted comments to check out MadRadio on the internet. I came across this via some mentioned resource in a book and have received much insight and valuable information from lay persons as well as professionals who have been interviewed. Schizophrenia and its diagnosed associated forms seems to me to be a vastly complicated phenomenon, just as each human being is a rich tapestry of mystery and vastly complicated phenomenon. The fact that individuals who have gone through this journey, and in many instances have contended with the often limiting and even damaging obstacles within the medical model paradigm, and emerged reconstituted to become wayshowers for others is indeed indication of there being light at the end of the tunnel.

      • Paull

        ” however, I believe we’re barking up the wrong tree looking for something wrong with the brain”

        Why is that Paris? Schizophrenia at it’s core causes stress in the body due to obsessive and compulsive thought processes. This stress becomes so toxic that it causes other distressing phenomenon. Why do you think that these thought processes should be accepted as ‘normal’? Normal if they didn’t cause any dysfunction maybe , but definetly not normal when we see the illness develop; spreading through the brain like a wildfire.

        I can only assume that you believe that schizophrenia is a transitionary mechanisim facilitating enlightenment and knowledge. That is why I originally posed the question to you ‘are you spiritual in nature’. This is not to deride you.
        Seriously what else are we to do if we dont look at the brain. You yourself have said that we are barking up the wrong tree. Sorry, but plain and simple that is not rational.

        I have said this here before, have you looked at the outcomes for schizophrenia and the people that develop it. Google famous schizophrenics and you will see to what level schizophrenics operate in society and the tangible results of their illness. The truth is some go around in an agitated and confused manner , some commit heinous crimes , many die too early in life , the list goes on Paris.

        Schizophrenics have a lot to offer , I encourage them to become rational in their thought processes.

        Also with respect to anyone that tells me that schizophrenia and its outcome can’t be quantified and measured by a Google search. That is where we differ in terms of our view of the world.

        • http://www.rethinkingmadness.com Paris Williams

          Hi Paul,

          I address most of your questions in another article on this website: HERE

          Generally speaking, those approaches that emphasized psychosocial support while minimizing or even completely avoiding neurological enterventions (i.e., typically psychiatric drugs) have demonstrated far better outcomes than the mainstream medical model treatment–we’ve seen well documented rates of full and lasting medication-free recovery as high as 82% in some cases. And those countries (typically the poorest) who use the least western psychiatric treatment have shown far higher rates of recovery. So you tell me which tree is likely to bear the most fruit? Supporting individuals in meeting their needs (cultivating healthy relationships with self and other, meaningful activity, connecting to their dreams and values, financial security, basic physical health, etc.), or continuing to seek for that “magic bullet” drug or some other miraculous psychosurgical intervention. At the moment, the vast majority of our resources in this regard continues to go to studying the brain, while these psychosocial alternatives that are well established to be extremely helpful are essentially neglected. Do you really think we should continue along this so far unfruitful path? And if so, why?

          • Paul

            “Do you really think we should continue along this so far unfruitful path? And if so, why?”

            It’s not perfect , but the outcomes for serious mental disorders is much better. It was only a century ago that the seriously mentally ill were locked up in inhumane conditions , subjected to physical abuse , restrained 24 hours a day , there were no medical interventions. A century or 2 before that , they were probably judged as evil , many of them lynched. So their is improvement , steady improvement , the need for long term and life long hospitalisation or incarceration has being addressed with psychiatric medication. Most people hospitalised now are for short periods of time. That’s an improvement. So the path has not being without merit , so their is benefit in the path. Its not ideal , we all know the side effects, etc and the long terms health concerns are a big problem , very big problem but things are better.

            As a schizophrenic why should we persist with medical research
            1) The effects of the illness are devastating

            I also believe that if we can stop spontaneous, random and compulsive thought processes without side effects. That would be fantastic. How could you be opposed to this. This would greatly improve the lives of schizophrenics the world over.

            Saying its not possible from the outset. I don’t agree with.

            I recall you yourself saying in a comment, maybe not on this discussion, that schizophrenics should normalise their symptoms , integrate them into their lives , adapt , etc. How long will it take for a schizophrenic to come into this frame of mind , in reality your talking years and years. And what do we do with all the acute cases in the interim.

            The above paragraph is set against the context of your perspective. My position is that the illness lies on a spectrum of severity. Some maybe able to normalise their symptoms and function , however for others the symptoms maybe too severe.

            Regards.

          • Paul

            “we’ve seen well documented rates of full and lasting medication-free recovery as high as 82% in some cases. And those countries (typically the poorest) ”

            I’m going to give you my opinion on this. There are many reasons that could explain this. Here’s a few I can think of , I’m sure I could get you sources of critical analysis of these figures and this phenomenon , but for what its worth, having the illness myself , here’s my opinion

            Citizens of poorer countries tend to be more servile and task oriented. It means there is less opinion , contradictory and oppositional language are reduced , eccentricity and egoistic language not used as much. In the west we communicate in a more spontaneous and erratic fashion. This is especially problematic for a schizophrenic.

            Citizens of poorer countries tend to be less sophisticated from a technology usage point of view. Technology can pose a problem to a schizophrenic in that it is prevalent , always on , and can flood the senses with mixed , irrelevant messages.

            Culturally poorer countries have a more social mindset , the west is far more individualistic and more concerned about their own personal lives rather than the collective.

            Individualistic Success is engrained in western culture and it’s stereotypes are forced upon us everyday through the media. This can lead to a malformed opinion of self and what it is to be human.

            Illicit drugs and vice are less accessible in these countries.

            Many poorer civilisations are more family oriented and support is more readily available.

            Poorer societies are judged more by what they do than what they say. Task orientation is driven by physical labour rather than complex verbal communication.

            Statistics can he hard to accurately collate due to lack of money and distrust of authority. Also there is a general distrust in scientific enquiry which could skew these success figures.

            Here are just a few I can think of.

            Regards.

          • http://www.rethinkingmadness.com Paris Williams, PhD

            Paul,

            I appreciate your willingness to really engage in these ideas and your interest in my own thinking and conclusions. I address essentially every point you mention here in Part One of my book, Rethinking Madness, where I go over a thorough review of the recovery research. Keep in mind that this literature review comes directly from my doctoral dissertation and so had to pass through a dissertation committee comprised of highly experienced professors of psychology with an expertise in psychosis. In other words, this review is about as peer-reviewed as reviews come. You can download this review for free by clicking on “View Excerpt” on this page. You can also download the dissertation itself for free HERE, though I think you’ll find book version more reader-friendly.

          • Paul

            I appreciate the replies ,

            I’ll pick up your book when I can. I too think that domination of the medical approach needs to be challenged with something else.

            Regards.

  • Mike

    So sorry, correction. I meant the book that Paris wrote.

  • http://www.robertdstolorow.googlepages.com Robert D. Stolorow
  • http://zenandtheartoftightropewalking.wordpress.com Viv

    This is very hopeful and quite revolutionary; but that said, I’ve begun to suspect that many things work this way. Depression especially. Perhaps the reason anti-depressants seem to work for a while then stop being effective is that the brain chemical changes noticed in studies are the result of depression not the cause.

  • Marti

    Dr. Williams-
    Have you data to share on the results that you’ve had in treating schizophrenia without the use of medication? Where can an adult whose life has been destroyed by schizophrenia receive quality treatment in this country? No job. No money. No care. My adult son is extremely intelligent. He is a mechanical engineer who attended a university ranked in the top 5 in our nation. About 5 years ago, he had a traumatic brain injury(requiring a craniotomy to remove a blood clot in his brain) and we believe that it was after this that he began to really slide into psychosis. He was away from home for the most part from age 18-27 (as a child, he was smart, athletic, and social). He recovered very quickly from brain surgery (2 weeks) and he was back to work. Though we definitely noticed changes in his personality after the accident, he was cognitively and physically performing at a very high level. He had a loving relationship with his high school sweetheart. He decided to quit his job and pursue a Masters Degree in Mechanical Engineering He was in the middle of completing his Masters Degree when he began to struggle with paranoia. He came back to live and work near home. The paranoia and mania or psychosis began to escalate and his girlfriend finally called us in desperation. This was a huge shock. He has now lost everything (girlfriend of 8 years, job, independence, financial devastation) and he hates us for saying that he needs help. At first, I truly believed that the brain injury had caused this all to happen, but, now, I see schizophrenia. He is now unable to function and extremely angry and paranoid. He begged to come home to escape the BAD GUYS and he now HATES living here as we are in a very small rural area and he is very isolated and we have not dealt well with the situation. He had a short period (4 days) of hospitalization and attended some sessions with a psychologist last summer (only because we made him), and got a job as a drafter for a company in town for 4 months before he lost the job due to marajuana use. He now thinks that his boss did him wrong and owes him thousands of dollars. He is absolutely opposed to medication. He has been manic and or psychotic on a regular basis for the last year and a half. He had to be removed from our house last night as he became violent toward my husband. I do not think that living with us is the right placement for him. He has already lost his trust in us and hates us. I can only have hope that he can find the right treatment and go on to live a life with some happiness and sense of fulfillment. I will rightfully admit that I have no idea how to help him other than conventional means and I can not live this way. This is a family of 6 and NO ONe is doing well at this point and time.

    • http://www.rethinkingmadness.com Paris Williams, PhD

      Hi Marti,

      I’m sorry to hear you guys are going though such a difficult time. Yes, you can lead a horse to water, but… It may help to simply let him know you’re concerned about him holding all of this himself and wondering if he’d like to find someone who can help him make some sense out of what’s going on. Probably counterproductive to try to convince him there’s anything wrong with him, but just acknowledging that he looks like he could really use some support.

      HERE is a fairly extensive list of resources on my own website. In particular, I would take a look at the MindFreedom International therapist directory and see if you can find anyone near where you live, and I’d also look at some of the peer support services.

      Regarding data with regard to recovery rates via non-medication approaches, I go over all of this research in Part One of my book, Rethinking Madness, which you can download for free by clicking “View Excerpt” on THIS PAGE.

      Sending my best wishes,
      Paris

  • Pingback: Schizophrenia and Psychosis – Brain Disease or Existential Crisis? | The Big Mad Experience

  • Anonymous

    What a beautifully structured, insightful and thoughtful article. I am twenty-one and have been experiencing awareness of what, say, a certain existentialist may refer to as “the abyss”, and an awful awareness that outside of life is nothingness, from quite a young age. I developed psychosis at the age of seventeen, and still struggle. I used to describe my existential depression as a vast void of darkness, and at the age of eighteen I actually began to hallucinate this terrifying image through dark lights and iridescence. How bizarre!
    I like to approach my experiences with psychosis and existential depression as something which will, eventually, lead me to become a more enlightened and content individual. I find the correlation between psychiatry and philosophy extremely interesting – I have often believed that psychosis may be the result of a distressed psyche lost amidst life and the previously mentioned agonizing sense of awareness. Existence perhaps may be only nothingness, however I won’t stop until I transcend the abyss and find, within myself, a comforting sense of nothingness, as really, if analysed in such a way, nothingness perhaps can be quite empowering.

  • Christian

    What do you know about demons?

    • Boggins

      Demons are the parts of yourself that you have cast out of your conscious mind. My angry self is too frightening to deal with so I chuck him into my unconscious where he lives a separate life until he breaks out in the form of psychosis.

Paris Williams, PhD

Paris Williams, PhD, works as a psychologist in the San Francisco Bay Area. He holds a PhD in Clinical Psychology from Saybrook University. He offers the rare perspective of someone who has experienced psychosis from both sides -- as a researcher and psychologist, and as someone who has himself fully recovered after struggling with psychotic experiences. In his book "Rethinking Madness," Dr. Williams takes the reader step by step on a highly engaging journey of discovery, exploring how the mainstream understanding of schizophrenia has become so profoundly misguided, while crafting a much more accurate and hopeful vision of madness.
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