Humanistic Theory and Therapy, Applied to the Psychotic Individual




Green Rorschach test

Sometimes people understand psychosis or schizophrenia to be unrelenting, even with the intervention of psychotherapy. It is contended herein that therapy, and humanistic therapy in particular, can be helpful to the psychotic individual, but, perhaps, the therapist may have difficulty understanding how this approach can be applied to the problems of psychosis. Although it is a prevalent opinion in our society that schizophrenics are not responsive to psychotherapy, it is asserted herein that any therapist can relate in a psychotic individual, and, if therapy is unsuccessful, this failure may stem from the therapist’s qualities instead of those of the psychotic individual.

Carl Rogers created a theory and therapy indicated by the terms “umanistic theory” and “person-centered therapy”. This theoretical perspective postulates many important ideas, and several of these ideas are pertinent to this discussion. The first of these is the idea of “conditions of worth”, and the idea of “the actualizing tendency.” Rogers asserts that our society applies to us “conditions of worth”. This means that we must behave in certain ways in order to receive rewards, and receipt of these rewards imply that we are worthy if we behave in ways that are acceptable. As an example, in our society, we are rewarded with money when we do work that is represented by employment.

In terms of the life of a schizophrenic, these conditions of worth are that from which stigmatization proceeds. The psychotic individuals in our society, without intentionality, do not behave in ways that produce rewards. Perhaps some people believe that schizophrenics are parasites in relation to our society. This estimation of the worth of these individuals serves only to compound their suffering. The mentally ill and psychotic individuals, in particular, are destitute in social, personal and financial spheres.

Carl Roger’s disapproved of conditions of worth, and, in fact, he believed that human beings and other organisms strive to fulfill their potential. This striving represents what Roger’s termed “the actualizing tendency” and the “force of life.” This growth enhancing aspect of life motivates all life forms to develop fully their own potential. Rogers believed that mental illness reflects distortions of the actualizing tendency, based upon faulty conditions of worth. It is clear that psychotic people deal with negatively skewed conditions of worth.

It is an evident reality that the mentally ill could more successfully exist in the world if stigmas were not applied to them. The mentally ill engage in self-denigration and self-laceration that culminate in the destruction of selfhood. This psychological violence toward the mentally ill is supported by non-mentally ill others. The type of self-abuse by psychotic individuals would certainly abate if the normative dismissal of the mentally ill as worthless is not perpetuated.

In spite of a prevalent view that psychotic individuals are unsuccessful in the context of psychotherapy, Roger’s theory and therapy of compassion cannot be assumed to be unhelpful to the mentally ill. The key components of Rogers’ approach to psychotherapy include unconditional positive regard, accurate empathy and genuineness. Unconditional positive regard, accurate empathy and genuineness are considered to be qualities of the therapist enacted in relation to the client in terms of humanistic therapy. These qualities are essential to the process of humanistic therapy.

In terms of these qualities, unconditional positive regard is a view of a person or client that is accepting and warm, no matter what that person in therapy reveals in terms of his or her emotional problems or experiences. This means that an individual in the context of humanistic psychotherapy, or in therapy with a humanistic psychologist or therapist, should expect the therapist to be accepting of whatever that individual reveals to the therapist. In this context, the therapist will be accepting and understanding regardless of what one tells the therapist.

Accurate empathy is represented as understanding a client from that person’s own perspective. This means that the humanistic psychologist or therapist will be able to perceive you as you perceive yourself, and that he will feel sympathy for you on the basis of the knowledge of your reality. He will know you in terms of knowing your thoughts and feelings toward yourself, and he will feel empathy and compassion for you based on that fact. .

As another quality enacted by the humanistic therapist, genuineness is truthfulness in one’s presentation toward the client; it is integrity or a self-representation that is real. To be genuine with a client reflects qualities in a therapist that entail more than simply being a therapist. It has to do with being an authentic person with one’s client. Carl Rogers believed that, as a therapist, one could be authentic and deliberate simultaneously. This means that the therapist can be a “real” person, even while he is intentionally saying and doing what is required to help you.

The goal of therapy from the humanistic orientation is to allow the client to achieve congruence in term of his real self and his ideal self. This means that what a person is and what he wants to be should become the same as therapy progresses. Self-esteem that is achieved in therapy will allow the client to elevate his sense of what he is, and self-esteem will also lessen his need to be better than what he is. Essentially, as the real self is more accepted by the client, and his raised self-esteem will allow him to be less than some kind of “ideal” self that he feels he is compelled to be. It is the qualities of unconditional positive regard, accurate empathy and genuineness in the humanistic therapist that allow the therapist to assist the client in cultivating congruence between the real self and the ideal self from that client’s perspective.

What the schizophrenic experiences can be confusing. It is clear that most therapists, psychiatrists and clinicians cannot understand the perspectives of the chronically mentally ill. Perhaps if they could understand what it is to feel oneself to be in a solitary prison of one’s skin and a visceral isolation within one’s mind, with hallucinations clamoring, then the clinicians who treat mental illness would be able to better empathize with the mentally ill. The problem with clinicians’ empathy for the mentally ill is that the views of mentally ill people are remote and unthinkable to them. Perhaps the solitariness within the minds of schizophrenics is the most painful aspect of being schizophrenics, even while auditory hallucinations can form what seems to be a mental populace.

Based upon standards that make them feel inadequate, the mentally ill respond to stigma by internalizing it. If the mentally ill person can achieve the goal of congruence between the real self and the ideal self, their expectations regarding who “they should be” may be reconciled with an acceptance of “who they are”. As they lower their high standards regarding who they should be, their acceptance of their real selves may follow naturally.

Carl Rogers said, “As I accept myself as I am, only then can I change.” In humanistic therapy, the therapist can help even a schizophrenic accept who they are by reflecting acceptance of the psychotic individual. This may culminate in curativeness, although perhaps not a complete cure. However, when the schizophrenic becomes more able to accept who they are, they can then change. Social acceptance is crucial for coping with schizophrenia, and social acceptance leads to self-acceptance by the schizophrenic. The accepting therapist can be a key component in reducing the negative consequences of stigma as it has affected the mental ill patient client.

This, then, relates to conditions of worth and the actualizing tendency. “Conditions of worth” affect the mentally ill more severely than other people. Simple acceptance and empathy by a clinician may be curative to some extent, even for the chronically mentally ill. If the schizophrenic individual is released from conditions of worth that are entailed by stigmatization, then perhaps the actualizing tendency would assert itself in them in a positive way, lacking distortion.

In the tradition of person-centered therapy, the client is allowed to lead the conversation or the dialogue of the therapy sessions. This is ideal for the psychotic individual, provided he believes he is being heard by his therapist. Clearly, the therapist’s mind will have to stretch as they seek to understand the client’s subjective perspective. In terms of humanistic therapy, this theory would seem to apply to all individuals, as it is based upon the psychology of all human beings, each uniquely able to benefit from this approach by through the growth potential that is inherent in them. In terms of the amelioration of psychosis by means of this therapy, Rogers offers hope.

Image via Kheng Guan Toh / Shutterstock.

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  • http://www.proofofgodandothertragedies.net Faith

    Hello. I appreciate your perspective on this topic. The understanding that stigma and “othering” have profound effects on self worth and actualization is a well-known psychological fact. What is less realized, however, is the fact that use of terms such as “chronically mentally ill” and “schizophrenic” contribute to the undervaluing of individual potential and experience.

    There is a great deal of irony in the use of such distorted and diminishing language in the context of an article intended to extend an invitation for genuine, open therapeutic rapport. Further, I do not know that therapists, humanistic or otherwise, are the best to inform anyone of ways to negotiate their real and ideal selves particularly when their view of the other’s real self is mediated by pathological confusion.

    I am consistently astounded by the dearth of awareness in modern humanistic psychology of practices such as Open Dialogue and in the severe and persistent use of language which is rooted in the medical model.

    • Dr. Ann Reitan

      Hi–I agree with your comments about language and pathologizing individuals who experience mental illness. What is needed is the development of language that does not stereotype individuals.

      Unfortunately, while nonpredudicial language evolves, so does the stigma attached to new terms. In distinguishing lower than average IQ, terms such as “moron” and “idiot” were used in the past. More recently, terms such as “mentally retarded” and “developmentally delayed” have been used.

      I am interested in what terms you would use for the “mentally ill”?

      Thanks, Dr. Reitan

      • Faith

        Thanks for your reply and question. I think that the term “mentally ill” is misleading in a lot of ways – as many people’s experiences of difficulty have more to do with trauma, sensory and processing issues, context of experience, etc. – than anything with a clear disease etiology. I prefer the term “human being having experiences” – but, yeah, that’s a little clunky.

        Thanks for writing on this topic. Language aside, it is vital that we develop new ways of approaching psychosis in treatment settings. I think, however, the current thinking about schizophrenia as a life-long illness really frames people’s experiences and perceptions of those experiences in a way that can undermine the potential for recovery. Thanks again…

        • Dr. Ann Reitan

          Yes, the term “life-long illness” referring to chronicity of mental illness sets people up for failure to an extent. I beleive, however, that the sporadic periods of lessneing symtoms of psychosis may eventuate as a result of the corect denial of delusional material. In this sense, “denial” may entail an accurate representation of reality.

          Moreover, I think that residual schizophrenia, that may occur in middle-age, might result from the confrontation with death that is aligned with this period of life. As trauma is an aspect of schizophrenia, the “trauma” of confrontation with death may lessen this trauma as one faces and accepts death.

      • Patricia Janae

        Dear Dr. Reitan:
        In response to your question about what better name could be given to “the mentally ill,”, the answer is “a person with mental illness” or “individuals with mental illness.” The National Alliance on Mental Illness (NAMI)advocates that the important rule in using non-stigmatizing language is to see and put the person first and the mental illness after that. In regards to self-worth, research shows that a person with any illness, physical or mental, does better if they can see themselves (their self-identity) as being more than the illness. Mental illness, schizophrenia and psychosis are diagnostic terms, and should never be used as if they are the person’s identity. Calling a person “a schizophrenic” is harmful because it reduces the person to being just a disease. Using phrases such as “a person with schizophrenia” or “individuals with psychosis” make the important distinction between the person and the illness, and emphasize that a person is much more than a disease or illness they happen to have. It is important to remember also that these are very broad diagnostic terms that include a diversity of people with a wide range of symptoms. So it misinforms and stereotypes to refer to “the mentally ill” and “schizophrenics” as if everyone in the diagnostic group is the same. Of course, these individuals are all very different, both diagnostically and as individual human beings. It is very important, therefore, both for treatment/ therapy purposes, and in daily living, to use language that recognizes the person as an individual. (p.s. I am the author of “What’s in a name: the case for changing the “s” word”, the article that one of the people commenting on your blog referred to.)

    • Morgan

      Would you like to point out precisely the words that bothered you in this article?

      I think in order for one to understand the message being conveyed, such words, words I think you are speaking of, have to be used.

      Over sensitivity is also a barrier to healing and progress.

      • Dr. Ann Reitan

        Morgan—I appreciate what you are saying. In my perspective, these labels take on new stigma as they are invented. It is hard to get around the stigma that they are associated with–even temporarily.

        The fact that people find them insulting may–may–have to do with their psychopathology, although this may be an unpopular idea to the mentally ill.

        I like what you are saying here. If one does not label herself in a negative light, perhaps that individual would not be as adverse to stigmatizing labels. It may be easier to reject the labels as inconsequential if one views himself in a positive light.

        • Maggie

          Counselors might say:

          people with ocd
          she is living with bipolar
          he is working with the symptoms of depression.

          The person’s main identity is not the issue/disease/whatever.
          To refer to people as the issue/illness/struggle is derogatory and stigmatizing.
          Also, using labels helps “labelers” achieve psychological distance from the “labeled”.

          it’s important to note why the system demands labels.

          Diagnosing, the treating professional/and medical billing
          contribute to the ongoing stigma of “having to label”. Stigma can worsen symptoms by further isolating people, and make obstacles to achieving quality of life.

          If this labeling is necessary, how about using up-to date terms, or even better yet, asking the person in front of you how they would like to be “labeled’.

          • Dr. Reitan

            I completely agree with you in this. I really like the idea that labels are used to distance others from those dealing with mental illness, and therefore alienate them in their psychopathology, which is a big part of the problem for the mentally ill.

            In this, there is damage to the mentally ill by means of labels.
            I think, though, that those dealing with psychiatric labels can choose or not choose to be defined by a label.

            Ann

  • Ricy Mardona

    Nice blog post. Keep sharing useful information.

  • Janet Reed

    In some ways compared to character/personality disorders, individuals with psychosis, if their symptoms are dealt with early by one of the rare therapists who “gets it,” have real possibility of being helped. I actually hold out the same belief about personality disorders, but as with psychosis, the therapist needs special insight, persistence, and imagination. Too often therapists are as beholden to unhelpful assumptions and stigmatizing as are ordinary lay people.

    • Dr. Ann Reitan

      I had a colleague who contended that borderline personality disordered individual should be treated by their clinicians with implacable good will. I believe that all mentally ill individuals in treatment should be treated with implacable good will.

      I think this quality adds to those characteristics in the therapist that you suggested, and, yes, intellectual creativity, empathy and persistence are necessary to “get it”, as you say.

  • Catherine

    I agree with your opinion.How to explain if the patient reluctant to cooperate with the therapist? Will his/her condition will become worse?What is another alternative ways to help this type of patient?

    • Dr. Ann Reitan

      Catherine,

      I think there is something to be said for the Rogerian “growth potential” and the Freudian “homeostatic mechanism”. Both of these involve the postulation that psychological problems have the potential to heal themselves.

      Alternatively, there are many forms of treatment. If individual therapy does not work for a client, perhaps group therapy (even art therapy, AA or an exercise club) or a day treatment program will work. There are many forms of treating Axis I and II disorders. It may just take some imagination.

      Ann

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  • http://www.mymaduniverse.blogspot.com Gabrielle

    I had some trouble getting to the point of your article. The term “psychotic individual” confuses me and it seems bias to used outdated terms such as “the schizophrenic” the mentally ill, etc. at least they are outdated in my mind.

    I think humanistic approaches and therapy are helpful. Schizophrenia is a genetically inherited brain disorder; just because it is genetic, does not mean it can’t be reversed or cured. Am I a “psychotic individual” just because I need to take medication that suppresses a certain action of my brain? Because I do NOT have symptoms when I take medication.

    I’m also on ADHD meds. It confuses me. When people like you refer to people like us as psychotic individuals or the schizophrenics, do you know what it does to us? Do you know what it’s like to associate with this sort of stigma in society?

    It’s not fair, it’s bad enough living with schizophrenia and it’s worse when people hurt us when we’re already in enough pain.

    • Dr. Ann Reitan

      Yes, I do know what you mean about these types of prejudicial terms. There are noted in philosophy aspects of labeling that are termed “thick concepts”. These are, essentially, stereotypes that have many underlying qaulities that are not perceived when one uses a label like “mentally ill” or “schizophrenic”.

      While I do not wish to stereotype others by labeling, I recognize that almost all labels, which may be used as a convenience, are thick concepts. Although I do not wish to confer onto others stereotypical prejudice, a beleive that there may be too many thick concepts to redefine in elaborated terms that may be too cumbersome.

      Female, bus driver, alcoholic, African American, intellectual, cowboy, politician, housewife, childlike—Do these not all contain stereotypes? And what, realistically, can be done about language that is inherently symbollic?

      • http://recoveryfromschizophrenia.org/2012/03/carl-jung-on-schizophrenia/ Gabrielle

        Thanks for the reply, Dr. Ann Reitan. Your article is insightful. My view is that psychosis is a behavior problem, not a genetic one, most often a response to traumatic experiences and uncontrollable events which CAUSE chemical stress. A person can become caught in a feedback-loop of perpetual distress and often the only way to heal the individual is through psychotherapy and to encourage them to foster their own independence and self-actualization. I no longer am under the impression that it is solely a chemical imbalance of the brain, or even passed on because the statistics and my own observations do not lead me to that conclusion.

        I still think the term schizophrenia is outdated and weighs in on the subjective view of the observer, without any sense of the internal depth a person could experience leading them to the very moments of discomfort they are seeking to avoid. The problem is that psychiatry often promotes the very thinking that keeps people trapped in a system of mental distress and fear. For instance: Dr says “If you go off this psychoactive drug you will most likely become “psychotic” AKA the patient would then have a re-enforced thought that if he/she went off medication, that they would become crazy, reckless, or their world would fall apart. Statistically this hasn’t even been proven. So it has become more of a matter of being held accountable as the clinician to the patient that you are honest and giving them enough information so that they do not become another helpless disabled victim of their own circumstances.

        You see, it’s up to the individual to reinforce the patterns which are provided by their immediate environment.

        Schizophrenia is the self-fulfilling error of humanity.

        • Dr. Ann Reitan

          I know of a quote that reads: “It is like trying to trace the shadow of your pencil with the tip of your writing instrument.”

          This is what thinking about thinking seems to be to me. One of the problems for those who are psychotic, or “perceptually different” in this sense, is that they are unable to “will belief”. Perhaps no one can believe something just because they want to–and I doubt that psychotic indivduals can “will” themselves into different belief systems. Perhaps psychotic individuals can refuse to make a judgment about hallucinations, and thereby avoid the formation of delusions.

          While I do believe that meds help disorders liker schizophrenia, I think that psychotherapy as an adjunct to meds is important. Thanks for your comment.

          • Bitch

            So last century, and I hope ya’ll die with it.

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  • Paul

    “As I accept myself as I am, only then can I change.”

    Don’t know exactly what this means , the necessity to change and the process of change implies some kind of spiritual awakening. I am a schizophrenic and the idea of change was something to strive for because I felt that I was in some kind of spiritual transition.

    Why? Because I was experiencing hallucinations caused by a malfunctioning brain and delusional interpretation inevitably followed. These are real symptoms that are physiologically motivated. Transport the somatic and tactile symptoms for example to a healthy cognitive base and regardless of the assurance of the cognitive base it would become delusional immediately. So I see the problem as somatic and hence medical. My question is ‘Why Change?’ if its to better handle stress I say fair enough , but suggesting the upheaval of self towards some spiritual end I say bolox.

  • Paul

    To clarify I see CBT , stress management and social counselling as the way forward. I think psychoanalysis , 12 step ideology and spirituality as unhelpful , all of which create unnecessary expectations on the individual and create mind and delusional constructs around the reasons for psychosis.

    • Dr. Ann Reitan

      Are you saying that the psychological and the psychiatric professions are a better bet in dealing with mental illness? I would agree to this, and, just recently I read an article that contained the conclusion that spiritual experience cannot be distinguished from mental illness. While I do not agree with this, I understand that both may represent experience that may largely correspond to internal, mental experience.

      The quote from Rogers “Only when I accept mayself as I an can I then change” is interesting. Rogers used “unconditional positive regard as a tool (if it could be called “a tool”) in therapy. I believe that, when one is accepted by an caring, empathic, nonjudgmental other, she is able to change–if only because she can see her self understood and reflected. Thus, she is able to accept herself by means of her therapist’s acceptance of her—and she then is able to change.

      This may yet be confusing, but I hope that it makes sense.

      • Paul

        Thanks for the reply

        Yes I see it as primarily a psychiatric problem and to a lesser extent psychological. I think the psychological perspective should reinforce ideas based firmly in reason and logic.

        In terms of the concept of change , I think the best approach is to see this as an
        adjustment in behavior so as to better manage stress
        become more self aware of symptoms , thought processes and improve insight
        take active responsibility for your own survival.

        The problem I have with ‘change’ is it can be synonymous with morality and everyone has their own construct of what morality is.
        A persons sense of self and well being is at the whim of everyone else’s thoughts and opinions of life.

        I am from a western vibrant democracy and stay within the confines of the law. I see that as reasonable behavior , I do not think of morality as it is counterproductive.

        • Dr. Ann Reitan

          I believe that you are speaking from a behavioral persepctive as such that is associated with Pavlov and Skinner. In my opinion, there are many avenues to change that reflect cognitve, relational, insight-oriented, and, yes, behavioral components, as well. I have to assert, however, that a change in one’s environment or the prescription of psychiatric meds are based on the goal of “change”, behavioral or not. I am not sure whether you would agree with this, given your statements about morality.

          My perspective is cogntive-relational. I believe in building a relationship with a client, so that he knows that “you are on his side”, and then “telling them like it is” or asking him questions as is reflected in the Socratic method of questioning. In spite my emphasis regarding the relational component of cognitve-relational theories and therapies, I believe Aaron Beck’s cognitive stance and Marsha Linehan’s CBT do contain relational apsects, as well. I would guess, all theories and therapies contain relational components.

          In terms of your reference to morality, I believe that “change” is not necessarily tied to morality: It is tied to functionality of the client as a primary goal.

          • Paul

            I agree with you remark re:improving functionality as a goal of any therapy. I also agree with the profound need for empathy when dealing with these situations…. Enforcement of rational behaviour based on reason and logic should of course be the end result.

            This is not to say that we create drones of people , who have no creative or even eccentric spark.

            That’s the beauty of rationality it allows for expression as it is mandated by our psychological makeup. Basically there is a need to express our selves , it isn’t a choice , at least for most people. It’s reasonable that we do this.

            Regards,
            Paul.

  • Ann Reitan

    Paul,

    I understand your emphasis on reason, rationality, science, empiricism and so forth—However, I believe that the paradoxical is an element of psychotherapy that works very well.

    For example, you mentioned AA. Although not a psychotherapy, AA advocates identification of oneself as an alcoholic for the rest of one’s life–this is the overt “content” of what the person in question is saying to herself or anyone else.

    In terms of what ensues, “process”, which is juxtaposed with this content, has the effect of allowing her to know, always, that she is suceptible to alcohol abuse–essentially, this has the effect protecting her from her own impulses in this regard–by making her always aware of them.

    Just telling her that she is suceptible to alcohol abuse may just inflict negative emotions in her toward herself. How does an alcoholic deal with negative emotions? She drinks.

    • Paul

      When you speak of AA I assume you are talking about 12 step programs. To the non psychotic effected some seem to find benefits in these programs , but for schizophrenic and people effected by psychotic disorders I see them as potentially dangerous. Here’s why ,

      the notion that an unseen unproven identity will help us. 12 step ideology tells you to refer insurmountable situations to a higher power. The problem with this is, in the psychotic mind , many slight simple issues, because of a malfunctioning brain, seem insurmountable. What you get in an effect is someone who eventually can not act rationally because ‘God’ is looking after them. Maybe you should look at the statistics that some argue about but none the less are indicative
      10% of schizophrenics Die by suicide
      20% attempt suicide
      30% never recover and become worse
      20% have persistent symptoms through out their life and live a sheltered existence.
      10% Manage their symptoms, can integrate with society but still remain effected by a certain amount of illness
      10% recover
      Life expectancy 15 years less than the normal
      Cause of death usually respiratory or cardiovascular disease.
      Higher prevalence of diabetes and circulatory problems when compared to the general population

      Now I do not want to depress people about this illness but I would like to frame the above, in the light of handing over responsibility for ones life to something completely unproven and as such only a mind construct.

      The facts tell us that schizophrenics and the psychotically effected need to find their way back to reality because such are the nature of data surrounding this illness, No God is going to help them.

    • Paul

      The biggest problem with 12 step ideology is the persistent iteration of rule making by the persons engaging in the program.

      The psychotic that makes persistent rules for him/herself who commits to live by those rules runs the risk of entrenching themselves in psychosis and obsession.

      Persistent unnecessary Rule-making will eventually tie the individual in knots. My opinion

    • Paul

      So I am going to tell you where I am at. I believe medication in principle is a good thing. Unfortunately the state of psychiatric medication is lamentable. while there is some strong evidence of meds addressing possitive sympthoms, they also unfortunately create and exaserbate negative sympthoms. In short they are not good enough to do the job conclusively, but can control florid episodes and bring some calm to a situation that could escelate. I see it represented in the following analogy , a sledge hammer to crack a nut. These drugs are just not niche enough yet. But the principal remains , basically physiological chronic and persistent disease should be medicated for , this is emboldened by the evidence that exist , in the vast majority of cases , when the disease goes unaddressed by medication.

      The illness like many other ailments lies on a spectrum of severity. I suspect that many that have found recovery were not as affected as others , the catatonic for example.

      In my subjective experience I can tell you that from a very young age 4+ , I was displaying sympthoms of this illness , serious sympthoms , I just didn’t understand them until they developed into tactile , somatic and visual sympthoms in a psychotic break in my mid 20’s. Why should I engage in psychoanalysis if I believe the pathology was persistent from day one and simply evolved and degenerated as I got older. Some people may wish to attribute this disease to psychological pressures , I just don’t believe that.

      That is why I believe that any form of psychological counselling should be aimed at improving insight, trying to address congnitive interpertation and responses and effectively ‘owning’ or taking responsibility for the illness.

      A schizophrenic will probably have to reformulate what they expect out of life based on the limitations their illness has placed upon them. In the same way as someone suffering from any other chronic condition.

      I see the camp that believe that schizophrenia is a psychological disorder , as unrepresentative of schizophrenia demographics. The people that recover I say congrats but the truth is that the vast majority do not. It is these people that I think of as I post my comments ,and what can be specifically done to improve their situation. As a person that falls into this category , the data makes sense , there have being a number of studies that shows that psychoanalysis is not effective as a means of managing or eradicating the illness , this tallies with my thoughts.

      So in an effect we have the alternative camp whose methods I would suggest only work for a minority of schizophrenic cases and we have the medical camp whose methods , while improving , the situation for some , remain intollerable to many,leading to medication non-compliance,in as much as 50% of cases.

      So this leaves so many suffering this illness in the wilderness. Fot them all that is left is reality. Not delusion or assumption. I encourage them to look at the principles that govern this world by looking at the objective data available and live your life as best you can.

      • Ann Reitan

        Paul,

        When I wrote about 12-step programs, I was really only trying to illustrate the fact that paradoxical interventions may work with schizophrenia and all form of mental illness. If you do not understand what I mean by this, check out Dialectical Behavior Therapy.

        In terms of approaching psychosis rationally by the psychotic individual, I think that your perspective works for you, due to your own idiosyncratic personality characteristics. Many psychotic individuals are not rational, and many lack frontal lobe activity, as a cause or a consequence of their illness.

        In terms of psychoanalysis, this is Freudian psychotherapy, and I agree that it is unlikely to work with schizophrenics. I might suggest, however, that “refusing to make a judgment” about one’s hallucinations represents good therapeutic advice.

        • Paul

          The judgement I make about hallucinations is that they are as of a result of a mind prone to stress , mostly as a result of faulty biology, and a somatic reaction within the brain to said stress. Do I see a hallucination as something to be ‘interpreted’ , no I do not. Do I believe stress in schizophrenia is routed in malformed psychology , no I do not. For many they have had terrible lives , abusive family life , poor social integration and acceptance , a history of substance abuse , lack of a continuous and safe environment , the list goes on. Such things are sure to exacerbate the illness , do I believe they are its root? no I do not. All I am saying is, what has a schizophrenic to loose by embracing the facts , it seems to me that so many of them think the world operates in a manner that is inconsistent with the way it actually does operate. And for so many it is actually killing them. I say give them the facts , whether it be biology , health science , physics, chemistry , history , sociology , psychology, economics , statistics , religion or whatever. At least they’ll know where the ground is and maybe for so many it maybe worth it in the end. Whenever they leave this life , the hope is that they’ll have their dignity.

          And I actually do think the vast majority of schizophrenic sufferers are capable of reason. That I believe.

          Regards.

        • Paul

          And yes, let the schizophrenic know the facts on pharmaceuticals.

  • Faith

    I have been following this discussion since I commented a while back, and so much of what you all have brought up warrants a great deal of appreciation. I agree with Paul that modes of experience that are characterized as schizophrenia are not simply psychological phenomenon. Nothing is, in my opinion, simply psychological. Our brains and bodies are involved in every aspect of our human experience. I do not carry a diagnosis of schizophrenia, but am considered to be on the “psychotic spectrum.” I have a diagnosis of bipolar disorder, severe with psychotic features. Those six words somewhat misrepresent the nature of my experience. I do consider myself to be neurodivergent, and to have particular sensory integration and processing differences, that contribute to my “vulnerability” to stress and anomalous experiences as a result of stress. Stress is another one of those concepts that is psychologized as a troubled state of mind, when in actuality the physiological and neurological effects of stress are very real, and affect the functioning of our brains, which in turn can present challenges in mind.
    I don’t think of stress vulnerability as being a weakness of some sort, or the effects of a disease, though stress can be toxic, can make us quite ill. I also experienced unique and challenging sensitivities and states of mind when I was very young. I was actually put into the psychiatric system at age 13, following a period of traumatic grief in response to a profound loss. I have always had issues with so-called sensory gating, and the way that I process and analyze information leads me easily to metaphor and loose associations. I experience emotion as a total affect, with physical and sensory accompaniments to feelings. These are qualities of my way of experiencing the world that present challenges at times (but also have benefits) and those challenges are deemed to meet criteria for a presumed severe and persistent mental illness. However, I really am much more comfortable with the thought that I am just wired differently and that, as a result, I cope differently and experience things differently.
    I have found an enormous amount of healing in recovery-oriented psychoeducation, learning skills such as mindfulness, wellness strategies, and ways to build an informed understanding of who I am and what works for me. I agree that medications can be helpful in tamping down florid states, that individuals struggle to cope with or make sense of, however I am opposed to the use of force and coercion in the administration of neuroleptics. There are non-medical means for individuals to de-escalate and regain psychological and neurological equilibrium. In my experience, psychosis is a potentially self-reinforcing state, in which one’s reactions have the capacity to exacerbate difficulties in subjective experience. The amount of stress sustained during a psychotic episode is tremendous.
    Anyway, this has gotten long. I apologize. I do want to respectfully counter Paul’s assertion that the vast majority of people with a diagnosis of schizophrenia do not recover, or cannot recover. There is a growing body of formal longitudinal research that indicates that many people can and do recover. Here are some references which cite well-respected longitudinal studies demonstrating that, in many cases, 1 of 2 people diagnosed with schizophrenia can and do recover. I actually believe the number could be higher, given advances in orthomolecular therapies, cognitive behavioral therapies, and more trauma-informed practice. I don’t know if it is appropriate to consider catatonic schizophrenia in the same way that we consider the other schizphrenias, though the neurological duress->dysfunction approach could also inform us as to why some people just get stuck within themselves.

    Ford, K. (2010). The concept of remission for people with schizophrenia. Mental Health Practice, 13(5), 22-25.

    Harding, C. M., G. W. Brooks, et al. (1987). The Vermont longitudinal study of persons with severe mental illness: I. Methodology, study sample, and overall status 32 years later. American Journal of Psychiatry, 144(6): 718-726.

    Harrow, M. M., Jobe, T. H., & Faull, R. N. (2012). Do all schizophrenia patients need antipsychotic treatment continuously throughout their lifetime? A 20-year longitudinal study. Psychological Medicine, 42(10), 2145-2155. doi:10.1017/S0033291712000220

    Kruger, A. (2000). Schizophrenia: Recovery and hope. Psychiatric Rehabilitation Journal, 24(1), 29.

    Luhrmann, Tanya. (2007). “Social defeat and the culture of chronicity: or, why schizophrenia does so well over there and so badly here.” Culture, Medicine and Psychiatry, 31(2), pp. 135-72.

    Mattsson, M., Topor, A., Cullberg, J., & Forsell, Y. (2008). Association between financial strain, social network and five-year recovery from first episode psychosis. Social Psychiatry & Psychiatric Epidemiology, 43(12), 947-952. doi:10.1007/s00127-008-0392-3

    Roe, D., Chopra, M., & Rudnick, A. (2004).Persons with psychosis as active agents interacting with their disorder. Psychiatric Rehabilitation Journal, 28(2), 122-128.

    Thanks again for the great discussion. I really respect the ideas that have come up in this comment thread.

    I can’t really think of anything more humanistic than acknowledging that we all experience the world differently and that the ways that we experience the world can change as we can. The thing that bothers me so much about negative prognosis is that it is so deterministic, and it denies the potential to heal and the potential to grow.

    Anyway, I hope you all have a nice day…

    • Ann Reitan

      I agree that psychosis is self-reinforcing. As the psychotic individual struggles to make sense of his experience, he may become entrenched in deepening psychotic ideation. And I like your comments on therapeutic interventions that might work with psychosis. I have an article that I may submit for publication on this website regarding psychoeducation and schizophrenia. I hope that it reaches you in the future.

  • Fell

    I think it might be a little defeatist to think in terms of stigma being bound to follow new names. It actually might not be hard to find a better name for schizophrenia, for example, if we adopt the attitude that the name ought to denote the core experience of the sufferer in a way she can agree on. For example, borderline personality disorder (maybe the most stigmatizing psychiatric epithet), if you think of the etymology (especially “personality” and “disorder” in a colloquial sense) and the history, essentially means “marginalized due to a character-flaw,” historically- and often still- essentially because of a poor response to treatment. It basically defines a person by the discomfort of others (uncomfortable countertransference is considered a diagnostic tool). Marsha Linehan’s suggestion of calling it a disorder of emotion regulation is more accurate and puts the name more in the hands of the sufferer and his true experience. If the name does this, then the stigma others unload onto it is easier and more empowering to oppose.

    We could do the same for schizophrenia and others. NAMI held a “Name the S word contest” and published a long list of contributions- in response to an article in Schizophrenia Digest: “What’s in a name: A case for changing the ‘S’ word” (Schizophrenia Digest, Spring 2006) which author Patricia Jane Teskey hopes will “inspire a grassroots campaign to get a new name for “schizophrenia” in time for publication of DSM-V in 2011.” Looks like that didn’t happen, but the campaign can still go on and the list is great. Some of them make a lot of sense and some are kinda “crazy” ! I like: Altered Reality Syndrome; Amazaphrenia; Hyper-Imaginative; Imagination Extremes; My-Mind-Lies-To-Me, or Mymindliestome; Neuroschizoterrafirmia; Perceptionitis; Smartpolar; Spiral Disease; and Whispering Mind. I also like the phrase often used by Windhorse Community Services: Extreme States.

    It seems also that what will help is science that can lead to a more specific understanding of the heterogeneity of the illness: “a new taxonomy, identifying the many disorders within the syndrome we now call ‘schizophrenia’ and hopefully replacing this aggregate label with a series of more precise diagnoses based on pathophysiology.” (NIMH) That goes for a lot of other illnesses too.

    I also like the idea of “person with/of/who” phrases, and though they can be awkward and seem “too politically correct” to some (and the flow of language is an important consideration), I think core meaning is sometimes more important than ease of use, that it doesn’t have to be just semantics or a lateral move. Naming controls people- in serious, if often subtle, ways. Also I don’t see why we have to wait around for some DSM committee to get it together. How about a grassroots re-naming. Names can be pretty catching, and with the right focus, can be really empowering. It’s always helpful when professionals used their insider status to promote these kinds of efforts.

    And thanks for this article and for inviting and engaging in a dialogue. There are so many gems in humanistic psychology that help me ease my own hopelessness, and Carl Rogers is just the best. And yeah, now my favorite lable of all time: human beings having experiences. I think Carl would approve.

    • Fell

      Hmm, I don’t know why that last part is in bold…

      • Fell

        Oh, it looks like the paragraph is in bold b/c it accidentally got turned into the link I posted. So if you click on that paragraph it will take you to the page about “Changing the S word.”

        • Ann Reitan

          I like your comments on DBT and labelling. And, yes, labels do affect people in insidious ways. The problem with creating new labels, in my opinion, is that these tend to take on stigma as different labels are replaced. Low IQ used to be defined by categories such as “idiot”, “imbecile” and “moron”. While changing labels periodically does help defeat stigma, prejudice still remains.

          And, yes, Carl Rogers is just the best.

    • Janet Reed

      Nice set of comments, Fell. I’d like to hear other people’s feedback on NAMI — is it a good, progressive organization?

    • Paul

      People who endure this condition suffer persistent hallucinations and delusions which directly impacts social function. It has to be called something. Using ‘emotional’ or ‘behavioural’ in a new naming premise for the illness is not something I would like. It gives the impression that the illness is based in psychology. However I accept that the outward display manifest in this way.

      One sure way to stigmatise someone is to give them the impression that they are somehow not ‘strong’ enough to surpass their illness.

      • Dr. Ann Reitan

        You know, Paul–the fact that you have a biochemical take on psychosis represents your viewpoint with respect to your particular psychological make-up. You are using your own mind to make a decision about how mental illness of this kind should be framed. Your viewpoint regarding the causes and treatment of psychosis is based on an a priori like any other theoretical perspective.

        Anyway…

        My father is the noted neuropsychologist Ralph Reitan. He is utterly against the use of stigmatizing labels. He has taught me not to define myself by labels, because, for rational reasons, these become self-fulfilling prophecy. No one should be taught that they are implacably handicapped by the fact that they have some condition that is reinforced by a label.

        • Paul

          Alright , I’m going to leave at this last post. You can reply if you wish , there will be nothing more from me on the matter. I appreciate your point of view , I appreciate that you are trying to de-stigmatise the illness , I am well aware of perspectives and projecting an internal subjective view of the world and trying to make it a reality for all. I would argue that this is what many who have found recovery outside of the medical model are also trying to do. Kind of like if it works for me it will work for everyone else , we don’t have to look too far in popular culture to see this is part of our collective social psychology. Religion is an example. A language and a made up sense of social expectation arises, cloaked in morality , reassuring the able and capable , whilst enslaving the meek and vulnerable. I think where and when any health professional can they should empower the patient and sufferer with facts or at least a critical appraisal of the raw data. First and foremost they should seek rationality , it is only then will they be able to disseminate the information ,and paradoxically I concede this , let them decide what is true.

          For me how do I know what’s true , I ignore what I think is true and find out what is actually true. How do I do that? I look at statistical data , how it was recorded and who recorded it. And I read critical appraisals of the conclusions should I not be in a position to fully grasp the complexities.

          Regards.

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  • Francis

    tremendous article.. I like your perspective on this.

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  • http://www.hummaa.com/user/marbleotter6 george

    This actually answered my problem, many thanks!

  • Amanda

    I believe “people first” language should be used. At the doctoral level, this writing may provide some good information, but your labels of schizophrenics is demeaning.

  • http://www.mymaduniverse.blogspot.com Gabby

    “Although it is a prevalent opinion in our society that schizophrenics are not responsive to psychotherapy, it is asserted herein that any therapist can relate in a psychotic individual, and, if therapy is unsuccessful, this failure may stem from the therapist’s qualities instead of those of the psychotic individual.”

    You are correct, it is a prevalent assumption that psychotherapy is not successful in treating people with psychosis. Further study is proving that assumption to be false.

    Secondly, a person who has had brief psychosis once should not immediately be considered a chronic case, which has happened more too often in the U.S. than we’d like to admit.

    Third, even if a person has chronic schizophrenia or psychosis, to call them “the psychotic individual” is incredibly dehumanizing and degrading, because more often individuals with this condition are not psychotic when they treat it.

    Treatment options vary as well. There are cases where no medication and therapy alone has proven successful, but is not so often the case of true chemical imbalances or an unknown underlying factor- this could be something like epilepsy, nerve damage, medication itself, drug abuse, or dementia running in the family.

    Without knowing what causes schizophrenia in these individuals yet, there should be no categorizing and stigmatizing them with labels.

    I do know what it looks like too. A person can become psychotic due to mania from an emotional regulation problem, or traumatic events in the case of PTSD.

    My psychosis came on quickly and I had no idea why other than I hadn’t been eating right, sleeping right, was on a vegetarian diet and had lost many pounds during an extensive hiking trip.

    I had mania and then I hit an extreme low. That was it. Then I was diagnosed with chronic paranoid schizophrenia at age sixteen after being forced to take anti-psychotic medication.

    This practically destroyed me. The labels themselves DO HURT US. It only takes someone trying to carry that diagnosis themselves to actually grasp that concept.

    How would you feel if suddenly your very life seemed to slip away into the realm of severe mania and psychotic depression, only to have it called something so ambiguous as “split mind syndrome” or psychotic individual seemingly to mean that you could slip back at anytime, lose your grip and go catapulting back into the realm of disillusionment, dreams and delusions. This doesn’t HELP anyone.

    It’s a brain imbalance, it can be brought on by stress, and there’s no proof that it’s a chronic disease of the mind when you’re only 16.

    I was put on too many medications that I suspect caused permanent lifetime damage.

    Another thing is it causes a lot of shame and fear in being different or “manic” or eccentric. There are plenty of eccentric people out there who don’t need labels.

    And the whole debasing language evolved around this “schizophrenia fad” is terrifying especially when most of it is untrue. Just watch 60 minutes episode about “the killers among you who mostly suffer from schizophrenia”

    a load of crap! Most people mean well. Schizophrenia does not take away your conscience. It takes away your reasoning skills. that means that you can tell right from wrong, you just don’t make as much sense and that gets in the way of expressing what you really mean, it causes serious cognitive deficits.

    And I worked on those a lot through psychotherapy and reading, because at one point I was so cognitively disoriented that my sentences followed no logical sense of order whatsoever.

    I’m not sure if that’s a sign of mania or not…because sometimes it wasn’t just being hyper, just a true inability to reason with the thoughts I had.

    Most of my life I displayed signs of high intelligence and aspergers.
    I scored highest at politics and essays at one point though, but my math skills were the first to go when I had my psychotic break. I was hit by an immense fog of fatigue. Every sound hurt. The noises just got to me. The loudness screamed in my ears, bells, trains, etc. I can’t filter them out.

    But it’s not like Autism in that I could socialize really well, other than for being shy.

    I didn’t hear voices until later, and I hope this is not a side effect of the medications I took. I still sometimes hear stuff, like waking up a brief sentence or sometimes I just talk to myself…but I don’t quite hear myself think like I used to…

    that’s prob a good thing IDK if it’s normal to constantly be in control of all your thoughts and everything…like I hate it so much. I hate that I have to focus on everything all the time, like I can’t do ANYTHING automatically. Is that dangerous? It’s like I’m either hypnotized or meditated all the time.

    But I’ve kinda always been this way. I’m always so hyper aware of myself that it’s frustrating just to let go.

  • Therapist in Portland OR

    A minor point: You note Rogers said, “As I accept myself as I am, only then can I change.”

    Of course change occurs also when our clients reach the very end of their wits having tried all their coping strategies to no avail.

    Having exhausted their behavioral repertoire, helpless, the only alternative left to them is the new.

  • http://brainblogger.com Ann Reitan, PsyD

    I have an article on remission of schizophrenia and defense mechanisms–in it, I argue that schizophrenics, at the end of their ropes, go correctly into denial of their delusions.

    I have also argued that when the schizophrenic accepts the inevitability of death as a natural stage of middle age, their condition of schizophrenia may remit.

    • Gabby

      I’d like to know your opinion on psychiatry’s influence on the prescription drug epidemic in our country, as no psychiatrist is looking to cure an individual whose been discriminated by being labeled as a schizophrenic, when no possibility of remission exists, neither is sought by our doctors, nor is hoped for.

  • http://billlubbe@wordpress.com Liam Ubert

    This ‘event’ (series of comments) is so interesting and has ‘changed’ my life. I am indirectly referencing the concept of idioverse introduced about 60 years ago by Saul Rozensweig: the individual is considered to be a universe of psychological events. He had cooperated with Carl Rogers in the 1940’s and had also said “The single, most remarkable mystery of life .. is the fact that every individual .. constitutes a unique and unreplicated unit. The particular combination of genes and ontogenetic experience is never repeated in nature.” The human need of labeling, classifying and stereotyping facilitates dealing with the vast complexity of life. It provides the basis for policies and guidelines, but it also causes a lot of pain.

  • Dr. Ann Reitan

    Hi– I am not sure what you are referring to–but you might address your question to Brainblogger.

    Thanks, Ann

Ann Reitan, PsyD

Ann Reitan, PsyD, is a clinical psychologist and well published essayist of fiction and creative nonfiction. She holds a Bachelor of Arts in Psychology from University of Washington, Master of Arts in Psychology from Pepperdine University, and Doctorate of Clinical Psychology from Alliant International University. Her post-doctoral research at Washington University in St. Louis, MO, involved personality theory, idiodynamics and creativity in literature. She recently published Illuminating Schizophrenia: Insights into the Uncommon Mind.
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