Paris Williams, PhD – Brain Blogger http://brainblogger.com Health and Science Blog Covering Brain Topics Mon, 08 Jan 2018 16:30:41 +0000 en-US hourly 1 https://wordpress.org/?v=4.9.1 Can Madness Save the World? http://brainblogger.com/2015/07/08/can-madness-save-the-world/ http://brainblogger.com/2015/07/08/can-madness-save-the-world/#respond Wed, 08 Jul 2015 15:20:44 +0000 http://brainblogger.com/?p=20109 Over the years of my explorations into psychosis and human evolution, a very interesting irony became increasingly apparent. It is well known that people who fall into those deeply transformative and chaotic states typically referred to as “psychosis” often feel at different points throughout their journeys that they have received a special calling to save the world, or at least the human race. Indeed, this experience played a particularly prominent role in my own extreme states, as well as within those of at least two of my own family members. From a pathological perspective, this is often referred to as a kind of “delusion of grandeur,” though in my own research and writing, I have come to feel that the term “heroic (or messianic) striving” is generally more accurate and helpful. The great irony I have come to appreciate is that while I think it’s true that these individuals are often experiencing some degree of confusion, mixing up different realms of experience (for example, mixing up collective or archetypal realms with consensus reality, or confusing unitive consciousness with dualistic/egoic consciousness), I have come to feel that perhaps the key to saving the world, or at least the human species, may in fact actually be revealed within these extreme experiences. To better explain this, let me first go over some key concepts.

Rethinking the Self

First of all, we need to reconsider what we mean by the term “self.” The twentieth century represented a real turning point for Western science in that it began to embrace a more holistic paradigm, in essence taking steps towards a paradigm established much earlier within the nondual traditions of the East (such as Taoism, Buddhism and the Vedic traditions) and even earlier within indigenous society. Quantum physics began to recognize just how deeply interdependent and interconnected the universe really is, capturing this with terms such as entanglement and nonlocality. Contemporary systems theory such as chaos theory and complexity theory similarly began to embrace this more holistic understanding of our world, drawing on important concepts such as Ilya Prigogene’s dissipative structure, which refers to the paradoxical way in which living entities maintain their existence across time while energy and matter continuously flow through them—similar to what we see in those little whirlpools standing above the drain of an emptying sink, in that all of the water that makes up its structure is continuously flowing through it and being replaced. Another term used extensively within these systems theories, and one that is particularly relevant to our discussion here about the “self,” is the term holon.

A holon essentially refers to what we generally think of as a living organism, but more precisely, it can be seen as a dynamic entity with three intrinsic qualities: (1) It is a self organizing system, exhibiting a kind of intrinsic consciousness or intelligence; (2) it is a dissipative structure, in that while it is able to maintain a relatively constant structure across time, it is also highly dynamic as it continuously exchanges matter and energy with the environment; and (3) it is irreducible, in the sense that any attempt to reduce it will simply result in the cessation of its existence. Although irreducible, a holon can merge symbiotically with other holons to emerge (another key concept within this holistic framework) into an altogether new holon of a higher order of complexity. This higher order holon is much more than simply the sum of its parts (the holons that compose it) in that it exhibits altogether new qualities that were simply nonexistent within the lower-order holons.

To put the idea of a holon into more concrete terms, we can say that an atom is a holon, which in turn merges with other atoms to form a molecule, a higher order holon that is much more than simply the sum of the atoms that compose it. Molecules in turn may merge symbiotically to create a living cell, what is generally thought of as the simplest living organism (a bacteria), in that some degree of consciousness and volition have become readily apparent. These in turn have merged to form yet another holon of still a higher order of complexity, the nucleated cell; and from these have emerged a still higher-order holon, the multi-celled organisms—the myriad fungus, plants and animals in our world. Certain kinds of groups of these individuals also self organize in ways that could arguably be thought of as higher order holons in their own right—flocks of birds, herds of deer, human families and tribes, an entire species, etc. Complex mergers of many different kinds of holons form ecosystems, which can be considered still higher-order holons. And finally, we recognize that out of a symbiotic relationship between the many different ecosystems of the Earth has emerged the biosphere. The well known NASA scientist, James Lovelock, has given the biosphere the name Gaia to signify that our entire biosphere can be seen as a single conscious and intelligent living organism in her own right, indeed the highest order holon on our planet.

Reversing this order of complexity is similarly illuminating, demonstrating that any attempt to reduce a holon to its parts merely results in an assemblage of lower-order holons, with the original holon itself having ceased to exist. For example, if a biologist kills a mouse in an attempt to better understand it in some way, all that remains is a collection of individual cells, some of which may continue to exist as individual cells, but which no longer work together symbiotically with the other cells to manifest as the more complex being (the mouse). The mouse as a living being, a holon, with all of its unique qualities, is no more.

So when we consider the concept of a self from this perspective, we find that our universe essentially consists of a hierarchically arranged array of holons arising from and embedded within a unified field. Lao-Tzu, writer of the Taoist text, the Tao-te Ching, said, “Tao [translated literally as ‘the way’] produced the One. The One produced the two. The two produced the three. And the three produced the ten thousand things” (Johanson & Kurtz, 1991, p. 1).

The Pros and Cons of Self Consciousness

By observing the behaviors of any living organism—whether it be a humble bacteria, a mighty redwood, or other members of our own human species—we can see clear signs of consciousness and intelligence, which I’m defining as simply the capacity to be aware of one’s environment, to make some kind of meaningful evaluation of it, and to then respond accordingly. What’s less clear is the degree to which different organisms are self conscious—aware of being aware—although it is quite clear that we humans have developed a significant capacity for self consciousness, and that this attribute brings with it both great rewards and serious risk.

On one hand, such a high degree of self awareness allows us to deeply appreciate the wonder of life and our universe. Indeed, we can recognize that our existence represents the achievement of the universe in having developed the capacity to contemplate itself. I find it difficult to conceive of anything more awesome than this. But on the other hand, such self consciousness brings with it a vulnerability to becoming profoundly confused, especially with regard to selfhood. It becomes all too easy to overly identify with the self only at the level of this particular self-aware holon, what is sometimes referred to as the personal or egoic self—that self that we typically refer to when we use the words “me,” “myself” and “I.” And along with this, we are at risk of losing sight of the fact that this personal self is merely one order of selfhood among many other orders of selfhood, as discussed above: at lower orders of complexity, the community of trillions of cells who have merged their collective wisdom and resources to manifest as this personal self, with each of these cells in turn being composed of a merger of yet simpler selves—the bacteria; and at higher orders of complexity, the communities, ecosystems and ultimately the entire biosphere of which we are part. Losing sight of this broader selfhood is not only extremely limiting, but also potentially extremely destructive.

The Breakdown of a Self

An example of the potential destruction that may occur when one member of a holon “forgets” that it is in fact such a member is in the case of cancer. In cancer, what we essentially find is an individual cell within a multi-celled organism that, for whatever reason, “forgets” it is a member of this more complex organism. We can say that its self identity has constricted radically, and it now identifies only with its personal self. Therefore, it still retains its innate tendency to meet its own needs and maintain its own survival, but it no longer contributes to the survival of the larger organism; and since it continues to be nourished by the larger organism while essentially not giving anything back, it develops a great capacity for autonomous reproduction and growth, but all the while increasingly interfering with the functioning of the larger organism. And as is well known, while cancer represents a period of very successful growth for the self-identified cells, if the organism is unable to either destroy these cells or regain their cooperation, the entire organism is likely to die, along with the cancer cells. Therefore, we can say that by losing sight of their broader selfhood, these cancer cells enthusiastically “thrived” their way all the way to their own demise.

Does this sound familiar? In the very same way that single cells live as symbiotic members of the larger multi-celled organism to which they belong, the human species can itself be seen as a holon living in a symbiotic relationship with other holons to form the higher-order holons of ecosystems and ultimately the entire biosphere, Gaia. And just like the case of the cancer cells, the human species has collectively forgotten about this symbiotic arrangement, this broader order of selfhood, and has become consumed with only its own survival at the species level (and at times this self identity is constricted even further to that of only a particular society, race, family, or even nothing more than the individual human being). And just as in the case of cancer, because now this particular holon is consumed only with its own survival while continuing to be fed by the larger organismic systems in which it is embedded, it initially reproduces and grows radically. However, also just as with the cancer cells, its own rampant growth combined with the underlying ignorance of its broader selfhood will ultimately lead to its own demise, as well as the demise of many of its fellow holons, threatening both those at a similar level within the holon hierarchy (other individual organisms and species), as well as higher-order holons such as ecosystems and perhaps even Gaia herself. This may sound farfetched to some, but it’s well established that Gaia has already had some very close calls within her long life, some of which were brought on by certain living organisms themselves, and of course any living system has its limits.

Breaking Down in the Service of Breaking Through

Ironically, the breakdown of a self can sometimes act as a breakthrough to a more sustainable existence of that self, or even in extreme cases, the emergence of an altogether higher order of selfhood –the emergence of holons of a higher order of complexity.

The contemporary evolution and systems sciences have come to recognize that a key component of evolution is the dance between chaos and order. A certain order is required to maintain the existence of holons over time, but when a significant threat of holon breakdown occurs, this can initiate a process of radical and unpredictable change—chaos—as a kind of desperate attempt to renew order when it has been seriously compromised, or even to break through to altogether new levels of order when necessary. So I think that one particularly useful way to define chaos is “a process that utilizes breaking down as a catalyst for breaking through.”

For example, it’s become widely accepted within the evolution sciences that after a very long and relatively stable period of time in the early history of the Earth during which only bacteria existed, a serious crisis emerged caused by the excessive consumption and waste products of the bacteria themselves. Prior to this, the nutrients the bacteria required for their survival were abundant enough that the bacteria were generally able to nourish themselves without bothering each other too much; but now with the population of bacteria exceeding the availability of many of these naturally occurring resources, a chaotic period ensued in which many of the bacteria were forced to consume each other. It’s speculated that some of the consumed bacteria managed to survive even after having been engulfed by other bacteria, and then went on to develop symbiotic relationships within the larger host. This in turn led to the evolution of a new holon of an altogether higher order—nucleated (eukaryotic) cells living as individuals, also referred to as protists. Then, sometime later, the conditions of the Earth had once again become very precarious for its inhabitants, and these single celled protists were forced to come together and live as symbiotic communities of cells, ultimately merging their collective wisdom and resources to evolve into an altogether new holon of yet a higher order of complexity—multi-celled organisms, which have eventually evolved into the fungus, plants and animals that exist today.

It’s important to acknowledge that this process of higher levels of complexity and order emerging from unsustainable conditions and a subsequent chaotic process is generally very risky. It often fails, not resolving successfully or even resulting in the deaths of the participating organisms. Hence the reason we find that it so often seems to require desperate conditions to precipitate such a desperate strategy. And this is where “madness” or “psychosis” comes into the story.

Can Madness Save Us?

I think it’s helpful to recognize that psychosis has both a destructive and a creative, or a chaotic and an ordered, aspect (I’ll use the term “psychosis” here, as I want to emphasize the idea of a particular kind of process occurring, and I feel that the term “madness,” while very helpful in other contexts, is a bit too generic for this purpose). On one hand, psychosis appears to occur as the result of impending breakdown—an individual’s personal paradigm, their experience and understanding of the self and the world, has for whatever reason reached a point in which it is no longer sustainable. But on the other hand, just as in the process of evolution described above, we see inherent in psychosis the utilization of “breaking down” as a kind of desperate strategy for “breaking through,” the utilization of chaos in the service of renewing order or even breaking through to an altogether different order. Yet as we’ve seen within the process of evolution, this can be a very haphazard and risky strategy that may or may not be successful, depending upon the resources and limitations of the particular organism or holon.

Whereas “psychosis” is often considered to be something occurring within a particular individual, I think we need to reconsider psychosis as occurring within the broader understanding of selfhood discussed above. So when an individual is experiencing what is often called psychosis (having anomalous beliefs, perceptions, impulses, etc., that are often extreme and/or unstable), I think it’s important to recognize that this may be the manifestation of a breakdown occurring not only within the individual, but also within the larger holon(s) within which the individual is embedded (the family, society, species, etc.). And I believe that this perspective offers us some compelling insights into how psychosis can be seen as both a warning of serious breakdown within these higher-order holons as well as the key to breaking through.

I think that anyone applying basic critical thinking skills to what can be observed about the state of the world today would be forced to come to the conclusion that we as a species are in serious trouble. No matter which angle you choose to come at it—accelerating climate change, rampant environmental destruction and mass species extinction, expanding and escalating war with over 17,000 nuclear warheads only a button’s push away from detonation—it’s only too clear that we’re skating on very thin ice. By our own doing, we have set the trajectory of our own species as well as that of the other holons of which we are a part toward great chaos. And yet, astonishingly, we collectively carry on with business as usual—increasing the amounts of greenhouse gases we release into the atmosphere, accelerating our destruction of species and ecosystems, expanding our wars and building even more nuclear weapons.

It’s as though we have become completely blind; and in many ways, I believe that’s exactly what has happened. Just like the cancer cells that have become blind to the fact that they are a completely dependent member of the larger organism, the human species has become blind to the fact that it is a dependent member of the broader ecosystems and the biosphere to which we belong, having become consumed with the needs of the more limited selves (one’s nation, one’s family, one’s personal self) at the direct expense of the broader selfhood to which we also belong. In other words, you could say that we have become stricken with a kind of disorder—a disorder of “constricted selfhood,” and unfortunately it appears that we have very little collective “insight” into this disorder.

Interestingly enough, it is perhaps those we deem “mad” who may be in the best position to support our species in developing this insight. Arnold Mindell, who offers the unique perspective of a psychologist steeped in depth psychology, systems theory and modern physics, suggested that:
“In a given collective, the schizophrenic patient occupies the part of the system in a family and a culture that is not taken up by anyone else. She occupies the unoccupied seat at the Round Table, so to speak, in order to have every seat filled. She is the collective’s dream, their compensation, secondary process and irritation”.

In other words, although a person experiencing psychosis may be experiencing great confusion and fluctuation between different realms of experience, these extreme states of mind often allow the person to act as a kind of conduit bringing forth the shadow—the unacknowledged, the unspoken, the denied—aspect of the particular system(s) or holon(s) to which they belong. Indeed, there is compelling evidence to suggest that someone experiencing psychosis is often able to perceive the world in a more raw and accurate manner than when in more ordinary states (such as, for example, their capacity to see through the illusion of the inverted face), and to bring forth within their anomalous experiences various valid shadow elements, such as with the prominent “paranoid delusion” of being watched over by government agencies experienced by many such individuals long before Edward Snowden revealed the actual truth of this, the long held apocalyptic themes that are uncomfortably close to what we now see actually unfolding within the world, or the voices of voice hearers that often correspond very closely with certain shadow elements within the individual’s family and broader social systems. Although these anomalous perceptions and beliefs are often exaggerated or distorted to some degree, perhaps it’s time we recognize the shadowy truths so often contained within them, and appreciate that such individuals can serve a very important role in our collective survival by acting as our canaries in the coal mine, helping us to develop insight into our impending breakdown.

It appears that nearly ubiquitous among indigenous societies is the appreciation for the potential gifts of such individuals, and the essential role that they play in maintaining the overall health of the tribe and larger social structures. Referring to such individuals as shamans, seers, visionaries, etc., indigenous societies have long recognized that without reserving an honoured place for such individuals within the social structure, the society is vulnerable to falling prey to increasingly narrow and rigid belief systems, which may ultimately undermine the health and adaptability of the society and lead to its demise (see John Weir Perry’s Trials of the Visionary Mind for what I believe is an excellent exploration of these ideas). When we look around at the state of contemporary human society, with its deepening entrenchment into rigid and dogmatic belief systems, we have to ask ourselves how wise it really is to continue invalidating such individuals as simply “crazy” or “brain diseased” and relegating them to a lifetime of mind-numbing drugs and institutionalization.

So if we consider that individuals who experience psychosis can play a very important role in helping the broader human society in developing “insight” into our unresolved shadow issues and especially the problem of our constricted selfhood, the question then arises, So what do we do about it? And again, I believe that the answer to this dilemma may well lie within the process of psychosis itself. If we consider that the human species is essentially struggling with a “disorder or constricted selfhood,” then it becomes clear that our salvation requires that we undergo a species-wide transformation of the self. Interestingly enough, when we inquire into the subjective experiences of individuals experiencing psychosis, what we so often find is a person grappling with exactly this process—a profound transformation of the self.

My own research (Williams, 2011, 2012) as well as numerous anecdotal accounts suggest that initially when a person enters into a psychotic process, their experience of the self and the world becomes highly chaotic and/or fragmented. However, those who manage to move through this process and experience successful resolution very often find that they arrive at an experience of self and the world that is qualitatively very different than that which existed prior to the psychosis. Many such people report significantly greater wellbeing and a more fluid, expansive and integrated experience of the self. For example, the participants of my own research who have experienced such a resolution all share the following common shifts as having occurred within their personal paradigms when comparing their experience now with what existed prior to the onset of their psychosis:

  • A significantly changed spectrum of feelings with more depth and unitive feelings
  • An increased experience of interconnectedness
  • A strong desire to contribute to the wellbeing of others
  • An integration of good and evil (feeling generally more whole and integrated within themselves; and seeing “evil” actions or intentions as simply the result of profound ignorance—especially as problems with constricted selfhood—rather than as anything intrinsic within anyone)
  • Appreciating the limits of consensus reality

And they all share the following lasting benefits (comparing their experience after the resolution of their psychosis to that which existed prior to the onset of the psychosis):

  • Greatly increased wellbeing
  • Greater equanimity
  • Greater resilience
  • Healthier, more rewarding relationships with others
  • Healthier relationship with oneself

In other words, it appears that such an individual often goes through a profound transformation of selfhood in which they emerge with a greater appreciation of the interconnectedness and interdependence of the world, and the inspiration to live in a way that is more in alignment with this shift in their personal paradigm—a way that is likely to be more beneficial for the personal self as well as for the other living organisms and living systems with whom they share the world. It is easy to see that this is exactly the kind of transformation the human species is in desperate need of undertaking—a profound transformative process from a highly constricted experience of the self to an experience of selfhood that is much more fluid, expansive, and humble. But how do we foster such a radical transformation?

To answer this question, I think we first need to look more closely at the state of the human species today. It’s self evident that the human species has collectively become entrenched in an experience of selfhood that is no longer sustainable, a condition very similar to what we see within an individual just prior to the onset of psychosis. It is equally self evident that, generally speaking, chaos and breakdown are rapidly escalating within human society and even within the higher order holons of the world’s ecosystems and biosphere. Again, we find conditions occurring within this higher order holon (the human society and species in general) very similar to that which occurs when an individual is slipping into a psychotic process. So would it not be appropriate, then, to consider that the human species as a whole is sliding into a kind of collective psychosis? And if so, is there some way that we can facilitate the transformation of our paradigm—our collective experience and understanding of the self—towards one that is more flexible, expansive and humble? Or do we simply have to hang on and go for the ride, trusting that a deeper wisdom will somehow see us through?

This is where I believe we may be able to take some guidance from those approaches that have been so effective in supporting individuals going through a psychotic process— residential facilities such as Soteria, Diabasis and I-Ward, the family and social systems approaches such as Open Dialogue, and the shamanic mentoring model we find within indigenous societies. All of these approaches share the belief that in spite of the chaotic and potentially destructive nature of psychosis, there is a deeper wisdom occurring within it that is striving to bring about a deep transformation from an experience of the self and the world that is no longer sustainable to one that is.

The general philosophy of the residential homes such as Soteria, Diabasis and I-Ward is that if a safe and nurturing cocoon is provided to the person—allowing for maximal freedom within a structure that ensures minimal harm and destruction—the psychosis is likely to naturally move through to a full and successful resolution. Applying this approach to the problem of our species-wide psychosis, then, it would make sense that we should strive to create similar conditions within our society at large—maximal freedom (i.e., genuine non-authoritarian democracy) within maximal safety (i.e., strict regulations placed upon harmful industry and excessive greed, while using nonviolent means and effective communication rather than aggression and war to settle our disputes).

The Open Dialogue approach and other family systems approaches directly address the need to create a context of an expanded experience of selfhood, especially in that they generally see psychosis as representing a breakdown occurring within the individual’s immediate social network (the family, close social group, etc.). And they support resolution of the psychosis, and the emergence of a more sustainable order within these various holons, by fostering open and authentic communication between the various members of these holons. In other words, all voices, especially those representing the shadow aspects of these systems, are honoured and brought to the table. This approach draws from the faith in the intrinsic self-organizing capacity of any living system or holon, seeing breakdown as occurring when various members of the system are excluded or ignored, and therefore seeing breakthrough as occurring when all members are included. Applying this approach to the problem of our species-wide psychosis, we again arrive at the conclusion that genuine, all-inclusive, non-authoritarian democracy is likely to be extremely important for our positive transformation. Furthermore, it becomes clear that effective communication and dialogue (both within self connection as well as in connection with others) are essential components of this, and that this dialogical process needs to extend beyond the various political boundaries and divisions we see in the world today to include the entire human species. Following the lead of some indigenous communities today, I would even take this further and suggest that the voices of the other holons within our expanded sphere of selfhood (the other living organisms and ecosystems) also need to be brought to the table.

Finally, indigenous societies generally have a system in which people who go through a psychotic process (sometimes referred to within this context as a shamanic illness) are mentored by others who have already successfully passed through such a process. This is somewhat akin to the various peer support systems we see in place today within contemporary society (peer respites, voice hearing groups, etc.). The potential benefits of this approach are quite obvious—those who have “been there” and have successfully integrated their experiences are often able to provide very effective support and guidance to those who are continuing to struggle with these experiences. Applying this approach to our species-wide psychosis suggests that those who have gone through psychosis and other extreme states themselves may be able to bring a particular kind of wisdom to the table that will be essential for our species-wide transformation. Indigenous societies have long recognized how important such voices are for the health of their communities; isn’t it time that contemporary societies rediscover the wisdom of this?

Anais Nin wrote a short poem that I think captures the essence of our dilemma while proposing a challenge that I think we need to seriously consider: “And then the day came when the risk it took to remain tight in a bud was more painful than the risk it took to blossom.” So what will it be? Will we as a species continue to cling to our constricted selfhood until the bitter end, or will we find within us the wisdom and the courage to “blossom” and reclaim our membership within the broader living systems of which we are a part?

Note: Between July 10-12, I and 11 others will be presenting different perspectives on the relationship between extreme states and spiritual awakening during a FREE 3-day online summit — Shades of Awakening. For those who aren’t able to attend, or if you’ve already missed these dates, these interviews will available for download.

References

Johanson, G., & Kurtz, R. (1991). Grace unfolding: Psychotherapy in the spirit of the Tao-te Ching. New York: Bell Tower.

Koestler, A. (1967). The ghost in the machine. London: Arkana.

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

Prigogine, I., & Strengers, I. (1984). Order out of chaos: Man’s new dialogue with nature. New York: Bantam.

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 connel / Shutterstock.

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Schizophrenia and Psychosis – Brain Disease or Existential Crisis? http://brainblogger.com/2012/08/07/schizophrenia-and-psychosis-brain-disease-or-existential-crisis/ http://brainblogger.com/2012/08/07/schizophrenia-and-psychosis-brain-disease-or-existential-crisis/#comments Tue, 07 Aug 2012 11:00:06 +0000 http://brainblogger.com/?p=13045 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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Is Schizophrenia Really a Brain Disease? http://brainblogger.com/2012/06/23/is-schizophrenia-really-a-brain-disease/ http://brainblogger.com/2012/06/23/is-schizophrenia-really-a-brain-disease/#comments Sat, 23 Jun 2012 23:36:17 +0000 http://brainblogger.com/?p=12737 In spite of over a hundred years of research and many billions of dollars spent, we still have no clear evidence that schizophrenia and other related psychotic disorders are the result of a diseased brain. Considering the famous PET scan and MRI scan images of “schizophrenic” brains and the regular press releases of the latest discoveries of one particular abnormal brain feature or another, this statement is likely to come as a surprise to some, and disregarded as absurdity by others. And yet, anyone who takes a close look at the actual research will simply not be able to honestly say otherwise. And not only does the brain disease hypothesis remain unsubstantiated, it has been directly countered by very well established findings within the recovery research, it has demonstrated itself to be particularly harmful to those so diagnosed (often leading to a self-fulfilling prophecy), and is highly profitable to the pharmaceutical and psychiatric industries (which likely plays a major role in why it has remained so deeply entrenched in society for so many years, in spite of our inability to validate it).

Deconstructing the Myths of Madness

The claim I am making here clearly runs counter to the mainstream understanding of schizophrenia, but we find that it’s a relatively straightforward task to back up this claim. We simply need to take the time to extract the actual research findings from the unsubstantiated assumptions and propaganda that are so often used to back up the brain disease hypothesis. I’ll go through the largest of these here:

Hypothesis #1: Schizophrenia is caused by a biochemical imbalance within the brain

This theory originated from the observation that drugs which block the transmission of the neurotransmitter dopamine within the brain (so called “antipsychotics,” originally referred to as “major tranquilizers”) appear to reduce the symptoms of schizophrenia. The reasoning behind the origin of this hypothesis was, since schizophrenic symptoms are reduced when dopamine transmission is suppressed, then perhaps schizophrenia is caused by too excessive dopamine within the brain.

This hypothesis originally appeared quite plausible; however, it has since been seriously discredited:

First, although it is known that an individual’s dopamine receptors (the type of receptors most affected by antipsychotic drugs) are completely blocked within hours of consuming a sufficient dose of an antipsychotic drug, the actual antipsychotic effects often do not become apparent for up to several weeks(even though a significant degree of apathy towards one’s psychotic experiences often does kick in quickly, as would be expected with any kind of tranquilizer). If psychotic symptoms are the direct result of too much dopamine, then why don’t we see a more immediate abatement of these symptoms as soon as the dopamine levels have been effectively reduced?

Second, with the introduction of PET and MRI scans, the dopamine hypothesis was apparently substantiated when it was recognized that  many “schizophrenic” brains do indeed seem to be set up to transmit excessive dopamine. However, it was eventually realized that the vast majority of brains studied had been exposed to long-term antipsychotic drugs, and it’s since been established that the effects of these drugs alone may very well account for these anomalies.

Finally, even many of the proponents of this theory have been forced to acknowledge that we still have not found any clear biochemical imbalance that we can associate consistently with schizophrenia or any of the “mental illness” diagnoses, and that all we can really say for sure is that psychiatric drugs themselves (and virtually any psychoactive drug, for that matter) does lead to the development of a biochemical imbalance in one’s brain.

Hypothesis #2: Schizophrenia is caused by anomalous brain structures

This hypothesis essentially states that schizophrenia is a disease caused by something wrong with the actual structure of one’s brain, specifically with regard to the relative size of the cerebral cortex and/or other nearby regions of the brain. This hypothesis is generally supported by the actual findings of such anomalies of the brains of those so diagnosed. But again, upon closer scrutiny of the research, we find an empty hypothesis that quickly crumbles away:

First, we have discovered that there are many different factors that can lead to these abnormalities, including: depression, alcoholism, early childhood trauma, water retention, pregnancy, advancing age, variations in educational achievement, social class, ethnicity, and head size. It was also discovered that the sizes of these regions of the brain can fluctuate quite rapidly within even healthy individuals, leading to varying results even within the same individual. And once again, what do you imagine we have found that is probably the most relevant factor causing such anomalies in the brain?  You guessed it… the use of antipsychotic drugs themselves. And virtually all of the research that has discovered such brain anomalies in those diagnosed with schizophrenia did not account for this very important factor, meaning that once again, most of the brains studied had most likely been affected by the long-term use of antipsychotic drugs.

A second serious challenge to the validity of the abnormal brain structure hypothesis came when it was recognized that the majority of those diagnosed with schizophrenia do not show any obvious brain abnormality at all. Lewine found that “there is no brain abnormality in schizophrenia that characterizes more than 20-33% of any given sample. The brains of the majority of individuals with schizophrenia are normal as far as researchers can tell at present [emphasis added]”; and this in spite of the fact that most of these participants were likely exposed to other brain changing factors such as trauma and/or antipsychotic medications. Conversely, it is common to find healthy individuals who have no schizophrenic symptoms at all and yet have brain abnormalities similar to those sometimes found in schizophrenics.

Hypothesis #3: Schizophrenia is a Genetic Disorder

This hypothesis is in close alignment with the two brain disease hypotheses (above) and suggests that this brain disease is transmitted genetically. But again we find some serious problems with the assumptions that have given rise to this hypothesis:

This hypothesis is based on a small handful of twin and adoption studies conducted many decades ago which, even when we ignore the many serious methodological flaws with these studies, the only conclusion that can actually be drawn from them is that there may be a hereditary component in one’s susceptibility to developing psychosis. However, this is not any different than the findings that there may be a hereditary component in intelligence, shyness, and other psychological characteristics that clearly are not indicative of any kind of physiological disease. In other words, it’s an illogical leap to assume that a hereditary predisposition for a psychological trait or experience must imply biological disease. Yes, there does seem to be some evidence that some of us may be born with a temperament or other psychological characteristics which make us more vulnerable to experiencing psychosis at some point in our life; but no, this evidence does not lend any validity to the hypothesis that schizophrenia is a genetically transmitted biological disease.

Another important area of research discrediting the “genetic disease” hypothesis is the far more substantial research showing high correlations with environmental (non-hereditary) factors and the development of psychosis/schizophrenia. For example, One study looked at 524 child guidance clinic attendees over 30 years and discovered that 35% of those later diagnosed with schizophrenia had been removed from their homes due to neglect, a percentage twice as high as that for any other diagnostic category; another study found that 46% of women hospitalized for psychosis had been victims of incest; another study of child inpatients found that 77% of those who had been sexually abused were diagnosed psychotic compared to only 10% of those who had not been so abused; and yet another study found that 83% of men and women who were diagnosed with schizophrenia had suffered significant childhood sexual abuse, childhood physical abuse, and/or emotional neglect. Bertram Karon, researcher and acclaimed psychosis psychotherapist, has found evidence of a high correlation between the experience of intense feelings of loneliness and terror within childhood and the later onset of schizophrenia, a finding that is clearly closely related to the findings of these other studies.

Even the strongest proponents of the brain disease hypothesis acknowledge that it has not yet been validated

The National Institute of Mental Health, on its Schizophrenia home page, proclaims confidently that “schizophrenia is a chronic, severe, and disabling brain disorder”, a statement you find on nearly every major page or publication they have put out on the topic; and yet if you spend a little more time looking through their literature, you will find that they admit that “the causes of schizophrenia are still unknown”. Similarly, the American Psychiatric Association also confidently proclaims that “schizophrenia is a chronic brain disorder”, but then they acknowledge on the very same page that “scientists do not yet know which factors produce the illness”, and that “the origin of schizophrenia has not been identified”. The strong bias towards the brain disease theory is clearly evident in the literature of these and other similar organizations, and yet the message comes through loud and clear that we still do not know the cause of schizophrenia. Even the U.S. Surgeon General began his report on the etiology of schizophrenia with the words, “The cause of schizophrenia has not yet been determined”. It would appear, then, that it is simply not appropriate to claim with such confidence that schizophrenia is the result of a brain disorder.

If schizophrenia really is a brain disease, then how do we account for the relatively high rates of full recovery from it?

The recovery research is extremely robust: Many people experience full and lasting recovery after having been diagnosed with schizophrenia. We see this evidence in the vast majority of the longitudinal recovery studies (See Chapter 4 in my book, Rethinking Madness, for a complete list of all major longitudinal studies), including those conducted by the National Institute of Mental Health and the World Health Organization. There is evidence of spontaneous recovery in between 5% and 71% of cases, depending upon the country of origin and other factors, and even as high as 82% with certain psychosocial interventions. It is illuminating to compare the high recovery rate for schizophrenia with the recovery rate for well-established diseases of the brain such as Parkinson’s, Alzheimer’s, or multiple sclerosis: There is no well documented evidence of even a single individual making a full recovery from any of these well-established diseases of the brain.

The mainstream paradigm of care may actually be creating a self-fulfilling prophecy of brain disease

A tragic result of the entrenched belief that schizophrenia is caused by a disease of the brain is that, whether or not schizophrenia is ever determined to be a disease of the brain, our mainstream paradigm of care is actually ensuring that enormous numbers of people actually do develop such a disease (see the figure; I will also discuss this in more detail in a future blog).

So what does cause schizophrenia?

So, if schizophrenia is not caused by a disease of the brain, then the obvious question that arises is, “Well, then what does cause it?” This is an extremely important yet somewhat complex question, which I address in great detail in my book, Rethinking Madness, and which I will try to capture in a nutshell (or perhaps several nutshells) in future blog postings within this series.

For a much more thorough discussion of these and closely related topics, as well as a detailed discussion of the finding of  Dr. Williams’ own recovery research, you can find Dr. Williams’ book, Rethinking Madness (Sky’s Edge Publishing), on Amazon and other major retailers. More information is available at www.RethinkingMadness.com

References

American Psychiatric Association [APA]. (2010). Schizophrenia. Healthy Minds, Healthy Lives [website].

Beck JC, & van der Kolk B (1987). Reports of childhood incest and current behavior of chronically hospitalized psychotic women. The American journal of psychiatry, 144 (11), 1474-6 PMID: 3674230

Harrow M, & Jobe TH (2007). Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medications: a 15-year multifollow-up study. The Journal of nervous and mental disease, 195 (5), 406-14 PMID: 17502806

Harrow M, Jobe TH, & Faull RN (2012). Do all schizophrenia patients need antipsychotic treatment continuously throughout their lifetime? A 20-year longitudinal study. Psychological medicine, 1-11 PMID: 22340278

Honig A, Romme MA, Ensink BJ, Escher SD, Pennings MH, & deVries MW (1998). Auditory hallucinations: a comparison between patients and nonpatients. The Journal of nervous and mental disease, 186 (10), 646-51 PMID: 9788642

Hopper, K., Harrison, G., Janca, A., & Sartorius, N. (2007). Recovery from schizophrenia: An international perspective: A report from the WHO Collaborative Project, The International Study of schizophrenia. New York, NY: Oxford University Press.

Joseph, J. (2004). Schizophrenia and heredity: Why the emperor has no genes. In J. Read, L. R. Mosher, & R. P. Bentall (Eds.), Models of madness: Psychological, social and biological approaches to schizophrenia (pp. 67-83). New York, NY: Routledge.

Karon BP (2003). The tragedy of schizophrenia without psychotherapy. The journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 31 (1), 89-118 PMID: 12722890

Lewine, R. (1998). Epilogue. In M. F. Lenzenweger & R. H. Dworkin (Eds.), Origin and development of schizophrenia (pp. 493-503). Washington, DC: American Psychological Association.

Livingston, R. (1987). Sexually and physically abused children. The Journal of the American Academy of Child and Adolescent Psychiatry, 26: 413-415.

Mosher LR (1999). Soteria and other alternatives to acute psychiatric hospitalization: a personal and professional review. The Journal of nervous and mental disease, 187 (3), 142-9 PMID: 10086470

National Institute of Mental Health [NIMH]. (2010a). Schizophrenia.

National Institute of Mental Health [NIMH]. (2010b). How is schizophrenia treated.

Read, J. (2004). Biological psychiatry’s lost cause. In J. Read, L. R. Mosher, & R. P. Bentall, (Eds.), Models of madness: Psychological, social and biological approaches to schizophrenia (pp. 57-65). New York: Routledge.

Robins, L. (1974). Deviant children grown up: A sociological and psychiatric study of sociopathic personality. Malabar, FL: R. E. Krieger Pub. Co.

Satcher, D. (1999). Etiology of schizophrenia.

Seikkula, J., Aaltonen, J., Alakare, B., Haarakangas, K., Keränen, J., & Lehtinen, K. (2006). Five-year experience of first-episode nonaffective psychosis in open-dialogue approach: Treatment principles, follow-up outcomes, and two case studies. Psychotherapy Research, 16(2), 214-228. doi: 10.1080/10503300500268490.

Siebert, A. (1999). Brain disease hypothesis for schizophrenia disconfirmed by all evidence.

Woodruff, P. W. R., & Lewis, S. (1996). Structural  brain imaging in schizophrenia. In S. Lewis & N. Higgins (Eds.), Brain imaging in psychiatry. Oxford, UK: Blackwell.

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Full Recovery from Schizophrenia? http://brainblogger.com/2012/05/29/full-recovery-from-schizophrenia/ http://brainblogger.com/2012/05/29/full-recovery-from-schizophrenia/#comments Tue, 29 May 2012 12:00:24 +0000 http://brainblogger.com/?p=12580 This is the first of a series of blog postings related to my own series of research studies (my doctoral research at Saybrook University) of people who have made full and lasting medication-free recoveries after being diagnosed with schizophrenia and other psychotic disorders. This is very exciting research because it is one of the few areas within psychological research that remains almost completely wide open. One reason it is so wide open is that most Westerners don’t believe that genuine recovery from schizophrenia and other related psychotic disorders is possible, in spite of significant evidence to the contrary. Since there are some very hopeful findings that have emerged within this research, I want to begin this series of postings by summing up one particularly hopeful aspect of my own research, which is a group of five factors that emerged which are considered to have been the most important factors in my participants’ recovery process. But before looking closer at these factors, we should back up for a minute…

Upon reading the statement in the preceding paragraph, “…people who have made full and lasting medication-free recoveries from schizophrenia…,” it’s likely that many readers did a double-take. Yes, you read this correctly. Contrary to this widespread myth about schizophrenia, the research is quite robust in showing us that not only is full medication-free recovery from schizophrenia possible, it’s surprisingly common, and is actually the most common outcome in many situations—such as in many of the poorest countries of the world, such as India, Columbia, and Nigeria, and as the result of certain psychosocial interventions, such as the Open Dialogue Approach used in Lapland, Finland.

This is likely to come as a surprise to many because we simply don’t hear much about this in the mainstream media. In fact, we generally hear quite the opposite message repeated again and again in various forms — something to the effect of, “Schizophrenia is a degenerative brain disease from which full recovery is not possible.” Considering how robust the evidence is that full recovery is possible and actually quite common, coming from sources no less prestigious than the World Health Organization and the National Institute of Mental Health, it is really quite tragic that the myth of no recovery continues essentially unimpeded. But for now, rather than going further into the details of this recovery research (which is well documented in my book, Rethinking Madness), let’s return to the topic at hand — the factors that appear to be particularly important for those who have experienced such full and lasting recoveries:

Factor #1Hope in the possibility of real recovery. All participants in all three of my research studies expressed that in order to even begin the journey towards real recovery, they first had to believe that such recovery is actually possible. And in order to do this, virtually all of them had to extract themselves from the intense hopelessness generated by the toxic (and untrue) belief that such recover is not possible — a belief that they all reported was forced upon them (quite heavily handed in most cases) within the mental health treatment that they had received.

This takes us to Factor #2Arriving at an understanding of their psychosis alternative to the brain disease theory. Every participant went through a process of developing a more hopeful understanding of their psychotic experiences, generally coming to see their psychosis as a natural though very risky and haphazard process initiated by their psyche in an attempt to cope and/or heal from a way of being in the world that was simply no longer sustainable for them.

Factor #3: Finding meaning. All participants expressed how important it was for them to connect with meaningful goals/activities that made their life worth living—that provided them with some motivation to greet each new day with open arms and to channel their energy productively. And they all expressed having to overcome significant inhibition to this factor coming from the mainstream treatment they had received, which typically included strong motivation-inhibiting drugs (antipsychotics in particular) and the advice to generally lay low and avoid stress at all costs.

Factor #4: Connecting with their aliveness. All participants reported how important it was for them to connect more deeply with themselves—particularly with their feelings, needs, and sense of self agency. And again, they all reported finding significant hindrance to this factor coming from the mainstream treatment they had received—both from the inner conflicts arising from the belief of having a diseased brain as well as from the serious aliveness-dampening psychiatric drugs they were on.

Factor #5: Dealing with their relationships. All participants expressed the importance of healing and/or distancing themselves from unhealthy relationships and cultivating healthy ones. They all felt that unhealthy relationships played a significant role in their vulnerability to developing psychosis in the first place, and so this kind of work was extremely important. A number of them expressed gratitude to a therapist or friend who facilitated this work.

So, as we look at the sum total of these recovery factors, what we find is the rather disturbing idea that the mainstream paradigm of care for psychosis/schizophrenia may often cause more of a hindrance than a benefit in one’s recovery. In particular, there are two generally unquestioned aspects of the mainstream paradigm of care that should probably be seriously reconsidered:

(1) In spite of the widespread belief that one must remain on antipsychotics or similarly powerful psychiatric drugs for the duration of one’s life, the emerging recovery research reveals a very different picture. Not only have we discovered this in my own research, but the most recent longitudinal research conducted by the National Institute of Mental Health (no less) paints a very similar picture. This study essentially consisted of following a number of people diagnosed with schizophrenia in a non-interfering manner, simply allowing them to go about their lives in their own way, and allowing them to choose what kind of treatment they wanted. At the 15 year mark, it was found that of those who chose to stop taking their psychiatric drugs, 44% were considered “recovered,” compared to only 5% of those who have remained compliant with these prescriptions. This is a difference of nearly nine-fold in favor of those who stopped taking their prescribed psychiatric drugs. The World Health Organization studies have also shown in the so called “developing” countries in which psychiatric drug use is quite rare, well over half of those diagnosed with schizophrenia have gone on to make full recoveries, compared to only about a third of those in the U.S. and other so called “developed” countries, where psychiatric drug use is much more common.

So we find ourselves in quite a predicament. On one hand, it’s considered extremely dangerous to suggest that those diagnosed with schizophrenia should consider coming off these drugs, and even the mention of this possibility is considered one of the worst forms of taboo within the mental health field; but on the other hand, the research suggests that for many people, this is exactly what is called for. Of course, the research also shows that coming off these powerful drugs is very risky and should be done very slowly and under the careful guidance of a professional.

(2) Another major aspect of the mainstream treatment model that we find particularly problematic is the practice of trying to convince someone that they have a brain disease from which they will likely never recover. But the reality is that the brain-disease hypothesis remains unsubstantiated (see Rethinking Madness for a thorough discussion of this), and that full and lasting recovery is quite common. We also find that the hopelessness so often generated by this belief often leads to a self fulfilling prophecy — it appears to be very difficult to experience real recovery when you don’t believe it’s possible. Considering these points, then, it’s clear that we need to seriously reconsider the harm/benefit ratio of pushing these beliefs onto people and even the ethical implications of continuing to do so.

So we find ourselves at a crucial juncture in our treatment of people diagnosed with schizophrenia and other related psychotic disorders. We can take the path of least resistance, ignoring the results of the emerging recovery research, and carry on with treatment as usual, continuing to pay the ever increasing costs of this treatment model to society, the diagnosed individuals, and their families. Or we can take up the challenge of really embracing the emerging recovery research and its implications. This path will surely require a major overhaul of our mental health care system, but it offers the potential of significantly more hopeful outcomes for those so diagnosed as well as the greatly reduced burden on our increasingly struggling society as a greater percentage of people recover and regain the ability to take care of themselves. The choice is ours.

For a much more thorough discussion of these and closely related topics, as well as a detailed discussion of the finding of  Dr. Williams’ own recovery research, you can find Dr. Williams’ book, Rethinking Madness (Sky’s Edge Publishing), on Amazon and other major retailers. More information is available at www.RethinkingMadness.com

References

Harrow M, & Jobe TH (2007). Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medications: a 15-year multifollow-up study. The Journal of nervous and mental disease, 195 (5), 406-14 PMID: 17502806

Harrow, M., Jobe, T., & Faull, R. (2012). Do all schizophrenia patients need antipsychotic treatment continuously throughout their lifetime? A 20-year longitudinal study Psychological Medicine, 1-11 DOI: 10.1017/S0033291712000220

Hopper, K., Harrison, G., Janca, A., & Sartorius, N. (2007). Recovery from schizophrenia: An international perspective: A report from the WHO Collaborative Project, The International Study of schizophrenia. New York, NY: Oxford University Press

Seikkula, J., Aaltonen, J., Alakare, B., Haarakangas, K., Keränen, J., & Lehtinen, K. (2006). Five-year experience of first-episode nonaffective psychosis in open-dialogue approach: Treatment principles, follow-up outcomes, and two case studies Psychotherapy Research, 16 (2), 214-228 DOI: 10.1080/10503300500268490

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).

Image via Zacarias Pereira da Mata / Shutterstock.

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