Serious Mental Illness Blog

An LIU Post Specialty Concentration

Posts tagged psychology

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How schizophrenia is shaped by our culture: Americans hear voices as threatening while Indians and Africans claim they are helpfulBy Ellie Zolfagharifard, DailyMail
Scientists came to the conclusion after speaking with 60 schizophrenics 20 came from California, 20 from Accra, Ghana and 20 from Chennai, India In America, voices were intrusion and a threat to patient’s private world In India and Africa, the study subjects were not as troubled by the voices. The difference may be down to the fact that Europeans and Americans tend to see themselves as individuals motivated by a sense of self identity. Whereas outside the West, people imagine the mind and self as interwoven with others and defined through relationships.
People suffering from schizophrenia can often hear imaginary voices so terrifying that they are left traumatized.
One American patient described the voices as ‘like torturing people, to take their eye out with a fork, or cut someone’s head and drink their blood.’
A study has now found that these voices can be shaped by culture, with Western cultures experiencing far more disturbing psychotic episodes.
Schizophrenia is a severe brain disorder that can cause people to hear ‘voices’ that other people don’t hear. It affects about one per cent of the global population over the age of 18.
Many people in Western cultures have reported hearing voices claiming other people are reading their minds, controlling their thoughts or plotting to kill them.
In Africa and India, however, these hallucinatory voices appear as harmless and even playful, according to the study by Stanford University in California. 
While there’s no cure for schizophrenia, this study suggests that therapies urging patients to develop relationships with their imaginary voices could prove useful.
As part of the study, Professor Tanya Luhrmann interviewed 60 adults diagnosed with schizophrenia; 20 each in San Mateo, California; Accra, Ghana; and Chennai, India.
Overall, there were 31 women and 29 men with an average age of 34, who were asked about their relationship with the imaginary voices.
While many of the African and Indian subjects registered largely positive experiences with their voices, not one American did.
Instead, the U.S. subjects were more likely to report experiences as violent and hateful.
For instance, they spoke of their voices as a call to battle or war – ‘the warfare of everyone just yelling.’
The Americans mostly did not know who spoke to them and they seemed to have less personal relationships with their voices, according to Professor Luhrmann.
But among the Indians in Chennai, more than half heard voices of kin or family members commanding them to do tasks.
'They talk as if elder people advising younger people,' one subject said. That contrasts to the Americans, only two of whom heard family members.
The Indians also heard fewer threatening voices than the Americans – several heard the voices as playful, as manifesting spirits or magic, and even as entertaining.
Finally, not as many of them described the voices in terms of a medical or psychiatric problem, as all of the Americans did.
In Accra, Ghana, where the culture accepts that disembodied spirits can talk, few subjects described voices in brain disease terms.
When people talked about their voices, 10 of them called the experience predominantly positive; 16 of them reported hearing God audibly. ‘Mostly, the voices are good,’ one participant remarked.
The difference may be down to the fact that Europeans and Americans tend to see themselves as individuals motivated by a sense of self identity, said Professor Luhrmann.
Whereas outside the West, people imagine the mind and self as interwoven with others and defined through relationships.
In America, the voices were an intrusion and a threat to one’s private world – the voices could not be controlled.
However, in India and Africa, the subjects were not as troubled by the voices – they seemed on one level to make sense in a more relational world.
Still, differences existed between the participants in India and Africa; the former’s voice-hearing experience emphasized playfulness and sex, whereas the latter more often involved the voice of God.
'The difference seems to be that the Chennai and Accra participants were more comfortable interpreting their voices as relationships and not as the sign of a violated mind,' the researchers wrote.
The research, Professor Luhrmann observed, suggests that the ‘harsh, violent voices so common in the West may not be an inevitable feature of schizophrenia.’
The findings may be clinically significant, according to the researchers and adds to research that shows specific therapies may alter what patients hear their voices say.
'Our hunch is that the way people think about thinking changes the way they pay attention to the unusual experiences associated with sleep and awareness, and that as a result, people will have different spiritual experiences, as well as different patterns of psychiatric experience,' Professor Luhrmann said.
For more mental health resources, Click Here to access the Serious Mental Illness Blog.Click Here to access original SMI Blog content

How schizophrenia is shaped by our culture: Americans hear voices as threatening while Indians and Africans claim they are helpful
By Ellie Zolfagharifard, DailyMail

Scientists came to the conclusion after speaking with 60 schizophrenics 20 came from California, 20 from Accra, Ghana and 20 from Chennai, India In America, voices were intrusion and a threat to patient’s private world In India and Africa, the study subjects were not as troubled by the voices. The difference may be down to the fact that Europeans and Americans tend to see themselves as individuals motivated by a sense of self identity. Whereas outside the West, people imagine the mind and self as interwoven with others and defined through relationships.

People suffering from schizophrenia can often hear imaginary voices so terrifying that they are left traumatized.

One American patient described the voices as ‘like torturing people, to take their eye out with a fork, or cut someone’s head and drink their blood.’

A study has now found that these voices can be shaped by culture, with Western cultures experiencing far more disturbing psychotic episodes.

Schizophrenia is a severe brain disorder that can cause people to hear ‘voices’ that other people don’t hear. It affects about one per cent of the global population over the age of 18.

Many people in Western cultures have reported hearing voices claiming other people are reading their minds, controlling their thoughts or plotting to kill them.

In Africa and India, however, these hallucinatory voices appear as harmless and even playful, according to the study by Stanford University in California. 

While there’s no cure for schizophrenia, this study suggests that therapies urging patients to develop relationships with their imaginary voices could prove useful.

As part of the study, Professor Tanya Luhrmann interviewed 60 adults diagnosed with schizophrenia; 20 each in San Mateo, California; Accra, Ghana; and Chennai, India.

Overall, there were 31 women and 29 men with an average age of 34, who were asked about their relationship with the imaginary voices.

While many of the African and Indian subjects registered largely positive experiences with their voices, not one American did.

Instead, the U.S. subjects were more likely to report experiences as violent and hateful.

For instance, they spoke of their voices as a call to battle or war – ‘the warfare of everyone just yelling.’

The Americans mostly did not know who spoke to them and they seemed to have less personal relationships with their voices, according to Professor Luhrmann.

But among the Indians in Chennai, more than half heard voices of kin or family members commanding them to do tasks.

'They talk as if elder people advising younger people,' one subject said. That contrasts to the Americans, only two of whom heard family members.

The Indians also heard fewer threatening voices than the Americans – several heard the voices as playful, as manifesting spirits or magic, and even as entertaining.

Finally, not as many of them described the voices in terms of a medical or psychiatric problem, as all of the Americans did.

In Accra, Ghana, where the culture accepts that disembodied spirits can talk, few subjects described voices in brain disease terms.

When people talked about their voices, 10 of them called the experience predominantly positive; 16 of them reported hearing God audibly. ‘Mostly, the voices are good,’ one participant remarked.

The difference may be down to the fact that Europeans and Americans tend to see themselves as individuals motivated by a sense of self identity, said Professor Luhrmann.

Whereas outside the West, people imagine the mind and self as interwoven with others and defined through relationships.

In America, the voices were an intrusion and a threat to one’s private world – the voices could not be controlled.

However, in India and Africa, the subjects were not as troubled by the voices – they seemed on one level to make sense in a more relational world.

Still, differences existed between the participants in India and Africa; the former’s voice-hearing experience emphasized playfulness and sex, whereas the latter more often involved the voice of God.

'The difference seems to be that the Chennai and Accra participants were more comfortable interpreting their voices as relationships and not as the sign of a violated mind,' the researchers wrote.

The research, Professor Luhrmann observed, suggests that the ‘harsh, violent voices so common in the West may not be an inevitable feature of schizophrenia.’

The findings may be clinically significant, according to the researchers and adds to research that shows specific therapies may alter what patients hear their voices say.

'Our hunch is that the way people think about thinking changes the way they pay attention to the unusual experiences associated with sleep and awareness, and that as a result, people will have different spiritual experiences, as well as different patterns of psychiatric experience,' Professor Luhrmann said.

For more mental health resources, Click Here to access the Serious Mental Illness Blog.
Click Here
 to access original SMI Blog content

Filed under schizophrenia schizophrenic psychosis psychotic america american americans india african mental health mental illness mental illness health psychology psychiatry counseling mind body brain wellness healthy recovery therapy therapist bipolar voices hearing voices hallucination hallucinations

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Mental health: The largest unmet health need in Ireland todayBy Dr Jim Lucey, Irish Examiner
Mental and emotional health issues are still stigmatised in Ireland, even though mental health is the largest unmet health need in our society, writes Dr Jim Lucey.
The topic of the Merriman Summer School this year is the emotional life of our country.
It is a timely agenda as our nation approaches its 100th birthday. Much of our national dialogue appears to be about economic and political agendas as though these existed in a vacuum.
But what is the emotional state of Ireland today? More speculatively let me ask this: what is it about a nation or a culture that nurtures and sustains emotional wellbeing? The answer to this second question could inform us as we try rebuild our country following its financial collapse.
Mental and emotional health issues are still stigmatised in Ireland, even though mental health is the largest unmet health need in our society.
Unfortunately the typical response to mental distress in Ireland is neglect, or postponement at best. It has been said that if your car breaks down today, you could probably have it repaired within an hour, but if you or I have a mental breakdown today, it is unlikely that we will get help for at least 18 months. The delay is largely in our inability to have the mental health conversation.
However, there is a pressing need to widen our discussion because of the importance of our mental health. It is necessary for us all to enter the mental health debate.
There is much said about our vision for change in mental health services in Ireland, but for many this vision is an Ashling rather than a reality. There is still no national strategy to tackle the problems of suicide in Ireland. The problems and the costs of alcohol and substance abuse are still given insufficient priority, since in Ireland today, the drinks industry has disproportionate influence.
So what is it about our mental and emotional health which makes it such a taboo subject? The answer is complicated. It has not have been helped by the poverty of our language around mental wellbeing or by our asylum history of shame, fear and guilt. The problem is also with our mental and emotional consciousness, and this is political and social and cultural.
Modern Ireland is very different from the nation imagined by its founders. It is still, as St Colmcille called it, “a small island on the edge of the world”, but today, Ireland is struggling to become “the best little country in the world… to do business in”. We might question whether this vision is sufficient for the real challenges we face.
The first one 100 years of Irish freedom has been as traumatic as the century before it was tragic, and these memories are persistent. Memories of trauma are not usually lost even if they do not remain in the forefront of our consciousness.
Our independence emerged on the background of the great famine and of the Great War. The “peace process” which brought to an end 30 years of bloody civil war, a conflict we euphemistically called “The Troubles” has left many questions still unanswered. Since then, nearly every institution in the State has been discredited to a greater or lesser extent. With each shameful disclosure, denial has been followed by incremental half truths seemingly extracted in dental fashion. This establishment response to distress, a game of cat and mouse with the truth, was well rehearsed long before the banks collapsed.
In psychological terms, this process of denial is damaging, not just because it postpones understanding and prolongs the struggle to find recovery, but because like Pavlov’s dogs, we may have become conditioned to non-disclosure.
Recent historians have described how to some extent in the early independent Ireland, we believed “we were a chosen people… a people set apart”. It was against this background of national self-deception that the earliest whistleblowers, as well as artists and reformers, must have struggled, since our processes seemed incapable of getting to insight.
On the other hand, our stated beliefs about Ireland have changed and “changed utterly”. Now we are given to question everything, and now we know at least some of the truths.
Our “states of fear” have been exposed so we now we know that in our asylums, 2% of our population was incarcerated against its will. We know that many of our young people and vulnerable adults were physically and sexually abused in church/state institutions and industrial schools, in the laundries, in the mother and baby homes, and all the rest.
These revelations have been so shocking that the sadness of it is too much to bear, too hard to hear, and yet we must hear it in order to understand and recover. We have only begun this work.
Despite these positives, the reality is that social and economic inequality is the biggest risk factor for poor health in Ireland. The mental and emotional health of nearly one quarter of our population is in jeopardy. The most common disorders are depression and anxiety.
So what does the description of mental disorder in Ireland tell us about the emotional health of our country today? The truth is there is no evidence that we are a depressed or an anxious nation. The measurable hallmarks of low mood and all the rest are not endemic in Ireland today. We do not lack energy and certainly we possess the drive and concentration to meet most challenges and succeed.
Equally, the features of anxiety disorder are not evident in our nation. If anything, it is impulsivity that is more typical. Experience shows that in Ireland, we are in distress and this is in response to the traumas of recent times.
In our next century, we could learn from our experience to create a culture that promotes and celebrates our mental health. We could prioritise the wellbeing of our people and build a concept beyond our current ideas of wealth. The mental capital of our country is our economic capital, and our economy can thrive again only if we include all those currently in distress within our recovery plan.
Surely a renewed conversation about values would be restorative. Perhaps then, the emotional and economic value of our homeless and unemployed would be acknowledged. Just as the emotional consequences of excluding the mentally ill needs to be recognised, the right to more effective means of recovery for all our people and our society needs to be endorsed.
So is there hope? Absolutely.
Our tendency to denial, dissociation, and non-disclosure, may not have helped us resolve our conflicts to date, but ultimately, we must re-engage if we are to recover.
How then can we move on from the distress of our past? This question is surely important for any nation which truly wishes to make progress, but only one nation that I know of has a specific word for the process. In Germany they call it “Vergangenheitsbewailtigung” or “wrestling with the past so as to come to terms with it”.
The meaning of this process for the German nation has been profound and the benefits are measurable. Denial is no more tolerable there than is dissociation. The result has been a cultural rebirth. Now as our 100th birthday approaches, is it possible that we would begin a cultural renewal based on a genuine dealing with our past? A cultural wrestling with our past could lead to the rebuilding of our country on universal principles of human rights. Into our second century, we could emphasise priorities that would make our young people and our old people strong and emotionally resilient. We could begin to include our homeless and our mortgaged, our emigrants and our immigrants, our believers and our unbelievers in a journey towards an Ireland that would be well and not only well-off. An emotionally healthy Irish life is not something that will happen by chance.
Certain resilience factors contribute to the development of a mentally healthy, emotionally resilient populations. They include a secure base, education, social competence and friendships, talents, interests and positive values. A renewed Irish society dedicated to building these resilience factors might prioritize them as much as finance or foreign affairs, and so future political and cultural decisions could be made congruent with these goals. A renaissance of our culture, of life and work and spirit, balanced with our sport, music and arts and respect for beliefs could emerge.
This working towards positive values would sustain growth; and with resilience the next generation could grow together to better withstand its traumas and rebuild itself.
Out of a sincere re-engagement with our history, we could make peace with ourselves and rediscover what it is to be truly mentally and emotionally well; so that more people could live independently, work productively and most of all, love each other with a whole heart.
Edited version of the keynote speech delivered by Dr Jim Lucey, clinical professor of psychiatry at TCD and medical director at St Patrick’s mental-health services, to mark the opening of the Merriman Summer School in Glór, Ennis, Co Clare.
For more mental health resources, Click Here to access the Serious Mental Illness Blog.Click Here to access original SMI Blog content

Mental health: The largest unmet health need in Ireland today
By Dr Jim Lucey, Irish Examiner

Mental and emotional health issues are still stigmatised in Ireland, even though mental health is the largest unmet health need in our society, writes Dr Jim Lucey.

The topic of the Merriman Summer School this year is the emotional life of our country.

It is a timely agenda as our nation approaches its 100th birthday. Much of our national dialogue appears to be about economic and political agendas as though these existed in a vacuum.

But what is the emotional state of Ireland today? More speculatively let me ask this: what is it about a nation or a culture that nurtures and sustains emotional wellbeing? The answer to this second question could inform us as we try rebuild our country following its financial collapse.

Mental and emotional health issues are still stigmatised in Ireland, even though mental health is the largest unmet health need in our society.

Unfortunately the typical response to mental distress in Ireland is neglect, or postponement at best. It has been said that if your car breaks down today, you could probably have it repaired within an hour, but if you or I have a mental breakdown today, it is unlikely that we will get help for at least 18 months. The delay is largely in our inability to have the mental health conversation.

However, there is a pressing need to widen our discussion because of the importance of our mental health. It is necessary for us all to enter the mental health debate.

There is much said about our vision for change in mental health services in Ireland, but for many this vision is an Ashling rather than a reality. There is still no national strategy to tackle the problems of suicide in Ireland. The problems and the costs of alcohol and substance abuse are still given insufficient priority, since in Ireland today, the drinks industry has disproportionate influence.

So what is it about our mental and emotional health which makes it such a taboo subject? The answer is complicated. It has not have been helped by the poverty of our language around mental wellbeing or by our asylum history of shame, fear and guilt. The problem is also with our mental and emotional consciousness, and this is political and social and cultural.

Modern Ireland is very different from the nation imagined by its founders. It is still, as St Colmcille called it, “a small island on the edge of the world”, but today, Ireland is struggling to become “the best little country in the world… to do business in”. We might question whether this vision is sufficient for the real challenges we face.

The first one 100 years of Irish freedom has been as traumatic as the century before it was tragic, and these memories are persistent. Memories of trauma are not usually lost even if they do not remain in the forefront of our consciousness.

Our independence emerged on the background of the great famine and of the Great War. The “peace process” which brought to an end 30 years of bloody civil war, a conflict we euphemistically called “The Troubles” has left many questions still unanswered. Since then, nearly every institution in the State has been discredited to a greater or lesser extent. With each shameful disclosure, denial has been followed by incremental half truths seemingly extracted in dental fashion. This establishment response to distress, a game of cat and mouse with the truth, was well rehearsed long before the banks collapsed.

In psychological terms, this process of denial is damaging, not just because it postpones understanding and prolongs the struggle to find recovery, but because like Pavlov’s dogs, we may have become conditioned to non-disclosure.

Recent historians have described how to some extent in the early independent Ireland, we believed “we were a chosen people… a people set apart”. It was against this background of national self-deception that the earliest whistleblowers, as well as artists and reformers, must have struggled, since our processes seemed incapable of getting to insight.

On the other hand, our stated beliefs about Ireland have changed and “changed utterly”. Now we are given to question everything, and now we know at least some of the truths.

Our “states of fear” have been exposed so we now we know that in our asylums, 2% of our population was incarcerated against its will. We know that many of our young people and vulnerable adults were physically and sexually abused in church/state institutions and industrial schools, in the laundries, in the mother and baby homes, and all the rest.

These revelations have been so shocking that the sadness of it is too much to bear, too hard to hear, and yet we must hear it in order to understand and recover. We have only begun this work.

Despite these positives, the reality is that social and economic inequality is the biggest risk factor for poor health in Ireland. The mental and emotional health of nearly one quarter of our population is in jeopardy. The most common disorders are depression and anxiety.

So what does the description of mental disorder in Ireland tell us about the emotional health of our country today? The truth is there is no evidence that we are a depressed or an anxious nation. The measurable hallmarks of low mood and all the rest are not endemic in Ireland today. We do not lack energy and certainly we possess the drive and concentration to meet most challenges and succeed.

Equally, the features of anxiety disorder are not evident in our nation. If anything, it is impulsivity that is more typical. Experience shows that in Ireland, we are in distress and this is in response to the traumas of recent times.

In our next century, we could learn from our experience to create a culture that promotes and celebrates our mental health. We could prioritise the wellbeing of our people and build a concept beyond our current ideas of wealth. The mental capital of our country is our economic capital, and our economy can thrive again only if we include all those currently in distress within our recovery plan.

Surely a renewed conversation about values would be restorative. Perhaps then, the emotional and economic value of our homeless and unemployed would be acknowledged. Just as the emotional consequences of excluding the mentally ill needs to be recognised, the right to more effective means of recovery for all our people and our society needs to be endorsed.

So is there hope? Absolutely.

Our tendency to denial, dissociation, and non-disclosure, may not have helped us resolve our conflicts to date, but ultimately, we must re-engage if we are to recover.

How then can we move on from the distress of our past? This question is surely important for any nation which truly wishes to make progress, but only one nation that I know of has a specific word for the process. In Germany they call it “Vergangenheitsbewailtigung” or “wrestling with the past so as to come to terms with it”.

The meaning of this process for the German nation has been profound and the benefits are measurable. Denial is no more tolerable there than is dissociation. The result has been a cultural rebirth. Now as our 100th birthday approaches, is it possible that we would begin a cultural renewal based on a genuine dealing with our past? A cultural wrestling with our past could lead to the rebuilding of our country on universal principles of human rights. Into our second century, we could emphasise priorities that would make our young people and our old people strong and emotionally resilient. We could begin to include our homeless and our mortgaged, our emigrants and our immigrants, our believers and our unbelievers in a journey towards an Ireland that would be well and not only well-off. An emotionally healthy Irish life is not something that will happen by chance.

Certain resilience factors contribute to the development of a mentally healthy, emotionally resilient populations. They include a secure base, education, social competence and friendships, talents, interests and positive values. A renewed Irish society dedicated to building these resilience factors might prioritize them as much as finance or foreign affairs, and so future political and cultural decisions could be made congruent with these goals. A renaissance of our culture, of life and work and spirit, balanced with our sport, music and arts and respect for beliefs could emerge.

This working towards positive values would sustain growth; and with resilience the next generation could grow together to better withstand its traumas and rebuild itself.

Out of a sincere re-engagement with our history, we could make peace with ourselves and rediscover what it is to be truly mentally and emotionally well; so that more people could live independently, work productively and most of all, love each other with a whole heart.

Edited version of the keynote speech delivered by Dr Jim Lucey, clinical professor of psychiatry at TCD and medical director at St Patrick’s mental-health services, to mark the opening of the Merriman Summer School in Glór, Ennis, Co Clare.

For more mental health resources, Click Here to access the Serious Mental Illness Blog.
Click Here
 to access original SMI Blog content

Filed under irish ireland europe mental health mental illness mental health illness mind body brain healthy wellness stigma stigmatized psychology psychiatry counseling psychologist psychiatrist counselor therapist abuse abused trauma ptsd culture society country

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The Inner Voices of Writers and ReadersBy Hearing the Voice
Many of us will recognize the experience of hearing, in our mind’s ear, the voices of people known to us. Memories of ferocious school teachers, passionate declarations of love, the everyday catchphrases of friends, and even the idiosyncratic trill of loud-mouthed celebrities – our minds are sometimes populated with a jumble of voices, each with its own distinctive auditory qualities.
So what’s it like to bring a new voice into being? And might writers – in the course of creating characters, imagined or historical – be uniquely well-placed to shed light on this?
Writers’ Inner Voices is a study being conducted by Hearing the Voice in collaboration with the Edinburgh International Book Festival. Its aim is to understand the ways in which writers and storytellers hear or imagine the voices of their characters and to explore what role this plays in the literary-creative process more broadly. 100 authors appearing at this year’s Edinburgh International Book Festival have completed our online questionnaire about their experience of their characters’ voices, and the preliminary results are fascinating. 70% of writers we surveyed said that they hear the voices of their characters out loud, and 57% could sense the presence of their characters in visual or other sensory modes.
During the course of the Festival itself, Dr Jenny Hodgson is conducting in-depth follow-up interviews with writers to find out more about the varied and complex ways in which they hear, experience, imagine and interact with their characters. She’ll be posting regular updates on twitter and on the Writers’ Inner Voices blog – so please do join in the conversation.

As a counterpart to the Writer’s Inner Voices project we’re also asking readers about their experiences of voices and characters. Since Saturday we’ve had nearly 1000 responses to our Readers’ Inner Voices study after it was profiled in the Guardian. and we hope to get many more over the course of the EIBF, with the ongoing events at Conversations With Ourselves and via our blogs for the Guardian. The link for the survey is  https://www.survey.bris.ac.uk/durham/innervoices, please consider participating, and spread the message far and wide!
For more mental health resources, Click Here to access the Serious Mental Illness Blog.Click Here to access original SMI Blog content

The Inner Voices of Writers and Readers
By
 

Many of us will recognize the experience of hearing, in our mind’s ear, the voices of people known to us. Memories of ferocious school teachers, passionate declarations of love, the everyday catchphrases of friends, and even the idiosyncratic trill of loud-mouthed celebrities – our minds are sometimes populated with a jumble of voices, each with its own distinctive auditory qualities.

So what’s it like to bring a new voice into being? And might writers – in the course of creating characters, imagined or historical – be uniquely well-placed to shed light on this?

Writers’ Inner Voices is a study being conducted by Hearing the Voice in collaboration with the Edinburgh International Book Festival. Its aim is to understand the ways in which writers and storytellers hear or imagine the voices of their characters and to explore what role this plays in the literary-creative process more broadly. 100 authors appearing at this year’s Edinburgh International Book Festival have completed our online questionnaire about their experience of their characters’ voices, and the preliminary results are fascinating. 70% of writers we surveyed said that they hear the voices of their characters out loud, and 57% could sense the presence of their characters in visual or other sensory modes.

During the course of the Festival itself, Dr Jenny Hodgson is conducting in-depth follow-up interviews with writers to find out more about the varied and complex ways in which they hear, experience, imagine and interact with their characters. She’ll be posting regular updates on twitter and on the Writers’ Inner Voices blog – so please do join in the conversation.

As a counterpart to the Writer’s Inner Voices project we’re also asking readers about their experiences of voices and characters. Since Saturday we’ve had nearly 1000 responses to our Readers’ Inner Voices study after it was profiled in the Guardian. and we hope to get many more over the course of the EIBF, with the ongoing events at Conversations With Ourselves and via our blogs for the Guardian. The link for the survey is  https://www.survey.bris.ac.uk/durham/innervoices, please consider participating, and spread the message far and wide!

For more mental health resources, Click Here to access the Serious Mental Illness Blog.
Click Here
 to access original SMI Blog content

Filed under write writer writing read reading voices hearing voices mind body brain wellness health healthy recover recovery treatment psychology psychiatry counseling mental health mental illness mental illness book books poet poets author authors story

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image

Trauma, Psychosis, and Dissociation
By Noel Hunter, M.A., M.S., Mad in America

Recent years have seen an influx of numerous studies providing an undeniable link between childhood/ chronic trauma and psychotic states. Although many researchers (i.e., Richard Bentall, Anthony Morrison, John Read) have been publishing and speaking at events around the world discussing the implications of this link, they are still largely ignored by mainstream practitioners, researchers, and even those with lived experience. While this may be partially due to an understandable (but not necessarily defensible) tendency to deny the existence of trauma, in general, there are also certainly many political, ideological, and financial reasons for this as well.

Many have called for the trauma and psychosis fields to join forces. So many valuable findings have come out of the trauma field that could inform practitioners and lay people alike in understanding how one might come to be so overwhelmingly distressed and behave in such seemingly strange ways (see Read, Fosse, Moskowitz, & Perry, 2014, for an informative overview of how trauma affects our bodies). Studies looking at how the non-disordered brain adapts to chronic stress, how cumulative adverse events affect how people perceive and react to the world around them, and how many creative ways people come up with to defend against their own awareness of their distress all can help others to understand the un-understandable. More importantly, the trauma field has shown time and again how trauma-informed care can help a person slowly heal from horrid life experiences.

Yet, the trauma and dissociation field often goes to great lengths in an apparent effort to draw a decisive line in the sand between “real” trauma “disorders” and “schizophrenia.” This largely is done by insinuating that “dissociation” is trauma-based and explains the bizarre behaviors of so many distressed individuals labeled with “borderline” or “dissociative identity disorder”, while some cognitive or brain-diseased factor contributes to “real” psychosis. Somebody with “schizophrenia” may have experienced trauma, but it is largely irrelevant to the present distress. Is this true? Is there any actual evidence for this beyond ideology? It may be helpful to look at the overlap and separation between “dissociation” and “psychosis” to get a better understanding.

Brief History of Trauma Research

Over 100 years ago, Pierre Janet became the first major figure to identify and treat the vast array of the effects of trauma.  In fact, he considered almost all “psychopathology” to be the result of childhood trauma and dissociation (Janet, 1919/25). Under the large umbrella term of “hysteria”, Janet identified the following symptoms: hallucinations in all senses, fugue states, amnesia, extreme suggestibility, an odd disposition, nightmares, psychosomatic and conversion symptoms, reenactments, flashbacks, paranoia, subjective experiences of possession, motor agitation, mutism, catatonia, thought disorder (or disorganized speech), and/or double personalities (Janet, 1907/1965). He believed that treatment consisted of a phase-based approach involving stabilization, trauma processing, and recovery. Fatefully, Janet’s use of hypnosis provided the main basis for his eventual expulsion from the psychiatric community. He responded to his exile by pointing out that the medical establishment denied the existence of trauma and its effects, to the point of focusing too much on the physiological and biological domain.

For the next 8 decades or so, the mental health field became more and more narrow in its focus on and recognition of trauma to the point of neglecting it completely in the more biological domains. It was not until the late1970′s, when a massive influx of veterans gained political clout and women began to speak out and be heard, that trauma was once again recognized as a major factor in extreme emotional distress. This also was the time when the DSM became psychiatry’s new bible; and so, while trauma was once again recognized, it was also separated into narrowly defined disorders that included PTSD, adjustment disorders, and dissociative disorders (including multiple personality disorder, as it was then known). It was then that the modern-day lines were drawn.

Dissociation

So what are people talking about when they speak of “dissociation”? Well, not too many people agree on this. It also appears as though the more professionals attempt to come to a consensus on what this term means, the more they do so in an effort to delineate it from any possible association with “psychosis”; their attempts to define dissociation are done by disassociating.

Wikipedia defines dissociation (in the broad sense) as: “an act of disuniting or separating a complex object into parts.” I do not believe that many mental health professionals, particularly dissociation researchers, would entirely disagree with this definition. Rather, it is the interpretation of this meaning that is a hotly debated topic within psychiatry (a general term I use to describe the entirety of the mental health field). In general, it may be used to describe a process, a multitude of symptoms, specific disorders, a division of the personality (or lack of integration), and/or a psychic defense. Many believe that it refers to disconnection from one’s thoughts, feelings, environment, self, others, etc. The term is also used to refer to a process of entering a trance-like state or extreme detachment. Most agree that dissociation lies on a continuum from “everyday dissociation” (i.e., losing track of time while driving, becoming absorbed in a book) to severe dysfunctional dissociation (i.e., “multiple personalities”). Lately, it appears as though trauma researchers and practitioners are interpreting dissociation as solely meaning a separation of identity states or ego functioning that is based in trauma and is clearly understandable (i.e., not psychosis).

If nobody agrees on what it means, then why do we really care? Because the political implications and resulting effects on treatment options are directly related to how one interprets this meaning. We can see by looking at the DSM how this might work…

DSM and all its Fancy Terms

Akin to many religions throughout time, psychiatry makes up many technical terms and then create circular and eccentric definitions to confuse lay people into believing that mental health issues can only be dealt with by an educated professional. Putting this political maneuvering aside, I would like to focus for a moment on key terms related to the topic at hand: trauma, dissociation, dissociative symptoms, psychosis, psychotic symptoms, dissociative disorders, and schizophrenia.

Trauma: Trauma is technically defined as an event that provokes death-related fears in an individual. It is also agreed upon that trauma is defined by the person’s response to such an event, rather than the event itself. But, what of the child whose parents are cold and over-protective? Or the child who is “only” bullied verbally? Or the child who is chronically invalidated? Or poverty? Or the person in existential crisis? Are these not a form of “trauma”? Certainly, they are shown to be chronically stressful which, physiologically, is not any different than “trauma” defined in the DSM-sense. Although it is understood that trauma is subjective, the DSM insists on narrowly defining it anyways.

Dissociation: As stated previously, very few professionals in psychiatry agree on what this term means. Instead of just saying “absorption”, “feeling unreal”, “feeling one’s surroundings are not real”, “lack of integrated sense of self”, or “detachment” (all considered in different circles as varied forms of dissociation), scholars instead argue over its meaning until it has no meaning at all. Often, it is an ideological term that is used to say “trauma” vs. “not trauma”, whether this is explicitly acknowledged or not. Therefore, when one’s “symptoms” are considered non-dissociative, the assumption generally tends to be that they also are not trauma-based.

Dissociative symptoms: Although dissociative symptoms are acknowledged as existing in a multitude of different DSM categories, they mostly are usurped by the dissociative disorder classifications. In this case, as I will discuss in a moment, dissociative symptoms often seem to take on the meaning of “not psychotic” rather than having any distinct meaning in and of themselves.

Psychosis: Psychosis is another technical term with no precise meaning. It tends to refer to a state in which a person appears to not be aware of or in touch with consensual reality. This can be for 5 minutes or 5 years, but the term itself is non-time specific. In practice, it tends to be used when the professional comes to a point where they say “I don’t understand you or agree with your interpretation of reality.”

Psychotic symptoms: Most people tend to think that psychotic symptoms clearly refer to things such as hearing voices, seeing visions, having strange beliefs, or disorganized thinking/speech. However, “psychotic symptoms” specifically refers to symptoms of psychosis. What is psychosis? Having psychotic symptoms. If you don’t have psychosis, then you may have “psychotic-like” symptoms or “quasi-” insert what you like here. What makes these symptoms psychotic-like instead of truly psychotic? Whether or not your therapist understands you.

Dissociative disorders: While there are 5 dissociative disorders, the one that is most intertwined with the idea of psychosis is dissociative identity disorder (DID). People who might meet the criteria for DID often experience what is inarguably the core of the term “dissociation”; namely, having a fragmented sense of self. In addition, they also experience periods where they cannot remember large gaps of time. This amnesia is certainly not an experience that is universal to many or even most individuals suffering extreme states; however, the other experiences common in DID are definitely non-specific to this classification. These include: hallucinations in all senses, incoherence, bizarre beliefs, impaired reality testing, lack of awareness of the present moment, paranoia, and paranormal experiences. However, these are reframed as: hearing voices of an “alter”, body memories, flashbacks, intrusions of trauma and/or “alters”, beliefs attributed to “alters”, not being grounded, and hypervigilence. These words do not necessarily indicate any difference in the lived-experience, but rather a difference in how psychiatry interprets the experience. And who wouldn’t rather say “I have body memories and intrusions” then “I have hallucinations and delusions”?

Schizophrenia: The category of schizophrenia, and all its sister disorders, is one that is assumed to be a largely biological, genetic brain disease. What differentiates it from DID? No one seems to be able to define where this distinction lies, but those in the dissociative disorder field will state that the difference is based on the existence of “delusions” and/or “thought disorder”. A delusion, of course, is a belief that society deems unacceptable. Yet, nobody seems to be able to explain where the line is separating a delusion from an acceptable belief. More specifically, nobody will explain what the difference is between believing “I have a bunch of people living inside of my body who are not me” (DID) and “I am God” (psychotic). But questionnaires that measure dissociation use this very distinction to say whether one has dissociation or not. And then they say “delusions are not related to dissociation” because they just ruled out dissociation by the fact that a person did not endorse an interpretation of their experience that the questionnaire makers deemed dissociative.

“Thought disorder” has been convincingly described by Richard Bentall as a problem in communication, rather than an indication of any true cognitive impairment (Bentall, 2003). Yet, the theory adopted by mainstream psychiatry remains that “thought disorder” is a neurological disease. And so, if one is considered to have DID, any indication of thought disorder is instead interpreted as “intrusions” or “rapid-switching” of altered identity states. Only those with “real” psychosis have a “real” thought disorder.

On the other hand, psychosis researchers solve the problem by simply saying DID just does not exist. People who present with altered identity states and memory problems (not attributed to an actual neurological problem) are considered as just “borderline” or “attention-seeking”. I honestly cannot think of much that is worse than experiencing such emotional turmoil and distress to the point of a break-down and then being told I am making it up for attention. But, then, of course, that is just my perspective.

In spite of these ideological battles, studies still have shown that individuals meeting criteria for schizophrenia endorse a greater level of dissociative symptoms than any other clinical group, discounting PTSD and dissociative disorders (Ross, Heber, Norton, & Anderson, 1989). Approximately two-thirds of individuals diagnosed with DID who are hospitalized also meet structured interview criteria for schizophrenia or schizoaffective disorder (Ross, 2007), 25-50% of anybody diagnosed with DID has received a previous diagnosis of schizophrenia (Ross & Keyes, 2004), and approximately 60% of those diagnosed with schizophrenia meet criteria for a dissociative disorder (Ross & Keyes, 2004). Up to 20% of individuals diagnosed with DID have been found to exhibit communication styles indicative of thought disorder (Putnam, Guroff, Silberman, Barban, & Post, 1986), and levels of dissociation are highly correlated with thought disorder (Allen, Coyne, & Console, 1997). Bizarre explanations for anomalous experiences are not rare in those diagnosed with DID; indeed, one study discovered that 41% of individuals diagnosed with DID have been found to believe they were possessed by demons, and 36% experienced possession by some other outer power or force not attributed to part of the self (Ross, 2011).  In addition, the original concept of ‘schizophrenia’ (as it was discussed by Kurt Schneider, Eugen Bleuler, Harry Stack Sullivan, and Harold Searles) appears to emphasize presentations indicative of a dissociative disorder.

On the other hand, it has been found that dissociatively detached individuals are not necessarily chronically psychotic and can function at a high level (Allen et al., 1997).  Individuals diagnosed with DID are often able to maintain reality testing despite experiencing “psychotic” phenomena (Howell, 2008).  Another difference is that persons diagnosed with DID also report higher levels of dissociation, and more child, angry, persecutory, and commenting voices (Dorahy et al., 2009; Laddis & Dell, 2012). They also generally report a higher rate of more severe childhood trauma than any other clinical group (Putnam et al., 1986).

What Does This all Mean???

It is often purported that “delusions” and “schizophrenia” are not dissociative, when using the narrow definition of dissociation; when dissociation means dis-integration of identity. I would argue that when one is so distressed so as to be labeled as having delusions or schizophrenia, the person has experienced such a high level of dissociation so as to have a completely shattered identity; dis-integration to the point of disintegrated oblivion. But, this is not acknowledged as dissociative, and so then is considered somehow something completely different and separate.

I do not believe it is possible to separate psychosis and dissociation; to me this is like attempting to separate a headache and a fever when I have the flu. Where does the headache begin and the fever end? And should I focus on “treating” my headache, fever, or maybe the virus that infected me and is creating an interconnected process of events in my body? While psychosis and dissociation are not the same thing, I believe that one does not have psychosis without dissociation or dissociation without psychosis. Often the difference simply boils down to: who can frame things the way that the professional wants to hear or agrees with.

Certainly not all those who experience altered identity states experience strange beliefs, voices, or incoherence, but most do. Not all those who experience extreme states also experience altered identity or memory loss, but some do. These experiences are not separate, even if they are different. Although one may appear more reality-based and “dissociative” while another may appear more out of touch with reality and incomprehensible, I believe both stem from the same underlying process of attempting to deal with overwhelming life experiences. And this is where “treatment” should be focused.

Of course, this belief comes with the caveat that some presentations of emotional distress (whether it is psychosis, depression, dissociation, or any other term or category one might like to think of) are dietary, biological, and/or neurologically based. These are not psychological or psychiatric problems, then, and should be dealt with in the medical realm. All individuals suffering from extreme states should evaluate their diet, exercise, and overall physical health; when these are shown to be a non-issue, however, it should be assumed that some difficulty with life has led to whatever the person is suffering through in the present rather than blaming a faulty brain or neurochemicals without any evidence to back up such assertions.

I do not have all the answers. But, I do ask why it is that mental health professionals do not start with just saying what they mean? We can talk about altered identity states, memory loss, feeling unreal, not knowing what is real or not, being terrified of others, etc. Mental health professionals can own the fact that “I do not understand this person” instead of taking this as equivocal evidence of some brain-diseased process of “psychosis.” Each of these experiences do not make a distinct disease. People are complex. People do not fit in nice, neat boxes. People suffer, and when they do this is not necessarily a disease. People adapt to unbearable life circumstances in a number of complex ways that cannot be categorized, no matter how much psychiatry insists that it can. And none of these labels can tell anybody much of anything about a person beyond the stereotypes and confirmation biases they elicit.

At the end of the day, extreme states and anomalous experiences are terrifying; they are terrifying to the people experiencing them and to all those around those people. Doctors are human beings (much as many might like to state otherwise) and they too often act out of that fear. Certainly, nobody wants to get labeled with being psychotic, and there is benevolence in the efforts of those who try to save many from being so doomed. Being recently labeled with “schizophrenia” appears to be enough to increase the likelihood somebody will commit suicide (Fleischhacker et. al, 2014).

Instead of trying to understand people through labeling and insisting on enforcement of an authoritarian dictation of what the experience “really” is, perhaps psychiatry can listen to those who have actually been there. The Hearing Voices Network has given us tools to work with voices and other anomalous experiences; the National Empowerment Center has given us tools on how to work with crises and extreme states; I am working to try to get first-person perspectives on how to work with altered identity states and memory loss; so many individuals (most famously Marsha Linehan) have given us tools on how to work with self-harm and suicidality.

Why does psychiatry then continue to insist on abiding by a broken and invalid system of disease mongering? Why do we not allow the experiencer to make sense of their experience through their own framework? Why must we be so evangelical and insist that they see things our way? There is NOTHING that truly, scientifically can say that one diagnosis is more “accurate” than another. All of these diagnoses are just checklists of behaviors- there is nothing that anybody “has” and until some biological test shows otherwise than nobody can claim that there is. What matters is being with a person in their world where they are at and understanding the MEANING behind the experience, not attempting to define the experience itself in a way that makes sense to us. This is nothing more than social control and perpetuation of the status quo, not science.

Even the most biologically-based medical doctor knows that treatment can only be effective when the underlying disease is recognized and addressed. In my opinion (and it is only that), the underlying “disease” is trauma, overwhelming emotions in reaction to an un-understandable and terrifying world, and/or fear of death/annihilation. If this is the issue, and logically then the issue that needs to be “treated”, then why do we spend so much time splitting hairs over differentiating what behaviors or beliefs belong in what technical categories? In the heart of the Hearing Voices Network, why are we not focusing all of our time on understanding what happened to the person, not what’s wrong with the person?

* * * * *

Disclaimer: The views presented here are constructed from my biased interpretation of the vast literature associated with the various topics discussed. This is based on my on-going dissertation work as well as personal and clinical experiences that influence my views. In no way is any of this meant as a criticism towards any individual organization or researcher. I have a great appreciation for the work done in both the trauma and psychosis fields, and recognize that we all cling to views that help us make sense of the world. I just hope that one day we might be able to move past some of these partialities and work towards improving options for people who are in extreme distress without further traumatizing them in the process.

This article’s references can be found HERE.

For more mental health resources, Click Here to access the Serious Mental Illness Blog.
Click Here
 to access original SMI Blog content

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NAMI program helps caregivers of adults with mental illness [Free 12-week course starts Aug. 11]By Jan Biles, CJOnline
Topeka resident Valerie Harper was looking for help a few years ago in coping with the difficulties associated with caring for a loved one with mental illness.
Harper and her husband, Will, a Vietnam War veteran diagnosed with post-traumatic stress disorder, had been attending a free peer support program for those affected by PTSD and other mental disorders at Colmery-O’Neil VA Medical Center. But the program was discontinued, and the couple was left to find other support services.
Harper said help came when she read about the National Alliance on Mental Illness’ Family-to-Family Education Program, a 12-week course for family members and caregivers of adults with mental illness, including schizophrenia, bipolar disorder, major depression, anxiety disorders and borderline personality disorder. She and her mother-in-law started attending the classes.
“Each session outlines the subjects that will be covered. There’s plenty of written materials,” Harper said. “There’s sharing of experiences. There’s lot of hugs and tears at times.”
Family-to-Family instructor Marilyn Rowland said the next course is scheduled from 6 to 8:30 p.m. Mondays Aug. 11 through Oct. 27 in Room 4 at Countryside United Methodist Church, 3221 S.W. Burlingame.
There is no fee for the program, and workbooks, snacks and beverages are provided. Other instructors are Susan Reynolds and Susan Wallace.
While gains have been made in the treatment of mental illness, the difficulties encountered by caregivers can be difficult, Rowland said. The Family-to-Family course provides caregivers with communication and problem-solving techniques, coping mechanisms and self-care skills needed to deal with their loved one’s mental illness and its impact on the family.
“We are not a support group,” Rowland said. “We are an education class.”
Topics covered during the course include recognition of symptoms, becoming informed about mental illness, pursuing treatment, encouraging the individual with mental illness to seek help, how to avoid placing blame, realistic expectations, staying connected with the loved one when words fail, the needs of other family members, developing a comprehensive plan for mental well-being and caring for yourself.
Harper said some people might be afraid to come to the classes because of the stigma society places on mental illness.
“The stigma is because people don’t understand (mental illness) and are afraid of what they don’t understand,” she said. “It’s a terrible feeling to be suffering and be alone and have people afraid of you.”
Will Harper, who experienced mood swings and nightmares as a result of PTSD, said he noticed a difference in his wife after she started attending the NAMI program.
“She knew how to treat me and not overreact,” he said. “She learned to be patient and work through things with me. That was a big help.”
Rowland said the message the course hopes to convey to individuals caring for adults with mental illness is they aren’t alone and help is available.
“We all need support and deserve support,” Valerie Harper said. “It’s an act of love to go for help, and it really could save someone’s life.”
For more mental health resources, Click Here to access the Serious Mental Illness Blog.
Click Here to access original SMI Blog content

NAMI program helps caregivers of adults with mental illness [Free 12-week course starts Aug. 11]
By Jan Biles, CJOnline

Topeka resident Valerie Harper was looking for help a few years ago in coping with the difficulties associated with caring for a loved one with mental illness.

Harper and her husband, Will, a Vietnam War veteran diagnosed with post-traumatic stress disorder, had been attending a free peer support program for those affected by PTSD and other mental disorders at Colmery-O’Neil VA Medical Center. But the program was discontinued, and the couple was left to find other support services.

Harper said help came when she read about the National Alliance on Mental Illness’ Family-to-Family Education Program, a 12-week course for family members and caregivers of adults with mental illness, including schizophrenia, bipolar disorder, major depression, anxiety disorders and borderline personality disorder. She and her mother-in-law started attending the classes.

“Each session outlines the subjects that will be covered. There’s plenty of written materials,” Harper said. “There’s sharing of experiences. There’s lot of hugs and tears at times.”

Family-to-Family instructor Marilyn Rowland said the next course is scheduled from 6 to 8:30 p.m. Mondays Aug. 11 through Oct. 27 in Room 4 at Countryside United Methodist Church, 3221 S.W. Burlingame.

There is no fee for the program, and workbooks, snacks and beverages are provided. Other instructors are Susan Reynolds and Susan Wallace.

While gains have been made in the treatment of mental illness, the difficulties encountered by caregivers can be difficult, Rowland said. The Family-to-Family course provides caregivers with communication and problem-solving techniques, coping mechanisms and self-care skills needed to deal with their loved one’s mental illness and its impact on the family.

“We are not a support group,” Rowland said. “We are an education class.”

Topics covered during the course include recognition of symptoms, becoming informed about mental illness, pursuing treatment, encouraging the individual with mental illness to seek help, how to avoid placing blame, realistic expectations, staying connected with the loved one when words fail, the needs of other family members, developing a comprehensive plan for mental well-being and caring for yourself.

Harper said some people might be afraid to come to the classes because of the stigma society places on mental illness.

“The stigma is because people don’t understand (mental illness) and are afraid of what they don’t understand,” she said. “It’s a terrible feeling to be suffering and be alone and have people afraid of you.”

Will Harper, who experienced mood swings and nightmares as a result of PTSD, said he noticed a difference in his wife after she started attending the NAMI program.

“She knew how to treat me and not overreact,” he said. “She learned to be patient and work through things with me. That was a big help.”

Rowland said the message the course hopes to convey to individuals caring for adults with mental illness is they aren’t alone and help is available.

“We all need support and deserve support,” Valerie Harper said. “It’s an act of love to go for help, and it really could save someone’s life.”

For more mental health resources, Click Here to access the Serious Mental Illness Blog.

Filed under caregiver care mental illness mental illness mental health health healthy mond body brain wellness diagnosis disorder psychology psychiatry counselor counseling therapy hope recovery treatment help caring schizophrenia bipolar depression anxiety borderline feelings