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[Article of Interest] High Deprivation, Population Density And Inequality Found To Increase Rates Of SchizophreniaArticle adapted by Medical News TodayHigher rates of schizophrenia in urban areas can be attributed to increased deprivation, increased population density and an increase in inequality within a neighbourhood, new research reveals. The research, led by the University of Cambridge in collaboration with Queen Mary University of London, was published in the journal Schizophrenia Bulletin.Dr James Kirkbride, lead author of the study from the University of Cambridge, said: “Although we already know that schizophrenia tends to be elevated in more urban communities, it was unclear why. Our research suggests that more densely populated, more deprived and less equal communities experience higher rates of schizophrenia and other similar disorders. This is important because other research has shown that many health and social outcomes also tend to be optimal when societies are more equal.”The scientists used data from a large population-based incidence study (the East London first-episode psychosis study directed by Professor Jeremy Coid at the East London NHS Foundation Trust and Queen Mary, University of London) conducted in three neighbouring inner city, ethnically diverse boroughs in East London: City & Hackney, Newham, and Tower Hamlets.427 people aged 18-64 years old were included in the study, all of whom experienced a first episode of psychotic disorder in East London between 1996 and 2000. The researchers assessed their social environment through measures of the neighbourhood in which they lived at the time they first presented to mental health services because of a psychotic disorder. Using the 2001 census, they estimated the population aged 18-64 years old in each neighbourhood, and then compared the incidence rate between neighbourhoods.The incidence of schizophrenia (and other similar disorders where hallucinations and delusions are the dominant feature) still showed variation between neighbourhoods after taking into account age, sex, ethnicity and social class. Three environmental factors predicted risk of schizophrenia - increased deprivation (which includes employment, income, education and crime) increased population density, and an increase in inequality (the gap between the rich and poor).Results from the study suggested that a percentage point increase in either neighbourhood inequality or deprivation was associated with an increase in the incidence of schizophrenia and other similar disorders of around 4%.Dr Kirkbride added: “Our research adds to a wider and growing body of evidence that inequality seems to be important in affecting many health outcomes, now possibly including serious mental illness. Our data seems to suggest that both absolute and relative levels of deprivation predict the incidence of schizophrenia."East London has changed substantially over recent years, not least because of the Olympic regeneration. It would be interesting to repeat this work in the region to see if the same patterns were found."The study also found that risk of schizophrenia in some migrant groups might depend on the ethnic composition of their neighbourhood. For black African people, the study found that rates tended to be lower in neighbourhoods where there were a greater proportion of other people of the same background. By contrast, rates of schizophrenia were lower for the black Caribbean group when they lived in more ethnically-integrated neighbourhoods. These findings support the possibility that the socio-cultural composition of our environment could positively or negatively influence risk of schizophrenia and other similar disorders.Dr John Williams, Head of Neuroscience and Mental Health at the Wellcome Trust said: “This research reminds us that we must understand the complex societal factors as well as the neural mechanisms that underpin the onset of mental illness, if we are to develop appropriate interventions.”

[Article of Interest] High Deprivation, Population Density And Inequality Found To Increase Rates Of Schizophrenia
Article adapted by Medical News Today

Higher rates of schizophrenia in urban areas can be attributed to increased deprivation, increased population density and an increase in inequality within a neighbourhood, new research reveals. The research, led by the University of Cambridge in collaboration with Queen Mary University of London, was published in the journal Schizophrenia Bulletin.
Dr James Kirkbride, lead author of the study from the University of Cambridge, said: “Although we already know that schizophrenia tends to be elevated in more urban communities, it was unclear why. Our research suggests that more densely populated, more deprived and less equal communities experience higher rates of schizophrenia and other similar disorders. This is important because other research has shown that many health and social outcomes also tend to be optimal when societies are more equal.”
The scientists used data from a large population-based incidence study (the East London first-episode psychosis study directed by Professor Jeremy Coid at the East London NHS Foundation Trust and Queen Mary, University of London) conducted in three neighbouring inner city, ethnically diverse boroughs in East London: City & Hackney, Newham, and Tower Hamlets.
427 people aged 18-64 years old were included in the study, all of whom experienced a first episode of psychotic disorder in East London between 1996 and 2000. The researchers assessed their social environment through measures of the neighbourhood in which they lived at the time they first presented to mental health services because of a psychotic disorder. Using the 2001 census, they estimated the population aged 18-64 years old in each neighbourhood, and then compared the incidence rate between neighbourhoods.
The incidence of schizophrenia (and other similar disorders where hallucinations and delusions are the dominant feature) still showed variation between neighbourhoods after taking into account age, sex, ethnicity and social class. Three environmental factors predicted risk of schizophrenia - increased deprivation (which includes employment, income, education and crime) increased population density, and an increase in inequality (the gap between the rich and poor).
Results from the study suggested that a percentage point increase in either neighbourhood inequality or deprivation was associated with an increase in the incidence of schizophrenia and other similar disorders of around 4%.
Dr Kirkbride added: “Our research adds to a wider and growing body of evidence that inequality seems to be important in affecting many health outcomes, now possibly including serious mental illness. Our data seems to suggest that both absolute and relative levels of deprivation predict the incidence of schizophrenia.
"East London has changed substantially over recent years, not least because of the Olympic regeneration. It would be interesting to repeat this work in the region to see if the same patterns were found."
The study also found that risk of schizophrenia in some migrant groups might depend on the ethnic composition of their neighbourhood. For black African people, the study found that rates tended to be lower in neighbourhoods where there were a greater proportion of other people of the same background. By contrast, rates of schizophrenia were lower for the black Caribbean group when they lived in more ethnically-integrated neighbourhoods. These findings support the possibility that the socio-cultural composition of our environment could positively or negatively influence risk of schizophrenia and other similar disorders.
Dr John Williams, Head of Neuroscience and Mental Health at the Wellcome Trust said: “This research reminds us that we must understand the complex societal factors as well as the neural mechanisms that underpin the onset of mental illness, if we are to develop appropriate interventions.”

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artfromtheedge:

The creators of the Serious Mental Illness blog invite you to submit your visual art, photography, video work, music, poetry, collage, or short fiction to Art from the Edge. 
Art from the Edge, a virtual gallery and resource center, is dedicated to art created in and about extreme mental states. It is an open and public world wide forum for artists to share their visual and written works and their personal stories with all those interested in the connection between creativity and “edge” states.
Much like art, which exists in a multitude of mediums and forms of expression, there are a plurality of “edge” states that inspire the artists who harbor them. For this reason, we leave the term completely open to our community’s interpretation, knowing from research and experience that this state could be driven by psychosis or trauma, or an altered state induced by drugs. It could be the offshoot of extreme depression or grief, or the aftermath of a spiritual or mystical state of consciousness.
Ultimately, we are interested in the artist’s individual experience and in his or her sense of what it is that drove the creative act. 
submissions@artfromtheedge.net
artfromtheedge.net

artfromtheedge:

The creators of the Serious Mental Illness blog invite you to submit your visual art, photography, video work, music, poetry, collage, or short fiction to Art from the Edge. 

Art from the Edge, a virtual gallery and resource center, is dedicated to art created in and about extreme mental states. It is an open and public world wide forum for artists to share their visual and written works and their personal stories with all those interested in the connection between creativity and “edge” states.

Much like art, which exists in a multitude of mediums and forms of expression, there are a plurality of “edge” states that inspire the artists who harbor them. For this reason, we leave the term completely open to our community’s interpretation, knowing from research and experience that this state could be driven by psychosis or trauma, or an altered state induced by drugs. It could be the offshoot of extreme depression or grief, or the aftermath of a spiritual or mystical state of consciousness.

Ultimately, we are interested in the artist’s individual experience and in his or her sense of what it is that drove the creative act. 

submissions@artfromtheedge.net

artfromtheedge.net

(Source: )

Filed under Questions western written emotions evolution Extreme emotion emotional rethinking madness research resilience theory theories talk Twitter tumblr unconscious intelligence internet illness psychology psychiatry psychoanalysis psychopharmacology psychopathology psychotherapy poetry painting poem paint

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[Article of Interest] Some Observations of Soteria-Alaska
By Daniel Mackler
I write this piece from Anchorage, Alaska, where I am presently filling in as the executive director of Soteria-Alaska while their founding executive director, Susan Musante, is on sabbatical.  Soteria-Alaska, a program designed to follow Loren Mosher’s California Soteria model from the 1970s and early 1980s, has been up and running for the past three years.  Soteria-Alaska is a house, staffed around-the-clock with gentle, open-minded nonprofessionals, with five beds for people experiencing psychosis.  The basic idea is that people can live in the house for about six months or so, give or take, in order to work through or pass through their psychosis with little or preferably no psychiatric medication.  Soteria-Alaska is a largely state- and grant-funded program open primarily to Alaska residents, for whom, if they are low-income, it is free.

In this article I will explore the work Soteria-Alaska does with clients — known as residents — and assess the quality and success of this work.  But first I will provide a little background.  Loren Mosher, a psychiatrist who was the Chief of the Center for Studies of Schizophrenia at the National Institute of Mental Health, designed the original Soteria Project as an alternative to hospitalization for people experiencing a first-time psychotic crisis — one of the variety that would traditionally be treated with a locked ward, neuroleptics, a likelihood of restraints, and an eventual diagnosis of schizophrenia.  All too often this traditional path resulted, and still results, in a lifetime of psychiatric disability, which the system considers normal, which is why it so often tells people experiencing psychosis for the first time that they need to “accept their illness,” “take their drugs for life,” and the like.  However, the original Soteria House in San Jose, California put this idea to shame.  Some sixty to seventy percent of its residents — all of whom, in the first several years of the program’s existence, came straight from San Jose’s local psychiatric emergency room — recovered fully.  They moved on to productive, non-disabled lives, returning to school, getting jobs, and leaving mental health treatment and psychosis behind.

Soteria-Alaska was founded by Jim Gottstein, an Alaskan psychiatric survivor and Harvard lawyer who recognized Anchorage’s need for a similar hospital diversion program.  Prior to the creation of Soteria-Alaska, there were no alternatives to hospitalization in Anchorage (or, for that matter, almost anywhere in the United States) that promoted the idea of full recovery without medication.  Jim, along with others, created Soteria-Alaska with a clear vision of helping people recover fully.  The main hurdle in implementing this, however, has been figuring out how to integrate a program with this vision into the mainstream biopsychiatric mental health system of Anchorage, which relies on heavy pharmaceutical interventions for its primary lines of defense.  Most programs and treatment providers in Anchorage, as in the rest of the United States, don’t consider as relevant the concepts upon which Soteria is based, and may even think them dangerous or harmful.

The basic model of Soteria is a sort of “live-and-let-live” philosophy — one of “being with,” not “doing to.”  Philosophically, Soteria avoids forcing or pressuring anyone to do anything.  By conventional standards, one could argue that Soteria is not really even “treatment,” per se, rather, a program which gets out of people’s way and gives them the respect and freedom to go through their process on their own, albeit with the emotional support of others.  Soteria views psychosis as a sort of crisis or emergency that is laden with meaning, and that people can derive value from their crisis while living in a community of respectful, caring, intuitive others.  This really is a radically different model, concept, and philosophy than that of mainstream biomedical psychiatry.  Yet the rub is that Soteria-Alaska, like the original California Soteria, gets its referrals from within the biomedical psychiatric system.  So basically Soteria contradicts, but nevertheless has to get along with, the traditional mental health system.  This is no small challenge.

This has affected the manifestation of Soteria-Alaska’s vision.  The main area of drift from the vision is that Soteria-Alaska hasn’t ended up working with the type of people for whom it was designed to help.  Instead, for a variety of reasons, Soteria has worked almost exclusively with people who are more “chronic” psychiatric patients, that is, people who, to varying degrees, have been in the psychiatric system for some time, have been exposed, in many cases for years, to psychiatric drugs (such as neuroleptics, mood stabilizers, antidepressants, and the like — and often combinations of them), have been psychiatrically hospitalized (sometimes multiple times), and may even be on government disability upon admission to the house.  This is quite a departure from the original Soteria model, because compared with people experiencing a first psychotic break, “chronic” patients generally have far more serious, intractable, and complex problems, and as the result tend to be far harder to help.

Because of this, Soteria-Alaska, from the information I have gathered, has not experienced good recovery rates — insofar as Mosher’s original Soteria definition of recovery involved people getting and staying out of the mental health system and living independently in the community (and, I would also add, becoming employed or returning to school).  Yet this is not to say that Soteria-Alaska has not had profound value as a program, or, like the California Soteria, as an experiment.  First let me address the value of both Soterias as experiments.  The California Soteria showed, beyond a doubt, and revolutionarily so, that people experiencing a first psychotic episode did far better living in an unstructured, homelike, protected, gentle, non-coercive house with other residents like themselves and with a staff picked for their interpersonal qualities and their lack of psychiatric training than did similar people if they received traditional psychiatric treatment.

The Soteria-Alaska experiment has, thus far, been a different one.  The experiment here, though not formally defined as such, has, to my mind, been to see if a house structured and staffed quite similarly to the original California Soteria House would be effective in helping chronic mental patients get fully out of psychiatry.  And, like any good experiment, a clear negative answer is just as good as a clear positive answer, which is why I consider this part of the Soteria-Alaska experiment to be a valid one, because I consider the answer to be clear:  Soteria as a program is not successful in helping catalyze the full recovery of chronic mental patients.  That said, it has been successful in catalyzing the partial recovery of several residents, beyond any expectation of traditional mental health.  Nevertheless, it has not yet proven itself, in its first three years, at promoting any full recoveries in line with the original Soteria definition.  Thus, my conclusion:  Soteria is not a one-size-fits-all program for clients.

To backtrack, though, I would like to address the thread regarding the help it has provided people.  Soteria-Alaska, after all, has been incredibly valuable to many, if not most, of its residents — even the most “chronic” ones.  Many people have grown with the help of Soteria-Alaska — even in spite of the 2011 shooting of a former resident by another former resident on the grounds of Soteria.  Overall, almost all residents at Soteria-Alaska have had a chance to experience freedom to make their own choices, to experience respect by the staff, to participate in a curious and welcoming community, to engage in healthy decision-making, to have healthy meals and healthy fun, to experience liberty to feel their own feelings, and to experience the opportunity to fall down — sometimes pretty hard — and to get back up again.  Also, many residents have gotten the invaluable chance to explore and express the limits of their nontraditional behavior in a way that almost no other mental health program I have ever witnessed would tolerate — let alone for such a long period of time.  As the result, many residents have matured profoundly as the result of their time at Soteria.  And at least one Soteria resident even came fully out of a profound psychosis, off-medication, during the resident’s stay at the house.

In no small part I credit their founding executive director, Susan Musante, for this.  She has fostered a community of staff, residents, former residents, volunteers, allies, and a board of directors who are passionate about the Soteria mission.  Her gift with people has nurtured something truly special — something which drew me to visit in 2011 and drew me back again now.  She has set a standard for authenticity and respect for personal choice that is rare in the modern mental health field.  And it permeates the Soteria climate.  The Soteria-Alaska staff are some of the most flexible, respectful people I have had the chance to work with.  And so many of the residents with whom I have interacted, even ones who left Soteria in rage or anger or resentment or crisis, note this — and note the value they received from this.  For many it has been the first time in their lives where they found a place that accepted them as they were and welcomed their evolving, and often terrifying, processes.  I myself have gotten to speak with several former residents about this, because they phone Soteria all the time and just want to talk.  Soteria is a place, and often one of the only places in their lives, where they feel safe to do that.

But I realized not long after I began my job here that the way Soteria-Alaska has manifested has come at a major price.  For starters, it can be extremely taxing on the staff.  It is not easy for them to interact so intensely, intimately, and authentically with chronically psychiatrized and institutionalized people, especially when these residents are coming off their psychiatric drugs and discovering their abilities to express themselves with almost entire freedom.  Staff burnout has been a serious issue here.  I would have to say that working at Soteria-Alaska is not a job I would reasonably expect someone to be able to do for a long period of time:  perhaps a few years at the most.  The reason, as I hypothesized to the staff shortly after I arrived, and to which they concurred, is that because they were working with chronic mental patients as opposed to people experiencing first psychotic breaks, yet holding nevertheless to the same Soteria goals of full recovery, they were working far harder for far less promising results.

Full recovery by a resident is a major boost for everyone because it sends positive shockwaves throughout the community.  It restores all of our hope — and reminds us that this seemingly mysterious thing called psychosis is just another normal human phenomenon through which we can pass and come out the other side, and even come out stronger and wiser.  But if people are not coming out the other side, or at best very rarely do to a full degree, who can expect people, especially long-time staff, to remain hopeful?  Partial recoveries partially boost hope, but not nearly to the same degree as full recoveries.  Thus, if staff don’t see full recovery, and especially if they don’t see it on a regular basis (which happened at the original Soteria House), they risk becoming demoralized and starting to think of psychosis not as episodic but as chronic.

That, as far as I can see, is the result of what the traditional mental health system’s near ubiquity has done to our perspective.  Once people spend increasing amounts of time in the system and on these drugs, especially the heavy ones in the combinations so presently prescribed, their actual likelihood of pulling fully out of chronic patienthood goes way down.  My experience as a therapist has shown me this loud and clear, and Robert Whitaker’s book “Anatomy of an Epidemic” outlines this same phenomenon from a scientific perspective.  My belief is that full recovery is just too difficult to achieve for many chronic mental patients unless they have a program working for them that is a lot more intensive and structured than Soteria.  Also, from what I have read, the people who end up heavily polymedicated for long periods of time have had their brains — and I use this word carefully, because I am not referring to their minds here — profoundly affected by these drugs.  It seems to me that so many of these people have their own special, individualized versions of traumatic brain injury.  And, in general, many need a lot more help than just love and kindness and respect and compassion of the Loren Mosher Soteria variety.

In this vein, Soteria was not really designed to be a medication withdrawal program.  Medication withdrawal, even with only one resident withdrawing at a time, risks being simply too intense for a Soteria environment to handle, and even more so when we envision several people simultaneously going through drug withdrawal and a consequential rebound psychosis.  Soteria’s work is hard enough; the drug withdrawal component, in my opinion, makes it just too hard.  And converting Soteria into a successful drug withdrawal program would, in my opinion, require that Soteria sacrifice so much of its basic philosophy and character that its very Soteria nature would most likely be undone.

For that reason, my primary goal during my short tenure at Soteria-Alaska has been to try to connect Soteria with the residents for whom it was designed:  people experiencing a first psychotic episode.  This is easier said than done — which, to be fair, is what everyone told me when I arrived.  Some even told me that such people no longer existed, because, according to them, most everyone with “problems” in Alaska gets medicated, to one degree or other, in childhood nowadays.  But I didn’t entirely believe this — because I have met some adults in Alaska experiencing first breaks, heard stories of many others, and also met recovered people here who themselves passed through unmedicated first breaks.

As I see it, the main hope for Soteria-Alaska, if it wishes to hold to the original Soteria model and remain a sustainable, nonintrusive, non-coercive, unstructured, freedom-respecting program that shifts its course toward getting robust recovery rates from psychosis, is to forge a strong, ongoing, positive relationship with Anchorage’s local psychiatric emergency room and create a way to assist them in diverting at least some percentage of their patients experiencing a first psychotic episode away from traditional psychiatry and toward us.  (I actually think an intimate connection with the local psychiatric emergency room would prove key to the success of almost any program that aspires to help people in first psychotic episodes.) I, along with Soteria’s directing clinician, have been working at developing this relationship with the emergency room staff, and so far, surprisingly, have been watching it blossom.

There have been some problems developing this relationship, though.  One main one is that that they have, for some time, held a generally negative view of Soteria-Alaska.  Their negativity seems to have arisen because their most primal contact with us has come from meeting some of our most conflicted residents when they are at their most troubled:  when they have left Soteria, are in a state of florid rebound psychosis from medication withdrawal, and have returned, often against their will, to the psychiatric emergency room.  Their staff also know the story of the 2011 shooting at Soteria, because it made all the local news.  So they have looked at Soteria through a skeptical lens.  And, from their perspective (even if I hold a different one), why wouldn’t they?  They see their job as to help stabilize psychosis with medication, and they see us doing the exact opposite.  Also, if Soteria were really helping many people recover fully, the psychiatric emergency room would be referring people to us, and not us to them.  Thus, I have been focused on changing the direction of that one-way street sign.

What made me hopeful that this was possible was that even though, in my first month at Soteria, the psychiatric emergency room staff held a negatively tinged view about us, they remained open to referring to us.  I found this curious, and I recently had the chance to ask one of their clinicians why this was.

Her answer, which I will paraphrase:  “We’re just doing our best here, we’re often overwhelmed with intakes, and we have so few resources aside from medication and hospitalization.  And some people who come to us really don’t want to take meds — and we don’t want to force people to do things against their wills, especially if they really don’t seem to be a danger to themselves or others.  So Soteria, if it really might be able to help some people, could be a resource — and we want to consider it.”

This made me hopeful.  But, as far as I saw, it also meant that Soteria-Alaska had to change some of its ways.  We had to make the house a safer, more respectful, more welcoming place for people experiencing first-episode psychosis.  In some ways Soteria-Alaska, as it was manifested when I arrived, was not always so welcoming.  Chronic mental patients, especially if they were coming off heavy, long-prescribed psychiatric drugs, could be very disruptive to the atmosphere of the house for a very long, and even seemingly indefinite, period of time.  I know that the original Soteria House in California worked with a lot of people who could be disruptive (window-smashing, violence, etc.), but it’s my understanding that these disruptions, however major, didn’t usually last that long:  they were measured more in days, perhaps several weeks.  At Soteria-Alaska these disruptions, including episodes of ongoing violence, destructive of property, threatening behavior, and, not least of all wild, super-intense, and very difficult-to-reach rebound psychosis, could last for endless months — and if given a chance, could last even longer.  This can have a serious negative impact on others’ recovery.

For this reason, I suggested and the staff agreed that for the first couple of months of my tenure here we only accept new residents who are experiencing a first psychotic break, or at the least something very close to it.  This was a high-pressure plan, as it entered us into a waiting game:  to see if we could build a relationship with the local psychiatric emergency room, and perhaps with other potential referral sources, like the local universities’ counseling services, quickly enough to find appropriate residents before we ran out of financial resources.

Yet, as I noted, things, at least preliminarily, have begun to blossom for us.  In the last month the psychiatric emergency room has sent us one person whose life situation rather closely fit within the criteria of our mission and another whose situation fit it perfectly.  Also, five weeks ago the local psychiatric hospital, with whom we also shared our new, clearly-defined mission, referred us another person who was very close to meeting our mission’s criteria, though this person had been on neuroleptic medications for a few days.  We accepted all of these young people, and so far they have all been living successfully at Soteria.  It is too soon to know exactly how Soteria will work for them, but so far one thing is clear:  it’s not not working!

Regarding these three new residents, one other key thing that I have observed is that none of them has been going through something so commonly experienced by past residents of Soteria-Alaska:  severe psychiatric drug withdrawal.  And all three of these new residents stopped taking their psychiatric medications by choice.  The two residents who came from the psychiatric emergency room had been on a neuroleptic for less than two days, and because of that had no noticeable effects from stopping taking it at Soteria.  The other resident, who had been taking a neuroleptic for slightly less than a week, experienced some disturbed sleep from stopping the drug — which the resident tapered, with our consultant psychiatrist’s supervision, over several days — but little else.

So in some ways we at Soteria have been feeling much less pressure — and much more hope.  We now know that the psychiatric emergency room staff are willing send us people whom they feel are appropriate for our services.  This is, to say the least, extremely exciting.  I must admit that I didn’t feel overly optimistic about this two months ago, before we had any residents in our house who fit our mission criteria, because it was by no means assured that the emergency room staff, or anyone, would ever send us anyone appropriate.  And I shuddered to consider what would have happened if no one connected us with anyone appropriate.  Would we go back to square one?  Would we have to change our program dramatically to accommodate a more psychiatrically chronic type of resident?  Would we have to contract with potential residents that one condition for staying at Soteria involved them agreeing to stay on their medications?

At the time, I brought up this final possibility with several staff members at Soteria and to a person they all said that if people were required to stay on their psychiatric drugs as a requirement for residency at Soteria then they would quit their jobs.

I heard:  “I couldn’t work at a place like that.”

And:  “I would lose my heart for this work.”

And:  “That goes against what I stand for.  People need to be free to choose their life path.”

And I don’t disagree.  But as I replied to them:  “Then we need to make sure we continue to work with people whom we can actually help, and really not take on people who are chronically disabled by psychiatry and institutions.”

They agreed.  Thus, the challenge remains — but at least now we have a bit more hope, and can see a bit more light at the end of the tunnel.

Meanwhile, we have used the new opportunities provided to us to strengthen our bond with the local mental health practitioners.  We have shared our early successes with them, and they have made it clear to us that they wish us — that is, they wish the residents they sent our way — to succeed.

And to me this signals a whole new area of hope, on a broader societal level, for the following reason:  if people who work in mainstream biological psychiatry are willing to consider referring people in severe psychiatric crises to a program that operates under both a completely alternative philosophy and model to their own, then I see hope for our world’s mental health system.  If our local psychiatric emergency room is willing to refer to a program like ours, then other psychiatric emergency rooms elsewhere in the United States and the world must be willing at least to consider doing the same.  For this reason, I do not feel like Don Quixote tilting at windmills.  I feel the system can change.

But the first thing we, and other programs like ours, need to do is to document our results and show people that these alternative programs can and do actually work.  We also need to be honest with ourselves about who we can help and who we can’t, and then we need give it our all to try to help those we can.  And for those we feel we will be less likely to help, we need to look seriously into creating programs that will realistically and practically help them.

But the bottom line is that we need to keep building on our successes.  This is the recipe for future hope.

[Article of Interest] Some Observations of Soteria-Alaska

By Daniel Mackler

I write this piece from Anchorage, Alaska, where I am presently filling in as the executive director of Soteria-Alaska while their founding executive director, Susan Musante, is on sabbatical.  Soteria-Alaska, a program designed to follow Loren Mosher’s California Soteria model from the 1970s and early 1980s, has been up and running for the past three years.  Soteria-Alaska is a house, staffed around-the-clock with gentle, open-minded nonprofessionals, with five beds for people experiencing psychosis.  The basic idea is that people can live in the house for about six months or so, give or take, in order to work through or pass through their psychosis with little or preferably no psychiatric medication.  Soteria-Alaska is a largely state- and grant-funded program open primarily to Alaska residents, for whom, if they are low-income, it is free.

In this article I will explore the work Soteria-Alaska does with clients — known as residents — and assess the quality and success of this work.  But first I will provide a little background.  Loren Mosher, a psychiatrist who was the Chief of the Center for Studies of Schizophrenia at the National Institute of Mental Health, designed the original Soteria Project as an alternative to hospitalization for people experiencing a first-time psychotic crisis — one of the variety that would traditionally be treated with a locked ward, neuroleptics, a likelihood of restraints, and an eventual diagnosis of schizophrenia.  All too often this traditional path resulted, and still results, in a lifetime of psychiatric disability, which the system considers normal, which is why it so often tells people experiencing psychosis for the first time that they need to “accept their illness,” “take their drugs for life,” and the like.  However, the original Soteria House in San Jose, California put this idea to shame.  Some sixty to seventy percent of its residents — all of whom, in the first several years of the program’s existence, came straight from San Jose’s local psychiatric emergency room — recovered fully.  They moved on to productive, non-disabled lives, returning to school, getting jobs, and leaving mental health treatment and psychosis behind.

Soteria-Alaska was founded by Jim Gottstein, an Alaskan psychiatric survivor and Harvard lawyer who recognized Anchorage’s need for a similar hospital diversion program.  Prior to the creation of Soteria-Alaska, there were no alternatives to hospitalization in Anchorage (or, for that matter, almost anywhere in the United States) that promoted the idea of full recovery without medication.  Jim, along with others, created Soteria-Alaska with a clear vision of helping people recover fully.  The main hurdle in implementing this, however, has been figuring out how to integrate a program with this vision into the mainstream biopsychiatric mental health system of Anchorage, which relies on heavy pharmaceutical interventions for its primary lines of defense.  Most programs and treatment providers in Anchorage, as in the rest of the United States, don’t consider as relevant the concepts upon which Soteria is based, and may even think them dangerous or harmful.

The basic model of Soteria is a sort of “live-and-let-live” philosophy — one of “being with,” not “doing to.”  Philosophically, Soteria avoids forcing or pressuring anyone to do anything.  By conventional standards, one could argue that Soteria is not really even “treatment,” per se, rather, a program which gets out of people’s way and gives them the respect and freedom to go through their process on their own, albeit with the emotional support of others.  Soteria views psychosis as a sort of crisis or emergency that is laden with meaning, and that people can derive value from their crisis while living in a community of respectful, caring, intuitive others.  This really is a radically different model, concept, and philosophy than that of mainstream biomedical psychiatry.  Yet the rub is that Soteria-Alaska, like the original California Soteria, gets its referrals from within the biomedical psychiatric system.  So basically Soteria contradicts, but nevertheless has to get along with, the traditional mental health system.  This is no small challenge.

This has affected the manifestation of Soteria-Alaska’s vision.  The main area of drift from the vision is that Soteria-Alaska hasn’t ended up working with the type of people for whom it was designed to help.  Instead, for a variety of reasons, Soteria has worked almost exclusively with people who are more “chronic” psychiatric patients, that is, people who, to varying degrees, have been in the psychiatric system for some time, have been exposed, in many cases for years, to psychiatric drugs (such as neuroleptics, mood stabilizers, antidepressants, and the like — and often combinations of them), have been psychiatrically hospitalized (sometimes multiple times), and may even be on government disability upon admission to the house.  This is quite a departure from the original Soteria model, because compared with people experiencing a first psychotic break, “chronic” patients generally have far more serious, intractable, and complex problems, and as the result tend to be far harder to help.

Because of this, Soteria-Alaska, from the information I have gathered, has not experienced good recovery rates — insofar as Mosher’s original Soteria definition of recovery involved people getting and staying out of the mental health system and living independently in the community (and, I would also add, becoming employed or returning to school).  Yet this is not to say that Soteria-Alaska has not had profound value as a program, or, like the California Soteria, as an experiment.  First let me address the value of both Soterias as experiments.  The California Soteria showed, beyond a doubt, and revolutionarily so, that people experiencing a first psychotic episode did far better living in an unstructured, homelike, protected, gentle, non-coercive house with other residents like themselves and with a staff picked for their interpersonal qualities and their lack of psychiatric training than did similar people if they received traditional psychiatric treatment.

The Soteria-Alaska experiment has, thus far, been a different one.  The experiment here, though not formally defined as such, has, to my mind, been to see if a house structured and staffed quite similarly to the original California Soteria House would be effective in helping chronic mental patients get fully out of psychiatry.  And, like any good experiment, a clear negative answer is just as good as a clear positive answer, which is why I consider this part of the Soteria-Alaska experiment to be a valid one, because I consider the answer to be clear:  Soteria as a program is not successful in helping catalyze the full recovery of chronic mental patients.  That said, it has been successful in catalyzing the partial recovery of several residents, beyond any expectation of traditional mental health.  Nevertheless, it has not yet proven itself, in its first three years, at promoting any full recoveries in line with the original Soteria definition.  Thus, my conclusion:  Soteria is not a one-size-fits-all program for clients.

To backtrack, though, I would like to address the thread regarding the help it has provided people.  Soteria-Alaska, after all, has been incredibly valuable to many, if not most, of its residents — even the most “chronic” ones.  Many people have grown with the help of Soteria-Alaska — even in spite of the 2011 shooting of a former resident by another former resident on the grounds of Soteria.  Overall, almost all residents at Soteria-Alaska have had a chance to experience freedom to make their own choices, to experience respect by the staff, to participate in a curious and welcoming community, to engage in healthy decision-making, to have healthy meals and healthy fun, to experience liberty to feel their own feelings, and to experience the opportunity to fall down — sometimes pretty hard — and to get back up again.  Also, many residents have gotten the invaluable chance to explore and express the limits of their nontraditional behavior in a way that almost no other mental health program I have ever witnessed would tolerate — let alone for such a long period of time.  As the result, many residents have matured profoundly as the result of their time at Soteria.  And at least one Soteria resident even came fully out of a profound psychosis, off-medication, during the resident’s stay at the house.

In no small part I credit their founding executive director, Susan Musante, for this.  She has fostered a community of staff, residents, former residents, volunteers, allies, and a board of directors who are passionate about the Soteria mission.  Her gift with people has nurtured something truly special — something which drew me to visit in 2011 and drew me back again now.  She has set a standard for authenticity and respect for personal choice that is rare in the modern mental health field.  And it permeates the Soteria climate.  The Soteria-Alaska staff are some of the most flexible, respectful people I have had the chance to work with.  And so many of the residents with whom I have interacted, even ones who left Soteria in rage or anger or resentment or crisis, note this — and note the value they received from this.  For many it has been the first time in their lives where they found a place that accepted them as they were and welcomed their evolving, and often terrifying, processes.  I myself have gotten to speak with several former residents about this, because they phone Soteria all the time and just want to talk.  Soteria is a place, and often one of the only places in their lives, where they feel safe to do that.

But I realized not long after I began my job here that the way Soteria-Alaska has manifested has come at a major price.  For starters, it can be extremely taxing on the staff.  It is not easy for them to interact so intensely, intimately, and authentically with chronically psychiatrized and institutionalized people, especially when these residents are coming off their psychiatric drugs and discovering their abilities to express themselves with almost entire freedom.  Staff burnout has been a serious issue here.  I would have to say that working at Soteria-Alaska is not a job I would reasonably expect someone to be able to do for a long period of time:  perhaps a few years at the most.  The reason, as I hypothesized to the staff shortly after I arrived, and to which they concurred, is that because they were working with chronic mental patients as opposed to people experiencing first psychotic breaks, yet holding nevertheless to the same Soteria goals of full recovery, they were working far harder for far less promising results.

Full recovery by a resident is a major boost for everyone because it sends positive shockwaves throughout the community.  It restores all of our hope — and reminds us that this seemingly mysterious thing called psychosis is just another normal human phenomenon through which we can pass and come out the other side, and even come out stronger and wiser.  But if people are not coming out the other side, or at best very rarely do to a full degree, who can expect people, especially long-time staff, to remain hopeful?  Partial recoveries partially boost hope, but not nearly to the same degree as full recoveries.  Thus, if staff don’t see full recovery, and especially if they don’t see it on a regular basis (which happened at the original Soteria House), they risk becoming demoralized and starting to think of psychosis not as episodic but as chronic.

That, as far as I can see, is the result of what the traditional mental health system’s near ubiquity has done to our perspective.  Once people spend increasing amounts of time in the system and on these drugs, especially the heavy ones in the combinations so presently prescribed, their actual likelihood of pulling fully out of chronic patienthood goes way down.  My experience as a therapist has shown me this loud and clear, and Robert Whitaker’s book “Anatomy of an Epidemic” outlines this same phenomenon from a scientific perspective.  My belief is that full recovery is just too difficult to achieve for many chronic mental patients unless they have a program working for them that is a lot more intensive and structured than Soteria.  Also, from what I have read, the people who end up heavily polymedicated for long periods of time have had their brains — and I use this word carefully, because I am not referring to their minds here — profoundly affected by these drugs.  It seems to me that so many of these people have their own special, individualized versions of traumatic brain injury.  And, in general, many need a lot more help than just love and kindness and respect and compassion of the Loren Mosher Soteria variety.

In this vein, Soteria was not really designed to be a medication withdrawal program.  Medication withdrawal, even with only one resident withdrawing at a time, risks being simply too intense for a Soteria environment to handle, and even more so when we envision several people simultaneously going through drug withdrawal and a consequential rebound psychosis.  Soteria’s work is hard enough; the drug withdrawal component, in my opinion, makes it just too hard.  And converting Soteria into a successful drug withdrawal program would, in my opinion, require that Soteria sacrifice so much of its basic philosophy and character that its very Soteria nature would most likely be undone.

For that reason, my primary goal during my short tenure at Soteria-Alaska has been to try to connect Soteria with the residents for whom it was designed:  people experiencing a first psychotic episode.  This is easier said than done — which, to be fair, is what everyone told me when I arrived.  Some even told me that such people no longer existed, because, according to them, most everyone with “problems” in Alaska gets medicated, to one degree or other, in childhood nowadays.  But I didn’t entirely believe this — because I have met some adults in Alaska experiencing first breaks, heard stories of many others, and also met recovered people here who themselves passed through unmedicated first breaks.

As I see it, the main hope for Soteria-Alaska, if it wishes to hold to the original Soteria model and remain a sustainable, nonintrusive, non-coercive, unstructured, freedom-respecting program that shifts its course toward getting robust recovery rates from psychosis, is to forge a strong, ongoing, positive relationship with Anchorage’s local psychiatric emergency room and create a way to assist them in diverting at least some percentage of their patients experiencing a first psychotic episode away from traditional psychiatry and toward us.  (I actually think an intimate connection with the local psychiatric emergency room would prove key to the success of almost any program that aspires to help people in first psychotic episodes.) I, along with Soteria’s directing clinician, have been working at developing this relationship with the emergency room staff, and so far, surprisingly, have been watching it blossom.

There have been some problems developing this relationship, though.  One main one is that that they have, for some time, held a generally negative view of Soteria-Alaska.  Their negativity seems to have arisen because their most primal contact with us has come from meeting some of our most conflicted residents when they are at their most troubled:  when they have left Soteria, are in a state of florid rebound psychosis from medication withdrawal, and have returned, often against their will, to the psychiatric emergency room.  Their staff also know the story of the 2011 shooting at Soteria, because it made all the local news.  So they have looked at Soteria through a skeptical lens.  And, from their perspective (even if I hold a different one), why wouldn’t they?  They see their job as to help stabilize psychosis with medication, and they see us doing the exact opposite.  Also, if Soteria were really helping many people recover fully, the psychiatric emergency room would be referring people to us, and not us to them.  Thus, I have been focused on changing the direction of that one-way street sign.

What made me hopeful that this was possible was that even though, in my first month at Soteria, the psychiatric emergency room staff held a negatively tinged view about us, they remained open to referring to us.  I found this curious, and I recently had the chance to ask one of their clinicians why this was.

Her answer, which I will paraphrase:  “We’re just doing our best here, we’re often overwhelmed with intakes, and we have so few resources aside from medication and hospitalization.  And some people who come to us really don’t want to take meds — and we don’t want to force people to do things against their wills, especially if they really don’t seem to be a danger to themselves or others.  So Soteria, if it really might be able to help some people, could be a resource — and we want to consider it.”

This made me hopeful.  But, as far as I saw, it also meant that Soteria-Alaska had to change some of its ways.  We had to make the house a safer, more respectful, more welcoming place for people experiencing first-episode psychosis.  In some ways Soteria-Alaska, as it was manifested when I arrived, was not always so welcoming.  Chronic mental patients, especially if they were coming off heavy, long-prescribed psychiatric drugs, could be very disruptive to the atmosphere of the house for a very long, and even seemingly indefinite, period of time.  I know that the original Soteria House in California worked with a lot of people who could be disruptive (window-smashing, violence, etc.), but it’s my understanding that these disruptions, however major, didn’t usually last that long:  they were measured more in days, perhaps several weeks.  At Soteria-Alaska these disruptions, including episodes of ongoing violence, destructive of property, threatening behavior, and, not least of all wild, super-intense, and very difficult-to-reach rebound psychosis, could last for endless months — and if given a chance, could last even longer.  This can have a serious negative impact on others’ recovery.

For this reason, I suggested and the staff agreed that for the first couple of months of my tenure here we only accept new residents who are experiencing a first psychotic break, or at the least something very close to it.  This was a high-pressure plan, as it entered us into a waiting game:  to see if we could build a relationship with the local psychiatric emergency room, and perhaps with other potential referral sources, like the local universities’ counseling services, quickly enough to find appropriate residents before we ran out of financial resources.

Yet, as I noted, things, at least preliminarily, have begun to blossom for us.  In the last month the psychiatric emergency room has sent us one person whose life situation rather closely fit within the criteria of our mission and another whose situation fit it perfectly.  Also, five weeks ago the local psychiatric hospital, with whom we also shared our new, clearly-defined mission, referred us another person who was very close to meeting our mission’s criteria, though this person had been on neuroleptic medications for a few days.  We accepted all of these young people, and so far they have all been living successfully at Soteria.  It is too soon to know exactly how Soteria will work for them, but so far one thing is clear:  it’s not not working!

Regarding these three new residents, one other key thing that I have observed is that none of them has been going through something so commonly experienced by past residents of Soteria-Alaska:  severe psychiatric drug withdrawal.  And all three of these new residents stopped taking their psychiatric medications by choice.  The two residents who came from the psychiatric emergency room had been on a neuroleptic for less than two days, and because of that had no noticeable effects from stopping taking it at Soteria.  The other resident, who had been taking a neuroleptic for slightly less than a week, experienced some disturbed sleep from stopping the drug — which the resident tapered, with our consultant psychiatrist’s supervision, over several days — but little else.

So in some ways we at Soteria have been feeling much less pressure — and much more hope.  We now know that the psychiatric emergency room staff are willing send us people whom they feel are appropriate for our services.  This is, to say the least, extremely exciting.  I must admit that I didn’t feel overly optimistic about this two months ago, before we had any residents in our house who fit our mission criteria, because it was by no means assured that the emergency room staff, or anyone, would ever send us anyone appropriate.  And I shuddered to consider what would have happened if no one connected us with anyone appropriate.  Would we go back to square one?  Would we have to change our program dramatically to accommodate a more psychiatrically chronic type of resident?  Would we have to contract with potential residents that one condition for staying at Soteria involved them agreeing to stay on their medications?

At the time, I brought up this final possibility with several staff members at Soteria and to a person they all said that if people were required to stay on their psychiatric drugs as a requirement for residency at Soteria then they would quit their jobs.

I heard:  “I couldn’t work at a place like that.”

And:  “I would lose my heart for this work.”

And:  “That goes against what I stand for.  People need to be free to choose their life path.”

And I don’t disagree.  But as I replied to them:  “Then we need to make sure we continue to work with people whom we can actually help, and really not take on people who are chronically disabled by psychiatry and institutions.”

They agreed.  Thus, the challenge remains — but at least now we have a bit more hope, and can see a bit more light at the end of the tunnel.

Meanwhile, we have used the new opportunities provided to us to strengthen our bond with the local mental health practitioners.  We have shared our early successes with them, and they have made it clear to us that they wish us — that is, they wish the residents they sent our way — to succeed.

And to me this signals a whole new area of hope, on a broader societal level, for the following reason:  if people who work in mainstream biological psychiatry are willing to consider referring people in severe psychiatric crises to a program that operates under both a completely alternative philosophy and model to their own, then I see hope for our world’s mental health system.  If our local psychiatric emergency room is willing to refer to a program like ours, then other psychiatric emergency rooms elsewhere in the United States and the world must be willing at least to consider doing the same.  For this reason, I do not feel like Don Quixote tilting at windmills.  I feel the system can change.

But the first thing we, and other programs like ours, need to do is to document our results and show people that these alternative programs can and do actually work.  We also need to be honest with ourselves about who we can help and who we can’t, and then we need give it our all to try to help those we can.  And for those we feel we will be less likely to help, we need to look seriously into creating programs that will realistically and practically help them.

But the bottom line is that we need to keep building on our successes.  This is the recipe for future hope.

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[Article of Interest] Talk Therapy Touted as First-Line Treatment for Youth with Psychosis Risk
By Traci Pedersen
A small clinical trial led by an Australian researcher suggests that young people at very high risk for psychotic illness should engage in talk therapy as an initial treatment rather than take antipsychotic drugs.
Only about 36 percent of high-risk individuals will likely develop psychosis within three years, and many physicians are concerned about the prospect of treating everyone at risk with drugs, which come with side effects.  Another concern is that individuals will carry the label of mental illness unnecessarily.
“This shows it’s quite safe and reasonably effective to offer supportive psychosocial care to these patients,” said study author Dr. Patrick McGorry. There is “no evidence to suggest that antipsychotic medications are needed in first-line” treatment, he said.
The  trial included 115 patients of a clinic in Melbourne, Australia, for young people believed to be at “ultra-high risk” for a psychotic disorder such as schizophrenia. The study was open to people between the ages of 14 and 30 who met at least one of three criteria: having low-level psychotic symptoms, having had previous brief episodes of psychotic symptoms that went away on their own or having a close relative with a psychotic disorder along with low mental functioning during the past year.
The study compared three types of treatment: talk therapy focused on reducing depression symptoms and stress while building coping skills plus a low dose of the antipsychotic risperidone, or talk therapy plus a placebo pill or therapy emphasizing social and emotional support plus a placebo. The goal was to see how many patients in each group progressed to full-blown psychosis.
After a year, there was no notable difference between the groups, but about 37 percent of the patients dropped out of the study. McGorry, a professor at the Centre for Youth Mental Health at The University of Melbourne, said if the trial had included more people, significant differences between the groups might have come forth.
“The importance of detecting early signs and symptoms of a serious mental illness is not controversial,” said Matcheri Keshavan, M.D., a professor of psychiatry at Harvard Medical School. “But the best way of treating or preventing it remains controversial.”
The rates of going on to full-blown psychosis—which ranged from about 10 percent to about 22 percent—were lower in all three groups than in previous studies.
The reasons for this aren’t clear, but McGorry said it’s possible that more participants will develop psychosis after the 12-month study period ends. Many of the study participants were also taking antidepressants, which may have eased psychotic symptoms.
Also, as with many trials, most patients showed poor adherence to the medications used, which may have influenced the results, the authors note.
In a 2010 study, McGorry found that fish oil supplements might prevent psychosis in the same type of at-risk individuals. Going forward, “what is needed is some way of finding predictive biomarkers that can tell who might be at the highest risk,” said Keshavan. “We need to understand their brains.”

[Article of Interest] Talk Therapy Touted as First-Line Treatment for Youth with Psychosis Risk

By Traci Pedersen

A small clinical trial led by an Australian researcher suggests that young people at very high risk for psychotic illness should engage in talk therapy as an initial treatment rather than take antipsychotic drugs.

Only about 36 percent of high-risk individuals will likely develop psychosis within three years, and many physicians are concerned about the prospect of treating everyone at risk with drugs, which come with side effects.  Another concern is that individuals will carry the label of mental illness unnecessarily.

“This shows it’s quite safe and reasonably effective to offer supportive psychosocial care to these patients,” said study author Dr. Patrick McGorry. There is “no evidence to suggest that antipsychotic medications are needed in first-line” treatment, he said.

The  trial included 115 patients of a clinic in Melbourne, Australia, for young people believed to be at “ultra-high risk” for a psychotic disorder such as schizophrenia. The study was open to people between the ages of 14 and 30 who met at least one of three criteria: having low-level psychotic symptoms, having had previous brief episodes of psychotic symptoms that went away on their own or having a close relative with a psychotic disorder along with low mental functioning during the past year.

The study compared three types of treatment: talk therapy focused on reducing depression symptoms and stress while building coping skills plus a low dose of the antipsychotic risperidone, or talk therapy plus a placebo pill or therapy emphasizing social and emotional support plus a placebo. The goal was to see how many patients in each group progressed to full-blown psychosis.

After a year, there was no notable difference between the groups, but about 37 percent of the patients dropped out of the study. McGorry, a professor at the Centre for Youth Mental Health at The University of Melbourne, said if the trial had included more people, significant differences between the groups might have come forth.

The importance of detecting early signs and symptoms of a serious mental illness is not controversial,” said Matcheri Keshavan, M.D., a professor of psychiatry at Harvard Medical School. “But the best way of treating or preventing it remains controversial.”

The rates of going on to full-blown psychosis—which ranged from about 10 percent to about 22 percent—were lower in all three groups than in previous studies.

The reasons for this aren’t clear, but McGorry said it’s possible that more participants will develop psychosis after the 12-month study period ends. Many of the study participants were also taking antidepressants, which may have eased psychotic symptoms.

Also, as with many trials, most patients showed poor adherence to the medications used, which may have influenced the results, the authors note.

In a 2010 study, McGorry found that fish oil supplements might prevent psychosis in the same type of at-risk individuals. Going forward, “what is needed is some way of finding predictive biomarkers that can tell who might be at the highest risk,” said Keshavan. “We need to understand their brains.”

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[Article of Interest] Is Facebook a Factor in Psychotic Symptoms?By American Friends of Tel Aviv UniversityTAU researcher connects computer communications and psychosisAs Internet access becomes increasingly widespread, so do related psychopathologies such as Internet addiction and delusions related to the technology and to virtual relationships. Computer communications such as Facebook and chat groups are an important part of this story, says Dr. Uri Nitzan of Tel Aviv University’s Sackler Faculty of Medicine and the Shalvata Mental Health Care Center in a new paper published in the Israel Journal of Psychiatry and Related Sciences.In his study, the researcher presented three in-depth case studies linking psychotic episodes to Internet communications from his own practice. According to Dr. Nitzan, patients shared some crucial characteristics, including loneliness or vulnerability due to the loss of or separation from a loved one, relative inexperience with technology, and no prior history of psychosis or substance abuse. In each case, a connection was found between the gradual development and exacerbation of psychotic symptoms, including delusions, anxiety, confusion, and intensified use of computer communications.The good news is that all of the patients, who willingly sought out treatment on their own, were able to make a full recovery with proper treatment and care, Dr. Nitzan says.Behind the screenThe Internet is a free and liberal space that many individuals use on a daily basis and a growing part of a normal social life. But while technologies such as Facebook have numerous advantages, some patients are harmed by these social networking sites, which can attract those who are lonely or vulnerable in their day-to-day lives or act as a platform for cyber-bullying and other predatory behavior.All three of Dr. Nitzan’s patients sought refuge from a lonely situation and found solace in intense virtual relationships. Although these relationships were positive at first, they eventually led to feelings of hurt, betrayal, and invasion of privacy, reports Dr. Nitzan. “All of the patients developed psychotic symptoms related to the situation, including delusions regarding the person behind the screen and their connection through the computer,” he says. Two patients began to feel vulnerable as a result of sharing private information, and one even experienced tactile hallucinations, believing that the person beyond the screen was physically touching her.Some of the problematic features of the Internet relate to issues of geographical and spatial distortion, the absence of non-verbal cues, and the tendency to idealize the person with whom someone is communicating, becoming intimate without ever meeting face-to-face. All of these factors can contribute to a patient’s break with reality, and the development of a psychotic state.A changing social landscapeDr. Nitzan and his colleagues plan to do more in-depth research on Facebook, studying the features and applications that have the potential to harm patients emotionally or permit patients to cause emotional harm to others. Some psychotic patients use the Internet to disturb people, abusing their ability to interact anonymously, he says.Because social media are now such an important part of our culture, mental health professionals should not overlook their influence when speaking to patients, Dr. Nitzan counsels. “When you ask somebody about their social life, it’s very sensible to ask about Facebook and social networking habits, as well as Internet use. How people conduct themselves on the Internet is quite important to psychiatrists, who shouldn’t ignore this dimension of their patients’ behavior patterns.”

[Article of Interest] Is Facebook a Factor in Psychotic Symptoms?
By American Friends of Tel Aviv University

TAU researcher connects computer communications and psychosis
As Internet access becomes increasingly widespread, so do related psychopathologies such as Internet addiction and delusions related to the technology and to virtual relationships. Computer communications such as Facebook and chat groups are an important part of this story, says Dr. Uri Nitzan of Tel Aviv University’s Sackler Faculty of Medicine and the Shalvata Mental Health Care Center in a new paper published in the Israel Journal of Psychiatry and Related Sciences.
In his study, the researcher presented three in-depth case studies linking psychotic episodes to Internet communications from his own practice. According to Dr. Nitzan, patients shared some crucial characteristics, including loneliness or vulnerability due to the loss of or separation from a loved one, relative inexperience with technology, and no prior history of psychosis or substance abuse. In each case, a connection was found between the gradual development and exacerbation of psychotic symptoms, including delusions, anxiety, confusion, and intensified use of computer communications.
The good news is that all of the patients, who willingly sought out treatment on their own, were able to make a full recovery with proper treatment and care, Dr. Nitzan says.

Behind the screen
The Internet is a free and liberal space that many individuals use on a daily basis and a growing part of a normal social life. But while technologies such as Facebook have numerous advantages, some patients are harmed by these social networking sites, which can attract those who are lonely or vulnerable in their day-to-day lives or act as a platform for cyber-bullying and other predatory behavior.
All three of Dr. Nitzan’s patients sought refuge from a lonely situation and found solace in intense virtual relationships. Although these relationships were positive at first, they eventually led to feelings of hurt, betrayal, and invasion of privacy, reports Dr. Nitzan. “All of the patients developed psychotic symptoms related to the situation, including delusions regarding the person behind the screen and their connection through the computer,” he says. Two patients began to feel vulnerable as a result of sharing private information, and one even experienced tactile hallucinations, believing that the person beyond the screen was physically touching her.
Some of the problematic features of the Internet relate to issues of geographical and spatial distortion, the absence of non-verbal cues, and the tendency to idealize the person with whom someone is communicating, becoming intimate without ever meeting face-to-face. All of these factors can contribute to a patient’s break with reality, and the development of a psychotic state.

A changing social landscape
Dr. Nitzan and his colleagues plan to do more in-depth research on Facebook, studying the features and applications that have the potential to harm patients emotionally or permit patients to cause emotional harm to others. Some psychotic patients use the Internet to disturb people, abusing their ability to interact anonymously, he says.
Because social media are now such an important part of our culture, mental health professionals should not overlook their influence when speaking to patients, Dr. Nitzan counsels. “When you ask somebody about their social life, it’s very sensible to ask about Facebook and social networking habits, as well as Internet use. How people conduct themselves on the Internet is quite important to psychiatrists, who shouldn’t ignore this dimension of their patients’ behavior patterns.”

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Violence and Mental Illness: The Facts

The discrimination and stigma associated with mental illnesses largely stem from the link between mental illness and violence in the minds of the general public, according to the U.S. Surgeon General (DHHS, 1999). The belief that persons with mental illness are dangerous is a significant factor in the development of stigma and discrimination (Corrigan, et al., 2002). The effects of stigma and discrimination are profound. The President’s New Freedom Commission on Mental Health found that, “Stigma leads others to avoid living, socializing, or working with, renting to, or employing people with mental disorders - especially severe disorders, such as schizophrenia. It leads to low self-esteem, isolation, and hopelessness. It deters the public from seeking and wanting to pay for care. Responding to stigma, people with mental health problems internalize public attitudes and become so embarrassed or ashamed that they often conceal symptoms and fail to seek treatment (New Freedom Commission, 2003).”

This link is often promoted by the entertainment and news media. For example, Mental Health America, (formerly the National Mental Health Association) reported that, according to a survey for the Screen Actors’ Guild, characters in prime time television portrayed as having a mental illness are depicted as the most dangerous of all demographic groups: 60 percent were shown to be involved in crime or violence. Also most news accounts portray people with mental illness as dangerous (Mental Health America, 1999). The vast majority of news stories on mental illness either focus on other negative characteristics related to people with the disorder (e.g., unpredictability and unsociability) or on medical treatments. Notably absent are positive stories that highlight recovery of many persons with even the most serious of mental illnesses (Wahl, et al., 2002). Inaccurate and stereotypical representations of mental illness also exist in other mass media, such as films, music, novels and cartoons (Wahl, 1995).

Most citizens believe persons with mental illnesses are dangerous. A longitudinal study of Americans’ attitudes on mental health between 1950 and 1996 found, “the proportion of Americans who describe mental illness in terms consistent with violent or dangerous behavior nearly doubled.” Also, the vast majority of Americans believe that persons with mental illnesses pose a threat for violence towards others and themselves (Pescosolido, et al., 1996, Pescosolido et al., 1999).

As a result, Americans are hesitant to interact with people who have mental illnesses. Thirty-eight percent are unwilling to be friends with someone having mental health difficulties; sixty-four percent do not want someone who has schizophrenia as a close co-worker, and more than sixty-eight percent are unwilling to have someone with depression marry into their family (Pescosolido, et al., 1996).

But, in truth, people have little reason for such fears. In reviewing the research on violence and mental illness, the Institute of Medicine concluded, “Although studies suggest a link between mental illnesses and violence, the contribution of people with mental illnesses to overall rates of violence is small,” and further, “the magnitude of the relationship is greatly exaggerated in the minds of the general population” (Institute of Medicine, 2006). For people with mental illnesses, violent behavior appears to be more common when there’s also the presence of other risk factors. These include substance abuse or dependence; a history of violence, juvenile detention, or physical abuse; and recent stressors such as being a crime victim, getting divorced, or losing a job (Elbogen and Johnson, 2009).

(Source: promoteacceptance.samhsa.gov)

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[Article of Interest] Why Some Schizophrenia Patients are Unresponsive to Antipsychotic Drugs
By Traci Pedersen

Patients with schizophrenia who fail to respond to antipsychotic medications may have something in common — they appear to have normal levels of the neurotransmitter dopamine. 
Schizophrenia is typically associated with an overactive dopamine system, which means that the brain is processing abnormally high levels of dopamine. Traditional antipsychotic drugs attempt to normalize this process by blocking dopamine. However, about one-third of individuals with schizophrenia do not respond to this treatment, and until now, no study has focused on whether dopamine abnormality is present in patients resistant to antipsychotic treatment.
“Despite considerable scientific and therapeutic progress over the last 50 years, we still do not know why some patients with schizophrenia respond to treatment whilst others do not.
“Treatment resistance in such a disabling condition is one of the greatest clinical and therapeutic challenges to psychiatry, significantly affecting patients, their families and society in general,” said researchers from King’s College London’s Institute of Psychiatry.
“Our findings suggest that there may be a different molecular mechanism leading to schizophrenia in patients who do not respond to anti-psychotic medication. Identifying the precise molecular pathway particularly in these patients is of utmost importance and will help inform the development of much-needed novel treatments,” they added.
For the study, the researchers used PET scan imaging to investigate dopamine synthesis capacity in 12 patients with schizophrenia who did not respond to treatment, 12 who did, and 12 healthy controls. The results showed that schizophrenia patients whose illness was resistant to antipsychotic treatment have relatively normal levels of dopamine synthesis capacity.  This would explain why the dopamine-blocking antipsychotic medication was not effective in this group.
However, researchers say that the findings need to be confirmed in larger samples before the study can affect clinical practice. They add that future research will have to center around patients who have never taken antipsychotics in order to see whether presynaptic dopamine regulation was normal in patients in the treatment-resistant group at the beginning of the disorder, before any exposure to antipsychotic drugs.

[Article of Interest] Why Some Schizophrenia Patients are Unresponsive to Antipsychotic Drugs

By Traci Pedersen

Patients with schizophrenia who fail to respond to antipsychotic medications may have something in common — they appear to have normal levels of the neurotransmitter dopamine

Schizophrenia is typically associated with an overactive dopamine system, which means that the brain is processing abnormally high levels of dopamine. Traditional antipsychotic drugs attempt to normalize this process by blocking dopamine. However, about one-third of individuals with schizophrenia do not respond to this treatment, and until now, no study has focused on whether dopamine abnormality is present in patients resistant to antipsychotic treatment.

“Despite considerable scientific and therapeutic progress over the last 50 years, we still do not know why some patients with schizophrenia respond to treatment whilst others do not.

“Treatment resistance in such a disabling condition is one of the greatest clinical and therapeutic challenges to psychiatry, significantly affecting patients, their families and society in general,” said researchers from King’s College London’s Institute of Psychiatry.

“Our findings suggest that there may be a different molecular mechanism leading to schizophrenia in patients who do not respond to anti-psychotic medication. Identifying the precise molecular pathway particularly in these patients is of utmost importance and will help inform the development of much-needed novel treatments,” they added.

For the study, the researchers used PET scan imaging to investigate dopamine synthesis capacity in 12 patients with schizophrenia who did not respond to treatment, 12 who did, and 12 healthy controls. The results showed that schizophrenia patients whose illness was resistant to antipsychotic treatment have relatively normal levels of dopamine synthesis capacity.  This would explain why the dopamine-blocking antipsychotic medication was not effective in this group.

However, researchers say that the findings need to be confirmed in larger samples before the study can affect clinical practice. They add that future research will have to center around patients who have never taken antipsychotics in order to see whether presynaptic dopamine regulation was normal in patients in the treatment-resistant group at the beginning of the disorder, before any exposure to antipsychotic drugs.

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artfromtheedge:

“Woman with Flowing Hair (Moods)”
By Matt Vaillette

Could you tell us a little about yourself?
I’m a bipolar artist. I create primarily for therapy, and it works quite well. You can find me at mebeingsocial.tumblr.com !!
Was your submission created about or in an extreme state? 
It was created to show the many volatile moods of bipolarity. This is how it feels not being able to rely on yourself, or your mental state. It also looks like a psychotic state to me. Any sort of negative/shocking mental state really.



Click here to submit your own artwork to Art from the Edge

artfromtheedge:

“Woman with Flowing Hair (Moods)”

By Matt Vaillette



Could you tell us a little about yourself?

I’m a bipolar artist. I create primarily for therapy, and it works quite well. You can find me at mebeingsocial.tumblr.com !!

Was your submission created about or in an extreme state? 

It was created to show the many volatile moods of bipolarity. This is how it feels not being able to rely on yourself, or your mental state. It also looks like a psychotic state to me. Any sort of negative/shocking mental state really.

Filed under Questions bipolar bipolarity art artiscreative creativity emotions evolution Extreme resilience rethinking madness theory theories unconscious intelligence psychology psychiatry psychoanalysis psychosis psychopathology psychotherapy visual therapy affective antipsychotic science serious mental illness Survivor strength Diagnostic

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artfromtheedge:

“A Killing Nightmare”
Could you tell us a little about yourself?
My name is Ashley Greene. I am 21 years old. I’m trying to get my life together, finish college to be a medical assistant or a phlebotomist. For the past 8 years of my life, I have made very poor choices and I have made a lot of mistakes that I have learned from. I enjoy doing art to pass time and keep myself busy as well as it being an emotional outlet.
Was your submission created about or in an extreme state? If yes, please elaborate below.
Yes. I had no idea that what was going on in my head was just a dream. I really thought that I was being killed. I think if it was enough to make me cry while I was sleeping, it must’ve been traumatic quite a good bit. Even after I realized that it wasn’t real, I was steal alive, and none of it had actually happened it was still frightening enough to make me still continue to cry.
Would you like to describe the process of creating your submission?
I used mixed media. I enjoy using many things to create my art. First, I drew the people in the outfits in india ink, leaving some places open for white and grey acrylic paint. I made a lighter wash from the india ink as well to use for shading of the characters and the background. For the lines of light I used food coloring (mixed to my own shades) as well as watercolor pencils.
Click Here for more about this piece!

artfromtheedge:

“A Killing Nightmare”

Could you tell us a little about yourself?

My name is Ashley Greene. I am 21 years old. I’m trying to get my life together, finish college to be a medical assistant or a phlebotomist. For the past 8 years of my life, I have made very poor choices and I have made a lot of mistakes that I have learned from. I enjoy doing art to pass time and keep myself busy as well as it being an emotional outlet.

Was your submission created about or in an extreme state? If yes, please elaborate below.

Yes. I had no idea that what was going on in my head was just a dream. I really thought that I was being killed. I think if it was enough to make me cry while I was sleeping, it must’ve been traumatic quite a good bit. Even after I realized that it wasn’t real, I was steal alive, and none of it had actually happened it was still frightening enough to make me still continue to cry.

Would you like to describe the process of creating your submission?

I used mixed media. I enjoy using many things to create my art. First, I drew the people in the outfits in india ink, leaving some places open for white and grey acrylic paint. I made a lighter wash from the india ink as well to use for shading of the characters and the background. For the lines of light I used food coloring (mixed to my own shades) as well as watercolor pencils.

Click Here for more about this piece!

(via artfromtheedge)

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[Article of Interest] Brain Scans Support Freud: Guilt Plays Key Role in Depression
Posted on ScienceDaily [Excerpt] Scientists have shown that the brains of people with depression respond differently to feelings of guilt — even after their symptoms have subsided. University of Manchester researchers found that the brain scans of people with a history of depression differed in the regions associated with guilt and knowledge of socially acceptable behaviour from individuals who never get depressed.
Lead researcher Dr Roland Zahn, from the University’s School of Psychological Sciences, said: “Our research provides the first brain mechanism that could explain the classical observation by Freud that depression is distinguished from normal sadness by proneness to exaggerated feelings of guilt or self-blame.
"For the first time, we chart the regions of the brain that interact to link detailed knowledge about socially appropriate behaviour — the anterior temporal lobe — with feelings of guilt — the subgenual region of the brain — in people who are prone to depression."
“The scans revealed that the people with a history of depression did not ‘couple’ the brain regions associated with guilt and knowledge of appropriate behaviour together as strongly as the never depressed control group do,” said Dr Zahn, a MRC Clinician Scientist Fellow.
"Interestingly, this ‘decoupling’ only occurs when people prone to depression feel guilty or blame themselves, but not when they feel angry or blame others. This could reflect a lack of access to details about what exactly was inappropriate about their behaviour when feeling guilty, thereby extending guilt to things they are not responsible for and feeling guilty for everything.”

[Article of Interest] Brain Scans Support Freud: Guilt Plays Key Role in Depression

Posted on ScienceDaily

[Excerpt] Scientists have shown that the brains of people with depression respond differently to feelings of guilt — even after their symptoms have subsided. University of Manchester researchers found that the brain scans of people with a history of depression differed in the regions associated with guilt and knowledge of socially acceptable behaviour from individuals who never get depressed.

Lead researcher Dr Roland Zahn, from the University’s School of Psychological Sciences, said: “Our research provides the first brain mechanism that could explain the classical observation by Freud that depression is distinguished from normal sadness by proneness to exaggerated feelings of guilt or self-blame.

"For the first time, we chart the regions of the brain that interact to link detailed knowledge about socially appropriate behaviour — the anterior temporal lobe — with feelings of guilt — the subgenual region of the brain — in people who are prone to depression."

The scans revealed that the people with a history of depression did not ‘couple’ the brain regions associated with guilt and knowledge of appropriate behaviour together as strongly as the never depressed control group do,” said Dr Zahn, a MRC Clinician Scientist Fellow.

"Interestingly, this ‘decoupling’ only occurs when people prone to depression feel guilty or blame themselves, but not when they feel angry or blame others. This could reflect a lack of access to details about what exactly was inappropriate about their behaviour when feeling guilty, thereby extending guilt to things they are not responsible for and feeling guilty for everything.”

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artfromtheedge:

“Social Anxiety”
By atheoryofmind

Could you describe your submission?A collage I made a few years ago to express my severe social anxiety.Could you tell us a little about yourself?I had severe social anxiety all through adolescence and through part of college. I majored in psychology and was aware of the current treatment methods for anxiety disorders. I decided to do exposure therapy on myself at school so that I could interact with others more easily. A year and a half later, no one knew the difference. Today, at age 24, people have trouble believing me when I tell them I used to be really socially anxious- I’m opinionated, direct, and put myself out there.Was your submission created about or in an extreme state?.As I said, I was extremely socially anxious at the time, but also very lonely as a result, and hating myself for both.
Click here to submit your own artwork to Art from the Edge

artfromtheedge:

“Social Anxiety”

By atheoryofmind




Could you describe your submission?
A collage I made a few years ago to express my severe social anxiety.
Could you tell us a little about yourself?
I had severe social anxiety all through adolescence and through part of college. I majored in psychology and was aware of the current treatment methods for anxiety disorders. I decided to do exposure therapy on myself at school so that I could interact with others more easily. A year and a half later, no one knew the difference. Today, at age 24, people have trouble believing me when I tell them I used to be really socially anxious- I’m opinionated, direct, and put myself out there.
Was your submission created about or in an extreme state?.
As I said, I was extremely socially anxious at the time, but also very lonely as a result, and hating myself for both.



Click here to submit your own artwork to Art from the Edge

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87 notes

[Video of Interest] Stephen Fry: The Secret Life Of The Manic Depressive

Stephen Fry presents this documentary exploring the disease of manic depression; a little understood but potentially devastating condition affecting an estimated two percent of the population. Stephen embarks on an emotional journey to meet fellow sufferers, and discuss the literal highs and lows of being bi-polar. Celebrities such as Carrie Fisher and Richard Dreyfuss invite the comedian into their home to relate their stories.

In addition, Stephen looks into the lives of ordinary people trying to deal with the illness at work and home, and of course to the people studying manic depression in an effort to better control it. A fascinating, moving and ultimately very entertaining Emmy Award-winning programme.

Filed under Questions western video documentary emotions Extreme research resilience rethinking madness theory manic depressive stephen fry bipolar trauma theories unconscious intelligence psychology psychiatry psychoanalysis psychosis psychopharmacology psychopathology psychotic personality disorder psychotherapy post traumatic Paranoid apa

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Art from the Edge: This World Is Black and White

artfromtheedge:

This World Is Black and White

This world is black and white
With a fog of gray we can not fight
Madness on the edge
Falling like molten sludge
As if a volcano had erupted
unforseen, unprompted
Unwanted
An intrusive visitor to our mind
That burns away the sanity
Leaving a subtle shell
That hints at a hidden hell
That holds everything that ever was
Or ever will be
Inescapable rapture of every bit of promise
The genius child turns into a mad man
Incapable of his prospective talent
Unable to even remember what loss it is
That he laments



Could you describe your submission?
It is a free form poem about the affects that mental states can have on someones life, and the silent feeling of loss felt

Could you tell us a little about yourself?
I am a former soldier, a cancer survivor, i have adhd and tuerretes and i have always felt as if something wasnt quite right, this is the feeling my poems are about

Was your submission created about or in an extreme state?
It was indeed created about extreme mental states, as ive said ive never felt like everything was ok, so im not sure if i could say it was created in an extreme mental state or not

Would you like to describe the process of creating your submission?
Poetry has always just come to me, there are times i sleep with a notepad and pen because i will wake up from a dead sleep with an idea on my mind and be unable to sleep until ive written it down

Click here to submit your own artwork to Art from the Edge

(via artfromtheedge)

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79 notes

artfromtheedge:

“Dissolve”
By Breanna

Could you describe your submission?
A stylized drawing of Slenderman rising up from a black fog at the bottom of the page.
Could you tell us a little about yourself? 
My name is Breanna, I suffer from Generalized Anxiety Disorder as well as Major Depression with Psychotic elements, and an as yet undiagnosed mood instability. I have a 13-month old son named William who keeps me going.
Was your submission created about or in an extreme state?
I was in a depressed and slightly anxious state, I was also high. (This does not happen anymore, haha)
Would you like to describe the process of creating your submission?
I became anxious one night so I smoked and then sat down quietly and began to draw. This was one of the results.

Click here to submit your own artwork to Art from the Edge

artfromtheedge:

“Dissolve”

By Breanna


Could you describe your submission?

A stylized drawing of Slenderman rising up from a black fog at the bottom of the page.

Could you tell us a little about yourself? 

My name is Breanna, I suffer from Generalized Anxiety Disorder as well as Major Depression with Psychotic elements, and an as yet undiagnosed mood instability. I have a 13-month old son named William who keeps me going.

Was your submission created about or in an extreme state?

I was in a depressed and slightly anxious state, I was also high. (This does not happen anymore, haha)

Would you like to describe the process of creating your submission?

I became anxious one night so I smoked and then sat down quietly and began to draw. This was one of the results.



Click here to submit your own artwork to Art from the Edge

Filed under Questions evolution emotions research resilience rethinking madness theory trauma theories unconscious intelligence drawing pencil sketch psychology psychiatry psychoanalysis psychosis paranoia psychotic psychotherapy psychopharmacology psychopathology post traumatic art artist anxiety addiction abuse apa

37 notes

artfromtheedge:

“Delusions of Grandeur” (2010)
By Matt Vaillette

Could you describe your submission?
This was a spontaneous piece I created in 2010, during a manic episode. Midway through I decided it represents the delusions of grandeur most of us live with, manic or otherwise.
Could you tell us a little about yourself?
I’m a Bipolar artist. I focus on the experience of creating and think a lot about states of mind and their resulting artistic outcomes. I currently put all my work on mebeingsocial.tumblr.com.
Was your submission created about or in an extreme state?
This was created in a mild manic state.
Would you like to describe the process of creating your submission?
I (stupidly) triggered a manic episode through sleep deprivation in order to create in such a state. From there I rode the waves, and followed strong feelings until it was finished.

artfromtheedge:

“Delusions of Grandeur” (2010)

By Matt Vaillette



Could you describe your submission?

This was a spontaneous piece I created in 2010, during a manic episode. Midway through I decided it represents the delusions of grandeur most of us live with, manic or otherwise.

Could you tell us a little about yourself?

I’m a Bipolar artist. I focus on the experience of creating and think a lot about states of mind and their resulting artistic outcomes. I currently put all my work on mebeingsocial.tumblr.com.

Was your submission created about or in an extreme state?

This was created in a mild manic state.

Would you like to describe the process of creating your submission?

I (stupidly) triggered a manic episode through sleep deprivation in order to create in such a state. From there I rode the waves, and followed strong feelings until it was finished.

(via artfromtheedge)

Filed under Questions western evolution emotions research resilience rethinking madness theory trauma theories unconscious intelligence painting Paranoid psychology paint psychiatry psychoanalysis psychosis personality disorder psychotic psychotherapy psychopharmacology psychopathology art artist anxiety affective science strength