Learning to be with ourselves: a response to Understanding Psychosis – Elizabeth Svanholmer

http://beyondmeds.com/2015/04/20/learning/

Click on the link to visit Monica Cassani’s resource-rich site, http://www.beyondmeds.com, for this great piece by Elizabeth Svanholmer, commenting on the recent report by The British Psychological Society, Division of Clinical Psychology, edited by Anne Cooke and entitled:-

‘Understanding Psychosis and Schizophrenia: Why people sometimes hear voices, believe things that others find strange, or appear out of touch with reality, and what can help’

Here’s a link to the entire (lengthy) report, which is worth a read:-

https://www.bps.org.uk/system/files/user-files/Division%20of%20Clinical%20Psychology/public/understanding_psychosis_-_final_19th_nov_2014.pdf

However, even if you do not have that kind of time at your disposal right now, the title gives the clue that this report steps well outside the psychiatric model/DSM framework. It feels like a profoundly encouraging move, especially from the Psychological Society, which has not necessarily carried a pioneering beacon on these themes in its history.

The writer has long resonated with the counselling axiom (not sure who first came up with this): ‘The behaviour is not the problem. The behaviour is the solution. So what’s the problem?’. The report introduces itself with a similar observation from Karl Menninger:-

‘An individual having unusual difficulties in coping with his environment struggles and kicks up the dust, as it were. I have used the figure of a fish caught on a hook: his gyrations must look peculiar to other fish that don’t understand the circumstances; but his splashes are not his affliction, they are his effort to get rid of his affliction and as every fisherman knows these efforts may succeed.’

Karl Menninger

 

150 or so pages on, it acknowledges that the current emphasis on CBT and/or medication is inimical to (and disrespectful of) client autonomy, and that it would serve us individually and culturally to bring attention instead to supporting people in their own choices, and educating all of us on some of the alternative perspectives and evidence covered in the report. It concludes:-

‘Firstly, research efforts have been weighted too heavily towards the search for biological abnormalities. The focus of research needs to turn much more towards the events and circumstances of people’s lives, and the way that these affect us at a social, psychological and even biological level.’

and:-

‘A fundamental message of this report is that ‘psychotic’ experiences are understandable in the same ways as ‘normal’ experiences, and can be approached in the same way.’

Much the same message that Laing, Rogers and many others have been giving us for well over half a century, and aligned with the person centered way of working.

The report quotes people who have had such experiences, and also those working with them. For example, here is Sally Edwards on a psychologist who helped her:-

‘Even from the very first session…. I felt a huge sense of relief. My‘symptoms’ became experiences again and rather than discouraging me to talk/engage/ entertain them, he actively encouraged this. He wanted to get to know the voices I was hearing using voice dialogue. Just a space to talk in detail about every quality of my voice hearing experience to someone that wanted to listen was enough to shift things. Rather than telling me that the beliefs I had were delusions that I should stop believing he asked all about my beliefs. He focussed on how these beliefs made me feel and how I could live whole heartedly within these beliefs. There was never a point were I was told what I experienced was wrong, illogical or meaningless and there was CERTAINLY no agenda to get rid of my experiences, rather, the aim was to get to know them…

Through writing I was able to begin sharing …. the sexual abuse I experienced as a child and young adult. He helped me to understand what had happened and understand and express how I felt about it. I had to begin to try and find myself not guilty and give the shame I felt back to its rightful owner… the abusers. When I started to express the rage, shame, fear and deep sadness I had bottled up, my voices began to calm down and give me an easier time.’

 

It also quotes Rufus May on coercive psychiatry:-

‘I am ever ready to support consideration of alternative models of care where there is less emphasis on coercive treatment. I still wake up from nightmares that I have been readmitted and highly medicated against my will. In my community work I recognise the same fear in clients who are desperate to not be misunderstood or judged hospitalisable. This fear of losing one’s freedom is a massive obstacle to collaborative mental health care. Where possible, therefore, I believe it is important to not see sectioning and locked wards as given and fundamentally

necessary.’

 

The report feels like a humanizing and open-spirited approach to themes more often characterized – even in the self-avowed person centered talking therapy world – by assumptive and diminishing generalizations couched in ‘mental health’ terminology (which may more accurately be seen as a political position than a scientific one).

Elizabeth Svanholmer’s piece is also well worth a read. She speaks from the perspective of having such experiences herself, the enduring fear and confusion these engender, and her own experiencing of what has/has not been helpful from herself and from others. The writer resonated with the points she makes about seeking cognitive understanding of such experiences – one of the most common questions in the therapeutic relationship is ‘why?’. ‘Why do I feel like this?’. Even where answers to this question are apparently available, it often seems to be one of the least useful questions arising in the therapeutic process.

Elizabeth comments:-

‘…some of my experiences completely refuse to be defined by me. They scream as if I am hurting them by trying to explain them. They will change shape, size and content to elude my cognitive grasp on them. They just want to be as they are, whatever they are without my intellectual interference. They don’t want my kindness or my empathy. They are just life expressing itself through me and me trying to make sense of them is almost like me putting a knife to my mind and then exclaiming ‘ah see it was a cut all along’.

‘They are just life expressing itself through me…’… a powerful and liberating perception.

She goes on to describe the way of being she would like to offer to her younger self – and her words beautifully and accurately capture person-centered, as we understand and practise it at this service:-

‘Imagine if we all learned from an early age that fear, pain, death, illness, age, distress and confusion are natural parts of life, not threats to life. Imagine if we learned to sit in front of someone in deep distress and just be there for them. Without any agenda.

Accepting that we don’t always know why things are as they are. Accepting that there are things we can’t prevent or fix.

I wish I had learned to not fear my experiences, fear myself, when I was younger. I wish I could go back to that girl I was and just sit with her. Not to explore with her what she was experiencing or find out why. Not to reassure her that things get better, that they change or that she will learn to cope with or even appreciate her experiences.

I would just want to sit there and envelop her in all the love I feel for her.

Show her that I am not scared.

Show her by staying.

Show her by listening without judgement or analysis.

Show her by holding her hand or hugging her if she lets me.

Show her by walking next to her as she angrily marches through the streets at night.

Show her by sitting there while she bangs her head against the wall and hits her fists against her thighs.

And I might just say to her;

“This is life, all of our experiences are part of life and this is just one little part of yours. You don’t have to fear it or fight it. It comes and it will pass. And there are so much more to your life than this. Other things you will experience. Painful, joyful, scary and beautiful.’

Amen to that.

Palace Gate Counselling Service, Exeter