Are you Prepared to Address Psychosis in Your Practice? (Feature-Length Version)
In Madness and Civilization, philosopher Michel Foucault has predicted a proliferation of madness as disparities increase and modern society advances. Indeed, with psychopharmacology industry booming, rates of addiction, fueled by the opioid epidemic, skyrocketing, terrorism wars raging abroad, ongoing drug wars afflicting low income neighborhoods, escalation in homeless encampments in major cities, and a rise in bullying in schools, and even cyberbullying, it really does seem like higher percentage of people have been forced to explore their mental health struggles. While mass shootings have kept danger stigma in the media high and the media response continues to reinforce silence about mental struggles, the field of psychotherapy does have a lot more trends to address.
When I look through my state’s psychotherapy association’s annual conference, I see many of these trends getting addressed in workshops. But ever invisible is the issue of psychosis. Is it possible that the issue of psychosis functions as a significant part of the madness narrative? Is it possible that psychosis too is affecting more and more Americans as Foucault inferred?
What the Statistic Say:
I do not believe that running through NIMH statistics reveals much about the prevalence of psychosis. I believe that psychosis affects individuals across diagnostic divides.
According to this year’s statistic by the NIMH, approximately one in five people will struggle with a mental health issue and 46 percent of the population will sometime struggle with their mental health. In fact, there is the suggestion that these stats may be a little lower than they have been in recent years perhaps due to the economy fluctuating. Contrast this with the ever-present statistic that one percent of the population carries a diagnosis of schizophrenia added to the unspecified number of individuals who experience bipolar (which is 4 percent of the population,) and the relevance of psychosis continues to seem very small.
I believe this is a gross underestimation. I believe hearing voices and other types of experiences that trigger alternate realities is very common throughout the population so much so that it warrants the attention of psychotherapists in private practice. I believe that many people go in and out of these experiences and may have occasions in which they are defined by them. However, the cost of being open about them is very high perhaps because there is little to no established treatment available outside the psychiatric ER.
On the Ground in Oakland, California:
As a psychotherapist on an outpatient psychiatric unit, I deal mostly with people who have spent their lives funneling through emergency rooms and perhaps lived in State Hospitals or at home until they aged out and hit the squalor of board and care homes. Or maybe they were homeless or incarcerated or maintained a job and, before the local housing crisis, an apartment. Indeed, I would like to convey that there are many who have worked but as they age, they get confronted by their issues with the aging process. Our participants would be labeled with SMI, “severe mental illness,” the majority being fifty years or older or 2.7 percent of the population. Oddly, according to NIMH statistics, the SMI population is approximately double the size among youth.
Finally, in the outpatient psychiatric unit, we provide treatment that has oft been neglected to address participants’ trauma and their mental health issues. I have created a program to address issues related to psychosis, or what I prefer to call special messages. And wouldn’t you know it, the issue of psychosis bubbles up in different ways for different people across diagnostic divides. Indeed, people many participants will share things with each other, they will not share with a psychiatrist.
Deserving of a Seat in the Psychotherapy Office:
In my training, I was always encouraged to refer out when it comes to psychosis. Let the ER deal with that, was the mantra of most of my trainers. Psychosis is scary.
Because I had to earn a living throughout my training, I took my living from the poor in the inner-city and volunteered my time for the rich. Perhaps, because I consider myself a wannabe philosopher and sociologist, when I finally got licensed and earned my freedom, I started to explore running psychoses focus groups on the unit that had supported me on my way through.
And after doing many groups over the past ten years I am writing to suggest that more and more psychosis deserves a place in private practice and the revolving door of the ER is not an ethical move on the part of the trained psychotherapist. I call our local ER the homeless encampment and feel that it sends people in psychosis a large and disturbing message when they get confined to it.
How Diversifying Causation Beliefs Can Lead to Recovery from Psychosis:
I believe that a powerful dialectic exists when participants study their similarities in psychoses focus groups. Converse to the great opportunities for growth that result when participants genuinely identify with each other, there are often important points of difference highlighted that likewise can lead to growth when nurtured properly.
To be specific, I have observed that participants often become more communicative about their diverse beliefs regarding the causation of their psychosis experiences. And I believe this leads to collaboration and accommodation that can help message receivers move toward social rehabilitation and recovery.
There is little doubt in my mind that the causation of psychosis experiences is a natural preoccupation for people who suffer. In fact, this preoccupation is so powerful, it warrants becoming part of the definition of psychosis in the model of treatment I have created.
Having led many long-term psychoses focus groups over the past ten years, one of the more powerful solutions I have developed involves helping sufferers learn diversity lessons about the causation of their (psychosis) or special message experiences.
I categorize the causation beliefs of sufferers as being: political, psychological, spiritual, scientific, or trauma based. In the thick of a body’s psychosis process, causation beliefs often rigidly stay in one or two of these styles. While there is often an ability to consider and ponder other beliefs, the tendency is to immediately create explanations according to a single style or two of causation beliefs. Further, there is often an immediate need to solve or comprehend what is happening that can feel addictive.
Increasing Flexibility of Causation Ideas:
What I believe happens particularly when it is finessed and highlighted by the leader is when sufferers tell stories about the experiences of their psychosis, they hear similar experiences interpreted with a different style of causation. In supporting their peers, they become forced to see how these rigid causation beliefs lead to errors.
If I could count the number individuals I’ve worked with who are in what I like to call message crisis (psychosis,) who try to reality check me when I tell my story—well, you might say I’d be a high scoring. Indeed, I have found training them to better understand my experiences often opens them up to be willing to share their story with me.
They say, “No, I don’t think you were really followed by the mafia, I think that is a delusion.”
Then, I review specific evidence that is convincing and some evidence (or special messages) that are less clear.
I have found that this helps people be more willing to reveal what is happening to them with me.
But to get back to what I primarily want to convey, I often see that when participants can see messages (or psychosis) happening to other people, it leads them to be more aware of the role that their own causation beliefs have in their suffering. Often the causation beliefs of others are at least slightly different. When the message receiver notices that different causation beliefs lead to errors, it challenges them to be more flexible in how they interpret their own psychosis experiences, which I like to call special messages.
Indeed, it is clearly conceivable that every special message (psychosis experience,) has a different causation style. Any psychosis (or message crisis) is full of thousands of these special message experiences. I believe that when every message can be interpreted with flexibility, the message receiver can return to accomplishing things that relate to social rehabilitation.
Five Styles of Causation Beliefs:
Below I have listed the five causation styles along with common explanations that have been expressed in groups I have lead over the years. Some are perhaps noticeable as common psychological theories, others as less conventional ideas that might be considered delusional.
I believe that all causation beliefs are valid, important, and perhaps operant at different times in a person’s story. I like to argue that people may be predominantly correct about the causation of their message experiences. This validates participants in a way that is needed to heal from the potential trauma they have been through. However, I argue that any given message receiver may need to incorporate other explanations to survive and thrive in the modern world.
- Messages are your inner thoughts or unconscious beliefs. They are just in your head. We broadcast our unconscious beliefs in ways that cause others to interact with us in ways that make our unconscious beliefs realities.
- Messages are a way of processing things that we are not willing to deal with.
- Messages are a return to a regressed period of attachment in which the baby has destructive relationships with the boobs.
- Messages come from people following you around and tormenting you to control or seek revenge on you. These followers could be a gang, police, CIA, government, corporations, masons, illuminati, aliens, or other secret societies.
- Messages are real evidence that the government is socially controlling and preventing the mainstream from knowing. They have their ways of taking snitches and putting them in ditches.
- Messages are nothing but figments of past perpetrators or abusers.
- Messages come from the social thoughts or judgments of others, the social mainstream, or the collective unconscious of others (Stigmas) that are being used to decrease your social standing
- Messages come from god, fairies, aliens, ghosts or what we in the west call supernatural experiences.
- Messages are processes that may help or hurt you in evolving or adapting to the dilemmas of a modern environment.
- Messages are there to test your ability to be good and evil and are there to lead you to lead others.
- Genetic differences or scientific processes that develop because of nuero-diversity. Eugenics suggest that these genes aren’t fit for survival and justify a complex system of abuse and social control.
- Messages happen when neuro-transmitters get changed through things like environmental stress patterns that fall into genetically derived conditions.
- Messages happen when spiritual genes get persecuted in our society
Because I don’t make it a habit using case histories out other message receivers, I will review my own story to demonstrate how all five causation styles may be necessary to employ to help a message receiver survive in the modern world.
I would agree with the reader who says this is convenient and limited as a result.
However, in my defense, I have used insights from other message receivers’ causation beliefs to be able to understand my journey in the following manner. Indeed, for years, I could not even tell these stories. I needed to attain economic stability and to lead professional groups with diverse individuals to be able to make sense of what happened to me.
Additionally, people take different routes on their journey to better functioning. I would also argue that being able to relate and recreate your own experiences is one of the benefits of listening and relating to other message receivers. Therefore, I host groups and encourage those who are stuck in a single style or two to come out and listen to help diversify their views.
Preoccupation with Political Abuse:
My own message experiences involved descent into political abuse that could have rendered me homeless and jobless if I had given up. Persistent throughout the two-years of psychosis I endured, I believed I was being harassed by the government and the mafia.
I was working in a section 8 housing authority complex amid significant drug use and trafficking and had leaked information to the press to try to protect the vulnerable. The result was that the company that contracted with my company, a powerful authority with connections to the President targeted the people I wanted to protect for eviction. Then, the housing authority offered to give me a large amount of free concert tickets.
Of course, I used the concert tickets to advertise the music festival throughout the project and take out twenty-four of the vulnerable clients who would come out to the expensive mainstream event. I felt it was a good use of the bribe.
After that stunt, I continued to be very popular among many of the residents. I persisted in trying to crack the mystery of the local drug war that just didn’t make sense. I learned more and more details, until I started to get scared of the persistent threats. I started to get a strong sense of connection, like people were putting on skits around me to either help or foil me.
Among other things, I called a friend with a nefarious history. He heard what I had to say and made a powerful threat. Then, I ran away. Then, I withdrew all my money from my bank account. Then, I headed for the Canadian border. Maybe my friend was using me to help him move drugs through the project. Suddenly, it all made sense.
As I neared the border of Canada I was convinced I was being followed. I stopped at a gas station to fuel and I got accosted by two policemen. One bruised my wrists and drove me eighty miles from my car.
At the hospital I lied to the psychiatrist and was given the opportunity to run.
I surrendered a few days later, from a ditch, on a mountain pass, at midnight.
In the State Hospital there was a clearly defined mafia daughter and a lot of people wanting to help her run away. She showed all patients documents of how she had taken a shot at her father. I suspected these were phony and wasn’t at all attracted to her.
However, she was most interested in me despite the persistence of my unpopular mannerisms. Indeed, she seemed to salivate after me trying to extract information about my sneaky escapades. I received an offer to join an outlaw gang for protection against her. A lot happened in three months.
Discharged to the streets, I took a greyhound and got a job in Fresno. But when I ran out of medication, I was released from the job. Not only had I refused to take over the supervisor’s job, I had started to act funny. Then, I couldn’t find any work for three months. I tried everywhere, from Walmart to county social work positions. Finally, I got a job at a Foster Care Agency.
This forced my family to get involved. At least it made me willing to accept their help. I thought they were an Irish mob family who had hidden their illegal activities from me.
A black sheep aunt who lived in the bay area was able to offer me a less risky job at an Italian Delicatessen if I moved up into Antioch, California.
Causation Beliefs toward Spiritual Causation:
My interpretation of all events that happened to me at the Italian Deli led me to the belief that I was human traffic to my mob bosses. Unable to afford a car I biked twenty miles a day to the train station and back and took the train an hour to reach my job, which was in a wealthy suburb. Every train ride I took, I could spot a rider who was clearly following me.
One day it was a resident from the job I had at the Seattle Housing Project. He was dressed in a jean jacket that had a CIA Officer sign attached to it’s pocket and handcuffs attached to the belt-loops of his jeans. I had heard he’d been arrested before for impersonating a CIA officer when I was in Seattle. He had also cackled at me like a chicken and told me he had killed people before.
I persisted this way for ten months. I tried to find any work I could find outside the deli where I felt harassed endlessly.
Finally, I got a call back from an interview I had in the tenderloin. The job would lengthen my commute by an hour; but paid a good deal better.
In the group interview, I noticed that several of the workers were religiously preoccupied. They reminded me of the State hospital patients I had been locked up with.
Suddenly, in the middle of an interview that was going swimmingly well, a Latina woman spoke out in a shrill voice, “Oh, my god, the energy in the room is intense. It reminds me of the movie Stigmata.”
The room was accepting and rolled with this outburst with inquisitive questions.
I went home and rented the movie and suddenly it occurred to me, it was possible I wasn’t the son of a famous Irish Mafia family, maybe I was the next Jesus Christ, himself . . .
Incorporating Scientific Causation:
I was called back for a third interview, but when I asked to change my day to accommodate the interview, my boss told me he’d have to fire me if he did. This was the way I was used to being treated there. They were very controlling.
“You’re allowed to work with us, but you just can’t work anywhere else,” I was told by my boss.
Even worse, I was being sexually harassed. A co-worker told me my reputation was smeared, by a female supervisor I jaded. She started a rumor about me that I was a pedophile.
However, now when I went to church, the priest seemed honored to have me in the congregation and to woo me as if he knew something I didn’t. I came across a Cadillac with a plasticine frog pinned to a cross and I figured that my crucifixion was eminent.
Then, I got hired by a wacky social worker at a therapy internship. His name was Jack and he said and sounded like he came from South Boston. “We’ve got to get you out of that Italian Deli before they cut those fingers off,” he said.
My hands were carefully bandaged to conceal the large warts that had taken over my hands ever since the uncleanly showers of C-Ward at Montana State Hospital.
“Hey, I get something from you,” he said, “I’ll bet you’ve been in some real impoverished neighborhoods back east.
Even though Jack was right about me, I was uneasy with his intuition.
“Do you trust me,” he asked.
The first day of the internship, I was utterly overwhelmed because everything Jack said seemed to come from private phone conversations I had had with my family. His face often turned red. “Hey, I know what they need to do with all those boys on the corners: just turn on cold showers and take the heat away from them. Then, they’ll be just fine.”
Later that afternoon I had another interview at a job I really wanted that bombed. The interviewer had been distressed by my level of anxiety and red face.
That night I didn’t sleep a wink. Was I ever going to avoid this eminent crucifixion? I kept blowing my professional opportunities. I had medical coverage. I decided to see a psychiatrist.
Incorporating Trauma Causation:
My boss at the delicatessen seemed to be much more accepting of me once I was medicated. He started to tell me, “good job!” when I continued to complete the tasks with care and detail.
It was true that I felt traumatized the whole time I was politically exploited. But I never thought the endemic bullying I experienced everywhere except amid the vulnerable population was my fault. Indeed, perhaps I was traumatized as a child and that was in part why I was bullied.
But now that I was medicated and started trying to make friends with my co-workers at the delicatessen I realized that they weren’t all bullying me in as organized a fashion as I imagined. There were ways I could appeal to injustice. Indeed, some of the less dominant kids really looked up to me. A few other young females had true crushes on me. They seemed to have fantasies of rescuing me. One even said, I had a beautiful mind.
It started to occur to me that I might not be a mafia kid but more of a bullied Aspergian child.
After all I already carried a diagnosis of ADD and Dyslexia, why not throw another neurodevelopmental difference in there. At least then I didn’t have to hate all the pot smoking population for participating in making me a political prisoner. I was very socially awkward and did tend to amuse people.
And, finally, I got the job outside the Deli, but agreed to stay on one day a week so that I could maintain the income necessary for my independence. Even though I had learned to shine my parents on, I did not like the way they used my economic need to control me. Indeed, being a piece of human traffic had helped me build personal skills.
And Finally, Incorporating Psychological Explanations:
It is hard for me to immediately define how I have come to consider that psychological processes may have been involved in my message experiences.
Perhaps, this is because the bay area therapist I saw believed that psychodynamic processes were happening between us. From my perspective, she was unable to admit that her fees were financially exploiting me. The therapy was imposed on me by my parents. I believed they would in fact hold me financially accountable for the very unhelpful relationship.
Indeed, I often felt that if people listened instead of presuming I was wrong about everything I experienced—if they explored the ways I was correct about what I was saying, that they could have really gotten my attention and helped me.
And a lot of what I believed has turned out to prove correct. For example, genetic testing has since revealed that my predominantly old money family really was predominantly Irish. Additionally, my mother who admired her father’s fame as the chair of the Harvard Psychology Department, may have in fact named me Timothy, after her father’s friend, Timothy Leary. (O’Leary, in my Irish mind.) Indeed, my Harvard grandfather really did work for the CIA and get rich from remarkably wise stock trading.
For example, it was true that my father, who everyone assumed I was wrong about, really had retired from his career at age forty-five, really did live primarily off-the-grid, via stocks and landholdings, yet still too busy to keep up with me. It was true that I really didn’t understand how he did this because finances were always hushed. Of course, my nefarious friend, an ununionized longshoreman, really did have a nefarious past with ties to the Philadelphia PD (an officer with the same first name as my father.)
Indeed, the drug war really does ensnare and incarcerate a disproportionate number of mentally ill individuals like myself leaving wealthy cartels to pay off the politicians. And support the dominant and violent. And I later learned that the Italian Deli that I worked at really did have mafia ties. I was able to confirm this when a street-wise person inadvertently dropped a name I recognized from my deli days.
Once I learned that I really was molested as a child just as I suspected; once I finally, in my first week employed away from the Deli, heard my name called in a harsh, metallic voice; once I developed the strength to call myself a schizophrenic and validate myself, I could start to see psychological causation beliefs. There were personal issues that were getting replayed in surrounding relationships. In fact, I will explore this process more in my next article as it is a component of my system of treatment.
Teaching Psychotherapists to Diversify Causation Beliefs:
Often, I find that message receivers in psychoses focus groups learn a lot from kicking around their ideas and experiences, much as I have just done. Though the order in which they uncover causation beliefs invariably differs, I believe that we can learn to support each other by proposing alternate meanings that are based on alternative causation beliefs. I believe that we can empower ourselves to navigate injustice and oppression in the modern world. I think we need psychotherapists who can help us with this.
Many message receivers aspire to become healers. In a traditional sense, it is our shamanic calling. As we learn to navigate message experience with rhythm and flow, groups are a great place to practice telling healing stories to message receivers who are still stuck and in crisis. On Facebook there are many sites dedicated to normalizing the spiritual emergence narrative. They need to be expanded and extended to the homeless population.
Additionally, in groups we can give each other credit and acknowledgement for diversifying causation beliefs. Not only can this be a great way to nurture and build relationships, it can reinforce movement to social rehabilitation. Too often, we stay stuck because our efforts to change our causation beliefs fail to arouse interest in those who are paid to support us.
Without mentors who can help us by modeling and articulating these insights, how are we to know we are on the right track? Perhaps, this is part of the reason it seems like so few of us survive to socially rehabilitate.
I believe that if psychotherapists support and learn from the experiences of the hearing voices network in other countries, they can become involved in providing services that teach message receivers to heal outside the punitive environments of the psychiatric ER or the State Hospital.
We need to promote healers and success stories who can connect with the one percent of the population that is persistently struggling and create pathways for social rehabilitation. We need statistics that more accurately report on the prevalence of psychosis to support these efforts. We need psychotherapy offices that specialize in psychosis!