I contend that the trendy depicton of psychosis as a thought disorder misleads the public and can lead to misunderstandings that sabotage treatment efforts. I am writing to suggest that psychosis should not be defined as the result of spewing distorted thoughts that need to be corrected, but is actually the result of uncanny perception and efforts to cope with that perception. I think that people who relate to those who experience psychosis need to understand that it is perceptual triggers that lead to self-sabotaging thinking and distress. Recognizing those triggers can be key to better strategies for coping.
Even the most advanced research on schizophrenia, which suggests that it is a neurodevelopmental syndrome rather than a psychiatric illness, alludes to the thought disorder narrative. I suspect that this is a political act of supporting the best practice of cognitive behavioral therapy. I am personally in favor of a therapeutic approach that is specifically created for people who experience psychosis across diagnostic divides.
For example, in her groundbreaking article in The Psychiatric Times, Sophia Vinogradov, MD suggests that the problem is cognitive:
We now understand that these are neurocognitive disorders (ie, how neural systems in the brain represent and process information). We also understand that they are neurodevelopmental disorders with genetic components and antecedents during gestation. The developmental course unfolds with increasing signs, symptoms, and cognitive dysfunction . . . (2019).
When problems are depicted as cognitive as such, the conclusion is that the thinking is faulty and that thoughts need to be changed. Too often, people hear this and believe that all such thoughts are incorrect and must be stopped. This can cause pressured and unhelpful communication. I think it is more important to listen and understand before there is an effort to challenge thoughts.
The Importance of Exploring the Meaning of the Experiences to Engage a Sufferer:
I intend to delve into better defining what psychosis in this post and will highlight the importance of other processes beside irrational thoughts that go into a “thought disorder.”
I have come to believe that experiences that cause the thoughts are valuable and need to be further explored for meaning and understanding.
I experienced a two-year crisis during which I thought my family was a mafia family and was persecuting me. I can attest that admitting that two years of my life were wasted on meaningless blither was not a way to engage me in meaningful change. Moreover, although I did need to change and stop making meaning of many things, I have since found that I learned a great deal of meaningful things during those two years that currently enrich my life.
Behind me, sits my eleven years of experience running professional groups in which I revealed my own experiences with psychosis. Behind me is also an international movement called the Hearing Voices Movement that has a considerably longer history.
The Experiences of Psychosis Fit into Different Causation Frameworks:
Those of us who learn to openly share experiences in group therapy, learn a host of different explanations for why our experiences are happening. The hearing voices network define these as frameworks. In other words, experiences are often interpreted from a framework and I am going to characterize five styles of frameworks that are representative of thousands of individual examples.
Often, experiences are perceived based on the dominant framework that the sufferer trusts the most. The framework often dominates the sufferers mind and makes it hard for the observer to even know the experiences that exist beneath the surface.
The first framework that I am going to present is that these experiences can come from spiritual experiences. Perhaps the magical perceptions seem to come from good or bad higher powers, depending on the tradition. At times, good and bad guidance may be mystical and at times those experiences can be erroneous. Experiences that are wrong can be characterized like Carl Jung’s concept of a trickster, they can cheat the sufferer and cause material loss.
All spiritual traditions include the concept of a trickster. Often, it can be hard to tell the difference between mystical wisdom and tricksters. Learning how to manage spiritual feedback takes time and training,
The second framework that often influences message receivers is the concept of political oppression and exploitation. Sometimes, and far too often, there are real people who belong to secret societies that are behind real abuse and marginalization. Consider a treatment team that meets without the patient present and misrepresents that person and extends their hospitalization!
Also, there are powerful government conspiracies that involve secret societies to prevent rebellion and promote public misconceptions. For many frameworks there are criminal, governmental, or intergalactic organizations that work to control the environment. The concept of targeted individuals validates and expresses the realities experienced by many sufferers. Such alternative realities suggest the phenomenon of gangstalking. Thus, learning to stop challenging power can help.
The third framework that is important to note is that there are ways that traumatic events and dilemmas can cause the mind to fragment and re-experience trauma. Differentiating trauma from the reality of current situations can be a lifetime project. This becomes a real issue that most people who experience psychosis have to deal with.
The fourth framework that is often used by treatment providers is that experiences are made up from unconscious psychological processes in the mind that may be related to attachment or fractured personalities. Such frameworks suggest that experiences are made up in the individuals head. Some people respect them and seek to explore and integrate them and some people just think they need to be ignored as a result.
Finally, there are scientific processes in the body that may be behind faulty thinking: misfiring of neurons, schizophrenia genes hidden in DNA that make people permanently impaired. Of course, there are more positive scientific frameworks out there like that some people have spiritual genes that are likely to get persecuted, or that some minds have an ability to perceive on the psychic energy of others, through observing scientific gamma, delta, or other radio waves rays that bounce off the body.
All these different frameworks represent different ways underlying experiences can be explained. Take an experience and put it in a different framework and the meaning of the experience vastly changes. Sometimes hearing thoughts without understanding the framework and experiences that accompany them can make the thoughts appear wildly distorted. Additionally, sufferers tend to get locked into a particular framework that adds to a tendency to interpret experiences in ways that may appear incorrect to someone who hasn’t listened and understood.
In fact, I like to argue that people like me who think the world is against them can lead lives in which the world really is against them. Telling them they are thinking wrong or that those underlying experiences don’t matter becomes invaliding and may result in further trauma and sense of alienation.
Learning the Value of Different Frameworks Can be Used to Disempower the Experiences:
I believe people who experience different frameworks in the stories of peers can learn to diversify the manner in which they interpret their experiences and begin to see how they come up with thoughts that appear faulty to the mainstream. Ultimately, I think that using different frameworks is necessary to take away the power of the underlying experiences so that a person can function in the social world.
In making such an assertion, it is arguable that there is real benefit of sitting in groups and hearing people’s stories. I believe it teaches a participant in a different manner than a genetic researcher learns through looking through a microscope at the neuroplasticity of neurons. One thing that I have personally learned from running up to three such groups a week over the years, is that people are extremely unique in the way they come to cognitive distortions.
It takes a great deal of work in order to open someone up to talking about their private experiences and to consider listening to others with genuine curiosity. Often, it is important to forget everything we know and listen with a psychosis mindset to make sense of another persons’ experience to draw out the story so that commonalities can be displayed and observed.
One thing that I believe is toxic in such groups is when a leader tries to impose their reality on participants. It is different for example to learn about a different framework by listening to a peer than it is to being told that your experiences really definitively fit a different framework. I believe all frameworks have merit at different times. Just because you know what works for you, doesn’t mean you know what works for someone else. The danger of overgeneralization is a valid concern.
That is why I really like a principle that the hearing voices network advocates for: participants are to speak from their own place of knowing, not the sense of knowing. I have used my experiences of learning from others to stop jumping to conclusions about my experiences and to wait and see. Thus, I am more mindful of my experiences and less attached to them.
As such, disempowering the experiences is helpful, but sometimes to do this it becomes important to pay more attention to them and rationally solve the problem of what is going on.
Identifying the Types of Experience that Lead to Cognitive Distortions Can Help:
It has also helped to do significant work in groups defining examples of underlying experiences. I call these experiences special messages. They include not only voices, visuals and tactile sensations, but also other experiences that trigger conspiracy ideas. Special messages are things like intuitions, premonitions, body language and use of codes and symbolic associations that hide alternate meanings. Some of us have gifts of knowing things that we become overly dependent on and that cause us to get focused on these experiences and trying to learn how they are possible.
Special messages provoke thoughts particularly when the person is trying to figure out what is happening. I define this as a state of sleuthing and the hearing voices network define it as making meaning. When multiple messages are happening fast the experiencer can get an internal buzz of trying to figure out experiences that only leads to having more and more experiences. It becomes very hard to distract from these herd-to-contain thoughts. So often the thinking fits a singular framework. The thinking and thinking about the experiences coupled with the way the public reacts to the person experiencing the thinking can turn the thoughts into distortions.
The interesting thing about the experiences is that they can often be preconscious. Indeed, the person can be more aware of what they are thinking than what they are experiencing. Of course, the thinking can be influenced by a framework and past experiences that have influenced the formulation of the framework. Thinking can affect behavior and cause the person to be treated in negative manners that add to and confirm the framework suffer. This can increase the power that is given to the underlying special messages experiences and the state of sleuthing and making meaning of what is happening.
The experiences will always happen. They can be real and at times hurtful. Additionally, the more a person sleuths or makes meaning of them, the more vulnerable they become to being impacted by more experiences, or special messages. However, sleuthing in community with others forces the sleuthing process to slow and be better defined. Moreover, doing so with support of others can help the sufferer solve the problems and make changes that can help them transform out of the emergency state.
How Behaviorally Changing Relationships with Underlying Experience Can Help:
Whether dealing with a bullying voice, a negative outcome, a bad energy perceived, or distressing serendipitous occurrence, there are times when the sufferer can be coached to change their behavioral relationship with the underlying special message experience. Talking back to the voice, or humbly adjusting to the situation can be exactly what is necessary.
If this is to happen the message receiver must spend time increasing their awareness of messages and changing the behavioral relationship they have with the experience. This can be just as important as challenging an irrational thought. In fact, it might be necessary to do before rational thinking can be expected.
Challenging Internalized Stigma Can Help:
Clearly there is an element of cognitive dysfunction experienced by those who experience psychosis. However, I believe that a majority of that dysfunction comes from the social definition of schizophrenia as being a progressive illness that gets worse over time. This misunderstanding of psychosis is so rampant in our culture that it leads many to stigmatized views of a sufferer’s abilities that then get internalized. I contend that a majority of these negative beliefs are reinforced by the way associates and mental health workers start to treat their subjects.
While clearly the level of support varies a great deal in a person’s experience, the negative treatment that people experience and the fear of schizophrenia often can set up the basis for extreme cognitive dysregulation. Thus, countering these stigmatic realities with support that emphasizes rational thinking can lead to help. However, getting people to use rationality as a tool to help balance them and increase their resilience does not prove that the problem is a thought disorder.
I believe there is a lot more to recovery from psychosis than just depicting reality as being rational thoughts. Many philosophers argued against rationality. Hence, I am arguing that depicting the problem as a thought disorder is misleading.