Psychosis is an antiquated word that leads to huge misunderstandings that play a large role oppressing a larger and larger portion of the population. For the past nine years I have run professional focus groups, going through the process of listening, exploring, reflecting, writing, seeking feedback and rewriting to get a better definition of psychosis.

Defining Psychosis, the Mainstream Way:

I remember using the mainstream definition as a young professional during the job I used to get me through my Master’s Program. Wondering how I was to connect with people who had delusions and voices that I clearly didn’t experience with my neurotic, highly-medicated self, I filled the white board with a list of labels and complicated words I was proud to be able to define. It was my college education that got me the job, and this was one way I could use it to be useful.

positive symptoms

Hallucinations:           reports of sounds (voices,) visuals, tactile sensations, tastes, and olfactory sensations that others do not experience

Delusions:                   “an idiosyncratic belief or impression that is firmly maintained despite being contradicted by what is generally accepted as reality or rational . . .” In spite of the “preponderance of the evidence”

Disorganized Speech: Frequent derailment or incoherence): Word salad, tangential, or circumspect speech

negative symptoms

1. Andhedonia
2. Avolition
3. Amotivation
4. Alogia
5. Attention Problems
6. Catatonia
7. Posturing
8. Lethargy
9. Flat affect
10. Social Withdrawal
11. Sexual Problems

The Errors of These Ways:

Life has taught me that the mainstream definition, as such, does little to depict what it feels like to have a break from reality. Indeed, not understanding this can cause a supporter to make things worse even when they have the best of intentions. Indeed, miscommunication, pain, and strained relationships often result once a sufferer has a break.

I now contend that this mainstream definition offers little helpful direction toward the healing that can be inevitable when a person accepts their situation, moves through it, and is not subjugated to the gross negligence of institutionalization.

I still remember some of the ridiculous conclusions I drew as a young clinician: for hallucinations, the answer was simple: ignore them; for delusions: I would recommend that the sufferer just think like everyone else does; and for disorganized speech the answer likewise seemed simple: do not speak, otherwise people will think something is wrong with you. I likely went so far as to make these assertions.

Cultural Delusions:

With what I know now, I don’t even believe that psychotic delusions exist. Sure errors, happen, but they do little to define the experience. Indeed, according to my current definition, the concept that delusions are wrong “in spite of a preponderance of the evidence” is a huge misrepresentation of what is happening.

For example, for years I heard fellow sufferers suggest that there are cameras in all televisions through which the government can spy on people. While I expressed as genuine an open mind to this idea as I could muster, I really didn’t think so. Then, the Wiki Leaks story broke, and I found out that the “delusional” people I work with were right after all. Once again, mainstream, Eurocentric ideas suggested that the world was flat.

Indeed, when the problem is defined as observable behavior, it fails to acknowledge the intrinsic value of the experiences to people who have them. It also fails to account for so much of what people go through when they are in the thick of it. So many anomalous perceptions turn out to be accurate.

I recall only one client who was brave enough to stand up to my degree and tell me that she felt she had a gift and that her experiences were valuable. I listened, but if I had truly accepted her help, it would have saved me years of torment.

What Happened to Me:

It wasn’t until I was thirty that I went through a psychotic break from reality or what I prefer to define as a message crisis. I was working amidst drug war politics and taking huge risks to promote safety for vulnerable and traumatized people. My boss threatened to fire me for associating with renegade activists. In fact, residents were dealing with violence and conspiracies in a large section 8 complex that was widely reported on in the paper.

For two years after my lengthily incarceration in a State Hospital, I moved around and was unable to find employment. I knew I could still work even though I was being followed. The only thing I had learned in the hospital was how to endure abuse and be prepared for utter squalor.

My best explanation for what had happened to me was that the mafia was following me. In fact, I had developed the idea that it was my own family who was responsible for the constant threats I was experiencing. Finally, I decided to trust my aunt, who was the black sheep of my father’s side of the family. She was able to attain a job for me making sandwiches at an Italian Deli.

Underemployed and harassed in the most controlling of ways for ten months, it would be a decade later when I would learn that that famous celebrity-chef I met and at one point surmised to be the local kingpin really was the kingpin just as I had suspected. It’s true that throughout my tenure at the deli, I surmised many people to be the kingpin, but still . . . When I returned to taking medications, I finally was able to get a social services job away from the deli. Eventually, I returned to work in mental health.

My Learning Process:

Nine years ago, I grew tired of running standard groups. In many cases, everyone in the group had experiences with psychosis, yet we all sat suppressing those experiences and were communicating in the language of the oppressor. I had heard about Hearing Voices Network groups in Europe, and I decided to create a specialty group in which I used my lived experience to further explore the experiences that people go through during psychosis.

Since that time, I have been deconstructing the concept of schizophrenia and reconstructing a definition for psychosis into eight components that might better reflect what people go through. I feel that the following eight components give the reader, supporters, and even provider-folks a better definition of what people who experience psychosis go through.

Psychosis Redefined in Eight Components:

1. Special Messages:

These are a collection of triggering experiences that give usspecial information that others may not be aware of.

• Uncanny intuitions,
• Hearing voices,
• ESP,
• Sensing the thoughts of another,
• Premonitions,
• Visions,
• Dreams,
• Tactile torture,
• Interpersonal feedback,
• Reading between the lines in media (TV, Movies, Newspapers,)
• Seeing clues in words,
• Seeing clues in numbers,
• Seeing clues in the world that surround you.

2. Divergent Views:            

Streams of thought about the way the world works that arise from special messages. These are thoughts that explain how the messages are possible. Often, only speculations, many divergent views we make aren’t wrong; in fact, many may be more correct than mainstream ideas (sometimes only in a sense though,) but most people will tell us they are wrong.

3. Sleuthing:

A state of mind in which we are straining to find the truth about special messages. This works with our powerful affect state and may seem like a way of surviving or exploring. Once we develop a divergent view we sleuth hard for more special message evidence to confirm correctness (a rational process.) As Special Messages build up we sleuth, and more divergent views get formed.

4. Theory:

A hypothesis or educated guess as to the ultimate cause of the message. Just when the message is received, the pre-conscious theory explains why the message happened, who sent it.  The theory is integral to our understanding of what the message means. Often the theory gets stuck on one causation modality (in sum I have developed five potential modalities that serve dozens and dozens of theories) and this drives us to sleuth intensely and make errors.

5. Tricksters:

Tricksters are potentially false, negative divergent views that we receive in the process of making meaning of special messages. Recall that, in fact, special messages lead to both accurate and inaccurate divergent views. In crisis, tricksters may really be false, but if we believe in them strongly enough, they work with a negative self-fulfilling prophesy to come true. Thus, we think we are followed and we end up in the hospital where we really are followed. We think we are in danger, put out fearful energy, and people are more likely to be antagonistic and try to harm us. When tricksters come true it convinces us that we are right to fervently believe in the truth of all our messages and not entertain mainstream views.

6. Retaliation Reactions:

Behaviors that exude strong emotional reaction to the whole divergent process:

• Glaring with angry or happy eyes
• Looking behind you for the possibility of tails
• Making gestures of prayer
• Talking with voices in public
• Coding our language as if we are talking to CIA agents.
• Talking in codes so that the people broadcasting our life on TV won’t be able to understand what we mean.
• Getting angry or entralled and treating someone in a way you wouldn’t otherwise.
• Walking backwards down the highway to make a statement.
• Barking at a passing bicycle because you are angry like a dog (which is god spelled backwards)

7. Social Sanctions:

These are punishments like: involuntary hospitalization, seclusion, restraint, incarceration, loss of housing, loss of employment, loss of social role, social rejection, public ridicule, loss of family financial support, anger and resentment, loss of respect and validation.

8. Stigma:

• In short, stigma is a real process that leads others to label us according to our reaction behavior.
• Stigma labels carries with them stereotypical assumptions that lead to social sanctions (external and internal,) and, ultimately, to real discrimination.
• Stigma often causes us, the recipients, to get defined as our illness. We may lose a sense of our outside strengths and interests and our sense of identity.

In Conclusion:

In effect, these eight definitions function as a road-map to the rabbit-hole of psychosis which can help those dealing with distress to find things like meaningful work, relationships, and social integration. With psychosis defined as such, there are numerous solution strategies I have been able to develop that can help move people out of crisis.

Indeed, I believe a new definition like the one I have sketched out is necessary for the public to internalize. I feel if the public had a better understanding and respect for what so many people with mental health challenges experience, not only those who carry the diagnosis of schizophrenia would benefit.

Indeed, such a definition places far less blame and belief in eugenics and brain damage. In fact, often brain damage may happen because of trauma we experience being invalidated and talked down to, dis-empowered and neglected. And still even the greatest traumas give us potential for glorious learning.

Indeed, special message experiences like intuitions, dreams, and interpersonal interactions are things that everyone can relate to and can benefit from navigating in meaningful manners.

The post A New Definition of Psychosis appeared first on Redefining "Psychosis".

Many people who have worked with me presume that when I say special messages I mean voices. It’s true that the words hearing voices ring true as music to my ears. Indeed, the hearing voices movement has vastly improved the social understanding of what is happening to message receivers. Less dominant are the memes associated with all the “psycho” stigma that gets equated with the psychosis word. However, I still argue that just saying hearing voices fails to unite all people under the umbrella of the word psychosis.

I have come to feel that saying hearing voices is like saying the letter “a” instead of the word alphabet. It’s true that voices offer real and valuable experiences that society tries to suppress. But, I think that there are at least twenty-five types of experiences in addition to voices that can be relevant in creating psychosis. Put those experiences together in different ways and a person can create a vast masterpiece of meaningful reality that functions as an alternative to mainstream thought.

Not everyone who experiences psychosis uses all twenty-six types of experience, but some individuals may use far more than I can depict in this article. I believe each message receiver has a profile of messages: some that they can and cannot relate to.

I contend that no message is sicker than another. Indeed, problems associated with special messages need to be measured by the level of distress they cause, not by their existence. In fact, someone who hears voices is not necessarily sicker than someone who has more “normal” message experiences like getting an intuition or having a dream. In fact, one person may hear a voice and experience little distress, but have an interpersonal interaction that troubles them drastically. Others don’t get upset about their intuitions or interpersonal interactions, but are harassed to no-end by the fact they hear controlling voices. Sometimes it is the convergence of many different types of messages that cause the distress.

An experience becomes a special message because not everyone else has experienced it and because its meaning is not always clearly defined. Indeed, special messages take an element of speculation to thoroughly understand. Ultimately, sometime message receivers are spot on accurate about reality based on their special messages, but mistake happen.

I have found that encouraging people to tell stories about message crisis or “psychosis,” over the years helps uncover a variety of types of special messages that fit different profiles. It also helps a person feel validated, heal and connect to others. Though it can take some time, I have seen many people realize they are not alone for the first time in treatment hearing stories that others tell.

I also believe healing involves being able to pay more attention to message processes instead of just suppressing them and pretending to be a normal droid. Thus, emotions associated with special messages can be felt without burning their way permanently into a person’s life.

Many of us who suffer may have become preoccupied with real issues of war, genocide, torture, apocalyptic fatalities, spirit discernment, metaphysics, social control, truth, mind control, propaganda, good and evil and healing from these dilemmas may help us become very wise and valuable social contributors.

Additionally, people in message crisis need people who are aware of what they are going through to be with them while they are going through it. Message crisis can be an extremely alienating experience in which everyone wants to correct, rather than support the message receiver.

Although some message experiences in a person’s profile may seem normal or “real,” in crisis, they can dominate the day particularly because they fit together with others that no one would believe. The following are questions that I have developed to help the reader identify experiences that have influenced message receivers into what I believe become cultural thoughts that get defined as psychosis:

• Do other people hint at things that profoundly relate to your life as though they know everything about you as though they have been listening to wire taps or are clued in through word of mouth, or other intuitive skills?

• Do you get special intuitions based on body language or voice inflection or reading peoples’ minds that often turn out to be correct?

• Do you get uncanny premonitions from gut feelings, or intuitions that might be considered ESP?

• Can you pick up on people’s energy so that you can tell how they’re feeling when they pass by?

• Do gestures or specific behaviors of others help you to most definitely know their unconscious thoughts?

• Are things that bear symbolic meaning being left around for you to find that might be there to re-program you as if they are counter intelligence?

• Do you have odd strings of “coincidence” that link together in ways that suggest or confirm things (serendipity?)

• Do people follow you on the bus or train bear objects that identify them to you as people who are following you for better or worse?

• Are you able to instantly tell if people are either for or against you

• Are people sent to represent other people you know for a significant reason (impostors, look-a-likes, doppelgangers, agents)

• Are you profoundly affected by dreams might be prophesies or reveal truths about yourself or the universe?

• Do you experience de ja vu occurrences during which something happens that feels like it is happening to you again for the second time?

• Do you find yourself reviewing vivid memories, sentences or words for hidden meanings?

• Do people use codes to communicate secret info like numbers or words; do you break words into syllables and look for punny linguistic coincidences?

• Do people have clear telepathic communication with you intentionally

• Do movies, songs or shows on the radio or TV come to take on new meanings when you read between the lines. Might they even be special broadcasts that only you get?

• Does certain forms Media contain secret coded truths that only you can understand?

• Are you touched by the truth when you read in between the lines of certain situations?

• Does it seem like people are putting on skits around you to teach you a lesson?

• Is history full of conspiracies that god reveals the truth to you about because of discernment of spirit?

• Are people slipping things in your food that are taking over your bodily processes?

• Do you have bizarre visual experiences that make you think you are in a different dimension or on a different planet?

• Do you see ghosts or entities that communicate with you in ways that other people may or may not be clued into?

• Do you hear your own thoughts as distinguishable words that give personal insights into your being?

• Do you hear people you know talking to you as though you are engaging in in telepathy?

• Do your voices become familiar characters to you that you keep track of and take on personalities that you name and react to?

• Do you get physically tortured through tactile pain or sensations that function in conjunction with your voices?

• Have you ever been taught about the “I” word—illusions—which are sounds, visual experiences, sensations, smells or tastes that mix with reality, that really are there but that may become distorted to give you uncommon experiences?

• Do people make uncanny comments about your private thoughts or experience when you pass by them talking in the community.

• Has a character on the TV starts talking directly at you referencing you by name?

• Has the hiss of a steam heater started turning into voices?

• Have clouds in the sky turn into visual shapes?

• Have you experienced things that are so strange it seems impossible that beliefs you hold are not true?

• Do you have an uncanny awareness of or evidence of who you were in a past life?

• Do you see projected images that show you secret images or entertaining stories that give you secrets about your ancestry or aliens or the mysteries of the universe?

• Can you communicate with spirits, aliens or ghosts?

• Do you sense when reincarnated spirits, aliens, or robot-machines have entered modern bodies as clones by looking at a person’s glistening eyeballs?

The post Why I Say Special Messages Instead of Psychosis appeared first on Redefining "Psychosis".

I wanted some of that trauma support when I found myself confined to a ward on a State Hospital. I knew I needed to establish safety with someone but couldn’t find anyone who would deal with me. Instead, no one treated me as though I was traumatized because they didn’t want to reinforce my delusions. This only made the trauma of what I experienced worse. Invariably, hospital workers were punitive and denied anything unjust was happening to me at all.

Because I worked tirelessly and had family support, I was able to return to my career in mental health. I got my psychotherapy license ten years ago and since that time I have worked to create trauma-sensitive treatment to address the needs of individuals who experience psychosis. Here, I intend to convey two trauma-sensitive solutions I have developed, working with people in groups and in individual treatment.

The Challenge of Establishing Trust:

It’s true that it is hard to establish safety with someone when they think they are being followed. I felt I was being followed by the mafia via government surveillance; others feel they are in miraculous communion with a spirit world. Any therapist who works with individuals who have experienced psychosis can tell you that trust with any such prototype takes time.

However, too many practitioners do not feel that the stories of psychosis are worth engaging for the simple reason they might have delusions in them! It’s true delusional ideas can cause a great deal of problems. For example, maybe the police didn’t really taunt me like I reported they did when they bruised my wrists. Maybe I was too hard on the pony-tailed man who wouldn’t give me food and testified against me at my competency diagnosing me with schizophrenia. Maybe I wasn’t really being followed by the FBI like I thought I was. Maybe I was delusional when I said I leaked information from the section 8 housing authority I was working for. All that I knew for sure was that nobody cared to listen. I was on my own for quite some time.

Many practitioners reason that they don’t want to reinforce anything that isn’t real. Instead, the best practice, CBT for Psychosis, directs the clinician to separate their reality from the sufferer and teach the sufferer to evaluate their thoughts to make sure they are rational. I believe CBT for Psychosis may work at times. In fact, think there comes a time when cognitive therapy is necessary for rehabilitation. However, there are times this single strategy may not address trauma involved with the experiences of psychosis.

In contrast, I have had significant success in working with people with psychosis by finding powerful ways to validate the contents of an individuals’ psychosis to address real trauma that may have transpired. This approach is increasingly accepted now thanks to the spread of the hearing voices network support groups. Indeed, I have found that providing group support that allows people to explore psychosis, to be very helpful. Increasingly research is proving to validate the idea that treating psychosis as you would a trauma results in far better outcomes.

The Challenges of Validating All Parts of Psychosis

Of course, some might argue that the hearing voices network does not have a clear methodology for how to validate delusions when they are not caused by voices. It’s true that, some delusions are hard to validate in a genuine manner. For example, many people who hear voices believe that other people are hearing what they are hearing. Such individuals may accuse the practitioner or group leader of many things that they aren’t responsible for, making therapy and group sustainability a challenging endeavor.

My own experience in therapy was a nightmare because my therapist didn’t believe me. Thousands of dollars were spent and not an ounce of trust was achieved.

I have found it’s possible to validate things that aren’t true; however, I have had to take apart the delusional experience and look at them with a microscope. Then, I have found it is possible to validate a part of the psychosis process without validating all the mistakes that happen.

For starters, I coined the term special messages to describe experiences that trigger an alternative way of taking in information and connecting with the world. Thus, not only voices but other meaningful experiences like intuition, dreams, interpersonal interactions, and coded realities from media can trigger alternative views about reality.

Then, I developed seven other code words to represent distinct aspects of sufferers’ experiences. In sum, if the sufferer can become more aware of the process of what they are doing during a psychosis process and the way this process relates to fellow sufferers, they can become more mindful and validated and heal from trauma.

The Message Mindfulness Solution that Supports Trauma Informed Care:

Message mindfulness happens when the person in psychosis learns to see their process by describing it to another person or by hearing similar process that they can relate to in a group. I have found that people in psychosis can often recognize delusions when they are listening to someone. However, when they are not mindful of special messages, they react and cannot see their own process as being potentially delusional.

I believe that when message receivers become mindful of what is happening to them and their peers, they go towards experiences that terrorize, anger or excite them. Then they can acknowledge their emotions in a way that can help them let go of those triggering special message experiences. With awareness, those special message experiences become less judged and easier to let go of without having emotions and thoughts spike. And the sufferer can then acknowledge that they often will be right but don’t necessarily have the evidence to presume that their special messages are accurate all the time.

Helping a sufferer or message receiver become mindful of the experiences that give rise to alternate thoughts or what I call divergent views is not an easy process and can take time. Indeed, message receivers who listen and learn from each other are better able to admit that some special messages may turn out to be true and others false. Still, they can all be considered real and can be validated and better observed by the people who get them. Plus, becoming increasingly mindful of other message processes can significantly help a body reconcile with the ways they were wrong and had their emotions spike needlessly.

The Solution of Mastery Tasks or What I call Recovery and Reality Tasks:

A second trauma informed solution that has resulted from redefining psychosis into eight components, is to distract from distress when emotions spike by completing mastery tasks. I call these mastery tasks, recovery and reality tasks.

In this process, high emotions are soothed by what I have termed the act of sleuthing. Sleuthing is the act of collecting a series of messages and to trying to figure out what is really going on. This leads to all kinds of thoughts about the way the world works (divergent views.) Then, divergent views cause the message receiver to sleuth again and be on the lookout for more special message experiences. Thus, the message receiver often gets more different types of messages until they become entirely preoccupied with distressing or enthralling special message material.

Therefore, I believe that distracting from sleuthing by completing mastery tasks may significantly reduce distressing and intense emotions. When the message receiver sits and sleuths all day they expend a great deal of emotional energy without accomplishing anything. Then, social workers or supporters are more likely to push for warehousing them.

However, to distract from sleuthing, the message receiver needs to practice and strengthen the skill of distracting.

Often, distracting efforts go unacknowledged by others because they are judged negatively in comparison to what could otherwise be accomplished. At first, in my beliefs, the message receiver needs to accept and be supported for basic actions that are productive. Thus, appreciating mastery tasks as helpful for wellness and supporting them regardless of their social standing is another way to validate and support message receivers.

Moving through trauma in such a manner beats being isolated, locked up, or restrained, which teaches the message receiver a great deal of helplessness. Nothing could discourage mastery tasks more. Indeed, these kinds of traumatizing events make message receivers less mindful and elevate the unreasonable expectation that special messages be suppressed.

Conclusion:

While I have also developed six additional solution strategies, I consider the above two solutions to be specific to addressing the trauma that message receivers experience. The six other solutions I propose are experiential, spiritual (there are two of these,) behavioral, cognitive and narrative. These solutions likewise may be responsive to trauma in some ways but are linked to differing components of special message experience and tend to work in different manners. Stay tuned for future solution focused blog posts that may help describe a recovery process

The post Two, Trauma-Sensitive Solutions for Psychosis appeared first on Redefining "Psychosis".

I have observed that participants often become more aware of their diverse beliefs regarding the causation of their psychosis experiences. I also believe 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 have learned to 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 mathematician. 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.

Also, what I primarily want to convey is 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. 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.

Psychological

• 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.

Political

• 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.

Traumatic

• 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

Spiritual

• 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.

Scientific

• 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

My Story as A Case Study:

Because I don’t make it a habit using case histories that 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 sit in groups with diverse individuals to be able to make sense of what happened to me.

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 and headed for the Canadian border. Maybe my friend was only using me to help me 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 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 when I refused to take over the supervisor’s job and acted 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. 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. My political perspective did not change.

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. This was a particularly intense fear of mine.

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.

Now 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. 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 an organized fashion. There were ways I could appeal to injustice. Indeed, some of the less dominant kids really looked up to me. A few other 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 them 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.

For example, genetic testing has since revealed that my predominantly old money family really was predominantly Irish. For example, 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. 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.

For example, 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 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. I will explore this process more in my next article as it is a component of my system of treatment.

Diversifying 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. I believe that when we learn to support each other by proposing alternate meanings that are based on alternative causation beliefs, we empower ourselves to navigate injustice and oppression in the modern world.

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.

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 so few of us survive to socially rehabilitate.

The post How Diversifying Causation Beliefs Can Lead to Recovery from Psychosis appeared first on Redefining "Psychosis".

Learning Question One: How do in-reach efforts that connect residents of board and care homes, single room occupancy (SRO) hotels and unlicensed boarding houses to social and recreational opportunities in and outside of the facility reduce social isolation and improve quality of life for isolated adults and older adults with serious mental illness?

To answer our first learning question we used several strategies to obtain participants who receive special messages from SROs and Board and Care homes.   Initially, we envisioned providing individual services to people who responded to flyers and presentations in board and care homes and SRO hotels; however we found we had to adjust our strategy.

Instead our strategies included:

• Passing out flyers to locations where residents in these locations are likely to frequent;
• Direct emails to the board and care and SRO facilities;
• Partnering with three social service agencies (PREP, East Bay Recovery, and Bonita House) and providing presentations and groups at those sites;
• Partnering with Gladman Hospital, a long term inpatient settings, and providing presentation and groups at that site;
• Outreaching to the homeless population;
• Presenting at Saint Vincent De Paul Shelter, the Pacific Care Senior Center; the Fairmont Partial Hospitalization Program, and to Villa Fairmont Inpatient Hospital;
• Coaching board and care staff;
• Working with families.

The Program Manager pointed to safety issues associated with marching directly into board and care homes and SRO settings and providing groups. Indeed our trainees were transitioning into peer support experiences and promoting safety was paramount.  Instead, we initiated the process of gaining visibility in the community and training via general outreach. Next, we outreached to the homeless and practiced using our stories and strengthening our presentation skills. Once we started presentations and got invited to conduct groups in more staffed and protective settings, the trainees ran groups and initiated one on one relationships with individuals who were receptive.

Direct responses from fliers were limited compared to the vast number distributed; however, once with individuals who did respond we were able to use strategies from our curriculum and personal experiences. Once the relationship was built, they became willing to go on outings with us.  In several cases, providing one-on-one services resulted in a massive increase in the participant’s willingness to partake in therapeutic activities available to them in the community.  It also resulted in very good training experiences for the Specialists.

The process of partnering with service agencies who serve residents living in SROs and Board and Care homes was aided by completing presentations at conferences to gain exposure, and reaching out to agencies via email. In following a one-on-one client we worked with in the community into a board and care center, we were able to support the staff, help the individual maintain housing, and receive a referral from that board and care.  This was one successful strategy to in reach to a board and care; however, it suggests that over time we may be able to have a significant impact in some board and care settings by following the strategies outlined here.

The  time spent in inpatient settings and outreaching to the homeless involved opportunities to plant seeds to let message receivers know they were not alone.  Once homeless individuals move indoors they may end up in SROs and board and care homes. Additionally  Specialists developed counseling skills sharing their stories of hope to those who either are not willing to receive services or who are waiting for services.

Learning Question Two: How does a place-based outreach program by trained peers to public locations in the community, such as parks, coffee shops, and libraries where otherwise isolated persons may go, be effective in reducing social isolation and increasing participation in mental health services among isolated adults and older adults with serious mental illness?

We found that although two of the specialists had completed Best Now, what we were doing in asking peers to be mindful and open about experiences with psychosis was so different, that we functioned not only as a service but also as a training program.  Balancing being open and public about “psychosis” with teaching professional and administrative skills was a focus.  Thus, outreaching into the community as a team and passing out flyers was a necessary step that was very supportive to the Specialists as it did a lot to build confidence and decrease stigma associated with “psychosis.”

Training peers as Specialists did a lot to add to the structure in their lives recreation. Increasingly they were able to model being open and talk about their message experiences and enjoyed initiating relationships in the community.  By demonstrating their own gains made they passed on hope to those they served.  This was especially meaningful in the homeless community.  Several Specialists were continuing to struggle with housing issues throughout the period of the grant. Spreading hope, their  heroism and a cultural view of the issues of “psychosis” prepared them to be presenters at agencies and readied them for group work.

In our intensive one-on one contact with a participant we were able to help her get out into the community in outings, but it often involved helping her with needs. Socialization was often stalled by signs of message crisis.  Other one on one efforts were meaningful, like playing tennis. However, outreach efforts to locations where message receivers might frequent primarily resulted in high functioning “psychics” establishing contact, not isolated message receivers, demonstrating the need for other strategies to make contact with message receivers.

There was a homeless individual who came to weekly training sessions held on Thursday nights. He was astounded by how helpful the group had been for him, though he did not become a regular attendee due to the fact that we met late in the day, this is an example of some of the outcomes we were able to create trolling through the community with cultural stories of hope. However, to really move forward as professionals and obtain a regular clientele, once the staff  developed as a team we moved to providing presentations at conferences and agencies and people who responded to our outreach and in reach efforts.  We learned to use our stories in presentations and transitioned to using group facilitation skills gained through training to individuals in the community.  This resulted in receiving  more referrals to work with people one-on-one.

Learning Question Three: How does a telephone- or telephone- and internet-based program that provides social interaction and individual support reduce isolation among adults and older adults with serious mental illness and lead to greater in-person social interaction over time?

Using phones is an essential component of reducing isolation. Use of phones first began during outreach. We received warm line calls, many from individuals who considered themselves “psychics” in the community who were interested in talking but not interested  in services. The fact that many were not able to respond to flyers is a great indicator of the level of isolation message receiver’s experience. Many message receivers in crisis have “delusions” with regard to phones.  We made contact in agencies and followed up using one-way phone contact helped maintain relationships. Our efforts helped reintroduce social relationships through phone contact.

During this process of reintroducing the phone to message receivers, our phones became very important in the training and development of staff as professionals.  We went out in teams and the teams often sought supervision and support from the Program Manager.  Seeking out support in a responsible way helped Specialist to develop professionally and as team members; it benefited the community as participants had a clear sense there was a team behind the support they received.  Specialists modeled the use of phones even early in training.

Specialists began running groups in the community and were expected to retain participants by calling individuals to maintain participation and gently move the group participation towards individual support. Connecting with individuals over the phone helped pave the way for our team to increase a sense of social support and promotion of social support.  Responsible phone contact complimented by caring greeting card outreach helped to maintain group participation and helped groups to grow and thrive.   By keeping in phone contact several individuals who were receiving our one on one support were interested in coming to the open Thursday Night Training and had a major increase in receptiveness to social communication and contact.

We explored strategies of making a Facebook page, but found that for isolated message receivers, one way phone contact was more pertinent and important to pursue. Our warm line stayed open, but remained relatively unused.

Additional recommendations to support isolated message receivers: We developed a strategy of reaching out to less isolated message receivers who might be interested in taking a training to help them learn to reach out to other message receivers.  We did this in part to add to the training of our Peer Specialists and to help individuals specialize in supporting those with special messages.  Advertising in Alameda County’s Pool of Consumer Champions (POCC), the Hearing Voices Network, and through the PEERS website we held a twelve week training series aimed at how to identify the universal aspects of their message experience (or “psychosis”) and to teach and promote coping skills.  Many less isolated individuals benefit astronomically from this endeavor.  Additionally, individuals who get introduced to the Special Messages project in the community have the option of coming to this training group.

Public presentations at conferences and at provider sites are an extremely important strategy to reaching in towards people who are isolated in their treatment by the fact “psychosis” is not always seen and dealt with in community agencies and treatment services.  Agencies who reach out to those isolated, would have their efforts greatly enhanced if they had components that acknowledged and addressed the concerns of those who have experiences with “psychosis.” A massive anti-stigma campaign within and outside the system supports isolated message receivers in connecting socially and for treatment.  As there is a sense of self help in addictions traditions, a similar mentality in “psychosis” treatment will be beneficial to message receivers. Efforts among the homeless remain extremely important as  Specialists in this project have stressed and demonstrated.

PROGRAM GOALS:

The goal of the program is two-fold:

• Help those individuals isolated by “psychosis” become motivated to associate with each other and seek services that can help them integrate and engage in community activities;
• Use an experienced Program Manager and an innovative curriculum to prepare peer specialists who have lived experience with “psychosis” to use that experience as an asset.

The vision behind these goals is that service teams might one day be staffed with individuals who have lived experience with “psychosis” who can take the lead in connecting with those isolated by “psychosis.” Ultimately we want to plant the seeds for creating an inclusive, local culture that teaches people to accept and thrive in spite of their message experiences, where message receivers work to support each other in succeeding in the community.  In doing this the stigma of “psychosis” will be markedly reduced and voluntary participation in the Hearing Voices Network will flourish.

PROGRAM DESIGN: The program is designed to train message receivers to become community builders and to help build a sense of community for message receiving participants.  The essential program components involve:

• Training about universal components of “psychosis” and coping skills;
• Community outreach to build visibility and decrease internalized stigma;
• Teaching team building skills;
• Gaining necessary administration skills;
• Distributing flyers and selling the program peer to peer;
• Providing phone warm-line and tele-support, particularly phone outreach to maintain participation;
• Teaching public presentation and story-telling skills;
• Training in group facilitation that involves personal disclosure;
• Providing public presentations to service providers and family members;
• Providing peer-to-peer support via group facilitation; and providing peer to peer support with individuals in the community in teams, using a survey to evaluate the impact of our work;

PROGRAM IMPACT

The program helped normalize the trauma-sensitive strategy of going toward experiences that make up “psychosis.” In going towards these experiences (as opposed to just suppressing them) trauma, spiritual, cognitive, behavioral and collaborative skills can be learned to better manage them. When groups are led by individuals who demonstrate mastery of such skills, participants can become more motivated to reduce self-stigma and join in community.

In the mainstream system of suppression, often message receivers learn that it is not safe to discuss or socialize over their symptoms because usually they will get punished for doing so.  Learning that it is safe to discuss with others who have been through similar experiences is an extremely important step towards drawing people out of isolation and inactivity.  And finding ways to do this that teach recovery and social rehabilitation skills is something that the curriculum helps with.

Success Stories

• In advertising for qualitative interviews with Stanford researcher, a respondent reported that the groups had revolutionized his sense of self in a way that he couldn’t wait to discuss more.
• In the field study, a client who repeatedly refused to have anything to do with our outreach, had been inexplicably helped in a revolutionary way by that individual’s parent. This individual, who now openly communicates with us, went through an unspoken transformation.
• An individual who was nearly mute, internally preoccupied, restless, and angry in our Thursday Evening training, heard the leader quote a rap lyric to teach a concept and started to talk. Hearing the rap lyrics started the process of coming out of isolation in this context.
• Services fit right into what already exists in a way that empowers and motivates people. We followed a one-on-one participant into a board and care environment and were able to support the staff and started receiving other referrals.

Strategies to reach in take a great deal of time, but teaching others that they are dealing with a culture bears the potential of impacting these environments. This  works planted seeds in the homeless and hospitalized communities about message culture.

PROGRAM STRATEGIES:

We recommend training with a curriculum that redefines experiences associated with “psychosis.” Along with training there are four phases to implement this project.

Phase One: Engagement:

The Program Manager works extensively on team building and maintaining professional expectations and boundaries. The team of Specialists gets trained in strategies on how to become visible in the community by going into public spaces, learning where services are, and initiating conversations with service providers.  Moving around the community as a team is very important as it initiates willingness to be visible as message receivers.  A collaboration with the Hearing Voices Network meeting should be established.

Phase 2: Outreach

During the outreach phase we recommend that trainees start to represent their cultural communities and learn presentation skills with ongoing team building.  We also encourage the team to create a flyer that can be handed out in the community. Adequate time should be given to support a trainee to open up with their stories about “psychosis.” After this comfort level is attained, trips into the community can start to involve personal conversations with people explaining a cultural view of “psychosis” to individuals in homeless communities. At this point it is recommended a warm line be set up to take in calls and trainees can start talking over the phone with people who call in. It is also recommended during this phase to start presentations at conferences and to peer-friendly organizations.

We recommend bringing in peer leaders to review the curriculum who can help the trainees start to use personal stories. It should be noted that initially  trainees may deny having any experiences of “psychosis.” Creating a group in which the majority of the group is talking openly can help support  trainees to open up.  Professional administrative skills may need to continue being a focus.

Phase 3: Peer-to-Peer

After the Curriculum is completed with peer leaders, inviting in community members gives the trainees the opportunity to start becoming hosts for the newcomers. Now they can take the leadership and start calling participants to maintain their attendance and offering one on one services to them.

The next four months can involve one-on-one relationships outreach. We recommend that outreach involve traveling into the community with phones and learning to relate to peers under the tutelage of the program manager who can support assessing for danger and maintaining boundaries over the phone. Additionally as agencies respond to invitations for presentations for service providers, trainees are able to start negotiating with  agencies to invite them in to run groups.  Trainees can start providing groups under the tutelage of the management team and can continue to outreach to homeless individuals when not running groups.

Phase 4: Field Work

Upon graduating people from the Thursday Night training, the curriculum can be successfully run by the trainees who might take turns sitting out to perform other duties. Newcomers can be welcomed in to the training.

The final four months of the training involves

• running groups and outreaching to individuals,
• following message receivers into board and care homes,
• completing groups more independently in agencies; and,
• outreaching for more one-on-one participants.

During this time increased phone contact with participants is advisable and beneficial in supporting their connection to a social support network.

It is likely that Specialists through attending trainings, performing outreach, providing one on one with participants will show interest in working in the field of mental health and trained individuals can be supported in looking for new job opportunities. Agencies can fund ongoing groups or part-time work can be available to those who can’t find work on the service team.

Target Subpopulation

This program worked with individuals who have experienced “psychosis” across cultural divides. Staff were selected to be inclusive of youth and elders; male, female and LGBT2S individuals; we provided cultural representatives from African American, Caucasian, Latino, Chicano, Caribbean and immigrant communities.  We made a specific effort to include Spanish speakers, homeless, individuals with a history of incarceration, and those with differing spiritual backgrounds including individuals accustomed to working with natural healers. This broad reach was by design and resulted in the development of a team with a wide array of experiences and cultural determinants. The resources on our team to maximize inclusion in a very diverse target population.

The target sub population sought to be effective was with people who had experienced “psychosis” and were willing to talk about it and receive acknowledgement for belonging to an oppressed culture that often does not get recognized.  Once isolation is broken through and  people are invited to be open and aware of the nature of “psychosis” participants will usually become motivated, like the Peer Specialists, to improve their social circumstances, enhance their social networks or engage in social rehabilitation. Meeting people where they are at, even if in treatment bring the best results.

PROJECT COLLABORATORS:

In addition to message receivers, service providers and family members were significantly served. Family members reached out to advocate for services for their younger message receivers, and worked well within the family support group mode.

The majority of  referrals came from successfully partnering with providers who were interested in having a series of groups for their clients.  In particular, These groups are most successful when participants are already in program or the hospital and can chose to have these groups in addition to other services. Groups are most successful when there is support from the agency. Establishing collaborative relationships with the providers is an important strategy.

Consumers may be included as collaborators by hiring local peers, and advertising through with consumer advocacy groups such as the  Pool of Consumer Champions for project  jobs and to participate in the peer facilitator training which can be comprised of  providers and peer leaders.

Providing presentations, workshops at mental health focused events will support broadening collaborative efforts. Examples from this project include the ACNMHC 25^th Anniversary, the Spirituality Conference, CASRA, CIIS Spiritual Emergence group, Heart and Soul Consumer group, and the POCC Conference.

Family members and family advocates mostly from BHCS service provider PREP collaborated with the project to enhance the success of  participants.

CULTURALLY RESPONSIVE STRATEGIES:

This work is essentially an effort to acculturate individuals who have had experiences with “psychosis” across diagnostic categories and cultural divides, teaching them to belong to and identify with universal components of these experiences.  The author of the curriculum used during the Thursday Night meetings, Tim Dreby, has identified eight components of “psychosis” that lead to common processes and experiences. These are experiences that in a safe setting message receiving individuals can relate to.  Below are key elements learned through the implementation of the project that address the culture within message receiving individuals and communities:

• By emphasizing what they have in common with others instead of how different their experiences are individuals can work with each other to emphasize solutions and live successfully with some degree of social rehabilitation.
• Using peer role models and bringing people together in various stages of recovery and a variety of walks of life is important so that message receivers can see that what is happening to them is in fact happening to others in different cultural contexts. The ability of a worker to say: “I’ve experienced this, in fact I still experience this,” is so essential to motivating individuals who are in isolation to try new things and make the monumental efforts to promote their own social rehabilitation. The challenge is that each participant has unique cultural characteristics. The ability to connect with others by going towards “psychosis” and making collective meaning of it is such an important need that doesn’t exist in treatment as we currently engage in it.
• A great deal of isolation will be reduced if we can destigmatize the collection of associated experiences and add this to our treatment protocols. Additionally, it might be noted that the material was developed among individuals who largely populate board and care homes and SRO facilities and was rearranged based on the learning that happened from the participants in the project.

Effectiveness of Strategies

This  strategy’s effectiveness is proven through the number of participants reached and evidence of personal growth witnessed by the project staff and providers. The simple message that the problem needs to be redefined and that isolation is largely caused by having the experiences of “psychosis” coercively suppressed resonated with many of the participants.

54 individuals from out in the community participated; 9 people were served one on one; 45 people participated in the groups, in addition 26 people were willing to participate in the field testing conducted.

The success rate is demonstrated not only by these numbers but also by qualitative comments and individual experiences with satisfied individuals who were willing to open up and share their most private experiences.  Much of this happened in confidential groups and involved the telling of stories of Special Messages Crisis, the most powerful healing determinant, in my opinion, and the hardest thing to document.  Additional evidence of effectiveness are:

• Peer specialists grew in their ability to be transparent about their “psychosis” experience while at the same time making gains in being professional, public and less isolated is a testament to the practice.
• Workers were encouraged to take their learning and move forward in career directions they chose themselves and all were able to sustain career growth in terms of volunteer or getting hired. One obtained a full time position outside the field, and, then a year later got a full time position in the field.  Another got hired on at PEERS.  One was hired within six months at a full time position with Abode Services. And finally one was  hired into two security positions, but remains a paid leader in the BAHVN group.

Staff grew in their ability to work with each other across cultural divides, learn to coordinate their roles, trust and cooperation has been significant.

EVIDENCE-BASED AND COMMUNITY DEFINED PRACTICE.

Much of the success of this as a treatment strategy has been observed by the successful running of groups at Highland Hospital Outpatient Psychiatric Unit over the past six years and the known successes of the Hearing Voices Network across European Nations (including Australia and New Zealand.)

A problem oriented path for counseling theory as has been started by the eclectic approaches of various evidence based practice movements (motivational Interviewing, WRAP, IPS Employment Model, Housing First, PET Support, and DBT.)  Study of the evidence based DBT has been a large personal motivator for writer to create the curriculum that seeks to reconstruct and redefine “psychosis.” Making the curriculum both trauma and spiritually sensitive is part of the work, much as Marsha Linnehan has done with DBT.

Another major aspect has been pioneered by the Program Manager, which involves a training program that teaches professional development to individuals who have experienced catastrophic loss, trauma and isolation as a result of their special message process.  Much of this is built on strategies for professional survival which resulted in enormous growth for our Specialists.

There was significant work done to make peer support a best practice that has influenced the hiring and training of the Specialists.  The Grant writer has been through WRAP and PET provided by Mary Ellen Copeland and Lori Ashcroft and seen the power of “I am the evidence,” stories that serve to motivate not only the audience but also the speaker.   The Program Manager implemented the very important community practice of reflection.

Measures of effectiveness: Provide quantitative and qualitative data that show the effectiveness of the strategies.  Include assessment tools and measures of effectiveness and data sources used.

We made a formal effort to measure success qualitatively and quantitatively by utilizing a Stanford researcher who sought to support us.  Initially, the qualitative interviews that would have involved 1-1/2 hour sessions reimbursed with twenty dollars resulted in only three responses after dispersing fliers throughout the people we supported.  By the time we observed that this response was not going to give us an accurate reflection of our work we decided to send out a survey to those who participated in events to let them identify how they were positively affected.  Unfortunately, in part because of the intense amount of work that piled up completing the field testing and closing down the effort, this effort wielded only 19 responses, but we still feel this is significant. And the results and survey are duplicated in Appendix A.

I does stand to be noted that it was observed that many message receivers had an aversion to completing the surveys.  The surveys were seven pages long and appeared to be great measures, however, some message receivers may have an aversion to filling out an entire survey because of a variety of reasons that include focus and tolerance of the task and perhaps mixed feelings about or willingness to be part of a study.

It is also arguable that the numbers in terms of the amount of participants and the success and increasing demand for the service that is documented above is a powerful measure of our success.  We have worked hard locally and learned that the best way to battle the self-stigma is to provide groups in addition to services that are otherwise being applied and follow up with one-on-one support.  We have learned that we can train amazing individuals who can develop and socially rehabilitate and effectively cut through the stigma and develop special relationships.  We feel they would be an excellent addition to service teams.

Additionally, I would argue that the qualitative data, which includes private personal stories heard, might be considered location based learning. Indeed if one is to read this program design and consider the places that received our outreach and our responses to the specific learning question, I’d argue that one gets an important view of the interplay between the local economy, the State’s laws, the county agencies and local businesses. I feel this interplay impacts the way that many message receivers get into institutional and depraved circumstances. This fits with private stories that I have heard in my work with Highland Hospital.

Let this be a platform in which I advocate for location-based learning. Consider how we hired individuals with lived, on the ground experience and we let them lead and represent their local experiences and culture. We listened and they took us to work with the homeless and into their communities. I believe this helped empower them to heal and it provided this grant writer with even more qualitative understanding of the location.

When I contrast the work of the HVN in New Zealand or England where the movement has vastly changed lives in undocumented manners, I think that it is important to have a project such as this. Our project drilled down and consider the differences in housing availability and the hefty reality of local homelessness. In a county with particularly high numbers of message receivers cycling through a perpetually crowded PES, we considered local factors that are needed to get into board and care homes and SRO’s. We found that we need to work through agencies if we are going to reach those truly marginalized in this economy. If we develop these resources only outside mental health agencies and only in early intervention programs, there will be a much larger underserved population that will languish and stagnate.

I’d argue the proof lies in the reality of the location, not in an artificial, mobile money-making laboratory.

Finally our two field tests yielded strong and supportive results.  Out of 26 attendees, there were 11 providers from: HHREC, BACS, PREP, the Liberation Institute, Telecare, La Familia, Center for Family Counseling, and FERC.  We also hosted 10 consumers with a variety of affiliations, and 5 family members.  We received the most positive feedback from Providers who were primarily complimentary and concerned about whether these services will be able to stay in the community, given the limitations of the grant. Consumers had a little more to say and were a little more critical, wanting to see the information inserted into schools and church settings along with being taught to providers.  And family members wanted scientific proof and to see the service expanded to include hospice programs.

See Appendix A for positive evidence based results of 19 individuals surveyed.

RECOMMENDATIONS FOR PROGRAM REPLICATION

To replicate the Special Messages project it’s recommended that there are three leadership roles: one Peer Support and Approach Trainer; a Lead Specialist; and one Administrative Project Manager.  The leadership team should work under a Director who is there to support and hold meetings helping to communicate and balance their roles.  Additional considerations are:

• Differentiation of leadership roles from the beginning
• Respect for the need for working as a team is important
• An ability for each to validate and support each other The leadership team needs to be able to share validation and challenge strategies for the Outreach Specialists. A sense of balance so that the Specialist get challenged to adapt to a professional environment but also feel seen and understood as to where they are.
• The leadership team needs to meet and strategize teaching: how to be a vulnerable and authentic peer supporter, and how to uphold professional skills standards, boundaries, assessing for danger, and expectations.

Hiring Personnel

Time needs to be taken for each hire and each leader to develop a relationship and understand each other’s’ skills and strengths.  And it needs to be clearly understood that time is necessary to train the staff to be visible in the community as representing “psychosis.”

If we had chosen people who were already healed and degreed, it may have limited important aspects of the peer element.

Additionally, it stands to be noted that we approached all team relationships with a failure is not an option attitude because of the vast amount of social vulnerability that Specialists are likely to start out with. This as a cultural trait that is often the result of a background of catastrophic loss or hardship. Relapse into Message Crisis needs to not result in job loss but wellness time off and support.

Additional Considerations

• Too many peer specialists who have lived experience with “psychosis” and serve on teams end up in extremely compromised and difficult circumstances. They may fail due to stigma and power struggles. They may have an uncanny ability to connect with other message receivers and get targeted for this. Supportive training is essential opportunities to be vulnerable without reprise. Peer Specialists referencing their struggles with messages and demonstrating to community participants that this kind of stress can be authentically managed and overcome. Training opportunities can be seen as important professional development opportunities and sends a message to the trainees of commitment to them and can help support team development. Training and team development are necessary before the implementation of services.

STAFFING REQUIREMENTS

Program Manager:

Roles and Responsibilities:

• Oversee the search for isolated individuals who have experienced “psychosis” via interfacing with and outreaching to community agencies
• Uphold a sense of professional expectations for the project that helps staff develop and reach their full potential
• Adjust the initial vision of the program so that it reflects the strengths of project personnel and the community response.
• Create innovative, strength based professional development trainings that help individuals work with each other in a diverse work setting
• Responsible for implementing disciplinary action so that employees have the opportunity to optimize their professional capacity in a safe environment.
• Responsible for overseeing and training for time tracking efforts and communicating with business manager over payroll issues
• Document and maintain bi-monthly individual supervision with Outreach specialists to assist with professional development.
• Able to use and provide supportive feedback for presentation skills.
• Able to track the budget and make decisions about where and when resources will be allocated
• Organize an office and lead documentation efforts aimed at recording outreach efforts, group participation, and individual support services.
• Create outreach strategies to help market the project
• Create and disperse flyers that can prompt engagement
• Lead safe groups in which stories of experiences in “psychosis” can be demonstrated and reflected upon in order to prompt others to tell stories about their experiences in “psychosis”
• Teach group facilitation Skills
• Shadow training and lead group supervision.
• Ability to accompany Outreach Specialists and provide leadership support.
• Seek feedback and support and work collaboratively with the Approach Trainer
• Exemplify professional conduct and communication respecting all team members and their diverse backgrounds.

Approach Trainer:

Roles and Responsibilities:

• Responsible for knowing and be able to teach and adjust the curriculum in training groups that involve the Outreach Specialists and Community Collaborators
• Use and exemplify use of their own story in working mutually with Outreach Specialists and Community Partners
• Travel with the Outreach Specialists and model good boundaries, yet transparency, authenticity, and mutuality in Peer Support
• Provide weekly individual supervision that is supportive but that upholds the professional expectations set by the Program Manager
• Support and help develop Specialists innovative ideas and represent them in meetings with the Program Manager and Director.
• Create quantitative and qualitative means for measuring the success of the program
• Work collaboratively with Program Manager to represent concerns of the Specialists yet have a willingness to support and enforce professional expectations created by the Program Manager.
• Help problem solve with regard to disciplinary actions and help make sure professional development occur
• Lead presentations aimed at educating providers, residential providers and a wide array of community partners towards a cultural view of “psychosis.”
• Seek mediation and function as a mediator when staff conflicts impede the progress of the project
• Provide and lead safe training sessions aimed at reconstructing and telling stories about experiences with “psychosis” exemplifying leadership and meaningful reflection.
• Inspire individuals to create innovative ways to connect with individuals when they are in “psychosis”
• Help address diversity issues in a fair and equitable manner having respect for differences.
• Responsible for writing project reports and overseeing writing projects associated with our marketing campaign.
• Responsible for knowing the local system and helping Project Manager make contact with individuals who can make events happen.
• Work with Project Manager to establish safety, structure and rules that are appropriate for a diverse team.

Lead Outreach Specialist:

Roles and Responsibilities:

• Familiarity with the training curriculum and a willingness to take leadership
• Competence with administrative duties like TT cards and travel reimbursement forms
• Demonstrated cultural competence and ability to assert needs of self and others
• Ability to participate in leadership team and trainee team: knowing who you are as a team member
• Assist with completing measurement and necessary paperwork
• Developed public speaking, group leadership abilities, and proven ability to manage boundaries in one-on-one relationships
• Curious to learn more skills and develop supervisory skills
• Willingness to reflect and represent lived experience with “psychosis”
• Ability to participate and contribute to training that seeks to redefine psychosis
• Able to oversee phone communications and complete associated documentation
• Problem resolution skills

Outreach Specialists

Roles and Responsibilities:

• Willingness to reflect and represent lived experience with “psychosis”
• Ability to participate and contribute to training that seeks to redefine psychosis
• Learn administrative skills and function as a collaborative team member
• Accept the professional direction of the Program Manager
• Learn and teach peer support outreach with support Approach Trainer
• Ability to meet professional expectations while learning to authentically relate your story and hardships
• Support Community presentations with an ability to represent personal story
• Structure own time and use phone to track participants and encourage them out to events
• Invite participants eventually to communicate about “psychosis” and come to support groups aimed at that very task.
• Learn to Lead support groups and outreach to individuals on a team

1. Required qualifications, certification and / or licensure

Project Manager: Strong employment history that includes some management experience: Bachelors or Master’s Degree.

Approach Trainer:  Strong Employment History, experience leading safe groups with message receivers, familiarity with the curriculum, Peer Support training, Licensure level training on counseling theory.

Lead Specialist:  Completion of training program that uses the curriculum, ability to lead groups, public speaking, interest in developing supervision skills, AA degree preferred, WRAP training a plus

Specialists: Peer Support Training; knowledge of local services, evidence of volunteer involvement in recovery services and significant recovery efforts

COLLABORATORS NECESSARY FOR REPLICATION This work has pioneered the marketing necessary to get invitations into collaborating agencies. A very important strategy for reaching isolated message receivers is flyer outreach strategies and the use of phone contact. Although these strategies do not result in high levels of voluntary referrals, particularly in the north county, they are good for training and destigmatizing individuals. There is a high degree of self-stigma and a high level of hardships that prevent many isolated individuals from voluntary responses.  That said, some of the  most successful one-on-one partners came through voluntary means, meaning that this is still a worthwhile endeavor and a great way to train Outreach Specialists.

All stakeholders should be included in outreach efforts: providers, consumers, and family members..  Service agencies are interested in receiving presentations and often will extend an invitation to run groups.

Partnerships with service agencies can create successful outcomes involving families. The Program Manager for this project was extremely competent in this area and it is recommended that she be independently reached out to for consultation with regard to not only how to train trainees but also how to include family members.

Significant support can be gained from consumer advocacy groups such as the POCC. We also used consumer and consumer/provider conferences to get the word out.

Best Now is a resource for conducting presentations and providing initial training. The BAHVN provided training and opportunities for our graduates.

• Recommendations for resource, facilities, and infrastructure requirements needed for support:

Technology and equipment needs

• three computers each with a desk
• one printer.
• a laptop and projector
• access to a conference room.
• a locking filing cabinet to remain HIPPA compliant.
• Transportation support (Bus passes, Clipper Cards, mileage reimbursement)

• Systems and services needs (e.g., billing, interpreter, etc.)

Partnering with an agency, such as PEERS or others can support the availability of resources (i.e.; internet services, ITT specialist, administrative forms, etc.) Working with an already established finance department is also suggested.  Include a Spanish speaking  staff member for interpretation skills.  Cell phone service with unlimited data plans.

• Budget requirements

This program could operate on a grant budget of approximately $275,000.00-300,000.00 yearly.  The primary costs would go to the salaries of the three leads including benefits and might involve the Specialists graduating to a salary increase.

• One – time costs (e.g., implementation and training)

Powerpoint Books for Training Manuals Training investments for Specialist that include CPR and First Aid, Compass Point to improve administrative skills, and Hearing Voices Network and WRAP Additionally Specialists found the practice of traveling together and making the team visible to the community services and tracking those services to be very valuable.  This required some expense without creating immediate results but was thought to be important for team development.  Our Program Manager used her own books on Team Development during this time.  I am aware that more money could’ve be spent on team development, but our Program Manager was very gifted, talented, and resourceful.  Additionally small issues like purchasing transit cards is a consideration.

• Other resources required for infrastructure support

0

Appendix A

SUMMARY FINDINGS

POST-INTERVENTION SURVEY:  ALAMEDA COUNTY SPECIAL MESSAGES PROJECT

Description & Methods

In order to better understand the impact of client participation in the Special Messages (SM) project, we administered an online survey to clients following participation in one or more SM activities (including trainings, support groups and one-on-one consultations).  The survey combined novel and adapted close-ended questions as well as optional open-ended questions.  Attempts were made to reach both past and current SM clients as well as clinicians and family members.

Survey Participants

In total, 18 participants completed a post-intervention survey regarding their experiences.  Participants included one clinician, one family member, and one friend in addition to 15 peers.  11/15 peers were directly involved in SM groups and/or 1:1 meetings and the remainder had attended a training or workshop.  See Table 1 for additional participant demographics.

Survey Highlights: Impact 

For the full sample, including participants who had attended a presentation or training but not participated directly in a SM services, the majority of participants reported improvement in one or more community engagement or recovery domain.  Individual items ranged from 6/17 (35%) of participants reporting a diminished sense of “not fitting in” to 13/17 (76.5%) reporting increased communication or connection with friends and/or peers. See Table 3 for full results.

Of those participants who were involved in a Special Messages group and/or met one-on-one with SM staff, 10/10 (100%; 1 missing) reported improvement in one or more community engagement or recovery domains.  For example, 9/10 (90%) reported increases in time spent “talking to or connecting with friends or peers” and 8/10 (80%) increased time “reflecting on [their] experiences of psychosis in a helpful way.”  Only 1/11 (10%) participants reported negative changes post-contact (including increased loneliness and feelings of not fitting in).  See table 4 for full results.

Survey Highlights: Comparing Special Messages Peer Staff with Non-SM Community Mental Health Staff

While the differences in participants’ experiences of the recovery-orientation of SM staff and non-SM community mental health staff did not reach statistical significance (almost certainly due to the sample size; data was missing for 8 participants), ratings of SM staff exceeded those of non-SM staff on every item (e.g. “staff see me as an equal partner;” “staff believe that I can grow, change and recovery;” “staff have helped me to better understand my experiences of psychosis”).   On the 4 staff-focused questions taken from the American Association of Community Psychiatry’s Recovery Oriented Service Evaluation (AACP ROSE), 20-30% (2-3 out of 10) of participants consistently listed non-SM staff as never or rarely engaging in recovery-oriented behaviors, while no (0%) SM staff were listed as never or rarely engaging in the same behaviors.  The highest ratings were assigned to SM staff at consistently higher rates.  For instance, 6/10 (60%) participants listed SM staff as “always or almost always” ‘seeing them as an equal partner’ whereas only 1/10 (10%) gave non-SM staff the same rating.  See Table 4 for additional details.

Qualitative (Open Ended) Responses

All comments regarding additional perceptions of participation in SM activities are listed in Tables 5 and 6.  Overall, open-ended responses suggest that at least some participants felt that SM activities increased their sense of self-worth and validated their experiences in additional to more interpersonal and/or community and treatment-focused effects.

Limitations & Conclusions

Participant sample size was limited and it is consequently unclear how the responses reported here generalize to the full population of clients who came in contact with Special Messages (SM).  It is also possible that participants with a more favorable impression of SM were more likely to complete the survey.  In addition, our survey was cross-sectional and lacked a control group limiting our ability to make strong claims about intervention effects.  We nevertheless see the survey as helping establish the feasibility of the SM project and participants’ favorable views.

For those who filled out the survey, results suggest that SM was generally perceived as effective in reducing isolation and increasing  personal and community engagement and well-liked by participants.  In addition, comparisons between SM and non-SM staff using the Recovery Oriented Services Evaluation (AACP ROSE), suggest that SM staff were more likely to be perceived as strongly recovery-oriented than non-SM staff.

Table 1 Participant Demographics

Table 2 Impact of Special Messages (Full Sample)

Table 3 Impact of Special Messages (Group and/or 1:1 Clients)

Table 6 Recovery Oriented Service Evaluation (AACP ROSE) Responses

Table 5 Additional Benefits of Involvement in Special Messages (Open Ended Responses)

Table 6  Additional Comments on Special Messages (Open Ended Responses)

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