“So, you have bipolar,” said the well-meaning psychiatrist, “So what’s the big deal?”

I had been talking about the stigma associated with presuming that all mental health challenges were disorders. He interrupted me.

But wait! This was the first time anyone ever suggested that I had bipolar!

Was I supposed to give up my perspective and feel I had achieved something? Somehow was this a more socially acceptable diagnosis? Was getting the right diagnosis supposed to fix everything that happened to me?

As a statistic, I was being moved from the 3.2 million individuals in the United States diagnosed with schizophrenia to the 5.7 million who experience bipolar. Of those with bipolar 70% experience psychosis during mania and 50% during depression.

I had been stable ten years. For the past four years I had been running innovative professional group psychotherapy that focuses on exploring psychosis across diagnostic categories.

I’d had the privilege or cracking open hundreds of stories and contrasting them against the diagnosis of differing staff psychiatrists. I felt I learned a lot about the mentality of each distinctive psychiatrist by doing this.

You see, if your bipolar is like mine and includes experiences associated with psychosis a lot can happen to you in the mental health system. If you stick with me through this article you may learn some innovative ways to cope with psychosis across diagnostic divides.

Common Reasons that People with Psychosis Get Diagnosed Bipolar: 

From my vantage point, there are many subjective reasons for bipolar to be selected over schizophrenia or schizoaffective. These subjective factors do not always involve a perfect equation of DSM-V criteria. I’ll go ahead and admit that I do not believe DSM criteria really helps the professional understand the reality of psychosis. Nor is being diagnosed with a psychotic disorder likely to result in more humane and appropriate treatment.

Perhaps, you get diagnosed bipolar because you have suffered a mood component and have a history of being expressive about it in the past. Maybe, your psychosis experiences are intermittent and discontinue with proper support. Perhaps you express experiences that are positive and spiritual that can make your mood and energy soar. Or maybe your body is responsive to small doses of antipsychotics.

Many get diagnosed bipolar because they have enough judgement to convincingly conceal or minimize their psychosis experiences. Sometimes you get the stamp because the psychiatrist respects and has hope for you. If you are a person of color or don’t come from a class the professionals relate to, you are less likely to get the bipolar stamp. I don’t feel I personally need research to believe this to be true. I believe my observations over time are acute enough. However, I do understand that this research does exist.

In my experience some professionals are open to learning and seeing people through the bipolar lenses, and some are more chronic in their ways.

Why Upgrade Your Diagnosis?

When in madness, there was no need to upgrade my diagnosis. I was living in an alternate reality, and I only wanted to feel safe. Being bipolar only meant that I was in danger of being killed and having it called a suicide. All I wanted was to get out of the reality as quick as possible.

In my experience of wellness, there is more of a sense of social acceptability associated with a bipolar diagnosis. Perhaps this is largely because of the misconception that schizophrenia is degenerative or only gets worse over time. Although this is not true, it’s arguable that social stigma does not lead the majority of people to believe otherwise. For example, in 2006 schizophrenia.com suggests a host of negative statistics about schizophrenia including that only 35% of sufferers experience repeated episodes without returning to functioning.

Still, negative statistics (like the one above) enhance the damage that gets done when supporters act without understanding that it is likely that people will heal from psychosis. Good people become institutionalized by bad statistics. Families may not finance a sufferer the opportunity to recover if they keep in mind statistic like that.

Looking closer at that 35% statistic, they come from E. Fuller Torrey’s 2006 statistics which suggest that after ten years, 15% of schizophrenics will be permanently hospitalized and 10% will have killed themselves verses those studied over thirty years during which 10% end up permanently hospitalized and 15% will have killed themselves. This starts to sound like a 35% throw away rate.

Consider that many health plans do not even offer treatment to people with schizophrenia. Likewise, I know locally it is easier to find a professional bipolar group or specialist than it is to find a professional schizophrenia group or specialist.

Less stigma, less negative statistics means less social persecution. That is why many people who are looking to make social rehabilitation gains try to suppress their psychosis and fight against a schizophrenia diagnosis. Many suffers learn to do this so people don’t reject you.

What it Takes to Suppress Psychosis Regardless of Diagnosis?

How does one suppress psychosis? I think it has a lot to do with having a project that is very meaningful to you and vying to be successful with it. Then, the sufferer just cannot let anything get in their way. Sound stupidly easy? The best way I can convey that it isn’t is to share pieces of my experience.

In State hospital, most staff who thought I was schizophrenic would just dominate and humiliate me. I believed that if people knew I was schizophrenic that that type of treatment would resume. My complex appeals to staff to convey that I okay with the FBI resulted in a beat-down by the cowboy security squad. Begging for aspirin with a highly uncomfortable fever, caused one nurse to write a note that I was sexually inappropriate with her. These are not the types of things you want to see happen to you on the outside,

Meanwhile many of my peers tried to recruit me into their white supremacy gang, or the Mexican mafia, or the FBI, or in one case, the Navy Seals. Sound safe in there?

These kinds of experiences cannot be spoken of when you suppress your experience. Nothing happened! They become buried secrets.

But the treatment that had the most lasting impact was the experiences I had to suppress in the community.

There was the woman who flashed me a secret service badge. She initially said I would be safe if I took the over-priced apartment. She showed up again the day I came home to find my apartment had been ransacked and accused my uncle of doing it.

There was also the mail that came from my county work applications that was repeatedly torn open in spite of my complaints at the postal service.

There was the occasion when I was followed on my way to work by a resident I knew from Seattle (I was working in California.) He had handcuffs and a jean jacket with a hand made sign that read CIA on it.

There was the time a computer hacker marked-up my resume at the local library. Several encounters later he told me that he worked for the multinational corporations.

This kind of treatment accompanied me for two years and stopped when I got professional employment. It was traumatic and perpetuated my emergency state, but I learned to pretend it didn’t matter.

If you can ignore the fact that you have no rights and just persist at your immediate project you can overcome psychosis.

It’s Just a Political Discussion:

Resuming professional employment, I worked seven days a week. Eventually, I managed to get a psychotherapy license and earn enough for a down payment on a house in the bay area. I met my wife and got married.

So finally, once I got that kind of support behind me and put a well-meaning psychiatrist in a spot that challenged his perception of disorders, I got bumped up from schizophrenia to bipolar, yay!

Now the DSM-V, which wasn’t yet written during my escapades, says that people with bipolar who go through psychosis in a low mood can experience fear and paranoia. This is exactly what I experienced. Perhaps, one day I’ll get out of my depression and become hypomanic! That gives me something to look forward to!

However, when we examine the recent research this point may become moot.

Laboratory Science Supports Treating Psychosis Across Diagnostic Divides!

In the laboratory they are coming out with scientific findings that strongly support the view that diagnostic differentiation is irrelevant.

In fact, in a very recent article published by The Psychiatric Times, schizophrenia is being considered a syndrome that is more of a neurodevelopmental disorder than an illness or disease. Additionally, these findings do not support different kinds of neurodevelopmental evidence for bipolar verses schizophrenia verses schizoaffective, verses depression with psychosis.

If treated poorly, the neurodevelopmental process will become more extreme! Thus, sufferers can be trained to cope like dyslexics can be trained to read. This vantage point can help promote training in social functioning like specialized job placement programs like the IPS model out of Dartmouth. This practice can help participants in early prevention programs, or at any stage of recovery. get back to work.

Of course, there are many other social skills to learn when you have to suppress trauma! Of course, social skills are gained through socialization groups.

Other Considerations Stemming from The Research:

Moreover, I believe that understanding that you have an underlying condition like ADD, Dyslexia, or Autism can save you from living out your depression and mania to their fullest. Instead of feeling like a slave to the moods, neurodevelopmental understanding helps understand the basis for the moods. By learning that there are reasons you haven’t been included, one can use it to make meaning of depression and play back tapes of the consequences of mania.

Additionally, sufferers can learn about ways they have been traumatized for being different. Also paying attention to real underlying trauma that exacerbates the expression of the syndrome becomes important.

All this can help people with bipolar psychosis learn how to live in their strengths and focus on their abilities and the ways they are exceptional. Albert Einstein, Temple Grayden, and Earnest Hemmingway are just a few of many examples of how people with neurodevelopmental issues can contribute to society in very advanced ways.

As a society, some of us are learning that celebrating neuro-diversity, like they do in some more traditional societies, can lead to better outcomes for people who are built differently. In fact, some might argue that if the problem is neurodevelopmental, expecting symptom suppression without accommodations and providing support groups is just not humane.

Treatment for Psychosis Across Diagnostic Categories:

Here is where I can help other bipolar people if they are willing to explore those terrifying experiences with other good people who are stigmatized. This may involve getting to know people who are from different cultures and may still be in challenging circumstances.

Losing privilege and connecting with those less fortunate is so counter-intuitive in this land where the haves hate the have-nots. But oddly going against the grain in this manner can help exponentially!

If your bipolar experience includes psychosis, treatment can exist in group therapy that normalizes and permits you to express your stories without getting punished. If you are encouraged to work with people with differing diagnostic histories you can learn to be a leader and supporter.

No doubt, the mental health incarceration system varies based on the socioeconomics of your locale. Regardless, it will train you to suppress those psychosis experiences and pretend like they are not real. If you fail to suppress, you will be rejected and ridiculed by others and if this upsets you, you will be punished by going back to the hospital.

If you are able to play the game and can return to work, go ahead and become the bipolar diagnosis. To do so you can simply engage in social rehabilitation and work without upsetting the applecart. It becomes a political discussion with a psychiatrist like the one I had above.

Group Therapy for Psychosis:

Okay, I’ll admit, suppression is not always so easy for all of us. But over the years I have seen many individuals hide their psychosis, avoid my groups, and pretend like what they went through was just bipolar stuff. Indeed, I had to play this game for six years. I had to start over again without anyone knowing anything about me.

However, if you are like me and had to overcome some dramatic circumstances, suppressing all those experiences and trauma may turn you into a traumatized droid. A part of you is permanently disassociated and all you can do is work and try to act in ways that keep you out of trouble.

I am here to promote one potential outlet that I was eventually able to use: group therapy in which the content of psychosis is shared and participants learn from each other.

For example, I hear very few voices and never thought of aliens, but when I learn from people who do, it helps me be more flexible in the meaning I make of what happened to me. My desire to collaborate and support helps me be flexible and decreases my distress.

As a psychotherapist, I started leading these groups and sharing my story to prompt others to feel comfortable in doing so. I learned that by sharing my story and demonstrating that I had recovered, I could use my suffering towards a useful purpose.

Whether you do it as a professional, a peer counselor, or a volunteer, getting support for those things you’ve been through and teaching others how to survive with psychosis can be very rewarding. It can help bring you back to life!

Opportunities to do this can be available through the hearing voices network movement. This is an international movement that seeks to set up peer support outside the mental health system. In the United States, you can click: www.hvn-usa.org!

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I contend that the negative power of a label is a significant part of a sufferer’s condition when they experience a “psychosis” or what I prefer to term a special message crisis. Indeed, many acknowledge that words like schizophrenia, schizoaffective, and bipolar lead people to being treated as though they have a hereditary brain disease with a poor prognosis that limits their ability to thrive.

It is arguable that the degree of stigma or what a sufferer’s surrounding social world starts to think about them varies a great deal. However, I contend that more often than not, it is based on an inaccurate understanding of what “psychosis” is and means. Many sufferers object to the social definition and deny that psychosis is what is going on with them. In treatment they are encouraged to suppress their experiences especially when they are in the hospital. If they disagree with the social definition, they may be labeled with poor insight and a poorer prognosis.

This article is about how the words associated with “psychosis” and the system of care work together in irrational ways that erode one’s sense of self, dignity, and identity. I believe that stigma deserves a place at the table when it comes to defining the experiences associated with “psychosis.”

Stigma in the Community and Clinic:

Before sufferers even arrive at the clinic, they have faced social stigma in their communities or the streets. Perhaps, they were confronted about being wrong, teased, talked about behind their backs. Then others caught wind that something was different, came to test it out and laughed or taunted. Maybe the message receiver has had this happen before, or maybe finding themselves alone and rejected is new. Perhaps, suddenly some people treat the sufferer like a charity case. Of course, people who care about them may give them orders that they sense are coming from a good place. The influx of stigma to perceive is alarming and it may become interwoven into the conspiracy that is for or against them.

In the emergency clinics and hospitals, many workers believe that this “psychosis” will cause progressive social decline and brain damage as time progresses. Thus, involuntary medication is ordered and administered. So many psychiatric survivors report hearing that they will have to be on medication the rest of their lives. The best they can hope for is to return to their functioning-level baseline. Often, supporters report getting told by professionals that they would be better off learning that their loved one has a diagnosis of cancer, rather than “schizophrenia.” So many treatment providers presume that therapy is a waste of time and behavioral control in a clinical setting is as good as it gets.

Not only is there is an absence of therapy specialists who have strategies that help reduce the suffering, often, supporters are encouraged to vie to reduce their loved one’s self-determination so that they can impose consensus reality on them and correct behavior. In worst case scenarios, the mentality is that if we all ban together and work together, the sufferer will be forced to listen to us and ignore those anomalous experiences.

Perhaps the sufferers’ valid extra-perceptual experiences sense that this is going on and it only adds to their distress.

Case Study—My Real Extra-Sensory Abilities and Confusion:

 For example, when I was on the streets and walking along the highways, I could sense via intuition and energy that some people wanted to support me, and others wanted to destroy me. While I may have been accurate in these perceptions, there was confusion that resulted from this ability. I did not know whether people were presuming I was ill or whether I was receiving these sensations because I was capable of exposing mass corruption. I believed in the latter to a greater degree.

Of course, believing I was a targeted individual as such, I tested people out to see whether they knew who I was or how quickly they would pick up on my purposely bizarre behavior. If people just thought I was ill, I was safe, if they thought I was a whistle blower, I was in danger. I couldn’t ask them these questions directly, I had to feel it out.

It’s true some targeted individual or voice hearers have the skills to evade treatment and live with their secret abilities. Many can survive in fringe communities or perhaps via using substances or through family support. Those able to conceal these experiences still face stigma. Others may think they just aren’t living up to their potential. Then, they may feel ignored and stigmatized as an underachiever, rather than as a “schizophrenic.”

I was one who was unable to evade treatment. What I found was that some people presumed I was ill, and others seemed to know about my ability to expose corruption, which was significant at the time. Even when this dilemma led to a three-month incarceration in a state hospital, there were different camps. Many were trying to figure out where I stood, and there were many opinions for me to perceive.

Was my dilemma real persecution or was I sensing different takes on the stigma of presumed illness because of my erratic behavior? It has taken twenty years, a return to my profession, and pioneering groups that specialize in treating psychosis to realize that I am not alone in experiencing these dilemmas.

Seeing and Accepting the Reality of Stigma:

The stigma of a label that is not accurate robs people of their identity and the roles that give them meaning and purpose. However, to minimize incarceration, message receivers must learn to lie and accept stigma.

The belief in inevitable decline is a lie. Even our imperfect research suggests to us that 25% of those with schizophrenia will recover on their own, 50% will take ten years to recover, and only 25% fit the stereotype of inevitable decline. Still many professionals presume message receivers are going to face inevitable decline. The idea that you can go into a hospital for a tune up and a board and care home to establish independence without facing inevitable decline stigma is naïve. Living like that is degrading and chaotic and in fact can be a lot to come back from. The goals of so many of our DSM financed institutions remain to impose upon the suffering the insight that they are ill and in need of medication, even in cases in which this is not accurate.

The pervading message is that sufferers are ill. As a result, many workers do not engage us with curiosity about our experiences with voices, visions, illusions, codes, synchronicities and extra-perceptual perceptions. These experiences may be streaming through sufferer’s lives but they must keep quiet and suppress them to earn back their freedom. Medications and drugs encourage us to suppress them and pretend they are not true. Even if we know they are true, we must pretend they don’t exist. Indeed, the realities we perceive are defined as symptoms whether they are accurate or only somewhat accurate.

Therefore, I contend that we are all facing stigma which is part of the “psychosis” process! Suffers like me need to know that this is the case. We need treatment that enable us to look at our experiences and strategize with each other.

Stigma is Irrational and Yet Pervasive in the Mental Health System:

I believe message receivers need to learn that stigma is not rational reality. This becomes hard to prove in mental health institutions where stigma is so pervasively embedded. However, message receivers who have been removed from such oppression can learn to use rationality as a tool to challenge stigma. Indeed, when we finally recognize the effects of stigma clearly, stigma becomes the spiritual trickster (see my previous article) that might come true if we believe in it. For many of our people, trust in stigma has left us to rot in poverty, inactivity and distress for so many years.

So many have determined that cognitive therapy for psychosis is the answer to this stagnation. However, teaching cognitive therapy may not help people in institutional settings like board and care homes. Most of the time message receivers may be forced to accept irrational stigma and submission in the institution. In the worst case scenario, the institution turns around and, in treatment, tells then that that irrational thoughts are part of their illness.

This is precisely why I believe that we sufferers must teach each other to acknowledge our skills and abilities yet conceal and not act on them. This serves to save us from being stigmatized. Pretending I was ill then, but now am well becomes a lifelong task for a person like me. I am a licensed therapist living life on the playing field of the oppressor—this has become my destiny. In reality I haven’t changed much other than gaining a sense of social power.

More on Using Rationality as a Tool:

It took me a long time, but I learned to conceal my anomalous experiences, and use emotional intelligence to wait and see what happens. Often, the truth becomes revealed to me at some point. Until then, I need to collect hard facts before I fully trust my message experiences even though often they prove to be correct a significant portion of the time.

In learning to survive amidst stigma, I have learned to respect people’s privacy and not expose corruption. That doesn’t mean I like and approve of corruption, but I am guarded with my suspicious version of truth until I know for sure. I have come to learn that there are many high powers that keep secrets and use them to manipulate. Secret societies are an epidemic in our nation and easy to confuse. Sometimes these powers may be good to me and sometimes, cruel.

I am only privileged with so much information. I do not know the whole truth unless I am watching Sons of Anarchy, Nine Seconds, the Wire, or Breaking Bad. Until facts are revealed to me, I will advocate for the truth to the best of my ability. That means info that I get from extrasensory I try not to act on, even when I believe it may be true. So often doing so comes back to haunt me.

At the same time, eradicating social, institutional, and self-stigma from my life means doing away with the hierarchy of corrupt and distorted facts. I do not trust information that others may believe. My goal is to help people live in their strengths and truth so that they can experience the meaning and purpose they deserve. To achieve this, I may use rationality and facts as a tool to empower people. Thus, instead of saying that the illness is caused by irrational thinking, I endorse cognitive therapy as a tool that is sometimes needed to eradicate the stigma. When presented in this manner, I argue, it becomes more palatable to the oppressed message receiver who already receives more blame for their lives than they deserve.

Acknowledging A Diversity of Stigma:

 I have learned a great deal being a Caucazoidal man working in a community that is predominantly African American. Indeed, there so often are multiple layers of stigma to face in a single institutionalization. In addition to mixing Caucasian and African American cultures there is a lot of other diversity in my workplace. In my opinion, mixing of cultures takes a little more care and effort but is an optimal place to reconstruct a culture of “psychosis” that can stand on its own two feet with stigma as part of its definition.

Participants in the program learn about oppression of many different types of cultures. Some of us may have a sense that their culture has turned on them when they send them to the institution. Others identify with the oppression of their culture’s history as a source of strength. Not only must they learn about deconstructing their own culture in a way to collaborate with others, doing so helps them understand themselves better and the trauma associated with special message crisis. Additionally, gaining cultural skills makes it easy to find common ground. I believe that “psychosis,” anomalous experiences, or what I prefer to call special messages experiences is its own culture that is dominated by stigma.

Learning to overcome multiple stigmas and greeting people where they are helps participants get a sense of their strengths. Eradicating stigma may well involve giving up privilege for me as a white male, but it is the right thing to do. It feels great and helps me accept myself for who I am and mutually grow with other people. As a therapist, I find myself constantly belittling my role to create mutuality.

I would love to say I am not guilty of racism, sexism, legalism, educationalist or stigma of any kind. But the fact is, to eradicate stigma from my life I must accept that it exists and be on the lookout for it in myself. That is part of my healing process. Judging things increases stigma.

Internalized Stigma, A Part of All “Psychosis” Related “Disorders:”

 Regardless of the stigmatized word, the public and the stigmatizing people in the institution have a way of getting into the message receiver’s head. Suddenly the message receiver starts thinking very irrationally about themselves. Distorted thoughts get expressed and must be countered with what I prefer to call anti-stigma cognitions.

When stigma gets internalized, the message receiver’s positive traits, inclinations, productivity, and the things that give them identity starts to decline. It doesn’t really matter what word gets used, what matters are willingly working with social skills and cognition to overcome stigma. Many message receivers can’t stop sensing that stigma is going on. They may effectively overcome it, but sensing it is a burden.

While currently the best practice for treating psychosis (CBT for Psychosis) involves eradicating irrational and stigmatizing thoughts, I must express my belief that it is also important to give message receivers the opportunity to map their voices or review their special message experiences with people who will not invalidate them. Telling their stories and collaborating with others who might help them change what the hearing voices networks calls “their frameworks” or what I have elsewhere termed “their causation theories” to make them more flexible in how they make meaning of these experiences.

Voices and messages may be an ongoing experience for many. Much like racism or sexism, suppressing or denying them may make them worse, while mindfully accepting them and letting them go may make them less burdensome. I believe that the more these experiences are stigmatized and suppressed, the harder it becomes to quit being impacted by them. The public, the institutions and the individual all need to learn to eradicate stigma to solve a person’s “schizophrenia.”

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