When people seek mental health services from me, I routinely break what was once a cardinal sin to me early on in my recovery; I review my diagnostic history. I do this with love in my heart to help inspire recovery, however, in the process, the “s” word, “schizophrenia,” will bubble up.

I do this habitually in the outpatient program I work in. I have done this by redefining the medical model definition of the word so that it more accurately reflects the shared internal process that we with “schizophrenia,” or “schizoaffective,” or “bipolar,” or “depression,” or hosts of other diagnoses experience.

As a professional with over twenty years of experience, a diagnosis tells me more about the doctor or therapist who diagnosed the person than it does the identified patient. Many clinicians will judge the mad person based on their counter-transference: their take on the color of their skin, their sex, the socioeconomic experiences in their story, their particular take on social Darwinism, or their subject’s level of trust or emotional openness.  “Schizophrenia” will result when the subject is not liked, is judged as hopeless, or by a clinician who is not accustomed to hearing harsh stories. Depression is more likely when the clinician has been snowed, has failed to really access the details of the dilemmas, or is a righteous advocate trying to undermine stigma.

For example, I recently found out based on my inability to get into a particular health insurance plan, that my current doctor has diagnosed me as a schizophrenic. My last doctor, said I was a bipolar. “So you’re bipolar, what’s the big deal about that!” He said when I described my redefinition work to him. And then there was younger-than-me doctor I saw before that, who clearly tried to be a good parent to me. He said I was a schizoaffective. One might imagine that I changed a lot, but I can assure the reader that with every psychiatrist case I deal with, I do not change my behavior or the details I share. I am cordial and accepting of the fact professionals are going to insist on seeing me until they have enough money or trust to know that I don’t need to be bothered with them.

In the program where I work, I entitle the specialty group I have developed special messages. I like to think that we have developed into a little counterculture. In group, participants are encouraged to share experiences associated with “psychosis.” Some will come to just listen. Others will talk when they are suffering without caring about what others think. Many become compelled to join the majority and talk. Still others will demure and filter into the group when they develop strong enough relationships on the unit so as not to face stigma. They may want to reflect on their growth or end their silence. Many share things with their peers they won’t share with their doctors.

I have created jargon to define seven other common experiences (in addition to special messages) that message receivers can relate to. I call this gooney-goo-goo jargon. Often, people who get helped by my groups come up to me and we have goofy fun with gooney-goo-goo talk, usually making nano nano signs. When we crack enough jokes, having enough fun to help each other feel cool and accepted, I like to think it makes onlookers more curious and willing to explore special messages. Many do.

It’s true that I have struggled some over the years with some of my clinician peers who have had issues with me being out as a schizophrenic. I think this is because historically, people presume that the role of the therapist is a competent model who can guide the client towards more mainstream success. For many the presence of special messages is an indicator that something is unhealthy.

However, among group participants, I have found that demonstrating that one can be mindful of special message processes without experiencing crisis offers hope. I have also found that crossing over and using peer techniques humanizes the process of therapy. This can be very welcome by a people who feel condemned to therapy as their sole purpose in life.

Clearly it is arguable that disclosing that you have schizophrenia has grave social consequences. Research on stigma conducted by Patrick Corrigan suggests that trying to eradicate stigma through education and through protest both lead to higher levels of stigma in the public. In contrast, this research suggests that first establishing contact with the local public and proving that you can fit in is necessary before you come out of the closet with your disability. Thus, contact is an effective means of eradicating stigma.

When I think of my professional experience I can see that when I have grounded myself in a therapeutic community for five years and demonstrated that I could out-work many and temper my emotions sufficiently, I have been able to eradicate stigma on the unit with support of the people who I help. When I left the small world of this community and assumed the role of an identified schizophrenic, schools of piranhas openly assaulted my reputation. I found myself widely targeted and irrationally scrutinized.

As a result, I believe that I have developed that unwarranted reputation because I am out as a schizophrenic in the county. I may be delusional, but they seem to disempower me frequently. They say I function without a strong peer support system; they say my college wasn’t good enough; they say I don’t utilize psychiatric emergency service enough. I have discerned this through both human interaction and intuition. The piranhas seem to say so much. But still, I am good at what I do.

With my new definition of what it means to be in “psychosis,” (or message crisis,) I have created and documented some very effective treatment strategies. I have had success connecting with people who have been silenced and institutionalized for years. I have learned to be my authentic neuro-divergent self and communicate about special messages in the room. With people who prefer individual contact, I have had to spend months being interviewed to prove that I truly have experienced message crisis. Some have needed to do this before enough safety was established to help transition them to talk about what is really going on with them.

Many message receivers live in constant states of immediate trauma. They are not willing or able to talk about the process of what is going on with them because doing so can get them punished in a psychiatric instituion. As a result they fail to get that perspective on what has happened to them to make that shift to a less traumatized state. Often, I have observed that groups with other people randomly telling stories are extremely helpful towards inspiring individuals to make that shift in awareness.

I yearn to share what I have learned in our de-stigmatized therapeutic community. Over the past few years, I have received an occasional speaking opportunity and am trying to hone those skills.  Now as I am marketing an award-winning memoir about my journey with “schizophrenia” and trying to prepare for service cuts that are likely in the current political climate, I am exploring opening a small private practice. But, I repeatedly run into that barrier of trying to sell myself as a schizophrenic. I struggle in contexts in which people are not warm toward me.

Already, I have been excluded from joining the county’s provider list once. This is a huge barrier towards being able to help the niche I specialize in.

Since that time, I wrote a grant program that sought to explore whether four individuals with a history of message crisis could learn to talk about their experiences as they develop into careers as mental health workers. The program was led by someone (not me) who had established themselves as a mental health professional in spite of having special message experiences. During the course of the grant several worked through housing crisis’s and struggled to improve their lives as they de-stigmatized the local community and started up groups in local clinics and hospitals. The grant was very successful and participants were able to use the training and support to improve their lives. Three of these pioneers now work in mental health full-time. They have helped prove to others that it could be done and give me hope that I can continue to survive telling those who accept services from me about my history with special messages.

However, in spite of all this work, I have only received more indications that my reputation has been further smeared. They say I protest against evidence based practice too much. They say my work doesn’t fit into the trendy early prevention focus that currently dominates treatment. They say I am rude for trying to push for services for those on the streets and institutions.

So with my recent application to join the county’s provider list lying in wait for potential rejection, I found myself leafing through my mail earlier this week. I received a copy of California Association of Marriage and Family Therapists Annual Conference brochure. In scanning this professional advocacy group’s workshops, I noted there continues to be no workshops that teach clinician’s about how to work with people in special message crisis.

So here I lie in wait to see if a person who has established a new therapy really can be permitted to do a private practice with the “s” word on the loose.

Will that CAMFT Annual Conference one day be able to diversify to include message receivers as people who also need therapeutic support? Will public insurance continue to fund treatment for message receivers at all? What will be the plans for those invisible people fall into the streets or into institutions?

If you heard that I have “schizophrenia,” would you seek out services from me?

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As many know, Emile Kraeplin (pronounced crap-land) formed the magical thoughts that are the basis of mainstream DSM propaganda that forms the businesses and billing systems that occupy the nation’s mental health. Though the idea that an observable behavior is the result of a specific brain dysfunction is more magical than proven, many feel it is best to uphold it to maintain social order. This will save jobs and maintain the power of political action committees that advocate for them, like the AMA the APA, and the big pharm PAC (pharmaceutical industry.) Still if people can grow anyway managing the manure in the pastures in effective manners if they learn to work together.

With a dominant discourse that assumes pathology, and exacerbates stigma myths that I have seen Patrick Corrigan define in lectures as: 1) danger; 2) developmental regression, and 3) loveable buffoonery; a sense of community can remain behind barb-wire confines of old institutional white walls, leaking urinals, in unheated or drug infested homes, sometimes tended with authoritarianism midst cigarette smoke, throughout days without a sense of meaning and purpose or inclusion in the monetary system.

Well-intended peoples who take home the money society prescribes for these hacienda communities may run patrol making assessments about what is real without an understanding of what the message experience is like.  Such workers eyes may operate with a subsequent skewed sense of their own power and health and without being encouraged to study or understand the process of the culture they work with. As a result well-intended people may not always hold high regard for the likeliness of competence and recovery that exists therein.

The purpose of this work is not to set off a bomb in such communities.  People trying to help may have had no training courses about what “psychosis” is and don’t realize that they may operate in manners that may exacerbate the condition.  If they have had the experience of an abnormal psychology course like the one I took, the understanding of psychosis may be full of fact distorting twin studies and brain scans; and magical, eugenic, disease-oriented thinking.

Many helpers don’t seem to consider the idea that people do live meaningfully with the experiences. All must adhere to, and some internalize, mainstream magical thinking. There is the differential labeling system of oppression divides individuals into labels and may not encourage them to systematically look for the similarities they have with each other. In essence there is an unintended mentality of divide-and-conquer that starts with the language of labels as if the Mad were to look to each other for an explanation of what is happening to them, that their loved ones would never get them back.

This work asks participants to consider the traumatic effects of being harshly judged on the basis of a desperate behavior; then treated in potentially inhumane manners.  This work envisions a system that is not hell bent on dominating and bullying these behaviors into change via punishment.  It looks at the manner in which the current social system oppresses and marginalizes.  Mainstream supporters, often impassioned toward bullying because they are fearful that if they don’t, they may cause irrevocable brain damage; social loss; or lead to permanent incarceration; or homelessness. Many such helpers may later look at the effects of their best intentions and declare: incurable disease proven.

While the experience of psychosis is involuntary, hospitalization, forced medication, seclusion and restraint so often result in a sense of feeling punished.  Too often the observable benefits of medication, which I do not argue need to be entirely disposed of, are heralded as the only hope for improvement, and treatment ends up being forceful in ways that can exacerbate trauma.

For some forced and in a state of emergency, clinical culture that records notes to justify payment may seems to resemble a U.S. prison with a diminished sense of justice and no sense of the potential for recovery.  One of the reasons for the oppressive culture that develops is an odd sense that acknowledgement or inquiry about the world that exits in the rabbit hole will make community members worse.  Thus, if one of those individuals receiving Special Messages starts to express themselves in ways others may not understand, they get halted.  It might bring up trauma that these people cannot handle.  Notes get written about that person’s ineffectual manner.  They get repeatedly told about how to behave as though their true experiences have not valid meaning.  They may be directed to focus on little kid things like hygiene in ways they stop listening to.  Oddly, hygiene may get worse in rebellion.

I recall early in my career a woman staying at a crisis house I worked in saying, “Okay, it’s time to clean the cans!” Throughout the day she had made reference to cleaning the cans and I had no idea what she meant. And, then, as she dunked the brush into the commode she exclaimed in the most oppressed of manners, “when they tell you to clean the can, you clean them . . . clean the cans, clean the cans, clean the cans.” While at the time I think I managed to handle this in a way so that we both had a laugh, her point reverberates in my mind: why listen when your sense of rights and ownership in the poverty of your board and care home or single room occupancy hotel remains. Why do what you’re told, when you don’t get anything for it, not even a safe place to live with some young kid telling you what to do.

“Don’t go down their rabbit-hole,” is the best advice of the well-intentioned, best educated of our clinical experts.

“Establish a relationship by separating your understanding of reality from theirs,” is the pervading mentality by CBT for “psychosis” experts.

While this wisdom may be the best psychiatric folks can do because they don’t understand processes of “psychosis.”  This work seeks to change this.

Excerpted and revised

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I’d like to think that if therapists like me who have been farting around with psychotherapy for twenty years or so, might be able to improve the way counseling theory is taught in graduate school. Ideally, I would like to support the development of theory that address social ills. I have found myself feeling this way when I think of all the different misconceptions that I have endeavored in over the years. Now that I have established my niche and am advocating for new movements and theories that make most sense to me, I am finding myself wanting to help budding therapists learn how to conduct the art of psychotherapy in ways that help solve pressing issues, not just apply a scientifically proven technique or pass a test.

I think psychotherapy has made a break through to some extent that doesn’t get talked about. More and more theory is being constructed that help therapists solve problems rather than exhibiting panacea proclamations. I consider panacea theory to be what I was taught in graduate school: in its most postmodern form it includes narrative and solution focused therapies. Panacea theory was often remiss to really address social ills as they exists in agencies and on the ground. I think the onset of what I would call problem-centered approaches began with movements like DBT and Motivational Interviewing.

Problem-Focused Therapy instead of Panacea Therapy:

And I think if we look at what works about the problem-focused therapies that already exist, we can learn a lot about not only about how to solve real social problems, but also how to create theoretical elements that actually help teach other therapists in ways that enhance their art of psychotherapy.

While it is clearly arguable that Evidence Based Practice represents the move in the problem-focused direction, I think that that movement is missing the genuine insight about what works in the art of psychotherapy. This may be due in part to our past of panacea proclamations mixed with big ego and money making desire of theorists that genuinely corrupt the movement towards health. But the idea that a movement must bear scientific proof and create fidelity measures that are imposed on the practitioner oversteps the utility of a theoretical model/movement. Perhaps, I have just seen fidelity measures fail to filter down too often to really understand their genius. However, it seems to me that this runs the risk of leaving community mental health in a state of being constantly and inappropriately experimented on by workers who are taught to listen to an organization or a science more to than their true self and their humanity.

To put it simply, I am only arguing the problem-centered theoretical movement needs to know when to teach and when to leave the psychotherapist alone. I think a good movement needs to create jargon that gets taught and understood in a way that defines and understands the problem and proposes direction for solution.  It needs to be a set of information that once known, enables creative and spontaneous technique to flow from within the practitioner’s character and towards the local circumstance that the individual is dealing with.

In my mind, fidelity focused techniques that are applied may fail to pay regard to both the therapist’s persona and the unique cultural entity that is a participant and the social context that surrounds them. I don’t see this being understood by everyone who follows fidelity techniques and I feel that there are times this can distort real authentic connection. As Evidence Based Practice exists now, many therapists can walk away from an encounter having applied the best practice technique feeling satisfied that they have done their job, without having any idea about how and whether it works; and the blame for failure once science becomes involved, ends up all on the participant, not the therapeutic movement.  It is the reverse of what reality is and it encourages practitioners to burn out.

Material that Inspires Spontaneous Techniques verses Scientific Notions:

Consider instead what Marsha Linehan has done in redefining elements of complex trauma and proposing solutions that enable the therapists to be themselves and complement each other in structured ways. This does not mean DBT is always going to be perfectly conveyed to the recipient.  There is plenty of space for there to be Damn Bad Therapy going on by personalities who are not good fits or by a failure to truly validate a subject, but in my mind the material does not claim to have control over this.

Speaking for myself, I have worked up an internalized sense of my own definition of “psychosis” along with complimentary solutions. I have done this based on my own experience in running groups for “psychosis” over eight years.  In doing this I have found that new ways to focus on treatment have started spilling out into my personal work in individual sessions. In doing this I find myself driven to use spontaneous techniques with a clear rationale for how and why they may be helpful to the individuals I work with. If they miss, I try again. I believe that with any kind of redefinition internalized that different people can make different kinds of techniques and interventions. Techniques need not be studied and applied, they need to flow out of authentic moments. And material needs to be created that inspires one to do this.

The more group leaders do what I have done, reconstruct the problem and accompany it with directions toward solutions, the more they will be able to focus on the cultural art of psychotherapy. Original techniques may come up naturally in the creative and spontaneous moment and will be more likely to work. The more that a student studies or is forced to utilize someone else’s technique, trying to apply them in a scientific manner, the more frustration and burnout and bad therapy is likely to result.

Supporting Counseling Theories that Address the Real Social Ills:

I am not arguing that the time spent studying panacea therapy is an entire waste of time: it has clearly been utilized in the eclectic approaches in DBT, MI, and the approaches I am developing towards work with “psychosis!”  But still, I think a lot could be done in the teaching of it so that misconceptions do not become institutionalized in a learner’s head.  Thinking that you must scientifically replicate a Minuchin or a Fritz Pearls is a misconception that I was taught on several occasions. Perhaps if I had continued in school, I may have learned this is not a valid contention. But I also think studying yourself as a person is also extremely important in addition to studying a theoretical model. And constantly questioning and reflecting on the errors of what you are doing is likewise necessary, even when they fit the standard of care, is extremely important

But, I’d also like to argue that right now there are major vacuums existing with for which problem-focused theories are desperately needed. Clearly, I feel “psychosis” is one of them, but so too is there a vacuum for OCD: both are highly neglected due to the western worlds institutionalized past. Of course, there are many other problems that could be addressed like psychopathology and socio-pathology if our society was not so influenced by concentration camp businesses like the prison, pharmacological, mental health, and drug war industries. Ultimately, these are some the issues that Counseling Theory most desperately needs to address.

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