I contend that the trendy depicton of psychosis as a thought disorder misleads the public and can lead to misunderstandings that sabotage treatment efforts. I am writing to suggest that psychosis should not be defined as the result of spewing distorted thoughts that need to be corrected, but is actually the result of uncanny perception and efforts to cope with that perception. I think that people who relate to those who experience psychosis need to understand that it is perceptual triggers that lead to self-sabotaging thinking and distress. Recognizing those triggers can be key to better strategies for coping.

Even the most advanced research on schizophrenia, which suggests that it is a neurodevelopmental syndrome rather than a psychiatric illness, alludes to the thought disorder narrative. I suspect that this is a political act of supporting the best practice of cognitive behavioral therapy. I am personally in favor of a therapeutic approach that is specifically created for people who experience psychosis across diagnostic divides.

For example, in her groundbreaking article in The Psychiatric Times, Sophia Vinogradov, MD suggests that the problem is cognitive:

We now understand that these are neurocognitive disorders (ie, how neural systems in the brain represent and process information). We also understand that they are neurodevelopmental disorders with genetic components and antecedents during gestation. The developmental course unfolds with increasing signs, symptoms, and cognitive dysfunction . . . (2019).

When problems are depicted as cognitive as such, the conclusion is that the thinking is faulty and that thoughts need to be changed. Too often, people hear this and believe that all such thoughts are incorrect and must be stopped. This can cause pressured and unhelpful communication. I think it is more important to listen and understand before there is an effort to challenge thoughts.

The Importance of Exploring the Meaning of the Experiences to Engage a Sufferer:

I intend to delve into better defining what psychosis in this post and will highlight the importance of other processes beside irrational thoughts that go into a “thought disorder.”

I have come to believe that experiences that cause the thoughts are valuable and need to be further explored for meaning and understanding.

I experienced a two-year crisis during which I thought my family was a mafia family and was persecuting me. I can attest that admitting that two years of my life were wasted on meaningless blither was not a way to engage me in meaningful change. Moreover, although I did need to change and stop making meaning of many things, I have since found that I learned a great deal of meaningful things during those two years that currently enrich my life.

Behind me, sits my eleven years of experience running professional groups in which I revealed my own experiences with psychosis. Behind me is also an international movement called the Hearing Voices Movement that has a considerably longer history.

The Experiences of Psychosis Fit into Different Causation Frameworks:

Those of us who learn to openly share experiences in group therapy, learn a host of different explanations for why our experiences are happening. The hearing voices network define these as frameworks. In other words, experiences are often interpreted from a framework and I am going to characterize five styles of frameworks that are representative of thousands of individual examples.

Often, experiences are perceived based on the dominant framework that the sufferer trusts the most. The framework often dominates the sufferers mind and makes it hard for the observer to even know the experiences that exist beneath the surface.

The first framework that I am going to present is that these experiences can come from spiritual experiences. Perhaps the magical perceptions seem to come from good or bad higher powers, depending on the tradition. At times, good and bad guidance may be mystical and at times those experiences can be erroneous. Experiences that are wrong can be characterized like Carl Jung’s concept of a trickster, they can cheat the sufferer and cause material loss.

All spiritual traditions include the concept of a trickster. Often, it can be hard to tell the difference between mystical wisdom and tricksters. Learning how to manage spiritual feedback takes time and training,

The second framework that often influences message receivers is the concept of political oppression and exploitation. Sometimes, and far too often, there are real people who belong to secret societies that are behind real abuse and marginalization. Consider a treatment team that meets without the patient present and misrepresents that person and extends their hospitalization!

Also, there are powerful government conspiracies that involve secret societies to prevent rebellion and promote public misconceptions. For many frameworks there are criminal, governmental, or intergalactic organizations that work to control the environment. The concept of targeted individuals validates and expresses the realities experienced by many sufferers. Such alternative realities suggest the phenomenon of gangstalking. Thus, learning to stop challenging power can help.

The third framework that is important to note is that there are ways that traumatic events and dilemmas can cause the mind to fragment and re-experience trauma. Differentiating trauma from the reality of current situations can be a lifetime project. This becomes a real issue that most people who experience psychosis have to deal with.

The fourth framework that is often used by treatment providers is that experiences are made up from unconscious psychological processes in the mind that may be related to attachment or fractured personalities. Such frameworks suggest that experiences are made up in the individuals head. Some people respect them and seek to explore and integrate them and some people just think they need to be ignored as a result.

Finally, there are scientific processes in the body that may be behind faulty thinking: misfiring of neurons, schizophrenia genes hidden in DNA that make people permanently impaired. Of course, there are more positive scientific frameworks out there like that some people have spiritual genes that are likely to get persecuted, or that some minds have an ability to perceive on the psychic energy of others, through observing scientific gamma, delta, or other radio waves rays that bounce off the body.

All these different frameworks represent different ways underlying experiences can be explained. Take an experience and put it in a different framework and the meaning of the experience vastly changes. Sometimes hearing thoughts without understanding the framework and experiences that accompany them can make the thoughts appear wildly distorted. Additionally, sufferers tend to get locked into a particular framework that adds to a tendency to interpret experiences in ways that may appear incorrect to someone who hasn’t listened and understood.

In fact, I like to argue that people like me who think the world is against them can lead lives in which the world really is against them. Telling them they are thinking wrong or that those underlying experiences don’t matter becomes invaliding and may result in further trauma and sense of alienation.

Learning the Value of Different Frameworks Can be Used to Disempower the Experiences: 

I believe people who experience different frameworks in the stories of peers can learn to diversify the manner in which they interpret their experiences and begin to see how they come up with thoughts that appear faulty to the mainstream. Ultimately, I think that using different frameworks is necessary to take away the power of the underlying experiences so that a person can function in the social world.

In making such an assertion, it is arguable that there is real benefit of sitting in groups and hearing people’s stories. I believe it teaches a participant in a different manner than a genetic researcher learns through looking through a microscope at the neuroplasticity of neurons. One thing that I have personally learned from running up to three such groups a week over the years, is that people are extremely unique in the way they come to cognitive distortions.

It takes a great deal of work in order to open someone up to talking about their private experiences and to consider listening to others with genuine curiosity. Often, it is important to forget everything we know and listen with a psychosis mindset to make sense of another persons’ experience to draw out the story so that commonalities can be displayed and observed.

One thing that I believe is toxic in such groups is when a leader tries to impose their reality on participants. It is different for example to learn about a different framework by listening to a peer than it is to being told that your experiences really definitively fit a different framework. I believe all frameworks have merit at different times. Just because you know what works for you, doesn’t mean you know what works for someone else. The danger of overgeneralization is a valid concern.

That is why I really like a principle that the hearing voices network advocates for: participants are to speak from their own place of knowing, not the sense of knowing. I have used my experiences of learning from others to stop jumping to conclusions about my experiences and to wait and see. Thus, I am more mindful of my experiences and less attached to them.

As such, disempowering the experiences is helpful, but sometimes to do this it becomes important to pay more attention to them and rationally solve the problem of what is going on.

Identifying the Types of Experience that Lead to Cognitive Distortions Can Help:

It has also helped to do significant work in groups defining examples of underlying experiences. I call these experiences special messages. They include not only voices, visuals and tactile sensations, but also other experiences that trigger conspiracy ideas. Special messages are things like intuitions, premonitions, body language and use of codes and symbolic associations that hide alternate meanings. Some of us have gifts of knowing things that we become overly dependent on and that cause us to get focused on these experiences and trying to learn how they are possible.

Special messages provoke thoughts particularly when the person is trying to figure out what is happening. I define this as a state of sleuthing and the hearing voices network define it as making meaning. When multiple messages are happening fast the experiencer can get an internal buzz of trying to figure out experiences that only leads to having more and more experiences. It becomes very hard to distract from these herd-to-contain thoughts. So often the thinking fits a singular framework. The thinking and thinking about the experiences coupled with the way the public reacts to the person experiencing the thinking can turn the thoughts into distortions.

The interesting thing about the experiences is that they can often be preconscious. Indeed, the person can be more aware of what they are thinking than what they are experiencing. Of course, the thinking can be influenced by a framework and past experiences that have influenced the formulation of the framework. Thinking can affect behavior and cause the person to be treated in negative manners that add to and confirm the framework suffer. This can increase the power that is given to the underlying special messages experiences and the state of sleuthing and making meaning of what is happening.

The experiences will always happen. They can be real and at times hurtful. Additionally, the more a person sleuths or makes meaning of them, the more vulnerable they become to being impacted by more experiences, or special messages. However, sleuthing in community with others forces the sleuthing process to slow and be better defined. Moreover, doing so with support of others can help the sufferer solve the problems and make changes that can help them transform out of the emergency state.

How Behaviorally Changing Relationships with Underlying Experience Can Help:

Whether dealing with a bullying voice, a negative outcome, a bad energy perceived, or distressing serendipitous occurrence, there are times when the sufferer can be coached to change their behavioral relationship with the underlying special message experience. Talking back to the voice, or humbly adjusting to the situation can be exactly what is necessary.

If this is to happen the message receiver must spend time increasing their awareness of messages and changing the behavioral relationship they have with the experience. This can be just as important as challenging an irrational thought. In fact, it might be necessary to do before rational thinking can be expected.

Challenging Internalized Stigma Can Help:

Clearly there is an element of cognitive dysfunction experienced by those who experience psychosis. However, I believe that a majority of that dysfunction comes from the social definition of schizophrenia as being a progressive illness that gets worse over time. This misunderstanding of psychosis is so rampant in our culture that it leads many to stigmatized views of a sufferer’s abilities that then get internalized. I contend that a majority of these negative beliefs are reinforced by the way associates and mental health workers start to treat their subjects.

While clearly the level of support varies a great deal in a person’s experience, the negative treatment that people experience and the fear of schizophrenia often can set up the basis for extreme cognitive dysregulation. Thus, countering these stigmatic realities with support that emphasizes rational thinking can lead to help. However, getting people to use rationality as a tool to help balance them and increase their resilience does not prove that the problem is a thought disorder.

Conclusion:

I believe there is a lot more to recovery from psychosis than just depicting reality as being rational thoughts. Many philosophers argued against rationality. Hence, I am arguing that depicting the problem as a thought disorder is misleading.

The post Depicting Psychosis as a Thought Disorder is Misleading! appeared first on Redefining "Psychosis".

In creating a new definition for psychosis, I contend that we not only consider internal processes operating during psychosis or special message crisis, but also external ones. Though much of the eight-part definition for psychosis I propose is, in fact, internal, the last three components are not. This article is about the first two of these external components which involve studying the external behaviour of message receivers, or retaliation reactions, and the external behaviour of society, or social sanctions.

Ultimately, I will argue that by studying behavior openly in group in this manner, we can learn to reinforce the message receiver’s learned behavior of suppressing evidence of messages to the public. Crediting the message receiver for things they already do helps build trust and safety that can ultimately aid in developing strategic social skills that can help message receivers make relationships with tormenters. The development of these social skills I jargonize as nine social skills. To teach nine social skills a supporter needs to conspire with the message receiver and learn what those unique skills might be.

For recovery to happen, message receiver will need this nine-social-skill concept to promote social rehabilitation relationships with people who would otherwise torment them. I will argue that what is most needed for a behavioral recovery is supportive places where message receivers can strategize developing nine social skills. I will share the nine skills I have selected for myself.

It is my contention that if treatment providers and family members learn some of the lessons that come up in group, they would be able to better support healing in individual interactions with message receivers. Thus, I will contend that studying different types of behavior via reading this article is helpful not only for message receivers but also for supporters.

Retaliation Reactions:

I believe that having message receivers identify the actions they have committed that has gotten them punished in the mental health system is very important. However, in most cases the discussion of social sanctions is needed first. Consider that it is easier to complain about the ridiculous treatment that you received than it is to own what you did to bring it about. Message receivers are often used to having responsibility imposed on them. It is wise not to replicate this in creating a safe healing environment. Thus, retaliation reactions and social sanctions often need to be studied in unison.

The definition of retaliation reactions is important to review. Retaliation reactions means acting as if your special messages and especially your divergent view are true. Thus, in a fluid story, using the previously discussed solution of message mindfulness, the articulation of the special message experiences and divergent view thoughts might be necessary. From the story telling process, the leader might have to extract the retaliation reaction behaviors in a normalizing shame-busting manner. Thus, peers can relate telling their stories and consider the actions they did that started the process.

Ideally starting off the topic with a list of examples can help. Consider using the following list of retaliation reactions:

• Glaring with angry eyes
• Not sleeping
• Being overjoyed in a way other people don’t understand
• Looking behind you for the possibility of tails
• Making gestures of prayer
• Talking with voices in public
• Treating others as if they are CIA agents
• Sweating or laughing excessively about spiritual coincidences
• Raging or ranting about an injustice that others would question or call the “D” word (delusion)
• Talking in codes so that the people broadcasting your life on TV won’t be able to understand what you mean.
• Treating someone in a way you wouldn’t otherwise.
• Crossing against the traffic to make a statement.
• Barking at a passing bicycle because you are angry like a dog (which is god spelled backwards)

One can imagine how bringing up these behaviours provokes larger stories. At times, the action on the part of the message receiver can be very minute; but identifying and acknowledging involuntary actions that led up to being punished is healing and fosters responsibility and discernment that can reduce a sense of trauma. Having peers or supporters bare witness to the suffers perception of what they did and how it relates back to special messages and divergent views can be very eye-opening.

What was the message receiver experiencing and thinking at the time and how was their behaviour misunderstood? If they did have violent behaviour, did the punishment fit the crime? How did the fact that they were identified as mentally ill message receivers affect the society’s system of justice towards the deed? What were the positives and negatives of the process? Creating a warm environment where these kinds of questions are weighed, makes for a restorative justice experience. It might be very healing just to have the message receiver’s version of events considered.

I have witnessed that it can be very challenging for some supporters to let the story be told without saying something that will cause the message receiver to be punished again. Thus, I urge facilitators to maintain unconditional positive regard and to normalize reactions by being able to identify times they’ve acted in ways that are less than admirable. Indeed, participants will feel invited to share if the leader shares. Many participants may wait to see if they will be punished for sharing before they take the plunge.

Social Sanctions:

Though some may object to the idea that treatment is punishment, I have observed that most message receivers I work with see it this way. Even when voluntary participants are complicit with treatment and report good outcomes, there might still be an invisible process of institutionalization that influences them. Additionally, compliant clients have observed non-compliant clients and can stand to reflect on that. Even if this doesn’t tip the scale, most message receivers can relate to a sense of being punished that happens in interpersonal relationships in the community. As mentioned in the last section, the sense of punishment needs to be brought up to get the message receiver to identify what they did to bring on punishment.

Again, a personal story from a facilitator is a good way to get the ball rolling. The facilitator might start with something that happened to them and then admit the behaviours they did to bring forth the social sanction. Additionally, the facilitator might consider using a list of potential social sanctions to help the disclosures start to flow:

• involuntary hospitalization,
• seclusion,
• restraint,
• bruising handcuffs,
• physical abuse
• 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

The group facilitator is wise to assess for the experience of traumatic recall as the stories are retold. The facilitator might consider strategies such as starting and ending with a grounding exercise, encouraging participants to be aware of the pain in their bodies, and warning participants to use discernment in deciding the full extent of the details to include.

However, I tend to verbally presume that message receivers are tough and can handle these talks. I not only consider this as a way of setting a brave tone for the group, but I have also witnessed that message receivers tend to experience relief and that normal observers or trainees are the ones who get traumatized.

As a result, I start the group, generous with details of my story to set the tone for sharing. I often talk about how I used to struggle with dealing with these details but have learned to share with practice and that I find the process to have significantly helped me. With the story, I bounce between retaliation reactions and social sanctions simultaneously as the details are often fluid in the play by play recount.

When message receivers get to the point where they can review and identify the punishments and the behaviour that led to them, a lot of healing can result. Reviewing the consequences of retaliation reactions seems to help many message receivers gain acceptance of traumatic content.

Starting the Behavioral Solution Process by Proving that the Social Sanction was Unjust!

Message receivers can often be observed experimenting with getting away with retaliation reactions to try to establish safety. When this is observed, know that it is a very important test! I believe if message receivers are provided with safety and support, particularly in a group or a supportive community, they will halt this retaliation reaction behaviour in the community and everyone will be happier. But before this happens, they may need to establish that the punishment of what they went through was unjust by establishing a relationship where their retaliation reaction is accepted, though, perhaps toned down.

Sometimes mirroring the retaliation reaction behaviour and accepting it, may lead message receivers towards a path of disclosure that might one day lead to a sense of safety. However, that is not to say that many message receivers may have a provocative tendency to stay quiet when they are invited to share and to share when it is inappropriate and not safe. In safe treatment this needs to be allowed. It needs to be acknowledged that this is a trust test. I like to celebrate retaliation reaction behaviour with mirroring and humour.

I qualify these comments on managing social sanctions with acknowledging that these stories may be hard for supporters to hear. It is true, in my opinion, that too often they go invisible and the stories of treatment providers or family members rule the day. That’s why I argue that it is a service to get these stories out in a group.

Studying Learned Behaviors to Reinforce them and Prove the Sanction was Unjust:

In preparing to review solution behaviours that involve nine social skills and forming relationships with tormenters, I am learning late in the game that it is valuable to study behaviour that message receivers arrive at to avoid trouble. This may be behaviour that scared participants exhibit at the beginning of a group process. Learned behaviours evade trouble but neglect the need for genuine relationships. In doing this message receivers will also need nine social skills to approach people who are punishing them, gain acceptance and correct the wrong being done.

It is true that message receivers are a diverse group of people and it is hard to generalize. People with positive message experiences or a strong counter-cultural affiliation may vary in their sense of utter alienation and need to connect with perceived punishers. But still, I believe that recovering message receivers must learn to pay lip service to consensus reality and therefore will hesitate to share their genuine selves in a group. They may be particularly challenged with the task of studying behaviour and on being mindful of special messages and divergent views.

Thus, listing learned behaviours that message receivers have can be key to unlocking stories of social sanctions and retaliation reactions. Indeed, listing learned behaviours also may convince participants to be more mindful of their message experience and divergent process in general. The point of highlighting learned behaviours says they are valuable and necessary for survival, but in another sense, it is a way of designating that it is safe here, that we can communicate in a way so that retaliation reactions won’t be dealt with the same way they were before.

In yet another sense, identifying learned behaviours is a way of sharing all the old tricks and highlighting the inherent stupidity of the way message receivers have been treated in the system that has worked to silence them. It is an invitation to share amid a culture of like-minded people and explore forming social relationships with people regardless of the fact the culture has been treated like untouchable outcasts. It is readying the message receiver to enter a slow steady movement of resistance that will enable them to penetrate normal enclaves and operate within them to create a social rehabilitation which can sustain the message receiver in society.

Ideally, the facilitator can start the process of studying learned behaviours by revealing a few tricks message receivers may relate to and encouraging group members to join in the process. To start the process, I will share a list I have started:

• we must lie about our experiences and thoughts to stay free
• we can’t talk about our divergent views without going to the hospital.
• we will be persecuted for our problems and as a result we will be more tempted to focus our attention on our special messages
• we don’t think we have experiences that cause our thoughts, we only have crazy thoughts
• we don’t have people who care about us if we speak up
• we learn to tell Psych ER that the voices or suicidal thoughts are loud when we need to be admitted
• we must learn to say the voices or suicidal thoughts are distant or vague when we want to get released
• we learn that we deserve to be neglected and are second-hand citizens
• we might as well not try, and just accept what we are given to avoid conflict
• we shouldn’t count on being able to depend on recovery and reality tasks to feel better
• we learn that we are better off withdrawing from social engagements
• we can’t trust other people who have message experiences, they are crazy and will burn us or ask for money and cigarettes.
• we must submit to normal people and play dumb, maybe with a little flair/humor
• we must be gamey to build trust with you

Nine Social Skills:

It is my contention that forming social relationships with chronically-normal people who might stigmatize us is necessary for social rehabilitation. Whether this is done through work, a consumer organization, a treatment team, or an activity focused meet-up social group, message receivers need to form relationships with people who can help them avoid the streets. To do this, they may have to practice social skills not only that are specific for message receivers but that are also particular for themselves. These social skills might not be the same as social skills that normals need to get ahead.

When I first started to work through identifying these skills, I tried to make them universal for all message receivers. However, I have been blessed with the opportunity to work in diverse circumstances and have come to see that my efforts are more personal and applying mostly to me and the self-directed life I have chosen. Thus, I suggest that message receivers create their own set of skills that work for them. Some of the nine skills I might utilize might work for some, but not for others. These are skills that can help someone climb up and out of the hole that mental health treatment, poverty, or internalized stigma has dug for them.

Appropriate Skill #1:   Learning lessons from being punished or unjustly victimized

I learned from a great many consequences for the retaliation reactions I committed.  While I had to suppress a lot, I needed to consider the consequences of committing retaliation reaction behaviour, so I didn’t lose the cultural capital gains I had made. This is made easier when it can be established that the punishment is unjust.

Appropriate Skill #2:   Maintaining a public- professional self

I was lucky to learn along the way how to be a professional counsellor. I had to learn to play that role on a regular basis despite a huge amount of ridicule and disrespect.

Appropriate Skill #3:   Killing stigma with kind social skills

I consider these bitter customer service skills that are ways of putting a tormentor on a pedestal no matter how ridiculously unjust the world is. It involves asking each rude customer if they would like a fork and knife (forkin knife) or a free piece of chocolate on you.

Appropriate Skill #4    Hanging in there with some troubled relationships:

I didn’t have any genuine relationships for two years and needed to tolerate a great deal of abuse. So, I extended relationship efforts with many people that I had no use for, just so I wouldn’t be alone.

Appropriate Skill #5:   Skillfully know when it’s time to hold or fold the trauma card to decrease stigma

Once I earned a sense of acceptance, there was always an effective time to come out of the closet with a humble reference to mental health and trauma. Containing emotion behind the disclosure is wise. I consider Patrick Corrigan’s research on stigma when I suggest this 😊

Appropriate Skill #6:   Make multi-cultural efforts to respect the Romans when in Rome.

When my parents divorced I eventually realized there was no way to win: I started to act like my mother in front of Dad; and my father in front of Mom. I learned to have fun with this in multiple contexts. When there is no hope for avoiding persecution, we may learn to do this. But we must learn to vigilantly check this behaviour when we are trying to build social support.

Appropriate Skill #7    Using humor:

Got to!

Appropriate Skill #8    Going towards many different relationships in many different contexts

Penetrate multiple cultural enclaves and participate even if you are persecuted for different reasons. Keep on moving and you will meet people in different contexts.

Appropriate Skill #9:   Presenting a strong front instead of acting as though I need a break

I try to do this because I know I wear my heart on my sleeve and it is a way of killing the normal with kindness.

I like to think supporters who work with specific message receivers and get to know them well enough to understand their learned behaviours to the point where they can help message receivers construct skills that will help them make genuine human relationships with the people who represent psychiatric and other forms oppression to them. Some may need to do this with oppressive voices. They are going to have to do it sometime. Of course, this really depends on the culture that surrounds the person and their experience of being punished and getting treatment.

Summary:

In many ways, the solution of using social skills in recovery from special message crisis requires understanding that retaliation reactions and social sanctions are both wrong ways to behave. Institutionalized message receivers know much better than most that they must submit to normal ideas and expectations. They may not know that recovery is even possible. It is skills that enable message receivers to suppress these experiences, keep them private and create relationships that one day might become of use to them that is necessary. Those skills need to be seen and acknowledged. Then, there needs to be a conspiracy started that can dupe the ignorant majority.

However, the message to supporters, providers and peer counsellors needs to be that social sanctions really damage the important skill of message mindfulness. Treatment needs to find new ways of managing retaliation reactions. Acceptance, mirroring, and perhaps toning it down is so needed. The same old punitive treatment is not going to help. It may control people, but it does not breed safe environments in which messages can be observed and reflected upon.

Treatment needs to conspire with message receivers to teach unique versions of nine social skills. And really, as it stands now, it is up to message receivers to train the supporters how not to punish them. However, it is my belief that message receivers can conspire with each other in support and therapy groups to develop the message mindfulness skills to study the ill behaviour of social sanctions that create institutionalization.

The post Behavioral Solutions that Arise in Psychoses Focus Groups: appeared first on Redefining "Psychosis".

I fervently believe that having survivor-led group therapy that redefines “psychosis” is missing in the system.

Over the last nine years, I’ve been leading what I call special message groups in multicultural settings. I have found that such groups can be run safely and have the power to transform lives. However, I do admit that when it comes to kicking people out of group to maintain group equilibrium and safety that I believe there are a few things to consider first.

Firstly, I believe that a group leader needs to be prepared for the fact that mad people show up in very different ways. Group facilitators need to be familiar with and recognize a wide variety of presentations or manifestations. Perhaps group members may feel like they are being mocked by others in the group via illusionary ideas of reference or even controlled by them. They may code up their language for protection. They may treat the facilitator as if the facilitator can hear the same voices they hear. They may not believe, in spite of stories shared, that the facilitator has experienced what they have.

I have prepared myself for these challenges by attempting to better define “psychosis.” I have reconstructed a definition that can sync up a wide variety of what have historically been defined as conditions. I believe if the leader is not prepared to accept all presentations, people will not feel safe talking about their experiences. Intolerance for people who show up in a different or what is perceived as a difficult manner can be extremely hurtful.

Secondly, I believe the facilitator can take measures to help train the group to be brave and tolerant of each other. I frame coming together with the specific purpose of sharing untold stories to be an oft neglected privilege that has unfortunately been denied because the “they” experts say it is not safe.

Spirit of Risk Taking

I am always willing to start out with my own story. I advocate for a spirit of risk taking by acknowledging that people in the group may be so used to dangerous or distressing experiences that guaranteeing safety would be a disservice. I also point out that despite what “they” say, this practice has been an effective movement in different countries and I’ve done it for a long time.

These kinds of comments are treating the “set of symptoms” as a neglected culture that is subjugated. In the earlier stages of group development, keeping the group focused on the things they have in common can help. Also, strongly supporting alienated individuals helps train the group to be more tolerant and can help avoid many problems that come up later in a group. It discourages them from expecting a trouble maker will be kicked out.

Thirdly, because there is a high degree of diversity in the mad community, I believe the facilitator needs to be extremely sensitive to all forms of culture, particularly pertaining to relevant issues of subjugation. Discerning the social factors that are affecting the person shows up in a difficult manner is key. Race, class, gender, sexual orientation, age, religion, education, legal justice history, substance abuse history, immigration, gang affiliation, disability, employment history are all social factors that can show up

It is wrong, I believe, to exclude someone because they are testing or trying to teach you about these kinds of issues. Some people may try to dominate the groups. A group facilitator needs to be prepared to accept, learn and support everyone. Again, a person who is not accepted on the basis of something that the facilitator is ignorant about or is not curious to explore, may do harm.

Fourthly, it may be necessary to meet with individuals outside of group to learn more about why they are hurting the group. If a group member is dominating to the point he or she is doing intentional harm, that individual may, in fact, be expressing a need to connect with you.

Perhaps, he is experiencing messages that are extremely misunderstood or there is a cultural issue with you that needs to be talked about.

But when the group is truly becoming unsafe for participants, which is rare, out-of-group meetings are necessary and the facilitator needs to work to better understand the problems that come up in group and clear up any cultural issues.

A meeting could involve two individuals. Making the time for this encounter outside the group is an important resource.

Behavior Contract

Finally, if taking the time for a meeting or two doesn’t improve the behavior, the leader can propose a specific behavior contract to protect the group. This approach is best utilized in real emergency circumstances and needs to be devoid of the leader’s cultural biases to the best of his/her ability. This approach is also something that requires the participant’s input so that the problem can be identified and an agreed upon solution can be proposed.

At the very least, the contract needs to be something the participant can buy into. When the participant takes the power to get involved, consequences can involve sitting some groups out or being referred to an individual therapist or perhaps a different group.

I’d suggest that if the participants take steps outside the group to improve themselves, the leader can be in communication with them, pining for their return.

It is true that many people who suffer from “psychosis” or message crisis also have complex histories, trauma and other co-morbid problems like substance abuse and nuero-diversity. I have seen these kinds of complex issues, that may challenge safety, get addressed within a group process as described, even by survivors who visit programs rather than work in them.

The post How to Keep “Psychosis” Focus Groups Inclusive: appeared first on Redefining "Psychosis".