Completing eight-hours of the Journey Through Madness Workshop in the month of November was a great learning experience. It was a humble but auspicious beginning for what I hope to be a fruitful effort to train people how to feel comfortable going down the rabbit hole with someone who has extraordinary experiences and extreme beliefs.

I was wrong about the fact that eight hours would be enough time to complete the whole training. I don’t think I completed a half of my material.

I also started with four and ended up with two loyal participants who want to complete the whole training. I now have four two-hour tapes that can be viewed on YouTube.

By the end of the training, I became comfortable with the situation and started to enjoy presenting the work. In the beginning I plowed through significant social anxiety that may have interfered some with the quality of the product.

I believe my work can transform a person’s perspective and ability to work with people who have a break from reality, and many others who have had extreme experiences that haunt their current relationships. I believe understanding how people who experience a break come to believe the things they do is useful to humanity. It humanizes the process when participants learn how they can relate to the experiences.

However, I also learned that my participants need more time to complete the training before they truly feel confident managing the anxiety associated with going down the rabbit hole.

Turns out I will need at least sixteen hours to complete the full training and plan to pace myself during recording sessions. I will need to do a little better with recruiting participants and deepen the pool of interested parties. I believe I may achieve this by recording one Sunday night a month.

Keep in touch with the Sign Up for the Journey Through Madness Workshop box on my website at https://timdreby.com/product/masterclassfor the latest in your opportunity to participate.

The post A Humble But Auspicious Begining . . . appeared first on Redefining "Psychosis".

How To Be A Healing Presence Without Becoming Anxious, Power-Struggling, Or Referring the Mad Person To A Hospital

How It Works

Starting this November in two-hour sessions on Sunday evenings, I will teach you a new model for understanding psychosis that will help you be able to relate with a person in madness in a manner that helps them heal. We are looking for nine volunteers who will receive the training for free in a webinar format on zoom. Volunteers may be professionals (including peer counselors) looking to hone their skills, family members seeking better relationships with their loved ones, or people with lived experience who want to share their perspective and contribute to a new model. The sessions will be taped and edited and eventually sold at an affordable price. Come bring your stories and perspectives to the discussion, ask questions, and we will all learn in community.

Here’s what we’ll go over:

Week 1

• How listening to stories and reflecting on commonalities helped me deconstruct experiences into solvable problems and formulate the structure of the rest of the presentation

• Why the medical model definitions lead to limited solutions and ultimately to the poor outcomes, stereotypes and the dehumanization we see.

• The way the thirty differential diagnoses that include psychotic experiences in them may have kept us from creating a counter culture and focusing on solutions. 

Week 2

• Why the notion that this is a thought disorder is wrong, and the importance of considering the conglomeration of experiences that cause one to experience a break from reality.

• The reason trying to stop a person from perseverating about their experiences by telling them that they are ill only decreases mindfulness and thwarts efforts to stop perseveration.

• Why it is often important to research and know about real government conspiracies to gain a message receiver’s trust and learn about what they think.

Week 3

• How expanding the ways message receivers think about what causes their experiences adds to flexibility and can have a positive impact on functioning.

• Learn to use what we term “the trickster concept” to likewise increase flexibility and open up faith without reality checking and sabotaging your trust with the message receiver.

• Why processing past behavior and negative outcomes is essential to help a message receiver start to accept boundaries and use the social skills that work for them.

Week 4

• How social, institutional, and internalized stigma are linked to a message receiver’s irrational thinking making timing and context important as cognitive therapy is used as a tool to help them. 

• How a mindful understanding of special messages can still be a valid part of an individual’s effort to discern reality without leading to a crisis or an emergency.

• How to use this system of care in group and individual contexts so that you can meet the message receiver where they are at and develop intervention strategies.

Hi, I’m Tim 

Early on in my 27 years of working in the trenches of community mental health, I thought I was a good worker when I did things like: 1) take care of people who were experiencing a break in reality by doing things for them to build trust; and 2) reminding them to take their medication. As I realized what people were living through in impoverished warehouse circumstances and fought for better services, I started to notice ways I was being followed by the company that owned the housing project where I worked. When I received a threat from a close friend, I myself descended into madness. I tried to flee to Canada  and was rapidly warehoused as a ward in a last resort State Hospital. I learned very quickly that madness wasn’t what I was trained to believe it was in school. I learned 1) that being treated like I was incapable of doing anything myself felt insulting; and 2) being told to take my medications was pointless; these kinds of interventions were not the help I needed.  

It was a lot harder to get ready to go back to work in mental health than I thought it would be after three months in an institution. Enduring housing insecurity, moves, and underemployment was very hard. When I did manage to get my license I started to run professional groups that explored not only what psychosis was, but also what could be done that was helpful. I used my lived experience to help other silenced individuals open up. The things we all learned in the process of sharing stories were astounding. I have documented these learnings over the past fifteen years and want to release to you my findings in a course that will help you know how to intervene when faced with someone who experiences a break from reality.   

Click to Schedule Interview with Tim

There will only be only nine to ten participants so set up your interview today

The post Nine Volunteers Can Join Journey Through Madness Webinar for Free appeared first on Redefining "Psychosis".

Over the last fifteen years, I have dedicated significant chunks of my weekend towards writing. I wrote a memoir, I developed draft after draft of my special message material, I built a website, and I grew my writing platform. It used to feel comfortable, like all this work was a natural part of my healing journey. I used to look forward to the weekends and my projects.

I recently got to the point where needed to take a break from writing blogs. I focused on developing my training so that I could teach the system of care that I have created that guides my interventions. I geared the training for providers and family members. But now I am done, and I am just not sure what to do. I am no longer comfortable creating my work. Could it be, it is time to share it?

I have suggested across my platforms that I want to build an online course and have set my website up to help me sign people up for a low-cost Beta Course so that I might practice and assess interest in this endeavor. I believe that the course will take eight hours to complete so I am starting to advertise for four Sunday evenings. I am currently targeting the month of November for this project. That would be November 3^rd, 10^th, 17^th, and 24^th 6pm-8pm PST.

The training is for providers, family members, or peer workers who are anxious about addressing comments that seem to be “delusional” in their work with people who hear voices or who experience “other” special messages experiences. In addition to clearly defining “other” types of experiences, the training provides an eight-part definition of psychosis and asserts eight solution constructs that can guide one in developing interventions.

By the time it’s over, the participant will have a system of care that can guide them in their work with others who struggle with these dilemmas. This helps the supporter keep from getting anxious or angry (which triggers trauma) and decreases the need to use the hospital to further marginalize the loved one.

I recognize that eight hours is a lot of time in our busy lives to dedicate to learning skills that will address a challenge like psychosis. It feels like a lot to ask; and perhaps that is the reason for my current sense of paralysis. But I also believe I have done a good job shaving down the material so that it is concise and fun. And understanding psychosis does take some time.

Now I’ll admit that before I decided to reach out with this email, I was trying to decide if I would be better off writing a book and using the platforms I have built along the way along with a launch plan to spread my work in that manner. I consider myself to be more of a writer than someone who enjoys looking at myself on the Zoom or YouTube platforms.

But for you, my followers, I have decided to cast these doubts away. It’s time to ask for your support to see if my work has what it takes to transform the understanding of psychosis, so that providers and family members know how to relate to it better.

The post My Training in the Month of November appeared first on Redefining "Psychosis".

https://www.blogtalkradio.com/bmorerealtalk/2019/10/18/baltimore-is-talking-live-with-clyde-dee

“Got to Keep the Devil Way Down in the Hole!”

Every week, Rev. Dr. Q and co-host, Aaron Green broadcast from the city of the hit TV series, The Wire. I was honored this week to be invited to discuss my book, story, and mental health. Click on the picture to visit their broadcast and hear our discussion.

The post Baltimore is Talking Live! appeared first on Redefining "Psychosis".

Twenty years ago, I experienced what might be termed a break from reality while I was working as a mental health worker. I worked in a last resort section 8 housing project that was rife with crime. It was called “The Hotel of Horrors” in an article in the local media.

For six months, I dedicated myself to acting as a safe resource to residents facing significant violence. I had the sense that my conduct which included alerting the press and working with local activists, was putting me and the project at risk. I kept doing what seemed to be the right thing and thinking, “I would be paranoid if I thought this action would be problematic!”

Still, my job was threatened by a supervisor who had a substance abuse problem. The pressure increased from the management company and a small segment of the residents. I decided to withdraw off the three medications I took for my hard-to-treat depression.

***

My own mental health struggles started with anorexia in high school and led to a rather impoverished and isolated collegiate experience. My best and only friend was an older recovering addict. I lived in a roach-infested apartment complex and made more friends with local people than I did with other students. However, when I graduated, I thrived as a social worker and was promoted once I put myself through graduate studies.

I was aware that I had a personality disorder that was often linked to schizophrenia. However, when I withdrew off my medication I found that I had enhanced intuition and that I experienced facts that were suggestive of corruption more intensely.

***

I called my old college friend and asked for advice and he threatened me. I bolted. I withdrew all my money from the bank, shaved my head and headed for the Canadian Border.

Sure enough, it was just as I feared! I was forced to stop to fill the tank at a gas station. Police had posted themselves at the station. “Did Mommy and Daddy say your brain chemicals are out of whack?” mocked an officer as they approached me.

I had my peaceful-ass taken in taken into custody with unnecessary pain tactics and bruised wrists. I was driven eighty miles from my car to the state capital where they turned me over to a psychiatrist to put me into a state hospital.

I first got confirmation that the mafia was in fact following me five days later after I finally surrendered to the police on a mountain pass late one night. My roommate identified himself as a Native American “hillbilly” with 130 IQ and told me the mafia was following me.

I had already met with my parents who had flown out to support the incarceration, so I told the “hillbilly” that I thought my family was the mafia.

***

I was only physically hurt once in the hospital. The beat down was by staff. My best guess was that I was outing an undercover FBI agent. I was confused. My parents were told I had become violent.

Indeed, I resisted invitations to run away with a Mexican mafia connected female who persisted in wooing me. I refused to join a white gang for protection against her. You see, I was hospitalized for three months in the State hospital. There would be icicles frozen on the inside of the window that was located above my bed.

***

When I got released, I packed the few belongings I had left that weren’t stolen, sold my car, and took a greyhound.

I tried to make it on my own. I got a job working in a daycare; but lost it when I ran out of medication. Then, I couldn’t find any work anywhere!

I had an aunt who found me a job at an upscale Italian deli in the bay area if I relocated. I moved to the outskirts boon town where housing was more affordable. I had a long bike and BART commute. I was able to use the service economy job with some help from my parents, to get back on my feet. It wasn’t easy because I had a bone to pick with the mafia and I was working at an Italian Deli with some substance-abusing rich kids, but I survived.

***

When I found myself incarcerated into a small day room for two weeks, I was traumatized. At least I knew not to accept the hospital social workers housing arrangements. Those kinds of resources are offered with the presumption of ongoing disability. Not only would I have had to deal with loss and ongoing psychosis, I would have had to languish behind the iron curtain of the mental health system. Many of my cohorts do so and end up on the streets. Many get put in jail or otherwise incarcerated and this dehumanizing treatment so often exacerbates the crisis.

For those readers who haven’t heard voices, try going through the traumatic treatment in our incarceration institutions, our public housing authority projects, or many of our board and care homes. See if you don’t come out hearing voices! I finally did hear voices after I escaped the Deli. I heard a demonic voice calling my name.

Now I am employed as a Marriage and Family Therapist and work with people in an inner-city mental health facility in Oakland CA. More and more as people are displaced in the city where I work, they end up in sprawling encampments, hard-to-get-into homeless shelters, board and care homes, bucket automobiles, and if they are lucky in a few years they may make it into an apartment in a housing project like the one I worked in. Many people who live in shelters work low wage service jobs like I did. Nowadays, it is easier for someone who has mental health struggles to fall and not be able to come back like I did.

The post A Glimpse Behind the Iron Curtain of the Mental Health System 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".

In these happier days, I am extremely thankful to have my wife and my dog with me. This Thanksgiving we have escaped the urban psychiatric backward upon which I work for a few days in Lake Tahoe. Still complex trauma must be managed. I am bound to have unpleasant holiday as memories bubble up, no matter what I do.

I may remember the first year I got diagnosed with a personality disorder. I was twenty and just out of the hospital. It was the first year I honored cultural traditions on my own. I remember sitting all alone on Thanksgiving in the roach infested inner-city apartment in Camden New Jersey writing a villanelle praying for a phone call because there was no one to reach out to. Indeed, neither my parents, who were traveling, or the female I’d just asked out were going to call.

I may recall awakening depressed the very next black Friday morning to two six-hour seasonal shifts. I might remember the ceaseless Christmas music, the selfish stress of the customers, the vat of Barney Dolls sitting right in front of the cash register I was operating. I might remember the one customer threated to throw-up on me because I was so slow. Others were free to pick the Barney dolls up squeeze them. The “I Love You,” song would play from beginning to end. “I love you, you love me, we are a happy family . . .” All day long! Three or four different dolls singing at a time!

Or I may remember losing one of those jobs because I handed out three twenty-dollar bills to three random customers. One customer even brought one back to prove I had done it. Perplexed, I’d quit the job and blamed myself. I didn’t want to risk getting fired. I’d not noticed the signs that I was likely the victim of a holiday flim-flam scheme. Poor cashiers need to have Christmas too. Forty-dollars does make a difference. They were right to target me. My family did come from money.

Or my mind might flash to the Thanksgiving I was just out of the state hospital and homeless. I might remember how I took the day off looking for work to bike ride away from the city of Fresno CA until I caught a flat. I may remember returning to town in the dark and sinking so low as to ask a worker at the cheap motel I was staying at out on a date. No longer did I care if I got any calls. I believed my relatives were mafia and had used their private fortune to facilitate my three-month hospitalization. They did not have access to my whereabouts. Though I hadn’t run out of medication yet, for the subsequent year and a half I would feel followed and threatened daily! I would be alone at Christmas with my credit cards frozen. At least that Thanksgiving, the pretty motel worker was polite about her boundaries and the fact that I was a drifter. I still remember the bitter taste of the Oscar Meyer cold cuts in my lonely room.

Of course, there are hosts of other bad holiday memories that may come up: Christmas, the years I was working seven days a week and the unstable girlfriend was giving me the silent treatment; the “festive” phone call from a cousin in which I heard her in-laws insult me; the Easter holiday I worked alone at the delicatessen because everyone else conspired to take the day off.

Not only will parts of these holiday experiences flash in my mind, they will mix with current stressors. For example, this year we had a well-loved co-worker suddenly die of sepsis during a routine operation. I work on an urban outpatient psychiatric unit. Supporting the clients through this stunning news meant processing violent deaths in the city of East Oakland. Imagine intimate details about a dear sibling getting gunned down in the Felix Mitchell eighties. Then, others would bring up a twenty-two-year-old cousin or two who’d faced similar demise. Imagine living in a board and care home with nothing but these memories and stories to process over the holiday. Or being wrongly incarcerated in Juvenile Hall during that grief and dropping out of school as a result.

Indeed, in Tahoe I feel guilty for being able to escape these realities and the fact that I survived what I did. When it comes to celebrating Thanksgiving, my mind skips from bad memory to current vicarious trauma, to the people who have hurt me during work politics, and then back to bad memory again.

Simple Formulas for Dealing with Complex Trauma:

I have created some simple formulas that help me endure the weekends and holidays when my head gets flooded like this. I have always enjoyed nature and hiking through my pain. One summer I was facing a lot of pain and I took off hiking for forty-six days and successfully covered six hundred miles of the Appalachian Trail. I learned that surviving natures elements is a great distraction.

I have learned that when I am suffering, I need to get out into he woods on a hike. There, I let the troubling thoughts and experiences bubble up. When I process and honor them I can accept them and move forward. It beats internalizing the choir of negative thoughts I have heard about myself over the years. Moreover, my breathing from the exercise grounds me and seeds of resilience kick in.

Another thing that has helped me endure is to acknowledge that I have disassociated through some traumatic incidents leaving me constantly mistrusting and hypervigilant. As I have recaptured a few of these early memories it helps me remember that I am not entirely a genetic mishap who must be behaviorally controlled in a board and care home. For two years I fought against everyone else who insisted this was my reality. Now I know that this is not true about me or anyone else. Sure, I was the child who never smiled, but I wasn’t smiling for a reason.

Also, it helps me to trace my relationship with the community back through my development. Ever since my earliest memories, relations with people who don’t have complex trauma are at the heart of my suffering. What saves me is knowing that my brain is different and truly hated by the chronically normal folk. I’ve got two or three neurodevelopmental conditions to prove it! Therefore, all those years I was bullied and excluded from the circle, it was because elements of trauma showed in my interpersonal relationships. At the time, I never understood why the world was so cruel. Now, when I recognize why and accept it, I can accept the choices I make and appreciate the love that I have found. I can get the chronically normal negative thoughts out of my head. I have had cohorts call me evil for my social awkwardness! I don’t have to agree. I can just say, different!

And finally, it helps to have found love. My wife gives me the space to go through my trauma on our hikes. She has nurtured other family members with complex trauma. In fact, with a history of learning disabilities and OCD, she may smile, but she doesn’t feel much better a lot of the time. She resists the invitation to gang up on me with the rest of my family during family get-togethers. I am so grateful for such a loyal companera.

However, without the support of my wife, without my writing habit, without grounding myself in nature, the judgements and true gossip of the chronically normal folk come into my head like a plague and rule the day. Judged thoughts are so much harder to let float by like a cloud in the sky. I can really see myself being depressed and frozen in a board and care home without these areas of privilege and resilience.

When Politics Bubble Up . . .

I can see that others gossip about complex trauma and poor social skills. I know it happens because I sit in team meetings listening to colleagues discuss the behavior of our patients with complex trauma. They may experience behavior that bubbles up from those painful memories. Cohorts may not understand. They may judge the person based on their pain when they are not grounded. Then, they talk about behavior out of context.

It is easy, for example, for me to hear a person who frequently assassinates the characters of others, and then I see how everyone around me is full of negative perspectives about me and my work and connect-the-dots. When this happens, it makes sense to imagine that there is a real likeliness that my complex trauma is being exploited. Indeed, treatment teams, behavioral health administrators or other forms of secret societies exist and meet!

In families, secret emails get sent, venting gets whispered-down-the-lane, and suddenly the person with complex trauma is barraged by a world of people reacting to what they’ve heard. It is a lot like being treated on a hospital unit. Indeed, the process is replicated in mental health organizations and even in some peer organizations led by those who vie to direct and manage the unit.

Sometimes in team meeting staff members can learn something helpful about complex trauma in their lengthily venting sessions. Sometimes I take the opportunity to speak up and challenge chronically normal reactions. Sometimes other workers speak up too. There are ways to endure and help heal. But we all must pick and choose our battles, or we too will be targeted.

A Simpler Formula for the Surrounding Community:

I suppose this essay isn’t only about surviving another year for me. As a marriage and family therapist I like to think I can share my story to help the chronically-normal-folk understand how not to make things worse.

Let’s not forget that some chronically normal minds might want to be in relationship with us! They may connect with us in ways that don’t stab us and make things worse. Indeed, these chronically normal folk may be our mothers, fathers, brothers, sisters, co-workers, therapists, case workers, hospital workers. People who are forced to deal with the grief we endure at this time.

Just as I have laid out a simple formula for my survival. My suggestions to the chronically normal brains of the earth is not very complicated. It involves only two things that can be avoided that would make a sufferers’ life much easier.

First, when someone is going through it, don’t tell them they are just being selfish, inappropriate, or shameful. Instead be curious about the stories behind the behavior.

Second, don’t spread an out-of-context freeze-frame of the pain we share, and play whisper down the lane with the community that surrounds. Especially don’t use the struggles against the person to rise to power. Instead try to honor the trauma and suffering the person endured.

If you want a relationship with the person you can tolerate their suffering without personally attacking them. If you don’t, that’s okay, just don’t do the whisper-down-the-lane. There are other ways to be successful.

Initially, I was not brave enough to share the worst memories I have. They involve reflecting on the people who have succeeded by throwing me under the bus in this manner. They often hold high positions in the mental health or other type of social hierarchy. On the other hand, if I were to point them out I would be breaking my second rule.

Remembering the Intention of the Holiday:

In surviving the holidays, I have no need for revenge. I am grateful to be where I am at. The best revenge up here in Lake Tahoe is to celebrate what I do have and take care of myself so I can continue to reach and teach others who are likewise suffering. The point of the holiday is to remember to be thankful. Right before one of the world’s largest genocides, the perpetrators recognized and remembered to be thankful for the kindness of their victim. For god’s sake, let’s hold on to the intention.

Sometimes when I make a biannual escape to Tahoe, I do hate myself for being so lucky! On top of other things, I have survivor’s guilt. But many people I work with on the outpatient psychiatric unit find their own ways to celebrate the holidays despite their trauma. They have ways of being resilient and the least I can do is respect them. No one wants to be pitied. Instead, I can appreciate what they teach me, accept that we all have our ways of coping, and try to be stronger for it. I celebrate with them on the unit and do not feign from mentally bringing them with me on my vacation. And those who are lost and truly suffering as I have been, may they one day find their way to some form of recovery as well!

The post Simple Formulas for Surviving Complex Trauma Over the Holidays appeared first on Redefining "Psychosis".

Sometimes I think therapy practitioners and mental health administrators don’t really think about what they are doing when they adhere to industry standards in trying to promote mental health for those marginalized in the mental health system. Whether working in the mental health system, administering mental health programs, or working out of their own psychotherapy office, practitioners are presumed via education and experience to know how to help. Many of us learn how to tout what the research says about the problems we encounter.

There is a presumption in mental health that help must be scientifically proven to be valid. At least there should be journal articles and laboratory results that validate what you have to say as a therapist. Many of us have participants who will ask for what the research says. Many of us feel compelled to keep current and familiarize ourselves with the latest trends. When we are faced with things we don’t understand perhaps we read up on it and seek training.

Thank goodness we also are all trained to think that it is appropriate to be curious and let the participant teach us things when we encounter a cultural issue. However, not often enough is this applied when a practitioner works with people who have experienced psychiatric incarceration in jails and hospitals, deprivation on the streets and shelters, or marginalization in board and care group housing. Here, practitioners with master’s degrees who have not been incarcerated, abandoned and deprived themselves need to do a lot of cultural exploration. Too often, rushing to the books to understand psychiatric oppression is likely to provide one with dehumanizing medical model constructs and eugenic beliefs.

As a practitioner with a twenty-five-year career working with marginalized populations, I am writing to emphasize an emerging trend in counselling theory and practice. In this article, I will argue that counselling theory is increasingly headed in the problem-focused direction. Additionally, I will emphasize the importance of letting this trend be guided more by culture and lived experience and less on evidence-based research.

Basing A Mental Health System on Evidence-Based Practices:

 I was once warned in the county in which I work that I could not tell anyone that I don’t believe in evidence-based practice. Indeed, in Alameda County in California, mental health recovery was once thought to be achieved through a researched method that is imposed in a top-down manner by experts who have established fidelity measures. In other words, evidence-based practice has been researched elsewhere and found to best work in a prescribed manner that must be replicated. All workers learn a practice that is taught to administrators (who must replicate it in the prescribed manner) and then the learning trickles down to the mental health worker who is taught through workshops and on the job training.

Much of the reason I criticize the roll-out of the evidence-based practices in this manner is that I worked in a failed project as an administrator. The Choices project rolled out in exactly this manner. We had three evidence-based practices going at the same time and were supposed to work together seamlessly so we would learn all three practices to a certain extent. I like to think that it did not take a researcher to know that recovery did not trickle down in this manner. But the expensive program did have researchers who helped end our collective misery after six years.

These best practices were the employment-based best practice developed out of Hanover New Hampshire (IPS Model,) the corporate peer counselling model represented by Recovery Innovations out of Phoenix Arizona and the housing-first model out of Seattle Washington, that suggests that if you rescue people from homelessness, mental health problems tend to fix themselves. As a staff, we were told that the established fidelity measures were proven to work across cultures.

Having gone through what I went through on that job, I don’t understand how best practice notions are thought to be able to cross cultural barriers. My biggest take from the terrible associated experiences was that best practices, like movements or revolutions, need to arise out of unique cultures by people who are targeting those cultures.

Evidence-Based Counseling Theories That Cross Cultures:

Back in the olden days, evidence-based research was considered an imperative part of developing counselling theories. In my master’s studies, which ended twenty years ago, the theory seemed to be touted as being functional to cross-cultural divides much as evidence-based practice is today. I learned many good theories as such that were proven to work across cultures, from Freud to Albert Ellis to White and Epstein.

For example, when I was young, structural family therapy could help children of the slums: European, African American, African, Asian, Latino and Indigenous. Across the nation, and the western world, not only slum families but also families with psychosomatic conditions such as anorexia or childhood diabetes could benefit. Anorexia was more often found in the suburban private schools, than in urban areas so the practice was statistically proven to cross cultures.

As a young therapist, I had the occasion to use some of the techniques rest assured they would work across the cultural divides. Of course, back when I was in school and learning from books than with my young twenty-something look and undiagnosed Asperger’s, I wasn’t too good at holding onto clients. But I did apply many of those intense techniques for better or worse because they were battle tested.

But were those techniques truly able to cross all cultural divides? I only needed to consider my own experience with them to know. Those techniques had ripped into my family support and resulted in the emotional cutoff. For example, being bullied into eating by my father may have worked to reveal family dynamics, but it really traumatized me that exacerbated my condition.

My parents were private school teachers and were not used to hearing that they or their kin were remedial in any way. Suddenly, it seemed like in their cultural tradition, it was more customary to throw the misfit off the lifeboat. My family had a member who has given a lobotomy a generation ago and who then disappeared into institutions. Suddenly I might be the next victim?

Perhaps, the structure that was unwittingly imposed on our Quaker boat was viewed as militaristic. The Argentinian, Minuchin, had worked with the Israeli Army. Maybe, in fact, it was a bad cultural fit. While the therapist didn’t initially let my parents throw me off the boat, I failed to gain weight and those ever-mysterious results from the psychological evaluations came back.

In fact, I have been to many therapists of very different orientations both before and after this experience and slowly I learned more about myself during the psychological evaluation of my soul. For example, I eventually learned that I had at least two distinct neurodevelopmental disorders that helped to explain my torment. I did not respond well to other schools of thought that just were pathologizing and added to the negative thinking in my head.

How Evidence-Based Counseling Theories Helped Me:

Twelve years later, I engaged in a rebellious political battle in a drug zone as a social worker. I found myself a ward of the state, confined for three months to a state hospital. I could only reflect on the way I had a series of powerful therapists use their culture to impose reality on me. I’d had to undergo quite a journey to realize that a history of having reality imposed on me resulted in degradation and a loss of sense of self. When, I was moved from the observation ward to the chronic unit, for example, I was essentially being trained for a life of degradation and abuse. I was forced to learn subservient behaviour to get off the unit, behaviour that makes it hard to be around the privileged culture of therapists.

I feel that imposing a behavioural change that isn’t wanted or isn’t possible for the subject results in subjugation and resentment.

Of course, there are many therapeutic traditions that function contrary to the view I assert above. In Uncommon Therapy, when Jay Healy explores the work of Milt Erickson, an alternate view is clearly explored. In such a model an exceedingly powerful therapist has figured everything out and knows how to trick the participant into behavioural change. Several theories work to impose a behavioural change in like manners.

Just because I have experienced a sense of feeling culturally dominated by powerful theories, doesn’t mean that other people may not benefit from them. And, so, particularly with culturally diverse people, I identify my own experience and how many therapies did not work for me. And then with a sense of curiosity and inquiry, I explore what the client’s experience has been and their view of their needs. I am not averse to an occasional paradoxical technique.

The Development of Problem-Focused Treatments:

 Since therapists have a shared history of studying western therapy movements, I think that therapy movements (or theories) are also important to explore culturally. In fact, as I have practised crossing cultural divides among marginalized individuals, I have often found that I must reflect on social circumstances about what made the therapeutic movements work to make what I know useful!

Ten years later when I dove back into the study of theory to pass my licensing requirements, I recall arguing to one of the few licensing teachers I trusted that I felt it was good that therapy theory was moving in the direction of what I called problem-focused treatments.

By then, I stopped treating counselling theory as a proven fact. I considered: firstly, who the theorist was culturally, and who their subjects were; and secondly, who I was, and who my client was cultural. Before I applied the techniques, I was thinking about how to transmit them. I figured some would fit in some contexts, but not in others. I put people first. I had learned that working eclectically with theories that matched the situation led to more success.

At the time I was leading DBT groups for individuals who suffered from complex trauma. There was a specialized treatment for addictions: AA and motivational interviewing. And there were also emerging treatments for trauma, like EMDR, Internal Family Systems, Emotional Freedom Techniques. I studied WRAP to help consumers across diagnostic divides work together to avoid public warehousing and watched it become an evidence-based practice. I figured there was a similar need to teach other therapists how to work with things like psychosis.

By then, I started to see many DSM diagnoses more as oppressed cultures that required specialized theoretical focus. I felt that different problems could be deconstructed and redefined in solvable components. This would help therapists and clients alike work together to better understand what was going on.

So, in my mind, problem-focused therapy is the new direction in which psychotherapy needs to head. The trick is to turn problems (or social phenomenon’s) into cultures, reconstruct those cultures into solvable definitions and bring people together across DSM cultural divides to work on them. Ten years ago, I could see this was being done for many problems already, just not for psychosis.

Respecting Lived Experience and Culture:

 Back when I was award in a state hospital, I was diagnosed with “schizophrenia” and given a poor prognosis. As a young social worker who had worked with “schizophrenic” clients for seven years, I could not accept the diagnosis. Misguided individuals tried to impose that diagnosis on me, but what I was going through had nothing to do with the “schizophrenia” I had observed and studied up to that point. It clearly had nothing to do with what they thought “schizophrenia” was either.

I experienced so little empathy and such hard conditions, I did not realize that anybody else could possibly have endured what I believe happened to me. I did not imagine at that time that many people across diagnostic categories really could relate to what I was going through. I never knew that one day I would see how it all went together.

For the last ten years, I have held specialized group therapy for psychosis and I have redefined what psychosis is through sharing my story and hearing the stories of others from my culture. This work has not been based on clinical trials, but a rather anthropological observation. I may be able to research journal articles and run experiments that prove what I am saying. Maybe one day I will. But what has helped me most throughout this time was my lived experience with myself and my ability to cross cultural barriers.

Many major figures in mental health have admitted that they used lived experience to develop their work. Consider evidence-based movement leaders such as Bill W., Bob Smith, Albert Ellis, Marsha Linehan, Mary Ellen Copeland, Bessel van der Kolk, Francine Shapiro, Marius Romme and Sandra Escher! I bet that others who have contributed significantly to the development of best practices have started with their own lived experience.

As a person who spends all my work day at practice, it feels odd that my work is often discounted. I did run a successful research grant to prove the validity of my approach but many of the marginalized participants I worked with were unwilling to fill out surveys. Perhaps it is a lot to ask marginalized people to partake in an experiment. I would have objected to it when I was not well.

I believe that my lived experience and curiosity has created something of value. I think these elements are more important in the development of counselling theory that the research which somehow doesn’t trickle down to serve marginalized people. I think it is time counselling theory and therapy practitioners who work with marginalized people to look to them for help in what they are doing. Really, this is already happening for many of us who effectively work with the disenfranchised. It’s just slow to see institutional change.

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Having returned from an east coast trip to attend the memorial of my stepfather, I am a little late with my monthly update. The trip back east was hard as my mother is currently suffering from her loss. I tried to spend time with her to offer her support, but may need to stay busy and our vastly differing interests made the week challenging for both of us.

Those who may have visited my blog may notice that I have only published one post this month. I have been working extensively on one essay that I am trying to prepare to get published. It is frustrating because I feel unproductive, but I have a need to master the essay and prove that I can publish.

When I wrote my memoir, I wrote extensively and edited the work down to make it more likeable. It was a learning process which I used to heal, and I really liked it. Now I am trying to learn to do the same thing with the essay—pack it all in for the short attention span. Make sure I get the title right.

But I am finding myself challenged when it comes to the process of getting published.  I usually write to live, not write to publish. I have read some blogs about the need to research publications and write specifically for them.

This puts me in a bit of a dilemma. It makes me realize that finding a place to publish my brand and mental health niche is a crap shoot. And suddenly I am getting pulled away from the reason I write in the first place, to be myself use my experience to grow wiser and heal and redeem myself.

The essay which I am sharing a sneak peek of in my newsletter is something that I am fretting over. It started as a 5000-word essay and I have cut and learned extensively. I find myself extremely frustrated that I must wait so long to even learn if I will get accepted. But I know I need to get my name out there to draw attention to my work.

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Humans inhabit the court room

Where right gets discerned from wrong

Investing all their damn money

Into the justice they long.

Anger bounces savagely

In tossed and yanked slinky veins

That domino amassment

Of hate in buzzing refrain.

These are the veins that disregard

Every glimpse of opposition,

Destroying truth in perspectives

That also yearn for fruition.

Such is any claim to truth

That harnesses the violence

Of obscure reaction,

Squawking with its insistence.

In court these truths are resolved

By the massive collection

Of endlessly abstracted,

Legally teased erections

Of verdicts gleaming brightly

Bearing a fiscal complexion

For conveyor and authors

Of soul-seizing infection.

Power pumps potent pulse

That occupies peaceful bones

Static crackling distraction

That tones out the doubts that drone.

Curse the evaluation

That sets inequality wild!

Curse the rules and regulations

That echo in the tiled

Order of institutional

Imprisonment! Curse the demise

Of esteem, punched contusions

By city’s violent sunrise!

People think that justice is concrete

When the whole concept is a cheat!

Profiteers are proud of their feats

Feasting on justice with deceit.

But what goddamn logic is it

That worships greed, and closets

Empathy? Here we elicit

Internal arrogant deposits

Of monetary tuition

That torques lawyer’s ambition

To create superstition

That breeds social recognition

And so I ask:

Why do legal collisions

Make right and wrong decisions

On god’s creative visions,

When they lack truth’s mission?

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