In my experience, people who survive psychosis are very diverse! There are many routes to recovery and many different tools used along the way to get there. Indeed, recovery looks very different for one person than it does for another.
For forty years, most everywhere in America there has been one treatment option that is forced on everyone: medication and psychiatric incarceration.
It is already clear that these imposed methods of suppression rarely work Most of us who do survive them are quick to condemn them. They often seem set up presuming that institutional board and care living is the inevitable outcome.
Maybe you’ve heard it said this works for a small 25% percent of us. Likewise, you might have also heard it said that 50% take ten years in treatment to find recovery. Then, there is the 25% that supposedly decline until they die. With these generalizations and with fear of permanent institutionalization and associated stereotypes, the effort to suppress experiences begins.
With suppression as the cultural expectation, it is well known that our brothers and sisters die an average of twenty-five years earlier than their counterparts.
Person-First Care Rather Than Best Practice:
However, I am writing today to encourage myself and other survivors and providers to approach any psychosis with curiosity and do more learning than we do teaching what works for us. We will review many new strategies and innovations aimed at aiding and/or overcoming suppression. These new methods are introduced and promoted all the time, often by survivors. They may be good points of learning, but I am arguing today that each are merely strategies to consider.
I feel like many survivors and providers are encouraged to flout what works for them or what the research says, like the path to recovery is a world religion. I think this leads more to crusading factions than highlighting the collective wisdom. Meanwhile there are vastly different social systems, structures, and barriers that can get in the way. We will explore these as well. People who are in crisis come with vastly different needs and resources.
American Best Practices
Currently, in Oakland CA, local administrators have explored researched alternatives like the vocational individualized placement services model, the housing first model, corporate peer counseling route, motivational interviewing (which is primarily used for substance abuse,) and CBT for psychosis as means of curing psychosis.
At agencies, providers are trained, often early in their mental health careers, in one or two of these best practices that will help people suppress and control symptoms.
Still, there can be a lingering sense of confusion when providers observe the behavior of people who experience “psychosis.” Many of us would rather be understood and listened to instead of having a researched alternative imposed. Still, I’d argue that there is no such thing as a simple formula or panacea best practice that will work for every individual.
I must admit that I believe that competing to establish and spread a best practice is the way to be most certain to sell out vast groups of people who have endured psychosis. In the competitive market of best practice, it is all about research and appropriations of money. I have seen this mentality ruin systems. Instead, if providers put the person first, they may utilize the researched method when it is needed, instead of imposing it because the system says so. If such care was taken by all of us, things would be a lot better.
An Alternative to the Suppression:
One thing I’ve learned about from listening to the radio and talking to some fellow survivors is the “new technology” ketamine or MMDA treatments. These types of interventions arguably use the reverse strategy to suppression that is available through incarceration and medication. I think they are beginning to provide alternative routes to healing that is appealing to some who have been harmed by incarceration and imposed psychotropic interventions. This route to healing which was suppressed in the sixties by the misuse of LSD in the counterculture, is being revitalized by people who responsibly micro-dose.
As I’ve listened to friends describe how this works for them. I must admit, I sometimes think of it is a strategy that can be done with or without chemical intervention. However, when the surrounding community expects suppression, hallucinogenic drugs give participants the permission to explore and lose their fear of psychosis. I have heard this helps normalize it and enables the exploration of meaning and self-understanding. Perhaps doing so helps them understand their conflicts and heal from the dilemmas that are beneath the surface. These then can be solved and great progress can be made.
I advocate letting people chose their route to recovery. I personally use psychotropics to help me function through abuse and chaos. Not all survivors need or are willing to do this and I think that is great. I think therapeutic hallucinogens are a valid way of responsibly addressing the problem. I don’t think one is superior to the other. I tend to resent notions that one recovery is superior to another.
From my perspective, recovery, like child-birth, is beautiful when it’s natural; but that may not be possible for everyone. Med free environments of the seventies like Soteria House worked for many and should not have been closed by the AMA, but they didn’t work for everyone. Med free environments are an alternative about which American propaganda program us to forget. We don’t walk around denigrating people whose mother’s used epidurals and had c-sections ranking our social structure accordingly.
Maybe we should! Our current system of rank is so in shambles, denigrating so many to homeless encampments!
Neocolonial Best Practices:
These days there are some new best practices that challenge the medicate and incarcerate model seem to come from European regimes that are built on vastly different norms. Open Dialogue and Hearing Voices Network support groups are examples of such potential best practices. One might argue they operate on superior notions of humanity than the libertarian democrazy that is currently assaulting American institutions. While also offering important alternatives to suppression, I aim to argue that mindlessly treating them as best practices that can be imported to distinct American regions can be problematic.
I call them neocolonial because there is still a need to vastly know the foundations of the local culture which includes the diaspora of migration to take the ideas that have worked elsewhere.
Indeed, many Americans have migrated from third world countries where social structures target neurodiversity in much less repressive manners than our medicalized way of addressing things. I ask: might it make sense to learn from those cultures as much as we learn from Europe. I think migrant communities offer a lifestyle that is extremely different and those cultures need to be understood and adjusted to before we impose Eurocentric practice on them. Particularly when we are working with those enduring the horrific repression of migration going on in libertarian America learning more about a person’s history is very important!
Factors that Complicate the Matter:
In America, different states and counties set up their instruments of suppression very differently! State laws develop vastly different norms in terms of length of conservatorship, intent of money-making industries, and the amount of resources that hurting families or communities have to spend.
It’s arguable that county hospitals are modeled after the needs of the prevailing ethos of the location. In other words, there may be gross generalizations that are made about the subject’s race, class, and support needs.
For example, I have heard it said our local psych ER is currently adjusting in the direction toward teaching homeless people to suppress their symptoms. This is because that is the dominant community norm as displacement is going on in Oakland is increasing struggles with mental health among the poor. ER workers may do their best but the structure is set elsewhere by people with other agendas responding perhaps to undisclosed libertarian agendas.
Supplant a person from a different class or race into this learning environment and there becomes significant potential for trauma for that person who essentially told: this is what you have to look forward to if you fail to suppress.
Considering Your Audience and Adjusting Your Practices:
If a person has experienced ten years of American institutionalization in the inner city there is a lot of hope in helping them! However, the order and emphasis of eclectic strategies may indeed be different than they are going to be when working with the College Kid who endures a first break.
Learning to work with each is so worthwhile. Why fight for the needs of one over the other? Setting up services according to researched, best practice narratives leaves an impression on young mental health workers and too many utilize the method it without being curious of the persons experiences that lie beneath the surface.
Why claim there is only one best practice strategy that works for all people. People who deal with psychosis have had very different life experiences and lived through different sectors of society!
For example, now we have the best practice, CBT for Psychosis that gets emphasized in early prevention programs. Let’s say a worker gets trained in CBT for Psychosis at a conference from an early prevention program, but is working with clients who have been institutionalized for ten years and live in tent encampments. It may be that the efforts to teach rational skills and reduce distorted thinking needs to be tweaked. Try taking rational entitlement to a board and care, state hospital, homeless shelter, or another institutionalized environment! In such setting there is a clear ethos of victim blaming and stigma that exist. I believe many is such setting will find rationality to be useless there. It may be there are other good strategies that might help.
One such practice I have developed in my eleven years of running groups amid urban institutionalization is what I call special message mindfulness. This involves becoming more aware of the experiences you’ve had that make you think about conspiracies and letting those experiences go by talking about them. While this won’t work for everyone, I have used it as a strategy for getting people to share their stories of psychosis openly.
In reality, I believe both CBT and Message Mindfulness strategies are valuable and may be needed at different times in different ways with different people.
Indeed, using experiences in group, I have started documenting a host of eclectic strategies in addition to mindfulness strategies. I’d consider such strategies to include spiritual, cultural, behavioral, and narrative wisdom.
Eclectic strategies are available for study here.
In fact, people who experience psychosis have endured different levels of abuse. Cognitive therapy may work for those with lower levels of dissociation and abuse, but other strategies might be needed or introduced first for people who cannot control their thoughts because of histories of dissociation and ongoing trauma.
Using Smart People to Adjust Eclectic Strategies:
In my limited experience navigating the podcast world, I learned about a woman out of Tacoma Washington who studied Open Dialogue in the Netherlands and implanted it into her system of care. I admire this kind of effort greatly, though I know very little about what she did or how to do it myself. I work primarily out of East Oakland and feel that integrating such concepts would be very different with the system and resources available to residents here.
Because I work primarily with older people who have lost their family support it has not been something I have explored. I’ve tended instead toward the Hearing Voices Network movement.
But to be clear, I would not want that person in Tacoma to teach me the principles of her system of care and hold me accountable to her fidelity measures in East Oakland. I think that concept is point blank ridiculous.
I think the survivor community needs to focus less on preserving the integrity of a foreign model, and more on creating an inclusive community across all social divides that explores the strength of the local culture and their local history and intervene in vastly different manners.
My Perception of Infighting that Persists
Among those of us who survive psychosis and try to set up support services, significant infighting can happen. Perhaps this happens because each believes their route to recovery is the way to go. We all can easily forget that we come from different social backgrounds. Perhaps other survivors do not experience this to the extent that I have. I get repeatedly attacked by other survivors because my views about what helps are different than their views.
When I first found out that other survivors exist, I presumed that I would finally find a home where I would be welcomed. While this does seem to happen for some, it certainly hasn’t worked that way for me. In fact, I have endured what I consider to be many attacks from other survivors.
This has been a shame for me. I also struggle with CPTSD and get very triggered when people flout their best practice or way of being. To someone like me, it really is already hard being out as a person with lived experience facing discrimination and slights from people who make projections upon me when they hear I have a psychiatric history. But the survivor community too has hurt me in ways that keep me withdrawn and writing.
They say time heals all wounds. They say lots of things. They still say research is necessary to deliver recovery.
I still say survivors and providers are diverse and require unique and eclectic methods. When I study my own recovery, I realize I utilized many of the strategies referenced here instead of trusting the psychiatric incarceration and medication that was offered in the system.