Laing's view on psychosis:
"Laing argued that the strange behavior and seemingly confused speech of people undergoing a psychotic episode were ultimately understandable as an attempt to communicate worries and concerns, often in situations where this was not possible or not permitted. Laing stressed the role of society, and particularly the family, in the development of madness. He argued that individuals can often be put in impossible situations, where they are unable to conform to the conflicting expectations of their peers, leading to a 'lose-lose situation' and immense mental distress for the individuals concerned. Madness was therefore an expression of this distress, and should be valued as a cathartic and transformative experience."
Fear arises and evolves into anxiety regarding a threat against the psychotic. Often psychosis begins with fears, leading to anxiety which then leads to insomnia that morphs into hypomania. When insomnia leads to mania, that often occurs due to inadequate rest, both of the body and of the mind.
Indeed, it is anxiety and possible repressed anger that precipitates insomnia which might escalate into hypomania and evolve further into psychosis. However, this is not always the case since the experienced mental health consumer learns the importance of sleep hygiene.
My counter argument to Laing is that psychosis is a resolution of the classic double-bind in a manner that is sometimes incomprehensible to society, due to conflicting desires and expectations on each of us.
In most cases, psychosis is non-violent and harmless.
Rather, it is the ignorance and fear of all involved parties including the mental health consumers and her concerned family members, friends and lovers which contributes to any co-morbidity of violence, be it harm to others or self-harm.
When psychotics do habituate towards violence due to what is dismissed as abnormal fear, that violence has been learned either from within the family environment originally or due to social interactions with the public and privately with care workers. Once learned, violence may become a co-morbid behavior associated with the psychiatric disorder of which psychosis is a symptom.
Thus it is imperative that an anxiolytic agent or physical action occurs to relive the anxiety so that any remaining fear motivates the mental health consumer in a positive and non-violent manner. This may consist of a tranquilizer or a non-violent action that relieves the anxiety.
Then the "best cure" for the psychotic is self-talk that counteracts negative self-talk, i.e. positive affirmations which calm her down, and thus removing the fear and the anxiety that it sometimes causes.
If a concerned family member or friend truly wishes to help a psychotic, then it is best to either believe in her even when her confused state of mind gives reason to fear for her grasp on reality, and to graciously remove oneself from the situation when one feels threatened.
In order to have rapport with the psychotic it is best to calmly facilitate positive non-violent confrontation, even to the point of supporting their belief in their limited world-view as delusion, with the intent of gaining compliance.
Direct confrontation with the psychotic is not often recommended since the subsequent anxiety due to negative adaptation during the resolution of the double-bind will only lead to reinforcement of the very delusion the care-giver is trying to "cure." Indeed, it is not helpful to cure the delusion of the mental health consumer while maintaining her psychosis.
Indeed, the wise care-giver should never patronize or belittle the psychotic lest it threaten their limited worldview. Instead, it is best to wait out the psychosis after treating it with a sedative when calm, non-threatening discussion with the mental health consumer fail to resolve the crisis.
Time is a better medication for most acute displays of psychosis which have little or no violent aspects.
In the case of serious (chronic) psychosis, it may be necessary to commit the psychotic to a psychiatric ward and for the use of the appropriate medication (usually atypical anti-psychotics such as seroquel or Abilify.
However, sedation resulting from anti-psychotic use may result in weight gain and its associated effect on the cardiovascular system.
Consequently, a weight-maintenance program may be useful as directed by a medical professional.
When the mental health consumer has stabilized mentally, it is necessary to provide mental health education including the use of coping strategies which relieve anxiety due to stress. Mental health professionals who omit such education by psychologists and psychotherapists merely set the stage for possible future relapse.
Indeed, psychiatric professionals and their support staff are still required to provide the minimum of self-care training of patients in their care. While sedatives might reduce symptoms of the mental health consumer, medication itself is not therapy.
In my opinion, on-line self therapy usually consists of a careful research and practice of coping strategies to reduce the impact that stress has upon the consumer.
Regarding the discussion of medication by my fellow mental health consumers, only the experienced consumer supplies correct information regarding psychotropic drugs. When a consumer's reaction to a drug appears to be clouded by their feelings about it, I usually consider it anecdotal and a possible emotional reaction rather than a physiological one.
Due to the density of emotional reaction to a particular medication, it is impossible to determine the physiological response to the drug. Therefore I tend not to value anecdotes on how the drug makes the consumer feel. Rather, it becomes more interesting to sift through the consumer anecdotes to find the rare anecdote that displays the physiological response.
I suppose this is why I would rather read the abstract about a medical trial than read discussion of medications on a mental health consumers forum. My impression of such candid on-line discussions is that most psychotropic drugs make people with a mental illness feel like crap because their mental health is compromised by seeing the glass half-empty.
Since they expect medication to dull their senses and otherwise impair their positive appreciation of life, it is no wonder that their impression of medication paints a negative picture of psychotropic medication.
Even so, I am touched by the emotional responses to medication because most mental health consumers would rather be treated as human beings. That is why the medications make them feel like crap: not one medication offers psychotherapy.
In the case of the psychotic mental health consumer, their mental health crisis requires treatment lest their psychoses threaten their safety or the safety of other people, both patients and care-givers.
I merely question the over-prescription of medication and especially the idea that a mental illness requires the long-term use of medications.
Thus it makes better sense to accept the psychotic's delusion as real until the psychotic explains her reason for creating it to not deal with the world realistically. Until then, it makes no sense to sedate the psychotic since most psychoses are harmless and resolve themselves on their own over time.
While I am not suggesting that Seroquel and Abilify are useless, I am adamant that the rights of mental health consumers be protected by informed consent when not psychotic, while obligations by mental health professionals be honored by providing psychotics with fast-acting sedatives which are not habit-forming.
Even if such a drug protocol meant the use of sedatives such as mirtazapine, then the doctor should not reject them because they are reserved for depression. Instead, the drugs used should be based on the criteria of least harm to the consumer.
As for therapy, the risk of burnout from stress has put off most psychology students from deciding to become psychotherapists. I am sure that a part of the reasoning behind this aversion to become a psychotherapist might have to do with the fear of people with mental illness and associate stigma associated with mental illness. It is rare that a psychology graduate is able to empathize with a psychiatric patient because he is apparently more mentally healthy than the patient.
However, on the average, there is actually no difference between a psychology graduate and the patient, except in degree of mental health. A dedicated psychotherapist is in service of the client seeking therapy. Any professional relationship between the client and the therapist is threatened by any overt superiority by either of them.
Thus there is need to emphasize that throughout the post-secondary education of a psychotherapist, the therapist is not the master of the client. Rather, the professional relationship between them implies equality. Without such humility, neither the patient not the therapist will benefit greatly from their relationship.
With regard to R.D. Laing and psychosis, it is important to emphasize that professional service by therapists and psychiatrists to all their patients requires that their clients understand the importance of the professional relationship that underlies therapy. This in no way is a personal relationship.
While the client may think she is under no obligation to behave professionally with her therapist or psychiatrist, it might be useful to consider this: would she think it is appropriate to expect her butcher to be at her beck and call?
Thus, it is important for mental health consumers to understand that the client is obliged to treat the therapist or psychiatrist with the respect she reserved for her favorite teacher in school, be it public or post-secondary.
I myself am thankful to my psychotherapist who provided me with welcome advice when he told me that I would never report to the Emergency ward of the local hospital if I was undergoing a psychosis. I take this to be advice that my mental health is determined by appropriate sleep hygiene and its positive effect of reducing insomnia.
To conclude this blog post I present a quote from psychiatrist Adolf Meyer to temper our reliance on medication to treat mental illness:
"Those who imagine that all psychiatry and psychopathology and therapy have to resolve themselves into a smattering of claims and hypotheses of psychoanalysis and that they stand or fall with one's feelings about psychoanalysis, are equally misguided".
Originally posted: May 5, 2005 6:03 PM PDT
References:
Adolf Meyer, psychiatrist - legacy: http://en.wikipedia.org/wiki/Adolf_Meyer_%28psychiatrist%29#Legacy
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