Quotes
Connecting in Psychotherapy
“The patient has a history of sanity as well as a history of illness.”
-Edward Podvol, Recovering Sanity: A Compassionate Approach to Understanding and Treating Psychosis, pg 274
“We must see treatment as a way by which the patient proceeds toward self-acceptance.”
-Stone, Albert, Forrest, and Arieti, Treating Schizophrenic Patients: A Clinical/Analytical Approach, pg 4
“Whether the long-range objectives for the psychological treatment of the schizophrenic patient are symptom reduction or psychic reorganization, the immediate goal must always be to help the patient put his experience into words.”
-Andrew Lotterman, Specific Techniques for the Psychotherapy of Schizophrenic Patients, pg 70
“Learning to understand neurotic persons (in the course of psychoanalytic training, for example) is rather like learning a new language. Learning to understand schizophrenics is like learning a separate language for each patient.”
-Stone, Albert, Forrest, and Arieti, Treating Schizophrenic Patients: A Clinical/Analytical Approach, pg 30
“For anyone to fully recover from psychosis, one must not only recognize and see through this awesome micromechanics of losing mind but must also become a student of the psychology of recovery. And, in its own way, the journey to recovery is just as dramatic and hectic as the descent into madness itself. Just as madness forces a confrontation with oneself, so does recovery. Moreover, recovery is not a temporary process, a fire through which to be burnished and then forever healed; it is an ongoing achievement in which one may have to face essential realities about oneself over and over again. “
-Edward Podvol, Recovering Sanity: A Compassionate Approach to Understanding and Treating Psychosis, pg 208
“….when contacting mental health professionals, however, we urge you to stay away from those who tell you or your family that you have a broken brain or defective genetics or are doomed to a mental disorder for life. Research (not to mention our own personal experience) shows this is not true, and it is certainly not the message you need to heal.”
-Mackler and Morrissey, A Way Out of Madness: Dealing with Your Family After You Have been Diagnosed with a Psychiatric Disorder
“We help the patient choose to get better, whereas often enough the important figures of his past tried, in desperation, to force him to get better.”
-Stone, Albert, Forrest, and Arieti, Treating Schizophrenic Patients: A Clinical/Analytical Approach, pg 163
“Many of these models suggest that it is the way that people interpret psychotic phenomena that accounts for distress and disability, rather than the psychotic experiences themselves.”
-Edited by Read, Mosher and Bentall, Models of Madness: Psychological, social and Biological Approaches to Schizophrenia, pg 291
“Not only is the symbolic meaning to the patient of the content of delusions and hallucinations explored, but a rigorous attempt is made to try to figure out how, why and when psychotic thinking began, and under what emotional and life circumstances. An attempt is also made to put the patient's psychosis into the perspective of the patient's life and customary ways of living.”
-Ira Steinman, Treating the 'Untreatable': Healing in the Realms of Madness, pg 20
“Information about the links between life event and specific psychotic experiences can also be helpful in reducing distress and providing an alternative explanation for hallucinations and delusions.”
-Edited by Read, Mosher and Bentall, Models of Madness: Psychological, social and Biological Approaches to Schizophrenia, pg 299
“In any extended psychotherapy, of course, our ultimate goal is to help the schizophrenic patient grow more comfortable with his inner feeling states, so that he can speak about them, however embarrassing they might be, with some candor.”
-Stone, Albert, Forrest, and Arieti, Treating Schizophrenic Patients: A Clinical/Analytical Approach, pg 29
“My only choice was to become as familiar with her world of magic and chaos as I was hoping she would become with my mundane world of eating, walking, talking, bathing, and sleeping. But that took a long time.”
-Edward Podvol, Recovering Sanity: A Compassionate Approach to Understanding and Treating Psychosis, pg 218
“Ultimately this book is about perceiving and nurturing islands of clarity, for in this way full recovery from psychosis has been accomplished and will continue to occur without aggressive or physically intrusive methods of treatment. “
-Edward Podvol -- Recovering Sanity: A Compassionate Approach to Understanding and Treating Psychosis
“But however brief, moments of recovery from psychosis are universal experiences – yet everyone who suffers with psychosis experiences them and reacts to them in different ways. Spontaneous flashes of clarity occur all the time during psychosis. They are generally experienced as moments of freshness of mind, or relaxation from intensified mind. These flashes represent a fundamental intelligence of the “intrinsic health” that exists beneath the psychotic delusions. …. they are fragile moments, and they need to be acknowledged and respected. This simple act will greatly facilitate anyone's recovery from psychosis.”
-Edward Podvol -- Recovering Sanity: A Compassionate Approach to Understanding and Treating Psychosis
“By guiding [clients] through altered states of consciousness rather than repressing them, Soteria's milieu [aimed] to help its clients emerge from their life crises as stronger, better educated persons with the ability to pursue [means of living] that they themselves consider to be successes....”
-Fort, Mosher & Hendrix -- Soteria: Through madness to deliverance
“The central task of all mental health professionals is to work alongside service users to create meaning out of chaos and despair.”
-Johnstone, L. (2017). Psychological formulation as an alternative to psychiatric diagnosis. Journal of Humanistic Psychology, 58(1), 30-46. Retrieved
“...the therapist must understand that they will not be able to push patients out of negative symptoms, but may instead be able to open doors for them.”
-Landa, Y. (2017). Cognitive behavioral therapy for psychosis (CBTp): An introductory manual for clinicians. Mental Illness Research, Education & Clinical
Center. Retrieved from https://www.mirecc.va.gov/visn2/docs/CBTp_Manual_VA_Yulia_Landa_2017.pdf
“In my work, I combine an initial emphasis on CBT techniques with a subsequent focus on psychodynamic work. Delusions are literally false, but they are figuratively true, meaning they are meaningful expressions of a person’s history and current state of mind… Once the CBT work has encouraged a patient’s doubt as to the veracity of a delusion, the patient and therapist are in a position to explore, based on the patient’s life history, how the delusion is expressive of the patient’s life experience, in many cases, a history of trauma. Psychodynamic work focuses primarily on unconscious fantasy, affect, and symbol formation.”
-Michael Garrett, MD. Interview. Retrieved from https://psychwire.com/free-resources/q-and-a/ciwne4/psychotherapy-for-psychosis
“The overall role of the therapist in CBTp is to create an alliance, let the patient lead the process, set treatment goals, promote homework, offer structure, understand the patient‘s beliefs, protect and enhance self-esteem, and help the patient to discover their own best way of coping.”
-Landa, Y. (2017). Cognitive behavioral therapy for psychosis (CBTp): An introductory manual for clinicians. Mental Illness Research, Education & Clinical
Center. Retrieved from https://www.mirecc.va.gov/visn2/docs/CBTp_Manual_VA_Yulia_Landa_2017.pdf
Attachment and Relationships
“We are all much more simply human than otherwise”
-Sullivan, H.S. (1947). Conceptions of Modern Psychiatry. New York, NY: William Alanson White Psychiatric Foundation
“The stages of recovery can only be understood from the experiences of those who have actually recovered. But one thing is clear. Recovery can only take place within the context of a sane environment, an environment of compassion and appreciation, which can permit the unwinding of the stages of transformation. Otherwise, recovery is extremely rare.”
-Edward Podvol -- Recovering Sanity: A Compassionate Approach to Understanding and Treating Psychosis
“When the environment is a safe one, with healthy friendship and patience, the psychosis may resolve itself in short order. On the other hand, when a psychosis that might naturally last only several hours or days is overreacted to by others in an attempt to suppress it as quickly as possible (as with overmedicating or other subjugating techniques), the disoriented one often fights against the effects of what he feels is an intrusion and a punishing abuse of his already-fragile mind. Such situations commonly lead to months or years of aggravated struggle with oneself and with psychiatric and legal authorities (while the psychosis worsens).”
-Stone, Albert, Forrest & Arieti -- Treating Schizophrenic Patients: A Clinical/Analytical Approach
“Universal primary prevention must take the form of a safe population-wide intervention that promotes normal development.”
-Fusar-Poli, P., McGorry, P.D. & Kane. J.M. (2017). Improving outcomes of first-episode psychosis: An overview. World Psychiatry, 16(3), 251-265. Retrieved
Developmental Stages
“Prevention of mental illness is about creating the preconditions necessary for a life worth living: the essential one being having sufficient autonomy to determine one's own life.”
-Read, Mosher & Bentall -- Models of Madness: Psychological, social and Biological Approaches to Schizophrenia
Psychological Defenses
“A fever is a coping response, not a sign of illness.”
-Vaillant, G. (2011). Involuntary coping mechanisms: A psychodynamic perspective. Dialogues in Clinical Neuroscience, 13(3), 366-370
“Much of what modern phenomenologists classify as mental disorders may be reclassified as the outward manifestations of the minds adaptive efforts to cope with psychological stress.”
-Vaillant, G. (1994). Ego mechanisms of defense and personality psychopathology. Journal of Abnormal Psychology, 103(1), 44-50
“.... without exception the experience and behavior that gets labeled schizophrenic is a special strategy that a person invents in order to live in an unlivable situation.”
-Laing, R. D. (1967). The politics of experience, and, the bird of paradise. Harmondsworth, UK: Penguin
“The origins of psychotic experiences should also be explored within this context, as they may have been functional at some stage as coping or survival strategies.”
-Edited by Read, Mosher and Bentall, Models of Madness: Psychological, social and Biological Approaches to Shizophrenia, pg 297
Impact of the Environment and Community Around Us
Stress-Vulnerability Model
Continuum Model
“...at different levels of distress all people are capable of having such experiences.”
-Landa, Y. (2017). Cognitive behavioral therapy for psychosis (CBTp): An introductory manual for clinicians. Mental Illness Research, Education & Clinical
Center. Retrieved from https://www.mirecc.va.gov/visn2/docs/CBTp_Manual_VA_Yulia_Landa_2017.pdf
“Having a schizophrenia label is correlated with childhood social adversity, childhood abuse and maltreatment, poverty, and a family history of migration.”
-Hickey, P. (2017, January 10). The biological evidence for “mental illness.” [blog post]. Retrieved from
http://behaviorismandmentalhealth.com/2017/01/10/the-biological-evidence-for-mental-illness/
“Although this may not be the majority opinion among psychiatrists, I believe that the primary cause of psychological disorders is that bad things have happened to a person. Some people react to adversity with symptoms of PTSD, while others develop Dissociative Identity Disorder (DID). Some are resilient, showing little sign of discernable illness. I have come to regard psychosis also as a complex trauma-related disorder with a biopsychosocial cause.
Although genes and epigenetic factors play a role, research in the last two decades has shown that childhood trauma dramatically increases the risk of psychosis in adolescence or young adulthood. For example, people with a history of sexual abuse as children are ten times more likely to develop a psychotic condition than people who have not faced such adversity.
Abused children form insecure attachments to caregivers and internalize mental representations of other people as untrustworthy and potentially dangerous. In adolescence, these fearful expectations interfere with the ordinary goals of a teenager making friends and working out their identity. Unable to meet ordinary developmental milestones in a real world they fail to navigate, they construct an alternate reality in which they must abide, at the great cost of suffering.”
-Michael Garrett, MD. Interview. Retrieved from https://psychwire.com/free-resources/q-and-a/ciwne4/psychotherapy-for-psychosis
Recovery
“It is important to remember that psychosis is a treatable condition and if help is sought early, an individual may never suffer another episode.”
-Yale School of Medicine (2019, September 24). Specialized treatment in early psychosis (STEP). Retrieved from
https://medicine.yale.edu/psychiatry/step/psychosis/phasis/
“Following recovery from a first episode, a significant number of people will never experience a recurrence of psychosis.”
-Mental Health Evaluation & Community Consultation Unit – MHECCU, (2020). Early identification of pschosis: A primer. Retrieved from
https://www.health.gov.bc.ca/library/publications/year/misc/Psychosis_Identification.pdf
“About a quarter of young people with schizophrenia who get treatment get better within six months to two years, research has found. Another 35 to 40 percent see significant improvements in their symptoms after longer-term treatment — enough to let them live relatively normal lives outside hospitals with only minor symptoms.”
-American Psychological Association. (2020). Schizophrenia Treatment. Retrieved from https://www.apa.org/topics/schiz/treatment
“...psychological treatments can be effective in reducing transition to psychosis.”
-Polese, D., Fornaro, M., Palermo, M., De Luca, V., & de Bartolomeis, A. (2019). Treatment-resistant to antipsychotics: A resistance to everything?
Psychotherapy in treatment-resistant schizophrenia and nonaffective psychosis: A 25-year systematic review and exploratory meta-analysis. Frontiers
in psychiatry, 10, 210. Retrieved from doi:10.3389/fpsyt.2019.00210
“Both individual and meta-analytic studies show that a prolonged period of psychotic illness without adequate treatment is the most consistent predictor of poor clinical and functional outcomes.”
-Hardy, K.V., Niendam, T.A. & Loewy R. (2017). Measuring the duration of untreated psychosis within first episode psychosis coordinated specialty. Retrieved
from https://www.nasmhpd.org/sites/default/files/DH-Measuring_UntreatedPsychosis_v3_2.pdf
“...a longer duration of treatment can generally show better results on negative symptoms.”
-Polese, D., Fornaro, M., Palermo, M., De Luca, V., & de Bartolomeis, A. (2019). Treatment-resistant to antipsychotics: A resistance to everything?
Psychotherapy in treatment-resistant schizophrenia and nonaffective psychosis: A 25-year systematic review and exploratory meta-analysis. Frontiers
in psychiatry, 10, 210. Retrieved from doi:10.3389/fpsyt.2019.00210
Spirituality
“There is increasing recognition that, irrespective of their personal position as regards spirituality, staff have a duty to those in their care to take this aspect of their life seriously. In the context of the acute inpatient unit, this means no longer dismissing the spiritual content of psychotic communication as merely 'illness.' “
-Clarke, I. & Wilson, H. (2009). Cognitive behaviour therapy for acute inpatient mental health units: Working with clients, staff and the milieu. New York,
NY: Routledge
“... some of the dramatic experiences and unusual states of mind that traditional psychiatry diagnoses and treats as mental diseases are actually crises of personal transformation, or “spiritual emergencies.”
-Grof, S. and Grof, C. (1989). Spiritual Emergency: When personal transformation becomes a crisis. New York, NY: Penguin
“When these states of mind are properly understood and treated supportively rather than suppressed by standard psychiatric routines, they can be healing and have very beneficial effects on the people who experience them.”
-Grof, S. and Grof, C. (1989). Spiritual Emergency: When personal transformation becomes a crisis. New York, NY: Penguin
“Integration is ideally achieved when the experience, its meaning and its aftereffects have been incorporated into ones life to a degree that is assuring to the experiencer; and when accompanying challenges, stresses, and disruptions are reduced to an acceptable minimum. ”
-ACISTE, (2013) Cultural competency guidelines for professionals working with clients who report issues related to their spiritually transformative
experiences. American Center for the Integration of Spiritually Transformative Experiences, Retrieved from https://aciste.org/competency-guidelines-
for-professionals/
“For those who do not integrate the STE's in a healthy way, the result can sometimes be spiritual emergencies, psychological disorders or harm to self or others.
-ACISTE, (2013) Cultural competency guidelines for professionals working with clients who report issues related to their spiritually transformative
experiences. American Center for the Integration of Spiritually Transformative Experiences, Retrieved from https://aciste.org/competency-guidelines-
for-professionals/
Open Dialogue Treatment
“Now they have the best documented outcomes in the Western World. For example, around 75% of those experiencing psychosis have returned to work or study within 2 years and only around 20% are still taking antipsychotic medication at 2 year follow-up.”
-Open-dialogue.net (2019). Open dialogue: An international community. Retrieved from http://open-dialogue.net/
“The primary aim in the meeting is not an intervention changing the family or the patient. The aim is to build up a new joint language for those experiences, which do not yet have words.”
-Aaltonen, J., Alakare, B. & Seikkula, J. (2015). Main principles of the open dialogue treatment: The Western Lapland idea. Retrieved from
http://developingopendialogue.com/wp-content/uploads/2015/04/OPEN-DIALOGUE-principles.pdf
Family Involvement in Treatment
“Every member of a family who participates in this reintegrative effort will understand that by helping the schizophrenic we may also help ourselves. We become less impervious to veiled hostility, less blind to what we do not want to see, more apt to understand a voice of dissent, even if it is expressed in an awkward or exaggerated manner. We become better able to listen to words we are generally inclined to ignore because they come from sources that seem irrational, meek, or inappropriately humble.”
-Stone, Albert, Forrest & Arieti -- Treating Schizophrenic Patients: A Clinical/Analytical Approach
Mindful Awareness, Being in the Present Moment and Grounding
“Decentered awareness or being mode of mind is with the interest that 'people may learn to allow voices, paranoid thoughts and images to come and go without the struggle that exacerbates distress; instead adopting a compassionate curiosity towards these experiences and their meaning in relation to self.' ”
-Newman-Taylor, K. & Abba, N. (2019). Mindfulness in CBT for psychosis. In C, Cupitt (Ed). CBT for psychosis: Process-orientated therapies and the third
wave (1st ed., pp. 64-78). New York, NY: Routledge
“When you focus your awareness on the sensations of breathing you also generate your power of attention.”
-Edward Podvol, Recovering Sanity: A Compassionate Approach to Understanding and Treating Psychosis, pg 168
Acceptance Instead of Change
“....having a focus on process rather than content, and being more concerned with someone's relationship to experience than the content of experience.”
-Cupitt (Ed). CBT for psychosis: Process-orientated therapies and the third wave (1st ed., pp. 98-114). New York, NY: Routledge
Psychotropic Medication
“A ‘harm reduction’ approach means not being pro- or anti- medication, but supporting people where they are at to make their own decisions, balancing the risks and benefits involved.”
-Theicarusproject.net, 2020, The Harm Reduction Guide to Coming Off of Psychiatric Drugs.
“Antipsychotic drugs play a crucial role in treatment. These drugs don’t cure schizophrenia. Instead, they reduce symptoms such as delusions and hallucinations. The drugs can have side effects, such as physical agitation and muscle spasms. In addition, their long-term use causes permanent neurological damage. Reduced symptoms don’t necessarily mean individuals are able to function effectively outside a hospital, however. Psychosocial support can help make that possible.”
-American Psychological Association. (2020). Schizophrenia Treatment. Retrieved from https://www.apa.org/topics/schiz/treatment
“I conclude that patients with schizophrenia not on antipsychotic medication for a long period of time have significantly better global functioning than those on antipsychotics.”
-Harrow, M. American Psychiatric Association annual meeting, 2008, in Whitaker, R. (2016, April). Anatomy of an epidemic:
The history and science of a failed paradigm of care [slide show]. Retrieved from https://www.madinamerica.com/anatomy-of-an-epidemic/
Iatrogenic Harm (Doctor induced harm)
“In short, the ‘chemical imbalance theory’ was never a real theory, nor was it widely propounded by responsible practitioners in the field of psychiatry.”
-Pies. R.W. (2014, April 15). Nuances, Narratives, and the ‘Chemical Imbalance’ Debate in Psychiatry [Blog post]. Retrieved from
“Under media pressure in 2005, Dr. Steven Sharfstein, president of the American Psychiatric Association, was forced to admit that there is “no clean cut lab test”
to determine a chemical imbalance in the brain. Dr. Mark Graff, Chair of Public Affairs of the APA said that this theory was “probably drug industry derived.”
-Public Interest Report on Medical Alternatives to Psychiatry By Citizens Commission on Human Rights International, January 2008. Mental Health Care:
What is the Alternative to Psychotropic Drugs? Retrieved from
https://www.cchrstl.org/documents/What_is_the_Alternative_to_Psychotropic_Drugs_White_Paper.pdf
“Remarkably, antipsychotic treatment can result in further psychotic symptomatology at this stage, due to a dopaminergic supersensitivity effect, induced by the treatment itself.”
-Polese, D., Fornaro, M., Palermo, M., De Luca, V., & de Bartolomeis, A. (2019). Treatment-resistant to antipsychotics: A resistance to everything?
Psychotherapy in treatment-resistant schizophrenia and nonaffective psychosis: A 25-year systematic review and exploratory meta-analysis. Frontiers
in psychiatry, 10, 210. Retrieved from doi:10.3389/fpsyt.2019.00210
“The core finding of the present meta-analysis is that longitudinal GMV decreases in schizophrenia patients were associated with higher cumulative exposure to antipsychotic over time, while no effects were observed for duration of illness and severity of symptoms.”
-Fusar-Poli, P., Smieskova, R., Kempton, M.J., Ho, B.C., Andreasen, N.C. & Borgwardt, S. (2013). Progressive brain changes in schizophrenia related to
antipsychotic treatment?: A meta-analysis of longitudinal MRI studies. Neuroscience & biobehavioral reviews, 37(8), 1680-1691. Retrieved from
“I know some excellent psychiatrists who help their patients a lot . . .I also know that some drugs can be helpful sometimes for some patients. And I am not ‘antipsychiatry’ in any way. But my studies in this area lead me to a very uncomfortable conclusion: Our citizens would be far better off if we removed all the psychotropic drugs from the market, as doctors are unable to handle them. It is inescapable that their availability creates more harm than good.”
-Gøtzsche, P.C. Co-founder of the Cochrane Collaboration, Director of the Nordic Cochrane Center in Whitaker, R. (2016, April). Anatomy of an epidemic:
The history and science of a failed paradigm of care [slide show]. Retrieved from https://www.madinamerica.com/anatomy-of-an-epidemic/
Forced Hospitalization
“There is clear evidence that old-style mental hospitals are not effective in providing the treatment that people with mental disorders need and violate basic human rights of persons with mental disorders.”
-World Health Organization. (2019, October 4). Schizophrenia: Key facts. Retrieved from
https://www.who.int/en/news-room/fact-sheets/detail/schizophrenia
“…much of the poor outcome in psychosis is an artifact of late detection, crude and reactive pharmacotherapy, sparse psychosocial care, and social neglect”
-McGorry, P.D., Killackey, E & Yung, A. (2013). Early intervention in psychosis: Concepts, evidence and future directions. World Psychiatry, 7(3), 148-156.
Retrieved from doi:org/10.1002/j.2051-5545.2008.tb00182
A key recommendation of the Action Plan is to shift services from institutions to the community.”
-World Health Organization. (2013). Mental Health Action Plan 2013-2020. Geneva, Switzerland: World Health Organization. Retrieved from
Diagnosis
“‘Schizophrenia' is not a unified condition. Rather, it is a loose collection of vaguely defined behaviors.”
-Hickey, P. (2014, February 12). Genetic protection against schizophrenia? [blog post]. Retrieved from
http://behaviorismandmentalhealth.com/2014/02/12/genetic-protection-against-schizophrenia/
“...Chair of DSM-IV committee, claimed that “DSM-5 will radically and recklessly expand the boundaries of psychiatry.... There is no reason to believe that DSM-5 is safe or scientifically sound.' ”
-Johnstone, L. (2017). Psychological formulation as an alternative to psychiatric diagnosis. Journal of Humanistic Psychology, 58(1), 30-46. Retrieved
The Importance of Taking Care of our Health
Individuals with “.... schizophrenia have a 40% to 60% greater chance of dying prematurely than the general population, owing to physical health problems that are often left unattended [such as cancers, cardiovascular diseases, diabetes and HIV infection] and suicide.”
-World Health Organization. (2013). Mental Health Action Plan 2013-2020. Geneva, Switzerland: World Health Organization. Retrieved from