Making Sense of Madness
What causes psychosis, and what can help? Psychotherapy, with its interest in life history and circumstance, and its emphasis on the transformative power of the therapeutic relationship, has more to offer in this area than we are often trained to think. Ahead of an upcoming conference on the origins and meaning of psychosis, Dr John Read, Professor of Clinical Psychology, explains why the psycho-social model must be hauled back into view
During the 15 years or so that I worked as a nursing assistant, clinical psychologist and manager of mental health services, I was always struck by the fact that even the seemingly weirdest of behaviours and experiences (‘psychotic symptoms’) made sense once I knew a bit about the person’s history and circumstances. And much of what I heard about the early lives of these people was none too pleasant. Of course the trick, the hard bit, was gaining the trust of people so that they felt like telling me about themselves in the first place. I had entered the field, nearly 50 years ago, full of Ronnie Laing’s ideas about the meaning of madness, and my experience proved to me, over and over again, that he was right.
I was also repeatedly struck by the lack of interest in history and circumstances from many of my colleagues, including most (but not all) psychiatrists. But they had entered the field with a psychiatry textbook and the DSM in their heads. And their inability to reach the person in front of them, to form a ‘therapeutic relationship’ – partly because all they did was ask about symptoms and drug them – proved to them that what they had read about ‘schizophrenia’ being a devastating and intractable illness was right.
When I eventually left mental health services to return to academia I was determined to research what so many ‘psychotic patients’ had taught me about the origin of their distress, despair and confusion. It is more than 20 years ago now that I published the first of many reviews of the literature on childhood adversities and psychosis. The pivotal one, however, was eight years later, which we managed to get some media coverage for. The Guardian wrote, ‘The psychiatric establishment is about to experience an earthquake that will shake its intellectual foundations’.
It seems, however, that the idea that bad things happen and can drive us crazy has only ever been contentious with one small group of people. The public (in all but one of the 23 countries where surveys have been conducted – the exception being the USA) believes that psychosis, madness, or ‘schizophrenia’ is caused primarily by psycho-social factors like stress, loneliness, violence, neglect, poverty and so on. Furthermore, people with a diagnosis of ‘schizophrenia’ have an even stronger psycho-social model than the rest of us. But this is called ‘lack of insight’ by psychiatrists and is itself, we are told, a symptom of the illness that the psychiatrist is telling you you have got but which you insist you have not got. There is a word for this particular type of abuse of power; it’s ‘mindf..k’.
All this, of course, is just an ‘anti-psychiatry’ rant, so don’t take it too seriously. That has become the standard defence against experts-by-experience condemning how badly they have been treated, or researchers showing how little evidence there really is for psychiatry’s genetic predispositions and chemical imbalances, or documenting just how ineffective and damaging their drugs are. This labelling as ‘anti-psychiatry’ anything that biological psychiatrists don’t like or can’t understand directly parallels how they use diagnoses to create the illusion of an explanation for, and to keep a distance from, their ‘patients’. “Aha! Now I
know why Read engages in critiquing the medical model behaviour. He has ‘anti-psychiatry’ in him, which makes him do it. End of story.”
Remembering who I am writing for, let me add this. Although, for me, the most exciting recent therapeutic developments have been the Hearing Voices Network and Open Dialogue, it has to be said that the treatment of psychosis with the most research backing is a form of Cognitive Behavior Therapy adapted especially for psychosis, with an emphasis on life history, on reducing distress rather than symptoms, and on enhancing quality of life (see Anthony Morrison’s paper in Models of Madness). But when researchers teased out the most effective ingredient it was not any of the CBT techniques (useful as they are) but the quality of the relationship between the therapist and the client. So Carl Rogers was right after all. Who knew?
Dr John Read will be speaking at the one-day conference Psychosis: Origins, Experience and Meaning, in Brighton on June 26