Category Archives: Psychotic

A mad world A diagnosis of mental illness is more common than ever – did psychiatrists create the problem, or just recognise it?

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Unfortunate Events

When a psychiatrist meets people at a party and reveals what he or she does for a living, two responses are typical. People either say, ‘I’d better be careful what I say around you,’ and then clam up, or they say, ‘I could talk to you for hours,’ and then launch into a litany of complaints and diagnostic questions, usually about one or another family member, in-law, co-worker, or other acquaintance. It seems that people are quick to acknowledge the ubiquity of those who might benefit from a psychiatrist’s attention, while expressing a deep reluctance ever to seek it out themselves…

…While a continuous view of mental illness probably reflects underlying reality, it inevitably results in grey areas where ‘caseness’ (whether someone does or does not have a mental disorder) must be decided based on judgment calls made by experienced clinicians. In psychiatry, those calls usually depend on whether a patient’s complaints are associated with significant distress or impaired functioning. Unlike medical disorders where morbidity is often determined by physical limitations or the threat of impending death, the distress and disruption of social functioning associated with mental illness can be fairly subjective. Even those on the softer, less severe end of the mental illness spectrum can experience considerable suffering and impairment. For example, someone with mild depression might not be on the verge of suicide, but could really be struggling with work due to anxiety and poor concentration. Many people might experience sub-clinical conditions that fall short of the threshold for a mental disorder, but still might benefit from intervention.

See link for interesting article on psychiatry…and bits about the importance of psychotherapeutic intervention…

http://aeon.co/magazine/being-human/have-psychiatrists-lost-perspective-on-mental-illness/

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The Shopping Experience for the SchizoAffected Mind

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The Shopping Experience for the SchizoAffected Mind

“It is advertising and the logic of mass consumerism that governs the depiction of reality in the mass media.” ~Christopher Lasch

As someone with SchizoAffective Disorder, there are certain aspects of socialized living that the SchizoAffected mind is unable to fathom and finds horrifying, terrifying and can result in a psychotic episode. One of such experiences, is spending a day shopping or patronizing too many stores, or running too many errands that can involve customizing too many stores. The Shopping Mall is simply out of the question. Also, the SchizoAffected Mind lives a non-druginduced psychadelic experience daily, as such, exposure to bright, flourescent lights, muzak, commercials playing at subvolume, muted and neuromarketed designs on the floors, ceilings, walls and layout of stores can result in information and sensual overload.

This is my experience of shopping.

The following sound painting (what I call the music/mixes/soundscapes I create) is an attempt to describe and illustrate the internal and psychic experience when I must visit a store. The beginning illustrates the first feelings of anxiety that quickly metamorph into an attempt to squelch the anxiety and just try to get through the act of choosing the items needed in order to exit the store as quickly as possible. As someone who also has Obsessive Compulsive Disorder, I often worry that I will be blamed for shoplifting, even though I have not, which causes me to walk about the store with my hands in my pockets or behind my back or up my shirt sleeves. The middle of the piece illustrates the dreadful feeling that slowly creeps in and the sort of sickly childish feeling of behaving like this, but being unable to stop it (hence the horror-like, chilling childrens’ theme). Once the psychosis begins to set in, the SchizoAffected mind begins to unravel and to shatter at the overload (hence, the noise, experimental music) as the end of the song approaches, and can feel as if the mind is trapped in a twisted game (which brings feelings and thoughts of paranoia).

 

(If the soundcloud player does not show up in your browser, here is the direct link).

QOTD Terence McKenna*Source

*Image Credit (used with permission through CC license and fair use):
“1964. . . check out the check out!” by James Vaughn

Medicinal

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Medicinal

“Medication Time! Medication Time!”

My music is a kind of poetical literature in instrumental form. In each piece, I attempt to tell a story.

This experimental, ambient piece tells the story of before, during, and after taking medication. In the past (a long ago past), I was highly against taking any kind of medication as part of treatment, as I considered medication a form of mind-control and I did not want anyone mucking about with my mind, despite the fact that, at that time, my mind was quite unfriendly towards me and regarded as monstrous. I explain this, to further illuminate the influence behind this particular piece and why I created it.

Fig. 1The beginning of the music portrays what triggers the (almost daily) psychotic episode (the affected part of SchizoAffective Disorder) and a depiction of the resulting mood and state of mind/consciousness (which is why the music grows from dark to a kind of chasing feel, as if the mind were chased by the impending psychosis). The middle of the piece/story portrays taking the medications (I no longer hold the same beliefs I did when I was younger about medication, I can now see its use and I now comprehend much more about the beneficial chemical effects it can have on the brain, which has an effect on the body and state of mind) and how differently the mind is affected and the semblance of peace it brings afterward (which sort of explains the lyrics in the middle, “Little did I know. . .”). But the medication lasts only a while and is not impervious to further triggers (shown in the immediacy of the return to the psychosis). The end portrays the return to the psychosis. . . and time again for medication. Basically, this piece illustrates the endless daily loop of life for a mind schizo affected (the reason behind the ending looping back to the beginning, although not exactly, because not every episode is the same).

Untitled*Image Credits (all artwork used with permission through CC license)–
“biTteRNeSS bEfoRE bREakFASt” by Sippanont Samchai
“Fig.1″ by Vacon Sartirani
“Untitled” by Andres Yeah

When the Edge Is Near: An Outline of a Psychotic Episode

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It is so easy it seems for my mind to be wrecked, thereby, wrecking perhaps an entire day, or an indeterminate number of hours of long, prolonged moments trying to piece my mind together. And people (the egos of Society) always say I am gaming or manipulating or faking or stupid or some other such nonsense to explain away the means in which my mind attempts to recover from its shattered state.

I would rather not have this happen; I would rather not be affected at any moment, like being stalked by a monster wearing your own face. Like being stalked by your best friend, whom only a second ago was still your best friend and not the lumbering, snarling, shrieking, screeching ogre stalking you. Knowing where all your favorite hiding spots are; using every secret shared; every years-discovered nuance; every shift, pitch and frequency of your voice; knowing with precision every line of your face and using that knowledge as weapons against you. Because it is your own mind that stalks, at any moment turning against you. Turning in on you, twisting and distorting an already upside down world, like an inverted stream of consciousness. A psychic whisperer so can use truth like lies.

A psychotic episode comes on like a holocaust, save there is no warning, no foreshadowing, no skepticism, no ‘wondering If’ before hand, nothing to have taken heed. Just at one second, friend, and the very next before the clock ticks completely over, monster. And it is worse when the break must be kept quiet else it may disturb others (egos in society) and cause further problems, which feeds back in on the break, pushing the mind farther towards the cliff. Suicidal ideations may be pondered and masticated in the mind, but the actual decision comes in an impulse, an instant. Because no one knows where the edge of the cliff is, so one does not know at which point one will fall, as such, suicide is an accidental decision. “It” just becomes too much and there is a knife nearby so you pick that up and rake it across your throat, without thought, without feeling other than desperation as if you are locked inside a 5 dimensional tessellated Schrödinger box. You just want. It. To. Stop. You want your mind to stop.

The misconception is that there are racing thoughts and voices forcing and compelling you. This is a bit of an oversimplification. There are no thoughts; thoughts at that point are not raw enough to embody such pain. Words cannot contain such concepts of horror. The abstraction of that kind of state of mind tessellates fractals, like a code you cannot crack, because it multiplies exponentially a new number to code with each attempt at cracking it. As if a hacker were trying to crack a password, but with each attack, the password randomly changed and used the hacker’s effort as its algorithm. Like tessellating a fractal into splitting dimensions. So, thought, the idea is like a joke. Thought could not possibly exist in this level of hell. Others assume there are only basic emotions, limbic system responses, fight or flight. This is another misconception. We are talking about a unique, personal, intimate, sensual, perfect, precise, tailored mental hell that is boundless and that changes and evolves faster than any “cure” or attempt to heal the gaping wound that SHINES its pain is so clean and perfect, like the most priceless of diamonds. We are talking about a spectrum of emotions. If you should see one registered on the face, then THAT is an external sign of an emergency, because that means that the internal hell is leaking out to the external, amalgamated reality, and that means the edge is near.

I wish I were at a place such that when these moments strike me I can immediately start making a song, like capturing its photography, like freezing light. Sometimes, that helps to get out the daemon. But when such avenues are ripped from you for reasons of social aptitude, it only pushes the edge closer. It only makes you wish for the edge. To need it, want it, love it. So much so that death becomes like a private joke within you. Only the laughter never ends.

No, not so much a spectrum of emotions, but a prism, so many occurring simultaneously that you cannot name them all. That you cannot possibly identify them, they are so subtle, so loud. To say that one is “sad” or “depressed” in this state is not only synonymous with sacrilege (in its wrongness) but also absurd to think that it was that easily named, that easily quantified. Madness has no hold here. Madness has come and fled before something far superior and far, far more terrifying. Satan has had his fill, Satan flees in terror, and this is Satan’s hell. His horror turned to reflect his un-ego.

That is what it is like to be in the throes of a psychotic episode.

Inspiration: Movies about mental illnesses

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– submitted by Ruth Levine, MD, University of Texas Medical Branch, Galveston

Black Swan (2010), Darren Aranofsky

Brilliant psychological movie. Dissociation?

 

Anxiety and Anxiety Disorders Bipolar Disorder/Mania
Copycat (panic/agoraphobia) Mr. Jones
As good as it gets (OCD) Network
The touching tree (Childhood OCD) Seven Percent Solution
Fourth of July (PTSD) Captain Newman, MD
The Deer Hunter (PTSD) Sophieís Choice
Ordinary People (PTSD) Sheís So Lovely
Depression Psychosis
Ordinary People Shine
Faithful I Never Promised You a Rose Garden
The Seventh Veil Clean Shaven
The Shrike Through a Glass Darkly
Itís a Wonderful Life (Adjustment disorder) An Angel at my Table
The Wrong Man (Adjustment disorder) Personal
Dissociative Disorders Man Facing Southwest
The Three Faces of Eve Madness of King George (Psychosis due to Porphyria)
Sybil Conspiracy Theory
Delirium
The Singing Detective
Substance Abuse
The Long Weekend (etoh) The Days of Wine and Roses (etoh)
Barfly (etoh) Basketball Diaries (opiates)
Kids (hallucinogens, rave scenes, etc.) Loosing Isaiah (crack)
Reefer Madness Under the Volcano
Long Day’s Journey into Night Ironweed
The Man with the Golden Arm (heroin) A Hatful of Rain (heroin)
Synanon (drug treatment) The Boost (cocaine)
The 7 Percent Solution (cocaine induced mania) Iím Dancing as Fast as I can (substance induced organic mental disorder)
Eating Disorders
The Best Little Girl in the World (made for TV)-Anorexia Kateís Secret (made for TV)-Bulemia

Axis II Disorders

Personality Pathology
Cluster A Cluster B
Remains of the Day- Schizoid PD Borderline PD
Taxi Driver-Schizotypal PD Fatal Attraction
The Caine Mutiny- Paranoid PD Play Misty for Me
The Treasure of Sierra Madre -Paranoid PD Frances
After Hours
Cluster C Looking for Mr. Goodbar
Zelig-Avoidant PD
Sophieís Choice-Dependent PD Histrionic PD
The Odd Couple-OCPD Bullets over Broadway
Gone with the Wind
A Streetcare Named Desire
Antisocial PD
A Clockwork Orange
Narcissism Obsession
All that Jazz Taxi Driver
Stardust Memories Single White Female
Zelig The King of Comedy
Jerry Maguire Triumph of Will
Alfie
Shampoo Mental Retardation
American Gigolo Charly
Citizen Kane Best Boy
Lawrence of Arabia Bill
Patton Bill, On His Own

Miscellaneous Issues

Family Early Adult Issues
Ordinary People Awakenings
The Field The Graduate
Kramer vs Kramer Spanking the Monkey
Diary of a Mad Housewife
Betrayal Latency and Adolescent Issues
Whoís Afraid of Virginia Woolfe Stand by Me
The Stone Boy Smooth Talk
The Great Santini
Doctor/Patient Relationship Boundary Violations
The Doctor The Prince of Tides
Mr. Jones
Idealized “Dr. Marvelous” Psychotherapy
Spellbound Suddenly Last Summer
The Snake Pit Captain Newman, MD
The Three Faces of Eve Ordinary People
Good Will Hunting

Steve Hyler directs an APA course on this topic, and
would be a good person to check with.
For more details, you can call me (409) 747-1351. Hope to see you in Maine!

Ruth Levine
University of Texas Medical Branch


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Humanistic theory and therapy, applied to the psychotic individual

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Humanistic Theory and Therapy, Applied to the Psychotic Individual

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Green Rorschach test

Sometimes people understand psychosis or schizophrenia to be unrelenting, even with the intervention of psychotherapy. It is contended herein that therapy, and humanistic therapy in particular, can be helpful to the psychotic individual, but, perhaps, the therapist may have difficulty understanding how this approach can be applied to the problems of psychosis. Although it is a prevalent opinion in our society that schizophrenics are not responsive to psychotherapy, it is asserted herein that any therapist can relate in a psychotic individual, and, if therapy is unsuccessful, this failure may stem from the therapist’s qualities instead of those of the psychotic individual.

Carl Rogers created a theory and therapy indicated by the terms “umanistic theory” and “person-centered therapy”. This theoretical perspective postulates many important ideas, and several of these ideas are pertinent to this discussion. The first of these is the idea of “conditions of worth”, and the idea of “the actualizing tendency.” Rogers asserts that our society applies to us “conditions of worth”. This means that we must behave in certain ways in order to receive rewards, and receipt of these rewards imply that we are worthy if we behave in ways that are acceptable. As an example, in our society, we are rewarded with money when we do work that is represented by employment.

In terms of the life of a schizophrenic, these conditions of worth are that from which stigmatization proceeds. The psychotic individuals in our society, without intentionality, do not behave in ways that produce rewards. Perhaps some people believe that schizophrenics are parasites in relation to our society. This estimation of the worth of these individuals serves only to compound their suffering. The mentally ill and psychotic individuals, in particular, are destitute in social, personal and financial spheres.

rogersCarl Roger’s disapproved of conditions of worth, and, in fact, he believed that human beings and other organisms strive to fulfill their potential. This striving represents what Roger’s termed “the actualizing tendency” and the “force of life.” This growth enhancing aspect of life motivates all life forms to develop fully their own potential. Rogers believed that mental illness reflects distortions of the actualizing tendency, based upon faulty conditions of worth. It is clear that psychotic people deal with negatively skewed conditions of worth.

It is an evident reality that the mentally ill could more successfully exist in the world if stigmas were not applied to them. The mentally ill engage in self-denigration and self-laceration that culminate in the destruction of selfhood. This psychological violence toward the mentally ill is supported by non-mentally ill others. The type of self-abuse by psychotic individuals would certainly abate if the normative dismissal of the mentally ill as worthless is not perpetuated.

In spite of a prevalent view that psychotic individuals are unsuccessful in the context of psychotherapy, Roger’s theory and therapy of compassion cannot be assumed to be unhelpful to the mentally ill. The key components of Rogers’ approach to psychotherapy include unconditional positive regard, accurate empathy and genuineness. Unconditional positive regard, accurate empathy and genuineness are considered to be qualities of the therapist enacted in relation to the client in terms of humanistic therapy. These qualities are essential to the process of humanistic therapy.

In terms of these qualities, unconditional positive regard is a view of a person or client that is accepting and warm, no matter what that person in therapy reveals in terms of his or her emotional problems or experiences. This means that an individual in the context of humanistic psychotherapy, or in therapy with a humanistic psychologist or therapist, should expect the therapist to be accepting of whatever that individual reveals to the therapist. In this context, the therapist will be accepting and understanding regardless of what one tells the therapist.

Accurate empathy is represented as understanding a client from that person’s own perspective. This means that the humanistic psychologist or therapist will be able to perceive you as you perceive yourself, and that he will feel sympathy for you on the basis of the knowledge of your reality. He will know you in terms of knowing your thoughts and feelings toward yourself, and he will feel empathy and compassion for you based on that fact. .

As another quality enacted by the humanistic therapist, genuineness is truthfulness in one’s presentation toward the client; it is integrity or a self-representation that is real. To be genuine with a client reflects qualities in a therapist that entail more than simply being a therapist. It has to do with being an authentic person with one’s client. Carl Rogers believed that, as a therapist, one could be authentic and deliberate simultaneously. This means that the therapist can be a “real” person, even while he is intentionally saying and doing what is required to help you.

The goal of therapy from the humanistic orientation is to allow the client to achieve congruence in term of his real self and his ideal self. This means that what a person is and what he wants to be should become the same as therapy progresses. Self-esteem that is achieved in therapy will allow the client to elevate his sense of what he is, and self-esteem will also lessen his need to be better than what he is. Essentially, as the real self is more accepted by the client, and his raised self-esteem will allow him to be less than some kind of “ideal” self that he feels he is compelled to be. It is the qualities of unconditional positive regard, accurate empathy and genuineness in the humanistic therapist that allow the therapist to assist the client in cultivating congruence between the real self and the ideal self from that client’s perspective.

<a href=”schizophrenia” title=””>What the schizophrenic experiences can be confusing. It is clear that most therapists, psychiatrists and clinicians cannot understand the perspectives of the chronically mentally ill. Perhaps if they could understand what it is to feel oneself to be in a solitary prison of one’s skin and a visceral isolation within one’s mind, with hallucinations clamoring, then the clinicians who treat mental illness would be able to better empathize with the mentally ill. The problem with clinicians’ empathy for the mentally ill is that the views of mentally ill people are remote and unthinkable to them. Perhaps the solitariness within the minds of schizophrenics is the most painful aspect of being schizophrenics, even while auditory hallucinations can form what seems to be a mental populace.

Based upon standards that make them feel inadequate, the mentally ill respond to stigma by internalizing it. If the mentally ill person can achieve the goal of congruence between the real self and the ideal self, their expectations regarding who “they should be” may be reconciled with an acceptance of “who they are”. As they lower their high standards regarding who they should be, their acceptance of their real selves may follow naturally.

Carl Rogers said, “As I accept myself as I am, only then can I change.” In humanistic therapy, the therapist can help even a schizophrenic accept who they are by reflecting acceptance of the psychotic individual. This may culminate in curativeness, although perhaps not a complete cure. However, when the schizophrenic becomes more able to accept who they are, they can then change. Social acceptance is crucial for coping with schizophrenia, and social acceptance leads to self-acceptance by the schizophrenic. The accepting therapist can be a key component in reducing the negative consequences of stigma as it has affected the mental ill patient client.

This, then, relates to conditions of worth and the actualizing tendency. “Conditions of worth” affect the mentally ill more severely than other people. Simple acceptance and empathy by a clinician may be curative to some extent, even for the chronically mentally ill. If the schizophrenic individual is released from conditions of worth that are entailed by stigmatization, then perhaps the actualizing tendency would assert itself in them in a positive way, lacking distortion.

In the tradition of person-centered therapy, the client is allowed to lead the conversation or the dialogue of the therapy sessions. This is ideal for the psychotic individual, provided he believes he is being heard by his therapist. Clearly, the therapist’s mind will have to stretch as they seek to understand the client’s subjective perspective. In terms of humanistic therapy, this theory would seem to apply to all individuals, as it is based upon the psychology of all human beings, each uniquely able to benefit from this approach by through the growth potential that is inherent in them. In terms of the amelioration of psychosis by means of this therapy, Rogers offers hope.

Image via Kheng Guan Toh / Shutterstock.

Ann Reitan, PsyD, is a clinical psychologist and well published essayist of fiction and creative nonfiction. She holds a Bachelor of Arts in Psychology from University of Washington, Master of Arts in Psychology from Pepperdine University, and Doctorate of Clinical Psychology from Alliant International University. Her post-doctoral research at Washington University in St. Louis, MO, involved personality theory, idiodynamics and creativity in literature.