A Simpler Psychosis — Dispersing Toxic Day-Dreams.
WHAT IF there really is a Golden Key to unlock SEVERE MENTAL ILLNESS? Fifty-three years of psychiatry teaches me there is. Yet medical editors now ostracise me, while a legal onslaught eats my livelihood. Why suppress the HEALING HAND OF KINDNESS, with insight? Would you?
summary: PSYCHOSES have long been shrouded in mystery. They appear to be without rhyme or reason. Freud would habitually and instantly dispatch every patient with psychotic symptoms to the nearest asylum, rather than explore any and all aetiology. Despite this, over the centuries, there have been conspicuous successes, which continue to the present day, notably Geel, The Early York Quaker Retreat (1796–1850s), Soteria, Open Dialogue, and other Therapeutic Community approaches. This paper explores why. Perhaps, if psychotic symptoms are viewed as toxic day-dreams, both aetiology and thereby a sensible more effective therapy can emerge.
introduction: Research into the aetiology of violence [1] indicates that trauma frequently has long term consequences. Even DSM-5 allows for 50 year old trauma to continue to have clinical relevance and impact [2]. The standard infant protection against overwhelming mental pain is generally known as ‘denial’, sometimes as dissociation. What it represents in holistic terms is a mental defence against a physical, potentially lethal, threat. The infant has no other recourse than to conclude, against the odds, that “this isn’t happening to me”. The problem is that in susceptible cases, it can be difficult for the sufferer to conclude that “it’s stopped happening to me”. Even to venture near the toxic ‘memory’ can trigger the original terror. Suppose, again in certain cases, that this distortion of reality becomes a persistent day-dream, as in for instance “Mum didn’t die”, “Dad would never hurt me”, and so forth.
The standard medical or therapeutic approach relies on the patient being able to declare what the symptoms are, and so what the problem is. Perversely, in the event of ‘denial’, this is precisely what is unavailable either to the sufferer, or the therapist, since the former has, in an earlier life, decided adamantly never to voluntarily reveal either, whether to therapist or vitally to self. This could account for the conspicuous failure of the ‘front-door’ therapeutic approach — “pull yourself together, and tell me what’s at the bottom of all this”. Though every sufferer would give their eye teeth to achieve precisely that happy outcome, they have engaged and continue to deploy a strategy which entails distorting reality, both yesterday’s and today’s. A rather more nuanced and sympathetic approach is therefore called for, which when successful, can astonish both parties. In simple practical terms, this amounts to little more than the healing hand of kindness, with insight.
method: In order to ‘undo’ toxic day-dreams of the type described, a solid trustworthy therapeutic security is vital. The challenge for this therapeutic approach, and indeed any team seeking to implement it, is to fully engage that person’s ‘intent’, their ‘motivation’, their determination, and to re-direct it from fearing reality to embracing it. This involves understanding, and therefore explaining to both parties, how reality was originally learnt to be too frightening to contemplate, unaided — but, following the arrival of adulthood, that today’s reality is vastly safer than yesterday’s. An uphill task at the best of times, and one which drugs can seriously derail — but which, when implemented with full-hearted consent all round, can indeed remove the ‘toxic day-dreams’, 100%. The principle of the approach is often clearer than its implementation — but this clarity is at a premium in this field, so it could be less than wise to dismiss it out of hand.
results: Careful analysis of 5 cases, including the late John Nash, Nobel Prizewinner (as in the film A Beautiful Mind), explores how susceptible individuals cling to quasi-known irrationalities, from which they can, with explicit consent, be gently weaned, provided the sufferer sees direct, safer advantages in doing so. Video and audio evidence show that Freda (aged 40) and Sam (45) preferred to keep their dead mothers ‘alive in the head’. Freda needed a “safe place to go when stressed”; while Sam feared leaving home in case “my dead mum hits me again”. Emma (65) clung to a deceased father, to rescue her when pressed. Tessa (18) built shrines to her dead mother, yet cut every available inch of skin. The late John Nash day-dreamt he was ‘Emperor of Antarctica’, which effectively demolished his promotion to professor at Princeton University. His psychotic symptoms followed shortly after his father’s death, which his mother blamed on his mistress’s turning up at the family home with his illegitimate son. My supposition is that he needed to ‘reason’ that he had in fact not killed his father. And further, that being an adult, he no longer needed to depend for survival on an ‘unreliable’ parent. What is conspicuous in his story is the ‘unconditional’ emotional support afforded him by his ex-wife, at the crucial juncture, and indeed, contrary to the film of his travails, his discontinuation of all medication.
What is significant is that what mattered in all these cases is a ‘re-programming’ of ‘intellectual’ reasoning, a re-alignment of how to cope in a generally unreliable reality. For this, a solid trustworthy security needed to be fully established — only in this way, would there be sufficient incentive for the sufferer to switch from the only strategy they have ever known — namely ‘denial’, to the one the rest of us need to deploy everyday — think today’s problems through, as best we can. Toxic day-dreams need bringing up to date, with the full hearted consent of all concerned.
discussion: One remarkable and unexpected merit from this approach is that it explains precisely why psychotic symptoms are unreal. It gives an indication of why the sufferer deploys their full intellect to keep them inexplicable. It offers the notion that this distortion is quasi-deliberate. By keeping them bizarre, unreal, and decidedly unrelated to others’ experience, this has the aim of ensuring that there are no unwanted intrusions from that reality. Toxic day-dreams cannot be shifted by arguing that they are unreal — to the sufferer that is precisely their supreme advantage. This ‘switch’ from real to unreal, has a cause, it can only come about because that individual learnt that ‘pretending’ in this severe way, protected them from the vicissitudes of an unsafe environment. Treatment, to be effective, relies on unconvincing them of this anomaly. Medication can merely zombify, or otherwise gum things up — an effect which might support the original aim of the toxic day-dream, but effectively seals off any chance of amelioration.
This paper therefore proposes that the reason why Soteria and the rest, succeed, is that they persuade sufferers it’s now safe to assert adult self-control. Success comes from empowering them to increase self-
confidence, self-esteem and dignity, which drugs degrade. Viewing them as daydreams gone bad, clarifies not only where psychotic symptoms come from, but also, once explained, establishes mutual therapeutic aims. The reason this approach, and similar, have made such little progress in established psychiatric circles, is that it relies on a number of ‘soft’ answers to otherwise intractable problems. Wider issues are discussed elsewhere [3]. Viewed in this light, this approach is obvious enough — certainly ‘simpler’.
Dr Bob Johnson Friday, 23 September 2016
www.DrBobJohnson.org GMC speciality register for psychiatry reg. num. 0400150
formerly Head of Therapy, Ashworth Maximum Security Hospital, Liverpool
formerly Consultant Psychiatrist, Special Unit, C-Wing, Parkhurst Prison, Isle of Wight.
MRCPsych (Member of Royal College of Psychiatrists),
MRCGP (Member of Royal College of General Practitioners).
Diploma in Psychotherapy Neurology & Psychiatry (Psychiatric Inst New York),
MA (Psychol), PhD(med computing), MBCS, DPM, MRCS.
Author Emotional Health ISBN 0–9551985–0-X & Unsafe at any dose ISBN 0–9551985–1–8
references:
[1] Felicity de Zulueta, “Inducing Traumatic Attachment In Adults With A History Of Child Abuse: Forensic Applications”. The British Journal of Forensic Practice; 8; 3 ; September 2006
[2] DSM-5. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 31 May 2013. American Psychiatric Association. Page 277
[3] Bob Johnson. “Consciousness: Using Clinical Evidence To Link Consciousness With Its Twin Perils Of Psychosis And Violence.” Chapter 6 : in “Consciousness: Social Perspectives, Psychological Approaches & Current Research”. ISBN: 978–1–63485–023–0 Editor: Lloyd Alvarado. Nova Science Publishers, Inc. 2016
See https://www.novapublishers.com/catalog/product_info.php?products_id=60019
note: For those unfamiliar with current psychiatric politics and ethos, psychiatry has been wracked since 1980 by the DSM-III. The latest version, DSM-5, is described by The Economist as ‘misguided’ [May 18th 2013], and the NIMH insists it not be used in any psychiatric research — who can therefore justify using it for health care generally? It’d be a waste of time my submitting this paper to a major medical journal — it’d upset them — they don’t want to know — do you?
health warning: never stop psychiatric drugs abruptly — your brain tissue has got used to them, and needs to be skilfully weaned off them. . . .
