Therapeutic Background: This page is in the stage of preparation
I am from a non-clinical, social work and 'Psychosocial' therapeutic, non-psychoanalytic (but rather social-analytic background). I have 35 years of experience in working with people with learning difficulties, autism, alcohol & drug effects on mental health, mental health generally and psychosis in particular. I am tired of the use of prejudiced concepts like 'normality'. Human Rights show the concept to be a nonsense. I have set up and ran a therapeutic Community for 6 years. This was eventually taken over by David Cooper (Politics of Schizophrenia), after it had been well established. I have since set up small, local mixed group 'therapeutic networks' of people with a range of psychological, emotional and social problems, including serious sensory & physical disabilities and diagnosed Psychosis. My Approach:
My greatest interest was in the working with people who exhibited the features of clinical psychosis of all kinds. My assumptive approach was to work with the ‘parts that work’, rather than focus on the bits that failed. My staff became very skilled at working with people who exhibited psychotic symptoms and associated behaviour, as well as with the psychiatric and psychological effects of other disabilities. Most showed substantial and even complete recovery from serious mental health conditions, to the extent that most of those who were identified as having schizophrenia and bipolar conditions, were eventually psychiatrically classified as ‘misdiagnosis’ (medication ceased); assumed to be ‘induced’ psychosis of some kind. The more recent examples tend to be re-classified as ‘personality disorders’. Many of these clients can remain quite vulnerable; their confidence is frail, often due to long-term poor treatment, with the recognised misdiagnosis. The slightest relapse, without appropriate early support, can result in aggressive psychiatric intervention, which itself is, quite ‘paranoiagenic’. This can even lead to further ‘psychiatric diagnoses’, including reversion to Schizophrenia and Bipolar conditions. Those who survive longer, with some minimal, skilled social support, or within strong ‘inclusive’ social networks, became more resilient and find ways of ‘enjoying’ their special, quite creative slant on life. These individuals effectively become ‘cured’ on the longer term. The discussion as to whether these were ‘cures’ or misdiagnosis is a little academic. The fact is there is substantial evidence that recovery is possible undermines the very organic foundations of these diagnosed conditions. Psychosocial Interventions:
I, and various staff teams I have worked with, or supported, have also gained significant improvements in the functioning of people diagnosed with Autism, ADHD and even Learning Difficulties and Dementia. These are clearly not ‘cures’, or even partial ‘cures’. The significant improvements have been the result of a number of important principles of non-clinical, ‘social’ intervention: Whatever the principle diagnosis, or identified disability, actively look for symptoms and the physical causations of problems, particularly relating to sensory, balance, cognitive and other ‘somatic’ sensory difficulties (including pain). When these are adequately dealt with the ‘primary disablement’ presentation is usually significantly lessoned and ‘experience improved. Look at dietary intake, quantity & frequency and for any allergic reactions. When these are identified and then resolved, there is often a marked improvement in the ‘presenting’ problems of the primary disability, whatever that is; LD, Autism, Schizophrenia, etc. (In some instances, identification and explanation is enough for mental health conditions). Raise expectations for recovery to a level that enables the person to aspire to progressive, step by step, ‘evidenced’ improvement in their circumstances and quality of their experiences. In many instances (psychiatric and ‘partial’ psychosomatic problems) this can involve the progressive reduction and even complete removal of psychotropic drug treatments. Accept and encourage the development of ‘alternative’ explanations for the variation between; what the person experiences and what the rest of us observe (or experience). As long as these retain some reasonable internal logic and establish an effective, good enough communication, the confidence in the person’s ‘control’ over their circumstances usually improves and the presentation and experience of the disablement lessens. Encourage staff not to be dogmatic about what ‘normal’ experience is. Provide and ‘open minded’ re-evaluation of the cause and effect of physical versus psychological, social and even spiritual causations. Start from the basis that these are multi-way, interactive features of cause and effect and relativistic perspectives of the same fundamental, unified problem. Effective communication is not the so much about the words used, as how the words, along with other emphases and communication channels, point towards sharable concepts and accessible perspectives. Graphical and metaphorical representations, art drama and music are some of these valid channels and can establish a rapport upon which verbal communication can then progress. These alternative conceptualisations and expressions should come from the client, wherever possible, with us ‘picking up’ on those that naturally show themselves. We can effectively propose and test out some options, where the person fails to propose, or demonstrate their own. Get staff to avoid picking up and ‘imposing’ and singular, ‘purified’ form of ‘treatment’. These are wholly value based and can confound the initial establishment of trust and communication. The idea is to build an effective communication base, to agree and disagree perspectives, without devaluing any one (this is quite different to ‘humouring’ or ‘condescending to’ the person). Almost all ‘researched’ psychodynamic and behavioural treatments have been ‘extracted’ from the ‘established bank’ of interacting learning & recovery styles and causal explanations (enabling and re-enabling, relativistic perspectives, often in ‘meta-language’). Conventional techniques work with those who are primarily disposed to those learning and communication styles. Not everyone is and there are other styles, as yet undiscovered, or inadequately validated (construct development overriding retentive memory and multi-dimensional, non-verbal concept formation, s two instances. Look for the channels of communication that are already effective. Look for the sensory channels that are functional and primary for the person. Look for the theoretical constructs that are extant and seek to engage them. Assume an internal logic that is translatable to ‘normal’ world experiences. Engage the physical bit that work and reduce focus on the bit that are failed, or absent.
Different Learning, Cognitive and Expression Styles (Types):
What became increasingly evident, through my own experience, through my work, research and reading was that there are ‘alternative’, cohesive, logical and creative, learning styles; dealing with largely internally cohesive, multidimensional cognitive constructs. These are usually problematic for communicating in the conventional, linear form of verbal language. This has always been the case and the reason why cultures have historically become increasingly constrained by the inconsistencies between socialised thinking and evolving social actions & behaviours (often dismissing all 'deviations' as immoral, aberrant, delinquent, witchcraft, deviant, etc.). Concepts become catch-alls for any difference. Socialised thinking becomes out of step with the 'social technologies' and the resultant 'expanding' social experiences. The general social language lags behind the wider social and technological development of the culture. Any important technological development (engineering or social) effectively arises out of an 'aberration' from the norm. It requires the 'technologist' to think outside the box and conceive of something differently from what has gone before. There is inadequate language to properly convey the idea, but a model or metaphor sometimes helps. Those who grow up with these new technologies and concepts, develop their own 'deviant' language, to the frustration of 'Elders'. Initial attempts at explaining these ideas are often dumbfounding to most others; the idea and new language is outside their experience and this should not be a surprise. Intolerance of 'difference' is also a 'fear' reaction that most individuals and cultures have, towards anything that threatens their established security; including the security of existing concepts and the 'magical power' of words. It is only when someone trusts the potential benefits of the 'idea' that it is translated into a practical and pragmatic outcome which others then admire. They then enjoy the benefits, while often refusing to accept the more challenging concepts and explanations (it is a new magic and they like it that way). The 'learned' translations, that some of us develop to communicate, are often inadequate to convey these more unique understandings and often give rise to 'compromised' communication of understandings. Because of this, some important meaning is lost. The 'socialised' speaker has to be satisfied with a partial communications. The resulting impact can vary across the following spectrum or 'reactions'. The new concepts have to be carried by some, translated by others and implemented by the general group, often in a 'new' prescriptive form. Some 'listeners' get the general idea, more-or-less as it was intended and progress to develop this idea further. They improve in practice (applying the social technology) and may even refine and improve the original concepts, advancing the concept 'outcomes' further. some get a compromised, but good enough understanding that is an advance and are able to progress towards a better understanding. They still practise in their usual style, but incorporate some of the social and practical technology as 'techniques'. others take the content and incorporate them into entirely inconsistent concepts, distorting the original meaning completely. They carry on in their usual ways, using different, convincing 'words', but little social or technological benefit and some negative impacts. others reject the whole concept on the basis that it does not fit with their general experience. They walk away with nothing new and may even be further entrenched in their established thinking, resisting anything new and sabotaging any attempts to advance. still others 'classify' the communication individual as a heretic, traitor, as deranged, or incompetent. They are (in recognising some difficult to understand 'truth') so threatened by the concept that they need to suppress it, maintaining their own 'expertise' and 'power'.
Professor Elliott Jaques recognised these variations from conventional assumptions of intelligence, as forms of 'Social Intelligence/Personality Types' (Ref: 1 & 2 below). The above descriptions are the typical social outcomes of the various 'Types' he was able to identify, when expressed within a dysfunctional institution or culture. Remembering that he was from a Melanie Klein (Kleinian), Psychoanalytic background. He would have recognised some of the consequences of these misconceived competence, resulting in psychosocial distress for some of his patients. He had other useful insights from his earliest research into the operation of 'Institutions' of various kinds. It would not have been unusual for him to have worked to help people resolve both the internal (cognitive) and the institutional conflicts that resulted from their profound understandings being constrained by ignorant and disabling conduct of a particular social, or institutional culture. He was fascinated by these various 'institutions'; how they can function to advance human understanding and social & economic progress. He was also aware how 'misplaced' individuals can also become 'institutionalised'. recognising their resistant to natural advancement, such that the institutions they manage becomes increasingly, intellectually and organisationally stagnant; so that they progressively fails. 'Theorists', 'Pragmatists', 'Specialists' and 'Generalists' are 'a few Types' which have the greatest relevance here. Another identified type, which I believe is very important; is the 'Translator'. What is most important here, is that these 'types' are all legitimate in their general roles and do not have to be 'inflexible' in their specialist understanding, or application. The defensiveness and conflict that can arise between 'Types' is a consequence of the competitive nature of social institutions. This damages the potential that each 'Type' can contribute to the more complete social & cultural context. The often revered 'competitiveness' can become a destructive, rather than the 'driving force' of good ideas & practice. The Professional Experts and Language Constructs:
Most of us with some 'expert' (or even radical) perspective, or perhaps a more unique insight into 'problems'; have to be satisfied that some ideas and constructs will not make the fullest, deeper sense to some others. Those with well established, socialised constructs, with 'engrained' social attitudes and 'convenient' understandings, will be resistant to any new ideas. This is not uncommon in most cultures, but is unacceptable and even counterproductive and inconsistent, within some professional, educational and therapeutic institutions. Sadly, it is often professional officials who originally established the socially incorporated misconceptions in the first place. People usually need to be convinced by evidence, which is fair enough, although the nature of 'evidence' can vary considerably. They also need a fuller understanding of the 'concepts'; which can be problematic. To be convinced, they must also be willing incorporate new ideas and convert these into new forms of action, or trust that the actions of others are consistent with these ideas and important, established & proven principles. Some acceptance is then based upon 'acts of faith', where other evidence has satisfied the listener of the general credibility of the speaker. Where the cognitive content of the speaker is accurate and useful, this is fine. Where it is detrimental, this can be socially disastrous. Mathematics and logical symbolism would probably do a better job with some of these evolving concepts. Those constructs, which do not yet have an adequate 'shared' verbal equivalence, can be very distressing, when a need to communicate a mental experience becomes requisite. Attempts are often seen as incompetent, idiosyncratic, or even psychotic. Characteristic 'repetitive' conversational styles are often a feature of these kinds of communications failures. They are initially a means of 'checking' that meaning is being conveyed by the speaker, recognise that listener (from the nature of their feedback) is not comprehending some important aspects the person's speech content. These characteristic vocal repetitions are also a 'magnified' feature of many 'distressed' conditions, where miscommunication has repeatedly taken place. They are characteristically seen as irritating, nonsensical and confounding, especially if the person is unable to 'paraphrase' the content of their speech (for any reason). The miscommunication is often compounded and can eventually become pathological (distressed, agitated and confusional). This characteristic of communication breakdown is evident in forms of Autism, Learning Difficulty, Dementia and Psychosis. Successful professional interventions reverses this trend and re-establish communication and mutual understanding. Communication Failures masquerading as Individual Incompetence:
This failure of communication is invariably due to the mismatch between two contradictory, but usually equally valid perspectives, for which there is inadequate, or misinterpreted mutual understanding. The 'social' convention wins by weight of numbers and the 'prevailing' linguistic and cognitive constructs. This is often the case, irrespective of the credibility of the speaker's cognitive competence. Even professionals make the same human mistakes as the average person. Once a convincing 'accusative' explanation for a communication failure is established, this soon becomes part of a 'diagnostic tool'. Once the idea takes hold, human frailty often reinforces this 'distortion'. Of course some speech content is nonsensical and irrational. It is problematic to identify which is what, although there are usually other clues which are often missed. These 'communication errors' often arise from reasonably cohesive forms of individualistic thinking. This only becomes problematic when attempts are made to communicate the ‘ideas’ to those who exclusively use established, ‘conventional’ constructs and communication channels; from a 'normalistic' perspective. There is often no satisfactory ‘direct’, translation. There are ‘hybrid’ cognitive structures which allow for ‘diverse’ and ‘lateral’ forms of thinking, in parallel with ‘conventional’ thinking and learning. There are always compromises though and some meaning is lost to some listeners. This problem is overcome in 'think tank' contexts, by a mutual tolerance of partial understanding and acceptable 'nonsense'. These same kinds of problems exist in translations between different cultural languages. It not a new problem. The unique, multidimensional conceptualisations and the inherent frustration of communication, means that the individual can build their own, socially isolated constructs, which become internally consistent and logically cohesive, perhaps incorporating all the essential information from the social world. An isolated 'grammar' evolves, which works for the individual's thinking but becomes increasingly detached for the shared grammar of normal communication. Unfortunately, if this process of misunderstanding happens early enough and goes unrecognised for any reason, some errors can also be incorporated into these isolated mental constructs. The thinker is unaware of these because of the miscommunication, but may be able to correct the errors, when good communication is eventually established. The biggest problems arise where these alternative styles of cognition are better, more 'general' representation of social experience and are therefore the person’s preferred constructs and channels for personal understanding, often providing some better predictability of experiences than those being offered by others. These different learning and cognitive ‘styles’ lead to the misunderstanding and can lead to conflict. This often magnifies the mutual agitation and confusion that arises. Social stigma and even serious Mental Ill Health (in some form) often results from assumption that this content is entirely nonsense &/or delusional thinking. From our often distorted 'normalised' experiences and resulting conceptualisation, we fail to see important 'alternative' meanings. We become part of the person's problem, often entrenching it. These are the 'idiosyncratic' forms of conceptualising and associates potential misunderstanding (and agitated misinterpretations), which often arise between disparate cultures; with differing ways of seeing and understanding the world. Sometimes there are even significant differences in their 'modes of perception’. These modes of thinking and styles of perceiving & learning, are not necessarily dysfunctional within an individual, any more than they are in a cultural group. They can become so, however; with inadequate opportunity to engage and ‘share’ critical information, or opportunity for diversity within a culture. A lack of facility to adequately 'translate' understandings and conventions, or for a sub-culture to become accepted into the host culture (or the international community) also frustrates this integration of knowledge. Diversified Thinking and Linguistic Difficulties:
Some forms of schizophrenia can be adequately explained in this way, as can many presentations of Autism, ADHD and other 'conflict' type 'social diversity' problems. To fully understand this more fully, it is helpful to conceive of being a very intelligent being who arrives 'as an alien' on another planet, about which you have no real knowledge or previous experience. You are on your own and you meet the indigenous population. Not only do you appreciate that their language is different (as may be expected), it is also appears so simplistic in its form that it is seems to be unable to contemplate some of the multidimensional concepts that you are trying to convey (based upon the extensive social and personal experience you have accumulated). You become very frustrated and begin to feel very isolated. Your are eventually forced to 'accept' some of their assertions as 'give' truths, in order to survive and stay sane. However, consider now that you persevere with getting to know and understand that culture and they also seek to understand your perspectives. You then find some 'simple' assertions, which when adequately translated and fully understood, prove to be based upon more fundamental understandings than your own. Some of the concepts that originally appeared simplistic and idiosyncratic, turn out to be 'simple', generalised, universal concepts, which explained and unified lots of your own rather fragmented concepts. Enlightenment; Eureka! Like an excited Sir Walter Raleigh's (with his newly discovered potatoes and tobacco), you take these new concepts home with you, along with clear instructions for what to do with them. It changes the future history of human development. Some conceptual and linguistic problems are 'perceived' to arise; because a person has developed preferential channels of perception and communication (non-verbal, or super-verbal) which are on the edge of established, 'normal' perspectives. Where a person discovers a rich resource for expression, in their chosen ‘medium’, through their preferred and often enhanced channels, we get the ‘expressions’ of perception and experience which can become 'fascinating' to others. These are often most fascinating to those less able to 'tune in' and more fully understand these 'altered perspectives'. This 'playing on the edge' is intriguing and 'touches' something chaotic and anarchic in ourselves. We all have some potential for both creating and enjoying these form of conceptual creativity, but may be less motivated, or adequately skilled, to engage in producing the material which intrigues others. We may also feel too insecure to 'engage' in the proper experiments of 'being on the edge'. Some are less reluctant and step over and back from the edge at will. Most of us, however, seem preordained to be fascinated by this 'on these edge experience', as long as it is not too prolonged and that we are able to turn away, or hide under the covers. This is what our fascination with music, poetry, art, drama and conceptual and moral puzzles is all about (Creativity, Diversified Thinking & Lateral Thinking). It is the consequential failure of legitimate, rewarding communication that causes many ‘diagnosed’ problems to present themselves. It is then as much the failure of ‘others’ to recognise the failed attempts to communicate these complex (actually simple) ideas to those who are unable to appreciate the important changes perspective. It is possible to conceive of someone being so 'advanced' on their peers, in some critical area thinking of the person, that the failure to get mutual understanding causes a psychosocial breakdown. This is the 'walking on the edge' scenario, where finding an adequate channel for expression and actualisation makes the difference between discovery and madness. To be continued . . . . Ref: 1 - Levels of Abstraction in Logic and Human Action: A theory of discontinuity in the structure of mathematical logic, psychological behaviour, and social organisation; Prof. Elliot Jaques (London: Heinemann Educational, 1978) with R.O. Gibson and D.J. Isaac [Editors] Ref: 2 - Life and Behavior of Living Organisms: A General Theory; Prof. Elliot Jaques (Greenwood, 2002) ISBN 0275975010 Professor Elliot Jacques obituary summarises his achievements and outlines some of his important contributions to thinking: http://www.telegraph.co.uk/news/obituaries/1425176/Elliot-Jaques.html - General Information: Elliott Jaques WORKING NOTES: Supplementary to the above: There are those who have particularly enhanced, integrated sensory information processing (ADHD).
See if you can contemplate more positive, 'alternative' perspectives on what might be happening with someone who displays these features. I have, with very productive outcomes for the people concerned. Send me your perspectives for publications. often quit low and the least but the manifest signs of psychosis were absent, often replaced by some creative and ‘imaginatory’ explanations for their experiences, while developing a good grasp of ‘social’ realities. The challenge of assumed causations of established diagnoses have range from Schizophrenia and Bipolar conditions; through Drug, Alcohol and other Toxic inducement of psychosis; to Autism, Physical Brain Trauma; Learning Disabilities and even Dementia. We usually assume too much about the wider impairments of any disablement. We also underestimate the potential for positive 'adjustment' and adaptation. In the process of our work, we were able to identify consistent evidence of serious psychosis being clearly induced by psycho-social trauma, which subsequently and consistently responded to psycho-social interventions of various kinds. This approach was mainly taken with those who were diagnosed as having schizophrenia, who's condition was actually entrenched by the treatment, rather than improved! © Terry Couchman; Visitweb / Your Choice; June, 2009 ; Revised Feb. 2010. |
