I have been working in mental health as a social work practitioner, counsellor and Psychosocial Therapist for over 30 years. I worked with the London Borough of Harrow, London Borough Ealing and London Borough Brent, running Therapeutic Communities and applying ‘therapeutic community’ principles within community settings and wider social networks.
David Cooper (Politics of Schizophrenia) took over the Therapeutic Community that I set up in Ealing. Since these earlier days of developing the techniques, I have since worked in the Voluntary Sector, organising small therapeutic networks and providing individual counselling to anyone with any form of psychological, social, or diagnosed serious ‘psychiatric’ problem.
With only a very few exceptions, anyone ‘voluntarily’ referred to us with a diagnosis of Schizophrenia and a fair few with Bi-Polar conditions, were identified to have had psychosocial experiences which fully accounted for any psychosis that they experienced, or demonstrated in their behaviour. RD Lang became, and remained, an inspiration for identifying psychosocial causation and developing psychosocial techniques.
These identified psychosocial features included very obvious; early developmental; adolescent transition; and ‘adult’ social ‘trauma’. In addition, there were sometimes drug, alcohol and other toxic impacts; including the use of prescribed psychotropic drugs. Often (but not always) it appeared to be a combination of these influences which triggered the first psychotic episode. Psychiatry did the rest.
These developmental and social trauma experiences, along with some toxic effects, proved adequate to account for the psychosis the person was experiencing. The fear of the experiences, coupled with the condition, the ‘induced’ belief that there was no ‘cure’ and an insistence that they would have to rely upon psychiatric expertise and heavy-duty medication; engrained the ‘problem’ and thoroughly disempowering the person.
Therapeutic Communities & Networks
We worked on that basis of getting the person to understand how their psychosis evolved out of their basic creative (imaginative) character. We demonstrated how this was compromised by poor developmental & social learning; poor social acceptance of individuality & self-determination (self-actualisation), intolerance of ‘difference’, misunderstanding of ‘learning’ and ‘expression’ styles; precipitated by some traumatic events in their lives.
This was enough to get them to take a new perspective on their condition and open up the possibilities of gaining insight into it. It is true that insight is difficult to achieve while within a ‘psychotic’, or ‘fright’ state, however, they were able to become skilled in anticipation and avoiding switching into such a state, once they more fully understood how this happened and what variables and influences contributed to this.
Reactions of Clinical Psychiatry
I was never accredited with ‘cure’ by any psychiatric institution, or psychiatrist, although the individuals were often astonished by how free they were of their symptoms and how empowered they had become, resulting from their therapy. Most came off all their medication, although some chose to maintain a reduced level. Others felt secure enough to return to medication in times of crisis, which may have precipitated a psychotic state.
The best we were able to get from psychiatry was an acknowledgment of a ‘misdiagnosis’. That was satisfying enough, as there were few exceptions to ‘substantial recovery’ (in as much as anyone is completely sane). I have found the same intractable behaviour from psychiatry since the earliest days, even with clear evidence presented to them. It is as if psychiatry itself is a collective delusional state, with one willing to speak out about the inconsistencies.
Even where there was a clear ‘organic’ character to the psychosis, which had led to the diagnosis of schizophrenia, there were clear benefits from the psychosocial therapy and clear causal understanding of ‘cause and effect’. Explanation of a condition, with improved ‘expectation’ of personal control over the condition, helped the person manage their symptoms better. This was mostly because the felt ‘safer’ with them and felt more ‘empowered’.
Psychosocial Therapeutic Skills
The socio-therapeutic techniques we used were the ‘natural’, social skills of open minded, young, optimistic therapists, with a sound grounding, understanding and critical perspective on psychology and sociology. They also had varying developmental and social experiences, including serious trauma and derivations, which they were willing to acknowledge.
The staff group were expected to engage in the same ‘psychosocial’ experiment as their clients. This mainly involved working from some very basic social rules and evolving an agreed set of rules and guidelines that fitted the group’s tasks and objectives.
Rather than ‘fragmenting’ the techniques into ‘cognitive’, ‘social’, ‘conscious’, ‘unconscious’, ‘rational’ and ‘intuitive’, etc.; we worked holistically, valuing our collective understanding of these various ‘understood’ and interacting components. Staff picked their own particular counselling & therapeutic styles and techniques, seeking training in the areas of their individual interests.
When working in the staff group, and the therapeutic community, they subjugated their individual styles to the more holistic approach. During individual counselling and small group therapies, the preferred styles of individual therapists came into their own. No style was ‘too precious’ just useful for dealing with a particular problem, or fitting a particular individual.
It is no wonder that it works so well and I still find it incredible that intelligent professionals are unable to appreciate that these techniques do work, very efficiently, over relative short periods of time and produce dramatically improved outcomes (especially when compared with long term, high level, psychotropic medications and periodic ‘intrusive’ interventions).
Of course, there are some psychotic conditions, which appear intractable and persistent. Some of these are evidentially organic in character. As I say, some improve non- the-less. Others, especially some extreme cases of paranoid schizophrenia, seem to be very resistant. Even this is simply explained. Most diagnostician seek to identify a single condition to explain all features. This is one of the biggest mistakes in psychiatry and psychology.
Cognitive Errors (of Psychiatry)
Too often, we assume all symptoms that are observed to be the result of a single ‘diagnosed’ condition. Only rarely to we see a proper appraisal of all the challenging features of a person’s psychosocial dynamic. If you have a diagnosed schizophrenia, all subsequent behaviours, altered states, and confounding expressions, are due to that single ‘condition’.
This often includes the anger expressed at restrictions and impositions (including those that we feel we can justify). It can include the frustration at not being listened to, or properly understood (sometimes because of ‘our’ limited thinking). There is also the depression and anxieties that arise out of having what we are told is an intractable and debilitating condition
Most importantly, there are the symptoms of all those other conditions we may develop quite independently. Some of these are other ‘reactive’ condition, which are designed to give us respite from distress, like grieving, low mood, anger and anxiety. Of course, these are soon turned into intractable condition, for being identified as ‘abnormal’. It seems we must never rests from stresses (unless we wish to be identified as ‘weak’).
Well, some of these other psychosocial conditions include features that are sociopathic and psychopathic in character. We understand these as personality features, rather than psychiatric conditions. Non-the-less, it is these ‘independent’ features when coupled with a ‘psychosis’ that produces the convenient, unified condition of ‘paranoid schizophrenia’.
Basically; reasonably socially integrated people experience psychosis because of developmental, social and toxic trauma. Fear, poor social reaction and psychiatric determinism entrench these features into the ‘diagnosed’ condition. Likewise, people who have a diminished, or corrupted, psychosocial relationships / cognitive styles (for whatever reason) can also develop psychosis and have this ‘condition’ become entrenched.
Outmoded Quasi-scientific Thinking
The whole system of psychiatric classification needs complete revision. It is essentially bankrupt. With the help of social-psychological developments (including a better ‘cognitive’ and ‘behavioural’ understanding of the effective therapeutic styles of intervention), psychiatry has made some advances in the treatments of neuroses and depressions, but is in the stone-age in respect of psychosis.
Delays in this revision are largely due to the psychiatry’s dependence, for income and credibility, on legal status of its diagnosis and the protection of society from risk (acknowledged) and inconvenience (disguised). Small wonder we see few changes and almost total resistance to acknowledging psychosocial causes (like work and social stress) and psychosocial ‘cures’.
The human, social and economic costs of this ‘distorted’ psychiatric perspectives, are accelerating and practices remain inconsistent with the established principles and laws of Human Rights. The principles of ‘least restrictive’, ‘dignity’ and relating to ‘mental capacity’, are seriously compromised by current psychiatric thinking and impacts on the entitlements of those with ADHD, Dementia and Autism, as well as the ‘Psychoses’.
Not only is there now sound evidence to challenge existing psychiatric thinking, there is also now sound logic and challenging theory which completely undermines the whole basis of classification and ‘normalistic’ understanding of traditional psychiatry.
Classical Psychiatry is now unable to defend its position, except in the most extreme cases of proven organic conditions. It must otherwise rely upon maintaining ‘fear’ to keep its control over our minds and behaviour.
