Psychosis is Not Normal – A Guest Blog

By Lynn Nanos author of Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry

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Image by 3D Animation Production Company from Pixabay

As I was selling copies of my book, Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry, at a National Alliance on Mental Illness (NAMI) conference in Albany, NY last month, I had an interesting conversation with someone which reminded me of the dangers of the antipsychiatry movement, which promotes the notion that mental illness doesn’t exist.

A man approached me at my booth and asked me about Breakdown and then shared his experience with bipolar disorder with psychotic features. He emphasized that he’s recovered.

I empathized with his experience and happened to mention “illness.”

Immediately upon hearing this, he interrupted me mid-sentence with “I do not have an illness. I don’t like the use of that word so please don’t use it. I have a condition. I’m not defined by my condition. We need to stop stigmatizing this.”

I thought, “I’m not sure how this conversation will end, but I have to educate this guy. Otherwise, he’ll continue to spread the façade that stigma is an enormous issue and the only way to mitigate it is by not accurately describing what he really has – an illness.”

So, I said to him, “According to several dictionaries, ‘condition’ means ‘illness.’”

His eyes and mouth widened with “What? That can’t be true. Are you sure?”

I’m sure. Check it out yourself. I’m sure you’re a lot more than your bipolar disorder, but not accurately defining what you have is stigmatizing, not the other way around.”

After a few more minutes of him working through his shock about my challenging him, he eventually said “Thank you for pressing me to change for the better. I’ll look this up.” Smiles and relief.

∞∞∞

Earlier this year, I attended the National Alliance on Mental Illness’ national convention in Seattle, WA. The event was kicked off with pomp and circumstance involving a ceremonial military march beside the United States flag on stage before me. As I looked around at a sea of thousands of guests, I couldn’t help but think, “NAMI is huge, important, and powerful.”

Most of the week was filled with lectures and workshops. The “Cognitive Behavioral Therapy (CBT) for Psychosis” workshop I attended reminded me of the benefits of this therapeutic modality for a variety of mental illnesses, but also left me alarmed at some of the messages NAMI has been sending to mostly family members of those with mental illness and some professionals. CBT teaches people to think about, describe, and respond to the environment accurately. It persuades people to behave in healthy ways in response to thoughts. The underlying presumption of CBT is that when either one’s thought, emotion, or behavior changes, the other mental components change.

As I vigorously took notes in the workshop led by psychologists Kate Hardy and Sarah Kopelovich, my review was mixed. Should CBT for psychosis be completely disregarded? No. I’m grateful to the late forensic psychologist Robert Powitzky who extensively directed services for prison inmates, for his educational reminders. He wrote to me, “CBT can have several benefits other than making observable changes in positive and negative symptoms…is often effective for patients with schizophrenia who are stabilized on medication in conjunction with supportive housing.” 

CBT for psychosis can be useful, especially once the psychosis has been stabilized and well-managed. The psychologists said that CBT has shown moderate effectiveness in reducing the negative symptoms of schizophrenia – social withdrawal, poverty of speech and thought, apathy, anhedonia, loss of motivation, and inattention to social or cognitive input. I credit the psychologists for pointing out, albeit briefly, that per psychologist Xavior Amador, one of the greatest predictors of successful treatment is awareness into illness. But this was as far as they got regarding insight.

On another note, I confirmed that NAMI was doing two dangerous things: marginalizing those whose psychosis interferes with the ability to engage or benefit from CBT and minimizing mental illness.  A mother stood up and said to the psychologists, “All I could think of while watching this was ‘bullshit!’ Employing these techniques was impossible when my son was too agitated and unable to listen because of his psychosis.” 

Below is a detailed account of exactly what these psychologists said in the “CBT for Psychosis” workshop accompanied by my impressions.

  • Psychosis is a temporary condition. It is usually permanent.
  • Everyone is susceptible to psychosis. Not quite. An extremely small percentage of the population is far more susceptible to developing psychosis than others.
  • Trauma and stressors make someone more susceptible to becoming psychotic than genetics. False.
  • There’s a correlation between creativity and psychosis. I don’t know whether this is true, but I’m not compelled to research it because it seems mostly irrelevant to treatment goals. Even if it were true, how could this possibly be used to help people with psychosis? Should psychiatrists and social workers offer painting materials instead of medication and psychosocial rehabilitation to people suffering from psychosis? Yes, this is a rhetorical question.
  • Psychosis is often part of PTSD and can be part of borderline personality disorder. Untrue.
  • It’s not helpful to tell the person with schizophrenia, “You need specialized treatment.” Psychosis is a special illness requiring specialized treatment. Treatment providers help their patients by telling them the truth.
  • Expect recovery. If you get good treatment, recovery is the norm. Hundreds of NAMI blogs are ridden with happy endings, but everyone with psychosis does not recover. Telling families that recovery is the norm inappropriately sets them up for huge disappointment when good treatment does not work. There are many factors that can interfere with recovery even when the best treatments are tried.
  • Intrusive thoughts, which everyone has, can be compared to delusions and hallucinations. Are you stating that psychosis is normal? It sure seems like it.
  • CBT inherently normalizes psychosis, because we all have negative thoughts, engage in unhelpful behaviors, and use unhealthy coping strategies. Thus, CBT normalizes psychotic symptoms. Psychosis is normal. The psychologists asked the audience, “How many of you ever felt others were trying to harm you?” There is nothing normal about psychosis!

With all of NAMI’s grandeur and influence, speaking out against its marginalizing those who are most ill and spreading the notion that mental illness is less than important is paramount if we want to alter the status quo. Let’s destigmatize mental illness by defining it accurately. It’s a condition, but more accurately, it’s a brain disease.

11 thoughts on “Psychosis is Not Normal – A Guest Blog

  1. Thank you Lynn for writing this. I appreciate very much all rhe energy that you have put forward in challenging very powerful forces that can ultimately make things worse for families and loved ones affected by serious mental illness.

    Liked by 2 people

  2. Lynn Nanos, you have been very clear and I believe helpful . If a person hasn’t got an illness that person does not need treatment. A psychosis is clearly a malfunction of the brain processing caused by an underlying medical condition, and the mal function responds hopefully to treatment. I have known many who want to use words like issues and omit the medical out of condition and refuse to call these illnesses ILLNESS. Empathy comes out of understanding what the condition is and from that comes compassion through understanding. Avoiding the truth deprives people of needed medical attention. Thank you.

    Liked by 2 people

  3. My son has suffered from refractory schizophrenia for twenty years in spite of good medical treatment. I am sick and tired of the patient blaming he receives from the mental health community. They tell him he failed CBT. No. He wasn’t well enough to take it. They tell him he failed the program in group housing. No. He was never aware enough to be engaged in any program.
    He is told he needs to do things like volunteer, write a resume etc. In other words, he’s not trying hard enough. Really? Have you tried listening to schizophrenic auditory hallucinations all day? How well do you function with voices in your head 24/7, many of them negative? Never mind the negative symptoms of schizophrenia or medication side effects.
    If my son had cancer, would the medical community tell him he had to move out and live on his own? Try harder. Volunteer. Take part in programs. Go to appointments. Remember to take his medication etc. He is ill! Just because brain disease is invisible doesn’t give people the right to judge patient’s behaviour and blame them for not trying hard enough!!!

    Liked by 3 people

    1. This is such a valuable account of the flaws of the recovery model which now dominates too much of the delivery of mental health services. Rather than creating hope, as it proclaims it does, it makes situations worse by minimizing or denying the reality of the symptoms which people with the most severe mental illnesses endure. Only by acknowledging and addressing these symptoms can we hope to provide the services that these people actually need. Unfortunately, the system turns to consumer leaders for their input and these people don’t have these symptoms and don’t seem to be concerned about the population who does have them. This is why families must be given an authentic voice in planning and assessing mental health services.

      Liked by 1 person

  4. Thank you Lynn! You are so on top of what really matters! I agree with you 100% that CBT could help someone with the terrible negative symptoms that accompany psychosis. But first, please people, get it right: people in psychosis have to be treated for the positive symptoms. Their minds are a cacaphony of noise and voices and racing thoughts that are telling them things that are not true and real. Their brains need expert medical attention!

    Liked by 1 person

  5. As someone who has struggled with mental illness, I have to disagree with your viewpoint. From my understanding, your actual research from the point of view of someone who has/is struggling with psychosis, was this “one time” you said something made them think differently. The reality of someone struggling with psychosis or illnesses that cause psychosis…is just that…their reality. I have to disagree with your opinions and lean more towards the opinions of NAMI based on my own lived experience, the lived experience of those who have actually struggled with psychosis and my own research. I work as a peer supporting peers in crisis. I actually spend the time to talk to them, listen to them and challenge them in subtle, gentle ways. I feel as if your viewpoints are a bit stigmatizing. Even more, I am almost absolutely sure that NAMI did not use the words “normal”, “all” or “everyone”.

    Liked by 1 person

  6. Hi Lynn,
    Thank you for your post. First off, your testament that the NAMI conference was kicked off with “a ceremonial military march beside the United States flag,” is ridiculous and a little alarming. I am pro-american as apple pie . . but this is not what mental illness awareness and reform is about. That seems more like a Trump rally. Not the idea.
    Also, a number of your revelations were alarming to me and I disagree with several of them.
    I do have to say that NAMI has been quite a positive influence in my life and I am very involved with their programs to combat stigma and improve conditions for those needing treatment.
    But should I ever run into someone saying that psychosis is just someone’s reality, I would have to disagree vehemently. It is a serious mental condition that needs equally serious treatment.
    I have a hard time believing that NAMI would condone this perspective as a whole, And if they do . . .I would fight back against and organization I have derived great comfort and relieve.
    I hope someone from NAMI responds to your post.

    Liked by 1 person

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