Basics of Schizophrenia

Cause:

Schizophrenia is thought by many to be caused by a chemical imbalance in the brain that causes gradually increasing, very realistic and sometimes symbolic hallucinations that cause a very strong set of delusions over time. Often, by the time the symptoms are noticed the person has had many real and seemingly real experiences making the delusional framework very tenacious and difficult to contradict.

 

Symptoms:

Psychosis can be thought of “mysticism on steroids”. We have highly magical thinking that is a result of our hallucinations and delusions. This causes extreme beliefs. For example, while mystical people might believe in some people being psychic, some people in psychosis believe that mind reading is common; while some religious people might believe that the Rapture may occur in our lifetimes, some people in psychosis believe that it will certainly happen and it might be triggered at any moment.

People in psychosis may display some of the following:

  • Seeming to be looking at nothing or listening when no one is talking; this may be   caused by seeing and hearing things
  • Long delays in responding to conversation; this is often caused by confused thinking or hearing voices
  • Repeating phrases that seem to have special, even magical significance, such as a phrase from the Bible, a truism, or a common phrase spoken in an usual way; this is because they think these phrases have magical power
  • Seeming to talk to themselves; this is often responding to voices they hear
  • Not sleeping well and having poor hygiene
  • Oddly decorating their rooms or homes and/or being sensitive to objects in the home being touched or moved; this is because they believe these objects have magical power to protect them and channel energy
  • Dressing inappropriately for the season (e.g., wearing clothes for cold weather in hot weather)
  • Pre-occupation with the possibility of cataclysmic events, such as the end of the world
  • Pre-occupation with magical solutions to real life and imagined problems

 

Some common beliefs:

  • That many people can read minds
  • That there is a the possibility of the end of the world at any moment
  • That there is a magical conspiracy to prevent people from recognizing this possibility
  • That TV, radio, and/or other media are secretly and magically controlled and this is a major source of the control of people
  • That they are being watched by an organization
  • That the world is divided into a conflict between purely good people and totally evil people and that they are the center of this conflict
  • That they can find a magical means to bring about a positive outcome to this situation
  • That they are some famous person, ranging from a religious leader to a celebrity
  • That words have hidden meanings
  • That angels, demons, gods, goddesses, or aliens are on the Earth right now
  • That it is possible to go into other realities or to other planets magically
  • A preoccupation with death, especially as a magical means to transform the world spiritually

 

What to do:

Despite a widespread belief that there is little that can be done for a person in psychosis, there are a number of techniques for helping someone deal with their experiences:

  1. The “Medical Model” approach sees psychosis as brought on by a chemical imbalance in the person’s brain and seeks to have the person take medication to return the person’s brain to normalcy. The traditional application of this approach often attempts to force compliance with medication, increasing the paranoia and driving the person away from treatment. In the last few years in the United States, the idea that the cause of psychosis is a chemical imbalance has been questioned by Robert Whitaker (Anatomy of an Epidemic) and others.
  2. Cognitive Behavioral Therapy (CBT) was developed to help the person in psychosis question the delusions they have by a process of gently questioning the logic underlying the person’s beliefs. CBT works to establish trust with the person, seek to know what their beliefs and experiences are, and “normalize” the beliefs by providing alternative explanations. CBT is generally meant to be used as part of a therapy that includes medicine.
  3. Listen-Empathize-Agree-Partner (LEAP) is a communication technique that seeks to listen to the person, empathize with their distress, agree on those solutions which can be agreed on, and partner with the person on the agreed upon suggestions. This calms the person, provides an ally, and over time gives people around the person in psychosis enough influence to convince the person to take medicine. LEAP combines Understanding Listening and CBT, along with original material, to provide a set of communication and persuasion skills that helps maintain the stability of the person.
  4. Open Dialogue is an approach from Western Lapland (Northern Finland) that has the best long-term success rates in the western world. It is marked by individual and group counseling with the person in psychosis and other key individuals and seeks to relieve underlying distress and turmoil within and around the person. The approach helps calm the person, resolve situational problems, and relies on medication only in those situations where dialogue and counseling are ineffective. There are trials of this approach planned in the United States, but at the present time this technique is not generally available in the US.

 

The philosophy of the Schizophrenia: A Blueprint for Recovery approach is that there are a number of different approaches that may (or may not) work for any one person, so it is important to support a diversity of options to create a “toolkit” for working with a person in psychosis. As such, the material in the handbook and DVDs is meant to add to the options above. The material does this in the following ways:

 

  • Schizophrenia: A Blueprint for Recovery contains substantial insights into the nature of psychosis itself, including how it slowly develops from hallucinatory experiences, contains grains of truth that often include symbolic experiences and creates a delusional framework that surrounds the person’s rational core.
  • The techniques advocated for working with a person in psychosis are, generally speaking, similar to a team using combinations of CBT and LEAP. The approach was developed independently, and uses insights from the understanding of psychosis to inform this process. Emphasize is put first on calming the person through developing relationships of trust and then seeking solutions, including medicine. The material also includes very concrete approaches to working with a person while he or she is in a crisis.
  • The approach outlines rules for “reality checking” by which a person who is or has experienced psychosis can determine whether or not the experiences they are having are being experienced by others.
  • There is substantial time and guidance given to post-psychotic counseling. Since many of the experiences and beliefs of psychosis in some way are meaningful to the person, post-psychotic counseling is used to reconnect the person’s experiences to his or her life and move towards completely integrating the experiences with life in recovery. In some ways, the post-psychotic counseling may be thought as having the same goals as the Open Dialogue approach, except that in Open Dialogue the counseling occurs during psychosis with a group of people.
  •  The 2012 revised version of the handbook (to be released sometime early in 2012) contains additional material on the nature of psychosis and provides a way that the counseling can be done without advocating the use of medication. While medication is a hotly debated topic in some circles, the intent of the handbook is to provide techniques to help people use whatever treatment approach seems to work best for the individual.

 

It is important to do research on groups and therapy options – review this website and the external links page