Psychosis: Origins, Experience and Meaning

Talks from ISPS UK conference are now on YouTube

Conference review by Isobel Todd, journalist:

“Let’s be clear, ” declared Professor John Read, near the start of this unique Brighton conference on the topic of psychosis; “whenever somebody uses the word schizophrenia, they’re talking nonsense”.

Open to practitioners, people with lived experience, families, carers, and anyone else with an interest in the subject, Psychosis: Origins and Meanings was a one-day event aimed at discussing and promoting good practice developments in the field. It shared its title with the morning plenary from Read, a clinical psychologist known for his research into the psychosocial causes of psychosis, and his dogged persistence in drawing these to wider attention. And it began with a wry warning from Bill McGowan, South Coast lead for ISPS (the International Society for Psychological and Social Approaches to Psychosis) UK, that “with John at the helm, it is going to be a choppy sea”.

But the day went remarkably smoothly for an inclusive, multi-organisation event brought together in just over six months. The main logistical sticking point was the amount of background buzz during the morning workshop programme – which probably resulted from the release of extra tickets due to unprecedented demand.

And in the end, for all his rhetorical directness, Read’s lecture was of course eminently sensible. Though that’s not to say it didn’t shock. He explained that schizophrenia (a word steadfastly absent from the conference’s own literature) was invented – yes, invented – by German psychiatrist Emil Kraepelin, the 19th Century founder of pharmacopsychology. Kraepelin identified hundreds of ‘symptoms’ associated with this new ‘disease’, such as ‘going in to church with a lighted cigar’. As Read pointed out, this is no list of symptoms, but rather a catalogue of broken social norms.

In relentlessly challenging the reductionist medical model ideology that dominates mental health services – with research that has proven strong links between what are commonly referred to as ‘mental disorders’ and experiences of childhood sexual abuse, parental loss and relative poverty – Read himself is breaking a norm. For this, he observed, he is often labelled ‘anti-psychiatry’, allowing his arguments to be easily dismissed as radical ravings. Read drew a comic but sharply instructive parallel with the way in which people who contest their schizophrenia diagnoses are said to be demonstrating the ‘symptom’ of schizophrenia known as ‘lack of insight’. It’s some catch, that catch 22.

Responding to an audience question about community treatment orders, Read declared forced medication to be “the last human rights battle”. So what is to be done? His response: join forces; don’t suffer in isolation. Cue punk activist Sascha Altman DuBrul, co-founder of peer-based mental health group and media project The Icarus Project, and Director of Learning at the Institute for the Development of Human Arts. DuBrul describes his interests as lying ‘at the intersection of the public mental health system and the Mad Underground’, and had just finished a UK tour on the subject of ‘Mental Illnesses or Dangerous Gifts?’

The charismatic New Yorker’s afternoon plenary was an at times frustratingly wide-flung but always vibrant ad-lib in praise of the role of creative social movements. Diagnosed with bipolar as a teen, he found solidarity and support amid the Eighties punk movement and the squat communities of the Lower East Side. DuBrul found that the drugs helped him survive, in a world that was hard to survive in. But creativity and community helped more. Now, his training for Peer Specialists and Peer Workers always begins with a history lesson, locating the origins of their role within the disability rights, feminist and LGBTQ+ movements, and the enduringly essential slogan, ‘Nothing about us without us’. DuBrul reminded us that, if you want to facilitate change in any sector, you should set about creating culture.

If psychosis isn’t a biological disease to be treated solely with psychiatric drugs, then how else should we understand it? The emphasis in the conference title was on the ‘s’ – psychosis has a plurality of meanings. Fittingly, the broad workshop programme offered an opportunity to experience a multiplicity of readings and responses.

Members of peer support group the Hearing Voices Network Brighton welcomed us in to their circle for an open version of their weekly meet-ups. Members spoke about very different relationships with their voices, some negative, some positive. We heard how voice dialogue work (similar to Gestalt chair work) helps some to gently engage with their voices. One member felt that voices aren’t always a symptom of psychosis, but do always have meaning.

Another way of being with, and responding to, psychosis was proposed by poet and Assistant Psychologist Mica Gray. She explores her own experience of psychosis in her recent poetry collection, When Daisies Talk. ‘Don’t get caught in the metaphors’ ran one memorable refrain, addressing the concept of grandiose and paranoid delusions. What might someone be telling you about their sense of purpose and their experience of persecution when they tell you they are Jesus? What might they be expressing about their lack of agency when they say they are being bugged by the CIA? Such communications about selfhood are easily dismissed in the medical model. Try listening and responding in the register of poetry, and they may reveal themselves to be potent with meaning.

A similarly hopeful reframing was proposed by Spiritual Crisis Network Brighton group. Their workshop explored how the psychological difficulties and loss of shared reality associated with psychosis might also be understood in terms of spiritual awakening. What we think of in terms of pathology may in fact, they suggest, be profound personal transformation.

Two further workshops were run by Yasmin Ishaq, on her work developing the NHS Open Dialogue approach in Kent, and Soteria Brighton, which is working towards the establishment of a Soteria House and related services in Brighton. The organisation introduced its new Managing Medication Group, starting this Autumn, which will help participants manage small reductions in antipsychotic medication, should they wish to. When Read cautioned, at the end of his rousing talk, that “It is not a good idea on the basis of one person’s lecture to start coming off your meds”, Dominic Pearson of Soteria Brighton was able to stand up and respond with this offer of specialised practical support. Unlike so many conferences, this felt like a place for words and actions to meet. With the conference’s collaborative organising committee already planning a second event, we seem to be edging closer to a genuine paradigm shift.

Isobel Todd