What we are Saying Anne Cooke

For all the facts, and crunching of evidence, and great argument, what I love most is that you have produced something which makes space for the voices of people who are suffering, and those who have thrived outside the psychiatric system. Jay Watts

What we are Saying Anne Cooke

Understanding Depression: Why people sometimes experience low mood, and what can help

Describing a psychological approach to psychosis

Thank you Anita Klein!

Psychosis and schizophrenia are disputed terms – people have different ideas about what they mean and whether they are helpful. We had long discussions about whether to use inverted commas in the title to reflect this. We try to demystify psychosis by using the ordinary English that people often use when talking about their own experiences, rather than professional terms which inevitably have a particular connotation eg schizophrenia implies disease. In traditional medical language the report would have been called the causes and treatment of schizophrenia but we chose not to

Some of the key messages. Four parts to the report.

One of the messages of the report is that it is possible to have ‘psychotic’ experiences such as hearing voices and not be distressed by them. So we cover the two things separately.

Again – getting away from technical language – not treatment

Services AND society

There’s a section at the end where we’ve brought together every resource we could find on this approach

Hearing voices or feeling paranoid are common experiences which can often be a reaction to trauma, abuse or deprivation. Calling them symptoms of mental illness, psychosis or schizophrenia is only one way of thinking about them, with advantages and disadvantages Some of the key messages

There is no clear dividing line between ‘psychosis’ and other thoughts, feelings and beliefs: psychosis can be understood in the same way as other psychological problems such as anxiety or shyness. ... i.e. as a result of the things that have happened to us, and how they affect how we see the world and experience and interpret subsequent events. Of course our biological makeup is important too.

Some people find it useful to think of themselves as having an illness Some people find it useful to think of themselves as having an illness. Others prefer to think of their problems as, for example, an aspect of their personality which sometimes gets them into trouble but which they would not want to be without.

In some cultures, experiences such as hearing voices are highly valued.

For many people the experiences are short-lived For many people the experiences are short-lived. Even people who continue to have them nevertheless often lead happy and successful lives. Getting away from the idea of a carnivorous illness called schizophrenia

Psychological therapies are helpful for many people Psychological therapies are helpful for many people. However most people are currently unable to access them. Shizophrenia Commission – 9 out of 10 who could benefit no access to good CBT

More generally, it is vital that services offer people the chance to talk in detail about their experiences and to make sense of them. Surprisingly few currently do. Not just about psychological therapies – it’s about the guiding ideas behind the whole service - a psychological formulation driving every conversation, and every worker being able to, and feeling that it’s their job to, have those conversations

Professionals should not insist that people accept any one particular framework of understanding, for example that their experiences are symptoms of an illness. We have quotes from people who find that helpful and people who don’t. Worker should present it as one way of viewing their experiences but not the only one. NB not saying people not distressed, struggling, in need of help Experiences are very real, the explanation may not be true or helpful

Many people find that ‘antipsychotic’ medication helps to make the experiences less frequent, intense or distressing. However, there is no evidence that it corrects an underlying biological abnormality. Recent evidence also suggests that long term use carries significant health risks. There is increasing evidence of harm with long term use. Studies usually only look at 2 year follow up. However may still be least worst option for some and quotes from people who find it helpful

Services need to change radically, and we need to invest in prevention by taking measures to reduce abuse, deprivation and inequality. Informed consent to how experiences understood will be a radical change. Getting away from ‘we know what you need’ idea. Also we need to invest in prevention: Best way to reduce rates of psychosis would be to reduce childhood adversity. We’re busy mopping the floor whilst leaving the tap