Thursday, 3 January 2013

Making Sense of Psychosis

[Mad in America blog post 3 January 2013] 

I can remember when psychoses used to be called nervous breakdowns and people just disappeared for a while and came back better, or at least more acceptable to society.  This was in the 1950's and 60's of my childhood and youth, when diagnoses were either schizophrenia or manic depression.  Things seemed a lot simpler then.  And what happened behind closed doors stayed there.  Shock treatment and other brain stuff.  They kept asking if you heard voices and even if you said "no" well the label schizophrenic still went in your notes.

We're much more sophisticated these days, with the range of psychiatric drugs, therapies and diagnoses on offer.  Courtesy of DSM5 or ICD10.  Nervous breakdowns have become psychoses and manic depression bipolar.  And there are many more classifications betwixt and between, as professionals attempt to get a handle on the madness that keeps breaking out and through.  While the survivors among us are continuing the rebellion and non-conformity, in the certain knowledge that we are the experts of our own lives.  It stands to reason.

As a survivor, of 3 psychotic episodes and the subsequent psychiatric involvement and incarceration, I am keen to see alternative ways of working with psychosis.  My experiences of the whole weren't positive.  Same can be said about other family members.  For me the psychosis was a coping mechanism at a time of stress caused by trauma (childbirth, menopause).  An escape from reality although still having insight but with more sensitivity to the world around me.  I wasn't angry or sad, however to others I wouldn't have been 'myself'.  No doubt this was interpreted as risky or unpredictable. More than usual.

The challenge, as I see it, is how to help a person come out of, or go through, a psychosis as gently as possible.  Since trauma or stress took me into a psychosis it surely makes sense not to compound the trauma by forcing me out of it.  Adding injury to insult.  The drugs didn't do it for me.  The anti-psychotic depressed me and the anti-depressant depressed me more.  Working against my recovery and taking me further away from myself and the real me.

Although this might have been the purpose of the treatment.  An assumption that the psychosis was an attempt to become a different person.  Which might be the case for some folk.  But not for me.  I was happy with who I was and it was only the situation at the time that caused me to remove myself from reality.  The pain of childbirth and of life changes, the wonder of it all.  Therefore it makes sense for psychiatrists to find out what led to the psychosis, rather than a 'one size fits all' treatment.

Shocking someone out of a psychosis is like telling them to pull themselves together.  The psychiatric drugs are a shock to the system and the brain.  A harsh bringing back to reality that takes no account of why a person went into an altered state of mind, without the use of substances.  After my most recent episode, in 2002, I remember the psychiatrist at an outpatient appointment keeping asking me "are you tearful?".  Well no I wasn't, being on risperidone and venlafaxine I was as flat as a pancake.  And that was the problem. Feeling no emotion for me was very depressing.  I wanted to cry and laugh, it would have been good for me.

I suppose that the psychiatrist was used to other patients being very distressed and needing drugs to keep the feelings at bay.  But he didn't know me as a person when well.  Now he does.  And I often say that people probably prefer me being on psychiatric drugs.  Then I would do as I was told, follow orders, be predictable and tow the line.  Rather than the non-conformist individual who is opinionated and passionate about causes.  Much easier if I could listen to the 'professionals', believe what they said and be nice. Not likely.

Thinking back to my first psychotic episode, in 1978, thirteen weeks after the birth of my second son, when I was living with my in-laws, on their farm.  My mother-in-law was mentally unwell at the time, had taken to her room 24/7, and we were living in the room next door.  A very stressful time and I escaped by going into what the doctors described at that time as a puerperal psychosis.  It had spiritual elements to it, in that I had hallucinations or flights of fancy, depending on how you describe them.  I wasn't sleeping and everything became a bit surreal.

I remember two doctors coming out to the farm to visit me and they seemed friendly if concerned.  The only option was to go voluntarily into the local psychiatric hospital, Hartwoodhill in Lanarkshire.  Leaving my baby and 2yr old son back at home.  It was very difficult.  I'd been breastfeeding so had to be bound to stop the milk.  I felt bereft without my baby.  And then they wanted me to take pills, which I wouldn't do.  They were strangers so why would I accept drugs from them?  So I was forcibly injected with chlorpromazine.

It was the era in the late 70's when ECT or electroshock was in fashion.  Many psychiatric patients got it, for this and that, and I used to see them lining up for it in the ward.  I was approached by the nurses who said I should have ECT, wanting me to sign a form, agreeing to it.  By this time the chlorpromazine had brought me harshly out of the psychosis.  I knew I didn't want ECT, my mother had got many courses of it throughout the 50's and 60's, against her will, so I wouldn't sign the form.  And, in my pyjamas (all patients had to wear them, our clothes were locked away), I got my husband to take me home in the car that night, escaping from the hospital.

But I had to go back in, because of suddenly coming off the chlorpromazine, getting muscle spasms, my neck going back.  The family probably thought I was doing it on purpose, part of the mental condition.  At that time I didn't know about the issues to do with suddenly stopping psychiatric drugs.  Ignorance is bliss?  And so I was taken back into the hospital, fearful I was going to be forcibly given ECT.  However I had avoided it, although the nurses kept saying to me that I'd have recovered quicker with having it.  I didn't believe them.

I think that ECT and psychiatric drugs do similar things, shocking a person out of a psychosis or alternative reality.  Like a knock on the head or a shake to the system, the ECT in my opinion being worse as it causes memory loss and I didn't want to not remember.  The treatment was like a punishment for having lost my senses or of not being able to cope.  It felt like this also for me in 1984 and 2002.  And I still am not happy with the way I was treated, the lack of respect and indignity.

I'd like to see a new way of looking at psychosis so that people are treated individually, according to their own experiences.  The hearing voices movement, inspired by the work of Romme and Escher, is doing a great job of deconstructing and reconstructing the experiences of voice hearers "the ethos of the hearing voices movement is to accept a diverse range of explanations for voice-hearing and support the person to find empowering ways to use these understandings- if an individual claims to be communing with God, and finds the experience valuable, no efforts are made to divest them of it, but discover what it means to them" Rufus May website.

1 comment:

  1. I am so glad that my daughter diagnosed with schizophrenia found your blog and has just recommended it to me. I have already read some of your posts and will keep doing it. Happy New Year, Chrys.
    Zofia from Dunfermline,Fife