in particular, the development of psychosis
by Tony Bennett, a Chartered Town Planner by training, has taught stress management and Tai Chi Qigong for over 5 years. He offers group training and one-to-one. He lives in North Yorks near Lancaster.
Email: releft@macunlimited.net
‘If stress overload, anxiety problems and depression were treated effectively…the patient’s own natural homeostatic processes would rebalance them, depression would lift in most cases and fewer people would degenerate into psychosis.’ Dreaming Reality by Joe Griffin and Ivan Tyrrell pp 194-195
© Tony Bennett
January 2008
INTRODUCTION
PART 1 PSYCHOSIS - THE PART PLAYED BY NEGATIVE STRESS
What is psychosis?
Treatment of psychosis?
What causes psychosis?
An alternative treatment for psychosis
PART 2 HOW TO PREVENT THE DEVELOPMENT OF PSYCHOSIS
PART 3 CONCLUSION
INTRODUCTION
New research puts forward the case that psychosis develops out of being in a stressed state, over time. If the press is anything to go by, stress and mental ill-health is on the increase. Companies and organisations are introducing Stress Management Training in response to the requirements of their insurers.
General Practitioners and mental health professionals are under increasing pressure, working in an environment where there are no clear parameters. Labels are used to diagnose mentally distressed people in order to aid decisions on treatment, such as anxiety, depression, schizophrenia, psychosis and so on. Conventionally, all mental health is treated with drug therapy, from depression and anxiety through to the psychotic states, although counselling therapy may be available in some areas. Drugs are related to labelled conditions. Anti-depressive drugs are widely prescribed. People can be diagnosed as schizophrenic by one ‘specialist’ and as psychotic by another and drugs are prescribed on the basis of the diagnosis. It is a very hit and miss affair. There is a lot of evidence that the drugs can, of themselves, bring about the symptoms being experienced. Hospitalised patients, there because they are considered a danger to themselves or to others, often find themselves in very distressing environments. Facilities for an alternative approach are limited and access to them dependent on an ability to pay.
There are many reasons why stress is on the increase. Plato’s dictum, ‘know thy self’ holds true today as it did in Plato’s time thousands of years ago. However, many people in the past found it difficult to get to know themselves, because they lived by rules laid down and imposed by others through institutional practices and social conventions. This may have had its advantages for some in society; for those who benefited from this regimen. Today, life is very much more complicated and people have access to a wide range of information and ideas. Institutions and social conventions are very much more diverse and some institutions, particularly the churches have less influence. People are now overwhelmed by choice. There has been a shift from conformity and belonging and to diversity, alienation and self-determination. In this climate, where opportunities for self-development and self-determination and the necessary associated, appropriate, support may not be available from parents, formal education, conventional health advisors and other leaders in the communities in which people live, many are challenged.
People do not have the skills to manage themselves so as to ride the pressures of life without damaging their mental and physical health. They do not recognise that this requires responsibility – an ability and willingness to respond positively to how we feel so that when the symptoms of negative stress (or distress) are felt that appropriate, positive action is taken.
Stress Management Training is an effective training approach that teaches people simple, straight forward life skills that can help prevent distress and a wide range of illness, both physical and mental. It will also enable them to function in society in a meaningful, satisfying and effective way.
In Part 1, this essay explores a new understanding of psychosis developed from research described in Dreaming Reality by Joe Griffin and Ivan Tyrrel. This research supports the argument that Stress Management Training would be an effective preventative measure and an effective contribution to the curative process. In Part 2, the essay considers some of the practicalities of making Stress Management Training more widely available.
PART 1. PSYCHOSIS - THE PART PLAYED BY NEGATIVE STRESS
WHAT IS PSYCHOSIS?
Conventionally psychosis is defined as ‘a severe mental derangement especially when resulting in delusions and loss of contact with external reality’ (The Concise Oxford Dictionary). People often display behaviour that is seemingly ‘out of this world’ and they do not connect meaningfully with their environment or the people in their lives.
Closely aligned to psychosis is schizophrenia defined as ‘a mental disease marked by the breakdown in the relation between thoughts, feelings, and actions frequently accompanied by delusions and retreat from social life’. We also talk about schizophrenic behaviour: ‘A mentality or approach characterised by inconsistent or contradictory elements. (The Concise Oxford Dictionary).
TREATMENT OF PSYCHOSIS
Medical science has developed ways of ways of treating and mitigating the effects of a genetic predisposition to illnesses and diseases through the use of drugs, surgical intervention, therapies, the management of nutrition, and exercise. There is growing interest in a wide range of alternative therapies in the management of illness, particularly chronic health conditions where conventional approaches are seen not to work.
Conventional treatment of mental ill-health is on the whole limited to drug therapy, although there is increasing recognition of the value of therapy. For example, the Government has embarked on a programme of increasing availability of Cognitive Behavioural Therapy (CBT) to people with mental health problems. There are many alternative approaches to the treatment of mental ill-health without the use of drugs that are not available through the National Health Service.
Alternative treatment methods depend on the stage of the development of the breakdown in mental health. Once a mental health condition has deteriorated to the point where other interventions that require the cooperation and commitment of the patient is not possible, drug therapy may well be required. The patient can then enter a vicious circle where the drug treatment can become the cause of the imbalance in mental health. The side effects of many of the drugs prescribed not only have side effects that affect the patient physically, but also they can generate the symptoms for which they were prescribed.
Most importantly, the conventional approach to treating mental ill-health puts emphasis on diagnosis. Griffin and Tyrrell in their book Dreaming Reality, HG Publishing (2006) argue that diagnostic observations, however subtle, do not in themselves explain anything, unless there is also an organising idea enabling an understanding of those diagnostic observations.
An understanding of the causes of mental ill-health, and appropriate responses to the early symptoms of mental stress, may enable the use of more positive therapies and methods for personal development and balance in mental health.
WHAT CAUSES PSYCHOSIS
Although it is much studied and there are numerous competing theories, there is no generally accepted understanding of the causes of the symptoms of psychotic breakdown and schizophrenia. See Bentall, R. P. (2003) Madness explained: Psychosis and human nature. Penguin/Allan Lane.
There is evidence that life experience and lifestyle are contributory factors in the development of mental ill-health (see evidence from WHO on differences in the treatment of patients with mental problems in the West and the Third World page 10 below). There might also be a genetic predisposition to developing psychosis, in the same way there may be a genetic predisposition to the development of any illness or disease in the body.
Conventional understanding of the causes of mental ill-health and the incidence of depression, psychotic and schizophrenic conditions in particular, are confined to knowledge of the changes of the chemistry in the brain. Drug therapy is designed to redress the imbalance of the chemistry that is affecting the patient. The underlying causes of that imbalance are not a consideration.
New research by Joe Griffin and Ivan Tyrrell, described in their book Dreaming Reality, HG Publishing, 2006 is considered by Dr Farouk Okhai as ‘one of the most important scientific breakthroughs of the last hundred years’. This research puts forward an organising principle for the development of psychosis that supports a very different approach to its prevention and treatment. This organising principle supports an holistic approach to an understanding and treatment of mental ill-health.
DREAMING REALITY – A NEW APPROACH TO UNDERSTANDING THE CAUSE OF PSYCHOSIS
‘We are now increasingly convinced that when people are in psychosis they are trapped in the REM (Rapid Eye Movement) state, a separate state of consciousness with dreamlike qualities. In other words, schizophrenia is waking reality processed through the dreaming brain’. See Human Givens by Joe Griffin and Ivan Tyrrell,p78.
This takes us straight to the nub of the issue. Effectively what is being said is that the psychotic state is when the patient’s experience is similar to the REM dream state, and yet they are wide awake. They will also be processing some sensory experience.
Could the REM state as reality generator be the link that makes sense of a huge variety of psychotic symptoms? The list below would suggest that there is a close relationship between people’s description of their dream state and experiencing a psychotic state.
Rapid eye movements with eyes open
Dissociation
Instant emotional response to metaphors
Reliving the intensity of remembered emotions
Trance logic
Hallucinating frightening faces on surfaces
Hearing voices
Losing touch with normal bodily sensations.
These same phenomena can also be experienced in hypnosis.
REM is an observed characteristic of being in a psychotic state. From studies of dreams we know that in the REM state we are cut off from sensory information: people talk about themselves dissolving or having empty limbs whilst in REM sleep. Psychotic patients report the same sensations, including resistance to pain. (It is this fact that is exploited when hypnosis is used for pain control or anaesthesia during surgery.)
Psychotic patients also talk about hearing voices. In dream state, province of the right side of the brain, (left brain province of independent thought), mind is ‘locked’ into the metaphorical script of the dream. Griffin and Tyrrell suggest that, ‘because the REM state operates through metaphor, the only way it could make sense of these independent left brain thoughts would be to create the metaphor of hearing voices, or being watched, or spied upon by aliens – which easily becomes paranoia.’
They go on to point out that visual illusions or delusions are characteristic of the dream state: hallucinatory realities unquestionably believed during the course of the dream. This is well demonstrated through stage hypnosis where people are in effect put into a psychotic state that induces them to believe that they are someone else or that non-existent people and objects exist.
In the dream state, arousals from the emotional brain trigger a thought pattern in the cortex, which is immediately converted into a sensory metaphor, the dream. Griffin and Tyrrell have observed that psychotic patients appear to very quickly convert thought into sensory experience: they can become highly emotional almost instantly. For example, when recalling a distressing memory, they are apparently instantly transported right back into that memory and re-experience the emotions connected with it. If indeed psychotic patients are experiencing life whilst in an REM state, it is not surprising that they not only talk in metaphors, but live them out. This would explain their often bizarre speech and behaviour.
SO HOW DO PEOPLE GET INTO AN REM STATE AND YET BE AWAKE AT THE SAME TIME?
‘A psychotic breakdown is almost always preceded by an overload of stress and severe depression in a person’s life, which results in excessive REM sleep.’ Dreaming Reality by Joe Griffin and Ivan Tyrrell
This statement is backed up by others. For example, Siris, S. G. states that psychotic breakdowns are invariably preceded by periods of extreme stress, anxiety and/or depression or use of mood-altering drugs in Depression and Schizophrenia (1995). See also Hirsch, S. R. & Weinberger, D.R. (Eds.) Schizophrenia. Blackwell and Huppert, J. D. & Smith. T. E. (2001) Longitudinal analysis of subjective quality of life in schizophrenia: anxiety as the best symptom predictor. Journal of Nervous and Mental Disease, 189, 669-75. and Emsley, R., Oosthuizen, P., Niehaus, D. & Stein, D. (2001) Anxiety symptoms in schizophrenia: the need for heightened clinical awareness. Primary Care Psychiatry, 7, 25-9.
The psychologist Daniel Nettle discussed in the journal Human Givens (8, 4) the link between psychosis and creative thinking arguing that ‘psychosis is a physical process (hardware not software problem, to use a computer analogy), and that environmental influences have chemical consequences.’ Sensory experience generates activity in the mind and body resulting in stress. What is argued is that psychosis could be on a continuum: stress overload (because of environmental factors and a person’s needs not being met), consequent depression, and development of psychotic symptoms.
So, what is the significance of the REM state and why do we go into the REM state when we have emotional overload (i.e. stress)
‘REM state is the mechanism that connects us to reality, constantly running in the background, searching out at lightning speed the codes needed to match metaphorically to whatever is meaningful in the environment, and thus creating our perception of reality. It is a reality generator accessing the templates that are the basis of meaning.’
See Hobson, J. A. (1994) The Chemistry of Conscious States: How the brain changes its mind. Little, Brown.
The body’s response to what it experiences through its senses or thought processes sets in train a wide range of hormonal and physical activity in the body in order to deal with the perceived danger or threat or other need for action. This results in tension in the muscles of the body and sensations that can be uncomfortable. This can also put a strain or stress on the body whilst the body is responding to this perceived need. If the mind continues to give the body the alarm call, then it will continue to respond in the way described.
The body has a process for managing stress so as to limit the damage that that stress might have on it and save its resources. The body does this during the REM state whilst we sleep. It is in this state that the brain completes un-acted out emotional arousals from the previous day. In other words, the brain processes the day’s emotional experiences so as to see them through with the intention of ‘laying them to rest’, allowing the alarm call to be reversed. It uses metaphor to do this, hence the strange and wonderful and sometimes terrifying dreams experienced by people.
What is being suggested by Griffin and Tyrrell is that, over time, if the body does not succeed in laying emotional arousal to rest whilst in the sleep-dream state, then a perception of anxiety develops in the day. Anxiety causes the body to remain in stress mode. If the cause of the anxiety is not dealt with, then depression can develop. As is suggested above, anxiety, depression and psychosis may be on a continuum. As the body continues to deal with the problem (remembering that the problem may not be in awareness, but in the subconscious), then the body continues to help itself by going into the REM state even when the body is awake. This is the psychotic state.
Evidence for this hypothesis is most graphically revealed in a letter from someone with experience of psychosis, E. Abbot, to the journal Human Givens 8, 4, 47-48. In her letter, she describes her experience in detail from the anxious state to the psychotic state. Once she understood that some of her thoughts were delusional, she was able to relax a little and ‘begin the long job of sorting out the ’real’ from the dreamlike, and deconstructing the ‘nightmare’ world. Even after I had learned to identify which was which, for quite a while, I was conscious of the two ‘worlds’: the ordinary one, where people are separate and there is some privacy; and the other ghastly, dreamlike one, where I was transparent, exposed and there was nowhere to hide.’
This person did not require medical intervention in moving through and out of psychotic experience. It is important to note that she had two advantages over many in dealing with her condition: she was able to be aware of her thoughts and to determine their relevance and she had loving support, care and understanding whilst she went through her experience. Both these conditions, it would seem, are prerequisites for dealing with this problem.
AN ALTERNATIVE TREATMENT FOR PSYCHOSIS
Griffin and Tyrrell would argue that it is necessary to work ‘from the givens of human nature and not from ideology, profit motives or bureaucratic convenience.’ In other words, the focus needs to be on whether the givens of human nature, human needs, are being met and where they are not being met to find ways of helping to bring about a change in the life of that person. This could require relatively minor changes or major changes that may be challenging not only to the individual but to the family and/or society in which they live.
It is interesting to note that experiments in the West have shown that patients ‘treated’ simply by being offered friendship and a regular routine of purposeful, practical activity, meals and sleep, had equally as good a recovery rate as the people being given the right type of social support in a drug-free environment in third world countries. Whitaker, R. (2002) Mad in America: Bad science, bad medicine and the enduring mistreatment of the mentally ill. Perseus Publishing. And Traditional community resources for mental health: a report of temple healing from India. (2002) British Medical Journal, 325, 38-40.
World Health Organisation (WHO) studies also show that flourishing rural communities in Third World countries, using these sorts of naturally supportive approaches, have a much higher success rate in curing psychotic illness than developed Western countries that have come to rely on ‘antipsychotic’ medication. Sartorius, N., Jablensky, A., Korten, A., Ernberg, G., Anker, M., Cooper, J.E. & Day, R. (1986) Early manifestations and first-contact incidence of schizophrenia in different cultures. Psychological Medicine, 16, 909-928.
A caring, drug-free approach is not only a challenge to our professionals, but to our societal values generally. What this says is that we need to learn to understand the way in which people with whom we work or interact at a social or domestic level are experiencing the world and, where that experience results in stress, we have to be sensitive to the causes from the perspective of the person concerned. Leading on from this understanding is the need to provide the right environment and care for their rehabilitation. This presents an opportunity for personal growth for all concerned in bringing about positive outcomes.
‘If stress overload, anxiety problems and depression were treated effectively, …. the patient’s own natural homeostatic processes would rebalance them, depression would lift in most cases and fewer people would degenerate into psychosis.’ Pages 194-195 Dreaming Reality by Joe Griffin and Ivan Tyrrell
One very effective approach, Stress Management Training, provides the opportunity for early intervention or to be complimentary to other therapies. It enables participants to learn to understand the relationship between their thoughts and the feelings they experience in their bodies – the way they breathe, their heart rate, tension in the muscles, pain in the joints, neck, back and so on. It trains participants in simple techniques whereby they can monitor their physical and mental state and use simple exercises that will result in a change in their (stressed) state.
Once the stress results in illness, which could be experienced anywhere along the continuum referred to above: anxiety, depression, psychosis, a more focused approach will be required.
From a Human Givens perspective, ‘helping the patient to be aware of their dreams, whether experienced during sleep or during the waking hours (i.e. their imagination) can provide insights into what is causing the stress. The person may find this awareness provides them with the insights they need to move them forward or specialist experience in dream interpretation may be needed so as to really understand what is troubling a patient, which ordinary language may not convey, may provide the sense of distance needed for an emotional, anxious or depressed person to stand back and see their situation with a new clarity and objectivity. A dream can also provide powerful, ready-made metaphors (that the patient is the more likely to related to as they are their own!). Metaphors can then be reframed towards a positive outcome.’
For many, relating to a psychotic person can be very disturbing and result in exacerbating the situation rather than helping it. However, most importantly, a psychotic patient’s language and behaviour may be clear metaphorical representations of their emotional needs and concerns, which they can express no other way if processing waking reality directly through the REM state.
An understanding of what the person is experiencing will help to enable those interacting with them to feel quite differently and to behave in a more constructive and positive way in supporting and caring for them. Griffin and Tyrrell report that ‘support workers who have studied our methods found they didn’t give too much attention to the voices, hallucinations and other strange behaviours patients exhibited, but concentrated instead on focusing them on activity, getting them engaged in the environment, helping them to keep down their stress levels, etc. (Dreaming Reality. Griffin and Tyrrell, HG Publishing, p 196).
Managing stress is central, it seems, if Griffin and Tyrrell’s work is to be respected, to the prevention of the onset of psychotic illness and its management. This can represent a challenge to those who are carers and health advisors to people who are suffering mental ill-health. However, in a caring society, there is surely no other way to go.
PART 2. HOW TO PREVENT THE DEVELOPMENT OF PSYCHOSIS
Stress is recognised in our society widely. Its significance, too, is recognised, particularly in its contributory role to heart disease. However, we perhaps do not yet quite appreciate how deep-seated are the causes of stress in our society and the shifts that are required in order to remove those stressors.
‘Evolution has provided us with lots of survival mechanisms. They can be roughly divided into two functional categories: growth and protection. These growth and protection mechanisms are the fundamental behaviours required for an organism to survive.’ The Biology of Belief by Bruce Lipton page 145.
In one sense, stress starts from the minute we are born, and possibly before we are born. The senses are receiving information all the time providing information about our environment and we are learning whether what is happening to us, our experience, is good or bad for us. By this is meant, whether we are in danger or not and whether we need to do anything to protect ourselves.
Remembering that human beings are organisms like any other, its main purpose in life is survival and development. We are learning all the time about whether what we are experiencing promotes our development or is a threat to our survival. The body’s mechanisms are constantly responding to sense information: putting it into defence mode (i.e. countering threat) or growth mode (i.e. enabling growth). We store the information about our experiences to guide us in reading, responding and reacting to future experiences. So, for example, we learn whether something hurts us when we touch it. If we have stored that information we do not touch that object again or only with caution.
This process continues over time and becomes more and more sophisticated. Some of our original perceptions change, we relearn, but some do not, remaining stored in our subconscious brains ready to trigger behaviour that may not be seen to relate to the circumstances.
Layered on top of this process is social convention. Conventions dictate what behaviour is ‘normal’ in given circumstances, irrespective of the experience of the person concerned. So, if a response to a situation does not accord with what is socially acceptable, then a range of responses to that behaviour follow such as anger, ridicule or ostracisation. These responses can train people to hide their emotional responses and change their behaviour. This does not deal with the problem; it buries it and causes increased stress.
ALL PEOPLE ARE AFFECTED IN THIS WAY, THOUGH SOME MORE THAN OTHERS. AND IT IS GETTING MORE AND MORE OBVIOUS THAT PEOPLE ARE NEGATIVELY STRESSED LEADING TO ANTI-SOCIAL BEHAVIOUR, ILLNESS AND POOR PERFORMANCE IN SOCIAL AND ECONOMICAL ACTIVITY.
In childhood, we learn to deal with our stresses, positively or negatively, primarily from those who care for us:
in our domestic experience: parents and/or carers
in our learning experience: teachers and carers
Once we have become adults then we learn from:
Advisers: friends, health professionals, personal development professionals
Managers/facilitators: in paid activity, in voluntary community activity.
So, stress is caused by a mismatch between our needs and our experience. It would appear that the nature of our society and the relationships we have within the domestic and public areas of our lives is the main cause. (cf. experience in other, third world countries referred to above, p10). Not only do more people need to understand the underlying causes of stress leading to mental ill-health and behavioural problems, but we have to consider ways of changing our values and priorities and the ways in which we interact.
How do we move forward in our own society so as to reduce the incidence of stress and the development of psychotic illness? There are three major prerequisites:
an understanding and acceptance of the causes of stress in people’s experience by as many people as possible
an appreciation of what is needed to mitigate stress in people’s experience at all stages of their development by as many people as possible. This requires a significant change in attitude towards those displaying symptoms of stress. We need to move from an attitude that encourages a covering up of the stress to one where there is a sharing and understanding of the causes and ways in which they can be mitigated.
That understanding to be enshrined in all our major institutions: domestic, education, health, social services, work, government.
There is a need for programmes of training in the nature of and management of stress.
So, where is the best place for this training to start? Clearly it needs to start at a point when a young person growing up can begin to learn these skills. Who can provide this training? Adults who are closest to a child growing up will influence a young person first and foremost by their attitude and behaviour and be in a position to pass on the skills at the appropriate time. Who might they be? Parents and carers; school teachers; social workers; doctors; nurses.
However, it is these people, those who interact and influence young people who first need access to this training. Programmes of Stress Management Training need to become main stream in the training of educational, health, social service and human resource professionals. This training will then filter down to parents, carers, students of all ages, patients, clients, workers.
PART 3. CONCLUSION
Psychosis is a condition that causes a great deal of distress for the person experiencing it and those who relate to that person, whether family, friend, carer or health professional. It also carries a stigma that can be very damaging. It is suggested that this is mainly because of a lack of understanding about and cause of the condition and what is being experienced by the person affected and the cause of their behaviour. Crucial to this understanding is that the condition in the most part can be healed and that the person experiencing the condition can go on to live a full life as a useful and valuable member of society.
Joe Griffin and Ivan Tyrrell give us a very different perspective on this condition. They provide a basis for both understanding its cause (extreme stress, over time) and the symptoms and behaviour associated with it due to the person entering a dream (nightmare) state whilst awake (We have all experienced strange and frightening dreams or nightmares, so we can all understand what is going on for the person experiencing these symptoms.)
Stress Management Training provides understanding and recognition of the causes of stress and ways of positively addressing those causes. It will also helps in the recognition of stress and the associated behaviour in others, resulting in understanding and a more caring attitude and approach.
In both the prevention and management of psychosis there is the need for a transformation in the way we deal with stress in our society. We need to become better at recognising stress in even the very youngest person and dealing with it so as to reduce or remove that stress. There is a need for a widespread programme of Stress Management Training that will instil in our society a very different approach to stress and the illnesses that it can cause, both mental and physical.