PARADIGM SHIFT, SEA CHANGE, SCIENTIFIC ADVANCE.

"Sea Change" by Lynne Taetzch

Most of this post is taken from the online notice about a paradigm shift in the convictions of the British Psychological Society about psychosis and schizophrenia.  The British Psychological Society has released a remarkable document entitled “Understanding Psychosis and Schizophrenia.” Its authors say that hearing voices and feeling paranoid are common experiences, and are often a reaction to trauma, abuse or deprivation.

The report says that there is no strict dividing line between psychosis and normal experience.  The report adds that antipsychotic medications are sometimes helpful, but that “there is no evidence that it corrects an underlying biological abnormality.” It then warns about the risk of taking these drugs for years.

And the report says that it is “vital” that those who suffer with distressing symptoms be given an opportunity to “talk in detail about their experiences and to make sense of what has happened to them” — and points out that mental health services rarely make such opportunities available.

This is a radically different vision of severe mental illness from the one held by most Americans, and indeed many American psychiatrists. Americans think of schizophrenia as a brain disorder that can be treated only with medication. Yet there is plenty of scientific evidence for the report’s claims.

. . . For decades, American psychiatric science took diagnosis to be fundamental. These categories — depression, schizophrenia, post-traumatic stress disorder — were assumed to represent biologically distinct diseases, and the goal of the research was to figure out the biology of the disease.  That didn’t pan out. . . . 

Out goes all those often pejorative labels and the diagnostic handbook that no one but insurance companies liked.

Under a program called Research Domain Criteria, all research must begin from a matrix of neuroscientific structures (genes, cells, circuits) that cut across behavioral, cognitive and social domains (acute fear, loss, arousal). To use an example from the program’s website, psychiatric researchers will no longer study people with anxiety; they will study fear circuitry.

The major RDoC research domains:

Negative Valence Systems

Positive Valence Systems

Cognitive Systems

Systems for Social Processes

Arousal/Modulatory Systems

. . . The implications are that social experience plays a significant role in who becomes mentally ill, when they fall ill and how their illness unfolds. We should view illness as caused not only by brain deficits but also by abuse, deprivation and inequality, which alter the way brains behave. Illness thus requires social interventions, not just pharmacological ones.

ONE outcome of this rethinking could be that talk therapy will regain some of the importance it lost when the new diagnostic system was young. And we know how to do talk therapy. That doesn’t rule out medication: while there may be problems with the long-term use of antipsychotics, many people find them useful when their symptoms are severe.

The rethinking comes at a time of disconcerting awareness that mental health problems are far more pervasive than we might have imagined. The World Health Organization estimates that one in four people will have an episode of mental illness in their lifetime. Mental and behavioral problems are the biggest single cause of disability on the planet. But in low- and middle-income countries, about four of five of those disabled by the illnesses do not receive treatment for them.

T. M. Luhrmann, quoted above, is a contributing opinion writer and a professor of anthropology at Stanford.

Below is a working list from the British Psychology Society

• 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.

• There is no clear dividing line between ‘psychosis’ and other thoughts, feelings and beliefs: psychosis can be understood and treated in the same way as other psychological problems such as anxiety or shyness. . . 

• 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.

Can a French shrink understand a Piegan?

("Jimmy P," a movie)

• Each individual’s experiences are unique – no one person’s problems, or ways of coping with them, are exactly the same as anyone else’s.

• For many people the experiences are short-lived. Even people who continue to have them nevertheless often lead happy and successful lives.

• It is a myth that people who have these experiences are likely to be violent.

• Psychological therapies – talking treatments such as Cognitive Behaviour Therapy (CBT) – are very helpful for many people. In the UK, the National Institute for Health and Care Excellence recommends that everyone with a diagnosis of psychosis or schizophrenia should be offered talking therapy. However most people are currently unable to access it and we regard this situation as scandalous.

• More generally, it is vital that services offer people the chance to talk in detail about their experiences and to make sense of what has happened to them. . . 

• 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 it carries significant risks, particularly if taken long term.

• The British Psychological Society believes that services need to change radically, and that we need to invest in prevention by taking measures to reduce abuse.

Walking the road . . .  ("Anne of Green Gables")

In my coming-to-consciousness years, even the ones before adolescence hit, I was aware that a person was unique and that society didn’t much like that unless a person is exceptional as an achiever.  The pattern was still left from wartime when there were soldiers -- obedient, predictable, uniform -- or officers -- who were expected to be brilliant and brave way above the norm. I rejected that pattern.  I wanted to take the side path.  Maybe it was the influence of Lucy Maude Montgomery and her “Anne of Green Gables” paradigm.  I didn’t pick up on romantic wandering in the blooming orchard so much as Anne cracking her slate over the head of Gilbert when he teased her.  But she did turn out to be exceptional.

The endless (literally -- they were played in a loop) newsreels that preceded today’s television news did not spare us the misery of WWII -- though any place not in contention was just a sort of blank and there were plenty of heroes.  Between the two factors of taking whatever action was necessary and high awareness of mass misery, both of which have remained part of me, this remarkable sea change in understanding psychological dilemmas and reconciling them with the new brain studies is very welcome. 

"Thousand yard stare"  By Tom Lea

I’ll research each of these domains named to see what they are talking about.  One post per domain might work.  Or things might turn out to be unexpected for everyone.  One development might be recognition of how much industrial chemicals are infiltrating our bodies and what they do to our minds, our genders, and our survival.  It may turn out that the pervasive plastics are as significant as viral infections.  Our true drug-induced madness may be food additives.  Or we may have just become allergic to ourselves.