{"id":54722,"date":"2015-02-28T13:39:27","date_gmt":"2015-02-28T18:39:27","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=54722"},"modified":"2015-02-28T15:46:02","modified_gmt":"2015-02-28T20:46:02","slug":"to-be-continued-2","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2015\/02\/28\/to-be-continued-2\/","title":{"rendered":"&lt;to be continued&gt;&#8230;"},"content":{"rendered":"\n<p align=\"justify\" class=\"small\"><a target=\"_blank\" href=\"https:\/\/www.bps.org.uk\/system\/files\/user-files\/Division%20of%20Clinical%20Psychology\/public\/understanding_psychosis_-_final_19th_nov_2014.pdf\"><img decoding=\"async\" width=\"140\" vspace=\"2\" hspace=\"4\" border=\"1\" align=\"right\" src=\"http:\/\/1boringoldman.com\/images\/understanding.jpg\" \/><\/a>It&#8217;s not easy to respond to the <em><font color=\"#200020\">British Psychological Society&#8217;s<\/font><\/em><font color=\"#200020\"> [BPS]<\/font>, <a href=\"http:\/\/www.bps.org.uk\/system\/files\/Public%20files\/rep03_understanding_psychosis.pdf\" target=\"_blank\">Understanding Psychosis and Schizophrenia<\/a>, primarily because of the extensive use of negation throughout the report. In their discussion, the phenomena formerly called a symptom [like hearing voices] is <u>not<\/u> <font color=\"#200020\">abnormal<\/font>, but rather something seen in <font color=\"#200020\">normal<\/font> mental life. A negative symptom like anhedonia is <u>not<\/u> some primary aspect of a disease state but rather the result of being overwhelmed. There is <u>not<\/u> any underlying condition causing symptoms [the Szaszian formulation of <a target=\"_blank\" href=\"http:\/\/en.wikipedia.org\/wiki\/The_Myth_of_Mental_Illness\">the Myth of Mental Illness<\/a>]. Medication is <u>not<\/u> treating some underlying pathology, but rather an optional adjunct some find helpful. Much of what is seen in these conditions is the result of being <u>not<\/u> understood or <u>not<\/u> listened to. In the etiologic dimension, the report suggests that these are people who have been traumatized by life experiences &#8211; <u>not<\/u> a flight into <em>fantasy<\/em> but a reaction to <em>fact<\/em>.<\/p>\n<p align=\"justify\" class=\"small\">The points made in the report are certainly well known to all of us. Besides echoing the words of <a href=\"http:\/\/en.wikipedia.org\/wiki\/Thomas_Szasz\" target=\"_blank\">Thomas Szasz<\/a> [who is nowhere mentioned in the report], it&#8217;s a position similar to the one expressed by <a href=\"http:\/\/www.madinamerica.com\/author\/rwhitaker\/\" target=\"_blank\">Robert Whitaker<\/a> in his books and by the bloggers on his web-site, <a href=\"http:\/\/www.madinamerica.com\/\" target=\"_blank\">Mad in America<\/a> [Whitaker is referenced extensively in the report]. It also mirrors the ideas of the <a href=\"http:\/\/en.wikipedia.org\/wiki\/Recovery_approach\" target=\"_blank\">Recovery Movement<\/a> and the <a href=\"http:\/\/en.wikipedia.org\/wiki\/Psychiatric_survivors_movement\" target=\"_blank\">Psychiatric Survivors Movement<\/a>. The phrase coined in the report that seems to define the approach being generally advocated is &quot;<em><strong><font color=\"#200020\">We need to replace paternalism with collaboration<\/font><\/strong><\/em>.&quot; In the section about <a href=\"https:\/\/www.bps.org.uk\/system\/files\/user-files\/Division%20of%20Clinical%20Psychology\/public\/understanding_psychosis_-_final_19th_nov_2014.pdf#page=74\" target=\"_blank\">recovery colleges<\/a>, there&#8217;s a table contrasting these models as discussed in this report:<\/p>\n<p align=\"center\" class=\"small\"><img loading=\"lazy\" decoding=\"async\" width=\"450\" height=\"242\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/recovery-college.gif\" \/><\/p>\n<div align=\"justify\" class=\"small\">So the report recommends a list of fundamental changes in the systems of mental health care:<\/div>\n<ul>\n<div align=\"justify\" class=\"small\"><a href=\"https:\/\/www.bps.org.uk\/system\/files\/user-files\/Division%20of%20Clinical%20Psychology\/public\/understanding_psychosis_-_final_19th_nov_2014.pdf#page=106\" target=\"_blank\"><font color=\"#660033\">Section 13<\/font><\/a><font color=\"#660033\">: What mental health services need to do differently<br \/>                  &nbsp;&nbsp;&nbsp;13.1 We need to move beyond the &lsquo;medical model&rsquo;<br \/>                  &nbsp;&nbsp;&nbsp;13.2 We need to replace paternalism with collaboration<br \/>                  &nbsp;&nbsp;&nbsp;13.3 We need to stop &lsquo;prescribing&rsquo; and start supporting people to choose<br \/>                  &nbsp;&nbsp;&nbsp;13.4 We need to make rights and expectations explicit<br \/>                  &nbsp;&nbsp;&nbsp;13.5 We need to reduce the use of compulsion and mental health legislation<br \/>                  &nbsp;&nbsp;&nbsp;13.6 We need to change the way we do research<br \/>                  &nbsp;&nbsp;&nbsp;13.7 We need to change how mental health professionals are trained and supported<\/font><\/div>\n<\/ul>\n<p align=\"justify\" class=\"small\">While I&#8217;m focusing on the overall thrust of the report, James Coyne of the PLoS blog, <a href=\"http:\/\/blogs.plos.org\/mindthebrain\/\" target=\"_blank\">Mind the Brain<\/a>, has addressed the content and I&#8217;d recommend looking at his take on the specifics of the report [<a target=\"_blank\" href=\"http:\/\/blogs.plos.org\/mindthebrain\/2015\/02\/26\/understanding-psychosis-and-schizophrenia-and-mental-health-service-users\/\">&ldquo;Understanding Psychosis and Schizophrenia&rdquo; and mental health service users<\/a>].<\/p>\n<div align=\"justify\" class=\"small\">The report is so focused on negation of the medical approach of mainstream psychiatry that I&#8217;ve included some references for those who want to explore the official versions of that medical position further:<\/div>\n<ol><span class=\"small\">                    <\/p>\n<li>\n<div align=\"justify\"><a target=\"_blank\" href=\"http:\/\/psychiatryonline.org\/pb\/assets\/raw\/sitewide\/practice_guidelines\/guidelines\/schizophrenia.pdf#page=36\">Practice Guideline for the Treatment of Patients With Schizophrenia<\/a> [APA 2004]<\/div>\n<\/li>\n<li>\n<div align=\"justify\"><a href=\"http:\/\/psychiatryonline.org\/pb\/assets\/raw\/sitewide\/practice_guidelines\/guidelines\/schizophrenia-watch.pdf\">Guideline Watch<\/a> [APA&nbsp; 2009]<\/div>\n<\/li>\n<div align=\"justify\">and from the <span class=\"small\">NIMH <a href=\"http:\/\/www.nimh.nih.gov\/health\/topics\/schizophrenia\/raise\/index.shtml\" target=\"_blank\">RAISE<\/a> Project<\/span> [now adopted by <a href=\"http:\/\/www.samhsa.gov\/samhsaNewsLetter\/Volume_22_Number_4\/serious_mental_illness_block_grant_priority\/\" target=\"_blank\">SAMHSA<\/a>]                   <\/div>\n<li>\n<div align=\"justify\"><a href=\"https:\/\/raiseetp.org\/studymanuals\/IRT%20Complete%20Manual.pdf\" target=\"_blank\">Individual Resiliency Training Manual<\/a> [NIMH 2014]<\/div>\n<\/li>\n<p>                    <\/span><\/ol>\n<div align=\"justify\" class=\"small\">It&#8217;s highly unlikely that anyone reading this doesn&#8217;t already have strong feelings on one side or the other of the points raised in this report. And what&#8217;s striking to me is how little this particular debate has changed in the forty plus years since I first encountered it. Back then [the 1970s], the gulf was largely sorted by disciplines, much as it today. Somewhere, shortly after I arrived and started hearing this debate, I actually found myself in a library looking up <em><font color=\"#200020\">the medical model of disease.<\/font><\/em> In a way, that still strikes me as kind of humorous, in that I was at the time a fully trained internist with practice experience who knew nothing [yet] about mental illness. But I could tell that in those heated arguments of the day, <em><font color=\"#200020\">the medical model of disease<\/font><\/em> was a being seen as a bad thing. I was looking it up because I didn&#8217;t know what they were referring to. As you can see in the <a href=\"https:\/\/www.bps.org.uk\/system\/files\/user-files\/Division%20of%20Clinical%20Psychology\/public\/understanding_psychosis_-_final_19th_nov_2014.pdf#page=106\" target=\"_blank\"><font color=\"#660033\">Section 13<\/font><\/a> table of contents above, those heated arguments are, if anything, even more heated today.<\/div>\n<p align=\"justify\" class=\"small\">Just for clarification, there are <u>two<\/u> central <em><font color=\"#200020\">medical models of disease<\/font><\/em>. The one being referred to here holds that <em><font color=\"#200020\">signs<\/font><\/em> [things you see] and <em><font color=\"#200020\">symptoms<\/font><\/em> [things reported] are external manifestations of an internal <em><font color=\"#200020\">cause<\/font><\/em> [a <em><font color=\"#200020\">disease<\/font><\/em>]. Diagnosis is focused on locating the underlying <em><font color=\"#200020\">cause<\/font><\/em> [which is also the object of treatment, if possible]. Treatment of the symptoms themselves is a secondary focus. There are several corollaries. <em><font color=\"#200020\">Aesculapian Authority<\/font><\/em> refers to the traditional physician role &#8211; the assumption that the physician may recommend doing something painful or counterintuitive, but that recommendation has <em><font color=\"#200020\">Therapeutic Intent<\/font><\/em> and operates under the principle of <em><a href=\"http:\/\/en.wikipedia.org\/wiki\/Primum_non_nocere\" title=\"Primum non nocere\">Primum non nocere<\/a> &#8211; &quot;first, do no harm.&quot;<\/em> Obviously, this BPS report questions the appropriateness of this model when applied to psychotic mental illness as well as the applicability of the corollaries.<\/p>\n<div align=\"justify\" class=\"small\">The second central <em><font color=\"#200020\">medical model of disease<\/font><\/em> is the <em><font color=\"#200020\">preventive model<\/font><\/em>. How one implements the preventive model depends on what you see as the <em>cause<\/em>. In psychiatry, the preventive efforts have been on detecting a <em>pre-psychosis<\/em> marker. The BPS report has a different focus:<\/div>\n<ul>\n<div align=\"justify\" class=\"small\"><a href=\"https:\/\/www.bps.org.uk\/system\/files\/user-files\/Division%20of%20Clinical%20Psychology\/public\/understanding_psychosis_-_final_19th_nov_2014.pdf#page=117\" target=\"_blank\"><font color=\"#660033\">Section 14<\/font><\/a><font color=\"#660033\">: What we all need to do differently<br \/>      14.1 We need take on board that we&#8217;re all in this together &#8211; there is no &#8216;us&#8217; and &#8216;them&#8217;<br \/>      14.2 We need to focus on prevention<br \/>      &nbsp;&nbsp;&nbsp;14.2.1 Prevention: towards a safer society<br \/>      &nbsp;&nbsp;&nbsp;14.2.2 Prevention: towards a more equal society<br \/>      &nbsp;&nbsp;&nbsp;14.2.3 Prevention: reducing discrimination and oppression<br \/>      &nbsp;&nbsp;&nbsp;14.2.4 Prevention: reducing harmful drug use and addressing its causes<br \/>      &nbsp;&nbsp;&nbsp;14.2.5 Prevention: what we can each do to protect our mental health<br \/>      14.3 We need to campaign against prejudice and discrimination<\/font> <\/div>\n<\/ul>\n<div class=\"small\"><font color=\"#200020\">&lt;to be continued&gt;<\/font><\/div>\n","protected":false},"excerpt":{"rendered":"<p>It&#8217;s not easy to respond to the British Psychological Society&#8217;s [BPS], Understanding Psychosis and Schizophrenia, primarily because of the extensive use of negation throughout the report. In their discussion, the phenomena formerly called a symptom [like hearing voices] is not abnormal, but rather something seen in normal mental life. A negative symptom like anhedonia is [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-54722","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/54722","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=54722"}],"version-history":[{"count":73,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/54722\/revisions"}],"predecessor-version":[{"id":54796,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/54722\/revisions\/54796"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=54722"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=54722"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=54722"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}