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Archive for June 12th, 2017

The plight of the seven imprisoned Bahá’í ‘leaders’ continues. So does the campaign to secure their release. The latest development in the UK  is described at this link.

As the ‘Yaran’, the seven Baha’is in Iran who have been unlawfully imprisoned since 2008, enter their ninth year of incarceration, a campaign all over the world has begun, bringing attention to the plight of these friends and calling for their immediate release. From India to the United States to South Africa to the United Kingdom, the hashtags #ReleaseBahai7Now and #NotAnotherYear are being used across social media to highlight the efforts made.

This year much focus has been given to the ‘years missed’, reflecting on the fact that “…during these nine years, the seven have endured awful conditions that are common in Iranian prisons. In human terms, they have also missed out on the numerous day-to-day joys – and sorrows – that make life sweet and precious” (Baha’i International Community).

In the UK, in response to this campaign, various artists have come together to participate in the ‘Prison Poems Project’, a series of short film clips that give voice to the poems of Mahvash Sabet, one of the seven prisoners.

Over the next few weeks, a poem will be recited once a day by a different artist.

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I am repeating my preamble to the first post to clarify the eventual focus of this sequence.

Readers of this blog will remember that I was struggling recently to find more detailed discussion of the possibility that some severe mental disturbances have spiritual aspects. Isabel Clarke’s Spirituality & Psychosis left me frustrated by its lack of such detail.

Recently I came across a second hand copy of Christina and Stanislav Grof’s The Stormy Search for the Self: understanding and living with spiritual emergency. It was published in 1991 at a less than universally receptive time so it is hard to determine from the book itself how far things might have moved on since. This is something I will have to investigate further.

It has echoes for me of Hillman’s The Soul’s Code in that it combines deep insights with what read like wild flights of fancy and carefully substantiated accounts of concrete experience with vague waves at unspecified bodies of invisible evidence. Even so, much of it is clearly derived from careful observation and direct experience, and goes a long way towards defining what look convincingly like spiritual manifestations within mental disturbances which are currently dismissed as mere madness. So, it seemed important to flag the book up at this point.

Before I go into more detail I need to place its thesis in perspective. We need to understand how much of an uphill battle it is going to be to get the spiritual dimensions of the experiences currently labelled psychosis accepted in mainstream psychiatry and psychology. I began by looking back at the history of the way the effects of trauma have been treated. I pick up the thread from there.

Meaning in Madness

Trauma and its effects took a long time to gain acceptance, as the last post explored.

It is taking much longer to acknowledge that extremes of mental disturbance may not be madness at all in many if not most cases.

It is thankfully being increasingly accepted that trauma leads to experiences that are then labelled psychotic which need to be managed and integrated not simply by drugs, which may sometimes be a temporary fix at best, but by therapeutic relationships within an accepting social context, something I have already explored at some length on this blog. I will briefly revisit the picture briefly here.

Richard Bentall’s examination of the issue in his 2003 edition of Madness Explained makes the problem clear. He writes (page 277):

In this discussion of environmental influences on psychosis, I have left the contribution of trauma until last because, for many psychologists and psychiatrists at least, even to raise this issue is to court to controversy.

Even so his conclusions on the basis of the best evidence at the time is (pages 478-79):

Despite difficulties, there is consistent evidence that a history of physical or sexual abuse is unusually common in psychotic women.

Comparable evidence of an association between trauma and psychosis has emerged from studies of men.

Even as late as 2010 there seemed to be persisting resistance to widespread acceptance of what should have by then have become obvious and widely accepted (The Impact of Early Life Traumapage 9):

Acceptance and acknowledgement of explanations more consistent with empirical findings need to overcome what societal attention to child abuse and neglect has always had to overcome: society’s desire for minimisation and denial. The existence and effect of child maltreatment is perpetually fighting for acceptance against powerful psychological and social processes set to deny, ignore or undermine it.

When we leap almost to the present day there is thankfully far less hesitation in many quarters. I’m not sure though that we have yet come to the end of the need to change the prevailing consensus.

Jamie Murphy, Mark Shevlin, James Edward Houston, and Gary Adamson uncover the true complexity of the problem (Modelling the co-occurrence of psychosis-like experiences and childhood sexual abuse –pages 1037-1043).

Evidence, in their view, has repeatedly shown that Childhood Sexual Abuse (CSA) is ‘significantly associated with psychosis at both clinical and sub-clinical levels (Psychotic-like Experiences – PLEs): the worse the CSA, the greater the risk, severity and duration of psychosis.’ They argue that the evidence from current psychological conceptualizations confirms that psychotic symptoms are closely related to a person’s psychological functioning and that they are therefore amenable to psychological intervention (quoting Yusupoff et al., 1996).

It is important that we make sure we are not being misled into attributing cause when we have only correlation. By this I mean that just because, when I am holding my key to either open or lock my front door, the light goes on, I should not jump to the conclusion that my door key is switching the light on. I need to understand that my mere presence with no key is enough to trigger the motion sensor. The key is a confounding variable that needs to be eliminated, for example by leaving the house without locking the door one night. I’d be wise not to go further than strictly necessary to prove the point though.

Longden and Read (The Role of Social Adversity in the Etiology of Psychosis – pages 7-8) deal extensively with this problem:

Large-scale population studies have shown that associations between adversity and psychotic experience remain significant when controlling for possible confounders, including: family history of psychosis and other mental health problems (which negates the notion that psychosis only occurs in those genetically predisposed), age, sex, ethnicity, marital status, exposure to discrimination, other psychiatric diagnoses, education level, neuroticism, and substance use. Furthermore, the association has repeatedly demonstrated a dose-response relationship; that is, the likelihood of psychosis increases relative to the extent of adversity exposure.

The full list is in the earlier sequence of posts.

It is some comfort that Bentall’s more recent book Doctoring the Mind brings the more grandiose pretentions of psychiatry back to the earth with a bump. Salley Vickers’ verdict in a review states:

Bentall’s thesis is that, for all the apparent advances in understanding psychiatric disorders, psychiatric treatment has done little to improve human welfare, because the scientific research which has led to the favouring of mind-altering drugs is, as he puts it, “fatally flawed”. He cites some startling evidence from the World Health Organisation that suggests patients suffering psychotic episodes in developing countries recover “better” than those from the industrialised world and the aim of the book is broadly to suggest why this might be so. . . .

My own view endorses Bentall’s rigorous analysis of the misleading inadequacy of psychiatry’s diagnostic system, its powerful and carefully argued exposure of the myths surrounding psychotropic medications and their supposed efficacy, and its moving description of the critical importance of positive relationships to recovery.

The Importance of Context

James Davies’ book Cracked also covers much of this same ground and is equally compelling. Both Bentall and Davies are very clear that there is still some considerable distance to travel.

What also needs to be acknowledged is that Davies also takes the argument to another level towards the end of his book.

Where he takes his case, in Chapter 10, I found both compelling and resonant. He is in tune with Bentall in seeing the importance of supportive relationships but, I think, explores that aspect somewhat more deeply.

He repeats basic points, to begin with (page 266):

What the evidence shows… is that what matters most in mental health care is not diagnosing problems and prescribing medication, but developing meaningful relationships with sufferers with the aim of cultivating insight into their problems, so the right interventions can be individually tailored to their needs. Sometimes this means giving meds, but more often it does not.

He then quotes research done by a psychiatrist he interviewed (page 267). Using two existing MH teams, Dr Sami Timimi set up a study comparing the results from two groups, one diagnostic, the usual approach, and the other non-diagnostic, where medication was given only sparingly, diagnosis was hardly used at all, and individual treatment plans were tailored to the person’s unique needs.’

In the non-diagnostic group the psychiatrist spent far more time exploring with his clients the context of their problems.

The results were clear (page 269):

Only 9 per cent of patients treated by the non-diagnostic approach continued needing treatment after two years, compared with 34 per cent of patients who were being treated via the medical model. Furthermore, only one person from the non-diagnostic group ended up having to be hospitalised, whereas over 15 people in the medical-model team were referred for inpatient hospital treatment. Finally, the non-diagnostic approach led to more people being discharged more quickly, and to the lowest patient ‘no-show’ rate out of all the mental health teams in the county.

This middle is by no means the norm, unfortunately.

Davies also interviewed Dr Peter Breggin, a US psychiatrist who is critical of the medical model. Breggin explained his viewpoint (page 279):

Most problems are created by the contexts in which people live and therefore require contextual not chemical solutions. ‘People who are breaking down are often like canaries in a mineshafts,’ explained Breggin. ‘They are a signal of a severe family issue.’ .  . . . For Breggin, because the medical model fails to take context seriously – whether the family or the wider social context – it overlooks the importance of understanding and managing context to help the person in distress.

Davies quotes Dr Pat Bracken as singing from the same hymn sheet (page 273):

We should start turning the paradigm round, start seeing the non-medical approach as the real work of psychiatry, rather than as incidental to the main thrust of the job, which is about diagnosing people and then getting them on the right drugs.

Davies’s final points I’ll leave till next time as a useful link between this theme and the issue spirituality and its treatment in Christina and Stanislav Grof’s The Stormy Search for the Self: understanding and living with spiritual emergency.

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