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Shifting the Paradigm:
From Disease-based Reductionism To Needs-based Holism
From Disease-based
Reductionism . . .
How do we Define Psychosis?
DSM Diagnoses
Schizophrenia (with a number of subtypes)
Schizoaffective disorder
Bipolar disorder (with subtypes)
Mood disorders with psychotic features
Delusional Disorders
How do we Define Psychosis?
Psychotic Experiences and Behaviors
Delusions
Hallucinations
Mania (or other apparently “bizarre” affect)
Delusions of Grandeur
Paranoia
Catatonia (bizarre movement or lack of movement)
What Causes Psychosis?
• Genetic disorder
• Biochemical Imbalance
• Faulty brain structure
• Virus
A disease of the brain likely to be caused by a . . .
How do we Treat Psychosis?
Encourage the person to let go of serious aspirations and generally “lay low”
Encourage “insight” that they have a “mental illness” (i.e., lifelong brain disease)
Encourage a lifelong regimen of antipsychotic drug use, resorting to coercion if necessary
Is it Possible to Fully Recover?
Unfortunately, no. This is a lifelong degenerative brain disease.
But if one diligently remains on their meds, they can manage their symptoms and reduce the risk of full relapse.
Schizophrenia Recovery Rates
"Developed" Countries
"Developing" Countries
28%
57%
• WHO study covering 13 countries
• Using their strictest criteria for recoveryGlobal DAS (Excellent/Good)
United StatesNew Zealand India
Bulgaria
4.4%3.9%
.1%.3%
Prevalance of Bipolar Disorder• WHO study covering 11 countries
• U.S. and N.Z have the 2 highest rates and are the only Western nations allowing direct-to-consumer drug advertising
Graph as printed in “Anatomy of an Epidemic” by Robert Whitaker
On vs. Off “Mainstream Treatment”
New Zealand (2000)
Australia (2001) New Zealand
(2010) Australia (2010)
1 in 168(23,142) 1 in 137
1 in 90(48,899)
1 in 98
Disability Rates• *Rates of disability due to mental health conditions
have increased radically, in direct correlation with the increase in psychiatric drug treatment (*For adults age 18-64)
Towards a Holistic
Organismic Perspective . . .
What is an Organism?
Organismic Wisdom: All living organisms have the innate desire and capacity to survive and thrive
What is an Organism?
NeedsAssessme
nt
Emotion / Motivation
To meet one’s needs
Response / Action
in an attempt tomeet one’s
needs
Organismic Process:
Human’s Basic Needs
Human’s Basic Needs
Unmet Needs Distress
Resources are simply unavailable
Unmet Needs Distress
Resources are simply unavailable
Resources available but unable to be utilized
Lack of self connection (to one’s needs)
Limiting beliefs preventing nourishment (i.e., Nourishment Barriers)
Formulating a Holistic
Needs-based System . . .
Genuine Support =
Helping Person to Identifyand Meet their Needs
Current System
NeedsAssessme
nt
Emotion / Motivation
To meet one’s needs
Response / Action
in an attempt tomeet one’s
needs
Misinformation (fixation on “disease” rather than needs)
Current System
NeedsAssessme
nt
Emotion / Motivation
To meet one’s needs
Response / Action
in an attempt tomeet one’s
needs
Suppression of Emotion / Motivation
Current System
NeedsAssessme
nt
Emotion / Motivation
To meet one’s needs
Response / Action
in an attempt tomeet one’s
needs
“Killing the Messenger” (fixation on suppressing experience rather than listening to its message and targeting the needs)
A Genuinely Supportive System
NeedsAssessme
nt
Emotion / Motivation
To meet one’s needs
Response / Action
in an attempt tomeet one’s
needs
Support person in identifying the unmet need(s)
A Genuinely Supportive System
NeedsAssessme
nt
Emotion / Motivation
To meet one’s needs
Response / Action
in an attempt tomeet one’s
needs
Foster healthy relationship with one’s inner world experiences and emotions
A Genuinely Supportive System
NeedsAssessme
nt
Emotion / Motivation
To meet one’s needs
Response / Action
in an attempt tomeet one’s
needs
Support person in developing effective, sustainable strategies for meeting their needs
A Holistic Organismic Understanding of Psychosis . . .
Overwhelming Distress Psychosis
Unmet Needs Distress
UnresolvedPeace/Existence Dialectic
Unable to maintain the experience of a secure and stable sense of self living in relatively secure and predictable world.
“I don’t have a right to exist”
“The world is not safe enough”
“I don’t know who I am and what my needs and values are”
“There is something fundamentally wrong with me”
UnresolvedPeace/Existence Dialectic
UnresolvedAutonomy/Connection Dialectic
Unable to feel secure with both one’s autonomy and one’s belonging & connection with others.
“I don’t belong here”“I am ashamed of who I am”“Others don’t love and accept me for who I am”“My needs are not as important as those of others”“I don’t matter”
UnresolvedAutonomy/Connection Dialectic
“I have a right to exist”
“The world is safe enough”
“I know who I am and what my needs and values are”
“I am intrinsically a whole person”
To arrive at the experience of myself as a relatively secure and stable self living in a relatively secure and predictable world…
ResolvedPeace/Existence Dialectic
“I belong here”“I love and accept myself for who I am”“I am loved and accepted by others for who I am”“My needs are just as important as those of others”“I matter!”
To arrive at a way of being in which I am loved and accepted for who I am:
ResolvedAutonomy/Connection Dialectic
Recovery FactorsFinding hope
Connecting with one’s aliveness
Finding meaning in life
Arriving at a more hopeful understanding of their psychosisDeveloping healthy relationships; Healing or distancing from unhealthy relationships
Harm from the psychiatric system hindering recovery
Factors supporting recovery
Factor hindering recovery
Offering Support Through Psychosis
Bringing a Holistic
Needs-based System to Life . . .
Prioritise Healthover Profit: Remove corporate and private interests from health care system—a true common-owned nonprofit health care system.
Redefine Our Priorities
From the Mind/Brain Debate
to a Holistic Systems Perspective
An organism consists of many systems working synergistically:
SocialPhysiologicalPsychological
Overwhelming distress on any one system can affect the whole, leading to various psychological disturbances and potentially even psychosis…
SpiritualEcological
Ensure that everyone’s basic needs are met:
Healthy food Clean water Adequate shelter Education (without industry sponsorship) Meaningful work/activity General health and relationship support
Prevention & Maintenance
Noncoercive Holistic needs-based Honoring expertise via “lived experience” Individual and relationship-based support Empathy-based noncoercive residential
facilities Freely available in every community
Empathy-based Crisis Support
A healthier use of drugs:
Accurate information about the short and long-term harms and benefits
Only as a last resort & for minimum duration Never without consent Support with tapering
Drugs take the back seat…
A Continuum of Care
OrdinaryPsychosocialSupport
Ordinary Human Distress Full Psychotic Process
Intensive Outpatient Support
• Peer support• Traditional therapy
(individual, family, group)• Making peace with the
experiences(CBT, ACT, Trauma-focused, Somatic/ Mindfulness)
Intensive Residential orFamily support• Soteria
homes• Peer Respite• Open
Dialogue• etc.
Full Dissertation: gradworks.umi.com/34/54/3454336.html
Website: RethinkingMadness.com
