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Secret #46: Madness with Dr. Eric Morris
220 Plays2 months ago
In this episode, Dr. Eric Morris, an associate professor at Latrobe University and Consultant Clinical Psychologist, challenges our traditional understanding of psychosis and mental health. With over 30 years of experience in both Australia and the UK, Morris brings a fresh perspective on how we view and treat unusual experiences often labeled as psychosis.
The conversation explores how the boundaries between what we consider "normal" and "psychotic" experiences are far more fluid than traditionally believed. Morris explains that unusual experiences, such as hearing voices or having unique perceptions, are actually more common in the general population than previously thought, with up to 10% of people experiencing voice hearing and 20-30% having paranoid or suspicious thoughts.
The discussion takes an important turn toward pragmatism, emphasizing that the key issue isn't the presence of unusual experiences but rather how we relate to them and their impact on daily functioning. Morris advocates for moving away from rigid categorization toward a more nuanced, contextual understanding that considers the person's entire life circumstances and cultural background.
This episode is essential listening for anyone interested in understanding mental health from a more compassionate, nuanced perspective.
Highlights:
- Psychotic-like Experiences in Everyday Life
- Common Misconceptions About Psychosis
- ACT (Acceptance and Commitment Therapy) and Psychosis
- Impacts of Cultural Narratives on Perception
- Path Forward: Rethinking Mental Health
Timestamps:
00:00 "Understanding Unusual Human Experiences"
06:09 Cultural Views on Psychosis
11:57 Understanding Diverse Perceptions of the Mind
21:28 Reevaluating Psychosis in Youth
25:11 Embracing and Understanding Life Experiences
32:41 Beyond Labels: Understanding Individual Experiences
39:29 Shifting Societal Expectations and Behaviors
43:24 Psychosis Treatment: Western Shortcomings
48:32 Stress and Isolation Induce Unusual Experiences
53:24 Facing Madness: Cultural Impressions
59:53 Defining Normalcy in Society
01:04:26 "Balancing Medication for Psychotic Experiences"
01:10:56 Broadening Conversations in Psychology
Recommended
Transcript
Society's Reward for Infallibility
00:00:02
Speaker
We are all very human and fallible, and yet we live in a society that rewards pretending we're not fallible, or the range of acceptable fallibility is narrow. We are constantly comparing our insides to other people's outsides and feeling inadequate and guilty, even ashamed. Trying to blend in means parts of ourselves will disappear, and we must then live in fear that we will be found out. Here, together, we will create a space where we can laugh, cry, and carry our suffering and hurts lightly in the service of being deeply human.
Meet Dr. Eric Morris
00:00:36
Speaker
This is Life's Dirty Little Secrets.
00:00:42
Speaker
Hello, I'm Chris McCurry, and this is Life's Dirty Little Secrets. And I'm Emma Waddington, and today our guest is Dr. Eric Morris, an associate professor at La Trobe University and consultant clinical psychologist at Northern Health in Melbourne. With over 30 years experience, he has worked both in Australia and in the UK, where I had pleasure of meeting him for the first time. Gosh, I was thinking,
00:01:09
Speaker
20 years ago probably when we first met and he has been working with specializing in complex mental health issues such as psychosis and bipolar disorder.
Psychosis and Psychological Flexibility
00:01:21
Speaker
He's trained in contextual cognitive behavioral therapies and that's how we met at talking and loving acceptance and commitment therapy.
00:01:29
Speaker
And Eric has contributed significantly to the field through his clinical work, his teaching and research, including his PhD on psychological flexibility and auditory hallucinations. And he's authored several books and treatment manuals and has been a leading figure in the development of ACT for psychosis recovery. He's passionate about improving mental health outcomes through innovative, evidence-based approaches. And we are delighted to have him here today. Welcome, Eric.
00:02:00
Speaker
Thanks very much, Emma. And Chris, it is a pleasure to be here on your podcast. And I think it has been about that long that we've known each other, Emma. So, hey, there we go. There we go. What great days those were. We had so much fun. Very early days in ACT, in and the model that we all train and work in, back in um London. Yes. Many months ago, but all days. So today,
00:02:30
Speaker
Eric, you're going to talk to us about your area of expertise, your passion, which is psychosis. And in particular, we were having a brief conversation before we started about some of those boundaries that we should believe that are well established between psychosis or what we might once upon a time have described as madness.
00:02:55
Speaker
and actually what is normal, that, you know, certain experiences are way more common than we'd like to think. And perhaps we can start there, Hugh. Yeah. So, you need us in that.
Cultural Interpretations of Psychosis
00:03:08
Speaker
Yes. and And our conversation today, I guess i'll I'm going to speak from my personal experience as a psychologist, you're right. Over the last 30 years, I have spent a good portion of my working life supporting people who have experienced psychosis. And in the kind of typical settings you would think a psychologist would work in. So in mental health settings, in public mental health settings, and I have supported people who've been diagnosed with schizophrenia and other psychotic disorders. But I would also like to yeah share today in the podcast, perhaps my own journey, if we want to say about understanding psychosis.
00:03:53
Speaker
And I think that over the last 30 years and the time I've been working, our ideas about what psychosis is have really changed, at least for psychological models. But I'm not sure the rest of the world has caught up to that. So when we talk about psychosis, I might use words like madness and other sort of more commonplace terms for this.
00:04:22
Speaker
And in part, that's because this is really old. We think that for as long as we've been a species of humans, There have been some of us who've had unusual experiences, and we've had various explanations for that. And by unusual experiences, I mean perceptions that other people don't share, such as hearing a voice or ah seeing things that that other people can't see, or developing ideas about what's happening that may seem really unusual to people.
00:04:59
Speaker
So in psychiatric parlance, we might talk about hallucinations and delusions, but also it sort of as people ever since they've been humans have had varied in their sense of things standing out, things holding an importance that other people can't share. And the listener may think, well, some of those things sound like spiritual experiences or you know the the types of perceptions that yeah know some people are just really good at detecting patterns that other people can't, and this sort of thing. and that's That's what's really interesting about this area. is we're We're talking about ways of being human
00:05:44
Speaker
where your experiences might be um wholly held by you and not necessarily by other people. And those experiences aren't necessarily wrong or bad. They're sort of part of the heritage we all have as human beings. And the interesting thing too to know is we all have a propensity towards having unusual experiences like this. So hopefully our conversation sort of get strays into those territory territory too. And I guess that the last thing i'll I'll say is our ideas of psychosis and madness are ah really in terms of thinking about something like a disorder like schizophrenia.
00:06:29
Speaker
are really only about 120, 130 years old, right? So these ideas of someone having a psychotic disorder are really kind of modern ideas, but the experiences of people hearing voices, seeing things, yeah holding unusual beliefs, of course, is as old as there have been human beings. And so our conception of adness, of difference, is highly dependent on our cultures and our history. And in talking in this area, one of the things that seems important to me is to recognize
00:07:12
Speaker
that because of those cultural ideas, there can be stigma and shame attached to these experiences. And yet, in another community, in another time, these experiences might be regarded differently.
00:07:30
Speaker
So that's what's interesting to me about this area is like all sorts of mental health problems or issues that are sort of culturally influenced, but also that that propensity to have these experiences, these days we understand just about every human being can under certain circumstances. And understanding those circumstances actually helps us to understand those experiences more.
00:08:02
Speaker
So, I hope I'll touch upon each of those things as we go today. First thing that came to my mind was the Joan of Arc and then some of the other the other people. I already go back to, you know, Old Testament prophets or whomever. And, you know, there was there was a book many years ago, The Origins of Consciousness and the Breakdown of the Bicameral Mind, yeah Julian Jaynes.
00:08:28
Speaker
I think you nobody really pays much attention to him anymore these days, but very interesting ideas about how the the human mind developed to actually kind of shut down some of that stuff and that was social pressure to not have those experiences or at least not talk about them.
00:08:48
Speaker
And I think kids get pressure, you know, whether it's to stop having an imaginary friend or some other experience that kids seem to be very, very receptive to, that there's there's subtle and not so subtle messages that, you know, that's not okay, that's not normal.
00:09:05
Speaker
And so I think a lot of this stuff does get suppressed, repressed. Yeah. and and And I hear in that, like, okay, cultural influences, what what the meaning of the time yeah makes of this. Because yeah, there's scholarship about, for example, the ancient Greeks had at times a different idea of the human mind.
00:09:32
Speaker
The human mind was permeable. You know, gods and spirits could, of course, influence what you think and feel. Well, to me, like a modern conception of the mind, at least the Western conception that ah that I was raised in, is your mind is yours. You shouldn't have alien experiences in it. There's maybe a privacy to your mind. You know, you think what you like, but you know behave in a certain way.
00:10:01
Speaker
You know, but we may also sometimes be taught that certain experiences of the mind are dangerous or wrong, right, as part of our socialization. And yet, this maybe modern idea of the mind is not how you know all humans experience their minds. And we know in, say, the Western tradition, you know the Greeks, the Romans, others experienced their mind in a different way from this separate, you know maybe Dakartian sort of idea of the mind. So without getting too highfalutin about it, it's like we all get taught
00:10:45
Speaker
Maybe we have a mind and what's appropriate in it and what you're allowed to do with it. And then when we make some of us discover our minds can do a lot more than what we're taught, then that becomes interesting.
00:11:01
Speaker
And as I talk, I don't want to, I guess, suggest that having unusual experiences ah is always a blessing, is always great. I mean, if you hear a voice that no one else can hear and you don't welcome hearing that voice or that voice says things to you that are distressing or worrying or distracting from what you want to do, this isn't necessarily something that you would welcome or want.
00:11:31
Speaker
to have, and yet it is in the capacity of the human mind to have those experiences. So this is what makes the area so interesting to me, is there have been other ways for us to experience our our minds. and And at other times in in the Western tradition, but also across the world, people perceive minds differently and
Acceptance of Unusual Experiences
00:11:57
Speaker
experiences differently. Certain experiences are not seen as illness.
00:12:01
Speaker
in cultures other than the ones that I participate in or are seen as important or or marked with significance. And so that kind of relatism that comes with it sort of brings to me a humility about this. But it also points to it's not the presence of these experiences that may be problematic as what they mean for someone.
00:12:30
Speaker
you know, whether they are supported by the communities you're in or whether they're seen as signs of difference that stigma and shame may be attached to. And while that's like a nice intellectual idea, oh, right, okay, these things are not all seen the same the same way by people, that's also a really practical. but It comes with a really practical ah approach to supporting people who have unusual experiences, that knowledge that, yeah, it's possible for just about anyone to have unusual experiences. And that the meaning of these experiences is not fixed. It's not necessarily a sign of disorder or that you're broken or flawed, that you have, you may hear a voice or be suspicious of other people or
00:13:27
Speaker
or hold ideas that other people don't hold. It's be pathologizing as a a good first step. Yeah. Of experiences that are some of the most pathologized, stigmatized experiences. Right. So yeah. Yeah. So that's what's interesting to me is as I discovered this, I can remember as ah a graduate student,
00:13:55
Speaker
i was I was taught in a pretty typical way about psychosis and schizophrenia. Now when I look back on it, it was a very othering way and a very disorder orientated way. you know and and and I came up in the 80s and the 90s, the decade of the brain. and You know, these experiences are, you know, obviously the sign of disordered brains and this sort of thing. The great hope was brain science was going to, ah you know, find yeah cures and that didn't work out. And, you know, there's probably some good reasons why that didn't work out, you know, or genetic science. Well, you know, this stuff that's sort of vaguely almost eugenics type stuff that we can alter things so people don't have these experiences.
00:14:41
Speaker
And none of that worked out or the new wonder drug is going to, you know, no, those new wonder drugs did not fundamentally improve things for many more people. And it's almost like we look in the wrong direction with this. If we look in a direction of pathology instead of trying to understand these experiences as human experiences. So,
00:15:06
Speaker
that as I came up and I discovered that sort of what I was taught was not the whole story. What I was taught was, you know, a disorder conception of these experiences is a dominant conception, but there are other ways of understanding these experiences. And as you take yeah adopt other stances to understand these experiences, you discover these experiences are more common than are suggested by a ah disorder perspective, and that many people have these experiences without having their lives shattered or yeah ah experiencing great distress, and that's really interesting too.
00:15:51
Speaker
so yeah other there So it's got me, gosh, my my head is buzzing. And I think this is wonderful because you're absolutely right. It is the most stigmatizing of all, or ah stigmatized of all the conditions. I had a couple of questions for you. ah that So the fact that they're more prevalent than we think, they're not as disordered in as much as they don't always lead to a lot of dysfunction and distress. Are there certain communities where, so I'm living in in Singapore and having worked in the
00:16:33
Speaker
local hospital, I've come to realize that certain communities have a different way of relating to unusual experiences. Voices, seeing things, they have a much more spiritual lens. They might believe that these are their ancestors and that they're a message. And I've seen multiple generations have these experiences.
Impact of Cultural Narratives on Mental Health
00:16:57
Speaker
And it's part of the family narrative. We are a family that has these special different relationships with the other world. You can see how you know it can create dysfunction if you relate to that in a different way, but for them it doesn't.
00:17:17
Speaker
and in their community, it's quite accepted and in some ways seen especially. yeah Not outside, not different, not a problem. So I was curious if for you other certain sort of communities, certain times in our lives where these unusual experiences are more common and and kind of make sense of that. I guess my my journey is to has been to move from this disorder orientation to, oh, right, it's the meaning of these experiences and the impact of these experiences rather than their presence. So, Emma and Chris, you you may have been more enlightened than me, but in the way I was trained, i I'd taken on the idea that there was
00:18:08
Speaker
There were people with serious mental health problems and everyone else, right? Or that there was this here clear boundary between the person who's psychotic and the person who's not. But as you're describing their amount, once you start looking at these particular experiences,
00:18:29
Speaker
then different communities have different meanings about these experiences. And and you may not be able to see the difference. you know like i've I've worked with people from non-Western communities who can describe, oh, this person hearing voices here. No, this is a sign of a a spiritual awakening as part of possibly a ah journey of, you know, like an initiation into deeper knowledge or, you know, and also point to someone in the same community and say, no, that that person's mad. And they that person also hears voices. But, you know, this sort of nuance between
00:19:10
Speaker
these experiences. all Or as you as you said at the start of our conversation, Chris, about Joan of Arc, Joan of Arc has all these unusual experiences and yet as a national hero, you know it achieved amazing things while also being ah an unusual person in her time, distinctive.
00:19:30
Speaker
And yet she heard voices, she had visions, she believed she had a special purpose. Many people with those experiences may not necessarily be functioning so well, but not all people with those experiences. So yeah this so sometimes I think of the idea of schizophrenia and psychosis is a very Western sort of idea of, oh, there's an idea of what good mental health is, and it is not having any any unusual experiences. And yet, when you start asking people in general population about unusual ideas, unusual perceptions, you discover that many more people
00:20:12
Speaker
than those who are deemed psychotic have these experiences. Gemma, to your question of whether there's certain times in our lives, well, when we are younger, adolescents and younger people as a population have more unusual experiences than adults, who you know, and when we're older. And you might think about when you were a young person my my experience when I was a young person, the self-consciousness I felt, the permeability of my identity, yeah that I had a sense of not being fixed or totally formed yet, yeah of still learning how to be with my mind and what what it did when I was stressed, and but also trying to work out other people's intentions and where I fit in things. And then
00:21:07
Speaker
and then having certain experiences that sort of pushed my my thinking and my perceiving in in certain directions. So, we now know that, yes, younger people have, and and please forgive the the the technical language here, but younger people are more likely to have psychotic-like experiences. See how we sort of adjusting the language, so so not psychosis, but psychotic-like, you know? So, which here combines things like... Light? Like or light? Light could be the word too, yeah. Psychotic like or psychotic light, yes.
00:21:48
Speaker
hearing things that other people can't pick up, see, you know, having brief experiences of seeing things other people can't see, having more blurring of the boundaries of you and your identity versus sort of other people having experiences. The first time you seriously fall in love with somebody, I mean, those boundaries just get like evaporated. Yeah. Yeah. And that's probably frightful online with some of those experiences. Yes. Yeah. And I guess, yeah, I'm, I'm, I'm sort of picking on this. I'm using this term permeability a lot today, but there's that, that these boundaries between you and other people or or how strongly you can experience things so that your perceptions change, like
00:22:41
Speaker
Maybe many of us have had experiences like that when we were younger. I mean, we may still do as adults, but there's just much more likelihood of many more people having those experiences when they were younger people. And there's sort of all sorts of theories about why that is, including sort of neuroscience theories about synapses and pruning and all this sort of stuff.
00:23:04
Speaker
it's The thing I would take from it is it's there in us. It's, it's possible to have these experiences. And many of us have these experiences and go on to function. Okay. You know, live lives that where we're free, you know, free to act and do things that matter and this sort of thing. A few of us may get stuck in these experiences or persist Yeah, have persisting experiences. And then how we respond to those experiences, how others respond to those experiences seems to play a sort of a heavy role in how impactful those experiences are. So sort of getting at what we're talking about, Emma and Chris is, yeah, well, if you have other people around you who who say, oh,
00:24:00
Speaker
you having this experience is okay. In fact, it might be part of something deep and special, right? Sure. And the experience might have moments of it being frightening, but it's understandable.
00:24:16
Speaker
That seems to help versus that's crazy. It's wrong. It's a sign that you're ill. It's something that other people shouldn't know about about you because, you know, you can see how these meanings can can affect your your experience of yourself and your mind. And so, yeah, again, that's what's interesting to me is I i'd moved from a position of, oh, it's very clear cut. You hear voices, you're psychotic, you know, holds really unusual ideas with with a high degree of conviction. Oh, that ah could be a sign of psychosis to something a little more blurry and nuanced. And I think that's actually helped me to be a more useful helper.
00:25:09
Speaker
with people who have these experiences is to understand that this is on a continuum, on a spectrum, rather than ah a clear difference between people.
00:25:22
Speaker
And I guess the one of us, I'm just thinking about that. One of the the the really powerful pieces around that is that part of the pathology, part of the the sort of place in which these unusual experiences become problematic is when we relate to them in the way that you describe that, you know, there are problems. And so if we layer their experience with that narrative, oh, well, you have a disorder.
00:25:52
Speaker
you might make that experience more distressing and more problematic. So we're kind of creating a problem. Yeah. True. True our response. Yes. Our response. Yeah. Even as collections, but also as a community. And I think it is because they have had this, this, this, and I wonder about, I mean, that would be a different conversation, potentially why, how we've got here to a place where we're so scared of.
00:26:20
Speaker
psychosis-like experiences that you know we find them so like yeah so intimidating, and we don't talk about them. Really, I remember in my, actually, in some of our earlier years, Eric, when we met, I remember meeting so many clinicians.
00:26:40
Speaker
who talked to me about their experience. And there was these beautiful conversations and it was part of what made for me that the the community that we belonged in so inviting and warm and connecting was this permission to be. ya Yeah, yeah.
00:26:59
Speaker
It was permission to have, I remember one of my first workshop with Kelly Wilson in 2005, we were a handful of people because you know it wasn't well known. One of his big things was about we're all in the same tube and we all carry our own things and even as psychologists, even as clinicians, and for me that felt like, oh, I found my home. I think that's what's so beautiful about what you're saying is that part of that permission to be part of those really sort of complex the complex tapestry, which is a human experience, can include some of these unusual experiences too. but that yes And if we layer on top of that, this acceptance in this room and this curiosity, what's going on here, how's this working for me versus this categorizing, it's normal, abnormal, good, bad.
00:27:58
Speaker
mad, sane, then yes, we can we we can hold it more lightly as we talk about it in this community, but also perhaps find a more expansive way of relating to each other and our experiences. Yeah. I mean, it's pragmatic. see what you See, to me, what you're describing is pragmatism, right? And and and that's, to me, what is exciting about taking a contextual view here is, I mean, I love ideas as you can you can hear, but I i love it even more. If I'm charged with doing a job of of supporting people, can I be practical and useful? yeah Can ideas guide
00:28:47
Speaker
my actions so that I can be useful to someone who who might be in the darkest place, the most stuck position, and not because of what they've done, but because of the the meanings around them, around it, or or experiences they haven't chosen to have, but they are having.
00:29:10
Speaker
and What you're describing there, Emma, is part of the appeal to, for me, of contextual behavioral science is it honors lived experience. ah You can't go to a Kelly Wilson workshop and not notice lived experience. Kelly will share yeah his experience, but he's encouraging you to connect with your own experience. And that's what's really interesting about the sort of radical behaviorism that's underneath this is actually your experience does matter.
00:29:41
Speaker
you know, actually noticing it. And, ah you know, in turns, we might say making room for it, but maybe loosening up around categorizing and judging might be pragmatic and useful. Right. And then the more we know about human psychology, the more we discover that categorization sometimes is not a pragmatic move.
00:30:09
Speaker
Now, I work in healthcare systems where we do categorize who's mentally ill and who isn't, but it seems to me that's about resources. you know And then when you actually work with a person, you're interested in their experience and what they you know aspire to, what they care about, their history, this sort of thing. And the label Schizophrenia is not so useful to me as a helper, as Well, what happened to you? What sense do you make of this? what you know Where are you wanting to go in life? If these experiences are going to yeah continue to be here, how might I work alongside you, the person having these experiences, to live as full a richer life as as is possible for you?
00:31:03
Speaker
Right? and And so it gets down to a pragmatic piece. So ah sort of I personally sort of think the these efforts of categorization are in some contexts pragmatic and useful, but you shouldn't take them so seriously that you are structuring your interactions with other people based on this.
00:31:28
Speaker
You know, I mean, when I meet with someone who has unusual experiences, it's not like I go in completely clean, yeah a ah blank canvas. I'm shaped by my culture and my history about these experiences.
00:31:44
Speaker
So, and experiences can be singular. They can be very hard to understand. Someone's trying to put words to a visceral set of experiences they have and it becomes confusing, you know, at times. It's unusual. I mean, that's, you know, we use the term unusual experiences or psychotic-like experiences there.
00:32:07
Speaker
they They might be very singular experiences and the person is through words you know or or and writing things down or trying to convey to me what it's like to be them. And I'm doing my best with the limitations I have to to understand. But in my experience as a helper,
00:32:28
Speaker
Many times that categorization is actually a as an additional limitation instead of of use to me. and It seems more useful to, you know, consider things from this sort of pragmatic science that that we're into, Emma and Chris. So, all right, people have experiences and those experiences can be context for them to be ding and behaving.
00:32:57
Speaker
The action of making sense of these experiences is influenced by all sorts of contingencies. maybe I can co-create with this person a context that supports pragmatism and flexibility and where it's useful openness and compassion around these experiences ah and and not ignore that these experiences have meanings attached to them
00:33:28
Speaker
from the cultures that we're in or from your own history. And that seems to me as a helper, the more useful thing is to have a framework for being open to human experience and thinking, well what's useful here in this? And many times what isn't useful is to say, you're mad, you're crazy. And when I imagine yeah There's so many unusual experiences. I know that that we're describing certain ah the and you know hearing voices, paranoia, seeing things, ah but they're also unusual experience when it comes to body images and you know how we think about ourselves and how preoccupied we get about cleanliness. Those are all under the unusual. law
00:34:22
Speaker
yes The psychology is full of unusual old experiences. And you know relating to any of those, I want to live in a world where we can see that our experiences are vast. And I think conversations like us today and other conversations that we've had on our podcast, conversations that we as clinicians are very privileged to have in our clinic rooms, help me live in that world where I can see that we are complex.
00:34:53
Speaker
And we have lots of of of ways of seeing the world, experiencing the world, understanding the world. But that pragmatic lens for me, thinking about how is this working for me? What is the life that I really want and how do I have to hold these experiences in a way that helps me move in that direction? And if I think of some of the more neurodivergent community, they have a lot of experiences that are unusual.
00:35:22
Speaker
and Perhaps in our community, it's more accepted, but to live in this community, there's certain expectations that you know you can't go around saying you're here in place. That's not a very useful behavior if you want to sit and get a job in an interview.
00:35:41
Speaker
Or I remember Emily Sanders back in many, many years ago, I talked to me about you know her daughter wanting to get a job, having a certain haircut and certain outfits. And she said, well, you know there are certain jobs where you know that's okay, but other jobs where you won't get a job if you look like that. And that's just what's expected.
00:36:02
Speaker
of you. And I think in that's the context, sensitivity that calls for us to think about, you know, what's expected of us and how we have to adapt. But that doesn't take away, that doesn't mean that our experiences are good or bad. Well, and there, as you say that, Emma, it's also that, well, context can change, expectations can change.
Neurodiversity in the Workplace
00:36:27
Speaker
What comes to mind to me as you described that is in a post-industrial society. I had this image in my mind of you know children learning to be obedient at school, or yeah how many of us who are knowledge workers, we work in offices in a very sort of Actually, there's a sort of range of behaviours that you can display and not others, right? And and what I mean by the sort of Taylorism is of it is, Taylor, who sort of came up with ideas of how people could work in factories, in so that human beings could... It didn't matter what type of human being you were, you could be sort of swapped in and out in terms of your role, right? How really those ideas
00:37:20
Speaker
of what are appropriate behaviors in an industrial society. Be quiet, pay attention, yeah know be diligent, show up on time at a certain time, handle being around lots of people working away at some task. You know like you can see how our schools, our little factories are preparing you to work in the factory around lots of other people. data ah And even our officers today, some of us don't have a lot of job control. You've got to show up at a certain time, you've got to look a certain way and all this. but That's all actually relatively new you know in in our culture, and and people are pushing back against some of those norms. so
00:38:08
Speaker
You know, to me, awesome. One of the things that's awesome about recognizing neurodiversity is why is the world organized this way? Why is it organized that you have to put up with certain sensory experiences or to contribute meaningfully, economically? I suspect a number of these norms were just created by you know white men who didn't actually have to be in those places, right? They're just, just hurting up people to do stuff for them, right? but then They had private offices. Yeah, they have, yeah, they have the corner office where they can behave any way they want to. ah know but but But COVID kind of blew all that up. Yeah. I mean, and where all of a sudden people were like, I like working remotely, you know, cause I couldn't, I don't have to like,
00:39:04
Speaker
wear clothes that are like incredibly uncomfortable and distracting and don't have to smell other people. And now people are freaking out because they're being made to go back into their offices and it's it's a huge adjustment again. Yeah. And you know, perhaps eight why it won't be going back.
00:39:23
Speaker
you know, like, like, although there's a push for it and all this, there is also, you know, a push against.
Psychosis Outcomes in Developing vs. Developed Countries
00:39:30
Speaker
Does the world have to stay this the way the world of work, for example, have to stay the way it is? I guess where this so of loops with the psychosis thing is that we we know that people in the developing world who have psychosis actually have better outcomes than people in the developed world.
00:39:53
Speaker
And, you know, there's various theories about why this might be, and it's no doubt it's multifaceted. But one of the ideas is, well, maybe in communities that that aren't post-industrial communities, you might have a role, you know, like you're not working in a sort of factory type office setting. you You could be where you are and you have a role in your family, you know, contributing to the family or the The world of work is sort of looser in terms of its expectations. like There are more types of jobs and roles than the ones that are offered to us in in highly industrialized places.
00:40:39
Speaker
And so that's really interesting as if you were sort of an arrogant Westerner thinking, oh, we've and we have the best health care and outcomes, then have a look at psychosis because no, we don't. Right. So our technological solutions and our ways of supporting people do not lead to the best outcomes for folk. You know, and so that's what's interesting as the the the ways we've pursued treating illness have not necessarily led to...
00:41:14
Speaker
better care for people. And you know and then you know in in a number of the societies that we're in, yeah know funding for mental health, for serious matter yeah know treat helping people with serious mental health has been a mess. you know In the US, a lot of the treatment of psychosis is actually in prisons, you know yeah high homelessness and this sort of thing. We haven't worked this out.
00:41:40
Speaker
And I but would be bold enough to say some of the issues of categorization, who's ill, who isn't, ah you you know, the meaning we make of it, contribute to some of the not so great ways we're trying to support people. You know, the other thing I think about with what you asked, Emma, is there's a fear of madness, right? And and so there have always being people who who don't fit in or who have who are very troubled.
00:42:17
Speaker
And if you look at that, again, the history of psychiatric care, like I remember when I lived in London, I visited the Bethlehem Museum, say the Royal Bethlehem Hospital, where we get the term bedlam from. It used to be based in the city of London. And then if you know London, and it it moved to where the Imperial War Museum is now. And and then it got moved again to Seven Oaks and Kent. And there's a museum there.
00:42:47
Speaker
Now, this is Western Europe's longest running psychiatric institution, 600 years of history. And if you want to be humble as a mental health professional, go visit that museum or or check out the online you know resources. You discover that people had all sorts of what you know wild and wondrous ideas of how to treat the mad.
00:43:12
Speaker
and And we can look back 100 years ago, oh that that oh that was awful, that was silly. But can we really honestly say that what we're doing now is better?
00:43:23
Speaker
you know And in fact, maybe our conception of this is part of the problem. And that would that would sound all great. Oh, that's a political point Eric's making. But the data suggests this too, that once you start looking at who hears voices or who holds unusual ideas, then you know the the prediction was, oh, 2% to 3% of people do. Well, no, it's up to 10% of people hear voices. And in terms of paranoid and suspicious ideas, it's 20% to 30% of us.
00:44:03
Speaker
do. right Now, maybe not to the severity or yeah with the impact that someone diagnosed with a psychotic disorder may experience, but that's way more people.
00:44:17
Speaker
than was traditionally thought. And then the other idea is an idea from the late 60s, the stress vulnerability model of mental illness. It's so already baked into psychiatry that with greater stress,
00:44:35
Speaker
can be yeah the possibility of people having unusual experiences. And and again, the work over the last 30 years has shown that when you put human beings in situations where they're profoundly isolated, or when they're under extreme stress, or you know you disrupt their sleep enough that they get very little sleep, they're just more likely to have unusual experiences.
00:45:01
Speaker
And, you know, those of us who've been parents and particularly those of us in mothering roles might have, oh, no sleep and unusual experiences. I kind of know what you're talking about here, right? You know, that it's contextual, right? Some people have a greater propensity to these experiences, but you put people under profound stress or deprivation or in situations where they're ostracized and lonely.
00:45:29
Speaker
And there's more likelihood of this. So it it sort of points to two things to me. One is, all right, this is actually more common than we think. And as a helper, that's useful, you know, if I'm working with an individual or family. But it also points to what are we doing with how we organize our societies?
00:45:54
Speaker
that might be inadvertently creating more experiences for people to struggle with. And then, as you say, i i'm like our expectations of how you should behave, well, there, who came up with those expectations? It's not like we drew up a plan and said, these are the best ways to behave for our health and wellbeing.
00:46:17
Speaker
Probably the best way is to behave, to make someone money, to produce lots of goods, but not necessarily for the health and wellbeing of people. And I know that's sort of, I'm being a bit radical in saying that, but it's good to go, it's good to be a contextualist with this because you say, oh, these are environments, these are contingencies that that affect people's capacity to have some of these experiences and we might be able to do things to to influence those things.
Reimagining Post-COVID Societal Norms
00:46:53
Speaker
and This is not unlike what we've touched upon when we've talked about burnout, that contexts that are created to get maximum productivity and efficiency and obedience out of people tend to burn them out. And so these are systemic issues, these are cultural issues that we need to be seriously thinking about.
00:47:15
Speaker
And again, you know kind of going back to the whole, what do we do post COVID and you know reimagining you know the the office and things like that, it would be it would be wonderful if we could see this as an opportunity to think, how can we be more humane, you know starting with schools and moving on up to to factories and office spaces and other environments that are stressful and that do demand a certain amount of conformity. but probably not to the degree and the rigidity that we find ourselves you know being expected to adhere to. that's That's certainly what I wonder about is that certain norms might be questioned. I take heart from where I am in Australia. Our federal government has just announced a five-year autism and initiative. And one of the one of the strands of it is is about people's employment.
00:48:13
Speaker
and the environments they're in and and how can we make workplaces more affirming, right? And to me, that's like, how do we alter these environments to be more comfortable environments for ah people who have a greater range of experiences, right? We all may, if we're workers, have to slightly contort ourselves into a shape to to fit a role.
00:48:41
Speaker
It's good to question whether or you have to contort yourself so much. You have to control yourself so much. I i personally suspect that a number of these norms were just laid down at some point in the past and not really looked at in terms of their how ergonomic they really are or you know how useful they are. And this is sort of where the the question of psychosis sort of comes to me is, I can personally remember a time in my life when I was afraid of madness and yeah and personally afraid that I would go mad. Now, how did I end up being afraid of these experiences? you know I don't want to lose control. i want you know I want to hold on to what I have and this sort of thing. But I i also am the product of
00:49:32
Speaker
my culture? When did I first learn about madness? Oh, you know, TV or a book or, you know, stories of where and unusual experiences are combined with being evil or or being out of control or, you know, et cetera. So no one sort of comes to this totally open and curious, right? They already sort of, you know, have a sort of view that's somewhat structured by by their learning experiences.
00:50:01
Speaker
And yet, what was interesting to me as as I read more and discovered more than just what my education had provided was there are all sorts of other ways of looking at this that could be useful, could be pragmatic. So the the flexibility of, oh,
00:50:22
Speaker
You know, if you don't think of this as a disease or a disorder, you think of this in some other way, like as you we talked about earlier, possibly a spiritual experience, possibly the capacity of the human mind is is amazing. Our management of abilities, you know, relating anything to anything.
00:50:40
Speaker
Yes. Wow. We can really have intense experiences that, you know, experiences of awe, experiences that are where we can't really even put words to to what's happening. That then, you know, what that sort of may focus your efforts as a helper to what is important. Maybe it isn't necessarily about categorizing people as much as, all right, what is madness? I think in what you were both saying earlier, it might be preoccupation. It might be how much how afraid or lost you get in these experiences.
00:51:24
Speaker
whether you can do the things that matter to you, even with the experiences. And certainly I work with people who have trouble with that. Yeah, you know, but yeah, also whether you yourself, the person with the experiences,
00:51:41
Speaker
have a range of ways of looking at and being with these experiences and finding your own personal agency in relation
Recovery from Schizophrenia
00:51:49
Speaker
to this. And and that seems the important bit to me. A categorical way of looking at this. I mean, how far do I go? Well, okay. A categorical way of looking at this, if you take that so literally, used to be the old, the old fashioned, you know, message that people would get if they got diagnosed schizophrenia is you'll never work.
00:52:11
Speaker
Maybe you'll never have a relationship. Maybe there is like no hope for you, right? And that's not even true. Most people diagnosed schizophrenia recover. yeah Some people have episodic, you know, they have episodes of of psychosis. Sure, some people have persisting experiences, but a third of people diagnosed with schizophrenia never have another episode.
00:52:34
Speaker
So, it's not you can't and you can't tell from how severe someone's psychotic episode was when, say, you you first meet them what their recovery is going to be like. So, that's these are the interesting things is is that it's it's not like really, really mad.
00:52:54
Speaker
ah Yeah, they're gonna they're going to have a hard life. It doesn't even sort of seem to work like that. So, I've just grown more suspicious of categorization, if I can put it that way, of categorization because it leads to maybe false stories about stuff, you know, or unhelpful messages.
00:53:15
Speaker
but we had steve haes on who talked about this at length. And you know there's you know basically the theme of there's no such thing as normal. And it was quite an interesting you know talk if you've ever heard him give that ah particular speech.
00:53:34
Speaker
Can I just actually, gosh, you've got me thinking, as you were relaying you know where this idea of what is normal, what's not normal, and how our society is defining that, especially our Western society. A case that I worked on years ago came tonight here, where it was a young person in here that had had unusual experiences. He was having a psychotic episode.
00:53:58
Speaker
Everyone was very upset and very worried. The school got involved and the services got involved. And when we went to meet the family, turns out mother had been having unusual experience for entire life and was living in the household and grandmother. And they had never sought help. They had never needed support. It was just part for them of their spiritual understanding. And yet this young person,
00:54:28
Speaker
who had described his experiences to the school counselor had activated an entire system. He was now talking about how much help he needed and how he needed medication, and his family was pushing back saying, he's fine. Leave him with us. We know what to do. And it just kind of reflects exactly what you're describing, that understanding so influenced his experience versus his family experience. And he was quite torn between listening to what his family was saying, it was like, it's okay. europe you This is your ancestors, I remember. And they were going to go off and and engraves as their way of relating to these unusual experiences for us.
00:55:13
Speaker
school, psychiatrists, psychologists telling him, no, no, no, no, no. This is really bad news. That became much more distressing than the narrative that was being had at home. and It was a real contrast. and For me, it was the first time I had seen this before. I've then seen other instances, but really that different ways of seeing unusual experiences and what really is useful. Was it useful for us to come along with an entire army to tell them how to do this or to support him with
00:55:48
Speaker
what felt like quite a useful narrative that maybe allowed him to continue to go to school and maybe allowed him to to to relate to his experience. But it was so jarring to what his new community was telling him. And I mean, I find this very interesting too, because as a helper, there's an epistemic supremacy that sometimes comes with an illness narrative or a disorder narrative. Like, oh, that's the answer.
00:56:15
Speaker
When, you know, I worked with lots of people from many cultures who you get the sense, you know, their family says, well, that's very nice. Those Western doctors have said this while we also have this view here. Right. And I don't I don't think it is so pragmatic and useful to have one versus the other. And you must adopt, you know, it's underneath should be pragmatism.
00:56:41
Speaker
So i yeah I think, sure, we we should we should take when a young person has unusual experiences, we should take this seriously and be watchful. and yeah Because yeah know these experiences, yeah, I mean, it could be.
00:57:00
Speaker
that a person has an unusual experience, and such as hearing a voice, but they find that ah experience comforting, they can function, they have a meaning around it that that is you know consistent with them, consistent with their culture, it works, and great. But you also have a person yeah Sometimes who's so preoccupied, worried, feels dominated by that experience may very well you know have commands to do things that that could be harmful to them or to other people. So you know you so there's this thing of, okay, we're not going to explore, oh, it's all good, yeah having unusual experiences. No, yeah, it can be dangerous and and threatening.
00:57:47
Speaker
But I want to support the person and the people around them to find a way of of being with these experiences and being pragmatic about it. know For a number of people, medications do help.
00:58:04
Speaker
But it's a pragmatic, I think, take a pragmatic lens on it, you know, as the medication helps to reduce the frequency of the intensity of the experience. What's the balance of the medication with side effects of the medication? You know, we know that many people prescribed medications for psychosis, stop taking these medications. And it's not because they lack insight, it's because, you know, there's sexual side effects. There's effects about how tranquilised you feel. And like, it's it's sometimes to me,
00:58:38
Speaker
a problem of imagination on the helper's side about how would you feel if you're impotent or you're struggling to be able to think through things or you can't follow a television program or something. I'm being an oldster here. A YouTube video, right? Because you're so tranquilized.
00:59:01
Speaker
Right. So pragmatism seems to me to be the important bit here of you don't have to adopt my explanation solely, you know, and my explanation is only important if it helps you pragmatically. Right. And so so I'm kind of suggesting a ah whole bit of diffusion around the whole thing, but not a a withdrawal from being trying to be useful and helpful. It's just Humility. You go visit the Bethlehem Royal Museum for 600 years. Everyone's had all sorts of amazing ideas about this and that hasn't necessarily moved the dial all that much about supporting people's personal recovery. So your cherished ideas about what's going on for someone, hold them lightly, be prepared to be wrong, but keep the person
00:59:54
Speaker
at the forefront, their wellbeing, their identity, their recovery, their roles, what they aspire to. that's That's the key bit. And as as we think about psychosis in ah in in a wider sense,
01:00:16
Speaker
Then we also in here is the actual lived experience of people with psychosis. We're talking about a group of people who have traditionally been voiceless and and these days they're not. you know sarah There are people, yeah lived experience experts who can speak in a much more informed, compelling way about this than I could ever do.
01:00:42
Speaker
about their own experience and what it's like to be a person with psychosis. and that That's important in this. is What does the person want? Am I as a helper?
01:00:56
Speaker
Yeah, informed about what I can offer, but also humble about maybe my way is not the only way. Maybe, you know, there might be things here in this person's community and their family that is way more impactful than what I have to offer. And this gets at things that, that like, there's an approach called open dialogue.
01:01:21
Speaker
developed in Finland, which situates the psychosis not inside the person, but as an issue in the community.
Open Dialogue Approach to Psychosis
01:01:28
Speaker
And it's about communication in the community wrapped around the person who's experiencing psychosis.
01:01:36
Speaker
you know a different conception than there's something wrong inside of you. There's something wrong with us in our community if you've experienced madness. And how can we practically, pragmatically address this together? Not to extinguish or get rid of unusual experiences, but to help the person feel connected and not so isolated or to maybe deal with some of the maddening communication that might have led to this person becoming unwell. There are some ways of looking at this that are different from who's mad and who isn't. right and That's what's exciting to me about it. I feel 30 years in, ah we're really just learning if we listen and if we're open.
01:02:25
Speaker
to understanding these experiences and understanding many more of us have these experiences than than the stereotype.
01:03:05
Speaker
Thank you so much, Eric. This is great. Yes.
01:03:31
Speaker
many more of us can talk about this. I realize my privilege today as a highly educat educated psychologist, you know, and but that's been my journey is is opening my eyes more and a functional perspective, of course, helped me to do that.
01:03:50
Speaker
you know, that, oh, once I let go of categorization disorder and I think functionally, then actually there's more here. Once I think of the person in their current and historical context, if I keep that at the heart of it and all the rest of sort of language games that we play and for what purpose, some of that language is useful, some of it's not. What's going to be useful to this person?
01:04:18
Speaker
then I think it sort of clarifies our purpose. And like you're saying, Emma, many more people, a conversation about this, not just held by an expert like me, you know, claiming things about what is a common human experience.
01:04:38
Speaker
you know, listening to all sorts of people about it, because, yeah, I think that the way we've been thinking about this has not necessarily let us, you know, in good directions. And so it may be time to learn more and be more curious and more open about it.
01:04:56
Speaker
Absolutely. I look forward to those conversations. Thank you very much. Thank you so much. yeah Thank you for the opportunity.
Closing Remarks and Feedback Invitation
01:05:06
Speaker
thanks so much for tuning into the life's dirty little secrets podcast if you have any feedback for us or secrets for future episodes you can email us at life'surdy little secrets podcast at gmail dot com Be sure to follow us on Instagram at Life's Dirty Little Secrets or on Facebook at Life's Dirty Little Secrets Podcast. We invite you to follow, rate, and review us on wherever you listen to this podcast. It is the best way to get our podcast out in front of new listeners. We'll be back in a couple weeks with more. See you then.