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Rethinking Madness with Dr Paris Williams- Episode 1 of the Humanosity podcast
13 Plays1 month ago
Dr. Paris Williams is a clinical psychologist licensed in California, Utah, and Colorado where he currently resides. He has pioneered research studies along with his academic training with an emphasis on somatic, humanistic, existential, and transpersonal perspectives. His doctoral research on links between developmental trauma, psychosis and other extreme states of mind, into the widely acclaimed book, Rethinking Madness: Towards a Paradigm Shift in Our Understanding and Treatment of Psychosis. In 2013 he moved to New Zealand where he worked as a clinical psychologist for 10 years before returning to the US. Throughout his professional career he has worked at a residential facility, a major medical hospital, a community mental health clinic, a treatment center for substance dependence, the New Zealand ACC System, and several private practice settings. He has facilitated dozens of workshops and trainings and has extensive experience providing supervision to health professionals. We talk about his extensive knowledge of the development and treatment of psychosis.
Dr Williams websites:
https://rethinkingmadness.com/
https://pariswilliamsphd.com/
03:20 What is psychosis?
04:52 What led Dr Williams to study psychotic states
11:12 Schizophrenia brain disease myth
15:37 Why misconceptions of schizophrenia still exist
21:36 Dopamine supersensitivity psychosis
25:16 Tapering and withdraw from psych meds
28:14 Importance of psychosocial support
34:04 Soteria House model history
40:42 Alternative understanding of psychosis as a process
47:10 Dr Williams's Duality Unity Integrative model
52:20 Why developmental trauma leads to psychosis
54:55 Reframing psychopathology/symptoms
Transcript
Introduction and Guest Background
00:00:00
Zach Handy
All right, welcome to the first official episode of the humanosity podcast. I have a very special guest, someone that is probably the perfect person to start this podcast off. that I'm very happy to have his name is Dr. Paris Williams. He's clinical psychologist, currently licensed in California, Utah and Colorado, where he resides. He has pioneered research studies along with his academic research emphasizing somatic, humanistic, existential, and transpersonal perspectives. His doctoral research on links between developmental trauma, psychosis, and other extreme states of mind was translated into the widely acclaimed book, Rethinking Madness Towards a Paradigm Shift in Our Understanding and Treatment of Psychosis, which I highly recommend.
00:00:48
Zach Handy
Checking out, in 2013, he moved to New Zealand, where he worked as a clinical psychologist for 10 years before returning to the U.S., Throughout his professional career, he has worked at a residential facility, a major medical hospital, a community mental health clinic, a treatment center for substance dependence, the New Zealand ACC system, and private practice settings.
00:00:59
Paris
Thank you.
00:01:10
Zach Handy
He has also facilitated dozens of workshops and trainings and has extensive experience in providing supervision to health professionals. He is a true expert in the field, especially understanding the development and treatment of psychosis, which I'll be talking to him about today.
Host's Perspective Shift on Schizophrenia
00:01:30
Zach Handy
Dr. Williams, welcome.
00:01:33
Paris
Yeah, thanks, Zach. Really nice to be here.
00:01:36
Zach Handy
um So starting off, I just kind of want to give you a background as to how I got introduced to your work. So I've been working at a behavioral health unit on a hospital for four years now.
00:01:50
Zach Handy
um And at the time, i really didn't have any interest or desire to work with people who were diagnosed with schizophrenia or going through episodes of psychosis. I never really thought much about it in grad school.
00:02:05
Zach Handy
And I sort of just had the basic idea that it was some sort of brain imbalance or abnormality and that the most effective treatment was medication. So I didn't think too much about it.
00:02:20
Zach Handy
And the year I started working at the hospital, I really started getting into Carl Jung, I started reading him for the first time.
00:02:28
Paris
It's interesting.
00:02:29
Zach Handy
And he was the first person i read that talked about the psyche having a telos, an aim, a purpose, a goal of adaptation and stabilization and development.
00:02:44
Zach Handy
Sort of like the body having its own wisdom, and knows how to develop and stabilize and That's sort of what you talk about with your concept of having an organismic wisdom or intelligence sort of guiding our beings.
00:03:01
Zach Handy
um And so at that same that same year, that's when I read your book and really shifted my perspective on things.
Defining and Understanding Psychosis
00:03:10
Zach Handy
So that's what I wanna talk to you about today.
00:03:13
Zach Handy
And just starting off, could you just define what psychosis is?
00:03:20
Paris
Yeah, great question and not a super easy question to answer, really. um ah different There's different definitions people use. And generally how I define it is it's a combination of someone having anomalous experiences or beliefs. And what I mean by anomalous is they're non-competitive.
00:03:40
Paris
the outside of what the particular community of that person would be deemed as um you know acceptable or truthful or valid. So those are anomalous experiences or beliefs.
00:03:53
Paris
And then in addition, they need to be distressing in the sense that they're undermining that person's needs in some way um and or have a kind of chaotic flavor to them and in which they might be shifting around. So obviously a person can have anomalous beliefs and not be in a psychotic process. Like for example, if one religious community would ah you know would seem to be psychotic to another religious community if you just simply used anonymous beliefs as the criteria, which often is used in our field, but that's why I add the additional criteria.
00:04:25
Paris
of having to be actually distressing, undermining needs in some way. And typically there's going to be a kind of chaotic flow to it. And, you know, it's not necessarily, and they're not necessarily going to have a sort of stable um flavor to
Personal Experience and Recovery Without Medication
00:04:40
Paris
the particular experiences or beliefs. So that's how I, I find is the most helpful definition for that term personally.
00:04:47
Zach Handy
Yeah, that was a very good good um definition. Can I ask, or can you talk about what led to your interest extreme states, episodes of psychosis, and where that led you career-wise and academically?
00:05:05
Paris
Yeah, um kind of interesting. Well, first of all, my mother would be, according to the kind of standards or DSM criteria, she would be deemed as having a psychotic disorder.
00:05:15
Zach Handy
Thank you.
00:05:18
Paris
However, she's had this very stable belief system throughout my whole life and doesn't seem to really undermine her needs. Like she's actually functions really well. She's never been hospitalized on meds or anything.
00:05:30
Paris
And so that was kind of a beginning of like, okay, something a little off here. Like she's actually doing pretty good. um But she, you know, she has some unusual beliefs. And then, um and then I ended up having a kind of breakdown in my late twenties where I went in, I definitely went into a kind of process where my whole construct of the world and self and other like broke down.
00:05:52
Paris
um So this was this was quite different than what I sort of experienced with my mother. this was i definitely went into a kind of chaotic process where my all my belief systems, my constructs about the world became quite chaotic. And... um And fortunately, I had a really strong mindfulness kind of meditation practice when that all happened. So I was able to have the wherewithal to kind of just turn into practicing that mindfulness practice. And I had the wherewithal to just spend a lot of time in an embodied way, like running and swimming and just really, you know connecting to nature. So I just really resourcing myself and not spending too much time in the kind of chaos that was going on in my mind.
00:06:29
Paris
So I was fortunate that I had the wherewithal to do that. And I also recognized that long i had quite a traumatic childhood, and here I am almost 30, this is happening. And I recognized, oh, this is so much material from my own childhood that was deeply repressed.
00:06:45
Paris
it's all just kind of like the damn burst basically it's all coming out it's kind of overwhelming me but if i go to a mental health professional there's a good chance i'll get diagnosed with a psychotic disorder because i was having some pretty bizarre beliefs and perceptions and things and i'll probably get put on some heavy drugs and you know given given a label and um it would actually kind of i was already living in a lot of fear and now telling somebody telling me that i had a broken brain would just probably be unbearable for me to hear that from a you know quote unquote professional.
00:07:17
Paris
So I managed to avoid the system. I sort of knew better and I avoided the system and i kind of put ah I was able to put on a ah good front to my friends and and others. So they didn't really, they kind of knew I was ah acting a little strange, but I managed to not really alarm anybody.
00:07:33
Paris
and So I had all that going for me, all those resources that are granted a little bit unusual. And I came out of the other side. It took me really a couple of years to kind of get through it. About six months was the worst of it. And then maybe two years to really feel like I was really through you know the tunnel.
00:07:49
Paris
um And I felt so much better than before I went in. Like I realized, wow, I actually had some really profound healing here that happened. And I could feel all that trauma from my childhood. It actually so much of it had resolved. Like it really felt integrated and worked through. And it all happened pretty spontaneously. Like I didn't i didn't see a therapist.
00:08:07
Paris
I did again, I did have a really strong mindfulness practice that definitely helped. And, and that and I was actually a hang gliding professional at the time. But anyway, that was a catalyst to make me think, gosh, this must be happening to so many other people, this kind of experience.
00:08:22
Paris
They go to the mental health, they go into the mental health field. They're given a diagnosis, put on the drugs, et cetera, totally have ah a brain disease. And then it actually becomes a kind of self-fulfilling prophecy. Like they actually end up becoming lifelong mental health patients, which I think I probably would have become.
00:08:37
Paris
And I just thought how tragic that is, that that happens to so many people. And so then I, that's when I made the shift into the field of psychology, psychology, And ultimately, my interest in extreme states and trauma and psychosis and kind of the relationship.
Holistic Approaches to Psychosis
00:08:52
Paris
And between those, as well as a kind of um had a strong kind of spiritual or transpersonal element to the way I was looking at these states as well, because I realized as I was going through them, my whole sense of self was kind of getting deconstructed and dissolving. And I was actually having some really kind of profound feelings.
00:09:09
Paris
unitive type experiences, like really experiencing you know the the deep interconnectedness and interdependence of the universe, of the world, of what I call myself. So that was all happening kind of spontaneously. And then as I started to study other people, I recognized the same links, the links to trauma, of the link especially childhood and early childhood trauma, the links often to profound spiritual type experiences.
00:09:33
Paris
even though there's often a lot of confusion you know between those different realms. So yeah, it's kind of a long answer, but...
00:09:41
Zach Handy
I didn't know, i didn't realize how personal and your personal experience with anomalous experiences was from a young age. So that that makes a lot of sense as to where it led you. And it's interesting to think about the different paths.
00:09:59
Zach Handy
And like you said, what could have happened if you did decide to seek help? And I think it's important for people who are going through similar experiences to hear hopefulness from a story like yours, because that's often not the case.
00:10:19
Paris
Yeah, and and i don't want I certainly don't imply not to seek help. I think I was quite fortunate, and I had so many good resources, and and I was a bit older when it kind of happened to me.
00:10:30
Paris
um But the challenge is to find the the right kind of help. you know, to find people who will be able to support you and kind of finding your own narrative, your own understanding of these experiences beyond the, you know, bioreductive medical model that you have a broken brain.
00:10:48
Paris
um And luckily there are actually a lot of clinics, therapists, et cetera, peer support networks. So like on my own website, rethinkingmadness.com, there's a whole resource page that lists lots of kind of therapist directories and things like that, um recovery centers that do come from a much more holistic perspective.
Debunking Myths About Schizophrenia
00:11:11
Zach Handy
So that that leads me into the first thing I wanted to talk to you about. which in your book you have you've laid out at the beginning for myths, when it comes to understanding, I guess what we could just say schizophrenia.
00:11:27
Zach Handy
And the first myth you lay out is that schizophrenia um is a brain disease. Could you talk about what the mainstream concept or understanding of schizophrenia is?
00:11:43
Paris
Yeah, so the term itself, actually a number of countries, including Japan, amongst many others, have actually eliminated that term altogether now because because there's so much false assumptions laden in that term. Like, for example, one of the assumptions that people have, one of the myths, is that you have a, this is a degenerative brain disease that you'll never recover from, and it will actually generally deteriorate, you know, your condition will generally deteriorate over the course of your life.
00:12:14
Paris
and that's been so debunked. Um, but you know, there's been so much research that shows many, many people actually do fully recover, um, from, you know, they go into, they satisfy all the criteria for that label schizophrenia.
00:12:30
Paris
And, uh, and then they get into the health system know, usually put on meds, et cetera. And then many of these people actually make full recoveries. Uh, and, um, In fact, in the in the most optimal circumstances, we found that the magic number seems to be about 85%. So like, for example, in the open dialogue approach in Finland, which is basically a kind of family therapy type model, systems theory model, they have consistently found about 85% full recovery rates. so they catch people with first episode psychosis.
00:13:05
Paris
And then they actually intervene with the whole family. They don't they start without any meds at all. They found that, um and there's been lots of other research as well, it shows that medication is a double-edged sword. It tends to make people feel better in the short term, but it actually can reduce the likelihood of recovery in the long term. So anyway, this particular model started with no meds or maybe used a little bit to kind of ease you know the suffering of the person, try to get them off as soon as possible. And they found that 85% would fully recover without you know any meds at all. Or if they were put on them, they were put on short term and then were able to come completely off. And then 15% couldn't, you know they couldn't quite get through it.
00:13:42
Paris
And then other types of research, like the World Health Organization um did a 25-year longitudinal study, 13 countries. And they found that the countries who ironically had the least access to Western psychiatric care and also um other There were the other factors too, that was a major factor. We're having kind of 75, 70-ish, up to 80% recovery rates spontaneously, full recovery, in the sense that they were no you know they were no longer having these distressing anomalous experiences, they were functioning fully. um so Because they basically this this was a 25-year longitudinal study where they went back and looked at the same people who were diagnosed over 25
00:14:23
Paris
so so we have this myth that no first of all nobody recovers and which is completely false um or even even if you're more optimistic the myth is maybe a few people recover but the reality is actually the majority of people would recover given the right kind of like fully recover without you know being able to get off all their meds with the right conditions and the right kind of support so that's that's a huge myth that most people still have and if it truly were if it truly were a degenerative brain disease, like something like, let's say Alzheimer's or Parkinson's or Huntington's or something which are very well-established diseases of the brain, um I have yet to see, i mean, correct me if I'm wrong, but I have yet to see any cases of full recovery from any of those conditions. So that, you know, they definitely satisfy the criteria of a degenerative brain disease, whereas what we call schizophrenia just simply doesn't, like, you know, with such a high degree of of recovery like that.
00:15:20
Zach Handy
I really love that you are hitting on points I had already written down to ask you about.
00:15:25
Paris
Okay. Okay.
00:15:26
Zach Handy
Yeah, so that's a great. um And I was going to ask you about the open dialogue approach and the IPSS study from the World Health Organization, which you already mentioned. I do have two follow up questions. So if so much of the research has debunked this myth that schizophrenia is a degenerative brain disease,
00:15:49
Zach Handy
Why do you think it is still widely assumed by clinicians in the field that that is the case or the general public?
00:15:58
Paris
Well, there's a few reasons. um One, there's what's called the clinician's illusion. So if you work if you work in a psychiatric hospital, say, and you know people come in with an acute psychosis and um you know and then they they get released once they're considered treated or you know essentially what we do is symptom management. So you can look at the drug use.
00:16:23
Paris
um And I don't wanna totally denigrate the use of drugs, by the way, because what they basically are is tranquilizers. So they reduce the intensity or the salience of of experience. but they kind of reduce it globally. So yes, your, your terror, your fear, your paranoia, all these things are are likely to get assuaged, you know, reduced by, by those medications for, for most people, but so is your joy and your love and your passion and your motivation and all these other things, which, you know, it's hard to live a good life without all of that's getting kind of turned down. Right.
00:16:53
Paris
um But okay. So they leave the hospital, you know, when they're considered quote unquote treated, Um, and then you're only going to see the ones that come back if you're a clinician, right? So
Medication: Short-term Relief vs Long-term Dependency
00:17:03
Paris
many of those people actually don't come back.
00:17:05
Paris
but So a lot of them actually, even, even with the, like I said, um, there's been plenty of research that the medications actually help in the short term for many people, but in the longterm, they actually, they make chronicity of the condition more likely.
00:17:19
Paris
um So in given, you know, our particular mainstream mental health system, just already putting them on the drugs, telling them they have a brain disease, which acts as a kind of nocebo effect, opposite of a placebo effect. Already we're kind of, we're hurting the conditions for recovery significantly right there, but still, even still many people still spontaneously recover and and and they don't come back to the hospital. So as a clinician, you don't see them again. So you don't see the people who recover.
00:17:47
Paris
So that's one reason. So there is a genuine kind of illusion that happens. And then the other reason is there's such a profitable, this is such a profitable industry. So there's basically a kind of psychiatric pharmaceutical complex, you know, the two working together that where the field of psychiatry rules the roost when it comes to mental health, but actually... you know, if you look at the study of psychiatry, like if you become a psychiatrist, you're just basically a medical doctor with some extra training. And and often and often the the training is really coming from this reductive medical model approach to labeling subjective experiences with, you know, different, what we call DSM labels, you know, mental health conditions, et cetera.
00:18:26
Paris
But very few of them actually learn to do any kind of psychosocial interventions themselves, like pretty much just drug prescribers for the most part. and ah And so the combination of the kind of psychiatric field and the pharmaceutical field, they're they're like they rule the roost of the whole mental health field, and which is a multi-billion dollar, multi-hundreds of billions of dollar profitable field.
00:18:35
Zach Handy
Thank you.
00:18:49
Paris
and um And there's so much incentive to maintain that status quo. And schizophrenia is almost like that's sort of the the golden egg in a way. It's like if you target if you if you attack the whole construct of schizophrenia, a way, like the whole edifice of that that medical model system will kind of crumble.
00:19:08
Paris
um yeah Because it's it's sort of, yeah. um So it's quite, I mean, I've faced this directly myself, just in my own work. I'm definitely upset some people with my work and my you know approach to this and hi those in the kind of high echelons of the field.
00:19:22
Paris
So I'd say those are probably the major reasons why we're sort of still stuck in that myth. um And of course, there's other factors for sure. I mean, like another factor is the reality of um why do people go into psychosis in the first place? And that's typically, lots of lots of research about it, typically associated with developmental trauma, childhood trauma, and where the world is kind of steadily entering into increasing social inequalities and you know lots of factors that ultimately you know increased um other factors like domestic violence, child abuse, sexual abuse, all this kind of stuff. So there's generally been a kind of increase in most of those things, which then
00:20:05
Paris
can create an increase in people going into psychosis. And then once they're on the psychiatric sort of treadmill, you know, they get the label and the meds and everything. Right. So that that reinforces the, the whole story. And once you are on the meds, like I say, it does make chronicity much more likely, which again, reinforces that belief that people don't recover.
00:20:27
Paris
So
00:20:29
Zach Handy
And you you brought up a really important point with the clinician illusion. um Working in a hospital, you know, you see a lot of people come in in very acute distress and very extreme states.
00:20:45
Zach Handy
And in a few days, sometimes they're in a much more stable state of mind and they clear up, they're discharged.
00:20:55
Paris
Thank you.
00:20:57
Zach Handy
and then may see them again in a couple months. And the initial like approach to them is, well, you stopped taking your meds, didn't you? And they're like, yeah, I haven't been on for a couple weeks or months. And then then it's, well, that's what's going on. That's why you're in this state.
00:21:17
Zach Handy
And one of my pet peeves a a lot is you hear patients being told, well, you know, you need to be on these medications because it's like a diabetic taking insulin.
00:21:32
Zach Handy
um And so my other question is on the, the theory of dopamine super sensitivity, where you start on the antipsychotic and then over time it leads to an increase in dopamine receptors.
00:21:52
Zach Handy
And when you stop, it prones you to experience psychosis again. Could you talk a little bit about that?
00:21:57
Paris
Yeah, so super sensitivity psychosis is sometimes called all psychoactive drugs basically work like this where your brain treats it as a toxin. You know, the the drug is by definition, a psychoactive drug passes through the blood brain barrier.
00:22:12
Paris
your brain is like, oh, this is basically a toxin. We have to counter the effect of this drug. And so you look at an antipsychotic, what does it do? It blocks dopamine, certain you know certain parts, certain regions of the brain.
00:22:24
Paris
And so the brain tries to counter that by like, oh, we we're not getting enough dopamine. So counters that by creating more more dopamine, essentially, more dopamine transmitters, receptors, et cetera. And so then you actually now you have a brain. So even though the evidence isn't clear at all that there was anything particularly wrong with the brain when the person started, you know, and they had the psychosis. Now they do have anomalous brain structure, like they actually have a brain which has become super sensitized to psychosis because it excessive dopamine being manufactured. And as soon as you remove the dopamine blocking drugs, now you have this excess of dopamine, which which definitely um can be a factor. And i mean, look at methamphetamines, right? Methamphetamines essentially really amplifies dopamine effects in the brain. and it's a real so leading cause of a psychotic break, right? When someone's taking methamphetamines, for example. So it's well established when there's excessive dopamine that really primes a person to have, you know, it's the opposite of the tranquilizing effect of the drug. Now everything feels acutely intense.
00:23:31
Paris
So with excessive dopamine, your whole experience, your emotions, the world, everything is super heightened now. You may or may not go into a psychosis from that, but you're certainly going to be sensitized to, and especially if you've already had, you know, a psychosis in the past. So clearly you've got a kind of vulnerability to that.
00:23:49
Zach Handy
So it's probably the the case quite a bit that people come in because they've used something like methamphetamine, which we see a lot in the hospital, and then they're in these very extreme states, and then they're given a dopamine blocker, which in the long run, prone to them experience these states again.
00:24:11
Paris
That's right. and And again, I want to be really kind of clear. i'm not I'm not like denigrating these drugs. Like I think they definitely have a place for people, especially for short-term use. It's just, you're kind of making a Faustian bargain for long-term use. For short-term use, if someone's in a really extreme heightened state and they're terrified and paranoid and whatever, yeah these drugs can really like help so much help settle them down, help them sleep. Often just anything to get them to sleep is a huge factor, right? And being able to come out of that extreme state.
00:24:41
Zach Handy
Yeah.
00:24:41
Paris
um And typically, you know, a few weeks or whatever on on on these kinds of drugs, your brain doesn't really have a chance to adjust to them yet. But once you get to a few months, now your brain is definitely starting to adapt by, in this case, becoming more sensitized to dopamine.
00:24:57
Paris
um or I should say, yeah, sensitized to psychosis by the excessive production of of dopamine. And so that's the fallacy and bargain now. And that actually keeps a person trapped on the drug. that It creates a dependency on the drug because now if you try to come off,
00:25:12
Paris
you've got that super sensitivity psychosis, like, you know, vulnerability. um So generally, it's a really important rule of thumb for people once they've been on any kind of psychoactive drug continuously for six months or longer, or really, I'd say three months or longer, really to be safe.
00:25:28
Paris
then the most likely they need to come off very slowly. And that's another problem in the field is either it's it's kind of twofold. Either doctors keep people on the drugs forever, right? And there's so many problems with that, so many adverse effects and everything else, or they take them off way too quickly.
00:25:46
Paris
And so coming off way too quickly off any drug, even antidepressants or anxiolytic, et cetera, coming off too quickly is a real problem. Like now you you're really shocking. your whole Your nervous system is adapted to the drug and you suddenly pull that drug away.
00:25:58
Paris
You're gonna have like a real anomalous state of neurotransmission within your brain. And that's gonna send you into some pretty probably wild directions. um So it's really important that people know.
00:26:10
Paris
and doctors are typically not trained in tapering very effectively at all. They're trained to get people on the drugs, not training them off. And most of the research we have on how for people have people can taper successfully actually comes from the kind of the peer support world.
00:26:25
Paris
Because again, if you kind of come back to, unfortunately, the dark side of capitalism here, there's a lot of profit to be made putting people on the drugs and there's not much profit to be made getting them off.
00:26:36
Paris
So there's so little research on helping people come off. um So that is just super important for people to know that when, you know, coming off slowly so that your brain can readapt to not having the drug at, you know, at the neurological pace, takes a while, typically, you know, six months or a year, kind of at least once you've been on for a significant period of time.
00:26:55
Paris
um So that can happen.
Importance of Tapering and Psychosocial Support
00:26:57
Paris
Oh, I was going to say the other, the other field of research that we have that related to this is in methadone usage. So So in methadone clinics, there actually is a um kind of incentive to get people, maybe not a profit incentive, but you know part of the treatment plan is typically to get people transition to methadone from like an opiate, say, dependency, and then from the methadone to slowly taper off.
00:27:22
Paris
And so there actually is research in that field that demonstrates that, yeah, it takes people usually at least six months, if not significantly longer, to be able to taper off in a relatively safe way.
00:27:32
Paris
And so that, that seems to translate to to other psychiatric psychiatric and psychoactive substances as well. That kind of timeframe.
00:27:43
Zach Handy
And I totally agree with you that in acute periods, I think that the antipsychotics are a very important tool in the tool belt for a lot of people.
00:27:56
Zach Handy
a lot of people experience a lot of relief in that short amount of time.
00:28:00
Paris
Yeah.
00:28:03
Zach Handy
But I don't think there's enough communication with how the patient should approach their long-term treatment.
00:28:17
Paris
Right. And yeah, well, then you kind of get into the territory more psychosocial support, which again, typically psychiatrists aren't really, for the most part, they're not really trained much in that. You know, that's, and so what led them to the psychosis in the first place, if you're coming from the belief that it's some kind of random, randomly established brain disease,
00:28:38
Paris
then why would psychosocial important be important ah support be important, right? We just have to treat the brain disease. And so that that is how most psychiatrists generally see it.
00:28:49
Paris
um So it's it's a totally different paradigm. um You know, and and's so but my book goes into so much detail, and there's a lot more that's come out since it's reinforced that about the psychosocial underpinnings, right? The trauma, particularly trauma, especially childhood trauma.
00:29:04
Paris
are so highly correlated and actually they're dose dependent, which means it's not just correlated, but causally linked to psychotic disorders. So like the research is so abundant.
00:29:16
Paris
And when you come from that perspective, you're like, okay, what was the factors that led this person to have this psychotic breakdown in the first place? And how do we address those factors in their life rather than just throwing them back into the fire, right? They get the treatment in the hospital and then we just kind of throw them right back into the same conditions that kind of led them there in the first place.
00:29:33
Paris
of course, how are they going to recover like that, right? Rather than thinking, okay, what what what led this person, what are the stressors in their life? How do we support them in sort of resolving and working through those stressors and getting that genuine kind of support they need? Maybe they have significant unresolved trauma from the past still that's acting as a catalyst. You know, some good trauma-informed therapy can go go a really long way for supporting them and not to mention social work, like maybe this person is really struggling with um homelessness or paying their bills, or, you know, they've got substance dependency issues, or they've got they're in a violent relationship or part of town or you know, so many factors like that, that just don't get addressed, which would make a huge difference for recovery.
00:30:19
Zach Handy
which I think is a good transition into another myth that you point out in your book is that people don't recover.
00:30:28
Paris
Yeah.
00:30:28
Zach Handy
And you mentioned the high correlation and causation factor of early trauma and abuse and neglect.
00:30:39
Zach Handy
um
00:30:43
Zach Handy
How do you personally as a clinician go about working with someone
00:30:46
Paris
No.
00:30:50
Paris
Yeah, so, well, generally speaking, when, um if someone's in an acute state of psychosis, like they've kind of got, now you're the ambulance at the bottom of the cliff instead of the fence at the top, it generally takes, ah it kind of takes a village.
00:31:05
Paris
Like, you know, you don't want to be a lone sort of therapist, really, trying to support someone through this, you know, kind of active psychosis. And this is where we have a, it's just a real problem that we just don't have a lot of really good support other outside of the kind of reductionistic, you know, psychiatric system for that.
00:31:20
Zach Handy
Thank you.
00:31:22
Paris
um Where what my work has shifted more to trying to be the fence at the top of the cliff now, instead of the ambulance at the bottom, I was doing ambulance at the bottom of the work for quite a while. But um as I shifted more into kind of a private practice work, it just wasn't really feasible. Like, you know, you you really need a kind of team to hold someone who's in that kind of space.
00:31:39
Paris
and also hold their family too like what you know again we're talking about why do why do they have this break what's the what's going on in their life what's going on in their family system all that stuff really needs to be held properly um and uh i mean there are there are some options out like there are residential facilities such as soteria homes um places similar to that there's there's another again on my website there's some links to different places like that um but generally peer support or groups like that is going to be, they're going to be the most helpful.
00:32:12
Zach Handy
you
00:32:14
Paris
And again, it's just a real, like, it's a real miss in our field. It's a real problem that we just don't have enough of that kind of support. So often the only support people have is to go to the hospital. And again, there can be a place for, okay they get put on the meds, they get some sleep, they settle down, they stabilize, but then recognizing that that's not the end of the road at all. That's actually just like, now they really need to get some support around how to all the social work stuff, all the psychotherapy stuff, you know, that really needs to kind of come in more prominently.
00:32:44
Paris
And that's kind of where I tend to do my work now is working with people who are in a more stabilized state, rather than people who are active, just because working by myself. And and where my work is is gone, particularly as trauma work and developmental, so really supporting people and resolving
00:32:53
Zach Handy
Yeah.
00:33:00
Paris
unresolved trauma, which can act like, like real catalysts. if someone's had significant developmental trauma, childhood trauma that they haven't resolved, that can get kind of pushed away or buried and they kind of go through life and things seem okay. But then a sort of, you know, a trigger happens or they, you know, significant stressors happen in their life and all that stuff suddenly comes out exactly like what happened to me, right? In my story. Yeah.
00:33:23
Paris
and then they get overwhelmed and then they don't know what to do and so what i've been trying to do is like i've been i do lots of trainings and i teach others how to work with trauma in different ways and there's typically signs that that's starting to happen sometimes it can just be a sudden break but oftentimes it's like the person's getting more and more stressed and then you know and then the break happens and So if they can actually get help before they get to that, you know, before they fall off the cliff, a good therapist, especially a trauma-informed therapist, can can make a huge difference for them. And and um I end up doing a lot of work with like social workers. I'll kind of work hand in hand with them to make sure that, you know, I'll be doing more of the psychotherapy work and then, you know have the social worker work on what's going on more in their environment and try to support them that way.
00:34:06
Zach Handy
So you mentioned Soteria houses. So the Soteria project started by Dr. Lauren Mosher.
00:34:14
Paris
Yes. Yeah.
00:34:15
Zach Handy
Could you talk about how those are structured? Because they do treat people in acute phases, right?
00:34:23
Paris
Yes. So
00:34:24
Zach Handy
So how, okay.
00:34:27
Paris
Yeah, well, there's first I'll go to the history of kind of, um there was a, would have been back in the 80s, there was quite a few, particularly in the San Francisco area in the US, but elsewhere, there was like Soteria, Diabasis, which had more of a Jungian kind of approach. There was Iward, and others too, that I'm kind of blanking on at the moment.
00:34:49
Paris
And the idea there was they, I'm not quite sure what the catalyst, why like they suddenly popped up at that particular time. I know the World Health Organization studies were already starting to come out, so that might have been a factor. But anyway, there was a recognition that the majority of people have held right in first episode psychosis can can fully recover.
00:35:08
Paris
So there is a real belief and and even you know evidence for that. And so, and there's also ah um evidence. So back then there was actually a lot of research and I have this in my book, doing long-term studies on people on and off antipsychotics. So someone has a first episode psychosis.
00:35:27
Paris
There was actually trial, you know, randomized controlled trials. Some people were put on the antipsychotics, other were put on anything. They're, you know, given other psychosocial support. Et cetera. And um and they found that in the short term, those on the antipsychotics did better, you know, within a year. But after a year, those who didn't get put on the antipsychotics were actually doing better.
00:35:46
Paris
And actually so and that happened again and again. in the psychiatric or I should say the pharmaceutical industry stopped doing those studies because it wasn't making the drugs look good. And so to this day, you will not find long-term studies like that anymore. Like I've looked and looked, because it makes almost all drugs, antidepressants, anxiolytics, et cetera, stimulants, it's just, it's the same story, short-term harm, short-term benefit, long-term harm.
00:36:12
Paris
So anyway, back to the eighties, they had this kind of information like, Hey, the drugs seem to be hurting a lot of people in the longterm. A lot of people recover spontaneously. Let's set up these residential kind of quote unquote blowout houses, they called them.
00:36:25
Paris
and really hold them in a container that's really safe. So we're not gonna let anyone hurt each other or themselves, um but we're gonna give them maximal freedom within that safety. um And and we don't they didn't even hire like really highly specialized therapists. was really just the the criteria was um as far as the people holding the container or that they were empathetic. So they had you know strong skills in empathy.
00:36:48
Paris
They were naturally compassionate and kind. and And then they created opportunities for them to do things like expressive arts. They varied a little bit. from each other, but generally the same, an opportunity to basically work with their experiences rather than try to stop them. So someone's going into these extreme states and they might have extreme emotions, There'd be like a rage room where they could just go like beat on some pillows for a while. Or maybe they were feeling some real creativity coming up. They could go into an art room and they could really, you know, or music, play with music or art to kind of let this creativity move through them and and get integrated. And they had people who would listen to them and just empathize and really hear their story and help them to create a coherent narrative.
00:37:25
Paris
And in general, they were having really great results. And this is all empirically, you know plenty of empirical data around this. And again, that magic 85% number was coming out again. About 85% of the people were fully recovering within like six, eight weeks on average.
00:37:40
Paris
And this became a huge threat for the status quo. And so the first Soteria house ended up, I guess there's a few, getting shut down without any clear reason by the state. They were having great results.
00:37:54
Paris
And as far as I could tell, there was a lot of political lobbying against it, essentially, and to shut them down because it was really threatening the whole status quo. And then... Same with the other homes.
00:38:05
Paris
They basically all got suppressed, shut down as well. And now they're starting to make a comeback, but it's hard because it's really hard to actually find first episode people in first episode psychosis because that's where they have the best rates of recovery if you can actually catch them right off the bat.
00:38:21
Paris
Once they get institutionalized and they spend time in the psychiatric system and on drugs, it actually makes recovery a lot more complicated. Yeah. So like, let's say you have someone who's been in institutionalized for a couple of years now, they've been on psychotics a few years, and they've already been like, inculcated in the belief that they they have a broken brain and all of this. And then you send them to a soteria house, it's actually going to be a lot harder for that house to be effective compared to if you can catch them like right off the bat.
00:38:47
Paris
So that's kind of what those home there's, you know, they're still trying, they're still out there, there's a few out there, and they're still working on but they're struggling with how do they get permission to bring people in right off the bat. And there's a lot of legal problems, you know, getting permission to do that kind of thing.
00:39:03
Zach Handy
So at the Soteria homes, are they given the choice, like if they want to take meds or not, are they ever forced upon them?
00:39:13
Paris
Well, again, it's changed a lot now. And I don't want to, and I know there's different opinions, but generally speaking, the philosophy has been, and I can't speak for any particular home now, philosophy has been to encourage the people to try no meds first.
00:39:29
Paris
And i I mean, typically, mean, part of the philosophy is empowering people. Like if they're just like, I just can't sleep. I really need some meds. And yeah, of course, you know, it's helped them. Oftentimes there'd be like a, um,
00:39:42
Paris
hierarchy like start with lighter meds first like give them some benzodiazepines first just to get them to sleep and then you know then pull those away and then okay let's try antipsychotic so there'd be a much more judicious use of meds if so starting with no meds at all and then okay benzos and maybe anis like so there'd be a kind of um much more judicious use of them and then an attempt to try to get them back off the meds as soon as possible if things are stabilizing So that the meds were, it was a totally different paradigm or it is a totally different paradigm. It's not, oh, you've got this problem. It's not like insulin for diabetes at all. It's like, no, you actually need a little help just kind of settling down and getting some sleep. So then we can let your own psyche do what it needs to do with support to actually recover, to go through its own kind of breakdown process and the service of ultimately breaking through, you know, to a healthy place on the other side.
00:40:35
Paris
So that's the philosophy. Now any particular home, I'm not sure exactly how they're going hold that, but that's that's generally still with the philosophy they're working with.
00:40:45
Zach Handy
And as you point out, I think one of the biggest differences between that philosophy and say the institutional hospital route or paradigm of treating psychosis is the respect of autonomy and seeing the psychotic episode as a process the person is going through, not specifically an illness that needs um medical intervention.
Psychosis as a Renewal Process
00:41:13
Paris
That's right. And that's, and that's a really big part of kind of my book. We hadn't really talked a whole lot about yet, but um essentially, do you want me to say a little bit about that? Just kind of ah that paradigm about the the organic process?
00:41:25
Zach Handy
Yeah, I mean, yeah, I was actually wanting to transition into an alternative understanding of what's happening in psychosis.
00:41:25
Paris
Yeah.
00:41:30
Paris
Yeah.
00:41:32
Zach Handy
So I think that'd be a good stepping stone or bring board into.
00:41:34
Paris
Okay. Yeah, yeah. in And all'll yeah I'll try to put it into a nutshell. So yeah if you if you consider it from infancy onwards, or you could even say really in utero onwards, and we start developing a kind of worldview, right? This is the way I, yeah beliefs about self, others, and world. We develop a kind of personal paradigm about the nature, cetera, of the world.
00:41:56
Paris
And if we're in a hostile or abusive or chaotic kind of environment, you know what we call developmental trauma, It's not always, again, it's not always necessarily in the family. Maybe I'm in a war-torn area, or maybe I'm experiencing a lot of discrimination, or you know there could be lots of factors there. But anyway, if if i'm I'm essentially in a relatively hostile environment, and I don't really get to experience much peace, and my my beliefs about self-othering world you know reflect that and and actually become really problem and problematic in many ways,
00:42:26
Paris
There's a good chance um as I kind of move and I get more and more developed that, you know, my whole experience of self and world will reach a point where it's just no longer tenable, it's no longer sustainable. Like it's just, there's so much distress and suffering and kind of chaos and pain and confusion. in my whole worldview, um this this is you know this is theory, so take it what you want, but it but it seems to fit you know really well what i and a lot of other people have seen. There's a kind of ah spontaneous process seems to be directly initiated by our own psyche.
00:42:59
Paris
Like this is no longer working, right? We need to like we need to break this down, ah kind of the fundamental layers of our whole cognitive cognition and cognitive constructs.
00:43:09
Paris
in the attempt to come up with something more wholesome, more adaptive, more present-centered, right? And so rather than just, oh, we're just gonna kind of edit these beliefs, it's like, because the kind of most limiting beliefs are right at the very short bottom, you might think of a skyscraper with a rotten couple, first floors are really rotten, right? Like, what do you do? Like, how do you how do you replace those? um And so in many ways, the skyscraper kind of comes crumbling down, you know, in service of a new building kind of getting erected. But that process of that crumbling down is the psychotic break, right? Like our our whole constructs of self-weathering world um end up becoming very flexible, very chaotic. They often can be very chaotic.
00:43:54
Paris
um But ultimately, it's in service of being able to build something more robust, more present-centered, more adaptive. And if all goes well, that's what we see. And my own research kind of panned this out, that people who actually are allowed and supported and whatever the factors that supported them to get through to the other side end up coming out in a much healthier place than what they went in. So if you look at, if you measure their state of kind of mind prior to the psychosis and then after the recovery, they're often better on almost every metric. You know, their sense of joy and peace and love and just general functioning is generally better. So it's not that they just recovered, they actually like went through a kind of profound healing process.
00:44:35
Paris
um and And I found that again and again, you know, in my own research, and I told you my own story, and I have so many other people with very similar stories. So it's not about romantic romanticizing psychosis at all, because people can get they can end up stuck in a really terrible and kind of nightmare indefinitely, right? I mean, it's a real risk, it's not something you would want to like wish on somebody.
00:44:55
Paris
But ultimately, when it does move through, that's what you often see. and And you can see that. So with psychedelic-assisted therapies now that are kind of coming more and more prominent, I see that as basically the same thing, right? So when you take a psychedelic, what's happening in a way, you're kind of like loosing all the constructs of self, other, and world, at least for those few hours that you know the drug is taking effect. and it creates an opportunity for maybe something more wholesome to emerge or not i mean it depends on how that psychedelic trip is is held because it could make things worse for the person right but um just like with psychosis except it's you don't need the drug you don't need the psychedelic it happens spontaneously and it tends to take a lot longer and it tends to be a lot deeper um so that's kind of in a nutshell of how an alternative way of seeing this a desperate attendant of a of a
00:45:45
Paris
suffering psyche to try to, you know, come into it move into a more wholesome place. Yeah.
00:45:51
Zach Handy
And like you said, it it is it's not something you would wish upon anyone or romanticize, but it does seem to be initiated by the psyche for a reason.
00:46:02
Zach Handy
And once that has started, um the best approach from what you're saying is to support the person through that process, which is what someone like, we haven't talked about them yet, but you did mention diabetes, which John, where Perry started, who was a student of Jung's um
00:46:17
Paris
Yeah.
00:46:21
Zach Handy
And he saw psychosis um similar as to what you are saying as a renewal process where and there is a self image or world image that is no longer tenable.
00:46:28
Paris
That's right.
00:46:34
Zach Handy
um The person can't tolerate anymore. And so the psyche initiates psychosis to to try to bring about a renewal of the personality.
00:46:48
Zach Handy
So we haven't got talk much about your your specific paradigm, which I know you have your own model in your book. You talk about the DUI model, the duality unity integrative model.
00:47:02
Zach Handy
um Could you talk a little bit about that? I know you've already mentioned some things that feed into that with your explanation of psychosis.
00:47:06
Paris
Yeah.
00:47:11
Zach Handy
Yeah.
00:47:12
Paris
Yeah, first of all very compatible with John Muir Perry's work is a great book called Trials of the Visionary Mind. by John Weir Perry, um which I highly recommend. A short read, but really, really deep and really drawing from the indigenous, kind of indigenous not only Jungian, but also indigenous perspectives, which you know most of us are aware of the term kind of shaman or shamanic crisis or shamanic illness, which is basically the same thing we're talking about. so What this whole process we're talking about, as far as we can tell, like it seems to exist have existed and still exists within all human communities going right back to, you know, hunter and gatherer times and this kind of thing.
00:47:50
Paris
The difference is that um indigenous societies treat it as as that, as this is actually a a spiritual crisis. if the person's supported, they can go on to become a great medicine person, right? They can actually help heal other people. and And the evidence is actually, that's what the World Health Organization kind of revealed is that actually those kinds of more collectivistic societies, actually, that kind of was true. They held it in a more spiritual, hopeful light, and most people were fully recovered and actually became really, really beneficial to their community. So yeah, i just want to put in a plug for John Ware Perry's work there.
00:48:23
Paris
Mine is very closely connected to that. And I definitely was inspired by his work. um So the duality unity integrative model I talk about essentially weaves together Western and an Eastern perspective, or wouldn't say Eastern because the indigenous is included as well, but the unity.
00:48:41
Paris
kind of aspect of it is the fact that all all um life the entire world the universe if you will is profoundly interconnected interdependent and the experience of self while we you know here's here's me separate from you it seems that's actually an illusion ultimately we're all just different waves on the same sea of the cosmos basically right so and even quantum physics know talks about that And and on at the very deepest level of our experience, we kind of sense that. We sense this really fundamental groundlessness.
00:49:14
Paris
And the sense of like, and our own ego can experience that as a real threat. Like, hey, the sense of a solid self and a solid, secure world is actually not true. And that's actually, it could be either deeply liberating, like really, it could lead to euphoria. Like, oh, wow, you know, that sense of oneness with the world can feel very euphoric on one hand.
00:49:34
Paris
and or extremely terrifying, right? Like the, you know, this existential annihilation, self annihilation. And that's the domain that that people often fall into when they go into a kind of psychosis. They often will tap into that real deep existential layer and they can often, they often swing between euphoria and terror or, you know, go both ways for sure.
00:49:55
Paris
um And so in a way it's actually a fundamental truth.
00:49:57
Zach Handy
Mm-hmm.
00:49:57
Paris
Like they're actually tapping into something that's really true that most of us don't really experience unless we have some really unusual extreme state, you know, facilitated by maybe a psychedelic or something else.
00:50:08
Paris
Um, So that's the u unity piece of the model. So that we could call that an existential dilemma that we all have to struggle with to some degree, even though most of us don't consciously struggle with it, but it's sort of there, you know, that in in our conscience somewhere.
00:50:24
Zach Handy
Can I intervene for a second, just ask a question?
00:50:26
Paris
Yeah, sure.
00:50:26
Zach Handy
So would you say that sort of the role of the psyche is to bring about an experience of the self to keep us from being overwhelmed by that unity?
00:50:36
Zach Handy
Our
00:50:39
Paris
Yeah, would, that's, I would, yeah, wouldn't argue with that framing.
00:50:41
Zach Handy
part.
00:50:42
Paris
I know, I think I was just had to think about it from it. It's, I would almost kind of say that it's a role of the ego in a way. I mean, which is kind of a part of the psyche.
00:50:47
Zach Handy
Yeah.
00:50:50
Paris
Um, you know, the ego is self, I, and in order to function, so the, here's the duality piece, right. In order. So on one hand you can say, yes, it's true. We're all just different waves on the cosmic sea, right.
00:51:01
Paris
You know, like that is a fundamental truth. Um, and when you really tap into it, it's freaking intense, you know, um, And it's also a truth, even though it's not a fundamental, it's more like an illusion, you might say, but it's a really important illusion that in order for this organism here, myself, Paris, right, in order for me to function and meet my needs as an a living organism in this world, I have to have a kind of boundary between self and other, I have to have the experience of a boundary between self and other, even if it's partly illusory. And and so we often call that the ego whatever. And that's that's kind of the dualistic aspect.
00:51:37
Paris
And so there's a dilemma there in the sense that on one hand, yes, so i have this i have to have an experience of me with my needs and I have to like function in this world and try to meet my needs and all of that.
00:51:48
Paris
And also i need, i have as a social being, I have needs for relationship. I have a relationship with other people and and other beings and things like that. So we kind of have this dialectic, um on one hand, we have this need for autonomy, for a sense of secure self and
00:51:58
Zach Handy
Thank
00:52:05
Paris
and empowerment, etc. And on the other hand, i have a need for connection with others. So this kind of like I call that the dualistic or duality sort of dialectic, because dialectic meaning it's both and like, it's not one or the other, like both sets of needs are really important.
00:52:19
Paris
And so this is the other, you might say if the if the basement level of my paradigm is the existential dialectic, you know, this sort of dilemma of like, wow, how do i find security in a world that's fundamentally so insecure, you know, there fundamentally is no self, you could say that's the basement level of my paradigm.
00:52:37
Paris
The first floor is going to be the dilemma of this kind of relational dialectic, like, how do i on one hand, feel empowered and have a sense of autonomy?
00:52:44
Zach Handy
Thank you.
00:52:47
Paris
And on the other hand, you know, feel connected, a sense of belonging and acceptance by others. And so that's more of the that's when we get into things like attachment theory, we're in that level. um And so these are like the two base levels of my whole paradigm. And typically everything else gets built on top of that.
00:53:05
Paris
And so that's why developmental trauma is so important because if those two foundations don't get built well, I don't get the sense of a relatively secure self and a relatively secure world. I don't feel like my autonomy and my authenticity is actually loved and accepted by important people in my life. If I don't get those needs met in my early years,
00:53:23
Paris
That creates a real vulnerability. My skyscraper that gets built on top of that is built on two rotten floors, you might say. and And it makes it very likely or or possible that my whole skyscraper, my whole paradigm could collapse.
00:53:36
Paris
And so that's where the you might say the predisposition or the vulnerability to psychosis why it's so correlated with early developmental trauma, because of those two floor layers.
00:53:44
Zach Handy
Thank you.
00:53:46
Paris
And when it collapses, and a person kind of falls right into those two base layers, like they're, they're like, drowning in those, you know, that whole sense of Oh, my God, myself is dissolving. My whole experience of the world feels so insecure.
00:53:59
Paris
and I end up ah often grasping to try to find some sense of security in the world, I grasp for some kind of belief system that feels like I can hang on to.
00:54:11
Paris
And so that's why when people fall into these states, there's often this grasping from one intense belief structure to another belief structure, right? They can just seem so crazy to the rest of us, but they're like drowning, trying to hang on to something that feels secure.
00:54:23
Paris
All right. And there's also often that flip-flop between extreme
00:54:24
Zach Handy
Thank you.
00:54:28
Paris
ah but kind of between these extremes of an extreme reified sense of self, which often a person can experience is very depressing and isolating. um And at extreme the other extreme, which is like extreme unitive type experiences, which often will show up as more like manic, you know, like where the sense of self feels either very grandiose or or even just kind of dissipated altogether.
00:54:52
Paris
so this is where, you know, like terms like bipolar disorder and schizoaffective disorder and schizophrenia are really all just pointing to the same process. um But they're pointing to like, how is it actually manifesting for this person? If there's a lot of swings between those experiences, and we often give them a bipolar label, if it's more cognitive, and they're having a lot of kind of real kind of wild belief systems, and and perceptions, you know, hearing,
00:55:16
Paris
you auditory perceptions and this kind of thing, then we tend to call more schizophrenia or schizoaffective would be somewhere in the middle. that's kind of my best crack at putting that into a nutshell into my, yeah, the D, the duality unity kind of integrative model.
00:55:31
Zach Handy
You tied that together very nicely.
00:55:33
Paris
Thank you.
00:55:34
Zach Handy
So, so what you're saying is there's this sort of dialectic, that's the foundation of a stable sense of self in the world. know, on one hand, then you talk about this in your book and you point to earlier psychologists like Otto Rank and, um,
00:55:46
Paris
so
00:55:51
Zach Handy
: Rollo may who also kind of had similar dialectics between our need to be an empowered individual individual have autonomy. : And then, on that side of the spectrum there's a if you go too far outside your window of tolerance there's a lot of existential anxiety around you know being alone isolated feeling disempowered maybe.
00:56:13
Zach Handy
And then on the other side of the spectrum, there's the desire, the need to belong, to merge, to connect with a group or others or the world. And on that side of the spectrum, there's the existential anxiety of losing your identity of engulfment.
00:56:30
Zach Handy
And that a lot of what we call psychopathology can be reframed and looked at through this lens of, um,
00:56:30
Paris
Yeah.
00:56:39
Zach Handy
which side of the spectrum are they having trouble with or not being able to reconcile both of those needs. Is that right?
00:56:49
Paris
Yeah, that's right. like ah and And we can frame that in attachment theory as well. you know So in attachment theory, we the idea is how do we relate to other people? Where's our comfort zones?
00:57:00
Paris
So someone might be considered sort you know in a more avoidant and secure place if they're more comfortable with the autonomy end of that spectrum and and less comfortable with connection. you know with Too much intimacy will quickly feel overwhelming, like I'm losing myself. So that person is more, you know we often call them avoidant and secure attachment.
00:57:18
Paris
Or the other extreme where they're not very comfortable alone, they're much more comfortable in relationship and they can get kind of clingy and terrified of, they're particularly terrified of getting isolated, right, of getting abandoned in isolation.
00:57:30
Paris
um So we often call that anxious or ambivalent insecure attachment. And then there's disorganized, which is really kind of flip-flop between the two, which is typically indicative of more severe trauma.
00:57:41
Paris
um So yeah, that's just that kind of using contemporary language for all that really wonderful work that people like Otto Rank and Rolla May and these others have done.
00:57:46
Zach Handy
Okay.
00:57:49
Paris
Attachment theory provides a really nice framework for exactly exactly that continuum between autonomy and connection and how we can kind of get fixated on one side or the other or more terrified of one side or the other.
00:58:01
Paris
And then the people who are more likely to end up in a going into a more psychotic process place or where both sides are are actually really scary for that person. Like they feel like they're damned if they do damned if they don't, it's like, you know, too much autonomy. And then I get overwhelmed with isolation, anxiety, too much intimacy. I'm overwhelmed with engulfment and anxiety. I'm losing myself. And they kind of get squeezed in this impossible pickle where they can no longer find security anywhere.
00:58:29
Paris
um And so that can, that goes with the kind of disorganized attachment style if you want to use that particular lens. But it's also, there's a real correlation between that particular presentation and psychosis.
00:58:43
Paris
You know, and makes sense because it's such an unsustainable way to live, right? Just terrified all the time, basically, right? yeah There's no security anywhere.
00:58:51
Zach Handy
So would you say that what we'd call symptoms of either, say, psychosis or even like mania are attempts by the psyche to try to compensate for instability on some level within that dialectic?
00:59:09
Paris
Yeah, that's right. So we're trying to, so, so if you want to say the psyche as a whole, the psyche as a whole, like, again, we have different aspects of ego is particularly focused on like maintaining a secure sense of self, for example, but the psyche as a whole is actually trying to maintain a balance.
00:59:23
Paris
Because if we are too if there's too strong of a sense of self, right we then we fall into usually like deep depression and just isolation and it's not really a good way to live. um And then on the other extreme, if we have too little sense of self, right then we then we're vulnerable to, you know we'll fall into that kind of existential terror or maybe mania if it has a kind of more euphoric or or enthusiastic flavor to it.
00:59:48
Paris
So our psyche as a whole is trying to maintain a balance. It's where all of our needs can be met. Needs for relationship, needs for autonomy, needs needs for empowerment of self, but also needs of ease, you know, being able. And that's kind of when we talk about the spiritual needs, you don't have to have a particular religion or anything like that that you follow. But the definition of spirituality I like is connecting to something larger than the limited self.
01:00:12
Paris
You know, for a lot of people might just simply experience that as as connecting to nature or whatever, but that that's a really important need for us to not be totally suffocating and too strong of a sense of self, right? We need to have some sense of feeling connected to the broader world.
01:00:28
Paris
So that balance, in a way, you've kind of got these two these two continuums, if you will, that are very closely linked, but a balance between too strong or too weak of a sense of self.
01:00:38
Paris
And then when we're kind of in the self territory, we're thinking more, okay, here I'm in my sense of self between autonomy and connection with others. So that's a healthy psyche does that automatically. We don't really think about that. And what will happen is we'll, if we start getting imbalanced on one side or the other, we'll feel a natural pull to the other side to balance. So if I start feeling too much alone time, I'm going to start feeling a strong impulse to connect to others. Right. And so then I'll pull, but once I get too much time with others, I'm like, okay, I need some me time now. Right. And, and, and you could use that on the other continuum as well. I start feeling like this real stifled sense of self,
01:01:14
Paris
and yeah I just need to get some fresh air. I need to maybe just go for a walk and connect with nature. Or maybe if you have a more religious tendency, maybe, you know, pray or meditate or something like that. And then, but if you go too far in that direction, right, then we need ground. We need to feel my body, feel the sense of connection to ground and, you know, solidity. So it's kind of, in a way, that's a big part of what I do when I help people is, okay, they're kind of imbalanced here. How do I help them get balanced?
01:01:41
Paris
Like, I really like the Icarus. Are you familiar with the Icarus, the myth of Icarus? who um It was a Greek myth of a... I won't spend much time, i snapshot of it, but he was, him and his father had to escape this island and they built these wings made of feathers and wax.
01:01:56
Zach Handy
Hmm.
01:01:56
Paris
And the father told the boy, because he knew the boy was going to love flying.
01:02:00
Paris
was like, be careful. If you fly too close to the sun, your wings will melt, right? You fall in. and if you get fly too close to the water, you'll get wet and you'll drown that way. But the boy couldn't help himself and he got higher and it was so fun.
01:02:11
Paris
He got higher and higher and closer to the sun and his wings melted and he and he drowned. it's kind of a tragic ending. And so when I'm working with people who are in extreme places and stuff, that myth is sometimes helpful. Like we need to kind of balance here.
01:02:25
Paris
You know, you're getting a bit high, you're getting too close to the sun. We need to actually connect to earth. We need to connect to ground, body, nature, feel the wind on your, feel your senses. Right. And then in the other extreme, like you're getting into this really dark, depressed, stagnant place.
01:02:40
Paris
What would it be like to go ahead and and do something that was a little bit, that loosened your sense of self a little bit, maybe do some meditation, go on a retreat, et cetera. So yeah, so that balancing act is hopefully automatic for most people, but for many people it's not, and then supporting them and that really helps.
01:02:59
Zach Handy
So I want to be mindful of your time. I know we got to wrap up here pretty quickly.
01:03:04
Paris
Yeah.
01:03:04
Zach Handy
um I just want to mention real quick, the other two myths in your book was one that schizophrenia is a valid construct or concept, which
01:03:11
Paris
Thank you.
01:03:12
Zach Handy
We don't have time to get into, but I think if people go back and listen to your explanation on how the sort of underlying dialectic or needs. um Between the the self, the individual and then belonging to a whole, how that sort of meshes together different presentations of what we would call psychopathology. And the other one is that modern treatment, the other myth that is, is that modern treatment has increased
01:03:44
Zach Handy
um results for people diagnosed with schizophrenia.
Conclusion and Resources
01:03:48
Zach Handy
So my my one question with that is from what you know with your research over the past, let's say four four or five decades, has anything gotten better for people diagnosed with schizophrenia?
01:04:02
Paris
Well, there, yeah, I mean, there has generally, again, it's very stuck still, but there's generally been a recognition that that the brain disease model is is flawed.
01:04:12
Paris
So that's become more mainstream now, recognizing, you know, the whole biochemical imbalance theory and all of that, that's that's become much more mainstream. In fact, even like, you know, leading leaders in the psychiatric field are acknowledging that as well.
01:04:25
Paris
That that's, that has never panned out that hypothesis that, you know, there's some neurotransmission imbalance, at least for the most part. I mean, I'm not going to deny there's certain cases where, yeah, there may be some physiological issues for sure for some, some people, but in general, we're talking about here, that's more the minority, at least initially.
01:04:40
Zach Handy
Right.
01:04:44
Paris
um So that, and, and, and a general movement towards more holistic approaches to supporting people, you know, kind of recognizing, and don't think anyone would argue, no matter what belief you come from, that distress is is a factor in at least worsening your condition. I think like you know,
01:04:59
Paris
kind of hardened reductionistic psychiatrists would sort of acknowledge that. um And but so there has been more movement and like, how do we help people kind of meet their basic needs for nutrition and social connection and, you know, trying to not be stuck in traumatic environments.
01:05:11
Zach Handy
Thank you.
01:05:14
Paris
And so that seems to have gotten better, but that's after coming from a huge dip in the seventies, sixties and seventies, there was actually this really optimistic movement towards family therapy and this kind of thing.
01:05:25
Paris
which was actually having really great results. And then that got completely like swept, almost, almost completely swept away um and by the bioreductive model. But that's starting to make a comeback, like the open dialogue approach in Finland, I told you, like has really helped and other other sort of systems theory methods have definitely been making comeback, but unfortunately they're still on the fringes.
01:05:46
Paris
So, yeah.
01:05:48
Zach Handy
Well, Paris, I really appreciate your time and talking to me and sharing your wisdom and knowledge on the subject. And there's a lot we didn't get into. And hopefully you'll come back again and we can talk about more.
01:05:58
Zach Handy
could Could you plug your websites for people who want to learn more about your work or who need some sort of support or help or resources?
01:05:58
Paris
Yeah.
01:06:08
Paris
Yeah, so ah Rethinking Madness, all one word, RethinkingMadness.com is the website for my book. You can actually download a free PDF of the entire book right there if you'd like, or or you can, yeah, yeah.
01:06:18
Zach Handy
You should buy it.
01:06:21
Paris
um You could definitely, yeah, buy it from Amazon and all the kind of major booksellers. And then there's also a resource directory that's really good and lots of my other articles and some webinars there.
01:06:32
Paris
And then my private practice is just my name, Paris Williams PhD. dot com So they're probably my two my two most relevant sites.
01:06:43
Zach Handy
Perfect. And I'll plug both of those in the description whenever I post this.
01:06:46
Paris
Okay.
01:06:46
Zach Handy
But I know you got to go, so I'm going let you get out of here. And thank you again for being my first official guest. I really appreciate it. And I hope you have.
01:06:55
Paris
Yeah, it's real honor.
01:06:58
Zach Handy
And have a good day with whatever you're doing.
01:07:02
Paris
Yeah, you too, Zach. Thanks for having me.
01:07:04
Zach Handy
All right. Bye, Dr. Williams.
01:07:05
Paris
Okay, take care.