Radio Show on Schizophrenia and Recovery
July 24, 2009Recovery: Why is it being redefined to mean “doing better but still mentally ill”?
August 15, 2009Changing focus is a key part of recovery: to recover from a “symptom” it is often necessary to quit focusing on trying to get rid of the symptom, at least in any direct way!
This is true of a great many kinds of mental health “symptoms.” The problem is that the things people do to control the “symptom” in the short run usually make both the “symptom” and the person’s life worse in the long run.
Let’s look at “anxiety” as one example. A man may perceive himself as having “too much” anxiety. In response, he avoids doing or thinking anything that creates more anxiety. As a result, he fails to learn that he could actually survive doing or thinking those things, and as a result of avoidance and hiding, he feels smaller and weaker and of course, more anxious. Also, because he is focused on reducing anxiety rather than getting on with his life, he becomes hypervigilant for more signs of anxiety, so he notices anxiety more often and it seems to get worse, etc. He may even take pills to avoid feeling the anxiety: this may work briefly, but when the pills wear off anxiety is even higher, plus as a result of using pills to manage the anxiety, he feels even less competent to manage the anxiety without the pills.
“Depression” is another example, it works much the same way. Depression involves a feeling that what one is doing is not worth doing. A person who identifies this depressed feeling as a problem might set a goal of having depressed feelings less often. One way of having the feeling that what one is doing is worthless occur less, is to more rarely exert oneself or do anything involving effort; so instead, one avoids activity and stays in bed or watches TV. Unfortunately, as a result of such avoidance one fails to experience any reward that might have actually come from activities, and the sense that one’s overall life is worthless only grows. One also might get hypervigilant for more depressed feelings, resulting in noticing them more and even more avoidance of exertion in response. Pills may ward off depressed feelings for a bit, but increase one’s sense that one cannot function if depressed feelings are present, which in turn makes relapse more likely when pills are discontinued.
Problems with “hearing voices” involve the same dynamics. A woman for example who identifies hearing voices as a problem may become willing to do almost anything to “make the voices go away.” This might mean overuse of distraction to avoid noticing the voice (which might lead to problems in concentration, and then as concentration fails paradoxically, she may find she has less ability to focus away from the voice!) Or, she might at times go the other way, and obey voice commands as a way to get the voice to be quiet for a bit. Both avoiding the voice, and giving in to its commands, makes her feel weaker than the voice, and unable to face it. And since the voice is what is believed to be the problem, she becomes hypervigilant to notice when it might be present, which of course increases the frequency of hearing it. She might also take pills to weaken the voice, but these may also result in voices that are even worse when she quits the pills, and reinforce her sense she is not strong enough to face the voice.
So what might work better? In all these cases, the solution is to quit seeing the “symptom” as the problem, and instead focus on making wise choices in response to “the symptom.”
So the anxiety is no longer the problem, instead the focus is on making wise choices when feeling anxiety – continuing to go forward without avoidance if the anxiety upon examination appears unwarranted, or changing course in appropriate ways if a realistic hazard exists that needs to be taken into account.
The depressed feeling, or sense that what one is doing is not worth doing, is no longer the problem, instead the focus is on making wise choices despite having depressed feelings. So if careful examination suggests that one’s actions really do have value, one persists despite the depressed feelings, while if it appears that one’s actions really do lack value for some reason or other, then one shifts to more appropriate actions that might have greater value.
The “voices” are no longer the problem, instead the focus is on making wise choices regardless of what the voices say. So the emphasis is on making good and thoughtful decisions, and opinions expressed by voices can even be considered in such decision making, though not allowed to dominate. With the emphasis on wise decisions, there is no need to either “get rid of” or “distract from” or to “give in to” the voices.
This change of focus toward making wise choices, and away from trying to control “symptoms” is not inconsistent with some effort toward long term reduction in “symptoms”, as long as that effort is not the primary focus. So one might notice that with less stress (such as less stress about trying to get rid of the symptom!), and better sleep and diet and more social support, one is likely to have fewer anxious and depressed feelings and fewer intrusive voices. Making changes in such directions are consistent with wisdom and with empowering the person, compared with the short term overly-symptom focused responses mentioned about which tend to amplify the long term problem and to disempower the person.
Notice that this change in focus is consistent with what are called “acceptance based therapies” which involve learning to accept “symptoms” rather than try to get rid of them. It is also consistent with efforts to resist being seen as “mentally ill” since it involves a shift from “I have to get rid of this voice which is part of my illness” to a perspective more like “my challenge is to make wise decisions in my life, which is the same challenge everyone faces. Whatever unique way my mind works toward such a decision is fine as long as the outcome is good.”
9 Comments
You are truly ignorant on this subject. I am disappointed. I hoped to find something that made sense……..
Wow! I like it when people just drop a “You’re ignorant”-line and don’t find it necessary to substantiate their judgement. They sound exactly like those professionals who slap you with a label of one or the other alleged brain disease, they have no physical test to prove valid: “You’re bipolar,” or “You’re schizophrenic.” Moral judgements. Nothing else.
I think, this makes perfectly sense. “What you fight you strengthen,” or “What you resist persists,” as eastern philosophy has it. Always has me recall this Calvin and Hobbs-cartoon where Calvin sits in his bed, asking: “Any monsters down there?” “Nope. No. None at all!” it sounds from underneath the bed…
My own experience is that listening to the “symptoms” instead of fighting them was the key to figuring out what originally had caused them. Of course, what had caused them was a thing of the past, and they aren’t “reasonable”, wise reactions anymore in the present moment. But it’s difficult to let go of something if you don’t know what exactly it is you’d have to let go of.
Also, they still are an unfailing bs-meter I value very much. I recently had an argument with someone in another blog’s comment field, about in how far people who self-harm, hear voices (“evil voices”, “the inner enemy”, were the terms my adversary used), etc. ought to be locked up, and forcibly prevented from harming themselves. Make that restraints and seclusion and stuff. Not maybe just holding on to someone in an acutely dangerous situation, as it was done at Soteria. The thing is, this person’s discourse otherwise is characterized by a remarkable amount of pathos. A real “helper”, if you know what I mean. So, although I’d smelled a rat for some time, I’d not been able to put a finger on anything she’d said. Well, what happened during this argument was that, to my great surprise, and initially also horror, I felt an increasing urge to self-harm. So, I took a closer look at this urge, and also at what exactly I was supposed to write in red letters, and how it fit in with the argument, and voilà, gotcha! While the urge to self-harm vaporized instantly.
You might say, the “symptoms” in a way see to that I’m not fooled that easily. it’s certainly not always a pleasant experience. But I so prefer it to being fooled.
Thanks Marian, for a good description of what it can be like to just accept “symptoms” and then work on making wise decisions about what to do about them, and what to do next in your life! Getting to know yourself and getting some idea of where they might be coming from is certainly a helpful part of that process.
I think we can get to a point where there is “nothing wasted” in our mind – that is, I believe everything we experience has some kind of positive value, if only we can find it! Sometimes the positive value of something is the opposite of what we might see if we took it at face value…..like in the film “The Doctor who hears voices” one positive value of the voice was that it pushed the concious part of the voice hearer to become stronger, to learn to stand up to it.
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When the fear and/of anger that drives SZ symptoms is gone, the symptoms will be gone. It’s that simple..
Difficult to work on but simple.
And yet even when you have therapists , very few of them have the courage to be emotional and help facilitate emotional functioning such as anger.
They just want to talk-talk cerebrally as if they and everyone else were Dr. Spock.
This is a cultural syndrome of ours which is counter-productive to emotional growth.
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It’s the emotions! DUH!
SZ do have emotional flattening not because they have no emotions but because basic strong negative emotions have failed to transform into other emotions.
Talk- talk cannot cure this – only emotional transformation can. and there are specific therapeutic exercises that can facilitate emotional expression and help transform emotions.
And thus it must be understood that our culture would be better off to embrace and love our inner selves including our inner negative emotions and learn to love our suffering including our anger fear and unhappiness. The more we learn to love and accept love our negative emotions the more they will work for us instead of against us.
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Sure it’s no point stopping symptoms – if you have a cold , and stifle your sneezing still have a cold!
One very specific thing that can be done with voices is to help change the negative dialogue, The negative dialogues are negative abuse dialogues learned from parents society etc, – it is very easy to teach a person to change that – you just use the same techniques you use for any patient whether SZ or simply neurotic.
Hi Max,
I agree with you that the emotions play a critical role, and that it takes courage on everyone’s part to face them. But I don’t agree with you that this means talk is useless: instead I think it’s usually a particular sort of talk, that accepts the emotions without getting swept away by them, that tends to help resolve things. Methods like Open Dialogue are all about talk, yet also all about emotions.
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