The cause and cure of psychoses is simple, and would be obvious to all, were it not for the mountain of prejudice which so obscures our view. What is needed is to look with a clear unbiased eye at what actually happens in a psychosis. This is not possible in cold print, but on the clear assumption that what follows is well below 50% accurate, try this. Suppose you meet a person suffering a psychotic break, the conversation might perhaps go somewhat as follows. You say “hello”, they don’t. You say “it’s a nice day” – they say nothing. They hear and see things you don’t. They describe fears and terrors you cannot see and do not believe in. They talk in ways that make no sense to you, and about things you cannot possibly understand or follow. The dialogue is not really a dialogue, more two monologues. There is no meeting of minds – there is no consensus as to what you are talking about, or indeed about the reality you are both sharing at that moment. What usually happens in a conversation between two people – indeed the underlying purpose of any and every conversation – is the overlapping and mutual confirmation of what reality is like just then. But this simply doesn’t happen when one participant is labouring under a psychosis. That’s what a psychosis is, and that is all that a psychosis is. The rest is embroidery. So the cure, obviously, would be to re-synchronise these two realities, yours and theirs. This requires establishing a common point, an agreed foundation or basis from which to start. Without this, you are running on parallel lines, your two versions of reality diverge. You are talking, not so much at cross-purposes, more at cross-realities. Psychotic thinking is unreal. And the origin of this unreality is fear, serious fear, best labelled terror. Psychosis does not occur unless the sufferer has been deflected from today’s reality – and the only thing powerful enough to deflect the human mind from finding out what is currently going on, is terror. The remedy for all and every psychosis therefore, is abating the terror. This is why ‘the healing hand of kindness’ has proved so effective in the past, and will do so increasingly in the future. It forms the basis of the Therapeutic Community approach in which I was trained in 1963, as also of the Soteria movement today. And it obviously makes sense. There is a prodigious reason why the person you are talking to does not converse, does not share your interest in what’s currently happening, in what is real. Remove that prodigious reason, and a commonality is again introduced, from which, since both are sociable human beings, both can benefit enormously. And the sovereign remedy for fear, is trust – whence the axiom: Truth, Trust and Consent, as discussed more fully elsewhere. Thus the cause of psychosis is terror which when removed leads invariably to cure. overpowering prejudices It is important here to uncover the overpowering prejudices, both medical and mythical, that so curdle our current view of psychosis. The first point to emphasise is that the orthodox medical approach is hamstrung by mental disease. No medical progress is possible without an understanding of what has gone wrong. The problem with all mental diseases however, is that the sufferer cannot tell you where the pain is coming from – and this is a particularly severe problem with the psychoses. The simple reason for this is that where the source of the agony is obvious, then the afflicted individual will already have taken all available steps to limit or expunge it. Where the origin of the pain is obscure – as here – then the sufferer can see no way through and therefore cannot help themselves. What they need most, is a clear, believable, and reliable pathway to stability – as do all those around them. While it may be understandable that the intrinsic nature of mental disease hobbles standard medical practice, nothing can justify the nihilism that prevails in psychiatry today, nor the neglect of common human courtesy nor of Human Rights, which currently risks comparison with Soviet psychiatry. The desperate flailing of the medical mind in seeking underlying causative factors leads to bizarre and indeed inconsistent and irrational notions, some of which are downright toxic. To counter this – no psychiatric disorder is caused by genetic defects, chemical aberrations, enzyme shenanigans nor permanent damage of any kind. All available evidence supports this – there has never been any evidence to refute it, there is none now, and there are powerful philosophical reasons to suppose there never will be, however much some might wish for it. Blaming parents is equally futile – deliberate parental damage does occur, but the heart-rending suffering so often seen in parents of the severely mentally ill eliminates this factor from our enquiries. The problem is that the underlying terror is deliberately well hidden, and therefore challengingly hard to winkle out – but it’s there all right, and winkling it out is undoubtedly a realistic objective. Simple, but by no means easy. The next point to emphasise is that every one of us can suffer psychotic breaks – we are none of us superman, or superwoman. Place any one of us under enough toxically-focussed stress, and we will all experience some or all of the following:– paranoia, inability to think straight, hallucinations, delusions, and invariably a loss of contact with today’s reality in which the rest of us live. A simpler illustration is the tantrum. Who among us can deny having at least one tantrum – the red mist descends, all other considerations are thrown to the wind, and contact with what is real is lost, temporarily for most, but longer for the psychotic sufferer. “I just went mad” is poignantly precise. The actual symptoms themselves as described by the psychotic sufferer are of no practical value whatsoever – their variability and fluidity being limited only by the imagination and creativity of that individual – another point which befuddles the standard medical mind. Their only clinical relevance is their severity, and less frequently their dangerousness. What they actually represent is the whirring of malperceptions – misperceptions of a malign hue. Once contact with reality – the common touchstone for all humanity – is lost, then there is simply no restraint on what can spout from a troubled mind. The psychotic sufferer labours under a belief system which is no longer based on today’s reality and is therefore alien to what the rest of us believe. Most of us hold on to reality as best we can, sometimes with difficulty – so to have one of us stoutly declare that the world is full of unseen terrors, that there are voices and visions which the rest of us cannot hear or see – this shakes us to our core. In particular it challenges our own personal belief systems – and when we are threatened, we tend to react aggressively, even destructively, which explains (though it does not excuse) the appalling history of maltreatment meted out to victims of psychosis over the millennia through, inexcusably, to the present day. the impact of terror Since September 1986, I have been exploring the impact terror has on the human mind. In a word it induces something akin to a prolonged panic, and sometimes a prolonged tantrum. Its chief pathological defect is that it leads to a paralysis of thought – a major handicap in a thinking species like homo sapiens. If it occurs early enough in human development, it can leave an impact for the rest of that individual’s life – until resolved 100% through Emotional Education. Again, this is not easy to convey in cold print – video is better, but neither is a substitute for the real thing. In psychosis, the terror prevents access to today’s reality, which alone can demonstrate that the source of the trouble is past. And here we come to an intriguing notion. We all start remarkably small, and impotent. We need sound parental attachment to survive. We need help not only in learning language but also in determining what is real, and what is a fairy tale. And it is here that we have to look for the cure for psychosis. For whatever reason (and the events can be legion) the sufferer from psychosis today has mislearnt the nature of human beings, of human reality. Instead of learning that human beings are born Lovable, Sociable and Non-Violent – the sufferer has picked up the message that reality is dangerous, that powerful human beings, including everyone else, are consistently malign. Such others may appear benign, they may say they are friendly – but the basic trust has been broken, and they are not to be believed. This disbelief is what needs countermanding – which explains not only what needs doing, but also that it is eminently doable, though only via inexhaustible supplies of the ‘healing hand of kindness’. Those trying to assist sufferers from psychotic disease are at a fundamental disadvantage – the sufferer will not, indeed cannot, disclose precisely what the problem is, who it was that misinformed them as to the nature of reality, and who therefore must be contradicted in that person’s mind. Attempts to second guess the lesion, the trauma, the true source of the terror are doomed. Attempts to persuade that individual too strongly, or prematurely, will result only in re-traumatisation, and a gross aggravation of the psychotic condition. In my clinical experience, death of a mother, a ferocious outburst on the part of a father, a tantrum from either parent may hit a vulnerable individual, at the wrong moment, in the wrong way, and cause something to ‘break’ in that person’s developing mind, such that the world is thereafter viewed as just too dangerous to tolerate – “if that’s reality, I don’t want to know”. This may well sound like gobbledy-gook to those not familiar with psychotic thinking, and perhaps even more so to those that are. Bear in mind that the individual sufferer will insist that the incident in question was trivial, jocular, of no consequence. And this insistence is intense – as if on pain of death. Bear in mind further that such individuals cannot “live with the fact that my parent tried to kill me”. Since they cannot live with this “fact”, they hide it away as fiercely and as deeply as they can. Which is anomalous, since this “fact” has not been born out by the event – namely your death – a point in logic, reason and today’s reality which can assist (though invariably only with the sufferer’s explicit consent) as a verbal spanner in unpacking this deep-seated terror. The quantity of calumny that has been heaped on my head because of this ‘denial’ is legion, and not only from my bemused psychiatric colleagues. It is a matter of record that psychiatric drugs have proved no better than sedatives – indeed for 50 years the evidence is that they prolong psychoses, and should therefore be relabelled ‘pro-psychotics’, not anti-psychotics. The reason for this is simple – they add, and are misguidedly intended to add, a chemical barrier to reality, to supplement the existing mental one. Mandatory administration of such medical ‘treatment’ without consent, calls for urgent legal and indeed political review. The root of psychosis Here is the true root of psychosis. The afflicted individual builds a ‘safer’ world, and conjures up in their imagination a more benign ‘pretend’ reality which, en passant, does not include the abuser, or at least the abusive event. The tragedy is that when they grow up, they cannot then readily re-connect with the reality in which the rest of us live, or try to live. To do that entails confronting the remnant of the misguided parent or carer who inadvertently or otherwise broke that infantile trust. All abused children carry among their mental furniture a parental figment or image of their abuser, which it is the aim of treatment to expel. In psychoses the figment is even more potent, and comes to act as a lethal gatekeeper for reality – do not question or disbelieve what your carer taught you, or you will come to a sticky end. The human mind is quite up to this sort of challenge, and builds barriers against it, which are as thick and robust as the mental resources available to that individual allow. The point being that these barriers are built as life-savers – hence they remain insuperable, and ferociously well defended, until melted by benign external forces. The sole aim of Cognitive Emotional Therapy is to dispel them, with the sufferer’s explicit consent – a handy challenge at the best of times. Simple yes, but not necessarily easy. There is thus a simple pattern to the cause and cure of psychosis. There is a simple logic to the picture just described. There are also vast fears and prejudices, medical and mythical, which belie this simplicity, and which strive to prevent it seeing the light of day. But there are also powerful and realistic forces pushing for a more humane approach to mental suffering. There is now even legal backing behind Human Rights, which are therapeutic. The foregoing is written in the hope and expectation that the more benign view will prevail.
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