Understanding psychosis and schizophrenia
A report published today by the British Psychological Society's Division of Clinical Psychology challenges received wisdom about the nature of mental illness.
Anne Cooke, Principal Lecturer in the School of Psychology, Politics and Sociology, has edited the report, 'Understanding Psychosis and Schizophrenia: Why people sometimes hear voices, believe things that others find strange, or appear out of touch with reality, and what can help'.
It has been written by a group of eminent clinical psychologists drawn from eight universities and six NHS trusts, together with people who have themselves experienced psychosis.
It provides an accessible overview of the current state of knowledge, and its conclusions have profound implications both for the way we understand 'mental illness' and for the future of mental health services.
Many people believe that schizophrenia is a frightening brain disease that makes people unpredictable and potentially violent, and can only be controlled by medication. However research conducted over the last 20 years and brought together in this report reveals that this view is false. Rather:
- The problems we think of as 'psychosis' – hearing voices, believing things that others find strange, or appearing out of touch with reality – can be understood in the same way as other psychological problems such as anxiety or shyness.
- They are often a reaction to trauma or adversity of some kind which impacts on the way we experience and interpret the world.
- They rarely lead to violence.
- No one can tell for sure what has caused a particular person's problems. The only way is to sit down with them and try and work it out.
- Services should not insist that people see themselves as ill. Some prefer to think of their problems as, for example, an aspect of their personality which sometimes gets them into trouble but which they would not want to be without.
- We need to invest much more in prevention by attending to inequality and child maltreatment. Concentrating resources only on treating existing problems is like mopping the floor while the tap is still running.
Consultant Clinical Psychologist Anne Cooke from the Salomons Centre for Applied Psychology at Canterbury Christ Church University, said:"The finding that psychosis can be understood in the same way as other psychological problems such as anxiety is one of the most important of recent years, and services need to change accordingly.
"In the past we have often seen drugs as the most important form of treatment. Whilst they have a place, we now need to concentrate on helping each person to make sense of their experiences and find the support that works for them.
"My dream is that our report will contribute to a sea change in attitudes so that rather than facing prejudice, fear and discrimination, people who experience psychosis will find those around them accepting, open-minded and willing to help."
Dr Geraldine Strathdee, NHS England's National Clinical Director for Mental Health, said: "I am a passionate advocate of supporting people to develop an understanding of the events and difficulties that led them to mental health services. That is the first step to getting back in control, and this important report will be a vital resource both for them and for those of us who design and deliver services.
"The British Psychological Society is a great force for change right at the grassroots of frontline services, in both acute care and long-term conditions, and are at the forefront of innovations that integrate physical and psychological care in primary care, community and acute hospital settings".
Rt Hon. Norman Lamb, Minister of State for Care and Support, said:"I strongly welcome the publication of this report. The Government is committed to the provision of psychological therapies, and has recently announced that, for the first time, maximum waiting times will be introduced for NHS mental health services, including for Early Intervention in Psychosis. We have also committed substantial resources to support the provision of psychological care for people with a range of mental health problems, including psychosis.
"I am delighted, therefore, to add my voice in recommending this report, which explains in everyday language the psychological science of why people sometimes hear voices, believe things other people find strange, or appear out of touch with reality. I am particularly pleased that it is the product of a partnership between expert psychologists in universities and NHS Trusts, and experts by experience – people who have themselves experienced psychosis. It helps us to understand such experiences better, to empathise with those who are distressed by them and to appreciate why the Government has made the psychological care of mental health problems a priority."
Professor Jamie Hacker-Hughes, President Elect of the British Psychological Society, said: "This report will be remembered as a milestone in psychological health.
Jacqui Dillon, Chair of the UK Hearing Voices Network, said: "This report is an example of the amazing things that are possible when professionals and people with personal experience work together. Both the report's content and the collaborative process by which it has been written are wonderful examples of the importance and power of moving beyond 'them and us' thinking in mental health".
Beth Murphy, Head of Information at Mind, said: "We welcome this report which highlights the range of ways in which we can understand experiences such as hearing voices. Anyone of us can experience problems with our mental health, whether we are diagnosed or not. People describe and relate to their own experiences in very different ways and it's important that services can accommodate the complex and varied range of experiences that people have. This can only be done by offering the widest possible range of treatments and therapies and by treating the person as whole, rather than as a set of symptoms.