The experiences that are lumped together under that single term are very
different when experienced from the inside, though to the observer there
may be some homogeneity.
The "voice in the head" psychosis or normal state is a good example of
the complexities of describing this experience. Many people have a voice
in their head. This is normal. Some people hear auditory hallucinations
however I have never come to a clear understanding whether these are
genuinely auditory hallucinations, i.e. experienced through the aural as
I have once had or simply the experience of inner voice as separated
from their self or their I (the 'voice' is a thought in the stream of
consciousness like we all experience but it is a thought experienced in
the inner conversation which can be thought of as a voice but is in fact
a thought in the stream of consciousness).
Ego dystonia is a term I came across that was used to describe the state
of consciousness I had reached post-psychosis. I came across it in a
paper published by one of the heroes of the progressive mental health
and healthcare movement, Professor Marius Romme. He wrote the
ground-breaking Accepting Voices with Sandra Escher and published by
Mind and it's one of the few fringe-perspective books that's made into
the mainstream. The book starts with research he conducted on coping and
non-coping voice hearers and their experience of survival. However in a
paper published in 1992 in the British Journal of Psychiatry he admitted
that all the copers had an ego dystonic state where the sense of another
consciousness was felt in the stream of consciousness. Upon Googling
this term the search results use the word in reference to
obssessive-compulsive disorder.
I heard the term schizotypy that referred to a coping state of psychosis
or a milder, non-pathological form of schizophrenia. This phrase may or
not be synonymous with ego dystonia. It may also become pathologised
with the new dimensional personality disorder axis of DSM-V under the
schizotypal dimension and may also fit into the new prepsychotic
syndrome or psychosis risk syndrome as it is also known.
So there are several states of consciousness that seem to be the same
and different. The words clearly have confused me and perhaps this is
just my lack of understanding showing rather than some problem with the
use of words in mental health. An engineer or scientists simply wouldn't
accept this level of confusion over the meaning of words because this is
a barrier to understanding deep and complex concepts. It is clear the
weak use of language could cause a lot of confusion for the public, many
of whom assume experiencing psychosis or hearing voices (or any of the
other terms) automatically mean a diagnosis of schizophrenia. This lack
of understanding of the mental health system is not just some failure in
knowledge. 30 years ago the Thud or Rosenberg experiment showed that
mental health professionals in America would automatically hospitalise
an individual on reporting hearing voices.
In the face of all this confusion there is a movement to change the
words. Currently positive mental health has become "well being". Mental
illness is not a mental health problem, and this is taken to absurdity
when the term "mental distress" is used. Schizophrenia, coming from the
Greek for shatter mind (though often falsely translated as spilt mind),
is going through a name change. In Japan it is now "social integration
disorder", the UK may see "post-trauma psychosis" or the use of
sub-typing classifcations of psychosis rather than the word
"schizophrenia" (e.g. anxiety psychosis, paranoid psychosis, stress
psychosis or drug psychosis). Some idiot has even suggested "Care bears."
The concepts underlying these words are highly significant. For example
the Japanese have chosen a purely social model word. Schizophrenia has
been traditionally considered a brain disease and a real mental illness
based on Kraeplin's basic paradigm of mental illness (biology and
aetiology if I remember right). Social integration disorder by its very
name suggests a totally different interpretation far different from the
traditional fundamental of what a mental illness actually is. Marius
Romme's interpretation of the experience of psychosis as a natural
reaction to psychological trauma is again another non-ostensive concept
and an important concept.
There are psychosanalogical terms such as "ego death" and "spiritual
crisis" that also elucidate on other important interpretations and
concepts.These two terms are used by people with lived experience of
psychosis and the material is usually at the progressive fringe of
mental health. These look at the experience non-pathologically. They
don't look at psychosis as part of dysfunction or illness. They consider
it as part of a change process or part of life's journey for some people.
These are the concepts that are important to attach to the word
schizophrenia (apart from Care Bears. That's just stupid.). If the
effort to brainwash people is going to be expended it is better to
expend the energy to brainwash people with something akin to the truth
of schizophrenia and psychosis, i.e. the positive and negative
interpretations, rather than brainwash them into misunderstanding the
experience and presenting a single view.
Research has been done into the use of the word schizophrenia versus the
word psychosis and the impact on doctors' estimates of prognosis showed
they felt a better outcome could be achieved for people diagnosed with a
psychosis-based synonym of schizophrenia. The power of belief may mean
that by changing the word there is potential that there could, perhaps,
be better outcomes for people with a diagnosis of schizophrenia in the
short term; as research studies start coming out showing the same
outcomes for the psychosis-based synonyms of schizophrenia the views of
doctors will return to the old estimations of poor prognosis (this is so
poor that there is an anecdote of a psychiatrist who'd tell patients and
carers that they'd be better off with a diagnosis of cancer).
It will be considerably easier to brainwash people by changing the words
than by the massive effort and expenditure required to do the right
thing and brainwash people with the whole concept of psychosis and
schizophrenia as understood by the different paradigms. So that's what
will happen. Nothing will improve in the public understanding of severe
mental illness. The stigma will return within a decade or two and be
redoubled for some of the subtypes which show increased levels of
violence or homicide.
The reconceptualisations based on the new terms, i.e. the shift from the
traditional biomedical model to psychosocial interpretations, is a
welcomed shift and may offer hope for better treatments in the long term
but again this progress would be better achieved by means such as adding
psychosocial education as part of the training of all doctors and make
this a significant part of psychiatric training or even more practical
measures such as humane care for first episode psychosis (rather than
being thrown into a dirty ward with lots of other people going through
crisis surrounded by staff who are too busy and don't have any
experience of what it's like to have your mind shattered).
The promotion of the concepts and the whole picture of what mental
illness is is much more important than fudging the language for a quick fix.
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