Schizophrenia: A Blueprint for Recovery
By Milt Greek
Copyright 2008, 2011, 2012 by Milt Greek
Published by Milt Greek at Smashwords
PO Box 475, Athens, Ohio 45701
For more information about this book and to purchase additional copies, visit http://www.schizophreniablueprint.com.
The author thanks Paul Komarek for his assistance in preparing this work for publication.
Cover Art Copyright 2012 by Jonathan Story, used with permission. The author wishes to express his appreciation to Jonathan for agreeing to allow his art to be used for this handbook.
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Important Disclaimer
This book is intended for general educational purposes only. It does not substitute for individual medical advice from your doctor. Please consult your doctor for advice on your individual situation.
Introduction to 2012 Revised Version
Chapter One The Building of Schizophrenic Psychosis
Chapter Two Working with Someone in Psychosis
Chapter Three Stabilizing on Medication
Chapter Four Reviewing Possible Causes of Schizophrenia
Chapter Five Counseling for Self-Understanding
Appendix A How A Series of Hallucinations Develops A Story
Appendix B Notes On Common Elements Within Delusions
Appendix C Informal Surveys of Experiences of Psychosis
Appendix E Materials Supporting Mentoring
Preface
During my early years in college, my life became more and more difficult. As problems grew and my life worsened, I gained insights into my life and my problems, but these insights alone didn't get my life back on track. As crisis followed crisis, my parents sought medical help for me, which at first I cooperated with, but then grew hostile towards because the medical establishment kept locking me up in mental hospitals and ignoring my insights and issues.
By a series of coincidences and with the help of friends, I came to the surprising realization that I was suffering from schizophrenia, as the doctors had been saying, and needed to take medication to get control of my life. After I accepted my diagnosis, I stabilized on medication but fell into deep depression, sleeping fourteen hours a day for the next two years. Despite this problem, I managed to finish degrees in psychology and sociology.
Unable to find work with my degrees, I retrained in computer programming. In spite of ongoing depression, I left welfare and worked without insurance for five years, finally gaining enough experience to receive insurance through work and stabilize my life economically. I eventually returned to the town where I had gone to college and met the woman who is now my wife.
With my wife's help I began to review the issues and delusions that had made up my mental illness. At the same time, I volunteered to help a couple of people who were in the psychotic stage of the illness and formed a schizophrenia peer support group. During these years my depression ended and I gained insights into the nature of schizophrenia. The result of this process is a blueprint for recovery which is described in this guidebook. Beginning with an explanation of the formation of the delusional framework and suggestions for ways to work with actively psychotic people, the blueprint discusses steps to move people from post-delusion lethargy into self-understanding and reintegration into mainstream society. Despite the brevity of this guidebook, the blueprint describes a process that took over ten years of my life. This time frame may be shorter or longer depending on the individual.
The material in this book is meant to provide people with schizophrenia, family members, and mental health workers insight into means of transforming a situation of seeming hopelessness into one of renewed strength and vitality. Its value lies not in dogmatic interpretation, but in being applied as befits each individual case. Those aspects of this book which prove useful in some cases may be less useful in others. Paying close attention to what works for a particular individual is key to working with a psychotic individual. The extent to which this guidebook provides the basis for insight into individual cases is the degree to which it is successful. I sincerely hope that it may provide help and comfort to you and your particular situation.
Milt Greek
Introduction to 2012 Revised Version
Since the writing of this handbook in 2006 and 2007, I have wanted to add more material. Some of this additional material was included in the 2009 recordings on DVDs detailing this material in seven talks. While I had hoped to complete these additions in 2010, new volunteer work cropped up, limiting the time I had to devote to this revision. In 2011, I set time aside for presenting and/or attending at five conferences involving schizophrenia and recovery and undertook a pilot survey of ten people in post-psychosis. These activities gave me a more complete sense of the role of this material in the larger community and rounded out my own views of schizophrenia and recovery.
The revisions contained in this work are mainly enhancements in understanding psychosis and a discussion of medication and alternatives. The additional material on psychosis is mainly in Chapter One and Appendices B and C.
At present there is a hotly debated question of medication verses non-medication and strong feelings on all sides about its use or nonuse. Some caregivers are committed to using medication; other caregivers are committed to not using medication. The updates on medication are attempts to make the approach in this handbook useful for both groups.
The purpose of this handbook is to provide a set of components that can be used independently of each other. As such, I have written this handbook to allow for people to use what works for their specific situation and to ignore what is not effective. It is important to view each person and their surroundings as unique and to apply these components as best fits with that unique situation. To the extent this handbook provides a variety of means to do this, it is successful.
Milt Greek, 2012
Chapter One
The Building of Schizophrenic Psychosis
This chapter explains how psychosis slowly builds, the experiences which give people with schizophrenia a strong belief in our delusions, and the underlying reality which people with schizophrenia perceive. This explanation will help the reader understand why we actively cling to delusions and what our behavior and attitudes are seeking to achieve. It will serve as a basis for the next chapter, which details approaches for working with the psychotic person and moving the person toward accepting diagnosis and a commitment to use medication.
Schizophrenic thinking has a number of basic elements that affect the forming of psychosis. Over time the elements gradually create a delusional framework that is usually fully in place when the person's problem comes to the attention of family and mental health workers. This delusional framework poses one of the toughest problems in working with psychotic people and persuading them to accept their diagnosis and take medication.
Chemical Imbalance Like Continuous LSD Trip
To understand how schizophrenia affects perception, it is important to start with the recognition that schizophrenia creates a situation where we experience hallucinations, voices, and other effects like a constant LSD trip. The experience is like unwittingly being given LSD every day for years on end. As a result, hallucinations and unusual thinking gradually become a constant part of everyday life. We have strange experiences, with increasing frequency and intensity, and we begin to develop ideas about the world around us and our own lives based on these experiences.
Basic rules of perception that we had known prior to schizophrenia are lost and in their place we develop new ways of thinking that mirror our new, hallucinatory reality. Arguing that we should return to the old rules of perception is a frequent and useless practice, since the new rules we apply match our daily experiences.
Loss of Object Permanency and the Flow of Realities
Object permanency is the psychological name for our belief that objects exist after they have disappeared from sight. It was described by the French child psychologist Jean Piaget, who noted that very young infants would forget about balls and other toys with which they were playing once the objects rolled out of sight. Piaget noted that after reaching a certain age, the children began to look for the missing toy, indicating they understood it still existed.
During psychosis, we lose object permanency. Hallucinations and other aspects of our experience indicate that objects actually do fade in and out of existence. Often, this can occur in a matter of moments. As a result, we come to believe that things and people appear and disappear for mystical reasons. For example, if I were going to a store and met a friend on the way, I would believe the chance appearance of my friend was closely connected to a higher purpose that was being fulfilled by my trip. In addition to whatever mundane purpose I had for going to the store, I might be attempting to change reality through a ritual involving money and purchases, and I would see my friend as someone whose presence indicated a central role in this ritual.
In place of object permanency, we develop the belief we are centered in a flow of multiple realities and potential futures that might be entered into at any moment. In normal life, choices such as in what community to live, what to do for work, for whom to work, and who to have as a spouse create long-term changes in one's destiny. For a person with schizophrenia, the possibility of entering into various futures is immediate and can be caused by any minor event or choice, such as to whom to talk or what magazine to read. This immediacy mirrors the hallucinatory experience, where minor events can trigger major hallucinatory episodes that seem to indicate a massive change in reality.
Since we have lost object permanency, we lose the concept of boundaries in time and place. Places, events and beings that are thought to exist outside of mundane reality--such as heaven, hell, the rapture, angels, gods and demons--can enter into this earthly reality and we can be taken into their reality at any time. Instead of the static physical reality the normal individual assumes, the person lives in a place where, in a matter of moments, small thoughts or actions can bring about eternal heaven on earth for everyone, or the end of the world and all creation being cast into the depths of hell. It is with this dramatic backdrop that people with schizophrenia view daily events.
Multiple Realities vs. Separation from Reality
Psychosis is commonly defined as being separated from reality, but is it much more accurate to view it as a consciousness which believes that there are multiple realities in addition to the commonly perceived consensus reality. The person's belief in multiple realities also perceives the additional realities as having more importance than the consensus reality. Much of our inability to deal with day to day reality comes from our need to act on the belief that these more significant realities take precedence over the reality we all perceive.
An example of this thinking would be that we may know that we are in a psychiatric hospital, but we may believe that we are simultaneously in an unearthly spiritual realm and some of the people and things in the hospital are actually from the spiritual realm and are on Earth with a special mission to transform us and others in some way. We will be focused on the spiritual transformation we believe is occurring and we will respond to events according to our view that this spiritual transformation is of paramount importance. Whether we believe that the spirits/people around us are benevolent or malevolent is dependent on other delusions and on how the hospital staff and patients appear to help or hinder our spiritual quest.
Group vs. Unique Experience Defining Reality
Central to our new perceptions of reality is a loss of the commonly held group definitions of reality and a replacement of this source of "truth" with a focus on unique individual experiences defining reality. In normal human culture, most people define reality through a loose collection of group beliefs that reflect one's personal world. For example, people in some parts of the United States may have consensus that the Bible is the source of truth about the spiritual world and world history, but may disagree on which books and chapters in the Bible are the most important in guiding our lives today. On the other hand, people elsewhere in the United States may believe that Darwin's theory of evolution and historical, archeological, and anthropological studies are the determiner of knowledge about these things and have consensus beliefs about the spiritual world (or lack of it) and world history stemming from these sources. Individuals within these two subcultures will generally define reality according to the group consensus around them and when members of one subculture come into contact with members of the other subculture there is often conflict and disbelief at how little the other knows about "truth."
Within hallucinatory perceptions, events that seem very real and of utmost universal importance--such as portents of the end of the world or revelations of potentially wonderful changes for the world--seem to be delivered to us in epiphanies. These events are often connected symbolically to our inner emotional nature and seem related to our real life histories. We believe we are being shown a mysterious and all-encompassing reality that underlies ordinary reality. We are well aware that if we hadn't had these unique experiences we would not believe as we do, yet we perceive these experiences as actual events of great importance.
In line with these experiences, we develop a very strong belief that individual revelation, rather than group consensus, is the key to uncovering true knowledge. As discussed in Appendix B on common delusions experienced by a small group of post-psychotic men, we often come to believe that the majority of people are in a state of numbness and ignorance, suffering from a sort of spiritual mind-control that blinds common people to the epiphanies that are so obvious to us. As a result, when we say things like we have met God or there are angels, demons, aliens, or similar entities presently on the Earth, we are basing these beliefs on perceptions of actual or hallucinatory events. When people respond that this is not possible, we almost invariably feel that "You weren't there, so how do you know?" While frustrating to the treatment team, this challenging attitude is actually a statement of a solid empirical axiom and should not be rejected out of hand. When people around us tell us that these things don't happen, even though they were not present when we witnessed them, it drives us into the company of those who do believe in such events and away from the treatment team. (Ways to handle this dilemma are discussed in Chapter Two.)
Synchronicity and Confusion
People with schizophrenia develop thinking based on synchronicity, a term coined by psychoanalyst Carl Jung to describe thoughts connecting to outside events. Prophetic dreams are an example of synchronicity.
People often observe synchronicity early in their illness and are intrigued by the spiritual and practical possibilities they pose. We believe that synchronicities indicate the possibility for the mind to magically affect the world, and often seek to do things that increase synchronicity in our lives. We begin to see connections--real or imagined--behind these events. The real events of synchronicity give strength to a mystical or religious view of the world that becomes the basis for our new way of thinking.
We begin to search the world for religious or symbolic structures underlying events in our world. These symbolic structures are like those theorized by Jung in his studies of symbols across cultures. Our search to uncover mystical knowledge is affected, however, by our inner turmoil. Our inner emotions are projected poetically onto the symbols we develop and make the symbolic system a deeply personal one, rather than one that applies to humanity and the universe. The underlying feelings indicated by the delusions can provide insight into the inner turmoil and issues hidden by the confused behavior and communication that are the hallmark of psychotic people. For example, people who are harming themselves or who believe that they are condemned by God are usually struggling with a moral dilemma in their real life.
We come to believe that the religious/symbolic system we think we are uncovering can ritually or magically be used to bring about miracles, either for ourselves or for the world as a whole. We attempt to manipulate these symbols through ritual or symbolic action, in hopes of finding a magical solution to our problems and the problems of the world. With the world-view that heaven or hell might occur at any time, we look for magical means to bring about heaven on earth. This search often results in odd behavior, including decorating our rooms and houses in unusual ways, small quirks of behavior, repeated phrases or expressions that seem meaningless to others, and sometimes more dramatic and occasionally dangerous attempts to ritually bring about a miraculously better world.
Accurate Intuitions during Hallucinations and Psychosis
One of the most validating aspects of psychosis for people experiencing it is the common phenomenon of accurate intuitions during psychosis, including as part of a hallucinatory episode. These accurate intuitions often provide insight and even guidance to the person, making us believe fervently that the experiences of psychosis are all meaningful. Accurate intuitions give us the belief that we are becoming aware of an underlying spiritual world that unites all life and uncovering this spiritual world becomes part of our personal goals during psychosis.
A recent survey I undertook of ten post-psychotic people asked individuals about their experiences with events that supported their belief in their delusions, including accurate intuitions. At the time of this writing the surveys are still being reviewed by objective evaluators, but by my estimation at least four of the ten people reported instances of accurate intuitions during psychosis. In one case, a woman reported being on horseback and seeing a man in long flowing robes riding a horse. From this the woman sensed that she should return home and soon afterwards a storm blew up. Since riding during a storm could have been dangerous, the woman regarded the event as helpful. In another case, a man reported repeated accurate intuitions, including predicting to his counselors that his wife would have a car accident. The wife did, in fact, have a car accident, but instead of acknowledging the validity of the man's experience the therapist reported the man to the police for possibly trying to harm his wife.
Accurate intuitions pose some of the more difficult phenomenon to explain with the mindset of many normal counselors. It is crucial to understand that the events are actually common during psychosis. Attempting to argue that these experiences are not valid is not only counterproductive, it is a failure to understand the complexity of the psychotic experience and devalues the person who is experiencing it. In place of attempting to dismiss actual events with a close-minded approach to life experiences, it is more important to acknowledge the validity of the experiences and work to help the person distinguish between actual events and jumping to false conclusions based on these events. (Again, Chapter Two discusses means to achieve this.)
Visions of Probable Futures, Static, and Confusion
During psychosis, people experience hallucinations that vary from minor, such as how a person's eyes might appear, to major episodes, in which reality seems to be in flux. Some hallucinations have no unusual qualities, and seamlessly blend with ordinary reality. These hallucinations are only recognized as such after the person asks other people present during the hallucinations if they saw the same thing.
Hallucinations may seem nonsensical to outsiders, but some hallucinations are actually intuitive images of possible future realities. A minor example of that occurred during my psychosis when I was about to enter a room that I knew another guy was in, but heard his voice say, "Let me open the door." I stood outside the door and waited for a few moments, after which the guy opened the door and walked out. There were no windows in the door or room, so I had no visual clue that he was about to walk out the door.
A more powerful example of the visionary quality of some hallucinations is described in Appendix A on the series of hallucinations I had involving God, Jesus, heaven, and hell. Those hallucinations, along with others that I had during psychosis, exemplify the strong symbolic and intuitive aspects that make many hallucinations deeply and personally meaningful.
Mixed in with the symbolic and visionary hallucinations are hallucinations that amount to static. These can be random voices, sounds, and sometimes frightening experiences that seem to be indicating some impending or actual event. Because of the occasional accurate intuitions that we experience, we tend to believe all of our unusual experiences are real and meaningful. In these instances, we believe that we are being shown a deeper aspect of reality, and will have the accurate, intuitive experiences as proof that the hallucinations are meaningful and significant.
People with schizophrenia combine the discovery of synchronicity with the visions of probable futures in an attempt to ritually manifest the best reality that can be imagined. Through a combination of synchronicity, magic, religious experience, ad hoc rituals, symbolic actions, and other forms of magical action, people will pursue the best probable future that their hallucinations and delusions point them toward. In some cases, this involves fanciful dreams of being on the doorstep to a heavenly realm; in others, this involves desperate and sometimes self-destructive or violent attempts to stave off worldwide catastrophe.
Voices and Dialogues
Most people have a single voice in their mind that they identify as their own. During schizophrenia, the central voice in our mind breaks down and is replaced by a cacophony of various voices, similar to the experience people sometime have when they are drifting off to sleep and different voices seem to be having conversations independently of their own voice.
The central voice acts not only as a single source of thought, but also as a censor for any thoughts that we strongly dislike. When it breaks down, the various other voices often express distressing or horrible thoughts that we would never think on our own. For example, one schizophrenic friend who was stridently against racism had a racist voice in his mind. During his psychosis, one of his greatest concerns was this racist voice and the possibility that he himself was racist. This was despite the fact that he was friends with people of different races.
It is my supposition that the voices we experience have a basis in dialogues between ourselves, our family, and members of our community. We develop strong impressions of how those around us think and these viewpoints shape us unconsciously. Our central voice develops in response to these dialogues and our thoughts are, in fact, our reply to others around us. In social psychology, this view is summarized in the works of George Herbert Mead and his theory of the I/Me.
When our central voice breaks down, the impressions left by those close to us become autonomous voices, speaking independently and chaotically. The voices can be very loud within our own mind, or can sometimes be heard outside our head. Mixed in with these voices are hallucinations of accurate intuition, as mentioned above. Once the voices become autonomous, they develop seemingly superhuman nature, becoming the voices of angels, demons, gods, goddesses, and other spirits. They become very difficult to resist.
As is common within families and communities, people with schizophrenia often grow up in situations where there are a number of strong-willed people who disagree with each other. The impressions received by a normal person growing up usually contain contradiction and conflict about what view of reality is true and should be followed. In the same way, the voices that we experience in schizophrenia represent basic contradictions in the sentiments of the family and community around us. In the seeming form of superhuman voices, however, the contradictions in which people with schizophrenia grew up become another layer of dramatic and frightening landscape in which we are torn between contradictory voices alternately condemning and uplifting us.
For outside observers, getting information about the family and community in which the person grew up can illuminate connections between the voices heard in childhood and the voices experienced as supernatural in psychosis. Understanding the dramas of these real life contradictions and imagining them as being acted out in extremely exaggerated and overwhelming fashion in the supernatural voices can help give insight into the psychotic inner world.
Double Binds of Reality
People are usually caught in double binds in the real world around them. These double binds can be both personal and universal, often have a moral dimension, and also will often be part of the contradictions in views and values that exist in the families and communities around the person. In the case of the schizophrenic person with the racist voice, he had both racist and stridently anti-racist members in his family and community, and he felt torn by his privileges as a white person. His disease resulted in a racist voice and anxiety around people of other races, but he felt compelled to be friends with a diversity of people and struggled successfully to be friends with people of other races. As mentioned before, one of his greatest concerns was the resolution of the double bind between racism, anti-racism, and his privileges as a white person.
The double binds create conflicting pressures and demands. Solving these double binds often becomes an obsession, even though the contradictions are often too great to be resolved by a single person, healthy or otherwise. Unable to resolve these conflicts through mundane actions and experiencing hallucinations and delusions that express the emotional conflict symbolically, people with schizophrenia will seek to find magical solutions to real life problems. For example, people concerned about the real world ecological crisis will seek to find ways to control the weather and reverse global warming through magic. They will also come up with difficult and sometimes impractical solutions to problems, such as deciding not to drive or ride in cars, buses, or other vehicles that add to global warming.
Poetic Expression of Reality
The feelings of people with schizophrenia about reality are expressed poetically in both normal thoughts and hallucinations. This poetic expression of reality appears in the form of hallucinations seen as actual events which confirm the deepest feelings about reality.
Once these symbolic ideas appear to manifest as concrete reality, they take on a life of their own. Instead of treating the hallucinations as symbolic visions of deeply personal feelings, the person misinterprets hallucinations as actual reality with universal implications. The person then responds to events as if these symbolic events were real and attempts to solve the dilemmas they create with sometimes wild or extreme acts.
For example, during psychosis I had a hallucination described in Appendix A during which I met Jesus. The experience was a symbolic expression of real life choices I faced between pursuing positive or negative paths which had origins in both my family and my community and which had universal implications in today's world. I responded to this symbolic experience with believing that I had been condemned by God to hell and that the rapture was beginning in subtle but expanding ways. I then began to act very wildly, as a normal person would if the rapture really were unfolding before one's eyes.
Hallucinations and False Perceptions
As shown in the example above, the hallucinations create false perceptions that seem based in concrete reality. Many hallucinations blend seamlessly with reality or express symbolically the innermost reality of people with schizophrenia. As such, hallucinations connect on a tremendously personal and real level, and seem to confirm what people feel about themselves, their reality, and the challenges they and the world face. Since hallucinations are frequently the poetic and intuitive expression of real problems that people cannot express clearly or directly, they are often valued as experiences which confirm their identity in the midst of contradiction, double binds, and crises.