Clinical Psychologists New Look at Psychosis


A report published today by the British Psychological Society’s Division of Clinical Psychology challenges received wisdom about the nature of mental illness.

‘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’ 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.
The report’s editor, consultant clinical psychologist Anne Cooke from the Salomons Centre for Applied Psychology, Canterbury Christ Church University, says:

“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.”

Anne Cooke has appeared on both All in the Mind and the Today programme this week to talk about Understanding Psychosis and Schizophrenia.

Dr Geraldine Strathdee, NHS England’s national clinical director for mental health, says:

“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”.

Norman Lamb, minister of state for care and support, says:

“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.”

Read more about Understanding Psychosis and Schizophrenia and download a copy from the Division of Clinical Psychology pages.


Well I am all for therapy and against stigma-- but I think the neurological and genetic factors in fact do exist-- it’s like a hardware problem, while purely psychological problems are like software problems.

But yes, therapy and insight and the right attitude are crucial, but I also believe medication to be just as important, if not an absolute necessity for us.


I am a bigger fan of medication interventions when it comes to severe mental illnesses like SZ or BP -
My attitude towards therapy for SZ/BP is lukewarm, but I do see a need for it as well



Psychiatrists would medicalize the weather if they could.


Psychologists would provide a formulation for the weather if they could.


When I was at the peak of my psychosis I don’t think any amount of talking i.e. therapy, could have helped completely. My symptoms were physically in my head, entrenched as a part of me. But hey, that’s just me. I just can’t believe that talking it out would have reduced my intense schizophrenia.


I’ll worry about psychologists when they start strapping me to beds or sticking needles in my butt.


I walked into my last therapists office very sick - she really tied to help me, but very little progress was made - this took 5 or more years of intense therapy. When I was switched over to a new medication by my psychiatrist, risperidone, I started to improve drastically - this was when I decided to say goodbye to my therapist, who tried so hard to try to improve my situation through CBT and talk therapy. The right meds improved my situation rapidly - the difference was astounding!
Talk therapy can help so much - being on the right meds makes all the difference in the world -
5 years and more of therapy, down the drain - 3 months of being on Risperdal and I was a new person - go figure


To each their own.

My feelings on this topic are well-known. I am encouraged by the humanistic approach psychology is adopting. Treating patients with compassion and respect is always commendable.


Agreed …