I am working on a specialized therapy for people with psychosis. Sometime during my PhD I’d like to practice this for my research project and maybe establish a new, evidence based therapy for psychosis since like…only one exists and its just a modified form of CBT. This one would be specifically made for people with psychosis.
The first part of it is recognizing the different phases of mental illness in my opinion. Phase 1 is denial. The person does not and will not recognize they have an issue. They are not open to or cooperative with treatment. Phase 2 is questioning. The person begins to question themselves and wonder if they do have an issue. The individual becomes open to treatment, but may quit it a number of times as they waver back and forth between believing they have an illness and not believing. This is a key phase in the recovery process and in my opinion the most difficult to reach. Phase 3 is recovery oriented, where the person acknowledges and fully accepts they have a mental illness and becomes dedicated to recovery from that illness, and is fully cooperative with treatment.
I want to understand more about what helps individuals move from phase 1 to phase 2. This is so,so important because as long as they are in that denial phase, they will never make progress, and will likely just be in and out of hospitals forever, or just in the hospital permanently. To me right now I can’t find any pattern other than people just seem to become aware on their own time, and others never seem to become aware at all.
My own case sheds no light on the answer because for the whole first part of my life until age 16 there was no way anyone could have convinced me that I was delusional and had an illness. Just no way. Any logical reason given my brain could find a way around. And then magically, at age 16 I just began questioning it finally once a friend pointed it out to me. But before that if people said I was crazy or just made fun of me I just thought they didnt understand because they hadn’t experienced what I had. So why was it at that particular time I was able to say “well why haven’t any of my beliefs come true yet? What if I’m just sick?” I have no idea. Please share your experiences of how and when you first gained insight so I can see if theres a pattern!
summary: I am trying to find out if there is some key or pattern to developing insight into your condition, please share your experience of how you developed insight into your illness
for me i gained insight as i was hearing voices thinking my brother was telepathically messing with me and i didnt realize something might be wrong with me and it may not be real until he left and was miles and miles away and i was still hearing the exact same voice once i realized that it wasnt real the voices started to criticize me whenever i had a moment and started thinking they were real again, ur completely right about the phases tho, basically just found evidence for whats wrong with me and it started to make more sense than what i thought
For me I guess it was this specific delusional belief I developed that if I was left alone, the devil would kidnap me and take me to hell to be impregnated with the antichrist. Of course it’s impossible to never be alone, as much as I tried, so I ended up being alone a number of times. I realized I hadn’t been kidnapped despite this. I tried to be like well I’m on my period so he can’t kidnap me yet because he couldn’t get me pregnant right now. But my period ended and still no kidnapping…so I began to be like what if my friend was right and this is all a lie…
So maybe what it takes is a very specific sort of delusion, one that the brain can’t find an explanation for why it’s happening and becomes skeptical of. Unfortunately that isn’t really something that can be provided by a therapist. Perhaps a seed of doubt has to be planted first?
Yes this strategy works for some people I’ve noticed, the just keep forcing them on meds until they come to their senses technique, but it doesn’t work for all people.
Maybe if you could stabilize the person on medications and then educate them as to the signs and symptoms of psychosis and how they manifest specifically in that person so they can recognize them when they happen in themselves again when they quit meds say then that can help improve chance of recovery?
Someone told me to ask my “all knowing” voices a math question that I didn’t know the answer to and couldn’t solve in my head. After all, omniscient voices should be able to use a fu cking calculator, right? Well, not a single voice ever gave a correct answer throughout the entire night that I was asking. At that point, my faith in “the beings” began to crumble, and my delusional world began to fall apart. During my last hospitalization, I still had delusional ideas, but I didn’t live in them. They were fleeting. My main reason for being there was command hallucinations that I got increasingly close to acting on.
The therapy would be tailored to the client depending on what phase of their illness they were in and each phase would have different goals. Phase 1 goal would be to have the person start to question their beliefs. This is the one I’m still formulating how to do of course. Perhaps stabilizing on medication, then would involve going over all the experiences the person had and showing them how they connect to the symptoms of psychosis. For example, if the person had believed the CIA was coming to get them because they had superpowers. We’d go over that and how the belief of having superpowers is an example of a grandiose delusion, that the CIA is after them is an example of paranoia, both classic in psychosis. We would then go over what those symptoms meant, like how grandiose delusions help protect from feelings of uselessness and insignificance and paranoid delusions were the brain explaining the strong fear the psychotic brain produces randomly. We’d develop alternative coping methods for these things and work on changing some thought processes. There would be reading provided or if reading was difficult for the patient we’d go over in session stories about other people with psychosis who had very similar symptoms. It would be excellent if I could facilitate some kind of group where people with psychosis could connect and see similarities between their symptoms.
Phase 2 goal is to get the person to come to accept their illness and to maintain treatment. We’d look at patterns of what happened before when quitting treatment. If possible we’d go over diary entries of the patient while ill or maybe even recordings so they could see what they were like off treatment. Knowing warning signs that illness was returning so that they could recognize whenever they went off meds that oh I do have an illness because I recognize it coming back.
Phase 3 goal would be recovery and then maintenance of stability. Involves dealing with any symptoms on a day to day basis, tweaking meds when necessary, monitoring symptoms, etc.
It would depend on the background of the patient. If they have a religious background then most of the delusions form in that guise. Then if their beliefs are magical (god) then undoing that religious paradigm would be even more difficult than an atheist for example.
I mean if that person has been indoctrinated into magical thinking in the first place the additional sz thinking is just magic on magic. How can they gain insight without deprogramming religious indoctrination?
An atheist can gain insight just by studying the ins and outs of scientific based sz studies which shows common delusions held by sz i.e disorganised thinking as illustrated by ‘knight moves’, voices shown on video of MRI scans showing the hearing lobe in action of sz patients when there is no noise and that nearly only sz patients have this brain action etc.
What a person believes can only be taken apart if you study the individual and their individual experiences. A common universal cure is almost impossible to replicate.
I don’t agree with this and don’t think you have to make everyone an atheist in order to promote recovery. I recovered without becoming an atheist. Also the insinuation that people who have spiritual beliefs are not capable of accepting and understanding science is a bit insulting.
I do agree you have to personalize the treatment based on the delusions, but not on the content of the delusion but rather the type. Whether you’re an atheist with the belief that you are from a special superior alien race or religious and believe you are the next messiah, these are both grandiose delusions that exist to protect the individual from feelings of being incompetent, insignificant, etc. So you would work with the person on these things. Versus if you had a person with just paranoid delusions, you would work with them differently.
I only gained insight because I was forced to take meds and they worked. But, like you said, before the full effect of my meds was felt, I went through a period of wavering back and forth between believing and not, in my delusions, and questioning my beliefs. After about 2 months I was delusion free, but I entered a depressive episode, because of finding out what I believed in was false all along.
I guess what I want to say is that, for me, what was key to gaining insight was taking meds
Oh yeah that’s another thing I forgot to mention. Phase 2 is extremely chaotic because the person is questioning their entire reality and soundness of mind which is very challenging, so therapy at that point would also deal with coping with these feelings and coming to accept them.
I think my insight came with reading up and studying sz/sza and going to so many hospitals and pdoc’s and taking meds.
Even after all this time though, I’m still in phase two because I end up repeatedly thinking I am fine and don’t need the meds anymore. I’m between 2 and 3 I’d say.
I was delusional at onset and in solitary confinement then in the year and a half following it kinda waxed and waned until it just let go for the most part. Since then I’ve had insight and haven’t been delusional.
I joined the forum around when I was coming around. It probably helped. I hear from other schizophrenics who are believing the same stuff as me, really convinced me it was an illness. Then I just started focusing on getting better and staying safe.
I didn’t suggest that you have to become an atheist to get recovery. i used an example that shows atheist recovery would be easier than a religious person’s.
The alien conspiracy is a good example of comparability of grandiose thinking. I would guess if I was going to take apart, dissect and recover from that one it would still be easier than childhood indoctrinated religious beliefs.
If a learned person could analyse these common delusions and come up with feasible arguments for each one that would be a start. The religious one would be longer though.
I’m between denial and questioning because no matter how much I point out the men no one sees them. On the other hand they have military background that makes them able to be like ghosts so it makes sense people don’t notice them. I’m in denial because the APs should make them go away but they dont
I just don’t believe that’s true though. You could have atheists that are just as absolutely entrenched in their delusional beliefs as religious people are. You have to realize that atheism is also a belief system.
In many cases with mental illness in fact spirituality or belief in some higher power has been shown to improve rates of recovery, for example AA and addicts.
I would suggest that if AA and other support groups have any recovery rates at all it is because of connection, which is the true antidote to addiction rather than the spiritual dimension factor.
Belief systems would be the place to begin with sz recovery and how to dissect, analyse and recover with and from them though.
I must add being able to function is only partial recovery if one is still plagued by “delusional beliefs”.
Still working on gaining insight. I get small clues every now and then but nothing like the sort of evidence I have to say it’s real. Here’s hoping though.
I’m still working on gaining insight.One part of me thinks the schizophrenia diagnosis is an exageration ( I was first diagnosed with schizotypal personality disorder).It’s hard.