Stranger In the City
The International Society for Psychological and Social approaches to Psychosis (ISPS) organises her 21st conference in Rotterdam the Netherlands, August 28 – September 1, 2019, the theme being:
Stranger In the City; On the Circular Relationships between Psychosis and Alienation and the Healing Power of Human Reconnection.
Psychosis, migration status and cultural transition. Metastudies have shown that for (forced) immigrants the relative risk to receive a diagnosis of schizophrenia is up to eight times to that of others. In clinical practice in the Netherlands immigrants seem to be overly and chronically medicated for psychotic-like symptoms while there is no or limited access to new and successful psychological and social approaches. Lack of cultural sensitivity and biased diagnostic methodology are, in part, to blame for this.
How does it feel to be a non-Western immigrant in a Western country? What are the dynamics of becoming psychotic, what insights does this bring? How to understand what it means for the offspring of immigrants to grow up within a family with scarce social connections and a low social status?
The connection between social exclusion and psychosis
Someone with psychosis can become a stranger for the people who surround her or him. However, more and more research shows that this relationship is circular: being treated as and feeling a stranger promotes psychosis, makes one in other words psychosis prone. The risk is for instance much higher when you:
- originate from a non-Western country and are living in a Western country. The chances to become psychotic appear to be much higher for immigrants (esp. those of colour) than for people who have been living for generations in the same country, esp. when one has felt discrimination;
- moved a lot within a Western country or countries when young;
- were bullied or otherwise excluded;
- grew up in a city or neighbourhood where people didn’t care about each other and were demoralized;
- are homosexual and do not dare to ‘come out’;
- are hard of hearing or deaf.
In short: when you don’t feel ‘at home’ or to belong you run a high risk to become psychotic.
In Western psychiatry psychosis is seen as a dangerous disease which must be treated thoroughly and quickly, primarily by medication and seclusion. Psychiatrists and other mental health professionals who want to cure can easily be experienced as enemies. Hospitalisations and esp. forced seclusions can be traumatic, while medication dulls emotions and often does not help in curing the problems that are bothering the person, like difficulty with thinking and functioning in study or work. Medication can make these problems even worse. Because of this, a vicious circle may start that makes people more and more alienated from themselves and their surroundings.
A different view on psychosis
Contrary to many psychiatrists and mental health professionals, the people that are themselves afflicted by a psychosis can have a view and an understanding of their experiences as being intense and real and closer to their real self. Some understand and give meaning to their psychotic experiences as presenting a developmental crisis, a turning point in their lives, that brings them insight. Also, in other times and cultures, there seems to have been more occasion for psychotic experiences to be seen in a more positive light, e.g. as becoming a shaman or as representing special wisdom.
The 2019 ISPS conference is meant to discuss the nature of psychosis and alternative psychological and social ways to deal with it, and to empower the people afflicted by psychosis, especially the more vulnerable ones. Scholars, scientists and clinicians, will talk about their findings. An especially important place is reserved for those who themselves have had a psychosis or who are psychosis prone and can talk from experience and combine these experiences with their professional background and education.
Important subthemes are:
Addressing family members and others the focus will be on reconnecting the psychotic person with them and with larger society. In this conference there will be much attention given to different modes of expression and to approaches and ways by which to reconnect as well as to alternative ways that people with psychotic experiences may find helpful, like addressing their bodily sensations.
Psychological approaches do not aim to fight the psychotic experiences but to cope with them and to come to terms with their special nature. For instance, someone with psychotic experiences can learn to find ways for these experiences not to take over. Or they can discover how memories of traumatic experiences can trigger them.
Connecting different therapeutic and cultural ways of understanding
In confronting and connecting the different views of therapeutic schools of thought, like cognitive-behaviour therapy and psychoanalysis, with what works, with what kind of problem, when and how, we hope to get a clearer view on the differences and the similarities and esp. their possible complementarity.
Prevention of psychosis: a political issue
A lot happens in early development and involves infant mental health while adolescence is also a critical period. More research is needed but we do know that it is important for parents and children to live in a safe neighbourhood and in an extended network, buffering stress. A safe community is the responsibility of people from all origins as well as of policy makers, mayors, teachers, policemen and neighbours.