ARE PSYCHOSES CURABLE? – does this 5 minute clip prove anything?
PSYCHOSIS mystifies – except that everyone, INCLUDING YOU, can agree two simple facts. FIRSTLY, there’s no psychosis without ‘thought disorder’, broken sentences, blocked phrases. If you don’t know this, then you fail your medical exams, and rightly so. SECONDLY, childhoods matter. OK so far? Problems thinking and problematic childhoods – can you suspend disbelief for a moment and blend these two long established facts, despite what you’ve been taught all your life?
In this 5 minute audio clip (transcribed below) Sam [a pseudonym], now 45, shows that, having apparently been hit by his father so hard at age 2, he is still “being hit” today. He didn’t want to believe this, any more than you do. So listen carefully to how he stumbles over the word ‘hit’, how he argues against the idea that he is currently stronger than his dad, even though the latter is now 74, and that even thinking he is stronger is ‘prohibited’ to him, by him. Whether he was actually hit or not, I don’t know, and I’m not interested – what matters is that he still thinks he is being hit today – and he isn’t, that is something I do know. The key is that he begins to feel ‘relief’ once today’s reality percolates through the cognitive mire. You don’t have to believe me, but if you want solid clinical evidence, have a listen. Osler told you to listen to the patient, because s/he is telling you the diagnosis. Here I invite you to listen to the dialogue, because Sam and Freda are telling you the pathology.
Freda [also a pseudonym] is now aged 40. Her mum died 33 years ago, but still paralyses her thinking, even in the supermarket – check it out below. Listen to her struggling to ‘think what we’re thinking about’. Elsewhere, she is coherent. Here she’s ‘blocked’.
SO WHAT’S GOING ON?
You could dismiss these 5 minutes, as being just a bee in my bonnet trying to link thought blocks and childhoods. Or you could listen, say to line 35, where Freda says “I can’t say it” – is this true, and if so why? If she wants her mum ‘to go’ (“I want to think her gone,” line 22), why can’t she think clearly enough so that she does? Is her cognition really clogged? Is this what psychosis is all about – gummed up cognitive processes, because the sufferer ‘thinks’ the trauma is still ‘alive’ in her head? If you provide her with adequate trustworthy emotional support, could you persuade her that, since her mum is dead, it’s over? If you did, would she be cured? We know childhood traumas ceased long ago – both these two don’t – what would happen if they caught up with reality? They keep desperately pressing me for more, because think they’d be cured. Do you?
The model is simple, though far from easy. Infants learn to cope with erratic parenting. Dad shouts, mum dies, or vice versa – the actual event is not material, the context is all. Infants have no physical defence, so they devise a mental one – “this isn’t happening to me”. So here’s a message to Sam’s dad, and to all parents – no parent I have ever met wants to give their child a psychosis, and I’m sure Sam’s didn’t – but some infants are caught on the hop, and get stuck. They can be unstuck, but only when they can be persuaded that thinking is safe again – simple, but not easy. Infant survival strategies prolonged into adulthood, ‘infantism’ – it doesn’t work, it can be shown not to work, and with enough emotional support, non-psychotic thinking can be restored. Or can it?
Like any ‘thought-coach’, I use whatever ‘verbal spanners’ I can that come to hand. You may find my responses brusque – but such is the trust between the three of us that they take it on the chin, and profess to be helped by it. Could this be clinical evidence of efficacy? They think it is, do you?
HEALTH WARNING – since the trauma is still going on in the head, though not in reality, expert care is needed in ALL SUCH CASES, not to make matters immeasurably worse – re-traumatisation is a constant, inevitable risk – so TAKE EXTRA CARE. What seems simple, and at one level is, defeats many, inflicting enormous mental pain – don’t make it worse because you don’t know what you're doing.
This audio clip is available for download at www.DrBobJohnson.org/audio - handle with care. I reproduce it here with permission. © Dr Bob Johnson, 2015, - but please feel free to circulate it, and this transcript, without charge, as widely as you wish.
Dr Bob Johnson, Sunday, 22 March 2015
===
5 MINUTE EXCERPT, ** *** 2015. [B: is Bob, me; F: is Freda; S: is Sam; ~ is ‘blocking’.]
1. B: [to Freda] So how does your experience agree with Sam’s?
2. F: um ~~ very much ~ the same
3. B: Go on – in what way?
4. F: I’m finding it SO difficult to think. . . and not just thn~. . I find it ~ to think about what’s being said, so difficult
5. B: [softly] Wow. That’s interesting, isn’t it. Why is it so difficult to think?
6. F: In this context . . .
7. B: yes
8. F: . . we’re talking about thinking about what we’re thinking about . .
9. B: yes
10. F: how to ~ stop our parents stop us thinking. What I’m doing ~. It happens ~ that I can’t think about it. But I can’t think ~ about the supermarket shopping when my mum’s in my head either. It goes on everywhere. But here, I can’t ~ I tried to get on the point of what Sam’s saying, ‘cos it’s relevant. . .
11. B: It is relevant, yes.
12. F: . . . and I can’t think [sighs exasperatedly]. I can’t think [sighs again] properly.
13. B: [gently] It’s training, right. You’ve trained yourself not to think
14. F: mmm
15. B: say that
16. F: ~~ I’ve trained ~. I have ~ trained, I’ve trained myself not to think.
17. B: yes, ‘and now I have to train myself TO think.’
18. F: [smoothly] and now I have to train myself to think.
19. B: what do you have to think?
20. F: I have to ~ think ~ what I want to think, individually
21. B: yes? And what with respect to your mum?
22. F: ummm. I want ~ if I want. I want her to go. I want to think her gone. I really have to believe that, that I want to think her gone, so that I can think. I get myself little rhythms, and tongue tied things that I . . .
23. B: you also have to look her in the eye, I’m afraid. And beat her. Not in a physical sense, but in a victorious sense. ‘I’m stronger than you mum’ – off you go.
24. S: [coughs]
25. F: er ~ I ~~~ I’m stronger than ~ you-mum. [rapidly]
26. B: well, that wasn’t very convincing was it?
27. F: [brightly] I actually believe it.
28. B: what do you believe?
29. F: that I’m stronger than my mum
30. B: well say so then, not with b-b-g, it’s called muttering. Come on. Off the top, come on . . .
31. F: I’m stronger than you mum.
32. B: it’s a bit feeble still, isn’t it? [2mins 18]. I mean you know, it wasn’t, you know, 100%. Sit her down there [loudly] ’HELLO MUM’ . . And tell her. Go on.
33. F: umm. Hello mum, I’m stronger than you
34. B: do you believe that?
35. F: I~ um~~. I can’t say it.
36. B: [loudly, lots of emphasis] WHY NOT?
37. F: [giggles nervously] ~ for thinking and speaking ~ for myself
38. B: a very good idea, try again
39. F:~~ I’m stronger than you mum
40. B: [to Sam] what do you think of that diction? It’s not good, is it?
41. S: mmm
42. B: what do you think? What’s your comment on that diction? [2:54]
43. S: . . . ummm. [softly] Doesn’t quite believe it.
44. B: she doesn’t, does she?
45. S: no
46. B: go on, tell her.
47. S: ugh.
48. B: [brightly] what about you? Are you stronger than your dad?
49. S: . . . . I don’t, I don’t think so, no.
50. B: well I want you to say ‘HELLO DAD, I’M STRONGER THAN YOU, you're 70, heh, heh, heh’.
51. S: all right, OK. Hello dad, I’m stronger than you, you're 74. [3:28]
52. B: 74? It’s gone up since I last asked. And what happens to you when you say that?
53. S: . . . a little tiny bit of relief
54. B: Ha! So if you said it and believed it you’d have lots of relief. Is that correct?
55. S: probably, yeah
56. B: what do you mean ‘probably’. The whole object of the exercise is to get you some relief. ‘Tiny bit of relief !’ Do it again.
57. S: hello dad, I’m stronger than you, you're 74 [chuckles briefly]
58. B: Hey ! See the giggle. So what happened then?
59. S: . . . . ummm . . . . like he dies or something?
60. B: no. It’s just real. If you're stronger than him, he’s not going to hit you. Say that please.
61. S: if I’m stronger than you, you can’t hit me [hurried] . . ~ can’t hit me
62. B: what happened to that sentence? Say it again [insistently].
63. S: if I’m stronger than you, ~~ you can’t ~ hit me
64. B: do you believe that?
65. S: partly
66. B what do you mean, ‘partly’ [derisive tone]
67. S: a bit
68. B: what do you mean, ‘a bit’ [argumentative] [4:40] It’s logical. Isn’t it?’
69. S: . . . I dare say ~ I don’t want to see him
70. B: [insistently] I beg your pardon?
71. S: ~ maybe . . . I don’t want to see him
72. B: Aah. Aah. ‘I don’t want to see him’. What effect does that have?
73. S: it makes me mad.
74. B: no it doesn’t, [lightly] it makes you impotent. It paralyses you. ‘I’m not looking at the person who’s hitting me. And he continues to hit me because I don’t look at him.’ [5:08] Hey, how about saying that? I like that. Off you go.
75. S: I don’t look at the person that’s hitting me . . .
76. B: yes
77. S: . . (because I don’t want to)
78. B: right. ‘I’ve trained myself to . . . ’
79. S: and umm . . . .
80. B: ‘he continues to hit me’
81. S: that makes me small and impotent, that’s like keeping me . . .[at 2]
82. B: so my advice is to look at him – OK?
83. F: I had a little thing to say there which is . . . . a bit . . .
84. B: off you go . . . [5:44]
Continues. This is an excerpt from over 3 hours of group work. The above is my rendering of the audio – check it out for yourself on www.DrBobJohnson.org/audio.
FURTHER COMMENTARY
If you look at this with a calm, non-prejudging eye, it is immediately clear, clinically, that thought block varies from line to line – it is not random, it is meaningful, and it is so much worse with some emotive topics than with others.
Starting with F: at line 12 “I can’t think properly”. Here is thought disorder from the inside. She can think clearly enough about a myriad other topics – she immediately has trouble when she begins to focus on how memories of mum derail her cognition.
Over the last 4 years I’ve spent upwards of 200 hours listening intensively to gobbledegook – raw, unadulterated, unbiased. I wonder how many others have had this privilege. The above is my conclusion. It has disturbing implications for all other aetiologies. Faulty brain chemicals, dopamine for example, do not vary within the same micro-second, neither do genomics – in order to claim these as causative factors, you’d have to assume they would impact on all thinking, and all speaking. If there is a significant neurological factor impacting on thinking and speaking – then it should impact right across the vocabulary, as it does in Alzheimer’s or paresis. Partial thought block, which characterises all psychoses, needs a different model – brain pathology alone won’t suffice. This is why clinical examination of the actual verbatim recording is so crucial – much is sane and non-psychotic, much else is anything but – how would you account for the difference?
The so-called ‘anti-psychotic’ drugs degrade the whole sensorium, not just those parts blocked, a sledgehammer by any other name. Indeed this is one explanation why they hinder recovery – fears cannot become ‘burnt out’, if thinking about them is obliterated not only emotionally, but also chemically.
Sadly, attempts to promulgate this type of detailed clinical reasoning are uphill – psychosis has for so long been taught to be life-long, intractable, and fundamentally inexplicable. And many of its more bizarre symptoms seem to confirm this – wild apparently random assertions, quite devoid of realism – the reason for which is described here. Clinical evidence presented here, however, shows that there is an underlying pattern which in favourable circumstances as here, can be discerned – but which the average sufferer from psychotic symptoms actively wishes you not to discern – for reasons touched on above. This all goes to show why the future of this approach remains problematic. At all events, I have now closed my clinic, in order to allow time to assemble further weighty clinical evidence of its efficacy. Thank you for your interest so far.
Dr Bob Johnson
Consultant Psychiatrist,
Empowering intent detoxifies psychoses
P O Box 49, Ventnor, Isle Of Wight, PO38 9AA, UK
e-mail DrBob@TruthTrustConsent.com
GMC speciality register for psychiatry
formerly Head of Therapy, Ashworth Maximum Security Hospital, Liverpool
formerly Consultant Psychiatrist, Special Unit, C-Wing, Parkhurst Prison, Isle of Wight.
MRCPsych (Member of Royal College of Psychiatrists),
MRCGP (Member of Royal College of General Practitioners).
Diploma in Psychotherapy Neurology & Psychiatry (Psychiatric Inst New York),
MA (Psychol), PhD(med computing), MBCS, DPM, MRCS.
Author Emotional Health ISBN 0-9551985-0-X & Unsafe at any dose ISBN 0-9551985-1-8
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