CRAZYWISE - the Brecon screening

“Crazy…or wise? The traditional wisdom of indigenous cultures often contradicts modern views about a mental health crisis. Is it a ‘calling’ to grow or just a ‘broken brain’? The documentary CRAZYWISE explores what can be learned from people around the world who have turned their psychological crisis into a positive transformative experience.”

On the longest (and probably hottest) day of 2017 I was at The Wellington Hotel in Brecon with PAVO colleagues, community groups, staff from mental health services and individuals to watch this new documentary film by directors Phil Borges and Kevin Tomlinson. The free community screening had been arranged by Avril Meyler of Emerging Paradigms in partnership with PAVO and Brecon community organisations. My colleagues Anne Woods, Philip Moisson and Jane Cooke helped organise the event and also facilitated the open discussion sessions following the screening.

Regular readers of this blog will know that we are keen to promote alternative approaches to looking at mental health distress, asking what has happened to a person who is in mental health crisis rather than concluding that something is wrong with them. So we were delighted to be asked to be involved in the first screening of this groundbreaking, powerful and as it turned out, very moving film, in Powys.

Avril explained in her introduction that she first saw CRAZYWISE at an #EmergingProud event in London during Mental Health Awareness Week in May and knew immediately that she wanted to bring it to her local community. (She has written about the Brecon screening on her blog: A Multidimensional Paradigm).  Avril anticipated that the documentary would prompt much interesting discussion, and suggested some of the questions we might ask at our tables once we'd watched the film, such as: “What can we learn from people who have successfully navigated a psychological crisis?” and “Is it time to pay more attention to the psycho/social and spiritual underpinnings of mental health and bring a more balanced approach to mental health care?”

Phil Moisson, Anne Woods, Avril Meyler, Jane Cooke, Andy Hall, Paul Stephens

And so to the film. “CRAZYWISE follows two young Americans diagnosed with “mental illness.” Adam, 27, suffers devastating side effects from medications before embracing meditation in hopes of recovery. Ekhaya, 32, survives childhood molestation and several suicide attempts before spiritual training to become a traditional South African healer gives her suffering meaning and brings a deeper purpose to her life.” 

Interspersed with Adam and Ekhaya’s stories are interviews with mental health professionals and indigenous peoples, and the director Phil Borges discovers: “a growing movement of professionals and psychiatric survivors who demand alternative treatments that focus on recovery, nurturing social connections, and finding meaning.” 

In the early scenes of CRAZYWISE, human-rights photographer and filmmaker Phil tells us what inspired him to start filming. After many years documenting indigenous cultures, he realised that their interpretation of “psychotic” symptoms as a journey of spiritual transformation is completely different to the way that psychosis is regarded in the West and a deep curiosity drew him to find out more. In an interview with Frontier Therapy magazine Phil describes changing his mind about “mental illness” – which he used to think was caused by a “chemical inbalance in the brain. “I now look at it as a natural transformational process waiting to happen. Unfortunately our culture does not look at it this way and so there is little support in helping the individual find meaning and purpose in their suffering."

Round table discussions

The film prompted some really thought-provoking discussion throughout the remainder of the day. Without divulging personal stories, I picked up on several key themes: 

The not so good…

• Questions about what has happened to you are never asked.
• In Powys the first port of call for someone in mental health distress is the GP – so people are set on to the medical route right at the start.
• If a GP was amenable to other options what would they offer? What is the alternative in Powys?
• It is horrendous trying to fight for help if labelled as an “alcoholic” or “nicotine-dependent.”
• People are labelled as having a problem when often the problem is external, such as work-related stress.
• If you have a problem outside Mon-Fri 9 – 5 you are stuck mental health-wise.
• Some people feared that if they referred to a spiritual experience that this would just add to their medical diagnosis.
• Patients with a physical illness are trusted to understand and monitor their medication. This happens far less with mental “illness”. 
• Being challenging is not an illness.
• Doctors will always be in control as they prescribe the medication.

Jane Cooke, Senior Officer Mental Health at PAVO and Tania Dolley, Psychologist at Powys Teaching Health Board

The opportunities for different approaches…

• “When I am in emotional crisis I want a community that welcomes the symptoms and says it will be alright. That is so healing.”
• “This could be a half-way house that accepts me for who I am. I don’t mind if the people there are peers or professionals, so long as they are the right people. This would save money as it would prevent long-term issues from developing and also possibly hospitalisation.”
• There should be a support system for people using services to empower them to question treatments and medication.
• In the film the professionals who supported The Diagnostic and Statistical Manual (DSM) are now against it. Some people in the system are more open-minded.
• "It would be nice to present a “basket of fruit” to the world – what works for one person is different for another. Someone might want a peach one day and a nectarine the next."

Andy Hall edits One in Four three times a year, available from Brecon & District Mind

And other questions and comments…

• Several people were keen to find out more about shamanism. (In some cultures a psychotic experience is viewed as a calling to become a healer or shaman). Others pointed out that a spiritual way is different for everybody – it could be a drumming session…. it could be being a mother….
• Medication works for some people and sometimes it can be helpful. In the film this was also stated.
• There are no psychiatrists or community psychiatric nurses in the room today. Where are they? We want them to hear our story.
• Are the professionals the community leaders of our time in terms of spiritual growth and connection? Or can it just be about grassroots social connections?

The hope now is that we can acquire the licence to show CRAZYWISE to many more audiences throughout Powys, so that further discussion can be stimulated and ideas gathered about changing the response to mental distress in the county.

What do you think? Would you be interested to see the film? If so, get in touch, or leave a comment below. You may also like to find out more about Open Dialogue, the Spiritual Crisis Network, and the Hearing Voices Network.

Whilst the film was running I was transfixed. It’s compelling stuff. I lifted my pen only once to write down a quote from mental health advocate and counsellor Will Hall who said: “The Diagnostic and Statistical Manual is basically a sophisticated way of not listening to people...” 

But as the film reinforced over and over again – people just want to be listened to no matter what they're going through.

More Harm Than Good

A couple of weeks ago our guest blogger, Anne Watmough, went along to this London conference - More Harm Than Good: Confronting the Psychiatric Medication Epidemic, organised by the Council for Evidence Based Psychiatry (CEP). The CEP website reports: "Global leaders in the critical psychiatry movement met for a one-day conference to address an urgent public health issue: the iatrogenic harm caused by the over-prescription of psychiatric medications." Anne kindly sent in a review of her experience of the day - read on.

I set out on Thursday the day before the conference at 9 o'clock in the morning and boarded the bus direct to London. My journey took five and a half hours. But I didn't mind as the coach was very comfortable.

I arrived at my small hotel to find my room cosy and spotlessly clean. I had a nice meal that evening at a Moroccan restaurant on King Street.

The next morning I rose early and went out to have a full English breakfast at a nice cafe. Where the chips were delicious. I allowed myself to eat this food because I was a traveller.

Then I took a taxi to Whiteland College, part of Roehampton University, over Hampstead Bridge.

I arrived to an empty auditorium - one of the very first people to get there. Then two women came to sit down beside me. These remarkable women both had sons like myself affected by psychiatry and psychiatric medications.

Amy, a most young looking natural blonde lady despite all of the transgressions her life has held, explained she was prescribed psychiatric medications whilst she was pregnant with her son. He was born handicapped and she has had his lifetime to regret what happened to her when she was most vulnerable and carrying him inside her.

She has devoted her life to caring for him.

The second woman I met was Jemima and she explained how she was fighting for her son who had had a bicycle accident when young. He was left disabled and in a wheelchair. She felt that when he was prescribed psychiatric medication his disabilities were made worse. How horrendous for a woman whose son was disabled for her to watch him become more disabled due to side effects of medication that is supposed to keep him healthy.

I listened to the wonderful speaker Peter Gotzsche and how he is fighting for the rights and care of people like myself. To keep us free!

There were several speakers who were educated renowned men.

But one of the speakers who most impressed me was the renowned American journalist Robert Whitaker. He wrote "Mad in America" and "Anatomy of an Epidemic". He has researched and investigated psychiatry and psychiatric medications. And the drug industry. He has a website - Mad in America - and his work is also on this along with that of other people. The epidemic of labelling and drugging is rife in America and also in Europe. More and more people suffering from normal emotional problems are sent to their GPs who go on to prescribe medications like anti-depresssants or refer them to a bio-psychiatrist. These medications do more harm then good. This award-winning journalist can be found also on YouTube.

The main speaker, and a man I totally am devoted to, was Dr. Peter Breggin. He came through from America on Skype. He couldn't attend because his wife Ginger was unwell and he felt he had to be by her side. He gave his talk and as I expected the audience gave him a rapturous applause.

Then he was up for some questions. I was the first to put up my hand to speak. The sound effects were an issue on that day and at first he couldn't hear me but I managed to speak loud enough and clear enough so my question could get through.

First, and this is the first time I ever had a chance to speak to him, I wanted to tell him I have read his books. "Toxic Psychiatry", "Your Drug May be Your Problem", "Withdrawing off Psychiatric Medications" are just a few of his wonderful writings. I have his latest book in front of me -  "Guilt, Shame and Anxiety" - which I think is his best book yet. My favourite being "The Psychology of Freedom" which he wrote in 1980 when my son was born. Which makes it 35 years old. Somehow my question got through to him despite the sound situation. And he answered me giving me hope about my own current brain damage.

Dr. Breggin has been a psychiatrist working in New York for 61 years. He started at the young age of 18 at Harvard University and went on to train. He never prescribes medication or sends off his patients to be incarcerated. He has never had a suicide on his books.

Which in my opinion makes the man incredibly remarkable.

After the joy of speaking to Dr. Peter the conference went on with the panel and people asking questions.

I am afraid my anger got the better of me on that day although I passionately expressed myself and did keep it in check. It is recorded on YouTube under the title of this article.

My son I feel has been damaged by psychiatric medications. And that they stirred in him mania which he may not have suffered from if given talking therapy which was suited to what ailed him emotionally at the time he was in crisis.

I have been in therapy these past two years and I feel I will never have another psychotic episode.

I became aware at the conference of the wonderful Sandra Breakspeare and her dream of starting up a farm called Chy-Sawel in St. Ives, Cornwall. Chy-Sawel is Cornish for ‘House of Health giving.' Sandra's son is incarcerated as we speak and has been in an institution over these past ten years. Which without a doubt makes this remarkable woman even more amazing.

This is an alternative to medication and is the way forward and will help millions. Anyone interested can find details online. Please do all you can to promote this.

I am also aware of Open Dialogue Therapy which is curing, with a 86% result, people who are suffering from first diagnosed psychosis. This is the way forward also. This nursing approach by psychiatrists and psychologists and trained nurses has been working in Lapland, Finland these past 20 years. It is slowly being introduced to the NHS in this country. Sandra is embodying this into her farm. Which is a non-profit making charity.

Open Dialogue UK is holding a conference next February in London. Anyone who wishes to attend can find details online.

I would say that not only has my therapy been a way forward to recovery for myself but attending this conference has also been life changing.

Simply Google Dr. Peter R Breggin psychiatrist, Robert Whitaker American journalist psychiatry, Open Dialogue Therapy Lapland Finland and Chy Sawel. And you will find these people.

Anne Watmough

Many thanks to Anne for telling us about this interesting day. If you want to find out more, you can watch videos of the event on the CEP YouTube channel.

Some names have been changed to protect the privacy of individuals.

Exploring Mental Health and Trauma: Books To Get Us Thinking ....

Guest Blog by Jane Cooke.

There has been a focus on trauma-oriented work and ‘treatment’ in recent Powys conferences.  You can watch Jacqui Dillon at the Powys Stronger in Partnership conference last year here and you can watch Sami Timimi at the Finding Meaning in Psychosis conference in March 2014 here.

One of my roles in life (when I’m not working within PAVO’s mental health team) is as a counsellor/psychotherapist. I have a trauma-oriented approach which has been reinforced by listening to these speakers and by reading around the subject.

A trauma-oriented approach, as advocated by Sami Timimi, is a gentle way of beginning work that enables a person to feel safe and able to gradually build up a personal sense of control over their own boundaries and in time over responses to events or reminders that can lead to upsetting and overwhelming reactions. Even if a person doesn’t identify trauma as being relevant to them and why they come for therapy, this approach is empowering and helpful anyway. (It is not about forcefully inducing ‘catharsis’, re-living the situation, ‘facing up to it’ or any other similar techniques which can be re-traumatising or even abusive in themselves.)

Sami Timimi is a psychiatrist and a founding member of recently established Council for Evidence-Based Psychiatry.  He believes that working in a trauma-oriented way makes sense for most people who come into contact with mental health services. Much more sense than identifying ‘pathology’, symptoms and ascribing a diagnosis; all of which generally ignore the story, the experience of the person, how it is that they are who they are.

There are two writers who I have found very helpful and their work complements each other. Both Judith Herman and Peter Levine are concerned that people (clients, patients, service users, survivors) gain/regain their own sense of personal power and agency as they recover from their trauma/s.

Peter Levine has written a number of books about trauma. One of his books “Healing Trauma” is a slim self-help book with a CD covering a programme of exercises that anyone can follow to help overcome the neurological ‘holding’ of trauma. It is, he says “for restoring the wisdom of your body”.  He does caution that professional help may still be required. An empowering way of working could be therapist and client working together with the book and exercises, keeping the client in control of the work.

‘Trauma’ is a word we use in everyday speech,  but paradoxically in relation to emotional well-being there is a limited perception that trauma has to relate to major events that are, for example, combat situations, witnessing  extreme violence, being in danger of one’s life or experiencing sexual violence or abuse in childhood or adulthood. However, as Peter Levine says “People, especially children, can be overwhelmed by what we usually think of as common everyday events …The fact is that, over time, a series of seemingly minor mishaps can have a damaging effect on a person. Trauma does not have to stem from a major catastrophe” (his italics).

There is increasing evidence for this. So, for example, bullying, repeatedly not getting your needs for love and positive attention met, feeling fear regularly such as maybe a frightening  walk to school, regular contact with a frightening , threatening teacher or relative; being regularly shamed by powerful people when you are young.  Many things can build up to create a response in the nervous system which then needs to be ‘taught’ to respond to the here and now and to recognise/feel  current sources of support and comfort, including your own capacity  to support and nurture yourself.

Jacqui Dillon (a survivor of childhood sexual abuse) told us how much she had been influenced and empowered by Judith Herman’s book “Trauma and Recovery”. Herman looks at the way in which women’s (and children’s) experiences of violence, fear, captivity (and you can be captive in all senses without the doors being locked) and powerlessness in the domestic and community realm have been seen as variously: natural, bought on by the victim themselves, exaggerated  and overcome-able by normal acts of will. She looks at the way in which their experiences are minimised and belittled.  “Social judgement of chronically traumatized people tends to be extremely harsh” .She also looks at ways of working with people who have experienced trauma. Judith Herman has a framework for recovery from trauma. There has to be in her experience, in sequence (and returned to as often as necessary) Safety, Remembrance and Mourning and Reconnection. This works very well with Peter Levine’s work which in the early stages emphasises ways of achieving an inner sense of safety, and of course actual safety in daily life is essential.

Judith Herman is very clear that therapists need good training and good support, this is work that can be complex and challenging.

There are many books about trauma; I would recommend these two. They are compassionate and well-grounded in research and experience. They are as much for the person recovering from trauma as they are for therapists and other workers.  

Judith Herman’s “Trauma and Recovery provides a radical, community oriented approach to recognising trauma in the lives of women in particular as well as a way of working that can lead to recovery.

Peter Levine’s book is a gentle, practical self-help book (although he does not minimise the need for professional support as well).

Between them they are a very good ‘starter kit’ to this subject whether you are a health professional, or someone who has experienced, is experiencing, trauma – and you could very well, of course, be both.

Trauma and Recovery. Judith Herman.  Pandora  ISBN 978-086358-430-5

Healing Trauma. Peter Levine. Sounds True ISBN 978-1-59179-658-9

Written by Jane Cooke

Member of PAVO Mental Health Team:  jane.cooke@pavo.org.uk

And when not working for PAVO....

Gestalt therapist, ecotherapist  and interpersonal skills trainer.  Jane.cooke@heartfeltwork.co.uk

www.heartfeltwork.co.uk

Open Dialogue in Nottingham

“The name Open Dialogue was first used in 1995 to describe two key features of the approach: the use of open family/network meetings and a set of principles for organising the whole psychiatric system that made dialogue possible.” Nottingham Open Dialogue group, September 2013

Back in early September I wrote about the conference I went to in Nottingham – Psychiatry beyond the current paradigm. One of the workshops at the event focussed on an innovative approach to mental distress and crisis work called Open Dialogue, and I promised to write more about it in a future post – so here goes.

Before going to Nottingham I had read briefly about the approach in Robert Whitaker’s book – Anatomy of an Epidemic. “Western Lapland in Finland has adopted a form of care for its psychotic patients that has produced astonishingly good long-term outcomes.” You can read more on Robert’s website here. Robert has subsequently referred to the Open Dialogue approach again in blogs and other writings, quoting it as a clear mandate for change. 

So, what happened at Nottingham? Well, first of all, hour one of the session was absolutely Powerpoint free. That was refreshing in itself. A group of people have been meeting informally in the city to look at what is happening in Finland, and several of them had agreed to lead this workshop. They introduced themselves, and explained that they were considering how Open Dialogue could be put into practice locally. They educate themselves at meetings, having a mailing list of about a hundred, and a core 16 – 18 people attend the meetings regularly. Originally they began as people with “lived experience”, but the group has now expanded to include some professionals “which has changed the dynamics”. 

What followed for the first half of the workshop was a dramatisation and replaying of an actual Open Dialogue meeting which had taken place in Finland some years ago. This was extremely powerful, as for those of us attending it really felt as if we were watching and listening to an actual meeting. The professionals involved listened for a long time without saying anything at all to both the person in distress and the close family members. Eventually, when they did speak, they shared their views amongst themselves and allowed the person and his family to listen in. Further dialogue between the whole group then followed, and throughout the session the sense of absolute crisis seemed to gradually ebb away through use of this continued dialogue. There is no video of the workshop, but if you want a feel read “The Story of Pekka and Maija” on pages 411- 414 of Jaakko Seikkula and Mary E. Olson’s article about the approach.

The second half of the Nottingham workshop was used to explore the Open Dialogue approach in more detail and for this a presentation was used, but again group members took turns to explore the different areas. Some of the key points for me were:

• Psychosis is a temporary, radical disengagement from shared communication practices.
• The need to create safety/trust to allow people to express deep fears.
• Stay with the situation as it is, and allow it to develop (without using specific “tools”).
• The reflection that the team does is in the family meeting.
• Results have been better for those who took no neuroleptic medication or had it at a later point.
• Is the medication for the sake of the individual or for those around them, including the team?

The group reported an 85% recovery rate for psychosis using this approach. So that, rather than a growing number of people going on from psychosis to be labelled as “schizophrenic”, there are actually very few people with this diagnosis in this area of Finland. It is actually disappearing.

A film-maker called Daniel Mackler has produced a number of videos on Open Dialogue, some of which are available on the web. I particularly enjoyed his interview of Jaakko Seikkula, Professor of Psychotherapy in Finland (author of the article quoted above), in which Jaakko states: “All of us could have psychotic problems! Psychosis is an answer to a very difficult life situation.” 

I was truly impressed by what the Nottingham group had found out so far, and how they conveyed their learning at the workshop. You can find further links to documents about Open Dialogue on our new website page here – and thank you to Nottingham Open Dialogue for sending us some of these. What can we do in Powys to bring this innovative approach a little closer to us…? Do you have ideas about this? Let us know by commenting below.

Meanwhile, to finish….  Monica Cassani, “a social worker and … a person whose life was severely ruptured by psychiatric drugs”, created the BeyondMeds blog and posts about the mental health system in the United States, and alternative approaches such as Open Dialogue. This week in the UK the BBC reported on the need for more psychiatric beds – in England…. I’m inclined to agree with Monica’s view that maybe, if the Open Dialogue approach was widely adopted just as has happened in Western Finland, then the psychiatric hospital beds (wherever they are in the world) would lie empty…

The Abandoned Illness

"The message that comes through loud and clear is that people are being badly let down by the system in every area of their lives." 
Professor Sir Robin Murray, Commission Chair, The Schizophrenia Commission

This week saw the publication of The Schizophrenia Commission's year long enquiry into schizophrenia and psychosis. It was carried out in England, but is clearly of interest here in Wales, where many of the issues will be relevant. It concluded that a major overhaul of schizophrenia services was required.

You can read and download the report here on the Commission's website. 

There is a BBC news story about the report here.

I first heard about the report early on Wednesday when I woke to Robin Murray speaking on Radio 4's Today programme about how schizophrenia is often triggered by a traumatic life event. He suggested that many people may be genetically vulnerable to developing schizophrenia, but not all do as they may never experience the trauma which could spark the schizophrenia or psychosis. Others do, and that trauma could be anything from bereavement, to losing a job, to witnessing a crime - well, anything traumatic in effect. 

Hafal, the mental health charity, has some useful information about schizophrenia here.

Do you have any experiences of schizophrenia services in Mid Wales? Let us know what you think.